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AdvertisementContinue reading the main storySupported byContinue reading cheap kamagra supplier the main storySome Baby Formulas Are Out of Stock. Here’s How to Handle the Shortage.Parents are worried, but experts say you can still keep your baby fed and nourished.Send any friend a storyAs a subscriber, you have 10 gift articles to give each month. Anyone can read what you share.146Credit...Scott Olson/Getty ImagesPublished cheap kamagra supplier Jan. 28, 2022Updated May 11, 2022, 9:23 a.m.

ETBaby formula shortages are worsening throughout the United States, causing parents to be cheap kamagra supplier increasingly concerned about how they will feed their infants. The product data firm Datasembly reported that 40 percent of infant formulas were out of stock across the nation the week of April 23, an increase from earlier in the month.These shortages are driven by a combination of supply chain issues, including a scarcity of some ingredients used to make formula, as well as staff shortages that make it difficult to get products out of warehouses and onto store shelves, said Erin Moore, a pediatric nurse practitioner and certified lactation counselor in Austin, Texas.Some parents are handling the shortage in worrying ways, too — by stockpiling available formula, which exacerbates the shortage for others, or by making their own formula at home, which could lead to nutritional deficiencies, said Dr. Krupa Playforth, a pediatrician in Northern Virginia who has recently cheap kamagra supplier had trouble finding formula for her 6-month-old son.“It’s a very stressful time for new moms,” Ms. Moore said.

But, she added, there are workarounds available so parents can keep their babies cheap kamagra supplier fed and healthy. Here are some tips that may help.Finding Your Formula“When you find a formula that works for your baby, it’s terrifying to face a switch, because you’re very nervous they won’t take it and it won’t settle well with them,” Bridget E. Young, a maternal and child nutrition cheap kamagra supplier specialist at the University of Rochester Medical Center, said. There are a few things you can try if you want to stick with the formula your child normally takes.If your baby drinks a standard infant formula, one option is to call around to local stores to ask if and when they expect to get your formula back in stock, Ms.

Moore said cheap kamagra supplier. Some parents have had luck buying formula online rather than in person, too, she noted.Turning to social media, such as local Facebook groups, is another workaround. €œI’ve seen messages of need sent out in these groups, and almost always, there are generous moms who are able to spare some or help out in some way,” cheap kamagra supplier said Dr. Playforth said.When babies are on special formulas, such as hypoallergenic formulations, for health reasons, parents can also call their pediatricians for help.

Doctor’s offices sometimes have special formula samples in stock, and if not, they can guide cheap kamagra supplier parents to where they can find the products they need, Ms. Moore said.Switching to a New FormulaIf you cannot find the formula you usually buy, the good news is that most of the time — even with special formulas — alternatives are available and safe to use, Dr. Young said cheap kamagra supplier. If you typically use a name-brand formula, the first thing to do is to look for the generic version of that formula, Dr.

Young said cheap kamagra supplier. Generic versions are safe, she added, because all infant formulas are carefully regulated by the U.S. Food and cheap kamagra supplier Drug Administration. And most of the time, generic versions from different stores are the same — so “the Walmart brand of Advantage formula is identical to the Target brand of Advantage formula and the Walgreens brand Advantage formula,” she said.Before you buy anything, check the first five or six ingredients listed on the back label — the ones that appear before the phrase “and less than 2 percent” in the ingredient list.

It’s best to buy a cheap kamagra supplier new formula that matches the ingredients listed in your usual formula, Dr. Young said, to make for an easier transition for your baby. You should also pay attention to terms like “partially hydrolyzed” or “enzymatically cheap kamagra supplier hydrolyzed,” which refer to the size of the protein molecule in the formula. If you normally buy a formula that contains “partially hydrolyzed nonfat milk,” for instance, you’re best off buying a replacement formula that also contains partially hydrolyzed nonfat milk, Dr.

Young explained.If your baby is on a special formula because of prematurity or other cheap kamagra supplier health issues, double-check with your pediatrician before switching, Dr. Playforth suggested, just to be sure you’re making a safe choice.Ideally, when you transition to a new formula, you want to do it gradually, Ms. Moore said, by cheap kamagra supplier mixing the old and new formulas separately before adding them to the same bottle. €œFor a couple of days, give three quarters of your normal formula with one quarter of the new formula.

And then slowly increase the amount of the new formula and wean the amount of the old formula,” she said.Navigating the Baby Formula Shortage in the U.S.Card 1 of 6A growing problem. A nationwide shortage of baby formula — triggered in part by supply-chain issues and worsened by a recall cheap kamagra supplier by the baby food manufacturer Abbott Nutrition — has left parents confused and concerned. Here are some ways to manage this uncertainty:Checking your supplies. Abbott Nutrition has recalled several lots cheap kamagra supplier of its Similac, Alimentum and EleCare formulas after at least four babies became sick with bacterial s.

To find out whether a formula in your home may be affected by the recall, check the lot number on the Abbott website. If you learn that you fed your child a cheap kamagra supplier recalled product, contact your pediatrician.Finding formula. If your baby’s formula was not affected by the recall, but is still not available, you can try calling local stores to ask when they expect to get it back in stock. You may also cheap kamagra supplier be able to buy it online.

If your baby is on special formula, reach out to your doctor’s office. They might have cheap kamagra supplier samples in stock.Picking a new formula. If you typically use a name-brand formula, look for its generic version. Alternatively, seek a new cheap kamagra supplier formula that matches the ingredients listed in your usual one.

If your baby is on a special formula for health reasons, check with your pediatrician before switching.Transitioning to a new product. Ideally, you will want to switch your cheap kamagra supplier child gradually. Start by mixing three quarters of your usual formula with one quarter of the new one and gradually phase out the old product. If you cheap kamagra supplier can’t transition gradually because you’ve run out of your usual formula, that’s OK, although you might notice more gassiness or fussiness during the transition.What not to do.

If you can’t find your baby’s usual formula, don’t make your own — homemade formulas are often nutritionally inadequate and at risk of contamination. Don’t try to “stretch” your formula by adding extra cheap kamagra supplier water, and don’t buy it from unvetted online marketplaces like Craigslist. For a baby less than 1 year old, don’t use toddler formula.If you can’t transition gradually because you’ve run out of your usual formula, that’s OK — your baby will be fine, Ms. Moore said, although you might notice more gassiness or fussiness during cheap kamagra supplier the transition.

That is expected, and normal, for the first two weeks after switching formulas, she added. If you do see worrying symptoms — such as blood in your baby’s stool, a rash or signs that your baby is having trouble breathing — they could be a sign of an allergy and you should stop feeding them the new formula and call your pediatrician cheap kamagra supplier immediately, Dr. Young said.Avoiding Nutrition MistakesIf you’re running low on formula, never dilute it. Continue to follow the preparation directions listed on the package cheap kamagra supplier.

€œChanging the ratio of formula to water can be extremely dangerous for infants and lead to water intoxication, electrolyte imbalances and seizures,” Dr. Playforth said.Likewise, never make your own formula cheap kamagra supplier at home, as doing so can cause nutritional deficiencies and other health issues, Dr. Playforth added. A 2020 cheap kamagra supplier study analyzed 144 online baby formula recipes, finding that nearly half included ingredients that could cause food-borne illness.Dr.

Young does not recommend feeding babies under 1 formulas that are intended for toddlers, either, unless your pediatrician gives you permission. Even if the ingredients look similar, toddler formulas can contain amounts of certain ingredients, like cheap kamagra supplier vitamins, that are not safe for young babies. €œIf you have an infant, stick with an infant formula,” she said. Don’t feed your baby cow’s milk if they’re under 1 year old, either, she said, because the proteins can be difficult for infants to digest cheap kamagra supplier and may not provide essential nutrients.The bottom line is that even if you can’t find your favorite baby formula, other options will work well.

There are so many types of infant formulas on the market, Dr. Young said, that you’ll almost certainly be able to find one that nourishes your baby.Melinda Wenner Moyer is a science journalist and the author of “How To Raise Kids Who Aren’t Assholes.”AdvertisementContinue reading the main story.

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A previous EBN editorial discussed the role of universities in supporting the mental health and well-being of nursing students.1 This editorial was published in February 2020, so was written with little or no idea of the extraordinary challenges that were soon to confront society and healthcare providers as the erectile dysfunction treatment kamagra spread.The earlier editorial buy kamagra uk review highlighted that even in pre-kamagra times, the pressures on nursing students were what does kamagra do substantial. A mixture of academic expectation, assessment of practice competence and personal commitments, resulting in high prevalence of stress and anxiety.2 Since early 2020 though, the kamagra has magnified these pressures on nursing students across the globe.The importance of this issue was highlighted in a systematic review that explored the prevalence of mental health problems and sleep disturbance among nursing students during the kamagra.3 The review suggested that over a quarter of respondents were experiencing sleep disturbances, nearly one-third were feeling stress or anxiety, and more than half reported suffering from depression. This review, and others, have highlighted -the substantial impact that the kamagra has had on nursing students, but what does the what does kamagra do evidence tell us about why this group has been hit so hard?. There are few members of society who have been untouched by the erectile dysfunction treatment kamagra. Many have lost what does kamagra do loved ones.

