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People in Aboriginal communities across NSW will have you could try here access to expanded suicide prevention support thanks to an investment of $7.7 low cost cialis million from the NSW Government.Minister for Mental Health Bronnie Taylor said the funding would enable 12 community organisations to deliver culturally appropriate suicide prevention activities. €œIn Aboriginal communities, there is a growing body of evidence around the healing power of culture when it comes to mental health issues and suicide prevention,” Mrs Taylor said. €œThis funding will support community-led and culturally appropriate initiatives to tackle these important issues.“These new programs will involve Elders and focus on building identity and connection, as well as helping Aboriginal people access mental health services.” The funding has been allocated to 12 Aboriginal Community Controlled Health Organisations (ACCHOs) which can use the funds flexibly for low cost cialis a combination of grassroots community activities and clinical services. Suicide is the fourth leading cause of death for Indigenous Australians living in NSW, compared to 17th for non-Indigenous Australians.

Minister for Aboriginal Affairs Don low cost cialis Harwin praised the initiative and echoed the importance of targeted efforts to address the issue within Aboriginal communities. €œToo many Aboriginal families in NSW are sadly impacted by suicide,” Mr Harwin said. €œI’m heartened that as part of the NSW Government’s Towards Zero Suicides strategy, this important investment will enable Aboriginal Community Controlled Health Organisations to deliver services to support the mental health and social and emotional wellbeing of our Aboriginal people and communities across the State.” Tharawal Aboriginal Medical Services in Campbelltown is one of the ACCHOs to receive funding and CEO Darryl Wright said he wants to see the low cost cialis next generation flourish. €œThis funding will go towards reducing the intergenerational grief and trauma that still impacts our youth today.

For every family that we can help heal low cost cialis and nourish, our community will grow stronger and our futures glow brighter," Mr Wright said. Building on Resilience in Aboriginal Communities is part of Towards Zero Suicides, a NSW Premier’s Priority and NSW Government investment of $87 million over three years in new and exisiting suicide prevention initiatives. If you, low cost cialis or someone you know, is thinking about suicide or experiencing a personal crisis or distress, please seek help immediately by calling 000 or one of these services. Lifeline 13 11 14Suicide Call Back Service 1300 659 467NSW Mental Health Line 1800 011 511 ​​​15 full-time equivalent specialist counsellors will be deployed across rural NSW to help prevent suicide, with the first two counsellors starting in the Eurobodalla and Snowy Mountains regions.NSW Mental Health Minister Bronnie Taylor said the relatively high rates of suicide in rural areas are devastating families and communities, and the $6.75 million investment will add another layer of help.“Many factors can contribute to suicide, from domestic violence, to relationship issues or unemployment, to stress and hardship,” Mrs Taylor said.

€œThese specialist mental health counsellors are there on the ground to support people thinking of suicide or impacted by suicide, and I encourage communities across the state to lean on them for support.”Director Mental Health Drug low cost cialis and Alcohol for Southern NSW Local Health District Damien Eggleton said he wants more people to ask for help when they need it. €œOur rural communities have proven beyond a doubt they’re resilient and fearless when faced with adversity, whether that be geographic isolation, searing drought or the impact of the current pandemic – but they don’t need to go it alone,” Mr Eggleton said. €œThe support provided by these counsellors will complement the peer work and drought support provided by our Farm Gate Counsellors and Drought Counsellors.”Rural counsellor Samara Byrne said she wants young people to know there are people low cost cialis you can turn to when feeling overwhelmed with life or feeling like a burden on others. €œWe are here for you and here to listen if you are feeling distressed, anxious or a burden to loved ones.

The service is easily accessible through the low cost cialis Mental Health Line. Just ask for the Rural Counsellor.”“Having moved from Sydney in 2016 to our beautiful farm in SNSW, I am so pleased to be able to do what I am most passionate about, supporting people’s wellbeing in Rural Australia and building on the natural local community resilience”.Minister Taylor urges people in the bush to get help by contacting these rural counsellors. €œSupport is available, all you need to do is pick up the phone and make an appointment by calling the NSW Mental Health Line on 1800 011 511.”The 15 rural counselling positions are part of the Towards low cost cialis Zero Suicides. A $87 million investment over three years in new suicide prevention initiatives.

A NSW Premier’s Priority, this is a whole-of-government commitment to transforming the way we identify and support anyone impacted by suicide.If you, or someone you know, is thinking about suicide or experiencing a personal crisis or distress, please seek help immediately in a life-threatening situation by calling 000 or seek support though one of these services:Lifeline 13 11 14Suicide Call Back Service 1300 659 467NSW Mental Health Line 1800 011 511.

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After watching a http://sw.keimfarben.de/cialis-liquid-drops-for-sale/ parent succumb to the deleterious effects of Alzheimer's disease, it's only natural to wonder if you might be doomed is generic cialis available in canada to the same fate. The good news?. That's not necessarily is generic cialis available in canada the case.

The bad news, however, is that the disease is so prevalent your overall risk is still relatively high — especially as you age. At 65, you have a is generic cialis available in canada roughly 3 percent chance of contracting Alzheimer's disease each year. This bumps up to a 17 percent chance after your 75th birthday, and increases to a roughly one in three chance you'll develop Alzheimer's after the age of 85.

Experts agree that family history elevates the risk, particularly if you have more than one parent or sibling with the disease, but they disagree on how much. Some studies indicate the risk hovers at around 30 percent, while others estimate an up is generic cialis available in canada to two or four times increased risk. Early onset Alzheimer's — which typically strikes individuals between the ages of 40 and 65 — has a more easily understood genetic link, with a 50 percent chance the child of an Alzheimer's patient will also be diagnosed with the disease.

Read More:Why Do Women is generic cialis available in canada Get Alzheimer’s More Than Men?. How Did Alzheimer's Disease Get Its Name?. Are We Close to Curing Alzheimer’s Disease?.

However, a combination of genetic and environmental factors come into play for the more common late-onset variation, says Rita Guerreiro, a neurogeneticist at the Van is generic cialis available in canada Andel Institute. Which makes things even more difficult to predict. €œMany people is generic cialis available in canada who have relatives with [Alzheimer's] never develop the disease, and many without a family history of the disease do develop it,” says Guerreiro.Interested in tipping the odds in your favor?.

Some scientists think keeping your mind active, consuming a diet low in red meat and sugar and exercising regularly could help keep the memory-zapping disease at bay.Late fall and early winter typically mean a flurry of holiday travel and get-togethers for a lot of people. But this year will be anything but normal. Making plans is more than a matter of shopping around for flight prices is generic cialis available in canada or car rental fees.

Many of us are probably also asking ourselves whether to stay home or see loved ones, and how to stay safe at holiday gatherings. For the lowest risk of spreading or becoming sick with COVID-19, not traveling is the way to go is generic cialis available in canada. However, there might be loved ones who desperately need companionship in the coming months.

€œThere are situations where people will choose, and choose correctly, to go and support those family members,” says Lin H. Chen, director of the Travel Medicine Center at Mount Auburn Hospital and president of the International is generic cialis available in canada Society of Travel Medicine. No matter if you’re going cross-country to see siblings or staying at home with your dog, experts say, remember two things.

Plan ahead is generic cialis available in canada and stay flexible.Tackle Logistics FirstFor those interested in interstate travel, first assess whether or not those plans are feasible. The states you’re going to (and coming back to) might have rules about isolating yourself for two weeks once you arrive. If you live in one of those states but a two-week isolation period isn’t feasible — because you have to go to work or send kids to school, for example — then traveling for the holidays won’t work for you, says Gabriela Andujar Vazquez, an infectious disease is generic cialis available in canada doctor at Tufts Medical Center.

Some states say that isolation requirements don’t apply if you get a negative COVID test. But testing you or your whole family may lie outside your budget if the exams aren’t covered by insurance, Andujar Vazquez says. Factor those financial decisions into your travel plans, too.If you do decide to travel, choose driving is generic cialis available in canada over flying if you can.

Busy rest stops might mean confronting crowds of other highway travelers, Chen says. However, compared is generic cialis available in canada to the entire process of flying — getting to an airport and waiting in lines repeatedly — driving likely means fewer crowds overall. €œThink about precautions through this journey,” Chen says, “not just on the plane, train, bus or car.”Airplanes themselves receive a lot of attention as potential virus spreaders.

But Chen says there are three instances of infected individuals spreading the disease to two or more people on a flight. Those transmissions happened before any airline required passengers is generic cialis available in canada to wear masks. Since then, other interventions like leaving seats open, disinfecting often and updated air filtration have been introduced on airplanes, too.

Though there’s no data yet on how effective these combined intervention strategies are, “the fact that we haven’t heard about masked transmission on recent flights is also reassuring,” is generic cialis available in canada Chen says. On the Big DayOdds are you’re debating travel plans for the sake of a big family meal. Or even if you’re staying local, you might try and work something out with friends and relatives nearby.

Both Chen and Andujar Vazquez emphasize that no matter which you choose, keep up is generic cialis available in canada the COVID-19 precautions once you’re all together. Generally, the smaller the gathering (and the fewer number of households), the better. Keep activities outdoors if you can, seat groups apart, and keep masks on while not eating is generic cialis available in canada.

You might also consider new ways to keep everyone fed. The typical buffet serving style can mean a lot of utensil sharing, so maybe opt for single-serving portioning or have everyone wash or sanitize hands before and after touching communal dishes. And as fun as it might be to is generic cialis available in canada play bartender, maybe choose a BYOB policy as well.

Oh, and “no one should be coming sick,” Andujar Vazquez says. €œYou cannot say that enough.”These might sound like is generic cialis available in canada a lot of holiday modifications, which is why it’s important to discuss what the situation will look like before coming together. €œPeople have to feel comfortable talking about these things, because it’s part of our daily life now,” Andujar Vazquez says.

€œHave that conversation before the event happens so people don’t have unexpected surprises or feel unsafe with some sort of behavior.”At the same time, acknowledge that even the most careful planning might fall apart. Your destination might become a COVID-19 hotspot days before you’re set to arrive, or you or someone in your gathering might is generic cialis available in canada start feeling unwell ahead of time. Though it’s easier said than done, accept that plans will change whether you want them to or not — and that celebrations in the coming months will look different than they used to.

€œRealistically, this holiday season is going to be difficult for a lot of people,” says Jonathan Kanter, psychologist and director of the Center for the Science of Social is generic cialis available in canada Connection at the University of Washington. In individuals coping with significant life changes, one of the best predictors of depression is whether or not people can leave former goals behind and adopt new ones, Kanter says. Letting go of old expectations — like is generic cialis available in canada how you normally gather with family, for example — can involve a kind of grieving process.

But recalibrating what you want to get out of a situation is an essential coping skill. €œYou won’t be able to get there unless you breathe and accept that you’re in a new context,” Kanter says. €œWith that acceptance, hopefully there's a lot of creativity and innovation and is generic cialis available in canada grace about how to make it as successful as possible.” The prospect of not seeing loved ones in the coming months might make some people nervous, for themselves and for others.

What's important to remember is that it's possible to make it through — and that future holidays will get better.As flu season creeps up on the Northern Hemisphere, cold and flu relief medications will inevitably fly off store shelves. A natural remedy that is generic cialis available in canada shoppers might reach for is elderberry, a small, blackish-purple fruit that companies turn into syrups, lozenges and gummies. Though therapeutic uses of the berry date back centuries, Michael Macknin, a pediatrician at the Cleveland Clinic, hadn’t heard of using elderberry to treat the flu until a patient’s mother asked him about it.

Some industry-sponsored research claims that the herbal remedy could cut the length of the symptoms by up to four days. For a comparison, Tamiflu, an FDA-approved treatment, only reduces flu duration by about is generic cialis available in canada a single day. €œI said, 'Gee, if that’s really true [about elderberry], it would be a huge benefit,'” Macknin says.

But the is generic cialis available in canada effectiveness and safety of elderberry is still fairly unclear. Unlike the over-the-counter medicines at your local pharmacy, elderberry hasn't been through rigorous FDA testing and approval. However, Macknin and his team recently published a study in the Journal of General Internal Medicine, which found that elderberry treatments did nothing for flu patients.

This prompts a need for further studies into the remedy — work that unfortunately stands a low chance of happening in the future, is generic cialis available in canada Macknin says. Looking For ProofElderberries are full of chemicals that could be good for your health. Like similar fruits, the berries contain high levels of antioxidants, compounds that shut down is generic cialis available in canada reactions in our bodies that damage cells.

But whether or not elderberry's properties also help immune systems fend off a virus is murky. There are only a handful of studies that have examined if elderberries reduced the severity or duration of the flu. And though some of the work prior to Macknin’s was well-designed and supported this herbal remedy as a helpful flu aid, at least some — and potentially all — of those studies were funded by elderberry treatment manufacturers.Macknin says an elderberry supplement company provided his team with their products and a placebo version for free, but that the company is generic cialis available in canada wasn’t involved in the research beyond that.

Macknin's study is the largest one conducted on elderberry to date, with 87 influenza patients completing the entire treatment course. Participants in the study were also welcome to take Tamiflu, for ethical reasons, as the team didn’t want to exclude anyone from taking a proven is generic cialis available in canada flu therapy. Additionally, each participant took home either a bottle of elderberry syrup or the placebo with instructions on when and how to take it.

The research team called participants every day for a symptom check and to remind them to take their medication.By chance, it turned out that a higher percentage of the patients given elderberry syrup had gotten their flu shot and also chose to take Tamiflu. Since the vaccination can reduce the severity of infection in recipients who still come down with the flu, the study coincidentally operated in favor of those who took the herbal remedy, is generic cialis available in canada Macknin says. Those patients could have dealt with a shorter, less-intense illness because of the Tamiflu and vaccination.

€œEverything was stacked is generic cialis available in canada to have it turn out better [for the elderberry group],” Macknin says, “and it turned out the same.” The researchers found no difference in illness duration or severity between the elderberry and placebo groups. While analyzing the data, the team also found that those on the herbal treatment might have actually fared worse than those on the placebo. The potential for this intervention to actually harm instead of help influenza patients explains why Macknin thinks the therapy is generic cialis available in canada needs further research.But, don't expect that work to happen any time soon.

Researchers are faced with a number of challenges when it comes to studying the efficacy of herbal remedies. For starters, there's little financial incentive to investigate if they actually work. Plant products are challenging to patent, making them less lucrative prospects for pharmaceutical companies or research is generic cialis available in canada organizations to investigate.

Additionally, investigations that try and prove a proposed therapy as an effective drug — like the one Macknin and his team accomplished — are expensive, Macknin says. Those projects need is generic cialis available in canada FDA oversight and additional paperwork, components that drive up study costs. €œIt’s extraordinarily expensive and there’s no money in it for anybody,” Macknin says.Talk To Your DoctorUltimately, research on elderberry therapies for flu patients is a mixed bag, and deserves more attention from scientists.

However, if you still want to discuss elderberry treatments for the flu with your doctor, that’s a conversation you should feel comfortable having, says Erica McIntyre, an expert focused on health and environmental psychology in the School of Public Health at the University of Technology Sydney. Navigating what research says about a particular herbal medicine is challenging is generic cialis available in canada for patients and health practitioners alike. The process is made more complex by the range of similar-sounding products on the market that lack standardized ingredients, McIntyre says.

But when doctors judge or shame patients for asking about non-conventional healthcare is generic cialis available in canada interventions, the response can distance people and push them closer to potentially unproven treatments. Even worse, those individuals might start to keep their herbal remedies a secret. €œIt is that fear about being judged for use of that medication,” McIntyre says, that drives up to 50 percent of people taking herbal treatments to withhold that information from healthcare practitioners.

That’s a dangerous choice, as some is generic cialis available in canada herbal and traditional medications can interact and cause health problems.If a physician shames someone for asking about alternative medicines, it’s likely time to find a new doctor, McIntyre says. Look for someone who will listen to your concerns — whether it's that you feel traditional treatments haven’t worked for you, or that you didn’t like the side effects, the two common reasons people pursue herbal treatments in the first place. €œYou’re not necessarily looking for a doctor that will let you do whatever you want,” McIntyre says, “but that they actually consider you as a patient, your treatment choices and your is generic cialis available in canada treatment priorities, and communicate in a way that’s supportive.” And if a doctor suggests that you avoid a treatment you’re interested in, ask why.

They generally have a good reason, McIntyre says.For now, know that even if your doctor doesn’t support you taking elderberry, there are other proven preventative measures that are worth your while — like the flu shot. Anyone six months or older should get it, Macknin says, and stick to the protocols we’re used to following to prevent COVID-19 infections, like social distancing, mask-wearing and hand-washing. Those measures also help prevent flu transmission, too — something, is generic cialis available in canada so far, no elderberry supplement package can claim.The yearly influenza season threatens to make the COVID-19 pandemic doubly deadly, but I believe that this isn’t inevitable.There are two commonly given vaccines – the pneumococcal vaccine and the Hib vaccine – that protect against bacterial pneumonias.

These bacteria complicate both influenza and COVID-19, often leading to death. My examination of disease trends and vaccination rates leads me to believe that broader use of the pneumococcal and Hib vaccines could guard against the worst is generic cialis available in canada effects of a COVID-19 illness.I am an immunologist and physiologist interested in the effects of combined infections on immunity. I have reached my insight by juxtaposing two seemingly unrelated puzzles.

Infants and children get SARS-CoV-2, the virus that causes COVID-19, but very rarely become hospitalized or die. And case numbers and death rates from COVID-19 began varying greatly from is generic cialis available in canada nation to nation and city to city even before lockdowns began. I wondered why.One night I woke up with a possible answer.

Vaccination rates is generic cialis available in canada. Most children, beginning at age two months, are vaccinated against numerous diseases. Adults less so is generic cialis available in canada.

And, both infant and adult vaccination rates vary widely across the world. Could differences in the rates of vaccination against one or more diseases account for differences in COVID-19 risks?. As someone who had previously investigated other pandemics such as the Great Flu Pandemic of 1918-19 and AIDS, and who has worked with vaccines, I had a strong background for tracking down the relevant data to test my hypothesis.Pneumococcal Vaccination Rates Correlate With Lower COVID-19 Cases and DeathsI gathered national and some local data on vaccination rates against influenza, polio, measles-mumps-rubella is generic cialis available in canada (MMR), diphtheria-tetanus-pertussis (DTP), tuberculosis (BCG), pneumococci and Haemophilus influenzae type B (Hib).

I correlated them with COVID-19 case rates and death rates for 24 nations that had experienced their COVID-19 outbreaks at about the same time. I controlled for is generic cialis available in canada factors such as percentage of the population who were obese, diabetic or elderly.I found that only pneumococcal vaccines afforded statistically significant protection against COVID-19. Nations such as Spain, Italy, Belgium, Brazil, Peru and Chile that have the highest COVID-19 rates per million have the poorest pneumococcal vaccination rates among both infants and adults.

Nations with the lowest rates of COVID-19 – Japan, Korea, Denmark, Australia and New Zealand – have the highest rates of pneumococcal vaccination among both infants and adults.A recent preprint study (not yet peer-reviewed) from researchers at the Mayo Clinic has also reported very strong associations between pneumococcal vaccination and protection against COVID-19. This is especially true among minority patients who are bearing is generic cialis available in canada the brunt of the coronavirus pandemic. The report also suggests that other vaccines, or combinations of vaccines, such as Hib and MMR may also provide protection.These results are important because in the U.S., childhood vaccination against pneumococci – which protects against Streptococcus pneumoniae bacteria – varies by state from 74% to 92%.

Although the CDC recommends that all adults 18-64 in high risk groups for COVID-19 and all adults over the age of 65 get a pneumococcal vaccination, only 23% of high-risk adults and 64% of those over the age of 65 do so.Similarly, although is generic cialis available in canada the CDC recommends at all infants and some high-risk adults be vaccinated against Haemophilus influenzae type B (Hib), only 80.7% of children in the U.S. And a handful of immunologically compromised adults have been. Pneumococcal and Hib vaccination rates are significantly lower in minority populations in the U.S.

And in countries that have been hit harder by COVID-19 than the U.S.Based on is generic cialis available in canada these data, I advocate universal pneumococcal and Hib vaccination among children, at-risk adults and all adults over 65 to prevent serious COVID-19 disease.Left. Combined rates of childhood and adult (over 65) pneumococcal vaccination (out of a possible 200). Right.

