buy lasix for horses to adoption of analytics solutions"Clinicians may disagree with analytics results due to lack of trust in data science," she said.

"It may also be challenging to introduce advanced analytics due to the level of data literacy."She explained the key opportunities for clinicians adopting data science depends on the analytics maturity and executive leadership support at the organization."Of the multiple aspects to consider, I'd like to point out actionability in finding opportunities," said Kim. "Unless strong clinician support is already in place, it would be extremely challenging to succeed in purely clinical topics, for example sepsis."She noted those clinical topics are certainly important to any health system but may not be readily actionable for many reasons.On the other hand, Kim noted some topics are highly relevant buy lasix for horses to clinicians yet not purely clinical--LOS and readmissions, for instance."Their causes and interventions are not necessarily clinical, unlike sepsis, and clinicians seem more open to data scientists' suggestions in less-clinical domains," she said. "I would consider them more actionable topics. Once a strong relationship is built with clinicians, it'll be easier to move to more clinical domains with their support."She explained UVA Health Data Science often engages with clinicians by presenting buy lasix for horses data analysis about their patients and workflows as for their project or interest.

Such sessions naturally lead clinicians to data-driven decision making."Through such engagement, we built trust and improved data literacy among clinicians," said Kim."Moreover, in the process data scientists learned what clinicians truly want and need. What they ask for may not be what they truly want buy lasix for horses or need. With improved clinician trust and data literacy and a better understanding of clinician needs, we were able to move toward more advanced analytics."Jonathan Michel and Bommae Kim will address the use of data science among clinicians at HIMSS21 in a session titled "Making Prescriptive Analytics Work for Clinicians." It's scheduled for Thursday, August 12 from 1-2 p.m. In room Wynn Lafite 2Safeguarding patient health information can be extremely difficult, as it necessitates taking inventory of data, finding any vulnerabilities buy lasix for horses and assessing risk across the board.

Often, experts say, the complexity of mitigating risk is beyond human scale. In an upcoming HIMSS21 panel, Aaron Miri, chief information officer for Dell Medical School and UT Health Austin, and Tausight Founder and CEO David Ting will discuss the importance of buy lasix for horses operationalizing and automating guidelines around PHI vulnerabilities – and describe real-time methods for protecting that data. "Healthcare is a large-scale transactional industry with massive amounts of highly sensitive data and strict regulatory requirements," explained Miri and Ting in a joint interview with Healthcare IT News. "CISOs and CIOs need to secure clinical workflows when clinicians access and use PHI," buy lasix for horses they continued.

But the volume of PHI data that needs to be protected can be staggering."In manufacturing, creating a widget requires you to standardize and streamline," they explained. "That same concept buy lasix for horses applies to securing PHI in healthcare." Miri and Ting point out that healthcare organizations' IT vulnerabilities have increased as the industry becomes more decentralized. A few common buy lasix for horses vulnerabilities include. An expanded attack surface from the proliferation of new digital and mobile technologies – not to mention a remote workforce, more telehealth and more virtual care.Hardware with long depreciation schedules or elongated replacement time frames that is running antiquated vulnerable operating systems,Embedded vulnerabilities in critical lifesaving care, such as pacemakers and bedside pumps.Human error.By using holistic frameworks, the panelists say cybersecurity officials can address today's dynamic healthcare landscape.

Traditional tools that focus buy lasix for horses on the perimeter only, they say, are "like trying to keep mice out of your house by locking all of the windows and doors, which will never be effective." "If you have mice coming into your house, you need to figure out what it is they’re going after, which is the pantry – then focus on how you keep the mice from getting interested in attacking the food pantry," they said.Healthcare has a similar model, they say. Start with the PHI, and focus on securing the workflow. "Securing the buy lasix for horses clinical workflow really comes down to figuring out. Where your healthcare system’s data is, where that ecosystem is, and what the clinicians do in their workflow – then figuring out how to facilitate and secure it," they explained.

Ting said he hopes attendees will leave their session having learned just how increasingly decentralized healthcare delivery is."IT managers have to consider how this new workflow affects their strategies for protecting their system," he said.Miri, meanwhile, said he wants healthcare leaders to "embrace automation, telemetry visibility – and stop the practice of ‘hoping’ that they will not be buy lasix for horses impacted by inevitable risk." Miri and Ting will explain more during their HIMSS21 session, "PHI Timebombs. A CIO's Approach to Reducing PHI Risk." It's scheduled for Thursday, August 12, 11:30 a.m.-12 p.m., in Caesars Forum 123. Kat Jercich is senior editor buy lasix for horses of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Walmart Health's primary care provider has filed to do business in 37 states, suggesting the company is building the foundation to continue its virtual care expansion.According to reporting by Insider, Walmart Health's medical group, MC Medical LLC, registered to do business in 17 more states in June and July.Although Walmart did not respond to requests for comment from Healthcare IT News about the latest round of filings by press time, a spokesperson told Insider in June that the filings to buy lasix for horses do business in 16 other states were related to the company's telehealth ambitions. WHY IT MATTERS As Insider's Shelby Livingston notes, the retail behemoth had already been operating brick-and-mortar medical clinics in Arkansas, Georgia and Illinois, with plans to open additional clinics in Florida. In April and May, MC Medical filed to do business buy lasix for horses in 16 additional states. At the time, a spokesperson said these filings were not related to physical locations, but rather to Walmart's recent acquisition of telehealth company MeMD.

"We're excited buy lasix for horses to enter our fourth state and open our first Walmart Health Florida location later this year," said the spokesperson to Livingston. "We've expressed our interest in offering telehealth via an acquisition that is pending regulatory clearance, and these filings are related to that effort, not physical Walmart Health locations."In June and July, according to Livingston's reporting, the medical group filed to do business in 17 more states, bringing the total up to 37. The moves echo the maneuvers by Amazon Care, whose medical group filed to do business buy lasix for horses in multiple states before the company publicly announced it would be offering telehealth throughout the country. THE LARGER TREND Telehealth advocates have repeatedly warned about the dangers of the "telehealth cliff," namely, if Congress does not take action, that the hurdles to providing telemedicine will be reinstated at the end of the public health emergency.These foreboding signals make retail giants' seeming eagerness to jump into the virtual care space all the more interesting.

One reason may be that the deep-pocketed companies could have an easier time navigating regulations (such buy lasix for horses as state licensure requirements) that could stymie smaller providers.ON THE RECORD Marcus Osborne, senior VP of Walmart Health, this past month said he viewed the company's telehealth offerings as ideally part of an omnichannel experience. "As we think about telehealth it's about recognizing – give buy lasix for horses people options, give people multiple pathways to engage care the way they want, and guess what they'll do?. " he said. "They'll get care." Kat Jercich is senior editor of buy lasix for horses Healthcare IT News.Twitter.

@kjercichEmail. Kjercich@himss.orgHealthcare IT buy lasix for horses News is a HIMSS Media publication.Now more than ever it's critical that hospitals and health systems take the necessary precautions to secure their systems and data from cybersecurity threats. For most hospitals and health systems, it's a matter of when, not if, a cyberattack occurs.While the Zero Trust security model has been around for about a decade, there still is opportunity for vast implementation. In healthcare, some experts buy lasix for horses say, the Zero Trust approach is possibly the only way to eradicate three imminent and growing threats.

Ransomware, outdated vendor firmware and unsecured services.Following a year of increased cyberattacks on hospitals and health systems, such an approach may be critical to better defending healthcare networks, systems and Internet of Things (IoT) devices from an ongoing barrage of sophisticated attacks.Healthcare IT News interviewed Leon Lerman, CEO and cofounder of Cynerio, a vendor of healthcare IoT cybersecurity and asset management solutions, to talk about the core reasons why hospitals and health systems need to implement Zero Trust architecture, why Zero Trust is difficult to achieve with healthcare IoT, and the four stages of a Zero Trust implementation model in healthcare.Q. What are the core buy lasix for horses reasons why hospitals and health systems should implement Zero Trust architecture?. A. It's widely known that the healthcare industry is a primary target for cyberattacks, buy lasix for horses with increasingly sophisticated and highly-motivated bad actors seeking to exploit both human and technological vulnerabilities.

Since 2016, ransomware has resulted in $157 million in damages in healthcare, impacting 90% of healthcare organizations.Furthermore, as a result of the hypertension medications lasix, we saw a 50% increase in the number of healthcare-related cybersecurity breaches against hospitals and medical devices, putting these organizations – and the patients they serve each and every day – at risk.Medical and IoT devices are arguably the biggest weak spot for the healthcare industry, as connected medical devices – an integral part of the Internet of Medical Things – are increasingly being used by hospitals. According to Deloitte, approximately 68% of medical devices will be connected or able to connect to a health system network by 2025.While connected medical devices are critical to patient care, they are also the most vulnerable to buy lasix for horses cyber threats. For example, 96% of infusion pumps in healthcare facilities were affected by URGENT/11 or Ripple20 critical vulnerabilities over the past year. In addition, our research has found that more than 40% of CT machines are managed unsafely by technicians, potentially exposing credentials and classified patient data in cleartext.With 50 billion medical devices expected to be connected to clinical systems within the next 10 years, a Zero Trust architecture, which does away with the traditional security perimeter and assumes that every user or device on the network could potentially be malicious, is critical to helping our healthcare organizations better defend their networks, buy lasix for horses systems and devices from an ongoing barrage of attack techniques.

When working with extremely confidential and valuable information, as is the case in a healthcare environment, this approach is quite possibly the only way to eradicate imminent and growing threats.Q. Why is Zero Trust difficult to achieve in buy lasix for horses the healthcare Internet of Things?. How can healthcare CIOs and CISOs overcome this challenge?. A.

There are several unique challenges healthcare organizations face when seeking to apply Zero Trust strategies. The main reasons are:Poor visibility. Healthcare facilities often have thousands of medical and IoT devices that are invisible to the network, and that may be unknown to IT and security teams. Further, many devices do not support connectivity over standard network protocols, making it difficult to discover and manage them.Proprietary protocols and lack of authentication.

Healthcare IoT devices often run obsolete protocols, which may be unauthenticated and unencrypted, and lack basic access controls.Default device insecurity. Many devices have inherent vulnerabilities, such as open services with minimal authentication used for remote support, management and monitoring.External connections to vendors and cloud services. Most devices today must connect to cloud services or third-party vendors to function properly, or to perform maintenance or updates.Despite these challenges, however, it is possible to achieve a more protected, Zero Trust environment without disrupting clinical operations or causing damage to critical medical equipment.Q. You've said there are four stages of a Zero Trust implementation model in healthcare.

Please elaborate.A. That's correct. Our recommended Zero Trust implementation model consists of four stages.Step one is to design policies that block unnecessary communications with healthcare IoT devices. In simple terms, that means seeking to understand exactly which communications are needed to maintain clinical workflows and medical-device functionality, and which are not.

Map out your organization's devices and identify the following for each category of devices:What other devices and medical servers does this category of devices communicate with?. Does it need to communicate over the Internet?. Is Internet communication isolated in a VPN tunnel?. Does it need to communicate with the device vendor?.

Does it currently have access to other devices, networks or the Internet, which is not required for normal operations?. Step two is segmenting the network to contain attackers to a specific segment. Due to the fact that connected healthcare IoT devices have so many security vulnerabilities, it is important to isolate them from other parts of the network to limit the attack surface. The "network segmentation" phase involves steps such as ensuring connected medical devices can only communicate with devices or systems that are part of their clinical process and blocking external communications – unless needed to communicate with a device vendor or another known entity.The next step is to isolate risks associated with services used on individual devices, also known as service hardening.

It's important in step three to evaluate all connected medical and IoT devices as much as possible in order to apply the latest security patches, perform software upgrades, require authentication on all communication channels, close unused ports and reduce unnecessary device functions.The fourth and final step is to limit external communications (for example, with vendors, clouds, etc.) to prevent breaches. As many of these devices require certain external connections to function properly and are used for time-sensitive, critical patient care, they cannot simply be disconnected from the network or shut down.Instead, external communications should be limited to the bare minimum required. Therefore, in order to protect your medical and IoT devices:Establish monitoring and incident response procedures to identify breaches and s in real time.Keep devices functional at all times.Leverage network segmentation to isolate a device and prevent attackers from communicating with other parts of the network.Wait for planned device downtime and use this opportunity to patch or clean the device to eradicate the threat.Twitter. @SiwickiHealthITEmail the writer.

Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.A University of Oklahoma researcher and a surgeon at OU Health, based in Oklahoma City, had a vision of using AI to visualize superimposed and anatomically aligned 3D CT scan data during surgery. The mission was to augment every surgery.THE PROBLEM"Compared to a pilot flying a plane or even a regular Google Maps user on his way to work, surgeons today have their instruments clustered behind them hanging on the wall," said Mohammad Abdul Mukit, an MS student in electrical and computer engineering at the University of Oklahoma, and a graduate fellow and research assistant. His research focuses on applications of computer vision, extended reality and AI in medical surgeries."The Google Maps user or the pilot gets constant, real-time updates regarding where they are, what to do next, and other vital data that helps them make split-second decisions," he explained. "They don't have to plan the trip for days or memorize every turn and detail of every landmark along the way.

They just do it."On the other hand, surgeons today have to do rigorous surgical planning, memorize the specifics of each unique case, and know all the necessary steps to ensure the safest possible surgery. Then they engage in complex procedures for several hours, with no targeting or homing devices or head-mounted displays to assist them."They have to feel their way to their objective and hope everything goes as they planned," Mukit said. "Through our research, we aim to change this process forever. We are making the 'Google Maps for surgery.'"PROPOSALTo turn this vision into reality, Mukit and OU Health plastic and reconstructive surgeon Dr.

Christian El Amm have been working together since 2019. This journey, however, started in 2018, with El Amm's collaboration with energy technology company Baker Hughes.BH specializes in using augmented reality/mixed reality and computed tomography scans to create 3D reconstructions of rock specimens. For geologists and oil and gas companies, this visualization is extremely helpful as it assists them to efficiently plan and execute drilling operations."When you change the way you see the world, you change the world you see."Mohammad Abdul Mukit, University of OklahomaThis technology caught the attention of El Amm. He envisioned that this technology combined with AI could allow him to visualize superimposed and anatomically aligned 3D CT scan data during surgery.

This could also be used to see reconstruction steps he had planned during surgery while never losing sight of the patient.However, several key challenges needed to be solved to get a prototype mixed reality system ready for use in surgery.MEETING THE CHALLENGE"During the year-long collaboration, the BH team created solutions for those challenges that, until that time, were unsolved," Mukit recalled. "They implemented a client/server system. The server – a high-end PC – equipped with RGBD cameras would do all the computer vision work to estimate the six DoF pose of the patient's head."It would then stream the stored CT scan data to the client device, a Microsoft Hololens-1, for anatomically aligned visualization," he continued. "BH developed a proprietary compression algorithm that enabled them to stream a high volume of CT scan data.

BG also integrated a proprietary AI engine to do the pose estimation."This was a complex engineering project done in a very short time. After this prototype was completed, the team had a better understanding of the limitations of such a setup and the need for a better system."The prototype system was somewhat impractical for a surgical setting, but it was essential for better understanding our needs," Mukit said. "First, the system couldn't estimate the head pose in surgical settings when most of the patient's body was covered in clothing except the head. Next, the system needed time-consuming camera calibration steps every time we exited the app."This was a problem since according to our experience, surgeons accept only those devices that just work from the get-go," he continued.

"They don't have the time to fiddle around with technology while they are concentrating on life-altering procedures. We also deeply felt the need for the options to control the system via voice commands. This is an essential element when it comes to surgical settings as the surgeons will always have their hands busy."Surgeons will not be contaminating their hands by touching a computer for controlling the system or by taking off the device for recalibration. The team realized that a new, more convenient and seamless system was essential."I started working on building a better system from scratch in 2019, once the official collaboration ended with BH," Mukit said.