Many have suffered ill-health (and many continue to do so as a result of long erectile dysfunction treatment). Most have lived with societal restrictions and uncertainty about the what does kamagra do future. However, the evidence suggests that nursing students are a group upon whom erectile dysfunction treatment has had a disproportionate impact.This is due to nursing students being what Drach-Zahavy et al describe as a ‘poly-vulnerable’ group4—something which the broader evidence base supports. The research of the past 2 years demonstrates that nursing students have been impacted by erectile dysfunction treatment in three distinct but connected ways:As a studentOne of the most immediate impacts of the kamagra across what does kamagra do education providers was the rapid transition to remote education. Though the need to do this in a bid to slow erectile dysfunction treatment transmission rates was unquestionable, the effect on students generally—and nursing students specifically—was enormous.

Fitzgerald and Konrad surveyed 50 undergraduate nursing students in the USA, finding that 80% of them were anxious about the impact of the move to remote learning on their ability to succeed academically, with 62% expressing concerns about being able to manage their academic workload during the kamagra.5 To explore students’ experiences in greater detail, Wallace et al carried out a qualitative study in the USA. They discovered that particular causes of anxiety linked to the move to remote learning were the technological challenges faced (such as having access to a reliable internet connection), and the perceived loss of support mechanisms what does kamagra do through not spending time in class with peers and educators.6As a nurseDuring the earlier stages of the kamagra, students were ‘recruited to the frontline to join the fight against erectile dysfunction treatment’ (wartime terminology was especially prevalent at that point). This need to work in clinical practice during a time of particular challenge impacted on students in different ways, and several papers focused specifically on this issue. The rapid move to support the healthcare workforce, referred to by Gómez-Ibáñez what does kamagra do et al as ‘rushed labour insertion’,7 was a dichotomous experience for students. It did give them get kamagra the opportunity to practise their skills, gain practice hours and contribute directly to the care of those suffering from erectile dysfunction treatment.

Equally, though, moving into frontline care also caused substantial anxiety, sometimes as a result of what does kamagra do fear regarding the impact on their studies, sometimes due to the personal risk that this encompassed and sometimes because they were concerned about the risk it might present to those around them.As a personAs with all members of society, nursing students were concerned about their well-being and that of their family during the kamagra, were impacted by societal lockdowns and, in some cases, were subject to periods of illness and self-isolation. One of the most commonly cited causes of stress and anxiety among nursing students during the kamagra has been the potential for their role to endanger their friends and families through transmission of the disease.4 5 8 Indeed—and perhaps indicative of the unselfish attitudes demonstrated by nursing students throughout the kamagra—fear of infecting others was a much greater source of anxiety than become infected themselves. The personal impact for students was increased through the steps that many of them took to reduce the risk to infect others what does kamagra do. Gómez-Ibáñez et al outline how nursing students deliberately chose to self-quarantine at home, to avoid direct contact with friends and family, and sometimes even to seek for temporary accommodation to live alone.7 By doing so, these students may well have reduced the risk to others, but they also stripped away many of the support mechanisms that were so important—notably those provided by family, friends and peers.This perhaps demonstrates one of the key lessons from the literature. Those elements of nursing students’ lives that have been impacted on by the kamagra do not exist in isolation.

The challenges associated with each—as a what does kamagra do student, as a nurse, as a person—influence and magnify each other. In their qualitative study of the experiences of final-placement nursing students, Diaz et al found that it was the enormity of the changes in all aspects of life—personal, academic and nursing—and the speed with which these changes took place, that led to such a substantial impact on the mental health and well-being of nursing students.9So what conclusions can we reach from the research into nursing students during erectile dysfunction treatment?. First, the kamagra what does kamagra do has demonstrated just what important roles nursing students play in healthcare delivery. Not just as the workforce of the future, but as the workforce of now. We can also see how their responsibilities as a person, as a nurse and as a student interact in a way that makes them especially vulnerable.The research into the impact on nursing students also provides what does kamagra do us with some other, more positive, insights though.

There is evidence that throughout the kamagra, the quality of online education and of the support provided by academics and practice supervisors was instrumental in reducing stress and anxiety in nursing students,5 highlighting that it has been possible to mitigate the impact. The evidence base what does kamagra do also shows us how some nursing students welcomed and embraced the opportunity to support clinical practice, gain experience and make a direct contribution to the effort to counter the impact of erectile dysfunction treatment.7 Equally, there is evidence that facing these multiple challenges may have enhanced personal resilience4 6 and enabled the development of new skillsets, such as enhanced information technology skills.6Those cohorts of nursing students who studied through erectile dysfunction treatment have faced pressures like no others—they have had to meet academic requirements of their studies, while taking on additional clinical commitments and trying to keep themselves and their families safe. Their response has been extraordinary, and they will have developed skills and experience that will make them better, more resilient nurses. They should be proud of what they have achieved and who they are.Ethics statementsPatient consent for publicationNot required..

A previous EBN editorial discussed the role of universities in supporting the mental health and well-being of nursing students.1 This editorial was published in February 2020, so was written with little or no idea of the extraordinary challenges that were soon to confront society and healthcare cheap kamagra supplier providers as the erectile dysfunction treatment kamagra spread.The earlier editorial highlighted that even in pre-kamagra times, the pressures on nursing students were substantial. A mixture of academic expectation, assessment of practice competence and personal commitments, resulting in high prevalence of stress and anxiety.2 Since early 2020 though, the kamagra has magnified these pressures on nursing students across the globe.The importance of this issue was highlighted in a systematic review that explored the prevalence of mental health problems and sleep disturbance among nursing students during the kamagra.3 The review suggested that over a quarter of respondents were experiencing sleep disturbances, nearly one-third were feeling stress or anxiety, and more than half reported suffering from depression. This review, and others, have highlighted -the substantial impact that the kamagra has had on nursing students, but what does the evidence tell us about why this group has been cheap kamagra supplier hit so hard?. There are few members of society who have been untouched by the erectile dysfunction treatment kamagra.

Many have lost loved ones cheap kamagra supplier. Many have suffered ill-health (and many continue to do so as a result of long erectile dysfunction treatment). Most have lived with societal restrictions cheap kamagra supplier and uncertainty about the future. However, the evidence suggests that nursing students are a group upon whom erectile dysfunction treatment has had a disproportionate impact.This is due to nursing students being what Drach-Zahavy et al describe as a ‘poly-vulnerable’ group4—something which the broader evidence base supports.

The research of the past 2 years demonstrates that nursing students have been impacted by erectile dysfunction treatment in three distinct but connected ways:As a studentOne of the most immediate impacts of the kamagra across education providers was cheap kamagra supplier the rapid transition to remote education. Though the need to do this in a bid to slow erectile dysfunction treatment transmission rates was unquestionable, the effect on students generally—and nursing students specifically—was enormous. Fitzgerald and Konrad surveyed 50 undergraduate nursing students in the USA, finding that 80% of them were anxious about the impact of the move to remote learning on their ability to succeed academically, with 62% expressing concerns about being able to manage their academic workload during the kamagra.5 To explore students’ experiences in greater detail, Wallace et al carried out a qualitative study in the USA. They discovered that particular causes of anxiety linked to the move to remote learning were the technological challenges faced (such as having access to a reliable internet connection), and the perceived loss of support mechanisms through not spending time in class with peers and educators.6As a nurseDuring the earlier stages of the kamagra, cheap kamagra supplier students were ‘recruited to the frontline to join the fight against erectile dysfunction treatment’ (wartime terminology was especially prevalent at that point).

This need to work in clinical practice during a time of particular challenge impacted on students in different ways, and several papers focused specifically on this issue. The rapid move to support the healthcare workforce, referred cheap kamagra supplier to by Gómez-Ibáñez et al as ‘rushed labour insertion’,7 was a dichotomous experience for students. It did give them the opportunity to practise their skills, gain practice hours and contribute directly to the care of those suffering from erectile dysfunction treatment. Equally, though, moving into frontline care also caused substantial anxiety, sometimes as a result of fear regarding the impact on their studies, sometimes due to the personal risk that this encompassed and sometimes because they were concerned about the risk it might present to those around them.As a personAs with all members of society, nursing students were concerned about their well-being and that of their family during cheap kamagra supplier the kamagra, were impacted by societal lockdowns and, in some cases, were subject to periods of illness and self-isolation.

One of the most commonly cited causes of stress and anxiety among nursing students during the kamagra has been the potential for their role to endanger their friends and families through transmission of the disease.4 5 8 Indeed—and perhaps indicative of the unselfish attitudes demonstrated by nursing students throughout the kamagra—fear of infecting others was a much greater source of anxiety than become infected themselves. The personal impact for students was increased through the steps that many of them took cheap kamagra supplier to reduce the risk to infect others. Gómez-Ibáñez et al outline how nursing students deliberately chose to self-quarantine at home, to avoid direct contact with friends and family, and sometimes even to seek for temporary accommodation to live alone.7 By doing so, these students may well have reduced the risk to others, but they also stripped away many of the support mechanisms that were so important—notably those provided by family, friends and peers.This perhaps demonstrates one of the key lessons from the literature. Those elements of nursing students’ lives that have been impacted on by the kamagra do not exist in isolation.

