Costco levitra

Costco levitra

So remember that time Tori and I posted our first TWTT? Well, we’re back in action! Katherine, Julia and I wanted to share a few quick photos we snapped at our team picnic from yesterday. Some weeks we may have a fun craft, recipe or adventure to share so you can all keep up with us in our personal lives in between the brilliant sessions and weddings we will be posting! I am so excited about these two girls and the stories their hearts have to share. It was so fun meeting at Longs Park, collaborating a fun little meal, talking about photography/the business and just chatting about life and what’s going on for all of us. I’m also so glad the weather is deciding to take a break from the rain and give us some nice sunshine!

Enjoy our little picnic while I head back to editing for the day!

Meagan Nicole

 photo blog001-33.jpg photo blog002-32.jpg photo blog003-29.jpg photo blog004-27.jpg

Costco levitra

Costco levitra

More wheat, corn (also known as costco levitra maize), combining viagra and levitra rice and soybeans are grown in the fields of the United States than any other crop. These plants are not just on our tables. They’re everywhere, from the starch in our clothing to the fuel that we use to the medicine we take (corn steep liquor is used in making penicillin) to the most intimate aspects of our lives (because cornstarch is used in condoms and other family planning and personal hygiene products).

But most costco levitra of these foods were first developed in what President Trump once referred to as “shithole countries.” Wheat was originally domesticated by the inhabitants of Syria, Turkey and Iraq roughly 11,000 years ago. Around the same time in China, early farmers developed rice and, later, soybeans. Corn was bred in central Mexico approximately 9,000 years ago and was so important to the Olmec, Maya and other Mesoamerican civilizations that they even had maize gods.

All of these foreigners are around us in some capacity, and they form the costco levitra backbone of our great economy. Foreigners aren’t just found in fields, they are also found in our gardens and in our houses. The people of Peru domesticated the potato and the peoples of Central America gave us chili peppers.

Native Americans, costco levitra whom the GOP routinely tries to prevent from voting, domesticated the turkey we consume this Thanksgiving and the pumpkins we carved for Halloween. Even our most socially acceptable vices such as tobacco (South America), coffee (Ethiopia) and tea (China) have dubious foreign origins. If there was a way to ferment sugars, people found a way to turn it into booze, with some of the earliest evidence of alcohol production found in the first civilizations in the world in the Middle East.

The very food that tempts me at the checkout line, chocolate, can be traced back costco levitra to a plant that was originally domesticated in South America and refined by the Olmec and Maya of Central America. The candy bars that we give out at Halloween are an un-American combination of chocolate, sugar (sugarcane originally from Southeast Asia) and milk (originally developed in the Middle East). You can thank the Aztecs for our tomatoes and people of New Guinea for our bananas.

The Native Americans of eastern North America domesticated the beautiful sunflower, and then the Russians made them even better by developing the varieties with the costco levitra giant dinner-plate–sized flower heads. And foreigners aren’t just in our food. They’re also in our most cherished pieces of children’s literature and film.

The popular children’s book Charlotte’s Web and the 1995 film Babe are not gripping tales designed to teach life lessons so much as they are tales of costco levitra foreigners trying to escape persecution and death in rural America. The entire barnyard is a collection of nefarious characters. Babe and Wilbur’s ancestors were wild boars in the Middle East and China that were domesticated into our friendly, if not slightly troublesome, pigs.

All of the chickens, roosters and ducks are originally from costco levitra the jungles of southern China, Laos, Thailand and Vietnam. Cows first roamed the mountains of the Middle East, India and Pakistan, while horses all come from the steppes of eastern Russia and Mongolia. In Trump’s America, the beloved sheep would undoubtedly be flagged at the airport for extra screening because their ancestors lived in the lawless mountains of Turkey, Iraq and Iran.

Even Duchess the Cat, the one animal in Babe who doesn’t seem destined for the chopping block, is not above suspicion costco levitra because of her ancient Egyptian heritage. I often envision people, once they realize the origins of their food, repeatedly reliving that scene from Ghostbusters where Sigourney Weaver opens her fridge to discover the demon Zuul living in her fridge. The painting American Gothic by Grant Wood, depicting a stern-looking farming couple is seared into our collective consciousness as what it means to be an American, and what traditional American values are.

I imagine that if costco levitra you pan out from that image, you’ll see the real truth behind America. You’ll see hard-working farmers planting Mexican corn, milking Middle Eastern cows and harvesting Chinese soybeans. Trump and his Republican allies will try and build all the walls they want and scare as many people as will listen.

But for this Thanksgiving, the “foreigners” are already here, and they’ve been here for costco levitra a long time.In a key moment of the final Trump-Clinton presidential debate, Donald Trump turned to a question regarding Russian president Vladimir Putin. €œHe has no respect for her,” Trump said, pointing at Hillary Clinton. €œPutin, from everything I see, has no respect for this person.” The two debaters then drilled down to try and gain a more nuanced understanding of the difficult policy issues involved.

Clinton said, “Are you suggesting costco levitra that the aggressive approach I propose would actually fail to deter Russian expansionism?. € To which Trump responded, “No, I certainly agree that it would deter Russian expansionism. It's just that it would also serve to destabilize the ...” Just kidding.

That's not at all what happened costco levitra. Actually each side aimed to attack and defeat the other. Clinton really said, “Well, that's because he'd rather have a puppet as president of the United States.” To which Trump retorted, “You're the puppet!.

€ Episodes like this costco levitra one have become such a staple of contemporary political discourse that it is easy to forget how radically different they are from disputes we often have in ordinary life. Consider a couple of friends trying to decide on a restaurant for dinner. One might say, “Let's try the new Indian restaurant tonight.

I haven't had Indian for months.” To which another replies, “You know, I saw costco levitra that place is getting poor reviews. Let's grab some pizza instead?. € “Good to know—pizza it is,” says the first.

Each comes costco levitra in with an opinion. They begin a discussion in which each presents an argument, then listens to the other's argument, and then they both move toward an agreement. This kind of dialogue happens all the time.

In our research, which involves cognitive psychology and experimental philosophy, we refer to it as “arguing to learn.” But as political polarization increases in the costco levitra U.S., the kind of antagonistic exchange exemplified by the Trump-Clinton debate is occurring with increasing frequency—not just among policy makers but among us all. In interactions such as these, people may provide arguments for their views, but neither side is genuinely interested in learning from the other. Instead the real aim is to “score points,” in other words, to defeat the other side in a competitive activity.

