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  • #500STRONG

    New Team, New Shenanigans
    Jan 09

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    Written by Tara Graham

    So pleased and proud to be part of this amazing group of hardworking people. Watch out 2014: #500STRONG is going to kill it.

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  • Mediating

    Aug 23

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    Written by Tara Graham

    SCRIPT EXCERPT: Many people today, particularly those living comfortably in the global North, want to do something to solve the problems of the world, such as the problem of global poverty. They want to act upon poverty, alleviate poverty, volunteer to end poverty—but we must ask: What motivates us to travel short or long distances, to spend a day, a week, many months, or even a spare 15 minutes,...

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  • Mediating

    #GlobalPOV=Doing Good Responsibly, Reports NextBillion
    Jul 29

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    Written by Tara Graham

    NextBillion, an initiative of the World Resources Institute’s Markets and Enterprise Program in partnership with the William Davidson Institute (WDI) at the University of Michigan, is a web forum for the community of business leaders, social entrepreneurs, NGOs, policy makers and academics who want to explore the connection between development and enterprise. NextBillion recently highlighted The #GlobalPOV Project as part of its “NexThought Monday” coverage: Hardly a day goes...

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  • Mediating

    Jul 02

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    Written by Tara Graham

    SCRIPT EXCERPT: Welcome to the world-class city. It has towers, expressways, shopping malls, airports, private schools, and gated condominiums with golf courses, swimming pools and tennis courts. It has no slums, but the world-class city is built by slums — a paradox isn’t it? To see the city from the slum provides a different view, a view of the global urban future. Based on Prof. Ananya Roy’s popular Global...

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  • Mediating

    May 06

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    Written by Tara Graham

    The third video in The #GlobalPOV Project series is an exploration of the poverty business. SCRIPT EXCERPT: The poor pay more for everything, and such transactions are highly profitable for those selling goods and services to the poor. Profits are made on the labor of the poor, the consumption of the poor, and the debt of the poor; meanwhile the poor remain — poor. So who profits from poverty? Based...

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  • Mediating

    #GlobalPOV on Mediabistro’s “AllTwitter”
    May 03

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    Written by Tara Graham

    AllTwitter, a Mediabistro website devoted to breaking Twitter news, highlighted The #GlobalPOV Project as part of its “Pay It Forward Friday” coverage. Regarding the #GlobalPOV video series, AllTwitter writes: And the online videos they’re creating are intended to help “crystallize the nuanced teachings of Berkeley’s biggest minor, Global Poverty and Practice, offered by the Blum Center for Developing Economies.” The videos are posted online so those outside of the school can...

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  • Reporting

    ABC’s 20/20 Features Viral Video Footage of Jonas Brothers Stampede
    Apr 26

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    Written by Tara Graham

    ABC’s primetime news magazine program, “20/20,” aired an investigative report on social behavior and crowd chaos that featured the viral stampede footage I shot using my smartphone at a Jonas Brothers concert in May, 2010. (ABC Air Date: Apr. 26, 2013, Episode: “In An Instant”). NOTE: This post is an update to a previous post tracking the viral popularity of (and subsequent mainstream media interest in) the stampede footage when I posted...

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  • Mediating

    Borgen Project Highlights #GlobalPOV Project
    Apr 16

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    Written by Tara Graham

    The Borgen Project, a nonprofit organization with mission to fight extreme poverty through policy (not charity!) intervention, recently published an article highlighting The #GlobalPOV Project’s mixed-media approach to curriculum development and pedagogy. Check out the article here. To learn more about The Borgen Project, visit the website or read its mission statement below: The Borgen Project believes that leaders of the most powerful nation on earth should be doing more to...

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  • Mediating

    #GlobalPOV Is “Groundbreaking,” Reports UC Berkeley NewsCenter
    Apr 09

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    Written by Tara Graham

    The UC Berkeley NewsCenter recently sat down and interviewed the #GlobalPOV team to discuss the theory behind the project, the production process, and the fact that Prof. Roy would have had an easier time writing and publishing a book already. (But then that would be boring, no?) The article describes the project as “a groundbreaking alternative to dominant forms of online education, a hot topic that’s on the minds...

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  • Mediating

    Mar 13

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    Written by Tara Graham

    Prof. Roy micro-lectured into a micro-phone. I painstakingly cut some denim pockets with an X-ACTO knife. And Abby tried to brew tea in cold water. This vid resulted. The following is a behind-the-scenes look into the making of #GlobalPOV’s “Can We Shop To End Poverty?” video. The #GlobalPOV Project is a program of the Global Poverty and Practice (GPP) Minor. Based at the Blum Center for Developing Economies, University of California, Berkeley, the GPP Minor...

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  • Mediating

    Mar 12

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    Written by Tara Graham

    The second video in The #GlobalPOV Project series is an exploration of ethical consumerism and fair trade interventions. SCRIPT EXCERPT: However tempting it may be to believe that we save lives, empower women and do good with our purchases, the impacts of our consumption on poverty cannot be reduced to mere product labels. Consumers need to understand the life histories of global commodities and advocate for changes in how...

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  • Mediating

    Blum Center News: #GlobalPOV Encourages Students To Become Public Scholars
    Dec 04

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    Written by Tara Graham

    The #GlobalPOV Project’s in-class tweeting component was covered in the Fall 2012 edition of the Blum Center newsletter. In the article, writer Javier Kordi notes: Being a public medium, Twitter allows anyone to join the conversation, but also forces Berkeley students to think of themselves as public scholars— everything they post falls under the scrutiny of the global community. . . . Tara Graham, the architect of this project,...

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  • Mediating

    Nov 29

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    Written by Tara Graham

    Prof. Roy yacked on and on about Bono. Abby did some doodling. I shoved a camera in everyone’s face. This vid resulted. The following is a behind-the-scenes look into the making of The #GlobalPOV Project’s “Who Sees Poverty?” pilot video. The #GlobalPOV Project is a program of the Global Poverty and Practice (GPP) Minor. Based at the Blum Center for Developing Economies at the University of California, Berkeley, the...

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  • Mediating

    Nov 27

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    Written by Tara Graham

    SCRIPT EXCERPT: Poverty exists. That it exists, that it persists, in the 21st century is an obscenity. We want to end this poverty. We want to make poverty history. But we have to ask ourselves: Who is the “we” who sees poverty? When we see poverty, what is that we see? And finally, how do we act upon these ways of seeing? Based on Prof. Ananya Roy’s popular Global...

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  • Mediating

    Daily Cal Talks Twitter In The Classroom
    Oct 16

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    Written by Tara Graham

    The Daily Californian, the student-run UC Berkeley paper of record, visited Prof. Ananya Roy’s “Global Poverty: Challenges and Hopes In The New Millennium” class this week to explore our use of Twitter in a large lecture hall setting. “By projecting tweets pertaining to the class on a screen, professors are able to use teaching methods that allow large groups of students to interact with one another and the professor...

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  • Mediating

    #GlobalPOV: From Public University To Twitterverse
    Sep 27

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    Written by Tara Graham

    The following was originally published via the #GlobalPOV Blog on the Blum Center for Developing Economies website. I co-authored the piece with Prof. Ananya Roy, Education Director of the Global Poverty and Practice Minor at the University of California, Berkeley. In it, we seek to explain the logic behind The #GlobalPOV Project’s Twitter integration and experimentation. By now, it’s common knowledge that Twitter and other forms of social media are...

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  • Reporting

    OPINION: Military, Money & Motives In Egypt
    Feb 18

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    Written by Tara Graham

    The following was originally published via the Harvard University Press Blog. I co-authored the piece with Nezar AlSayyad, Professor of Architecture and Urban History, and Chair of the Center for Middle Eastern Studies at the University of California, Berkeley. “Egypt has passed through a critical period in her recent history characterized by bribery, mischief, and the absence of governmental stability . . . Accordingly, we have undertaken to clean ourselves up...

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  • Reporting

    Syrian President Bashar al-Assad To Me: “Ask The People If I Am Their Dictator”
    Dec 21

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    Written by Tara Graham

    In December 2010, days before a street vendor in Tunisia self-immolated and effectively set the Middle East region afire with a wave of popular uprisings, I had the opportunity to accompany an academic delegation to Bashar al-Assad’s presidential palace in Damascus, Syria. I was the only journalist in the delegation, so I was able to ask Assad a series of questions about his leadership style (does he consider himself a dictator?),...

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  • Reporting

    May 15

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    Written by Tara Graham

    The Jonas Brothers launched their 2010 world tour by giving a free concert at The Grove in Los Angeles, Calif., on May 15, 2010. Over 25,000 adoring fans showed up and made a mad rush for the stage, trampling over each other and security barriers in the process. Chaos ensued, but no injuries were reported. I was there to capture the madness on my smartphone (see above). Nick and...

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  • Reporting

    News Statesman Mag: Sampling of Published Work
    Jul 23

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    Written by Tara Graham

    While taking a University of Southern California foreign reporting class in London, England, during the summer of 2009, I had the opportunity to work as a web editor for the New Statesman magazine. The following is a sampling of the work produced during this time. I mostly reported U.S. political news stories for the website, but I also had the opportunity to contribute research assistance and book reviews to the print publication....

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  • Reporting

    Race In America: ’08 HuffPo Election Coverage Generates Online Debate
    Oct 14

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    Written by Tara Graham

    I had the opportunity to report for The Huffington Post’s “Off-The-Bus” election coverage team while studying journalism on an Annenberg Graduate Fellowship at the University of Southern California. The following story highlights excerpts from my interview with L.A. radio host Joe Hicks, a conservative who said he intended to vote for then-presidential candidate John McCain. The story was one of the most popular on the HuffPo site at the time...

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  • So Tweet Me Maybe?

    Sep 12

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    Written by Tara Graham

    Tweets by @LilMissWordy

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    Fencing Policies is a website produced by U.C. Berkeley undergraduate student Maria Esparza during the 2013 spring semester. ACCORDING...

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    Literacy Lockup is a website produced by U.C. Berkeley undergraduate student Katherine Fleeman during the 2013 spring semester. ACCORDING...

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    SPACExRACE is a website produced by U.C. Berkeley undergraduate student Nishant Budhraja during the 2013 spring semester. ACCORDING TO...

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    The Conflict Medium is a website produced by U.C. Berkeley undergraduate student Rashad Sisemore in my online research and...

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    Poverty Pitch is a website produced by U.C. Berkeley undergraduate student Dominique Martinez in my online research and web...

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    Musical Bark is a website produced by U.C. Berkeley undergraduate student Erica Smolin in my online research and web...

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    Righteous Eats is a website produced by U.C. Berkeley undergraduate student Rachel Soeharto in my online research and web...

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    Bursting the Bubble is a website produced by U.C. Berkeley undergraduate student Nupur Behera during the 2012 spring...

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    Fist Pump The World is a website produced by U.C. Berkeley undergraduate student Kyle Meshna in my international reporting...

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    Media, Politics & Society: The Arab World In The Global Context is a website I produced to house all...

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Résumé

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CLICK HERE to view the most up-to-date version of my CV, along with testimonials from former managers, teammates, collaborators and students.


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UNIVERSITY OF SOUTHERN CALIFORNIA, Los Angeles

UNIVERSITY OF CALIFORNIA, Berkeley


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Oct. 2013 — May 2016 | DIRECTOR, BUSINESS DEVELOPMENT & GLOBAL PROGRAMS
500 Startups, Silicon Valley, CA, USA

I led content, branding, marketing, operations, and partnerships for business development & events at 500 Startups. With aim to educate startup and investor audiences, grow the #500STRONG community worldwide, and produce profitable programming, my responsibilities included:

  • Cialis 20mg price in usa

    AbstractBrazil is currently home to the largest cialis 20mg price in usa Japanese population outside of Japan. In Brazil today, Japanese-Brazilians are considered to be successful members of Brazilian society. This was not always the case, however, cialis 20mg price in usa and Japanese immigrants to Brazil endured much hardship to attain their current level of prestige.

    This essay explores this community’s trajectory towards the formation of the Japanese-Brazilian identity and the issues of mental health that arise in this immigrant community. Through the analysis of Japanese-Brazilian novels, TV shows, film and public health studies, I seek to disentangle the themes of gender and modernisation, and how these themes concurrently grapple with Japanese-Brazilian mental health issues. These fictional narratives provide a lens into the experience of the Japanese-Brazilian community that is unavailable in traditional medical studies about cialis 20mg price in usa their mental health.filmliterature and medicinemental health caregender studiesmedical humanitiesData availability statementData are available in a public, open access repository.Introduction and philosophical backgroundWork in the medical humanities has noted the importance of the ‘medical gaze’ and how it may ‘see’ the patient in ways which are specific, while possessing broad significance, in relation to developing medical knowledge.

    To diagnosis. And to cialis 20mg price in usa the social position of the medical profession.1 Some authors have emphasised that vision is a distinctive modality of perception which merits its own consideration, and which may have a particular role to play in medical education and understanding.2 3 The clothing we wear has a strong impact on how we are perceived. For example, commentary in this journal on the ‘white coat’ observes that while it may rob the medical doctor of individuality, it nonetheless grants an elevated status4.

