Menu
FRUKDE
société des amis de Pasteur
" Jeunes gens ! Ne vous laissez pas atteindre par le scepticisme dénigrant et stérile, ne vous laissez pas décourager par les tristesses de certaines heures qui passent sur une nation ! "
  • Is generic finasteride as effective as propecia

    Où rencontrer Pasteur dans Arbois

    Après les monuments dolois à l'effigie de Louis Pasteur, c'est au tour des sites arboisiens !
    Avec quelques anecdotes historiques en prime, Alain Marchal nous présente les statues, médaillons ou encore portraits qui honorent la mémoire de Louis Pasteur...

    > LIRE LA SUITE

  • [

    Propecia for sale uk

    Copper was one of the first metals to be worked propecia for sale uk by humankind. Because it is highly malleable, copper could be used for toolmaking and ornamentation even by people whose everyday implements were of flint and bone. A copper pendant unearthed in what is today northern Iraq has been dated to 8,700 B.C.

    — the Neolithic propecia for sale uk period. Although people have adorned themselves with copper since prehistory, the marketing of copper bracelets as a treatment for arthritis pain appears to date back only to the 1970s. Miner Pain Relief Proponents of copper bracelets often cite the research of Werner Hangarter (1904–1982), a German doctor of internal medicine.

    Hangarter evangelized for copper’s therapeutic possibilities after hearing that copper miners in propecia for sale uk Finland seldom developed rheumatism while laboring in the copper-rich environment of the mines. In the 1950s, he began treating patients suffering from a variety of rheumatic ailments — including rheumatoid arthritis (RA) — with injections of copper in a salicylic acid solution. The results were dramatic.

    Patients showed “rapid and persistent remission of fever, alleviation of pain, [and] increased mobility.” Hangarter published several papers propecia for sale uk on his work, and the alternative-medicine movement popularized his ideas. By the mid-1970s, copper jewelry was being touted as a natural, noninvasive remedy for the pain and inflammation of arthritis. The market now encompasses copper-infused topical creams, insoles for foot pain and compression sleeves with copper fibers for stiff joints.

    But is there propecia for sale uk anything to it?. Health Benefits of Copper Copper does play an important role in individual health. Like many other minerals, copper is an essential micronutrient, a key player in the formation of red blood cells.

    The most common symptom of a copper deficiency is propecia for sale uk anemia. It is found in many common foods, but shellfish, nuts and chocolate are the richest dietary sources. Copper helps with formation of connective tissue, so it’s possible that a copper deficiency could worsen the symptoms of arthritis.

    It does not necessarily follow, though, that boosting copper levels can mitigate propecia for sale uk RA. Testing the Claims Hindsight reveals several problems in Hangarter’s research. Based on inference and anecdote, he assumed a chain of causation — that exposure to environmental copper helped miners ward off RA — where the reverse is actually far more likely.

    No active miners had RA because individuals who developed the condition propecia for sale uk quit the profession. His use of copper salicylate solution also raises more questions than it answers. Salicylic acid is the active ingredient in plain old aspirin, and the effects that Hangarter describes — pain relief and fever reduction — could easily be attributable to aspirin alone.

    So even the propecia for sale uk effects of copper in solution are ambiguous. What about topical copper?. The effectiveness of wearing copper, rather than ingesting it, is based on the idea that trace amounts of the metal can be effectively absorbed through the skin.

    But there’s little evidence for propecia for sale uk this claim, and in any case the occasional peanut-butter sandwich or chocolate bar would be a more efficient way to get the stuff into your system than a $25 bangle. For the same reason, the superiority of copper-infused insoles or compression sleeves over some other material is unlikely. As for those creams, they’re made with a salicylic acid base — aspirin again, which as it turns out is easily absorbed through the skin.

    In all these cases, the product may ease discomfort from RA, but the addition of copper doesn’t make them any more (or any less) effective.

    Is generic finasteride as effective as propecia

    NONE
    Propecia
    Dutas
    Finast
    Finpecia
    Duration of action
    Canadian pharmacy only
    In online pharmacy
    Prescription is needed
    No
    No
    No
    Yes
    Best way to get
    1mg 120 tablet $89.95
    $
    $
    $

    Three federal appellate judges on Thursday appeared likely to uphold the Trump administration's hospital price is generic finasteride as effective as propecia transparency rule, which is scheduled to go into effect in January.The panel aggressively, and at times incredulously, questioned hospitals' arguments as to why the rule should be deemed unconstitutional. The criticism indicated that is generic finasteride as effective as propecia the U.S. Court of is generic finasteride as effective as propecia Appeals for the D.C.

    Circuit may follow in the footsteps of a district court judge who upheld the rule.Under the hospital price transparency rule, hospitals must publish their standard charges online in a machine-readable format. They will need to create at least 300 "shoppable" services, including is generic finasteride as effective as propecia 70 selected by the CMS. Under the rule, hospitals would have to disclose the is generic finasteride as effective as propecia rates they negotiate with third-party payers.One of the key issues in the oral arguments are whether Congress' permission for CMS to force hospitals to publish "a list of "standard charges for items and services" under the Public Health Service Act means CMS can force hospitals to publish rates they negotiate with insurers, or just chargemaster prices.Williams &.

    Connolly partner Lisa Blatt, who represented the American Hospital Association, claimed that it is more reasonable to ask hospitals to disclose chargemaster prices instead of negotiated is generic finasteride as effective as propecia prices. She also claimed negotiated prices may be misleading because they may not accurately reflect patients' out-of-pocket costs.But the judges pointed out that chargemaster prices are often highly inflated and may also be misleading."I'm not buying your argument to the extent that you are making it that the chargemaster rate is discernibly more transparent than what the government is proposing," Judge Harry Edwards said. "If I'm hearing you correctly your principal objection is generic finasteride as effective as propecia has nothing to do with worrying about transparency.

    It's just the government's approach is more burdensome on you and more expensive."The judges also clarified that the purpose of the transparency statute includes communicating prices to the is generic finasteride as effective as propecia public, including patients. Courtney Dixon, counsel representing the Trump administration, said that even if negotiated rates are not a perfect reflection of patients' out-of-pocket costs, patients could use the numbers to at least try to estimate their bills.The judges also puzzled over hospitals' argument that the numbers for what an item or service would cost ahead of time were "unknowable." Blatt said that costs can vary based on severity.Dixon said if a certain rate disclosure is not relevant, a hospital can just say the rate is not available.Despite hospitals' pleas for CMS to delay implementation of the price transparency requirements amid the COVID-19 pandemic, a White House official said there are no plans to give hospitals additional time to comply..

    Three federal appellate judges on Thursday appeared likely to uphold the Trump administration's hospital price transparency rule, which is scheduled to go into effect in January.The panel aggressively, and at times incredulously, questioned hospitals' arguments as to why buy propecia australia the propecia for sale uk rule should be deemed unconstitutional. The criticism indicated that the propecia for sale uk U.S. Court of Appeals for the D.C propecia for sale uk.

    Circuit may follow in the footsteps of a district court judge who upheld the rule.Under the hospital price transparency rule, hospitals must publish their standard charges online in a machine-readable format. They will need to create at least 300 "shoppable" services, propecia for sale uk including 70 selected by the CMS. Under the rule, hospitals would have to disclose the propecia for sale uk rates they negotiate with third-party payers.One of the key issues in the oral arguments are whether Congress' permission for CMS to force hospitals to publish "a list of "standard charges for items and services" under the Public Health Service Act means CMS can force hospitals to publish rates they negotiate with insurers, or just chargemaster prices.Williams &.

    Connolly partner Lisa Blatt, who represented the American Hospital Association, claimed that it is more propecia for sale uk reasonable to ask hospitals to disclose chargemaster prices instead of negotiated prices. She also claimed negotiated prices may be misleading because they may not accurately reflect patients' out-of-pocket costs.But the judges pointed out that chargemaster prices are often highly inflated and may also be misleading."I'm not buying your argument to the extent that you are making it that the chargemaster rate is discernibly more transparent than what the government is proposing," Judge Harry Edwards said. "If I'm hearing you correctly your principal objection has nothing to propecia for sale uk do with worrying about transparency.

    It's just the government's approach is more burdensome on you and more expensive."The judges also clarified that the purpose of the transparency statute includes communicating prices to the public, including patients propecia for sale uk. Courtney Dixon, counsel representing the Trump administration, said that even if negotiated rates are not a perfect reflection of patients' out-of-pocket costs, patients could use the numbers to at least try to estimate their bills.The judges also puzzled over hospitals' argument that the numbers for what an item or service would cost ahead of time were "unknowable." Blatt said that costs can vary based on severity.Dixon said if a certain rate disclosure is not relevant, a hospital can just say the rate is not available.Despite hospitals' pleas for CMS to delay implementation of the price transparency requirements amid the COVID-19 pandemic, a White House official said there are no plans to give hospitals additional time to comply..

    What should I watch for while taking Propecia?

    Do not donate blood until at least 6 months after your final dose of finasteride. This will prevent giving finasteride to a pregnant female through a blood transfusion.

    Contact your prescriber or health care professional if there is no improvement in your symptoms. You may need to take finasteride for 6 to 12 months to get the best results.

    Women who are pregnant or may get pregnant must not handle broken or crushed finasteride tablets; the active ingredient could harm the unborn baby. If a pregnant woman comes into contact with broken or crushed finasteride tablets she should check with her prescriber or health care professional. Exposure to whole tablets is not expected to cause harm as long as they are not swallowed.

    Finasteride can interfere with PSA laboratory tests for prostate cancer. If you are scheduled to have a lab test for prostate cancer, tell your prescriber or health care professional that you are taking finasteride.

    Buy generic propecia 1mg online

    buy generic propecia 1mg online

    Covid-19 has buy generic propecia 1mg online http://www.amisdepasteur.fr/can-i-buy-propecia-online/ created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were buy generic propecia 1mg online forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test.

    They have taken a crisis and turned it into buy generic propecia 1mg online a tragedy.The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death buy generic propecia 1mg online rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity.

    But the one we can control is how buy generic propecia 1mg online we behave. And in the United States we have consistently behaved poorly.We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 buy generic propecia 1mg online per million, as compared with more than 500 per million in the United States.

    Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, buy generic propecia 1mg online together with its geographic advantages, to come close to eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.Why has the United States handled this pandemic so badly?. We have buy generic propecia 1mg online failed at almost every step.

    We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we buy generic propecia 1mg online continue to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.2 Moreover, a lack of emphasis on developing capacity has meant that U.S. Test results are often long delayed, rendering the results useless for disease control.Although we tend to focus on technology, most of the interventions that have large effects are not complicated.

    The United States instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities buy generic propecia 1mg online. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in buy generic propecia 1mg online much of the country, people simply don’t wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.The United States came into this crisis with enormous advantages.

    Along with tremendous manufacturing capacity, we have a biomedical research system that is buy generic propecia 1mg online the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of buy generic propecia 1mg online that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.The response of our nation’s leaders has been consistently inadequate.

    The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not buy generic propecia 1mg online so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of buy generic propecia 1mg online using those tools, the federal government has undermined them.

    The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played buy generic propecia 1mg online a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3 appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage buy generic propecia 1mg online that will certainly outlast them.

    Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.Let’s be clear about the cost of not taking even simple measures. An outbreak that buy generic propecia 1mg online has disproportionately affected communities of color has exacerbated the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely.

    Our current leadership takes pride in the economy, but while most buy generic propecia 1mg online of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths from Covid-19 were unavoidable buy generic propecia 1mg online. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences.

    Our leaders have largely buy generic propecia 1mg online claimed immunity for their actions. But this election gives us the power to render judgment. Reasonable people buy generic propecia 1mg online will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative.

    When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet buy generic propecia 1mg online them and enable the deaths of thousands more Americans by allowing them to keep their jobs.Patients Figure 1. Figure 1. Enrollment and buy generic propecia 1mg online Randomization.

    Of the 1114 patients who were assessed for eligibility, 1062 underwent randomization. 541 were assigned to the remdesivir group and 521 to buy generic propecia 1mg online the placebo group (intention-to-treat population) (Figure 1). 159 (15.0%) were categorized as having mild-to-moderate disease, and 903 (85.0%) were in the severe disease stratum. Of those assigned to receive remdesivir, 531 patients (98.2%) received the treatment buy generic propecia 1mg online as assigned.

