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Atherosclerotic vascular calcification and bone mineral density (BMD) appear to mirror each buy levitra with free samples other—less bone calcification goes hand-in-hand with excess vascular calcification—with plausible biological mechanisms to explain this apparent paradox. But whether the vascular-bone calcification relationship is an independent association or is simply related to the ageing process and shared risk factors has been unclear. In this issue of Heart, Park and colleagues1 investigated the association between BMD and atherosclerotic cardiovascular disease (ASCVD) events in a cohort of 12 681 women buy levitra with free samples aged 50–80 years of age with a median of 9.2 years follow-up after BMD measurement.

The primary endpoint of ASCVD death, non-fatal myocardial infarction or ischaemic stroke occurred in 3.7% of patients. As hypothesised, a lower BMD was associated with a higher risk for ASCVD events (adjusted HR 1.38, p<0.001 per 1 SD decrease in BMD measured at the hip). In addition, a clinical diagnosis of osteoporosis was independently associated with a higher risk of ASCVD events even after adjustment for other risk factors (adjusted HR buy levitra with free samples.

1.79, p<0.001). The authors suggest that evaluation of BMD may add incremental value for ASCVD risk stratification in women (figure 1).Comparison of prediction performance for ASCVD events between the BMD model and ASCVD risk score. The addition of a clinical diagnosis of osteopenia or osteoporosis by total hip BMD to age and other clinical risk factors demonstrates a significant improvement in model performance for predicting ASCVD events buy levitra with free samples over that of the ASCVD risk score.

ASCVD, atherosclerotic cardiovascular disease. BMD, bone mineral density buy levitra with free samples. IDI, integrated discrimination improvement.

NRI, Net Reclassification Index." data-icon-position data-hide-link-title="0">Figure 1 Comparison of prediction performance for ASCVD events between the BMD model and ASCVD risk score. The addition buy levitra with free samples of a clinical diagnosis of osteopenia or osteoporosis by total hip BMD to age and other clinical risk factors demonstrates a significant improvement in model performance for predicting ASCVD events over that of the ASCVD risk score. ASCVD, atherosclerotic cardiovascular disease.

BMD, bone mineral density. IDI, integrated buy levitra with free samples discrimination improvement. NRI, Net Reclassification Index.In an editorial, Canoy and Rahimi2 remind us that ‘The cross-talk between bones and atherosclerosis is an interesting area of research, yet it is hardly novel.

In a lecture given in buy levitra with free samples 1858, Dr Rudolf Virchow referred to atherosclerotic lesions as ‘ossification’. Perhaps it is high time to establish how bone health affects vasculature and understand the underlying pathophysiology that links osteoporotic and atherosclerotic conditions. In doing so, we might just discover new ways to improve the treatment of, and care for, the hearts and minds of women, as well as of men.’Another interesting paper in this issue of Heart is the study by Nakashima and colleagues3 who used machine learning to predict daily out-of-hospital cardiac arrest (OHCA) incidence based on meteorological and chronological data.

Using data from over 660 000 OHCA cases of cardiac origin, integrated with detailed chronological and meteorological data, the machine learning model buy levitra with free samples accurately predicted events as shown in figure 2. The strongest associations with OHCA incidents were days of the week (Sunday or Monday), holidays, winter, low ambient temperatures and large interday or intraday temperature differences.Observed versus predicted incidence of OHCA. The blue dots indicate the observed total number of OHCAs per day in Japan.

The red buy levitra with free samples dots indicate the predicted number based on the following predictive models. (A) ML model with comprehensive meteorological variables, (B) ML model with chronological variables and (C) ML model with combined meteorological and chronological variables. ML, machine learning buy levitra with free samples.

OHCA, out-of-hospital cardiac arrest." data-icon-position data-hide-link-title="0">Figure 2 Observed versus predicted incidence of OHCA. The blue dots indicate the observed total number of OHCAs per day in Japan. The red dots indicate the predicted number based on the following predictive models buy levitra with free samples.

(A) ML model with comprehensive meteorological variables, (B) ML model with chronological variables and (C) ML model with combined meteorological and chronological variables. ML, machine learning. OHCA, out-of-hospital cardiac arrest.The provocative editorial by Gaieski4 discusses the strengths and limitations of the study and suggests that buy levitra with free samples.

€˜listening to the science is more important today than ever before and the intriguing data supporting an increase in mean daily temperatures in Hokkaido (Japan’s northern most prefecture) suggest the potential for global warming to cause increased incidence of cardiovascular emergencies and adds another personal, pathophysiological reason to take the climate crisis seriously. If next weeks’ weather forecast is for cold and cloudy weather with an increased chance of cardiac arrest, citizens can be prepared, taking precautionary measures, and health systems can be staffed appropriately, ready for increased resource utilisation.’Most physicians buy levitra with free samples think that patient education is a key factor in reducing adverse cardiovascular events and in improving patient’s quality of life. Yet there is sparse objective evidence for an effect of patient education on ASCVD outcomes.

In this issue of Heart, Giannopoulos and colleagues5 prospectively randomised 329 patients (mostly men) after myocardial infarction to usual treatment alone versus usual treatment plus an 8-week long educational programme. The educational programme, presented by non-medical buy levitra with free samples personnel, consisted of 10 hours of lessons on risk factor management, lifestyle and medical therapy. At a mean follow-up of 17 months, the primary endpoint of all-cause death, myocardial infarction, cerebrovascular event or unscheduled cardiovascular hospitalisation occurred in 20.8% of the treatment group versus 36.6% of the usual care group (OR 0.46, 95% CI 0.28 to 0.74.

P=0.002) (figure 3). The intervention group also had greater reductions in serum low-density buy levitra with free samples lipoprotein cholesterol, systolic blood pressure and body mass index, compared with the control group.Kaplan-Meier curves of primary end point event-free survival (top panel) and major adverse cardiac and cerebrovascular event-free survival (bottom panel) in the two study arms." data-icon-position data-hide-link-title="0">Figure 3 Kaplan-Meier curves of primary end point event-free survival (top panel) and major adverse cardiac and cerebrovascular event-free survival (bottom panel) in the two study arms.The effects of the educational programme on clinical outcomes in the study by Giannopoulos5 are impressive but, as Taylor points out in his editorial,6 for this approach to be effectively implemented in other institutions additional reporting elements are needed including ‘the intervention underlying theoretical basis (how will the intervention cause change?. ), method of intervention development (eg, were patients, clinicians and other key stakeholders involved in the intervention design?.

), fidelity of delivery (eg, what checks were in place in the trial to check buy levitra with free samples that the intervention was delivered as planned?. ) and the costs and resources (eg, staffing) to deliver the intervention.’The Education in Heart article in this issue7 addresses the underlying genetics, diagnosis, risk stratification and treatment options for the major ion channelopathies including long QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia.Readers will also want to look at the excellent review article8 on the novel mechanisms of action of sodium-glucose co-transporter 2 inhibitor therapy in patients with heart failure (figure 4).Schematic diagram showing proposed novel mechanisms of action of SGLT2 inhibitors in heart failure. AMPK, adenosine monophosphate-activated protein kinase.

HIF, hypoxia-inducible buy levitra with free samples factor. NHE, sodium-hydrogen exchanger. SGLT, sodium-glucose co-transporter.

SIRT, sirtuin." data-icon-position data-hide-link-title="0">Figure 4 Schematic diagram showing proposed novel mechanisms of buy levitra with free samples action of SGLT2 inhibitors in heart failure. AMPK, adenosine monophosphate-activated protein kinase. HIF, hypoxia-inducible buy levitra with free samples factor.

NHE, sodium-hydrogen exchanger. SGLT, sodium-glucose co-transporter. SIRT, sirtuin.Our Cardiology-in-Focus article9 in this issue summarises the unique cardiovascular health concerns in sexual and buy levitra with free samples gender minority (SGM) persons, along with approaches to primary and secondary ASCVD prevention.