    In contrast, the patient hospital gown may rob patients of individuality in a way that stigmatises them,5 reducing their status in the ward, and ultimately dehumanises them, in conflict with the humanistic approaches seen as central to the best practice in the care of older patients, and particularly those living with dementia.6The broad context of our concern is the visibility of patients and their needs. We draw on observations made during an ethnographic study of the everyday care of people living with dementia within acute hospital cialis 20mg price in usa wards, to consider how patients’ clothing may impact on the way they were perceived by themselves and by others. Hence, we draw on this ethnography to contribute to discussion of the ‘medical gaze’ in a specific and informative context.The acute setting illustrates a situation in which there are great many biomedical, technical, recording, and timetabled routine task-oriented demands, organised and delivered by different staff members, together with demands for care and attention to particular individuals and an awareness of their needs.

    Within this ward setting, we focus on patients who are living with dementia, since this group may be particularly vulnerable to a dehumanising gaze.6 We frame our discussion within the broader context of the general philosophical question of how we acquire knowledge of different types, and the moral consequences of this, particularly knowledge through visual perception.Debates throughout the history of philosophy raise questions about the nature and sources of our knowledge. Contrasts are often drawn between more cialis 20mg price in usa reliable or less reliable knowledge. And between knowledge that is more technical or ‘objective’, and knowledge that is more emotionally based or more ‘subjective’.

    A frequent point of discussion is the reliability and cialis 20mg price in usa characteristics of perception as a source of knowledge. This epistemological discussion is mostly focused on vision, indicating its particular importance as a mode of perception to humans.7Likewise, in ethics, there is discussion of the origin of our moral knowledge and the particular role of perception.8 There is frequent recognition that the observer has some significant role in acquiring moral knowledge. Attention to qualities of the moral observer is not in itself a denial of moral reality.

    Indeed, it is the very essence of cialis 20mg price in usa an ethical response to the world to recognise the deep reality of others as separate persons. The nature of ethical attention to the world and to those around us is debated and has been articulated in various ways. The quality of ethical attention may vary and achieving a high level of ethical attention may require certain conditions, certain virtues, and the time and mental space to attend to the situation and claims of the other.9Consideration has already been given to how different modes of attention to the world might be of relevance to the practice of medicine.

    Work that examines different cialis 20mg price in usa ways of processing information, and of interacting with and being in the world, can be found in Iain McGilchrist’s The Master and His Emissary,10 where he draws on neurological discoveries and applies his ideas to the development of human culture. McGilchrist has recently expanded on the relevance of understanding two different approaches to knowledge for the practice of medicine.11 He argues that task-oriented perception, and a wider, more emotionally attuned awareness of the environment are necessary partners, but may in some circumstances compete, with the competitive edge often being given to the narrower, task-based attention.There has been critique of McGilchrist’s arguments as well as much support. We find his work a useful framework for understanding important debates cialis 20mg price in usa in the ethics of medicine and of nursing about relationships of staff to patients.

    In particular, it helps to illuminate the consequences of patients’ dress and personal appearance for how they are seen and treated.Dementia and personal appearanceOur work focuses on patients living with dementia admitted to acute hospital wards. Here, they are a large group, present alongside older patients unaffected by dementia, as well as younger patients. This mixed population provides a useful setting to consider the impact of personal appearance on different patient groups.The role of appearance in the presentation of the self has been explored extensively by Tseëlon,12 13 drawing on Goffman’s work on stigma5 and the presentation of the self14 using interactionist cialis 20mg price in usa approaches.

    Drawing on the experiences on women in the UK, Tseëlon argues Goffman’s interactionist approach best supports how we understand the relationship appearance plays in self presentation, and its relationships with other signs and interactions surrounding it. Tseëlon suggests that understandings in this area, in the role appearance and clothing have in the presentation of the self, have been restricted by the perceived trivialities of the topic and limited to the field of fashion studies.15The personal appearance of older patients, and patients living with dementia in particular, has, more recently, been shown to be worthy of attention and of particular significance. Older people cialis 20mg price in usa are often assumed to be left out of fashion, yet a concern with appearance remains.16 17 Lack of attention to clothing and to personal care may be one sign of the varied symptoms associated with cognitive impairment or dementia, and so conversely, attention to appearance is one way of combatting the stigma associated with dementia.

    Families and carers may also feel the importance of personal appearance. The significant body of work by Twigg and Buse in this field in particular draws attention to the role clothing has cialis 20mg price in usa on preserving the identity and dignity or people living with dementia, while also constraining and enabling elements of care within long-term community settings.16–19 Within this paper, we examine the ways in which these phenomena can be even more acutely felt within the impersonal setting of the acute hospital.Work has also shown how people living with dementia strongly retain a felt, bodily appreciation for the importance of personal appearance. The comfort and sensuous feel of familiar clothing may remain, even after cognitive capacities such as the ability to recognise oneself in a mirror, or verbal fluency, are lost.18 More strongly still, Kontos,20–22 drawing on the work of Merleau-Ponty and of Bourdieu, has convincingly argued that this attention to clothing and personal appearance is an important aspect of the maintenance of a bodily sense of self, which is also socially mediated, in part via such attention to appearance.

    Our observations lend support to Kontos’ hypothesis.Much of this previous work has considered clothing in the everyday life of people living with dementia in the context of community or long-term residential care.18 Here, we look at the visual impact of clothing and appearance in the different setting of the hospital ward and consider the consequent implications for patient care. This setting enables us to consider how the short-term and unfamiliar environments of the acute ward, together with the contrast between personal and institutional attire, impact on the perception of the patient by self and by others.There is a body of literature that examines the work of restoring the appearance of residents within long-term community care settings, for instance Ward et al’s work that demonstrates the importance of hair and grooming as a key component of care.23 24 The work of Iltanen-Tähkävuori25 examines the usage of garments designed for long-term care settings, exploring the conflict between clothing used to prevent undressing or facilitate the delivery of care, and the distress such clothing can cause, being powerfully symbolic of lower social status and associated with reduced autonomy.26 27Within this literature, there has also been a significant focus on the cialis 20mg price in usa role of clothing, appearance and the tasks of personal care surrounding it, on the older female body. A corpus of feminist literature has examined the ageing process and the use of clothing to conceal ageing, the presentation of a younger self, or a ‘certain’ age28 It argues that once the ability to conceal the ageing process through clothing and grooming has been lost, the aged person must instead conceal themselves, dressing to hide themselves and becoming invisible in the process.29 This paper will explore how institutional clothing within hospital wards affects both the male and female body, the presentation of the ageing body and its role in reinforcing the invisibility of older people, at a time when they are paradoxically most visible, unclothed and undressed, or wearing institutional clothing within the hospital ward.Institutional clothing is designed and used to fulfil a practical function.

    Its use may therefore perhaps incline us towards a ‘task-based’ mode of attention, which as McGilchrist argues,10 while having a vital place in our understanding of the world, may on occasion interfere with the forms of attention that may be needed to deliver good person-oriented care responsive to individual needs.MethodsEthnography involves the in-depth study of people’s actions and accounts within their natural everyday setting, collecting relatively unstructured data from a range of sources.30 Importantly, it can take into account the perspectives of patients, carers and hospital staff.31 Our approach to ethnography is informed by the symbolic interactionist research tradition, which aims to provide an interpretive understanding of the social world, with an emphasis on interaction, focusing on understanding how action and meaning are constructed within a setting.32 The value of this approach is the depth of understanding and theory generation it can provide.33The goal of ethnography is to identify social processes within the data. There are multiple complex and nuanced cialis 20mg price in usa interactions within these clinical settings that are capable of ‘communicating many messages at once, even of subverting on one level what it appears to be “saying” on another’.34 Thus, it is important to observe interaction and performance. How everyday care work is organised and delivered.

    By obtaining observational data from within each institution on the everyday work of hospital wards, their family carers and the nursing and healthcare assistants (HCAs) who carry out this work, we can explore the ways in cialis 20mg price in usa which hospital organisation, procedures and everyday care impact on care during a hospital admission. It remedies a common weakness in many qualitative studies, that what people say in interviews may differ from what they do or their private justifications to others.35Data collection (observations and interviews) and analysis were informed by the analytic tradition of grounded theory.36 There was no prior hypothesis testing and we used the constant comparative method and theoretical sampling whereby data collection (observation and interview data) and analysis are inter-related,36 37 and are carried out concurrently.38 39 The flexible nature of this approach is important, because it can allow us to increase the ‘analytic incisiveness’35 of the study. Preliminary analysis of data collected from individual sites informed the focus of later stages of sampling, data collection and analysis in other sites.Thus, sampling requires a flexible, pragmatic approach and purposive and maximum variation sampling (theoretical sampling) was used.

    This included five hospitals selected to represent a range of hospitals types, cialis 20mg price in usa geographies and socioeconomic catchments. Five hospitals were purposefully selected to represent a range of hospitals types. Two large university teaching hospitals, two medium-sized general hospitals and one smaller general hospital.

    This included one urban, two inner city and two hospitals covering a mix cialis 20mg price in usa of rural and suburban catchment areas, all situated within England and Wales.These sites represented a range of expertise and interventions in caring for people with dementia, from no formal expertise to the deployment of specialist dementia workers. Fractures, nutritional disorders, urinary tract and pneumonia40 41 are among the principal causes of admission to acute hospital settings among people with dementia. Thus, we focused observation within trauma and orthopaedic wards (80 days) cialis 20mg price in usa and medical assessment units (MAU.

    75 days).Across these sites, 155 days of observational fieldwork were carried out. At each of the five sites, a minimum of 30 days observation took place, split between the two ward types. Observations were carried out by two researchers, each working in clusters of 2–4 days over a cialis 20mg price in usa 6-week period at each site.

    A single day of observation could last a minimum of 2 hours and a maximum of 12 hours. A total of 684 hours of observation were conducted for this study. This produced approximately 600 000 words of observational fieldnotes that were transcribed, cleaned and anonymised (by KF cialis 20mg price in usa and AN).

    We also carried out ethnographic (during observation) interviews with trauma and orthopaedic ward (192 ethnographic interviews and 22 group interviews) and MAU (222 ethnographic interviews) staff (including nurses, HCAs, auxiliary and support staff and medical teams) as they cared for this patient group. This allowed us to question what they are doing and why, and what are the caring practices of ward staff when interacting with people living with cialis 20mg price in usa dementia.Patients within these settings with a diagnosis of dementia were identified through ward nursing handover notes, patient records and board data with the assistance of ward staff. Following the provision of written and verbal information about the study, and the expression of willingness to take part, written consent was taken from patients, staff and visitors directly observed or spoken to as part of the study.To optimise the generalisability of our findings,42 our approach emphasises the importance of comparisons across sites,43 with theoretical saturation achieved following the search for negative cases, and on exploring a diverse and wide range of data.

    When no additional empirical data were found, we concluded that the analytical categories were saturated.36 44Grounded theory and ethnography are complementary traditions, with grounded theory strengthening the ethnographic aims of achieving a theoretical interpretation of the data, while the ethnographic approach prevents a rigid application of grounded theory.35 Using an ethnographic approach can mean that everything within a setting is treated as data, which can lead to large volumes of unconnected data and a descriptive analysis.45 This approach provides a middle ground in which the ethnographer, often seen as a passive observer of the social world, uses grounded theory to provide a systematic approach to data collection and analysis that can be used to develop theory to address the interpretive realities of participants within this setting.35Patient and public involvementThe data presented in this paper are drawn from a wider ethnographic study supported by an advisory group of people living with dementia and their family carers. It was this advisory group that informed us of the need of a better understanding of the impacts of the everyday care received by people living with dementia cialis 20mg price in usa in acute hospital settings. The authors met with this group on a regular basis throughout the study, and received guidance on both the design of the study and the format of written materials used to recruit participants to the study.

    The external oversight group for this study included, and was chaired, by carers of people living with dementia. Once data analysis was complete, the advisory group commented on our initial cialis 20mg price in usa findings and recommendations. During and on completion of the analysis, a series of public consultation events were held with people living with dementia and family carers to ensure their involvement in discussing, informing and refining our analysis.FindingsWithin this paper, we focus on exploring the medical gaze through the embedded institutional cultures of patient clothing, and the implications this have for patients living with dementia within acute hospital wards.

    These findings emerged from our wider analysis of our ethnographic cialis 20mg price in usa study examining ward cultures of care and the experiences of people living with dementia. Here, we examine the ways in which the cultures of clothing within wards impact on the visibility of patients within it, what clothing and identity mean within the ward and the ways in which clothing can be a source of distress. We will look at how personal grooming and appearance can affect status within the ward, and finally explore the removal of clothing, and the impacts of its absence.Ward clothing culturesAcross our sites, there was variation in the cultures of patient clothing and dress.

    Within many wards, it was typical for all older patients to be dressed in hospital-issued institutional gowns and pyjamas (typically in pastel blue, pink, green or peach), paired with hospital supplied socks (usually bright red, although there was some small variation) with non-slip grip soles, while in other wards, it cialis 20mg price in usa was standard practice for people to be supported to dress in their own clothes. Across all these wards, we observed that younger patients (middle aged/working age) were more likely to be able to wear their own clothes while admitted to a ward, than older patients and those with a dementia diagnosis.Among key signifiers of social status and individuality are the material things around the person, which in these hospital wards included the accoutrements around the bedside. Significantly, it was observed that people living with dementia were more likely to be wearing an institutional hospital gown or institutional pyjamas, and to have little to individuate the person at the bedside, on either their cabinet or the mobile tray table at their bedside.

