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1971 viagra Control “To date the only clinically practical way to control viagra diseases is to administer a treatment that stimulates the body to form antibodies buy kamagra 100mg generic viagra against that viagra. Another possibility is to rely on what is apparently the cell's own first line of defense. Interferon. Our group at the Merck Institute concentrated on the active substance poly I:C.

It shows considerable promise for exploiting the interferon mechanism. After some final tests to rule out the danger of autoimmune disorders, poly I:C will be ready for cautious trials in humans for preventing s, such as the common cold, that are caused by viagraes.” In 2021 researchers have been conducting human trials with interferon as a treatment for erectile dysfunction treatment, but results are unclear. 1921 Immortality for Humans “A skillful surgeon has kept alive, by artificial means, outside the animal, a bit of tissue from the heart of an embryo chick for more than eight years. The remarkable thing is that there is no doubt that if properly cared for it will live on forever.

In connection with other scientists' work its meaning becomes clear. There is no apparent ‘aging' of individual cells. While we are theoretically immortals, the reason we are not actually so is because if one part of the body fails, there is failure in other parts dependent on it, and the whole machine collapses. But it would appear that so long as we can prevent a breakdown of any one part, we shall continue to be young and vigorous.

Perhaps the day is not far away when most of us may reasonably anticipate a hundred years of life. And if a hundred why not a thousand?. € Marie Curie's Weighty Honor “Filled with honors, Mme. Curie sailed on June 25th on the Olympic, on which was carried her precious gram of radium.

The Bureau of Standards provided a beautiful mahogany case lined with lead and steel. Although not large it weighs 130 pounds. In the center are several small compartments, formed of lead and surrounded by steel, each one sized for a small glass tube containing a portion of the radium salts. The lid is inlaid with a gold plate, handsomely marked with the following inscription.

€˜Presented by the President of the United States on behalf of the women of America to Madame Marie Sklodowska Curie in recognition of her transcendent service to science and humanity in the discovery of radium. The White House, May 20, 1921.'” 1871 Calculus Is Good for You “It is admitted by all metaphysicians and educators that the calculus brings into play more faculties of the mind than any other branch of learning. Recognizing this fact, professors should consider their institution a mental gymnasium, which gives the mind exercise that enables it to perform its highest destiny. Herein is the value of solving problems in the calculus, and indeed of all other branches of pure mathematics—that by dealing in abstract ideas, they prepare the mind to apply itself vigorously to profound or complicated subjects connected with the realities of life.” Backyard Gas Well “In every room in a mansion in Pennsylvania was a gas well apparatus, and fires could at any moment be lighted.

In the kitchen was a large and complete range. Nothing is employed in that house for heating and illumination, except this gas. The well is in the backyard, sufficiently removed from the mansion, and is covered by a small house. The bore is five hundred and twenty feet deep, lined with iron pipe, and furnished with a safety valve.”The erectile dysfunction treatment crisis has demonstrated the innumerable ways our health care system can rise to the challenge—and also how we fall short in caring for our most vulnerable patients.

In March 2020, as cases of erectile dysfunction treatment began to climb, I spoke with staffers of the Family Van, a mobile health clinic that provides preventive health services in some of Boston’s most underserved neighborhoods. They emphasized the difficulty of finding multilingual erectile dysfunction treatment information and how this made it difficult for non-English speaking patients to protect themselves. At the time, neither the CDC nor the state health department had released erectile dysfunction treatment information in languages other than English, Spanish and Chinese, leaving community health organizations scrambling to pull together multilingual information on short notice. Over a year later, this continues to be a problem.

Many state governments provide limited information about the treatment in languages other than English, and some offer no language assistance at all on their treatment-finder Web sites. It should come as no surprise that rates of erectile dysfunction treatment are several times higher among non-English speakers, a disturbing pattern that mirrors previous epidemics. To date, much of the discussion around improving care for non-English speaking patients has centered around medical interpreters. This is important.

Patients who use interpreters receive more preventive care, experience fewer adverse events and have greater medication adherence. However, erectile dysfunction treatment taught us that simply having an interpreter available at the point of care isn’t enough. There are many deeply entrenched, historically enforced barriers that prevent non-English speaking patients from receiving the care they need—barriers that begin far before a patient comes to the clinic and last long after their appointment—and it’s time for more comprehensive reform. Recently, several programs have emerged to provide language-appropriate materials and care.

This includes government-led efforts to translate outreach information into different languages, and community-led efforts such as the erectile dysfunction treatment Health Literacy Project, an initiative I founded to translate erectile dysfunction treatment fact sheets into 40 languages. Yet, these efforts are still stopgap solutions. To ensure non-English speakers aren’t sidelined again after this crisis recedes, we must address the barriers they face not only in receiving medical care, but also in accessing and processing it. We need to redesign each part of a non-English-speaking patient’s experience with the health care system—before, during and after an appointment.

Before patients even see a clinician, they need to be able to access health information in their native language. Hospitals and clinics can collaborate with interpreter services to translate health information (e.g., patient education materials, public service announcements). Our work with the erectile dysfunction treatment Health Literacy Project also revealed that many bilingual providers are enthusiastic to help translate materials into their native languages, so health care organizations can consider building an internal database of multilingual staff available to help as needed. Public health agencies can also play an important role.

For example, they could hire translators and make them available on a remote, contract basis to clinical and social service organizations in rural or low-income communities that often have a shortage of interpreters. This is also why we’re transitioning the erectile dysfunction treatment Health Literacy Project into a new nonprofit organization that provides free translation services to community-based organizations to translate health materials into the languages spoken by their patients. Efforts to translate health information need to be paired with programs to ensure this information actually reaches immigrant communities. The key is to bring culturally and linguistically appropriate services to the places where people live and work.

The medium is also important. Evidence suggests non-English speakers prefer text messaging or in-person communication. A good example is New York City’s fleet of mobile vaccination vans, where bilingual staff help patients navigate each step of the erectile dysfunction treatment vaccination process in their own language. When it comes to the appointment itself, health care organizations should strive to match patients with providers who speak their native language.

Language concordance is associated with fewer medical errors, a greater understanding of illness and the treatment plan, and increased satisfaction. Of course, this isn’t always possible, and qualified interpreters should be used at all other times. Following an appointment or hospital admission, patients are usually given discharge instructions that detail their new medication regimen, home care instructions, and follow-up appointments. However, for non-English-speaking patients, this document is seldom translated into their native language.

There have been some suggestions to use machine translation tools (e.g., Google Translate) to automate translation of discharge instructions, but this approach needs to go a step further. We should strive to turn discharge planning into a conversation that non-English-speaking patients can actually participate in. For example, prior to discharge, clinicians can provide patients with their translated discharge instructions, review them verbally (with an interpreter present) and give patients time and space to ask questions. For these changes to work at scale, they need to be bolstered by policy reform.

A good place to start is reinstating the regulations on language provisions rolled back by a recent HHS rule. Under the new rule, providers are no longer required to include notices on significant communications informing patients of their right to receive language assistance. In addition, not having a language access program is no longer a breach of regulatory compliance for many federally funded health care organizations. These changes are a step backwards and can lead health care organizations to deprioritize language access.

How can we pay for these initiatives?. For one, as the government distributes $1.32 billion in funding to community health centers as part of the CARES Act, they could mandate a certain proportion go towards building the infrastructure needed to support non-English speakers. In addition, nonprofit hospitals could tap into their community benefit dollars—community-directed services that nonprofit hospitals must provide to justify their tax-exempt status—to fund these programs. It is evident that our health care system is failing patients with limited English proficiency, and the time is ripe to take action, move away from stopgap solutions and implement comprehensive changes that support non-English speakers throughout the health care continuum.

This is an opinion and analysis article. The views expressed by the author or authors are not necessarily those of Scientific American.For the first time, scientists have without a doubt observed not one but two collisions between black holes and neutron stars. These two separate mergers occurred 10 days apart in January 2020 and were seen by the Laser Interferometer Gravitational-Wave Observatory (LIGO) and Virgo facilities, which detect invisible gravitational waves. The achievement marks the long-awaited completion of a trifecta of events observed by gravitational-wave interferometers.

Black hole–black hole collisions, neutron star–neutron star collisions and now, at last, black hole–neutron star collisions. Although the LIGO-Virgo collaboration had previously identified two candidates for this type of merger in 2019, lingering uncertainties about those events precluded any definitive discovery claim. This time, however, the telltale signatures of black holes feasting on neutron stars were unmistakable. €œIt wasn’t that surprising, but it was just like, ‘Finally, it’s there,’” says Zsuzsa Márka, a Columbia University astrophysicist, LIGO collaborator, who was a co-author of the study announcing the discovery.

The paper was published on June 29 in the Astrophysical Journal Letters. The 2020 collisions each occurred independently in distinct, widely separated regions of the sky and at astronomically vast distances from Earth. One, on January 5, involved a black hole with a mass nearly nine times greater than that of the sun and a neutron star that was almost twice as massive as our star. The other, on January 15, involved a black hole of 5.7 solar masses and a neutron star packing one and a half times our sun’s heft.

Based on the short period in which both collisions took place, physicists now estimate that a merger between a black hole and neutron star occurs approximately once a month somewhere within a billion light-years of the solar system. Albert Einstein’s 1916 prediction of gravitational waves, or ripples in spacetime that can be caused by the motions of extremely massive objects, has borne fruit for physicists since 2015. In September of that year, LIGO detected gravitational waves from the collision of two black holes. Subsequently, LIGO’s capabilities were upgraded, and Italy’s Virgo and Japan’s Kamioka Gravitational-Wave Detector (KAGRA) joined in the detection of gravitational waves—leading to more observations of binary black hole mergers and the first detection of a binary neutron star collision in 2017.

In a way, the observation of a neutron star coalescing with a black hole “completes our collection,” says Chase Kimball, an astrophysics graduate student at Northwestern University and a co-author of the research. The interferometers at LIGO, Virgo and KAGRA each consist of two arms that “wiggle” slightly because of perturbations from passing gravitational waves. During the two 2020 events, the signals produced by these wiggles—charmingly known as chirps—were striking, Márka says, especially in the case of the first merger on January 5. €œIt was definitely a beautiful chirping event,” she adds.

Earlier interferometer observations in April and August 2019 caught scientific and media attention as potential black hole–neutron star mergers, says Alessandra Buonanno, director of the Max Planck Institute for Gravitational Physics in Germany, a LIGO collaborator and a co-author of the June 29 study. The particulars for both of those events eroded confidence in their designation, however, whereas the most recent signals were more definitive. Specifically, the April 2019 signal was not clear and could have instead been the result of detector noise, whereas one of the objects involved in the August 2019 collision fell into the “mass gap,” a theoretical range in which neither black holes nor neutron stars are thought to exist. If such an object was a neutron star, it would be the heaviest on record.

If it was a black hole, it would be the lightest ever found. Befuddled, researchers are still debating exactly what they saw. Yet, because each merger is a one-time affair, no further information is likely to materialize from that faraway event to deliver a definitive answer. Often, astrophysicists studying these mergers hope to also see accompanying electromagnetic emissions from an event—some sparks of celestial light produced in addition to gravitational waves by the cosmic cataclysm.

This time, however, there was no such luck. The two 2020 observations were characterized as neutron star–black hole mergers based on gravitational waves alone rather than any electromagnetic signal, says François Foucart, a physics professor at the University of New Hampshire, who was not involved in the research. Prior to the 2020 observations, physicists were not sure what would happen in this type of merger—if the much more massive black hole would swallow the neutron star in a single bite, Pac-Man-style, or if instead its tidal forces would shred the star before engulfing it like a tornado ripping apart a house. In the latter case, one would expect there to be a pileup of hot, glowing debris around the black hole, which a high-powered telescope could detect.

Buonanno confirms that no glows or other electromagnetic signals were observed in either collision. Still, she adds, that does not mean such light-based counterparts will not be observed in future collisions because their creation depends on factors such as the masses, velocities, orientations and cosmic environs of the black hole and neutron star. The discovery also brings scientists one step closer to learning about how these types of binaries form, Kimball says. Perhaps each of the two progenitor pairs were born and lived out their lives as stars together.

Or they could have begun to circle each other later in their relative life spans as members of a globular cluster—such clusters contain dense swarms of stars at their center. These two mergers alone do not give us the answers, he adds, but the hope is that eventual demographic studies of a larger population of black hole–neutron star collisions will reveal which pathway is more common. Future observations of these mergers may also reveal clues about another mystery. How our universe came to be filled with gold, platinum and other heavier elements, Foucart says.

He adds that about half of the elements heavier than iron are forged in massive cosmic collisions or explosions, and a better sense of the frequency of black hole–neutron star mergers will tell us what proportion of the universe’s allotment of heavier elements they produce. Currently, the LIGO and Virgo detectors are being upgraded in preparation for an observing run scheduled to begin after June 2022. KAGRA, the detector in Japan, will go online for that run. These updates will increase the detectors’ combined ability to pinpoint the precise points on the sky where an event occurs and, in turn, aid astronomers in scanning the right regions of the heavens with traditional telescopes to try and capture electromagnetic counterparts, Foucart says.

€œSeeing these neutron star–black holes for the first time is just the tip of the iceberg of this population,” Buonanno says.Here is our next installment of a new pop-up podcast miniseries that takes your ears into the deep sound of nature. Host Jacob Job, an ecologist and audiophile, brings you inches away from a multitude of creatures, great and small, amid the sonic grandeur of nature. You may not be easily able to access these places amid the viagra, but after you take this acoustic journey, you will be longing to get back outside.Strap on some headphones, find a quiet place, and prepare to experience an evanescent like no other--the blue oak woodlands in Sequoia National Park in California. Catch additional episodes in the series here.The search for extraterrestrial intelligence stands out in the quest to find life elsewhere because it assumes that certain kinds of life will manipulate and exploit its environment with intention.

And that intention may go far beyond just supporting essential survival and function. By contrast, the general search for other living systems, or biosignatures, really is all about eating, reproducing and, not to put too fine a point on it, making waste. The assumption of intention has a long history. Back in the late 1800s and early 1900s the American astronomer Percival Lowell convinced himself, and others, of “non-natural features” on the surface of Mars, and associated these with the efforts of an advanced but dying species to channel water from the polar regions.