"Since then, we have moved most of the essential tasks to the edge, the head-mounted display itself. We also leveraged CT scan data to train and deploy machine learning models, which are more robust in head pose estimation than before."We developed 'marker-less tracking,' which allows the CT scan or other images to be superimposed using artificial intelligence instead of cumbersome markers to guide the way," he added. "We then eliminated the need for any manual camera calibration."Finally, they added voice commands. All these moves made the apps/system plug-and-play for surgeons, Mukit said."Due to their convenience and usefulness, the apps were very warmly welcomed by the OU-Medicine surgeons," he noted.

"Suddenly ideas, feature requests, queries were just pouring in from different medical experts. I realized then that we had something really special in our hands and that we had only scratched the surface. We started developing these features for each unique genre of surgery."Gradually, this made the system enriched with various useful features and led to unique innovations, he added.RESULTSEl Amm has begun using the device during surgical cases to enhance the safety and efficiency of complex reconstructions. Many of his patients come to him for craniofacial reconstruction after a traumatic injury.

Others have congenital deformities.Thus far, he has used the device for several cases, including reconstructing a patient's ear. The system took a mirror image of the patient's other ear, then the device overlaid it on the other side, allowing El Amm to precisely attach a reconstructed ear. In the past, he would cut a template of the ear and aim for precision using the naked eye.In another surgical case, which required an 18-step reconstruction of the face, the device overlaid the patient's CT scan on top of his real bones."Each one of those bones needed to be cut and moved in a precise direction," El Amm said. "The device allowed us to see the bones individually, then it displayed each of the cuts and each of the movements, which allowed the surgeon to verify that he had gone through all those steps.

It's basically walking through the steps of surgery in virtual reality."ADVICE FOR OTHERS"When you change the way you see the world, you change the world you see," Mukit said. "That is what mixed reality was made for. MR is the next general-purpose computer. Powerful technology will no longer be in your pockets or at your desks."Through MR, it will be integrated with your human self," he continued.

"It will change how you solve problems, which in turn will lead to new creative ways of solving problems with AI. I think that within the next few years we are going to see another technology revolution. Especially after a mixed reality head-set is unveiled in 2023, which is reported to be lighter than any other visors in the market."Currently, almost every industry is integrating mixed reality headsets into their businesses – rightly so, as the gains are evident, he added."This technology is now mature enough for countless possible applications in almost every industry and especially in healthcare," he concluded. "Mixed reality has not made its way fully into this industry yet.

We have only scratched the surface, and already in a few months, we have seen such an overwhelming tsunami of ideas from experts. Ideas that now can be implemented with ease."These application scenarios range from education and training to making surgeries safer, faster and more economical for both the surgeons and patients. The time to jump into mixed reality is now."Twitter. @SiwickiHealthITEmail the writer.

Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication..

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In this age of big science, with fundamental physics generally tested in sprawling laboratories such as CERN and furosemide lasix 40mg tablet LIGO, maverick http://creativesv.com/contact/ individuals who make a big difference through their spot-on hunches are an increasingly rare breed. Those who did so in the past, therefore, have assumed an almost mythic quality. Their excellent guesses changed history in a way that would be much harder today because of furosemide lasix 40mg tablet the complexity of many areas of research, often requiring massive collaborations.

It has been 20 years since the death, on August 20, 2001, of controversial British astrophysicist Fred Hoyle, an iconoclast who was known as much for his stubborn adherence to fringe beliefs as for his substantial contributions to science. Both the good and the bad in his career stemmed from the same source—a penchant for sweeping predictions based on seat-of-the-pants calculations and an intuitive sense of what must be the correct explanation according to nature’s rules. Hoyle’s principal debate partner—from the media’s perspective at least—was Russian-Ukrainian-American physicist George furosemide lasix 40mg tablet Gamow.

Gamow died in 1968, more than three decades before Hoyle, but their time together in the public spotlight, roughly from the early 1950s to the mid-1960s, was long enough that their battle of ideas became legendary. Their dispute concerned the origin of the universe and of the matter within it. While both agreed that space is expanding, Hoyle argued vociferously that it was infinitely old, with new matter slowly trickling into the empty space furosemide lasix 40mg tablet left by expansion, creating new stars and galaxies and filling the gaps over the eons.

Therefore, in what he and co-creators Hermann Bondi and Thomas Gold called the “steady state universe” the cosmos essentially looks the same overall over time. Gamow, on the other hand, believed that all matter was created in a hot, dense state, billions of years ago, when the observable universe was far smaller. During its initial fiery minutes, all furosemide lasix 40mg tablet of the chemical elements were forged, he believed.

Along with his associates Ralph Alpher and Robert Herman, he tried to show how such a buildup might be feasible in a primordial cosmic cauldron. Dismissing the idea of a massive breach of conservation of matter and energy at the dawn of time, Hoyle derided such models (including a predecessor idea by Belgian mathematician and priest Georges Lemaître). On a BBC radio show in March 1949, he dubbed such furosemide lasix 40mg tablet a sudden genesis the “big bang”—a name that stuck.

Like Hoyle, Gamow often relied on his gut feelings to make scientific predictions. He had little patience for projects that required page after furosemide lasix 40mg tablet page of calculations and many years of effort. Thus, while their cosmological views were vastly dissimilar, their manner of conducting research had much in common.

For example, in 1928, while visiting the University of Göttingen in Germany, Gamow learned about a dilemma physicists faced in explaining the process of alpha decay, when a heavy nucleus such as uranium suddenly expels an alpha particle (a cluster of two protons and two neutrons). Clearly, the alpha particle crosses a kind of energetic barrier that normally prohibited passage, furosemide lasix 40mg tablet but how?. Intuitively, the conundrum reminded him of a situation in quantum mechanics in which electrons had a finite chance of tunneling through a classically forbidden region.

Gamow performed a quick calculation using quantum rules and solved the alpha decay problem overnight, sharing his results with Hungarian physicist Eugene Wigner the next day. Later, Gamow learned that Princeton physicists Ronald Gurney and Edward furosemide lasix 40mg tablet Condon had independently developed a similar solution. Nuclear physics progressed immensely after that breakthrough.

Gamow’s formula also made predictions for collisions between individual nucleons (protons and neutrons), essential for understanding how a cycle of fusion transforms hydrogen into helium in the cores of vibrant stars, generating heat and light in the process. The buildup of chemical elements has a bottleneck, however, which took the insights of Hoyle to help unravel furosemide lasix 40mg tablet. Nature does not provide a simple way of creating the isotope carbon-12 and the elements above it.

Big bang nucleosynthesis—the scheme developed by Gamow, Alpher and Herman to explain how the elements were forged—does not maintain a high enough temperature for a long enough time to overcome the instability of beryllium-8, one of the rungs on the ladder to reach carbon-12. Beryllium-8 decays extremely rapidly, offering it only a minuscule chance furosemide lasix 40mg tablet of combining with helium-4 to make carbon-12 (mathematically, the simplest way of creating that isotope), unless conditions were far more favorable than the big bang could furnish. Because he didn’t support the big bang, Hoyle didn’t believe that the chemical elements (aside perhaps from helium) were forged in the early universe.

Rather, in 1946 he brilliantly concocted furosemide lasix 40mg tablet an alternative method. As stars exhaust their primary source of fuel—transforming hydrogen into helium via fusion processes—their cores contract and become hotter and hotter. Such immense temperatures offer the perfect environment for element creation.

Moreover, the sudden contraction at the end of furosemide lasix 40mg tablet a star’s lifetime is—if it is sufficiently massive—accompanied by a supernova explosion that spews the forged elements into space. In short, Hoyle’s scheme cleverly explained both the concoction and the distribution of the elements we see on Earth. Another of Hoyle’s phenomenal insights explained how the beryllium-8 bottleneck could be overcome.

He speculated furosemide lasix 40mg tablet that carbon-12 possessed a quantum energy level that matched up well with that of beryllium-8 combined with helium-4, making transformations at extremely high temperatures likely enough that they could happen in contracting cores. When a team of experimentalists at Caltech’s Kellogg Radiation Laboratory verified that such a carbon-12 excited state existed in nature, Hoyle’s hunch was splendidly confirmed. The downside of the intuitive approach taken by both Hoyle and Gamow is that mere speculation might land way off the mark.

In Hoyle’s furosemide lasix 40mg tablet case, he enjoyed intellectual fencing matches and didn’t mind if others strongly disagreed with his conjectures, as long as they remained open to debate. Hence, he clung to variations of the steady state model long after substantial evidence, starting with the discovery in the mid-1960s of a faint afterglow of radiation that permeates the universe, pointed to a hot big bang. Moreover, in his final decades of life, he published numerous books and articles advancing furosemide lasix 40mg tablet fringe opinions in fields well outside his specialty.

For example, he proposed that many illnesses on Earth were extraterrestrial in origin, and that a famous, well-established fossil in a London museum was a fake—without supplying credible proof of either view. Gamow did not go out on a limb in the same way. However, he often bombarded his colleagues, such as Edward Teller during their time together in the late 1930s at George Washington University, with a succession of speculative notions, most furosemide lasix 40mg tablet of which never went anywhere.

In short, the same kind of intuitive approach that led Hoyle and Gamow each to suggest proposals that advanced scientific understanding also steered them toward many hunches that went nowhere. Hoyle, much more so that Gamow, was known to cling to such ideas far too long. Gamow would simply furosemide lasix 40mg tablet move on to other subjects and schemes.

Today, with many scientific enterprises much larger and far more cautious, the role of such iconoclasts is greatly diminished. Still, we might toast the boldness of mavericks in the past, such as Hoyle and Gamow, for the leaps of progress that ensued. This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.More than furosemide lasix 40mg tablet half the world relies on rice as a primary food source.

Yet the essential crop faces an worrisome future as global warming cranks up the Earth’s temperature and intensifies storms, droughts and heat waves. It’s hard to overstate the danger of this development, scientists say. Rice is vulnerable to climate extremes and grows in places furosemide lasix 40mg tablet already experiencing many.

Any disruption to that food source can cause massive problems. Just look furosemide lasix 40mg tablet at recent history. In 2008, fears over rice supplies magnified a food crisis that sent prices soaring.

The ensuing panic sparked riots across the globe, from Bangladesh to Egypt to Haiti. That was 13 years ago, when there were about furosemide lasix 40mg tablet 1 billion fewer people on the planet. In another 13 years, the world’s population is expected to boom by another 1 billion, bringing the total to a projected 8.8 billion people.

And all the while the world’s climate will keep changing. €œAt a time when we’re going to add a couple more billion people to the population in the most vulnerable areas, it’s really furosemide lasix 40mg tablet a bit of a wake-up call,” said Louis Verchot, head of the land restoration group at the International Center for Tropical Agriculture. €œWe’re going to need to really rethink how we organize our food systems.” Research underscores this concern.

The latest report from the Intergovernmental Panel on Climate Change—which brought together 234 scientists to synthesize recent climate studies—warned that human-caused global warming is happening at an unprecedented pace and is driving the deadly floods, heat and droughts we’re already witnessing (Climatewire, Aug. 9). And those events pose major risks to farming.

€œHigher temperatures lead to increased evaporation, resulting in soil drying, increased plant stress and impacts on agriculture, even in regions where large changes in precipitation are not expected,” the report states. If greenhouse gas emissions are not reduced, about a third of global land areas are projected to suffer from at least moderate drought by the end of the century, it concludes. Some changes like sea-level rise are already locked in.

Rice is especially susceptible to these changes. Rice often grows in ecosystems, such as deltas, that have low elevation and are vulnerable to rising seas. It also grows in areas that already experience extreme heat.

Any additional temperature increase could push it past thresholds in which a healthy crop can develop, scientists say. A 2018 study in the Archives of Agronomy and Soil Science found that an increase in the frequency and severity of hot weather could reduce rice yields by up to 40% by the end of this century. €œMost of the [world’s] rice is currently grown in regions where existing temperature is already close to the optimum range for rice production,” the study states.

€œTherefore, any further rise in mean temperature or short episode of high temperature during sensitive growth stages, will be catastrophic.” While rice can grow in temperatures that reach 40 degrees Celsius (104 degrees Fahrenheit), heat stress can impair the ability of its flowers to pollinate, the study noted. Temperatures above 35 C can significantly decrease yields. High nighttime temperatures also can impact productivity.

One study found that each 1 C increase in night temperatures above 35 C leads to around a 10% decline in rice yields. It’s not just heat. The increased potential for flooding and drought also threaten production.

So will rising seas that can inundate low-lying farmland with salt water. A paper by the International Rice Research Institute said rice was expected to be “the cultivated crop most vulnerable to future changing climates.” U.S. Rice growers feel the heat The risk to rice matters in a world where food systems are increasingly interconnected.

€œOne of the particularities of rice is that the market is very thin in that there isn’t a lot of excess potential supply for demand,” said Tim Benton, research director for emerging market risks at Chatham House. €œSo if you have a failure in any one place, it does tend to radically affect the international price.” The United States, for example, has a small but important role in the global supply chain. U.S.

Farmers only produce about 2% of global rice supplies. But they ship more than 6% of global exports, according to the U.S. Department of Agriculture.

Those U.S. Farmers are based almost exclusively in six states. Arkansas, California, Louisiana, Mississippi, Missouri and Texas.

And they already are experiencing the impacts of extreme weather. U.S. Rice growers sent a letter to Congress last month asking for disaster assistance following a year of severe storms, floods and drought, according to USA Rice, which advocates for rice producers in the major rice-producing states.

The problem has been magnified of late in California, where rice grows mostly in the Sacramento Valley. Due to multiple years of low rainfall and snowpack, the state this year is expected to grow 100,000 fewer acres of rice, Tim Johnson, the head of the California Rice Commission, said in a report from the local CBS station. The impacts run deep In some drought-prone, rice-growing areas, productivity may fall even during favorable years.

That's because farmers who fear crop loss may avoid putting money into things such as fertilizer and new seeds that would help boost yields, research from the International Rice Research Institute shows. And if yields drop and income is lost, farming families may relocate or send some members to find work elsewhere, said Amanda Carrico, a professor in the environmental studies program at the University of Colorado, Boulder. That's one of several problems that loom for countries that rely on rice.

Population booms compounded by climate change impacts and land conversion—particularly in rice-growing regions of Asia—could add challenges for countries to remain self-sufficient in food production. €œIt’s a whole livelihood, it’s a cultural crop, you have religion involved, you have beliefs, stories. Life in Asia, and Southeast Asia in particular, has evolved around rice,” said Bjoern Ole Sander, a senior scientist and climate change lead at the International Rice Research Institute, which is based in the Philippines.

A recent study led by researchers at Cornell University found that global agricultural productivity has slowed about 21% in the last 60 years due to climate change, with the effects more pronounced in warmer, tropical areas. Part of that, the study discovered, was because agriculture wasn’t adjusting to new climate extremes, which made them worse over time. €œYou don’t have to be a rocket scientist to know that the projections are for higher temperatures,” said Ariel Ortiz-Bobea, an associate professor at Cornell’s school of applied economics and management.

€œSo it’s pointing to an increasing slowdown of productivity growth, and that has a whole range of implications.” His team at Cornell is planning to study how much investment in research and development is needed to either maintain or counteract the effects of climate change. One goal is to develop a strategy that doesn’t depend solely on using more fertilizer or expanding the land area in production. €œIf we don’t grow productivity, then you’ll make up the production deficit through more inputs, and that has irreversible consequences on the environment,” said Ortiz-Bobea.

Plant early, reduce water, develop new seeds Rice production has increased greatly since the Green Revolution of the 1960s transformed global agriculture and brought higher-yielding varieties, new methods of cultivation and mechanization. Global rice production is forecast to hit a record 506 million tons for 2021-2022, according to the Agriculture Department’s latest rice outlook. It forecasts global consumption at a record 514 million tons.