    The wearing of institutional clothing was typically connected to fewer personal items on display or within reach of the cialis 20mg price in usa patient, with any items tidied away out of sight. In contrast, younger working age patients often had many personal belongings, cards, gadgets, books, media players, with young adults also often having a range of ‘get well soon’ gifts, balloons and so on from the hospital gift shop) on display. This both afforded some elements of familiarity, but also marked the person out as someone with individuality and a certain social standing and place.Visibility of patients on a wardThe significance of the obscurity or invisibility of the patient in artworks depicting doctors has been commented on.4 Likewise, we observed that cialis 20mg price in usa some patients within these wards were much more ‘visible’ to staff than others.

    It was often apparent how the wearing of personal clothing could make the patient and their needs more readily visible to others as a person. This may be especially so given the contrast in appearance clothing may produce in this particular setting. On occasion, this may be remarked on by staff, and the resulting attention received favourably by the patient.A member of the bay team returned to a patient and found her freshly dressed in a white tee shirt, navy slacks and black velvet slippers and exclaimed aloud and appreciatively, ‘Wow, look at you! cialis 20mg price in usa.

    €™ The patient looked pleased as she sat and combed her hair [site 3 day 1].Such a simple act of recognition as someone with a socially approved appearance takes on a special significance in the context of an acute hospital ward, and for patients living with dementia whose personhood may be overlooked in various ways.46This question of visibility of patients may also be particularly important when people living with dementia may be less able to make their needs and presence known. In this example, a whole bay of patients was seemingly ‘invisible’. Here, the ethnographer is observing a four-bed bay occupied by male patients living with dementia.The man in bed cialis 20mg price in usa 17 is sitting in his bedside chair.

    He is dressed in green hospital issue pyjamas and yellow grip socks. At 10 a.m., the physiotherapy team come and see him cialis 20mg price in usa. The physiotherapist crouches down in front of him and asks him how he is.

    He says he is unhappy, and the physiotherapist explains that she’ll be back later to see him again. The nurse checks on him, asks him if he wants a pillow, and puts it behind cialis 20mg price in usa his head explaining to him, ‘You need to sit in the chair for a bit’. She pulls his bedside trolley near to him.

    With the help of a Healthcare Assistant they make the bed. The Healthcare Assistant chats to cialis 20mg price in usa him, puts cake out for him, and puts a blanket over his legs. He is shaking slightly and I wonder if he is cold.The nurse explains to me, ‘The problem is this is a really unstimulating environment’, then says to the patient, ‘All done, let’s have a bit of a tidy up,’ before wheeling the equipment out.The neighbouring patient in bed 18, is now sitting in his bedside chair, wearing (his own) striped pyjamas.

    His eyes are open, and he is looking cialis 20mg price in usa around. After a while, he closes his eyes and dozes. The team chat to patient 19 behind the curtains.

    He says he doesn’t want to sit, and they say that is fine unless cialis 20mg price in usa the doctors tell them otherwise.The nurse puts music on an old radio with a CD player which is at the doorway near the ward entrance. It sounds like music from a musical and the ward it is quite noisy suddenly. She turns down the volume a bit, but it is very jaunty and upbeat.

    The man in cialis 20mg price in usa bed 19 quietly sings along to the songs. €˜I am going to see my baby when I go home on victory day…’At ten thirty, the nurse goes off on her break. The rest of the team are spread around the other bays and side cialis 20mg price in usa rooms.

    There are long distances between bays within this ward. After all the earlier activity it is now very calm and peaceful in the bay. Patient 20 is sitting cialis 20mg price in usa in the chair tapping his feet to the music.

    He has taken out a large hessian shopping bag out of his cabinet and is sorting through the contents. There is a lot of paperwork in it which he is reading through closely and sorting.Opposite, patient 17 looks very cialis 20mg price in usa uncomfortable. He is sitting with two pillows behind his back but has slipped down the chair.

    His head is in his hands and he suddenly looks in pain. He hasn’t touched his tea, and is talking cialis 20mg price in usa to himself. The junior medic was aware that 17 was not comfortable, and it had looked like she was going to get some advice, but she hasn’t come back.

    18 drinks his tea and looks at a wool twiddle mitt sleeve, puts it down, and dozes. 19 has finished all his coffee and manages to put the cup down on the trolley.Everyone is tapping their feet or wiggling their toes to the music, or singing quietly to it, when a student nurse, who is working at the computer station in the corridor outside the room, comes in cialis 20mg price in usa. She has a strong purposeful stride and looks irritated as she switches the music off.

    It feels like a jolt to the room cialis 20mg price in usa. She turns and looks at me and says, ‘Sorry were you listening to it?. €™ I tell her that I think these gentlemen were listening to it.She suddenly looks very startled and surprised and looks at the men in the room for the first time.

    They have all stopped tapping cialis 20mg price in usa their toes and stopped singing along. She turns it back on but asks me if she can turn it down. She leaves and goes back to her paperwork outside.

    Once it is turned back on everyone starts tapping cialis 20mg price in usa their toes again. The music plays on. €˜There’ll be bluebirds over the white cliffs of Dover, just you wait and see…’[Site 3 day 3]The music was played by staff to help combat the drab and cialis 20mg price in usa unstimulating environment of this hospital ward for the patients, the very people the ward is meant to serve.

    Yet for this member of ward staff the music was perceived as a nuisance, the men for whom the music was playing seemingly did not register to her awareness. Only an individual of ‘higher’ status, the researcher, sitting at the end of this room was visible to her. This example cialis 20mg price in usa illustrates the general question of the visibility or otherwise of patients.

    Focusing on our immediate topic, there may be complex pathways through which clothing may impact on how patients living with dementia are perceived, and on their self-perception.Clothing and identityOn these wards, we also observed how important familiar aspects of appearance were to relatives. Family members may be distressed if they find the person they knew so well, looking markedly different. In the example below, a mother and two adult daughters visit the father of the family, who is not visible to them as the person they were so cialis 20mg price in usa familiar with.

    His is not wearing his glasses, which are missing, and his daughters find this very difficult. Even though he looks very different following his admission—he has lost a large amount of weight and has sunken cialis 20mg price in usa cheekbones, and his skin has taken on a darker hue—it is his glasses which are a key concern for the family in their recognition of their father:As I enter the corridor to go back to the ward, I meet the wife and daughter of the patient in bed 2 in the hall and walk with them back to the ward. Their father looks very frail, his head is back, and his face is immobile, his eyes are closed, and his mouth is open.

    His skin looks darker than before, and his cheekbones and eye sockets are extremely prominent from weight loss. €˜I am like a bird I want cialis 20mg price in usa to fly away…’ plays softly in the radio in the bay. I sit with them for a bit and we chat—his wife holds his hand as we talk.

    His wife has to take two busses to get to the hospital and we talk about the potential care home they expect her husband will be discharged to. They hope it cialis 20mg price in usa will be close because she does not drive. He isn’t wearing his glasses and his daughter tells me that they can’t find them.

    We look in cialis 20mg price in usa the bedside cabinet. She has never seen her dad without his glasses. €˜He doesn’t look like my dad without his glasses’ [Site 2 day 15].It was often these small aspects of personal clothing and grooming that prompted powerful responses from visiting family members.

    Missing glasses and missing teeth were notable in this regard cialis 20mg price in usa (and with the follow-up visits from the relatives of discharged patients trying to retrieve these now lost objects). The location of these possessions, which could have a medical purpose in the case of glasses, dental prosthetics, hearing aids or accessories which contained personal and important aspects of a patient’s identity, such as wallets or keys, and particularly, for female patients, handbags, could be a prominent source of distress for individuals. These accessories to personal clothing were notable on these wards by their everyday absence, hidden away in bedside cupboards or simply not brought in with the patient at admission, and by the frequency with which patients requested and called out for them or tried to look for them, often in repetitive cycles that indicated their underlying anxiety about these belongings, but which would become invisible to staff, becoming an everyday background intrusion to the work of the wards.When considering the visibility and recognition of individual persons, missing glasses, especially glasses for distance vision, have a particular significance, for without them, a person may be less able to recognise and interact visually with others.

    Their presence cialis 20mg price in usa facilitates the subject of the gaze, in gazing back, and hence helps to ground meaningful and reciprocal relationships of recognition. This may be one factor behind the distress of relatives in finding their loved ones’ glasses to be absent.Clothing as a source of distressAcross all sites, we observed patients living with dementia who exhibited obvious distress at aspects of their institutional apparel and at the absence of their own personal clothing. Some older patients were clearly able to verbalise their cialis 20mg price in usa understandings of the impacts of wearing institutional clothing.

    One patient remarked to a nurse of her hospital blue tracksuit. €˜I look like an Olympian or Wentworth prison in this outfit!. The latter I expect…’ The staff laughed as they walked her out of the bay cialis 20mg price in usa (site 3 day 1).Institutional clothing may be a source of distress to patients, although they may be unable to express this verbally.

    Kontos has shown how people living with dementia may retain an awareness at a bodily level of the demands of etiquette.20 Likewise, in our study, a man living with dementia, wearing a very large institutional pyjama top, which had no collar and a very low V neck, continually tried to pull it up to cover his chest. The neckline was particularly low, because the pyjamas were far too large for him. He continued to fiddle with his very low-necked top even when his lunch tray was placed in cialis 20mg price in usa front of him.

    He clearly felt very uncomfortable with such clothing. He continued cialis 20mg price in usa using his hands to try to pull it up to cover his exposed chest, during and after the meal was finished (site 3 day 5).For some patients, the communication of this distress in relation to clothing may be liable to misinterpretation and may have further impacts on how they are viewed within the ward. Here, a patient living with dementia recently admitted to this ward became tearful and upset after having a shower.

    She had no fresh clothes, and so the team had provided her with a pink hospital gown to wear.‘I want my trousers, where is my bra, I’ve got no bra on.’ It is clear she doesn’t feel right without her own clothes on. The one-to-one healthcare assistant assigned to this patient tells her, ‘Your bra is dirty, do cialis 20mg price in usa you want to wear that?. €™ She replies, ‘No I want a clean one.

    Where are my trousers?. I want them, I’ve lost them.’ The healthcare assistant cialis 20mg price in usa repeats the explaination that her clothes are dirty, and asks her, ‘Do you want your dirty ones?. €™ She is very teary ‘No, I want my clean ones.’ The carer again explains that they are dirty.The cleaner who always works in the ward arrives to clean the floor and sweeps around the patient as she sits in her chair, and as he does this, he says ‘Hello’ to her.

    She is very teary and explains that she has lost cialis 20mg price in usa her clothes. The cleaner listens sympathetically as she continues ‘I am all confused. I have lost my clothes.

    I am all cialis 20mg price in usa confused. How am I going to go to the shops with no clothes on!. €™ (site 5 day 5).This person experienced significant distress because of her absent clothes, but this would often be simply attributed to confusion, seen as a feature of her dementia.

    This then may solidify staff perceptions cialis 20mg price in usa of her condition. However, we need to consider that rather than her condition (her diagnosis of dementia) causing distress about clothing, the direction of causation may be the reverse. The absence of her cialis 20mg price in usa own familiar clothing contributes significantly to her distress and disorientation.

    Others have argued that people with limited verbal capacity and limited cognitive comprehension will have a direct appreciation of the grounding familiarity of wearing their own clothes, which give a bodily felt notion of comfort and familiarity.18 47 Familiar clothing may then be an essential prop to anchor the wearer within a recognisable social and meaningful space. To simply see clothing from a task-oriented point of view, as fulfilling a simply mechanical function, and that all clothing, whether personal or institutional have the same value and role, might be to interpret the desire to wear familiar clothing as an ‘optional extra’. However, for those patients most at risk of disorientation and distress within an unfamiliar environment, it could be a valuable necessity.Personal grooming and social cialis 20mg price in usa statusIncluding in our consideration of clothing, we observed other aspects of the role of personal grooming.

    Personal grooming was notable by its absence beyond the necessary cleaning required for reasons of immediate hygiene and clinical need (such as the prevention of pressure ulcers). Older patients, and particular those living with dementia who were unable to carry out ‘self-care’ independently and were not able to request support with personal grooming, could, over their admission, become visibly unkempt and scruffy, hair could be left unwashed, uncombed and unstyled, while men could become hirsute through a lack of shaving. The simple act of a visitor dressing and grooming a patient as they prepared for discharge could transform their appearance and leave that patient looking more alert, appear to having increased capacity, than when sitting ungroomed in their bed or bedside chair.It is important to consider the impact of appearance and of personal cialis 20mg price in usa care in the context of an acute ward.

    Kontos’ work examining life in a care home, referred to earlier, noted that people living with dementia may be acutely aware of transgressions in grooming and appearance, and noted many acts of self-care with personal appearance, such as stopping to apply lipstick, and conformity with high standards of table manners. Clothing, etiquette and personal grooming are important indicators of social class and hence an aspect of belonging and identity, and of how an individual relates cialis 20mg price in usa to a wider group. In Kontos’ findings, these rituals and standards of appearance were also observed in negative reactions, such as expressions of disgust, towards those residents who breached these standards.