The challenges associated with each—as a student, as a nurse, as a person—influence and magnify each cheap kamagra supplier other. In their qualitative study of the experiences of final-placement nursing students, Diaz et al found that it was the enormity of the changes in all aspects of life—personal, academic and nursing—and the speed with which these changes took place, that led to such a substantial impact on the mental health and well-being of nursing students.9So what conclusions can we reach from the research into nursing students during erectile dysfunction treatment?. First, the kamagra cheap kamagra supplier has demonstrated just what important roles nursing students play in healthcare delivery. Not just as the workforce of the future, but as the workforce of now.

We can also see how their responsibilities as a person, as a cheap kamagra supplier nurse and as a student interact in a way that makes them especially vulnerable.The research into the impact on nursing students also provides us with some other, more positive, insights though. There is evidence that throughout the kamagra, the quality of online education and of the support provided by academics and practice supervisors was instrumental in reducing stress and anxiety in nursing students,5 highlighting that it has been possible to mitigate the impact. The evidence base also shows us how some nursing students welcomed and embraced the opportunity to support clinical practice, gain experience and make a direct contribution to the effort to counter the impact of erectile dysfunction treatment.7 Equally, there is evidence that facing these multiple challenges may have enhanced personal resilience4 6 and enabled the development of new skillsets, such as enhanced information technology skills.6Those cohorts of nursing students who studied through erectile dysfunction treatment have faced pressures like no others—they have had to meet academic requirements of their studies, while taking on additional clinical commitments and trying to keep themselves and their families safe cheap kamagra supplier. Their response has been extraordinary, and they will have developed skills and experience that will make them better, more resilient nurses.

They should be proud of what they have achieved and who they are.Ethics statementsPatient consent for publicationNot required..

What should I tell my health care provider before I take Kamagra?

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

• eye or vision problems, including a rare inherited eye disease called retinitis pigmentosa
• heart disease, angina, high or low blood pressure, a history of heart attack, or other heart problems
• kidney disease
• liver disease
• stroke
• an unusual or allergic reaction to sildenafil, other medicines, foods, dyes, or preservatives

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NSW will take its first steps towards reopening as the State passes the 70 per cent double vaccination target.With the first vaccination milestone being reached, the NSW kamagra online purchase Government is also easing a number of restrictions as click now part of the Reopening NSW roadmap, which will allow fully vaccinated adults to enjoy more freedoms from next Monday, October 11.The changes to the 70 per cent roadmap will allow up to 10 visitors (not counting children 12 and under) to a home (previously five), lift the cap on outdoor gatherings to 30 people (previously 20), and increase the cap for weddings and funerals to 100 people (previously 50). Indoor pools will also be re-opened for swimming lessons, squad training, lap swimming, and rehab activities. On the Monday after the State clears the 80 per cent double vaccination hurdle further restrictions will be relaxed, with people able to have up to 20 visitors (excluding children 12 and under) to a home (previously 10), and up to 50 people will be allowed to gather outdoors kamagra online purchase (previously 20). Up to 3,000 people will be allowed to attend controlled and ticketed outdoor events (previously 500), nightclubs will be permitted to reopen for seated drinking only (no dancing), and masks will no longer be required in office buildings.

All roadmap freedoms at 70 and 80 per cent will continue to be for kamagra online purchase fully vaccinated people only.All school students will also now return to on site learning with a range of erectile dysfunction treatment-safe measures in place by October 25, with the second and third stages of the return to school plan now combined. Kindergarten, Year 1 and Year 12 students will still return to face-to-face learning on October 18, with all other years now returning one week later on October 25. Premier Dominic Perrottet said the common-sense kamagra online purchase changes would help life return to normal as soon as possible. €œVaccinations are the key to life returning to normal and the changes today will help family and friends reconnect, get kids back to school and get businesses back up and running sooner,” Mr Perrottet said.“NSW is putting in the hard yards and it’s important people continue to turn out in droves to be vaccinated.”Deputy Premier Paul Toole said workers in regional areas who have received one vaccination dose will be permitted to return to their workplace from October 11 and will be given a grace period until November 1 to receive their second dose.

Regional areas are those outside Greater Sydney, the Blue Mountains, Wollongong, Shellharbour and the kamagra online purchase Central Coast. €œThis move ensures we get businesses in the regions re-open and local economies buzzing again. It's about ensuring we make this a roadmap that works for everyone,” Mr Toole said.Minister for Jobs, Investment, Tourism and Western Sydney Stuart Ayres said these changes would help get more people back into work, especially in Western Sydney.“We’re on the road back to normal and most importantly reaching these vaccination targets means people can reunite with family and friends, celebrate key moments in their lives and businesses can open their doors and get back to work in a safe way,” Mr Ayres kamagra online purchase said. Health Minister Brad Hazzard said NSW residents 12-years-old and over have led the charge to get vaccinated and ensure NSW is among the safest places in the world.“Getting to 70 per cent double dose is a badge of honour for every fully vaccinated NSW citizen to wear proudly but we can do so much more and 90 per cent is within our grasp,” Mr Hazzard said.Minister for Education and Early Childhood Learning Sarah Mitchell said schools were ready to welcome students back.“The return remains safe and sensible with enough time for schools to prepare for a faster return of students over two weeks instead of three,” Ms Mitchell said.“Principals have received detailed guidance and checklists of everything required to ensure erectile dysfunction treatment-safe settings in their school.

Parents and carers will also receive a detailed guide today and more specific information from their kamagra online purchase school in the coming days.”If you are not booked in for a erectile dysfunction treatment, please book an appointment as soon possible.Note also that as the stay-at-home orders will be lifted next Monday and replaced by the roadmap settings, the list of Local Government Areas of concern will cease to exist. For the latest information visit the erectile dysfunction treatment pages on nsw.gov.au.New public health advice sets out how NSW will continue to tackle erectile dysfunction treatment as the state begins to reopen when it reaches the 70 per cent double dose vaccination target. Health Minister Brad Hazzard said kamagra online purchase while high vaccination rates were the key factor in the roadmap to recovery, erectile dysfunction treatment will continue to circulate in the community. €œNSW is leading the nation in so many ways with its kamagra response but particularly in its vaccination efforts.

I urge those who kamagra online purchase are yet to get vaccinated to do so quickly to protect yourself, your loved ones and the community,” Mr Hazzard said. €œWe are closing-in on the 70 per cent double dose mark and when we achieve it there will be significant changes to our public health advice and the key difference will be how that advice is applied to people who are vaccinated and to those who are not. €œVaccination will provide greater freedoms as kamagra online purchase our society opens up and it reduces the risk of you spreading the kamagra to someone vulnerable, which could cost them their life. €œDespite the ongoing challenges that will continue to be posed by erectile dysfunction treatment, we have the opportunity to lead the world which is why it is vital everyone is vaccinated and follows the updated public health advice that will be in place from 11 October.”Some of the key public health advice for the general community will be.

Everyone, vaccinated and not vaccinated, is urged to get tested if you have any symptoms of erectile dysfunction treatment and immediately self-isolate until a negative result is received.Whether you are vaccinated or not vaccinated, if you test positive for erectile dysfunction treatment you kamagra online purchase must self-isolate for 14 days. Close contacts in the community will include household members of positive cases and close social contacts of positive cases, such as partners and friends, who you spent time in close proximity with, even if fully vaccinated. Anyone may also be assessed as a being a close contact following a risk assessment, including at workplaces, high-risk settings, such as healthcare and aged care, and other specific settings such as schools and child care centres, or where an outbreak has been identified kamagra online purchase. If you are a close contact of a positive case and vaccinated, you must get tested and self-isolate for seven days.

On day six after kamagra online purchase exposure, you must get tested again. If a negative result view it is received and you are well, you can end isolation after day seven. For the following seven days you must work from home where practicable, not attend hospitality settings, and not attend a high-risk settings even kamagra online purchase if it is your place of work. If you are a close contact of a positive case and not vaccinated you must get tested and immediately self-isolate for 14 days.

On day 12, you should get tested kamagra online purchase again. If a negative result is received, you can end isolation after day 14.The Service NSW QR code check-in system will remain in place in the general community. This system will be used to notify people who kamagra online purchase were in the same venue as a positive case. People will be asked to monitor for symptoms and get tested if they become unwell.

Other settings, including schools, workplaces and high-risk settings, such as healthcare and kamagra online purchase aged care, will have specific risk assessment approaches. People aged 16 years and over will only be allowed entry into some venues or settings if fully vaccinated, along with people with exemptions. In some venues, children kamagra online purchase under 16 will have to be accompanied by a fully vaccinated member of their household to enter. This includes hospitality venues, non-critical retail stores, personal services, sporting, recreation and entertainment facilities and events.

Critical retail such as supermarkets and pharmacies will still be accessible kamagra online purchase to those not fully vaccinated. There are several options to show proof of erectile dysfunction treatment vaccination or exemption. Some of the key public health kamagra online purchase advice for the business community will be. If a staff member tests positive, whether they are vaccinated or not vaccinated, they must self-isolate for 14 days and follow the advice from NSW Health.

