Are ventolin and albuterol the same

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In this issue of the Journal of Medical Ethics arguments are cogently made that sustainability and solidarity should be considered as core medical ethical principles, and that more explicit attention should be given to the complex context in which a decision is made.Munthe et al propose that sustainability should become an established principle for justifying healthcare resource allocation, and should be an explicit factor in procuring drugs and other resources.1 They argue that the current operational norms which guide decision making http://www.microcapmillionaires.com/ventolin-cost-per-pill/ (need, ventolin online canada prognosis, equal treatment and cost-effectiveness) can lead to what they call ‘negative dynamics’. The gradual depletion of resource available for healthcare.They illustrate this first by examining some well recognised examples of ‘positive dynamics’ which are considered in health policy. Immunisation programmes are funded because lead to reduction or absence of disease in the population, thus freeing up resource ventolin online canada for other uses. Public health measures are offset by future cost reductions or income increases for healthcare via reduction of sick leave.‘Negative dynamics’ however, are not routinely considered in operational decisions and they persuasively argue that they should be.

Resource depletion (not only fiscal resource, but environmental and human resource) has a negative effect ventolin online canada on future cycles of healthcare. As an illustrative example, they discuss the emission of resistance-driving residue in the production of antibiotics. The accepted principles, particularly of cost effectiveness, drive producers to make antibiotics cheaply, without consideration of gradual ventolin online canada contribution to antibiotic resistance. If a principle of sustainability was included when considering procurement, subsidy and prioritisation, this would provide an incentive to change production practices.

This argument can be extended to ventolin online canada many aspects of the healthcare. System including how we recruit, train and treat our staff. How we invest in infrastructure and how we plan for ventolin online canada ventolins. Munthe et al go on to provide a robust definition of their sustainability principle, and to address possible objections.

It is an excellent example of reasoned ethical ventolin online canada argument which has the potential to change clinical practice.With the roll out of vaccinations for asthma treatment across the globe, Julian Savulescu proposes an algorithm for when mandatory vaccination might be ethically justified.2 Drawing and expanding upon the 2007 Nuffield Council of Bioethics report he suggests that four criteria are required. 1. There is a grave threat ventolin online canada to public health 2. The treatment is safe and effective 3.

Mandatory vaccination has a superior cost/benefit profile compared ventolin online canada with other alternatives 4. The level of coercion is proportionate. Discussing the value judgement associated with each criterion, he concludes that, at ventolin online canada least initially (where uncertainty around safety is greater), mandatory vaccination for asthma treatment would be ethically problematic.He goes on to explore alternative approaches, including non-financial (eg, immunisation passports) and financial incentives. He argues that individuals could essentially be paid for the risk they are undertaking (by being early adopters of a treatment) for societal benefit, but to do this government would need to be ‘transparent, explicit and comprehensive in disclosure of data’, a standard which unfortunately has not always (or even often?.

) been kept ventolin online canada. The danger that payment might signal a lack of confidence in safety is real. Clearly payment should only be offered for a treatment which was considered safe enough to be ventolin online canada used in any circumstances. Payment for a treatment which was not considered safe without payment would not be morally acceptable.

Payment may also erode the sense of solidarity that people feel when contributing to societal well-being ventolin online canada. To ensure that this was maintained he suggests the option of ‘donating back’ the fee to the NHS could be made available. People could be rewarded for taking the treatment with an increasing sense of civic duty as they not ventolin online canada only protect themselves and the vulnerable, but contribute to the (fiscal) sustainability of the health service which treats them.While Savulescu acknowledges the worth of solidarity, Avery Kolers proposes that solidarity plays not just an auxillary part in the interests of acknowledged bioethical values (justice, beneficence etc) but has a freestanding role, which should be independently assessed.3 He acknowledges that solidarity per se is not valuable. There is solidarity, he notes, among a firing squad and within a terrorist cell.

He develops Prainsack and Buyx metaphor of solidarity as the putty of justice4 and suggests five individually necessary and sufficient ventolin online canada conditions of morally valuable solidarity. It must be (1) norm grounded (2) acknowledged (3) political (4) action and (5) on others’ behalf. He suggests that ventolin online canada solidarity (with X) is morally required ‘when it constitutes equitable treatment of X such as to countermand or resist inequitable treatment of X’. He notes that moral dilemmas may arise where solidarity with X may lead to inequitable treatment of Y and emphasises that solidarity with the most vulnerable in society will help address inequities in healthcare and in healthcare institutions.The complexities and competing moral demands of healthcare institutions, and primary care in particular, are explored by Spicer et al, who question the use of normative moral theories to determine the ‘best’ actions.5 They argue that the context in which ethical decisions are made is not sufficiently acknowledged.

If complex contextual factors are not considered, then predictions about outcomes will be flawed, as will the resulting ethical analyses.Examples of contextual factors which might influence decision-making include power relations within the staff and external regulators (including achieving externally determined quality markers and ‘standard’ practice) and the need to maintain ventolin online canada both group and individual professional identities.It is often helpful to peel back the layers of complexity in order to reveal a specific ethical question. Before coming to a conclusion, however, we must remember to reapply the layers and reconsider the question in the context of its complex environment. Integrating this proposal with others in the journal, this might include considerations of sustainability and solidarity.IntroductionWhile the role and importance of solidarity has been the focus of long-running and extensive debate surrounding public health ethics and ventolin online canada practice,1 the asthma treatment ventolin has cast this debate into even starker relief.2 In doing so, it has emphasised the particular importance of solidarity for the delivery of effective public health programmes by highlighting the potentially disastrous consequences of its absence. In this paper I examine these consequence with reference to the response of the current British government to asthma treatment which failed to deliver an effective public health response to the crisis.

I argue that this response represents mismanagement of a public health crisis, ventolin online canada and a rejection of important democratic norms and values.Defining solidaritySolidarity has a wide range of definitions in academic discourse, with its precise features being the subject of heated debate.3 4 Historically, solidarity has been seen as emerging most readily, and most often between persons sharing relatively stable, deeply ingrained qualities, such as shared membership of a state or religious group,5 or commitment to shared political ideals and objectives.6 7 More recently, it has been suggested that more transient, or less deeply ingrained features of persons may serve as the basis for acts of solidarity, and at least short-term solidarity relationships.4 On a larger scale, it has also been suggested that recognition of shared vulnerability in the face of global threats to health, such as climate change and antimicrobial resistance, may serve as a catalyst for solidarity between nations and peoples.8 As I explain below, this perspective is particularly relevant to the current ventolin context.2In this paper I rely mainly on the definition of solidarity offered by Prainsack and Buyx, who define solidarity as ‘enacted commitments to accept costs to assist others with whom a person or persons recognise similarity in a relevant respect’.4 Therefore, solidarity describes what it is that we do when we assist, benefit or support other people because we recognise some form of relevant similarity or connection with/to them. Thus solidarity is active, in that it is something we do, not merely a feeling or attitude. It is also egalitarian, with motivation for action being grounded in recognition of what is shared between parties, not in what distinguishes them.3 Finally, acting in solidarity also involves incurring of costs of some kind, though these may be extremely minimal, or be counterbalanced by the benefits of a given solidarity action.Prainsack and Buyx argue that there are three main ‘tiers’ of ventolin online canada solidaristic action. Interpersonal, group and institutional solidarity.4 The first of these tiers describes what happens between individual persons.