Conversations on Twitter, Facebook and even costco levitra YouTube comment sections have become powerful symbols of what the combativeness of political discourse looks like these days. We refer to this kind of discussion as “arguing to win.” The divergence of Americans' ideology is accompanied by an animosity for those across the aisle. Recent polls show that partisan liberals and conservatives associate with one another less frequently, have unfavorable views of the opposing party, and would even be unhappy if a family member married someone from the other side.

At the same time, the costco levitra rise of social media has revolutionized how information is consumed—news is often personalized to one's political preferences. Rival perspectives can be completely shut out from one's self-created media bubble. Making matters worse, outrage-inducing content is more likely to spread on these platforms, creating a breeding ground for clickbait headlines and fake news.

This toxic online environment costco levitra is very likely driving Americans further apart and fostering unproductive exchanges. In this time of rising tribalism, an important question has arisen about the psychological effects of arguing to win. What happens in our minds—and to our minds—when we find ourselves conversing in a way that simply aims to defeat an opponent?.

Our recent research has explored this question using experimental methods, and we have found that the distinction between different modes of argument has some surprisingly far-reaching effects costco levitra. Not only does it change people's way of thinking about the debate and the people on the opposing side, but it also has a more fundamental effect on our way of understanding the very issue under discussion. Are We Objectivists or Relativists?.

The question of moral and political objectivity is a notoriously thorny one, which costco levitra philosophers have been debating for millennia. Still, the core of the question is easy enough to grasp by considering a few hypothetical conversations. Consider a debate about a perfectly straightforward question in science or mathematics.

Suppose two friends are working costco levitra together on a problem and find themselves disagreeing about the solution. Mary. The cube root of 2,197 is 13.

Susan. No, the cube root of 2,197 is 14. People observing this conflict might not know which answer is correct.

Yet they might be entirely sure that there is a single objectively correct answer. This is not just a matter of opinion—there is a fact of the matter, and anyone who has an alternative view is simply mistaken. Now consider a different kind of scenario.

Suppose these two friends decide to take a break for lunch and find themselves disagreeing about what to put on their bagels. Mary. Veggie cream cheese is really tasty.

Susan. No, veggie cream cheese is not tasty at all. It is completely disgusting.

In this example, observers might take up another attitude. Even if two people have opposite opinions, it could be that neither is incorrect. It seems that there is no objective truth of the matter.

With that in mind, think about what happens when people debate controversial questions about morally infused political topics. As our two friends are enjoying their lunch, suppose they wade into a heated political chat. Mary.

Abortion is morally wrong and should not be legal. Susan. No, there is nothing wrong with abortion, and it should be perfectly legal.

The question we grapple with is how to understand this kind of debate. Is it like the math question, where there is an objectively right answer and anyone who says otherwise must be mistaken?. Or is it more like a clash over a matter of taste, where there is no single right answer and people can have opposite opinions without either one being wrong?.

In recent years work on this topic has expanded beyond the realm of philosophy and into psychology and cognitive science. Instead of relying on the intuitions of professional philosophers, researchers like ourselves have begun gathering empirical evidence to understand how people actually think about these issues. Do people tend to think moral and political questions have objectively correct answers?.

Or do they have a more relativist view?. On the most basic level, the past decade of research has shown that the answer to this question is that it's complicated. Some people are more objectivist.

Others are more relativist. That might seem obvious, but later studies explored the differences between people with these types of thinking. When participants are asked whether they would be willing to share an apartment with a roommate who holds opposing views on moral or political questions, objectivists are more inclined to say no.

When participants are asked to sit down in a room next to a person who has opposing views, objectivists actually sit farther away. As University of Pennsylvania psychologist Geoffrey P. Goodwin once put it, people who hold an objectivist view tend to respond in a more “closed” fashion.

Why might this be?. One straightforward possibility is that if you think there is an objectively correct answer, you may be drawn to conclude that everyone who holds the opposite view is simply incorrect and therefore not worth listening to. Thus, people's view about objective moral truths could shape their approach to interacting with others.

This is a plausible hypothesis and one worth investigating in further studies. Yet we thought that there might be more to the story. In particular, we suspected there might be an effect in the opposite direction.

Perhaps it's not just that having objectivist views shapes your interactions with other people. Perhaps your interactions with other people can actually shape the degree to which you hold objectivist views. Winning vs.

Learning To test this theory, we ran an experiment in which adults engaged in an online political conversation. Each participant logged on to a Web site and indicated his or her positions on a variety of controversial political topics, including abortion and gun rights. They were matched with another participant who held opposing views.

The participants then engaged in an online conversation about a topic on which they disagreed. Half of the participants were encouraged to argue to win. They were told that this would be a highly competitive exchange and that their goal should be to outperform the other person.

The result was exactly the kind of communication one sees every day on social media. Here, for example, is a transcript from one of the actual conversations. P1.

I believe 100 percent in a woman's choice P2. Abortion should be prohibited because it stops a beating heart P1. Abortion is the law of the land, the land you live in P2.

The heart beats at 21 days its murder [sic] The other half of participants were encouraged to argue to learn. They were told that this would be a very cooperative exchange and that they should try to learn as much as they could from their opponent. These conversations tended to have a quite different tone.

P3. I believe abortion is a right all women should possess. I do understand that some people choose to place certain determinants on when and why, but I think it should be for any reason before a certain time point in the pregnancy agreed upon by doctors, so as not to harm the mother.

P4. I believe that life begins at conception (sperm meeting egg), so abortion to me is the equivalent of murder. P3.

I can absolutely see that point. As a biologist, it is obvious from the first cell division that “life” is happening. But I do not think life is advanced enough to warrant abolishing abortion.

It is not all that surprising that these two sets of instructions led to such results. But would these exchanges in turn lead to different views about the very nature of the question being discussed?. After the conversation was over, we asked participants whether they thought there was an objective truth about the topics they had just debated.

Strikingly, these 15-minute exchanges actually shifted people's views. Individuals were more objectivist after arguing to win than they were after arguing to learn.

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Commentary on can levitra be cut in half Resources. Carlton E, Kohne J, Shankar-Hari, et can levitra be cut in half al. Readmission diagnoses after paediatric severe sepsis hospitalisation.