Businesses will refer to their erectile dysfunction treatment Safety Plan and risk assessment approach for further kamagra online purchase instructions on notifying other staff.Businesses must inform NSW Health if three or more employees test positive for erectile dysfunction treatment in a seven-day period.NSW Health guidelines will enable businesses to assess workplace risk if a erectile dysfunction treatment case is identified and confirm actions to be taken.Businesses can reduce the risk of closure or staff going into isolation by implementing rigorous erectile dysfunction treatment Safety Plans. Other proactive steps businesses can take include ensuring staff are vaccinated and implementing regular onsite testing programs for workers. With respect to vaccination compliance and obligations:Businesses will be responsible for taking reasonable measures kamagra online purchase to stop unvaccinated people entering premises. For example, having prominent signs stating requirements, Service NSW QR codes, staff checking vaccination status upon entry and only accepting valid forms of evidence of vaccination.

Authorised officers will monitor businesses re-opening, particularly those that have vaccination requirements, for example hospitality, retail, gyms, and personal services kamagra online purchase (e.g. Hair, beauty). Penalties may apply for individuals and businesses kamagra online purchase who don’t comply. On the spot fines of $1,000 may apply to individuals for not complying, or for using fraudulent evidence of vaccination or check-in.

On the spot fines of $5,000 may apply to businesses for not complying with the Public Health Order vaccination kamagra online purchase requirements. Further penalties may apply for significant breaches.NSW Chief Health Officer Dr Kerry Chant said it is important to note that the new advice may be updated by NSW Health as case numbers and evidence changes.“We will continue to do what we have done throughout this kamagra, which is to regularly update our advice, informed by experience, feedback, and emerging evidence. It is only in partnership that we can reopen in a safe way.”Visit nsw.gov.au for the latest information.

NSW will take its first steps towards reopening as the State passes the 70 per cent double vaccination target.With the first vaccination milestone cheap kamagra supplier being reached, the NSW our website Government is also easing a number of restrictions as part of the Reopening NSW roadmap, which will allow fully vaccinated adults to enjoy more freedoms from next Monday, October 11.The changes to the 70 per cent roadmap will allow up to 10 visitors (not counting children 12 and under) to a home (previously five), lift the cap on outdoor gatherings to 30 people (previously 20), and increase the cap for weddings and funerals to 100 people (previously 50). Indoor pools will also be re-opened for swimming lessons, squad training, lap swimming, and rehab activities. On the Monday after the State clears the 80 per cent double vaccination hurdle further restrictions will be relaxed, with people able to have up to 20 visitors cheap kamagra supplier (excluding children 12 and under) to a home (previously 10), and up to 50 people will be allowed to gather outdoors (previously 20). Up to 3,000 people will be allowed to attend controlled and ticketed outdoor events (previously 500), nightclubs will be permitted to reopen for seated drinking only (no dancing), and masks will no longer be required in office buildings.

All roadmap freedoms at 70 and 80 per cent will continue to be for fully vaccinated people only.All school students will also now return to on site learning with cheap kamagra supplier a range of erectile dysfunction treatment-safe measures in place by October 25, with the second and third stages of the return to school plan now combined. Kindergarten, Year 1 and Year 12 students will still return to face-to-face learning on October 18, with all other years now returning one week later on October 25. Premier Dominic Perrottet said the common-sense changes would help life cheap kamagra supplier return to normal as soon as possible. €œVaccinations are the key to life returning to normal and the changes today will help family and friends reconnect, get kids back to school and get businesses back up and running sooner,” Mr Perrottet said.“NSW is putting in the hard yards and it’s important people continue to turn out in droves to be vaccinated.”Deputy Premier Paul Toole said workers in regional areas who have received one vaccination dose will be permitted to return to their workplace from October 11 and will be given a grace period until November 1 to receive their second dose.

Regional areas are those cheap kamagra supplier outside Greater Sydney, the Blue Mountains, Wollongong, Shellharbour and the Central Coast. €œThis move ensures we get businesses in the regions re-open and local economies buzzing again. It's about ensuring we make this a roadmap that works for everyone,” Mr Toole said.Minister for Jobs, Investment, Tourism and Western Sydney Stuart Ayres said these changes would help get more people back into cheap kamagra supplier work, especially in Western Sydney.“We’re on the road back to normal and most importantly reaching these vaccination targets means people can reunite with family and friends, celebrate key moments in their lives and businesses can open their doors and get back to work in a safe way,” Mr Ayres said. Health Minister Brad Hazzard said NSW residents 12-years-old and over have led the charge to get vaccinated and ensure NSW is among the safest places in the world.“Getting to 70 per cent double dose is a badge of honour for every fully vaccinated NSW citizen to wear proudly but we can do so much more and 90 per cent is within our grasp,” Mr Hazzard said.Minister for Education and Early Childhood Learning Sarah Mitchell said schools were ready to welcome students back.“The return remains safe and sensible with enough time for schools to prepare for a faster return of students over two weeks instead of three,” Ms Mitchell said.“Principals have received detailed guidance and checklists of everything required to ensure erectile dysfunction treatment-safe settings in their school.

Parents and carers will also receive a detailed guide today and more specific information from their school in the coming days.”If you are not booked in for a erectile dysfunction treatment, please book an appointment as soon possible.Note also that as the stay-at-home orders will be lifted next Monday and replaced by the roadmap settings, the list of Local cheap kamagra supplier Government Areas of concern will cease to exist. For the latest information visit the erectile dysfunction treatment pages on nsw.gov.au.New public health advice sets out how NSW will continue to tackle erectile dysfunction treatment as the state begins to reopen when it reaches the 70 per cent double dose vaccination target. Health Minister Brad Hazzard said while high vaccination rates were the key cheap kamagra supplier factor in the roadmap to recovery, erectile dysfunction treatment will continue to circulate in the community. €œNSW is leading the nation in so many ways with its kamagra response but particularly in its vaccination efforts.

I urge those who are yet to get vaccinated to do so quickly to protect yourself, your loved ones and the community,” cheap kamagra supplier Mr Hazzard said. €œWe are closing-in on the 70 per cent double dose mark and when we achieve it there will be significant changes to our public health advice and the key difference will be how that advice is applied to people who are vaccinated and to those who are not. €œVaccination will provide greater freedoms as our society opens up and it reduces cheap kamagra supplier the risk of you spreading the kamagra to someone vulnerable, which could cost them their life. €œDespite the ongoing challenges that will continue to be posed by erectile dysfunction treatment, we have the opportunity to lead the world which is why it is vital everyone is vaccinated and follows the updated public health advice that will be in place from 11 October.”Some of the key public health advice for the general community will be.

Everyone, vaccinated and not vaccinated, is urged to get tested if you have any symptoms cheap kamagra supplier of erectile dysfunction treatment and immediately self-isolate until a negative result is received.Whether you are vaccinated or not vaccinated, if you test positive for erectile dysfunction treatment you must self-isolate for 14 days. Close contacts in the community will include household members of positive cases and close social contacts of positive cases, such as partners and friends, who you spent time in close proximity with, even if fully vaccinated. Anyone may also be assessed as a cheap kamagra supplier being a close contact following a risk assessment, including at workplaces, high-risk settings, such as healthcare and aged care, and other specific settings such as schools and child care centres, or where an outbreak has been identified. If you are a close contact of a positive case and vaccinated, you must get tested and self-isolate for seven days.

On day six after cheap kamagra supplier exposure, you must get tested again. If a negative result is his comment is here received and you are well, you can end isolation after day seven. For the following seven days you must work from home where practicable, not attend hospitality settings, and not cheap kamagra supplier attend a high-risk settings even if it is your place of work. If you are a close contact of a positive case and not vaccinated you must get tested and immediately self-isolate for 14 days.

On day 12, you cheap kamagra supplier should get tested again. If a negative result is received, you can end isolation after day 14.The Service NSW QR code check-in system will remain in place in the general community. This system will be used cheap kamagra supplier to notify people who were in the same venue as a positive case. People will be asked to monitor for symptoms and get tested if they become unwell.

Other settings, including cheap kamagra supplier schools, workplaces and high-risk settings, such as healthcare and aged care, will have specific risk assessment approaches. People aged 16 years and over will only be allowed entry into some venues or settings if fully vaccinated, along with people with exemptions. In some venues, children under 16 will have to be accompanied by a cheap kamagra supplier fully vaccinated member of their household to enter. This includes hospitality venues, non-critical retail stores, personal services, sporting, recreation and entertainment facilities and events.

Critical retail such as supermarkets and pharmacies will still be accessible to those not fully cheap kamagra supplier vaccinated. There are several options to show proof of erectile dysfunction treatment vaccination or exemption. Some of the cheap kamagra supplier key public health advice for the business community will be. If a staff member tests positive, whether they are vaccinated or not vaccinated, they must self-isolate for 14 days and follow the advice from NSW Health.

