LOVE LIBRARY

Can i buy diflucan at walgreens

SALT LAKE can i buy diflucan at walgreens when diflucan doesnt work CITY, Aug. 12, 2021 can i buy diflucan at walgreens /PRNewswire/ -- Health Catalyst, Inc. ("Health Catalyst," Nasdaq. HCAT), a leading provider of data can i buy diflucan at walgreens and analytics technology and services to healthcare organizations, today announced an expansive, multi-year partnership with Oklahoma Heart Hospital (OHH), one of the largest cardiovascular networks in the United States. Initially, Health Catalyst and OHH will work to accelerate the organization's efforts to improve revenue cycle analytics and performance, drive transparency on the cost of care, and empower clinicians with the right data to inform their patient care delivery processes.

In support of OHH's commitment to keeping patient care at the heart of everything they do, the partnership will also focus on OHH's future operational and clinical improvement can i buy diflucan at walgreens projects. "We are excited to partner with Health Catalyst to help transform OHH's analytics capability," said Tracy Enloe, CFO of Oklahoma Heart Hospital. "We are confident that the combination of OHH's commitment to world-class patient care and Health Catalyst's extensive data and analytics experience will ensure OHH is positioned for continued success as the healthcare landscape continues to evolve." To support this transformational work, can i buy diflucan at walgreens OHH has selected Health Catalyst's Data Operating System (DOSâ¢) platform and DOSâ¢ Marts. Built on the DOS platform that combines the features of data warehousing, clinical data repositories, and health information exchanges, DOS Marts provide a curated, reusable, customizable layer of data content, logic, and algorithms, and are designed to address many analytic scenarios. The comprehensive solution includes access to the Health Catalyst CORUSâ¢ (Clinical Operations Resource Utilization System) Suite and Revenue Cycle Advisor, giving OHH a comprehensive view of the true cost of patient care and empowering financial decision-makers and analysts with the ability to quickly identify trends and variances, create standard and ad hoc reports, and address root causes of performance issues."We are honored to partner with Oklahoma Heart Hospital, one of the nation's leading cardiovascular networks, on their can i buy diflucan at walgreens continued journey to clinical and financial success," said Dan Burton, CEO of Health Catalyst.

"We believe our Solution, combined with OHH's team members' commitment to quality and improvement, will yield massive, measurable healthcare transformation."About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platformâpowered by data from more than 100 million patient records and encompassing trillions can i buy diflucan at walgreens of factsâas well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed.Media Contact:Amanda Hundtamanda.hundt@healthcatalyst.com575-491-0974 View original content to download multimedia:https://www.prnewswire.com/news-releases/health-catalyst-oklahoma-heart-hospital-team-up-to-accelerate-cost-management-transformation-and-improved-patient-outcomes-301353072.htmlSOURCE Health Catalyst.

Diflucan candida

	Diflucan	Grifulvin	Micogel	Nizoral	Lotrisone	Mentax
Best price for generic	50mg 60 tablet $104.95	250mg 180 tablet $129.80	2% 15g 3 tube $199.95	200mg 180 tablet $399.95	0.05% + 1% 10g 3 cream $79.95	1% 15g 3 cream $32.95
Does work at first time	Canadian Pharmacy	At cvs	Canadian Pharmacy	Online Pharmacy	At walgreens	Indian Pharmacy
Cheapest price	100mg 180 tablet $407.00	250mg 360 tablet $243.50	2% 15g 1 tube $71.95	200mg 90 tablet $219.95	0.05% + 1% 10g 3 cream $79.95	1% 15g 4 cream $38.95
Buy with american express	100mg	250mg	2% 15g	200mg	0.025% + 1% 15g	1% 15g
UK pharmacy price	No	Yes	No	Yes	Online	Online

As I write todayâs brief introduction Generic propecia cost to our March issue, I am acutely aware that 1âyear ago in March, we shut diflucan candida down for the first time due to the antifungal medication diflucan. As a historian of medicine, I have always understood that the progression from epidemic to control is long and fraught, and that we still have much to do before we reach normative social interactions pre-diflucan. Then again, in many ways, there can be no return to âbeforeâ. We live, now, exclusively in the âafterâ.The diflucan has stripped away comfortable illusions, has exposed how â¦.

As I write todayâs Look At This brief introduction to our March issue, I am acutely aware that 1âyear ago in March, we shut down for the first time due to can i buy diflucan at walgreens the antifungal medication diflucan. As a historian of medicine, I have always understood that the progression from epidemic to control is long and fraught, and that we still have much to do before we reach normative social interactions pre-diflucan. Then again, in many ways, there can be no return to âbeforeâ. We live, now, exclusively in the âafterâ.The diflucan has stripped away comfortable illusions, has exposed how â¦.

What side effects may I notice from Diflucan?

Side effects that you should report to your doctor or health care professional as soon as possible:

allergic reactions like skin rash or itching, hives, swelling of the lips, mouth, tongue, or throat
dark urine
feeling dizzy or faint
irregular heartbeat or chest pain
redness, blistering, peeling or loosening of the skin, including inside the mouth
trouble breathing
unusual bruising or bleeding
vomiting
yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

changes in how food tastes
diarrhea
headache
stomach upset or nausea

This list may not describe all possible side effects.

How long does diflucan work

For around 3,000 years, people have sought out bee venom for its numerous health benefits how long does diflucan work when coupled with acupuncture, or even from a learn this here now purposeful sting. While it may sound like a nightmare for some (particularly those with allergies), evidence increasingly suggests that a range of bee-derived substances can help address medical conditions that lack highly effective treatments.Intentional bee stings can of course come with some significant hazards like anaphylaxis and even death. Thatâs why how long does diflucan work researchers are taking the sting out of the equation by isolating the most important components in bee products as they search for innovative drugs.Bees As Pharmacists Bee venom contains several ingredients with pharmaceutical potential.

These include melittin, a peptide found in the European honey beeâs venom that has attracted scientistsâ attention since the 1950s. Itâs now believed to confer a host of benefits, including how long does diflucan work immune system regulation and anti-inflammatory, antimicrobial and antiviral properties. For these reasons, melittin may be useful in tackling diseases like cancer, antifungal medication and Lyme, along with s like HIV.But labs have struggled to conceive drug delivery methods over the past two decades because melittin quickly degrades in blood and is difficult to target toward specific cells.

A pioneering breakthrough may come from chemist and bioengineer Dipanjan Pan, who is currently looking into a melittin-based cancer therapy with his lab at the University of Maryland, Baltimore County.Amid calls for safer, more successful cancer treatments, Pan inspected toad, scorpion and bee venom for answers. ÂThe philosophy of my research how long does diflucan work is biomimetics, or bringing inspiration from Mother Nature,â he says. These animal poisons include toxins like melittin, which is considered a host defense peptide.

Most multicellular how long does diflucan work organisms have these peptides to ward off disease, including humans, but only some creatures weaponize them in the form of powerful venom. Funnily enough, this toxin could end up saving human lives. And it isnât particularly difficult to create synthetic melittin in a lab, Pan says, which is optimal for drug development due to its convenience, quality control, and relative safety compared to crude natural sources.

The real challenge how long does diflucan work. Designing an effective delivery method that squashes cancer growth but leaves surrounding cells healthy. Chemotherapy, for example, commonly causes patients to lose their hair because it damages follicles in the process how long does diflucan work.

ÂThat has been the key bottleneck in targeted [cancer] therapy,â he adds. ÂIt boils down how long does diflucan work to. How can we make these venom peptides more selective and targeted to the cancer cell?.

Itâs like finding a needle in a haystack.âPan's former lab at the University of Illinois made headlines in 2014 after injecting melittin into nanoparticles that can attach to cancer cells. This method may be how long does diflucan work particularly beneficial in stomping out lingering cells that resist chemotherapy, the team proposed. Panâs latest research, which was published in 2017, revealed that peptides like melittin could work by interfering with the DNA transcription thatâs associated with cancer spread.

Another promising how long does diflucan work bee venom component. An enzyme called phospholipase A2, or PLA2, which is also found in venoms from animals, including snakes. Like melittin, these enzymes have also been shown to exhibit anti-cancer properties.

Even more, PLA2 could mitigate Parkinsonâs disease how long does diflucan work by reducing brain inflammation. Still, this evidence largely comes from studies on mice.It isnât yet clear how exactly phospholipase A2, or other components of bee venom, could tackle neurodegenerative conditions. The proposed mechanisms are how long does diflucan work largely speculation, says E.

Paul Cherniack, a geriatrician and internal medicine professor at the University of Arizona who has written reviews on bee venom acupuncture and other crawly crittersâ medicinal potential.Itâs also possible that melittin and PLA2 could work synergistically to treat conditions like cancer and bacterial s, which could explain bee venomâs broader impacts.The Pros of Propolis and HoneyPropolis, another practical bee product, is a resin-like mixture made by bees thatâs composed of material from tree buds and their own saliva. They use it to build hives, how long does diflucan work but humans have long adapted the substance for their own benefit. Hippocrates may have applied it to wounds and ulcers, and it was listed as an official drug in 17th-century Britain.

During World War II, Soviet clinics used propolis to treat tuberculosis. Nowadays, you can find propolis incorporated into products like lotion, shampoo, ointment and toothpaste how long does diflucan work. Researchers are now looking to define propolisâ drug potential via cell, animal and, increasingly, human studies.

It may strengthen the immune system and could fight damage from hazards like how long does diflucan work free radicals. After all, research indicates bees that produce higher amounts of propolis lead healthier, relatively longer lives.Relatively small human trials have suggested that standardized doses of propolis are safe and could help alleviate ailments like diabetes, respiratory tract s, asthma and chronic kidney disease. Of course, larger studies are needed to confirm these results.Chemical compounds within propolis called polyphenols, which are naturally found in plants and therefore various foods and drinks (including wine), may explain some of these advantages.

ÂSome of these polyphenols have been studied for a whole host of things, like treatments of various kinds of cancer and even to [slow] the how long does diflucan work aging process itself,â Cherniack says. ÂPolyphenols might even be useful even in affecting neurodegenerative diseases, cardiovascular diseases â¦ anything involving inflammation.âTheyâre also present in honey, a tasty food that may even play a role in protecting people from the harmful effects of radiation. Yet itâs difficult to discern how exactly the human body processes polyphenols, which limits scientistsâ ability to develop drugs how long does diflucan work harnessing them specifically.

It could therefore help to focus on administering propolis in controlled doses. Pollinating the Medical FieldDespite the wide range of possible bee-derived treatments, weâre still far from an embrace by mainstream medicine. For one, researchers how long does diflucan work like Pan are still formulating how to safely and effectively utilize agents like melittin.

In the case of cancer treatment, the goal is to design the nanoparticles containing melittin to activate only when they reach the cells of concern, Pan says. To complicate things, the body how long does diflucan work will likely try to reject these foreign objects â an issue heâs currently trying to work around.Some teams have looked into gene therapy, which would introduce genes into peopleâs bodies that are coded to deliver melittin to cancer cells. Others have considered giving patients IV doses of melittin engineered to bind with these cells.Yet the drug development process can take nearly two decades, Pan notes, when you factor in the numerous phases before possible FDA approval.

The entire venture can cost hundreds of millions of dollars (sometimes in the billion range), and cancer research has struggled for funding amid federal spending cuts and diflucan-driven financial shortfalls.Pan has encountered skeptical study reviewers who wince at the mention of bee venom, despite the use of isolated peptides that donât carry the how long does diflucan work same dangers as the real thing. Still, he says, the evidence speaks for itself. ÂThey have been proven, pre-clinically at least, with a strong efficacy,â he says.

ÂThese are tremendous results, but we do struggle getting funding for this kind of research.âIn 1968, researchers from the Royal College of General Practitioners began tracking approximately 46,000 women in the United Kingdom â half of how long does diflucan work whom actively used the birth control pill and half of whom had never used it. Follow-up reports on the study, one of the worldâs largest continuing explorations into the health effects of hormonal contraception, suggested that pill users have a significantly lower rate of death from cancers and other diseases but a higher rate of death from something surprising. Violence.The longer theyâd been on how long does diflucan work the pill, the more likely this fate became.

Those whoâd been on the pill for more than eight years had an increased risk of 116 percent. Itâs a small finding, but significant enough that chance couldnât explain it.According to the United Nations Department of Economic and Social Affairs, approximately 151 million women worldwide used the pill as a method of contraception in 2019. Despite this, thereâs still a lot we donât know how long does diflucan work about it.

As new data is collected, Philip Hannaford, corresponding author of the study and a professor emeritus of primary care at the University of Aberdeen in Scotland, continues to see the same violent death statistics. He just canât explain why.Partner PreferencesBecause intimate partner violence accounts for more than a third of women murdered in the United States, a new review published in the journal Frontiers in Behavioral Neuroscience argues that many of these violent deaths likely occurred at the hands of romantic partners.Lisa Welling, an associate professor of psychology at Oakland University, studies how long does diflucan work the influence of hormones on behavior. Sheâs found that contraceptive pill users tend to use more tactics to keep their relationship afloat â as do their partners.

ÂJealousy is a normal reaction people have in response to a potential or perceived threat how long does diflucan work to their relationship,â she says. ÂItâs an early warning system so we can take steps to correct issues before a break-up."One way jealousy can be expressed is through mate-retention behaviors, which are any behaviors that might be engaged to keep a partner from straying. This can include buying a partner a gift or complementing them, Welling says, but it can also mean violence.She agrees that the pill could be influencing whom women chose as their romantic partners.

However, she doubts that hormonal changes are to blame for the relationship between how long does diflucan work the pill and violent deaths. For one, research shows that pill-users prefer less masculine men, who studies have found are less likely to be perpetrators of violent crime. ÂWomen prefer more masculine males when theyâre fertile, but the contraceptive pill keeps a steady dose of hormones how long does diflucan work that mimics the phase when theyâre already ovulated," Welling says.

"So you donât tend to see fluctuations in hormones across the cycle, and therefore you donât see the same subtle changes in preferences.âCorrelation or Causation?. Another possible explanation is that people tend to have more jealous reactions when their estrogen levels are higher, a hormone that the combined pill (the most commonly prescribed pill) contains along with progesterone. ÂSome say [adding in estrogen] more closely approximates the ratio of progesterone and estrogen of a natural menstrual cycle,â Welling says, âbut really, itâs added in how long does diflucan work to help deal with the pillâs side effects.âThese synthetic hormones have also been found to affect how satisfied users are with their relationship.

A 2014 study showed that people might see a change in their relationship dynamics and a drop in satisfaction if they go off the pill, or start it during a relationship, Welling says â although there is limited support for this theory. While some argue that these hormones dangerously alter preference in a partner, most researchers how long does diflucan work agree there isnât enough evidence to draw that conclusion. Instead, there could be alternative explanations for Hannafordâs findings.For instance, a 2002 study found that women using oral contraception, on average, reported a greater number of sexual partners across their lifetimes.

