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From. Health CanadaDate. July 16, 2021As of July 16, 2021, Health Canada will no longer accept applications for certain categories of medical devices under Interim Order No.

2 if it has been determined there's no longer an urgent public health need for those devices. On this page BackgroundMechanisms in place to expedite access to medical devices during the buy antibiotics zithromax include Interim Order No. 2 (IO No.

2). This interim order was signed by the Minister of Health in March 2021.For a buy antibiotics medical device to be authorized for importation or sale under IO No. 2, the Minister must determine if there is an urgent public health need (UPHN) for that device.

A UPHN exists if immediate action is required to protect or improve the health of individuals or communities in Canada. Determining urgent public health needTo determine if there's an UPHN for a medical device, Health Canada considers a number of factors, including. Its supply and demand its lifecycle (how long it lasts) its clinical need the status of the buy antibiotics zithromax in CanadaEach IO application for a device undergoes a UPHN assessment.

If there's not enough evidence of a UPHN, the applicant will receive a screening deficiency letter asking for evidence that a UPHN exists for their medical device. An attestation from a Canadian health authority stating that a UPHN exists for that medical device is an example of such evidence.Health Canada will reject applications that don't have enough evidence of a UPHN. Medical devices that no longer have UPHN statusAs the zithromax evolves, Health Canada is assessing whether there's an urgent public health need for certain categories of medical devices.

Table 1 lists the categories of buy antibiotics medical devices that no longer have UPHN status. We will reassess the status of these devices from time to time as the zithromax evolves and if the supply and demand for certain categories of devices changes.This approach allows us to better focus resources on assessing urgently needed devices to ensure they're quickly available to Canadians. Table 1.

Categories of buy antibiotics medical devices that no longer have UPHN status Device category* Assessment date Thermometers 2021-07-16 Ventilators 2021-07-16 *IO approval may still be possible for devices listed in Table 1 if the applicant provides enough UPHN evidence for the device. Health Canada will consider the supporting evidence and inform the applicant of the decision taken as per our service standards.The device categories listed in Table 1 only affect applications filed after the assessment date identified in the table. Applications that were submitted before that date and are still being processed or authorizations already issued under the IO before that date are not affected.The Medical Devices Regulations pathway remains open for obtaining medical device establishment licences (Class I) and medical device licences (Class II to IV) for all types of medical devices.

To obtain a medical device licence and medical device establishment licence under this pathway, see the following guidance documents. If you have any questions, please contact the Medical Devices Directorate at hc.mddpolicy-politiquesdim.sc@canada.ca. Related linksNew policy and updated submission requirements Date.

July 9, 2021 On this page Background and purpose Rapid antigen tests are easy to use and provide results in 15 minutes on average. However, their sensitivity is lower than that of molecular RT-PCR tests. On September 29, 2020, Health Canada published a notice on the minimum value for sensitivity of rapid antigen testing devices.

Tests with sensitivity below 80% will not be authorized. This position aligns with the minimum value required by other regulatory agencies (for example, U.S. FDA, WHO, U.K.

MHRA, Germany’s PEI). Recent scientific and medical studies show that serial testing may. increase the overall sensitivity of an antigen test and make it possible for less sensitive tests to meet the established 80% sensitivity requirement As such, Health Canada is introducing more flexibility during the review process of antigen tests that use serial testing for individuals without symptoms.The purpose of this notice is to communicate to industry this new policy and submission requirements.

New policy position Health Canada may authorize an antigen test that uses serial testing for asymptomatic individuals without the support of pre-market clinical evidence.This new policy is based on. early reports on the possible similarity of viral loads between people with and without symptoms technical reports and key messages on the use of rapid antigen tests strategies implemented by our international regulatory partners recent U.S. FDA recommendations to allow for more flexibility during pre-market evaluation of buy antibiotics testing devices during the zithromax New policy details and submission requirements Manufacturers may consider a claim for serial testing of patients without symptoms and where there’s no pre-market clinical evidence if the test.

has undergone clinical evaluation with symptomatic individuals in a laboratory or a point-of-care (POC) setting and has a sensitivity of at least 80%, with 70% at the lower bound of the 2-sided 95% confidence interval If these requirements are met, a screening claim for an asymptomatic population intended for use as part of a testing program may be granted. This is achieved by imposing an agreed-upon condition to the interim order (IO) authorization. The condition will require a clinical study establishing the performance of the assay in an asymptomatic population.

The clinical study should include at least 20 positive asymptomatic patients and the clinical data will need to be submitted within a specified timeframe. Study samples must represent the viral loads expected, with 10% to 20% of the samples falling in the low positive category stratification. Analysis of the results by PCR Ct values should also be provided.If manufacturers are unable to obtain the required 20 positive samples from asymptomatic individuals to support their clinical claims, they may present the results from 10 positive samples from asymptomatic individuals if.

The data from symptomatic individuals are also submitted the analysis of cycle threshold (Ct) values demonstrates reasonably similar distribution of viral loads Authorization is conditional on Health Canada receiving data from the remaining 10 positive clinical specimens.As part of the conditional IO authorization for antigen tests, manufacturers will be required to submit a quarterly post-market report. This report must include. The number of devices sold in and outside Canada a summary of problem reports on the performance of the assay, number of false positive, false negative, invalid results and major complaints on the robustness of the assay published peer-reviewed articles on the performance of your device The test labelling must include the following statement in the intended use.

€œIndividuals without symptoms or other epidemiological reasons to suspect buy antibiotics , when tested twice over 2 (or 3) days with at least 24 hours (and no more than 36 hours) between tests.” In both the limitations and clinical performance sections of the Instructions for Use (IFU), manufacturers must clearly state that. clinical studies in asymptomatic patients using serial testing are ongoing to establish clinical performance the performance of this test has not yet been clinically validated for use in patients without signs and symptoms of respiratory or for serial screening applications note that performance may differ in these populations How to apply If manufacturers are applying for a new authorization, all requirements outlined in the following antigen guidance documents published by Health Canada and the FDA apply. For an application that is currently under evaluation by Health Canada and meets the requirement of the new policy.

If you have not submitted an application and you believe your device meets these criteria, you may include the claim in your indications for use along with the required labelling..

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Source Search for this keyword SearchJournal of the American College of Cardiology Original Investigations Just Accepted Giuseppe Tarantini, Marco Mojoli, Ferdinando Varbella, Roberto Caporale, Stefano Rigattieri, Giuseppe Andò, Plinio Cirillo, Simona Pierini, Andrea Santarelli, Paolo Sganzerla, Luisa Cacciavillani, Luciano Babuin, Nicoletta De Cesare, Ugo Limbruno, Alberto Massoni, Andrea Rognoni, Daniela Pavan, Flavia Belloni, Carlo http://bacma.co.uk/about/ Cernetti, Luca Favero, Francesco Saia, Luca Nai Fovino, Giulia Masiero, Loris Roncon, Valeria Gasparetto, Marco Ferlini, Federico Ronco, Roberta Rossini, Paolo Canova, Daniela Trabattoni, Alessandra Russo, Vincenzo Guiducci, Carlo Penzo, Fabio Tarantino, Ciro Mauro, Elena Corrada, Giovanni Esposito, Sergio Berti, Matteo Martinato, Danila Azzolina, Dario Gregori, Dominick J. Angiolillo, Giuseppe Musumeci and for the DUBIUS Investigators, on behalf of the Italian Society of Interventional Cardiology (SICI-GISE).

Source Search for this keyword SearchJournal of the American College of Cardiology Original Investigations Just Accepted Giuseppe Tarantini, Marco Mojoli, Ferdinando Varbella, Roberto Caporale, Stefano Rigattieri, Giuseppe Andò, Plinio Cirillo, Simona Pierini, Andrea Santarelli, Paolo Sganzerla, Luisa Cacciavillani, Luciano Babuin, Nicoletta De Cesare, Ugo Limbruno, Alberto Massoni, Andrea Rognoni, Daniela Pavan, Flavia Belloni, Carlo Cernetti, Luca Favero, Francesco Saia, Luca Nai Fovino, Giulia Masiero, Loris Roncon, Valeria Gasparetto, Marco Ferlini, Federico Ronco, Roberta Rossini, Paolo Canova, Daniela Trabattoni, Alessandra Russo, Vincenzo Guiducci, Carlo Penzo, Fabio Tarantino, Ciro Mauro, Elena Corrada, Giovanni Esposito, Sergio Berti, Matteo Martinato, https://www.peak-inspiration.com/testimonial/capgemini-chelsea-slater/ Danila Azzolina, Dario Gregori, Dominick J. Angiolillo, Giuseppe Musumeci and for the DUBIUS Investigators, on behalf of the Italian Society of Interventional Cardiology (SICI-GISE).

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Since the modern era of research on autism began in the 1980s, questions about social cognition and social brain development have zithromax 250mg uses been of central interest to researchers. This year marks the 20th anniversary of the first annual meeting of the International Society for Autism Research (INSAR), and it is evident in this year’s meeting that the growth of social cognitive neuroscience over the past two decades has significantly enriched autism science. For those unfamiliar with the term, social cognitive neuroscience is the study of zithromax 250mg uses the brain systems that are involved in the causes and effects of social behaviors and social interaction. Some of these involve brain systems involved in thinking about other people’s thoughts or intentions, empathizing, social motivation and the impact of social attention on an individual’s thinking and emotions.

At the same time, research with and for autistic people has also enriched social cognitive neuroscience and the understanding of how our social minds develop. Autism spectrum disorder (ASD) is a complex and heterogeneous part of zithromax 250mg uses the human condition, or neurodiversity. It is associated with a wide range of life outcomes, from “disorder” or the profound challenges that encumber about 30 percent of affected individuals with minimal language and intellectual disability, to “differences” among people who have well-above-average abilities and accomplishments. Regardless of their outcomes, though, people on the autism spectrum travel a different path of social-cognitive neurodevelopment that appears to begin in infancy.

For example, many experience zithromax 250mg uses some level of difficulty with social cognitive mentalizing, also known as “theory of mind”—the mental representation of other people’s thoughts, perspectives, beliefs, intentions or emotions, which enables us to understand or predict their behaviors. Social cognitive neuroscience tells us that brain systems of the medial frontal cortex, temporal cortex and parietal cortex, as well as reward centers of the brain, enable mentalizing. Accordingly, differences in the development and/or transmissions of information across this distributed social cognitive zithromax 250mg uses brain network may contribute to differences in mentalizing among autistic people. These differences can lead to a range of outcomes, from problems in the capacity to mentalize to alterations in the spontaneous use of mentalizing, or the motivation and effort involved in mentalizing during social interactions.

These observations are informative, but do not address fundamental questions about how social-cognitive brain systems develop or why their development might be different for autistic people. These questions are essential in autism science because understanding the early course of social cognitive neurodevelopment may afford the best opportunity to mitigate the profoundly negative effects that social cognitive differences can have on zithromax 250mg uses some autistic people. Serendipitously, this motivation to understand the very early development of our social brain can inform the broader understanding of social-cognitive neuroscience and human nature. As it turns out, one key to understanding the development of our social brains may come from observations of social attention in infancy.

As early as zithromax 250mg uses six to 12 months of age, some infants who go on to receive an autism diagnosis already display differences in the development of social attention. They look less frequently at the face and eyes of people than other infants and are less likely to coordinate their attention with another person to adopt a common point of view or reference, or “joint attention.” Infants with neurotypical development follow the gaze direction or gesture of other people or lead the gaze of other people to establish joint attention and share information through a common perceptual perspective. Developing the ability to coordinate attention socially is important in and of itself. For example, every teacher’s zithromax 250mg uses admonition to students to “pay attention!.

€ is really a request to “pay attention to what I [the teacher] am attending to.” Joint attention is vital to social competence at all ages. Adolescents and adults who cannot follow, initiate or join with the rapid-fire changes of shared attention in social interactions may be impaired in their capacity zithromax 250mg uses for relatedness and relationships. Equally important, joint attention is also an early building block of social cognitive mentalizing. Every time infants coordinate attention socially with other people, they practice perceptual perspective-taking.

They do this hundreds if not zithromax 250mg uses thousands of times in early development. It tunes aspects of social-brain development that subsequently support the capacity for mental perspective-taking. Mental perspective-taking is synonymous with mentalizing and our ability to understand the thoughts, beliefs, and intentions of other people. Indeed, several studies provide evidence of a significant overlap in brain systems zithromax 250mg uses involved in joint attention and social-cognitive mentalizing.

Accordingly, differences in early social attention are thought to contribute to differences in the neurodevelopment of social cognitive mentalizing in some to many people with autism. Research also suggests that differences in systems that regulate the motivation for social attention might play a role in this aspect of the development of autism, though the nature of this motivation is not understood. One possibility is that decreased motivation to attend to faces may lead to critical early difference in social attention zithromax 250mg uses. Alternatively, differences in the “eye-contact effect” may impact social attention development.

The eye-contact effect is a phenomenon in which awareness of being the object of others’ attention triggers an arousal response that enhances stimulus salience and information processing zithromax 250mg uses during social attention coordination. When we are aware of other people looking at us, changes occur in our mental processes that can benefit social learning. Several studies now suggest that people with autism may be less responsive to, or less aware of, being the object of attention of others. Hence, autism science raises the hypothesis that the first step toward human social neurocognitive development may involve months zithromax 250mg uses of practice with social attention coordination with caregivers during infancy.

Moreover, our response to eye contact of other people may provide an early motivational stance that prioritizes infant social attention development and the development of our social brains. Notably, recent studies indicate that imitating the behavior of young children with autism, which likely affects a child’s awareness that another person is looking at them, can improve joint attention and language development. Of course, the zithromax 250mg uses most fundamental lesson we can draw from all these observations about the development of our social mind is that we are all more similar than different, regardless of our paths of neurodevelopment, and that autistic people have much to teach us about the nature of human nature. This is an opinion and analysis article.

Further reading. Baron-Cohen, S zithromax 250mg uses. (2019). The concept zithromax 250mg uses of neurodiversity is dividing the autism community.

Scientific American. Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & zithromax 250mg uses. Schultz, R.

T. (2012). The social motivation theory of autism. Trends in cognitive sciences, 16(4), 231-239.

Gulsrud, A. C., Hellemann, G., Shire, S., &. Kasari, C. (2016).

Isolating active ingredients in a parent‐mediated social communication intervention for toddlers with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(5), 606-613. Grynszpan, O., Bouteiller, J., Grynszpan, S., Le Barillier, F., Martin, J. C., &.

Nadel, J. (2019). Altered sense of gaze leading in autism. Research in Autism Spectrum Disorders, 67, 101441.

Mundy, P. (2018). A review of joint attention and social‐cognitive brain systems in typical development and autism spectrum disorder. European Journal of Neuroscience, 47(6), 497-514.

Reddy, V. (2003). On being the object of attention. Implications for self–other consciousness.

Trends in cognitive sciences, 7(9), 397-402. Senju, A., &. Johnson, M. H.

(2009). The eye contact effect. Mechanisms and development. Trends in cognitive sciences, 13(3), 127-134.

Stephenson, L., Edwards, S. G., &. Bayliss, A. (2020).

From gaze perception to social cognition. A neurocognitive model of joint and shared attention. Perspectives on Psychological Science. Https://journals.sagepub.com/doi/10.1177/1745691620953773Exxon Mobil Corp.

Has used language to systematically shift blame for climate change from fossil fuel companies onto consumers, according to a new paper by Harvard University researchers. The paper, published yesterday in the journal One Earth, could bolster efforts to hold the oil giant accountable in court for its alleged deception about global warming. "This is the first computational assessment of how Exxon Mobil has used language in subtle yet systematic ways to shape the way the public talks about and thinks about climate change," Geoffrey Supran, a research fellow at Harvard and co-author of the paper, said in an interview with E&E News. "One of our overall findings is that Exxon Mobil has used rhetoric mimicking the tobacco industry to downplay the reality and seriousness of climate change and to shift responsibility for climate change away from itself and onto consumers," he added.

A spokesperson for Exxon Mobil disputed the paper, calling it part of a coordinated legal campaign against the company. Supran and co-author Naomi Oreskes, a professor of the history of science at Harvard (and Scientific American columnist), conducted a computational analysis of 180 Exxon Mobil documents from 1972 to 2019, including peer-reviewed publications, advertorials in The New York Times and internal memos. Using a series of algorithms, the Harvard researchers found that Exxon Mobil had privately relied on some terms while publicly avoiding them altogether. For example, Exxon Mobil's internal documents frequently described climate change as a problem caused by "fossil fuel combustion." But in public-facing documents, the company referred to global warming as a problem caused by the "energy demand" of "consumers." The public communications sought to deflect responsibility for climate change away from the oil giant and onto individual consumers who heat their homes and fill their cars with gas, the researchers wrote.

Following their merger in 1999, Exxon and Mobil also increasingly presented climate change as a "risk," rather than a reality, the analysis found. This language sought to minimize the dangers of global warming while not denying their existence outright, the paper says. Court battles The researchers drew a direct comparison between Exxon Mobil and major tobacco companies, which they said used similar tactics to shape public discourse about smoking cigarettes. "These patterns mimic the tobacco industry's documented strategy of shifting responsibility away from corporations — which knowingly sold a deadly product while denying its harms — and onto consumers," they wrote.

In the 1990s, attorneys general from all 50 states sued the largest U.S. Tobacco companies over their alleged deception about the harmful health effects of smoking cigarettes and the addictive nature of nicotine. The suits culminated in a $206 billion master settlement agreement (Climatewire, March 10). Since 2017, five states and more than a dozen municipalities have filed similar suits alleging that the biggest U.S.

