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Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population.

The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over.

The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids.

The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit.

The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation.

The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors.

However, he explains, this cancer type is often caused by a levitra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

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Educating the media on responsible suicide reporting andy levitre wife. Fostering socio-emotional life skills in adolescents. And early identification, assessment, management andy levitre wife and follow-up of those with suicidal thoughts and behaviour.The guidance highlights that in the social media age, media reports can prompt copycat suicides, especially when surrounding a celebrity.

It calls for suicide coverage to be counteracted with articles highlighting successful recovery from andy levitre wife mental health challenges or suicidal thoughts. It also recommends working with social media companies to increase awareness and remove harmful content.Since half of all mental health conditions appear before children reach 14, adolescence is a critical period, according to WHO, which encourages anti-bullying programmes, support services and clear protocols for people working in schools when suicide risk is identified.Prevent heartbreakA previous suicide attempt is one of the most important risk factors for a future suicide, said the UN health agency.Healthcare workers should be trained in early identification, assessment, management and follow-up and crisis services should also be available to individuals in acute distress, according to the guidance.“A comprehensive national suicide prevention strategy should be the ultimate goal for all Governments”, said Alexandra Fleischmann, WHO suicide prevention expert, adding that “LIVE LIFE interventions can save lives and prevent the heartbreak that follows for those left behind”.The UN humanitarian coordination office OCHA, said the deaths and injuries occurred during five separate attacks on health workers – the latest in a recent spate which saw three health workers killed in March during the national polio vaccination effort in Nangahar.Earlier this month, humanitarian workers with the Halo Trust demining group, came under attack in northern Afghanistan, where extremists from an ISIL affiliate killed ten and wounded more than a dozen, in what the UN Security Council described as an "atrocious and cowardly targeted attack".The United Nations strongly condemns all attacks on health workers anywhere. Delivery of health care andy levitre wife is impartial attack against health workers and those who defends them is an attack on children, whose very lives they are trying to protect.

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Based on its estimates that more than 700,000 people, or one-in-100, died by suicide in 2019, the World Health Organization (WHO) produced new LIVE LIFE guidelines to help countries reduce that rate by a third, no later than 2030.“We cannot – and must not – ignore suicide”, said WHO chief Tedros Adhanom Ghebreyesus.erectile dysfunction treatment pressureFrom job loss to financial stress and social isolation, the many risk factors triggered by the erectile dysfunction treatment levitra make suicide prevention “even more important now”, said the top WHO official.The WHO guidance “provides a clear path for stepping up suicide prevention efforts”, he added.Suicide breakdown Among young people aged 15-29, suicide was buy levitra professional online the fourth leading cause of death after road injury, tuberculosis and interpersonal violence, according to the study. Suicide worldwide in 2019.While rates varied between countries, regions and gender, the analysis shows that more than twice as many men kill themselves, than women.Those rates are generally greater in high-income countries, while the highest suicide rates for women were found in lower middle-income countries.Per 100,000 people, the 2019 global average of suicide buy levitra professional online rates stood at 9.0, while that number jumped to 11.2 in the WHO Africa region. 10.5 in buy levitra professional online Europe. And 10.2 in Southeast Asia.

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Research with mice and https://www.nickiandkaren.com/best-place-to-buy-viagra-online-2020/ preliminary human studies suggest that taking estrogen can have protective effects on can u buy levitra over the counter your hearing. However, an analysis with the largest data pool to date on the topic actually found the opposite. So far studies have produced mix resultswhen looking at the impact of hormoneson hearing loss. If you don’t currently have hearing loss, HT could increase your risk, can u buy levitra over the counter according to a team led by Dr.

Sharon Curhan, MD, a physician and epidemiologist at Brigham and Women’s Hospital in Boston. This was true for both pills and patches, and for formulas with estrogen only or combined with progesterone. To get can u buy levitra over the counter down to the numbers. When Curhan’s team analyzed data for more than 47,000 female nurses spanning 22 years, they concluded that a course of HT for five to ten years increased a woman's risk of hearing loss by 15 percent compared to a woman not taking HT.

Risk increased the longer a woman stayed on HT. The analysis also found that women who undergo menopause at an can u buy levitra over the counter older age have a higher risk of hearing loss. Menopause and hearing loss It's possible that your hearing may change, or you may develop tinnitus (ringing in the ears) as you approach menopause. Why?.

Drops in can u buy levitra over the counter estrogen can trigger symptoms like hot flashes. Estrogen, a hormone, plays a role throughout the body—in your muscles and bones, heart and brain as well as reproductive system. Scientists know we have estrogen receptors in ear cells and in auditory pathways, but it’s still unknown exactly how estrogen affects hearing. Sex hormone levels change during a menstrual cycle, and during menstruation, your hearing can can u buy levitra over the counter become less sensitive.

During perimenopause—the years before your ovaries stop releasing eggs and your period ends—your ovaries gradually produce less estrogen. In the last one to two years of perimenopause, the drop in estrogen speeds up. After your period ends, typically after age 45, the ovaries produce little estrogen but you still get some from your adrenal can u buy levitra over the counter glands and fat tissue. As Curhan’s team reports, both human and animal studies have shown that low estrogen levels can impair hearing, possibly through alterations in blood flow to the cochlea, the hollow tube in the inner ear.

A separate study that measured hearing and blood levels of estradiol (a form of estrogen) in 1,830 post-menopausal women found that the volunteers with less estradiol were more likely to have hearing loss. Another key reproductive hormone, progesterone, begins to can u buy levitra over the counter drop in your thirties. Progesterone, which regulates pregnancy, is the yin to estrogen’s yang. It reduces receptor cells for estrogen.

