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Once it is published it will be available on this page kamagra for sale uk in an official form. Until then, you can download the unpublished PDF version. Although we make a concerted effort to reproduce the original document in full on our Public Inspection pages, in some cases graphics may not be displayed, and non-substantive markup language may appear alongside substantive text.

If you kamagra for sale uk are using public inspection listings for legal research, you should verify the contents of documents against a final, official edition of the Federal Register. Only official editions of the Federal Register provide legal notice to the public and judicial notice to the courts under 44 U.S.C. 1503 &.

1507. Learn more here.Start Preamble Centers for Medicare &. Medicaid Services (CMS), HHS.

Extension of timeline for publication of final rule. This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021.

Start Further Info Lisa O. Wilson, (410) 786-8852. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule that addressed undue regulatory impact and burden of the physician self-referral law.

The proposed rule was issued in conjunction with the Centers for Medicare &. Medicaid Services' (CMS) Patients over Paperwork initiative and the Department of Health and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care. In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers.

A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician. A new exception for donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health records (EHR) items and services.

The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations. This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation.

In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances. In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020.

However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date. This notice extends the timeline for publication of the final rule until August 31, 2021. Start Signature Dated.

August 24, 2020. Wilma M. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services.

End Signature End Supplemental Information [FR Doc. 2020-18867 Filed 8-26-20.

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SOBRE NOTICIAS EN ESPAÑOLNoticias en español es una kamagra oral jelly in chennai sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en http://sw.keimfarben.de/kamagra-street-price/ los Estados Unidos. Use kamagra oral jelly in chennai Nuestro Contenido Este contenido puede usarse de manera gratuita (detalles). La temporada de influenza se verá diferente este año, ya que los Estados Unidos se enfrentan a una pandemia de coronavirus que ya ha matado a más de 176.000 personas.Muchos estadounidenses son reacios a ir al médico y los funcionarios de salud pública temen que las personas eviten vacunarse.

Aunque a veces kamagra oral jelly in chennai se considera incorrectamente como un resfriado, la gripe también mata a decenas de miles de personas en el país cada año. Los más vulnerables son los niños pequeños, los adultos mayores y las personas con enfermedades subyacentes. Cuando se combina con los efectos de COVID-19, los expertos en salud pública dicen que es más importante que nunca vacunarse contra la gripe.Si una cantidad suficiente de la población se vacuna, más del 45% lo hizo la temporada de gripe pasada, podría ayudar a evitar un escenario kamagra oral jelly in chennai de pesadilla este invierno, con hospitales llenos de pacientes con COVID-19 y los que sufren los efectos graves de la influenza.Además de la posible carga para los hospitales, existe la posibilidad de que las personas contraigan ambos virus y “nadie sabe qué sucede si se contrae influenza y COVID simultáneamente porque nunca sucedió antes”, dijo la doctora Rachel Levine, secretaria de Salud de Pennsylvania, a reporteros.En respuesta, este año los fabricantes están produciendo más suministros de vacunas, entre 194 y 198 millones de dosis, unas 20 millones más de las que se distribuyeron la temporada pasada, según los Centros para el Control y Prevención de Enfermedades (CDC).Mientras se acerca la temporada de gripe, aquí hay algunas respuestas a preguntas frecuentes:P.

¿Cuándo debo vacunarme contra la gripe?. La publicidad kamagra oral jelly in chennai ya ha comenzado y algunas farmacias y clínicas ya tienen sus suministros. Pero, debido a que la efectividad de la vacuna puede disminuir con el tiempo, los CDC recomiendan no recibir la dosis en agosto.Muchas farmacias y clínicas comenzarán las inmunizaciones a principios de septiembre.

Generalmente, los kamagra oral jelly in chennai virus de la influenza comienzan a circular a mediados o fines de octubre, pero se expanden masivamente más tarde, en el invierno. Se necesitan aproximadamente dos semanas después de recibir la inyección para que los anticuerpos, que circulan en la sangre y frustran las infecciones, se acumulen.“Las personas jóvenes y sanas pueden comenzar a vacunarse contra la gripe en septiembre, y las personas mayores y otras poblaciones vulnerables pueden hacerlo en octubre”, dijo el doctor Steve Miller, director clínico de la aseguradora Cigna.Los CDC recomiendan que las personas “se vacunen contra la influenza a fines de octubre”, pero señalaron que se puede recibir la vacuna más tarde porque “aún puede ser beneficiosas y la vacunación debe ofrecerse a lo largo de toda la temporada de influenza”.Aun así, algunos expertos recomiendan no esperar demasiado este año, no solo por COVID-19, sino también en caso de que haya escasez debido a la abrumadora demanda.P. ¿Cuáles son las razones por las que kamagra oral jelly in chennai las que debería ofrecer mi brazo para vacunarme?.

Hay que vacunarse porque brinda protección contra la gripe y, por lo tanto, contra la propagación a otras personas, lo que puede ayudar a disminuir la carga para los hospitales y el personal médico.Y hay otro mensaje que puede resonar en estos tiempos extraños.“Le da a la gente la sensación de que hay algunas cosas que pueden controlar”, dijo Eduardo Sánchez, director médico de prevención de la American Heart Association.Si bien una vacuna contra la gripe no evitará COVID-19, recibirla podría ayudar al médico a diferenciar entre las dos enfermedades si se desarrolla algún síntoma (fiebre, tos, dolor de garganta) que ambas infecciones comparten, explicó Sánchez.Y aunque las vacunas contra la gripe no evitarán todos los casos de gripe, vacunarse puede reducir la gravedad si la persona se enferma, dijo.Todas las personas elegibles, especialmente los trabajadores esenciales, los que sufren de afecciones subyacentes y aquellos en mayor riesgo, incluidos los niños muy pequeños y las mujeres embarazadas, deben buscar protección, dijeron los CDC. La entidad kamagra oral jelly in chennai recomienda la vacunación a partir de los 6 meses.P. ¿Qué sabemos sobre la efectividad de la vacuna de este año?.

Se deben producir nuevas vacunas contra la gripe cada año, porque el virus muta y la efectividad de la vacuna varía, dependiendo de qué tan bien coincida con el virus circulante.Se kamagra oral jelly in chennai calculó que la formulación del año pasado tuvo una eficacia de aproximadamente un 45% para prevenir la gripe en general, con una efectividad de aproximadamente un 55% en los niños. Las vacunas disponibles en el país este año tienen como objetivo prevenir al menos tres cepas diferentes del virus, y la mayoría cubre cuatro.Todavía no se sabe qué tan bien coincidirá el suministro de este año con las cepas que circularán en los Estados Unidos. Las primeras indicaciones del hemisferio sur, que atraviesa su temporada de gripe durante kamagra oral jelly in chennai nuestro verano, son alentadoras.

Allí, las personas practicaron el distanciamiento social, usaron máscaras y se vacunaron en mayor número este año, y los niveles mundiales de gripe son más bajos de lo esperado. Sin embargo, expertos advierten que no se debe contar con una temporada igual kamagra oral jelly in chennai de suave en los Estados Unidos, en parte porque los esfuerzos por usar mascara facial y de distanciamiento social varían ampliamente.P. ¿Qué están haciendo diferente los seguros y sistemas de salud este año?.

Las aseguradoras y los sistemas de salud contactados por KHN dicen que seguirán las pautas de los CDC, que exigen limitar y espaciar la cantidad de personas que kamagra oral jelly in chennai esperan en las filas y las áreas de vacunación. Algunos están programando citas para vacunas contra la gripe para ayudar a controlar el flujo.Health Fitness Concepts, una compañía que trabaja con UnitedHealth Group y otras empresas para establecer clínicas de vacunación contra la gripe en el noreste del país, dijo que está “fomentando eventos más pequeños y frecuentes para apoyar el distanciamiento social” y “exigiendo que se completen todos los formularios y arremangarse las camisas antes de entrar al área de vacunación contra la influenza”.Se requerirá que todos usen máscaras.Además, a nivel nacional, algunos grupos médicos contratados por UnitedHealth instalarán carpas, para que las inyecciones se puedan administrar al aire libre, dijo un vocero.Kaiser Permanente planifica las vacunas directamente en autos en algunos de sus centros médicos y está probando los procedimientos de detección y registro sin contacto en algunos lugares.Geisinger Health, un proveedor de salud regional en Pennsylvania y Nueva Jersey, dijo que también tendría programas de vacunación contra la influenza al aire libre en sus instalaciones.Además, “Geisinger exige que todos los empleados reciban la vacuna contra la influenza este año”, dijo Mark Shelly, director de prevención y control de infecciones del sistema. €œAl dar este paso, esperamos transmitir a nuestros kamagra oral jelly in chennai vecinos la importancia de la vacuna contra la influenza para todos”.P.

Por lo general, me vacunan contra la gripe en el trabajo. ¿Seguirá siendo una kamagra oral jelly in chennai opción este año?. Con el objetivo de evitar riesgosas reuniones en interiores, muchos empleadores se muestran reacios a patrocinar las clínicas de gripe en oficinas como han ofrecido en años anteriores.

Y con tanta gente que kamagra oral jelly in chennai sigue trabajando desde casa, hay menos necesidad de llevar las vacunas contra la gripe al lugar de trabajo. En cambio, muchos empleadores están alentando a los trabajadores a que reciban vacunas de sus médicos de atención primaria, en farmacias u otros entornos comunitarios. El seguro generalmente cubrirá el costo de la vacuna.Algunos empleadores están considerando ofrecer cupones para vacunas contra la gripe a sus trabajadores sin seguro o a aquellos que no participan en el plan médico de la compañía, dijo Julie Stone, directora general de salud y beneficios de Willis Towers Watson, una firma consultora.Estos cupones podrían, por ejemplo, permitir a los trabajadores obtener la vacuna en un laboratorio en particular sin costo.Algunos empleadores están comenzando a pensar en cómo podrían usar sus kamagra oral jelly in chennai estacionamientos para administrar vacunas contra la gripe enlos autos, dijo el doctor David Zieg, líder de servicios clínicos para el consultor de beneficios Mercer.Aunque la ley federal permite a los empleadores exigir a los empleados que se vacunen contra la gripe, ese paso generalmente lo toman solo los centros de atención médica y algunas universidades donde las personas viven y trabajan en estrecha colaboración, dijo Zieg.Pero sucede.

El mes pasado, el sistema de kamagra oral jelly in chennai la Universidad de California emitió una orden ejecutiva que requiere que todos los estudiantes, profesores y personal se vacunen contra la gripe antes del 1 de noviembre, con limitadas excepciones.P. ¿Qué están haciendo las farmacias para alentar a las personas a vacunarse contra la gripe?. Algunas farmacias están haciendo un esfuerzo adicional para salir a la comunidad y kamagra oral jelly in chennai ofrecer vacunas contra la gripe.Walgreens, que tiene casi 9,100 farmacias en todo el país, continúa una asociación iniciada en 2015 con organizaciones comunitarias, iglesias y empleadores que ha ofrecido alrededor de 150,000 clínicas de gripe móviles hasta la fecha.El programa pone especial énfasis en trabajar con poblaciones vulnerables y en áreas desatendidas, dijo el doctor Kevin Ban, director médico de la cadena de farmacias.Walgreens comenzó a ofrecer vacunas contra la gripe a mediados de agosto y está animando a las personas a no demorar en vacunarse.Tanto Walgreens como CVS están estimulando a las personas a programar citas y hacer trámites en línea este año para minimizar el tiempo que pasan en los locales.En los CVS MinuteClinic, una vez que los pacientes se han registrado para recibir la vacuna contra la gripe, deben esperar afuera o en su automóvil, ya que las áreas de espera interiores ahora están cerradas.“No tenemos un arsenal contra COVID”, dijo Ban, de Walgreens.

€œPero quitar la presión del sistema de atención médica proporcionando vacunas por adelantado es algo que sí podemos hacer”. Julie kamagra oral jelly in chennai Appleby. jappleby@kff.org, @Julie_Appleby Michelle Andrews.

andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Noticias En Español Public Health CDC COVID-19 Insurers VaccinesThis story was produced in partnership kamagra oral jelly in chennai with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the COVID pandemic and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!. € And, even as the nation’s COVID-19 death toll exceeded kamagra oral jelly in chennai 180,000, Trump was upbeat.

€œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible enemy,” he said. €œLike those brave Americans before us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact did an in-depth fact check on Trump’s entire kamagra oral jelly in chennai acceptance speech. Here are the highlights related to the administration’s COVID-19 response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but it needs context.It’s accurate that the U.S.

Developed its COVID-19 testing system from scratch, because the government didn’t accept kamagra oral jelly in chennai the World Health Organization’s testing recipe. But whether the system is the “largest” or “most advanced” is subject to debate.The U.S. Has tested more individuals than kamagra oral jelly in chennai any other country.

But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested. Another useful metric would be the percentage of the population that has been kamagra oral jelly in chennai tested. The U.S.

Is one of the most populous kamagra oral jelly in chennai countries but has tested a lower percentage of its population than other countries. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter. The kamagra oral jelly in chennai U.S.

Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the kamagra oral jelly in chennai size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [COVID-19] case fatality rates of any major country in the world.

The European Union’s case fatality rate is kamagra oral jelly in chennai nearly three times higher than ours.”The case fatality rate measures the known number of cases against the known number of deaths. The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a pandemic, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of the virus, experts say, is to look at the number of deaths per 100,000 residents. Viewed that kamagra oral jelly in chennai way, the U.S.

Has the 10th-highest death rate in the world.“We will produce a vaccine before the end of the year, or maybe even sooner.”It’s far from guaranteed that a coronavirus vaccine will be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the vaccine will be available to the public, which is what’s most important. Six vaccines are in the third kamagra oral jelly in chennai phase of testing, which involves thousands of patients. Like earlier phases, this kamagra oral jelly in chennai one looks at the safety of a vaccine but also examines its effectiveness and collects more data on side effects.

Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021.”And federal health officials and other experts have generally predicted a vaccine will be available in early 2021. Federal committees are working on recommendations for kamagra oral jelly in chennai vaccine distribution, including which groups should get it first. €œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously optimistic that we will have a vaccine by the end of this year and as we go into 2021,” said Dr.

Anthony Fauci, kamagra oral jelly in chennai the nation’s top infectious diseases expert. €œI don’t think it’s dreaming.”“Last month, I took on Big Pharma. You think kamagra oral jelly in chennai that is easy?.

I signed orders that would massively lower the cost of your prescription drugs.”Quite misleading. Trump signed four executive orders on July kamagra oral jelly in chennai 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do.

In 2017, Trump supported congressional efforts to repeal the kamagra oral jelly in chennai ACA. The Trump administration is now backing GOP-led efforts to overturn the ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply with the ACA.“Joe kamagra oral jelly in chennai Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading.

During a June 2019 Democratic primary debate, candidates were asked. €œRaise your hand if your government plan would provide coverage for undocumented immigrants.” All candidates on stage, including Biden, raised kamagra oral jelly in chennai their hands. They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status.

A task force recommended that he kamagra oral jelly in chennai allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy for the vulnerable, yet the party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and related precedents. This would kamagra oral jelly in chennai generally limit abortions to the first 20 to 24 weeks of gestation.

States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and legal abortion — kamagra oral jelly in chennai regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y. Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report.

Related Topics Elections Health Industry Pharmaceuticals Public Health kamagra oral jelly in chennai The Health Law Abortion COVID-19 Immigrants KHN &. PolitiFact HealthCheck Preexisting Conditions Trump Administration VaccinesThis story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a coronavirus pandemic that has killed more than 172,000 people. Many Americans are reluctant to visit a doctor’s office and public health kamagra oral jelly in chennai officials worry people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people in the U.S.

Each year, with the very young, the elderly and those with underlying conditions the most vulnerable. When coupled with the effects of kamagra oral jelly in chennai COVID-19, public health experts say it’s more important than ever to get a flu shot.If enough of the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both COVID-19 patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both viruses — and “no one knows what happens if you get influenza and COVID [simultaneously] because it’s never happened before,” Dr.

Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, manufacturers are producing more vaccine supply this year, between 194 million and 198 million doses, or about 20 million more than they distributed last season, according to the Centers for Disease Control kamagra oral jelly in chennai and Prevention. Email Sign-Up Subscribe kamagra oral jelly in chennai to KHN’s free Morning Briefing. As flu season approaches, here are some answers to a few common questions:Q.

When should I get my flu shot? kamagra oral jelly in chennai. Advertising has already begun, and some pharmacies and clinics have their supplies now. But, because the effectiveness of the vaccine can wane over kamagra oral jelly in chennai time, the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September.

Generally, influenza viruses start circulating in mid- to late October but become more widespread later, in the winter. It takes about two weeks after getting a shot for antibodies — which circulate in the blood and thwart infections — to build up kamagra oral jelly in chennai. €œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin in October,” said Dr.

Steve Miller, chief clinical officer for insurer Cigna.The CDC has recommended that people “get a flu vaccine by the end of October,” but noted it’s not too late to get one after kamagra oral jelly in chennai that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of COVID-19, but also in case a shortage develops because of overwhelming demand.Q. What are the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in kamagra oral jelly in chennai this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent COVID-19, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu vaccine.All eligible people, especially essential workers, those with underlying conditions and those at higher risk — including very young children and pregnant women — should seek protection, the CDC said.

It recommends that children over 6 months old get vaccinated.Q. What do we kamagra oral jelly in chennai know about the effectiveness of this year’s vaccine?. Flu vaccines — which must be developed anew each year because influenza viruses mutate — range in effectiveness annually, depending on how well they match the circulating virus.

Last year’s formulation was estimated to kamagra oral jelly in chennai be about 45% effective in preventing the flu overall, with about a 55% effectiveness in children. The vaccines available in the U.S. This year are aimed at preventing at least three strains of the virus, and most cover four.It isn’t yet known how well this year’s supply will match kamagra oral jelly in chennai the strains that will circulate in the U.S.

Early indications from the Southern Hemisphere, which goes through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global flu levels are kamagra oral jelly in chennai lower than expected. Experts caution, however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.Q.

What are insurance plans and health kamagra oral jelly in chennai systems doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas. Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social kamagra oral jelly in chennai distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations.

(KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu vaccine this year,” said Mark Shelly, the system’s director of infection prevention and control. €œBy taking this kamagra oral jelly in chennai step, we hope to convey to our neighbors the importance of the flu vaccine for everyone.”Q. Usually I get a flu shot at work.

Will that be kamagra oral jelly in chennai an option this year?. Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need to bring flu shots to kamagra oral jelly in chennai employees on the job.

Instead, many employers are encouraging workers http://sw.keimfarben.de/kamagra-100mg-price-in-canada/ to get shots from their primary care doctors, at pharmacies or kamagra oral jelly in chennai in other community settings. Insurance will generally cover the cost of the vaccine.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm. The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers kamagra oral jelly in chennai are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr.

David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are pharmacies doing to encourage people to get flu kamagra oral jelly in chennai shots?. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr.

Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, kamagra oral jelly in chennai they must wait outside or in their car, since the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against COVID,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing vaccines in advance is one thing we can do.” Julie Appleby. jappleby@kff.org, @Julie_Appleby Michelle Andrews kamagra oral jelly in chennai.

andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Public Health CDC COVID-19 Insurers VaccinesUse Our Content This story can be republished for free (details). As the smoke thickened near her home in Santa Cruz, California, last week, Amanda Smith kept asking herself the same questions. Should we kamagra oral jelly in chennai leave?. And where would we go?.

The wildfire evacuation zone, at the time, ended a kamagra oral jelly in chennai few blocks from her house. But she worried about what the air quality — which had reached the second-highest warning level, purple for “very unhealthy” — would do to her children’s lungs. Her 4-year-old twins had spent time in the neonatal kamagra oral jelly in chennai intensive care unit.

One was later diagnosed with asthma, and last year was hospitalized with pneumonia.By Tuesday, said Smith, “we all had headaches, the kids were coughing a little bit, and it was raining ash.” The family had been conscientiously isolating at home because of the COVID pandemic, and leaving meant potential exposures. But on Wednesday, Smith said, “I looked at my partner and said, maybe we should leave.”She called a friend in Orange County, about 380 miles south, who offered her parents’ empty kamagra oral jelly in chennai condo. But the next day, the friend’s child spiked a fever — a possible case of COVID-19 — and the plan fell through amid the distraction.Amanda Smith takes a selfie of herself and her twin children in Santa Cruz, California, in April.

(Amanda Smith)So kamagra oral jelly in chennai Smith looked on Airbnb, careful to seek out hosts who detailed their COVID precautions, and found an apartment in San Bruno, about an hour’s drive north. She stuffed photos and documents into a suitcase, grabbed the go-bags, and her family headed out.“It’s coming out of our savings to stay here,” Smith said from the safety of her apartment rental, which runs about $1,150 a week. €œIt was a really fraught decision to leave, but as soon as we got over the hill and the sky was blue, I took a big sigh of relief and knew that it had been a good decision.”As the twin disasters of COVID-19 and fire season kamagra oral jelly in chennai sweep through California, thousands of residents like Smith are weighing difficult options, pitting risk against risk as they decide where to evacuate, whether from imminent flames or the toxic air.

Amid a virulent pandemic, which is safest?. Doubling kamagra oral jelly in chennai up at a friend’s home?. A hotel?.

An evacuation center? kamagra oral jelly in chennai. And when do the risks of smoke inhalation outweigh the risk of a deadly infection?. €œObviously the most important kamagra oral jelly in chennai thing is for people to do what they can to protect their lives, not only from the fire, but also from COVID,” said Detective Rosemerry Blankswade, public information officer for the San Mateo County Sheriff’s Office, which is helping coordinate response to the massive CZU Lightning Complex fires.“You have to evaluate the big picture here.

If fire is your most imminent danger, maybe take the COVID risk. But if you kamagra oral jelly in chennai can avoid both of them, that’s obviously going to be the best option. It’s kind of a little bit of triage that we’re asking for people to do in their own lives kamagra oral jelly in chennai right now.” Email Sign-Up Subscribe to KHN’s free Morning Briefing.

In San Mateo, one of two counties where the CZU Lightning Complex fires are blazing, officials are advising people to head to an evacuation center, where county workers will assist them in finding a hotel room. Meanwhile, in neighboring Santa Cruz, where tens of thousands of residents have evacuated and shelters have limited space, officials are asking those under orders to leave to stay with family and friends whenever possible.What’s the right choice when all options pose additional kamagra oral jelly in chennai risks?. We spoke with several experts to help guide your thought process.You have to evacuate.

Where should you kamagra oral jelly in chennai go?. If your region is under an evacuation order, do not hesitate. Leave immediately kamagra oral jelly in chennai.

If you can afford it, booking a room at a hotel or motel outside the evacuation zones may be the best option, said Dr. Michael Wilkes, a professor at kamagra oral jelly in chennai the University of California-Davis School of Medicine. They almost always have air-conditioning units, which help filter the air from both smoke and virus.

Many hotels are implementing new cleaning kamagra oral jelly in chennai processes. Ask staffers to detail what they’re doing to sanitize rooms, and consider skipping the daily cleaning service during your stay. You might also check review sites such as TripAdvisor to see what kamagra oral jelly in chennai other guests report.

When possible, avoid the lobby and other shared spaces, and opt for contactless check-in.Amanda Smith at home in Santa Cruz, California, with her twin children. Smith and her family decided to voluntarily evacuate kamagra oral jelly in chennai their home on Aug. 20, due to heavy smoke in the area from the CZU Lightning Complex fires in the nearby Santa Cruz Mountains.

(Anna Maria Barry-Jester/KHN)With so many people in Northern California fleeing the kamagra oral jelly in chennai fires, many hotels are already full, especially in more remote areas. So what about staying with family or friends?. After months of being shut in and avoiding close contact beyond immediate family, moving into kamagra oral jelly in chennai someone else’s home means a host of potential exposures.

Consider whether you or anyone else in the home is at high risk from COVID-19 because of age or a preexisting condition.“If so, that’s a reason to think twice before going to someone’s home,” said Dr. Gina Solomon, a kamagra oral jelly in chennai program director at the Oakland-based Public Health Institute.Consider, too, what precautions your friends or family have been taking. Sheltering with someone whose job brings them into frequent contact with other people may not be as safe as sheltering with people who largely have been staying home.

Another question is how crowded the home kamagra oral jelly in chennai is. If you have your own room and, preferably, your own bathroom, that makes staying with friends a better option. If a separate bedroom is not available and smoky skies are not a problem, you might consider pitching a tent in their backyard.For those with an RV or tent, camping can present another good option — although, with hundreds of wildfires burning across California, kamagra oral jelly in chennai it may be challenging to drive far enough away to avoid fire and smoke.

If you do camp, try to find a site away from wooded areas. And think twice before using group kamagra oral jelly in chennai bathrooms.Is an evacuation center safe?. Many counties have implemented new precautions at emergency shelters to prevent the spread of the coronavirus.

In Santa Cruz, for example, officials are scaling back the capacity in each shelter to allow for social distancing, providing tents for people to use as shielding inside and allowing camping kamagra oral jelly in chennai in the parking lots.Still, staying in a shelter should probably not be your first choice. In terms of COVID risk, deciding between a hotel and a kamagra oral jelly in chennai friend’s house is “nipping at the edges,” said Dr. John Swartzberg, a clinical professor emeritus at the UC-Berkeley School of Public Health, while “being in a congregate setting is only better than being completely exposed to the elements.”If an evacuation shelter is your best immediate option, again, do not hesitate.

€œYou have kamagra oral jelly in chennai these standards you want to practice for yourselves,” Swartzberg said, “but when something worse comes along, it trumps how careful we can be with COVID because the need for shelter is greater.” You can lower your risk of infection by wearing a mask, washing hands frequently and sanitizing surfaces.Smith’s partner, Grant Whipple, walks with their children in Big Sur on March 7. That was their last camping trip before the COVID-19 pandemic hit, Smith says. That area is now under kamagra oral jelly in chennai threat from wildfire.

