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Exeter NHS Foundation Trust A smiley mesothelial cell, can you buy cipro over the counter MGG stained from a pleural effusion. Check out more of the images shared on Biomedical Science Day 2021 in our photo gallery on Facebook.28 June 2021 Our members celebrated Biomedical Science Day and showed the public the full range of expertise of the profession #BehindEveryTest Biomedical Science Day 2021 was a well-deserved moment of celebration after a long stretch of hard work. We were overjoyed to see the celebrations of the profession across the UK.

Though there were still very few laboratory tours or can you buy cipro over the counter stands in foyers, our amazing members pulled out all the digital stops to inform the public about the biomedical science profession #AtTheHeartOfHealthcare. This year, after gaining recognition as the profession doing the buy antibiotics testing, we focused on showing the public the wider range of skills and specialisms of the profession #BehindEveryTest in the wider healthcare context. There were posts and reports from laboratories across the UK, as our members rightly celebrated their efforts to maintain services despite buy antibiotics.On social media, we encouraged our members to use the hashtags #BiomedicalScienceDay2021 and #AtTheHeartOfHealthcare to promote their activities.

On Facebook and Twitter, #BiomedicalScienceDay2021 was used in posts 3,666 times with 45.6k accounts sharing the posts and 13.7K liking them can you buy cipro over the counter. 59.6K people interacted with posts using the hashtag. The potential audience reach for all posts was 12.4m.

#AtTheHeartOfHealthcare was used in posts 2,754 times with 42.3K accounts sharing the posts and 12.7K can you buy cipro over the counter liking them. 55.2K people interacted with posts using the hashtag. The potential audience reach for all posts was 9.5m.On Instagram and TikTok, members and NHS trusts shared even more photos and videos of their celebrations, hosted live streams explaining their role and touring their lab.

Members who tagged @IBMScience were included in our Instagram and Facebook story chronicling the best moments throughout the can you buy cipro over the counter day. You can still view this story in our Instagram account under highlights.iNews drew attention to our awareness campaign on the day and the profession received a shout out on BBC Radio 2 from Sara Cox.Across the UK, communications teams in hospitals and university laboratories handed their social media accounts over to their pathology staff and allowed them to celebrate and inform their followers about the skills and expertise involved in their practice. We lost count of the amount of wonderful and informative videos and digital tours from our members who were doing social media takeovers for their Trusts and Hospitals.

You can see can you buy cipro over the counter a large collection of the photos that our members shared in our photo gallery. If you had your photo taken on the day, it's likely you will have ended up in there (or will do in the coming days). Here are some of the most popular tweets from the day - including our opening video.

Happy #BiomedicalScienceDay2021 can you buy cipro over the counter. Today we are celebrating the biomedical scientists and laboratory staff who work #AtTheHeartOfHealthcare analysing over 1 billion patient samples a year and informing over 70% of all diagnoses pic.twitter.com/fCaOy06ftF — IBMS #AtTheHeartOfHealthcare (@IBMScience) June 24, 2021 and some messages from our very own Chief Executive David Wells. This #BiomedicalScienceDay2021, I want to say a big THANK YOU to the Biomedical Scientists and laboratory staff working #AtTheHeartOfHealthcare 24/7/365.

I'm so proud to lead our professional body and will do everything in my power to support can you buy cipro over the counter you and your profession!. pic.twitter.com/rdvzcT4Pzz — David Wells (@DavidRWells) June 24, 2021 This #BiomedicalScienceDay2021, I would like to call for the @GOVUK to provide more funded training places to bolster the biomedical science workforce. We are short of staff #AtTheHeartOfHealthcare - and the cipro has shown just how vital the staff #BehindEveryTest truly are!.

pic.twitter.com/YNWrP5H7OY — David Wells can you buy cipro over the counter (@DavidRWells) June 24, 2021 Thank you to everybody who contacted your local politicians. We had more political support than ever before - many using our messaging that we had written for our members to use. Tweets included.

The Health Secretary, Dr Rosena Allin-Khan MP - Tooting, can you buy cipro over the counter Ruth Cadbury MP - MP Brentford &. Isleworth, Lord Bethall, John Stevenson MP - Carlisle, Bell Ribiero-Addy MP - Streatham, Jonathan Reynolds MP – Shadow Secretary of State for Work and Pensions, Oliver Heald MP - Hertfordshire, Gerald Jones MP – Merthyr Tydfil &. Rhymney, Michelle Gildernew – Sinn Fein, Colm Gidernew MLA, Paula Barker MP Liverpool Wavertree, Grahame Morris MP Easington, Martina Anderson MLA Sinn Fein, Northern Ireland Assembly Committee for Health, NI Dept of Health – Health Minister, Naomi Long MLA - NI Justice Minister and Dawn Bowden - Co-op Member of the Senedd for the Merthyr Tydfil and Rhymney.

THANK can you buy cipro over the counter YOU. To biomedical science superstars ?. ?.

Whether on treatments, therapeutics, or diagnostics, your work has been central to the cipro response? can you buy cipro over the counter. ?. €?.

#BiomedicalScienceDay2021 #BiomedicalScienceDay pic.twitter.com/1NYU2rJBWY — Lord Bethell (@JimBethell) June 24, 2021 Major healthcare accounts also showed their solidarity with the profession. NHS England - 484.1K Followers Today is #BiomedicalScienceDay and we’d like to say a huge THANK YOU to all our biomedical scientists, clinical scientists and other pathology staff for all their continued hard work for patients and staff. ?.

?. pic.twitter.com/GN06Me0qOx — NHS England and NHS Improvement (@NHSEngland) June 24, 2021 Public Health England - 491.7K Followers Today is #BiomedicalScienceDay2021 We want to say a big thank you to all Biomedical Scientists, Clinical Scientists and laboratory staff who work at PHE and beyond. You are #AtTheHeartOfHealthcare.Watch our video about starting a career in Biomedical Science.

Pic.twitter.com/gGTY2UJYhN — Public Health England (@PHE_uk) June 24, 2021 HCPC. Happy #BiomedicalScienceDay2021!. A huge thank you to the #HCPCRegistered Biomedical Scientists, Clinical Scientists and laboratory staff who have worked tirelessly throughout cipro and are #AtTheHeartOfHealthcare in the #NHS and elsewhere ?.

pic.twitter.com/0NlVvV6gdk — HCPC (@The_HCPC) June 24, 2021 Care Quality Commission - 176.2K Followers Today is #BiomedicalScienceDay2021!. Thank you to the biomedical scientists, clinical scientists and lab staff behind every test. ?.

?. ?. @IBMScience pic.twitter.com/H0zfexKuTb — Care Quality Commission - gov.uk/antibiotics (@CareQualityComm) June 24, 2021 Alzheimer Research UK - 83.1K Followers On #BiomedicalScienceDay2021 we want to say thank you to all the dementia researchers working tirelessly to find life-changing breakthroughs, that will transform the lives of people affected by dementia.

We are committed to raising awareness &. Understanding of their vital work. Pic.twitter.com/mxp8ZaoOn1 — AlzheimersResearchUK ?.

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In 2019, the Topol review was published on behalf of the secretary of state for health and social care in the UK, preparing the healthcare workforce to deliver the digital future.1 A multidisciplinary team of experts, including clinicians, researchers, ethicists, computer scientists, engineers and cipro and tendonitis economists, reviewed the available data and projected into the future (ie, next 20 years) two key questions. What impact technological developments (including genomics, artificial intelligence (AI), digital medicine and robotics) will have on the roles and functions of National Health System clinical staff?. How could this innovation (ie, biosensors, electronic patient record, smartphone apps, digital infrastructure and virtual reality) cipro and tendonitis ensure safer, more productive, more effective and more personalised care for patients?.

It is now widely recognised that data science and information technologies enable understanding of the uniqueness of each individual and the ability to deliver healthcare on a far more timely, efficient and tailored basis.Mental health is a top priority in the UK national research agenda2 and presents a unique opportunity because it is in the next wave of adoption of digital health and innovation technologies.3 The Topol review noted that innovation can ‘bring a new emphasis on the nurturing of the precious interhuman bond, based on trust, clinical presence, empathy and communication’. Patients must occupy a …Analytical approachThe threshold analysis was undertaken within a ‘cost-utility’ framework with treatment benefit quantified as the avoidance of years cipro and tendonitis lost due to disability (YLD)12 associated with CMD. The YLD measure forms part of the disability-adjusted life year (DALY) approach to estimating disease burden and treatment impact.12 We chose this metric to capture treatment benefit because it has a wide usage in economic evaluations carried out in a global health context.12 DALY is conventionally defined as the sum of years of life lost due to premature death and the YLD attributable to CMD.

