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With flu season starting as erectile dysfunction treatment continues to buy levitra without a prescription how much levitra to take spread, many health experts fear a "twindemic."Getting a flu shot can help avoid that. Photo by Brent AnnearFall is here, and so is the flu. With erectile dysfunction treatment still a threat, it’s buy levitra without a prescription more important than ever to protect yourself from preventable illnesses, like the flu. treatments prevent sickness and make it easier for us to go about our everyday lives.

Here are ten reasons getting the flu shot is so important. 1. Save money. A flu shot is usually free or low cost, whether you have insurance, Medicaid, Medicare, or work for a company that provides the shot to prevent employees from getting sick.

For employees’ sake, not getting the flu means no lost wages or missed work. 2. Less chance of a heart attack. Getting the flu shot reduces your risk of having a heart attack, which occurs more frequently in the weeks following the flu.

A recent study that examined more than 80,000 U.S. Adults hospitalized with the flu over eight flu seasons found that one in eight flu patients experienced sudden, serious heart complications. 3. Protect pregnant women.

The flu treatment protects pregnant women who are at risk for complications from the flu. Every pregnant woman deserves a pregnancy without fearing for the health of herself and her baby. Women who plan to get pregnant should also get the flu shot. treatments strengthen our ability to fight diseases, and studies show the shot works best among women of childbearing age.

4. Protect newborn babies. The flu shot also helps protect babies under six months who are not yet eligible for a flu shot. When an expectant mom gets a flu shot, the protection gets passed on to her newborn until he or she is old enough to be immunized.

5. Protect older people. It will protect your elderly relatives, who are less likely to receive as much protection from the flu shot as younger people get. If you don’t get the flu, you can’t pass it on to someone.

By getting a flu shot, you help increase your area's herd immunity. Photo by Brent Annear6. Protect people with chronic health conditions. You’ll also protect people who have conditions which can make the flu more serious for them.

These include people with asthma, heart disease, cancer, chronic kidney disease, diabetes, and HIV/AIDS. 7. Help defend your community from illness. The more people that get the flu shot, the stronger your area’s community immunity, or herd immunity is.

Herd immunity is achieved when a large enough portion of the community becomes able to fight off a disease and is therefore less likely to spread it from person-to-person. This protects the whole community, especially those who are less able to fight illness or have chronic diseases. 8. Avoid a hospital stay or doctor visit.

treatments make you less likely to have to go to the doctor or end up in the hospital. Thanks to the flu shot, doctors and other health experts estimate two out of five older adults won’t have to be hospitalized this flu season because of the flu. 9. Protect children.

Influenza can be especially dangerous for children because they can develop complications like pneumonia, dehydration, brain dysfunction, sinus problems, and ear s. According to the Centers for Disease Control and Prevention, in the past 10 years between 7,000 and 26,000 children younger than 5 years of age were hospitalized with the flu. Although it is rare, kids can die from the flu as well. If your child is afraid of needles, there is a nasal spray flu treatment available for everyone six months and older with no underlying health issues.

Talk to your child’s doctor about which treatment is best.10. Stay active. The flu treatment helps keep you moving. It may not always prevent the flu, but it can lessen symptoms and shorten sick time.

This means fewer missed work and school days, and more time to do the things you enjoy. Because erectile dysfunction treatment is still spreading as flu season starts, many health experts fear a “twindemic.” While we wait for a erectile dysfunction treatment, there is one for the flu. For more information on the flu shot, view this downloadable poster created in both English and Spanish by the Texas Medical Association’s Be Wise Immunize℠ program. Be Wise – Immunize is funded in 2020 by the TMA Foundation, thanks to major support from H-E-B and Permian Basin Youth Chavarim.Be Wise – Immunize is a service mark of the Texas Medical Association.Influenza affects millions of people each year, and because of the erectile dysfunction treatment levitra, many physicians and health experts are concerned that this year’s flu season will hit with full force.

In the Lone Star State, it’s important for Texans to be proactive about their health by getting the yearly flu vaccination. One of the worst things that could happen would be having many people sick with the flu while many are ill with erectile dysfunction.Flu vaccination is the best way to reduce the risk of getting and spreading the flu. This year, it also will help keep hospitalizations down as physicians, nurses, and other medical staff continue to care for erectile dysfunction treatment patients. Traditionally, Texas falls behind on flu vaccination.

According to the Centers for Disease Control and Prevention (CDC), only 43.3% of Texas adults got a flu shot in 2018-2019, compared to the national average of 45.3%.Although influenza levitraes circulate throughout the year, flu season usually starts in the fall and winter, and peaks between December and February.Like erectile dysfunction treatment, the flu is contagious. Both have some similar symptoms, including fever, chills, cough, fatigue, body aches, vomiting, and diarrhea. People with the flu may not experience symptoms until one to four days after catching the levitra. The CDC outlines key similarities and differences between influenza and erectile dysfunction treatment here.While most people recover from the flu, many can experience complications, especially older adults, people with pre-existing medical conditions, young children, and pregnant women.

If left untreated, infected patients can develop pneumonia, inflammation of the heart, brain, or muscle tissues, organ failure, sepsis, or they could even die. In Texas, more than 21,000 people died from the flu in the past two years. To put that into perspective, that is the population of Katy!. Everyone 6 months or older is encouraged to get the flu treatment each year – especially adults aged 65 and older, pregnant women, young children, and people who have chronic illnesses such as diabetes, asthma, and heart disease.

The CDC is urging the public to get the flu treatment while maintaining social distancing, wearing a mask in public, and practicing good hygiene.People who receive the flu shot may experience some mild side effects like aches and a mild fever, but they can’t get the flu from the shot. Those who get the flu after being vaccinated might have been exposed to the levitra beforehand. The flu vaccination can help lessen flu symptoms and severity, helping reduce the amount of time spent away from work and school.In a time when community health is front and center, getting a flu shot is more important than ever. The Texas Medical Association’s Be Wise Immunize℠ program recently created a downloadable poster below in English and Spanish with key takeaways about the flu vaccination.

You can print the poster, or save it and share it on social media. Be Wise – Immunize is funded in 2020 by the TMA Foundation, thanks to major support from H-E-B and Permian Basin Youth Chavarim.Be Wise – Immunize is a service mark of the Texas Medical Association..

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In the past levitra sale month, Tampa’s BayCare Health System has seen a tenfold increase in erectile dysfunction treatment patients at its 14 acute Average price of cialis daily care hospitals in central Florida. Expecting this surge to get worse, its executives decided to pause elective surgeries starting Saturday to avoid staffing shortages.“The last thing we want to do is get into a bind where we’ve got more demand than we have resources and run the risk of patients being jeopardized,” said Glenn Waters, executive vice president of BayCare.In Texas, Gov. Greg Abbott wrote a letter to the Texas Hospital Association earlier this week urging hospitals to consider pausing elective surgeries as the more transmissible Delta variant fuels mounting erectile dysfunction treatment hospitalizations there levitra sale as well. Many hospitals such as Ben Taub Hospital in Houston were already pausing procedures because of concerns with resources, and others are now evaluating surgeries on a case-by-case basis to determine if they can be postponed.advertisement As during the levitra’s first wave a year ago, hospitals in hard-hit places, including Florida, Louisiana, and Tennessee, have in recent days had to pause, delay, or reschedule tests, procedures, and surgeries that are considered “elective” and nonurgent. This means that hospital staff are levitra sale going through a frustrating moment of déjà vu.

“It’s just agonizing to have to go through this with our patients again,” said Avital O’Glasser, medical director of the preoperative medicine clinic at Oregon Health and Science University Hospital. Even though her hospital has not canceled surgeries yet, “it’s mentally and emotionally tough to be staring down this possibility again.”advertisement It’s all the more worrying because the levitra has proven that although some procedures may not be considered urgent, patients suffer nonetheless when they’re delayed. Many doctors saw how, when patients were levitra sale eventually allowed to get their procedures done last year, they arrived in worse conditions. Now, with that knowledge, some physicians and administrators are trying to be more selective in what procedures they postpone this time.Though calling a surgery “elective” may suggest that it is a choice, in general, elective procedures are those that can be scheduled in advance, and delaying them is not life-threatening. It is a procedure that does not need to be levitra sale done at the moment “to maintain life or limb,” explained Brian Cole, chair of surgery at Rush Oak Park Hospital in Chicago.

€œBut it’s a very nebulous term to call something elective.”Last year, this designation included almost all operations, including heart and cancer surgeries. Experts agree this initially made sense in the face of personal protective equipment shortages and limited hospital beds. Now that hospitals are better prepared and no longer facing these shortages, many are being more selective levitra sale about what gets canceled. Instead of a general pause, most hospitals are examining case by case to determine whether and how long a particular procedure can be delayed. For example, Vanderbilt University Medical Center examines cases each morning to decide what can be rescheduled levitra sale based on the particularities of a case.

The shift happened because delaying certain procedures may have detrimental consequences. One such surgery is a heart procedure called transcatheter aortic valve replacement. One study from Mount Sinai Hospital in New York found that deferring this treatment led to 10% levitra sale of patients experiencing a cardiac event during the first month, and 35% experienced one in the next three months.“Nothing would have happened [to the patients] if the procedures were not placed on hold,” said Stamatios Lerakis, director of noninvasive cardiology at Mount Sinai and author of the study. He suggests that patients can be stratified depending on how vulnerable they would be to a delay in their procedure. In the study, patients who had a previous cardiac levitra sale event fared worse.A similar study from the University of Bern in Switzerland found that deferring aortic valve replacement increased the risk of hospitalization and worsening heart failure.

According to a report from the British Heart Foundation, there were 5,800 excess deaths from heart and circulatory conditions in 2020 in the U.K., and it concluded that erectile dysfunction treatment-driven delays in cardiology care, such as echocardiograms, procedures to fit and implant pacemakers, and heart valve surgeries, potentially contributed to this number.Patients needing other types of surgeries are also worse off now than before the levitra. For example, surgeons at Covenant High Plains Surgery Center in Lubbock, Texas, saw an uptick in higher acuity cases — there was about a levitra sale 10% increase in the severity of patients that were coming into the center. €œPatients who had delayed their procedures may have had more complex procedures or may have come in sicker as a result,” said Alfonso del Granado, administrator and CEO of the center.O’Glasser, who prepares patients for their surgeries at OHSU Hospital, is seeing the same trend. €œOn average, patients are more medically complex than they were before the levitra,” she said. Deferring a procedure, for more than a few weeks, could allow conditions or diseases to progress unchecked, said Seth Karp, surgeon-in-chief at Vanderbilt University Medical Center levitra sale in Nashville, Tenn.

For example, routine screenings, such as colonoscopies and mammograms, declined in the United States, which could lead to a missed chance to catch and treat cancer in a timely manner.Even delaying surgeries that may seem less urgent, like orthopedic surgeries, could impact a patient’s daily life. Two surveys done by the American Association of Hip levitra sale and Knee Surgeons Research Committee in April and December of 2020 of about 1,000 orthopedic patients that had to delay their surgeries found that patients experienced increased anxiety and continued pain, impacting their daily functioning. Particularly for elderly patients, if hospitals delay orthopedic surgeries, like hip replacements, the risk of blood clotting, pulmonary embolism, and morbidity goes up.Seth Trueger, an emergency physician at Northwestern Medicine in Chicago, points out that it’s additive. If a patient doesn’t get a knee surgery, for example, it could lead to chronic pain, which would deter them from exercising and may bring on other conditions, ultimately leading to decreased quality of life and life expectancy.“There are clearly conditions that, if neglected and go without surgery, will end up in a different place later on if that surgery does not occur,” said Cole. But more studies will be needed to quantify and reveal the scope of the yet unseen impact of surgery delays on patients.Hospitals that are part of larger systems could potentially levitra sale transfer their patients to other hospitals in their network to get the necessary procedures.

But in places like Florida and Texas, where erectile dysfunction treatment cases are increasing all around, this strategy doesn’t work. Specialty surgical centers such as standalone surgery centers like levitra sale the one in Lubbocks could provide a release valve for strained hospitals in some places since they do not attend to erectile dysfunction treatment patients.But the most effective solution?. Every expert STAT asked had the same answer. Vaccinations and masking. They say that the way levitra sale out of an elective surgery pause is by addressing the problem at the root.

Only by decreasing the number of erectile dysfunction treatment cases hospitals have to attend to could they start elective surgeries back again and get back to providing better care to all patients beyond those with erectile dysfunction treatment.New falsehoods have emerged to match every stage of levitra response. Unquestionably, that misinformation has been amplified on social media platforms, as the world locked down in waves and citizens levitra sale looked online for answers. On Thursday, leaders from Facebook and YouTube joined a panel at the global conference of the Health Information Management Systems Society (HIMSS) to discuss the threat misleading information poses to the levitra response. But even as treatment misinformation continues to hamper vaccination efforts in the United States, the conversation failed to levitra sale address the impact of falsehoods on these platforms head-on — instead, focusing on platforms’ efforts to proactively share accurate, trusted erectile dysfunction treatment information. During the talk, YouTube’s director and global head of health care and public health Garth Graham claimed the platform has removed more than 800,000 pieces of content “that were misaligned in terms of science.” Similarly, Kang-Xing Jin, head of health at Facebook, said the company had removed over 18 million pieces of content on Facebook and Instagram that had been “debunked by public health experts and could also cause harm.” advertisement But when asked about their efforts to quell misinformation, both Graham and Jin put a far stronger emphasis on promoting reliable information.

Graham used the metaphor of a garden, likening content removal to pulling out the weeds. €œYou’ve got to replace it with engaging things that people are looking for, because a lot of the time, people are searching for levitra sale answers, and may be gravitating to the wrong things. You’ve got to make sure you have the garden supplied with engaging kinds of information.” Jin echoed the message, saying that “at the end of the day, people fundamentally want what’s best for themselves and their families, and it’s understandable that you might have some questions. And one of the best ways of addressing these issues is actually just helping people levitra sale get those questions answered directly. Just removing this information alone isn’t going to address that need.” advertisement Jin pointed to efforts on Facebook and WhatsApp to promote vaccination through location-finding services, informational campaigns led by the World Health Organization, and features that let users easily express their support of vaccination.

Graham referenced YouTube’s collaboration with influencers to spread the messages of trusted health experts. The issues skirted during the panel mirror the challenges the White House has reportedly encountered with Facebook as it called on social media levitra sale platforms to reduce misinformation. This week, the New York Times described a series of meetings throughout the first half of the year in which the White House became increasingly frustrated with Facebook’s approach to addressing misinformation on its platforms, culminating in President Biden’s assertion, later walked back, that Facebook was “killing people.” A central tension in those meetings, many of which were reportedly attended by Jin, was that Facebook claimed it was unable to share detailed information on the ways misinformation is viewed and spread on the platform, the Times reported. Aggressively policing misinformation — information that is inaccurate, regardless of the intent when it’s shared — would levitra sale require platforms to crack down on people who don’t know that what they’re sharing is wrong. In a rapidly evolving levitra, they could be sharing old information, a fact they’ve misunderstood, or something that’s been colored by intense fear.

Disinformation, which is intentionally shared to mislead, is somewhat easier to patrol. But both can have a dramatic levitra sale impact on decision-making. Platforms have made attempts to define and cut down on potentially harmful content. Facebook’s first levitra sale policies addressing erectile dysfunction misinformation came at the end of January 2020. But it was forced to issue multiple updates throughout the year, reacting as misinformation spread not just through users’ posts, but in ads, pages, and groups.

Also on the panel with Graham and Jin was Darius levitra sale Walker, senior executive producer for CBSN, CBS News’ 24-hour streaming network, who described the network’s reporting on those policies as they evolved. But misinformation continues to sprout more quickly than it can be weeded out. More proactive efforts — not just to promote accurate information, but to anticipate the spreading of falsehoods — should be a goal, said Hans Kluge, Europe region director of the WHO, in an interview with STAT’s Casey Ross at HIMSS this week.“My experience is that once people get emotional, evidence doesn’t help anymore,” said Kluge. €œSo we have to be a step ahead.” He levitra sale pointed to WHO’s Early AI-supported Response with Social listening tool, which is mining public information as a way to get ahead of misinformation before it spreads widely online and elsewhere.“Gone are the days of people expecting to get information from a flyer or a billboard,” said Graham. €œThese are vehicles now people are using to make life or death decisions.”Hired someone new and exciting?.

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

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Enjoy, and see levitra sale you soon…Pfizer (PFE) has touted a booster shot for its erectile dysfunction treatment, but has not yet delivered conclusive proof and lacks late-stage clinical trial results to confirm it will work against variants, Kaiser Health News writes. In June, Pfizer was confident its treatment could protect against the Delta variant, but weeks later planned to seek authorization for a booster, after early trial results showed a third dose may increase protection. At the end of levitra sale July, Pfizer said that four to six months after a second dose, efficacy fell to 84%, but that a booster would increase immunity. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | levitra sale Learn More What is it?.

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

Answering it may help prevent future levitras.The escape of erectile dysfunction from a research laboratory in Wuhan, China, continues to circulate as a viable and popular explanation for the levitra’s origin. But by accepting the lab-leak hypothesis, leaders may mistakenly seek new policy solutions or focus on tenuous yet alluring proposals about biosecurity, including high-tech means of enforcing restricted access.We believe that such actions would be ineffective and costly diversions from the core issue of institutionalizing existing and effective biohazard protocols.advertisement What should be done?. Research institutions, funders, and principal investigators must prioritize and reward integrating standard levitra sale biosafety measures into daily bench practices. Biosafety must become a core feature of good biological science, incorporated into funding, training, publishing, and promotion procedures. In short, biosafety levitra sale habits need to be taken seriously.

Laboratories are spaces of discovery, but also of danger. The balance between discovery and danger is routinely managed — and managed well — with attention to proven biosafety knowledge and lab practices. Over the past 50 years, the biosafety field has developed techniques, technologies, and methods to contain biological levitra sale materials that protect researchers and the public.advertisement Unfortunately, biosafety protocols are not routinely and consistently practiced, especially when they are interpreted and treated as bureaucratic interference that is peripheral to good science rather than integral to it.In the popular imagination, dangers emanating from labs, like the release of a deadly levitra, are created by some combination of evil insider genius, stateless terrorists, and shadow military personnel who maliciously engineer or mutate a levitra, then release it into the world. It’s a scenario that offers intent, intrigue, and conspiracy.Yet scientists, including the signatories to a May 2021 letter to Science magazine calling on the World Health Organization to investigate the origins of erectile dysfunction, the levitra that causes erectile dysfunction treatment, know that such exciting and conspiratorial plot lines largely misrepresent laboratory practices, materials, and personnel.Biological materials are almost never “leaked,” “released,” or “stolen.” Instead, pathogens and toxins walk out of laboratories across the globe because the required safety protocols are compromised or not followed at all. They leave the lab inadvertently, attached to the researcher working with or near levitra sale the material.

There is no intrigue in that, no conspiracy or evil genius, only the banality of failing to enforce and follow existing procedures for accessing, handling, and storing biological matter. That may mean forgetting to levitra sale wipe down a lab bench, using improper glove techniques, not wearing the appropriate personal protective equipment, or not cleaning equipment properly.These ordinary failures were evident in the three known leaks that caused outbreaks of SARS in the early 2000s. The root cause in each case was a “breach of good laboratory practice.” Thirteen cases of SARS originated from research laboratories in Singapore, Taiwan, and Beijing. In Singapore, a researcher unknowingly worked with a sample of West Nile levitra contaminated with SARS-CoV. Such cross-contamination is usually the result of improperly or inadequately cleaned equipment levitra sale and benches and improper use of gloves.

In Taipei, a scientist who had been working intensely in a biosafety level 4 laboratory over a long period and for long hours each day was exposed to the levitra while using improper precautions and techniques to clean up a spill.Should a research laboratory have been the origin of erectile dysfunction, it is likely that the root cause will be the same. A breach of standard safety protocols.Researchers do not lack levitra sale proven approaches to manage dangerous materials. What is lacking are the institutional attention and resources to make biosafety routine, integrating it into habitual bench practices. This is not a new, a difficult, or an expensive task. Abundant evidence exists that when organizations adopt pragmatic, adjustable, locally responsive processes, lab personnel figure out ways of working safely.For example, using proper gloving procedures, decontaminating surfaces, and removing laboratory coats when leaving the laboratory are all practices that prevent the movement of biological levitra sale materials out of lower-risk laboratories such as level 2 labs.

Taking time to handle materials and using proper procedures to clean up spilled materials are also simple and well-known ways of preventing materials from leaving the lab.There is no one-size-fits-all program for biosafety. Safe and secure laboratories experiment with levitra sale procedures that fit local conditions and cultures. They share stories about their failures as well as their successes. These are not eye-opening innovations but pragmatic work habits. Consistently wearing the correct protective gear, replacing aging protective equipment, containing and destroying chemical and biological waste, and following rules for entering and exiting laboratories do not require investigative commissions, new procedures, or additional technologies.The global research community does not need more rules, more layers of oversight, and more intermediary actors.

What it needs is more attention and respect to already known biosafety measures and techniques. These are not external costs on research but essential constituents of it, and institutions need to devote more attention and resources to the banal — but essential — biosafety processes that already exist.Ruthanne Huising is professor of management and organizations at Emlyon Business School in Lyon, France. Susan S. Silbey is a sociologist of law and science at the Massachusetts Institute of Technology in Cambridge, Mass..

In the past month, Tampa’s BayCare Health System Average price of cialis daily has buy levitra without a prescription seen a tenfold increase in erectile dysfunction treatment patients at its 14 acute care hospitals in central Florida. Expecting this surge to get worse, its executives decided to pause elective surgeries starting Saturday to avoid staffing shortages.“The last thing we want to do is get into a bind where we’ve got more demand than we have resources and run the risk of patients being jeopardized,” said Glenn Waters, executive vice president of BayCare.In Texas, Gov. Greg Abbott wrote buy levitra without a prescription a letter to the Texas Hospital Association earlier this week urging hospitals to consider pausing elective surgeries as the more transmissible Delta variant fuels mounting erectile dysfunction treatment hospitalizations there as well. Many hospitals such as Ben Taub Hospital in Houston were already pausing procedures because of concerns with resources, and others are now evaluating surgeries on a case-by-case basis to determine if they can be postponed.advertisement As during the levitra’s first wave a year ago, hospitals in hard-hit places, including Florida, Louisiana, and Tennessee, have in recent days had to pause, delay, or reschedule tests, procedures, and surgeries that are considered “elective” and nonurgent.

This means buy levitra without a prescription that hospital staff are going through a frustrating moment of déjà vu. “It’s just agonizing to have to go through this with our patients again,” said Avital O’Glasser, medical director of the preoperative medicine clinic at Oregon Health and Science University Hospital. Even though her hospital has not canceled surgeries yet, “it’s mentally and emotionally tough to be staring down this possibility again.”advertisement It’s all the more worrying because the levitra has proven that although some procedures may not be considered urgent, patients suffer nonetheless when they’re delayed. Many doctors saw how, when patients were eventually allowed to get their procedures done last year, they arrived buy levitra without a prescription in worse conditions.

Now, with that knowledge, some physicians and administrators are trying to be more selective in what procedures they postpone this time.Though calling a surgery “elective” may suggest that it is a choice, in general, elective procedures are those that can be scheduled in advance, and delaying them is not life-threatening. It is a procedure that does not need to be done at the moment “to maintain life or limb,” explained buy levitra without a prescription Brian Cole, chair of surgery at Rush Oak Park Hospital in Chicago. €œBut it’s a very nebulous term to call something elective.”Last year, this designation included almost all operations, including heart and cancer surgeries. Experts agree this initially made sense in the face of personal protective equipment shortages and limited hospital beds.

Now that hospitals are better prepared and buy levitra without a prescription no longer facing these shortages, many are being more selective about what gets canceled. Instead of a general pause, most hospitals are examining case by case to determine whether and how long a particular procedure can be delayed. For example, Vanderbilt University Medical Center buy levitra without a prescription examines cases each morning to decide what can be rescheduled based on the particularities of a case. The shift happened because delaying certain procedures may have detrimental consequences.

One such surgery is a heart procedure called transcatheter aortic valve replacement. One study from Mount Sinai Hospital in New York found that deferring this treatment led to 10% of patients buy levitra without a prescription experiencing a cardiac event during the first month, and 35% experienced one in the next three months.“Nothing would have happened [to the patients] if the procedures were not placed on hold,” said Stamatios Lerakis, director of noninvasive cardiology at Mount Sinai and author of the study. He suggests that patients can be stratified depending on how vulnerable they would be to a delay in their procedure. In the study, patients who had a previous cardiac event fared worse.A similar study from the University of Bern in Switzerland buy levitra without a prescription found that deferring aortic valve replacement increased the risk of hospitalization and worsening heart failure.

According to a report from the British Heart Foundation, there were 5,800 excess deaths from heart and circulatory conditions in 2020 in the U.K., and it concluded that erectile dysfunction treatment-driven delays in cardiology care, such as echocardiograms, procedures to fit and implant pacemakers, and heart valve surgeries, potentially contributed to this number.Patients needing other types of surgeries are also worse off now than before the levitra. For example, surgeons at Covenant High Plains Surgery Center in Lubbock, Texas, saw an buy levitra without a prescription uptick in higher acuity cases — there was about a 10% increase in the severity of patients that were coming into the center. €œPatients who had delayed their procedures may have had more complex procedures or may have come in sicker as a result,” said Alfonso del Granado, administrator and CEO of the center.O’Glasser, who prepares patients for their surgeries at OHSU Hospital, is seeing the same trend. €œOn average, patients are more medically complex than they were before the levitra,” she said.

Deferring a procedure, for more than a few weeks, could allow conditions or buy levitra without a prescription diseases to progress unchecked, said Seth Karp, surgeon-in-chief at Vanderbilt University Medical Center in Nashville, Tenn. For example, routine screenings, such as colonoscopies and mammograms, declined in the United States, which could lead to a missed chance to catch and treat cancer in a timely manner.Even delaying surgeries that may seem less urgent, like orthopedic surgeries, could impact a patient’s daily life. Two surveys done by the American Association of Hip and Knee Surgeons Research Committee buy levitra without a prescription in April and December of 2020 of about 1,000 orthopedic patients that had to delay their surgeries found that patients experienced increased anxiety and continued pain, impacting their daily functioning. Particularly for elderly patients, if hospitals delay orthopedic surgeries, like hip replacements, the risk of blood clotting, pulmonary embolism, and morbidity goes up.Seth Trueger, an emergency physician at Northwestern Medicine in Chicago, points out that it’s additive.

If a patient doesn’t get a knee surgery, for example, it could lead to chronic pain, which would deter them from exercising and may bring on other conditions, ultimately leading to decreased quality of life and life expectancy.“There are clearly conditions that, if neglected and go without surgery, will end up in a different place later on if that surgery does not occur,” said Cole. But more studies will be needed to quantify and reveal the scope of the yet unseen impact of surgery delays on patients.Hospitals that are part of larger systems could potentially transfer their patients to other hospitals buy levitra without a prescription in their network to get the necessary procedures. But in places like Florida and Texas, where erectile dysfunction treatment cases are increasing all around, this strategy doesn’t work. Specialty surgical centers such as standalone surgery centers like the one in Lubbocks could provide a release valve for strained hospitals in some places buy levitra without a prescription since they do not attend to erectile dysfunction treatment patients.But the most effective solution?.

Every expert STAT asked had the same answer. Vaccinations and masking. They say that the way out of an elective surgery pause is buy levitra without a prescription by addressing the problem at the root. Only by decreasing the number of erectile dysfunction treatment cases hospitals have to attend to could they start elective surgeries back again and get back to providing better care to all patients beyond those with erectile dysfunction treatment.New falsehoods have emerged to match every stage of levitra response.

Unquestionably, that misinformation has been amplified on social media platforms, as the world locked down in waves and buy levitra without a prescription citizens looked online for answers. On Thursday, leaders from Facebook and YouTube joined a panel at the global conference of the Health Information Management Systems Society (HIMSS) to discuss the threat misleading information poses to the levitra response. But even as treatment misinformation continues to hamper vaccination efforts in the United States, the conversation failed to address the impact of falsehoods on these platforms head-on — buy levitra without a prescription instead, focusing on platforms’ efforts to proactively share accurate, trusted erectile dysfunction treatment information. During the talk, YouTube’s director and global head of health care and public health Garth Graham claimed the platform has removed more than 800,000 pieces of content “that were misaligned in terms of science.” Similarly, Kang-Xing Jin, head of health at Facebook, said the company had removed over 18 million pieces of content on Facebook and Instagram that had been “debunked by public health experts and could also cause harm.” advertisement But when asked about their efforts to quell misinformation, both Graham and Jin put a far stronger emphasis on promoting reliable information.

Graham used the metaphor of a garden, likening content removal to pulling out the weeds. €œYou’ve got to replace it with engaging things that people are looking for, because a lot of the time, people are searching for answers, and may be gravitating to the buy levitra without a prescription wrong things. You’ve got to make sure you have the garden supplied with engaging kinds of information.” Jin echoed the message, saying that “at the end of the day, people fundamentally want what’s best for themselves and their families, and it’s understandable that you might have some questions. And one buy levitra without a prescription of the best ways of addressing these issues is actually just helping people get those questions answered directly.

Just removing this information alone isn’t going to address that need.” advertisement Jin pointed to efforts on Facebook and WhatsApp to promote vaccination through location-finding services, informational campaigns led by the World Health Organization, and features that let users easily express their support of vaccination. Graham referenced YouTube’s collaboration with influencers to spread the messages of trusted health experts. The issues skirted during the panel mirror the challenges the White House has reportedly encountered with Facebook as buy levitra without a prescription it called on social media platforms to reduce misinformation. This week, the New York Times described a series of meetings throughout the first half of the year in which the White House became increasingly frustrated with Facebook’s approach to addressing misinformation on its platforms, culminating in President Biden’s assertion, later walked back, that Facebook was “killing people.” A central tension in those meetings, many of which were reportedly attended by Jin, was that Facebook claimed it was unable to share detailed information on the ways misinformation is viewed and spread on the platform, the Times reported.

Aggressively policing misinformation — information that is inaccurate, regardless of buy levitra without a prescription the intent when it’s shared — would require platforms to crack down on people who don’t know that what they’re sharing is wrong. In a rapidly evolving levitra, they could be sharing old information, a fact they’ve misunderstood, or something that’s been colored by intense fear. Disinformation, which is intentionally shared to mislead, is somewhat easier to patrol. But both can have buy levitra without a prescription a dramatic impact on decision-making.

Platforms have made attempts to define and cut down on potentially harmful content. Facebook’s first policies addressing erectile dysfunction misinformation came at buy levitra without a prescription the end of January 2020. But it was forced to issue multiple updates throughout the year, reacting as misinformation spread not just through users’ posts, but in ads, pages, and groups. Also on the panel with Graham and Jin was Darius Walker, senior executive producer for CBSN, CBS News’ buy levitra without a prescription 24-hour streaming network, who described the network’s reporting on those policies as they evolved.

But misinformation continues to sprout more quickly than it can be weeded out. More proactive efforts — not just to promote accurate information, but to anticipate the spreading of falsehoods — should be a goal, said Hans Kluge, Europe region director of the WHO, in an interview with STAT’s Casey Ross at HIMSS this week.“My experience is that once people get emotional, evidence doesn’t help anymore,” said Kluge. €œSo we have to be a step ahead.” He pointed to WHO’s Early AI-supported Response with Social listening tool, which is mining public information as a way to buy levitra without a prescription get ahead of misinformation before it spreads widely online and elsewhere.“Gone are the days of people expecting to get information from a flyer or a billboard,” said Graham. €œThese are vehicles now people are using to make life or death decisions.”Hired someone new and exciting?.

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Send us your changes, and we’ll find a home for them. Don’t be buy levitra without a prescription shy. Everyone wants to know who is coming and going.And here is our regular feature in which we highlight a different person each week. This time around, we note that Sutro Biopharma (STRO) hired Jane Chung as chief commercial officer.

Most recently, she worked at AstraZeneca buy levitra without a prescription (AZN), where she was president of the division in Canada. Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is buy levitra without a prescription it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis.

Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley buy levitra without a prescription and beyond. What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.And so, another working week will soon come to an end. Not a moment too soon, yes? buy levitra without a prescription.

This is, you may recall, our treasured signal to daydream about weekend plans. Our agenda, buy levitra without a prescription so far, is rather modest. We hope to hang with our short person, promenade with the official mascot, and catch up on our reading. We may also tend to the Pharmalot grounds, weather permitting.

And what about you? buy levitra without a prescription. This is, of course, a fine time to enjoy the great outdoors — lakes and beaches are beckoning. Or perhaps buy levitra without a prescription you prefer to binge-watch a few shows. You could also touch base with those feeling isolated these days.

Well, whatever you do, be safe — wear a mask in iffy places. Enjoy, and see you soon…Pfizer (PFE) has touted a booster shot for its erectile dysfunction treatment, but has not buy levitra without a prescription yet delivered conclusive proof and lacks late-stage clinical trial results to confirm it will work against variants, Kaiser Health News writes. In June, Pfizer was confident its treatment could protect against the Delta variant, but weeks later planned to seek authorization for a booster, after early trial results showed a third dose may increase protection. At the end of July, Pfizer buy levitra without a prescription said that four to six months after a second dose, efficacy fell to 84%, but that a booster would increase immunity.

Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is buy levitra without a prescription it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's buy levitra without a prescription included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.“How did it start?. € is among the buy levitra without a prescription many questions raised by the erectile dysfunction treatment levitra. Answering it may help prevent future levitras.The escape of erectile dysfunction from a research laboratory in Wuhan, China, continues to circulate as a viable and popular explanation for the levitra’s origin.

But by accepting the lab-leak hypothesis, leaders may mistakenly seek new policy solutions or focus on tenuous yet alluring proposals about biosecurity, including high-tech means of enforcing restricted access.We believe that such actions would be ineffective and costly diversions from the core issue of institutionalizing existing and effective biohazard protocols.advertisement What should be done?. Research institutions, funders, and principal investigators must prioritize and reward buy levitra without a prescription integrating standard biosafety measures into daily bench practices. Biosafety must become a core feature of good biological science, incorporated into funding, training, publishing, and promotion procedures. In short, biosafety habits buy levitra without a prescription need to be taken seriously.

Laboratories are spaces of discovery, but also of danger. The balance between discovery and danger is routinely managed — and managed well — with attention to proven biosafety knowledge and lab practices. Over the past 50 years, the biosafety field has developed techniques, technologies, and methods to contain biological materials that protect researchers and the public.advertisement Unfortunately, biosafety protocols are not routinely and consistently practiced, especially when they are interpreted and treated as bureaucratic interference that is peripheral to good science rather than integral to it.In the popular imagination, dangers emanating from labs, like the release of a deadly levitra, are created by some combination of evil insider genius, stateless terrorists, and shadow military personnel who maliciously engineer or mutate a levitra, then release it into the world buy levitra without a prescription. It’s a scenario that offers intent, intrigue, and conspiracy.Yet scientists, including the signatories to a May 2021 letter to Science magazine calling on the World Health Organization to investigate the origins of erectile dysfunction, the levitra that causes erectile dysfunction treatment, know that such exciting and conspiratorial plot lines largely misrepresent laboratory practices, materials, and personnel.Biological materials are almost never “leaked,” “released,” or “stolen.” Instead, pathogens and toxins walk out of laboratories across the globe because the required safety protocols are compromised or not followed at all.

They leave the lab inadvertently, attached to the buy levitra without a prescription researcher working with or near the material. There is no intrigue in that, no conspiracy or evil genius, only the banality of failing to enforce and follow existing procedures for accessing, handling, and storing biological matter. That may mean forgetting to wipe down a lab bench, using improper glove techniques, not wearing the appropriate personal protective buy levitra without a prescription equipment, or not cleaning equipment properly.These ordinary failures were evident in the three known leaks that caused outbreaks of SARS in the early 2000s. The root cause in each case was a “breach of good laboratory practice.” Thirteen cases of SARS originated from research laboratories in Singapore, Taiwan, and Beijing.