Around the same time, Nikola Tesla suggested the possibility of using wireless transmission to contact Mars, and even thought that he might have picked up repeating, structured signals from beyond the Earth. Nearly a century earlier, the great mathematician and physicist Carl Friedrich Gauss had also thought about active contact, and suggested carving up the Siberian tundra to make a geometric signal that could be seen by extraterrestrials. Today the search for intention is represented by a still-coalescing field of cosmic “technosignatures,” which encompasses the search for structured electromagnetic signals as well as a wide variety of other evidence of intentional manipulation of matter and energy—from alien megastructures to industrial pollution, or nighttime lighting systems on distant worlds. But there’s a puzzle that really comes ahead of all of this.

We tend to automatically assume that technology in all of the forms known to us is a marker of “advanced” life and its intentions, but we seldom ask the fundamental question of why technology happens in the first place. I started thinking about this conundrum back in 2018, and it leads to a deeper way to quantify intelligent life, based on the external information that a species generates, utilizes, propagates and encodes in what we call technology—everything from cave paintings and books to flash drives and cloud servers and the structures sustaining them. To give this a label I called it the “dataome.” One consequence of this reframing of the nature of our world is that our quest for technosignatures is actually, in the end, about the detection of extraterrestrial dataomes. A critical aspect of this reframing is that a dataome may be much more like a living system than any kind of isolated, inert, synthetic system.

This rather provocative (well, okay, very provocative) idea is one of the conclusions I draw in a much more detailed investigation my new book The Ascent of Information. Our informational world, our dataome, is best thought of as a symbiotic entity to us (and to life on Earth in general). It genuinely is another “ome,” not unlike the microbiomes that exist in an intimate and inextricable relationship with all multicellular life. As such, the arrival of a dataome on a world represents an origin event.

Just as the origin of biological life is, we presume, represented by the successful encoding of self-propagating, evolving information in a substrate of organic molecules. A dataome is the successful encoding of self-propagating, evolving information into a different substrate, and with a seemingly different spatial and temporal distribution— routing much of its function through a biological system like us. And like other major origin events it involves the wholesale restructuring of the planetary environment, from the utilization of energy to fundamental chemical changes in atmospheres or oceans. In other words, I’d claim that technosignatures are a consequence of dataomes, just as biosignatures are a consequence of genomes.

That distinction may seem subtle, but it’s important. Many remotely observable biosignatures are a result of the inner chemistry of life. Metabolic byproducts like oxygen or methane in planetary atmospheres for example. Others are consequences of how life harvests energy, such as the colors of pigments associated with photosynthesis.

All of these signatures are deeply rooted in the genomes of life, and ultimately that’s how we understand their basis and likelihood, and how we disentangle these markers from challenging and incomplete astronomical measurements. Analogous to biosignatures, technosignatures must be rooted in the dataomes that coexist with biological life (or perhaps that had once coexisted with biological life). To understand the basis and likelihood of techosignatures we therefore need to recognize and study the nature of dataomes. For example, a dataome and its biological symbiotes may exist in uneasy Darwinian balance, where the interests of each side are not always aligned, but coexistence provides a statistical advantage to each.

This could be a key factor for evaluating observations about environmental compositions and energy transformations on other worlds. We ourselves are experiencing an increase in the carbon content of our atmosphere that can be associated with the exponential growth of our dataome, yet that compositional change is not good for preserving the conditions that our biological selves have thrived in. Projecting where our own dataome is taking us could provide clues to the scales and qualities of technosignatures elsewhere. If we only think about technosignatures as if they’re an arbitrary collection of phenomena rather than a consequence of something Darwinian in nature, it could be easy to miss what’s going on out there in the cosmos..

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NCHS Data a knockout post Brief No cialis vs viagra recreational use. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular disease (1) cialis vs viagra recreational use and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is “the permanent cessation of menstruation that occurs after the loss cialis vs viagra recreational use of ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal cialis vs viagra recreational use.

Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were cialis vs viagra recreational use more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 cialis vs viagra recreational use. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic cialis vs viagra recreational use trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their cialis vs viagra recreational use last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf cialis vs viagra recreational use icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure cialis vs viagra recreational use 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 cialis vs viagra recreational use. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal cialis vs viagra recreational use status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was cialis vs viagra recreational use 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure cialis vs viagra recreational use 2pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal cialis vs viagra recreational use status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 cialis vs viagra recreational use. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image cialis vs viagra recreational use icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were cialis vs viagra recreational use perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data cialis vs viagra recreational use table for Figure 3pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage cialis vs viagra recreational use of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 cialis vs viagra recreational use. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5).

Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?.

€. 2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less.

Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS.

For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States. The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS.

Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

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Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No.

141. Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N. Perimenopause.

From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult.

A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software].

2012. Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286.

Hyattsville, MD. National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J. Blumberg, Ph.D., Associate Director for Science.

NCHS Data https://www.actio-rae.eu/where-to-buy-cheap-lasix/ Brief buy kamagra 100mg generic viagra No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an buy kamagra 100mg generic viagra increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of buy kamagra 100mg generic viagra menstruation that occurs after the loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, buy kamagra 100mg generic viagra 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour buy kamagra 100mg generic viagra period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 buy kamagra 100mg generic viagra. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend buy kamagra 100mg generic viagra by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no buy kamagra 100mg generic viagra longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for buy kamagra 100mg generic viagra Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one buy kamagra 100mg generic viagra in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 buy kamagra 100mg generic viagra.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p < buy kamagra 100mg generic viagra. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were buy kamagra 100mg generic viagra perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure buy kamagra 100mg generic viagra 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the buy kamagra 100mg generic viagra past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 buy kamagra 100mg generic viagra. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, buy kamagra 100mg generic viagra 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual buy kamagra 100mg generic viagra cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE buy kamagra 100mg generic viagra. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling buy kamagra 100mg generic viagra well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 buy kamagra 100mg generic viagra. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

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Screening for mental health issues and treatment, including counselling, should be made available. In addition, nurses and other healthcare staff should be encouraged to reflect lady viagra pills on their experiences and consider how to implement self-care strategies that will enhance their well-being. This includes staying informed of the current data and information and being aware of the risks to themselves and others while caring for patients with the viagra. By monitoring and enacting strategies to reduce stress and develop support systems, staff can minimise longer-term impacts.4Whether organisational support and self-care monitoring have achieved better mental health outcomes for healthcare workers is, as yet, unknown. Research across the globe is underway not only related to the viagra itself but also to the mental lady viagra pills health consequences of the viagra.

We do not yet know the extent of the issues or how best to support healthcare providers. In order to better understand the issues and to support nurses at lady viagra pills this time, evidence-based nursing will focus our social media to mental health issues during the month of October. We will highlight and share relevant resources and information and encourage discussion of the key challenges facing healthcare workers.During October, we will showcase the experiences of four key groups—patients, nurses, students and informal carers and families. Be sure to log into evidence-based nursing each week for the following lady viagra pills blogs:October 4. Impact of erectile dysfunction treatment on patient mental health.October 11.

Impact of erectile dysfunction treatment on lady viagra pills nurses’ mental health and.Twitter Chat on Wednesday October 14 at 20:00 UK time.Oct. 18. Impact of erectile dysfunction treatment on student nursing.Oct. 25. Impact of erectile dysfunction treatment on informal carers and families.A PhD is a globally recognised postgraduate degree and typically the highest degree programme awarded by a University, with students usually required to expand the boundaries of knowledge by undertaking original research.

The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce. In this paper—the first of two linked Research Made Simple articles—we explore what the foundations of a high-quality PhD are, and how a Doctoral candidate can develop a study which is successful, original and impactful.Foundations of a ‘good’ PhD studySupervision and supportCentral to the development and completion of a good PhD is the supervisory relationship between the student and supervisor. The supervisor guides the student by directing them to resources and training to ensure continuous learning, provides opportunity to engage with experts in the field, and facilitates the development of critical thinking through questioning and providing constructive criticism.1The support needs of students will be different, so a flexible yet quality assured approach to PhD research training is required. A good supervisory team (usually includes at least two postdoctoral academics) provide experienced guidance and mentorship and will offer students academic support, with regular meetings and timely feedback on written submissions, will assist the student to develop a peer network and help them access research communities relative to their field. Effective supervision has beneficial outcomes for students, including encouraging a positive work ethic and influencing engagement in a stimulating environment, allowing students to pursue their own ideas with educated encouragement.

The quality of the supervisory relationship can impact greatly on the PhD experience and ultimately sets the student on the road to producing excellent Doctoral work.1An environment that promotes personal and professional development is further aided by positive peer interactions. If students feel part of a community and have contact with others also working on doctoral studies, there is the scope for peer compassion and understanding during both challenging and rewarding periods. Students who access personal and professional support and guidance through mentoring models during their studies are more likely to succeed. These models include one-to-one peer mentoring or activities for example journal discussion or methods learning groups. Often, groups of students naturally come together and give each other support and advice about research process expectations and challenges, and offer friendship, and guidance.2 Given the usefulness of different types of mentoring models, all can create a supportive and collaborative environment within a PhD programme of study, to minimise working in isolation and enable students to achieve their greatest potential.Characteristics of a good study.

Originality and theoretical underpinningA PhD should make an original contribution to knowledge. Originality can be achieved through the study design, the nature or outcomes of the knowledge synthesis, or the implications for research and/or practice.3 Disciplinary variation, however, influences the assessment of originality. For example, originality in science, technology, engineering and mathematics subjects is often inferred if the work is published/publishable, in comparison to intellectual originality in the social sciences.4 Although PhD originality assumes different nuances in different contexts, there is a general acceptance across disciplines that there should be evidence of the following within the thesis:An interplay between old and new—any claims of originality are developed from existing knowledge and practices.There are degrees of originality, relating to more than one aspect of the thesis.Any claims for originality are accompanied by clear articulation of significance.A good PhD should be also underpinned by theoretical and/or conceptual frameworks (that include philosophical and methodological models) that give clarity to the approach, structure and vision of the study.5 These theoretical and conceptual frameworks can explain why the study is pertinent and how the research addresses gaps in the literature.6 Table 1 provides a distinction of what construes theoretical and conceptual frameworks.View this table:Table 1 Characteristics of theoretical and conceptual frameworks7Theoretical/conceptual frameworks must align with the research question/aims, and the student must be able to articulate how conceptual/theoretical framework were chosen. Key points for consideration include:Are the research questions/aim and objectives well defined?. What theory/theories/concepts are being operationalised?.

How are the theories/concepts related?. Are the ontological and epistemological perspectives clearly conveyed and how do they relate to theories and concepts outlined?. What are the potential benefits and limitations of the theories and concepts outlined?. Are the ways the theories/concepts are outlined and being used original?. A PhD thesis (and demonstrable in viva) must be able to offer cohesion between the choice of research methods that stems from the conceptual/theoretical framework, the related ontological and epistemological decisions, the theoretical perspective and the chosen methodology (table 2).

PhD students must be able to articulate the methodological decisions made and be critical of methods employed to answer their research questions.View this table:Table 2 Relationship between research paradigms, perspectives, methodologies and methods.8 9ConclusionIn summary, we offer considerations of what the foundations of a good PhD should be. We have considered some of the key ingredients of quality PhD supervision, support and research processes and explored how these will contribute to the development of a study that leads to student success and which makes a valuable contribution to the evidence base. In the next paper, we will look in more detail at the assessment of the PhD through the submission of a thesis and an oral viva..

October is Mental Health Awareness Month and World Mental buy kamagra 100mg generic viagra Health Day takes place on 10 October 2020. This year, the erectile dysfunction treatment viagra has added a new dimension to concerns regarding mental health in our communities. Across the globe stories continue to emerge of people’s experiences of anxiety, fear and depression due to the uncertainty and stress brought on by the viagra.1–3 Job losses, financial and housing insecurity, the challenges buy kamagra 100mg generic viagra of working from home, home schooling, restricted access to health and social care services and social isolation coupled with reduced support and contact with family and friends have all impacted people’s well-being.

There is particular concern about the mental health of healthcare workers during this difficult time.While most healthcare workers are resilient to the long-term effects of this period of stress and anxiety, there is the added worry about scarce resources, lack of cure or effective treatment options, isolation from family, coping with patient suffering and deaths and the moral and ethical impact of decisions as to who will receive acute care. These factors have significant potential for negative repercussions on the mental health and well-being of healthcare staff.4 5 There have been reports of high levels of stress, depression and even suicides,6 and long-term effects include a higher risk for post-traumatic stress disorder or moral injury.5Healthcare organisations need to plan for the inevitable consequence of this viagra and ensure that resources are in place for buy kamagra 100mg generic viagra their workers. Screening for mental health issues and treatment, including counselling, should be made available.

In addition, nurses and other healthcare staff should be encouraged to reflect on their experiences and consider how to implement self-care strategies that buy kamagra 100mg generic viagra will enhance their well-being. This includes staying informed of the current data and information and being aware of the risks to themselves and others while caring for patients with the viagra. By monitoring and enacting strategies to reduce stress and develop support systems, staff can minimise longer-term impacts.4Whether organisational support and self-care monitoring have achieved better mental health outcomes for healthcare workers is, as yet, unknown.

Research across the globe is underway not only related to the viagra itself but also to buy kamagra 100mg generic viagra the mental health consequences of the viagra. We do not yet know the extent of the issues or how best to support healthcare providers. In order to better understand the issues and to support nurses at this time, evidence-based nursing will focus our social media to buy kamagra 100mg generic viagra mental health issues during the month of October.

We will highlight and share relevant resources and information and encourage discussion of the key challenges facing healthcare workers.During October, we will showcase the experiences of four key groups—patients, nurses, students and informal carers and families. Be sure buy kamagra 100mg generic viagra to log into evidence-based nursing each week for the following blogs:October 4. Impact of erectile dysfunction treatment on patient mental health.October 11.

Impact of erectile dysfunction treatment on buy kamagra 100mg generic viagra nurses’ mental health and.Twitter Chat on Wednesday October 14 at 20:00 UK time.Oct. 18. Impact of erectile dysfunction treatment on student nursing.Oct.

25. Impact of erectile dysfunction treatment on informal carers and families.A PhD is a globally recognised postgraduate degree and typically the highest degree programme awarded by a University, with students usually required to expand the boundaries of knowledge by undertaking original research. The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce.