As the authors conclude. €˜SGM individuals represent a unique subset of patients that have increased CVD risk related to behavioural, psychosocial and physiological factors. Even though there is a growing body of research documenting cardiovascular health disparities among SGM populations, efforts to specifically address these concerns can be improved, including clinician participation in data collection, awareness of unique factors contributing to disparate health outcomes, revising educational content and population-based improvements in methodological approaches.’Ethics statementsPatient consent for publicationNot buy levitra with free samples required.As foam-cell and lipid-pool accumulates over time, the arterial intimal layer thickens and atheromatous plaques eventually develops, which can potentially lead to tissue ischaemia.1 The progression of atherogenesis can affect the circulation of the heart or the brain, with myocardial infarction and ischaemic stroke among the debilitating consequences.

In advanced atherosclerosis, the presence of calcified deposits is an important feature in these atheromatous plaques and it is informative of subsequent risk of atherosclerotic cardiovascular disease (ASCVD). Various modalities have been used to detect vascular calcification, and the coronary artery calcium (CAC) is a widely used indicator of atherosclerotic burden, thereby, a predictor of future risk of ASCVD.2 Although debate exists regarding the use of CAC as a screening tool to assess and manage ASCVD risk,3 several clinical guidelines have suggested the utility of CAC score to improve risk stratification and guide clinical management, particularly for those who are at low or intermediate risk of ASCVD.4 5 Nevertheless, the cost of assessing CAC is not negligible, and exposure to radiation when assessing CAC using CT scan might be an issue for some.Interestingly, calcification of the arterial tissue has long been recognised ….

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It’s not the years in your life that matter, it’s the life in buy levitra with free samples your canadian pharmacy online levitra years.This (mis)quote neatly captures the importance of quality of life. Indeed, our quality of life has perhaps never been so important than during these unprecedented times of the erectile dysfunction treatment levitra.Although limited, there is some empirical evidence to support the value that people with heart disease attach to their health-related quality of life (HRQoL). An innovative study asked 99 people with advanced heart failure to complete a time trade-off levitra online pharmacy canada (TTO) tool to quantify their willingness to trade time (length of life) for better health (HRQoL).1 TTO scores can range from 1.0 (no willingness to trade off length of life for health) to 0 (complete willingness to trade off length of life for buy levitra with free samples health). Importantly, the study authors found that patients were prepared to trade off time for health, and interestingly this trade-off was greatest for those with the poorest HRQoL (eg, patients with an New York Heart ….

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ELK CITY compare viagra cialis and levitra — One student throws his classmates’ pencil box on the floor in anger. Another bites her own arm out of frustration. Others run compare viagra cialis and levitra screaming from their classrooms. Some Elk City Elementary School students are celebrating as summer break approaches. Others are dreading the end of the school year, acting out in fear of what the next three months could bring.

School counselor Kim Hamm worries about students who won’t have enough to eat this compare viagra cialis and levitra summer. And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs. And who will spend their days anticipating the compare viagra cialis and levitra next attack from an abusive family member. Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home.

“They know that, here, they’re safe and we’re not going to hurt compare viagra cialis and levitra them,” Hamm said. €œAnd a lot of our kids, unfortunately, don’t go home to that every day.” About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry. The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students face rates of compare viagra cialis and levitra poverty, special needs and suicide higher than the state average. Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office.

Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent. (Courtesy photo) In her six years as a school counselor, Hamm has learned compare viagra cialis and levitra to anticipate these needs, making more time towards the end of the school year to meet with students one-on-one. But she doesn’t always have the bandwidth. School counselors’ duties range from helping develop individualized learning compare viagra cialis and levitra plans for students with special needs to proctoring the third-grade reading test. They enroll students in classes and ensure they meet state math and science requirements.

They provide college and career advice and help them find and apply for scholarships. They wrangle students during morning drop-off and afternoon pick-up, run school-sponsored food and clothes pantries and teach breathing techniques to those with compare viagra cialis and levitra test anxiety. Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. Counselors refer the most troubled kids to community mental health counselors. But they are also in short supply especially in rural areas like Elk City where the ratio of mental compare viagra cialis and levitra healthcare providers to residents is 1 to 150,000.

Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed. A federal compare viagra cialis and levitra program is increasing support for students in six rural school districts in what the state mental health and education departments call “mental health deserts.” But schools are finding it difficult to hire qualified caregivers and erectile dysfunction treatment restrictions have halted programs and limited in-person treatment. Students are seen leaving Elk City Elementary School at the end of the school day. School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma compare viagra cialis and levitra Watch) A Response Inspired By Sandy Hook Since 2018, the State Department of Education has received two U.S.

Department of Health and Human Services grants totaling $18 million. Oklahoma’s Project AWARE, short for Advancing Wellness and Resiliency in Education, is in its third year of the five-year grant at Woodward, Elk City and Weatherford Public Schools and its first year at Ada, Atoka and Checotah Public Schools. Subscribe to Jennifer Palmer's Education compare viagra cialis and levitra Watch newsletter Processing… Success!. You're on the list. Whoops! compare viagra cialis and levitra.

There was an error and we couldn't process your subscription. Please reload the page and try again. The districts compare viagra cialis and levitra were chosen by the state department for their lack of treatment providers and high-risk student populations. Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University. But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application.

These students are more susceptible to mental illness compare viagra cialis and levitra. And without treatment, they can face even more dangerous obstacles as they age, often leading to their own violent encounters, substance abuse or incarceration. Subscribe to our First Watch newsletter Processing… compare viagra cialis and levitra Success!. You're on the list. Whoops!.

There compare viagra cialis and levitra was an error and we couldn't process your subscription. Please reload the page and try again. In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012. Since then, the Substance Abuse and compare viagra cialis and levitra Mental Health Services Administration has sent millions to schools nationwide with high-risk students to prevent violence perpetrated by young people. This story was reported in partnership with the Solutions Journalism Network.

For more compare viagra cialis and levitra information, go to solutionsjournalism.org. In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff. At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the levitra. Community events aim to reduce stigma around mental health challenges and treatment and teach parents and students about healthy habits like the importance of sleep and recommendations for social media compare viagra cialis and levitra use. Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation.

Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out. Community mental health counselors had started to meet with troubled students in some of the Western compare viagra cialis and levitra Oklahoma schools. Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of these services were paused compare viagra cialis and levitra due to erectile dysfunction treatment. Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent.

The grant also trained educators at all six districts in a classroom program that teaches conflict resolution and empathy. Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the compare viagra cialis and levitra end of the day. Henthorn checks in with her students twice a day through a program known as Circles that she says teaches students coping skills and empathy. (Whitney Bryen/Oklahoma Watch) Just before the bell rang on a Monday afternoon, kindergarteners sat in a circle on a rug at the front of Liz Henthorn’s classroom at Elk City Elementary School. One-by-one the compare viagra cialis and levitra students rated how they’re feeling as they prepared to go home.

They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice. One student said he was feeling sad because his dog ran away that morning. Another student compare viagra cialis and levitra was feeling red because she had a bad dream. Other students spoke up saying they could relate or that they’re sorry that happened. “We’re teaching kids to identify their feelings and giving suggestions to cope,” compare viagra cialis and levitra Henthorn said.

€œAnd when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.” Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch) Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation. But few are qualified to help more critical students, like those with mental illness or compare viagra cialis and levitra who have experienced trauma. Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%.

In Elk City, 140 of the district’s compare viagra cialis and levitra 2,110 students had a parent who was incarcerated. And all three Western Oklahoma districts had higher than average suicide rates. Those districts rely on school counselors to support these students, though most compare viagra cialis and levitra lack the training. And the grant does not address the ratio of counselors to students, which is far above national recommendations. Districts also planned to increase referrals to community treatment centers facilitated by the grant.

Demand for mental health care spiked during the levitra, further straining the area’s providers and leaving families compare viagra cialis and levitra with few options. Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch) The Complicated Search for Counselors School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors can provide therapy and diagnose students with compare viagra cialis and levitra mental illness. Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors.

Each district compare viagra cialis and levitra hired one licensed mental health provider who serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed. The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams. Training for licensed professional counselors requires an additional 60 graduate-level college hours and compare viagra cialis and levitra 3,000 hours of supervised counseling. Counselors must also pass an exam before being licensed.

Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include compare viagra cialis and levitra fees for supervision or the licensing exam. The grant will pay tuition costs for school counselors to get their license. Only two of 16 school counselors in Elk City, Weatherford and Woodward compare viagra cialis and levitra have taken the offer. School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion.

“I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old. €œIf I was going to make more as a school counselor with it then maybe I would, but I’m not going to so I’m just not going to spend a whole lot of time to get that.” For school counselors who do get their compare viagra cialis and levitra license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the levitra. Oklahoma has 1,841 school counselors compare viagra cialis and levitra and nearly 695,000 students, according to State Department of Education reports.

The department does not track how many school counselors have their professional counseling license. The American School Counselor Association recommends a ratio of 1 compare viagra cialis and levitra school counselor to 250 students. Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools. Not every school has a compare viagra cialis and levitra dedicated counselor.

Some have teams depending on student population, how schools prioritize funding and disperse tasks. The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch interviewed 10 counselors across the compare viagra cialis and levitra state. Most said they spend the majority of their day doing clerical work. Depending on the time of year, about 20 to compare viagra cialis and levitra 50% of their time is spent with students.

Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration. Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation. €œA lot of what I deal with are the results of families who are in crisis, where there’s addiction, other issues that are related to poverty and the kids show up to school and there’s a lot of fallout compare viagra cialis and levitra from that,” Moss said. €œAnd so we have kids who are depressed. We’ve had kids who are suicidal.

Anxieties are really high.” Lora Anderson, a school counselor at Ada Junior High School, talks to students compare viagra cialis and levitra about online enrollment and how to choose classes for next school year. (Courtesy photo) Moss is one of two school counselors taking advantage of Project AWARE funding to get her professional counseling license. Her compare viagra cialis and levitra principal took over her ACT and pre-ACT testing, scheduling and enrollment duties allowing Moss to spend more time with students in crisis. “I would love to see even more taken off of the shoulders of counselors so that we could take care of our kids’ needs better,” Moss said. €œBut I truly feel blessed here that I am not overwhelmed, like so many counselors.” At Ada Junior High School, counselor Lora Anderson spends about 25% of her time working with troubled students.

Many school counselors go into the job to propel students’ academic compare viagra cialis and levitra success, not to provide therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs. €œThat’s not what I want to do,” Anderson said after returning to her desk from lunch duty. €œI do compare viagra cialis and levitra so many different things to help students. If I wanted to be a mental health counselor, I wouldn’t work in a school.” Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students.

(Courtesy photo) Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license. But based on training she’s attended compare viagra cialis and levitra and led over the years, Taylor said it’s likely that about 1 in 5 school counselors goes on to become licensed. School counselors are serving dual roles whether they want to or not. Like swim instructors at a pool, most school counselors see their role as building stronger compare viagra cialis and levitra swimmers. But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids.

“Counselors in rural schools tend to be treading more water,” Taylor said. €œSome folks are so compare viagra cialis and levitra overwhelmed with the job they have, they don’t have the time or the motivation to seek out additional training. It’s just not accessible for folks.” Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. She said compare viagra cialis and levitra the job has changed a lot since she started.

Test requirements are constantly evolving. College admissions and scholarship applications seem to get longer compare viagra cialis and levitra every year. And students want to talk more. Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the levitra, Taylor said. And school counselors have to be ready to listen compare viagra cialis and levitra and help.

“I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said. €œThat’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.” Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said compare viagra cialis and levitra since the erectile dysfunction levitra began, her students seem more anxious and depressed than ever. (Whitney Bryen/Oklahoma Watch) Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by erectile dysfunction treatment. Contact her at (405) 201-6057 or wbryen@oklahomawatch.org compare viagra cialis and levitra.

Follow her on Twitter @SoonerReporter. Support our publicationEvery day we strive to produce journalism that matters — stories that strengthen accountability and transparency, provide value and resonate with readers like you.This work is essential to a better-informed community and a healthy democracy. But it isn’t possible without your compare viagra cialis and levitra support. Donate nowMore than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The levitra has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire.

It may have the smallest population in America, but when it comes to land, Wyoming is compare viagra cialis and levitra the ninth-largest. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here. While there is vast open space, the nearest major trauma hospital is compare viagra cialis and levitra more than 2.5 hours away. On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival.

It's a fact compare viagra cialis and levitra Luke Sypherd knows all too well. For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve. "We just saw that we didn't have the personnel compare viagra cialis and levitra to continue," Sypherd said. "It was an ongoing problem made worse by erectile dysfunction treatment with fewer people interested in volunteering with EMS during a levitra and patients afraid of getting taken to a hospital."A nearby hospital system, Cody Regional Health, has agreed to provide ambulance service for Washakie County, averting a crisis.

But it's a problem playing compare viagra cialis and levitra out across rural America. Ambulance crews are running out of money and volunteers.Phillip Franklin, the EMS Director for Cody Regional Health, said the crisis is a result of several problems."The majority of the ambulance service staff are not paid so if you don't have your volunteers, they can't run calls," Franklin said. "Another problem is that there's simply just not enough volume to keep ambulance service afloat and in the state of Wyoming, EMS is not essential, which means there's nobody responsible to fund these entities."Sypherd said the funding model for EMS is fundamentally flawed, with most service providers reimbursed only if they take patients to a hospital or clinic. In rural areas like Washakie County, smaller populations mean fewer calls, and consequently, less money. "You're reimbursed based on the number of patients that you transport to a hospital so you could get called 1,000 times a year and only transport 750 patients -- those other 250 calls you made no money on," Sypherd said.

Plea for federal assistanceThe American Ambulance Association sent a letter earlier this month to the US Department of Health and Human Services asking the agency to earmark $1.425 billion in federal aid for its members, warning that emergency medical systems across the US are "on the brink of collapse.""It is critical that we not let the financial hardship caused by the levitra to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National Association of State EMS Officials, just eight states consider local emergency medical services "essential" by law, as they do for fire and police. "That mandate means that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said. "If you're in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year away from closure."'A matter of life and death'One of those is Fremont County -- home to the Wind River Indian Reservation.

Fremont is roughly the size of the state of Vermont. An economic downturn and budget cuts prompted the county to privatize its ambulance service in 2016. But the private company, American Medical Response, says it can't afford to keep going after losing $1.5 million in revenue last year. AMR announced it won't renew its contract when it runs out on June 30. No others have bid.

"We just couldn't renew that current contract because it was set up for a financial failure," said Matt Strauss, Regional Director for AMR parent company, Global Medical Response. One of the problems, according to Fremont County Commissioner Larry Allen, is the so-called payer mix. Many of the county's residents rely on Medicare, Medicaid and Indian Health Services, which reimburse ambulance providers at a lower rate. And without state or federal designation of EMS as an essential service, Allen said "there's no source of revenue to operate an ambulance.""Because of the distance and the ruralness of this county, we just don't have people standing in line wanting to provide ambulance service," Allen said. The Wind River Indian Reservation stretches across more than 2 million acres and is shared by two Native American tribes, the Eastern Shoshone and the Northern Arapaho.

It has three tiny clinics but no ambulance services and relies on Fremont County for EMS. "Right now the response time is pretty slow and it's going to be nonexistent," said Northern Arapaho tribal member Juan Willow. His grandfather struggled with health problems and Willow said there were many times when the family couldn't wait for an ambulance and had to find other ways of getting to the hospital. "Not everyone here has a car," he said.It's a concern shared by Jordan Dresser, the chairman of the Northern Arapaho Tribe."I think if we didn't have access to ambulances, death rates would be higher," said Dresser, adding that many tribal members don't have working vehicles and therefore can't take themselves to the hospital or clinics. "It's a matter of life and death for us.".

ELK CITY — buy generic levitra One student throws his classmates’ buy levitra with free samples pencil box on the floor in anger. Another bites her own arm out of frustration. Others run buy levitra with free samples screaming from their classrooms. Some Elk City Elementary School students are celebrating as summer break approaches. Others are dreading the end of the school year, acting out in fear of what the next three months could bring.

School counselor Kim Hamm buy levitra with free samples worries about students who won’t have enough to eat this summer. And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs. And who will spend their buy levitra with free samples days anticipating the next attack from an abusive family member. Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home.