    Fifty-two patients had remdesivir treatment discontinued before day 10 because of an adverse event or a serious adverse event other than death and 10 withdrew consent. Of those assigned to receive placebo, 517 patients (99.2%) received placebo as assigned. Seventy patients discontinued placebo before day 10 because buy generic propecia 1mg online of an adverse event or a serious adverse event other than death and 14 withdrew consent. A total of 517 patients in the remdesivir group and 508 in the placebo group completed the trial through day 29, recovered, or died.

    Fourteen patients who buy generic propecia 1mg online received remdesivir and 9 who received placebo terminated their participation in the trial before day 29. A total of 54 of the patients who were in the mild-to-moderate stratum at randomization were subsequently determined to meet the criteria for severe disease, resulting in 105 patients in the mild-to-moderate disease stratum and 957 in the severe stratum. The as-treated population included 1048 patients who received the assigned treatment (532 in the remdesivir buy generic propecia 1mg online group, including one patient who had been randomly assigned to placebo and received remdesivir, and 516 in the placebo group). Table 1.

    Table 1 buy generic propecia 1mg online. Demographic and Clinical Characteristics of the Patients at Baseline. The mean age of the patients was 58.9 years, and 64.4% were male buy generic propecia 1mg online (Table 1). On the basis of the evolving epidemiology of Covid-19 during the trial, 79.8% of patients were enrolled at sites in North America, 15.3% in Europe, and 4.9% in Asia (Table S1 in the Supplementary Appendix).

    Overall, 53.3% of the patients were White, 21.3% were Black, 12.7% were Asian, and 12.7% were designated as other or not reported. 250 (23.5%) were buy generic propecia 1mg online Hispanic or Latino. Most patients had either one (25.9%) or two or more (54.5%) of the prespecified coexisting conditions at enrollment, most commonly hypertension (50.2%), obesity (44.8%), and type 2 diabetes mellitus (30.3%). The median buy generic propecia 1mg online number of days between symptom onset and randomization was 9 (interquartile range, 6 to 12) (Table S2).

    A total of 957 patients (90.1%) had severe disease at enrollment. 285 patients (26.8%) met category 7 criteria on the ordinal scale, 193 (18.2%) buy generic propecia 1mg online category 6, 435 (41.0%) category 5, and 138 (13.0%) category 4. Eleven patients (1.0%) had missing ordinal scale data at enrollment. All these buy generic propecia 1mg online patients discontinued the study before treatment.

    During the study, 373 patients (35.6% of the 1048 patients in the as-treated population) received hydroxychloroquine and 241 (23.0%) received a glucocorticoid (Table S3). Primary Outcome Figure 2. Figure 2 buy generic propecia 1mg online. Kaplan–Meier Estimates of Cumulative Recoveries.

    Cumulative recovery estimates are shown in the overall population (Panel buy generic propecia 1mg online A), in patients with a baseline score of 4 on the ordinal scale (not receiving oxygen. Panel B), in those with a baseline score of 5 (receiving oxygen. Panel C), in those with a baseline score of 6 (receiving high-flow oxygen or noninvasive buy generic propecia 1mg online mechanical ventilation. Panel D), and in those with a baseline score of 7 (receiving mechanical ventilation or extracorporeal membrane oxygenation [ECMO].

    Panel E).Table 2 buy generic propecia 1mg online. Table 2. Outcomes Overall and According to Score on the Ordinal Scale in the Intention-to-Treat Population. Figure 3 buy generic propecia 1mg online.

    Figure 3. Time to Recovery According buy generic propecia 1mg online to Subgroup. The widths of the confidence intervals have not been adjusted for multiplicity and therefore cannot be used to infer treatment effects. Race and buy generic propecia 1mg online ethnic group were reported by the patients.Patients in the remdesivir group had a shorter time to recovery than patients in the placebo group (median, 10 days, as compared with 15 days.

    Rate ratio for recovery, 1.29. 95% confidence interval [CI], 1.12 to 1.49 buy generic propecia 1mg online. P<0.001) (Figure 2 and Table 2). In the severe disease stratum (957 patients) the median time to recovery was 11 days, as compared with 18 days (rate ratio for recovery, 1.31.

    95% CI, buy generic propecia 1mg online 1.12 to 1.52) (Table S4). The rate ratio for recovery was largest among patients with a baseline ordinal score of 5 (rate ratio for recovery, 1.45. 95% CI, buy generic propecia 1mg online 1.18 to 1.79). Among patients with a baseline score of 4 and those with a baseline score of 6, the rate ratio estimates for recovery were 1.29 (95% CI, 0.91 to 1.83) and 1.09 (95% CI, 0.76 to 1.57), respectively.

    For those receiving buy generic propecia 1mg online mechanical ventilation or ECMO at enrollment (baseline ordinal score of 7), the rate ratio for recovery was 0.98 (95% CI, 0.70 to 1.36). Information on interactions of treatment with baseline ordinal score as a continuous variable is provided in Table S11. An analysis adjusting for baseline ordinal score as a covariate was conducted to evaluate the overall effect (of the percentage buy generic propecia 1mg online of patients in each ordinal score category at baseline) on the primary outcome. This adjusted analysis produced a similar treatment-effect estimate (rate ratio for recovery, 1.26.

    95% CI, 1.09 buy generic propecia 1mg online to 1.46). Patients who underwent randomization during the first 10 days after the onset of symptoms had a rate ratio for recovery of 1.37 (95% CI, 1.14 to 1.64), whereas patients who underwent randomization more than 10 days after the onset of symptoms had a rate ratio for recovery of 1.20 (95% CI, 0.94 to 1.52) (Figure 3). The benefit of remdesivir was larger when given earlier in the illness, though the benefit persisted in most analyses of duration of symptoms (Table S6). Sensitivity analyses in which data were censored at earliest reported use of glucocorticoids or hydroxychloroquine still showed efficacy of buy generic propecia 1mg online remdesivir (9.0 days to recovery with remdesivir vs.

    14.0 days to recovery with placebo. Rate ratio, buy generic propecia 1mg online 1.28. 95% CI, 1.09 to 1.50, and 10.0 vs. 16.0 days buy generic propecia 1mg online to recovery.

    Rate ratio, 1.32. 95% CI, 1.11 to 1.58, respectively) (Table S8) buy generic propecia 1mg online. Key Secondary Outcome The odds of improvement in the ordinal scale score were higher in the remdesivir group, as determined by a proportional odds model at the day 15 visit, than in the placebo group (odds ratio for improvement, 1.5. 95% CI, 1.2 to 1.9, adjusted for disease severity) (Table 2 and Fig.

    S7). Mortality Kaplan–Meier estimates of mortality by day 15 were 6.7% in the remdesivir group and 11.9% in the placebo group (hazard ratio, 0.55. 95% CI, 0.36 to 0.83). The estimates by day 29 were 11.4% and 15.2% in two groups, respectively (hazard ratio, 0.73.

    95% CI, 0.52 to 1.03). The between-group differences in mortality varied considerably according to baseline severity (Table 2), with the largest difference seen among patients with a baseline ordinal score of 5 (hazard ratio, 0.30. 95% CI, 0.14 to 0.64). Information on interactions of treatment with baseline ordinal score with respect to mortality is provided in Table S11.

    Additional Secondary Outcomes Table 3. Table 3. Additional Secondary Outcomes. Patients in the remdesivir group had a shorter time to improvement of one or of two categories on the ordinal scale from baseline than patients in the placebo group (one-category improvement.

    Median, 7 vs. 9 days. Rate ratio for recovery, 1.23. 95% CI, 1.08 to 1.41.

    Two-category improvement. Median, 11 vs. 14 days. Rate ratio, 1.29.

    95% CI, 1.12 to 1.48) (Table 3). Patients in the remdesivir group had a shorter time to discharge or to a National Early Warning Score of 2 or lower than those in the placebo group (median, 8 days vs. 12 days. Hazard ratio, 1.27.

    95% CI, 1.10 to 1.46). The initial length of hospital stay was shorter in the remdesivir group than in the placebo group (median, 12 days vs. 17 days). 5% of patients in the remdesivir group were readmitted to the hospital, as compared with 3% in the placebo group.

    Among the 913 read more patients receiving oxygen at enrollment, those in the remdesivir group continued to receive oxygen for fewer days than patients in the placebo group (median, 13 days vs. 21 days), and the incidence of new oxygen use among patients who were not receiving oxygen at enrollment was lower in the remdesivir group than in the placebo group (incidence, 36% [95% CI, 26 to 47] vs. 44% [95% CI, 33 to 57]). For the 193 patients receiving noninvasive ventilation or high-flow oxygen at enrollment, the median duration of use of these interventions was 6 days in both the remdesivir and placebo groups.

    Among the 573 patients who were not receiving noninvasive ventilation, high-flow oxygen, invasive ventilation, or ECMO at baseline, the incidence of new noninvasive ventilation or high-flow oxygen use was lower in the remdesivir group than in the placebo group (17% [95% CI, 13 to 22] vs. 24% [95% CI, 19 to 30]). Among the 285 patients who were receiving mechanical ventilation or ECMO at enrollment, patients in the remdesivir group received these interventions for fewer subsequent days than those in the placebo group (median, 17 days vs. 20 days), and the incidence of new mechanical ventilation or ECMO use among the 766 patients who were not receiving these interventions at enrollment was lower in the remdesivir group than in the placebo group (13% [95% CI, 10 to 17] vs.

    23% [95% CI, 19 to 27]) (Table 3). Safety Outcomes In the as-treated population, serious adverse events occurred in 131 of 532 patients (24.6%) in the remdesivir group and in 163 of 516 patients (31.6%) in the placebo group (Table S17). There were 47 serious respiratory failure adverse events in the remdesivir group (8.8% of patients), including acute respiratory failure and the need for endotracheal intubation, and 80 in the placebo group (15.5% of patients) (Table S19). No deaths were considered by the investigators to be related to treatment assignment.

    Grade 3 or 4 adverse events occurred on or before day 29 in 273 patients (51.3%) in the remdesivir group and in 295 (57.2%) in the placebo group (Table S18). 41 events were judged by the investigators to be related to remdesivir and 47 events to placebo (Table S17). The most common nonserious adverse events occurring in at least 5% of all patients included decreased glomerular filtration rate, decreased hemoglobin level, decreased lymphocyte count, respiratory failure, anemia, pyrexia, hyperglycemia, increased blood creatinine level, and increased blood glucose level (Table S20). The incidence of these adverse events was generally similar in the remdesivir and placebo groups.

    Crossover After the data and safety monitoring board recommended that the preliminary primary analysis report be provided to the sponsor, data on a total of 51 patients (4.8% of the total study enrollment) — 16 (3.0%) in the remdesivir group and 35 (6.7%) in the placebo group — were unblinded. 26 (74.3%) of those in the placebo group whose data were unblinded were given remdesivir. Sensitivity analyses evaluating the unblinding (patients whose treatment assignments were unblinded had their data censored at the time of unblinding) and crossover (patients in the placebo group treated with remdesivir had their data censored at the initiation of remdesivir treatment) produced results similar to those of the primary analysis (Table S9).Trial Objectives, Participants, and Oversight We assessed the safety and immunogenicity of three dose levels of BNT162b1 and BNT162b2. Healthy adults 18 to 55 years of age or 65 to 85 years of age were eligible for inclusion.

    Key exclusion criteria were known infection with human immunodeficiency virus, hepatitis C virus, or hepatitis B virus. An immunocompromised condition. A history of autoimmune disease. A previous clinical or microbiologic diagnosis of Covid-19.

    The receipt of medications intended to prevent Covid-19. Any previous coronavirus vaccination. Positive test for SARS-CoV-2 IgM or IgG at the screening visit. And positive nasal-swab results on a SARS-CoV-2 nucleic acid amplification test within 24 hours before the receipt of trial vaccine or placebo.

    BioNTech was the regulatory sponsor of the trial. Pfizer was responsible for the trial design. For the collection, analysis, and interpretation of the data. And for the writing of the report.

    The corresponding author had full access to all the data in the trial and had final responsibility for the decision to submit the manuscript for publication. All the trial data were available to all the authors. Trial Procedures Using an interactive Web-based response technology system, we randomly assigned trial participants to groups defined according to the vaccine candidate, dose level, and age range. Groups of participants 18 to 55 years of age and 65 to 85 years of age were to receive doses of 10 μg, 20 μg, or 30 μg of BNT162b1 or BNT162b2 (or placebo) on a two-dose schedule.

