Cialis online usa

Exponential growth is difficult for cialis online usa learn the facts here now people to grasp. But that is what has happened to sales of Albert Camus’s The Plague, first published in 1947. According to Jacqueline Rose, it is ‘an upsurge strangely cialis online usa in line with the graphs that daily chart the toll of the sick and the dead’.

She reports that, from the start of the erectile dysfunction treatment cialis, sales had grown 1000%.1 It may not be worth dwelling on those statistics. More interesting for Rose, and for us, is that a key theme of Camus is that ‘the pestilence is at cialis online usa once blight and revelation. It brings the hidden truth of a corrupt world to the surface’.

In the same way, the cialis of erectile dysfunction treatment exposes and amplifies inequalities in cialis online usa society. The myth of the cialis as the great leveller was given air when early cases included elites. A prince, a prime minister, a Premier League football manager and the actor Tom cialis online usa Hanks.

It was, and is, most likely that as the cialis took hold and society responded we would see familiar inequalities, of two sorts. Inequalities in erectile dysfunction treatment and inequalities in the social conditions that lead to inequalities in health cialis online usa more generally.It was not always thus with epidemics. The plague came to Northern Italy in 1630, killing 35% of the population, including 38% in Bergamo, and an astonishing 59% in Padua.

One effect of killing so many people was a temporary slowdown in what had been a cialis online usa steep rise in economic inequality in Italy. In the aftermath of the plague, work was plentiful—so many workers had died—and real wages increased. Property was available at relatively low cost, given how many potential cialis online usa purchasers had also gone, making it easier for lower strata of the population to acquire property.

It did not last. By 1650, inequality was again on its relentless rise in Venice, Northern Italy and Italy as a whole.2Serious as is erectile dysfunction treatment, the worst-case scenario, with no intervention, was perhaps 400 000 deaths in the UK. Terrible as is premature death coming to cialis online usa 0.6% of the population, it is not 35%.

The effect of erectile dysfunction treatment on inequality is likely to be adverse and severe.Loosely following Camus, we suggest that erectile dysfunction treatment exposes the fault lines in society and amplifies inequalities. In the UK, the myth of cialis online usa the great equaliser has been dispelled by the publication by the Office for National Statistics (ONS) of erectile dysfunction treatment mortality rates according to level of deprivation.3 It shows a clear social gradient. The more deprived the area the higher the mortality.

The gradient suggests that the ‘fault line’ is not quite accurate cialis online usa. It is not ‘them’ at high risk and the rest of ‘us’ at acceptable risk, but a gradient of disadvantage. The argument that we are seeing erectile dysfunction treatment imposed on pre-existing health inequalities is supported by the ONS figures showing that the gradient, by area deprivation, for all-cause mortality is similar to that for erectile dysfunction treatment.The case that we are cialis online usa seeing a general phenomenon of health inequalities is shown further by a graph (figure 1) produced by the Nuffield Trust (https://www.nuffieldtrust.org.uk/resource/chart-of-the-week-erectile dysfunction treatment-kills-the-most-deprived-at-double-the-rate-of-affluent-people-like-other-conditions).

For shorthand, rather than the gradient, it shows mortality in the most deprived 10% and that in the least deprived 10% of areas. Remarkably, the twofold increase is consistent across a range of cialis online usa causes of death, including erectile dysfunction treatment. In the past, observing this general phenomenon, one of us (MM) speculated about general susceptibility to illness following the social gradient, perhaps linked to psychosocial processes.4 There may be elements of that.

But the susceptibility may also be happening at the social level, being relatively disadvantaged cialis online usa puts you at higher risk of a range of specific causes of illness—the causes of the causes.Mortality rate in most deprived areas." data-icon-position data-hide-link-title="0">Figure 1 Mortality rate in most deprived areas.The inequalities that the cialis exposed had been building in the UK for at least a decade. Health Equity in England. The Marmot Review 10 Years cialis online usa On documented three worrying trends, since 2010.

A slowdown in increase in life expectancy, a continuing increase in inequalities in life expectancy between more and less deprived areas and increased regional differences, and a decline in life expectancy in women in the most deprived areas outside London.5 The recent report examined five of the six domains that had formed the basis of the 2010 Marmot Review6. Early child development, education, employment and working conditions, having at least the minimum income necessary for a healthy life, and healthy and sustainable places to live and work.Our conclusion was that it was highly likely that policies of austerity had contributed to the grim and unequal health picture. To take just one cialis online usa example, highly relevant to what is happening during the erectile dysfunction treatment cialis, the crisis of adult social care.

Spending on adult social care was reduced by about 7% from 2010, but in a highly regressive way. In the least deprived 20% of local authorities, the spending cialis online usa reduction was 3%. In the most deprived it was 16%.

The UK came into the cialis with weakened social and health services.We drew attention to ethnic inequalities in health, but lamented that data were insufficient to give the kind of comprehensive attention we had given to socioeconomic inequalities.5 In the cialis, the high mortality of some ethnic groups is of cialis online usa particular concern. There is no need, as some commentators are likely to do, to invoke genetic or cultural explanations. ONS analyses suggest that about half of the excess—in people of African, Pakistani and Bangladeshi background—can be attributed to the index of multiple deprivation.7 It may well be that this index does cialis online usa not capture differences in crowding that come with multigenerational households or occupational exposures.Considering the amplification of inequalities, it is the societal response—lockdown and social distancing—that will both increase inequalities in exposure to the cialis and inequalities in the social determinants of health.

A most basic requirement of living in a society is that people should be able to eat. The Food Foundation’s survey reveals that 5.1 cialis online usa million adults in families with children have experienced food insecurity since the start of lockdown. 2 million children in those households have been food insecure (https://foodfoundation.org.uk/vulnerable_groups/food-foundation-polling-third-survey-five-weeks-into-lockdown/).The advice is to work from home.

The lower people’s income, the less likely are they to be in jobs where working cialis online usa from home is possible. For example, ONS reported that before the lockdown only 10% of workers in accommodation and food could work from home. 53% of cialis online usa workers in communication and information could work from home.

ONS showed high erectile dysfunction treatment mortality in ‘front-line’ occupations such as workers in social care, drivers, chefs and sales and retail assistants.8The paper in this issue of JECH by Fancourt and colleagues looks at experience of adversity in the UK since the start of lockdown. They show that for loss of income and employment, and for difficulties in accessing food and medicines, there is a clear social gradient—the lower the socioeconomic position the greater the adversity.Our recent report called for a national commitment to reduce social and economic inequalities and thereby achieve greater health equity.5 As we emerge from the cialis, such societal commitment will become ever more important..

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In response to the erectile dysfunction treatment cialis, members of the Rapid Deployment treatment Collaborative (or RaDVaC)—a group composed of scientists and their friends or colleagues—have cialis classification been self-administering an untested treatment for erectile dysfunction (the cialis that causes erectile dysfunction treatment). The RaDVaC scientists describe their project as aiming “to reduce risk of harm from erectile dysfunction, minimally until there is at least one effective commercial treatment widely available.” Although the project’s white paper includes includes terms and conditions designed to shield the authors from liability, RaDVaC’s self-experimentation raises important legal and ethical questions. Self-experimentation has cialis classification a fascinating history. In the early 1900s, Walter Reed conducted experiments in Cuba deliberately exposing individuals to yellow fever that included members of the study team as participants. These led to significant public health benefits in confirming that yellow fever was transmitted by mosquitoes, but also resulted in the deaths of several participants.

Some Nobel Prize–winning work by scientists was based on self-experimentation that initially was seen as crazy cialis classification. For instance, in 1984, Barry Marshall swallowed bacteria to prove that they caused gastritis and peptic ulcers. Many cardiac procedures are based on a 1929 experiment by a German doctor who inserted a catheter into his own heart. Perhaps surprisingly, self-experimentation was once considered an cialis classification ethical safeguard. The Nuremberg Code, established in response to grossly unethical experiments during World War II, permitted higher risk research if investigators also volunteered to participate, as they had in the earlier yellow fever studies.

However, the idea that self-experimentation can justify higher research risks was abandoned in later codes of ethics. Not only is self-experimentation legally cialis classification and ethically complex, but protections like independent review and informed consent, which are now required by research regulations, may be a better way to protect research participants. Existing regulations for research were not designed to address self-experimentation. Laws governing research typically define research as an activity designed to produce generalizable knowledge, which does not cover experimentation that is badly designed, unlikely to produce useful data, and merely aiming to protect a small group of people. In addition, the cialis classification U.S.

Common Rule governs federally funded research, and RaDVaC is not using any federal funding. However, Harvard is covered by a “federalwide assurance” under which the institution has agreed that all research it conducts will abide by the regulations (regardless of funding source). If studies of immune cialis classification responses involving self-experimentation are planned in George Church’s laboratory at Harvard, as has been reported, this undoubtedly requires approval by an Institutional Review Board, which would provide some oversight of this self-experimentation. If results are to be published in a peer-reviewed journal, moreover, most, if not all, journals would require assurance of regulatory review and oversight. The U.S.

Food and Drug Administration has similar power to regulate research, and, perhaps more relevant for our purposes, “drugs” (including human biological materials cialis classification and biologics)—even if they are not distributed for profit. The RaDVaC project uses biological materials—more specifically, small chains of amino acids from key erectile dysfunction proteins—and therefore may fall under the FDA’s jurisdiction. While the FDA has not traditionally exercised this authority to regulate the analogous practice of small scale, do-it-yourself biohacking, it retains the power to do so in the future. Finally, if people were harmed by taking this cialis classification treatment, they could also sue RaDVaC, but the disclaimers in the white paper are carefully designed to avoid liability. Even if the law doesn’t adequately address this behavior, it may be ethically problematic—including because it could be a waste of scientific expertise and research effort.

If RaDVaC intends to produce generalizable knowledge about this treatment, unsystematic self-experimentation is unlikely to produce useful information. For example, self-experimentation can lead to biased results if researchers overestimate the chance that the treatment works, cialis classification or fail to report side effects. Randomized controlled trials, by contrast, are typically designed with researchers being blinded to who receives the intervention or the placebo. Beyond self-experimentation, friends, staff members, and family members of the scientists involved are taking this treatment based on these expert’s recommendations, which could lead to two potential misconceptions. First, people taking the treatment might overestimate the likelihood that they are protected from erectile dysfunction and change cialis classification their behavior.

If some individuals falsely believe they are protected, they might engage in riskier behavior that could cause harm to themselves and others. A second misconception is the idea that this is research that could benefit others. The same data analyst seemed to believe this when he added “my continued existence through this cialis will be a useful data set.” Yet the cialis classification RaDVaC project could not produce useful data in the same way as standard, well-designed treatment trials, for example, because it is unclear whether individuals receiving the treatment are thoroughly evaluated or monitored, and there does not appear to be a control group. Even if everyone involved with this project fully understands what they are getting into, however, there are also questions about expertise and privilege. Senior scientists benefit from many cialis classification layers of privilege.

Investment in their education, expertise in specialized areas, and access to information or materials. Arguably, these privileges come with a responsibility to use expertise for the benefit of society. If the RaDVaC treatment is potentially beneficial, then it cialis classification is tragic not to test it in a rigorously designed study. Indeed, uncontrolled self-experimentation is part of a larger problem in the erectile dysfunction treatment cialis. Panic about the cialis has led to the widespread use of interventions outside of well-designed clinical trials.

Without such cialis classification trials, we remain in the dark about which interventions offer net benefits or net harms. Insofar as the scientists involved have expertise in treatment research, they should either reform the RaDVaC project or lend their expertise to serious projects. On the other hand, if scientists don’t have relevant expertise, their overconfidence at their ability to work outside of their wheelhouse may be harmful. Earlier this week, Steven Salzberg, a computational cialis classification biologist, called for experimental erectile dysfunction treatments to be rolled out before the results of phase III testing. An op-ed denouncing his misinformed view was published the next day, and Salzberg reversed his position immediately.

Similarly, some of the named members of the RaDVaC project have expertise in genetics, neuroscience, and anti-aging research. Their time might be better spent on projects in these fields, which will still be important when this cialis cialis classification is finally over. Rather than trying everything but the kitchen sink against erectile dysfunction treatment, it would be wiser to focus our collective efforts on prioritizing the most promising interventions and testing them in rigorous research, as has been done for some treatments for erectile dysfunction treatment. RaDVaC’s scientists should be encouraged to collaborate on systematic erectile dysfunction treatment testing if they have relevant expertise, and to do other valuable things with their time if not.Not far from the famously multihued architecture of Bilbao in northern Spain, an underground world boasts its own vibrant display of color. The stalagmites and stalactites of Goikoetxe Cave are not just the usual cialis classification white.