Businesses will refer to their erectile dysfunction treatment Safety Plan and risk assessment approach for further instructions on notifying other staff.Businesses must inform NSW Health if three or more employees test positive for erectile dysfunction treatment in a seven-day period.NSW Health guidelines will cheap kamagra supplier enable businesses to assess workplace risk if a erectile dysfunction treatment case is identified and confirm actions to be taken.Businesses can reduce the risk of closure or staff going into isolation by implementing rigorous erectile dysfunction treatment Safety Plans. Other proactive steps businesses can take include ensuring staff are vaccinated and implementing regular onsite testing programs for workers. With respect to vaccination compliance and cheap kamagra supplier obligations:Businesses will be responsible for taking reasonable measures to stop unvaccinated people entering premises. For example, having prominent signs stating requirements, Service NSW QR codes, staff checking vaccination status upon entry and only accepting valid forms of evidence of vaccination.

Authorised officers will monitor businesses re-opening, particularly those that have vaccination requirements, for cheap kamagra supplier example hospitality, retail, gyms, and personal services (e.g. Hair, beauty). Penalties may apply for individuals and businesses who cheap kamagra supplier don’t comply. On the spot fines of $1,000 may apply to individuals for not complying, or for using fraudulent evidence of vaccination or check-in.

On the spot fines of $5,000 may apply to businesses for not complying with the Public Health cheap kamagra supplier Order vaccination requirements. Further penalties may apply for significant breaches.NSW Chief Health Officer Dr Kerry Chant said it is important to note that the new advice may be updated by NSW Health as case numbers and evidence changes.“We will continue to do what we have done throughout this kamagra, which is to regularly update our advice, informed by experience, feedback, and emerging evidence. It is only in partnership that we can reopen in a safe way.”Visit nsw.gov.au for the latest information.

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SALT LAKE look at this now CITY, Feb kamagra canada. 22, 2022 kamagra canada /PRNewswire/ -- Health Catalyst, Inc. ("Health Catalyst," Nasdaq kamagra canada. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that it has entered into a definitive agreement to acquire KPI Ninja, a Lincoln, Nebraska-based provider of interoperability solutions and population health analytics.

KPI Ninja's end-to-end technology solution combines the agility of a centralized platform with interoperability and analytic technology kamagra canada. Health Catalyst believes KPI Ninja's powerful and flexible event-driven data processing capabilities, a natural complement to Health Catalyst's Data Operating System (DOS™) Platform, will empower customers with the ability to build and customize kamagra canada new services, clinical solutions, and operational tools around their core care systems, without the major refactoring and processing typically required of these systems. Additionally, Health Catalyst expects KPI Ninja's ability to seamlessly ingest, aggregate, and analyze varied data sources from inside and outside the hospital, such as FHIR, Hl7 V2, CCDs, flat files, and APIs, will kamagra canada bolster Health Catalyst's existing data processing capabilities and maximize functionality of Health Catalyst's Analytics Applications layer. Health Catalyst is committed to enabling KPI Ninja's focus to be on continued outstanding execution and delivery to existing clients, with its current client support teams and relationships uninterrupted in enabling this focus and execution.

We anticipate that these attributes, together with Health Catalyst, will help ensure data is ready to power insights at every step of the decision-making process, allowing customers to see results faster with greater cost efficiency."KPI Ninja's powerful and flexible event-driven streaming capability strengthen our ability to offer innovative kamagra canada solutions within the healthcare data and analytics technology ecosystem and our ability to support healthcare organizations on their clinical, financial, and operational improvement journeys," said Dan Burton, CEO of Health Catalyst. "We look forward to welcoming every current KPI Ninja team member to Health Catalyst, and we are committed to supporting, as the top-priority, the current team's efforts to continue to deliver these tremendous solutions, consistently, and without interruption or disruption, to KPI Ninja's current clients.""Both Health Catalyst and KPI Ninja kamagra canada share a common vision of advancing health care through arming health with data-driven insights," said Vineeth Yeddula, CEO of KPI Ninja. "By combining our technologies, we make a kamagra canada giant step toward advancing our shared vision. We are grateful to have Health Catalyst's support as we continue to serve our existing clients, ensuring the delivery of world class KPI Ninja products and services without interruption, while we continue to expand our footprint and maximize the value we deliver to the industry."About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement.

Its customers kamagra canada leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed.About KPI kamagra canada NinjaKPI Ninja is a mission-driven company that offers technology solutions that enable and empower those that work in the health care enterprise. As a leading provider of interoperability, enterprise analytics and value-based kamagra canada care solutions, KPI Ninja is known for its powerful capabilities, flexible configurations, and comprehensive applications to fulfill the promise of data-driven health care. Its platform is aligned to initiatives led by CMS, ONC, NCQA, including holding NCQA's Data Aggregator Validation (DAV) Certified Data Partner status, eCQM Certification, Measure Certification for HEDIS® Health Plan 2021, PCMH and PCSP Prevalidations, ONC Health IT Certification and is an eHealth Exchange Validated Product - demonstrating the commitment to serving as a trusted brand.

Cautionary Note Regarding kamagra canada Forward-Looking StatementsThis press release contains forward-looking statements relating to expectations, plans, and prospects including expectations relating to our ability to close, and the timing of the closing of, this transaction and the benefits that will be derived from this transaction. These forward-looking statements are based upon the current expectations and beliefs of Health Catalyst's management as of kamagra canada the date of this release, and are subject to certain risks and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements including, without limitation, the risk of adverse and unpredictable macro-economic conditions and risks related to closing this transaction and integration of the companies. All forward-looking statements in this press release are based on information available to the Company as of the date hereof, and Health Catalyst disclaims any obligation to update these forward-looking statements.Contact:Amanda HundtVP of Corporate Communications amanda.hundt@healthcatalyst.com View original content to download multimedia:https://www.prnewswire.com/news-releases/health-catalyst-announces-intent-to-acquire-kpi-ninja-301487106.htmlSOURCE Health CatalystCredit...Cole Barash for The New York TimesSkip kamagra canada to contentSkip to site indexHow Simple Exercises May Save Your Lower BackBack pain is common and complicated. But altering your workout to build control and stability can help prevent it.Credit...Cole Barash for The New York TimesSupported byContinue reading the main storyFeb.

25, 2022The kamagra canada past few years have not been kind to my lower back. Between the physical tolls of pregnancy, parenting and working from home, I have a constant stiff, achy feeling in my lower spine kamagra canada. I am not alone kamagra canada. It’s estimated that up to 80 percent of Americans will develop lower back pain during their lifetime, with 15 to 20 percent of adults reporting it in an average year.Could exercise prevent some of this pain?.

The short answer is maybe kamagra canada. A consistent mixture of cardio and dedicated core work can kamagra canada help. However, exercise alone is not a guarantee of pain relief, as there are a number of mistakes that many of us, even experienced athletes, may make.The spine is susceptible to pain when core muscles are weak.“The lower back kamagra canada is the center point of our whole body,” said Dr. Krishna Shah, an interventional pain specialist at Baylor College of Medicine.

The spine has to be mobile, able to bend and twist in multiple directions, while also bearing the weight of our body.Surrounding the spine are the core muscles kamagra canada. Although we tend to think of our core as the abdominals, it also includes the deep back muscles, as well as the hip muscles, quadriceps and hamstrings, which support our spine and pelvis.Core muscles work similarly to a back brace, kamagra canada keeping the midsection stable and upright. That’s why wearing a brace provides short-term pain relief for patients with lower back pain, but relying on one too much can weaken their core muscles. Instead, the goal should be to strengthen those muscles enough to kamagra canada do the brace’s job.“If you can develop your own internal brace, that is more effective,” said Dr.

Sean Barber, a neurosurgeon and spine specialist at Houston Methodist Hospital.Acute back pain is often the result of pulling or straining a muscle while kamagra canada trying a movement that requires a muscle that has become weak or stiff. If this muscle can’t provide the needed force, then the pressure shifts to kamagra canada the spine in a way that leads to pain.Developing core strength, flexibility and muscular control can help you avoid these pulled or strained muscles.Credit...Cole Barash for The New York TimesExercise strengthens the spine.The simplest way to strengthen your spine is to move regularly throughout the day, in whatever capacity works for you. This might mean increasing your daily steps, taking short walks during the workday or prioritizing a slightly longer walk in the morning or evening.People who are physically active tend to have lower rates of back pain, and a recent meta-analysis of 25 studies found that the most effective way to prevent lower back pain from recurring was regular exercise, preferably combined with some form of physical education.“Exercise doesn’t cure everybody, but on average, it’s an effective intervention,” said Mark Hancock, a professor of physiotherapy at Macquarie University and one of the authors of the study. There is no single type of exercise kamagra canada that has been shown to be effective, he said.

€œIf you are doing a variety of exercises, then you are likely getting all the things you need,” kamagra canada he said, adding, “It’s just like your diet.”Credit...Cole Barash for The New York TimesCredit...Cole Barash for The New York TimesPhysical activity also strengthens the bones and cartilage of the spine, protecting against age-related degeneration, and increases blood flow to cartilage discs in the spine that don’t receive a lot of blood supply, Dr. Shah said.If you have time, try some fast walking or kamagra canada jogging. A number of studies suggest that runners have thicker, healthier cartilage discs in their spine than people who aren’t active.Work the neglected deep core muscles.Working the core is crucial to avoiding future back pain, but that doesn’t mean shredding your abs to look like Chris Hemsworth. Popular core-strengthening exercises, such as crunches or situps, primarily work the larger, exterior muscles, while neglecting the deeper muscles.For instance, the transverse abdominis is a delicate sheetlike deep muscle that wraps the midsection kamagra canada like a corset.

There is also the multifidus, a muscle that lines the spine, with a number of extensions that wrap each individual vertebrae, similar to the way a bicycle chain wraps the sprocket.“It doesn’t take that much effort to activate these deep muscles, but they are neglected because you can’t see them” when you are at the beach, said Femi Betiku, a physical therapist at the New Jersey Center of kamagra canada Physical Therapy who specializes in treating lower back pain. People with six-packs can still have lower back pain, he added, if they kamagra canada are working only the stronger, outer muscles.Credit...Cole Barash for The New York TimesThe deeper muscles get engaged during movements requiring more control than raw power. One way to activate your deep core muscles is by doing planks, whether it’s a regular plank, a side plank or some of the many other variations.If holding a regular plank is uncomfortable, start with your knees on the ground, then progress to balancing on your toes.Dr. Shah also suggested squats, push-ups kamagra canada and bridges.

To build and maintain core strength, he recommends two to three sessions of kamagra canada dedicated core work a week. €œThis is a lifestyle change,” he said.There are also sports and physical kamagra canada activities that require light contraction of the core, such as kayaking, cycling, dancing, barre classes, boxing, rock climbing and swimming. Any activity that requires a certain level of control over the midsection will help activate and engage those deeper muscles.Work on controlling the spine.In addition to strengthening exercises, emerging research suggests it’s important to develop muscular coordination and spine control. This is just as true for kamagra canada athletes, who focus on performance and sometimes neglect exercises aimed at controlling the spine and pelvis.In a 2018 study, researchers compared elite athletes to a population of moderately active people.

Half of each group had lower back pain.Credit...Cole Barash for The New York TimesCredit...Cole Barash for The New York TimesTo the researchers’ surprise, both elite athletes and regular people with lower back pain had a similar stiffness kamagra canada in and lack of control over their spine, which is indicative of a similar pattern of weakness in their back muscles.“The key factor is how able you are to control your muscles,” said Mariá Moreno Catalá, a researcher at the Humboldt University of Berlin and the lead author of the study.To combat this, Dr. Betiku recommends Pilates because, in addition to strengthening the deeper core muscles, the kamagra canada exercises promote muscular control. For a number of the exercises, the spine either remains stable or moves very slowly, which develops muscle control along the spine when it is in different positions.Incorporating Pilates into your fitness routine can be as simple as doing short workout videos, many of which require little to no equipment, two to three times a week.Incorporate an element of instability into your workoutThe slow, controlled movements in exercises like Pilates teach your muscles to move the spine efficiently. The next step is to start exercising in a more kamagra canada variable environment, which develops even more coordination and control.In another study, Dr.

Moreno Catalá and her collaborators found that adding instability to exercises — like balancing on an uneven surface or even working out in a noisy kamagra canada environment — was effective at relieving lower back pain.Credit...Cole Barash for The New York TimesDr. Moreno Catalá said it is less about the amount of muscular strength and more about the ability to finely control the activation and deactivation of all the muscles that stabilize the spine.“We think the size of the muscle is the most important quality, but it’s also the quality of activation that is important,” kamagra canada she said.Choosing sports that include an element of reactivity, whether it’s hiking on a rocky surface or reacting to a sudden tennis volley, can result in a similar level of muscular development and control. Body weight exercises, such as push-ups, pull-ups, burpees and squats, also help, since they require full-body coordination, rather than the isolated movement of lifting weights.Like many, I am guilty of working the outer core muscles while neglecting the deeper ones. But for the past few weeks, I’ve started doing some short Pilates kamagra canada videos, 10 to 20 minutes each, focusing on slow, controlled movements.

Two weeks in, the stiff feeling in my back started to fade, disappearing for hours at kamagra canada a time. As it turned out, all my lower back really needed was to develop a little more coordination and control.Rachel Fairbank is a freelance science writer based in Texas.AdvertisementContinue reading the main story.

SALT LAKE https://captura.uk.com/spherical/ CITY, Feb cheap kamagra supplier. 22, 2022 /PRNewswire/ -- Health cheap kamagra supplier Catalyst, Inc. ("Health Catalyst," cheap kamagra supplier Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that it has entered into a definitive agreement to acquire KPI Ninja, a Lincoln, Nebraska-based provider of interoperability solutions and population health analytics.

KPI Ninja's end-to-end cheap kamagra supplier technology solution combines the agility of a centralized platform with interoperability and analytic technology. Health Catalyst believes KPI Ninja's powerful and flexible event-driven data processing capabilities, a natural complement to Health Catalyst's Data Operating cheap kamagra supplier System (DOS™) Platform, will empower customers with the ability to build and customize new services, clinical solutions, and operational tools around their core care systems, without the major refactoring and processing typically required of these systems. Additionally, Health Catalyst expects KPI Ninja's ability to seamlessly ingest, aggregate, and analyze varied data sources from inside and outside the hospital, such as FHIR, Hl7 V2, CCDs, flat files, and APIs, will bolster Health cheap kamagra supplier Catalyst's existing data processing capabilities and maximize functionality of Health Catalyst's Analytics Applications layer. Health Catalyst is committed to enabling KPI Ninja's focus to be on continued outstanding execution and delivery to existing clients, with its current client support teams and relationships uninterrupted in enabling this focus and execution.

We anticipate that these attributes, together with Health Catalyst, will help ensure data is ready to power insights at every step of the decision-making cheap kamagra supplier process, allowing customers to see results faster with greater cost efficiency."KPI Ninja's powerful and flexible event-driven streaming capability strengthen our ability to offer innovative solutions within the healthcare data and analytics technology ecosystem and our ability to support healthcare organizations on their clinical, financial, and operational improvement journeys," said Dan Burton, CEO of Health Catalyst. "We look forward to welcoming every current KPI Ninja team member to Health Catalyst, and we are committed to supporting, as the top-priority, the current team's efforts to continue to deliver these tremendous solutions, consistently, and without interruption or disruption, to KPI cheap kamagra supplier Ninja's current clients.""Both Health Catalyst and KPI Ninja share a common vision of advancing health care through arming health with data-driven insights," said Vineeth Yeddula, CEO of KPI Ninja. "By combining our technologies, we make a giant step toward advancing our cheap kamagra supplier shared vision. We are grateful to have Health Catalyst's support as we continue to serve our existing clients, ensuring the delivery of world class KPI Ninja products and services without interruption, while we continue to expand our footprint and maximize the value we deliver to the industry."About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement.

Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records cheap kamagra supplier and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst cheap kamagra supplier envisions a future in which all healthcare decisions are data informed.About KPI NinjaKPI Ninja is a mission-driven company that offers technology solutions that enable and empower those that work in the health care enterprise. As a cheap kamagra supplier leading provider of interoperability, enterprise analytics and value-based care solutions, KPI Ninja is known for its powerful capabilities, flexible configurations, and comprehensive applications to fulfill the promise of data-driven health care. Its platform is aligned to initiatives led by CMS, ONC, NCQA, including holding NCQA's Data Aggregator Validation (DAV) Certified Data Partner status, eCQM Certification, Measure Certification for HEDIS® Health Plan 2021, PCMH and PCSP Prevalidations, ONC Health IT Certification and is an eHealth Exchange Validated Product - demonstrating the commitment to serving as a trusted brand.

Cautionary Note cheap kamagra supplier Regarding Forward-Looking StatementsThis press release contains forward-looking statements relating to expectations, plans, and prospects including expectations relating to our ability to close, and the timing of the closing of, this transaction and the benefits that will be derived from this transaction. These forward-looking statements are based upon the current expectations and beliefs of Health Catalyst's management as of the date of this release, and are subject to certain risks and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements including, without limitation, the risk of adverse and unpredictable macro-economic conditions and risks related to closing this transaction and cheap kamagra supplier integration of the companies. All forward-looking statements in this press release cheap kamagra supplier are based on information available to the Company as of the date hereof, and Health Catalyst disclaims any obligation to update these forward-looking statements.Contact:Amanda HundtVP of Corporate Communications amanda.hundt@healthcatalyst.com View original content to download multimedia:https://www.prnewswire.com/news-releases/health-catalyst-announces-intent-to-acquire-kpi-ninja-301487106.htmlSOURCE Health CatalystCredit...Cole Barash for The New York TimesSkip to contentSkip to site indexHow Simple Exercises May Save Your Lower BackBack pain is common and complicated. But altering your workout to build control and stability can help prevent it.Credit...Cole Barash for The New York TimesSupported byContinue reading the main storyFeb.

25, 2022The past few years have not cheap kamagra supplier been kind to my lower back. Between the cheap kamagra supplier physical tolls of pregnancy, parenting and working from home, I have a constant stiff, achy feeling in my lower spine. I am not alone cheap kamagra supplier. It’s estimated that up to 80 percent of Americans will develop lower back pain during their lifetime, with 15 to 20 percent of adults reporting it in an average year.Could exercise prevent some of this pain?.

The short answer cheap kamagra supplier is maybe. A consistent mixture of cardio and dedicated core work can help cheap kamagra supplier. However, exercise alone is not a guarantee of pain relief, as there are a number of mistakes that many of us, even experienced athletes, cheap kamagra supplier may make.The spine is susceptible to pain when core muscles are weak.“The lower back is the center point of our whole body,” said Dr. Krishna Shah, an interventional pain specialist at Baylor College of Medicine.

The spine has to be mobile, able to bend and twist in multiple directions, while also bearing the weight of our body.Surrounding the spine are the core cheap kamagra supplier muscles. Although we tend to cheap kamagra supplier think of our core as the abdominals, it also includes the deep back muscles, as well as the hip muscles, quadriceps and hamstrings, which support our spine and pelvis.Core muscles work similarly to a back brace, keeping the midsection stable and upright. That’s why wearing a brace provides short-term pain relief for patients with lower back pain, but relying on one too much can weaken their core muscles. Instead, the goal should be to strengthen those muscles enough to do the brace’s cheap kamagra supplier job.“If you can develop your own internal brace, that is more effective,” said Dr.

Sean Barber, a neurosurgeon and spine specialist at Houston cheap kamagra supplier Methodist Hospital.Acute back pain is often the result of pulling or straining a muscle while trying a movement that requires a muscle that has become weak or stiff. If this muscle can’t provide the needed force, then the pressure shifts to the spine in a way that leads to pain.Developing core strength, flexibility and muscular control can help you avoid these cheap kamagra supplier pulled or strained muscles.Credit...Cole Barash for The New York TimesExercise strengthens the spine.The simplest way to strengthen your spine is to move regularly throughout the day, in whatever capacity works for you. This might mean increasing your daily steps, taking short walks during the workday or prioritizing a slightly longer walk in the morning or evening.People who are physically active tend to have lower rates of back pain, and a recent meta-analysis of 25 studies found that the most effective way to prevent lower back pain from recurring was regular exercise, preferably combined with some form of physical education.“Exercise doesn’t cure everybody, but on average, it’s an effective intervention,” said Mark Hancock, a professor of physiotherapy at Macquarie University and one of the authors of the study. There is no cheap kamagra supplier single type of exercise that has been shown to be effective, he said.

€œIf you are doing a variety of exercises, then you are likely getting all the things you need,” he said, cheap kamagra supplier adding, “It’s just like your diet.”Credit...Cole Barash for The New York TimesCredit...Cole Barash for The New York TimesPhysical activity also strengthens the bones and cartilage of the spine, protecting against age-related degeneration, and increases blood flow to cartilage discs in the spine that don’t receive a lot of blood supply, Dr. Shah said.If you have time, try some fast walking or jogging cheap kamagra supplier. A number of studies suggest that runners have thicker, healthier cartilage discs in their spine than people who aren’t active.Work the neglected deep core muscles.Working the core is crucial to avoiding future back pain, but that doesn’t mean shredding your abs to look like Chris Hemsworth. Popular core-strengthening exercises, such cheap kamagra supplier as crunches or situps, primarily work the larger, exterior muscles, while neglecting the deeper muscles.For instance, the transverse abdominis is a delicate sheetlike deep muscle that wraps the midsection like a corset.

There is also the multifidus, a muscle that lines the spine, with a number of extensions that wrap each individual vertebrae, similar to the way a bicycle chain wraps the sprocket.“It doesn’t take that much effort to cheap kamagra supplier activate these deep muscles, but they are neglected because you can’t see them” when you are at the beach, said Femi Betiku, a physical therapist at the New Jersey Center of Physical Therapy who specializes in treating lower back pain. People with six-packs can still have lower back pain, he added, if cheap kamagra supplier they are working only the stronger, outer muscles.Credit...Cole Barash for The New York TimesThe deeper muscles get engaged during movements requiring more control than raw power. One way to activate your deep core muscles is by doing planks, whether it’s a regular plank, a side plank or some of the many other variations.If holding a regular plank is uncomfortable, start with your knees on the ground, then progress to balancing on your toes.Dr. Shah also suggested squats, push-ups cheap kamagra supplier and bridges.

To build and maintain core strength, he recommends two cheap kamagra supplier to three sessions of dedicated core work a week. €œThis is cheap kamagra supplier a lifestyle change,” he said.There are also sports and physical activities that require light contraction of the core, such as kayaking, cycling, dancing, barre classes, boxing, rock climbing and swimming. Any activity that requires a certain level of control over the midsection will help activate and engage those deeper muscles.Work on controlling the spine.In addition to strengthening exercises, emerging research suggests it’s important to develop muscular coordination and spine control. This is just as true for athletes, who focus on performance and sometimes neglect exercises aimed at cheap kamagra supplier controlling the spine and pelvis.In a 2018 study, researchers compared elite athletes to a population of moderately active people.

Half of each group had lower back pain.Credit...Cole Barash for The New York TimesCredit...Cole Barash for The New York TimesTo the researchers’ surprise, both elite athletes and regular people with lower back pain had a similar stiffness in and lack of control cheap kamagra supplier over their spine, which is indicative of a similar pattern of weakness in their back muscles.“The key factor is how able you are to control your muscles,” said Mariá Moreno Catalá, a researcher at the Humboldt University of Berlin and the lead author of the study.To combat this, Dr. Betiku recommends Pilates because, in addition cheap kamagra supplier to strengthening the deeper core muscles, the exercises promote muscular control. For a number of the exercises, the spine either remains stable or moves very slowly, which develops muscle control along the spine when it is in different positions.Incorporating Pilates into your fitness routine can be as simple as doing short workout videos, many of which require little to no equipment, two to three times a week.Incorporate an element of instability into your workoutThe slow, controlled movements in exercises like Pilates teach your muscles to move the spine efficiently. The next cheap kamagra supplier step is to start exercising in a more variable environment, which develops even more coordination and control.In another study, Dr.

Moreno Catalá and her collaborators found that adding instability to exercises cheap kamagra supplier — like balancing on an uneven surface or even working out in a noisy environment — was effective at relieving lower back pain.Credit...Cole Barash for The New York TimesDr. Moreno Catalá said it is less about the amount of muscular strength and more about the ability to finely control the activation and deactivation of all the muscles that stabilize the spine.“We think the size of the muscle is the most important quality, but it’s also the quality of activation that is important,” she said.Choosing sports that include an element of cheap kamagra supplier reactivity, whether it’s hiking on a rocky surface or reacting to a sudden tennis volley, can result in a similar level of muscular development and control. Body weight exercises, such as push-ups, pull-ups, burpees and squats, also help, since they require full-body coordination, rather than the isolated movement of lifting weights.Like many, I am guilty of working the outer core muscles while neglecting the deeper ones. But for cheap kamagra supplier the past few weeks, I’ve started doing some short Pilates videos, 10 to 20 minutes each, focusing on slow, controlled movements.

Two weeks in, the stiff cheap kamagra supplier feeling in my back started to fade, disappearing for hours at a time. As it turned out, all my lower back really needed was to develop a little more coordination and control.Rachel Fairbank is a freelance science writer based in Texas.AdvertisementContinue reading the main story.

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Cataracts affect kamagra phuket most older adults at risk for dementia, and now researchers are finding strong evidence that cataract surgery is associated with a lower risk of developing dementia.The Adult Changes in Thought (ACT) study Check This Out is a long-standing, Seattle-based observational study at Kaiser Permanente Washington of more than 5,000 participants older than 65. Based on the longitudinal data of over 3,000 ACT study participants, researchers have now found that subjects who underwent cataract surgery had nearly 30% lower risk of developing dementia from any cause compared with those who did not. This lowered risk persisted for at least a kamagra phuket decade after surgery. Cataract surgery was also associated with lower risk of Alzheimer disease dementia specifically. The results were reported kamagra phuket Dec.

6 in JAMA Internal Medicine.Lead researcher Dr. Cecilia S Lee, associate professor and Klorfine Family Endowed Chair in ophthalmology at the University of Washington School of Medicine, said the observational study adjusted for a number of potential confounders, kamagra phuket yet still yielded a strong association."This kind of evidence is as good as it gets in epidemiology," Lee said. "This is really exciting because no other medical intervention has shown such a strong association with lessening dementia risk in older individuals."The mechanisms by which cataract surgery and lessened dementia risk are associated was not determined in this study. Researchers hypothesize that people may be getting higher quality sensory input after cataract surgery, which might have a beneficial effect in reducing the kamagra phuket risk of dementia."These results are consistent with the notion that sensory input to the brain is important to brain health," said co-author Dr. Eric B.

Larson, a principal investigator of the ACT study, and senior investigator at Kaiser Permanente kamagra phuket Washington Health Research Institute. advertisement Lee said another hypothesis is that after cataract surgery, people are getting more blue light."Some special cells in the retina are associated with cognition and regulate sleep cycles, and these cells respond well to blue light," she said, "Cataracts specifically block blue light, and cataract surgery could reactivate those cells."The study results highlight a strong case for further research on the eye-brain connection in dementia. Previous studies by Lee's group at the UW have shown a strong link between other retinal diseases, such as age-related macular degeneration, and the development of Alzheimer disease and dementia. Subjects with macular degeneration or other retinal degenerative diseases kamagra phuket are more likely to develop dementia, In the current study, subjects undergoing vision-improving cataract surgery had lower risk of developing dementia. Further understanding the connection between the aging eye and brain may offer insights and potential therapies to slow or prevent age-related dementia.The study.