    One group of participants 18 to 55 years of age was assigned to receive 100-μg doses of BNT162b1 or placebo. All the participants were assigned to receive two 0.5-ml injections of active vaccine (BNT162b1 or BNT162b2) or placebo into the deltoid, administered 21 days apart. The first five participants in each new dose level or age group (with a randomization ratio of 4:1 for active vaccine:placebo) were observed for 4 hours after the injection to identify immediate adverse events. All the other participants were observed for 30 minutes.

    Blood samples were obtained for safety and immunogenicity assessments. Safety The primary end points in phase 1 of this trial were solicited local reactions (i.e., specific local reactions as prompted by and recorded in an electronic diary), systemic events, and use of antipyretic or pain medication within 7 days after the receipt of vaccine or placebo, as prompted by and recorded in an electronic diary. Unsolicited adverse events and serious adverse events (i.e., those reported by the participants, without electronic-diary prompts), assessed from the receipt of the first dose through 1 month and 6 months, respectively, after the receipt of the second dose. Clinical laboratory abnormalities, assessed 1 day and 7 days after the receipt of vaccine or placebo.

    And grading shifts in laboratory assessments between baseline and 1 day and 7 days after the first dose and between 2 days and 7 days after the second dose. Protocol-specified safety stopping rules were in effect for all the participants in the phase 1 portion of the trial. The full protocol, including the statistical analysis plan, is available with the full text of this article at NEJM.org. An internal review committee and an external data and safety monitoring committee reviewed all safety data.

    Immunogenicity Immunogenicity assessments (SARS-CoV-2 serum neutralization assay and receptor-binding domain [RBD]–binding or S1-binding IgG direct Luminex immunoassays) were conducted before the administration of vaccine or placebo, at 7 days and 21 days after the first dose, and at 7 days (i.e., day 28) and 14 days (i.e., day 35) after the second dose. The neutralization assay, which also generated previously described virus-neutralization data from trials of the BNT162 candidates,2,5 used a previously described strain of SARS-CoV-2 (USA_WA1/2020) that had been generated by reverse genetics and engineered by the insertion of an mNeonGreen gene into open reading frame 7 of the viral genome.11,12 The 50% neutralization titers and 90% neutralization titers were reported as the interpolated reciprocal of the dilutions yielding 50% and 90% reductions, respectively, in fluorescent viral foci. Any serologic values below the lower limit of quantitation were set to 0.5 times the lower limit of quantitation. Available serologic results were included in the analysis.

    Immunogenicity data from a human convalescent serum panel were included as a benchmark. A total of 38 serum samples were obtained from donors 18 to 83 years of age (median age, 42.5 years) who had recovered from SARS-CoV-2 infection or Covid-19. Samples were obtained at least 14 days after a polymerase chain reaction–confirmed diagnosis and after symptom resolution. Neutralizing geometric mean titers (GMTs) in subgroups of the donors were as follows.

    90, among 35 donors with symptomatic infections. 156, among 3 donors with asymptomatic infection. And 618, in 1 donor who was hospitalized. Each serum sample in the panel was from a different donor.

    Thus, most of the serum samples were obtained from persons with moderate Covid-19 who had not been hospitalized. The serum samples were obtained from Sanguine Biosciences, the MT Group, and Pfizer Occupational Health and Wellness. Statistical Analysis We report descriptive results of safety and immunogenicity analyses, and the sample size was not based on statistical hypothesis testing. Results of the safety analyses are presented as counts, percentages, and associated Clopper–Pearson 95% confidence intervals for local reactions, systemic events, and any adverse events after the administration of vaccine or placebo, according to terms in the Medical Dictionary for Regulatory Activities, version 23.0, for each vaccine group.

    Summary statistics are provided for abnormal laboratory values and grading shifts. Given the small number of participants in each group, the trial was not powered for formal statistical comparisons between dose levels or between age groups. Immunogenicity analyses of SARS-CoV-2 serum neutralizing titers, S1-binding IgG and RBD-binding IgG concentrations, GMTs, and geometric mean concentrations (GMCs) were computed along with associated 95% confidence intervals. The GMTs and GMCs were calculated as the mean of the assay results after the logarithmic transformation was made.

    We then exponentiated the mean to express results on the original scale. Two-sided 95% confidence intervals were obtained by performing logarithmic transformations of titers or concentrations, calculating the 95% confidence interval with reference to Student’s t-distribution, and then exponentiating the limits of the confidence intervals.Confidence in any Covid-19 vaccine that is made available under an emergency use authorization (EUA) will depend on the rigor of the clinical criteria, including the duration of follow-up, used to evaluate it. Recently published guidance from the Food and Drug Administration (FDA) recommends that data from phase 3 studies to support an EUA (which may result from a protocol-specified interim analysis) include a median follow-up duration of at least 2 months after completion of the full vaccination regimen.1 This recommendation takes into consideration the likely rapid administration of a vaccine to millions of otherwise healthy Americans, and potentially billions more people around the world.An EUA allows use of unapproved medical products (or unapproved uses of approved medical products) to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by threat agents, such as Covid-19, in response to a declared public health emergency for which there are no adequate, approved, and available alternatives. In order to issue an EUA, the FDA must determine, among other things, that the known and potential benefits of a product outweigh its known and potential risks and that the product may be effective in preventing, diagnosing, or treating serious or life-threatening diseases or conditions caused by the agent or agents identified in the EUA declaration.

    A favorable benefit–risk determination cannot be made for vaccines that might have only modest benefit2 or for which there are insufficient data to assess the safety profile. At stake is public confidence in America’s response to the pandemic, in Covid-19 vaccines, and in vaccines in general, all of which are essential to achieving desired public health outcomes.Use of an investigational vaccine under an EUA would not be subject to the usual informed consent requirements for clinical investigations. Nevertheless, vaccine recipients will be provided a fact sheet that describes the investigational nature of the product, the known and potential benefits and risks, available alternatives, and the option to refuse vaccination. To minimize the risk that use of a vaccine under an EUA will interfere with long-term assessment of safety and efficacy in ongoing trials, it will be essential to continue to gather data about the vaccine even after it is made available under the EUA.

    Continued follow-up of clinical trial participants to further refine efficacy estimates, further evaluate the potential for enhanced disease and waning of immunity, and obtain additional active safety follow-up will be essential in order to ensure public confidence in a broadly administered vaccine. The quality of the data available to inform ongoing assessment of a vaccine’s benefits and risks will depend on the ability to continue evaluating the vaccine against a placebo comparator in clinical trials for as long as feasible. Moreover, evaluation of other potentially superior vaccines will depend on the ability to continue to maintain placebo controls in ongoing trials. Thus, issuance of an EUA should not, in and of itself, require unblinding of a Covid-19 vaccine trial and immediate vaccination of placebo recipients, since doing so may jeopardize approval of these products.In setting criteria for EUAs, regulators determine the amount of data that could support a positive benefit–risk assessment, providing people who wish to receive an investigational vaccine the opportunity to realize that benefit while also providing confidence that a vaccine is unlikely to cause net harm when used in this manner.From a safety perspective, a 2-month median follow-up (meaning that at least half of vaccine recipients in clinical trials have at least 2 months of follow-up) after completion of the full vaccination regimen will allow identification of potential adverse events that were not apparent in the immediate postvaccination period and will also provide greater confidence in their absence, if none are observed.

    Adverse events considered plausibly linked to vaccination generally start within 6 weeks after vaccine receipt.3 Two months of follow-up will provide time for potential immune-mediated adverse events that began within this 6-week period to be observed and evaluated. Notably, to support licensure of a vaccine, the FDA generally requires at least 6 months of safety follow-up for serious and other medically attended adverse events in a sufficient number of vaccinees. Given that some vaccines under evaluation for preventing Covid-19 are based on technologies not previously used in licensed vaccines, arguments could be made in favor of longer safety follow-up to support an EUA. A median follow-up period of at least 2 months after the final vaccine dose is justified, however, by extensive historical experience with adverse events after vaccination, the need for a vaccine to address the current pandemic, and the magnitude of vaccine effectiveness that will be required to support a favorable benefit–risk profile for use of a Covid-19 vaccine under an EUA.From the perspective of vaccine efficacy, it will be important to have data to assess whether protection mediated by early responses (e.g., the presence of IgM and IgG antibodies, which peak at or before 2 to 4 weeks after vaccination) has started to wane.

    Such an assessment is particularly relevant to coronavirus vaccines, because natural immunity to coronavirus infection is relatively short-lived.4 Although 2 months of follow-up is insufficient to fully evaluate the duration of vaccine protection, substantial waning of protective responses might start to become apparent in the second month. Thus, a median of 2 months is the shortest follow-up period required to achieve some confidence that any protection against Covid-19 is likely to be more than very short-lived. The World Health Organization recently proposed draft guidelines requiring 3 months of efficacy follow-up data before a vaccine could be considered for its Emergency Use Listing.5To support FDA approval, most vaccine clinical trials include substantially longer follow-up of trial participants to track both safety and efficacy. For example, for shingles vaccines, participants in Shingrix clinical trials were followed for a median of 3.1 years in one study and 3.9 years in another, and participants in Zostavax clinical trials were followed for a median of 1.3 years in one study and 3.1 years in another.Recognizing the gravity of the current public health emergency and the importance of making a vaccine available as soon as possible, we believe that a median 2-month follow-up after completion of the vaccine regimen will provide the necessary safety and effectiveness data to support distribution of an investigational vaccine under an EUA.

    Curtailment of this minimum follow-up could destroy the scientific credibility of the decision to authorize any vaccine for use under an EUA in the United States. Appropriate conditions for issuing EUAs for Covid-19 vaccines are expected to be discussed further at the October 22, 2020, meeting of the FDA Vaccines and Related Biological Products Advisory Committee.Trial Design and Oversight The RECOVERY trial is an investigator-initiated platform trial to evaluate the effects of potential treatments in patients hospitalized with Covid-19. The trial is being conducted at 176 hospitals in the United Kingdom. (Details are provided in the Supplementary Appendix, available with the full text of this article at NEJM.org.) The investigators were assisted by the National Institute for Health Research Clinical Research Network, and the trial is coordinated by the Nuffield Department of Population Health at the University of Oxford, the trial sponsor.

    Although patients are no longer being enrolled in the hydroxychloroquine, dexamethasone, and lopinavir–ritonavir groups, the trial continues to study the effects of azithromycin, tocilizumab, convalescent plasma, and REGN-COV2 (a combination of two monoclonal antibodies directed against the SARS-CoV-2 spike protein). Other treatments may be studied in the future. The hydroxychloroquine that was used in this phase of the trial was supplied by the U.K. National Health Service (NHS).

    Hospitalized patients were eligible for the trial if they had clinically-suspected or laboratory-confirmed SARS-CoV-2 infection and no medical history that might, in the opinion of the attending clinician, put patients at substantial risk if they were to participate in the trial. Initially, recruitment was limited to patients who were at least 18 years of age, but the age limit was removed as of May 9, 2020. Written informed consent was obtained from all the patients or from a legal representative if they were too unwell or unable to provide consent. The trial was conducted in accordance with Good Clinical Practice guidelines of the International Conference on Harmonisation and was approved by the U.K.

    Medicines and Healthcare Products Regulatory Agency (MHRA) and the Cambridge East Research Ethics Committee. The protocol with its statistical analysis plan are available at NEJM.org, with additional information in the Supplementary Appendix and on the trial website at www.recoverytrial.net. The initial version of the manuscript was drafted by the first and last authors, developed by the writing committee, and approved by all members of the trial steering committee. The funders had no role in the analysis of the data, in the preparation or approval of the manuscript, or in the decision to submit the manuscript for publication.

    The first and last members of the writing committee vouch for the completeness and accuracy of the data and for the fidelity of the trial to the protocol and statistical analysis plan. Randomization and Treatment We collected baseline data using a Web-based case-report form that included demographic data, level of respiratory support, major coexisting illnesses, the suitability of the trial treatment for a particular patient, and treatment availability at the trial site. Using a Web-based unstratified randomization method with the concealment of trial group, we assigned patients to receive either the usual standard of care or the usual standard of care plus hydroxychloroquine or one of the other available treatments that were being evaluated. The number of patients who were assigned to receive usual care was twice the number who were assigned to any of the active treatments for which the patient was eligible (e.g., 2:1 ratio in favor of usual care if the patient was eligible for only one active treatment group, 2:1:1 if the patient was eligible for two active treatments, etc.).