In Singapore, a researcher unknowingly worked with a sample of West Nile levitra contaminated with SARS-CoV. Such cross-contamination is usually the result of improperly or inadequately cleaned equipment and buy levitra without a prescription benches and improper use of gloves. In Taipei, a scientist who had been working intensely in a biosafety level 4 laboratory over a long period and for long hours each day was exposed to the levitra while using improper precautions and techniques to clean up a spill.Should a research laboratory have been the origin of erectile dysfunction, it is likely that the root cause will be the same. A breach of standard safety protocols.Researchers do not lack proven approaches to manage dangerous materials.

What is lacking are the institutional attention and resources to make biosafety routine, integrating it into habitual bench practices. This is not a new, a difficult, or an expensive task. Abundant evidence exists that when organizations adopt pragmatic, adjustable, locally responsive processes, lab personnel figure out ways of working safely.For example, using proper gloving procedures, decontaminating surfaces, and removing laboratory coats when leaving the laboratory are all practices that prevent the movement of biological materials out of lower-risk laboratories such as level 2 labs. Taking time to handle materials and using proper procedures to clean up spilled materials are also simple and well-known ways of preventing materials from leaving the lab.There is no one-size-fits-all program for biosafety.

Safe and secure laboratories experiment with procedures that fit local conditions and cultures. They share stories about their failures as well as their successes. These are not eye-opening innovations but pragmatic work habits. Consistently wearing the correct protective gear, replacing aging protective equipment, containing and destroying chemical and biological waste, and following rules for entering and exiting laboratories do not require investigative commissions, new procedures, or additional technologies.The global research community does not need more rules, more layers of oversight, and more intermediary actors.

What it needs is more attention and respect to already known biosafety measures and techniques. These are not external costs on research but essential constituents of it, and institutions need to devote more attention and resources to the banal — but essential — biosafety processes that already exist.Ruthanne Huising is professor of management and organizations at Emlyon Business School in Lyon, France. Susan S. Silbey is a sociologist of law and science at the Massachusetts Institute of Technology in Cambridge, Mass..

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When chemistry graduate student Abby Gatmaitan first visited the University of Texas at Austin on a recruiting tour, http://www.finedesigncontracting.com/?page_id=378 she learned buy levitra overnight shipping about the MasSpec Pen—a handheld device that scientists there were developing to diagnose tumors on contact. €œI knew that was where I wanted to do my research,” she says. Shortly after joining the buy levitra overnight shipping lab, she realized that if the pen could categorize human tissue, it would probably also work on other animals. Gatmaitan had a very specific problem in mind, and her hunch paid off. Her research, published this spring in the Journal of Agricultural and Food Chemistry, showed that touching the tip of the “pen” to a sample of raw meat or fish could correctly identify the species it came from.

The device was tested on five samples and took less than 15 seconds for each buy levitra overnight shipping of them. Roughly the length of a typical ink pen, the tool provided answers about 720 times faster than a leading meat-evaluating technique called polymerase chain reaction (PCR) testing—and it was much easier to use. Gatmaitan says it could help scientists tackle a global conservation issue. Mislabeled seafood buy levitra overnight shipping. Seafood fraud is not just a concern for the restaurant diner who orders expensive, wild-caught red snapper, only to wind up with a plate of mercury-laden tilefish.

Such deception also threatens the environment. Mislabeled fishes often come from poorly managed fisheries that can harm local ecosystems buy levitra overnight shipping. Sometimes a fish is passed off as the wrong species or is falsely claimed to have been caught in a different geographical area in order to evade conservation laws or sell a catch for more money than its market value. The MasSpec Pen was originally developed to diagnose buy levitra overnight shipping tumors. Credit.

Anna Krieger/Abby Gatmaitan/UT Austin The problem is widespread. A 2019 analysis in Biological Conservation found that around 8 percent of seafood products buy levitra overnight shipping are mislabeled. Some fish are more prone to fraud than others. One study by the nonprofit ocean conservation organization Oceana sampled species known for being mislabeled, such as snapper and tuna, and found that a whopping 87 and 59 percent, respectively, were labeled incorrectly. To spot mislabeled fish before it reaches buy levitra overnight shipping consumers, inspectors from government organizations, including the U.S.

Food and Drug Administration, must be able to test whether a sample’s purported species and place of origin are accurate. Such testing also enables watchdog organizations to stamp the packaging of verified fish with “ecolabels,” which show consumers that the seafood meets the organizations’ inspection standards. Using the pen technology “seems to be an affordable and quick way for businesses to make some buy levitra overnight shipping quick, science-based verifications of what exactly the species is,” says Natalie Hunter, head of supply chain development at the Marine Stewardship Council (MSC), a nonprofit group that provides one of the most prominent ecolabels currently in use. The MasSpec device looks like a swollen gray ballpoint pen with a thin tube snaking out one end that connects it to a mass spectrometer and a supply of solvent. To test its performance, Gatmaitan touched the pen’s tip to samples of fish she had bought at the grocery store.

The pen released a droplet of solvent onto the sample’s surface and then sucked it back into the pen, through the tube and into the mass spectrometer buy levitra overnight shipping. Inside the machine, each sample was automatically dissolved in the solvent and then vaporized, turning its chemical components into ions. The ions were beamed through a magnetic field, which bent their path so that each one shot in a new direction—based on its mass and buy levitra overnight shipping electrical charge—before landing on a detector plate. By noting each ion’s position on the plate, the system could identify which chemicals (and how much of each) were in the sample. Almost immediately after the pen touched the fish, the machine’s computer screen displayed a hilly graph showing each compound’s amount, which varies, depending on a fish’s species and diet.

Other scientists have already learned the chemical profiles that categorized many fish buy levitra overnight shipping species, and Gatmaitan’s team used these profiles to train the device’s computer. It associates certain graph shapes with various fish species and then displays their names on a screen. €œhalibut,” “cod,” “sockeye salmon.” In the future, the researchers could build similar chemical profiles to reveal where a fish came from and whether it was wild-caught or farm-raised. The device buy levitra overnight shipping is relatively affordable. It uses disposable tips and a couple droplets of common solvents per test.

And it does not harm the sample, so fish can be safely sold and eaten after testing. The MasSpec buy levitra overnight shipping Pen will enter a commercial market that already has reliable (if slower and costlier) techniques, including DNA testing. Any new technology like this will initially lack the robust public data repository needed to make it accessible and verifiable, notes Katie Longo, a senior scientist at MSC. Still, Gatmaitan buy levitra overnight shipping says several government labs have expressed interest in using the pen to test food, and the U.T. Austin researchers are working to make it more field-friendly.

Fish testing labs can connect the pen to their own mass spectrometer equipment—but Gatmaitan and her colleagues also want it to be connectable to existing portable machines so it can function in various locations. They are currently building up their database of fish species’ chemical profiles so they can test mixed samples or pinpoint where in the world buy levitra overnight shipping a fish was caught. €œAtlantic salmon and sockeye salmon are very easily substituted for each other because they look identical, but their habitat is different,” Gatmaitan says. €œWe hope to get even more specific than that—maybe even determine which fishery they came from.”When you look at Earth from space, you realize just how vulnerable life is on this planet. The atmosphere is incredibly thin and fragile looking buy levitra overnight shipping.

Almost like a contact lens on someone’s eye. During my first mission, in 1999, to fix the Hubble Space Telescope, I remember passing over South America and being awed by the sheer size of the Amazon rainforest. On my last mission in 2016, only 17 years later, burning and clear-cutting buy levitra overnight shipping were clearly evident. After seeing the Earth dramatically change from this unique perspective, I firmly believe that solving climate change is the moonshot of the 21st century. Many of the tools and resources that I used on my missions, such solar panels and rechargeable storage batteries, are also the answer to our problems here on Earth.

On the buy levitra overnight shipping International Space Station, solar energy powered almost everything. Navigation, life support, science experiments. The station uses eight giant solar rays that collect energy from buy levitra overnight shipping the sun and stores it in batteries to operate all of its systems. The batteries are critical so that when you’re on the dark side of the Earth, you still have energy. And for the last 20 years, it’s worked great.

After these experiences, I buy levitra overnight shipping decided to put solar panels on my home in Colorado this year. I wanted energy from the sun powering my house instead of any other source. The sun has been the most reliable and important power source for the last four and a half billion years and will continue to be so for the rest of human existence. I am buy levitra overnight shipping happy to take advantage of it here on Earth. Rechargeable solar battery systems are needed now more than ever before.

Already in 2020, one in three Americans have experienced a blackout or expect to in the near future, underscoring the importance of rechargeable solar batteries and preparing for potential outages while social distancing and working from home. The 2020 Atlantic hurricane season was the most active on record, and America’s West Coast experienced historically bad wildfires this summer and fall, leading to many blackouts that were particularly challenging as many buy levitra overnight shipping homeowners were working from home because of the erectile dysfunction treatment levitra. Unsurprisingly, the levitra is driving increased demand for home energy systems. Residential solar energy provider Sunrun recently released a study that showed homeowners are considering solar energy systems and rechargeable batteries because of increased home energy buy levitra overnight shipping consumption during the levitra. According to the study, 57 percent of homeowners say the levitra has made them want to make home improvements, including nearly 40 percent who have a growing interest in backup power sources.

Solar can both help us mitigate climate change and help us adapt to climate change by making our homes more resilient to extreme weather. Beyond powering our buy levitra overnight shipping own homes through blackouts, solar and batteries can help us power our neighbors’ homes and our communities. New collaborations between utilities and the private sector to launch “virtual power plants,” or VPPs, which are networks of home battery and solar systems linked together and to the grid, are already taking shape. When demand surges and the grid is strained, VPPs can mitigate blackouts and eliminate the need to fire up dirty, faraway fossil fuel–burning plants. As the cleantech industry achieves scale, every newly installed solar energy system drives the price buy levitra overnight shipping down for customers.

Solar is quickly becoming more affordable than ever before. It is now just as affordable to install a solar energy system as it is to pay a local utility provider for power in many parts of the country. You don’t see political borders from space—only humanity as a buy levitra overnight shipping whole. We’re facing one of the greatest challenges in the history of humankind, but we are a very capable and resilient species. We can meet this challenge by leveraging solar power and new advances in battery storage.

This is our century’s moonshot, and we need to rise to the challenge.Since the modern era of research on autism began in the 1980s, questions about social cognition and social brain development have been of buy levitra overnight shipping central interest to researchers. This year marks the 20th anniversary of the first annual meeting of the International Society for Autism Research (INSAR), and it is evident in this year’s meeting that the growth of social cognitive neuroscience over the past two decades has significantly enriched autism science. For those unfamiliar with the term, social cognitive neuroscience buy levitra overnight shipping is the study of the brain systems that are involved in the causes and effects of social behaviors and social interaction. Some of these involve brain systems involved in thinking about other people’s thoughts or intentions, empathizing, social motivation and the impact of social attention on an individual’s thinking and emotions. At the same time, research with and for autistic people has also enriched social cognitive neuroscience and the understanding of how our social minds develop.

Autism spectrum disorder buy levitra overnight shipping (ASD) is a complex and heterogeneous part of the human condition, or neurodiversity. It is associated with a wide range of life outcomes, from “disorder” or the profound challenges that encumber about 30 percent of affected individuals with minimal language and intellectual disability, to “differences” among people who have well-above-average abilities and accomplishments. Regardless of their outcomes, though, people on the autism spectrum travel a different path of social-cognitive neurodevelopment that appears to begin in infancy. For example, many experience some level of difficulty with social cognitive mentalizing, also known as “theory of mind”—the mental representation of other people’s thoughts, perspectives, beliefs, intentions or emotions, which enables buy levitra overnight shipping us to understand or predict their behaviors. Social cognitive neuroscience tells us that brain systems of the medial frontal cortex, temporal cortex and parietal cortex, as well as reward centers of the brain, enable mentalizing.

Accordingly, differences in the development and/or transmissions of information across this distributed social cognitive brain network may contribute to differences in mentalizing among autistic people. These differences can lead to a range of outcomes, from problems in the capacity to mentalize to alterations buy levitra overnight shipping in the spontaneous use of mentalizing, or the motivation and effort involved in mentalizing during social interactions. These observations are informative, but do not address fundamental questions about how social-cognitive brain systems develop or why their development might be different for autistic people. These questions are essential in autism science because understanding buy levitra overnight shipping the early course of social cognitive neurodevelopment may afford the best opportunity to mitigate the profoundly negative effects that social cognitive differences can have on some autistic people. Serendipitously, this motivation to understand the very early development of our social brain can inform the broader understanding of social-cognitive neuroscience and human nature.

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

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

It tunes aspects of social-brain development that subsequently support the capacity for buy levitra overnight shipping mental perspective-taking. Mental perspective-taking is synonymous with mentalizing and our ability to understand the thoughts, beliefs, and intentions of other people. Indeed, several studies provide evidence buy levitra overnight shipping of a significant overlap in brain systems involved in joint attention and social-cognitive mentalizing. Accordingly, differences in early social attention are thought to contribute to differences in the neurodevelopment of social cognitive mentalizing in some to many people with autism. Research also suggests that differences in systems that regulate the motivation for social attention might play a role in this aspect of the development of autism, though the nature of this motivation is not understood.

One possibility is that buy levitra overnight shipping decreased motivation to attend to faces may lead to critical early difference in social attention. Alternatively, differences in the “eye-contact effect” may impact social attention development. The eye-contact effect is a phenomenon in which awareness of being the object of others’ attention triggers an arousal response that enhances stimulus salience and information processing during social attention coordination. When we are aware of other people looking at us, changes occur in our mental buy levitra overnight shipping processes that can benefit social learning. Several studies now suggest that people with autism may be less responsive to, or less aware of, being the object of attention of others.

Hence, autism science raises the hypothesis that the first step toward human social neurocognitive development may involve months of practice with social attention coordination with caregivers during infancy. Moreover, our response to eye contact of other people may provide an early motivational stance buy levitra overnight shipping that prioritizes infant social attention development and the development of our social brains. Notably, recent studies indicate that imitating the behavior of young children with autism, which likely affects a child’s awareness that another person is looking at them, can improve joint attention and language development. Of course, the most fundamental lesson we can draw from all these observations about the development of our social mind is that we are all more similar than buy levitra overnight shipping different, regardless of our paths of neurodevelopment, and that autistic people have much to teach us about the nature of human nature. This is an opinion and analysis article.

Further reading. Baron-Cohen, S buy levitra overnight shipping. (2019). The concept of neurodiversity is dividing the autism community. Scientific American buy levitra overnight shipping.

Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., &. Schultz, R buy levitra overnight shipping. T. (2012).

The social buy levitra overnight shipping motivation theory of autism. Trends in cognitive sciences, 16(4), 231-239. Gulsrud, A buy levitra overnight shipping. C., Hellemann, G., Shire, S., &. Kasari, C.

(2016). Isolating active ingredients in a parent‐mediated social communication intervention for toddlers with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 57(5), where can i get levitra 606-613. Grynszpan, O., Bouteiller, J., Grynszpan, S., Le Barillier, F., Martin, J. C., &.

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

(2018). A review of joint attention and social‐cognitive brain systems in typical development and autism spectrum disorder. European Journal of Neuroscience, 47(6), 497-514. Reddy, V. (2003).

On being the object of attention. Implications for self–other consciousness. Trends in cognitive sciences, 7(9), 397-402. Senju, A., &. Johnson, M.

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

Stephenson, L., Edwards, S. G., &. Bayliss, A. (2020). From gaze perception to social cognition.

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

"This is the first computational assessment of how Exxon Mobil has used language in subtle yet systematic ways to shape the way the public talks about and thinks about climate change," Geoffrey Supran, a research fellow at Harvard and co-author of the paper, said in an interview with E&E News. "One of our overall findings is that Exxon Mobil has used rhetoric mimicking the tobacco industry to downplay the reality and seriousness of climate change and to shift responsibility for climate change away from itself and onto consumers," he added. A spokesperson for Exxon Mobil disputed the paper, calling it part of a coordinated legal campaign against the company. Supran and co-author Naomi Oreskes, a professor of the history of science at Harvard (and Scientific American columnist), conducted a computational analysis of 180 Exxon Mobil documents from 1972 to 2019, including peer-reviewed publications, advertorials in The New York Times and internal memos. Using a series of algorithms, the Harvard researchers found that Exxon Mobil had privately relied on some terms while publicly avoiding them altogether.

For example, Exxon Mobil's internal documents frequently described climate change as a problem caused by "fossil fuel combustion." But in public-facing documents, the company referred to global warming as a problem caused by the "energy demand" of "consumers." The public communications sought to deflect responsibility for climate change away from the oil giant and onto individual consumers who heat their homes and fill their cars with gas, the researchers wrote. Following their merger in 1999, Exxon and Mobil also increasingly presented climate change as a "risk," rather than a reality, the analysis found. This language sought to minimize the dangers of global warming while not denying their existence outright, the paper says. Court battles The researchers drew a direct comparison between Exxon Mobil and major tobacco companies, which they said used similar tactics to shape public discourse about smoking cigarettes. "These patterns mimic the tobacco industry's documented strategy of shifting responsibility away from corporations — which knowingly sold a deadly product while denying its harms — and onto consumers," they wrote.

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

The complaints ask the oil industry to help cover the costs of addressing floods, wildfires and other disasters fueled by rising global temperatures. Supran said that although he didn't conduct the study with the climate liability litigation in mind, the findings can nonetheless inform the legal fights. "Obviously, we did this completely independently. I've never spoken to any of the lawyers involved," Supran said. "But certainly with hindsight, our insights may be relevant, especially to these more nascent cases alleging deceptive marketing." Last month, New York City filed a lawsuit asserting that Exxon Mobil, BP PLC and Royal Dutch Shell PLC violated the city's consumer protection law by engaging in "green washing," or the practice of making their fossil fuel products seem more environmentally friendly than they really are.

Exxon pushback Asked for comment on the paper, Exxon spokesperson Casey Norton said in an email to E&E News. "This research is clearly part of a litigation strategy against Exxon Mobil and other energy companies." Norton noted that Oreskes is on retainer with Sher Edling LLP, a San Francisco-based law firm that represents a slew of the challengers in the climate liability suits. "Oreskes did not disclose this blatant conflict of interest," he said. Norton also pointed to the paper's partial funding from the Rockefeller family, which Exxon has accused of supporting a climate conspiracy against the company (Climatewire, May 4). "The research was paid for by the Rockefeller Family Fund, which is helping finance climate change litigation against energy companies," he said.

"This follows a previous study attacking Exxon Mobil that used a similar discredited methodology." Norton was referring to a 2017 paper by Supran and Oreskes in the journal Environmental Research Letters that found Exxon's communications from 1977 to 2014 misled the public about climate science. Vijay Swarup, Exxon's vice president of research and development, previously blasted the 2017 paper as "fundamentally flawed" in a comment in Environmental Research Letters last year. Norton concluded by stressing that Exxon supports climate action, noting that the oil giant recently proposed a massive carbon capture project in Houston (Energywire, April 20). "Exxon Mobil supports the Paris climate agreement, and is working to reduce company emissions and helping customers reduce their emissions while working on new lower-emission technologies and advocating for effective policies," he said. In a joint statement to E&E News, Supran and Oreskes pushed back on Norton's allegations.

"Sher Edling played no role in the paper we published today, nor in any other academic work we have done. They have not funded any of our studies. They have not reviewed our data or interpretations prior to its peer-reviewed publication. And we have never discussed any of our work concerning ExxonMobil with them. Therefore, there is no conflict of interest and nothing to disclose," the researchers said.

"For context, we note that over the past four years, ExxonMobil have attacked us and our work," they added. "It has become a familiar pattern. We publish science, ExxonMobil offers spin and character assassination. ExxonMobil is now misleading the public about its history of misleading the public." Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021.

E&E News provides essential news for energy and environment professionals.And then there were two. Today China says it safely landed a spacecraft on Mars—for the first time in its history and in its first attempt, becoming the only other nation besides the U.S. To achieve such a feat. Its Zhurong rover, named after a god of fire from Chinese folklore, successfully touched down in Utopia Planitia around 7:18 P.M. EST as part of the Tianwen-1 mission, according to the China National Space Administration.

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

But while Perseverance descended straight to the surface, Tianwen-1 instead entered an elliptical orbit around the planet to give its scientists a god’s-eye view for scouting out their planned landing site in Utopia Planitia, an immense impact basin on Mars. €œChina does not have its own detailed Mars maps,” says Brian Harvey, a writer who covers the country’s space program. At least, that was the case until today, when Tianwen-1’s controllers decided they had seen enough to confidently initiate the spacecraft’s daring descent. Packed inside a cone-shaped protective shell, Zhurong and its rocket-powered landing platform detached from the orbiter, descended toward Mars and began the fiery plunge through the planet’s upper atmosphere. After jettisoning its protective shell lower in the atmosphere, the spacecraft unfurled parachutes to slow its descent before riding thrusters down to a gentle landing on the surface.

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

Reached the surface with its Beagle 2 lander in 2003. The craft’s communications antenna failed to deploy, however, dooming the mission. The European Space Agency (ESA) and Russia also came close with their Schiaparelli lander—until it crashed on Mars in 2016. ESA will try again with its Rosalind Franklin rover in 2022. Until today, only the U.S.

Had successfully operated any spacecraft on Mars for a significant period of time, starting with the Viking landers of 1976 and extending to the country’s multiple landers and rovers that are exploring the surface today. China now joins this most elite and exclusive of clubs. €œIt’s a big day for China,” says Mark McCaughrean, senior scientific adviser for science and exploration at ESA. €œWe know better than anyone how hard it can be to get safely down to the surface.” China will now wait an undisclosed amount of time, as little as a day or up to perhaps a week, before driving the Zhurong rover down a ramp from the lander and onto the surface. The six-wheeled solar-powered vehicle has a planned lifetime of 90 Martian days and is thought to have a top speed of 200 meters per hour, Jones says, although it will likely explore much more slowly.

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

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

Alongside a similar instrument on the Tianwen-1 orbiter, which will continue studying the planet from afar, the rover’s magnetometer could reveal the details of how Mars lost its magnetic field—and consequently its atmosphere and water—billions of years ago. €œConceivably this instrument could help address that question,” says David Flannery, an astrobiologist at the Queensland University of Technology in Australia, who is familiar with China’s space activities. €œTogether the instruments will tell us more about how the Martian magnetic field operates today.” Another instrument of note is the Mars Surface Composition Detector (MarSCoDe), a device similar to ChemCam on NASA’s Curiosity rover and SuperCam on Perseverance, which will use a laser to vaporize rock specimens on the surface, revealing their composition. Cousin is part of both the ChemCam and SuperCam teams, and she was among a group of European collaborators that helped China develop their instrument. She traveled to Shanghai in 2019 to exchange information with Tianwen-1 scientists on topics such as data-processing techniques and calibration targets to include on the rover to test the instrument on Mars.

€œThey wanted big calibration targets” for MarSCoDe, Cousin says. €œSo we gave them one”. A two-centimeter-wide square of an igneous rock called norite that is one of 12 such targets on the rover. While the science goals of the rover may be somewhat modest, it is also expected to be a technology demonstration for a much more ambitious future project. By 2028 or 2030, China hopes to send a sample-return mission to Mars to bring pristine Martian rocks back to Earth.

That timing is similar to, or perhaps even in advance of, when NASA and ESA plan to do the same with their own interplanetary grab-and-go effort. €œWill it be China bringing the first Mars material back to Earth, or will it be NASA and ESA?. € says Jacqueline Myrrhe, a journalist affiliated with the Chinese space Web site Go Taikonauts!. “This could be a very good question.” Landing on Mars is the latest pinnacle achievement from China’s planned portfolio of ambitious space activities. But already the nation has more than proved its mettle.

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

When chemistry graduate student Abby Gatmaitan first visited the University of Texas at Austin on a recruiting tour, she learned about the MasSpec Pen—a handheld device that scientists there were developing to diagnose tumors buy levitra without a prescription on contact. €œI knew that was where I wanted to do my research,” she says. Shortly after joining the lab, she realized that if the buy levitra without a prescription pen could categorize human tissue, it would probably also work on other animals.

Gatmaitan had a very specific problem in mind, and her hunch paid off. Her research, published this spring in the Journal of Agricultural and Food Chemistry, showed that touching the tip of the “pen” to a sample of raw meat or fish could correctly identify the species it came from. The device was tested on buy levitra without a prescription five samples and took less than 15 seconds for each of them.

Roughly the length of a typical ink pen, the tool provided answers about 720 times faster than a leading meat-evaluating technique called polymerase chain reaction (PCR) testing—and it was much easier to use. Gatmaitan says it could help scientists tackle a global conservation issue. Mislabeled seafood buy levitra without a prescription.

Seafood fraud is not just a concern for the restaurant diner who orders expensive, wild-caught red snapper, only to wind up with a plate of mercury-laden tilefish. Such deception also threatens the environment. Mislabeled fishes often come from buy levitra without a prescription poorly managed fisheries that can harm local ecosystems.

Sometimes a fish is passed off as the wrong species or is falsely claimed to have been caught in a different geographical area in order to evade conservation laws or sell a catch for more money than its market value. The MasSpec Pen was originally developed to diagnose tumors buy levitra without a prescription. Credit.

Anna Krieger/Abby Gatmaitan/UT Austin The problem is widespread. A 2019 analysis in Biological buy levitra without a prescription Conservation found that around 8 percent of seafood products are mislabeled. Some fish are more prone to fraud than others.

One study by the nonprofit ocean conservation organization Oceana sampled species known for being mislabeled, such as snapper and tuna, and found that a whopping 87 and 59 percent, respectively, were labeled incorrectly. To spot mislabeled fish before it reaches consumers, inspectors from government buy levitra without a prescription organizations, including the U.S. Food and Drug Administration, must be able to test whether a sample’s purported species and place of origin are accurate.

Such testing also enables watchdog organizations to stamp the packaging of verified fish with “ecolabels,” which show consumers that the seafood meets the organizations’ inspection standards. Using the pen technology “seems to be an affordable and quick way for businesses to make some quick, science-based verifications of what exactly the species is,” says Natalie Hunter, head of supply chain development at the Marine Stewardship Council (MSC), a nonprofit group that provides one buy levitra without a prescription of the most prominent ecolabels currently in use. The MasSpec device looks like a swollen gray ballpoint pen with a thin tube snaking out one end that connects it to a mass spectrometer and a supply of solvent.

To test its performance, Gatmaitan touched the pen’s tip to samples of fish she had bought at the grocery store. The pen released a droplet of solvent onto the sample’s surface and then sucked it buy levitra without a prescription back into the pen, through the tube and into the mass spectrometer. Inside the machine, each sample was automatically dissolved in the solvent and then vaporized, turning its chemical components into ions.

The ions were beamed through a magnetic field, which bent their path so that each buy levitra without a prescription one shot in a new direction—based on its mass and electrical charge—before landing on a detector plate. By noting each ion’s position on the plate, the system could identify which chemicals (and how much of each) were in the sample. Almost immediately after the pen touched the fish, the machine’s computer screen displayed a hilly graph showing each compound’s amount, which varies, depending on a fish’s species and diet.

Other scientists have already learned the chemical profiles that categorized many fish species, and Gatmaitan’s team used these profiles to train the buy levitra without a prescription device’s computer. It associates certain graph shapes with various fish species and then displays their names on a screen. €œhalibut,” “cod,” “sockeye salmon.” In the future, the researchers could build similar chemical profiles to reveal where a fish came from and whether it was wild-caught or farm-raised.

The device buy levitra without a prescription is relatively affordable. It uses disposable tips and a couple droplets of common solvents per test. And it does not harm the sample, so fish can be safely sold and eaten after testing.

The MasSpec Pen buy levitra without a prescription will enter a commercial market that already has reliable (if slower and costlier) techniques, including DNA testing. Any new technology like this will initially lack the robust public data repository needed to make it accessible and verifiable, notes Katie Longo, a senior scientist at MSC. Still, Gatmaitan says several government labs have expressed interest in buy levitra without a prescription using the pen to test food, and the U.T.

Austin researchers are working to make it more field-friendly. Fish testing labs can connect the pen to their own mass spectrometer equipment—but Gatmaitan and her colleagues also want it to be connectable to existing portable machines so it can function in various locations. They are currently building up their database of fish species’ chemical profiles so they can buy levitra without a prescription test mixed samples or pinpoint where in the world a fish was caught.

€œAtlantic salmon and sockeye salmon are very easily substituted for each other because they look identical, but their habitat is different,” Gatmaitan says. €œWe hope to get even more specific than that—maybe even determine which fishery they came from.”When you look at Earth from space, you realize just how vulnerable life is on this planet. The atmosphere is incredibly thin and fragile looking buy levitra without a prescription.

Almost like a contact lens on someone’s eye. During my first mission, in 1999, to fix the Hubble Space Telescope, I remember passing over South America and being awed by the sheer size of the Amazon rainforest. On my last mission in 2016, only 17 years later, burning and clear-cutting were clearly evident buy levitra without a prescription.

After seeing the Earth dramatically change from this unique perspective, I firmly believe that solving climate change is the moonshot of the 21st century. Many of the tools and resources that I used on my missions, such solar panels and rechargeable storage batteries, are also the answer to our problems here on Earth. On the buy levitra without a prescription International Space Station, solar energy powered almost everything.

Navigation, life support, science experiments. The station uses eight giant solar rays that collect energy buy levitra without a prescription from the sun and stores it in batteries to operate all of its systems. The batteries are critical so that when you’re on the dark side of the Earth, you still have energy.

And for the last 20 years, it’s worked great. After these experiences, I decided to put solar panels on my home buy levitra without a prescription in Colorado this year. I wanted energy from the sun powering my house instead of any other source.

The sun has been the most reliable and important power source for the last four and a half billion years and will continue to be so for the rest of human existence. I am happy to take advantage of buy levitra without a prescription it here on Earth. Rechargeable solar battery systems are needed now more than ever before.

Already in 2020, one in three Americans have experienced a blackout or expect to in the near future, underscoring the importance of rechargeable solar batteries and preparing for potential outages while social distancing and working from home. The 2020 Atlantic hurricane season was the most active on record, and America’s West Coast experienced historically bad wildfires this summer and fall, leading to many blackouts that were particularly buy levitra without a prescription challenging as many homeowners were working from home because of the erectile dysfunction treatment levitra. Unsurprisingly, the levitra is driving increased demand for home energy systems.

Residential solar energy provider Sunrun recently released a study that buy levitra without a prescription showed homeowners are considering solar energy systems and rechargeable batteries because of increased home energy consumption during the levitra. According to the study, 57 percent of homeowners say the levitra has made them want to make home improvements, including nearly 40 percent who have a growing interest in backup power sources. Solar can both help us mitigate climate change and help us adapt to climate change by making our homes more resilient to extreme weather.

Beyond powering our own homes through blackouts, solar and batteries can help us power buy levitra without a prescription our neighbors’ homes and our communities. New collaborations between utilities and the private sector to launch “virtual power plants,” or VPPs, which are networks of home battery and solar systems linked together and to the grid, are already taking shape. When demand surges and the grid is strained, VPPs can mitigate blackouts and eliminate the need to fire up dirty, faraway fossil fuel–burning plants.

As the cleantech industry achieves scale, every newly installed solar energy system drives the price down buy levitra without a prescription for customers. Solar is quickly becoming more affordable than ever before. It is now just as affordable to install a solar energy system as it is to pay a local utility provider for power in many parts of the country.

You don’t see political borders from space—only humanity as a whole buy levitra without a prescription. We’re facing one of the greatest challenges in the history of humankind, but we are a very capable and resilient species. We can meet this challenge by leveraging solar power and new advances in battery storage.

This is our century’s moonshot, and we need to rise to the challenge.Since the modern era of research on buy levitra without a prescription autism began in the 1980s, questions about social cognition and social brain development have been of central interest to researchers. This year marks the 20th anniversary of the first annual meeting of the International Society for Autism Research (INSAR), and it is evident in this year’s meeting that the growth of social cognitive neuroscience over the past two decades has significantly enriched autism science. For those unfamiliar with the term, social cognitive neuroscience is the study of the brain systems buy levitra without a prescription that are involved in the causes and effects of social behaviors and social interaction.

Some of these involve brain systems involved in thinking about other people’s thoughts or intentions, empathizing, social motivation and the impact of social attention on an individual’s thinking and emotions. At the same time, research with and for autistic people has also enriched social cognitive neuroscience and the understanding of how our social minds develop. Autism spectrum disorder (ASD) is a buy levitra without a prescription complex and heterogeneous part of the human condition, or neurodiversity.

It is associated with a wide range of life outcomes, from “disorder” or the profound challenges that encumber about 30 percent of affected individuals with minimal language and intellectual disability, to “differences” among people who have well-above-average abilities and accomplishments. Regardless of their outcomes, though, people on the autism spectrum travel a different path of social-cognitive neurodevelopment that appears to begin in infancy. For example, many experience some level of difficulty with social cognitive mentalizing, also buy levitra without a prescription known as “theory of mind”—the mental representation of other people’s thoughts, perspectives, beliefs, intentions or emotions, which enables us to understand or predict their behaviors.

Social cognitive neuroscience tells us that brain systems of the medial frontal cortex, temporal cortex and parietal cortex, as well as reward centers of the brain, enable mentalizing. Accordingly, differences in the development and/or transmissions of information across this distributed social cognitive brain network may contribute to differences in mentalizing among autistic people. These differences can lead to a buy levitra without a prescription range of outcomes, from problems in the capacity to mentalize to alterations in the spontaneous use of mentalizing, or the motivation and effort involved in mentalizing during social interactions.

These observations are informative, but do not address fundamental questions about how social-cognitive brain systems develop or why their development might be different for autistic people. These questions are essential in autism science because understanding the early course of social cognitive neurodevelopment may afford the best opportunity buy levitra without a prescription to mitigate the profoundly negative effects that social cognitive differences can have on some autistic people. Serendipitously, this motivation to understand the very early development of our social brain can inform the broader understanding of social-cognitive neuroscience and human nature.

As it turns out, one key to understanding the development of our social brains may come from observations of social attention in infancy. As early as six to 12 months of age, some infants who go on to receive an autism diagnosis buy levitra without a prescription already display differences in the development of social attention. They look less frequently at the face and eyes of people than other infants and are less likely to coordinate their attention with another person to adopt a common point of view or reference, or “joint attention.” Infants with neurotypical development follow the gaze direction or gesture of other people or lead the gaze of other people to establish joint attention and share information through a common perceptual perspective.

Developing the ability to coordinate attention socially is important in and of itself. For example, every teacher’s admonition to students to “pay buy levitra without a prescription attention!. € is really a request to “pay attention to what I [the teacher] am attending to.” Joint attention is vital to social competence at all ages.

Adolescents and adults who cannot follow, initiate or join with the rapid-fire changes of shared attention in social interactions may be impaired in their capacity for relatedness and relationships. Equally important, joint attention is also an early building block of social cognitive mentalizing buy levitra without a prescription. Every time infants coordinate attention socially with other people, they practice perceptual perspective-taking.

They do this hundreds if not thousands of times in early development. It tunes aspects of social-brain development that buy levitra without a prescription subsequently support the capacity for mental perspective-taking. Mental perspective-taking is synonymous with mentalizing and our ability to understand the thoughts, beliefs, and intentions of other people.

Indeed, several studies provide evidence of a significant overlap in brain systems involved in joint attention and buy levitra without a prescription social-cognitive mentalizing. Accordingly, differences in early social attention are thought to contribute to differences in the neurodevelopment of social cognitive mentalizing in some to many people with autism. Research also suggests that differences in systems that regulate the motivation for social attention might play a role in this aspect of the development of autism, though the nature of this motivation is not understood.

One possibility is that decreased motivation to attend to faces may lead to buy levitra without a prescription critical early difference in social attention. Alternatively, differences in the “eye-contact effect” may impact social attention development. The eye-contact effect is a phenomenon in which awareness of being the object of others’ attention triggers an arousal response that enhances stimulus salience and information processing during social attention coordination.

When we are aware of other people looking at us, changes occur in our mental processes that can benefit buy levitra without a prescription social learning. Several studies now suggest that people with autism may be less responsive to, or less aware of, being the object of attention of others. Hence, autism science raises the hypothesis that the first step toward human social neurocognitive development may involve months of practice with social attention coordination with caregivers during infancy.

Moreover, our response to eye contact of other people may provide an early motivational stance that prioritizes infant social attention development buy levitra without a prescription and the development of our social brains. Notably, recent studies indicate that imitating the behavior of young children with autism, which likely affects a child’s awareness that another person is looking at them, can improve joint attention and language development. Of course, the most fundamental lesson we can draw from all these observations about the development of our social mind is buy levitra without a prescription that we are all more similar than different, regardless of our paths of neurodevelopment, and that autistic people have much to teach us about the nature of human nature.

This is an opinion and analysis article. Further reading. Baron-Cohen, S buy levitra without a prescription.

(2019). The concept of neurodiversity is dividing the autism community. Scientific American buy levitra without a prescription.

Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., &. Schultz, R buy levitra without a prescription.

T. (2012). The social motivation theory buy levitra without a prescription of autism.

Trends in cognitive sciences, 16(4), 231-239. Gulsrud, A buy levitra without a prescription. C., Hellemann, G., Shire, S., &.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To achieve such a feat. Its Zhurong rover, named after a god of fire from Chinese folklore, successfully touched down in Utopia Planitia around 7:18 P.M. EST as part of the Tianwen-1 mission, according to the China National Space Administration.

Soon the rover should drive down the ramp of its landing platform, ready to explore its unearthly surroundings. If there was any doubt about China’s spacefaring prowess, it has been dispelled now that the nation has added interplanetary landings as a coveted notch on its belt. €œMars is hard,” says Roger Launius, NASA’s former chief historian.

€œThis is a really big deal.” Tianwen-1 was launched in July 2020 as part of a summer Martian armada that also included launches of NASA’s Perseverance rover and the United Arab Emirates’ Hope orbiter. All three missions arrived at Mars in February. But while Perseverance descended straight to the surface, Tianwen-1 instead entered an elliptical orbit around the planet to give its scientists a god’s-eye view for scouting out their planned landing site in Utopia Planitia, an immense impact basin on Mars.

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

After jettisoning its protective shell lower in the atmosphere, the spacecraft unfurled parachutes to slow its descent before riding thrusters down to a gentle landing on the surface. This was “very similar” to the powered landings China has used in its Chang’e missions to Earth’s moon, says Andrew Jones, a space journalist who follows the Chinese space program. The latest of those missions returned samples to Earth in 2020.

Other nations have tried and failed to land on Mars, but China’s success highlights how it is rapidly catching up to, if not exceeding, many of its counterparts. The Soviet Union notably attempted multiple landings in the 1970s, coming closest with Mars 3, which touched down on the planet but stopped working moments later. The U.K.

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

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

China now joins this most elite and exclusive of clubs. €œIt’s a big day for China,” says Mark McCaughrean, senior scientific adviser for science and exploration at ESA. €œWe know better than anyone how hard it can be to get safely down to the surface.” China will now wait an undisclosed amount of time, as little as a day or up to perhaps a week, before driving the Zhurong rover down a ramp from the lander and onto the surface.

The six-wheeled solar-powered vehicle has a planned lifetime of 90 Martian days and is thought to have a top speed of 200 meters per hour, Jones says, although it will likely explore much more slowly. China will upload commands to the rover via its Tianwen-1 orbiter, with ESA’s Mars Express orbiter acting as a backup. The rover will then perform its tasks autonomously on the surface, similar to the operational protocols NASA uses for its own fleet of robotic Martian explorers.

Utopia Planitia was also the site for NASA’s Viking 2 in 1976. It is a rather bland expanse of rock-strewn sand—decent for spacecraft landings but decidedly subpar for addressing cutting-edge research questions, such as whether Mars harbors past or present life. €œ[China is] not looking for biosignatures,” says Agnes Cousin, a planetary scientist at the Institute for Research in Astrophysics and Planetology in France, who has advised Tianwen-1 scientists.

Yet Zhurong is still expected to perform important science on the surface of the Red Planet. €œWe always have surprises when we arrive on the surface,” Cousin says. €œFor the overall geological implications for Mars, it’s very nice to have a new location to compare.” The rover is equipped with a suite of six instruments and cameras to study the surface.

They include a ground-penetrating radar that could look for water and ice up to 100 meters below the surface (NASA’s Perseverance boasts a similar instrument). Zhurong also has a magnetometer, the first ever sent to Mars on a rover. Alongside a similar instrument on the Tianwen-1 orbiter, which will continue studying the planet from afar, the rover’s magnetometer could reveal the details of how Mars lost its magnetic field—and consequently its atmosphere and water—billions of years ago.

€œConceivably this instrument could help address that question,” says David Flannery, an astrobiologist at the Queensland University of Technology in Australia, who is familiar with China’s space activities. €œTogether the instruments will tell us more about how the Martian magnetic field operates today.” Another instrument of note is the Mars Surface Composition Detector (MarSCoDe), a device similar to ChemCam on NASA’s Curiosity rover and SuperCam on Perseverance, which will use a laser to vaporize rock specimens on the surface, revealing their composition. Cousin is part of both the ChemCam and SuperCam teams, and she was among a group of European collaborators that helped China develop their instrument.

She traveled to Shanghai in 2019 to exchange information with Tianwen-1 scientists on topics such as data-processing techniques and calibration targets to include on the rover to test the instrument on Mars. €œThey wanted big calibration targets” for MarSCoDe, Cousin says. €œSo we gave them one”.

A two-centimeter-wide square of an igneous rock called norite that is one of 12 such targets on the rover. While the science goals of the rover may be somewhat modest, it is also expected to be a technology demonstration for a much more ambitious future project. By 2028 or 2030, China hopes to send a sample-return mission to Mars to bring pristine Martian rocks back to Earth.

That timing is similar to, or perhaps even in advance of, when NASA and ESA plan to do the same with their own interplanetary grab-and-go effort. €œWill it be China bringing the first Mars material back to Earth, or will it be NASA and ESA?. € says Jacqueline Myrrhe, a journalist affiliated with the Chinese space Web site Go Taikonauts!.

“This could be a very good question.” Landing on Mars is the latest pinnacle achievement from China’s planned portfolio of ambitious space activities. But already the nation has more than proved its mettle. It has conducted numerous sorties to the moon and has begun the construction of a space station in Earth orbit.

The nation may send a pair of spacecraft to the edge of the solar system in just a few years and launch a mission to Jupiter by the end of the decade. Now that Tianwen-1 has shown that China is an adept interplanetary explorer, even more audacious projects may be on the horizon. €œIt’s the first step for much more,” Myrrhe says..

Can levitra be purchased over the counter

Maximizing health can levitra be purchased over the counter coverage for DAP clients. Before and after winning the case Outline prepared by Geoffrey Hale and Cathy Roberts - updated August 2012 This outline is intended to assist Disability Advocacy Program (DAP) advocates maximize health insurance coverage for clients they are representing on Social Security/SSI disability determinations. We begin with a can levitra be purchased over the counter discussion of coverage options available while your client’s DAP case is pending and then outline the effect winning the DAP case can have on your client’s access to health care coverage. How your client is affected will vary depending on the source and amount of disability income he or she receives after the successful appeal. I.

BACKGROUND can levitra be purchased over the counter. Public health coverage for your clients will primarily be provided by Medicaid and Medicare. The two programs are structured differently and have different can levitra be purchased over the counter eligibility criteria, but in order to provide the most complete coverage possible for your clients, they must work effectively together. Understanding their interactions is essential to ensuring benefits for your client. Here is a brief overview of the programs we will cover.

A. Medicaid. Medicaid is the public insurance program jointly funded by the federal, state and local governments for people of limited means. For federal Medicaid law, see 42 U.S.C. § 1396 et seq., 42 C.F.R.

§ 430 et seq. Regular Medicaid is described in New York’s State Plan and codified at N.Y. Soc. Serv. L.

§§ 122, 131, 363- 369-1. 18 N.Y.C.R.R. § 360, 505. New York also offers several additional programs to provide health care benefits to those whose income might be too high for Regular Medicaid. i.

Family Health Plus (FHPlus) is an extension of New York’s Medicaid program that provides health coverage for adults who are over-income for regular Medicaid. FHPlus is described in New York’s 1115 waiver and codified at N.Y. Soc. Serv. L.

§369-ee. ii. Child Health Plus (CHPlus) is a sliding scale premium program for children who are over-income for regular Medicaid. CHPlus is codified at N.Y. Pub.

Health L. §2510 et seq. b. Medicare. Medicare is the federal health insurance program providing coverage for the elderly, disabled, and people with end-stage renal disease.

Medicare is codified under title XVIII of the Social Security Law, see 42 U.S.C. § 1395 et seq., 42 C.F.R. § 400 et seq. Medicare is divided into four parts. i.

Part A covers hospital, skilled nursing facility, home health, and hospice care, with some deductibles and coinsurance. Most people are eligible for Part A at no cost. See 42 U.S.C. § 1395c, 42 C.F.R. Pt.

406. ii. Part B provides medical insurance for doctor’s visits and other outpatient medical services. Medicare Part B has significant cost-sharing components. There are monthly premiums (the standard premium in 2012 is $99.90.

In addition, there is a $135 annual deductible (which will increase to $155 in 2010) as well as 20% co-insurance for most covered out-patient services. See 42 U.S.C. § 1395k, 42 C.F.R. Pt. 407.

iii. Part C, also called Medicare Advantage, provides traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C. § 1395w, 42 C.F.R. Pt.

422. Premium amounts for Medicare Advantage plans vary. Some Medicare Advantage plans include prescription drug coverage. iv. Part D is an optional prescription drug benefit available to anyone with Medicare Parts A and B.

See 42 U.S.C. § 1395w, 42 C.F.R. § 423.30(a)(1)(i) and (ii). Unlike Parts A and B, Part D benefits are provided directly through private plans offered by insurance companies. In order to receive prescription drug coverage, a Medicare beneficiary must join a Part D Plan or participate in a Medicare Advantage plan that provides prescription drug coverage.

C. Medicare Savings Programs (MSPs). Funded by the State Medicaid program, MSPs help eligible individuals meet some or all of their cost-sharing obligations under Medicare. See N.Y. Soc.

Serv. L. § 367-a(3)(a), (b), and (d). There are three separate MSPs, each with different eligibility requirements and providing different benefits. i.

Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits. Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. ii.

Special Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only. iii. Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, but not otherwise Medicaid eligible, the QI-1 program covers Medicare Part B premiums.

D. Medicare Part D Low Income Subsidy (LIS or “Extra Help”). LIS is a federal subsidy administered by CMS that helps Medicare beneficiaries with limited income and/or resources pay for some or most of the costs of Medicare prescription drug coverage. See 42 C.F.R. § 423.773.

Some of the costs covered in full or in part by LIS include the monthly premiums, annual deductible, co-payments, and the coverage gap. Individuals eligible for Medicaid, SSI, or MSP are deemed eligible for full LIS benefitsSee 42 C.F.R. § 423.773(c). LIS applications are treated as (“deemed”) applications for MSP benefits, See the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, Pub. Law 110-275.

II. WHILE THE DAP APPEAL IS PENDING Does your client have health insurance?. If not, why isn’t s/he getting Medicaid, Family Health Plus or Child Health Plus?. There have been many recent changes which expand eligibility and streamline the application process. All/most of your DAP clients should qualify.

Significant changes to Medicaid include. Elimination of the resource test for certain categories of Medicaid applicants/recipients and all applicants to the Family Health Plus program. N.Y. Soc. Serv.

L. §369-ee (2), as amended by L. 2009, c. 58, pt. C, § 59-d.

As of October 1, 2009, a resource test is no longer required for these categories. Elimination of the fingerprinting requirement. N.Y. Soc. Serv.

L. §369-ee, as amended by L. 2009, c. 58, pt. C, § 62.

Elimination of the waiting period for CHPlus. N.Y. Pub. Health L. §2511, as amended by L.

2008, c. 58. Elimination of the face-to-face interview requirement for Medicaid, effective April 1, 2010. N.Y. Soc.

Serv. L. §366-a (1), as amended by L. 2009, c. 58, pt.

C, § 60. Higher income levels for Single Adults and Childless Couples. N.Y. Soc. Serv.

L. §366(1)(a)(1),(8) as amended by L. 2008, c. 58. See also.

GIS 08 MA/022. Higher income levels for Medicaid’s Medically Needy program. N.Y. Soc. Serv.

L. §366(2)(a)(7) as amended by L. 2008, c. 58. See also.

GIS 08 MA/022 More detailed information on recent changes to Medicaid is available at. III. AFTER CLIENT IS AWARDED DAP BENEFITS a. Medicaid eligibility. Clients receiving even $1.00 of SSI should qualify for Medicaid automatically.

The process for qualifying will differ, however, depending on the source of payment. 1. Clients Receiving SSI Only. i. These clients are eligible for full Medicaid without a spend-down.

ii. Medicaid coverage is automatic. No separate application/ recertification required. iii. Most SSI-only recipients are required to participate in Medicaid managed care.

2. Concurrent (SSI/SSD) cases. Eligible for full Medicaid since receiving SSI. See N.Y. Soc.

I. They can still qualify for Medicaid but may have a spend-down. Federal Law allows states to use a “spend-down” to extend Medicaid to “medically needy” persons in the federal mandatory categories (children, caretakers, elderly and disabled people) whose income or resources are above the eligibility level for regular Medicaid. See 42 U.S.C. § 1396 (a) (10) (ii) (XIII).

ii. Under spend-down, applicants in New York’s Medically Needy program can qualify for Medicaid once their income/resources, minus incurred medical expenses, fall below the specified level. For an explanation of spend-down, see 96 ADM 15. B. Family Health Plus Until your client qualifies for Medicare, those over-income for Medicaid may qualify for Family Health Plus without needing to satisfy a spend-down.

It covers adults without children with income up to 100% of the FPL and adults with children up to 150% of the FPL.[1] The eligibility tests are the same as for regular Medicaid with two additional requirements. Applicants must be between the ages of 19 and 64 and they generally must be uninsured. See N.Y. Soc. Serv.

L. § 369-ee et. Seq. Once your client begins to receive Medicare, he or she will not be eligible for FHP, because FHP is generally only available to those without insurance. For more information on FHP see our article on Family Health Plus.

IV. LOOMING ISSUES - MEDICARE ELIGIBILITY (WHETHER YOU LIKE IT OR NOT) a. SSI-only cases Clients receiving only SSI aren’t eligible for Medicare until they turn 65, unless they also have End Stage Renal Disease. B. Concurrent (SSD and SSI) cases 1.

Medicare eligibility kicks in beginning with 25th month of SSD receipt. See 42 U.S.C. § 426(f). Exception. In 2000, Congress eliminated the 24-month waiting period for people diagnosed with ALS (Lou Gehrig’s Disease.) See 42 U.S.C.

§ 426 (h) 2. Enrollment in Medicare is a condition of eligibility for Medicaid coverage. These clients cannot decline Medicare coverage. (05 OMM/ADM 5. Medicaid Reference Guide p.

344.1) 3. Medicare coverage is not free. Although most individuals receive Part A without any premium, Part B has monthly premiums and significant cost-sharing components. 4. Medicaid and/or the Medicare Savings Program (MSP) should pick up most of Medicare’s cost sharing.

Most SSI beneficiaries are eligible not only for full Medicaid, but also for the most comprehensive MSP, the Qualified Medicare Beneficiary (QMB) program. I. Parts A &. B (hospital and outpatient/doctors visits). A.

Medicaid will pick up premiums, deductibles, co-pays. N.Y. Soc. Serv. L.

§ 367-a (3) (a). For those not enrolled in an MSP, SSA normally deducts the Part B premium directly from the monthly check. However, SSI recipients are supposed to be enrolled automatically in QMB, and Medicaid is responsible for covering the premiums. Part B premiums should never be deducted from these clients’ checks.[1] Medicaid and QMB-only recipients should NEVER be billed directly for Part A or B services. Even non-Medicaid providers are supposed to be able to bill Medicaid directly for services.[2] Clients are only responsible for Medicaid co-pay amount.

See 42 U.S.C. § 1396a (n) ii. Part D (prescription drugs). a. Clients enrolled in Medicaid and/or MSP are deemed eligible for Low Income Subsidy (LIS aka Extra Help).

See 42 C.F.R. § 423.773(c). SSA POMS SI § 01715.005A.5. New York State If client doesn’t enroll in Part D plan on his/her own, s/he will be automatically assigned to a benchmark[3] plan. See 42 C.F.R.

§ 423.34 (d). LIS will pick up most of cost-sharing.[3] Because your clients are eligible for full LIS, they should have NO deductible and NO premium if they are in a benchmark plan, and will not be subject to the coverage gap (aka “donut hole”). See 42 C.F.R. §§ 423.780 and 423.782. The full LIS beneficiary will also have co-pays limited to either $1.10 or $3.30 (2010 amounts).

See 42 C.F.R. § 423.104 (d) (5) (A). Other important points to remember. - Medicaid co-pay rules do not apply to Part D drugs. - Your client’s plan may not cover all his/her drugs.

- You can help your clients find the plan that best suits their needs. To figure out what the best Part D plans are best for your particular client, go to www.medicare.gov. Click on “formulary finder” and plug in your client’s medication list. You can enroll in a Part D plan through www.medicare.gov, or by contacting the plan directly. €“ Your clients can switch plans at any time during the year.

Iii. Part C (“Medicare Advantage”). a. Medicare Advantage plans provide traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C.

§ 1395w, 42 C.F.R. Pt. 422. Medicare Advantage participation is voluntary. For those clients enrolled in Medicare Advantage Plans, the QMB cost sharing obligations are the same as they are under traditional Medicare.