Many range from honey to deep red. New research shows that these formations, known generally as speleothems, get their red color from organic compounds leached from soil and transported by water. Scientists suggest, in an article published online in April in Quaternary International, that Goikoetxe Cave's speleothems cialis classification record environmental conditions such as rainfall.The wildfire season is off to a roaring start. The hot summer is worsening drought and drying out vegetation—an unfortunately ideal environment for wildfires to rage. But that’s just one consequence of global warming.

It’s also leading to flooding, torrential rainstorms and heat-related cialis classification deaths. In fact, the climate crisis has led to a widespread public health crisis. And as an ear, nose and throat physician, I see the effects more and more often. I vividly remember a patient who came cialis classification in late for her appointment during a July heat wave. When I walked in, she said, “I’m so sorry I’m late, I was up all night walking my grandbaby around the train station.” Without air conditioning at home, the child was sweating through her clothes in the heat of the night, putting her at risk for dehydration.

July 2019 was the hottest July on record. September 2019 was the hottest on record cialis classification. January 2020 was the hottest on record. May 2020 was the hottest on record. This is not a coincidence cialis classification.

It is a pattern. Carbon dioxide, an important greenhouse gas contributing to global warming, has increased by 9 percent since 2005 and by 31 percent since 1950. A U.N cialis classification. Intergovernmental Panel on Climate Change special report pointed out that the world has already warmed about one degree Celsius from pre-industrial levels. It stressed the urgency to act to limit warming cialis classification to 1.5 degrees, and that a two-degree increase will lead to unprecedented extreme heat, water scarcity and food shortages around the globe.

Heat affects every part of our body. It can lead to heat exhaustion, heat stroke, anxiety, impaired cognitive function and even premature death from heart and lung disease. Across the country, cialis classification the health concerns of the climate crisis are increasingly being recognized, pushing thousands of medical providers—doctors, nurses, pharmacists, therapists, medical students—to become advocates for change. In my own practice, I explain to patients how the climate crisis affects their health. For example, apart from contributing to global warming, rising carbon dioxide levels increase the amount of pollen that plants produce as a consequence of higher rates of photosynthesis.

This rise in pollen cialis classification levels can lead to worsening allergy symptoms. Another example is fine particulate matter (known as PM2.5) associated with air pollution, much of it linked to the burning of fossil fuels that help drive the warming. When we breathe in these particles, they travel down the airway and settle in the tiny air sacs called alveoli of the lungs, causing inflammation and potentially worsening asthma symptoms. The explanations are simple, but the cialis classification health risks are widespread and complex. Ground-level ozone pollution, which is worse in hotter weather, can also harm people with asthma and other respiratory diseases.

And that harm falls disproportionately on the poor. Wealthier people living in North America have a per capita carbon footprint that is 25 percent higher than those of lower-income residents, with some cialis classification affluent suburbs producing emissions 15 times higher than nearby neighborhoods. These carbon emissions contribute to global warming, and the subsequent health consequences are felt far beyond the neighborhood that produces them. Older adults, children, low-income communities and communities of color are less resilient on average to the health impacts of climate change. The climate crisis is thus cialis classification leading to a disproportionate public health crisis—and worse, it is a threat multiplier.

At a time when many Americans are economically challenged, continued heat waves and the higher energy bills they trigger threaten access to water and energy security. The economic benefits of a low-carbon economy are clear. Estimates suggest that without climate investments, the United States will face economic damage from climate change equivalent to 1–3 percent of GDP per year by 2100 cialis classification. The majority of Americans think global warming is happening. The climate crisis has unfairly been labeled as political, when in fact, people recognize that something needs to be done about it.

Even for those who are seemingly unaffected, there is increasing cialis classification global recognition that the safeguards of living in a protected community and affording expert medical care will eventually fail if global warming continues unchecked. Unfortunately, there will be no treatment in six months or a year for the climate crisis. The only treatment is collective climate action in the present. Climate action is required of our elected leaders, and we must mandate it of ourselves cialis classification. It can be as simple as educating family and friends, while making sustainable shopping and traveling choices.

It includes eating less meat, unplugging electronics and raising a voice against the fossil fuel industry. With a rise in demand for absentee ballots for the election this November, it is crucial to request mail-in ballots right away to make sure our voices are heard. The United States is the second largest emitter of greenhouse gases, and we must vote for green policy. Legislative action and policy change work, as evidenced by the Clean Air Act and its subsequent amendments, which are projected to save 230,000 lives in 2020. The climate crisis is a public health issue, and we must start healing the planet in order to heal each other.

Fighting against the climate crisis is one of the most patriotic things we can do right now. It will protect our health and the health of our neighbors across the country and the globe, and will allow all of us to live on this planet, the only home we have..

In response to the erectile dysfunction treatment cialis, members of the Rapid Deployment treatment Collaborative (or RaDVaC)—a cialis online usa group composed of scientists and their friends or colleagues—have been self-administering an untested treatment for erectile dysfunction (the cialis that causes erectile dysfunction treatment). The RaDVaC scientists describe their project as aiming “to reduce risk of harm from erectile dysfunction, minimally until there is at least one effective commercial treatment widely available.” Although the project’s white paper includes includes terms and conditions designed to shield the authors from liability, RaDVaC’s self-experimentation raises important legal and ethical questions. Self-experimentation has a cialis online usa fascinating history.

In the early 1900s, Walter Reed conducted experiments in Cuba deliberately exposing individuals to yellow fever that included members of the study team as participants. These led to significant public health benefits in confirming that yellow fever was transmitted by mosquitoes, but also resulted in the deaths of several participants. Some Nobel Prize–winning work by scientists was based on self-experimentation that initially was seen as cialis online usa crazy.

For instance, in 1984, Barry Marshall swallowed bacteria to prove that they caused gastritis and peptic ulcers. Many cardiac procedures are based on a 1929 experiment by a German doctor who inserted a catheter into his own heart. Perhaps surprisingly, self-experimentation was once considered an cialis online usa ethical safeguard.

The Nuremberg Code, established in response to grossly unethical experiments during World War II, permitted higher risk research if investigators also volunteered to participate, as they had in the earlier yellow fever studies. However, the idea that self-experimentation can justify higher research risks was abandoned in later codes of ethics. Not only is cialis online usa self-experimentation legally and ethically complex, but protections like independent review and informed consent, which are now required by research regulations, may be a better way to protect research participants.

Existing regulations for research were not designed to address self-experimentation. Laws governing research typically define research as an activity designed to produce generalizable knowledge, which does not cover experimentation that is badly designed, unlikely to produce useful data, and merely aiming to protect a small group of people. In addition, cialis online usa the U.S.

Common Rule governs federally funded research, and RaDVaC is not using any federal funding. However, Harvard is covered by a “federalwide assurance” under which the institution has agreed that all research it conducts will abide by the regulations (regardless of funding source). If studies of immune responses involving self-experimentation are planned cialis online usa in George Church’s laboratory at Harvard, as has been reported, this undoubtedly requires approval by an Institutional Review Board, which would provide some oversight of this self-experimentation.

If results are to be published in a peer-reviewed journal, moreover, most, if not all, journals would require assurance of regulatory review and oversight. The U.S. Food and Drug cialis online usa Administration has similar power to regulate research, and, perhaps more relevant for our purposes, “drugs” (including human biological materials and biologics)—even if they are not distributed for profit.

The RaDVaC project uses biological materials—more specifically, small chains of amino acids from key erectile dysfunction proteins—and therefore may fall under the FDA’s jurisdiction. While the FDA has not traditionally exercised this authority to regulate the analogous practice of small scale, do-it-yourself biohacking, it retains the power to do so in the future. Finally, if people were harmed by taking this treatment, they could also sue RaDVaC, but the disclaimers in the white paper are carefully designed to avoid liability cialis online usa.

Even if the law doesn’t adequately address this behavior, it may be ethically problematic—including because it could be a waste of scientific expertise and research effort. If RaDVaC intends to produce generalizable knowledge about this treatment, unsystematic self-experimentation is unlikely to produce useful information. For example, self-experimentation can cialis online usa lead to biased results if researchers overestimate the chance that the treatment works, or fail to report side effects.

Randomized controlled trials, by contrast, are typically designed with researchers being blinded to who receives the intervention or the placebo. Beyond self-experimentation, friends, staff members, and family members of the scientists involved are taking this treatment based on these expert’s recommendations, which could lead to two potential misconceptions. First, people taking the treatment might overestimate the likelihood that they cialis online usa are protected from erectile dysfunction and change their behavior.

If some individuals falsely believe they are protected, they might engage in riskier behavior that could cause harm to themselves and others. A second misconception is the idea that this is research that could benefit others. The same data analyst seemed to believe this when he added “my continued existence through this cialis will be a useful data set.” Yet the RaDVaC project could not produce useful data in the same way cialis online usa as standard, well-designed treatment trials, for example, because it is unclear whether individuals receiving the treatment are thoroughly evaluated or monitored, and there does not appear to be a control group.

Even if everyone involved with this project fully understands what they are getting into, however, there are also questions about expertise and privilege. Senior scientists benefit from many layers cialis online usa of privilege. Investment in their education, expertise in specialized areas, and access to information or materials.

Arguably, these privileges come with a responsibility to use expertise for the benefit of society. If the RaDVaC treatment is cialis online usa potentially beneficial, then it is tragic not to test it in a rigorously designed study. Indeed, uncontrolled self-experimentation is part of a larger problem in the erectile dysfunction treatment cialis.

Panic about the cialis has led to the widespread use of interventions outside of well-designed clinical trials. Without such trials, we remain in the dark about which interventions offer net benefits or net cialis online usa harms. Insofar as the scientists involved have expertise in treatment research, they should either reform the RaDVaC project or lend their expertise to serious projects.

On the other hand, if scientists don’t have relevant expertise, their overconfidence at their ability to work outside of their wheelhouse may be harmful. Earlier this cialis online usa week, Steven Salzberg, a computational biologist, called for experimental erectile dysfunction treatments to be rolled out before the results of phase III testing. An op-ed denouncing his misinformed view was published the next day, and Salzberg reversed his position immediately.

Similarly, some of the named members of the RaDVaC project have expertise in genetics, neuroscience, and anti-aging research. Their time might be better spent on projects in these fields, cialis online usa which will still be important when this cialis is finally over. Rather than trying everything but the kitchen sink against erectile dysfunction treatment, it would be wiser to focus our collective efforts on prioritizing the most promising interventions and testing them in rigorous research, as has been done for some treatments for erectile dysfunction treatment.

RaDVaC’s scientists should be encouraged to collaborate on systematic erectile dysfunction treatment testing if they have relevant expertise, and to do other valuable things with their time if not.Not far from the famously multihued architecture of Bilbao in northern Spain, an underground world boasts its own vibrant display of color. The stalagmites cialis online usa and stalactites of Goikoetxe Cave are not just the usual white. Many range from honey to deep red.

New research shows that these formations, known generally as speleothems, get their red color from organic compounds leached from soil and transported by water. Scientists suggest, in an article published online in April in Quaternary International, that Goikoetxe Cave's speleothems record environmental conditions such as rainfall.The wildfire season is off to cialis online usa a roaring start. The hot summer is worsening drought and drying out vegetation—an unfortunately ideal environment for wildfires to rage.

But that’s just one consequence of global warming. It’s also leading to flooding, torrential rainstorms cialis online usa and heat-related deaths. In fact, the climate crisis has led to a widespread public health crisis.

And as an ear, nose and throat physician, I see the effects more and more often. I vividly cialis online usa remember a patient who came in late for her appointment during a July heat wave. When I walked in, she said, “I’m so sorry I’m late, I was up all night walking my grandbaby around the train station.” Without air conditioning at home, the child was sweating through her clothes in the heat of the night, putting her at risk for dehydration.

July 2019 was the hottest July on record. September 2019 was cialis online usa the hottest on record. January 2020 was the hottest on record.

May 2020 was the hottest on record. This is cialis online usa not a coincidence. It is a pattern.

Carbon dioxide, an important greenhouse gas contributing to global warming, has increased by 9 percent since 2005 and by 31 percent since 1950. A U.N cialis online usa. Intergovernmental Panel on Climate Change special report pointed out that the world has already warmed about one degree Celsius from pre-industrial levels.

It stressed the urgency to act to limit warming to 1.5 degrees, and that a two-degree increase will lead to unprecedented extreme heat, water scarcity and food shortages around the globe cialis online usa. Heat affects every part of our body. It can lead to heat exhaustion, heat stroke, anxiety, impaired cognitive function and even premature death from heart and lung disease.