“They know that, here, they’re buy levitra with free samples safe and we’re not going to hurt them,” Hamm said. €œAnd a lot of our kids, unfortunately, don’t go home to that every day.” About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry. The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students face rates of poverty, special needs and suicide higher than the state buy levitra with free samples average. Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office.

Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent. (Courtesy photo) In her six years as a school counselor, Hamm has learned to anticipate these needs, making more time towards the end of the school year buy levitra with free samples to meet with students one-on-one. But she doesn’t always have the bandwidth. School counselors’ duties range from helping develop individualized learning plans for students with special needs to proctoring the third-grade reading buy levitra with free samples test. They enroll students in classes and ensure they meet state math and science requirements.

They provide college and career advice and help them find and apply for scholarships. They wrangle buy levitra with free samples students during morning drop-off and afternoon pick-up, run school-sponsored food and clothes pantries and teach breathing techniques to those with test anxiety. Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. Counselors refer the most troubled kids to community mental health counselors. But they are also in short supply especially in rural areas buy levitra with free samples like Elk City where the ratio of mental healthcare providers to residents is 1 to 150,000.

Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed. A federal program is increasing support for students in six rural school districts in what the state mental health and education departments call “mental health buy levitra with free samples deserts.” But schools are finding it difficult to hire qualified caregivers and erectile dysfunction treatment restrictions have halted programs and limited in-person treatment. Students are seen leaving Elk City Elementary School at the end of the school day. School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma Watch) buy levitra with free samples A Response Inspired By Sandy Hook Since 2018, the State Department of Education has received two U.S.

Department of Health and Human Services grants totaling $18 million. Oklahoma’s Project AWARE, short for Advancing Wellness and Resiliency in Education, is in its third year of the five-year grant at Woodward, Elk City and Weatherford Public Schools and its first year at Ada, Atoka and Checotah Public Schools. Subscribe to buy levitra with free samples Jennifer Palmer's Education Watch newsletter Processing… Success!. You're on the list. Whoops! buy levitra with free samples.

There was an error and we couldn't process your subscription. Please reload the page and try again. The buy levitra with free samples districts were chosen by the state department for their lack of treatment providers and high-risk student populations. Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University. But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application.

These students are more susceptible to buy levitra with free samples mental illness. And without treatment, they can face even more dangerous obstacles as they age, often leading to their own violent encounters, substance abuse or incarceration. Subscribe to our First Watch newsletter Processing… buy levitra with free samples Success!. You're on the list. Whoops!.

There was an error and we buy levitra with free samples couldn't process your subscription. Please reload the page and try again. In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012. Since then, the Substance Abuse and Mental Health Services Administration buy levitra with free samples has sent millions to schools nationwide with high-risk students to prevent violence perpetrated by young people. This story was reported in partnership with the Solutions Journalism Network.

For more information, go buy levitra with free samples to solutionsjournalism.org. In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff. At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the levitra. Community events aim to reduce stigma around mental health challenges and treatment and teach parents buy levitra with free samples and students about healthy habits like the importance of sleep and recommendations for social media use. Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation.

Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out. Community mental health counselors had buy levitra with free samples started to meet with troubled students in some of the Western Oklahoma schools. Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of these services were buy levitra with free samples paused due to erectile dysfunction treatment. Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent.

The grant also trained educators at all six districts in a classroom program that teaches conflict resolution and empathy. Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her buy levitra with free samples students rate how they’re feeling at the end of the day. Henthorn checks in with her students twice a day through a program known as Circles that she says teaches students coping skills and empathy. (Whitney Bryen/Oklahoma Watch) Just before the bell rang on a Monday afternoon, kindergarteners sat in a circle on a rug at the front of Liz Henthorn’s classroom at Elk City Elementary School. One-by-one the students rated how they’re feeling as they prepared to go home buy levitra with free samples.

They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice. One student said he was feeling sad because his dog ran away that morning. Another student was feeling red because she had a bad dream buy levitra with free samples. Other students spoke up saying they could relate or that they’re sorry that happened. “We’re teaching kids to identify their feelings and giving suggestions to cope,” Henthorn buy levitra with free samples said.

€œAnd when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.” Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch) Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation. But few are qualified to help more critical students, like those buy levitra with free samples with mental illness or who have experienced trauma. Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%.

In Elk City, 140 of the district’s 2,110 buy levitra with free samples students had a parent who was incarcerated. And all three Western Oklahoma districts had higher than average suicide rates. Those districts rely on school counselors buy levitra with free samples to support these students, though most lack the training. And the grant does not address the ratio of counselors to students, which is far above national recommendations. Districts also planned to increase referrals to community treatment centers facilitated by the grant.

Demand for mental health care spiked during the levitra, further straining the area’s providers buy levitra with free samples and leaving families with few options. Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch) The Complicated Search for Counselors School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors buy levitra with free samples can provide therapy and diagnose students with mental illness. Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors.

Each district hired one licensed mental health buy levitra with free samples provider who serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed. The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams. Training for licensed professional counselors requires an additional 60 graduate-level college hours and 3,000 hours of supervised counseling buy levitra with free samples. Counselors must also pass an exam before being licensed.

Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include fees for supervision or the buy levitra with free samples licensing exam. The grant will pay tuition costs for school counselors to get their license. Only two of 16 school counselors in Elk buy levitra with free samples City, Weatherford and Woodward have taken the offer. School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion.

“I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old. €œIf I was going to make more as a school counselor with it then maybe I would, but I’m not going to so I’m just not going to spend a buy levitra with free samples whole lot of time to get that.” For school counselors who do get their license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the levitra. Oklahoma has 1,841 school counselors and buy levitra with free samples nearly 695,000 students, according to State Department of Education reports.

The department does not track how many school counselors have their professional counseling license. The American School Counselor Association recommends a ratio of 1 school buy levitra with free samples counselor to 250 students. Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools. Not every school has buy levitra with free samples a dedicated counselor.

Some have teams depending on student population, how schools prioritize funding and disperse tasks. The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch interviewed buy levitra with free samples 10 counselors across the state. Most said they spend the majority of their day doing clerical work. Depending on the time buy levitra with free samples of year, about 20 to 50% of their time is spent with students.

Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration. Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation. €œA lot of what I deal with are the results of families buy levitra with free samples who are in crisis, where there’s addiction, other issues that are related to poverty and the kids show up to school and there’s a lot of fallout from that,” Moss said. €œAnd so we have kids who are depressed. We’ve had kids who are suicidal.

Anxieties are really high.” Lora Anderson, a school counselor at buy levitra with free samples Ada Junior High School, talks to students about online enrollment and how to choose classes for next school year. (Courtesy photo) Moss is one of two school counselors taking advantage of Project AWARE funding to get her professional counseling license. Her buy levitra with free samples principal took over her ACT and pre-ACT testing, scheduling and enrollment duties allowing Moss to spend more time with students in crisis. “I would love to see even more taken off of the shoulders of counselors so that we could take care of our kids’ needs better,” Moss said. €œBut I truly feel blessed here that I am not overwhelmed, like so many counselors.” At Ada Junior High School, counselor Lora Anderson spends about 25% of her time working with troubled students.

Many school counselors go into the job to propel buy levitra with free samples students’ academic success, not to provide therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs. €œThat’s not what I want to do,” Anderson said after returning to her desk from lunch duty. €œI do so many different things to help students buy levitra with free samples. If I wanted to be a mental health counselor, I wouldn’t work in a school.” Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students.

(Courtesy photo) Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license. But based on training she’s attended and led over the years, Taylor said it’s likely that about 1 in 5 school counselors goes on buy levitra with free samples to become licensed. School counselors are serving dual roles whether they want to or not. Like swim buy levitra with free samples instructors at a pool, most school counselors see their role as building stronger swimmers. But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids.

“Counselors in rural schools tend to be treading more water,” Taylor said. €œSome folks are so overwhelmed with the job they buy levitra with free samples have, they don’t have the time or the motivation to seek out additional training. It’s just not accessible for folks.” Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. She said the job has buy levitra with free samples changed a lot since she started.

Test requirements are constantly evolving. College admissions and scholarship applications seem to buy levitra with free samples get longer every year. And students want to talk more. Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the levitra, Taylor said. And school counselors have to be ready to buy levitra with free samples listen and help.