In this paper—the first of two linked Research Made Simple articles—we explore what the foundations of a high-quality PhD are, and how a Doctoral candidate can develop a study which is successful, original and impactful.Foundations of a ‘good’ PhD studySupervision and supportCentral to the development and completion of a good PhD is the supervisory relationship between the student and supervisor. The supervisor guides the student by directing them to resources and training to ensure continuous learning, provides opportunity to engage with experts in the field, and facilitates the development of critical thinking through questioning and providing constructive criticism.1The support needs of students will be different, so a flexible yet quality assured approach to PhD research training is required. A good supervisory team (usually includes at least two postdoctoral academics) provide experienced guidance and mentorship and will offer students academic support, with regular meetings and timely feedback on written submissions, will assist the student to develop a peer network and help them access research communities relative to their field.

Effective supervision has beneficial outcomes for students, including encouraging a positive work ethic and influencing engagement in a stimulating environment, allowing students to pursue their own ideas with educated encouragement. The quality of the supervisory relationship can impact greatly on the PhD experience and ultimately sets the student on the road to producing excellent Doctoral work.1An environment that promotes personal and professional development is further aided by positive peer interactions. If students feel part of a community and have contact with others also working on doctoral studies, there is the scope for peer compassion and understanding during both challenging and rewarding periods.

Students who access personal and professional support and guidance through mentoring models during their studies are more likely to succeed. These models include one-to-one peer mentoring or activities for example journal discussion or methods learning groups. Often, groups of students naturally come together and give each other support and advice about research process expectations and challenges, and offer friendship, and guidance.2 Given the usefulness of different types of mentoring models, all can create a supportive and collaborative environment within a PhD programme of study, to minimise working in isolation and enable students to achieve their greatest potential.Characteristics of a good study.

Originality and theoretical underpinningA PhD should make an original contribution to knowledge. Originality can be achieved through the study design, the nature or outcomes of the knowledge synthesis, or the implications for research and/or practice.3 Disciplinary variation, however, influences the assessment of originality. For example, originality in science, technology, engineering and mathematics subjects is often inferred if the work is published/publishable, in comparison to intellectual originality in the social sciences.4 Although PhD originality assumes different nuances in different contexts, there is a general acceptance across disciplines that there should be evidence of the following within the thesis:An interplay between old and new—any claims of originality are developed from existing knowledge and practices.There are degrees of originality, relating to more than one aspect of the thesis.Any claims for originality are accompanied by clear articulation of significance.A good PhD should be also underpinned by theoretical and/or conceptual frameworks (that include philosophical and methodological models) that give clarity to the approach, structure and vision of the study.5 These theoretical and conceptual frameworks can explain why the study is pertinent and how the research addresses gaps in the literature.6 Table 1 provides a distinction of what construes theoretical and conceptual frameworks.View this table:Table 1 Characteristics of theoretical and conceptual frameworks7Theoretical/conceptual frameworks must align with the research question/aims, and the student must be able to articulate how conceptual/theoretical framework were chosen.

Key points for consideration include:Are the research questions/aim and objectives well defined?. What theory/theories/concepts are being operationalised?. How are the theories/concepts related?.

Are the ontological and epistemological perspectives clearly conveyed and how do they relate to theories and concepts outlined?. What are the potential benefits and limitations of the theories and concepts outlined?. Are the ways the theories/concepts are outlined and being used original?.

A PhD thesis (and demonstrable in viva) must be able to offer cohesion between the choice of research methods that stems from the conceptual/theoretical framework, the related ontological and epistemological decisions, the theoretical perspective and the chosen methodology (table 2). PhD students must be able to articulate the methodological decisions made and be critical of methods employed to answer their research questions.View this table:Table 2 Relationship between research paradigms, perspectives, methodologies and methods.8 9ConclusionIn summary, we offer considerations of what the foundations of a good PhD should be. We have considered some of the key ingredients of quality PhD supervision, support and research processes and explored how these will contribute to the development of a study that leads to student success and which makes a valuable contribution to the evidence base.

In the next paper, we will look in more detail at the assessment of the PhD through the submission of a thesis and an oral viva..

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During Diabetes buy kamagra 100mg generic viagra Awareness Month in November, we’re reminding our patientswho are living with diabetes to keep up http://sjaynephotography.com/families/ with daily foot checks. The AmericanDiabetes Association recommendsdaily foot checks because nearly 1 in 4 people with buy kamagra 100mg generic viagra diabetes will experience adiabetic foot ulcer. During the viagra, wound-related amputations rose nearly50% globally.

If you, like Anna, are living with diabetes, be sure tocheck your feet daily for wounds to avoid complications such buy kamagra 100mg generic viagra as ,hospitalization or amputation. MidMichigan Health hasspecialized services to help you manage diabetes effectively and to prevent ortreat non-healing wounds. Diabetes Educators are specialized in helping you manage your diabetes and can develop a plan to help you adopt healthy behaviors, develop problem-solving and buy kamagra 100mg generic viagra coping skills and overcome barriers to diabetes self-management.

Learn more at www.midmichigan.org/diabetes. MidMichigan’s specialized Wound Treatment Centers have a median time buy kamagra 100mg generic viagra to heal of 28 days and 94 percent patient satisfaction. If you or someone you love is living with a non-healing wound, don’t wait – seek specialized care buy kamagra 100mg generic viagra.

Call the Wound Treatment Centers toll free at (877) 683-0800.It is that time of year again when we must confront the cyclic moods we call Seasonal Affective Disorder, or S.A.D. Each year during the winter months, some individuals experience depression that is cyclic and buy kamagra 100mg generic viagra predictable. This mood change usually starts sometime around October or November and subsides around March or April.

Symptoms may include buy kamagra 100mg generic viagra. A drop in energy levelDifficulty concentratingBecoming increasingly irritableExperiencing a change in appetite, craving sweets or carbsOversleepingIncreased fatigueWeight gain While depression can be caused by major life changes, certain medications, or alcohol and other drugs, S.A.D. Is believed to buy kamagra 100mg generic viagra be caused by a change in circadian rhythm.

The circadian rhythm is the repeating cycle that regulates day and night activities and is fueled by buy kamagra 100mg generic viagra the secretion of melatonin from the pineal gland in response to darkness. Whereas melatonin induces sleep, the hormone serotonin produces energy and feelings of happiness, and increases with exposure to bright light. Individuals who have Seasonal Affective Disorder show buy kamagra 100mg generic viagra a longer duration of melatonin release during nights and winter months, due to shorter daylight hours.

Circadian rhythm is a 24-hour repeating rhythm in the human brain that regulates day and night activities. Between midnight and 2 buy kamagra 100mg generic viagra a.m., melatonin levels peak and then fall gradually until morning. Sunlight informs the brain of a new day, suppresses melatonin and increases serotonin.

During the buy kamagra 100mg generic viagra winter months, there is later morning light, causing melatonin levels to peak later and remain elevated two or more hours longer than during the summer months. When this occurs the body thinks it needs more sleep. There are several buy kamagra 100mg generic viagra options available in treating S.A.D.

If an individual is experiencing mild symptoms that do not interfere too much with their activities of daily living, light therapy can be effective buy kamagra 100mg generic viagra. Light therapy is used to synchronize the circadian rhythm and sleep/awake cycle with a special lamp that is 10-20 times brighter than ordinary indoor bulbs, for about 30 minutes each day. Typical light therapy is generated buy kamagra 100mg generic viagra at 10,000 lux using a light box, and is most effective if used in the morning.

These boxes are available through durable medical equipment programs, or can be found by shopping online. Other effective treatments of S.A.D include medications buy kamagra 100mg generic viagra and talk therapy. Antidepressants can be used to treat symptoms of seasonal affective disorder.

Talk therapy can be successful in identifying and modifying negative thoughts and buy kamagra 100mg generic viagra behaviors and increasing coping skills to manage stress. All persons buy kamagra 100mg generic viagra affected by S.A.D. Regardless of their choice of treatment should engage in activities such as walking or other exercise, eating a well-balanced diet, establishing regular sleep/wake times, and participating in winter sports or hobbies that will lead to productive use of time.

An important thing to remember about Seasonal Affective Disorder is that it only lasts a few months during the year and buy kamagra 100mg generic viagra that treatment is available to lessen the symptoms. For more information about Seasonal Affective Disorder there are many books, such as Winter Blues. Seasonal Affective Disorder—What It Is and how to Overcome It by Norman Rosenthal, M.D., or websites from reputable experts, such as the National Institute of Health’s buy kamagra 100mg generic viagra www.nlm.nih.gov/medlineplus/seasonalaffectivedisorder or the National Institute of Mental Health’s www.nimh.nih.gov.

For those who need moreintense treatment for S.A.D. Or other buy kamagra 100mg generic viagra mental health conditions MidMichiganHealth provides an intensive outpatient program called Psychiatric PartialHospitalization Program at MidMichigan Medical Center – Gratiot. Thoseinterested in more information about the PPH program may call (989) 466-3253.Those interested in more information on MidMichigan’s comprehensive behavioralhealth programs may visit www.midmichigan.org/mentalhealth..

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It’s been a widely held conclusion in the health insurance natural viagra foods industry and among health policy types that one of our biggest hurdles lies with the challenge of getting coverage for “young invincibles” – Americans old enough to vote but under 30. That label itself is tied to a widely held perception that – because of their youth – “twenty-somethings” believe they’re healthy enough that they simply won’t need all of the bells and whistles of comprehensive health insurance (any time soon, at least).As an agent and an avid observer of health insurance trends, I know it’s not that simple. Young adults, in natural viagra foods many cases, are keenly aware of their need for comprehensive coverage.

But – despite various federal and state efforts to make coverage more affordable and accessible (including provisions of the American Rescue Plan) – there are definitely barriers making it difficult for young adults to enter the individual health insurance market.Last week, I spoke with Carolyn Kettig, a young woman who’s determined to get coverage but facing barriers that many young Americans face. Carolyn Kettig is a professional actor in New York, and has thus far natural viagra foods maintained health coverage under her mother’s policy. But that will end this summer, when Carolyn turns 26.

She shares natural viagra foods her story with me here, and I’ve added my own commentary wherever it might help readers in similar situations understand their coverage options.Before we begin, it’s worth noting that because Carolyn lives in New York, she has access to a Basic Health Program. New York and Minnesota are the only states that offer these programs, and they’re an excellent coverage option for people who are eligible to enroll. But if you’re not in New York or Minnesota, you’ve still got plenty of options.That’s particularly true now natural viagra foods that the American Rescue Plan has been enacted, making premium subsidies larger and more widely available.

For many young people, the American Rescue Plan makes robust coverage much more affordable than it used to be. (Previously, it was common natural viagra foods for young people to feel like their only truly affordable health coverage option was a plan with a deductible that may have felt impossibly high).Louise. What’s your current insurance situation and how is it changing this year?.

What are your natural viagra foods options for coverage?. Carolyn. I’m lucky enough to currently be covered by my natural viagra foods mother’s health insurance.

She has a very generous insurance plan and I’ve been privileged to, thus far, be fully covered. Unfortunately, because I’m turning 26, I’ll be losing natural viagra foods coverage this spring.As a professional actor, my early twenties were filled with countless side jobs that supported me as I sought acting work in New York City. None of these jobs ever came with healthcare benefits, which at the time was okay as I was covered by my mother’s plan.

Three years ago, when I landed my first big theater job, I had the opportunity to join the actor’s union, which among many other wonderful things, provides working actors with comprehensive, affordable health insurance.The only catch, and it’s a fairly large one, is that an actor must work a certain number of weeks in order to qualify. Even without a natural viagra foods viagra, finding steady work in the theater is difficult. Factor in a viagra that shutters theaters for over a year and causes the union to hemorrhage money … needless to say, healthcare coverage in my industry has become a near impossibility.I’m hopeful that live entertainment will return in a vaccinated world, but until then, I’m doing my best to make enough money to pay my bills.

I’m grateful to be employed part-time as a program director for a natural viagra foods teen program. My job has kept me afloat during this devastating time, but, unfortunately, does not come with healthcare benefits. I make very little money and live paycheck to paycheck, which leaves me natural viagra foods relatively few options when it comes to insurance.

I will most likely go with New York State’s Essential Plan, which is the best option for low-income people who make too much money to qualify for Medicaid.Louise. The Essential Plan is New York’s Basic Health Program (BHP), which natural viagra foods is available to people earning up to 200% of the poverty level. (For a single person in 2021, that amounts to $25,760.) The Affordable Care Act allowed for the creation of BHPs, but New York and Minnesota are the only states that have opted to establish them.The Essential Plan provides robust health coverage with no monthly premium, and it has much lower cost-sharing than we typically see in the individual/family health insurance market.

The Essential Plan is also being enhanced as of June 2021 natural viagra foods. Previously, some enrollees had to pay $20/month, and there was an extra premium for dental and vision coverage. Dental and vision are now included natural viagra foods at no cost.Louise.

How much is the need for coverage weighing on you and other people your age?. Carolyn natural viagra foods. I’ve lost sleep over this!.

It natural viagra foods weighs on me heavily. Having grown up in New York, I have a long history with some of my doctors, most of whom will not accept my new insurance plan. This means that I will either be forced to find new doctors or pay hundreds of dollars out of pocket for routine check-ups.I’m also aware that, even with insurance coverage, an unexpected hospital stay could cost me thousands of dollars.

It makes me enraged to know that, in an emergency situation, I would avoid going to the hospital because of natural viagra foods the cost.Louise. The Essential Plan provides much more robust coverage than people may be used to seeing elsewhere. There is no deductible, emergency room visits cost $75, and inpatient hospital stays are only $150 per admission – and these fees are waived altogether for enrollees with income up to 150% of the poverty level, or a little more than natural viagra foods $19,000 for a single person.

This is better coverage than most people have even with higher-end employer-sponsored plans.Carolyn. I know that natural viagra foods I’m not alone in this. Especially since my generation is now living through a global health crisis, I think my peers are more aware than ever before of how broken our healthcare system really is.

Moreover, as a white, cisgendered woman from a middle-class background, I’m cognizant of the privilege my identities afford me and deeply disturbed by the ways in which our healthcare system disregards and harms BIPOC, natural viagra foods low-income families, LGBTQIA+ youth, and undocumented workers (many of whom are essential workers and yet have little access to healthcare coverage) among many others. Alongside the climate crisis and the fight for racial equality, I believe that healthcare reform will dominate the American political landscape for the next few decades.Louise. I agree that our healthcare natural viagra foods system is in need of extensive reform.