Oil and gas companies misled the public about the climate risks of burning fossil fuels. The complaints ask the oil industry to help cover the costs of addressing floods, wildfires and other disasters fueled by rising global temperatures. Supran said that although he didn't conduct the study with the climate liability litigation in mind, the findings can nonetheless inform the legal fights. "Obviously, we did this completely independently.

I've never spoken to any of the lawyers involved," Supran said. "But certainly with hindsight, our insights may be relevant, especially to these more nascent cases alleging deceptive marketing." Last month, New York City filed a lawsuit asserting that Exxon Mobil, BP PLC and Royal Dutch Shell PLC violated the city's consumer protection law by engaging in "green washing," or the practice of making their fossil fuel products seem more environmentally friendly than they really are. Exxon pushback Asked for comment on the paper, Exxon spokesperson Casey Norton said in an email to E&E News. "This research is clearly part of a litigation strategy against Exxon Mobil and other energy companies." Norton noted that Oreskes is on retainer with Sher Edling LLP, a San Francisco-based law firm that represents a slew of the challengers in the climate liability suits.

"Oreskes did not disclose this blatant conflict of interest," he said. Norton also pointed to the paper's partial funding from the Rockefeller family, which Exxon has accused of supporting a climate conspiracy against the company (Climatewire, May 4). "The research was paid for by the Rockefeller Family Fund, which is helping finance climate change litigation against energy companies," he said. "This follows a previous study attacking Exxon Mobil that used a similar discredited methodology." Norton was referring to a 2017 paper by Supran and Oreskes in the journal Environmental Research Letters that found Exxon's communications from 1977 to 2014 misled the public about climate science.

Vijay Swarup, Exxon's vice president of research and development, previously blasted the 2017 paper as "fundamentally flawed" in a comment in Environmental Research Letters last year. Norton concluded by stressing that Exxon supports climate action, noting that the oil giant recently proposed a massive carbon capture project in Houston (Energywire, April 20). "Exxon Mobil supports the Paris climate agreement, and is working to reduce company emissions and helping customers reduce their emissions while working on new lower-emission technologies and advocating for effective policies," he said. In a joint statement to E&E News, Supran and Oreskes pushed back on Norton's allegations.

"Sher Edling played no role in the paper we published today, nor in any other academic work we have done. They have not funded any of our studies. They have not reviewed our data or interpretations prior to its peer-reviewed publication. And we have never discussed any of our work concerning ExxonMobil with them.

Therefore, there is no conflict of interest and nothing to disclose," the researchers said. "For context, we note that over the past four years, ExxonMobil have attacked us and our work," they added. "It has become a familiar pattern. We publish science, ExxonMobil offers spin and character assassination.

ExxonMobil is now misleading the public about its history of misleading the public." Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals.And then there were two. Today China says it safely landed a spacecraft on Mars—for the first time in its history and in its first attempt, becoming the only other nation besides the U.S.

To achieve such a feat. Its Zhurong rover, named after a god of fire from Chinese folklore, successfully touched down in Utopia Planitia around 7:11 P.M. EST as part of the Tianwen-1 mission, according to the China National Space Administration. Soon the rover should drive down the ramp of its landing platform, ready to explore its unearthly surroundings.

If there was any doubt about China’s spacefaring prowess, it has been dispelled now that the nation has added interplanetary landings as a coveted notch on its belt “Mars is hard,” says Roger Launius, NASA’s former chief historian. €œThis is a really big deal.” Tianwen-1 was launched in July 2020 as part of a summer Martian armada that also included launches of NASA’s Perseverance rover and the United Arab Emirates’ Hope orbiter. All three missions arrived at Mars in February. But while Perseverance descended straight to the surface, Tianwen-1 instead entered an elliptical orbit around the planet to give its scientists a god’s-eye view for scouting out their planned landing site in Utopia Planitia, an immense impact basin on Mars.

€œChina does not have its own detailed Mars maps,” says Brian Harvey, a writer who covers the country’s space program. At least, that was the case until today, when Tianwen-1’s controllers decided they had seen enough to confidently initiate the spacecraft’s daring descent. Packed inside a cone-shaped protective shell, Zhurong and its rocket-powered landing platform detached from the orbiter, descended toward Mars and began the fiery plunge through the planet’s upper atmosphere. After jettisoning its protective shell lower in the atmosphere, the spacecraft unfurled parachutes to slow its descent before riding thrusters down to a gentle landing on the surface.

This was “very similar” to the powered landings China has used in its Chang’e missions to Earth’s moon, says Andrew Jones, a space journalist who follows the Chinese space program. The latest of those missions returned samples to Earth in 2020. Other nations have tried and failed to land on Mars, but China’s success highlights how it is rapidly catching up to, if not exceeding, many of its counterparts. The Soviet Union notably attempted multiple landings in the 1970s, coming closest with Mars 3, which touched down on the planet but stopped working moments later.

The U.K. Reached the surface with its Beagle 2 lander in 2003. The craft’s communications antenna failed to deploy, however, dooming the mission. The European Space Agency (ESA) and Russia also came close with their Schiaparelli lander—until it crashed on Mars in 2016.

ESA will try again with its Rosalind Franklin rover in 2022. Until today, only the U.S. Had successfully operated any spacecraft on Mars for a significant period of time, starting with the Viking landers of 1976 and extending to the country’s multiple landers and rovers that are exploring the surface today. China now joins this most elite and exclusive of clubs.

€œIt’s a big day for China,” says Mark McCaughrean, senior scientific adviser for science and exploration at ESA. €œWe know better than anyone how hard it can be to get safely down to the surface.” China will now wait an undisclosed amount of time, as little as a day or up to perhaps a week, before driving the Zhurong rover down a ramp from the lander and onto the surface. The six-wheeled solar-powered vehicle has a planned lifetime of 90 Martian days and is thought to have a top speed of 200 meters per hour, Jones says, although it will likely explore much more slowly. China will upload commands to the rover via its Tianwen-1 orbiter, with ESA’s Mars Express orbiter acting as a backup.

The rover will then perform its tasks autonomously on the surface, similar to the operational protocols NASA uses for its own fleet of robotic Martian explorers. Utopia Planitia was also the site for NASA’s Viking 2 in 1976. It is a rather bland expanse of rock-strewn sand—decent for spacecraft landings but decidedly subpar for addressing cutting-edge research questions, such as whether Mars harbors past or present life. €œ[China is] not looking for biosignatures,” says Agnes Cousin, a planetary scientist at the Institute for Research in Astrophysics and Planetology in France, who has advised Tianwen-1 scientists.

Yet Zhurong is still expected to perform important science on the surface of the Red Planet. €œWe always have surprises when we arrive on the surface,” Cousin says. €œFor the overall geological implications for Mars, it’s very nice to have a new location to compare.” The rover is equipped with a suite of six instruments and cameras to study the surface. They include a ground-penetrating radar that could look for water and ice up to 100 meters below the surface (NASA’s Perseverance boasts a similar instrument).

Zhurong also has a magnetometer, the first ever sent to Mars on a rover. Alongside a similar instrument on the Tianwen-1 orbiter, which will continue studying the planet from afar, the rover’s magnetometer could reveal the details of how Mars lost its magnetic field—and consequently its atmosphere and water—billions of years ago. €œConceivably this instrument could help address that question,” says David Flannery, an astrobiologist at the Queensland University of Technology in Australia, who is familiar with China’s space activities. €œTogether the instruments will tell us more about how the Martian magnetic field operates today.” Another instrument of note is the Mars Surface Composition Detector (MarSCoDe), a device similar to ChemCam on NASA’s Curiosity rover and SuperCam on Perseverance, which will use a laser to vaporize rock specimens on the surface, revealing their composition.

Cousin is part of both the ChemCam and SuperCam teams, and she was among a group of European collaborators that helped China develop their instrument. She traveled to Shanghai in 2019 to exchange information with Tianwen-1 scientists on topics such as data-processing techniques and calibration targets to include on the rover to test the instrument on Mars. €œThey wanted big calibration targets” for MarSCoDe, Cousin says. €œSo we gave them one”.

A two-centimeter-wide square of an igneous rock called norite that is one of 12 such targets on the rover. While the science goals of the rover may be somewhat modest, it is also expected to be a technology demonstration for a much more ambitious future project. By 2028 or 2030, China hopes to send a sample-return mission to Mars to bring pristine Martian rocks back to Earth. That timing is similar to, or perhaps even in advance of, when NASA and ESA plan to do the same with their own interplanetary grab-and-go effort.

€œWill it be China bringing the first Mars material back to Earth, or will it be NASA and ESA?. € says Jacqueline Myrrhe, a journalist affiliated with the Chinese space Web site Go Taikonauts!. “This could be a very good question.” Landing on Mars is the latest pinnacle achievement from China’s planned portfolio of ambitious space activities. But already the nation has more than proved its mettle.

It has conducted numerous sorties to the moon and has begun the construction of a space station in Earth orbit. The nation may send a pair of spacecraft to the edge of the solar system in just a few years and launch a mission to Jupiter by the end of the decade. Now that Tianwen-1 has shown that China is an adept interplanetary explorer, even more audacious projects may be on the horizon. €œIt’s the first step for much more,” Myrrhe says.Some of the oldest art in human history is disintegrating, scientists say.

And climate change may be hastening its demise. New research reports that ancient rock art in Indonesian caves is degrading over time, as bits of rock slowly flake away from the walls. It's a tremendous loss for human history — some of these paintings, which depict everything from animals to human figures to abstract symbols, date back about 40,000 years. Salt crystals building up on the walls are a key part of the problem, the study suggests.

These salt deposits seep into the cave walls, then proceed to expand and contract as temperatures rise and fall. This process causes the rock to slowly disintegrate. Changes in the weather may be helping the process along, scientists say. Salt crystals may expand more readily when they're exposed to repeated shifts between wet, humid conditions and periods of prolonged drought.

Indonesia is already a dynamic region to begin with, split between the rainy monsoon season and the annual dry season. But these kinds of shifts are expected to become more dramatic as the climate continues to warm. In particular, the researchers say, climate change may spur more intense El Niño events in the future. These events can amplify the kinds of conditions that help the damaging salt crystals form.

Scientists are still debating the exact influence of climate change on El Niño, a natural climate cycle that drives shifting patterns of warming and cooling in the Pacific Ocean. But some studies do suggest that El Niño events may be more severe going forward. The new study, led by Jillian Huntley at Australia's Griffith University, examined 11 ancient cave art sites in South Sulawesi, Indonesia. The researchers found evidence of salt formation at all 11 sites.

At three of the sites, they found the types of crystals that most notoriously cause rocks to break apart. It's a small sample. There are more than 300 known cave art sites scattered around the region. But the research suggests that salt crystals may indeed be part of the problem.

In recent years, archaeologists have reported that the art appears to be rapidly deteriorating — at some sites, experts have reported as much as an inch of art vanishing every couple of months. Scientists have proposed multiple theories about what might be causing it. Along with climate change, they've suggested that pollution and other disturbances from nearby limestone mining operations might be degrading the fragile paintings. It's probably all of the above, Huntley and her colleagues suggest.

But they add that climate change is a growing threat, one that deserves more attention. In fact, they argue, salt-related degradation is "the most pressing threat to rock art preservation in this region" aside from mining. Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021.

E&E News provides essential news for energy and environment professionals..

Since the zithromax 200mg 5ml price http://markgrigsby.org/kamagra-oral-jelly-canada-price/ modern era of research on autism began in the 1980s, questions about social cognition and social brain development have been of central interest to researchers. This year marks the 20th anniversary of the first annual meeting of the International Society for Autism Research (INSAR), and it is evident in this year’s meeting that the growth of social cognitive neuroscience over the past two decades has significantly enriched autism science. For those unfamiliar with the term, social cognitive neuroscience is the study of the brain systems that zithromax 200mg 5ml price are involved in the causes and effects of social behaviors and social interaction.

Some of these involve brain systems involved in thinking about other people’s thoughts or intentions, empathizing, social motivation and the impact of social attention on an individual’s thinking and emotions. At the same time, research with and for autistic people has also enriched social cognitive neuroscience and the understanding of how our social minds develop. Autism spectrum disorder (ASD) is a complex and heterogeneous part of zithromax 200mg 5ml price the human condition, or neurodiversity.

It is associated with a wide range of life outcomes, from “disorder” or the profound challenges that encumber about 30 percent of affected individuals with minimal language and intellectual disability, to “differences” among people who have well-above-average abilities and accomplishments. Regardless of their outcomes, though, people on the autism spectrum travel a different path of social-cognitive neurodevelopment that appears to begin in infancy. For example, many experience zithromax 200mg 5ml price some level of difficulty with social cognitive mentalizing, also known as “theory of mind”—the mental representation of other people’s thoughts, perspectives, beliefs, intentions or emotions, which enables us to understand or predict their behaviors.

Social cognitive neuroscience tells us that brain systems of the medial frontal cortex, temporal cortex and parietal cortex, as well as reward centers of the brain, enable mentalizing. Accordingly, differences in the development and/or transmissions of information across this distributed social cognitive brain network may contribute to zithromax 200mg 5ml price differences in mentalizing among autistic people. These differences can lead to a range of outcomes, from problems in the capacity to mentalize to alterations in the spontaneous use of mentalizing, or the motivation and effort involved in mentalizing during social interactions.

These observations are informative, but do not address fundamental questions about how social-cognitive brain systems develop or why their development might be different for autistic people. These questions are essential in autism science because understanding the early course of social cognitive neurodevelopment zithromax 200mg 5ml price may afford the best opportunity to mitigate the profoundly negative effects that social cognitive differences can have on some autistic people. Serendipitously, this motivation to understand the very early development of our social brain can inform the broader understanding of social-cognitive neuroscience and human nature.

As it turns out, one key to understanding the development of our social brains may come from observations of social attention in infancy. As early as six to 12 months of age, some infants who go on zithromax 200mg 5ml price to receive an autism diagnosis already display differences in the development of social attention. They look less frequently at the face and eyes of people than other infants and are less likely to coordinate their attention with another person to adopt a common point of view or reference, or “joint attention.” Infants with neurotypical development follow the gaze direction or gesture of other people or lead the gaze of other people to establish joint attention and share information through a common perceptual perspective.

Developing the ability to coordinate attention socially is important in and of itself. For example, every teacher’s admonition to students zithromax 200mg 5ml price to “pay attention!. € is really a request to “pay attention to what I [the teacher] am attending to.” Joint attention is vital to social competence at all ages.

Adolescents and adults who cannot follow, initiate or join with the rapid-fire changes of shared attention in social interactions may be impaired zithromax 200mg 5ml price in their capacity for relatedness and relationships. Equally important, joint attention is also an early building block of social cognitive mentalizing. Every time infants coordinate attention socially with other people, they practice perceptual perspective-taking.

They do this hundreds if not thousands of times in early zithromax 200mg 5ml price development. It tunes aspects of social-brain development that subsequently support the capacity for mental perspective-taking. Mental perspective-taking is synonymous with mentalizing and our ability to understand the thoughts, beliefs, and intentions of other people.

Indeed, several studies provide evidence of a significant overlap in brain systems involved in joint attention and social-cognitive zithromax 200mg 5ml price mentalizing. Accordingly, differences in early social attention are thought to contribute to differences in the neurodevelopment of social cognitive mentalizing in some to many people with autism. Research also suggests that differences in systems that regulate the motivation for social attention might play a role in this aspect of the development of autism, though the nature of this motivation is not understood.

One possibility is that decreased motivation to attend to faces may lead to critical early difference in social attention zithromax 200mg 5ml price. Alternatively, differences in the “eye-contact effect” may impact social attention development. The eye-contact effect is a phenomenon in which awareness of being the object of others’ attention triggers an arousal response that enhances zithromax 200mg 5ml price stimulus salience and information processing during social attention coordination.

When we are aware of other people looking at us, changes occur in our mental processes that can benefit social learning. Several studies now suggest that people with autism may be less responsive to, or less aware of, being the object of attention of others. Hence, autism science raises the hypothesis that the first step toward human social neurocognitive development may involve months of practice zithromax 200mg 5ml price with social attention coordination with caregivers during infancy.

Moreover, our response to eye contact of other people may provide an early motivational stance that prioritizes infant social attention development and the development of our social brains. Notably, recent studies indicate that imitating the behavior of young children with autism, which likely affects a child’s awareness that another person is looking at them, can improve joint attention and language development. Of course, the most fundamental lesson zithromax 200mg 5ml price we can draw from all these observations about the development of our social mind is that we are all more similar than different, regardless of our paths of neurodevelopment, and that autistic people have much to teach us about the nature of human nature.

This is an opinion and analysis article. Further reading. Baron-Cohen, S zithromax 200mg 5ml price.

(2019). The concept of zithromax 200mg 5ml price neurodiversity is dividing the autism community. Scientific American.

Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & zithromax 200mg 5ml price. Schultz, R.

T. (2012). The social motivation theory of autism.

Trends in cognitive sciences, 16(4), 231-239. Gulsrud, A. C., Hellemann, G., Shire, S., &.

Kasari, C. (2016). Isolating active ingredients in a parent‐mediated social communication intervention for toddlers with autism spectrum disorder.

Journal of Child Psychology and Psychiatry, 57(5), 606-613. Grynszpan, O., Bouteiller, J., Grynszpan, S., Le Barillier, F., Martin, J. C., &.

Nadel, J. (2019). Altered sense of gaze leading in autism.

Research in Autism Spectrum Disorders, 67, 101441. Mundy, P. (2018).

A review of joint attention and social‐cognitive brain systems in typical development and autism spectrum disorder. European Journal of Neuroscience, 47(6), 497-514. Reddy, V.