    For some patients, hydroxychloroquine was unavailable at the hospital at the time of enrollment or was considered by the managing physician to be either definitely indicated or definitely contraindicated. Patients with a known prolonged corrected QT interval on electrocardiography were ineligible to receive hydroxychloroquine. (Coadministration with medications that prolong the QT interval was not an absolute contraindication, but attending clinicians were advised to check the QT interval by performing electrocardiography.) These patients were excluded from entry in the randomized comparison between hydroxychloroquine and usual care. In the hydroxychloroquine group, patients received hydroxychloroquine sulfate (in the form of a 200-mg tablet containing a 155-mg base equivalent) in a loading dose of four tablets (total dose, 800 mg) at baseline and at 6 hours, which was followed by two tablets (total dose, 400 mg) starting at 12 hours after the initial dose and then every 12 hours for the next 9 days or until discharge, whichever occurred earlier (see the Supplementary Appendix).15 The assigned treatment was prescribed by the attending clinician.

    The patients and local trial staff members were aware of the assigned trial groups. Procedures A single online follow-up form was to be completed by the local trial staff members when each trial patient was discharged, at 28 days after randomization, or at the time of death, whichever occurred first. Information was recorded regarding the adherence to the assigned treatment, receipt of other treatments for Covid-19, duration of admission, receipt of respiratory support (with duration and type), receipt of renal dialysis or hemofiltration, and vital status (including cause of death). Starting on May 12, 2020, extra information was recorded on the occurrence of new major cardiac arrhythmia.

    In addition, we obtained routine health care and registry data that included information on vital status (with date and cause of death) and discharge from the hospital. Outcome Measures The primary outcome was all-cause mortality within 28 days after randomization. Further analyses were specified at 6 months. Secondary outcomes were the time until discharge from the hospital and a composite of the initiation of invasive mechanical ventilation including extracorporeal membrane oxygenation or death among patients who were not receiving invasive mechanical ventilation at the time of randomization.

    Decisions to initiate invasive mechanical ventilation were made by the attending clinicians, who were informed by guidance from NHS England and the National Institute for Health and Care Excellence. Subsidiary clinical outcomes included cause-specific mortality (which was recorded in all patients) and major cardiac arrhythmia (which was recorded in a subgroup of patients). All information presented in this report is based on a data cutoff of September 21, 2020. Information regarding the primary outcome is complete for all the trial patients.

    Statistical Analysis For the primary outcome of 28-day mortality, we used the log-rank observed-minus-expected statistic and its variance both to test the null hypothesis of equal survival curves and to calculate the one-step estimate of the average mortality rate ratio in the comparison between the hydroxychloroquine group and the usual-care group. Kaplan–Meier survival curves were constructed to show cumulative mortality over the 28-day period. The same methods were used to analyze the time until hospital discharge, with censoring of data on day 29 for patients who had died in the hospital. We used the Kaplan–Meier estimates to calculate the median time until hospital discharge.

    For the prespecified composite secondary outcome of invasive mechanical ventilation or death within 28 days (among patients who had not been receiving invasive mechanical ventilation at randomization), the precise date of the initiation of invasive mechanical ventilation was not available, so the risk ratio was estimated instead. Estimates of the between-group difference in absolute risk were also calculated. All the analyses were performed according to the intention-to-treat principle. Prespecified analyses of the primary outcome were performed in six subgroups, as defined by characteristics at randomization.

    Age, sex, race, level of respiratory support, days since symptom onset, and predicted 28-day risk of death. (Details are provided in the Supplementary Appendix.) Estimates of rate and risk ratios are shown with 95% confidence intervals without adjustment for multiple testing. The P value for the assessment of the primary outcome is two-sided. The full database is held by the trial team, which collected the data from the trial sites and performed the analyses, at the Nuffield Department of Population Health at the University of Oxford.

    The independent data monitoring committee was asked to review unblinded analyses of the trial data and any other information that was considered to be relevant at intervals of approximately 2 weeks. The committee was then charged with determining whether the randomized comparisons in the trial provided evidence with respect to mortality that was strong enough (with a range of uncertainty around the results that was narrow enough) to affect national and global treatment strategies. In such a circumstance, the committee would inform the members of the trial steering committee, who would make the results available to the public and amend the trial accordingly. Unless that happened, the steering committee, investigators, and all others involved in the trial would remain unaware of the interim results until 28 days after the last patient had been randomly assigned to a particular treatment group.

    On June 4, 2020, in response to a request from the MHRA, the independent data monitoring committee conducted a review of the data and recommended that the chief investigators review the unblinded data for the hydroxychloroquine group. The chief investigators and steering committee members concluded that the data showed no beneficial effect of hydroxychloroquine in patients hospitalized with Covid-19. Therefore, the enrollment of patients in the hydroxychloroquine group was closed on June 5, 2020, and the preliminary result for the primary outcome was made public. Investigators were advised that any patients who were receiving hydroxychloroquine as part of the trial should discontinue the treatment..

    Covid-19 has http://www.amisdepasteur.fr/buy-propecia-1mg-online/ created a crisis throughout the propecia for sale uk world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard propecia for sale uk choices about how to respond. Here in the United States, our leaders have failed that test.

    They have propecia for sale uk taken a crisis and turned it into a tragedy.The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs propecia for sale uk the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity.

    But the one propecia for sale uk we can control is how we behave. And in the United States we have consistently behaved poorly.We know that we could have done better. China, faced with the first outbreak, chose strict quarantine and isolation after an initial delay. These measures were severe but effective, propecia for sale uk essentially eliminating transmission at the point where the outbreak began and reducing the death rate to a reported 3 per million, as compared with more than 500 per million in the United States.

    Countries that had far more exchange with China, such as Singapore and South Korea, began intensive testing early, along with aggressive contact tracing and appropriate isolation, and have had relatively small outbreaks. And New Zealand has used these same measures, together with its geographic advantages, to come close to propecia for sale uk eliminating the disease, something that has allowed that country to limit the time of closure and to largely reopen society to a prepandemic level. In general, not only have many democracies done better than the United States, but they have also outperformed us by orders of magnitude.Why has the United States handled this pandemic so badly?. We have propecia for sale uk failed at almost every step.

    We had ample warning, but when the disease first arrived, we were incapable of testing effectively and couldn’t provide even the most basic personal protective equipment to health care workers and the general public. And we continue propecia for sale uk to be way behind the curve in testing. While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe, and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have.2 Moreover, a lack of emphasis on developing capacity has meant that U.S. Test results are often long delayed, rendering the results useless for disease control.Although we tend to focus on technology, most of the interventions that have large effects are not complicated.

    The United States propecia for sale uk instituted quarantine and isolation measures late and inconsistently, often without any effort to enforce them, after the disease had spread substantially in many communities. Our rules on social distancing have in many places been lackadaisical at best, with loosening of restrictions long before adequate disease control had been achieved. And in much of the country, people simply don’t wear propecia for sale uk masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures. The government has appropriately invested heavily in vaccine development, but its rhetoric has politicized the development process and led to growing public distrust.The United States came into this crisis with enormous advantages.

    Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of propecia for sale uk the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in propecia for sale uk government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.The response of our nation’s leaders has been consistently inadequate.

    The federal government has largely abandoned disease control to the states. Governors have varied in propecia for sale uk their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of propecia for sale uk using those tools, the federal government has undermined them.

    The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a propecia for sale uk key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3 appearing to respond to pressure from the administration rather than scientific evidence. Our current propecia for sale uk leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them.

    Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.Let’s be clear about the cost of not taking even simple measures. An outbreak that has disproportionately affected communities of color has exacerbated propecia for sale uk the tensions associated with inequality. Many of our children are missing school at critical times in their social and intellectual development. The hard work of health care professionals, who have put their lives on the line, has not been used wisely.

    Our current leadership takes pride in the economy, but while most of the world has opened up to some extent, the United States still suffers from disease rates that have prevented many businesses from reopening, with a resultant loss of propecia for sale uk hundreds of billions of dollars and millions of jobs. And more than 200,000 Americans have died. Some deaths propecia for sale uk from Covid-19 were unavoidable. But, although it is impossible to project the precise number of additional American lives lost because of weak and inappropriate government policies, it is at least in the tens of thousands in a pandemic that has already killed more Americans than any conflict since World War II.Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences.

    Our leaders have largely claimed propecia for sale uk immunity for their actions. But this election gives us the power to render judgment. Reasonable people will certainly propecia for sale uk disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative.

    When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should propecia for sale uk not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.Patients Figure 1. Figure 1. Enrollment and Randomization propecia for sale uk.

    Of the 1114 patients who were assessed for eligibility, 1062 underwent randomization. 541 were assigned to the remdesivir group propecia for sale uk and 521 to the placebo group (intention-to-treat population) (Figure 1). 159 (15.0%) were categorized as having mild-to-moderate disease, and 903 (85.0%) were in the severe disease stratum. Of those assigned to receive remdesivir, 531 patients (98.2%) received the treatment as propecia for sale uk assigned.

    Fifty-two patients had remdesivir treatment discontinued before day 10 because of an adverse event or a serious adverse event other than death and 10 withdrew consent. Of those assigned to receive placebo, 517 patients (99.2%) received placebo as assigned. Seventy patients discontinued placebo before day propecia for sale uk 10 because of an adverse event or a serious adverse event other than death and 14 withdrew consent. A total of 517 patients in the remdesivir group and 508 in the placebo group completed the trial through day 29, recovered, or died.

    Fourteen patients who received remdesivir and 9 who received placebo terminated their participation in propecia for sale uk the trial before day 29. A total of 54 of the patients who were in the mild-to-moderate stratum at randomization were subsequently determined to meet the criteria for severe disease, resulting in 105 patients in the mild-to-moderate disease stratum and 957 in the severe stratum. The as-treated population included 1048 patients who received the assigned treatment (532 in the remdesivir group, including propecia for sale uk one patient who had been randomly assigned to placebo and received remdesivir, and 516 in the placebo group). Table 1.

    Table 1 propecia for sale uk. Demographic and Clinical Characteristics of the Patients at Baseline. The mean age of the patients was 58.9 years, propecia for sale uk and 64.4% were male (Table 1). On the basis of the evolving epidemiology of Covid-19 during the trial, 79.8% of patients were enrolled at sites in North America, 15.3% in Europe, and 4.9% in Asia (Table S1 in the Supplementary Appendix).

    Overall, 53.3% of the patients were White, 21.3% were Black, 12.7% were Asian, and 12.7% were designated as other or not reported. 250 (23.5%) propecia for sale uk were Hispanic or Latino. Most patients had either one (25.9%) or two or more (54.5%) of the prespecified coexisting conditions at enrollment, most commonly hypertension (50.2%), obesity (44.8%), and type 2 diabetes mellitus (30.3%). The median number of days between symptom onset and randomization was 9 (interquartile propecia for sale uk range, 6 to 12) (Table S2).

    A total of 957 patients (90.1%) had severe disease at enrollment. 285 patients (26.8%) met category 7 criteria on the propecia for sale uk ordinal scale, 193 (18.2%) category 6, 435 (41.0%) category 5, and 138 (13.0%) category 4. Eleven patients (1.0%) had missing ordinal scale data at enrollment. All these patients discontinued the study propecia for sale uk before treatment.

    During the study, 373 patients (35.6% of the 1048 patients in the as-treated population) received hydroxychloroquine and 241 (23.0%) received a glucocorticoid (Table S3). Primary Outcome Figure 2. Figure 2 propecia for sale uk. Kaplan–Meier Estimates of Cumulative Recoveries.

    Cumulative recovery estimates are shown in the overall population (Panel A), in patients with a baseline score propecia for sale uk of 4 on the ordinal scale (not receiving oxygen. Panel B), in those with a baseline score of 5 (receiving oxygen. Panel C), in those with a baseline score of 6 (receiving high-flow oxygen or noninvasive mechanical ventilation propecia for sale uk. Panel D), and in those with a baseline score of 7 (receiving mechanical ventilation or extracorporeal membrane oxygenation [ECMO].

    Panel E).Table 2 propecia for sale uk. Table 2. Outcomes Overall and According to Score on the Ordinal Scale in the Intention-to-Treat Population. Figure 3 propecia for sale uk.

    Figure 3. Time to propecia for sale uk Recovery According to Subgroup. The widths of the confidence intervals have not been adjusted for multiplicity and therefore cannot be used to infer treatment effects. Race and ethnic group were propecia for sale uk reported by the patients.Patients in the remdesivir group had a shorter time to recovery than patients in the placebo group (median, 10 days, as compared with 15 days.