Progesterone doesn’t affect the cochlea directly but it could by reducing estrogen receptors and therefore can u buy levitra over the counter blood flow to the ear. Does the age when you hit menopause affect your hearing?. The link between low estrogen and impaired hearing suggests that women who arrive at menopause later, at age 50 or older—51 is the average age of menopause in the United States—might have a lower risk of hearing loss. After all, it would make sense that women who reach menopause sooner experienced earlier can u buy levitra over the counter drops in estrogen.

However, when Curhan’s team looked at a pool of data on nearly 81,000 nurses, the opposite was true. The women with late natural menopause surprisingly had a 10 percent higher chance of hearing loss. The reason can u buy levitra over the counter for this finding is unclear, since we don’t have a full picture of all the factors that affect the age of menopause, Dr. Curhan told Healthy Hearing.

Monitor your hearing when starting hormone therapy If you are about to start hormone therapy Dr. Curhan suggests monitoring your hearing and taking HT only as long as can u buy levitra over the counter needed. Some women have reacted to HT with sudden hearing loss, tinnitus and vertigo. Contact your provider right away if this happens to you.

If you’re can u buy levitra over the counter considering HT, you’re likely to be offered a combination with progestin (a medication like progesterone) if you still have your uterus. Estrogen alone could cause unwanted side effects, such as increasing your risk of endometrial cancer, so it's more commonly used for women who have had a hysterectomy. It should also be used with caution in women with high blood pressure (who are also at higher risk of hearing loss). If can u buy levitra over the counter you do opt for HT, Dr.

Curhan suggests monitoring your hearing and taking HT only as long as needed. Some people have reacted to HT with sudden hearing loss, tinnitus and vertigo. Dr can u buy levitra over the counter. Sharon Curhan Perimenopause and tinnitus The relationship between menopause, hormone replacement therapy and tinnitus is a topic that also needs more study.

Some women may experience tinnitus when starting hormone therapy for perimenopause. But studies have also shown that hormone therapy can actually lower can u buy levitra over the counter the rate of tinnitus in women who are perimenopausal. “We are looking forward to understanding more about risk factors for tinnitus,” Dr. Curhan told Healthy Hearing.

She is can u buy levitra over the counter studying its relation to menopause and HT. So what can women do to protect their hearing?. Diet, exercise, and maintaining a healthy weight all count. €œWe found that people who ate diets that most closely resembled the Mediterranean or DASH [Dietary Approaches to Stop Hypertension] patterns had a substantially lower risk of hearing loss,” can u buy levitra over the counter Dr.

Curhan said. That means eating more fish, vegetables, and whole grains—and less meat and junk food. More. How a healthy diet helps your hearing.

Also be mindful of medications linked to hearing loss. Curhan’s research with the same big data pool found that using the over-the-counter pain-relievers ibuprofen and acetaminophen two or more times a week may be linked to hearing loss (aspirin is OK). But there was no tie to alcohol. Lastly, steer clear of loud or constant background noise, get your hearing checked and wear prescribed hearing aids regularly, and you’ll know you’ve done your best to prevent hearing loss as you age.Fantastical notions of all-powerful robots, straight out of Hollywood, may come to mind when you think about artificial intelligence (AI).

But set aside thoughts of the machines taking over. When it comes to your hearing aides, AI helps the devices function better. For instance, AI can help wrangle one of the most challenging situations if you struggle to hear. Engaging in a conversation when you’re in a crowded, loud space (think.

A restaurant or cafe). Because as you know if you wear a hearing aid, louder isn’t the solution. From month to month, year to year, researchers are finding more ways to harness this technology and use it to improve hearing aids. Here’s what you need to know about how hearing aids use AI—and if a hearing aid with this functionality is right for you or a loved one.

Key terms. AI, machine learning, deep neural network Put simply, artificial intelligence is defined as the ability of a machine to simulate human intelligence, performing a set of tasks that require “intelligent” decisions by following predetermined rules. “Artificial intelligence is a very broad definition. Machine learning, neural network, deep learning, and all of those, fall under the AI umbrella,” says Issa M.S.

Panahi, PhD, professor of electrical and computer engineering in the Erik Jonsson School of Engineering and Computer Science at the University of Texas at Dallas. Through machine learning, a subset of AI, machines use algorithms (aka, a set of rules) to sort through giant amounts of data and make decisions or predictions. Go one level deeper, and we get to the deep neural network (DNN). This form of AI is set up to mimic the neural habits of the brain, and aims to respond the same way your brain would, without being explicitly programmed how to react in a given situation.

You’re familiar with this technology if your inbox sorts emails into categories (important, promotional, etc.), if you take advantage of recommendations of "what to watch next" on streaming networks, or if you’ve marveled over self-parking cars. Some more mundane but important examples of deep learning include weather forecasting and credit card fraud protection. These tools have gotten much better in recent years due to deep learning. How hearing aids use AI Audiologist Scott Young “The AI that occurs in hearing aids has actually been going on for years, but it’s a slow burn to think about how that’s actually happened,” says Scott Young, Aud, CCC-A, owner of Hearing Solution Centers, Inc.

In Tulsa, Okla. Hearing aids used to be relatively simple, he notes, but when hearing aids introduced a technology known as wide dynamic range compression (WDRC) the devices actually began to make a few decisions based on what it heard, he says. “Over the last several years, AI has come even further—it actually listens to what the environment does,” Scott says. And, it responds accordingly.

Essentially, a DNN allows hearing aids to begin to mimic how your brain would hear sound if your hearing wasn’t impaired. For hearing aids to work effectively, they need to adapt to a person’s individual hearing needs as well as all sorts of background noise environments, Panahi says. €œAI, machine learning, and neural networks, are very good techniques to deal with such a complicated, nonlinear, multi-variable type of problem,” he says. What the research shows Researchers have been able to accomplish a lot with AI to date, when it comes to improving hearing.

