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€œYou are brand name propecia online not alone.” These four words is a message to each and every one who has ever been depressed, anxious, had suicidal thoughts or suffer from mental illness. During Suicide Prevention Month, MidMichigan Health professionals brand name propecia online remind you that it is okay to talk about suicide and that seeking help is crucial and never a sign of weakness.“According to the National Alliance on Mental Illness, suicide is now the tenth most common cause of death in the United States and the second leading cause of death in those 10 to 34 years old,” said Kathy Dollard, Psy.D., L.P., director of behavioral health at MidMichigan Health. €œPaying attention to warning signs and certain behaviors in individuals can be key to getting them the support and help that they need.”The warning signs before suicide aren’t always clear, nor are they universal. Suicide is often complex brand name propecia online and usually not from a single cause.

Still, across the board, mental health experts say certain behaviors shouldn’t be ignored.Signals that may indicate someone is in need of help can include both verbal signs and behavioral cues. Verbal signs may be talking about wanting to die or kill oneself brand name propecia online. Declarations of feeling trapped or having nothing to live for. Talking about brand name propecia online great guilt or unbearable pain.

Insistence of being a burden to others. Speaking of brand name propecia online revenge. Lack of communication or noticeable withdrawal.Behavioral cues that may signal an individual is in trouble can include acting anxious, agitated or restless. Increased use of brand name propecia online alcohol or drugs.

Sleeping too little or brand name propecia online too much. Suggestive actions, such as online searches or obtaining a gun. Giving away possessions or making brand name propecia online visits to say goodbye. Reckless conduct or extreme mood swings.Suicide can become a threat after a loss.

It could be the death of a loved one, including a pet, or the loss of a job or relationship.Although the age of onset is usually mid-teens, mental health conditions can also begin to develop in younger brand name propecia online children. Because they’re still learning how to identify and talk about thoughts and emotions, their most obvious symptoms in children and teens are behavioral. Symptoms may include changes in school performance, excessive worry or anxiety, fighting to avoid brand name propecia online bed or school, hyperactive behavior, frequent nightmares, disobedience or temper tantrums. In addition to the symptoms mentioned, teens might isolate, use substances, and have drastic personality changes.To help address mental health and the wellbeing of middle and high school youth, the ROCK Center for Youth Development was recently awarded a grant from the Midland Area Community Foundation.

The grant will be used to implement the University of Michigan’s Peer to Peer Depression Awareness Program in Midland county high and middle schools.“Middle and high school age is when students first experience depression and anxiety symptoms, so it is important that they are able to recognize it and feel comfortable seeking help early,” explains Dollard, co-chair of a coalition for youth suicide prevention and a board member of brand name propecia online the ROCK. €œThe Peer to Peer program includes training for school personal about mental health concerns and suicide prevention, selecting youth who will be trained and mentored as they launch a school-wide awareness campaign and establishing mental health resources for successful and timely referral when a youth is identified as needing care. The program is built on the premise that teens are more likely to listen to their friends than a brand name propecia online well-meaning adult. If we can help youth brand name propecia online to know what to do when one of their friends is struggling, we can potentially save lives.”MidMichigan Health offers a variety of behavioral health programs, including psychiatric inpatient care, outpatient care and office-based care.

Those interested in learning more may visit www.midmichigan.org/mentalhealth.Those concerned about the imminent danger of another taking their life should call 911 immediately. Those needing assistance or have questions are recommended to call the National brand name propecia online Suicide Prevention Lifeline at 1 (800) 273-TALK (8255). In addition, people in crisis can also text HOME to 741741 to connect with a crisis counselor.Tammy Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees in a recent ceremony in which she was named this year’s recipient of the Bernard E. Lorimer Award.Tammy Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other brand name propecia online employees in a recent ceremony in which she was named this year’s recipient of the Bernard E.

Lorimer Award.Her co-workers, who nominated her for the award, said Terrell is a dedicated and loyal employee who has led the health system through extraordinary challenges this year. Her leadership through the hair loss treatment crisis brand name propecia online was calm and steady. In addition, she remained unruffled as MidMichigan Medical Center – Midland experienced a historical flood, spending both days and nights onsite to ensure patients and employees were safe.“The Lorimer Award is like being selected into our Hall of Fame,” said Greg Rogers, president, MidMichigan Medical Center – Midland, and executive vice president and chief operating officer, MidMichigan Health. €œIt’s a lifetime brand name propecia online award for an employee’s commitment to our Medical Center.

Tammy is very deserving of this award. She is brand name propecia online selfless, kind, wise, intelligent and thoughtful. She is the perfect example of what makes MidMichigan Health excellent.”Terrell has been with MidMichigan Health for 38 years, beginning her career in 1982 as a staff nurse in the brand name propecia online Emergency Department (ED) for 14 years and later was the nurse manager for the ED and Perioperative Services Departments at MidMichigan Medical Center – Gratiot. Then, in February 2006, she was promoted to director of nursing for the Medical Center in Alma.

Seven years later she moved over to the director of nursing brand name propecia online administration for MidMichigan Medical Center – Midland. In August 2018, Terrell then became the system director of emergency services in Midland and shortly after was promoted to system vice president and chief nursing officer for MidMichigan Health.The Lorimer Award was first given in 1978 and recognizes one employee each year who possesses the characteristics that Bernard E. Lorimer exemplified during his career brand name propecia online as president of the Medical Center in Midland. Those qualities include compassion and concern for people, loyalty and dedication to the Medical Center through extended length of service, cooperation, a positive attitude and a willingness to help others.Previous Bernard E.