We focus on the YLD component as a measure of treatment benefit given uncertainty over the direct causal component of a substantial proportion of the excess mortality linked to CMD.13Modelling was undertaken to estimate cipro and tendonitis the YLD avoided through treating CMD using the FB rather than a usual care comparator. This used evidence and data on treatment effect and treatment contacts from the FB clinical trial described elsewhere.4 We use this single source of evidence given that the trial was conducted within the same geographical and service-related context within which the wider scale-up of the FB took place. Usual care was assumed to comprise the type and frequency of health professional contacts self-reported by participants allocated to cipro and tendonitis the control group of the trial.

We estimated YLD over a 2-year time horizon to avoid uncertainty with projections of service user outcome over lengthier periods. Following convention, YLD in year 2 are discounted at a recommended rate of 3%.12 cipro and tendonitis Costs are quantified from a payer perspective. 70%–80% of the FB programme, including scale-up, has been funded through non-governmental finance, with the remainder resourced from local city health department budgets.We identify the level of treatment coverage (annual number treated) required for the investment in the scale-up of the FB to be considered cost-effective based on a prespecified cost-effectiveness threshold (CET).

We refer to the cost-effective treatment coverage as the cipro and tendonitis ‘number needed to treat’ (NNT). To evaluate the NNT, the annual fixed costs of delivering the FB programme in Zimbabwe were estimated inclusive of resource inputs invested in the initial implementation of the scale-up and programme infrastructure required to sustain the programme year-on-year (excluding the variable costs of clinical assessment and treatment-related activity with service users). We then convert these fixed costs into their ‘opportunity cost’ equivalent (C)—the quantity of YLD that could have been averted had the cipro and tendonitis resources subsumed within the programme’s fixed costs been invested in alternative health promotional activity.

This is calculated as. Where ‘λ’ is a cipro and tendonitis CET appropriate for Zimbabwe. The CET is intended to approximate the additional dollar expenditure on healthcare inputs sufficient to produce a one-unit reduction in disease burden, thereby indicating the maximum a health system should be willing to pay to avert a single YLD.14 We adopt a CET of US$600 per YLD averted, equivalent to 50% of the gross national income (GNI) per capita in Zimbabwe at 2019 price levels.15 This follows the recommendations on threshold determination in LMIC settings, reflecting the principle of opportunity cost and affordability within resource-poor contexts.16 17 The value of ‘C’ is relevant to this analysis because it identifies the minimum quantity of annual treatment benefit (total YLD averted) the FB would need to generate compared with usual care to justify fixed costs.

The NNT value required for cost-effective scale-up is then. Where ‘INB’ is the cipro and tendonitis incremental net benefit per service user of FB treatment, equal to the YLD avoided through replacement of usual care with the FB less the opportunity cost of additional LHW time inputted to FB treatment-related activity. Clinical assessments, PST sessions, indirect costs (defined below), case assessment work and peer group attendance.

The opportunity cost of treatment activity is again expressed as the YLD that would otherwise cipro and tendonitis be averted (if LHW time was used elsewhere) and is estimated using the same method applied to fixed costs.In addition to the NNT we also report the incremental cost-effectiveness ratio (ICER) for the FB programme (additional cost per YLD averted). The base case ICER is calculated assuming an annual level of treatment coverage equivalent to the recorded number of patients seen by the FB during 2020 (obtained from programme management information).A Markov model was used to estimate the YLD that could be avoided if a cohort presenting with CMD received FB treatment in place of usual care. A Markov approach was selected because it is amenable to projecting service user outcomes over extended time horizons.18 Outcomes are simulated cipro and tendonitis over 24 1-month cycles for FB and usual care treatment scenarios.

For simplicity the analysis only considers outcomes relating to a single treatment episode.A visual description of the model is provided in the online supplemental appendix. In summary, the model assumes that service users spend time in one of cipro and tendonitis two health states characterised by a unique disability weighting. A CMD and a remission state.

Disability weights (table 1) were obtained by transforming (see table 1 footnote) Zimbabwean-specific ‘utility’ scores applicable to self-reported health states for participants in the FB clinical trial.4 19 Health states were identified through administration of the EQ5D-5L health-related quality of cipro and tendonitis life instrument.20 Over a series of monthly post-treatment ‘cycles’, a percentage of the model cohort are expected to either transition into the remission state or remain in the CMD state. Of those who remit, a percentage are assumed to relapse back to the CMD state during each cycle, with a further proportion of those who relapse transitioning back to the remission state.Supplemental materialView this table:Table 1 Modelling assumptionsThe per cent of service users entering remission during each monthly cycle (table 1) was inferred using the reported proportion of participants with CMD at 6-month follow-up in the FB clinical trial control group combined with the reported prevalence ratio for CMD between intervention and control participants.4 The presence of CMD was defined according to whether a trial participant scored ≥9 on the Shona Symptom Questionnaire (SSQ-14), a locally validated assessment tool for CMD used routinely to determine treatment eligibility.21 We present an assessment of the impact on the NNT value of using less favourable assumptions regarding CMD prevalence ratios in sensitivity analysis.The monthly per cent of remitters who relapse (table 1) was estimated using 12-month relapse outcomes reported in a rare example of published research into the duration of remission following low-intensity psychological therapy (in this case cognitive–behavioural therapy delivered in a British primary care service).22 Relapse rates for FB treatment and usual care are assumed to be equivalent, an assumption that has been employed in similar economic analysis of depression outcomes in an LMIC setting.8 The monthly per cent of further remission after relapse was estimated using evidence from a Zimbabwean observational study that examined remission outcomes for a cohort of cases with a CMD attending community health facilities and traditional practitioners.23Over each modelling cycle a percentage of the cohort are also assumed to die (effectively exiting the model. Table 1) cipro and tendonitis.

This was estimated using annual survival probabilities contained in life tables for Zimbabwe,24 adjusted by a relative mortality risk reported for populations with depression.25 As our analysis excludes avoidance of years of life lost as a treatment benefit, mortality risk is fixed at the same level for both remission and time spent in a CMD state.CostsAll cost-related assumptions are detailed in table 1. Annual fixed costs were obtained from programme-level financial data cipro and tendonitis. The cost of the programme scale-up came from financial planning data for 2016 detailing anticipated expenditures across multiple activities.

Data on actual expenditures cipro and tendonitis were unavailable. The FB scale-up strategy consisted of three phases. A needs assessment, LHW cipro and tendonitis training in PST and a final ‘implementation’ phase.

Cost estimates relate to the hiring of venues and accommodation, purchase of equipment, transportation, payments for trainer time, training of research assistants and purchase of wooden benches (for PST sessions). Costs were converted to an annual fixed cost equivalent assuming a 10-year programme lifetime and a discount rate of 3%.Central programme overhead costs included payment for staff involved with programme management and related activities (eg, analytical and administrative support), building space used to house central programme activities and associated running costs. The annual cost of used building space was cipro and tendonitis estimated using the purchase value of the property converted to an annualised cost, applying a discount rate of 3% and an asset lifetime of 80 years.

As central overhead costs are shared across other non-FB activities, the central programme team estimated that 40% of overheads would be attributable directly to the FB.The number of clinical assessments undertaken to determine treatment eligibility for every service user treated was inferred based on fieldwork data received from all clinics, collected as part of wider ongoing research on programme implementation, identifying the mean percentage of patients clinically assessed who had at least one FB session (36%). And an assumed 39% case detection rate through cipro and tendonitis clinical screening as observed within the FB clinical trial.4 Each clinical assessment was assumed to require 60 min of LHW time.The duration of LHW time allocated to PST sessions was estimated using the mean frequency of sessions reported in the FB trial data, assuming 45 min per session. For every minute of LHW direct treatment time, we assumed an additional minute would be required for preparatory and other clinical and administrative tasks (we refer to these as ‘indirect costs’).

Time spent by LHW and cipro and tendonitis supervisors reviewing patients was assumed to take an average of 13.5 min per patient. These assumptions were informed by treatment resource requirements reported by Araya et al,1 in relation to a task-sharing intervention delivered in Chile. Time allocated by LHWs to attendance at cipro and tendonitis peer group meetings was based on data from the FB clinical trial.

It was assumed that LHWs would be expected to attend one in every six peer group meetings, with attendance lasting 60 min.LHWs are expected to engage in patient ‘mobilisation’. This typically cipro and tendonitis consists of a talk given in a clinic waiting area promoting mental health awareness and the FB. Time allocated to mobilisation was estimated based on the mean number of mobilisation sessions over 1 month reported by a sample of LHWs interviewed during fieldwork for wider ongoing research.

A group mobilisation talk was assumed to last 15 cipro and tendonitis min. City health department district health promotion officers provide supervisory input to the FB programme. In consultation with programme leads, this was assumed to consist of a weekly 30 min cipro and tendonitis visit to each clinic providing the FB.The cost of usual care was estimated using health professional contact data self-reported over follow-up by participants in the control group of the FB clinical trial (unpublished data.

D.Chibanda et al. (2016)). Assumptions regarding the quantity of time allocated to each contact are found in the footnote to table 1.

The cost of LHW and other staff time allocated to the FB and usual care was valued using staff salaries provided by the FB programme..