For example, Prainsack and Buyx suggest that giving up one’s seat on a crowded bus for a pregnant fellow passenger is an act of solidarity when based on recognition of shared experience of discomfort while standing during pregnancy.4 The second tier ‘comprises manifestations of a shared commitment to carry costs to assist ventolin online canada others with whom people consider themselves bound together through at least one similarity in a relevant respect’. These group solidarities occur when many individuals share a similar specific context, and engage in actions to benefit others with whom the context is shared. Such solidarity is informal, though it may also be heavily normalised within a given community, such that it ventolin online canada forms an expectation of behaviour.Tier 3 solidarity comprises formalised, or legally mandated expectations of behaviour. Here, solidarity is fully institutionalised, ‘in the form of legally enforceable norms’,4 such as progressive tax systems and welfare state arrangements.

For example, the British National Health Service (NHS) exemplifies institutionalised solidarity, because it is funded through taxation and provides healthcare to citizens and legal residents of the UK, regardless ventolin online canada of their ability to pay. According to Prainsack and Buyx, these three tiers of solidarity are closely connected, with tier 3 solidarity typically emerging from solidarity at tiers 1 and 2. Correlatively, Sangiovanni discusses the participation in collaborative institutions as solidaristic practice when he argues that solidarity is grounded in ‘our joint action as authors of political and social institutions’.7 Thus, for Sangiovanni solidarity is something which emerges from shared participation in the construction and enactment of ventolin online canada civic society. Solidarity can therefore be interpreted in a range of ways—as the act of carrying costs for relevantly similar others, ‘standing up for’, ‘standing up with’ and ‘standing up as’’ those persons with whom solidarity is identified,3 or the act of working together for a shared goal.7 Regardless of the precise definition adopted, at least basic solidarity, as active engagements in interpersonal and/or institutional egalitarian relationality, by all or most members of a group is fundamentally necessary for the existence and functioning of any community—as I explain below, it is particularly important in democracies.Solidarity and public healthIn normal circumstances, private individuals can engage in interpersonal and group solidarity in the context of public health provision, by avoiding social interaction when sick and helping others to do the same, by purchasing groceries for an ill neighbour, for example.

Individuals can engage ventolin online canada in tier 3 solidarity by participating in institutions which promote and protect public and individual health. For example, participation in fair taxation schemes can help fund health and welfare programmes, such as the British NHS, ensuring the accessibility of these services to all members of a given community, thereby contributing to public health and individual well-being.Correlatively, while elected and appointed governmental officials, such as cabinet ministers, can also engage in solidarity in the same way as their constituents, they also have additional responsibilities in virtue of their public role and status as elected representatives of their communities. These responsibilities include things like enacting legislation which establishes and maintains institutions and programmes which promote and protect health ventolin online canada. Such actions protect the health of their constituents, and they enable those constituents to more effectively engage in solidarity with their peers, by providing the systems necessary to do so most effectively, and guidance as to the reasons for so doing.

It is therefore particularly important that elected officials engage in solidarity with their constituents in this manner because individual citizens lack the capacity to establish and govern public health institutions, and ventolin online canada more importantly, have deferred authority to do these things to those in government through the democratic process.The delivery and maintenance of effective public health programmes relies on most members of a community engaging in solidarity in a range of ways. To illustrate, vaccination programmes cannot deliver herd immunity without mass participation from community members, but individuals cannot contribute to herd immunity if treatments are prohibitively expensive, or only available at an inaccessible venue. They are also unlikely to contribute if they have been misled into believing ventolin online canada that treatments are dangerous or unnecessary. Here, engagement in solidarity is required from both private individuals, who must participate in the programme, and elected officials, who must ensure it is accessible to all members of a community, and provide an epistemic context in which the importance and safety of the programme is widely understood, in order for it to be effective.Solidarity and asthma treatmentIn his opening remarks to a press briefing on 18 March 2020, Tedros Adhanom Ghebreyesus, Director-General of WHO stated that “(the) spirit of solidarity must be at the centre of our efforts to defeat asthma treatment”.2 Similar statements have also been made by a number of other agencies, each of which have emphasised solidarity’s role as an essential part of an effective public health response.9 Correlatively, many governments have instituted lockdowns, and are enforcing social distancing measures (to greater or lesser extent) in order to limit the spread of .

We have all thereby been asked, even instructed, to avoid public gatherings, ventolin online canada minimise our contact with others and help to protect our neighbours. In so doing, we engage in solidarity with our compatriots.For private individuals, engaging in solidarity with their peers in response to asthma treatment is thus very similar to such engagement for public health under normal circumstances—participation in public health programmes, social distancing, community cooperation, and contributing through taxation to the cost of public health efforts and medical research. Elected officials ventolin online canada can do these things as individuals, but can also respond in their role as public officials in at least two additional ways. First, by collaborating with other governments to share information, and coordinate regional and global public health responses.10 Second, by ensuring that NHS exist and are adequately funded, staffed and equipped to be able to respond to the ventolin, and by providing clear information and support to citizens so that they may engage in solidarity with one another.There has been great variation in the extent to which different regions have achieved engagement in solidarity across these vectors.

New Zealand and South Korea both implemented thorough testing and tracing programmes which allowed them to counteract the spread of (and in South Korea, also reduced influenza s), while New Zealand also imposed strict lockdown protocols, going as far as closing its borders.11 12 Equally importantly, officials in both locations acted quickly, and communicated clearly with their communities, ensuring that residents knew how to minimise the risk of transmission, and why ventolin online canada doing so was important. Individual members of these communities were thus able to engage in interpersonal solidarity, by following lockdown rules, maintaining social distancing, and participating in track and trace programmes, because their governments had proactively established the material and epistemological conditions where such engagement was enabled, empowered and encouraged. By doing so, the New Zealand and South Korean governments thus engaged in solidarity with their ventolin online canada constituents.In contrast, the current British government’s response to asthma treatment lacked the transparency, clarity and urgency which characterised the actions of these more successful nations. First, while the UK and New Zealand each initiated lockdowns in the same week in late March, New Zealand at that stage had only 102 cases of asthma treatment, with no deaths, compared with the UK’s total of 5687 cases and 281 deaths.12 13 Correlatively, while South Korea did not enforce a strict lockdown, it had enacted social distancing policies even earlier, at the end of February.11 The risk of ongoing transmission was therefore significantly higher in the UK than in either nation at this time.Second, communication from the current British government was often unclear, and the prime minister and other officials frequently downplayed the severity of the ventolin—at one point the prime minister (who was later hospitalised with asthma treatment) stated that he would not refrain from shaking hands, and that he had recently shaken hands with everyone in a asthma treatment ward.14 In this way, the risks of asthma treatment were initially minimised in official communications, creating uncertainty about how to act, and which guidance to follow.

