Taken As Given Meaning

[Dona Vansoest]

Somewomen have heard they need to be dilated (meaning the cervix opens in preparation for birth) a certain amount before an epidural is given. However, according to guidelines from the American College of Obstetricians and Gynecologists (ACOG), a request from the mother is sufficient.

Usually, women have to stay in bed after receiving an epidural because of decreased sensation in their legs, which puts them at risk of falling. However, they are able to move their legs and can move around in bed, Dr. McGuire explains.

Other possible complications include low blood pressure, itchy skin, and headaches. Blood pressure in both the baby and mother is constantly monitored during labor. If it goes too far down or up for either, blood pressure medication can be administered intravenously to the mother, which will help the baby.

Additional risks include failed or one-sided pain relief, which would require redoing the epidural, and difficulty emptying the bladder while the epidural is in place. Women may also experience a low-grade fever and heaviness or tingling in their legs during labor, depending on how much medication has been administered.

Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.

Paxlovid, an oral antiviral pill that can be taken at home, is the go-to treatment for COVID-19. If you are at high risk for severe disease from COVID, and you take it within the first five days of experiencing symptoms, it will lower your risk of getting so sick that you need to be hospitalized.

Paxlovid is available to anyone ages 12 and up, depending on their risk for severe illness from COVID. The Food and Drug Administration (FDA) gave the drug full approval in May 2023 for adults with mild-to-moderate COVID at high risk for severe disease, hospitalization, and death. This was after the administration initially granted an Emergency Use Authorization (EUA) in December 2021 for everyone 12 and older (weighing at least 88 pounds). That EUA remains in place for adolescents and teens 12 and older who have mild-to-moderate disease and are at high risk for their infection becoming more severe.

Paxlovid is an antiviral therapy that consists of two separate medications packaged together. When you take your three-pill dose, two of those pills will be nirmatrelvir, which inhibits a key enzyme that the COVID virus requires in order to make functional virus particles. After nirmatrelvir treatment, the COVID virus that is released from the cells is no longer able to enter uninfected cells in the body, which, in turn, stops the infection.

In order to qualify for a prescription, you must be at high risk for developing severe COVID. That means you must either be 50 or older (or especially 65 or older), although, the FDA still authorizes Paxlovid for adolescents and teens ages 12 and older who weigh at least 88 pounds.

You also qualify if you have certain underlying conditions or lifestyle factors that could increase the risk of progression to severe disease. Pfizer estimates that roughly 75% of adults in the U.S. have at least one risk factor, which could include a condition such as cancer, diabetes, heart disease, pregnancy, a weakened immune system, or a mental health disorder. Adults are also at higher risk if they are unvaccinated or not up to date on their COVID vaccinations (although even if you are vaccinated, Paxlovid can provide additional protection).

When it applied for FDA authorization in 2021, Pfizer presented data from a clinical trial conducted between mid-July and early December 2021. That data showed that participants, who were given Paxlovid were 89% less likely to develop severe illness and death compared to trial participants who received a placebo. All of the trial participants were unvaccinated and they took the drug within three days of symptom onset.

In November 2022, the CDC reported on a real-world study that showed adults who took Paxlovid within five days of a COVID diagnosis had a 51% lower hospitalization rate within the next 30 days than those who were not given the drug. The study included people who had been vaccinated or had a previous infection, which the CDC said implied the drug should be offered to people who are eligible regardless of their vaccination status.

However, a study by Pfizer, published in the New England Journal of Medicine in April 2024, suggested that Paxlovid may not be beneficial for people at low to moderate risk who have mild illness and those who have been fully vaccinated.

Pfizer launched a clinical trial in March 2022 to study the safety and efficacy of Paxlovid in children and teenagers ages 6 to 17 who have COVID-19 symptoms and test positive for the virus, and who are neither hospitalized nor at risk for severe disease.

