Get a prescription for cialis

Welcome to the first issue of get a prescription for cialis 2022! cialis online 20mg. We have several exciting changes to announce in the new year. To begin with, we have been increasing our number of published submissions per issue, get a prescription for cialis including some of our content exclusively online (the most common way that our readers access the journal). In addition, we have put out additional calls for submissions and look forward to receiving new work.We have spent the last 4 years working towards social justice, accessibility, global …IntroductionThe subject of care is gaining importance within the medical humanities, but it also remains elusive. Hence, this paper aims to unpack theoretical notions of care in a way that integrates the elusiveness rather than trying to avoid it.

It also responds to a recent article by Julia Kristeva et al, in which they claim that care get a prescription for cialis holds humanity (Kristeva et al. 2018).When in need of theoretical elaboration or re-development, medical humanities scholars have sometimes evoked Greek or Roman myths, such as those of Narcissus, Hephaestus or Leto (Cilione, Marinozzi, and Gazzaniga 2019. Pannese 2011. Schott 2017) get a prescription for cialis. Similarly, this article evokes the Roman myth of Cura to unpack theoretical understandings of care.

In this myth, known from the writings of the first century mythographer Hyginus, humanity is created from clay by a personification of care. It has proven useful to thinkers as diverse as Martin Heidegger, get a prescription for cialis Arthur Kleinman (Kleinman and van der Geest 2009) and Julia Kristeva (Kristeva (2012), Kristeva et al. 2018). While utilisation by Heidegger 1927, 196–200 ‘challenges the myth of self-sufficiency and individual atomization that that has shaped much of modern Western philosophy’ (Froese 2005, 16), both Kleinman and Kristeva explore the tension between universalised knowledge and the singularity of individual patients and intimate care (Engebretsen, Fraas Henrichsen, and Ødemark 2020).While none of these scholars engage with Hyginus’ Fabulae directly, I use the get a prescription for cialis text as an ‘engine’ in a four-step endeavour. This endeavour follows Brandy Schillace’s description of the medical humanities as ‘a field that at its core considers the human story behind and within medicine, its history, its cultural valence and its influence on practice’ Schillace (2017, 139).First, a ‘human story’ entails agency, the things that humans do in their lives.

While the ‘appeal’ from Kristeva et al uses a case from intercultural psychoanalysis, the authors have previously researched a variety of professional healthcare practices (Engebretsen 2016. Engebretsen, Sandset, and Ødemark 2017 get a prescription for cialis. Hetrick et al. 2017). However, it is crucial to note that Cura (in Hyginus’ text) will ‘hold’ humanity quamdiu vixerit get a prescription for cialis (for as long as he shall live).

Such a life-long temporality does not dovetail with the temporary, regulated and systematised relations of healthcare organisations. Hyginus’ text has, I argue, a much stronger affinity to the temporality of parental care. Hence, I begin get a prescription for cialis the endeavour by acknowledging that I am a scholar, and the father of a boy with little linguistic function.1 Although my parental care for my son entails a multitude of meanings and instances, I begin with two tales from my parental care in 2020:Sometimes, if he does not understand what is going on, or if his actions feel unintelligible to others who are present, I take him in my arms. In that way, we are at least together in a situation when both of us otherwise would have been on our own. Suddenly, it feels as get a prescription for cialis if I am not only holding or embracing him away from an abyss.

I am also holding him—or, perhaps, shielding him—in the face of many, many abysses to come.In rough-and-tumble play, I often lift him up with my arms straight—holding him while he straightens his body, and ‘is an airplane’. Although this play is exhausting, particularly since I live with cerebral palsy, this is nevertheless an activity where we can be close to one another. When I hold him up like this, or suddenly ‘crash’ him safely down next to me on the bed, we are skin to skin, but not exactly like I used to be with his older siblings, and I suddenly have the impression that it also differs from how most fathers do this with their get a prescription for cialis children. I cannot know if our way is exclusively ours, but while I hold him, that is how it feels.Second, a human story ‘behind and within medicine’—or, for that matter, behind and within any social field—consists of underlying notions and involved cultural categories. Hence, this article aims to unpack theoretical notions of care with reference to the thinkers mentioned above.

Throughout, I try to unpack how different aspects of care ‘follow’ each other in an analytical get a prescription for cialis ‘path’ or trajectory, as if in a story (Kristeva et al. 2018).Third, the investigation of the human story of care must become an investigation of ‘history’ and ‘cultural valence’. In order to think historically, the analytical ‘engine’ includes Hyginus’ text, and 18th and 19th century uses of Cura and related motifs.Fourth, I follow Schillace’s advice to examine ‘influence on practice’. In addition to the practice of parental care, the exploration ends with a discussion of get a prescription for cialis medical humanities as practice. When medical humanities scholars ’consider’ the human story of care, they bring together different perspectives and forms of knowledge.

In this case, however both the intertextual analyses and the autotheoretical work indicate that those complexities might overpower get a prescription for cialis our theoretical perspectives. Hence, I conclude with a call for epistemological and analytical modesty.MethodAlthough the abovementioned scholars have used the myth of Cura for clearly theoretical purposes, several of them explore this also as carers in a personal sense. Julia Kristeva writes her work on care as the mother of a man with severe disabilities Kristeva (2013, 219–221), Arthur Kleinman and Geest (2009, 159–163) begin their rethinking with a rich narrative of his caring for his wife who lives with Alzheimer’s disease. In line with their work, this article combines textual interpretation with autotheoretical get a prescription for cialis work.Often used in connection with genre-bending memoir The Argonauts by Maggie Nelson (2015), the term ‘autotheory’ designates a literary form involving ‘the combination of autobiography and critical theory’ (Pearl 2018, 200). In this article, however, I rely on the work of the Canadian artist, curator, writer and interdisciplinary researcher Fournier (2019), who has unpacked autotheory with particular reference to illness and embodiment.

Fournier describes autotheory as a specific form of academic practice:In autotheory as a conceptual and performative feminist practice, artists, writers, and critics use the first person, or related practices of self-imaging (Jones, Self/Image 134), to process, perform, enact, iterate, and wrestle with the hegemonic discourses of ‘theory’ and philosophy, extending the feminist practice of theorizing from one’s subject positioning as a way of engendering insights into questions related to aesthetics, politics, ethics, and social and cultural theory. In autotheory, get a prescription for cialis one’s embodied experiences become the material through which one theorizes, and, in a similar way, theory becomes the discourse through which one’s lived experience is refracted (658).In Fournier’s definition, theory functions as ‘hegemonic discourses’, and as discourses through which one’s lived experience is refracted. Contrary to this emphasis on language—as well as their emphasis on language elsewhere (Heidegger 1927Heidegger 1937. Kleinman 1995. Kristeva 2019)—neither Kristeva nor Kleinman or Heidegger focus on Hyginus’ get a prescription for cialis text.

In contrast to this body of research, this article emphasizes the interpretative potential of the original text. In addition to grammatical get a prescription for cialis analysis, I utilize the well-known concept of intertextuality, as introduced by Kristeva (1980). However, I use it in a less structuralist sense than in her early formulations in Desire in Language. Instead, I approach Hyginus’ text in line with her approach in ‘Nos Deux’ or a short (hi)story of intertextuality (Kristeva 2002).For me, intertextuality is mostly a way of making history go down in us. We, two texts, two destinies, two psyches get a prescription for cialis.

It is a way if introducing history to structuralism and its orphan, lonely texts and readings. […] the etymological meaning of ‘semeion’ is a distinctive mark, a trace, an engraved or written sign, that makes us think of the Freudian ‘psychical’ marks, called drives, rhythmical articulations of embodied impulses and psychical movements. In this sense, the meaning of the socio-historical aspect of intertextuality, as already developed by Bakhtin get a prescription for cialis and Barthes, acquires a new significance. Within each sociolect or ideology, (both well-established sign-systems) there will always be a breach of subjectivity carrying out a hidden matrix of pre-symbolic forces able to make history move on through all its short and singular stories. (2002.

8-9)First, this means that I study Hyginus’ text not as a ‘lonely text’, but get a prescription for cialis as part of a historical trajectory. The ‘singular stories’ are used to disturb the orderly (structural) notions of both textual and philosophical analysis.Second, I interpret Hyginus’ text—as well as other utilisations of the myth—with focus on traces. Or, more specifically, to find ‘distinctive marks’ relevant to the same material get a prescription for cialis as in authotheretical work. €˜embodied impulses and psychical movements’. This, however, does not mean that the texts are reduced to a canvas for an engraved sign.

In methodological term, the aim is to allow the two destinies—the textual trajectory of the Cura motif, and the personal trajectory that becomes so intimate when I hold my son in my arms—to shed light on one another.Third, the interaction get a prescription for cialis between these two methodological approaches will hopefully allow history—what Schillace calls the ‘human story’—to move in two diachronic ways. I aim to emphasise the differences between the different utilisations of the myth. Finally, I also aim to locate breaches in the ‘well-established sign systems’ we call theories of care, to get a glimpse of something yet hidden.Humanity as creation, care as fundamental conditionIn a narrative sense, Hyginus tells three stories. A story of the creation of humanity followed by a story of a quarrel between deities and finally, a verdict get a prescription for cialis on the ontological role of care in human life. The first story in Hyginus’ fable begins thus:Cura cum quendam fluvium transiret, vidit cretosum lutum.

Sustulit cogitabunda et coepit fingere hominem.When Cura was crossing a certain river, she saw some clayey mud. She took it up thoughtfully and began to get a prescription for cialis fashion a man.Before interpreting this first story, we must first acknowledge that the fable is an alteration or addition in a philological sense. While Fabulae is almost exclusively filled with Greek myths, the Cura fable’s position at the end of the collection suggests, ‘that this particularly Roman tale was simply added to the end of the existing narrative portion’ (Smith and Trzaskoma 2007, xlix). Moreover, philological research consistently argues that get a prescription for cialis fable CCXX ‘hinges on Latin wordplay’ (Smith and Trzaskoma 2007, xlviii).More specifically, Hyginus, in the Cura fable, alters a prevailing myth in late antiquity, one that he has even told earlier in the pages of Fabulae. That of how the titan Prometheus fashioned man from clay.

In fable CXLII (‘Pandora’), Hyginus states explicitly that Prometheus lapeti filius primus homines ex luto finxit (Prometheus, son of Iapetus, first fashioned men from clay).Most Greek and Roman sources place the Prometheus plasticator motif within a three-stage narrative. First, Prometheus shapes the human from clay, and then Athena gives the creature get a prescription for cialis inner life. Finally, sometimes after Prometheus has given humankind fire against the orders of Jove, Jove intervenes and sentences Prometheus to eternal punishment in the Caucasus.To understand the human story—to which both this motif and Hyginus’ text belong—comparison is needed. First, we must note that the neutral or slightly idyllic depictions in Hyginus and Ovid (respectively) differ from earlier and less optimistic renderings in Republican times. The poet get a prescription for cialis Propertius, for instance, in his Libri Elegiarum from the first-century BC, laments and elaborates on how Prometheus was careless in his creating.