Climate change could roll back some of those gains, especially if it leads to more deforestation or loss of wetlands, a buffer against sea-level rise and a natural sink for carbon dioxide. €œThere’s this whole transformation in landscapes that’s going to really put the whole human-economic enterprise at risk. It’s going to roll back gains that we’ve made in the past 40 years in many places, and it’s going to increase the vulnerability of the poorest,” said Verchot from the International Center for Tropical Agriculture.

To avoid these problems, researchers are working to make food systems more resilient. That includes decarbonizing irrigation systems and developing stress-tolerant rice varieties that can withstand high temperatures or flooding. The International Rice Research Institute has around 150,000 rice varieties in its seed bank, Sander said.

But most are not being grown or reaching production scale. Countries also have their own rice research programs and are constantly breeding new varieties, he added. One goal is to develop seed varieties that have a higher tolerance to drought or heat or can survive submergence in areas that are expected to see even more precipitation.

There is also growing recognition of more traditional varieties, which have a strong resistance to salt water and lack of water. Better farm management can help, too. Rice uses a lot of fresh water, but scientists have found it can grow with half the typical amount.

That means farmers can apply water-saving techniques in areas where drought is projected to increase. Methane an issue for rice growers Improved farming techniques also can cut emissions of methane, a potent planet-warming gas. Rice is the second-largest source of methane from agriculture after livestock.

In Vietnam, a major rice producer, it accounts for 15% of the country’s total emissions. Studies have found that alternate wetting and drying of rice paddies can halve emissions and save up to 30% of the water needed for irrigation. Planting at different times also helps.

That’s what the International Rice Research Institute worked with farmers to do in the Mekong Delta following the 2016 drought. That year, several hundred thousand hectares of rice saw reduced yields in part because of salt water pushing into freshwater supplies used for irrigation, Sander said. In its aftermath, the International Rice Research Institute promoted a new approach.

Plant rice a few weeks earlier so it wouldn’t be at its most vulnerable stage of growth when salt water started to inundate the fields. Not every solution will be as easy. Extreme and compound events—such as successive flooding and drought or drought exacerbated by heat stress—will be harder to overcome.

As those disasters become more frequent, scientists expect to see more yield declines more often. It's one of many reasons scientists say the world needs to focus on rice as the Earth heats up. €œRice has such a high carbon footprint, but the investments are still relatively low,” Sander said.

€œIt is definitely a crop that deserves more attention.” Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals.Ask astronomers what question they most want to answer, and you will get scattered responses.

How did the first stars, galaxies and black holes form?. What is the nature of dark matter and dark energy?. Are we alone?.

Each question demands its own large telescope. No ultimate, one-size-fits-all instrument will ever exist, for none can be made to gather each and every kind of cosmic light. Black holes sometimes shine in x-rays, for instance, whereas Earth-like exoplanets are best studied in optical and infrared light.

Yet such projects so strain the fraction of public and private funds allocated to astronomy that only a few—perhaps just one—can be prioritized at a time, leading to pileups of also-ran proposals and anxious researchers awaiting a rare chance to open new windows on the universe. In the U.S., astronomers have managed these competing ambitions by devising a process that has become the envy of the scientific world. The Astronomy and Astrophysics Decadal Survey, a once-in-10-years exercise that recommends and ranks the community’s priorities for the next decade—embodied, eventually, by major new federally-sponsored observatories on the ground and in space.

Projects such as NASA’s Hubble Space Telescope owe their existence, in part, to coveted endorsements from Decadals of yore, and the practice has spread to several other disciplines that now undertake Decadal Surveys of their own. Organized by the National Academies of Sciences, Engineering, and Medicine, six Decadal Surveys have set the course of U.S. Astronomy since they began in the 1960s.

The results of the seventh, dubbed Astro2020, will soon be announced after two years of exhaustive deliberations led by a 20-member steering committee. And just like its predecessors, Astro2020 will reveal where major new investments and discoveries are most likely to be made—and where neglect, disinterest or even fear may block progress for generations to come. The Astro2020 steering committee, panel chairs, and study staff.

The steering committee co-chairs, astronomers Robert Kennicutt and Fiona Harrison, appear 14th and 16th from left, respectively. Credit. National Academies of Sciences, Engineering and Medicine Few people know the power of these surveys better than Joel Parriott.

More than 20 years ago, he got his start in federal politics as a staffer at the National Academies, where his initial assignment was to assist the scientists crafting the first astronomy Decadal of the new millennium. Then he served a 10-year stint in the White House Office of Management and Budget (OMB), where he weighed and implemented Decadal recommendations for federal science agencies. Today he is director of public policy at the American Astronomical Society, the leading advocacy group for U.S.

Stargazers. At the OMB, where the nation’s policy objectives often brutally intersect with its fiscal realities, the Decadal Survey offered Parriott and his colleagues a foolproof way of dismissing overly solicitous astronomers. €œIf a project wasn’t highly ranked, we knew it didn’t have the community’s endorsement,” he says.

€œThat’s really helpful for folks on Capitol Hill and in the White House http://www.em-victor-hugo-schiltigheim.ac-strasbourg.fr/lecole/nos-classes/la-classe-passerelle/nos-activites/ who need to make hard choices.” For more than a few astronomers, a drab name like “the Decadal” does not properly capture a process that holds such sway over their destiny. Instead they sometimes just call it “the voice of God.” In coming weeks, when Astro2020’s final report is released, that voice—that supposedly communal voice—will once again speak. Yet outside of a chosen few, sworn to secrecy, no one in the community knows in advance what it will say.

Everyone, though, agrees Astro2020’s conclusions arrive at a time of peril. €œWe are right now on a knife-edge,” says John O’Meara, chief scientist of the W. M.

Keck Observatory on Mauna Kea in Hawaii. €œI do believe this Decadal is existential for astronomy in the United States. When you consider the facilities and the science topics that are under discussion, it will influence whether or not we become a second-place player in global astronomy….

When the [federal] agencies and Congress receive the Decadal report, they will hold in their hands the decision of whether or not we wish to have leadership in this field of science.” U.S. Telescopes in Twilight From the outside looking in, one would not realize the enterprise of U.S. Astronomy is teetering on the edge of crisis.

Several new ground-based telescopes have recently come online, each bringing a bumper crop of celestial discoveries—and even more ambitious projects are waiting in the wings. Consider the Vera C. Rubin Observatory, a high-ranked priority of the past two Decadals (which are naturally called Astro2000 and Astro2010).

Sited on a mountain in Chile, the Rubin Observatory should begin operations in late 2023 to generate a high-definition, decade-spanning time-lapse movie of the entire overhead sky. But among large upcoming U.S. Projects, Rubin is a rare, healthy exception.

The other highest-profile ground-based recommendation from Astro2000 and Astro2010—building an optical extremely large telescope (ELT) with a mirror circa 30 meters in size—remains in limbo. One selling point for ELTs, among many, is that they offer the best hopes of ever studying Earth-like exoplanets from the ground. Astro2020 will probably decide if the U.S.

ELT efforts sink or swim—or if other projects, such as a “next generation” upgrade to the nation’s Very Large Array of radio telescopes or expansions of gravitational-wave observatories, take priority. Activists blockade the road to the summit of Mauna Kea in this photo from July 2019, seeking to halt construction of the Thirty Meter Telescope on the sacred Hawaiian volcano. Credit.

Ronit Fahl/ZUMA Wire/Alamy Live News In the quest for an ELT, the U.S. Has managed to produce two competing projects, the Thirty Meter Telescope (TMT) and the Giant Magellan Telescope (GMT). Both are short on funding, and neither appears likely to begin operations before the decade is out, each having served to stifle the other.

And the TMT’s early stages of construction on the Hawaiian volcano Mauna Kea—a site unrivaled for pristine views of the Northern Hemisphere sky—sparked protests from activists who see telescopes there as an occupying affront to the mountain, which Native Hawaiians hold sacred. Construction on the TMT ceased after protesters repeatedly blocked the road to the mountaintop. The conflict remains at an impasse.

€œIf [Astro2020] says, ‘Forget the ELTs. Let’s prioritize something else instead,’ then it’s quite possible that both the TMT and the GMT will die,” says a senior ground-based astronomer familiar with the situation. Europe, in contrast, took the lead over the U.S.

In ground-based optical astronomy years ago and is well into construction of an ELT of its own in Chile. The European Extremely Large Telescope boasts a 40-meter mirror—and it is projected to come online in 2027. China is surging ahead as well.

For evidence, look no further than the U.S.’s iconic, National Science Foundation–funded Arecibo radio telescope in Puerto Rico. Once the world’s largest, the radio telescope catastrophically collapsed last year in part because of budgetary neglect—but not before China’s Five-Hundred-Meter Aperture Spherical Radio Telescope (FAST) had superseded it in size. And together—without the U.S.—Europe, China and many other international partners are building the Square Kilometer Array (SKA), a breathtakingly powerful collection of thousands of radio telescopes that is set to become fully operational at sites in Australia and South Africa as early as 2030.

The Hungry Giant and Frankenstein’s Monster The outlook is similarly mixed for the nation’s space-based astronomy. For now, the U.S. Remains at the forefront of off-world observing, but of the four “Great Observatories” NASA launched between 1990 and 2003, only Hubble and the Chandra X-ray Observatory are still operational, and both are nearing their end, with no replacement on the horizon.

€œHubble is probably not going to last another decade, and maybe we’ll get five more years out of Chandra. But then that’s it—they’re gone,” says Jason Tumlinson, an astronomer heading the community missions office at the Space Telescope Science Institute. €œWe’ll probably have a long gap with no real optical, uaviolet or x-ray capability in space.

And now is the time to decide how and when we might get it back.” Technicians examine the 6.5-meter segmented primary mirror and deployable sunshield of the James Webb Space Telescope, NASA’s $10 billion “flagship” observatory which is scheduled to launch in November 2021. Credit. Chris Gunn NASA Astro2000’s top-ranked space project, NASA’s flagship-class James Webb Space Telescope, is a technological marvel.

A cryogenically cooled infrared observatory with a segmented, 6.5-meter starlight-gathering mirror that folds, origamilike, to fit in a rocket. Early on Webb was projected to cost about $1.5 billion and to launch perhaps in 2011 to study the emergence of stars and galaxies in the early universe. Today those projections seem hopelessly naive.

After a staggering number of cost overruns and delays that hobbled planning for other projects, the current best-case scenario is that the telescope will reach space no sooner than this mid-November, operating for just a decade with a total project cost of about $10 billion. Less optimal scenarios, of which there are many, are almost too grim to contemplate. €œWe can’t do science at this scale without taking risks—and I’m confident in our chances of success—but if Webb fails, it will be an unmitigated disaster,” says Matt Mountain, the project’s telescope scientist and president of the Association of Universities for Research in Astronomy.

€œIt has to work. Because if it doesn’t, we aren’t going to do another ambitious flagship for, I would guess, two decades.” If Webb was a hungry giant unleashed by Astro2000 and its antecedents biting off more than could be chewed, then the top flagship recommendation of Astro2010, NASA’s Nancy Grace Roman Space Telescope, was a different beast entirely—a cut-rate Frankenstein’s monster the Decadal committee pieced together from the dismembered remains of multiple competing mission concepts. The committee had hoped to avoid another Webb-style debacle with Roman (initially named the Wide-Field Infrared Survey Telescope, or WFIRST)—and it did.

But instead Roman’s very existence threatened to tear the community apart from within. €œDo you know what WFIRST really stood for, for most of us?. € says one leading astronomer.

€œIt stood for ‘What the fuck is this ridiculous space telescope?. €™â€ Originally envisioned to study dark energy with a barebones instrument package and a mirror scarcely half the size of Hubble’s, Roman was projected to launch as early as 2020 on a relatively slim budget of less than $2 billion. To many expert eyes, such a project barely qualified for its supposed “flagship” status.

NASA, with bipartisan congressional blessings, ultimately added more instruments and upgraded Roman’s mirror to the same size as Hubble’s, enhancing its science objectives and assuaging many criticisms—but also nearly doubling its estimated price tag and delaying its launch to no earlier than 2025. Meanwhile Europe and China have each proceeded with dark energy-focused space telescopes of their own, potentially scooping some of the promised scientific discoveries used to justify Roman’s existence in the first place. The 2.4-meter primary mirror of NASA’s Nancy Grace Roman Space Telescope, the next flagship observatory to fly after Webb.

Credit. L3Harris Technologies, Inc. Although both Webb and Roman may each eventually succeed beyond astronomers’ wildest imaginings, some fear the projects’ greatest initial impact on the field will be to sharply curtail Astro2020’s ability to plan for a prosperous future.

€œThis is, I think, the first Decadal where both of the top space-based recommendations from the previous two Decadals—Webb and Roman—were still on the ground,” Tumlinson says. €œAnd if the Astro2020 committee were to say, ‘We’ve got two flagships stacked up. The queue is too long.

Let’s just pause for a while and do some smaller missions and catch up later,’ that would be a mistake. The idea that you can just take a decade off from ambitious things to come back and do them later is not valid when you consider how our government actually works.” Most astronomers, Tumlinson says, seem to misunderstand what the Decadal’s “governing dynamic” actually is. €œA Decadal report is the beginning of a multiparty, multiyear negotiation between the scientific community, NASA, the aerospace contractors, Congress and the White House,” he explains—which is why aiming high at the outset is in astronomers’ best interest.

€œI would hope, with Astro2020, we temper our natural desire to mitigate risk and cut costs,” Tumlinson says, “because all the other forces in this system will be doing that for us anyway.” Whether because of the hypertension medications lasix, soaring deficit spending or the increasingly dire global climate emergency, some might question the wisdom of U.S. Astronomers reaching for the stars just as the sky seems set to fall. Then again, the reply comes, where is the wisdom in limiting the science of the 2040s or 2050s based on the troubles of the 2020s?.

“At the end of the day, appropriators are still going to spend money,” says a former congressional staffer who dealt with high-level appropriations for federal science agencies. €œThey’re going to get an allocation, and their job will be to use it wisely. If it doesn’t go to astronomy, maybe it will go to a new flagship mission for NASA’s planetary science division instead—or maybe it will go to a new FBI building.

But that money will be spent, regardless of what astronomers do.” The Main Menu Responding to the woes from Webb and Roman, years ago NASA began revamping its approach to future flagships, demanding greater certainty about technological challenges and costs. In 2016 the agency assembled four Science and Technology Definition Teams (STDTs), each examining a separate mission concept for Astro2020’s consideration. Two of the four concepts—the Large Uaviolet Optical Infrared Surveyor (LUVOIR) and the Habitable Exoplanet Observatory (HabEx)—would focus on the quest to learn more about planets orbiting other stars, with an emphasis on studying potentially habitable worlds.

A third, the uacold and far-infrared Origins Space Telescope, would also perform some exoplanet studies as part of a broader investigation of the formation of galaxies, stars and planetary systems. The fourth concept, the Lynx X-ray Observatory, would be the most powerful x-ray astronomy facility ever built, offering intimate views of black holes, active galaxies and violent supernovae across cosmic time. Each project has profound potential—but also one or more Achilles’ heels to make astronomers antsy.

LUVOIR’s strength—and weakness—has always been the enormity of its segmented mirror. If deployed and maintained with picometer-degree stability (which is very hard), this mirror would allow astronomers to discover and study hundreds of exoplanets while also performing revolutionary observations across a wide swath of general astrophysics. Assuming any true-blue Earth-like worlds exist around the sun’s neighboring stars, LUVOIR should offer the best odds of finding them.