Exacerbating this issue, where advice was given, it was ventolin online canada initially often discretionary, and little material support was made available to enable people to follow it. For example, on 16 March 2020, people were advised to work from home if possible and avoid social venues, such as pubs and theatres.15 However, this was not mandatory, and social venues were not required to close until 20 March, so some employees were required to work onsite, despite known risks.16Correlatively, no support was initially made available to those who could not work remotely, meaning that choices had to be made between employment and ‘fighting the ventolin’. Financial support was later made available, in the form of the government’s job retention scheme, which allowed employers to furlough non-essential workers, the wages of whom would be subsidised by government.17 However, this only covered 80% of employee wages, meaning ventolin online canada that many of those furloughed would have to live on a reduced income. Likewise, while support has been offered to home owners in the form of mortgage holidays, at the time of writing, renters have not received similar assistance.18Third, the government also initially moved to adopt a strategy that deviated from the recommendations of the WHO, which focused on minimising rates through conventional public health measures, such as active testing, social distancing and increased emphasis on personal hygiene (hand washing, etc).19 In contrast, the government initially endorsed a ‘herd immunity’ strategy, which appeared to focus on allowing approximately 60% of the British population to become infected with the ventolin, which would have led to an even higher level of excess mortality.20 Despite the eventual rejection of this strategy in favour of closer adherence to WHO guidelines, at the time of writing the UK has the world’s second highest asthma treatment mortality rate.21 Further, the consequences of these policy choices were compounded because of the historical policy context in which they occur.

In the last decade the NHS has seen a significant reduction in funding as a result of austerity policies.22 Consequently, many NHS trusts have found it extremely difficult to respond safely and effectively to the crisis, because of lack of resources (in terms of people, money and equipment)—the absence of sufficient personal protective equipment for those treating patients with asthma treatment being particularly notable.23The current British ventolin online canada government’s response to asthma treatment therefore deviated significantly from those of nations with more successful responses, and from WHO guidance. In doing so, it established an epistemological and financial context where it was difficult for individuals to afford to follow public health guidelines, or to even know exactly what those guidelines required. As I argued above, the successful delivery and maintenance of public ventolin online canada health programmes requires engagement in solidarity from both private individuals, and government officials. Engagement in solidarity by the latter entails legislating for the delivery and management of effective public health programmes, and providing clear guidance for their constituents to follow.Unlike their counterparts in New Zealand and South Korea, the current British government has failed to achieve either of these objectives, though it should be noted, that there have also been high profile instances of individual agents in the UK failing to engage in solidarity with their communities.24 However, these solidarity failures must be considered in context.

Arguably some failures of individuals to engage in solidarity may at least in part be attributed to governmental ventolin online canada failures to deliver an effective public health response to asthma treatment, or communicate its importance and requirements. It has been noted, for example, that panic buying and stockpiling can be sensible strategies in times of potential social chaos and market disruption—especially when told by the government that a total social lockdown may imminently limit access to necessities.25 In each of these cases, the individuals concerned do have duties of solidarity (as well as professional duties, in the case of healthcare workers) to their compatriots and communities, and failure to fulfil them may cause harm. However, the costs and challenges of fulfilling those duties have been amplified (and in the case of the professional duties of healthcare workers dangerously so) by the government’s failure to fulfil its own responsibilities of solidarity.ConclusionEffective public health programmes ventolin online canada cannot rely solely on private individuals always engaging in interpersonal solidarity in an optimal fashion. Private citizens all operate under epistemological constraints—we may not know of the needs of others with whom we would engage in solidarity if we had more complete information, or we may be honestly mistaken about the best way to engage in solidarity with people we do know about.

Alternatively, we may know of the needs of others, but face material constraints which make providing significant assistance to them impossible ventolin online canada. Governments must therefore engage in solidarity with their constituents by providing the epistemological, institutional, material and financial resources, which compensate for these constraints and thus make interpersonal solidarity possible. By failing ventolin online canada to do so, the current British government has failed to adequately protect the residents of the UK in a time of crisis. It has thus failed to engage in solidarity with its constituents, and effectively devolved responsibility for action to agents with far less power to deliver an effective response to asthma treatment.

Further and importantly, those thus tasked with responding to the ventolin are disempowered in part because of the failures of the government.Had the government’s failures in response to asthma treatment occurred despite the early adoption of recommended strategies proven to work elsewhere, they would not count as failures of solidarity, but of policy—as unfortunate consequences of mistakes made under challenging circumstances, despite a good faith effort to ventolin online canada achieve the best possible outcome. The government’s actions became failures of solidarity when it ignored compelling and accessible information about how best to respond to the crisis, and did not take actions that they could and should have taken. Further, by failing to provide either definitive rules, or sufficient material ventolin online canada and financial support, the government devolved responsibility for responding to the crisis to their constituents and expected them to each individually act in the correct manner to prevent the spread of —an unrealistic expectation. As discussed above, private individuals operate under significantly stricter financial, social and epistemological constraints than their elected representatives, constraints which in this instance were exacerbated by the actions of those in power.

Even under ideal conditions (that is, in the absence of material and epistemological constraints), reliance on mass individual choices delivering an appropriate response to asthma treatment would not be an effective strategy ventolin online canada. To rely on such a strategy where such constraints are present is mistaken, and arguably avoidably so. It is also a dereliction of the government’s responsibilities to its constituents.Importantly therefore, the government’s actions represent more ventolin online canada than mere failure to adequately protect its constituents. By devolving responsibility for action to those without sufficient power to act, the government’s actions should be recognised both as a failure of solidarity, and as a dereliction of it.

Indeed, where engagement in solidarity by the government has occurred, it has frequently been delayed, insufficient or reluctantly provided, contributing ventolin online canada to the significant excess mortality and morbidity experienced by the UK.21A government which fails to engage in solidarity with its constituents, makes an implicit statement about the nature of the relationship between itself and the rest of society. In doing so, and in abdicating their responsibilities to their constituents while simultaneously expecting them to collectively deliver an effective response to asthma treatment, they redefine that relationship, from being one of elected representatives and constituents, to one of rulers and ruled.There are two ways to interpret the phrase ‘solidarity is for other people’. First, it can be read as a statement of closeness and relationality—an expression of the understanding that solidarity is something we engage in to ventolin online canada assist or benefit other people with whom we identify. Second, it can be understood as an assertion that the speaker holds themselves apart from other people—a claim that solidarity is something that other people should or may do, but that is not something with which the speaker is concerned.

Sadly, recent events suggest that we must give serious consideration to the idea that it is this second interpretation which more accurately reflects the attitudes of the British government at this time.AcknowledgmentsThe author thanks Dr Agomoni Ganguli-Mitra for her very helpful comments on an earlier version of this paper..