Here, the adverbial clause ille parum caute casts Prometheus as a figure of titanic heedlessness:ille parum caute pectoris egit opus.corpora disponens mentem non vidit in arto:The making of man’s reason he performed with too little care.Arranging our bodies, he overlooked the mind in his handiwork (Goold 1990, 232).Carelessness, the counterpart to the notion of care, is involved in the Prometheus plasticator motif throughout antiquity. The adverbial clause ille parum caute does not derive from the same verb as Cura, but rather from the verb caveo (to take precautions, to be aware of something). Nevertheless, Prometheus’ lack of care underlines how Hyginus’ text is an inversion these get a prescription for cialis earlier texts. Instead of being created in a careless way, humanity is created by care.To be fair, a singular text never exhausts the potential of the history to which it belongs. Specific understandings—in this get a prescription for cialis case.

Theoretical notions of care—are only a part of a wide array of potentials. The Prometheus Plasticator motif foreshadows 20th and 21st century theories of care, and 18th and 19th century depictions of Prometheus as a figure of romantic transgression. In Goethe’s poem Promethevs (written 1774, published 1789), Prometheus becomes a figure of independence and defiance—as expressed, for instance, in the final stanza:Hier sitz' ich, forme Menschen / Nach meinem Bilde, / Ein Geschlecht, das mir gleich sei, / Zu get a prescription for cialis leiden, zu weinen, / Zu genießen und zu freuen sich, / Und dein nicht zu achten, / Wie ich!. (Goethe 1998, 44–46)Here sit I, forming mortals /In my image. / A race resembling me, / To suffer, to weep, / To enjoy, to be glad, / And thee to scorn, /As I!.

(Bowring 2015, get a prescription for cialis 182)Typical of Goethe’s Sturm und Drang period, his Prometheus Plasticator is a figure of creativity, and embodies ‘ideals of freedom and rebellion’ (Raggio 1958, 44). Goethe’s poem emphasised the ‘autonomous existence’ of mankind (Dougherty 2006, 95), thereby constituting an ‘emancipatory gesture’ (Edgar 2002, 161). Hyginus’ text inverts both classical and romantic evokings of the myth by inserting dependency rather than autonomy and expansion. To shed further light on this inversion, we must first unpack the name of the personification that get a prescription for cialis Hyginus instals in the Prometheus Plasticator motif. Cura.The name Cura is derived from the verb curo.

The Oxford Latin Dictionary defines the verb thus:To watch over, look after, care for.To tend to, to do what is necessary to.To administer remedies, to treat (a sick person, wound, disease, etc).To have charge of. (absol.) to be in command.To devote oneself to, to cultivate (a person).To undertake, to see to (a task or a responsibility).To regard with get a prescription for cialis anxiety or interest, worry or care about, heed.As we can see, the first three senses of this verb invert the Prometheus motif we found in Propertius. To instal the personification of curo in the motif is to instal carefulness, attentiveness and responsibility in a motif usually filled with lack of care. The third get a prescription for cialis sense also injects an aspect that is totally absent in classical anthropogenies. That of human frailty.

It also relates to aspects of human lives that are particularly relevant to understanding care, illness, disease and disability.The fifth and sixth senses of the word similarly invert the romantic depictions of Prometheus motif. The anthropogenic act is no longer about rebellion get a prescription for cialis and expansion, but devotion and responsibility. The seventh sense finally reverses the political impulse of the Sturm und Drang—the desire for increased individual freedom and self-expansion in every imaginable way—into worrying and heeding.In addition to these intertextual relations, it is also fruitful to note the verbs that connect humanity to the three deities. While Cura’s creating is described with the verb fingo (in Hyginus. €˜fingere’), Jove’s and Tellus’ acts of giving get a prescription for cialis are described by do (in Hyginus.

€˜dedisti’). While the former verb is a very tactile verb, a matter of touch and contact, do signifies separation—to deliver or give something, to separate it from something in order to unite it with something else. An initial understanding of care emerges from get a prescription for cialis these textual relations. Care is fundamental (by belonging to the anthropogony), antithetical (by being the antithesis of carelessness and neglect) and intimate (by establishing relation through touch).Care imaginationsWhen modern scholars use Hyginus’ text, one word of the first sentence is often overlooked. Cogitabunda (thoughtful) get a prescription for cialis.

Although an adjective in the purely grammatical sense, this is the only word with an adverbial function in Hyginus’ text. Hence, it is the lone term specifying how actions and interactions take place. While Greco-Roman deities often act from rage (as in the conflict between the titans and Olympian deities) or desire (as in the story of get a prescription for cialis Zeus and Leda), Cura acts thoughtfully or with thought.As we can see, the adverb cogitabunda is attached to the picking up of the clay, not primarily to the act of creation. Sustulit cogitabunda et coepit fingere hominem. Moreover, the temporal clause ‘and begun to’ (et coepit) also locates this thought as prior to the creation of humanity.

To understand care as get a prescription for cialis thoughtful, then, is about understanding thoughts and imaginaries ‘involved’ in care, and it includes thoughts and imaginaries that ‘pre-exist’, ‘frame’ or ‘underpin’ care and care work.It is useful to explore how the meaning of cogitabunda is preserved and unveiled in the work of the German philosopher, poet and literary critic Johann Gottfried Herder (1744–1803). In his poem ‘Das Kind der Sorge’ (1787), Herder follows Hyginus very closely (Bernays 1869, 158-163). This poem was widely read, and it provided the basis for Goethe’s use of the Cura motif in Faust II (1832). Finally, Heidegger also comments on the poem and cites it in extenso when he develops his notion of Sorge as the fundamental human condition (Dye 2009, 207–218)., Kristeva (2001), too, refers several times to get a prescription for cialis Herder, and even refers directly to this poem (25–26). The first stanza describes the moment of creation thus:Einst saß am murmelnden StromeDie Sorge nieder und sann:Da bildet im Traum der GedankenIhr Finger ein leimernes Bild (von Herder 1889, 75).Once by a murmuring riverSorrow sat down, and there,In a vision, thought to form with the touchA wavering figure (Groth 2016, 31).von Herder positions the moment of creation as a radically imaginative act in at least three ways.

First, the get a prescription for cialis gaze is far more manifest in von Herder’s text than in Hyginus’. While Hyginus’ Cura shapes a human (hominen) directly, von Herder’s ‘Sorge’ shapes an image (Bild). This dovetails well with important insights from care research. In relations of care, the cared-for becomes visible to the carer(s), thereby also get a prescription for cialis becoming a valued imago. Conversely, the carer(s) become visible in the imagination of the cared-for—even in a Western culture that often obscures or silences interpersonal interdependence.Second, cogitabunda in Hyginus is also intertextually connected von Herder’s adverbial clause im Traum der Gedanken.

This phrase, roughly translatable as ‘in the dream of thoughts’, roots humanity in a singular image (or dream) that consist of or belong to several different thoughts or ways of thinking. This tension get a prescription for cialis between individuality and multitude dovetails with research on the knowledge complexities involved in care.Third, the word ‘Traum’ (dream) in Traum der Gedanken does not denote unreality, fantasy or illusion. For von Herder, dreams are not the opposite of reality, but thoughts beyond or above manifest reality (Wirklichkeit überhöhenden Gedankens). A dream of thoughts, then, is an experience or interpretation wherein the understanding of a phenomenon moves beyond how the phenomenon presently is, to what it should or could be. Just as Hyginus’ cogitabunda can, if we interpret in intertextual connection with von Herder’s Traum get a prescription for cialis der Gedanken, also refract my experiences of holding my son in my arms.

This is true of the experiences of performing actions that seem strange or unintelligible to those around us, but particularly true of the feeling of doing this in a way that is uniquely ours. The combination of these feelings—where the socially estranged ways of get a prescription for cialis caring is fundamentally ours and integral to my parenting—engenders or entails a striving ‘upwards’. This striving is not limited to the idealisation that so often takes place in parenting, but is also a utopian, imaginative glimpse of a world wherein the both of us truly belong.In other words, the Cura motif foreshadows the ‘horizontal’ complexities involved in care (multiple cultural imaginaries, multiple forms of knowledge). It also foreshadows ‘vertical’ complexities, through which care imaginations include both underlying categories and überhöhende dimensions. These overarching or utopical dimensions, that both stem from and go beyond the localised, singular imaginations of care, is known by get a prescription for cialis many names in and beyond the medical humanities.

Examples include ’underlying values’, ‘ethical content of particular practices’, ‘transformative learning’ and many others (Ayala 2019, 269. Pettersen 2008, 188. Winthrop 2003).Cogitabunda, can mean to get a prescription for cialis be thoughtful and to be ‘full of thoughts’. The adverbial clause im Traum der Gedanken by von Herder (1888, 533), similarly, also signifies something unclear or disorganised. In his poetotological treatise Über Bild, Dictung und Fabel (1888, 533), von Herder juxtaposes this state with being in Leidenschaft (in passion), in Verrückung (in madness) or nicht auf seiner Hut (off guard).

There is complexity and get a prescription for cialis openness—perhaps even fantasy or at least exploration—in this. When I hold my son in my arms connecting different realms of thought. As in ruff-and-tumble-play, these realms are also get a prescription for cialis at play as I think.The quarrel of the deities. Culture, nature and careAfter the first narrative, the second deals with a quarrel between the deities Cura, Jove and Tellus. Once humanity has been given inner life, the focus in Hyginus’ texts shifts from creating to name-giving:Cum vellet Cura nomen suum imponere, Iovis prohibuit suumque nomen ei dandum esse dixit.

Dum de nomine Cura et lovis disceptarent, surrexit et Tellus suumque nomen ei imponi debere dicebat, quandoquidem corpus suum praebuisset.When Cura wanted to give it her name, Jove get a prescription for cialis forbade, and said that his name should be given it. But while they were disputing about the name, Tellus arose and said that it should have her name, since she had given her own body.To name something after something else (and, perhaps particularly, after someone else) places the object within a certain taxonomy. Major deities such as Jove and Tellus are both rulers and personifications of different ontological realms or ‘elements’. Hyginus’ Cura is get a prescription for cialis not known from other Roman sources. Instead, Cura is a ‘deification of abstract ideas’, a common feature of Roman culture (Axtell 1907).

Hence, it becomes clear that the quarrel deals with ontological ideas, more specifically with the ontology of humanity. Each deity proposes a ‘location’ in classical get a prescription for cialis ontology.The philosopher John T. Hamilton has used the myth of Cura to explore how any understanding of security presupposes both care and carefulness. He underlines how this ‘locating’ somehow names humanity after something that is neither identical nor particularly resembling humanity:The controversy over the creature’s name strives to resolve the issue of the figure’s proper being, without the aid of physical get a prescription for cialis resemblance, without the talent for self-reflection. In my view, the debate over the name revolves on whether humanity is essentially atemporal (Telluric matter or Iovian spirit) or instead fundamentally temporal and constituted by time and history (Hamilton 2013, 71).It is worth noting that the deities are not offering or suggesting certain framings of human life.

Hyginus’ text—in particular, the fact that Jove forbade any name other than his own—indicates conflicts between perspectives and disciplines. The imaginative richness involved in care, indicated by Hyginus cogitabunda get a prescription for cialis or by the plural in von Herder’s Traum der Gedanken, is a plurality where incommensurabilities remain. In my view, the myth of Cura points towards three possible but incommensurable ways of studying, describing and interpreting care (corresponding to Jove, Tellus and Cura, respectively):As a cultural or semantic phenomenon, elucidated in terms of meaning or more or less idealised notions.As a biological phenomenon, elucidated in medical, psychological or other health-related terms.As a relational phenomenon, elucidated in terms of care work (professional or not).Although it is necessary to understand care in all these ways, it is nevertheless impossible to fully merge them or produce those understandings simultaneously. Hence, it is necessary to add a more epistemologically oriented aspect of care. Care is fundamentally imaginative and context-dependent, and stands in-between get a prescription for cialis otherwise incommensurable interpretative domains.Saturn’s verdict.