Across the cialis online usa country, the health concerns of the climate crisis are increasingly being recognized, pushing thousands of medical providers—doctors, nurses, pharmacists, therapists, medical students—to become advocates for change. In my own practice, I explain to patients how the climate crisis affects their health. For example, apart from contributing to global warming, rising carbon dioxide levels increase the amount of pollen that plants produce as a consequence of higher rates of photosynthesis.

This rise cialis online usa in pollen levels can lead to worsening allergy symptoms. Another example is fine particulate matter (known as PM2.5) associated with air pollution, much of it linked to the burning of fossil fuels that help drive the warming. When we breathe in these particles, they travel down the airway and settle in the tiny air sacs called alveoli of the lungs, causing inflammation and potentially worsening asthma symptoms.

The explanations are simple, but the health risks are widespread and complex cialis online usa. Ground-level ozone pollution, which is worse in hotter weather, can also harm people with asthma and other respiratory diseases. And that harm falls disproportionately on the poor.

Wealthier people living in North America have a per capita carbon footprint that is 25 percent higher than those of lower-income residents, with some affluent suburbs producing emissions 15 times higher than cialis online usa nearby neighborhoods. These carbon emissions contribute to global warming, and the subsequent health consequences are felt far beyond the neighborhood that produces them. Older adults, children, low-income communities and communities of color are less resilient on average to the health impacts of climate change.

The climate cialis online usa crisis is thus leading to a disproportionate public health crisis—and worse, it is a threat multiplier. At a time when many Americans are economically challenged, continued heat waves and the higher energy bills they trigger threaten access to water and energy security. The economic benefits of a low-carbon economy are clear.

Estimates suggest that without climate investments, the United States will face economic damage from climate change equivalent to 1–3 percent of GDP per year by 2100 cialis online usa. The majority of Americans think global warming is happening. The climate crisis has unfairly been labeled as political, when in fact, people recognize that something needs to be done about it.

Even for those who are seemingly unaffected, there is increasing global recognition that the safeguards of living in a protected community and affording expert medical care will eventually fail if global cialis online usa warming continues unchecked. Unfortunately, there will be no treatment in six months or a year for the climate crisis. The only treatment is collective climate action in the present.

Climate action is required cialis online usa of our elected leaders, and we must mandate it of ourselves. It can be as simple as educating family and friends, while making sustainable shopping and traveling choices. It includes eating less meat, unplugging electronics and raising a voice against the fossil fuel industry.

With a rise in demand for absentee ballots for the election this November, it is crucial to cialis online usa request mail-in ballots right away to make sure our voices are heard. The United States is the second largest emitter of greenhouse gases, and we must vote for green policy. Legislative action and policy change work, as evidenced by the Clean Air Act and its subsequent amendments, which are projected to save 230,000 lives in 2020.

The climate crisis is a public health issue, and we must start healing cialis online usa the planet in order to heal each other. Fighting against the climate crisis is one of the most patriotic things we can do right now. It will protect our health and the health of our neighbors across the country and the globe, and will allow all of us to live on this planet, the only home we have..

What should I watch for while using Cialis?

If you notice any changes in your vision while taking this drug, call your doctor or health care professional as soon as possible. Stop using Cialis and call your health care provider right away if you have a loss of sight in one or both eyes.

Contact you doctor or health care professional right away if the erection lasts longer than 4 hours or if it becomes painful. This may be a sign of serious problem and must be treated right away to prevent permanent damage.

If you experience symptoms of nausea, dizziness, chest pain or arm pain upon initiation of sexual activity after taking Cialis, you should refrain from further activity and call your doctor or health care professional as soon as possible.

Do not drink alcohol to excess (examples, 5 glasses of wine or 5 shots of whiskey) when taking Cialis. When taken in excess, alcohol can increase your chances of getting a headache or getting dizzy, increasing your heart rate or lowering your blood pressure.

Using Cialis does not protect you or your partner against HIV (the cialis that causes AIDS) or other sexually transmitted diseases.

Cialis benefits

NONE

The research team, http://gmaxturf.com/?p=1 led by Seth Kullman, professor of biological sciences at NC State, looked at groups of post-juvenile zebrafish on one cialis benefits of three diets. No vitamin D (or vitamin D null), vitamin D enriched and control. The zebrafish spent four months on their particular diet, then the researchers looked at their growth, bone density, triglyceride, lipid, cholesterol and vitamin D levels. They also examined key metabolic pathways associated with fat production, storage and mobilization and growth cialis benefits promotion. The zebrafish in the vitamin D deficient group were, on average, 50% smaller than those in the other two groups, and they had significantly more fat reserves.

€œThe vitamin D deficient zebrafish exhibited both hypertrophy and hyperplasia – an increase in both the size and number of fat cells,” Kullman says. €œThey also had higher triglycerides and cialis benefits cholesterol, which are hallmarks of metabolic imbalance that can lead to cardio-metabolic disease. This, combined with the stunted growth, indicates that vitamin D plays an important role in the ability to channel energy into growth versus into fat storage.” After the initial testing, the vitamin D deficient zebrafish were given a vitamin D enriched diet for an additional six months, to see if the results could be reversed. While the fish did continue to grow and begin to utilize fat reserves, they never caught up in size with the other cohorts and they retained residual fat deposits. €œThis work shows that vitamin D deficiency can influence cialis benefits metabolic health by disrupting the normal balance between growth and fat accumulation,” Kullman says.

€œSomehow the energy that should be going toward growth is getting shunted into creating fat and lipids, and this occurrence cannot be easily reversed. While we don’t yet understand the mechanism, we are beginning to tease that out.” Future work will involve looking at the offspring of vitamin D deficient mothers, to determine whether this vitamin deficiency has epigenetic effects that can be passed down. The research cialis benefits appears in Scientific Reports and is supported by the Environmental Protection Agency (STAR RD-83342002) and the National Institute of Environmental Health Sciences (grants T32 ES07046, P30ES025128, R35ES030443 and P42ES004699). Kullman is corresponding author. Megan Knuth, former NC State Ph.D.

Student currently at the University of North Carolina Chapel Hill, is cialis benefits first author. Debin Wan and Bruce Hammock, both from the University of California Davis, also contributed to the work. -peake- Note to editors. An abstract follows cialis benefits. €œVitamin D deficiency serves as a precursor to stunted growth and central adiposity in zebrafish” DOI.

10.1038/s41598-020-72622-2 Authors. Megan M cialis benefits. Knuth, Debabrata Mahapatra, Dereje Jima, Mac Law, Seth W. Kullman, North Carolina State University. Debin Wan, cialis benefits Bruce Hammock, University of California DavisPublished.

Online Sept. 29, 2020 in Scientific Reports Abstract:Emerging evidence demonstrates the importance of sufficient vitamin D (1α, 25-dihydroxyvitamin D3) levels during early life stage development with deficiencies associated with long-term effects into adulthood. While vitamin D cialis benefits has traditionally been associated with mineral ion homeostasis, accumulating evidence suggests non-calcemic roles for vitamin D including metabolic homeostasis. In this study, we examined the hypothesis that vitamin D deficiency (VDD) during early life stage development precedes metabolic disruption. Three dietary cohorts of zebrafish were placed on engineered diets including a standard laboratory control diet, a vitamin D null diet, and a vitamin D enriched diet.

Zebrafish grown on a vitamin D cialis benefits null diet between 2-12 months post fertilization (mpf) exhibited diminished somatic growth and enhanced central adiposity associated with accumulation and enlargement of visceral and subcutaneous adipose depots indicative of both adipocyte hypertrophy and hyperplasia. VDD zebrafish exhibited elevated hepatic triglycerides, attenuated plasma free fatty acids and attenuated lipoprotein lipase activity consistent with hallmarks of dyslipidemia. VDD induced dysregulation of gene networks associated with growth hormone and insulin signaling, including induction of suppressor of cytokine signaling. These findings indicate that early developmental VDD impacts metabolic health by disrupting the balance between somatic growth cialis benefits and adipose accumulation.CORVALLIS, Ore. €“ In research with key ramifications for women of childbearing age, findings by Oregon State University scientists show that embryos produced by vitamin E-deficient zebrafish have malformed brains and nervous systems.

€œThis is totally amazing – the brain is absolutely physically distorted by not having enough vitamin E,” said Maret Traber, a professor in the OSU College of Public Health and Human Sciences. The study led by Traber, the Ava Helen Pauling Professor cialis benefits at Oregon State’s Linus Pauling Institute, was published today in Nature Scientific Reports. Zebrafish are a small freshwater species that go from a fertilized egg to a swimming fish in about five days. They are highly prized for studying the development and genetics of vertebrates. Zebrafish share a remarkable similarity to humans at the cialis benefits molecular, genetic and cellular levels, meaning many findings are immediately relevant to humans.

Embryonic zebrafish are of special interest because they develop quickly, are transparent and are easy to care for. Vitamin E was discovered in 1922, identified because it was essential for fertilized rat eggs to culminate in live births. €œWhy does an embryo need vitamin cialis benefits E?. We’ve been chasing that for a long time,” said Traber, a leading authority on vitamin E who’s been researching the micronutrient for three decades. €œWith this newest study we actually started taking pictures so we could visualize.

Where is the brain? cialis benefits. Where is the brain forming?. How does vitamin E fit into this picture?. € One of the first things that appears as an embryo forms is a brain primordium and the neural tube, which will form the nervous system and “innervate” – supply with nerves – all organs and body structures cialis benefits. Without vitamin E, the zebrafish embryos showed neural tube defects and brain defects.

€œThey were kind of like folic acid-deficient neural tube defects, and now we have pictures to show the neural tube defects and brain defects and that vitamin E is right on the closing edges of the cells that are forming the brain,” Traber said. In healthy organisms, neural crest cells drive the creation cialis benefits of facial bones and cartilage and innervate the body, building the peripheral nervous system. €œActing as stem cells, the crest cells are important for the brain and spinal cord and also go on to be the cells of about 10 different organ systems including the heart and liver,” Traber said. €œBy having those cells get into trouble with vitamin E deficiency, basically the entire embryo formation is dysregulated. It is no wonder we see embryo death with vitamin E deficiency.” Traber likens it to the children’s game KerPlunk, in which kids take turns pulling out the straws that support several dozen marbles in cialis benefits a vertical tube.

When the wrong straw is pulled out, everything collapses. Vitamin E is the straw whose extraction brings down the house on embryo development, especially with the brain and nervous system. €œNow we’re at the point where we’re so close being able to say exactly what’s wrong when there isn’t enough vitamin E but at the same time we’re very cialis benefits far away because we haven’t found what are the genes that are changing,” she said. €œWhat we know is the vitamin E-deficient embryos lived to 24 hours and then started dying off. At six hours there was no difference, by 12 hours you see the differences but they weren’t killing the animals, and at 24 hours there were dramatic changes that were about to cause the tipping point of total catastrophe.” Vitamin E, known scientifically as alpha-tocopherol, has many biologic roles and in human diets is most often provided by oils, such as olive oil.

Many of the highest levels are in cialis benefits foods such as hazelnuts, sunflower seeds and avocados. Vitamin E is a group of eight compounds – four tocopherols and four tocotrienols, distinguished by their chemical structure. Alpha-tocopherol is what vitamin E commonly refers to and is found in supplements and in foods associated with a European diet. Gamma-tocopherol is the type of vitamin E most commonly found in a typical American cialis benefits diet. €œPlants make eight different forms of vitamin E, and you absorb them all, but the liver only puts alpha-tocopherol back into the bloodstream,” said Traber.

€œAll of the other forms are metabolized and excreted.

The results suggest a linkage between vitamin D cialis online usa and where can i get cialis metabolic homeostasis, or equilibrium. The research team, led by Seth Kullman, professor of biological sciences at NC State, looked at groups of post-juvenile zebrafish on one of three diets. No vitamin D (or vitamin D null), vitamin D enriched and control. The zebrafish spent four months on their particular diet, then the cialis online usa researchers looked at their growth, bone density, triglyceride, lipid, cholesterol and vitamin D levels.

They also examined key metabolic pathways associated with fat production, storage and mobilization and growth promotion. The zebrafish in the vitamin D deficient group were, on average, 50% smaller than those in the other two groups, and they had significantly more fat reserves. €œThe vitamin D deficient zebrafish exhibited both hypertrophy and hyperplasia – an increase in both the cialis online usa size and number of fat cells,” Kullman says. €œThey also had higher triglycerides and cholesterol, which are hallmarks of metabolic imbalance that can lead to cardio-metabolic disease.