But whether considering either a 15-meter “deluxe model” or an eight-meter “budget size” one, putting such a demanding deployable mirror into space translates to an astronomical cost. €œWhen I started working on this, I closed my eyes and said, ‘It’s gonna be $1 billion a meter. But if LUVOIR realizes its vision, that would be a bargain,” says O’Meara, one of the leaders of the this mission concept’s STDT.

Estimates from two separate groups at NASA’s Goddard Space Flight Center have arrived at slightly higher figures, placing a deluxe LUVOIR somewhere in the realm of $15 billion or $20 billion and finding the budget version between about $12 billion or $15 billion. [embedded content] A time-accelerated visualization of the deployment of the 15-meter LUVOIR mission in space. Thanks to its smaller four-meter mirror, HabEx would be cheaper than either version of LUVOIR, with an estimated cost approaching $10 billion.

But it would yield far fewer exoplanets—delivering details on perhaps 10 potential exo-Earths rather than dozens. It represents an all-in bet on a novel technology. A secondary sunflower-shaped spacecraft called a “starshade” that would unfurl to more than 50 meters across and fly more than 75,000 kilometers in front of the four-meter mirror to blot out a target star’s light, revealing comparatively dimmer accompanying worlds.

€œThe starshade concept, although potentially very powerful, scares a lot of people for whom it is a relatively new idea,” says Scott Gaudi, an astronomer at the Ohio State University, who co-chaired the HabEx STDT. Yet he maintains that scientists have a realistic plan for managing risks and developing the starshade on budget. [embedded content] A narrated overview of the HabEx mission.

Origins is, in most respects, the “safe” choice. It features a large but nonsegmented mirror of nearly six meters and is based mostly on preexisting technologies, netting a cost estimate of around $7 billion. Chilled to less than five kelvins above absolute zero, the telescope would offer a 1,000-fold increase in far-infrared sensitivity over previous missions, allowing astronomers to map the inner workings of galaxies across the observable universe while also studying a handful of small exoplanets as well as water in protoplanetary disks around nearby stars.

But Origins’ tried-and-true approach makes it relatively bland. It would not answer the burning questions about Earth-like worlds that LUVOIR or HabEx might. Its infrared optics would not deliver the crisp, colorful images of Hubble.

And a top ranking from Astro2020 would make it, after Webb and Roman, the third infrared flagship in a row recommended to NASA. Some might call Origins a space telescope only an astronomer could love. €œWe have a real PR problem in the infrared,” says Cara Battersby, an astronomer at the University of Connecticut, who served on the Origins STDT.

€œBut if you look at the specs of each [STDT] concept and the science questions they have in common, such as planets and the coevolution of black holes with galaxies, I challenge you to not conclude that Origins is the most well-rounded and safest of them all.” [embedded content] A time-accelerated visualization of the deployment of the Origins Space Telescope. Lynx is the oddball of the four, with a projected price tag slightly shy of that of Origins but a radically different design and goal. Its “mirror” would be a first-of-its-kind three-meter-wide assembly of nearly 460 nested shells of polished silicon, all densely packed and angled to reflect and focus high-energy x-rays.

That design would provide far better performance than Chandra or other earlier x-ray telescopes, allowing Lynx to unveil new details of the universe’s oldest and biggest black holes. Some astronomers fret about potential budget-busting difficulties in making Lynx’s exotic mirror, but most instead worry about duplicating the efforts of a similar, already approved project. The European Space Agency’s Advanced Telescope for High-Energy Astrophysics (Athena), which is set to launch in 2031.

€œFor many people, the existence of Athena is an insurmountable argument against Lynx,” says Grant Tremblay, an astronomer and a contributor to the Lynx STDT at the Center for Astrophysics at Harvard University and the Smithsonian Institution. €œBut I sincerely believe there is a very compelling argument for why these two missions are scientifically complementary to each other.” [embedded content] A visualization of the Lynx X-ray Observatory detailing its major components. Collectively, these four STDT concepts make up the main menu of flagship options that the Astro2020 steering committee is most likely to choose from—presuming, that is, the committee picks one at all.

All four projects are subject to Astro2020’s Technical Risk and Cost Evaluation (TRACE) process, a brand-new, behind-closed-doors checkup by the Aerospace Corporation on each STDT concept’s estimates. If the TRACE deems all four concepts far more expensive than the STDTs’ in-house estimates, the steering committee could opt to choose none. The New Great Observatories Astronomers have named the four likeliest outcomes of the Astro2020 deliberations.

€œScenario one, we call ‘the shit sandwich,’ which is if they recommend no flagships,” says one senior scientist. €œMost of us think that would be disastrous. The ‘shit sandwich with a side of pickle’ is when they choose no flagships but recommend technology development for whatever could come next—which is close to what happened with Astro2010.

The ‘nice lunch’ is what we get if they pick a true flagship. And the ‘perfect meal’ is their picking a flagship and setting priorities for technology development to enable a few more.” For now, most members of the STDTs are lining up for a “perfect meal.” Remarkably, after years spent extolling the virtues of their chosen missions, they have almost universally concluded that the ideal future for U.S. Astronomy in space is one in which none of their pet projects triumph over all but rather where multiple flagships are somehow built and launched in rapid succession.

Such an approach would effectively create a “New Great Observatories” program for the 21st century, much like the one that produced Hubble and its epochal kin. €œI’ve promised—and many of my colleagues have, too—that if the Decadal chooses any flagship, then that is what I’ll be cheering for,” O’Meara says. €œSomething like the New Great Observatories can only happen if we stop shooting into each other’s backyards.” Or rather the New Great Observatories can only happen if astronomers become more savvy at what Gaudi has termed “astropolitics.” “I’m utterly convinced a ‘New Great Observatories’ program with Lynx, Origins, and LUVOIR or HabEx—a ‘LuvEx,’ so to speak—could be done with a single phone call to the right person,” Tremblay says.

€œBecause on Capitol Hill, it’s not about total cost—it’s about annual appropriation. A couple hundred million dollars a year added to NASA’s astrophysics line would suffice.” Such hopeful speculations are not necessarily just wishful thinking. €œWe’re talking a 1 or 2 percent increase in real dollars to NASA’s budget to enable another Great Observatories program,” says one Beltway insider.

€œThese are the perturbations concerted advocacy can create. Only about 30 senators are really involved in appropriations, and the annual discretionary budget of the federal government is running at about $2 trillion. So divide $2 trillion by 30 and then factor in the staffers working for each of those senators.

You’ll find, perhaps to your horror, that anything much below about half a billion dollars a year is essentially left to staffers and lost in the margins.” Tremblay puts it more bluntly. €œNASA does not really work for the Executive Office of the President,” he says. €œIt works for the 25-year-olds a few years out of college who serve on appropriations committees.

A flagship mission—or a whole new series of Great Observatories—could be green-lit over lunch by some low-level staffer while they’re eating a burrito.” A Single Question To secure a multiflagship future, astronomers will likely need an overarching goal that resonates not only with professional scientists but also with policy makers and the general public they serve (burrito-munching congressional staffers included). And for that, arguably no topic has broader appeal than humankind’s long, unrequited search for alien life. €œIf the Decadal wants to get the most public buy-in, they should distill the next 30 years of U.S.

Astronomy down to a single question. How does the universe enable biology?. € O’Meara says.

€œThink about what’s needed to get answers for that. It’s not just going out and taking pictures of small, temperate exoplanets. You need to track the creation of atoms and molecules from the big bang all the way to planetary biosignatures, and you need to understand how galaxies and stars arise so that the universe could make planets in the first place.

You also need to understand where life can and cannot exist, which means deeper exploration of the solar system and probably even sending astronauts to Mars. Addressing that single, fundamental question could speak to all of NASA while bringing in the NSF and international partners as well.” “This is another reason to consider Astro2020 ‘special,’” Tumlinson says. €œFor the first time, we can say with a straight face that we’re conceptually designing missions with reasonable expectations of finding life on planets outside the solar system.

And to not do that when you have the opportunity to —well, that seems a little crazy to me.” Yet many astronomers are also uneasy about promising more than they might be able to deliver. €œThis mentality, that we all must be behind one big thing and that this one thing has to be so big to justify us all being behind it, is exactly how we’ve gotten into trouble before,” says Sara Seager, an astrophysicist at the Massachusetts Institute of Technology, who, alongside Gaudi, co-chaired the HabEx STDT. €œOf course looking for other Earths has public support!.

But if you put a dollar figure on it—if you tell the public it may cost a half-billion or a billion per planet, what do you think they’ll say then?. It just so happens that we live on a really hard planet to find—Earths are small and faint, and they’re right next to big, bright stars. That makes seeing them—or searching for signs of life on them—nearly impossible.” At least, that is the case if astronomers try to achieve those goals within existing budgets and a Decadal’s 10-year time frame.

€œFor us to decide on the future of astronomy based on some arbitrary length of time that just happens to be the number of fingers we have on our hands may not be the best way to go about things,” Gaudi says. €œMaybe we should decide on a different, longer timespan that actually corresponds to the missions we’re considering—missions that are getting more ambitious, complicated and technologically challenging over time. These really aren’t ‘Decadal’ surveys anymore, and they haven’t been for a while.

They’re multidecadal surveys, and we just need to start being honest about that.” After experiencing the process and its imperfections from within the National Academies, the White House and now the largest advocacy group for U.S. Astronomers, Parriott offers a simple recommendation of his own. €œWe need to support the Decadal, because it’s probably the best we can hope for in planning and executing a program of benefit to all of us,” he says.

€œYou know that old saying about democracy?. Well, maybe it applies to the Decadal, too. It’s the worst way to do things—except for all the other ways.”.

In this age of big science, with fundamental physics generally tested in sprawling laboratories such as CERN and LIGO, maverick individuals who make a big difference through their spot-on hunches are an increasingly rare buy lasix for horses breed. Those who did so in the past, therefore, have assumed an almost mythic quality. Their excellent guesses changed history buy lasix for horses in a way that would be much harder today because of the complexity of many areas of research, often requiring massive collaborations. It has been 20 years since the death, on August 20, 2001, of controversial British astrophysicist Fred Hoyle, an iconoclast who was known as much for his stubborn adherence to fringe beliefs as for his substantial contributions to science. Both the good and the bad in his career stemmed from the same source—a penchant for sweeping predictions based on seat-of-the-pants calculations and an intuitive sense of what must be the correct explanation according to nature’s rules.

Hoyle’s principal debate partner—from the media’s perspective at buy lasix for horses least—was Russian-Ukrainian-American physicist George Gamow. Gamow died in 1968, more than three decades before Hoyle, but their time together in the public spotlight, roughly from the early 1950s to the mid-1960s, was long enough that their battle of ideas became legendary. Their dispute concerned the origin of the universe and of the matter within it. While both agreed that space is expanding, Hoyle argued vociferously that buy lasix for horses it was infinitely old, with new matter slowly trickling into the empty space left by expansion, creating new stars and galaxies and filling the gaps over the eons. Therefore, in what he and co-creators Hermann Bondi and Thomas Gold called the “steady state universe” the cosmos essentially looks the same overall over time.

Gamow, on the other hand, believed that all matter was created in a hot, dense state, billions of years ago, when the observable universe was far smaller. During its initial fiery minutes, all buy lasix for horses of the chemical elements were forged, he believed. Along with his associates Ralph Alpher and Robert Herman, he tried to show how such a buildup might be feasible in a primordial cosmic cauldron. Dismissing the idea of a massive breach of conservation of matter and energy at the dawn of time, Hoyle derided such models (including a predecessor idea by Belgian mathematician and priest Georges Lemaître). On a BBC radio show buy lasix for horses in March 1949, he dubbed such a sudden genesis the “big bang”—a name that stuck.

Like Hoyle, Gamow often relied on his gut feelings to make scientific predictions. He had little patience for projects that required page after buy lasix for horses page of calculations and many years of effort. Thus, while their cosmological views were vastly dissimilar, their manner of conducting research had much in common. For example, in 1928, while visiting the University of Göttingen in Germany, Gamow learned about a dilemma physicists faced in explaining the process of alpha decay, when a heavy nucleus such as uranium suddenly expels an alpha particle (a cluster of two protons and two neutrons). Clearly, the alpha particle crosses a kind of energetic barrier that normally prohibited buy lasix for horses passage, but how?.

Intuitively, the conundrum reminded him of a situation in quantum mechanics in which electrons had a finite chance of tunneling through a classically forbidden region. Gamow performed a quick calculation using quantum rules and solved the alpha decay problem overnight, sharing his results with Hungarian physicist Eugene Wigner the next day. Later, Gamow learned that Princeton physicists Ronald Gurney and Edward Condon had buy lasix for horses independently developed a similar solution. Nuclear physics progressed immensely after that breakthrough. Gamow’s formula also made predictions for collisions between individual nucleons (protons and neutrons), essential for understanding how a cycle of fusion transforms hydrogen into helium in the cores of vibrant stars, generating heat and light in the process.

The buildup of chemical elements has a bottleneck, buy lasix for horses however, which took the insights of Hoyle to help unravel. Nature does not provide a simple way of creating the isotope carbon-12 and the elements above it. Big bang nucleosynthesis—the scheme developed by Gamow, Alpher and Herman to explain how the elements were forged—does not maintain a high enough temperature for a long enough time to overcome the instability of beryllium-8, one of the rungs on the ladder to reach carbon-12. Beryllium-8 decays extremely rapidly, offering it only a minuscule chance of combining with helium-4 to make carbon-12 (mathematically, the simplest way of creating that isotope), unless conditions buy lasix for horses were far more favorable than the big bang could furnish. Because he didn’t support the big bang, Hoyle didn’t believe that the chemical elements (aside perhaps from helium) were forged in the early universe.

Rather, in 1946 he brilliantly concocted an alternative buy lasix for horses method. As stars exhaust their primary source of fuel—transforming hydrogen into helium via fusion processes—their cores contract and become hotter and hotter. Such immense temperatures offer the perfect environment for element creation. Moreover, the sudden contraction buy lasix for horses at the end of a star’s lifetime is—if it is sufficiently massive—accompanied by a supernova explosion that spews the forged elements into space. In short, Hoyle’s scheme cleverly explained both the concoction and the distribution of the elements we see on Earth.

Another of Hoyle’s phenomenal insights explained how the beryllium-8 bottleneck could be overcome. He speculated that carbon-12 buy lasix for horses possessed a quantum energy level that matched up well with that of beryllium-8 combined with helium-4, making transformations at extremely high temperatures likely enough that they could happen in contracting cores. When a team of experimentalists at Caltech’s Kellogg Radiation Laboratory verified that such a carbon-12 excited state existed in nature, Hoyle’s hunch was splendidly confirmed. The downside of the intuitive approach taken by both Hoyle and Gamow is that mere speculation might land way off the mark. In Hoyle’s case, he enjoyed intellectual fencing matches and didn’t mind if others strongly disagreed with his conjectures, as long as they remained open to buy lasix for horses debate.

Hence, he clung to variations of the steady state model long after substantial evidence, starting with the discovery in the mid-1960s of a faint afterglow of radiation that permeates the universe, pointed to a hot big bang. Moreover, in his final decades of buy lasix for horses life, he published numerous books and articles advancing fringe opinions in fields well outside his specialty. For example, he proposed that many illnesses on Earth were extraterrestrial in origin, and that a famous, well-established fossil in a London museum was a fake—without supplying credible proof of either view. Gamow did not go out on a limb in the same way. However, he often bombarded his colleagues, such as Edward Teller during their time together in the late 1930s buy lasix for horses at George Washington University, with a succession of speculative notions, most of which never went anywhere.

In short, the same kind of intuitive approach that led Hoyle and Gamow each to suggest proposals that advanced scientific understanding also steered them toward many hunches that went nowhere. Hoyle, much more so that Gamow, was known to cling to such ideas far too long. Gamow would simply buy lasix for horses move on to other subjects and schemes. Today, with many scientific enterprises much larger and far more cautious, the role of such iconoclasts is greatly diminished. Still, we might toast the boldness of mavericks in the past, such as Hoyle and Gamow, for the leaps of progress that ensued.