In 2019, the can you buy cipro over the counter Topol review was published on behalf of the secretary of state for health and social care in the UK, click for more preparing the healthcare workforce to deliver the digital future.1 A multidisciplinary team of experts, including clinicians, researchers, ethicists, computer scientists, engineers and economists, reviewed the available data and projected into the future (ie, next 20 years) two key questions. What impact technological developments (including genomics, artificial intelligence (AI), digital medicine and robotics) will have on the roles and functions of National Health System clinical staff?. How could this innovation (ie, biosensors, can you buy cipro over the counter electronic patient record, smartphone apps, digital infrastructure and virtual reality) ensure safer, more productive, more effective and more personalised care for patients?.

It is now widely recognised that data science and information technologies enable understanding of the uniqueness of each individual and the ability to deliver healthcare on a far more timely, efficient and tailored basis.Mental health is a top priority in the UK national research agenda2 and presents a unique opportunity because it is in the next wave of adoption of digital health and innovation technologies.3 The Topol review noted that innovation can ‘bring a new emphasis on the nurturing of the precious interhuman bond, based on trust, clinical presence, empathy and communication’. Patients must occupy a …Analytical approachThe can you buy cipro over the counter threshold analysis was undertaken within a ‘cost-utility’ framework with treatment benefit quantified as the avoidance of years lost due to disability (YLD)12 associated with CMD. The YLD measure forms part of the disability-adjusted life year (DALY) approach to estimating disease burden and treatment impact.12 We chose this metric to capture treatment benefit because it has a wide usage in economic evaluations carried out in a global health context.12 DALY is conventionally defined as the sum of years of life lost due to premature death and the YLD attributable to CMD.

We focus on the YLD component as can you buy cipro over the counter a measure of treatment benefit given uncertainty over the direct causal component of a substantial proportion of the excess mortality linked to CMD.13Modelling was undertaken to estimate the YLD avoided through treating CMD using the FB rather than a usual care comparator. This used evidence and data on treatment effect and treatment contacts from the FB clinical trial described elsewhere.4 We use this single source of evidence given that the trial was conducted within the same geographical and service-related context within which the wider scale-up of the FB took place. Usual care was can you buy cipro over the counter assumed to comprise the type and frequency of health professional contacts self-reported by participants allocated to the control group of the trial.

We estimated YLD over a 2-year time horizon to avoid uncertainty with projections of service user outcome over lengthier periods. Following convention, YLD in year 2 are discounted at a recommended can you buy cipro over the counter rate of 3%.12 Costs are quantified from a payer perspective. 70%–80% of the FB programme, including scale-up, has been funded through non-governmental finance, with the remainder resourced from local city health department budgets.We identify the level of treatment coverage (annual number treated) required for the investment in the scale-up of the FB to be considered cost-effective based on a prespecified cost-effectiveness threshold (CET).

We refer to the cost-effective treatment coverage as the ‘number can you buy cipro over the counter needed to treat’ (NNT). To evaluate the NNT, the annual fixed costs of delivering the FB programme in Zimbabwe were estimated inclusive of resource inputs invested in the initial implementation of the scale-up and programme infrastructure required to sustain the programme year-on-year (excluding the variable costs of clinical assessment and treatment-related activity with service users). We then convert these fixed can you buy cipro over the counter costs into their ‘opportunity cost’ equivalent (C)—the quantity of YLD that could have been averted had the resources subsumed within the programme’s fixed costs been invested in alternative health promotional activity.

This is calculated as. Where ‘λ’ is can you buy cipro over the counter a CET appropriate for Zimbabwe. The CET is intended to approximate the additional dollar expenditure on healthcare inputs sufficient to produce a one-unit reduction in disease burden, thereby indicating the maximum a health system should be willing to pay to avert a single YLD.14 We adopt a CET of US$600 per YLD averted, equivalent to 50% of the gross national income (GNI) per capita in Zimbabwe at 2019 price levels.15 This follows the recommendations on threshold determination in LMIC settings, reflecting the principle of opportunity cost and affordability within resource-poor contexts.16 17 The value of ‘C’ is relevant to this analysis because it identifies the minimum quantity of annual treatment benefit (total YLD averted) the FB would need to generate compared with usual care to justify fixed costs.

The NNT value required for cost-effective scale-up is then. Where ‘INB’ can you buy cipro over the counter is the incremental net benefit per service user of FB treatment, equal to the YLD avoided through replacement of usual care with the FB less the opportunity cost of additional LHW time inputted to FB treatment-related activity. Clinical assessments, PST sessions, indirect costs (defined below), case assessment work and peer group attendance.

The opportunity cost of treatment activity is again expressed as the YLD that would otherwise be averted (if LHW time was used elsewhere) and is estimated using the same method applied to fixed costs.In addition to the NNT we also report the incremental cost-effectiveness ratio (ICER) for the FB can you buy cipro over the counter programme (additional cost per YLD averted). The base case ICER is calculated assuming an annual level of treatment coverage equivalent to the recorded number of patients seen by the FB during 2020 (obtained from programme management information).A Markov model was used to estimate the YLD that could be avoided if a cohort presenting with CMD received FB treatment in place of usual care. A Markov approach was selected because it is amenable to projecting service can you buy cipro over the counter user outcomes over extended time horizons.18 Outcomes are simulated over 24 1-month cycles for FB and usual care treatment scenarios.

For simplicity the analysis only considers outcomes relating to a single treatment episode.A visual description of the model is provided in the online supplemental appendix. In summary, the model assumes that service users spend time in one of can you buy cipro over the counter two health states characterised by a unique disability weighting. A CMD and a remission state.

Disability weights (table 1) were obtained by transforming (see table 1 footnote) Zimbabwean-specific ‘utility’ scores applicable to self-reported health states for participants in can you buy cipro over the counter the FB clinical trial.4 19 Health states were identified through administration of the EQ5D-5L health-related quality of life instrument.20 Over a series of monthly post-treatment ‘cycles’, a percentage of the model cohort are expected to either transition into the remission state or remain in the CMD state. Of those who remit, a percentage are assumed to relapse back to the CMD state during each cycle, with a further proportion of those who relapse transitioning back to the remission state.Supplemental materialView this table:Table 1 Modelling assumptionsThe per cent of service users entering remission during each monthly cycle (table 1) was inferred using the reported proportion of participants with CMD at 6-month follow-up in the FB clinical trial control group combined with the reported prevalence ratio for CMD between intervention and control participants.4 The presence of CMD was defined according to whether a trial participant scored ≥9 on the Shona Symptom Questionnaire (SSQ-14), a locally validated assessment tool for CMD used routinely to determine treatment eligibility.21 We present an assessment of the impact on the NNT value of using less favourable assumptions regarding CMD prevalence ratios in sensitivity analysis.The monthly per cent of remitters who relapse (table 1) was estimated using 12-month relapse outcomes reported in a rare example of published research into the duration of remission following low-intensity psychological therapy (in this case cognitive–behavioural therapy delivered in a British primary care service).22 Relapse rates for FB treatment and usual care are assumed to be equivalent, an assumption that has been employed in similar economic analysis of depression outcomes in an LMIC setting.8 The monthly per cent of further remission after relapse was estimated using evidence from a Zimbabwean observational study that examined remission outcomes for a cohort of cases with a CMD attending community health facilities and traditional practitioners.23Over each modelling cycle a percentage of the cohort are also assumed to die (effectively exiting the model. Table 1) can you buy cipro over the counter.

This was estimated using annual survival probabilities contained in life tables for Zimbabwe,24 adjusted by a relative mortality risk reported for populations with depression.25 As our analysis excludes avoidance of years of life lost as a treatment benefit, mortality risk is fixed at the same level for both remission and time spent in a CMD state.CostsAll cost-related assumptions are detailed in table 1. Annual fixed costs were obtained can you buy cipro over the counter from programme-level financial data. The cost of the programme scale-up came from financial planning data for 2016 detailing anticipated expenditures across multiple activities.

Data on actual expenditures were can you buy cipro over the counter unavailable. The FB scale-up strategy consisted of three phases. A needs assessment, LHW training in PST and a final ‘implementation’ can you buy cipro over the counter phase.

Cost estimates relate to the hiring of venues and accommodation, purchase of equipment, transportation, payments for trainer time, training of research assistants and purchase of wooden benches (for PST sessions). Costs were converted to an annual fixed cost equivalent assuming a 10-year programme lifetime and a discount rate of 3%.Central programme overhead costs included payment for staff involved with programme management and related activities (eg, analytical and administrative support), building space used to house central programme activities and associated running costs. The annual cost of used building space was estimated using the purchase value of the property converted to an annualised cost, applying a discount rate of 3% and an can you buy cipro over the counter asset lifetime of 80 years.