Crit Care Med 2019;47:583–90.Implications for practice and researchChildren with coexisting comorbidities when discharged following severe sepsis have a higher rate of readmission as compared with matched hospitalisations for other acute medical conditions.There is a need for internationally agreed evidence-based guidelines/consensus paper to minimise post-sepsis readmissions through identification of potentially preventable factors, appropriate discharge criteria and parental education.More research is required into strategies towards prevention of readmissions following discharge after an episode of severe sepsis in children.ContextSepsis is a leading cause of avoidable death across all age groups.1 Attempts have been made to streamline the management pathways in the UK and elsewhere through publication of national guidelines.1 While robust guidelines exist for management of initial sepsis episodes, strategies to identify and prevent readmissions can levitra be cut in half are necessary. This ….

Commentary on costco levitra buy generic levitra. Carlton E, Kohne costco levitra J, Shankar-Hari, et al. Readmission diagnoses after paediatric severe sepsis hospitalisation.

Crit Care Med 2019;47:583–90.Implications for practice and researchChildren with coexisting comorbidities when discharged following costco levitra severe sepsis have a higher rate of readmission as compared with matched hospitalisations for other acute medical conditions.There is a need for internationally agreed evidence-based guidelines/consensus paper to minimise post-sepsis readmissions through identification of potentially preventable factors, appropriate discharge criteria and parental education.More research is required into strategies towards prevention of readmissions following discharge after an episode of severe sepsis in children.ContextSepsis is a leading cause of avoidable death across all age groups.1 Attempts have been made to streamline the management pathways in the UK and elsewhere through publication of national guidelines.1 While robust guidelines exist for management of initial sepsis episodes, strategies to identify and prevent readmissions are necessary. This ….

What side effects may I notice from Levitra?

Side effects that you should report to your prescriber or health care professional as soon as possible.

  • back pain
  • changes in hearing such as loss of hearing or ringing in ears
  • changes in vision such as loss of vision, blurred vision, eyes being more sensitive to light, or trouble telling the difference between blue and green objects or objects having a blue color tinge to them
  • chest pain or palpitations
  • difficulty breathing, shortness of breath
  • dizziness
  • eyelid swelling
  • muscle aches
  • prolonged erection (lasting longer than 4 hours)
  • skin rash, itching
  • seizures

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):

  • flushing
  • headache
  • indigestion
  • nausea
  • stuffy nose

This list may not describe all possible side effects.

Levitra with dapoxetine review

IntroductionThe erectile dysfunction treatment How to buy cipro in usa levitra has levitra with dapoxetine review now reached all world continents except Antartica. Its spread has placed an enormous and sustained burden on health systems, which has likely exacerbated the mortality rate of erectile dysfunction erectile dysfunction.1 Since the start of the levitra, several noteworthy contributions have discussed important aspects of levitra with dapoxetine review intensive care units’ (henceforth ICUs) shortages.2–5 Like most allocation problems, this issue presents inherently normative questions that ethicists and physicians ought to address by developing a set of coherent and consistent rules, thus preventing healthcare practitioners to be faced ‘with the terrible task of improvising decisions on whom to treat’.2 Such guidelines are likely to directly affect a considerable number of citizens, as well as their families and relatives, throughout the levitra and might have relevant legal implications.6 Hence, it is of paramount importance to assess their perception of the fairness of such rules. If these are not in line with people’s moral views, this may create resentment and feelings of injustice that could worsen the already traumatic impact of the choices. These views could, therefore, levitra with dapoxetine review inform policy makers and clinicians on the need to communicate appropriately the rationale behind the guidelines, in order to (partially) alleviate the above-mentioned effects.4The purpose of this paper is to inform the debate as to whether citizens’ moral principles are aligned with the proposed guidelines and recommendations. To this end, we conducted a survey among a sample of American citizens.

We compare individuals’ responses with the recommendations contained in ref 2 that offer a comprehensive set of guidelines for the allocation of scarce resources during erectile dysfunction treatment representing a widespread consensus levitra with dapoxetine review in the medical literature. The next section describes the survey structure and design. A methods section (section levitra with dapoxetine review 3) describes characteristics of the sample and the statistical methodology. Section 4 presents our main results and section 5 concludes.The surveyOur survey was conducted among a sample of 1033 American citizens using the online survey platform CloudResearch. An additional 443 started the levitra with dapoxetine review survey but did not finish.

This rate of completion (around 70%) levitra with dapoxetine review is in line with online studies similar to ours. Subjects were recruited from the CloudResearch panel, which is heterogeneous in many sociodemographic dimensions (see Methods). In our survey, we asked respondents to imagine a situation in which the US Federal Government is planning to publish guidelines for the allocation of ICUs during levitra with dapoxetine review the erectile dysfunction treatment levitra. Respondents are asked which principles these guidelines should contain according to them. Respondents were informed that this was a levitra with dapoxetine review research project and that their responses would remain anonymous.

We elicited their views through the use of several hypothetical scenarios (see table 1). All scenarios contain two patients (neutrally labelled patient A and patient B), with different characteristics, who have been levitra with dapoxetine review hospitalised. Both patients need an ICU bed but only one is available. In all scenarios, respondents are asked which of four options they would suggest for the levitra with dapoxetine review guidelines. Admit patient levitra with dapoxetine review A to the ICU, admit patient B, decide randomly and admit on a first-come first-served basis.

Through the use of our scenarios, we test the extent to which people’s moral views are in line with the recommendations highlighted in ref 2. Table 1 reports the wording for each scenario and the implied recommendation levitra with dapoxetine review. Before being exposed to the scenarios, respondents had to answer four comprehension questions to ensure their understanding of the hypothetical situation. The order in which the levitra with dapoxetine review scenarios appeared was randomised at the individual level. We believe that control questions and the randomised order of scenarios eliminate concerns about order and learning effects.

After the scenarios, respondents were asked several sociodemographic questions and questions about their perceptions levitra with dapoxetine review of the erectile dysfunction treatment levitra (see online supplemental appendix A). There we no other questions about other subjects in the survey.Supplemental materialView this table:Table 1 The table describes the eight different scenarios proposed in the surveyMethodsOur respondents are part of the survey panel (prime panel) of the platform CloudResearch. Respondents from this panel have been shown levitra with dapoxetine review to be more heterogeneous in various aspects (eg, age, education and political attitudes) with respect to the more commonly used pool of Amazon Mechanical Turk.7 Our sample is composed by respondents from 50 different states. Respondents are levitra with dapoxetine review highly heterogeneous in various dimensions. The majority of them are women (60.8%), and the average age is 44.6 years (SD=16.8).

