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Start Preamble Food ventolin cost per pill http://www.smhgg.org.uk/where-can-i-buy-ventolin-nebules-online/ and Drug Administration, HHS. Notice of availability. The Food and Drug ventolin cost per pill Administration (FDA or Agency) is announcing the availability of FDA guidance documents related to the asthma Disease 2019 (asthma treatment) public health emergency (PHE). This notice of availability (NOA) is pursuant to the process that FDA announced, in the Federal Register of March 25, 2020, for making available to the public asthma treatment-related guidances. The guidances identified in this notice address issues related to the asthma treatment PHE and have been issued in accordance ventolin cost per pill with the process announced in the March 25, 2020, notice.

The guidances have been implemented without prior comment, but they remain subject to comment in accordance with the Agency's good guidance practices. The announcement of the guidances is published in the Federal Register on November 18, ventolin cost per pill 2020. You may submit either electronic or written comments on Agency guidances at any time as follows. Electronic Submissions ventolin cost per pill Submit electronic comments in the following way. Federal eRulemaking Portal.

Https://www.regulations.gov. Follow the instructions for submitting comments. Comments submitted electronically, including attachments, to https://www.regulations.gov will be posted to the docket unchanged. Because your comment will be made public, you are solely responsible for ensuring that your comment does not include any confidential information that you or a third party may not wish to be posted, such as medical information, your or anyone else's Social Security number, or confidential business information, such as a manufacturing process. Please note that if you include your name, contact information, or other information that identifies you in the body of your comments, that information will be posted on https://www.regulations.gov.

If you want to submit a comment with confidential information that you do not wish to be made available to the public, submit the comment as a written/paper submission and in the manner detailed (see “Written/Paper Submissions” and “Instructions”). Written/Paper Submissions Submit written/paper submissions as follows. Mail/Hand Delivery/Courier (for written/paper submissions). Dockets Management Staff (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852.

For written/paper comments submitted to the Dockets Management Staff, FDA will post your comment, as well as any attachments, except for information submitted, marked and identified, as confidential, if submitted as detailed in “Instructions.” Instructions. All submissions received must include the name of the guidance Start Printed Page 73486document that the comments address and the docket number for the guidance (see table 1). Received comments will be placed in the docket(s) and, except for those submitted as “Confidential Submissions,” publicly viewable at https://www.regulations.gov or at the Dockets Management Staff between 9 a.m. And 4 p.m., Monday through Friday, 240-402-7500. Confidential Submissions—To submit a comment with confidential information that you do not wish to be made publicly available, submit your comments only as a written/paper submission.

You should submit two copies total. One copy will include the information you claim to be confidential with a heading or cover note that states “THIS DOCUMENT CONTAINS CONFIDENTIAL INFORMATION.” The Agency will review this copy, including the claimed confidential information, in its consideration of comments. The second copy, which will have the claimed confidential information redacted/blacked out, will be available for public viewing and posted on https://www.regulations.gov. Submit both copies to the Dockets Management Staff. If you do not wish your name and contact information to be made publicly available, you can provide this information on the cover sheet and not in the body of your comments and you must identify this information as “confidential.” Any information marked as “confidential” will not be disclosed except in accordance with 21 CFR 10.20 and other applicable disclosure law.

For more information about FDA's posting of comments to public dockets, see 80 FR 56469, September 18, 2015, or access the information at. Https://www.govinfo.gov/​content/​pkg/​FR-2015-09-18/​pdf/​2015-23389.pdf. Docket. For access to the docket to read background documents or the electronic and written/paper comments received, go to https://www.regulations.gov and insert the docket number, found in brackets in the heading of this document, into the “Search” box and follow the prompts and/or go to the Dockets Management Staff, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852, 240-402-7500.

You may submit comments on any guidance at any time (see § 10.115(g)(5) (21 CFR 10.115(g)(5))). Submit written requests for single copies of these guidances to the address noted in table 1. Send two self-addressed adhesive labels to assist that office in processing your requests. See the SUPPLEMENTARY INFORMATION section for electronic access to the guidances. Start Further Info Stephen Ripley, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration, 10903 New Hampshire Ave., Bldg.

71, Rm. 7301, Silver Spring, MD 20993-0002, 240-402-7911, or Erica Takai, Center for Devices and Radiological Health (CDRH), Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 66, Rm. 5456, Silver Spring, MD 20993-0002, 301-796-6353. End Further Info End Preamble Start Supplemental Information I.

Background On January 31, 2020, as a result of confirmed cases of asthma treatment, and after consultation with public health officials as necessary, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority under section 319 of the Public Health Service Act (42 U.S.C. 247d) (PHS Act), determined that a PHE exists and has existed since January 27, 2020, nationwide.[] On March 13, 2020, President Donald J. Trump declared that the asthma treatment outbreak in the United States constitutes a national emergency, beginning March 1, 2020.[] In the Federal Register of March 25, 2020 (85 FR 16949) (the March 25, 2020, notice) (available at https://www.govinfo.gov/​content/​pkg/​FR-2020-03-25/​pdf/​2020-06222.pdf), FDA announced procedures for making available FDA guidances related to the asthma treatment PHE. These procedures, which operate within FDA's established good guidance practices regulations, are intended to allow FDA to rapidly disseminate Agency recommendations and policies related to asthma treatment to industry, FDA staff, and other stakeholders.

The March 25, 2020, notice stated that due to the need to act quickly and efficiently to respond to the asthma treatment PHE, FDA believes that prior public participation will not be feasible or appropriate before FDA implements asthma treatment-related guidances. Therefore, FDA will issue asthma treatment-related guidances for immediate implementation without prior public comment (see section 701(h)(1)(C) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 371(h)(1)(C)) and § 10.115(g)(2)). The guidances are available on FDA's web pages entitled “asthma treatment-Related Guidance Documents for Industry, FDA Staff, and Other Stakeholders” (available at. Https://www.fda.gov/​emergency-preparedness-and-response/​mcm-issues/​asthma treatment-related-guidance-documents-industry-fda-staff-and-other-stakeholders) and “Search for FDA Guidance Documents” (available at.

Https://www.fda.gov/​regulatory-information/​search-fda-guidance-documents). The March 25, 2020, notice further stated that, in general, rather than publishing a separate NOA for each asthma treatment-related guidance, FDA intends to publish periodically a consolidated NOA announcing the availability of certain asthma treatment-related guidances that FDA issued during the relevant period, as included in table 1. This notice announces asthma treatment-related guidances that are posted on FDA's website. II. Availability of asthma treatment-Related Guidance Documents Pursuant to the process described in the March 25, 2020, notice, FDA is announcing the availability of the following asthma treatment-related guidances.

Table 1—Guidances Related to the asthma treatment Public Health EmergencyDocket No.CenterTitle of guidanceContact information to request single copiesFDA-2020-D-1137CBEREmergency Use Authorization for treatments to Prevent asthma treatment (October 2020)Office of Communication, Outreach and Development, 10903 New Hampshire Ave., Bldg. 71, Rm. 3128, Silver Spring, MD 20993-0002. 1-800-835-4709 or 240-402-8010. Email ocod@fda.hhs.gov.Start Printed Page 73487FDA-2020-D-1138CDRHEnforcement Policy for Modifications to FDA Cleared Molecular Influenza and RSV Tests During the asthma Disease 2019 (asthma treatment) Public Health Emergency (October 2020)CDRH—Guidance@fda.hhs.gov/.

Please include the document number 20046 and complete title of the guidance in the request. Although these guidances have been implemented immediately without prior comment, FDA will consider all comments received and revise the guidances as appropriate (see § 10.115(g)(3)). These guidances are being issued consistent with FDA's good guidance practices regulation (§ 10.115). The guidances represent the current thinking of FDA. They do not establish any rights for any person and are not binding on FDA or the public.

You can use an alternative approach if it satisfies the requirements of the applicable statutes and regulations. III. Paperwork Reduction Act of 1995 A. CBER Guidance While this guidance contains no collection of information, it does refer to previously approved FDA collections of information (listed in table 2). Therefore, clearance by the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C.

3501-3521) is not required for this guidance. The previously approved collections of information are subject to review by OMB under the PRA. The collections of information in the following FDA regulations and guidances have been approved by OMB as listed in the following table. Table 2—CBER Guidance and Collectionsasthma treatment guidance titleCFR cite referenced in asthma treatment guidanceAnother guidance title referenced in asthma treatment guidanceOMB control No(s).Emergency Use Authorization for treatments to Prevent asthma treatment (October 2020)21 CFR 314.420 21 CFR part 312 21 CFR parts 210, 211, and 6100910-0001 0910-0014 0910-0139 21 CFR part 600 21 CFR part 6010910-0308 0910-0338 Emergency Use Authorization of Medical Products and Related Authorities0910-0595 B. CDRH Guidance While this guidance contains no collection of information, it does refer to previously approved FDA collections of information (listed in table 3).

Therefore, clearance by OMB under the PRA is not required for this guidance. The previously approved collections of information are subject to review by OMB under the PRA. The collections of information in the following FDA regulations have been approved by OMB as listed in the table below. Table 3—CDRH Guidance and Collectionsasthma treatment guidance titleCFR cite referenced in asthma treatment guidanceAnother guidance title referenced in asthma treatment guidanceOMB control No(s).Enforcement Policy for Modifications to FDA—Cleared Molecular Influenza and RSV Tests During the asthma Disease 2019 (asthma treatment) Public Health Emergency (October 2020)800, 801, and 809 807, subpart E 820N/A0910-0485 0910-0120 0910-0073 IV. Electronic Access Persons with access to the internet may obtain asthma treatment-related guidances at.

Start Signature Dated. November 13, 2020. Lauren K. Roth, Acting Principal Associate Commissioner for Policy. End Signature End Supplemental Information [FR Doc.

2020-25399 Filed 11-17-20. 8:45 am]BILLING CODE 4164-01-P.

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Start Preamble adverse effects of ventolin Centers for http://www.ec-pres-lingolsheim.ac-strasbourg.fr/evenements/ Medicare &. Medicaid Services (CMS), HHS. Extension of adverse effects of ventolin timeline for publication of final rule. This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule.

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

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

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

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

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

Wilma M adverse effects of ventolin. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature adverse effects of ventolin End Supplemental Information [FR Doc. 2020-18867 Filed 8-26-20.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4:15 pm]BILLING CODE 4150-03-PNCHS Data Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is “the permanent cessation of menstruation that occurs after the loss of ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal.

Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5).

Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?.

€. 2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less.

Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS.

For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States. The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS.

Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No.

141. Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N. Perimenopause.

From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult.

A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software].

2012. Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286.

Hyattsville, MD. National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J. Blumberg, Ph.D., Associate Director for Science.

Start Preamble helpful site Centers for Medicare ventolin cost per pill &. Medicaid Services (CMS), HHS. Extension of timeline for publication of final rule ventolin cost per pill. This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule ventolin cost per pill to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021.

Start Further Info Lisa O. Wilson, (410) 786-8852. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed rule that addressed undue ventolin cost per pill regulatory impact and burden of the physician self-referral law. The proposed rule was issued in conjunction with the Centers for Medicare &. Medicaid Services' (CMS) Patients over Paperwork initiative and the ventolin cost per pill Department of Health and Human Services' (the Department or HHS) Regulatory Sprint to Coordinated Care.

In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician. A new exception ventolin cost per pill for donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed ventolin cost per pill rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute and regulations.

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

However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date. This notice ventolin cost per pill extends the timeline for publication of the final rule until August 31, 2021. Start Signature Dated. August 24, 2020. Wilma M ventolin cost per pill.

Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental ventolin cost per pill Information [FR Doc. 2020-18867 Filed 8-26-20. 8:45 am]BILLING CODE 4120-01-PStart Preamble Notice of amendment. The Secretary issues ventolin cost per pill this amendment pursuant to section 319F-3 of the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures.

This amendment to the Declaration published on March 17, 2020 (85 FR 15198) is effective as of August 24, 2020. Start Further ventolin cost per pill Info Robert P. Kadlec, MD, MTM&H, MS, Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201. Telephone. 202-205-2882.

End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act. Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law 109-148, Division C, § 2. It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C.

247d-6d and 42 U.S.C. 247d-6e, respectively. Section 319F-3 of the PHS Act has been amended by the ventolin and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the asthma Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the asthma treatment outbreak.

Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against asthma treatment (85 FR 15198, Mar. 17, 2020) (the Declaration). On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020).

On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm asthma treatment might otherwise cause. The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any treatment that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended treatments).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only asthma treatment caused by asthma or a ventolin mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by asthma treatment, asthma, or a ventolin mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed.

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

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

Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations. Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other -control practices, such as the use of masks. The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by asthma treatment. Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates.

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

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

The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training Start Printed Page 52139program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of treatments, and the recognition and treatment of emergency reactions to treatments.[] The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation.[] The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.[] The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment.[] The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregivers accompanying the children of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate.[] These requirements are consistent with those in many States that permit licensed pharmacists to order and administer treatments to children and permit licensed or registered pharmacy interns acting under their supervision to administer treatments to children.[] Administering vaccinations to children age three and older is less complicated and requires less training and resources than administering vaccinations to younger children. That is because ACIP generally recommends administering intramuscular injections in the deltoid muscle for individuals age three and older.[] For individuals less than three years of age, ACIP generally recommends administering intramuscular injections in the anterolateral aspect of the thigh muscle.[] Administering injections in the thigh muscle often presents additional complexities and requires additional training and resources including additional personnel to safely position the child while another healthcare professional injects the treatment.[] Moreover, as of 2018, 40% of three-year-olds were enrolled in preprimary programs (i.e. Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended treatments according to ACIP's standard immunization schedule.

All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return. Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended treatments and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended treatments ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified ventolin and epidemic products that “limit the harm such ventolin or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140asthma treatment as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C.

300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures. Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by asthma treatment.

The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only asthma treatment caused by asthma or a ventolin mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by asthma treatment, asthma, or a ventolin mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against asthma treatment. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against asthma treatment, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar. 17, 2020) and amended at 85 FR 21012 (Apr.

15, 2020) and 85 FR 35100 (June 8, 2020). 1. Covered Persons, section V, delete in full and replace with. V. Covered Persons 42 U.S.C.

247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an emergency. (b) any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act.

And (d) a State-licensed pharmacist who orders and administers, and pharmacy interns who administer (if the pharmacy intern acts under the supervision of such pharmacist and the pharmacy intern is licensed or registered by his or her State board of pharmacy), treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule. Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met. The treatment must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule. The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE).

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

The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers treatments, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (treatment registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a treatment must review the treatment registry or other vaccination records prior to administering a treatment. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate. Nothing in this Declaration shall be construed to affect the National treatment Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National treatment Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq.

Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2. Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with. VIII.

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

August 19, 2020. Alex M. Azar II, Secretary of Health and Human Services. End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20.

4:15 pm]BILLING CODE 4150-03-PNCHS Data Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

What should I tell my health care providers before I take Ventolin?

They need to know if you have any of the following conditions:

• diabetes
• heart disease or irregular heartbeat
• high blood pressure
• pheochromocytoma
• seizures
• thyroid disease
• an unusual or allergic reaction to albuterol, levalbuterol, sulfites, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

Is ventolin safe for pregnancy

As I write this editorial, it is almost 14 months since I first developed is ventolin safe for pregnancy asthma treatment symptoms and my journey with long asthma treatment continues. In their guideline on long asthma treatment NICE/SIGN define post-asthma treatment syndrome as signs and symptoms is ventolin safe for pregnancy that develop during or after a asthma treatment , continuing for more than 12 weeks, and not explained by an alternative diagnosis. More information about long asthma treatment can be found in the blog written by @jakesuett and me in September 2020.