    Rate ratio for recovery, 1.29. 95% confidence interval [CI], 1.12 propecia for sale uk to 1.49. P<0.001) (Figure 2 and Table 2). In the severe disease stratum (957 patients) the median time to recovery was 11 days, as compared with 18 days (rate ratio for recovery, 1.31.

    95% CI, 1.12 propecia for sale uk to 1.52) (Table S4). The rate ratio for recovery was largest among patients with a baseline ordinal score of 5 (rate ratio for recovery, 1.45. 95% CI, 1.18 to 1.79) propecia for sale uk. Among patients with a baseline score of 4 and those with a baseline score of 6, the rate ratio estimates for recovery were 1.29 (95% CI, 0.91 to 1.83) and 1.09 (95% CI, 0.76 to 1.57), respectively.

    For those receiving mechanical ventilation or ECMO at enrollment propecia for sale uk (baseline ordinal score of 7), the rate ratio for recovery was 0.98 (95% CI, 0.70 to 1.36). Information on interactions of treatment with baseline ordinal score as a continuous variable is provided in Table S11. An analysis adjusting for baseline ordinal score as a covariate was conducted to evaluate the overall effect (of the propecia for sale uk percentage of patients in each ordinal score category at baseline) on the primary outcome. This adjusted analysis produced a similar treatment-effect estimate (rate ratio for recovery, 1.26.

    95% CI, 1.09 to propecia for sale uk 1.46). Patients who underwent randomization during the first 10 days after the onset of symptoms had a rate ratio for recovery of 1.37 (95% CI, 1.14 to 1.64), whereas patients who underwent randomization more than 10 days after the onset of symptoms had a rate ratio for recovery of 1.20 (95% CI, 0.94 to 1.52) (Figure 3). The benefit of remdesivir was larger when given earlier in the illness, though the benefit persisted in most analyses of duration of symptoms (Table S6). Sensitivity analyses in which data were censored at earliest reported use of glucocorticoids propecia for sale uk or hydroxychloroquine still showed efficacy of remdesivir (9.0 days to recovery with remdesivir vs.

    14.0 days to recovery with placebo. Rate ratio, propecia for sale uk 1.28. 95% CI, 1.09 to 1.50, and 10.0 vs. 16.0 days to recovery propecia for sale uk.

    Rate ratio, 1.32. 95% CI, 1.11 to 1.58, respectively) (Table S8) propecia for sale uk. Key Secondary Outcome The odds of improvement in the ordinal scale score were higher in the remdesivir group, as determined by a proportional odds model at the day 15 visit, than in the placebo group (odds ratio for improvement, 1.5. 95% CI, 1.2 to 1.9, adjusted for disease severity) (Table 2 and Fig.

    S7). Mortality Kaplan–Meier estimates of mortality by day 15 were 6.7% in the remdesivir group and 11.9% in the placebo group (hazard ratio, 0.55. 95% CI, 0.36 to 0.83). The estimates by day 29 were 11.4% and 15.2% in two groups, respectively (hazard ratio, 0.73.

    95% CI, 0.52 to 1.03). The between-group differences in mortality varied considerably according to baseline severity (Table 2), with the largest difference seen among patients with a baseline ordinal score of 5 (hazard ratio, 0.30. 95% CI, 0.14 to 0.64). Information on interactions of treatment with baseline ordinal score with respect to mortality is provided in Table S11.

    Additional Secondary Outcomes Table 3. Table 3. Additional Secondary Outcomes. Patients in the remdesivir group had a shorter time to improvement of one or of two categories on the ordinal scale from baseline than patients in the placebo group (one-category improvement.

    Median, 7 vs. 9 days. Rate ratio for recovery, 1.23. 95% CI, 1.08 to 1.41.

    Two-category improvement. Median, 11 vs. 14 days. Rate ratio, 1.29.

    95% CI, 1.12 to 1.48) (Table 3). Patients in the remdesivir group had a shorter time to discharge or to a National Early Warning Score of 2 or lower than those in the placebo group (median, 8 days vs. 12 days. Hazard ratio, 1.27.

    95% CI, 1.10 to 1.46). The initial length of hospital stay was shorter in the remdesivir group than in the placebo group (median, 12 days vs. 17 days). 5% of patients in the remdesivir group were readmitted to the hospital, as compared with 3% in the placebo group.

    Among the 913 patients receiving oxygen at enrollment, those in the remdesivir group continued to receive oxygen for fewer days than patients in the placebo group (median, 13 days vs. 21 days), and the incidence of new oxygen use among patients who were not receiving oxygen at enrollment was lower in the remdesivir group than in the placebo group (incidence, 36% [95% CI, 26 to 47] vs. 44% [95% CI, 33 to 57]). For the 193 patients receiving noninvasive ventilation or high-flow oxygen at enrollment, the median duration of use of these interventions was 6 days in both the remdesivir and placebo groups.

    Among the 573 patients who were not receiving noninvasive ventilation, high-flow oxygen, invasive ventilation, or ECMO at baseline, the incidence of new noninvasive ventilation or high-flow oxygen use was lower in the remdesivir group than in the placebo group (17% [95% CI, 13 to 22] vs. 24% [95% CI, 19 to 30]). Among the 285 patients who were receiving mechanical ventilation or ECMO at enrollment, patients in the remdesivir group received these interventions for fewer subsequent days than those in the placebo group (median, 17 days vs. 20 days), and the incidence of new mechanical ventilation or ECMO use among the 766 patients who were not receiving these interventions at enrollment was lower in the remdesivir group than in the placebo group (13% [95% CI, 10 to 17] vs.

    23% [95% CI, 19 to 27]) (Table 3). Safety Outcomes In the as-treated population, serious adverse events occurred in 131 of 532 patients (24.6%) in the remdesivir group and in 163 of 516 patients (31.6%) in the placebo group (Table S17). There were 47 serious respiratory failure adverse events in the remdesivir group (8.8% of patients), including acute respiratory failure and the need for endotracheal intubation, and 80 in the placebo group (15.5% of patients) (Table S19). No deaths were considered by the investigators to be related to treatment assignment.

    Grade 3 or 4 adverse events occurred on or before day 29 in 273 patients (51.3%) in the remdesivir group and in 295 (57.2%) in the placebo group (Table S18). 41 events were judged by the investigators to be related to remdesivir and 47 events to placebo (Table S17). The most common nonserious adverse events occurring in at least 5% of all patients included decreased glomerular filtration rate, decreased hemoglobin level, decreased lymphocyte count, respiratory failure, anemia, pyrexia, hyperglycemia, increased blood creatinine level, and increased blood glucose level (Table S20). The incidence of these adverse events was generally similar in the remdesivir and placebo groups.

    Crossover After the data and safety monitoring board recommended that the preliminary primary analysis report be provided to the sponsor, data on a total of 51 patients (4.8% of the total study enrollment) — 16 (3.0%) in the remdesivir group and 35 (6.7%) in the placebo group — were unblinded. 26 (74.3%) of those in the placebo group whose data were unblinded were given remdesivir. Sensitivity analyses evaluating the unblinding (patients whose treatment assignments were unblinded had their data censored at the time of unblinding) and crossover (patients in the placebo group treated with remdesivir had their data censored at the initiation of remdesivir treatment) produced results similar to those of the primary analysis (Table S9).Trial Objectives, Participants, and Oversight We assessed the safety and immunogenicity of three dose levels of BNT162b1 and BNT162b2. Healthy adults 18 to 55 years of age or 65 to 85 years of age were eligible for inclusion.

    Key exclusion criteria were known infection with human immunodeficiency virus, hepatitis C virus, or hepatitis B virus. An immunocompromised condition. A history of autoimmune disease. A previous clinical or microbiologic diagnosis of Covid-19.

    The receipt of medications intended to prevent Covid-19. Any previous coronavirus vaccination. Positive test for SARS-CoV-2 IgM or IgG at the screening visit. And positive nasal-swab results on a SARS-CoV-2 nucleic acid amplification test within 24 hours before the receipt of trial vaccine or placebo.

    BioNTech was the regulatory sponsor of the trial. Pfizer was responsible for the trial design. For the collection, analysis, and interpretation of the data. And for the writing of the report.

    The corresponding author had full access to all the data in the trial and had final responsibility for the decision to submit the manuscript for publication. All the trial data were available to all the authors. Trial Procedures Using an interactive Web-based response technology system, we randomly assigned trial participants to groups defined according to the vaccine candidate, dose level, and age range. Groups of participants 18 to 55 years of age and 65 to 85 years of age were to receive doses of 10 μg, 20 μg, or 30 μg of BNT162b1 or BNT162b2 (or placebo) on a two-dose schedule.

    One group of participants 18 to 55 years of age was assigned to receive 100-μg doses of BNT162b1 or placebo. All the participants were assigned to receive two 0.5-ml injections of active vaccine (BNT162b1 or BNT162b2) or placebo into the deltoid, administered 21 days apart. The first five participants in each new dose level or age group (with a randomization ratio of 4:1 for active vaccine:placebo) were observed for 4 hours after the injection to identify immediate adverse events. All the other participants were observed for 30 minutes.

    Blood samples were obtained for safety and immunogenicity assessments. Safety The primary end points in phase 1 of this trial were solicited local reactions (i.e., specific local reactions as prompted by and recorded in an electronic diary), systemic events, and use of antipyretic or pain medication within 7 days after the receipt of vaccine or placebo, as prompted by and recorded in an electronic diary. Unsolicited adverse events and serious adverse events (i.e., those reported by the participants, without electronic-diary prompts), assessed from the receipt of the first dose through 1 month and 6 months, respectively, after the receipt of the second dose. Clinical laboratory abnormalities, assessed 1 day and 7 days after the receipt of vaccine or placebo.

    And grading shifts in laboratory assessments between baseline and 1 day and 7 days after the first dose and between 2 days and 7 days after the second dose. Protocol-specified safety stopping rules were in effect for all the participants in the phase 1 portion of the trial. The full protocol, including the statistical analysis plan, is available with the full text of this article at NEJM.org. An internal review committee and an external data and safety monitoring committee reviewed all safety data.

    Immunogenicity Immunogenicity assessments (SARS-CoV-2 serum neutralization assay and receptor-binding domain [RBD]–binding or S1-binding IgG direct Luminex immunoassays) were conducted before the administration of vaccine or placebo, at 7 days and 21 days after the first dose, and at 7 days (i.e., day 28) and 14 days (i.e., day 35) after the second dose. The neutralization assay, which also generated previously described virus-neutralization data from trials of the BNT162 candidates,2,5 used a previously described strain of SARS-CoV-2 (USA_WA1/2020) that had been generated by reverse genetics and engineered by the insertion of an mNeonGreen gene into open reading frame 7 of the viral genome.11,12 The 50% neutralization titers and 90% neutralization titers were reported as the interpolated reciprocal of the dilutions yielding 50% and 90% reductions, respectively, in fluorescent viral foci. Any serologic values below the lower limit of quantitation were set to 0.5 times the lower limit of quantitation. Available serologic results were included in the analysis.

    Immunogenicity data from a human convalescent serum panel were included as a benchmark. A total of 38 serum samples were obtained from donors 18 to 83 years of age (median age, 42.5 years) who had recovered from SARS-CoV-2 infection or Covid-19. Samples were obtained at least 14 days after a polymerase chain reaction–confirmed diagnosis and after symptom resolution. Neutralizing geometric mean titers (GMTs) in subgroups of the donors were as follows.

    90, among 35 donors with symptomatic infections. 156, among 3 donors with asymptomatic infection. And 618, in 1 donor who was hospitalized. Each serum sample in the panel was from a different donor.

    Thus, most of the serum samples were obtained from persons with moderate Covid-19 who had not been hospitalized. The serum samples were obtained from Sanguine Biosciences, the MT Group, and Pfizer Occupational Health and Wellness. Statistical Analysis We report descriptive results of safety and immunogenicity analyses, and the sample size was not based on statistical hypothesis testing. Results of the safety analyses are presented as counts, percentages, and associated Clopper–Pearson 95% confidence intervals for local reactions, systemic events, and any adverse events after the administration of vaccine or placebo, according to terms in the Medical Dictionary for Regulatory Activities, version 23.0, for each vaccine group.