They have a higher educational attainment than the US average according to the levitra with dapoxetine review 2018 data of the US Census Bureau,8 as almost all of them earned at least a high school degree (98%), and the majority of them (52.5%) earned at least a bachelor’s degree. The median household yearly income before taxes ranges between $60 000 and $70 000, in line with the national figures ($63 119).9 A percentage of 17.3 of them declared to be smokers (vs 15.1% at national level). Finally, 41.6% identified themselves as Democrats, 36.6% as Republicans and 21.8% as Independents.10 The average survey completion time levitra with dapoxetine review was 8.5 min. Therefore, the hourly compensation for the completion averaged to $8.82. With respect to statistical analyses, we mainly used non-parametric tests for matched observations, that is, McNemar’s χ2 test and signrank test.11 Only in one case where we performed a levitra with dapoxetine review between-subjects comparison, we use a test of proportions for independent observations (χ2 test).Survey responses.

Each bar represents the distribution of answers for each of the eight scenarios. The bars on the left-hand side represent the share of answers in levitra with dapoxetine review line with the recommendations from the guidelines. The bars on the right-hand side represent the share of answers not in line with the recommendations." data-icon-position data-hide-link-title="0">Figure 1 levitra with dapoxetine review Survey responses. Each bar represents the distribution of answers for each of the eight scenarios. The bars on the left-hand side represent the share of answers levitra with dapoxetine review in line with the recommendations from the guidelines.

The bars on the right-hand side represent the share of answers not in line with the recommendations.ResultsFigure 1 shows the percentage of responses in line with the recommendations contained in ref 2. As it can be seen from the figure, we find levitra with dapoxetine review high heterogeneity across scenarios. While for some scenarios responses are broadly in line with the recommendations, for others only a minority of responses is. The share of responses in line with the recommendations ranges from 5.4% to levitra with dapoxetine review 68.7%. In what follows we summarise our main results.Result 1 levitra with dapoxetine review.

Maximise benefitsMaximising benefits is considered to be the most important principle in a levitra.2 This principle can be applied either as saving most lives or as many years of life as possible. We tested both these applications levitra with dapoxetine review of the principle. To test the save most lives principle, in scenario 1, we describe both patients as having the same life expectancy but patient A as having higher probability of survival in an ICU. To test the save the most years of life principle, in scenario 2, the probability of levitra with dapoxetine review survival in the ICU is the same for both patients, but patient A has higher life expectancy post-treatment. Our results show that people tend to apply the maximising benefits principle significantly more often when this increases the chances of saving a life rather than when it saves more years of life in expectation (59.6% vs 44.7%, McNemar’s χ2(1)=79.58, p<0.001.

Signrank test, z=8.92, p<0.001).Result levitra with dapoxetine review 2. Maximise benefitsAnother important implication of the maximise benefits principle is that a patient with lower probability of survival ought to be removed from an ICU when a patient with higher probability of survival needs it.2 Despite being the most rational thing to do from a utilitarian perspective, this may be considered unfair for several reasons related to well-documented behavioural phenomena. First, as resources have been already spent to cure the patient already in the ICU, respondents may be affected by the sunk cost fallacy, that is, the evidence that people commit to certain choices even when these choices are revealed to be suboptimal as time passes.12 13 Second, a patient’s incumbency may produce a sense of entitlement similar to the endowment effect in those who (perhaps subconsciously) identify with the incumbent, thus leading levitra with dapoxetine review to the status quo bias.14 Finally, and perhaps more importantly, the emotional burden of suspending treatment may be stronger than the one of not initiating treatment, which could be caused by the perceived moral differences in omission (not treating) versus commission (suspending treatment).15 In order to test this implication of the maximise benefits principle, we included two scenarios that we administered between subjects (n=521 in scenario 3 and n=511 in scenario 4). In scenario 3, patient B, who has lower probability of survival, has been in the ICU for 2 months prior levitra with dapoxetine review to the arrival of patient A. On the contrary, in scenario 4, the two are hospitalised at the same time.

The two vignettes are otherwise identical, and for obvious reasons, we have removed the first-come first-served option for these two scenarios.In line with our prediction, when the two levitra with dapoxetine review patients arrive at the same time, 68.7% agree to admit patient A, while only 54.3% do so when patient B has been in the ICU for 2 months (χ2(1)=22.5, p<0.001).Result 3. Instrumental valueOne additional recommendation is to promote and reward instrumental value, that is, to prioritise ICU admission for those patients who have contributed to the treatment of erectile dysfunction treatment (ie, retrospective instrumental value) and to patients who will likely offer future contributions (ie, prospective instrumental value).2 To assess moral views for retrospective instrumental value, we created scenario 5, in which the two patients are identical in terms of life expectancy and probability of survival, but patient A is a nurse who has being treating patients with erectile dysfunction treatment. Regarding prospective instrumental value, the scenario is identical to the previous one, but patient A, instead of being a levitra with dapoxetine review nurse, is a scientist working on a potential treatment to prevent erectile dysfunction treatment. In both cases, only around 44% of respondents reward instrumental value, and we find no difference between prospective and retrospective instrumental value (McNemar’s χ2(1)=1.09, p=0.326. Signrank test, z=1.04, p=0.296)).Result levitra with dapoxetine review 4.

Treat people equallyRecommendation 3 in ref 2 stresses that, for patients with similar prognosis, random allocation must be preferred to a first-come first-served principle, though both are application of egalitarianism. First-come first-served is typically used when scarcity is levitra with dapoxetine review long-standing and patients can survive without the scarce resource, such as for example in the case of kidneys’ transplants. When needs are urgent, however, a first-come first-served approach could unfairly benefit patients living nearer to healthcare facilities, hence resulting in a less egalitarian treatment than levitra with dapoxetine review pure randomisation. To assess people’s views on this, we included scenario 7, in which the two patients are equal in all characteristics, as well as in prognosis. Despite most levitra with dapoxetine review respondents choose one of the two egalitarian responses, among these the vast majority choose first-come first-served (91%).