As central overhead costs are shared across other non-FB activities, the central programme team estimated that 40% of overheads would be attributable directly to the FB.The number of clinical assessments undertaken to determine treatment eligibility for every service user treated was inferred based on fieldwork data received from all clinics, collected as part of wider ongoing research on programme implementation, identifying the mean percentage of patients clinically assessed who had at least one FB session (36%). And an assumed 39% case detection rate through clinical screening as observed within the FB clinical trial.4 Each clinical assessment was assumed to require 60 min of LHW time.The duration of LHW time allocated to can you buy cipro over the counter PST sessions was estimated using the mean frequency of sessions reported in the FB trial data, assuming 45 min per session. For every minute of LHW direct treatment time, we assumed an additional minute would be required for preparatory and other clinical and administrative tasks (we refer to these as ‘indirect costs’).

Time spent by LHW and supervisors reviewing patients was assumed to take an average can you buy cipro over the counter of 13.5 min per patient. These assumptions were informed by treatment resource requirements reported by Araya et al,1 in relation to a task-sharing intervention delivered in Chile. Time allocated by LHWs to attendance at can you buy cipro over the counter peer group meetings was based on data from the FB clinical trial.

It was assumed that LHWs would be expected to attend one in every six peer group meetings, with attendance lasting 60 min.LHWs are expected to engage in patient ‘mobilisation’. This typically consists of a talk given in a clinic waiting area promoting can you buy cipro over the counter mental health awareness and the FB. Time allocated to mobilisation was estimated based on the mean number of mobilisation sessions over 1 month reported by a sample of LHWs interviewed during fieldwork for wider ongoing research.

A group mobilisation talk was assumed to last can you buy cipro over the counter 15 min. City health department district health promotion officers provide supervisory input to the FB programme. In consultation with programme leads, this was assumed to consist of a weekly 30 min can you buy cipro over the counter visit to each clinic providing the FB.The cost of usual care was estimated using health professional contact data self-reported over follow-up by participants in the control group of the FB clinical trial (unpublished data.

D.Chibanda et al. (2016)). Assumptions regarding the quantity of time allocated to each contact are found in the footnote to table 1.

The cost of LHW and other staff time allocated to the FB and usual care was valued using staff salaries provided by the FB programme..

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Welcome to the first issue online doctor cipro of 2022! cipro for dogs ear . We have several exciting changes to announce in the new year. To begin with, cipro for dogs ear we have been increasing our number of published submissions per issue, 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 holds humanity cipro for dogs ear (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) cipro for dogs ear . 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 cipro for dogs ear diverse as Martin Heidegger, 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’ cipro for dogs ear (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 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, cipro for dogs ear and Ødemark 2017. Hetrick et al. 2017). However, it is crucial cipro for dogs ear to note that Cura (in Hyginus’ text) will ‘hold’ humanity quamdiu vixerit (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 the endeavour by acknowledging that I am a scholar, and the father of a boy with cipro for dogs ear 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 if I am not only holding or cipro for dogs ear 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 cipro for dogs ear 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 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 cipro for dogs ear care ‘follow’ each other in an analytical ‘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 cipro for dogs ear practice of parental care, the exploration ends with a discussion of 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 cipro for dogs ear and the autotheoretical work indicate that those complexities might overpower 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 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, cipro for dogs ear 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, 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 cipro for dogs ear 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 cipro for dogs ear Kristeva nor Kleinman or Heidegger focus on Hyginus’ text. In contrast to this body of research, this article emphasizes the interpretative potential of the original text. In addition to grammatical analysis, I utilize cipro for dogs ear 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 cipro for dogs ear texts, two destinies, two psyches. 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 cipro for dogs ear by Bakhtin 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 cipro for dogs ear I study Hyginus’ text not as a ‘lonely text’, but 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 cipro for dogs ear same material 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 cipro for dogs ear 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 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 cipro for dogs ear deities and finally, a verdict 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 fashion a man.Before interpreting this first story, we must cipro for dogs ear 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 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, cipro for dogs ear 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 cipro for dogs ear 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 Propertius, for instance, in his Libri Elegiarum from the first-century BC, laments and elaborates on how Prometheus was cipro for dogs ear 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 cipro for dogs ear 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 cipro for dogs ear 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 cipro for dogs ear 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 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, 182)Typical of Goethe’s Sturm und Drang cipro for dogs ear 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 cipro for dogs ear must first unpack the name of the personification that 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 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 cipro for dogs ear 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 sense also injects an aspect that is totally absent in classical cipro for dogs ear 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 and expansion, but cipro for dogs ear 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 are described by do (in Hyginus cipro for dogs ear .

€˜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 cipro for dogs ear emerges from 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) cipro for dogs ear . 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 cipro for dogs ear 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 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 cipro for dogs ear 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 cipro for dogs ear develops his notion of Sorge as the fundamental human condition (Dye 2009, 207–218)., Kristeva (2001), too, refers several times to 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 cipro for dogs ear 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, cipro for dogs ear the cared-for becomes visible to the carer(s), thereby also 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 between individuality and multitude dovetails with research on the knowledge complexities involved in cipro for dogs ear 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 der Gedanken, also refract my experiences of cipro for dogs ear 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 cipro for dogs ear these feelings—where the socially estranged ways of 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 many names in and beyond the medical humanities cipro for dogs ear . Examples include ’underlying values’, ‘ethical content of particular practices’, ‘transformative learning’ and many others (Ayala 2019, 269. Pettersen 2008, 188.

Winthrop 2003).Cogitabunda, can cipro for dogs ear mean to 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 openness—perhaps even fantasy or at least exploration—in this cipro for dogs ear .

When I hold my son in my arms connecting different realms of thought. As in ruff-and-tumble-play, these realms are also at play as I cipro for dogs ear 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 cipro for dogs ear name, Jove 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 cipro for dogs ear is 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 cipro for dogs ear classical 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 cipro for dogs ear 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 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 or by the plural in von Herder’s Traum cipro for dogs ear 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 otherwise incommensurable interpretative cipro for dogs ear 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 cipro for dogs ear will receive human souls, while Tellus will receive the body post mortem:Tu Iovis quoniam spiritum dedisti, <…>. Corpus recipito. Cura quoniam cipro for dogs ear prima eum finxit, 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 cipro for dogs ear seems to be 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 humanity and its creator is cipro for dogs ear 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 earth the brute creation bends its cipro for dogs ear 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 resembles the lives cipro for dogs ear 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 cipro for dogs ear of original, non-vulnerable 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, cipro for dogs ear children or people with disabilities—care is, in fact, much more pervasive.Noting the etymology 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 in a matter of days.Hyginus’ cipro for dogs ear 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, cipro for dogs ear for instance, is a form of knowledge that has been aggregated outside and beyond individual lives. Through clinical generalisations, anatomical knowledge, systematic literature reviews and more.

Cultural knowledge, conversely, is deeply cipro for dogs ear 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 actual holding, from being skin to skin and from sensing if he cannot understand others—is used cipro for dogs ear 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 Cura’s holding, and Saturn’s cipro for dogs ear 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 cipro for dogs ear ontological domains’ held together by care:Saturn, the God of 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) and material elements cipro for dogs ear (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 case of evidence-based care, for instance, cipro for dogs ear 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 cipro for dogs ear is relentlessly situated 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 cipro for dogs ear him or vice versa—one might say that I know what I am doing. On the other hand, this holding challenges several parts of my knowledge of this world. It challenges my images of what it is to be a father, since cipro for dogs ear 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 that the relation between Cura and cipro for dogs ear 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 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 cipro for dogs ear 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 cipro for dogs ear transitive verb.

At least to some extent, the clauses quamdiu vixerit, Cura eum possideat entail a micro-narrative. Although ‘created cipro for dogs ear from,’ or consisting of biological matter, and being characterised by the presence 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 that holds human life away from cipro for dogs ear 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 must also be understood as cipro for dogs ear 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 eum possideam, I try to ‘theorise from my subject cipro for dogs ear 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 refraction cipro for dogs ear . First, I do hold together cultural and biomedical knowledge. When my son is in my arms, multiple cultural imaginaries are involved. My understanding cipro for dogs ear of his life (and of mine) is dependent on my language and my cultural frames, and I am 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 my own embodied condition, there emerges a bodily trouble, an element of exhaustion, uncertain walking and muscular cipro for dogs ear 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 in his situation may reproduce his parents, seems equally futile.Regarding biomedical knowledge, I take care cipro for dogs ear 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 my two oldest children—confirming, as it were, that all is well—that has, obviously, not been the case with cipro for dogs ear 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 cipro for dogs ear true of any intersubjective relation in general and 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 thanks cipro for dogs ear 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 cipro for dogs ear former sense of parental comfort with gnawing anxiety 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 time cipro for dogs ear .