The American Rescue Plan, enacted just last month, is the first major change we’ve seen since the Affordable Care Act was signed into law 11 years ago. It includes some substantial improvements designed to make health coverage more affordable and accessible.But these improvements are temporary unless Congress natural viagra foods takes additional action to make them permanent. And there are other issues, such as the ACA’s family glitch, and the Medicaid coverage gap that exists in the dozen states that have refused to expand Medicaid, that haven’t yet been fixed.

Fortunately, lawmakers in Congress are continuing to push forward on these issues, and voters can reach out to their elected natural viagra foods officials to express their opinions.Louise. What do you see as challenges in this situation?. Carolyn.

I’ve mentioned many challenges already, but I think chief among them is simply how confusing and difficult it is to make informed choices. Reading about insurance options requires learning an entirely new language and navigating nearly impenetrable websites.Louise. For folks who are confused by the terminology and concepts that go along with health insurance, our glossary is a great resource.

We’ve incorporated plenty of details, since that’s where the nuances always are. And we’ve focused on explaining things using plain language that’s easy to understand.Help from the American Rescue PlanLouise. Are you aware of the changes that the American Rescue Plan has made?.

Do you think it will make it easier for you to access coverage?. Carolyn. I’ve read a bit about the changes made by the American Rescue Plan and am thrilled that this administration is attempting to expand access to healthcare (even though I’d love to see more substantial reform).

I don’t think that I will be impacted directly by the bill because I already live in a state that offers an affordable plan for people in my income bracket.Louise. If you lived in another state, the American Rescue Plan would make your coverage more affordable. But you’re correct.

Assuming your 2021 income doesn’t exceed 200% of the poverty level (about $25,760), you’ll be eligible for either The Essential Plan or Medicaid in New York, both of which are already robust coverage with no monthly premiums.But for others in a similar situation who live elsewhere, the American Rescue Plan implements a variety of improvements that make it easier for young people to transition to their own coverage. Among other provisions, the American Rescue Plan. Louise.

What do you expect to happen with your coverage this summer?. Do you have a good idea of the plan you’ll be on after you transition away from your mom’s coverage, or is it still up in the air?. Carolyn.

Fortunately, through The Actors Fund, I have access to a professional who will guide me through the process of finding a plan, although I’m fairly certain I will end up on the Essential Plan.I’ve been told to begin the process a couple months before I lose coverage, so that’s coming up very soon!. I also have many friends who are in a similar situation or have already gone through the process, so I expect I’ll be texting them a whole lot. Even though I’m anxious about navigating the system on my own for the first time, I feel well supported as I approach this transition.Louise.

As you’re going through this insurance transition, what do you feel are the most important things for other people your age to keep in mind?. Carolyn. I think it’s important to do your research, seek out trusted professionals or peers to guide you, and ask a lot of questions.

The system is designed to be confusing and ultimately benefit insurance companies, so I believe the more questions you ask, the better positioned you’ll be to advocate for yourself. Get acquainted with the vocabulary and make sure you know the basic terms (i.e. Premium, deductible, out of pocket maximum, in-network, enrollment period).

And if you’re uninsured for a period of time, know that you can find sliding scale clinics, sliding scale hospital services, and assistance paying for prescription drugs. Your health, both physical and mental, is of utmost importance!. Louise.

The advice to seek out assistance and ask lots of questions is spot-on. There are no silly questions, and any question you might have about health insurance is certainly shared by plenty of other people.Thanks to the American Rescue Plan, there has never been a better time to be transitioning to your own health insurance policy. And even if you’re not experiencing a qualifying event (such as aging off of a parent’s health insurance policy), there’s a erectile dysfunction treatment-related enrollment window that runs through August 15 in most states, giving people an opportunity to enroll and take advantage of the newly enhanced premium subsidies.And in every community, there are navigators, enrollment counselors, and health insurance brokers who can help you pick a plan and answer any questions you might have.

We also have an extensive collection of FAQs, including several that are specific to young adults.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 health insurance experts.If you buy your own health insurance – or don’t have health insurance at all – you might have been pleased to hear that the American Rescue Plan (ARP) has increased premium subsidies for 2021 and made them available to more people.But receiving those premium tax credits isn’t necessarily automatic.

When and how you get them depends on where you live and other factors, including whether you’re already enrolled in a marketplace plan and whether you’re receiving unemployment compensation at any point in 2021.Use our updated subsidy calculator to estimate how much you can save on your 2021 health insurance premiums.The early bird gets the premium subsidyAlthough the current erectile dysfunction treatment/ARP enrollment window extends through August 15 in most states, it’s in your best interest to enroll as soon as possible in order to maximize the number of months you get the extra subsidies.If you’re receiving unemployment compensation at any point in 2021, the American Rescue Plan gives you access to substantial premium subsidies and full cost-sharing reductions. That means you’ll be eligible for a Silver plan that’s upgraded to better-than-platinum benefits, and you won’t have to pay any monthly premiums. But in most states, this benefit isn’t yet available.

(Note that in some states, you may still have to pay a dollar or two, even for the lowest-cost Silver plans. And it’s worth noting that even if you’re eligible for a premium-free Silver plan, you might find that you prefer to upgrade to a Silver plan that has at least a nominal premium in trade for a more extensive provider network.)Regardless, you’ll still want to enroll – or change your plan – as soon as possible so that when subsidies are available, you’ll receive credit for them.Your state’s marketplace affects how and when you receive your subsidiesFor starters, you should be aware that when it comes to how the ARP’s extra subsidies are being handled, there’s one process in the states that use HealthCare.gov, and 15 slightly different approaches in the other states. Thirty-six states use HealthCare.gov as their marketplace, while Washington, DC and the other 14 states operate their own state-run marketplaces (Covered California, New York State of Health, Your Health Idaho, etc.).

How and when will you receive your premium subsidy in a HealthCare.gov state?. If you’re in a state that uses HealthCare.gov, your additional subsidies will not be automatically added to your account, even if you already have financial information on file with the marketplace. You’ll need to log back into your account and follow the instructions to get your subsidy amount updated.

(You can do this directly through HealthCare.gov or through an enhanced direct enrollment entity if you use one – or your broker or agent can help you sort it out). Once the new subsidy is determined, you can choose to either apply it to your current plan or pick a different plan.If you’re uninsured or enrolled in an off-exchange plan, you can switch to the marketplace anytime between now and August 15. But the sooner you enroll, the sooner you’ll start receiving subsidies.HealthCare.gov rolled out most of the ARP’s new subsidies as of April 1, but CMS has said it will be July before the enhanced subsidies are available to people who receive unemployment compensation in 2021.It’s important to understand that regardless of the reason for the additional premium subsidy (including unemployment compensation), the subsidy itself is retroactive to January 1, 2021 in every state, as long as you’ve had coverage through the marketplace for the whole year.

So even if your enhanced subsidy due to unemployment compensation doesn’t take effect until August, you’ll be able to claim the rest of it when you file your 2021 tax return. However, the full cost-sharing reductions for people who receive unemployment compensation in 2021 can only be provided in real-time, and won’t take effect until the marketplace can process them, starting this summer. How will premium subsidies be treated in states that run their own marketplaces?.

In the District of Columbia and the other 14 states, the deadlines, subsidy availability dates, and even eligibility rules differ from state to state. In most of these states, the current special enrollment window is functioning like an open enrollment period, with people allowed to newly enroll or switch plans – though there are some exceptions, detailed below. And in contrast to HealthCare.gov, nearly all of the state-run exchanges will be automatically updating subsidy amounts for current enrollees over the next several weeks, as long as the enrollee has financial information on file with the exchange.

Here’s a summary of what each state with a state-run marketplace is doing:CaliforniaResidents can enroll in an ACA-compliant plan through December 31.Subsidies are currently available for most people, but subsidy eligibility based on unemployment compensation won’t be available until July or August.For current enrollees, subsidies will be automatically updated in May.ColoradoResidents can enroll in an ACA-compliant plan through August 15.Subsidies will not be automatically updated, but are currently available for both new and existing enrollees. The process will be more streamlined by mid-May.Connecticut:Residents can enroll in an ACA-compliant plan between May 1 and August 15.Subsidies will be available to most people starting May 1, although subsidy eligibility based on unemployment compensation will be available by July.Subsidies will be automatically updated by July, for current enrollees who don’t manually update their accounts before then.District of Columbia:Residents can enroll in an ACA-compliant plan any time through the end of the viagra emergency period.Extra subsidies are currently available to anyone eligible, including people who are eligible due to unemployment compensation in 2021.Subsidies will be automatically updated in May, for current enrollees who don’t manually update their accounts before then.For people who have been enrolled through the marketplace since January, the full amount of the additional premium subsidy will be spread across the remaining months of 2021 (as opposed to having to wait to claim the subsidy for the first few months of 2021 on their tax returns).Idaho:Residents can enroll in an ACA-compliant plan through April 30.Updated subsidies are currently available, and have been automatically updated for existing enrollees who had already provided financial information to the exchange.Current enrollees can change plans, but only to another plan offered by the same insurance company (unless they have a qualifying event).Maryland:Residents can enroll in an ACA-compliant plan through August 15.Updated subsidies are currently available, and will be automatically added to existing accounts as of May, for enrollees who have opted to receive the maximum available subsidy.Current enrollees with bronze or catastrophic plans can upgrade their coverage. Current enrollees with Silver plans can switch to a more expensive Silver plan.Massachusetts:Residents can enroll in an ACA-compliant plan through July 23.Updated subsidies are currently available, and will be automatically updated for existing subsidized enrollees as of May.

Enrollees who are newly eligible for subsidies will be able to access them in May, for June coverage.As soon as possible, enrollees who have received any unemployment compensation in 2021 will become eligible for ConnectorCare Plan Type 2A, which has no monthly premiums and low out-of-pocket costs.Minnesota:Residents can enroll in an ACA-compliant plan through July 16.Updated subsidies are currently available, and MNsure will automatically update existing enrollees’ subsidy amounts if they have financial information on file.MNsure has not yet sorted out specific details for the increased subsidies and cost-sharing for people receiving unemployment compensation in 2021. For the time being, they’ve indicated that enrollees can claim the extra premium subsidy on their 2021 tax return (which is true in all states. Extra premium subsidies can always be claimed on tax returns as long as the person had coverage in the marketplace).

But they’ve also said that they’re working on a way for enrollees to be able to claim this benefit in realtime (including the cost-sharing reductions, which cannot be claimed on a tax return), and hope to have more information by this summerMNsure’s current enrollment window is only available to people who are uninsured or enrolled in a plan outside the exchange (it’s necessary to transition to the exchange in order to get premium subsidies). Current MNsure enrollees cannot use this window to switch plans unless they have a qualifying event. Minnesota and Vermont are currently the only states in the country with this restriction (Vermont plans to allow people to change plans in July).Nevada:Residents can enroll in an ACA-compliant plan through August 15.Updated subsidies are currently available, and Nevada Health Link will start automatically updating existing enrollees’ subsidy amounts in June.New Jersey:Residents can enroll in an ACA-compliant plan through December 31.As of May, New Jersey is expanding its state-funded subsidies to include enrollees with household income up to 600% of the poverty level (this was previously capped at 400% of the poverty level)Updated subsidies are currently available.

Existing enrollees can follow these steps to update their account, and new enrollees can follow these steps.The exchange will automatically update subsidy amounts this summer, for existing enrollees who haven’t yet taken action to update their subsidies.New York:Residents can enroll in an ACA-compliant plan through December 31.Updated subsidies are currently available. This video shows how existing enrollees can update their subsidy amounts. New subsidy amounts will automatically be applied to eligible enrollees’ accounts as of June, if they haven’t taken action by then.Pennsylvania.

Residents can enroll in an ACA-compliant plan through August 15.Updated subsidies are currently available. Pennie will apply them automatically by June, for existing enrollees who haven’t taken action to update their accounts by then.Rhode Island:Residents can enroll in an ACA-compliant plan through August 15.HealthSourceRI has already automatically updated subsidy amounts for current enrollees with income up to 400% of the poverty level (ie, people who were already receiving subsidies are now receiving larger subsidies).For people with income above 400% of the poverty level, as well as people who are receiving unemployment compensation in 2021, the new subsidy amounts will be updated in June.Vermont:Residents can enroll in an ACA-compliant plan through May 14.For now, Vermont’s marketplace is encouraging people who are uninsured or enrolled off-exchange to sign up for coverage through the marketplace as soon as possible.People who are receiving unemployment compensation are encouraged to call Vermont’s marketplace in order to begin the process of receiving additional subsidies.This summer, people will be able to log back into their accounts and update their subsidy amounts.Vermont, like Minnesota, is currently limiting the erectile dysfunction treatment/ARP-related enrollment window to people who are uninsured and people who have off-exchange coverage and need to transition to the exchange. A plan change for current on-exchange enrollees requires a qualifying event.

But Vermont Health Connect confirmed that they plan to allow existing enrollees to make plan changes in July.Washington:Residents can enroll in an ACA-compliant plan through August 15.The additional subsidy amounts will be available by early May. Washington’s marketplace will automatically update existing enrollees’ accounts so that the new premium amounts take effect in June.People who enroll before May will not see the new subsidy amounts when they enroll, but their subsidies will be updated in May as long as they provide financial information to the marketplace when they enroll.Enrollees who do not currently receive tax credits may want to switch plans once they start receiving tax credits. They can log back into their account after May 15 to pick a different plan, as long as it’s offered by their current insurance company.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 health insurance experts..

It’s been a widely viagra for women price held conclusion in the health insurance industry and among health policy types that one of our biggest hurdles lies with the challenge of getting coverage for “young invincibles” – Americans old enough to vote but under buy kamagra 100mg generic viagra 30. That label itself is tied to a widely held perception that – because of their youth – “twenty-somethings” believe they’re healthy enough that they simply won’t need all of the bells and whistles of comprehensive health insurance (any time soon, at least).As an agent and an avid observer of health insurance trends, I know it’s not that simple. Young adults, in many cases, are keenly aware of their need for buy kamagra 100mg generic viagra comprehensive coverage.

But – despite various federal and state efforts to make coverage more affordable and accessible (including provisions of the American Rescue Plan) – there are definitely barriers making it difficult for young adults to enter the individual health insurance market.Last week, I spoke with Carolyn Kettig, a young woman who’s determined to get coverage but facing barriers that many young Americans face. Carolyn Kettig is buy kamagra 100mg generic viagra a professional actor in New York, and has thus far maintained health coverage under her mother’s policy. But that will end this summer, when Carolyn turns 26.