    Summary statistics are provided for abnormal laboratory values and grading shifts. Given the small number of participants in each group, the trial was not powered for formal statistical comparisons between dose levels or between age groups. Immunogenicity analyses of SARS-CoV-2 serum neutralizing titers, S1-binding IgG and RBD-binding IgG concentrations, GMTs, and geometric mean concentrations (GMCs) were computed along with associated 95% confidence intervals. The GMTs and GMCs were calculated as the mean of the assay results after the logarithmic transformation was made.

    We then exponentiated the mean to express results on the original scale. Two-sided 95% confidence intervals were obtained by performing logarithmic transformations of titers or concentrations, calculating the 95% confidence interval with reference to Student’s t-distribution, and then exponentiating the limits of the confidence intervals.Confidence in any Covid-19 vaccine that is made available under an emergency use authorization (EUA) will depend on the rigor of the clinical criteria, including the duration of follow-up, used to evaluate it. Recently published guidance from the Food and Drug Administration (FDA) recommends that data from phase 3 studies to support an EUA (which may result from a protocol-specified interim analysis) include a median follow-up duration of at least 2 months after completion of the full vaccination regimen.1 This recommendation takes into consideration the likely rapid administration of a vaccine to millions of otherwise healthy Americans, and potentially billions more people around the world.An EUA allows use of unapproved medical products (or unapproved uses of approved medical products) to diagnose, treat, or prevent serious or life-threatening diseases or conditions caused by threat agents, such as Covid-19, in response to a declared public health emergency for which there are no adequate, approved, and available alternatives. In order to issue an EUA, the FDA must determine, among other things, that the known and potential benefits of a product outweigh its known and potential risks and that the product may be effective in preventing, diagnosing, or treating serious or life-threatening diseases or conditions caused by the agent or agents identified in the EUA declaration.

    A favorable benefit–risk determination cannot be made for vaccines that might have only modest benefit2 or for which there are insufficient data to assess the safety profile. At stake is public confidence in America’s response to the pandemic, in Covid-19 vaccines, and in vaccines in general, all of which are essential to achieving desired public health outcomes.Use of an investigational vaccine under an EUA would not be subject to the usual informed consent requirements for clinical investigations. Nevertheless, vaccine recipients will be provided a fact sheet that describes the investigational nature of the product, the known and potential benefits and risks, available alternatives, and the option to refuse vaccination. To minimize the risk that use of a vaccine under an EUA will interfere with long-term assessment of safety and efficacy in ongoing trials, it will be essential to continue to gather data about the vaccine even after it is made available under the EUA.

    Continued follow-up of clinical trial participants to further refine efficacy estimates, further evaluate the potential for enhanced disease and waning of immunity, and obtain additional active safety follow-up will be essential in order to ensure public confidence in a broadly administered vaccine. The quality of the data available to inform ongoing assessment of a vaccine’s benefits and risks will depend on the ability to continue evaluating the vaccine against a placebo comparator in clinical trials for as long as feasible. Moreover, evaluation of other potentially superior vaccines will depend on the ability to continue to maintain placebo controls in ongoing trials. Thus, issuance of an EUA should not, in and of itself, require unblinding of a Covid-19 vaccine trial and immediate vaccination of placebo recipients, since doing so may jeopardize approval of these products.In setting criteria for EUAs, regulators determine the amount of data that could support a positive benefit–risk assessment, providing people who wish to receive an investigational vaccine the opportunity to realize that benefit while also providing confidence that a vaccine is unlikely to cause net harm when used in this manner.From a safety perspective, a 2-month median follow-up (meaning that at least half of vaccine recipients in clinical trials have at least 2 months of follow-up) after completion of the full vaccination regimen will allow identification of potential adverse events that were not apparent in the immediate postvaccination period and will also provide greater confidence in their absence, if none are observed.

    Adverse events considered plausibly linked to vaccination generally start within 6 weeks after vaccine receipt.3 Two months of follow-up will provide time for potential immune-mediated adverse events that began within this 6-week period to be observed and evaluated. Notably, to support licensure of a vaccine, the FDA generally requires at least 6 months of safety follow-up for serious and other medically attended adverse events in a sufficient number of vaccinees. Given that some vaccines under evaluation for preventing Covid-19 are based on technologies not previously used in licensed vaccines, arguments could be made in favor of longer safety follow-up to support an EUA. A median follow-up period of at least 2 months after the final vaccine dose is justified, however, by extensive historical experience with adverse events after vaccination, the need for a vaccine to address the current pandemic, and the magnitude of vaccine effectiveness that will be required to support a favorable benefit–risk profile for use of a Covid-19 vaccine under an EUA.From the perspective of vaccine efficacy, it will be important to have data to assess whether protection mediated by early responses (e.g., the presence of IgM and IgG antibodies, which peak at or before 2 to 4 weeks after vaccination) has started to wane.

    Such an assessment is particularly relevant to coronavirus vaccines, because natural immunity to coronavirus infection is relatively short-lived.4 Although 2 months of follow-up is insufficient to fully evaluate the duration of vaccine protection, substantial waning of protective responses might start to become apparent in the second month. Thus, a median of 2 months is the shortest follow-up period required to achieve some confidence that any protection against Covid-19 is likely to be more than very short-lived. The World Health Organization recently proposed draft guidelines requiring 3 months of efficacy follow-up data before a vaccine could be considered for its Emergency Use Listing.5To support FDA approval, most vaccine clinical trials include substantially longer follow-up of trial participants to track both safety and efficacy. For example, for shingles vaccines, participants in Shingrix clinical trials were followed for a median of 3.1 years in one study and 3.9 years in another, and participants in Zostavax clinical trials were followed for a median of 1.3 years in one study and 3.1 years in another.Recognizing the gravity of the current public health emergency and the importance of making a vaccine available as soon as possible, we believe that a median 2-month follow-up after completion of the vaccine regimen will provide the necessary safety and effectiveness data to support distribution of an investigational vaccine under an EUA.

    Curtailment of this minimum follow-up could destroy the scientific credibility of the decision to authorize any vaccine for use under an EUA in the United States. Appropriate conditions for issuing EUAs for Covid-19 vaccines are expected to be discussed further at the October 22, 2020, meeting of the FDA Vaccines and Related Biological Products Advisory Committee.Trial Design and Oversight The RECOVERY trial is an investigator-initiated platform trial to evaluate the effects of potential treatments in patients hospitalized with Covid-19. The trial is being conducted at 176 hospitals in the United Kingdom. (Details are provided in the Supplementary Appendix, available with the full text of this article at NEJM.org.) The investigators were assisted by the National Institute for Health Research Clinical Research Network, and the trial is coordinated by the Nuffield Department of Population Health at the University of Oxford, the trial sponsor.

    Although patients are no longer being enrolled in the hydroxychloroquine, dexamethasone, and lopinavir–ritonavir groups, the trial continues to study the effects of azithromycin, tocilizumab, convalescent plasma, and REGN-COV2 (a combination of two monoclonal antibodies directed against the SARS-CoV-2 spike protein). Other treatments may be studied in the future. The hydroxychloroquine that was used in this phase of the trial was supplied by the U.K. National Health Service (NHS).

    Hospitalized patients were eligible for the trial if they had clinically-suspected or laboratory-confirmed SARS-CoV-2 infection and no medical history that might, in the opinion of the attending clinician, put patients at substantial risk if they were to participate in the trial. Initially, recruitment was limited to patients who were at least 18 years of age, but the age limit was removed as of May 9, 2020. Written informed consent was obtained from all the patients or from a legal representative if they were too unwell or unable to provide consent. The trial was conducted in accordance with Good Clinical Practice guidelines of the International Conference on Harmonisation and was approved by the U.K.

    Medicines and Healthcare Products Regulatory Agency (MHRA) and the Cambridge East Research Ethics Committee. The protocol with its statistical analysis plan are available at NEJM.org, with additional information in the Supplementary Appendix and on the trial website at www.recoverytrial.net. The initial version of the manuscript was drafted by the first and last authors, developed by the writing committee, and approved by all members of the trial steering committee. The funders had no role in the analysis of the data, in the preparation or approval of the manuscript, or in the decision to submit the manuscript for publication.

    The first and last members of the writing committee vouch for the completeness and accuracy of the data and for the fidelity of the trial to the protocol and statistical analysis plan. Randomization and Treatment We collected baseline data using a Web-based case-report form that included demographic data, level of respiratory support, major coexisting illnesses, the suitability of the trial treatment for a particular patient, and treatment availability at the trial site. Using a Web-based unstratified randomization method with the concealment of trial group, we assigned patients to receive either the usual standard of care or the usual standard of care plus hydroxychloroquine or one of the other available treatments that were being evaluated. The number of patients who were assigned to receive usual care was twice the number who were assigned to any of the active treatments for which the patient was eligible (e.g., 2:1 ratio in favor of usual care if the patient was eligible for only one active treatment group, 2:1:1 if the patient was eligible for two active treatments, etc.).

    For some patients, hydroxychloroquine was unavailable at the hospital at the time of enrollment or was considered by the managing physician to be either definitely indicated or definitely contraindicated. Patients with a known prolonged corrected QT interval on electrocardiography were ineligible to receive hydroxychloroquine. (Coadministration with medications that prolong the QT interval was not an absolute contraindication, but attending clinicians were advised to check the QT interval by performing electrocardiography.) These patients were excluded from entry in the randomized comparison between hydroxychloroquine and usual care. In the hydroxychloroquine group, patients received hydroxychloroquine sulfate (in the form of a 200-mg tablet containing a 155-mg base equivalent) in a loading dose of four tablets (total dose, 800 mg) at baseline and at 6 hours, which was followed by two tablets (total dose, 400 mg) starting at 12 hours after the initial dose and then every 12 hours for the next 9 days or until discharge, whichever occurred earlier (see the Supplementary Appendix).15 The assigned treatment was prescribed by the attending clinician.

    The patients and local trial staff members were aware of the assigned trial groups. Procedures A single online follow-up form was to be completed by the local trial staff members when each trial patient was discharged, at 28 days after randomization, or at the time of death, whichever occurred first. Information was recorded regarding the adherence to the assigned treatment, receipt of other treatments for Covid-19, duration of admission, receipt of respiratory support (with duration and type), receipt of renal dialysis or hemofiltration, and vital status (including cause of death). Starting on May 12, 2020, extra information was recorded on the occurrence of new major cardiac arrhythmia.

    In addition, we obtained routine health care and registry data that included information on vital status (with date and cause of death) and discharge from the hospital. Outcome Measures The primary outcome was all-cause mortality within 28 days after randomization. Further analyses were specified at 6 months. Secondary outcomes were the time until discharge from the hospital and a composite of the initiation of invasive mechanical ventilation including extracorporeal membrane oxygenation or death among patients who were not receiving invasive mechanical ventilation at the time of randomization.

    Decisions to initiate invasive mechanical ventilation were made by the attending clinicians, who were informed by guidance from NHS England and the National Institute for Health and Care Excellence. Subsidiary clinical outcomes included cause-specific mortality (which was recorded in all patients) and major cardiac arrhythmia (which was recorded in a subgroup of patients). All information presented in this report is based on a data cutoff of September 21, 2020. Information regarding the primary outcome is complete for all the trial patients.

    Statistical Analysis For the primary outcome of 28-day mortality, we used the log-rank observed-minus-expected statistic and its variance both to test the null hypothesis of equal survival curves and to calculate the one-step estimate of the average mortality rate ratio in the comparison between the hydroxychloroquine group and the usual-care group. Kaplan–Meier survival curves were constructed to show cumulative mortality over the 28-day period. The same methods were used to analyze the time until hospital discharge, with censoring of data on day 29 for patients who had died in the hospital. We used the Kaplan–Meier estimates to calculate the median time until hospital discharge.

    For the prespecified composite secondary outcome of invasive mechanical ventilation or death within 28 days (among patients who had not been receiving invasive mechanical ventilation at randomization), the precise date of the initiation of invasive mechanical ventilation was not available, so the risk ratio was estimated instead. Estimates of the between-group difference in absolute risk were also calculated. All the analyses were performed according to the intention-to-treat principle. Prespecified analyses of the primary outcome were performed in six subgroups, as defined by characteristics at randomization.

    Age, sex, race, level of respiratory support, days since symptom onset, and predicted 28-day risk of death. (Details are provided in the Supplementary Appendix.) Estimates of rate and risk ratios are shown with 95% confidence intervals without adjustment for multiple testing. The P value for the assessment of the primary outcome is two-sided. The full database is held by the trial team, which collected the data from the trial sites and performed the analyses, at the Nuffield Department of Population Health at the University of Oxford.

