Where to buy symbicort pills

Long-term conditions where to buy symbicort pills pose a major http://pentwin.co.uk/symbicort-price-with-insurance/ challenge for the New Zealand health system. The prevalence of long-term conditions is high and rising, particularly for Māori and Pacific people who experience the onset of disease at a younger age and face a higher risk of complications and early death. Long-term conditions lead to significant social and economic impacts both for individuals and their whānau and for the health system and society in general.This report provides a summary of the where to buy symbicort pills New Zealand and international evidence base on the health and societal costs of long-term conditions.

It updates a 2009 report, incorporating more recent research in this space. The scope of the report was also increased to consider a larger number of long-term conditions and associated risk factors. The report involved a systematic where to buy symbicort pills review of published literature on the cost of illness for a broad set of long-term conditions.

It aims to bring together the latest evidence base in one report, to support improved access to and use of this information. New Zealand cost-of-illness studies were identified for ten long-term conditions and three risk factors where to buy symbicort pills. Additional information was extracted from overseas studies where little or no cost evidence for New Zealand was identified.

The review notes significant gaps in the New Zealand cost of illness literature as well as methodological variations which make comparability challenging..

Symbicort 160

	Symbicort	Azulfidine	Lotemax	Estrace
Female dosage	160mcg + 4.5mcg 1 inhaler $69.95	500mg 30 tablet $69.99	0.5% 5ml 4 solution $48.00	2mg 140 tablet $215.95
Take with high blood pressure	Ask your Doctor	Yes	No	No
Buy with echeck	20h	3h	10h	8h
CANADA pharmacy price	No	No	No	Yes
Buy with visa	Consultation	One pill	0.5% 5ml	Ask your Doctor

In 2019, the http://hr-upshot.com/cost-of-lasix/ Topol review was published on behalf of the secretary of state for health and social care in the UK, preparing the healthcare workforce to deliver the digital future.1 A multidisciplinary team of experts, including clinicians, researchers, ethicists, computer scientists, engineers and economists, symbicort 160 reviewed the available data and projected into the future (ie, next 20 years) two key questions. What impact technological developments (including genomics, artificial intelligence (AI), digital medicine and robotics) will have on the roles and functions of National Health System clinical staff?. How could this innovation (ie, biosensors, electronic patient record, smartphone apps, digital infrastructure and virtual reality) ensure safer, more productive, more effective and more personalised care for patients?. It is now widely recognised that data science and information technologies enable understanding of the uniqueness of each individual and the ability to deliver healthcare on a far more timely, efficient and tailored basis.Mental health is a top priority in the UK national research agenda2 and presents a unique opportunity because it is in the next wave of adoption of digital health and innovation technologies.3 The Topol review noted that innovation can ‘bring a new emphasis on the nurturing of the precious interhuman bond, based on trust, clinical presence, empathy and communication’.

In 2019, the Topol review was published on behalf of the http://hr-upshot.com/cost-of-lasix/ secretary of state for health and social care in the UK, preparing the healthcare workforce to deliver the digital future.1 A multidisciplinary team of experts, including clinicians, researchers, ethicists, computer scientists, engineers and economists, reviewed the available data and projected into the future where to buy symbicort pills (ie, next 20 years) two key questions. What impact technological developments (including genomics, artificial intelligence (AI), digital medicine and robotics) will have on the roles and functions of National Health System clinical staff?. How could this innovation (ie, biosensors, electronic patient record, smartphone apps, digital infrastructure and virtual reality) ensure safer, more productive, more effective and more personalised care for patients?. It is now widely recognised that data science and information technologies enable understanding of the uniqueness of each individual and the ability to deliver healthcare on a far more timely, efficient and tailored basis.Mental health is a top priority in the UK national research agenda2 and presents a unique opportunity because it is in the next wave of adoption of digital health and innovation technologies.3 The Topol review noted that innovation can ‘bring a new emphasis on the nurturing of the precious interhuman bond, based on trust, clinical presence, empathy and communication’.

How should I take Symbicort?

Budesonide+Formoterol may increase the risk of asthma-related death. Use only the prescribed dose of Budesonide+Formoterol, and do not use it for longer than your doctor recommends. Follow all patient instructions for safe use. Talk with your doctor about your individual risks and benefits in using this medication. Do not use Budesonide+Formoterol to treat an asthma attack that has already begun. It will not work fast enough. Use only a fast-acting inhalation medication.
Prime the Budesonide+Formoterol inhaler device before the first use by pumping 2 test sprays into the air, away from your face. Shake the inhaler for at least 5 seconds before each spray. Prime the inhaler if it has not been used for longer than 7 days, or if the inhaler has been dropped.

If you also use a steroid medication, do not stop using the steroid suddenly or you may have unpleasant withdrawal symptoms. Talk with your doctor about using less and less of the steroid before stopping completely.

Use all of your medications as directed by your doctor.

Do not use a second form of Formoterol or use a similar inhaled bronchodilator such as salmeterol or arFormoterol unless your doctor has told you to.

Cheap symbicort online

Welcome to cheap symbicort online the first issue of 2022!. We have several exciting changes to announce in the new year. To begin with, we have been increasing our number of published submissions per issue, including some cheap symbicort online of our content exclusively online (the most common way that our readers access the journal). In addition, we have put out additional calls for submissions and look forward to receiving new work.We have spent the last 4 years working towards social justice, accessibility, global …IntroductionThe subject of care is gaining importance within the medical humanities, but it also remains elusive.

Hence, this paper aims to unpack theoretical notions of care in a way that integrates the elusiveness rather than trying to avoid it. It also responds to a recent article by Julia Kristeva et al, in which they claim that care cheap symbicort online holds humanity (Kristeva et al. 2018).When in need of theoretical elaboration or re-development, medical humanities scholars have sometimes evoked Greek or Roman myths, such as those of Narcissus, Hephaestus or Leto (Cilione, Marinozzi, and Gazzaniga 2019. Pannese 2011.

Schott 2017) cheap symbicort online. Similarly, this article evokes the Roman myth of Cura to unpack theoretical understandings of care. In this myth, known from the writings of the first century mythographer Hyginus, humanity is created from clay by a personification of care. It has proven useful to thinkers as diverse cheap symbicort online as Martin Heidegger, Arthur Kleinman (Kleinman and van der Geest 2009) and Julia Kristeva (Kristeva (2012), Kristeva et al.

2018). While utilisation by Heidegger 1927, 196–200 ‘challenges the myth of self-sufficiency and individual atomization that that has shaped much of modern Western philosophy’ (Froese 2005, 16), both Kleinman and Kristeva explore the tension between universalised knowledge and the singularity of individual patients and intimate care (Engebretsen, Fraas cheap symbicort online Henrichsen, and Ødemark 2020).While none of these scholars engage with Hyginus’ Fabulae directly, I use the text as an ‘engine’ in a four-step endeavour. This endeavour follows Brandy Schillace’s description of the medical humanities as ‘a field that at its core considers the human story behind and within medicine, its history, its cultural valence and its influence on practice’ Schillace (2017, 139).First, a ‘human story’ entails agency, the things that humans do in their lives. While the ‘appeal’ from Kristeva et al uses a case from intercultural psychoanalysis, the authors have previously researched a variety of professional healthcare practices (Engebretsen 2016.

Engebretsen, Sandset, cheap symbicort online and Ødemark 2017. Hetrick et al. 2017). However, it is crucial to note that Cura (in Hyginus’ text) will ‘hold’ humanity quamdiu vixerit (for cheap symbicort online as long as he shall live).

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

Suddenly, it feels as if I am not only holding or embracing cheap symbicort online him away from an abyss. I am also holding him—or, perhaps, shielding him—in the face of many, many abysses to come.In rough-and-tumble play, I often lift him up with my arms straight—holding him while he straightens his body, and ‘is an airplane’. Although this play is exhausting, particularly since I live with cerebral palsy, this is nevertheless an activity where we can be close to one another. When I hold him up like this, or suddenly ‘crash’ him safely down next to me cheap symbicort online on the bed, we are skin to skin, but not exactly like I used to be with his older siblings, and I suddenly have the impression that it also differs from how most fathers do this with their children.

I cannot know if our way is exclusively ours, but while I hold him, that is how it feels.Second, a human story ‘behind and within medicine’—or, for that matter, behind and within any social field—consists of underlying notions and involved cultural categories. Hence, this article aims to unpack theoretical notions of care with reference to the thinkers mentioned above. Throughout, I try to unpack how different aspects of cheap symbicort online care ‘follow’ each other in an analytical ‘path’ or trajectory, as if in a story (Kristeva et al. 2018).Third, the investigation of the human story of care must become an investigation of ‘history’ and ‘cultural valence’.

In order to think historically, the analytical ‘engine’ includes Hyginus’ text, and 18th and 19th century uses of Cura and related motifs.Fourth, I follow Schillace’s advice to examine ‘influence on practice’. In addition to the practice of parental care, cheap symbicort online the exploration ends with a discussion of medical humanities as practice. When medical humanities scholars ’consider’ the human story of care, they bring together different perspectives and forms of knowledge. In this case, however both the intertextual analyses and the autotheoretical work indicate that those complexities might cheap symbicort online overpower our theoretical perspectives.

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

Fournier describes autotheory as a specific form of academic practice:In autotheory as a conceptual and performative feminist practice, artists, writers, and critics use the first person, or related practices of self-imaging (Jones, Self/Image 134), to process, perform, enact, iterate, and wrestle with the hegemonic discourses of ‘theory’ and philosophy, extending the feminist practice of theorizing from one’s subject positioning as a way of engendering insights into questions related to aesthetics, politics, ethics, and social and cultural theory. In autotheory, one’s embodied experiences become the material through which one theorizes, and, in a similar cheap symbicort online way, theory becomes the discourse through which one’s lived experience is refracted (658).In Fournier’s definition, theory functions as ‘hegemonic discourses’, and as discourses through which one’s lived experience is refracted. Contrary to this emphasis on language—as well as their emphasis on language elsewhere (Heidegger 1927Heidegger 1937. Kleinman 1995.

Kristeva 2019)—neither Kristeva nor Kleinman or Heidegger focus on cheap symbicort online Hyginus’ text. In contrast to this body of research, this article emphasizes the interpretative potential of the original text. In addition to grammatical analysis, I utilize the well-known concept cheap symbicort online of intertextuality, as introduced by Kristeva (1980). However, I use it in a less structuralist sense than in her early formulations in Desire in Language.

Instead, I approach Hyginus’ text in line with her approach in ‘Nos Deux’ or a short (hi)story of intertextuality (Kristeva 2002).For me, intertextuality is mostly a way of making history go down in us. We, two cheap symbicort online texts, two destinies, two psyches. It is a way if introducing history to structuralism and its orphan, lonely texts and readings. […] the etymological meaning of ‘semeion’ is a distinctive mark, a trace, an engraved or written sign, that makes us think of the Freudian ‘psychical’ marks, called drives, rhythmical articulations of embodied impulses and psychical movements.

In this sense, cheap symbicort online the meaning of the socio-historical aspect of intertextuality, as already developed by Bakhtin and Barthes, acquires a new significance. Within each sociolect or ideology, (both well-established sign-systems) there will always be a breach of subjectivity carrying out a hidden matrix of pre-symbolic forces able to make history move on through all its short and singular stories. (2002. 8-9)First, this means that I study Hyginus’ text not as a ‘lonely text’, but as part cheap symbicort online of a historical trajectory.

The ‘singular stories’ are used to disturb the orderly (structural) notions of both textual and philosophical analysis.Second, I interpret Hyginus’ text—as well as other utilisations of the myth—with focus on traces. Or, more specifically, to cheap symbicort online find ‘distinctive marks’ relevant to the same material as in authotheretical work. €˜embodied impulses and psychical movements’. This, however, does not mean that the texts are reduced to a canvas for an engraved sign.

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

The first story in Hyginus’ fable begins thus:Cura cum quendam fluvium transiret, vidit cretosum lutum. Sustulit cogitabunda et coepit fingere hominem.When Cura was crossing a certain river, she saw some clayey mud. She took it up thoughtfully and began to fashion a man.Before interpreting cheap symbicort online this first story, we must first acknowledge that the fable is an alteration or addition in a philological sense. While Fabulae is almost exclusively filled with Greek myths, the Cura fable’s position at the end of the collection suggests, ‘that this particularly Roman tale was simply added to the end of the existing narrative portion’ (Smith and Trzaskoma 2007, xlix).

Moreover, philological research consistently argues that fable CCXX ‘hinges on Latin wordplay’ (Smith and Trzaskoma 2007, xlviii).More specifically, Hyginus, in the Cura fable, alters a prevailing myth in late antiquity, one cheap symbicort online that he has even told earlier in the pages of Fabulae. That of how the titan Prometheus fashioned man from clay. In fable CXLII (‘Pandora’), Hyginus states explicitly that Prometheus lapeti filius primus homines ex luto finxit (Prometheus, son of Iapetus, first fashioned men from clay).Most Greek and Roman sources place the Prometheus plasticator motif within a three-stage narrative. First, Prometheus shapes the human from cheap symbicort online clay, and then Athena gives the creature inner life.

Finally, sometimes after Prometheus has given humankind fire against the orders of Jove, Jove intervenes and sentences Prometheus to eternal punishment in the Caucasus.To understand the human story—to which both this motif and Hyginus’ text belong—comparison is needed. First, we must note that the neutral or slightly idyllic depictions in Hyginus and Ovid (respectively) differ from earlier and less optimistic renderings in Republican times. The poet Propertius, for instance, in his Libri Elegiarum from the first-century BC, laments and elaborates on how Prometheus was careless in his creating cheap symbicort online. Here, the adverbial clause ille parum caute casts Prometheus as a figure of titanic heedlessness:ille parum caute pectoris egit opus.corpora disponens mentem non vidit in arto:The making of man’s reason he performed with too little care.Arranging our bodies, he overlooked the mind in his handiwork (Goold 1990, 232).Carelessness, the counterpart to the notion of care, is involved in the Prometheus plasticator motif throughout antiquity.

The adverbial clause ille parum caute does not derive from the same verb as Cura, but rather from the verb caveo (to take precautions, to be aware of something). Nevertheless, Prometheus’ lack of care underlines how Hyginus’ text is an inversion these earlier texts cheap symbicort online. Instead of being created in a careless way, humanity is created by care.To be fair, a singular text never exhausts the potential of the history to which it belongs. Specific understandings—in cheap symbicort online this case.

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

/ A race resembling me, / To suffer, to weep, / To enjoy, to be glad, / And thee to scorn, /As I!. (Bowring 2015, 182)Typical of Goethe’s Sturm und Drang period, his Prometheus Plasticator is a figure of creativity, and embodies ‘ideals cheap symbicort online of freedom and rebellion’ (Raggio 1958, 44). Goethe’s poem emphasised the ‘autonomous existence’ of mankind (Dougherty 2006, 95), thereby constituting an ‘emancipatory gesture’ (Edgar 2002, 161). Hyginus’ text inverts both classical and romantic evokings of the myth by inserting dependency rather than autonomy and expansion.

To shed further light on this inversion, we must first unpack the name of the personification cheap symbicort online that Hyginus instals in the Prometheus Plasticator motif. Cura.The name Cura is derived from the verb curo. The Oxford Latin Dictionary defines the verb thus:To watch over, look after, care for.To tend to, to do what is necessary to.To administer remedies, to treat (a sick person, wound, disease, etc).To have charge of. (absol.) to be in command.To devote oneself to, to cultivate (a person).To undertake, to see to (a task or a cheap symbicort online responsibility).To regard with anxiety or interest, worry or care about, heed.As we can see, the first three senses of this verb invert the Prometheus motif we found in Propertius.