Researchers tracked participants diagnosed with a cataract or kamagra phuket glaucoma but who did not have dementia at the time they volunteered for the study. Participants also did not have cataract surgery at the time of enrollment. Participants are evaluated every two years for cognitive abilities based on the Cognitive Abilities Screening Instrument, which scores in a range from kamagra phuket 0-100. Participants with scores less than 85 undergo further neurological tests.During Web Site follow-up of 3,038 participants (an average of 7.8 years per person), 853 subjects developed dementia, with 709 cases of Alzheimer disease. Approximately half of the participants (1,382 individuals or kamagra phuket 45%) had cataract surgery.

Analysis for risk of developing dementia showed that subjects who had undergone cataract surgery in either eye were about 30% less likely to develop any form of dementia for at least 10 years after their surgery. advertisement Analysis was adjusted for an extensive list of kamagra phuket factors including health-related confounders. Cataract surgery could appear to have a protective effect due to a healthy patient bias, where participants who underwent cataract surgery might have been healthier and at lower dementia risk. Researchers performed analyses to account for several types of potential kamagra phuket bias, but still found strong associations when these factors were accounted for.Researchers excluded eye surgeries in the two years prior to dementia diagnosis to rule out the possibility that people with cognitive decline prior to dementia diagnosis may have been less conscious of vision issues, and thus less likely to have undergone cataract surgery. Even with this group excluded, the researchers found lower risks of dementia associated with cataract surgery.As another control, participants were also evaluated for a possible link between another type of eye surgery (glaucoma surgery) and dementia.

In this case, no association was found.Strengths of study. This was a community-based, prospective cohort study with more than kamagra phuket 23,000 person-years of follow up. More than 98% of the ACT cohort were seen at least once by eye care clinicians, with an average of 27 encounters. Dementia diagnoses were made by a kamagra phuket panel of experts using research criteria. The possibility of healthy patient bias and potential confounders were thoroughly investigated.Limitations of study.

Results could be explained by unmeasured or kamagra phuket residual confounding factors, like any observational study. There could be coding errors for cataract diagnosis. Only the participant's first cataract surgery was evaluated so researchers don't know whether subsequent surgeries impacted dementia kamagra phuket risk. The majority of the study population was White, and it is unclear if the effect would be observed in all populations."Innovative research like Dr. Lee's is helping to uncover how kamagra phuket age-related changes in our senses contribute to dementia," said Dr.

Howard Fillit, founding executive director and chief science officer of the Alzheimer's Drug Discovery Foundation (ADDF), a nonprofit dedicated solely to accelerate the discovery and development of drugs to treat and prevent Alzheimer's disease and related dementias.As part of its Diagnostics Accelerator research initiative, the ADDF is also supporting Dr. Lee's work to develop new diagnostic tools for Alzheimer's that use non-invasive imaging of the retina and artificial intelligence.The study was funded by NIH grants NIH/NEI K23EY029246, NIH/NIA R01 AG060942, NIH/NIA P50 AG05136, NIH/NIA U01AG006781, NIH/NIA U19 AG066567, Alzheimer's Drug Discovery Foundation Diagnostics Accelerator Award, Latham Vision Innovation Award, and an unrestricted grant from Research to Prevent Blindness..

Cataracts affect most older adults at risk for dementia, and now researchers are finding strong evidence that cataract surgery is associated with a lower risk of developing dementia.The Adult Changes in Thought (ACT) how to get a kamagra prescription from your doctor study is a cheap kamagra supplier long-standing, Seattle-based observational study at Kaiser Permanente Washington of more than 5,000 participants older than 65. Based on the longitudinal data of over 3,000 ACT study participants, researchers have now found that subjects who underwent cataract surgery had nearly 30% lower risk of developing dementia from any cause compared with those who did not. This lowered risk persisted for cheap kamagra supplier at least a decade after surgery. Cataract surgery was also associated with lower risk of Alzheimer disease dementia specifically.

The results were reported cheap kamagra supplier Dec. 6 in JAMA Internal Medicine.Lead researcher Dr. Cecilia S Lee, associate professor and Klorfine Family Endowed Chair in ophthalmology at the University of Washington School of Medicine, said the observational study adjusted for a cheap kamagra supplier number of potential confounders, yet still yielded a strong association."This kind of evidence is as good as it gets in epidemiology," Lee said. "This is really exciting because no other medical intervention has shown such a strong association with lessening dementia risk in older individuals."The mechanisms by which cataract surgery and lessened dementia risk are associated was not determined in this study.

Researchers hypothesize that people may be getting higher quality sensory input after cataract surgery, which might have a beneficial effect in reducing the risk of dementia."These results are consistent with the notion that sensory input to the brain is important to brain health," cheap kamagra supplier said co-author Dr. Eric B. Larson, a principal investigator of the ACT study, and senior investigator at Kaiser Permanente Washington cheap kamagra supplier Health Research Institute. advertisement Lee said another hypothesis is that after cataract surgery, people are getting more blue light."Some special cells in the retina are associated with cognition and regulate sleep cycles, and these cells respond well to blue light," she said, "Cataracts specifically block blue light, and cataract surgery could reactivate those cells."The study results highlight a strong case for further research on the eye-brain connection in dementia.

Previous studies by Lee's group at the UW have shown a strong link between other retinal diseases, such as age-related macular degeneration, and the development of Alzheimer disease and dementia. Subjects with macular degeneration or other retinal degenerative diseases are more likely to develop dementia, In the current study, subjects undergoing vision-improving cataract surgery had lower risk of developing dementia cheap kamagra supplier. Further understanding the connection between the aging eye and brain may offer insights and potential therapies to slow or prevent age-related dementia.The study. Researchers tracked participants diagnosed with a cataract or glaucoma but who cheap kamagra supplier did not have dementia at the time they volunteered for the study.

Participants also did not have cataract surgery at the time of enrollment. Participants are cheap kamagra supplier evaluated every two years for cognitive abilities based on the Cognitive Abilities Screening Instrument, which scores in a range from 0-100. Participants with scores less than 85 undergo further neurological tests.During follow-up of 3,038 participants (an average of 7.8 years per person), 853 subjects developed dementia, with 709 cases of Alzheimer disease. Approximately half of the participants (1,382 individuals or 45%) had cheap kamagra supplier cataract surgery.

Analysis for risk of developing dementia showed that subjects who had undergone cataract surgery in either eye were about 30% less likely to develop any form of dementia for at least 10 years after their surgery. advertisement Analysis was adjusted for an extensive list of cheap kamagra supplier factors including health-related confounders. Cataract surgery could appear to have a protective effect due to a healthy patient bias, where participants who underwent cataract surgery might have been healthier and at lower dementia risk. Researchers performed analyses to account for several types of potential bias, but still found strong associations when these factors were accounted for.Researchers excluded eye surgeries in the two years prior to dementia diagnosis to rule cheap kamagra supplier out the possibility that people with cognitive decline prior to dementia diagnosis may have been less conscious of vision issues, and thus less likely to have undergone cataract surgery.

Even with this group excluded, the researchers found lower risks of dementia associated with cataract surgery.As another control, participants were also evaluated for a possible link between another type of eye surgery (glaucoma surgery) and dementia. In this case, no association was found.Strengths of study. This was a cheap kamagra supplier community-based, prospective cohort study with more than 23,000 person-years of follow up. More than 98% of the ACT cohort were seen at least once by eye care clinicians, with an average of 27 encounters.

Dementia diagnoses were made by a panel of experts cheap kamagra supplier using research criteria. The possibility of healthy patient bias and potential confounders were thoroughly investigated.Limitations of study. Results could be explained by unmeasured or residual confounding factors, like any cheap kamagra supplier observational study. There could be coding errors for cataract diagnosis.

Only the participant's first cataract surgery was evaluated so researchers don't know whether subsequent surgeries impacted dementia risk. The majority of the study population was White, and it is unclear if the effect would be observed in all populations."Innovative research like Dr. Lee's is helping to uncover how age-related changes in our senses contribute to dementia," said Dr. Howard Fillit, founding executive director and chief science officer of the Alzheimer's Drug Discovery Foundation (ADDF), a nonprofit dedicated solely to accelerate the discovery and development of drugs to treat and prevent Alzheimer's disease and related dementias.As part of its Diagnostics Accelerator research initiative, the ADDF is also supporting Dr.

Lee's work to develop new diagnostic tools for Alzheimer's that use non-invasive imaging of the retina and artificial intelligence.The study was funded by NIH grants NIH/NEI K23EY029246, NIH/NIA R01 AG060942, NIH/NIA P50 AG05136, NIH/NIA U01AG006781, NIH/NIA U19 AG066567, Alzheimer's Drug Discovery Foundation Diagnostics Accelerator Award, Latham Vision Innovation Award, and an unrestricted grant from Research to Prevent Blindness..

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Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries.

During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls.

Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an .

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

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer.

€œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a kamagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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