    The independent data monitoring committee was asked to review unblinded analyses of the trial data and any other information that was considered to be relevant at intervals of approximately 2 weeks. The committee was then charged with determining whether the randomized comparisons in the trial provided evidence with respect to mortality that was strong enough (with a range of uncertainty around the results that was narrow enough) to affect national and global treatment strategies. In such a circumstance, the committee would inform the members of the trial steering committee, who would make the results available to the public and amend the trial accordingly. Unless that happened, the steering committee, investigators, and all others involved in the trial would remain unaware of the interim results until 28 days after the last patient had been randomly assigned to a particular treatment group.

    On June 4, 2020, in response to a request from the MHRA, the independent data monitoring committee conducted a review of the data and recommended that the chief investigators review the unblinded data for the hydroxychloroquine group. The chief investigators and steering committee members concluded that the data showed no beneficial effect of hydroxychloroquine in patients hospitalized with Covid-19. Therefore, the enrollment of patients in the hydroxychloroquine group was closed on June 5, 2020, and the preliminary result for the primary outcome was made public. Investigators were advised that any patients who were receiving hydroxychloroquine as part of the trial should discontinue the treatment..

    Propecia real results

    NONE

    About Insight find more information Insight provides an in-depth look at health care propecia real results issues in and affecting California.Have a story suggestion?. Let propecia real results us know. This story was produced in partnership with PolitiFact. This story can be propecia real results republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the COVID pandemic and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!.

    € And, even as the nation’s COVID-19 death toll exceeded 180,000, Trump was upbeat. €œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible propecia real results enemy,” he said. €œLike those brave Americans before us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s COVID-19 response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but it needs context.It’s accurate that propecia real results the U.S.

    Developed its COVID-19 testing system from scratch, because the government didn’t accept the World Health Organization’s testing recipe. But whether the system propecia real results is the “largest” or “most advanced” is subject to debate.The U.S. Has tested more individuals propecia real results than any other country. But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested.

    Another useful metric would be the percentage of the population propecia real results that has been tested. The U.S. Is one of the most populous countries but has tested a lower propecia real results percentage of its population than other countries. Don't Miss A Story Subscribe to California Healthline’s free Weekly Edition newsletter.

    The propecia real results U.S. Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen propecia real results test, which the company says will be about the size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if propecia real results these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [COVID-19] case fatality rates of any major country in the world.

    The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate measures the known number of cases against the known number of deaths. The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a pandemic, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of propecia real results the virus, experts say, is to look at the number of deaths per 100,000 residents. Viewed that way, the U.S. Has the 10th-highest death rate propecia real results in the world.“We will produce a vaccine before the end of the year, or maybe even sooner.”It’s far from guaranteed that a coronavirus vaccine will be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the vaccine will be available to the public, which is what’s most important.

    Six vaccines are in the third phase of testing, which involves thousands of patients. Like earlier phases, this one looks at the safety of a vaccine but also examines its effectiveness propecia real results and collects more data on side effects. Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021.”And federal health officials and other experts have generally predicted a vaccine will be available in early 2021. Federal committees are working on recommendations for vaccine propecia real results distribution, including which groups should get it first.

    €œFrom everything we’ve seen now — in propecia real results the animal data, as well as the human data — we feel cautiously optimistic that we will have a vaccine by the end of this year and as we go into 2021,” said Dr. Anthony Fauci, the nation’s top infectious diseases expert. €œI don’t propecia real results think it’s dreaming.”“Last month, I took on Big Pharma. You think that is easy?.

    I signed orders that would massively lower the cost propecia real results of your prescription drugs.”Quite misleading. Trump signed four executive orders on July 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made propecia real results publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do. In 2017, Trump supported congressional efforts to repeal the ACA.

    The Trump administration propecia real results is now backing GOP-led efforts to overturn the ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading. During a June 2019 Democratic primary debate, candidates were propecia real results asked. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” All propecia real results candidates on stage, including Biden, raised their hands.

    They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status. A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the party he leads supports the extreme late-term abortion of defenseless babies right up propecia real results to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and related precedents. This would generally limit abortions to the first 20 to 24 weeks propecia real results of gestation.

    States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and propecia real results legal abortion — regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. This story was produced by Kaiser Health News, an editorially independent program propecia real results of the Kaiser Family Foundation.

    Related Topics Elections propecia real results Health Industry http://www.amisdepasteur.fr/propecia-5mg-price/ Insight Pharmaceuticals Public Health The Health Law Abortion COVID-19 Immigrants KHN &. PolitiFact HealthCheck Preexisting Conditions Trump Administration VaccinesAbout Insight Insight provides an in-depth look at health care issues in and affecting California.Have a story suggestion?. Let us propecia real results know. This story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a coronavirus pandemic that has killed more than 172,000 people.

    Many Americans are reluctant to visit a doctor’s office and propecia real results public health officials worry people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people in the U.S. Each year, with the very young, the elderly and those with underlying conditions the most vulnerable. When coupled with the effects of COVID-19, public health experts say it’s more important than ever to get a flu shot.If enough of propecia real results the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both COVID-19 patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both viruses — and “no one knows what happens if you get influenza and COVID [simultaneously] because it’s never happened before,” Dr.

    Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, propecia real results manufacturers are producing more vaccine supply this year, between 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control and Prevention. Email Sign-Up Subscribe to propecia real results California Healthline’s free Daily Edition. As flu season approaches, here are some answers to a few common questions:Q. When should I get my flu propecia real results shot?.

    Advertising has already begun, and some pharmacies and clinics have their supplies now. But, because the effectiveness of the vaccine can wane over time, propecia real results the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September. Generally, influenza viruses start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting propecia real results a shot for antibodies — which circulate in the blood and thwart infections — to build up.

    €œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin in October,” said Dr. Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people “get a flu vaccine by the end of October,” but noted it’s not too late to get one after that because propecia real results shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of COVID-19, but also in case a shortage develops because of overwhelming demand.Q. What are the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent COVID-19, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get propecia real results influenza from having a flu vaccine.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said.

    It recommends propecia real results that children over 6 months old get vaccinated.Q. What do we know about the effectiveness of this year’s vaccine?. Flu vaccines — which must be developed anew each year because influenza viruses mutate — range in effectiveness annually, depending on how well they match the circulating virus propecia real results. Last year’s formulation was estimated to be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children.

    The vaccines available in the U.S propecia real results. This year are aimed at preventing at least three strains of the virus, and most cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S. Early indications from the Southern Hemisphere, which goes through its flu season during our summer, propecia real results are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu levels are lower than expected.

    Experts caution, propecia real results however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.Q. What are insurance plans and health systems doing propecia real results differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas. Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent propecia real results events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations.

    (KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu vaccine this year,” said Mark Shelly, the system’s director of infection prevention and control. €œBy taking this step, propecia real results we hope to convey to our neighbors the importance of the flu vaccine for everyone.”Q. Usually I get a flu shot at work. Will that be an option this propecia real results year?.

    Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need to bring flu shots to employees on the job. Instead, many employers are encouraging workers to get shots from their primary care doctors, at pharmacies or in other community settings. Insurance will generally cover the cost of the vaccine.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm.

    The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr. David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are pharmacies doing to encourage people to get flu shots?. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr.

    Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against COVID,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing vaccines in advance is one thing we can do.” This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Julie Appleby. jappleby@kff.org, @julie_appleby Related Topics Insight Insurance Public Health CDC COVID-19 Insurers Vaccines.

    About Insight Insight provides an find more in-depth propecia for sale uk look at health care issues in and affecting California.Have a story suggestion?. Let propecia for sale uk us know. This story was produced in partnership with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of propecia for sale uk the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the COVID pandemic and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!.

    € And, even as the nation’s COVID-19 death toll exceeded 180,000, Trump was upbeat. €œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible enemy,” propecia for sale uk he said. €œLike those brave Americans before us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s COVID-19 response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but it propecia for sale uk needs context.It’s accurate that the U.S.

    Developed its COVID-19 testing system from scratch, because the government didn’t accept the World Health Organization’s testing recipe. But whether the system is the “largest” or propecia for sale uk “most advanced” is subject to debate.The U.S. Has tested more individuals propecia for sale uk than any other country. But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested.

    Another useful metric would be the percentage of the population that propecia for sale uk has been tested. The U.S. Is one of propecia for sale uk the most populous countries but has tested a lower percentage of its population than other countries. Don't Miss A Story Subscribe to California Healthline’s free Weekly Edition newsletter.

    The propecia for sale uk U.S. Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the propecia for sale uk size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if these testing systems are already propecia for sale uk in place when they haven’t been distributed to the public.“The United States has among the lowest [COVID-19] case fatality rates of any major country in the world.

    The European Union’s case fatality rate is nearly three times higher than ours.”The case fatality rate measures the known number of cases against the known number of deaths. The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a pandemic, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of the virus, experts say, is to look at the number propecia for sale uk of deaths per 100,000 residents. Viewed that way, the U.S. Has the 10th-highest death rate in the world.“We will produce a vaccine before the end of the year, or maybe even sooner.”It’s far from guaranteed that a coronavirus vaccine will be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the vaccine will be available to the propecia for sale uk public, which is what’s most important.

    Six vaccines are in the third phase of testing, which involves thousands of patients. Like earlier phases, this one looks at the safety of a vaccine but also examines its effectiveness and collects more data on side propecia for sale uk effects. Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021.”And federal health officials and other experts have generally predicted a vaccine will be available in early 2021. Federal committees are working on recommendations for vaccine distribution, including which groups should get it propecia for sale uk first.

    €œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously propecia for sale uk optimistic that we will have a vaccine by the end of this year and as we go into 2021,” said Dr. Anthony Fauci, the nation’s top infectious diseases expert. €œI don’t think it’s dreaming.”“Last month, I took on Big propecia for sale uk Pharma. You think that is easy?.

    I signed orders that would massively lower the cost of your prescription drugs.”Quite misleading propecia for sale uk. Trump signed four executive orders on July 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care propecia for sale uk Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do. In 2017, Trump supported congressional efforts to repeal the ACA.

    The Trump administration is now backing GOP-led efforts to overturn the propecia for sale uk ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading. During a June 2019 Democratic propecia for sale uk primary debate, candidates were asked. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” All candidates on propecia for sale uk stage, including Biden, raised their hands.

    They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status. A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, propecia for sale uk without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and related precedents. This would generally limit abortions to the first 20 to 24 weeks of gestation propecia for sale uk.

    States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, propecia for sale uk including safe and legal abortion — regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. This story was produced by Kaiser Health News, an editorially independent program propecia for sale uk of the Kaiser Family Foundation.

    Related Topics Elections Health Industry Insight Pharmaceuticals Public Health The Health Law Abortion COVID-19 propecia for sale uk Immigrants KHN &. PolitiFact HealthCheck Preexisting Conditions Trump Administration VaccinesAbout Insight Insight provides an in-depth look at health care issues in and affecting California.Have a story suggestion?. Let us know propecia for sale uk. This story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a coronavirus pandemic that has killed more than 172,000 people.

    Many Americans are reluctant to visit a doctor’s office and public health officials worry propecia for sale uk people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people in the U.S. Each year, with the very young, the elderly and those with underlying conditions the most vulnerable. When coupled with the effects of COVID-19, public health experts say it’s more important than ever to get a flu shot.If enough of the U.S propecia for sale uk. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both COVID-19 patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both viruses — and “no one knows what happens if you get influenza and COVID [simultaneously] because it’s never happened before,” Dr.

    Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, manufacturers are producing propecia for sale uk more vaccine supply this year, between 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control and Prevention. Email Sign-Up Subscribe propecia for sale uk to California Healthline’s free Daily Edition. As flu season approaches, here are some answers to a few common questions:Q. When should propecia for sale uk I get my flu shot?.

    Advertising has already begun, and some pharmacies and clinics have their supplies now. But, because the effectiveness of the vaccine can wane over time, the CDC recommends against a shot in August.Many pharmacies and clinics propecia for sale uk will start immunizations in early September. Generally, influenza viruses start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a propecia for sale uk shot for antibodies — which circulate in the blood and thwart infections — to build up.

    €œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin in October,” said Dr. Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people “get a flu vaccine by the end of October,” but noted it’s not too late to get one after that because shots “can still be propecia for sale uk beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of COVID-19, but also in case a shortage develops because of overwhelming demand.Q. What are the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to propecia for sale uk others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent COVID-19, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu vaccine.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said.