To instal the personification of curo in the motif is to instal carefulness, attentiveness and responsibility in a motif usually filled with lack of care. The third sense also injects an aspect that cheap symbicort online is totally absent in classical anthropogenies. That of human frailty. It also relates to aspects of human lives that are particularly relevant to understanding care, illness, disease and disability.The fifth and sixth senses of the word similarly invert the romantic depictions of Prometheus motif.

The anthropogenic act is no longer about rebellion and expansion, but cheap symbicort online devotion and responsibility. The seventh sense finally reverses the political impulse of the Sturm und Drang—the desire for increased individual freedom and self-expansion in every imaginable way—into worrying and heeding.In addition to these intertextual relations, it is also fruitful to note the verbs that connect humanity to the three deities. While Cura’s creating is described with the verb fingo (in Hyginus. €˜fingere’), Jove’s cheap symbicort online and Tellus’ acts of giving are described by do (in Hyginus.

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

Cogitabunda (thoughtful) cheap symbicort online. Although an adjective in the purely grammatical sense, this is the only word with an adverbial function in Hyginus’ text. Hence, it is the lone term specifying how actions and interactions take place. While Greco-Roman deities often act from rage (as in the conflict between cheap symbicort online the titans and Olympian deities) or desire (as in the story of Zeus and Leda), Cura acts thoughtfully or with thought.As we can see, the adverb cogitabunda is attached to the picking up of the clay, not primarily to the act of creation.

Sustulit cogitabunda et coepit fingere hominem. Moreover, the temporal clause ‘and begun to’ (et coepit) also locates this thought as prior to the creation of humanity. To understand care as thoughtful, then, is about understanding thoughts and imaginaries ‘involved’ in care, and it includes thoughts and imaginaries that ‘pre-exist’, ‘frame’ or ‘underpin’ care and care work.It is useful to explore how the meaning of cogitabunda is preserved and unveiled in the work of the German cheap symbicort online philosopher, poet and literary critic Johann Gottfried Herder (1744–1803). In his poem ‘Das Kind der Sorge’ (1787), Herder follows Hyginus very closely (Bernays 1869, 158-163).

This poem was widely read, and it provided the basis for Goethe’s use of the Cura motif in Faust II (1832). Finally, Heidegger also comments on the poem and cites it in extenso when he develops his notion of Sorge as the fundamental human condition (Dye 2009, 207–218)., Kristeva (2001), too, refers several times to Herder, cheap symbicort online and even refers directly to this poem (25–26). The first stanza describes the moment of creation thus:Einst saß am murmelnden StromeDie Sorge nieder und sann:Da bildet im Traum der GedankenIhr Finger ein leimernes Bild (von Herder 1889, 75).Once by a murmuring riverSorrow sat down, and there,In a vision, thought to form with the touchA wavering figure (Groth 2016, 31).von Herder positions the moment of creation as a radically imaginative act in at least three ways. First, the gaze is far more manifest in von Herder’s text than in cheap symbicort online Hyginus’.

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

This phrase, roughly translatable as ‘in the dream of thoughts’, roots humanity in a singular image (or dream) that consist of or belong to several different thoughts or ways of thinking. This tension cheap symbicort online between individuality and multitude dovetails with research on the knowledge complexities involved in care.Third, the word ‘Traum’ (dream) in Traum der Gedanken does not denote unreality, fantasy or illusion. For von Herder, dreams are not the opposite of reality, but thoughts beyond or above manifest reality (Wirklichkeit überhöhenden Gedankens). A dream of thoughts, then, is an experience or interpretation wherein the understanding of a phenomenon moves beyond how the phenomenon presently is, to what it should or could be.

Just as Hyginus’ cogitabunda can, if we interpret in intertextual cheap symbicort online connection with von Herder’s Traum der Gedanken, also refract my experiences of holding my son in my arms. This is true of the experiences of performing actions that seem strange or unintelligible to those around us, but particularly true of the feeling of doing this in a way that is uniquely ours. The combination of these feelings—where the socially estranged ways of caring is fundamentally ours and cheap symbicort online integral to my parenting—engenders or entails a striving ‘upwards’. This striving is not limited to the idealisation that so often takes place in parenting, but is also a utopian, imaginative glimpse of a world wherein the both of us truly belong.In other words, the Cura motif foreshadows the ‘horizontal’ complexities involved in care (multiple cultural imaginaries, multiple forms of knowledge).

It also foreshadows ‘vertical’ complexities, through which care imaginations include both underlying categories and überhöhende dimensions. These overarching or utopical dimensions, that both stem from and go beyond the localised, singular imaginations of care, is known by many names in and beyond cheap symbicort online the medical humanities. Examples include ’underlying values’, ‘ethical content of particular practices’, ‘transformative learning’ and many others (Ayala 2019, 269. Pettersen 2008, 188.

Winthrop 2003).Cogitabunda, cheap symbicort online can mean to be thoughtful and to be ‘full of thoughts’. The adverbial clause im Traum der Gedanken by von Herder (1888, 533), similarly, also signifies something unclear or disorganised. In his poetotological treatise Über Bild, Dictung und Fabel (1888, 533), von Herder juxtaposes this state with being in Leidenschaft (in passion), in Verrückung (in madness) or nicht auf seiner Hut (off guard). There is complexity cheap symbicort online and openness—perhaps even fantasy or at least exploration—in this.

When I hold my son in my arms connecting different realms of thought. As in ruff-and-tumble-play, these realms are also at play as I think.The quarrel of the cheap symbicort online deities. Culture, nature and careAfter the first narrative, the second deals with a quarrel between the deities Cura, Jove and Tellus. Once humanity has been given inner life, the focus in Hyginus’ texts shifts from creating to name-giving:Cum vellet Cura nomen suum imponere, Iovis prohibuit suumque nomen ei dandum esse dixit.

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

Instead, Cura is a ‘deification of abstract ideas’, a common feature of Roman culture (Axtell 1907). Hence, it becomes clear that the quarrel deals with ontological ideas, more specifically with the ontology of humanity. Each deity proposes a ‘location’ cheap symbicort online in classical ontology.The philosopher John T. Hamilton has used the myth of Cura to explore how any understanding of security presupposes both care and carefulness.

He underlines how this ‘locating’ somehow names humanity after something that is neither identical nor particularly resembling humanity:The controversy over the creature’s name strives to resolve cheap symbicort online the issue of the figure’s proper being, without the aid of physical resemblance, without the talent for self-reflection. In my view, the debate over the name revolves on whether humanity is essentially atemporal (Telluric matter or Iovian spirit) or instead fundamentally temporal and constituted by time and history (Hamilton 2013, 71).It is worth noting that the deities are not offering or suggesting certain framings of human life. Hyginus’ text—in particular, the fact that Jove forbade any name other than his own—indicates conflicts between perspectives and disciplines. The imaginative richness involved in care, indicated by Hyginus cogitabunda or by the plural in von Herder’s Traum der Gedanken, is a plurality where incommensurabilities cheap symbicort online remain.

In my view, the myth of Cura points towards three possible but incommensurable ways of studying, describing and interpreting care (corresponding to Jove, Tellus and Cura, respectively):As a cultural or semantic phenomenon, elucidated in terms of meaning or more or less idealised notions.As a biological phenomenon, elucidated in medical, psychological or other health-related terms.As a relational phenomenon, elucidated in terms of care work (professional or not).Although it is necessary to understand care in all these ways, it is nevertheless impossible to fully merge them or produce those understandings simultaneously. Hence, it is necessary to add a more epistemologically oriented aspect of care. Care is fundamentally cheap symbicort online imaginative and context-dependent, and stands in-between otherwise incommensurable interpretative domains.Saturn’s verdict. The continuous presence of careIn the third narrative in Hyginus, the quarrel is somehow resolved when the deities choose Saturn as their judge.

Sadly, this part of the text is fragmented. There is agreement, however, that Saturn’s verdict clarifies that Jove will receive human cheap symbicort online souls, while Tellus will receive the body post mortem:Tu Iovis quoniam spiritum dedisti, <…>. Corpus recipito. Cura quoniam cheap symbicort online prima eum finxit, quamdiu vixerit, cura eum possideat.

Sed quoniam de nomine eius controversia est, homo vocetur quoniam ex humo videtur esse factusJove, since you gave him spirit, let [Tellus] receive his body. Since Cura fashioned him from the start, let Cura possess him for as long as he lives. But since there is controversy about his name, let cheap symbicort online him be called homo, since he seems to be made from humus.Let us begin by pointing out that Saturn’s verdict exposes yet another way in which Hyginus’ text alters the Prometheus plasticator motif. In most classical renderings, Prometheus is a trickster, and a transgressor from whom humanity is eventually separated.

After discovering his transgressions, the Olympian deities chain Prometheus to a mountain in the Caucasus, and humanity lives on without him. The relation between cheap symbicort online humanity and its creator is therefore temporary. Hyginus, in contrast, makes it clear that humanity will remain under the guardianship of Cura quamdiu vixerit ‘for as long as he shall live’.The significance of this difference becomes clearer if we compare Hyginus’ text to Ovid’s use of the Prometheus plasticator motif in Metamorphoses. After describing the original moment when Prometheus created Humanity, Ovid goes on to describe the human condition:quam satus Iapeto mixtam pluvialibus undis / finxit in effigiem moderantum cuncta deorum, / pronaque cum spectent animalia cetera terram, / os homini sublime dedit caelumque videre(Ovid 1997, 47)so that his new creation, upright man, / was made in image of commanding gods?.

/ On earth the brute creation bends its gaze, / cheap symbicort online but man was given a lofty countenance / and was commanded to behold the skies. / and with an upright face may view the stars (Melville and Kenney 2009, 76).As we can see, Ovid’s Prometheus creates a strong and vital human being. Humanity seems not dependent on care or assistance, but ‘made in image of commanding gods’. In Ovid, human life is essentially an independent life which resembles the lives of cheap symbicort online gods (in effigiem moderantum cuncta deorum).

It is common—and tempting—to imagine care relations as exceptions in human lives. In care research, for instance, one often cheap symbicort online reserves care needs for vulnerable groups, thereby contrasting them with some kind of original, non-vulnerable state. In life-course research, similarly, care leaves life as people move into adolescence and adulthood, only to re-enter it in the special cases of disability, serious illness or old age. Hyginus’ text, in contrast, opens up for a rethinking of care as a fundamental, continuous part of human lives.This is essentially an ontological argument.

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

Cura somehow ‘holds’ humanity in this life, indicating that Jove’s and Tellus’ receiving somehow lies outside that life (after death). For the medical humanities, this understanding of care suggests ways to think about both medical and cultural knowledge as forms of afterlife. Biological knowledge, for instance, is a form of knowledge that has been cheap symbicort online aggregated outside and beyond individual lives. Through clinical generalisations, anatomical knowledge, systematic literature reviews and more.

Cultural knowledge, conversely, is deeply historical and contextual—thereby inevitably also a testament to cheap symbicort online how both historical and contextual relations stretch far beyond individual lives.These ambiguities lead to a further understanding of care. Care is not only a fundamental precondition—whose impact depends on context and interpretation—care is indeed a fundamental and omnipresent condition, that continuously engenders and relies on interpretative processes.Care as holding-togetherWhen I hold my son I ruff-and-tumble play, I am also holding together forms of knowledge. I connect many different forms of knowledge—my intimate experiences with him, my research experience from disability studies, the bits of knowledge I have received from medical and educational professionals and many others—with one another. Moreover, the knowledge I produce—from the actual holding, from being skin to skin and from sensing if he cheap symbicort online cannot understand others—is used in knowledge translation.

I use it to stretch the understandings of medical professionals beyond uncertain prognoses. I also use it to connect the knowledge of the preschool teachers—a knowledge which mainly deals with so-called ordinary children—with the lives of extraordinary children such as my son.In Hyginus’ text, too, Cura holds together what otherwise would have been separate. Had it not been for Cura’s holding, and Saturn’s cheap symbicort online verdict, humanity would have belonged to either Jove or Tellus. A recent ‘appeal to the medical humanities’ uses the potential of this narrative.

In it, Kristeva et al. (2018) use the myth of Cura to explore how humanity ‘belongs to cheap symbicort online different ontological domains’ held together by care:Saturn, the God of time, settles the matter through an act of naming and by dividing and temporalising the possession of the various parts that comprise man. Jove is offered man’s soul and Tellus his body, after man’s death, while Cura will possess the creation in its lifetime since she made it. […] Thus, human life as a composite assembly of spiritual (Jove) and material elements (Tellus) is held together by Cura’s temporal care (55).In their unpacking, Cura’s holding of humanity becomes a holding-together of cheap symbicort online two forms of knowledge.

Biomedical knowledge of bios and sociocultural knowledge of zoe. Faced with situations of care—situations that neither biomedical science nor cultural studies of health can understand sufficiently—the understanding of care becomes a point of intersection between otherwise separate landscapes.This holding-together is visible in a variety of care practices. In the case of evidence-based care, for instance, temporal cheap symbicort online doing at a certain point in time and history (professional work) holds together atemporal knowledge of effects (evidence) and atemporal norms (professional ethics). The temporal care work may seem like a mere ‘application’ of these atemporal knowledges.

However, recent studies argue that both evidence and norms exist as such if and only if they are interwoven with embodied practices. While ‘evidence in cheap symbicort online clinical decision making is relentlessly situated and contextual’ (Wieringa et al. 2017, 964), so can the normative aspects only be sufficiently understood as ‘embodied process’, located at ‘the action level’ (Doane and Varcoe 2008).Jove, Tellus and Cura personify ontological orders (ways of being), and epistemological orders (ways of knowing). If we then revisit the epistemological aspect of care, a further understanding emerges.

Care is a relational matter—in the lived lives of care receivers, as well as in the work of care professionals—and it is crucial in holding together different cheap symbicort online social agents and different knowledge domains.Care as withholdingWhen I ‘play airplane’ with my son—or hold him close to me in situations where others do not understand him or vice versa—one might say that I know what I am doing. On the other hand, this holding challenges several parts of my knowledge of this world. It challenges my images of what it is to cheap symbicort online be a father, since the play differs from how most fathers do this with their children. More importantly, perhaps, the knowledge produced when I hold my son in my arms in the face of many, many abysses to come differs from much of my academic and medical knowledge, including that which is inherent in his diagnoses and prognoses.This withholding might seem, contrary to the straightforward clarity of Hyginus’ text.

However, a more detailed examination can refract these interpretations. It is particularly worth noting that the relation between Cura and the human being—that is, the cheap symbicort online fundamental ontological condition in this life—is described with a specific verbal clause with the verb possideo. Cura eum possideat (Cura shall hold him).The Oxford Latin Dictionary defines possideo thusly:To have (land) in one’s control, occupy (as a tenant, etc). (absol.) to hold land.(in general) to hold as property, b.

To take (property) into one’s keeping, appropriate.(of a sovereign, army, etc) to have control of (a country, position, etc) […] to assume or exercise control over (persons).To take or have in its power, dominate, overwhelm, possess.To fill or take up (a space) with one’s bulk.To take up wholly (a person’s time) cheap symbicort online. To absorb the thoughts and energies of someone.Possideo denotes not a general sense of holding, or a more general sense of contact or connection, but an exclusive holding—similar to the English verb to possess. Cura, then, is not only holding a humanity that belongs to both Jove and Tellus, but she is also withholding this humanity from them. This becomes even cheap symbicort online clearer if we emphasise that possideo is a transitive verb.