Medicaid must cover any premiums required by the plan, up to the Part B premium amount. Medicaid must also cover any co-payments and co-insurance under the plan. As with traditional Medicare, both providers and plans are prohibited from billing the beneficiary directly for these co-payments. C. SSD only individuals.

1. Same Medicare eligibility criteria (24 month waiting period, except for persons w/ ALS). I. During the 24 month waiting period, explore eligibility for Medicaid or Family Health Plus. 2.

Once Medicare eligibility begins. ii. Parts A &. B. SSA will automatically enroll your client.

Part B premiums will be deducted from monthly Social Security benefits. (Part A will be free – no monthly premium) Clients have the right to decline ongoing Part B coverage, BUT this is almost never a good idea, and can cause all sorts of headaches if client ever wants to enroll in Part B in the future. (late enrollment penalty and can’t enroll outside of annual enrollment period, unless person is eligible for Medicare Savings Program – see more below) Clients can decline “retro” Part B coverage with no penalty on the Medicare side – just make sure they don’t actually need the coverage. Risky to decline if they had other coverage during the retro period – their other coverage may require that Medicare be utilized if available. Part A and Part B also have deductibles and co-pays.

Medicaid and/or the MSPs can help cover this cost sharing. iii. Part D. Client must affirmatively enroll in Part D, unless they receive LIS. See 42 U.S.C.

§ 1395w-101 (b) (2), 42 C.F.R. § 423.38 (a). Enrollment is done through individual private plans. LIS recipients will be auto-assigned to a Part D benchmark plan if they have not selected a plan on their own. Client can decline Part D coverage with no penalty if s/he has “comparable coverage.” 42 C.F.R.

§ 423.34 (d) (3) (i). If no comparable coverage, person faces possible late enrollment penalty &. Limited enrollment periods. 42 C.F.R. § 423.46.

However, clients receiving LIS do not incur any late enrollment penalty. 42 C.F.R. § 423.780 (e). Part D has a substantial cost-sharing component – deductibles, premiums and co-pays which vary from plan to plan. There is also the coverage gap, also known as “donut hole,” which can leave beneficiaries picking up 100% of the cost of their drugs until/unless a catastrophic spending limit is reached.

The LIS program can help with Part D cost-sharing. Use Medicare’s website to figure out what plan is best for your client. (Go to www.medicare.gov , click on “formulary finder” and plug in your client’s medication list. ) You can also enroll in a Part D plan directly through www.medicare.gov. Iii.

Help with Medicare cost-sharing a. Medicaid – After eligibility for Medicare starts, client may still be eligible for Medicaid, with or without a spend-down. There are lots of ways to help clients meet their spend-down – including - Medicare cost sharing amounts (deductibles, premiums, co-pays) - over the counter medications if prescribed by a doctor. - expenses paid by state-funded programs like EPIC and ADAP. - medical bills of person’s spouse or child.

- health insurance premiums. - joining a pooled Supplemental Needs Trust (SNT). B. Medicare Savings Program (MSP) – If client is not eligible for Medicaid, explore eligibility for Medicare Savings Program (MSP). MSP pays for Part B premiums and gets you into the Part D LIS.

There are no asset limits in the Medicare Savings Program. One of the MSPs (QMB), also covers all cost sharing for Parts A &. B. If your client is eligible for Medicaid AND MSP, enrolling in MSP may subject him/her to, or increase a spend-down, because Medicaid and the various MSPs have different income eligibility levels. It is the client’s choice as to whether or not to be enrolled into MSP.

C. Part D Low Income Subsidy (LIS) – If your client is not eligible for MSP or Medicaid, s/he may still be eligible for Part D Low Income Subsidy. Applications for LIS are also be treated as applications for MSP, unless the client affirmatively indicates that s/he does not want to apply for MSP. d. Medicare supplemental insurance (Medigap) -- Medigap is supplemental private insurance coverage that covers all or some of the deductibles and coinsurance for Medicare Parts A and B.

Medigap is not available to people enrolled in Part C. E. Medicare Advantage – Medicare Advantage plans “package” Medicare (Part A and B) benefits, with or without Part D coverage, through a private health insurance plan. The cost-sharing structure (deductible, premium, co-pays) varies from plan to plan. For a list of Medicare Advantage plans in your area, go to www.medicare.gov – click on “find health plans.” f.

NY Prescription Saver Card -- NYP$ is a state-sponsored pharmacy discount card that can lower the cost of prescriptions by as much as 60 percent on generics and 30 percent on brand name drugs. Can be used during the Part D “donut hole” (coverage gap) g. For clients living with HIV. ADAP [AIDS Drug Assistance Program] ADAP provides free medications for the treatment of HIV/AIDS and opportunistic s. ADAP can be used to help meet a Medicaid spenddown and get into the Part D Low Income subsidy.

For more information about ADAP, go to V. GETTING MEDICAID IN THE DISABLED CATEGORY AFTER AN SSI/SSDI DENIAL What if your client's application for SSI or SSDI is denied based on SSA's finding that they were not "disabled?. " Obviously, you have your appeals work cut out for you, but in the meantime, what can they do about health insurance?. It is still possible to have Medicaid make a separate disability determination that is not controlled by the unfavorable SSA determination in certain situations. Specifically, an applicant is entitled to a new disability determination where he/she.

alleges a different or additional disabling condition than that considered by SSA in making its determination. Or alleges less than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated, alleges a new period of disability which meets the duration requirement, and SSA has refused to reopen or reconsider the allegations, or the individual is now ineligible for SSA benefits for a non-medical reason. Or alleges more than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated since the SSA determination and alleges a new period of disability which meets the duration requirement, and has not applied to SSA regarding these allegations. See GIS 10-MA-014 and 08 OHIP/INF-03.[4] [1] Potential wrinkle – for some clients Medicaid is not automatically pick up cost-sharing. In Monroe County we have had several cases where SSA began deducting Medicare Part B premiums from the checks of clients who were receiving SSI and Medicaid and then qualified for Medicare.

The process should be automatic. Please contact Geoffrey Hale in our Rochester office if you encounter any cases like this. [2]Under terms established to provide benefits for QMBs, a provider agreement necessary for reimbursement “may be executed through the submission of a claim to the Medicaid agency requesting Medicaid payment for Medicare deductibles and coinsurance for QMBs.” CMS State Medicaid Manual, Chapter 3, Eligibility, 3490.14 (b), available at. http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?. ItemID=CMS021927.

[3]Benchmark plans are free if you are an LIS recipient. The amount of the benchmark changes from year to year. In 2013, a Part D plan in New York State is considered benchmark if it provides basic Part D coverage and its monthly premium is $43.22 or less. [4] These citations courtesy of Jim Murphy at Legal Services of Central New York. This site provides general information only.

This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelp.org/ny. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law.

However, we do not guarantee the accuracy of this information.Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $148.50 in 2021. MIPP is for some groups who are either not eligible for -- or who are not yet enrolled in-- the Medicare Savings Program (MSP), which is the main program that pays the Medicare Part B premium for low-income people. Some people are not eligible for an MSP even though they have full Medicaid with no spend down. This is because they are in a special Medicaid eligibility category -- discussed below -- with Medicaid income limits that are actually HIGHER than the MSP income limits.

MIPP reimburses them for their Part B premium because they have “full Medicaid” (no spend down) but are ineligible for MSP because their income is above the MSP SLIMB level (120% of the Federal Poverty Level (FPL). Even if their income is under the QI-1 MSP level (135% FPL), someone cannot have both QI-1 and Medicaid). Instead, these consumers can have their Part B premium reimbursed through the MIPP program. In this article. The MIPP program was established because the State determined that those who have full Medicaid and Medicare Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7).

There are generally four groups of dual-eligible consumers that are eligible for MIPP. Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down. Those consumers can qualify for MIPP and have their Part B premiums reimbursed. Here is an example. Sam is age 50 and has Medicare and MBI-WPD.

She gets $1500/mo gross from Social Security Disability and also makes $400/month through work activity. $ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies. $400 - $65 = $335. Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability = $1,667.50 --TOTAL income. This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP.

2. Parent/Caretaker Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries. Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher or lower than 120% of the FPL.

If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income is above 120% FPL, then they can enroll in MIPP. (See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP. However, the transition time can vary based on age.

AGE 65+ Those who enroll in Medicare at age 65+ will receive a letter from their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02. The Medicaid case takes about four months to be rebudgeted and approved by the LDSS. The consumer is entitled to MIPP payments for at least three months during the transition. Once the case is with the LDSS she should automatically be re-evaluated for MSP, even if the LDSS determines the consumer is not eligible for Medicaid because of excess income or assets.

08 OHIP/ADM-4. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd. 4(c). These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS. NOTE during erectile dysfunction treatment emergency their case may remain with NYSoH for more than 12 months.

See here. EXAMPLE. Sam, age 60, was last authorized for Medicaid on the Marketplace in June 2020. He became enrolled in Medicare based on disability in August 2020, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2020.

Sam has to pay for his Part B premium - it is deducted from his Social Security check. He may call the Marketplace and request a refund. This will continue until the end of his 12 months of continuous MAGI Medicaid eligibility. He will be reimbursed regardless of whether he is in a Medicaid managed care plan. See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district.

See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. That directive also clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan. Note. During the erectile dysfunction treatment emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should keep the same MAGI budgeting and automatically receive MIPP payments.

See GIS 20 MA/04 or this article on erectile dysfunction treatment eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC). Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN.

See this article. Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums. See page 96 of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP.

If higher than the threshold, they can be reimbursed via MIPP. See also 95-ADM-11. Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle &. 1619B.

5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit. The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021). They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019.

Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check. In contrast, MSP enrollees are not charged for their premium. Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B.

It does not have any of the other benefits MSPs can provide, such as. A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only. Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &.

Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment. Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP.

If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov. If Medicaid case is with other local districts in NYS, call your local county DSS. See more here about consumers who have Medicaid on NYSofHealth who then enroll in Medicare - how they access MIPP. Once enrolled, it make take a few months for payments to begin. Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program.

The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing. See attached sample for what to look for. Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:.

Maximizing health buy levitra without a prescription coverage for DAP clients http://2018.swissbiotechday.ch/how-can-i-buy-amoxil/. Before and after winning the case Outline prepared by Geoffrey Hale and Cathy Roberts - updated August 2012 This outline is intended to assist Disability Advocacy Program (DAP) advocates maximize health insurance coverage for clients they are representing on Social Security/SSI disability determinations. We begin with a discussion of coverage options available while your client’s DAP case is pending and then outline the effect buy levitra without a prescription winning the DAP case can have on your client’s access to health care coverage. How your client is affected will vary depending on the source and amount of disability income he or she receives after the successful appeal. I.

BACKGROUND buy levitra without a prescription. Public health coverage for your clients will primarily be provided by Medicaid and Medicare. The two programs are structured differently and have different eligibility criteria, but in buy levitra without a prescription order to provide the most complete coverage possible for your clients, they must work effectively together. Understanding their interactions is essential to ensuring benefits for your client. Here is a brief overview of the programs we will cover.

A. Medicaid. Medicaid is the public insurance program jointly funded by the federal, state and local governments for people of limited means. For federal Medicaid law, see 42 U.S.C. § 1396 et seq., 42 C.F.R.

§ 430 et seq. Regular Medicaid is described in New York’s State Plan and codified at N.Y. Soc. Serv. L.

§§ 122, 131, 363- 369-1. 18 N.Y.C.R.R. § 360, 505. New York also offers several additional programs to provide health care benefits to those whose income might be too high for Regular Medicaid. i.

Family Health Plus (FHPlus) is an extension of New York’s Medicaid program that provides health coverage for adults who are over-income for regular Medicaid. FHPlus is described in New York’s 1115 waiver and codified at N.Y. Soc. Serv. L.

§369-ee. ii. Child Health Plus (CHPlus) is a sliding scale premium program for children who are over-income for regular Medicaid. CHPlus is codified at N.Y. Pub.

Health L. §2510 et seq. b. Medicare. Medicare is the federal health insurance program providing coverage for the elderly, disabled, and people with end-stage renal disease.

Medicare is codified under title XVIII of the Social Security Law, see 42 U.S.C. § 1395 et seq., 42 C.F.R. § 400 et seq. Medicare is divided into four parts. i.

Part A covers hospital, skilled nursing facility, home health, and hospice care, with some deductibles and coinsurance. Most people are eligible for Part A at no cost. See 42 U.S.C. § 1395c, 42 C.F.R. Pt.

406. ii. Part B provides medical insurance for doctor’s visits and other outpatient medical services. Medicare Part B has significant cost-sharing components. There are monthly premiums (the standard premium in 2012 is $99.90.

In addition, there is a $135 annual deductible (which will increase to $155 in 2010) as well as 20% co-insurance for most covered out-patient services. See 42 U.S.C. § 1395k, 42 C.F.R. Pt. 407.

iii. Part C, also called Medicare Advantage, provides traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C. § 1395w, 42 C.F.R. Pt.

422. Premium amounts for Medicare Advantage plans vary. Some Medicare Advantage plans include prescription drug coverage. iv. Part D is an optional prescription drug benefit available to anyone with Medicare Parts A and B.

See 42 U.S.C. § 1395w, 42 C.F.R. § 423.30(a)(1)(i) and (ii). Unlike Parts A and B, Part D benefits are provided directly through private plans offered by insurance companies. In order to receive prescription drug coverage, a Medicare beneficiary must join a Part D Plan or participate in a Medicare Advantage plan that provides prescription drug coverage.

C. Medicare Savings Programs (MSPs). Funded by the State Medicaid program, MSPs help eligible individuals meet some or all of their cost-sharing obligations under Medicare. See N.Y. Soc.

Serv. L. § 367-a(3)(a), (b), and (d). There are three separate MSPs, each with different eligibility requirements and providing different benefits. i.

Qualified Medicare Beneficiary (QMB). The QMB program provides the most comprehensive benefits. Available to those with incomes at or below 100% of the Federal Poverty Level (FPL), the QMB program covers virtually all Medicare cost-sharing obligations. Part B premiums, Part A premiums, if there are any, and any and all deductibles and co-insurance. ii.

Special Low-Income Medicare Beneficiary (SLMB). For those with incomes between 100% and 120% FPL, the SLMB program will cover Part B premiums only. iii. Qualified Individual (QI-1). For those with incomes between 120% and 135% FPL, but not otherwise Medicaid eligible, the QI-1 program covers Medicare Part B premiums.

D. Medicare Part D Low Income Subsidy (LIS or “Extra Help”). LIS is a federal subsidy administered by CMS that helps Medicare beneficiaries with limited income and/or resources pay for some or most of the costs of Medicare prescription drug coverage. See 42 C.F.R. § 423.773.

Some of the costs covered in full or in part by LIS include the monthly premiums, annual deductible, co-payments, and the coverage gap. Individuals eligible for Medicaid, SSI, or MSP are deemed eligible for full LIS benefitsSee 42 C.F.R. § 423.773(c). LIS applications are treated as (“deemed”) applications for MSP benefits, See the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, Pub. Law 110-275.

II. WHILE THE DAP APPEAL IS PENDING Does your client have health insurance?. If not, why isn’t s/he getting Medicaid, Family Health Plus or Child Health Plus?. There have been many recent changes which expand eligibility and streamline the application process. All/most of your DAP clients should qualify.

Significant changes to Medicaid include. Elimination of the resource test for certain categories of Medicaid applicants/recipients and all applicants to the Family Health Plus program. N.Y. Soc. Serv.

L. §369-ee (2), as amended by L. 2009, c. 58, pt. C, § 59-d.

As of October 1, 2009, a resource test is no longer required for these categories. Elimination of the fingerprinting requirement. N.Y. Soc. Serv.

L. §369-ee, as amended by L. 2009, c. 58, pt. C, § 62.

Elimination of the waiting period for CHPlus. N.Y. Pub. Health L. §2511, as amended by L.

2008, c. 58. Elimination of the face-to-face interview requirement for Medicaid, effective April 1, 2010. N.Y. Soc.

Serv. L. §366-a (1), as amended by L. 2009, c. 58, pt.

C, § 60. Higher income levels for Single Adults and Childless Couples. N.Y. Soc. Serv.

L. §366(1)(a)(1),(8) as amended by L. 2008, c. 58. See also.

GIS 08 MA/022. Higher income levels for Medicaid’s Medically Needy program. N.Y. Soc. Serv.

L. §366(2)(a)(7) as amended by L. 2008, c. 58. See also.

GIS 08 MA/022 More detailed information on recent changes to Medicaid is available at. III. AFTER CLIENT IS AWARDED DAP BENEFITS a. Medicaid eligibility. Clients receiving even $1.00 of SSI should qualify for Medicaid automatically.

The process for qualifying will differ, however, depending on the source of payment. 1. Clients Receiving SSI Only. i. These clients are eligible for full Medicaid without a spend-down.

ii. Medicaid coverage is automatic. No separate application/ recertification required. iii. Most SSI-only recipients are required to participate in Medicaid managed care.

2. Concurrent (SSI/SSD) cases. Eligible for full Medicaid since receiving SSI. See N.Y. Soc.

I. They can still qualify for Medicaid but may have a spend-down. Federal Law allows states to use a “spend-down” to extend Medicaid to “medically needy” persons in the federal mandatory categories (children, caretakers, elderly and disabled people) whose income or resources are above the eligibility level for regular Medicaid. See 42 U.S.C. § 1396 (a) (10) (ii) (XIII).

ii. Under spend-down, applicants in New York’s Medically Needy program can qualify for Medicaid once their income/resources, minus incurred medical expenses, fall below the specified level. For an explanation of spend-down, see 96 ADM 15. B. Family Health Plus Until your client qualifies for Medicare, those over-income for Medicaid may qualify for Family Health Plus without needing to satisfy a spend-down.

It covers adults without children with income up to 100% of the FPL and adults with children up to 150% of the FPL.[1] The eligibility tests are the same as for regular Medicaid with two additional requirements. Applicants must be between the ages of 19 and 64 and they generally must be uninsured. See N.Y. Soc. Serv.

L. § 369-ee et. Seq. Once your client begins to receive Medicare, he or she will not be eligible for FHP, because FHP is generally only available to those without insurance. For more information on FHP see our article on Family Health Plus.

IV. LOOMING ISSUES - MEDICARE ELIGIBILITY (WHETHER YOU LIKE IT OR NOT) a. SSI-only cases Clients receiving only SSI aren’t eligible for Medicare until they turn 65, unless they also have End Stage Renal Disease. B. Concurrent (SSD and SSI) cases 1.

Medicare eligibility kicks in beginning with 25th month of SSD receipt. See 42 U.S.C. § 426(f). Exception. In 2000, Congress eliminated the 24-month waiting period for people diagnosed with ALS (Lou Gehrig’s Disease.) See 42 U.S.C.

§ 426 (h) 2. Enrollment in Medicare is a condition of eligibility for Medicaid coverage. These clients cannot decline Medicare coverage. (05 OMM/ADM 5. Medicaid Reference Guide p.

344.1) 3. Medicare coverage is not free. Although most individuals receive Part A without any premium, Part B has monthly premiums and significant cost-sharing components. 4. Medicaid and/or the Medicare Savings Program (MSP) should pick up most of Medicare’s cost sharing.

Most SSI beneficiaries are eligible not only for full Medicaid, but also for the most comprehensive MSP, the Qualified Medicare Beneficiary (QMB) program. I. Parts A &. B (hospital and outpatient/doctors visits). A.

Medicaid will pick up premiums, deductibles, co-pays. N.Y. Soc. Serv. L.

§ 367-a (3) (a). For those not enrolled in an MSP, SSA normally deducts the Part B premium directly from the monthly check. However, SSI recipients are supposed to be enrolled automatically in QMB, and Medicaid is responsible for covering the premiums. Part B premiums should never be deducted from these clients’ checks.[1] Medicaid and QMB-only recipients should NEVER be billed directly for Part A or B services. Even non-Medicaid providers are supposed to be able to bill Medicaid directly for services.[2] Clients are only responsible for Medicaid co-pay amount.

See 42 U.S.C. § 1396a (n) ii. Part D (prescription drugs). a. Clients enrolled in Medicaid and/or MSP are deemed eligible for Low Income Subsidy (LIS aka Extra Help).

See 42 C.F.R. § 423.773(c). SSA POMS SI § 01715.005A.5. New York State If client doesn’t enroll in Part D plan on his/her own, s/he will be automatically assigned to a benchmark[3] plan. See 42 C.F.R.

§ 423.34 (d). LIS will pick up most of cost-sharing.[3] Because your clients are eligible for full LIS, they should have NO deductible and NO premium if they are in a benchmark plan, and will not be subject to the coverage gap (aka “donut hole”). See 42 C.F.R. §§ 423.780 and 423.782. The full LIS beneficiary will also have co-pays limited to either $1.10 or $3.30 (2010 amounts).

See 42 C.F.R. § 423.104 (d) (5) (A). Other important points to remember. - Medicaid co-pay rules do not apply to Part D drugs. - Your client’s plan may not cover all his/her drugs.

- You can help your clients find the plan that best suits their needs. To figure out what the best Part D plans are best for your particular client, go to www.medicare.gov. Click on “formulary finder” and plug in your client’s medication list. You can enroll in a Part D plan through www.medicare.gov, or by contacting the plan directly. €“ Your clients can switch plans at any time during the year.

Iii. Part C (“Medicare Advantage”). a. Medicare Advantage plans provide traditional Medicare coverage (Parts A and B) through private managed care insurers. See 42 U.S.C.

§ 1395w, 42 C.F.R. Pt. 422. Medicare Advantage participation is voluntary. For those clients enrolled in Medicare Advantage Plans, the QMB cost sharing obligations are the same as they are under traditional Medicare.

Medicaid must cover any premiums required by the plan, up to the Part B premium amount. Medicaid must also cover any co-payments and co-insurance under the plan. As with traditional Medicare, both providers and plans are prohibited from billing the beneficiary directly for these co-payments. C. SSD only individuals.

1. Same Medicare eligibility criteria (24 month waiting period, except for persons w/ ALS). I. During the 24 month waiting period, explore eligibility for Medicaid or Family Health Plus. 2.

Once Medicare eligibility begins. ii. Parts A &. B. SSA will automatically enroll your client.

Part B premiums will be deducted from monthly Social Security benefits. (Part A will be free – no monthly premium) Clients have the right to decline ongoing Part B coverage, BUT this is almost never a good idea, and can cause all sorts of headaches if client ever wants to enroll in Part B in the future. (late enrollment penalty and can’t enroll outside of annual enrollment period, unless person is eligible for Medicare Savings Program – see more below) Clients can decline “retro” Part B coverage with no penalty on the Medicare side – just make sure they don’t actually need the coverage. Risky to decline if they had other coverage during the retro period – their other coverage may require that Medicare be utilized if available. Part A and Part B also have deductibles and co-pays.

Medicaid and/or the MSPs can help cover this cost sharing. iii. Part D. Client must affirmatively enroll in Part D, unless they receive LIS. See 42 U.S.C.

§ 1395w-101 (b) (2), 42 C.F.R. § 423.38 (a). Enrollment is done through individual private plans. LIS recipients will be auto-assigned to a Part D benchmark plan if they have not selected a plan on their own. Client can decline Part D coverage with no penalty if s/he has “comparable coverage.” 42 C.F.R.

§ 423.34 (d) (3) (i). If no comparable coverage, person faces possible late enrollment penalty &. Limited enrollment periods. 42 C.F.R. § 423.46.

However, clients receiving LIS do not incur any late enrollment penalty. 42 C.F.R. § 423.780 (e). Part D has a substantial cost-sharing component – deductibles, premiums and co-pays which vary from plan to plan. There is also the coverage gap, also known as “donut hole,” which can leave beneficiaries picking up 100% of the cost of their drugs until/unless a catastrophic spending limit is reached.

The LIS program can help with Part D cost-sharing. Use Medicare’s website to figure out what plan is best for your client. (Go to www.medicare.gov , click on “formulary finder” and plug in your client’s medication list. ) You can also enroll in a Part D plan directly through www.medicare.gov. Iii.

Help with Medicare cost-sharing a. Medicaid – After eligibility for Medicare starts, client may still be eligible for Medicaid, with or without a spend-down. There are lots of ways to help clients meet their spend-down – including - Medicare cost sharing amounts (deductibles, premiums, co-pays) - over the counter medications if prescribed by a doctor. - expenses paid by state-funded programs like EPIC and ADAP. - medical bills of person’s spouse or child.

- health insurance premiums. - joining a pooled Supplemental Needs Trust (SNT). B. Medicare Savings Program (MSP) – If client is not eligible for Medicaid, explore eligibility for Medicare Savings Program (MSP). MSP pays for Part B premiums and gets you into the Part D LIS.

There are no asset limits in the Medicare Savings Program. One of the MSPs (QMB), also covers all cost sharing for Parts A &. B. If your client is eligible for Medicaid AND MSP, enrolling in MSP may subject him/her to, or increase a spend-down, because Medicaid and the various MSPs have different income eligibility levels. It is the client’s choice as to whether or not to be enrolled into MSP.

C. Part D Low Income Subsidy (LIS) – If your client is not eligible for MSP or Medicaid, s/he may still be eligible for Part D Low Income Subsidy. Applications for LIS are also be treated as applications for MSP, unless the client affirmatively indicates that s/he does not want to apply for MSP. d. Medicare supplemental insurance (Medigap) -- Medigap is supplemental private insurance coverage that covers all or some of the deductibles and coinsurance for Medicare Parts A and B.

Medigap is not available to people enrolled in Part C. E. Medicare Advantage – Medicare Advantage plans “package” Medicare (Part A and B) benefits, with or without Part D coverage, through a private health insurance plan. The cost-sharing structure (deductible, premium, co-pays) varies from plan to plan. For a list of Medicare Advantage plans in your area, go to www.medicare.gov – click on “find health plans.” f.

NY Prescription Saver Card -- NYP$ is a state-sponsored pharmacy discount card that can lower the cost of prescriptions by as much as 60 percent on generics and 30 percent on brand name drugs. Can be used during the Part D “donut hole” (coverage gap) g. For clients living with HIV. ADAP [AIDS Drug Assistance Program] ADAP provides free medications for the treatment of HIV/AIDS and opportunistic s. ADAP can be used to help meet a Medicaid spenddown and get into the Part D Low Income subsidy.

For more information about ADAP, go to V. GETTING MEDICAID IN THE DISABLED CATEGORY AFTER AN SSI/SSDI DENIAL What if your client's application for SSI or SSDI is denied based on SSA's finding that they were not "disabled?. " Obviously, you have your appeals work cut out for you, but in the meantime, what can they do about health insurance?. It is still possible to have Medicaid make a separate disability determination that is not controlled by the unfavorable SSA determination in certain situations. Specifically, an applicant is entitled to a new disability determination where he/she.

alleges a different or additional disabling condition than that considered by SSA in making its determination. Or alleges less than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated, alleges a new period of disability which meets the duration requirement, and SSA has refused to reopen or reconsider the allegations, or the individual is now ineligible for SSA benefits for a non-medical reason. Or alleges more than 12 months after the most recent unfavorable SSA disability determination that his/her condition has changed or deteriorated since the SSA determination and alleges a new period of disability which meets the duration requirement, and has not applied to SSA regarding these allegations. See GIS 10-MA-014 and 08 OHIP/INF-03.[4] [1] Potential wrinkle – for some clients Medicaid is not automatically pick up cost-sharing. In Monroe County we have had several cases where SSA began deducting Medicare Part B premiums from the checks of clients who were receiving SSI and Medicaid and then qualified for Medicare.

The process should be automatic. Please contact Geoffrey Hale in our Rochester office if you encounter any cases like this. [2]Under terms established to provide benefits for QMBs, a provider agreement necessary for reimbursement “may be executed through the submission of a claim to the Medicaid agency requesting Medicaid payment for Medicare deductibles and coinsurance for QMBs.” CMS State Medicaid Manual, Chapter 3, Eligibility, 3490.14 (b), available at. http://www.cms.hhs.gov/Manuals/PBM/itemdetail.asp?. ItemID=CMS021927.

[3]Benchmark plans are free if you are an LIS recipient. The amount of the benchmark changes from year to year. In 2013, a Part D plan in New York State is considered benchmark if it provides basic Part D coverage and its monthly premium is $43.22 or less. [4] These citations courtesy of Jim Murphy at Legal Services of Central New York. This site provides general information only.

This is not legal advice. You can only obtain legal advice from a lawyer. In addition, your use of this site does not create an attorney-client relationship. To contact a lawyer, visit http://lawhelp.org/ny. We make every effort to keep these materials and links up-to-date and in accordance with New York City, New York state and federal law.

However, we do not guarantee the accuracy of this information.Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $148.50 in 2021. MIPP is for some groups who are either not eligible for -- or who are not yet enrolled in-- the Medicare Savings Program (MSP), which is the main program that pays the Medicare Part B premium for low-income people. Some people are not eligible for an MSP even though they have full Medicaid with no spend down. This is because they are in a special Medicaid eligibility category -- discussed below -- with Medicaid income limits that are actually HIGHER than the MSP income limits.

MIPP reimburses them for their Part B premium because they have “full Medicaid” (no spend down) but are ineligible for MSP because their income is above the MSP SLIMB level (120% of the Federal Poverty Level (FPL). Even if their income is under the QI-1 MSP level (135% FPL), someone cannot have both QI-1 and Medicaid). Instead, these consumers can have their Part B premium reimbursed through the MIPP program. In this article. The MIPP program was established because the State determined that those who have full Medicaid and Medicare Part B should be reimbursed for their Part B premium, even if they do not qualify for MSP, because Medicare is considered cost effective third party health insurance, and because consumers must enroll in Medicare as a condition of eligibility for Medicaid (See 89 ADM 7).

There are generally four groups of dual-eligible consumers that are eligible for MIPP. Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down. Those consumers can qualify for MIPP and have their Part B premiums reimbursed. Here is an example. Sam is age 50 and has Medicare and MBI-WPD.

She gets $1500/mo gross from Social Security Disability and also makes $400/month through work activity. $ 167.50 -- EARNED INCOME - Because she is disabled, the DAB earned income disregard applies. $400 - $65 = $335. Her countable earned income is 1/2 of $335 = $167.50 + $1500.00 -- UNEARNED INCOME from Social Security Disability = $1,667.50 --TOTAL income. This is above the SLIMB limit of $1,288 (2021) but she can still qualify for MIPP.

2. Parent/Caretaker Relatives with MAGI-like Budgeting - Including Medicare Beneficiaries. Consumers who fall into the DAB category (Age 65+/Disabled/Blind) and would otherwise be budgeted with non-MAGI rules can opt to use Affordable Care Act MAGI rules if they are the parent/caretaker of a child under age 18 or under age 19 and in school full time. This is referred to as “MAGI-like budgeting.” Under MAGI rules income can be up to 138% of the FPL—again, higher than the limit for DAB budgeting, which is equivalent to only 83% FPL. MAGI-like consumers can be enrolled in either MSP or MIPP, depending on if their income is higher or lower than 120% of the FPL.

If their income is under 120% FPL, they are eligible for MSP as a SLIMB. If income is above 120% FPL, then they can enroll in MIPP. (See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4) When a consumer has Medicaid through the New York State of Health (NYSoH) Marketplace and then enrolls in Medicare when she turns age 65 or because she received Social Security Disability for 24 months, her Medicaid case is normally** transferred to the local department of social services (LDSS)(HRA in NYC) to be rebudgeted under non-MAGI budgeting. During the transition process, she should be reimbursed for the Part B premiums via MIPP. However, the transition time can vary based on age.

AGE 65+ Those who enroll in Medicare at age 65+ will receive a letter from their local district asking them to "renew" Medicaid through their local district. See 2014 LCM-02. The Medicaid case takes about four months to be rebudgeted and approved by the LDSS. The consumer is entitled to MIPP payments for at least three months during the transition. Once the case is with the LDSS she should automatically be re-evaluated for MSP, even if the LDSS determines the consumer is not eligible for Medicaid because of excess income or assets.

08 OHIP/ADM-4. Consumers UNDER 65 who receive Medicare due to disability status are entitled to keep MAGI Medicaid through NYSoH for up to 12 months (also known as continuous coverage, See NY Social Services Law 366, subd. 4(c). These consumers should receive MIPP payments for as long as their cases remain with NYSoH and throughout the transition to the LDSS. NOTE during erectile dysfunction treatment emergency their case may remain with NYSoH for more than 12 months.

See here. EXAMPLE. Sam, age 60, was last authorized for Medicaid on the Marketplace in June 2020. He became enrolled in Medicare based on disability in August 2020, and started receiving Social Security in the same month (he won a hearing approving Social Security disability benefits retroactively, after first being denied disability). Even though his Social Security is too high, he can keep Medicaid for 12 months beginning June 2020.

Sam has to pay for his Part B premium - it is deducted from his Social Security check. He may call the Marketplace and request a refund. This will continue until the end of his 12 months of continuous MAGI Medicaid eligibility. He will be reimbursed regardless of whether he is in a Medicaid managed care plan. See GIS 18 MA/001 Medicaid Managed Care Transition for Enrollees Gaining Medicare (PDF) When that ends, he will renew Medicaid and apply for MSP with his local district.

See GIS 18 MA/001 - 2018 Medicaid Managed Care Transition for Enrollees Gaining Medicare, #4 for an explanation of this process. That directive also clarified that reimbursement of the Part B premium will be made regardless of whether the individual is still in a Medicaid managed care (MMC) plan. Note. During the erectile dysfunction treatment emergency, those who have Medicaid through the NYSOH marketplace and enroll in Medicare should NOT have their cases transitioned to the LDSS. They should keep the same MAGI budgeting and automatically receive MIPP payments.

See GIS 20 MA/04 or this article on erectile dysfunction treatment eligibility changes 4. Those with Special Budgeting after Losing SSI (DAC, Pickle, 1619b) Disabled Adult Child (DAC). Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child (DAC) benefits (or receive an increase in the amount of their benefit). Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN.

See this article. Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums. See page 96 of the Medicaid Reference Guide (Categorical Factors). If their income is lower than the MSP SLIMB threshold, they can be added to MSP.

If higher than the threshold, they can be reimbursed via MIPP. See also 95-ADM-11. Medical Assistance Eligibility for Disabled Adult Children, Section C (pg 8). Pickle &. 1619B.

5. When the Part B Premium Reduces Countable Income to Below the Medicaid Limit Since the Part B premium can be used as a deduction from gross income, it may reduce someone's countable income to below the Medicaid limit. The consumer should be paid the difference to bring her up to the Medicaid level ($904/month in 2021). They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium. See GIS 02-MA-019.

Reimbursement of Health Insurance Premiums MIPP and MSP are similar in that they both pay for the Medicare Part B premium, but there are some key differences. MIPP structures the payments as reimbursement -- beneficiaries must continue to pay their premium (via a monthly deduction from their Social Security check or quarterly billing, if they do not receive Social Security) and then are reimbursed via check. In contrast, MSP enrollees are not charged for their premium. Their Social Security check usually increases because the Part B premium is no longer withheld from their check. MIPP only provides reimbursement for Part B.

It does not have any of the other benefits MSPs can provide, such as. A consumer cannot have MIPP without also having Medicaid, whereas MSP enrollees can have MSP only. Of the above benefits, Medicaid also provides Part D Extra Help automatic eligibility. There is no application process for MIPP because consumers should be screened and enrolled automatically (00 OMM/ADM-7). Either the state or the LDSS is responsible for screening &.

Distributing MIPP payments, depending on where the Medicaid case is held and administered (14 /2014 LCM-02 Section V). If a consumer is eligible for MIPP and is not receiving it, they should contact whichever agency holds their case and request enrollment. Unfortunately, since there is no formal process for applying, it may require some advocacy. If Medicaid case is at New York State of Health they should call 1-855-355-5777. Consumers will likely have to ask for a supervisor in order to find someone familiar with MIPP.