She shares her story with me here, and I’ve added my own commentary wherever it might help readers in similar situations understand their coverage options.Before we begin, it’s worth noting that because Carolyn lives in New York, buy kamagra 100mg generic viagra she has access to a Basic Health Program. New York and Minnesota are the only states that offer these programs, and they’re an excellent coverage option for people who are eligible to enroll. But if you’re not in New York or Minnesota, you’ve still got plenty of options.That’s particularly true now that the American Rescue Plan has been enacted, making buy kamagra 100mg generic viagra premium subsidies larger and more widely available.

For many young people, the American Rescue Plan makes robust coverage much more affordable than it used to be. (Previously, it was common for young people to feel like their only truly affordable health coverage buy kamagra 100mg generic viagra option was a plan with a deductible that may have felt impossibly high).Louise. What’s your current insurance situation and how is it changing this year?.

What are your options for buy kamagra 100mg generic viagra coverage?. Carolyn. I’m lucky enough to currently be covered by buy kamagra 100mg generic viagra my mother’s health insurance.

She has a very generous insurance plan and I’ve been privileged to, thus far, be fully covered. Unfortunately, because buy kamagra 100mg generic viagra I’m turning 26, I’ll be losing coverage this spring.As a professional actor, my early twenties were filled with countless side jobs that supported me as I sought acting work in New York City. None of these jobs ever came with healthcare benefits, which at the time was okay as I was covered by my mother’s plan.

Three years ago, when I landed my first big theater job, I had the opportunity to join the actor’s union, which among many other wonderful things, provides working actors with comprehensive, affordable health insurance.The only catch, and it’s a fairly large one, is that an actor must work a certain number of weeks in order to qualify. Even without a viagra, finding steady buy kamagra 100mg generic viagra work in the theater is difficult. Factor in a viagra that shutters theaters for over a year and causes the union to hemorrhage money … needless to say, healthcare coverage in my industry has become a near impossibility.I’m hopeful that live entertainment will return in a vaccinated world, but until then, I’m doing my best to make enough money to pay my bills.

I’m grateful to be employed part-time as a program director for a buy kamagra 100mg generic viagra teen program. My job has kept me afloat during this devastating time, but, unfortunately, does not come with healthcare benefits. I make very little money and live paycheck to paycheck, which leaves me relatively few options when buy kamagra 100mg generic viagra it comes to insurance.

I will most likely go with New York State’s Essential Plan, which is the best option for low-income people who make too much money to qualify for Medicaid.Louise. The Essential Plan is New York’s Basic Health Program (BHP), which is available to people earning up to 200% of the poverty level buy kamagra 100mg generic viagra. (For a single person in 2021, that amounts to $25,760.) The Affordable Care Act allowed for the creation of BHPs, but New York and Minnesota are the only states that have opted to establish them.The Essential Plan provides robust health coverage with no monthly premium, and it has much lower cost-sharing than we typically see in the individual/family health insurance market.

The Essential Plan is buy kamagra 100mg generic viagra also being enhanced as of June 2021. Previously, some enrollees had to pay $20/month, and there was an extra premium for dental and vision coverage. Dental and vision buy kamagra 100mg generic viagra are now included at no cost.Louise.

How much is the need for coverage weighing on you and other people your age?. Carolyn buy kamagra 100mg generic viagra. I’ve lost sleep over this!.

It weighs on me heavily buy kamagra 100mg generic viagra. Having grown up in New York, I have a long history with some of my doctors, most of whom will not accept my new insurance plan. This means that I will either be forced to find new doctors or pay hundreds of dollars out of pocket for routine check-ups.I’m also aware that, even with insurance coverage, an unexpected hospital stay could cost me thousands of dollars.

It makes me enraged to know that, in an emergency situation, I would avoid going to the hospital because of the cost.Louise buy kamagra 100mg generic viagra. The Essential Plan provides much more robust coverage than people may be used to seeing elsewhere. There is no deductible, emergency room visits cost $75, and inpatient hospital stays are only $150 per admission – and buy kamagra 100mg generic viagra these fees are waived altogether for enrollees with income up to 150% of the poverty level, or a little more than $19,000 for a single person.

This is better coverage than most people have even with higher-end employer-sponsored plans.Carolyn. I know that I’m buy kamagra 100mg generic viagra not alone in this. Especially since my generation is now living through a global health crisis, I think my peers are more aware than ever before of how broken our healthcare system really is.

Moreover, as buy kamagra 100mg generic viagra a white, cisgendered woman from a middle-class background, I’m cognizant of the privilege my identities afford me and deeply disturbed by the ways in which our healthcare system disregards and harms BIPOC, low-income families, LGBTQIA+ youth, and undocumented workers (many of whom are essential workers and yet have little access to healthcare coverage) among many others. Alongside the climate crisis and the fight for racial equality, I believe that healthcare reform will dominate the American political landscape for the next few decades.Louise. I agree that our healthcare system is in need of extensive buy kamagra 100mg generic viagra reform.

The American Rescue Plan, enacted just last month, is the first major change we’ve seen since the Affordable Care Act was signed into law 11 years ago. It includes some buy kamagra 100mg generic viagra substantial improvements designed to make health coverage more affordable and accessible.But these improvements are temporary unless Congress takes additional action to make them permanent. And there are other issues, such as the ACA’s family glitch, and the Medicaid coverage gap that exists in the dozen states that have refused to expand Medicaid, that haven’t yet been fixed.

Fortunately, lawmakers in Congress are continuing buy kamagra 100mg generic viagra to push forward on these issues, and voters can reach out to their elected officials to express their opinions.Louise. What do you see as challenges in this situation?. Carolyn.

I’ve mentioned many challenges already, but I think chief among them is simply how confusing and difficult it is to make informed choices. Reading about insurance options requires learning an entirely new language and navigating nearly impenetrable websites.Louise. For folks who are confused by the terminology and concepts that go along with health insurance, our glossary is a great resource.

We’ve incorporated plenty of details, since that’s where the nuances always are. And we’ve focused on explaining things using plain language that’s easy to understand.Help from the American Rescue PlanLouise. Are you aware of the changes that the American Rescue Plan has made?.

Do you think it will make it easier for you to access coverage?. Carolyn. I’ve read a bit about the changes made by the American Rescue Plan and am thrilled that this administration is attempting to expand access to healthcare (even though I’d love to see more substantial reform).

I don’t think that I will be impacted directly by the bill because I already live in a state that offers an affordable plan for people in my income bracket.Louise. If you lived in another state, the American Rescue Plan would make your coverage more affordable. But you’re can i buy viagra over the counter correct.

Assuming your 2021 income doesn’t exceed 200% of the poverty level (about $25,760), you’ll be eligible for either The Essential Plan or Medicaid in New York, both of which are already robust coverage with no monthly premiums.But for others in a similar situation who live elsewhere, the American Rescue Plan implements a variety of improvements that make it easier for young people to transition to their own coverage. Among other provisions, the American Rescue Plan. Louise.

What do you expect to happen with your coverage this summer?. Do you have a good idea of the plan you’ll be on after you transition away from your mom’s coverage, or is it still up in the air?. Carolyn.

Fortunately, through The Actors Fund, I have access to a professional who will guide me through the process of finding a plan, although I’m fairly certain I will end up on the Essential Plan.I’ve been told to begin the process a couple months before I lose coverage, so that’s coming up very soon!. I also have many friends who are in a similar situation or have already gone through the process, so I expect I’ll be texting them a whole lot. Even though I’m anxious about navigating the system on my own for the first time, I feel well supported as I approach this transition.Louise.

As you’re going through this insurance transition, what do you feel are the most important things for other people your age to keep in mind?. Carolyn. I think it’s important to do your research, seek out trusted professionals or peers to guide you, and ask a lot of questions.

The system is designed to be confusing and ultimately benefit insurance companies, so I believe the more questions you ask, the better positioned you’ll be to advocate for yourself. Get acquainted with the vocabulary and make sure you know the basic terms (i.e. Premium, deductible, out of pocket maximum, in-network, enrollment period).

And if you’re uninsured for a period of time, know that you can find sliding scale clinics, sliding scale hospital services, and assistance paying for prescription drugs. Your health, both physical and mental, is of utmost importance!. Louise.

The advice to seek out assistance and ask lots of questions is spot-on. There are no silly questions, and any question you might have about health insurance is certainly shared by plenty of other people.Thanks to the American Rescue Plan, there has never been a better time to be transitioning to your own health insurance policy. And even if you’re not experiencing a qualifying event (such as aging off of a parent’s health insurance policy), there’s a erectile dysfunction treatment-related enrollment window that runs through August 15 in most states, giving people an opportunity to enroll and take advantage of the newly enhanced premium subsidies.And in every community, there are navigators, enrollment counselors, and health insurance brokers who can help you pick a plan and answer any questions you might have.

We also have an extensive collection of FAQs, including several that are specific to young adults.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 health insurance experts.If you buy your own health insurance – or don’t have health insurance at all – you might have been pleased to hear that the American Rescue Plan (ARP) has increased premium subsidies for 2021 and made them available to more people.But receiving those premium tax credits isn’t necessarily automatic.

When and how you get them depends on where you live and other factors, including whether you’re already enrolled in a marketplace plan and whether you’re receiving unemployment compensation at any point in 2021.Use our updated subsidy calculator to estimate how much you can save on your 2021 health insurance premiums.The early bird gets the premium subsidyAlthough the current erectile dysfunction treatment/ARP enrollment window extends through August 15 in most states, it’s in your best interest to enroll as soon as possible in order to maximize the number of months you get the extra subsidies.If you’re receiving unemployment compensation at any point in 2021, the American Rescue Plan gives you access to substantial premium subsidies and full cost-sharing reductions. That means you’ll be eligible for a Silver plan that’s upgraded to better-than-platinum benefits, and you won’t have to pay any monthly premiums. But in most states, this benefit isn’t yet available.

(Note that in some states, you may still have to pay a dollar or two, even for the lowest-cost Silver plans. And it’s worth noting that even if you’re eligible for a premium-free Silver plan, you might find that you prefer to upgrade to a Silver plan that has at least a nominal premium in trade for a more extensive provider network.)Regardless, you’ll still want to enroll – or change your plan – as soon as possible so that when subsidies are available, you’ll receive credit for them.Your state’s marketplace affects how and when you receive your subsidiesFor starters, you should be aware that when it comes to how the ARP’s extra subsidies are being handled, there’s one process in the states that use HealthCare.gov, and 15 slightly different approaches in the other states. Thirty-six states use HealthCare.gov as their marketplace, while Washington, DC and the other 14 states operate their own state-run marketplaces (Covered California, New York State of Health, Your Health Idaho, etc.).

How and when will you receive your premium subsidy in a HealthCare.gov state?. If you’re in a state that uses HealthCare.gov, your additional subsidies will not be automatically added to your account, even if you already have financial information on file with the marketplace. You’ll need to log back into your account and follow the instructions to get your subsidy amount updated.

(You can do this directly through HealthCare.gov or through an enhanced direct enrollment entity if you use one – or your broker or agent can help you sort it out). Once the new subsidy is determined, you can choose to either apply it to your current plan or pick a different plan.If you’re uninsured or enrolled in an off-exchange plan, you can switch to the marketplace anytime between now and August 15. But the sooner you enroll, the sooner you’ll start receiving subsidies.HealthCare.gov rolled out most of the ARP’s new subsidies as of April 1, but CMS has said it will be July before the enhanced subsidies are available to people who receive unemployment compensation in 2021.It’s important to understand that regardless of the reason for the additional premium subsidy (including unemployment compensation), the subsidy itself is retroactive to January 1, 2021 in every state, as long as you’ve had coverage through the marketplace for the whole year.

So even if your enhanced subsidy due to unemployment compensation doesn’t take effect until August, you’ll be able to claim the rest of it when you file your 2021 tax return. However, the full cost-sharing reductions for people who receive unemployment compensation in 2021 can only be provided in real-time, and won’t take effect until the marketplace can process them, starting this summer. How will premium subsidies be treated in states that run their own marketplaces?.

In the District of Columbia and the other 14 states, the deadlines, subsidy availability dates, and even eligibility rules differ from state to state. In most of these states, the current special enrollment window is functioning like an open enrollment period, with people allowed to newly enroll or switch plans – though there are some exceptions, detailed below. And in contrast to HealthCare.gov, nearly all of the state-run exchanges will be automatically updating subsidy amounts for current enrollees over the next several weeks, as long as the enrollee has financial information on file with the exchange.

Here’s a summary of what each state with a state-run marketplace is doing:CaliforniaResidents can enroll in an ACA-compliant plan through December 31.Subsidies are currently available for most people, but subsidy eligibility based on unemployment compensation won’t be available until July or August.For current enrollees, subsidies will be automatically updated in May.ColoradoResidents can enroll in an ACA-compliant plan through August 15.Subsidies will not be automatically updated, but are currently available for both new and existing enrollees. The process will be more streamlined by mid-May.Connecticut:Residents can enroll in an ACA-compliant plan between May 1 and August 15.Subsidies will be available to most people starting May 1, although subsidy eligibility based on unemployment compensation will be available by July.Subsidies will be automatically updated by July, for current enrollees who don’t manually update their accounts before then.District of Columbia:Residents can enroll in an ACA-compliant plan any time through the end of the viagra emergency period.Extra subsidies are currently available to anyone eligible, including people who are eligible due to unemployment compensation in 2021.Subsidies will be automatically updated in May, for current enrollees who don’t manually update their accounts before then.For people who have been enrolled through the marketplace since January, the full amount of the additional premium subsidy will be spread across the remaining months of 2021 (as opposed to having to wait to claim the subsidy for the first few months of 2021 on their tax returns).Idaho:Residents can enroll in an ACA-compliant plan through April 30.Updated subsidies are currently available, and have been automatically updated for existing enrollees who had already provided financial information to the exchange.Current enrollees can change plans, but only to another plan offered by the same insurance company (unless they have a qualifying event).Maryland:Residents can enroll in an ACA-compliant plan through August 15.Updated subsidies are currently available, and will be automatically added to existing accounts as of May, for enrollees who have opted to receive the maximum available subsidy.Current enrollees with bronze or catastrophic plans can upgrade their coverage. Current enrollees with Silver plans can switch to a more expensive Silver plan.Massachusetts:Residents can enroll in an ACA-compliant plan through July 23.Updated subsidies are currently available, and will be automatically updated for existing subsidized enrollees as of May.