    Hence, even in cases where an individual may be assessed as having considerable cognitive impairment, the importance of personal appearance must not be overlooked.For some patients within these wards, routine practices of everyday care at the bedside can increase the potential to influence whether they feel and appear socially acceptable. The delivery of routine timetabled care at the bedside can impact on people’s appearance in ways that may mark them out as failing to achieve cialis 20mg price in usa accepted standards of embodied personhood. The task-oriented timetabling of mealtimes may have significance.

    It was a typical observed feature of this routine, when a mealtime has ended, that people living with dementia were left with visible signs and features of the mealtime through spillages on faces, clothes, bed sheets and bedsides, that leave them at risk of being assessed as less socially acceptable and marked as having reduced independence. For example, a volunteer attempts to ‘feed’ a person living cialis 20mg price in usa with dementia, when she gives up and leave the bedside (this woman living with dementia has resisted her attempts and explicitly says ‘no’), remnants of the food is left spread around her mouth (site E). In a different ward, the mealtime has ended, yet a large white plastic bib to prevent food spillages remains attached around the neck of a person living with dementia who is unable to remove it (site X).Of note, an adult would not normally wear a white plastic bib at home or in a restaurant.

    It signifies cialis 20mg price in usa a task-based apparel that is demeaning to an individual’s social status. This example also contrasts poignantly with examples from Kontos’ work,20 such as that of a female who had little or no ability to verbalise, but who nonetheless would routinely take her pearl necklace out from under her bib at mealtimes, showing she retained an acute awareness of her own appearance and the ‘right’ way to display this symbol of individuality, femininity and status. Likewise, Kontos gives the example of a resident who at mealtimes ‘placed her hand on her chest, to prevent her blouse from touching the food as she leaned over her plate’.20Patients who are less robust, who have cognitive impairments, who may be liable to disorientation and whose agency and personhood are most vulnerable are thus those for whom appropriate and familiar clothing may be most advantageous.

    However, we found the cialis 20mg price in usa ‘Matthew effect’ to be frequently in operation. To those who have the least, even that which they have will be taken away.48 Although there may be institutional and organisational rationales for putting a plastic cover over a patient, leaving it on for an extended period following a meal may act as a marker of dehumanising loss of social status. By being able to maintain familiar clothing and adornment to visually display social standing and identity, a person living with dementia may maintain a continuity of selfhood.However, it is also possible that dressing and grooming an older person may itself be a task-oriented institutional activity in certain contexts, as discussed by Lee-Treweek49 in the context of a nursing home preparing residents for ‘lounge view’ where visitors would see them, using residents to ‘create a visual product for others’ sometimes to the detriment of residents’ needs.

    Our observations regarding the importance of patient appearance must therefore be considered as part of the care of the whole cialis 20mg price in usa person and a significant feature of the institutional culture.Patient status and appearanceWithin these wards, a new grouping of class could become imposed on patients. We understand class not simply as socioeconomic class but as an indicator of the strata of local social organisation to which an individual belongs. Those in the lowest classes may have limited opportunities to participate in society, and we observed cialis 20mg price in usa the ways in which this applied to the people living with dementia within these acute wards.

    The differential impact of clothing as signifiers of social status has also been observed in a comparison of the white coat and the patient gown.4 It has been argued that while these both may help to mask individuality, they have quite different effects on social status on a ward. One might say that the white coat increases visibility as a person of standing and the attribution of agency, the patient gown diminishes both of these. (Within these wards, although white coats were not to be found, the dress code of medical staff did make cialis 20mg price in usa them stand out.

    For male doctors, for example, the uniform rarely strayed beyond chinos paired with a blue oxford button down shirt, sleeves rolled up, while women wore a wider range of smart casual office wear.) Likewise, we observed that the same arrangement of attire could be attributed to entirely different meanings for older patients with or without dementia.Removal of clothes and exposureWithin these wards, we observed high levels of behaviour perceived by ward staff as people living with dementia displaying ‘resistance’ to care.50 This included ‘resistance’ towards institutional clothing. This could include pulling up or removing hospital gowns, removing institutional pyjama trousers or pulling up gowns, and standing with gowns untied and exposed at the back (although this last example is an unavoidable design feature of the clothing itself). Importantly, the removal of clothing was limited to institutional gowns and pyjamas and we did not see any patients removing their own clothing cialis 20mg price in usa.

    This also included the removal of institutional bedding, with instances of patients pulling or kicking sheets from their bed. These acts could and was often interpreted by ward staff as a patient’s ‘resistance’ cialis 20mg price in usa to care. There was some variation in this interpretation.

    However, when an individual patient response to their institutional clothing and bedding was repeated during a shift, it was more likely to be conceived by the ward team as a form of resistance to their care, and responded to by the replacement and reinforcement of the clothing and bedding to recover the person.The removal of gowns, pyjamas and bedsheets often resulted in a patient exposing their genitalia or continence products (continence pads could be visible as a large diaper or nappy or a pad visibly held in place by transparent net pants), and as such, was disruptive to the norms and highly visible to staff and other visitor to these wards. Notably, unlike other behaviours considered by staff to be disruptive or inappropriate within these cialis 20mg price in usa wards such as shouting or crying out, the removal of bedsheets and the subsequent bodily exposure would always be immediately corrected, the sheet replaced and the patient covered by either the nurse or HCA. The act of removal was typically interpreted by ward staff as representing a feature of the person’s dementia and staff responses were framed as an issue of patient dignity, or the dignity and embarrassment of other patients and visitors to the ward.

    However, such responses to removal could lead to further cycles of removal and cialis 20mg price in usa replacement, leading to an escalation of distress in the person. This was important, because the recording of ‘refusal of care’, or presumed ‘confusion’ associated with this, could have significant impacts on the care and discharge pathways available and prescribed for the individual patient.Consider the case of a woman living with dementia who is 90 years old (patient 1), in the example below. Despite having no immediate medical needs, she has been admitted to the MAU from a care home (following her husband’s stroke, he could no longer care for her).

    Across the previous evening and morning shift, she was shouting, refusing all food and care and has received assistance from the specialist dementia care cialis 20mg price in usa worker. However, during this shift, she has become calmer following a visit from her husband earlier in the day, has since eaten and requested drinks. Her care home would not readmit her, which meant she was not able to be discharged from the unit (an overflow unit due to a high number of admissions to the emergency department during a patch of exceptionally hot weather) until alternative arrangements could be made by social services.During our observations, she remains calm for the first 2 hours.

    When she does talk, she is very loud and high pitched, but this is normal for her and not cialis 20mg price in usa a sign of distress. For staff working on this bay, their attention is elsewhere, because of the other six patients on the unit, one is ‘on suicide watch’ and another is ‘refusing their medication’ (but does not have a diagnosis of dementia). At 15:10 patient 1 begins to remove her cialis 20mg price in usa sheets:15:10.

    The unit seems chaotic today. Patient 1 has begun to loudly drum her fingers on the tray table. She still has not been brought more milk, which she requested from the HCA an hour earlier cialis 20mg price in usa.

    The bay that patient 1 is admitted to is a temporary overflow unit and as a result staff do not know where things are. 1 has moved her sheets off her legs, her bare knees peeking out over the top of piled sheets.15:15. The nurse in cialis 20mg price in usa charge says, ‘Hello,’ when she walks past 1’s bed.

    1 looks across and smiles back at her. The nurse in charge explains to her that she needs to cialis 20mg price in usa shuffle up the bed. 1 asks the nurse about her husband.

    The nurse reminds 1 that her husband was there this morning and that he is coming back tomorrow. 1 says cialis 20mg price in usa that he hasn’t been and she does not believe the nurse.15:25. I overhear the nurse in charge question, under her breath to herself, ‘Why 1 has been left on the unit?.

    €™ 1 has started asking for somebody to come and see her. The nurse in cialis 20mg price in usa charge tells 1 that she needs to do some jobs first and then will come and talk to her.15:30. 1 has once again kicked her sheets off of her legs.

    A social worker comes onto the cialis 20mg price in usa unit. 1 shouts, ‘Excuse me’ to her. The social worker replies, ‘Sorry I’m not staff, I don’t work here’ and leaves the bay.15:40.

    1 keeps kicking sheets off her bed, otherwise the unit cialis 20mg price in usa is quiet. She now whimpers whenever anyone passes her bed, which is whenever anyone comes through the unit’s door. 1 is the only elderly patient on the unit.

    Again, the nurse in charge is heard sympathizing that this is not cialis 20mg price in usa the right place for her.16:30. A doctor approaches 1, tells her that she is on her list of people to say hello to, she is quite friendly. 1 tells her that she has been cialis 20mg price in usa here for 3 days, (the rest is inaudible because of pitch).

    The doctor tries to cover 1 up, raising her bed sheet back over the bed, but 1 loudly refuses this. The doctor responds by ending the interaction, ‘See you later’, and leaves the unit.16:40. 1 attempts cialis 20mg price in usa to talk to the new nurse assigned to the unit.

    She goes over to 1 and says, ‘What’s up my darling?. €™ It’s hard to follow 1 now as she sounds very upset. The RN’s first instinct, like with the doctor and the nurse cialis 20mg price in usa in charge, is to cover up 1 s legs with her bed sheet.

    When 1 reacts to this she talks to her and they agree to cover up her knees. 1 is talking about how her husband won’t come and visit her, and still sounds really upset about this cialis 20mg price in usa. [Site 3, Day 13]Of note is that between days 6 and 15 at this site, observed over a particularly warm summer, this unit was uncomfortably hot and stuffy.

    The need to be uncovered could be viewed as a reasonable response, and in fact was considered acceptable for patients without a classification of dementia, provided they were otherwise clothed, such as the hospital gown patient 1 was wearing. This is an example of an aspect of care where the choice and autonomy granted to patients assessed as having (or assumed to have) cognitive capacity is not available to people who are considered to have impaired cognitive capacity (a diagnosis of dementia) and cialis 20mg price in usa carries the additional moral judgements of the appropriateness of behaviour and bodily exposure. In the example given above, the actions were linked to the patient’s resistance to their admission to the hospital, driven by her desire to return home and to be with her husband.

    Throughout observations over this 10-day period, patients perceived by staff as rational agents were allowed to strip down their bedding for comfort, whereas patients living with dementia who responded in this way were often viewed by staff as ‘undressing’, which would be interpreted as a feature of their condition, to be challenged and corrected by staff.Note how the same visual data triggered opposing interpretations of personal autonomy. Just as in the example above where distress over loss of familiar clothing may be interpreted as an aspect of confusion, yet cialis 20mg price in usa lead to, or exacerbate, distress and disorientation. So ‘deviant’ bedding may be interpreted, for some patients only, in ways that solidify notions of lack of agency and confusion, is another example of the Matthew effect48 at work through the organisational expectations of the clothed appearance of patients.Within wards, it is not unusual to see patients, especially those with a diagnosis of dementia or cognitive impairment, walking in the corridor inadvertently in some state of undress, typically exposed from behind by their hospital gowns.

    This exposure in itself is of course, an intrinsic functional feature of the design of cialis 20mg price in usa the flimsy back-opening institutional clothing the patient has been placed in. This task-based clothing does not even fulfil this basic function very adequately. However, this inadvertent exposure could often be interpreted as an overt act of resistance to the ward and towards staff, especially when it led to exposed genitalia or continence products (pads or nappies).We speculate that the interpretation of resistance may be triggered by the visual prompt of disarrayed clothing and the meanings assumed to follow, where lack of decorum in attire is interpreted as indicating more general behavioural incompetence, cognitive impairment and/or standing outside the social order.DiscussionPrevious studies examining the significance of the visual, particularly Twigg and Buse’s work16–19 exploring the materialities of appearance, emphasise its key role in self-presentation, visibility, dignity and autonomy for older people and especially those living with dementia in care home settings.

    Similarly, care home studies have demonstrated that institutional clothing, designed to facilitate task-based care, can be potentially dehumanising or and distressing.25 26 Our findings resonate with this work, but find that for people living with dementia within a key site of care, the acute ward, the impact of institutional clothing on the individual patient living with dementia, is poorly recognised, cialis 20mg price in usa but is significant for the quality and humanity of their care.Our ethnographic approach enabled the researchers to observe the organisation and delivery of task-oriented fast-paced nature of the work of the ward and bedside care. Nonetheless, it should also be emphasised the instances in which staff such as HCAs and specialist dementia staff within these wards took time to take note of personal appearance and physical caring for patients and how important this can be for overall well-being. None of our observations should be read as critical of any individual staff, but reflects longstanding institutional cultures.Our previous work has examined how readily a person living with dementia within a hospital wards is vulnerable to dehumanisation,51 and to their behaviour within these wards being interpreted as a feature of their condition, rather than a response to the ways in which timetabled care is delivered at their bedside.50 We have also examined the ways in which visual stimuli within these wards in the form of signs and symbols indicating a diagnosis of dementia may inadvertently focus attention away from the individual patient and may incline towards simplified and inaccurate categorisation of both needs and the diagnostic category of dementia.52Our work supports the analysis of the two forms of attention arising from McGilchrist’s work.10 The institutional culture of the wards produces an organisational task-based technical attention, which we found appeared to compete with and reduce the opportunity for ward staff to seek a finer emotional attunement to the person they are caring for and their needs.