Cases (per million) population of COVID-19 at about 90 days into the pandemic for 24 nations. Nations with high pneumococcal vaccination rates have low COVID-19 case rates. (Credit.

CC BY-SA)How Pneumococcal Vaccination Protects Against COVID-19Protection against serious COVID-19 disease by pneumococcal and Hib vaccines makes sense for several reasons. First, recent studies reveal that the majority of hospitalized COVID-19 patients, and in some studies nearly all, are infected with streptococci, which causes pneumococcal pneumonias, Hib or other pneumonia-causing bacteria. Pneumococcal and Hib vaccinations should protect coronavirus patients from these infections and thus significantly cut the risk of serious pneumonia.I also found that pneumococcal, Hib and possibly rubella vaccines may confer specific protection against the SARS-CoV-2 virus that causes COVID-19 by means of “molecular mimicry.”Molecular mimicry occurs when the immune system thinks one microbe looks like another.

In this case, proteins found in pneumococcal vaccines and, to a lesser degree, ones found in Hib and rubella vaccines as well look like several proteins produced by the SARS-CoV-2 virus.Two of these proteins found in pneumococcal vaccines mimic the spike and membrane proteins that permit the virus to infect cells. This suggests pneumococcal vaccination may prevent SARS-CoV-2 infection. Two other mimics are the nucleoprotein and replicase that control virus replication.

These proteins are made after viral infection, in which case pneumococcal vaccination may control, but not prevent, SARS-CoV-2 replication.Either way, these vaccines may provide proxy protection against SARS-CoV-2 infection that we can implement right now, even before we have a specific virus vaccine. Such protection may not be complete. People might still suffer a weakened version of COVID-19 but, like most infants and children, be protected against the worst effects of the infection.Fighting Influenza-related Pneumonias During the COVID-19 PandemicWhile the specific protection these other vaccines confer against COVID-19 has not yet been tested in a clinical trial, I advocate broader implementation of pneumococcal and Hib vaccination for one additional, well-validated reason.Pneumococcal and Hib pneumonias – both caused by bacteria – are the major causes of death following viral influenza.

The influenza virus rarely causes death directly. Most often, the virus makes the lungs more susceptible to bacterial pneumonias, which are deadly. Dozens of studies around the world have demonstrated that increasing rates of pneumococcal and Hib vaccination dramatically lowers influenza-related pneumonias.Similar studies demonstrate that the price of using these vaccines is balanced by savings due to lower rates of influenza-related hospitalizations, intensive care unit admissions and deaths.

In the context of COVID-19, lowering rates of influenza-related hospitalizations and ICU admissions would free up resources to fight the coronavirus, independent of any effect these vaccines might have on SARS-CoV-2 itself. In my opinion, that is a winning scenario.In short, we need not wait for a SARS-CoV-2 vaccine to slow down COVID-19.I believe that we can and should act now by fighting the coronavirus with all the tools at our disposal, including influenza, Hib, pneumococcal and perhaps rubella vaccinations.Preventing pneumococcal and Hib complications of influenza and COVID-19, and perhaps proxy-vaccinating against SARS-CoV-2 itself, helps everyone. Administering these already available and well-tested pneumococcal and Hib vaccines to people will save money by freeing up hospital beds and ICUs.

It will also improve public health by reducing the spread of multiple infections and boost the economy by nurturing a healthier population.Robert Root-Bernstein is a Professor of Physiology at Michigan State University. This article was originally published on The Conversation under a Creative Commons liscense Read the original here.This story appeared in the November 2020 issue as "Bacteria and the Brain." Subscribe to Discover magazine for more stories like this.It’s not always easy to convince people that the human gut is a sublime and wondrous place worthy of special attention. Sarkis Mazmanian discovered that soon after arriving at Caltech for his first faculty job 14 years ago, when he explained to a local artist what he had in mind for the walls outside his new office.The resulting mural greets visitors to the Mazmanian Lab today.

A vaguely psychedelic, 40-foot-long, tube-shaped colon that’s pink, purple and red snakes down the hallway. In a panel next to it, fluorescent yellow and green bacteria explode out of a deeply inflamed section of the intestinal tract, like radioactive lava from outer space.The mural is modest compared with what the scientist has been working on since. Over the last decade or so, Mazmanian has been a leading proponent of the idea that the flora of the human digestive tract has a far more powerful effect on the human body and mind than we thought — a scientific effort that earned him a $500,000 MacArthur Fellowship “Genius Grant” in 2012.

Since then, Mazmanian and a small but growing cadre of fellow microbiologists have amassed a tantalizing body of evidence on the microbiome’s role in all kinds of brain disorders, including schizophrenia, Alzheimer’s disease, Parkinson’s disease and depression.But the results they’ve seen in autism could, in the end, prove the most transformative. Autism affects about 1 in 59 children in the U.S., and involves profound social withdrawal, communication problems, and sometimes anxiety and aggression. The causes of the brain disorder have remained speculative.

Now, Mazmanian and other researchers are finding that autism may be inextricably linked to — or even caused by — irregularities in the gut microbiome.A Biology StoryAt 47, Mazmanian — with his shaved head, flannel shirt and skinny jeans — resembles a young, urban hipster on his way to write at the local café. Originally, literary life was his plan. Born in Lebanon to two Armenian refugees, neither of whom had more than a first-grade education, Mazmanian landed in the class of an energetic high school English teacher in California’s San Fernando Valley, where his family first settled.

The teacher recognized his gift for language and encouraged him to pursue a career in literature. Mazmanian enrolled at UCLA in 1990, planning to major in English.Everything changed when he took his first biology class. Hunched over his new, thick textbook in the library, reading about basic biological concepts like photosynthesis, Mazmanian felt a vast new world opening up to him.Sarkis Mazmanian, shown in front of a mural that celebrates the human gut, is part of a group of microbiologists researching the effects of the digestive tract on a range of disorders.

(Credit. Caltech)“For the first time in my life, I wanted to turn the page and see where the story was going to go,” he says. €œI think I decided that minute to become a scientist.”Mazmanian was most fascinated by the idea that tiny organisms, invisible to the naked eye, could function as powerful, self-contained machines — powerful enough to take over and destroy the human body.

After graduating with a degree in microbiology, Mazmanian joined a UCLA infectious diseases lab and began studying bacteria that cause staph infections.As his dissertation defense approached, Mazmanian read a one-page commentary penned by a prominent microbiologist, highlighting the fact that our intestines are teeming with hundreds, if not thousands, of different species of bacteria. But it was still largely unknown what they are and how they affect the human body.When Mazmanian dug further, he found that no one had yet answered what seemed to him to be the most obvious question. Why would the human immune system, designed to attack and destroy foreign invaders, allow hundreds of species of bacteria to live and thrive in our guts unmolested?.

To him, the bacteria’s survival implied that we had evolved to coexist with them. And if that were so, he reasoned, there must be some benefit to both the microbes and the human body — a symbiotic relationship. But what was it?.

Gut InvadersMazmanian set out to study the link between gut microbes and the immune system. As a postdoctoral researcher, he joined the lab of Harvard University infectious disease specialist Dennis Kasper.To start, Mazmanian examined how the immune systems of germ-free mice — lab mice completely protected, starting at birth, from all microbes — differed from those of mice with either few or normal levels of microbes. He expected this initial census would be just a first step in a long and arduous quest for scientific pay dirt.

But when he went to examine a printout of his results in the lab, he realized immediately he might already be onto something big. The germ-free mice had a 30 to 40 percent reduction in a specific type of immune cell known as helper T-cells.This colorized close-up of a mouse’s gut reveals the tight relationship between the gut microbe Bacteroides fragilis (red) and the epithelial surface of the colon (blue). (Credit.

Caltech)Since helper T-cells play a key role in coordinating attacks against invading pathogens, the finding suggested that the immune systems of the germ-free mice were far less robust than those found in peers with normal levels of microbes.“That was exciting, right?. € Mazmanian recalls. €œObviously I repeated it and tested it in a number of different ways.

Then I asked the next question. €˜Can I restore the [immune] function in an adult animal?. €™â€‰â€Mazmanian colonized the guts of the immunocompromised, germ-free mice with microbes from standard lab mice.

After receiving the fecal transplant, their T-cell counts shot up. Within a month, their numbers were identical to mice raised outside the germ-free bubble.Resolving to identify the microorganisms causing this transformation, Mazmanian resorted to trial and error. One by one, he added strains of bacteria found in the guts of mice to the guts of germ-free mice.He got nowhere with the first five or six species he examined.

Then, simply because it was convenient, he decided to test one more that was readily available in his lab. Mazmanian’s adviser, Kasper, had been studying a gut microbe called Bacteroides fragilis. When Mazmanian implanted one of Kasper’s specimens into the gut of his germ-free mice, the results were dramatic.

The T-cell numbers spiked to normal. Eventually, Mazmanian demonstrated he could reproduce this effect simply by adding a single molecule that these bacteria produce, called polysaccharide A, to their guts.“There was no logic in the choice whatsoever,” Mazmanian recalls. €œ[B.

Fragilis] was available, it came from the gut.” In other words, he got lucky.Mazmanian dug deeper and discovered that the biggest impact B. Fragilis had was on the population of a subtype of helper T-cells called regulatory, or suppressor, T-cells. These cells play a key role in preventing the immune system from attacking its host body, protecting against autoimmune or inflammatory diseases.

It was the first time any scientist had demonstrated that a single compound from a single microbe could reverse a specific problem with the immune system.To Mazmanian, the finding, published in 2005 in the journal Cell, alluded to new approaches to treating a wide array of autoimmune, inflammatory and allergic disorders. What if it were possible to help a faulty immune system by tweaking a patient’s microbiome?. It was with this exploration in mind that he arrived in Pasadena in 2006 to set up his lab at Caltech.A Convenient CollaborationA few years later, Mazmanian was having lunch on campus with neuroscientist and colleague Paul Patterson.

Patterson had been preoccupied with a mystery that had, for years, confounded those studying autism in humans. When pregnant mothers have a severe infection in the second trimester, their babies are much more likely to develop autism.As Mazmanian tells it, Patterson was a man of few words, and at lunch Mazmanian was “going on and on” about his own work.“You know,” Patterson interjected thoughtfully, “I think kids with autism have GI issues.”Patterson recalled reading that something like 60 percent of children with autism had some form of clinical GI problem, such as bloating, constipation, flatulence or diarrhea. Was it possible, he wondered, that there was a microbiome connection?.

As they talked, Mazmanian’s excitement grew.A few years earlier, Patterson had discovered that when he exposed pregnant mice to pathogens like the influenza virus, they gave birth to pups that grew up more likely to be startled by loud noises, to shy away from social contact and to groom themselves repetitively — symptoms that resemble those of autism. Patterson was in the process of comparing the brains of these autism-mimicking mice with their neurotypical cousins to see if he could detect any differences that might explain how the maternal immune system was somehow interfering with the pups’ brain development.Mazmanian had a suggestion. The next time Patterson sacrificed one of his autistic mice to study their brains, what if he set the intestines aside for his colleague down the hall?.

When the guts arrived in Mazmanian’s lab, he found that the intestines of the neurotypical mice looked normal. But the guts of the autism-mimicking offspring were almost uniformly inflamed. Could it be that the microbiome was the cause of this inflammation?.

And could that, in turn, be somehow connected to the behavioral symptoms?. Throughout the winter and spring of 2012, Mazmanian and Patterson continued their conversation. Mazmanian found distinct differences in the microbiomes of the mice.

And, they noticed, the mice with the features of autism had leaky gut syndrome, an increased permeability of the gut lining that can allow pathogens and allergens to leach out. This condition had also been reported in children with autism.So Mazmanian and Patterson turned their attention outside the gut. They took blood samples to see if any gut microbes, or the compounds they produce, were circulating in the rest of the body.

They homed in on one molecule in particular, called 4-ethylphenyl sulfate, which was roughly 45 times as abundant in the mice that had symptoms of autism. And it looked familiar. Structurally, it was almost identical to a molecule recently found to be significantly elevated in human children with autism.It was enough to take the next step.

Every day for three weeks, Mazmanian injected the molecule, harvested from the mice with autism-like symptoms, directly into the bloodstream of 5-week-old normal lab mice (the age at which the autistic mice normally developed leaky gut). Then Mazmanian and his team gave them a series of behavioral tests. The mice were far more easily startled and were less comfortable in large empty spaces than their untreated peers, indications of an increase in anxiety-related behaviors commonly seen in the mice with autism-like symptoms.

The researchers published their results in Cell in 2013.Though surprising, the data made sense in some ways. Many drug companies rely on small-molecule drugs that can be taken orally, but still manage to cross the blood-brain barrier and affect behavior. It seemed entirely possible that small molecules, created by bacteria in the gut, could enter the bloodstream and reach the brain.

And they don’t even have to leak out of the gut to do so.Of Mice and MenPatterson died in 2014, at age 70, just six months after the publication of the duo’s groundbreaking Cell paper. Around the same time, a series of parallel experiments in a clinic hundreds of miles away was already paving the way forward. While Patterson and Mazmanian had been working in mice, Rosa Krajmalnik-Brown, a microbiologist at Arizona State University, had teamed up with Jim Adams, who directs the university’s autism and Asperger’s research program, to study humans.The researchers were conducting a detailed analysis of the microbiome of human autism patients and found that the bacteria were far less diverse in the children with autism.

Notably, several important species involved in the digestion of carbohydrates were severely depleted.Krajmalnik-Brown and Adams launched a preliminary trial to test the effects of fecal transplants on 18 children between the ages of 7 and 16 with severe autism, who also had severe GI issues. The researchers administered powerful antibiotics to kill off the microbiomes of the children and followed them with a bowel cleanse. They then replaced the microbes with transplanted flora taken from the guts of healthy neurotypical adult volunteers.The results were better than anyone could have expected.

The procedure resulted in a large reduction in GI symptoms and increased the diversity of bacteria in the children’s guts. But more significantly, their neurological symptoms were reduced. At the onset of the study in 2017, an independent evaluator found 83 percent of participants had severe autism.

Two years after the initial trial, only 17 percent were rated as severely autistic. And 44 percent were no longer on the autism scale.“[My child] did a complete 180,” says Dana Woods, whose then-7-year-old son Ethan enrolled in the initial study five years ago. €œHis ability to communicate is so much different now.

He’s just so much more present. He’s so much more aware. He’s no longer in occupational therapy.

He’s no longer in speech therapy. After the study, he tested two points away from a neurotypical child.”In their first report on the trial in 2017, the team highlighted a number of distinct changes in the microbiome after the transplants, in particular a surge in the populations of three types of bacteria. Among them was a four-fold increase in Bifidobacterium, a probiotic organism that seems to play a key role in the maintenance of a healthy gut.But figuring out what was happening on a cellular level — to really look inside some guts — would require another vehicle.

The ASU team needed Mazmanian’s mice.“At the end of the day, what we care about is healing people and how the microbiome affects people,” explains Krajmalnik-Brown. €œThat’s why we work with people. But with mice you can do things that are more mechanistic.”The Great Mouse Detective(Credit.

Caltech)Together, Krajmalnik-Brown, Mazmanian and their collaborators would uncover some tantalizing new insights that go a long way to solving the mystery. In May 2019, the team published another high-profile paper in Cell, after they transplanted stool samples from Krajmalnik-Brown’s severely autistic patients into the guts of Mazmanian’s germ-free mice. The offspring of these mice showed the autism-like symptoms, such as repetitive and compulsive behavior.This time, the team dug even deeper into the biochemical processes playing out in the brain, looking not just at behavior but at the chemicals involved in creating it.

The mice that developed autism-like behaviors had measurably lower levels of two substances called taurine and 5-aminovaleric acid (5AV). When they dug into the literature, the team learned that these two substances are known to mimic activity of a key signaling agent in the brain called gamma-aminobutyric acid (GABA) — a neurotransmitter that other studies have found is deficient in the brains of children with autism.What’s more, some have speculated that the tendency of children with autism to experience sensory overstimulation may stem from the inability to tamp down overexcited neurons. A lack of GABA could lead to just that.The scientists next orally administered high levels of taurine and 5AV to pregnant mice with the autistic children’s microbiomes.

When their pups were born, the researchers continued to feed the young the substances until they reached adulthood. Compared with untreated animals, the second-generation mice had significantly fewer behavioral symptoms. Taurine reduced repetitive behavior, as measured by marble burying, increased the level of social interaction, and relieved anxiety.

Mice administered 5AV were more active and social.“We healed humans with behavioral problems,” says Krajmalnik-Brown. €œ[And we] transferred some of those deficits and behaviors to mice — basically the opposite. It’s huge.”Mazmanian hopes to take the next step in the months ahead.“I can flip a switch, turn on a light, I know that switch turns on that light.

I don’t know the circuit, I don’t know where the wire is,” Mazmanian says. €œExactly how that’s happening … we just don’t understand that.”This most recent study, by itself, hardly proves that dysregulated microbiomes cause the brain disorder — a point that plenty of other scientists skeptical of Mazmanian’s work are happy to make.“The paper made a big splash, but trying to model psychiatric-related human conditions in mice, in my view, is a little bit of a stretch,” says Sangram Sisodia, a neurobiologist at the University of Chicago who studies the microbiome. €œA mouse with autism?.

€Nor was that the only criticism. Several researchers have suggested that the group didn’t give proper attention to one of their tests ­— one whose results conflicted with their thesis ­— while others found flaws in the statistical methods they used to assess their results. Mazmanian downplays these criticisms, but agrees the work is not yet conclusive.Meanwhile, the ASU trial has also engendered skepticism, mainly due to its tiny sample size, the lack of a control group and the methods by which the children were assessed for autism severity.

Krajmalnik-Brown and Adams say they stand by their results, but agree more research is needed. In recent months, they have launched two new studies that will address these issues.Adams insists the work is already changing lives. €œWe followed up with every one of our 18 participants,” he says, referring to the children who received fecal transplants.

€œSure enough, we found that most of the GI benefits had remained. And family after family said their child just slowly, steadily continued making more improvement.” They published the update in Scientific Reports in spring 2019.“I’m not ready to say the case is closed,” says Mazmanian. €œHealthy skepticism is a good thing.

I believe the preclinical data, I believe the mouse data. But there’s a lot of studies that still need to be done.” A Healthy Gut, A New OutlookEthan Woods had GI issues and symptoms of autism until researchers introduced new microbes to his gut. His mother says the treatment changed everything.

(Credit. Dana Woods)Prior to his fecal transplant at age 7, Ethan Woods suffered from chronic and severe diarrhea, constipation and cramping, symptoms so extreme that to his mother, Dana, he sounded like “a bit like a woman in labor when he was trying to have a bowel movement.” “It was just awful watching your child go through this,” she says, explaining that when she enrolled her autistic son in the Arizona State study, her “only goal was to fix his gut.”Remarkably, Ethan’s agony began to disappear just a few weeks into the trial. But that was not the most dramatic difference.

Before the transplant, Ethan’s speech was drawn out and slow, his language skills rudimentary. He seemed to live in his own bubble. He had frequent outbursts.

For as long as Dana could remember, her mornings with Ethan had been marked by arguing, fighting, pushing and anger. But then one morning, something shocking happened.“He woke me up one morning with his face right in my face with this big smile and he said, ‘Morning, Mom!. €™â€‰â€ she recalls.

€œAnd he was just excited and happy and ready to go about his day with this big smile. It choked me up to the point where I teared up because I had never experienced a happy kid in the morning.”Later, Ethan carried over an iPad and opened an app with a talking cat that repeats back the words children speak aloud. He played back a video recording of himself from just a few weeks earlier.“[He] looks me in the eye and says, ‘Mom, why did I talk like that?.

What is wrong with me?. €™ And as soon as he did that, I caught my breath. I had to compose myself and say, ‘I don’t know.

But do you feel better?. Do you feel different?. Why do you think?.

€™â€‰â€Ethan’s communication skills had already begun to improve. Within a year of the study, his speech therapist graduated him from speech therapy because he had met all his goals.“He went from one end of the rainbow all the way to the other end of the rainbow,” she says. €œPrior to the study, I was very afraid.

My biggest fear was ‘how is he going to navigate the world when I’m not here?. €™ And I think I have a lot of hope now that he is going to be OK now on his own.”.