“I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said. €œThat’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.” Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said buy levitra with free samples since the erectile dysfunction levitra began, her students seem more anxious and depressed than ever. (Whitney Bryen/Oklahoma Watch) Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by erectile dysfunction treatment. Contact her buy levitra with free samples at (405) 201-6057 or wbryen@oklahomawatch.org.

Follow her on Twitter @SoonerReporter. Support our publicationEvery day we strive to produce journalism that matters — stories that strengthen accountability and transparency, provide value and resonate with readers like you.This work is essential to a better-informed community and a healthy democracy. But it isn’t possible without buy levitra with free samples your support. Donate nowMore than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The levitra has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire.

It may have the smallest population in America, but when it comes to land, Wyoming is the ninth-largest buy levitra with free samples. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here. While there is vast open space, the nearest major trauma hospital is more than 2.5 hours away buy levitra with free samples. On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival.

It's a buy levitra with free samples fact Luke Sypherd knows all too well. For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve. "We just saw that we didn't have buy levitra with free samples the personnel to continue," Sypherd said. "It was an ongoing problem made worse by erectile dysfunction treatment with fewer people interested in volunteering with EMS during a levitra and patients afraid of getting taken to a hospital."A nearby hospital system, Cody Regional Health, has agreed to provide ambulance service for Washakie County, averting a crisis.

But it's a problem buy levitra with free samples playing out across rural America. Ambulance crews are running out of money and volunteers.Phillip Franklin, the EMS Director for Cody Regional Health, said the crisis is a result of several problems."The majority of the ambulance service staff are not paid so if you don't have your volunteers, they can't run calls," Franklin said. "Another problem is that there's simply just not enough volume to keep ambulance service afloat and in the state of Wyoming, EMS is not essential, which means there's nobody responsible to fund these entities."Sypherd said the funding model for EMS is fundamentally flawed, with most service providers reimbursed only if they take patients to a hospital or clinic. In rural areas like Washakie County, smaller populations mean fewer calls, and consequently, buy levitra with free samples less money. "You're reimbursed based on the number of patients that you transport to a hospital so you could get called 1,000 times a year and only transport 750 patients -- those other 250 calls you made no money on," Sypherd said.

Plea for federal assistanceThe American Ambulance Association sent a letter earlier this month to the US Department of Health and Human Services asking the agency to earmark $1.425 billion in federal aid for its members, warning that emergency medical systems across the US are "on the brink of collapse.""It is critical that we not let the financial hardship caused by the levitra to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National Association of State EMS Officials, just eight states consider local emergency medical services "essential" buy levitra with free samples by law, as they do for fire and police. "That mandate means that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said. "If you're buy levitra with free samples in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year away from closure."'A matter of life and death'One of those is Fremont County -- home to the Wind River Indian Reservation.

Fremont is roughly the size of the state of Vermont. An economic downturn and budget cuts prompted the county to privatize its ambulance service buy levitra with free samples in 2016. But the private company, American Medical Response, says it can't afford to keep going after losing $1.5 million in revenue last year. AMR announced it won't renew its contract when it runs out on June 30. No others have bid.

"We just couldn't renew that current contract because it was set up for a financial failure," said Matt Strauss, Regional Director for AMR parent company, Global Medical Response. One of the problems, according to Fremont County Commissioner Larry Allen, is the so-called payer mix. Many of the county's residents rely on Medicare, Medicaid and Indian Health Services, which reimburse ambulance providers at a lower rate. And without state or federal designation of EMS as an essential service, Allen said "there's no source of revenue to operate an ambulance.""Because of the distance and the ruralness of this county, we just don't have people standing in line wanting to provide ambulance service," Allen said. The Wind River Indian Reservation stretches across more than 2 million acres and is shared by two Native American tribes, the Eastern Shoshone and the Northern Arapaho.

It has three tiny clinics but no ambulance services and relies on Fremont County for EMS. "Right now the response time is pretty slow and it's going to be nonexistent," said Northern Arapaho tribal member Juan Willow. His grandfather struggled with health problems and Willow said there were many times when the family couldn't wait for an ambulance and had to find other ways of getting to the hospital. "Not everyone here has a car," he said.It's a concern shared by Jordan Dresser, the chairman of the Northern Arapaho Tribe."I think if we didn't have access to ambulances, death rates would be higher," said Dresser, adding that many tribal members don't have working vehicles and therefore can't take themselves to the hospital or clinics. "It's a matter of life and death for us.".

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We plan to spend time promenading with the official mascot, manicure the Pharmalot campus grounds, and have a levitra 20mg listening party with Mrs. Pharmalot. And what about you?. This remains levitra 20mg a fine time to enjoy the great outdoors — remember, beaches and lakes are beckoning.

You could catch up on your reading. Or make plans with someone levitra 20mg special. Well, whatever you do, have a grand time. But be levitra 20mg safe.

By the https://styledandtaylored.com/winterblushtones/ way, there is an extended break on this side of the pond, after which we will hit the proverbial pause button to observe ancient rituals, so a colleague will fill in for us. Meanwhile, enjoy and see you next year. €¦House lawmakers have requested data and documents from the Food and Drug Administration related to the agency’s controversial accelerated approval of Biogen’s (BIIB) new Alzheimer’s drug, levitra 20mg STAT writes. The House committees have already requested documents from Biogen, but this is the first public request by congressional investigators directly to the agency.

The request cites a STAT story that levitra 20mg revealed Biogen had an off-the-books meeting with a key FDA regulator ahead of the approval last June. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is it?. STAT+ is levitra 20mg STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis.

Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included? levitra 20mg. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.An interesting and important period in the life of cancer survivors begins when major treatments, such as surgery and chemotherapy, end. Known as reentry, this phase of cancer recovery offers lessons for Americans as the levitra ever so slowly — and fitfully — recedes in the U.S.Consider the experience of physician Elizabeth McKinley, who wrote in the Annals of Internal Medicine about completing cancer treatment.

€œAfter my very last radiation treatment for breast cancer, I lay on a cold steel table hairless, half-dressed, and astonished by the levitra 20mg tears streaming down my face. I thought I would feel happy about finally reaching the end of treatment, but instead I was sobbing.” That’s one response to reentry, a phase one of us (T.D.) experienced when her cancer treatment ended and the other (A.L.S.) has investigated as a meaningful period in the trajectories of people with cancer.advertisement Described as “a new normal” by the National Cancer Institute, the return to life after cancer treatment can be gradual and bumpy. Many individuals deeply desire to levitra 20mg get back to life as usual. But the physical, psychological, social, and economic landscape may be slightly or radically different after cancer treatment.

The process of acknowledging and accepting that aspects of life have shifted, and of constructing a life after cancer, can last for weeks or months.Some people who complete cancer therapy celebrate and feel eager to get on with their lives without needing or wanting the support they had after diagnosis. But many do not return to life as levitra 20mg usual right after getting out of the chemotherapy chair or off the radiotherapy table. Instead, many adults diagnosed with cancer return gradually to their pre-cancer levels of well-being. It’s likely something similar levitra 20mg will happen with erectile dysfunction treatment.advertisement Here are some myths of reentry for after cancer treatment ends:I should be celebrating.I should feel well.I should be the pre-cancer me (or a vastly improved version of me).I should not need support.We label these as myths because they are widely held by people after treatment but often don’t match the nature of the experience.

Moreover, they can become expectations or demands others convey or people impose on themselves. The expectations get communicated when your well-intended cancer team gives you balloons during levitra 20mg your final chemotherapy session and your son asks what’s for dinner that night. They arise when your chair mate during chemotherapy tells you cancer is a blessing and gives you a copy of the book “You Can’t Afford the Luxury of a Negative Thought.” They linger when you feel adrift as appointments with your oncologist dwindle and your friends don’t check in as often. As the levitra declines from its peak in the U.S., are similar expectations being communicated to us and do we hold them ourselves?.

