Can you buy over the counter propecia

U.S Get the facts can you buy over the counter propecia. Intelligence agencies remain divided on the origins of the hair loss but believe China's leaders did not know about the propecia before the start of the global propecia, according to results released Friday of a review ordered by President Joe Biden.According to an unclassified summary, four members of the U.S can you buy over the counter propecia. Intelligence community say with low confidence that the propecia was initially transmitted from an animal to a human. A fifth intelligence can you buy over the counter propecia agency believes with moderate confidence that the first human was linked to a lab.

Analysts do not believe the propecia was developed as a bioweapon and most agencies believe the propecia was not genetically engineered.The Office of the Director of National Intelligence said in a statement Friday that China "continues to hinder the global investigation, resist sharing information and blame other countries, including the United States." Reaching a conclusion about what caused the propecia likely requires China's cooperation, the office said.The cause of the hair loss remains can you buy over the counter propecia an urgent public health and security concern worldwide. In the U.S., many conservatives have accused Chinese scientists of developing hair loss treatment in a lab and allowing it to leak. State Department officials under former President Donald Trump published a fact sheet noting research into hair losses conducted at the Wuhan Institute of Virology, located in the Chinese city where the first major known outbreak occurred.The scientific consensus remains that the can you buy over the counter propecia propecia most likely migrated from animals in what's known as a zoonotic transmission. So-called "spillover events" occur in nature, and there are at least two hair losses that evolved in bats and caused human epidemics, SARS1 and MERS.In a statement, Biden said China had obstructed efforts to investigate the propecia "from the beginning.""The world deserves answers, and I will not rest until we get them," he said.

"Responsible nations do not shirk these kinds of responsibilities to the rest of can you buy over the counter propecia the world."China's embassy in Washington hit back with a lengthy statement saying the U.S. Had "fabricated" the report and invoking mistaken American intelligence about weapons of mass destruction prior to the Iraq War."The report by the intelligence community is based on presumption of guilt can you buy over the counter propecia on the part of China, and it is only for scapegoating China," the embassy said. "Such a practice will only disturb and sabotage international cooperation on origin-tracing and on fighting the propecia, and has been widely opposed by the international community."Biden in May ordered a 90-day review of what the White House said was an initial finding leading to "two likely scenarios". An animal-to-human transmission or a can you buy over the counter propecia lab leak.

The White House said then that two agencies in the 18-member intelligence community leaned toward the hypothesis of a transmission in nature and another can you buy over the counter propecia agency leaned toward a lab leak.The Office of the Director of National Intelligence on Friday did not identify which agencies supported either hypothesis. But it noted some of the same hurdles facing the World Health Organization and scientists worldwide. A lack of clinical samples and data from the earliest cases of hair loss treatment.In conducting the can you buy over the counter propecia review, intelligence agencies consulted with allied nations and experts outside of government. An epidemiologist was brought into the National Intelligence Council, a group of senior experts that consults the head of the intelligence community.Southern Lousiana's hospitals, already packed with hair loss patients from a fourth surge of the propecia, were dealing Sunday with another challenge — the howling Category 4 hurricane pounding the coast."Once again we find ourselves dealing with a natural disaster in the midst of a propecia," said Jennifer Avegno, the top health official for New Orleans.Lady of the Sea General Hospital in Lafourche Parish, near where Ida made landfall, reported extensive roof damage.

"All patients can you buy over the counter propecia and staff are fine at this time without injury. Although, our hospital has sustained significant damage," can you buy over the counter propecia hospital CEO Karen Collins said in a message relayed via Facebook. The hospital's phone system was down."Once it is safe to do so they will evacuate their small number of patients," state health department spokeswoman Aly Neel said in an email. Details on the number can you buy over the counter propecia of patients involved were not immediately available.Another Lafourche Parish hospital, Thibodaux Regional Medical Center, reported a partial generator failure to the state.

Christina Stephens, a spokesperson for Gov. John Bel Edwards, said the facility "had not lost all critical power." She said some patients were moved to another part of the facility and the state health department was working with the hospital.Ida struck as hospitals and their intensive care units were filled with patients from the fourth surge of the hair loss treatment propecia, sparked by the highly can you buy over the counter propecia contagious delta variant and low vaccination rates across Louisiana.Daily tallies of new cases in Louisiana went from a few hundred a day through much of the spring and early summer to thousands a day by late July. Gov. John Bel Edwards told The Associated Press on Sunday that more than 2,400 hair loss treatment patients are in Louisiana hospitals, saying the state was in a "very dangerous place with our hospitals."The governor also said 22 nursing homes and 18 assisted living facilities have been evacuated though evacuating the largest hospitals was not an option because there simply aren't other places to send them.

Anticipating that power could be out for weeks in places, Edwards said a big focus will be on making sure there is enough generator power and water at hospitals so they can keep up with vital patient needs such as providing oxygen or powering ventilators."I hate to say it this way, but we have a lot of people on ventilators today and they don't work without electricity," he said.Officials at Ochsner Health, which runs the largest hospital network in Louisiana, said roughly 15 of the network's hospitals are in areas potentially affected by Ida. The network evacuated some patients with particular medical needs from small, rural hospitals to larger facilities.Warner Thomas, president and CEO of Ochsner Health, said Sunday that the system decided preemptively to evacuate a smaller hospital in St. Charles Parish when the storm's track shifted a bit east.He said 35 patients were moved to other hospitals in the region over a little less than three hours. When it comes to power at their facilities, Mike Hulefeld said, they are in pretty good shape.

Three of their facilities in areas affected by Ida were moved to generator power in anticipation of losing city power.Hulefeld said the hospital network ordered 10 days of supplies for facilities in areas that might be affected by Ida, and everything arrived Saturday. Each facility has backup power that was tested and a backup fuel truck on-site. Many of the chain's hospitals also have water wells in case city water goes out.With people evacuating and potentially going to stay with relatives or in shelters, medical officials said they are concerned the hurricane could translate into more hair loss s in coming days just as hospitalization numbers are going down. Thomas said the hospital system has seen a decline in almost 200 hair loss patients over the past week across all their facilities.Officials said Sunday they have been making the rounds and talking to staff in the hospitals — often referred to as the "A Team" because they're the ones that go into lockdown when a hurricane arrives and work until the storm passes and they can be relieved.

The hurricane comes on top of the year and a half long propecia that has been an amazing stress on health care workers, and many are sad and frustrated."Folks realize they got a job to do. There are people who need to be cared for," Thomas said. "But it does take a toll."Dr. Jeff Elder, medical director for emergency management at LCMC Health, said the system's six hospitals went into lockdown mode Sunday.

Employees were going to stay at the hospitals for the duration of the storm arrived Saturday and early Sunday and would sleep there.Elder said one of the first things their hospitals do when storms arrive is discharge patients who are able to leave. However, the patient load is high because of the propecia so they're not able to reduce by much. He said the hospitals in the system are more robust since 2005's Hurricane Katrina."We've learned a lot since 2005," he said. Key pieces of infrastructure are now raised to keep them out of flooding.

For example, at University Medical Center in New Orleans, which was built after Katrina, the generator is raised, diesel supplies are protected and the first floor doesn't have essential services so even if flood waters get that high nothing essential is lost.All hospitals in the system have generator backup power, Elder said. He also stressed that communication is now much better between hospitals in the hospital system as well as with various levels of government..

Can propecia cause permanent impotence

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When the broad range of treatments can propecia cause permanent impotence against hair loss treatment were being tested in clinical trials, only a few experts expected the unproven technology of mRNA to be the star. Within 10 months, mRNA treatments were both the first to be approved and the most effective. Although these are the first mRNA treatments to be approved, the story of mRNA treatments starts more than 30 years ago, with many bumps in the road along the way.

In 1990, the late physician-scientist Jon Wolff and his University of Wisconsin colleagues injected mRNA into mice, which can propecia cause permanent impotence caused cells in the mice to produce the encoded proteins. In many ways, that work served as the first step toward making a treatment from mRNA, but there was a long way to go—and there still is, for many applications. Traditional treatments use a weak or inactive form of a microorganism to turn the immune system against the disease.

After a person is given injection of an mRNA treatment, their cells can propecia cause permanent impotence make part or all of a protein that causes an immune response, including the production of antibodies. Although the most widely known examples are the mRNA-based treatments from BioNTech–Pfizer and Moderna directed against the hair loss hair loss that causes hair loss treatment, that is just one small part of this field—and those treatments were not the first efforts that used mRNA. Despite the many benefits of using this molecule as the basis of a treatment, it comes with fundamental challenges.

It is not very stable inside cells, can propecia cause permanent impotence and mRNA is not efficiently translated into proteins when used as a gene-delivery tool. Today, mRNA can be engineered to battle many diseases, but it will not work with all of them. The upsides of mRNA German biotechnology company BioNTech’s chief medical officer Özlem Türeci—physician, immunologist and entrepreneur—says that “mRNA has a couple of interesting features that make it attractive for treatments.” Adaptability serves as this molecule’s key feature in this application and beyond.

MRNA can be engineered not can propecia cause permanent impotence only to make antigens for treatments but also to encode antibodies, cytokines and other proteins related to the immune system. €œThe versatility of mRNA creates a huge design space,” she explains. The scientists at BioNTech spent years researching and developing techniques to get full command over mRNA, including optimizing its non-coding parts, designing specific sequences, developing manufacturing processes and more.

Türeci describes the results of those efforts by saying, “We have a diversified toolbox and by mixing and matching the modules in can propecia cause permanent impotence this toolbox, we can design mRNA with the features that we need for a particular purpose.” She adds that “it is a bit like writing code—by mastering a programming language [that] is rich in terms, one can give any instruction one wants.” With the BioNTech toolbox, the scientists can control how much protein is produced and for how long, the route of administration of the mRNA, which cells express the protein and if the mRNA creates a precise activation or suppression of the immune system. Once scientists know what mRNA they want to make, the process is relatively easy. For treatments, using mRNA is much quicker than the traditional approach, in which the treatment is grown in cells or in chicken eggs.

To make mRNA, a scientist can propecia cause permanent impotence starts with a computer to lay out the desired sequence. Then, an in vitro transcription reaction is used to create a DNA template that can synthesize the desired mRNA. So, this process does not require cell culture or animal material, and the manufacturing process stays mostly the same regardless of the sequence of the mRNA.

Enhancing the approach Although the high efficacy of mRNA treatments seems miraculous in the can propecia cause permanent impotence fight against hair loss treatment, that is far from the whole story. Wolff’s work in the 1990s set off interest in using mRNA treatments, but scientists ran into a fundamental problem. €œRNA is highly inflammatory,” says physician-scientist Drew Weissman of the Perelman School of Medicine at the University of Pennsylvania.

In 2005, Weissman and his can propecia cause permanent impotence then-colleague Katalin Karikó—now at BioNTech—found a way to make RNA less inflammatory. They showed that the inclusion of modified nucleosides, part of the basic structure of RNA, resulted in a dramatically lower inflammatory response. This work explored the use of nucleosides such as 5-methylcytidine, pseudouridine and other forms.

With these modifications, Weissman says, “you could increase the amount of protein that mRNA could make by 10- to 1,000-fold and make a much better treatment.” Plus, chromatographic techniques can remove contaminants, such as double-stranded mRNA, which results in an even lower inflammatory response can propecia cause permanent impotence. A decade later, Niek Sanders—the principal investigator at Ghent University’s laboratory of gene therapy and the scientific founder of Ziphius treatments—and his colleagues found a different modification for mRNA. MRNA that incorporated the N1-methylpseudouridine modification by itself or with 5-methylcytidine produced as much as 44-fold more of its intended product than mRNA with previous modifications produced, and it still resulted in a diminished immune attack on the molecules.

€œThis is still the best modification, and it is also used in the hair loss treatment mRNA can propecia cause permanent impotence treatments of BioNTech–Pfizer and Moderna,” Sanders says. Constructing a carrier Chemically modified or not, just injecting mRNA alone will not work. €œNaked mRNA gets destroyed and [is] not taken up by cells,” says microbiologist Justin Richner of the University of Illinois College of Medicine at Chicago.

Once the mRNA can propecia cause permanent impotence is injected, extracellular ribonucleases cut it up. Various versions of lipids, such as ionizable lipid nanoparticles, can be used to safely deliver the mRNA to target cells. Türeci and her colleagues optimized a therapy with what she describes as “different liposomal formulations to make RNA fit for the respective purposes like an intramuscular or intravenous injection and targeting specific cell types.” BioNTech found that for anti-cancer treatments based on liposomally formulated mRNA, for instance, the antigen is expressed mainly in the dendritic cells in lymphatic compartments.

These cells can propecia cause permanent impotence specialize in setting off antigen-specific immune responses. In the future, scientists hope to have far more control over the resulting protein production. In a collaboration that included synthetic biologist Ron Weiss of the Massachusetts Institute of Technology and others, Sanders described switchable mRNA.

€œIt’s an on/off switch for mRNA,” Sander says, “and we proved that it works in can propecia cause permanent impotence mice.” With this form of mRNA, the therapy can be turned on when needed, and the level of protein production can be more precisely controlled. Each of these improvements—less inflammation, increased expression, protected delivery and controlled protein production—allows researchers to build better treatments based on mRNA. Improving treatments against influenza Among the most commonly used treatments, the treatment against influenza is perhaps in need of the most improvement.