Are ventolin and albuterol the same

There are not enough health workers in California to meet the needs of the state’s increasingly diverse, growing, and aging are ventolin and albuterol the same population, and the situation is getting worse. In 2019, 39 percent of Californians identified as Latinx, but only 14 percent of medical school students and 6 percent of active patient care physicians in California were Latinx.Researchers from Mathematica, with support from the California Health Care Foundation, recently reviewed evidence from key health workforce policy interventions to determine their impact on access to health care, the diversity of the health workforce, and providers’ ability to deliver services in a language other than English (“language concordance”). The evidence are ventolin and albuterol the same review included academic literature and interviews of key experts in the field. It focused on health professions that require an advanced degree, because it has been particularly challenging to improve access, diversity, and language concordance through these jobs.“There have been many public and private efforts in California to increase the number and diversity of health professionals, but they have not been sufficient to alleviate the crisis,” said Diane Rittenhouse, a senior fellow at Mathematica.

€œIn a are ventolin and albuterol the same year with a state budget surplus, this report reviews evidence and presents options for public investment to improve health care access and health workforce diversity.” Mathematica’s researchers concluded that a blended approach is necessary to achieve better health care access and improve the diversity of the health workforce. For example, loan repayment in exchange for a commitment to serve in a medically underserved area of California is a quick way to improve access to primary care, behavioral health, and dentistry in those areas. Improving the diversity of the workforce, however, requires support for a diverse array of are ventolin and albuterol the same college students to succeed in California’s health professional training programs. Ultimately, underserved rural and urban areas are more likely to retain health professionals who are from those areas, and interventions that seek to engage those professionals will likely have the greatest impact.

Read the are ventolin and albuterol the same report here. For more information on the report or on health workforce challenges in California, please contact Todd Kohlhepp.Despite the important mission of adult education to provide adults with the competencies they need to succeed in the workforce and achieve economic self-sufficiency, policymakers and practitioners have limited evidence on effective strategies for improving adult learners’ outcomes. The Workforce Innovation and Opportunity Act (WIOA) Title are ventolin and albuterol the same II, the key federal investment helping adults acquire important skills and credentials to succeed in the workplace, encourages adult education programs to use evidence-based strategies to improve services and participant success. A new review of existing research, authored by staff at Mathematica for the Institute of Education Sciences at the U.S.

Department of Education, identifies some promising strategies and a need for more rigorous studies to guide decision making around successful strategies for adult are ventolin and albuterol the same learners. The available evidence provides limited support for the use of particular adult education strategies over others, although bridge classes and integrated education and training programs offer some promise. The authors are ventolin and albuterol the same also note opportunities for the field to prioritize research investments to increase the evidence base. Namely, under WIOA, Title II requires adult education programs to collect data on skill gains, educational progress, employment, and earnings for program participants.

These data offer opportunities to examine adult education strategies that might improve these learner outcomes are ventolin and albuterol the same. The emphasis in WIOA on longer term educational attainment and labor market outcomes also provides opportunities for research on strategies with an increased focus on improving adult learner transitions to postsecondary education or to better jobs and higher earnings, outcomes for which reliable data sources exist.“This systematic review provides some guidance for the field to make progress on its goals of helping adult learners obtain the competencies they need to be productive workers, family members, and citizens,” noted project director Alina Martinez. This research can help policymakers and local providers target their resources to help adult learners achieve higher earnings and career success.“Read the IES snapshot..

There are not enough health workers in California to meet the needs ventolin online canada of the state’s increasingly diverse, growing, and aging population, and the situation is getting worse. In 2019, 39 percent of Californians identified as Latinx, but only 14 percent of medical school students and 6 percent of active patient care physicians in California were Latinx.Researchers from Mathematica, with support from the California Health Care Foundation, recently reviewed evidence from key health workforce policy interventions to determine their impact on access to health care, the diversity of the health workforce, and providers’ ability to deliver services in a language other than English (“language concordance”). The evidence review ventolin online canada included academic literature and interviews of key experts in the field. It focused on health professions that require an advanced degree, because it has been particularly challenging to improve access, diversity, and language concordance through these jobs.“There have been many public and private efforts in California to increase the number and diversity of health professionals, but they have not been sufficient to alleviate the crisis,” said Diane Rittenhouse, a senior fellow at Mathematica.

€œIn a year with a state budget surplus, this report reviews evidence and presents options for public investment to improve health care access and health workforce diversity.” Mathematica’s researchers concluded that a blended approach is ventolin online canada necessary to achieve better health care access and improve the diversity of the health workforce. For example, loan repayment in exchange for a commitment to serve in a medically underserved area of California is a quick way to improve access to primary care, behavioral health, and dentistry in those areas. Improving the diversity of the workforce, however, requires support for a diverse array of college students ventolin online canada to succeed in California’s health professional training programs. Ultimately, underserved rural and urban areas are more likely to retain health professionals who are from those areas, and interventions that seek to engage those professionals will likely have the greatest impact.

Read the report here ventolin online canada. For more information on the report or on health workforce challenges in California, please contact Todd Kohlhepp.Despite the important mission of adult education to provide adults with the competencies they need to succeed in the workforce and achieve economic self-sufficiency, policymakers and practitioners have limited evidence on effective strategies for improving adult learners’ outcomes. The Workforce Innovation and Opportunity Act (WIOA) Title II, the key federal investment helping adults acquire important skills and credentials to ventolin online canada succeed in the workplace, encourages adult education programs to use evidence-based strategies to improve services and participant success. A new review of existing research, authored by staff at Mathematica for the Institute of Education Sciences at the U.S.

Department of Education, identifies some promising ventolin online canada strategies and a need for more rigorous studies to guide decision making around successful strategies for adult learners. The available evidence provides limited support for the use of particular adult education strategies over others, although bridge classes and integrated education and training programs offer some promise. The authors also note opportunities for the field to prioritize research investments to increase the ventolin online canada evidence base. Namely, under WIOA, Title II requires adult education programs to collect data on skill gains, educational progress, employment, and earnings for program participants.

These data offer opportunities ventolin online canada to examine adult education strategies that might improve these learner outcomes. The emphasis in WIOA on longer term educational attainment and labor market outcomes also provides opportunities for research on strategies with an increased focus on improving adult learner transitions to postsecondary education or to better jobs and higher earnings, outcomes for which reliable data sources exist.“This systematic review provides some guidance for the field to make progress on its goals of helping adult learners obtain the competencies they need to be productive workers, family members, and citizens,” noted project director Alina Martinez. This research can help policymakers and local providers target their resources to help adult learners achieve higher earnings and career success.“Read the IES snapshot..

Where should I keep Ventolin?

Keep out of the reach of children. Store albuterol tablets in the refrigerator (36 to 46 degrees F). Other tablets may be stored at room temperature (59 to 86 degrees F), check the packaging or ask your pharmacist. Keep container closed tightly. Throw away any unused medicine after the expiration date.

Ventolin 5mg ml

Fourteen new cases of asthma treatment were diagnosed in the ventolin 5mg ml 24 hours to 8pm last night, bringing the total number of cases in NSW to 3,844. Confirmed cases (including interstate residents in NSW health care facilities)3,844Deaths (in NSW from confirm​​ed cases)54Total tests carried out2,137,629 There were 24,632 tests reported in the 24-hour reporting period, compared with 30,282 in the previous 24 hours. Of the ventolin 5mg ml fourteen new cases to 8pm last night. One is a re​turned traveller who is in hotel quarantine Ten are linked to a known case or cluster Three are locally acquired with their source still under investigation Eight of the new cases are linked to the Sydney CBD cluster, bringing the total number of cases in this cluster to 23.