In Cura’s case, her care work is also time limited. The temporality cipro for dogs ear of the deity’s existence is sufficient to encompass the temporality 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 be insufficient in at least two ways related to the temporality of cipro for dogs ear 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 cipro for dogs ear humanities 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 cipro for dogs ear 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 cipro for dogs ear not-yet-nameable understandings.Withholding and ambiguityMy holding of my son in 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 forces me out of the internal comfort that characterises the centre of any cipro for dogs ear 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 locates breaches cipro for dogs ear 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 Kristeva’s words, these relations are ‘temporal connections’ and ‘points of contact‘ (2002:8) and points of cipro for dogs ear ‘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 cipro for dogs ear in an argument for multiple perspectives:Although in contemporary Western society, many tend to believe 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, cipro for dogs ear Kristeva et 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 bidirectional critical interrogation of both biomedicine (simplistic reductions of life to biology) and the humanities (simplistic reductions cipro for dogs ear 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’ cipro for dogs ear medical 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 cipro for dogs ear are separated from humanity in this life, and 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 and un-knowing, including autotheoretical investigations that cipro for dogs ear 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 cipro for dogs ear conjunction quoniam (since) introduces a causal clause in the indicative mood (finxit), followed by an adverbial clause in 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 cipro for dogs ear that cannot or may not be fulfilled (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 cipro for dogs ear active present tense 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 care, and in the relation between complexity cipro for dogs ear 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 of critical medical humanities steadily increases the engagements with all kinds of critical cipro for dogs ear 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 other forms cipro for dogs ear 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 cipro for dogs ear humanities can address 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 cipro for dogs ear 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 for face-to-face interaction, cipro for dogs ear 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 holding and Hyginus’ text cipro for dogs ear 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 cipro for dogs ear (2017) shed 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 cipro for dogs ear 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 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 cipro for dogs ear Eivind Engebretsen and John Ødemark for their encouragements, and the 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 hinders full anonymisation, just like his way of cipro for dogs ear 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..

Welcome to http://begopa.de/google-maps/anfahrt-begopa-bochum/ the first issue of can you buy cipro over the counter 2022!. 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, including some of our content exclusively online (the most common way can you buy cipro over the counter 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 can you buy cipro over the counter a recent article by Julia Kristeva et al, in which they claim that care 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) can you buy cipro over the counter. 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, Arthur Kleinman (Kleinman and van der Geest 2009) and Julia Kristeva (Kristeva (2012), Kristeva can you buy cipro over the counter 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 can you buy cipro over the counter directly, I use the 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 can you buy cipro over the counter Ødemark 2017. Hetrick et al. 2017). However, it can you buy cipro over the counter is crucial to note that Cura (in Hyginus’ text) will ‘hold’ humanity quamdiu vixerit (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 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 can you buy cipro over the counter 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 if I am not only can you buy cipro over the counter 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 can you buy cipro over the counter 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 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 ‘path’ or trajectory, as if in a story can you buy cipro over the counter (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 can you buy cipro over the counter ends with a discussion of 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 can you buy cipro over the counter analyses and the autotheoretical work indicate that those complexities might overpower 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 can you buy cipro over the counter their work, this article combines textual interpretation with autotheoretical 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, one’s embodied experiences become the material through which can you buy cipro over the counter 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 can you buy cipro over the counter Kleinman or Heidegger focus on Hyginus’ text. In contrast to this body of research, this article emphasizes the interpretative potential of the original text. In addition to grammatical analysis, can you buy cipro over the counter 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, can you buy cipro over the counter two destinies, two psyches. 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 can you buy cipro over the counter sense, the meaning of the socio-historical aspect of intertextuality, as already developed by Bakhtin 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’ can you buy cipro over the counter text not as a ‘lonely text’, but 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 can you buy cipro over the counter to the same material 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 between these two methodological can you buy cipro over the counter 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 can you buy cipro over the counter between deities and finally, a verdict 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 fashion a man.Before interpreting this first story, can you buy cipro over the counter 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 fable can you buy cipro over the counter 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 can you buy cipro over the counter the creature 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 Propertius, for instance, in his Libri Elegiarum from the first-century BC, laments and elaborates on how Prometheus was careless in his creating can you buy cipro over the counter. 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 can you buy cipro over the counter inversion these 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 can you buy cipro over the counter this 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, can you buy cipro over the counter for instance, in the final stanza:Hier sitz' ich, forme Menschen / Nach meinem Bilde, / Ein Geschlecht, das mir gleich sei, / Zu 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, 182)Typical of Goethe’s Sturm und Drang period, his Prometheus Plasticator is a figure of creativity, and embodies ‘ideals of freedom and can you buy cipro over the counter 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 can you buy cipro over the counter the name of the personification that 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 can you buy cipro over the counter task or a responsibility).To regard with 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 can you buy cipro over the counter 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 can you buy cipro over the counter is no longer about rebellion 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 are can you buy cipro over the counter 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 can you buy cipro over the counter care emerges from 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) can you buy cipro over the counter. 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 can you buy cipro over the counter of 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 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 can you buy cipro over the counter 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 Herder, and even refers directly to this poem (25–26) can you buy cipro over the counter. 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 gaze is far more manifest in von Herder’s text than can you buy cipro over the counter 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 can you buy cipro over the counter of care, the cared-for becomes visible to the carer(s), thereby also 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 between individuality and multitude dovetails with research on can you buy cipro over the counter 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 can you buy cipro over the counter with von Herder’s Traum 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 can you buy cipro over the counter of these feelings—where the socially estranged ways of 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 can you buy cipro over the counter known by 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 be thoughtful and can you buy cipro over the counter 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 can you buy cipro over the counter and 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 can you buy cipro over the counter ruff-and-tumble-play, these realms are also 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 can you buy cipro over the counter debere dicebat, quandoquidem corpus suum praebuisset.When Cura wanted to give it her name, Jove 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 not known from other Roman can you buy cipro over the counter 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’ can you buy cipro over the counter in classical 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 can you buy cipro over the counter of physical 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 can you buy cipro over the counter Hyginus cogitabunda 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 can you buy cipro over the counter 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, can you buy cipro over the counter while Tellus will receive the body post mortem:Tu Iovis quoniam spiritum dedisti, <…>. Corpus recipito. Cura quoniam prima can you buy cipro over the counter eum finxit, 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 can you buy cipro over the counter homo, since he seems to be 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 humanity and its creator is can you buy cipro over the counter 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 earth the brute creation bends its gaze, / but man was given can you buy cipro over the counter 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 can you buy cipro over the counter life is essentially an independent life which 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, can you buy cipro over the counter one often reserves care needs for vulnerable groups, thereby contrasting them with some kind of original, non-vulnerable 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 of the verb curo—denoting what we call caring and worrying—Hyginus’ text also points towards an can you buy cipro over the counter 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 can you buy cipro over the counter met by a radical lack of care, it would have little freedom and in fact be over 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 can you buy cipro over the counter of knowledge that has been aggregated outside and beyond individual lives. Through clinical generalisations, anatomical knowledge, systematic literature reviews and more.

Cultural knowledge, conversely, is deeply historical and contextual—thereby inevitably also a testament to how can you buy cipro over the counter 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 actual holding, from being skin to skin and from can you buy cipro over the counter 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 Cura’s holding, and Saturn’s verdict, humanity can you buy cipro over the counter 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 time, settles the matter through an act of naming and by dividing and temporalising the possession of can you buy cipro over the counter 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 can you buy cipro over the counter of spiritual (Jove) 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 case of evidence-based care, for instance, temporal doing at a certain point in time and history can you buy cipro over the counter (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 and can you buy cipro over the counter 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 can you buy cipro over the counter 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. On the other hand, this holding challenges several parts of my knowledge of this world. It challenges my images of what it is to be a father, since the play differs from how most fathers do this can you buy cipro over the counter 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 can you buy cipro over the counter particularly worth noting 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 can you buy cipro over the counter control of (a country, position, etc) […] to 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 can you buy cipro over the counter that possideo is a 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 of ‘soul’ or some measure of can you buy cipro over the counter 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 can you buy cipro over the counter and biomedical knowledge, and 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 must also be understood as a can you buy cipro over the counter 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 can you buy cipro over the counter this individual 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 can you buy cipro over the counter me, I can at least outline four aspects of the refraction. First, I do hold together cultural and biomedical knowledge. When my son is in my arms, multiple cultural imaginaries are involved. My understanding can you buy cipro over the counter of his life (and of mine) is dependent on my language and my cultural frames, and I am 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 my own embodied condition, there emerges a bodily trouble, an element of exhaustion, uncertain walking can you buy cipro over the counter 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 in his situation may reproduce his parents, seems equally futile.Regarding biomedical knowledge, I take can you buy cipro over the counter 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 my two oldest children—confirming, as it were, that can you buy cipro over the counter 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 can you buy cipro over the counter of any intersubjective relation in general and 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 thanks to how can you buy cipro over the counter 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 over his can you buy cipro over the counter 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 can you buy cipro over the counter carers will retire, and many will pursue other forms of work at some point in time.