The FDA says that anyone who takes Paxlovid should contact their health provider right away if they have any signs and symptoms of liver problems: loss of appetite, yellowing of the skin and whites of the eyes (jaundice), dark-colored urine, pale-colored stools and itchy skin, or stomach-area (abdominal) pain.

The list of drugs that Paxlovid interacts with includes some organ anti-rejection drugs that transplant patients take, as well as more common drugs like some used to treat heart arrhythmias. Paxlovid also decreases the metabolism of anticoagulants, or blood thinners, that many older adults depend on, driving up levels of those medications in the body to a point where they are unsafe, Dr. Topal explains.

Anyone who has Human Immunodeficiency Virus 1 (HIV-1) infection should talk to their health care provider before taking Paxlovid, since it may lead to some HIV-1 medicines not working as well in the future.

When it approved Paxlovid in May 2023, the FDA said there not a clear association between Paxlovid treatment and COVID rebound based on available data, and rebound rates in clinical trials were similar among participants who took Paxlovid and those who took a placebo.

However, scientists are still studying the Paxlovid rebound. The CDC says a rebound does not mean a person was resistant to Paxlovid, nor does it mean they were reinfected with the virus. In June, the CDC released guidance for clinicians, saying a brief return of symptoms may be part of the natural history of SARS-CoV-2 infection in some people, independent of treatment with Paxlovid, adding that there is no evidence additional treatment is needed. A CDC study in 2022 reported that rebound symptoms tended to be unlikely to require hospitalization and milder than symptoms experienced during the primary infection.

If you are experiencing symptoms of COVID and think you are eligible for a treatment, you can visit the government Test-to-Treat Locater. You can use the site to search for the places near you where you can fill a COVID prescription, or identify sites that provide testing, medical care, and COVID medications.

If finances are an issue, a U.S. Government Patient Assistance Program operated by Pfizer is making Paxlovid available at no cost through Dec. 31, 2024 to eligible individuals covered under federal programs such as Medicare and Medicaid, and to those who are uninsured. More information is available at

Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.

The Matthew effect of accumulated advantage, sometimes called the Matthew principle, is the tendency of individuals to accrue social or economic success in proportion to their initial level of popularity, friends, and wealth. It is sometimes summarized by the adage or platitude "the rich get richer and the poor get poorer".[1][2] The term was coined by sociologists Robert K. Merton and Harriet Zuckerman[3] in 1968[4] and takes its name from the Parable of the Talents in the biblical Gospel of Matthew.

The Matthew effect may largely be explained by preferential attachment, whereby wealth or credit is distributed among individuals according to how much they already have. This has the net effect of making it increasingly difficult for low ranked individuals to increase their totals because they have fewer resources to risk over time, and increasingly easy for high rank individuals to preserve a large total because they have a large amount to risk.[5]

Early studies of Matthew effects were primarily concerned with the inequality in the way scientists were recognized for their work. However, Norman W. Storer, of Columbia University, led a new wave of research. He believed he discovered that the inequality that existed in the social sciences also existed in other institutions.[6]

And he answered them, "To you it has been given to know the secrets of the kingdom of heaven, but to them it has not been given. For to him who has will more be given, and he will have abundance; but from him who has not, even what he has will be taken away."

Merton and Zuckerman furthermore argued that in the scientific community the Matthew effect reaches beyond simple reputation to influence the wider communication system, playing a part in social selection processes and resulting in a concentration of resources and talent. They gave as an example the disproportionate visibility given to articles from acknowledged authors, at the expense of equally valid or superior articles written by unknown authors. They also noted that the concentration of attention on eminent individuals can lead to an increase in their self-assurance, pushing them to perform research in important but risky problem areas.[4]

In education, the term "Matthew effect" has been adopted by psychologist Keith Stanovich and popularised by education theorist Anthony Kelly to describe a phenomenon observed in research on how new readers acquire the skills to read. Effectively, early success in acquiring reading skills usually leads to later successes in reading as the learner grows, while failing to learn to read before the third or fourth year of schooling may be indicative of lifelong problems in learning new skills.[14]

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