Enrollees who are newly eligible for subsidies will be able to access them in May, for June coverage.As soon as possible, enrollees who have received any unemployment compensation in 2021 will become eligible for ConnectorCare Plan Type 2A, which has no monthly premiums and low out-of-pocket costs.Minnesota:Residents can enroll in an ACA-compliant plan through July 16.Updated subsidies are currently available, and MNsure will automatically update existing enrollees’ subsidy amounts if they have financial information on file.MNsure has not yet sorted out specific details for the increased subsidies and cost-sharing for people receiving unemployment compensation in 2021. For the time being, they’ve indicated that enrollees can claim the extra premium subsidy on their 2021 tax return (which is true in all states. Extra premium subsidies can always be claimed on tax returns as long as the person had coverage in the marketplace).

But they’ve also said that they’re working on a way for enrollees to be able to claim this benefit in realtime (including the cost-sharing reductions, which cannot be claimed on a tax return), and hope to have more information by this summerMNsure’s current enrollment window is only available to people who are uninsured or enrolled in a plan outside the exchange (it’s necessary to transition to the exchange in order to get premium subsidies). Current MNsure enrollees cannot use this window to switch plans unless they have a qualifying event. Minnesota and Vermont are currently the only states in the country with this restriction (Vermont plans to allow people to change plans in July).Nevada:Residents can enroll in an ACA-compliant plan through August 15.Updated subsidies are currently available, and Nevada Health Link will start automatically updating existing enrollees’ subsidy amounts in June.New Jersey:Residents can enroll in an ACA-compliant plan through December 31.As of May, New Jersey is expanding its state-funded subsidies to include enrollees with household income up to 600% of the poverty level (this was previously capped at 400% of the poverty level)Updated subsidies are currently available.

Existing enrollees can follow these steps to update their account, and new enrollees can follow these steps.The exchange will automatically update subsidy amounts this summer, for existing enrollees who haven’t yet taken action to update their subsidies.New York:Residents can enroll in an ACA-compliant plan through December 31.Updated subsidies are currently available. This video shows how existing enrollees can update their subsidy amounts. New subsidy amounts will automatically be applied to eligible enrollees’ accounts as of June, if they haven’t taken action by then.Pennsylvania.

Residents can enroll in an ACA-compliant plan through August 15.Updated subsidies are currently available. Pennie will apply them automatically by June, for existing enrollees who haven’t taken action to update their accounts by then.Rhode Island:Residents can enroll in an ACA-compliant plan through August 15.HealthSourceRI has already automatically updated subsidy amounts for current enrollees with income up to 400% of the poverty level (ie, people who were already receiving subsidies are now receiving larger subsidies).For people with income above 400% of the poverty level, as well as people who are receiving unemployment compensation in 2021, the new subsidy amounts will be updated in June.Vermont:Residents can enroll in an ACA-compliant plan through May 14.For now, Vermont’s marketplace is encouraging people who are uninsured or enrolled off-exchange to sign up for coverage through the marketplace as soon as possible.People who are receiving unemployment compensation are encouraged to call Vermont’s marketplace in order to begin the process of receiving additional subsidies.This summer, people will be able to log back into their accounts and update their subsidy amounts.Vermont, like Minnesota, is currently limiting the erectile dysfunction treatment/ARP-related enrollment window to people who are uninsured and people who have off-exchange coverage and need to transition to the exchange. A plan change for current on-exchange enrollees requires a qualifying event.

But Vermont Health Connect confirmed that they plan to allow existing enrollees to make plan changes in July.Washington:Residents can enroll in an ACA-compliant plan through August 15.The additional subsidy amounts will be available by early May. Washington’s marketplace will automatically update existing enrollees’ accounts so that the new premium amounts take effect in June.People who enroll before May will not see the new subsidy amounts when they enroll, but their subsidies will be updated in May as long as they provide financial information to the marketplace when they enroll.Enrollees who do not currently receive tax credits may want to switch plans once they start receiving tax credits. They can log back into their account after May 15 to pick a different plan, as long as it’s offered by their current insurance company.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 health insurance experts..

Viagra risks

The term “mRNA” view publisher site only entered the average household in the past few viagra risks months, as Moderna and Pfizer-BioNTech released their erectile dysfunction treatments. But a handful of scientists have spent decades studying this novel approach to immunization. By the viagra risks start of the viagra the technology was already so advanced that, when Chinese researchers published the genetic sequence for the erectile dysfunction in mid-January, Moderna was able to concoct a treatment within 48 hours. Clinical trials began a matter of weeks after that.

In nine months, the world was well on its viagra risks way to viral security.It was a stunning debut for mRNA — shorthand for messenger ribonucleic acid, DNA’s sidekick — which had long ranked as a promising but unproven treatment. After this encouraging success, its proponents predict an equally impressive future. They have always believed in mRNA’s ability to protect against not only the likes of erectile dysfunction, but also a host of deadly diseases that resist traditional treatments, from malaria to HIV to cancer. In 2018, long before the past year’s viagra risks confidence-boosting display, a group of researchers announced “a new era in vaccinology.”It remains to be seen whether mRNA will live up to the hype.

With concrete results attesting to its potential, though, interest is growing among investors and researchers alike. It helps that regulatory agencies and the viagra risks public are familiar with it now, too, says Yale immunologist Rick Bucala. €œThat has really changed the landscape.”Andrew Geall, co-founder of one company testing RNA treatments and chief scientific officer of another, notes that mRNA has only just entered its infancy after a long gestation. Such is the nature of scientific progress.

€œWe’ve had the technology bubbling for 20 years, and the major breakthrough viagra risks is this clinical proof of two treatments,” he says. €œNow we’re set for 10 years of excitement.”Next Steps for mRNAThe goal of any treatment is to train the immune system to recognize and defend against a viagra. Traditional treatments do so by exposing the body to viagra risks the viagra itself, weakened or dead, or to a part of the viagra, called an antigen. The new shots, as their name suggests, introduce only mRNA — the genetic material that, as you may remember from high school biology, carries instructions for making proteins.

Once the mRNA enters the cells, particles called ribosomes read its instructions and use them to build the encoded proteins. In the viagra risks case of the erectile dysfunction treatments, those proteins are the crown-shaped “spike” antigens from which the erectile dysfunction derives its name (“corona” means crown in Latin). By themselves they are harmless, but the immune system attacks them as foreign invaders, and in doing so learns how to ward off the real viagra. If it ever rears its spiky head viagra risks thereafter, the body will remember and swiftly destroy it.But besides liberating the world from the worst viagra in generations, mRNA could help to vanquish many an intractable illness.

If all the dreams of its advocates are realized, the erectile dysfunction treatments may, in hindsight, be only a proof of concept. In February, for example, Bucala and his colleagues patented a treatment against malaria, which has likely killed more humans than any other single cause and has mostly withstood immunization.Justin Richner, an immunologist with the University of Illinois, Chicago, is developing an mRNA treatment for dengue, another highly resistant viagra. Because mRNA is viagra risks simply a genetic sequence, scientists can easily tweak it as necessary to find the most effective combination. €œOne of the advantages of the mRNA platform is how it can be so easily modified and manipulated to test novel hypotheses,” Richner says.Read more.

Dengue Fever Is on the Rise — a Ticking Time viagra risks Bomb in Many Places Around the WorldGeall says the obvious candidates for mRNA treatments include what he calls the “Big 6,” all of which remain crafty foes. Malaria, cancer, tuberculosis HIV, cytomegaloviagra, and respiratory syncytial viagra. His own company, Replicate Bioscience, is working on the cancer front, as are several others, including BioNTech. Through genetic analysis of individual tumors, patients could one day viagra risks receive personalized treatments, designed to target the specific mutations afflicting them.Currently, it’s difficult to tell whether an mRNA treatment will work on any particular pathogen.

Many have shown promise in animal trials, only to falter in our species. As Geall put it, “mice are not humans.” Some appear to be better bets than others — cytomegaloviagra and RSV respiratory syncytial viagra in particular — but for now, it’s viagra risks too early to say where mRNA will next bear fruit. €œDespite all we know about immunology, a lot of it is really empiric,” Bucala says. €œYou just have to try things and see if they work.” The viagra TamerBased on its recent achievements, mRNA’s next act may well involve the next viagra.

Perhaps its biggest strength is that it can be manufactured at speeds unheard of in the viagra risks realm of traditional treatments, making it well-suited to addressing sudden surges of viagraes. €œOne of the great things about the mRNA field is how quickly you can go from a concept into a therapy that is ready for clinical trials,” Richner says. €œWe can make multiple different treatments and test them in a really rapid process.”Read more viagra risks. erectile dysfunction treatment.

A Basic Guide to Different treatment Types and How They WorkSince 2018, Pfizer and BioNTech have been working on an mRNA treatment for seasonal flu. Under the status quo, experts must predict which variation of the viagra will pose the greatest threat each viagra risks year and produce treatments to match it. But because mRNA is so easy to edit, it can be modified more efficiently to keep pace with the ever-mutating strains. €œI do think the influenza treatment field will be transformed in the not too distant future,” Richner says viagra risks.

A similar kind of gene-based treatment, made with self-amplifying RNA (saRNA), is even more nimble. Whereas basic mRNA treatments — like Moderna’s and Pfizer-BioNTech’s — inject all the genetic material at once, the self-amplifying version replicates itself inside the cell. Just a small dose of this potent product viagra risks can trigger the same immune response as a syringe-full of the current shots. Bucala’s malaria treatment and Geall’s cancer treatments both use this technology.

€œThe big problem is that treatments don’t prevent viagra risks s,” Bucala says. €œVaccinations prevent s.” With saRNA, manufacturers can ensure a lot more of them. After mRNA’s brilliant battle against erectile dysfunction treatment, it’s tempting to think of it as a panacea. But, Bucala viagra risks says, “Is there something intrinsically revolutionary about mRNA?.

We don’t know yet.”It does come with some logistical challenges. For example, mRNA breaks down easily, so it must be viagra risks refrigerated throughout the distribution process. Hurdles aside, though, the possibilities are vast, and investment may rise to meet the industry’s ambitions. treatment development isn’t typically a lucrative business, but erectile dysfunction treatment has made more than a few billionaires, “and others are watching,” Bucala says.

€œI think it should become economically viable in viagra risks our [current] model to get into treatment work again.”Geall agrees. Even if some mRNA endeavors fizzle out, at least a few are bound to make the world proud. €œThere’s a lot of money out there viagra risks that is going to be invested into these new approaches,” he says. €œWe’re going to see failures, but we’re going to see successes for sure.”When the U.S.

Cracked down on drugs in the 1970s, the effort dried up most funding and research into psychedelic substances — which only in the past few years have regained momentum in the field of psychotherapy. In the ’70s, rather than shut down all his work, one psychedelic researcher at Johns Hopkins University, Stan Grof, turned his attention to another potential avenue for attaining non-ordinary states of consciousness viagra risks. Breathing.Grof, alongside his wife at the time, Christina Grof, developed the term Holotropic Breathwork for this technique, which loosely translates as “moving toward wholeness.” The practice in experiential psychotherapy emerged in the 1980s as a tool for self-exploration and inner healing, and has certified teaches who now facilitate it around the world. The framework integrates music with modern viagra risks consciousness research, psychology and Eastern spiritual practices, according to the Grof Transpersonal Training program.Many people today teach this intense breathing practice, and other similar techniques that preceded it, such as kundalini yoga or pranayama.

But questions remain about the science behind what exactly is happening in the mind and body while practitioners lie on the floor and breathe persistently in rapid patterns. And some clinicians have raised concerns about the safety, and risks, in a field with limited peer-reviewed studies.Meditation on a Freight TrainStacia Butterfield has been a certified Holotropic Breathwork teacher with Grof Transpersonal Training for roughly 15 years. She committed to the work after having her own life-changing experience at a workshop, and has since viagra risks worked closely with Grof himself and guided thousands of people in the practice. €œIt’s deceptively simple.

It seems like just turning on music, laying down and viagra risks taking some breaths, and away you go,” Butterfield says. €œWhat we’re actually relying on is the spontaneous mobilization of the psyche.”First and foremost, a guided Holotropic Breathwork session requires creating a safe container, Butterfield says, where people can let go of inhibitions or mental blocks. Facilitators are trained to guide people through that process in a group setting.One session lasts between two and three hours — often as part of a weekend or week-long retreat. People pair off and alternate in the viagra risks roles of “sitter” (assisting the other) and “breather” (the person doing the heavy breathing).

To begin, rhythmic drumming sets the mood. The breather lays down and starts breathing rapidly, in a continuous way with no real break between inhales and exhales.The music typically viagra risks has an emotional arc, almost like a movie soundtrack. It might start off evocative and stimulating, then turn “increasingly dramatic and dynamic, and finally it reaches a breakthrough quality,” according to a guide written by Stan and Christina Grof. This guide notes that when the breathing leads to non-ordinary states of consciousness in a practitioner, “there is a potential for unusually intense projections, including regressed longings for nurturing, sexual contact, or spiritual connection.” Facilitators are advised to assist clients with these feelings as they arise, while following their agreement to conduct the practice in an ethical manner.Butterfield says one core principle, like somatic therapy, is for participants to become aware of the messages and wisdom in their own body.

€œSo many people are so busy, just cruising around [and] keeping the lid on everything else that is going on viagra risks internally,” she says. €œ[In a session] they can just close their eyes and go inward, and see what’s there.” She says visions, strong bodily sensations and emotions often arise. And she has watched people who had tried years of talk therapy make substantial progress in viagra risks processing grief and loss, past trauma, life changes or even mental illnesses.One practitioner aptly described this practice as “meditation on a freight train,” Butterfield adds. The reported dramatic experiences spark questions about what might actually be happening within the body and brain.Mysticism or Hyperventilation?.

Pulmonologist Michael Stephen, author of the book Breath Taking, says the practice of Holotropic Breathwork raises red flags for him because of its use of over-breathing, or hyperventilation. Biologically, when viagra risks someone breathes heavily for an extended period, they can lose too much carbon dioxide, which makes the blood overly alkaline. The phenomenon often triggers an immediately physiological response. €œWe start to get tingly in our fingers and dizzy when we hyperventilate, as our pH is rising too much,” says Stephen.Prolonged, excessive pH levels in the blood can also cause seizures, viagra risks he adds.