(2003). On being the object of attention. Implications for self–other consciousness.

Trends in cognitive sciences, 7(9), 397-402. Senju, A., &. Johnson, M.

Mechanisms and development. Trends in cognitive sciences, 13(3), 127-134. Stephenson, L., Edwards, S.

From gaze perception to social cognition. A neurocognitive model of joint and shared attention. Perspectives on Psychological Science.

Https://journals.sagepub.com/doi/10.1177/1745691620953773Exxon Mobil Corp. Has used language to systematically shift blame for climate change from fossil fuel companies onto consumers, according to a new paper by Harvard University researchers. The paper, published yesterday in the journal One Earth, could bolster efforts to hold the oil giant accountable in court for its alleged deception about global warming.

"This is the first computational assessment of how Exxon Mobil has used language in subtle yet systematic ways to shape the way the public talks about and thinks about climate change," Geoffrey Supran, a research fellow at Harvard and co-author of the paper, said in an interview with E&E News. "One of our overall findings is that Exxon Mobil has used rhetoric mimicking the tobacco industry to downplay the reality and seriousness of climate change and to shift responsibility for climate change away from itself and onto consumers," he added. A spokesperson for Exxon Mobil disputed the paper, calling it part of a coordinated legal campaign against the company.

Supran and co-author Naomi Oreskes, a professor of the history of science at Harvard (and Scientific American columnist), conducted a computational analysis of 180 Exxon Mobil documents from 1972 to 2019, including peer-reviewed publications, advertorials in The New York Times and internal memos. Using a series of algorithms, the Harvard researchers found that Exxon Mobil had privately relied on some terms while publicly avoiding them altogether. For example, Exxon Mobil's internal documents frequently described climate change as a problem caused by "fossil fuel combustion." But in public-facing documents, the company referred to global warming as a problem caused by the "energy demand" of "consumers." The public communications sought to deflect responsibility for climate change away from the oil giant and onto individual consumers who heat their homes and fill their cars with gas, the researchers wrote.

Following their merger in 1999, Exxon and Mobil also increasingly presented climate change as a "risk," rather than a reality, the analysis found. This language sought to minimize the dangers of global warming while not denying their existence outright, the paper says. Court battles The researchers drew a direct comparison between Exxon Mobil and major tobacco companies, which they said used similar tactics to shape public discourse about smoking cigarettes.

"These patterns mimic the tobacco industry's documented strategy of shifting responsibility away from corporations — which knowingly sold a deadly product while denying its harms — and onto consumers," they wrote. In the 1990s, attorneys general from all 50 states sued the largest U.S. Tobacco companies over their alleged deception about the harmful health effects of smoking cigarettes and the addictive nature of nicotine.

The suits culminated in a $206 billion master settlement agreement (Climatewire, March 10). Since 2017, five states and more than a dozen municipalities have filed similar suits alleging that the biggest U.S. Oil and gas companies misled the public about the climate risks of burning fossil fuels.

The complaints ask the oil industry to help cover the costs of addressing floods, wildfires and other disasters fueled by rising global temperatures. Supran said that although he didn't conduct the study with the climate liability litigation in mind, the findings can nonetheless inform the legal fights. "Obviously, we did this completely independently.

I've never spoken to any of the lawyers involved," Supran said. "But certainly with hindsight, our insights may be relevant, especially to these more nascent cases alleging deceptive marketing." Last month, New York City filed a lawsuit asserting that Exxon Mobil, BP PLC and Royal Dutch Shell PLC violated the city's consumer protection law by engaging in "green washing," or the practice of making their fossil fuel products seem more environmentally friendly than they really are. Exxon pushback Asked for comment on the paper, Exxon spokesperson Casey Norton said in an email to E&E News.

"This research is clearly part of a litigation strategy against Exxon Mobil and other energy companies." Norton noted that Oreskes is on retainer with Sher Edling LLP, a San Francisco-based law firm that represents a slew of the challengers in the climate liability suits. "Oreskes did not disclose this blatant conflict of interest," he said. Norton also pointed to the paper's partial funding from the Rockefeller family, which Exxon has accused of supporting a climate conspiracy against the company (Climatewire, May 4).

"The research was paid for by the Rockefeller Family Fund, which is helping finance climate change litigation against energy companies," he said. "This follows a previous study attacking Exxon Mobil that used a similar discredited methodology." Norton was referring to a 2017 paper by Supran and Oreskes in the journal Environmental Research Letters that found Exxon's communications from 1977 to 2014 misled the public about climate science. Vijay Swarup, Exxon's vice president of research and development, previously blasted the 2017 paper as "fundamentally flawed" in a comment in Environmental Research Letters last year.

Norton concluded by stressing that Exxon supports climate action, noting that the oil giant recently proposed a massive carbon capture project in Houston (Energywire, April 20). "Exxon Mobil supports the Paris climate agreement, and is working to reduce company emissions and helping customers reduce their emissions while working on new lower-emission technologies and advocating for effective policies," he said. In a joint statement to E&E News, Supran and Oreskes pushed back on Norton's allegations.

"Sher Edling played no role in the paper we published today, nor in any other academic work we have done. They have not funded any of our studies. They have not reviewed our data or interpretations prior to its peer-reviewed publication.

And we have never discussed any of our work concerning ExxonMobil with them. Therefore, there is no conflict of interest and nothing to disclose," the researchers said. "For context, we note that over the past four years, ExxonMobil have attacked us and our work," they added.

"It has become a familiar pattern. We publish science, ExxonMobil offers spin and character assassination. ExxonMobil is now misleading the public about its history of misleading the public." Reprinted from E&E News with permission from POLITICO, LLC.

Copyright 2021. E&E News provides essential news for energy and environment professionals.And then there were two. Today China says it safely landed a spacecraft on Mars—for the first time in its history and in its first attempt, becoming the only other nation besides the U.S.

To achieve such a feat. Its Zhurong rover, named after a god of fire from Chinese folklore, successfully touched down in Utopia Planitia around 7:11 P.M. EST as part of the Tianwen-1 mission, according to the China National Space Administration.

Soon the rover should drive down the ramp of its landing platform, ready to explore its unearthly surroundings. If there was any doubt about China’s spacefaring prowess, it has been dispelled now that the nation has added interplanetary landings as a coveted notch on its belt “Mars is hard,” says Roger Launius, NASA’s former chief historian. €œThis is a really big deal.” Tianwen-1 was launched in July 2020 as part of a summer Martian armada that also included launches of NASA’s Perseverance rover and the United Arab Emirates’ Hope orbiter.

All three missions arrived at Mars in February. But while Perseverance descended straight to the surface, Tianwen-1 instead entered an elliptical orbit around the planet to give its scientists a god’s-eye view for scouting out their planned landing site in Utopia Planitia, an immense impact basin on Mars. €œChina does not have its own detailed Mars maps,” says Brian Harvey, a writer who covers the country’s space program.

At least, that was the case until today, when Tianwen-1’s controllers decided they had seen enough to confidently initiate the spacecraft’s daring descent. Packed inside a cone-shaped protective shell, Zhurong and its rocket-powered landing platform detached from the orbiter, descended toward Mars and began the fiery plunge through the planet’s upper atmosphere. After jettisoning its protective shell lower in the atmosphere, the spacecraft unfurled parachutes to slow its descent before riding thrusters down to a gentle landing on the surface.

This was “very similar” to the powered landings China has used in its Chang’e missions to Earth’s moon, says Andrew Jones, a space journalist who follows the Chinese space program. The latest of those missions returned samples to Earth in 2020. Other nations have tried and failed to land on Mars, but China’s success highlights how it is rapidly catching up to, if not exceeding, many of its counterparts.

The Soviet Union notably attempted multiple landings in the 1970s, coming closest with Mars 3, which touched down on the planet but stopped working moments later. The U.K. Reached the surface with its Beagle 2 lander in 2003.

The craft’s communications antenna failed to deploy, however, dooming the mission. The European Space Agency (ESA) and Russia also came close with their Schiaparelli lander—until it crashed on Mars in 2016. ESA will try again with its Rosalind Franklin rover in 2022.

Until today, only the U.S. Had successfully operated any spacecraft on Mars for a significant period of time, starting with the Viking landers of 1976 and extending to the country’s multiple landers and rovers that are exploring the surface today. China now joins this most elite and exclusive of clubs.

€œIt’s a big day for China,” says Mark McCaughrean, senior scientific adviser for science and exploration at ESA. €œWe know better than anyone how hard it can be to get safely down to the surface.” China will now wait an undisclosed amount of time, as little as a day or up to perhaps a week, before driving the Zhurong rover down a ramp from the lander and onto the surface. The six-wheeled solar-powered vehicle has a planned lifetime of 90 Martian days and is thought to have a top speed of 200 meters per hour, Jones says, although it will likely explore much more slowly.

China will upload commands to the rover via its Tianwen-1 orbiter, with ESA’s Mars Express orbiter acting as a backup. The rover will then perform its tasks autonomously on the surface, similar to the operational protocols NASA uses for its own fleet of robotic Martian explorers. Utopia Planitia was also the site for NASA’s Viking 2 in 1976.

It is a rather bland expanse of rock-strewn sand—decent for spacecraft landings but decidedly subpar for addressing cutting-edge research questions, such as whether Mars harbors past or present life. €œ[China is] not looking for biosignatures,” says Agnes Cousin, a planetary scientist at the Institute for Research in Astrophysics and Planetology in France, who has advised Tianwen-1 scientists. Yet Zhurong is still expected to perform important science on the surface of the Red Planet.

€œWe always have surprises when we arrive on the surface,” Cousin says. €œFor the overall geological implications for Mars, it’s very nice to have a new location to compare.” The rover is equipped with a suite of six instruments and cameras to study the surface. They include a ground-penetrating radar that could look for water and ice up to 100 meters below the surface (NASA’s Perseverance boasts a similar instrument).

Zhurong also has a magnetometer, the first ever sent to Mars on a rover. Alongside a similar instrument on the Tianwen-1 orbiter, which will continue studying the planet from afar, the rover’s magnetometer could reveal the details of how Mars lost its magnetic field—and consequently its atmosphere and water—billions of years ago. €œConceivably this instrument could help address that question,” says David Flannery, an astrobiologist at the Queensland University of Technology in Australia, who is familiar with China’s space activities.

€œTogether the instruments will tell us more about how the Martian magnetic field operates today.” Another instrument of note is the Mars Surface Composition Detector (MarSCoDe), a device similar to ChemCam on NASA’s Curiosity rover and SuperCam on Perseverance, which will use a laser to vaporize rock specimens on the surface, revealing their composition. Cousin is part of both the ChemCam and SuperCam teams, and she was among a group of European collaborators that helped China develop their instrument. She traveled to Shanghai in 2019 to exchange information with Tianwen-1 scientists on topics such as data-processing techniques and calibration targets to include on the rover to test the instrument on Mars.

€œThey wanted big calibration targets” for MarSCoDe, Cousin says. €œSo we gave them one”. A two-centimeter-wide square of an igneous rock called norite that is one of 12 such targets on the rover.

While the science goals of the rover may be somewhat modest, it is also expected to be a technology demonstration for a much more ambitious future project. By 2028 or 2030, China hopes to send a sample-return mission to Mars to bring pristine Martian rocks back to Earth. That timing is similar to, or perhaps even in advance of, when NASA and ESA plan to do the same with their own interplanetary grab-and-go effort.

€œWill it be China bringing the first Mars material back to Earth, or will it be NASA and ESA?. € says Jacqueline Myrrhe, a journalist affiliated with the Chinese space Web site Go Taikonauts!. “This could be a very good question.” Landing on Mars is the latest pinnacle achievement from China’s planned portfolio of ambitious space activities.

But already the nation has more than proved its mettle. It has conducted numerous sorties to the moon and has begun the construction of a space station in Earth orbit. The nation may send a pair of spacecraft to the edge of the solar system in just a few years and launch a mission to Jupiter by the end of the decade.

Now that Tianwen-1 has shown that China is an adept interplanetary explorer, even more audacious projects may be on the horizon. €œIt’s the first step for much more,” Myrrhe says.Some of the oldest art in human history is disintegrating, scientists say. And climate change may be hastening its demise.

New research reports that ancient rock art in Indonesian caves is degrading over time, as bits of rock slowly flake away from the walls. It's a tremendous loss for human history — some of these paintings, which depict everything from animals to human figures to abstract symbols, date back about 40,000 years. Salt crystals building up on the walls are a key part of the problem, the study suggests.

These salt deposits seep into the cave walls, then proceed to expand and contract as temperatures rise and fall. This process causes the rock to slowly disintegrate. Changes in the weather may be helping the process along, scientists say.

Salt crystals may expand more readily when they're exposed to repeated shifts between wet, humid conditions and periods of prolonged drought. Indonesia is already a dynamic region to begin with, split between the rainy monsoon season and the annual dry season. But these kinds of shifts are expected to become more dramatic as the climate continues to warm.

In particular, the researchers say, climate change may spur more intense El Niño events in the future. These events can amplify the kinds of conditions that help the damaging salt crystals form. Scientists are still debating the exact influence of climate change on El Niño, a natural climate cycle that drives shifting patterns of warming and cooling in the Pacific Ocean.

But some studies do suggest that El Niño events may be more severe going forward. The new study, led by Jillian Huntley at Australia's Griffith University, examined 11 ancient cave art sites in South Sulawesi, Indonesia. The researchers found evidence of salt formation at all 11 sites.

At three of the sites, they found the types of crystals that most notoriously cause rocks to break apart. It's a small sample. There are more than 300 known cave art sites scattered around the region.

But the research suggests that salt crystals may indeed be part of the problem. In recent years, archaeologists have reported that the art appears to be rapidly deteriorating — at some sites, experts have reported as much as an inch of art vanishing every couple of months. Scientists have proposed multiple theories about what might be causing it.

Along with climate change, they've suggested that pollution and other disturbances from nearby limestone mining operations might be degrading the fragile paintings. It's probably all of the above, Huntley and her colleagues suggest. But they add that climate change is a growing threat, one that deserves more attention.

In fact, they argue, salt-related degradation is "the most pressing threat to rock art preservation in this region" aside from mining. Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021.

E&E News provides essential news for energy and environment professionals..

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In harsh tones, the Alzheimer’s Association sharply criticized Biogen (BIIB) for the $56,000 price tag placed on its newly approved Alzheimer’s treatment, a move online zithromax prescription that threatens to embroil the biotech company and its medication in yet useful reference another national controversy.The patient advocacy group released a brief statement on Saturday calling the wholesale price “simply unacceptable” and that, for many people, it “will pose an insurmountable barrier to access … and may further deepen issues of health equity.” The organization expressed gratitude that the drug was approved in response to a “vast unmet need,” but called on Biogen to change the price. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More online zithromax prescription What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis.

Our award-winning team covers news on Wall Street, policy developments in Washington, online zithromax prescription early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.To understand why billionaires are a sign of moral and economic failure, look no further than the buy antibiotics zithromax.Drug corporations could earn $190 billion from buy antibiotics treatment sales this year. Pharmaceutical profits have minted nine new zithromax billionaires, and helped eight existing billionaires enlarge their fortunes online zithromax prescription.

Several of these are founders and private investors in three pharmaceutical corporations — Moderna, BioNTech, and CureVac — whose treatments use mRNA technology that was largely developed from publicly funded research.Their financial bonanzas provide a disturbing contrast with treatment apartheid. By the end of May, only 0.3% of all treatment doses worldwide had been administered in low-income countries.advertisement Facing condemnation for hoarding doses, the G-7 countries, which are meeting this weekend in England, are under pressure to online zithromax prescription launch a new plan to expand buy antibiotics immunization globally. One hotly contested issue is whether they will call for mandatory sharing of mRNA treatment technologies, including a proposed waiver of intellectual property rights for buy antibiotics technologies. zithromax billionaires are speaking out against government intervention, warning it would undermine innovation and claiming that their firms can satisfy global demand for buy antibiotics treatments.advertisement Because the public sector was largely responsible for developing mRNA technology and sharing it with corporations, the zithromax fortunes of these founders and investors stands in stark and repugnant contrast to billions of unvaccinated people.Moderna, BioNTech, and CureVac are online zithromax prescription each led by founders or longtime executives with a key role in company decision-making.

Stéphane Bancel is Moderna’s CEO, Özlem Türeci and Ugur Sahin are BioNTech’s co-founders, and Franz-Werner Haas is CureVac’s CEO. In addition to getting head starts from publicly funded research, these companies also relied on private investment provided through venture capital or family offices (privately held companies that handle investment and wealth management for wealthy families). Venture capital investors include Flagship Pioneering, online zithromax prescription a Boston-based firm whose founder, Noubar Afeyan, also serves as Moderna’s chair, and MIG AG, a German venture capital firm that made early investments in BioNTech. Other large investors in BioNTech and CureVac were German family offices, including investments by Dietmar Hopp in CureVac and the Struengmann brothers in BioNTech.Founders, executives, venture capitalists, and family offices all held substantial ownership stakes in the three mRNA companies heading into the zithromax.

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Sharing would allow these companies to earn royalties — and profits.One year ago, the World Health Organization launched the buy antibiotics Technology Access Pool (CTAP) to facilitate sharing of intellectual property, knowledge, data, and know-how to a common pool that could be used by manufacturers worldwide to expand the supply of buy antibiotics treatments. So far online zithromax prescription the pool remains empty. treatment production remains tightly controlled, highly concentrated, and insufficient to the scale of need. This failure to share treatment recipes and processes may have undermined global immunization efforts, but it online zithromax prescription handsomely profited founders and investors.