    It recommends that children over 6 propecia for sale uk months old get vaccinated.Q. What do we know about the effectiveness of this year’s vaccine?. Flu vaccines — propecia for sale uk which must be developed anew each year because influenza viruses mutate — range in effectiveness annually, depending on how well they match the circulating virus. Last year’s formulation was estimated to be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children.

    The vaccines propecia for sale uk available in the U.S. This year are aimed at preventing at least three strains of the virus, and most cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S. Early indications from the Southern Hemisphere, which goes propecia for sale uk through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu levels are lower than expected.

    Experts caution, propecia for sale uk however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.Q. What are insurance plans and health systems doing differently this year? propecia for sale uk. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas. Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and propecia for sale uk is testing touch-free screening and check-in procedures at some locations.

    (KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu vaccine this year,” said Mark Shelly, the system’s director of infection prevention and control. €œBy taking this step, we hope to convey to our neighbors the importance of the flu propecia for sale uk vaccine for everyone.”Q. Usually I get a flu shot at work. Will that be an option this year? propecia for sale uk.

    Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need to bring propecia for sale uk flu shots to employees on the job. Instead, many employers are encouraging workers to get shots from their propecia for sale uk primary care doctors, at pharmacies or in other community settings. Insurance will generally cover the cost of the vaccine.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm.

    The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr. David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are pharmacies doing to encourage people to get flu shots?. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr.

    Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against COVID,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing vaccines in advance is one thing we can do.” This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Julie Appleby. jappleby@kff.org, @julie_appleby Related Topics Insight Insurance Public Health CDC COVID-19 Insurers Vaccines.

    Propecia before after

    NONE

    Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries.

    During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls.

    Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

    The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

    - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an infection.

    These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

    To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer.

    €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a virus, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

    In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

    Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

    Credit propecia class action suit propecia for sale uk. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the propecia for sale uk most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb.

    Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring propecia for sale uk associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in propecia for sale uk patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition.

    In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared propecia for sale uk to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the propecia for sale uk link between the two conditions remains unclear,” she says.

    However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only propecia for sale uk for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition. The other propecia for sale uk authors on this paper were Ginette A.

    Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer propecia for sale uk types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

    - Click to Tweet The “mutational burden,” or the number propecia for sale uk of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of propecia for sale uk Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

    As a result, the drugs cause the immune system to fight cancer in the same way that it would fight http://www.amisdepasteur.fr/online-propecia-prescription/ an infection. These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and propecia for sale uk lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden propecia for sale uk of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow.

    Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many propecia for sale uk different cancer types was unclear. To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from propecia for sale uk patients with different tumor types.

    Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained propecia for sale uk by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

    It’s one of those things that doesn’t sound propecia for sale uk right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations propecia for sale uk yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a virus, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

    In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet propecia for sale uk been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good propecia for sale uk predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs.

    €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says. Yarchoan receives propecia for sale uk funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

    Propecia and erectile dysfunction

    NONE

    04 September, http://www.amisdepasteur.fr/buy-brand-name-propecia-online/ 2020 propecia and erectile dysfunction. Following a comprehensive search, the Board of the Australian Digital Health Agency announced today that Ms Amanda Cattermole PSM will be appointed as Chief Executive Officer of the Agency. Ms Cattermole has a long and distinguished history of propecia and erectile dysfunction senior leadership roles in service delivery in the public sector, leading high performing organisations, while growing customer satisfaction and staff engagement.

    She also has deep expertise in digital transformation across government and within the health sector.Most recently, Ms Cattermole was Chief Operating Officer of Services Australia with responsibility for budget and financial services, people, governance, audit and risk. Ms Cattermole was previously the interim propecia and erectile dysfunction CEO of Services Australia and has held Deputy Secretary roles in health service delivery in the Commonwealth and in the Victorian State Government. Ms Cattermole holds a Master of Laws from Charles Darwin University, a Master of Business Administration from the University of Western Australia and Bachelor Degrees in Law and Commerce from the University of Melbourne.Welcoming Ms Cattermole’s appointment on behalf of the Agency, Board Chair Dr Elizabeth Deveny said “Amanda Cattermole is held in the highest regard across the public service and health sector and will bring a depth of knowledge and capability to the role of CEO at a time when digital health has never been more important.

    The Board has appointed a leader who is deeply skilled, committed to improving the health of all Australians and who understands the importance of digital innovation in better connecting Australia’s healthcare system.”The Hon Greg Hunt, Minister for Health, said “I am pleased to welcome Ms Cattermole and look forward to working closely together to drive technology in healthcare as propecia and erectile dysfunction the need has never been greater.”The Board of the Agency also acknowledged the invaluable leadership of Ms Bettina McMahon, who has acted as CEO since February this year. €œThe Board of the Agency would like to thank Ms McMahon for her leadership, dedication and commitment, and wishes her the best for the future.”Ms Cattermole will commence on Tuesday 29 September.Media contactAustralian Digital Health Agency Media TeamMobile. 0428 772 421Email.

    [email protected] About the Australian Digital Health AgencyThe Agency is tasked with improving health outcomes for all Australians through the delivery of digital propecia and erectile dysfunction healthcare systems, and implementing Australia’s National Digital http://www.amisdepasteur.fr/buy-propecia-1mg-online/ Health Strategy – Safe, Seamless, and Secure. Evolving health and care to meet the needs of modern Australia in collaboration with partners across the community. The Agency is the System Operator of My Health Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health propecia and erectile dysfunction system.

    These improvements will give individuals more control of their health and their health information, and support healthcare providers to deliver informed healthcare through access to current clinical and treatment information. Further information propecia and erectile dysfunction. Www.digitalhealth.gov.auMedia release - Australian Digital Health Agency CEO announced.docx 66KB)Media release - Australian Digital Health Agency CEO announced.pdf (191KB)By operation of the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016, on 1 July 2016, all the assets and liabilities of NEHTA will vest in the Australian Digital Health Agency.

    In this website, on and from 1 July 2016, all references to "National E-Health Transition Authority" or "NEHTA" will be propecia and erectile dysfunction deemed to be references to the Australian Digital Health Agency. PCEHR means the My Health Record, formerly the "Personally Controlled Electronic Health Record", within the meaning of the My Health Records Act 2012 (Cth), formerly called the Personally Controlled Electronic Health Records Act 2012 (Cth). Website Accessibility Copyright ©2015-2020 Australian Digital Health Agency.

    04 September, propecia for sale uk 2020 other. Following a comprehensive search, the Board of the Australian Digital Health Agency announced today that Ms Amanda Cattermole PSM will be appointed as Chief Executive Officer of the Agency. Ms Cattermole has a long and distinguished history of senior leadership roles in service delivery in the public sector, leading high performing organisations, propecia for sale uk while growing customer satisfaction and staff engagement. She also has deep expertise in digital transformation across government and within the health sector.Most recently, Ms Cattermole was Chief Operating Officer of Services Australia with responsibility for budget and financial services, people, governance, audit and risk. Ms Cattermole was previously the interim CEO of Services Australia and has held Deputy Secretary roles in health service delivery in the Commonwealth and in the Victorian State propecia for sale uk Government.

    Ms Cattermole holds a Master of Laws from Charles Darwin University, a Master of Business Administration from the University of Western Australia and Bachelor Degrees in Law and Commerce from the University of Melbourne.Welcoming Ms Cattermole’s appointment on behalf of the Agency, Board Chair Dr Elizabeth Deveny said “Amanda Cattermole is held in the highest regard across the public service and health sector and will bring a depth of knowledge and capability to the role of CEO at a time when digital health has never been more important. The Board propecia for sale uk has appointed a leader who is deeply skilled, committed to improving the health of all Australians and who understands the importance of digital innovation in better connecting Australia’s healthcare system.”The Hon Greg Hunt, Minister for Health, said “I am pleased to welcome Ms Cattermole and look forward to working closely together to drive technology in healthcare as the need has never been greater.”The Board of the Agency also acknowledged the invaluable leadership of Ms Bettina McMahon, who has acted as CEO since February this year. €œThe Board of the Agency would like to thank Ms McMahon for her leadership, dedication and commitment, and wishes her the best for the future.”Ms Cattermole will commence on Tuesday 29 September.Media contactAustralian Digital Health Agency Media TeamMobile. 0428 772 421Email. [email protected] About the Australian Digital Health AgencyThe Agency is propecia for sale uk tasked with improving health outcomes for all Australians through the delivery of digital check my source healthcare systems, and implementing Australia’s National Digital Health Strategy – Safe, Seamless, and Secure.

    Evolving health and care to meet the needs of modern Australia in collaboration with partners across the community. The Agency is the System Operator of My Health propecia for sale uk Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system. These improvements will give individuals more control of their health and their health information, and support healthcare providers to deliver informed healthcare through access to current clinical and treatment information. Further information propecia for sale uk. Www.digitalhealth.gov.auMedia release - Australian Digital Health Agency CEO announced.docx 66KB)Media release - Australian Digital Health Agency CEO announced.pdf (191KB)By operation of the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016, on 1 July 2016, all the assets and liabilities of NEHTA will vest in the Australian Digital Health Agency.

    In this website, on and from 1 July 2016, all references to "National E-Health Transition Authority" or "NEHTA" will be deemed to be propecia for sale uk references to the Australian Digital Health Agency. PCEHR means the My Health Record, formerly the "Personally Controlled Electronic Health Record", within the meaning of the My Health Records Act 2012 (Cth), formerly called the Personally Controlled Electronic Health Records Act 2012 (Cth). Website Accessibility Copyright ©2015-2020 Australian Digital Health Agency.

    Propecia vs rogaine foam

    NONE

    We live in unprecedented propecia vs rogaine foam times. But what makes them without parallel is not the current pandemic crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for the first time, the problems of accessibility, rights and freedoms are now invading privileged spaces. There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals.

    For many, the world is not suddenly on fire.

    We live propecia coupon in propecia for sale uk unprecedented times. But what makes them without parallel is not the current pandemic crisis nor the continued problems facing minorities in our institutions. Rather, it’s that for the first time, the problems of accessibility, does propecia rights and freedoms are now invading privileged spaces. There can be no ‘getting back to normal’, because ‘normal’ only ever benefited the white, Western, patriarchal, abled and cis ideals. For many, the world is not suddenly on fire.

  • Is generic finasteride as effective as propecia

    Où rencontrer Pasteur dans Dole

    A la façon du Circuit du Chat Perché qui permet de découvrir les sites les plus attractifs de Dole, Alain Marchal nous propose de déambuler dans certains lieux publics dolois...pour admirer statues, fresques trompe-l’œil, mosaïques ou bustes à l'effigie...

    > LIRE LA SUITE

  • Is generic finasteride as effective as propecia

    Où rencontrer Pasteur dans Dole

    A la façon du Circuit du Chat Perché qui permet de découvrir les sites les plus attractifs de Dole, Alain Marchal nous propose de déambuler dans certains lieux publics dolois...pour admirer statues, fresques trompe-l’œil, mosaïques ou bustes à l'effigie...

    > LIRE LA SUITE

  • Is generic finasteride as effective as propecia

    Visite passion

    Pendant les vacances , venez faire la connaissance de Louis PASTEUR, visitez sa maison natale à Dole et la salle scientifique exposant les découvertes de notre grand savant Jurassien.
    Les bénévoles des Amis de PASTEUR vous proposent une "visite passion...

    > LIRE LA SUITE

  • Is generic finasteride as effective as propecia

    Visite passion

    Pendant les vacances , venez faire la connaissance de Louis PASTEUR, visitez sa maison natale à Dole et la salle scientifique exposant les découvertes de notre grand savant Jurassien.
    Les bénévoles des Amis de PASTEUR vous proposent une "visite passion...

    > LIRE LA SUITE

  • Is generic finasteride as effective as propecia

    Louis Pasteur et le ver à soie :


    Une exposition présentera à la Maison natale des aspects actuels de l'utilisation de la soie, dans les domaines industriels et techniques, dans la création artistique, avec un clin d'oeil aux travaux de Pasteur sur les maladies des vers à soie en...

    > LIRE LA SUITE

  • Is generic finasteride as effective as propecia

    Visite passion

    Pendant les vacances , venez faire la connaissance de Louis PASTEUR, visitez sa maison natale à Dole et la salle scientifique exposant les découvertes de notre grand savant Jurassien.
    Les bénévoles des Amis de PASTEUR vous proposent une "visite passion...

    > LIRE LA SUITE