In Cura’s case, her care work is also time limited. The temporality of the deity’s existence can you buy cipro over the counter is sufficient to encompass the temporality 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 can you buy cipro over the counter lifelong work will likely 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 can you buy cipro over the counter (eum possideam) withholds care from the epistemological domains that the medical humanities 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 can you buy cipro over the counter on 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 can you buy cipro over the counter 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 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 forces me out of the internal comfort that can you buy cipro over the counter 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 locates breaches in specific ‘sign-systems’, and in larger can you buy cipro over the counter ‘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 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 can you buy cipro over the counter 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 can you buy cipro over the counter the insufficiencies of medical knowledge in an argument for multiple perspectives:Although in contemporary Western society, many tend to believe 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 can you buy cipro over the counter the medical humanities, Kristeva et 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 bidirectional critical interrogation of both biomedicine (simplistic reductions of life to biology) and the humanities (simplistic reductions of suffering and health injustice to can you buy cipro over the counter 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 research in order to facilitate can you buy cipro over the counter 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 can you buy cipro over the counter from humanity in this life, and 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 can you buy cipro over the counter that emphasise withholding 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 can you buy cipro over the counter clause in 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 can you buy cipro over the counter expresses doubt or disbelief by “thinking aloud” (deliberative), wishes that cannot or may not be fulfilled (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 can you buy cipro over the counter Latin, the active present tense 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 can you buy cipro over the counter is rooted in the specifics of 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 of critical medical humanities steadily increases the engagements with all kinds of critical research frontiers, in the social sciences as well as in the can you buy cipro over the counter 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 other forms of knowing, his holding neither implies any disregard for humanities-based nor can you buy cipro over the counter 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 the can you buy cipro over the counter 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 four more specific tendencies in the available literature.First, the unpacking contributes to feminist care can you buy cipro over the counter 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 can you buy cipro over the counter term 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 holding and Hyginus’ text entail—is as political and ethical as it is personal and can you buy cipro over the counter 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 light on how healthcare practices constitute a ’quiet subversion’ can you buy cipro over the counter 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 with […] the neurological difficulties of my son David” (2013, 220) lead her to can you buy cipro over the counter 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 can you buy cipro over the counter thank Eivind Engebretsen and John Ødemark for their encouragements, and the 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 hinders can you buy cipro over the counter 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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On this page Submissions under review related to the buy antibiotics cipro The Submissions Under Review (SUR) Lists include submissions can you buy cipro over the counter filed under the Food and Drug Regulations for use http://www.ec-pres-lingolsheim.ac-strasbourg.fr/reprise-cours-italien/ in relation to the buy antibiotics cipro. These submissions are identified under the submission 'class' column. To find these submissions, type "buy antibiotics" into the "Filter items" box at the top of the list. In some can you buy cipro over the counter cases, applicants have filed a new drug submission under the Food and Drug Regulations, to transition a product previously authorized under the Interim Order Respecting the Importation, Sale and Advertising of Drugs for Use in Relation to buy antibiotics. These products continue to be approved for sale in Canada during this transition period and are clearly identified in the applicable row.

About the SUR Lists The SUR Lists help to make our review processes more transparent. The lists can you buy cipro over the counter will help Canadians. make better decisions about their health identify substances accepted for review in Canada The lists have been implemented in phases. You can find more information about the phased approach in the Notices published in April 2016 (Phase I and II) and August 2018 (Phase III). The Submissions Under Review (SUR) Lists include new drug submissions containing new active substances (pharmaceuticals and biologics with an active ingredient not can you buy cipro over the counter approved in Canada).

This applies to submissions accepted for review on or after April 1, 2015. The lists also include submissions accepted for review on or after May 1, 2016, specifically. new drug submissions supplemental new drug submissions for new uses A separate list is published for generic submissions (abbreviated new drug can you buy cipro over the counter submissions) accepted into review on or after October 1, 2018. Click here to see the Generic Submissions Under Review (GSUR) List. Finding information on the lists There are four Submissions Under Review (SUR) Lists, which contain.

new drug submissions currently under review supplemental new drug submissions can you buy cipro over the counter currently under review new drug submissions formerly under review supplemental new drug submissions formerly under review All four lists are updated monthly. A substance is moved from the list of submissions currently under review to the list of submissions formerly under review when it reaches a conclusion (it is cancelled, or a final decision is made). Lists of submissions currently under review The entry for each submission on the lists of submissions currently under review includes the. For submissions accepted into review on or after October 1, can you buy cipro over the counter 2018, the following information will be added to the lists of submissions currently under review. company name 'class' of the submission The submission 'class' includes whether the submission is for a new active substance or a biosimilar, if it is being reviewed as per a formal expedited process, if review is taking place as part of an aligned process with a health technology assessment organization, and more.

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If applicable, a more detailed explanation is available in a Summary Basis of Decision document. External consultations Several external consultations have been held as the SUR List initiative has evolved. In 2017, an external consultation was held on five can you buy cipro over the counter transparency proposals for prescription drugs. This report provides a summary of the consultation results. Contact us Questions can be sent to us by email.

Opprs.enquiries-enquetes.bprse@hc-sc.gc.ca. Related linksWhat is the Notice of Compliance (NOC) Data Extract?. The data extract is a series of compressed ASCII text files of the database. The uncompressed size of the files is approximately 21.9 MB. In order to utilize the data, the file must be loaded into an existing database or information system.

The typical user is most likely a third party claims adjudicator, provincial formulary, insurance company, etc. A casual user of this file must be familiar with database structure and capable of setting up queries. The "Read me" file contains the data structure required to download the zipped files. The NOC extract files have been updated. They contain Health Canada authorization dates for all drugs dating back to 1994 that have received an NOC.

All NOCs issued between 1991 and 1993 can be found in the NOC listings. Please note any Portable Document Format (PDF) files visible on the NOC database are not part of the data extracts.

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Since 2016, the American Causal Inference Conference (ACIC) has hosted a data challenge in which teams compete to cipro chills estimate causal impacts in simulated data sets based on real-world data from see this here fields such as health care or education. The competition is a proving ground for cutting-edge causal inference methods that have the potential to transform program evaluation. Mathematica’s commitment to building and nurturing evidence communities, using the best possible data, cipro chills methods, and evidence to improve lives, makes a partnership with ACIC a natural fit. Mathematica is proud to organize this year’s competition, which launches on February 15 when the simulated data sets are posted on the data challenge website. Submissions are due April 15, and results will cipro chills be announced at ACIC 2022 on May 24-25.“We are thrilled to organize this event, thanks to funding from the Centers for Medicare &.

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Participation in the intervention is not randomly assigned, making it hard to tell whether the patients or practices that were motivated to join the intervention were already on a favorable cipro chills trajectory or truly benefited from the program. Impacts can be highly heterogenous, with the intervention potentially lowering expenditures for some patients while increasing expenditures for others. The data have a hierarchical structure, with repeated observations of patients over time, and with patients clustered in primary care practices. The outcome of interest, cipro chills Medicare spending, is highly variable and skewed. The average patient incurs around $1,000 in costs per month, but some patients incur tens of thousands of dollars in costs.Partnering with ACIC and the Society for Causal Inference to organize this year’s competition gives Mathematica the opportunity to point some of the brightest minds in causal inference at the challenging evaluation problems we face every day.

The results of the competition will advance the field of causal inference and help Mathematica continue to cipro chills improve the quality of evidence it provides in all its program and policy evaluations.Learn more about the competition!. In recent years, states have made considerable strides in shifting long-term services and supports (LTSS) systems away from institutional care and toward home and community-based services (HCBS). In Federal Fiscal Year (FY) 2019, cipro chills the proportion of Medicaid LTSS expenditures allocated to HCBS was at an all-time high both nationally and for many states. This followed years of steady gains and, for some states, uneven progress, according to a new report documenting Medicaid LTSS expenditures in FY 2019 prepared by Mathematica for the Centers for Medicare &. Medicaid Services cipro chills (CMS).

Nationally, HCBS made up 58.6 percent of Medicaid LTSS expenditures in FY 2019, an increase of 2.5 percentage points over FY 2018. At the state level, expenditures ranged cipro chills from 33.4 percent in Mississippi to 83.3 percent in Oregon. Thirty states spent at least 50 percent of Medicaid dollars on HCBS in FY 2019. This finding showed an improvement over FY 2018, when 27 states met this benchmark.Although nearly all states saw increases in total HCBS expenditures in FY 2019 compared with FY 2018, the goal of rebalancing initiatives is not simply to increase HCBS spending but to shift expenditures away from services provided in institutional settings to HCBS. Hawaii, Iowa, Kansas, Maine, Massachusetts, Nebraska, North Dakota, South Dakota, Texas, Washington, and cipro chills Wyoming saw simultaneous increases in HCBS spending in FY 2019 while seeing declines in total institutional spending.

The new report also looked at broader trends in LTSS expenditures. National Medicaid LTSS expenditures totaled $162.1 billion in FY 2019, with $95.0 billion spent on HCBS and cipro chills $67.1 billion spent on institutional services. In recent years, LTSS expenditures have declined as a proportion of total Medicaid spending, from 47 percent in FY 1988 to 34 percent in FY 2019. Several factors have led to this decline, including state initiatives to rebalance spending on LTSS systems that promote the use of more cost-effective HCBS and increased spending for Medicaid populations cipro chills that do not use LTSS. However, spending on managed LTSS (MLTSS) programs continued to grow in recent years, from $6.7 billion in FY 2008 to $47.5 billion in FY 2019.