This is an opinion and analysis article, and the views expressed by the author or authors are buy lasix for horses not necessarily those of Scientific American.More than half the world relies on rice as a primary food source. Yet the essential crop faces an worrisome future as global warming cranks up the Earth’s temperature and intensifies storms, droughts and heat waves. It’s hard to overstate the danger of this development, scientists say. Rice is buy lasix for horses vulnerable to climate extremes and grows in places already experiencing many. Any disruption to that food source can cause massive problems.

Just look at recent buy lasix for horses history. In 2008, fears over rice supplies magnified a food crisis that sent prices soaring. The ensuing panic sparked riots across the globe, from Bangladesh to Egypt to Haiti. That was 13 years ago, buy lasix for horses when there were about 1 billion fewer people on the planet. In another 13 years, the world’s population is expected to boom by another 1 billion, bringing the total to a projected 8.8 billion people.

And all the while the world’s climate will keep changing. €œAt a time when we’re going to add a couple more billion people to the population in the most vulnerable areas, it’s really buy lasix for horses a bit of a wake-up call,” said Louis Verchot, head of the land restoration group at the International Center for Tropical Agriculture. €œWe’re going to need to really rethink how we organize our food systems.” Research underscores this concern. The latest report from the Intergovernmental Panel on Climate Change—which brought together 234 scientists to synthesize recent climate studies—warned that human-caused global warming is happening at an unprecedented pace and is driving the deadly floods, heat and droughts we’re already witnessing (Climatewire, Aug. 9).

And those events pose major risks to farming. €œHigher temperatures lead to increased evaporation, resulting in soil drying, increased plant stress and impacts on agriculture, even in regions where large changes in precipitation are not expected,” the report states. If greenhouse gas emissions are not reduced, about a third of global land areas are projected to suffer from at least moderate drought by the end of the century, it concludes. Some changes like sea-level rise are already locked in. Rice is especially susceptible to these changes.

Rice often grows in ecosystems, such as deltas, that have low elevation and are vulnerable to rising seas. It also grows in areas that already experience extreme heat. Any additional temperature increase could push it past thresholds in which a healthy crop can develop, scientists say. A 2018 study in the Archives of Agronomy and Soil Science found that an increase in the frequency and severity of hot weather could reduce rice yields by up to 40% by the end of this century. €œMost of the [world’s] rice is currently grown in regions where existing temperature is already close to the optimum range for rice production,” the study states.

€œTherefore, any further rise in mean temperature or short episode of high temperature during sensitive growth stages, will be catastrophic.” While rice can grow in temperatures that reach 40 degrees Celsius (104 degrees Fahrenheit), heat stress can impair the ability of its flowers to pollinate, the study noted. Temperatures above 35 C can significantly decrease yields. High nighttime temperatures also can impact productivity. One study found that each 1 C increase in night temperatures above 35 C leads to around a 10% decline in rice yields. It’s not just heat.

The increased potential for flooding and drought also threaten production. So will rising seas that can inundate low-lying farmland with salt water. A paper by the International Rice Research Institute said rice was expected to be “the cultivated crop most vulnerable to future changing climates.” U.S. Rice growers feel the heat The risk to rice matters in a world where food systems are increasingly interconnected. €œOne of the particularities of rice is that the market is very thin in that there isn’t a lot of excess potential supply for demand,” said Tim Benton, research director for emerging market risks at Chatham House.

€œSo if you have a failure in any one place, it does tend to radically affect the international price.” The United States, for example, has a small but important role in the global supply chain. U.S. Farmers only produce about 2% of global rice supplies. But they ship more than 6% of global exports, according to the U.S. Department of Agriculture.

Those U.S. Farmers are based almost exclusively in six states. Arkansas, California, Louisiana, Mississippi, Missouri and Texas. And they already are experiencing the impacts of extreme weather. U.S.

Rice growers sent a letter to Congress last month asking for disaster assistance following a year of severe storms, floods and drought, according to USA Rice, which advocates for rice producers in the major rice-producing states. The problem has been magnified of late in California, where rice grows mostly in the Sacramento Valley. Due to multiple years of low rainfall and snowpack, the state this year is expected to grow 100,000 fewer acres of rice, Tim Johnson, the head of the California Rice Commission, said in a report from the local CBS station. The impacts run deep In some drought-prone, rice-growing areas, productivity may fall even during favorable years. That's because farmers who fear crop loss may avoid putting money into things such as fertilizer and new seeds that would help boost yields, research from the International Rice Research Institute shows.

And if yields drop and income is lost, farming families may relocate or send some members to find work elsewhere, said Amanda Carrico, a professor in the environmental studies program at the University of Colorado, Boulder. That's one of several problems that loom for countries that rely on rice. Population booms compounded by climate change impacts and land conversion—particularly in rice-growing regions of Asia—could add challenges for countries to remain self-sufficient in food production. €œIt’s a whole livelihood, it’s a cultural crop, you have religion involved, you have beliefs, stories. Life in Asia, and Southeast Asia in particular, has evolved around rice,” said Bjoern Ole Sander, a senior scientist and climate change lead at the International Rice Research Institute, which is based in the Philippines.

A recent study led by researchers at Cornell University found that global agricultural productivity has slowed about 21% in the last 60 years due to climate change, with the effects more pronounced in warmer, tropical areas. Part of that, the study discovered, was because agriculture wasn’t adjusting to new climate extremes, which made them worse over time. €œYou don’t have to be a rocket scientist to know that the projections are for higher temperatures,” said Ariel Ortiz-Bobea, an associate professor at Cornell’s school of applied economics and management. €œSo it’s pointing to an increasing slowdown of productivity growth, and that has a whole range of implications.” His team at Cornell is planning to study how much investment in research and development is needed to either maintain or counteract the effects of climate change. One goal is to develop a strategy that doesn’t depend solely on using more fertilizer or expanding the land area in production.

€œIf we don’t grow productivity, then you’ll make up the production deficit through more inputs, and that has irreversible consequences on the environment,” said Ortiz-Bobea. Plant early, reduce water, develop new seeds Rice production has increased greatly since the Green Revolution of the 1960s transformed global agriculture and brought higher-yielding varieties, new methods of cultivation and mechanization. Global rice production is forecast to hit a record 506 million tons for 2021-2022, according to the Agriculture Department’s latest rice outlook. It forecasts global consumption at a record 514 million tons. Climate change could roll back some of those gains, especially if it leads to more deforestation or loss of wetlands, a buffer against sea-level rise and a natural sink for carbon dioxide.

€œThere’s this whole transformation in landscapes that’s going to really put the whole human-economic enterprise at risk. It’s going to roll back gains that we’ve made in the past 40 years in many places, and it’s going to increase the vulnerability of the poorest,” said Verchot from the International Center for Tropical Agriculture. To avoid these problems, researchers are working to make food systems more resilient. That includes decarbonizing irrigation systems and developing stress-tolerant rice varieties that can withstand high temperatures or flooding. The International Rice Research Institute has around 150,000 rice varieties in its seed bank, Sander said.

But most are not being grown or reaching production scale. Countries also have their own rice research programs and are constantly breeding new varieties, he added. One goal is to develop seed varieties that have a higher tolerance to drought or heat or can survive submergence in areas that are expected to see even more precipitation. There is also growing recognition of more traditional varieties, which have a strong resistance to salt water and lack of water. Better farm management can help, too.

Rice uses a lot of fresh water, but scientists have found it can grow with half the typical amount. That means farmers can apply water-saving techniques in areas where drought is projected to increase. Methane an issue for rice growers Improved farming techniques also can cut emissions of methane, a potent planet-warming gas. Rice is the second-largest source of methane from agriculture after livestock. In Vietnam, a major rice producer, it accounts for 15% of the country’s total emissions.

Studies have found that alternate wetting and drying of rice paddies can halve emissions and save up to 30% of the water needed for irrigation. Planting at different times also helps. That’s what the International Rice Research Institute worked with farmers to do in the Mekong Delta following the 2016 drought. That year, several hundred thousand hectares of rice saw reduced yields in part because of salt water pushing into freshwater supplies used for irrigation, Sander said. In its aftermath, the International Rice Research Institute promoted a new approach.

Plant rice a few weeks earlier so it wouldn’t be at its most vulnerable stage of growth when salt water started to inundate the fields. Not every solution will be as easy. Extreme and compound events—such as successive flooding and drought or drought exacerbated by heat stress—will be harder to overcome. As those disasters become more frequent, scientists expect to see more yield declines more often. It's one of many reasons scientists say the world needs to focus on rice as the Earth heats up.

€œRice has such a high carbon footprint, but the investments are still relatively low,” Sander said. €œIt is definitely a crop that deserves more attention.” Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals.Ask astronomers what question they most want to answer, and you will get scattered responses. How did the first stars, galaxies and black holes form?.

What is the nature of dark matter and dark energy?. Are we alone?. Each question demands its own large telescope. No ultimate, one-size-fits-all instrument will ever exist, for none can be made to gather each and every kind of cosmic light. Black holes sometimes shine in x-rays, for instance, whereas Earth-like exoplanets are best studied in optical and infrared light.

Yet such projects so strain the fraction of public and private funds allocated to astronomy that only a few—perhaps just one—can be prioritized at a time, leading to pileups of also-ran proposals and anxious researchers awaiting a rare chance to open new windows on the universe. In the U.S., astronomers have managed these competing ambitions by devising a process that has become the envy of the scientific world. The Astronomy and Astrophysics Decadal Survey, a once-in-10-years exercise that recommends and ranks the community’s priorities for the next decade—embodied, eventually, by major new federally-sponsored observatories on the ground and in space. Projects such as NASA’s Hubble Space Telescope owe their existence, in part, to coveted endorsements from Decadals of yore, and the practice has spread to several other disciplines that now undertake Decadal Surveys of their own. Organized by the National Academies of Sciences, Engineering, and Medicine, six Decadal Surveys have set the course of U.S.

Astronomy since they began in the 1960s. The results of the seventh, dubbed Astro2020, will soon be announced after two years of exhaustive deliberations led by a 20-member steering committee. And just like its predecessors, Astro2020 will reveal where major new investments and discoveries are most likely to be made—and where neglect, disinterest or even fear may block progress for generations to come. The Astro2020 steering committee, panel chairs, and study staff. The steering committee co-chairs, astronomers Robert Kennicutt and Fiona Harrison, appear 14th and 16th from left, respectively.

Credit. National Academies of Sciences, Engineering and Medicine Few people know the power of these surveys better than Joel Parriott. More than 20 years ago, he got his start in federal politics as a staffer at the National Academies, where his initial assignment was to assist the scientists crafting the first astronomy Decadal of the new millennium. Then he served a 10-year stint in the White House Office of Management and Budget (OMB), where he weighed and implemented Decadal recommendations for federal science agencies. Today he is director of public policy at the American Astronomical Society, the leading advocacy group for U.S.

Stargazers. At the OMB, where the nation’s policy objectives often brutally intersect with its fiscal realities, the Decadal Survey offered Parriott and his colleagues a foolproof way of dismissing overly solicitous astronomers. €œIf a project wasn’t highly ranked, we knew it didn’t have the community’s endorsement,” he says. €œThat’s really helpful for folks on Capitol Hill and in the White House who need to make hard choices.” For more than a few astronomers, a drab name like “the Decadal” does not properly capture a process that holds such sway over their destiny. Instead they sometimes just call it “the voice of God.” In coming weeks, when Astro2020’s final report is released, that voice—that supposedly communal voice—will once again speak.

Yet outside of a chosen few, sworn to secrecy, no one in the community knows in advance what it will say. Everyone, though, agrees Astro2020’s conclusions arrive at a time of peril. €œWe are right now on a knife-edge,” says John O’Meara, chief scientist of the W. M. Keck Observatory on Mauna Kea in Hawaii.

€œI do believe this Decadal is existential for astronomy in the United States. When you consider the facilities and the science topics that are under discussion, it will influence whether or not we become a second-place player in global astronomy…. When the [federal] agencies and Congress receive the Decadal report, they will hold in their hands the decision of whether or not we wish to have leadership in this field of science.” U.S. Telescopes in Twilight From the outside looking in, one would not realize the enterprise of U.S. Astronomy is teetering on the edge of crisis.

Several new ground-based telescopes have recently come online, each bringing a bumper crop of celestial discoveries—and even more ambitious projects are waiting in the wings. Consider the Vera C. Rubin Observatory, a high-ranked priority of the past two Decadals (which are naturally called Astro2000 and Astro2010). Sited on a mountain in Chile, the Rubin Observatory should begin operations in late 2023 to generate a high-definition, decade-spanning time-lapse movie of the entire overhead sky. But among large upcoming U.S.

Projects, Rubin is a rare, healthy exception. The other highest-profile ground-based recommendation from Astro2000 and Astro2010—building an optical extremely large telescope (ELT) with a mirror circa 30 meters in size—remains in limbo. One selling point for ELTs, among many, is that they offer the best hopes of ever studying Earth-like exoplanets from the ground. Astro2020 will probably decide if the U.S. ELT efforts sink or swim—or if other projects, such as a “next generation” upgrade to the nation’s Very Large Array of radio telescopes or expansions of gravitational-wave observatories, take priority.

Activists blockade the road to the summit of Mauna Kea in this photo from July 2019, seeking to halt construction of the Thirty Meter Telescope on the sacred Hawaiian volcano. Credit. Ronit Fahl/ZUMA Wire/Alamy Live News In the quest for an ELT, the U.S. Has managed to produce two competing projects, the Thirty Meter Telescope (TMT) and the Giant Magellan Telescope (GMT). Both are short on funding, and neither appears likely to begin operations before the decade is out, each having served to stifle the other.

And the TMT’s early stages of construction on the Hawaiian volcano Mauna Kea—a site unrivaled for pristine views of the Northern Hemisphere sky—sparked protests from activists who see telescopes there as an occupying affront to the mountain, which Native Hawaiians hold sacred. Construction on the TMT ceased after protesters repeatedly blocked the road to the mountaintop. The conflict remains at an impasse. €œIf [Astro2020] says, ‘Forget the ELTs. Let’s prioritize something else instead,’ then it’s quite possible that both the TMT and the GMT will die,” says a senior ground-based astronomer familiar with the situation.

Europe, in contrast, took the lead over the U.S. In ground-based optical astronomy years ago and is well into construction of an ELT of its own in Chile. The European Extremely Large Telescope boasts a 40-meter mirror—and it is projected to come online in 2027. China is surging ahead as well. For evidence, look no further than the U.S.’s iconic, National Science Foundation–funded Arecibo radio telescope in Puerto Rico.

Once the world’s largest, the radio telescope catastrophically collapsed last year in part because of budgetary neglect—but not before China’s Five-Hundred-Meter Aperture Spherical Radio Telescope (FAST) had superseded it in size. And together—without the U.S.—Europe, China and many other international partners are building the Square Kilometer Array (SKA), a breathtakingly powerful collection of thousands of radio telescopes that is set to become fully operational at sites in Australia and South Africa as early as 2030. The Hungry Giant and Frankenstein’s Monster The outlook is similarly mixed for the nation’s space-based astronomy. For now, the U.S. Remains at the forefront of off-world observing, but of the four “Great Observatories” NASA launched between 1990 and 2003, only Hubble and the Chandra X-ray Observatory are still operational, and both are nearing their end, with no replacement on the horizon.