The continuous presence of careIn the third narrative in Hyginus, the quarrel is somehow resolved when the deities choose Saturn as their judge. Sadly, this part of the text is fragmented. There is agreement, however, that Saturn’s verdict clarifies that Jove will receive human souls, while Tellus will receive get a prescription for cialis the body post mortem:Tu Iovis quoniam spiritum dedisti, <…>. Corpus recipito. Cura quoniam prima eum finxit, get a prescription for cialis quamdiu vixerit, cura eum possideat.

Sed quoniam de nomine eius controversia est, homo vocetur quoniam ex humo videtur esse factusJove, since you gave him spirit, let [Tellus] receive his body. Since Cura fashioned him from the start, let Cura possess him for as long as he lives. But since there is controversy about his name, let him be called homo, since he seems to be get a prescription for cialis made from humus.Let us begin by pointing out that Saturn’s verdict exposes yet another way in which Hyginus’ text alters the Prometheus plasticator motif. In most classical renderings, Prometheus is a trickster, and a transgressor from whom humanity is eventually separated. After discovering his transgressions, the Olympian deities chain Prometheus to a mountain in the Caucasus, and humanity lives on without him.

The relation between get a prescription for cialis humanity and its creator is therefore temporary. Hyginus, in contrast, makes it clear that humanity will remain under the guardianship of Cura quamdiu vixerit ‘for as long as he shall live’.The significance of this difference becomes clearer if we compare Hyginus’ text to Ovid’s use of the Prometheus plasticator motif in Metamorphoses. After describing the original moment when Prometheus created Humanity, Ovid goes on to describe the human condition:quam satus Iapeto mixtam pluvialibus undis / finxit in effigiem moderantum cuncta deorum, / pronaque cum spectent animalia cetera terram, / os homini sublime dedit caelumque videre(Ovid 1997, 47)so that his new creation, upright man, / was made in image of commanding gods?. / On get a prescription for cialis earth the brute creation bends its gaze, / but man was given a lofty countenance / and was commanded to behold the skies. / and with an upright face may view the stars (Melville and Kenney 2009, 76).As we can see, Ovid’s Prometheus creates a strong and vital human being.

Humanity seems not dependent on care or assistance, but ‘made in image of commanding gods’. In Ovid, human life is essentially an independent life which get a prescription for cialis resembles the lives of gods (in effigiem moderantum cuncta deorum). It is common—and tempting—to imagine care relations as exceptions in human lives. In care research, for instance, one often reserves care needs for vulnerable groups, thereby contrasting them with some kind of original, non-vulnerable get a prescription for cialis state. In life-course research, similarly, care leaves life as people move into adolescence and adulthood, only to re-enter it in the special cases of disability, serious illness or old age.

Hyginus’ text, in contrast, opens up for a rethinking of care as a fundamental, continuous part of human lives.This is essentially an ontological argument. Although we often reserve the term for human beings who have unusual needs—for instance, children or people with disabilities—care is, in fact, much more pervasive.Noting the etymology get a prescription for cialis of the verb curo—denoting what we call caring and worrying—Hyginus’ text also points towards an understanding of care as protection. The notion of care becomes meaningful in and of itself, and in relation to its counterparts, such as conflict, violence and neglect. If the so-called ‘normal’ human life—in Ovid’s words. Lives lived ‘in the image of commanding gods’—is met by a radical lack of care, it would have little freedom and in fact be over get a prescription for cialis in a matter of days.Hyginus’ text points towards an understanding wherein care reigns, organises or facilitates human lives.

Cura somehow ‘holds’ humanity in this life, indicating that Jove’s and Tellus’ receiving somehow lies outside that life (after death). For the medical humanities, this understanding of care suggests ways to think about both medical and cultural knowledge as forms of afterlife. Biological knowledge, for instance, is a form of knowledge get a prescription for cialis that has been aggregated outside and beyond individual lives. Through clinical generalisations, anatomical knowledge, systematic literature reviews and more. Cultural knowledge, get a prescription for cialis conversely, is deeply historical and contextual—thereby inevitably also a testament to how both historical and contextual relations stretch far beyond individual lives.These ambiguities lead to a further understanding of care.

Care is not only a fundamental precondition—whose impact depends on context and interpretation—care is indeed a fundamental and omnipresent condition, that continuously engenders and relies on interpretative processes.Care as holding-togetherWhen I hold my son I ruff-and-tumble play, I am also holding together forms of knowledge. I connect many different forms of knowledge—my intimate experiences with him, my research experience from disability studies, the bits of knowledge I have received from medical and educational professionals and many others—with one another. Moreover, the knowledge I produce—from the get a prescription for cialis actual holding, from being skin to skin and from sensing if he cannot understand others—is used in knowledge translation. I use it to stretch the understandings of medical professionals beyond uncertain prognoses. I also use it to connect the knowledge of the preschool teachers—a knowledge which mainly deals with so-called ordinary children—with the lives of extraordinary children such as my son.In Hyginus’ text, too, Cura holds together what otherwise would have been separate.

Had it not been for get a prescription for cialis Cura’s holding, and Saturn’s verdict, humanity would have belonged to either Jove or Tellus. A recent ‘appeal to the medical humanities’ uses the potential of this narrative. In it, Kristeva et al. (2018) use the myth of Cura to explore how humanity ‘belongs to different ontological domains’ held together by care:Saturn, the God of get a prescription for cialis time, settles the matter through an act of naming and by dividing and temporalising the possession of the various parts that comprise man. Jove is offered man’s soul and Tellus his body, after man’s death, while Cura will possess the creation in its lifetime since she made it.

[…] Thus, human life as a composite assembly of spiritual (Jove) get a prescription for cialis and material elements (Tellus) is held together by Cura’s temporal care (55).In their unpacking, Cura’s holding of humanity becomes a holding-together of two forms of knowledge. Biomedical knowledge of bios and sociocultural knowledge of zoe. Faced with situations of care—situations that neither biomedical science nor cultural studies of health can understand sufficiently—the understanding of care becomes a point of intersection between otherwise separate landscapes.This holding-together is visible in a variety of care practices. In the get a prescription for cialis case of evidence-based care, for instance, temporal doing at a certain point in time and history (professional work) holds together atemporal knowledge of effects (evidence) and atemporal norms (professional ethics). The temporal care work may seem like a mere ‘application’ of these atemporal knowledges.

However, recent studies argue that both evidence and norms exist as such if and only if they are interwoven with embodied practices. While ‘evidence in clinical decision making is relentlessly situated get a prescription for cialis and contextual’ (Wieringa et al. 2017, 964), so can the normative aspects only be sufficiently understood as ‘embodied process’, located at ‘the action level’ (Doane and Varcoe 2008).Jove, Tellus and Cura personify ontological orders (ways of being), and epistemological orders (ways of knowing). If we then revisit the epistemological aspect of care, a further understanding emerges. Care is a relational matter—in the lived lives of care receivers, as well as in the work of care professionals—and it is crucial in holding together different social agents and different knowledge domains.Care as withholdingWhen I ‘play airplane’ with my son—or hold him close to me in situations where others do not understand him or vice versa—one might say that I know what I am doing get a prescription for cialis.

On the other hand, this holding challenges several parts of my knowledge of this world. It challenges get a prescription for cialis my images of what it is to be a father, since the play differs from how most fathers do this with their children. More importantly, perhaps, the knowledge produced when I hold my son in my arms in the face of many, many abysses to come differs from much of my academic and medical knowledge, including that which is inherent in his diagnoses and prognoses.This withholding might seem, contrary to the straightforward clarity of Hyginus’ text. However, a more detailed examination can refract these interpretations. It is particularly worth noting get a prescription for cialis that the relation between Cura and the human being—that is, the fundamental ontological condition in this life—is described with a specific verbal clause with the verb possideo.

Cura eum possideat (Cura shall hold him).The Oxford Latin Dictionary defines possideo thusly:To have (land) in one’s control, occupy (as a tenant, etc). (absol.) to hold land.(in general) to hold as property, b. To take (property) into one’s keeping, appropriate.(of a sovereign, army, etc) to have control of (a country, position, etc) […] to get a prescription for cialis assume or exercise control over (persons).To take or have in its power, dominate, overwhelm, possess.To fill or take up (a space) with one’s bulk.To take up wholly (a person’s time). To absorb the thoughts and energies of someone.Possideo denotes not a general sense of holding, or a more general sense of contact or connection, but an exclusive holding—similar to the English verb to possess. Cura, then, is not only holding a humanity that belongs to both Jove and Tellus, but she is also withholding this humanity from them.

This becomes even clearer if we emphasise that possideo is a get a prescription for cialis transitive verb. At least to some extent, the clauses quamdiu vixerit, Cura eum possideat entail a micro-narrative. Although ‘created from,’ or consisting of biological matter, and being characterised by the presence get a prescription for cialis of ‘soul’ or some measure of cognition, humanity is fundamentally ‘controlled’ by care in this life. The separating into meaning (spirit) and biology (bodily remains) takes place outside this life. Cura’s holding, then, allows us to understand the holding-together of medicine and culture, and a withholding from both these domains.The ‘hermeneutic story’ (Kristeva 2002, 10) of Hyginus’ possideat—wherein care holds humanity at the expense of both culture and biomedicine—contradicts epistemological optimism.

Hyginus text allows us to glimpse intimate care knowledge that connects cultural and biomedical knowledge, and get a prescription for cialis that holds human life away from generalised knowledge. When Cura withholds humanity from generalised cultural knowledge (Jove) and generalised biochemical knowledge (Tellus) and care produces knowing—often described as insight, sharing and holding-together—and un-knowing.These difficulties indicate the need for an additional understanding of care. Care must be understood as a practice that holds together multiple parties and multiple forms of knowledge. However, it get a prescription for cialis must also be understood as a practice—or if you will. A form of human relation—that withholds something from knowledge.I shall hold him for as long as I shall liveThe ‘human story’ of care relations (eum possideat) will necessarily entail a human story of singular actions that to some extent can only be described in first-person singular.

Eum possideam (I shall hold him). To explore this individual get a prescription for cialis eum possideam, I try to ‘theorise from my subject position’ (Fournier 2019, 658). When activating my own intimate experiences, it became clear that interpretations of my eum possideam quamdiu vixerit can refract—or even fracture—theoretical notions of care.To connect intimate experiences of holding—be it in bodily care, in adverse social situations or in rough-and-tumble play—with cultural and political theory is clearly a daunting task. Although this still seems unclear to me, I can at least outline four aspects of the get a prescription for cialis refraction. First, I do hold together cultural and biomedical knowledge.

When my son is in my arms, multiple cultural imaginaries are involved. My understanding of his life (and of mine) is dependent on my language and my cultural frames, and I am get a prescription for cialis consistently aware of a clinical gaze. My son’s life—and, thereby, also my own life and my care work—are viewed or observed by medical professionals, psychologists, special needs educators and preschool teachers.Second, the holding is troublesome. In a narrower sense, I note that his needs lead me to hold and even carry him in ways that most parents only do with substantially younger children. Combined with get a prescription for cialis my own embodied condition, there emerges a bodily trouble, an element of exhaustion, uncertain walking and muscular pain.