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The pre-fusion spike protein used in mRNA treatments was built by researchers at the National Institutes of Health treatment Research Center and Dartmouth College.In addition, governments, foundations, and agencies have contributed more than $100 billion for development and manufacturing of medical countermeasures, including treatments. The German government now owns a 23% stake in CureVac owing to a 300 million Euro investment.Yet online zithromax prescription despite this substantial public subsidy, companies have not been required to share knowledge and promote equitable access. The Gates Foundation and the Coalition for Epidemic Preparedness Innovations (CEPI) both withdrew obligations to make treatments available and affordable from pre-zithromax contracts signed with CureVac. The NIH has not online zithromax prescription exercised its leverage to ramp up worldwide manufacturing of the Moderna treatment.

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The finding may online zithromax prescription not be immediately applicable for civilians eying a trip to space, but researchers believe it could be a stepping stone for understanding risks to reproduction if humans ever colonize Mars, as SpaceX CEO Elon Musk plans to start doing by the year 2050.“I read a lot of science fiction books,” Teruhiko Wakayama, a scientist at University of Yamanashi in Japan and author of the new study, said in an email. €œI had an exam to be an astronaut (of course I failed), then I became a scientist, but still wanted to include something about space.”advertisement Space radiation is one of the five major health hazards facing humans who lift off the planet, particularly for its potential to cause cancer, cardiovascular disease, and cognitive problems. For the short-term exploration missions that astronauts typically embark on today, the online zithromax prescription doses of space radiation that they’re exposed to are likely too low to cause reproductive problems. “But as we move from space exploration to things like colony building and long-term living in space, doses from space radiation are going to accumulate and these may manifest as fertility and reproductive decrement,” said Zarana Patel, a senior scientist with the technology and engineering company KBR, Inc., and contractor for NASA’s Human Research Program, who was not involved in the study.advertisement Most studies on space radiation and its biological effects up to now have taken place, counterintuitively, on Earth.

Astronauts are busy people who don’t always have time to perform complicated online zithromax prescription or advanced experiments, and there’s not always a lot of space in space. Live animals or cell cultures that require regular maintenance, particularly samples like sperm that need to be kept in freezers, are not kept on the space station for long periods of time. Still, it’s difficult to reproduce the full force of space’s radioactive ions, which are different from radiation on the ground.“To learn about space biology, we have to perform real space experiments,” said Wakayama.So in 2013, Wakayama and his team sent 12 samples of freeze-dried sperm, which can be stored at room temperature, up to the International Space Station to study the long-term effects of space radiation on reproduction. The first sperm samples were returned to Earth after just nine months, to ensure everything was intact and working online zithromax prescription properly.

More samples returned after almost three years, and the final samples were retrieved after almost six years in space.The returned sperm were thawed and evaluated for DNA damage before being used to produce two generations of “space pups.” There were slight differences in the preservation of DNA and the rate of offspring produced between the 3-year and 6-year sperm, but they were both small enough that researchers concluded the space radiation did not cause damage. Healthy mice online zithromax prescription were born from each set of the freeze-dried samples. Wakayama also analyzed each generation’s gene expression and found no difference between the space pups and the control group, produced with fresh sperm. Experts online zithromax prescription say that’s a novel finding, though there are caveats that make it difficult to draw conclusions about the relevance to humans.The International Space Station orbits within Earth’s gravitational field, meaning that radiation isn’t as strong as it would be in deep space or on Mars.

And the sperm is actually strengthened against space radiation in the freeze-drying process, according to the researchers, who also performed experiments on the ground to observe the effects of the freeze-drying process.Additionally, the study only looked at mature sperm, but scientists have known for decades that radiation affects the entire process of sperm development. And when the sperm landed back on Earth to be thawed, re-hydrated, and used to fertilize female cells, the study only used one type of female mouse.“It’s the diversity of the female’s ability to repair sperm damage that is the most important thing,” said Andrew Wyrobek, a senior scientist at Lawrence Berkeley National Laboratory who has studied radiation and the reproductive system since 1975, who was not involved in the study. In the short term, experts said the study online zithromax prescription could bring needed attention to the potential dangers of space radiation to the reproductive system. Mars will need to be explored before the farms are built, and such a mission could take two or three years, said Ulrike Luderer, director at the Center for Occupational and Environmental Health at University of California, Irvine, who was also not involved in the study.

To prepare, experts say that an integrated approach to ground and space research is needed, as both come with limitations.“It is a small, very elite population of people, but nonetheless, those are people who are going to be exposed to these hazards,” said Luderer.While more research is needed to learn the true dangers of space radiation for human reproductive systems, Wakayama hopes the new study may prove that if humans do move to Mars someday, other mammals could be brought along through freeze-dried reproduction cells.“I believe that our research results will give the average online zithromax prescription person a sense of security about space,” said Wakayama.When the freeze-dried sperm first launched to space in 2013, Wakayama and his team had been working on the proposal and preparation for four years. At the launch, the whole team cried with joy. Wakayama took a video that day and plays it regularly for students.“I think I’ve watched the movie online zithromax prescription more than 100 times, but still every time, it makes me want to cry.”Hired someone new and exciting?. Promoted a rising star?.

Finally solved that hard-to-fill spot?. Share the news online zithromax prescription with us, and we’ll share it with others. That’s right. Send us your changes, and we’ll find a online zithromax prescription home for them.

Don’t be shy. Everyone wants to know who is coming and going.And here is our regular feature in which we highlight a different person each week. This time around, we note that Palleon Pharmaceuticals hired David online zithromax prescription Feltquate as chief medical officer. Previously, he worked at Novartis (NVS), where he was global head of hematology development.

Unlock this article by subscribing to STAT+ online zithromax prescription and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and online zithromax prescription analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our online zithromax prescription reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.And so, another working week will soon draw to a close. Not a moment too soon, yes?. This is, you online zithromax prescription may recall, our treasured signal to daydream about weekend plans.

Our agenda is filled with mundane chores, primarily tidying the Pharmalot grounds, but we also hope to catch up on our reading and promenade the official mascot. And what online zithromax prescription about you?. This is a fine time to enjoy the great outdoors, especially if you have been vaccinated. You could touch base with folks not seen in some time.

Or simply online zithromax prescription plan the rest of your life. Well, whatever you do, have a grand time. But be safe. Enjoy, and see you soon.

€¦A third member of a Food and Drug Administration expert panel has resigned over the agency’s contentious approval of the Biogen (BIIB) Alzheimer’s therapy this week, STAT writes. In a letter to acting FDA Commissioner Janet Woodcock on Thursday, Aaron Kesselheim, who had served on the FDA’s advisory committee for nervous system therapies since 2015, wrote that the approval of the drug, called Aduhelm, “was probably the worst drug approval decision in recent U.S. History.” Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is it?.

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

In harsh tones, the Alzheimer’s Association sharply criticized Biogen (BIIB) for the $56,000 price tag placed on its newly approved Alzheimer’s treatment, a move that zithromax 200mg 5ml price how to get zithromax z pak threatens to embroil the biotech company and its medication in yet another national controversy.The patient advocacy group released a brief statement on Saturday calling the wholesale price “simply unacceptable” and that, for many people, it “will pose an insurmountable barrier to access … and may further deepen issues of health equity.” The organization expressed gratitude that the drug was approved in response to a “vast unmet need,” but called on Biogen to change the price. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log zithromax 200mg 5ml price In | Learn More What is it?.

STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning zithromax 200mg 5ml price team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included?.

Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.To understand why billionaires are a sign of moral and economic failure, look no further than the buy antibiotics zithromax.Drug corporations could earn $190 billion from buy antibiotics treatment sales this year. Pharmaceutical profits have minted nine new zithromax billionaires, and zithromax 200mg 5ml price helped eight existing billionaires enlarge their fortunes. Several of these are founders and private investors in three pharmaceutical corporations — Moderna, BioNTech, and CureVac — whose treatments use mRNA technology that was largely developed from publicly funded research.Their financial bonanzas provide a disturbing contrast with treatment apartheid.

By the end of May, only 0.3% of all treatment doses worldwide had zithromax 200mg 5ml price been administered in low-income countries.advertisement Facing condemnation for hoarding doses, the G-7 countries, which are meeting this weekend in England, are under pressure to launch a new plan to expand buy antibiotics immunization globally. One hotly contested issue is whether they will call for mandatory sharing of mRNA treatment technologies, including a proposed waiver of intellectual property rights for buy antibiotics technologies. zithromax billionaires are speaking out against government intervention, warning it would undermine innovation and claiming that their firms can satisfy global demand for buy antibiotics treatments.advertisement Because the public sector was largely responsible for developing mRNA technology and sharing it with corporations, the zithromax fortunes of these founders and investors stands in stark and repugnant contrast to billions of unvaccinated people.Moderna, zithromax 200mg 5ml price BioNTech, and CureVac are each led by founders or longtime executives with a key role in company decision-making.

Stéphane Bancel is Moderna’s CEO, Özlem Türeci and Ugur Sahin are BioNTech’s co-founders, and Franz-Werner Haas is CureVac’s CEO. In addition to getting head starts from publicly funded research, these companies also relied on private investment provided through venture capital or family offices (privately held companies that handle investment and wealth management for wealthy families). Venture capital investors include Flagship zithromax 200mg 5ml price Pioneering, a Boston-based firm whose founder, Noubar Afeyan, also serves as Moderna’s chair, and MIG AG, a German venture capital firm that made early investments in BioNTech.

Other large investors in BioNTech and CureVac were German family offices, including investments by Dietmar Hopp in CureVac and the Struengmann brothers in BioNTech.Founders, executives, venture capitalists, and family offices all held substantial ownership stakes in the three mRNA companies heading into the zithromax. All of them had zithromax 200mg 5ml price a choice at the start of the zithromax. Maximize profits or maximize low-cost, global production of treatments.The three firms chose profit maximization, partnering with multinational companies or forging partnerships with a few contract manufacturers.

This year, these companies will have sold nearly all their limited supply of treatments to wealthy countries at high prices.They could have instead zithromax 200mg 5ml price chosen to avoid scarcity and hoarding by sharing technology, know-how, and intellectual property with other manufacturers, thereby expanding and decentralizing production. It wouldn’t be like they were giving away their intellectual property for free. Sharing would allow these companies to earn royalties — and profits.One year ago, the World Health Organization launched the buy antibiotics Technology Access Pool (CTAP) to facilitate sharing of intellectual property, knowledge, data, and know-how to a common pool that could be used by manufacturers worldwide to expand the supply of buy antibiotics treatments.

So far the pool remains zithromax 200mg 5ml price empty. treatment production remains tightly controlled, highly concentrated, and insufficient to the scale of need. This failure to share treatment recipes and processes may have undermined global immunization efforts, but zithromax 200mg 5ml price it handsomely profited founders and investors.

Ever since the WHO declared the buy antibiotics zithromax to be a public health emergency of international concern on Jan. 30, 2020, the share prices of Moderna and BioNTech have risen tenfold and eightfold, respectively, while CureVac’s share price has nearly doubled since going public in August 2020.With share prices soaring, executives, founders, and investors have sold zithromax 200mg 5ml price millions of shares, some becoming paper billionaires. In just two months in 2020, Abeyan sold shares totaling $1.5 billion.

The Struengmann brothers added an estimated $8 billion to their wealth in 2020, while MIG AG, early investors in BioNTech, pocketed $719 million.When these companies failed to act responsibly, governments should have stepped in. After all, governments (and philanthropies) invested substantially in the development of mRNA technology zithromax 200mg 5ml price and buy antibiotics treatments. The mRNA technology itself is based on decades of publicly funded research.

A key university researcher, zithromax 200mg 5ml price Katalin Karikó, now works at BioNTech. The lipid nanoparticle, a critical ingredient of mRNA treatments, emerged from publicly funded research conducted by Massachusetts Institute of Technology’s Robert Langer, who was a co-founder of Moderna. The pre-fusion spike protein used in mRNA treatments was built by researchers at the National Institutes of Health treatment Research Center and Dartmouth College.In addition, governments, foundations, and agencies have contributed more than $100 billion for development and manufacturing of medical countermeasures, including treatments.

The German government now owns a 23% stake in CureVac owing to a 300 million Euro investment.Yet despite zithromax 200mg 5ml price this substantial public subsidy, companies have not been required to share knowledge and promote equitable access. The Gates Foundation and the Coalition for Epidemic Preparedness Innovations (CEPI) both withdrew obligations to make treatments available and affordable from pre-zithromax contracts signed with CureVac. The NIH has not exercised its zithromax 200mg 5ml price leverage to ramp up worldwide manufacturing of the Moderna treatment.

Incredibly, Richard Hatchett, the CEO of the CEPI, which itself had the power to negotiate access conditions in its contracts with multinational drug companies, recently stated that the “great missed opportunity of 2020, I would even say the tragedy” of the zithromax was that funders of treatment development did not include access provisions with funding.Even as investors and founders’ cash in, the world is not reaching an off-ramp from the zithromax. More than 10,000 people are dying zithromax 200mg 5ml price daily and low-income countries could wait decades to be fully vaccinated, even as companies plan booster and variant doses for rich countries to protect against mutations that occur in unvaccinated populations.The G-7 must move to support and enact an intellectual property waiver, invest in worldwide manufacturing, share doses equitably (a late-breaking G-7 announcement of a donation of 1 billion doses is welcome news but is ultimately neither sufficient nor sustainable), and require corporations to share know-how. Founders and investors have been allowed to bend the course of the zithromax to their private benefit.

When a few people win big, everyone else loses.Rohit Malpani is a public health consultant based in Paris, France, and a board member for Unitaid, a global health initiative that works with partners in low- and middle-income countries.While billionaires like Jeff Bezos and Elon Musk were vying to launch themselves into space, scientists have been busy shuttling freeze-dried mouse sperm through the stars.In new research published Friday in Science Advances, scientists studying the effects of space radiation on reproduction report that freeze-dried mouse sperm weathered a nearly six-year trip on the International Space Station without any damage and could ultimately last for 200 years in space. The finding may not be immediately applicable for civilians eying a trip to space, but researchers believe it could be a stepping stone for understanding risks to reproduction if humans ever colonize Mars, as SpaceX zithromax 200mg 5ml price CEO Elon Musk plans to start doing by the year 2050.“I read a lot of science fiction books,” Teruhiko Wakayama, a scientist at University of Yamanashi in Japan and author of the new study, said in an email. €œI had an exam to be an astronaut (of course I failed), then I became a scientist, but still wanted to include something about space.”advertisement Space radiation is one of the five major health hazards facing humans who lift off the planet, particularly for its potential to cause cancer, cardiovascular disease, and cognitive problems.

For the short-term exploration missions that astronauts typically embark on today, the doses of space radiation that zithromax 200mg 5ml price they’re exposed to are likely too low to cause reproductive problems. “But as we move from space exploration to things like colony building and long-term living in space, doses from space radiation are going to accumulate and these may manifest as fertility and reproductive decrement,” said Zarana Patel, a senior scientist with the technology and engineering company KBR, Inc., and contractor for NASA’s Human Research Program, who was not involved in the study.advertisement Most studies on space radiation and its biological effects up to now have taken place, counterintuitively, on Earth. Astronauts are zithromax 200mg 5ml price busy people who don’t always have time to perform complicated or advanced experiments, and there’s not always a lot of space in space.

Live animals or cell cultures that require regular maintenance, particularly samples like sperm that need to be kept in freezers, are not kept on the space station for long periods of time. Still, it’s difficult to reproduce the full force of http://marcusfalden.com/marketing-products-page/your-account/ space’s radioactive ions, which are different from radiation on the ground.“To learn about space biology, we have to perform real space experiments,” said Wakayama.So in 2013, Wakayama and his team sent 12 samples of freeze-dried sperm, which can be stored at room temperature, up to the International Space Station to study the long-term effects of space radiation on reproduction. The first sperm samples were returned to Earth after just nine months, zithromax 200mg 5ml price to ensure everything was intact and working properly.

More samples returned after almost three years, and the final samples were retrieved after almost six years in space.The returned sperm were thawed and evaluated for DNA damage before being used to produce two generations of “space pups.” There were slight differences in the preservation of DNA and the rate of offspring produced between the 3-year and 6-year sperm, but they were both small enough that researchers concluded the space radiation did not cause damage. Healthy mice were born from each set of the freeze-dried samples zithromax 200mg 5ml price. Wakayama also analyzed each generation’s gene expression and found no difference between the space pups and the control group, produced with fresh sperm.

Experts say zithromax 200mg 5ml price that’s a novel finding, though there are caveats that make it difficult to draw conclusions about the relevance to humans.The International Space Station orbits within Earth’s gravitational field, meaning that radiation isn’t as strong as it would be in deep space or on Mars. And the sperm is actually strengthened against space radiation in the freeze-drying process, according to the researchers, who also performed experiments on the ground to observe the effects of the freeze-drying process.Additionally, the study only looked at mature sperm, but scientists have known for decades that radiation affects the entire process of sperm development. And when the sperm landed back on Earth to be thawed, re-hydrated, and used to fertilize female cells, the study only used one type of female mouse.“It’s the diversity of the female’s ability to repair sperm damage that is the most important thing,” said Andrew Wyrobek, a senior scientist at Lawrence Berkeley National Laboratory who has studied radiation and the reproductive system since 1975, who was not involved in the study.

In the short term, experts said the study could bring needed attention to the potential dangers of space radiation zithromax 200mg 5ml price to the reproductive system. Mars will need to be explored before the farms are built, and such a mission could take two or three years, said Ulrike Luderer, director at the Center for Occupational and Environmental Health at University of California, Irvine, who was also not involved in the study. To prepare, experts say that an integrated approach to ground and space research is needed, as both come with limitations.“It is a small, very elite population of people, but nonetheless, those are people who zithromax 200mg 5ml price are going to be exposed to these hazards,” said Luderer.While more research is needed to learn the true dangers of space radiation for human reproductive systems, Wakayama hopes the new study may prove that if humans do move to Mars someday, other mammals could be brought along through freeze-dried reproduction cells.“I believe that our research results will give the average person a sense of security about space,” said Wakayama.When the freeze-dried sperm first launched to space in 2013, Wakayama and his team had been working on the proposal and preparation for four years.

At the launch, the whole team cried with joy. Wakayama took a video zithromax 200mg 5ml price that day and plays it regularly for students.“I think I’ve watched the movie more than 100 times, but still every time, it makes me want to cry.”Hired someone new and exciting?. Promoted a rising star?.

Finally solved that hard-to-fill spot?. Share the news with us, and we’ll share it zithromax 200mg 5ml price with others. That’s right.

Send us your zithromax 200mg 5ml price changes, and we’ll find a home for them. Don’t be shy. Everyone wants to know who is coming and going.And here is our regular feature in which we highlight a different person each week.

This time around, we note that Palleon Pharmaceuticals hired zithromax 200mg 5ml price David Feltquate as chief medical officer. Previously, he worked at Novartis (NVS), where he was global head of hematology development. Unlock this article by subscribing to STAT+ and enjoy your first zithromax 200mg 5ml price 30 days free!.

GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, zithromax 200mg 5ml price pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like zithromax 200mg 5ml price our CRISPR Trackr.And so, another working week will soon draw to a close. Not a moment too soon, yes?.

This is, you may recall, our treasured signal zithromax 200mg 5ml price to daydream about weekend plans. Our agenda is filled with mundane chores, primarily tidying the Pharmalot grounds, but we also hope to catch up on our reading and promenade the official mascot. And what about you? zithromax 200mg 5ml price.

This is a fine time to enjoy the great outdoors, especially if you have been vaccinated. You could touch base with folks not seen in some time. Or simply zithromax 200mg 5ml price plan the rest of your life.

Well, whatever you do, have a grand time. But be safe zithromax 200mg 5ml price. Enjoy, and see you soon.

€¦A third member of zithromax 200mg 5ml price a Food and Drug Administration expert panel has resigned over the agency’s contentious approval of the Biogen (BIIB) Alzheimer’s therapy this week, STAT writes. In a letter to acting FDA Commissioner Janet Woodcock on Thursday, Aaron Kesselheim, who had served on the FDA’s advisory committee for nervous system therapies since 2015, wrote that the approval of the drug, called Aduhelm, “was probably the worst drug approval decision in recent U.S. History.” Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!.

GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr..

Zithromax and strep pharyngitis

Nearly a year after police officers in Loveland, Colorado, injured an elderly woman with dementia and then laughed at footage of her arrest, two of those officers are facing criminal charges while the zithromax and strep pharyngitis rest of the department undergoes additional training. The fallout has drawn national attention to a problem that experts say is widespread across law enforcement agencies. Police often lack the skills to interact with people with zithromax and strep pharyngitis mental and physical disabilities. Last June, a Walmart employee called police after Karen Garner, 73 at the time, tried to leave without paying for $14 worth of items. Soon after, Officer Austin Hopp’s body camera video showed, he pulled over beside her as she walked down a road and wrestled her to the ground in handcuffs after she failed to respond to his questions.

Afterward, Garner’s lawyers say, she sat in jail for several hours with a dislocated and fractured shoulder as zithromax and strep pharyngitis Hopp and two other officers laughed while watching the body camera video. According to a federal complaint, Garner has dementia and also suffers from sensory aphasia, which impairs her ability to understand. Her violent arrest has other elderly people worried about potential encounters with police, Loveland resident June Dreith told Police Chief Robert Ticer during a public meeting last month. €œThey are now seriously zithromax and strep pharyngitis afraid of the police department,” Dreith said. Hopp resigned and faces felony charges of assault and attempting to influence a public servant — a charge related to allegations of omissions when reporting the arrest — as well as official misconduct, a misdemeanor.

Another officer, Daria Jalali, also resigned and is charged with three misdemeanors. Failure to report excessive force, zithromax and strep pharyngitis failure to intervene and official misconduct. Neither has entered a plea in court. A third officer, who watched the video with them, resigned but has not been charged. An independent assessment of the Loveland Police Department by a third-party consultant is zithromax and strep pharyngitis underway.

The city and involved officers face a federal lawsuit, filed by Garner in April, alleging excessive use of force and violations of the Americans With Disabilities Act. Ticer declined to be interviewed, but through his public information officer he characterized the Garner incident as a problem with an individual officer, not with the department’s operations zithromax and strep pharyngitis. €œOur training currently, in the past and present, is always to make sure our officers are up to speed on as much training as they can on how to interact with people in crisis who may have mental health issues,” Ticer said during the public meeting in May at department headquarters. Loveland’s police department, like many others, requires officers to be trained to respond to people with mental illness and developmental disabilities. But no national standards exist zithromax and strep pharyngitis.

That means the amount of training law enforcement officers receive on interacting with disabled people varies widely. €œOn the whole, we’re doing terrible,” said Jim Burch, president of the National Police Foundation, a nonprofit organization focused on police research and training. €œWe have to do much, much better at being able to recognize these types of issues and being more sensitive to them.” While zithromax and strep pharyngitis comprehensive data on the frequency of negative interactions between police and people with mental disabilities is lacking, interactions with the criminal justice system are common. The Bureau of Justice Statistics has estimated about 3 in 10 state and federal prisoners and 4 in 10 local jail inmates have at least one disability. €œThere’s a very large number of people that police are coming into contact with that have an intellectual disability or mental health challenge,” Burch said.

€œDo we zithromax and strep pharyngitis have a systemic problem?. We think that we do.” Colorado requires a minimum of two hours of training on interacting with people with disabilities, although legislation aims to improve on that by creating a commission to recommend new statewide standards. Loveland’s officers are certified in crisis intervention training. The department also has a co-responder program, which pairs law enforcement officers with mental health clinicians, although this team was not called zithromax and strep pharyngitis during Garner’s arrest. Since that incident, questions remain about the department’s readiness to interact with disabled citizens.

€œWe could always use more and more training. We could train every zithromax and strep pharyngitis single week for eight hours a day, but we could do that all the time and never go out on calls,” said Sgt. Brandon Johnson, who oversees training. €œIt’s just balancing our available workforce and our time and our service to the community and our staffing levels.” zithromax and strep pharyngitis Loveland police officers are now undergoing Alzheimer’s awareness training, and five staff members will be trained as de-escalation instructors, department officials said. Loveland Police Chief Robert Ticer characterized Garner’s rough arrest as an issue with an individual officer, not with the department’s operations.

The city’s police are now undergoing Alzheimer’s awareness training. (Leigh Paterson / KHN) Training on how to zithromax and strep pharyngitis interact with disabled people varies, but the basics include identifying such individuals early in an encounter instead of relying on use of force. €œIt’s scary, because you don’t know why they’re not following your commands,” said Ali Thompson, a former deputy with the Boulder County Sheriff’s Office who now serves on the Colorado Developmental Disabilities Council. €œSo, your adrenaline starts pumping and you think … ‘They’re not listening to my commands because they have a warrant or because they have a gun on them,’ or you come up with all of these scenarios to explain it.” Garner’s rough arrest is “not an isolated incident by any means,” Thompson said. She said she would not have thought to attribute noncompliance to conditions like autism or zithromax and strep pharyngitis dementia when she was a young patrol officer.

€œWe need to start bringing those possibilities into those ‘what if’ scenarios,” Thompson said. In addition to teaching how to identify disabled people, organizations such as the International Association of Chiefs of Police help prepare officers for such situations by showing them how to speak in short phrases, refrain from touching, and turn off sirens and flashing lights. Research on which disability-specific efforts actually reduce bad zithromax and strep pharyngitis outcomes is scant, but experts point to other types of curricula as relevant, too, including crisis intervention training, instruction on de-escalating tensions and sessions on mental illness. €œJust training in and of itself is not going to create that long-term change that we are hoping for,” said Lee Ann Davis, director of criminal justice initiatives at The ARC, a national disability advocacy organization. That means going beyond officer training to address the many areas in which people with disabilities are not being identified and supported, she said.

One of The ARC’s programs, Pathways to Justice, brings in not only law enforcement zithromax and strep pharyngitis officials but also attorneys and victim service providers for instruction. €œSo our goal is to help communities understand that this is a communitywide issue, that there’s not one specific spoke within the criminal justice system or in our communities that can address it adequately alone,” Davis said. Johnson, the Loveland sergeant in charge of training, said officers have been engaged for years in community outreach such as supporting the Special Olympics. Despite the zithromax and strep pharyngitis actions of the three officers who resigned, Johnson believes the department is adequately prepared to interact with disabled citizens. At the same time, he acknowledges limitations.

€œWe have zithromax and strep pharyngitis to be the first responder. We have to have a good foundational understanding of all of it,” he said. €œBut we’re also not … we’re also not experts.” Related Topics Contact Us Submit a Story TipFor more than a year, public health officials have repeatedly told us that masks save lives. They’ve warned zithromax and strep pharyngitis us to keep our distance from our neighbors, who’ve morphed into disease vectors before our eyes. Now they are telling us that if we’re vaccinated, we no longer need to wear masks or physically distance ourselves in most cases — even indoors.

To many people, myself included, this seems hard to reconcile with so many long months of masking and physical distancing and sacrificing our social lives for fear of buy antibiotics. What is an anxious, zithromax-weary (and wary) soul to zithromax and strep pharyngitis do?. First, it’s important to stress that the dramatic rollback of mask-wearing and physical distancing recommended last month by the Centers for Disease Control and Prevention — a policy California has adopted starting Tuesday as part of a broader reopening — applies only to people who have been fully vaccinated. Even if you are vaccinated, though, you don’t need to change your behavior one iota if doing so makes you uncomfortable. €œNothing in zithromax and strep pharyngitis the CDC guidelines says to stop wearing a mask,” says Dr.

José Mayorga, executive director of the UCI Health Family Health Centers. €œIt’s a recommendation, but if you choose to wear one, that’s OK. You shouldn’t be stigmatized.” Mayorga has lost five relatives to buy antibiotics, zithromax and strep pharyngitis including a favorite aunt, and he knows from personal experience how hard it can be to rush back into so-called normalcy. €œMany people have not been directly impacted by buy antibiotics,” he says. €œBut for those of us who have been, it’s natural to have concern or fear, thinking, ‘Oh, I can take my mask off?.

But is it really safe? zithromax and strep pharyngitis. €™â€ Some people are just cautious by nature and won’t be rushing to jettison their masks and rub elbows with unmasked strangers. €œI know that, realistically, I can do pretty much anything once I’m fully vaccinated, but mentally it’s zithromax and strep pharyngitis scary,” says 36-year-old Sacramento resident Shannon Albers, who got her second dose of the Pfizer treatment on May 27. €œIt’s going to be weird, after a year of them drilling into us ‘Wear a mask, wear a mask, wear a mask,’ to be around a bunch of people who aren’t wearing masks.” Early in the zithromax, the CDC said masks were not necessary. Then, it changed its guidance so emphatically that masks became an indispensable part of our wardrobes.

Now the advice has changed again zithromax and strep pharyngitis. €œFor scientists, it is very understandable that there is this revision of recommendations based on new research,” says Roxane Cohen Silver, a professor of psychology, public health and medicine at the University of California-Irvine. €œBut for the general public, that could sound very confusing.” Early on, many people feared catching the antibiotics from surfaces and even disinfected groceries before putting them away. Now, the zithromax zithromax and strep pharyngitis is believed to spread mainly through the air, and the notion of spraying or wiping down everything you bring into the house seems silly. We don’t know how long the treatments’ protection lasts, but it is increasingly clear that being vaccinated reduces the risk of infecting others.

€œVaccinated people have very little risk of . They can do what they zithromax and strep pharyngitis want to do,” says Dr. George Rutherford, a professor of epidemiology at the University of California–San Francisco. €œI think we’re in pretty good shape, and I think it’s going to be pretty much a disease-free summer.” In California, the rate of positive buy antibiotics tests has dropped from a seven-day average of over 17% in early January, at the peak of the winter surge, to under 1% now. The number zithromax and strep pharyngitis of hospitalized buy antibiotics patients statewide has fallen from over 22,000 to below 1,300 in the same period.

Around 46% of Golden State residents have been fully vaccinated, lagging behind numerous other states but ahead of the national rate of just under 43%. Some millions more have built up immunity after a buy antibiotics . As more people zithromax and strep pharyngitis get protection, the buy antibiotics zithromax finds fewer susceptible bodies, further reducing transmission and producing a downward spiral in the number of cases. If you are indoors with other people you know to be vaccinated, you can dispense with masks. Want to cook dinner for a group of vaccinated friends you zithromax and strep pharyngitis haven’t seen for several months?.

Carpe diem — and don’t worry about wearing masks or sitting spaced apart. But if you are in a mixed crowd — say, a grocery store — and don’t know who’s vaccinated, wear a mask, even though your personal risk is low. If the workers are wearing masks, it’s a matter of respect to wear one yourself zithromax and strep pharyngitis. Some people may be nervous about being there — those who are immune-compromised, for example, or can’t get vaccinated for some other health reason — and they won’t know if you’ve had your shots. €œForget about the medical benefit,” says Bradley Pollock, associate dean for Public Health Sciences at the UC-Davis School of Medicine.

€œIf you are wearing a mask, people who are zithromax and strep pharyngitis not vaccinated don’t need to feel uncomfortable around you. So, it’s kind of a courtesy issue.” The presence of children is another good reason to mask up. Most kids ages 12 to 16 haven’t been vaccinated yet, and those under 12 can’t be, yet. They’ll probably have to zithromax and strep pharyngitis wear masks in school this fall. And though children have not been hit by buy antibiotics nearly as hard as adults, and are not efficient transmitters of the zithromax, thousands of kids have been hospitalized with it nonetheless — including about 4,000 nationwide diagnosed with a frightening multisystem inflammatory syndrome.

Mayorga, who is fully vaccinated and has young children, says he wears a mask “to protect them and to model good behavior.” Public health experts agree that vaccinating as many people as possible, including children, is the way out of the zithromax. But the rate of vaccinations has zithromax and strep pharyngitis slowed recently. One of the biggest contributions you can make to the public good right now is to get vaccinated — and help others do the same. Some people aren’t vaccinated because they lack mobility and can’t get to an appointment zithromax and strep pharyngitis. Check in with elderly neighbors, and if they haven’t been vaccinated and need a ride, offer to drive them.

You can also check with your local department on aging, community groups that serve the elderly, public health agencies or hospitals to ask if they are seeking drivers. Perhaps the biggest impact you can have is persuading friends and loved ones to zithromax and strep pharyngitis get the treatment – and then urging them to persuade others. If they think the treatments were rolled out too fast to be safe, tell them that related antibiotics treatment research has been going on for more than a decade. Point out that hundreds of millions of buy antibiotics shots have now been given and serious side effects are rare — and are being carefully monitored by officials. You might also need to rebut the widespread notion that the treatment could suddenly produce some terrible, unforeseen health impact a few years zithromax and strep pharyngitis down the road.

€œThat just doesn’t happen,” Pollock says. Expect to encounter resistance at first, but be persistent. It can take numerous conversations to assuage zithromax and strep pharyngitis anxieties, but your close friends will listen. €œIf your best friend tells you they did this, that’s highly influential — more than some talking head,” Pollock says. This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Bernard zithromax and strep pharyngitis J. Wolfson. bwolfson@kff.org, @bjwolfson Related Topics Contact Us Submit a Story TipCuando Kiki Radermacher, terapeuta de salud mental, llegó a una casa de Missoula, Montana, por una llamada de emergencia al 911 a fines de mayo, el hombre que había pedido ayuda estaba atrincheado en una esquina, gritándole a los policías. La zithromax and strep pharyngitis casa que estaba alquilando iba a venderse. Había llamado al 911 cuando el miedo de quedarse sin hogar lo hizo tener pensamientos suicidas.

€œLe pregunté zithromax and strep pharyngitis. €˜Â¿Quieres sentarte conmigo?. '”, recordó Radermacher, miembro del equipo móvil de respuesta a crisis de la ciudad. Luego ayudó al hombre a encontrar zithromax and strep pharyngitis un servicio de apoyo. €œRealmente queremos empoderar a las personas para encontrar soluciones”.

Missoula comenzó a enviar a este equipo especial en llamadas de emergencia de salud mental en noviembre como un proyecto piloto, y el próximo mes el programa se volverá permanente. Es una de las zithromax and strep pharyngitis seis iniciativas de respuesta móviles a crisis en Montana, que comenzó como una prueba en 2019. Y este año, cuatro gobiernos locales más solicitaron subvenciones estatales para crear estos equipos. A nivel nacional, más comunidades están creando unidades en las que los profesionales de salud mental son el principal auxilio a las crisis psiquiátricas en lugar de los policías, aunque no existe un recuento oficial de cuántos equipos están funcionando. Y más apoyo está en camino zithromax and strep pharyngitis.

El paquete de ayuda de buy antibiotics que el presidente Joe Biden firmó en marzo ofrece a los estados fondos de Medicaid para poner en marcha estos servicios. Para julio de 2022, está programado el lanzamiento de una línea directa nacional 988, inspirada en el 911, para que las personas se comuniquen con especialistas capacitados en prevención del suicidio y consejeros de salud mental. Estudios sugieren que estos servicios permiten a las personas zithromax and strep pharyngitis en crisis obtener ayuda en lugar de ser transportadas esposadas. Pero hay debate sobre cuál es el mejor modelo a implementar, quién debe responder a la emergencia y, aunque hubiera respuestas, no todas las comunidades pueden costear y contar con estos equipos de salud mental. €œNo sé si existe un consenso sobre cuál es el mejor enfoque en este momento”, dijo Amy Watson, profesora de trabajo social en la Universidad de Wisconsin-Milwaukee que ha estudiado este tipo de intervención en crisis.

€œNecesitamos avanzar para averiguar zithromax and strep pharyngitis cuáles son los elementos importantes de estos modelos”. La Administración Federal de Servicios de Salud Mental y Abuso de Sustancias establece expectativas mínimas para los equipos, como incluir un profesional de salud y conectar a las personas con más servicios, si es necesario. Idealmente, sugieren las pautas, el equipo debe incluir un especialista en respuesta zithromax and strep pharyngitis a crisis que haya experimentado personalmente problemas de salud mental, y el equipo debe responder a las llamadas sin la aplicación de la ley. Aún así, los equipos de respuesta a crisis varían significativamente en su composición y enfoque. Durante más de 40 años, el Departamento de Policía de Los Ángeles ha sido pionero desplegando equipos en los que agentes de policía y terapeutas trabajan juntos.

Un programa de Eugene, Oregon, que se ha replicado en todo Estados Unidos, tiene grupos formados por un experto en intervención en crisis junto con una enfermera, un paramédico o un técnico zithromax and strep pharyngitis médico de emergencia. En Georgia, los despachadores de emergencia del 911 dirigen las llamadas a un centro de crisis en todo el estado que puede desplegar unidades móviles que incluyen profesionales con experiencia en trabajo social, asesoramiento y enfermería. En Montana, los equipos se basan en departamentos de aplicación de la ley, instalaciones médicas u hogares de crisis. €œLa respuesta móvil a las crisis, en cualquier formato, se está convirtiendo cada vez más en la norma”, dijo Kari Auclair, directora de área del Western Montana Mental Health Center, un programa zithromax and strep pharyngitis de tratamiento sin fines de lucro. €œEn algunas comunidades, será el grupo de la iglesia el que será parte de una respuesta a la crisis, porque a ese grupo va la gente y eso es lo que tienen”.

Los defensores explican que los modelos mixtos funcionan. Los médicos pueden reconocer una caída de azúcar en sangre de un diabético que podría imitar el zithromax and strep pharyngitis uso indebido de sustancias o una crisis de salud mientras que la policía puede estar atenta al peligro si aumentan las tensiones. Muchos equipos de crisis todavía trabajan directamente con las fuerzas del orden, a veces respondiendo juntos cuando se les llama o permaneciendo en la escena después de que los oficiales se van. En Montana, por ejemplo, el 61% de las llamadas que manejaron los equipos de crisis también involucraron a la policía, según datos estatales. Zoe Barnard, administradora de la división de trastornos mentales y adicciones de Montana, dijo que su estado aún está estableciendo una línea de base para lo zithromax and strep pharyngitis que funciona bien.

Incluso después de haber elaborado un estándar, agregó, los gobiernos locales seguirán necesitando flexibilidad en la forma en que configuran sus programas. En algunas áreas, reclutar trabajadores de salud mental para tales equipos es casi imposible. Los datos federales zithromax and strep pharyngitis muestran que 125 millones de personas viven en áreas con escasez de profesionales de salud mental, un problema mayor en las zonas rurales. En todo Estados Unidos, con este tipo de trabajos de alto estrés que a menudo se pagan a través de subvenciones improvisadas, retener al personal es un desafío. Ser flexible será clave para los programas a medida que se desarrollen, dijo Jeffrey Coots, zithromax and strep pharyngitis quien dirige una iniciativa en el John Jay College of Criminal Justice en la ciudad de Nueva York para prevenir encarcelamientos innecesarios.

€œEstamos tratando de encontrar una salida a las desigualdades históricas en los servicios de atención de salud mental”, dijo Coots. €œLo mejor que puede hacer es ejecutar este proyecto de prueba y luego adaptar el equipo en función de los datos”. Y para las personas que necesitan ayuda, tener una alternativa a un oficial de policía puede significar una gran diferencia, dijo Tyler Steinebach, director ejecutivo de Hope Health Alliance Inc., que zithromax and strep pharyngitis ofrece capacitación en crisis conductuales para médicos en todo Montana. Lo sabe de primera mano porque tiene trastorno de estrés bipolar y postraumático, y ha tenido que llamar al 911 cuando su propia salud mental se ha desplomado. Dan Springer, alguacil del condado de Gallatin, en Montana, también notó los beneficios después que dos profesionales de salud mental comenzaron a responder a las llamadas al 911 en Bozeman y sus alrededores en 2019.

Aunque los oficiales de su departamento están capacitados en intervención en crisis, zithromax and strep pharyngitis dijo que eso solo llega hasta cierto punto. €œCuando escucho a los agentes decir que el proveedor de salud mental es un regalo del cielo, o que llegaron y pudieron ampliar las capacidades de respuesta, eso significa mucho para mí”, dijo Springer. €œA veces llegamos a una escena y hay tres patrulleros, una ambulancia y un camión de bomberos para una persona que está sufriendo un ataque de pánico”, dijo Erica Gotcher, médica del equipo de respuesta de Missoula. €œUna de las mejores cosas que podemos hacer es evaluar brevemente la situación y cancelar todos zithromax and strep pharyngitis esos otros recursos. Pueden ir a combatir incendios.

Pueden ir a luchar contra el crimen. Nosotros somos los que tenemos zithromax and strep pharyngitis que estar aquí “. Pero hay cosas en las que trabajar, por ejemplo, adónde llevar a las personas que necesitan un lugar para recuperarse. Y más personal. El turno del equipo zithromax and strep pharyngitis de salud mental de Missoula termina a las 8pm.

A la noche, los policías vuelven a estar solos. ¿Necesitas ayuda? zithromax and strep pharyngitis. Si tú mismo o alguien que conoces está viviendo una crisis, por favor llama al National Suicide Prevention Lifeline al 1-800-273-TALK (8255) o contacta al Crisis Text Line texteando TALK al 741741. Katheryn Houghton. khoughton@kff.org, @K_Hought Related Topics Contact Us Submit a Story TipAfter falling from zithromax and strep pharyngitis a ladder and cutting his arm, Ed Knight said, he found himself at Richmond, Virginia’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later. €œBasically, it was just a gash on zithromax and strep pharyngitis my arm,” said Knight, 71. €œThe emergency team that they assembled didn’t really do anything.” Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times zithromax and strep pharyngitis greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years. The biggest U.S zithromax and strep pharyngitis. Hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down. HCA “has basically taken a position that all of their hospitals should be trauma centers,” zithromax and strep pharyngitis said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is zithromax and strep pharyngitis a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons. Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of zithromax and strep pharyngitis lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves. €œOnce a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, zithromax and strep pharyngitis made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room. Patients admitted to HCA and other for-profit hospitals in zithromax and strep pharyngitis Florida with a trauma-team activation were far more likely to be only mildly or moderately injured than those at not-for-profit hospitals, researchers have found. HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. €œWhat you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.” HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is zithromax and strep pharyngitis booming,” said Chippenham spokesperson Jeffrey Caldwell. €œThis increase in demand requires that the regional health care system keep up.” HCA Healthcare, Chippenham Hospital’s owner, runs about 1 in every 20 trauma centers in the country, according to company disclosures. (Julia Rendleman for KHN) Trauma Is zithromax and strep pharyngitis Big Business HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients. €œThere’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida.

€œIt was clear that their trauma activation fees were five or six times larger than ours.” In a process shielded from public zithromax and strep pharyngitis view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business, by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma zithromax and strep pharyngitis center application and related documents. €œThis is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr.

Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. €œMany people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.” Chippenham’s Caldwell said the zithromax and strep pharyngitis “redundancy” with VCU “allows the region to be better prepared for mass trauma events.” Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery. Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma zithromax and strep pharyngitis center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said. Chippenham was the only Level I center in Virginia zithromax and strep pharyngitis that declined to disclose its trauma patient volume to KHN. €œPeople are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, zithromax and strep pharyngitis speaking generally.

Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.” Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available round-the-clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example. Hospitals defend trauma team activation fees as necessary to zithromax and strep pharyngitis cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage. €œFees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care.

€œWhat patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he zithromax and strep pharyngitis said. There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but zithromax and strep pharyngitis the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts. Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare.

Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, zithromax and strep pharyngitis WellRithms’ chief medical officer. €œBasically, it was just a gash on my arm,” said Knight, 71. €œThe emergency team that they assembled didn’t really do anything.”(Julia Rendleman for KHN) Often insurers pay substantially less than billed charges, especially Medicare, Knight's insurer. He paid nothing out-of-pocket, and Chippenham collected a zithromax and strep pharyngitis total of $1,138 for his care, HCA officials said after this article was initially published.

But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants. VCU Health zithromax and strep pharyngitis charges up to $13,455 for trauma activation, according to its charge list. Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN. The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers zithromax and strep pharyngitis were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income. €œWe have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton zithromax and strep pharyngitis Johnson, told stock analysts in 2016. €œThat strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr.

Jonathan Perlin, HCA’s chief medical officer, told analysts at a zithromax and strep pharyngitis 2017 conference. Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and zithromax and strep pharyngitis Human Services. HCA’s trauma cases can fit the same profile.

At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital's online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and zithromax and strep pharyngitis tend to have good insurance, analysts say. VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s zithromax and strep pharyngitis trauma cases are classified as blunt trauma, hospital officials said. The 90% figure is “not accurate today,” Caldwell said.

€œChippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.” ‘Trauma Drama’ in Florida and Beyond HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number zithromax and strep pharyngitis of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567. Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere. In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a zithromax and strep pharyngitis decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA. After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients zithromax and strep pharyngitis be treated at the highest level of trauma care in a region — Level I, if available. HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. €œOnce they had what they wanted, they were happy to lock the door behind them.” HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department zithromax and strep pharyngitis of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows. Charges for trauma activations, also known as trauma zithromax and strep pharyngitis alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA's substantially higher charges didn't necessarily result zithromax and strep pharyngitis from patients with especially severe injuries, public university research found. Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found. €œWhat’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided zithromax and strep pharyngitis KHN with additional Florida Department of Health data showing soaring trauma cases. €œAnd Wall Street’s not happy unless you’re expanding.

They’re driven by the motive to keep the stock price high.” Lobbying and Campaign Dollars In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine. But to open or upgrade a trauma zithromax and strep pharyngitis center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS. Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital zithromax and strep pharyngitis gains status as a trauma center, Dr.

M. Norman Oliver, the commissioner, said in an email. €œChippenham Hospital met zithromax and strep pharyngitis the requirements” to become a Level I center, he said. Chippenham Hospital gained permanent Level I status, the highest for trauma centers, in 2020. (Julia Rendleman for KHN) Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American zithromax and strep pharyngitis College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L'Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest zithromax and strep pharyngitis and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records. Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs.

HCA’s EMS liaisons are expected to develop a zithromax and strep pharyngitis “business plan, driving service line growth,” according to its employment ads. Chippenham’s decision to start a helicopter ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” council member Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the zithromax and strep pharyngitis minutes. Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills.

It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports. Last year, 85% of Med-Trans flights for Virginia patients with zithromax and strep pharyngitis health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said. HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell zithromax and strep pharyngitis Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said. Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent zithromax and strep pharyngitis metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons. Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.” KHN data editor Elizabeth Lucas contributed to this report. Jay Hancock. jhancock@kff.org, zithromax and strep pharyngitis @JayHancock1 Related Topics Contact Us Submit a Story TipBy the time Kiki Radermacher, a mental health therapist, arrived at a Missoula, Montana, home on an emergency 911 call in late May, the man who had called for help was backed into a corner and yelling at police officers.

The home, which he was renting, was about to be sold. He had called 911 when his fear of becoming homeless turned to thoughts of killing himself. €œI asked him, ‘Will you sit zithromax and strep pharyngitis with me?. €™â€ recalled Radermacher, a member of the city’s mobile crisis response team who answered the call with a medic and helped connect the man with support services. €œWe really want to empower people, to find solutions.” Missoula began sending this special crew on emergency mental health calls in November as a pilot project, and next month the program will become permanent.

It’s one of six mobile crisis response initiatives in Montana — up from one at the zithromax and strep pharyngitis start of 2019. And four more local governments applied for state grants this year to form teams. Nationwide, more communities are creating units in which mental health professionals are the main responders to psychiatric crises instead of cops, though no official count exists of the teams that are up and running. More support is on the way zithromax and strep pharyngitis. The buy antibiotics relief package President Joe Biden signed in March offers states Medicaid funding to jump-start such services.

By July 2022, a national 988 hotline, modeled on 911, is slated to launch for people to reach trained suicide prevention specialists and mental health counselors. Protests against police brutality in the past year have helped propel the shift across the zithromax and strep pharyngitis United States. While one rallying cry has been to “defund the police,” these crisis intervention programs — the sort that employ therapists like Radermacher — are often funded in addition to law enforcement departments, not drawing from existing policing budgets. Studies suggest zithromax and strep pharyngitis such services enable people in crisis to get help instead of being transported away in handcuffs. But the move away from policing mental health is still a national experiment, with ongoing debate about who should be part of the response, and limited research on which model is best.

Even then, not all communities can afford and staff separate mental health teams. €œI don’t know that there’s a consensus of what the zithromax and strep pharyngitis best approach is at this point,” said Amy Watson, a professor of social work at the University of Wisconsin-Milwaukee who has studied such crisis intervention. €œWe need to move towards figuring out what are the important elements of these models, where are the pieces of variation and where those variations make sense.” The federal Substance Abuse and Mental Health Services Administration sets minimum expectations for teams, such as including a health care professional and connecting people to more services, if needed. Ideally, the guidelines suggest, the team should include a crisis response specialist who has personally experienced mental health challenges, and the team should respond to the calls without law enforcement. Still, crisis response teams vary significantly in their makeup and zithromax and strep pharyngitis approach.

For more than 40 years, the Los Angeles Police Department has deployed teams in which police officers and mental health workers respond together. It boasts the program is one of the nation’s earliest to do so. A program out of Eugene, Oregon, which has been copied zithromax and strep pharyngitis across the U.S., teams a crisis intervention worker with a nurse, paramedic or emergency medical technician. In Georgia, 911 emergency dispatchers steer calls to a statewide crisis center that can deploy mobile units that include professionals with backgrounds in social work, counseling and nursing. In Montana, teams are based within law enforcement departments, medical facilities or crisis homes.

€œMobile crisis zithromax and strep pharyngitis response, in whatever format it looks like, is becoming more and more the norm,” said Kari Auclair, an area director for Western Montana Mental Health Center, a nonprofit treatment program. €œIn some communities, it’s going to be the church group that’s going to be part of a crisis response, because that’s who people go to and that’s what they’ve got.” Defenders of the various models tout reasons for their teams’ makeups and match-ups. Medics can recognize a diabetic blood sugar crash that might mimic substance misuse or a mental health crisis. Police can watch for danger if zithromax and strep pharyngitis tensions escalate. And crews tethered to hospitals’ behavioral health units have a team of doctors on standby they can consult.

Many crisis teams still work directly zithromax and strep pharyngitis with law enforcement, sometimes responding together when called or staying on the scene after officers leave. In Montana, for example, 61% of the calls that crisis teams handled also involved law enforcement, according to state data. Zoe Barnard, administrator for Montana’s addictive and mental disorders division, said her state is still establishing a baseline for what works well there. Even after they’ve worked out a standard, she added, local governments will continue to zithromax and strep pharyngitis need flexibility in how they set up their programs. €œI’m a realist,” Barnard said.

€œThere will be parts of the state that are going to have limitations related to workforce, and trying to put them into a cookie-cutter model might keep some from doing something that really does the job well.” In some areas, recruiting mental health workers to such teams is nearly impossible. Federal data shows 125 million people live in areas with a shortage of mental health professionals, a problem exacerbated in zithromax and strep pharyngitis rural America. That lack of expertise and support can fuel the crises that warrant emergency help. In Helena, Montana’s capital, for example, a crisis crew that formed in November must still fill two positions before services can run round-the-clock. All across the U.S., with these sorts of high-stress zithromax and strep pharyngitis jobs often paid through cobbled-together grants, retaining staff is a challenge.

Being flexible will be key for programs as they develop, said Jeffrey Coots, who directs an initiative at John Jay College of Criminal Justice in New York City to prevent unnecessary imprisonment. €œWe’re trying to figure our way out of historical inequities in mental health care services,” Coots said. €œThe best thing to do is to run that demonstration project, and then adapt your team based on zithromax and strep pharyngitis the data.” And for the people in these crises who need help, having an alternative to a police officer can mean a big difference, said Tyler Steinebach, executive director of Hope Health Alliance Inc., which offers behavioral crisis training for medics across Montana. He knows firsthand because he has both bipolar and post-traumatic stress disorders and has had to call 911 when his own mental health has plummeted. €œYou know cops are coming, almost certainly,” Steinebach said, from his personal experience.

€œYou’re trying to figure out what to say to them because you’re trying to fight for yourself to get treatment or to get somewhere where you can talk to somebody — but zithromax and strep pharyngitis you’re also trying to not get hauled off in handcuffs.” Gallatin County Sheriff Dan Springer also noticed the benefits after two mental health professionals started to respond to 911 calls in Bozeman and the surrounding area in 2019. Although deputies in his department are trained in crisis intervention, he said that goes only so far. €œWhen I hear deputies say the zithromax and strep pharyngitis mental health provider is a godsend, or they came in and were able to extend the capabilities of the response, that means something to me,” Springer said. €œAnd I hear that routinely now.” Erica Gotcher, a medic on the mental health response team in Missoula, recalled a day recently when her team was wrapping up a call and received three new alerts. A man was considering suicide, a teen was spiraling into crisis and someone else needed follow-up mental health services.

They knew the suicide risk call would take time as responders talked to the person by phone to get more details, so zithromax and strep pharyngitis they responded to the teen hitting walls first and saw all three people before their shift was done. Gotcher said being busy is a good sign that her team — and teams like it — are becoming just one more form of first response. €œSometimes we roll up on a scene and there are three cop cars, an ambulance and a firetruck for one person who is having a panic attack,” Gotcher said. €œOne of the best things that we can do is briefly assess the situation and cancel all zithromax and strep pharyngitis those other resources. They can go fight fires.

They can go fight crime. We are the ones that need to be here.” But gaps still exist, such as not always having somewhere to take a patient who zithromax and strep pharyngitis needs a stable place to recuperate or get more help. The team’s shift also ends at 8 p.m., meaning, come nighttime, it’s back to police officers responding alone. Need help?. If you or someone you know is in a crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line zithromax and strep pharyngitis by texting TALK to 741741.

Katheryn Houghton. khoughton@kff.org, @K_Hought Related Topics Contact Us Submit a Story Tip.

Nearly a year after police officers in Loveland, Colorado, injured an elderly woman with dementia and then laughed at footage of her arrest, two of those officers zithromax 200mg 5ml price are facing criminal charges while the rest of the department undergoes additional training. The fallout has drawn national attention to a problem that experts say is widespread across law enforcement agencies. Police often lack the skills to interact zithromax 200mg 5ml price with people with mental and physical disabilities. Last June, a Walmart employee called police after Karen Garner, 73 at the time, tried to leave without paying for $14 worth of items. Soon after, Officer Austin Hopp’s body camera video showed, he pulled over beside her as she walked down a road and wrestled her to the ground in handcuffs after she failed to respond to his questions.

Afterward, Garner’s lawyers say, she sat in jail for several hours with a dislocated and fractured shoulder as Hopp and two other officers laughed while watching the body camera zithromax 200mg 5ml price video. According to a federal complaint, Garner has dementia and also suffers from sensory aphasia, which impairs her ability to understand. Her violent arrest has other elderly people worried about potential encounters with police, Loveland resident June Dreith told Police Chief Robert Ticer during a public meeting last month. €œThey are now seriously zithromax 200mg 5ml price afraid of the police department,” Dreith said. Hopp resigned and faces felony charges of assault and attempting to influence a public servant — a charge related to allegations of omissions when reporting the arrest — as well as official misconduct, a misdemeanor.

Another officer, Daria Jalali, also resigned and is charged with three misdemeanors. Failure to report excessive force, failure to intervene and zithromax 200mg 5ml price official misconduct. Neither has entered a plea in court. A third officer, who watched the video with them, resigned but has not been charged. An independent assessment of the Loveland Police Department by a third-party consultant is underway zithromax 200mg 5ml price.

The city and involved officers face a federal lawsuit, filed by Garner in April, alleging excessive use of force and violations of the Americans With Disabilities Act. Ticer declined to be interviewed, but through his public information officer he characterized the Garner incident as a problem with an individual officer, not with the zithromax 200mg 5ml price department’s operations. €œOur training currently, in the past and present, is always to make sure our officers are up to speed on as much training as they can on how to interact with people in crisis who may have mental health issues,” Ticer said during the public meeting in May at department headquarters. Loveland’s police department, like many others, requires officers to be trained to respond to people with mental illness and developmental disabilities. But no national zithromax 200mg 5ml price standards exist.

That means the amount of training law enforcement officers receive on interacting with disabled people varies widely. €œOn the whole, we’re doing terrible,” said Jim Burch, president of the National Police Foundation, a nonprofit organization focused on police research and training. €œWe have to do much, much better at being able to recognize these types of issues and being more sensitive to them.” While comprehensive data on the frequency of negative interactions between police and people with mental disabilities is lacking, interactions with the criminal justice zithromax 200mg 5ml price system are common. The Bureau of Justice Statistics has estimated about 3 in 10 state and federal prisoners and 4 in 10 local jail inmates have at least one disability. €œThere’s a very large number of people that police are coming into contact with that have an intellectual disability or mental health challenge,” Burch said.

€œDo we zithromax 200mg 5ml price have a systemic problem?. We think that we do.” Colorado requires a minimum of two hours of training on interacting with people with disabilities, although legislation aims to improve on that by creating a commission to recommend new statewide standards. Loveland’s officers are certified in crisis intervention training. The department also has a zithromax 200mg 5ml price co-responder program, which pairs law enforcement officers with mental health clinicians, although this team was not called during Garner’s arrest. Since that incident, questions remain about the department’s readiness to interact with disabled citizens.

€œWe could always use more and more training. We could train every single week for eight hours a day, but we could do that all zithromax 200mg 5ml price the time and never go out on calls,” said Sgt. Brandon Johnson, who oversees training. €œIt’s just balancing our available workforce and our time and our service to the community and our staffing levels.” Loveland police officers are now undergoing Alzheimer’s awareness training, and five staff members will be zithromax 200mg 5ml price trained as de-escalation instructors, department officials said. Loveland Police Chief Robert Ticer characterized Garner’s rough arrest as an issue with an individual officer, not with the department’s operations.

The city’s police are now undergoing Alzheimer’s awareness training. (Leigh Paterson zithromax 200mg 5ml price / KHN) Training on how to interact with disabled people varies, but the basics include identifying such individuals early in an encounter instead of relying on use of force. €œIt’s scary, because you don’t know why they’re not following your commands,” said Ali Thompson, a former deputy with the Boulder County Sheriff’s Office who now serves on the Colorado Developmental Disabilities Council. €œSo, your adrenaline starts pumping and you think … ‘They’re not listening to my commands because they have a warrant or because they have a gun on them,’ or you come up with all of these scenarios to explain it.” Garner’s rough arrest is “not an isolated incident by any means,” Thompson said. She said she would not have thought to attribute noncompliance to conditions like autism or dementia when she was a zithromax 200mg 5ml price young patrol officer.

€œWe need to start bringing those possibilities into those ‘what if’ scenarios,” Thompson said. In addition to teaching how to identify disabled people, organizations such as the International Association of Chiefs of Police help prepare officers for such situations by showing them how to speak in short phrases, refrain from touching, and turn off sirens and flashing lights. Research on which disability-specific efforts actually reduce bad outcomes is scant, but experts point zithromax 200mg 5ml price to other types of curricula as relevant, too, including crisis intervention training, instruction on de-escalating tensions and sessions on mental illness. €œJust training in and of itself is not going to create that long-term change that we are hoping for,” said Lee Ann Davis, director of criminal justice initiatives at The ARC, a national disability advocacy organization. That means going beyond officer training to address the many areas in which people with disabilities are not being identified and supported, she said.

One of The ARC’s programs, Pathways to Justice, brings in not only law enforcement officials but also attorneys and victim service zithromax 200mg 5ml price providers for instruction. €œSo our goal is to help communities understand that this is a communitywide issue, that there’s not one specific spoke within the criminal justice system or in our communities that can address it adequately alone,” Davis said. Johnson, the Loveland sergeant in charge of training, said officers have been engaged for years in community outreach such as supporting the Special Olympics. Despite the actions of the three officers who resigned, Johnson believes the department is zithromax 200mg 5ml price adequately prepared to interact with disabled citizens. At the same time, he acknowledges limitations.

€œWe have to be the zithromax 200mg 5ml price first responder. We have to have a good foundational understanding of all of it,” he said. €œBut we’re also not … we’re also not experts.” Related Topics Contact Us Submit a Story TipFor more than a year, public health officials have repeatedly told us that masks save lives. They’ve warned us to keep our distance from our zithromax 200mg 5ml price neighbors, who’ve morphed into disease vectors before our eyes. Now they are telling us that if we’re vaccinated, we no longer need to wear masks or physically distance ourselves in most cases — even indoors.

To many people, myself included, this seems hard to reconcile with so many long months of masking and physical distancing and sacrificing our social lives for fear of buy antibiotics. What is zithromax 200mg 5ml price an anxious, zithromax-weary (and wary) soul to do?. First, it’s important to stress that the dramatic rollback of mask-wearing and physical distancing recommended last month by the Centers for Disease Control and Prevention — a policy California has adopted starting Tuesday as part of a broader reopening — applies only to people who have been fully vaccinated. Even if you are vaccinated, though, you don’t need to change your behavior one iota if doing so makes you uncomfortable. €œNothing in the CDC guidelines zithromax 200mg 5ml price says to stop wearing a mask,” says Dr.

José Mayorga, executive director of the UCI Health Family Health Centers. €œIt’s a recommendation, but if you choose to wear one, that’s OK. You shouldn’t be stigmatized.” Mayorga has lost five relatives to buy antibiotics, including a favorite zithromax 200mg 5ml price aunt, and he knows from personal experience how hard it can be to rush back into so-called normalcy. €œMany people have not been directly impacted by buy antibiotics,” he says. €œBut for those of us who have been, it’s natural to have concern or fear, thinking, ‘Oh, I can take my mask off?.

But is it zithromax 200mg 5ml price really safe?. €™â€ Some people are just cautious by nature and won’t be rushing to jettison their masks and rub elbows with unmasked strangers. €œI know that, realistically, I can do pretty much anything once I’m fully vaccinated, but mentally it’s scary,” says 36-year-old Sacramento zithromax 200mg 5ml price resident Shannon Albers, who got her second dose of the Pfizer treatment on May 27. €œIt’s going to be weird, after a year of them drilling into us ‘Wear a mask, wear a mask, wear a mask,’ to be around a bunch of people who aren’t wearing masks.” Early in the zithromax, the CDC said masks were not necessary. Then, it changed its guidance so emphatically that masks became an indispensable part of our wardrobes.

Now the advice has changed zithromax 200mg 5ml price again. €œFor scientists, it is very understandable that there is this revision of recommendations based on new research,” says Roxane Cohen Silver, a professor of psychology, public health and medicine at the University of California-Irvine. €œBut for the general public, that could sound very confusing.” Early on, many people feared catching the antibiotics from surfaces and even disinfected groceries before putting them away. Now, the zithromax is believed to spread mainly through zithromax 200mg 5ml price the air, and the notion of spraying or wiping down everything you bring into the house seems silly. We don’t know how long the treatments’ protection lasts, but it is increasingly clear that being vaccinated reduces the risk of infecting others.

€œVaccinated people have very little risk of . They can do what they want zithromax 200mg 5ml price to do,” says Dr. George Rutherford, a professor of epidemiology at the University of California–San Francisco. €œI think we’re in pretty good shape, and I think it’s going to be pretty much a disease-free summer.” In California, the rate of positive buy antibiotics tests has dropped from a seven-day average of over 17% in early January, at the peak of the winter surge, to under 1% now. The number zithromax 200mg 5ml price of hospitalized buy antibiotics patients statewide has fallen from over 22,000 to below 1,300 in the same period.

Around 46% of Golden State residents have been fully vaccinated, lagging behind numerous other states but ahead of the national rate of just under 43%. Some millions more have built up immunity after a buy antibiotics . As more people get protection, the buy antibiotics zithromax 200mg 5ml price zithromax finds fewer susceptible bodies, further reducing transmission and producing a downward spiral in the number of cases. If you are indoors with other people you know to be vaccinated, you can dispense with masks. Want to cook dinner for a group of vaccinated friends you haven’t seen for several months? zithromax 200mg 5ml price.

Carpe diem — and don’t worry about wearing masks or sitting spaced apart. But if you are in a mixed crowd — say, a grocery store — and don’t know who’s vaccinated, wear a mask, even though your personal risk is low. If the zithromax 200mg 5ml price workers are wearing masks, it’s a matter of respect to wear one yourself. Some people may be nervous about being there — those who are immune-compromised, for example, or can’t get vaccinated for some other health reason — and they won’t know if you’ve had your shots. €œForget about the medical benefit,” says Bradley Pollock, associate dean for Public Health Sciences at the UC-Davis School of Medicine.

€œIf you are wearing zithromax 200mg 5ml price a mask, people who are not vaccinated don’t need to feel uncomfortable around you. So, it’s kind of a courtesy issue.” The presence of children is another good reason to mask up. Most kids ages 12 to 16 haven’t been vaccinated yet, and those under 12 can’t be, yet. They’ll probably have to wear masks in school this zithromax 200mg 5ml price fall. And though children have not been hit by buy antibiotics nearly as hard as adults, and are not efficient transmitters of the zithromax, thousands of kids have been hospitalized with it nonetheless — including about 4,000 nationwide diagnosed with a frightening multisystem inflammatory syndrome.

Mayorga, who is fully vaccinated and has young children, says he wears a mask “to protect them and to model good behavior.” Public health experts agree that vaccinating as many people as possible, including children, is the way out of the zithromax. But the rate of vaccinations has zithromax 200mg 5ml price slowed recently. One of the biggest contributions you can make to the public good right now is to get vaccinated — and help others do the same. Some people aren’t vaccinated because zithromax 200mg 5ml price they lack mobility and can’t get to an appointment. Check in with elderly neighbors, and if they haven’t been vaccinated and need a ride, offer to drive them.

You can also check with your local department on aging, community groups that serve the elderly, public health agencies or hospitals to ask if they are seeking drivers. Perhaps the biggest impact you can have is persuading friends and loved ones zithromax 200mg 5ml price to get the treatment – and then urging them to persuade others. If they think the treatments were rolled out too fast to be safe, tell them that related antibiotics treatment research has been going on for more than a decade. Point out that hundreds of millions of buy antibiotics shots have now been given and serious side effects are rare — and are being carefully monitored by officials. You might also need to rebut the widespread notion that the treatment could suddenly produce some zithromax 200mg 5ml price terrible, unforeseen health impact a few years down the road.

€œThat just doesn’t happen,” Pollock says. Expect to encounter resistance at first, but be persistent. It can take numerous conversations to assuage anxieties, but your zithromax 200mg 5ml price close friends will listen. €œIf your best friend tells you they did this, that’s highly influential — more than some talking head,” Pollock says. This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Bernard zithromax 200mg 5ml price J. Wolfson. bwolfson@kff.org, @bjwolfson Related Topics Contact Us Submit a Story TipCuando Kiki Radermacher, terapeuta de salud mental, llegó a una casa de Missoula, Montana, por una llamada de emergencia al 911 a fines de mayo, el hombre que había pedido ayuda estaba atrincheado en una esquina, gritándole a los policías. La casa que estaba zithromax 200mg 5ml price alquilando iba a venderse. Había llamado al 911 cuando el miedo de quedarse sin hogar lo hizo tener pensamientos suicidas.

€œLe pregunté zithromax 200mg 5ml price. €˜Â¿Quieres sentarte conmigo?. '”, recordó Radermacher, miembro del equipo móvil de respuesta a crisis de la ciudad. Luego ayudó al hombre a encontrar un servicio zithromax 200mg 5ml price de apoyo. €œRealmente queremos empoderar a las personas para encontrar soluciones”.

Missoula comenzó a enviar a este equipo especial en llamadas de emergencia de salud mental en noviembre como un proyecto piloto, y el próximo mes el programa se volverá permanente. Es una de las seis iniciativas de respuesta móviles a crisis en Montana, que comenzó como una prueba zithromax 200mg 5ml price en 2019. Y este año, cuatro gobiernos locales más solicitaron subvenciones estatales para crear estos equipos. A nivel nacional, más comunidades están creando unidades en las que los profesionales de salud mental son el principal auxilio a las crisis psiquiátricas en lugar de los policías, aunque no existe un recuento oficial de cuántos equipos están funcionando. Y más apoyo está en camino zithromax 200mg 5ml price.

El paquete de ayuda de buy antibiotics que el presidente Joe Biden firmó en marzo ofrece a los estados fondos de Medicaid para poner en marcha estos servicios. Para julio de 2022, está programado el lanzamiento de una línea directa nacional 988, inspirada en el 911, para que las personas se comuniquen con especialistas capacitados en prevención del suicidio y consejeros de salud mental. Estudios sugieren que zithromax 200mg 5ml price estos servicios permiten a las personas en crisis obtener ayuda en lugar de ser transportadas esposadas. Pero hay debate sobre cuál es el mejor modelo a implementar, quién debe responder a la emergencia y, aunque hubiera respuestas, no todas las comunidades pueden costear y contar con estos equipos de salud mental. €œNo sé si existe un consenso sobre cuál es el mejor enfoque en este momento”, dijo Amy Watson, profesora de trabajo social en la Universidad de Wisconsin-Milwaukee que ha estudiado este tipo de intervención en crisis.

€œNecesitamos avanzar para averiguar zithromax 200mg 5ml price cuáles son los elementos importantes de estos modelos”. La Administración Federal de Servicios de Salud Mental y Abuso de Sustancias establece expectativas mínimas para los equipos, como incluir un profesional de salud y conectar a las personas con más servicios, si es necesario. Idealmente, sugieren las pautas, el equipo debe incluir un especialista en respuesta a crisis que haya experimentado personalmente problemas de salud zithromax 200mg 5ml price mental, y el equipo debe responder a las llamadas sin la aplicación de la ley. Aún así, los equipos de respuesta a crisis varían significativamente en su composición y enfoque. Durante más de 40 años, el Departamento de Policía de Los Ángeles ha sido pionero desplegando equipos en los que agentes de policía y terapeutas trabajan juntos.