(Amanda Smith)If you aren’t in a fire zone, should you invite friends and family to stay with you?. Deciding whether to open your home to friends who kamagra oral jelly in chennai are evacuating is an intensely personal decision and may depend on whether anyone in your family has a preexisting condition.“I guess it depends on how good a friend they are and how desperate they are,” said Swartzberg. It may also depend on how much space you have.

If your guests can have their own bedroom and bathroom, it might be safer.If you do offer your home, experts advise against simply considering yourself a new pod kamagra oral jelly in chennai with your guests. Instead, take steps to lower your chances of infection.“It might not be pleasant, but wearing a mask anytime you’re not in your own bedroom is the safest way to go,” said Solomon. Stay outside as much as possible, she added, and consider eating meals outdoors or eating in shifts to avoid being maskless with those outside your family unit kamagra oral jelly in chennai.

Sanitize surfaces and wash hands frequently. If air quality permits, keep the windows open to improve airflow.If you’re in a region with hazardous smoke conditions, kamagra oral jelly in chennai should you leave?. If your area has dense smoke but no imminent fire risk, the thought of heading somewhere else may be appealing, especially if you have respiratory issues.

But in most cases, Wilkes said, it would be kamagra oral jelly in chennai safer not to leave your COVID bubble. And given the expanse of California’s fires, anywhere you flee could end up having lousy air quality by the time you arrive.“The better part of rationality,” Wilkes said, “would be to stay at home, not exercise [outdoors], stay inside as much as you can, turn on the air conditioning.”California Healthline senior correspondent Anna Maria Barry-Jester contributed to this report. Jenny Gold kamagra oral jelly in chennai.

jgold@kff.org, @JennyAGold Related Topics California Public Health States COVID-19 Environmental Health Natural DisastersIn the 2014 elections, Republicans rode a wave of anti-Affordable Care Act sentiment to pick up nine Senate seats, the largest gain for either party since 1980. Newly elected Republicans such as Cory Gardner in Colorado and Steve Daines in Montana had hammered their Democratic opponents over the health care law during the campaign and promised to repeal it.Six years later, those kamagra oral jelly in chennai senators are up for reelection. Not only is the law still around, but it’s gaining in popularity.

What was once a winning strategy kamagra oral jelly in chennai has become a political liability.Public sentiment about the ACA, also known as Obamacare, has shifted considerably during the Trump administration after Republicans tried but failed to repeal it. Now, in the midst of the COVID-19 pandemic and the ensuing economic crisis, which has led to the loss of jobs and health insurance for millions of people, health care again looks poised to be a key issue for voters this election. Don't Miss A Story Subscribe kamagra oral jelly in chennai to KHN’s free Weekly Edition newsletter.

With competitive races in Colorado, Montana, Arizona, North Carolina and Iowa pitting Republican incumbents who voted to repeal the ACA against Democratic challengers promising to protect it, attitudes surrounding the health law could help determine control of the Senate. Republicans hold a slim kamagra oral jelly in chennai three-vote majority in the Senate but are defending 23 seats in the Nov. 3 election.

Only one Democratic Senate seat — in Alabama, where incumbent Doug Jones is up against former Auburn University football coach Tommy Tuberville — is considered in play for Republicans.“The fall election will significantly revolve around people’s belief about kamagra oral jelly in chennai what [candidates] will do for their health coverage,” said Dr. Daniel Derksen, a professor of public health at the University of Arizona.The Affordable Care Act has been a wedge issue since it was signed into law in 2010. Because it then took four years kamagra oral jelly in chennai to enact, its opponents talked for years about how bad the not-yet-created marketplace for insurance would be, said Joe Hanel, spokesperson for the Colorado Health Institute, a nonpartisan nonprofit focused on health policy analysis.

And they continued to attack the law as it took full effect in 2014.Gardner, for example, ran numerous campaign ads that year criticizing the ACA and, in particular, President Barack Obama’s assertion that “if you like your health care plan, you’ll be kamagra oral jelly in chennai able to keep your health care plan.”But now, Hanel said, the ACA’s policies have become much more popular in Colorado as the costs of health exchange plans have dropped. Thus, political messaging has changed, too.“This time it’s the opposite,” Hanel said. €œThe people bringing up the Affordable Care Act are the Democrats.”Despite Gardner’s multiple votes to repeal kamagra oral jelly in chennai the ACA, he has largely avoided talking about the measure during the 2020 campaign.

He even removed his pro-repeal position from his campaign website.Democratic attack ads in July blasted Gardner for repeatedly dodging questions in an interview with Colorado Public Radio about his stance on a lawsuit challenging the ACA.His opponent, Democrat John Hickenlooper, fully embraced the law when he was Colorado governor, using the measure to expand Medicaid eligibility to more low-income people and to create a state health insurance exchange. Now, he’s campaigning on that record, with promises to expand health care access even further.Polling DataPolling conducted by KFF for the past 10 years shows a shift in public opinion kamagra oral jelly in chennai has occurred nationwide. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)“Since Trump won the election in 2016, we now have consistently found that a larger share of the public holds favorable views” of the health law, said Ashley Kirzinger, associate director of public opinion and survey research for the foundation.

€œThis really solidified in 2017 after kamagra oral jelly in chennai the failed repeal in the Senate.”The foundation’s polling found that, in July 2014, 55% of voters opposed the law, while 36% favored it. By July 2020, that had flipped, with 51% favoring the law and 38% opposing it. A shift was seen across all political groups, though 74% of Republicans still viewed it unfavorably in the latest poll.Public support for individual provisions of the ACA — such as protections for people with preexisting conditions or allowing young adults to stay on their parents’ health plans until age 26 — have proved even more popular than the law as a kamagra oral jelly in chennai whole.

And the provision that consistently polled unfavorably — the mandate that those without insurance must pay a fine — was eliminated in 2017.“We’re 10 years along and the sky hasn’t caved in,” said Sabrina Corlette, a health policy professor at Georgetown University.Political MessagingFollowing the passage of the ACA, Democrats didn’t reference the law in their campaigns, said Erika Franklin Fowler, a government professor at Wesleyan University and the director of the Wesleyan Media Project, which tracks political advertising.“They ran on any other issue they could find,” Fowler said.Republicans, she said, kept promising to “repeal and replace” but weren’t able to do so.Then, in the 2018 election, Democrats seized on the shift in public opinion, touting the effects of the law and criticizing Republicans for their attempts to overturn it.“In the decade I have been tracking political advertising, there wasn’t a single-issue topic that was as prominent as health care was in 2018,” she said.As the global health crisis rages, health care concerns again dominate political ads in the 2020 races, Fowler said, although most ads haven’t explicitly focused on the ACA. Many highlight Republicans’ support for the lawsuit challenging preexisting condition protections or kamagra oral jelly in chennai specific provisions of the ACA that their votes would have overturned. Republicans say they, too, will protect people with preexisting conditions but otherwise have largely avoided talking about the ACA.“Cory Gardner has been running a lot on his environmental bills and conservation funding,” Fowler said.

€œIt’s not difficult to figure out why he’s doing that. It’s easier for him to tout that in a state like Colorado than it is to talk about health care.”Similar dynamics are playing out in other key Senate races. In Arizona, Republican Sen.

Martha McSally was one of the more vocal advocates of repealing the ACA while she served in the House of Representatives. She publicly acknowledged those votes may have hurt her 2018 Senate bid.“I did vote to repeal and replace Obamacare,” McSally said on conservative pundit Sean Hannity’s radio show during the 2018 campaign. €œI’m getting my ass kicked for it right now.”She indeed lost but was appointed to fill the seat of Sen.

Jon Kyl after he resigned at the end of 2018. Now McSally is in a tight race with Democratic challenger Mark Kelly, an astronaut and the husband of former Rep. Gabby Giffords.“Kelly doesn’t have a track record of voting one way or another, but certainly in his campaign this is one of his top speaking points.

What he would do to expand coverage and reassure people that coverage won’t be taken away,” said Derksen, the University of Arizona professor.The ACA has proved a stumbling block for Republican Sens. Thom Tillis of North Carolina and Joni Ernst of Iowa. In Maine, GOP Sen.

Susan Collins cast a key vote that prevented the repeal of the law but cast other votes that weakened it. She now also appears vulnerable — but more for her vote to confirm Brett Kavanaugh’s nomination to the Supreme Court and for not doing more to oppose President Donald Trump.In Montana, Daines, who voted to repeal the ACA, is trying to hold on to his seat against Democratic Gov. Steve Bullock, who used the law to expand the state’s Medicaid enrollment in 2015.

At its peak, nearly 1 in 10 Montanans were covered through the expansion.As more Montanans now face the high cost of paying for health care on their own amid pandemic-related job losses, Montana State University political science professor David Parker said he expects Democrats to talk about Daines’ votes to repeal cost-saving provisions of the ACA.“People are losing jobs, and their jobs bring health care with them,” Parker said. €œI don’t think it’s a good space for Daines to be right now.” Markian Hawryluk. MarkianH@kff.org, @MarkianHawryluk Related Topics Elections Health Care Costs Health Care Reform Insurance States Arizona Colorado Montana North Carolina Obamacare Plans.

SOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en kamagra for sale uk la población hispana que top article vive en los Estados Unidos. Use Nuestro Contenido Este contenido puede usarse de kamagra for sale uk manera gratuita (detalles). La temporada de influenza se verá diferente este año, ya que los Estados Unidos se enfrentan a una pandemia de coronavirus que ya ha matado a más de 176.000 personas.Muchos estadounidenses son reacios a ir al médico y los funcionarios de salud pública temen que las personas eviten vacunarse. Aunque a veces se considera incorrectamente como un resfriado, kamagra for sale uk la gripe también mata a decenas de miles de personas en el país cada año. Los más vulnerables son los niños pequeños, los adultos mayores y las personas con enfermedades subyacentes.

Cuando se combina con los efectos de COVID-19, los expertos en salud pública dicen que es más importante que nunca vacunarse contra la gripe.Si una cantidad suficiente de la población se vacuna, más del 45% lo hizo la temporada de gripe pasada, podría ayudar a evitar kamagra for sale uk un escenario de pesadilla este invierno, con hospitales llenos de pacientes con COVID-19 y los que sufren los efectos graves de la influenza.Además de la posible carga para los hospitales, existe la posibilidad de que las personas contraigan ambos virus y “nadie sabe qué sucede si se contrae influenza y COVID simultáneamente porque nunca sucedió antes”, dijo la doctora Rachel Levine, secretaria de Salud de Pennsylvania, a reporteros.En respuesta, este año los fabricantes están produciendo más suministros de vacunas, entre 194 y 198 millones de dosis, unas 20 millones más de las que se distribuyeron la temporada pasada, según los Centros para el Control y Prevención de Enfermedades (CDC).Mientras se acerca la temporada de gripe, aquí hay algunas respuestas a preguntas frecuentes:P. ¿Cuándo debo vacunarme contra la gripe?. La publicidad ya ha comenzado kamagra for sale uk y algunas farmacias y clínicas ya tienen sus suministros. Pero, debido a que la efectividad de la vacuna puede disminuir con el tiempo, los CDC recomiendan no recibir la dosis en agosto.Muchas farmacias y clínicas comenzarán las inmunizaciones a principios de septiembre. Generalmente, los virus de la influenza comienzan a circular a mediados o fines de octubre, pero se expanden masivamente más kamagra for sale uk tarde, en el invierno.

Se necesitan aproximadamente dos semanas después de recibir la inyección para que los anticuerpos, que circulan en la sangre y frustran las infecciones, se acumulen.“Las personas jóvenes y sanas pueden comenzar a vacunarse contra la gripe en septiembre, y las personas mayores y otras poblaciones vulnerables pueden hacerlo en octubre”, dijo el doctor Steve Miller, director clínico de la aseguradora Cigna.Los CDC recomiendan que las personas “se vacunen contra la influenza a fines de octubre”, pero señalaron que se puede recibir la vacuna más tarde porque “aún puede ser beneficiosas y la vacunación debe ofrecerse a lo largo de toda la temporada de influenza”.Aun así, algunos expertos recomiendan no esperar demasiado este año, no solo por COVID-19, sino también en caso de que haya escasez debido a la abrumadora demanda.P. ¿Cuáles son las razones por las que las que debería ofrecer mi brazo kamagra for sale uk para vacunarme?. Hay que vacunarse porque brinda protección contra la gripe y, por lo tanto, contra la propagación a otras personas, lo que puede ayudar a disminuir la carga para los hospitales y el personal médico.Y hay otro mensaje que puede resonar en estos tiempos extraños.“Le da a la gente la sensación de que hay algunas cosas que pueden controlar”, dijo Eduardo Sánchez, director médico de prevención de la American Heart Association.Si bien una vacuna contra la gripe no evitará COVID-19, recibirla podría ayudar al médico a diferenciar entre las dos enfermedades si se desarrolla algún síntoma (fiebre, tos, dolor de garganta) que ambas infecciones comparten, explicó Sánchez.Y aunque las vacunas contra la gripe no evitarán todos los casos de gripe, vacunarse puede reducir la gravedad si la persona se enferma, dijo.Todas las personas elegibles, especialmente los trabajadores esenciales, los que sufren de afecciones subyacentes y aquellos en mayor riesgo, incluidos los niños muy pequeños y las mujeres embarazadas, deben buscar protección, dijeron los CDC. La entidad kamagra for sale uk recomienda la vacunación a partir de los 6 meses.P. ¿Qué sabemos sobre la efectividad de la vacuna de este año?.

Se deben producir nuevas vacunas kamagra for sale uk contra la gripe cada año, porque el virus muta y la efectividad de la vacuna varía, dependiendo de qué tan bien coincida con el virus circulante.Se calculó que la formulación del año pasado tuvo una eficacia de aproximadamente un 45% para prevenir la gripe en general, con una efectividad de aproximadamente un 55% en los niños. Las vacunas disponibles en el país este año tienen como objetivo prevenir al menos tres cepas diferentes del virus, y la mayoría cubre cuatro.Todavía no se sabe qué tan bien coincidirá el suministro de este año con las cepas que circularán en los Estados Unidos. Las primeras indicaciones del hemisferio sur, que kamagra for sale uk atraviesa su temporada de gripe durante nuestro verano, son alentadoras. Allí, las personas practicaron el distanciamiento social, usaron máscaras y se vacunaron en mayor número este año, y los niveles mundiales de gripe son más bajos de lo esperado. Sin embargo, expertos advierten que no se debe contar con una temporada igual de suave kamagra for sale uk en los Estados Unidos, en parte porque los esfuerzos por usar mascara facial y de distanciamiento social varían ampliamente.P.

¿Qué están haciendo diferente los seguros y sistemas de salud este año?. Las aseguradoras y los sistemas de salud contactados por kamagra for sale uk KHN dicen que seguirán las pautas de los CDC, que exigen limitar y espaciar la cantidad de personas que esperan en las filas y las áreas de vacunación. Algunos están programando citas para vacunas contra la gripe para ayudar a controlar el flujo.Health Fitness Concepts, una compañía que trabaja con UnitedHealth Group y otras empresas para establecer clínicas de vacunación contra la gripe en el noreste del país, dijo que está “fomentando eventos más pequeños y frecuentes para apoyar el distanciamiento social” y “exigiendo que se completen todos los formularios y arremangarse las camisas antes de entrar al área de vacunación contra la influenza”.Se requerirá que todos usen máscaras.Además, a nivel nacional, algunos grupos médicos contratados por UnitedHealth instalarán carpas, para que las inyecciones se puedan administrar al aire libre, dijo un vocero.Kaiser Permanente planifica las vacunas directamente en autos en algunos de sus centros médicos y está probando los procedimientos de detección y registro sin contacto en algunos lugares.Geisinger Health, un proveedor de salud regional en Pennsylvania y Nueva Jersey, dijo que también tendría programas de vacunación contra la influenza al aire libre en sus instalaciones.Además, “Geisinger exige que todos los empleados reciban la vacuna contra la influenza este año”, dijo Mark Shelly, director de prevención y control de infecciones del sistema. €œAl dar este paso, esperamos transmitir a nuestros vecinos la importancia de kamagra for sale uk la vacuna contra la influenza para todos”.P. Por lo general, me vacunan contra la gripe en el trabajo.

¿Seguirá siendo kamagra for sale uk una opción este año?. Con el objetivo de evitar riesgosas reuniones en interiores, muchos empleadores se muestran reacios a patrocinar las clínicas de gripe en oficinas como han ofrecido en años anteriores. Y con tanta gente que sigue trabajando desde casa, hay menos necesidad de llevar las vacunas contra la kamagra for sale uk gripe al lugar de trabajo. En cambio, muchos empleadores están alentando a los trabajadores a que reciban vacunas de sus médicos de atención primaria, en farmacias u otros entornos comunitarios. El seguro generalmente cubrirá el costo de la vacuna.Algunos empleadores están considerando ofrecer cupones para vacunas contra la gripe a sus trabajadores sin seguro o a aquellos que no participan en el plan médico de la compañía, dijo Julie Stone, directora general de salud y beneficios de Willis Towers Watson, una firma consultora.Estos cupones podrían, por ejemplo, permitir a los trabajadores obtener la vacuna en un laboratorio en particular sin costo.Algunos empleadores están comenzando a pensar en cómo podrían usar sus estacionamientos para administrar vacunas contra la gripe enlos autos, dijo el doctor David Zieg, líder de servicios clínicos para el consultor de beneficios Mercer.Aunque la ley federal permite a los empleadores exigir a los empleados que se vacunen contra la gripe, ese paso generalmente lo toman solo los centros de atención kamagra for sale uk médica y algunas universidades donde las personas viven y trabajan en estrecha colaboración, dijo Zieg.Pero sucede.

El mes pasado, el sistema de la Universidad de California emitió una orden kamagra for sale uk ejecutiva que requiere que todos los estudiantes, profesores y personal se vacunen contra la gripe antes del 1 de noviembre, con limitadas excepciones.P. ¿Qué están haciendo las farmacias para alentar a las personas a vacunarse contra la gripe?. Algunas farmacias están haciendo un esfuerzo adicional para salir a la comunidad y ofrecer vacunas contra la gripe.Walgreens, que tiene casi 9,100 farmacias en todo el país, continúa una asociación iniciada en 2015 con organizaciones comunitarias, iglesias y empleadores que ha ofrecido alrededor de 150,000 clínicas de gripe móviles hasta la fecha.El programa pone especial énfasis en trabajar con poblaciones vulnerables y en áreas desatendidas, dijo el doctor Kevin Ban, director médico de la cadena de farmacias.Walgreens comenzó a ofrecer vacunas contra la gripe a mediados de agosto y está animando a las personas a no demorar en vacunarse.Tanto Walgreens como CVS están estimulando a las personas kamagra for sale uk a programar citas y hacer trámites en línea este año para minimizar el tiempo que pasan en los locales.En los CVS MinuteClinic, una vez que los pacientes se han registrado para recibir la vacuna contra la gripe, deben esperar afuera o en su automóvil, ya que las áreas de espera interiores ahora están cerradas.“No tenemos un arsenal contra COVID”, dijo Ban, de Walgreens. €œPero quitar la presión del sistema de atención médica proporcionando vacunas por adelantado es algo que sí podemos hacer”. Julie kamagra for sale uk Appleby.

jappleby@kff.org, @Julie_Appleby Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics kamagra for sale uk Insurance Noticias En Español Public Health CDC COVID-19 Insurers VaccinesThis story was produced in partnership with PolitiFact. This story can be republished for free (details). President Donald Trump accepted the Republican Party’s nomination for president in a 70-minute speech from the South Lawn of the White House on Thursday night.Speaking to a friendly crowd that didn’t appear to be observing social distancing conventions, and with few participants wearing masks, he touched on a range of topics, including many related to the COVID pandemic and health care in general.Throughout, the partisan crowd applauded and chanted “Four more years!. € And, even as the nation’s COVID-19 death toll kamagra for sale uk exceeded 180,000, Trump was upbeat. €œIn recent months, our nation and the entire planet has been struck by a new and powerful invisible enemy,” he said.

€œLike those brave Americans before us, we are meeting this challenge.”At the end of the event, there were fireworks.Our partners at PolitiFact kamagra for sale uk did an in-depth fact check on Trump’s entire acceptance speech. Here are the highlights related to the administration’s COVID-19 response and other health policy issues:“We developed, from scratch, the largest and most advanced testing system in the world.” This is partially right, but it needs context.It’s accurate that the U.S. Developed its COVID-19 testing system from scratch, because the government didn’t kamagra for sale uk accept the World Health Organization’s testing recipe. But whether the system is the “largest” or “most advanced” is subject to debate.The U.S. Has tested more individuals than any kamagra for sale uk other country.

But experts told us a more meaningful metric would be the percentage of positive tests out of all tests, indicating that not only sick people were getting tested. Another useful metric would be the percentage of the population that has been kamagra for sale uk tested. The U.S. Is one of the most populous countries but has tested a lower percentage of its population than kamagra for sale uk other countries. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter.

The kamagra for sale uk U.S. Was also slower than other countries in rolling out tests and amping up testing capacity. Even now, many states are experiencing delays in reporting test results to positive individuals.As for “the most advanced,” Trump may be referring to new testing investments and kamagra for sale uk systems, like Abbott’s recently announced $5, 15-minute rapid antigen test, which the company says will be about the size of a credit card, needs no instrumentation and comes with a phone app through which people can view their results. But Trump’s comment makes it sound as if these testing systems are already in place when they haven’t been distributed to the public.“The United States has among the lowest [COVID-19] case fatality rates of any major country in the world. The European Union’s case fatality rate is nearly kamagra for sale uk three times higher than ours.”The case fatality rate measures the known number of cases against the known number of deaths.

The European Union has a rate that’s about 2½ times greater than the United States.But the source of that data, Oxford University’s Our World in Data project, reports that “during an outbreak of a pandemic, the case fatality rate is a poor measure of the mortality risk of the disease.”A better way to measure the threat of the virus, experts say, is to look at the number of deaths per 100,000 residents. Viewed that kamagra for sale uk way, the U.S. Has the 10th-highest death rate in the world.“We will produce a vaccine before the end of the year, or maybe even sooner.”It’s far from guaranteed that a coronavirus vaccine will be ready before the end of the year.While researchers are making rapid strides, it’s not yet known precisely when the vaccine will be available to the public, which is what’s most important. Six vaccines are in the third kamagra for sale uk phase of testing, which involves thousands of patients. Like earlier phases, this one looks at the safety of a vaccine but also kamagra for sale uk examines its effectiveness and collects more data on side effects.

Results of the third phase will be submitted to the Food and Drug Administration for approval.The government website Operation Warp Speed seems less optimistic than Trump, announcing it “aims to deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021.”And federal health officials and other experts have generally predicted a vaccine will be available in early 2021. Federal committees are working on recommendations for vaccine distribution, including which kamagra for sale uk groups should get it first. €œFrom everything we’ve seen now — in the animal data, as well as the human data — we feel cautiously optimistic that we will have a vaccine by the end of this year and as we go into 2021,” said Dr. Anthony Fauci, the nation’s top infectious diseases expert kamagra for sale uk. €œI don’t think it’s dreaming.”“Last month, I took on Big Pharma.

You think kamagra for sale uk that is easy?. I signed orders that would massively lower the cost of your prescription drugs.”Quite misleading. Trump signed kamagra for sale uk four executive orders on July 24 aimed at lowering prescription drug prices. But those orders haven’t taken effect yet — the text of one hasn’t even been made publicly available — and experts told us that, if implemented, the measures would be unlikely to result in significant drug price reductions for the majority of Americans.“We will always and very strongly protect patients with preexisting conditions, and that is a pledge from the entire Republican Party.”Trump’s pledge is undermined by his efforts to overturn the Affordable Care Act, the only law that guarantees people with preexisting conditions both receive health coverage and do not have to pay more for it than others do. In 2017, Trump supported congressional efforts to repeal the kamagra for sale uk ACA.

The Trump administration is now backing GOP-led efforts to overturn the ACA through a court case. And Trump has also expanded short-term health plans that don’t have to comply kamagra for sale uk with the ACA.“Joe Biden recently raised his hand on the debate stage and promised he was going to give it away, your health care dollars to illegal immigrants, which is going to bring a massive number of immigrants into our country.”This is misleading. During a June 2019 Democratic primary debate, candidates were asked. €œRaise your kamagra for sale uk hand if your government plan would provide coverage for undocumented immigrants.” All candidates on stage, including Biden, raised their hands. They were not asked if that coverage would be free or subsidized.Biden supports extending health care access to all immigrants, regardless of immigration status.

A task force recommended that he allow immigrants who are in the country illegally to buy health insurance, without federal subsidies.“Joe Biden claims he has empathy kamagra for sale uk for the vulnerable, yet the party he leads supports the extreme late-term abortion of defenseless babies right up to the moment of birth.”This mischaracterizes the Democratic Party’s stance on abortion and Biden’s position.Biden has said he would codify the Supreme Court’s ruling in Roe v. Wade and related precedents. This would generally limit abortions to the kamagra for sale uk first 20 to 24 weeks of gestation. States are allowed under court rulings to ban abortion after the point at which a fetus can sustain life, usually considered to be between 24 and 28 weeks from the mother’s last menstrual period — and 43 states do. But the rulings kamagra for sale uk require states to make exceptions “to preserve the life or health of the mother.” Late-term abortions are very rare, about 1%.The Democratic Party platform holds that “every woman should have access to quality reproductive health care services, including safe and legal abortion — regardless of where she lives, how much money she makes, or how she is insured.” It does not address late-term abortion.PolitiFact’s Daniel Funke, Jon Greenberg, Louis Jacobson, Noah Y.