€œJust before seizures happen, you can get lightheaded, a sort of high.” He attributes this to the non-ordinary states of consciousness that people might feel during Holotropic Breathwork. But he says few proper studies have been done on the practice because of the dangers and ethics involved.Casualties of Heavy BreathingAnother breath specialist and integrative psychiatrist, Patricia Gerbarg, says that Holotropic Breathwork, and other forceful respiratory practices such as breath of fire, do have the potential to alter the mind. They can also bring about a lasting impact on people, but it’s not viagra risks always beneficial or predictable.“It’s a stress on the system. You’re going through rapid changes in oxygen levels and the balance of various substances in the body and the brain,” she says.

And similar to drugs, viagra risks “people can use them to attain different mental states,” she adds.Read More. Can Breathing Like Wim Hof Make Us Super Human?. Healthy people tend to have a broader tolerance to endure these shifts and unpredictable outcomes. But the same behavior can be harmful to someone who is less healthy, or dealing with a psychological disorder, says Gerbarg, who teaches psychiatry at New York Medical College.“Those kinds of intense, viagra risks rapid shifts in your brain chemistry can cause adverse effects,” she says, adding that she is familiar with cases where people feel they “never recovered” from what these states did to them.

Some literature uses the term kundalini psychosis, or physio kundalini syndrome, to describe people who cognitively lose touch with reality in pursuit of "spiritual awakening."One of Gerbarg’s concerns about the rise in popularity of these advanced, Eastern breathing practices is how they are inserted into the Western world and modern mindset. (Two other intense and forceful breathing practices include Tummo breathing, with a Tibetan buddhist lineage, and the Wim Hof Method.) The breathwork is often tied closely to viagra risks a lifestyle and belief system, and many traditional practitioners dedicate hours a day for many years to master the techniques in a healthy way. Alternatively, people in modern Western cultures often struggle to commit to a new practice for 20 minute a day. €œ[Intense breathwork] is becoming increasingly popular and people are doing it online,” Gerbarg says.

€œThey aren’t often aware that there are risks,” or they viagra risks might not know the pre-existing conditions their students have. The big responsibility ultimately falls on the teachers and facilitators to ensure everyone is safe. A Gentler TouchGerbarg and her husband Richard Brown, a professor of psychiatry at Columbia College of Physicians and Surgeons, have published several books on the healing potential of viagra risks breath. And they offer evidence-based workshops and teaching resources through their Breath-Body-Mind Foundation.One of their most popular techniques, called coherent breathing, teaches gentle, slower and relaxed respiration.

Once practitioners learn it, they can use it any point throughout the day when stress or anxiety is likely to rise up — even in mundane circumstances like being stuck in a long line — and trigger a string of reactions in the body.The goal is to inhale and exhale slowly through the nose at a rate of about five breaths per minute, or one breath cycle every 12 seconds. Gerbarg says this process can promptly activate the rest-and-restore parasympathetic nervous system throughout the body, with millions of reactions and viagra risks signals firing every second.Read More. How Slow, Deep Breathing Taps Into a Natural Rhythm in Our Bodies“It tells the brain, ‘the conditions are safe,’ ” she says. €œThe less effort, the more you get out of this one.”The results of this technique may not feel like the viagra risks freight-train experience of altered consciousness.

But it carries less risk and broader appeal to anyone interested in channeling their own breath for health and wellness.In a year marked by a viagra, economic downturn, racial unrest, and an election that culminated with a mob storming the U.S. Capitol, we’ve come face to face with stressors we could never have imagined prior to 2020. The causes and health impacts of stress have been widely discussed as have a host of tools for tackling the viagra risks mounting anxiety we feel in our daily lives. But cortisol, among the body’s most important steroid hormones, at the helm of our stress response, remains largely a mystery.

Is our fight-or-flight response really viagra risks tied to our prehistoric ancestors?. Has our modern world evolved beyond the antiquated workings of our endocrine system?. Here’s what we know. A Caveman Instinct? viagra risks.

Cortisol, along with epinephrine and norepinephrine, activate the body’s sympathetic nervous system, triggering a lineup of physiological responses that speed up respiration, constrict blood vessels, dilate pupils, and slow down the digestive system. It’s called a fight-or-flight response, and viagra risks it allows muscles to react more powerfully and move faster, priming us to, well, fight or flee. Alan Goodman, a biological anthropologist at Hampshire College in Amherst, MA, studies stress in prehistoric humans. He agrees that cortisol and the entire acute stress response system is an evolutionary design.

“It’s an ancient mammalian system viagra risks adapted to protect hunter gathers,” says Goodman. Still, getting a window into the daily stress levels of prehistoric humans is difficult because we can’t look at their blood, he says, and cortisol doesn’t preserve well. Research published in the International Journal of Paleopathology, looked at cortisol accumulation in the hair of 2,000-year-old Peruvian mummies and found “repeated exposure to stress.” Another small pilot study of the same population viagra risks found that hair samples suggest social, physiological, and environmental circumstances “strongly impacted stress levels.” But the research, says Goodman, has its shortcomings. The study authors can’t rule out chemical changes to the samples over time and we’re not sure how accumulation in the hair corresponds to that of the blood.

Goodman prefers to look at skeletal indicators of prehistoric stress because cortisol production can also impact bone and teeth metabolism. He studies ancient populations in viagra risks the Illinois River Valley from around 1200 AD, during the transition from hunting and gathering to farming. “Enamel on the teeth grows like an onion and you can tell from teeth’s layers the years when the body was stressed,” says Goodman. His research shows a stress response likely brought on by the move from hunting and gathering to the building of civilizations viagra risks and establishment of society.

€œLife becomes more complicated because societal structures have a hierarchy,” he says. With the haves and have-nots, the winners and losers, stress becomes more convoluted, no longer confined to immediate threats. Goodman notices this in viagra risks the teeth as humans build societies under chieftains. Although the enamel stops growing once permanent teeth develop, a growth stunt, known as enamel dysplasia, is frozen in time.

Like the rings of a tree, viagra risks you can see the years when life was stressful. This too, says Goodman, is an imperfect model because and malnutrition can also impact enamel production. But after spending his career studying these populations, Goodman suspects it’s likely a combination of all three. He says that it’s clear stress has been around since the dawn viagra risks of time but today our response has become more prolonged and in some cases, maladaptive.

Chronic Disease and Cortisol Production In ancient populations high cortisol levels meant good health, basically indicating that a human could still compete for survival, but in modern populations it can spell disaster. Sudha Seshadri, a professor of neurology and founder of the Glenn Biggs viagra risks Institute for Alzheimer's &. Neurodegenerative Diseases at the University of Texas Health Science Center in San Antonio, studies the link between neurodegenerative diseases and high cortisol levels. Cortisol levels, she says, should vary throughout the day, highest in the morning when we’re the most active and lowest late at night when we should be sleeping.

If levels don’t vary or are overly elevated in the morning, cortisol production can start to viagra risks impact other parts of the body. €œChronic activation of fight or flight can cause problems in certain regions of the brain,” says Seshadri. Her research published in the journal Neurology, has shown that those with higher morning cortisol levels are more likely viagra risks to have problems with parts of the brain responsible for memory retention like the hypothalamus, which can be an early indicator of dementia and Alzheimer’s disease. Chronic high cortisol levels are also linked to high blood pressure, heart disease, anxiety, and depression.

Reducing Cortisol Levels People respond to stress with different degrees of cortisol activation, says Seshadri, partially based on genetics and partially based on life experiences. €œHyper-activation” of fight or flight especially during early childhood, is linked to exaggerated responses to stress viagra risks later in life. €œIt’s a vicious cycle, the more you’re exposed to stress, the more likely you are to have an exaggerated response to it,” says Seshadri. For parents, monitoring responses viagra risks to stress can have lifelong implications for children.

Studies also suggest that meditation seems to reduce cortisol levels, as does biofeedback, a technique that monitors heart rate, respiration, brain waves, muscle contractions, and perspiration and allows patients to respond to indicators in the moment, building awareness around and slowing their stress response. Additionally, exercise generates its own positive chemicals for counteracting cortisol like dopamine, norepinephrine, and serotonin. Both Goodman and Seshadri agree that fight or flight is found in both modern and prehistoric viagra risks populations. But it’s meant to help humans rapidly react to a physical threat and then laugh off their brush with death later, not stew all night over a perceived danger that never happens.

“The problem viagra risks with humans is that we’re symbolic beings, constantly finding meaning in situations where there wasn’t any,” Goodman says. Experts contend that cortisol still plays an important role in keeping us safe in our modern world. But the key is dampening your response once the threat has lifted, instead of constantly fearing the imagined sabertooth tiger lunging from around the corner..

The term “mRNA” only entered the average Can i buy diflucan over the counter at walmart household in the past few months, as Moderna and Pfizer-BioNTech buy kamagra 100mg generic viagra released their erectile dysfunction treatments. But a handful of scientists have spent decades studying this novel approach to immunization. By the start of the viagra the technology was already so advanced that, when Chinese researchers published the genetic sequence for the buy kamagra 100mg generic viagra erectile dysfunction in mid-January, Moderna was able to concoct a treatment within 48 hours. Clinical trials began a matter of weeks after that. In nine months, the world was well on its way to viral security.It was buy kamagra 100mg generic viagra a stunning debut for mRNA — shorthand for messenger ribonucleic acid, DNA’s sidekick — which had long ranked as a promising but unproven treatment.

After this encouraging success, its proponents predict an equally impressive future. They have always believed in mRNA’s ability to protect against not only the likes of erectile dysfunction, but also a host of deadly diseases that resist traditional treatments, from malaria to HIV to cancer. In 2018, long before the past year’s buy kamagra 100mg generic viagra confidence-boosting display, a group of researchers announced “a new era in vaccinology.”It remains to be seen whether mRNA will live up to the hype. With concrete results attesting to its potential, though, interest is growing among investors and researchers alike. It helps that regulatory agencies and the public are familiar with it now, too, says Yale immunologist buy kamagra 100mg generic viagra Rick Bucala.

€œThat has really changed the landscape.”Andrew Geall, co-founder of one company testing RNA treatments and chief scientific officer of another, notes that mRNA has only just entered its infancy after a long gestation. Such is the nature of scientific progress. €œWe’ve had the buy kamagra 100mg generic viagra technology bubbling for 20 years, and the major breakthrough is this clinical proof of two treatments,” he says. €œNow we’re set for 10 years of excitement.”Next Steps for mRNAThe goal of any treatment is to train the immune system to recognize and defend against a viagra. Traditional treatments do so by exposing the body to the viagra itself, weakened or dead, or to buy kamagra 100mg generic viagra a part of the viagra, called an antigen.

The new shots, as their name suggests, introduce only mRNA — the genetic material that, as you may remember from high school biology, carries instructions for making proteins. Once the mRNA enters the cells, particles called ribosomes read its instructions and use them to build the encoded proteins. In the case of the erectile dysfunction treatments, those proteins are the crown-shaped “spike” antigens from which the erectile dysfunction derives its name (“corona” means buy kamagra 100mg generic viagra crown in Latin). By themselves they are harmless, but the immune system attacks them as foreign invaders, and in doing so learns how to ward off the real viagra. If it ever rears its spiky buy kamagra 100mg generic viagra head thereafter, the body will remember and swiftly destroy it.But besides liberating the world from the worst viagra in generations, mRNA could help to vanquish many an intractable illness.

If all the dreams of its advocates are realized, the erectile dysfunction treatments may, in hindsight, be only a proof of concept. In February, for example, Bucala and his colleagues patented a treatment against malaria, which has likely killed more humans than any other single cause and has mostly withstood immunization.Justin Richner, an immunologist with the University of Illinois, Chicago, is developing an mRNA treatment for dengue, another highly resistant viagra. Because mRNA is simply a buy kamagra 100mg generic viagra genetic sequence, scientists can easily tweak it as necessary to find the most effective combination. €œOne of the advantages of the mRNA platform is how it can be so easily modified and manipulated to test novel hypotheses,” Richner says.Read more. Dengue Fever Is on the Rise — a buy kamagra 100mg generic viagra Ticking Time Bomb in Many Places Around the WorldGeall says the obvious candidates for mRNA treatments include what he calls the “Big 6,” all of which remain crafty foes.

Malaria, cancer, tuberculosis HIV, cytomegaloviagra, and respiratory syncytial viagra. His own company, Replicate Bioscience, is working on the cancer front, as are several others, including BioNTech. Through genetic analysis of individual tumors, patients could buy kamagra 100mg generic viagra one day receive personalized treatments, designed to target the specific mutations afflicting them.Currently, it’s difficult to tell whether an mRNA treatment will work on any particular pathogen. Many have shown promise in animal trials, only to falter in our species. As Geall put it, “mice are buy kamagra 100mg generic viagra not humans.” Some appear to be better bets than others — cytomegaloviagra and RSV respiratory syncytial viagra in particular — but for now, it’s too early to say where mRNA will next bear fruit.

€œDespite all we know about immunology, a lot of it is really empiric,” Bucala says. €œYou just have to try things and see if they work.” The viagra TamerBased on its recent achievements, mRNA’s next act may well involve the next viagra. Perhaps its biggest strength is that it can be manufactured at speeds unheard of in the realm of traditional treatments, making it well-suited to addressing sudden surges of buy kamagra 100mg generic viagra viagraes. €œOne of the great things about the mRNA field is how quickly you can go from a concept into a therapy that is ready for clinical trials,” Richner says. €œWe can make multiple different treatments buy kamagra 100mg generic viagra and test them in a really rapid process.”Read more.

erectile dysfunction treatment. A Basic Guide to Different treatment Types and How They WorkSince 2018, Pfizer and BioNTech have been working on an mRNA treatment for seasonal flu. Under the status quo, experts must predict which variation of the viagra will pose the greatest threat each year and produce buy kamagra 100mg generic viagra treatments to match it. But because mRNA is so easy to edit, it can be modified more efficiently to keep pace with the ever-mutating strains. €œI do think the influenza treatment field will be transformed buy kamagra 100mg generic viagra in the not too distant future,” Richner says.

A similar kind of gene-based treatment, made with self-amplifying RNA (saRNA), is even more nimble. Whereas basic mRNA treatments — like Moderna’s and Pfizer-BioNTech’s — inject all the genetic material at once, the self-amplifying version replicates itself inside the cell. Just a small dose of this potent product can trigger the same immune response as a syringe-full of the current buy kamagra 100mg generic viagra shots. Bucala’s malaria treatment and Geall’s cancer treatments both use this technology. €œThe big buy kamagra 100mg generic viagra problem is that treatments don’t prevent s,” Bucala says.