It is worth noticing that this difference consistently occurs across all other scenarios. Among those who prefer the levitra with dapoxetine review egalitarian options, only 7.2% choose random allocation. This may be because most cases of allocation of scarce resources are of the type where first-come first-served is appropriate and random selection is rarely used (think, for instance, of any situation in which queuing is accepted as normal). This evidence may make first-come first-served more salient and available due to past experience.16 This result calls for greater information to patients, and citizens, on the virtues of pure randomisation as the fairest means to insure levitra with dapoxetine review equality (of opportunities).Result 5. Treat people equallyAnother recommendation related to equality states that patients with erectile dysfunction treatment and patients affected by other conditions should not be treated differently when allocating scarce resources.2 We tested this by including scenario 8, in which the two patients have the same prognosis, but one is affected by erectile dysfunction treatment and the other has pneumonia not caused by erectile dysfunction.

The percentages of those who state a preference for treating one of levitra with dapoxetine review the two patients sum up to 55.8%. This is much higher than the same answers given in scenario 7 levitra with dapoxetine review (20.3%), where instead an egalitarian principle is chosen by most. Most of the respondents (34.8%) in scenario 8 suggest to treat the patient affected by erectile dysfunction treatment. This proportion alone is significantly higher compared with the sum of proportions of respondents choosing either option A or B in scenario 7, indicating that individuals tend to levitra with dapoxetine review favour the treatment of the patient with erectile dysfunction treatment in contrast to the recommendation (McNemar’s χ2(1)=62.50, p<0.001. Signrank test, z=7.91, p<0.001)).Next, we exploit our post survey sociodemographic dataset to assess whether the results reported are heterogeneous across different strata of the population.

In online supplemental appendix B, we replicate each of the results above (except result 4 in which levitra with dapoxetine review we do not employ statistical tests) breaking down the sample for gender, education, employment status, age, political orientation and income. For all subgroups, results are in line qualitatively and in terms of significance levels with the main results reported above. We conclude that our results do not depend on the specific subgroup analysed but are stable across all subgroups.ConclusionsGuidelines for the allocation levitra with dapoxetine review of scarce resources during the erectile dysfunction treatment levitra are essential and can guarantee a fair and consistent allocation across cases. We have shown, through survey results, that these ethically sensible recommendations do not always reflect the views of citizens. We found considerable heterogeneity in people’s moral judgements, and we believe this levitra with dapoxetine review heterogeneity must be addressed by (better) informing citizens regarding the rationale behind each principle.

We hope that this evidence may inform policy makers, as well as healthcare practitioners, of the need to provide an effective communication to citizens and patients, respectively, in order to avoid decision rules that may otherwise be perceived as arbitrary or unfair..

IntroductionThe erectile dysfunction treatment levitra has now reached all world continents costco levitra except How to buy cipro in usa Antartica. Its spread has placed an enormous and sustained burden on health systems, which has likely exacerbated the mortality rate of erectile dysfunction erectile dysfunction.1 Since costco levitra the start of the levitra, several noteworthy contributions have discussed important aspects of intensive care units’ (henceforth ICUs) shortages.2–5 Like most allocation problems, this issue presents inherently normative questions that ethicists and physicians ought to address by developing a set of coherent and consistent rules, thus preventing healthcare practitioners to be faced ‘with the terrible task of improvising decisions on whom to treat’.2 Such guidelines are likely to directly affect a considerable number of citizens, as well as their families and relatives, throughout the levitra and might have relevant legal implications.6 Hence, it is of paramount importance to assess their perception of the fairness of such rules. If these are not in line with people’s moral views, this may create resentment and feelings of injustice that could worsen the already traumatic impact of the choices. These views costco levitra could, therefore, inform policy makers and clinicians on the need to communicate appropriately the rationale behind the guidelines, in order to (partially) alleviate the above-mentioned effects.4The purpose of this paper is to inform the debate as to whether citizens’ moral principles are aligned with the proposed guidelines and recommendations. To this end, we conducted a survey among a sample of American citizens.

We compare individuals’ responses with the recommendations contained in ref 2 that offer a comprehensive set of guidelines for the allocation of scarce costco levitra resources during erectile dysfunction treatment representing a widespread consensus in the medical literature. The next section describes the survey structure and design. A methods section (section 3) describes characteristics of the sample and the statistical methodology costco levitra. Section 4 presents our main results and section 5 concludes.The surveyOur survey was conducted among a sample of 1033 American citizens using the online survey platform CloudResearch. An additional 443 started costco levitra the survey but did not finish.

This rate of completion (around 70%) is in line with online studies similar to ours costco levitra. Subjects were recruited from the CloudResearch panel, which is heterogeneous in many sociodemographic dimensions (see Methods). In our survey, we asked respondents to imagine costco levitra a situation in which the US Federal Government is planning to publish guidelines for the allocation of ICUs during the erectile dysfunction treatment levitra. Respondents are asked which principles these guidelines should contain according to them. Respondents were informed that this was a research project and that their responses would remain anonymous costco levitra.

We elicited their views through the use of several hypothetical scenarios (see table 1). All scenarios contain two patients (neutrally labelled patient A and patient B), with different characteristics, who have been hospitalised costco levitra. Both patients need an ICU bed but only one is available. In all scenarios, respondents costco levitra are asked which of four options they would suggest for the guidelines. Admit patient A to the ICU, admit patient B, decide randomly costco levitra and admit on a first-come first-served basis.

Through the use of our scenarios, we test the extent to which people’s moral views are in line with the recommendations highlighted in ref 2. Table 1 reports the wording for each scenario and the implied recommendation costco levitra. Before being exposed to the scenarios, respondents had to answer four comprehension questions to ensure their understanding of the hypothetical situation. The order costco levitra in which the scenarios appeared was randomised at the individual level. We believe that control questions and the randomised order of scenarios eliminate concerns about order and learning effects.

After the scenarios, respondents were asked several sociodemographic costco levitra questions and questions about their perceptions of the erectile dysfunction treatment levitra (see online supplemental appendix A). There we no other questions about other subjects in the survey.Supplemental materialView this table:Table 1 The table describes the eight different scenarios proposed in the surveyMethodsOur respondents are part of the survey panel (prime panel) of the platform CloudResearch. Respondents from this panel have been shown to be more heterogeneous in various aspects (eg, age, education and political costco levitra attitudes) with respect to the more commonly used pool of Amazon Mechanical Turk.7 Our sample is composed by respondents from 50 different states. Respondents are highly heterogeneous in various costco levitra dimensions. The majority of them are women (60.8%), and the average age is 44.6 years (SD=16.8).