    Focus on efficiency, pace and record keeping that measures individual task completion within cialis 20mg price in usa a timetable of care may worsen all these effects. Indeed, other work has shown that in some contexts, attention to visual appearance may itself be little more than a ‘task’ to achieve.49 McGilchrist makes clear, and we agree, that both forms of attention are vital, but more needs to be done to enable staff to find a balance.Previous work has shown how important appearance is to older people, and to people living with dementia in particular, both in terms of how they are perceived by others, but also how for this group, people living with dementia, clothing and personal grooming may act as a particularly important anchor into a familiar social world. These twin aspects of clothing and appearance—self-perception and perception by others—may be especially important in the fast-paced context of an acute ward environment, where patients living with dementia may be cialis 20mg price in usa struggling with the impacts of an additional acute medical condition within in a highly timetabled and regimented and unfamiliar environment of the ward, and where staff perceptions of them may feed into clinical assessments of their condition and subsequent treatment and discharge pathways.

    We have seen above, for instance, how behaviour in relation to appearance may be seen as ‘resisting care’ in one group of patients, but as the natural expression of personal preference in patients viewed as being without cognitive impairments. Likewise, personal grooming might impact favourably on a patient’s alertness, visibility and status within the ward.Prior work has demonstrated the importance of the medical gaze for the perceptions of the patient. Other work has also shown how older people, and in particular people living with dementia, may be thought to be beyond concern for appearance, yet this does not accurately reflect the importance of appearance cialis 20mg price in usa we found for this patient group.

    Indeed, we argue that our work, along with the work of others such as Kontos,20 21 shows that if anything, visual appearance is especially important for people living with dementia particularly within clinical settings. In considering the task of washing the patient, Pols53 considered ‘dignitas’ in terms of aesthetic values, in comparison to humanitas conceived as citizen values of equality between persons. Attention to dignitas in the form of appearance may be a way of facilitating the treatment by others of a person with cialis 20mg price in usa humanitas, and helping to realise dignity of patients.Data availability statementNo data are available.

    Data are unavailable to protect anonymity.Ethics statementsPatient consent for publicationNot required.Ethics approvalEthics committee approval for the study was granted by the NHS Research Ethics Service (15/WA/0191).AcknowledgmentsThe authors acknowledge funding support from the NIHR.Notes1. Devan Stahl (2013) cialis 20mg price in usa. €œLiving into the imagined body.

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    501–514.13. E Tseëlon (1995). The masque of femininity.

    The presentation of woman in everyday life. London. Sage.14.

    E Goffman (1990b). The Presentation of Self in Everyday Life Penguin15. Efrat Tseëlon (2001).

    €œFashion research and its discontents”. Fashion Theory, 5 (4). 435–451.16.

    Julia Twigg (2010a). €œClothing and dementia. A neglected dimension?.

    € Journal of Ageing Studies 24(4). 223–230.17. Julia Twigg and Christina E Buse (2013).

    €œDress, dementia and the embodiment of identity.” Dementia 12(3). 326–336.18. C.

    E Buse and J. Twigg (2015). €œClothing, embodied identity and dementia.

    Maintaining the self through dress.” Age, Culture, Humanities (2).19. Christina Buse and Julia Twigg (2018). €œDressing disrupted.

    Negotiating care through the materiality of dress in the context of dementia.” Sociology of Health &. Illness, 40(2). 340-352.20.

    PIA C Kontos (2004). Ethnographic reflections on selfhood, embodiment and Alzheimer's disease. Ageing &.

    C Kontos (2005). €œEmbodied selfhood in Alzheimer's disease. Rethinking person-centred care.” Dementia 4 (4).

    Naglie (2007). €œBridging theory and practice. Imagination, the body, and person-centred dementia care.” Dementia 6 (4).

    549–569.23. Richard Ward et al. (2016a).

    €œâ€˜Gonna make yer gorgeous’. Everyday transformation, resistance and belonging in the care-based hair salon.” Dementia, 15(3). 395–413.24.

    Richard Ward, Sarah Campbell, and John Keady (2016b). €œAssembling the salon. Learning from alternative forms of body work in dementia care.” Sociology of Health &.

    Illness, 38(8). 1287–1302.25. Sonja Iltanen-Tähkävuori, Minttu Wikberg, and Päivi Topo (2012).

    Design and dementia. A case of garments designed to prevent undressing. Dementia, 11(1).

    49–59.26. Päivi Topo and Sonja Iltanen-Tähkävuori (2010). €œScripting patienthood with patient clothing.” Social Science &.

    Medicine, 70(11). 1682–1689.27. Julia Twigg (2010b).

    €œWelfare embodied. The materiality of hospital dress. A commentary on Topo and Iltanen-Tähkävuori”.

    Social Science and Medicine, 70(11), 1690–1692.28. Kathleen Woodward (2006). €œPerforming age, performing gender” National Women’s Studies Association (NWSA) Journal 18(1).

    162–89.29. K.M Woodward (1999). Introduction.

    In K.M. Woodward (ed.), Figuring Age. Women, Bodies and Generations (pp.

    Ix-xxix). Bloomington. Indiana University Press.30.

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    Research in the Schools, 13(1). 84–92.32. W Housley and P Atkinson (2003).

    Interactionism, Sage33. M Hammersley (1987) What's Wrong with Ethnography?. Methodological Explorations.

    London. Routledge34. V Turner and E Bruner (1986).

    The Anthropology of Experience New York. PAJ Publications. 2435.

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    B Glaser and A Strauss (1967). The Discovery of Grounded Theory. London.

    Weidenfeld and Nicholson, 24(25). 288–30437. Juliet M.

    Corbin and Anselm Strauss (1990). Grounded theoryrResearch. Procedures, canons, and evaluative criteria.

    Grounded theory and the constant comparative method. BMJ (Clinical research ed.), 316 (7137),:1064.39. Roy Suddaby (2006).

    €œFrom the editors. What grounded theory is not.” Academy of management journal, 49(4). 633–642.40.

    Elizabeth L Sampson et al. (2009). €œDementia in the acute hospital.

    Prospective cohort study of prevalence and mortality”. British Journal of Psychiatry,195(1). 61–66.

    Doi:10.1192/bjp.bp.108.05533541. C Pinkert and B Holle (2012). €œPeople with dementia in acute hospitals.

    Literature review of prevalence and reasons for hospital admission”. Z. Gerontol.

    Robert E Herriott and William A. Firestone (1983) “Multisite qualitative policy research. Optimising description and generalizability”.

    Education Research 12:14–1943. F Vogt (2002). €œNo ethnography without comparison.

    The methodological significance of comparison in ethnographic research” Studies in Education Ethnography 6:23–4244. Benjamin Saunders et al. (2018).

    €œSaturation in qualitative research. Exploring its conceptualization and operationalization.” Quality and Quantity 52 (4). 1893–1907.45.

    A Coffey and P Atkinson (1996). Making sense of qualitative data. Complementary research strategies.

    Sage Publications, Inc.46. Paula Boddington and Katie Featherstone (2018). €œThe canary in the coal mine.

    Continence care for people with dementia in acute hospital wards as a crisis of dehumanisation”. Bioethics, 32(4). 251–260.47.

    Christina Buse et al. (2014). €œLooking “out of place”.

    Analysing the spatial and symbolic meanings of dementia care settings through dress.” International Journal of Ageing and Later Life 9 (1). 69–95.48. R.

    K. Merton (1968). €œThe Matthew effect in science.

    The reward and communication systems of science are considered.” Science 159 (3810). 56–63.49. Geraldine Lee-Treweek (1997) “Women, resistance and care.

    An ethnographic study of nursing auxiliary work” Work, Employment and Society, 11(1). 47–6350. Katie Featherstone et al.

    (2019b). €œRefusal and resistance to care by people living with dementia being cared for within acute hospital wards. An ethnographic study” Health Service and Delivery Research51.

    Katie Featherstone, Andy Northcott, and Jackie Bridges (2019a). €œRoutines of resistance. An ethnography of the care of people living with dementia in acute hospital wards and its consequences.” International Journal of Nursing Studies.52.

    K Featherstone, A Northcott, and P Boddington (2020). €œUsing signs and symbols to identify hospital patients with a dementia diagnosis. Help or hindrance to recognition and care?.

    € Narrative Inquiry in Bioethics53. Jeannette Pols (2013). €œWashing the patient.

    Dignity and aesthetic values in nursing care” Nursing Philosophy, 14(3). 186–200.

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    No creo que can you buy cialis without a prescription haya nada más básico que eso. Jenny Gold. jgold@kff.org, @JennyAGold Related Topics Contact Us Submit a Story TipCan’t see the video player?.

    View the video here can you buy cialis without a prescription. What does ageism in health care look like?. It can be a thoughtless quip that makes an older person feel diminished.

    Or an assumption that can you buy cialis without a prescription patients are unable to follow a conversation or make their own decisions. Maybe it occurs when a concern is voiced, then discounted or dismissed. Ageism is reflected in care strategies that ignore a patient’s values and ideas about what constitutes a productive life.

    Too often, attitudes can you buy cialis without a prescription such as “these patients are old and near the end anyway” or “there’s not much we can do to help them” prevail. Ageism is not new, but the erectile dysfunction treatment cialis brought it shockingly into view. In its early days, the cialis was shrugged off as something of concern mostly to older people, with some arguing they were expendable if the alternative was shutting down the economy.

    In the grave months that followed, many who died in nursing care can you buy cialis without a prescription were dehumanized in news reports that showed body bags piled outside facilities. To date, about 80% of those who have died of erectile dysfunction treatment have been older adults, including nearly 140,000 nursing home residents — a population beset by understaffing, inadequate control and neglect. KHN and The John A.

    Hartford Foundation held a can you buy cialis without a prescription web event Thursday. Judith Graham, KHN’s Navigating Aging columnist, hosted the discussion. She was joined by.

    Dr can you buy cialis without a prescription. Louise Aronson, a geriatrician, professor of medicine at the University of California-San Francisco and author of “Elderhood.” Dr. Michael Wasserman, a geriatrician, advocate for vulnerable older adults during the cialis and leader of the public policy committee of the California Association of Long Term Care Medicine.

    Dr. Javette Orgain, a family physician and medical director for Longevity Health Plan of Illinois, which serves nursing home residents. Former president of the National Medical Association, which represents African American physicians and their patients.

    And former assistant dean of the University of Illinois-Chicago’s Urban Health Program. Dr. Rebecca Elon, a geriatrician and caregiver for her mother, who has dementia, and husband, who died earlier this year.

    Jess Maurer, a lawyer and executive director of the Maine Council on Aging, which promotes an anti-ageism pledge. Related Topics Contact Us Submit a Story TipPOPLAR, Mont. €” When Maria Vega was a senior in high school in 2015, she found the body of one of her closest friends, who had died by suicide.

    A few days later, devastated by the loss, Vega tried to take her own life. After the attempt failed, she was arrested and taken to juvenile detention in Poplar, a remote town on the Missouri River a short drive from the North Dakota oil fields. She was put in a cell and kept under observation for several days until a mental health specialist was available to see her.

    Her only interaction was with the woman who brought food to her cell. €œI remember asking her if I could have a hug and she told me, ‘I’m sorry, I can’t do that,’” Vega recalled. €œThat was honestly one of the hardest things I ever went through in my life.

    I felt like I was being punished for being sad.” Jailing people because of a mental health issue is illegal in Montana and every other state except New Hampshire. But Vega is a member of the Fort Peck Assiniboine and Sioux Tribes, a sovereign nation with its own laws. An 11-year-old tribal policy allows law enforcement to put members who threaten or attempt suicide in jail or juvenile detention to prevent another attempt.

    Fort Peck’s tribal leaders say they approved the policy out of necessity because there were no mental health facilities equipped for short-term housing of people in mental crisis. The erectile dysfunction treatment cialis has only exacerbated the crisis. In 2020, the tribes filed a record 62 aggravated disorderly conduct charges, the criminal charge they created in 2010 to allow law enforcement to book people they deemed a risk to themselves or others.

    Stacie FourStar, chief judge of the Fort Peck Tribal Court, said this year has been even worse. The tribe is filing two to four charges per week. The policy has swept up people — particularly adolescents — with no criminal records and no experience with the criminal justice system, she said.

    The judge fears it creates a perverse incentive not to call 911 or reach out for help when depression sets in. €œThey don’t want to go to jail,” FourStar said. €œThey just want somebody to talk to.” Stacie FourStar, chief judge of the Fort Peck tribal court, says the cialis has resulted in an increase in the number of people jailed for suicide attempts, and she worries the policy discourages others in mental crisis from seeking help.

    (Sara Reardon for KHN) Tribal officials and various mental health advocates have been trying to find an alternative for nearly a decade. But the reservation is still badly lacking in both secure psychiatric facilities and qualified mental health workers. Despite funding available for new positions, recruitment efforts have failed and there is still no viable alternative to keep people safe.

    €œTheir hands are tied,” FourStar said, noting that if “personnel and facilities aren’t available, we’ll be putting people in an unsafe situation.” Having experienced imprisonment herself as a teen, Vega is now part of a team of tribal members, state educators and policy experts looking for alternative solutions. The group’s ideas include ensuring that a mental health specialist is the first point of contact for a person in crisis and setting up safe houses, said Harvard University political scientist Daniel Carpenter, the project’s leader. In May, the group presented a plan to the Fort Peck Tribal Council, which has yet to act on its recommendations.

    A spokesperson for the Fort Peck Tribes said the tribes are looking into the policy but declined to comment further. Yet tribal leaders say that unless they can attract mental health workers to remote northeastern Montana, the jailings will likely continue. €œWe can propose all we want,” said Jestin Dupree, a tribal legislator and chairman of the law and justice committee.

    €œWe’re not getting the doctors, the qualified people.” The Fort Peck reservation, a windswept cluster of small towns surrounded by 2 million acres of rolling farmland, has a suicide rate that in some years has topped six times the national average. Native American adolescents are twice as likely to die by suicide as their white peers. The 2010 policy that put Vega in jail followed a cluster of more than 150 suicide attempts and the deaths of at least six teenagers.

    Overwhelmed by the crisis, Fort Peck’s tribal government created the “aggravated disorderly conduct” charge. €œIt came from desperation,” said FourStar, who was chief tribal prosecutor at the time. €œFamilies weren’t able to handle the needs of their loved ones and they didn’t want them to hurt themselves.” People charged with aggravated disorderly conduct are held until they can undergo a mental health evaluation and attend a court hearing, where they may receive a court-ordered treatment plan.

    If they comply with the plans, the charge is dropped. They usually don’t end up with a public criminal record, but the court system can still track them. The Fort Peck tribal juvenile detention center is pictured in Poplar, Montana, on April 2, 2021.

    Tribal officials hoping to change an 11-year-old policy of jailing people who attempt suicide say the policy has swept up people, particularly adolescents, without criminal records during the cialis. (Sara Reardon for KHN) Nontribal members are never put in jail, because the tribe lacks jurisdictional authority over them. Instead, a police officer ends up sitting with them in the hospital — sometimes for days — until they can be evaluated.

    Not every suicide threat or attempt ends in an aggravated disorderly conduct charge. Ideally, a person in crisis is immediately evaluated by a mental health professional at the Indian Health Service or a telemedicine provider who can refer them to emergency care, if needed. €œEven though there’s difficulties in trying to get care for them, we still persevere,” said Sylvia Longknife, an IHS mental health specialist in Poplar.

    Longknife is IHS’ only mental health worker on the Fort Peck reservation since two other providers quit this year, meaning she can’t always immediately see somebody in crisis. Longknife said she sees between two and five emergency cases a week. If the situation is deemed an emergency, the patient is referred to a facility four hours away in Billings.

    IHS doesn’t have its own transportation, so it either asks family members to drive the patient or requests transportation funds from the tribe. If a suicide attempt occurs on a weekend, after hours or when a mental health worker is unavailable, police officers who respond may end up taking the person to a hospital for medical treatment, if necessary, and then to jail. Lisa Dailey, executive director of the Treatment Advocacy Center, a national nonprofit that pushes for access to mental health treatment, said jailing people for attempting suicide criminalizes mental illness.

    €œPrison or jail are the worst settings you can possibly be because you’re in a psychiatric crisis,” she said. Even if the care is good, she said, “being incarcerated is a traumatizing experience.” Studies have shown that the risk of self-harm in prison increases if someone has been held in solitary confinement or has previously attempted suicide. The Fort Peck reservation isn’t the only jurisdiction where people can be jailed after a suicide attempt.

    In New Hampshire, suicidal people often end up in the state’s only secure facility. The men’s prison. After the Fort Peck tribes approached Carpenter’s Native American politics class last year for ideas, he and his undergraduate students began consulting with tribal members and others in Montana and working to research potential alternatives to jail.

    The Flathead tribe in western Montana, for instance, specifies that people should be held in the “least restrictive environment” possible to protect their well-being, short of a jail cell. Carpenter said this could take the form of a “safe house” that separates a person from weapons. Other potential fixes include requiring that a mental health worker accompany police during interactions with a suicidal person to ensure that jail is the last resort, and creating a new “mental health code” that would treat suicidal people differently from those who pose a threat to others.

    The state of Colorado put $9.5 million toward community-based health treatment in 2017, then made it illegal to jail people awaiting mental health evaluations who hadn’t been charged with a crime. But places like reservations may have no choice. €œWith no resources, there’s very little you can do about any of those issues,” Dailey said.

    The IHS office has sufficient funds to hire four more mental health workers for Fort Peck. €œWe’re definitely aggressively trying to fill empty vacancies,” said Steve Williamson, chief medical officer of the IHS’ Billings area office. But the positions have been difficult to fill.

    IHS and other health providers in northeastern Montana struggle to attract candidates to live in a region 70 miles from the nearest Walmart, with few jobs or entertainment options for families. FourStar said the tribes hope to use erectile dysfunction treatment relief aid to improve behavioral health services so that suicide attempts can be treated as civil cases instead of criminal ones. €œI think this will go somewhere, as long as we can get the manpower,” she said.

    Need Help?. If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741. Sara Reardon.

    @Sara_Reardon Related Topics Contact Us Submit a Story TipSearching for the Nuns Who Ghosted Fort Scott Host Sarah Jane Tribble sets out on a mission to learn more about the Sisters of Mercy, the nuns who founded Fort Scott’s Mercy Hospital and were once prominent leaders of the community. Tribble’s first glimpse into their lives takes her to an old convent. To learn more about the founding of Fort Scott’s hospital, listen to Episode Four.

    Can’t see the audio player?. Click here to listen. Click here to read the episode transcript.

    How’s Josh?. Before Fort Scott’s hospital shut down, Josh was a teenager coping with his aging grandparents and the emotional burden of his mother’s opioid death. The family’s troubles worsened after the hospital closed.

    Tribble gives Josh a call to find out his next steps. If you want to hear more of Josh’s story, we tell it in Episode Six. Can’t see the audio player?.

    Click here to listen. Click here to read the episode transcript. “Where It Hurts” is a podcast collaboration between KHN and St.

    Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.” Subscribe to Where It Hurts on Apple Podcasts, Stitcher, Google, Spotify, Pocket Casts or wherever you listen to podcasts. To hear all KHN podcasts, click here.

    Sarah Jane Tribble. sjtribble@kff.org, @SJTribble Related Topics Contact Us Submit a Story TipFor parents living in poverty, “diaper math” is a familiar and distressingly pressing daily calculation. Babies in the U.S.

    Go through six to 10 disposable diapers a day, at an average cost of $70 to $80 a month. Name-brand diapers with high-end absorption sell for as much as a half a dollar each, and can result in upwards of $120 a month in expenses. One in every three American families cannot afford enough diapers to keep their infants and toddlers clean, dry and healthy, according to the National Diaper Bank Network.

    For many parents, that leads to wrenching choices. Diapers, food or rent?. The erectile dysfunction treatment cialis has exacerbated the situation, both by expanding unemployment rolls and by causing supply chain disruptions that have triggered higher prices for a multitude of products, including diapers.

    Diaper banks — community-funded programs that offer free diapers to low-income families — distributed 86% more diapers on average in 2020 than in 2019, according to the National Diaper Bank Network. In some locations, distribution increased by as much as 800%. Yet no federal program helps parents pay for this childhood essential.

    The government’s food assistance program does not cover diapers, nor do most state-level public aid programs. California is the only state to directly fund diapers for families, but support is limited. CalWORKS, a financial assistance program for families with children, provides $30 a month to help families pay for diapers for kids under age 3.

    Federal policy shifts also may be in the works. Democratic lawmakers are pushing to include $200 million for diaper distribution in the massive budget reconciliation package. Without adequate resources, low-income parents are left scrambling for ways to get the most use out of each diaper.

    This stressful undertaking is the subject of a recent article in American Sociological Review by Jennifer Randles, a professor of sociology at California State University-Fresno. In 2018, Randles conducted phone interviews with 70 mothers in California over nine months. She tried to recruit fathers as well, but only two men responded.

    Randles spoke with KHN’s Jenny Gold about how the cost of diapers weighs on low-income moms, and the “inventive mothering” many low-income women adopt to shield their children from the harms of poverty. The conversation has been edited for length and clarity. Jennifer Randles, a professor of sociology at California State University-Fresno, has done novel research into the role diapers — and not having enough of them — play in the anxieties of low-income moms.

    €œIn my sample, half of the mothers told me that they worried more about diapers than they worried about food or housing,” Randles says.(Vickie Kirby) Q. How do diapers play into day-to-day anxieties for low-income mothers?. In my sample, half of the mothers told me that they worried more about diapers than they worried about food or housing.

    I started to ask mothers, “Can you tell me how many diapers you have on hand right now?. € Almost every one told me with exact specificity how many they had — five or seven or 12. And they knew exactly how long that number of diapers would last, based on how often their children defecated and urinated, if their kid was sick, if they had a diaper rash at the time.

    So just all the emotional and cognitive labor that goes into keeping such careful track of diaper supplies. They were worrying and figuring out, “OK, I’m down to almost my last diaper. What do I do now?.

    Do I go find some cans [to sell]?. Do I go sell some things in my house?. Who in my social network might have some extra cash right now?.

    € I talked to moms who sell blood plasma just to get their infants diapers. Q. What coping strategies stood out to you?.

    Those of us who study diapers often call them diaper-stretching strategies. One was leaving on a diaper a little bit longer than someone might otherwise leave it on and letting it get completely full. Some mothers figured out if they bought a [more expensive] diaper that held more and leaked less, they could leave the diaper on longer.

    They would also do things like letting the baby go diaperless, especially when they were at home and felt like they wouldn’t be judged for letting their baby go without a diaper. And they used every household good you can imagine to make makeshift diapers. Mothers are using cloth, sheets and pillowcases.

    They’re using things that are disposable like paper towels with duct tape. They’re making diapers out their own period supplies or adult incontinence supplies when they can get a sample. One of the questions I often get is, “Why don’t they just use cloth?.

    € A lot of the mothers that I spoke with had tried cloth diapers and they found that they were very cost- and labor-prohibitive. If you pay for a full startup set of cloth diapers, you’re looking at anywhere from $500 to $1,000. And these moms never had that much money.

    Most of them didn’t have in-home washers and dryers. Some of them didn’t even have homes or consistent access to water, and it’s illegal in a lot of laundromats and public laundry facilities to wash your old diapers. So the same conditions that would prevent moms from being able to readily afford disposable diapers are the same conditions that keep them from being able to use cloth.

    Q. You found that many women’s concept of being a good mother is wrapped up in diapering. Why is that?.

    Diapers and managing diapers was so fundamental to their identity as good moms. Most of the mothers in my sample went without their own food. They weren’t paying a cellphone bill or buying their own medicine or their own menstrual supplies, as a way of saving diaper money.

    I talked to a lot of moms who said, when your baby is hungry, that’s horrible. Obviously, you do everything to prevent that. But there’s something about a diaper that covers this vulnerable part of a very young baby’s body, this very delicate skin.

    And being able to do something to meet this human need that we all have, and to maintain dignity and cleanliness. A lot of the moms had been through the welfare system, and so they’re living in this constant fear [of losing their children]. This is especially true among mothers of color, who are much more likely to get wrapped up in the child welfare system.

    People can’t necessarily see when your baby’s hungry. But people can see a saggy diaper. That’s going to be one of the things that tags you as a bad mom.

    Q. Was your work on diapers influenced by your experience as a parent?. When I was doing these interviews, my daughter was about 2 or 3.

    So still in diapers. When my daughter peed during a diaper change, I thought, “Oh, I can just toss that one. Here, let me get another clean one.” That’s a really easy choice.

    For me. That’s a crisis for the mothers I interviewed. Many of them told me they have an anxiety attack with every diaper change.

    Q. Do you see a clear policy solution to diaper stress?. What’s kind of ironic is how much physical, emotional and cognitive labor goes into managing something that society and lawmakers don’t even recognize.

    Diapers are still not really recognized as a basic need, as evidenced by the fact that they’re still taxed in 35 states. I think what California is doing is an excellent start. And I think diaper banks are a fabulous type of community-based organization that are filling a huge need that is not being filled by safety net policies.

    So, public support for diaper banks. The direct cash aid part of the social safety net has been all but dismantled in the last 25 years. California is pretty generous.

    También hacían cosas como dejar que el bebé se quedara sin cialis 20mg price in usa pañal, especialmente cuando estaban en la casa y sentían que no serían Levitra discount program juzgadas por esto. Y utilizaban todos los bienes domésticos que puedas imaginar para hacer pañales improvisados. Telas, sábanas y fundas de almohada. Están usando cosas que son desechables como toallas de papel con cinta adhesiva cialis 20mg price in usa.

    Están haciendo pañales con sus propios suministros para la menstruación o suministros para la incontinencia de adultos cuando pueden obtener una muestra gratis. Una de las preguntas que me hacen a menudo es. €œÂ¿Por qué no cialis 20mg price in usa usan simplemente tela?. € Muchas de las madres con las que hablé habían probado los pañales de tela y descubrieron que eran muy costosos y la mano de obra, prohibitiva.

    Si pagas por un juego completo de pañales de tela para comenzar, estamos hablando de entre $500 y $1,000. Y estas cialis 20mg price in usa mamás nunca tuvieron tanto dinero. La mayoría no tenían lavadoras ni secadoras en casa. Algunas ni siquiera tenían casa o acceso consistente a agua, y es ilegal en muchas lavanderías comunitarias y públicas lavar pañales usados.

    Por lo cialis 20mg price in usa tanto, las mismas condiciones que evitarían que las mamás puedan pagar fácilmente pañales desechables son las mismas condiciones que les impiden usar telas. Descubrió que el concepto de muchas mujeres de ser “una buena madre” está relacionado con el cambio de pañales. ¿Por qué es eso?. Los pañales y el manejo de los pañales eran fundamentales para cialis 20mg price in usa su identidad como buenas mamás.

    La mayoría de las madres de mi muestra se privaban de su propia comida. No estaban pagando una factura de teléfono celular o comprando sus propios medicamentos o sus propios suministros menstruales, como una forma de ahorrar dinero para pañales. Hablé con muchas mamás que dijeron cialis 20mg price in usa que cuando su bebé tiene hambre, eso es horrible. Obviamente, haces todo lo posible para evitarlo.

    Pero hay algo en un pañal que cubre esta parte vulnerable del cuerpo de un bebé muy pequeño, esta piel tan delicada. Y poder hacer algo para satisfacer esta necesidad humana que cialis 20mg price in usa todos tenemos, y mantener la dignidad y la limpieza. Muchas de las mamás habían pasado por el sistema de asistencia social, por lo que viven con este miedo constante [de perder a sus hijos]. Esto es especialmente cierto entre las madres de color, que son mucho más propensas a ser parte del sistema de bienestar infantil.

    Las personas no necesariamente pueden ver cuándo un cialis 20mg price in usa bebé tiene hambre. Pero la gente puede ver un pañal en mal estado. Esa será una de las cosas que la etiquetará como mala madre. ¿Su trabajo con los pañales se vio influenciado por cialis 20mg price in usa su experiencia como madre?.

    Cuando estaba haciendo estas entrevistas, mi hija tenía alrededor de 2 o 3 años. Así que todavía estaba en pañales. Cuando mi hija orinaba durante un cialis 20mg price in usa cambio de pañal, pensaba. €œOh, puedo tirar ese.

    Déjame conseguir otro limpio”. Esa es una elección cialis 20mg price in usa realmente fácil. Para mi. Pero es una crisis para las madres que entrevisté.

    Muchas me dijeron que tienen un ataque de ansiedad con cada cialis 20mg price in usa cambio de pañal. ¿Ve una solución política clara para el estrés relacionado con los pañales?. Lo que resulta un tanto irónico es la cantidad de trabajo físico, emocional y cognitivo que implica la gestión de algo que la sociedad y los legisladores ni siquiera reconocen. Los pañales todavía no se reconocen realmente como una necesidad básica, como cialis 20mg price in usa lo demuestra el hecho de que todavía están sujetos a impuestos en 35 estados.

    Creo que lo que está haciendo California es un excelente comienzo. Y creo que los bancos de pañales son un tipo de organización comunitaria fabulosa, que está satisfaciendo una gran necesidad que no está siendo cubierta por las políticas de la red de seguridad. Entonces, apoyo cialis 20mg price in usa público a los bancos de pañales. La ayuda directa en efectivo que forma parte de la red de seguridad social prácticamente se ha desmantelado en los últimos 25 años.

    California es bastante generosa. Pero hay algunos estados donde solo el costo de los pañales usaría casi la mitad del beneficio estatal promedio cialis 20mg price in usa de TANF [Asistencia Temporal para Familias Necesitadas] para una familia de tres. Creo que realmente tenemos que abordar el hecho de que el valor de la ayuda en efectivo compra mucho menos de lo que solía hacerlo. Su trabajo sobre el matrimonio y la familia es fascinante e inusual.

    ¿Hay una pregunta central detrás de su investigación? cialis 20mg price in usa. El hilo conductor es. ¿Cómo apoyan nuestras políticas de red de seguridad los objetivos de crianza de los hijos de las familias de bajos ingresos?. ¿Son igualitarias las condiciones de la crianza cialis 20mg price in usa de los hijos?.

    Lo considero un problema de justicia reproductiva. La capacidad de tener un hijo o no tener un hijo, y luego criar a ese hijo en condiciones en las que se satisfagan las necesidades básicas del niño. Nos gusta decir que somos cialis 20mg price in usa aptos para tener niños y familias. El tema de los pañales es solo uno de muchos, muchos problemas en los que realmente no ponemos nuestro dinero o nuestras políticas en lo que decimos que haremos, en términos de apoyo a las familias y apoyo a los niños.

    Creo que mi trabajo está tratando de hacer que la gente piense de manera más colectiva acerca de tener una responsabilidad social con todas las familias y con el otro. Ningún país, pero especialmente el país más rico del planeta, debería tener 1 de cada 3 niños cialis 20mg price in usa muy pequeños sin satisfacer una de sus necesidades básicas. Entrevisté a un padre que estaba preso porque escribió un cheque sin fondos. Y como me lo describió, tenía una cierta cantidad de dinero y necesitaban tanto pañales como leche para el bebé.

    Y nunca cialis 20mg price in usa lo olvidaré, dijo, “No tomé una buena decisión, pero tomé la correcta”. Estos no son zapatos elegantes. No se trata de ropa de marca. Este era un padre que necesitaba leche cialis 20mg price in usa y pañales.

    No creo que haya nada más básico que eso. Jenny Gold. jgold@kff.org, cialis 20mg price in usa @JennyAGold Related Topics Contact Us Submit a Story TipCan’t see the video player?. View the video here.

    What does ageism in health care look like?. It can be a thoughtless quip that makes an older person cialis 20mg price in usa feel diminished. Or an assumption that patients are unable to follow a conversation or make their own decisions. Maybe it occurs when a concern is voiced, then discounted or dismissed.

    Ageism is reflected in care strategies that ignore a patient’s values and ideas cialis 20mg price in usa about what constitutes a productive life. Too often, attitudes such as “these patients are old and near the end anyway” or “there’s not much we can do to help them” prevail. Ageism is not new, but the erectile dysfunction treatment cialis brought it shockingly into view. In its early days, the cialis was shrugged off as something of concern mostly to older cialis 20mg price in usa people, with some arguing they were expendable if the alternative was shutting down the economy.

    In the grave months that followed, many who died in nursing care were dehumanized in news reports that showed body bags piled outside facilities. To date, about 80% of those who have died of erectile dysfunction treatment have been older adults, including nearly 140,000 nursing home residents — a population beset by understaffing, inadequate control and neglect. KHN and The John cialis 20mg price in usa A. Hartford Foundation held a web event Thursday.

    Judith Graham, KHN’s Navigating Aging columnist, hosted the discussion. She was cialis 20mg price in usa joined by. Dr. Louise Aronson, a geriatrician, professor of medicine at the University of California-San Francisco and author of “Elderhood.” Dr.

    Michael Wasserman, a geriatrician, advocate for vulnerable older adults during the cialis and leader of the public policy committee of the cialis 20mg price in usa California Association of Long Term Care Medicine. Dr. Javette Orgain, a family physician and medical director for Longevity Health Plan of Illinois, which serves nursing home residents. Former president of the National Medical cialis 20mg price in usa Association, which represents African American physicians and their patients.

    And former assistant dean of the University of Illinois-Chicago’s Urban Health Program. Dr. Rebecca Elon, a geriatrician and caregiver for her mother, who has dementia, and husband, who died earlier cialis 20mg price in usa this year. Jess Maurer, a lawyer and executive director of the Maine Council on Aging, which promotes an anti-ageism pledge.

    Related Topics Contact Us Submit a Story TipPOPLAR, Mont. €” When Maria Vega cialis 20mg price in usa was a senior in high school in 2015, she found the body of one of her closest friends, who had died by suicide. A few days later, devastated by the loss, Vega tried to take her own life. After the attempt failed, she was arrested and taken to juvenile detention in Poplar, a remote town on the Missouri River a short drive from the North Dakota oil fields.

    She was put in a cell and kept under observation for several days until a mental health specialist was available cialis 20mg price in usa to see her. Her only interaction was with the woman who brought food to her cell. €œI remember asking her if I could have a hug and she told me, ‘I’m sorry, I can’t do that,’” Vega recalled. €œThat was honestly cialis 20mg price in usa one of the hardest things I ever went through in my life.

    I felt like I was being punished for being sad.” Jailing people because of a mental health issue is illegal in Montana and every other state except New Hampshire. But Vega is a member of the Fort Peck Assiniboine and Sioux Tribes, a sovereign nation with its own laws. An 11-year-old tribal policy allows law enforcement to put members who threaten or attempt suicide in jail or juvenile detention to prevent another cialis 20mg price in usa attempt. Fort Peck’s tribal leaders say they approved the policy out of necessity because there were no mental health facilities equipped for short-term housing of people in mental crisis.

    The erectile dysfunction treatment cialis has only exacerbated the crisis. In 2020, the tribes filed a record 62 aggravated disorderly conduct charges, the criminal charge they created in cialis 20mg price in usa 2010 to allow law enforcement to book people they deemed a risk to themselves or others. Stacie FourStar, chief judge of the Fort Peck Tribal Court, said this year has been even worse. The tribe is filing two to four charges per week.

    The policy has swept up people — particularly cialis 20mg price in usa adolescents — with no criminal records and no experience with the criminal justice system, she said. The judge fears it creates a perverse incentive not to call 911 or reach out for help when depression sets in. €œThey don’t want to go to jail,” FourStar said. €œThey just want somebody to talk to.” Stacie FourStar, chief judge of the Fort Peck tribal court, says the cialis has resulted in an increase in the number of people jailed for suicide attempts, and she worries the policy discourages others in mental crisis from seeking help cialis 20mg price in usa.

    (Sara Reardon for KHN) Tribal officials and various mental health advocates have been trying to find an alternative for nearly a decade. But the reservation is still badly lacking in both secure psychiatric facilities and qualified mental health workers. Despite funding available for new positions, recruitment efforts have failed and cialis 20mg price in usa there is still no viable alternative to keep people safe. €œTheir hands are tied,” FourStar said, noting that if “personnel and facilities aren’t available, we’ll be putting people in an unsafe situation.” Having experienced imprisonment herself as a teen, Vega is now part of a team of tribal members, state educators and policy experts looking for alternative solutions.

    The group’s ideas include ensuring that a mental health specialist is the first point of contact for a person in crisis and setting up safe houses, said Harvard University political scientist Daniel Carpenter, the project’s leader. In May, the group presented a plan to the Fort Peck Tribal Council, which has yet to act on its recommendations cialis 20mg price in usa. A spokesperson for the Fort Peck Tribes said the tribes are looking into the policy but declined to comment further. Yet tribal leaders say that unless they can attract mental health workers to remote northeastern Montana, the jailings will likely continue.

    €œWe can propose all we want,” said Jestin Dupree, cialis 20mg price in usa a tribal legislator and chairman of the law and justice committee. €œWe’re not getting the doctors, the qualified people.” The Fort Peck reservation, a windswept cluster of small towns surrounded by 2 million acres of rolling farmland, has a suicide rate that in some years has topped six times the national average. Native American adolescents are twice as likely to die by suicide as their white peers. The 2010 policy that put Vega in jail followed a cluster of more than 150 suicide attempts and the deaths of at least cialis 20mg price in usa six teenagers.

    Overwhelmed by the crisis, Fort Peck’s tribal government created the “aggravated disorderly conduct” charge. €œIt came from desperation,” said FourStar, who was chief tribal prosecutor at the time. €œFamilies weren’t able to handle the needs of their cialis 20mg price in usa loved ones and they didn’t want them to hurt themselves.” People charged with aggravated disorderly conduct are held until they can undergo a mental health evaluation and attend a court hearing, where they may receive a court-ordered treatment plan. If they comply with the plans, the charge is dropped.

    They usually don’t end up with a public criminal record, but the court system can still track them. The Fort Peck cialis 20mg price in usa tribal juvenile detention center is pictured in Poplar, Montana, on April 2, 2021. Tribal officials hoping to change an 11-year-old policy of jailing people who attempt suicide say the policy has swept up people, particularly adolescents, without criminal records during the cialis. (Sara Reardon for KHN) Nontribal members are never put in jail, because the tribe lacks jurisdictional authority over them.

    Instead, a police officer ends up sitting cialis 20mg price in usa with them in the hospital — sometimes for days — until they can be evaluated. Not every suicide threat or attempt ends in an aggravated disorderly conduct charge. Ideally, a person in crisis is immediately evaluated by a mental health professional at the Indian Health Service or a telemedicine provider who can refer them to emergency care, if needed. €œEven though there’s difficulties in trying to get care for them, we still persevere,” said Sylvia Longknife, an cialis 20mg price in usa IHS mental health specialist in Poplar.

    Longknife is IHS’ only mental health worker on the Fort Peck reservation since two other providers quit this year, meaning she can’t always immediately see somebody in crisis. Longknife said she sees between two and five emergency cases a week. If the situation is deemed an emergency, the patient is referred to a facility four hours away cialis 20mg price in usa in Billings. IHS doesn’t have its own transportation, so it either asks family members to drive the patient or requests transportation funds from the tribe.