Typically, Welling says, higher numbers of sexual partners encompass unattached encounters as well, referred to how long does diflucan work as casual sex. "And research backs up that women who engage in more casual sex are often more likely victims of crime,â she says, emphasizing that sheâs not blaming the victims.Hannaford agrees that alternative explanations for the association he found must be considered. Itâs more likely, for example, that the women in his study who were on the pill were in relationships, more likely to be risk-takers or accident-prone, he says.

In fact, how long does diflucan work Hannaford doesnât think weâll ever truly know if the pill causes women to pick partners who will go on to kill them, or if thereâs another reason for the correlation. ÂItâs very unlikely weâll ever know the biology enough,â he says. ÂItâs a very difficult thing to study, how long does diflucan work partly because the outcome is so rare â weâre talking about six per 100,000 women.âAnd donât expect to hear this statistic at your next doctor appointment.

While Hannaford acknowledges that itâs important for pill-users to be informed of any risks, he says the main concern he discusses with anyone contemplating the pill is venous thrombosis [caused by blood clots]. Welling agrees, adding that, although 116 percent is a significant statistical effect, itâs not significant enough for doctors to be warning their patients about until the theory is backed up by two or three more datasets.(Inside Science) â It doesn't take much to nudge people into making healthier choices at the grocery store -- just removing confectionery and other unhealthy products from checkouts and the ends of nearby aisles and placing fruit and vegetables near store entrances have a real impact on what people buy. That's the key finding from a new study published last week in the journal PLOS how long does diflucan work Medicine.

Very few people in the U.K. (and around the globe) eat enough fruit and vegetables, said Christine Vogel, a public health how long does diflucan work nutrition researcher at Southampton University, who co-authored the study. Instead of blaming consumers or the cost of fresh food, Vogel said, she is really interested in looking at the food environment -- the places where people get their food, especially supermarkets where many families buy most of what they eat.

Vogel and her colleagues focused on the food choices made by women of childbearing age. Some of their early findings showed that the food how long does diflucan work environment was important, particularly for women who had poor dietary choices. Vogel reached out to a discount supermarket chain called Iceland, which she said is quite heavily used by families who are more vulnerable economically and by younger adults who tend to have poorer quality diets.

She pitched them a plan to change the store layout how long does diflucan work slightly to encourage the purchase of healthy food.In the study, the chain removed confectionery items from the checkouts and from the ends of the aisles near the checkout areas in three stores for six months each. Instead, they stocked those areas with nonfood items like deodorant, water, and toothpaste and expanded the fruit and vegetable sections near the entrances of the stores. They compared how long does diflucan work the buying habits of consumers at those stores with those of consumers at stores that made no change but had similar clientele.

The study showed that increasing the range of fresh fruit and vegetables and placing them in an expanded area at the front of the store increased customer purchases of fruit and vegetables in a substantial way. The increase added up to almost 10,000 additional portions of fruit and vegetables per week per store, which Vogel said could be translated into significant improvements in population diet. The study also found there were 1,500 fewer portions of confectionery purchased each week in each store -- a significant reduction in foods high in fat, sugar or salt.The study also tracked customers that use the supermarkets regularly, how long does diflucan work analyzing loyalty card data to see what they placed in their shopping baskets.

The researchers tracked them over nine months http://freedombrass.com/fall-2016-concerts/ and found that the women -- whom the researchers focused on because they often are the ones who purchase food for a household -- who shopped at the healthier stores purchased more fruit and vegetables, and this also translated into a healthier diet when they answered surveys about what they were eating. Vogel said the findings provide some additional support how long does diflucan work for the U.K. Government's intention to ban the sale of foods high in fat, salt or sugar at the front of the store, because it will reduce the number of occasions that customers can interact with those foods.

Other interventions, like adding signage about healthy options, has a far smaller effect in studies, Vogel said. The findings from the study affirm other research suggesting that food environments matter and supermarkets how long does diflucan work can do more to encourage healthy choices without compromising the bottom line, said Allison Karpyn, who co-directs the Center for Research Education and Social Policy at the University of Delaware. "Oftentimes small changes in supermarkets such as placing products in a different part of the store, or on a different shelf, or with a larger tag, can result in significant shifts in what shoppers buy -- often without the shopper even realizing it," she said.

"And while the results might seem modest, if you multiply impacts across communities, the potential to improve public health is large." Vogel said the next steps in her research include more digging into the effect how long does diflucan work of placing nonfood items at the checkout, since that's where many impulse purchases are made. Reducing impulsive purchases, she said, "is a way to reduce the opportunity for individuals and families to have added unnecessary calories." This story was published on Inside Science. Read the original here.Around 440,000 how long does diflucan work people in the U.S.

Use a gastrostomy tube (also called a G-tube), according to 2013 data. It can replace or supplement oral feedings by delivering water, food and drugs to the stomach, where a G-tube is surgically, radiographically or endoscopically placed.I use one myself. Eating was how long does diflucan work always a chore for me because I have several disabilities from a childhood brain tumor.

Many of my recent hospital visits have been due to pneumonia. But after a lengthy stay in the ICU and months of swallow therapy, I decided to put a G-tube in because it would be safer for my lungs and conserve energy from the laborious task of eating â and it would be healthier than my past diet.Thereâs two kinds how long does diflucan work of G-tubes. One is called a âconventional tubeâ and is about six inches long.

Itâs floppy like a noodle, and is coiled and taped to the torso. Therefore, it can how long does diflucan work unfortunately build up residue and irritate skin. This type is most frequently stocked in hospitals.

Itâs used while the body forms a feeding channel between the stomach and skin how long does diflucan work. Elderly people tend to need it the most because they more often require nutritional support.This conventional model can render physical movement difficult or painful, and some health care providers assume that older people are less active. Still, people with G-tubes (regardless of age) deserve to partake in daily activities like errands and fitness classes.

The other type â a âlow-profile Mic-key tubeâ â must be ordered by a hospital and is how long does diflucan work meant for a younger, more active population. A part of the Mic-key called a âbuttonâ sticks out an inch from the stomach. The button how long does diflucan work has a hole in which an extension tube is twisted and locked into place.

Then, a syringe is connected at the other end for feeding. While most people how long does diflucan work use a G-tube for a short amount of time while recovering from an injury or experiencing a serious illness, some have it permanently implanted. Despite their advantages, these devices can endanger patients.

Due to allergy and sensitivity problems, digestive or absorption issues, or a rejection of the enteral feeding, about three in 10 individuals experience Enteral Feeding Intolerance (EFI). This can result in pneumonia and other serious how long does diflucan work complications. And the Mic-key tube needs to be replaced every six months because it may become blocked, dislodged or degraded.The G-tubeâs supply and safety issues have prompted a new approach.

Last July, Belgium-based manufacturer VIPUN and Baxter Inc., one of the countryâs biggest medical suppliers, announced a partnership to create a smart feeding tube how long does diflucan work. What will make a smart G-tube âsmartâ is its ability to measure stomach motility (or movement) for clinicians.This specialized G-tube will certainly help prevent nurses and doctors from getting liquids and medications into patientsâ lungs. Still, the claim is somewhat misleading because Baxter solely focuses on the amount of liquid in the stomach, not the content.

If a patient gets sick from one ingredient, it likely doesnât matter if their stomach is completely full or half full.With the increase of smart biotech products like Dexcom, which measures glucose levels, and Fitbitâs oxygen and heart rate monitoring, itâs fair to say the wearables market is ramping up how long does diflucan work â giants like Cardinal Health are also looking into a smart G-tube design. And while many people see the equipment's invasive nature as a disadvantage, it may actually render it the next biotechnology breakthrough.A proper smart G-tube would not have its information distorted by the skin. Hypothetically, the data could how long does diflucan work be accessed through an encrypted app like Signal, and sent to medical professionals in real time.

This technology is already life-saving, but it could be more so if the individual is unconscious or unable to communicate.Another worrying aspect of the G-tube experience is the environmental waste it creates. From formula cartons to syringes, all of the associated products should be made from biodegradable materials to decrease how long does diflucan work their toxic impact on our world. We have already witnessed how medical equipment takes its toll on the Earth.

Currently, tube extensions are made of polyurethane or silicone and need to be replaced every six months. These materials are then destined for how long does diflucan work a landfill. If a smart G-tube had an extension like a rubber straw that only required replacement once or twice every several years, we could cut down on waste.A smart G-tube may sound far-fetched, but plenty of people spend their lives with a pace-maker or Inspire device (which is used to treat sleep apnea) inside their bodies.

In 2019, the global feeding tube market was valued at $2.5 how long does diflucan work billion. That figure may grow to $4.2 billion by 2027. Numbers aside, a robust smart G-tube should be made simply because it will improve hundreds of thousands of peopleâs quality of life.

And if we can land the Perseverance rover 38 million miles away at 1,200 miles per how long does diflucan work hour, we can make a G-tube that's flush with the skin.As Earthâs climate heats up, extreme heat events will become more likely. According to a recent study, by 2100 extreme heat and humidity will affect 1.2 billion people worldwide â more than four times the number of people affected today. And those how long does diflucan work effects can be deadly.

According to the World Health Organization (WHO), more than 166,000 people died as a result of heatwaves between 1998 and 2017. Seventy thousand of those died in how long does diflucan work just one summer, during Europeâs 2003 heatwave. In the U.S.

Alone, heat kills more than 600 people each year.So yes, heat kills. But how? how long does diflucan work. Overwhelming the SystemsRemarkably, the human body operates within a very narrow range of temperatures.

That range how long does diflucan work varies a little from person to person, but not all that much. The body has clever ways of maintaining that optimal temperature range, which is why we stay at a more or less steady internal body temperature winter and summer, indoors and out. However, thereâs a limit to what the body can deal with.

Prolonged exposure to very high temperatures how long does diflucan work can throw that control system out of whack. Daniel Henning is an emergency room physician at the University of Washington Medical Center in Seattle. Heâs seen a how long does diflucan work lot of heat illness in his career, especially this summer.

He explains that when the body gets too hot, the mechanisms it has for keeping the temperature in the safety zone can get overwhelmed. When the skin gets hot, the blood vessels just underneath the skin get hot, too. That too-warm how long does diflucan work blood is circulated deeper into the bodyâs core.

This triggers the bodyâs built-in cooling system. Sweating. As sweat seeps â or sometimes pours â out of the skin, it evaporates, thus cooling the skin and the blood vessels underneath.

Your core body temperature comes back down.However, if youâre exposed to really high temperatures for a long enough time, your body may not be able to produce enough sweat to keep your body temperature under control. (This can also be exacerbated if youâre already dehydrated, which is why itâs especially important to drink plenty of water when itâs hot.)When sweating isnât enough, your body has to work even harder to cool you down. The heart beats faster, trying to get the heat thatâs built up in the core back to the surface where it can be cooled.

The kidneys have to work harder, too.When the bodyâs core temperature reaches 40Â° C (104Â° F), youâre in real trouble. At this point you have hyperthermia, sometimes called heat stroke, and the bad news just keeps coming. Your proteins and enzymes start breaking down.

Your gut can begin to leak toxins into the bloodstream, creating a kind of sepsis. The immune system can begin producing an inflammatory reaction that further damages your organs. ÂUsually,â says Henning, âby the time you've gotten to these really high temperatures, all of these things are happening simultaneously.âEven if you get into serious trouble from extreme heat, with prompt treatment you can still survive.

But without it, your odds are not good. High RiskSeveral factors increase the risk of heat stroke. Being dehydrated, being obese, having certain medical conditions (such as heart disease, diabetes, alcoholism, or opioid use disorder), taking certain medications (such as diuretics, beta blockers, and antidepressants), and drinking alcohol.Construction workers, farmers, athletes, and other people who work or play outside are also at higher risk for hyperthermia, as are young children.

However, most deaths from heat are among older people who live in homes without air conditioning, in part because older people are more likely to have one or more of the above risk factors.What should you do to stay safe during extreme heat events?. Stay inside an air-conditioned building. Drink plenty of water.

If you do have to be outside, do it early in the day, stop for frequent breaks, and donât overdo it. Sounds simple enough. But for many people those arenât options.

Poor people, who often have to work outdoors and are less likely to have access to air conditioning, are the most vulnerable.Jeremy J. Hess, Director of the Center for Health and the Global Environment at the University of Washington, is a lead author on several climate-change assessments, including the Intergovernmental Panel on Climate Change Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation. He says that as the world continues to heat up, we can expect increases in the frequency, severity, and sometimes duration of extreme heat events.

That means more people will be exposed to dangerous levels of heat. We can save lives, but to do that, we will have to take action to reduce the risks to those who are most vulnerable. ÂIn a lot of places, we're seeing these exposures increase faster than the protections,â he says.

One of the many challenges of the changing climate is how to keep the vulnerable safe from deadly heat..

For around 3,000 years, can i buy diflucan at walgreens his comment is here people have sought out bee venom for its numerous health benefits when coupled with acupuncture, or even from a purposeful sting. While it may sound like a nightmare for some (particularly those with allergies), evidence increasingly suggests that a range of bee-derived substances can help address medical conditions that lack highly effective treatments.Intentional bee stings can of course come with some significant hazards like anaphylaxis and even death. Thatâs why can i buy diflucan at walgreens researchers are taking the sting out of the equation by isolating the most important components in bee products as they search for innovative drugs.Bees As Pharmacists Bee venom contains several ingredients with pharmaceutical potential. These include melittin, a peptide found in the European honey beeâs venom that has attracted scientistsâ attention since the 1950s.

Itâs now believed to confer a can i buy diflucan at walgreens host of benefits, including immune system regulation and anti-inflammatory, antimicrobial and antiviral properties. For these reasons, melittin may be useful in tackling diseases like cancer, antifungal medication and Lyme, along with s like HIV.But labs have struggled to conceive drug delivery methods over the past two decades because melittin quickly degrades in blood and is difficult to target toward specific cells. A pioneering breakthrough may come from chemist and bioengineer Dipanjan Pan, who is currently looking into a melittin-based cancer therapy with his lab at the University of Maryland, Baltimore County.Amid calls for safer, more successful cancer treatments, Pan inspected toad, scorpion and bee venom for answers. ÂThe philosophy of my research is biomimetics, or bringing inspiration can i buy diflucan at walgreens from Mother Nature,â he says.

These animal poisons include toxins like melittin, which is considered a host defense peptide. Most multicellular organisms have these peptides to ward off disease, including humans, but only some creatures weaponize can i buy diflucan at walgreens them in the form of powerful venom. Funnily enough, this toxin could end up saving human lives. And it isnât particularly difficult to create synthetic melittin in a lab, Pan says, which is optimal for drug development due to its convenience, quality control, and relative safety compared to crude natural sources.

The real can i buy diflucan at walgreens challenge. Designing an effective delivery method that squashes cancer growth but leaves surrounding cells healthy. Chemotherapy, for example, commonly causes patients to lose their hair because it damages follicles in the can i buy diflucan at walgreens process. ÂThat has been the key bottleneck in targeted [cancer] therapy,â he adds.

ÂIt boils down to can i buy diflucan at walgreens. How can we make these venom peptides more selective and targeted to the cancer cell?. Itâs like finding a needle in a haystack.âPan's former lab at the University of Illinois made headlines in 2014 after injecting melittin into nanoparticles that can attach to cancer cells. This method may be particularly beneficial in stomping out lingering cells that resist can i buy diflucan at walgreens chemotherapy, the team proposed.

Panâs latest research, which was published in 2017, revealed that peptides like melittin could work by interfering with the DNA transcription thatâs associated with cancer spread. Another promising bee venom can i buy diflucan at walgreens component. An enzyme called phospholipase A2, or PLA2, which is also found in venoms from animals, including snakes. Like melittin, these enzymes have also been shown to exhibit anti-cancer properties.

Even more, PLA2 could mitigate Parkinsonâs disease can i buy diflucan at walgreens by reducing brain inflammation. Still, this evidence largely comes from studies on mice.It isnât yet clear how exactly phospholipase A2, or other components of bee venom, could tackle neurodegenerative conditions. The proposed can i buy diflucan at walgreens mechanisms are largely speculation, says E. Paul Cherniack, a geriatrician and internal medicine professor at the University of Arizona who has written reviews on bee venom acupuncture and other crawly crittersâ medicinal potential.Itâs also possible that melittin and PLA2 could work synergistically to treat conditions like cancer and bacterial s, which could explain bee venomâs broader impacts.The Pros of Propolis and HoneyPropolis, another practical bee product, is a resin-like mixture made by bees thatâs composed of material from tree buds and their own saliva.

They use it to build hives, but humans have can i buy diflucan at walgreens long adapted the substance for their own benefit. Hippocrates may have applied it to wounds and ulcers, and it was listed as an official drug in 17th-century Britain. During World War II, Soviet clinics used propolis to treat tuberculosis. Nowadays, you can find propolis incorporated into products like lotion, shampoo, ointment and toothpaste can i buy diflucan at walgreens.

Researchers are now looking to define propolisâ drug potential via cell, animal and, increasingly, human studies. It may strengthen the immune system and could fight damage from hazards like free radicals can i buy diflucan at walgreens. After all, research indicates bees that produce higher amounts of propolis lead healthier, relatively longer lives.Relatively small human trials have suggested that standardized doses of propolis are safe and could help alleviate ailments like diabetes, respiratory tract s, asthma and chronic kidney disease. Of course, larger studies are needed to confirm these results.Chemical compounds within propolis called polyphenols, which are naturally found in plants and therefore various foods and drinks (including wine), may explain some of these advantages.

ÂSome of these polyphenols have been studied for a whole host of things, like treatments of various kinds of cancer can i buy diflucan at walgreens and even to [slow] the aging process itself,â Cherniack says. ÂPolyphenols might even be useful even in affecting neurodegenerative diseases, cardiovascular diseases â¦ anything involving inflammation.âTheyâre also present in honey, a tasty food that may even play a role in protecting people from the harmful effects of radiation. Yet itâs difficult to discern how exactly the human body processes polyphenols, which limits scientistsâ can i buy diflucan at walgreens ability to develop drugs harnessing them specifically. It could therefore help to focus on administering propolis in controlled doses.

Pollinating the Medical FieldDespite the wide range of possible bee-derived treatments, weâre still far from an embrace by mainstream medicine. For one, researchers like Pan are can i buy diflucan at walgreens still formulating how to safely and effectively utilize agents like melittin. In the case of cancer treatment, the goal is to design the nanoparticles containing melittin to activate only when they reach the cells of concern, Pan says. To complicate things, the body will likely try to reject these foreign objects â an issue heâs currently trying to work around.Some teams have looked into gene therapy, which would introduce genes into peopleâs bodies that are coded to deliver melittin to cancer can i buy diflucan at walgreens cells.

Others have considered giving patients IV doses of melittin engineered to bind with these cells.Yet the drug development process can take nearly two decades, Pan notes, when you factor in the numerous phases before possible FDA approval. The entire venture can cost hundreds of millions of dollars (sometimes in the billion range), and cancer research has struggled for funding amid federal spending cuts and diflucan-driven financial shortfalls.Pan has encountered skeptical study reviewers who wince at the mention of bee venom, despite the use of isolated peptides that donât carry the can i buy diflucan at walgreens same dangers as the real thing. Still, he says, the evidence speaks for itself. ÂThey have been proven, pre-clinically at least, with a strong efficacy,â he says.

ÂThese are tremendous results, but we do struggle getting funding for this kind of research.âIn can i buy diflucan at walgreens 1968, researchers from the Royal College of General Practitioners began tracking approximately 46,000 women in the United Kingdom â half of whom actively used the birth control pill and half of whom had never used it. Follow-up reports on the study, one of the worldâs largest continuing explorations into the health effects of hormonal contraception, suggested that pill users have a significantly lower rate of death from cancers and other diseases but a higher rate of death from something surprising. Violence.The longer can i buy diflucan at walgreens theyâd been on the pill, the more likely this fate became. Those whoâd been on the pill for more than eight years had an increased risk of 116 percent.

Itâs a small finding, but significant enough that chance couldnât explain it.According to the United Nations Department of Economic and Social Affairs, approximately 151 million women worldwide used the pill as a method of contraception in 2019. Despite this, thereâs still a lot we donât know about can i buy diflucan at walgreens it. As new data is collected, Philip Hannaford, corresponding author of the study and a professor emeritus of primary care at the University of Aberdeen in Scotland, continues to see the same violent death statistics. He just canât explain why.Partner PreferencesBecause intimate partner violence accounts for more than a third of women murdered in the United States, a new review published in the journal Frontiers can i buy diflucan at walgreens in Behavioral Neuroscience argues that many of these violent deaths likely occurred at the hands of romantic partners.Lisa Welling, an associate professor of psychology at Oakland University, studies the influence of hormones on behavior.

Sheâs found that contraceptive pill users tend to use more tactics to keep their relationship afloat â as do their partners. ÂJealousy is a normal reaction people have in can i buy diflucan at walgreens response to a potential or perceived threat to their relationship,â she says. ÂItâs an early warning system so we can take steps to correct issues before a break-up."One way jealousy can be expressed is through mate-retention behaviors, which are any behaviors that might be engaged to keep a partner from straying. This can include buying a partner a gift or complementing them, Welling says, but it can also mean violence.She agrees that the pill could be influencing whom women chose as their romantic partners.

However, she can i buy diflucan at walgreens doubts that hormonal changes are to blame for the relationship between the pill and violent deaths. For one, research shows that pill-users prefer less masculine men, who studies have found are less likely to be perpetrators of violent crime. ÂWomen prefer more masculine males can i buy diflucan at walgreens when theyâre fertile, but the contraceptive pill keeps a steady dose of hormones that mimics the phase when theyâre already ovulated," Welling says. "So you donât tend to see fluctuations in hormones across the cycle, and therefore you donât see the same subtle changes in preferences.âCorrelation or Causation?.

Another possible explanation is that people tend to have more jealous reactions when their estrogen levels are higher, a hormone that the combined pill (the most commonly prescribed pill) contains along with progesterone. ÂSome say [adding in estrogen] more can i buy diflucan at walgreens closely approximates the ratio of progesterone and estrogen of a natural menstrual cycle,â Welling says, âbut really, itâs added in to help deal with the pillâs side effects.âThese synthetic hormones have also been found to affect how satisfied users are with their relationship. A 2014 study showed that people might see a change in their relationship dynamics and a drop in satisfaction if they go off the pill, or start it during a relationship, Welling says â although there is limited support for this theory. While some argue that these hormones dangerously alter preference in a can i buy diflucan at walgreens partner, most researchers agree there isnât enough evidence to draw that conclusion.

Instead, there could be alternative explanations for Hannafordâs findings.For instance, a 2002 study found that women using oral contraception, on average, reported a greater number of sexual partners across their lifetimes. Typically, Welling says, can i buy diflucan at walgreens higher numbers of sexual partners encompass unattached encounters as well, referred to as casual sex. "And research backs up that women who engage in more casual sex are often more likely victims of crime,â she says, emphasizing that sheâs not blaming the victims.Hannaford agrees that alternative explanations for the association he found must be considered. Itâs more likely, for example, that the women in his study who were on the pill were in relationships, more likely to be risk-takers or accident-prone, he says.

In fact, Hannaford doesnât think weâll ever truly know if the pill causes women to can i buy diflucan at walgreens pick partners who will go on to kill them, or if thereâs another reason for the correlation. ÂItâs very unlikely weâll ever know the biology enough,â he says. ÂItâs a very difficult can i buy diflucan at walgreens thing to study, partly because the outcome is so rare â weâre talking about six per 100,000 women.âAnd donât expect to hear this statistic at your next doctor appointment. While Hannaford acknowledges that itâs important for pill-users to be informed of any risks, he says the main concern he discusses with anyone contemplating the pill is venous thrombosis [caused by blood clots].

Welling agrees, adding that, although 116 percent is a significant statistical effect, itâs not significant enough for doctors to be warning their patients about until the theory is backed up by two or three more datasets.(Inside Science) â It doesn't take much to nudge people into making healthier choices at the grocery store -- just removing confectionery and other unhealthy products from checkouts and the ends of nearby aisles and placing fruit and vegetables near store entrances have a real impact on what people buy. That's the key finding from a new study published last week can i buy diflucan at walgreens in the journal PLOS Medicine. Very few people in the U.K. (and around the globe) eat enough fruit and can i buy diflucan at walgreens vegetables, said Christine Vogel, a public health nutrition researcher at Southampton University, who co-authored the study.

Instead of blaming consumers or the cost of fresh food, Vogel said, she is really interested in looking at the food environment -- the places where people get their food, especially supermarkets where many families buy most of what they eat. Vogel and her colleagues focused on the food choices made by women of childbearing age. Some of their early findings showed that the food environment was important, particularly for women who had poor dietary choices can i buy diflucan at walgreens. Vogel reached out to a discount supermarket chain called Iceland, which she said is quite heavily used by families who are more vulnerable economically and by younger adults who tend to have poorer quality diets.

She pitched them can i buy diflucan at walgreens a plan to change the store layout slightly to encourage the purchase of healthy food.In the study, the chain removed confectionery items from the checkouts and from the ends of the aisles near the checkout areas in three stores for six months each. Instead, they stocked those areas with nonfood items like deodorant, water, and toothpaste and expanded the fruit and vegetable sections near the entrances of the stores. They compared the buying habits of consumers at those stores with those of consumers at stores that made no change but had similar can i buy diflucan at walgreens clientele. The study showed that increasing the range of fresh fruit and vegetables and placing them in an expanded area at the front of the store increased customer purchases of fruit and vegetables in a substantial way.

The increase added up to almost 10,000 additional portions of fruit and vegetables per week per store, which Vogel said could be translated into significant improvements in population diet. The study also found there were 1,500 fewer portions of confectionery purchased each week can i buy diflucan at walgreens in each store -- a significant reduction in foods high in fat, sugar or salt.The study also tracked customers that use the supermarkets regularly, analyzing loyalty card data to see what they placed in their shopping baskets. The researchers tracked them over nine months and found that the women -- whom the researchers focused on because they often are the ones who purchase food for a household -- who shopped at the healthier stores purchased more fruit and vegetables, and this also translated into a healthier diet when they answered surveys about what they were eating. Vogel said can i buy diflucan at walgreens the findings provide some additional support for the U.K.

Government's intention to ban the sale of foods high in fat, salt or sugar at the front of the store, because it will reduce the number of occasions that customers can interact with those foods. Other interventions, like adding signage about healthy options, has a far smaller effect in studies, Vogel said. The findings from the study affirm other research suggesting that food environments matter and supermarkets can do more to encourage can i buy diflucan at walgreens healthy choices without compromising the bottom line, said Allison Karpyn, who co-directs the Center for Research Education and Social Policy at the University of Delaware. "Oftentimes small changes in supermarkets such as placing products in a different part of the store, or on a different shelf, or with a larger tag, can result in significant shifts in what shoppers buy -- often without the shopper even realizing it," she said.

"And while the results might seem modest, if you multiply impacts across communities, the potential to can i buy diflucan at walgreens improve public health is large." Vogel said the next steps in her research include more digging into the effect of placing nonfood items at the checkout, since that's where many impulse purchases are made. Reducing impulsive purchases, she said, "is a way to reduce the opportunity for individuals and families to have added unnecessary calories." This story was published on Inside Science. Read the can i buy diflucan at walgreens original here.Around 440,000 people in the U.S. Use a gastrostomy tube (also called a G-tube), according to 2013 data.

It can replace or supplement oral feedings by delivering water, food and drugs to the stomach, where a G-tube is surgically, radiographically or endoscopically placed.I use one myself. Eating was always a chore for me because I have several disabilities from a childhood brain tumor can i buy diflucan at walgreens. Many of my recent hospital visits have been due to pneumonia. But after a lengthy stay in the ICU and months of swallow therapy, I decided to put a G-tube in because it would be safer for my lungs and conserve energy from the laborious task of eating can i buy diflucan at walgreens â and it would be healthier than my past diet.Thereâs two kinds of G-tubes.

One is called a âconventional tubeâ and is about six inches long. Itâs floppy like a noodle, and is coiled and taped to the torso. Therefore, it can unfortunately build can i buy diflucan at walgreens up residue and irritate skin. This type is most frequently stocked in hospitals.

Itâs used while the body forms a feeding channel between can i buy diflucan at walgreens the stomach and skin. Elderly people tend to need it the most because they more often require nutritional support.This conventional model can render physical movement difficult or painful, and some health care providers assume that older people are less active. Still, people with G-tubes (regardless of age) deserve to partake in daily activities like errands and fitness classes. The other type â a âlow-profile Mic-key tubeâ â must be ordered by a hospital and is can i buy diflucan at walgreens meant for a younger, more active population.

A part of the Mic-key called a âbuttonâ sticks out an inch from the stomach. The button has a hole in which an extension tube is twisted and locked can i buy diflucan at walgreens into place. Then, a syringe is connected at the other end for feeding. While most people use a G-tube for a short amount of time while recovering from an injury or experiencing a serious illness, some have can i buy diflucan at walgreens it permanently implanted.

Despite their advantages, these devices can endanger patients. Due to allergy and sensitivity problems, digestive or absorption issues, or a rejection of the enteral feeding, about three in 10 individuals experience Enteral Feeding Intolerance (EFI). This can result in can i buy diflucan at walgreens pneumonia and other serious complications. And the Mic-key tube needs to be replaced every six months because it may become blocked, dislodged or degraded.The G-tubeâs supply and safety issues have prompted a new approach.

Last July, Belgium-based manufacturer VIPUN and Baxter Inc., one of the countryâs biggest medical suppliers, announced a partnership to create a smart can i buy diflucan at walgreens feeding tube. What will make a smart G-tube âsmartâ is its ability to measure stomach motility (or movement) for clinicians.This specialized G-tube will certainly help prevent nurses and doctors from getting liquids and medications into patientsâ lungs. Still, the claim is somewhat misleading because Baxter solely focuses on the amount of liquid in the stomach, not the content. If a can i buy diflucan at walgreens patient gets sick from one ingredient, it likely doesnât matter if their stomach is completely full or half full.With the increase of smart biotech products like Dexcom, which measures glucose levels, and Fitbitâs oxygen and heart rate monitoring, itâs fair to say the wearables market is ramping up â giants like Cardinal Health are also looking into a smart G-tube design.

And while many people see the equipment's invasive nature as a disadvantage, it may actually render it the next biotechnology breakthrough.A proper smart G-tube would not have its information distorted by the skin. Hypothetically, the data could be accessed through an encrypted app like Signal, and sent to medical professionals in can i buy diflucan at walgreens real time. This technology is already life-saving, but it could be more so if the individual is unconscious or unable to communicate.Another worrying aspect of the G-tube experience is the environmental waste it creates. From formula cartons to syringes, all of the associated products can i buy diflucan at walgreens should be made from biodegradable materials to decrease their toxic impact on our world.

We have already witnessed how medical equipment takes its toll on the Earth. Currently, tube extensions are made of polyurethane or silicone and need to be replaced every six months. These materials can i buy diflucan at walgreens are then destined for a landfill. If a smart G-tube had an extension like a rubber straw that only required replacement once or twice every several years, we could cut down on waste.A smart G-tube may sound far-fetched, but plenty of people spend their lives with a pace-maker or Inspire device (which is used to treat sleep apnea) inside their bodies.

In 2019, the global can i buy diflucan at walgreens feeding tube market was valued at $2.5 billion. That figure may grow to $4.2 billion by 2027. Numbers aside, a robust smart G-tube should be made simply because it will improve hundreds of thousands of peopleâs quality of life. And if we can land can i buy diflucan at walgreens the Perseverance rover 38 million miles away at 1,200 miles per hour, we can make a G-tube that's flush with the skin.As Earthâs climate heats up, extreme heat events will become more likely.

According to a recent study, by 2100 extreme heat and humidity will affect 1.2 billion people worldwide â more than four times the number of people affected today. And those effects can be deadly can i buy diflucan at walgreens. According to the World Health Organization (WHO), more than 166,000 people died as a result of heatwaves between 1998 and 2017. Seventy thousand of those died in can i buy diflucan at walgreens just one summer, during Europeâs 2003 heatwave.

In the U.S. Alone, heat kills more than 600 people each year.So yes, heat kills. But how? can i buy diflucan at walgreens. Overwhelming the SystemsRemarkably, the human body operates within a very narrow range of temperatures.

That range can i buy diflucan at walgreens varies a little from person to person, but not all that much. The body has clever ways of maintaining that optimal temperature range, which is why we stay at a more or less steady internal body temperature winter and summer, indoors and out. However, thereâs a limit to what the body can deal with. Prolonged exposure to very high temperatures can throw that control system out of can i buy diflucan at walgreens whack.

Daniel Henning is an emergency room physician at the University of Washington Medical Center in Seattle. Heâs seen a lot of can i buy diflucan at walgreens heat illness in his career, especially this summer. He explains that when the body gets too hot, the mechanisms it has for keeping the temperature in the safety zone can get overwhelmed. When the skin gets hot, the blood vessels just underneath the skin get hot, too.

That too-warm blood is circulated deeper into can i buy diflucan at walgreens the bodyâs core. This triggers the bodyâs built-in cooling system. Sweating. As sweat seeps â or sometimes pours â out of the skin, it evaporates, thus cooling the skin and the blood vessels underneath.

At this point you have hyperthermia, sometimes called heat stroke, and the bad news just keeps coming. Your proteins and enzymes start breaking down. Your gut can begin to leak toxins into the bloodstream, creating a kind of sepsis. The immune system can begin producing an inflammatory reaction that further damages your organs.

ÂUsually,â says Henning, âby the time you've gotten to these really high temperatures, all of these things are happening simultaneously.âEven if you get into serious trouble from extreme heat, with prompt treatment you can still survive. But without it, your odds are not good. High RiskSeveral factors increase the risk of heat stroke. Being dehydrated, being obese, having certain medical conditions (such as heart disease, diabetes, alcoholism, or opioid use disorder), taking certain medications (such as diuretics, beta blockers, and antidepressants), and drinking alcohol.Construction workers, farmers, athletes, and other people who work or play outside are also at higher risk for hyperthermia, as are young children.

Sounds simple enough. But for many people those arenât options. Poor people, who often have to work outdoors and are less likely to have access to air conditioning, are the most vulnerable.Jeremy J. Hess, Director of the Center for Health and the Global Environment at the University of Washington, is a lead author on several climate-change assessments, including the Intergovernmental Panel on Climate Change Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation.

He says that as the world continues to heat up, we can expect increases in the frequency, severity, and sometimes duration of extreme heat events. That means more people will be exposed to dangerous levels of heat. We can save lives, but to do that, we will have to take action to reduce the risks to those who are most vulnerable. ÂIn a lot of places, we're seeing these exposures increase faster than the protections,â he says.

One of the many challenges of the changing climate is how to keep the vulnerable safe from deadly heat..

Diflucan 250mg

ÂWhen weâre in a crisis like this, can we meet this problem head on before it becomes a bigger problem and requires hospitalization.âDuring this latest Delta surge in Alaska, itâs been crucial to keep people out of the hospital â not just Petersburgâs local clinics, but also keeping people from getting medevacâd to the bigger hospitals in Anchorage.Plus, itâs diflucan 250mg a more personal way to receive care. This team in Petersburg is planning on keeping up this level of home health care even when theyâre no longer caring for antifungal medication patients.Home Health Nurse Manager Kirsten Testoni prepares to treat a person with antifungal medication in their home. (Photo by Angela Denning/KFSK)Later in the day, Testoni is in her car gearing up to visit a small house where three people are infected with antifungal medication.She puts on two face masks, goggles, a hair net, a gown, and blue rubber gloves.âAlrightâ¦You ready?. Letâs do it,â she said.Natocha diflucan 250mg Lyons answers the door.

Sheâs 43. Sheâs in a black sweatshirt, her blond hair pulled back.âSorry my house is not cleaned,â Lyons said. ÂI donât have any energy.âIn the last week, sheâs been to the ER twice.âI was so bad and so diflucan 250mg weak I couldnât even get up to go pee at one point. I had to have help from my son,â Lyons said.

Home health drove her back and forth to the hospital. She received oxygen, IV fluids, monoclonal antibody treatment, and steroids.âIf it wasnât for the home health people I wouldnât have made it because I was too weak to drive myself, diflucan 250mg I was too weak to even walk, I was too weak to do anything,â she said. ÂItâs been very scary for me.âTestoni checks out her oxygen levels.âOoo, it was 98!. Thatâs the best itâs been since forever!.

Â said Lyons diflucan 250mg. ÂThe lowest I went was 84.ââYeah, thatâs pretty low,â Testoni said. Like many Petersburg residents this team has been caring for this month, Lyons isnât vaccinated. And she hasnât changed her mind even after two trips to the ER.But Testoni never pushes the diflucan 250mg issue.âThatâs not our role,â she said.

ÂWe donât do that. We are going to take care of people regardless of what their choices are.âWalking back to the car, Testoni says her job isnât to convince patients of anything. Itâs to meet them where they are diflucan 250mg. And so far, thatâs been enough to keep them alive.Start Preamble Centers for Medicare &.

Medicaid Services, Health and Human Services (HHS). Notice. The Centers for Medicare &. Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public.

Under the Paperwork Reduction Act of 1995 (the PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden. Comments must be received by January 25, 2022. When commenting, please reference the document identifier or OMB control number.

To be assured consideration, comments and recommendations must be submitted in any one of the following ways. 1. Electronically. You may send your comments electronically to http://www.regulations.gov.

Follow the instructions for âComment or Submissionâ or âMore Search Optionsâ to find the information collection document(s) that are accepting comments. 2. By regular mail. You may mail written comments to the following address.

CMS, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention. Document Identifier/OMB Control Number. ___, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following.

1. Access CMS' website address at website address at https://www.cms.gov/âRegulations-and-Guidance/âLegislation/âPaperworkReductionActof1995/âPRA-Listing.html. Start Further Info William N. Parham at (410) 786-4669.

End Further Info End Preamble Start Supplemental Information Contents This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection's supporting statement and associated materials (see ADDRESSES ). CMS-10599âReview Choice Demonstration for Home Health Services CMS-10433âContinuation of Data Collection to Support QHP Certification and other Financial Management and Exchange Operations CMS-10330âNotice of Rescission of Coverage and Disclosure Requirements for Patient Protection under the Affordable Care Act CMS-10780 Requirements Related to Surprise Billing. Qualifying Payment Amount, Notice and Consent, and Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in Under the PRA (44 U.S.C.

3501-3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term âcollection of informationâ is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a Start Printed Page 67474 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval.

To comply with this requirement, CMS is publishing this notice. Information Collection 1. Type of Information Collection Request. Revision of a currently approved collection.

Title of Information Collection. Review Choice Demonstration for Home Health Services. Use. Section 402(a)(1)(J) of the Social Security Amendments of 1967 (42 U.S.C.

1395b-1(a)(1)(J)) authorizes the Secretary to âdevelop or demonstrate improved methods for the investigation and prosecution of fraud in the provision of care or services under the health programs established by the Social Security Act (the Act).â Pursuant to this authority, the CMS seeks to develop and implement a Medicare demonstration project, which CMS believes will help assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies (HHA) providing services to Medicare beneficiaries. This revised demonstration helps assist in developing improved procedures for the identification, investigation, and prosecution of potential Medicare fraud. The demonstration helps make sure that payments for home health services are appropriate through either pre-claim or postpayment review, thereby working towards the prevention and identification of potential fraud, waste, and abuse. The protection of Medicare Trust Funds from improper payments.

And the reduction of Medicare appeals. CMS has implemented the demonstration in Illinois, Ohio, North Carolina, Florida, and Texas with the option to expand to other states in the Palmetto/JM jurisdiction. Under this demonstration, CMS offers choices for providers to demonstrate their compliance with CMS' home health policies. Providers in the demonstration states may participate in either 100 percent pre-claim review or 100 percent postpayment review.

These providers will continue to be subject to a review method until the HHA reaches the target affirmation or claim approval rate. Once a HHA reaches the target pre-claim review affirmation or post-payment review claim approval rate, it may choose to be relieved from claim reviews, except for a spot check of their claims to ensure continued compliance. Providers who do not wish to participate in either 100 percent pre-claim or postpayment reviews have the option to furnish home health services and submit the associated claim for payment without undergoing such reviews. However, they will receive a 25 percent payment reduction on all claims submitted for home health services and may be eligible for review by the Recovery Audit Contractors.

The information required under this collection is required by Medicare contractors to determine proper payment or if there is a suspicion of fraud. Under the pre-claim review option, the HHA sends the pre-claim review request along with all required documentation to the Medicare contractor for review prior to submitting the final claim for payment. If a claim is submitted without a pre-claim review decision one file, the Medicare contractor will request the information from the HHA to determine if payment is appropriate. For the postpayment review option, the Medicare contractor will also request the information from the HHA provider who submitted the claim for payment from the Medicare program to determine if payment was appropriate.

Form Number. CMS-10599 (OMB control number. 0938-1311). Frequency.

Frequently, until the HHA reaches the target affirmation or claim approval threshold and then occasionally. Affected Public. Private Sector (Business or other for-profits and Not-for-profits). Number of Respondents.

3,631. Number of Responses. 1,467,243. Total Annual Hours.

744,5143. (For questions regarding this collection contact Jennifer McMullen (410)786-7635.) 2. Type of Information Collection Request. Revision of a currently approved collection.

Title of Information Collection. Continuation of Data Collection to Support QHP Certification and other Financial Management and Exchange Operations. Use. As directed by the rule Establishment of Exchanges and Qualified Health Plans.

Exchange Standards for Employers (77 FR 18310) (Exchange rule), each Exchange is responsible for the certification and offering of Qualified Health Plans (QHPs). To offer insurance through an Exchange, a health insurance issuer must have its health plans certified as QHPs by the Exchange. A QHP must meet certain necessary minimum certification standards, such as network adequacy, inclusion of Essential Community Providers (ECPs), and non-discrimination. The Exchange is responsible for ensuring that QHPs meet these minimum certification standards as described in the Exchange rule under 45 CFR 155 and 156, based on the Patient Protection and Affordable Care Act (PPACA), as well as other standards determined by the Exchange.

Issuers can offer individual and small group market plans outside of the Exchanges that are not QHPs. Form Number. CMS-10433 (OMB control number. 0938-1187).

Frequency. Annually. Affected Public. Private sector, State, Local, or Tribal Governments, Business or other for-profits.

Number of Respondents. 2,925. Number of Responses. 2,925.

Total Annual Hours. 71,660. (For questions regarding this collection, contact Nicole Levesque at (617) 565-3138). 3.

Type of Information Collection Request. Extension of a currently approved collection. Title of Information Collection. Notice of Rescission of Coverage and Disclosure Requirements for Patient Protection under the Affordable Care Act.

Use. Sections 2712 and 2719A of the Public Health Service Act (PHS Act), as added by the Affordable Care Act, contain rescission notice, and patient protection disclosure requirements that are subject to the Paperwork Reduction Act of 1995. The No Surprises Act, enacted as part of the Consolidated Appropriations Act, 2021, amended section 2719A of the PHS Act to sunset when the new emergency services protections under the No Surprises Act take effect. The provisions of section 2719A of the PHS Act will no longer apply with respect to plan years beginning on or after January 1, 2022.

The No Surprises Act re-codified the patient protections related to choice of health care professional under section 2719A of the PHS Act in newly added section 9822 of the Internal Revenue Code, section 722 of the Employee Retirement Income Security Act, and section 2799A-7 of the PHS Act and extended the applicability of these provisions to grandfathered health plans for plan years beginning on or after January 1, 2022. The rescission notice will be used by health plans to provide advance notice to certain individuals that their coverage may be rescinded as a result of fraud or intentional misrepresentation of material fact. The patient protection notification will be used by health plans to inform certain individuals of their right to choose a primary care provider or pediatrician and to use obstetrical/gynecological services without prior authorization. The related provisions are finalized in the 2015 final regulations titled âFinal Rules under the Affordable Care Act for Grandfathered Plans, Preexisting Condition Exclusions, Start Printed Page 67475 Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protectionsâ (80 FR 72192, November 18, 2015) and 2021 interim final regulations titled âRequirements Related to Surprise Billing.

Part Iâ (86 FR 36872, July 13, 2021). The 2015 final regulations also require that, if State law prohibits balance billing, or a plan or issuer is contractually responsible for any amounts balanced billed by an out-of-network emergency services provider, a plan or issuer must provide a participant, beneficiary or enrollee adequate and prominent notice of their lack of financial responsibility with respect to amounts balanced billed in order to prevent inadvertent payment by the individual. Plans and issuers will not be required to provide this notice for plan years beginning on or after January 1, 2022. Form Number.

CMS-10330 (OMB control number. 0938-1094). Frequency. On Occasion.

Affected Public. State, Local, or Tribal Governments, Private Sector. Number of Respondents. 2,277.

Total Annual Responses. 15,752. Total Annual Hours. 814.

(For policy questions regarding this collection, contact Usree Bandyopadhyay at (410) 786-6650.) 4. Type of Information Collection Request. Extension of a currently approved collection. Title of Information Collection.

Requirements Related to Surprise Billing. Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in. Use. On December 27, 2020, the Consolidated Appropriations Act, 2021 (Pub.

L. 116-260), which included the No Surprises Act, was signed into law. The No Surprises Act provides federal protections against surprise billing and limits out-of-network cost sharing under many of the circumstances in which surprise medical bills arise most frequently. The 2021 interim final regulations âRequirements Related to Surprise Billing.

Part Iâ (86 FR 36872, 2021 interim final regulations) issued by the Departments of Health and Human Services, the Department of Labor, the Department of Treasury, and the Office of Personnel Management, implement provisions of the No Surprises Act that apply to group health plans, health insurance issuers offering group or individual health insurance coverage, and carriers in the Federal Employees Health Benefits (FEHB) Program that provide protections against balance billing and out-of-network cost sharing with respect to emergency services, non-emergency services furnished by nonparticipating providers at certain participating health care facilities, and air ambulance services furnished by nonparticipating providers of air ambulance services. The 2021 interim final regulations prohibit nonparticipating providers, emergency facilities, and providers of air ambulance services from balance billing participants, beneficiaries, and enrollees in certain situations unless they satisfy certain notice and consent requirements.

ÂSometimes thereâs a little bit of a resistance.âMany times the nurses will transport patients to the hospital themselves or they can call an ambulance.Stephanie Romine says home health is different than her many years working in the hospital.âYou never know, can i buy diflucan at walgreens you can walk in and find someone on the floor,â Romine said. ÂYou really donât know what youâre walking in to a lot of times.âMany hospitals have home health departments but itâs different in a rural town like Petersburg, says Jared Kosin. He heads the Alaska State Hospital and Nursing Home Association.âYouâre going to have almost, in some respects, a more nimble healthcare system because everybody knows everyone,â Kosin said.

ÂWhen weâre in a crisis like this, can we meet this problem head on before it becomes a bigger problem and requires hospitalization.âDuring this latest Delta surge in Alaska, itâs been crucial to keep people out of the hospital â not just Petersburgâs local clinics, but also keeping can i buy diflucan at walgreens people from getting medevacâd to the bigger hospitals in Anchorage.Plus, itâs a more personal way to receive care. This team in Petersburg is planning on keeping up this level of home health care even when theyâre no longer caring for antifungal medication patients.Home Health Nurse Manager Kirsten Testoni prepares to treat a person with antifungal medication in their home. (Photo by Angela Denning/KFSK)Later in the day, Testoni is in her car gearing up to visit a small house where three people are infected with antifungal medication.She puts on two face masks, goggles, a hair net, a gown, and blue rubber gloves.âAlrightâ¦You ready?.

Letâs do it,â she said.Natocha Lyons answers can i buy diflucan at walgreens the door. Sheâs 43. Sheâs in a black sweatshirt, her blond hair pulled back.âSorry my house is not cleaned,â Lyons said.

ÂI donât have any energy.âIn the last week, sheâs been to the can i buy diflucan at walgreens ER twice.âI was so bad and so weak I couldnât even get up to go pee at one point. I had to have help from my son,â Lyons said. Home health drove her back and forth to the hospital.

She received oxygen, IV fluids, monoclonal antibody treatment, and steroids.âIf it wasnât for the home health people I wouldnât have made it because I was too weak to drive myself, I can i buy diflucan at walgreens was too weak to even walk, I was too weak to do anything,â she said. ÂItâs been very scary for me.âTestoni checks out her oxygen levels.âOoo, it was 98!. Thatâs the best itâs been since forever!.

Â said can i buy diflucan at walgreens Lyons. ÂThe lowest I went was 84.ââYeah, thatâs pretty low,â Testoni said. Like many Petersburg residents this team has been caring for this month, Lyons isnât vaccinated.

And she hasnât changed her mind even after two trips to the can i buy diflucan at walgreens ER.But Testoni never pushes the issue.âThatâs not our role,â she said. ÂWe donât do that. We are going to take care of people regardless of what their choices are.âWalking back to the car, Testoni says her job isnât to convince patients of anything.

Itâs to can i buy diflucan at walgreens meet them where they are. And so far, thatâs been enough to keep them alive.Start Preamble Centers for Medicare &. Medicaid Services, Health and Human Services (HHS).

Notice. The Centers for Medicare &. Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public.

When commenting, please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in any one of the following ways. 1.

Electronically. You may send your comments electronically to http://www.regulations.gov. Follow the instructions for âComment or Submissionâ or âMore Search Optionsâ to find the information collection document(s) that are accepting comments.

2. By regular mail. You may mail written comments to the following address.

To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following. 1. Access CMS' website address at website address at https://www.cms.gov/âRegulations-and-Guidance/âLegislation/âPaperworkReductionActof1995/âPRA-Listing.html.

Start Further Info William N. Parham at (410) 786-4669. End Further Info End Preamble Start Supplemental Information Contents This notice sets out a summary of the use and burden associated with the following information collections.

More detailed information can be found in each collection's supporting statement and associated materials (see ADDRESSES ). CMS-10599âReview Choice Demonstration for Home Health Services CMS-10433âContinuation of Data Collection to Support QHP Certification and other Financial Management and Exchange Operations CMS-10330âNotice of Rescission of Coverage and Disclosure Requirements for Patient Protection under the Affordable Care Act CMS-10780 Requirements Related to Surprise Billing. Qualifying Payment Amount, Notice and Consent, and Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in Under the PRA (44 U.S.C.

Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a Start Printed Page 67474 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice. Information Collection 1.

Type of Information Collection Request. Revision of a currently approved collection. Title of Information Collection.

Review Choice Demonstration for Home Health Services. Use. Section 402(a)(1)(J) of the Social Security Amendments of 1967 (42 U.S.C.

The protection of Medicare Trust Funds from improper payments. And the reduction of Medicare appeals. CMS has implemented the demonstration in Illinois, Ohio, North Carolina, Florida, and Texas with the option to expand to other states in the Palmetto/JM jurisdiction.

Under this demonstration, CMS offers choices for providers to demonstrate their compliance with CMS' home health policies. Providers in the demonstration states may participate in either 100 percent pre-claim review or 100 percent postpayment review. These providers will continue to be subject to a review method until the HHA reaches the target affirmation or claim approval rate.

Once a HHA reaches the target pre-claim review affirmation or post-payment review claim approval rate, it may choose to be relieved from claim reviews, except for a spot check of their claims to ensure continued compliance. Providers who do not wish to participate in either 100 percent pre-claim or postpayment reviews have the option to furnish home health services and submit the associated claim for payment without undergoing such reviews. However, they will receive a 25 percent payment reduction on all claims submitted for home health services and may be eligible for review by the Recovery Audit Contractors.

For the postpayment review option, the Medicare contractor will also request the information from the HHA provider who submitted the claim for payment from the Medicare program to determine if payment was appropriate. Form Number. CMS-10599 (OMB control number.

0938-1311). Frequency. Frequently, until the HHA reaches the target affirmation or claim approval threshold and then occasionally.

Affected Public. Private Sector (Business or other for-profits and Not-for-profits). Number of Respondents.

Total Annual Hours. 744,5143. (For questions regarding this collection contact Jennifer McMullen (410)786-7635.) 2.

Type of Information Collection Request. Revision of a currently approved collection. Title of Information Collection.

Continuation of Data Collection to Support QHP Certification and other Financial Management and Exchange Operations. Use. As directed by the rule Establishment of Exchanges and Qualified Health Plans.

The Exchange is responsible for ensuring that QHPs meet these minimum certification standards as described in the Exchange rule under 45 CFR 155 and 156, based on the Patient Protection and Affordable Care Act (PPACA), as well as other standards determined by the Exchange. Issuers can offer individual and small group market plans outside of the Exchanges that are not QHPs. Form Number.

CMS-10433 (OMB control number. 0938-1187). Frequency.

Annually. Affected Public. Private sector, State, Local, or Tribal Governments, Business or other for-profits.

Number of Respondents. 2,925. Number of Responses.

(For questions regarding this collection, contact Nicole Levesque at (617) 565-3138). 3. Type of Information Collection Request.

Extension of a currently approved collection. Title of Information Collection. Notice of Rescission of Coverage and Disclosure Requirements for Patient Protection under the Affordable Care Act.

The provisions of section 2719A of the PHS Act will no longer apply with respect to plan years beginning on or after January 1, 2022. The No Surprises Act re-codified the patient protections related to choice of health care professional under section 2719A of the PHS Act in newly added section 9822 of the Internal Revenue Code, section 722 of the Employee Retirement Income Security Act, and section 2799A-7 of the PHS Act and extended the applicability of these provisions to grandfathered health plans for plan years beginning on or after January 1, 2022. The rescission notice will be used by health plans to provide advance notice to certain individuals that their coverage may be rescinded as a result of fraud or intentional misrepresentation of material fact.

The patient protection notification will be used by health plans to inform certain individuals of their right to choose a primary care provider or pediatrician and to use obstetrical/gynecological services without prior authorization. The related provisions are finalized in the 2015 final regulations titled âFinal Rules under the Affordable Care Act for Grandfathered Plans, Preexisting Condition Exclusions, Start Printed Page 67475 Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protectionsâ (80 FR 72192, November 18, 2015) and 2021 interim final regulations titled âRequirements Related to Surprise Billing. Part Iâ (86 FR 36872, July 13, 2021).

The 2015 final regulations also require that, if State law prohibits balance billing, or a plan or issuer is contractually responsible for any amounts balanced billed by an out-of-network emergency services provider, a plan or issuer must provide a participant, beneficiary or enrollee adequate and prominent notice of their lack of financial responsibility with respect to amounts balanced billed in order to prevent inadvertent payment by the individual. Plans and issuers will not be required to provide this notice for plan years beginning on or after January 1, 2022. Form Number.

CMS-10330 (OMB control number. 0938-1094). Frequency.

On Occasion. Affected Public. State, Local, or Tribal Governments, Private Sector.

Number of Respondents. 2,277. Total Annual Responses.

(For policy questions regarding this collection, contact Usree Bandyopadhyay at (410) 786-6650.) 4. Type of Information Collection Request. Extension of a currently approved collection.

Title of Information Collection. Requirements Related to Surprise Billing. Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in.

Use. On December 27, 2020, the Consolidated Appropriations Act, 2021 (Pub. L.

116-260), which included the No Surprises Act, was signed into law. The No Surprises Act provides federal protections against surprise billing and limits out-of-network cost sharing under many of the circumstances in which surprise medical bills arise most frequently.

Does diflucan affect birth control

Malheur County, Oregon, is one of 10 counties does diflucan affect birth control in the state considered frontier areas because it has six or fewer people http://promediation.co.za/where-can-i-buy-kamagra-oral-jelly per square mile. By Addy Hatch, WSU College of NursingGiving nurse practitioners the authority to prescribe buprenorphine has brought that gold standard treatment for opioid addiction to people who might not have had access to it before, according to a new study led by Tracy Klein, PhD, associate professor at the Washington State University College of Nursing in Vancouver.Klein and her colleagues Dan Hartung, PharmD, and Jonah Geddes, does diflucan affect birth control MPH, used prescription drug monitoring data to look at prescription and dispensing patterns in Oregon before and after nurse practitioners and physician assistants gained the authority to prescribe buprenorphine in 2017. Before that time, only physicians were allowed to prescribe the medication nationally.Her study found that nurse practitioners almost immediately had an impact on access to buprenorphine in rural Oregon, especially in the sparsely populated areas known as frontier does diflucan affect birth control regions â counties with six or fewer people per square mile.By the end of 2018, nurse practitioners accounted for nearly 1 in 5 buprenorphine prescriptions in rural Oregon, according to the study, published in the Journal of Rural Health. In frontier areas â 10 of Oregonâs 36 counties â nurse practitioners accounted for more than a third of buprenorphine prescriptions dispensed, it said.Nurse practitioners are sometimes the only healthcare provider in these very rural areas, Klein said.Tracy KleinâItâs not surprising that having nurse practitioners be does diflucan affect birth control able to do this would increase access to buprenorphine in rural areas,â she said.

ÂIt was surprising the extent to which people were reliant on nurse practitioners for this service and that nurse practitioners were stepping up to the plate and providing it.âOpioid addiction âcontinues to be an does diflucan affect birth control enormous public health crisis that claimed over 46,000 lives in 2018,â the study notes.Implementation of the Comprehensive Addiction and Recovery Act in early 2017 was intended to expand availability of medication-assisted treatment, which includes prescribing buprenorphine in an office or clinic.Klein said her study âoffers a good opportunity to look at whether changing a law has an impact on patient care,â especially in little-studied frontier areas.Said Klein, âThis is one of the few studies thatâs really looked at the impact of nurse practitioners in frontier areas. Most studies look at urban versus rural, but itâs important to consider frontier areas that are even more isolated and underserved, and the contribution nurse practitioners make to this very important aspect of health care.âMedia contact:Tracy Klein, PhD, associate professor, Washington State University College of Nursing-Vancouver, 360-546-9142, taklein@wsu.edu.

Malheur County, Oregon, is one of 10 counties in can i buy diflucan at walgreens the state considered frontier areas because it has six or fewer people per square mile. By Addy Hatch, WSU College of NursingGiving nurse practitioners the authority to prescribe buprenorphine has brought that gold standard treatment for opioid addiction to people who might not have had access to it before, according to a new study led by Tracy Klein, PhD, associate professor at the Washington State University College of Nursing in Vancouver.Klein and her colleagues Dan Hartung, PharmD, and Jonah Geddes, MPH, used prescription drug can i buy diflucan at walgreens monitoring data to look at prescription and dispensing patterns in Oregon before and after nurse practitioners and physician assistants gained the authority to prescribe buprenorphine in 2017. Before that time, only physicians were allowed to prescribe the medication nationally.Her study found that nurse practitioners almost immediately had an impact on access to buprenorphine in rural Oregon, especially in the sparsely populated areas known as frontier regions â counties with six can i buy diflucan at walgreens or fewer people per square mile.By the end of 2018, nurse practitioners accounted for nearly 1 in 5 buprenorphine prescriptions in rural Oregon, according to the study, published in the Journal of Rural Health.

In frontier areas â 10 of Oregonâs 36 counties â nurse practitioners accounted for more than a third of buprenorphine prescriptions dispensed, it said.Nurse practitioners can i buy diflucan at walgreens are sometimes the only healthcare provider in these very rural areas, Klein said.Tracy KleinâItâs not surprising that having nurse practitioners be able to do this would increase access to buprenorphine in rural areas,â she said. ÂIt was surprising the extent to which people were reliant on nurse practitioners for this service and that nurse practitioners were stepping up to the plate and providing it.âOpioid addiction âcontinues to be an enormous public health crisis that claimed over 46,000 lives in 2018,â the study notes.Implementation of the Comprehensive Addiction and Recovery Act in early 2017 was intended to expand availability of can i buy diflucan at walgreens medication-assisted treatment, which includes prescribing buprenorphine in an office or clinic.Klein said her study âoffers a good opportunity to look at whether changing a law has an impact on patient care,â especially in little-studied frontier areas.Said Klein, âThis is one of the few studies thatâs really looked at the impact of nurse practitioners in frontier areas. Most studies look at urban versus rural, but itâs important to consider frontier areas that are even more isolated and underserved, and the contribution nurse practitioners make to this very important aspect of health care.âMedia contact:Tracy Klein, PhD, associate professor, Washington State University College of Nursing-Vancouver, 360-546-9142, taklein@wsu.edu.

Diflucan 100mg for yeast

GREAT FALLS, diflucan 100mg for yeast Mont. Â For months, the jail in central Montanaâs Cascade County was free of the antifungals, which seemed as distant a threat as it did in much of the nationâs rural Mountain West.Then a few people who had the diflucan were arrested. By the diflucan 100mg for yeast time Paul Krogue, the jailâs medical director, realized there was a problem, nearly 50 inmates were infected in the jail, where some had been sleeping on mats on an overcrowded floor.

After several weeks, Mr. Krogue got a call that s were spreading to a side of the jail that had been diflucan-free.He hung up the phone and put his head in his hands.âI just kind of lost it, like, âMy God, I donât know diflucan 100mg for yeast how much longer I can do this,ââ Mr. Krogue, a nurse practitioner, recalled.

ÂI was just scared that Iâm not going to be able to see it through, that Iâm going to get sick â you just feel so exhausted and itâs just a lot.âThe Mountain West, which for months avoided the worst of the diflucan, has rapidly devolved into one of the most alarming hot spots in a country that recorded its eight millionth confirmed case on Thursday, a day when more than 65,000 cases were announced nationwide, the most in a single day since July.Seventeen states, including many in the Mountain West, have added more cases in the past week than any other week of the diflucan. And the spread diflucan 100mg for yeast through sparsely populated areas of rural America has created problems in small towns that lack critical resources â including doctors â even in ordinary times.Wyoming, which did not have 1,000 total cases until June, recently added more than 1,000 in a single week. Reports of new s have recently reached record levels in Alaska, Colorado and Idaho.

And Montana, where more than half diflucan 100mg for yeast of the stateâs cases have been announced since August, is averaging more than 500 cases per day.In Cascade County, more than 300 inmates and staff members have been infected in a facility meant to hold 365 people, the countyâs first major outbreak in a region where the diflucan is suddenly surging.The county seat, Great Falls, is seeing its worst case numbers yet. The local hospital and its 27-bed antifungal medication unit is at capacity. The county health department is racing to hire new contact tracers.

And Mr diflucan 100mg for yeast . Krogue, who also teaches nursing at Montana State Universityâs Great Falls campus, has seen attendance in his classes dwindle as students fall ill or quarantine.âI was just scared that Iâm not going to be able to see it through, that Iâm going to get sick,â said Paul Krogue, the jailâs medical director.Credit...Tailyr Irvine for The New York TimesOne place where the s have spread has been local jails, which are confined, often crowded spaces. Jails are staples of local communities and tend to have people diflucan 100mg for yeast coming and going more quickly than prisons.

Jails can hold everyone from people awaiting criminal trials for months to those picked up for a suspended driverâs license for a few hours. With so many people filtering in and out, jails pose extra risks for the diflucanâs spread â not only inside facilities but in potentially feeding outbreaks in diflucan 100mg for yeast the rest of the community.Nationally, jails and prisons have seen disproportionate rates of and death, with a mortality rate twice as high as in the general population and an rate more than four times as high, according to recent data.A New York Times database has tracked clusters of at least 50 antifungals cases in a dozen rural jails in Montana, Idaho, Utah and New Mexico during the diflucan. Among them.

The Purgatory Correctional Center in Hurricane, Utah, with 166 s. The jail diflucan 100mg for yeast in Twin Falls, Idaho, with 279. And, in New Mexico, the Cibola County Correctional Center, which has reported 357 cases.In Cascade County, s at the jail make up about a quarter of all known diflucan cases in the county.

Health authorities say that the jailâs outbreak, which began in mid-August, was not believed to be the main cause of the communityâs recent surge, but that it diflucan 100mg for yeast had led to some cases. In the past two months, Mr. Krogue said, the jail released 29 people who were considered actively infected.s at the jail make up about a quarter of Cascade Countyâs known diflucan cases.Credit...Tailyr Irvine for The New York TimesGreat Falls, home to about 58,000 residents, is in the less mountainous part of Montana, with the Missouri River flowing through and a large oil refinery on its banks.

The Cascade County Detention diflucan 100mg for yeast Center sits along a highway at the edge of town. Drive five miles in any direction and you are surrounded by wide-open plains.Montana requires that masks be worn inside businesses and indoor public spaces, and many people in Great Falls wear them when walking around downtownâs Central Avenue, where shops and cafes are still recovering from shutting down in the spring. Others go without masks, citing the open space and lack of crowds.Bob Kelly, the mayor, said people had not been overly worried about how the jail outbreak might affect the rest of town when it diflucan 100mg for yeast started.âI think that by the very definition of a jail, hopefully, the disease will be incarcerated, as well as the patients,â he said.

ÂIs there concern?. Sure, thereâs concern diflucan 100mg for yeast . But is there overreaction?.

No.âThe mayor of Great Falls said that residents had considered the jailâs outbreak a distant concern at first.Credit...Tailyr Irvine for The New York TimesSome residentsâ nonchalance about the risks of the diflucan, said Mr. Krogue, the jailâs medical director, can be traced to a spring and early summer when almost no one in diflucan 100mg for yeast Cascade County knew anyone who had been sickened.âWe benefited from that early on,â he said. ÂBut in some ways, I think it did us a disservice, too, because it also created a certain level of complacency.âThat has quickly shifted now, he said, as cases have spiked.The number of active cases known to county officials on any given day has risen sharply to about 600, according to Trisha Gardner, Cascade Countyâs health officer.

The county has seen 1,261 cases and six deaths during the diflucan, a Times diflucan 100mg for yeast database shows. Some of the cases have been tied to the jail outbreak, she said, and others have been connected to bars and restaurants. Even figuring out what has led to some cases has been complex, she said, as residents have been reluctant to cooperate with contact tracers.âOur hospitals are at capacity, our public health system is at capacity,â she said.

ÂItâs not sustainable at this rate.âWhen the outbreak at the jail began, social diflucan 100mg for yeast distancing was impossible, the authorities said. Three inmates shared cells designed for two. At night, men slept on thin blue diflucan 100mg for yeast pads in every available space.

On the floor in the day room, in shower stalls, in stairwells, in hallways outside of cells.Inmates did not receive masks until August, and jail officials said many have refused to wear them.In interviews with more than a dozen inmates and their family members, inmates described the jail during the outbreak as chaotic and unsanitary. They said their pleas for help often went unanswered by nurses and guards.Newly arriving inmates were not always quarantined from one another before their test results were known because of a lack of space, inmates and jail officials said.Owen Hawley, 30, said every inmate in his living area of 38 men had tested positive for the diflucan. He said he had been unable to eat for three days, had intensive body aches and suffered from a headache so powerful it felt as if it diflucan 100mg for yeast was âbehind my eyes.ââAfter the fourth day of like, not eating and stuff, I just shut off, you know?.

Â he said.A jail area set aside for quarantining new inmates.Credit...Tailyr Irvine for The New York TimesAt one point, Mr. Hawley said, he and other prisoners protested the way the diflucan was being handled by refusing to leave their living areas and by blocking new inmates from entering diflucan 100mg for yeast . Everyone was ultimately tested, Mr.

Hawley said, and each prisoner was given a disposable mask.Sierra Jasmine Wells, 25, another inmate, said women in her dormitory had grown ill, one after the next.âEveryone around me was diflucan 100mg for yeast getting sick and it was tough on me,â she said. ÂBy then, I had already accepted the fact that I was going to get sick.âWhen she became infected, she said, she was given cough syrup and Tylenol.âI kind of was just left alone to deal with it,â she said.Jesse Slaughter, the county sheriff who oversees the jail, said that the jailâs medical staff was doing everything it could, and that he had been seeking health care assistance from other counties. Officials defended their handling of the outbreak, noting that all inmates received standard medications including Tylenol twice a day and were taken to area hospitals when they needed added care.

Seven inmates, diflucan 100mg for yeast as well as some staff members, were hospitalized. No one from the jail has died from the diflucan, officials said.Sheriff Jesse Slaughter, who oversees the jail, said he had been seeking health care assistance from other counties.Credit...Tailyr Irvine for The New York TimesMr. Krogue said that since the start of the outbreak he had been working diflucan 100mg for yeast up to 16 hours each day and sleeping in his basement, away from his wife and children.

He remains healthy but says he fears bringing the diflucan home. The diflucan has slowed some in the jail, and officials have moved some inmates to other facilities, but other prisons and jails in the state are now seeing outbreaks.âYou can start to see what some of these other places experienced much earlier on, and we just didnât have that experience, but itâs certainly happening now,â Mr. Krogue said diflucan 100mg for yeast .

ÂItâs just real in a way that it wasnât.âLucy Tompkins reported from Great Falls, Maura Turcotte from Chicago and Libby Seline from Lincoln, Neb. Reporting was contributed by Izzy ColÃ³n from Columbia, Mo., Brendon Derr from Phoenix, Rebecca Griesbach from Tuscaloosa, Ala., Danya Issawi and diflucan 100mg for yeast Timothy Williams from New York, Ann Hinga Klein from Des Moines, K.B. Mensah from Silver Spring, Md., and Mitch Smith from Chicago.Start Preamble Federal Transit Administration (FTA), DOT.

Notice of diflucan 100mg for yeast funding opportunity. The antifungals Disease 2019 (antifungal medication) public health emergency Start Printed Page 63654has had a significant impact on transit operations. During a series of FTA listening sessions held over the last three months, transit agencies asked FTA to support research to identify solutions to address the operational challenges that they are facing as a result of antifungal medication.

In response, FTA makes available through this Notice of Funding Opportunity (NOFO) funding to support research demonstration grants to public transit agencies to develop, deploy, and diflucan 100mg for yeast demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the antifungal medication public health emergency. Demonstration grants under this NOFO are authorized under FTA's Public Transportation Innovation Program (49 U.S.C. 5312).

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

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

FTA may supplement this amount if additional funding becomes available. Applicants must submit completed proposals for funding opportunity FTA-2020-015-TRI through the GRANTS.GOV âAPPLYâ function by 11:59 p.m. Eastern Time on November 2, 2020.

Prospective applicants should register as soon as possible on the GRANTS.GOV website to ensure they can complete the application process before the submission deadline. Application instructions are available on FTA's website at http://transit.dot.gov/âhowtoapply and in the âFINDâ module of GRANTS.GOV. FTA will not accept mail and fax submissions.

Start Further Info Please send any questions on this notice to Jamel El-Hamri email. Jamel.El-Hamri@dot.gov phone. 2020-366-8985.

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

Federal Award Information C. Eligibility Information D. Application and Submission Information E.

Application Review Information F. Federal Award Administration Information G. Federal Awarding Agency Contact Information A.

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

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

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

FTA may supplement the total funds available if additional funding becomes available at the time project selections are made. FTA will grant pre-award authority starting on the date of the project award announcement for selected projects and should be completed within 24 months from the date of award. Funds are available only for eligible expenses incurred after the announcement of project selections.

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

5311) formula funds, and Indian tribes. Eligible applicants are limited to FTA grantees or subrecipients who would be the primary beneficiaries of the innovative products and services that are developedâtypically public transit agencies. Except for projects proposed by Indian tribes, proposals for projects in rural (non-urbanized) areas must be submitted as part of a consolidated State proposal.

States and other eligible applicants also may submit consolidated proposals for projects in urbanized areas. The submission of the Statewide application will not preclude the submission and consideration of any application from other eligible recipients in an urbanized area in a State. Proposals may contain projects to be implemented by the recipient or its subrecipients.

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

FTA may give additional consideration to applicants that propose a local share and may view these applicants as more competitive. The applicant must document the source(s) of the local match, if any, in the grant application. For any applicants proposing match, eligible local match sources include the following.

Cash from non-Government sources other than revenues from providing public transportation services. Revenues derived from the sale of advertising and concessions. Revenues generated from value capture financing mechanisms.

Funds from an undistributed cash surplus. Replacement or depreciation cash fund or reserve. New capital.

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

Exposure mitigation measures such a real-time notification of rail and bus passenger loads. New multi-modal payment innovative mobility systems such as contactless payments. And measures that strengthen public confidence in transit.

Each applicant may only submit one proposal.Start Printed Page 63655 D. Application and Submission Information (1) Address and Form of Application Submission Applications must be submitted through GRANTS.GOV. Applicants can find general information for submitting applications through GRANTS.GOV at www.fta.dot.gov/âhowtoapply, along with specific instructions for the forms and attachments required for submission.

Mail and fax submissions will not be accepted. (2) Content and Form of Application Submission a. Proposal Submission A complete proposal submission consists of at least two forms.

1. The SF-424 Mandatory Form (downloadable from GRANTS.GOV) and 2. The supplemental form for the FY 2020 antifungal medication Demonstration Program (downloadable from GRANTS.GOV), which is available on FTA's website at (placeholder for FTA antifungal medication Demonstration Program).

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

FTA encourages applicants to consider submitting a single supplemental form that includes multiple activities to be evaluated as a consolidated proposal. Applicants may attach additional supporting information to the SF-424 submission, including but not limited to letters of support, project budgets, or excerpts from relevant planning documents. Supporting documentation must be described and referenced by file name in the appropriate response section of the supplemental form, or it may not be reviewed.

Information such as applicant name, Federal amount requested, local match amount, description of areas served, etc., may be requested in varying degrees of detail on both the SF-424 form and supplemental form. Applicants must fill in all fields unless stated otherwise on the forms. If applicants copy information into the supplemental form from another source, they should verify that the supplemental form has fully captured pasted text and that it has not truncated the text due to character limits built into the form.

Applicants should use both the âCheck Package for Errorsâ and the âValidate Formâ validation buttons on both forms to check all required fields. Applicants should also ensure that the Federal and local amounts specified are consistent. Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage.

Consistent with the R.O.U.T.E.S. Initiative, the Department encourages applicants to consider how the project will address the challenges faced by rural areas. B.

Application Content The SF-424 Mandatory Form and the supplemental form will prompt applicants for the required information, including. I. Applicant Name ii.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number iii. Key contact information (contact name, address, email address, and phone number) iv. Congressional district(s) where project will take place v.

Project Information (title, executive summary, and type) vi. A detailed description of the need for the project vii. A detailed description of how the project will support the Program objectives viii.

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

Details on the local matching funds xii. A detailed project timeline xiii. Whether the project impacts an Opportunity Zone (3) Unique Entity Identifier and System for Award Management (SAM) Each applicant is required to.

(1) Be registered in SAM before submitting an application. (2) provide a valid unique entity identifier in its application. And (3) continue to maintain an active SAM registration with current information at all times during which the applicant has an active Federal award or an application or plan under consideration by FTA.

These requirements do not apply if the applicant. (1) Is excepted from the requirements under 2 CFR 25.110(b) or (c). Or (2) has an exception approved by FTA under 2 CFR 25.110(d).

FTA may not make an award until the applicant has complied with all applicable unique entity identifier and SAM requirements. If an applicant has not fully complied with the requirements by the time FTA is ready to make an award, FTA may determine that the applicant is not qualified to receive an award and use that determination as a basis for making a Federal award to another applicant. All applicants must provide a unique entity identifier provided by SAM.

Registration in SAM may take as little as 3-5 business days, but there can be unexpected steps or delays. For example, the applicant may need to obtain an Employer Identification Number. FTA recommends allowing ample time, up to several weeks, to complete all steps.

For additional information on obtaining a unique entity identifier, please visit www.sam.gov. (4) Submission Dates and Times Project proposals must be submitted electronically through GRANTS.GOV by 11:59 p.m. Eastern on November 2, 2020.

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

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

(1) Confirmation of successful transmission to GRANTS.GOV. And (2) confirmation of successful validation by GRANTS.GOV. If the applicant does not receive confirmation of successful validation or receives a notice of failed validation or incomplete materials, the applicant must address the reason for the failed validation, as described in the email notice, and resubmit before the submission deadline.

If making a resubmission for any reason, applicants must include all original attachments regardless of which attachments were updated and check the box on the supplemental form indicating this is a resubmission. Applicants are encouraged to begin the process of registration on the GRANTS.GOV site well in advance of the submission deadline. Registration is Start Printed Page 63656a multi-step process, which may take several weeks to complete before an application can be submitted.

Registered applicants may still be required to update their registration before submitting an application. Registration in SAM is renewed annually and persons making submissions on behalf of the Authorized Organization Representative (AOR) must be authorized in GRANTS.GOV by the AOR to make submissions. (5) Funding Restrictions Funds may be used for post-award expenditures only.

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

The applicant must provide a clear explanation of how a reduced award would affect the project budget and scope. FTA may award a lesser amount whether or not the applicant provides a scalable option. E.

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

(b) Project Approach. (c) National Applicability. (d) Commercialization and/or Knowledge Transfer.

And (e) Technical, Legal and Financial Capacity. FTA encourages each applicant to demonstrate how a project supports all criteria with the most relevant information the applicant can provide, regardless of whether such information has been specifically requested or identified in this notice. A.

Project Innovation and Impact i. Effectiveness of the project in achieving and demonstrating the specific objectives of this program. Ii.

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

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

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

National Applicability i. Degree to which the project could be replicated by other transit agencies regionally or nationally. Ii.

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

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

Ii. How the project team plans to work with the industry on improving best practices, guidance and/or standards, if applicable. Iii.

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

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

The FTA Administrator will consider the following key DOT objectives. A. Utilizing alternative funding sources and innovative financing models to attract non-Federal sources of investment.

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

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

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

Federal Award Administration Information (1) Federal Award Notices FTA will announce the final project selections on the FTA website. Project recipients should contact their FTA Regional Office for additional information regarding allocations for Start Printed Page 63657projects. At the time project selections are announced, FTA will extend pre-award authority for the selected projects.

There is no blanket pre-award authority for these projects before announcement. There is no minimum or maximum grant award amount, but FTA intends to fund as many meritorious projects as possible. FTA only will consider proposals from eligible recipients for eligible activities.

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

Pre-Award Authority FTA will issue specific guidance to recipients regarding pre-award authority at the time of selection. FTA does not provide pre-award authority for competitive funds until projects are selected, and there are Federal requirements that must be met before costs are incurred. For more information about FTA's policy on pre-award authority, see the FY 2020 Apportionments Notice published on June 3, 2020, at https://www.govinfo.gov/âcontent/âpkg/âFR-2020-06-03/âpdf/â2020-11946.pdf.

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

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

The applicant acknowledges that it is under a continuing obligation to comply with the terms and conditions of the grant agreement issued for its project with FTA. The applicant understands that Federal laws, regulations, policies, and administrative practices might be modified from time to time and may affect the implementation of the project. The applicant agrees that the most recent Federal requirements will apply to the project unless FTA issues a written determination otherwise.

The applicant must submit the Certifications and Assurances before receiving a grant if it does not have current certifications on file. E. Free Speech and Religious Liberty In connection with any program or activity conducted with or benefiting from funds awarded under this notice, recipients of funds must comply with all applicable requirements of Federal law, including, without limitation, the Constitution of the United States.

Statutory, regulatory, and public policy requirements, including without limitation, those protecting free speech, religious liberty, public welfare, the environment, and prohibiting discrimination. The conditions of performance, non-discrimination requirements, and other assurances made applicable to the award of funds in accordance with regulations of the Department of Transportation. And applicable Federal financial assistance and contracting principles promulgated by the Office of Management and Budget.

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

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

FTA may request data and reports to support the evaluation and Annual Report. A. Independent Evaluation To achieve a comprehensive understanding of the impacts and implications of each proposed antifungal medication Research Demonstration Program, projects funded under this announcement will require the recipient to conduct a third party independent evaluation of their project.

Recipients will be required to contract with a third party independent evaluator to assist in developing an evaluation plan, and collecting, storing and managing data required to fulfill the evaluation requirement. No more than 10 percent of the Federal share of the project may be used to hire the third-party independent evaluator and the inclusion of a third-party independent evaluation should be described in the grant application. If the project duration is more than two years, an interim evaluation report would need to be submitted to FTA, otherwise the evaluation report should be included as part of the final project report.

B. antifungal medication Research Demonstration Grant Program Evaluation Projects funded under this announcement will be required to establish a set of performance metrics set by the third-party independent evaluator and shared with FTA. G.

Federal Awarding Agency Contacts Information For questions about applying, please contact Jamel El-Hamri email. Jamel.El-Hamri@dot.gov phone. 202-366-8985.

A TDD is available at 1-800-877-8339 (TDDFIRS). To ensure that applicants receive accurate information about eligibility or the program, applicants are encouraged to contact FTA directly with questions, rather than through intermediaries or third parties.Start Printed Page 63658 FTA staff also may conduct briefings on the competitive grants selection and award process upon request. Start Signature K.

Jane Williams, Deputy Administrator. End Signature End Supplemental Information [FR Doc. 2020-22316 Filed 10-7-20.

GREAT FALLS, diflucan for sale online Mont can i buy diflucan at walgreens. Â For months, the jail in central Montanaâs Cascade County was free of the antifungals, which seemed as distant a threat as it did in much of the nationâs rural Mountain West.Then a few people who had the diflucan were arrested. By the time Paul Krogue, the jailâs medical director, realized there was a problem, nearly 50 inmates were infected in the jail, where some had can i buy diflucan at walgreens been sleeping on mats on an overcrowded floor. After several weeks, Mr.

Krogue got a call that s were spreading to a side of the jail that had been diflucan-free.He hung up the phone and put his head in his hands.âI just kind of lost it, like, âMy God, I donât know how much longer can i buy diflucan at walgreens I can do this,ââ Mr. Krogue, a nurse practitioner, recalled. ÂI was just scared that Iâm not going to be able to see it through, that Iâm going to get sick â you just feel so exhausted and itâs just a lot.âThe Mountain West, which for months avoided the worst of the diflucan, has rapidly devolved into one of the most alarming hot spots in a country that recorded its eight millionth confirmed case on Thursday, a day when more than 65,000 cases were announced nationwide, the most in a single day since July.Seventeen states, including many in the Mountain West, have added more cases in the past week than any other week of the diflucan. And the can i buy diflucan at walgreens spread through sparsely populated areas of rural America has created problems in small towns that lack critical resources â including doctors â even in ordinary times.Wyoming, which did not have 1,000 total cases until June, recently added more than 1,000 in a single week.

Reports of new s have recently reached record levels in Alaska, Colorado and Idaho. And Montana, where more than half of the stateâs cases have been announced since August, is averaging more than 500 cases per day.In Cascade County, more than 300 inmates and staff members have been infected in a facility meant to hold 365 people, can i buy diflucan at walgreens the countyâs first major outbreak in a region where the diflucan is suddenly surging.The county seat, Great Falls, is seeing its worst case numbers yet. The local hospital and its 27-bed antifungal medication unit is at capacity. The county health department is racing to hire new contact tracers.

And Mr can i buy diflucan at walgreens. Krogue, who also teaches nursing at Montana State Universityâs Great Falls campus, has seen attendance in his classes dwindle as students fall ill or quarantine.âI was just scared that Iâm not going to be able to see it through, that Iâm going to get sick,â said Paul Krogue, the jailâs medical director.Credit...Tailyr Irvine for The New York TimesOne place where the s have spread has been local jails, which are confined, often crowded spaces. Jails are staples of local communities and tend to can i buy diflucan at walgreens have people coming and going more quickly than prisons. Jails can hold everyone from people awaiting criminal trials for months to those picked up for a suspended driverâs license for a few hours.

With so many can i buy diflucan at walgreens people filtering in and out, jails pose extra risks for the diflucanâs spread â not only inside facilities but in potentially feeding outbreaks in the rest of the community.Nationally, jails and prisons have seen disproportionate rates of and death, with a mortality rate twice as high as in the general population and an rate more than four times as high, according to recent data.A New York Times database has tracked clusters of at least 50 antifungals cases in a dozen rural jails in Montana, Idaho, Utah and New Mexico during the diflucan. Among them. The Purgatory Correctional Center in Hurricane, Utah, with 166 s. The jail in Twin can i buy diflucan at walgreens Falls, Idaho, with 279.

And, in New Mexico, the Cibola County Correctional Center, which has reported 357 cases.In Cascade County, s at the jail make up about a quarter of all known diflucan cases in the county. Health authorities say that the jailâs outbreak, which began in mid-August, can i buy diflucan at walgreens was not believed to be the main cause of the communityâs recent surge, but that it had led to some cases. In the past two months, Mr. Krogue said, the jail released 29 people who were considered actively infected.s at the jail make up about a quarter of Cascade Countyâs known diflucan cases.Credit...Tailyr Irvine for The New York TimesGreat Falls, home to about 58,000 residents, is in the less mountainous part of Montana, with the Missouri River flowing through and a large oil refinery on its banks.

The Cascade County Detention Center sits along a can i buy diflucan at walgreens highway at the edge of town. Drive five miles in any direction and you are surrounded by wide-open plains.Montana requires that masks be worn inside businesses and indoor public spaces, and many people in Great Falls wear them when walking around downtownâs Central Avenue, where shops and cafes are still recovering from shutting down in the spring. Others go without masks, citing the open space and lack of can i buy diflucan at walgreens crowds.Bob Kelly, the mayor, said people had not been overly worried about how the jail outbreak might affect the rest of town when it started.âI think that by the very definition of a jail, hopefully, the disease will be incarcerated, as well as the patients,â he said. ÂIs there concern?.

Sure, thereâs can i buy diflucan at walgreens concern. But is there overreaction?. No.âThe mayor of Great Falls said that residents had considered the jailâs outbreak a distant concern at first.Credit...Tailyr Irvine for The New York TimesSome residentsâ nonchalance about the risks of the diflucan, said Mr. Krogue, the jailâs medical director, can be traced to a spring and early summer when almost can i buy diflucan at walgreens no one in Cascade County knew anyone who had been sickened.âWe benefited from that early on,â he said.

ÂBut in some ways, I think it did us a disservice, too, because it also created a certain level of complacency.âThat has quickly shifted now, he said, as cases have spiked.The number of active cases known to county officials on any given day has risen sharply to about 600, according to Trisha Gardner, Cascade Countyâs health officer. The county can i buy diflucan at walgreens has seen 1,261 cases and six deaths during the diflucan, a Times database shows. Some of the cases have been tied to the jail outbreak, she said, and others have been connected to bars and restaurants. Even figuring out what has led to some cases has been complex, she said, as residents have been reluctant to cooperate with contact tracers.âOur hospitals are at capacity, our public health system is at capacity,â she said.

ÂItâs not sustainable at this rate.âWhen the outbreak at the jail began, social distancing was can i buy diflucan at walgreens impossible, the authorities said. Three inmates shared cells designed for two. At night, can i buy diflucan at walgreens men slept on thin blue pads in every available space. On the floor in the day room, in shower stalls, in stairwells, in hallways outside of cells.Inmates did not receive masks until August, and jail officials said many have refused to wear them.In interviews with more than a dozen inmates and their family members, inmates described the jail during the outbreak as chaotic and unsanitary.

They said their pleas for help often went unanswered by nurses and guards.Newly arriving inmates were not always quarantined from one another before their test results were known because of a lack of space, inmates and jail officials said.Owen Hawley, 30, said every inmate in his living area of 38 men had tested positive for the diflucan. He said he had been can i buy diflucan at walgreens unable to eat for three days, had intensive body aches and suffered from a headache so powerful it felt as if it was âbehind my eyes.ââAfter the fourth day of like, not eating and stuff, I just shut off, you know?. Â he said.A jail area set aside for quarantining new inmates.Credit...Tailyr Irvine for The New York TimesAt one point, Mr. Hawley said, he and other prisoners protested the way the diflucan was being handled by refusing to leave their living areas and by blocking new inmates from can i buy diflucan at walgreens entering.

Everyone was ultimately tested, Mr. Hawley said, and each prisoner was given a disposable mask.Sierra Jasmine Wells, 25, another inmate, said women can i buy diflucan at walgreens in her dormitory had grown ill, one after the next.âEveryone around me was getting sick and it was tough on me,â she said. ÂBy then, I had already accepted the fact that I was going to get sick.âWhen she became infected, she said, she was given cough syrup and Tylenol.âI kind of was just left alone to deal with it,â she said.Jesse Slaughter, the county sheriff who oversees the jail, said that the jailâs medical staff was doing everything it could, and that he had been seeking health care assistance from other counties. Officials defended their handling of the outbreak, noting that all inmates received standard medications including Tylenol twice a day and were taken to area hospitals when they needed added care.

Seven inmates, as well as some staff members, were can i buy diflucan at walgreens hospitalized. No one from the jail has died from the diflucan, officials said.Sheriff Jesse Slaughter, who oversees the jail, said he had been seeking health care assistance from other counties.Credit...Tailyr Irvine for The New York TimesMr. Krogue said that since the start of the outbreak he had been working up to can i buy diflucan at walgreens 16 hours each day and sleeping in his basement, away from his wife and children. He remains healthy but says he fears bringing the diflucan home.

The diflucan has slowed some in the jail, and officials have moved some inmates to other facilities, but other prisons and jails in the state are now seeing outbreaks.âYou can start to see what some of these other places experienced much earlier on, and we just didnât have that experience, but itâs certainly happening now,â Mr. Krogue said can i buy diflucan at walgreens. ÂItâs just real in a way that it wasnât.âLucy Tompkins reported from Great Falls, Maura Turcotte from Chicago and Libby Seline from Lincoln, Neb. Reporting was contributed by Izzy ColÃ³n from Columbia, Mo., Brendon Derr from can i buy diflucan at walgreens Phoenix, Rebecca Griesbach from Tuscaloosa, Ala., Danya Issawi and Timothy Williams from New York, Ann Hinga Klein from Des Moines, K.B.

Mensah from Silver Spring, Md., and Mitch Smith from Chicago.Start Preamble Federal Transit Administration (FTA), DOT. Notice of funding opportunity can i buy diflucan at walgreens. The antifungals Disease 2019 (antifungal medication) public health emergency Start Printed Page 63654has had a significant impact on transit operations. During a series of FTA listening sessions held over the last three months, transit agencies asked FTA to support research to identify solutions to address the operational challenges that they are facing as a result of antifungal medication.

In response, FTA makes available through this Notice of Funding Opportunity (NOFO) funding to support research demonstration grants to public transit agencies to develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance can i buy diflucan at walgreens the mobility of transit users affected by the antifungal medication public health emergency. Demonstration grants under this NOFO are authorized under FTA's Public Transportation Innovation Program (49 U.S.C. 5312). Eligible projects will demonstrate innovative solutions to improve the operational efficiencies of transit systems and enhance mobility for their communities in four major areas.

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

The total funding available for awards under this NOFO is $10,000,000. FTA may supplement this amount if additional funding becomes available. Applicants must submit completed proposals for funding opportunity FTA-2020-015-TRI through the GRANTS.GOV âAPPLYâ function by 11:59 p.m. Eastern Time on November 2, 2020.

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

Program Description B. Federal Award Information C. Eligibility Information D. Application and Submission Information E.

Application Review Information F. Federal Award Administration Information G. Federal Awarding Agency Contact Information A. Program Description The Public Transportation antifungal medication Research Demonstration Grant Program is funded through the Public Transportation Innovation Program (49 U.S.C.

5312), with the goal to develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the antifungal medication public health emergency. Eligible projects will propose to develop and deploy innovative solutions in four major areas. (1) Vehicle, facility, equipment and infrastructure cleaning and dis. (2) exposure mitigation measures.

(3) innovative mobility such as contactless payments. And (4) measures that strengthen public confidence in transit. As required by 49 U.S.C. 5312(e)(4), projects funded under this NOFO must participate in an evaluation by an independent outside entity that will conduct a comprehensive evaluation of the success or failure of the projects funded under this subsection and any plan for broad-based implementation of the innovation promoted by successful projects.

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

FTA will grant pre-award authority starting on the date of the project award announcement for selected projects and should be completed within 24 months from the date of award. Funds are available only for eligible expenses incurred after the announcement of project selections. C. Eligibility Information (1) Eligible Applicants Eligible applicants include State and local governmental authorities, direct recipients of Urbanized Area (49 U.S.C.

5307) and Rural Area (49 U.S.C. 5311) formula funds, and Indian tribes. Eligible applicants are limited to FTA grantees or subrecipients who would be the primary beneficiaries of the innovative products and services that are developedâtypically public transit agencies. Except for projects proposed by Indian tribes, proposals for projects in rural (non-urbanized) areas must be submitted as part of a consolidated State proposal.

Eligible applicants may submit consolidated proposals for projects. (2) Cost Sharing or Matching The maximum Federal share of project costs is 100 percent. FTA may give additional consideration to applicants that propose a local share and may view these applicants as more competitive. The applicant must document the source(s) of the local match, if any, in the grant application.

For any applicants proposing match, eligible local match sources include the following. Cash from non-Government sources other than revenues from providing public transportation services. Revenues derived from the sale of advertising and concessions. Revenues generated from value capture financing mechanisms.

Funds from an undistributed cash surplus. Replacement or depreciation cash fund or reserve. New capital. Or in-kind contributions.

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

And measures that strengthen public confidence in transit. Each applicant may only submit one proposal.Start Printed Page 63655 D. Application and Submission Information (1) Address and Form of Application Submission Applications must be submitted through GRANTS.GOV. Applicants can find general information for submitting applications through GRANTS.GOV at www.fta.dot.gov/âhowtoapply, along with specific instructions for the forms and attachments required for submission.

Mail and fax submissions will not be accepted. (2) Content and Form of Application Submission a. Proposal Submission A complete proposal submission consists of at least two forms. 1.

The SF-424 Mandatory Form (downloadable from GRANTS.GOV) and 2. The supplemental form for the FY 2020 antifungal medication Demonstration Program (downloadable from GRANTS.GOV), which is available on FTA's website at (placeholder for FTA antifungal medication Demonstration Program). The application must include responses to all sections of the SF-424 mandatory form and the supplemental form unless a section is indicated as optional. FTA will use the information on the supplemental form to determine applicant and project eligibility for the program and to evaluate the proposal against the selection criteria described in part E of this notice.

FTA will accept only one supplemental form per SF-424 submission. FTA encourages applicants to consider submitting a single supplemental form that includes multiple activities to be evaluated as a consolidated proposal. Applicants may attach additional supporting information to the SF-424 submission, including but not limited to letters of support, project budgets, or excerpts from relevant planning documents. Supporting documentation must be described and referenced by file name in the appropriate response section of the supplemental form, or it may not be reviewed.

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

B. Application Content The SF-424 Mandatory Form and the supplemental form will prompt applicants for the required information, including. I. Applicant Name ii.

A detailed description of the need for the project vii. A detailed description of how the project will support the Program objectives viii. Evidence that the applicant can provide the local cost shares ix. A description of the technical, legal, and financial capacity of the applicant x.

A detailed project budget xi. Details on the local matching funds xii. A detailed project timeline xiii. Whether the project impacts an Opportunity Zone (3) Unique Entity Identifier and System for Award Management (SAM) Each applicant is required to.

(1) Is excepted from the requirements under 2 CFR 25.110(b) or (c). Or (2) has an exception approved by FTA under 2 CFR 25.110(d). FTA may not make an award until the applicant has complied with all applicable unique entity identifier and SAM requirements. If an applicant has not fully complied with the requirements by the time FTA is ready to make an award, FTA may determine that the applicant is not qualified to receive an award and use that determination as a basis for making a Federal award to another applicant.

All applicants must provide a unique entity identifier provided by SAM. Registration in SAM may take as little as 3-5 business days, but there can be unexpected steps or delays. For example, the applicant may need to obtain an Employer Identification Number. FTA recommends allowing ample time, up to several weeks, to complete all steps.

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

Within 48 hours after submitting an electronic application, the applicant should receive two email messages from GRANTS.GOV. (1) Confirmation of successful transmission to GRANTS.GOV. And (2) confirmation of successful validation by GRANTS.GOV. If the applicant does not receive confirmation of successful validation or receives a notice of failed validation or incomplete materials, the applicant must address the reason for the failed validation, as described in the email notice, and resubmit before the submission deadline.

Registration in SAM is renewed annually and persons making submissions on behalf of the Authorized Organization Representative (AOR) must be authorized in GRANTS.GOV by the AOR to make submissions. (5) Funding Restrictions Funds may be used for post-award expenditures only. Funds under this NOFO cannot be used to reimburse projects for otherwise eligible expenses incurred prior to the date of project award announcements. (6) Other Submission Requirements FTA encourages applicants to identify scaled funding options in case insufficient funding is available to fund a project at the full requested amount.

If an applicant indicates that a project is scalable, the applicant must provide an appropriate minimum funding amount that will fund an eligible project that achieves the objectives of the program and meets all relevant program requirements. The applicant must provide a clear explanation of how a reduced award would affect the project budget and scope. FTA may award a lesser amount whether or not the applicant provides a scalable option. E.

Application Review Information (1) Project Evaluation Criteria Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage. Consistent with the R.O.U.T.E.S. Initiative, the Department will consider how the project will address the challenges faced by rural areas. In addition, the Department will review and consider applications for funding pursuant to this Notice in accordance with the President's September 2, 2020 memorandum, entitled Memorandum on Reviewing Funding to State and Local Government Recipients of Federal Funds that Are Permitting Anarchy, Violence, and Destruction in American Cities, consistent with guidance from the Office of Management and Budget and the Attorney General and with all applicable laws.

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

(d) Commercialization and/or Knowledge Transfer. And (e) Technical, Legal and Financial Capacity. FTA encourages each applicant to demonstrate how a project supports all criteria with the most relevant information the applicant can provide, regardless of whether such information has been specifically requested or identified in this notice. A.

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

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

Quality of the project approach such as existing partnerships, collaboration strategies and level of commitment of the project partners. Ii. Proposal is realistic in its approach to fulfill the milestones/deliverables, schedule and goals. C.

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

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

Demonstrates a realistic plan for moving the results of the project into the transit marketplace (patents, conferences, articles in trade magazines, webinar, site visits, etc.). Ii. How the project team plans to work with the industry on improving best practices, guidance and/or standards, if applicable. Iii.

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

(2) Review and Selection Process An FTA technical evaluation committee will evaluate proposals based on the published project evaluation criteria. Members of the technical evaluation committee will rate the applications and may seek clarification about any statement in an application. The FTA Administrator will determine the final selection and amount of funding for each project after consideration of the findings of the technical evaluation committee. Geographic diversity, diversity of the project type, the amount of local match to be provided, and the applicant's receipt and management of other Federal transit funds may be considered in FTA's award decisions.

Prior fare payment innovation efforts may receive priority consideration. The FTA Administrator will consider the following key DOT objectives. A. Utilizing alternative funding sources and innovative financing models to attract non-Federal sources of investment.

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

The extent to which the project addresses challenges specific to the provision of rural public transportation. (3) FAPIIS Review Prior to making a grant award, FTA is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) accessible through SAM. An applicant may review and comment on information about itself that a Federal awarding agency previously entered. FTA will consider any comments by the applicant, in addition to the other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 2 CFR 200.205 Federal Awarding Agency Review of Risk Posed by Applicants.

F. Federal Award Administration Information (1) Federal Award Notices FTA will announce the final project selections on the FTA website. Project recipients should contact their FTA Regional Office for additional information regarding allocations for Start Printed Page 63657projects. At the time project selections are announced, FTA will extend pre-award authority for the selected projects.

In those cases, applicants must be able to demonstrate that the proposed projects are still viable and can be completed with the amount awarded. (2) Administrative and National Policy Requirements a. Pre-Award Authority FTA will issue specific guidance to recipients regarding pre-award authority at the time of selection. FTA does not provide pre-award authority for competitive funds until projects are selected, and there are Federal requirements that must be met before costs are incurred.

For more information about FTA's policy on pre-award authority, see the FY 2020 Apportionments Notice published on June 3, 2020, at https://www.govinfo.gov/âcontent/âpkg/âFR-2020-06-03/âpdf/â2020-11946.pdf. b. Grant Requirements Selected applicants will submit a grant application through FTA's electronic grant management system and adhere to the customary FTA grant requirements for research project (insert Circular name). All competitive grants, regardless of award amount, will be subject to the Congressional notification and release process.

FTA emphasizes that third-party procurement applies to all funding awards, as described in FTA Circular 4220.1F, âThird Party Contracting Guidance.â However, FTA may approve applications that include a specifically identified partnering organization(s) (2 CFR 200.302(f)). When included, the application, budget, and budget narrative should provide a clear understanding of how the selection of these organizations is critical for the project and give sufficient detail about the costs involved. C. Planning FTA encourages applicants to engage the appropriate State Departments of Transportation, Regional Transportation Planning Organizations, or Metropolitan Planning Organizations in areas to be served by the project funds available under this program.

D. Standard Assurances The applicant assures that it will comply with all applicable Federal statutes, regulations, executive orders, FTA circulars, and other Federal administrative requirements in carrying out any project supported by the FTA grant. The applicant acknowledges that it is under a continuing obligation to comply with the terms and conditions of the grant agreement issued for its project with FTA. The applicant understands that Federal laws, regulations, policies, and administrative practices might be modified from time to time and may affect the implementation of the project.

The applicant agrees that the most recent Federal requirements will apply to the project unless FTA issues a written determination otherwise. The applicant must submit the Certifications and Assurances before receiving a grant if it does not have current certifications on file. E. Free Speech and Religious Liberty In connection with any program or activity conducted with or benefiting from funds awarded under this notice, recipients of funds must comply with all applicable requirements of Federal law, including, without limitation, the Constitution of the United States.

If the Department determines that a recipient has failed to comply with applicable Federal requirements, the Department may terminate the award of funds and disallow previously incurred costs, requiring the recipient to reimburse any expended award funds. (3) Reporting The post-award reporting requirements include submission of the Federal Financial Report (FFR) and Milestone Progress Report in TrAMS. An evaluation of the grant will occur at various points in the demonstration process and at the end of the project. In addition, FTA is responsible for producing an Annual Report to Congress that compiles evaluation of selected projects, including an evaluation of the performance measures identified by the applicants.

All applicants must develop an evaluation plan to measure the success or failure of their projects and describe any plans for broad-based implementation of successful projects. FTA may request data and reports to support the evaluation and Annual Report. A. Independent Evaluation To achieve a comprehensive understanding of the impacts and implications of each proposed antifungal medication Research Demonstration Program, projects funded under this announcement will require the recipient to conduct a third party independent evaluation of their project.

antifungal medication Research Demonstration Grant Program Evaluation Projects funded under this announcement will be required to establish a set of performance metrics set by the third-party independent evaluator and shared with FTA. G. Federal Awarding Agency Contacts Information For questions about applying, please contact Jamel El-Hamri email. Jamel.El-Hamri@dot.gov phone.

202-366-8985. A TDD is available at 1-800-877-8339 (TDDFIRS). To ensure that applicants receive accurate information about eligibility or the program, applicants are encouraged to contact FTA directly with questions, rather than through intermediaries or third parties.Start Printed Page 63658 FTA staff also may conduct briefings on the competitive grants selection and award process upon request. Start Signature K.

Jane Williams, Deputy Administrator. End Signature End Supplemental Information [FR Doc. 2020-22316 Filed 10-7-20. 8:45 am]BILLING CODE 4910-57-P.

;