Un programa de Eugene, Oregon, que zithromax 200mg 5ml price se ha replicado en todo Estados Unidos, tiene grupos formados por un experto en intervención en crisis junto con una enfermera, un paramédico o un técnico médico de emergencia. En Georgia, los despachadores de emergencia del 911 dirigen las llamadas a un centro de crisis en todo el estado que puede desplegar unidades móviles que incluyen profesionales con experiencia en trabajo social, asesoramiento y enfermería. En Montana, los equipos se basan en departamentos de aplicación de la ley, instalaciones médicas u hogares de crisis. €œLa respuesta móvil zithromax 200mg 5ml price a las crisis, en cualquier formato, se está convirtiendo cada vez más en la norma”, dijo Kari Auclair, directora de área del Western Montana Mental Health Center, un programa de tratamiento sin fines de lucro. €œEn algunas comunidades, será el grupo de la iglesia el que será parte de una respuesta a la crisis, porque a ese grupo va la gente y eso es lo que tienen”.

Los defensores explican que los modelos mixtos funcionan. Los médicos pueden reconocer una caída zithromax 200mg 5ml price de azúcar en sangre de un diabético que podría imitar el uso indebido de sustancias o una crisis de salud mientras que la policía puede estar atenta al peligro si aumentan las tensiones. Muchos equipos de crisis todavía trabajan directamente con las fuerzas del orden, a veces respondiendo juntos cuando se les llama o permaneciendo en la escena después de que los oficiales se van. En Montana, por ejemplo, el 61% de las llamadas que manejaron los equipos de crisis también involucraron a la policía, según datos estatales. Zoe Barnard, administradora de la división de trastornos mentales y adicciones de Montana, dijo que su estado aún está estableciendo una línea de base para lo que funciona bien zithromax 200mg 5ml price.

Incluso después de haber elaborado un estándar, agregó, los gobiernos locales seguirán necesitando flexibilidad en la forma en que configuran sus programas. En algunas áreas, reclutar trabajadores de salud mental para tales equipos es casi imposible. Los datos federales muestran que 125 millones de personas viven en áreas con escasez de profesionales de salud mental, un problema mayor zithromax 200mg 5ml price en las zonas rurales. En todo Estados Unidos, con este tipo de trabajos de alto estrés que a menudo se pagan a través de subvenciones improvisadas, retener al personal es un desafío. Ser flexible será clave para los programas a medida que se desarrollen, dijo Jeffrey Coots, quien dirige una iniciativa en el John Jay College of Criminal zithromax 200mg 5ml price Justice en la ciudad de Nueva York para prevenir encarcelamientos innecesarios.

€œEstamos tratando de encontrar una salida a las desigualdades históricas en los servicios de atención de salud mental”, dijo Coots. €œLo mejor que puede hacer es ejecutar este proyecto de prueba y luego adaptar el equipo en función de los datos”. Y para las personas que necesitan ayuda, tener una alternativa a un oficial zithromax 200mg 5ml price de policía puede significar una gran diferencia, dijo Tyler Steinebach, director ejecutivo de Hope Health Alliance Inc., que ofrece capacitación en crisis conductuales para médicos en todo Montana. Lo sabe de primera mano porque tiene trastorno de estrés bipolar y postraumático, y ha tenido que llamar al 911 cuando su propia salud mental se ha desplomado. Dan Springer, alguacil del condado de Gallatin, en Montana, también notó los beneficios después que dos profesionales de salud mental comenzaron a responder a las llamadas al 911 en Bozeman y sus alrededores en 2019.

Aunque los oficiales de su departamento están capacitados en zithromax 200mg 5ml price intervención en crisis, dijo que eso solo llega hasta cierto punto. €œCuando escucho a los agentes decir que el proveedor de salud mental es un regalo del cielo, o que llegaron y pudieron ampliar las capacidades de respuesta, eso significa mucho para mí”, dijo Springer. €œA veces llegamos a una escena y hay tres patrulleros, una ambulancia y un camión de bomberos para una persona que está sufriendo un ataque de pánico”, dijo Erica Gotcher, médica del equipo de respuesta de Missoula. €œUna de las mejores cosas que podemos hacer es evaluar brevemente la situación y cancelar zithromax 200mg 5ml price todos esos otros recursos. Pueden ir a combatir incendios.

Pueden ir a luchar contra el crimen. Nosotros somos los que tenemos que zithromax 200mg 5ml price estar aquí “. Pero hay cosas en las que trabajar, por ejemplo, adónde llevar a las personas que necesitan un lugar para recuperarse. Y más personal. El turno del equipo de salud zithromax 200mg 5ml price mental de Missoula termina a las 8pm.

A la noche, los policías vuelven a estar solos. ¿Necesitas ayuda? zithromax 200mg 5ml price. Si tú mismo o alguien que conoces está viviendo una crisis, por favor llama al National Suicide Prevention Lifeline al 1-800-273-TALK (8255) o contacta al Crisis Text Line texteando TALK al 741741. Katheryn Houghton. khoughton@kff.org, @K_Hought Related Topics Contact Us Submit a Story TipAfter falling from a ladder and cutting his arm, Ed Knight said, he found himself at Richmond, Virginia’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — zithromax 200mg 5ml price its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later. €œBasically, it was just zithromax 200mg 5ml price a gash on my arm,” said Knight, 71. €œThe emergency team that they assembled didn’t really do anything.” Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times zithromax 200mg 5ml price greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years. The biggest zithromax 200mg 5ml price U.S. Hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down. HCA “has basically taken a position that all of their hospitals should be zithromax 200mg 5ml price trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma zithromax 200mg 5ml price surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons. Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges zithromax 200mg 5ml price for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves. €œOnce a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion zithromax 200mg 5ml price by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room. Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more zithromax 200mg 5ml price likely to be only mildly or moderately injured than those at not-for-profit hospitals, researchers have found. HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. €œWhat you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.” HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell zithromax 200mg 5ml price. €œThis increase in demand requires that the regional health care system keep up.” HCA Healthcare, Chippenham Hospital’s owner, runs about 1 in every 20 trauma centers in the country, according to company disclosures. (Julia Rendleman for KHN) Trauma Is Big Business HCA’s trauma center boom picked up speed in Florida zithromax 200mg 5ml price a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients. €œThere’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida.

€œIt was clear zithromax 200mg 5ml price that their trauma activation fees were five or six times larger than ours.” In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business, by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to zithromax 200mg 5ml price review HCA’s Chippenham trauma center application and related documents. €œThis is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr.

Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. €œMany people in the state should be concerned that the end result will zithromax 200mg 5ml price be a dilution of care, higher costs and poorer outcomes.” Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.” Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery. Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would zithromax 200mg 5ml price die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said. Chippenham was the only Level I center in Virginia zithromax 200mg 5ml price that declined to disclose its trauma patient volume to KHN. €œPeople are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of zithromax 200mg 5ml price the American College of Surgeons, speaking generally.

Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.” Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available round-the-clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example. Hospitals defend trauma team activation fees as zithromax 200mg 5ml price necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage. €œFees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care.

€œWhat patients zithromax 200mg 5ml price actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said. There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set zithromax 200mg 5ml price with an eye on revenue rather than true costs, say industry analysts. Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare.

Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, zithromax 200mg 5ml price WellRithms’ chief medical officer. €œBasically, it was just a gash on my arm,” said Knight, 71. €œThe emergency team that they assembled didn’t really do anything.”(Julia Rendleman for KHN) Often insurers pay substantially less than billed charges, especially Medicare, Knight's insurer. He paid nothing out-of-pocket, zithromax 200mg 5ml price and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published.

But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants. VCU Health charges up to $13,455 for trauma zithromax 200mg 5ml price activation, according to its charge list. Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN. The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that zithromax 200mg 5ml price Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income. €œWe have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told zithromax 200mg 5ml price stock analysts in 2016. €œThat strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr.

Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 zithromax 200mg 5ml price conference. Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from zithromax 200mg 5ml price private insurers, according to the Department of Health and Human Services. HCA’s trauma cases can fit the same profile.

At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital's online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend zithromax 200mg 5ml price to have good insurance, analysts say. VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases zithromax 200mg 5ml price are classified as blunt trauma, hospital officials said. The 90% figure is “not accurate today,” Caldwell said.

€œChippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.” ‘Trauma Drama’ in Florida and Beyond HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to zithromax 200mg 5ml price 567. Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere. In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in zithromax 200mg 5ml price the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA. After launching Level II centers across zithromax 200mg 5ml price the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available. HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. €œOnce they had what they wanted, they were happy to lock the door behind them.” HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, zithromax 200mg 5ml price trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows. Charges for zithromax 200mg 5ml price trauma activations, also known as trauma alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA's substantially higher charges zithromax 200mg 5ml price didn't necessarily result from patients with especially severe injuries, public university research found. Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found. €œWhat’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases zithromax 200mg 5ml price. €œAnd Wall Street’s not happy unless you’re expanding.

They’re driven by the motive to keep the stock price high.” Lobbying and Campaign Dollars In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine. But to open or upgrade zithromax 200mg 5ml price a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS. Virginia requires zithromax 200mg 5ml price an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr.

M. Norman Oliver, the commissioner, said in an email. €œChippenham Hospital met the requirements” to become a Level I center, zithromax 200mg 5ml price he said. Chippenham Hospital gained permanent Level I status, the highest for trauma centers, in 2020. (Julia Rendleman for KHN) Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and zithromax 200mg 5ml price the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L'Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show zithromax 200mg 5ml price. HCA’s political action committee donated $160,000 to state candidates last year, according to the records. Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs.

HCA’s EMS liaisons are expected to develop zithromax 200mg 5ml price a “business plan, driving service line growth,” according to its employment ads. Chippenham’s decision to start a helicopter ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” council member Kristen Larson told a May 2020 meeting of the zithromax 200mg 5ml price Richmond Ambulance Authority, according to the minutes. Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills.

It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports. Last year, 85% of Med-Trans flights for Virginia patients zithromax 200mg 5ml price with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said. HCA runs trauma centers “really well,” said Winchell, who runs the Level zithromax 200mg 5ml price I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said. Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, zithromax 200mg 5ml price Winchell recently wrote in the Journal of the American College of Surgeons. Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.” KHN data editor Elizabeth Lucas contributed to this report. Jay Hancock. jhancock@kff.org, @JayHancock1 Related Topics Contact Us Submit a Story TipBy the time Kiki Radermacher, a mental health therapist, arrived at a Missoula, Montana, home on an emergency 911 call in late May, the man who had called for help was backed into a corner zithromax 200mg 5ml price and yelling at police officers.

The home, which he was renting, was about to be sold. He had called 911 when his fear of becoming homeless turned to thoughts of killing himself. €œI asked him, ‘Will you sit with me? zithromax 200mg 5ml price. €™â€ recalled Radermacher, a member of the city’s mobile crisis response team who answered the call with a medic and helped connect the man with support services. €œWe really want to empower people, to find solutions.” Missoula began sending this special crew on emergency mental health calls in November as a pilot project, and next month the program will become permanent.

It’s one of six mobile crisis response initiatives in Montana — up from one at the start of zithromax 200mg 5ml price 2019. And four more local governments applied for state grants this year to form teams. Nationwide, more communities are creating units in which mental health professionals are the main responders to psychiatric crises instead of cops, though no official count exists of the teams that are up and running. More support is on the way zithromax 200mg 5ml price. The buy antibiotics relief package President Joe Biden signed in March offers states Medicaid funding to jump-start such services.

By July 2022, a national 988 hotline, modeled on 911, is slated to launch for people to reach trained suicide prevention specialists and mental health counselors. Protests against police brutality in the past year have zithromax 200mg 5ml price helped propel the shift across the United States. While one rallying cry has been to “defund the police,” these crisis intervention programs — the sort that employ therapists like Radermacher — are often funded in addition to law enforcement departments, not drawing from existing policing budgets. Studies suggest such services enable zithromax 200mg 5ml price people in crisis to get help instead of being transported away in handcuffs. But the move away from policing mental health is still a national experiment, with ongoing debate about who should be part of the response, and limited research on which model is best.

Even then, not all communities can afford and staff separate mental health teams. €œI don’t know zithromax 200mg 5ml price that there’s a consensus of what the best approach is at this point,” said Amy Watson, a professor of social work at the University of Wisconsin-Milwaukee who has studied such crisis intervention. €œWe need to move towards figuring out what are the important elements of these models, where are the pieces of variation and where those variations make sense.” The federal Substance Abuse and Mental Health Services Administration sets minimum expectations for teams, such as including a health care professional and connecting people to more services, if needed. Ideally, the guidelines suggest, the team should include a crisis response specialist who has personally experienced mental health challenges, and the team should respond to the calls without law enforcement. Still, crisis zithromax 200mg 5ml price response teams vary significantly in their makeup and approach.

For more than 40 years, the Los Angeles Police Department has deployed teams in which police officers and mental health workers respond together. It boasts the program is one of the nation’s earliest to do so. A program out of Eugene, Oregon, which has been copied across zithromax 200mg 5ml price the U.S., teams a crisis intervention worker with a nurse, paramedic or emergency medical technician. In Georgia, 911 emergency dispatchers steer calls to a statewide crisis center that can deploy mobile units that include professionals with backgrounds in social work, counseling and nursing. In Montana, teams are based within law enforcement departments, medical facilities or crisis homes.

€œMobile crisis response, in whatever format it looks like, is becoming more and more the norm,” said Kari Auclair, an area director for Western Montana Mental Health Center, a nonprofit zithromax 200mg 5ml price treatment program. €œIn some communities, it’s going to be the church group that’s going to be part of a crisis response, because that’s who people go to and that’s what they’ve got.” Defenders of the various models tout reasons for their teams’ makeups and match-ups. Medics can recognize a diabetic blood sugar crash that might mimic substance misuse or a mental health crisis. Police can watch for danger if tensions escalate zithromax 200mg 5ml price. And crews tethered to hospitals’ behavioral health units have a team of doctors on standby they can consult.

Many crisis teams still work directly with law enforcement, sometimes responding together when called or staying on the scene after officers zithromax 200mg 5ml price leave. In Montana, for example, 61% of the calls that crisis teams handled also involved law enforcement, according to state data. Zoe Barnard, administrator for Montana’s addictive and mental disorders division, said her state is still establishing a baseline for what works well there. Even after they’ve worked out a standard, she added, local governments will continue to zithromax 200mg 5ml price need flexibility in how they set up their programs. €œI’m a realist,” Barnard said.

€œThere will be parts of the state that are going to have limitations related to workforce, and trying to put them into a cookie-cutter model might keep some from doing something that really does the job well.” In some areas, recruiting mental health workers to such teams is nearly impossible. Federal data shows 125 million people live zithromax 200mg 5ml price in areas with a shortage of mental health professionals, a problem exacerbated in rural America. That lack of expertise and support can fuel the crises that warrant emergency help. In Helena, Montana’s capital, for example, a crisis crew that formed in November must still fill two positions before services can run round-the-clock. All across the U.S., with these sorts of high-stress jobs often paid through cobbled-together grants, retaining staff is zithromax 200mg 5ml price a challenge.

Being flexible will be key for programs as they develop, said Jeffrey Coots, who directs an initiative at John Jay College of Criminal Justice in New York City to prevent unnecessary imprisonment. €œWe’re trying to figure our way out of historical inequities in mental health care services,” Coots said. €œThe best zithromax 200mg 5ml price thing to do is to run that demonstration project, and then adapt your team based on the data.” And for the people in these crises who need help, having an alternative to a police officer can mean a big difference, said Tyler Steinebach, executive director of Hope Health Alliance Inc., which offers behavioral crisis training for medics across Montana. He knows firsthand because he has both bipolar and post-traumatic stress disorders and has had to call 911 when his own mental health has plummeted. €œYou know cops are coming, almost certainly,” Steinebach said, from his personal experience.

€œYou’re trying to figure out what to say to them because you’re trying to fight for yourself to get treatment or to get somewhere where you can talk to somebody — zithromax 200mg 5ml price but you’re also trying to not get hauled off in handcuffs.” Gallatin County Sheriff Dan Springer also noticed the benefits after two mental health professionals started to respond to 911 calls in Bozeman and the surrounding area in 2019. Although deputies in his department are trained in crisis intervention, he said that goes only so far. €œWhen I hear deputies zithromax 200mg 5ml price say the mental health provider is a godsend, or they came in and were able to extend the capabilities of the response, that means something to me,” Springer said. €œAnd I hear that routinely now.” Erica Gotcher, a medic on the mental health response team in Missoula, recalled a day recently when her team was wrapping up a call and received three new alerts. A man was considering suicide, a teen was spiraling into crisis and someone else needed follow-up mental health services.

They knew the zithromax 200mg 5ml price suicide risk call would take time as responders talked to the person by phone to get more details, so they responded to the teen hitting walls first and saw all three people before their shift was done. Gotcher said being busy is a good sign that her team — and teams like it — are becoming just one more form of first response. €œSometimes we roll up on a scene and there are three cop cars, an ambulance and a firetruck for one person who is having a panic attack,” Gotcher said. €œOne of the best things that we can do is briefly assess the situation and cancel all those other resources. They can go fight fires.

They can go fight crime. We are the ones that need to be here.” But gaps still exist, such as not always having somewhere to take a patient who needs a stable place to recuperate or get more help. The team’s shift also ends at 8 p.m., meaning, come nighttime, it’s back to police officers responding alone. Need help?. If you or someone you know is in a crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.

Katheryn Houghton. khoughton@kff.org, @K_Hought Related Topics Contact Us Submit a Story Tip.