Kim, Bill McCarthy, Samantha Putterman, Amy Sherman, Miriam Valverde and KHN reporter Victoria Knight contributed to this report. Related Topics Elections Health Industry Pharmaceuticals kamagra for sale uk Public Health The Health Law Abortion COVID-19 Immigrants KHN &. PolitiFact HealthCheck Preexisting Conditions Trump Administration VaccinesThis story also ran on CNN. This story can be republished for free (details). Flu season will look different this year, as the country grapples with a coronavirus pandemic that has killed more than 172,000 people. Many Americans are reluctant to visit a doctor’s office and public health officials worry people will shy away from being immunized.Although sometimes incorrectly regarded as just another bad cold, flu also kills tens of thousands of people kamagra for sale uk in the U.S. Each year, with the very young, the elderly and those with underlying conditions the most vulnerable.

When coupled with the effects of COVID-19, public kamagra for sale uk health experts say it’s more important than ever to get a flu shot.If enough of the U.S. Population gets vaccinated — more than the 45% who did last flu season — it could help head off a nightmare scenario in the coming winter of hospitals stuffed with both COVID-19 patients and those suffering from severe effects of influenza.Aside from the potential burden on hospitals, there’s the possibility people could get both viruses — and “no one knows what happens if you get influenza and COVID [simultaneously] because it’s never happened before,” Dr. Rachel Levine, Pennsylvania’s secretary of health, told reporters this month.In response, manufacturers are producing more vaccine supply this year, between 194 million and 198 million doses, or about 20 million kamagra for sale uk more than they distributed last season, according to the Centers for Disease Control and Prevention. Email Sign-Up Subscribe to kamagra for sale uk KHN’s free Morning Briefing. As flu season approaches, here are some answers to a few common questions:Q.

When should I get my flu kamagra for sale uk shot?. Advertising has already begun, and some pharmacies and clinics have their supplies now. But, because kamagra for sale uk the effectiveness of the vaccine can wane over time, the CDC recommends against a shot in August.Many pharmacies and clinics will start immunizations in early September. Generally, influenza viruses start circulating in mid- to late October but become more widespread later, in the winter. It takes kamagra for sale uk about two weeks after getting a shot for antibodies — which circulate in the blood and thwart infections — to build up.

€œYoung, healthy people can begin getting their flu shots in September, and elderly people and other vulnerable populations can begin in October,” said Dr. Steve Miller, chief clinical officer for insurer Cigna.The kamagra for sale uk CDC has recommended that people “get a flu vaccine by the end of October,” but noted it’s not too late to get one after that because shots “can still be beneficial and vaccination should be offered throughout the flu season.”Even so, some experts say not to wait too long this year — not only because of COVID-19, but also in case a shortage develops because of overwhelming demand.Q. What are the reasons I should roll up my sleeve for this?. Get a shot because it protects you from catching the flu and spreading it to others, which may help lessen the burden on hospitals and medical staffs.And there’s another message that may resonate in this strange time.“It gives people a sense that there are some things you can control,” said Eduardo Sanchez, chief medical officer for prevention at the American Heart Association.While a flu shot won’t prevent COVID-19, he said, getting one could help your doctors differentiate between the diseases if you develop any symptoms — fever, cough, sore throat — they share.And even though flu shots won’t prevent all cases of the flu, getting vaccinated can lessen the severity if you do fall ill, he said.You cannot get influenza from having a flu vaccine.All eligible people, especially essential workers, those with underlying conditions and those at kamagra for sale uk higher risk — including very young children and pregnant women — should seek protection, the CDC said. It recommends that children over 6 months old get vaccinated.Q.

What do we know about the kamagra for sale uk effectiveness of this year’s vaccine?. Flu vaccines — which must be developed anew each year because influenza viruses mutate — range in effectiveness annually, depending on how well they match the circulating virus. Last year’s formulation was estimated to be about 45% effective in kamagra for sale uk preventing the flu overall, with about a 55% effectiveness in children. The vaccines available in the U.S. This year are aimed at preventing at least three strains of the virus, and kamagra for sale uk most cover four.It isn’t yet known how well this year’s supply will match the strains that will circulate in the U.S.

Early indications from the Southern Hemisphere, which goes through its flu season during our summer, are encouraging. There, people practiced social distancing, wore masks and got vaccinated in greater numbers this year — and global kamagra for sale uk flu levels are lower than expected. Experts caution, however, not to count on a similarly mild season in the U.S., in part because masking and social distancing efforts vary widely.Q. What are insurance plans and health kamagra for sale uk systems doing differently this year?. Insurers and health systems contacted by KHN say they will follow CDC guidelines, which call for limiting and spacing out the number of people waiting in lines and vaccination areas.

Some are setting appointments for flu shots to help manage the flow.Health Fitness Concepts, a company that works with UnitedHealth Group kamagra for sale uk and other businesses to set up flu shot clinics in the Northeast, said it is “encouraging smaller, more frequent events to support social distancing” and “requiring all forms to be completed and shirtsleeves rolled up before entering the flu shot area.” Everyone will be required to wear masks.Also, nationally, some physician groups contracted with UnitedHealth will set up tent areas so shots can be given outdoors, a spokesperson said.Kaiser Permanente plans drive-thru vaccinations at some of its medical facilities and is testing touch-free screening and check-in procedures at some locations. (KHN is not affiliated with Kaiser Permanente.)Geisinger Health, a regional health provider in Pennsylvania and New Jersey, said it, too, would have outdoor flu vaccination programs at its facilities.Additionally, “Geisinger is making it mandatory for all employees to receive the flu vaccine this year,” said Mark Shelly, the system’s director of infection prevention and control. €œBy taking this step, we hope to convey to kamagra for sale uk our neighbors the importance of the flu vaccine for everyone.”Q. Usually I get a flu shot at work. Will that be an option this year? kamagra for sale uk.

Aiming to avoid risky indoor gatherings, many employers are reluctant to sponsor the on-site flu clinics they’ve offered in years past. And with so many people continuing to work from home, there’s less need kamagra for sale uk to bring flu shots to employees on the job. Instead, many employers are encouraging workers kamagra jelly for women to get shots from their primary care doctors, at pharmacies or in kamagra for sale uk other community settings. Insurance will generally cover the cost of the vaccine.Some employers are considering offering vouchers for flu shots to their uninsured workers or those who don’t participate in the company plan, said Julie Stone, managing director for health and benefits at Willis Towers Watson, a consulting firm. The vouchers could allow workers to get the shot at a particular lab at no cost, for example.Some employers kamagra for sale uk are starting to think about how they might use their parking lots for administering drive-thru flu shots, said Dr.

David Zieg, clinical services leader for benefits consultant Mercer.Although federal law allows employers to require employees to get flu shots, that step is typically taken only by health care facilities and some universities where people live and work closely together, Zieg said.Q. What are pharmacies kamagra for sale uk doing to encourage people to get flu shots?. Some pharmacies are making an extra push to get out into the community to offer flu shots.Walgreens, which has nearly 9,100 pharmacies nationwide, is continuing a partnership begun in 2015 with community organizations, churches and employers that has offered about 150,000 off-site and mobile flu clinics to date.The program places a special emphasis on working with vulnerable populations and in underserved areas, said Dr. Kevin Ban, chief medical officer for the drugstore chain.Walgreens began offering flu shots in mid-August and is encouraging people not to delay getting vaccinated.Both Walgreens and CVS are encouraging people to schedule appointments and do paperwork online this year to minimize time spent in the stores.At CVS MinuteClinic locations, once patients have checked in for their flu shot, they must wait outside or in their car, since kamagra for sale uk the indoor waiting areas are now closed.“We don’t have tons of arrows in our quiver against COVID,” Walgreens’ Ban said. €œTaking pressure off the health care system by providing vaccines in advance is one thing we can do.” Julie Appleby.

jappleby@kff.org, @Julie_Appleby Michelle kamagra for sale uk Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Insurance Public Health CDC COVID-19 Insurers VaccinesUse Our Content This story can be republished for free (details). As the smoke thickened near her home in Santa Cruz, California, last week, Amanda Smith kept asking herself the same questions. Should we kamagra for sale uk leave?. And where would we go?. The wildfire evacuation zone, at the time, ended a kamagra for sale uk few blocks from her house.

But she worried about what the air quality — which had reached the second-highest warning level, purple for “very unhealthy” — would do to her children’s lungs. Her 4-year-old kamagra for sale uk twins had spent time in the neonatal intensive care unit. One was later diagnosed with asthma, and last year was hospitalized with pneumonia.By Tuesday, said Smith, “we all had headaches, the kids were coughing a little bit, and it was raining ash.” The family had been conscientiously isolating at home because of the COVID pandemic, and leaving meant potential exposures. But on Wednesday, Smith said, “I looked at my partner and said, maybe kamagra for sale uk we should leave.”She called a friend in Orange County, about 380 miles south, who offered her parents’ empty condo. But the next day, the friend’s child spiked a fever — a possible case of COVID-19 — and the plan fell through amid the distraction.Amanda Smith takes a selfie of herself and her twin children in Santa Cruz, California, in April.

(Amanda Smith)So Smith looked on Airbnb, careful to seek out hosts who detailed their COVID precautions, and found an apartment in San Bruno, about an hour’s drive kamagra for sale uk north. She stuffed photos and documents into a suitcase, grabbed the go-bags, and her family headed out.“It’s coming out of our savings to stay here,” Smith said from the safety of her apartment rental, which runs about $1,150 a week. €œIt was a really fraught decision to leave, but as soon as we got over the hill and the sky was blue, I took a big sigh of relief and knew that it had been a good decision.”As kamagra for sale uk the twin disasters of COVID-19 and fire season sweep through California, thousands of residents like Smith are weighing difficult options, pitting risk against risk as they decide where to evacuate, whether from imminent flames or the toxic air. Amid a virulent pandemic, which is safest?. Doubling up kamagra for sale uk at a friend’s home?.

A hotel?. An kamagra for sale uk evacuation center?. And when do the risks of smoke inhalation outweigh the risk of a deadly infection?. €œObviously the most important thing is for people to do what they can to protect their lives, not only from the fire, but also kamagra for sale uk from COVID,” said Detective Rosemerry Blankswade, public information officer for the San Mateo County Sheriff’s Office, which is helping coordinate response to the massive CZU Lightning Complex fires.“You have to evaluate the big picture here. If fire is your most imminent danger, maybe take the COVID risk.

But if you can avoid both of them, that’s obviously going to kamagra for sale uk be the best option. It’s kind of a little bit of triage that we’re asking for people to do in their own lives right now.” Email Sign-Up Subscribe to KHN’s free Morning kamagra for sale uk Briefing. In San Mateo, one of two counties where the CZU Lightning Complex fires are blazing, officials are advising people to head to an evacuation center, where county workers will assist them in finding a hotel room. Meanwhile, in kamagra for sale uk neighboring Santa Cruz, where tens of thousands of residents have evacuated and shelters have limited space, officials are asking those under orders to leave to stay with family and friends whenever possible.What’s the right choice when all options pose additional risks?. We spoke with several experts to help guide your thought process.You have to evacuate.

Where should you kamagra for sale uk go?. If your region is under an evacuation order, do not hesitate. Leave immediately kamagra for sale uk. If you can afford it, booking a room at a hotel or motel outside the evacuation zones may be the best option, said Dr. Michael Wilkes, kamagra for sale uk a professor at the University of California-Davis School of Medicine.

They almost always have air-conditioning units, which help filter the air from both smoke and virus. Many hotels are implementing new kamagra for sale uk cleaning processes. Ask staffers to detail what they’re doing to sanitize rooms, and consider skipping the daily cleaning service during your stay. You might also check review sites such as TripAdvisor to see what other guests kamagra for sale uk report. When possible, avoid the lobby and other shared spaces, and opt for contactless check-in.Amanda Smith at home in Santa Cruz, California, with her twin children.

Smith and her family decided to voluntarily evacuate kamagra for sale uk their home on Aug. 20, due to heavy smoke in the area from the CZU Lightning Complex fires in the nearby Santa Cruz Mountains. (Anna Maria Barry-Jester/KHN)With kamagra for sale uk so many people in Northern California fleeing the fires, many hotels are already full, especially in more remote areas. So what about staying with family or friends?. After months of being shut in and kamagra for sale uk avoiding close contact beyond immediate family, moving into someone else’s home means a host of potential exposures.

Consider whether you or anyone else in the home is at high risk from COVID-19 because of age or a preexisting condition.“If so, that’s a reason to think twice before going to someone’s home,” said Dr. Gina Solomon, a program director at the kamagra for sale uk Oakland-based Public Health Institute.Consider, too, what precautions your friends or family have been taking. Sheltering with someone whose job brings them into frequent contact with other people may not be as safe as sheltering with people who largely have been staying home. Another question is how crowded kamagra for sale uk the home is. If you have your own room and, preferably, your own bathroom, that makes staying with friends a better option.

If a separate bedroom is not available and smoky skies are not a problem, you might consider pitching a tent in their backyard.For those with an RV or kamagra for sale uk tent, camping can present another good option — although, with hundreds of wildfires burning across California, it may be challenging to drive far enough away to avoid fire and smoke. If you do camp, try to find a site away from wooded areas. And think twice before using group bathrooms.Is an evacuation kamagra for sale uk center safe?. Many counties have implemented new precautions at emergency shelters to prevent the spread of the coronavirus. In Santa Cruz, for example, officials are scaling back the capacity in each shelter to allow for social distancing, providing tents for people to kamagra for sale uk use as shielding inside and allowing camping in the parking lots.Still, staying in a shelter should probably not be your first choice.

In terms kamagra for sale uk of COVID risk, deciding between a hotel and a friend’s house is “nipping at the edges,” said Dr. John Swartzberg, a clinical professor emeritus at the UC-Berkeley School of Public Health, while “being in a congregate setting is only better than being completely exposed to the elements.”If an evacuation shelter is your best immediate option, again, do not hesitate. €œYou have these standards you want to practice for yourselves,” Swartzberg said, “but when something worse comes along, it trumps how careful we can be with COVID because the need for shelter is greater.” You can lower your kamagra for sale uk risk of infection by wearing a mask, washing hands frequently and sanitizing surfaces.Smith’s partner, Grant Whipple, walks with their children in Big Sur on March 7. That was their last camping trip before the COVID-19 pandemic hit, Smith says. That area is now under threat from wildfire kamagra for sale uk.

(Amanda Smith)If you aren’t in a fire zone, should you invite friends and family to stay with you?. Deciding whether to open your home to friends who are evacuating is kamagra for sale uk an intensely personal decision and may depend on whether anyone in your family has a preexisting condition.“I guess it depends on how good a friend they are and how desperate they are,” said Swartzberg. It may also depend on how much space you have. If your guests can have their own bedroom and bathroom, it kamagra for sale uk might be safer.If you do offer your home, experts advise against simply considering yourself a new pod with your guests. Instead, take steps to lower your chances of infection.“It might not be pleasant, but wearing a mask anytime you’re not in your own bedroom is the safest way to go,” said Solomon.

Stay outside as much as possible, she added, and consider eating meals outdoors or eating in shifts to avoid being maskless with kamagra for sale uk those outside your family unit. Sanitize surfaces and wash hands frequently. If air quality permits, keep the windows open to improve airflow.If you’re in a region kamagra for sale uk with hazardous smoke conditions, should you leave?. If your area has dense smoke but no imminent fire risk, the thought of heading somewhere else may be appealing, especially if you have respiratory issues. But in most cases, Wilkes said, it would be safer not to leave your COVID bubble kamagra for sale uk.

And given the expanse of California’s fires, anywhere you flee could end up having lousy air quality by the time you arrive.“The better part of rationality,” Wilkes said, “would be to stay at home, not exercise [outdoors], stay inside as much as you can, turn on the air conditioning.”California Healthline senior correspondent Anna Maria Barry-Jester contributed to this report. Jenny Gold kamagra for sale uk. jgold@kff.org, @JennyAGold Related Topics California Public Health States COVID-19 Environmental Health Natural DisastersIn the 2014 elections, Republicans rode a wave of anti-Affordable Care Act sentiment to pick up nine Senate seats, the largest gain for either party since 1980. Newly elected kamagra for sale uk Republicans such as Cory Gardner in Colorado and Steve Daines in Montana had hammered their Democratic opponents over the health care law during the campaign and promised to repeal it.Six years later, those senators are up for reelection. Not only is the law still around, but it’s gaining in popularity.

What was once a winning strategy has become a political liability.Public sentiment about the ACA, also known as Obamacare, has shifted considerably during the Trump administration after Republicans tried but failed kamagra for sale uk to repeal it. Now, in the midst of the COVID-19 pandemic and the ensuing economic crisis, which has led to the loss of jobs and health insurance for millions of people, health care again looks poised to be a key issue for voters this election. Don't kamagra for sale uk Miss A Story Subscribe to KHN’s free Weekly Edition newsletter. With competitive races in Colorado, Montana, Arizona, North Carolina and Iowa pitting Republican incumbents who voted to repeal the ACA against Democratic challengers promising to protect it, attitudes surrounding the health law could help determine control of the Senate. Republicans hold a slim three-vote majority in the kamagra for sale uk Senate but are defending 23 seats in the Nov.

3 election. Only one Democratic Senate seat — in Alabama, where incumbent kamagra for sale uk Doug Jones is up against former Auburn University football coach Tommy Tuberville — is considered in play for Republicans.“The fall election will significantly revolve around people’s belief about what [candidates] will do for their health coverage,” said Dr. Daniel Derksen, a professor of public health at the University of Arizona.The Affordable Care Act has been a wedge issue since it was signed into law in 2010. Because it then took four years to enact, its opponents talked for years about how bad the not-yet-created marketplace for insurance would be, said Joe Hanel, spokesperson for kamagra for sale uk the Colorado Health Institute, a nonpartisan nonprofit focused on health policy analysis. And they continued to attack the law as it took kamagra for sale uk full effect in 2014.Gardner, for example, ran numerous campaign ads that year criticizing the ACA and, in particular, President Barack Obama’s assertion that “if you like your health care plan, you’ll be able to keep your health care plan.”But now, Hanel said, the ACA’s policies have become much more popular in Colorado as the costs of health exchange plans have dropped.

Thus, political messaging has changed, too.“This time it’s the opposite,” Hanel said. €œThe people bringing up the kamagra for sale uk Affordable Care Act are the Democrats.”Despite Gardner’s multiple votes to repeal the ACA, he has largely avoided talking about the measure during the 2020 campaign. He even removed his pro-repeal position from his campaign website.Democratic attack ads in July blasted Gardner for repeatedly dodging questions in an interview with Colorado Public Radio about his stance on a lawsuit challenging the ACA.His opponent, Democrat John Hickenlooper, fully embraced the law when he was Colorado governor, using the measure to expand Medicaid eligibility to more low-income people and to create a state health insurance exchange. Now, he’s campaigning on that record, with promises to expand health care access even further.Polling DataPolling conducted by KFF for the past 10 years shows kamagra for sale uk a shift in public opinion has occurred nationwide. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)“Since Trump won the election in 2016, we now have consistently found that a larger share of the public holds favorable views” of the health law, said Ashley Kirzinger, associate director of public opinion and survey research for the foundation.

€œThis really solidified in 2017 after the failed repeal in the Senate.”The foundation’s polling found that, in July 2014, 55% of voters opposed the law, while 36% favored it. By July 2020, that had flipped, with 51% favoring the law and 38% opposing it. A shift was seen across all political groups, though 74% of Republicans still viewed it unfavorably in the latest poll.Public support for individual provisions of the ACA — such as protections for people with preexisting conditions or allowing young adults to stay on their parents’ health plans until age 26 — have proved even more popular than the law as a whole. And the provision that consistently polled unfavorably — the mandate that those without insurance must pay a fine — was eliminated in 2017.“We’re 10 years along and the sky hasn’t caved in,” said Sabrina Corlette, a health policy professor at Georgetown University.Political MessagingFollowing the passage of the ACA, Democrats didn’t reference the law in their campaigns, said Erika Franklin Fowler, a government professor at Wesleyan University and the director of the Wesleyan Media Project, which tracks political advertising.“They ran on any other issue they could find,” Fowler said.Republicans, she said, kept promising to “repeal and replace” but weren’t able to do so.Then, in the 2018 election, Democrats seized on the shift in public opinion, touting the effects of the law and criticizing Republicans for their attempts to overturn it.“In the decade I have been tracking political advertising, there wasn’t a single-issue topic that was as prominent as health care was in 2018,” she said.As the global health crisis rages, health care concerns again dominate political ads in the 2020 races, Fowler said, although most ads haven’t explicitly focused on the ACA. Many highlight Republicans’ support for the lawsuit challenging preexisting condition protections or specific provisions of the ACA that their votes would have overturned.

Republicans say they, too, will protect people with preexisting conditions but otherwise have largely avoided talking about the ACA.“Cory Gardner has been running a lot on his environmental bills and conservation funding,” Fowler said. €œIt’s not difficult to figure out why he’s doing that. It’s easier for him to tout that in a state like Colorado than it is to talk about health care.”Similar dynamics are playing out in other key Senate races. In Arizona, Republican Sen. Martha McSally was one of the more vocal advocates of repealing the ACA while she served in the House of Representatives.

She publicly acknowledged those votes may have hurt her 2018 Senate bid.“I did vote to repeal and replace Obamacare,” McSally said on conservative pundit Sean Hannity’s radio show during the 2018 campaign. €œI’m getting my ass kicked for it right now.”She indeed lost but was appointed to fill the seat of Sen. Jon Kyl after he resigned at the end of 2018. Now McSally is in a tight race with Democratic challenger Mark Kelly, an astronaut and the husband of former Rep. Gabby Giffords.“Kelly doesn’t have a track record of voting one way or another, but certainly in his campaign this is one of his top speaking points.

What he would do to expand coverage and reassure people that coverage won’t be taken away,” said Derksen, the University of Arizona professor.The ACA has proved a stumbling block for Republican Sens. Thom Tillis of North Carolina and Joni Ernst of Iowa. In Maine, GOP Sen. Susan Collins cast a key vote that prevented the repeal of the law but cast other votes that weakened it. She now also appears vulnerable — but more for her vote to confirm Brett Kavanaugh’s nomination to the Supreme Court and for not doing more to oppose President Donald Trump.In Montana, Daines, who voted to repeal the ACA, is trying to hold on to his seat against Democratic Gov.

Steve Bullock, who used the law to expand the state’s Medicaid enrollment in 2015. At its peak, nearly 1 in 10 Montanans were covered through the expansion.As more Montanans now face the high cost of paying for health care on their own amid pandemic-related job losses, Montana State University political science professor David Parker said he expects Democrats to talk about Daines’ votes to repeal cost-saving provisions of the ACA.“People are losing jobs, and their jobs bring health care with them,” Parker said. €œI don’t think it’s a good space for Daines to be right now.” Markian Hawryluk. MarkianH@kff.org, @MarkianHawryluk Related Topics Elections Health Care Costs Health Care Reform Insurance States Arizona Colorado Montana North Carolina Obamacare Plans.

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Headlines popped kamagra preis up spreading the news, sparking conversations far and wide and forcing many to reconsider their preferred style of face mask. A Washington Post story said “some cotton cloth masks are about as effective as surgical masks, while thin polyester spandex gaiters may be worse than going maskless.” A Forbes article, referring to neck gaiters, said the study “found that one type of face covering might actually be doing more harm than good.” But the study didn’t show that, nor was it designed to. It was actually a test on how to test masks inexpensively, not to determine which one was most effective. The researchers set up a green laser kamagra preis beam in a dark room. A masked subject was then asked to speak so that the droplets from the speaker’s mouth showed up in the green beam.

The whole process was video recorded on a cell phone, after which researchers calculated the number of droplets that showed up. The process was repeated 10 times for each mask (14 in total, one of which was kamagra preis a neck gaiter) and the setup cost less than $200. What was meant as a study on the pricing and efficacy of a test turned into, at least in some journalistic circles, a definitive nail-in-the-coffin for gaiters. Days after the initial reports that neck gaiters might not only be useless but maybe even harmful, a new round of new reports came out saying that those initial reports were overblown and misleading. The authors of the study even held a press conference where they emphasized kamagra preis that their study was never meant to test the effectiveness of masks.

They only tested one gaiter-style mask, which says nothing about that style of mask in general. The combination of reporting on the actual findings of the study and the direct comments from the authors seems to have abated the anti-neck gaiter fervor. But all of this this—or most of it, anyway—likely kamagra preis could have been prevented. You could make the argument that it’s not a scientist’s job to worrying about how their science might be interpreted. It’s their job to do the research and publish it in a scientific manuscript.

Leave the communicating for someone else kamagra preis. But that’s not how the spread of information works. Fewer and fewer newsrooms have staffers with scientific backgrounds, or who are dedicated to scientific reporting. To be clear, journalists don’t need to be scientists to understand science, but reporting on science does kamagra preis require a certain amount of expertise. When newsrooms ask reporters to cover more and more topic areas and this specialization decreases, an attention to detail is sometimes lost.

So, the onus to help journalists (and frankly, all nonscientists) get the facts straight falls to the scientists doing the science. That’s where science communication training comes kamagra preis in. Science communication, or scicomm as it’s known colloquially, is not a core part of coursework in a majority of degree-granting science programs at the undergraduate and graduate levels. This trend is slowly changing as more institutions incorporate scicomm into their curriculums. Outside of academia, nonprofits and scientific societies kamagra preis are taking up the mantle.

I work for the American Geophysical Union (AGU), a society for Earth and space scientists, in the Sharing Science program, where we teach scientists to communicate with nonscientists through courses, workshops, webinars and other trainings. Aside from the AGU, there is the American Association for the Advancement of Science (AAAS), the Stony Brook–affiliated Alan Alda Center for Communicating Science and the science storytelling organization The Story Collider, to name just to name a few. We teach the so-called “soft skills” that the ivory tower of science kamagra preis has shunned for so long but that are so necessary in effectively communicating. One thing we stress is “know your audience.” Scientists must think about how their science will be perceived, no matter how relevant or not it might be to the broader public. Science does not exist in a vacuum.