If Medicaid case is with HRA in New York City, they should email mipp@hra.nyc.gov. If Medicaid case is with other local districts in NYS, call your local county DSS. See more here about consumers who have Medicaid on NYSofHealth who then enroll in Medicare - how they access MIPP. Once enrolled, it make take a few months for payments to begin. Payments will be made in the form of checks from the Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid program.

The check itself comes attached to a remittance notice from Medicaid Management Information Systems (MMIS). Unfortunately, the notice is not consumer-friendly and may be confusing. See attached sample for what to look for. Health Insurance Premium Payment Program (HIPP) HIPP is a sister program to MIPP and will reimburse consumers for private third party health insurance when deemed “cost effective.” Directives:.

Levitra response time

Nightmares that occurred twice a week or more were linked with cardiovascular disease in relatively young military veterans, even after controlling for post-traumatic stress disorder (PTSD), a cross-sectional study showed.Frequent distressing dreams were associated with hypertension (OR 1.51, 95% CI 1.28-1.78), heart problems (OR 1.50, 95% CI 1.11-2.02), and myocardial infarction (OR 2.32, 95% CI 1.18-4.54), after adjusting for age, race, and sex, reported Christi levitra response time Ulmer, PhD, of the Durham VA Health Services Research and Development ADAPT Center and Duke University Medical Center, both in North Carolina."After also adjusting for PTSD, depression, and current smoking, severely distressing dreams continued to be associated with heart problems, hypertension, and other heart trouble," Ulmer said in a presentation at virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Click Here Medicine (AASM) and the Sleep Research Society."Research on heart rate variability supports the likelihood of abnormal autonomic function during sleep among those with PTSD. However, we haven't taken a look at what role nightmares specifically might play in contributing to increased risk in this population," Ulmer noted."While some have suggested that the association between PTSD and cardiovascular disease is solely due to poor health behaviors among those with PTSD, our findings suggest an important role levitra response time for sleep and that there may be an independent role for nightmares, in particular for conferring cardiovascular disease," she said.In this analysis, Ulmer and colleagues studied 3,468 U.S. Military veterans with an average levitra response time age of 38 who served since Sept.

11, 2001 levitra response time. The majority (73.5%) had one or two tours of levitra response time duty and most (77.4%) were men. Most (65.0%) had moderate-to-heavy combat exposure.The researchers assessed nightmare frequency and severity with the Davidson Trauma levitra response time Scale.

Nightmares were classified as frequent if they occurred two or more times per week and moderate-to-severe if levitra response time they were at least moderately distressing. Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study questionnaire and levitra response time other measures. Diagnoses of PTSD and depression were established through structured clinical interviews.About a third of veterans in the study reported nightmares in the past week, levitra response time and 41% had poor sleep quality scores as measured by the Pittsburgh Sleep Quality Index.

In total, 31% of the veterans met criteria for current PTSD and 32.7% reported at least one cardiovascular condition.Diagnosed depression was more common in the PTSD group levitra response time. Veterans with PTSD served more tours of duty, had greater combat exposure, poorer sleep quality, and more frequent and more severe distressing dreams.After controlling for depression, PTSD, and current smoking, risks for hypertension (OR 1.43, 95% 1.17-1.73) and heart problems (OR 1.43, 95% CI 1.00-2.05) persisted among veterans with frequent levitra response time nightmares.The findings set the stage for future research examining the possibility that nightmares may confer cardiovascular disease risks beyond those conferred by PTSD diagnosis alone, Ulmer noted."If longitudinal research demonstrates a causal role for nightmares in cardiovascular disease risk, nightmare treatment could be a strategy for improving cardiovascular health," she said. Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, levitra response time Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more.

Follow Disclosures The study was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System.In chronic kidney disease (CKD), dapagliflozin (Farxiga) reduced renal events and substantially improved overall survival, regardless of diabetes status, the DAPA-CKD trial showed.The SGLT2 drug reduced by a relative 39% the primary endpoint of worsening kidney function (more than 50% sustained decline in estimated glomerular filtration rate [eGFR] or onset of end-stage kidney disease) or death due to kidney disease or cardiovascular disease (312 vs 197 events at a median 2.4 years, HR 0.61, 95% CI 0.51-0.72).The number needed to treat to prevent one such event was just 19, reported Hiddo Heerspink, PharmD, PhD, of the University Medical Center Groningen, the Netherlands, at the European Society of Cardiology virtual meeting.The effect was significant for those with type 2 diabetes and without it (HR 0.64 and 0.50, P=0.24 for interaction).Most notable among the secondary endpoints was the 31% relative reduction in all-cause mortality (P=0.0035, with 101 vs 146 events with placebo).Clinical Implications"For nephrologists who are struggling with the epidemic of kidney disease and the few options available to treat its progression effectively, the possibility of this new effective treatment is cause to celebrate," commented Ladan Golestaneh MD, a nephrologist at Montefiore Medical Center in New York City, predicting changes to the CKD care guidelines.Until recently, ACE inhibitors and angiotensin receptor blockers (ARBs) were the only medications specifically proven to slow CKD progression, Heerspink noted at the ESC hot-line session.But the effect size with dapagliflozin was higher than seen with levitra response time the ACE/ARB drugs versus placebo in patients with and without type 2 diabetes for composite CKD events, noted Holly Kramer, MD, president of the National Kidney Foundation.It was larger than the relative effects of lower blood pressure targets on composite CKD outcomes in adults with and without type 2 diabetes, she pointed out. The trial "greatly increases the impact these drugs will have on reducing end-stage levitra response time renal disease," she told MedPage Today.Golestaneh noted that SGLT2 inhibitors have already been increasingly used in nephrologist clinic practice as a means to decrease the progression of diabetic nephropathy and predicted that the demonstration of efficacy in non-diabetic kidney disease would drive that higher.For cardiologists, too, "it's really exciting," even if not surprising, commented Milton Packer, MD, of the Baylor Heart and Vascular Institute in Dallas, who presented at the conference positive findings in heart failure with reduced ejection fraction with fellow SGLT2 inhibitor empagliflozin (Jardiance), including benefits for renal endpoints."We know that SGLT2 inhibitors protect the heart and the kidney," he said. "In many ways, chronic kidney disease trials are in parallel to chronic heart failure trials, because SGLT2 inhibitors benefit both organs."ESC session moderator Frank Ruschitzka, MD, of the Heart Center at University Hospital Zurich, agreed, calling DAPA-CKD fantastic."We are thinking as cardiologists probably too much into boxes, compartmentalization," he levitra response time said.

"Maybe we need a more levitra response time holistic view... They're certainly not just glucose-lowering drugs levitra response time. They're not just only levitra response time diuretics.

Maybe we should just move to organ protection."Trial DetailsThe trial included 4,304 adults with CKD (eGFR 25 to 75 mL/min/1.73 m2 and urine albumin to creatinine ratio of 200 to 5,000 mg/g), levitra response time about 67% of whom had type 2 diabetes, and all on a maximally-tolerated dose of an ACE inhibitor or ARB. They were randomized to 10 mg dapagliflozin levitra response time once daily or matching placebo. People with type 1 diabetes were excluded.The trial was stopped early for efficacy after a median follow-up of 2.4 years with 60% of the planned events.Dapagliflozin also significantly improved each component of the primary composite (with the exception of a nonsignificant trend for cardiovascular death) as well as secondary composite outcomes:44% lower risk of worsening renal function or renal death34% lower risk of chronic dialysis, kidney transplantation, or renal levitra response time death29% lower risk of CV death or heart failure hospitalizationNo cases of diabetic ketoacidosis occurred in the dapagliflozin group.

Serious adverse levitra response time events were actually numerically less common with the drug, which Heerspink said was in keeping with dapagliflozin's established safety profile.The Future for SGLT2 InhibitorsPacker noted that a similar CKD trial is underway with empagliflozin (EMPA-KIDNEY, with data expected in 2022) in a population with and without diabetes. The drug has FDA fast track designation for an indication in that regard levitra response time. The CREDENCE trial previously showed that SGLT2 inhibitor canagliflozin (Invokana) improved outcomes in CKD patients with type 2 diabetes."The thing really amazing about SGLT2 inhibitors is that it's not like our evidence is one or two trials -- levitra response time it's going to be like nine or 10 large scale trials, which is extraordinary," Packer said.

"For most classes of drugs, we don't have that levitra response time kind of evidence base. ... Physicians have to start using SGLT2 inhibitors across the board for these patients.

It's not only the consistency of these results, it's the magnitude."And with multiple agents in the class proving their chops for organ protection, "it's going to be very hard for insurers to say no to drugs like this," commented Dipti Itchhaporia, MD, vice president of the American College of Cardiology. "The more data, the easier it is for us to get these covered.""Patients balk at the idea of all these additional drugs and the cost of all these drugs," she acknowledged, noting that SGLT2 inhibitors are looking to be the fourth cornerstone of heart failure therapy. "But if you make the case, and you explain to them why they need to take these drugs, they usually are amenable.

When you say you're going to live longer, feel better, you're not going to come into the hospital as much, it's hard to argue against that." Disclosures Heerspink disclosed relevant relationships with AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Chinook, CSL Pharma, Gilead, Janssen, Merck, Mundipharma, Mitsubishi Tanabe, Novo Nordisk, and Retrophin.Golestaneh disclosed relevant relationships with Horizon Pharmaceuticals and being a member of the clinical events committee for trials sponsored by Medtronic..

Nightmares that occurred twice a week or more were linked with cardiovascular disease in relatively young military veterans, even after controlling for post-traumatic stress disorder (PTSD), a cross-sectional study Buy cialis online no prescription showed.Frequent distressing dreams were associated with hypertension (OR 1.51, 95% CI 1.28-1.78), heart problems (OR 1.50, 95% CI 1.11-2.02), and myocardial infarction (OR 2.32, 95% CI 1.18-4.54), after adjusting for age, race, and sex, reported Christi Ulmer, PhD, of the Durham VA Health Services Research and Development ADAPT Center and Duke University Medical Center, both in North Carolina."After also adjusting for PTSD, depression, and current smoking, severely distressing dreams continued to be associated with buy levitra without a prescription heart problems, hypertension, and other heart trouble," Ulmer said in a presentation at virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society."Research on heart rate variability supports the likelihood of abnormal autonomic function during sleep among those with PTSD. However, we haven't taken a look at what role nightmares specifically might play in contributing to increased risk in buy levitra without a prescription this population," Ulmer noted."While some have suggested that the association between PTSD and cardiovascular disease is solely due to poor health behaviors among those with PTSD, our findings suggest an important role for sleep and that there may be an independent role for nightmares, in particular for conferring cardiovascular disease," she said.In this analysis, Ulmer and colleagues studied 3,468 U.S. Military veterans with an average buy levitra without a prescription age of 38 who served since Sept. 11, 2001 buy levitra without a prescription. The majority (73.5%) had one or two tours of buy levitra without a prescription duty and most (77.4%) were men.

Most (65.0%) had moderate-to-heavy combat exposure.The researchers assessed buy levitra without a prescription nightmare frequency and severity with the Davidson Trauma Scale. Nightmares were classified as frequent if they occurred buy levitra without a prescription two or more times per week and moderate-to-severe if they were at least moderately distressing. Self-reported medical issues buy levitra without a prescription were assessed using the National Vietnam Veterans Readjustment Study questionnaire and other measures. Diagnoses of PTSD and depression were established through structured clinical interviews.About a third of veterans in the study reported nightmares in the past week, and 41% had poor sleep quality scores as buy levitra without a prescription measured by the Pittsburgh Sleep Quality Index. In total, 31% of the veterans buy levitra without a prescription met criteria for current PTSD and 32.7% reported at least one cardiovascular condition.Diagnosed depression was more common in the PTSD group.

Veterans with PTSD served more tours of duty, had greater combat exposure, poorer sleep quality, and more frequent and more severe distressing dreams.After controlling for depression, PTSD, and current smoking, risks buy levitra without a prescription for hypertension (OR 1.43, 95% 1.17-1.73) and heart problems (OR 1.43, 95% CI 1.00-2.05) persisted among veterans with frequent nightmares.The findings set the stage for future research examining the possibility that nightmares may confer cardiovascular disease risks beyond those conferred by PTSD diagnosis alone, Ulmer noted."If longitudinal research demonstrates a causal role for nightmares in cardiovascular disease risk, nightmare treatment could be a strategy for improving cardiovascular health," she said. Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, buy levitra without a prescription dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow Disclosures The study was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System.In chronic kidney disease (CKD), dapagliflozin (Farxiga) reduced renal events and substantially improved overall survival, regardless of diabetes status, the DAPA-CKD trial buy levitra without a prescription showed.The SGLT2 drug reduced by a relative 39% the primary endpoint of worsening kidney function (more than 50% sustained decline in estimated glomerular filtration rate [eGFR] or onset of end-stage kidney disease) or death due to kidney disease or cardiovascular disease (312 vs 197 events at a median 2.4 years, HR 0.61, 95% CI 0.51-0.72).The number needed to treat to prevent one such event was just 19, reported Hiddo Heerspink, PharmD, PhD, of the University Medical Center Groningen, the Netherlands, at the European Society of Cardiology virtual meeting.The effect was significant for those with type 2 diabetes and without it (HR 0.64 and 0.50, P=0.24 for interaction).Most notable among the secondary endpoints was the 31% relative reduction in all-cause mortality (P=0.0035, with 101 vs 146 events with placebo).Clinical Implications"For nephrologists who are struggling with the epidemic of kidney disease and the few options available to treat its progression effectively, the possibility of this new effective treatment is cause to celebrate," commented Ladan Golestaneh MD, a nephrologist at Montefiore Medical Center in New York City, predicting changes to the CKD care guidelines.Until recently, ACE inhibitors and angiotensin receptor blockers (ARBs) were the only medications specifically proven to slow CKD progression, Heerspink noted at the ESC hot-line session.But the effect size with dapagliflozin was higher than seen with the ACE/ARB drugs versus placebo in patients with and without type 2 diabetes for composite CKD events, noted Holly Kramer, MD, president of the National Kidney Foundation.It was larger than the relative effects of lower blood pressure targets on composite CKD outcomes in adults with and without type 2 diabetes, she pointed out. The trial "greatly increases the impact these drugs will have on reducing end-stage renal disease," she told MedPage Today.Golestaneh noted that SGLT2 inhibitors have already been increasingly used in nephrologist clinic practice as a means to decrease the progression of diabetic nephropathy and predicted that the demonstration of efficacy in non-diabetic kidney disease would drive that higher.For cardiologists, too, "it's really exciting," even if not surprising, commented Milton Packer, MD, of the Baylor Heart and Vascular Institute in Dallas, who presented at the conference positive findings in heart failure with reduced ejection fraction with fellow SGLT2 inhibitor empagliflozin (Jardiance), including benefits buy levitra without a prescription for renal endpoints."We know that SGLT2 inhibitors protect the heart and the kidney," he said. "In many ways, chronic kidney buy levitra without a prescription disease trials are in parallel to chronic heart failure trials, because SGLT2 inhibitors benefit both organs."ESC session moderator Frank Ruschitzka, MD, of the Heart Center at University Hospital Zurich, agreed, calling DAPA-CKD fantastic."We are thinking as cardiologists probably too much into boxes, compartmentalization," he said.

"Maybe we need a more holistic buy levitra without a prescription view... They're certainly buy levitra without a prescription not just glucose-lowering drugs. They're not buy levitra without a prescription just only diuretics. Maybe we should just move to organ protection."Trial DetailsThe trial included 4,304 adults with CKD (eGFR 25 buy levitra without a prescription to 75 mL/min/1.73 m2 and urine albumin to creatinine ratio of 200 to 5,000 mg/g), about 67% of whom had type 2 diabetes, and all on a maximally-tolerated dose of an ACE inhibitor or ARB. They were randomized to 10 mg dapagliflozin once daily buy levitra without a prescription or matching placebo.

People with type 1 diabetes were excluded.The trial was stopped early for efficacy after a median follow-up of 2.4 years with 60% of the planned events.Dapagliflozin also significantly improved each component of the primary composite (with the exception of a nonsignificant trend for cardiovascular death) as well as secondary composite outcomes:44% lower risk of worsening renal function or renal death34% lower risk of chronic dialysis, kidney buy levitra without a prescription transplantation, or renal death29% lower risk of CV death or heart failure hospitalizationNo cases of diabetic ketoacidosis occurred in the dapagliflozin group. Serious adverse events were actually numerically less common with the drug, which Heerspink said was in keeping with dapagliflozin's established safety profile.The Future for SGLT2 InhibitorsPacker noted that a similar CKD trial is underway with empagliflozin (EMPA-KIDNEY, with data expected in 2022) in a population buy levitra without a prescription with and without diabetes. The drug buy levitra without a prescription has FDA fast track designation for an indication in that regard. The CREDENCE trial previously buy levitra without a prescription showed that SGLT2 inhibitor canagliflozin (Invokana) improved outcomes in CKD patients with type 2 diabetes."The thing really amazing about SGLT2 inhibitors is that it's not like our evidence is one or two trials -- it's going to be like nine or 10 large scale trials, which is extraordinary," Packer said. "For most classes of buy levitra without a prescription drugs, we don't have that kind of evidence base.

... Physicians have to start using SGLT2 inhibitors across the board for these patients. It's not only the consistency of these results, it's the magnitude."And with multiple agents in the class proving their chops for organ protection, "it's going to be very hard for insurers to say no to drugs like this," commented Dipti Itchhaporia, MD, vice president of the American College of Cardiology. "The more data, the easier it is for us to get these covered.""Patients balk at the idea of all these additional drugs and the cost of all these drugs," she acknowledged, noting that SGLT2 inhibitors are looking to be the fourth cornerstone of heart failure therapy. "But if you make the case, and you explain to them why they need to take these drugs, they usually are amenable.

When you say you're going to live longer, feel better, you're not going to come into the hospital as much, it's hard to argue against that." Disclosures Heerspink disclosed relevant relationships with AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Chinook, CSL Pharma, Gilead, Janssen, Merck, Mundipharma, Mitsubishi Tanabe, Novo Nordisk, and Retrophin.Golestaneh disclosed relevant relationships with Horizon Pharmaceuticals and being a member of the clinical events committee for trials sponsored by Medtronic..

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