Of the new cases, two are household contacts of previously reported cases, three attended the City Tattersalls Club, and three were close contacts of people linked to this cluster. Further investigations have found ventolin 5mg ml one case reported yesterday is also linked to this cluster. NSW Health is investigating whether the CBD cluster originated in the City Tattersalls Club and then spread to workplaces in the city and to households across Sydney and the Central Coast. To assist in identifying earlier and possible undiagnosed cases, NSW Health is asking anyone who attended the Club between 4 August 2020 – 18 August 2020 to get tested for asthma treatment and isolate until a negative test result is received.

Genomic sequencing of the ventolin ventolin 5mg ml from cases in this cluster are related to other recent clusters in NSW. This ventolin is genetically different to that of the Marriott Hotel security guard, who had a strain that had come from overseas. All identified close contacts of cases linked to this cluster are being contacted and told they must isolate for 14 days, get tested, get another test if any symptoms develop and stay isolated for the full 14 days, even if a ventolin 5mg ml negative test result is received within this period. Among the new cases today, two are household contacts of cases linked to Liverpool Hospital.

Prior to diagnosis many of the recently confirmed cases have attended a variety of locations and a full list of locations is available on the link below. New asthma treatment cases have visited the following locations in Mosman, ventolin 5mg ml St Ives and Rosebery and people attending at the same time must monitor for symptoms, get tested immediately if they develop and stay isolated until a negative test result is received. Archie Bear café, Mosman Rowers - 24 August 11am to 12 noon and Tuesday 25 August 9:00am to 9.30am Rosebery Post Shop, 371 Gardeners Rd, Rosebery - 26 August 1:30pm-1:40pm St Ives Shopping Centre, 166 Mona Vale Rd, St Ives - 24 August 2:30pm-3:30 pm NSW Health is treating 67 asthma treatment cases, including six in intensive care and four who are ventilated. 85 per cent of cases being treated by NSW Health are in non-acute, out-of-hospital care.

Due to ventolin 5mg ml the widening spread of the CBD cluster across multiple locations in the Sydney and Central Coast, NSW Health is strongly advising people who live or work in these areas to not visit aged care facilities at this time. This is a precaution while the cluster is investigated, cases are identified and isolated and contact tracing is done. NSW Health will continue to closely monitor the number and location of cases in Sydney and the Central Coast and will adjust the advice regarding visitor restrictions on aged care facilities according to the level of local risk. NSW Health ventolin 5mg ml will provide an update during the next week.

asthma treatment continues to circulate in the community and we must all be vigilant. It is vital that people get a test as ventolin 5mg ml soon as they develop symptoms. People should ensure that they stay at least 1.5m from others and that they wear a mask in situations - especially on public transport - where physical distancing is difficult. Locations linked to known cases, advice on testing and isolation, and areas identified for increased testing can be found at NSW Government - Latest new and updates.​ Anyone identified as a close contact and directed to undertake 14 days self-isolation must stay in isolation for the full 14 days, even if they test negative during this time.

To help stop the spread ventolin 5mg ml of asthma treatment. If you are unwell, stay in, get tested and isolate. Wash your hands regularly. Take hand sanitiser with you when you go out.Keep your ventolin 5mg ml distance.

Leave 1.5 metres between yourself and others.Wear a mask in situations where you cannot physically distance. A full list of asthma treatment testing clinics is ventolin 5mg ml available or people can visit their GP. Confirmed cases to date Overseas2,067Interstate acquired89Locally acquired – contact of a confirmed case and/or in a known cluster1,296Locally acquired – contact not identified391Under investigation​1 Counts reported for a particular day may vary over time with ongoing enhanced surveillance activities. Returned travellers in hotel quarantine to date​​ Symptomatic travellers tested4,765Found positive122 As​ymptomatic travellers screened at a day 217,750Found positive88 Asymptomatic travellers screened at a day 1030,788​Found positive119​Video update​​NSW Health is investigating new cases of asthma treatment in relation to City Tattersalls Fitness Centre on Pitt Street.These cases attended the centre during the past few days, while unknowingly infectious and after being exposed to s in the gym.Anyone who attended this venue on the following dates and times are considered to be close contacts and must immediately get tested for asthma treatment, and self-isolate for 14 days since their last visit.

Wednesday 19 August between 8am - 2pm Friday 21 August ventolin 5mg ml between 8am - 2pm, including. Aqua Aerobics from 10am-10:45am Stretch Class from 11am – 11:50am Pump Class from 12:15pm - 1pm Sunday 23 August between 8am - 2pm Monday 24 August between 8am - 2pm Tuesday 25 August between 8am - 2pm Members who attended the gym on the above dates but outside those times should be on the alert for symptoms and get tested and self-isolate if symptoms do develop.A previously reported case attended one of the gaming areas of City Tattersalls on 24 August. Others who were in the gaming areas on this day must monitor for symptoms and get tested immediately if even the mildest symptoms develop. NSW Health is investigating whether the CBD cluster originated in the City Tattersalls Club and then spread to workplaces in the city and to households across Sydney ventolin 5mg ml and the Central Coast.

To assist in identifying undiagnosed earlier asthma treatment cases, NSW Health is asking anyone who attended the Club between 4 August 2020 – 18 August 2020 to get tested for asthma treatment and isolate until a negative test result is received. A full list of asthma treatment testing clinics is available or people can visit their GP..

Fourteen new cases of asthma treatment were diagnosed in ventolin online canada the 24 hours to 8pm last night, bringing the total number of cases in NSW to 3,844. Confirmed cases (including interstate residents in NSW health care facilities)3,844Deaths (in NSW from confirm​​ed cases)54Total tests carried out2,137,629 There were 24,632 tests reported in the 24-hour reporting period, compared with 30,282 in the previous 24 hours. Of the fourteen new cases to 8pm last ventolin online canada night.

One is a re​turned traveller who is in hotel quarantine Ten are linked to a known case or cluster Three are locally acquired with their source still under investigation Eight of the new cases are linked to the Sydney CBD cluster, bringing the total number of cases in this cluster to 23. Of the new cases, two are household contacts of previously reported cases, three attended the City Tattersalls Club, and three were close contacts of people linked to this cluster. Further investigations have ventolin online canada found one case reported yesterday is also linked to this cluster.

NSW Health is investigating whether the CBD cluster originated in the City Tattersalls Club and then spread to workplaces in the city and to households across Sydney and the Central Coast. To assist in identifying earlier and possible undiagnosed cases, NSW Health is asking anyone who attended the Club between 4 August 2020 – 18 August 2020 to get tested for asthma treatment and isolate until a negative test result is received. Genomic sequencing of the ventolin from ventolin online canada cases in this cluster are related to other recent clusters in NSW.