It never kamagra preis has. But especially now, and especially with anything related to COVID-19, scientists much be hypervigilant when communicating results and try, to the best of their abilities, to account for as many interpretations as possible. Yes, it is onerous, especially on top of the multitude of other responsibilities that come with being a scientist, but it is necessary. The traditional ways in which scientists communicate their results (i.e., scientific manuscripts) are kamagra preis not going away anytime soon. However, and while it may be an unfair ask, scientists must not only be able to communicate their science to their peers.

They must always think about nonscience audiences as the lines between science and “the public” continue to blur. Training scientists to effectively communicate to, or at least think about, diverse audiences is kamagra preis a necessary part of science.In 1835 French philosopher Auguste Comte asserted that nobody would ever know what the stars were made of. €œWe understand the possibility of determining their shapes, their distances, their sizes and their movements,” he wrote, “whereas we would never know how to study by any means their chemical composition, or their mineralogical structure, and, even more so, the nature of any organized beings that might live on their surface.” Comte would be stunned by the discoveries made since then. Today we know that the universe is far bigger and stranger than anyone suspected. Not only does it extend beyond the Milky Way to untold numbers of kamagra preis other galaxies—this would come as a surprise to astronomers of the 19th and early 20th century to whom our galaxy was “the universe”—but it is expanding faster every day.

Now we can confidently trace cosmic history back 13.8 billion years to a moment only a billionth of a second after the big bang. Astronomers have pinned down our universe's expansion rate, the mean density of its main constituents, and other key numbers to a precision of 1 or 2 percent. They have also worked out kamagra preis new laws of physics governing space—general relativity and quantum mechanics—that turn out to be much more outlandish than the classical laws people understood before. These laws in turn predicted cosmic oddities such as black holes, neutron stars and gravitational waves. The story of how we gained this knowledge is full of accidental discoveries, stunning surprises and dogged scientists pursuing goals others thought unreachable.

Our first hint of the true nature of stars kamagra preis came in 1860, when Gustav Kirchhoff recognized that the dark lines in the spectrum of light coming from the sun were caused by different elements absorbing specific wavelengths. Astronomers analyzed similar features in the light of other bright stars and discovered that they were made of the same materials found on Earth—not of some mysterious “fifth essence” as the ancients had believed. But it took longer to understand what fuel made the stars shine. Lord Kelvin (William Thomson) calculated that if stars derived their power just from gravity, slowly deflating as their radiation leaked out, then the sun's age was 20 kamagra preis million to 40 million years—far less time than Charles Darwin or the geologists of the time inferred had elapsed on Earth. In his last paper on the subject, in 1908, Kelvin inserted an escape clause stating that he would stick by his estimate “unless there were some other energy source laid up in the storehouse of creation.” That source, it turned out, is nuclear fusion—the process by which atomic nuclei join to create a larger nucleus and release energy.

In 1925 astrophysicist Cecilia Payne-Gaposchkin used the light spectra of stars to calculate their chemical abundances and found that, unlike Earth, they were made mainly of hydrogen and helium. She revealed her conclusions in what astronomer Otto Struve described as “the most brilliant kamagra preis Ph.D. Thesis ever written in astronomy.” A decade later physicist Hans Bethe showed that the fusion of hydrogen nuclei into helium was the main power source in ordinary stars. What is the source of the sun's power?. The answer—fusion—came kamagra preis in 1938.

Credit. SOHO (ESA and NASA) At the same time stars were becoming less mysterious, so, too, was the nature of fuzzy “nebulae” becoming clearer. In a “great debate” held before the National Academy of Sciences in Washington, D.C., on April 26, 1920, Harlow Shapley maintained that our Milky Way kamagra preis was preeminent and that all the nebulae were part of it. In contrast, Heber Curtis argued that some of the fuzzy objects in the sky were separate galaxies—“island universes”—fully the equal of our Milky Way. The conflict was settled not that night but just a few years later, in 1924, when Edwin Hubble measured the distances to many nebulae and proved they were beyond the reaches of the Milky Way.

His evidence came from Cepheids, variable stars in the nebulae that reveal their true brightness, and thus their distance, by their pulsation period—a relation discovered by Henrietta Swan Leavitt kamagra preis. Soon after Hubble realized that the universe was bigger than many had thought, he found that it was still growing. In 1929 he discovered that spectral features in the starlight from distant galaxies appeared redder—that is, they had longer wavelengths—than the same features in nearby stars. If this effect was interpreted as a Doppler shift—the natural spreading of waves as they recede—it kamagra preis would imply that other galaxies were moving away from one another and from us. Indeed, the farther away they were, the faster their recession seemed to be.

This was the first clue that our cosmos was not static but was expanding all the time. The universe also appeared to contain much that we kamagra preis could not see. In 1933 Fritz Zwicky estimated the mass of all the stars in the Coma cluster of galaxies and found that they make up only about 1 percent of the mass necessary to keep the cluster from flying apart. The discrepancy was dubbed “the missing mass problem,” but many scientists at the time doubted Zwicky's suggestion that hidden matter might be to blame. The question remained divisive until the kamagra preis 1970s, when work by Vera Rubin and W.

Kent Ford (observing stars) and by Morton Roberts and Robert Whitehurst (making radio observations) showed that the outer parts of galactic disks would also fly apart unless they were subject to a stronger gravitational pull than stars and gas alone could provide. Finally, most astronomers were compelled to accept that some kind of “dark matter” must be present. €œWe have peered into a new world,” Rubin wrote, “and have seen that it is more mysterious and more complex than we had imagined.” Scientists now believe that dark matter outnumbers visible matter by about a factor of five, yet we are kamagra preis hardly closer than we were in the 1930s to figuring out what it is. Gravity, the force that revealed all that dark matter, has proved to be nearly as baffling. A pivotal moment came in 1915 when Albert Einstein published his general theory of relativity, which transcended Isaac Newton's mechanics and revealed that gravity is actually the deformation of the fabric of space and time.

This new theory was slow kamagra preis to take hold. Even after it was shown to be correct by observations of a 1919 solar eclipse, many dismissed the theory as an interesting quirk—after all, Newton's laws were still good enough for calculating most things. €œThe discoveries, while very important, did not, however, affect anything on this earth,” astronomer W.J.S. Lockyer told the kamagra preis New York Times after the eclipse. For almost half a century after it was proposed, general relativity was sidelined from the mainstream of physics.

Then, beginning in the 1960s, astronomers started discovering new and extreme phenomena that only Einstein's ideas could explain. One example lurks in the Crab Nebula, one of the best-known objects in the sky, which is composed kamagra preis of the expanding debris from a supernova witnessed by Chinese astronomers in a.d. 1054. Since it appeared, the nebula has kept on shining blue and bright—but how?. Its light source was a longtime puzzle, but the answer came in 1968, when the kamagra preis dim star at its center was revealed to be anything but normal.

It was actually an ultracompact neutron star, heavier than the sun but only a few miles in radius and spinning at 30 revolutions per second. €œThis was a totally unexpected, totally new kind of object behaving in a way that astronomers had never expected, never dreamt of,” said Jocelyn Bell Burnell, one of the discoverers of the phenomenon. The star's excessive spin sends out a wind kamagra preis of fast electrons that generate the blue light. The gravitational force at the surface of such an incredibly dense object falls way outside of Newton's purview—a rocket would need to be fired at half the speed of light to escape its pull. Here the relativistic effects predicted by Einstein must be taken into account.

Thousands of such spinning neutron kamagra preis stars—called pulsars—have been discovered. All are believed to be remnants of the cores of stars that exploded as supernovae, offering an ideal laboratory for studying the laws of nature under extreme conditions. The most exotic result of Einstein's theory was the concept of black holes—objects that have collapsed so far that not even light can escape their gravitational pull. For decades these were only conjecture, and Einstein wrote in 1939 that they “do not exist in physical reality.” But in 1963 astronomers discovered quasars kamagra preis. Mysterious, hyperluminous beacons in the centers of some galaxies.

More than a decade passed before a consensus emerged that this intense brightness was generated by gas swirling into huge black holes lurking in the galaxies' cores. It was the strongest evidence yet that these bizarre kamagra preis predictions of general relativity actually exist. When did the universe begin?. Did it even have a beginning?. Astronomers had long debated these questions when, in the middle of the 20th century, two competing theories proposed very different kamagra preis answers.

The “hot big bang” model said the cosmos began extremely small, hot and dense and then cooled and spread out over time. The “steady state” hypothesis held that the universe had essentially existed in the same form forever. The contest kamagra preis was settled by a serendipitous discovery. In 1965 radio astronomers Arno Penzias and Robert Wilson were trying to calibrate a new antenna at Bell Labs in New Jersey. They had a problem.

No matter what they did to reduce background interference, they measured kamagra preis a consistent level of noise in every direction. They even evicted a family of pigeons that had been nesting in the antenna in the hope that they were the source of the problem. But the signal persisted. They had discovered that intergalactic kamagra preis space is not completely cold. Instead it is warmed to nearly three kelvins (just above absolute zero) by weak microwaves.

Penzias and Wilson had accidentally uncovered the “afterglow of creation”—the cooled and diluted relic of an era when everything in the universe was squeezed until it was hot and dense. The finding tipped the balance firmly in favor of the big bang picture of kamagra preis cosmology. According to the model, during the earliest, hottest epochs of time, the universe was opaque, rather like the inside of a star, and light was repeatedly scattered by electrons. When the temperature fell to 3,000 kelvins, however, the electrons slowed down enough to be captured by protons and created neutral atoms. Thereafter light could travel freely kamagra preis.

The Bell Labs signal was this ancient light, first released about 300,000 years after the birth of the universe and still pervading the cosmos—what we call the cosmic microwave background. It took a while for the magnitude of the discovery to sink in for the scientists who made it. €œWe were very pleased to have kamagra preis a possible explanation [for the antenna noise], but I don't think either of us really took the cosmology very seriously at first,” Wilson says. €œWalter Sullivan wrote a first-page article in the New York Times about it, and I began to think at that point that, you know, maybe I better start taking this cosmology seriously.” Measurements of this radiation have since enabled scientists to understand how galaxies emerged. Precise observations of the microwaves reveal that they are not completely uniform over the sky.

Some patches are slightly hotter, others slightly kamagra preis cooler. The amplitude of these fluctuations is only one part in 100,000, but they are the seeds of today's cosmic structure. Any region of the expanding universe that started off slightly denser than average expanded less because it was subjected to extra gravity. Its growth lagged further and further, the contrast between its density and that of its surroundings becoming greater and kamagra preis greater. Eventually these clumps were dense enough that gas was pulled in and compressed into stars, forming galaxies.

The crucial point is this. Computer models that simulate this process are fed the initial fluctuations measured in the cosmic kamagra preis microwave background, which represent the universe when it was 300,000 years old. The output after 13.8 billion years of virtual time have elapsed is a cosmos where galaxies resemble those we see, clustered as they are in the actual universe. This is a real triumph. We understand, at least in outline, 99.998 percent kamagra preis of cosmic history.

It is not only the big cosmic picture that we have come to understand. A series of discoveries has also revealed the history of the elemental building blocks that make up stars, planets and even our own bodies. Starting in the 1950s, progress in atomic physics led to accurate modeling of stars' kamagra preis surface layers. Simultaneously, detailed knowledge of the nuclei not just of hydrogen and helium atoms but also of the rest of the elements allowed scientists to calculate which nuclear reactions dominate at different stages in a star's life. Astronomers came to understand how nuclear fusion creates an onion-skin structure in massive stars as atoms successively fuse to build heavier and heavier elements, ending with iron in the innermost, hottest layer.

Inside the Crab kamagra preis Nebula is a neutron star. Classical physics fails, and relativity applies. Credit. NASA, ESA and Hubble Heritage Team (STSCI and AURA) Astronomers also learned how stars die when they exhaust their hydrogen fuel and blow off kamagra preis their outer gaseous layers. Lighter stars then settle down to a quiet demise as dense, dim objects called white dwarfs, but heavier stars shed more of their mass, either in winds during their lives or in an explosive death via supernova.

This expelled mass turns out to be crucial to our own existence. It mixes into the interstellar medium and kamagra preis recondenses into new stars orbited by planets such as Earth. The concept was conceived by Fred Hoyle, who developed it during the 1950s along with two other British astronomers, Margaret Burbidge and Geoffrey Burbidge, and American nuclear physicist William Fowler. In their classic 1957 paper in Reviews of Modern Physics (known by the initials of its authors as BBFH), they analyzed the networks of the nuclear reactions involved and discovered how most atoms in the periodic table came to exist. They calculated why oxygen and carbon, for instance, are common, whereas gold and kamagra preis uranium are rare.

Our galaxy, it turns out, is a huge ecological system where gas is being recycled through successive generations of stars. Each of us contains atoms forged in dozens of different stars spread across the Milky Way that lived and died more than 4.5 billion years ago. Scientists long assumed kamagra preis this process was seeding planets—and possibly even life—around stars other than our own sun. But we did not know for sure whether planets existed outside our solar system until the 1990s, when astronomers developed clever methods for identifying worlds that are too dim for us to see directly. One technique looks for tiny periodic changes in a star's movement caused by the gravitational pull of a planet orbiting it.

In 1995 Michel Mayor and Didier Queloz used this strategy to detect 51 Pegasi kamagra preis b, the first known exoplanet orbiting a sunlike star. The technique can reveal a planet's mass, the length of its “year” and the shape of its orbit. So far more than 800 exoplanets have been found this way. A second technique kamagra preis works better for smaller planets. A star dims slightly when a planet transits in front of it.

An Earth-like planet passing a sunlike star can cause a dimming of about one part in 10,000 once per orbit. The Kepler spacecraft launched in 2009 found more than 2,000 planets this way, kamagra preis many no bigger than Earth. A big surprise to come from astronomers' success in planet hunting was the variety of different planets out there—many much larger and closer to their stars than the bodies in our solar system—suggesting that our cosmic neighborhood may be somewhat special. By this point scientists understood where almost all the elements that form planets, stars and galaxies originated. The final piece kamagra preis in this puzzle, however, arrived very recently and from a seemingly unrelated inquiry.

General relativity had predicted a phenomenon called gravitational waves—ripples in spacetime produced by the movement of massive objects. Despite decades of searching for them, however, no waves were seen—until September 2015. That was when the Laser kamagra preis Interferometer Gravitational-wave Observatory (LIGO) detected the first evidence of gravitational waves in the form of a “chirp”—a minute shaking of spacetime that speeds up and then dies away. In this case, it was caused by two black holes in a binary system that had started out orbiting each other but gradually spiraled together and eventually converged into a single massive hole. The crash occurred more than a billion light-years away.

LIGO's detectors consist of mirrors four kilometers apart whose separation is measured by laser beams that reflect light back kamagra preis and forth between them. A passing gravitational wave causes the space between the two mirrors to jitter by an amount millions of times as small as the diameter of a single atom—LIGO is indeed an amazing feat of precision engineering and perseverance. Since that first find, more than a dozen similar events have been detected, opening up a new field that probes the dynamics of space itself. One event was of special astrophysical interest because it signaled kamagra preis the merger of two pulsars. Unlike black hole mergers, this kind of collision, a splat between two ultradense stars, yields a pulse of optical light, x-rays and gamma rays.

The discovery filled a gap in the classic work of BBFH. The authors had explained the genesis of many of the elements in space but were kamagra preis flummoxed by the forging of gold. In the 1970s David N. Schramm and his colleagues had speculated that the exotic nuclear processes involved in hypothetical mergers of pulsar stars might do the job—a theory that has since been validated. Despite the incredible progress in astronomy over the past 175 years, we have perhaps kamagra preis more questions now than we did back then.

Take dark matter. I am on record as having said more than 20 years ago that we would know dark matter's nature long before today. Although that kamagra preis prediction has proved wrong, I have not given up hope. Dark energy, however, is a different story. Dark energy entered the picture in 1998, when researchers measuring the distances and speeds of supernovae found that the expansion of the universe was actually accelerating.

Gravitational attraction pulling galaxies toward one another seemed to be overwhelmed by a mysterious new force latent in empty kamagra preis space that pushes galaxies apart—a force that came to be known as dark energy. The mystery of dark energy has lingered—we still do not know what causes it or why it has the particular strength it does—and we probably will not understand it until we have a model for the graininess of space on a scale a billion billion times smaller than an atomic nucleus. Theorists working on string theory or loop quantum gravity are tackling this challenge, but the phenomenon seems so far from being accessible by any experiment that I am not expecting answers anytime soon. The upside, however, is that a theory kamagra preis that could account for the energy in the vacuum of space might also yield insights into the very beginning of our universe, when everything was so compressed and dense that quantum fluctuations could shake the entire cosmos. Which brings us to another major question facing us now.

How did it all begin?. What kamagra preis exactly set off the big bang that started our universe?. Did space undergo a period of extremely rapid early expansion called inflation, as many theorists believe?. And there is something else. Some models, such kamagra preis as eternal inflation, suggest that “our” big bang could be just one island of spacetime in a vast archipelago—one big bang among many.

If this hypothesis is true, different big bangs may cool down differently, leading to unique laws of physics in each case—a “multiverse” rather than a universe. Some physicists hate the multiverse concept because it means that we will never have neat explanations for the fundamental numbers that govern our physical laws, which may in this grander perspective be just environmental accidents. But our kamagra preis preferences are irrelevant to nature. About 10 years ago I was on a panel at Stanford University where we were asked by someone in the audience how much we would bet on the multiverse concept. I said that on a scale of betting my goldfish, my dog or my life, I was nearly at the dog level.

Andrei Linde, who had spent 25 years promoting eternal inflation, said kamagra preis he would almost bet his life. Later, on being told this, physicist Steven Weinberg said he would happily bet my dog and Linde's life. Linde, my dog and I will all be dead before the question is settled. But none of this should be kamagra preis dismissed as metaphysics. It is speculative science—exciting science.

And it may be true. And what kamagra preis will happen to this universe—or multiverse—of ours?. Long-range forecasts are seldom reliable, but the best and most conservative bet is that we have almost an eternity ahead with an ever colder and ever emptier cosmos. Galaxies will accelerate away and disappear. All that will be left from our vantage point will be the remnants kamagra preis of the Milky Way, Andromeda and smaller neighbors.

Protons may decay, dark matter particles may be annihilated, there may be occasional flashes when black holes evaporate—and then silence. This possible future is based on the assumption that the dark energy stays constant. If it decays, however, there could be a “big crunch” with the universe kamagra preis contracting in on itself. Or if dark energy strengthens, there would be a “big rip” when galaxies, stars and even atoms are torn apart. Other questions closer to home tantalize us.

Could there be life on any of these new planets we are discovering? kamagra preis. Here we are still in the realm of speculation. But unless the origin of life on Earth involved a rare fluke, I expect evidence of a biosphere on an exoplanet within 20 years. I will not hold my breath for the discovery of aliens, but I kamagra preis think the search for extraterrestrial intelligence is a worthwhile gamble. Success in the search would carry the momentous message that concepts of logic and physics are not limited to the hardware in human skulls.

Until now, progress in cosmology and astrophysics has owed 95 percent to advancing instruments and technology and less than 5 percent to armchair theory. I expect kamagra preis that balance to persist. What Hubble wrote in the 1930s remains a good maxim today. €œNot until the empirical resources are exhausted, need we pass on to the dreamy realms of speculation.” There have been many particularly exhilarating eras in the past 175 years—the 1920s and 1930s, when we realized the universe was not limited to the Milky Way, and the 1960s and 1970s, when we discovered objects that defy classical physics, such as neutron stars and quasars, and clues about the beginning of time from the cosmic microwave background. Since then, the pace of advancement has kamagra preis crescendoed rather than slackened.

When the history of science gets written, this amazing progress will be acclaimed as one of its greatest triumphs—up there with plate tectonics, the genome and the Standard Model of particle physics. And some major fields in astronomy are just getting going. Exoplanet research is only 25 years old, kamagra preis and serious work in astrobiology is really only starting. Some exoplanets may have life—they may even harbor aliens who know all the answers already. I find that encouraging.

Credit kamagra preis. Moritz Stefaner and Christian LässerFor more context, see “Visualizing 175 Years of Words in Scientific American”Fully functional quantum computers and a new quantum industry may appear much sooner than many have anticipated—thanks to five new National Quantum Information Science Research centers just announced by the U.S. Department of Energy. This latest development in the recently launched National Quantum Initiative Act, signed kamagra preis into law in December 2018, comes with $625 million in funding over five years. It’s a huge deal.

For the first time, researchers from academia, U.S. National labs and industry will be working side by side aiming to speed up the fundamental kamagra preis quantum information science research. And more research should bring us closer to advanced quantum technologies and the grandest goal of quantum information science, creating a fault-tolerant quantum computer that can indefinitely compute without errors. Why do we need quantum computers?. We need them to speed up the process of scientific discovery kamagra preis so that we can address some our greatest global challenges, from designing new materials for more efficient carbon capture plants and batteries to better drugs and vaccines.

Traditionally, material design has depended a lot on either happy accidents or a long and tedious iterative process of experimentation. Over the past half a century, classical computers have greatly accelerated this process by performing molecular simulations. Still, classical computers can’t simulate complex molecules with enough accuracy, and that’s kamagra preis where quantum computing will be able to help. Quantum computers rely on the same physical rules as atoms to manipulate information. Just like traditional, classical, computers execute logical circuits to run software programs, quantum computers use the physics phenomena of superposition, entanglement and interference to execute quantum circuits.

One day soon, they should be able to perform mathematical kamagra preis calculations out of the reach of the most advanced current and future classical supercomputers. But to get there, we will need to build quantum machines that compute without errors. Quantum computers rely on fragile qubits, short for quantum bits, which are only of use when they are in a delicate quantum state. Any external disturbances or “noise,” such as heat, light or vibrations, inevitably yanks these qubits out of kamagra preis their quantum state and turns them into regular bits. Overcoming this hurdle is beyond the limits of a single team, and we need scores of scientists from academia, the national labs and industry to get us there.

This is where the new centers come in. At last, they will get the kamagra preis talent from all our R&D sectors to work together on quantum-related issues. Take the problem of building a quantum system that would compute without errors. Our best theories estimate that to get there, we should build machines with tens of millions of qubits on a single cooled-down chip. But we don’t want to cool down quantum kamagra preis chips the size of football fields.

To avoid it, we need many breakthroughs—meaning we have to invest in research at scale. Luckily, some of the latest results show that it’s possible to reduce the number of qubits we need to implement error-correcting codes. But even if we achieve this, we will have to overcome kamagra preis another hurdle. Linking quantum processors, just like we connect today’s computer chips inside data centers using intranets. This requires quantum interconnects that transfer the fragile quantum information stored in the processor’s qubits into a different quantum format (say, photons) that “communicate” the data to another processor.

Advances in this space must unite disparate technologies like superconducting qubits and fiber optics, while solving outstanding challenges in materials science and quantum communications. Research teams could probably solve these problems, and many other challenges the quantum information science community is tackling, individually. But it would take decades, and we can’t afford to wait this long. Partnerships and collaboration, through the new centers, will offer us the chance of making the quantum leap we need. With a long-term vision of establishing a robust national quantum ecosystem, academia, national labs and industry partners at last have a quantum roadmap.

Now it’s up to all the partners in this joint effort to create a quantum ecosystem and industry.

Headlines popped up spreading the kamagra for sale uk browse around this site news, sparking conversations far and wide and forcing many to reconsider their preferred style of face mask. A Washington Post story said “some cotton cloth masks are about as effective as surgical masks, while thin polyester spandex gaiters may be worse than going maskless.” A Forbes article, referring to neck gaiters, said the study “found that one type of face covering might actually be doing more harm than good.” But the study didn’t show that, nor was it designed to. It was actually a test on how to test masks inexpensively, not to determine which one was most effective.

The researchers set up a kamagra for sale uk green laser beam in a dark room. A masked subject was then asked to speak so that the droplets from the speaker’s mouth showed up in the green beam. The whole process was video recorded on a cell phone, after which researchers calculated the number of droplets that showed up.

The process kamagra for sale uk was repeated 10 times for each mask (14 in total, one of which was a neck gaiter) and the setup cost less than $200. What was meant as a study on the pricing and efficacy of a test turned into, at least in some journalistic circles, a definitive nail-in-the-coffin for gaiters. Days after the initial reports that neck gaiters might not only be useless but maybe even harmful, a new round of new reports came out saying that those initial reports were overblown and misleading.

The authors of the study even held a press conference where they emphasized that their study was kamagra for sale uk never meant to test the effectiveness of masks. They only tested one gaiter-style mask, which says nothing about that style of mask in general. The combination of reporting on the actual findings of the study and the direct comments from the authors seems to have abated the anti-neck gaiter fervor.

But all of this this—or most of kamagra for sale uk it, anyway—likely could have been prevented. You could make the argument that it’s not a scientist’s job to worrying about how their science might be interpreted. It’s their job to do the research and publish it in a scientific manuscript.

Leave the communicating for kamagra for sale uk someone else. But that’s not how the spread of information works. Fewer and fewer newsrooms have staffers with scientific backgrounds, or who are dedicated to scientific reporting.

To be clear, journalists don’t need to be scientists to understand science, but reporting on science does require a certain amount of kamagra for sale uk expertise. When newsrooms ask reporters to cover more and more topic areas and this specialization decreases, an attention to detail is sometimes lost. So, the onus to help journalists (and frankly, all nonscientists) get the facts straight falls to the scientists doing the science.

That’s where science communication training kamagra for sale uk comes in. Science communication, or scicomm as it’s known colloquially, is not a core part of coursework in a majority of degree-granting science programs at the undergraduate and graduate levels. This trend is slowly changing as more institutions incorporate scicomm into their curriculums.

Outside of kamagra for sale uk academia, nonprofits and scientific societies are taking up the mantle. I work for the American Geophysical Union (AGU), a society for Earth and space scientists, in the Sharing Science program, where we teach scientists to communicate with nonscientists through courses, workshops, webinars and other trainings. Aside from the AGU, there is the American Association for the Advancement of Science (AAAS), the Stony Brook–affiliated Alan Alda Center for Communicating Science and the science storytelling organization The Story Collider, to name just to name a few.