€œHubble is probably not going to last another decade, and maybe we’ll get five more years out of Chandra. But then that’s it—they’re gone,” says Jason Tumlinson, an astronomer heading the community missions office at the Space Telescope Science Institute. €œWe’ll probably have a long gap with no real optical, uaviolet or x-ray capability in space. And now is the time to decide how and when we might get it back.” Technicians examine the 6.5-meter segmented primary mirror and deployable sunshield of the James Webb Space Telescope, NASA’s $10 billion “flagship” observatory which is scheduled to launch in November 2021. Credit.

Chris Gunn NASA Astro2000’s top-ranked space project, NASA’s flagship-class James Webb Space Telescope, is a technological marvel. A cryogenically cooled infrared observatory with a segmented, 6.5-meter starlight-gathering mirror that folds, origamilike, to fit in a rocket. Early on Webb was projected to cost about $1.5 billion and to launch perhaps in 2011 to study the emergence of stars and galaxies in the early universe. Today those projections seem hopelessly naive. After a staggering number of cost overruns and delays that hobbled planning for other projects, the current best-case scenario is that the telescope will reach space no sooner than this mid-November, operating for just a decade with a total project cost of about $10 billion.

Less optimal scenarios, of which there are many, are almost too grim to contemplate. €œWe can’t do science at this scale without taking risks—and I’m confident in our chances of success—but if Webb fails, it will be an unmitigated disaster,” says Matt Mountain, the project’s telescope scientist and president of the Association of Universities for Research in Astronomy. €œIt has to work. Because if it doesn’t, we aren’t going to do another ambitious flagship for, I would guess, two decades.” If Webb was a hungry giant unleashed by Astro2000 and its antecedents biting off more than could be chewed, then the top flagship recommendation of Astro2010, NASA’s Nancy Grace Roman Space Telescope, was a different beast entirely—a cut-rate Frankenstein’s monster the Decadal committee pieced together from the dismembered remains of multiple competing mission concepts. The committee had hoped to avoid another Webb-style debacle with Roman (initially named the Wide-Field Infrared Survey Telescope, or WFIRST)—and it did.

But instead Roman’s very existence threatened to tear the community apart from within. €œDo you know what WFIRST really stood for, for most of us?. € says one leading astronomer. €œIt stood for ‘What the fuck is this ridiculous space telescope?. €™â€ Originally envisioned to study dark energy with a barebones instrument package and a mirror scarcely half the size of Hubble’s, Roman was projected to launch as early as 2020 on a relatively slim budget of less than $2 billion.

To many expert eyes, such a project barely qualified for its supposed “flagship” status. NASA, with bipartisan congressional blessings, ultimately added more instruments and upgraded Roman’s mirror to the same size as Hubble’s, enhancing its science objectives and assuaging many criticisms—but also nearly doubling its estimated price tag and delaying its launch to no earlier than 2025. Meanwhile Europe and China have each proceeded with dark energy-focused space telescopes of their own, potentially scooping some of the promised scientific discoveries used to justify Roman’s existence in the first place. The 2.4-meter primary mirror of NASA’s Nancy Grace Roman Space Telescope, the next flagship observatory to fly after Webb. Credit.

L3Harris Technologies, Inc. Although both Webb and Roman may each eventually succeed beyond astronomers’ wildest imaginings, some fear the projects’ greatest initial impact on the field will be to sharply curtail Astro2020’s ability to plan for a prosperous future. €œThis is, I think, the first Decadal where both of the top space-based recommendations from the previous two Decadals—Webb and Roman—were still on the ground,” Tumlinson says. €œAnd if the Astro2020 committee were to say, ‘We’ve got two flagships stacked up. The queue is too long.

Let’s just pause for a while and do some smaller missions and catch up later,’ that would be a mistake. The idea that you can just take a decade off from ambitious things to come back and do them later is not valid when you consider how our government actually works.” Most astronomers, Tumlinson says, seem to misunderstand what the Decadal’s “governing dynamic” actually is. €œA Decadal report is the beginning of a multiparty, multiyear negotiation between the scientific community, NASA, the aerospace contractors, Congress and the White House,” he explains—which is why aiming high at the outset is in astronomers’ best interest. €œI would hope, with Astro2020, we temper our natural desire to mitigate risk and cut costs,” Tumlinson says, “because all the other forces in this system will be doing that for us anyway.” Whether because of the hypertension medications lasix, soaring deficit spending or the increasingly dire global climate emergency, some might question the wisdom of U.S. Astronomers reaching for the stars just as the sky seems set to fall.

Then again, the reply comes, where is the wisdom in limiting the science of the 2040s or 2050s based on the troubles of the 2020s?. “At the end of the day, appropriators are still going to spend money,” says a former congressional staffer who dealt with high-level appropriations for federal science agencies. €œThey’re going to get an allocation, and their job will be to use it wisely. If it doesn’t go to astronomy, maybe it will go to a new flagship mission for NASA’s planetary science division instead—or maybe it will go to a new FBI building. But that money will be spent, regardless of what astronomers do.” The Main Menu Responding to the woes from Webb and Roman, years ago NASA began revamping its approach to future flagships, demanding greater certainty about technological challenges and costs.

In 2016 the agency assembled four Science and Technology Definition Teams (STDTs), each examining a separate mission concept for Astro2020’s consideration. Two of the four concepts—the Large Uaviolet Optical Infrared Surveyor (LUVOIR) and the Habitable Exoplanet Observatory (HabEx)—would focus on the quest to learn more about planets orbiting other stars, with an emphasis on studying potentially habitable worlds. A third, the uacold and far-infrared Origins Space Telescope, would also perform some exoplanet studies as part of a broader investigation of the formation of galaxies, stars and planetary systems. The fourth concept, the Lynx X-ray Observatory, would be the most powerful x-ray astronomy facility ever built, offering intimate views of black holes, active galaxies and violent supernovae across cosmic time. Each project has profound potential—but also one or more Achilles’ heels to make astronomers antsy.

LUVOIR’s strength—and weakness—has always been the enormity of its segmented mirror. If deployed and maintained with picometer-degree stability (which is very hard), this mirror would allow astronomers to discover and study hundreds of exoplanets while also performing revolutionary observations across a wide swath of general astrophysics. Assuming any true-blue Earth-like worlds exist around the sun’s neighboring stars, LUVOIR should offer the best odds of finding them. But whether considering either a 15-meter “deluxe model” or an eight-meter “budget size” one, putting such a demanding deployable mirror into space translates to an astronomical cost. €œWhen I started working on this, I closed my eyes and said, ‘It’s gonna be $1 billion a meter.

But if LUVOIR realizes its vision, that would be a bargain,” says O’Meara, one of the leaders of the this mission concept’s STDT. Estimates from two separate groups at NASA’s Goddard Space Flight Center have arrived at slightly higher figures, placing a deluxe LUVOIR somewhere in the realm of $15 billion or $20 billion and finding the budget version between about $12 billion or $15 billion. [embedded content] A time-accelerated visualization of the deployment of the 15-meter LUVOIR mission in space. Thanks to its smaller four-meter mirror, HabEx would be cheaper than either version of LUVOIR, with an estimated cost approaching $10 billion. But it would yield far fewer exoplanets—delivering details on perhaps 10 potential exo-Earths rather than dozens.

It represents an all-in bet on a novel technology. A secondary sunflower-shaped spacecraft called a “starshade” that would unfurl to more than 50 meters across and fly more than 75,000 kilometers in front of the four-meter mirror to blot out a target star’s light, revealing comparatively dimmer accompanying worlds. €œThe starshade concept, although potentially very powerful, scares a lot of people for whom it is a relatively new idea,” says Scott Gaudi, an astronomer at the Ohio State University, who co-chaired the HabEx STDT. Yet he maintains that scientists have a realistic plan for managing risks and developing the starshade on budget. [embedded content] A narrated overview of the HabEx mission.

Origins is, in most respects, the “safe” choice. It features a large but nonsegmented mirror of nearly six meters and is based mostly on preexisting technologies, netting a cost estimate of around $7 billion. Chilled to less than five kelvins above absolute zero, the telescope would offer a 1,000-fold increase in far-infrared sensitivity over previous missions, allowing astronomers to map the inner workings of galaxies across the observable universe while also studying a handful of small exoplanets as well as water in protoplanetary disks around nearby stars. But Origins’ tried-and-true approach makes it relatively bland. It would not answer the burning questions about Earth-like worlds that LUVOIR or HabEx might.

Its infrared optics would not deliver the crisp, colorful images of Hubble. And a top ranking from Astro2020 would make it, after Webb and Roman, the third infrared flagship in a row recommended to NASA. Some might call Origins a space telescope only an astronomer could love. €œWe have a real PR problem in the infrared,” says Cara Battersby, an astronomer at the University of Connecticut, who served on the Origins STDT. €œBut if you look at the specs of each [STDT] concept and the science questions they have in common, such as planets and the coevolution of black holes with galaxies, I challenge you to not conclude that Origins is the most well-rounded and safest of them all.” [embedded content] A time-accelerated visualization of the deployment of the Origins Space Telescope.

Lynx is the oddball of the four, with a projected price tag slightly shy of that of Origins but a radically different design and goal. Its “mirror” would be a first-of-its-kind three-meter-wide assembly of nearly 460 nested shells of polished silicon, all densely packed and angled to reflect and focus high-energy x-rays. That design would provide far better performance than Chandra or other earlier x-ray telescopes, allowing Lynx to unveil new details of the universe’s oldest and biggest black holes. Some astronomers fret about potential budget-busting difficulties in making Lynx’s exotic mirror, but most instead worry about duplicating the efforts of a similar, already approved project. The European Space Agency’s Advanced Telescope for High-Energy Astrophysics (Athena), which is set to launch in 2031.

€œFor many people, the existence of Athena is an insurmountable argument against Lynx,” says Grant Tremblay, an astronomer and a contributor to the Lynx STDT at the Center for Astrophysics at Harvard University and the Smithsonian Institution. €œBut I sincerely believe there is a very compelling argument for why these two missions are scientifically complementary to each other.” [embedded content] A visualization of the Lynx X-ray Observatory detailing its major components. Collectively, these four STDT concepts make up the main menu of flagship options that the Astro2020 steering committee is most likely to choose from—presuming, that is, the committee picks one at all. All four projects are subject to Astro2020’s Technical Risk and Cost Evaluation (TRACE) process, a brand-new, behind-closed-doors checkup by the Aerospace Corporation on each STDT concept’s estimates. If the TRACE deems all four concepts far more expensive than the STDTs’ in-house estimates, the steering committee could opt to choose none.

The New Great Observatories Astronomers have named the four likeliest outcomes of the Astro2020 deliberations. €œScenario one, we call ‘the shit sandwich,’ which is if they recommend no flagships,” says one senior scientist. €œMost of us think that would be disastrous. The ‘shit sandwich with a side of pickle’ is when they choose no flagships but recommend technology development for whatever could come next—which is close to what happened with Astro2010. The ‘nice lunch’ is what we get if they pick a true flagship.

And the ‘perfect meal’ is their picking a flagship and setting priorities for technology development to enable a few more.” For now, most members of the STDTs are lining up for a “perfect meal.” Remarkably, after years spent extolling the virtues of their chosen missions, they have almost universally concluded that the ideal future for U.S. Astronomy in space is one in which none of their pet projects triumph over all but rather where multiple flagships are somehow built and launched in rapid succession. Such an approach would effectively create a “New Great Observatories” program for the 21st century, much like the one that produced Hubble and its epochal kin. €œI’ve promised—and many of my colleagues have, too—that if the Decadal chooses any flagship, then that is what I’ll be cheering for,” O’Meara says. €œSomething like the New Great Observatories can only happen if we stop shooting into each other’s backyards.” Or rather the New Great Observatories can only happen if astronomers become more savvy at what Gaudi has termed “astropolitics.” “I’m utterly convinced a ‘New Great Observatories’ program with Lynx, Origins, and LUVOIR or HabEx—a ‘LuvEx,’ so to speak—could be done with a single phone call to the right person,” Tremblay says.

€œBecause on Capitol Hill, it’s not about total cost—it’s about annual appropriation. A couple hundred million dollars a year added to NASA’s astrophysics line would suffice.” Such hopeful speculations are not necessarily just wishful thinking. €œWe’re talking a 1 or 2 percent increase in real dollars to NASA’s budget to enable another Great Observatories program,” says one Beltway insider. €œThese are the perturbations concerted advocacy can create. Only about 30 senators are really involved in appropriations, and the annual discretionary budget of the federal government is running at about $2 trillion.

So divide $2 trillion by 30 and then factor in the staffers working for each of those senators. You’ll find, perhaps to your horror, that anything much below about half a billion dollars a year is essentially left to staffers and lost in the margins.” Tremblay puts it more bluntly. €œNASA does not really work for the Executive Office of the President,” he says. €œIt works for the 25-year-olds a few years out of college who serve on appropriations committees. A flagship mission—or a whole new series of Great Observatories—could be green-lit over lunch by some low-level staffer while they’re eating a burrito.” A Single Question To secure a multiflagship future, astronomers will likely need an overarching goal that resonates not only with professional scientists but also with policy makers and the general public they serve (burrito-munching congressional staffers included).

And for that, arguably no topic has broader appeal than humankind’s long, unrequited search for alien life. €œIf the Decadal wants to get the most public buy-in, they should distill the next 30 years of U.S. Astronomy down to a single question. How does the universe enable biology?. € O’Meara says.

€œThink about what’s needed to get answers for that. It’s not just going out and taking pictures of small, temperate exoplanets. You need to track the creation of atoms and molecules from the big bang all the way to planetary biosignatures, and you need to understand how galaxies and stars arise so that the universe could make planets in the first place. You also need to understand where life can and cannot exist, which means deeper exploration of the solar system and probably even sending astronauts to Mars. Addressing that single, fundamental question could speak to all of NASA while bringing in the NSF and international partners as well.” “This is another reason to consider Astro2020 ‘special,’” Tumlinson says.

€œFor the first time, we can say with a straight face that we’re conceptually designing missions with reasonable expectations of finding life on planets outside the solar system. And to not do that when you have the opportunity to —well, that seems a little crazy to me.” Yet many astronomers are also uneasy about promising more than they might be able to deliver. €œThis mentality, that we all must be behind one big thing and that this one thing has to be so big to justify us all being behind it, is exactly how we’ve gotten into trouble before,” says Sara Seager, an astrophysicist at the Massachusetts Institute of Technology, who, alongside Gaudi, co-chaired the HabEx STDT. €œOf course looking for other Earths has public support!. But if you put a dollar figure on it—if you tell the public it may cost a half-billion or a billion per planet, what do you think they’ll say then?.

It just so happens that we live on a really hard planet to find—Earths are small and faint, and they’re right next to big, bright stars. That makes seeing them—or searching for signs of life on them—nearly impossible.” At least, that is the case if astronomers try to achieve those goals within existing budgets and a Decadal’s 10-year time frame. €œFor us to decide on the future of astronomy based on some arbitrary length of time that just happens to be the number of fingers we have on our hands may not be the best way to go about things,” Gaudi says. €œMaybe we should decide on a different, longer timespan that actually corresponds to the missions we’re considering—missions that are getting more ambitious, complicated and technologically challenging over time. These really aren’t ‘Decadal’ surveys anymore, and they haven’t been for a while.

They’re multidecadal surveys, and we just need to start being honest about that.” After experiencing the process and its imperfections from within the National Academies, the White House and now the largest advocacy group for U.S. Astronomers, Parriott offers a simple recommendation of his own. €œWe need to support the Decadal, because it’s probably the best we can hope for in planning and executing a program of benefit to all of us,” he says. €œYou know that old saying about democracy?. Well, maybe it applies to the Decadal, too.

It’s the worst way to do things—except for all the other ways.”.

What should I tell my health care provider before I take Lasix?