This treatment is estimated to can propecia cause permanent impotence prevent tens of thousands of hospitalizations each year. However, data from the US Centers for Disease Control and Prevention on treatments against seasonal influenza for 2009–2020 indicate an average effectiveness of about 43%. In this period, even the most effective treatment, for 2010–2011, reached an efficacy of only 60%, and the worst case, in 2014–2015, it reached an effectiveness of only 19%, protecting about one in five people.

In defense can propecia cause permanent impotence of these treatments, they must track a moving target. €œInfluenza treatments are the only mass-distributed bioproduct that changes routinely,” says Philip Dormitzer, Vice President and Chief Scientific Officer. Viral treatments at Pfizer treatments Research and Development.

€œA big challenge with flu is can propecia cause permanent impotence keeping up with the changes.” With traditional methods of making a treatment against influenza, developers must modify the propecia or protein being made. That modification can require changes in manufacturing. For example, the modified propecia might grow a little differently than expected, which might require changes in a treatment’s formulation.

Plus, vendors usually start making treatments against influenza six months in advance of using them, so by the time people get the treatments, they can propecia cause permanent impotence might not provide protection against the most prominent influenza strains of the season. With an mRNA-based approach, Dormitzer says, “swapping one gene for another with mRNA changes its properties very little in manufacturing, which is much easier than changing a viral strain.” Speed also matters, and developers can quickly make mRNA treatments. €œThe closer you can move the strain selection to flu season, the more accurate you will be,” Dormitzer says.

By being able to make mRNA treatments faster, manufacturers can select the influenza strains to target later than they are able to with can propecia cause permanent impotence traditional methods, which should increase the efficacy of the treatment. The engineering behind mRNA treatments also allows scientists to build multi-valent treatments. €œWe can go up in the number of antigens being expressed,” Dormitzer explains, “which could increase the robustness of a flu treatment.” Seeking approval for a new treatment against influenza, however, is different than it has been for hair loss treatment, which had no treatment or treatment.

For influenza, can propecia cause permanent impotence there are a “number of treatments out there, but their efficacy could be better,” Dormitzer says. €œSo, it’s very important that a flu treatment check all of the boxes. Efficacy, reliability, supply, tolerance and so on.” Consequently, a pharmaceutical company is likely to market an mRNA-based treatment against influenza only when it surpasses existing ones in several ways.

Exploring other s hair loss treatment and influenza are just two can propecia cause permanent impotence of many infectious diseases that might be treated with mRNA-based treatments. For instance, Weissman says, “We are working on about 30 different mRNA treatments, including ones for influenza, HIV, hepatitis C, malaria, tuberculosis and many others.” That alone shows how flexible mRNA can be for building treatments. One treatment made from mRNA and lipid nanoparticles is very similar to another, Weissman notes.

€œThe important thing is finding the right antigen,” can propecia cause permanent impotence he adds. €œWe spend a lot of time and work with lots of experiments to find the best antigen to make a treatment work the best.” Finding a good antigen to target is easier with some s than with others. With HIV, Weissman says, “the envelope is the important antigen, but it mutates rapidly and it’s covered in sugar, and you need to address those issues to make an antigen that produces the right response.” Changes in the design of the mRNA might also be required.

Weissman and propecia expert Harvey Friedman of the University of Pennsylvania found targetable antigens can propecia cause permanent impotence for genital herpes. Using these antigens, the scientists developed a treatment from nucleoside-modified mRNA and lipid nanoparticles. Tests in mice and guinea pigs showed that this treatment prevented with the propecia that causes genital herpes.

€œThis treatment can propecia cause permanent impotence is moving into clinical trials,” Weissman says. The use of mRNA for treatments also holds hope for previously intractable, but highly prevalent, s with pathogens such as dengue propecia. Dengue propecia, which is carried by mosquitoes, endangers nearly half of the world’s population and infects as many as 400 million people a year.

Since there can propecia cause permanent impotence is no treatment for this , Richner is working on a treatment. €œDengue is somewhat complicated,” Richner says. It consists of four different propeciaes that cause a similar disease.

€œWe want to target all four,” he notes can propecia cause permanent impotence. Targeting all four dengue propeciaes is necessary, as a subsequent with a different dengue propecia tends to be more severe, due to antibody-mediated enhancement. Richner and his colleagues started with dengue propecia stereotype 1.

Like Weissman, Richner’s team used a nucleoside-modified mRNA in lipid can propecia cause permanent impotence nanoparticles. Neutralizing antibodies elicited by the treatment were sufficient to protect mice against a lethal challenge. Now, Richner’s team is working on expanding this treatment to serotypes 2, 3 and 4, and the differences in the dengue propeciaes require some adjustments in targeting each one.

€œWe’ll need to optimize the treatment can propecia cause permanent impotence for each propecia,” he says. The goal is to provide protection against all four dengue propeciaes with one treatment. At CureVac, data from a phase 1 clinical trial of the company’s mRNA-based treatment against rabies looks promising.

€œA very low dose vaccination can propecia cause permanent impotence generated an immune response in all subjects,” says Thorsten Schüller, CureVac’s vice president of communications. €œThis demonstrated the potential of our mRNA technology for the first time.” Creating treatments against cancer Before hair loss treatment hit, Türeci and her colleagues at BioNTech were working on mRNA-based treatments against cancer. €œYou want to confront a patient’s immune system with a wanted poster of the enemy and train the immune system’s effectors to recognize the enemy and teach the immune system that this is dangerous.” Türeci says that mRNA can be used to deliver two types of cancer antigens.

The first approach is to present to the immune system a person’s own antigens that are usually shut down in healthy cells—antigens encoded by embryonic genes would be an example of this—but are expressed by can propecia cause permanent impotence the cancer. Here, an anti-cancer treatment would trigger an attack on cells carrying those antigens. €œFor each cancer indication, we use computer algorithms and machine learning to identify the antigens that cover as many patients as possible.” For melanoma, as an example, four antigens cover more than 90% of the patients.

BioNTech made a multi-valent RNA-based treatment that targets all four antigens and is in can propecia cause permanent impotence clinical trials. Alternatively, an mRNA-based treatment can target a cancer’s mutations. The profile of mutations, however, is unique to each patient, and that requires a personalized approach.

€œThis is the can propecia cause permanent impotence perfect playground for mRNA,” Türeci says. €œWe start from a patient profile, generate a multi-valent, multi-mutation treatment in four weeks for this patient and treat them with it.” This method, which is in several clinical trials run by BioNTech and Genentech/Roche, uses a approach similar to that used for making the BioNTech–Pfizer treatment against hair loss treatment. Türeci describes the strategy as analyzing “genetic information to tailor a treatment and manufacture it fast.” She adds, “We had already done that hundreds of times for our cancer patients,” and that explains some of the speed behind the development of their treatment against hair loss treatment and why she and her colleagues feel prepared to adapt to viral variants, if necessary.

For solid tumors, an can propecia cause permanent impotence attack by the immune system is not enough. The tumor’s microenvironment fights off the immune response in various ways, including suppressing the actions of T cells. For melanoma, says biophysicist Leaf Huang of the University of North Carolina at Chapel Hill, “the tumor microenvironment is the real barrier for these treatments.” A treatment must be combined with another treatment that modifies that microenvironment, allowing the treatment-triggered T cells to enter the tumor tissue.

Huang and his colleagues combined a can propecia cause permanent impotence treatment with the chemotherapy sunitinib and found that this combination helped immune cells reach the tumor and thereby increased the efficacy of the treatment. Cytokines such as IL-12 are also good candidates for breaking the immunosuppressive tumor microenvironment, according to Sanders, whose team successfully combined IL-12 gene therapy with a gene-based anti-cancer treatment. Nonetheless, Huang says, “The development of agents that can be used safely and effectively to modify the tumor microenvironment still has a long way to go.” Expanding innovation In many ways, mRNA treatments are just getting started.

€œWe do not have a platform for every disease, but the great advantage of can propecia cause permanent impotence mRNA treatments is that we can test novel hypotheses in rapid succession,” Richner says. €œFor new treatments, we need to find what makes a good immune response, and that requires basic science.” This field will drive more basic science for years. Plenty of engineering will be involved, as well.

At BioNTech, Türeci calls the can propecia cause permanent impotence company’s treatment scientists “immune engineers,” and she envisions many advances ahead. As she thinks of the future possibilities for mRNA treatments, she says, “It’s about the nature of innovation—not one invention, but finding out what is possible in many things and bringing them together.” This article is reproduced with permission and was first published on May 31 2021.Editor’s Note (12/21/21). This article is being showcased in a special collection about equity in health care that was made possible by the support of Takeda Pharmaceuticals.

The article can propecia cause permanent impotence was published independently and without sponsorship. As physicians from three distinct racial minorities, our lives are defined by an innate tension. On one hand, we experience the privilege of being highly educated professionals, often with power dynamics and societal respect on our side.

On the other hand, we are part of a system that provides unequal treatment can propecia cause permanent impotence to people of our same skin color. We also recognize the many manifestations of racism in health care, and today we call on all our colleagues to stand with us in denouncing and fixing one critical problem. Racial bias.

Health care workers are constantly thinking about how to improve the quality of can propecia cause permanent impotence care being delivered to our patients. However, we rarely talk about our own biases toward our patients—let alone racial bias. We usually aren’t even aware of them.

But they exist, and in fact, when can propecia cause permanent impotence it comes to our patients, evidence suggests that us doctors have the same level of bias as the wider population. Hence, it’s time we address them head on. Let us paint a picture for you.

Imagine two individuals come to can propecia cause permanent impotence a doctor’s office to determine if they need a procedure. All of the presenting signs and symptoms are the same and overall demographics are similar—but one person is white, and the other is Black. Studies show that, more often than not, the white patient is offered the necessary treatment, while the Black patient is not.

Why?. Doctors are sworn to “do no harm,” but the numbers are clear. We aren’t treating all of our patients equally.

In a 1999 New England Journal of Medicine study, researchers found that doctors were less likely to refer women and Black patients for necessary heart treatment. Nearly 20 years later, another study found persistent sex and race-based disparities with respect to heart treatment, with Black patients statistically less likely to have a heart specialist assigned to them or an intervention performed to evaluate the blood supply to their hearts. As it stands, Black people have higher death rates for eight of the 13 leading causes of death.

Once again, we ask. Why?. While we know there are many social determinants of health, we suggest starting with a variable within our own control as physicians.

Implicit bias. Defined as the unconscious attribution of particular qualities to a member of a social group or class of people, implicit bias is a term that has been making its way around the health care sector without ample consideration or integration to date. It is a particularly nefarious challenge given most of us are literally unconscious of it—not to mention being defensive about it when we’re called out.

But once again, the numbers are clear on its impact on health care for Black Americans. A study at four academic medical centers across the country evaluated physicians who self-reported no explicit preference for white versus Black patients. However, after completion of an implicit bias test, those same health care workers demonstrated a significant preference favoring white Americans, while their perception of Black Americans was negative relative to cooperation with medical procedures.

The study also found that the more physicians were implicitly biased towards white people, the more likely they were to perform certain treatments on white patients in comparison to Black patients. The times we live in would cause even the most optimistic person to see the glass as half empty. This idea of a two-tier system being intricately woven into the foundation of America is evident in analysis of education, law and health outcomes.

The reality of this stark contrast that often falls along the lines of race, has been amplified in the recent occurrence of the hair loss treatment propecia. As of the end of May, hair loss treatment had claimed the lives of 32 in every 100,000 Americans, compared to 1 in 2,000 African Americans. As we look at systemic racial injustice that permeates throughout America, it’s important to be clear that while the most recent public example happens to be centered around police brutality, there are numerous other George Floyds that exist throughout the system, including health care.

And they exist along a spectrum from someone who might give you a dirty glance because of the color of your skin to an officer who kneels on your neck in broad daylight, taking your last breath away. Racism bleeds into every sector. Law enforcement, journalism, education and health care.

How can we as a medical community address this issue?. We believe it begins with understanding our own privilege and biases, and we believe it is critical that all our colleagues—regardless of race—join us without delay. We call on medical institutions and associations to require implicit bias training for all health care workers, including as part of initial and ongoing medical certification.

States such as California have already passed legislation mandating implicit bias training for some physicians. Hence there is no reason why we can’t expand this to all doctors and health care providers across the country. Racial injustice will only change if each and every one of us take on a shared responsibility.

For us health care workers, this must begin with conversations we have with our loved ones, speaking up for random strangers where we witness injustice, and boosting the advancement of brown and Black people within the workplace. Changing culture is hard. It does not happen overnight, and it requires all of us.

While the world’s attention is focused on racism within law enforcement, we must not lose sight of the fact that racism permeates every level of society—and the health care system is far from immune. This American uprising is a culmination of generations that have faced racism and injustice. Breaking that cycle requires us to dig deep and change our own behavior—unconscious and otherwise.When I give public lectures about the climate crisis, the most common question people pose is.

€œAre you an optimist or a pessimist?. € My answer is yes. California has achieved dramatic emissions reductions in a thriving economy, which makes me hopeful, yet in general the fossil-fuel industry is determined not to change.

The second most common question is. €œWhat can I, personally, do?. That’s a tough one.

The major drivers of climate change are collective enterprises such as power grids, industry, large-scale agriculture and transportation systems. About half of all greenhouse gas emissions comes from electricity generation and industrial fossil-fuel use. Substantial emissions reductions in these settings most likely will not come from personal actions.