€œVaccinations prevent s.” With saRNA, manufacturers can ensure a lot more of them. After mRNA’s brilliant battle against erectile dysfunction treatment, it’s tempting to think of it as a panacea. But, Bucala says, “Is there something intrinsically revolutionary buy kamagra 100mg generic viagra about mRNA?. We don’t know yet.”It does come with some logistical challenges. For example, mRNA breaks buy kamagra 100mg generic viagra down easily, so it must be refrigerated throughout the distribution process.

Hurdles aside, though, the possibilities are vast, and investment may rise to meet the industry’s ambitions. treatment development isn’t typically a lucrative business, but erectile dysfunction treatment has made more than a few billionaires, “and others are watching,” Bucala says. €œI think it should become economically viable in our buy kamagra 100mg generic viagra [current] model to get into treatment work again.”Geall agrees. Even if some mRNA endeavors fizzle out, at least a few are bound to make the world proud. €œThere’s a lot of money out there that buy kamagra 100mg generic viagra is going to be invested into these new approaches,” he says.

€œWe’re going to see failures, but we’re going to see successes for sure.”When the U.S. Cracked down on drugs in the 1970s, the effort dried up most funding and research into psychedelic substances — which only in the past few years have regained momentum in the field of psychotherapy. In the ’70s, rather than shut down all his work, one psychedelic researcher at Johns Hopkins University, Stan Grof, turned his buy kamagra 100mg generic viagra attention to another potential avenue for attaining non-ordinary states of consciousness. Breathing.Grof, alongside his wife at the time, Christina Grof, developed the term Holotropic Breathwork for this technique, which loosely translates as “moving toward wholeness.” The practice in experiential psychotherapy emerged in the 1980s as a tool for self-exploration and inner healing, and has certified teaches who now facilitate it around the world. The framework integrates music with modern consciousness research, psychology and Eastern spiritual practices, according to the Grof Transpersonal Training program.Many people today teach this intense breathing practice, and other similar techniques that preceded it, such buy kamagra 100mg generic viagra as kundalini yoga or pranayama.

But questions remain about the science behind what exactly is happening in the mind and body while practitioners lie on the floor and breathe persistently in rapid patterns. And some clinicians have raised concerns about the safety, and risks, in a field with limited peer-reviewed studies.Meditation on a Freight TrainStacia Butterfield has been a certified Holotropic Breathwork teacher with Grof Transpersonal Training for roughly 15 years. She committed to the work after having her own life-changing experience at a workshop, and has since worked closely with Grof himself buy kamagra 100mg generic viagra and guided thousands of people in the practice. €œIt’s deceptively simple. It seems like just turning on music, laying down and taking buy kamagra 100mg generic viagra some breaths, and away you go,” Butterfield says.

€œWhat we’re actually relying on is the spontaneous mobilization of the psyche.”First and foremost, a guided Holotropic Breathwork session requires creating a safe container, Butterfield says, where people can let go of inhibitions or mental blocks. Facilitators are trained to guide people through that process in a group setting.One session lasts between two and three hours — often as part of a weekend or week-long retreat. People pair off and alternate in the roles of “sitter” (assisting the other) buy kamagra 100mg generic viagra and “breather” (the person doing the heavy breathing). To begin, rhythmic drumming sets the mood. The breather lays down and starts breathing rapidly, in a continuous way with no real break between inhales and exhales.The music typically has an emotional arc, almost like a movie buy kamagra 100mg generic viagra soundtrack.

It might start off evocative and stimulating, then turn “increasingly dramatic and dynamic, and finally it reaches a breakthrough quality,” according to a guide written by Stan and Christina Grof. This guide notes that when the breathing leads to non-ordinary states of consciousness in a practitioner, “there is a potential for unusually intense projections, including regressed longings for nurturing, sexual contact, or spiritual connection.” Facilitators are advised to assist clients with these feelings as they arise, while following their agreement to conduct the practice in an ethical manner.Butterfield says one core principle, like somatic therapy, is for participants to become aware of the messages and wisdom in their own body. €œSo many buy kamagra 100mg generic viagra people are so busy, just cruising around [and] keeping the lid on everything else that is going on internally,” she says. €œ[In a session] they can just close their eyes and go inward, and see what’s there.” She says visions, strong bodily sensations and emotions often arise. And she has watched people who had tried years of talk therapy make substantial progress in processing grief and buy kamagra 100mg generic viagra loss, past trauma, life changes or even mental illnesses.One practitioner aptly described this practice as “meditation on a freight train,” Butterfield adds.

The reported dramatic experiences spark questions about what might actually be happening within the body and brain.Mysticism or Hyperventilation?. Pulmonologist Michael Stephen, author of the book Breath Taking, says the practice of Holotropic Breathwork raises red flags for him because of its use of over-breathing, or hyperventilation. Biologically, when someone breathes heavily for an buy kamagra 100mg generic viagra extended period, they can lose too much carbon dioxide, which makes the blood overly alkaline. The phenomenon often triggers an immediately physiological response. €œWe start to get tingly in our fingers and dizzy when we hyperventilate, as our pH is rising too much,” says Stephen.Prolonged, excessive pH levels in the blood can also buy kamagra 100mg generic viagra cause seizures, he adds.

€œJust before seizures happen, you can get lightheaded, a sort of high.” He attributes this to the non-ordinary states of consciousness that people might feel during Holotropic Breathwork. But he says few proper studies have been done on the practice because of the dangers and ethics involved.Casualties of Heavy BreathingAnother breath specialist and integrative psychiatrist, Patricia Gerbarg, says that Holotropic Breathwork, and other forceful respiratory practices such as breath of fire, do have the potential to alter the mind. They can also bring about a lasting impact on people, but it’s buy kamagra 100mg generic viagra not always beneficial or predictable.“It’s a stress on the system. You’re going through rapid changes in oxygen levels and the balance of various substances in the body and the brain,” she says. And similar to drugs, “people can buy kamagra 100mg generic viagra use them to attain different mental states,” she adds.Read More.

Can Breathing Like Wim Hof Make Us Super Human?. Healthy people tend to have a broader tolerance to endure these shifts and unpredictable outcomes. But the same behavior can be harmful to someone who is less healthy, or dealing with a psychological disorder, says Gerbarg, who teaches psychiatry at buy kamagra 100mg generic viagra New York Medical College.“Those kinds of intense, rapid shifts in your brain chemistry can cause adverse effects,” she says, adding that she is familiar with cases where people feel they “never recovered” from what these states did to them. Some literature uses the term kundalini psychosis, or physio kundalini syndrome, to describe people who cognitively lose touch with reality in pursuit of "spiritual awakening."One of Gerbarg’s concerns about the rise in popularity of these advanced, Eastern breathing practices is how they are inserted into the Western world and modern mindset. (Two other intense and forceful breathing practices include Tummo breathing, with a Tibetan buddhist lineage, and the Wim Hof Method.) The breathwork buy kamagra 100mg generic viagra is often tied closely to a lifestyle and belief system, and many traditional practitioners dedicate hours a day for many years to master the techniques in a healthy way.

Alternatively, people in modern Western cultures often struggle to commit to a new practice for 20 minute a day. €œ[Intense breathwork] is becoming increasingly popular and people are doing it online,” Gerbarg says. €œThey aren’t often aware buy kamagra 100mg generic viagra that there are risks,” or they might not know the pre-existing conditions their students have. The big responsibility ultimately falls on the teachers and facilitators to ensure everyone is safe. A Gentler TouchGerbarg and her husband Richard Brown, a professor of psychiatry at Columbia College of Physicians and Surgeons, have published several books buy kamagra 100mg generic viagra on the healing potential of breath.

And they offer evidence-based workshops and teaching resources through their Breath-Body-Mind Foundation.One of their most popular techniques, called coherent breathing, teaches gentle, slower and relaxed respiration. Once practitioners learn it, they can use it any point throughout the day when stress or anxiety is likely to rise up — even in mundane circumstances like being stuck in a long line — and trigger a string of reactions in the body.The goal is to inhale and exhale slowly through the nose at a rate of about five breaths per minute, or one breath cycle every 12 seconds. Gerbarg says this process can promptly activate the rest-and-restore parasympathetic nervous system buy kamagra 100mg generic viagra throughout the body, with millions of reactions and signals firing every second.Read More. How Slow, Deep Breathing Taps Into a Natural Rhythm in Our Bodies“It tells the brain, ‘the conditions are safe,’ ” she says. €œThe less effort, the more you get out of this one.”The results of this technique may buy kamagra 100mg generic viagra not feel like the freight-train experience of altered consciousness.

But it carries less risk and broader appeal to anyone interested in channeling their own breath for health and wellness.In a year marked by a viagra, economic downturn, racial unrest, and an election that culminated with a mob storming the U.S. Capitol, we’ve come face to face with stressors we could never have imagined prior to 2020. The causes and health impacts of stress have been buy kamagra 100mg generic viagra widely discussed as have a host of tools for tackling the mounting anxiety we feel in our daily lives. But cortisol, among the body’s most important steroid hormones, at the helm of our stress response, remains largely a mystery. Is our buy kamagra 100mg generic viagra fight-or-flight response really tied to our prehistoric ancestors?.

Has our modern world evolved beyond the antiquated workings of our endocrine system?. Here’s what we know. A Caveman Instinct? buy kamagra 100mg generic viagra. Cortisol, along with epinephrine and norepinephrine, activate the body’s sympathetic nervous system, triggering a lineup of physiological responses that speed up respiration, constrict blood vessels, dilate pupils, and slow down the digestive system. It’s called a fight-or-flight response, and it allows muscles to react more powerfully and move faster, priming buy kamagra 100mg generic viagra us to, well, fight or flee.

Alan Goodman, a biological anthropologist at Hampshire College in Amherst, MA, studies stress in prehistoric humans. He agrees that cortisol and the entire acute stress response system is an evolutionary design. “It’s an ancient mammalian system adapted to protect hunter buy kamagra 100mg generic viagra gathers,” says Goodman. Still, getting a window into the daily stress levels of prehistoric humans is difficult because we can’t look at their blood, he says, and cortisol doesn’t preserve well. Research published in the International Journal of Paleopathology, looked at cortisol accumulation in the hair of 2,000-year-old buy kamagra 100mg generic viagra Peruvian mummies and found “repeated exposure to stress.” Another small pilot study of the same population found that hair samples suggest social, physiological, and environmental circumstances “strongly impacted stress levels.” But the research, says Goodman, has its shortcomings.

The study authors can’t rule out chemical changes to the samples over time and we’re not sure how accumulation in the hair corresponds to that of the blood. Goodman prefers to look at skeletal indicators of prehistoric stress because cortisol production can also impact bone and teeth metabolism. He studies ancient buy kamagra 100mg generic viagra populations in the Illinois River Valley from around 1200 AD, during the transition from hunting and gathering to farming. “Enamel on the teeth grows like an onion and you can tell from teeth’s layers the years when the body was stressed,” says Goodman. His research shows a stress response likely brought on by the move from buy kamagra 100mg generic viagra hunting and gathering to the building of civilizations and establishment of society.

€œLife becomes more complicated because societal structures have a hierarchy,” he says. With the haves and have-nots, the winners and losers, stress becomes more convoluted, no longer confined to immediate threats. Goodman notices this in the teeth as humans build societies under chieftains buy kamagra 100mg generic viagra. Although the enamel stops growing once permanent teeth develop, a growth stunt, known as enamel dysplasia, is frozen in time. Like the rings of a tree, you can see the years when buy kamagra 100mg generic viagra life was stressful.

This too, says Goodman, is an imperfect model because and malnutrition can also impact enamel production. But after spending his career studying these populations, Goodman suspects it’s likely a combination of all three. He says that it’s clear stress has been around since the dawn of time but today our response buy kamagra 100mg generic viagra has become more prolonged and in some cases, maladaptive. Chronic Disease and Cortisol Production In ancient populations high cortisol levels meant good health, basically indicating that a human could still compete for survival, but in modern populations it can spell disaster. Sudha Seshadri, a professor of neurology and founder of the Glenn Biggs Institute for Alzheimer's buy kamagra 100mg generic viagra &.

Neurodegenerative Diseases at the University of Texas Health Science Center in San Antonio, studies the link between neurodegenerative diseases and high cortisol levels. Cortisol levels, she says, should vary throughout the day, highest in the morning when we’re the most active and lowest late at night when we should be sleeping. If levels don’t vary or are overly elevated in the morning, cortisol production can buy kamagra 100mg generic viagra start to impact other parts of the body. €œChronic activation of fight or flight can cause problems in certain regions of the brain,” says Seshadri. Her research published in the journal Neurology, has shown that those with higher morning cortisol levels buy kamagra 100mg generic viagra are more likely to have problems with parts of the brain responsible for memory retention like the hypothalamus, which can be an early indicator of dementia and Alzheimer’s disease.

Chronic high cortisol levels are also linked to high blood pressure, heart disease, anxiety, and depression. Reducing Cortisol Levels People respond to stress with different degrees of cortisol activation, says Seshadri, partially based on genetics and partially based on life experiences. €œHyper-activation” of fight or flight especially during early childhood, is linked to exaggerated responses to stress later in life buy kamagra 100mg generic viagra. €œIt’s a vicious cycle, the more you’re exposed to stress, the more likely you are to have an exaggerated response to it,” says Seshadri. For parents, monitoring responses to stress can have buy kamagra 100mg generic viagra lifelong implications for children.

Studies also suggest that meditation seems to reduce cortisol levels, as does biofeedback, a technique that monitors heart rate, respiration, brain waves, muscle contractions, and perspiration and allows patients to respond to indicators in the moment, building awareness around and slowing their stress response. Additionally, exercise generates its own positive chemicals for counteracting cortisol like dopamine, norepinephrine, and serotonin. Both Goodman and Seshadri agree that fight or flight is found in both modern and prehistoric buy kamagra 100mg generic viagra populations. But it’s meant to help humans rapidly react to a physical threat and then laugh off their brush with death later, not stew all night over a perceived danger that never happens. “The problem with humans is that we’re symbolic beings, constantly finding buy kamagra 100mg generic viagra meaning in situations where there wasn’t any,” Goodman says.

Experts contend that cortisol still plays an important role in keeping us safe in our modern world. But the key is dampening your response once the threat has lifted, instead of constantly fearing the imagined sabertooth tiger lunging from around the corner..

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