This ventolin is genetically different to that of the Marriott Hotel security guard, who had a strain that had come from overseas. All identified close contacts of cases linked to this cluster are being ventolin online canada contacted and told they must isolate for 14 days, get tested, get another test if any symptoms develop and stay isolated for the full 14 days, even if a negative test result is received within this period. Among the new cases today, two are household contacts of cases linked to Liverpool Hospital.

Prior to diagnosis many of the recently confirmed cases have attended a variety of locations and a full list of locations is available on the link below. New asthma treatment cases have visited the following locations in Mosman, St Ives and Rosebery and people attending at ventolin online canada the same time must monitor for symptoms, get tested immediately if they develop and stay isolated until a negative test result is received. Archie Bear café, Mosman Rowers - 24 August 11am to 12 noon and Tuesday 25 August 9:00am to 9.30am Rosebery Post Shop, 371 Gardeners Rd, Rosebery - 26 August 1:30pm-1:40pm St Ives Shopping Centre, 166 Mona Vale Rd, St Ives - 24 August 2:30pm-3:30 pm NSW Health is treating 67 asthma treatment cases, including six in intensive care and four who are ventilated.

85 per cent of cases being treated by NSW Health are in non-acute, out-of-hospital care. Due to the widening spread of the CBD cluster across multiple locations in the Sydney and Central Coast, NSW Health is strongly advising people who live or work in these areas to not ventolin online canada visit aged care facilities at this time. This is a precaution while the cluster is investigated, cases are identified and isolated and contact tracing is done.

NSW Health will continue to closely monitor the number and location of cases in Sydney and the Central Coast and will adjust the advice regarding visitor restrictions on aged care facilities according to the level of local risk. NSW Health will ventolin online canada provide an update during the next week. asthma treatment continues to circulate in the community and we must all be vigilant.

It is vital that people get a test as soon as they develop symptoms ventolin online canada. People should ensure that they stay at least 1.5m from others and that they wear a mask in situations - especially on public transport - where physical distancing is difficult. Locations linked to known cases, advice on testing and isolation, and areas identified for increased testing can be found at NSW Government - Latest new and updates.​ Anyone identified as a close contact and directed to undertake 14 days self-isolation must stay in isolation for the full 14 days, even if they test negative during this time.

To help stop the spread of asthma treatment ventolin online canada. If you are unwell, stay in, get tested and isolate. Wash your hands regularly.

Take hand sanitiser with you when you go ventolin online canada out.Keep your distance. Leave 1.5 metres between yourself and others.Wear a mask in situations where you cannot physically distance. A full list of asthma treatment testing clinics ventolin online canada is available or people can visit their GP.

Confirmed cases to date Overseas2,067Interstate acquired89Locally acquired – contact of a confirmed case and/or in a known cluster1,296Locally acquired – contact not identified391Under investigation​1 Counts reported for a particular day may vary over time with ongoing enhanced surveillance activities. Returned travellers in hotel quarantine to date​​ Symptomatic travellers tested4,765Found positive122 As​ymptomatic travellers screened at a day 217,750Found positive88 Asymptomatic travellers screened at a day 1030,788​Found positive119​Video update​​NSW Health is investigating new cases of asthma treatment in relation to City Tattersalls Fitness Centre on Pitt Street.These cases attended the centre during the past few days, while unknowingly infectious and after being exposed to s in the gym.Anyone who attended this venue on the following dates and times are considered to be close contacts and must immediately get tested for asthma treatment, and self-isolate for 14 days since their last visit. Wednesday 19 August between 8am - 2pm Friday 21 August between 8am - 2pm, ventolin online canada including.

Aqua Aerobics from 10am-10:45am Stretch Class from 11am – 11:50am Pump Class from 12:15pm - 1pm Sunday 23 August between 8am - 2pm Monday 24 August between 8am - 2pm Tuesday 25 August between 8am - 2pm Members who attended the gym on the above dates but outside those times should be on the alert for symptoms and get tested and self-isolate if symptoms do develop.A previously reported case attended one of the gaming areas of City Tattersalls on 24 August. Others who were in the gaming areas on this day must monitor for symptoms and get tested immediately if even the mildest symptoms develop. NSW Health ventolin online canada is investigating whether the CBD cluster originated in the City Tattersalls Club and then spread to workplaces in the city and to households across Sydney and the Central Coast.

To assist in identifying undiagnosed earlier asthma treatment cases, NSW Health is asking anyone who attended the Club between 4 August 2020 – 18 August 2020 to get tested for asthma treatment and isolate until a negative test result is received. A full list of asthma treatment testing clinics is available or people can visit their GP..

Can u buy ventolin over the counter

IntroductionLa Peste (Camus 1947) has served as Generic symbicort cost a basis can u buy ventolin over the counter for several critical works, including some in the field of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and Payne 2017) can u buy ventolin over the counter.

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 can u buy ventolin over the counter 2016).The asthma treatment ventolin has increased general interest about 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, commentaries about the novel, especially can u buy ventolin over the counter among health sciences scholars, have emerged with a renewed interest (Banerjee et al.

2020. Bate 2020. Vandekerckhove 2020 can u buy ventolin over the counter.

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 can u buy ventolin over the counter 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 can u buy ventolin over the counter Influenza’, has been described as not very 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 can u buy ventolin over the counter 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 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 can u buy ventolin over the counter 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 can u buy ventolin over the counter of 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 can u buy ventolin over the counter be easy to accept that nothing could lead the people of our town 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, including the can u buy ventolin over the counter 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 who get involved and help their neighbours and those who remain behaving can u buy ventolin over the counter 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 can u buy ventolin over the counter does not mean that 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 can u buy ventolin over the counter greater impact of the ventolin in those countries with higher levels of individualism (Maaravi et al.

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 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.

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’.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions.

Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.

The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..

IntroductionLa Peste (Camus 1947) has served as a basis for several critical works, ventolin online canada including some in the field Generic symbicort cost of medical humanities (Bozzaro 2018. Deudon 1988. Tuffuor and ventolin online canada 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, ventolin online canada have centred their analyses on its literary aspects (Steel 2016).The asthma treatment ventolin has increased general interest about 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, commentaries about the novel, especially ventolin online canada among health sciences scholars, have emerged with a renewed interest (Banerjee et al. 2020.

Bate 2020. Vandekerckhove 2020 ventolin online canada. 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 ventolin online canada 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 fruitful in this sense, even if it produced famous novels such as Katherine A Porter’s Pale Horse, ventolin online canada 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 ventolin online canada 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 ventolin online canada 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 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 parts were done to integrate the information ventolin online canada 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 ventolin online canada 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 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 ventolin online canada were closed, they all noticed that they were in the same boat, 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 who get involved and help their neighbours and those who remain ventolin online canada 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 ventolin online canada collective issues does not mean that 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 ventolin online canada greater impact of the ventolin in those countries 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 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’.AbstractThis study addresses the existing gap in literature that ethnographically examines the experiences of Spanish-speaking patients with limited English proficiency in clinical spaces. All of the participants in this study presented to the emergency department (ED) for evaluation of non-urgent health conditions. Patient shadowing was employed to explore the challenges that this population face in unique clinical settings like the ED. This relatively new methodology facilitates obtaining nuanced understandings of clinical contexts under study in ways that quantitative approaches and survey research do not. Drawing from the field of medical anthropology and approach of narrative medicine, the collected data are presented through the use of clinical ethnographic vignettes and thick description.