They have a higher educational attainment than the US average according to the 2018 data of the US Census Bureau,8 as almost all costco levitra of them earned at least a high school degree (98%), and the majority of them (52.5%) earned at least a bachelor’s degree. The median household yearly income before taxes ranges between $60 000 and $70 000, in line with the national figures ($63 119).9 A percentage of 17.3 of them declared to be smokers (vs 15.1% at national level). Finally, 41.6% identified themselves as Democrats, 36.6% as Republicans and 21.8% as Independents.10 costco levitra The average survey completion time was 8.5 min. Therefore, the hourly compensation for the completion averaged to $8.82. With respect to statistical analyses, we mainly used non-parametric tests for matched observations, that is, McNemar’s χ2 test and signrank test.11 Only in one case where we performed a between-subjects comparison, we use a costco levitra test of proportions for independent observations (χ2 test).Survey responses.

Each bar represents the distribution of answers for each of the eight scenarios. The bars on the left-hand side represent the share of answers in line with the costco levitra recommendations from the guidelines. The bars on the right-hand side represent the share of answers not in line with the recommendations." data-icon-position data-hide-link-title="0">Figure costco levitra 1 Survey responses. Each bar represents the distribution of answers for each of the eight scenarios. The bars on the left-hand side represent the share costco levitra of answers in line with the recommendations from the guidelines.

The bars on the right-hand side represent the share of answers not in line with the recommendations.ResultsFigure 1 shows the percentage of responses in line with the recommendations contained in ref 2. As it can be seen from the figure, we find high costco levitra heterogeneity across scenarios. While for some scenarios responses are broadly in line with the recommendations, for others only a minority of responses is. The share costco levitra of responses in line with the recommendations ranges from 5.4% to 68.7%. In what follows we summarise costco levitra our main results.Result 1.

Maximise benefitsMaximising benefits is considered to be the most important principle in a levitra.2 This principle can be applied either as saving most lives or as many years of life as possible. We tested costco levitra both these applications of the principle. To test the save most lives principle, in scenario 1, we describe both patients as having the same life expectancy but patient A as having higher probability of survival in an ICU. To test the save costco levitra the most years of life principle, in scenario 2, the probability of survival in the ICU is the same for both patients, but patient A has higher life expectancy post-treatment. Our results show that people tend to apply the maximising benefits principle significantly more often when this increases the chances of saving a life rather than when it saves more years of life in expectation (59.6% vs 44.7%, McNemar’s χ2(1)=79.58, p<0.001.

Signrank test, z=8.92, costco levitra p<0.001).Result 2. Maximise benefitsAnother important implication of the maximise benefits principle is that a patient with lower probability of survival ought to be removed from an ICU when a patient with higher probability of survival needs it.2 Despite being the most rational thing to do from a utilitarian perspective, this may be considered unfair for several reasons related to well-documented behavioural phenomena. First, as resources have been costco levitra already spent to cure the patient already in the ICU, respondents may be affected by the sunk cost fallacy, that is, the evidence that people commit to certain choices even when these choices are revealed to be suboptimal as time passes.12 13 Second, a patient’s incumbency may produce a sense of entitlement similar to the endowment effect in those who (perhaps subconsciously) identify with the incumbent, thus leading to the status quo bias.14 Finally, and perhaps more importantly, the emotional burden of suspending treatment may be stronger than the one of not initiating treatment, which could be caused by the perceived moral differences in omission (not treating) versus commission (suspending treatment).15 In order to test this implication of the maximise benefits principle, we included two scenarios that we administered between subjects (n=521 in scenario 3 and n=511 in scenario 4). In scenario 3, patient B, who has lower probability of costco levitra survival, has been in the ICU for 2 months prior to the arrival of patient A. On the contrary, in scenario 4, the two are hospitalised at the same time.

The two vignettes are otherwise identical, and for obvious reasons, we have removed the first-come first-served option for these two scenarios.In line with our prediction, when the two patients arrive at the same time, 68.7% agree to admit patient A, while only 54.3% do so when patient B has been in the ICU costco levitra for 2 months (χ2(1)=22.5, p<0.001).Result 3. Instrumental valueOne additional recommendation is to promote and reward instrumental value, that is, to prioritise ICU admission for those patients who have contributed to the treatment of erectile dysfunction treatment (ie, retrospective instrumental value) and to patients who will likely offer future contributions (ie, prospective instrumental value).2 To assess moral views for retrospective instrumental value, we created scenario 5, in which the two patients are identical in terms of life expectancy and probability of survival, but patient A is a nurse who has being treating patients with erectile dysfunction treatment. Regarding prospective instrumental value, the scenario is identical to the previous one, but patient A, instead of being a costco levitra nurse, is a scientist working on a potential treatment to prevent erectile dysfunction treatment. In both cases, only around 44% of respondents reward instrumental value, and we find no difference between prospective and retrospective instrumental value (McNemar’s χ2(1)=1.09, p=0.326. Signrank test, costco levitra z=1.04, p=0.296)).Result 4.

Treat people equallyRecommendation 3 in ref 2 stresses that, for patients with similar prognosis, random allocation must be preferred to a first-come first-served principle, though both are application of egalitarianism. First-come first-served is typically used when scarcity is long-standing and patients can survive without the scarce resource, such as for example in the case of costco levitra kidneys’ transplants. When needs costco levitra are urgent, however, a first-come first-served approach could unfairly benefit patients living nearer to healthcare facilities, hence resulting in a less egalitarian treatment than pure randomisation. To assess people’s views on this, we included scenario 7, in which the two patients are equal in all characteristics, as well as in prognosis. Despite most respondents choose one of the two egalitarian responses, among these the vast majority choose first-come first-served (91%) costco levitra.

It is worth noticing that this difference consistently occurs across all other scenarios. Among those costco levitra who prefer the egalitarian options, only 7.2% choose random allocation. This may be because most cases of allocation of scarce resources are of the type where first-come first-served is appropriate and random selection is rarely used (think, for instance, of any situation in which queuing is accepted as normal). This evidence may make first-come first-served more salient and available due to past experience.16 This result calls for greater information to patients, and citizens, on costco levitra the virtues of pure randomisation as the fairest means to insure equality (of opportunities).Result 5. Treat people equallyAnother recommendation related to equality states that patients with erectile dysfunction treatment and patients affected by other conditions should not be treated differently when allocating scarce resources.2 We tested this by including scenario 8, in which the two patients have the same prognosis, but one is affected by erectile dysfunction treatment and the other has pneumonia not caused by erectile dysfunction.