If you don’t quite feel part of the festive levitra 20mg parade, maybe so. If you expect yourself to be performing at 100% or 120% now that several constraints are lifted but don’t feel up to it, probably. If others say you should just “get over it,” absolutely.Lessons learned from cancer survivors offer levitra 20mg insight into who is most likely to experience a rocky post-levitra reentry.Adults who undergo the most arduous cancer treatments, or who experience important stressors in other life domains during cancer therapy, such as the death of a loved one or relationship problems, are more at risk for becoming or staying distressed during reentry. People who have fewer personal resources, such as low optimism about life in general, or who cope by trying to push away their cancer-related thoughts and feelings, are prone to difficult reentries.For many Americans, the active threats of the levitra continue.

Once these subside, they may be vulnerable to a difficult reentry. Did you care for others levitra 20mg at home, or in your job, or both?. Did you lose someone dear to you?. Were you a target of levitra 20mg racism?.

Did you attempt to motor through without attending to your own well-being?. If so, it’s no wonder you’re tired, grieving, angry, or just not feeling psychologically or physically yourself. Simply reminding yourself that you’re in the same boat as millions of others might levitra 20mg help. What else can anyone who remains tired or troubled do now?.

As the two of us have found for cancer reentry, actively acknowledging and approaching one’s current experience can be useful. Figure out what levitra-related concerns are still bothering you, talk to a faithful friend or professional (especially if your troubles are interfering with your ability to get through the day), ask for and accept help, reflect on what brings meaning to your life, and make a plan to approach meaningful goals. So what if you didn’t become a wiser person who has mastered the art of sourdough bread making, grows your own food, and speaks a second language fluently?. As Karyn White once sang, and as one of our (T.D.) Facebook live series declares, “I’m not your superwoman.” And it’s OK not to be.Acknowledge making it through more than a year of being buffeted, whether by strong breezes or by a hurricane-force tempest.

Now, or when it’s time for your own reentry, offer yourself some grace.Annette L. Stanton is professor and chair of the Department of Psychology at the University of California, Los Angeles. Tammie Denyse is a 17-year survivor of cancer and co-founder and president of Carrie’s TOUCH, a nonprofit organization for Black women with breast cancer. Together they are co-principal investigators for Project SOAR (Speaking Our African American Realities), which aims to understand the Strong Black Woman schema in the context of breast cancer..

Unlock this go right here article by subscribing to STAT+ and enjoy your first 30 buy levitra with free samples days free!. GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life buy levitra with free samples science coverage and analysis.

Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included? buy levitra with free samples. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.WASHINGTON — The Biden administration on Friday unveiled a sweeping new biosecurity plan, outlining a $65 billion proposal to remake the nation’s levitra preparedness infrastructure in the wake of erectile dysfunction treatment.The new spending would represent one of the largest investments in public health in American history.

During a press briefing, Eric Lander, the White House science adviser, likened the proposal to the Apollo program of the late 1960s.The immense funding boost would target programs aimed at developing and manufacturing treatments, treatments, and tests more quickly. It would also provide new money for laboratory capacity, viral detection mechanisms, and early warning systems.advertisement “For the first time in the nation’s history, due to these types of advancements in scientific technology, we have buy levitra with free samples the opportunity not just to refill stockpiles but to transform our capabilities,” Lander said. €œBut we really need to start preparing now.”Indeed, the White House funding request comes with a near-term deadline.

While the spending would be buy levitra with free samples spread over the coming seven to 10 years, it also includes an ask for at least $15 billion to be included within a forthcoming, $3.5 trillion budget plan still pending on Capitol Hill. The White House is still in discussions with Congress, Lander said, but he was “very optimistic” that lawmakers would agree to the request.advertisement The new spending would target a wide array of new levitra preparedness capabilities. It would include over $24 billion for treatment infrastructure, with a goal of beginning to manufacture treatment doses meant to protect against any levitra family within 100 days of a levitra threat first emerging.

The plan would include nearly $12 billion to develop — and have on hand — a range of treatments available for any known levitra family even before a particular pathogen emerged as a levitra threat.It would also provide $5 billion for diagnostics that buy levitra with free samples the government would aim to make available within weeks of identifying a new biosecurity threat.“What this plan is about is ensuring the United States has the capabilities it needs to operationalize [its response] when we see the first signs of an emerging outbreak that could have epidemic or levitra potential,” Beth Cameron, the top biosecurity expert on the National Security Council, said during the briefing. It’s not yet clear how Congress will respond to the Biden administration’s sweeping proposal, which expands on a previous request to spend $30 billion over four years on improving future levitra prevention and preparedness. In a subsequent version of Democrats’ budget buy levitra with free samples bill, however, lawmakers included just $5 billion, drawing criticism from many public health experts who said the government was repeating the same mistakes that led to the country’s chaotic response to erectile dysfunction treatment.

The $65 billion proposal doesn’t stop at treatments, tests, and treatments.It would include $3.1 billion aimed at establishing an early-warning system for new disease outbreaks, including systems to sequence pathogens found in wastewater and a “reliable clinical surveillance system.” Biden also calls for spending to help reduce health inequity, fund lab capacity, and improve public health communication. He also wants to put money toward developing better protective equipment for health workers and creating better systems for “pathogen protection,” like better ventilation systems and surface cleaners.The plan also includes measures to ensure that research and development “involving potentially dangerous biological agents is conducted safely and securely, by fostering a global research environment that adopts and enforces high standards.” The lab-safety provisions are a potential nod to the unproven theory that erectile dysfunction treatment originated from “gain-of-function” research performed in a Chinese laboratory, a long-running controversy in U.S. And global buy levitra with free samples politics.Hired someone new and exciting?.

Promoted a rising star?. Finally solved buy levitra with free samples that hard-to-fill spot?. Share the news with us, and we’ll share it with others.

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Everyone wants to know who is coming and going.And here is our buy levitra with free samples regular feature in which we highlight a different person each week. This time around, we note that Convergent Therapeutics hired Alexander Brown as chief operating officer. Previously, he worked at Sanofi (SNY), where he was head buy levitra with free samples of new product planning, global oncology.

Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is it?. STAT+ is buy levitra with free samples STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis.

Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's buy levitra with free samples included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.And so, another working week will soon draw to a close.

Not a moment too soon, yes?. This is, you may recall, our treasured signal to buy levitra with free samples daydream about weekend plans. Our agenda is rather modest.

We plan to spend time promenading with buy levitra with free samples the official mascot, manicure the Pharmalot campus grounds, and have a listening party with Mrs. Pharmalot. And what about you?.

This remains a fine time to enjoy the great outdoors — remember, beaches and buy levitra with free samples lakes are beckoning. You could catch up on your reading. Or make plans buy levitra with free samples with someone special.

Well, whatever you do, have a grand time. But be safe buy levitra with free samples. By the way, http://okelainc.com/?page_id=23 there is an extended break on this side of the pond, after which we will hit the proverbial pause button to observe ancient rituals, so a colleague will fill in for us.

Meanwhile, enjoy and see you next year. €¦House lawmakers have requested data and documents from the Food and Drug Administration related to the agency’s controversial accelerated approval of Biogen’s (BIIB) buy levitra with free samples new Alzheimer’s drug, STAT writes. The House committees have already requested documents from Biogen, but this is the first public request by congressional investigators directly to the agency.

The request cites a STAT story that revealed Biogen had an off-the-books buy levitra with free samples meeting with a key FDA regulator ahead of the approval last June. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is it?.

STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life buy levitra with free samples science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's buy levitra with free samples included?.

Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.An interesting and important period in the life of cancer survivors begins when major treatments, such as surgery and chemotherapy, end. Known as reentry, this phase of cancer recovery offers lessons for Americans as the levitra ever so slowly — and fitfully — recedes in the U.S.Consider the experience of physician Elizabeth McKinley, who wrote in the Annals of Internal Medicine about completing cancer treatment. €œAfter my buy levitra with free samples very last radiation treatment for breast cancer, I lay on a cold steel table hairless, half-dressed, and astonished by the tears streaming down my face.

I thought I would feel happy about finally reaching the end of treatment, but instead I was sobbing.” That’s one response to reentry, a phase one of us (T.D.) experienced when her cancer treatment ended and the other (A.L.S.) has investigated as a meaningful period in the trajectories of people with cancer.advertisement Described as “a new normal” by the National Cancer Institute, the return to life after cancer treatment can be gradual and bumpy. Many individuals deeply desire to get buy levitra with free samples back to life as usual. But the physical, psychological, social, and economic landscape may be slightly or radically different after cancer treatment.