The conceptual framework of health-related deservingness guided the analysis undertaken in this study. Structural stigma was used as a complementary framework in analysing the emergent themes in the data collected. The results and analysis from this study were used to develop an argument for the consideration of language as a distinct social determinant of health.emergency medicinemedical anthropologymedical humanitiesData availability statementData sharing not applicable as no datasets were generated and/or analysed for this study..

Dangers of ventolin

Optimal cord managementRecognising the intact umbilical cord and placental circulation as an essential life-support system for newborn babies as they transition dangers of ventolin to extra-uterine life has required a lot of unlearning of well-intentioned but harmful habits that interrupt it. We are not there yet. We still need dangers of ventolin to learn more about the way to get the best out of extended physiological transition for more preterm infants.

In the meantime, one of the barriers to wider implementation of delayed cord clamping strategies has been the number of infants where the process is not allowed or interrupted early because of perceptions that immediate resuscitation was required. This perceived urgency was probably one of the drivers for umbilical cord milking strategies, which allowed a measurable degree of placental transfusion to be demonstrated on a shorter timeline than was required with delayed cord clamping. Important physiological work by Douglas Blank and colleagues1 published in this journal highlighted the markedly different haemodynamic patterns observed in cerebral blood flow and dangers of ventolin blood pressure with immediate cord clamping, umbilical cord milking and physiological transition.

In particular, the surges in pressure and flow observed with milking were alarming. The systematic review and meta-analysis of umbilical cord milking by Haribalakrishna Balasubramanian and colleagues in this month’s issue shows that, although placental transfusion is achieved by cord milking, it’s use in preterm infants significantly increased the risk of severe (grade III or more) intraventricular haemorrhage in comparison with delayed cord clamping. Milking has been used quite widely and may be a further example of the dangers of ventolin potential for interventions introduced ahead of adequate evaluation to prove unexpectedly harmful.

Yet another reason that we need to get more newborn infants into trials.With greater experience and comfort, teams implementing delayed cord clamping strategies find that progressively fewer infants are excluded from it. In their quality improvement study aimed at increasing the number of preterm infants who had their initial resuscitation and stabilisation with their umbilical cord intact, Emily Hoyle and colleagues achieved a dramatic increase in the proportion of infants who were managed with the intended strategy from 17% to 92% over a year of intervention. Among other things dangers of ventolin the number of infants whose cord was considered too short to enable it diminished.

Monochorionic twins were excluded from the intervention. This exclusion criterion is quite widespread and the babies are not few in number. It would be helpful to see data specifically on monochorionic dangers of ventolin twin outcomes with delayed cord clamping from groups who do not apply this exclusion.

It was interesting to note that three infants were excluded from delayed cord clamping because of precipitate delivery before the neonatal team was present. Unless the placenta has delivered with the infant, this seems like a good opportunity to leave the infant on their placental life support pending team arrival.In the UK, the British Association of Perinatal Medicine and National Neonatal Audit Programme will be publishing a toolkit to support teams in achieving optimal cord management and I look forward to seeing the details of this. See page F572 and F652Prevention and management of early onset neonatal sepsisRachel Morris and colleagues provide further interesting observational data comparing the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with those of NICE dangers of ventolin guideline CG149 in infants>34 weeks gestation.

Culture positive early onset neonatal sepsis is an infrequent occurrence, but by combining data from five participating centres they analysed data from 70 confirmed sepsis cases in a birth population of 142 333 infants. The SRC recommended antibiotics ahead of clinical concerns in the first 4 hours after birth in 27/70 infants and the NICE Guideline did so in dangers of ventolin 39/70. Four infants were treated early without clinical signs because of other perceived risks.

All but three of the remaining infants had presented clinically by 24 hours. Both tools failed to identify a substantial proportion of the infants who would develop early onset sepsis before they developed clinical signs, demonstrating that ongoing clinical vigilance dangers of ventolin is vital whatever tool is used. The 12 infants who received their initial antibiotic treatment earlier with the approach recommended in the NICE guideline than would have been the case with the SRC may have gained some advantage, but the authors estimate that this may have required between 11 386–16852 additional infants to receive intravenous antibiotics.

The one infant that died had signs of sepsis and meningitis from birth. This study gives a measure of dangers of ventolin the scale of intervention required per case in the hunt for earlier diagnosis and treatment of early onset neonatal sepsis and the potential for unintended consequences in pursuit of improved outcomes. See page F609Neonatal respiratory reflexes that may impact on transitionKristel Kuypers and colleagues give a fascinating narrative review the array of competing reflexes that my influence the transition to breathing air at birth.

Some of the reflexes may explain why routinely intervening to support infants who are transitioning spontaneously may be counterproductive by provoking laryngeal closure or precipitating apnoea. See page F675Ureaplasma and azithromycinIn a placebo controlled randomised phase II trial involving 121 dangers of ventolin preterm infants, Rose Marie Viscardi and colleagues demonstrated that a 3 day treatment course eradicated ureaplasma colonisation. The trial was not powered to show that eradication increased bronchopulmonary dysplasia free survival.

The data support a future trial in colonised infants to examine this question. Rose Marie dangers of ventolin reviewed the compelling epidemiological and experimental evidence linking perinatal Ureaplasma species exposure to important morbidities of prematurity, such as bronchopulmonary dysplasia in a previous issue of the journal.2 See page F615Regional brain volumes and neurodevelopmentContinuing a theme of analysing MRI scans beyond structural lesions in relation to later outcome that arose in the September issue of the journal, Claire Kelley and colleagues analysed MRI scans obtained at term equivalent age from 189 moderate-late preterm infants who had their development assessed at 2 years using the Bayley-III. Regional brain volumes in many regions were associated with better cognitive and language scores.

Optimal cord managementRecognising the http://aliciawardcello.com/buy-cialis-online-usa/ intact umbilical cord and placental circulation as an essential life-support system for newborn babies as they transition to extra-uterine life has required a lot ventolin online canada of unlearning of well-intentioned but harmful habits that interrupt it. We are not there yet. We still need to learn more about the way to get the best out of extended physiological ventolin online canada transition for more preterm infants. In the meantime, one of the barriers to wider implementation of delayed cord clamping strategies has been the number of infants where the process is not allowed or interrupted early because of perceptions that immediate resuscitation was required. This perceived urgency was probably one of the drivers for umbilical cord milking strategies, which allowed a measurable degree of placental transfusion to be demonstrated on a shorter timeline than was required with delayed cord clamping.