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

Hyginus text allows us to cheap symbicort online glimpse intimate care knowledge that connects cultural and biomedical knowledge, and that holds human life away from generalised knowledge. When Cura withholds humanity from generalised cultural knowledge (Jove) and generalised biochemical knowledge (Tellus) and care produces knowing—often described as insight, sharing and holding-together—and un-knowing.These difficulties indicate the need for an additional understanding of care. Care must be understood as a practice that holds together multiple parties and multiple forms of knowledge. However, it cheap symbicort online must also be understood as a practice—or if you will.

A form of human relation—that withholds something from knowledge.I shall hold him for as long as I shall liveThe ‘human story’ of care relations (eum possideat) will necessarily entail a human story of singular actions that to some extent can only be described in first-person singular. Eum possideam (I shall hold him). To explore this individual eum possideam, I try cheap symbicort online to ‘theorise from my subject position’ (Fournier 2019, 658). When activating my own intimate experiences, it became clear that interpretations of my eum possideam quamdiu vixerit can refract—or even fracture—theoretical notions of care.To connect intimate experiences of holding—be it in bodily care, in adverse social situations or in rough-and-tumble play—with cultural and political theory is clearly a daunting task.

Although this still seems unclear to me, I can at least outline four aspects of cheap symbicort online the refraction. First, I do hold together cultural and biomedical knowledge. When my son is in my arms, multiple cultural imaginaries are involved. My understanding of his life (and of mine) is dependent on my language and my cheap symbicort online cultural frames, and I am consistently aware of a clinical gaze.

My son’s life—and, thereby, also my own life and my care work—are viewed or observed by medical professionals, psychologists, special needs educators and preschool teachers.Second, the holding is troublesome. In a narrower sense, I note that his needs lead me to hold and even carry him in ways that most parents only do with substantially younger children. Combined with cheap symbicort online my own embodied condition, there emerges a bodily trouble, an element of exhaustion, uncertain walking and muscular pain. Regarding my cultural knowledge, it becomes clear that my own imaginaries entail expectations and understandings that somehow seem incompatible with his life.

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

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

However, his situation exposes uncertainty in a more radical way. Culturally, it exposes how I see my other children—as having quite stable chances for social reproduction—partly thanks to how I see him cheap symbicort online. Through a fatherly lens of rather unclear hopes and worries. Medically, the tests of my youngest son continuously yield inconclusive results.

This has replaced my former sense of parental comfort with gnawing anxiety over his future cheap symbicort online. Moreover, the complexities of his living leaves me, as a caregiver, with the unpredictability of his diagnostic results, rather than with stable prognoses.Fourth, these intimate situations entail a particular life-course temporality, which differs from the temporality of professional care, as well from the temporality in Hyginus’ text. In the case of professional careers, their work is regulated to certain hours (of paid work), and to certain phases of life. Most professional carers will retire, and many will pursue other forms of work at some cheap symbicort online point in time.

In Cura’s case, her care work is also time limited. The temporality of the deity’s existence cheap symbicort online is sufficient to encompass the temporality of humanity. In both cases, the life course temporality of the carer is sufficient for the imagined care work.In my parental care work, however, the temporality is insufficient rather than sufficient. In all likelihood, I will somehow care for my son for as long as I am alive.

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

Second, the temporality involved in parental care (quamdiu vixero) withholds something from the temporality of professional care. Third, something is also withheld from the ‘parental temporality.’. The need care depends on his cheap symbicort online life (quamidiu vixerit), not on mine. Several forms of knowledge, and several forms of embodied holding, are involved without being fully commensurable.

Since I cannot resolve these cheap symbicort online enigmatic forms of withholding, the theoretical understandings remain breached, implicitly pointing towards not-yet-explicable or not-yet-nameable understandings.Withholding and ambiguityMy holding of my son in my arms come with several temptations. One of them—in particular, as I am holding him, or, perhaps, shielding him—is to think that I hold some kind of vast, privileged knowledge. While this is of course true to some extent, there are more powerful movements at play. On the one hand, the complexities in the situation forces me out of the internal comfort that characterises the cheap symbicort online centre of any ontological or epistemological ‘domain’.

On the other hand, I am also forced to admit another thing. That I can hold him, but it remains unclear—to some extent—if I can know him. I cannot know if our way is exclusively ours.Similarly, intertextual analysis locates breaches in specific ‘sign-systems’, and in larger ‘social and cheap symbicort online historical material’ (Kristeva 2002, 9–10). Hence, the specific inquiries presented in this article relate to more general ways of inquiry.

When we use those notions, we connect different academic investigations, and different academic disciplines, theoretical traditions and research methodologies. In Julia Kristeva’s words, these relations are ‘temporal connections’ and ‘points of contact‘ (2002:8) and points of ‘distortion, ambiguity and contradiction’ (2002:11).The understanding of care as holding-together connects very well with the rise cheap symbicort online in interdisciplinarity within the medical humanities. The three deities Jove, Tellus and Cura are brought together in dispute, and Saturn’s verdict foreshadows how different ontological domains are held together in human life.Studying an interaction between form of knowledge—in their case. The interaction between medical imagining and patient creativity—Stahl and cheap symbicort online Stahl use the insufficiencies of medical knowledge in an argument for multiple perspectives:Although in contemporary Western society, many tend to believe the hard science provide the truest or most accurate interpretation of the natural world, it cannot exhaust the meaning of the body.

If we believe we are more than the sum of our parts, then we ought to allow for multiple and even varied interpretations of our bodies (Stahl and Stahl 2016, 159).Interpreting care as connectedness and holding-together, medical humanities scholars aim to hold together medical and cultural knowledge in new, explorative and enriching ways, and they often succeed.Such interpretations also speak to an even more radical ambition, that of academic convergence, sometimes referred to as transdisciplinary research. Such appeals are often embedded in a considerable epistemological ambition. Pointing out cheap symbicort online the insufficiencies of ‘illustrative’ or ‘additive’ work in the medical humanities, Kristeva et al. (2018) express a particularly radical version of this ambition:[W]e do not consider the humanities as a critical and potentially liberating perspective that can be applied to medicine as an object in need of repairment.

Medical humanities should not be construed as a humanistic perspective on medicine. They should rather be seen as a cross-disciplinary and cross-cultural space for a bidirectional critical interrogation of both biomedicine (simplistic reductions of life to biology) and the cheap symbicort online humanities (simplistic reductions of suffering and health injustice to cultural relativism). On the one hand, this implies breaking with the culture–nature dichotomy and considering both the humanities and medicine as biocultural practices. On the other hand, it also implies understanding that boundary work requires boundaries, and that incommensurability between various partial disciplinary perspectives can—and will—emerge (56).The ambition at stake here listens to the holding-together outlined above.

Whereas more ‘additive’ ways of connecting knowledge are valuable—for instance, when humanities-based research ‘fill cheap symbicort online the gaps’ of ‘pure’ medical research in order to facilitate evidence-based care—this is not what Hyginus’ text indicates. Just as the relation between Jove and Tellus is symmetric and mutual (they are equally necessary for the creation of humanity and will ‘hold’ remain with equal sovereignty after this life), so is the relation between Cura and the two other deities. Jove and Tellus are separated cheap symbicort online from humanity in this life, and Cura is equally separated from humanity after this life. This fable cannot be intertextually connected with asymmetrical or additive relations between knowledge fields, but it is connected with a ‘space for bidirectional critical interrogation’.It is perhaps less clear how care as un-knowing speaks to larger trends in the medical humanities.

It is therefore necessary to ask. How can understandings cheap symbicort online of care that emphasise withholding and un-knowing, including autotheoretical investigations that increase uncertainty, ambiguity and painful affects, inform knowledge production?. To outline a provisional response to this question, it is useful to return to Hyginus’ text once again. The description of Cura’s relation to humanity—Cura quoniam prima eum finxit, quamdiu vixerit, cura eum possideat (Since Cura fashioned him from the start, let Cura hold him for as long as he shall live)—should also be read with attention to grammar.

While the conjunction quoniam (since) introduces a causal clause in the indicative mood (finxit), followed by an adverbial clause in the indicative (vixerit), the cheap symbicort online resulting clause is in the subjunctive (possideat). Interestingly, this subjunctive inflection is the only use of the subjunctive mood in Hyginus’ text.This use of the subjunctive mood—sometimes called ‘independent’ usage—can have a variety of purposes. Although the usage in fable CCXX is iussive—in the sense that makes a permanent judgement—it is worth noting that the subjunctive mood is often associated with potentiality in classical Latin. Other common areas of usage include ‘questions in which the speaker or writer expresses doubt or disbelief by “thinking aloud” (deliberative), wishes that cannot or may not be fulfilled (optative), and the cheap symbicort online potentiality that something may happen or might have happened (potential)’ (Palma 2012, 377).

Moreover, it is worth noting that possideat is in present tense. Since the cheap symbicort online subjunctive mood lacks a future tense in Latin, the active present tense can also denote future actions. Hyginus’ text, then, points towards knowing and un-knowing, and towards openness to potentiality and some degree of uncertainty.When held together, withholding and uncertainty give a clear implication for the medical humanities as a form of academic practice. The epistemological ambitiousness in medical humanities should be supplemented with what one might call epistemological modesty.

Such modesty is rooted in the specifics of care, and in the relation between complexity and synthesis cheap symbicort online. What is at stake in care research—if we take the abovementioned complexities into account—is a ‘bidirectional space’, and an ever-expanding and exponentially multidimensional space. When medical humanities emerged, it was only a question of time before the field began to involve other humanities and social sciences disciplines than those involved in the initial phase. Similarly, the growth of critical medical humanities steadily cheap symbicort online increases the engagements with all kinds of critical research frontiers, in the social sciences as well as in the humanities.

At least in an area such as studies of care—where the intimacy is so acutely palpable—it will become increasingly clear that the medical humanities will remain ‘outnumbered’ or ‘overpowered’ by the analytical complexities the field itself brings forth.Some scholars in the critical humanities have argued that scholars should ‘embrace’ this kind of overpowering (Viney, Callard, and Woods 2015, 2–7). However, Hyginus’ text complicates the relation between care practices (Cura), culture (Jove) and biomedicine (Tellus) regardless of such embraces. Although care holds humanity at the expense of cheap symbicort online the other forms of knowing, his holding neither implies any disregard for humanities-based nor medical knowledge. Rather, the unpacking presented in this article demonstrates how care brings forth an epistemological modesty.

Only an cheap symbicort online epistemologically modest way of doing medical humanities can address the intimate and enigmatic qualities of care.Discussion. Scholarly and analytical contributionWhile the textual and autotheoretical analyses presented in this paper followed the suggestion from Kristeva et al—to we question ‘the cultural distinction between the objectivity of (medical) science and the subjectivity of culture’ (2018:55)—it nevertheless ended in an emphasis on intimate withholding. This withholding—be it epistemological, theoretical or inherent in the intimate experience of holding or embracing my son away from an abyss—is relevant to the medical humanities in general. However, it is also a contribution to four more specific tendencies in the available literature.First, the cheap symbicort online unpacking contributes to feminist care research.

Beginning with the canonical work on ‘a different voice’ by Gilligan (1982), feminist care research has increasingly emphasised the knowledge multitude involved in care. More recent research also shows a multitude of empirical delineations. While some scholars cheap symbicort online reserve the term for face-to-face interaction, or for situations characterised by asymmetrical dependency, others do not. The investigation in this article brings forth additional multitude by combining academic disciplines that rarely interact—care research, linguistic analysis of Latin texts, romanticism studies and autotheoretical analysis work—and implies many possibilities for further research.Second, the autotheoretical interpretations can contribute to the research field sometimes known as ethics of care.

Following such works as the book Learning from my Daughter by Kittay Kittay (2019, xx), where she proposes that the relation of parental care provides ‘the only universal and morally significant property that all humans possess’, I aim to shed light on how care work engenders ethical thinking. My holding of my son in my arms—as well as the withholding that both this holding and Hyginus’ text entail—is as political and ethical as it is personal and cheap symbicort online embodied.Third, this paper also relates to a more critical strain of ethics of care. Pettersen (2008) work, for instance, demonstrates how the ethics of care ’subverts the public/private dimension altogether’, thereby allowing for a broader range of criticism (45). Moreover, Fletcher and Piemonte (2017) shed light on how healthcare practices constitute a ’quiet subversion’ cheap symbicort online of neoliberal cultural structures.

Arguably, both intimate withholding and epistemological overwhelming shows the power involved in such subversions.Fourth, I hope to contribute to the strand of research—in care research as well as in disability studies—that relate to the work of Julia Kristeva. On the one hand, the rethinking presented in this paper dovetails with her perspectives on how intimate aspects of care destabilise the larger frameworks, cultural structures that are nevertheless sustained by those actions of care. The autotheoretical exploration towards the emblematic formulation eum possideam quamdiu vixero (I shall hold him for as long as I shall live) might also respond fruitfully to Kristeva’s account of how her “living with […] the neurological difficulties of my son David” (2013, 220) lead her to explore maternity as I want that cheap symbicort online you be (2013, 229). On the other hand, I also try to challenge what I see as an epistemological and political optimism in Kristeva’s work.Data availability statementNo data are available.

Since this is an autoethnographic investigation, primary data will not be available.Ethics statementsPatient consent for publicationNot required.Ethics approvalThe ethical aspects have been reviewed by the research management at the Work Research Institute. See also footnote 1.AcknowledgmentsI would like to thank Eivind Engebretsen and cheap symbicort online John Ødemark for their encouragements, and the anonymous reviewers for their helpful suggestions.Notes1. Patient and public involvement statement. Although there is no public involvement in the writing of this paper, the autotheoretical approach does of course involve my son.

This approach hinders full anonymisation, just like cheap symbicort online his way of living in this world hinders informed consent in the traditional sense. The approach also excludes the potential for full anonymisation. The consent is therefore, in consultation with his mother, given by me as his legal guardian..

Welcome to the first issue of 2022! where to buy symbicort pills. We have several exciting changes to announce in the new year. To begin with, we have been increasing our number of published submissions per issue, including some of our content exclusively online where to buy symbicort pills (the most common way that our readers access the journal). In addition, we have put out additional calls for submissions and look forward to receiving new work.We have spent the last 4 years working towards social justice, accessibility, global …IntroductionThe subject of care is gaining importance within the medical humanities, but it also remains elusive.

Hence, this paper aims to unpack theoretical notions of care in a way that integrates the elusiveness rather than trying to avoid it. It also responds to a recent article by Julia Kristeva et al, where to buy symbicort pills in which they claim that care holds humanity (Kristeva et al. 2018).When in need of theoretical elaboration or re-development, medical humanities scholars have sometimes evoked Greek or Roman myths, such as those of Narcissus, Hephaestus or Leto (Cilione, Marinozzi, and Gazzaniga 2019. Pannese 2011.

Schott 2017) where to buy symbicort pills. Similarly, this article evokes the Roman myth of Cura to unpack theoretical understandings of care. In this myth, known from the writings of the first century mythographer Hyginus, humanity is created from clay by a personification of care. It has proven useful to thinkers as where to buy symbicort pills diverse as Martin Heidegger, Arthur Kleinman (Kleinman and van der Geest 2009) and Julia Kristeva (Kristeva (2012), Kristeva et al.