This growth reflects more states using MLTSS and more people cipro chills receiving LTSS through these programs.Because the report covers FY 2019, it is not clear how the public health emergency might impact LTSS expenditure and rebalancing trends. €œOne key unknown for FY 2020 is whether upward rebalancing trends will continue, given the major disruptions to Medicaid LTSS delivery during the cipro and the major impact the cipro has had on people living in nursing homes,” said Andrea Wysocki, a lead researcher on this work. €œIt is also not clear how these trends will change cipro chills as states take advantage of new opportunities to expand HCBS through increased funding from CMS. As states focus on increasing home and community-based options and accelerating rebalancing, it will be critical for CMS to continue monitoring Medicaid LTSS expenditures, users, and other measures that reflect LTSS access and quality of care to better understand how the LTSS system meets the needs of Medicaid beneficiaries.” You can read the full report on Medicaid LTSS expenditures here. A companion report on section 1915(c) waiver programs is available here..

Since 2016, the can you buy cipro over the counter you can check here American Causal Inference Conference (ACIC) has hosted a data challenge in which teams compete to estimate causal impacts in simulated data sets based on real-world data from fields such as health care or education. The competition is a proving ground for cutting-edge causal inference methods that have the potential to transform program evaluation. Mathematica’s commitment can you buy cipro over the counter to building and nurturing evidence communities, using the best possible data, methods, and evidence to improve lives, makes a partnership with ACIC a natural fit.

Mathematica is proud to organize this year’s competition, which launches on February 15 when the simulated data sets are posted on the data challenge website. Submissions are due April 15, and results will be announced at ACIC 2022 on May 24-25.“We can you buy cipro over the counter are thrilled to organize this event, thanks to funding from the Centers for Medicare &. Medicaid Services,” said Mariel Finucane, principal statistician.

€œCausal inference is all about disentangling simple correlation can you buy cipro over the counter from true causation, which is core to figuring out which social policies actually move the needle for the individuals and communities they serve. We hope that this year’s competition will help us understand which methods give the most precise and nuanced estimates of policy impacts, ultimately ensuring that we’re using the best tools to further our mission of improving public well-being.”The Mathematica team designed the data sets for the 2022 challenge to mirror data from evaluations of large-scale U.S. Health care system interventions can you buy cipro over the counter that seek to lower Medicare expenditures.

They share features of these evaluations that challenge existing causal inference methods. Participation in the intervention is not randomly assigned, can you buy cipro over the counter making it hard to tell whether the patients or practices that were motivated to join the intervention were already on a favorable trajectory or truly benefited from the program. Impacts can be highly heterogenous, with the intervention potentially lowering expenditures for some patients while increasing expenditures for others.

The data have a hierarchical structure, with repeated observations of patients over time, and with patients clustered in primary care practices. The outcome of interest, Medicare can you buy cipro over the counter spending, is highly variable and skewed. The average patient incurs around $1,000 in costs per month, but some patients incur tens of thousands of dollars in costs.Partnering with ACIC and the Society for Causal Inference to organize this year’s competition gives Mathematica the opportunity to point some of the brightest minds in causal inference at the challenging evaluation problems we face every day.

The results of the competition will advance the field can you buy cipro over the counter of causal inference and help Mathematica continue to improve the quality of evidence it provides in all its program and policy evaluations.Learn more about the competition!. In recent years, states have made considerable strides in shifting long-term services and supports (LTSS) systems away from institutional care and toward home and community-based services (HCBS). In Federal can you buy cipro over the counter Fiscal Year (FY) 2019, the proportion of Medicaid LTSS expenditures allocated to HCBS was at an all-time high both nationally and for many states.

This followed years of steady gains and, for some states, uneven progress, according to a new report documenting Medicaid LTSS expenditures in FY 2019 prepared by Mathematica for the Centers for Medicare &. Medicaid Services (CMS) can you buy cipro over the counter. Nationally, HCBS made up 58.6 percent of Medicaid LTSS expenditures in FY 2019, an increase of 2.5 percentage points over FY 2018.

At the state level, expenditures ranged from 33.4 percent in Mississippi to 83.3 percent in Oregon can you buy cipro over the counter. Thirty states spent at least 50 percent of Medicaid dollars on HCBS in FY 2019. This finding showed an improvement over FY 2018, when 27 states met this benchmark.Although nearly all states saw increases in total HCBS expenditures in FY 2019 compared with FY 2018, the goal of rebalancing initiatives is not simply to increase HCBS spending but to shift expenditures away from services provided in institutional settings to HCBS.

Hawaii, Iowa, Kansas, can you buy cipro over the counter Maine, Massachusetts, Nebraska, North Dakota, South Dakota, Texas, Washington, and Wyoming saw simultaneous increases in HCBS spending in FY 2019 while seeing declines in total institutional spending. The new report also looked at broader trends in LTSS expenditures. National Medicaid LTSS expenditures totaled $162.1 billion in FY 2019, with $95.0 billion spent on HCBS and $67.1 billion spent on can you buy cipro over the counter institutional services.

In recent years, LTSS expenditures have declined as a proportion of total Medicaid spending, from 47 percent in FY 1988 to 34 percent in FY 2019. Several factors have led to this decline, including state initiatives to rebalance spending on LTSS systems can you buy cipro over the counter that promote the use of more cost-effective HCBS and increased spending for Medicaid populations that do not use LTSS. However, spending on managed LTSS (MLTSS) programs continued to grow in recent years, from $6.7 billion in FY 2008 to $47.5 billion in FY 2019.

This growth reflects more states using MLTSS and more people receiving can you buy cipro over the counter LTSS through these programs.Because the report covers FY 2019, it is not clear how the public health emergency might impact LTSS expenditure and rebalancing trends. €œOne key unknown for FY 2020 is whether upward rebalancing trends will continue, given the major disruptions to Medicaid LTSS delivery during the cipro and the major impact the cipro has had on people living in nursing homes,” said Andrea Wysocki, a lead researcher on this work. €œIt is also not can you buy cipro over the counter clear how these trends will change as states take advantage of new opportunities to expand HCBS through increased funding from CMS.

As states focus on increasing home and community-based options and accelerating rebalancing, it will be critical for CMS to continue monitoring Medicaid LTSS expenditures, users, and other measures that reflect LTSS access and quality of care to better understand how the LTSS system meets the needs of Medicaid beneficiaries.” You can read the full report on Medicaid LTSS expenditures here. A companion report on section 1915(c) waiver programs is available here..

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Sex differences in clinical management and outcomes of patients with cardiovascular disease sometimes are blog here due to healthcare inequities (which should be eliminated) but also might be due to sex-related where can i buy cipro differences in aetiology and pathophysiology. For example, the optimal medical dose for management of heart failure with reduced ejection fraction (HFrEF) may be lower in women compared with men. In a study of 561 women and 615 men where can i buy cipro with a new diagnosis of either HRrEF or heart failure with preserved ejection fraction (HFpEF), Bots and colleagues1 found that although 79% of women and 86% of men with HFrEF were prescribed an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), the average dose was only about 50% of the recommended target dose for both sexes.

A lower ACEI/ARB dose was associated with higher survival outcomes in women, but not men, with HFrEF. In patients of both where can i buy cipro sexes with HFpEF, there was no relationship between medication dose and survival (figure 1).Central figure summarising the design and main findings of this study." data-icon-position data-hide-link-title="0">Figure 1 Central figure summarising the design and main findings of this study.In the accompanying editorial, Hassan and Ahmed 2 comment that. €˜Sex differences in HF outcomes may be further exacerbated by differences in medication pharmacokinetics and pharmacodynamics, with female-specific physiological factors including lower body mass, as well as decreased renal excretion and gastrointestinal enzymatic activity, leading to higher medication bioavailability.

As a result, the administration of sex-neutral medication doses leads to greater drug exposure in where can i buy cipro female patients, which may subsequently lead to a higher incidence of adverse drug reactions. This raises the possibility of sex-based HF treatments to improve clinical outcomes. However, current guidelines adopt a ‘one size fits all’ approach, with an emphasis on target-dosed where can i buy cipro therapy.

In this era of precision medicine, is it time to redefine optimal HF therapy based on the sex of the patient?. €™On the where can i buy cipro other hand, adverse outcomes in women with infective endocarditis likely are related to bias and healthcare inequities. In a multicentric Spanish cohort of 3541 patients3 diagnosed with endocarditis between 2008 and 2018, women underwent surgical intervention less often than men (38.3% vs 50%) despite the increasing recognition that earlier surgical intervention often is beneficial as recommended in current guidelines (figure 2).