Lorimer Award recipients brand name propecia online include. Carolyn Fraser, Mary Buffa-Tacey, Pete McKnight, Fran Mayhew, Marilyn Haeussler, Lloyd Hoag, Rea Mason, Jan Albar, Harriet Robbins, Barb Dinger, Pauline Fischer, JoAnne Johnston, Sandy Ebright, Becky Dunn, Dave Chapman, Deb Badour, Jan Penney, Dennis Bauer, Karen Calkins, Jan Morrone, Pam Gifford, Carol Campbell, Mary Jane Howe, Norm Adams, Jeanie Hepinstall, Randy Wyse, Bob Valenta, Sally Vajda, Donna Herringshaw, Kathy Squires, Mary Ann Kovacevich, Sue Haley, Andrea Frederick, Peggy Lark, Tonia VanWieren, Rich Weiler, Teresa Wakeman, Susan Janke, Kathleen Ludwig, Sasha Savage, M.D., Cheryl Meyette and Jodi Herman.Terrell attended the University of Phoenix where she received her Bachelor of Science degree in nursing in 2007. She completed her Master of Science degree in nursing at Walden University in June brand name propecia online 2013. Terrell is married and resides with her husband of 37 years on their family farm in Gratiot County.

She is the mother of four children and has five grandchildren brand name propecia online. Her favorite pastime is being at the lake and spending time with family.Those interested in more information on MidMichigan Health may visit www.midmichigan.org..

Propecia and birth defects

AdvertisementContinue reading the main storySupported byContinue propecia and birth defects reading the main storyPhys EdHow Weight Training May Help With Weight ControlPeople who regularly do muscle-strengthening exercises are about 20 to 30 percent less likely to become obese over time than people who do not.Credit...Neil Hall/EPA, via ShutterstockJuly 7, 2021Lifting weights a few times a http://portofinowest.com/wine/item/pinot-grigio-ecco-domani-2/ week might help us stave off obesity, according to an interesting new study of resistance exercise and body fat. It shows that people who regularly complete muscle-strengthening exercises of any kind are about 20 propecia and birth defects to 30 percent less likely to become obese over time than people who do not, whether they also work out aerobically or not.The findings indicate that weight training could be more consequential for weight control than many of us might expect, and a little lifting now may keep us lighter, later.The incidence of obesity in America is rising, with about 40 percent of adults currently meeting the standard criteria for obesity. That number is expected to increase to more than 50 percent by the end of this decade.Unfortunately, few of us will drop any added pounds, long term, once we gain them. Most people who shed more than about 5 percent of their body propecia and birth defects weight regain it within five years.The most effective way to deal with obesity, then, is probably to prevent it.

And regular exercise can help in that regard. Many studies show that people who often walk, jog, cycle, swim or otherwise work out aerobically tend to gain less weight with age than sedentary people and are at lower propecia and birth defects risk of becoming obese.But far less has been known about whether weight training likewise influences weight. Some past research hints that resistance training helps people retain muscle mass while people are trying to propecia and birth defects lose weight. But whether it might also check long-term weight gain and avert obesity has not been clear.So, for the new study, which was published in June in PLOS Medicine, researchers at Iowa State University in Ames, Iowa, and other institutions, decided to look into the relationship, if any, between weights and waistlines.

They began by turning to the large and useful database compiled for the Aerobics Center Longitudinal propecia and birth defects Study, a famous undertaking that had tracked the medical, health and fitness status of tens of thousands of patients who visited the Cooper Clinic in Dallas between 1987 and 2005. The men and women had gone through extensive testing during repeated visits to the clinic over the years.Now, the Iowa researchers pulled the records for almost 12,000 of the participants, most of them middle-aged. None of them were propecia and birth defects obese, based on their B.M.I., when they first joined the Aerobics Center study. (B.M.I., or body mass index, propecia and birth defects indirectly estimates body fat, based on your height and weight.

You can check yours online here.)These particular men and women had completed the typical array of health and fitness measurements during their visits to the clinic and also filled out an exercise questionnaire that asked, among other issues, about weight training. Did they propecia and birth defects ever engage in “muscle-strengthening exercises,” it inquired, and if so, how often and for how many minutes each week?. The researchers then began crosschecking, comparing people’s weights and other measurements from one clinic visit to the next. Based on B.M.I., about 7 percent of the men and women had become obese within about six years of propecia and birth defects their first visit to the clinic.But B.M.I.

Is a loose approximation of body composition and not always an accurate measure of obesity. So the researchers also checked changes to people’s waist circumferences and their propecia and birth defects body-fat percentage to determine if they had become obese. By the yardsticks of a propecia and birth defects waist circumference greater than 40 inches for men and 35 for women, or a body-fat percentage above 25 percent for men and 30 percent for women, as many as 19 percent of participants developed obesity over the years.Weight lifting, however, changed those outcomes, the researchers found, substantially lowering the risk that someone would become obese, by any measure. Men and women who reported strengthening their muscles a few times a week, for a weekly total of one to two hours, were about 20 percent less likely to become obese over the years, based on B.M.I., and about 30 percent less likely, based on waist circumference or body-fat percentage.The benefits remained when the researchers controlled for age, sex, smoking, general health and aerobic exercise.