We teach the so-called “soft skills” that the ivory tower of science has shunned kamagra for sale uk for so long but that are so necessary in effectively communicating. One thing we stress is “know your audience.” Scientists must think about how their science will be perceived, no matter how relevant or not it might be to the broader public. Science does not exist in a vacuum.

It never kamagra for sale uk has. But especially now, and especially with anything related to COVID-19, scientists much be hypervigilant when communicating results and try, to the best of their abilities, to account for as many interpretations as possible. Yes, it is onerous, especially on top of the multitude of other responsibilities that come with being a scientist, but it is necessary.

The traditional ways in which scientists communicate their results (i.e., scientific manuscripts) are not going away anytime soon kamagra for sale uk. However, and while it may be an unfair ask, scientists must not only be able to communicate their science to their peers. They must always think about nonscience audiences as the lines between science and “the public” continue to blur.

Training scientists to effectively communicate to, or at least think about, diverse audiences is a necessary part of science.In 1835 French philosopher Auguste Comte asserted that nobody would ever know kamagra for sale uk what the stars were made of. €œWe understand the possibility of determining their shapes, their distances, their sizes and their movements,” he wrote, “whereas we would never know how to study by any means their chemical composition, or their mineralogical structure, and, even more so, the nature of any organized beings that might live on their surface.” Comte would be stunned by the discoveries made since then. Today we know that the universe is far bigger and stranger than anyone suspected.

Not only does it extend beyond the Milky Way to untold numbers of other galaxies—this would come as a surprise to astronomers of the 19th and early 20th century to whom our kamagra for sale uk galaxy was “the universe”—but it is expanding faster every day. Now we can confidently trace cosmic history back 13.8 billion years to a moment only a billionth of a second after the big bang. Astronomers have pinned down our universe's expansion rate, the mean density of its main constituents, and other key numbers to a precision of 1 or 2 percent.

They have also worked out new laws of physics governing space—general relativity and quantum mechanics—that turn out to be much more outlandish than the classical laws people understood before kamagra for sale uk. These laws in turn predicted cosmic oddities such as black holes, neutron stars and gravitational waves. The story of how we gained this knowledge is full of accidental discoveries, stunning surprises and dogged scientists pursuing goals others thought unreachable.

Our first hint of the true nature of kamagra for sale uk stars came in 1860, when Gustav Kirchhoff recognized that the dark lines in the spectrum of light coming from the sun were caused by different elements absorbing specific wavelengths. Astronomers analyzed similar features in the light of other bright stars and discovered that they were made of the same materials found on Earth—not of some mysterious “fifth essence” as the ancients had believed. But it took longer to understand what fuel made the stars shine.

Lord Kelvin (William Thomson) calculated that if stars derived their power just from gravity, slowly deflating as their radiation leaked out, then the sun's age was 20 million to 40 million years—far less time than kamagra for sale uk Charles Darwin or the geologists of the time inferred had elapsed on Earth. In his last paper on the subject, in 1908, Kelvin inserted an escape clause stating that he would stick by his estimate “unless there were some other energy source laid up in the storehouse of creation.” That source, it turned out, is nuclear fusion—the process by which atomic nuclei join to create a larger nucleus and release energy. In 1925 astrophysicist Cecilia Payne-Gaposchkin used the light spectra of stars to calculate their chemical abundances and found that, unlike Earth, they were made mainly of hydrogen and helium.

She revealed her conclusions in what astronomer kamagra for sale uk Otto Struve described as “the most brilliant Ph.D. Thesis ever written in astronomy.” A decade later physicist Hans Bethe showed that the fusion of hydrogen nuclei into helium was the main power source in ordinary stars. What is the source of the sun's power?.

The kamagra for sale uk answer—fusion—came in 1938. Credit. SOHO (ESA and NASA) At the same time stars were becoming less mysterious, so, too, was the nature of fuzzy “nebulae” becoming clearer.

In a “great debate” held before the National Academy of Sciences in Washington, D.C., on April 26, 1920, Harlow Shapley maintained that our Milky Way was preeminent and that kamagra for sale uk all the nebulae were part of it. In contrast, Heber Curtis argued that some of the fuzzy objects in the sky were separate galaxies—“island universes”—fully the equal of our Milky Way. The conflict was settled not that night but just a few years later, in 1924, when Edwin Hubble measured the distances to many nebulae and proved they were beyond the reaches of the Milky Way.

His evidence came from Cepheids, variable stars in the nebulae that reveal their true brightness, and thus their distance, by their pulsation period—a relation discovered kamagra for sale uk by Henrietta Swan Leavitt. Soon after Hubble realized that the universe was bigger than many had thought, he found that it was still growing. In 1929 he discovered that spectral features in the starlight from distant galaxies appeared redder—that is, they had longer wavelengths—than the same features in nearby stars.

If this effect was interpreted kamagra for sale uk as a Doppler shift—the natural spreading of waves as they recede—it would imply that other galaxies were moving away from one another and from us. Indeed, the farther away they were, the faster their recession seemed to be. This was the first clue that our cosmos was not static but was expanding all the time.

The universe also appeared to contain much that we kamagra for sale uk could not see. In 1933 Fritz Zwicky estimated the mass of all the stars in the Coma cluster of galaxies and found that they make up only about 1 percent of the mass necessary to keep the cluster from flying apart. The discrepancy was dubbed “the missing mass problem,” but many scientists at the time doubted Zwicky's suggestion that hidden matter might be to blame.

The question remained kamagra for sale uk divisive until the 1970s, when work by Vera Rubin and W. Kent Ford (observing stars) and by Morton Roberts and Robert Whitehurst (making radio observations) showed that the outer parts of galactic disks would also fly apart unless they were subject to a stronger gravitational pull than stars and gas alone could provide. Finally, most astronomers were compelled to accept that some kind of “dark matter” must be present.

€œWe have peered into a new world,” Rubin wrote, “and have seen that it is more mysterious and more complex than we had imagined.” Scientists now believe kamagra for sale uk that dark matter outnumbers visible matter by about a factor of five, yet we are hardly closer than we were in the 1930s to figuring out what it is. Gravity, the force that revealed all that dark matter, has proved to be nearly as baffling. A pivotal moment came in 1915 when Albert Einstein published his general theory of relativity, which transcended Isaac Newton's mechanics and revealed that gravity is actually the deformation of the fabric of space and time.

This new theory kamagra for sale uk was slow to take hold. Even after it was shown to be correct by observations of a 1919 solar eclipse, many dismissed the theory as an interesting quirk—after all, Newton's laws were still good enough for calculating most things. €œThe discoveries, while very important, did not, however, affect anything on this earth,” astronomer W.J.S.

Lockyer told kamagra for sale uk the New York Times after the eclipse. For almost half a century after it was proposed, general relativity was sidelined from the mainstream of physics. Then, beginning in the 1960s, astronomers started discovering new and extreme phenomena that only Einstein's ideas could explain.

One example lurks in the kamagra for sale uk Crab Nebula, one of the best-known objects in the sky, which is composed of the expanding debris from a supernova witnessed by Chinese astronomers in a.d. 1054. Since it appeared, the nebula has kept on shining blue and bright—but how?.

Its light source was a longtime puzzle, but the kamagra for sale uk answer came in 1968, when the dim star at its center was revealed to be anything but normal. It was actually an ultracompact neutron star, heavier than the sun but only a few miles in radius and spinning at 30 revolutions per second. €œThis was a totally unexpected, totally new kind of object behaving in a way that astronomers had never expected, never dreamt of,” said Jocelyn Bell Burnell, one of the discoverers of the phenomenon.

The star's excessive spin sends out kamagra for sale uk a wind of fast electrons that generate the blue light. The gravitational force at the surface of such an incredibly dense object falls way outside of Newton's purview—a rocket would need to be fired at half the speed of light to escape its pull. Here the relativistic effects predicted by Einstein must be taken into account.

Thousands of such spinning neutron stars—called pulsars—have kamagra for sale uk been discovered. All are believed to be remnants of the cores of stars that exploded as supernovae, offering an ideal laboratory for studying the laws of nature under extreme conditions. The most exotic result of Einstein's theory was the concept of black holes—objects that have collapsed so far that not even light can escape their gravitational pull.

For decades these were only conjecture, and Einstein wrote in 1939 that they “do kamagra for sale uk not exist in physical reality.” But in 1963 astronomers discovered quasars. Mysterious, hyperluminous beacons in the centers of some galaxies. More than a decade passed before a consensus emerged that this intense brightness was generated by gas swirling into huge black holes lurking in the galaxies' cores.

It was the strongest evidence kamagra for sale uk yet that these bizarre predictions of general relativity actually exist. When did the universe begin?. Did it even have a beginning?.

Astronomers had long debated these questions when, in the middle of the 20th century, two competing theories proposed very different kamagra for sale uk answers. The “hot big bang” model said the cosmos began extremely small, hot and dense and then cooled and spread out over time. The “steady state” hypothesis held that the universe had essentially existed in the same form forever.

The contest was settled by kamagra for sale uk a serendipitous discovery. In 1965 radio astronomers Arno Penzias and Robert Wilson were trying to calibrate a new antenna at Bell Labs in New Jersey. They had a problem.

No matter what they kamagra for sale uk did to reduce background interference, they measured a consistent level of noise in every direction. They even evicted a family of pigeons that had been nesting in the antenna in the hope that they were the source of the problem. But the signal persisted.

They had discovered that kamagra for sale uk intergalactic space is not completely cold. Instead it is warmed to nearly three kelvins (just above absolute zero) by weak microwaves. Penzias and Wilson had accidentally uncovered the “afterglow of creation”—the cooled and diluted relic of an era when everything in the universe was squeezed until it was hot and dense.

The finding tipped the balance firmly in favor of the big bang picture kamagra for sale uk of cosmology. According to the model, during the earliest, hottest epochs of time, the universe was opaque, rather like the inside of a star, and light was repeatedly scattered by electrons. When the temperature fell to 3,000 kelvins, however, the electrons slowed down enough to be captured by protons and created neutral atoms.

Thereafter light kamagra for sale uk could travel freely. The Bell Labs signal was this ancient light, first released about 300,000 years after the birth of the universe and still pervading the cosmos—what we call the cosmic microwave background. It took a while for the magnitude of the discovery to sink in for the scientists who made it.

€œWe were very pleased kamagra for sale uk to have a possible explanation [for the antenna noise], but I don't think either of us really took the cosmology very seriously at first,” Wilson says. €œWalter Sullivan wrote a first-page article in the New York Times about it, and I began to think at that point that, you know, maybe I better start taking this cosmology seriously.” Measurements of this radiation have since enabled scientists to understand how galaxies emerged. Precise observations of the microwaves reveal that they are not completely uniform over the sky.

Some patches are slightly hotter, kamagra for sale uk others slightly cooler. The amplitude of these fluctuations is only one part in 100,000, but they are the seeds of today's cosmic structure. Any region of the expanding universe that started off slightly denser than average expanded less because it was subjected to extra gravity.

Its growth lagged further and further, the contrast between kamagra for sale uk its density and that of its surroundings becoming greater and greater. Eventually these clumps were dense enough that gas was pulled in and compressed into stars, forming galaxies. The crucial point is this.

Computer models that simulate this process are fed the initial fluctuations measured kamagra for sale uk in the cosmic microwave background, which represent the universe when it was 300,000 years old. The output after 13.8 billion years of virtual time have elapsed is a cosmos where galaxies resemble those we see, clustered as they are in the actual universe. This is a real triumph.

We understand, at least in outline, 99.998 percent kamagra for sale uk of cosmic history. It is not only the big cosmic picture that we have come to understand http://sw.keimfarben.de/kamagra-street-price/. A series of discoveries has also revealed the history of the elemental building blocks that make up stars, planets and even our own bodies.

Starting in the 1950s, progress in atomic physics kamagra for sale uk led to accurate modeling of stars' surface layers. Simultaneously, detailed knowledge of the nuclei not just of hydrogen and helium atoms but also of the rest of the elements allowed scientists to calculate which nuclear reactions dominate at different stages in a star's life. Astronomers came to understand how nuclear fusion creates an onion-skin structure in massive stars as atoms successively fuse to build heavier and heavier elements, ending with iron in the innermost, hottest layer.

Inside the Crab Nebula kamagra for sale uk is a neutron star. Classical physics fails, and relativity applies. Credit.

NASA, ESA and Hubble Heritage Team (STSCI and AURA) Astronomers also learned how stars die when they exhaust their hydrogen fuel and blow off kamagra for sale uk their outer gaseous layers. Lighter stars then settle down to a quiet demise as dense, dim objects called white dwarfs, but heavier stars shed more of their mass, either in winds during their lives or in an explosive death via supernova. This expelled mass turns out to be crucial to our own existence.

It mixes into the interstellar medium and recondenses kamagra for sale uk into new stars orbited by planets such as Earth. The concept was conceived by Fred Hoyle, who developed it during the 1950s along with two other British astronomers, Margaret Burbidge and Geoffrey Burbidge, and American nuclear physicist William Fowler. In their classic 1957 paper in Reviews of Modern Physics (known by the initials of its authors as BBFH), they analyzed the networks of the nuclear reactions involved and discovered how most atoms in the periodic table came to exist.

They calculated kamagra for sale uk why oxygen and carbon, for instance, are common, whereas gold and uranium are rare. Our galaxy, it turns out, is a huge ecological system where gas is being recycled through successive generations of stars. Each of us contains atoms forged in dozens of different stars spread across the Milky Way that lived and died more than 4.5 billion years ago.

Scientists long assumed this kamagra for sale uk process was seeding planets—and possibly even life—around stars other than our own sun. But we did not know for sure whether planets existed outside our solar system until the 1990s, when astronomers developed clever methods for identifying worlds that are too dim for us to see directly. One technique looks for tiny periodic changes in a star's movement caused by the gravitational pull of a planet orbiting it.

In 1995 Michel Mayor and Didier Queloz used this strategy to detect 51 Pegasi b, the first known exoplanet kamagra for sale uk orbiting a sunlike star. The technique can reveal a planet's mass, the length of its “year” and the shape of its orbit. So far more than 800 exoplanets have been found this way.

A second technique kamagra for sale uk works better for smaller planets. A star dims slightly when a planet transits in front of it. An Earth-like planet passing a sunlike star can cause a dimming of about one part in 10,000 once per orbit.

The Kepler spacecraft launched in kamagra for sale uk 2009 found more than 2,000 planets this way, many no bigger than Earth. A big surprise to come from astronomers' success in planet hunting was the variety of different planets out there—many much larger and closer to their stars than the bodies in our solar system—suggesting that our cosmic neighborhood may be somewhat special. By this point scientists understood where almost all the elements that form planets, stars and galaxies originated.

The final piece in this puzzle, however, arrived very kamagra for sale uk recently and from a seemingly unrelated inquiry. General relativity had predicted a phenomenon called gravitational waves—ripples in spacetime produced by the movement of massive objects. Despite decades of searching for them, however, no waves were seen—until September 2015.

That was when the Laser Interferometer Gravitational-wave Observatory (LIGO) detected the first evidence of gravitational waves in the form of a “chirp”—a minute shaking of spacetime that kamagra for sale uk speeds up and then dies away. In this case, it was caused by two black holes in a binary system that had started out orbiting each other but gradually spiraled together and eventually converged into a single massive hole. The crash occurred more than a billion light-years away.

LIGO's detectors consist of mirrors four kilometers apart whose separation is kamagra for sale uk measured by laser beams that reflect light back and forth between them. A passing gravitational wave causes the space between the two mirrors to jitter by an amount millions of times as small as the diameter of a single atom—LIGO is indeed an amazing feat of precision engineering and perseverance. Since that first find, more than a dozen similar events have been detected, opening up a new field that probes the dynamics of space itself.

One event was of special astrophysical interest because it kamagra for sale uk signaled the merger of two pulsars. Unlike black hole mergers, this kind of collision, a splat between two ultradense stars, yields a pulse of optical light, x-rays and gamma rays. The discovery filled a gap in the classic work of BBFH.

The authors had kamagra for sale uk explained the genesis of many of the elements in space but were flummoxed by the forging of gold. In the 1970s David N. Schramm and his colleagues had speculated that the exotic nuclear processes involved in hypothetical mergers of pulsar stars might do the job—a theory that has since been validated.

Despite the incredible progress in astronomy over the past kamagra for sale uk 175 years, we have perhaps more questions now than we did back then. Take dark matter. I am on record as having said more than 20 years ago that we would know dark matter's nature long before today.

Although that prediction has kamagra for sale uk proved wrong, I have not given up hope. Dark energy, however, is a different story. Dark energy entered the picture in 1998, when researchers measuring the distances and speeds of supernovae found that the expansion of the universe was actually accelerating.

Gravitational attraction pulling galaxies toward one another seemed to be kamagra for sale uk overwhelmed by a mysterious new force latent in empty space that pushes galaxies apart—a force that came to be known as dark energy. The mystery of dark energy has lingered—we still do not know what causes it or why it has the particular strength it does—and we probably will not understand it until we have a model for the graininess of space on a scale a billion billion times smaller than an atomic nucleus. Theorists working on string theory or loop quantum gravity are tackling this challenge, but the phenomenon seems so far from being accessible by any experiment that I am not expecting answers anytime soon.

The upside, however, is that a theory that could account for the energy in the vacuum of space might also yield insights into the very beginning of our universe, when everything was so compressed and dense that quantum fluctuations could shake the entire kamagra for sale uk cosmos. Which brings us to another major question facing us now. How did it all begin?.

What exactly set kamagra for sale uk off the big bang that started our universe?. Did space undergo a period of extremely rapid early expansion called inflation, as many theorists believe?. And there is something else.

Some models, such as eternal inflation, suggest that “our” big bang could be just one island kamagra for sale uk of spacetime in a vast archipelago—one big bang among many. If this hypothesis is true, different big bangs may cool down differently, leading to unique laws of physics in each case—a “multiverse” rather than a universe. Some physicists hate the multiverse concept because it means that we will never have neat explanations for the fundamental numbers that govern our physical laws, which may in this grander perspective be just environmental accidents.

But our kamagra for sale uk preferences are irrelevant to nature. About 10 years ago I was on a panel at Stanford University where we were asked by someone in the audience how much we would bet on the multiverse concept. I said that on a scale of betting my goldfish, my dog or my life, I was nearly at the dog level.

Andrei Linde, who had spent 25 years promoting eternal inflation, said kamagra for sale uk he would almost bet his life. Later, on being told this, physicist Steven Weinberg said he would happily bet my dog and Linde's life. Linde, my dog and I will all be dead before the question is settled.

But none of this should be kamagra for sale uk dismissed as metaphysics. It is speculative science—exciting science. And it may be true.

And what will happen to this universe—or multiverse—of kamagra for sale uk ours?. Long-range forecasts are seldom reliable, but the best and most conservative bet is that we have almost an eternity ahead with an ever colder and ever emptier cosmos. Galaxies will accelerate away and disappear.

All that will be left from our vantage point will be kamagra for sale uk the remnants of the Milky Way, Andromeda and smaller neighbors. Protons may decay, dark matter particles may be annihilated, there may be occasional flashes when black holes evaporate—and then silence. This possible future is based on the assumption that the dark energy stays constant.

If it decays, however, there could be a “big crunch” with the universe contracting in kamagra for sale uk on itself. Or if dark energy strengthens, there would be a “big rip” when galaxies, stars and even atoms are torn apart. Other questions closer to home tantalize us.

Could there be life on any of these new planets we are kamagra for sale uk discovering?. Here we are still in the realm of speculation. But unless the origin of life on Earth involved a rare fluke, I expect evidence of a biosphere on an exoplanet within 20 years.

I will kamagra for sale uk not hold my breath for the discovery of aliens, but I think the search for extraterrestrial intelligence is a worthwhile gamble. Success in the search would carry the momentous message that concepts of logic and physics are not limited to the hardware in human skulls. Until now, progress in cosmology and astrophysics has owed 95 percent to advancing instruments and technology and less than 5 percent to armchair theory.

I expect kamagra for sale uk that balance to persist. What Hubble wrote in the 1930s remains a good maxim today. €œNot until the empirical resources are exhausted, need we pass on to the dreamy realms of speculation.” There have been many particularly exhilarating eras in the past 175 years—the 1920s and 1930s, when we realized the universe was not limited to the Milky Way, and the 1960s and 1970s, when we discovered objects that defy classical physics, such as neutron stars and quasars, and clues about the beginning of time from the cosmic microwave background.

Since then, the pace kamagra for sale uk of advancement has crescendoed rather than slackened. When the history of science gets written, this amazing progress will be acclaimed as one of its greatest triumphs—up there with plate tectonics, the genome and the Standard Model of particle physics. And some major fields in astronomy are just getting going.

Exoplanet research is only 25 years old, and serious work in astrobiology is kamagra for sale uk really only starting. Some exoplanets may have life—they may even harbor aliens who know all the answers already. I find that encouraging.

Credit kamagra for sale uk. Moritz Stefaner and Christian LässerFor more context, see “Visualizing 175 Years of Words in Scientific American”Fully functional quantum computers and a new quantum industry may appear much sooner than many have anticipated—thanks to five new National Quantum Information Science Research centers just announced by the U.S. Department of Energy.

This latest development in the recently launched National Quantum Initiative Act, signed into law in December 2018, comes with $625 million kamagra for sale uk in funding over five years. It’s a huge deal. For the first time, researchers from academia, U.S.

National labs and industry will be working side by side aiming to speed kamagra for sale uk up the fundamental quantum information science research. And more research should bring us closer to advanced quantum technologies and the grandest goal of quantum information science, creating a fault-tolerant quantum computer that can indefinitely compute without errors. Why do we need quantum computers?.

We need them to speed kamagra for sale uk up the process of scientific discovery so that we can address some our greatest global challenges, from designing new materials for more efficient carbon capture plants and batteries to better drugs and vaccines. Traditionally, material design has depended a lot on either happy accidents or a long and tedious iterative process of experimentation. Over the past half a century, classical computers have greatly accelerated this process by performing molecular simulations.

Still, classical computers can’t simulate complex molecules with enough accuracy, and that’s where quantum computing will be able kamagra for sale uk to help. Quantum computers rely on the same physical rules as atoms to manipulate information. Just like traditional, classical, computers execute logical circuits to run software programs, quantum computers use the physics phenomena of superposition, entanglement and interference to execute quantum circuits.

One day soon, they should be able to perform mathematical calculations out of the reach of the most advanced current kamagra for sale uk and future classical supercomputers. But to get there, we will need to build quantum machines that compute without errors. Quantum computers rely on fragile qubits, short for quantum bits, which are only of use when they are in a delicate quantum state.

Any external disturbances or “noise,” such as heat, light or vibrations, inevitably yanks these qubits out of their quantum state and turns them into regular kamagra for sale uk bits. Overcoming this hurdle is beyond the limits of a single team, and we need scores of scientists from academia, the national labs and industry to get us there. This is where the new centers come in.

At last, they kamagra for sale uk will get the talent from all our R&D sectors to work together on quantum-related issues. Take the problem of building a quantum system that would compute without errors. Our best theories estimate that to get there, we should build machines with tens of millions of qubits on a single cooled-down chip.

But we kamagra for sale uk don’t want to cool down quantum chips the size of football fields. To avoid it, we need many breakthroughs—meaning we have to invest in research at scale. Luckily, some of the latest results show that it’s possible to reduce the number of qubits we need to implement error-correcting codes.

But even if we achieve this, we kamagra for sale uk will have to overcome another hurdle. Linking quantum processors, just like we connect today’s computer chips inside data centers using intranets. This requires quantum interconnects that transfer the fragile quantum information stored in the processor’s qubits into a different quantum format (say, photons) that “communicate” the data to another processor.

Advances in this space must unite disparate technologies like superconducting qubits and fiber optics, while solving outstanding challenges in materials science and quantum kamagra for sale uk communications. Research teams could probably solve these problems, and many other challenges the quantum information science community is tackling, individually. But it would take decades, and we can’t afford to wait this long.

Partnerships and collaboration, through the new centers, will offer us the kamagra for sale uk chance of making the quantum leap we need. With a long-term vision of establishing a robust national quantum ecosystem, academia, national labs and industry partners at last have a quantum roadmap. Now it’s up to all the partners in this joint effort to create a quantum ecosystem and industry.

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HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that it has completed its seventh annual and first ever virtual Healthcare Analytics Summit (HAS), with record registration of more than 3,500 attendees. Keynotes included sildamax and kamagra Dr. Amy Abernethy, Principal Deputy Commissioner and Acting CIO of the U.S.

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DOS will further enhance the analytics insights made available by Vitalware's technology by combining charge and revenue data with claims, cost, and quality data. Vitalware's flagship offering is a Best in KLAS chargemaster management solution that delivers results for the complex regulatory and compliance functions needed by all healthcare provider systems. "As announced on August 11, 2020, we entered into an acquisition agreement sildamax and kamagra to acquire Vitalware and expected to close the acquisition in Q3 or Q4 of 2020.

We are pleased to announce that we closed the acquisition on September 1, 2020. We are thrilled to formalize the combination of our solutions for the benefit of our customers and the industry," said CEO Dan Burton sildamax and kamagra. On its upcoming Q3 2020 earnings call, Health Catalyst will share the impact of Vitalware on its Q3 2020 financial performance, which will not be significant given the timing of the acquisition, as well as update its full year 2020 guidance to include the impact of Vitalware.

Health Catalyst Co-Founder Steve Barlow has returned from his three-year full-time volunteer mission for the Church of Jesus Christ of Latter-Day Saints, having served as Mission President sildamax and kamagra of the Ecuador Quito Mission. He has rejoined Health Catalyst's companywide Leadership Team as a Senior Vice President, responsible for some of the company's largest customer relationships. Dan Burton said, "We couldn't be more excited sildamax and kamagra about Steve's return to Health Catalyst.