Regarding my cultural knowledge, it becomes clear that my own imaginaries entail expectations and understandings that somehow seem incompatible with his life. In this social context—parenting in Norway, located in middle-class families—childhood is simultaneously about ‘findings one’s own voice’ (autonomy) and about ‘following the path’ (social reproduction). To claim that autonomy outside language is possible, or that a person get a prescription for cialis in his situation may reproduce his parents, seems equally futile.Regarding biomedical knowledge, I take care of my 4-year-old (as I do all three of my children) within a biomedical framework. Most Norwegian children are screened regularly for somatic problems, and to measure linguistic, cognitive and psychosocial development. While this knowledge has thus far granted me a certain comfort in parenting get a prescription for cialis my two oldest children—confirming, as it were, that all is well—that has, obviously, not been the case with my youngest son.

Hence, his life is also framed by medical knowledge in a more direct way. He receives a range of health-related services, a provision that also positions my parental care within the same frame.Third, there is an uncertain future involved in this. This is of course always true of any intersubjective relation in general and get a prescription for cialis of care relations in particular. The future is open, and it can entail painful events. However, his situation exposes uncertainty in a more radical way.

Culturally, it exposes how I see my other children—as having quite stable chances for social reproduction—partly get a prescription for cialis thanks to how I see him. Through a fatherly lens of rather unclear hopes and worries. Medically, the tests of my youngest son continuously yield inconclusive results. This has replaced my former sense of parental comfort with gnawing anxiety get a prescription for cialis over his future. Moreover, the complexities of his living leaves me, as a caregiver, with the unpredictability of his diagnostic results, rather than with stable prognoses.Fourth, these intimate situations entail a particular life-course temporality, which differs from the temporality of professional care, as well from the temporality in Hyginus’ text.

In the case of professional careers, their work is regulated to certain hours (of paid work), and to certain phases of life. Most professional carers will retire, and many will pursue other forms of work at some point in get a prescription for cialis time. In Cura’s case, her care work is also time limited. The temporality of the deity’s existence is sufficient to encompass the temporality get a prescription for cialis of humanity. In both cases, the life course temporality of the carer is sufficient for the imagined care work.In my parental care work, however, the temporality is insufficient rather than sufficient.

In all likelihood, I will somehow care for my son for as long as I am alive. Moreover, this lifelong work will likely get a prescription for cialis be insufficient in at least two ways related to the temporality of my life. My own ageing will likely reduce my ability to perform the care work, and I will likely die before my son, leaving him without parental care. Hence, the temporality of my care cannot be formulated as eum possideam quamdiu vixerit (I shall hold him for as long as he shall live), but as eum possideam quamdiu vixero (I shall hold him for as long as I shall live).This rudimentary autotheoretical investigation brings to light three forms of withholding. First, the nature of the holding (eum possideam) withholds care from the epistemological domains that the medical humanities get a prescription for cialis traditionally investigate.

Second, the temporality involved in parental care (quamdiu vixero) withholds something from the temporality of professional care. Third, something is also withheld from the ‘parental temporality.’. The need care depends on get a prescription for cialis his life (quamidiu vixerit), not on mine. Several forms of knowledge, and several forms of embodied holding, are involved without being fully commensurable. Since I cannot resolve these enigmatic forms of withholding, the theoretical understandings remain breached, implicitly pointing towards not-yet-explicable or not-yet-nameable understandings.Withholding and ambiguityMy holding of my son in get a prescription for cialis my arms come with several temptations.

One of them—in particular, as I am holding him, or, perhaps, shielding him—is to think that I hold some kind of vast, privileged knowledge. While this is of course true to some extent, there are more powerful movements at play. On the one hand, the complexities in the situation get a prescription for cialis forces me out of the internal comfort that characterises the centre of any ontological or epistemological ‘domain’. On the other hand, I am also forced to admit another thing. That I can hold him, but it remains unclear—to some extent—if I can know him.

I cannot know if our way is exclusively ours.Similarly, intertextual analysis get a prescription for cialis locates breaches in specific ‘sign-systems’, and in larger ‘social and historical material’ (Kristeva 2002, 9–10). Hence, the specific inquiries presented in this article relate to more general ways of inquiry. When we use those notions, we connect different academic investigations, and different academic disciplines, theoretical traditions and research methodologies. In Julia get a prescription for cialis Kristeva’s words, these relations are ‘temporal connections’ and ‘points of contact‘ (2002:8) and points of ‘distortion, ambiguity and contradiction’ (2002:11).The understanding of care as holding-together connects very well with the rise in interdisciplinarity within the medical humanities. The three deities Jove, Tellus and Cura are brought together in dispute, and Saturn’s verdict foreshadows how different ontological domains are held together in human life.Studying an interaction between form of knowledge—in their case.

The interaction between medical imagining and patient creativity—Stahl and Stahl use the insufficiencies of medical knowledge in an argument for multiple perspectives:Although in contemporary Western society, many tend to believe get a prescription for cialis the hard science provide the truest or most accurate interpretation of the natural world, it cannot exhaust the meaning of the body. If we believe we are more than the sum of our parts, then we ought to allow for multiple and even varied interpretations of our bodies (Stahl and Stahl 2016, 159).Interpreting care as connectedness and holding-together, medical humanities scholars aim to hold together medical and cultural knowledge in new, explorative and enriching ways, and they often succeed.Such interpretations also speak to an even more radical ambition, that of academic convergence, sometimes referred to as transdisciplinary research. Such appeals are often embedded in a considerable epistemological ambition. Pointing out the insufficiencies of ‘illustrative’ or ‘additive’ work in the medical humanities, Kristeva et get a prescription for cialis al. (2018) express a particularly radical version of this ambition:[W]e do not consider the humanities as a critical and potentially liberating perspective that can be applied to medicine as an object in need of repairment.

Medical humanities should not be construed as a humanistic perspective on medicine. They should rather be seen as a cross-disciplinary and cross-cultural space for a get a prescription for cialis bidirectional critical interrogation of both biomedicine (simplistic reductions of life to biology) and the humanities (simplistic reductions of suffering and health injustice to cultural relativism). On the one hand, this implies breaking with the culture–nature dichotomy and considering both the humanities and medicine as biocultural practices. On the other hand, it also implies understanding that boundary work requires boundaries, and that incommensurability between various partial disciplinary perspectives can—and will—emerge (56).The ambition at stake here listens to the holding-together outlined above. Whereas more ‘additive’ ways of connecting knowledge are valuable—for instance, when humanities-based research ‘fill the gaps’ of ‘pure’ medical get a prescription for cialis research in order to facilitate evidence-based care—this is not what Hyginus’ text indicates.

Just as the relation between Jove and Tellus is symmetric and mutual (they are equally necessary for the creation of humanity and will ‘hold’ remain with equal sovereignty after this life), so is the relation between Cura and the two other deities. Jove and Tellus are separated from humanity in this life, and get a prescription for cialis Cura is equally separated from humanity after this life. This fable cannot be intertextually connected with asymmetrical or additive relations between knowledge fields, but it is connected with a ‘space for bidirectional critical interrogation’.It is perhaps less clear how care as un-knowing speaks to larger trends in the medical humanities. It is therefore necessary to ask. How can understandings of care that emphasise withholding get a prescription for cialis and un-knowing, including autotheoretical investigations that increase uncertainty, ambiguity and painful affects, inform knowledge production?.

To outline a provisional response to this question, it is useful to return to Hyginus’ text once again. The description of Cura’s relation to humanity—Cura quoniam prima eum finxit, quamdiu vixerit, cura eum possideat (Since Cura fashioned him from the start, let Cura hold him for as long as he shall live)—should also be read with attention to grammar. While the conjunction quoniam (since) introduces a causal clause in the indicative mood (finxit), followed by an adverbial clause in get a prescription for cialis the indicative (vixerit), the resulting clause is in the subjunctive (possideat). Interestingly, this subjunctive inflection is the only use of the subjunctive mood in Hyginus’ text.This use of the subjunctive mood—sometimes called ‘independent’ usage—can have a variety of purposes. Although the usage in fable CCXX is iussive—in the sense that makes a permanent judgement—it is worth noting that the subjunctive mood is often associated with potentiality in classical Latin.

Other common areas of usage include ‘questions in which the speaker or writer expresses doubt or disbelief by “thinking aloud” (deliberative), wishes that cannot or may not be fulfilled get a prescription for cialis (optative), and the potentiality that something may happen or might have happened (potential)’ (Palma 2012, 377). Moreover, it is worth noting that possideat is in present tense. Since the subjunctive mood lacks a future tense in Latin, the active present tense get a prescription for cialis can also denote future actions. Hyginus’ text, then, points towards knowing and un-knowing, and towards openness to potentiality and some degree of uncertainty.When held together, withholding and uncertainty give a clear implication for the medical humanities as a form of academic practice. The epistemological ambitiousness in medical humanities should be supplemented with what one might call epistemological modesty.

Such modesty is rooted in the specifics of get a prescription for cialis care, and in the relation between complexity and synthesis. What is at stake in care research—if we take the abovementioned complexities into account—is a ‘bidirectional space’, and an ever-expanding and exponentially multidimensional space. When medical humanities emerged, it was only a question of time before the field began to involve other humanities and social sciences disciplines than those involved in the initial phase. Similarly, the growth get a prescription for cialis of critical medical humanities steadily increases the engagements with all kinds of critical research frontiers, in the social sciences as well as in the humanities. At least in an area such as studies of care—where the intimacy is so acutely palpable—it will become increasingly clear that the medical humanities will remain ‘outnumbered’ or ‘overpowered’ by the analytical complexities the field itself brings forth.Some scholars in the critical humanities have argued that scholars should ‘embrace’ this kind of overpowering (Viney, Callard, and Woods 2015, 2–7).

However, Hyginus’ text complicates the relation between care practices (Cura), culture (Jove) and biomedicine (Tellus) regardless of such embraces. Although care holds humanity at the expense of the get a prescription for cialis other forms of knowing, his holding neither implies any disregard for humanities-based nor medical knowledge. Rather, the unpacking presented in this article demonstrates how care brings forth an epistemological modesty. Only an epistemologically modest way of doing medical humanities can address get a prescription for cialis the intimate and enigmatic qualities of care.Discussion. Scholarly and analytical contributionWhile the textual and autotheoretical analyses presented in this paper followed the suggestion from Kristeva et al—to we question ‘the cultural distinction between the objectivity of (medical) science and the subjectivity of culture’ (2018:55)—it nevertheless ended in an emphasis on intimate withholding.

This withholding—be it epistemological, theoretical or inherent in the intimate experience of holding or embracing my son away from an abyss—is relevant to the medical humanities in general. However, it is also a contribution to get a prescription for cialis four more specific tendencies in the available literature.First, the unpacking contributes to feminist care research. Beginning with the canonical work on ‘a different voice’ by Gilligan (1982), feminist care research has increasingly emphasised the knowledge multitude involved in care. More recent research also shows a multitude of empirical delineations. While some scholars reserve the term get a prescription for cialis for face-to-face interaction, or for situations characterised by asymmetrical dependency, others do not.