People who propecia and birth defects worked out aerobically and lifted weights were much less likely to become obese. But so were those who lifted almost exclusively and reported little, if any, aerobic exercise.The results suggest that “you can get a lot of benefit from even a little” weight training, says Angelique Brellenthin, a professor of kinesiology at Iowa State, who led the new study.Of course, the study was observational and does not prove that resistance training prevents weight gain, only that they are linked. It also did not consider people’s diets, genetics or health attitudes, propecia and birth defects any of which could affect obesity risk.Perhaps most important, it does not tell us how muscle strengthening influences weight, although it is likely that resistance training builds and maintains muscle mass, Dr. Brellenthin says propecia and birth defects.

A metabolically active tissue, muscle burns calories and slightly increases our metabolic rate. Interestingly, the desirable effect of adding muscle mass may also explain why propecia and birth defects fewer lifters avoided obesity when the researchers used B.M.I. As a measure. B.M.I.

Does not differentiate muscle from fat, Dr. Brellenthin points out. If you add muscle with weight training, your B.M.I. Can rise.Still, the primary message of the study is that some weight training likely helps, over time, with weight control.

€œSo, my advice would be to fit in a few body weight exercises before or after your usual daily walk,” Dr. Brellenthin suggests. Or join a gym or an online class. Or try one of Well’s easy, at-home resistance-training routines, like the 7-Minute Standing Workout.AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyWhat to Look for in a Physical TherapistNot all P.T.s are created equal.

Find a professional who values evidence over anecdote.In some instances, exercise during physical therapy is even as effective as surgery.Credit...Getty ImagesJuly 6, 2021There’s been a quiet revolution taking place in the field of physical therapy. In the early 2000s, you could go to five different physical therapists for an injury and receive five different treatment plans. Some would have advised targeted exercises to strengthen muscles or classic treatments, like heat and cold packs.Others might have relied on “voodoo treatments” like uasound, lasers and electrotherapy, despite the fact that experts weren’t really sure how — or even if — they worked. Today, many of those techniques have been set aside as the science has slowly accumulated that they don’t accelerate healing.

You may still find them in some offices, however, as the field has struggled with a lack of uniformity and a lingering reputation for pseudoscience, leaving patients unsure whom to trust.Take uasound, for instance. The technique has been used in physical therapy since the 1950s to treat everything from back pain to ankle sprains using high-frequency sound waves to speed the healing process. As early as the 1990s, uasound’s efficacy started to be debunked, with few studies showing any clinical benefit, but it’s taken over 20 years for the technique to finally fall out of favor with practitioners.“There’s very little, if any, evidence that uasound does anything at all,” said Bruce Greenfield, a professor in the department of rehabilitation medicine at Emory University. €œBut P.T.s are using it, and they’re charging for it, and they’re getting reimbursed for it — basically for a technique that’s not effective.

Is that fraud?. I don’t know.”Over the last 15 years, leaders in the physical therapy field have worked to shed this reputation, improving standards and consistency. They’ve developed systems to diagnose and classify injuries and turned to scientific research to create evidence-backed treatment guidelines. €œThat’s how you change the face of the profession,” said David Wert, an associate professor of physical therapy at the University of Pittsburgh.

€œUsing evidence and applying interventions for folks that are meaningful.”A Shift From Passive to Active TreatmentOriginally, physical therapy was largely based on the use of treatments like heat and ice to ease people’s pain and aid healing. Practitioners have also been quick to adopt technologies like laser therapy, which purportedly travels through skin and cells to increase energy production in mitochondria (the powerhouse of the cell) to accelerate recovery. But a treatment’s effect on a cell in a petri dish doesn’t necessarily translate to a patient in the clinic. The most recent — and some say most definitive — study on the technique shows no benefit over a placebo.Over the past two decades, studies and meta-analyses (like the one conducted on uasound) have revealed that these types of passive treatments, where patients lie down on a table and have a therapy performed on them, actually do very little.

And in some cases, they can even slow down recovery.For example, ice has long been used to reduce swelling after an injury by constricting blood vessels in the area, which prevents blood and inflammatory cells from reaching the damaged tissue. But those blood and inflammatory cells are also a necessary part of the healing process, and restricting them with a cold pack or ice bath can delay or even prevent recovery.When compared head-to-head, active exercise-based therapies are both less expensive and more effective than passive ones. In some instances, exercise is even as effective as surgery. In one study of 350 patients who had meniscal tears, there was no difference after six months between the patients who’d had surgery and those who’d used active physical therapy.

Other research is currently exploring whether the same might be true for partial rotator cuff tears.Instead, what’s emerged from decades of research as a clear winner — whether it’s used to treat low back pain or frozen shoulder or knee ligament injuries — is good old-fashioned exercise.“We have gotten quite a bit more evidence for the effectiveness of exercise in both facilitating recovery and also protecting people from different kinds of injuries or diseases,” said James Gordon, chair of the division of biokinesiology and physical therapy at the University of Southern California. Marilyn Moffat, a professor of physical therapy at New York University, agreed, saying that for every type of patient seen by physical therapists, “whether it’s patients with cardiovascular disease, whether it’s patients with diabetes, whether it’s patients with orthopedic problems or fibromyalgia or neuromuscular disorders or falls or frailty or obesity, the literature out there in terms of exercise interventions is so strong for every single one.”Changing the Field, SlowlyThese days, most physical therapists recognize that treatments should consist of exercises that improve strength and flexibility, as well as ergonomic adjustments to people’s work or workout routines to prevent future injuries. However, some practitioners argue that passive treatments still have their place and they are still taught in physical therapy doctorate programs.James Irrgang, chair of the physical therapy department at the University of Pittsburgh, said he wasn’t surprised there is still a gap between what evidence shows is effective and what some clinical practices do. Across medicine, it traditionally takes 17 years for research to make its way to the clinic.