Data from the Office for National Statistics in April 2021 estimated that 1.1 million people in the UK reported experiencing is ventolin safe for pregnancy some form of long asthma treatment symptoms. Despite this, the UK Government continues to focus on the outcomes of asthma treatment being binary. Dying or is ventolin safe for pregnancy surviving.

Box 1 provides details about some useful sources of information on long asthma treatment.Box 1 Useful sources of information about long asthma treatmentNICE/SIGN rapid guideline published in December 2020.The NIHR review of evidence. Living with asthma treatment—second Review (March 2021).Paper in nature in April 2021 provides a summary of how post acute asthma treatment (long asthma treatment) can affect different organ systems.Paper published in March 2021 describing the range of signs is ventolin safe for pregnancy and symptoms experienced by people with long asthma treatment via a social media survey.Everyone’s long asthma treatment journey is different. Recovery is not linear with many relapses along the way.

Fourteen months on, I is ventolin safe for pregnancy am better than I was but still not fit enough to return to work and need to be careful not to do too much. My ongoing symptoms include:Breathlessness—e.g. After having a shower or walking short distances.Brain fog—unable to read for more than 15–20 min or concentrate on anything for more than 30 min.Headache.Fatigue.Poor temperature control and hot flushes.Deterioration in my is ventolin safe for pregnancy eyesight—potentially due to steroids.Tingling in faceSwollen glands.Nausea.I am one of the lucky ones—I was reviewed at a (virtual) long asthma treatment clinic in February 2021.

As suggested by the NICE/SIGN guidelines, I had some tests ordered to rule out any organic causes for my symptoms. The blood is ventolin safe for pregnancy tests showed that I had developed type 2 diabetes. A brain MRI indicated I have had a stroke at some point.Nowadays, there is an expectation that most illnesses can be cured.

This makes it more difficult when there are no answers is ventolin safe for pregnancy. As a patient group we struggled, and in many cases, are still struggling, to get access to is ventolin safe for pregnancy the tests we needed which exacerbated this situation. This is perhaps not surprising in the middle of a ventolin.

I always felt slightly uncomfortable fighting for access to tests when I knew the NHS was at crisis point but as a registered nurse had some knowledge as to where to is ventolin safe for pregnancy turn for help. This was particularly helpful when I was rung with the results of my tests following my long asthma treatment clinic appointment. Having been told is ventolin safe for pregnancy I had developed type 2 diabetes, the advice was to ‘go on a low sugar diet’ and have my bloods tested again in a few months.

However, I was able to reach out to friends for advice as well as referring myself to the diabetes nurse at my GP practice. I am now on a low carb diet and have been prescribed metformin that is ventolin safe for pregnancy would not have happened if I had just followed the initial advice. Getting advice about my stroke has not been so easy.

Over 6 weeks down the line, I am still awaiting my referral to the stroke clinic.On an intellectual level, as someone is ventolin safe for pregnancy who has spent much of their nursing career promoting evidence-based practice, it has been interesting having a new disease and observing as information about potential treatments emerge. People within the long asthma treatment community were willing to try almost anything in an attempt to get better. A scene from the recent TV series It’s a sin struck a chord—someone who thought they had AIDS/HIV in the mid 1980s ringing a hotline and asking whether a list of potential cures, including drinking bleach, would cure him.As a registered nurse and editor of is ventolin safe for pregnancy Evidence Based Nursing, I found it challenging when other people with long asthma treatment appeared to me to be ‘grasping at straws’ and trying any treatment that was available despite a lack of evidence to support it.

I understand this is a reaction to the lack of available treatments as well as many people being told by the medical profession their symptoms were ‘all in their head’. But, on occasion, it made is ventolin safe for pregnancy it difficult being part of these groups. Going forward, we need robust research to identify treatments for long asthma treatment.

An international multistakeholder forum has recently produced is ventolin safe for pregnancy a list of research priorities for long asthma treatment. Governments are beginning to allocate money for research into long asthma treatment—for example, in the USA, the NIH has put US$1.15 billion aside. These are definitely steps in the right direction but more needs to be done worldwide to care for those of us with Long asthma treatment.Ethics statementsPatient consent for publicationNot required.Using interpretative phenomenological analysis to explore multiperspectivesInterpretative phenomenological analysis (IPA) was originally developed in 1995 by Johnathan Smith as a method to undertake experiential research in psychology and has gained prominence across health and social sciences is ventolin safe for pregnancy as a way to understand and interpret topics that are complex and emotionally laden, such as chronic illness experiences.1 2 IPA aims to uncover what a lived experience means to the individual through a process of in-depth reflective inquiry.3 The IPA draws on phenomenological thinking, with the purpose to return ‘to the things themselves’3 (p168).

However, IPA also acknowledges is ventolin safe for pregnancy that we are each influenced by the worlds in which we live and the experiences we encounter. Therefore, IPA is an interpretative process between the researcher and researched, influenced predominantly by Heidegger’s interpretive phenomenology, hermeneutics and idiography. Within IPA, it is typical is ventolin safe for pregnancy for researchers to select a small homogenous sample to explore the shared perspectives on a single phenomenon of interest4.

Within IPA studies, the focus has been on individual people living within diverse settings and populations such as chronic or long-term illnesses. The focus is on understandings of rich, lived experiences, and, given the small samples, IPA studies have is ventolin safe for pregnancy typically not focused on those connected to the person living with diversity or disease. Recently, there has been an interest within IPA to suggest the value of capturing more complex data through multiple perspectives using designs and processes to address this shortcoming in IPA.4 This may involve the use of multiple participants and a range of data collection methods such as the use of dyads or focus groups.

The aim of this paper is to explore the utility of IPA approaches using multiperspectives through focusing on a specific case study to illustrate this approach.Case studyThis case study focuses on an IPA study that focused on the lived experiences of adolescents is ventolin safe for pregnancy and young adults (AYA) and their family/significant other living with malignant melanoma (MM). Families and other people important to the experience can provide a logical and insightful perspectives on a shared psychosocial phenomenon. Multiperspective designs are gaining increasing prominence among researchers who recognise that an experience such as living with a long-term disease ‘is not solely located within the accounts of those with the diagnosis’4 (p182) is ventolin safe for pregnancy.

For the purposes of this case study, the family/significant others were seen as integral to the experience for the AYA living with MM and their journey together in supporting one another through this experience.During the 1970s, melanoma in AYA was rare, but over the intervening decades, there has been a marked increase in the reported incidence of MM in AYA around the globe.5–7 There is a significant amount of biomedical empirical research evidence on melanoma but a dearth of qualitative research around the lived experience for AYA and their family/significant other living with this disease.A purposive sample of young participants, 16–26 years, were identified by the Clinical Nurse Specialists that ensured the participants were experiencing the same phenomenon.8–10 Although the intention was to carry out individual interviews with all the participants following the typical IPA approach, most of the AYA lived at home and the young participants expressed the desire for a shared interview, which was accommodated by the first author. The four individuals (n=4) and three-dyad interviews (n=6) is ventolin safe for pregnancy allowed for the shared experience and the phenomena to be captured and understood through data analysis and interpretation.4 Although the use of individual and joint interviews had implications for data collection and analysis—such as the parent wishing to have their voice heard over their child—the researcher had to ensure that questions were also directed to the young participant in order to capture both voices. In depth, semistructured interviews were undertaken within the AYAs primary treatment centre on the day of the outpatient appointment and they were often accompanied with someone who was significant in their journey.

Interviews lasted between 90 and is ventolin safe for pregnancy 120 min.This study was novel to the experiences of AYA and family/significant other living with MM, which offers a new perspective on the dynamics that are present within the MM experience. Our findings can be valuable for both an AYA, family/significant other and health and social care professionals. Both AYA and is ventolin safe for pregnancy the family/significant other seemed to consider the emotional implications of talking about the disease.

Throughout this process, participants seemed to strive for a shared understanding of the MM experience, a story that unified rather than divided them.Strengths and challengesA social phenomenological perspective demands an emphasis on understanding the participant’s experience of the world from their situation and then interpreting how that understanding is intersubjectively constructed.4 11 In-depth semistructured interviews, therefore, offered an appropriate and compelling method to generate data that permitted such insights is ventolin safe for pregnancy and reflections, allowing participants to reconstruct their understandings of a phenomenon3 through narrative. Qualitative researchers are increasingly using ‘oint interviews’ (dyad) to explore the lived experiences in health and capture the multiperspective. However, the decision of whether to interview participants separately or together as a dyad is an important consideration because it influences the nature of the data collected and having two is ventolin safe for pregnancy different types of data.

Each transcript was analysed separately both for the AYA and then the family/significant other, whether as an individual or dyad. This was important as the researcher (first author) was not sure whether the findings for the AYA would be different is ventolin safe for pregnancy from that of the family/significant other. There also needs to be time built into the study for the data analysis and IPA founders suggest following the IPA methodology, researchers should follow the key steps.3 Analysing the data individually allowed the narrative to ‘open up’ and reveal the experiences of the participant’s as various ‘individual parts’ and then as a ‘whole’.2 3 Throughout the data analysis, the six key steps supported the rigour, transparency and coherence of the findings.Findings of the case studyThis study was organised hierarchically into themes and following the iterative process of analysis, the 'Life interrupted' meta-narrative was identified from all the participant’s lives.

€˜Life interrupted’ speaks to the various ways that participants’ lives were interrupted due to the cancer diagnosis, and the journey this disease is ventolin safe for pregnancy took them on as well as the unsettling emotions that were experienced during this journey. This is woven into the whole journey experience and figure 1 illustrates the core conceptual thread and the interconnection between AYA and the family/significant other. The interconnection is ventolin safe for pregnancy between the four super-ordinate and the 12 subthemes is also shown.

The ebb and flow of familial relationships can, in some situations, magnify the impact of the physical disease, with the emotional turmoil often rivalling the physical manifestation of the disease.8 11 Conversely, relationships may help the AYA and the family/significant other cope with the disease in a more positive and supportive way. The importance of these unique and changing relationships in living with MM should not be underestimated, and psychosocial research about YPs experiences of is ventolin safe for pregnancy cancer would be enhanced through the further use and development of the multiperspective approach underpinned by IPA as used in this study, which is able to capture these dynamic inter-relationships. A visual representation is provided within figure 1 and how the individual voices were captured through the individual and dyad interview.Visual multi-perspective IPA design.

IPA, interpretative phenomenological analysis." data-icon-position data-hide-link-title="0">Figure is ventolin safe for pregnancy 1 Visual multi-perspective IPA design. IPA, interpretative phenomenological analysis.ConclusionsThis paper presents experiences of life events and processes that are intersubjective and relational. Meaning is ‘in between’ us but is rarely studied is ventolin safe for pregnancy that way in phenomenological inquiry.4 The meanings of events and processes are often contested and can sometimes be understood in a more complex manner when viewed from the multiple perspectives involved in the system that constitutes them.

Multiple perspective designs can be a useful way for IPA researchers to address research questions that engage with these phenomena.Ethics statementsPatient consent for publicationNot required..

As I write this editorial, it is almost 14 months since I ventolin cost per pill first developed asthma treatment symptoms and my journey with long asthma treatment continues. In their guideline on long asthma treatment NICE/SIGN define post-asthma treatment syndrome as signs and symptoms that develop during or after a asthma treatment , continuing for more than 12 weeks, and not explained by an alternative ventolin cost per pill diagnosis. More information about long asthma treatment can be found in the blog written by @jakesuett and me in September 2020. Data from the Office for National Statistics in April 2021 estimated that 1.1 million people in the UK reported experiencing ventolin cost per pill some form of long asthma treatment symptoms. Despite this, the UK Government continues to focus on the outcomes of asthma treatment being binary.

Dying or ventolin cost per pill surviving. Box 1 provides details about some useful sources of information on long asthma treatment.Box 1 Useful sources of information about long asthma treatmentNICE/SIGN rapid guideline published in December 2020.The NIHR review of evidence. Living with asthma treatment—second Review (March 2021).Paper in nature in April 2021 provides a summary of how post acute asthma treatment (long asthma treatment) ventolin cost per pill can affect different organ systems.Paper published in March 2021 describing the range of signs and symptoms experienced by people with long asthma treatment via a social media survey.Everyone’s long asthma treatment journey is different. Recovery is not linear with many relapses along the way. Fourteen months on, I am better than I was but still not fit enough to return to work and need to ventolin cost per pill be careful not to do too much.

My ongoing symptoms include:Breathlessness—e.g. After having a shower or walking short distances.Brain fog—unable to read for more than 15–20 min or concentrate on anything for more than 30 min.Headache.Fatigue.Poor temperature control and hot flushes.Deterioration in my eyesight—potentially due to steroids.Tingling in faceSwollen glands.Nausea.I am ventolin cost per pill one of the lucky ones—I was reviewed at a (virtual) long asthma treatment clinic in February 2021. As suggested by the NICE/SIGN guidelines, I had some tests ordered to rule out any organic causes for my symptoms. The blood tests showed that ventolin cost per pill I had developed type 2 diabetes. A brain MRI indicated I have had a stroke at some point.Nowadays, there is an expectation that most illnesses can be cured.

This makes it more difficult when there are no ventolin cost per pill answers. As a patient group we struggled, and in many cases, are still struggling, ventolin cost per pill to get access to the tests we needed which exacerbated this situation. This is perhaps not surprising in the middle of a ventolin. I always ventolin cost per pill felt slightly uncomfortable fighting for access to tests when I knew the NHS was at crisis point but as a registered nurse had some knowledge as to where to turn for help. This was particularly helpful when I was rung with the results of my tests following my long asthma treatment clinic appointment.

Having been told I ventolin cost per pill had developed type 2 diabetes, the advice was to ‘go on a low sugar diet’ and have my bloods tested again in a few months. However, I was able to reach out to friends for advice as well as referring myself to the diabetes nurse at my GP practice. I am now on a low carb diet and have been prescribed metformin that would ventolin cost per pill not have happened if I had just followed the initial advice. Getting advice about my stroke has not been so easy. Over 6 weeks ventolin cost per pill down the line, I am still awaiting my referral to the stroke clinic.On an intellectual level, as someone who has spent much of their nursing career promoting evidence-based practice, it has been interesting having a new disease and observing as information about potential treatments emerge.

People within the long asthma treatment community were willing to try almost anything in an attempt to get better. A scene ventolin cost per pill from the recent TV series It’s a sin struck a chord—someone who thought they had AIDS/HIV in the mid 1980s ringing a hotline and asking whether a list of potential cures, including drinking bleach, would cure him.As a registered nurse and editor of Evidence Based Nursing, I found it challenging when other people with long asthma treatment appeared to me to be ‘grasping at straws’ and trying any treatment that was available despite a lack of evidence to support it. I understand this is a reaction to the lack of available treatments as well as many people being told by the medical profession their symptoms were ‘all in their head’. But, on occasion, ventolin cost per pill it made it difficult being part of these groups. Going forward, we need robust research to identify treatments for long asthma treatment.

An international multistakeholder forum has recently produced a list of ventolin cost per pill research priorities for long asthma treatment. Governments are beginning to allocate money for research into long asthma treatment—for example, in the USA, the NIH has put US$1.15 billion aside. These are definitely steps in the right direction but more needs to be done worldwide to care for those of us with Long asthma treatment.Ethics statementsPatient consent for publicationNot required.Using interpretative phenomenological analysis to explore multiperspectivesInterpretative phenomenological analysis (IPA) was originally developed in 1995 by Johnathan Smith as a method to undertake experiential research in psychology and has gained ventolin cost per pill prominence across health and social sciences as a way to understand and interpret topics that are complex and emotionally laden, such as chronic illness experiences.1 2 IPA aims to uncover what a lived experience means to the individual through a process of in-depth reflective inquiry.3 The IPA draws on phenomenological thinking, with the purpose to return ‘to the things themselves’3 (p168). However, IPA also acknowledges that we are each influenced by the worlds in which we live and ventolin cost per pill the experiences we encounter. Therefore, IPA is an interpretative process between the researcher and researched, influenced predominantly by Heidegger’s interpretive phenomenology, hermeneutics and idiography.

Within IPA, it is typical for researchers to select a small homogenous sample to explore the ventolin cost per pill shared perspectives on a single phenomenon of interest4. Within IPA studies, the focus has been on individual people living within diverse settings and populations such as chronic or long-term illnesses. The focus is on understandings of rich, lived experiences, and, given the small samples, ventolin cost per pill IPA studies have typically not focused on those connected to the person living with diversity or disease. Recently, there has been an interest within IPA to suggest the value of capturing more complex data through multiple perspectives using designs and processes to address this shortcoming in IPA.4 This may involve the use of multiple participants and a range of data collection methods such as the use of dyads or focus groups. The aim of this paper is to explore the utility of IPA approaches using multiperspectives through focusing on a specific case study to illustrate this approach.Case studyThis case study focuses on an ventolin cost per pill IPA study that focused on the lived experiences of adolescents and young adults (AYA) and their family/significant other living with malignant melanoma (MM).

Families and other people important to the experience can provide a logical and insightful perspectives on a shared psychosocial phenomenon. Multiperspective designs are gaining increasing prominence ventolin cost per pill among researchers who recognise that an experience such as living with a long-term disease ‘is not solely located within the accounts of those with the diagnosis’4 (p182). For the purposes of this case study, the family/significant others were seen as integral to the experience for the AYA living with MM and their journey together in supporting one another through this experience.During the 1970s, melanoma in AYA was rare, but over the intervening decades, there has been a marked increase in the reported incidence of MM in AYA around the globe.5–7 There is a significant amount of biomedical empirical research evidence on melanoma but a dearth of qualitative research around the lived experience for AYA and their family/significant other living with this disease.A purposive sample of young participants, 16–26 years, were identified by the Clinical Nurse Specialists that ensured the participants were experiencing the same phenomenon.8–10 Although the intention was to carry out individual interviews with all the participants following the typical IPA approach, most of the AYA lived at home and the young participants expressed the desire for a shared interview, which was accommodated by the first author. The four individuals (n=4) and three-dyad interviews (n=6) allowed for the shared experience ventolin cost per pill and the phenomena to be captured and understood through data analysis and interpretation.4 Although the use of individual and joint interviews had implications for data collection and analysis—such as the parent wishing to have their voice heard over their child—the researcher had to ensure that questions were also directed to the young participant in order to capture both voices. In depth, semistructured interviews were undertaken within the AYAs primary treatment centre on the day of the outpatient appointment and they were often accompanied with someone who was significant in their journey.

Interviews lasted between 90 and 120 min.This study was novel to the experiences of AYA and family/significant other living with MM, which offers a new ventolin cost per pill perspective on the dynamics that are present within the MM experience. Our findings can be valuable for both an AYA, family/significant other and health and social care professionals. Both AYA and the family/significant other seemed to consider the emotional implications of talking ventolin cost per pill about the disease. Throughout this process, participants seemed to strive for a shared understanding of the MM experience, a story that unified rather than divided them.Strengths and challengesA social phenomenological perspective demands an emphasis on understanding the participant’s experience of the world from their situation and then interpreting how that understanding is intersubjectively constructed.4 11 In-depth semistructured interviews, therefore, ventolin cost per pill offered an appropriate and compelling method to generate data that permitted such insights and reflections, allowing participants to reconstruct their understandings of a phenomenon3 through narrative. Qualitative researchers are increasingly using ‘oint interviews’ (dyad) to explore the lived experiences in health and capture the multiperspective.

However, the decision ventolin cost per pill of whether to interview participants separately or together as a dyad is an important consideration because it influences the nature of the data collected and having two different types of data. Each transcript was analysed separately both for the AYA and then the family/significant other, whether as an individual or dyad. This was important as the researcher ventolin cost per pill (first author) was not sure whether the findings for the AYA would be different from that of the family/significant other. There also needs to be time built into the study for the data analysis and IPA founders suggest following the IPA methodology, researchers should follow the key steps.3 Analysing the data individually allowed the narrative to ‘open up’ and reveal the experiences of the participant’s as various ‘individual parts’ and then as a ‘whole’.2 3 Throughout the data analysis, the six key steps supported the rigour, transparency and coherence of the findings.Findings of the case studyThis study was organised hierarchically into themes and following the iterative process of analysis, the 'Life interrupted' meta-narrative was identified from all the participant’s lives. €˜Life interrupted’ speaks to the various ways that participants’ lives were interrupted due to the cancer diagnosis, and the journey this disease took them on as well as the unsettling emotions that ventolin cost per pill were experienced during this journey.

This is woven into the whole journey experience and figure 1 illustrates the core conceptual thread and the interconnection between AYA and the family/significant other. The interconnection between the four super-ordinate and the 12 subthemes is ventolin cost per pill also shown. The ebb and flow of familial relationships can, in some situations, magnify the impact of the physical disease, with the emotional turmoil often rivalling the physical manifestation of the disease.8 11 Conversely, relationships may help the AYA and the family/significant other cope with the disease in a more positive and supportive way. The importance of these unique and changing relationships in living with MM should not be underestimated, and psychosocial research about YPs experiences of cancer would be enhanced through the further use and development of the multiperspective approach underpinned by IPA as used in this study, which is able to capture ventolin cost per pill these dynamic inter-relationships. A visual representation is provided within figure 1 and how the individual voices were captured through the individual and dyad interview.Visual multi-perspective IPA design.

IPA, interpretative ventolin cost per pill phenomenological analysis." data-icon-position data-hide-link-title="0">Figure 1 Visual multi-perspective IPA design. IPA, interpretative phenomenological analysis.ConclusionsThis paper presents experiences of life events and processes that are intersubjective and relational. Meaning is ‘in between’ us but is rarely studied that way in phenomenological inquiry.4 The meanings of events and processes are often ventolin cost per pill contested and can sometimes be understood in a more complex manner when viewed from the multiple perspectives involved in the system that constitutes them. Multiple perspective designs can be a useful way for IPA researchers to address research questions that engage with these phenomena.Ethics statementsPatient consent for publicationNot required..

Is ventolin a stimulant

HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that Dan Burton, CEO, and Adam Brown, SVP of Investor Relations and FP&A, will participate in the 41st Annual William Blair Growth Stock Conference including a fireside chat on Wednesday, June is ventolin a stimulant 2, 2021 at 5:40 p.m. ET. A webcast link will be available at https://ir.healthcatalyst.com/investor-relations. About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services is ventolin a stimulant to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement.

Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed. Health Catalyst Investor Relations Contact is ventolin a stimulant. Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact.

Amanda Hundtamanda.hundt@healthcatalyst.com+1 (575) 491-0974SALT LAKE CITY, May 06, 2021 (GLOBE NEWSWIRE) -- Health Catalyst, Inc. ("Health Catalyst," is ventolin a stimulant Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today reported financial results for the quarter ended March 31, 2021. €œIn the first quarter of 2021, I am pleased to share that we achieved strong performance across our business, including exceeding the mid-point of our quarterly guidance for both revenue and Adjusted EBITDA,” said Dan Burton, CEO of Health Catalyst.

€œI am also happy to report that in the most recent team member engagement and satisfaction survey, is ventolin a stimulant independently administered by the Gallup organization, team member satisfaction scores at Health Catalyst measured in the 96th percentile. This latest engagement level continues a pattern that has been in place for many years, of industry-leading engagement, consistently ranked between the 95th and 99th percentile in overall team member satisfaction scores. This latest result is of particular significance given that it comes during a period where we were required to adapt to global ventolin necessitating a remote-only work environment, as well as having welcomed nearly two hundred new teammates who came to us primarily through multiple recent acquisitions.” Financial Highlights for the Three Months Ended March 31, 2021 Key Financial Metrics Three Months Ended March 31, Year over Year Change 2021 2020 GAAP Financial Data:(in thousands, except percentages, unaudited)Technology revenue$33,839 $24,699 37%Professional services revenue$22,007 $20,417 8%Total revenue$55,846 $45,116 24%Loss from operations$(24,317) $(18,105) (34)%Net loss$(28,370) $(17,490) (62)%Other Non-GAAP Financial Data:(1) Adjusted Technology Gross Profit$23,388 $16,969 38%Adjusted Technology Gross Margin69% 69% Adjusted Professional Services Gross Profit$6,929 $5,071 37%Adjusted Professional Services Gross Margin31% 25% Total Adjusted Gross Profit$30,317 $22,040 38%Total Adjusted Gross Margin54% 49% Adjusted EBITDA$(837) $(5,971) 86%________________________(1) These measures are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). See the accompanying "Non-GAAP Financial Measures" section below for more information about these financial measures, including the limitations of such measures, and for a reconciliation of each measure to the most directly comparable measure is ventolin a stimulant calculated in accordance with GAAP.

Financial Outlook Health Catalyst provides forward-looking guidance on total revenue, a GAAP measure, and Adjusted EBITDA, a non-GAAP measure. For the second quarter of 2021, we expect. Total revenue between $55.1 million and $58.1 is ventolin a stimulant million, andAdjusted EBITDA between $(4.8) million and $(2.8) millionFor the full year of 2021, we expect. Total revenue between $228.1 million and $231.1 million, andAdjusted EBITDA between $(15.0) million and $(13.0) millionWe have not reconciled guidance for Adjusted EBITDA to net loss, the most directly comparable GAAP measure, and have not provided forward-looking guidance for net loss, because there are items that may impact net loss, including stock-based compensation, that are not within our control or cannot be reasonably predicted.

Chair of the Board Transition On April 29, 2021, our board of directors (the board) accepted Dr. Tim Ferris's resignation from the board and all is ventolin a stimulant board committees, effective May 1, 2021. Dr. Ferris's resignation is not the result of any disagreement with Health Catalyst, but rather as a result of his new role as the National Director of Transformation for England's National Health Service (NHS).

NHS required Dr is ventolin a stimulant. Ferris to resign from our board in connection with his NHS appointment. €œDr. Ferris provided is ventolin a stimulant a unique perspective that will continue to impact our company for years to come.

We are grateful for the opportunity to have benefited from his wisdom and experience, and we congratulate him on his new role as National Director of Transformation at NHS,” said Dan Burton, CEO. Health Catalyst is thrilled to announce that John A. (Jack) Kane is ventolin a stimulant has accepted the invitation to serve as chair of the board effective May 1, 2021. Mr.

Kane has been a director of the Company and has been the chair of the audit committee of the board since February 2016. Mr. Kane has more than 30 years’ experience in healthcare technology, including as a director and chairperson of the audit committee of Merchants Bancshares, Inc. (MBVT) from 2005 until 2014 and athenahealth, Inc.

From 2007 until February 2019. He previously occupied the position of CFO, Treasurer &. Senior VP-Administration at IDX Systems Corp. €œJack has served on our board for many years.

His valuable guidance and feedback often challenges us to think deeply about our solutions. I am grateful for Jack’s dedication to our mission and his depth of financial leadership experience in healthcare and technology, which make him uniquely qualified to serve as our chair,” said Burton. Quarterly Conference Call Details The company will host a conference call to review the results today, Thursday, May 6, 2021, at 5:00 p.m. E.T.

The conference call can be accessed by dialing 1-877-295-1104 for U.S. Participants, or 1-470-495-9486 for international participants, and referencing participant code 9183315. A live audio webcast will be available online at https://ir.healthcatalyst.com/. A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days.

About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed. Available Information Health Catalyst intends to use its Investor Relations website as a means of disclosing material non-public information and for complying with its disclosure obligations under Regulation FD.

Forward-Looking Statements This release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, as amended. These forward-looking statements include statements regarding our future growth and our financial outlook for Q2 and fiscal year 2021. Forward-looking statements are subject to risks and uncertainties and are based on potentially inaccurate assumptions that could cause actual results to differ materially from those expected or implied by the forward-looking statements. Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance.

Important risks and uncertainties that could cause our actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following. (i) changes in laws and regulations applicable to our business model. (ii) changes in market or industry conditions, regulatory environment and receptivity to our technology and services. (iii) results of litigation or a security incident.

(iv) the loss of one or more key customers or partners. (v) the impact of asthma treatment on our business and results of operations. And (vi) changes to our abilities to recruit and retain qualified team members. For a detailed discussion of the risk factors that could affect our actual results, please refer to the risk factors identified in our SEC reports, including, but not limited to the Annual Report on Form 10-K for the year ended December 31, 2020 filed with the SEC on or about February 25, 2021 and the Quarterly Report on Form 10-Q for the fiscal quarter ended March 31, 2021 expected to be filed with the SEC on or about May 7, 2021.

All information provided in this release and in the attachments is as of the date hereof, and we undertake no duty to update or revise this information unless required by law. Condensed Consolidated Balance Sheets(in thousands, except share and per share data, unaudited) As ofMarch 31, As ofDecember 31, 2021 2020Assets Current assets. Cash and cash equivalents$132,627 $91,954 Short-term investments133,807 178,917 Accounts receivable, net45,905 48,296 Prepaid expenses and other assets12,404 10,632 Total current assets324,743 329,799 Property and equipment, net18,653 12,863 Intangible assets, net91,840 98,921 Operating lease right-of-use assets24,093 24,729 Goodwill107,822 107,822 Other assets4,068 3,606 Total assets$571,219 $577,740 Liabilities and stockholders’ equity Current liabilities. Accounts payable$4,626 $5,332 Accrued liabilities12,946 16,510 Acquisition-related consideration payable— 2,000 Deferred revenue51,634 47,145 Operating lease liabilities2,454 2,622 Contingent consideration liabilities15,902 14,427 Convertible senior notes, net171,864 — Total current liabilities259,426 88,036 Convertible senior notes, net of current portion— 168,994 Deferred revenue, net of current portion1,135 1,878 Operating lease liabilities, net of current portion23,083 23,669 Contingent consideration liabilities, net of current portion16,509 16837 Other liabilities2,230 2227 Total liabilities302,383 301,641 Commitments and contingencies Stockholders’ equity.

Common stock, $0.001 par value. 44,340,036 and 43,376,848 shares issued and outstanding as of March 31, 2021 and December 31, 2020, respectively44 43 Additional paid-in capital1,022,781 1,001,645 Accumulated deficit(754,020) (725,650)Accumulated other comprehensive income31 61 Total stockholders' equity268,836 276,099 Total liabilities and stockholders’ equity$571,219 $577,740 Condensed Consolidated Statements of Operations(in thousands, except per share data, unaudited) Three Months EndedMarch 31, 2021 2020Revenue. Technology$33,839 $24,699 Professional services22,007 20,417 Total revenue55,846 45,116 Cost of revenue, excluding depreciation and amortization. Technology(1)10,825 7,906 Professional services(1)16,513 16,162 Total cost of revenue, excluding depreciation and amortization27,338 24,068 Operating expenses.

Sales and marketing(1)15,651 13,487 Research and development(1)14,345 13,088 General and administrative(1)(2)(3)15,015 9,701 Depreciation and amortization7,814 2,877 Total operating expenses52,825 39,153 Loss from operations(24,317) (18,105)Interest and other expense, net(3,952) (621)Loss before income taxes(28,269) (18,726)Income tax provision (benefit)101 (1,236)Net loss$(28,370) $(17,490)Net loss per share, basic and diluted$(0.65) $(0.47)Weighted-average shares outstanding used in calculating net loss per share, basic and diluted43,870 37,109 Adjusted net loss(4)$(2,753) $(6,083)Adjusted net loss per share, basic and diluted(4)$(0.06) $(0.16) _______________(1) Includes stock-based compensation expense as follows. Three Months EndedMarch 31, 2021 2020 Stock-Based Compensation Expense:(in thousands)Cost of revenue, excluding depreciation and amortization. Technology$374 $176 Professional services1,435 816 Sales and marketing4,818 3,182 Research and development2,257 1,882 General and administrative4,626 2,685 Total$13,510 $8,741 (2) Includes acquisition transaction costs as follows. Three Months EndedMarch 31, 2021 2020 Acquisition transaction costs:(in thousands)General and administrative$— $875 (3) Includes the change in fair value of contingent consideration liabilities, as follows.

Three Months EndedMarch 31, 2021 2020 Change in fair value of contingent consideration liabilities:(in thousands)General and administrative$2,156 $(359)(4) Includes non-GAAP adjustments to net loss. Refer to the "Non-GAAP Financial Measures—Adjusted Net Loss Per Share" section below for further details. Condensed Consolidated Statements of Cash Flows(in thousands, unaudited) Three Months Ended March 31,Cash flows from operating activities2021 2020Net loss$(28,370) $(17,490)Adjustments to reconcile net loss to net cash used in operating activities. Depreciation and amortization7,814 2,877 Amortization of debt discount and issuance costs2,870 285 Non-cash operating lease expense965 741 Investment discount and premium amortization417 (6)Provision for expected credit losses300 51 Stock-based compensation expense13,510 8,741 Deferred tax (benefit) provision2 (1,280)Change in fair value of contingent consideration liabilities2,156 (359)Other(34) (4)Change in operating assets and liabilities.

Accounts receivable, net2,090 (7,335)Deferred costs— 444 Prepaid expenses and other assets(2,173) (2,244)Accounts payable, accrued liabilities, and other liabilities(5,352) (4,283)Deferred revenue3,745 3,936 Operating lease liabilities(1,083) (843)Net cash used in operating activities(3,143) (16,769) Cash flows from investing activities Purchase of short-term investments(8,621) — Proceeds from the sale and maturity of short-term investments53,240 66,653 Acquisition of businesses, net of cash acquired— (15,249)Purchase of property and equipment(5,882) (428)Capitalization of internal use software(887) (78)Purchase of intangible assets(480) (758)Proceeds from sale of property and equipment6 6 Net cash provided by investing activities37,376 50,146 Cash flows from financing activities Proceeds from exercise of stock options6,488 9,046 Proceeds from employee stock purchase plan1,349 1,289 Payments of acquisition-related consideration(1,391) (748)Net cash provided by financing activities6,446 9,587 Effect of exchange rate on cash and cash equivalents(6) (31)Net increase in cash and cash equivalents40,673 42,933 Cash and cash equivalents at beginning of period91,954 18,032 Cash and cash equivalents at end of period$132,627 $60,965 Non-GAAP Financial Measures To supplement our financial information presented in accordance with GAAP, we believe certain non-GAAP measures, including Adjusted Gross Profit, Adjusted Gross Margin, Adjusted EBITDA, Adjusted Net Loss, and Adjusted Net Loss per share, basic and diluted, are useful in evaluating our operating performance. For example, we exclude stock-based compensation expense because it is non-cash in nature and excluding this expense provides meaningful supplemental information regarding our operational performance and allows investors the ability to make more meaningful comparisons between our operating results and those of other companies. We use this non-GAAP financial information to evaluate our ongoing operations, as a component in determining employee bonus compensation, and for internal planning and forecasting purposes. We believe that non-GAAP financial information, when taken collectively, may be helpful to investors because it provides consistency and comparability with past financial performance.

However, non-GAAP financial information is presented for supplemental informational purposes only, has limitations as an analytical tool and should not be considered in isolation or as a substitute for financial information presented in accordance with GAAP. In addition, other companies, including companies in our industry, may calculate similarly-titled non-GAAP measures differently or may use other measures to evaluate their performance. A reconciliation is provided below for each non-GAAP financial measure to the most directly comparable financial measure stated in accordance with GAAP. Investors are encouraged to review the related GAAP financial measures and the reconciliation of these non-GAAP financial measures to their most directly comparable GAAP financial measures, and not to rely on any single financial measure to evaluate our business.

Adjusted Gross Profit and Adjusted Gross Margin Adjusted Gross Profit is a non-GAAP financial measure that we define as revenue less cost of revenue, excluding depreciation and amortization and excluding stock-based compensation. We define Adjusted Gross Margin as our Adjusted Gross Profit divided by our revenue. We believe Adjusted Gross Profit and Adjusted Gross Margin are useful to investors as they eliminate the impact of certain non-cash expenses and allow a direct comparison of these measures between periods without the impact of non-cash expenses and certain other non-recurring operating expenses. The following is a reconciliation of revenue, the most directly comparable GAAP financial measure, to Adjusted Gross Profit, for the three months ended March 31, 2021 and 2020.

Three Months Ended March 31, 2021 (in thousands, except percentages) Technology Professional Services TotalRevenue$33,839 $22,007 $55,846 Cost of revenue, excluding depreciation and amortization(10,825) (16,513) (27,338)Gross profit, excluding depreciation and amortization23,014 5,494 28,508 Add. Stock-based compensation374 1,435 1,809 Adjusted Gross Profit$23,388 $6,929 $30,317 Gross margin, excluding depreciation and amortization68% 25% 51%Adjusted Gross Margin69% 31% 54% Three Months Ended March 31, 2020 (in thousands, except percentages) Technology Professional Services TotalRevenue$24,699 $20,417 $45,116 Cost of revenue, excluding depreciation and amortization(7,906) (16,162) (24,068)Gross profit, excluding depreciation and amortization16,793 4,255 21,048 Add. Stock-based compensation176 816 992 Adjusted Gross Profit$16,969 $5,071 $22,040 Gross margin, excluding depreciation and amortization68% 21% 47%Adjusted Gross Margin69% 25% 49% Adjusted EBITDA Adjusted EBITDA is a non-GAAP financial measure that we define as net loss adjusted for (i) interest and other expense, net, (ii) income tax (benefit) provision, (iii) depreciation and amortization, (iv) stock-based compensation, (v) acquisition transaction costs, and (vi) change in fair value of contingent consideration liabilities when they are incurred. We view acquisition-related expenses when applicable, such as transaction costs and changes in the fair value of contingent consideration liabilities that are directly related to business combinations as events that are not necessarily reflective of operational performance during a period.

We believe Adjusted EBITDA provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance. The following is a reconciliation of our net loss, the most directly comparable GAAP financial measure, to Adjusted EBITDA, for the three months ended March 31, 2021 and 2020. Three Months EndedMarch 31, 2021 2020 (in thousands)Net loss$(28,370) $(17,490)Add. Interest and other expense, net3,952 621 Income tax (benefit) provision101 (1,236)Depreciation and amortization7,814 2,877 Stock-based compensation13,510 8,741 Acquisition transaction costs— 875 Change in fair value of contingent consideration liabilities2,156 (359)Adjusted EBITDA$(837) $(5,971) Adjusted Net Loss Per Share Adjusted Net Loss is a non-GAAP financial measure that we define as net loss attributable to common stockholders adjusted for (i) stock-based compensation, (ii) amortization of acquired intangibles, (iii) acquisition transaction costs, (iv) change in fair value of contingent consideration liabilities, and (v) non-cash interest expense related to our convertible senior notes.

We believe Adjusted Net Loss provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance. Three Months Ended March 31, 2021 2020 Numerator:(in thousands, except share and per share amounts)Net loss attributable to common stockholders$(28,370) $(17,490)Add. Stock-based compensation13,510 8,741 Amortization of acquired intangibles7,081 2,150 Acquisition transaction costs— 875 Change in fair value of contingent consideration liabilities2,156 (359)Non-cash interest expense related to convertible senior notes2,870 — Adjusted Net Loss$(2,753) $(6,083)Denominator.

ET. A webcast link will be available at https://ir.healthcatalyst.com/investor-relations. About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements.

Health Catalyst envisions a future in which all healthcare decisions are data informed. Health Catalyst Investor Relations Contact. Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact. Amanda Hundtamanda.hundt@healthcatalyst.com+1 (575) 491-0974SALT LAKE CITY, May 06, 2021 (GLOBE NEWSWIRE) -- Health Catalyst, Inc.

("Health Catalyst," Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today reported financial results for the quarter ended March 31, 2021. €œIn the first quarter of 2021, I am pleased to share that we achieved strong performance across our business, including exceeding the mid-point of our quarterly guidance for both revenue and Adjusted EBITDA,” said Dan Burton, CEO of Health Catalyst. €œI am also happy to report that in the most recent team member engagement and satisfaction survey, independently administered by the Gallup organization, team member satisfaction scores at Health Catalyst measured in the 96th percentile.

This latest engagement level continues a pattern that has been in place for many years, of industry-leading engagement, consistently ranked between the 95th and 99th percentile in overall team member satisfaction scores. This latest result is of particular significance given that it comes during a period where we were required to adapt to global ventolin necessitating a remote-only work environment, as well as having welcomed nearly two hundred new teammates who came to us primarily through multiple recent acquisitions.” Financial Highlights for the Three Months Ended March 31, 2021 Key Financial Metrics Three Months Ended March 31, Year over Year Change 2021 2020 GAAP Financial Data:(in thousands, except percentages, unaudited)Technology revenue$33,839 $24,699 37%Professional services revenue$22,007 $20,417 8%Total revenue$55,846 $45,116 24%Loss from operations$(24,317) $(18,105) (34)%Net loss$(28,370) $(17,490) (62)%Other Non-GAAP Financial Data:(1) Adjusted Technology Gross Profit$23,388 $16,969 38%Adjusted Technology Gross Margin69% 69% Adjusted Professional Services Gross Profit$6,929 $5,071 37%Adjusted Professional Services Gross Margin31% 25% Total Adjusted Gross Profit$30,317 $22,040 38%Total Adjusted Gross Margin54% 49% Adjusted EBITDA$(837) $(5,971) 86%________________________(1) These measures are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). See the accompanying "Non-GAAP Financial Measures" section below for more information about these financial measures, including the limitations of such measures, and for a reconciliation of each measure to the most directly comparable measure calculated in accordance with GAAP. Financial Outlook Health Catalyst provides forward-looking guidance on total revenue, a GAAP measure, and Adjusted EBITDA, a non-GAAP measure.

For the second quarter of 2021, we expect. Total revenue between $55.1 million and $58.1 million, andAdjusted EBITDA between $(4.8) million and $(2.8) millionFor the full year of 2021, we expect. Total revenue between $228.1 million and $231.1 million, andAdjusted EBITDA between $(15.0) million and $(13.0) millionWe have not reconciled guidance for Adjusted EBITDA to net loss, the most directly comparable GAAP measure, and have not provided forward-looking guidance for net loss, because there are items that may impact net loss, including stock-based compensation, that are not within our control or cannot be reasonably predicted. Chair of the Board Transition On April 29, 2021, our board of directors (the board) accepted Dr.

Tim Ferris's resignation from the board and all board committees, effective May 1, 2021. Dr. Ferris's resignation is not the result of any disagreement with Health Catalyst, but rather as a result of his new role as the National Director of Transformation for England's National Health Service (NHS). NHS required Dr.

Ferris to resign from our board in connection with his NHS appointment. €œDr. Ferris provided a unique perspective that will continue to impact our company for years to come. We are grateful for the opportunity to have benefited from his wisdom and experience, and we congratulate him on his new role as National Director of Transformation at NHS,” said Dan Burton, CEO.

Health Catalyst is thrilled to announce that John A. (Jack) Kane has accepted the invitation to serve as chair of the board effective May 1, 2021. Mr. Kane has been a director of the Company and has been the chair of the audit committee of the board since February 2016.

Mr. Kane has more than 30 years’ experience in healthcare technology, including as a director and chairperson of the audit committee of Merchants Bancshares, Inc. (MBVT) from 2005 until 2014 and athenahealth, Inc. From 2007 until February 2019.

He previously occupied the position of CFO, Treasurer &. Senior VP-Administration at IDX Systems Corp. €œJack has served on our board for many years. His valuable guidance and feedback often challenges us to think deeply about our solutions.

I am grateful for Jack’s dedication to our mission and his depth of financial leadership experience in healthcare and technology, which make him uniquely qualified to serve as our chair,” said Burton. Quarterly Conference Call Details The company will host a conference call to review the results today, Thursday, May 6, 2021, at 5:00 p.m. E.T. The conference call can be accessed by dialing 1-877-295-1104 for U.S.

Participants, or 1-470-495-9486 for international participants, and referencing participant code 9183315. A live audio webcast will be available online at https://ir.healthcatalyst.com/. A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days. About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement.

Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed. Available Information Health Catalyst intends to use its Investor Relations website as a means of disclosing material non-public information and for complying with its disclosure obligations under Regulation FD. Forward-Looking Statements This release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, as amended.

These forward-looking statements include statements regarding our future growth and our financial outlook for Q2 and fiscal year 2021. Forward-looking statements are subject to risks and uncertainties and are based on potentially inaccurate assumptions that could cause actual results to differ materially from those expected or implied by the forward-looking statements. Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance. Important risks and uncertainties that could cause our actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following.

(i) changes in laws and regulations applicable to our business model. (ii) changes in market or industry conditions, regulatory environment and receptivity to our technology and services. (iii) results of litigation or a security incident. (iv) the loss of one or more key customers or partners.

(v) the impact of asthma treatment on our business and results of operations. And (vi) changes to our abilities to recruit and retain qualified team members. For a detailed discussion of the risk factors that could affect our actual results, please refer to the risk factors identified in our SEC reports, including, but not limited to the Annual Report on Form 10-K for the year ended December 31, 2020 filed with the SEC on or about February 25, 2021 and the Quarterly Report on Form 10-Q for the fiscal quarter ended March 31, 2021 expected to be filed with the SEC on or about May 7, 2021. All information provided in this release and in the attachments is as of the date hereof, and we undertake no duty to update or revise this information unless required by law.

Condensed Consolidated Balance Sheets(in thousands, except share and per share data, unaudited) As ofMarch 31, As ofDecember 31, 2021 2020Assets Current assets. Cash and cash equivalents$132,627 $91,954 Short-term investments133,807 178,917 Accounts receivable, net45,905 48,296 Prepaid expenses and other assets12,404 10,632 Total current assets324,743 329,799 Property and equipment, net18,653 12,863 Intangible assets, net91,840 98,921 Operating lease right-of-use assets24,093 24,729 Goodwill107,822 107,822 Other assets4,068 3,606 Total assets$571,219 $577,740 Liabilities and stockholders’ equity Current liabilities. Accounts payable$4,626 $5,332 Accrued liabilities12,946 16,510 Acquisition-related consideration payable— 2,000 Deferred revenue51,634 47,145 Operating lease liabilities2,454 2,622 Contingent consideration liabilities15,902 14,427 Convertible senior notes, net171,864 — Total current liabilities259,426 88,036 Convertible senior notes, net of current portion— 168,994 Deferred revenue, net of current portion1,135 1,878 Operating lease liabilities, net of current portion23,083 23,669 Contingent consideration liabilities, net of current portion16,509 16837 Other liabilities2,230 2227 Total liabilities302,383 301,641 Commitments and contingencies Stockholders’ equity. Common stock, $0.001 par value.

44,340,036 and 43,376,848 shares issued and outstanding as of March 31, 2021 and December 31, 2020, respectively44 43 Additional paid-in capital1,022,781 1,001,645 Accumulated deficit(754,020) (725,650)Accumulated other comprehensive income31 61 Total stockholders' equity268,836 276,099 Total liabilities and stockholders’ equity$571,219 $577,740 Condensed Consolidated Statements of Operations(in thousands, except per share data, unaudited) Three Months EndedMarch 31, 2021 2020Revenue. Technology$33,839 $24,699 Professional services22,007 20,417 Total revenue55,846 45,116 Cost of revenue, excluding depreciation and amortization. Technology(1)10,825 7,906 Professional services(1)16,513 16,162 Total cost of revenue, excluding depreciation and amortization27,338 24,068 Operating expenses. Sales and marketing(1)15,651 13,487 Research and development(1)14,345 13,088 General and administrative(1)(2)(3)15,015 9,701 Depreciation and amortization7,814 2,877 Total operating expenses52,825 39,153 Loss from operations(24,317) (18,105)Interest and other expense, net(3,952) (621)Loss before income taxes(28,269) (18,726)Income tax provision (benefit)101 (1,236)Net loss$(28,370) $(17,490)Net loss per share, basic and diluted$(0.65) $(0.47)Weighted-average shares outstanding used in calculating net loss per share, basic and diluted43,870 37,109 Adjusted net loss(4)$(2,753) $(6,083)Adjusted net loss per share, basic and diluted(4)$(0.06) $(0.16) _______________(1) Includes stock-based compensation expense as follows.

Three Months EndedMarch 31, 2021 2020 Stock-Based Compensation Expense:(in thousands)Cost of revenue, excluding depreciation and amortization. Technology$374 $176 Professional services1,435 816 Sales and marketing4,818 3,182 Research and development2,257 1,882 General and administrative4,626 2,685 Total$13,510 $8,741 (2) Includes acquisition transaction costs as follows. Three Months EndedMarch 31, 2021 2020 Acquisition transaction costs:(in thousands)General and administrative$— $875 (3) Includes the change in fair value of contingent consideration liabilities, as follows. Three Months EndedMarch 31, 2021 2020 Change in fair value of contingent consideration liabilities:(in thousands)General and administrative$2,156 $(359)(4) Includes non-GAAP adjustments to net loss.

Refer to the "Non-GAAP Financial Measures—Adjusted Net Loss Per Share" section below for further details. Condensed Consolidated Statements of Cash Flows(in thousands, unaudited) Three Months Ended March 31,Cash flows from operating activities2021 2020Net loss$(28,370) $(17,490)Adjustments to reconcile net loss to net cash used in operating activities. Depreciation and amortization7,814 2,877 Amortization of debt discount and issuance costs2,870 285 Non-cash operating lease expense965 741 Investment discount and premium amortization417 (6)Provision for expected credit losses300 51 Stock-based compensation expense13,510 8,741 Deferred tax (benefit) provision2 (1,280)Change in fair value of contingent consideration liabilities2,156 (359)Other(34) (4)Change in operating assets and liabilities. Accounts receivable, net2,090 (7,335)Deferred costs— 444 Prepaid expenses and other assets(2,173) (2,244)Accounts payable, accrued liabilities, and other liabilities(5,352) (4,283)Deferred revenue3,745 3,936 Operating lease liabilities(1,083) (843)Net cash used in operating activities(3,143) (16,769) Cash flows from investing activities Purchase of short-term investments(8,621) — Proceeds from the sale and maturity of short-term investments53,240 66,653 Acquisition of businesses, net of cash acquired— (15,249)Purchase of property and equipment(5,882) (428)Capitalization of internal use software(887) (78)Purchase of intangible assets(480) (758)Proceeds from sale of property and equipment6 6 Net cash provided by investing activities37,376 50,146 Cash flows from financing activities Proceeds from exercise of stock options6,488 9,046 Proceeds from employee stock purchase plan1,349 1,289 Payments of acquisition-related consideration(1,391) (748)Net cash provided by financing activities6,446 9,587 Effect of exchange rate on cash and cash equivalents(6) (31)Net increase in cash and cash equivalents40,673 42,933 Cash and cash equivalents at beginning of period91,954 18,032 Cash and cash equivalents at end of period$132,627 $60,965 Non-GAAP Financial Measures To supplement our financial information presented in accordance with GAAP, we believe certain non-GAAP measures, including Adjusted Gross Profit, Adjusted Gross Margin, Adjusted EBITDA, Adjusted Net Loss, and Adjusted Net Loss per share, basic and diluted, are useful in evaluating our operating performance.

For example, we exclude stock-based compensation expense because it is non-cash in nature and excluding this expense provides meaningful supplemental information regarding our operational performance and allows investors the ability to make more meaningful comparisons between our operating results and those of other companies. We use this non-GAAP financial information to evaluate our ongoing operations, as a component in determining employee bonus compensation, and for internal planning and forecasting purposes. We believe that non-GAAP financial information, when taken collectively, may be helpful to investors because it provides consistency and comparability with past financial performance. However, non-GAAP financial information is presented for supplemental informational purposes only, has limitations as an analytical tool and should not be considered in isolation or as a substitute for financial information presented in accordance with GAAP.

In addition, other companies, including companies in our industry, may calculate similarly-titled non-GAAP measures differently or may use other measures to evaluate their performance. A reconciliation is provided below for each non-GAAP financial measure to the most directly comparable financial measure stated in accordance with GAAP. Investors are encouraged to review the related GAAP financial measures and the reconciliation of these non-GAAP financial measures to their most directly comparable GAAP financial measures, and not to rely on any single financial measure to evaluate our business. Adjusted Gross Profit and Adjusted Gross Margin Adjusted Gross Profit is a non-GAAP financial measure that we define as revenue less cost of revenue, excluding depreciation and amortization and excluding stock-based compensation.

We define Adjusted Gross Margin as our Adjusted Gross Profit divided by our revenue. We believe Adjusted Gross Profit and Adjusted Gross Margin are useful to investors as they eliminate the impact of certain non-cash expenses and allow a direct comparison of these measures between periods without the impact of non-cash expenses and certain other non-recurring operating expenses. The following is a reconciliation of revenue, the most directly comparable GAAP financial measure, to Adjusted Gross Profit, for the three months ended March 31, 2021 and 2020. Three Months Ended March 31, 2021 (in thousands, except percentages) Technology Professional Services TotalRevenue$33,839 $22,007 $55,846 Cost of revenue, excluding depreciation and amortization(10,825) (16,513) (27,338)Gross profit, excluding depreciation and amortization23,014 5,494 28,508 Add.

Stock-based compensation374 1,435 1,809 Adjusted Gross Profit$23,388 $6,929 $30,317 Gross margin, excluding depreciation and amortization68% 25% 51%Adjusted Gross Margin69% 31% 54% Three Months Ended March 31, 2020 (in thousands, except percentages) Technology Professional Services TotalRevenue$24,699 $20,417 $45,116 Cost of revenue, excluding depreciation and amortization(7,906) (16,162) (24,068)Gross profit, excluding depreciation and amortization16,793 4,255 21,048 Add. Stock-based compensation176 816 992 Adjusted Gross Profit$16,969 $5,071 $22,040 Gross margin, excluding depreciation and amortization68% 21% 47%Adjusted Gross Margin69% 25% 49% Adjusted EBITDA Adjusted EBITDA is a non-GAAP financial measure that we define as net loss adjusted for (i) interest and other expense, net, (ii) income tax (benefit) provision, (iii) depreciation and amortization, (iv) stock-based compensation, (v) acquisition transaction costs, and (vi) change in fair value of contingent consideration liabilities when they are incurred. We view acquisition-related expenses when applicable, such as transaction costs and changes in the fair value of contingent consideration liabilities that are directly related to business combinations as events that are not necessarily reflective of operational performance during a period. We believe Adjusted EBITDA provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance.

The following is a reconciliation of our net loss, the most directly comparable GAAP financial measure, to Adjusted EBITDA, for the three months ended March 31, 2021 and 2020. Three Months EndedMarch 31, 2021 2020 (in thousands)Net loss$(28,370) $(17,490)Add. Interest and other expense, net3,952 621 Income tax (benefit) provision101 (1,236)Depreciation and amortization7,814 2,877 Stock-based compensation13,510 8,741 Acquisition transaction costs— 875 Change in fair value of contingent consideration liabilities2,156 (359)Adjusted EBITDA$(837) $(5,971) Adjusted Net Loss Per Share Adjusted Net Loss is a non-GAAP financial measure that we define as net loss attributable to common stockholders adjusted for (i) stock-based compensation, (ii) amortization of acquired intangibles, (iii) acquisition transaction costs, (iv) change in fair value of contingent consideration liabilities, and (v) non-cash interest expense related to our convertible senior notes. We believe Adjusted Net Loss provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance.

Three Months Ended March 31, 2021 2020 Numerator:(in thousands, except share and per share amounts)Net loss attributable to common stockholders$(28,370) $(17,490)Add. Stock-based compensation13,510 8,741 Amortization of acquired intangibles7,081 2,150 Acquisition transaction costs— 875 Change in fair value of contingent consideration liabilities2,156 (359)Non-cash interest expense related to convertible senior notes2,870 — Adjusted Net Loss$(2,753) $(6,083)Denominator. Weighted-average number of shares used in calculating net loss, basic and diluted43,870,288 37,108,998 Adjusted net loss per share, basic and diluted$(0.06) $(0.16) Health Catalyst Investor Relations Contact:Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact:Amanda HundtVice President, Corporate Communicationsamanda.hundt@healthcatalyst.com+1 (575) 491-0974.

Does ventolin increase blood pressure

But is it does ventolin increase blood pressure read the article sustainable?. EVs powered by renewable energy may help reduce the carbon footprint of transport. Yet, the measure of sustainability is not merely the carbon footprint but the material footprint.

The aggregate quantity of biomass, metal ores, construction minerals and does ventolin increase blood pressure fossil fuels used during production and consumption of a product. The approximate metric tonne weight of an EV constitutes materials such as metals (including rare earths), plastics, glass and rubber. Therefore, a global spike in the demand for EVs would drive an increased demand for each of these materials.

Every stage of the life cycle of any manufactured product exacts environmental costs does ventolin increase blood pressure. Habitat destruction, biodiversity loss and pollution (including carbon emissions) from extraction of raw materials, manufacturing / construction, through to disposal. Thus, it is the increasing global material footprint that is fundamentally the reason for the twin climate and ecological crises.

The global material footprint does ventolin increase blood pressure has grown in lockstep with the exponentially rising global economy (GDP) since the industrial revolution. This is largely because of egregious consumption by the super-affluent in a socioeconomic system founded on growth without limits. Can we resolve this fundamental conflict between the quest for limitless growth and the consequent environmental destruction?.

Industrial era exponential rise does ventolin increase blood pressure in the use of primary and derived physical resources. Cropland (a), fossil fuels (b), freshwater (c), metals (d), plastic (e). Credit.

Our World does ventolin increase blood pressure in Data (CC BY-SA 3.0 AU). ENTER TECHNOLOGY Technological innovation and efficiency improvements are often cited as pathways to decouple growth in material use from economic growth. While technology undoubtedly has a crucial role to play in the transition to a sustainable world, it is constrained by fundamental physical principles and pragmatic economic considerations.

Examples abound does ventolin increase blood pressure. The engine efficiency of airplanes has improved little for decades since they have long been operating close to their theoretical peak efficiency. Likewise, there is a hard limit on the efficiency of photovoltaic cells of about 35 percent because of the physical properties of the semiconductors that constitute them.

In practice few exceed 20 percent for does ventolin increase blood pressure economic and pragmatic reasons. The power generation of large wind farms is limited to about one watt per square meter as a simple yet utterly unavoidable physical consequence of wake effects. The awesome exponential increase in computing power of the past five decades will end by about 2025 since it is physically impossible to make the transistors on the computer chip, already roughly 5 percent of the size of the asthma, much smaller.

Whether it is principles of classical, quantum or solid state physics or thermodynamics, each places different but inexorable constraints on does ventolin increase blood pressure technological solutions. Basically, physical principles that have allowed incredible technological leaps over the past century also inevitably limit them. We might consider that extensive recycling of materials would offset efficiency limits.

Recycling is crucial does ventolin increase blood pressure. However, while glass and metals can be recycled almost indefinitely without loss of quality, materials such as paper and plastic can be recycled only a few times before becoming too degraded. Additionally, recycling itself may be an energy- and materials-intensive process.

Even if physical laws could be broken does ventolin increase blood pressure (they cannot) to achieve recycling with 100 percent efficiency, added demand from the imperative for economic growth would necessarily require virgin materials. The key point is that efficiency is limited by physics, but there is no sufficiency limit on the socioeconomic construct of “demand.” Unfortunately, the situation is even more dire. Economic growth is required to be exponential.

That is, the size of the economy must double in a does ventolin increase blood pressure fixed period. As referenced earlier, this has driven a corresponding increase in the material footprint. To understand the nature of exponential growth, consider the EV.

Suppose that we have enough (easily extractable) lithium for the batteries needed to fuel the EV revolution for does ventolin increase blood pressure another 30 years. Now assume that deep-sea mining provides four times the current amount of these materials. Are we covered for 120 years?.

No, because the current 10 percent rate of growth in demand for lithium does ventolin increase blood pressure is equivalent to doubling of demand every seven years, which means we would only have enough for 44 years. In effect, we would cause untold, perhaps irreversible, devastation of marine ecosystems to buy ourselves a few extra years’ supply of raw materials. Exponential growth swiftly, inevitably, swamps anything in finite supply.

For a ventolin, that finite resource is the human population and in the context of the planet it does ventolin increase blood pressure is its physical resources. The inescapable inference is that it is essentially impossible to decouple material use from economic growth. And this is exactly what has transpired.

Wiedmann et al., 2015 did a careful accounting of the material footprint, including those embedded does ventolin increase blood pressure in international trade, for several nations. In the 1990–2008 period covered by the study, no country achieved a planned, deliberate economywide decoupling for a sustained length of time. Claims by the Global North to the contrary conceal the substantial offshoring of its production, and the associated ecological devastation, to the Global South.

Recent proposals for ecocidal deep-sea and fantastical exoplanetary mining are an does ventolin increase blood pressure unsurprising consequence of a growth paradigm that refuses to recognize these inconvenient truths. WHAT IS SUSTAINABILITY?. These observations lead us to a natural minimum condition for sustainability.

All resource use curves must be does ventolin increase blood pressure simultaneously flatlined and all pollution curves simultaneously extinguished. It is this resource perspective that allows us to see why EVs may help offset carbon emissions yet remain utterly unsustainable under the limitless growth paradigm. Sustainability from a resource perspective.

Exponentially rising resource use and pollution does ventolin increase blood pressure (a and b) are unsustainable. We define sustainability as flatlined resource use (c) and extinguished pollution (d). Credit.

Aditi Deshpande THE REAL QUESTION We have argued that the inextricable link does ventolin increase blood pressure between material consumption and GDP makes the infinite-growth paradigm incompatible with sustaining ecological integrity. Thus, while EVs constitute a partial answer to the climate question, within the current paradigm they will only exacerbate the larger anthropogenic crises connected to unsustainable resource consumption. The real question is this.

How do we transition to alternative does ventolin increase blood pressure economic paradigms founded on the reconciliation of equitable human well-being with ecological integrity?. This is an opinion and analysis article. The views expressed by the author or authors are not necessarily those of Scientific American.The New York Times recently conducted an important investigation revealing the use of sickle cell trait (SCT) as a cover-up for the deaths of Black people at the hands of police while in custody.

The newspaper reported finding 47 cases in the past 25 years in which medical examiners, law enforcement officials or defenders of accused officers cited the trait as a cause or major factor in a Black does ventolin increase blood pressure person’s death in custody, with 15 of these deaths occurring since 2015. As hematologists who specialize in both SCT and sickle cell disease, we appreciate the importance of highlighting the disturbing information uncovered by this investigation, including ascriptions of SCT as a causative factor in the death of individuals who have been “roughed up” by the police. SCT is a benign genetic condition.

It is not a disease and is not associated with decreased does ventolin increase blood pressure life expectancy like sickle cell disease. SCT does not cause “sickle cell crisis,” “cardiac hypertrophy,” or “positional asphyxia,” which has been cited in several cases. In the seminal work published by Graham Serjeant, Sickle Cell Disease (third edition),the author notes that in people with SCT, “studies of morbidity have also failed to demonstrate any difference in the age, duration or pattern of hospital admissions in the [people with] SCT compared to normal controls.” SCT is also extremely common.

An estimated three million Americans and hundreds of millions of persons worldwide have does ventolin increase blood pressure SCT, and most will live normal life spans with no adverse health events related to SCT. Cases of sudden death in people with SCT are the rare exception rather than the rule. Previous reports of these cases are in the setting of extraordinary exertion, such as older formats of military basic training and intensive athletic conditioning.

A recent study published in the New England Journal of Medicine including data from over 47,000 Black soldiers in the United States Army from 2011 to 2014 found that there was does ventolin increase blood pressure no increased risk of sudden death in soldiers with SCT compared to those without SCT. In people with SCT, there is a well-recognized risk of exertional rhabdomyolysis, a condition of severe muscle breakdown that can cause kidney failure, although the NEJM study found that this risk was no greater than the risk of rhabdomyolysis associated with obesity, tobacco use, or use of statin medications. On the contrary, multiple studies have shown that people with SCT are able to tolerate moderate exercise and show no clear differences in metabolic breakdown products, oxygen exchange or cardiopulmonary function.

In light of sound scientific research and expert hematologist opinion, it is clear that SCT is not associated with an increased risk of does ventolin increase blood pressure sudden death. The American Society of Hematology, the world’s largest hematology society, with renowned sickle cell experts as members, has recently released a response to the Times investigation, affirming that there is no medical merit to SCT to explain in-custody deaths. It is equally clear that Black men who interact with the police have a significantly increased risk of mortality.

A report published by the National Academy of Sciences in 2019 estimates that one does ventolin increase blood pressure in 1,000 Black men are killed by police. Black men are 2.5 times more likely to be killed by police during their lifetime than white men. Disappointingly, official data on the number of deaths that occur in police custody are not available, despite passage of the Death in Custody Reporting Act in 2014.

In the cases reported by the Times, statistics are does ventolin increase blood pressure not necessary to highlight the blatant police brutality and disregard for human life and safety. In many of the cases reported, police deployed stun guns and tasers, they chased men who rightfully feared for their lives, they knelt on necks, and they beat people with batons. In some cases, we will never know the true nature of their brutality, as the abuse was inflicted under cover of a forest at night, or with body cameras turned off or footage withheld.

The medical field itself has a shameful does ventolin increase blood pressure history of creating and perpetuating the pseudoscience of race-based physiological differences and performing unethical research. The onus is therefore on us, as physicians, to publicly denounce the use of these outdated and racist notions when they are used to provide cover for the mistreatment and murder of Black men and women at the hands of the police. We must not enable those who would conceal the fact that these men very plausibly died as a result of excessive use of force.

Medical examiners determine the does ventolin increase blood pressure manner and cause of death. We must demand that these medical examiners stop the perpetuation of the misinformation about SCT. It is neither a contributor to nor cause of death in almost all of these cases.

We call on medical examiners to evaluate their own biases and conflicts does ventolin increase blood pressure of interest and to stop the misuse of medicine and science to potentially exculpate the police in the racist brutalization of Black men. To be clear, decreasing bias and removing medical mythology from the medical examiners’ assessment of deaths of Black men in police custody is a crucial component in holding police accountable. Following the one-year anniversary of the murder of George Floyd, this charge is more urgent than ever.

President Joe Biden had does ventolin increase blood pressure asked for Congress to pass the H.R. 7120 George Floyd Justice in Policing Act. It is currently stalled in the Senate, and we need to call on our congresspeople to act in passing this bill.

As Americans we should all want better policing with improved accountability, including with police encounters with other Americans with SCT does ventolin increase blood pressure. Blaming the deaths of 47 Black men on SCT as causative instead of associated is inaccurate and disrespectful. It is clear that it was not a variant in the beta hemoglobin gene (HBB), but rather the melanin receptor gene (MCR1), that was the cause of these men’s deaths.

Put more simply, the genetic trait that contributed most to these men’s death was evidently the color of their skin, does ventolin increase blood pressure not the contents of their red blood cells.Birth and death are the bookends of life, yet we welcome one and dread the other. Why is it that birth is celebrated, but death is taboo?. When a friend was expecting her first child, she needed additional support through her pregnancy, so she hired a birth doula.

The idea of women helping other women during does ventolin increase blood pressure childbirth is not new. Since the beginning of time, women have labored and birthed at home, attended by a midwife and their female friends and kin. This camaraderie of women, once universal, was a way to provide birth support and also to pass on knowledge about pregnancy, childbirth and parenting.

The natural birth movement of the 1960s begged a return to this approach with women demanding unmedicated, less does ventolin increase blood pressure interventional births. Hence, the inception of the birth doula—a nonmedical caregiver who assisted pregnant women in the transition to motherhood. Can the same idea apply to death?.

The evolution does ventolin increase blood pressure of death care has followed a similar trajectory to that of childbirth care. For most of human history, people were cared for and died at home, with corpses even displayed on the dining room table for mourning. This began to change in the mid-20th century as society saw great advancements in medical technology for diagnosis and treatment of illnesses.

These developments moved health care away from the local does ventolin increase blood pressure doctor, who made house calls, to inpatient stays at hospitals. When people fell ill, they went to the hospital and eventually died there. In 1980, 60.5 percent of people died can i get ventolin over the counter in hospitals.

This number peaked in the mid-1980’s, but has since does ventolin increase blood pressure steadily decreased in response to a growing movement for death to be less medicalized, less institutionalized, and more natural. By 2016, half as many people (29.4 percent) were dying in hospitals, roughly equaling the number of people dying at home (30.5 percent). While this trend is encouraging, these numbers still do not reflect the fact that 71 percent of people would prefer to die at home.

I am a death doula, or does ventolin increase blood pressure what is now more commonly termed an end-of-life doula. This role grew out of the increasing awareness of and desire for more humane and compassionate ways to die. Similar to birth doulas, end-of-life doulas are nonmedical professionals offering emotional, spiritual, informational and physical support—not at birth, but at the other end of the spectrum of life—at death.

An elderly does ventolin increase blood pressure man with a terminal illness is afraid to die. He fears for the family he will leave behind—his wife, children and grandchildren—and how they will cope after he is gone. He has not expressed this fear to his doctors or to his wife, who is already handling so much.

I listen does ventolin increase blood pressure. I hold space for his despair and angst. He realizes the fear is based on his immense love for his family.

He drinks does ventolin increase blood pressure champagne with them on his deathbed. Reconciliation with the things that are important can allow one the peace to let go. End-of-life doulas work with those with serious illnesses who are facing death—and also for those who are healthy and just want to prepare for death.

On practical matters, doulas can advise on advance care directives, vigil planning and postdeath options, and assist with life review does ventolin increase blood pressure and legacy. On more emotional matters, doulas can facilitate conversations about unresolved issues or complex family dynamics and offer space for the fears and uncertainties around death and dying. When we are prepared for death, we are better able to face it when the time comes.

Despite her wish to die at home, an elderly woman is taken to the hospital by her son, who can no does ventolin increase blood pressure longer bear to watch his mother die in excruciating pain. The hospital wants to discharge her, finding nothing wrong, and, at her age, what can be done anyhow?. The family is distressed by the hospital’s response and calls me.

I suggest that they ask for a palliative care consultation does ventolin increase blood pressure. Eventually, the mother is placed on a proper pain management plan and discharged to hospice care. How do you know what to ask for, if you don’t know the choices?.

Palliative and hospice care are philosophies of care that focus on comfort does ventolin increase blood pressure and symptom management to alleviate pain and suffering. Both are available to persons with serious illnesses. While palliative care can be given concurrently with curative care, hospice is typically for those who no longer seek curative treatments.

End-of-life doulas does ventolin increase blood pressure advocate for the wishes and needs of the dying person. We work with the health care team in ongoing care and coordinate with the support network of family and friends in place or help to establish a needed support system. We fill gaps in care and tackle tasks that are difficult to do or face.

All the while, we can be a calming presence for does ventolin increase blood pressure loved ones and the dying person, especially for those who are facing death all alone. A middle-aged man lies actively dying, completely nonresponsive, in his bed. He displays “death rattle” breathing, and his body has occasional violent spasms.

At his does ventolin increase blood pressure bedside, a petite woman sits, his aunt, pained to watch her nephew die this way. After creating rapport with the aunt, I seek to allay her distress and encourage her to speak to him. The aunt responds gratefully, awakened to the possibility of making a difference for her nephew.

He dies peacefully, immersed in soft does ventolin increase blood pressure light, music and love. Sometimes all a loved one needs is permission to be an active participant in the process, to turn helplessness into empowerment. While death brings sadness and loss, there can also be positive emotions of love, honor and pride.

It is possible to feel seemingly contradictory emotions all at the same time—because death is loss, does ventolin increase blood pressure and grief is the natural expression of love. On the end-of-life journey, we doulas are your personal advocate, cheerleader, companion, guide, ear, rock—whatever you need us to be to face a difficult, intense and emotional time, because no one who wants support at the end of life should have to go without. This is an opinion and analysis article.The items below are highlights from the free newsletter, “Smart, useful, science stuff about asthma treatment.” To receive newsletter issues daily in your inbox, sign up here.

Novavax reports that its two-dose protein-based treatment against asthma treatment has been 100% effective in preventing severe illness, hospitalization and death due to asthma treatment, as well as 90.4% effective against asthma treatment does ventolin increase blood pressure symptoms in large-scale human studies. These studies, which involved thousands of people in the U.S. And Mexico, showed that the treatment also was highly effective against “Alpha,” the asthma variant first identified in Great Britain, reports Carl Zimmer at The New York Times (6/14/21).

€œNovavax plans to does ventolin increase blood pressure apply for authorization in UK, EU, India, South Korea, and possibly the U.S.,” according to an Unbiased SciPod post (6/15/21). A 6/17/21 story by Tanya Lewis at Scientific American describes some of the incentives being offered to people for getting vaccinated against asthma treatment — including lottery tickets, college scholarships, train tickets, firearms, cash pay-outs, cannabis joints, doughnuts, free trips, cruises, and gift certificates. €œPublic health experts use incentives all the time to get people to quit smoking, exercise more, and so on,” the story describes the director of the Health Decision Sciences Center at Massachusetts General Hospital’s general medicine division as saying.

An unpublished does ventolin increase blood pressure study by the Mass General researcher suggests that incentives might effectively induce people to get a asthma treatment, Lewis reports. But for some people the best inducement is an opportunity to stop wearing a mask and a general return to normalcy, the story suggests. Some positive news for people who have transplanted organs and thus take immune-suppressing drugs.

A third dose of a mRNA treatment against asthma treatment provoked a stronger immune response, at least in the does ventolin increase blood pressure form of antibodies, in organ transplant patients than the standard two doses did, per various reports. The findings, from a small study of patients who received a third dose this spring, were published 6/15/21 in Annals of Internal Medicine. The findings are “part of a broader discussion about whether and when to offer extra doses to vulnerable individuals,” writes Jennifer Couzin-Frankel at Science (6/14/21).

In past does ventolin increase blood pressure studies, organ transplant patients who got a two-dose asthma treatment were far less likely to make protective antibodies against asthma than the general population was. Some larger three-dose studies among people with compromised immune systems are under way, Couzin-Frankel reports. A medical oncologist at the University of Pennsylvania is not very worried about the effectiveness of asthma treatments among people with cancer, the story states.

The story then describes two recent studies of cancer patients showing that they produced antibodies against does ventolin increase blood pressure asthma after receiving a asthma treatment. However, a third study found much lower antibody levels among vaccinated cancer patients than it did among their healthy family members who also were vaccinated, Couzin-Frankel reports. The Unbiased SciPod posted some helpful informational graphics about Pfizer’s ongoing studies of its asthma treatment in children under 12 (6/11/21).

The post states that dosages have been set based on initial smaller studies in children (one-third the adult dose for ages 5-11 and one-tenth the adult dose for ages 6 months to 5 years), and that researchers will enroll 4,500 children across 90 sites globally for does ventolin increase blood pressure the larger safety and effectiveness studies. €œChildren have immune system components that are more potent compared to adults. They may not need as high a dose for protection.

Age criteria are related to does ventolin increase blood pressure immune system development, not physical size,” the post states. The results will likely become available this fall for review by the U.S. Food and Drug Administration, with a first batch — from studies in children ages 5 to 11 — expected in early September, the post states.

Nearly one does ventolin increase blood pressure quarter of all people in the U.S. Who were infected with asthma last year, including 19% of those who never reported asthma treatment symptoms from their , had new medical problems within a month or more of recovering from the ventolin, according to a large study covered by Pam Belluck at The New York Times (6/15/21). Belluck writes.

€œThose affected does ventolin increase blood pressure were all ages, including children. Their most common new health problems were pain, including in nerves and muscles. Breathing difficulties.

High cholesterol does ventolin increase blood pressure. Malaise and fatigue. And high blood pressure.

Other issues does ventolin increase blood pressure included intestinal symptoms. Migraines. Skin problems.

Heart abnormalities does ventolin increase blood pressure. Sleep disorders. And mental health conditions like anxiety and depression.” The study, conducted by non-profit organization FAIR Health and not formally reviewed by experts for flaws, involved evaluating electronic health-insurance records.

A 6/11/21 story by Emily Anthes at The New York Times runs down does ventolin increase blood pressure some evidence-based approaches that employers can take to reduce the risk of asthma s and other health problems as workers return to offices nationwide. Employers should flush unused taps and other plumbing to clear any metals or Legionella bacteria colonies that accumulated, the story states. Employers also should upgrade their ventilation and fiation systems, the story states.

The goal is four to six air changes per hour, the story states, which is equivalent to completely refreshing air every 10 to 15 minutes in a does ventolin increase blood pressure room. Portable air purifiers or even “desktop level HEPA filters” can help. And continue to wash your hands routinely, for at least 20 seconds each time, advises a Northwestern University environmental microbiologist who is quoted in the story.

Not solutions does ventolin increase blood pressure. Desk shields (plexiglass barriers are a good idea in grocery stores though), foggers, fumigators, ionizers, ozone generators and other ‘air cleaning’ devices,’ the story states. In most non-medical or non-lab settings, wiping down surfaces with bleach solutions or disinfectant solutions or wipes does little to prevent asthma transmission.

Besides, inhaling these substances is does ventolin increase blood pressure harmful. €œThe no. 1 thing is to get vaccinated,” the story quotes Joseph Allen at the Harvard School of Public Health as saying.

A debate among scientists about whether asthma spreads mainly by does ventolin increase blood pressure fallen respiratory droplets on surfaces that people touch or spreads in air hampered public health efforts to control the ventolin and to prevent deaths. The implications for this debate were crucial, as Megan Molteni at Wired writes (5/13/21) — officials need to know whether public-health messages should focus on hand washing or on masking and isolation or both, particularly before treatments become available. The general debate is over, as you probably know — the ventolin is mostly spread in indoor air.

But why does ventolin increase blood pressure did researchers disagree until recently?. In part, it’s because the arguments against airborne asthma all rested on an assumption that only particles smaller than 5 microns could hang in the air. Larger ones, aka droplets, fall to surfaces.

But in reality, larger particles can stay afloat and behave like aerosols, many scientists and engineers have known, including aerosols expert Linsey Marr of Virginia Tech, Molteni does ventolin increase blood pressure and others have written. Molteni’s story masterfully traces the events, conversations, and research that came to expose the “fallacy of the 5-micron boundary.” The hero of this engaging story is Katie Randall, a graduate student who specializes in detective work to figure out how bits of knowledge are passed along through published research papers over time. Guidance from the U.S.

Centers for Disease Control in April stated that international and domestic travel are low-risk activities does ventolin increase blood pressure for people vaccinated against asthma treatment (so, this does not pertain, unfortunately, to U.S. Children under 12, for whom asthma treatments are not yet authorized). In response to that update, Ceylan Yeginsu at The New York Times has written up answers to some of the questions that vaccinated travelers have these days (6/15/21).

A summary of the answers (again, does ventolin increase blood pressure this information is all for vaccinated people in the U.S.). 1) Yes, you must still wear a mask at the airport and on flights. 2) No, you don’t have to quarantine or test if you travel domestically, unless it is required by a state or territory.

3) No, you don’t have to take a asthma test before departure to international destinations — not for the U.S. At least. Check for your destination.

4) Yes, you have to test, even if vaccinated, three days before you return by air to the U.S..

But is it http://websitesbyelizabeth.com/design-showcase/ sustainable? ventolin cost per pill. EVs powered by renewable energy may help reduce the carbon footprint of transport. Yet, the measure of sustainability is not merely the carbon footprint but the material footprint.

The aggregate quantity of biomass, metal ores, construction minerals and fossil fuels used during production ventolin cost per pill and consumption of a product. The approximate metric tonne weight of an EV constitutes materials such as metals (including rare earths), plastics, glass and rubber. Therefore, a global spike in the demand for EVs would drive an increased demand for each of these materials.

Every stage of the life cycle of any manufactured ventolin cost per pill product exacts environmental costs. Habitat destruction, biodiversity loss and pollution (including carbon emissions) from extraction of raw materials, manufacturing / construction, through to disposal. Thus, it is the increasing global material footprint that is fundamentally the reason for the twin climate and ecological crises.

The global material footprint has grown in lockstep with the exponentially rising ventolin cost per pill global economy (GDP) since the industrial revolution. This is largely because of egregious consumption by the super-affluent in a socioeconomic system founded on growth without limits. Can we resolve this fundamental conflict between the quest for limitless growth and the consequent environmental destruction?.

Industrial era exponential rise in the use of ventolin cost per pill primary and derived physical resources. Cropland (a), fossil fuels (b), freshwater (c), metals (d), plastic (e). Credit.

Our World in Data (CC BY-SA ventolin cost per pill 3.0 AU). ENTER TECHNOLOGY Technological innovation and efficiency improvements are often cited as pathways to decouple growth in material use from economic growth. While technology undoubtedly has a crucial role to play in the transition to a sustainable world, it is constrained by fundamental physical principles and pragmatic economic considerations.

Examples ventolin cost per pill abound. The engine efficiency of airplanes has improved little for decades since they have long been operating close to their theoretical peak efficiency. Likewise, there is a hard limit on the efficiency of photovoltaic cells of about 35 percent because of the physical properties of the semiconductors that constitute them.

In practice few exceed 20 percent for economic and pragmatic ventolin cost per pill reasons. The power generation of large wind farms is limited to about one watt per square meter as a simple yet utterly unavoidable physical consequence of wake effects. The awesome exponential increase in computing power of the past five decades will end by about 2025 since it is physically impossible to make the transistors on the computer chip, already roughly 5 percent of the size of the asthma, much smaller.

Whether it is principles of classical, quantum or solid ventolin cost per pill state physics or thermodynamics, each places different but inexorable constraints on technological solutions. Basically, physical principles that have allowed incredible technological leaps over the past century also inevitably limit them. We might consider that extensive recycling of materials would offset efficiency limits.

Recycling is crucial ventolin cost per pill. However, while glass and metals can be recycled almost indefinitely without loss of quality, materials such as paper and plastic can be recycled only a few times before becoming too degraded. Additionally, recycling itself may be an energy- and materials-intensive process.

Even if physical laws could be broken (they cannot) to achieve recycling with 100 percent ventolin cost per pill efficiency, added demand from the imperative for economic growth would necessarily require virgin materials. The key point is that efficiency is limited by physics, but there is no sufficiency limit on the socioeconomic construct of “demand.” Unfortunately, the situation is even more dire. Economic growth is required to be exponential.

That is, the size of the economy must double in ventolin cost per pill a fixed period. As referenced earlier, this has driven a corresponding increase in the material footprint. To understand the nature of exponential growth, consider the EV.

Suppose that we have ventolin cost per pill enough (easily extractable) lithium for the batteries needed to fuel the EV revolution for another 30 years. Now assume that deep-sea mining provides four times the current amount of these materials. Are we covered for 120 years?.

No, because the current 10 percent rate of growth in ventolin cost per pill demand for lithium is equivalent to doubling of demand every seven years, which means we would only have enough for 44 years. In effect, we would cause untold, perhaps irreversible, devastation of marine ecosystems to buy ourselves a few extra years’ supply of raw materials. Exponential growth swiftly, inevitably, swamps anything in finite supply.

For a ventolin, that finite resource ventolin cost per pill is the human population and in the context of the planet it is its physical resources. The inescapable inference is that it is essentially impossible to decouple material use from economic growth. And this is exactly what has transpired.

Wiedmann et al., 2015 did a careful accounting of the material footprint, including ventolin cost per pill those embedded in international trade, for several nations. In the 1990–2008 period covered by the study, no country achieved a planned, deliberate economywide decoupling for a sustained length of time. Claims by the Global North to the contrary conceal the substantial offshoring of its production, and the associated ecological devastation, to the Global South.

Recent proposals for ecocidal ventolin cost per pill deep-sea and fantastical exoplanetary mining are an unsurprising consequence of a growth paradigm that refuses to recognize these inconvenient truths. WHAT IS SUSTAINABILITY?. These observations lead us to a natural minimum condition for sustainability.

All resource use curves must be simultaneously flatlined ventolin cost per pill and all pollution curves simultaneously extinguished. It is this resource perspective that allows us to see why EVs may help offset carbon emissions yet remain utterly unsustainable under the limitless growth paradigm. Sustainability from a resource perspective.

Exponentially rising resource ventolin cost per pill use and pollution (a and b) are unsustainable. We define sustainability as flatlined resource use (c) and extinguished pollution (d). Credit.

Aditi Deshpande THE REAL QUESTION We have argued that the inextricable link between material consumption and GDP ventolin cost per pill makes the infinite-growth paradigm incompatible with sustaining ecological integrity. Thus, while EVs constitute a partial answer to the climate question, within the current paradigm they will only exacerbate the larger anthropogenic crises connected to unsustainable resource consumption. The real question is this.

How do we transition to alternative economic paradigms founded on the reconciliation ventolin cost per pill of equitable human well-being with ecological integrity?. This is an opinion and analysis article. The views expressed by the author or authors are not necessarily those of Scientific American.The New York Times recently conducted an important investigation revealing the use of sickle cell trait (SCT) as a cover-up for the deaths of Black people at the hands of police while in custody.

The newspaper ventolin cost per pill reported finding 47 cases in the past 25 years in which medical examiners, law enforcement officials or defenders of accused officers cited the trait as a cause or major factor in a Black person’s death in custody, with 15 of these deaths occurring since 2015. As hematologists who specialize in both SCT and sickle cell disease, we appreciate the importance of highlighting the disturbing information uncovered by this investigation, including ascriptions of SCT as a causative factor in the death of individuals who have been “roughed up” by the police. SCT is a benign genetic condition.

It is not a disease and is not associated with decreased life expectancy ventolin cost per pill like sickle cell disease. SCT does not cause “sickle cell crisis,” “cardiac hypertrophy,” or “positional asphyxia,” which has been cited in several cases. In the seminal work published by Graham Serjeant, Sickle Cell Disease (third edition),the author notes that in people with SCT, “studies of morbidity have also failed to demonstrate any difference in the age, duration or pattern of hospital admissions in the [people with] SCT compared to normal controls.” SCT is also extremely common.

An estimated three million Americans and hundreds of ventolin cost per pill millions of persons worldwide have SCT, and most will live normal life spans with no adverse health events related to SCT. Cases of sudden death in people with SCT are the rare exception rather than the rule. Previous reports of these cases are in the setting of extraordinary exertion, such as older formats of military basic training and intensive athletic conditioning.

A recent study published in the New England Journal of Medicine including data from over 47,000 Black soldiers in the United States Army from 2011 to 2014 found that there was no increased risk of sudden death in soldiers with SCT compared to those ventolin cost per pill without SCT. In people with SCT, there is a well-recognized risk of exertional rhabdomyolysis, a condition of severe muscle breakdown that can cause kidney failure, although the NEJM study found that this risk was no greater than the risk of rhabdomyolysis associated with obesity, tobacco use, or use of statin medications. On the contrary, multiple studies have shown that people with SCT are able to tolerate moderate exercise and show no clear differences in metabolic breakdown products, oxygen exchange or cardiopulmonary function.

In light of sound ventolin cost per pill scientific research and expert hematologist opinion, it is clear that SCT is not associated with an increased risk of sudden death. The American Society of Hematology, the world’s largest hematology society, with renowned sickle cell experts as members, has recently released a response to the Times investigation, affirming that there is no medical merit to SCT to explain in-custody deaths. It is equally clear that Black men who interact with the police have a significantly increased risk of mortality.

A report published by the National Academy of Sciences in 2019 ventolin cost per pill estimates that one in 1,000 Black men are killed by police. Black men are 2.5 times more likely to be killed by police during their lifetime than white men. Disappointingly, official data on the number of deaths that occur in police custody are not available, despite passage of the Death in Custody Reporting Act in 2014.

In the cases reported by the Times, statistics are not necessary to ventolin cost per pill highlight the blatant police brutality and disregard for human life and safety. In many of the cases reported, police deployed stun guns and tasers, they chased men who rightfully feared for their lives, they knelt on necks, and they beat people with batons. In some cases, we will never know the true nature of their brutality, as the abuse was inflicted under cover of a forest at night, or with body cameras turned off or footage withheld.

The medical field itself has a shameful history of creating and perpetuating the pseudoscience ventolin cost per pill of race-based physiological differences and performing unethical research. The onus is therefore on us, as physicians, to publicly denounce the use of these outdated and racist notions when they are used to provide cover for the mistreatment and murder of Black men and women at the hands of the police. We must not enable those who would conceal the fact that these men very plausibly died as a result of excessive use of force.

Medical examiners determine the manner and cause of ventolin cost per pill death. We must demand that these medical examiners stop the perpetuation of the misinformation about SCT. It is neither a contributor to nor cause of death in almost all of these cases.

We call on medical examiners to evaluate their own biases and conflicts of interest and to stop the misuse of ventolin cost per pill medicine and science to potentially exculpate the police in the racist brutalization of Black men. To be clear, decreasing bias and removing medical mythology from the medical examiners’ assessment of deaths of Black men in police custody is a crucial component in holding police accountable. Following the one-year anniversary of the murder of George Floyd, this charge is more urgent than ever.

President Joe Biden had asked for Congress to pass ventolin cost per pill the H.R. 7120 George Floyd Justice in Policing Act. It is currently stalled in the Senate, and we need to call on our congresspeople to act in passing this bill.

As Americans we should all want better policing with ventolin cost per pill improved accountability, including with police encounters with other Americans with SCT. Blaming the deaths of 47 Black men on SCT as causative instead of associated is inaccurate and disrespectful. It is clear that it was not a variant in the beta hemoglobin gene (HBB), but rather the melanin receptor gene (MCR1), that was the cause of these men’s deaths.

Put more simply, the genetic trait that contributed most to these men’s death was evidently the color of their skin, not the contents of their red blood ventolin cost per pill cells.Birth and death are the bookends of life, yet we welcome one and dread the other. Why is it that birth is celebrated, but death is taboo?. When a friend was expecting her first child, she needed additional support through her pregnancy, so she hired a birth doula.

The idea ventolin cost per pill of women helping other women during childbirth is not new. Since the beginning of time, women have labored and birthed at home, attended by a midwife and their female friends and kin. This camaraderie of women, once universal, was a way to provide birth support and also to pass on knowledge about pregnancy, childbirth and parenting.

The natural birth movement of the 1960s begged a return to this approach with women demanding unmedicated, less interventional ventolin cost per pill births. Hence, the inception of the birth doula—a nonmedical caregiver who assisted pregnant women in the transition to motherhood. Can the same idea apply to death?.

The evolution of death care has followed a similar trajectory ventolin cost per pill to that of childbirth care. For most of human history, people were cared for and died at home, with corpses even displayed on the dining room table for mourning. This began to change in the mid-20th century as society saw great advancements in medical technology for diagnosis and treatment of illnesses.

These developments moved health care away from the local doctor, who made house calls, to ventolin cost per pill inpatient stays at hospitals. When people fell ill, they went to the hospital and eventually died there. In 1980, 60.5 percent of people died in hospitals.

This number peaked in the mid-1980’s, but has since steadily decreased in response to a growing movement for death to be less medicalized, less institutionalized, ventolin cost per pill and more natural. By 2016, half as many people (29.4 percent) were dying in hospitals, roughly equaling the number of people dying at home (30.5 percent). While this trend is encouraging, these numbers still do not reflect the fact that 71 percent of people would prefer to die at home.

I am a death doula, or what is ventolin cost per pill now more commonly termed an end-of-life doula. This role grew out of the increasing awareness of and desire for more humane and compassionate ways to die. Similar to birth doulas, end-of-life doulas are nonmedical professionals offering emotional, spiritual, informational and physical support—not at birth, but at the other end of the spectrum of life—at death.

An elderly ventolin cost per pill man with a terminal illness is afraid to die. He fears for the family he will leave behind—his wife, children and grandchildren—and how they will cope after he is gone. He has not expressed this fear to his doctors or to his wife, who is already handling so much.

I listen ventolin cost per pill. I hold space for his despair and angst. He realizes the fear is based on his immense love for his family.

He drinks champagne with them on his ventolin cost per pill deathbed. Reconciliation with the things that are important can allow one the peace to let go. End-of-life doulas work with those with serious illnesses who are facing death—and also for those who are healthy and just want to prepare for death.

On practical matters, doulas can advise on advance care directives, vigil planning and postdeath options, and assist with life review and legacy ventolin cost per pill. On more emotional matters, doulas can facilitate conversations about unresolved issues or complex family dynamics and offer space for the fears and uncertainties around death and dying. When we are prepared for death, we are better able to face it when the time comes.

Despite her wish to die at home, an elderly woman is taken to the hospital by her ventolin cost per pill son, who can no longer bear to watch his mother die in excruciating pain. The hospital wants to discharge her, finding nothing wrong, and, at her age, what can be done anyhow?. The family is distressed by the hospital’s response and calls me.

I suggest that they ask for a palliative care consultation ventolin cost per pill. Eventually, the mother is placed on a proper pain management plan and discharged to hospice care. How do you know what to ask for, if you don’t know the choices?.

Palliative and ventolin cost per pill hospice care are philosophies of care that focus on comfort and symptom management to alleviate pain and suffering. Both are available to persons with serious illnesses. While palliative care can be given concurrently with curative care, hospice is typically for those who no longer seek curative treatments.

End-of-life doulas advocate for ventolin cost per pill the wishes and needs of the dying person. We work with the health care team in ongoing care and coordinate with the support network of family and friends in place or help to establish a needed support system. We fill gaps in care and tackle tasks that are difficult to do or face.

All the while, we can be a calming presence for loved ones and the dying ventolin cost per pill person, especially for those who are facing death all alone. A middle-aged man lies actively dying, completely nonresponsive, in his bed. He displays “death rattle” breathing, and his body has occasional violent spasms.

At his bedside, a petite woman sits, his aunt, pained ventolin cost per pill to watch her nephew die this way. After creating rapport with the aunt, I seek to allay her distress and encourage her to speak to him. The aunt responds gratefully, awakened to the possibility of making a difference for her nephew.

He dies peacefully, ventolin cost per pill immersed in soft light, music and love. Sometimes all a loved one needs is permission to be an active participant in the process, to turn helplessness into empowerment. While death brings sadness and loss, there can also be positive emotions of love, honor and pride.

It is possible to feel seemingly contradictory emotions all at the ventolin cost per pill same time—because death is loss, and grief is the natural expression of love. On the end-of-life journey, we doulas are your personal advocate, cheerleader, companion, guide, ear, rock—whatever you need us to be to face a difficult, intense and emotional time, because no one who wants support at the end of life should have to go without. This is an opinion and analysis article.The items below are highlights from the free newsletter, “Smart, useful, science stuff about asthma treatment.” To receive newsletter issues daily in your inbox, sign up here.

Novavax reports ventolin cost per pill that its two-dose protein-based treatment against asthma treatment has been 100% effective in preventing severe illness, hospitalization and death due to asthma treatment, as well as 90.4% effective against asthma treatment symptoms in large-scale human studies. These studies, which involved thousands of people in the U.S. And Mexico, showed that the treatment also was highly effective against “Alpha,” the asthma variant first identified in Great Britain, reports Carl Zimmer at The New York Times (6/14/21).

€œNovavax plans to apply for authorization in UK, EU, India, South Korea, and possibly the U.S.,” according to an Unbiased SciPod post ventolin cost per pill (6/15/21). A 6/17/21 story by Tanya Lewis at Scientific American describes some of the incentives being offered to people for getting vaccinated against asthma treatment — including lottery tickets, college scholarships, train tickets, firearms, cash pay-outs, cannabis joints, doughnuts, free trips, cruises, and gift certificates. €œPublic health experts use incentives all the time to get people to quit smoking, exercise more, and so on,” the story describes the director of the Health Decision Sciences Center at Massachusetts General Hospital’s general medicine division as saying.

An unpublished study by the Mass General researcher suggests that ventolin cost per pill incentives might effectively induce people to get a asthma treatment, Lewis reports. But for some people the best inducement is an opportunity to stop wearing a mask and a general return to normalcy, the story suggests. Some positive news for people who have transplanted organs and thus take immune-suppressing drugs.

A third dose of a mRNA treatment against asthma treatment ventolin cost per pill provoked a stronger immune response, at least in the form of antibodies, in organ transplant patients than the standard two doses did, per various reports. The findings, from a small study of patients who received a third dose this spring, were published 6/15/21 in Annals of Internal Medicine. The findings are “part of a broader discussion about whether and when to offer extra doses to vulnerable individuals,” writes Jennifer Couzin-Frankel at Science (6/14/21).

In past studies, organ transplant patients who got a two-dose asthma treatment were far less likely to make protective antibodies against ventolin cost per pill asthma than the general population was. Some larger three-dose studies among people with compromised immune systems are under way, Couzin-Frankel reports. A medical oncologist at the University of Pennsylvania is not very worried about the effectiveness of asthma treatments among people with cancer, the story states.

The story ventolin cost per pill then describes two recent studies of cancer patients showing that they produced antibodies against asthma after receiving a asthma treatment. However, a third study found much lower antibody levels among vaccinated cancer patients than it did among their healthy family members who also were vaccinated, Couzin-Frankel reports. The Unbiased SciPod posted some helpful informational graphics about Pfizer’s ongoing studies of its asthma treatment in children under 12 (6/11/21).

The post states that dosages have been set based on initial smaller studies in children (one-third the adult dose for ages 5-11 and one-tenth the adult dose for ages 6 months to 5 years), and that researchers will enroll 4,500 children across 90 sites globally for the larger safety and effectiveness studies ventolin cost per pill. €œChildren have immune system components that are more potent compared to adults. They may not need as high a dose for protection.

Age criteria are related to immune system ventolin cost per pill development, not physical size,” the post states. The results will likely become available this fall for review by the U.S. Food and Drug Administration, with a first batch — from studies in children ages 5 to 11 — expected in early September, the post states.

Nearly one quarter of all people in the ventolin cost per pill U.S. Who were infected with asthma last year, including 19% of those who never reported asthma treatment symptoms from their , had new medical problems within a month or more of recovering from the ventolin, according to a large study covered by Pam Belluck at The New York Times (6/15/21). Belluck writes.

€œThose affected were all ages, including children ventolin cost per pill. Their most common new health problems were pain, including in nerves and muscles. Breathing difficulties.

High cholesterol ventolin cost per pill. Malaise and fatigue. And high blood pressure.

Other issues ventolin cost per pill included intestinal symptoms. Migraines. Skin problems.

Heart abnormalities ventolin cost per pill. Sleep disorders. And mental health conditions like anxiety and depression.” The study, conducted by non-profit organization FAIR Health and not formally reviewed by experts for flaws, involved evaluating electronic health-insurance records.

A 6/11/21 story by Emily Anthes at The New ventolin cost per pill York Times runs down some evidence-based approaches that employers can take to reduce the risk of asthma s and other health problems as workers return to offices nationwide. Employers should flush unused taps and other plumbing to clear any metals or Legionella bacteria colonies that accumulated, the story states. Employers also should upgrade their ventilation and fiation systems, the story states.

The goal is four to six ventolin cost per pill air changes per hour, the story states, which is equivalent to completely refreshing air every 10 to 15 minutes in a room. Portable air purifiers or even “desktop level HEPA filters” can help. And continue to wash your hands routinely, for at least 20 seconds each time, advises a Northwestern University environmental microbiologist who is quoted in the story.

Not solutions ventolin cost per pill. Desk shields (plexiglass barriers are a good idea in grocery stores though), foggers, fumigators, ionizers, ozone generators and other ‘air cleaning’ devices,’ the story states. In most non-medical or non-lab settings, wiping down surfaces with bleach solutions or disinfectant solutions or wipes does little to prevent asthma transmission.

Besides, inhaling ventolin cost per pill these substances is harmful. €œThe no. 1 thing is to get vaccinated,” the story quotes Joseph Allen at the Harvard School of Public Health as saying.

A debate among ventolin cost per pill scientists about whether asthma spreads mainly by fallen respiratory droplets on surfaces that people touch or spreads in air hampered public health efforts to control the ventolin and to prevent deaths. The implications for this debate were crucial, as Megan Molteni at Wired writes (5/13/21) — officials need to know whether public-health messages should focus on hand washing or on masking and isolation or both, particularly before treatments become available. The general debate is over, as you probably know — the ventolin is mostly spread in indoor air.

But why did researchers disagree until ventolin cost per pill recently?. In part, it’s because the arguments against airborne asthma all rested on an assumption that only particles smaller than 5 microns could hang in the air. Larger ones, aka droplets, fall to surfaces.

But in ventolin cost per pill reality, larger particles can stay afloat and behave like aerosols, many scientists and engineers have known, including aerosols expert Linsey Marr of Virginia Tech, Molteni and others have written. Molteni’s story masterfully traces the events, conversations, and research that came to expose the “fallacy of the 5-micron boundary.” The hero of this engaging story is Katie Randall, a graduate student who specializes in detective work to figure out how bits of knowledge are passed along through published research papers over time. Guidance from the U.S.

Centers for Disease Control in April stated that international and domestic travel are low-risk activities for people vaccinated against asthma treatment (so, this does not ventolin cost per pill pertain, unfortunately, to U.S. Children under 12, for whom asthma treatments are not yet authorized). In response to that update, Ceylan Yeginsu at The New York Times has written up answers to some of the questions that vaccinated travelers have these days (6/15/21).

A summary of the answers (again, this information is all ventolin cost per pill for vaccinated people in the U.S.). 1) Yes, you must still wear a mask at the airport and on flights. 2) No, you don’t have to quarantine or test if you travel domestically, unless it is required by a state or territory.

3) No, ventolin cost per pill you don’t have to take a asthma test before departure to international destinations — not for the U.S. At least. Check for your destination.

4) Yes, you have to test, even if vaccinated, three days before you return by air to the U.S..

Where to get ventolin

That the heart which had for where to get ventolin centuries been the centre of life, emotions and personhood lost out to the brain as the organ par excellence of selfhood. This process was not clear-cut or definitive. There had been interest in craniocentric versions of the self in the ancient world, and there is continued emphasis in the emotional heart in the present day, as Josh Hordern’s article explores through such examples as the organ scandal at Alder Hey Children’s Hospital in Liverpool. So, what where to get ventolin is it about the heart, that peculiar, emotive and sensorially charged organ, that continues to be associated with some essence of the self?.

After all, in medical terms, it is a mere pump.Except that the heart-as-pump is beginning to lose favour. Not in teaching or mainstream popular dialogue, where the pump metaphor has become ubiquitous, to explain the movement of the heart, and as a way of connecting to the ‘spare parts’ model of the body. Viewing the body as a series of spare parts is critical where to get ventolin to the principles and practice of organ donation. That is not to say that the process must be an unemotional one.

Organ donation rests principally on the idea of the ‘gift’, of an altruistic exchange from one person to another. It also raises questions about bodily ownership, however, especially given the development of presumed consent via the ‘opt-out’ system of transplantation in the UK as in many other countries.It is difficult to align popular perceptions about the heart as a site …AbstractIn ‘Chronic fatigue syndrome and where to get ventolin an illness-focused approach to care. Controversy, morality and paradox’, authors Michael Sharpe and Monica Greco begin by characterising myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as illness-without-disease. On that basis they ask why patients reject treatments for illness-without-disease, and they answer with a philosophical idea.

Whitehead’s ‘bifurcation of nature’, they suggest, still dominates public and professional thinking, and that where to get ventolin conceptual confusion leads patients to reject the treatment they need. A great deal has occurred, however, since Whitehead characterised his culture’s confusions 100 years ago. In our time, I suggest, experience is no longer construed as an invalid second cousin of bodily states in philosophy, in medicine or in the culture at large. More importantly, we must evaluate where to get ventolin medical explanations before we reach for philosophical alternatives.

The National Institutes of Health and the Institute of Medicine have concluded that ME/CFS is, in fact, a biomedical disease, and all US governmental health organisations now agree. Although it would be productive for Sharpe and Greco to state and support their disagreement with the other side of the disease debate, it is no longer tenable, or safe, to ignore the possibility of disease in patients with ME/CFS, or to recommend that clinicians should do so. When we find ourselves in a framework that suggests the possibility of medical need is somehow beside the point for medical providers, it is time to reconsider our conceptual foundations.medical humanitiespsychiatrymedical ethics/bioethicsphilosophy of medicine/health carehealth policy.

In Matters ventolin cost per pill of the Heart. History, Medicine, Emotion (Bound Alberti, 2010), I posited that the heart of culture and the heart of science became disconnected in the nineteenth century. That the heart which had for centuries been the centre of life, emotions and personhood lost out to the brain as the organ par excellence of selfhood. This process was not clear-cut ventolin cost per pill or definitive.

There had been interest in craniocentric versions of the self in the ancient world, and there is continued emphasis in the emotional heart in the present day, as Josh Hordern’s article explores through such examples as the organ scandal at Alder Hey Children’s Hospital in Liverpool. So, what is it about the heart, that peculiar, emotive and sensorially charged organ, that continues to be associated with some essence of the self?. After all, in medical terms, it is a ventolin cost per pill mere pump.Except that the heart-as-pump is beginning to lose favour. Not in teaching or mainstream popular dialogue, where the pump metaphor has become ubiquitous, to explain the movement of the heart, and as a way of connecting to the ‘spare parts’ model of the body.

Viewing the body as a series of spare parts is critical to the principles and practice of organ donation. That is ventolin cost per pill not to say that the process must be an unemotional one. Organ donation rests principally on the idea of the ‘gift’, of an altruistic exchange from one person to another. It also raises questions about bodily ownership, however, especially given the development of presumed consent via the ‘opt-out’ system of transplantation in the UK as in many other countries.It is difficult to align popular perceptions about the heart as a site …AbstractIn ‘Chronic fatigue syndrome and an illness-focused approach to care.

Controversy, morality and paradox’, authors Michael Sharpe and Monica Greco begin ventolin cost per pill by characterising myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as illness-without-disease. On that basis they ask why patients reject treatments for illness-without-disease, and they answer with a philosophical idea. Whitehead’s ‘bifurcation of nature’, they suggest, still dominates public and professional thinking, and that conceptual confusion leads patients to reject the treatment they need. A great deal has occurred, however, since Whitehead characterised his ventolin cost per pill culture’s confusions 100 years ago.

In our time, I suggest, experience is no longer construed as an invalid second cousin of bodily states in philosophy, in medicine or in the culture at large. More importantly, we must evaluate medical explanations before we reach for philosophical alternatives. The National Institutes of Health and the Institute of Medicine have concluded that ME/CFS is, in fact, a biomedical disease, and all US governmental health organisations now agree.