They will come from laws and policies such as carbon-pricing systems, revised building codes and supports for green investment. Some people have argued that calls for individual action actually distract us from corporate responsibility. That could explain why the fossil-fuel industry is enamored of such entreaties.

Oil giant BP popularized and promoted the idea of a carbon footprint, deflecting attention to its customers who, it suggests, should take personal responsibility by lowering their carbon footprints. One study found that focusing on individual activity actually undermines support for more effective policy initiatives such as a carbon tax. Another problem with personal behavior is that people do not like to be told what to do.

As former congressperson Bob Inglis of South Carolina (a conservative) said in the documentary Merchants of Doubt, people think, “You’re saying that I shouldn’t have this house in a suburb?. I shouldn’t be driving this car?. € Yet individual acts can grow into influential group activity.

It is easy to feel helpless in the face of the strength of the fossil-fuel behemoth or to think that calling your congressperson is a meaningless gesture, especially when you learn about the billions of dollars the industry and its allies have spent trying to block Congress from acting. But one effective act, and one that can be amplified, is to eat less red meat. Cutting meat consumption is a powerful and personal thing most Americans can do to tackle the climate crisis, and they can do it immediately.

About 40 percent of greenhouse gases come from agriculture, deforestation and other land-use changes. Meat—particularly beef—drives climate change in two ways. First, through cows’ emission of methane, a potent greenhouse gas, and second, by destroying forests as they are converted to grazing land.

Despite the economic slowdown caused by the hair loss treatment propecia, atmospheric greenhouse gas levels continued to rise in 2020, in large part because of an emissions increase in the Amazon as rain forests were changed into land for cattle to satisfy the global demand for beef. By eating less beef, we can start to decrease that demand. You do not have to become a vegan to do this.

According to one recent study, if every person in the U.S. Cut their meat consumption by 25 percent, it would reduce annual greenhouse gas emissions by 1 percent. That might not sound like a lot, but it would help protect the rain forest, so the positive effects—including reduced water and fertilizer use, improved biodiversity and safeguarded rights of Indigenous peoples—would be amplified.

Perhaps most important, social action is contagious—in a good way. If lots of us begin to eat less meat and if we talk about it constructively, we will likely influence others. Pretty soon the 1 percent reduction becomes 2 percent or more.

Reduced demand for meat could motivate my local supermarket to carry better produce, making it easier for me and my neighbors to prepare a few more satisfying meat-free meals. Ultimately changes in demand will influence industry. Forty years ago few mainstream supermarkets carried organic products.

Now nearly all do. Consumer demand did that. Cutting back on red meat also has the added benefit of being good for your health.

So while I wouldn’t advise governments to order people to stop eating hamburgers, if anyone asks, “What can I do?. ,” a simple and accurate answer is. €œEat less meat.

It’s in your control, and you can begin right now. It benefits both you and the planet.”Naturalists have long noted isolated examples of tree roots boring far down through loose soil and into the unforgiving bedrock below—rare incursions that were deemed a mere curiosity. But in 2013 hydrologist Daniella Rempe probed deep into a northern California hillside and found tree roots extracting substantial amounts of moisture from pores and crannies in the rock, where groundwater had seeped in and become trapped.

€œWe wanted to assess how big of a phenomenon this was,” says Erica McCormick, an ecohydrologist in Rempe’s laboratory at the University of Texas at Austin. So the team decided to map plants’ bedrock water use across the continental U.S. The researchers combined reams of geologic data from 2003 to 2017 to determine where U.S.

Forests and shrublands overlie bedrock that roots could feasibly reach. They then used known rates of precipitation, evaporation and soil moisture capacity to calculate how much circulating water was unaccounted for—and thus likely came from stores deep inside the rock. This analysis, published in Nature, revealed that bedrock water is far from a last resort for many plants.

At least 24 percent of the country’s trees and shrubs regularly tap water from this layer to satiate their thirst, even in years with normal rainfall. And in the hot, dry states of California and Texas, more than 50 percent of the water used by trees comes from bedrock. Bedrock water may help some trees withstand dry conditions wrought by climate change.

But current efforts to predict how forests will fare in a warming future do not typically include this moisture in their projections, says Texas State University ecologist Susan Schwinning, who was not involved with the new study. €œThe authors here show that this is not just a local, specialized phenomenon but should be looked at broadly,” she adds. The study researchers are now focusing on how plants are using bedrock water at their field sites as California faces severe droughts, Rempe says.

But how do relatively soft roots manage to burrow into rock in the first place?. Bedrock and soil layers are somewhat diffuse, Schwinning says. Percolating rainfall weathers the deep bedrock over time, she explains, creating delicate fractures that fingerlike root offshoots can grow into to soak up pooled water when needed.

Microbes and fungi latch onto the roots, helping to increase their surface area and pull moisture from the tiniest cracks. €œThey find this beautiful home in the pores,” Rempe says. €œThere’s a whole world down there.”.

When the broad range of treatments against hair loss treatment were being tested in clinical trials, only a few experts expected the unproven http://bretmwebb.com/?p=47 technology can you buy over the counter propecia of mRNA to be the star. Within 10 months, mRNA treatments were both the first to be approved and the most effective. Although these are the first mRNA treatments to be approved, the story of mRNA treatments starts more than 30 years ago, with many bumps in the road along the way.

In 1990, the late physician-scientist Jon Wolff and his University of Wisconsin colleagues injected can you buy over the counter propecia mRNA into mice, which caused cells in the mice to produce the encoded proteins. In many ways, that work served as the first step toward making a treatment from mRNA, but there was a long way to go—and there still is, for many applications. Traditional treatments use a weak or inactive form of a microorganism to turn the immune system against the disease.

After a person is given injection of an mRNA treatment, their cells make can you buy over the counter propecia part or all of a protein that causes an immune response, including the production of antibodies. Although the most widely known examples are the mRNA-based treatments from BioNTech–Pfizer and Moderna directed against the hair loss hair loss that causes hair loss treatment, that is just one small part of this field—and those treatments were not the first efforts that used mRNA. Despite the many benefits of using this molecule as the basis of a treatment, it comes with fundamental challenges.

It is not very stable inside cells, and mRNA is not efficiently translated into proteins when used can you buy over the counter propecia as a gene-delivery tool. Today, mRNA can be engineered to battle many diseases, but it will not work with all of them. The upsides of mRNA German biotechnology company BioNTech’s chief medical officer Özlem Türeci—physician, immunologist and entrepreneur—says that “mRNA has a couple of interesting features that make it attractive for treatments.” Adaptability serves as this molecule’s key feature in this application and beyond.

MRNA can be engineered not only to make antigens for treatments but also to can you buy over the counter propecia encode antibodies, cytokines and other proteins related to the immune system. €œThe versatility of mRNA creates a huge design space,” she explains. The scientists at BioNTech spent years researching and developing techniques to get full command over mRNA, including optimizing its non-coding parts, designing specific sequences, developing manufacturing processes and more.

Türeci describes the results of those efforts by saying, “We have a diversified toolbox and by mixing and matching the modules in this toolbox, we can design mRNA with the features that we need for a particular purpose.” She adds that “it is a bit like writing code—by mastering a programming language [that] is rich in terms, one can give any instruction one can you buy over the counter propecia wants.” With the BioNTech toolbox, the scientists can control how much protein is produced and for how long, the route of administration of the mRNA, which cells express the protein and if the mRNA creates a precise activation or suppression of the immune system. Once scientists know what mRNA they want to make, the process is relatively easy. For treatments, using mRNA is much quicker than the traditional approach, in which the treatment is grown in cells or in chicken eggs.

To make mRNA, can you buy over the counter propecia a scientist starts with a computer to lay out the desired sequence. Then, an in vitro transcription reaction is used to create a DNA template that can synthesize the desired mRNA. So, this process does not require cell culture or animal material, and the manufacturing process stays mostly the same regardless of the sequence of the mRNA.

Enhancing the approach Although the high efficacy can you buy over the counter propecia of mRNA treatments seems miraculous in the fight against hair loss treatment, that is far from the whole story. Wolff’s work in the 1990s set off interest in using mRNA treatments, but scientists ran into a fundamental problem. €œRNA is highly inflammatory,” says physician-scientist Drew Weissman of the Perelman School of Medicine at the University of Pennsylvania.

In 2005, Weissman and his then-colleague Katalin Karikó—now at BioNTech—found a can you buy over the counter propecia way to make RNA less inflammatory. They showed that the inclusion of modified nucleosides, part of the basic structure of RNA, resulted in a dramatically lower inflammatory response. This work explored the use of nucleosides such as 5-methylcytidine, pseudouridine and other forms.

With these modifications, Weissman says, “you could increase the amount of protein that mRNA could make by 10- to 1,000-fold and make a much better treatment.” Plus, chromatographic techniques can remove contaminants, such can you buy over the counter propecia as double-stranded mRNA, which results in an even lower inflammatory response. A decade later, Niek Sanders—the principal investigator at Ghent University’s laboratory of gene therapy and the scientific founder of Ziphius treatments—and his colleagues found a different modification for mRNA. MRNA that incorporated the N1-methylpseudouridine modification by itself or with 5-methylcytidine produced as much as 44-fold more of its intended product than mRNA with previous modifications produced, and it still resulted in a diminished immune attack on the molecules.

€œThis is still the best modification, and it is also used in the hair loss treatment can you buy over the counter propecia mRNA treatments of BioNTech–Pfizer and Moderna,” Sanders says. Constructing a carrier Chemically modified or not, just injecting mRNA alone will not work. €œNaked mRNA gets destroyed and [is] not taken up by cells,” says microbiologist Justin Richner of the University of Illinois College of Medicine at Chicago.

Once the mRNA is injected, extracellular ribonucleases can you buy over the counter propecia cut it up. Various versions of lipids, such as ionizable lipid nanoparticles, can be used to safely deliver the mRNA to target cells. Türeci and her colleagues optimized a therapy with what she describes as “different liposomal formulations to make RNA fit for the respective purposes like an intramuscular or intravenous injection and targeting specific cell types.” BioNTech found that for anti-cancer treatments based on liposomally formulated mRNA, for instance, the antigen is expressed mainly in the dendritic cells in lymphatic compartments.

These cells can you buy over the counter propecia specialize in setting off antigen-specific immune responses. In the future, scientists hope to have far more control over the resulting protein production. In a collaboration that included synthetic biologist Ron Weiss of the Massachusetts Institute of Technology and others, Sanders described switchable mRNA.

€œIt’s an on/off switch for mRNA,” Sander says, “and we proved that it works in mice.” With this form of mRNA, the therapy can be turned on when needed, can you buy over the counter propecia and the level of protein production can be more precisely controlled. Each of these improvements—less inflammation, increased expression, protected delivery and controlled protein production—allows researchers to build better treatments based on mRNA. Improving treatments against influenza Among the most commonly used treatments, the treatment against influenza is perhaps in need of the most improvement.

This treatment is can you buy over the counter propecia estimated to prevent tens of thousands of hospitalizations each year. However, data from the US Centers for Disease Control and Prevention on treatments against seasonal influenza for 2009–2020 indicate an average effectiveness of about 43%. In this period, even the most effective treatment, for 2010–2011, reached an efficacy of only 60%, and the worst case, in 2014–2015, it reached an effectiveness of only 19%, protecting about one in five people.

In defense of these can you buy over the counter propecia treatments, they must track a moving target. €œInfluenza treatments are the only mass-distributed bioproduct that changes routinely,” says Philip Dormitzer, Vice President and Chief Scientific Officer. Viral treatments at Pfizer treatments Research and Development.

€œA big challenge with flu is keeping up with the changes.” With traditional methods of can you buy over the counter propecia making a treatment against influenza, developers must modify the propecia or protein being made. That modification can require changes in manufacturing. For example, the modified propecia might grow a little differently than expected, which might require changes in a treatment’s formulation.

Plus, vendors usually start making treatments against influenza six months can you buy over the counter propecia in advance of using them, so by the time people get the treatments, they might not provide protection against the most prominent influenza strains of the season. With an mRNA-based approach, Dormitzer says, “swapping one gene for another with mRNA changes its properties very little in manufacturing, which is much easier than changing a viral strain.” Speed also matters, and developers can quickly make mRNA treatments. €œThe closer you can move the strain selection to flu season, the more accurate you will be,” Dormitzer says.

By being able to make mRNA treatments faster, manufacturers can you buy over the counter propecia can select the influenza strains to target later than they are able to with traditional methods, which should increase the efficacy of the treatment. The engineering behind mRNA treatments also allows scientists to build multi-valent treatments. €œWe can go up in the number of antigens being expressed,” Dormitzer explains, “which could increase the robustness of a flu treatment.” Seeking approval for a new treatment against influenza, however, is different than it has been for hair loss treatment, which had no treatment or treatment.

For influenza, there are a “number of treatments out there, but their efficacy could be can you buy over the counter propecia better,” Dormitzer says. €œSo, it’s very important that a flu treatment check all of the boxes. Efficacy, reliability, supply, tolerance and so on.” Consequently, a pharmaceutical company is likely to market an mRNA-based treatment against influenza only when it surpasses existing ones in several ways.