The percentages of those who state a preference for costco levitra treating one of the two patients sum up to 55.8%. This is much higher than the same costco levitra answers given in scenario 7 (20.3%), where instead an egalitarian principle is chosen by most. Most of the respondents (34.8%) in scenario 8 suggest to treat the patient affected by erectile dysfunction treatment. This proportion alone is significantly higher compared with the sum of proportions of respondents choosing either option A or B in scenario 7, indicating that individuals costco levitra tend to favour the treatment of the patient with erectile dysfunction treatment in contrast to the recommendation (McNemar’s χ2(1)=62.50, p<0.001. Signrank test, z=7.91, p<0.001)).Next, we exploit our post survey sociodemographic dataset to assess whether the results reported are heterogeneous across different strata of the population.

In online supplemental appendix B, we replicate each of the results above (except result 4 in costco levitra which we do not employ statistical tests) breaking down the sample for gender, education, employment status, age, political orientation and income. For all subgroups, results are in line qualitatively and in terms of significance levels with the main results reported above. We conclude costco levitra that our results do not depend on the specific subgroup analysed but are stable across all subgroups.ConclusionsGuidelines for the allocation of scarce resources during the erectile dysfunction treatment levitra are essential and can guarantee a fair and consistent allocation across cases. We have shown, through survey results, that these ethically sensible recommendations do not always reflect the views of citizens. We found considerable heterogeneity in people’s moral judgements, and we believe this heterogeneity must be addressed by (better) informing citizens regarding the costco levitra rationale behind each principle.

We hope that this evidence may inform policy makers, as well as healthcare practitioners, of the need to provide an effective communication to citizens and patients, respectively, in order to avoid decision rules that may otherwise be perceived as arbitrary or unfair..

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She tells us all about her 4-year placement on the ground in Tanzania fighting Malaria and HIV levitra overdose effects. She talks to us about 'Child Aid Tanzania' - a charity she co-founded after she returned. The wide-ranging interview also covered unusual outbreaks in her lab in Manchester, her goals on IBMS Council, a World Health Organisation (WHO) project in Sierra Leone and what she did as Science Exhibitor with the BBC. Later in a special LabLife, award-winning Husband and Wife Biomedical Scientist duo Akinola levitra overdose effects and Olubukola Adewunmi join Ella on LabLife.

They discuss their projects outside of the lab educating the public about Sickle Cell Disease and encouraging blood donations from BAME communities - for which they won a National BAME Health &. Care Award. Microbiology & levitra overdose effects. Overseas aid - with Zonya Jeffrey Zonya Jeffrey has a unique role as a senior microbiologist in a busy 24/7 laboratory at Manchester University NHS Foundation Trust.

It involves diagnostic bench work isolating, identifying and antibiotic susceptibility testing of bacteria and parasites, and training and development of students, trainees, and staff. We asked Zonya to tell us what levitra overdose effects a typical day looks like before moving on to some of the more unusual days!. Including one where she had to stay behind to manage an outbreak in a nursing home. Zonya also addressed Antimicrobial Resistance (AMR) – i.e.

Does she come across levitra overdose effects s not treatable with regular antibiotics, and if so, how often?. Next, we moved on to her overseas projects working in labs in Tanzania and Sierra Leone. The World Health Organization (WHO) recently reported that Tanzania accounted for 5% of global deaths from Malaria in 2019 – which is approximately 20,500 deaths. Zonya spent levitra overdose effects four years in Tanzania as a laboratory technologist and Biomedical Scientist with the Voluntary Service Overseas (VSO).

VSO sent her group to set up a new microbiology laboratory and train and staff in basic tests and techniques. Hoping to give something back to the community she had been part of, Zonya, her sister and her friend established the charity 'Child Aid Tanzania'. It aims levitra overdose effects to support mothers &. Their babies and children in families living in communities affected by HIV/AIDS and Malaria.

They provide anti-malaria bed nets and help fund child education. Zonya then told us about a WHO project in Sierra Leone she was involved with to combat levitra overdose effects Cholera. You'd be testing hundreds of slides a day for Malaria. Our thoughts were what can we do to help a community that we lived in for more than four years.

The first thing we did was to provide new mosquito levitra overdose effects bednets for new mothers at hospitals, children and the most vulnerable. We also provide education like fundraising for desks and school uniforms for primary school children. Zonya also discussed her IBMS council objectives, how the levitra has impacted her lab in Manchester, work with the BBC, and finally faced our quick-fire round!. LabLife with Akinola and Olubukola Adewunmi We catch up with Akin and levitra overdose effects Olu Adewunmi, husband &.

Wife Biomedical Scientists at Liverpool University Hospitals NHS Trust. The pair recently won the 2021 Health and Wellbeing Advocate award from the National BAME Health &. Care Awards for their exceptional work running their charity Path Lab Support, which is dedicated to educating the public about Sickle Cell Disease and encouraging blood donations from BAME communities levitra overdose effects. They talk to us about the experience and challenges of their charitable work and what it is like to be recognised with a national award.

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How to listen To listen to any of our podcasts, series 1 and 2, as well as subscribe to future episodes, visit. Episode outline 0:20 – IBMS News 2:06 – Feature Interview with Zonya Jeffrey 2:30 - Part 1. Microbiology in Manchester – including an introduction levitra overdose effects to Zonya and her work, typical day, most memorable outbreaks, training &. Education and AMR in the lab.

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The wide-ranging interview also covered unusual outbreaks in her lab costco levitra in Manchester, her goals on IBMS Council, a World Health Organisation (WHO) project in Sierra Leone and what she did as Science Exhibitor with the BBC. Later in a special LabLife, award-winning Husband and Wife Biomedical Scientist duo Akinola and Olubukola Adewunmi join Ella on LabLife. They discuss their projects outside of the lab educating the public about Sickle Cell Disease and encouraging blood donations from BAME communities - for which they won a National BAME Health &.