His energy, dedication and commitment to transforming healthcare launched our journey and will continue to make us better and stronger. Steve is leading and sildamax and kamagra overseeing all aspects of our partnerships with some of our largest and longest-standing customers. Steve's extraordinary experience and capability enable him to be a critical partner and leader in enabling these customers' continued improvement and success." "My experience over the past three years in Ecuador reinforced for me how fortunate I am to be in a country with high-quality healthcare," said Barlow.

"It has been invigorating to return to Health Catalyst and witness the incredible growth and expansion that has occurred over the past few years. We are better positioned than ever before sildamax and kamagra to achieve our mission of being the catalyst for massive, measurable, data-informed healthcare improvement. I am grateful to be reunited with our longstanding team members and customers, and I'm thrilled to get to know and work alongside our new customers and teammates in this critical work." Effective October 1, 2020, Chief Technology Officer Dale Sanders will be transitioning to a Senior Advisor role with Health Catalyst, and the company is pleased to announce that one of Dale's longtime protégés and colleagues, Bryan Hinton, will serve as Health Catalyst's next Chief Technology Officer.

Hinton joined sildamax and kamagra Health Catalyst in 2012 and currently serves as the Senior Vice President and General Manager of the DOS Platform Business. He will continue to lead this business in addition to assuming the responsibilities of CTO. He has been instrumental in the development and integration of DOS and has been working directly with Dale and other technology leaders at Health Catalyst for sildamax and kamagra many years.

His experience prior to joining Health Catalyst includes four years with the .NET Development Center of Excellence at The Church of Jesus Christ of Latter-Day Saints, where he established the architectural guidance of all .NET projects. Previously, at sildamax and kamagra Intel, he was responsible for the development and implementation of Intel's factory data warehouse product installed at Intel global factories. Hinton graduated from Brigham Young University with a BS in Computer Science.

"Dale has been central to Health Catalyst's growth and success and we are grateful to him for his many years of service to our company and to the broader healthcare industry," said Dan Burton, CEO of Health Catalyst. "Thanks to Dale's vision, passion, innovative thinking sildamax and kamagra and broad-based industry experience and perspective, Health Catalyst has grown from a handful of clients to a large number of organizations relying on us as their digital transformation partner, helping the healthcare ecosystem to constantly learn and improve. Dale's technology leadership was critical to the company's overall maturation, and I am convinced that we could not have grown and scaled as we have without Dale's foundational leadership and contributions.

We are grateful to continue our association with Dale in sildamax and kamagra the months and years ahead in his next role as a Senior Advisor to the company." Burton added, "We are thrilled to see Bryan Hinton take on this added role after having demonstrated his technology leadership prowess during the course of his tenure at Health Catalyst and having been mentored by Dale for many years. Bryan is well-prepared and ready for this additional responsibility, and we extend our congratulations to him." "I feel like a parent saying goodbye to my kids at their college graduation," said Dale Sanders. "Many of sildamax and kamagra the concepts we first developed and applied over 20 years ago at Intermountain and then later refined during my tenure as CIO at Northwestern had a big influence on our technology and products at Health Catalyst.

The vision of the Data Operating System and its application ecosystem originated in the real-world healthcare operations and research trenches of Northwestern. At Health Catalyst, I had the sildamax and kamagra wonderful opportunity to lead the teams who made that vision a reality for the benefit of the entire industry. None of it would have been possible without Bryan Hinton leading the DOS team and Eric Just and Dan Unger leading the application development teams.

We've been working side-by-side for sildamax and kamagra many years to make the vision real. Bryan is the consummate modern CTO from outside of healthcare that healthcare needs. I've always described Eric as having a manufacturing engineer's mindset with a healthcare data and software engineer's skills, with Dan Unger leveraging his deep domain expertise in financial transformation to oversee the development of meaningful applications and solutions so relevant for CFOs.

I'm honored and thrilled to step aside and turn the future over to their very capable hands sildamax and kamagra. Under their leadership, the best is yet to come for Health Catalyst's technology." About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations, and is committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional sildamax and kamagra services expertise to make data-informed decisions and realize measurable clinical, financial and operational improvements.

Health Catalyst envisions a future in which all healthcare decisions are data informed.Health Catalyst Media Contact:Kristen BerrySenior Vice President, Public Relations+1 (617) 234-4123HealthCatalyst@we-worldwide.com View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-completes-hosting-of-the-largest-ever-healthcare-analytics-summit-and-announces-the-close-of-the-vitalware-acquisition-301125125.htmlSOURCE Health CatalystNEW YORK and SALT LAKE CITY, Aug. 12, 2020 /PRNewswire/ sildamax and kamagra -- Northwell Health today joined Health Catalyst, Inc. ("Health Catalyst," Nasdaq.

HCAT), a leading sildamax and kamagra provider of data and analytics technology and services to healthcare organizations, in announcing a long-term strategic partnership to transform the quality of patient care by using data and analytics to better anticipate and respond to the evolving needs of patients, providers and payers in today's rapidly evolving healthcare ecosystem. In this partnership, Health Catalyst will provide solutions to allow for increased cloud-based reliance on data and analytics, while sharing insights and best practices from a decade of support to hundreds of other healthcare clients. This will accelerate greater efficiency in data mapping and data storage to/with the Electronic Medical Record (EMR) and the affordable emergence of an enterprise solution for meaningful and measurable clinical, financial and operational improvements.

The solutions will be used across the Northwell Health enterprise, which includes the Feinstein Institute sildamax and kamagra and Donald and Barbara Zucker School of Medicine at Hofstra. "Northwell Health's goal is a simple one that has not changed since our inception. Be better tomorrow than sildamax and kamagra we are today.

Partnering with Health Catalyst will allow us to accelerate the generation of critical insights for one of the world's most diverse patient populations which includes more than 11 million individuals who will potentially turn to us for care," said Michael Dowling, President and CEO of Northwell Health. "Health Catalyst's Augmented Intelligence (AI) and data science experience and expertise, sildamax and kamagra along with our shared cultural attributes and mission alignment, will allow us to use data-informed decision making to achieve our shared commitment of transforming healthcare for the communities we serve."Northwell Health is New York State's largest health care provider and private employer, with 23 hospitals, nearly 800 outpatient facilities and more than 18,500 affiliated physicians. More than 11,000 COVID-19 patients have received care from Northwell's 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners, and using 1,600 additional COVID-19 focused beds."We are honored to have the opportunity to join Northwell Health on its mission-driven journey to transform healthcare," said Dan Burton, CEO of Health Catalyst.

"We have deep respect for our Northwell sildamax and kamagra colleagues and are excited about combining our Solution with Northwell's team members' experience, knowledge and passion for improvement. We are also honored to have Northwell's CEO Michael Dowling as a keynote speaker at Health Catalyst's upcoming Healthcare Analytics Summit (HAS), where we'll hear his important perspectives on the COVID-19 pandemic and the future of healthcare delivery." This partnership will be built using Health Catalyst's DOS™ technology, a data-first analytics and application platform, to capture and map raw data into meaningful, actionable insights. Northwell Health will also immediately have access to Health Catalyst's growing suite of sildamax and kamagra COVID-19 solutions, including but not limited to a registry, staff and patient tracker and capacity planning tool.

Broadly sharing Northwell Health's data driven insights from its COVID-19 work is another significant opportunity for transformational care."Health Catalyst will become our data and analytics backbone, as their Solutions will enable our organization to take our current data adoption and transformation to entirely new heights," said John Bosco, Senior Vice President and Chief Information Officer at Northwell Health. "We are looking forward to leaning on DOS to create an affordable, yet innovative enterprise solution that will further enable transformative care to the patients we serve."About Northwell HealthNorthwell Health is New York State's largest health care provider and private employer, with 23 hospitals, 665 outpatient facilities and more than 18,500 affiliated physicians. We care for over sildamax and kamagra two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities.

Our 66,000 employees – 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We are making breakthroughs in medicine at sildamax and kamagra the Feinstein Institute for Medical Research. We are training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies.

For information on our more than 100 medical specialties, visit Northwell.edu.About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations, sildamax and kamagra and is committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial and operational improvements. Health Catalyst sildamax and kamagra envisions a future in which all healthcare decisions are data informed.

Northwell Health Media Contact:Michelle Pinto516-321-6708mpinto@northwell.edu Health Catalyst Media Contact:Kristen BerrySenior Vice President, Public Relations+1 (617) 234-4123+1 (774) 573-0455 (m)kberry@we-worldwide.com View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-and-northwell-health-partner-to-transform-patient-care-with-cloud-based-data-and-analytics-enterprise-solution-301110803.htmlSOURCE Health CatalystPeople tried to escape a heat wave baking the West by heading to Castaic Lake in California on Saturday.Credit...Marcio Jose Sanchez/Associated PressFor many Americans, Labor Day is a goodbye to summer before children go back to school and cold weather arrives. But public health experts are worried that in the midst of a pandemic, the traditional last blast of summer could translate into disaster this fall.After the Memorial Day and Fourth of July weekends, cases of Covid-19 surged around the country after people held family gatherings or congregated in large groups. Dr.

Anthony S. Fauci, the country’s top infectious disease expert, said he wanted people to enjoy Labor Day weekend but urged them to take precautions to avoid a post-holiday spike in cases. Take the fun outdoors.

Avoid crowds, keep gatherings to 10 people or fewer. And even outdoors, where transmission risk is much lower, you still need to wear a mask and practice physical distancing if you’re spending time with people outside your household.“We’ve been through this before,” Dr. Fauci said.

€œWe see what happens over holiday weekends, and we want to make sure we don’t have an uptick. What I have been saying is kind of a plea to the American public, and to the younger people, that they can enjoy themselves over Labor Day weekend, but please be aware of and adhere to public health guidelines.”In terms of daily case counts, the United States over all was in worse shape going into Labor Day weekend than it was for Memorial Day weekend. The nation is now averaging about 40,000 new confirmed cases per day, up from about 22,000 per day ahead of Memorial Day weekend.

Dr. Fauci said that the number of daily cases in the United States was “unacceptably high” and that a spike in Covid-19 infections following Labor Day would make it far tougher to control the spread of the disease in the fall as people head indoors.“We’d like to get a good head start into the fall by getting our daily cases and our test positivity as low as possible,” Dr. Fauci said.

€œIf we get another resurgence of infections after Labor Day, it will make it that much more difficult to get that baseline down and make it much more problematic as we enter the fall season.”Public health experts said it might be even more challenging to persuade people to curtail their Labor Day weekend plans, compared with past holiday weekends, because so many people are suffering from pandemic fatigue after six months of social-distancing restrictions, closures and separation from loved ones.“People are getting tired of taking these precautions and of having their lives upended,” said Eleanor J. Murray, an assistant professor of epidemiology at the Boston University School of Public Health. €œThey’re missing their friends and family, and everyone wishes things were back to normal.

That’s totally understandable, but unfortunately we don’t get a say, really.”Dr. Murray said it was important for people to remember that just one gathering could lead to spikes in cases that would affect many more people. She noted that a wedding in Maine with an estimated 65 guests had resulted in 147 infections, including three deaths among people who didn’t even attend the wedding.Dr.

Murray said that if people decided to ignore public health guidelines this weekend, at the very least they should place themselves in quarantine for two weeks after the event. €œIf those people at the wedding had said, ‘This is a risk I’m personally willing to take,’ but after the wedding they had quarantined, then the maximum number of cases would have been the 65 wedding attendees,” she said.Although it’s safer to gather outside than indoors, the virus can still be transmitted in outdoor spaces when people gather in large groups or stand close to one another for long periods of time. Alcohol can loosen inhibitions, prompting people to forget about social distancing.

Loud music can prompt people to stand closer and speak louder, which can spew more viral particles and put you at risk even if you’re wearing a mask, health experts say.Dr. Murray said that whatever plan you have for the holiday weekend, ask yourself how you can make it safer for everyone.“People need to socialize and to see people who are important to them,” Dr. Murray said.

€œIf you were thinking of being indoors, go outdoors. If you were thinking about being outdoors, spread out further. Wear masks.

Think about what you can do to move down the risk continuum.”While many people feel safer socializing with family members, a number of outbreaks have been traced back to family parties that included relatives from more than one household. In Maryland, 44 percent of the state’s new cases were traced back to family gatherings, compared with 23 percent from house parties and 21 percent to outdoor events, according to a tweet posted by Gov. Larry Hogan.After a family gathering of two dozen people in Catawba County, N.C., 14 people who attended became ill, but it didn’t end there.

€œBefore they started to show symptoms, they continued with their daily lives, such as going to work or taking a beach trip with other families,” Jennifer McCracken, Catawba County’s public health director, wrote in a case study of the event. €œThis set into motion a person-to-person contact chain that to date has spread COVID-19 to 41 people in nine different families and eight different workplaces.”Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said the holiday weekend would multiply the number of family gatherings around the country.“A family gathering one weekend in August that sets off cases in a given county or town is one thing,” Dr. Gonsalves said.

€œOne hundred family gatherings in that county on Labor Day weekend makes it a much larger epidemiological impact.”Dr. Gonsalves said concerns about Labor Day celebrations were being compounded by the fact that there are already large outbreaks on college campuses. €œWe’ve had this gigantic migration event over the past few weeks where students are moving all over the country from homes to universities,” Dr.

Gonsalves said. €œThe relative calm of places like New York and Connecticut has to be now thought of in the context of all this big jumble of people crisscrossing the country to get back to college.”ABC News posted a video on Twitter showing crowds of people gathering at a sports bar near the University of South Carolina. The university has reported more than 1,735 cases since Aug.

1, including 1,461 active cases, according to its Covid-19 dashboard.Brian Pace, a 35-year old psychologist in Phoenix, said he and his friends in Salt Lake City had talked about getting together for a socially distanced outdoor barbecue this weekend. He decided it was smarter to stay home, so he will get takeout from a local barbecue restaurant, JL Smokehouse, instead.“I debated with friends,” Mr. Pace said.

€œBut in the end, my decision boiled down to. Will I look back five years from now and say, ‘That was pretty stupid,’ or regret that I didn’t do it?. It probably would be that it was stupid to do that, so we’re pretty much hunkered down here.

When I go out, I wear a mask, and it’s takeout only.”Dr. Fauci said he didn’t want his words of caution about Labor Day celebrations to stop people from enjoying the holiday. He said he personally planned to spend the weekend with his wife, fishing in the Potomac and having dinner with two friends, for a total of four people, on his backyard deck.“You don’t want to tell people on a holiday weekend that even outdoors is bad — they will get completely discouraged,” Dr.

Fauci said. €œWhat we try to say is enjoy outdoors, but you can do it with safe spacing. You can be on a beach, and you don’t have to be falling all over each other.

You can be six, seven, eight, nine or 10 feet apart. You can go on a hike. You can go on a run.

You can go on a picnic with a few people. You don’t have to be in a crowd with 30, 40 or 50 people all breathing on each other.”The medical mistakes that befell the 87-year-old mother of a North Carolina pharmacist should not happen to anyone, and my hope is that this column will keep you and your loved ones from experiencing similar, all-too-common mishaps.As the pharmacist, Kim H. DeRhodes of Charlotte, N.C., recalled, it all began when her mother went to the emergency room two weeks after a fall because she had lingering pain in her back and buttocks.

Told she had sciatica, the elderly woman was prescribed prednisone and a muscle relaxant. Three days later, she became delirious, returned to the E.R., was admitted to the hospital, and was discharged two days later when her drug-induced delirium resolved.A few weeks later, stomach pain prompted a third trip to the E.R. And a prescription for an antibiotic and proton-pump inhibitor.

Within a month, she developed severe diarrhea lasting several days. Back to the E.R., and this time she was given a prescription for dicyclomine to relieve intestinal spasms, which triggered another bout of delirium and three more days in the hospital. She was discharged after lab tests and imaging studies revealed nothing abnormal.“Review of my mother’s case highlights separate but associated problems.

Likely misdiagnosis and inappropriate prescribing of medications,” Ms. DeRhodes wrote in JAMA Internal Medicine. €œDiagnostic errors led to the use of prescription drugs that were not indicated and caused my mother further harm.

The muscle relaxer and prednisone led to her first incidence of delirium. Prednisone likely led to the gastrointestinal issues, and the antibiotic likely led to the diarrhea, which led to the prescribing of dicyclomine, which led to the second incidence of delirium.”The doctors who wrote the woman’s prescriptions apparently never consulted the Beers Criteria, a list created by the American Geriatrics Society of drugs often unsafe for the elderly.In short, Ms. DeRhodes’s mother was a victim of two medical problems that are too often overlooked by examining doctors and unrecognized by families.

The first is giving an 87-year-old medications known to be unsafe for the elderly. The second is a costly and often frightening medically induced condition called “a prescribing cascade” that starts with drug-induced side effects which are then viewed as a new ailment and treated with yet like it another drug or drugs that can cause still other side effects.I’d like to think that none of this would have happened if instead of going to the E.R. The older woman had seen her primary care doctor.

But experts told me that no matter where patients are treated, they are not immune to getting caught in a prescribing cascade. The problem also can happen to people who self-treat with over-the-counter or herbal remedies. Nor is it limited to the elderly.

Young people can also become victims of a prescribing cascade, Ms. DeRhodes said.“Doctors are often taught to think of everything as a new problem,” Dr. Timothy Anderson, internist at Beth Israel Deaconess Medical Center in Boston, said.

€œThey have to start thinking about whether the patient is on medication and whether the medication is the problem.”“Doctors are very good at prescribing but not so good at deprescribing,” Ms. DeRhodes said. €œAnd a lot of times patients are given a prescription without first trying something else.”A popular treatment for high blood pressure, which afflicts a huge proportion of older people, is a common precipitant of the prescribing cascade, Dr.

Anderson said.He cited a Canadian study of 41,000 older adults with hypertension who were prescribed drugs called calcium channel blockers. Within a year after treatment began, nearly one person in 10 was given a diuretic to treat leg swelling caused by the first drug. Many were inappropriately prescribed a so-called loop diuretic that Dr.

Anderson said can result in dehydration, kidney problems, lightheadedness and falls.Type 2 diabetes is another common condition in which medications are often improperly prescribed to treat drug-induced side effects, said Lisa M. McCarthy, doctor of pharmacy at the University of Toronto who directed the Canadian study. Recognizing a side effect for what it is can be hampered when the effect doesn’t happen for weeks or even months after a drug is started.

While patients taking opioids for pain may readily recognize constipation as a consequence, Dr. McCarthy said that over time, patients taking metformin for diabetes can develop diarrhea and may self-treat with Lomotil, which in turn can cause dizziness and confusion.Dr. Paula Rochon, geriatrician at Women’s College Hospital in Ontario, said patients taking a drug called a cholinesterase inhibitor to treat early dementia can develop urinary incontinence, which is then treated with another drug that can worsen the patient’s confusion.Complicating matters is the large number of drugs some people take.

€œOlder adults frequently take many medications, with two-fifths taking five or more,” Dr. Anderson wrote in JAMA Internal Medicine. In cases of polypharmacy, as this is called, it can be hard to determine which, if any, of the drugs a person is taking is the cause of the current symptom.Dr.

Rochon emphasized that a prescribing cascade can happen to anybody. She said, “Everyone needs to consider the possibility every time a drug is prescribed.”Before accepting a prescription, she recommended that patients or their caregivers should ask the doctor a series of questions, starting with “Am I experiencing a symptom that could be a side effect of a drug I’m taking?. € Follow-up questions should include:Is this new drug being used to treat a side effect?.

Is there a safer drug available than the one I’m taking?. Could I take a lower dose of the prescribed drug?. Most important, Dr.

Rochon said, patients should ask “Do I need to take this drug at all?. €Patients and doctors alike often overlook or resist alternatives to medication that may be more challenging to adopt than swallowing a pill. For example, among well-established nondrug remedies for hypertension are weight loss, increasing physical activity, consuming less salt and other sources of sodium, and eating more potassium-rich foods like bananas and cantaloupe.For some patients, frequent use of a nonsteroidal anti-inflammatory drug sold over-the-counter, like ibuprofen or naproxen, is responsible for their elevated blood pressure.The risk of getting caught in a prescribing cascade is increased when patients are prescribed medications by more than one provider.

It’s up to patients to be sure every doctor they consult is given an up-to-date list of every drug they take, whether prescription or over-the-counter, as well as nondrug remedies and dietary supplements. Dr. Rochon recommended that patients maintain an up-to-date list of when and why they started every new drug, along with its dose and frequency, and show that list to the doctor as well.People tried to escape a heat wave baking the West by heading to Castaic Lake in California on Saturday.Credit...Marcio Jose Sanchez/Associated PressFor many Americans, Labor Day is a goodbye to summer before children go back to school and cold weather arrives.

But public health experts are worried that in the midst of a pandemic, the traditional last blast of summer could translate into disaster this fall.After the Memorial Day and Fourth of July weekends, cases of Covid-19 surged around the country after people held family gatherings or congregated in large groups. Dr. Anthony S.

Fauci, the country’s top infectious disease expert, said he wanted people to enjoy Labor Day weekend but urged them to take precautions to avoid a post-holiday spike in cases. Take the fun outdoors. Avoid crowds, keep gatherings to 10 people or fewer.

And even outdoors, where transmission risk is much lower, you still need to wear a mask and practice physical distancing if you’re spending time with people outside your household.“We’ve been through this before,” Dr. Fauci said. €œWe see what happens over holiday weekends, and we want to make sure we don’t have an uptick.

What I have been saying is kind of a plea to the American public, and to the younger people, that they can enjoy themselves over Labor Day weekend, but please be aware of and adhere to public health guidelines.”In terms of daily case counts, the United States over all was in worse shape going into Labor Day weekend than it was for Memorial Day weekend. The nation is now averaging about 40,000 new confirmed cases per day, up from about 22,000 per day ahead of Memorial Day weekend. Dr.

Fauci said that the number of daily cases in the United States was “unacceptably high” and that a spike in Covid-19 infections following Labor Day would make it far tougher to control the spread of the disease in the fall as people head indoors.“We’d like to get a good head start into the fall by getting our daily cases and our test positivity as low as possible,” Dr. Fauci said. €œIf we get another resurgence of infections after Labor Day, it will make it that much more difficult to get that baseline down and make it much more problematic as we enter the fall season.”Public health experts said it might be even more challenging to persuade people to curtail their Labor Day weekend plans, compared with past holiday weekends, because so many people are suffering from pandemic fatigue after six months of social-distancing restrictions, closures and separation from loved ones.“People are getting tired of taking these precautions and of having their lives upended,” said Eleanor J.

Murray, an assistant professor of epidemiology at the Boston University School of Public Health. €œThey’re missing their friends and family, and everyone wishes things were back to normal. That’s totally understandable, but unfortunately we don’t get a say, really.”Dr.

Murray said it was important for people to remember that just one gathering could lead to spikes in cases that would affect many more people. She noted that a wedding in Maine with an estimated 65 guests had resulted in 147 infections, including three deaths among people who didn’t even attend the wedding.Dr. Murray said that if people decided to ignore public health guidelines this weekend, at the very least they should place themselves in quarantine for two weeks after the event.

€œIf those people at the wedding had said, ‘This is a risk I’m personally willing to take,’ but after the wedding they had quarantined, then the maximum number of cases would have been the 65 wedding attendees,” she said.Although it’s safer to gather outside than indoors, the virus can still be transmitted in outdoor spaces when people gather in large groups or stand close to one another for long periods of time. Alcohol can loosen inhibitions, prompting people to forget about social distancing. Loud music can prompt people to stand closer and speak louder, which can spew more viral particles and put you at risk even if you’re wearing a mask, health experts say.Dr.

Murray said that whatever plan you have for the holiday weekend, ask yourself how you can make it safer for everyone.“People need to socialize and to see people who are important to them,” Dr. Murray said. €œIf you were thinking of being indoors, go outdoors.

If you were thinking about being outdoors, spread out further. Wear masks. Think about what you can do to move down the risk continuum.”While many people feel safer socializing with family members, a number of outbreaks have been traced back to family parties that included relatives from more than one household.

In Maryland, 44 percent of the state’s new cases were traced back to family gatherings, compared with 23 percent from house parties and 21 percent to outdoor events, according to a tweet posted by Gov. Larry Hogan.After a family gathering of two dozen people in Catawba County, N.C., 14 people who attended became ill, but it didn’t end there. €œBefore they started to show symptoms, they continued with their daily lives, such as going to work or taking a beach trip with other families,” Jennifer McCracken, Catawba County’s public health director, wrote in a case study of the event.

€œThis set into motion a person-to-person contact chain that to date has spread COVID-19 to 41 people in nine different families and eight different workplaces.”Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said the holiday weekend would multiply the number of family gatherings around the country.“A family gathering one weekend in August that sets off cases in a given county or town is one thing,” Dr. Gonsalves said. €œOne hundred family gatherings in that county on Labor Day weekend makes it a much larger epidemiological impact.”Dr.

Gonsalves said concerns about Labor Day celebrations were being compounded by the fact that there are already large outbreaks on college campuses. €œWe’ve had this gigantic migration event over the past few weeks where students are moving all over the country from homes to universities,” Dr. Gonsalves said.

€œThe relative calm of places like New York and Connecticut has to be now thought of in the context of all this big jumble of people crisscrossing the country to get back to college.”ABC News posted a video on Twitter showing crowds of people gathering at a sports bar near the University of South Carolina. The university has reported more than 1,735 cases since Aug. 1, including 1,461 active cases, according to its Covid-19 dashboard.Brian Pace, a 35-year old psychologist in Phoenix, said he and his friends in Salt Lake City had talked about getting together for a socially distanced outdoor barbecue this weekend.

He decided it was smarter to stay home, so he will get takeout from a local barbecue restaurant, JL Smokehouse, instead.“I debated with friends,” Mr. Pace said. €œBut in the end, my decision boiled down to.