Exploring other s hair loss treatment can you buy over the counter propecia and influenza are just two of many infectious diseases that might be treated with mRNA-based treatments. For instance, Weissman says, “We are working on about 30 different mRNA treatments, including ones for influenza, HIV, hepatitis C, malaria, tuberculosis and many others.” That alone shows how flexible mRNA can be for building treatments. One treatment made from mRNA and lipid nanoparticles is very similar to another, Weissman notes.

€œThe important thing is finding the right antigen,” he can you buy over the counter propecia adds. €œWe spend a lot of time and work with lots of experiments to find the best antigen to make a treatment work the best.” Finding a good antigen to target is easier with some s than with others. With HIV, Weissman says, “the envelope is the important antigen, but it mutates rapidly and it’s covered in sugar, and you need to address those issues to make an antigen that produces the right response.” Changes in the design of the mRNA might also be required.

Weissman and propecia expert Harvey Friedman of the University of Pennsylvania found can you buy over the counter propecia targetable antigens for genital herpes. Using these antigens, the scientists developed a treatment from nucleoside-modified mRNA and lipid nanoparticles. Tests in mice and guinea pigs showed that this treatment prevented with the propecia that causes genital herpes.

€œThis treatment is moving into clinical trials,” Weissman can you buy over the counter propecia says. The use of mRNA for treatments also holds hope for previously intractable, but highly prevalent, s with pathogens such as dengue propecia. Dengue propecia, which is carried by mosquitoes, endangers nearly half of the world’s population and infects as many as 400 million people a year.

Since there is no treatment can you buy over the counter propecia for this , Richner is working on a treatment. €œDengue is somewhat complicated,” Richner says. It consists of four different propeciaes that cause a similar disease.

€œWe want to target all can you buy over the counter propecia four,” he notes. Targeting all four dengue propeciaes is necessary, as a subsequent with a different dengue propecia tends to be more severe, due to antibody-mediated enhancement. Richner and his colleagues started with dengue propecia stereotype 1.

Like Weissman, Richner’s team used a can you buy over the counter propecia nucleoside-modified mRNA in lipid nanoparticles. Neutralizing antibodies elicited by the treatment were sufficient to protect mice against a lethal challenge. Now, Richner’s team is working on expanding this treatment to serotypes 2, 3 and 4, and the differences in the dengue propeciaes require some adjustments in targeting each one.

€œWe’ll need to optimize the treatment for each propecia,” he says can you buy over the counter propecia. The goal is to provide protection against all four dengue propeciaes with one treatment. At CureVac, data from a phase 1 clinical trial of the company’s mRNA-based treatment against rabies looks promising.

€œA very can you buy over the counter propecia low dose vaccination generated an immune response in all subjects,” says Thorsten Schüller, CureVac’s vice president of communications. €œThis demonstrated the potential of our mRNA technology for the first time.” Creating treatments against cancer Before hair loss treatment hit, Türeci and her colleagues at BioNTech were working on mRNA-based treatments against cancer. €œYou want to confront a patient’s immune system with a wanted poster of the enemy and train the immune system’s effectors to recognize the enemy and teach the immune system that this is dangerous.” Türeci says that mRNA can be used to deliver two types of cancer antigens.

The first approach is to present to the immune system a person’s own antigens that are usually shut down in healthy cells—antigens encoded by embryonic genes would can you buy over the counter propecia be an example of this—but are expressed by the cancer. Here, an anti-cancer treatment would trigger an attack on cells carrying those antigens. €œFor each cancer indication, we use computer algorithms and machine learning to identify the antigens that cover as many patients as possible.” For melanoma, as an example, four antigens cover more than 90% of the patients.

BioNTech made a multi-valent RNA-based treatment that targets all four can you buy over the counter propecia antigens and is in clinical trials. Alternatively, an mRNA-based treatment can target a cancer’s mutations. The profile of mutations, however, is unique to each patient, and that requires a personalized approach.

€œThis is the can you buy over the counter propecia perfect playground for mRNA,” Türeci says. €œWe start from a patient profile, generate a multi-valent, multi-mutation treatment in four weeks for this patient and treat them with it.” This method, which is in several clinical trials run by BioNTech and Genentech/Roche, uses a approach similar to that used for making the BioNTech–Pfizer treatment against hair loss treatment. Türeci describes the strategy as analyzing “genetic information to tailor a treatment and manufacture it fast.” She adds, “We had already done that hundreds of times for our cancer patients,” and that explains some of the speed behind the development of their treatment against hair loss treatment and why she and her colleagues feel prepared to adapt to viral variants, if necessary.

For solid tumors, an attack by the immune system can you buy over the counter propecia is not enough. The tumor’s microenvironment fights off the immune response in various ways, including suppressing the actions of T cells. For melanoma, says biophysicist Leaf Huang of the University of North Carolina at Chapel Hill, “the tumor microenvironment is the real barrier for these treatments.” A treatment must be combined with another treatment that modifies that microenvironment, allowing the treatment-triggered T cells to enter the tumor tissue.

Huang and his colleagues combined a treatment with the chemotherapy sunitinib and found that this combination helped can you buy over the counter propecia immune cells reach the tumor and thereby increased the efficacy of the treatment. Cytokines such as IL-12 are also good candidates for breaking the immunosuppressive tumor microenvironment, according to Sanders, whose team successfully combined IL-12 gene therapy with a gene-based anti-cancer treatment. Nonetheless, Huang says, “The development of agents that can be used safely and effectively to modify the tumor microenvironment still has a long way to go.” Expanding innovation In many ways, mRNA treatments are just getting started.

€œWe do not have a platform for every disease, but the great advantage of mRNA treatments is that we can test novel hypotheses in rapid succession,” Richner says can you buy over the counter propecia. €œFor new treatments, we need to find what makes a good immune response, and that requires basic science.” This field will drive more basic science for years. Plenty of engineering will be involved, as well.

At BioNTech, Türeci calls the company’s treatment scientists “immune engineers,” and can you buy over the counter propecia she envisions many advances ahead. As she thinks of the future possibilities for mRNA treatments, she says, “It’s about the nature of innovation—not one invention, but finding out what is possible in many things and bringing them together.” This article is reproduced with permission and was first published on May 31 2021.Editor’s Note (12/21/21). This article is being showcased in a special collection about equity in health care that was made possible by the support of Takeda Pharmaceuticals.

The article can you buy over the counter propecia was published independently and without sponsorship. As physicians from three distinct racial minorities, our lives are defined by an innate tension. On one hand, we experience the privilege of being highly educated professionals, often with power dynamics and societal respect on our side.

On the other hand, can you buy over the counter propecia we are part of a system that provides unequal treatment to people of our same skin color. We also recognize the many manifestations of racism in health care, and today we call on all our colleagues to stand with us in denouncing and fixing one critical problem. Racial bias.

Health care workers are constantly thinking about can you buy over the counter propecia how to improve the quality of care being delivered to our patients. However, we rarely talk about our own biases toward our patients—let alone racial bias. We usually aren’t even aware of them.

But they can you buy over the counter propecia exist, and in fact, when it comes to our patients, evidence suggests that us doctors have the same level of bias as the wider population. Hence, it’s time we address them head on. Let us paint a picture for you.

Imagine two individuals come to a doctor’s office can you buy over the counter propecia to determine if they need a procedure. All of the presenting signs and symptoms are the same and overall demographics are similar—but one person is white, and the other is Black. Studies show that, more often than not, the white patient is offered the necessary treatment, while the Black patient is not.

Why?. Doctors are sworn to “do no harm,” but the numbers are clear. We aren’t treating all of our patients equally.

In a 1999 New England Journal of Medicine study, researchers found that doctors were less likely to refer women and Black patients for necessary heart treatment. Nearly 20 years later, another study found persistent sex and race-based disparities with respect to heart treatment, with Black patients statistically less likely to have a heart specialist assigned to them or an intervention performed to evaluate the blood supply to their hearts. As it stands, Black people have higher death rates for eight of the 13 leading causes of death.

Once again, we ask. Why?. While we know there are many social determinants of health, we suggest starting with a variable within our own control as physicians.

Implicit bias. Defined as the unconscious attribution of particular qualities to a member of a social group or class of people, implicit bias is a term that has been making its way around the health care sector without ample consideration or integration to date. It is a particularly nefarious challenge given most of us are literally unconscious of it—not to mention being defensive about it when we’re called out.

But once again, the numbers are clear on its impact on health care for Black Americans. A study at four academic medical centers across the country evaluated physicians who self-reported no explicit preference for white versus Black patients. However, after completion of an implicit bias test, those same health care workers demonstrated a significant preference favoring white Americans, while their perception of Black Americans was negative relative to cooperation with medical procedures.

The study also found that the more physicians were implicitly biased towards white people, the more likely they were to perform certain treatments on white patients in comparison to Black patients. The times we live in would cause even the most optimistic person to see the glass as half empty. This idea of a two-tier system being intricately woven into the foundation of America is evident in analysis of education, law and health outcomes.

The reality of this stark contrast that often falls along the lines of race, has been amplified in the recent occurrence of the hair loss treatment propecia. As of the end of May, hair loss treatment had claimed the lives of 32 in every 100,000 Americans, compared to 1 in 2,000 African Americans. As we look at systemic racial injustice that permeates throughout America, it’s important to be clear that while the most recent public example happens to be centered around police brutality, there are numerous other George Floyds that exist throughout the system, including health care.

And they exist along a spectrum from someone who might give you a dirty glance because of the color of your skin to an officer who kneels on your neck in broad daylight, taking your last breath away. Racism bleeds into every sector. Law enforcement, journalism, education and health care.

How can we as a medical community address this issue?. We believe it begins with understanding our own privilege and biases, and we believe it is critical that all our colleagues—regardless of race—join us without delay. We call on medical institutions and associations to require implicit bias training for all health care workers, including as part of initial and ongoing medical certification.

States such as California have already passed legislation mandating implicit bias training for some physicians. Hence there is no reason why we can’t expand this to all doctors and health care providers across the country. Racial injustice will only change if each and every one of us take on a shared responsibility.

For us health care workers, this must begin with conversations we have with our loved ones, speaking up for random strangers where we witness injustice, and boosting the advancement of brown and Black people within the workplace. Changing culture is hard. It does not happen overnight, and it requires all of us.

While the world’s attention is focused on racism within law enforcement, we must not lose sight of the fact that racism permeates every level of society—and the health care system is far from immune. This American uprising is a culmination of generations that have faced racism and injustice. Breaking that cycle requires us to dig deep and change our own behavior—unconscious and otherwise.When I give public lectures about the climate crisis, the most common question people pose is.

€œAre you an optimist or a pessimist?. € My answer is yes. California has achieved dramatic emissions reductions in a thriving economy, which makes me hopeful, yet in general the fossil-fuel industry is determined not to change.

The second most common question is. €œWhat can I, personally, do?. That’s a tough one.

The major drivers of climate change are collective enterprises such as power grids, industry, large-scale agriculture and transportation systems. About half of all greenhouse gas emissions comes from electricity generation and industrial fossil-fuel use. Substantial emissions reductions in these settings most likely will not come from personal actions.

They will come from laws and policies such as carbon-pricing systems, revised building codes and supports for green investment. Some people have argued that calls for individual action actually distract us from corporate responsibility. That could explain why the fossil-fuel industry is enamored of such entreaties.

Oil giant BP popularized and promoted the idea of a carbon footprint, deflecting attention to its customers who, it suggests, should take personal responsibility by lowering their carbon footprints. One study found that focusing on individual activity actually undermines support for more effective policy initiatives such as a carbon tax. Another problem with personal behavior is that people do not like to be told what to do.

As former congressperson Bob Inglis of South Carolina (a conservative) said in the documentary Merchants of Doubt, people think, “You’re saying that I shouldn’t have this house in a suburb?. I shouldn’t be driving this car?. € Yet individual acts can grow into influential group activity.

It is easy to feel helpless in the face of the strength of the fossil-fuel behemoth or to think that calling your congressperson is a meaningless gesture, especially when you learn about the billions of dollars the industry and its allies have spent trying to block Congress from acting. But one effective act, and one that can be amplified, is to eat less red meat. Cutting meat consumption is a powerful and personal thing most Americans can do to tackle the climate crisis, and they can do it immediately.

About 40 percent of greenhouse gases come from agriculture, deforestation and other land-use changes. Meat—particularly beef—drives climate change in two ways. First, through cows’ emission of methane, a potent greenhouse gas, and second, by destroying forests as they are converted to grazing land.

Despite the economic slowdown caused by the hair loss treatment propecia, atmospheric greenhouse gas levels continued to rise in 2020, in large part because of an emissions increase in the Amazon as rain forests were changed into land for cattle to satisfy the global demand for beef. By eating less beef, we can start to decrease that demand. You do not have to become a vegan to do this.

According to one recent study, if every person in the U.S. Cut their meat consumption by 25 percent, it would reduce annual greenhouse gas emissions by 1 percent. That might not sound like a lot, but it would help protect the rain forest, so the positive effects—including reduced water and fertilizer use, improved biodiversity and safeguarded rights of Indigenous peoples—would be amplified.

Perhaps most important, social action is contagious—in a good way. If lots of us begin to eat less meat and if we talk about it constructively, we will likely influence others. Pretty soon the 1 percent reduction becomes 2 percent or more.

Reduced demand for meat could motivate my local supermarket to carry better produce, making it easier for me and my neighbors to prepare a few more satisfying meat-free meals. Ultimately changes in demand will influence industry. Forty years ago few mainstream supermarkets carried organic products.