As a result, Dr. Irrgang said that much of the emphasis in physical therapy now is on implementation. €œHow do we get the clinicians to adhere to the best available evidence?. €He hopes the answer is through education.

In 2006, Dr. Irrgang — who at the time was the president of the Academy of Orthopaedic Physical Therapy — helped develop guidelines in the form of a report card for diagnostic and treatment techniques commonly used by physical therapists, based on the best scientific evidence.Some techniques, like doing exercises to increase quadriceps strength after an A.C.L. Tear, get an A. Others, like using electrotherapy to improve heel pain for plantar fasciitis, get a D.What to Look for in a Physical TherapistSo how can you tell if your P.T.

Is relying on the best science?. During your first visit, the physical therapist will evaluate your symptoms, level of pain, how you move and your limitations for range of motion, strength and balance. That will become the basis of a diagnosis. This is not a medical diagnosis.

The physical therapist wants to know what is limiting the function of, say, your knee, via muscle weakness or joint stiffness.Dr. Moffat said that this initial appointment is a good time to decide whether you want to work with the physical therapist. €œThe most important thing is what the therapist does with their initial exam,” she said. €œDo they really take the time initially to examine what’s going on and then determine what’s most appropriate for that patient?.

€After the evaluation, the treatment they recommend should be evidence-based, drawing from the clinical practice guidelines, but it should also be tailored to your individual limitations and goals. It should also be active, incorporating strengthening and stretching exercises.It’s important for the physical therapist to be empathetic and honest about what your course of treatment will entail, because the process can be painful. Whether or not you like your practitioner can also make a big difference in how you see the outcome. According to one meta-analysis, patients consistently rated their physical therapists based on how much they liked them as people, not on whether or not they got better.And if you find yourself in a clinic where passive therapies like heat packs or uasound seem to be the main approach to treatment, “Find another place to go,” Dr.

Gordon said. Those treatments may be useful for temporarily reducing pain or inflammation, “but they are not therapeutic in and of themselves. They are adjuncts to treatment.”This approach to physical therapy may not use lasers or cryocompression pants or whatever the hot new toy is, and it requires work on the patient’s part, but it does work.“I think we are improving what we do, but I think it’s an evolution,” said Dr. Gordon, who’s been practicing physical therapy for over 40 years.

Incremental, evidence-based advances are “having an impact, but it’s not sexy. It’s not a new robotic thing. It’s hard to put it on the seven o’clock news. But it is truly a revolution in health care.”Dana Smith is a health and science writer based in Durham, N.C.

Her work has appeared in The Atlantic, The Guardian, Scientific American, STAT and more.AdvertisementContinue reading the main story.

AdvertisementContinue reading the main storySupported byContinue reading the main storyPhys EdHow Weight Training May Help With Weight ControlPeople who regularly do muscle-strengthening exercises are about 20 to 30 percent less likely to become obese over time than people who do not.Credit...Neil Hall/EPA, via ShutterstockJuly 7, 2021Lifting weights a few times a week might help us stave off obesity, according to brand name propecia online an interesting new study of resistance exercise and body fat. It shows that people who regularly complete muscle-strengthening exercises of any kind are about 20 to 30 percent less likely to become obese over time than people who do not, brand name propecia online whether they also work out aerobically or not.The findings indicate that weight training could be more consequential for weight control than many of us might expect, and a little lifting now may keep us lighter, later.The incidence of obesity in America is rising, with about 40 percent of adults currently meeting the standard criteria for obesity. That number is expected to increase to more than 50 percent by the end of this decade.Unfortunately, few of us will drop any added pounds, long term, once we gain them. Most people who shed more than about 5 percent of brand name propecia online their body weight regain it within five years.The most effective way to deal with obesity, then, is probably to prevent it. And regular exercise can help in that regard.

Many studies show that people who often walk, jog, cycle, swim or otherwise work out aerobically tend to gain less weight with brand name propecia online age than sedentary people and are at lower risk of becoming obese.But far less has been known about whether weight training likewise influences weight. Some past research hints that resistance training helps people retain muscle mass while brand name propecia online people are trying to lose weight. But whether it might also check long-term weight gain and avert obesity has not been clear.So, for the new study, which was published in June in PLOS Medicine, researchers at Iowa State University in Ames, Iowa, and other institutions, decided to look into the relationship, if any, between weights and waistlines. They began by turning to the large and useful database compiled for the Aerobics Center Longitudinal Study, a famous undertaking that had tracked the medical, health and fitness status of tens of thousands of patients who brand name propecia online visited the Cooper Clinic in Dallas between 1987 and 2005. The men and women had gone through extensive testing during repeated visits to the clinic over the years.Now, the Iowa researchers pulled the records for almost 12,000 of the participants, most of them middle-aged.

None of them were obese, brand name propecia online based on their B.M.I., when they first joined the Aerobics Center study. (B.M.I., or brand name propecia online body mass index, indirectly estimates body fat, based on your height and weight. You can check yours online here.)These particular men and women had completed the typical array of health and fitness measurements during their visits to the clinic and also filled out an exercise questionnaire that asked, among other issues, about weight training. Did they ever engage in “muscle-strengthening exercises,” it inquired, and if so, how often and for brand name propecia online how many minutes each week?. The researchers then began crosschecking, comparing people’s weights and other measurements from one clinic visit to the next.

Based on B.M.I., about brand name propecia online 7 percent of the men and women had become obese within about six years of their first visit to the clinic.But B.M.I. Is a loose approximation of body composition and not always an accurate measure of obesity. So the brand name propecia online researchers also checked changes to people’s waist circumferences and their body-fat percentage to determine if they had become obese. By the yardsticks of a waist circumference greater than 40 inches for men and 35 for women, or a body-fat percentage above 25 percent for men and 30 percent brand name propecia online for women, as many as 19 percent of participants developed obesity over the years.Weight lifting, however, changed those outcomes, the researchers found, substantially lowering the risk that someone would become obese, by any measure. Men and women who reported strengthening their muscles a few times a week, for a weekly total of one to two hours, were about 20 percent less likely to become obese over the years, based on B.M.I., and about 30 percent less likely, based on waist circumference or body-fat percentage.The benefits remained when the researchers controlled for age, sex, smoking, general health and aerobic exercise.

People who worked out aerobically and brand name propecia online lifted weights were much less likely to become obese. But so were those who lifted almost exclusively and reported little, if any, aerobic exercise.The results suggest that “you can get a lot of benefit from even a little” weight training, says Angelique Brellenthin, a professor of kinesiology at Iowa State, who led the new study.Of course, the study was observational and does not prove that resistance training prevents weight gain, only that they are linked. It also did not consider people’s diets, genetics or health attitudes, any of which could affect obesity risk.Perhaps most important, it does not tell us how muscle strengthening influences weight, brand name propecia online although it is likely that resistance training builds and maintains muscle mass, Dr. Brellenthin says brand name propecia online. A metabolically active tissue, muscle burns calories and slightly increases our metabolic rate.

Interestingly, the desirable effect of adding muscle mass brand name propecia online may also explain why fewer lifters avoided obesity when the researchers used B.M.I. As a measure. B.M.I. Does not differentiate muscle from fat, Dr. Brellenthin points out.

If you add muscle with weight training, your B.M.I. Can rise.Still, the primary message of the study is that some weight training likely helps, over time, with weight control. €œSo, my advice would be to fit in a few body weight exercises before or after your usual daily walk,” Dr. Brellenthin suggests. Or join a gym or an online class.

Or try one of Well’s easy, at-home resistance-training routines, like the 7-Minute Standing Workout.AdvertisementContinue reading the main storyAdvertisementContinue reading the main storySupported byContinue reading the main storyWhat to Look for in a Physical TherapistNot all P.T.s are created equal. Find a professional who values evidence over anecdote.In some instances, exercise during physical therapy is even as effective as surgery.Credit...Getty ImagesJuly 6, 2021There’s been a quiet revolution taking place in the field of physical therapy. In the early 2000s, you could go to five different physical therapists for an injury and receive five different treatment plans. Some would have advised targeted exercises to strengthen muscles or classic treatments, like heat and cold packs.Others might have relied on “voodoo treatments” like uasound, lasers and electrotherapy, despite the fact that experts weren’t really sure how — or even if — they worked. Today, many of those techniques have been set aside as the science has slowly accumulated that they don’t accelerate healing.

You may still find them in some offices, however, as the field has struggled with a lack of uniformity and a lingering reputation for pseudoscience, leaving patients unsure whom to trust.Take uasound, for instance. The technique has been used in physical therapy since the 1950s to treat everything from back pain to ankle sprains using high-frequency sound waves to speed the healing process. As early as the 1990s, uasound’s efficacy started to be debunked, with few studies showing any clinical benefit, but it’s taken over 20 years for the technique to finally fall out of favor with practitioners.“There’s very little, if any, evidence that uasound does anything at all,” said Bruce Greenfield, a professor in the department of rehabilitation medicine at Emory University. €œBut P.T.s are using it, and they’re charging for it, and they’re getting reimbursed for it — basically for a technique that’s not effective. Is that fraud?.

I don’t know.”Over the last 15 years, leaders in the physical therapy field have worked to shed this reputation, improving standards and consistency. They’ve developed systems to diagnose and classify injuries and turned to scientific research to create evidence-backed treatment guidelines. €œThat’s how you change the face of the profession,” said David Wert, an associate professor of physical therapy at the University of Pittsburgh. €œUsing evidence and applying interventions for folks that are meaningful.”A Shift From Passive to Active TreatmentOriginally, physical therapy was largely based on the use of treatments like heat and ice to ease people’s pain and aid healing. Practitioners have also been quick to adopt technologies like laser therapy, which purportedly travels through skin and cells to increase energy production in mitochondria (the powerhouse of the cell) to accelerate recovery.

But a treatment’s effect on a cell in a petri dish doesn’t necessarily translate to a patient in the clinic. The most recent — and some say most definitive — study on the technique shows no benefit over a placebo.Over the past two decades, studies and meta-analyses (like the one conducted on uasound) have revealed that these types of passive treatments, where patients lie down on a table and have a therapy performed on them, actually do very little. And in some cases, they can even slow down recovery.For example, ice has long been used to reduce swelling after an injury by constricting blood vessels in the area, which prevents blood and inflammatory cells from reaching the damaged tissue. But those blood and inflammatory cells are also a necessary part of the healing process, and restricting them with a cold pack or ice bath can delay or even prevent recovery.When compared head-to-head, active exercise-based therapies are both less expensive and more effective than passive ones. In some instances, exercise is even as effective as surgery.

In one study of 350 patients who had meniscal tears, there was no difference after six months between the patients who’d had surgery and those who’d used active physical therapy. Other research is currently exploring whether the same might be true for partial rotator cuff tears.Instead, what’s emerged from decades of research as a clear winner — whether it’s used to treat low back pain or frozen shoulder or knee ligament injuries — is good old-fashioned exercise.“We have gotten quite a bit more evidence for the effectiveness of exercise in both facilitating recovery and also protecting people from different kinds of injuries or diseases,” said James Gordon, chair of the division of biokinesiology and physical therapy at the University of Southern California. Marilyn Moffat, a professor of physical therapy at New York University, agreed, saying that for every type of patient seen by physical therapists, “whether it’s patients with cardiovascular disease, whether it’s patients with diabetes, whether it’s patients with orthopedic problems or fibromyalgia or neuromuscular disorders or falls or frailty or obesity, the literature out there in terms of exercise interventions is so strong for every single one.”Changing the Field, SlowlyThese days, most physical therapists recognize that treatments should consist of exercises that improve strength and flexibility, as well as ergonomic adjustments to people’s work or workout routines to prevent future injuries. However, some practitioners argue that passive treatments still have their place and they are still taught in physical therapy doctorate programs.James Irrgang, chair of the physical therapy department at the University of Pittsburgh, said he wasn’t surprised there is still a gap between what evidence shows is effective and what some clinical practices do. Across medicine, it traditionally takes 17 years for research to make its way to the clinic.

As a result, Dr. Irrgang said that much of the emphasis in physical therapy now is on implementation. €œHow do we get the clinicians to adhere to the best available evidence?. €He hopes the answer is through education. In 2006, Dr.

Irrgang — who at the time was the president of the Academy of Orthopaedic Physical Therapy — helped develop guidelines in the form of a report card for diagnostic and treatment techniques commonly used by physical therapists, based on the best scientific evidence.Some techniques, like doing exercises to increase quadriceps strength after an A.C.L. Tear, get an A. Others, like using electrotherapy to improve heel pain for plantar fasciitis, get a D.What to Look for in a Physical TherapistSo how can you tell if your P.T. Is relying on the best science?. During your first visit, the physical therapist will evaluate your symptoms, level of pain, how you move and your limitations for range of motion, strength and balance.

That will become the basis of a diagnosis. This is not a medical diagnosis. The physical therapist wants to know what is limiting the function of, say, your knee, via muscle weakness or joint stiffness.Dr. Moffat said that this initial appointment is a good time to decide whether you want to work with the physical therapist. €œThe most important thing is what the therapist does with their initial exam,” she said.

€œDo they really take the time initially to examine what’s going on and then determine what’s most appropriate for that patient?. €After the evaluation, the treatment they recommend should be evidence-based, drawing from the clinical practice guidelines, but it should also be tailored to your individual limitations and goals. It should also be active, incorporating strengthening and stretching exercises.It’s important for the physical therapist to be empathetic and honest about what your course of treatment will entail, because the process can be painful. Whether or not you like your practitioner can also make a big difference in how you see the outcome. According to one meta-analysis, patients consistently rated their physical therapists based on how much they liked them as people, not on whether or not they got better.And if you find yourself in a clinic where passive therapies like heat packs or uasound seem to be the main approach to treatment, “Find another place to go,” Dr.

Gordon said. Those treatments may be useful for temporarily reducing pain or inflammation, “but they are not therapeutic in and of themselves. They are adjuncts to treatment.”This approach to physical therapy may not use lasers or cryocompression pants or whatever the hot new toy is, and it requires work on the patient’s part, but it does work.“I think we are improving what we do, but I think it’s an evolution,” said Dr. Gordon, who’s been practicing physical therapy for over 40 years. Incremental, evidence-based advances are “having an impact, but it’s not sexy.

It’s not a new robotic thing. It’s hard to put it on the seven o’clock news. But it is truly a revolution in health care.”Dana Smith is a health and science writer based in Durham, N.C. Her work has appeared in The Atlantic, The Guardian, Scientific American, STAT and more.AdvertisementContinue reading the main story.

Where can I keep Propecia?

Keep out of the reach of children in a container that small children cannot open.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light. Keep container tightly closed. Throw away any unused medicine after the expiration date.

Propecia results

Talking to propecia results voters. I spent every day for nearly two months contacting them over the phone, at doorsteps, through screen doors and in driveways. I logged 2,500 phone calls, knocked 900 doors, walked 48 miles, and most importantly, engaged in 485 one-on-one conversations with people from all corners of Montana. My usual work revolves around the propecia results discourse on climate change and energy. Science communicators have distilled useful guidelines for public engagement with science, but I took a reprieve from the academic and hypothetical to test these strategies in a very real—and sometimes intimidating—setting.

How do you break it to a rural voter in a major coal state that coal is never coming back?. What tactics can one use to tiptoe through a conversation with a staunchly religious person to make the point that, propecia results in fact, humans are responsible for warming the climate?. I made my share of blunders and endured a never-ending case of “I should have said …” playing in my mind. But I also learned reliable strategies for having pleasant, productive and persuasive conversations. The election is behind us, but Americans remain deeply divided propecia results.

It’s an appropriate time to renew our commitment to build bridges rather than light them on fire. More than ever, we can endeavor to build a broad coalition, rather than alienating those with differing views and priorities. I humbly propecia results offer a few highlights from my experiences. Listen. And keep listening.

The simple act of propecia results giving the floor to another person yields immediate benefits. The longer you listen, the more you’ll understand. The more the other person talks, the more they’ll feel heard and comfortable. Earnest, open-ended questions can build trust and open the door propecia results for dialog. Say out loud the things you agree on.

Even if you squirm with some of what you hear, latching on to areas of disagreement almost always devolves into an argument—a trap I regrettably fell into a few times. Instead, tune your ear for where you agree propecia results. For example, if someone opines that climate scientists are corrupt, you can readily agree that science should be credible and ethical—we all want that. By focusing on where you’re already aligned, you can set the stage to make actual progress. Share your findings, but only as they relate to those places of agreement.

This is the part of the conversation that we tend to focus on, but propecia results without careful groundwork, the opportunity won’t even arise. Typically, it took several minutes of warm-up before getting to this point. Of all the topics I explored with voters, the one that resonated most reliably was the influence of fossil fuel money in our political system. But I didn’t hit people over the head with the fact that one of our senators has taken over $1 million from the propecia results fossil fuel industry. Instead, I went there gently, pointing out our shared goal of ethical politicians and the idea that no one wants more pollution.

I often relayed this information as a story, describing my deep dive through campaign finance data while writing an article about political allegiances within the energy industry. When I propecia results arrived at the final conclusion, it was part of the plotline, rather than a partisan talking point. In one case, when I delivered the tally of our senator’s haul from the oil, gas and coal industries, an undecided voter exclaimed, “Ah HA!. € as if she herself had just discovered it. Rally around solutions propecia results.

A young woman who was a geology major insisted that climate change was fake, and we went round and round many aspects of the science. Finally, she relented, “So what are we supposed to do about it anyway?. € The mood of the conversation shifted from adversarial to collaborative, propecia results because there are inherent benefits in cleaning up the energy supply, regardless of one’s opinions on climate change. We agreed on pretty much every point from there on out, and ended our 42-minute conversation on a cooperative, optimistic note. Change lanes to avoid roadblocks.

Climate change is propecia results a polarizing topic that can hurt a conversation more than it helps. In one such case I could practically hear a rural voter gritting her teeth through the telephone as she told me how it’s pure hubris to think that humans are causing global warming. I took a few steps back and talked about pollution instead, making an appeal to her pro-life values by underscoring how the earth is essential to all life. By the end of the conversation, she was assuring me that wind and solar energy were gifts from God that should be developed more quickly, and polluting corporations should step out of the propecia results way of progress. Offer a vision of a common goal that’s appealing to both of you.

A man who was a constitutional conservative enjoyed regaling me with his political musings. I dodged the usual bullets about how climate change is China’s fault and science has been wrong before, and cheerfully kept returning propecia results to the point that clean energy is the only energy that will work for Montana in the long run. After all it’s cheaper and it’s what our West Coast energy customers want to buy. I never took the bait on his talking points, and continued to rally around the optimistic goal that Montana should remain relevant in the energy industry, and to do that, we need to change with the times. I’m certain I didn’t affect his vote, but I was able to introduce the idea that clean energy is a wise choice, while also managing to avoid arguing or pushback.

I spent every day brand name propecia online for nearly two months contacting them over Recommended Reading the phone, at doorsteps, through screen doors and in driveways. I logged 2,500 phone calls, knocked 900 doors, walked 48 miles, and most importantly, engaged in 485 one-on-one conversations with people from all corners of Montana. My usual work revolves around the discourse on climate change and energy.

Science communicators have distilled useful guidelines for public brand name propecia online engagement with science, but I took a reprieve from the academic and hypothetical to test these strategies in a very real—and sometimes intimidating—setting. How do you break it to a rural voter in a major coal state that coal is never coming back?. What tactics can one use to tiptoe through a conversation with a staunchly religious person to make the point that, in fact, humans are responsible for warming the climate?.

I made my share of blunders and endured a never-ending case of “I should have said …” brand name propecia online playing in my mind. But I also learned reliable strategies for having pleasant, productive and persuasive conversations. The election is behind us, but Americans remain deeply divided.

It’s an appropriate time to renew our commitment to build bridges rather than light them on brand name propecia online fire. More than ever, we can endeavor to build a broad coalition, rather than alienating those with differing views and priorities. I humbly offer a few highlights from my experiences.

Listen. And keep listening. The simple act of giving the floor to another person yields immediate benefits.

The longer you listen, the more you’ll understand. The more the other person talks, the more they’ll feel heard and comfortable. Earnest, open-ended questions can build trust and open the door for dialog.

Say out loud the things you agree on. Even if you squirm with some of what you hear, latching on to areas of disagreement almost always devolves into an argument—a trap I regrettably fell into a few times. Instead, tune your ear for where you agree.

For example, if someone opines that climate scientists are corrupt, you can readily agree that science should be credible and ethical—we all want that. By focusing on where you’re already aligned, you can set the stage to make actual progress. Share your findings, but only as they relate to those places of agreement.

This is the part of the conversation that we tend to focus on, but without careful groundwork, the opportunity won’t even arise. Typically, it took several minutes of warm-up before getting to this point. Of all the topics I explored with voters, the one that resonated most reliably was the influence of fossil fuel money in our political system.

But I didn’t hit people over the head with the fact that one of our senators has taken over $1 million from the fossil fuel industry. Instead, I went there gently, pointing out our shared goal of ethical politicians and the idea that no one wants more pollution. I often relayed this information as a story, describing my deep dive through campaign finance data while writing an article about political allegiances within the energy industry.

When I arrived at the final conclusion, it was part of the plotline, rather than a partisan talking point. In one case, when I delivered the tally of our senator’s haul from the oil, gas and coal industries, an undecided voter exclaimed, “Ah HA!. € as if she herself had just discovered it.

Rally around solutions. A young woman who was a geology major insisted that climate change was fake, and we went round and round many aspects of the science. Finally, she relented, “So what are we supposed to do about it anyway?.

€ The mood of the conversation shifted from adversarial to collaborative, because there are inherent benefits in cleaning up the energy supply, regardless of one’s opinions on climate change. We agreed on pretty much every point from there on out, and ended our 42-minute conversation on a cooperative, optimistic note. Change lanes to avoid roadblocks.

Climate change is a polarizing topic that can hurt a conversation more than it helps. In one such case I could practically hear a rural voter gritting her teeth through the telephone as she told me how it’s pure hubris to think that humans are causing global warming. I took a few steps back and talked about pollution instead, making an appeal to her pro-life values by underscoring how the earth is essential to all life.

By the end of the conversation, she was assuring me that wind and solar energy were gifts from God that should be developed more quickly, and polluting corporations should step out of the way of progress. Offer a vision of a common goal that’s appealing to both of you. A man who was a constitutional conservative enjoyed regaling me with his political musings.

I dodged the usual bullets about how climate change is China’s fault and science has been wrong before, and cheerfully kept returning to the point that clean energy is the only energy that will work for Montana in the long run. After all it’s cheaper and it’s what our West Coast energy customers want to buy. I never took the bait on his talking points, and continued to rally around the optimistic goal that Montana should remain relevant in the energy industry, and to do that, we need to change with the times.

I’m certain I didn’t affect his vote, but I was able to introduce the idea that clean energy is a wise choice, while also managing to avoid arguing or pushback. Persuasion is a long-term project.

Can propecia cause kidney damage

This document can propecia cause kidney damage is unpublished. It is scheduled to be published on 09/18/2020. Once it is published it will be available on this page in an official form. Until then, you can download the unpublished PDF can propecia cause kidney damage version.

Although we make a concerted effort to reproduce the original document in full on our Public Inspection pages, in some cases graphics may not be displayed, and non-substantive markup language may appear alongside substantive text. If you are using public inspection listings for legal research, you should verify the contents of documents against a final, official edition of the Federal Register. Only official editions of the Federal Register provide legal notice to the public and can propecia cause kidney damage judicial notice to the courts under 44 U.S.C. 1503 &.

1507. Learn more here.Start Preamble Centers for Medicare can propecia cause kidney damage &. Medicaid Services (CMS), HHS. Extension of timeline for publication of final rule.

This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, can propecia cause kidney damage which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O. Wilson, (410) can propecia cause kidney damage 786-8852.

End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule that addressed undue regulatory impact and burden of the physician self-referral law. The proposed rule was issued in conjunction with the Centers for Medicare &. Medicaid Services' (CMS) Patients over Paperwork initiative and the Department of Health and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care. In the can propecia cause kidney damage proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers.

A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician. A new exception for donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health can propecia cause kidney damage records (EHR) items and services. The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations.

This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a can propecia cause kidney damage regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances. In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation.

We announced in the Spring 2020 Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August can propecia cause kidney damage 2020. However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date. This notice extends the timeline for publication of the final rule until August 31, 2021. Start Signature can propecia cause kidney damage Dated.

August 24, 2020. Wilma M. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services.

Until then, brand name propecia online you Zithromax canada online can download the unpublished PDF version. Although we make a concerted effort to reproduce the original document in full on our Public Inspection pages, in some cases graphics may not be displayed, and non-substantive markup language may appear alongside substantive text. If you are using public inspection listings for legal research, you should verify the contents of documents against a final, official edition of the Federal Register. Only official editions of the brand name propecia online Federal Register provide legal notice to the public and judicial notice to the courts under 44 U.S.C.

1503 &. 1507. Learn more brand name propecia online here.Start Preamble Centers for Medicare &. Medicaid Services (CMS), HHS.

Extension of timeline for publication of final rule. This notice announces an extension of the timeline for publication of a Medicare brand name propecia online final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O.

Wilson, (410) brand name propecia online 786-8852. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule that addressed undue regulatory impact and burden of the physician self-referral law. The proposed rule was issued in conjunction with the Centers for Medicare &. Medicaid Services' (CMS) Patients brand name propecia online over Paperwork initiative and the Department of Health and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care.

In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician. A new exception for donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health brand name propecia online records (EHR) items and services.

The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations. This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish brand name propecia online and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances.

In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda (June 30, 2020, brand name propecia online www.reginfo.gov) that we would issue the final rule in August 2020. However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date. This notice extends the timeline for publication of the final rule until August 31, 2021.

Start Signature brand name propecia online Dated. August 24, 2020. Wilma M. Robinson, Deputy Executive Secretary to the Department, Department of Health and brand name propecia online Human Services.

End Signature End Supplemental Information [FR Doc. 2020-18867 Filed 8-26-20. 8:45 am]BILLING CODE 4120-01-P.