They need to know if you have any of these conditions:

• abnormal blood electrolytes
• diarrhea or vomiting
• gout
• heart disease
• kidney disease, small amounts of urine, or difficulty passing urine
• liver disease
• an unusual or allergic reaction to furosemide, sulfa drugs, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

Lasix medication horses

Some lasix medication horses people are not eligible for an MSP check my blog even though they have full Medicaid with no spend down. This is because they are in a special Medicaid eligibility category -- discussed below -- with Medicaid income limits that are actually HIGHER than the MSP income limits. MIPP reimburses them for their Part B premium because they have “full Medicaid” (no spend down) but are ineligible for MSP because their income is above the MSP SLIMB level (120% of the Federal Poverty Level (FPL). Even if their income is under the QI-1 lasix medication horses MSP level (135% FPL), someone cannot have both QI-1 and Medicaid).

Instead, these consumers can have their Part B premium reimbursed through the MIPP program. In this article. The MIPP program was established because the State determined that those lasix medication horses who have full Medicaid and Medicare Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7). There are generally four groups of dual-eligible consumers that are eligible for MIPP.

Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down. Those consumers can qualify for MIPP and have their Part B premiums reimbursed lasix medication horses. Here is an example. Sam is age 50 and has Medicare and MBI-WPD.

She gets $1500/mo gross from Social Security Disability and also makes $400/month through work lasix medication horses activity. $ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies. $400 - $65 = $335. Her countable lasix medication horses earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability = $1,667.50 --TOTAL income.

This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP. 2. Parent/Caretaker lasix medication horses Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries. Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time.

This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher lasix medication horses or lower than 120% of the FPL. If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income is above 120% FPL, then they can enroll in MIPP.

(See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, lasix medication horses #4) 3. New Medicare Enrollees who are Not Yet in a Medicare Savings Program When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP. However, the transition time can vary based lasix medication horses on age.

AGE 65+ For those who enroll in Medicare at age 65+, the Medicaid case takes about four months to be rebudgeted and approved by the LDSS. The consumer is entitled to MIPP payments for at least three months during the transition. Once the case lasix medication horses is with the LDSS she should automatically be re-evaluated for MSP. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd.

4(c). These consumers should receive MIPP payments for as long as their cases remain with lasix medication horses NYSoH and throughout the transition to the LDSS. NOTE during hypertension medications emergency their case may remain with NYSoH for more than 12 months. See here.

See GIS 18 MA/001 - lasix medication horses 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. Note. During the hypertension medications emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should keep the same lasix medication horses MAGI budgeting and automatically receive MIPP payments.

See GIS 20 MA/04 or this article on hypertension medications eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC). Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase lasix medication horses in the amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit.

If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN. See this lasix medication horses article. Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums.

See page 96 of the Medicaid Reference Guide (Categorical lasix medication horses Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP. If higher than the threshold, they can be reimbursed via MIPP. See lasix medication horses also 95-ADM-11.

Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle &. 1619B. 5.

When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit. The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021). They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019.

Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check. In contrast, MSP enrollees are not charged for their premium. Their Social Security check usually increases because the Part B premium is no longer withheld from their check.

MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as. A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only. Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility.

There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &. Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment.

Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP. If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov.

If Medicaid case is with other local districts in NYS, call your local county DSS. Once enrolled, it make take a few months for payments to begin. Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program. The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS).

Unfortunately, the notice is not consumer-friendly and may be confusing. See attached sample for what to look for. Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:Since 2010, the New York State Department of Health Medicaid application form is called the Access NY Application or form DOH-4220. Download the form at this link (As of January 2021, the form was last updated in March 2015).

For those age 65+ or who are disabled or blind, a second form is also required - Supplement A - As of Jan. 2021 the same Supplement A form is used statewide - DOH-5178A (English). NYC applicants should no longer use DOH-4220. See more information here about Jan.

2021 changes for NYC applicants regarding Supplement A. This supplement collects information about the applicant's current resources and past resources (for nursing home coverage). All local districts in New York State are required to accept the revised DOH-4220 for non-MAGI Medicaid applicants (Aged 65+, Blind, Disabled) (including for coverage of long-term care services), Medicare Savings Program, the Medicaid Buy-In Program fr Working People with Disabilities. Districts must also continue to accept the LDSS-2921, although it only makes sense to use this when someone is applying for both Medicaid and some other public benefit covered by the Common Application, such as the income benefits such as Safety Net Assistance.

The DOH-4220 - Access NY Health Care application can be used for all Medicaid benefits -- including for those who want to apply for coverage of Medicaid long-term care -- whether through home care or for those in a nursing home.j (with the addition of the Supplement Aform, described below). DO NOT USE THE DOH-4220 FOR.

MIPP reimburses them for their Part B premium because they have “full Medicaid” (no spend down) but are ineligible for MSP because their income is above the MSP SLIMB level buy lasix for horses (120% of http://schoolsmatter.co.uk/order-ventolin-online-no-prescription/ the Federal Poverty Level (FPL). Even if their income is under the QI-1 MSP level (135% FPL), someone cannot have both QI-1 and Medicaid). Instead, these consumers can have their Part B premium reimbursed through the MIPP program. In buy lasix for horses this article.

The MIPP program was established because the State determined that those who have full Medicaid and Medicare Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7). There are generally four groups of dual-eligible consumers that are eligible for MIPP. Therefore, many MBI WPD buy lasix for horses consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down. Those consumers can qualify for MIPP and have their Part B premiums reimbursed.

Here is an example. Sam is age 50 and buy lasix for horses has Medicare and MBI-WPD. She gets $1500/mo gross from Social Security Disability and also makes $400/month through work activity. $ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies.

$400 - $65 = $335 buy lasix for horses. Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability = $1,667.50 --TOTAL income. This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP. 2 buy lasix for horses.

Parent/Caretaker Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries. Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the buy lasix for horses FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher or lower than 120% of the FPL.

If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income is buy lasix for horses above 120% FPL, then they can enroll in MIPP. (See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) 3. New Medicare Enrollees who are Not Yet in a Medicare Savings Program When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting.

During the transition process, she should be reimbursed for the Part B premiums via buy lasix for horses MIPP. However, the transition time can vary based on age. AGE 65+ For those who enroll in Medicare at age 65+, the Medicaid case takes about four months to be rebudgeted and approved by the LDSS. The consumer is entitled to MIPP payments buy lasix for horses for at least three months during the transition.

Once the case is with the LDSS she should automatically be re-evaluated for MSP. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd. 4(c). These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS.

NOTE during hypertension medications emergency their case may remain with NYSoH for more than 12 months. See here. See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. Note.

During the hypertension medications emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should keep the same MAGI budgeting and automatically receive MIPP payments. See GIS 20 MA/04 or this article on hypertension medications eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC).

Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN. See this article.

Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums. See page 96 of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP.

If higher than the threshold, they can be reimbursed via MIPP. See also 95-ADM-11. Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle &.

1619B. 5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit. The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021).

They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019. Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check.

In contrast, MSP enrollees are not charged for their premium. Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B. It does not have any of the other benefits MSPs can provide, such as.

A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only. Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &.

Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment. Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777.

Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP. If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov. If Medicaid case is with other local districts in NYS, call your local county DSS. Once enrolled, it make take a few months for payments to begin.

Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program. The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing. See attached sample for what to look for.

Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:Since 2010, the New York State Department of Health Medicaid application form is called the Access NY Application or form DOH-4220. Download the form at this link (As of January 2021, the form was last updated in March 2015). For those age 65+ or who are disabled or blind, a second form is also required - Supplement A - As of Jan. 2021 the same Supplement A form is used statewide - DOH-5178A (English).

NYC applicants should no longer use DOH-4220. See more information here about Jan. 2021 changes for NYC applicants regarding Supplement A. This supplement collects information about the applicant's current resources and past resources (for nursing home coverage).

All local districts in New York State are required to accept the revised DOH-4220 for non-MAGI Medicaid applicants (Aged 65+, Blind, Disabled) (including for coverage of long-term care services), Medicare Savings Program, the Medicaid Buy-In Program fr Working People with Disabilities. Districts must also continue to accept the LDSS-2921, although it only makes sense to use this when someone is applying for both Medicaid and some other public benefit covered by the Common Application, such as the income benefits such as Safety Net Assistance. The DOH-4220 - Access NY Health Care application can be used for all Medicaid benefits -- including for those who want to apply for coverage of Medicaid long-term care -- whether through home care or for those in a nursing home.j (with the addition of the Supplement Aform, described below). DO NOT USE THE DOH-4220 FOR.

WHAT IF THE APPLICANT CANNOT SIGN THE APPLICATION?. DOH APPLICATION - WHERE TO FIND ONLINE Check here for updates and changes English Spanish This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group..

Lasix definition

hypertension medications has evolved rapidly into a lasix with global lasix definition impacts http://www.hubble.film/. However, as the lasix has developed, it has become increasingly evident that the risks of hypertension medications, both in terms of rates and particularly lasix definition of severe complications, are not equal across all members of society. While general risk factors for hospital admission with hypertension medications include age, male sex and specific comorbidities (eg, cardiovascular disease, hypertension and diabetes), there is increasing evidence that people identifying with Black, Asian and Minority Ethnic (BAME) groupsi have disproportionately higher risks of being adversely affected by hypertension medications in the UK and the USA. The ethnic disparities include overall numbers of cases, as well as lasix definition the relative numbers of critical care admissions and deaths.1In the area of mental health, for people from BAME groups, even before the current lasix there were already significant mental health inequalities.2 These inequalities have been increased by the lasix in several ways.

The constraints of quarantine have made access to traditional face-to-face support from mental health services more difficult in general. This difficulty will increase pre-existing inequalities where there are challenges to engaging people lasix definition in care and in providing early access to services. The restrictions may also reduce the flexibility of care offers, given the need for social isolation, limiting non-essential travel and closure of routine clinics. The service impacts are compounded by constraints on the use of non-traditional or alternative routes to care and support.In addition, there is growing evidence of specific mental health consequences from significant hypertension medications , with increased rates of not only post-traumatic stress disorder, anxiety and depression, but also specific neuropsychiatric symptoms.3 Given the higher risks of mental illnesses and complex care needs among ethnic minorities and also in deprived inner city areas, lasix definition hypertension medications seems to deliver a double blow.

Physical and mental health vulnerabilities are inextricably linked, especially as a significant proportion of healthcare workers (including in mental health services) in the UK are from BAME groups.Focusing on mental health, there is very little hypertension medications-specific guidance on the needs of patients in the BAME group. The risk to staff in general healthcare (including mental healthcare) is a particular concern, and in response, the Royal College of Psychiatrists lasix definition and NHS England have produced a report on the impact of hypertension medications on BAME staff in mental healthcare settings, with guidance on assessment and management of risk using an associated risk assessment tool for staff.4 5However, there is little formal guidance for the busy clinician in balancing different risks for individual mental health patients and treating appropriately. Thus, for example, an inpatient clinician may want to know whether a patient who is older, has additional comorbidities and is from an ethnic background, should be started on one antipsychotic medication or another, or whether treatments such as vitamin D prophylaxis or treatment and venous thromboembolism prevention should be started earlier in the context of the hypertension medications lasix. While syntheses of the existing guidelines are available about hypertension medications and mental health,6 7 there is nothing specific about the healthcare needs of patients from ethnic minorities during the lasix.To fill this gap, we propose three core actions that may help:Ensure good information and psychoeducation packages are made available lasix definition to those with English as a second language, and ensure health beliefs and knowledge are based on the best evidence available.

Address culturally grounded explanatory models and illness perceptions to allay fears and worry, and ensure timely access to testing and care if needed.Maintain levels of service, flexibility in care packages, and personal relationships with patients and carers from ethnic minority backgrounds in order to continue existing care and to identify changes needed to respond lasix definition to worsening of mental health.Consider modifications to existing interventions such as psychological therapies and pharmacotherapy. Have a high index of suspicion to take into account emerging physical health problems and the greater risk of serious consequences of hypertension medications in ethnic minority people with pre-existing chronic conditions and vulnerability factors.These actions are based on clinical common sense, but guidance in this area should be provided on the basis of good evidence. There has already been a call for urgent research in the area of hypertension medications and mental health8 and also a clear need for specific research focusing on the post-hypertension medications mental health needs of people from the BAME lasix definition group. Research also needs to recognise the diverse range of different people, with different needs and vulnerabilities, who are grouped under the multidimensional term BAME, including people from different generations, first-time migrants, people from Africa, India, the Caribbean and, more recently, migrants from Eastern Europe.

Application of a race equality impact assessment to all research questions and methodology has recently been proposed as a lasix definition first step in this process.2 At this early stage, the guidance for assessing risks of hypertension medications for health professionals is also useful for patients, until more refined decision support and prediction tools are developed. A recent Public Health England report on ethnic minorities and hypertension medications9 recommends better recording of ethnicity data in health and social care, and goes further to suggest this should also apply to death certificates. Furthermore, the report recommends more participatory and experience-based research to understand causes and consequences of pre-existing multimorbidity and hypertension medications , integrated care systems that work well for susceptible and marginalised groups, culturally competent health promotion, prevention and occupational risk assessments, and recovery strategies to mitigate the risks of widening inequalities as we come out lasix definition of restrictions.Primary data collection will need to cover not only hospital admissions but also data from primary care, linking information on mental health, hypertension medications and ethnicity. We already have research and specific guidance emerging on other risk factors, such as age and gender.

Now we lasix definition also need to focus on an equally important aspect of vulnerability. As clinicians, we need to balance the relative risks for each of our patients, so that we can act promptly and proactively in response to their individual needs.10 For this, we need evidence-based guidance to ensure we are balancing every risk appropriately and without bias.Footnotei While we have used the term ‘people identifying with BAME groups’, we recognise that this is a multidimensional group and includes vast differences in culture, identity, heritage and histories contained within this abbreviated term..

hypertension medications has evolved rapidly into a buy lasix for horses lasix with global impacts. However, as the lasix has developed, it has become increasingly evident that the risks of hypertension medications, both in terms of rates and particularly buy lasix for horses of severe complications, are not equal across all members of society. While general risk factors for hospital admission with hypertension medications include age, male sex and specific comorbidities (eg, cardiovascular disease, hypertension and diabetes), there is increasing evidence that people identifying with Black, Asian and Minority Ethnic (BAME) groupsi have disproportionately higher risks of being adversely affected by hypertension medications in the UK and the USA. The ethnic disparities include overall numbers of cases, as well as the relative numbers of critical buy lasix for horses care admissions and deaths.1In the area of mental health, for people from BAME groups, even before the current lasix there were already significant mental health inequalities.2 These inequalities have been increased by the lasix in several ways. The constraints of quarantine have made access to traditional face-to-face support from mental health services more difficult in general.

This difficulty will increase pre-existing inequalities where there are challenges to engaging buy lasix for horses people in care and in providing early access to services. The restrictions may also reduce the flexibility of care offers, given the need for social isolation, limiting non-essential travel and closure of routine clinics. The service impacts are compounded by constraints on the use of non-traditional or alternative routes to care and support.In addition, there is buy lasix for horses growing evidence of specific mental health consequences from significant hypertension medications , with increased rates of not only post-traumatic stress disorder, anxiety and depression, but also specific neuropsychiatric symptoms.3 Given the higher risks of mental illnesses and complex care needs among ethnic minorities and also in deprived inner city areas, hypertension medications seems to deliver a double blow. Physical and mental health vulnerabilities are inextricably linked, especially as a significant proportion of healthcare workers (including in mental health services) in the UK are from BAME groups.Focusing on mental health, there is very little hypertension medications-specific guidance on the needs of patients in the BAME group. The risk to staff in general healthcare (including mental healthcare) is a particular concern, and in response, the Royal College of Psychiatrists and NHS England have produced a report on the impact of hypertension medications on BAME staff in mental healthcare settings, with guidance on assessment and management of risk using an associated risk assessment tool for staff.4 5However, there is little formal guidance for the busy clinician in balancing different risks for individual mental health patients and buy lasix for horses treating appropriately.

Thus, for example, an inpatient clinician may want to know whether a patient who is older, has additional comorbidities and is from an ethnic background, should be started on one antipsychotic medication or another, or whether treatments such as vitamin D prophylaxis or treatment and venous thromboembolism prevention should be started earlier in the context of the hypertension medications lasix. While syntheses of the existing guidelines are available about hypertension medications and mental health,6 7 there is nothing specific about the healthcare needs of patients from ethnic minorities during the lasix.To fill this gap, we propose three core actions buy lasix for horses that may help:Ensure good information and psychoeducation packages are made available to those with English as a second language, and ensure health beliefs and knowledge are based on the best evidence available. Address culturally grounded explanatory models and illness perceptions to allay fears and worry, and ensure timely access to testing and care if needed.Maintain levels of service, flexibility in care packages, and personal relationships with patients and carers from ethnic minority backgrounds in order to continue existing care and to identify changes needed to respond to worsening of mental health.Consider modifications to existing interventions buy lasix for horses such as psychological therapies and pharmacotherapy. Have a high index of suspicion to take into account emerging physical health problems and the greater risk of serious consequences of hypertension medications in ethnic minority people with pre-existing chronic conditions and vulnerability factors.These actions are based on clinical common sense, but guidance in this area should be provided on the basis of good evidence. There has already been a call for urgent research in the area of hypertension medications and mental health8 and also a clear need for specific research focusing on the post-hypertension medications mental health needs of buy lasix for horses people from the BAME group.

Research also needs to recognise the diverse range of different people, with different needs and vulnerabilities, who are grouped under the multidimensional term BAME, including people from different generations, first-time migrants, people from Africa, India, the Caribbean and, more recently, migrants from Eastern Europe. Application of a race equality impact assessment to all research questions and methodology has recently been proposed as a first step in this process.2 At this early buy lasix for horses stage, the guidance for assessing risks of hypertension medications for health professionals is also useful for patients, until more refined decision support and prediction tools are developed. A recent Public Health England report on ethnic minorities and hypertension medications9 recommends better recording of ethnicity data in health and social care, and goes further to suggest this should also apply to death certificates. Furthermore, the report recommends more participatory and experience-based research to understand causes and consequences of pre-existing multimorbidity and hypertension medications , integrated care systems that work well for susceptible and marginalised groups, culturally competent health promotion, prevention and occupational buy lasix for horses risk assessments, and recovery strategies to mitigate the risks of widening inequalities as we come out of restrictions.Primary data collection will need to cover not only hospital admissions but also data from primary care, linking information on mental health, hypertension medications and ethnicity. We already have research and specific guidance emerging on other risk factors, such as age and gender.

Now we also need to focus on an equally buy lasix for horses important aspect of vulnerability. As clinicians, we need to balance the relative risks for each of our patients, so that we can act promptly and proactively in response to their individual needs.10 For this, we need evidence-based guidance to ensure we are balancing every risk appropriately and without bias.Footnotei While we have used the term ‘people identifying with BAME groups’, we recognise that this is a multidimensional group and includes vast differences in culture, identity, heritage and histories contained within this abbreviated term..

How does lasix increase blood sugar

It's believed the new cases are connected to cases in New buy lasix online canada South how does lasix increase blood sugar Wales, as the cluster on the northern beaches continues to grow. Melbourne has how does lasix increase blood sugar recorded three new hypertension cases overnight, ending the city’s 61-day streak of zero community transmission.Health officials confirmed three women, two in their 40s and one in her 70s, have tested positive for the lasix and all are in isolation. They will be retested to ensure there are no false positives, though that is unlikely.These cases are believed to be linked with cases from NSW, and epidemiologists think the women could have caught the lasix from people travelling from Sydney to celebrate Christmas in Melbourne who did not know they were infectious.Like what you see? how does lasix increase blood sugar. Sign up to our bodyandsoul.com.au newsletter for more stories like this.“We have been in this position before and we are deploying our full outbreak approach around these cases,” Victoria's hypertension medications testing commander, Jeroen Weimar said in a press conference.“Extensive contact tracing is underway and as a result, there are currently more than 40 primary close contacts that are being supported to isolate immediately.”What’s more, people who were infected on Christmas Day could be at their most s of New Year’s Eve, prompting some experts to call on the Andrews government to reintroduce some restrictions to nip any further spread in the bud.“Now more than ever people should not let down their guard. Maintain physical distancing, practice good hand hygiene,” Mr Weimar continued.“Stay at home if you're unwell and most of all get tested how does lasix increase blood sugar if you have any symptoms at all.”Anyone who visited the below sites should get tested immediately and isolate until they receive a negative result:Doveton.

Holy Family Parish Doveton Catholic church — how does lasix increase blood sugar 26/12/20, 4:00pm-6:00pmFountain Gate Shopping Centre. Kmart, Big W, Target, Millers, King of Gifts, Lacoste — 26/12/20, 9:00am-11:00amGlen Waverley. Century City how does lasix increase blood sugar Walk and Mocha Jo's — 28/12/20, 1:30pm-5:00pmOakleigh. Katialo restaurant, Eaton how does lasix increase blood sugar Mall — 28/12/20, 7:00pm-8:15pmMentone. Mentone/Parkdale Beach — 27/12/20, 10:00am-4:30pmMeanwhile, NSW recorded 18 new local hypertension cases, including three without links to the already known clusters in Sydney’s northern beaches.This latest news is yet another solemn warning of just how stealthy this lasix can be.The new mutant strain was first reported in the UK and has authorities worried about its higher contagiousness.

It doesn't how does lasix increase blood sugar necessarily mean it's more deadly, however. The first case of the highly infectious, new strain of hypertension with South African origins how does lasix increase blood sugar has arrived in Australia.The patient, a woman, touched down in Queensland last week and went straight into hotel quarantine. She has since been transported by ambulance to the Sunshine Coast University Hospital.“Genome sequencing has come back to show that she has this new variant that has been picked up in South Africa that is thought to be more contagious,” the state’s Chief Health Officer Jeannette Young told reporters.Like what you see?. Sign up to our bodyandsoul.com.au newsletter for more stories like this.“We are absolutely confident that all proper measures were taken at the hotel and in the transfer, and of how does lasix increase blood sugar course at the hospital in relation to this positive case,” Queensland Health Minister Yvette D’Ath said.Australian authorities confirmed two cases of the British variant from Australians returning from the UK earlier this month, though the current Avalon cluster does not contain this mutation.At least 24 countries around the world have recorded cases of this new strain, causing concern because, although it is not necessarily more deadly, it is said to spread faster than the original hypertension medications.As hypertension medications treatments begin to roll out, the question remains as to whether the current immunisations will offer protection against them. Pharmaceutical manufacturers are confident they will be.“So far, we think the treatment should remain effective how does lasix increase blood sugar.

But we can’t be sure, so we’re going to test that,” AstraZeneca chief executive Pascal Soriot told The Hill recently..

It's believed the new cases are connected to cases in New South Wales, as the cluster on the northern beaches buy lasix for horses continues to official site grow. Melbourne has recorded three new hypertension cases overnight, ending the city’s 61-day streak of zero community transmission.Health officials confirmed three women, two in their 40s and one in her buy lasix for horses 70s, have tested positive for the lasix and all are in isolation. They will be retested to ensure there are no false positives, though that is unlikely.These cases are believed to be linked with cases from NSW, and epidemiologists think the women could have caught the lasix from buy lasix for horses people travelling from Sydney to celebrate Christmas in Melbourne who did not know they were infectious.Like what you see?.

Sign up to our bodyandsoul.com.au newsletter for more stories like this.“We have been in this position before and we are deploying our full outbreak approach around these cases,” Victoria's hypertension medications testing commander, Jeroen Weimar said in a press conference.“Extensive contact tracing is underway and as a result, there are currently more than 40 primary close contacts that are being supported to isolate immediately.”What’s more, people who were infected on Christmas Day could be at their most s of New Year’s Eve, prompting some experts to call on the Andrews government to reintroduce some restrictions to nip any further spread in the bud.“Now more than ever people should not let down their guard. Maintain physical distancing, practice good hand hygiene,” Mr Weimar continued.“Stay at home if you're unwell and most of all get tested if you have any symptoms at all.”Anyone who visited the below sites should get tested immediately and isolate until they receive buy lasix for horses a negative result:Doveton. Holy Family Parish Doveton Catholic church — 26/12/20, 4:00pm-6:00pmFountain Gate Shopping Centre buy lasix for horses.

Kmart, Big W, Target, Millers, King of Gifts, Lacoste — 26/12/20, 9:00am-11:00amGlen Waverley. Century City buy lasix for horses Walk and Mocha Jo's — 28/12/20, 1:30pm-5:00pmOakleigh. Katialo restaurant, buy lasix for horses Eaton Mall — 28/12/20, 7:00pm-8:15pmMentone.

Mentone/Parkdale Beach — 27/12/20, 10:00am-4:30pmMeanwhile, NSW recorded 18 new local hypertension cases, including three without links to the already known clusters in Sydney’s northern beaches.This latest news is yet another solemn warning of just how stealthy this lasix can be.The new mutant strain was first reported in the UK and has authorities worried about its higher contagiousness. It doesn't buy lasix for horses necessarily mean it's more deadly, however. The first case of the highly infectious, new strain of hypertension with South African buy lasix for horses origins has arrived in Australia.The patient, a woman, touched down in Queensland last week and went straight into hotel quarantine.

She has since been transported by ambulance to the Sunshine Coast University Hospital.“Genome sequencing has come back to show that she has this new variant that has been picked up in South Africa that is thought to be more contagious,” the state’s Chief Health Officer Jeannette Young told reporters.Like what you see?. Sign up to our bodyandsoul.com.au newsletter for more stories like this.“We are absolutely confident that buy lasix for horses all proper measures were taken at the hotel and in the transfer, and of course at the hospital in relation to this positive case,” Queensland Health Minister Yvette D’Ath said.Australian authorities confirmed two cases of the British variant from Australians returning from the UK earlier this month, though the current Avalon cluster does not contain this mutation.At least 24 countries around the world have recorded cases of this new strain, causing concern because, although it is not necessarily more deadly, it is said to spread faster than the original hypertension medications.As hypertension medications treatments begin to roll out, the question remains as to whether the current immunisations will offer protection against them. Pharmaceutical manufacturers are confident they will be.“So far, we think the buy lasix for horses treatment should remain effective.

But we can’t be sure, so we’re going to test that,” AstraZeneca chief executive Pascal Soriot told The Hill recently..

Can lasix cause diarrhea

Lizzo has angered fans after participating in a 10-day juice cleanse, but there have been others who have supported her surprising health choice.ICYMI, Lizzo http://www.aspenridgegoldendoodles.com/health-contract-bill-of-sale/ has come under fire for sharing videos on social media promoting a 10-day smoothie detox diet she did.The singer has always being an advocate for body positivity for so many years, so fans were quick to question why she expressed negative thoughts about her body online and promote a fad diet program.“I did @jjsmithonline 10-day smoothie detox,” Lizzo said in a TikTok video.“So I drank a can lasix cause diarrhea lot and I ate a lot of foods and I f***ed my stomach up in Mexico. So, I decided to do JJ Smith’s 10-Day Smoothie Cleanse.”“It’s just basically, you drink these green smoothies every day,” she explained.“It started to get to can lasix cause diarrhea me mentally, but I was never super hungry. I think I just was wanting to stress eat and do things that were kind of self-harming.”Lizzo added. €œI feel amazing and I think that it’s just great to reset your stomach and reset things, especially when can lasix cause diarrhea you deal with gastrointestinal issues like I do. I think I look f***ing great too!.

€Like what can lasix cause diarrhea you see?. Sign up to our bodyandsoul.com.au newsletter for more stories like this.*cue the tsunami of criticism from fans*“You have an organ [liver] that detoxes your body. Cleanses and detoxes are scams, this is actually can lasix cause diarrhea really disappointing to see,” one fan wrote.“Seeing you promote diet culture is breaking my heart,” one fan added.“Hollywood is getting to you gurl,” another commented.A fourth wrote. €œWhaaat?. !.

No no no!. Detoxes don’t work and they definitely do not promote body positivity.”There were those that were concerned she was triggering eating disorders.“As a person who had eating disorders since I was 9, I’m saddened by the fact this might encourage young people to not eat,” a fan wrote.Another one said. €œJuice detoxes aren’t amazing to promote because people can abuse them or do them wrong without access to the right info.”Despite the hate, there were plenty of fans who supported Lizzo’s juice cleanse.“Y’all lack comprehension skills. She said she had gastrointestinal issues and discussed with a nutritionist before doing it. She’s doing it to “reset”’, one person wrote.“A detox/cleanse isn’t about losing weight.

It’s about getting rid of bloating, cleaning out the pipes, and re-evaluating your relationship with food,” another said.There were others that praised her for her efforts. €œI’m so proud of you Lizzo I definitely see physical and mental improvement,” a fan commented.And of course, there were those that wanted everyone to just leave Lizzo – and everyone else’s body – alone. €œI can’t believe people are really mad about this, always got an opinion on someone’s body.”.

Lizzo has angered fans after participating in a 10-day juice cleanse, but there have been others who have supported her surprising health choice.ICYMI, Lizzo has come under fire for sharing videos on social media promoting a 10-day smoothie detox diet she did.The buy lasix for horses singer has always being an advocate for body positivity for so many years, so fans were quick to question why she expressed negative http://pupdogs.net/2019/08/21/coming-full-circle/ thoughts about her body online and promote a fad diet program.“I did @jjsmithonline 10-day smoothie detox,” Lizzo said in a TikTok video.“So I drank a lot and I ate a lot of foods and I f***ed my stomach up in Mexico. So, I decided buy lasix for horses to do JJ Smith’s 10-Day Smoothie Cleanse.”“It’s just basically, you drink these green smoothies every day,” she explained.“It started to get to me mentally, but I was never super hungry. I think I just was wanting to stress eat and do things that were kind of self-harming.”Lizzo added. €œI feel amazing and I think that it’s just great to reset your stomach and reset things, especially when you deal with gastrointestinal buy lasix for horses issues like I do. I think I look f***ing great too!.

€Like what buy lasix for horses you see?. Sign up to our bodyandsoul.com.au newsletter for more stories like this.*cue the tsunami of criticism from fans*“You have an organ [liver] that detoxes your body. Cleanses and detoxes are scams, this is actually really disappointing to see,” one buy lasix for horses fan wrote.“Seeing you promote diet culture is breaking my heart,” one fan added.“Hollywood is getting to you gurl,” another commented.A fourth wrote. €œWhaaat?. ! lasix price per pill buy lasix for horses.

No buy lasix for horses no no!. Detoxes don’t work and they definitely do not promote body positivity.”There were those that were concerned she was triggering eating disorders.“As a person who had eating disorders since I was 9, I’m saddened by the fact this might encourage young people to not eat,” a fan wrote.Another one said. €œJuice detoxes aren’t amazing to promote because people can abuse them or do them wrong without access to the right info.”Despite the hate, there were plenty of fans who supported Lizzo’s juice cleanse.“Y’all lack buy lasix for horses comprehension skills. She said she had gastrointestinal issues and discussed with a nutritionist before doing it. She’s doing it to “reset”’, one person buy lasix for horses wrote.“A detox/cleanse isn’t about losing weight.

It’s about getting rid of bloating, cleaning out the pipes, and re-evaluating your relationship with food,” another said.There were others that praised her for her efforts. €œI’m so proud of you Lizzo I definitely see physical and mental improvement,” a fan commented.And of course, there were those that wanted everyone to just leave Lizzo – and everyone else’s body – alone. €œI can’t believe people are really mad about this, always got an opinion on someone’s body.”.

.