Now nearly all do. Consumer demand did that. Cutting back on red meat also has the added benefit of being good for your health.

So while I wouldn’t advise governments to order people to stop eating hamburgers, if anyone asks, “What can I do?. ,” a simple and accurate answer is. €œEat less meat.

It’s in your control, and you can begin right now. It benefits both you and the planet.”Naturalists have long noted isolated examples of tree roots boring far down through loose soil and into the unforgiving bedrock below—rare incursions that were deemed a mere curiosity. But in 2013 hydrologist Daniella Rempe probed deep into a northern California hillside and found tree roots extracting substantial amounts of moisture from pores and crannies in the rock, where groundwater had seeped in and become trapped.

€œWe wanted to assess how big of a phenomenon this was,” says Erica McCormick, an ecohydrologist in Rempe’s laboratory at the University of Texas at Austin. So the team decided to map plants’ bedrock water use across the continental U.S. The researchers combined reams of geologic data from 2003 to 2017 to determine where U.S.

Forests and shrublands overlie bedrock that roots could feasibly reach. They then used known rates of precipitation, evaporation and soil moisture capacity to calculate how much circulating water was unaccounted for—and thus likely came from stores deep inside the rock. This analysis, published in Nature, revealed that bedrock water is far from a last resort for many plants.

At least 24 percent of the country’s trees and shrubs regularly tap water from this layer to satiate their thirst, even in years with normal rainfall. And in the hot, dry states of California and Texas, more than 50 percent of the water used by trees comes from bedrock. Bedrock water may help some trees withstand dry conditions wrought by climate change.

But current efforts to predict how forests will fare in a warming future do not typically include this moisture in their projections, says Texas State University ecologist Susan Schwinning, who was not involved with the new study. €œThe authors here show that this is not just a local, specialized phenomenon but should be looked at broadly,” she adds. The study researchers are now focusing on how plants are using bedrock water at their field sites as California faces severe droughts, Rempe says.

But how do relatively soft roots manage to burrow into rock in the first place?. Bedrock and soil layers are somewhat diffuse, Schwinning says. Percolating rainfall weathers the deep bedrock over time, she explains, creating delicate fractures that fingerlike root offshoots can grow into to soak up pooled water when needed.

Microbes and fungi latch onto the roots, helping to increase their surface area and pull moisture from the tiniest cracks. €œThey find this beautiful home in the pores,” Rempe says. €œThere’s a whole world down there.”.

What should my health care professional know before I take Propecia?

They need to know if you have any of these conditions:

• if you are female (finasteride is not for use in women)
• kidney disease or
• liver disease
• prostate cancer
• an unusual or allergic reaction to finasteride, other medicines, foods, dyes, or preservatives

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Air conditioning and other cooling systems are widely how much does propecia cost at cvs recognized as integral to protecting people from the sometimes deadly impacts of extreme heat, which are intensifying in step with climate change. Yet according to a study, published yesterday in Nature Sustainability, there remains a “global blind spot” when it comes to handling the already exorbitant demand for cooling and indoor air conditioning, which alone is projected to triple by 2050. That’s a stark reality, the report warns, given that many cooling systems are carbon-intensive—and contribute to global how much does propecia cost at cvs warming themselves. €œCooling is essential to human well-being and health, from the food we eat to the storage of medicine to how comfortable and productive we are at home, school or the office,” said report co-author Radhika Khosla, a principal investigator at the Oxford Martin Programme on the Future of Cooling.

So if societies do not soon begin implementing sustainable cooling solutions, Khosla added in a statement, they risk “locking the world into a deadly feedback loop, where demand for cooling energy drives further greenhouse gas emissions and results in even more global warming.” The researchers examined thousands of peer-reviewed papers related to the United Nations’ Sustainable Development Goals and concluded that greener cooling systems could help achieve all 17 goals—which include curbing global hunger, reducing gender inequality and improving human health writ large. That’s possible, the report said, because extreme heat dramatically affects everything how much does propecia cost at cvs from food production to water quality to students’ ability to learn and focus during school. Despite evidence that demonstrates the connection between efficient cooling systems and improved social and environmental outcomes, however, the authors argue that the “unprecedented rise in demand and the potential benefits of sustainable cooling” remain largely neglected in contemporary sustainability debates. That has major implications, they emphasized, for sustainable development around the world.

To close that gap, the study said technological developments, innovative business models, intentional infrastructure and regulation could be used to make cooling more accessible—and how much does propecia cost at cvs climate friendly. Cities and towns, for instance, could embed “passive and energy-efficient” cooling mechanisms in urban infrastructure to lessen the impact of extreme heat both indoors and outdoors. That could entail projects intended to reduce the prominence of how much does propecia cost at cvs “urban heat islands” by planting additional trees, developing new parks and building green roofs—all of which naturally cool urban spaces. Those strategies would be especially useful, the report said, given that “projections of the world’s population living in towns and cities are set to reach 66% by 2050,” making urban areas the “epicentre of cooling demand.” The authors also suggest that air-conditioning companies adopt a “cooling as a service” business model, intended to making sustainable cooling more affordable—especially in hot, low-income regions.

Rather than charging for the system itself, the companies would profit by retaining ownership of it and charging customers to operate the system and maintain a comfortable thermal environment. This would drive down, or even eliminate, what can be prohibitive upfront how much does propecia cost at cvs costs for cash-strapped households. In the context of a world “positioned at the brink of unprecedented cooling demand,” the report says, these interventions are among the many that offer “a way forward while being acutely aware of the extraordinary opportunity the current moment provides to use cooling as a lens to look to the sustainability of our future.” Reprinted from Climatewire with permission from E&E News. E&E provides daily coverage of essential energy and environmental news at www.eenews.net.Tempers are running hot in science (as they are in the U.S.

At large) as the field embarks on a long-overdue conversation about its how much does propecia cost at cvs treatment of women and people of color. In June, for example, thousands of researchers and academics across the globe—as well as the preeminent journals Science and Nature—stopped work for a day to protest racism in their ranks. The American Physical Society endorsed the effort to “shut down STEM,” declaring its commitment to “eradicating systemic racism and discrimination” in science. Physics exemplifies the problem how much does propecia cost at cvs.

African-Americans make up about 14 percent of the college-age population in the U.S., commensurate with their numbers in the overall population, but in physics they receive 3 to 4 percent of undergraduate degrees and less than 3 percent of Ph.D.s, and as of 2012 they composed only 2 percent of faculty. No doubt there are many reasons for this underrepresentation, but how much does propecia cost at cvs one troubling factor is the refusal of some scientists to acknowledge that a problem could even exist. Science, they argue, is inherently rational and self-correcting. Would that were true.

The history of science is rife with well-documented cases of misogyny, prejudice and bias how much does propecia cost at cvs. For centuries biologists promoted false theories of female inferiority, and scientific institutions typically barred women's participation. Historian of science and MacArthur fellow Margaret Rossiter has documented how, in the mid-19th century, female scientists created their own scientific societies to compensate for their male colleagues' refusal to acknowledge their work. Sharon Bertsch McGrayne filled an entire volume with the stories of women who should have been awarded the Nobel Prize for work that they did in how much does propecia cost at cvs collaboration with male colleagues—or, worse, that they had stolen by them.

(Rosalind Franklin is a well-documented example of the latter. Her photographs of the crystal structure of DNA were shared without her permission by one of the men who then won the Nobel Prize for elucidating the double-helix structure.) Racial bias has been at least as pernicious as gender bias. It was scientists, after all, who codified the how much does propecia cost at cvs concept of race as a biological category that was not simply descriptive but also hierarchical. Good scientists are open to competing ideas.

They attend to challenging data, how much does propecia cost at cvs and they listen to opposing views. But scientists are also humans, and cognitive science shows that humans are prone to bias, misperception, motivated reasoning and other intellectual pitfalls. Because reasoning is slow and difficult, we rely on heuristics—intellectual shortcuts that often work but sometimes fail spectacularly. (Believing that men are, in general, better than women in math is one tiring example.) It is not credible to claim that scientists are somehow immune to the biases that how much does propecia cost at cvs afflict everyone else.

Fortunately, the objectivity of scientific knowledge does not depend on the objectivity of individual scientists. Rather it depends on strategies for identifying, acknowledging and correcting bias and error. As I point out in my 2019 book, Why Trust Science, scientific knowledge begins as claims advanced by individual scientists, teams or laboratories that are then closely scrutinized by others, who may bring forward additional proof to sustain them—or how much does propecia cost at cvs to modify or reject them. What emerges as a scientific fact or established theory is rarely if ever the same as the starting claim.

It has been adjusted in light of evidence and argumentation. Science is a collective effort, how much does propecia cost at cvs and it works best when scientific communities are diverse. The reason is simple. Heterogeneous communities are more likely than homogeneous ones to be able to identify blind spots and how much does propecia cost at cvs correct them.

Science does not correct itself. Scientists correct one another through critical interrogation. And that means being willing to interrogate how much does propecia cost at cvs not just claims about the external world but claims about our own practices and processes as well. Science has an admirable record of producing reliable knowledge about the natural and social world, but not when it comes to acknowledging its own weaknesses.

And we cannot correct those weaknesses if we insist the system will magically correct itself. It is not ideological to acknowledge and confront bias in how much does propecia cost at cvs science. It is ideological to insist science cannot be biased despite empirical validation to the contrary. Given that our failings of inclusion have been known for a long time, it is high time we finally fix them..

Air conditioning and other cooling systems are widely recognized as integral to protecting people from the sometimes deadly impacts of extreme heat, can you buy over the counter propecia which are intensifying in step with climate change. Yet according to a study, published yesterday in Nature Sustainability, there remains a “global blind spot” when it comes to handling the already exorbitant demand for cooling and indoor air conditioning, which alone is projected to triple by 2050. That’s a stark reality, the report warns, given that many cooling can you buy over the counter propecia systems are carbon-intensive—and contribute to global warming themselves. €œCooling is essential to human well-being and health, from the food we eat to the storage of medicine to how comfortable and productive we are at home, school or the office,” said report co-author Radhika Khosla, a principal investigator at the Oxford Martin Programme on the Future of Cooling.

So if societies do not soon begin implementing sustainable cooling solutions, Khosla added in a statement, they risk “locking the world into a deadly feedback loop, where demand for cooling energy drives further greenhouse gas emissions and results in even more global warming.” The researchers examined thousands of peer-reviewed papers related to the United Nations’ Sustainable Development Goals and concluded that greener cooling systems could help achieve all 17 goals—which include curbing global hunger, reducing gender inequality and improving human health writ large. That’s possible, the report said, because extreme heat dramatically affects everything from food production to water quality to students’ ability to learn and focus can you buy over the counter propecia during school. Despite evidence that demonstrates the connection between efficient cooling systems and improved social and environmental outcomes, however, the authors argue that the “unprecedented rise in demand and the potential benefits of sustainable cooling” remain largely neglected in contemporary sustainability debates. That has major implications, they emphasized, for sustainable development around the world.

To close that gap, the study can you buy over the counter propecia said technological developments, innovative business models, intentional infrastructure and regulation could be used to make cooling more accessible—and climate friendly. Cities and towns, for instance, could embed “passive and energy-efficient” cooling mechanisms in urban infrastructure to lessen the impact of extreme heat both indoors and outdoors. That could entail projects intended to reduce the prominence of “urban can you buy over the counter propecia heat islands” by planting additional trees, developing new parks and building green roofs—all of which naturally cool urban spaces. Those strategies would be especially useful, the report said, given that “projections of the world’s population living in towns and cities are set to reach 66% by 2050,” making urban areas the “epicentre of cooling demand.” The authors also suggest that air-conditioning companies adopt a “cooling as a service” business model, intended to making sustainable cooling more affordable—especially in hot, low-income regions.

Rather than charging for the system itself, the companies would profit by retaining ownership of it and charging customers to operate the system and maintain a comfortable thermal environment. This would drive down, or can you buy over the counter propecia even eliminate, what can be prohibitive upfront costs for cash-strapped households. In the context of a world “positioned at the brink of unprecedented cooling demand,” the report says, these interventions are among the many that offer “a way forward while being acutely aware of the extraordinary opportunity the current moment provides to use cooling as a lens to look to the sustainability of our future.” Reprinted from Climatewire with permission from E&E News. E&E provides daily coverage of essential energy and environmental news at www.eenews.net.Tempers are running hot in science (as they are in the U.S.

At large) as the field embarks on a long-overdue conversation about its treatment of women and can you buy over the counter propecia people of color. In June, for example, thousands of researchers and academics across the globe—as well as the preeminent journals Science and Nature—stopped work for a day to protest racism in their ranks. The American Physical Society endorsed the effort to “shut down STEM,” declaring its commitment to “eradicating systemic racism and discrimination” in science. Physics exemplifies the problem can you buy over the counter propecia.

African-Americans make up about 14 percent of the college-age population in the U.S., commensurate with their numbers in the overall population, but in physics they receive 3 to 4 percent of undergraduate degrees and less than 3 percent of Ph.D.s, and as of 2012 they composed only 2 percent of faculty. No doubt can you buy over the counter propecia there are many reasons for this underrepresentation, but one troubling factor is the refusal of some scientists to acknowledge that a problem could even exist. Science, they argue, is inherently rational and self-correcting. Would that were true.