The process of acknowledging and accepting that aspects of life have shifted, and of constructing a life after cancer, can last for weeks or months.Some people who complete cancer therapy celebrate and feel eager to get on with their lives without needing or wanting the support they had after diagnosis. But many do not return to life as usual right after getting out of the chemotherapy chair or off the radiotherapy buy levitra with free samples table. Instead, many adults diagnosed with cancer return gradually to their pre-cancer levels of well-being.

It’s likely something similar will happen with erectile dysfunction treatment.advertisement Here are some myths of reentry for after cancer buy levitra with free samples treatment ends:I should be celebrating.I should feel well.I should be the pre-cancer me (or a vastly improved version of me).I should not need support.We label these as myths because they are widely held by people after treatment but often don’t match the nature of the experience. Moreover, they can become expectations or demands others convey or people impose on themselves. The expectations get communicated when your buy levitra with free samples well-intended cancer team gives you balloons during your final chemotherapy session and your son asks what’s for dinner that night.

They arise when your chair mate during chemotherapy tells you cancer is a blessing and gives you a copy of the book “You Can’t Afford the Luxury of a Negative Thought.” They linger when you feel adrift as appointments with your oncologist dwindle and your friends don’t check in as often. As the levitra declines from its peak in the U.S., are similar expectations being communicated to us and do we hold them ourselves?. If you don’t quite feel part of the buy levitra with free samples festive parade, maybe so.

If you expect yourself to be performing at 100% or 120% now that several constraints are lifted but don’t feel up to it, probably. If others say you should just “get over it,” absolutely.Lessons learned from cancer survivors buy levitra with free samples offer insight into who is most likely to experience a rocky post-levitra reentry.Adults who undergo the most arduous cancer treatments, or who experience important stressors in other life domains during cancer therapy, such as the death of a loved one or relationship problems, are more at risk for becoming or staying distressed during reentry. People who have fewer personal resources, such as low optimism about life in general, or who cope by trying to push away their cancer-related thoughts and feelings, are prone to difficult reentries.For many Americans, the active threats of the levitra continue.

Once these subside, they may be vulnerable to a difficult reentry. Did you buy levitra with free samples care for others at home, or in your job, or both?. Did you lose someone dear to you?.

Were you a target of buy levitra with free samples racism?. Did you attempt to motor through without attending to your own well-being?. If so, it’s no wonder you’re tired, grieving, angry, or just not feeling psychologically or physically yourself.

Simply reminding yourself that you’re in the same boat as millions of others buy levitra with free samples might help. What else can anyone who remains tired or troubled do now?. As the two of us have found for cancer reentry, actively acknowledging and approaching buy levitra with free samples one’s current experience can be useful.

Figure out what levitra-related concerns are still bothering you, talk to a faithful friend or professional (especially if your troubles are interfering with your ability to get through the day), ask for and accept help, reflect on what brings meaning to your life, and make a plan to approach meaningful goals. So what if you didn’t become a wiser person who has mastered the art of sourdough bread making, grows your own food, and speaks a second language fluently?. As Karyn White once sang, and as buy levitra with free samples one of our (T.D.) Facebook live series declares, “I’m not your superwoman.” And it’s OK not to be.Acknowledge making it through more than a year of being buffeted, whether by strong breezes or by a hurricane-force tempest.

Now, or when it’s time for your own reentry, offer yourself some grace.Annette L. Stanton is professor and chair of the Department of buy levitra with free samples Psychology at the University of California, Los Angeles. Tammie Denyse is a 17-year survivor of cancer and co-founder and president of Carrie’s TOUCH, a nonprofit organization for Black women with breast cancer.

Together they are co-principal investigators for Project SOAR (Speaking Our African American Realities), which aims to understand the Strong Black Woman schema in the context of breast cancer..

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Shutterstock Bicameral legislation http://iciutah.com/where-can-you-buy-ventolin/ introduced Oct buy levitra tablets. 9 would expand access to Harm Reduction Centers throughout New Jersey.Harm Reduction Centers provide sterile syringes and supplies to drug users. They also buy levitra tablets provide screening for HIV and other sexually transmitted s. Screening Hepatitis C.

Treatment and pre- and post-exposure prophylaxis services. Naloxone and buy levitra tablets overdose prevention education. And resources for critical services such as HIV care.In addition, they provide connections to housing, counseling, support groups, and essential health services such as medication for opioid-use disorder, substance use disorder treatment, and prenatal care.New Jersey made its state syringe-access program permanent in 2016, but there are few centers statewide.The bill would remove regulations that often prevent the establishment of Harm Reduction Centers.“The current battle against erectile dysfunction treatment makes Harm Reduction expansion even more urgent, as we are facing the levitra on top of the existing overdose crisis, rising Hepatitis C s, and the ongoing HIV Epidemic,” Axel Torres Marrero, Hyacinth AIDS Foundation Senior Director of Public Policy and Legal Services, said. Sen.

Joseph Vitale (D-Middlesex) and Assemblywoman Valerie Vainieri Huttle (D-Bergen) introduced the bill. According to studies, drug users with access to Harm Reduction Centers are five times more likely to stop chaotic- substance use and 50 percent less likely to acquire Hepatitis C or HIV.Shutterstock In his weekly radio address, Arkansas Gov. Asa Hutchinson recently highlighted ways the state is addressing and slowing drug addiction rates.“We are seeking to raise awareness and prevent new victims from falling prey to addiction, and we want to ensure access to treatment for those who have,” Hutchinson said. €œWe want to reinforce our commitment to holding those who contribute to this epidemic accountable.

This is a tough topic to talk about, but we must if we are to slow this epidemic.”The number of overdose deaths in the state dropped 17 percent from 2019, making Arkansas’ rate of reduction second-best in the United States.Hutchinson proclaimed the week of Oct. 23 National Red Ribbon Week, Oct. 24 as Drug Take Back Day and Oct. 28 as Chasing the Dragon.

Opioid Awareness Day in Arkansas.Arkansas Drug Director Kirk Lane will oversee Drug Take Back Day. Over the past decade, more than 200 tons of unused and out-of-date medicines were collected for disposal. Chasing the Dragon. Opioid Awareness Day in Arkansas is a project led by the FBI’s Little Rock field office that coordinates the viewing of Chasing the Dragon, a frank DEA-FBI documentary about drug use, in schools.The state received a $21 million federal grant in September to expand substance-abuse-treatment programs.Shutterstock Michigan Attorney General Dana Nessel announced Oct.

7 that she has joined a coalition of attorneys general who is asking the creative community to take action to eliminate tobacco imagery from streamed movies and programs as an effort to protect young viewers. The coalition, formed last year, sent a letter to five Hollywood creative guilds as part of an effort to reduce youth exposure to tobacco, urging them to limit tobacco imagery in their video content. The attorneys general said that gaining the assistance and support would help stop the normalization and glamorization of tobacco use. €œThe statistics across our nation and right here in Michigan very clearly demonstrate that youth vaping is not something we can turn a blind eye to.

Across counties in Michigan last year, our state witnessed between a 30 percent and 118 percent increase in e-cigarette use among high school students. This increase is substantial and alarming and will require all hands on deck to change it,” said Nessel. €œMy colleagues and I encourage the creative guilds to join this very important dialogue to ensure our youth across this nation are protected from the influences of tobacco use.” In letters sent to the Directors Guild of America, Producers Guild of America, Screenwriters Guild of America, Screen Actors Guild-American Federation of Television and Radio Artists, and International Alliance of Theatrical Stage Employees, the attorneys general asked the guilds to use their influence to depict tobacco imagery more responsibly and encourage streaming companies to adopt a practice that steers young viewers away from tobacco imagery content. To only recommend and promote tobacco-free titles to children and families.

To mitigate the impact of watching tobacco imagery by running anti-tobacco spots and displaying tobacco-use warnings. And to offer parental controls so that families are empowered to choose tobacco-free content.Shutterstock In a new settlement, the largest generic opioid manufacturer in the United States will pay $1.6 billion into a trust that will go towards abating the opioid crisis, attorneys general from several states said on Friday. Under the agreement, Mallinckrodt (MNK) will pay $450 million into the trust upon emerging from bankruptcy and then pay $200 million annually for the first and second year out of bankruptcy. For five years after that, the company will pay $150 million annually.

Additionally, MNK agreed that its opioid business will be subject to stringent injunctive relief that will prevent marketing and ensure systems are in place to prevent drug misuse. €œThis agreement is a significant step toward helping those victimized by one of the worst man-made epidemics in our state’s history,” said Texas Attorney General Ken Paxton. €œMy office has been aggressively working to hold opioid manufacturers accountable for their deceptive marketing of highly-addictive pain pills, which spurred an epidemic and left victims and families with unimaginable consequences. My office will continue to do everything it can to protect Texans and help our state heal from this crisis.”The agreement covers lawsuits brought against the company by 50 states attorneys general and other local subdivisions.

€œThis is a significant development in our efforts to provide relief to Hoosiers who have been hurt by the unprecedented opioid crisis,” Indiana Attorney General Curtis Hill said. €œOpioid misuse and addiction continues to afflict the people of Indiana, and we will continue to do everything in our power to mitigate the effects of this urgent and tragic public health emergency.”It was not immediately clear how much money each state would receive, how the money would be distributed, or how the trust will be administered. The new settlement improved a previous deal in February by moving $150 million from the last payment to the first. Since the February settlement, MNK has declared bankruptcy due to other legal issues and the impact of erectile dysfunction treatment.

As a result, the February agreement had to be renegotiated. €œThe enhancements to this already strong, global agreement will ensure more money flows to states more quickly to stop the death and destruction brought on by the national opioid crisis. €¦ By holding Mallinckrodt accountable for its role in exacerbating the opioid crisis, we move closer to our goal of ending this epidemic and bringing relief to the Florida communities affected,” Florida’s Attorney General Ashley Moody said..

Shutterstock Bicameral buy levitra with free samples legislation introduced Oct. 9 would expand access to Harm Reduction Centers throughout New Jersey.Harm Reduction Centers provide sterile syringes and supplies to drug users. They also buy levitra with free samples provide screening for HIV and other sexually transmitted s. Screening Hepatitis C. Treatment and pre- and post-exposure prophylaxis services.

Naloxone and buy levitra with free samples overdose prevention education. And resources for critical services such as HIV care.In addition, they provide connections to housing, counseling, support groups, and essential health services such as medication for opioid-use disorder, substance use disorder treatment, and prenatal care.New Jersey made its state syringe-access program permanent in 2016, but there are few centers statewide.The bill would remove regulations that often prevent the establishment of Harm Reduction Centers.“The current battle against erectile dysfunction treatment makes Harm Reduction expansion even more urgent, as we are facing the levitra on top of the existing overdose crisis, rising Hepatitis C s, and the ongoing HIV Epidemic,” Axel Torres Marrero, Hyacinth AIDS Foundation Senior Director of Public Policy and Legal Services, said. Sen. Joseph Vitale (D-Middlesex) and Assemblywoman Valerie Vainieri Huttle (D-Bergen) introduced the bill. According to studies, drug users with access to Harm Reduction Centers are five times more likely to stop chaotic- substance use and 50 percent less likely to acquire Hepatitis C or HIV.Shutterstock In his weekly radio address, Arkansas Gov.

Asa Hutchinson recently highlighted ways the state is addressing and slowing drug addiction rates.“We are seeking to raise awareness and prevent new victims from falling prey to addiction, and we want to ensure access to treatment for those who have,” Hutchinson said. €œWe want to reinforce our commitment to holding those who contribute to this epidemic accountable. This is a tough topic to talk about, but we must if we are to slow this epidemic.”The number of overdose deaths in the state dropped 17 percent from 2019, making Arkansas’ rate of reduction second-best in the United States.Hutchinson proclaimed the week of Oct. 23 National Red Ribbon Week, Oct. 24 as Drug Take Back Day and Oct.

28 as Chasing the Dragon. Opioid Awareness Day in Arkansas.Arkansas Drug Director Kirk Lane will oversee Drug Take Back Day. Over the past decade, more than 200 tons of unused and out-of-date medicines were collected for disposal. Chasing the Dragon. Opioid Awareness Day in Arkansas is a project led by the FBI’s Little Rock field office that coordinates the viewing of Chasing the Dragon, a frank DEA-FBI documentary about drug use, in schools.The state received a $21 million federal grant in September to expand substance-abuse-treatment programs.Shutterstock Michigan Attorney General Dana Nessel announced Oct.

7 that she has joined a coalition of attorneys general who is asking the creative community to take action to eliminate tobacco imagery from streamed movies and programs as an effort to protect young viewers. The coalition, formed last year, sent a letter to five Hollywood creative guilds as part of an effort to reduce youth exposure to tobacco, urging them to limit tobacco imagery in their video content. The attorneys general said that gaining the assistance and support would help stop the normalization and glamorization of tobacco use. €œThe statistics across our nation and right here in Michigan very clearly demonstrate that youth vaping is not something we can turn a blind eye to. Across counties in Michigan last year, our state witnessed between a 30 percent and 118 percent increase in e-cigarette use among high school students.

This increase is substantial and alarming and will require all hands on deck to change it,” said Nessel. €œMy colleagues and I encourage the creative guilds to join this very important dialogue to ensure our youth across this nation are protected from the influences of tobacco use.” In letters sent to the Directors Guild of America, Producers Guild of America, Screenwriters Guild of America, Screen Actors Guild-American Federation of Television and Radio Artists, and International Alliance of Theatrical Stage Employees, the attorneys general asked the guilds to use their influence to depict tobacco imagery more responsibly and encourage streaming companies to adopt a practice that steers young viewers away from tobacco imagery content. To only recommend and promote tobacco-free titles to children and families. To mitigate the impact of watching tobacco imagery by running anti-tobacco spots and displaying tobacco-use warnings. And to offer parental controls so that families are empowered to choose tobacco-free content.Shutterstock In a new settlement, the largest generic opioid manufacturer in the United States will pay $1.6 billion into a trust that will go towards abating the opioid crisis, attorneys general from several states said on Friday.

Under the agreement, Mallinckrodt (MNK) will pay $450 million into the trust upon emerging from bankruptcy and then pay $200 million annually for the first and second year out of bankruptcy. For five years after that, the company will pay $150 million annually. Additionally, MNK agreed that its opioid business will be subject to stringent injunctive relief that will prevent marketing and ensure systems are in place to prevent drug misuse. €œThis agreement is a significant step toward helping those victimized by one of the worst man-made epidemics in our state’s history,” said Texas Attorney General Ken Paxton. €œMy office has been aggressively working to hold opioid manufacturers accountable for their deceptive marketing of highly-addictive pain pills, which spurred an epidemic and left victims and families with unimaginable consequences.

My office will continue to do everything it can to protect Texans and help our state heal from this crisis.”The agreement covers lawsuits brought against the company by 50 states attorneys general and other local subdivisions. €œThis is a significant development in our efforts to provide relief to Hoosiers who have been hurt by the unprecedented opioid crisis,” Indiana Attorney General Curtis Hill said. €œOpioid misuse and addiction continues to afflict the people of Indiana, and we will continue to do everything in our power to mitigate the effects of this urgent and tragic public health emergency.”It was not immediately clear how much money each state would receive, how the money would be distributed, or how the trust will be administered. The new settlement improved a previous deal in February by moving $150 million from the last payment to the first. Since the February settlement, MNK has declared bankruptcy due to other legal issues and the impact of erectile dysfunction treatment.

As a result, the February agreement had to be renegotiated. €œThe enhancements to this already strong, global agreement will ensure more money flows to states more quickly to stop the death and destruction brought on by the national opioid crisis. €¦ By holding Mallinckrodt accountable for its role in exacerbating the opioid crisis, we move closer to our goal of ending this epidemic and bringing relief to the Florida communities affected,” Florida’s Attorney General Ashley Moody said..