After watching a parent succumb low cost cialis to the deleterious effects of Alzheimer's disease, it's only natural to wonder if you might be doomed to the same fate. The good news?. That's low cost cialis not necessarily the case.

The bad news, however, is that the disease is so prevalent your overall risk is still relatively high — especially as you age. At 65, you have a roughly 3 percent chance low cost cialis of contracting Alzheimer's disease each year. This bumps up to a 17 percent chance after your 75th birthday, and increases to a roughly one in three chance you'll develop Alzheimer's after the age of 85.

Experts agree that family history elevates the risk, particularly if you have more than one parent or sibling with the disease, but they disagree on how much. Some studies indicate the risk hovers at around 30 percent, while others estimate an up to two or four times increased risk low cost cialis. Early onset Alzheimer's — which typically strikes individuals between the ages of 40 and 65 — has a more easily understood genetic link, with a 50 percent chance the child of an Alzheimer's patient will also be diagnosed with the disease.

Read More:Why low cost cialis Do Women Get Alzheimer’s More Than Men?. How Did Alzheimer's Disease Get Its Name?. Are We Close to Curing Alzheimer’s Disease?.

However, a low cost cialis combination of genetic and environmental factors come into play for the more common late-onset variation, says Rita Guerreiro, a neurogeneticist at the Van Andel Institute. Which makes things even more difficult to predict. €œMany people low cost cialis who have relatives with [Alzheimer's] never develop the disease, and many without a family history of the disease do develop it,” says Guerreiro.Interested in tipping the odds in your favor?.

Some scientists think keeping your mind active, consuming a diet low in red meat and sugar and exercising regularly could help keep the memory-zapping disease at bay.Late fall and early winter typically mean a flurry of holiday travel and get-togethers for a lot of people. But this year will be anything but normal. Making plans is more than a low cost cialis matter of shopping around for flight prices or car rental fees.

Many of us are probably also asking ourselves whether to stay home or see loved ones, and how to stay safe at holiday gatherings. For the low cost cialis lowest risk of spreading or becoming sick with COVID-19, not traveling is the way to go. However, there might be loved ones who desperately need companionship in the coming months.

€œThere are situations where people will choose, and choose correctly, to go and support those family members,” says Lin H. Chen, director of the Travel Medicine Center at low cost cialis Mount Auburn Hospital and president of the International Society of Travel Medicine. No matter if you’re going cross-country to see siblings or staying at home with your dog, experts say, remember two things.

Plan ahead low cost cialis and stay flexible.Tackle Logistics FirstFor those interested in interstate travel, first assess whether or not those plans are feasible. The states you’re going to (and coming back to) might have rules about isolating yourself for two weeks once you arrive. If you live in one of those states but a two-week isolation period isn’t feasible — because you have to go to work or send kids to school, for example — then traveling low cost cialis for the holidays won’t work for you, says Gabriela Andujar Vazquez, an infectious disease doctor at Tufts Medical Center.

Some states say that isolation requirements don’t apply if you get a negative COVID test. But testing you or your whole family may lie outside your budget if the exams aren’t covered by insurance, Andujar Vazquez says. Factor those financial decisions into your low cost cialis travel plans, too.If you do decide to travel, choose driving over flying if you can.

Busy rest stops might mean confronting crowds of other highway travelers, Chen says. However, compared to the entire process of flying — getting to an airport and waiting in lines repeatedly — low cost cialis driving likely means fewer crowds overall. €œThink about precautions through this journey,” Chen says, “not just on the plane, train, bus or car.”Airplanes themselves receive a lot of attention as potential virus spreaders.

But Chen says there are three instances of infected individuals spreading the disease to two or more people on a flight. Those transmissions happened before any airline required passengers to low cost cialis wear masks. Since then, other interventions like leaving seats open, disinfecting often and updated air filtration have been introduced on airplanes, too.

Though there’s no data yet on how effective these combined intervention strategies are, “the fact that we haven’t heard about masked transmission on recent flights is also low cost cialis reassuring,” Chen says. On the Big DayOdds are you’re debating travel plans for the sake of a big family meal. Or even if you’re staying local, you might try and work something out with friends and relatives nearby.

Both Chen and Andujar Vazquez emphasize that no matter which you choose, keep up the COVID-19 precautions once you’re all low cost cialis together. Generally, the smaller the gathering (and the fewer number of households), the better. Keep activities outdoors if you can, seat low cost cialis groups apart, and keep masks on while not eating.

You might also consider new ways to keep everyone fed. The typical buffet serving style can mean a lot of utensil sharing, so maybe opt for single-serving portioning or have everyone wash or sanitize hands before and after touching communal dishes. And as fun as it might be to low cost cialis play bartender, maybe choose a BYOB policy as well.

Oh, and “no one should be coming sick,” Andujar Vazquez says. €œYou cannot say that enough.”These might sound like a lot of holiday modifications, which is why it’s low cost cialis important to discuss what the situation will look like before coming together. €œPeople have to feel comfortable talking about these things, because it’s part of our daily life now,” Andujar Vazquez says.

€œHave that conversation before the event happens so people don’t have unexpected surprises or feel unsafe with some sort of behavior.”At the same time, acknowledge that even the most careful planning might fall apart. Your destination might become a COVID-19 hotspot days before you’re set to arrive, or you or someone in your gathering might start feeling unwell ahead low cost cialis of time. Though it’s easier said than done, accept that plans will change whether you want them to or not — and that celebrations in the coming months will look different than they used to.

€œRealistically, this holiday season is going to be difficult for a lot of people,” says Jonathan Kanter, psychologist and director of the Center for the Science of Social Connection at the University of Washington low cost cialis. In individuals coping with significant life changes, one of the best predictors of depression is whether or not people can leave former goals behind and adopt new ones, Kanter says. Letting go of old expectations — like how you low cost cialis normally gather with family, for example — can involve a kind of grieving process.

But recalibrating what you want to get out of a situation is an essential coping skill. €œYou won’t be able to get there unless you breathe and accept that you’re in a new context,” Kanter says. €œWith that acceptance, hopefully there's a lot of creativity and innovation and grace about how to make low cost cialis it as successful as possible.” The prospect of not seeing loved ones in the coming months might make some people nervous, for themselves and for others.

What's important to remember is that it's possible to make it through — and that future holidays will get better.As flu season creeps up on the Northern Hemisphere, cold and flu relief medications will inevitably fly off store shelves. A natural remedy that low cost cialis shoppers might reach for is elderberry, a small, blackish-purple fruit that companies turn into syrups, lozenges and gummies. Though therapeutic uses of the berry date back centuries, Michael Macknin, a pediatrician at the Cleveland Clinic, hadn’t heard of using elderberry to treat the flu until a patient’s mother asked him about it.

Some industry-sponsored research claims that the herbal remedy could cut the length of the symptoms by up to four days. For a comparison, Tamiflu, an FDA-approved treatment, only reduces low cost cialis flu duration by about a single day. €œI said, 'Gee, if that’s really true [about elderberry], it would be a huge benefit,'” Macknin says.

But the low cost cialis effectiveness and safety of elderberry is still fairly unclear. Unlike the over-the-counter medicines at your local pharmacy, elderberry hasn't been through rigorous FDA testing and approval. However, Macknin and his team recently published a study in the Journal of General Internal Medicine, which found that elderberry treatments did nothing for flu patients.

This prompts a need for low cost cialis further studies into the remedy — work that unfortunately stands a low chance of happening in the future, Macknin says. Looking For ProofElderberries are full of chemicals that could be good for your health. Like similar fruits, the berries contain high levels of antioxidants, compounds that shut down reactions in our bodies that damage cells low cost cialis.

But whether or not elderberry's properties also help immune systems fend off a virus is murky. There are only a handful of studies that have examined if elderberries reduced the severity or duration of the flu. And though some of the work prior to Macknin’s was well-designed and supported this herbal remedy as a helpful low cost cialis flu aid, at least some — and potentially all — of those studies were funded by elderberry treatment manufacturers.Macknin says an elderberry supplement company provided his team with their products and a placebo version for free, but that the company wasn’t involved in the research beyond that.

Macknin's study is the largest one conducted on elderberry to date, with 87 influenza patients completing the entire treatment course. Participants in the study were also welcome to take Tamiflu, for ethical low cost cialis reasons, as the team didn’t want to exclude anyone from taking a proven flu therapy. Additionally, each participant took home either a bottle of elderberry syrup or the placebo with instructions on when and how to take it.

The research team called participants every day for a symptom check and to remind them to take their medication.By chance, it turned out that a higher percentage of the patients given elderberry syrup had gotten their flu shot and also chose to take Tamiflu. Since the vaccination can reduce the severity of infection in low cost cialis recipients who still come down with the flu, the study coincidentally operated in favor of those who took the herbal remedy, Macknin says. Those patients could have dealt with a shorter, less-intense illness because of the Tamiflu and vaccination.

€œEverything was low cost cialis stacked to have it turn out better [for the elderberry group],” Macknin says, “and it turned out the same.” The researchers found no difference in illness duration or severity between the elderberry and placebo groups. While analyzing the data, the team also found that those on the herbal treatment might have actually fared worse than those on the placebo. The potential for this intervention to low cost cialis actually harm instead of help influenza patients explains why Macknin thinks the therapy needs further research.But, don't expect that work to happen any time soon.

Researchers are faced with a number of challenges when it comes to studying the efficacy of herbal remedies. For starters, there's little financial incentive to investigate if they actually work. Plant products are challenging to patent, making them less lucrative prospects for pharmaceutical companies or low cost cialis research organizations to investigate.

Additionally, investigations that try and prove a proposed therapy as an effective drug — like the one Macknin and his team accomplished — are expensive, Macknin says. Those projects low cost cialis need FDA oversight and additional paperwork, components that drive up study costs. €œIt’s extraordinarily expensive and there’s no money in it for anybody,” Macknin says.Talk To Your DoctorUltimately, research on elderberry therapies for flu patients is a mixed bag, and deserves more attention from scientists.

However, if you still want to discuss elderberry treatments for the flu with your doctor, that’s a conversation you should feel comfortable having, says Erica McIntyre, an expert focused on health and environmental psychology in the School of Public Health at the University of Technology Sydney. Navigating what low cost cialis research says about a particular herbal medicine is challenging for patients and health practitioners alike. The process is made more complex by the range of similar-sounding products on the market that lack standardized ingredients, McIntyre says.

But when doctors judge or shame patients for asking about non-conventional healthcare interventions, the response can distance people and low cost cialis push them closer to potentially unproven treatments. Even worse, those individuals might start to keep their herbal remedies a secret. €œIt is that fear about being judged for use of that medication,” McIntyre says, that drives up to 50 percent of people taking herbal treatments to withhold that information from healthcare practitioners.

That’s a dangerous choice, as some herbal and traditional medications can interact and cause health problems.If a physician shames someone for asking about alternative medicines, it’s low cost cialis likely time to find a new doctor, McIntyre says. Look for someone who will listen to your concerns — whether it's that you feel traditional treatments haven’t worked for you, or that you didn’t like the side effects, the two common reasons people pursue herbal treatments in the first place. €œYou’re not necessarily looking for a doctor that will let you do whatever you want,” McIntyre says, “but that they actually consider you as a patient, your treatment choices and your treatment priorities, and communicate in a way that’s supportive.” And if a doctor suggests that you avoid a treatment you’re interested low cost cialis in, ask why.

They generally have a good reason, McIntyre says.For now, know that even if your doctor doesn’t support you taking elderberry, there are other proven preventative measures that are worth your while — like the flu shot. Anyone six months or older should get it, Macknin says, and stick to the protocols we’re used to following to prevent COVID-19 infections, like social distancing, mask-wearing and hand-washing. Those measures also help prevent flu low cost cialis transmission, too — something, so far, no elderberry supplement package can claim.The yearly influenza season threatens to make the COVID-19 pandemic doubly deadly, but I believe that this isn’t inevitable.There are two commonly given vaccines – the pneumococcal vaccine and the Hib vaccine – that protect against bacterial pneumonias.

These bacteria complicate both influenza and COVID-19, often leading to death. My examination of disease trends and vaccination rates leads me to believe that broader use of the pneumococcal and Hib vaccines could guard against the worst effects of a COVID-19 illness.I am an immunologist low cost cialis and physiologist interested in the effects of combined infections on immunity. I have reached my insight by juxtaposing two seemingly unrelated puzzles.

Infants and children get SARS-CoV-2, the virus that causes COVID-19, but very rarely become hospitalized or die. And case numbers and death rates from COVID-19 began varying greatly from nation to nation and city to city even before lockdowns began low cost cialis. I wondered why.One night I woke up with a possible answer.

Vaccination rates low cost cialis. Most children, beginning at age two months, are vaccinated against numerous diseases. Adults less low cost cialis so.

And, both infant and adult vaccination rates vary widely across the world. Could differences in the rates of vaccination against one or more diseases account for differences in COVID-19 risks?. As someone who had previously investigated other pandemics such as the Great Flu Pandemic of 1918-19 and AIDS, and who has worked with vaccines, I had a strong background for tracking down the relevant data to test my hypothesis.Pneumococcal Vaccination Rates Correlate With Lower COVID-19 Cases and DeathsI gathered low cost cialis national and some local data on vaccination rates against influenza, polio, measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), tuberculosis (BCG), pneumococci and Haemophilus influenzae type B (Hib).

I correlated them with COVID-19 case rates and death rates for 24 nations that had experienced their COVID-19 outbreaks at about the same time. I controlled low cost cialis for factors such as percentage of the population who were obese, diabetic or elderly.I found that only pneumococcal vaccines afforded statistically significant protection against COVID-19. Nations such as Spain, Italy, Belgium, Brazil, Peru and Chile that have the highest COVID-19 rates per million have the poorest pneumococcal vaccination rates among both infants and adults.

Nations with the lowest rates of COVID-19 – Japan, Korea, Denmark, Australia and New Zealand – have the highest rates of pneumococcal vaccination among both infants and adults.A recent preprint study (not yet peer-reviewed) from researchers at the Mayo Clinic has also reported very strong associations between pneumococcal vaccination and protection against COVID-19. This is especially true low cost cialis among minority patients who are bearing the brunt of the coronavirus pandemic. The report also suggests that other vaccines, or combinations of vaccines, such as Hib and MMR may also provide protection.These results are important because in the U.S., childhood vaccination against pneumococci – which protects against Streptococcus pneumoniae bacteria – varies by state from 74% to 92%.

Although the CDC recommends that all adults 18-64 in high risk groups for COVID-19 and all adults over the age of 65 get a pneumococcal vaccination, only 23% of high-risk adults and 64% of those over the age of 65 do so.Similarly, although the CDC recommends at all infants and some high-risk adults be vaccinated against Haemophilus influenzae type low cost cialis B (Hib), only 80.7% of children in the U.S. And a handful of immunologically compromised adults have been. Pneumococcal and Hib vaccination rates are significantly lower in minority populations in the U.S.

And in countries that have been hit harder by COVID-19 than the U.S.Based on these data, I advocate universal pneumococcal and Hib vaccination among children, at-risk adults and all adults over 65 to prevent low cost cialis serious COVID-19 disease.Left. Combined rates of childhood and adult (over 65) pneumococcal vaccination (out of a possible 200). Right.

Cases (per million) population of COVID-19 at about 90 days into the pandemic for 24 nations. Nations with high pneumococcal vaccination rates have low COVID-19 case rates. (Credit.

CC BY-SA)How Pneumococcal Vaccination Protects Against COVID-19Protection against serious COVID-19 disease by pneumococcal and Hib vaccines makes sense for several reasons. First, recent studies reveal that the majority of hospitalized COVID-19 patients, and in some studies nearly all, are infected with streptococci, which causes pneumococcal pneumonias, Hib or other pneumonia-causing bacteria. Pneumococcal and Hib vaccinations should protect coronavirus patients from these infections and thus significantly cut the risk of serious pneumonia.I also found that pneumococcal, Hib and possibly rubella vaccines may confer specific protection against the SARS-CoV-2 virus that causes COVID-19 by means of “molecular mimicry.”Molecular mimicry occurs when the immune system thinks one microbe looks like another.

In this case, proteins found in pneumococcal vaccines and, to a lesser degree, ones found in Hib and rubella vaccines as well look like several proteins produced by the SARS-CoV-2 virus.Two of these proteins found in pneumococcal vaccines mimic the spike and membrane proteins that permit the virus to infect cells. This suggests pneumococcal vaccination may prevent SARS-CoV-2 infection. Two other mimics are the nucleoprotein and replicase that control virus replication.

These proteins are made after viral infection, in which case pneumococcal vaccination may control, but not prevent, SARS-CoV-2 replication.Either way, these vaccines may provide proxy protection against SARS-CoV-2 infection that we can implement right now, even before we have a specific virus vaccine. Such protection may not be complete. People might still suffer a weakened version of COVID-19 but, like most infants and children, be protected against the worst effects of the infection.Fighting Influenza-related Pneumonias During the COVID-19 PandemicWhile the specific protection these other vaccines confer against COVID-19 has not yet been tested in a clinical trial, I advocate broader implementation of pneumococcal and Hib vaccination for one additional, well-validated reason.Pneumococcal and Hib pneumonias – both caused by bacteria – are the major causes of death following viral influenza.

The influenza virus rarely causes death directly. Most often, the virus makes the lungs more susceptible to bacterial pneumonias, which are deadly. Dozens of studies around the world have demonstrated that increasing rates of pneumococcal and Hib vaccination dramatically lowers influenza-related pneumonias.Similar studies demonstrate that the price of using these vaccines is balanced by savings due to lower rates of influenza-related hospitalizations, intensive care unit admissions and deaths.

In the context of COVID-19, lowering rates of influenza-related hospitalizations and ICU admissions would free up resources to fight the coronavirus, independent of any effect these vaccines might have on SARS-CoV-2 itself. In my opinion, that is a winning scenario.In short, we need not wait for a SARS-CoV-2 vaccine to slow down COVID-19.I believe that we can and should act now by fighting the coronavirus with all the tools at our disposal, including influenza, Hib, pneumococcal and perhaps rubella vaccinations.Preventing pneumococcal and Hib complications of influenza and COVID-19, and perhaps proxy-vaccinating against SARS-CoV-2 itself, helps everyone. Administering these already available and well-tested pneumococcal and Hib vaccines to people will save money by freeing up hospital beds and ICUs.

It will also improve public health by reducing the spread of multiple infections and boost the economy by nurturing a healthier population.Robert Root-Bernstein is a Professor of Physiology at Michigan State University. This article was originally published on The Conversation under a Creative Commons liscense Read the original here.This story appeared in the November 2020 issue as "Bacteria and the Brain." Subscribe to Discover magazine for more stories like this.It’s not always easy to convince people that the human gut is a sublime and wondrous place worthy of special attention. Sarkis Mazmanian discovered that soon after arriving at Caltech for his first faculty job 14 years ago, when he explained to a local artist what he had in mind for the walls outside his new office.The resulting mural greets visitors to the Mazmanian Lab today.

A vaguely psychedelic, 40-foot-long, tube-shaped colon that’s pink, purple and red snakes down the hallway. In a panel next to it, fluorescent yellow and green bacteria explode out of a deeply inflamed section of the intestinal tract, like radioactive lava from outer space.The mural is modest compared with what the scientist has been working on since. Over the last decade or so, Mazmanian has been a leading proponent of the idea that the flora of the human digestive tract has a far more powerful effect on the human body and mind than we thought — a scientific effort that earned him a $500,000 MacArthur Fellowship “Genius Grant” in 2012.

Since then, Mazmanian and a small but growing cadre of fellow microbiologists have amassed a tantalizing body of evidence on the microbiome’s role in all kinds of brain disorders, including schizophrenia, Alzheimer’s disease, Parkinson’s disease and depression.But the results they’ve seen in autism could, in the end, prove the most transformative. Autism affects about 1 in 59 children in the U.S., and involves profound social withdrawal, communication problems, and sometimes anxiety and aggression. The causes of the brain disorder have remained speculative.

Now, Mazmanian and other researchers are finding that autism may be inextricably linked to — or even caused by — irregularities in the gut microbiome.A Biology StoryAt 47, Mazmanian — with his shaved head, flannel shirt and skinny jeans — resembles a young, urban hipster on his way to write at the local café. Originally, literary life was his plan. Born in Lebanon to two Armenian refugees, neither of whom had more than a first-grade education, Mazmanian landed in the class of an energetic high school English teacher in California’s San Fernando Valley, where his family first settled.

The teacher recognized his gift for language and encouraged him to pursue a career in literature. Mazmanian enrolled at UCLA in 1990, planning to major in English.Everything changed when he took his first biology class. Hunched over his new, thick textbook in the library, reading about basic biological concepts like photosynthesis, Mazmanian felt a vast new world opening up to him.Sarkis Mazmanian, shown in front of a mural that celebrates the human gut, is part of a group of microbiologists researching the effects of the digestive tract on a range of disorders.

(Credit. Caltech)“For the first time in my life, I wanted to turn the page and see where the story was going to go,” he says. €œI think I decided that minute to become a scientist.”Mazmanian was most fascinated by the idea that tiny organisms, invisible to the naked eye, could function as powerful, self-contained machines — powerful enough to take over and destroy the human body.

After graduating with a degree in microbiology, Mazmanian joined a UCLA infectious diseases lab and began studying bacteria that cause staph infections.As his dissertation defense approached, Mazmanian read a one-page commentary penned by a prominent microbiologist, highlighting the fact that our intestines are teeming with hundreds, if not thousands, of different species of bacteria. But it was still largely unknown what they are and how they affect the human body.When Mazmanian dug further, he found that no one had yet answered what seemed to him to be the most obvious question. Why would the human immune system, designed to attack and destroy foreign invaders, allow hundreds of species of bacteria to live and thrive in our guts unmolested?.

To him, the bacteria’s survival implied that we had evolved to coexist with them. And if that were so, he reasoned, there must be some benefit to both the microbes and the human body — a symbiotic relationship. But what was it?.

Gut InvadersMazmanian set out to study the link between gut microbes and the immune system. As a postdoctoral researcher, he joined the lab of Harvard University infectious disease specialist Dennis Kasper.To start, Mazmanian examined how the immune systems of germ-free mice — lab mice completely protected, starting at birth, from all microbes — differed from those of mice with either few or normal levels of microbes. He expected this initial census would be just a first step in a long and arduous quest for scientific pay dirt.

But when he went to examine a printout of his results in the lab, he realized immediately he might already be onto something big. The germ-free mice had a 30 to 40 percent reduction in a specific type of immune cell known as helper T-cells.This colorized close-up of a mouse’s gut reveals the tight relationship between the gut microbe Bacteroides fragilis (red) and the epithelial surface of the colon (blue). (Credit.

Caltech)Since helper T-cells play a key role in coordinating attacks against invading pathogens, the finding suggested that the immune systems of the germ-free mice were far less robust than those found in peers with normal levels of microbes.“That was exciting, right?. € Mazmanian recalls. €œObviously I repeated it and tested it in a number of different ways.

Then I asked the next question. €˜Can I restore the [immune] function in an adult animal?. €™â€‰â€Mazmanian colonized the guts of the immunocompromised, germ-free mice with microbes from standard lab mice.

After receiving the fecal transplant, their T-cell counts shot up. Within a month, their numbers were identical to mice raised outside the germ-free bubble.Resolving to identify the microorganisms causing this transformation, Mazmanian resorted to trial and error. One by one, he added strains of bacteria found in the guts of mice to the guts of germ-free mice.He got nowhere with the first five or six species he examined.

Then, simply because it was convenient, he decided to test one more that was readily available in his lab. Mazmanian’s adviser, Kasper, had been studying a gut microbe called Bacteroides fragilis. When Mazmanian implanted one of Kasper’s specimens into the gut of his germ-free mice, the results were dramatic.

The T-cell numbers spiked to normal. Eventually, Mazmanian demonstrated he could reproduce this effect simply by adding a single molecule that these bacteria produce, called polysaccharide A, to their guts.“There was no logic in the choice whatsoever,” Mazmanian recalls. €œ[B.

Fragilis] was available, it came from the gut.” In other words, he got lucky.Mazmanian dug deeper and discovered that the biggest impact B. Fragilis had was on the population of a subtype of helper T-cells called regulatory, or suppressor, T-cells. These cells play a key role in preventing the immune system from attacking its host body, protecting against autoimmune or inflammatory diseases.

It was the first time any scientist had demonstrated that a single compound from a single microbe could reverse a specific problem with the immune system.To Mazmanian, the finding, published in 2005 in the journal Cell, alluded to new approaches to treating a wide array of autoimmune, inflammatory and allergic disorders. What if it were possible to help a faulty immune system by tweaking a patient’s microbiome?. It was with this exploration in mind that he arrived in Pasadena in 2006 to set up his lab at Caltech.A Convenient CollaborationA few years later, Mazmanian was having lunch on campus with neuroscientist and colleague Paul Patterson.

Patterson had been preoccupied with a mystery that had, for years, confounded those studying autism in humans. When pregnant mothers have a severe infection in the second trimester, their babies are much more likely to develop autism.As Mazmanian tells it, Patterson was a man of few words, and at lunch Mazmanian was “going on and on” about his own work.“You know,” Patterson interjected thoughtfully, “I think kids with autism have GI issues.”Patterson recalled reading that something like 60 percent of children with autism had some form of clinical GI problem, such as bloating, constipation, flatulence or diarrhea. Was it possible, he wondered, that there was a microbiome connection?.

As they talked, Mazmanian’s excitement grew.A few years earlier, Patterson had discovered that when he exposed pregnant mice to pathogens like the influenza virus, they gave birth to pups that grew up more likely to be startled by loud noises, to shy away from social contact and to groom themselves repetitively — symptoms that resemble those of autism. Patterson was in the process of comparing the brains of these autism-mimicking mice with their neurotypical cousins to see if he could detect any differences that might explain how the maternal immune system was somehow interfering with the pups’ brain development.Mazmanian had a suggestion. The next time Patterson sacrificed one of his autistic mice to study their brains, what if he set the intestines aside for his colleague down the hall?.

When the guts arrived in Mazmanian’s lab, he found that the intestines of the neurotypical mice looked normal. But the guts of the autism-mimicking offspring were almost uniformly inflamed. Could it be that the microbiome was the cause of this inflammation?.

And could that, in turn, be somehow connected to the behavioral symptoms?. Throughout the winter and spring of 2012, Mazmanian and Patterson continued their conversation. Mazmanian found distinct differences in the microbiomes of the mice.

And, they noticed, the mice with the features of autism had leaky gut syndrome, an increased permeability of the gut lining that can allow pathogens and allergens to leach out. This condition had also been reported in children with autism.So Mazmanian and Patterson turned their attention outside the gut. They took blood samples to see if any gut microbes, or the compounds they produce, were circulating in the rest of the body.

They homed in on one molecule in particular, called 4-ethylphenyl sulfate, which was roughly 45 times as abundant in the mice that had symptoms of autism. And it looked familiar. Structurally, it was almost identical to a molecule recently found to be significantly elevated in human children with autism.It was enough to take the next step.

Every day for three weeks, Mazmanian injected the molecule, harvested from the mice with autism-like symptoms, directly into the bloodstream of 5-week-old normal lab mice (the age at which the autistic mice normally developed leaky gut). Then Mazmanian and his team gave them a series of behavioral tests. The mice were far more easily startled and were less comfortable in large empty spaces than their untreated peers, indications of an increase in anxiety-related behaviors commonly seen in the mice with autism-like symptoms.

The researchers published their results in Cell in 2013.Though surprising, the data made sense in some ways. Many drug companies rely on small-molecule drugs that can be taken orally, but still manage to cross the blood-brain barrier and affect behavior. It seemed entirely possible that small molecules, created by bacteria in the gut, could enter the bloodstream and reach the brain.

And they don’t even have to leak out of the gut to do so.Of Mice and MenPatterson died in 2014, at age 70, just six months after the publication of the duo’s groundbreaking Cell paper. Around the same time, a series of parallel experiments in a clinic hundreds of miles away was already paving the way forward. While Patterson and Mazmanian had been working in mice, Rosa Krajmalnik-Brown, a microbiologist at Arizona State University, had teamed up with Jim Adams, who directs the university’s autism and Asperger’s research program, to study humans.The researchers were conducting a detailed analysis of the microbiome of human autism patients and found that the bacteria were far less diverse in the children with autism.

Notably, several important species involved in the digestion of carbohydrates were severely depleted.Krajmalnik-Brown and Adams launched a preliminary trial to test the effects of fecal transplants on 18 children between the ages of 7 and 16 with severe autism, who also had severe GI issues. The researchers administered powerful antibiotics to kill off the microbiomes of the children and followed them with a bowel cleanse. They then replaced the microbes with transplanted flora taken from the guts of healthy neurotypical adult volunteers.The results were better than anyone could have expected.

The procedure resulted in a large reduction in GI symptoms and increased the diversity of bacteria in the children’s guts. But more significantly, their neurological symptoms were reduced. At the onset of the study in 2017, an independent evaluator found 83 percent of participants had severe autism.

Two years after the initial trial, only 17 percent were rated as severely autistic. And 44 percent were no longer on the autism scale.“[My child] did a complete 180,” says Dana Woods, whose then-7-year-old son Ethan enrolled in the initial study five years ago. €œHis ability to communicate is so much different now.

He’s just so much more present. He’s so much more aware. He’s no longer in occupational therapy.

He’s no longer in speech therapy. After the study, he tested two points away from a neurotypical child.”In their first report on the trial in 2017, the team highlighted a number of distinct changes in the microbiome after the transplants, in particular a surge in the populations of three types of bacteria. Among them was a four-fold increase in Bifidobacterium, a probiotic organism that seems to play a key role in the maintenance of a healthy gut.But figuring out what was happening on a cellular level — to really look inside some guts — would require another vehicle.

The ASU team needed Mazmanian’s mice.“At the end of the day, what we care about is healing people and how the microbiome affects people,” explains Krajmalnik-Brown. €œThat’s why we work with people. But with mice you can do things that are more mechanistic.”The Great Mouse Detective(Credit.

Caltech)Together, Krajmalnik-Brown, Mazmanian and their collaborators would uncover some tantalizing new insights that go a long way to solving the mystery. In May 2019, the team published another high-profile paper in Cell, after they transplanted stool samples from Krajmalnik-Brown’s severely autistic patients into the guts of Mazmanian’s germ-free mice. The offspring of these mice showed the autism-like symptoms, such as repetitive and compulsive behavior.This time, the team dug even deeper into the biochemical processes playing out in the brain, looking not just at behavior but at the chemicals involved in creating it.

The mice that developed autism-like behaviors had measurably lower levels of two substances called taurine and 5-aminovaleric acid (5AV). When they dug into the literature, the team learned that these two substances are known to mimic activity of a key signaling agent in the brain called gamma-aminobutyric acid (GABA) — a neurotransmitter that other studies have found is deficient in the brains of children with autism.What’s more, some have speculated that the tendency of children with autism to experience sensory overstimulation may stem from the inability to tamp down overexcited neurons. A lack of GABA could lead to just that.The scientists next orally administered high levels of taurine and 5AV to pregnant mice with the autistic children’s microbiomes.

When their pups were born, the researchers continued to feed the young the substances until they reached adulthood. Compared with untreated animals, the second-generation mice had significantly fewer behavioral symptoms. Taurine reduced repetitive behavior, as measured by marble burying, increased the level of social interaction, and relieved anxiety.

Mice administered 5AV were more active and social.“We healed humans with behavioral problems,” says Krajmalnik-Brown. €œ[And we] transferred some of those deficits and behaviors to mice — basically the opposite. It’s huge.”Mazmanian hopes to take the next step in the months ahead.“I can flip a switch, turn on a light, I know that switch turns on that light.

I don’t know the circuit, I don’t know where the wire is,” Mazmanian says. €œExactly how that’s happening … we just don’t understand that.”This most recent study, by itself, hardly proves that dysregulated microbiomes cause the brain disorder — a point that plenty of other scientists skeptical of Mazmanian’s work are happy to make.“The paper made a big splash, but trying to model psychiatric-related human conditions in mice, in my view, is a little bit of a stretch,” says Sangram Sisodia, a neurobiologist at the University of Chicago who studies the microbiome. €œA mouse with autism?.

€Nor was that the only criticism. Several researchers have suggested that the group didn’t give proper attention to one of their tests ­— one whose results conflicted with their thesis ­— while others found flaws in the statistical methods they used to assess their results. Mazmanian downplays these criticisms, but agrees the work is not yet conclusive.Meanwhile, the ASU trial has also engendered skepticism, mainly due to its tiny sample size, the lack of a control group and the methods by which the children were assessed for autism severity.

Krajmalnik-Brown and Adams say they stand by their results, but agree more research is needed. In recent months, they have launched two new studies that will address these issues.Adams insists the work is already changing lives. €œWe followed up with every one of our 18 participants,” he says, referring to the children who received fecal transplants.

€œSure enough, we found that most of the GI benefits had remained. And family after family said their child just slowly, steadily continued making more improvement.” They published the update in Scientific Reports in spring 2019.“I’m not ready to say the case is closed,” says Mazmanian. €œHealthy skepticism is a good thing.

I believe the preclinical data, I believe the mouse data. But there’s a lot of studies that still need to be done.” A Healthy Gut, A New OutlookEthan Woods had GI issues and symptoms of autism until researchers introduced new microbes to his gut. His mother says the treatment changed everything.

(Credit. Dana Woods)Prior to his fecal transplant at age 7, Ethan Woods suffered from chronic and severe diarrhea, constipation and cramping, symptoms so extreme that to his mother, Dana, he sounded like “a bit like a woman in labor when he was trying to have a bowel movement.” “It was just awful watching your child go through this,” she says, explaining that when she enrolled her autistic son in the Arizona State study, her “only goal was to fix his gut.”Remarkably, Ethan’s agony began to disappear just a few weeks into the trial. But that was not the most dramatic difference.

Before the transplant, Ethan’s speech was drawn out and slow, his language skills rudimentary. He seemed to live in his own bubble. He had frequent outbursts.

For as long as Dana could remember, her mornings with Ethan had been marked by arguing, fighting, pushing and anger. But then one morning, something shocking happened.“He woke me up one morning with his face right in my face with this big smile and he said, ‘Morning, Mom!. €™â€‰â€ she recalls.

€œAnd he was just excited and happy and ready to go about his day with this big smile. It choked me up to the point where I teared up because I had never experienced a happy kid in the morning.”Later, Ethan carried over an iPad and opened an app with a talking cat that repeats back the words children speak aloud. He played back a video recording of himself from just a few weeks earlier.“[He] looks me in the eye and says, ‘Mom, why did I talk like that?.

What is wrong with me?. €™ And as soon as he did that, I caught my breath. I had to compose myself and say, ‘I don’t know.

But do you feel better?. Do you feel different?. Why do you think?.

€™â€‰â€Ethan’s communication skills had already begun to improve. Within a year of the study, his speech therapist graduated him from speech therapy because he had met all his goals.“He went from one end of the rainbow all the way to the other end of the rainbow,” she says. €œPrior to the study, I was very afraid.

My biggest fear was ‘how is he going to navigate the world when I’m not here?. €™ And I think I have a lot of hope now that he is going to be OK now on his own.”.

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Cialis jelly review

NONE

Patients Figure i thought about this 1 cialis jelly review. Figure 1 cialis jelly review. Enrollment and Randomization.

Of the 1107 patients who were assessed for cialis jelly review eligibility, 1063 underwent randomization. 541 were assigned to the remdesivir group and 522 to the placebo group (Figure 1). Of those assigned to receive cialis jelly review remdesivir, 531 patients (98.2%) received the treatment as assigned.

Forty-nine patients had remdesivir treatment discontinued before day 10 because of an adverse event or a serious adverse event other than death (36 patients) or because the patient withdrew consent (13). Of those assigned to receive placebo, 518 patients (99.2%) received placebo as cialis jelly review assigned. Fifty-three patients discontinued placebo before day 10 because of an adverse event or a serious adverse event other than death (36 patients), because the patient withdrew consent (15), or because the patient was found to be ineligible for trial enrollment (2).

As of cialis jelly review April 28, 2020, a total of 391 patients in the remdesivir group and 340 in the placebo group had completed the trial through day 29, recovered, or died. Eight patients who received remdesivir and 9 who received placebo terminated their participation in the trial before day 29. There were 132 patients in the remdesivir group cialis jelly review and 169 in the placebo group who had not recovered and had not completed the day 29 follow-up visit.

The analysis population included 1059 patients for whom we have at least some postbaseline data available (538 in the remdesivir group and 521 in the placebo group). Four of the 1063 patients were not included in the primary analysis because cialis jelly review no postbaseline data were available at the time of the database freeze. Table 1.

Table 1 cialis jelly review. Demographic and Clinical Characteristics at Baseline. The mean cialis jelly review age of patients was 58.9 years, and 64.3% were male (Table 1).

On the basis of the evolving epidemiology of Covid-19 during the trial, 79.8% of patients were enrolled at sites in North America, 15.3% in Europe, and 4.9% in Asia (Table S1). Overall, 53.2% of the patients were white, 20.6% were black, 12.6% were Asian, and 13.6% were designated as other cialis jelly review or not reported. 249 (23.4%) were Hispanic or Latino.

Most patients had either one (27.0%) or two or more (52.1%) of the prespecified coexisting cialis jelly review conditions at enrollment, most commonly hypertension (49.6%), obesity (37.0%), and type 2 diabetes mellitus (29.7%). The median number of cialis jelly review days between symptom onset and randomization was 9 (interquartile range, 6 to 12). Nine hundred forty-three (88.7%) patients had severe disease at enrollment as defined in the Supplementary Appendix.

272 (25.6%) patients met category 7 criteria on the ordinal scale, 197 (18.5%) category 6, 421 (39.6%) category cialis jelly review 5, and 127 (11.9%) category 4. There were 46 (4.3%) patients who had missing ordinal scale data at enrollment. No substantial imbalances in baseline cialis jelly review characteristics were observed between the remdesivir group and the placebo group.

Primary Outcome Figure 2. Figure 2 cialis jelly review. Kaplan–Meier Estimates of Cumulative Recoveries.

Cumulative recovery estimates are shown in the overall population (Panel A), in cialis jelly review patients with a baseline score of 4 on the ordinal scale (not receiving oxygen. Panel B), in those with a baseline score of 5 (receiving oxygen. Panel C), in those with a baseline cialis jelly review score of 6 (receiving high-flow oxygen or noninvasive mechanical ventilation.

Panel D), and in those with a baseline score of 7 (receiving mechanical ventilation or ECMO. Panel E) cialis jelly review. Table 2.

Table 2 cialis jelly review. Outcomes Overall and According to Score on the Ordinal Scale in the Intention-to-Treat Population. Figure cialis jelly review 3.

Figure 3. Time to cialis jelly review Recovery According to Subgroup. The widths of the confidence intervals have not been adjusted for multiplicity and therefore cannot be used to infer treatment effects.

Race and ethnic group cialis jelly review were reported by the patients. Patients in the remdesivir group cialis jelly review had a shorter time to recovery than patients in the placebo group (median, 11 days, as compared with 15 days. Rate ratio for recovery, 1.32.

95% confidence interval [CI], 1.12 to cialis jelly review 1.55. P<0.001. 1059 patients (Figure 2 and cialis jelly review Table 2).

Among patients with a baseline ordinal score of 5 (421 patients), the rate ratio for recovery was 1.47 (95% CI, 1.17 to 1.84). Among patients with a baseline score cialis jelly review of 4 (127 patients) and those with a baseline score of 6 (197 patients), the rate ratio estimates for recovery were 1.38 (95% CI, 0.94 to 2.03) and 1.20 (95% CI, 0.79 to 1.81), respectively. For those receiving mechanical ventilation or ECMO at enrollment (baseline ordinal scores of 7.

272 patients), the rate ratio for cialis jelly review recovery was 0.95 (95% CI, 0.64 to 1.42). A test of interaction of treatment with baseline score on the ordinal scale was not significant. An analysis adjusting for baseline cialis jelly review ordinal score as a stratification variable was conducted to evaluate the overall effect (of the percentage of patients in each ordinal score category at baseline) on the primary outcome.

This adjusted analysis produced a similar treatment-effect estimate (rate ratio for recovery, 1.31. 95% CI, cialis jelly review 1.12 to 1.54. 1017 patients).

Table S2 in the Supplementary Appendix cialis jelly review shows results according to the baseline severity stratum of mild-to-moderate as compared with severe. Patients who underwent randomization during the first 10 days after the onset of symptoms had a rate ratio for recovery of 1.28 (95% CI, 1.05 to 1.57. 664 patients), whereas patients who underwent randomization more than 10 days after the onset of symptoms had a rate ratio cialis jelly review for recovery of 1.38 (95% CI, 1.05 to 1.81.

380 patients) (Figure 3). Key Secondary Outcome The odds of improvement in the ordinal scale score were higher in the remdesivir group, as cialis jelly review determined by a proportional odds model at the day 15 visit, than in the placebo group (odds ratio for improvement, 1.50. 95% CI, 1.18 to cialis jelly review 1.91.

P=0.001. 844 patients) cialis jelly review (Table 2 and Fig. S5).

Mortality was numerically lower in the remdesivir group than cialis jelly review in the placebo group, but the difference was not significant (hazard ratio for death, 0.70. 95% CI, 0.47 to 1.04. 1059 patients) cialis jelly review.

The Kaplan–Meier estimates of mortality by 14 days were 7.1% and 11.9% in the remdesivir and placebo groups, respectively (Table 2). The Kaplan–Meier estimates of mortality by 28 days are not reported in this preliminary analysis, given the large number of patients that had yet cialis jelly review to complete day 29 visits. An analysis with adjustment for baseline ordinal score as a stratification variable showed a hazard ratio for death of 0.74 (95% CI, 0.50 to 1.10).

Safety Outcomes Serious adverse events occurred in cialis jelly review 114 patients (21.1%) in the remdesivir group and 141 patients (27.0%) in the placebo group (Table S3). 4 events (2 in each group) were judged by site investigators to be related to remdesivir or placebo. There were 28 serious respiratory failure adverse events in cialis jelly review the remdesivir group (5.2% of patients) and 42 in the placebo group (8.0% of patients).

Acute respiratory failure, hypotension, viral pneumonia, and acute kidney injury were slightly more common among patients in the placebo group. No deaths were considered to be related to treatment assignment, as judged by the cialis jelly review site investigators. Grade 3 or 4 adverse events occurred in 156 patients (28.8%) in the remdesivir group and in 172 in the placebo group (33.0%) (Table S4).

The most common adverse events in the remdesivir group cialis jelly review were anemia or decreased hemoglobin (43 events [7.9%], as compared with 47 [9.0%] in the placebo group). Acute kidney injury, decreased estimated glomerular filtration rate or creatinine clearance, or increased blood creatinine (40 events [7.4%], as compared with 38 [7.3%]). Pyrexia (27 cialis jelly review events [5.0%], as compared with 17 [3.3%]).

Hyperglycemia or increased blood glucose level (22 events [4.1%], as compared with 17 [3.3%]). And increased aminotransferase cialis jelly review levels including alanine aminotransferase, aspartate aminotransferase, or both (22 events [4.1%], as compared with 31 [5.9%]). Otherwise, the incidence of adverse events was not found to be significantly different between the remdesivir group and the placebo group..

Patients Figure low cost cialis how long before cialis works 1. Figure 1 low cost cialis. Enrollment and Randomization. Of the 1107 low cost cialis patients who were assessed for eligibility, 1063 underwent randomization. 541 were assigned to the remdesivir group and 522 to the placebo group (Figure 1).

Of those assigned to receive low cost cialis remdesivir, 531 patients (98.2%) received the treatment as assigned. Forty-nine patients had remdesivir treatment discontinued before day 10 because of an adverse event or a serious adverse event other than death (36 patients) or because the patient withdrew consent (13). Of those assigned to low cost cialis receive placebo, 518 patients (99.2%) received placebo as assigned. Fifty-three patients discontinued placebo before day 10 because of an adverse event or a serious adverse event other than death (36 patients), because the patient withdrew consent (15), or because the patient was found to be ineligible for trial enrollment (2). As of April 28, 2020, a total of 391 patients in the remdesivir group and 340 in the low cost cialis placebo group had completed the trial through day 29, recovered, or died.

Eight patients who received remdesivir and 9 who received placebo terminated their participation in the trial before day 29. There were 132 patients in the remdesivir low cost cialis group and 169 in the placebo group who had not recovered and had not completed the day 29 follow-up visit. The analysis population included 1059 patients for whom we have at least some postbaseline data available (538 in the remdesivir group and 521 in the placebo group). Four of the 1063 patients were not included in the primary analysis because no postbaseline data were low cost cialis available at the time of the database freeze. Table 1.

Table 1 low cost cialis. Demographic and Clinical Characteristics at Baseline. The mean age of low cost cialis patients was 58.9 years, and 64.3% were male (Table 1). On the basis of the evolving epidemiology of Covid-19 during the trial, 79.8% of patients were enrolled at sites in North America, 15.3% in Europe, and 4.9% in Asia (Table S1). Overall, 53.2% of the patients were white, 20.6% were black, 12.6% were Asian, low cost cialis and 13.6% were designated as other or not reported.

249 (23.4%) were Hispanic or Latino. Most patients had either one (27.0%) or two or more (52.1%) of the prespecified coexisting conditions at enrollment, low cost cialis most commonly hypertension (49.6%), obesity (37.0%), and type 2 diabetes mellitus (29.7%). The median low cost cialis number of days between symptom onset and randomization was 9 (interquartile range, 6 to 12). Nine hundred forty-three (88.7%) patients had severe disease at enrollment as defined in the Supplementary Appendix. 272 (25.6%) low cost cialis patients met category 7 criteria on the ordinal scale, 197 (18.5%) category 6, 421 (39.6%) category 5, and 127 (11.9%) category 4.

There were 46 (4.3%) patients who had missing ordinal scale data at enrollment. No substantial imbalances in baseline characteristics were observed low cost cialis between the remdesivir group and the placebo group. Primary Outcome Figure 2. Figure 2 low cost cialis. Kaplan–Meier Estimates of Cumulative Recoveries.

Cumulative recovery estimates are shown in the overall population (Panel A), in patients with a low cost cialis baseline score of 4 on the ordinal scale (not receiving oxygen. Panel B), in those with a baseline score of 5 (receiving oxygen. Panel C), in those with a baseline score low cost cialis of 6 (receiving high-flow oxygen or noninvasive mechanical ventilation. Panel D), and in those with a baseline score of 7 (receiving mechanical ventilation or ECMO. Panel E) low cost cialis.

Table 2. Table 2 low cost cialis. Outcomes Overall and According to Score on the Ordinal Scale in the Intention-to-Treat Population. Figure 3 low cost cialis. Figure 3.

Time to low cost cialis Recovery According to Subgroup. The widths of the confidence intervals have not been adjusted for multiplicity and therefore cannot be used to infer treatment effects. Race and low cost cialis ethnic group his comment is here were reported by the patients. Patients in the remdesivir group low cost cialis had a shorter time to recovery than patients in the placebo group (median, 11 days, as compared with 15 days. Rate ratio for recovery, 1.32.

95% confidence interval [CI], low cost cialis 1.12 to 1.55. P<0.001. 1059 patients (Figure 2 and low cost cialis Table 2). Among patients with a baseline ordinal score of 5 (421 patients), the rate ratio for recovery was 1.47 (95% CI, 1.17 to 1.84). Among patients with a baseline score of 4 (127 patients) and low cost cialis those with a baseline score of 6 (197 patients), the rate ratio estimates for recovery were 1.38 (95% CI, 0.94 to 2.03) and 1.20 (95% CI, 0.79 to 1.81), respectively.

For those receiving mechanical ventilation or ECMO at enrollment (baseline ordinal scores of 7. 272 patients), the rate ratio for recovery was 0.95 (95% CI, 0.64 low cost cialis to 1.42). A test of interaction of treatment with baseline score on the ordinal scale was not significant. An analysis adjusting for baseline ordinal score as a stratification variable was low cost cialis conducted to evaluate the overall effect (of the percentage of patients in each ordinal score category at baseline) on the primary outcome. This adjusted analysis produced a similar treatment-effect estimate (rate ratio for recovery, 1.31.

95% CI, low cost cialis 1.12 to 1.54. 1017 patients). Table S2 in the Supplementary Appendix shows results according low cost cialis to the baseline severity stratum of mild-to-moderate as compared with severe. Patients who underwent randomization during the first 10 days after the onset of symptoms had a rate ratio for recovery of 1.28 (95% CI, 1.05 to 1.57. 664 patients), low cost cialis whereas patients who underwent randomization more than 10 days after the onset of symptoms had a rate ratio for recovery of 1.38 (95% CI, 1.05 to 1.81.

380 patients) (Figure 3). Key Secondary Outcome low cost cialis The odds of improvement in the ordinal scale score were higher in the remdesivir group, as determined by a proportional odds model at the day 15 visit, than in the placebo group (odds ratio for improvement, 1.50. 95% CI, 1.18 to low cost cialis 1.91. P=0.001. 844 patients) low cost cialis (Table 2 and Fig.

S5). Mortality was numerically low cost cialis lower in the remdesivir group than in the placebo group, but the difference was not significant (hazard ratio for death, 0.70. 95% CI, 0.47 to 1.04. 1059 patients) low cost cialis. The Kaplan–Meier estimates of mortality by 14 days were 7.1% and 11.9% in the remdesivir and placebo groups, respectively (Table 2).

The Kaplan–Meier estimates of mortality by 28 days are not reported in this preliminary analysis, given the large number of patients that had yet to complete low cost cialis day 29 visits. An analysis with adjustment for baseline ordinal score as a stratification variable showed a hazard ratio for death of 0.74 (95% CI, 0.50 to 1.10). Safety Outcomes Serious adverse events occurred in 114 patients (21.1%) in the remdesivir group and 141 patients (27.0%) in low cost cialis the placebo group (Table S3). 4 events (2 in each group) were judged by site investigators to be related to remdesivir or placebo. There were 28 serious respiratory failure adverse events in the remdesivir group (5.2% low cost cialis of patients) and 42 in the placebo group (8.0% of patients).

Acute respiratory failure, hypotension, viral pneumonia, and acute kidney injury were slightly more common among patients in the placebo group. No deaths were considered low cost cialis to be related to treatment assignment, as judged by the site investigators. Grade 3 or 4 adverse events occurred in 156 patients (28.8%) in the remdesivir group and in 172 in the placebo group (33.0%) (Table S4). The most common adverse events in the remdesivir group low cost cialis were anemia or decreased hemoglobin (43 events [7.9%], as compared with 47 [9.0%] in the placebo group). Acute kidney injury, decreased estimated glomerular filtration rate or creatinine clearance, or increased blood creatinine (40 events [7.4%], as compared with 38 [7.3%]).

Pyrexia (27 low cost cialis events [5.0%], as compared with 17 [3.3%]). Hyperglycemia or increased blood glucose level (22 events [4.1%], as compared with 17 [3.3%]). And increased aminotransferase levels including low cost cialis alanine aminotransferase, aspartate aminotransferase, or both (22 events [4.1%], as compared with 31 [5.9%]). Otherwise, the incidence of adverse events was not found to be significantly different between the remdesivir group and the placebo group..

Cialis and adderall

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At a cialis efectos adversos glance cialis and adderall. Medicare enrollment in Hawaii How cialis and adderall many Hawaiians are enrolled in Medicare?. As of July 2020, 280,006 Hawaii residents — nearly 20 percent of the state’s population — were enrolled in Medicare.For most Americans, filing for Medicare is part of turning 65. But Medicare coverage is cialis and adderall also available to people under the age of 65 who have been receiving disability benefits for at least two years, or who have ALS or end-stage renal disease. Nationwide, 85 percent of Medicare beneficiaries are eligible due to being at least 65 years old, while the other 15 percent are under 65.Hawaii has the smallest percentage of disabled Medicare beneficiaries of any state in the country – just 9 percent Hawaii’s Medicare beneficiaries are under 65 and eligible due to a disability (if we also include US territories, just 8 percent of the Virgin Islands’ Medicare beneficiaries are under 65).

The other 91 percent of Hawaii’s Medicare beneficiaries are eligible due to their age.Medicare Advantage in HawaiiIn Hawaii in 2018, cialis and adderall 45 percent of Medicare beneficiaries were enrolled in private Medicare Advantage plans — as opposed to 34 percent of Medicare beneficiaries nationwide. The remaining 55 percent of the state’s beneficiaries had Medicare coverage enrollment under Original Medicare.Hawaii has five counties, and the availability of Medicare Advantage plans varies by county. In Honolulu County in 2020, Medicare beneficiaries can select from cialis and adderall among 20 different Medicare Advantage plans. But in tiny Kalawao County (which had just 86 residents as of 2019), there are only six Medicare Advantage plans available (it’s noteworthy that in some low-population areas in other states — including the entire state of Alaska — there are no Medicare Advantage plans available at all, but plans are available throughout Hawaii).Medicare Advantage enrollment is available when a person is first eligible for Medicare, and there’s also an annual enrollment period in the fall when beneficiaries can enroll in Medicare Advantage plans if they choose to do so. And there is another window — the Medicare Advantage open enrollment period (January 1 to March 31) — during which people who are already enrolled in Medicare Advantage can switch their Medicare Advantage enrollment to a different plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in HawaiiMedigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) cialis and adderall that people would otherwise incur if they only had Original Medicare on its own.As of 2020, there are 13 insurers offering Medigap plans in Hawaii.Medigap plans are standardized under federal rules, although states can add their own regulations.

Hawaii’s Medigap regulations are available here.The state also requires (see §16-12-6.2) all Medigap insurers to offer all plans on a guaranteed-issue basis (and without adjusting premiums based on medical underwriting) to any enrollee during the six-month window that begins when the person is enrolled in Medicare Part B. This applies regardless of age in cialis and adderall Hawaii. Federal law grants cialis and adderall a six-month guaranteed-issue open enrollment window, but only when people are enrolled in Part B and also age 65. So Hawaii’s law extends the same protections to people who are under 65 and eligible for Medicare as a result of a disability. As noted above, Medicare in Hawaii has the nation’s lowest percentage of beneficiaries who are eligible due to a disability.The majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, but unlike most of them Hawaii also prohibits Medigap insurers from charging higher premiums cialis and adderall for people under the age of 65, based on their disability.

So while it’s common to see under-65 Medigap policies sold in other states with premiums that are well above the age-65 premiums, that’s not the case in Hawaii.Hawaii Medicare Part DOriginal Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan that includes integrated Medicare Part D coverage, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D prescription drug plan.For 2020 coverage, insurers are offering 25 stand-alone Medicare Part D plans in Hawaii, with premiums ranging from $13 to $87 per month.As of mid-2020, there were 72,585 people with Medicare in Hawaii cialis and adderall who had prescription coverage under stand-alone Medicare Part D plans. Another 128,545 beneficiaries had Medicare Part D coverage integrated with their Medicare Advantage plans, so the majority of Part D coverage in Hawaii is provided via Medicare Advantage plans as opposed to stand-alone Medicare Part D plans (most Medicare Advantage plans include Part D coverage. Stand-alone Medicare Part D plans are usually used to supplement Original Medicare, since it never includes prescription coverage).Medicare Part D enrollment is an option when a person first submits their Medicare application in Hawaii, or when they lose access to other creditable drug coverage (eg, they retire and lose the drug coverage cialis and adderall that they had from their employer). The annual open enrollment period that runs from October 15 to December 7 each year is also an opportunity for Medicare beneficiaries to sign up for a Part D plan or switch to a different Part D plan.

Medicare spending cialis and adderall in HawaiiAs of 2018, per-beneficiary spending on Medicare in Hawaii was the lowest in the nation, at $6,971. Nationwide, the average was $10,096 (and on the high end, per-beneficiary spending exceeded $11,000 in Florida, Texas, Mississippi, Oklahoma, and Louisiana). That’s according to data that were standardized to account for regional differences in payment rates, but cialis and adderall the data did not include costs under Medicare Advantage, and Hawaii has a larger-than-average share of its Medicare population enrolled in Medicare Advantage plans.Medicare in Hawaii. Resources for Medicare beneficiaries and caregiversQuestions about Medicare eligibility in Hawaii or Medicare enrollment in Hawaii? cialis and adderall. You can contact the Hawaii State Health Insurance Assistance Program with questions related to Medicare in Hawaii.The state of Hawaii’s Employer-Union Health Benefits Trust Fund also has an overview of Medicare.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org cialis and adderall. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Medicare in Maryland at a glance Medicare enrollment in Maryland The number of Maryland residents with Medicare coverage surpassed one million as of April 2018. By July 2020, it stood at 1,054,500 — about 17 percent of the cialis and adderall state’s population enrolled in Medicare.87 percent of Maryland’s Medicare beneficiaries are eligible based on their age (ie, they are at least 65 years old), while the other 13 percent are eligible due to a disability that has lasted at least 24 months (people with ALS or end-stage renal disease do not have to wait 24 months for their Medicare coverage to take effect). Nationwide, 85 percent of people filing for Medicare benefits are at least 65 years old, while 15 percent are under 65 and eligible due to disability.Medicare Advantage in MarylandNationwide, about a third of all Medicare beneficiaries were enrolled in private Medicare Advantage plans as of 2018. But in Maryland, just 11 percent of Medicare beneficiaries selected Medicare Advantage plans cialis and adderall.

Most of the rest were covered under Original Medicare, but there are also some Maryland Medicare beneficiaries with Medicare Cost plan coverage.By mid-2020, about 13 percent of people with Medicare in Maryland were enrolled in private plans (mostly Medicare Advantage plans, but also some Medicare Cost plans), while the other 87 percent were enrolled in Original Medicare. At that cialis and adderall point, total private plan enrollment among Medicare beneficiaries nationwide had grown to 40 percent, but Medicare Advantage enrollment continues to be less popular in Maryland.The availability of Medicare Advantage plans in Maryland varies from one county to another. In St. Mary’s County, Maryland, there is just one Medicare Advantage cialis and adderall plan available in 2020. But in Baltimore County and Montgomery County, there are 24 plans and 20 plans available, respectively.Medicare beneficiaries can switch back cialis and adderall and forth from Medicare Advantage to Original Medicare or vice versa each fall during the annual open enrollment period (October 15 through December 7).

There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in MarylandMedigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.Medigap plans are standardized under federal rules, with ten different plan options available. In Maryland in 2020, 50 insurers offer Medigap plans, although some only offer cialis and adderall a few of the ten plan designs.Under federal rules, Medicare beneficiaries have a six-month window, when they turn 65 and file for benefits under Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.But Maryland is among the majority of the states that ensure at least some access to Medigap plans for enrollees under the age of 65. In Maryland, Medigap insurers are required to offer Plan A to enrollees who are under 65, on a guaranteed-issue basis if the person applies for the Medigap plan within six months of enrolling in Medicare Part B (insurers are also required to offer Medigap Plan D to beneficiaries, but only if the insurer offers that plan to other enrollees cialis and adderall. Insurers that offer Medigap Plan C must also offer it to disabled Medigap enrollees who were already eligible for Medicare prior to 2020.

Under federal rules, Medigap plans C and F cannot be sold to anyone who is newly eligible for Medicare in 2020 or later) cialis and adderall. The requirement that Medigap insurers offer coverage to disabled beneficiaries is a result of Maryland S.B.48, which took effect in 2017.The premiums are higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point, or pick a plan other than Plan A or C/D. And Maryland does limit the pricing on Medigap cialis and adderall Plan A for disabled enrollees. It cannot exceed the average of the premiums paid for that Plan A by enrollees who are 65 and older.Medicare Part D plans in MarylandOriginal Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via Medicaid (if they’re qualified by low income and assets), a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription plan.For 2020 coverage, insurers are offering 27 stand-alone Part D plans available in Maryland, with premiums ranging from $14 to $97 per month.549,075 Maryland Medicare beneficiaries — about 52 percent of the state’s Medicare population — were enrolled in stand-alone Part D prescription drug plans in Maryland cialis and adderall as of July 2020.

Nationwide, about 40 percent of all Medicare beneficiaries were enrolled in stand-alone Part D plans.Most Medicare Advantage plans include Part D prescription drug coverage, so stand-alone Part D plans are typically used to supplement Original Medicare. Enrollment in Original Medicare in Maryland is higher than average, which is why stand-alone Medicare Part D enrollment in Maryland cialis and adderall is also higher than average. In addition to the people with stand-alone Part D coverage, nearly 114,000 Medicare beneficiaries in Maryland cialis and adderall have Part D coverage as part of their Medicare Advantage coverage. Medicare spending in MarylandIn 2018, Original Medicare spent an average of $10,115 per beneficiary in Maryland, according to data that were standardized to eliminate regional differences in payment rates. The analysis was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees — cialis and adderall but Maryland has a much lower-than-average proportion of its Medicare beneficiaries enrolled in Medicare Advantage.The national average Medicare spending that year was $10,096 per enrollee, so Medicare spending in Maryland was virtually the same as the national average.

On the extreme ends of the spectrum, Louisiana had the highest average per-enrollee costs, at $11,932, while Hawaii had the lowest, at $6,971.Medicare in Maryland. Resources for Medicare beneficiaries and their caregiversIf you need help with your Medicare application in Maryland or have general questions about Medicare eligibility in Maryland, you can contact the Maryland Senior Health Insurance Program.The Maryland Insurance Administration has a comprehensive overview of Medigap in Maryland, and a detailed comparison of how Medigap premiums vary by age and insurer in Maryland.The Maryland Health Care Commission’s Consumer Guide to Long Term Care is also a good resource for people with Medicare who want to understand how they’ll need to prepare cialis and adderall for the potential cost of long-term care.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health cialis and adderall reform and by other health insurance experts.At a glance. Medicare enrollment in Hawaii How many Hawaiians are enrolled in Medicare?.

As of July 2020, 280,006 Hawaii residents — nearly 20 percent of the state’s population — were enrolled in Medicare.For most Americans, cialis and adderall filing for Medicare is part of turning 65. But Medicare coverage is also available to people under the age of 65 who have been receiving disability benefits for at least two years, or who have ALS or end-stage renal disease. Nationwide, 85 percent of Medicare beneficiaries are eligible due to being at least 65 years cialis and adderall old, while the other 15 percent are under 65.Hawaii has the smallest percentage of disabled Medicare beneficiaries of any state in the country – just 9 percent Hawaii’s Medicare beneficiaries are under 65 and eligible due to a disability (if we also include US territories, just 8 percent of the Virgin Islands’ Medicare beneficiaries are under 65). The other 91 percent of Hawaii’s Medicare beneficiaries are eligible due to their age.Medicare Advantage in HawaiiIn Hawaii in 2018, 45 percent of Medicare beneficiaries were enrolled in private Medicare Advantage cialis and adderall plans — as opposed to 34 percent of Medicare beneficiaries nationwide. The remaining 55 percent of the state’s beneficiaries had Medicare coverage enrollment under Original Medicare.Hawaii has five counties, and the availability of Medicare Advantage plans varies by county.

In Honolulu County in 2020, Medicare beneficiaries can select from among cialis and adderall 20 different Medicare Advantage plans. But in tiny Kalawao County (which had just 86 residents as of 2019), there are only six Medicare Advantage plans available (it’s noteworthy that in some low-population areas in other states — including the entire state of Alaska — there are no Medicare Advantage plans available at all, but plans are available throughout Hawaii).Medicare Advantage enrollment is available when a person is first eligible for Medicare, and there’s also an annual enrollment period in the fall when beneficiaries can enroll in Medicare Advantage plans if they choose to do so. And there is another window — the Medicare Advantage open enrollment period (January 1 to March 31) — during which people who are already enrolled in Medicare Advantage can switch their Medicare Advantage enrollment to a different plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in HawaiiMedigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its cialis and adderall own.As of 2020, there are 13 insurers offering Medigap plans in Hawaii.Medigap plans are standardized under federal rules, although states can add their own regulations. Hawaii’s Medigap regulations are available here.The state also requires (see §16-12-6.2) all Medigap insurers to offer all plans on a guaranteed-issue basis (and without adjusting premiums based on medical underwriting) to any enrollee during the six-month window that begins when the person is enrolled in Medicare Part B. This applies regardless cialis and adderall of age in Hawaii.

Federal law grants a six-month guaranteed-issue open enrollment window, but only when people are enrolled in Part B and also age 65. So Hawaii’s law extends the same protections to people who are under 65 and eligible for Medicare cialis and adderall as a result of a disability. As noted above, Medicare in Hawaii has the nation’s lowest percentage of beneficiaries who are eligible due to a disability.The majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, but unlike most of them Hawaii also prohibits Medigap insurers from charging higher premiums for people under the age of 65, based on their disability. So while it’s common to see under-65 Medigap policies sold in other states cialis and adderall with premiums that are well above the age-65 premiums, that’s not the case in Hawaii.Hawaii Medicare Part DOriginal Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan that includes integrated Medicare Part D coverage, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D prescription drug plan.For 2020 coverage, insurers are offering 25 stand-alone Medicare Part D plans in Hawaii, with premiums ranging from $13 to $87 per month.As of mid-2020, there were 72,585 people with Medicare in Hawaii who had prescription coverage under stand-alone Medicare Part D plans.

Another 128,545 beneficiaries had Medicare Part D coverage integrated with their Medicare Advantage plans, so the majority of Part D coverage in Hawaii is provided via Medicare cialis and adderall Advantage plans as opposed to stand-alone Medicare Part D plans (most Medicare Advantage plans include Part D coverage. Stand-alone Medicare Part D plans are usually used to supplement Original Medicare, since it never includes prescription coverage).Medicare Part D enrollment is an cialis and adderall option when a person first submits their Medicare application in Hawaii, or when they lose access to other creditable drug coverage (eg, they retire and lose the drug coverage that they had from their employer). The annual open enrollment period that runs from October 15 to December 7 each year is also an opportunity for Medicare beneficiaries to sign up for a Part D plan or switch to a different Part D plan. Medicare spending in cialis and adderall HawaiiAs of 2018, per-beneficiary spending on Medicare in Hawaii was the lowest in the nation, at $6,971. Nationwide, the average was $10,096 (and on the high end, per-beneficiary spending exceeded $11,000 in Florida, Texas, Mississippi, Oklahoma, and Louisiana).

That’s according cialis and adderall to data that were standardized to account for regional differences in payment rates, but the data did not include costs under Medicare Advantage, and Hawaii has a larger-than-average share of its Medicare population enrolled in Medicare Advantage plans.Medicare in Hawaii. Resources for Medicare beneficiaries and caregiversQuestions about Medicare eligibility in Hawaii or Medicare enrollment in Hawaii?. You can contact the Hawaii State Health Insurance Assistance Program with questions related to Medicare in Hawaii.The state of Hawaii’s Employer-Union Health Benefits Trust Fund also has an overview of Medicare.Louise Norris is an individual health insurance broker who has been writing cialis and adderall about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Medicare in Maryland at a glance Medicare enrollment in Maryland The number of Maryland residents with Medicare coverage surpassed one million as of April 2018 cialis and adderall.

By July 2020, it stood at 1,054,500 — about 17 percent of the state’s population enrolled in Medicare.87 percent of Maryland’s Medicare beneficiaries are eligible based on their age (ie, they are at least 65 years old), while the other 13 percent are eligible due to a disability that has lasted at least 24 months (people with ALS or end-stage renal disease do not have to wait 24 months for their Medicare coverage to take effect). Nationwide, 85 percent of people filing for Medicare benefits are at least 65 years old, while 15 percent are under 65 and eligible due to disability.Medicare Advantage in MarylandNationwide, about a cialis and adderall third of all Medicare beneficiaries were enrolled in private Medicare Advantage plans as of 2018. But in cialis and adderall Maryland, just 11 percent of Medicare beneficiaries selected Medicare Advantage plans. Most of the rest were covered under Original Medicare, but there are also some Maryland Medicare beneficiaries with Medicare Cost plan coverage.By mid-2020, about 13 percent of people with Medicare in Maryland were enrolled in private plans (mostly Medicare Advantage plans, but also some Medicare Cost plans), while the other 87 percent were enrolled in Original Medicare. At that point, total private plan enrollment among Medicare beneficiaries nationwide had grown to 40 percent, but Medicare Advantage enrollment continues to be less popular in Maryland.The availability cialis and adderall of Medicare Advantage plans in Maryland varies from one county to another.

In St. Mary’s County, Maryland, cialis and adderall there is just one Medicare Advantage plan available in 2020. But in Baltimore County and Montgomery County, there are 24 plans and 20 plans available, respectively.Medicare beneficiaries can switch back and forth from Medicare Advantage to Original Medicare or vice versa each fall during the annual open enrollment period (October 15 through December 7). There is also a Medicare Advantage open enrollment period (January cialis and adderall 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in MarylandMedigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.Medigap plans are standardized under federal rules, with ten different plan options available. In Maryland in 2020, 50 insurers offer Medigap plans, although some only offer a few of the ten plan designs.Under federal rules, Medicare beneficiaries have a six-month window, when they turn 65 and file for benefits under Original Medicare, during which coverage is guaranteed issue for Medigap plans.

Federal rules do not, however, guarantee access to a Medigap plan if cialis and adderall you’re under 65 and eligible for Medicare as a result of a disability.But Maryland is among the majority of the states that ensure at least some access to Medigap plans for enrollees under the age of 65. In Maryland, Medigap insurers are required to offer Plan A to enrollees who are under 65, on a guaranteed-issue basis if the person applies for the Medigap plan within six months of enrolling in Medicare Part B (insurers are also required to offer Medigap Plan D to beneficiaries, but only if the insurer offers that plan to other enrollees. Insurers that offer Medigap Plan C must also offer it to disabled Medigap cialis and adderall enrollees who were already eligible for Medicare prior to 2020. Under federal cialis and adderall rules, Medigap plans C and F cannot be sold to anyone who is newly eligible for Medicare in 2020 or later). The requirement that Medigap insurers offer coverage to disabled beneficiaries is a result of Maryland S.B.48, which took effect in 2017.The premiums are higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point, or pick a plan other than Plan A or C/D.

And Maryland does limit the pricing on Medigap Plan A for cialis and adderall disabled enrollees. It cannot exceed the average of the premiums paid for that Plan A by enrollees who are 65 and older.Medicare Part D plans in MarylandOriginal Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via Medicaid (if they’re qualified by low income and assets), a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription plan.For 2020 coverage, insurers are offering 27 stand-alone Part D plans available in Maryland, with premiums ranging from $14 to $97 per month.549,075 Maryland Medicare beneficiaries — about 52 percent of the state’s Medicare population — were enrolled in stand-alone Part D prescription drug plans in Maryland cialis and adderall as of July 2020. Nationwide, about 40 percent of all Medicare beneficiaries were enrolled in stand-alone Part D plans.Most Medicare Advantage plans include Part D prescription drug coverage, so stand-alone Part D plans are typically used to supplement Original Medicare. Enrollment in Original Medicare in Maryland is higher than average, which is why stand-alone Medicare Part D cialis and adderall enrollment in Maryland is also higher than average.

In addition to the people with stand-alone Part D coverage, nearly 114,000 Medicare beneficiaries in Maryland have Part D coverage as part of their Medicare Advantage coverage. Medicare spending in MarylandIn 2018, Original Medicare spent an average of $10,115 per beneficiary in Maryland, according to data that were standardized to cialis and adderall eliminate regional differences in payment rates. The analysis was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees — but Maryland has a much lower-than-average proportion of its Medicare beneficiaries enrolled in Medicare Advantage.The national average Medicare spending that year was $10,096 per enrollee, so Medicare spending in Maryland was virtually the same as the national average. On the extreme ends of the spectrum, Louisiana had the highest average per-enrollee costs, at $11,932, while Hawaii had cialis and adderall the lowest, at $6,971.Medicare in Maryland. Resources for Medicare beneficiaries and their caregiversIf you need help with your Medicare application in Maryland or have general questions about Medicare eligibility in Maryland, cialis and adderall you can contact the Maryland Senior Health Insurance Program.The Maryland Insurance Administration has a comprehensive overview of Medigap in Maryland, and a detailed comparison of how Medigap premiums vary by age and insurer in Maryland.The Maryland Health Care Commission’s Consumer Guide to Long Term Care is also a good resource for people with Medicare who want to understand how they’ll need to prepare for the potential cost of long-term care.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange cialis and adderall updates are regularly cited by media who cover health reform and by other health insurance experts.REDWOOD CITY, Calif., Sept. 01, 2020 (GLOBE NEWSWIRE) -- Guardant Health, Inc. (Nasdaq. GH) today announced the company will be participating in the upcoming Morgan Stanley Virtual Healthcare Conference.Guardant Health’s management is scheduled for a fireside chat on Tuesday, September 15 at 8:45 a.m.

Pacific Time / 11:45 a.m. Eastern Time. Interested parties may access a live and archived webcast of the presentation on the “Investors” section of the company website at. Www.guardanthealth.com.About Guardant HealthGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary blood tests, vast data sets, and advanced analytics. The Guardant Health Oncology Platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs across all stages of the cancer care continuum.

Guardant Health has launched liquid biopsy-based Guardant360® and GuardantOMNI® tests for advanced stage cancer patients. These tests fuel development of its LUNAR program, which aims to address the needs of early stage cancer patients with neoadjuvant and adjuvant treatment selection, cancer survivors with surveillance, asymptomatic individuals eligible for cancer screening and individuals at a higher risk for developing cancer with early detection.Investor Contact:Carrie Mendivilinvestors@guardanthealth.comMedia Contact:Anna Czenepress@guardanthealth.comCourtney Carrollcourtney.carroll@uncappedcommunications.com Source. Guardant Health, Inc.COVID-19 diagnostic expands testing supply, protects the continuity of essential cancer work at Guardant Health, and helps with reopening at Delaware State UniversityREDWOOD CITY, Calif., Aug. 24, 2020 (GLOBE NEWSWIRE) -- Guardant Health, Inc. (Nasdaq.

GH) announces that the U.S. Food and Drug Administration (FDA) has granted the Guardant-19 test emergency use authorization (EUA) for use in the detection of the novel coronavirus, SARS-CoV-2. The test is being offered to Guardant Health employees and select partner organizations through the company’s CLIA-certified clinical laboratory.The Guardant-19 test is a reverse transcriptase polymerase chain reaction next generation sequencing (rt-PCR-seq) test that detects coronavirus SARS-CoV-2 nucleic acid from upper respiratory nasal specimens including nasopharyngeal swabs, oropharyngeal swabs, nasal swabs, interior nasal swabs, mid-turbinate nasal swabs, nasopharyngeal wash/aspirates, nasal aspirates, and nasal washes. The test has a validated limit of detection (LoD) of 125 copies per mL and results are typically returned the next day. The heavily multiplexed testing workflow used has the ability to scale to over 10,000 tests per day.“While serving cancer patients remains our top priority, we are proud to be able to leverage our expertise in liquid biopsy testing to contribute to battling the COVID-19 pandemic by offering a highly accurate test that is truly additive to the testing options available today,” said AmirAli Talasaz, Guardant Health president.

€œSince the beginning of the pandemic we believed it was our social responsibility to not only protect the health and safety of our employees, but to also help our greater community with return to work and school initiatives. It gives me great pride knowing that Guardant Health is able to deliver.”The Guardant-19 test is being used to help Delaware State University, a Historically Black College &. University, in its efforts to reopen safely. €œGuardant is providing us with an innovative testing technology to help protect the safety of our entire campus community,” said Tony Allen, president of Delaware State University, which is being advised by nonprofit Testing for America on its reopening plans.“Our mission is to permanently and safely reopen schools, business and the US economy by providing affordable, accessible and frequent testing and screening. We believe that a testing option like the one provided by Guardant Health can help achieve the highly accurate and rapid results at a scale that we need,” said Dr.

Joan Coker, surgeon and Advisory Council member of Testing for America.The Healing Grove Health Center in San Jose, California is another partner organization. €œWe are thankful for a high-throughput, fast, accurate COVID-19 test from Guardant Health,” said Brett Bymaster, the center’s executive director. €œOur patients are low-income and high risk, and we are seeing a high positivity rate. When we catch these positive cases early, we are possibly saving hundreds of people from getting infected with COVID-19 by ensuring that they quarantine. By working closely with Guardant Health, we have gotten results quickly and have been able to keep our COVID-positive patients recovering at home, limiting the severity of the outbreak in this important community.”To learn more about accessing the Guardant-19 test, email.

Guardant19support@guardanthealth.com.About Guardant HealthGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary blood tests, vast data sets, and advanced analytics. The Guardant Health Oncology Platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs across all stages of the cancer care continuum. Guardant Health has launched liquid biopsy-based Guardant360® and GuardantOMNI® tests for advanced stage cancer patients. These tests fuel development of its LUNAR program, which aims to address the needs of early stage cancer patients with neoadjuvant and adjuvant treatment selection, cancer survivors with surveillance, asymptomatic individuals eligible for cancer screening and individuals at a higher risk for developing cancer with early detection.Investor Contact:Carrie Mendivilinvestors@guardanthealth.comMedia Contact:Anna Czenepress@guardanthealth.comCourtney Carrollcourtney.carroll@uncappedcommunications.com Source. Guardant Health, Inc..

At a glance low cost cialis http://sw.keimfarben.de/cheap-cialis-canadian-pharmacy/. Medicare enrollment in Hawaii How many Hawaiians are enrolled in Medicare? low cost cialis. As of July 2020, 280,006 Hawaii residents — nearly 20 percent of the state’s population — were enrolled in Medicare.For most Americans, filing for Medicare is part of turning 65. But Medicare coverage is also available to people under the age of 65 who have been receiving disability benefits for low cost cialis at least two years, or who have ALS or end-stage renal disease.

Nationwide, 85 percent of Medicare beneficiaries are eligible due to being at least 65 years old, while the other 15 percent are under 65.Hawaii has the smallest percentage of disabled Medicare beneficiaries of any state in the country – just 9 percent Hawaii’s Medicare beneficiaries are under 65 and eligible due to a disability (if we also include US territories, just 8 percent of the Virgin Islands’ Medicare beneficiaries are under 65). The other 91 percent of Hawaii’s Medicare beneficiaries are eligible due to their age.Medicare Advantage in HawaiiIn low cost cialis Hawaii in 2018, 45 percent of Medicare beneficiaries were enrolled in private Medicare Advantage plans — as opposed to 34 percent of Medicare beneficiaries nationwide. The remaining 55 percent of the state’s beneficiaries had Medicare coverage enrollment under Original Medicare.Hawaii has five counties, and the availability of Medicare Advantage plans varies by county. In Honolulu County in 2020, Medicare beneficiaries can low cost cialis select from among 20 different Medicare Advantage plans.

But in tiny Kalawao County (which had just 86 residents as of 2019), there are only six Medicare Advantage plans available (it’s noteworthy that in some low-population areas in other states — including the entire state of Alaska — there are no Medicare Advantage plans available at all, but plans are available throughout Hawaii).Medicare Advantage enrollment is available when a person is first eligible for Medicare, and there’s also an annual enrollment period in the fall when beneficiaries can enroll in Medicare Advantage plans if they choose to do so. And there is another window — the Medicare Advantage open enrollment period (January 1 to March 31) — during which people who are already enrolled in Medicare Advantage can switch their Medicare Advantage enrollment to a different plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in HawaiiMedigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs low cost cialis (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.As of 2020, there are 13 insurers offering Medigap plans in Hawaii.Medigap plans are standardized under federal rules, although states can add their own regulations. Hawaii’s Medigap regulations are available here.The state also requires (see §16-12-6.2) all Medigap insurers to offer all plans on a guaranteed-issue basis (and without adjusting premiums based on medical underwriting) to any enrollee during the six-month window that begins when the person is enrolled in Medicare Part B. This applies regardless of age low cost cialis in Hawaii.

Federal law grants a six-month guaranteed-issue open enrollment window, but only low cost cialis when people are enrolled in Part B and also age 65. So Hawaii’s law extends the same protections to people who are under 65 and eligible for Medicare as a result of a disability. As noted above, Medicare in Hawaii has the nation’s lowest percentage of beneficiaries who are eligible due to a disability.The majority of the states have adopted rules to ensure at least some access to Medigap plans low cost cialis for enrollees under the age of 65, but unlike most of them Hawaii also prohibits Medigap insurers from charging higher premiums for people under the age of 65, based on their disability. So while it’s common to see under-65 Medigap policies sold in other states with premiums that are well above the age-65 premiums, that’s not the case in Hawaii.Hawaii Medicare Part DOriginal Medicare does not cover outpatient prescription drugs.

But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan that includes integrated Medicare Part D coverage, an employer-sponsored plan low cost cialis (offered by a current or former employer), or a stand-alone Medicare Part D prescription drug plan.For 2020 coverage, insurers are offering 25 stand-alone Medicare Part D plans in Hawaii, with premiums ranging from $13 to $87 per month.As of mid-2020, there were 72,585 people with Medicare in Hawaii who had prescription coverage under stand-alone Medicare Part D plans. Another 128,545 beneficiaries had Medicare Part D coverage integrated with their Medicare Advantage plans, so the majority of Part D coverage in Hawaii is provided via Medicare Advantage plans as opposed to stand-alone Medicare Part D plans (most Medicare Advantage plans include Part D coverage. Stand-alone Medicare Part low cost cialis D plans are usually used to supplement Original Medicare, since it never includes prescription coverage).Medicare Part D enrollment is an option when a person first submits their Medicare application in Hawaii, or when they lose access to other creditable drug coverage (eg, they retire and lose the drug coverage that they had from their employer). The annual open enrollment period that runs from October 15 to December 7 each year is also an opportunity for Medicare beneficiaries to sign up for a Part D plan or switch to a different Part D plan.

Medicare spending low cost cialis in HawaiiAs of 2018, per-beneficiary spending on Medicare in Hawaii was the lowest in the nation, at $6,971. Nationwide, the average was $10,096 (and on the high end, per-beneficiary spending exceeded $11,000 in Florida, Texas, Mississippi, Oklahoma, and Louisiana). That’s according to data that were standardized to account for regional low cost cialis differences in payment rates, but the data did not include costs under Medicare Advantage, and Hawaii has a larger-than-average share of its Medicare population enrolled in Medicare Advantage plans.Medicare in Hawaii. Resources for Medicare beneficiaries and caregiversQuestions about Medicare eligibility in Hawaii or low cost cialis Medicare enrollment in Hawaii?.

You can contact the Hawaii State Health Insurance Assistance Program with questions related to Medicare in Hawaii.The state of Hawaii’s Employer-Union Health Benefits Trust Fund also has an overview of Medicare.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable low cost cialis Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Medicare in Maryland at a glance Medicare enrollment in Maryland The number of Maryland residents with Medicare coverage surpassed one million as of April 2018. By July 2020, it stood at 1,054,500 — about 17 percent of the state’s population enrolled in Medicare.87 percent of Maryland’s Medicare beneficiaries are eligible low cost cialis based on their age (ie, they are at least 65 years old), while the other 13 percent are eligible due to a disability that has lasted at least 24 months (people with ALS or end-stage renal disease do not have to wait 24 months for their Medicare coverage to take effect).

Nationwide, 85 percent of people filing for Medicare benefits are at least 65 years old, while 15 percent are under 65 and eligible due to disability.Medicare Advantage in MarylandNationwide, about a third of all Medicare beneficiaries were enrolled in private Medicare Advantage plans as of 2018. But in Maryland, just 11 percent of Medicare beneficiaries selected low cost cialis Medicare Advantage plans. Most of the rest were covered under Original Medicare, but there are also some Maryland Medicare beneficiaries with Medicare Cost plan coverage.By mid-2020, about 13 percent of people with Medicare in Maryland were enrolled in private plans (mostly Medicare Advantage plans, but also some Medicare Cost plans), while the other 87 percent were enrolled in Original Medicare. At that point, total private plan enrollment among Medicare beneficiaries nationwide had grown to low cost cialis 40 percent, but Medicare Advantage enrollment continues to be less popular in Maryland.The availability of Medicare Advantage plans in Maryland varies from one county to another.

In St. Mary’s County, Maryland, there is just one Medicare Advantage plan available in 2020 low cost cialis. But in Baltimore County and Montgomery County, there are 24 plans and 20 plans available, respectively.Medicare beneficiaries can switch back and forth from Medicare Advantage to low cost cialis Original Medicare or vice versa each fall during the annual open enrollment period (October 15 through December 7). There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in MarylandMedigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.Medigap plans are standardized under federal rules, with ten different plan options available.

In Maryland in 2020, 50 insurers offer Medigap plans, although some only offer a few of the ten plan designs.Under federal rules, Medicare beneficiaries have a six-month window, when they turn low cost cialis 65 and file for benefits under Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.But Maryland is among the majority of the states that ensure at least some access to Medigap plans for enrollees under the age of 65. In Maryland, Medigap insurers are required to offer Plan A low cost cialis to enrollees who are under 65, on a guaranteed-issue basis if the person applies for the Medigap plan within six months of enrolling in Medicare Part B (insurers are also required to offer Medigap Plan D to beneficiaries, but only if the insurer offers that plan to other enrollees. Insurers that offer Medigap Plan C must also offer it to disabled Medigap enrollees who were already eligible for Medicare prior to 2020.

Under federal rules, Medigap plans C and F cannot be sold to low cost cialis anyone who is newly eligible for Medicare in 2020 or later). The requirement that Medigap insurers offer coverage to disabled beneficiaries is a result of Maryland S.B.48, which took effect in 2017.The premiums are higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point, or pick a plan other than Plan A or C/D. And Maryland does limit the pricing on Medigap Plan A for disabled low cost cialis enrollees. It cannot exceed the average of the premiums paid for that Plan A by enrollees who are 65 and older.Medicare Part D plans in MarylandOriginal Medicare does not cover outpatient prescription drugs.

But Medicare beneficiaries can get prescription coverage via Medicaid (if they’re qualified by low income and assets), a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription low cost cialis plan.For 2020 coverage, insurers are offering 27 stand-alone Part D plans available in Maryland, with premiums ranging from $14 to $97 per month.549,075 Maryland Medicare beneficiaries — about 52 percent of the state’s Medicare population — were enrolled in stand-alone Part D prescription drug plans in Maryland as of July 2020. Nationwide, about 40 percent of all Medicare beneficiaries were enrolled in stand-alone Part D plans.Most Medicare Advantage plans include Part D prescription drug coverage, so stand-alone Part D plans are typically used to supplement Original Medicare. Enrollment in Original Medicare in Maryland is higher than average, which is why stand-alone Medicare Part D enrollment in Maryland is also higher than average low cost cialis. In addition to the people with stand-alone Part D coverage, nearly 114,000 low cost cialis Medicare beneficiaries in Maryland have Part D coverage as part of their Medicare Advantage coverage.

Medicare spending in MarylandIn 2018, Original Medicare spent an average of $10,115 per beneficiary in Maryland, according to data that were standardized to eliminate regional differences in payment rates. The analysis was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees — but Maryland has a much lower-than-average proportion of its Medicare beneficiaries enrolled in Medicare Advantage.The national average Medicare spending that year was $10,096 per enrollee, so Medicare spending in Maryland was virtually the same as low cost cialis the national average. On the extreme ends of the spectrum, Louisiana had the highest average per-enrollee costs, at $11,932, while Hawaii had the lowest, at $6,971.Medicare in Maryland. Resources for Medicare beneficiaries and their caregiversIf you need help with your Medicare application in Maryland or have general questions about Medicare eligibility in Maryland, you can contact the Maryland Senior Health Insurance Program.The Maryland Insurance Administration has a comprehensive overview of Medigap in Maryland, and a detailed comparison of how Medigap premiums vary by age and insurer in Maryland.The Maryland Health Care Commission’s Consumer Guide to Long Term Care is also a good resource for people with Medicare who want low cost cialis to understand how they’ll need to prepare for the potential cost of long-term care.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media low cost cialis who cover health reform and by other health insurance experts.At a glance. Medicare enrollment in Hawaii How many Hawaiians are enrolled in Medicare?. As of July 2020, 280,006 Hawaii residents — nearly 20 percent of the state’s population — were enrolled in low cost cialis Medicare.For most Americans, filing for Medicare is part of turning 65.

But Medicare coverage is also available to people under the age of 65 who have been receiving disability benefits for at least two years, or who have ALS or end-stage renal disease. Nationwide, 85 percent of Medicare beneficiaries low cost cialis are eligible due to being at least 65 years old, while the other 15 percent are under 65.Hawaii has the smallest percentage of disabled Medicare beneficiaries of any state in the country – just 9 percent Hawaii’s Medicare beneficiaries are under 65 and eligible due to a disability (if we also include US territories, just 8 percent of the Virgin Islands’ Medicare beneficiaries are under 65). The other 91 percent of Hawaii’s Medicare beneficiaries are eligible due to their age.Medicare Advantage in HawaiiIn Hawaii in 2018, 45 percent of Medicare beneficiaries were enrolled in low cost cialis private Medicare Advantage plans — as opposed to 34 percent of Medicare beneficiaries nationwide. The remaining 55 percent of the state’s beneficiaries had Medicare coverage enrollment under Original Medicare.Hawaii has five counties, and the availability of Medicare Advantage plans varies by county.

In Honolulu County in 2020, Medicare beneficiaries can select from among 20 low cost cialis different Medicare Advantage plans. But in tiny Kalawao County (which had just 86 residents as of 2019), there are only six Medicare Advantage plans available (it’s noteworthy that in some low-population areas in other states — including the entire state of Alaska — there are no Medicare Advantage plans available at all, but plans are available throughout Hawaii).Medicare Advantage enrollment is available when a person is first eligible for Medicare, and there’s also an annual enrollment period in the fall when beneficiaries can enroll in Medicare Advantage plans if they choose to do so. And there is another window — the Medicare Advantage open enrollment period (January 1 to March 31) — during which people who are already enrolled in Medicare Advantage can switch their Medicare Advantage enrollment to a different plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in HawaiiMedigap low cost cialis plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.As of 2020, there are 13 insurers offering Medigap plans in Hawaii.Medigap plans are standardized under federal rules, although states can add their own regulations. Hawaii’s Medigap regulations are available here.The state also requires (see §16-12-6.2) all Medigap insurers to offer all plans on a guaranteed-issue basis (and without adjusting premiums based on medical underwriting) to any enrollee during the six-month window that begins when the person is enrolled in Medicare Part B.

This applies regardless low cost cialis of age in Hawaii. Federal law grants a six-month guaranteed-issue open enrollment window, but only when people are enrolled in Part B and also age 65. So Hawaii’s law extends the same protections to people who are under 65 and eligible for Medicare as a result of low cost cialis a disability. As noted above, Medicare in Hawaii has the nation’s lowest percentage of beneficiaries who are eligible due to a disability.The majority of the states have adopted rules to ensure at least some access to Medigap plans for enrollees under the age of 65, but unlike most of them Hawaii also prohibits Medigap insurers from charging higher premiums for people under the age of 65, based on their disability.

So while it’s common to see under-65 Medigap policies sold in other states with low cost cialis premiums that are well above the age-65 premiums, that’s not the case in Hawaii.Hawaii Medicare Part DOriginal Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan that includes integrated Medicare Part D coverage, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D prescription drug plan.For 2020 coverage, insurers are offering 25 stand-alone Medicare Part D plans in Hawaii, with premiums ranging from $13 to $87 per month.As of mid-2020, there were 72,585 people with Medicare in Hawaii who had prescription coverage under stand-alone Medicare Part D plans. Another 128,545 beneficiaries had Medicare Part D coverage integrated with their Medicare Advantage plans, so the majority of Part D coverage low cost cialis in Hawaii is provided via Medicare Advantage plans as opposed to stand-alone Medicare Part D plans (most Medicare Advantage plans include Part D coverage. Stand-alone Medicare Part D plans are usually used to supplement Original Medicare, since it never includes prescription coverage).Medicare Part D enrollment is an option low cost cialis when a person first submits their Medicare application in Hawaii, or when they lose access to other creditable drug coverage (eg, they retire and lose the drug coverage that they had from their employer).

The annual open enrollment period that runs from October 15 to December 7 each year is also an opportunity for Medicare beneficiaries to sign up for a Part D plan or switch to a different Part D plan. Medicare spending in HawaiiAs of 2018, low cost cialis per-beneficiary spending on Medicare in Hawaii was the lowest in the nation, at $6,971. Nationwide, the average was $10,096 (and on the high end, per-beneficiary spending exceeded $11,000 in Florida, Texas, Mississippi, Oklahoma, and Louisiana). That’s according to data that were standardized to account for regional low cost cialis differences in payment rates, but the data did not include costs under Medicare Advantage, and Hawaii has a larger-than-average share of its Medicare population enrolled in Medicare Advantage plans.Medicare in Hawaii.

Resources for Medicare beneficiaries and caregiversQuestions about Medicare eligibility in Hawaii or Medicare enrollment in Hawaii?. You can contact the Hawaii State Health Insurance Assistance Program with questions low cost cialis related to Medicare in Hawaii.The state of Hawaii’s Employer-Union Health Benefits Trust Fund also has an overview of Medicare.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover low cost cialis health reform and by other health insurance experts.Medicare in Maryland at a glance Medicare enrollment in Maryland The number of Maryland residents with Medicare coverage surpassed one million as of April 2018.

By July 2020, it stood at 1,054,500 — about 17 percent of the state’s population enrolled in Medicare.87 percent of Maryland’s Medicare beneficiaries are eligible based on their age (ie, they are at least 65 years old), while the other 13 percent are eligible due to a disability that has lasted at least 24 months (people with ALS or end-stage renal disease do not have to wait 24 months for their Medicare coverage to take effect). Nationwide, 85 percent of people filing for Medicare benefits low cost cialis are at least 65 years old, while 15 percent are under 65 and eligible due to disability.Medicare Advantage in MarylandNationwide, about a third of all Medicare beneficiaries were enrolled in private Medicare Advantage plans as of 2018. But in Maryland, just 11 percent of Medicare beneficiaries low cost cialis selected Medicare Advantage plans. Most of the rest were covered under Original Medicare, but there are also some Maryland Medicare beneficiaries with Medicare Cost plan coverage.By mid-2020, about 13 percent of people with Medicare in Maryland were enrolled in private plans (mostly Medicare Advantage plans, but also some Medicare Cost plans), while the other 87 percent were enrolled in Original Medicare.

At that point, total private plan enrollment among Medicare beneficiaries nationwide had grown to 40 percent, but Medicare Advantage low cost cialis enrollment continues to be less popular in Maryland.The availability of Medicare Advantage plans in Maryland varies from one county to another. In St. Mary’s County, Maryland, there is just one Medicare Advantage plan available low cost cialis in 2020. But in Baltimore County and Montgomery County, there are 24 plans and 20 plans available, respectively.Medicare beneficiaries can switch back and forth from Medicare Advantage to Original Medicare or vice versa each fall during the annual open enrollment period (October 15 through December 7).

There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.Medigap in MarylandMedigap plans are used to supplement Original Medicare, covering some or all low cost cialis of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.Medigap plans are standardized under federal rules, with ten different plan options available. In Maryland in 2020, 50 insurers offer Medigap plans, although some only offer a few of the ten plan designs.Under federal rules, Medicare beneficiaries have a six-month window, when they turn 65 and file for benefits under Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.But Maryland is among the majority of the states that ensure at least some access to Medigap plans for enrollees low cost cialis under the age of 65. In Maryland, Medigap insurers are required to offer Plan A to enrollees who are under 65, on a guaranteed-issue basis if the person applies for the Medigap plan within six months of enrolling in Medicare Part B (insurers are also required to offer Medigap Plan D to beneficiaries, but only if the insurer offers that plan to other enrollees.

Insurers that offer Medigap Plan low cost cialis C must also offer it to disabled Medigap enrollees who were already eligible for Medicare prior to 2020. Under federal rules, low cost cialis Medigap plans C and F cannot be sold to anyone who is newly eligible for Medicare in 2020 or later). The requirement that Medigap insurers offer coverage to disabled beneficiaries is a result of Maryland S.B.48, which took effect in 2017.The premiums are higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point, or pick a plan other than Plan A or C/D. And Maryland does limit the pricing on Medigap Plan A for low cost cialis disabled enrollees.

It cannot exceed the average of the premiums paid for that Plan A by enrollees who are 65 and older.Medicare Part D plans in MarylandOriginal Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via Medicaid (if they’re qualified by low income and assets), a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D prescription plan.For 2020 coverage, insurers are offering 27 stand-alone Part D plans available in Maryland, with premiums ranging from $14 to $97 per month.549,075 Maryland Medicare beneficiaries — about 52 percent of the state’s Medicare population — were enrolled in stand-alone Part D prescription drug low cost cialis plans in Maryland as of July 2020. Nationwide, about 40 percent of all Medicare beneficiaries were enrolled in stand-alone Part D plans.Most Medicare Advantage plans include Part D prescription drug coverage, so stand-alone Part D plans are typically used to supplement Original Medicare. Enrollment in Original Medicare in Maryland is higher than average, which is why stand-alone Medicare Part D enrollment in Maryland is also higher low cost cialis than average.

In addition to the people with stand-alone Part D coverage, nearly 114,000 Medicare beneficiaries in Maryland have Part D coverage as part of their Medicare Advantage coverage. Medicare spending in MarylandIn 2018, Original Medicare spent an average of $10,115 per beneficiary in Maryland, according to data that were standardized to low cost cialis eliminate regional differences in payment rates. The analysis was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees — but Maryland has a much lower-than-average proportion of its Medicare beneficiaries enrolled in Medicare Advantage.The national average Medicare spending that year was $10,096 per enrollee, so Medicare spending in Maryland was virtually the same as the national average. On the extreme ends of the spectrum, Louisiana had low cost cialis the highest average per-enrollee costs, at $11,932, while Hawaii had the lowest, at $6,971.Medicare in Maryland.

Resources for Medicare beneficiaries and their low cost cialis caregiversIf you need help with your Medicare application in Maryland or have general questions about Medicare eligibility in Maryland, you can contact the Maryland Senior Health Insurance Program.The Maryland Insurance Administration has a comprehensive overview of Medigap in Maryland, and a detailed comparison of how Medigap premiums vary by age and insurer in Maryland.The Maryland Health Care Commission’s Consumer Guide to Long Term Care is also a good resource for people with Medicare who want to understand how they’ll need to prepare for the potential cost of long-term care.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other low cost cialis health insurance experts.REDWOOD CITY, Calif., Sept. 01, 2020 (GLOBE NEWSWIRE) -- Guardant Health, Inc.

(Nasdaq. GH) today announced the company will be participating in the upcoming Morgan Stanley Virtual Healthcare Conference.Guardant Health’s management is scheduled for a fireside chat on Tuesday, September 15 at 8:45 a.m. Pacific Time / 11:45 a.m. Eastern Time.

Interested parties may access a live and archived webcast of the presentation on the “Investors” section of the company website at. Www.guardanthealth.com.About Guardant HealthGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary blood tests, vast data sets, and advanced analytics. The Guardant Health Oncology Platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs across all stages of the cancer care continuum. Guardant Health has launched liquid biopsy-based Guardant360® and GuardantOMNI® tests for advanced stage cancer patients.

These tests fuel development of its LUNAR program, which aims to address the needs of early stage cancer patients with neoadjuvant and adjuvant treatment selection, cancer survivors with surveillance, asymptomatic individuals eligible for cancer screening and individuals at a higher risk for developing cancer with early detection.Investor Contact:Carrie Mendivilinvestors@guardanthealth.comMedia Contact:Anna Czenepress@guardanthealth.comCourtney Carrollcourtney.carroll@uncappedcommunications.com Source. Guardant Health, Inc.COVID-19 diagnostic expands testing supply, protects the continuity of essential cancer work at Guardant Health, and helps with reopening at Delaware State UniversityREDWOOD CITY, Calif., Aug. 24, 2020 (GLOBE NEWSWIRE) -- Guardant Health, Inc. (Nasdaq.

GH) announces that the U.S. Food and Drug Administration (FDA) has granted the Guardant-19 test emergency use authorization (EUA) for use in the detection of the novel coronavirus, SARS-CoV-2. The test is being offered to Guardant Health employees and select partner organizations through the company’s CLIA-certified clinical laboratory.The Guardant-19 test is a reverse transcriptase polymerase chain reaction next generation sequencing (rt-PCR-seq) test that detects coronavirus SARS-CoV-2 nucleic acid from upper respiratory nasal specimens including nasopharyngeal swabs, oropharyngeal swabs, nasal swabs, interior nasal swabs, mid-turbinate nasal swabs, nasopharyngeal wash/aspirates, nasal aspirates, and nasal washes. The test has a validated limit of detection (LoD) of 125 copies per mL and results are typically returned the next day.

The heavily multiplexed testing workflow used has the ability to scale to over 10,000 tests per day.“While serving cancer patients remains our top priority, we are proud to be able to leverage our expertise in liquid biopsy testing to contribute to battling the COVID-19 pandemic by offering a highly accurate test that is truly additive to the testing options available today,” said AmirAli Talasaz, Guardant Health president. €œSince the beginning of the pandemic we believed it was our social responsibility to not only protect the health and safety of our employees, but to also help our greater community with return to work and school initiatives. It gives me great pride knowing that Guardant Health is able to deliver.”The Guardant-19 test is being used to help Delaware State University, a Historically Black College &. University, in its efforts to reopen safely.

€œGuardant is providing us with an innovative testing technology to help protect the safety of our entire campus community,” said Tony Allen, president of Delaware State University, which is being advised by nonprofit Testing for America on its reopening plans.“Our mission is to permanently and safely reopen schools, business and the US economy by providing affordable, accessible and frequent testing and screening. We believe that a testing option like the one provided by Guardant Health can help achieve the highly accurate and rapid results at a scale that we need,” said Dr. Joan Coker, surgeon and Advisory Council member of Testing for America.The Healing Grove Health Center in San Jose, California is another partner organization. €œWe are thankful for a high-throughput, fast, accurate COVID-19 test from Guardant Health,” said Brett Bymaster, the center’s executive director.

€œOur patients are low-income and high risk, and we are seeing a high positivity rate. When we catch these positive cases early, we are possibly saving hundreds of people from getting infected with COVID-19 by ensuring that they quarantine. By working closely with Guardant Health, we have gotten results quickly and have been able to keep our COVID-positive patients recovering at home, limiting the severity of the outbreak in this important community.”To learn more about accessing the Guardant-19 test, email. Guardant19support@guardanthealth.com.About Guardant HealthGuardant Health is a leading precision oncology company focused on helping conquer cancer globally through use of its proprietary blood tests, vast data sets, and advanced analytics.

The Guardant Health Oncology Platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs across all stages of the cancer care continuum. Guardant Health has launched liquid biopsy-based Guardant360® and GuardantOMNI® tests for advanced stage cancer patients. These tests fuel development of its LUNAR program, which aims to address the needs of early stage cancer patients with neoadjuvant and adjuvant treatment selection, cancer survivors with surveillance, asymptomatic individuals eligible for cancer screening and individuals at a higher risk for developing cancer with early detection.Investor Contact:Carrie Mendivilinvestors@guardanthealth.comMedia Contact:Anna Czenepress@guardanthealth.comCourtney Carrollcourtney.carroll@uncappedcommunications.com Source. Guardant Health, Inc..

Active ingredient in cialis

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A 26-year-old man was killed in active ingredient in cialis a single-vehicle crash in the Hudson Valley.The crash happened just after 8:45 a.m. Saturday, Oct. 10, in Rockland County on the Palisades active ingredient in cialis Interstate Parkway in the town of Orangetown. An investigation revealed that a 2010 Hyundai Elantra, being operated Anthonelli Ramos, of New York City, was traveling north on the PIP and was exiting at exit 9E at the time of the crash, police said.Ramos then failed to negotiate a sharp turn and left the roadway and overturned, state police said. Ramos was active ingredient in cialis ejected from the vehicle, according to police.

Nanuet EMS transported Ramos to Nyack Hospital where he was pronounced dead. Troopers were active ingredient in cialis assisted by Nanuet Fire Department and EMS. Click here to sign up for Daily Voice's free daily emails and news alerts..

A 26-year-old is cialis covered by blue shield man was killed low cost cialis in a single-vehicle crash in the Hudson Valley.The crash happened just after 8:45 a.m. Saturday, Oct. 10, in low cost cialis Rockland County on the Palisades Interstate Parkway in the town of Orangetown. An investigation revealed that a 2010 Hyundai Elantra, being operated Anthonelli Ramos, of New York City, was traveling north on the PIP and was exiting at exit 9E at the time of the crash, police said.Ramos then failed to negotiate a sharp turn and left the roadway and overturned, state police said.

Ramos was ejected from the Get More Info vehicle, according to police low cost cialis. Nanuet EMS transported Ramos to Nyack Hospital where he was pronounced dead. Troopers were assisted by Nanuet Fire Department low cost cialis and EMS. Click here to sign up for Daily Voice's free daily emails and news alerts..

Cialis amazon

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Etchells E, Ho cialis amazon M, Shojania KG blog here. Value of small sample sizes in rapid-cycle quality improvement projects. BMJ Qual cialis amazon Safe 2016;25:202–6.The article has been corrected since it was published online. The authors want to alert readers to the following error identified in the published version. The error is in the last paragraph of the section “Small samples can make ‘rapid improvement’ Rapid”, wherein the minimum sample cialis amazon size has been considered as six instead of eight.For this first (convenience) sample of 10 volunteer users, 5/10 (50%) completed the form without any input or instructions.

The other five became frustrated and gave up. Table 1 tells you that, with an observed success rate of 50% and a desired target of 90%, any audit with a sample of six or more allows you to confidently reject the null hypothesis that your form is working at a 90% success rate.For decades, those working in hospitals normalised the incessant cialis amazon alarms from medical devices as a necessary, almost comforting, reality of a high tech industry. While nurses drowned in excessive, frequently uninformative alarms, other members of the healthcare team often paid little attention. Fortunately, times are changing and managing alarm fatigue is now a key patient safety priority in acute care environments.1Adverse patient events from alarm fatigue, particularly related to excessive physiological monitor alarms, have received widespread attention over the last decade, including from the news media.2–5 In the USA, hospitals redoubled alarm safety efforts following the 2013 Joint Commission Sentinel Event Alert and subsequent National Patient Safety Goals on alarm safety.1 2 6 We are now beginning to understand cialis amazon how to reduce excessive non-actionable alarms (including invalid alarms as well as those that are valid but not actionable or informative),7 8 better manage alarm notifications and ultimately improve patient safety. Alarm data are readily available and measuring alarm response time during patient care is possible.7 9 Yet we have few high-quality reports describing clear improvement to clinical alarm burden, and most published interventions are of limited scope, duration or both.10 11 To demonstrate value in alarm quality improvement (QI) efforts moving forward, we need more rigorous evidence for interventions and more meaningful outcome measures.In this issue of BMJ Quality and Safety, Pater et al12 report the results of a comprehensive multidisciplinary alarm management QI project executed over 3½ years in a 17-bed paediatric acute care cardiology unit.

The primary project goal was cialis amazon to reduce alarm notifications from continuous bedside monitoring. Although limited to a single unit, the project is an important contribution to the scant literature on alarm management in paediatric settings for three reasons. First, the initiative lasted longer than most that have been reported, which allowed for tailoring of alarm interventions to the needs of the unit and patient population and measuring the impacts and sustainability over time. Second, the scope of the intervention bundle encompassed a wide variety cialis amazon of changes including adoption of a smartphone notification system. Addition of time delays between when alarm thresholds are violated and when an alarm notification is issued.

Implementation of an alarm notification escalation algorithm after a certain amount of time in alarm threshold violation cialis amazon. Deactivation of numerous technical alarms (such as respiratory lead detachment). Monitoring of electrode lead replacement cialis amazon every 24 hours. And discussion of alarm parameters on daily rounds. Third, the authors introduced a novel strategy for reducing the stress that alarms may cause patients and families by deactivating inroom alarm audio, although no outcomes were reported attributable directly to cialis amazon this component of the intervention.This project constitutes an important contribution to the published literature.

However, Pater et al faced two challenges that are ubiquitous in the field of clinical alarm management. (1) Identification of meaningful cialis amazon outcome measures and (2) Lack of high-quality evidence for most interventions. With regards to the first challenge, the primary outcome measure used in the study comprised ‘initial alarm notifications’, defined as the first notification of a monitor alarm delivered to the nurse’s mobile device. Although initial alarm notifications declined by 68% following the intervention, http://sw.keimfarben.de/cheapest-canadian-pharmacy-for-cialis/ these notifications accounted for only about half of all alarm notifications. The other cialis amazon half included second and third notifications for alarms exceeding specified delay thresholds, which were sent both to the mobile device of the primary nurse and to ‘buddy’ nurses, potentially increasing alarm burden.

On the other hand, eliminating inroom audible alarms may have reduced the perceived alarm burden for nurses compared with having both bedside and mobile device notifications. Determining the true benefit of a reduction in a subset of alarms presents complex challenges.Alarm frequency is the most commonly used cialis amazon outcome measure in alarm research and QI projects, but reduction in alarms does not necessarily indicate improved patient safety or a highly functional alarm management system. Alarm reduction could easily be achieved in an undesirable way by simply turning off alarms. Unfortunately, most cialis amazon studies have not been powered to statistically evaluate improvements in patient safety. (Pater et al did monitor patient safety balancing measures, which remained stable after intervention implementation).

To assess change in nurses’ perceptions of alarm frequency, Pater et al conducted a prepost survey, which despite the small sample size (n=38 preintervention cialis amazon and n=25 postintervention) managed to show improvement, with the percentage of nurses agreeing they could respond to alarms appropriately and quickly increasing from 32% to 76% (p<0.001). That said, this survey was not a validated measure of alarm fatigue. In fact, we currently have no widely accepted, validated tool for assessing alarm fatigue.11As we look towards future evaluations of alarm management strategies, the focus needs to shift away from simply reducing the frequency cialis amazon of alarms to more meaningful outcome metrics. In addition to alarm rates, outcomes such as response time to actual patient alarms7 9 or to simulated alarms injected into real patient care environments13 may be better indicators of whether the entire alarm response system is functioning correctly. Larger, multisite studies are needed to assess patient outcomes.In addition to meaningful outcome measures, the second challenge for alarm QI projects is the lack of good evidence for alarm management interventions.

Most alarm reduction interventions have not been systematically evaluated at all or only in small studies without a control group.10 11 As a result, alarm management projects tend to involve complex and costly bundles of cialis amazon interventions of uncertain benefit. The cost of these interventions is due in part to the growing industry of technology solutions for alarm management. Some institutions have also made massive investments in personnel, such as monitor ‘watchers’ to help nurses identify actionable alarms, for which there is also little evidence.14Future alarm management QI initiatives will benefit cialis amazon from a higher quality evidence base for the growing list of potential alarm management interventions. Pragmatic trials that leverage meaningful outcome measures to assess alarm interventions are warranted. In addition, we need to evaluate interventions that address the full spectrum cialis amazon of the alarm management system.

Most alarm management interventions to date have focused primarily on filtering out non-actionable alarms. Far less emphasis has been placed on ensuring that the nurse receiving the notification is available to respond to the alarm, a prime opportunity for future work.Even if alarms are actionable, we know that nurses may not always respond quickly for a variety of reasons.7 15–17 Factors like insufficient staffing, high severity of illness cialis amazon on the unit and unbalanced nursing skill mix all likely contribute to inadequate alarm response. In critical care, nurses have reported that the nature of their work requires that they function as a team to respond to one another’s alarms.15 Although not ideal, nurses have developed heuristics based on factors like family presence at the bedside to help them prioritise alarm response in hectic work environments.7 16 Emphasising outcomes like faster alarm response time without addressing systems factors risks trading one patient safety problem for another. We do not want to engender more frequent interruptions of high-risk activities, like medication administration,18 cialis amazon 19 because nurses feel compelled to respond more quickly to alarms.The robust QI initiative carried out by Pater et al reflects the type of thoughtful approach needed to implement and tailor alarm management interventions for a particular unit, demonstrating a generalisable process for others to emulate. Ultimately, every alarm offers a potential benefit (opportunity to rescue a patient) and comes with a potential cost (eg, increased alarm fatigue, interruptions of other activities).

This trade-off needs to be optimised in the context of the individual unit, accounting for the unit-specific and systems factors that influence the cost of each additional alarm, including non-actionable alarm rates, unit layout, severity of illness and nurse staffing.17 20 With more robust outcome measures and more evidence to support interventions, we can increase the value of alarm QI initiatives and accelerate progress towards optimising alarm management systems.AcknowledgmentsWe thank Charles McCulloch, PhD (University of California, San Francisco) for comments on an early draft..

Etchells E, Ho M, low cost cialis Shojania KG cialis efectos adversos. Value of small sample sizes in rapid-cycle quality improvement projects. BMJ Qual Safe 2016;25:202–6.The article has been low cost cialis corrected since it was published online. The authors want to alert readers to the following error identified in the published version. The error is in the last paragraph of the section “Small samples can make ‘rapid improvement’ Rapid”, wherein the minimum sample size has been considered as six instead of low cost cialis eight.For this first (convenience) sample of 10 volunteer users, 5/10 (50%) completed the form without any input or instructions.

The other five became frustrated and gave up. Table 1 tells you that, with an observed success rate of 50% and a desired target of 90%, any audit with a sample of six or more allows low cost cialis you to confidently reject the null hypothesis that your form is working at a 90% success rate.For decades, those working in hospitals normalised the incessant alarms from medical devices as a necessary, almost comforting, reality of a high tech industry. While nurses drowned in excessive, frequently uninformative alarms, other members of the healthcare team often paid little attention. Fortunately, times low cost cialis are changing and managing alarm fatigue is now a key patient safety priority in acute care environments.1Adverse patient events from alarm fatigue, particularly related to excessive physiological monitor alarms, have received widespread attention over the last decade, including from the news media.2–5 In the USA, hospitals redoubled alarm safety efforts following the 2013 Joint Commission Sentinel Event Alert and subsequent National Patient Safety Goals on alarm safety.1 2 6 We are now beginning to understand how to reduce excessive non-actionable alarms (including invalid alarms as well as those that are valid but not actionable or informative),7 8 better manage alarm notifications and ultimately improve patient safety. Alarm data are readily available and measuring alarm response time during patient care is possible.7 9 Yet we have few high-quality reports describing clear improvement to clinical alarm burden, and most published interventions are of limited scope, duration or both.10 11 To demonstrate value in alarm quality improvement (QI) efforts moving forward, we need more rigorous evidence for interventions and more meaningful outcome measures.In this issue of BMJ Quality and Safety, Pater et al12 report the results of a comprehensive multidisciplinary alarm management QI project executed over 3½ years in a 17-bed paediatric acute care cardiology unit.

The primary low cost cialis project goal was to reduce alarm notifications from continuous bedside monitoring. Although limited to a single unit, the project is an important contribution to the scant literature on alarm management in paediatric settings for three reasons. First, the initiative lasted longer than most that have been reported, which allowed for tailoring of alarm interventions to the needs of the unit and patient population and measuring the impacts and sustainability over time. Second, the scope of the intervention low cost cialis bundle encompassed a wide variety of changes including adoption of a smartphone notification system. Addition of time delays between when alarm thresholds are violated and when an alarm notification is issued.

Implementation of an alarm notification escalation algorithm after a certain amount of time in alarm threshold low cost cialis violation. Deactivation of numerous technical alarms (such as respiratory lead detachment). Monitoring of electrode lead replacement every 24 hours low cost cialis. And discussion of alarm parameters on daily rounds. Third, the authors introduced low cost cialis a novel strategy for reducing the stress that alarms may cause patients and families by deactivating inroom alarm audio, although no outcomes were reported attributable directly to this component of the intervention.This project constitutes an important contribution to the published literature.

However, Pater et al faced two challenges that are ubiquitous in the field of clinical alarm management. (1) Identification of meaningful outcome measures and (2) Lack of high-quality low cost cialis evidence for most interventions. With regards to the first challenge, the primary outcome measure used in the study comprised ‘initial alarm notifications’, defined as the first notification of a monitor alarm delivered to the nurse’s mobile device. Although initial alarm notifications declined by 68% following the cialis everyday pill intervention, these notifications accounted for only about half of all alarm notifications. The other half included second and low cost cialis third notifications for alarms exceeding specified delay thresholds, which were sent both to the mobile device of the primary nurse and to ‘buddy’ nurses, potentially increasing alarm burden.

On the other hand, eliminating inroom audible alarms may have reduced the perceived alarm burden for nurses compared with having both bedside and mobile device notifications. Determining the low cost cialis true benefit of a reduction in a subset of alarms presents complex challenges.Alarm frequency is the most commonly used outcome measure in alarm research and QI projects, but reduction in alarms does not necessarily indicate improved patient safety or a highly functional alarm management system. Alarm reduction could easily be achieved in an undesirable way by simply turning off alarms. Unfortunately, most studies have low cost cialis not been powered to statistically evaluate improvements in patient safety. (Pater et al did monitor patient safety balancing measures, which remained stable after intervention implementation).

To assess change in nurses’ perceptions of alarm frequency, Pater et al low cost cialis conducted a prepost survey, which despite the small sample size (n=38 preintervention and n=25 postintervention) managed to show improvement, with the percentage of nurses agreeing they could respond to alarms appropriately and quickly increasing from 32% to 76% (p<0.001). That said, this survey was not a validated measure of alarm fatigue. In fact, we currently have no widely accepted, validated tool for assessing alarm fatigue.11As we look towards future evaluations of alarm management strategies, the focus needs to shift away from simply reducing the frequency of alarms to more meaningful low cost cialis outcome metrics. In addition to alarm rates, outcomes such as response time to actual patient alarms7 9 or to simulated alarms injected into real patient care environments13 may be better indicators of whether the entire alarm response system is functioning correctly. Larger, multisite studies are needed to assess patient outcomes.In addition to meaningful outcome measures, the second challenge for alarm QI projects is the lack of good evidence for alarm management interventions.

Most alarm reduction interventions have not been systematically evaluated at all or only in small studies without a control group.10 11 As a result, alarm low cost cialis management projects tend to involve complex and costly bundles of interventions of uncertain benefit. The cost of these interventions is due in part to the growing industry of technology solutions for alarm management. Some institutions have also made massive investments in personnel, such as monitor ‘watchers’ to help nurses identify actionable alarms, for which there is also little evidence.14Future alarm management QI initiatives will benefit from a higher quality evidence base for the growing list of potential alarm low cost cialis management interventions. Pragmatic trials that leverage meaningful outcome measures to assess alarm interventions are warranted. In addition, we need to evaluate interventions low cost cialis that address the full spectrum of the alarm management system.

Most alarm management interventions to date have focused primarily on filtering out non-actionable alarms. Far less emphasis has been placed on ensuring that the nurse receiving the low cost cialis notification is available to respond to the alarm, a prime opportunity for future work.Even if alarms are actionable, we know that nurses may not always respond quickly for a variety of reasons.7 15–17 Factors like insufficient staffing, high severity of illness on the unit and unbalanced nursing skill mix all likely contribute to inadequate alarm response. In critical care, nurses have reported that the nature of their work requires that they function as a team to respond to one another’s alarms.15 Although not ideal, nurses have developed heuristics based on factors like family presence at the bedside to help them prioritise alarm response in hectic work environments.7 16 Emphasising outcomes like faster alarm response time without addressing systems factors risks trading one patient safety problem for another. We do not want to engender more frequent interruptions of high-risk activities, like medication administration,18 19 because nurses feel compelled to respond more quickly to alarms.The robust QI initiative carried out by Pater et al reflects the type of thoughtful approach needed to implement and tailor alarm low cost cialis management interventions for a particular unit, demonstrating a generalisable process for others to emulate. Ultimately, every alarm offers a potential benefit (opportunity to rescue a patient) and comes with a potential cost (eg, increased alarm fatigue, interruptions of other activities).

This trade-off needs to be optimised in the context of the individual unit, accounting for the unit-specific and systems factors that influence the cost of each additional alarm, including non-actionable alarm rates, unit layout, severity of illness and nurse staffing.17 20 With more robust outcome measures and more evidence to support interventions, we can increase the value of alarm QI initiatives and accelerate progress towards optimising alarm management systems.AcknowledgmentsWe thank Charles McCulloch, PhD (University of California, San Francisco) for comments on an early draft..