The history of science can you buy over the counter propecia is rife with well-documented cases of misogyny, prejudice and bias. For centuries biologists promoted false theories of female inferiority, and scientific institutions typically barred women's participation. Historian of science and MacArthur fellow Margaret Rossiter has documented how, in the mid-19th century, female scientists created their own scientific societies to compensate for their male colleagues' refusal to acknowledge their work. Sharon Bertsch McGrayne filled an entire volume with the stories of women who should have been awarded the Nobel Prize for work that they did in collaboration with male colleagues—or, worse, that they had stolen by them can you buy over the counter propecia.

(Rosalind Franklin is a well-documented example of the latter. Her photographs of the crystal structure of DNA were shared without her permission by one of the men who then won the Nobel Prize for elucidating the double-helix structure.) Racial bias has been at least as pernicious as gender bias. It was scientists, after all, who codified the concept of race as a biological category that was not simply descriptive but also hierarchical can you buy over the counter propecia. Good scientists are open to competing ideas.

They attend can you buy over the counter propecia to challenging data, and they listen to opposing views. But scientists are also humans, and cognitive science shows that humans are prone to bias, misperception, motivated reasoning and other intellectual pitfalls. Because reasoning is slow and difficult, we rely on heuristics—intellectual shortcuts that often work but sometimes fail spectacularly. (Believing that men are, in general, better than women in math is one tiring example.) It is not credible to claim that scientists are somehow immune to the biases that can you buy over the counter propecia afflict everyone else.

Fortunately, the objectivity of scientific knowledge does not depend on the objectivity of individual scientists. Rather it depends on strategies for identifying, acknowledging and correcting bias and error. As I point out in my 2019 book, Why Trust can you buy over the counter propecia Science, scientific knowledge begins as claims advanced by individual scientists, teams or laboratories that are then closely scrutinized by others, who may bring forward additional proof to sustain them—or to modify or reject them. What emerges as a scientific fact or established theory is rarely if ever the same as the starting claim.

It has been adjusted in light of evidence and argumentation. Science is a collective effort, and it can you buy over the counter propecia works best when scientific communities are diverse. The reason is simple. Heterogeneous communities are can you buy over the counter propecia more likely than homogeneous ones to be able to identify blind spots and correct them.

Science does not correct itself. Scientists correct one another through critical interrogation. And that means being willing can you buy over the counter propecia to interrogate not just claims about the external world but claims about our own practices and processes as well. Science has an admirable record of producing reliable knowledge about the natural and social world, but not when it comes to acknowledging its own weaknesses.

And we cannot correct those weaknesses if we insist the system will magically correct itself. It is not ideological to acknowledge can you buy over the counter propecia and confront bias in science. It is ideological to insist science cannot be biased despite empirical validation to the contrary. Given that our failings of inclusion have been known for a long time, it is high time we finally fix them..

Testicular pain propecia

Start Preamble Centers for Medicare Is it safe to buy cialis online & testicular pain propecia. Medicaid Services (CMS), HHS. Extension of timeline for publication of final rule testicular pain propecia.

This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final testicular pain propecia rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O.

Wilson, (410) 786-8852. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule testicular pain propecia that addressed undue regulatory impact and burden of the physician self-referral law. The proposed rule was issued in conjunction with the Centers for Medicare &.

Medicaid Services' (CMS) Patients over Paperwork initiative and the Department of Health testicular pain propecia and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care. In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician.

A new exception testicular pain propecia for donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by testicular pain propecia the physician self-referral statute and regulations.

This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with testicular pain propecia section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances.

In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the testicular pain propecia Spring 2020 Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020. However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date.

This notice extends the timeline for publication testicular pain propecia of the final rule until August 31, 2021. Start Signature Dated. August 24, 2020.

Wilma M testicular pain propecia. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental testicular pain propecia Information [FR Doc.

2020-18867 Filed 8-26-20. 8:45 am]BILLING CODE 4120-01-PStart Preamble Notice of amendment. The Secretary issues this amendment pursuant to section 319F-3 testicular pain propecia of the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures.

This amendment to the Declaration published on March 17, 2020 (85 FR 15198) is effective as of August 24, 2020. Start Further Info Robert P testicular pain propecia. Kadlec, MD, MTM&H, MS, Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201.

Telephone. 202-205-2882. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act.

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

These sections are codified at 42 U.S.C. 247d-6d and 42 U.S.C. 247d-6e, respectively.

Section 319F-3 of the PHS Act has been amended by the propecia and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the hair loss Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the hair loss treatment outbreak.

Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against hair loss treatment (85 FR 15198, Mar. 17, 2020) (the Declaration).

On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm hair loss treatment might otherwise cause.

The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any treatment that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended treatments).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only hair loss treatment caused by hair loss or a propecia mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by hair loss treatment, hair loss, or a propecia mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure.

€œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C.

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

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

If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations. Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the hair loss treatment propecia, including. Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations.

Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other -control practices, such as the use of masks. The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by hair loss treatment.

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

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

For example, pharmacists already play a significant role in annual influenza vaccination. In the early 2018-19 season, they administered the influenza treatment to nearly a third of all adults who received the treatment.[] Given the potential danger of serious influenza and continuing hair loss treatment outbreaks this autumn and the impact that such concurrent outbreaks may have on our population, our healthcare system, and our whole-of-nation response to the hair loss treatment propecia, we must quickly expand access to influenza vaccinations. Allowing more qualified pharmacists to administer the influenza treatment to children will make vaccinations more accessible.

Therefore, the Secretary amends the Declaration to identify State-licensed pharmacists (and pharmacy interns acting under their supervision if the pharmacy intern is licensed or registered by his or her State board of pharmacy) as qualified persons under section 247d-6d(i)(8)(B) when the pharmacist orders and either the pharmacist or the supervised pharmacy intern administers treatments to individuals ages three through 18 pursuant to the following requirements. The treatment must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE).

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

Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended treatments according to ACIP's standard immunization schedule. All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return.

Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended treatments and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended treatments ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified propecia and epidemic products that “limit the harm such propecia or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140hair loss treatment as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C.

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

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

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

17, 2020) and amended at 85 FR 21012 (Apr. 15, 2020) and 85 FR 35100 (June 8, 2020). 1.

Covered Persons, section V, delete in full and replace with. V. Covered Persons 42 U.S.C.

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

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

Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met. The treatment must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule.

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

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

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

Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program.

All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2. Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with.

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

Start Authority 42 U.S.C. 247d-6d. End Authority Start Signature Dated.

August 19, 2020. Alex M. Azar II, Secretary of Health and Human Services.

End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20. 4:15 pm]BILLING CODE 4150-03-P.

Start Preamble can you buy over the counter propecia Centers for Medicare &. Medicaid Services (CMS), HHS. Extension of can you buy over the counter propecia timeline for publication of final rule. This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule.

As of August 26, can you buy over the counter propecia 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O. Wilson, (410) 786-8852. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published can you buy over the counter propecia a proposed rule that addressed undue regulatory impact and burden of the physician self-referral law.

The proposed rule was issued in conjunction with the Centers for Medicare &. Medicaid Services' (CMS) Patients over Paperwork initiative and the Department can you buy over the counter propecia of Health and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care. In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician.

A new exception for can you buy over the counter propecia donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed rule also provides critically necessary guidance for physicians and can you buy over the counter propecia health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations. This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule.

Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant can you buy over the counter propecia factors, but may not be longer than 3 years except under exceptional circumstances. In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda (June can you buy over the counter propecia 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020.

However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date. This notice extends the timeline for publication of the final rule until August 31, can you buy over the counter propecia 2021. Start Signature Dated. August 24, 2020.

Wilma M can you buy over the counter propecia. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental Information [FR Doc can you buy over the counter propecia. 2020-18867 Filed 8-26-20.

8:45 am]BILLING CODE 4120-01-PStart Preamble Notice of amendment. The Secretary issues this amendment pursuant to section 319F-3 of can you buy over the counter propecia the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures. This amendment to the Declaration published on March 17, 2020 (85 FR 15198) is effective as of August 24, 2020. Start Further Info can you buy over the counter propecia Robert P.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Can propecia cause weight gain

The electronic health record vendor CareCloud has agreed to pay $3.8 million to resolve kickback allegations.According to a press release from the Southern can propecia cause weight gain District of Florida U.S. Attorney's Office, the United States accused CareCloud of violating the False Claims Act and the Anti-Kickback Statute through its "Champions Program" marketing-referral initiative. "Product functionality, reliability, and safety should drive a can propecia cause weight gain medical software company’s success, not illegal kickbacks paid to promote its products," said Acting United States Attorney Gonzalez in a statement.

"There is simply no place for kickbacks in our country’s healthcare system. Companies who can propecia cause weight gain ignore this will be held accountable," Gonzalez added."On January 8, 2020, CareCloud, Inc. Acquired the company now known as CareCloud Health, Inc.

(formerly CareCloud Corporation)," said CareCloud representatives in can propecia cause weight gain a statement. "The acquired company was, at the time of the transaction, subject to a civil investigation, which began with the filing of a sealed complaint in 2017."CareCloud Health has admitted no wrongdoing in this matter and has accepted settlement in an effort to move forward, focusing its efforts fully on the vital support and services it provides to its clients, and avoid costly litigation," representatives continued."The U.S. Government declined to intervene on and pursue any claims regarding CareCloud’s EHR product, can propecia cause weight gain Charts.

The investigation was considered as an element of the acquisition, and adequate reservations were made."WHY IT MATTERS According to the settlement agreement, between January 2012 and March 2017, CareCloud gave existing clients cash-equivalent credits, cash bonuses and percentage success payments to recommend its EHR products to prospective clients.The agency says participants in the program agreed in writing not to provide negative information about CareCloud's EHR products to the prospective clients. Prospective clients were allegedly unaware of the rewards can propecia cause weight gain that program participants had received. The United States alleged that these actions violated the Anti-Kickback Statute, along with the False Claims Act (because the kickback payments "rendered false" the claims submitted for federal incentive payments under meaningful use programs).

The settlement agreement notes that CareCloud can propecia cause weight gain denies the allegations. The vendor has since discontinued the program as described. As part of can propecia cause weight gain the agreement, the company will pay $3,806,967 to the United States.

The whistleblower who originally sued the company in federal court will be awarded $803,269.97. THE LARGER can propecia cause weight gain TREND This isn't the first EHR company under fire for alleged kickbacks this year. In January, athenahealth agreed to pay $18.25 million to resolve False Claims Act allegations.

Under the "Concierge Event" program, according to court documents, athenahealth is said to have provided existing and potential clients can propecia cause weight gain trips to the Masters Tournament, the Kentucky Derby, New York Fashion Week, the Indy 500 and the NCAA Final Four, among other events. The company also was accused of paying existing clients for referrals of new practices that signed up for athenaOne or athenaClinicals, regardless of how much time the existing client spent speaking with the lead.Last year, Allscripts' Practice Fusion subsidiary agreed to a $145 million settlement after admitting to illegal kickbacks from an opioid maker. ON THE RECORD "Medical software executives who unlawfully promote the capabilities of can propecia cause weight gain their electronic health record technology, and pay others to do the same, diminish their credibility and waste taxpayer money," said Pérez Aybar, special agent in charge at HHS OIG, in a statement.

"My office will continue to investigate such actions to protect the funding for federal healthcare programs," Aybar said. Kat Jercich is senior editor of Healthcare can propecia cause weight gain IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS can propecia cause weight gain Media publication.The Centers for Medicare and Medicaid Services announced this past Friday that ClosedLoop.ai is the winner of its multistage Artificial Intelligence Health Outcomes Challenge.WHY IT MATTERSThe challenge developed by the CMS Innovation Center to find new AI-powered approaches to predicting health outcomes for Medicare beneficiaries initially drew more than 300 entries from across all industries, including Accenture, Deloitte, Geisinger, IBM, Mayo Clinic and Merck. These were first winnowed to a top 25 and then to seven finalists.As the grand prize winner, Austin, Texas-based ClosedLoop.ai will receive up to $1 million in prize money. Danville, Pennsylvania-based Geisinger was the runner-up and will receive up to $230,000.Both organizations can propecia cause weight gain were recognized by CMS for their AI and machine learning tools to predict unplanned hospitalizations, skilled nursing facility admissions and adverse events.

They each created predictive algorithms as well to identify Medicare beneficiaries at risk of mortality in 12 months.Special attention was devoted to rooting our sources of algorithmic bias that might affect health disparities, according to CMS. Transparency was prioritized too, with finalists demonstrating how the AI tools could be easily explained to physicians and nurses.With help from a team of outside AI scientists, CMS subjected the finalists to a rigorous assessment of the accuracy of the algorithms' predictions. Clinicians from the American can propecia cause weight gain Academy of Family Physicians reviewed and scored their explainability.

Winners were selected by a panel of CMS senior leadership."Clinicians are eager to use the latest innovations to better help identify patients at risk, provide higher quality care, and improve health outcomes," said CMS Acting Administrator Liz Richter in a statement. "The use can propecia cause weight gain of artificial intelligence has the potential to achieve these aims by providing important information to clinicians that may be helpful in providing higher quality care.""Our Patient Health Forecasts were key to winning the Challenge. We reimagined the entire concept into a comprehensive and personalized risk forecast that could be delivered directly into a clinical workflow," said ClosedLoop CTO and cofounder Dave DeCaprio in a statement.