Will I look back five years from now and say, ‘That was pretty stupid,’ or regret that I didn’t do it?. It probably would be that it was stupid to do that, so we’re pretty much hunkered down here. When I go out, I wear a mask, and it’s takeout only.”Dr.

Fauci said he didn’t want his words of caution about Labor Day celebrations to stop people from enjoying the holiday. He said he personally planned to spend the weekend with his wife, fishing in the Potomac and having dinner with two friends, for a total of four people, on his backyard deck.“You don’t want to tell people on a holiday weekend that even outdoors is bad — they will get completely discouraged,” Dr. Fauci said.

€œWhat we try to say is enjoy outdoors, but you can do it with safe spacing. You can be on a beach, and you don’t have to be falling all over each other. You can be six, seven, eight, nine or 10 feet apart.

You can go on a hike. You can go on a run. You can go on a picnic with a few people.

You don’t have to be in a crowd with 30, 40 or 50 people all breathing on each other.”The medical mistakes that befell the 87-year-old mother of a North Carolina pharmacist should not happen to anyone, and my hope is that this column will keep you and your loved ones from experiencing similar, all-too-common mishaps.As the pharmacist, Kim H. DeRhodes of Charlotte, N.C., recalled, it all began when her mother went to the emergency room two weeks after a fall because she had lingering pain in her back and buttocks. Told she had sciatica, the elderly woman was prescribed prednisone and a muscle relaxant.

Three days later, she became delirious, returned to the E.R., was admitted to the hospital, and was discharged two days later when her drug-induced delirium resolved.A few weeks later, stomach pain prompted a third trip to the E.R. And a prescription for an antibiotic and proton-pump inhibitor. Within a month, she developed severe diarrhea lasting several days.

Back to the E.R., and this time she was given a prescription for dicyclomine to relieve intestinal spasms, which triggered another bout of delirium and three more days in the hospital. She was discharged after lab tests and imaging studies revealed nothing abnormal.“Review of my mother’s case highlights separate but associated problems. Likely misdiagnosis and inappropriate prescribing of medications,” Ms.

DeRhodes wrote in JAMA Internal Medicine. €œDiagnostic errors led to the use of prescription drugs that were not indicated and caused my mother further harm. The muscle relaxer and prednisone led to her first incidence of delirium.

Prednisone likely led to the gastrointestinal issues, and the antibiotic likely led to the diarrhea, which led to the prescribing of dicyclomine, which led to the second incidence of delirium.”The doctors who wrote the woman’s prescriptions apparently never consulted the Beers Criteria, a list created by the American Geriatrics Society of drugs often unsafe for the elderly.In short, Ms. DeRhodes’s mother was a victim of two medical problems that are too often overlooked by examining doctors and unrecognized by families. The first is giving an 87-year-old medications known to be unsafe for the elderly.

The second is a costly and often frightening medically induced condition called “a prescribing cascade” that starts with drug-induced side effects which are then viewed as a new ailment and treated with yet another drug or drugs that can cause still other side effects.I’d like to think that none of this would have happened if instead of going to the E.R. The older woman had seen her primary care doctor. But experts told me that no matter where patients are treated, they are not immune to getting caught in a prescribing cascade.

The problem also can happen to people who self-treat with over-the-counter or herbal remedies. Nor is it limited to the elderly. Young people can also become victims of a prescribing cascade, Ms.

DeRhodes said.“Doctors are often taught to think of everything as a new problem,” Dr. Timothy Anderson, internist at Beth Israel Deaconess Medical Center in Boston, said. €œThey have to start thinking about whether the patient is on medication and whether the medication is the problem.”“Doctors are very good at prescribing but not so good at deprescribing,” Ms.

DeRhodes said. €œAnd a lot of times patients are given a prescription without first trying something else.”A popular treatment for high blood pressure, which afflicts a huge proportion of older people, is a common precipitant of the prescribing cascade, Dr. Anderson said.He cited a Canadian study of 41,000 older adults with hypertension who were prescribed drugs called calcium channel blockers.

Within a year after treatment began, nearly one person in 10 was given a diuretic to treat leg swelling caused by the first drug. Many were inappropriately prescribed a so-called loop diuretic that Dr. Anderson said can result in dehydration, kidney problems, lightheadedness and falls.Type 2 diabetes is another common condition in which medications are often improperly prescribed to treat drug-induced side effects, said Lisa M.

McCarthy, doctor of pharmacy at the University of Toronto who directed the Canadian study. Recognizing a side effect for what it is can be hampered when the effect doesn’t happen for weeks or even months after a drug is started. While patients taking opioids for pain may readily recognize constipation as a consequence, Dr.

McCarthy said that over time, patients taking metformin for diabetes can develop diarrhea and may self-treat with Lomotil, which in turn can cause dizziness and confusion.Dr. Paula Rochon, geriatrician at Women’s College Hospital in Ontario, said patients taking a drug called a cholinesterase inhibitor to treat early dementia can develop urinary incontinence, which is then treated with another drug that can worsen the patient’s confusion.Complicating matters is the large number of drugs some people take. €œOlder adults frequently take many medications, with two-fifths taking five or more,” Dr.

Anderson wrote in JAMA Internal Medicine. In cases of polypharmacy, as this is called, it can be hard to determine which, if any, of the drugs a person is taking is the cause of the current symptom.Dr. Rochon emphasized that a prescribing cascade can happen to anybody.

She said, “Everyone needs to consider the possibility every time a drug is prescribed.”Before accepting a prescription, she recommended that patients or their caregivers should ask the doctor a series of questions, starting with “Am I experiencing a symptom that could be a side effect of a drug I’m taking?. € Follow-up questions should include:Is this new drug being used to treat a side effect?. Is there a safer drug available than the one I’m taking?.

Could I take a lower dose of the prescribed drug?. Most important, Dr. Rochon said, patients should ask “Do I need to take this drug at all?.

€Patients and doctors alike often overlook or resist alternatives to medication that may be more challenging to adopt than swallowing a pill. For example, among well-established nondrug remedies for hypertension are weight loss, increasing physical activity, consuming less salt and other sources of sodium, and eating more potassium-rich foods like bananas and cantaloupe.For some patients, frequent use of a nonsteroidal anti-inflammatory drug sold over-the-counter, like ibuprofen or naproxen, is responsible for their elevated blood pressure.The risk of getting caught in a prescribing cascade is increased when patients are prescribed medications by more than one provider. It’s up to patients to be sure every doctor they consult is given an up-to-date list of every drug they take, whether prescription or over-the-counter, as well as nondrug remedies and dietary supplements.

Dr. Rochon recommended that patients maintain an up-to-date list of when and why they started every new drug, along with its dose and frequency, and show that list to the doctor as well..

SALT LAKE kamagra for sale uk kamagra oral jelly sydney CITY, Sept. 8, 2020 /PRNewswire/ -- Health Catalyst, Inc. ("Health Catalyst," kamagra for sale uk Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that it has completed its seventh annual and first ever virtual Healthcare Analytics Summit (HAS), with record registration of more than 3,500 attendees. Keynotes included kamagra for sale uk Dr.

Amy Abernethy, Principal Deputy Commissioner and Acting CIO of the U.S. Food and Drug Administration, Michael Dowling, CEO of Northwell Health, Vice Admiral Raquel Bono, kamagra for sale uk MD, and many others. Other business updates include:The Vitalware, LLC ("VitalWare"), transaction has closed, and integration is underway of the Yakima, Washington-based provider of revenue workflow optimization and analytics SaaS technology solutions for health organizations. This is another example of kamagra for sale uk Health Catalyst's ability to scale software on top of its cloud-based Data Operating System (DOS™). DOS will further enhance the analytics insights made available by Vitalware's technology by combining charge and revenue data with claims, cost, and quality data.

Vitalware's flagship offering is a Best in KLAS chargemaster management solution that delivers results for the complex regulatory and compliance functions needed by all healthcare provider systems. "As kamagra for sale uk announced on August 11, 2020, we entered into an acquisition agreement to acquire Vitalware and expected to close the acquisition in Q3 or Q4 of 2020. We are pleased to announce that we closed the acquisition on September 1, 2020. We are thrilled to formalize the combination of our solutions for the benefit of our customers and the industry," said kamagra for sale uk CEO Dan Burton. On its upcoming Q3 2020 earnings call, Health Catalyst will share the impact of Vitalware on its Q3 2020 financial performance, which will not be significant given the timing of the acquisition, as well as update its full year 2020 guidance to include the impact of Vitalware.

Health Catalyst Co-Founder Steve Barlow has returned from his three-year full-time volunteer mission for the Church of Jesus kamagra for sale uk Christ of Latter-Day Saints, having served as Mission President of the Ecuador Quito Mission. He has rejoined Health Catalyst's companywide Leadership Team as a Senior Vice President, responsible for some of the company's largest customer relationships. Dan Burton said, "We couldn't kamagra for sale uk be more excited about Steve's return to Health Catalyst. His energy, dedication and commitment to transforming healthcare launched our journey and will continue to make us better and stronger. Steve is leading and kamagra for sale uk overseeing all aspects of our partnerships with some of our largest and longest-standing customers.

Steve's extraordinary experience and capability enable him to be a critical partner and leader in enabling these customers' continued improvement and success." "My experience over the past three years in Ecuador reinforced for me how fortunate I am to be in a country with high-quality healthcare," said Barlow. "It has been invigorating to return to Health Catalyst and witness the incredible growth and expansion that has occurred over the past few years. We are better positioned than ever before to kamagra for sale uk achieve our mission of being the catalyst for massive, measurable, data-informed healthcare improvement. I am grateful to be reunited with our longstanding team members and customers, and I'm thrilled to get to know and work alongside our new customers and teammates in this critical work." Effective October 1, 2020, Chief Technology Officer Dale Sanders will be transitioning to a Senior Advisor role with Health Catalyst, and the company is pleased to announce that one of Dale's longtime protégés and colleagues, Bryan Hinton, will serve as Health Catalyst's next Chief Technology Officer. Hinton joined Health Catalyst in 2012 kamagra for sale uk and currently serves as the Senior Vice President and General Manager of the DOS Platform Business.

He will continue to lead this business in addition to assuming the responsibilities of CTO. He has been instrumental in the development and integration of DOS and has been working kamagra for sale uk directly with Dale and other technology leaders at Health Catalyst for many years. His experience prior to joining Health Catalyst includes four years with the .NET Development Center of Excellence at The Church of Jesus Christ of Latter-Day Saints, where he established the architectural guidance of all .NET projects. Previously, at Intel, he was kamagra for sale uk responsible for the development and implementation of Intel's factory data warehouse product installed at Intel global factories. Hinton graduated from Brigham Young University with a BS in Computer Science.

"Dale has been central to Health Catalyst's growth and success and we are grateful to him for his many years of service to our company and to the broader healthcare industry," said Dan Burton, CEO of Health Catalyst. "Thanks to Dale's vision, passion, innovative thinking kamagra for sale uk and broad-based industry experience and perspective, Health Catalyst has grown from a handful of clients to a large number of organizations relying on us as their digital transformation partner, helping the healthcare ecosystem to constantly learn and improve. Dale's technology leadership was critical to the company's overall maturation, and I am convinced that we could not have grown and scaled as we have without Dale's foundational leadership and contributions. We are grateful to continue our association with Dale in the months kamagra for sale uk and years ahead in his next role as a Senior Advisor to the company." Burton added, "We are thrilled to see Bryan Hinton take on this added role after having demonstrated his technology leadership prowess during the course of his tenure at Health Catalyst and having been mentored by Dale for many years. Bryan is well-prepared and ready for this additional responsibility, and we extend our congratulations to him." "I feel like a parent saying goodbye to my kids at their college graduation," said Dale Sanders.

"Many of the concepts we first developed and applied over 20 years ago at Intermountain and then later kamagra for sale uk refined during my tenure as CIO at Northwestern had a big influence on our technology and products at Health Catalyst. The vision of the Data Operating System and its application ecosystem originated in the real-world healthcare operations and research trenches of Northwestern. At Health Catalyst, I had the wonderful opportunity kamagra for sale uk to lead the teams who made that vision a reality for the benefit of the entire industry. None of it would have been possible without Bryan Hinton leading the DOS team and Eric Just and Dan Unger leading the application development teams. We've been working side-by-side for many years to kamagra for sale uk make the vision real.

Bryan is the consummate modern CTO from outside of healthcare that healthcare needs. I've always described Eric as having a manufacturing engineer's mindset with a healthcare data and software engineer's skills, with Dan Unger leveraging his deep domain expertise in financial transformation to oversee the development of meaningful applications and solutions so relevant for CFOs. I'm honored and thrilled to step aside and turn the future over to kamagra for sale uk their very capable hands. Under their leadership, the best is yet to come for Health Catalyst's technology." About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations, and is committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered kamagra for sale uk by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial and operational improvements.

Health Catalyst envisions a future in which all healthcare decisions are data informed.Health Catalyst Media Contact:Kristen BerrySenior Vice President, Public Relations+1 (617) 234-4123HealthCatalyst@we-worldwide.com View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-completes-hosting-of-the-largest-ever-healthcare-analytics-summit-and-announces-the-close-of-the-vitalware-acquisition-301125125.htmlSOURCE Health CatalystNEW YORK and SALT LAKE CITY, Aug. 12, 2020 /PRNewswire/ -- Northwell Health today joined Health kamagra for sale uk Catalyst, Inc. ("Health Catalyst," Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, in announcing a long-term strategic partnership to transform the quality of patient care by using data and analytics to better anticipate and respond to the evolving needs of patients, providers kamagra for sale uk and payers in today's rapidly evolving healthcare ecosystem. In this partnership, Health Catalyst will provide solutions to allow for increased cloud-based reliance on data and analytics, while sharing insights and best practices from a decade of support to hundreds of other healthcare clients.

This will accelerate greater efficiency in data mapping and data storage to/with the Electronic Medical Record (EMR) and the affordable emergence of an enterprise solution for meaningful and measurable clinical, financial and operational improvements. The solutions will be used across the kamagra for sale uk Northwell Health enterprise, which includes the Feinstein Institute and Donald and Barbara Zucker School of Medicine at Hofstra. "Northwell Health's goal is a simple one that has not changed since our inception. Be better tomorrow kamagra for sale uk than we are today. Partnering with Health Catalyst will allow us to accelerate the generation of critical insights for one of the world's most diverse patient populations which includes more than 11 million individuals who will potentially turn to us for care," said Michael Dowling, President and CEO of Northwell Health.

"Health Catalyst's Augmented Intelligence (AI) and data science experience and expertise, along with our shared cultural attributes and mission alignment, will allow us to use data-informed decision making to achieve our shared commitment of transforming healthcare for the communities we serve."Northwell Health is New York State's largest health care provider and private employer, with 23 hospitals, nearly 800 outpatient facilities and more than 18,500 affiliated kamagra for sale uk physicians. More than 11,000 COVID-19 patients have received care from Northwell's 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners, and using 1,600 additional COVID-19 focused beds."We are honored to have the opportunity to join Northwell Health on its mission-driven journey to transform healthcare," said Dan Burton, CEO of Health Catalyst. "We have deep respect for our Northwell colleagues and are excited about combining our Solution with Northwell's team members' kamagra for sale uk experience, knowledge and passion for improvement. We are also honored to have Northwell's CEO Michael Dowling as a keynote speaker at Health Catalyst's upcoming Healthcare Analytics Summit (HAS), where we'll hear his important perspectives on the COVID-19 pandemic and the future of healthcare delivery." This partnership will be built using Health Catalyst's DOS™ technology, a data-first analytics and application platform, to capture and map raw data into meaningful, actionable insights. Northwell Health will also immediately have access to Health Catalyst's growing suite of COVID-19 solutions, including but not limited to a registry, staff and patient kamagra for sale uk tracker and capacity planning tool.

Broadly sharing Northwell Health's data driven insights from its COVID-19 work is another significant opportunity for transformational care."Health Catalyst will become our data and analytics backbone, as their Solutions will enable our organization to take our current data adoption and transformation to entirely new heights," said John Bosco, Senior Vice President and Chief Information Officer at Northwell Health. "We are looking forward to leaning on DOS to create an affordable, yet innovative enterprise solution that will further enable transformative care to the patients we serve."About Northwell HealthNorthwell Health is New York State's largest health care provider and private employer, with 23 hospitals, 665 outpatient facilities and more than 18,500 affiliated physicians. We care for over two kamagra for sale uk million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 66,000 employees – 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We are making breakthroughs in medicine at kamagra for sale uk the Feinstein Institute for Medical Research.

We are training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. For information on our more than 100 medical specialties, visit Northwell.edu.About Health CatalystHealth Catalyst is a leading provider of data and analytics technology kamagra for sale uk and services to healthcare organizations, and is committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial and operational improvements. Health Catalyst envisions a future in which all kamagra for sale uk healthcare decisions are data informed. Northwell Health Media Contact:Michelle Pinto516-321-6708mpinto@northwell.edu Health Catalyst Media Contact:Kristen BerrySenior Vice President, Public Relations+1 (617) 234-4123+1 (774) 573-0455 (m)kberry@we-worldwide.com View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-and-northwell-health-partner-to-transform-patient-care-with-cloud-based-data-and-analytics-enterprise-solution-301110803.htmlSOURCE Health CatalystPeople tried to escape a heat wave baking the West by heading to Castaic Lake in California on Saturday.Credit...Marcio Jose Sanchez/Associated PressFor many Americans, Labor Day is a goodbye to summer before children go back to school and cold weather arrives.

But public health experts are worried that in the midst of a pandemic, the traditional last blast of summer could translate into disaster this fall.After the Memorial Day and Fourth of July weekends, cases of Covid-19 surged around the country after people held family gatherings or congregated in large groups. Dr. Anthony S. Fauci, the country’s top infectious disease expert, said he wanted people to enjoy Labor Day weekend but urged them to take precautions to avoid a post-holiday spike in cases. Take the fun outdoors.

Avoid crowds, keep gatherings to 10 people or fewer. And even outdoors, where transmission risk is much lower, you still need to wear a mask and practice physical distancing if you’re spending time with people outside your household.“We’ve been through this before,” Dr. Fauci said. €œWe see what happens over holiday weekends, and we want to make sure we don’t have an uptick. What I have been saying is kind of a plea to the American public, and to the younger people, that they can enjoy themselves over Labor Day weekend, but please be aware of and adhere to public health guidelines.”In terms of daily case counts, the United States over all was in worse shape going into Labor Day weekend than it was for Memorial Day weekend.

The nation is now averaging about 40,000 new confirmed cases per day, up from about 22,000 per day ahead of Memorial Day weekend. Dr. Fauci said that the number of daily cases in the United States was “unacceptably high” and that a spike in Covid-19 infections following Labor Day would make it far tougher to control the spread of the disease in the fall as people head indoors.“We’d like to get a good head start into the fall by getting our daily cases and our test positivity as low as possible,” Dr. Fauci said. €œIf we get another resurgence of infections after Labor Day, it will make it that much more difficult to get that baseline down and make it much more problematic as we enter the fall season.”Public health experts said it might be even more challenging to persuade people to curtail their Labor Day weekend plans, compared with past holiday weekends, because so many people are suffering from pandemic fatigue after six months of social-distancing restrictions, closures and separation from loved ones.“People are getting tired of taking these precautions and of having their lives upended,” said Eleanor J.

Murray, an assistant professor of epidemiology at the Boston University School of Public Health. €œThey’re missing their friends and family, and everyone wishes things were back to normal. That’s totally understandable, but unfortunately we don’t get a say, really.”Dr. Murray said it was important for people to remember that just one gathering could lead to spikes in cases that would affect many more people. She noted that a wedding in Maine with an estimated 65 guests had resulted in 147 infections, including three deaths among people who didn’t even attend the wedding.Dr.

Murray said that if people decided to ignore public health guidelines this weekend, at the very least they should place themselves in quarantine for two weeks after the event. €œIf those people at the wedding had said, ‘This is a risk I’m personally willing to take,’ but after the wedding they had quarantined, then the maximum number of cases would have been the 65 wedding attendees,” she said.Although it’s safer to gather outside than indoors, the virus can still be transmitted in outdoor spaces when people gather in large groups or stand close to one another for long periods of time. Alcohol can loosen inhibitions, prompting people to forget about social distancing. Loud music can prompt people to stand closer and speak louder, which can spew more viral particles and put you at risk even if you’re wearing a mask, health experts say.Dr. Murray said that whatever plan you have for the holiday weekend, ask yourself how you can make it safer for everyone.“People need to socialize and to see people who are important to them,” Dr.

Murray said. €œIf you were thinking of being indoors, go outdoors. If you were thinking about being outdoors, spread out further. Wear masks. Think about what you can do to move down the risk continuum.”While many people feel safer socializing with family members, a number of outbreaks have been traced back to family parties that included relatives from more than one household.

In Maryland, 44 percent of the state’s new cases were traced back to family gatherings, compared with 23 percent from house parties and 21 percent to outdoor events, according to a tweet posted by Gov. Larry Hogan.After a family gathering of two dozen people in Catawba County, N.C., 14 people who attended became ill, but it didn’t end there. €œBefore they started to show symptoms, they continued with their daily lives, such as going to work or taking a beach trip with other families,” Jennifer McCracken, Catawba County’s public health director, wrote in a case study of the event. €œThis set into motion a person-to-person contact chain that to date has spread COVID-19 to 41 people in nine different families and eight different workplaces.”Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said the holiday weekend would multiply the number of family gatherings around the country.“A family gathering one weekend in August that sets off cases in a given county or town is one thing,” Dr. Gonsalves said.

€œOne hundred family gatherings in that county on Labor Day weekend makes it a much larger epidemiological impact.”Dr. Gonsalves said concerns about Labor Day celebrations were being compounded by the fact that there are already large outbreaks on college campuses. €œWe’ve had this gigantic migration event over the past few weeks where students are moving all over the country from homes to universities,” Dr. Gonsalves said. €œThe relative calm of places like New York and Connecticut has to be now thought of in the context of all this big jumble of people crisscrossing the country to get back to college.”ABC News posted a video on Twitter showing crowds of people gathering at a sports bar near the University of South Carolina.

The university has reported more than 1,735 cases since Aug. 1, including 1,461 active cases, according to its Covid-19 dashboard.Brian Pace, a 35-year old psychologist in Phoenix, said he and his friends in Salt Lake City had talked about getting together for a socially distanced outdoor barbecue this weekend. He decided it was smarter to stay home, so he will get takeout from a local barbecue restaurant, JL Smokehouse, instead.“I debated with friends,” Mr. Pace said. €œBut in the end, my decision boiled down to.

Will I look back five years from now and say, ‘That was pretty stupid,’ or regret that I didn’t do it?. It probably would be that it was stupid to do that, so we’re pretty much hunkered down here. When I go out, I wear a mask, and it’s takeout only.”Dr. Fauci said he didn’t want his words of caution about Labor Day celebrations to stop people from enjoying the holiday. He said he personally planned to spend the weekend with his wife, fishing in the Potomac and having dinner with two friends, for a total of four people, on his backyard deck.“You don’t want to tell people on a holiday weekend that even outdoors is bad — they will get completely discouraged,” Dr.

Fauci said. €œWhat we try to say is enjoy outdoors, but you can do it with safe spacing. You can be on a beach, and you don’t have to be falling all over each other. You can be six, seven, eight, nine or 10 feet apart. You can go on a hike.

You can go on a run. You can go on a picnic with a few people. You don’t have to be in a crowd with 30, 40 or 50 people all breathing on each other.”The medical mistakes that befell the 87-year-old mother of a North Carolina pharmacist should not happen to anyone, and my hope is that this column will keep you and your loved ones from experiencing similar, all-too-common mishaps.As the pharmacist, Kim H. DeRhodes of Charlotte, N.C., recalled, it all began when her mother went to the emergency room two weeks after a fall because she had lingering pain in her back and buttocks. Told she had sciatica, the elderly woman was prescribed prednisone and a muscle relaxant.

Three days later, she became delirious, returned to the E.R., was admitted to the hospital, and was discharged two days later when her drug-induced delirium resolved.A few weeks later, stomach pain prompted a third trip to the E.R. And a prescription for an antibiotic and proton-pump inhibitor. Within a month, she developed severe diarrhea lasting several days. Back to the E.R., and this time she was given a prescription for dicyclomine to relieve intestinal spasms, which triggered another bout of delirium and three more days in the hospital. She was discharged after lab tests and imaging studies revealed nothing abnormal.“Review of my mother’s case highlights separate but associated problems.

Likely misdiagnosis and inappropriate prescribing of medications,” Ms. DeRhodes wrote in JAMA Internal Medicine. €œDiagnostic errors led to the use of prescription drugs that were not indicated and caused my mother further harm. The muscle relaxer and prednisone led to her first incidence of delirium. Prednisone likely led to the gastrointestinal issues, and the antibiotic likely led to the diarrhea, which led to the prescribing of dicyclomine, which led to the second incidence of delirium.”The doctors who wrote the woman’s prescriptions apparently never consulted the Beers Criteria, a list created by the American Geriatrics Society of drugs often unsafe for the elderly.In short, Ms.

DeRhodes’s mother was a victim of two medical problems that are too often overlooked by examining doctors and unrecognized by families. The first is giving an 87-year-old medications known to be unsafe for the elderly. The second is a costly and often frightening medically induced condition called “a prescribing cascade” that starts with drug-induced side effects which are then viewed as a new ailment and treated with yet another drug or drugs that can cause still other side effects.I’d like to think that none of this would have happened if instead of going to the E.R. The older woman had seen her primary care doctor. But experts told me that no matter where patients are treated, they are not immune to getting caught in a prescribing cascade.

The problem also can happen to people who self-treat with over-the-counter or herbal remedies. Nor is it limited to the elderly. Young people can also become victims of a prescribing cascade, Ms. DeRhodes said.“Doctors are often taught to think of everything as a new problem,” Dr. Timothy Anderson, internist at Beth Israel Deaconess Medical Center in Boston, said.