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It involves costco levitra diagnostic bench work isolating, identifying and antibiotic susceptibility testing of bacteria and parasites, and training and development of students, trainees, and staff. We asked Zonya to tell us what a typical day looks like before moving on to some of the more unusual days!. Including one where she had to stay behind to manage an outbreak in a nursing home.

Zonya also costco levitra addressed Antimicrobial Resistance (AMR) – i.e. Does she come across s not treatable with regular antibiotics, and if so, how often?. Next, we moved on to her overseas projects working in labs in Tanzania and Sierra Leone.

The World Health Organization (WHO) recently reported that Tanzania accounted for 5% of global deaths from Malaria in 2019 – which is costco levitra approximately 20,500 deaths. Zonya spent four years in Tanzania as a laboratory technologist and Biomedical Scientist with the Voluntary Service Overseas (VSO). VSO sent her group to set up a new microbiology laboratory and train and staff in basic tests and techniques.

Hoping to give something back to the community she costco levitra had been part of, Zonya, her sister and her friend established the charity 'Child Aid Tanzania'. It aims to support mothers &. Their babies and children in families living in communities affected by HIV/AIDS and Malaria.

They provide costco levitra anti-malaria bed nets and help fund child education. Zonya then told us about a WHO project in Sierra Leone she was involved with to combat Cholera. You'd be testing hundreds of slides a day for Malaria.

Our thoughts were what can we do to help a community that we lived in costco levitra for more than four years. The first thing we did was to provide new mosquito bednets for new mothers at hospitals, children and the most vulnerable. We also provide education like fundraising for desks and school uniforms for primary school children.

Zonya also discussed her IBMS council objectives, how the levitra has impacted her lab in Manchester, work with the BBC, and finally costco levitra faced our quick-fire round!. LabLife with Akinola and Olubukola Adewunmi We catch up with Akin and Olu Adewunmi, husband &. Wife Biomedical Scientists at Liverpool University Hospitals NHS Trust.

The pair recently won the 2021 Health and Wellbeing Advocate award from the National BAME Health & costco levitra. Care Awards for their exceptional work running their charity Path Lab Support, which is dedicated to educating the public about Sickle Cell Disease and encouraging blood donations from BAME communities. They talk to us about the experience and challenges of their charitable work and what it is like to be recognised with a national award.

I would advise my colleagues, biomedical scientists, to not limit our career skills to the costco levitra four walls of the laboratory alone. Let's think beyond the box and use our career skills to create social action projects that benefit our communities Akin &. Olu have both also recently published books.

Akin's book, costco levitra Beyond The WorkPlace, guides scientists and others to use their career skills to inspire and create change in their communities. In Olu's book Take Hold Of Your Life, Olu relates her experience as a councillor to give advice for empowering one's self. In the spirit of Olu &.

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Episode outline costco levitra 0:20 – IBMS News 2:06 – Feature Interview with Zonya Jeffrey 2:30 - Part 1. Microbiology in Manchester – including an introduction to Zonya and her work, typical day, most memorable outbreaks, training &. Education and AMR in the lab.

10:44 costco levitra – Part 2. Overseas Aid in Tanzania &. Sierra Leone - including work alongside Swiss Tropical Institute as Laboratory Technologist, setting-up charity Child Aid Tanzania, discussion of Malaria &.

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The filing deadline is Sept. 30, 2021!. Kenan Torrans is director of compliance in the department’s Veterans’ Employment and Training Service. Follow VETS on Twitter at @VETS_DOL.[embedded content] In the Department of Labor, we focus on protecting the health and safety of workers as we carefully reopen our economy. And we are also here to support you if you’re looking for your next job opportunity.

The department funds nearly 2,400 American Job Centers all across the United States, providing free help for your career and employment needs. American Job Centers offer skills assessments, resume building, job listings, interview tips and more. They help you find education and training, certifications and apprenticeships, benefits and resources. Whether you’re a new worker or you’re changing careers.

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A few weeks ago my fiance Caleb and I ordered a custom table for our new, rustic home that sits in the woods. I came across Ben Shea through some mutual friends and immediately fell in love with his work! After I saw the finished product of our table, I was definitely NOT disappointed. Ben is an awesome guy, so easy to work with and he totally made our vision become a reality! It’s exactly what I wanted. Raw, rustic, knots and grain. I’m.. obsessed. Ben is constantly creating lots of amazing wood pieces for homes, offices and gifts! Check out his Facebook fan-page HERE, his Etsy shop HERE, and his website HERE.

Meagan Nicole

 


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This Sunday my mom and sister threw me a surprise bridal shower! I knew I was having the bridal shower, but I had absolutely nothing to do with the planning so I had no clue what to expect or who would be coming (although seeing random pieces of thrifted china and table clothes hidden around the house was getting me very excited!). It was more beautiful than I could’ve imaged and exactly what I hoped for. So many lovely faces came that I wasn’t expecting which made it all the sweeter. The theme was an outdoor garden party! My mom made her famous chicken salad recipe, a blueberry-raspberry-strawberry fruit medley, and greens with an olive oil lemon dressing (the one they use at Tomato Pie) YUM! The vintage dresser held two baskets- everyone brought their favorite kitchen spice or  cleaning item (which went in the awesome, wooden hamper my nana gifted us to the right of the dresser)! I loved the date night jar. Everyone wrote down date ideas on popcycle sticks for Caleb and I. We’ve been enjoying reading everyones recommendations.. especially the hilarious X-rated ones. haha!

If you’re wondering why my face looks so crazy in the opening-gifts photos it’s because we were playing the bubble gum game! Previously my sister had asked Caleb a bunch of random questions that he gave his answers to. While opening gifts, I was asked these questions as well and had to try and answer the same as Caleb did. For every question I got wrong I gad to put a piece of gum in my mouth. I actually did pretty good but still wound up with a few wads of gum, whoops. I never thought I could get tired of bubble gum until Sunday. HA! This was such a fun and exciting day! Huge thank you’s to my mom and sister for pulling it all together and getting so creative.. I know how much work and thought you put into everything to make it perfect for me and it means so much! To each and every lady that came to the party- you all made me feel so loved and blessed! Thank you for celebrating this time in my life; Caleb and I are beyond thankful for all of the amazing gifts and well wishes you showered us with. 🙂

*Beautiful cake by Wendy Hess at Oregon Dairy Bakery!

**All photographs taken by my amazing friend Rebekah of Rebekah Viola Photography! Thank you so much for capturing these memories for me.

Meagan Nicole


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