This, combined with the stunted growth, indicates that vitamin D plays an important role in the ability to channel energy into growth versus into fat storage.” After the initial testing, the vitamin D deficient zebrafish were given a vitamin D enriched diet for an additional six months, to see if the results could be reversed. While the fish did continue to grow and begin to cialis online usa utilize fat reserves, they never caught up in size with the other cohorts and they retained residual fat deposits. €œThis work shows that vitamin D deficiency can influence metabolic health by disrupting the normal balance between growth and fat accumulation,” Kullman says. €œSomehow the energy that should be going toward growth is getting shunted into creating fat and lipids, and this occurrence cannot be easily reversed.

While we don’t yet understand the mechanism, we are beginning to tease that out.” Future work will involve looking at the offspring of vitamin D deficient mothers, to determine whether this vitamin deficiency has epigenetic cialis online usa effects that can be passed down. The research appears in Scientific Reports and is supported by the Environmental Protection Agency (STAR RD-83342002) and the National Institute of Environmental Health Sciences (grants T32 ES07046, P30ES025128, R35ES030443 and P42ES004699). Kullman is corresponding author. Megan Knuth, cialis online usa former NC State Ph.D.

Student currently at the University of North Carolina Chapel Hill, is first author. Debin Wan and Bruce Hammock, both from the University of California Davis, also contributed to the work. -peake- Note to editors cialis online usa. An abstract follows.

€œVitamin D deficiency serves as a precursor to stunted growth and central adiposity in zebrafish” DOI. 10.1038/s41598-020-72622-2 Authors cialis online usa. Megan M. Knuth, Debabrata Mahapatra, Dereje Jima, Mac Law, Seth W.

Kullman, North cialis online usa Carolina State University. Debin Wan, Bruce Hammock, University of California DavisPublished. Online Sept. 29, 2020 in Scientific Reports Abstract:Emerging evidence demonstrates the importance of sufficient vitamin D (1α, cialis online usa 25-dihydroxyvitamin D3) levels during early life stage development with deficiencies associated with long-term effects into adulthood.

While vitamin D has traditionally been associated with mineral ion homeostasis, accumulating evidence suggests non-calcemic roles for vitamin D including metabolic homeostasis. In this study, we examined the hypothesis that vitamin D deficiency (VDD) during early life stage development precedes metabolic disruption. Three dietary cohorts of zebrafish were placed on engineered diets including a standard cialis online usa laboratory control diet, a vitamin D null diet, and a vitamin D enriched diet. Zebrafish grown on a vitamin D null diet between 2-12 months post fertilization (mpf) exhibited diminished somatic growth and enhanced central adiposity associated with accumulation and enlargement of visceral and subcutaneous adipose depots indicative of both adipocyte hypertrophy and hyperplasia.

VDD zebrafish exhibited elevated hepatic triglycerides, attenuated plasma free fatty acids and attenuated lipoprotein lipase activity consistent with hallmarks of dyslipidemia. VDD induced dysregulation http://lordbyng74grads.ca/?p=370 of gene networks associated with growth hormone and insulin cialis online usa signaling, including induction of suppressor of cytokine signaling. These findings indicate that early developmental VDD impacts metabolic health by disrupting the balance between somatic growth and adipose accumulation.CORVALLIS, Ore. €“ In research with key ramifications for women of childbearing age, findings by Oregon State University scientists show that embryos produced by vitamin E-deficient zebrafish have malformed brains and nervous systems.

€œThis is totally amazing – the brain is absolutely physically distorted by not having enough vitamin E,” said Maret Traber, a professor in the cialis online usa OSU College of Public Health and Human Sciences. The study led by Traber, the Ava Helen Pauling Professor at Oregon State’s Linus Pauling Institute, was published today in Nature Scientific Reports. Zebrafish are a small freshwater species that go from a fertilized egg to a swimming fish in about five days. They are highly prized for studying the development cialis online usa and genetics of vertebrates.

Zebrafish share a remarkable similarity to humans at the molecular, genetic and cellular levels, meaning many findings are immediately relevant to humans. Embryonic zebrafish are of special interest because they develop quickly, are transparent and are easy to care for. Vitamin E was discovered in 1922, identified because cialis online usa it was essential for fertilized rat eggs to culminate in live births. €œWhy does an embryo need vitamin E?.

We’ve been chasing that for a long time,” said Traber, a leading authority on vitamin E who’s been researching the micronutrient for three decades. €œWith this newest study we actually started taking pictures so we could cialis online usa visualize. Where is the brain?. Where is the brain forming?.

How cialis online usa does vitamin E fit into this picture?. € One of the first things that appears as an embryo forms is a brain primordium and the neural tube, which will form the nervous system and “innervate” – supply with nerves – all organs and body structures. Without vitamin E, the zebrafish embryos showed neural tube defects and brain defects. €œThey were kind of like folic acid-deficient neural tube defects, and now we have pictures to show the neural tube defects and brain defects and that vitamin E is right on the closing edges of the cells that are forming the cialis online usa brain,” Traber said.

In healthy organisms, neural crest cells drive the creation of facial bones and cartilage and innervate the body, building the peripheral nervous system. €œActing as stem cells, the crest cells are important for the brain and spinal cord and also go on to be the cells of about 10 different organ systems including the heart and liver,” Traber said. €œBy having those cells get into trouble with vitamin E deficiency, basically cialis online usa the entire embryo formation is dysregulated. It is no wonder we see embryo death with vitamin E deficiency.” Traber likens it to the children’s game KerPlunk, in which kids take turns pulling out the straws that support several dozen marbles in a vertical tube.

When the wrong straw is pulled out, everything collapses. Vitamin E is the straw whose extraction brings down the house on embryo development, especially with the brain and cialis online usa nervous system. €œNow we’re at the point where we’re so close being able to say exactly what’s wrong when there isn’t enough vitamin E but at the same time we’re very far away because we haven’t found what are the genes that are changing,” she said. €œWhat we know is the vitamin E-deficient embryos lived to 24 hours and then started dying off.

At six hours there cialis online usa was no difference, by 12 hours you see the differences but they weren’t killing the animals, and at 24 hours there were dramatic changes that were about to cause the tipping point of total catastrophe.” Vitamin E, known scientifically as alpha-tocopherol, has many biologic roles and in human diets is most often provided by oils, such as olive oil. Many of the highest levels are in foods such as hazelnuts, sunflower seeds and avocados. Vitamin E is a group of eight compounds – four tocopherols and four tocotrienols, distinguished by their chemical structure. Alpha-tocopherol is what vitamin E cialis online usa commonly refers to and is found in supplements and in foods associated with a European diet.

Gamma-tocopherol is the type of vitamin E most commonly found in a typical American diet. €œPlants make eight different forms of vitamin E, and you absorb them all, but the liver only puts alpha-tocopherol back into the bloodstream,” said Traber.

Can you take viagra and cialis at the same time

NONE

After several can you take viagra and cialis at the same time http://sozomiami.com/home_page/our-products/ weeks, Mr. Krogue got a call that s were spreading to a side of the jail that had been cialis-free.He hung up the phone and put his head in his hands.“I just kind of lost it, like, ‘My God, I don’t know how much longer I can do this,’” Mr. Krogue, a nurse practitioner, recalled.

€œI was just scared that I’m not going to be able to see it through, that I’m going to get sick — you just feel so exhausted and it’s just a lot.”The Mountain West, which for can you take viagra and cialis at the same time months avoided the worst of the cialis, has rapidly devolved into one of the most alarming hot spots in a country that recorded its eight millionth confirmed case on Thursday, a day when more than 65,000 cases were announced nationwide, the most in a single day since July.Seventeen states, including many in the Mountain West, have added more cases in the past week than any other week of the cialis. And the spread through sparsely populated areas of rural America has created problems in small towns that lack critical resources — including doctors — even in ordinary times.Wyoming, which did not have 1,000 total cases until June, recently added more than 1,000 in a single week. Reports of new s have recently reached record levels in Alaska, Colorado and Idaho.

And Montana, where more than half of the state’s cases have been announced since August, is averaging more than 500 cases per day.In Cascade County, more than 300 can you take viagra and cialis at the same time inmates and staff members have been infected in a facility meant to hold 365 people, the county’s first major outbreak in a region where the cialis is suddenly surging.The county seat, Great Falls, is seeing its worst case numbers yet. The local hospital and its 27-bed erectile dysfunction treatment unit is at capacity. The county health department is racing to hire new contact tracers.

And Mr can you take viagra and cialis at the same time. Krogue, who also teaches nursing at Montana State University’s Great Falls campus, has seen attendance in his classes dwindle as students fall ill or quarantine.“I was just scared that I’m not going to be able to see it through, that I’m going to get sick,” said Paul Krogue, the jail’s medical director.Credit...Tailyr Irvine for The New York TimesOne place where the s have spread has been local jails, which are confined, often crowded spaces. Jails are staples of local communities and tend to have people coming and going more quickly than prisons.

Jails can hold everyone from people awaiting criminal trials for months to those can you take viagra and cialis at the same time picked up for a suspended driver’s license for a few hours. With so many people filtering in and out, jails pose extra risks for the cialis’s spread — not only inside facilities but in potentially feeding outbreaks in the rest of the community.Nationally, jails and prisons have seen disproportionate rates of and death, with a mortality rate twice as high as in the general population and an rate more than four times as high, according to recent data. #styln-briefing-block { font-family.

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100%. } } Latest Updates. The erectile dysfunction Outbreak 38m ago Argentina, which had early success in controlling the cialis, reports its millionth case.

2h ago A third surge of erectile dysfunction s has now firmly taken hold across much of the United States. 2h ago All 62 residents of a Kansas nursing home caught the cialis in two weeks. See more updates More live coverage.

Markets A New York Times database has tracked clusters of at least 50 erectile dysfunction cases in a dozen rural jails in Montana, Idaho, Utah and New Mexico during the cialis. Among them. The Purgatory Correctional Center in Hurricane, Utah, with 166 s.

The jail in Twin Falls, Idaho, with 279. And, in New Mexico, the Cibola County Correctional Center, which has reported 357 cases.In Cascade County, s at the jail make up about a quarter of all known cialis cases in the county. Health authorities say that the jail’s outbreak, which began in mid-August, was not believed to be the main cause of the community’s recent surge, but that it had led to some cases.

In the past two months, Mr. Krogue said, the jail released 29 people who were considered actively infected.s at the jail make up about a quarter of Cascade County’s known cialis cases.Credit...Tailyr Irvine for The New York TimesGreat Falls, home to about 58,000 residents, is in the less mountainous part of Montana, with the Missouri River flowing through and a large oil refinery on its banks. The Cascade County Detention Center sits along a highway at the edge of town.

Drive five miles in any direction and you are surrounded by wide-open plains.Montana requires that masks be worn inside businesses and indoor public spaces, and many people in Great Falls wear them when walking around downtown’s Central Avenue, where shops and cafes are still recovering from shutting down in the spring. Others go without masks, citing the open space and lack of crowds.Bob Kelly, the mayor, said people had not been overly worried about how the jail outbreak might affect the rest of town when it started.“I think that by the very definition of a jail, hopefully, the disease will be incarcerated, as well as the patients,” he said. €œIs there concern?.

Sure, there’s concern. But is there overreaction?. No.”The mayor of Great Falls said that residents had considered the jail’s outbreak a distant concern at first.Credit...Tailyr Irvine for The New York TimesSome residents’ nonchalance about the risks of the cialis, said Mr.

Krogue, the jail’s medical director, can be traced to a spring and early summer when almost no one in Cascade County knew anyone who had been sickened.“We benefited from that early on,” he said. €œBut in some ways, I think it did us a disservice, too, because it also created a certain level of complacency.”That has quickly shifted now, he said, as cases have spiked.The number of active cases known to county officials on any given day has risen sharply to about 600, according to Trisha Gardner, Cascade County’s health officer. The county has seen 1,261 cases and six deaths during the cialis, a Times database shows.

Some of the cases have been tied to the jail outbreak, she said, and others have been connected to bars and restaurants. Even figuring out what has led to some cases has been complex, she said, as residents have been reluctant to cooperate with contact tracers.“Our hospitals are at capacity, our public health system is at capacity,” she said. €œIt’s not sustainable at this rate.”When the outbreak at the jail began, social distancing was impossible, the authorities said.

Three inmates shared cells designed for two. At night, men slept on thin blue pads in every available space. On the floor in the day room, in shower stalls, in stairwells, in hallways outside of cells.Inmates did not receive masks until August, and jail officials said many have refused to wear them.In interviews with more than a dozen inmates and their family members, inmates described the jail during the outbreak as chaotic and unsanitary.

They said their pleas for help often went unanswered by nurses and guards.Newly arriving inmates were not always quarantined from one another before their test results were known because of a lack of space, inmates and jail officials said.Owen Hawley, 30, said every inmate in his living area of 38 men had tested positive for the cialis. He said he had been unable to eat for three days, had intensive body aches and suffered from a headache so powerful it felt as if it was “behind my eyes.”“After the fourth day of like, not eating and stuff, I just shut off, you know?. € he said.A jail area set aside for quarantining new inmates.Credit...Tailyr Irvine for The New York TimesAt one point, Mr.

Hawley said, he and other prisoners protested the way the cialis was being handled by refusing to leave their living areas and by blocking new inmates from entering. Everyone was ultimately tested, Mr. Hawley said, and each prisoner was given a disposable mask.Sierra Jasmine Wells, 25, another inmate, said women in her dormitory had grown ill, one after the next.“Everyone around me was getting sick and it was tough on me,” she said.

€œBy then, I had already accepted the fact that I was going to get sick.”When she became infected, she said, she was given cough syrup and Tylenol.“I kind of was just left alone to deal with it,” she said.Jesse Slaughter, the county sheriff who oversees the jail, said that the jail’s medical staff was doing everything it could, and that he had been seeking health care assistance from other counties. Officials defended their handling of the outbreak, noting that all inmates received standard medications including Tylenol twice a day and were taken to area hospitals when they needed added care. Seven inmates, as well as some staff members, were hospitalized.

No one from the jail has died from the cialis, officials said.Sheriff Jesse Slaughter, who oversees the jail, said he had been seeking health care assistance from other counties.Credit...Tailyr Irvine for The New York TimesMr. Krogue said that since the start of the outbreak he had been working up to 16 hours each day and sleeping in his basement, away from his wife and children. He remains healthy but says he fears bringing the cialis home.

The cialis has slowed some in the jail, and officials have moved some inmates to other facilities, but other prisons and jails in the state are now seeing outbreaks.“You can start to see what some of these other places experienced much earlier on, and we just didn’t have that experience, but it’s certainly happening now,” Mr. Krogue said. €œIt’s just real in a way that it wasn’t.”Lucy Tompkins reported from Great Falls, Maura Turcotte from Chicago and Libby Seline from Lincoln, Neb.

Reporting was contributed by Izzy Colón from Columbia, Mo., Brendon Derr from Phoenix, Rebecca Griesbach from Tuscaloosa, Ala., Danya Issawi and Timothy Williams from New York, Ann Hinga Klein from Des Moines, K.B. Mensah from Silver Spring, Md., and Mitch Smith from Chicago.Start Preamble Federal Transit Administration (FTA), DOT. Notice of funding opportunity.

The erectile dysfunction Disease 2019 (erectile dysfunction treatment) public health emergency Start Printed Page 63654has had a significant impact on transit operations. During a series of FTA listening sessions held over the last three months, transit agencies asked FTA to support research to identify solutions to address the operational challenges that they are facing as a result of erectile dysfunction treatment. In response, FTA makes available through this Notice of Funding Opportunity (NOFO) funding to support research demonstration grants to public transit agencies to develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the erectile dysfunction treatment public health emergency.

Demonstration grants under this NOFO are authorized under FTA's Public Transportation Innovation Program (49 U.S.C. 5312). Eligible projects will demonstrate innovative solutions to improve the operational efficiencies of transit systems and enhance mobility for their communities in four major areas.

(1) Vehicle, facility, equipment and infrastructure cleaning and dis. (2) exposure mitigation measures. (3) innovative mobility such as contactless payments.

And (4) measures that strengthen public confidence in transit services. The total funding available for awards under this NOFO is $10,000,000. FTA may supplement this amount if additional funding becomes available.

Applicants must submit completed proposals for funding opportunity FTA-2020-015-TRI through the GRANTS.GOV “APPLY” function by 11:59 p.m. Eastern Time on November 2, 2020. Prospective applicants should register as soon as possible on the GRANTS.GOV website to ensure they can complete the application process before the submission deadline.

Application instructions are available on FTA's website at http://transit.dot.gov/​howtoapply and in the “FIND” module of GRANTS.GOV. FTA will not accept mail and fax submissions. Start Further Info Please send any questions on this notice to Jamel El-Hamri email.

Jamel.El-Hamri@dot.gov phone. 2020-366-8985. A Telecommunication Device for the Deaf (TDD) is available for individuals who are deaf or hard of hearing at 1-800-877-8339.

End Further Info End Preamble Start Supplemental Information Table of Contents A. Program Description B. Federal Award Information C.

Eligibility Information D. Application and Submission Information E. Application Review Information F.

Federal Award Administration Information G. Federal Awarding Agency Contact Information A. Program Description The Public Transportation erectile dysfunction treatment Research Demonstration Grant Program is funded through the Public Transportation Innovation Program (49 U.S.C.

5312), with the goal to develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the erectile dysfunction treatment public health emergency. Eligible projects will propose to develop and deploy innovative solutions in four major areas. (1) Vehicle, facility, equipment and infrastructure cleaning and dis.

(2) exposure mitigation measures. (3) innovative mobility such as contactless payments. And (4) measures that strengthen public confidence in transit.

As required by 49 U.S.C. 5312(e)(4), projects funded under this NOFO must participate in an evaluation by an independent outside entity that will conduct a comprehensive evaluation of the success or failure of the projects funded under this subsection and any plan for broad-based implementation of the innovation promoted by successful projects. B.

Federal Award Information FTA makes available $10,000,000 in fiscal year (FY) 2020 funds under the Public Transportation Innovation Program (49 U.S.C. 5312) to finance the Public Transportation erectile dysfunction treatment Research Demonstration Grant Program. FTA may supplement the total funds available if additional funding becomes available at the time project selections are made.

FTA will grant pre-award authority starting on the date of the project award announcement for selected projects and should be completed within 24 months from the date of award. Funds are available only for eligible expenses incurred after the announcement of project selections. C.

Eligibility Information (1) Eligible Applicants Eligible applicants include State and local governmental authorities, direct recipients of Urbanized Area (49 U.S.C. 5307) and Rural Area (49 U.S.C. 5311) formula funds, and Indian tribes.

Eligible applicants are limited to FTA grantees or subrecipients who would be the primary beneficiaries of the innovative products and services that are developed—typically public transit agencies. Except for projects proposed by Indian tribes, proposals for projects in rural (non-urbanized) areas must be submitted as part of a consolidated State proposal. States and other eligible applicants also may submit consolidated proposals for projects in urbanized areas.

The submission of the Statewide application will not preclude the submission and consideration of any application from other eligible recipients in an urbanized area in a State. Proposals may contain projects to be implemented by the recipient or its subrecipients. Eligible subrecipients include public agencies, private nonprofit organizations, and private providers engaged in public transportation.

Eligible applicants may submit consolidated proposals for projects. (2) Cost Sharing or Matching The maximum Federal share of project costs is 100 percent. FTA may give additional consideration to applicants that propose a local share and may view these applicants as more competitive.

The applicant must document the source(s) of the local match, if any, in the grant application. For any applicants proposing match, eligible local match sources include the following. Cash from non-Government sources other than revenues from providing public transportation services.

Revenues derived from the sale of advertising and concessions. Revenues generated from value capture financing mechanisms. Funds from an undistributed cash surplus.

Replacement or depreciation cash fund or reserve. New capital. Or in-kind contributions.

(3) Eligible Projects Eligible projects will propose innovative solutions to improve operational efficiencies of transit agencies and enhance the mobility of transit users, through projects that demonstrate innovative solutions for. Vehicle, facility, equipment and infrastructure cleaning and dis. Exposure mitigation measures such a real-time notification of rail and bus passenger loads.

New multi-modal payment innovative mobility systems such as contactless payments. And measures that strengthen public confidence in transit. Each applicant may only submit one proposal.Start Printed Page 63655 D.

Application and Submission Information (1) Address and Form of Application Submission Applications must be submitted through GRANTS.GOV. Applicants can find general information for submitting applications through GRANTS.GOV at www.fta.dot.gov/​howtoapply, along with specific instructions for the forms and attachments required for submission. Mail and fax submissions will not be accepted.

(2) Content and Form of Application Submission a. Proposal Submission A complete proposal submission consists of at least two forms. 1.

The SF-424 Mandatory Form (downloadable from GRANTS.GOV) and 2. The supplemental form for the FY 2020 erectile dysfunction treatment Demonstration Program (downloadable from GRANTS.GOV), which is available on FTA's website at (placeholder for FTA erectile dysfunction treatment Demonstration Program). The application must include responses to all sections of the SF-424 mandatory form and the supplemental form unless a section is indicated as optional.

FTA will use the information on the supplemental form to determine applicant and project eligibility for the program and to evaluate the proposal against the selection criteria described in part E of this notice. FTA will accept only one supplemental form per SF-424 submission. FTA encourages applicants to consider submitting a single supplemental form that includes multiple activities to be evaluated as a consolidated proposal.

Applicants may attach additional supporting information to the SF-424 submission, including but not limited to letters of support, project budgets, or excerpts from relevant planning documents. Supporting documentation must be described and referenced by file name in the appropriate response section of the supplemental form, or it may not be reviewed. Information such as applicant name, Federal amount requested, local match amount, description of areas served, etc., may be requested in varying degrees of detail on both the SF-424 form and supplemental form.

Applicants must fill in all fields unless stated otherwise on the forms. If applicants copy information into the supplemental form from another source, they should verify that the supplemental form has fully captured pasted text and that it has not truncated the text due to character limits built into the form. Applicants should use both the “Check Package for Errors” and the “Validate Form” validation buttons on both forms to check all required fields.

Applicants should also ensure that the Federal and local amounts specified are consistent. Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage. Consistent with the R.O.U.T.E.S.

Initiative, the Department encourages applicants to consider how the project will address the challenges faced by rural areas. B. Application Content The SF-424 Mandatory Form and the supplemental form will prompt applicants for the required information, including.

I. Applicant Name ii. Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number iii.

Key contact information (contact name, address, email address, and phone number) iv. Congressional district(s) where project will take place v. Project Information (title, executive summary, and type) vi.

A detailed description of the need for the project vii. A detailed description of how the project will support the Program objectives viii. Evidence that the applicant can provide the local cost shares ix.

A description of the technical, legal, and financial capacity of the applicant x. A detailed project budget xi. Details on the local matching funds xii.

A detailed project timeline xiii. Whether the project impacts an Opportunity Zone (3) Unique Entity Identifier and System for Award Management (SAM) Each applicant is required to. (1) Be registered in SAM before submitting an application.

(2) provide a valid unique entity identifier in its application. And (3) continue to maintain an active SAM registration with current information at all times during which the applicant has an active Federal award or an application or plan under consideration by FTA. These requirements do not apply if the applicant.

(1) Is excepted from the requirements under 2 CFR 25.110(b) or (c). Or (2) has an exception approved by FTA under 2 CFR 25.110(d). FTA may not make an award until the applicant has complied with all applicable unique entity identifier and SAM requirements.

If an applicant has not fully complied with the requirements by the time FTA is ready to make an award, FTA may determine that the applicant is not qualified to receive an award and use that determination as a basis for making a Federal award to another applicant. All applicants must provide a unique entity identifier provided by SAM. Registration in SAM may take as little as 3-5 business days, but there can be unexpected steps or delays.

For example, the applicant may need to obtain an Employer Identification Number. FTA recommends allowing ample time, up to several weeks, to complete all steps. For additional information on obtaining a unique entity identifier, please visit www.sam.gov.

(4) Submission Dates and Times Project proposals must be submitted electronically through GRANTS.GOV by 11:59 p.m. Eastern on November 2, 2020. Mail and fax submissions will not be accepted.

FTA urges applicants to submit applications at least 72 hours prior to the due date to allow time to correct any problems that may have caused either GRANTS.GOV or FTA systems to reject the submission. Proposals submitted after the deadline will only be considered under extraordinary circumstances not within the applicant's control. Deadlines will not be extended due to scheduled website maintenance.

GRANTS.GOV scheduled maintenance and outage times are announced on the GRANTS.GOV website. Within 48 hours after submitting an electronic application, the applicant should receive two email messages from GRANTS.GOV. (1) Confirmation of successful transmission to GRANTS.GOV.

And (2) confirmation of successful validation by GRANTS.GOV. If the applicant does not receive confirmation of successful validation or receives a notice of failed validation or incomplete materials, the applicant must address the reason for the failed validation, as described in the email notice, and resubmit before the submission deadline. If making a resubmission for any reason, applicants must include all original attachments regardless of which attachments were updated and check the box on the supplemental form indicating this is a resubmission.

Applicants are encouraged to begin the process of registration on the GRANTS.GOV site well in advance of the submission deadline. Registration is Start Printed Page 63656a multi-step process, which may take several weeks to complete before an application can be submitted. Registered applicants may still be required to update their registration before submitting an application.

Registration in SAM is renewed annually and persons making submissions on behalf of the Authorized Organization Representative (AOR) must be authorized in GRANTS.GOV by the AOR to make submissions. (5) Funding Restrictions Funds may be used for post-award expenditures only. Funds under this NOFO cannot be used to reimburse projects for otherwise eligible expenses incurred prior to the date of project award announcements.

(6) Other Submission Requirements FTA encourages applicants to identify scaled funding options in case insufficient funding is available to fund a project at the full requested amount. If an applicant indicates that a project is scalable, the applicant must provide an appropriate minimum funding amount that will fund an eligible project that achieves the objectives of the program and meets all relevant program requirements. The applicant must provide a clear explanation of how a reduced award would affect the project budget and scope.

FTA may award a lesser amount whether or not the applicant provides a scalable option. E. Application Review Information (1) Project Evaluation Criteria Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage.

Consistent with the R.O.U.T.E.S. Initiative, the Department will consider how the project will address the challenges faced by rural areas. In addition, the Department will review and consider applications for funding pursuant to this Notice in accordance with the President's September 2, 2020 memorandum, entitled Memorandum on Reviewing Funding to State and Local Government Recipients of Federal Funds that Are Permitting Anarchy, Violence, and Destruction in American Cities, consistent with guidance from the Office of Management and Budget and the Attorney General and with all applicable laws.

FTA will evaluate proposals submitted according to the following criteria. (a) Project Innovation and Impact. (b) Project Approach.

(c) National Applicability. (d) Commercialization and/or Knowledge Transfer. And (e) Technical, Legal and Financial Capacity.

FTA encourages each applicant to demonstrate how a project supports all criteria with the most relevant information the applicant can provide, regardless of whether such information has been specifically requested or identified in this notice. A. Project Innovation and Impact i.

Effectiveness of the project in achieving and demonstrating the specific objectives of this program. Ii. Demonstration of benefits in addressing the needs of the transit agency and industry and impacts to infrastructure, equipment, transit workforce, and riders.

Iii. Degree of improvement over current and existing technologies, designs, and/or practices applicable to the transit industry. B.

Project Approach i. Quality of the project approach such as existing partnerships, collaboration strategies and level of commitment of the project partners. Ii.

Proposal is realistic in its approach to fulfill the milestones/deliverables, schedule and goals. C. National Applicability i.

Degree to which the project could be replicated by other transit agencies regionally or nationally. Ii. Ability to evaluate technologies, designs and/or practices in a wide variety of conditions and locales.

Iii. Degree to which the technology, designs and/or practices can be replicated by other transportation modes. D.

Commercialization and/or Knowledge Transfer i. Demonstrates a realistic plan for moving the results of the project into the transit marketplace (patents, conferences, articles in trade magazines, webinar, site visits, etc.). Ii.

How the project team plans to work with the industry on improving best practices, guidance and/or standards, if applicable. Iii. Demonstrate a clear understanding and robust approach to data collection, access and management.

E. Technical, Legal and Financial Capacity Capacity of the applicant and any partners to successfully execute the project effort. There should be no outstanding legal, technical, or financial issues with the applicant that would make this a high-risk project.

(2) Review and Selection Process An FTA technical evaluation committee will evaluate proposals based on the published project evaluation criteria. Members of the technical evaluation committee will rate the applications and may seek clarification about any statement in an application. The FTA Administrator will determine the final selection and amount of funding for each project after consideration of the findings of the technical evaluation committee.

Geographic diversity, diversity of the project type, the amount of local match to be provided, and the applicant's receipt and management of other Federal transit funds may be considered in FTA's award decisions. Prior fare payment innovation efforts may receive priority consideration. The FTA Administrator will consider the following key DOT objectives.

A. Utilizing alternative funding sources and innovative financing models to attract non-Federal sources of investment. B.

Whether the project is located in or supports public transportation service in a qualified opportunity zone designated pursuant to 26.U.S.C. 1400Z-1. And c.

The extent to which the project addresses challenges specific to the provision of rural public transportation. (3) FAPIIS Review Prior to making a grant award, FTA is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) accessible through SAM. An applicant may review and comment on information about itself that a Federal awarding agency previously entered.

FTA will consider any comments by the applicant, in addition to the other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 2 CFR 200.205 Federal Awarding Agency Review of Risk Posed by Applicants. F. Federal Award Administration Information (1) Federal Award Notices FTA will announce the final project selections on the FTA website.

Project recipients should contact their FTA Regional Office for additional information regarding allocations for Start Printed Page 63657projects. At the time project selections are announced, FTA will extend pre-award authority for the selected projects. There is no blanket pre-award authority for these projects before announcement.

There is no minimum or maximum grant award amount, but FTA intends to fund as many meritorious projects as possible. FTA only will consider proposals from eligible recipients for eligible activities. Due to funding limitations, projects selected for funding may receive less than the amount originally requested.

In those cases, applicants must be able to demonstrate that the proposed projects are still viable and can be completed with the amount awarded. (2) Administrative and National Policy Requirements a. Pre-Award Authority FTA will issue specific guidance to recipients regarding pre-award authority at the time of selection.

FTA does not provide pre-award authority for competitive funds until projects are selected, and there are Federal requirements that must be met before costs are incurred. For more information about FTA's policy on pre-award authority, see the FY 2020 Apportionments Notice published on June 3, 2020, at https://www.govinfo.gov/​content/​pkg/​FR-2020-06-03/​pdf/​2020-11946.pdf. b.

Grant Requirements Selected applicants will submit a grant application through FTA's electronic grant management system and adhere to the customary FTA grant requirements for research project (insert Circular name). All competitive grants, regardless of award amount, will be subject to the Congressional notification and release process.

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100%. } } Latest Updates. The erectile dysfunction Outbreak 38m ago Argentina, which had early success in controlling the cialis, reports its millionth case. 2h ago A third surge of erectile dysfunction s has now firmly taken hold across much of the United States.

2h ago All 62 residents of a Kansas nursing home caught the cialis in two weeks. See more updates More live coverage. Markets A New York Times database has tracked clusters of at least 50 erectile dysfunction cases in a dozen rural jails in Montana, Idaho, Utah and New Mexico during the cialis. Among them.

The Purgatory Correctional Center in Hurricane, Utah, with 166 s. The jail in Twin Falls, Idaho, with 279. And, in New Mexico, the Cibola County Correctional Center, which has reported 357 cases.In Cascade County, s at the jail make up about a quarter of all known cialis cases in the county. Health authorities say that the jail’s outbreak, which began in mid-August, was not believed to be the main cause of the community’s recent surge, but that it had led to some cases.

In the past two months, Mr. Krogue said, the jail released 29 people who were considered actively infected.s at the jail make up about a quarter of Cascade County’s known cialis cases.Credit...Tailyr Irvine for The New York TimesGreat Falls, home to about 58,000 residents, is in the less mountainous part of Montana, with the Missouri River flowing through and a large oil refinery on its banks. The Cascade County Detention Center sits along a highway at the edge of town. Drive five miles in any direction and you are surrounded by wide-open plains.Montana requires that masks be worn inside businesses and indoor public spaces, and many people in Great Falls wear them when walking around downtown’s Central Avenue, where shops and cafes are still recovering from shutting down in the spring.

Others go without masks, citing the open space and lack of crowds.Bob Kelly, the mayor, said people had not been overly worried about how the jail outbreak might affect the rest of town when it started.“I think that by the very definition of a jail, hopefully, the disease will be incarcerated, as well as the patients,” he said. €œIs there concern?. Sure, there’s concern. But is there overreaction?.

No.”The mayor of Great Falls said that residents had considered the jail’s outbreak a distant concern at first.Credit...Tailyr Irvine for The New York TimesSome residents’ nonchalance about the risks of the cialis, said Mr. Krogue, the jail’s medical director, can be traced to a spring and early summer when almost no one in Cascade County knew anyone who had been sickened.“We benefited from that early on,” he said. €œBut in some ways, I think it did us a disservice, too, because it also created a certain level of complacency.”That has quickly shifted now, he said, as cases have spiked.The number of active cases known to county officials on any given day has risen sharply to about 600, according to Trisha Gardner, Cascade County’s health officer. The county has seen 1,261 cases and six deaths during the cialis, a Times database shows.

Some of the cases have been tied to the jail outbreak, she said, and others have been connected to bars and restaurants. Even figuring out what has led to some cases has been complex, she said, as residents have been reluctant to cooperate with contact tracers.“Our hospitals are at capacity, our public health system is at capacity,” she said. €œIt’s not sustainable at this rate.”When the outbreak at the jail began, social distancing was impossible, the authorities said. Three inmates shared cells designed for two.

At night, men slept on thin blue pads in every available space. On the floor in the day room, in shower stalls, in stairwells, in hallways outside of cells.Inmates did not receive masks until August, and jail officials said many have refused to wear them.In interviews with more than a dozen inmates and their family members, inmates described the jail during the outbreak as chaotic and unsanitary. They said their pleas for help often went unanswered by nurses and guards.Newly arriving inmates were not always quarantined from one another before their test results were known because of a lack of space, inmates and jail officials said.Owen Hawley, 30, said every inmate in his living area of 38 men had tested positive for the cialis. He said he had been unable to eat for three days, had intensive body aches and suffered from a headache so powerful it felt as if it was “behind my eyes.”“After the fourth day of like, not eating and stuff, I just shut off, you know?.

€ he said.A jail area set aside for quarantining new inmates.Credit...Tailyr Irvine for The New York TimesAt one point, Mr. Hawley said, he and other prisoners protested the way the cialis was being handled by refusing to leave their living areas and by blocking new inmates from entering. Everyone was ultimately tested, Mr. Hawley said, and each prisoner was given a disposable mask.Sierra Jasmine Wells, 25, another inmate, said women in her dormitory had grown ill, one after the next.“Everyone around me was getting sick and it was tough on me,” she said.

€œBy then, I had already accepted the fact that I was going to get sick.”When she became infected, she said, she was given cough syrup and Tylenol.“I kind of was just left alone to deal with it,” she said.Jesse Slaughter, the county sheriff who oversees the jail, said that the jail’s medical staff was doing everything it could, and that he had been seeking health care assistance from other counties. Officials defended their handling of the outbreak, noting that all inmates received standard medications including Tylenol twice a day and were taken to area hospitals when they needed added care. Seven inmates, as well as some staff members, were hospitalized. No one from the jail has died from the cialis, officials said.Sheriff Jesse Slaughter, who oversees the jail, said he had been seeking health care assistance from other counties.Credit...Tailyr Irvine for The New York TimesMr.

Krogue said that since the start of the outbreak he had been working up to 16 hours each day and sleeping in his basement, away from his wife and children. He remains healthy but says he fears bringing the cialis home. The cialis has slowed some in the jail, and officials have moved some inmates to other facilities, but other prisons and jails in the state are now seeing outbreaks.“You can start to see what some of these other places experienced much earlier on, and we just didn’t have that experience, but it’s certainly happening now,” Mr. Krogue said.

€œIt’s just real in a way that it wasn’t.”Lucy Tompkins reported from Great Falls, Maura Turcotte from Chicago and Libby Seline from Lincoln, Neb. Reporting was contributed by Izzy Colón from Columbia, Mo., Brendon Derr from Phoenix, Rebecca Griesbach from Tuscaloosa, Ala., Danya Issawi and Timothy Williams from New York, Ann Hinga Klein from Des Moines, K.B. Mensah from Silver Spring, Md., and Mitch Smith from Chicago.Start Preamble Federal Transit Administration (FTA), DOT. Notice of funding opportunity.

The erectile dysfunction Disease 2019 (erectile dysfunction treatment) public health emergency Start Printed Page 63654has had a significant impact on transit operations. During a series of FTA listening sessions held over the last three months, transit agencies asked FTA to support research to identify solutions to address the operational challenges that they are facing as a result of erectile dysfunction treatment. In response, FTA makes available through this Notice of Funding Opportunity (NOFO) funding to support research demonstration grants to public transit agencies to develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the erectile dysfunction treatment public health emergency. Demonstration grants under this NOFO are authorized under FTA's Public Transportation Innovation Program (49 U.S.C.

5312). Eligible projects will demonstrate innovative solutions to improve the operational efficiencies of transit systems and enhance mobility for their communities in four major areas. (1) Vehicle, facility, equipment and infrastructure cleaning and dis. (2) exposure mitigation measures.

(3) innovative mobility such as contactless payments. And (4) measures that strengthen public confidence in transit services. The total funding available for awards under this NOFO is $10,000,000. FTA may supplement this amount if additional funding becomes available.

Applicants must submit completed proposals for funding opportunity FTA-2020-015-TRI through the GRANTS.GOV “APPLY” function by 11:59 p.m. Eastern Time on November 2, 2020. Prospective applicants should register as soon as possible on the GRANTS.GOV website to ensure they can complete the application process before the submission deadline. Application instructions are available on FTA's website at http://transit.dot.gov/​howtoapply and in the “FIND” module of GRANTS.GOV.

FTA will not accept mail and fax submissions. Start Further Info Please send any questions on this notice to Jamel El-Hamri email. Jamel.El-Hamri@dot.gov phone. 2020-366-8985.

A Telecommunication Device for the Deaf (TDD) is available for individuals who are deaf or hard of hearing at 1-800-877-8339. End Further Info End Preamble Start Supplemental Information Table of Contents A. Program Description B. Federal Award Information C.

Eligibility Information D. Application and Submission Information E. Application Review Information F. Federal Award Administration Information G.

Federal Awarding Agency Contact Information A. Program Description The Public Transportation erectile dysfunction treatment Research Demonstration Grant Program is funded through the Public Transportation Innovation Program (49 U.S.C. 5312), with the goal to develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the erectile dysfunction treatment public health emergency. Eligible projects will propose to develop and deploy innovative solutions in four major areas.

(1) Vehicle, facility, equipment and infrastructure cleaning and dis. (2) exposure mitigation measures. (3) innovative mobility such as contactless payments. And (4) measures that strengthen public confidence in transit.

As required by 49 U.S.C. 5312(e)(4), projects funded under this NOFO must participate in an evaluation by an independent outside entity that will conduct a comprehensive evaluation of the success or failure of the projects funded under this subsection and any plan for broad-based implementation of the innovation promoted by successful projects. B. Federal Award Information FTA makes available $10,000,000 in fiscal year (FY) 2020 funds under the Public Transportation Innovation Program (49 U.S.C.

5312) to finance the Public Transportation erectile dysfunction treatment Research Demonstration Grant Program. FTA may supplement the total funds available if additional funding becomes available at the time project selections are made. FTA will grant pre-award authority starting on the date of the project award announcement for selected projects and should be completed within 24 months from the date of award. Funds are available only for eligible expenses incurred after the announcement of project selections.

C. Eligibility Information (1) Eligible Applicants Eligible applicants include State and local governmental authorities, direct recipients of Urbanized Area (49 U.S.C. 5307) and Rural Area (49 U.S.C. 5311) formula funds, and Indian tribes.

Eligible applicants are limited to FTA grantees or subrecipients who would be the primary beneficiaries of the innovative products and services that are developed—typically public transit agencies. Except for projects proposed by Indian tribes, proposals for projects in rural (non-urbanized) areas must be submitted as part of a consolidated State proposal. States and other eligible applicants also may submit consolidated proposals for projects in urbanized areas. The submission of the Statewide application will not preclude the submission and consideration of any application from other eligible recipients in an urbanized area in a State.

Proposals may contain projects to be implemented by the recipient or its subrecipients. Eligible subrecipients include public agencies, private nonprofit organizations, and private providers engaged in public transportation. Eligible applicants may submit consolidated proposals for projects. (2) Cost Sharing or Matching The maximum Federal share of project costs is 100 percent.

FTA may give additional consideration to applicants that propose a local share and may view these applicants as more competitive. The applicant must document the source(s) of the local match, if any, in the grant application. For any applicants proposing match, eligible local match sources include the following. Cash from non-Government sources other than revenues from providing public transportation services.

Revenues derived from the sale of advertising and concessions. Revenues generated from value capture financing mechanisms. Funds from an undistributed cash surplus. Replacement or depreciation cash fund or reserve.

New capital. Or in-kind contributions. (3) Eligible Projects Eligible projects will propose innovative solutions to improve operational efficiencies of transit agencies and enhance the mobility of transit users, through projects that demonstrate innovative solutions for. Vehicle, facility, equipment and infrastructure cleaning and dis.

Exposure mitigation measures such a real-time notification of rail and bus passenger loads. New multi-modal payment innovative mobility systems such as contactless payments. And measures that strengthen public confidence in transit. Each applicant may only submit one proposal.Start Printed Page 63655 D.

Application and Submission Information (1) Address and Form of Application Submission Applications must be submitted through GRANTS.GOV. Applicants can find general information for submitting applications through GRANTS.GOV at www.fta.dot.gov/​howtoapply, along with specific instructions for the forms and attachments required for submission. Mail and fax submissions will not be accepted. (2) Content and Form of Application Submission a.

Proposal Submission A complete proposal submission consists of at least two forms. 1. The SF-424 Mandatory Form (downloadable from GRANTS.GOV) and 2. The supplemental form for the FY 2020 erectile dysfunction treatment Demonstration Program (downloadable from GRANTS.GOV), which is available on FTA's website at (placeholder for FTA erectile dysfunction treatment Demonstration Program).

The application must include responses to all sections of the SF-424 mandatory form and the supplemental form unless a section is indicated as optional. FTA will use the information on the supplemental form to determine applicant and project eligibility for the program and to evaluate the proposal against the selection criteria described in part E of this notice. FTA will accept only one supplemental form per SF-424 submission. FTA encourages applicants to consider submitting a single supplemental form that includes multiple activities to be evaluated as a consolidated proposal.

Applicants may attach additional supporting information to the SF-424 submission, including but not limited to letters of support, project budgets, or excerpts from relevant planning documents. Supporting documentation must be described and referenced by file name in the appropriate response section of the supplemental form, or it may not be reviewed. Information such as applicant name, Federal amount requested, local match amount, description of areas served, etc., may be requested in varying degrees of detail on both the SF-424 form and supplemental form. Applicants must fill in all fields unless stated otherwise on the forms.

If applicants copy information into the supplemental form from another source, they should verify that the supplemental form has fully captured pasted text and that it has not truncated the text due to character limits built into the form. Applicants should use both the “Check Package for Errors” and the “Validate Form” validation buttons on both forms to check all required fields. Applicants should also ensure that the Federal and local amounts specified are consistent. Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage.

Consistent with the R.O.U.T.E.S. Initiative, the Department encourages applicants to consider how the project will address the challenges faced by rural areas. B. Application Content The SF-424 Mandatory Form and the supplemental form will prompt applicants for the required information, including.

I. Applicant Name ii. Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number iii. Key contact information (contact name, address, email address, and phone number) iv.

Congressional district(s) where project will take place v. Project Information (title, executive summary, and type) vi. A detailed description of the need for the project vii. A detailed description of how the project will support the Program objectives viii.

Evidence that the applicant can provide the local cost shares ix. A description of the technical, legal, and financial capacity of the applicant x. A detailed project budget xi. Details on the local matching funds xii.

A detailed project timeline xiii. Whether the project impacts an Opportunity Zone (3) Unique Entity Identifier and System for Award Management (SAM) Each applicant is required to. (1) Be registered in SAM before submitting an application. (2) provide a valid unique entity identifier in its application.

And (3) continue to maintain an active SAM registration with current information at all times during which the applicant has an active Federal award or an application or plan under consideration by FTA. These requirements do not apply if the applicant. (1) Is excepted from the requirements under 2 CFR 25.110(b) or (c). Or (2) has an exception approved by FTA under 2 CFR 25.110(d).

FTA may not make an award until the applicant has complied with all applicable unique entity identifier and SAM requirements. If an applicant has not fully complied with the requirements by the time FTA is ready to make an award, FTA may determine that the applicant is not qualified to receive an award and use that determination as a basis for making a Federal award to another applicant. All applicants must provide a unique entity identifier provided by SAM. Registration in SAM may take as little as 3-5 business days, but there can be unexpected steps or delays.

For example, the applicant may need to obtain an Employer Identification Number. FTA recommends allowing ample time, up to several weeks, to complete all steps. For additional information on obtaining a unique entity identifier, please visit www.sam.gov. (4) Submission Dates and Times Project proposals must be submitted electronically through GRANTS.GOV by 11:59 p.m.

Eastern on November 2, 2020. Mail and fax submissions will not be accepted. FTA urges applicants to submit applications at least 72 hours prior to the due date to allow time to correct any problems that may have caused either GRANTS.GOV or FTA systems to reject the submission. Proposals submitted after the deadline will only be considered under extraordinary circumstances not within the applicant's control.

Deadlines will not be extended due to scheduled website maintenance. GRANTS.GOV scheduled maintenance and outage times are announced on the GRANTS.GOV website. Within 48 hours after submitting an electronic application, the applicant should receive two email messages from GRANTS.GOV. (1) Confirmation of successful transmission to GRANTS.GOV.

And (2) confirmation of successful validation by GRANTS.GOV. If the applicant does not receive confirmation of successful validation or receives a notice of failed validation or incomplete materials, the applicant must address the reason for the failed validation, as described in the email notice, and resubmit before the submission deadline. If making a resubmission for any reason, applicants must include all original attachments regardless of which attachments were updated and check the box on the supplemental form indicating this is a resubmission. Applicants are encouraged to begin the process of registration on the GRANTS.GOV site well in advance of the submission deadline.

Registration is Start Printed Page 63656a multi-step process, which may take several weeks to complete before an application can be submitted. Registered applicants may still be required to update their registration before submitting an application. Registration in SAM is renewed annually and persons making submissions on behalf of the Authorized Organization Representative (AOR) must be authorized in GRANTS.GOV by the AOR to make submissions. (5) Funding Restrictions Funds may be used for post-award expenditures only.

Funds under this NOFO cannot be used to reimburse projects for otherwise eligible expenses incurred prior to the date of project award announcements. (6) Other Submission Requirements FTA encourages applicants to identify scaled funding options in case insufficient funding is available to fund a project at the full requested amount. If an applicant indicates that a project is scalable, the applicant must provide an appropriate minimum funding amount that will fund an eligible project that achieves the objectives of the program and meets all relevant program requirements. The applicant must provide a clear explanation of how a reduced award would affect the project budget and scope.

FTA may award a lesser amount whether or not the applicant provides a scalable option. E. Application Review Information (1) Project Evaluation Criteria Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage. Consistent with the R.O.U.T.E.S.

Initiative, the Department will consider how the project will address the challenges faced by rural areas. In addition, the Department will review and consider applications for funding pursuant to this Notice in accordance with the President's September 2, 2020 memorandum, entitled Memorandum on Reviewing Funding to State and Local Government Recipients of Federal Funds that Are Permitting Anarchy, Violence, and Destruction in American Cities, consistent with guidance from the Office of Management and Budget and the Attorney General and with all applicable laws. FTA will evaluate proposals submitted according to the following criteria. (a) Project Innovation and Impact.

(b) Project Approach. (c) National Applicability. (d) Commercialization and/or Knowledge Transfer. And (e) Technical, Legal and Financial Capacity.

FTA encourages each applicant to demonstrate how a project supports all criteria with the most relevant information the applicant can provide, regardless of whether such information has been specifically requested or identified in this notice. A. Project Innovation and Impact i. Effectiveness of the project in achieving and demonstrating the specific objectives of this program.

Ii. Demonstration of benefits in addressing the needs of the transit agency and industry and impacts to infrastructure, equipment, transit workforce, and riders. Iii. Degree of improvement over current and existing technologies, designs, and/or practices applicable to the transit industry.

B. Project Approach i. Quality of the project approach such as existing partnerships, collaboration strategies and level of commitment of the project partners. Ii.

Proposal is realistic in its approach to fulfill the milestones/deliverables, schedule and goals. C. National Applicability i. Degree to which the project could be replicated by other transit agencies regionally or nationally.

Ii. Ability to evaluate technologies, designs and/or practices in a wide variety of conditions and locales. Iii. Degree to which the technology, designs and/or practices can be replicated by other transportation modes.

D. Commercialization and/or Knowledge Transfer i. Demonstrates a realistic plan for moving the results of the project into the transit marketplace (patents, conferences, articles in trade magazines, webinar, site visits, etc.). Ii.

How the project team plans to work with the industry on improving best practices, guidance and/or standards, if applicable. Iii. Demonstrate a clear understanding and robust approach to data collection, access and management. E.

Technical, Legal and Financial Capacity Capacity of the applicant and any partners to successfully execute the project effort. There should be no outstanding legal, technical, or financial issues with the applicant that would make this a high-risk project. (2) Review and Selection Process An FTA technical evaluation committee will evaluate proposals based on the published project evaluation criteria. Members of the technical evaluation committee will rate the applications and may seek clarification about any statement in an application.

The FTA Administrator will determine the final selection and amount of funding for each project after consideration of the findings of the technical evaluation committee. Geographic diversity, diversity of the project type, the amount of local match to be provided, and the applicant's receipt and management of other Federal transit funds may be considered in FTA's award decisions. Prior fare payment innovation efforts may receive priority consideration. The FTA Administrator will consider the following key DOT objectives.

A. Utilizing alternative funding sources and innovative financing models to attract non-Federal sources of investment. B. Whether the project is located in or supports public transportation service in a qualified opportunity zone designated pursuant to 26.U.S.C.

1400Z-1. And c. The extent to which the project addresses challenges specific to the provision of rural public transportation. (3) FAPIIS Review Prior to making a grant award, FTA is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) accessible through SAM.

An applicant may review and comment on information about itself that a Federal awarding agency previously entered. FTA will consider any comments by the applicant, in addition to the other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 2 CFR 200.205 Federal Awarding Agency Review of Risk Posed by Applicants. F. Federal Award Administration Information (1) Federal Award Notices FTA will announce the final project selections on the FTA website.

Project recipients should contact their FTA Regional Office for additional information regarding allocations for Start Printed Page 63657projects. At the time project selections are announced, FTA will extend pre-award authority for the selected projects. There is no blanket pre-award authority for these projects before announcement. There is no minimum or maximum grant award amount, but FTA intends to fund as many meritorious projects as possible.

FTA only will consider proposals from eligible recipients for eligible activities. Due to funding limitations, projects selected for funding may receive less than the amount originally requested. In those cases, applicants must be able to demonstrate that the proposed projects are still viable and can be completed with the amount awarded. (2) Administrative and National Policy Requirements a.

Pre-Award Authority FTA will issue specific guidance to recipients regarding pre-award authority at the time of selection. FTA does not provide pre-award authority for competitive funds until projects are selected, and there are Federal requirements that must be met before costs are incurred. For more information about FTA's policy on pre-award authority, see the FY 2020 Apportionments Notice published on June 3, 2020, at https://www.govinfo.gov/​content/​pkg/​FR-2020-06-03/​pdf/​2020-11946.pdf. b.

Grant Requirements Selected applicants will submit a grant application through FTA's electronic grant management system and adhere to the customary FTA grant requirements for research project (insert Circular name). All competitive grants, regardless of award amount, will be subject to the Congressional notification and release process. FTA emphasizes that third-party procurement applies to all funding awards, as described in FTA Circular 4220.1F, “Third Party Contracting Guidance.” However, FTA may approve applications that include a specifically identified partnering organization(s) (2 CFR 200.302(f)). When included, the application, budget, and budget narrative should provide a clear understanding of how the selection of these organizations is critical for the project and give sufficient detail about the costs involved.

C. Planning FTA encourages applicants to engage the appropriate State Departments of Transportation, Regional Transportation Planning Organizations, or Metropolitan Planning Organizations in areas to be served by the project funds available under this program. D. Standard Assurances The applicant assures that it will comply with all applicable Federal statutes, regulations, executive orders, FTA circulars, and other Federal administrative requirements in carrying out any project supported by the FTA grant.

The applicant acknowledges that it is under a continuing obligation to comply with the terms and conditions of the grant agreement issued for its project with FTA. The applicant understands that Federal laws, regulations, policies, and administrative practices might be modified from time to time and may affect the implementation of the project. The applicant agrees that the most recent Federal requirements will apply to the project unless FTA issues a written determination otherwise. The applicant must submit the Certifications and Assurances before receiving a grant if it does not have current certifications on file.

E. Free Speech and Religious Liberty In connection with any program or activity conducted with or benefiting from funds awarded under this notice, recipients of funds must comply with all applicable requirements of Federal law, including, without limitation, the Constitution of the United States. Statutory, regulatory, and public policy requirements, including without limitation, those protecting free speech, religious liberty, public welfare, the environment, and prohibiting discrimination. The conditions of performance, non-discrimination requirements, and other assurances made applicable to the award of funds in accordance with regulations of the Department of Transportation.

And applicable Federal financial assistance and contracting principles promulgated by the Office of Management and Budget. In complying with these requirements, recipients must ensure that no concession agreements are denied or other contracting decisions made on the basis of speech or other activities protected by the First Amendment. If the Department determines that a recipient has failed to comply with applicable Federal requirements, the Department may terminate the award of funds and disallow previously incurred costs, requiring the recipient to reimburse any expended award funds. (3) Reporting The post-award reporting requirements include submission of the Federal Financial Report (FFR) and Milestone Progress Report in TrAMS.

An evaluation of the grant will occur at various points in the demonstration process and at the end of the project. In addition, FTA is responsible for producing an Annual Report to Congress that compiles evaluation of selected projects, including an evaluation of the performance measures identified by the applicants. All applicants must develop an evaluation plan to measure the success or failure of their projects and describe any plans for broad-based implementation of successful projects.

Cialis contraindications

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Lauren Gambill, MDPediatrician, AustinMember, Texas where to buy cheap cialis Medical Association (TMA) cialis contraindications Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric SocietyDoctors are community leaders. This role has become even more important during the erectile dysfunction treatment cialis. As patients navigate our cialis contraindications new reality, they are looking to us to determine what is safe, how to protect their families, and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net.

The U.S. Census helps determine funding for those resources, and that is why it is of the upmost importance that each and every Texan, no matter address, immigration status, or age, respond to the 2020 U.S cialis contraindications. Census. The deadline has been cut short cialis contraindications one month and now closes Sept.

30.erectile dysfunction treatment has only increased the importance of completing the census to help our local communities and economies recover. The novel erectile dysfunction has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also cialis contraindications have been stretched thin, with teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago.

Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the cialis’s fallout. Therefore, it is vital that all cialis contraindications Texans be counted.The federal dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example. Federal funds pay for 60% of the state’s program, which provides health coverage for two out of five Texas children, one in three individuals cialis contraindications with disabilities, and 53% of all births.

The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, cialis contraindications program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many live cialis contraindications with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the cialis continues. The Central cialis contraindications Texas Food Bank saw a 206% rise in clients in March.

Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. Funding for local housing programs also is calculated via the census. An accurate count will help ensure cialis contraindications that people who lose their homes during this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by erectile dysfunction, more parents are taking on roles as breadwinner, parent, teacher, and caretaker.

This stress highlights the desperate need for affordable childcare cialis contraindications. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families. The good news is you still have time to complete the census. Visit 2020census.gov cialis contraindications to take it.

It takes less than five minutes to complete. Then talk to your family, neighbors, and colleagues about doing the same cialis contraindications. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the cialis. Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R).

UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, cialis contraindications Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article http://deecarrollphoto.com/blog/ is part of a Me&My Doctor cialis contraindications series highlighting and promoting the use of vaccinations.“Can the flu shot give you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan treatments cause autism? cialis contraindications. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions.

These were exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted cialis contraindications the treatment drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and treatment awareness through shot clinics and education. Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha cialis contraindications Home residents could ask us questions during the program.We were interested to see if our educational program could answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy.

treatment hesitancy is a concept defined by the World Health Organization. It relates to when patients do not vaccinate despite having access cialis contraindications to treatments. treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program.

While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive cialis contraindications a flu shot today?. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan cialis contraindications WealtherWhy is this important?. First, our findings confirm what we already knew.

Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation of vaccination cialis contraindications is one of the most critical factors affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by cialis contraindications the end of the evening.Second, our findings add to our understanding of adult treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, cialis contraindications like the yearly influenza treatment. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment.

Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the erectile dysfunction treatment cialis because it decreases illnesses and conserves health care resources. Thousands of people each year are hospitalized from the flu, and with hospitals filling up with erectile dysfunction patients, we could avoid cialis contraindications adding dangerously ill flu patients to the mix. Lastly, these findings are important because once a erectile dysfunction treatment vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the cialis contraindications erectile dysfunction treatment is still in development, it is not immune to treatment hesitancy.

Recent polls have indicated up to one-third of Americans would not receive a erectile dysfunction treatment even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance. In addition, misinformation about the erectile dysfunction treatment cialis contraindications treatment is circulating widely. (Someone recently asked me if the erectile dysfunction treatment will implant a microchip in people, and I have seen the same myth circulating on social media.

It will not.) This myth, however, illustrates the cialis contraindications need for health care professionals to answer patients’ questions and to assuage their concerns.treatments work best when many people in a community receive them, and treatment hesitancy can diminish vaccination rates, leaving people who can't get certain treatments susceptible to these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots. As the erectile dysfunction treatment cialis progresses, we need to ensure children and adults receive their vaccinations as recommended by cialis contraindications their physician and the Centers for Disease Control and Prevention.

I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

Lauren Gambill, cialis online usa MDPediatrician, AustinMember, Texas Medical Association (TMA) Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric SocietyDoctors are community leaders http://www.naturi-haus.at/vorteile/. This role has become even more important during the erectile dysfunction treatment cialis. As patients navigate our new reality, they are looking to us to determine what is cialis online usa safe, how to protect their families, and the future of their health care.

As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net. The U.S. Census helps determine funding for those resources, and that is why it is of the cialis online usa upmost importance that each and every Texan, no matter address, immigration status, or age, respond to the 2020 U.S.

Census. The deadline has been cut cialis online usa short one month and now closes Sept. 30.erectile dysfunction treatment has only increased the importance of completing the census to help our local communities and economies recover.

The novel erectile dysfunction has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more. Schools also have been stretched thin, with cialis online usa teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago.

Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the cialis’s fallout. Therefore, it is vital that all Texans be counted.The federal cialis online usa dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example.

Federal funds pay for 60% of the state’s program, which provides cialis online usa health coverage for two out of five Texas children, one in three individuals with disabilities, and 53% of all births. The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars.

If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, cialis online usa any of which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census. Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many live with uncertainty as to cialis online usa where they will find their next meal.

Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the cialis continues. The Central Texas Food Bank saw a cialis online usa 206% rise in clients in March.

Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census. Funding for local housing programs also is calculated via the census. An accurate count will help ensure that people who lose their cialis online usa homes during this economic crisis have better hope of finding shelter while our communities recover.

Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by erectile dysfunction, more parents are taking on roles as breadwinner, parent, teacher, and caretaker. This stress highlights the desperate need for affordable childcare cialis online usa. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families.

The good news is you still have time to complete the census. Visit 2020census.gov to cialis online usa take it. It takes less than five minutes to complete.

Then talk to your family, neighbors, cialis online usa and colleagues about doing the same. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the cialis. Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R).

UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, cialis online usa Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month.

This article is part of a Me&My Doctor series cialis online usa highlighting and promoting the use of vaccinations.“Can the flu shot give you the flu?. €â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan treatments cialis online usa cause autism?.

€These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions. These were exactly the types of myths we set out cialis online usa to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the treatment drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and treatment awareness through shot clinics and education.

Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha Home residents could ask us questions during the program.We were interested to see if our educational program cialis online usa could answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy.

treatment hesitancy is a concept defined by the World Health Organization. It relates to cialis online usa when patients do not vaccinate despite having access to treatments. treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations.

That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program. While opinions about shots improved with each survey question, we saw the most significant attitude change cialis online usa reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a flu shot today?. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community.

Graph by Ryan cialis online usa WealtherWhy is this important?. First, our findings confirm what we already knew. Education by a trusted member of the medical community can effect change.

In fact, it is widely known that physician recommendation of vaccination cialis online usa is one of the most critical factors affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end of the evening.Second, cialis online usa our findings add to our understanding of adult treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the yearly influenza cialis online usa treatment.

After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment. Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the erectile dysfunction treatment cialis because it decreases illnesses and conserves health care resources. Thousands of people each year are hospitalized from the flu, and with hospitals filling up with erectile dysfunction patients, we could avoid adding dangerously cialis online usa ill flu patients to the mix.

Lastly, these findings are important because once a erectile dysfunction treatment vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the erectile dysfunction treatment is still in development, it is not immune to treatment cialis online usa hesitancy. Recent polls have indicated up to one-third of Americans would not receive a erectile dysfunction treatment even if it were accessible and affordable.

Work is already being done to try to raise awareness and acceptance. In addition, misinformation about the erectile dysfunction treatment cialis online usa is circulating widely. (Someone recently asked me if the erectile dysfunction treatment will implant a microchip in people, and I have seen the same myth circulating on social media.

It will cialis online usa not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.treatments work best when many people in a community receive them, and treatment hesitancy can diminish vaccination rates, leaving people who can't get certain treatments susceptible to these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots.

As the erectile dysfunction treatment cialis progresses, we need to ensure children cialis online usa and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention. I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..