    If a suicide attempt occurs on a weekend, after hours or when a mental health worker is unavailable, police officers who respond may end up taking the person to a hospital for medical treatment, if necessary, and then to jail. Lisa Dailey, executive director of cialis 20mg price in usa the Treatment Advocacy Center, a national nonprofit that pushes for access to mental health treatment, said jailing people for attempting suicide criminalizes mental illness. €œPrison or jail are the worst settings you can possibly be because you’re in a psychiatric crisis,” she said. Even if the care is good, she said, “being incarcerated is a traumatizing experience.” Studies have shown that the risk of self-harm in prison increases if someone has been held in solitary confinement or has previously attempted suicide.

    The Fort Peck reservation isn’t the only jurisdiction where people can be jailed after a suicide cialis 20mg price in usa attempt. In New Hampshire, suicidal people often end up in the state’s only secure facility. The men’s prison. After the Fort Peck tribes approached Carpenter’s Native American politics cialis 20mg price in usa class last year for ideas, he and his undergraduate students began consulting with tribal members and others in Montana and working to research potential alternatives to jail.

    The Flathead tribe in western Montana, for instance, specifies that people should be held in the “least restrictive environment” possible to protect their well-being, short of a jail cell. Carpenter said this could take the form of a “safe house” that separates a person from weapons. Other potential fixes include requiring that a mental health worker accompany police cialis 20mg price in usa during interactions with a suicidal person to ensure that jail is the last resort, and creating a new “mental health code” that would treat suicidal people differently from those who pose a threat to others. The state of Colorado put $9.5 million toward community-based health treatment in 2017, then made it illegal to jail people awaiting mental health evaluations who hadn’t been charged with a crime.

    But places like reservations may have no choice. €œWith no resources, there’s very little you can do about any of cialis 20mg price in usa those issues,” Dailey said. The IHS office has sufficient funds to hire four more mental health workers for Fort Peck. €œWe’re definitely aggressively trying to fill empty vacancies,” said Steve Williamson, chief medical officer of the IHS’ Billings area office.

    But the cialis 20mg price in usa positions have been difficult to fill. IHS and other health providers in northeastern Montana struggle to attract candidates to live in a region 70 miles from the nearest Walmart, with few jobs or entertainment options for families. FourStar said the tribes hope to use erectile dysfunction treatment relief aid to improve behavioral health services so that suicide attempts can be treated as civil cases instead of criminal ones. €œI think cialis 20mg price in usa this will go somewhere, as long as we can get the manpower,” she said.

    Need Help?. If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741. Sara Reardon cialis 20mg price in usa. @Sara_Reardon Related Topics Contact Us Submit a Story TipSearching for the Nuns Who Ghosted Fort Scott Host Sarah Jane Tribble sets out on a mission to learn more about the Sisters of Mercy, the nuns who founded Fort Scott’s Mercy Hospital and were once prominent leaders of the community.

    Tribble’s first glimpse into their lives takes her to an old convent. To learn more about the founding cialis 20mg price in usa of Fort Scott’s hospital, listen to Episode Four. Can’t see the audio player?. Click here to listen.

    Click here to read the episode cialis 20mg price in usa transcript. How’s Josh?. Before Fort Scott’s hospital shut down, Josh was a teenager coping with his aging grandparents and the emotional burden of his mother’s opioid death. The family’s troubles worsened after the hospital cialis 20mg price in usa closed.

    Tribble gives Josh a call to find out his next steps. If you want to hear more of Josh’s story, we tell it in Episode Six. Can’t see the audio player? cialis 20mg price in usa. Click here to listen.

    Click here to read the episode transcript. “Where It Hurts” is a podcast collaboration between KHN cialis 20mg price in usa and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.” Subscribe to Where It Hurts on Apple Podcasts, Stitcher, Google, Spotify, Pocket Casts or wherever you listen to podcasts.

    To hear all KHN podcasts, click cialis 20mg price in usa here. Sarah Jane Tribble. sjtribble@kff.org, @SJTribble Related Topics Contact Us Submit a Story TipFor parents living in poverty, “diaper math” is a familiar and distressingly pressing daily calculation. Babies in cialis 20mg price in usa the U.S.

    Go through six to 10 disposable diapers a day, at an average cost of $70 to $80 a month. Name-brand diapers with high-end absorption sell for as much as a half a dollar each, and can result in upwards of $120 a month in expenses. One in every three American families cannot afford enough diapers to keep their infants and toddlers clean, dry cialis 20mg price in usa and healthy, according to the National Diaper Bank Network. For many parents, that leads to wrenching choices.

    Diapers, food or rent?. The erectile dysfunction treatment cialis 20mg price in usa cialis has exacerbated the situation, both by expanding unemployment rolls and by causing supply chain disruptions that have triggered higher prices for a multitude of products, including diapers. Diaper banks — community-funded programs that offer free diapers to low-income families — distributed 86% more diapers on average in 2020 than in 2019, according to the National Diaper Bank Network. In some locations, distribution increased by as much as 800%.

    Yet no federal cialis 20mg price in usa program helps parents pay for this childhood essential. The government’s food assistance program does not cover diapers, nor do most state-level public aid programs. California is the only state to directly fund diapers for families, but support is limited. CalWORKS, a financial assistance program for families with children, provides $30 a month to help families pay for diapers for kids under age 3 cialis 20mg price in usa.

    Federal policy shifts also may be in the works. Democratic lawmakers are pushing to include $200 million for diaper distribution in the massive budget reconciliation package. Without adequate resources, low-income cialis 20mg price in usa parents are left scrambling for ways to get the most use out of each diaper. This stressful undertaking is the subject of a recent article in American Sociological Review by Jennifer Randles, a professor of sociology at California State University-Fresno.

    In 2018, Randles conducted phone interviews with 70 mothers in California over nine months. She tried to recruit fathers as well, but only cialis 20mg price in usa two men responded. Randles spoke with KHN’s Jenny Gold about how the cost of diapers weighs on low-income moms, and the “inventive mothering” many low-income women adopt to shield their children from the harms of poverty. The conversation has been edited for length and clarity.

    Jennifer Randles, a professor of sociology at California State University-Fresno, has done novel research into the role diapers — and not having enough of them — play in the anxieties of low-income moms cialis 20mg price in usa. €œIn my sample, half of the mothers told me that they worried more about diapers than they worried about food or housing,” Randles says.(Vickie Kirby) Q. How do diapers play into day-to-day anxieties for low-income mothers?. In my sample, half of the mothers told me that they worried more about diapers than they worried about food or housing cialis 20mg price in usa.

    I started to ask mothers, “Can you tell me how many diapers you have on hand right now?. € Almost every one told me with exact specificity how many they had — five or seven or 12. And they knew exactly how long that number of diapers would last, based on how often their children defecated and urinated, if their kid was sick, if they had a diaper rash at the cialis 20mg price in usa time. So just all the emotional and cognitive labor that goes into keeping such careful track of diaper supplies.

    They were worrying and figuring out, “OK, I’m down to almost my last diaper. What do I cialis 20mg price in usa do now?. Do I go find some cans [to sell]?. Do I go sell some things in my house?.

    Who in my social network might have some extra cash right cialis 20mg price in usa now?. € I talked to moms who sell blood plasma just to get their infants diapers. Q. What coping cialis 20mg price in usa strategies stood out to you?.

    Those of us who study diapers often call them diaper-stretching strategies. One was leaving on a diaper a little bit longer than someone might otherwise leave it on and letting it get completely full. Some mothers figured out if they bought a [more expensive] diaper that held more cialis 20mg price in usa and leaked less, they could leave the diaper on longer. They would also do things like letting the baby go diaperless, especially when they were at home and felt like they wouldn’t be judged for letting their baby go without a diaper.

    And they used every household good you can imagine to make makeshift diapers. Mothers are cialis 20mg price in usa using cloth, sheets and pillowcases. They’re using things that are disposable like paper towels with duct tape. They’re making diapers out their own period supplies or adult incontinence supplies when they can get a sample.

    One of the questions I often get is, “Why don’t they just use cialis 20mg price in usa cloth?. € A lot of the mothers that I spoke with had tried cloth diapers and they found that they were very cost- and labor-prohibitive. If you pay for a full startup set of cloth diapers, you’re looking at anywhere from $500 to $1,000. And these moms never cialis 20mg price in usa had that much money.

    Most of them didn’t have in-home washers and dryers. Some of them didn’t even have homes or consistent access to water, and it’s illegal in a lot of laundromats and public laundry facilities to wash your old diapers. So the same conditions that would prevent moms from cialis 20mg price in usa being able to readily afford disposable diapers are the same conditions that keep them from being able to use cloth. Q.

    You found that many women’s concept of being a good mother is wrapped up in diapering. Why is that? cialis 20mg price in usa. Diapers and managing diapers was so fundamental to their identity as good moms. Most of the mothers in my sample went without their own food.

    They weren’t paying a cellphone bill or buying their own medicine or their own menstrual supplies, cialis 20mg price in usa as a way of saving diaper money. I talked to a lot of moms who said, when your baby is hungry, that’s horrible. Obviously, you do everything to prevent that. But there’s something about a diaper that covers this vulnerable part of cialis 20mg price in usa a very young baby’s body, this very delicate skin.

    And being able to do something to meet this human need that we all have, and to maintain dignity and cleanliness. A lot of the moms had been through the welfare system, and so they’re living in this constant fear [of losing their children]. This is especially true among mothers of color, who are much more cialis 20mg price in usa likely to get wrapped up in the child welfare system. People can’t necessarily see when your baby’s hungry.

    But people can see a saggy diaper. That’s going to be one of the things that tags you cialis 20mg price in usa as a bad mom. Q. Was your work on diapers influenced by your experience as a parent?.

    When I was doing these interviews, my cialis 20mg price in usa daughter was about 2 or 3. So still in diapers. When my daughter peed during a diaper change, I thought, “Oh, I can just toss that one. Here, let me get another clean cialis 20mg price in usa one.” That’s a really easy choice.

    For me. That’s a crisis for the mothers I interviewed. Many of cialis 20mg price in usa them told me they have an anxiety attack with every diaper change. Q.

    Do you see a clear policy solution to diaper stress?. What’s kind of ironic is how much physical, cialis 20mg price in usa emotional and cognitive labor goes into managing something that society and lawmakers don’t even recognize. Diapers are still not really recognized as a basic need, as evidenced by the fact that they’re still taxed in 35 states. I think what California is doing is an excellent start.

    And I think diaper banks are a fabulous type cialis 20mg price in usa of community-based organization that are filling a huge need that is not being filled by safety net policies. So, public support for diaper banks. The direct cash aid part of the social safety net has been all but dismantled in the last 25 years. California is cialis 20mg price in usa pretty generous.

    But there are some states where just the cost of diapers alone would use almost half of the average state TANF [Temporary Assistance for Needy Families] benefit for a family of three. I think we really do have to address the fact that the value of cash aid buys so much less than it used to. Q. Your body of work on marriage and families is fascinating and unusual.

    Is there a single animating question behind your research?. The common thread is. How do our safety net policies support low-income families’ parenting goals?. And do they equalize the conditions of parenting?.

    I think of it as a reproductive justice issue. The ability to have a child or to not have a child, and then to parent that child in conditions where the child’s basic needs are met. We like to say that we’re child and family friendly. The diaper issue is just one of many, many issues where we don’t really put our money or our policies where our mouth is, in terms of supporting families and supporting children.

    I think my work is trying to get people to think more collectively about having a social responsibility to all families and to each other. No country, but especially the richest country on the planet, should have 1 in 3 very young children not having one of their basic needs met. I interviewed one dad who was incarcerated because he wrote a bad check. And as he described it to me, he had a certain amount of money, and they needed both diapers and milk for the baby.

    And I’ll never forget, he said, “I didn’t make a good choice, but I made the right one.” These are not fancy shoes.

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About

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Lose the shirt off my back? Nah.

When life got dicey, I opened my closet doors, bypassed the blouses, and earned a (modest) payday by selling used hangers in 25-pack bundles.

More recently, I put my hustle into play at 500 Startups, the world’s most active venture capital fund and startup accelerator, where I led content, branding, marketing, operations, and corporate partnerships for business development and global programs.

Before transitioning into tech, I worked in higher education, teaching online research and media production classes across a variety of disciplines at the University of California, Berkeley. During that time, I also worked as the Director and Executive Producer of Digital Media Projects at the Blum Center for Developing Economies, where I co-founded and led The #GlobalPOV Project, a mixed-media approach to thinking about poverty, inequality, and undertaking poverty action.

In addition, I was the Director of Media at the Center for Middle Eastern Studies, where I had the opportunity to interview Bashar al-Assad in his presidential palace in Damascus, Syria, in late December of 2010. I asked Assad if he considered himself a dictator. He dodged the inquiry, but his actions in the immediate weeks, months, and years to follow answered the question . . . and then some. Sadly.

Before that, I was a practicing journalist and graduate fellow at the University of Southern California. During that time, I worked as a web reporter and photographer for KCET’s “SoCal Connected,”​ as an online editor for the London-based New Statesman magazine, and as the co-editor-in-chief of USC Annenberg’s award-winning digital news website. I got my start in journalism as a full-time associate editor (and employee #20!) at P✪PSUGAR, a Sequoia-backed content and commerce startup turned global media empire.

My freelance reporting has been featured in NBC, CBS, and ABC news broadcasts and in online publications, including The Huffington Post. I have also done manuscript editing for various authors with recognized commercial and university presses.

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Let’s connect! Join me on Twitter or Instagram or LinkedIn.

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