€œThey have to start thinking about whether the patient is on medication and whether the medication is the problem.”“Doctors are very good at prescribing but not so good at deprescribing,” Ms. DeRhodes said. €œAnd a lot of times patients are given a prescription without first trying something else.”A popular treatment for high blood pressure, which afflicts a huge proportion of older people, is a common precipitant of the prescribing cascade, Dr. Anderson said.He cited a Canadian study of 41,000 older adults with hypertension who were prescribed drugs called calcium channel blockers. Within a year after treatment began, nearly one person in 10 was given a diuretic to treat leg swelling caused by the first drug.

Many were inappropriately prescribed a so-called loop diuretic that Dr. Anderson said can result in dehydration, kidney problems, lightheadedness and falls.Type 2 diabetes is another common condition in which medications are often improperly prescribed to treat drug-induced side effects, said Lisa M. McCarthy, doctor of pharmacy at the University of Toronto who directed the Canadian study. Recognizing a side effect for what it is can be hampered when the effect doesn’t happen for weeks or even months after a drug is started. While patients taking opioids for pain may readily recognize constipation as a consequence, Dr.

McCarthy said that over time, patients taking metformin for diabetes can develop diarrhea and may self-treat with Lomotil, which in turn can cause dizziness and confusion.Dr. Paula Rochon, geriatrician at Women’s College Hospital in Ontario, said patients taking a drug called a cholinesterase inhibitor to treat early dementia can develop urinary incontinence, which is then treated with another drug that can worsen the patient’s confusion.Complicating matters is the large number of drugs some people take. €œOlder adults frequently take many medications, with two-fifths taking five or more,” Dr. Anderson wrote in JAMA Internal Medicine. In cases of polypharmacy, as this is called, it can be hard to determine which, if any, of the drugs a person is taking is the cause of the current symptom.Dr.

Rochon emphasized that a prescribing cascade can happen to anybody. She said, “Everyone needs to consider the possibility every time a drug is prescribed.”Before accepting a prescription, she recommended that patients or their caregivers should ask the doctor a series of questions, starting with “Am I experiencing a symptom that could be a side effect of a drug I’m taking?. € Follow-up questions should include:Is this new drug being used to treat a side effect?. Is there a safer drug available than the one I’m taking?. Could I take a lower dose of the prescribed drug?.

Most important, Dr. Rochon said, patients should ask “Do I need to take this drug at all?. €Patients and doctors alike often overlook or resist alternatives to medication that may be more challenging to adopt than swallowing a pill. For example, among well-established nondrug remedies for hypertension are weight loss, increasing physical activity, consuming less salt and other sources of sodium, and eating more potassium-rich foods like bananas and cantaloupe.For some patients, frequent use of a nonsteroidal anti-inflammatory drug sold over-the-counter, like ibuprofen or naproxen, is responsible for their elevated blood pressure.The risk of getting caught in a prescribing cascade is increased when patients are prescribed medications by more than one provider. It’s up to patients to be sure every doctor they consult is given an up-to-date list of every drug they take, whether prescription or over-the-counter, as well as nondrug remedies and dietary supplements.

Dr. Rochon recommended that patients maintain an up-to-date list of when and why they started every new drug, along with its dose and frequency, and show that list to the doctor as well.People tried to escape a heat wave baking the West by heading to Castaic Lake in California on Saturday.Credit...Marcio Jose Sanchez/Associated PressFor many Americans, Labor Day is a goodbye to summer before children go back to school and cold weather arrives. But public health experts are worried that in the midst of a pandemic, the traditional last blast of summer could translate into disaster this fall.After the Memorial Day and Fourth of July weekends, cases of Covid-19 surged around the country after people held family gatherings or congregated in large groups. Dr. Anthony S.

Fauci, the country’s top infectious disease expert, said he wanted people to enjoy Labor Day weekend but urged them to take precautions to avoid a post-holiday spike in cases. Take the fun outdoors. Avoid crowds, keep gatherings to 10 people or fewer. And even outdoors, where transmission risk is much lower, you still need to wear a mask and practice physical distancing if you’re spending time with people outside your household.“We’ve been through this before,” Dr. Fauci said.

€œWe see what happens over holiday weekends, and we want to make sure we don’t have an uptick. What I have been saying is kind of a plea to the American public, and to the younger people, that they can enjoy themselves over Labor Day weekend, but please be aware of and adhere to public health guidelines.”In terms of daily case counts, the United States over all was in worse shape going into Labor Day weekend than it was for Memorial Day weekend. The nation is now averaging about 40,000 new confirmed cases per day, up from about 22,000 per day ahead of Memorial Day weekend. Dr. Fauci said that the number of daily cases in the United States was “unacceptably high” and that a spike in Covid-19 infections following Labor Day would make it far tougher to control the spread of the disease in the fall as people head indoors.“We’d like to get a good head start into the fall by getting our daily cases and our test positivity as low as possible,” Dr.

Fauci said. €œIf we get another resurgence of infections after Labor Day, it will make it that much more difficult to get that baseline down and make it much more problematic as we enter the fall season.”Public health experts said it might be even more challenging to persuade people to curtail their Labor Day weekend plans, compared with past holiday weekends, because so many people are suffering from pandemic fatigue after six months of social-distancing restrictions, closures and separation from loved ones.“People are getting tired of taking these precautions and of having their lives upended,” said Eleanor J. Murray, an assistant professor of epidemiology at the Boston University School of Public Health. €œThey’re missing their friends and family, and everyone wishes things were back to normal. That’s totally understandable, but unfortunately we don’t get a say, really.”Dr.

Murray said it was important for people to remember that just one gathering could lead to spikes in cases that would affect many more people. She noted that a wedding in Maine with an estimated 65 guests had resulted in 147 infections, including three deaths among people who didn’t even attend the wedding.Dr. Murray said that if people decided to ignore public health guidelines this weekend, at the very least they should place themselves in quarantine for two weeks after the event. €œIf those people at the wedding had said, ‘This is a risk I’m personally willing to take,’ but after the wedding they had quarantined, then the maximum number of cases would have been the 65 wedding attendees,” she said.Although it’s safer to gather outside than indoors, the virus can still be transmitted in outdoor spaces when people gather in large groups or stand close to one another for long periods of time. Alcohol can loosen inhibitions, prompting people to forget about social distancing.

Loud music can prompt people to stand closer and speak louder, which can spew more viral particles and put you at risk even if you’re wearing a mask, health experts say.Dr. Murray said that whatever plan you have for the holiday weekend, ask yourself how you can make it safer for everyone.“People need to socialize and to see people who are important to them,” Dr. Murray said. €œIf you were thinking of being indoors, go outdoors. If you were thinking about being outdoors, spread out further.

Wear masks. Think about what you can do to move down the risk continuum.”While many people feel safer socializing with family members, a number of outbreaks have been traced back to family parties that included relatives from more than one household. In Maryland, 44 percent of the state’s new cases were traced back to family gatherings, compared with 23 percent from house parties and 21 percent to outdoor events, according to a tweet posted by Gov. Larry Hogan.After a family gathering of two dozen people in Catawba County, N.C., 14 people who attended became ill, but it didn’t end there. €œBefore they started to show symptoms, they continued with their daily lives, such as going to work or taking a beach trip with other families,” Jennifer McCracken, Catawba County’s public health director, wrote in a case study of the event.

€œThis set into motion a person-to-person contact chain that to date has spread COVID-19 to 41 people in nine different families and eight different workplaces.”Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said the holiday weekend would multiply the number of family gatherings around the country.“A family gathering one weekend in August that sets off cases in a given county or town is one thing,” Dr. Gonsalves said. €œOne hundred family gatherings in that county on Labor Day weekend makes it a much larger epidemiological impact.”Dr. Gonsalves said concerns about Labor Day celebrations were being compounded by the fact that there are already large outbreaks on college campuses. €œWe’ve had this gigantic migration event over the past few weeks where students are moving all over the country from homes to universities,” Dr.

Gonsalves said. €œThe relative calm of places like New York and Connecticut has to be now thought of in the context of all this big jumble of people crisscrossing the country to get back to college.”ABC News posted a video on Twitter showing crowds of people gathering at a sports bar near the University of South Carolina. The university has reported more than 1,735 cases since Aug. 1, including 1,461 active cases, according to its Covid-19 dashboard.Brian Pace, a 35-year old psychologist in Phoenix, said he and his friends in Salt Lake City had talked about getting together for a socially distanced outdoor barbecue this weekend. He decided it was smarter to stay home, so he will get takeout from a local barbecue restaurant, JL Smokehouse, instead.“I debated with friends,” Mr.

Pace said. €œBut in the end, my decision boiled down to. Will I look back five years from now and say, ‘That was pretty stupid,’ or regret that I didn’t do it?. It probably would be that it was stupid to do that, so we’re pretty much hunkered down here. When I go out, I wear a mask, and it’s takeout only.”Dr.

Fauci said he didn’t want his words of caution about Labor Day celebrations to stop people from enjoying the holiday. He said he personally planned to spend the weekend with his wife, fishing in the Potomac and having dinner with two friends, for a total of four people, on his backyard deck.“You don’t want to tell people on a holiday weekend that even outdoors is bad — they will get completely discouraged,” Dr. Fauci said. €œWhat we try to say is enjoy outdoors, but you can do it with safe spacing. You can be on a beach, and you don’t have to be falling all over each other.

You can be six, seven, eight, nine or 10 feet apart. You can go on a hike. You can go on a run. You can go on a picnic with a few people. You don’t have to be in a crowd with 30, 40 or 50 people all breathing on each other.”The medical mistakes that befell the 87-year-old mother of a North Carolina pharmacist should not happen to anyone, and my hope is that this column will keep you and your loved ones from experiencing similar, all-too-common mishaps.As the pharmacist, Kim H.

DeRhodes of Charlotte, N.C., recalled, it all began when her mother went to the emergency room two weeks after a fall because she had lingering pain in her back and buttocks. Told she had sciatica, the elderly woman was prescribed prednisone and a muscle relaxant. Three days later, she became delirious, returned to the E.R., was admitted to the hospital, and was discharged two days later when her drug-induced delirium resolved.A few weeks later, stomach pain prompted a third trip to the E.R. And a prescription for an antibiotic and proton-pump inhibitor. Within a month, she developed severe diarrhea lasting several days.

Back to the E.R., and this time she was given a prescription for dicyclomine to relieve intestinal spasms, which triggered another bout of delirium and three more days in the hospital. She was discharged after lab tests and imaging studies revealed nothing abnormal.“Review of my mother’s case highlights separate but associated problems. Likely misdiagnosis and inappropriate prescribing of medications,” Ms. DeRhodes wrote in JAMA Internal Medicine. €œDiagnostic errors led to the use of prescription drugs that were not indicated and caused my mother further harm.

The muscle relaxer and prednisone led to her first incidence of delirium. Prednisone likely led to the gastrointestinal issues, and the antibiotic likely led to the diarrhea, which led to the prescribing of dicyclomine, which led to the second incidence of delirium.”The doctors who wrote the woman’s prescriptions apparently never consulted the Beers Criteria, a list created by the American Geriatrics Society of drugs often unsafe for the elderly.In short, Ms. DeRhodes’s mother was a victim of two medical problems that are too often overlooked by examining doctors and unrecognized by families. The first is giving an 87-year-old medications known to be unsafe for the elderly. The second is a costly and often frightening medically induced condition called “a prescribing cascade” that starts with drug-induced side effects which are then viewed as a new ailment and treated with yet another drug or drugs that can cause still other side effects.I’d like to think that none of this would have happened if instead of going to the E.R.

The older woman had seen her primary care doctor. But experts told me that no matter where patients are treated, they are not immune to getting caught in a prescribing cascade. The problem also can happen to people who self-treat with over-the-counter or herbal remedies. Nor is it limited to the elderly. Young people can also become victims of a prescribing cascade, Ms.

DeRhodes said.“Doctors are often taught to think of everything as a new problem,” Dr. Timothy Anderson, internist at Beth Israel Deaconess Medical Center in Boston, said. €œThey have to start thinking about whether the patient is on medication and whether the medication is the problem.”“Doctors are very good at prescribing but not so good at deprescribing,” Ms. DeRhodes said. €œAnd a lot of times patients are given a prescription without first trying something else.”A popular treatment for high blood pressure, which afflicts a huge proportion of older people, is a common precipitant of the prescribing cascade, Dr.

Anderson said.He cited a Canadian study of 41,000 older adults with hypertension who were prescribed drugs called calcium channel blockers. Within a year after treatment began, nearly one person in 10 was given a diuretic to treat leg swelling caused by the first drug. Many were inappropriately prescribed a so-called loop diuretic that Dr. Anderson said can result in dehydration, kidney problems, lightheadedness and falls.Type 2 diabetes is another common condition in which medications are often improperly prescribed to treat drug-induced side effects, said Lisa M. McCarthy, doctor of pharmacy at the University of Toronto who directed the Canadian study.

Recognizing a side effect for what it is can be hampered when the effect doesn’t happen for weeks or even months after a drug is started. While patients taking opioids for pain may readily recognize constipation as a consequence, Dr. McCarthy said that over time, patients taking metformin for diabetes can develop diarrhea and may self-treat with Lomotil, which in turn can cause dizziness and confusion.Dr. Paula Rochon, geriatrician at Women’s College Hospital in Ontario, said patients taking a drug called a cholinesterase inhibitor to treat early dementia can develop urinary incontinence, which is then treated with another drug that can worsen the patient’s confusion.Complicating matters is the large number of drugs some people take. €œOlder adults frequently take many medications, with two-fifths taking five or more,” Dr.

Anderson wrote in JAMA Internal Medicine. In cases of polypharmacy, as this is called, it can be hard to determine which, if any, of the drugs a person is taking is the cause of the current symptom.Dr. Rochon emphasized that a prescribing cascade can happen to anybody. She said, “Everyone needs to consider the possibility every time a drug is prescribed.”Before accepting a prescription, she recommended that patients or their caregivers should ask the doctor a series of questions, starting with “Am I experiencing a symptom that could be a side effect of a drug I’m taking?. € Follow-up questions should include:Is this new drug being used to treat a side effect?.

Is there a safer drug available than the one I’m taking?. Could I take a lower dose of the prescribed drug?. Most important, Dr. Rochon said, patients should ask “Do I need to take this drug at all?. €Patients and doctors alike often overlook or resist alternatives to medication that may be more challenging to adopt than swallowing a pill.

For example, among well-established nondrug remedies for hypertension are weight loss, increasing physical activity, consuming less salt and other sources of sodium, and eating more potassium-rich foods like bananas and cantaloupe.For some patients, frequent use of a nonsteroidal anti-inflammatory drug sold over-the-counter, like ibuprofen or naproxen, is responsible for their elevated blood pressure.The risk of getting caught in a prescribing cascade is increased when patients are prescribed medications by more than one provider. It’s up to patients to be sure every doctor they consult is given an up-to-date list of every drug they take, whether prescription or over-the-counter, as well as nondrug remedies and dietary supplements. Dr. Rochon recommended that patients maintain an up-to-date list of when and why they started every new drug, along with its dose and frequency, and show that list to the doctor as well..

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Under the stewardship of the MidMichigan Health Foundation, this kamagra site year, 23 area students will received scholarship awards from the Tolfree Scholarship, the Dr. George Schaiberger, Sr., Dr kamagra site. Howard VanOosten and Dr.

Lloyd Wiegerink kamagra site Medical Scholarship, and the Paul A. Poling Memorial Scholarship.Awardees receiving the Dr. George Schaiberger, kamagra site Sr., Dr.

Howard VanOosten and Dr. Lloyd Wiegerink Medical Staff kamagra site Memorial Scholarship are. Allie Morand, Camden Groff, Nicholas Morse, Anna Erickson, Emily Terry, Brooke Chenette, Tyler Walters, Austin Raymond, Jordan Williams, kamagra site Andrew Waack, Rylie Alward, Nicholas Thomas and Madison Nachtrieb.

Those receiving the Tolfree Scholarship are. Allie Morand, Nicholas Morse, Anna Erickson, Emily kamagra site Terry and Andrew Waack. Lastly, awardees receiving the Paul A.Poling Memorial Scholarship are Emily Terry, Anna Erickson, Nicholas Morse, Allie Morand and Andrew Waack.“The intent of our generous donors in creating these scholarships is to provide our rural counties, particularly those served by MidMichigan Medical Center – West Branch, with future generations of excellent health care professionals,” said Nicole Potter, director, MidMichigan Health Foundation.

€œWe congratulate all of this year’s recipients, as well as the parents and teachers who help them arrive at this kamagra site major milestone in these students’ lives. We wish each one of them the best of success and hope to see them back again in a few years serving the people of their own hometown.”Examples of the health professions being pursued by these individuals include physical therapy, pre-medicine, nursing, health administration, sports medicine, neuroscience and human biology.Applications for the 2021-2022 school year will be accepted from Dec. 1, 2020, through kamagra site March 1, 2021.

Those interested kamagra site in reviewing the eligibility guidelines, including a scholarship application, may visit www.midmichigan.org/scholarships or call (989) 343-3694.Growers donate produce to staff and patients at MidMichigan Health Park – Bay.Residents in the Bay area have an additional opportunity to embrace healthy lifestyles near MidMichigan Health Park – Bay. Produce by the Park, a community garden that began late last year with a donation from MidMichigan Health Foundation, is flourishing, allowing patients, friends and neighbors to literally enjoy the fruits of their labor.Brenda Turner, director, MidMichigan Physicians Group, has a farming background and dreamt of a garden for her community for years. When the Health Park was built with ample property behind and support from the kamagra site Foundation, that dream was brought to life.“We are so pleased to be able to support this project as it represents very well MidMichigan Health’s purpose of building healthy communities – together,” said Denise O’Keefe, executive director, MidMichigan Health Foundation.Other local organizations came on board to offer help.

Tri-County Equipment of Saginaw donated dirt, and the Agriscience classes at John Glenn High School volunteered to get plots prepared for gardening. The Building Trades program at Bay kamagra site Arenac ISD built and installed a tool shed. Woodchips from Weiler Tree Service were donated to cut down on weeding, and Nature’s Own Landscaping and Irrigation hooked up a spigot in a central location so that all gardeners could access it easily.“During our first season, we had just a few plots of our two-acre garden assigned and less than ten participants,” said Ashleigh Palmer, practice manager, MidMichigan Health Park – Bay.

€œThis year, we have all plots filled with kamagra site more than 40 participants. We have couples, families and individuals who share their experience, produce and recipes with kamagra site each other. It’s a lot of fun to see the friendships that have developed among our gardeners.

The ground is fertile, so produce is thriving, and excess vegetables kamagra site are being donated to patients of the facility.”Jarod Morse, 21, saw the garden information on Facebook and is excited to be participating. €œMy whole family - brother, sister and her fiancé, mom, and Papa - are working on the garden together,” Morse stated. A few of the items they are growing kamagra site are cabbage, cauliflower and a variety of peppers.

€œThe best part,” he added, “is getting to share knowledge and smiles with other members of the garden.”Rows of produce growing in the community garden, Produce by the Park.MidMichigan Health staffers Shelby Kuch and Kellie Picard do much of the organizing, serving as “garden ambassadors.” They are excited to see it thriving.“It has been fun to see how each person has their own unique approach to gardening and harvesting,” said Kuch. €œThere are so kamagra site many things being grown. Cabbage, corn, kamagra site potatoes, broccoli, tomatoes, and beautiful sunflowers.

You wouldn’t believe the variety and the willingness to share what is harvested with other gardeners, members of the community and patients.”Picard is pleased to see elderly residents becoming involved. €œMany don’t kamagra site have the room to plant where they live,” she explained. €œThis place gives them a chance to be outside, grow their own food, socialize with others and get some exercise.

It’s inspiring to see their work pay off in so many ways.”Those who are interested in securing a plot must fill out an application and waiver, and kamagra site agree to the terms set by Produce by the Park. All skill levels are welcome and there is no cost associated with securing a plot.“Our goal has evolved,” said Palmer. €œWe hope to build upon this year’s successes to increase food security by providing access to kamagra site fresh, healthy foods while reinforcing ties to the environment and encouraging community members to work together.

I think we are well on our way.”Those interested in more information on the Produce by the Park or to request an application may visit www.midmichigan.org/bay/garden or contact Palmer at (989) 778-2888 or ashleigh.palmer@midmichigan.org..

Under the kamagra for sale uk stewardship of the MidMichigan Health Foundation, this year, 23 area look these up students will received scholarship awards from the Tolfree Scholarship, the Dr. George Schaiberger, Sr., kamagra for sale uk Dr. Howard VanOosten and Dr. Lloyd Wiegerink Medical Scholarship, and the Paul A kamagra for sale uk.

Poling Memorial Scholarship.Awardees receiving the Dr. George Schaiberger, kamagra for sale uk Sr., Dr. Howard VanOosten and Dr. Lloyd Wiegerink kamagra for sale uk Medical Staff Memorial Scholarship are.

Allie Morand, Camden Groff, Nicholas Morse, Anna Erickson, Emily Terry, Brooke Chenette, Tyler Walters, Austin Raymond, Jordan Williams, Andrew Waack, Rylie Alward, Nicholas kamagra for sale uk Thomas and Madison Nachtrieb. Those receiving the Tolfree Scholarship are. Allie Morand, Nicholas Morse, Anna Erickson, Emily kamagra for sale uk Terry and Andrew Waack. Lastly, awardees receiving the Paul A.Poling Memorial Scholarship are Emily Terry, Anna Erickson, Nicholas Morse, Allie Morand and Andrew Waack.“The intent of our generous donors in creating these scholarships is to provide our rural counties, particularly those served by MidMichigan Medical Center – West Branch, with future generations of excellent health care professionals,” said Nicole Potter, director, MidMichigan Health Foundation.

€œWe congratulate all of this year’s recipients, as well as the parents and kamagra for sale uk teachers who help them arrive at this major milestone in these students’ lives. We wish each one of them the best of success and hope to see them back again in a few years serving the people of their own hometown.”Examples of the health professions being pursued by these individuals include physical therapy, pre-medicine, nursing, health administration, sports medicine, neuroscience and human biology.Applications for the 2021-2022 school year will be accepted from Dec. 1, 2020, through March 1, kamagra for sale uk 2021. Those interested in reviewing the eligibility guidelines, including kamagra for sale uk a scholarship application, may visit www.midmichigan.org/scholarships or call (989) 343-3694.Growers donate produce to staff and patients at MidMichigan Health Park – Bay.Residents in the Bay area have an additional opportunity to embrace healthy lifestyles near MidMichigan Health Park – Bay.

Produce by the Park, a community garden that began late last year with a donation from MidMichigan Health Foundation, is flourishing, allowing patients, friends and neighbors to literally enjoy the fruits of their labor.Brenda Turner, director, MidMichigan Physicians Group, has a farming background and dreamt of a garden for her community for years. When the Health Park was built with ample property behind and support from kamagra for sale uk the Foundation, that dream was brought to life.“We are so pleased to be able to support this project as it represents very well MidMichigan Health’s purpose of building healthy communities – together,” said Denise O’Keefe, executive director, MidMichigan Health Foundation.Other local organizations came on board to offer help. Tri-County Equipment of Saginaw donated dirt, and the Agriscience classes at John Glenn High School volunteered to get plots prepared for gardening. The Building Trades program at Bay Arenac kamagra for sale uk ISD built and installed a tool shed.

Woodchips from Weiler Tree Service were donated to cut down on weeding, and Nature’s Own Landscaping and Irrigation hooked up a spigot in a central location so that all gardeners could access it easily.“During our first season, we had just a few plots of our two-acre garden assigned and less than ten participants,” said Ashleigh Palmer, practice manager, MidMichigan Health Park – Bay. €œThis year, we have all kamagra for sale uk plots filled with more than 40 participants. We have kamagra for sale uk couples, families and individuals who share their experience, produce and recipes with each other. It’s a lot of fun to see the friendships that have developed among our gardeners.

The ground is fertile, so produce is thriving, and excess vegetables are being donated to patients of the facility.”Jarod Morse, 21, saw the garden information on Facebook and is excited to be kamagra for sale uk participating. €œMy whole family - brother, sister and her fiancé, mom, and Papa - are working on the garden together,” Morse stated. A few of the items they are growing are kamagra for sale uk cabbage, cauliflower and a variety of peppers. €œThe best part,” he added, “is getting to share knowledge and smiles with other members of the garden.”Rows of produce growing in the community garden, Produce by the Park.MidMichigan Health staffers Shelby Kuch and Kellie Picard do much of the organizing, serving as “garden ambassadors.” They are excited to see it thriving.“It has been fun to see how each person has their own unique approach to gardening and harvesting,” said Kuch.

€œThere are so many things being grown kamagra for sale uk. Cabbage, corn, kamagra for sale uk potatoes, broccoli, tomatoes, and beautiful sunflowers. You wouldn’t believe the variety and the willingness to share what is harvested with other gardeners, members of the community and patients.”Picard is pleased to see elderly residents becoming involved. €œMany don’t have the room kamagra for sale uk to plant where they live,” she explained.

€œThis place gives them a chance to be outside, grow their own food, socialize with others and get some exercise. It’s inspiring to see their work pay off in so many ways.”Those who are interested in securing a plot kamagra for sale uk must fill out an application and waiver, and agree to the terms set by Produce by the Park. All skill levels are welcome and there is no cost associated with securing a plot.“Our goal has evolved,” said Palmer. €œWe hope to build upon this year’s successes to increase food security by providing access to fresh, healthy foods while reinforcing ties to the environment and encouraging community members kamagra for sale uk to work together.

I think we are well on our way.”Those interested in more information on the Produce by the Park or to request an application may visit www.midmichigan.org/bay/garden or contact Palmer at (989) 778-2888 or ashleigh.palmer@midmichigan.org..