2018). While utilisation by Heidegger 1927, 196–200 ‘challenges the myth of self-sufficiency and individual atomization that that has shaped much of modern Western philosophy’ (Froese 2005, 16), both Kleinman and Kristeva explore the tension between universalised knowledge and the singularity of individual patients and intimate care (Engebretsen, Fraas Henrichsen, and Ødemark 2020).While none of where to buy symbicort pills these scholars engage with Hyginus’ Fabulae directly, I use the text as an ‘engine’ in a four-step endeavour. This endeavour follows Brandy Schillace’s description of the medical humanities as ‘a field that at its core considers the human story behind and within medicine, its history, its cultural valence and its influence on practice’ Schillace (2017, 139).First, a ‘human story’ entails agency, the things that humans do in their lives. While the ‘appeal’ from Kristeva et al uses a case from intercultural psychoanalysis, the authors have previously researched a variety of professional healthcare practices (Engebretsen 2016.

Engebretsen, Sandset, and where to buy symbicort pills Ødemark 2017. Hetrick et al. 2017). However, it is crucial to note that where to buy symbicort pills Cura (in Hyginus’ text) will ‘hold’ humanity quamdiu vixerit (for as long as he shall live).

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

Suddenly, it where to buy symbicort pills feels as if I am not only holding or embracing him away from an abyss. I am also holding him—or, perhaps, shielding him—in the face of many, many abysses to come.In rough-and-tumble play, I often lift him up with my arms straight—holding him while he straightens his body, and ‘is an airplane’. Although this play is exhausting, particularly since I live with cerebral palsy, this is nevertheless an activity where we can be close to one another. When I hold him up like this, or suddenly ‘crash’ him safely down next to me on the bed, we are skin to skin, but not exactly like I used to be with his older siblings, and I suddenly have the impression that where to buy symbicort pills it also differs from how most fathers do this with their children.

I cannot know if our way is exclusively ours, but while I hold him, that is how it feels.Second, a human story ‘behind and within medicine’—or, for that matter, behind and within any social field—consists of underlying notions and involved cultural categories. Hence, this article aims to unpack theoretical notions of care with reference to the thinkers mentioned above. Throughout, I try to unpack how different aspects of care ‘follow’ each other in an analytical ‘path’ or trajectory, as if in where to buy symbicort pills a story (Kristeva et al. 2018).Third, the investigation of the human story of care must become an investigation of ‘history’ and ‘cultural valence’.

In order to think historically, the analytical ‘engine’ includes Hyginus’ text, and 18th and 19th century uses of Cura and related motifs.Fourth, I follow Schillace’s advice to examine ‘influence on practice’. In addition to the practice of parental care, the exploration ends with a discussion of medical humanities as where to buy symbicort pills practice. When medical humanities scholars ’consider’ the human story of care, they bring together different perspectives and forms of knowledge. In this case, however both the intertextual analyses and the autotheoretical work indicate that those complexities might overpower our where to buy symbicort pills theoretical perspectives.

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

Fournier describes autotheory as a specific form of academic practice:In autotheory as a conceptual and performative feminist practice, artists, writers, and critics use the first person, or related practices of self-imaging (Jones, Self/Image 134), to process, perform, enact, iterate, and wrestle with the hegemonic discourses of ‘theory’ and philosophy, extending the feminist practice of theorizing from one’s subject positioning as a way of engendering insights into questions related to aesthetics, politics, ethics, and social and cultural theory. In autotheory, one’s embodied experiences become the material through which one theorizes, and, in a similar where to buy symbicort pills way, theory becomes the discourse through which one’s lived experience is refracted (658).In Fournier’s definition, theory functions as ‘hegemonic discourses’, and as discourses through which one’s lived experience is refracted. Contrary to this emphasis on language—as well as their emphasis on language elsewhere (Heidegger 1927Heidegger 1937. Kleinman 1995.

Kristeva 2019)—neither Kristeva nor Kleinman or where to buy symbicort pills Heidegger focus on Hyginus’ text. In contrast to this body of research, this article emphasizes the interpretative potential of the original text. In addition to grammatical analysis, I utilize the well-known concept of intertextuality, as introduced where to buy symbicort pills by Kristeva (1980). However, I use it in a less structuralist sense than in her early formulations in Desire in Language.

Instead, I approach Hyginus’ text in line with her approach in ‘Nos Deux’ or a short (hi)story of intertextuality (Kristeva 2002).For me, intertextuality is mostly a way of making history go down in us. We, two where to buy symbicort pills texts, two destinies, two psyches. It is a way if introducing history to structuralism and its orphan, lonely texts and readings. […] the etymological meaning of ‘semeion’ is a distinctive mark, a trace, an engraved or written sign, that makes us think of the Freudian ‘psychical’ marks, called drives, rhythmical articulations of embodied impulses and psychical movements.

In this sense, the meaning of the socio-historical aspect of intertextuality, as where to buy symbicort pills already developed by Bakhtin and Barthes, acquires a new significance. Within each sociolect or ideology, (both well-established sign-systems) there will always be a breach of subjectivity carrying out a hidden matrix of pre-symbolic forces able to make history move on through all its short and singular stories. (2002. 8-9)First, this means that I study Hyginus’ text not as a ‘lonely text’, where to buy symbicort pills but as part of a historical trajectory.

The ‘singular stories’ are used to disturb the orderly (structural) notions of both textual and philosophical analysis.Second, I interpret Hyginus’ text—as well as other utilisations of the myth—with focus on traces. Or, more specifically, to find ‘distinctive marks’ relevant to the same material as in where to buy symbicort pills authotheretical work. €˜embodied impulses and psychical movements’. This, however, does not mean that the texts are reduced to a canvas for an engraved sign.

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

The first story in Hyginus’ fable begins thus:Cura cum quendam fluvium transiret, vidit cretosum lutum. Sustulit cogitabunda et coepit fingere hominem.When Cura was crossing a certain river, she saw some clayey mud. She took it up thoughtfully and began to fashion a man.Before interpreting this first story, we must first acknowledge that the fable is an alteration or addition in a philological where to buy symbicort pills sense. While Fabulae is almost exclusively filled with Greek myths, the Cura fable’s position at the end of the collection suggests, ‘that this particularly Roman tale was simply added to the end of the existing narrative portion’ (Smith and Trzaskoma 2007, xlix).

Moreover, philological research consistently argues that fable CCXX ‘hinges on Latin wordplay’ (Smith and Trzaskoma 2007, xlviii).More specifically, Hyginus, in the Cura fable, alters a prevailing myth in late antiquity, one that he where to buy symbicort pills has even told earlier in the pages of Fabulae. That of how the titan Prometheus fashioned man from clay. In fable CXLII (‘Pandora’), Hyginus states explicitly that Prometheus lapeti filius primus homines ex luto finxit (Prometheus, son of Iapetus, first fashioned men from clay).Most Greek and Roman sources place the Prometheus plasticator motif within a three-stage narrative. First, Prometheus shapes the human where to buy symbicort pills from clay, and then Athena gives the creature inner life.

Finally, sometimes after Prometheus has given humankind fire against the orders of Jove, Jove intervenes and sentences Prometheus to eternal punishment in the Caucasus.To understand the human story—to which both this motif and Hyginus’ text belong—comparison is needed. First, we must note that the neutral or slightly idyllic depictions in Hyginus and Ovid (respectively) differ from earlier and less optimistic renderings in Republican times. The poet Propertius, for instance, in his Libri Elegiarum from the first-century BC, laments and elaborates on how Prometheus was careless in his creating where to buy symbicort pills. Here, the adverbial clause ille parum caute casts Prometheus as a figure of titanic heedlessness:ille parum caute pectoris egit opus.corpora disponens mentem non vidit in arto:The making of man’s reason he performed with too little care.Arranging our bodies, he overlooked the mind in his handiwork (Goold 1990, 232).Carelessness, the counterpart to the notion of care, is involved in the Prometheus plasticator motif throughout antiquity.

The adverbial clause ille parum caute does not derive from the same verb as Cura, but rather from the verb caveo (to take precautions, to be aware of something). Nevertheless, Prometheus’ lack of care underlines how Hyginus’ where to buy symbicort pills text is an inversion these earlier texts. Instead of being created in a careless way, humanity is created by care.To be fair, a singular text never exhausts the potential of the history to which it belongs. Specific understandings—in this case where to buy symbicort pills.

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

/ A race resembling me, / To suffer, to weep, / To enjoy, to be glad, / And thee to scorn, /As I!. (Bowring 2015, 182)Typical of Goethe’s Sturm und Drang period, where to buy symbicort pills his Prometheus Plasticator is a figure of creativity, and embodies ‘ideals of freedom and rebellion’ (Raggio 1958, 44). Goethe’s poem emphasised the ‘autonomous existence’ of mankind (Dougherty 2006, 95), thereby constituting an ‘emancipatory gesture’ (Edgar 2002, 161). Hyginus’ text inverts both classical and romantic evokings of the myth by inserting dependency rather than autonomy and expansion.

To shed further light on this inversion, we must first unpack the name of the personification that Hyginus instals in the Prometheus where to buy symbicort pills Plasticator motif. Cura.The name Cura is derived from the verb curo. The Oxford Latin Dictionary defines the verb thus:To watch over, look after, care for.To tend to, to do what is necessary to.To administer remedies, to treat (a sick person, wound, disease, etc).To have charge of. (absol.) to be in command.To devote oneself to, to cultivate (a person).To undertake, to see to (a task or a responsibility).To regard where to buy symbicort pills with anxiety or interest, worry or care about, heed.As we can see, the first three senses of this verb invert the Prometheus motif we found in Propertius.

To instal the personification of curo in the motif is to instal carefulness, attentiveness and responsibility in a motif usually filled with lack of care. The third sense also injects an aspect that is where to buy symbicort pills totally absent in classical anthropogenies. That of human frailty. It also relates to aspects of human lives that are particularly relevant to understanding care, illness, disease and disability.The fifth and sixth senses of the word similarly invert the romantic depictions of Prometheus motif.

The anthropogenic act is no longer about rebellion and expansion, but where to buy symbicort pills devotion and responsibility. The seventh sense finally reverses the political impulse of the Sturm und Drang—the desire for increased individual freedom and self-expansion in every imaginable way—into worrying and heeding.In addition to these intertextual relations, it is also fruitful to note the verbs that connect humanity to the three deities. While Cura’s creating is described with the verb fingo (in Hyginus. €˜fingere’), Jove’s and Tellus’ acts of giving are described by do where to buy symbicort pills (in Hyginus.

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

Cogitabunda (thoughtful) where to buy symbicort pills. Although an adjective in the purely grammatical sense, this is the only word with an adverbial function in Hyginus’ text. Hence, it is the lone term specifying how actions and interactions take place. While Greco-Roman deities often act from rage (as in the conflict between the titans and Olympian deities) or desire (as in the story of Zeus and Leda), Cura acts thoughtfully or with thought.As we can see, the adverb cogitabunda is attached to the picking up of the clay, not primarily to the act of where to buy symbicort pills creation.

Sustulit cogitabunda et coepit fingere hominem. Moreover, the temporal clause ‘and begun to’ (et coepit) also locates this thought as prior to the creation of humanity. To understand care as thoughtful, then, is about understanding thoughts and imaginaries ‘involved’ in care, and it includes thoughts and imaginaries that ‘pre-exist’, ‘frame’ or ‘underpin’ care and care work.It is useful to explore how the meaning of cogitabunda is preserved and unveiled in the work of the German philosopher, poet and literary where to buy symbicort pills critic Johann Gottfried Herder (1744–1803). In his poem ‘Das Kind der Sorge’ (1787), Herder follows Hyginus very closely (Bernays 1869, 158-163).

This poem was widely read, and it provided the basis for Goethe’s use of the Cura motif in Faust II (1832). Finally, Heidegger also comments on the poem and cites where to buy symbicort pills it in extenso when he develops his notion of Sorge as the fundamental human condition (Dye 2009, 207–218)., Kristeva (2001), too, refers several times to Herder, and even refers directly to this poem (25–26). The first stanza describes the moment of creation thus:Einst saß am murmelnden StromeDie Sorge nieder und sann:Da bildet im Traum der GedankenIhr Finger ein leimernes Bild (von Herder 1889, 75).Once by a murmuring riverSorrow sat down, and there,In a vision, thought to form with the touchA wavering figure (Groth 2016, 31).von Herder positions the moment of creation as a radically imaginative act in at least three ways. First, the gaze is far where to buy symbicort pills more manifest in von Herder’s text than in Hyginus’.

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

This phrase, roughly translatable as ‘in the dream of thoughts’, roots humanity in a singular image (or dream) that consist of or belong to several different thoughts or ways of thinking. This tension between individuality and multitude dovetails with research on the knowledge complexities involved in care.Third, the word ‘Traum’ (dream) in Traum der where to buy symbicort pills Gedanken does not denote unreality, fantasy or illusion. For von Herder, dreams are not the opposite of reality, but thoughts beyond or above manifest reality (Wirklichkeit überhöhenden Gedankens). A dream of thoughts, then, is an experience or interpretation wherein the understanding of a phenomenon moves beyond how the phenomenon presently is, to what it should or could be.

Just as Hyginus’ cogitabunda can, if we interpret in intertextual connection with von Herder’s Traum der Gedanken, also refract my experiences of holding my son in my where to buy symbicort pills arms. This is true of the experiences of performing actions that seem strange or unintelligible to those around us, but particularly true of the feeling of doing this in a way that is uniquely ours. The combination where to buy symbicort pills of these feelings—where the socially estranged ways of caring is fundamentally ours and integral to my parenting—engenders or entails a striving ‘upwards’. This striving is not limited to the idealisation that so often takes place in parenting, but is also a utopian, imaginative glimpse of a world wherein the both of us truly belong.In other words, the Cura motif foreshadows the ‘horizontal’ complexities involved in care (multiple cultural imaginaries, multiple forms of knowledge).

It also foreshadows ‘vertical’ complexities, through which care imaginations include both underlying categories and überhöhende dimensions. These overarching or utopical dimensions, that both stem from and go beyond the localised, singular where to buy symbicort pills imaginations of care, is known by many names in and beyond the medical humanities. Examples include ’underlying values’, ‘ethical content of particular practices’, ‘transformative learning’ and many others (Ayala 2019, 269. Pettersen 2008, 188.

Winthrop 2003).Cogitabunda, can mean to be thoughtful and to be where to buy symbicort pills ‘full of thoughts’. The adverbial clause im Traum der Gedanken by von Herder (1888, 533), similarly, also signifies something unclear or disorganised. In his poetotological treatise Über Bild, Dictung und Fabel (1888, 533), von Herder juxtaposes this state with being in Leidenschaft (in passion), in Verrückung (in madness) or nicht auf seiner Hut (off guard). There is complexity and openness—perhaps even fantasy where to buy symbicort pills or at least exploration—in this.

When I hold my son in my arms connecting different realms of thought. As in ruff-and-tumble-play, these realms are also at play as I think.The quarrel where to buy symbicort pills of the deities. Culture, nature and careAfter the first narrative, the second deals with a quarrel between the deities Cura, Jove and Tellus. Once humanity has been given inner life, the focus in Hyginus’ texts shifts from creating to name-giving:Cum vellet Cura nomen suum imponere, Iovis prohibuit suumque nomen ei dandum esse dixit.

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

Instead, Cura is a ‘deification of abstract ideas’, a common feature of Roman culture (Axtell 1907). Hence, it becomes clear that the quarrel deals with ontological ideas, more specifically with the ontology of humanity. Each deity proposes a ‘location’ in classical ontology.The philosopher where to buy symbicort pills John T. Hamilton has used the myth of Cura to explore how any understanding of security presupposes both care and carefulness.

He underlines how this ‘locating’ somehow names humanity after something that is neither identical nor particularly resembling humanity:The controversy over the creature’s name strives to resolve the issue of the figure’s proper being, without the aid of physical resemblance, where to buy symbicort pills without the talent for self-reflection. In my view, the debate over the name revolves on whether humanity is essentially atemporal (Telluric matter or Iovian spirit) or instead fundamentally temporal and constituted by time and history (Hamilton 2013, 71).It is worth noting that the deities are not offering or suggesting certain framings of human life. Hyginus’ text—in particular, the fact that Jove forbade any name other than his own—indicates conflicts between perspectives and disciplines. The imaginative richness involved in care, indicated by Hyginus cogitabunda or by the plural in von Herder’s Traum der Gedanken, is where to buy symbicort pills a plurality where incommensurabilities remain.

In my view, the myth of Cura points towards three possible but incommensurable ways of studying, describing and interpreting care (corresponding to Jove, Tellus and Cura, respectively):As a cultural or semantic phenomenon, elucidated in terms of meaning or more or less idealised notions.As a biological phenomenon, elucidated in medical, psychological or other health-related terms.As a relational phenomenon, elucidated in terms of care work (professional or not).Although it is necessary to understand care in all these ways, it is nevertheless impossible to fully merge them or produce those understandings simultaneously. Hence, it is necessary to add a more epistemologically oriented aspect of care. Care is fundamentally imaginative and context-dependent, and stands where to buy symbicort pills in-between otherwise incommensurable interpretative domains.Saturn’s verdict. The continuous presence of careIn the third narrative in Hyginus, the quarrel is somehow resolved when the deities choose Saturn as their judge.

Sadly, this part of the text is fragmented. There is agreement, however, that where to buy symbicort pills Saturn’s verdict clarifies that Jove will receive human souls, while Tellus will receive the body post mortem:Tu Iovis quoniam spiritum dedisti, <…>. Corpus recipito. Cura quoniam prima eum finxit, quamdiu vixerit, cura where to buy symbicort pills eum possideat.

Sed quoniam de nomine eius controversia est, homo vocetur quoniam ex humo videtur esse factusJove, since you gave him spirit, let [Tellus] receive his body. Since Cura fashioned him from the start, let Cura possess him for as long as he lives. But since where to buy symbicort pills there is controversy about his name, let him be called homo, since he seems to be made from humus.Let us begin by pointing out that Saturn’s verdict exposes yet another way in which Hyginus’ text alters the Prometheus plasticator motif. In most classical renderings, Prometheus is a trickster, and a transgressor from whom humanity is eventually separated.

After discovering his transgressions, the Olympian deities chain Prometheus to a mountain in the Caucasus, and humanity lives on without him. The relation between humanity and its creator is therefore temporary where to buy symbicort pills. Hyginus, in contrast, makes it clear that humanity will remain under the guardianship of Cura quamdiu vixerit ‘for as long as he shall live’.The significance of this difference becomes clearer if we compare Hyginus’ text to Ovid’s use of the Prometheus plasticator motif in Metamorphoses. After describing the original moment when Prometheus created Humanity, Ovid goes on to describe the human condition:quam satus Iapeto mixtam pluvialibus undis / finxit in effigiem moderantum cuncta deorum, / pronaque cum spectent animalia cetera terram, / os homini sublime dedit caelumque videre(Ovid 1997, 47)so that his new creation, upright man, / was made in image of commanding gods?.

/ On earth the brute creation bends its gaze, / but man was given a lofty where to buy symbicort pills countenance / and was commanded to behold the skies. / and with an upright face may view the stars (Melville and Kenney 2009, 76).As we can see, Ovid’s Prometheus creates a strong and vital human being. Humanity seems not dependent on care or assistance, but ‘made in image of commanding gods’. In Ovid, human life is essentially an where to buy symbicort pills independent life which resembles the lives of gods (in effigiem moderantum cuncta deorum).

It is common—and tempting—to imagine care relations as exceptions in human lives. In care research, for instance, one often reserves care needs for vulnerable groups, thereby contrasting them with some kind of where to buy symbicort pills original, non-vulnerable state. In life-course research, similarly, care leaves life as people move into adolescence and adulthood, only to re-enter it in the special cases of disability, serious illness or old age. Hyginus’ text, in contrast, opens up for a rethinking of care as a fundamental, continuous part of human lives.This is essentially an ontological argument.

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

Cura somehow ‘holds’ humanity in this life, indicating that Jove’s and Tellus’ receiving somehow lies outside that life (after death). For the medical humanities, this understanding of care suggests ways to think about both medical and cultural knowledge as forms of afterlife. Biological knowledge, for instance, is a form of knowledge that has been where to buy symbicort pills aggregated outside and beyond individual lives. Through clinical generalisations, anatomical knowledge, systematic literature reviews and more.

Cultural knowledge, conversely, is deeply historical and contextual—thereby inevitably also a testament to how both historical and contextual relations stretch far beyond individual lives.These ambiguities lead to a where to buy symbicort pills further understanding of care. Care is not only a fundamental precondition—whose impact depends on context and interpretation—care is indeed a fundamental and omnipresent condition, that continuously engenders and relies on interpretative processes.Care as holding-togetherWhen I hold my son I ruff-and-tumble play, I am also holding together forms of knowledge. I connect many different forms of knowledge—my intimate experiences with him, my research experience from disability studies, the bits of knowledge I have received from medical and educational professionals and many others—with one another. Moreover, the where to buy symbicort pills knowledge I produce—from the actual holding, from being skin to skin and from sensing if he cannot understand others—is used in knowledge translation.

I use it to stretch the understandings of medical professionals beyond uncertain prognoses. I also use it to connect the knowledge of the preschool teachers—a knowledge which mainly deals with so-called ordinary children—with the lives of extraordinary children such as my son.In Hyginus’ text, too, Cura holds together what otherwise would have been separate. Had it not been for Cura’s holding, and Saturn’s verdict, humanity would have belonged to where to buy symbicort pills either Jove or Tellus. A recent ‘appeal to the medical humanities’ uses the potential of this narrative.

In it, Kristeva et al. (2018) use the myth of Cura to explore how humanity ‘belongs to different ontological domains’ held together by care:Saturn, the God of time, settles the matter through an act of naming and by dividing and temporalising the possession where to buy symbicort pills of the various parts that comprise man. Jove is offered man’s soul and Tellus his body, after man’s death, while Cura will possess the creation in its lifetime since she made it. […] Thus, human life as a composite assembly of spiritual (Jove) and material elements (Tellus) is held together by Cura’s temporal care (55).In their unpacking, Cura’s holding of humanity becomes a holding-together of two forms where to buy symbicort pills of knowledge.

Biomedical knowledge of bios and sociocultural knowledge of zoe. Faced with situations of care—situations that neither biomedical science nor cultural studies of health can understand sufficiently—the understanding of care becomes a point of intersection between otherwise separate landscapes.This holding-together is visible in a variety of care practices. In the case of evidence-based care, for instance, temporal doing at a certain point in time and history (professional work) holds together atemporal knowledge of effects (evidence) and atemporal norms (professional where to buy symbicort pills ethics). The temporal care work may seem like a mere ‘application’ of these atemporal knowledges.

However, recent studies argue that both evidence and norms exist as such if and only if they are interwoven with embodied practices. While ‘evidence in where to buy symbicort pills clinical decision making is relentlessly situated and contextual’ (Wieringa et al. 2017, 964), so can the normative aspects only be sufficiently understood as ‘embodied process’, located at ‘the action level’ (Doane and Varcoe 2008).Jove, Tellus and Cura personify ontological orders (ways of being), and epistemological orders (ways of knowing). If we then revisit the epistemological aspect of care, a further understanding emerges.

Care is a relational matter—in the lived lives of care receivers, as well as in the work of care professionals—and it is crucial in holding together different social agents and different knowledge domains.Care as withholdingWhen I ‘play airplane’ with my son—or hold him close to me in situations where others do not understand him or vice versa—one might say that I where to buy symbicort pills know what I am doing. On the other hand, this holding challenges several parts of my knowledge of this world. It challenges my images of what it is to be a father, since the play differs from how where to buy symbicort pills most fathers do this with their children. More importantly, perhaps, the knowledge produced when I hold my son in my arms in the face of many, many abysses to come differs from much of my academic and medical knowledge, including that which is inherent in his diagnoses and prognoses.This withholding might seem, contrary to the straightforward clarity of Hyginus’ text.

However, a more detailed examination can refract these interpretations. It is particularly where to buy symbicort pills worth noting that the relation between Cura and the human being—that is, the fundamental ontological condition in this life—is described with a specific verbal clause with the verb possideo. Cura eum possideat (Cura shall hold him).The Oxford Latin Dictionary defines possideo thusly:To have (land) in one’s control, occupy (as a tenant, etc). (absol.) to hold land.(in general) to hold as property, b.

To take (property) into one’s keeping, appropriate.(of a sovereign, army, etc) to have control of (a country, position, etc) […] to assume or exercise control over (persons).To take or have in its power, dominate, overwhelm, possess.To fill or take up (a space) with one’s bulk.To take up wholly (a person’s where to buy symbicort pills time). To absorb the thoughts and energies of someone.Possideo denotes not a general sense of holding, or a more general sense of contact or connection, but an exclusive holding—similar to the English verb to possess. Cura, then, is not only holding a humanity that belongs to both Jove and Tellus, but she is also withholding this humanity from them. This becomes even where to buy symbicort pills clearer if we emphasise that possideo is a transitive verb.

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

Hyginus text allows us to glimpse intimate care knowledge that connects cultural where to buy symbicort pills and biomedical knowledge, and that holds human life away from generalised knowledge. When Cura withholds humanity from generalised cultural knowledge (Jove) and generalised biochemical knowledge (Tellus) and care produces knowing—often described as insight, sharing and holding-together—and un-knowing.These difficulties indicate the need for an additional understanding of care. Care must be understood as a practice that holds together multiple parties and multiple forms of knowledge. However, it must also be understood as a practice—or if you will where to buy symbicort pills.

A form of human relation—that withholds something from knowledge.I shall hold him for as long as I shall liveThe ‘human story’ of care relations (eum possideat) will necessarily entail a human story of singular actions that to some extent can only be described in first-person singular. Eum possideam (I shall hold him). To explore this individual eum possideam, I try where to buy symbicort pills to ‘theorise from my subject position’ (Fournier 2019, 658). When activating my own intimate experiences, it became clear that interpretations of my eum possideam quamdiu vixerit can refract—or even fracture—theoretical notions of care.To connect intimate experiences of holding—be it in bodily care, in adverse social situations or in rough-and-tumble play—with cultural and political theory is clearly a daunting task.

Although this still seems unclear where to buy symbicort pills to me, I can at least outline four aspects of the refraction. First, I do hold together cultural and biomedical knowledge. When my son is in my arms, multiple cultural imaginaries are involved. My understanding of his life (and of mine) is dependent on my language and my cultural frames, and I am where to buy symbicort pills consistently aware of a clinical gaze.

My son’s life—and, thereby, also my own life and my care work—are viewed or observed by medical professionals, psychologists, special needs educators and preschool teachers.Second, the holding is troublesome. In a narrower sense, I note that his needs lead me to hold and even carry him in ways that most parents only do with substantially younger children. Combined with my own embodied condition, there where to buy symbicort pills emerges a bodily trouble, an element of exhaustion, uncertain walking and muscular pain. Regarding my cultural knowledge, it becomes clear that my own imaginaries entail expectations and understandings that somehow seem incompatible with his life.

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

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

However, his situation exposes uncertainty in a more radical way. Culturally, it exposes how I see my other children—as having quite stable chances for social reproduction—partly thanks to how where to buy symbicort pills I see him. Through a fatherly lens of rather unclear hopes and worries. Medically, the tests of my youngest son continuously yield inconclusive results.

This has replaced my former where to buy symbicort pills sense of parental comfort with gnawing anxiety over his future. Moreover, the complexities of his living leaves me, as a caregiver, with the unpredictability of his diagnostic results, rather than with stable prognoses.Fourth, these intimate situations entail a particular life-course temporality, which differs from the temporality of professional care, as well from the temporality in Hyginus’ text. In the case of professional careers, their work is regulated to certain hours (of paid work), and to certain phases of life. Most professional carers will retire, and many will pursue where to buy symbicort pills other forms of work at some point in time.

In Cura’s case, her care work is also time limited. The temporality of the deity’s existence is where to buy symbicort pills sufficient to encompass the temporality of humanity. In both cases, the life course temporality of the carer is sufficient for the imagined care work.In my parental care work, however, the temporality is insufficient rather than sufficient. In all likelihood, I will somehow care for my son for as long as I am alive.

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

Second, the temporality involved in parental care (quamdiu vixero) withholds something from the temporality of professional care. Third, something is also withheld from the ‘parental temporality.’. The need care depends on his life where to buy symbicort pills (quamidiu vixerit), not on mine. Several forms of knowledge, and several forms of embodied holding, are involved without being fully commensurable.

Since I cannot resolve these enigmatic forms of withholding, the theoretical understandings remain breached, implicitly pointing towards not-yet-explicable or where to buy symbicort pills not-yet-nameable understandings.Withholding and ambiguityMy holding of my son in my arms come with several temptations. One of them—in particular, as I am holding him, or, perhaps, shielding him—is to think that I hold some kind of vast, privileged knowledge. While this is of course true to some extent, there are more powerful movements at play. On the one hand, the complexities in the situation forces me out of the internal comfort that characterises the centre of any ontological or epistemological where to buy symbicort pills ‘domain’.

On the other hand, I am also forced to admit another thing. That I can hold him, but it remains unclear—to some extent—if I can know him. I cannot know if our way is exclusively ours.Similarly, intertextual analysis locates where to buy symbicort pills breaches in specific ‘sign-systems’, and in larger ‘social and historical material’ (Kristeva 2002, 9–10). Hence, the specific inquiries presented in this article relate to more general ways of inquiry.

When we use those notions, we connect different academic investigations, and different academic disciplines, theoretical traditions and research methodologies. In Julia Kristeva’s words, these relations are ‘temporal connections’ and ‘points of contact‘ (2002:8) and points of ‘distortion, ambiguity and contradiction’ (2002:11).The understanding where to buy symbicort pills of care as holding-together connects very well with the rise in interdisciplinarity within the medical humanities. The three deities Jove, Tellus and Cura are brought together in dispute, and Saturn’s verdict foreshadows how different ontological domains are held together in human life.Studying an interaction between form of knowledge—in their case. The interaction between medical imagining and patient creativity—Stahl and Stahl use the insufficiencies of medical knowledge in an argument for multiple perspectives:Although in contemporary Western society, many tend to believe the hard science provide the truest or where to buy symbicort pills most accurate interpretation of the natural world, it cannot exhaust the meaning of the body.

If we believe we are more than the sum of our parts, then we ought to allow for multiple and even varied interpretations of our bodies (Stahl and Stahl 2016, 159).Interpreting care as connectedness and holding-together, medical humanities scholars aim to hold together medical and cultural knowledge in new, explorative and enriching ways, and they often succeed.Such interpretations also speak to an even more radical ambition, that of academic convergence, sometimes referred to as transdisciplinary research. Such appeals are often embedded in a considerable epistemological ambition. Pointing out the insufficiencies of where to buy symbicort pills ‘illustrative’ or ‘additive’ work in the medical humanities, Kristeva et al. (2018) express a particularly radical version of this ambition:[W]e do not consider the humanities as a critical and potentially liberating perspective that can be applied to medicine as an object in need of repairment.

Medical humanities should not be construed as a humanistic perspective on medicine. They should rather be seen as a cross-disciplinary and cross-cultural space for a bidirectional critical interrogation of both biomedicine (simplistic where to buy symbicort pills reductions of life to biology) and the humanities (simplistic reductions of suffering and health injustice to cultural relativism). On the one hand, this implies breaking with the culture–nature dichotomy and considering both the humanities and medicine as biocultural practices. On the other hand, it also implies understanding that boundary work requires boundaries, and that incommensurability between various partial disciplinary perspectives can—and will—emerge (56).The ambition at stake here listens to the holding-together outlined above.

Whereas more ‘additive’ ways of connecting knowledge are valuable—for instance, when humanities-based research ‘fill the gaps’ of ‘pure’ medical research in where to buy symbicort pills order to facilitate evidence-based care—this is not what Hyginus’ text indicates. Just as the relation between Jove and Tellus is symmetric and mutual (they are equally necessary for the creation of humanity and will ‘hold’ remain with equal sovereignty after this life), so is the relation between Cura and the two other deities. Jove and Tellus are separated from humanity in this where to buy symbicort pills life, and Cura is equally separated from humanity after this life. This fable cannot be intertextually connected with asymmetrical or additive relations between knowledge fields, but it is connected with a ‘space for bidirectional critical interrogation’.It is perhaps less clear how care as un-knowing speaks to larger trends in the medical humanities.

It is therefore necessary to ask. How can understandings of care that emphasise withholding and un-knowing, where to buy symbicort pills including autotheoretical investigations that increase uncertainty, ambiguity and painful affects, inform knowledge production?. To outline a provisional response to this question, it is useful to return to Hyginus’ text once again. The description of Cura’s relation to humanity—Cura quoniam prima eum finxit, quamdiu vixerit, cura eum possideat (Since Cura fashioned him from the start, let Cura hold him for as long as he shall live)—should also be read with attention to grammar.

While the conjunction quoniam (since) introduces a causal clause in the where to buy symbicort pills indicative mood (finxit), followed by an adverbial clause in the indicative (vixerit), the resulting clause is in the subjunctive (possideat). Interestingly, this subjunctive inflection is the only use of the subjunctive mood in Hyginus’ text.This use of the subjunctive mood—sometimes called ‘independent’ usage—can have a variety of purposes. Although the usage in fable CCXX is iussive—in the sense that makes a permanent judgement—it is worth noting that the subjunctive mood is often associated with potentiality in classical Latin. Other common areas of usage include ‘questions in which the speaker or writer expresses doubt or disbelief by “thinking aloud” (deliberative), wishes where to buy symbicort pills that cannot or may not be fulfilled (optative), and the potentiality that something may happen or might have happened (potential)’ (Palma 2012, 377).

Moreover, it is worth noting that possideat is in present tense. Since the subjunctive mood lacks a future tense where to buy symbicort pills in Latin, the active present tense can also denote future actions. Hyginus’ text, then, points towards knowing and un-knowing, and towards openness to potentiality and some degree of uncertainty.When held together, withholding and uncertainty give a clear implication for the medical humanities as a form of academic practice. The epistemological ambitiousness in medical humanities should be supplemented with what one might call epistemological modesty.

Such modesty is rooted in the specifics of care, and where to buy symbicort pills in the relation between complexity and synthesis. What is at stake in care research—if we take the abovementioned complexities into account—is a ‘bidirectional space’, and an ever-expanding and exponentially multidimensional space. When medical humanities emerged, it was only a question of time before the field began to involve other humanities and social sciences disciplines than those involved in the initial phase. Similarly, the growth of critical medical humanities steadily increases where to buy symbicort pills the engagements with all kinds of critical research frontiers, in the social sciences as well as in the humanities.

At least in an area such as studies of care—where the intimacy is so acutely palpable—it will become increasingly clear that the medical humanities will remain ‘outnumbered’ or ‘overpowered’ by the analytical complexities the field itself brings forth.Some scholars in the critical humanities have argued that scholars should ‘embrace’ this kind of overpowering (Viney, Callard, and Woods 2015, 2–7). However, Hyginus’ text complicates the relation between care practices (Cura), culture (Jove) and biomedicine (Tellus) regardless of such embraces. Although care holds humanity at the expense of the other forms of knowing, his holding neither implies any disregard for humanities-based nor where to buy symbicort pills medical knowledge. Rather, the unpacking presented in this article demonstrates how care brings forth an epistemological modesty.

Only an epistemologically modest way of doing medical humanities can where to buy symbicort pills address the intimate and enigmatic qualities of care.Discussion. Scholarly and analytical contributionWhile the textual and autotheoretical analyses presented in this paper followed the suggestion from Kristeva et al—to we question ‘the cultural distinction between the objectivity of (medical) science and the subjectivity of culture’ (2018:55)—it nevertheless ended in an emphasis on intimate withholding. This withholding—be it epistemological, theoretical or inherent in the intimate experience of holding or embracing my son away from an abyss—is relevant to the medical humanities in general. However, it is also a contribution to four more specific tendencies in the available literature.First, the unpacking where to buy symbicort pills contributes to feminist care research.

Beginning with the canonical work on ‘a different voice’ by Gilligan (1982), feminist care research has increasingly emphasised the knowledge multitude involved in care. More recent research also shows a multitude of empirical delineations. While some scholars where to buy symbicort pills reserve the term for face-to-face interaction, or for situations characterised by asymmetrical dependency, others do not. The investigation in this article brings forth additional multitude by combining academic disciplines that rarely interact—care research, linguistic analysis of Latin texts, romanticism studies and autotheoretical analysis work—and implies many possibilities for further research.Second, the autotheoretical interpretations can contribute to the research field sometimes known as ethics of care.

Following such works as the book Learning from my Daughter by Kittay Kittay (2019, xx), where she proposes that the relation of parental care provides ‘the only universal and morally significant property that all humans possess’, I aim to shed light on how care work engenders ethical thinking. My holding of my son in my arms—as well as the withholding where to buy symbicort pills that both this holding and Hyginus’ text entail—is as political and ethical as it is personal and embodied.Third, this paper also relates to a more critical strain of ethics of care. Pettersen (2008) work, for instance, demonstrates how the ethics of care ’subverts the public/private dimension altogether’, thereby allowing for a broader range of criticism (45). Moreover, Fletcher where to buy symbicort pills and Piemonte (2017) shed light on how healthcare practices constitute a ’quiet subversion’ of neoliberal cultural structures.

Arguably, both intimate withholding and epistemological overwhelming shows the power involved in such subversions.Fourth, I hope to contribute to the strand of research—in care research as well as in disability studies—that relate to the work of Julia Kristeva. On the one hand, the rethinking presented in this paper dovetails with her perspectives on how intimate aspects of care destabilise the larger frameworks, cultural structures that are nevertheless sustained by those actions of care. The autotheoretical exploration towards the emblematic formulation eum possideam quamdiu vixero (I where to buy symbicort pills shall hold him for as long as I shall live) might also respond fruitfully to Kristeva’s account of how her “living with […] the neurological difficulties of my son David” (2013, 220) lead her to explore maternity as I want that you be (2013, 229). On the other hand, I also try to challenge what I see as an epistemological and political optimism in Kristeva’s work.Data availability statementNo data are available.

Since this is an autoethnographic investigation, primary data will not be available.Ethics statementsPatient consent for publicationNot required.Ethics approvalThe ethical aspects have been reviewed by the research management at the Work Research Institute. See also footnote 1.AcknowledgmentsI would like to thank Eivind Engebretsen and John Ødemark where to buy symbicort pills for their encouragements, and the anonymous reviewers for their helpful suggestions.Notes1. Patient and public involvement statement. Although there is no public involvement in the writing of this paper, the autotheoretical approach does of course involve my son.

This approach hinders full anonymisation, just like his way of living in where to buy symbicort pills this world hinders informed consent in the traditional sense. The approach also excludes the potential for full anonymisation. The consent is therefore, in consultation with his mother, given by me as his legal guardian..

Symbicort patent expiration

The number of people symbicort patent expiration living http://agilexperts.co.uk/buy-propecia-online-canada/ with and beyond cancer is rising rapidly. With earlier detection and better treatments many people are living symbicort patent expiration for years following a diagnosis of cancer. Healthcare systems need to adapt to manage this demand and better meet the needs of this growing population.1The consequences of cancer and its treatment are common, can arise at any point and may be long lasting.2 They can have a significant impact on daily life and include a range of physical symptoms and late effects such as pain, fatigue, bowel dysfunction.

Psychological concerns such as anxiety, depression and symbicort patent expiration fear of recurrence. And social impacts including disruption to previously enjoyed activities, ability to work and relationships.3 Lifestyle changes symbicort patent expiration and long-term medications to reduce the risk of recurrence, hospital appointments, routine surveillance and monitoring for signs of potential disease progression can create additional burden. People may lack confidence and struggle to manage the impact on their daily lives resulting in disrupted lives and futures.4 This can exacerbate mental health problems such as depression and anxiety.

Low confidence to self-manage and depression have been associated with worse health and well-being outcomes up to 2 years after diagnosis.5 In addition, as most people are diagnosed with cancer in later life, many are also living with symbicort patent expiration long-term conditions which can exacerbate problems further.6 Understanding how best to support people to manage the consequences of cancer and its treatment to reduce health crises and quality of life is a global concern.7The good news is that appropriate support can reduce health crises, enhance confidence to manage and improve mental health, quality of life and other outcomes.8 9 The National Health Service (NHS) Long Term Plan10 states that by 2021 ‘where appropriate every person diagnosed with cancer will have access to personalized care, including needs assessment, a care plan, and health and well-being information and support’ (p 61). Tailoring support and care according to need as soon as possible following diagnosis presents an opportunity to enhance confidence to manage consequences of cancer, mental health and quality of life outcomes during treatment.11 This support should continue beyond treatment because the consequences of treatment may persist over time, late effects may emerge which require self-management and long-term lifestyle changes are usually required to reduce the risk of recurrence. New models of care are being developed and tested to support people after treatment and the evidence base is growing.12–14Self-management is a term symbicort patent expiration used to describe what people living with long-term conditions do to manage their condition.

It includes ‘the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition’ (p 177).15 Self-management has more recently been applied in the context of cancer and additionally includes routine surveillance and self-monitoring for signs of disease progression symbicort patent expiration to reduce the risk of recurrence. The benefits of successful self-management include reduced crises involving emergency admissions to hospital, improved quality of life and greater confidence to manage the impact of cancer on everyday life in spite of challenging consequences and the associated disruption.16 17While it is recognised that people need support to manage the wide-ranging impact on their everyday lives, self-management support is inconsistently delivered in cancer care.7 A recent global call to action has highlighted the need for improved quality of self-management support to enable people to develop the knowledge, confidence and skills they need for optimal self-management.7 Without adequate self-management support, patients with cancer and survivors may struggle to manage the impact of cancer and treatment in their daily lives resulting in poorer health and well-being and poorer quality of survival.4There is evidence that the right self-management support at the right time enables people to manage consequences of cancer during treatment and beyond.8 12 13 Howell et al18 demonstrate that both organisational and clinician barriers and enablers need to be considered in advance of implementation of self-management support to inform specific strategies for implementation within cancer care. The three cancer centres in Howell et al’s18 study each identified barriers and enablers to implementation and readiness to change which require different approaches to support implementation symbicort patent expiration.

Howell et al18 highlight key considerations, based on their experience in ambulatory cancer care involving patients with colorectal, lung and lymphoma cancer, that need to be acknowledged and planned for prior to implementation of self-management support in cancer care. First, healthcare professionals and the organisations in which they work need support in shifting from a paternalistic symbicort patent expiration culture to one that engages patients as partners in their care. Second, healthcare professionals and those in administration and management need to understand symbicort patent expiration what self-management support is, what it involves and what the benefits could be for people living with and beyond cancer.

Third, recognition that healthcare professionals need support, tools and skills to enhance their practice of self-management support.Howell et al’s18 study focuses on the preimplementation phase in a treatment setting. We can also learn symbicort patent expiration from a UK study which assessed the introduction of supported self-management to the follow-up care pathway. The traditional approach to follow-up care where all patients have routine follow-up appointments and regular surveillance does not adequately address patients’ needs and is not sustainable given the growing number of cancer survivors.19 The TrueNTH UK Supported Self-management and Follow-up Care Pathway (TrueNTH UK pathway) was introduced into parts of the NHS for men who have had primary prostate cancer treatment and are suitable for self-managed follow-up.20 The TrueNTH UK pathway includes a Band 4 support worker who is the key point of contact and support for men after treatment.

A 4-hour workshop which provides information and supports the development of symbicort patent expiration men’s skills and confidence to self-manage. Remote monitoring with hospital appointments only when test symbicort patent expiration results indicate further investigation is necessary. Access to test results through an online portal.

And holistic symbicort patent expiration needs assessment made through contact with the support worker. This new model of care has been shown to be more efficient and cost-effective than traditional follow-up and is acceptable to patients.12 It has also been adapted for patients with colorectal and breast cancer. A toolkit to support implementation of supported self-managed follow-up has been produced.20The findings from Howell et al’s18 study and the TrueNTH UK pathway align with a recent call to action from an international group of researchers and healthcare professionals—the Global Partners for Self-Management in Cancer—regarding workforce development and readying healthcare providers for successful self-management support.7 These include:A necessary cultural shiftHowell et al18 highlight the need for healthcare professionals and the organisations in which they work to shift from a paternalistic culture to a partnership arrangement where patients and healthcare professionals work symbicort patent expiration together.

This partnership will engage symbicort patent expiration patients in their care and recovery to identify what matters to them, rather than what is the matter with them, and support them to be effective and confident self-managers equipped with the skills they need.7 8To achieve this, Howell et al18 emphasise the need for healthcare professionals as well as healthcare organisation administrators and managers to be involved in the design of new self-management programmes. This will allow a full understanding of concerns, barriers and enablers for the implementation of self-management support. Subsequent implementation strategies symbicort patent expiration will engage with professional and organisational understanding of what self-management support is, why it matters, and attempt to overcome barriers arising from this understanding.Early barriers experienced in implementing the TrueNTH UK pathway included lack of buy-in from clinicians.

Concerns about patient safety. Concern that health professionals would have limited contact with those patients symbicort patent expiration doing well after treatment. Concern that introduction symbicort patent expiration of the pathway could result in reduced funding.

Lack of understanding of the components of the new pathway. Challenges of having to navigate multiple symbicort patent expiration administrative systems. And challenges implementing and integrating the information technology (IT) system.

These barriers were identified in the early stages of implementation and where these challenges were overcome, the pathway was successfully introduced, was acceptable to patients and reduced costs.12 Howell et al’s study suggests that these barriers, both in terms of healthcare professional and organisational readiness to change, could have been identified at an earlier stage and strategies developed to inform smoother uptake prior to implementation.Enablers to support the cultural shift needed to implement the TrueNTH UK pathway included identifying clinical leads to support early engagement with a wide range of stakeholders including commissioners, clinical governance and service improvement leads, IT to support integration of self-management support into digital systems and administrative support to overcome the complexity brought about by multiple administrative systems symbicort patent expiration. A working group led by a healthcare professional (eg, urologist, oncologist, clinical nurse specialist) responsible for implementation of the TrueNTH UK pathway and taking symbicort patent expiration decisions on the development of clinical guidelines and governance protocols supported the implementation and delivery of safe and effective follow-up care. This group also supported teams to maximise understanding of the new pathway and what it entails, as well as collection of data to support accurate cost modelling.Preparing the workforceHowell et al18 emphasise that for successful implementation, a common understanding of what self-management in cancer care means, why it is important and what good self-management support looks like is a necessary starting point.

Healthcare professionals need support to acquire the knowledge and skills required to enable patients to self-manage effectively and agree core curricula to support symbicort patent expiration this.7TrueNTH UK also emphasised the importance of wide stakeholder engagement to identify concerns and needs of different stakeholders throughout this process to develop a common understanding and identify local need and encourage buy-in. A local clinical champion to help drive this forward is beneficial to support clinical teams responsible for implementation to understand what is required and involve them in early discussions to shape the pathways, guidance and associated protocols.20Core set of outcome measuresBoth Howell et al18 and TrueNTH UK highlighted the importance of data to demonstrate the benefits of supported self-management, such as reduced emergency admissions. In order to determine whether or not self-management support is effective, consensus as to desired outcomes also needs to be symbicort patent expiration established.

An agreed symbicort patent expiration core set of patient-reported outcome measures is also required. Evidence suggests that self-efficacy to manage the consequences of cancer and its treatment should be included as one indicator of successful self-management as it is both amenable to intervention and is a key predictor of health and well-being outcomes.5 21Expand reach and access to self-management supportBoth SMARTCare (Howell et al18) and TrueNTH UK pathway are designed to form part of routine care. The TrueNTH UK pathway has been integrated into routine care and is therefore not an symbicort patent expiration optional extra.

All eligible patients are placed on symbicort patent expiration the pathway. Patients are supported to understand what self-management support is and how to engage with it. In contrast, optional programmes tend to attract well-educated patients who already self-manage well.22 Consequently, those implementing self-management support need to consider the diversity of need within the population served so symbicort patent expiration that those with greatest need are the focus of attention.

The needs of the population served need to be assessed with involvement of those typically under-represented. Meaningful patient engagement to symbicort patent expiration uncover needs should feed into the development of self-management support. Self-management support needs to come in a number of forms including workshops, symbicort patent expiration digital support and one-to-one clinical conversations that are culturally sensitive and inclusive of those with low health literacy.ConclusionFor self-management support to be a success, we need to anticipate, uncover and overcome organisational and healthcare professional barriers to implementation, have a clear understanding of what good looks like, have agreement regarding how to evidence successful self-management support and gather evidence of good practice so that this can be shared, replicated and adapted as appropriate.

Champions in organisations across the globe are needed to lead the way in high-quality and consistent self-management support to improve the lives of those living with and beyond cancer.Ethics statementsPatient consent for publicationNot required.Central venous access catheters are often used for patients requiring repeated infusions, blood sampling, invasive monitoring or where peripheral access is difficult. For intravenous access of up to 2 weeks in duration, a midline catheter is usually satisfactory, but for longer-term use, peripherally inserted central catheters (PICCs) are increasingly used, including in clinical areas outside of critical care.1Despite enabling complex care to be delivered more easily, these catheters are associated with significant complications—including central line associated bloodstream symbicort patent expiration s (CLABSI), venous thromboembolism (VTE) and line occlusion. Such complications can result in poor patient outcomes and are associated with prolonged hospital stays and increased costs of care.

In one series of 438 patients with central lines, 61% reported at least one complication, including bloodstream .2 Accumulating evidence suggests that being symbicort patent expiration selective about who receives PICC lines, of what type and for what duration, could reduce the frequency of such complications. For example, the use of multilumen PICC lines when a single lumen would suffice is associated with increased early and thrombosis.3 In a Canadian study, CLABSI was reported in 5.0% of 907 double-lumen catheters compared with 2.4% of 618 single lumen catheters.3 Thrombosis leading to reinsertion was also much higher with double-lumen lines.3 A simple change in practice of inserting single lumen devices, unless there was clear justification for the contrary, may therefore symbicort patent expiration result in reductions in complications as well as major cost savings.Concurrently, evidence about best practices in implementing interventions to reduce central-line associated complications is also emerging. Critical care units in Michigan, USA, have long demonstrated leadership in research to reduce catheter-related complications.

In 2004, Pronovost and colleagues used a package of evidence-based interventions in 108 intensive care units (ICUs) with the aim of reducing CLABSI, including s associated with PICC lines.4 A significant reduction was symbicort patent expiration maintained throughout the 18 months of the study. A key element was the designation of a physician and a nurse as team leaders at each site. This inspired a UK project called Matching Michigan that demonstrated, in symbicort patent expiration a stepped-wedge study design, that a combination of technical and behavioural interventions could lead to significant reductions in CLABSI rates in the critical care setting.5 However, these programmes have been limited to the critical care setting,6 can be labour-intensive and the long-term effects are uncertain.7 While simpler-to-implement educational programmes have been associated with marked reductions in the rate of CLABSI,8 training and care processes need to be refreshed regularly and supported with feedback on performance to be effective.9PICCs are now widely used, including in outpatient settings, and complications other than are more common than for other central venous catheters.

A broader approach, applicable outside of critical care and for a wider set of complications, is therefore needed.Enter the Michigan Appropriateness Guide for Intravenous Catheters (‘MAGIC’), which was developed to determine when PICC insertion is appropriate, with the aim of reducing the incidence of the associated complications.10 11 Specifically, the major focus of MAGIC was to reduce the use of PICCs for less than 5 days or with multiple lumens and to avoid use in patients with symbicort patent expiration chronic kidney disease.11 12 Implementation of MAGIC now includes online learning, access to subject matter experts, quarterly knowledge-sharing meetings, feedback on performance and pay-for-performance incentives.11 12 Initial research demonstrated preliminary evidence of effectiveness, reducing inappropriate PICC use by 13.8% in one hospital compared with nine control sites (OR 0.86. 95% CI 0.74 to 0.99). PICC line usage decreased and single lumen line use increased, but, although catheter occlusion fell significantly, VTE and CLABSI were not significantly reduced in this relatively small scale study,11 and until now, the impact on patient outcomes in a large number of patients across a range of hospitals had not been explored.It is in this context that a further study in this issue12 now builds on this work by demonstrating that the MAGIC programme also reduces the incidence of symbicort patent expiration complications.

Data were extracted from case records on PICC insertions across 52 hospitals, with inappropriate use more common in seriously ill patients and CLABSI more common in those judged ‘inappropriate’. Following the implementation of MAGIC, catheter occlusion fell from 10.6% to 7.4% of PICC lines, symbicort patent expiration VTE from 3.3% to 2.5% and CLABSI from 1.8% to 1.4%. While the study design does not allow causation to be proven, these effects were statistically significant, suggesting symbicort patent expiration the programme to be effective, and that it should be implemented elsewhere.

This therefore raises the question of whether the same benefits are likely to be realised elsewhere.It is clear that inappropriate selection of both patients and intravenous catheter types is an expensive and widespread international problem. In France, when pharmacist approval was required for placement of PICCs, 5% of requests were declined as being inappropriate.13 In Canada, application of the MAGIC definitions suggested 13%–21% of 3479 PICC placements to be symbicort patent expiration inappropriate.14 The MAGIC programme, or similar initiatives, are therefore likely to minimise harm to patients from complications associated with inappropriate use of PICCs in other countries. Clear evidence-based criteria for selection of patients for PICC insertion, combined with multidisciplinary communication, as proposed in the MAGIC programme, are likely to be important internationally in deciding when to place a PICC rather than another access device.

However, adaptation to local methods and contexts of healthcare delivery are likely to be symbicort patent expiration needed. This is for several symbicort patent expiration reasons. First, countries outside the USA may not share the pay-for-performance framework that provided incentives to hospitals participating in the MAGIC project.Second, some countries may have already introduced other interventions to reduce complications of central venous catheters.

In India, basic training in hand hygiene and hub care, repeated until a high level symbicort patent expiration of knowledge was demonstrated in tests, resulted in CLABSI reduction from 8.7 to 4.5/1000 catheter days.13 In Italy, training of healthcare workers based on a package of evidence-based preventative measures including removal of catheters when no longer needed, reduced CLABSI from 8.6 to 2.6/1000 catheter days.14Third, the method of delivery of PICC insertion may vary by country, which has important implications for whom to target with the MAGIC intervention. Delivery of PICC insertion in a number of countries, as in USA, follows a variety of models, including specialist nurse training and delivery, off-site insertion or use of interventional radiology vascular access teams.15 Selection of patients and insertion of central venous catheters, particularly outside critical care, are often the responsibility of a dedicated specialist team with access to uasound or interventional radiology. High levels of training improve standards of insertion and reduce rates, especially when combined with surveillance and feedback of performance.4 5 However, dedicated symbicort patent expiration specialist teams may be asked to insert PICCs for inappropriate indications, or where there are inadequate skills or resources in the clinical teams to use alternatives.

Others have reduced use of PICC catheters by improving training in uasound guided peripheral intravenous catheter placement.16Fourth, to be effective on a national scale, particularly where there are wide variations in performance between individual hospitals, quality improvement programmes such as MAGIC need to be supported by robust and independent surveillance symbicort patent expiration that incorporates feedback systems.5 MAGIC was introduced into an established quality improvement infrastructure and adequate staffing. Surveillance is time-consuming when reliant on manual data collection and, if resources are limited, surveillance may not be possible, or data collectors may only observe samples of the patient population. The advent of electronic patient record systems allows more patients to be monitored symbicort patent expiration and in the ICU can be both more sensitive and more specific than manual collection of data for healthcare-acquired s.17 These surveillance systems are gradually improving and spreading, providing continuous feedback and peer comparison, based on semiautomated electronic data collection.18 However, the software packages required for extraction of the data are expensive and, in some countries, many hospitals do not have electronic patient records.

National implementation of MAGIC could be achieved by using an existing surveillance and improvement network, or by linking local quality improvement projects, to allow peer comparisons. One such system started in the UK in 2016 and has been recruiting ICUs in surveillance of bacteraemia and catheter s, including PICC-related s.18 This in Critical Care symbicort patent expiration Quality Improvement Programme is a joint initiative between professional organisations representing adult, paediatric and neonatal intensive care, microbiology and control, supported by Public Health England. In its first year, 45% of adult ICUs took part and reported 2.3 ICU-associated CLABSI per 1000 central venous catheter days while also demonstrating marked variation between symbicort patent expiration sites in both practice and outcomes.

Broadening such a programme to include other complications of PICC would be relatively straightforward.Now is the time to see if MAGIC or similar programmes can be extended to different healthcare systems internationally. The quality of patient care may be improved considerably if the practices of the best performers were adopted more widely, whether in ensuring the appropriate means of vascular access is used and/or in improving training symbicort patent expiration in insertion and care of the line. According to the context in each country, a mixture of incentives and requirements for education, surveillance and feedback of complication rates associated with PICCs, driven by leadership from professional bodies and programmes such as MAGIC, are likely to be needed for significant national improvements to be made.Ethics statementsPatient consent for publicationNot required..

The number where to buy symbicort pills of people living with and beyond cancer is rising rapidly http://agilexperts.co.uk/buy-propecia-online-canada/. With earlier detection and better treatments where to buy symbicort pills many people are living for years following a diagnosis of cancer. Healthcare systems need to adapt to manage this demand and better meet the needs of this growing population.1The consequences of cancer and its treatment are common, can arise at any point and may be long lasting.2 They can have a significant impact on daily life and include a range of physical symptoms and late effects such as pain, fatigue, bowel dysfunction. Psychological concerns such as anxiety, depression where to buy symbicort pills and fear of recurrence.

And social impacts including disruption to previously enjoyed activities, ability to work and relationships.3 Lifestyle changes and long-term medications to reduce the risk of recurrence, hospital appointments, routine surveillance and monitoring for signs of potential where to buy symbicort pills disease progression can create additional burden. People may lack confidence and struggle to manage the impact on their daily lives resulting in disrupted lives and futures.4 This can exacerbate mental health problems such as depression and anxiety. Low confidence to self-manage and depression have been associated with worse health and well-being outcomes up to 2 years after diagnosis.5 In addition, as most people are diagnosed with cancer in later life, many are also living with long-term conditions which can exacerbate problems further.6 Understanding how best to support people to manage where to buy symbicort pills the consequences of cancer and its treatment to reduce health crises and quality of life is a global concern.7The good news is that appropriate support can reduce health crises, enhance confidence to manage and improve mental health, quality of life and other outcomes.8 9 The National Health Service (NHS) Long Term Plan10 states that by 2021 ‘where appropriate every person diagnosed with cancer will have access to personalized care, including needs assessment, a care plan, and health and well-being information and support’ (p 61). Tailoring support and care according to need as soon as possible following diagnosis presents an opportunity to enhance confidence to manage consequences of cancer, mental health and quality of life outcomes during treatment.11 This support should continue beyond treatment because the consequences of treatment may persist over time, late effects may emerge which require self-management and long-term lifestyle changes are usually required to reduce the risk of recurrence.

New models of care are being developed and tested to support people after treatment and the evidence base is growing.12–14Self-management where to buy symbicort pills is a term used to describe what people living with long-term conditions do to manage their condition. It includes ‘the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition’ (p 177).15 Self-management has more recently been applied in the context of cancer and additionally includes routine surveillance and where to buy symbicort pills self-monitoring for signs of disease progression to reduce the risk of recurrence. The benefits of successful self-management include reduced crises involving emergency admissions to hospital, improved quality of life and greater confidence to manage the impact of cancer on everyday life in spite of challenging consequences and the associated disruption.16 17While it is recognised that people need support to manage the wide-ranging impact on their everyday lives, self-management support is inconsistently delivered in cancer care.7 A recent global call to action has highlighted the need for improved quality of self-management support to enable people to develop the knowledge, confidence and skills they need for optimal self-management.7 Without adequate self-management support, patients with cancer and survivors may struggle to manage the impact of cancer and treatment in their daily lives resulting in poorer health and well-being and poorer quality of survival.4There is evidence that the right self-management support at the right time enables people to manage consequences of cancer during treatment and beyond.8 12 13 Howell et al18 demonstrate that both organisational and clinician barriers and enablers need to be considered in advance of implementation of self-management support to inform specific strategies for implementation within cancer care. The three where to buy symbicort pills cancer centres in Howell et al’s18 study each identified barriers and enablers to implementation and readiness to change which require different approaches to support implementation.

Howell et al18 highlight key considerations, based on their experience in ambulatory cancer care involving patients with colorectal, lung and lymphoma cancer, that need to be acknowledged and planned for prior to implementation of self-management support in cancer care. First, healthcare professionals and the organisations in which they work need support in shifting from where to buy symbicort pills a paternalistic culture to one that engages patients as partners in their care. Second, healthcare professionals and those where to buy symbicort pills in administration and management need to understand what self-management support is, what it involves and what the benefits could be for people living with and beyond cancer. Third, recognition that healthcare professionals need support, tools and skills to enhance their practice of self-management support.Howell et al’s18 study focuses on the preimplementation phase in a treatment setting.

We can also learn from where to buy symbicort pills a UK study which assessed the introduction of supported self-management to the follow-up care pathway. The traditional approach to follow-up care where all patients have routine follow-up appointments and regular surveillance does not adequately address patients’ needs and is not sustainable given the growing number of cancer survivors.19 The TrueNTH UK Supported Self-management and Follow-up Care Pathway (TrueNTH UK pathway) was introduced into parts of the NHS for men who have had primary prostate cancer treatment and are suitable for self-managed follow-up.20 The TrueNTH UK pathway includes a Band 4 support worker who is the key point of contact and support for men after treatment. A 4-hour workshop which provides information and supports where to buy symbicort pills the development of men’s skills and confidence to self-manage. Remote monitoring where to buy symbicort pills with hospital appointments only when test results indicate further investigation is necessary.

Access to test results through an online portal. And holistic needs assessment made where to buy symbicort pills through contact with the support worker. This new model of care has been shown to be more efficient and cost-effective than traditional follow-up and is acceptable to patients.12 It has also been adapted for patients with colorectal and breast cancer. A toolkit to support implementation of supported self-managed follow-up has been produced.20The findings from Howell et al’s18 study and the TrueNTH UK pathway align with a recent call to action from an international group of researchers and healthcare professionals—the Global Partners for Self-Management in Cancer—regarding workforce development and readying healthcare providers for successful self-management support.7 These include:A necessary cultural shiftHowell et al18 highlight the need for where to buy symbicort pills healthcare professionals and the organisations in which they work to shift from a paternalistic culture to a partnership arrangement where patients and healthcare professionals work together.

This partnership will engage patients in their care and recovery to identify what matters to them, rather than what is the matter with them, and support them to be effective and confident self-managers equipped with the skills they need.7 8To achieve this, Howell et al18 emphasise the need for healthcare professionals as well as healthcare organisation administrators and managers to be involved in the design of new self-management programmes where to buy symbicort pills. This will allow a full understanding of concerns, barriers and enablers for the implementation of self-management support. Subsequent implementation strategies will engage with professional and organisational understanding of what self-management support is, why it matters, and attempt to overcome barriers arising from this understanding.Early barriers experienced in implementing the TrueNTH UK pathway where to buy symbicort pills included lack of buy-in from clinicians. Concerns about patient safety.

Concern that health professionals would have limited contact with where to buy symbicort pills those patients doing well after treatment. Concern that introduction of the pathway could result where to buy symbicort pills in reduced funding. Lack of understanding of the components of the new pathway. Challenges of where to buy symbicort pills having to navigate multiple administrative systems.

And challenges implementing and integrating the information technology (IT) system. These barriers were identified in the early stages of implementation and where these challenges were overcome, the pathway was successfully introduced, was acceptable to patients and reduced costs.12 Howell et al’s study suggests that these barriers, both in terms of healthcare professional and organisational readiness to change, could have been identified at an earlier stage and strategies developed to inform smoother uptake prior to implementation.Enablers to support the cultural shift where to buy symbicort pills needed to implement the TrueNTH UK pathway included identifying clinical leads to support early engagement with a wide range of stakeholders including commissioners, clinical governance and service improvement leads, IT to support integration of self-management support into digital systems and administrative support to overcome the complexity brought about by multiple administrative systems. A working group led by a healthcare professional (eg, urologist, oncologist, clinical nurse specialist) responsible where to buy symbicort pills for implementation of the TrueNTH UK pathway and taking decisions on the development of clinical guidelines and governance protocols supported the implementation and delivery of safe and effective follow-up care. This group also supported teams to maximise understanding of the new pathway and what it entails, as well as collection of data to support accurate cost modelling.Preparing the workforceHowell et al18 emphasise that for successful implementation, a common understanding of what self-management in cancer care means, why it is important and what good self-management support looks like is a necessary starting point.

Healthcare professionals need support to acquire the knowledge and skills required to enable patients to self-manage effectively and agree core curricula to support this.7TrueNTH UK also emphasised the importance of wide stakeholder engagement to identify concerns and needs of different stakeholders throughout where to buy symbicort pills this process to develop a common understanding and identify local need and encourage buy-in. A local clinical champion to help drive this forward is beneficial to support clinical teams responsible for implementation to understand what is required and involve them in early discussions to shape the pathways, guidance and associated protocols.20Core set of outcome measuresBoth Howell et al18 and TrueNTH UK highlighted the importance of data to demonstrate the benefits of supported self-management, such as reduced emergency admissions. In order to determine whether or not self-management support is effective, consensus where to buy symbicort pills as to desired outcomes also needs to be established. An agreed core set of patient-reported outcome where to buy symbicort pills measures is also required.

Evidence suggests that self-efficacy to manage the consequences of cancer and its treatment should be included as one indicator of successful self-management as it is both amenable to intervention and is a key predictor of health and well-being outcomes.5 21Expand reach and access to self-management supportBoth SMARTCare (Howell et al18) and TrueNTH UK pathway are designed to form part of routine care. The TrueNTH UK pathway has been integrated into routine where to buy symbicort pills care and is therefore not an optional extra. All eligible patients are placed on the where to buy symbicort pills pathway. Patients are supported to understand what self-management support is and how to engage with it.

In contrast, optional programmes tend to attract well-educated patients who already self-manage well.22 Consequently, those implementing self-management support need to consider the diversity of need within the population served where to buy symbicort pills so that those with greatest need are the focus of attention. The needs of the population served need to be assessed with involvement of those typically under-represented. Meaningful patient engagement to uncover needs should feed where to buy symbicort pills into the development of self-management support. Self-management support needs to come in a number of forms including workshops, digital support and one-to-one clinical conversations that are culturally sensitive and inclusive of where to buy symbicort pills those with low health literacy.ConclusionFor self-management support to be a success, we need to anticipate, uncover and overcome organisational and healthcare professional barriers to implementation, have a clear understanding of what good looks like, have agreement regarding how to evidence successful self-management support and gather evidence of good practice so that this can be shared, replicated and adapted as appropriate.

Champions in organisations across the globe are needed to lead the way in high-quality and consistent self-management support to improve the lives of those living with and beyond cancer.Ethics statementsPatient consent for publicationNot required.Central venous access catheters are often used for patients requiring repeated infusions, blood sampling, invasive monitoring or where peripheral access is difficult. For intravenous access of up to 2 weeks in duration, a midline catheter is usually satisfactory, but for longer-term use, peripherally inserted central catheters (PICCs) are increasingly used, including in clinical areas outside where to buy symbicort pills of critical care.1Despite enabling complex care to be delivered more easily, these catheters are associated with significant complications—including central line associated bloodstream s (CLABSI), venous thromboembolism (VTE) and line occlusion. Such complications can result in poor patient outcomes and are associated with prolonged hospital stays and increased costs of care. In one series of 438 patients with central lines, 61% reported at least one complication, including bloodstream .2 Accumulating evidence suggests that being selective about where to buy symbicort pills who receives PICC lines, of what type and for what duration, could reduce the frequency of such complications.

For example, the use of multilumen PICC lines when a single lumen would suffice is associated with increased early and thrombosis.3 In a Canadian study, CLABSI was reported in 5.0% of 907 double-lumen catheters compared with 2.4% of 618 single lumen where to buy symbicort pills catheters.3 Thrombosis leading to reinsertion was also much higher with double-lumen lines.3 A simple change in practice of inserting single lumen devices, unless there was clear justification for the contrary, may therefore result in reductions in complications as well as major cost savings.Concurrently, evidence about best practices in implementing interventions to reduce central-line associated complications is also emerging. Critical care units in Michigan, USA, have long demonstrated leadership in research to reduce catheter-related complications. In 2004, where to buy symbicort pills Pronovost and colleagues used a package of evidence-based interventions in 108 intensive care units (ICUs) with the aim of reducing CLABSI, including s associated with PICC lines.4 A significant reduction was maintained throughout the 18 months of the study. A key element was the designation of a physician and a nurse as team leaders at each site.

This inspired a UK project called Matching Michigan that demonstrated, in a where to buy symbicort pills stepped-wedge study design, that a combination of technical and behavioural interventions could lead to significant reductions in CLABSI rates in the critical care setting.5 However, these programmes have been limited to the critical care setting,6 can be labour-intensive and the long-term effects are uncertain.7 While simpler-to-implement educational programmes have been associated with marked reductions in the rate of CLABSI,8 training and care processes need to be refreshed regularly and supported with feedback on performance to be effective.9PICCs are now widely used, including in outpatient settings, and complications other than are more common than for other central venous catheters. A broader approach, applicable outside of critical care and for a wider set of complications, is therefore needed.Enter the Michigan Appropriateness Guide for Intravenous Catheters (‘MAGIC’), which was developed to determine when PICC insertion is appropriate, with the aim of reducing the incidence of the associated complications.10 11 Specifically, the major focus of MAGIC was to reduce the use of PICCs for less than 5 days or with multiple lumens and to avoid use in patients with chronic kidney disease.11 12 Implementation of where to buy symbicort pills MAGIC now includes online learning, access to subject matter experts, quarterly knowledge-sharing meetings, feedback on performance and pay-for-performance incentives.11 12 Initial research demonstrated preliminary evidence of effectiveness, reducing inappropriate PICC use by 13.8% in one hospital compared with nine control sites (OR 0.86. 95% CI 0.74 to 0.99). PICC line usage decreased and single lumen line use increased, but, although catheter occlusion fell significantly, VTE and CLABSI were not significantly reduced in this relatively small scale study,11 and until now, the impact on patient outcomes where to buy symbicort pills in a large number of patients across a range of hospitals had not been explored.It is in this context that a further study in this issue12 now builds on this work by demonstrating that the MAGIC programme also reduces the incidence of complications.

Data were extracted from case records on PICC insertions across 52 hospitals, with inappropriate use more common in seriously ill patients and CLABSI more common in those judged ‘inappropriate’. Following the implementation of MAGIC, catheter occlusion fell from 10.6% to 7.4% where to buy symbicort pills of PICC lines, VTE from 3.3% to 2.5% and CLABSI from 1.8% to 1.4%. While the study design does not allow causation to be proven, these effects were statistically significant, suggesting the programme to be effective, where to buy symbicort pills and that it should be implemented elsewhere. This therefore raises the question of whether the same benefits are likely to be realised elsewhere.It is clear that inappropriate selection of both patients and intravenous catheter types is an expensive and widespread international problem.

In France, when pharmacist approval was required for placement of PICCs, 5% of requests were declined as being inappropriate.13 In Canada, application of the MAGIC definitions suggested 13%–21% of 3479 PICC placements to be inappropriate.14 The where to buy symbicort pills MAGIC programme, or similar initiatives, are therefore likely to minimise harm to patients from complications associated with inappropriate use of PICCs in other countries. Clear evidence-based criteria for selection of patients for PICC insertion, combined with multidisciplinary communication, as proposed in the MAGIC programme, are likely to be important internationally in deciding when to place a PICC rather than another access device. However, adaptation to local methods and contexts of healthcare delivery are likely to where to buy symbicort pills be needed. This is where to buy symbicort pills for several reasons.

First, countries outside the USA may not share the pay-for-performance framework that provided incentives to hospitals participating in the MAGIC project.Second, some countries may have already introduced other interventions to reduce complications of central venous catheters. In India, basic training in hand hygiene and hub care, repeated until a high level of knowledge was demonstrated in tests, resulted in CLABSI reduction from 8.7 to 4.5/1000 catheter days.13 In Italy, training of healthcare workers based on a package of evidence-based preventative measures including removal of catheters when no longer needed, reduced CLABSI from 8.6 to 2.6/1000 catheter days.14Third, the method of delivery of PICC insertion where to buy symbicort pills may vary by country, which has important implications for whom to target with the MAGIC intervention. Delivery of PICC insertion in a number of countries, as in USA, follows a variety of models, including specialist nurse training and delivery, off-site insertion or use of interventional radiology vascular access teams.15 Selection of patients and insertion of central venous catheters, particularly outside critical care, are often the responsibility of a dedicated specialist team with access to uasound or interventional radiology. High levels of training improve standards of insertion and reduce rates, especially when combined with surveillance and feedback of performance.4 5 However, dedicated specialist teams may be where to buy symbicort pills asked to insert PICCs for inappropriate indications, or where there are inadequate skills or resources in the clinical teams to use alternatives.

Others have reduced use of PICC catheters by improving where to buy symbicort pills training in uasound guided peripheral intravenous catheter placement.16Fourth, to be effective on a national scale, particularly where there are wide variations in performance between individual hospitals, quality improvement programmes such as MAGIC need to be supported by robust and independent surveillance that incorporates feedback systems.5 MAGIC was introduced into an established quality improvement infrastructure and adequate staffing. Surveillance is time-consuming when reliant on manual data collection and, if resources are limited, surveillance may not be possible, or data collectors may only observe samples of the patient population. The advent of electronic patient record systems allows more patients to be monitored and in the ICU can be both more sensitive and more specific than manual collection of data for healthcare-acquired s.17 These surveillance systems are gradually improving and spreading, providing continuous feedback and peer comparison, based on semiautomated electronic data where to buy symbicort pills collection.18 However, the software packages required for extraction of the data are expensive and, in some countries, many hospitals do not have electronic patient records. National implementation of MAGIC could be achieved by using an existing surveillance and improvement network, or by linking local quality improvement projects, to allow peer comparisons.

One such system started in the UK in 2016 and has been recruiting ICUs in surveillance of bacteraemia and catheter s, including PICC-related s.18 This in Critical Care Quality Improvement Programme is a joint initiative between professional organisations representing adult, paediatric and neonatal intensive care, microbiology and where to buy symbicort pills control, supported by Public Health England. In its first year, 45% of adult ICUs took part and reported 2.3 ICU-associated CLABSI per 1000 central venous catheter days while also demonstrating marked variation between sites in both practice and where to buy symbicort pills outcomes. Broadening such a programme to include other complications of PICC would be relatively straightforward.Now is the time to see if MAGIC or similar programmes can be extended to different healthcare systems internationally. The quality of patient care may be improved considerably if the where to buy symbicort pills practices of the best performers were adopted more widely, whether in ensuring the appropriate means of vascular access is used and/or in improving training in insertion and care of the line.

According to the context in each country, a mixture of incentives and requirements for education, surveillance and feedback of complication rates associated with PICCs, driven by leadership from professional bodies and programmes such as MAGIC, are likely to be needed for significant national improvements to be made.Ethics statementsPatient consent for publicationNot required..

Symbicort turbuhaler dosage

Notice: Undefined variable: FsFrom in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/api.php on line 116
Notice: Undefined variable: FsFrom in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/api.php on line 117
Notice: Undefined variable: FsFrom in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/api.php on line 180
Notice: Undefined variable: FsTo in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/api.php on line 180
Warning: [obfuscated]() expects parameter 1 to be array, null given in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/text.php on line 0
Warning: [obfuscated](): Invalid arguments passed in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/text.php on line 0
Notice: Undefined variable: FsFrom in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/api.php on line 180
Notice: Undefined variable: FsTo in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/api.php on line 180
Warning: [obfuscated]() expects parameter 1 to be array, null given in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/text.php on line 0
Warning: [obfuscated](): Invalid arguments passed in /var/www/adminuser/data/www/xuletext.com/rb/inc/lib/model/text.php on line 0