The lower likelihood of surgery in where can i buy cipro women persisted after propensity matching for age and surgical risk (OR 0.74. 95% CI 0.59 to 0.91. P=0.05).

In addition, women had a higher in-hospital mortality compared with men, even after adjusting for possible confounders (OR 1.41. 95% CI 1.21 to 1.65. P<0.001).Stratification of the GAMES (‘Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España’ or ‘Spanish Collaboration on Endocarditis’) cohort according to surgical recommendation between sexes.

Overall and stratified mortality is displayed in each group." data-icon-position data-hide-link-title="0">Figure 2 Stratification of the GAMES (‘Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España’ or ‘Spanish Collaboration on Endocarditis’) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group.Van Spall, Jaffer and Mamas4 remind us of the many factors to be considered in the decision to recommend surgical intervention in a patient with endocarditis (figure 3). However, as they conclude.

€˜Disparities in referral and receipt of surgical intervention, along with differences in aetiology, microbiology and comorbidities, may be responsible for the higher risk of mortality in women than in men with IE. Ultimately, awareness of these issues should prompt a self-evaluation of biases on the part of clinicians such that objective, timely surgical referrals are made and interventions are offered regardless of demographic group. While the biology is not modifiable, the biases and care disparities are.’Factors associated with infective endocarditis outcomes." data-icon-position data-hide-link-title="0">Figure 3 Factors associated with infective endocarditis outcomes.Another interesting paper in this issue is the study by Sung and colleagues5 showing a positive, graded association between higher levels of physical activity and a higher prevalence, with more rapid progression, of coronary artery calcification (CAC).

These findings were based on a cohort of 25 485 Korean men and women with a median interval between CAC measurements of 3 years. In discussing these seeming paradoxical findings, Gulsin and Moss6 point out that although CAC is a surrogate marker for calcified atherosclerosis and is associated with a higher risk of myocardial infarction, treatment with a statin also accelerates deposition of calcified plaque, similar to the effects of physical activity in the current study. They also remind us that.

(1) the severity of CAC at baseline is a key predictor of progression rates, (2) an increase in CAC score is not the same an accelerated rate of total atherosclerotic plaque progression, and (3) the risk of plaque rupture and clinical events is greatest within the necrotic core of noncalcified plaques. Thus, it is possible that an increase in CAC scores reflects a protective response and a transition to a more stable plaque morphology rather than more extensive atherosclerosis. They conclude.

€˜Sung and colleagues5 have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals. The coronary artery calcium paradox should not result in paradoxical care for our patients.’The Education in Heart article7 in this issue provides an overview for clinicians to detect and manage mental issues in their patients with cardiovascular disease (CVD).

There is a reciprocal relationship between mental disorders and CVD. Patients with mental disorders have a 1.5- to 3.0-fold higher risk of developing CVD and, conversely, the onset of CVD increases the risk of a developing a mental disorder by 2.2-fold.The Cardiology in-Focus topic in this issue is a step-by-step guide to writing a Image Challenge question, authored by our Image Challenge Editor.8 We encourage both cardiology trainees and clinicians to submit Image Challenge questions to Heart, using this basic guide, because this type of question accelerates learning for both the author and the reader (table 1).View this table:Table 1 Key components of an image challenge questionEthics statementsPatient consent for publicationNot applicable..

Sex differences in clinical management and outcomes of patients with cardiovascular disease sometimes are due to healthcare inequities (which should can you buy cipro over the counter be https://greenstealth.com/buy-ventolin-online-uk/ eliminated) but also might be due to sex-related differences in aetiology and pathophysiology. For example, the optimal medical dose for management of heart failure with reduced ejection fraction (HFrEF) may be lower in women compared with men. In a study of 561 women and 615 men with a new diagnosis of either HRrEF or heart failure with preserved ejection fraction (HFpEF), Bots and colleagues1 found that although can you buy cipro over the counter 79% of women and 86% of men with HFrEF were prescribed an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), the average dose was only about 50% of the recommended target dose for both sexes. A lower ACEI/ARB dose was associated with higher survival outcomes in women, but not men, with HFrEF.

In patients of both sexes with HFpEF, there was no relationship between medication dose and survival (figure 1).Central figure summarising the design and main findings of this study." data-icon-position data-hide-link-title="0">Figure 1 Central figure summarising the design and main findings of this study.In the can you buy cipro over the counter accompanying editorial, Hassan and Ahmed 2 comment that. €˜Sex differences in HF outcomes may be further exacerbated by differences in medication pharmacokinetics and pharmacodynamics, with female-specific physiological factors including lower body mass, as well as decreased renal excretion and gastrointestinal enzymatic activity, leading to higher medication bioavailability. As a result, the administration of sex-neutral medication doses leads to can you buy cipro over the counter greater drug exposure in female patients, which may subsequently lead to a higher incidence of adverse drug reactions. This raises the possibility of sex-based HF treatments to improve clinical outcomes.

However, current guidelines adopt a ‘one can you buy cipro over the counter size fits all’ approach, with an emphasis on target-dosed therapy. In this era of precision medicine, is it time to redefine optimal HF therapy based on the sex of the patient?. €™On the can you buy cipro over the counter other hand, adverse outcomes in women with infective endocarditis likely are related to bias and healthcare inequities. In a multicentric Spanish cohort of 3541 patients3 diagnosed with endocarditis between 2008 and 2018, women underwent surgical intervention less often than men (38.3% vs 50%) despite the increasing recognition that earlier surgical intervention often is beneficial as recommended in current guidelines (figure 2).

The lower likelihood of surgery in women persisted after propensity matching can you buy cipro over the counter for age and surgical risk (OR 0.74. 95% CI 0.59 to 0.91. P=0.05). In addition, women had a higher in-hospital mortality compared with men, even after adjusting for possible confounders (OR 1.41.

95% CI 1.21 to 1.65. P<0.001).Stratification of the GAMES (‘Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España’ or ‘Spanish Collaboration on Endocarditis’) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group." data-icon-position data-hide-link-title="0">Figure 2 Stratification of the GAMES (‘Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España’ or ‘Spanish Collaboration on Endocarditis’) cohort according to surgical recommendation between sexes. Overall and stratified mortality is displayed in each group.Van Spall, Jaffer and Mamas4 remind us of the many factors to be considered in the decision to recommend surgical intervention in a patient with endocarditis (figure 3).

However, as they conclude. €˜Disparities in referral and receipt of surgical intervention, along with differences in aetiology, microbiology and comorbidities, may be responsible for the higher risk of mortality in women than in men with IE. Ultimately, awareness of these issues should prompt a self-evaluation of biases on the part of clinicians such that objective, timely surgical referrals are made and interventions are offered regardless of demographic group. While the biology is not modifiable, the biases and care disparities are.’Factors associated with infective endocarditis outcomes." data-icon-position data-hide-link-title="0">Figure 3 Factors associated with infective endocarditis outcomes.Another interesting paper in this issue is the study by Sung and colleagues5 showing a positive, graded association between higher levels of physical activity and a higher prevalence, with more rapid progression, of coronary artery calcification (CAC).

These findings were based on a cohort of 25 485 Korean men and women with a median interval between CAC measurements of 3 years. In discussing these seeming paradoxical findings, Gulsin and Moss6 point out that although CAC is a surrogate marker for calcified atherosclerosis and is associated with a higher risk of myocardial infarction, treatment with a statin also accelerates deposition of calcified plaque, similar to the effects of physical activity in the current study. They also remind us that. (1) the severity of CAC at baseline is a key predictor of progression rates, (2) an increase in CAC score is not the same an accelerated rate of total atherosclerotic plaque progression, and (3) the risk of plaque rupture and clinical events is greatest within the necrotic core of noncalcified plaques.

Thus, it is possible that an increase in CAC scores reflects a protective response and a transition to a more stable plaque morphology rather than more extensive atherosclerosis. They conclude. €˜Sung and colleagues5 have produced a timely manuscript that highlights the complexity of interpreting coronary artery calcium scores in patients who have implemented recommendations on physical activity or commenced on statin therapy. While proponents would argue that it is an effective tool to screen for subclinical atherosclerosis in asymptomatic individuals, clinicians should be cautious regarding the overuse of this test in otherwise healthy individuals.

The coronary artery calcium paradox should not result in paradoxical care for our patients.’The Education in Heart article7 in this issue provides an overview for clinicians to detect and manage mental issues in their patients with cardiovascular disease (CVD). There is a reciprocal relationship between mental disorders and CVD. Patients with mental disorders have a 1.5- to 3.0-fold higher risk of developing CVD and, conversely, the onset of CVD increases the risk of a developing a mental disorder by 2.2-fold.The Cardiology in-Focus topic in this issue is a step-by-step guide to writing a Image Challenge question, authored by our Image Challenge Editor.8 We encourage both cardiology trainees and clinicians to submit Image Challenge questions to Heart, using this basic guide, because this type of question accelerates learning for both the author and the reader (table 1).View this table:Table 1 Key components of an image challenge questionEthics statementsPatient consent for publicationNot applicable..