For instance, researchers at the Perception and Neurodynamics Laboratory (PNL) at the Ohio State University trained a DNN to distinguish speech (what people want to hear) from other noise (such as humming and other background conversations), writes DeLiang Wang, professor of computer science and engineering at Ohio State University, in IEEE Spectrum. €œPeople with hearing impairment could decipher only 29 percent of words muddled by babble without the program, but they understood 84 percent after the processing,” Wang writes. Photo. UT-DallasDr.

Issa Panahi is working on smartphone-based AI apps to help people with hearingloss. And at University of Texas at Dallas, Panahi, along with co-principal investigator Dr. Linda Thibodeau, used AI to create a smartphone app that can tell the direction where speech is coming from. This app calls on models built using a massive library of sounds to identify and diminish background noise, so people hear better.

Place a smartphone with the app on a table, or rest it in the GPS stand in your car, and “clean speech is transmitted to the hearing aid devices or earbuds,” Panahi says. “The importance of AI is it overcom[es] a lot of issues that cannot be easily solved by a traditional mathematical approach for signal processing,” Panahi says. The app is not yet available to the public, Dr. Thibodeau says (code, demos, and more information are available on the website).

Neural-network powered hearing aids In recent years, major hearing aid manufacturers have been adding AI technology to their premium hearing aid models. For example Widex's Moment hearing aid utilizes AI and machine learning to create hearing programs based on a wearer's typical environments. And this January, Oticon introduced its newest hearing aid device, Oticon More™, the first hearing aid with an on-board deep neural network. Oticon More was trained—using 12 million-plus real-life sounds—so that people wearing it can better understand speech and the sounds around them.

Oticon More hearing aids, which arerechargeable. In a complicated "sound scene"—picture a bustling airport or hospital emergency room—the Oticon More's neural net receives a complicated layer of sounds, known as input. The DNN gets to work, first scanning and extracting simple sound elements and patterns from the input. It builds these elements together to recognize and make sense of what's happening.

Lastly, the hearing aids then make a decision on how to balance the sound scene, making sure the output is clean and ideally balanced to the person's unique type of hearing loss. "We wanted our system to be able to find speech even when it's embedded in background noise. And that's happening in real-time and in an ongoing basis." This improvement is especially key for speech in noise, explained Donald J. Schum, PhD, Vice President of Audiology at Oticon, during the product launch event.

"Speech and other sounds in the environment are complicated acoustic wave forms, but with unique patterns and structures that are exactly the sort of data deep learning is designed to analyze," he said. "We wanted our system to be able to find speech even when it's embedded in background noise. And that's happening in real-time and in an ongoing basis." Do I need a hearing aid with AI?. Think of hearing aids as existing on a spectrum, says Young—hearing aids range widely in price, and some at the lower end have fewer AI-driven bells and whistles, he says.

He points out that some patients may not need all the features—people who live alone or rarely leave the house, and don’t find themselves in crowded scenarios often, for instance, might not benefit from the functionality found in higher-end models. But for anyone who is out and about a lot, especially in situations where there are big soundscapes, AI-powered features allow for an improved hearing experience.

If you don’t currently have hearing loss, HT could buy levitra professional online increase your risk, according to a team led by Dr. Sharon Curhan, MD, a physician and epidemiologist at Brigham and Women’s Hospital in Boston. This was true for both pills and patches, and for formulas with estrogen only or combined with progesterone.

To get down to the buy levitra professional online numbers. When Curhan’s team analyzed data for more than 47,000 female nurses spanning 22 years, they concluded that a course of HT for five to ten years increased a woman's risk of hearing loss by 15 percent compared to a woman not taking HT. Risk increased the longer a woman stayed on HT.

The analysis also found that women who undergo menopause buy levitra professional online at an older age have a higher risk of hearing loss. Menopause and hearing loss It's possible that your hearing may change, or you may develop tinnitus (ringing in the ears) as you approach menopause. Why?.

Drops in estrogen buy levitra professional online can trigger symptoms like hot flashes. Estrogen, a hormone, plays a role throughout the body—in your muscles and bones, heart and brain as well as reproductive system. Scientists know we have estrogen receptors in ear cells and in auditory pathways, but it’s still unknown exactly how estrogen affects hearing.

Sex hormone levels change during a menstrual buy levitra professional online cycle, and during menstruation, your hearing can become less sensitive. During perimenopause—the years before your ovaries stop releasing eggs and your period ends—your ovaries gradually produce less estrogen. In the last one to two years of perimenopause, the drop in estrogen speeds up.

After your period ends, typically after age buy levitra professional online 45, the ovaries produce little estrogen but you still get some from your adrenal glands and fat tissue. As Curhan’s team reports, both human and animal studies have shown that low estrogen levels can impair hearing, possibly through alterations in blood flow to the cochlea, the hollow tube in the inner ear. A separate study that measured hearing and blood levels of estradiol (a form of estrogen) in 1,830 post-menopausal women found that the volunteers with less estradiol were more likely to have hearing loss.

Another key buy levitra professional online reproductive hormone, progesterone, begins to drop in your thirties. Progesterone, which regulates pregnancy, is the yin to estrogen’s yang. It reduces receptor cells for estrogen.

Progesterone doesn’t affect the cochlea directly but it could by reducing buy levitra professional online estrogen receptors and therefore blood flow to the ear. Does the age when you hit menopause affect your hearing?. The link between low estrogen and impaired hearing suggests that women who arrive at menopause later, at age 50 or older—51 is the average age of menopause in the United States—might have a lower risk of hearing loss.

After all, it would make sense that women who reach menopause sooner experienced earlier buy levitra professional online drops in estrogen. However, when Curhan’s team looked at a pool of data on nearly 81,000 nurses, the opposite was true. The women with late natural menopause surprisingly had a 10 percent higher chance of hearing loss.

The reason buy levitra professional online for this finding is unclear, since we don’t have a full picture of all the factors that affect the age of menopause, Dr. Curhan told Healthy Hearing. Monitor your hearing when starting hormone therapy If you are about to start hormone therapy Dr.

Curhan suggests monitoring your hearing and buy levitra professional online taking HT only as long as needed. Some women have reacted to HT with sudden hearing loss, tinnitus and vertigo. Contact your provider right away if this happens to you.

If you’re considering HT, you’re buy levitra professional online likely to be offered a combination with progestin (a medication like progesterone) if you still have your uterus. Estrogen alone could cause unwanted side effects, such as increasing your risk of endometrial cancer, so it's more commonly used for women who have had a hysterectomy. It should also be used with caution in women with high blood pressure (who are also at higher risk of hearing loss).

If you do opt buy levitra professional online for HT, Dr. Curhan suggests monitoring your hearing and taking HT only as long as needed. Some people have reacted to HT with sudden hearing loss, tinnitus and vertigo.

Dr buy levitra professional online. Sharon Curhan Perimenopause and tinnitus The relationship between menopause, hormone replacement therapy and tinnitus is a topic that also needs more study. Some women may experience tinnitus when starting hormone therapy for perimenopause.

But studies have buy levitra professional online also shown that hormone therapy can actually lower the rate of tinnitus in women who are perimenopausal. “We are looking forward to understanding more about risk factors for tinnitus,” Dr. Curhan told Healthy Hearing.

She is buy levitra professional online studying its relation to menopause and HT. So what can women do to protect their hearing?. Diet, exercise, and maintaining a healthy weight all count.

€œWe found buy levitra professional online that people who ate diets that most closely resembled the Mediterranean or DASH [Dietary Approaches to Stop Hypertension] patterns had a substantially lower risk of hearing loss,” Dr. Curhan said. That means eating more fish, vegetables, and whole grains—and less meat and junk food.

More. How a healthy diet helps your hearing. Also be mindful of medications linked to hearing loss.

Curhan’s research with the same big data pool found that using the over-the-counter pain-relievers ibuprofen and acetaminophen two or more times a week may be linked to hearing loss (aspirin is OK). But there was no tie to alcohol. Lastly, steer clear of loud or constant background noise, get your hearing checked and wear prescribed hearing aids regularly, and you’ll know you’ve done your best to prevent hearing loss as you age.Fantastical notions of all-powerful robots, straight out of Hollywood, may come to mind when you think about artificial intelligence (AI).

But set aside thoughts of the machines taking over. When it comes to your hearing aides, AI helps the devices function better. For instance, AI can help wrangle one of the most challenging situations if you struggle to hear.

Engaging in a conversation when you’re in a crowded, loud space (think. A restaurant or cafe). Because as you know if you wear a hearing aid, louder isn’t the solution.

From month to month, year to year, researchers are finding more ways to harness this technology and use it to improve hearing aids. Here’s what you need to know about how hearing aids use AI—and if a hearing aid with this functionality is right for you or a loved one. Key terms.

AI, machine learning, deep neural network Put simply, artificial intelligence is defined as the ability of a machine to simulate human intelligence, performing a set of tasks that require “intelligent” decisions by following predetermined rules. “Artificial intelligence is a very broad definition. Machine learning, neural network, deep learning, and all of those, fall under the AI umbrella,” says Issa M.S.

Panahi, PhD, professor of electrical and computer engineering in the Erik Jonsson School of Engineering and Computer Science at the University of Texas at Dallas. Through machine learning, a subset of AI, machines use algorithms (aka, a set of rules) to sort through giant amounts of data and make decisions or predictions. Go one level deeper, and we get to the deep neural network (DNN).

This form of AI is set up to mimic the neural habits of the brain, and aims to respond the same way your brain would, without being explicitly programmed how to react in a given situation. You’re familiar with this technology if your inbox sorts emails into categories (important, promotional, etc.), if you take advantage of recommendations of "what to watch next" on streaming networks, or if you’ve marveled over self-parking cars. Some more mundane but important examples of deep learning include weather forecasting and credit card fraud protection.

These tools have gotten much better in recent years due to deep learning. How hearing aids use AI Audiologist Scott Young “The AI that occurs in hearing aids has actually been going on for years, but it’s a slow burn to think about how that’s actually happened,” says Scott Young, Aud, CCC-A, owner of Hearing Solution Centers, Inc. In Tulsa, Okla.

Hearing aids used to be relatively simple, he notes, but when hearing aids introduced a technology known as wide dynamic range compression (WDRC) the devices actually began to make a few decisions based on what it heard, he says. “Over the last several years, AI has come even further—it actually listens to what the environment does,” Scott says. And, it responds accordingly.

Essentially, a DNN allows hearing aids to begin to mimic how your brain would hear sound if your hearing wasn’t impaired. For hearing aids to work effectively, they need to adapt to a person’s individual hearing needs as well as all sorts of background noise environments, Panahi says. €œAI, machine learning, and neural networks, are very good techniques to deal with such a complicated, nonlinear, multi-variable type of problem,” he says.

What the research shows Researchers have been able to accomplish a lot with AI to date, when it comes to improving hearing. For instance, researchers at the Perception and Neurodynamics Laboratory (PNL) at the Ohio State University trained a DNN to distinguish speech (what people want to hear) from other noise (such as humming and other background conversations), writes DeLiang Wang, professor of computer science and engineering at Ohio State University, in IEEE Spectrum. €œPeople with hearing impairment could decipher only 29 percent of words muddled by babble without the program, but they understood 84 percent after the processing,” Wang writes.

Photo. UT-DallasDr. Issa Panahi is working on smartphone-based AI apps to help people with hearingloss.

And at University of Texas at Dallas, Panahi, along with co-principal investigator Dr. Linda Thibodeau, used AI to create a smartphone app that can tell the direction where speech is coming from. This app calls on models built using a massive library of sounds to identify and diminish background noise, so people hear better.

Place a smartphone with the app on a table, or rest it in the GPS stand in your car, and “clean speech is transmitted to the hearing aid devices or earbuds,” Panahi says. “The importance of AI is it overcom[es] a lot of issues that cannot be easily solved by a traditional mathematical approach for signal processing,” Panahi says. The app is not yet available to the public, Dr.

Thibodeau says (code, demos, and more information are available on the website). Neural-network powered hearing aids In recent years, major hearing aid manufacturers have been adding AI technology to their premium hearing aid models. For example Widex's Moment hearing aid utilizes AI and machine learning to create hearing programs based on a wearer's typical environments.

And this January, Oticon introduced its newest hearing aid device, Oticon More™, the first hearing aid with an on-board deep neural network. Oticon More was trained—using 12 million-plus real-life sounds—so that people wearing it can better understand speech and the sounds around them. Oticon More hearing aids, which arerechargeable.

In a complicated "sound scene"—picture a bustling airport or hospital emergency room—the Oticon More's neural net receives a complicated layer of sounds, known as input. The DNN gets to work, first scanning and extracting simple sound elements and patterns from the input. It builds these elements together to recognize and make sense of what's happening.

Lastly, the hearing aids then make a decision on how to balance the sound scene, making sure the output is clean and ideally balanced to the person's unique type of hearing loss. "We wanted our system to be able to find speech even when it's embedded in background noise. And that's happening in real-time and in an ongoing basis." This improvement is especially key for speech in noise, explained Donald J.

Schum, PhD, Vice President of Audiology at Oticon, during the product launch event. "Speech and other sounds in the environment are complicated acoustic wave forms, but with unique patterns and structures that are exactly the sort of data deep learning is designed to analyze," he said. "We wanted our system to be able to find speech even when it's embedded in background noise.

And that's happening in real-time and in an ongoing basis." Do I need a hearing aid with AI?. Think of hearing aids as existing on a spectrum, says Young—hearing aids range widely in price, and some at the lower end have fewer AI-driven bells and whistles, he says. He points out that some patients may not need all the features—people who live alone or rarely leave the house, and don’t find themselves in crowded scenarios often, for instance, might not benefit from the functionality found in higher-end models.

But for anyone who is out and about a lot, especially in situations where there are big soundscapes, AI-powered features allow for an improved hearing experience. Listening effort is reduced What "improvement" looks like can be measured in a lot of ways, but one key indicator is memory recall, Schum explained. It's not that the hearing aids like Oticon More literally improve a person's memory, he explained, it's that artificial intelligence helps people spend less time trying to make sense of the noise around them, a process known as "listening effort." When the listening effort is more natural, a person can focus more on the conversation and all the nuances conveyed within.

"It's allowing the brain to work in the most natural way possible," he said.

How to use levitra for best results

Start Preamble Notice how to use levitra for best results of amendment. The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures. This amendment to the Declaration published on March 17, 2020 (85 FR 15198) is effective as of August how to use levitra for best results 24, 2020. Start Further Info Robert P.

Kadlec, MD, MTM&H, MS, Assistant Secretary for Preparedness and Response, Office of how to use levitra for best results the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201. Telephone. 202-205-2882. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act.

Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law 109-148, Division C, § 2. It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C.

247d-6d and 42 U.S.C. 247d-6e, respectively. Section 319F-3 of the PHS Act has been amended by the levitra and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the erectile dysfunction Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C.

247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the erectile dysfunction treatment outbreak. Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against erectile dysfunction treatment (85 FR 15198, Mar. 17, 2020) (the Declaration).

On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm erectile dysfunction treatment might otherwise cause. The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any treatment that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended treatments).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only erectile dysfunction treatment caused by erectile dysfunction or a levitra mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by erectile dysfunction treatment, erectile dysfunction, or a levitra mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act.

42 U.S.C. 247d-6d(i)(8).[] By this amendment to the Declaration, the Secretary identifies an additional category of persons who are qualified persons under section 247d-6d(i)(8)(B).[] On May 8, 2020, CDC reported, “The identified declines in routine pediatric treatment ordering and doses administered might indicate that U.S. Children and their communities face increased risks for outbreaks of treatment-preventable diseases,” and suggested that a decrease in rates of routine childhood vaccinations were due to changes in healthcare access, social distancing, and other erectile dysfunction treatment mitigation strategies.[] The report also stated that “[p]arental concerns about potentially exposing their children to erectile dysfunction treatment during well child visits might contribute to the declines observed.” [] On July 10, 2020, CDC reported its findings of a May survey it conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the erectile dysfunction treatment levitra. The survey, which was limited to practices participating in the treatments for Children program, found that, as of mid-May, 15 percent of Northeast pediatric practices were closed, 12.5 percent of Midwest practices were closed, 6.2 percent of practices in the South were closed, and 10 percent of practices in the West were closed.

Most practices had reduced office hours for in-person visits. When asked whether their practices would likely be able to accommodate new patients for immunization services through August, 418 practices (21.3 percent) either responded that this was not likely or the practice was permanently closed or not resuming immunization services for all patients, and 380 (19.6 percent) responded that they were unsure. Urban practices and those in the Northeast were less likely to be able to accommodate new patients compared with rural practices and those in the South, Midwest, or West.[] In response to these troubling developments, CDC and the American Academy of Pediatrics have stressed, “Well-child visits and vaccinations are essential services and help make sure children are protected.” [] The Secretary re-emphasizes that important recommendation to parents and legal guardians here. If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations.

Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the erectile dysfunction treatment levitra, including. Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations. Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other -control practices, such as the use of masks.

The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by erectile dysfunction treatment. Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates. We must quickly do so to avoid preventable s in children, additional strains on our healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with additional resurgence of erectile dysfunction treatment. Together with pediatricians and other healthcare professionals, pharmacists are positioned to expand access to childhood vaccinations.

Many States already allow pharmacists to administer treatments to children of any age.[] Other States permit pharmacists to administer treatments to children depending on the age—for example, 2, 3, 5, 6, 7, 9, 10, 11, or 12 years of age and older.[] Few States restrict pharmacist-administered vaccinations to only adults.[] Many States also allow properly trained individuals under the supervision of a trained pharmacist to administer those treatments.[] Pharmacists are well positioned to increase access to vaccinations, particularly in certain areas or for certain populations that have too few pediatricians and other primary-care providers, or that are otherwise medically underserved.[] As of 2018, nearly 90 percent of Americans lived within five miles of a community pharmacy.[] Pharmacies often offer extended hours and added convenience. What is more, pharmacists are trusted healthcare professionals with established relationships with their patients. Pharmacists also have strong relationships with local medical providers and hospitals to refer patients as appropriate. For example, pharmacists already play a significant role in annual influenza vaccination.

In the early 2018-19 season, they administered the influenza treatment to nearly a third of all adults who received the treatment.[] Given the potential danger of serious influenza and continuing erectile dysfunction treatment outbreaks this autumn and the impact that such concurrent outbreaks may have on our population, our healthcare system, and our whole-of-nation response to the erectile dysfunction treatment levitra, we must quickly expand access to influenza vaccinations. Allowing more qualified pharmacists to administer the influenza treatment to children will make vaccinations more accessible. Therefore, the Secretary amends the Declaration to identify State-licensed pharmacists (and pharmacy interns acting under their supervision if the pharmacy intern is licensed or registered by his or her State board of pharmacy) as qualified persons under section 247d-6d(i)(8)(B) when the pharmacist orders and either the pharmacist or the supervised pharmacy intern administers treatments to individuals ages three through 18 pursuant to the following requirements. The treatment must be FDA-authorized or FDA-approved.

The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training Start Printed Page 52139program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation.[] The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.[] The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment.[] The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregivers accompanying the children of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate.[] These requirements are consistent with those in many States that permit licensed pharmacists to order and administer treatments to children and permit licensed or registered pharmacy interns acting under their supervision to administer treatments to children.[] Administering vaccinations to children age three and older is less complicated and requires less training and resources than administering vaccinations to younger children. That is because ACIP generally recommends administering intramuscular injections in the deltoid muscle for individuals age three and older.[] For individuals less than three years of age, ACIP generally recommends administering intramuscular injections in the anterolateral aspect of the thigh muscle.[] Administering injections in the thigh muscle often presents additional complexities and requires additional training and resources including additional personnel to safely position the child while another healthcare professional injects the treatment.[] Moreover, as of 2018, 40% of three-year-olds were enrolled in preprimary programs (i.e.

Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended treatments according to ACIP's standard immunization schedule. All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return. Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended treatments and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended treatments ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified levitra and epidemic products that “limit the harm such levitra or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140erectile dysfunction treatment as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration.

Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program.

All other terms and conditions of the Declaration apply to such covered countermeasures. Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by erectile dysfunction treatment. The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only erectile dysfunction treatment caused by erectile dysfunction or a levitra mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by erectile dysfunction treatment, erectile dysfunction, or a levitra mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against erectile dysfunction treatment. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against erectile dysfunction treatment, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar. 17, 2020) and amended at 85 FR 21012 (Apr.

15, 2020) and 85 FR 35100 (June 8, 2020). 1. Covered Persons, section V, delete in full and replace with. V.

Covered Persons 42 U.S.C. 247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an emergency.

(b) any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act. And (d) a State-licensed pharmacist who orders and administers, and pharmacy interns who administer (if the pharmacy intern acts under the supervision of such pharmacist and the pharmacy intern is licensed or registered by his or her State board of pharmacy), treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule. Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met.

The treatment must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule. The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.

The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.

The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C.

300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2.

Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with. VIII. Category of Disease, Health Condition, or Threat 42 U.S.C. 247d-6d(b)(2)(A) The category of disease, health condition, or threat for which I recommend the administration or use of the Covered Countermeasures is not only erectile dysfunction treatment caused by erectile dysfunction or a levitra mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by erectile dysfunction treatment, erectile dysfunction, or a levitra mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Start Authority 42 U.S.C. 247d-6d. End Authority Start Signature Dated. August 19, 2020.

Alex M. Azar II, Secretary of Health and Human Services. End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20.

4:15 pm]BILLING CODE 4150-03-PToday, the U.S. Department of Health and Human Services released Healthy People 2030, the nation's 10-year plan for addressing our most critical public health priorities and challenges. Since 1980, HHS's Office of Disease Prevention and Health Promotion has set measurable objectives and targets to improve the health and well-being of the nation.This decade, Healthy People 2030 features 355 core – or measurable – objectives with 10-year targets, new objectives related to opioid use disorder and youth e-cigarette use, and resources for adapting Healthy People 2030 to emerging public health threats like erectile dysfunction treatment. For the first time, Healthy People 2030 also sets 10-year targets for objectives related to social determinants of health."Healthy People was the first national effort to lay out a set of data-driven priorities for health improvement," said HHS Secretary Alex Azar.

"Healthy People 2030 adopts a more focused set of objectives and more rigorous data standards to help the federal government and all of our partners deliver results on these important goals over the next decade."Healthy People has led the nation with its focus on social determinants of health, and continues to prioritize economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context as factors that influence health. Healthy People 2030 also continues to prioritize health disparities, health equity, and health literacy."Now more than ever, we need programs like Healthy People that set a shared vision for a healthier nation, where all people can achieve their full potential for health and well-being across the lifespan," said ADM Brett P. Giroir, MD, Assistant Secretary for Health. "erectile dysfunction treatment has brought the importance of public health to the forefront of our national dialogue.

Achieving Healthy People 2030's vision would help the United States become more resilient to public health threats like erectile dysfunction treatment."Healthy People 2030 emphasizes collaboration, with objectives and targets that span multiple sectors. A federal advisory committee of 13 external thought leaders and a workgroup of subject matter experts from more than 20 federal agencies contributed to Healthy People 2030, along with public comments received throughout the development process.The HHS Office of Disease Prevention and Health Promotion leads Healthy People in partnership with the National Center for Health Statistics at the Centers for Disease Control and Prevention, which oversees data in support of the initiative.HHS Secretary Alex M. Azar II, ADM Brett P. Giroir, MD, Assistant Secretary for Health, and U.S.

Surgeon General Jerome M. Adams, MD, MPH, and others from HHS and CDC will launch Healthy People 2030 during a webcast on August 18 at 1 pm (EDT) at https://www.hhs.gov/live. No registration is necessary. For more information about Healthy People 2030, visit https://healthypeople.gov..

Start Preamble Notice of amendment buy levitra professional online. The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures. This amendment to the Declaration published on March 17, 2020 (85 FR 15198) is effective as buy levitra professional online of August 24, 2020. Start Further Info Robert P. Kadlec, MD, MTM&H, MS, Assistant Secretary for Preparedness buy levitra professional online and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201.

Telephone. 202-205-2882. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act. Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law 109-148, Division C, § 2.

It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C. 247d-6d and 42 U.S.C. 247d-6e, respectively. Section 319F-3 of the PHS Act has been amended by the levitra and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the erectile dysfunction Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act.

On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the erectile dysfunction treatment outbreak. Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against erectile dysfunction treatment (85 FR 15198, Mar. 17, 2020) (the Declaration).

On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm erectile dysfunction treatment might otherwise cause. The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any treatment that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended treatments).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only erectile dysfunction treatment caused by erectile dysfunction or a levitra mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by erectile dysfunction treatment, erectile dysfunction, or a levitra mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Description of This Amendment by Section Section V.

Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C. 247d-6d(i)(8).[] By this amendment to the Declaration, the Secretary identifies an additional category of persons who are qualified persons under section 247d-6d(i)(8)(B).[] On May 8, 2020, CDC reported, “The identified declines in routine pediatric treatment ordering and doses administered might indicate that U.S.

Children and their communities face increased risks for outbreaks of treatment-preventable diseases,” and suggested that a decrease in rates of routine childhood vaccinations were due to changes in healthcare access, social distancing, and other erectile dysfunction treatment mitigation strategies.[] The report also stated that “[p]arental concerns about potentially exposing their children to erectile dysfunction treatment during well child visits might contribute to the declines observed.” [] On July 10, 2020, CDC reported its findings of a May survey it conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the erectile dysfunction treatment levitra. The survey, which was limited to practices participating in the treatments for Children program, found that, as of mid-May, 15 percent of Northeast pediatric practices were closed, 12.5 percent of Midwest practices were closed, 6.2 percent of practices in the South were closed, and 10 percent of practices in the West were closed. Most practices had reduced office hours for in-person visits. When asked whether their practices would likely be able to accommodate new patients for immunization services through August, 418 practices (21.3 percent) either responded that this was not likely or the practice was permanently closed or not resuming immunization services for all patients, and 380 (19.6 percent) responded that they were unsure. Urban practices and those in the Northeast were less likely to be able to accommodate new patients compared with rural practices and those in the South, Midwest, or West.[] In response to these troubling developments, CDC and the American Academy of Pediatrics have stressed, “Well-child visits and vaccinations are essential services and help make sure children are protected.” [] The Secretary re-emphasizes that important recommendation to parents and legal guardians here.

If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations. Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the erectile dysfunction treatment levitra, including. Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations. Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other -control practices, such as the use of masks.

The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by erectile dysfunction treatment. Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates. We must quickly do so to avoid preventable s in children, additional strains on our healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with additional resurgence of erectile dysfunction treatment. Together with pediatricians and other healthcare professionals, pharmacists are positioned to expand access to childhood vaccinations. Many States already allow pharmacists to administer treatments to children of any age.[] Other States permit pharmacists to administer treatments to children depending on the age—for example, 2, 3, 5, 6, 7, 9, 10, 11, or 12 years of age and older.[] Few States restrict pharmacist-administered vaccinations to only adults.[] Many States also allow properly trained individuals under the supervision of a trained pharmacist to administer those treatments.[] Pharmacists are well positioned to increase access to vaccinations, particularly in certain areas or for certain populations that have too few pediatricians and other primary-care providers, or that are otherwise medically underserved.[] As of 2018, nearly 90 percent of Americans lived within five miles of a community pharmacy.[] Pharmacies often offer extended hours and added convenience.

What is more, pharmacists are trusted healthcare professionals with established relationships with their patients. Pharmacists also have strong relationships with local medical providers and hospitals to refer patients as appropriate. For example, pharmacists already play a significant role in annual influenza vaccination. In the early 2018-19 season, they administered the influenza treatment to nearly a third of all adults who received the treatment.[] Given the potential danger of serious influenza and continuing erectile dysfunction treatment outbreaks this autumn and the impact that such concurrent outbreaks may have on our population, our healthcare system, and our whole-of-nation response to the erectile dysfunction treatment levitra, we must quickly expand access to influenza vaccinations. Allowing more qualified pharmacists to administer the influenza treatment to children will make vaccinations more accessible.

Therefore, the Secretary amends the Declaration to identify State-licensed pharmacists (and pharmacy interns acting under their supervision if the pharmacy intern is licensed or registered by his or her State board of pharmacy) as qualified persons under section 247d-6d(i)(8)(B) when the pharmacist orders and either the pharmacist or the supervised pharmacy intern administers treatments to individuals ages three through 18 pursuant to the following requirements. The treatment must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training Start Printed Page 52139program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation.[] The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.[] The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment.[] The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregivers accompanying the children of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate.[] These requirements are consistent with those in many States that permit licensed pharmacists to order and administer treatments to children and permit licensed or registered pharmacy interns acting under their supervision to administer treatments to children.[] Administering vaccinations to children age three and older is less complicated and requires less training and resources than administering vaccinations to younger children.

That is because ACIP generally recommends administering intramuscular injections in the deltoid muscle for individuals age three and older.[] For individuals less than three years of age, ACIP generally recommends administering intramuscular injections in the anterolateral aspect of the thigh muscle.[] Administering injections in the thigh muscle often presents additional complexities and requires additional training and resources including additional personnel to safely position the child while another healthcare professional injects the treatment.[] Moreover, as of 2018, 40% of three-year-olds were enrolled in preprimary programs (i.e. Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended treatments according to ACIP's standard immunization schedule. All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return. Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended treatments and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended treatments ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified levitra and epidemic products that “limit the harm such levitra or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140erectile dysfunction treatment as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration.

Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures.

Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by erectile dysfunction treatment. The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only erectile dysfunction treatment caused by erectile dysfunction or a levitra mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by erectile dysfunction treatment, erectile dysfunction, or a levitra mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against erectile dysfunction treatment. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against erectile dysfunction treatment, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below.

All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar. 17, 2020) and amended at 85 FR 21012 (Apr. 15, 2020) and 85 FR 35100 (June 8, 2020). 1. Covered Persons, section V, delete in full and replace with.

V. Covered Persons 42 U.S.C. 247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an emergency.

(b) any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act. And (d) a State-licensed pharmacist who orders and administers, and pharmacy interns who administer (if the pharmacy intern acts under the supervision of such pharmacist and the pharmacy intern is licensed or registered by his or her State board of pharmacy), treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule. Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met. The treatment must be FDA-authorized or FDA-approved.

The vaccination must be ordered and administered according to ACIP's standard immunization schedule. The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments. The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.

The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program.

Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2.

Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with. VIII. Category of Disease, Health Condition, or Threat 42 U.S.C. 247d-6d(b)(2)(A) The category of disease, health condition, or threat for which I recommend the administration or use of the Covered Countermeasures is not only erectile dysfunction treatment caused by erectile dysfunction or a levitra mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by erectile dysfunction treatment, erectile dysfunction, or a levitra mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Start Authority 42 U.S.C.

247d-6d. End Authority Start Signature Dated. August 19, 2020. Alex M. Azar II, Secretary of Health and Human Services.

End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20. 4:15 pm]BILLING CODE 4150-03-PToday, the U.S. Department of Health and Human Services released Healthy People 2030, the nation's 10-year plan for addressing our most critical public health priorities and challenges. Since 1980, HHS's Office of Disease Prevention and Health Promotion has set measurable objectives and targets to improve the health and well-being of the nation.This decade, Healthy People 2030 features 355 core – or measurable – objectives with 10-year targets, new objectives related to opioid use disorder and youth e-cigarette use, and resources for adapting Healthy People 2030 to emerging public health threats like erectile dysfunction treatment.

For the first time, Healthy People 2030 also sets 10-year targets for objectives related to social determinants of health."Healthy People was the first national effort to lay out a set of data-driven priorities for health improvement," said HHS Secretary Alex Azar. "Healthy People 2030 adopts a more focused set of objectives and more rigorous data standards to help the federal government and all of our partners deliver results on these important goals over the next decade."Healthy People has led the nation with its focus on social determinants of health, and continues to prioritize economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context as factors that influence health. Healthy People 2030 also continues to prioritize health disparities, health equity, and health literacy."Now more than ever, we need programs like Healthy People that set a shared vision for a healthier nation, where all people can achieve their full potential for health and well-being across the lifespan," said ADM Brett P. Giroir, MD, Assistant Secretary for Health. "erectile dysfunction treatment has brought the importance of public health to the forefront of our national dialogue.

Achieving Healthy People 2030's vision would help the United States become more resilient to public health threats like erectile dysfunction treatment."Healthy People 2030 emphasizes collaboration, with objectives and targets that span multiple sectors. A federal advisory committee of 13 external thought leaders and a workgroup of subject matter experts from more than 20 federal agencies contributed to Healthy People 2030, along with public comments received throughout the development process.The HHS Office of Disease Prevention and Health Promotion leads Healthy People in partnership with the National Center for Health Statistics at the Centers for Disease Control and Prevention, which oversees data in support of the initiative.HHS Secretary Alex M. Azar II, ADM Brett P. Giroir, MD, Assistant Secretary for Health, and U.S. Surgeon General Jerome M.

Adams, MD, MPH, and others from HHS and CDC will launch Healthy People 2030 during a webcast on August 18 at 1 pm (EDT) at https://www.hhs.gov/live. No registration is necessary. For more information about Healthy People 2030, visit https://healthypeople.gov..