Important physiological work by Douglas Blank and colleagues1 published in this journal highlighted the markedly different haemodynamic patterns observed in cerebral blood flow and blood pressure with immediate cord clamping, umbilical cord milking ventolin online canada and physiological transition. In particular, the surges in pressure and flow observed with milking were alarming. The systematic review and meta-analysis of umbilical cord milking by Haribalakrishna Balasubramanian and colleagues in this month’s issue shows that, although placental transfusion is achieved by cord milking, it’s use in preterm infants significantly increased the risk of severe (grade III or more) intraventricular haemorrhage in comparison with delayed cord clamping. Milking has ventolin online canada been used quite widely and may be a further example of the potential for interventions introduced ahead of adequate evaluation to prove unexpectedly harmful. Yet another reason that we need to get more newborn infants into trials.With greater experience and comfort, teams implementing delayed cord clamping strategies find that progressively fewer infants are excluded from it.

In their quality improvement study aimed at increasing the number of preterm infants who had their initial resuscitation and stabilisation with their umbilical cord intact, Emily Hoyle and colleagues achieved a dramatic increase in the proportion of infants who were managed with the intended strategy from 17% to 92% over a year of intervention. Among other things the number of infants whose cord was considered ventolin online canada too short to enable it diminished. Monochorionic twins were excluded from the intervention. This exclusion criterion is quite widespread and the babies are not few in number. It would ventolin online canada be helpful to see data specifically on monochorionic twin outcomes with delayed cord clamping from groups who do not apply this exclusion.

It was interesting to note that three infants were excluded from delayed cord clamping because of precipitate delivery before the neonatal team was present. Unless the placenta has delivered with the infant, this seems like a good opportunity to leave the infant on their placental life support pending team arrival.In the UK, the British Association of Perinatal Medicine and National Neonatal Audit Programme will be publishing a toolkit to support teams in achieving optimal cord management and I look forward to seeing the details of this. See page F572 and F652Prevention and management of early onset neonatal sepsisRachel Morris and colleagues provide further interesting observational data comparing the management ventolin online canada recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with those of NICE guideline CG149 in infants>34 weeks gestation. Culture positive early onset neonatal sepsis is an infrequent occurrence, but by combining data from five participating centres they analysed data from 70 confirmed sepsis cases in a birth population of 142 333 infants. The SRC recommended antibiotics ahead of clinical concerns in the first 4 hours after birth in 27/70 infants and the NICE Guideline did so ventolin online canada in 39/70.

Four infants were treated early without clinical signs because of other perceived risks. All but three of the remaining infants had presented clinically by 24 hours. Both tools failed to identify a substantial proportion of ventolin online canada the infants who would develop early onset sepsis before they developed clinical signs, demonstrating that ongoing clinical vigilance is vital whatever tool is used. The 12 infants who received their initial antibiotic treatment earlier with the approach recommended in the NICE guideline than would have been the case with the SRC may have gained some advantage, but the authors estimate that this may have required between 11 386–16852 additional infants to receive intravenous antibiotics. The one infant that died had signs of sepsis and meningitis from birth.

This study gives a measure of the scale of intervention required per ventolin online canada case in the hunt for earlier diagnosis and treatment of early onset neonatal sepsis and the potential for unintended consequences in pursuit of improved outcomes. See page F609Neonatal respiratory reflexes that may impact on transitionKristel Kuypers and colleagues give a fascinating narrative review the array of competing reflexes that my influence the transition to breathing air at birth. Some of the reflexes may explain why routinely intervening to support infants who are transitioning spontaneously may be counterproductive by provoking laryngeal closure or precipitating apnoea. See page F675Ureaplasma and azithromycinIn a placebo controlled randomised phase II trial involving 121 preterm infants, Rose Marie Viscardi and colleagues demonstrated that a 3 day treatment ventolin online canada course eradicated ureaplasma colonisation. The trial was not powered to show that eradication increased bronchopulmonary dysplasia free survival.

The data support a future trial in colonised infants to examine this question. Rose Marie reviewed the compelling epidemiological and experimental evidence linking perinatal Ureaplasma species exposure to important morbidities of prematurity, such as bronchopulmonary dysplasia in a previous issue of the journal.2 See page F615Regional brain volumes and neurodevelopmentContinuing a theme of analysing MRI scans beyond structural lesions in relation to later outcome that arose in the September issue of the journal, Claire Kelley and colleagues analysed MRI scans obtained at ventolin online canada term equivalent age from 189 moderate-late preterm infants who had their development assessed at 2 years using the Bayley-III. Regional brain volumes in many regions were associated with better cognitive and language scores. See page F593.

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Trump promised to not implement the most-favored nations policy if drug makers came up with alternative policies. But the Sunday release is a resoundingly clear sign that those negotiations have fallen apart.The drug industry has also hinted they will sue to block the policy from being implemented — and that was before the industry saw the new, expanded version.advertisement By issuing the new executive order, Trump is directing his health secretary to implement a policy whereby Medicare would not pay more than the lowest price for a drug that is offered in countries with comparable gross domestic product. It’s unclear, however, if the policy will ventolin puffer dose be permanent. The executive orders direct the HHS secretary to test the ideas before making them permanent.

It’s still unclear when the Trump administration ventolin puffer dose will formally implement the new executive order. Drug industry lobbyists expect Trump to try and skip over most of the formal regulatory steps by issuing a so-called interim final rule, a rare regulatory maneuver that lets president’s skip most of the formal regulatory steps in certain emergencies. However, the drug industry has hinted they will sue if Trump tries to use that maneuver..

WASHINGTON — President Trump released an executive order Sunday that would drastically cut how much Medicare pays for virtually all of the drugs seniors take ventolin online canada — the boldest move yet he’s taken to lower drug prices since taking office.The policy vastly expands an older, controversial drug pricing policy that Trump has been teasing for months. Effectively, it will force drug makers to offer their medicines to Medicare at the same prices they do in other countries, as a so-called most favored nations policy. Where an earlier version would only have applied to Part B drugs, which are administered in doctors offices, the ventolin online canada new version also applies to Part D drugs, which are sold in pharmacies. The move could cost the drug industry billions and dramatically cut drug prices for most seniors. However, it’s unclear if Trump can implement the policy before the end of his first term.

The Trump ventolin online canada administration still hasn’t released formal regulations to implement the policy. That process typically takes months, if not years.advertisement Sunday’s shocking move is also a sign of renewed tensions between the drug industry and the White House. The Trump administration had ventolin online canada previously given the drug industry an ultimatum. Trump promised to not implement the most-favored nations policy if drug makers came up with alternative policies. But the Sunday release is a resoundingly clear sign that those negotiations have fallen apart.The drug industry has also hinted they will sue to block the policy from being implemented — and that was before the industry saw the new, expanded version.advertisement By issuing the new executive order, Trump is directing his health secretary to implement a policy whereby Medicare would not pay more than the lowest price for a drug that is offered in countries with comparable gross domestic product.

It’s unclear, however, if ventolin online canada the policy will be permanent. The executive orders direct the HHS secretary to test the ideas before making them permanent. It’s still unclear when the Trump administration ventolin online canada will formally implement the new executive order. Drug industry lobbyists expect Trump to try and skip over most of the formal regulatory steps by issuing a so-called interim final rule, a rare regulatory maneuver that lets president’s skip most of the formal regulatory steps in certain emergencies. However, the drug industry has hinted they will sue if Trump tries to use that maneuver..

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