"Each forecast surfaces key variables and explains precisely how they contribute to a patient’s specific risk."THE LARGER TRENDThe competition, in collaboration with the AAFP and Arnold Ventures, was launched in 2019 with the aim of accelerating development of AI solutions for predicting patient health outcomes for Medicare beneficiaries for potential use by the Innovation Center.Of $1.65 million in total prizes to participants, Arnold Ventures will contribute up to $300,000 and the AAFP is contributing up to $340,000.ON THE RECORD"We are excited about the early successes and great potential of Artificial Intelligence to dramatically improve health outcomes, reduce administrative burden, and create smarter health can propecia cause weight gain IT," said American Academy of Family Physicians CEO Shawn Martin in a statement. "We look forward to seeing the winning, and all of the great, solutions in the market.""Avoidable hospitalizations and skilled nursing facility stays are bad for patients and make our healthcare system costlier and less sustainable for everyone," said Mark Miller, executive vice president of health care at Arnold Ventures. "We are eager to see how the winners of the competition use new data approaches can propecia cause weight gain to identify solutions to improve care in Medicare.""Finding effective ways to improve outcomes and reduce the cost of care is a national imperative," said ClosedLoop CEO Andrew Eye.

"The Challenge drove us to improve our capabilities across the board – scalability, accuracy, deep explainability, and ways to address algorithmic bias and fairness." Twitter. @MikeMiliardHITNEmail the writer can propecia cause weight gain. Mike.miliard@himssmedia.comHealthcare IT News is a HIMSS publication.The U.S.

Centers for Disease Control and Prevention and the can propecia cause weight gain Department of Health and Human Services have rolled out a service allowing people to find hair loss treatments available nearby via text message. The text-line will launch alongside treatments.gov – a revamped version of treatmentFinder.org that similarly allows users to search for available treatment doses by ZIP code – and a to-be-released 1-800 number to help those who prefer to get information via phone."As we work to increase access to the hair loss treatments, these tools will eliminate burdens and help make it easier to find vaccination sites," said Surgeon General Dr. Vivek Murthy can propecia cause weight gain in a statement provided to Healthcare IT News.

Although the site officially went live on May 1, some users – including members of the Healthcare IT News team – reported downtime on Monday as more individuals tried to use the tool.WHY IT MATTERS According to the agencies, anyone can now text their ZIP code to GETVAX (438829) in English, or VACUNA (822862) in Spanish, to get the contact information of three locations near them with available treatments. The tool is can propecia cause weight gain aimed at key populations, such as young people or those with limited broadband connectivity who might prefer SMS-based messaging. HHS representatives did not respond to questions about which vendor was hosting the text-based service.

Meanwhile, the agencies also announced the conversion of can propecia cause weight gain treatmentFinder.org – a project first launched by Boston Children's Hospital, Castlight and the CDC – to a new site, treatments.gov. The agencies say that they have worked with jurisdiction and pharmacy partners to increase data reporting to include information for all states.Although spokespeople were not specific as to which vendor was responsible for which component of the site, they said President Joe Biden's administration had worked to forge partnerships between treatmentFinder.org and Google, Apple and Microsoft. According to the CDC website, hair loss treatment vaccination providers are can propecia cause weight gain required to report inventory each day, although sharing their location to the public is optional.

The tool notes that inventories are subject to change. Indeed, as of Monday, some Chicago-area locations that were displaying availability can propecia cause weight gain on the treatments.gov website did not have same-day appointments available on the provider website – likely a result of the delay between real-time vaccinations and reporting to the CDC, or between reporting to the CDC and website updates. Agency spokespeople cited the tools as a bridge to access for those who have been unable to obtain a treatment so far.

For instance, in Alabama – currently ranked last in the can propecia cause weight gain country for vaccination rates – various ZIP codes returned several providers within 50 miles. The same was true in Montana, even with ZIP codes with populations of fewer than 1,000 people. The website is currently available in English and in Spanish, and spokespeople said that the agencies had worked to build it can propecia cause weight gain with high accessibility standards.

The National hair loss treatment Vaccination Assistance Hotline, a 1-800 number that has not yet been announced, will be available as well for people who prefer to get information via phone. Assistance will be provided in English, Spanish and more than 150 other languages. It also includes a teletype line to support access for can propecia cause weight gain hearing-impaired callers.

Of course, the tools do not include the actual booking process, so callers may still encounter barriers when they try to make appointments. Still, administration officials say their can propecia cause weight gain new tools are intended to complement those already available nationwide. THE LARGER TREND Biden teased the rollout of the national treatment finder website during a speech in March.

Other municipalities can propecia cause weight gain (and individuals) had already launched similar projects on a local level. "At the time when every adult is eligible in May, we will launch, with our partners, new tools to make it easier for you to find the treatment and where to get the shot, including a new website that will help you find a place to get vaccinated and the one nearest you," he said. The announcement prompted speculation can propecia cause weight gain from those in the health IT community, some of whom remembered the not-so-triumphant initial launch of the Healthcare.gov insurance exchange portal in 2013.

"We know that when the government tries to create IT systems, they've been plagued with bugs," said Dr. Ezekiel Emanuel, former health advisor to President Barack Obama, who also served on President Biden's hair loss treatment advisory board, can propecia cause weight gain this past month. ON THE RECORD "We want to make it as easy as possible for people to get vaccinated, once they make the decision to do so," said Murthy.

"By making can propecia cause weight gain it easier to find a treatment, we will help people take a big step towards protecting themselves against hair loss treatment and returning to their lives," Murthy added. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.The hair loss treatment propecia has necessitated a new era in medicine in which telehealth appointments are a core aspect of the patient-provider relationship and provide broader access to healthcare.So what has the healthcare industry learned about telehealth usage over the past year, and how can it use those learnings to deliver more accessible and high-quality healthcare for all?. Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth, has telehealth insights learned from athenahealth's vast nationwide network data sourced from 18.4 million appointments held by 60,000 providers.Healthcare IT News interviewed Sweeney-Platt on the subjects of telemedicine adoption, utilization, scheduling and permanence, seeking her expertise and lessons learned from athenahealth's treasure trove of telehealth data.Q. In your experience, what was telehealth adoption like over the past 12 months?.

Where were you seeing most of the adoption, and in which specialties?. A. Despite the fact that telehealth has been around, in one form or another, since the 1950s, it was the almost total shutdown of the country in March and April of 2020 that truly established it as a mainstream access point.

Not surprisingly, early adoption patterns followed the path of the most acute hair loss treatment breakouts. We saw early spikes in the Northeast and the Western regions of the country, followed by the Midwest and the South.States in the Northeast had the highest percentage (nearly 70% in April 2020) of virtual appointments initially but were overtaken by the West during the second wave of the propecia in June and July 2020.The Midwest has been consistently the second-lowest adopting region percentage-wise (a little over 40% in April 2020), and the South is consistently lowest in terms of percentages (roughly 30% in April 2020). The Northeast is also much more consistent than other regions, with high virtual rates throughout each state.In all, we've seen telehealth go from less than 1% of total athenahealth network volumes to as high as 32%, before settling in at around 10-11%.

The Northeast and the West lead the country for adoption and sustained volume of primary care telehealth appointments.In terms of specialties, not surprisingly we've seen mental health and primary care use telehealth the most. Mental health has seen the largest percentage of appointments held virtually, with 33%, followed by primary care at 17%.Q. You noticed that practices that have settled in at higher rates of utilization also tend to be practices that had some experience with telehealth pre-hair loss treatment.

Please elaborate on what this tells you.A. This tells us that the adoption of technologies like telehealth may be, in part, due to a trusted person that has already figured out how to make it work in that particular organization. These "IT champions" might help overcome some of the initial uncertainty that accompanies any new way of doing things – some of the basic infrastructure and knowledge may have already been in place.This may be a helpful insight moving forward as physicians and medical groups look to implement other technologies.

Never underestimate the power of a good pilot or experiment.This pattern was just one of the observations that led us to believe that (at least from what we can see in our data) patients' use of telehealth is driven more by their practice than it is by individual preferences.We saw some surprising findings when we looked at adoption levels across different racial and ethnic groups, and when we looked more closely, we realized that these patterns were driven by the overall adoption patterns of the practices. As is true with so many other care decisions, if your doctor or care team tells you that this is a safe and acceptable option, patients will likely follow that advice.Q. In your experience, you noted that scheduling has a big part to play in the logistical outcomes of telemedicine services.

What did you observe?. What were the results?. A.

Overall, the patterns that we see in the scheduling of virtual visits is quite different from the scheduling of in-person visits. We were working from a de-identified data set of 18.4 million appointments that took place between November 1, 2020, and January 31, 2021, and which covers 60,000 providers on the athenahealth network.What we saw was that compared to in-person visits (4%), telehealth visits are more likely to occur after-hours or on weekends (7%). Telehealth appointments are almost two times as likely to be scheduled for the same day as compared to in-person appointments.Finally, telehealth appointments are typically shorter.

They are more likely to be under 15 minutes long (70%), compared to in-person visits (62%). Altogether, this paints a picture of patients integrating care on somewhat of a "just-in-time" basis, which allows for more spontaneous access, at times that are perhaps more convenient for folks trying to juggle a lot of other commitments.We have also heard from physicians that telehealth has allowed flexibility in their own schedules. This is a little more anecdotal, but the physicians and providers that we've interviewed talk a lot about how telehealth is something that allows them to interact with patients from wherever they happen to be.One physician talked at length about how important it was to him that he could do a telehealth visit from his car, then go in and see his son play basketball, whereas he would have missed that opportunity before.

The impact on the provider schedule is something that we would actually like to dig into a little more over time from a data perspective.Q. So, we've seen remarkable adoption of telemedicine in the past 12 months, but will it hold?. What kind of permanence will it achieve?.

A. On balance, we are bullish on the future of telehealth and virtual care. This is not to say that there still aren't things that the system needs to work out.

One big wrinkle is long-term reimbursement for these services. It's still an open question as to how much of the regulatory and payment restrictions that were removed in early 2020 will be made permanent. So, any prognostication has to have that giant asterisk next to it.But again, we are bullish on the future, mainly because we see that virtual care helps address real pain points.

Whether it's busy people trying to squeeze a physician visit into their day, or a patient with chronic illness who just needs a check-in and med check, or as a way to make behavioral health services available to more people in more places, virtual care is a valuable addition to the care toolkit.And for providers, virtual care has helped reduce cognitive burden and improve work/life balance. They can take telehealth appointments from the office or at home, which allows them to have more freedom, while still providing top-notch care for patients.We may have seen adoption surge initially as a result of hair loss treatment. But, assuming that it remains financially viable, we think telehealth will have great staying power, because it provides flexibility, convenience and lower-cost access for those using it.Twitter.

@SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication..

The electronic health record vendor CareCloud Buy propecia online has agreed to pay $3.8 million to can you buy over the counter propecia resolve kickback allegations.According to a press release from the Southern District of Florida U.S. Attorney's Office, the United States accused CareCloud of violating the False Claims Act and the Anti-Kickback Statute through its "Champions Program" marketing-referral initiative. "Product functionality, reliability, and safety should drive a medical software company’s success, not illegal kickbacks paid to promote its products," said Acting United States can you buy over the counter propecia Attorney Gonzalez in a statement.

"There is simply no place for kickbacks in our country’s healthcare system. Companies who ignore this will be held accountable," Gonzalez added."On January 8, can you buy over the counter propecia 2020, CareCloud, Inc. Acquired the company now known as CareCloud Health, Inc.

(formerly CareCloud Corporation)," said CareCloud can you buy over the counter propecia representatives in a statement. "The acquired company was, at the time of the transaction, subject to a civil investigation, which began with the filing of a sealed complaint in 2017."CareCloud Health has admitted no wrongdoing in this matter and has accepted settlement in an effort to move forward, focusing its efforts fully on the vital support and services it provides to its clients, and avoid costly litigation," representatives continued."The U.S. Government declined to intervene on and pursue any claims regarding CareCloud’s EHR product, can you buy over the counter propecia Charts.

The investigation was considered as an element of the acquisition, and adequate reservations were made."WHY IT MATTERS According to the settlement agreement, between January 2012 and March 2017, CareCloud gave existing clients cash-equivalent credits, cash bonuses and percentage success payments to recommend its EHR products to prospective clients.The agency says participants in the program agreed in writing not to provide negative information about CareCloud's EHR products to the prospective clients. Prospective clients were allegedly unaware of the rewards that program can you buy over the counter propecia participants had received. The United States alleged that these actions violated the Anti-Kickback Statute, along with the False Claims Act (because the kickback payments "rendered false" the claims submitted for federal incentive payments under meaningful use programs).

The settlement agreement notes that CareCloud denies the allegations can you buy over the counter propecia. The vendor has since discontinued the program as described. As part of the can you buy over the counter propecia agreement, the company will pay $3,806,967 to the United States.

The whistleblower who originally sued the company in federal court will be awarded $803,269.97. THE LARGER TREND This isn't the first can you buy over the counter propecia EHR company under fire for alleged kickbacks this year. In January, athenahealth agreed to pay $18.25 million to resolve False Claims Act allegations.