The investigation in this article brings forth additional multitude by combining academic disciplines that rarely interact—care research, linguistic analysis of Latin texts, romanticism studies and autotheoretical analysis work—and implies many possibilities for further research.Second, the autotheoretical interpretations can contribute to the research field sometimes known as ethics of care. Following such works as the book Learning from my Daughter by Kittay Kittay (2019, xx), where she proposes that the relation of parental care provides ‘the only universal and morally significant property that all humans possess’, I aim to shed light on how care work engenders ethical thinking. My holding of my son in my arms—as well as the withholding that both this get a prescription for cialis holding and Hyginus’ text entail—is as political and ethical as it is personal and embodied.Third, this paper also relates to a more critical strain of ethics of care. Pettersen (2008) work, for instance, demonstrates how the ethics of care ’subverts the public/private dimension altogether’, thereby allowing for a broader range of criticism (45). Moreover, Fletcher and Piemonte (2017) shed get a prescription for cialis light on how healthcare practices constitute a ’quiet subversion’ of neoliberal cultural structures.

Arguably, both intimate withholding and epistemological overwhelming shows the power involved in such subversions.Fourth, I hope to contribute to the strand of research—in care research as well as in disability studies—that relate to the work of Julia Kristeva. On the one hand, the rethinking presented in this paper dovetails with her perspectives on how intimate aspects of care destabilise the larger frameworks, cultural structures that are nevertheless sustained by those actions of care. The autotheoretical exploration towards the emblematic formulation eum possideam quamdiu vixero (I shall hold him for as long as I shall live) might also respond fruitfully to Kristeva’s account of how her “living get a prescription for cialis with […] the neurological difficulties of my son David” (2013, 220) lead her to explore maternity as I want that you be (2013, 229). On the other hand, I also try to challenge what I see as an epistemological and political optimism in Kristeva’s work.Data availability statementNo data are available. Since this is an autoethnographic investigation, primary data will not be available.Ethics statementsPatient consent for publicationNot required.Ethics approvalThe ethical aspects have been reviewed by the research management at the Work Research Institute.

See also footnote 1.AcknowledgmentsI would like to thank Eivind Engebretsen and John Ødemark for their encouragements, and the get a prescription for cialis anonymous reviewers for their helpful suggestions.Notes1. Patient and public involvement statement. Although there is no public involvement in the writing of this paper, the autotheoretical approach does of course involve my son. This approach get a prescription for cialis hinders full anonymisation, just like his way of living in this world hinders informed consent in the traditional sense. The approach also excludes the potential for full anonymisation.

The consent is therefore, in consultation with his mother, given by me as his legal guardian..

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Treat STIs rapidly and reduce onward transmission and enhance partner cialis lower blood pressure notification and contact tracing. And Equity and access to services to reduce STI-related stigma and remove barriers affecting health seeking behaviour.The strategy was developed in consultation with clinicians, academics, community partners, and local health services across NSW through cialis lower blood pressure a strong partnership which will help to effectively respond to STIs.More information about the NSW Sexually Transmissible s Strategy 2022 – 2026 including the strategic framework can be found at NSW Sexually Transmissible s Strategy 2022-2026..

NSW Health is urging the community to continue to look out for one another after mandatory isolation ends this Friday, 14 October by remembering lessons learned.NSW Chief Health Officer Dr Kerry Chant said at the top of the list is staying home if you have cold or flu-like symptoms, get tested and if you must head out, wear a mask.“We all know from experience what works best to protect one another from erectile dysfunction treatment so please, continue to take those simple but important steps,” Dr Chant said.“In particular, we urge people to please stay at home if they have cold or flu-like symptoms http://www.ec-maisonsgoutte.ac-strasbourg.fr/signaler-une-absence-a-maisonsgoutte/ such as a runny nose, sore throat, cough or fever and go and get tested.“If you have erectile dysfunction treatment you may be infectious for up to 10 days but you are most infectious in the two days before your symptoms start and while you have symptoms.“If you have to leave the house while unwell, wear a mask when indoors and on public transport, avoid large gatherings and indoor crowded places, and don’t visit high risk settings, such as hospitals, aged or disability care facilities for at least seven days.”Dr Chant said people should talk to their employer about when they can safely return to the workplace, with the risk to be managed under occupational health and safety frameworks.High-risk settings such as hospitals, disability and aged care facilities have been advised by Dr Chant that staff should only return to these settings after seven days, subject to their own work, health, and safety assessment, and if symptom-free.“It is important we continue to think of others, especially those most vulnerable and the best thing people of all ages can do to protect themselves remains to make sure they are up to date with their erectile dysfunction treatment and influenza vaccinations,” Dr Chant said.While registration of a positive rapid antigen get a prescription for cialis test (RAT) will also no longer be mandatory from Friday, NSW Health asks people to continue the practice voluntarily.“Registering a positive RAT through Service NSW allows us to connect people to medical care, particularly older people and the immunocompromised, and it also helps inform our ongoing public health response,” Dr Chant said.Close contacts of positive cases are most at risk of catching the cialis so if you are a close contact, remember:Monitor for symptoms. If you get sick, get tested and stay home.Avoid visiting high-risk settings such as a hospital, aged or disability care facilities, or visiting anyone at high risk of severe illness for at least seven days, and then ensure you have a negative RAT before visiting.Wear a mask when indoors and on public transport.Frequent RATs may help identify early – this is particularly important if you are in contact with people at high risk of severe illness.For more advice on how to stay safe and prevent the spread of respiratory cialises including erectile dysfunction treatment, visit the NSW Government website.NSW Health has released a new long-term roadmap to encourage prevention, regular testing and to enable better access to timely treatment for those affected by Sexually Transmissible s (STIs).NSW Chief Health Officer Dr Kerry Chant said the NSW Sexually Transmissible s Strategy 2022-2026 aims to bring down STI rates across the state and help reduce their impacts."One in six people are likely to have an STI at some point in their get a prescription for cialis lives. If you are sexually active, it's important to use preventative measures such as condoms, get tested regularly, and seek treatment early so you can get a prescription for cialis stay healthy and protect the wider community from ," Dr Chant said. "Sexual health is an important part of health get a prescription for cialis and wellbeing. If left untreated, STIs pose a significant risk to reproductive health and could lead to harmful outcomes for mother and baby, neonatal s, cancer, and increased risk of other s."While NSW remains a world leader in responding to STIs, with HIV notifications having dropped to their lowest levels get a prescription for cialis on record, data shows some STI rates have increased.

Rates of infectious syphilis have doubled since 2016 from 11.2 notifications per 100,000 people, to 21.2 per 100,000 people in 2021.The strategy sets out four key focus areas to achieve ambitious targets, which include the elimination of congenital get a prescription for cialis syphilis and reduction of syphilis and gonorrhoea notification rates by five per cent by 2026. Prevent new s through education, health promotion and utilising new and existing methods, such as condoms, treatments and health get a prescription for cialis promotion. Test often, normalise testing, and promote innovative testing models such as peer-based testing and point-of-care testing get a prescription for cialis. Treat STIs rapidly and get a prescription for cialis reduce onward transmission and enhance partner notification and contact tracing. And Equity and access to services to reduce STI-related stigma and remove barriers affecting get a prescription for cialis health seeking behaviour.The strategy was developed in consultation with clinicians, academics, community partners, and local health services across NSW through a strong partnership which will help to effectively respond to STIs.More information about the NSW Sexually Transmissible s Strategy 2022 – 2026 including the strategic framework can be found at NSW Sexually Transmissible s Strategy 2022-2026..

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Outcomes of preterm infantsIn 2010, the Dutch practice regarding initiation of active Buy zithromax canada treatment in extremely preterm infants was lowered from 25 completed weeks’ to 24 completed cialis facts weeks’ gestation. The Editor’s choice for this issue is the EPI-DAF study, reported by Pauline E van Beek and colleagues. The study provides contemporary population-based neurodevelopmental outcome data for all Dutch live-born infants, born between 240/7 weeks’ and 266/7 weeks’ gestational age, who reached 2 years’ corrected cialis facts age in 2018–2020. Assessments included medical history taking, physical and neurological examination, and assessment of mental and psychomotor development with the Dutch version of the Bayley Scales of Infant and Toddler Development (Bayley-III-NL).

Parents filled out the Child Behavioural Checklist. A combination of medical history cialis facts and results of the assessment was used to rate hearing and vision status. A composite outcome representing all these domains was classified as either moderate-to-severe impairment or mild or no impairment, based on the most severe individual component. 991 infants were cialis facts live born at 24–26 completed weeks’ GA, of whom 891 (90%) were admitted to a NICU.

Of these, 651 (73%) infants survived and 587 (90%) were seen for follow-up at 2 years. Mortality (not admitted to NICU or died after NICU admission) was 58%, 31% and 21% at 24, 25, and 26 weeks' respectively. Rates of moderate to severe NDI in any domain on follow-up were comparable (around 18% of survivors) between children born at 24 weeks’, 25 weeks’ and cialis facts 26 weeks’ gestation. Lowering the threshold for supporting active treatment from 25 completed weeks to 24 completed weeks was not associated with a large increase in the number of survivors with moderate-severe neurodevelopmental impairment.In a separate study from Canada, Magdalena Jaworski and colleagues asked parents of infants born <29 weeks’ gestational age presenting at a neonatal follow-up clinic to evaluate their children’s health and development.

248 parents of 213 children (mean gestational age 26.6±1.6 weeks, 20% with severe neurodevelopmental impairment) cialis facts were recruited. Parents evaluated their children’s health at a median of 9/10. See pages F467 and F495Tactile stimulation during initial stabilisationNewborn infants get tactile stimulation to encourage them to breathe at birth but this does not necessarily continue once positive pressure ventilation is commenced. Vincent Gaertner and colleagues analysed video and respiratory function monitor data gathered during a study of different face masks to report observational data on the association between cialis facts tactile stimulation and breathing patterns during positive pressure ventilation (PPV).

20 of 40 infants born >34 weeks' gestation received stimulation during PPV and this was associated with increased spontaneous breaths and increased exhaled tidal volume. Increased duration cialis facts of stimulation and surface area of applied stimulus were associated with a larger increase in spontaneous breaths. See page F508Associations of body composition with regional brain volumes in very preterm infantsKatherine Bell and colleagues performed MRI scans and air displacement plethysmography to determine body composition at term equivalent age in 85 preterm infants born <33 weeks gestation. Lean mass—but not fat—at term was associated with larger brain volume and white matter microstructure differences that suggest improved maturation.

Weight is a simplistic measure of overall nutrition and studies like this, with later neurodevelopmental outcomes will help to refine our understanding of how to measure optimal nutrition cialis facts for preterm infants. See page F533Effect of prophylactic dextrose gel on the neonatal gut microbiomeAs part of a placebo controlled randomised trial, Sophie St Claire and colleagues found no effect of orally administered glucose gel in the first hour after birth on the gut microbiome at 1,7, and 28 days. These data should reassure parents and clinicians that use of dextrose gel in the newborn period will not have adverse cialis facts consequences on the microbiome. See page F501Neonatal and fetal therapy of congenital diaphragmatic Hernia-related pulmonary hypertensionFelix De Bie and colleagues discuss clinically available neonatal and fetal therapies specifically targeting the pulmonary hypertension associated with congenital diaphragmatic hernia and review the most promising experimental treatments and future research avenues.

See page F458Ethics statementsPatient consent for publicationNot applicable.Ethics approvalNot applicable..

Outcomes of get a prescription for cialis preterm infantsIn 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks’ to 24 completed weeks’ gestation. The Editor’s choice for this issue is the EPI-DAF study, reported by Pauline E van Beek and colleagues. The study provides contemporary population-based neurodevelopmental outcome data for all Dutch live-born infants, born between get a prescription for cialis 240/7 weeks’ and 266/7 weeks’ gestational age, who reached 2 years’ corrected age in 2018–2020.

Assessments included medical history taking, physical and neurological examination, and assessment of mental and psychomotor development with the Dutch version of the Bayley Scales of Infant and Toddler Development (Bayley-III-NL). Parents filled out the Child Behavioural Checklist. A combination of get a prescription for cialis medical history and results of the assessment was used to rate hearing and vision status.

A composite outcome representing all these domains was classified as either moderate-to-severe impairment or mild or no impairment, based on the most severe individual component. 991 infants were live born at 24–26 completed weeks’ GA, of whom 891 (90%) were admitted to a NICU get a prescription for cialis. Of these, 651 (73%) infants survived and 587 (90%) were seen for follow-up at 2 years.

Mortality (not admitted to NICU or died after NICU admission) was 58%, 31% and 21% at 24, 25, and 26 weeks' respectively. Rates of moderate to severe NDI in any domain on follow-up were comparable get a prescription for cialis (around 18% of survivors) between children born at 24 weeks’, 25 weeks’ and 26 weeks’ gestation. Lowering the threshold for supporting active treatment from 25 completed weeks to 24 completed weeks was not associated with a large increase in the number of survivors with moderate-severe neurodevelopmental impairment.In a separate study from Canada, Magdalena Jaworski and colleagues asked parents of infants born <29 weeks’ gestational age presenting at a neonatal follow-up clinic to evaluate their children’s health and development.

248 parents get a prescription for cialis of 213 children (mean gestational age 26.6±1.6 weeks, 20% with severe neurodevelopmental impairment) were recruited. Parents evaluated their children’s health at a median of 9/10. See pages F467 and F495Tactile stimulation during initial stabilisationNewborn infants get tactile stimulation to encourage them to breathe at birth but this does not necessarily continue once positive pressure ventilation is commenced.

Vincent Gaertner and get a prescription for cialis colleagues analysed video and respiratory function monitor data gathered during a study of different face masks to report observational data on the association between tactile stimulation and breathing patterns during positive pressure ventilation (PPV). 20 of 40 infants born >34 weeks' gestation received stimulation during PPV and this was associated with increased spontaneous breaths and increased exhaled tidal volume. Increased duration of stimulation and surface area of applied stimulus get a prescription for cialis were associated with a larger increase in spontaneous breaths.

See page F508Associations of body composition with regional brain volumes in very preterm infantsKatherine Bell and colleagues performed MRI scans and air displacement plethysmography to determine body composition at term equivalent age in 85 preterm infants born <33 weeks gestation. Lean mass—but not fat—at term was associated with larger brain volume and white matter microstructure differences that suggest improved maturation. Weight is a simplistic measure of overall nutrition and studies like this, with later neurodevelopmental outcomes will help to refine our understanding of how to measure optimal nutrition for preterm get a prescription for cialis infants.

See page F533Effect of prophylactic dextrose gel on the neonatal gut microbiomeAs part of a placebo controlled randomised trial, Sophie St Claire and colleagues found no effect of orally administered glucose gel in the first hour after birth on the gut microbiome at 1,7, and 28 days. These data should reassure parents and clinicians that get a prescription for cialis use of dextrose gel in the newborn period will not have adverse consequences on the microbiome. See page F501Neonatal and fetal therapy of congenital diaphragmatic Hernia-related pulmonary hypertensionFelix De Bie and colleagues discuss clinically available neonatal and fetal therapies specifically targeting the pulmonary hypertension associated with congenital diaphragmatic hernia and review the most promising experimental treatments and future research avenues.

See page F458Ethics statementsPatient consent for publicationNot applicable.Ethics approvalNot applicable..

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NSW residents are being urged to book in for their flu treatment, with the number of s increasing significantly in how can i get cialis recent weeks.NSW Chief Health Officer Dr Kerry Chant said cases are rising quickly throughout the community, with several recent outbreaks also affecting boarding schools.“There were 2,000 new flu cases notified in NSW in the week ending 7 May 2022, compared with 1,024 cases in the Can i get cialis over the counter previous week, as well as around 60 emergency department presentations for flu-like illness that required an admission to hospital,” Dr Chant said.“We are also seeing an increase in the proportion of people testing positive. Of 25,556 tests conducted for influenza in how can i get cialis the week ending 7 May 2022, 9.1 per cent were positive, compared with 5.3 per cent in the previous week.”NSW Health is aware of recent flu outbreaks in four boarding schools and Dr Chant said it is important that students and staff get their flu shot.“As with erectile dysfunction treatment, boarding schools are a high-risk setting for flu transmission. We’re strongly encouraging all students and staff in boarding schools to get their flu treatment,” Dr how can i get cialis Chant said.“Boarders with flu should be isolated from others until their symptoms resolve. If a school has three or more boarders with flu, they are urged to contact the local Public Health Unit for advice.”Further advice for schools this winter is available on this webpage.Vaccination affords essential protection for people how can i get cialis of all ages against severe illness from influenza, but it is particularly important for those more vulnerable.Everyone six months and older is recommended to get a flu shot.

The rollout of the flu vaccination program is the Commonwealth Government’s responsibility and treatments are available through GPs, and pharmacies for everyone aged 10 years and over.Those considered how can i get cialis to be at higher risk of severe illness from influenza are eligible for a free flu treatment. This includes:Aboriginal and Torres Strait Islander people from six months of ageChildren from six months to under five years of agePeople with serious health conditions (including severe asthma, diabetes, cancer, immune disorders, obesity, kidney, heart, lung or liver disease)Pregnant womenPeople aged 65 and over.When people book, they should ask how can i get cialis their pharmacist or GP which treatment is right for them.NSW Health continues to urge everyone to take simple precautions to protect each other:Stay at home if you are sick and avoid close contact with other people to protect yourself and the community from flu and erectile dysfunction treatmentWear a mask in indoor spaces if you are unable to physically distanceGather in well ventilated spaces or open windows and doorsSneeze into your elbow instead of your handsWash your hands thoroughly and often. The latest information on how can i get cialis the flu and erectile dysfunction treatment is reported in the latest NSW Respiratory Surveillance Report, published today..

NSW residents are being urged to book in for their flu treatment, with the get a prescription for cialis number of s increasing significantly in recent weeks.NSW Chief Health Officer Dr Kerry Chant said cases are rising quickly throughout the community, with several recent outbreaks also affecting boarding schools.“There were 2,000 new flu cases notified look at this now in NSW in the week ending 7 May 2022, compared with 1,024 cases in the previous week, as well as around 60 emergency department presentations for flu-like illness that required an admission to hospital,” Dr Chant said.“We are also seeing an increase in the proportion of people testing positive. Of 25,556 tests conducted for influenza in the week ending 7 May 2022, 9.1 per cent were positive, compared with 5.3 per cent in the previous week.”NSW Health is aware get a prescription for cialis of recent flu outbreaks in four boarding schools and Dr Chant said it is important that students and staff get their flu shot.“As with erectile dysfunction treatment, boarding schools are a high-risk setting for flu transmission. We’re strongly encouraging all students and staff in boarding schools to get their flu treatment,” Dr Chant said.“Boarders with flu should be isolated from others get a prescription for cialis until their symptoms resolve.

If a school has three or more boarders get a prescription for cialis with flu, they are urged to contact the local Public Health Unit for advice.”Further advice for schools this winter is available on this webpage.Vaccination affords essential protection for people of all ages against severe illness from influenza, but it is particularly important for those more vulnerable.Everyone six months and older is recommended to get a flu shot. The rollout of the flu vaccination program is the Commonwealth Government’s responsibility and treatments are available through GPs, and pharmacies for everyone aged 10 years and over.Those considered get a prescription for cialis to be at higher risk of severe illness from influenza are eligible for a free flu treatment. This includes:Aboriginal and Torres Strait Islander people from six months of ageChildren from six months to under five years of agePeople with serious health conditions (including severe asthma, diabetes, cancer, immune disorders, obesity, kidney, heart, lung or liver disease)Pregnant womenPeople aged 65 and over.When people book, they should ask their pharmacist or GP which treatment is right for them.NSW Health continues to urge everyone to take simple precautions to protect each other:Stay at home if you are sick and avoid close contact with other people to protect yourself and the community from flu and erectile dysfunction treatmentWear a mask in indoor spaces if get a prescription for cialis you are unable to physically distanceGather in well ventilated spaces or open windows and doorsSneeze into your elbow instead of your handsWash your hands thoroughly and often.

The latest information on the flu and erectile dysfunction treatment is reported in the latest NSW Respiratory Surveillance get a prescription for cialis Report, published today..

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Medicaid Services (CMS) is announcing an opportunity buy cialis 10mg uk for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow Start Printed Page 9626 a second opportunity for public comment on the notice. Interested persons are invited to send comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.

Comments on the collection(s) of information must be received by the OMB desk officer by March 24, 2022 buy cialis 10mg uk. Written comments and recommendations for the proposed information collection should be sent within 30 days of publication of this notice to www.reginfo.gov/​public/​do/​PRAMain. Find this particular information collection by selecting “Currently under 30-day Review—Open for Public Comments” or by using the search function.

To obtain copies buy cialis 10mg uk of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following. 1. Access CMS' website address at website address at.

Https://www.cms.gov/​Regulations-and-Guidance/​Legislation/​PaperworkReductionActof1995/​PRA-Listing.html buy cialis 10mg uk. Start Further Info William Parham at (410) 786-4669. End Further Info End Preamble Start Supplemental Information Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C.

3501-3520), federal agencies must obtain approval from the buy cialis 10mg uk Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term “collection of information” is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party.

Section 3506(c)(2)(A) of buy cialis 10mg uk the PRA (44 U.S.C. 3506(c)(2)(A)) requires federal agencies to publish a 30-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice that summarizes the following proposed collection(s) of information for public comment.

1 buy cialis 10mg uk. Type of Information Collection Request. New collection (Request for a new OMB Control Number).

Title of Information buy cialis 10mg uk Collection. Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act Section 1003 Demonstration Evaluation. Use.

Section 1003 of the SUPPORT Act authorizes the Secretary of HHS, in consultation with the Director of the Agency for Healthcare Research and Quality (AHRQ) and the Assistant Secretary for Mental Health and Substance Use from the Substance Abuse and Mental Health Services Administration (SAMHSA), to conduct a 54-month demonstration project (hereinafter, “the Demonstration”) which is designed to increase the capacity of buy cialis 10mg uk Medicaid providers to deliver substance use disorder (SUD) treatment and recovery services. Section 1003 also requires an evaluation of the demonstration. The evaluation is designed to assess.

The effectiveness of the Demonstration in increasing the capacity of providers participating under the Medicaid state plan (or a waiver of such plan) to buy cialis 10mg uk provide substance use disorder treatment or recovery services under such plan (or waiver). The activities carried out under the planning grants and demonstration project. The extent to which participating states have achieved the stated goals.

And The strengths and limitations of the planning grants and demonstration buy cialis 10mg uk project. This collection of information request is intended to satisfy the reporting requirements, defined in the statute, regarding the impact of the Demonstration. The evaluation of the Demonstration will assess the extent to which the participating states achieved the goals they established to increase substance use treatment or recovery provider capacity under the Medicaid program.

This includes both the planning and post-planning periods of the demonstration, as evaluation during both phases will enable CMS and stakeholders to assess the effects of the additional support provided to states during the post-planning period, relative to the planning period buy cialis 10mg uk only. Primary data collection will occur in two rounds in year two and year four of the evaluation. In both rounds, data collection will consist of.

(1) A survey of providers in all 15 Planning Grant states who are eligible to prescribe and/or administer either buprenorphine or methadone medication for opioid use disorder (OUD), and (2) focus groups of buy cialis 10mg uk providers in five post-planning period states (two focus groups per state, with six to eight participants in each group) who treat SUD, including OUD. The survey will gather information on provider experiences related to Medicaid provider enrollment, SUD service delivery, and changes in OUD medication treatment, including barriers and enablers of prescribing and dispensing. The focus groups will examine the impact of key aspects of implementation, such as perceived burdens associated with Medicaid enrollment or MAT delivery, access to referral placements, value of state-provided TA, and benefits and unanticipated outcomes experienced by providers during the Demonstration.

Form Number buy cialis 10mg uk. CMS-10786 (OMB control number. 0938-NEW).

Private sector (Business or other for-profits and Not-for-profit institutions). Number of Respondents. 28,810.

Total Annual Responses. 14,405. Total Annual Hours.

3,689. (For policy questions regarding this collection contact Melanie Brown at 410-786-1095.) 2. Type of Information Collection Request.

New collection (Request for a new OMB control number). Title of Information Collection. Patient-Reported Indicator Survey (PaRIS).

Use. The Centers for Medicare and Medicaid Services (CMS) invites comments on a proposed new Information Collection Request (ICR) to conduct the International Survey of People Living with Chronic Conditions (hereafter referred to as the PaRIS Survey). This survey has been developed by a collaborative workgroup under the auspices of the Organization for Economic Cooperation and Development (OECD), an international organization that works with governments, policy makers, and citizens to shape policies that foster prosperity, equality, opportunity, and well-being for all.

The OECD launched the PaRIS initiative in 2017 to address gaps in health outcomes measures, particularly regarding user experiences with health care services. OECD member countries, including the U.S., are working together to develop, standardize, and implement indicators that measure outcomes and experiences of health care that matter most to people. The PaRIS Survey will provide a common set of measures that support policy makers across participating countries to improve health care delivery.

On behalf of the Start Printed Page 9627 Department of Health and Human Services (DHHS) Assistant Secretary for Planning and Evaluation (ASPE), the Office of Enterprise Data and Analytics (OEDA) in CMS has been designated as the lead participant for the U.S. The PaRIS Survey will help to close critical policy gaps by focusing on. (1) Patient Reported Experience Measures (PREMS) which measure how patients experience health care, and (2) Patient Reported Outcome Measures (PROMS) which measure how patients assess the results of the care they receive.

The PaRIS survey includes both PREMS and PROMS items and aims to collect vital information about primary health care, by asking about topics such as the respondent's health, health behaviors, patient activation and confidence in managing their health care, experiences with health care and health providers including access to health care, quality of life, physical functioning, and psychological well-being. OECD and its member countries will use data collected by the PaRIS Survey to shed light on key questions about how well care in each country is organized around the needs of patients. Results from the survey will show how key outcomes and experiences vary across and within countries.

This will allow countries to benchmark and learn from each other's approaches. The survey will also help policy makers in OECD member countries understand how health systems are addressing the needs of persons with chronic health conditions. Findings will foster a dialogue with service providers about how to further improve the performance and people-centeredness of primary health care services.

To facilitate U.S. Participation in this important initiative, CMS will leverage the existing sample for the Medicare Current Beneficiary Survey (MCBS). The MCBS is a continuous, multi-purpose survey of a representative national sample of the Medicare population.

It is conducted under OMB clearance number 0938-0568. While the MCBS sample includes the population of beneficiaries aged 65 and over and beneficiaries aged 64 and below with certain disabling conditions residing in the U.S., selection for the PaRIS Survey will be limited to beneficiaries aged 65 and over who have seen a medical provider in the last six months to provide a comparable population to survey respondents selected in other participating OECD countries. Interviewers will telephone MCBS respondents and administer the PaRIS Survey by phone as a one-time standalone survey during January through April 2023.

Non-response follow-up will be conducted by telephone and in-person as needed. It is estimated that 5,144 Medicare beneficiaries will participate in this 40-minute survey. CMS plans to release a disclosure protected public use file with accompanying methodological documentation.

This public use file will also be made available to OECD for analysis and released with data from other participating countries. Form Number. CMS-10792 (OMB.

Affected Public. Individuals residing in households. Total Number of Respondents.

Total Hours. 3,814 (For policy questions regarding this collection contact William Long at 410-786-7927.) 3. Type of Information Collection Request.

Extension of a currently approved collection. Title of Information Collection. Generic Clearance for the Health Care Payment Learning and Action Network.

Use. The Center for Medicare and Medicaid Services (CMS), through the Center for Medicare and Medicaid Innovation, develops and tests innovative new payment and service delivery models in accordance with the requirements of section 1115A and in consideration of the opportunities and factors set forth in section 1115A(b)(2) of the Act. To date, CMS has built a portfolio of models (in operation or recently announced) that have attracted participation from a broad array of health care providers, states, payers, and other stakeholders.

To more effectively partner with stakeholders across the health care system and accelerate system transformation, CMS launched the Health Care Payment Learning and Action Network (LAN) to accelerate the transition to Medicare and non-Medicare alternative payment models by collaborating with a broad array of health care delivery stakeholders, identifying best practices in their implementation, and monitoring the adoption of value-based alternative payment models across the U.S. Health care system—to include the percentage of Medicare, Medicaid, and non-Medicare payments tied to (and U.S. Lives covered by) alternative payment models that reward the quality of care delivered.

Form Number. CMS-10575 (OMB control number. 0938-1297).

Individuals and Households, State, Local, or Tribal Governments, Federal Government, Private Sector (Business or other for-profits and Not-for-profits). Number of Respondents. 30,110.

Number of Responses. 23,110. Total Annual Hours.

26,467. (For questions regarding this collection contact Dustin Allison (303) 437-6123.) Start Signature Dated. February 16, 2022.

William N. Parham, III, Director, Paperwork Reduction Staff, Office of Strategic Operations and Regulatory Affairs. End Signature End Supplemental Information [FR Doc.

2022-03725 Filed 2-18-22. 8:45 am]BILLING CODE 4120-01-PStart Preamble Centers for Medicare &. Medicaid Services (CMS), Department of Health and Human Services (HHS).

Final rule. Correction and correcting amendment. In the November 19, 2021 issue of the Federal Register , we published a final rule entitled “Medicare Program.

CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies. Medicare Shared Savings Program Requirements. Provider Enrollment Regulation Updates.

And Provider and Supplier Prepayment and Post-Payment Medical Review Requirements” (referred to hereafter as the “CY 2022 PFS final rule”). The effective date was January 1, 2022. This document corrects a limited number of technical and typographical errors identified in the November 19, 2021 final rule.

This document is effective February 10, 2022, and is applicable beginning January 1, 2022. Start Further Info Terri Plumb, (410) 786-4481, Gaysha Brooks, (410) 786-9649, or Annette Brewer (410) 786 6580. End Further Info End Preamble Start Supplemental Information   I.

Background In FR Doc. 2021-23972 of November 19, 2021, the CY 2022 PFS final rule (86 FR 64996), there were technical errors that are identified and corrected in this Start Printed Page 7747 correcting document. These corrections are applicable as if they had been included in the CY 2022 PFS final rule, which was effective January 1, 2022.

II. Summary of Errors A. Summary of Errors in the Preamble On page 65059, in discussing the policy we finalized for certain mental health telehealth services, we made a typographical error in indicating the number of months within which the physician or practitioner must have furnished an item or service in person, without the use of telehealth.

On page 65132 in Table 20. CY 2022 Work RVUs for New, Revised and Potentially Misvalued Codes, due to a clerical error in which the incorrect version of the table was included, the listed CMS work RVUs for CPT codes 64633 and 66989 are incorrect. On page 65133, in Table 20.

CY 2022 Work RVUs for New, Revised and Potentially Misvalued Codes, due to the same clerical error, the listed CMS work RVU for CPT code 66991 is incorrect. On page 65274, in bulleted paragraph describing Chronic Care Management (CCM), due to a clerical error, the description of CPT code 99X21 is inaccurate. On page 65501, we made typographical errors in the year designations of the performance period and MIPS payment year.

B. Summary of Errors in the Regulations Text On page 65674, we made typographical errors in the year designations of the performance period and MIPS payment year. III.

Waiver of Proposed Rulemaking Under 5 U.S.C. 553(b) of the Administrative Procedure Act (the APA), the agency is required to publish a notice of the proposed rule in the Federal Register before the provisions of a rule take effect. Similarly, section 1871(b)(1) of the Social Security Act (the Act) requires the Secretary to provide for notice of the proposed rule in the Federal Register and provide a period of not less than 60 days for public comment.

In addition, section 553(d) of the APA and section 1871(e)(1)(B)(i) of the Act mandate a 30-day delay in effective date after issuance or publication of a rule. Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from the APA notice and comment, and delay in effective date requirements. In cases in which these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-day comment period and delay in effective date requirements of the Act as well.

The term “collection of information” get a prescription for cialis read here is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires federal agencies to publish a 30-day notice in the Federal Register concerning each proposed collection of information, get a prescription for cialis including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval.

To comply with this requirement, CMS is publishing this notice that summarizes the following proposed collection(s) of information for public comment. 1. Type of get a prescription for cialis Information Collection Request. New collection (Request for a new OMB Control Number).

Title of Information Collection. Substance Use-Disorder Prevention get a prescription for cialis that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act Section 1003 Demonstration Evaluation. Use. Section 1003 of the SUPPORT Act authorizes the Secretary of HHS, in consultation with the Director of the Agency for Healthcare Research and Quality (AHRQ) and the Assistant Secretary for Mental Health and Substance Use from the Substance Abuse and Mental Health Services Administration (SAMHSA), to conduct a 54-month demonstration project (hereinafter, “the Demonstration”) which is designed to increase the capacity of Medicaid providers to deliver substance use disorder (SUD) treatment and recovery services.

Section 1003 also get a prescription for cialis requires an evaluation of the demonstration. The evaluation is designed to assess. The effectiveness of the Demonstration in increasing the capacity of providers participating under the Medicaid state plan (or a waiver of such plan) to provide substance use disorder treatment or recovery services under such plan (or waiver). The activities carried out get a prescription for cialis under the planning grants and demonstration project.

The extent to which participating states have achieved the stated goals. And The strengths and limitations of the planning grants and demonstration project. This collection of information get a prescription for cialis request is intended to satisfy the reporting requirements, defined in the statute, regarding the impact of the Demonstration. The evaluation of the Demonstration will assess the extent to which the participating states achieved the goals they established to increase substance use treatment or recovery provider capacity under the Medicaid program.

This includes both the planning and post-planning periods of the demonstration, as evaluation during both phases will enable CMS and stakeholders to assess the effects of the additional support provided to states during the post-planning period, relative to the planning period only. Primary data get a prescription for cialis collection will occur in two rounds in year two and year four of the evaluation. In both rounds, data collection will consist of. (1) A survey of providers in all 15 Planning Grant states who are eligible to prescribe and/or administer either buprenorphine or methadone medication for opioid use disorder (OUD), and (2) focus groups of providers in five post-planning period states (two focus groups per state, with six to eight participants in each group) who treat SUD, including OUD.

The survey will gather information on provider experiences related to Medicaid provider enrollment, SUD service delivery, get a prescription for cialis and changes in OUD medication treatment, including barriers and enablers of prescribing and dispensing. The focus groups will examine the impact of key aspects of implementation, such as perceived burdens associated with Medicaid enrollment or MAT delivery, access to referral placements, value of state-provided TA, and benefits and unanticipated outcomes experienced by providers during the Demonstration. Form Number. CMS-10786 (OMB get a prescription for cialis control number.

0938-NEW). Frequency. Biennial. Affected Public.

Private sector (Business or other for-profits and Not-for-profit institutions). Number of Respondents. 28,810. Total Annual Responses.

14,405. Total Annual Hours. 3,689. (For policy questions regarding this collection contact Melanie Brown at 410-786-1095.) 2.

Type of Information Collection Request. New collection (Request for a new OMB control number). Title of Information Collection. Patient-Reported Indicator Survey (PaRIS).

Use. The Centers for Medicare and Medicaid Services (CMS) invites comments on a proposed new Information Collection Request (ICR) to conduct the International Survey of People Living with Chronic Conditions (hereafter referred to as the PaRIS Survey). This survey has been developed by a collaborative workgroup under the auspices of the Organization for Economic Cooperation and Development (OECD), an international organization that works with governments, policy makers, and citizens to shape policies that foster prosperity, equality, opportunity, and well-being for all. The OECD launched the PaRIS initiative in 2017 to address gaps in health outcomes measures, particularly regarding user experiences with health care services.

OECD member countries, including the U.S., are working together to develop, standardize, and implement indicators that measure outcomes and experiences of health care that matter most to people. The PaRIS Survey will provide a common set of measures that support policy makers across participating countries to improve health care delivery. On behalf of the Start Printed Page 9627 Department of Health and Human Services (DHHS) Assistant Secretary for Planning and Evaluation (ASPE), the Office of Enterprise Data and Analytics (OEDA) in CMS has been designated as the lead participant for the U.S. The PaRIS Survey will help to close critical policy gaps by focusing on.

(1) Patient Reported Experience Measures (PREMS) which measure how patients experience health care, and (2) Patient Reported Outcome Measures (PROMS) which measure how patients assess the results of the care they receive. The PaRIS survey includes both PREMS and PROMS items and aims to collect vital information about primary health care, by asking about topics such as the respondent's health, health behaviors, patient activation and confidence in managing their health care, experiences with health care and health providers including access to health care, quality of life, physical functioning, and psychological well-being. OECD and its member countries will use data collected by the PaRIS Survey to shed light on key questions about how well care in each country is organized around the needs of patients. Results from the survey will show how key outcomes and experiences vary across and within countries.

This will allow countries to benchmark and learn from each other's approaches. The survey will also help policy makers in OECD member countries understand how health systems are addressing the needs of persons with chronic health conditions. Findings will foster a dialogue with service providers about how to further improve the performance and people-centeredness of primary health care services. To facilitate U.S.

Participation in this important initiative, CMS will leverage the existing sample for the Medicare Current Beneficiary Survey (MCBS). The MCBS is a continuous, multi-purpose survey of a representative national sample of the Medicare population. It is conducted under OMB clearance number 0938-0568. While the MCBS sample includes the population of beneficiaries aged 65 and over and beneficiaries aged 64 and below with certain disabling conditions residing in the U.S., selection for the PaRIS Survey will be limited to beneficiaries aged 65 and over who have seen a medical provider in the last six months to provide a comparable population to survey respondents selected in other participating OECD countries.

Interviewers will telephone MCBS respondents and administer the PaRIS Survey by phone as a one-time standalone survey during January through April 2023. Non-response follow-up will be conducted by telephone and in-person as needed. It is estimated that 5,144 Medicare beneficiaries will participate in this 40-minute survey. CMS plans to release a disclosure protected public use file with accompanying methodological documentation.

This public use file will also be made available to OECD for analysis and released with data from other participating countries. Form Number. CMS-10792 (OMB. 0938-New).

Frequency. One-time collection. Affected Public. Individuals residing in households.

Total Number of Respondents. 10,498. Total Number of Responses. 10,498.

Total Hours. 3,814 (For policy questions regarding this collection contact William Long at 410-786-7927.) 3. Type of Information Collection Request. Extension of a currently approved collection.

Title of Information Collection. Generic Clearance for the Health Care Payment Learning and Action Network. Use. The Center for Medicare and Medicaid Services (CMS), through the Center for Medicare and Medicaid Innovation, develops and tests innovative new payment and service delivery models in accordance with the requirements of section 1115A and in consideration of the opportunities and factors set forth in section 1115A(b)(2) of the Act.

To date, CMS has built a portfolio of models (in operation or recently announced) that have attracted participation from a broad array of health care providers, states, payers, and other stakeholders. To more effectively partner with stakeholders across the health care system and accelerate system transformation, CMS launched the Health Care Payment Learning and Action Network (LAN) to accelerate the transition to Medicare and non-Medicare alternative payment models by collaborating with a broad array of health care delivery stakeholders, identifying best practices in their implementation, and monitoring the adoption of value-based alternative payment models across the U.S. Health care system—to include the percentage of Medicare, Medicaid, and non-Medicare payments tied to (and U.S. Lives covered by) alternative payment models that reward the quality of care delivered.

Form Number. CMS-10575 (OMB control number. 0938-1297). Frequency.

Occasionally. Affected Public. Individuals and Households, State, Local, or Tribal Governments, Federal Government, Private Sector (Business or other for-profits and Not-for-profits). Number of Respondents.

30,110. Number of Responses. 23,110. Total Annual Hours.

26,467. (For questions regarding this collection contact Dustin Allison (303) 437-6123.) Start Signature Dated. February 16, 2022. William N.

Parham, III, Director, Paperwork Reduction Staff, Office of Strategic Operations and Regulatory Affairs. End Signature End Supplemental Information [FR Doc. 2022-03725 Filed 2-18-22. 8:45 am]BILLING CODE 4120-01-PStart Preamble Centers for Medicare &.

Medicaid Services (CMS), Department of Health and Human Services (HHS). Final rule. Correction and correcting amendment. In the November 19, 2021 issue of the Federal Register , we published a final rule entitled “Medicare Program.

CY 2022 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies. Medicare Shared Savings Program Requirements. Provider Enrollment Regulation Updates. And Provider and Supplier Prepayment and Post-Payment Medical Review Requirements” (referred to hereafter as the “CY 2022 PFS final rule”).

The effective date was January 1, 2022. This document corrects a limited number of technical and typographical errors identified in the November 19, 2021 final rule. This document is effective February 10, 2022, and is applicable beginning January 1, 2022. Start Further Info Terri Plumb, (410) 786-4481, Gaysha Brooks, (410) 786-9649, or Annette Brewer (410) 786 6580.

End Further Info End Preamble Start Supplemental Information   I. Background In FR Doc. 2021-23972 of November 19, 2021, the CY 2022 PFS final rule (86 FR 64996), there were technical errors that are identified and corrected in this Start Printed Page 7747 correcting document. These corrections are applicable as if they had been included in the CY 2022 PFS final rule, which was effective January 1, 2022.

II. Summary of Errors A. Summary of Errors in the Preamble On page 65059, in discussing the policy we finalized for certain mental health telehealth services, we made a typographical error in indicating the number of months within which the physician or practitioner must have furnished an item or service in person, without the use of telehealth. On page 65132 in Table 20.

CY 2022 Work RVUs for New, Revised and Potentially Misvalued Codes, due to a clerical error in which the incorrect version of the table was included, the listed CMS work RVUs for CPT codes 64633 and 66989 are incorrect. On page 65133, in Table 20. CY 2022 Work RVUs for New, Revised and Potentially Misvalued Codes, due to the same clerical error, the listed CMS work RVU for CPT code 66991 is incorrect. On page 65274, in bulleted paragraph describing Chronic Care Management (CCM), due to a clerical error, the description of CPT code 99X21 is inaccurate.

On page 65501, we made typographical errors in the year designations of the performance period and MIPS payment year. B. Summary of Errors in the Regulations Text On page 65674, we made typographical errors in the year designations of the performance period and MIPS payment year. III.

Waiver of Proposed Rulemaking Under 5 U.S.C. 553(b) of the Administrative Procedure Act (the APA), the agency is required to publish a notice of the proposed rule in the Federal Register before the provisions of a rule take effect. Similarly, section 1871(b)(1) of the Social Security Act (the Act) requires the Secretary to provide for notice of the proposed rule in the Federal Register and provide a period of not less than 60 days for public comment. In addition, section 553(d) of the APA and section 1871(e)(1)(B)(i) of the Act mandate a 30-day delay in effective date after issuance or publication of a rule.

Sections 553(b)(B) and 553(d)(3) of the APA provide for exceptions from the APA notice and comment, and delay in effective date requirements. In cases in which these exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide exceptions from the notice and 60-day comment period and delay in effective date requirements of the Act as well. Section 553(b)(B) of the APA and section 1871(b)(2)(C) of the Act authorize an agency to dispense with normal notice and comment rulemaking procedures for good cause if the agency makes a finding that the notice and comment process is impracticable, unnecessary, or contrary to the public interest, and includes a statement of the finding and the reasons for it in the rule. In addition, section 553(d)(3) of the APA and section 1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay in effective date where such delay is contrary to the public interest and the agency includes in the rule a statement of the finding and the reasons for it.

In our view, this correcting document does not constitute a rulemaking that would be subject to these requirements. This document merely corrects technical errors in the CY 2022 PFS final rule. The corrections contained in this document are consistent with, and do not make substantive changes to, the policies and payment methodologies that were proposed, subject to notice and comment procedures, and adopted in the CY 2022 PFS final rule. As a result, the corrections made through this correcting document are intended to resolve inadvertent errors so that the rule accurately reflects the policies adopted in the final rule.

Even if this were a rulemaking to which the notice and comment and delayed effective date requirements applied, we find that there is good cause to waive such requirements. Undertaking further notice and comment procedures to incorporate the corrections in this document into the CY 2022 PFS final rule or delaying the effective date of the corrections would be contrary to the public interest because it is in the public interest to ensure that the rule accurately reflects our policies as of the date they take effect. Further, such procedures would be unnecessary because we are not making any substantive revisions to the final rule, but rather, we are simply correcting the Federal Register document to reflect the policies that we previously proposed, received public comment on, and subsequently finalized in the final rule. For these reasons, we believe there is good cause to waive the requirements for notice and comment and delay in effective date.

IV. Correction of Errors in Preamble In FR Doc. 2021-23972 of November 19, 2021 (86 FR 64996) make the following corrections.