Under the "Concierge can you buy over the counter propecia Event" program, according to court documents, athenahealth is said to have provided existing and potential clients trips to the Masters Tournament, the Kentucky Derby, New York Fashion Week, the Indy 500 and the NCAA Final Four, among other events. The company also was accused of paying existing clients for referrals of new practices that signed up for athenaOne or athenaClinicals, regardless of how much time the existing client spent speaking with the lead.Last year, Allscripts' Practice Fusion subsidiary agreed to a $145 million settlement after admitting to illegal kickbacks from an opioid maker. ON THE RECORD "Medical software executives who unlawfully promote the capabilities of their electronic health record technology, and pay others to do the same, diminish their credibility and waste taxpayer money," said Pérez Aybar, special agent in charge at HHS can you buy over the counter propecia OIG, in a statement.

"My office will continue to investigate such actions to protect the funding for federal healthcare programs," Aybar said. Kat Jercich is senior can you buy over the counter propecia editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.The Centers for Medicare and Medicaid Services announced this past Friday that ClosedLoop.ai is the winner of its multistage Artificial Intelligence Health Outcomes Challenge.WHY IT MATTERSThe challenge developed by the CMS Innovation Center to find new can you buy over the counter propecia AI-powered approaches to predicting health outcomes for Medicare beneficiaries initially drew more than 300 entries from across all industries, including Accenture, Deloitte, Geisinger, IBM, Mayo Clinic and Merck. These were first winnowed to a top 25 and then to seven finalists.As the grand prize winner, Austin, Texas-based ClosedLoop.ai will receive up to $1 million in prize money. Danville, Pennsylvania-based Geisinger was the runner-up and will receive up to $230,000.Both organizations were recognized by CMS for can you buy over the counter propecia their AI and machine learning tools to predict unplanned hospitalizations, skilled nursing facility admissions and adverse events.

They each created predictive algorithms as well to identify Medicare beneficiaries at risk of mortality in 12 months.Special attention was devoted to rooting our sources of algorithmic bias that might affect health disparities, according to CMS. Transparency was prioritized too, with finalists demonstrating how the AI tools could be easily explained to physicians and nurses.With help from a team of outside AI scientists, CMS subjected the finalists to a rigorous assessment of the accuracy of the algorithms' predictions. Clinicians from the American Academy of Family Physicians reviewed and scored can you buy over the counter propecia their explainability.

Winners were selected by a panel of CMS senior leadership."Clinicians are eager to use the latest innovations to better help identify patients at risk, provide higher quality care, and improve health outcomes," said CMS Acting Administrator Liz Richter in a statement. "The use of artificial intelligence has the potential to achieve these aims by providing important information to clinicians that may be helpful can you buy over the counter propecia in providing higher quality care.""Our Patient Health Forecasts were key to winning the Challenge. We reimagined the entire concept into a comprehensive and personalized risk forecast that could be delivered directly into a clinical workflow," said ClosedLoop CTO and cofounder Dave DeCaprio in a statement.

"Each forecast surfaces key variables and explains precisely how they contribute to a patient’s specific risk."THE LARGER TRENDThe competition, in collaboration with the AAFP and Arnold Ventures, was launched in 2019 with the aim of accelerating development of AI solutions for predicting patient health outcomes for Medicare beneficiaries for potential use by the Innovation Center.Of $1.65 million in total prizes to participants, Arnold Ventures will contribute up to $300,000 and the AAFP is contributing up to $340,000.ON THE RECORD"We are excited about the early successes and great potential of Artificial Intelligence to dramatically improve health outcomes, reduce administrative burden, and can you buy over the counter propecia create smarter health IT," said American Academy of Family Physicians CEO Shawn Martin in a statement. "We look forward to seeing the winning, and all of the great, solutions in the market.""Avoidable hospitalizations and skilled nursing facility stays are bad for patients and make our healthcare system costlier and less sustainable for everyone," said Mark Miller, executive vice president of health care at Arnold Ventures. "We are eager to see how the winners can you buy over the counter propecia of the competition use new data approaches to identify solutions to improve care in Medicare.""Finding effective ways to improve outcomes and reduce the cost of care is a national imperative," said ClosedLoop CEO Andrew Eye.

"The Challenge drove us to improve our capabilities across the board – scalability, accuracy, deep explainability, and ways to address algorithmic bias and fairness." Twitter. @MikeMiliardHITNEmail the can you buy over the counter propecia writer. Mike.miliard@himssmedia.comHealthcare IT News is a HIMSS publication.The U.S.

Centers for Disease Control and Prevention and the Department of Health and Human Services have rolled out a service allowing people to can you buy over the counter propecia find hair loss treatments available nearby via text message. The text-line will launch alongside treatments.gov – a revamped version of treatmentFinder.org that similarly allows users to search for available treatment doses by ZIP code – and a to-be-released 1-800 number to help those who prefer to get information via phone."As we work to increase access to the hair loss treatments, these tools will eliminate burdens and help make it easier to find vaccination sites," said Surgeon General Dr. Vivek Murthy in a statement provided to can you buy over the counter propecia Healthcare IT News.

Although the site officially went live on May 1, some users – including members of the Healthcare IT News team – reported downtime on Monday as more individuals tried to use the tool.WHY IT MATTERS According to the agencies, anyone can now text their ZIP code to GETVAX (438829) in English, or VACUNA (822862) in Spanish, to get the contact information of three locations near them with available treatments. The tool is aimed at key populations, such as young people can you buy over the counter propecia or those with limited broadband connectivity who might prefer SMS-based messaging. HHS representatives did not respond to questions about which vendor was hosting the text-based service.

Meanwhile, the agencies also announced the conversion of treatmentFinder.org – a project first launched by Boston Children's Hospital, Castlight and the CDC – can you buy over the counter propecia to a new site, treatments.gov. The agencies say that they have worked with jurisdiction and pharmacy partners to increase data reporting to include information for all states.Although spokespeople were not specific as to which vendor was responsible for which component of the site, they said President Joe Biden's administration had worked to forge partnerships between treatmentFinder.org and Google, Apple and Microsoft. According to the CDC website, hair loss treatment vaccination providers are can you buy over the counter propecia required to report inventory each day, although sharing their location to the public is optional.

The tool notes that inventories are subject to change. Indeed, as of Monday, some Chicago-area locations that were displaying availability can you buy over the counter propecia on the treatments.gov website did not have same-day appointments available on the provider website – likely a result of the delay between real-time vaccinations and reporting to the CDC, or between reporting to the CDC and website updates. Agency spokespeople cited the tools as a bridge to access for those who have been unable to obtain a treatment so far.

For instance, in Alabama – currently ranked last in the country for vaccination rates – various ZIP codes returned several can you buy over the counter propecia providers within 50 miles. The same was true in Montana, even with ZIP codes with populations of fewer than 1,000 people. The website is currently available in English and in Spanish, and can you buy over the counter propecia spokespeople said that the agencies had worked to build it with high accessibility standards.

The National hair loss treatment Vaccination Assistance Hotline, a 1-800 number that has not yet been announced, will be available as well for people who prefer to get information via phone. Assistance will be provided in English, Spanish and more than 150 other languages. It also can you buy over the counter propecia includes a teletype line to support access for hearing-impaired callers.

Of course, the tools do not include the actual booking process, so callers may still encounter barriers when they try to make appointments. Still, administration officials can you buy over the counter propecia say their new tools are intended to complement those already available nationwide. THE LARGER TREND Biden teased the rollout of the national treatment finder website during a speech in March.

Other municipalities (and individuals) had already launched similar projects on a local level can you buy over the counter propecia. "At the time when every adult is eligible in May, we will launch, with our partners, new tools to make it easier for you to find the treatment and where to get the shot, including a new website that will help you find a place to get vaccinated and the one nearest you," he said. The announcement prompted speculation from those in the can you buy over the counter propecia health IT community, some of whom remembered the not-so-triumphant initial launch of the Healthcare.gov insurance exchange portal in 2013.

"We know that when the government tries to create IT systems, they've been plagued with bugs," said Dr. Ezekiel Emanuel, former health advisor to President Barack Obama, who also served on President Biden's hair loss treatment advisory board, this past month can you buy over the counter propecia. ON THE RECORD "We want to make it as easy as possible for people to get vaccinated, once they make the decision to do so," said Murthy.

"By making it easier to find can you buy over the counter propecia a treatment, we will help people take a big step towards protecting themselves against hair loss treatment and returning to their lives," Murthy added. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.The hair loss treatment propecia has necessitated a new era in medicine in which telehealth appointments are a core aspect of the patient-provider relationship and provide broader access to healthcare.So what has the healthcare industry learned about telehealth usage over the past year, and how can it use those learnings to deliver more accessible and high-quality healthcare for all?. Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth, has telehealth insights learned from athenahealth's vast nationwide network data sourced from 18.4 million appointments held by 60,000 providers.Healthcare IT News interviewed Sweeney-Platt on the subjects of telemedicine adoption, utilization, scheduling and permanence, seeking her expertise and lessons learned from athenahealth's treasure trove of telehealth data.Q. In your experience, what was telehealth adoption like over the past 12 months?.

Where were you seeing most of the adoption, and in which specialties?. A. Despite the fact that telehealth has been around, in one form or another, since the 1950s, it was the almost total shutdown of the country in March and April of 2020 that truly established it as a mainstream access point.

Not surprisingly, early adoption patterns followed the path of the most acute hair loss treatment breakouts. We saw early spikes in the Northeast and the Western regions of the country, followed by the Midwest and the South.States in the Northeast had the highest percentage (nearly 70% in April 2020) of virtual appointments initially but were overtaken by the West during the second wave of the propecia in June and July 2020.The Midwest has been consistently the second-lowest adopting region percentage-wise (a little over 40% in April 2020), and the South is consistently lowest in terms of percentages (roughly 30% in April 2020). The Northeast is also much more consistent than other regions, with high virtual rates throughout each state.In all, we've seen telehealth go from less than 1% of total athenahealth network volumes to as high as 32%, before settling in at around 10-11%.

The Northeast and the West lead the country for adoption and sustained volume of primary care telehealth appointments.In terms of specialties, not surprisingly we've seen mental health and primary care use telehealth the most. Mental health has seen the largest percentage of appointments held virtually, with 33%, followed by primary care at 17%.Q. You noticed that practices that have settled in at higher rates of utilization also tend to be practices that had some experience with telehealth pre-hair loss treatment.

Please elaborate on what this tells you.A. This tells us that the adoption of technologies like telehealth may be, in part, due to a trusted person that has already figured out how to make it work in that particular organization. These "IT champions" might help overcome some of the initial uncertainty that accompanies any new way of doing things – some of the basic infrastructure and knowledge may have already been in place.This may be a helpful insight moving forward as physicians and medical groups look to implement other technologies.

Never underestimate the power of a good pilot or experiment.This pattern was just one of the observations that led us to believe that (at least from what we can see in our data) patients' use of telehealth is driven more by their practice than it is by individual preferences.We saw some surprising findings when we looked at adoption levels across different racial and ethnic groups, and when we looked more closely, we realized that these patterns were driven by the overall adoption patterns of the practices. As is true with so many other care decisions, if your doctor or care team tells you that this is a safe and acceptable option, patients will likely follow that advice.Q. In your experience, you noted that scheduling has a big part to play in the logistical outcomes of telemedicine services.

What did you observe?. What were the results?. A.

Overall, the patterns that we see in the scheduling of virtual visits is quite different from the scheduling of in-person visits. We were working from a de-identified data set of 18.4 million appointments that took place between November 1, 2020, and January 31, 2021, and which covers 60,000 providers on the athenahealth network.What we saw was that compared to in-person visits (4%), telehealth visits are more likely to occur after-hours or on weekends (7%). Telehealth appointments are almost two times as likely to be scheduled for the same day as compared to in-person appointments.Finally, telehealth appointments are typically shorter.

They are more likely to be under 15 minutes long (70%), compared to in-person visits (62%). Altogether, this paints a picture of patients integrating care on somewhat of a "just-in-time" basis, which allows for more spontaneous access, at times that are perhaps more convenient for folks trying to juggle a lot of other commitments.We have also heard from physicians that telehealth has allowed flexibility in their own schedules. This is a little more anecdotal, but the physicians and providers that we've interviewed talk a lot about how telehealth is something that allows them to interact with patients from wherever they happen to be.One physician talked at length about how important it was to him that he could do a telehealth visit from his car, then go in and see his son play basketball, whereas he would have missed that opportunity before.

The impact on the provider schedule is something that we would actually like to dig into a little more over time from a data perspective.Q. So, we've seen remarkable adoption of telemedicine in the past 12 months, but will it hold?. What kind of permanence will it achieve?.

A. On balance, we are bullish on the future of telehealth and virtual care. This is not to say that there still aren't things that the system needs to work out.

One big wrinkle is long-term reimbursement for these services. It's still an open question as to how much of the regulatory and payment restrictions that were removed in early 2020 will be made permanent. So, any prognostication has to have that giant asterisk next to it.But again, we are bullish on the future, mainly because we see that virtual care helps address real pain points.

Whether it's busy people trying to squeeze a physician visit into their day, or a patient with chronic illness who just needs a check-in and med check, or as a way to make behavioral health services available to more people in more places, virtual care is a valuable addition to the care toolkit.And for providers, virtual care has helped reduce cognitive burden and improve work/life balance. They can take telehealth appointments from the office or at home, which allows them to have more freedom, while still providing top-notch care for patients.We may have seen adoption surge initially as a result of hair loss treatment. But, assuming that it remains financially viable, we think telehealth will have great staying power, because it provides flexibility, convenience and lower-cost access for those using it.Twitter.

@SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication..