Buy cialis daily online

Plants, and the insects which rely on them, are the buy cialis daily online living foundations of our https://arif.uk/cialis-usa-buy/ planet. But these foundations are under stress because, as we urbanize and suburbanize natural areas, we have an unfortunate tendency to sterilize the landscape. Fields and forests are replaced with biological deserts made up of millions of acres of concrete, lawns and an array of ornamental trees and shrubs imported from around the world.

Adding to the problem, our obsession with perfection leads us to spray pesticides liberally buy cialis daily online. These actions are part of the reason global biodiversity is crashing. There are over three billion fewer wild birds in North America than there were in 1970.

This past summer saw at buy cialis daily online least tens of thousands of migrating birds drop dead from the sky over the Southwest. Amphibian and reptile populations are in a free fall across the planet. Recent research shows that insect numbers, even in nature reserves, have plummeted by orders of magnitude, and 40 percent of all insect species may be extinct within a few decades.

This is bleak news, buy cialis daily online and while the reasons for some of these declines are complicated, there are actions we can take to help bring at least some species back. The first step is to redefine our concept of “garden” to include more than just plants. We need to intentionally share our space, and not just with the birds, bees and butterflies that visit our flowers, but also with the less charismatic nonpollinators, the little insects that may eat a portion (very rarely all) of our plants.

Holes made by bugs in leaves are a sign of life and like a dinner bell for birds and buy cialis daily online other animals. We need to see the plants in our gardens as part of nature and not just exterior decoration to be kept as pristine as possible. Therefore, we must limit pesticide use.

It’s crucial buy cialis daily online to support nature’s resurgence, and it’s much better for everyone. No doctor has ever recommended long-term exposure to pesticides. Too many of the exotic plants sold in nurseries are essentially inedible to most native animals.

A movement has begun to turn the tide and bring natives back, but this push to restore is coming up against droves of drought-tolerant exotic plants that are still being touted for buy cialis daily online arid climates. Unfortunately, this kaleidoscope of alien plants brought in from across the planet is being passed off as ecofriendly. Mostly they’re not.

Yes, you’re saving water over planting thirsty ornamentals or a lawn, but drought-tolerant exotic plants can become invasive disasters when they buy cialis daily online escape our yards. Helping the environment can be about more than saving water. Even in drier areas, like the American West, the selection of attractive native plants to choose from is vast.

If dry is your style, there are native succulents, and a vast array of wildflowers, flowering bushes and trees that can meet any aesthetic allowing you to save buy cialis daily online water and nature. Challenges like climate change, invasive species and habitat destruction are pushing native ecosystems to brink, making urban and suburban space potentially critical for many species. But xeriscapes leave many gardeners thirsting for green, and there’s an important alternative that has been largely ignored.

For those disenchanted with dry landscaping, using underappreciated buy cialis daily online and lush water-loving native plants to make your garden a real-life oasis could lifesaving to wildlife. In nature, this unsung group of native plants is limited to riparian zones, the narrow strips of green along water bodies, but these moist habitats provide a disproportionate abundance of food and shelter for creatures that exist nowhere else. If consumers demand them, nurseries will increasingly carry these riparian species, and the presence of such plants in the garden will provide a smorgasbord for many animals including not just butterflies and their kin but also colorful birds like tanagers, warblers and vireos that depend on arthropods fostered by these plants.

No doubt, drought-tolerant oaks are great, but buy cialis daily online other native trees that need a bit of water like local species of willow, cottonwood and maple also support a kaleidoscope of life. Shrubs like hazelnut, dogwood and native azaleas match exotics with spring flowers and blazing fall colors. These verdant plants depend on some water year-round, though, importantly, not more water than the array of exotic ornamentals currently dominating our gardens and landscapes.

With some water, they will thrive and support far more nature buy cialis daily online than the sterile exotics they’ve replaced. The ideal garden would offer a combination of drought-tolerant native plants and a few species that need a little more water, providing a feast of options for little guests and the bigger ones that will come to eat them. Even starting slow helps—a single primrose in a pot on a balcony is a rest stop for hungry bees.

But we should all opt for as many natives as possible, and as more creatures stop by to share our yards, we will be making nature, and us all, a little healthier buy cialis daily online. In much of the United States, especially the drier regions, winter is the planting season, and we could be making the best of erectile dysfunction treatment quarantines to do something positive for nature and ourselves.If you were to trace both “sides” of a Möbius strip, you would never have to lift your finger. A single-sided surface with no boundaries, the strip is an artist’s reverie and a mathematician’s feat.

A typical thought experiment to demonstrate how the three-dimensional strip buy cialis daily online operates involves imagining an ant on an adventure. Picture the insect traversing the Möbius band. One apparent loop would land the ant not where it started but upside down, only halfway through a full circuit.

After two loops, the ant would be back at buy cialis daily online the beginning—but dizzy. The figurative and narrative implications of the Möbius strip are rich. When you try to go forward, you ring sideways, when you try to circle in, you find yourself outside.

It’s an apt allegory buy cialis daily online for losing control. We might ask ourselves after 2020, where are we?. Have we spun around after so much chaos, and found our position stagnated, back where we started?.

Or are we at a new beginning? buy cialis daily online. The continuum of crossing a Möbius strip is emblematic of how we experience time in a nonlinear way. Artists and authors explore this phenomenon as well.

One salient buy cialis daily online literary example is Gabriel García Márquez’s One Hundred Years of Solitude. Melding history, memory, and prophecy, the novel follows the Buendía family through cyclical patterns of behavior and emotion. An exchange between two family members illustrates this central theme.

€œÃšrsula sighed buy cialis daily online. €˜Time passes.’ ‘That’s how it goes,’ Aureliano admitted, ‘but not so much.’” The unorientable quality of the Möbius strip is perhaps its most distinctive. Orientability can be defined as “a continuous choice of local orientation.” A more colloquial explanation.

€œa space is orientable if you can choose ‘inward’ and ‘outward’ buy cialis daily online or ‘up’ and ‘down’ directions at every point on the surface that are compatible. You will never accidentally end up at the same point but with ‘up’ flipped to ‘down.’” The Möbius strip was independently discovered by two German mathematicians in 1858. August Ferdinand Möbius was a mathematician and theoretical astronomer (and also the first to introduce “homogenous coordinates” into “projective geometry”).

Johann Benedict Listing, a younger mathematician, coined the buy cialis daily online term “topology” for the study of surfaces, and in conducting that research, independently determined the properties of the Möbius strip. Though perhaps too neat a metaphor, it’s interesting to note that these two men arrived at the same conclusion, from different directions, at the same time. You can make a model of the Möbius strip with just a rectangular piece of paper.

Give it an odd number of buy cialis daily online half-twists, then tape the ends back together. But the strip was long thought never to occur in the natural world. Because it has never been observed in our organic environment, it is sometimes referred to as an “impossible shape.” Practical applications of it abound in the world of human invention, however.

For instance, Möbius strips are buy cialis daily online used in continuous-loop recording tapes, typewriter ribbons and computer print cartridges. In the 1960s, Sandia Laboratories also used Möbius bands in the design of adaptable electronic resistors. Conveyor belts use Möbius strips because they allow the entire surface area of the belt to receive an equal amount of wear, which makes it last longer.

The Möbius strip has also been tailored buy cialis daily online to various artistic and cultural products. Paintings have displayed Möbius shapes, as have earrings, necklaces and other pieces of jewelry. The green, three-arrowed universal sign for recycling also composes the Möbius band.

There’s a depth to the image buy cialis daily online that reminds you to reduce, reuse and recycle. It is not just a circular action. It’s dynamic.

The symbol buy cialis daily online seeks to represent the three interdependent aspects of a sustainable loop. The collection of materials to be recycled, the manufacturing of recycled materials into new products, and the purchase and use of the products made from recycled materials. Each arrow pleats and pivots itself, as all three arrows pursue and power one another.

The Möbius band is used in hardware and popular imagery, but the mathematical and scientific fascination with the Möbius strip has also buy cialis daily online endured for over a century. In 2005, Isaac Freund at Bar-Ilan University in Israel, proposed that light’s polarization could be twisted. Light’s polarization is a property that describes how its electric field moves.

Polarization in physics is defined as “the action of restricting the vibrations of a transverse wave, especially light, wholly or partially to one direction.” buy cialis daily online A transverse wave means that light’s oscillations travel perpendicular to the direction in which its energy moves. Scientists can confine light to certain planes depending on its orientation in space. In other words, light can be coaxed into new shapes.

In 2015, Peter Banzer of the Max Planck Institute for the Science of Light buy cialis daily online in Erlangen Germany tested Freund’s hypothesis that light could be twisted. According to Katherine Kornei, writing at New Scientist, “Banzer’s team scattered two [polarized] green laser beams off a gold bead that was smaller than the wavelength of the light. The resulting inference introduced a polarization pattern with either three or five twists, giving it a Möbius-like structure.” When I was in high school, my English teacher, Ms.

Mulvihill, gave buy cialis daily online each of our classmates an individual question to answer for a final assignment. One of my peers was asked, “What is the shape of time in One Hundred Years of Solitude?. € He responded with a story.

His family used buy cialis daily online to have a dog that would chase his tail. The dog drove himself crazy, running in circles, teeth bared, hunting his own hind legs. One day, racing after his tail, he bit it off.

That’s the shape of time buy cialis daily online in One Hundred Years of Solitude. In this year of solitude, disorientation and distance, we have been navigating what feels like misshapen terrain and time. But unlike the characters in Macondo, Márquez’s fictional town that is “exiled from the memory of men,” we continue to remember and discover.

Even as we mourn the people we have lost, scientific innovation is thriving, and buy cialis daily online salving. Darkness can seem like an endless, unbounded surface. We can walk it alone.

We can buy cialis daily online walk it together. But we now know something else can be an infinite curl, a dizzying ground, an effervescent hypothesis confirmed. Light.

It only needs a little nudging.US president-elect Joe Biden has chosen decorated geneticist Eric Lander buy cialis daily online as presidential science adviser and director of the Office of Science and Technology Policy (OSTP). In what would be a first for this position, if Lander is confirmed by the US Senate, he will serve as a member of Biden’s cabinet. Many scientists have long called for the OSTP director to be raised to a cabinet-level position.

€œHaving science elevated to its buy cialis daily online rightful place in the administration seems to me a very positive step,” says Harold Varmus, a professor at Weill Cornell Medicine in New York and former head of the National Institutes of Health. €œI think it marks a very important moment in the history of science in the government.” “It signifies the importance of who will be in the room when decisions are being made,” says Roger Pielke Jr., a science policy expert at the University of Colorado Boulder. Lander was a key leader of the Human Genome Project—the race to sequence the human genome, which ended in 2003—and is president and founding director of the Broad Institute of MIT and Harvard in Cambridge, Massachusetts.

He will be the first biologist to buy cialis daily online run OSTP. Between 2009 and 2017, he also co-chaired the President’s Council of Advisors on Science and Technology (PCAST), an elite panel that advises the US president. Among the PCAST reports issued during Lander’s tenure were some dealing with cialiss, vaccination, energy and climate change.

"This is a marvelous appointment, buy cialis daily online it’s great to see a life scientist running the OSTP,” says Varmus, who co-chaired PCAST with Lander. When Biden named Lander to his team on 15 January, he also announced a number of other respected scientists to key positions in his administration. €œScience will always be at the forefront of my administration—and these world-renowned scientists will ensure everything we do is grounded in science, facts, and the truth,” Biden said in a statement.

Caltech bioengineer buy cialis daily online and Nobel laureate Frances Arnold and MIT geophysicist Maria Zuber will co-chair PCAST under Biden. Alondra Nelson, nominated to be deputy director for science and society at OSTP, is a social scientist at the Institute for Advanced Study in Princeton, New Jersey, who studies genetics, race and other societal issues. €œThese are excellent appointments, highly qualified and experienced, and well grounded in science,” Rita Colwell, a microbiologist at the University of Maryland at College Park, and a former director of the National Science Foundation, wrote to Nature in an e-mail.

Biden also announced that buy cialis daily online geneticist Francis Collins would stay on as head of the National Institutes of Health. Collins was appointed to lead the biomedical research agency in 2009 by President Barack Obama. One major question is what parts of science policy Lander and his office will be responsible for.

Biden has already established a separate, high-level team to lead the national response to the erectile dysfunction treatment cialis, as buy cialis daily online well as a team to drive forward his climate agenda. With erectile dysfunction treatment and climate tasked to other groups, it remains to be seen what science issues OSTP will be able to take the lead on, says Pielke. €œOSTP always has a challenge in figuring out what policy lanes it plays in,” he says.

OSTP typically buy cialis daily online coordinates science policy and priorities across US federal agencies, including organizing how much money the president will ask Congress to allocate for various research areas throughout the government. Biden has given at least a hint of what he’d like Lander to work on, however. In a letter to Lander, Biden outlined five key questions he wanted OSTP to tackle, including how to draw lessons from the cialis to inform public health more broadly and how science and technology breakthroughs could help address climate change.

Originally trained as a mathematician, Lander is a powerful figure in US science circles and one of the highest-cited researchers in the world buy cialis daily online. As one of the leaders of the epic race to sequence the human genome, he oversaw the huge centre of automated machines that performed much of the sequencing. In 2016, he was criticized for writing a history of the gene-editing technique CRISPR that emphasized the role of his Broad colleague Feng Zhang and downplayed the role of Jennifer Doudna of the University California, Berkeley, and Emmanuelle Charpentier of the Max Planck Unit for the Science of Pathogens, in Berlin.

The Broad Institute was embroiled in a CRISPR patent battle with Berkeley at buy cialis daily online the time. Charpentier and Doudna went on to win the 2020 Nobel Prize in Chemistry for their pioneering work on CRISPR. Biden is scheduled to be inaugurated as president on 20 January.

Lander’s appointment is only the buy cialis daily online fourth time since the OSTP was created, in 1976, that a leader has been tapped for it prior to Inauguration Day, says Pielke. The outgoing OSTP director, meteorologist Kelvin Droegemeier, wasn’t appointed by President Donald Trump until more than a year and a half into his administration. This article is reproduced with permission and was first published on January 16 2021.The items below are highlights from the free newsletter, “Smart, useful, science stuff about erectile dysfunction treatment.” To receive newsletter issues daily in your inbox, sign up here.

treatment (and masking) lessons can be drawn from the reported erectile dysfunction s among three members of Congress who sheltered in a crowded room among buy cialis daily online unmasked colleagues during the Jan. 6 storming of the U.S. Capitol, writes Ben Guarino at The Washington Post (1/13/21).

All 3 representatives had received buy cialis daily online just one of their two-dose shots against the cialis — one member received it on Dec. 29 while the other two received it on Jan. 4, Guarino reports.

The two buy cialis daily online treatments being administered in the U.S. Require two doses to confer their full protection. €œEarly protection against erectile dysfunction treatment may occur from about 12 days after dose one,” a Johns Hopkins Bloomberg School of Public Health physician and epidemiologist is quoted as saying.

People “should not really consider themselves protected until after a week buy cialis daily online or two following dose two,” he adds. Most people who recover from erectile dysfunction treatment still have at least one symptom six months later, according to a study published (1/8/20) in The Lancet and covered the same day by Elizabeth Cooney at STAT. The study is based on interviews with about 1,700 erectile dysfunction treatment patients discharged from a hospital in Wuhan between January and May 2020.

Some subjects also underwent tests of their lungs, blood, and buy cialis daily online overall health. Nearly two-thirds of the patients said they still had fatigue and muscle weakness, Cooney reports. A few small studies are finding that most if not all pregnant women infected with erectile dysfunction in their third trimester pass neither the cialis nor antibodies to it to their newborn infants.

Ariel H buy cialis daily online. Kim and Lauren L. Zhang covered two of the studies (one published 12/22/20 in JAMA Network Open and one in Cell the same day) for The Harvard Crimson (1/8/21).

I haven’t found any coverage yet but I suspect that some people on immune-suppressing drugs, which are often prescribed for people with transplanted organs or to treat an autoimmune disease, will be encouraged by results described in this 1/7/21 press release from the buy cialis daily online Johns Hopkins Bloomberg School of Public Health. The release describes research published 1/5/21 in Clinical Infectious Diseases suggesting that when hospitalized for erectile dysfunction treatment, people on these drugs fare no worse on average than do people not taking them. The researchers now are studying whether outcomes vary for people on specific types of these drugs, the release states.

In the context of the novel erectile dysfunction, more buy cialis daily online infectious disease experts are refocusing on the strong connection between “the health of nature, wildlife, and humans,” writes Jim Robbins for Kaiser Health News (1/4/21). Experts call this a One Health approach or concept, and they want governments to factor it into policies, Robbins reports. As humans move into more of Earth’s natural environments, more spillovers of animal diseases into humans are expected.

€œThe spillover of animal, or zoonotic, cialises into humans causes some 75% of emerging infectious buy cialis daily online diseases,” Robbins writes. You might enjoy, “Here’s how time works in 2021,” by Eli Grober in McSweeney’s.Taking a person’s temperature is no sweat. Slip a thermometer under their tongue, say, and watch the reading climb to somewhere in the vicinity of 98 degrees Fahrenheit.

But that single number actually results from each buy cialis daily online of the 30 trillion or so cells in the human body generating its own heat. The dispersal of that heat sets an overall body temperature, with different types of cells contributing to varying degrees. To really understand how living things regulate their body’s temperature, researchers must look to individual cells.

But even as scientists’ abilities to spy on molecular interactions up close have improved tremendously over the past decade, they have struggled to buy cialis daily online develop tools that accurately measure a cell’s thermal properties from the inside. Now a new study fills in a crucial knowledge gap. For the first time, researchers have measured the thermal conductivity—the rate at which heat is conducted—inside human cells.

In a paper published on Friday in Science Advances, scientists used miniscule diamond-based sensors that simultaneously release and measure heat to demonstrate that heat dissipates in cells much more slowly than they previously buy cialis daily online believed. €œThat was very surprising for us and others in the field,” says Madoka Suzuki, a biophysicist at Osaka University in Japan and a co-author of the paper. Because the fluid in cells is water-based, scientists have generally assumed it carries heat much like water does.

Instead heat dissipates buy cialis daily online in cells about five times more slowly—a speed more akin to the way it dissipates in oil. Until now “nobody knew this basic property of living cells,” Suzuki says. €œWithout that value, we cannot model how cellular temperature changes.” “These are intriguing results that need to be better understood,” says Harvard University physicist Mikhail Lukin, who has developed sensors for probing temperatures within cells but did not work on this project.

€œIf they hold, they would buy cialis daily online be quite important.” The findings may help resolve a major mystery about cell temperatures that has flummoxed biologists. The existence of hyperlocalized heat spikes. Scientists have reported transient differences of a few degrees F from spot to spot within a cell, a space that ranges from about five to 120 microns in diameter in humans.

(That is somewhere between the width of a clump of dust mite poop and that of an actual dust mite.) buy cialis daily online One 2018 study even claimed that mitochondria, cells’ pill-shaped energy pumps, run at a toasty 122 degrees F. The idea that cells can harbor such large temperature gradients is surprising because in such a minute space, a sharp rise in heat should dissipate quite quickly. But the reports have been convincing, says Luís Carlos, a nanoscientist at the University of Aveiro in Portugal, who studies intracellular thermometry but was not involved in the new study.

€œI think experimental results in the last five years buy cialis daily online consistently point out the existence of temperature fluctuations inside the cell.” In the new work, Suzuki and his colleagues built on technology first developed by Lukin to create a fluorescent nanodiamond sensor coated in a heat-releasing polymer. Local temperature changes ever so slightly expand imperfections in the nanodiamond, changing the degree to which it fluoresces when hit by a laser. Because diamonds are so inert, the method is much more stable than other types of probes, Lukin says.

The heat conductivity identified in the new work can explain smaller heat buy cialis daily online spikes of a couple of degrees F, though not the massive heat surge in mitochondria, Suzuki says. He speculates that they may act as a previously unrecognized signaling system within the cell. For example, a boost in heat might tell proteins to fold or unfold, drive certain enzymatic reactions or provide feedback to channels that regulate calcium levels in muscles.

Suzuki and Lukin agree that it will still take more research to pin down whether these gradients really exist and, if so, how they are buy cialis daily online generated. €œThere is this outstanding problem that people are very confused about, and it has to be resolved,” Lukin says. €œThe fact that this new tool can answer this biological question—I think that’s really new.”.

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€œThese hospitals are small hospitals and they don't have a large nurse workforce.”Years of low patient volume, a high number cialis and tylenol interaction of uninsured patients, along with government-funded insurance payers, led to a record number of rural hospital closures last year, according to the Cecil G. Sheps Center for Health Services Research.Dozens of rural hospitals filed for bankruptcy last year, including Eastern Niagara Hospital in Lockport, New York, Faith Community Health System in Jacksboro, Texas, and Pinnacle Healthcare System hospitals in Kansas and Missouri. Another 216 rural hospitals are currently at high risk of closure, said Brock Slabach, chief operations officer with National Rural Health Association.“The rural hospital workforce has always been a challenge,” Slabach said. €œWhat erectile dysfunction treatment was uniquely suited to do was take advantage of every fracture and widen it significantly and make it even harder to cope with demands being placed on them.”Most of the demand is not even cialis and tylenol interaction directly related to erectile dysfunction treatment patients, said Susan Salka, CEO of AMN Healthcare Services Inc., on an earnings call last month. Rather, it is "leaves of absence, clinician fatigue, normal patient volumes rising and operating room backlog.

Our clients are telling us that this is unlikely to change anytime soon,” she said.While the surge in popularity of travel nursing has deepened the country’s nursing shortage, it has been a boon for staffing agencies. AMN Healthcare Services Inc., a San Diego-based medical staffing agency, reported a 41 percent increase in revenue from the same time last year cialis and tylenol interaction. Its travel nurse staffing business alone grew by 37 percent, it reported.Cross Country Healthcare CEO Kevin Clark told investors in an earnings call last month that travel nurse orders across the staffing agency’s clients increased by nearly 50 percent over the course of the second quarter. Revenue for its travel nurse business rose by 58 percent, he said.“We are coming out of the cialis with, I think, flying colors,” he said. €œFirst time travelers are up significantly cialis and tylenol interaction this year.

That trend continued through the second quarter.”Many nurses are turning to travel nursing in large part because of pay, but also the opportunity to hone their skills and advance their careers, said Nicole Rouhana, director of the graduate nursing program at the Decker School of Nursing at Binghamton University. Nurses in rural areas are considered jacks of all trades, she said. One night they could be working the emergency room and another night they could be assisting with a birth.“[Travel nursing] is more popular right now and I think it’s partially because we're also a mobile society and there is some attractiveness in going to Southern California and working six weeks and going to the northeast and working in the summer,” she said.Rouhana, along with other nursing programs and cialis and tylenol interaction clinics, have rolled out new fellowships and short-term educational experiences for nurses to learn new skills in a rural hospital setting, in hopes that they continue to serve the community. Some state programs will forgive college debt for nurses who spend a certain number of years working in rural hospitals. At the same time, health care companies are offering bonuses.

Unity Health in Newport, Arkansas, increased its signing bonus to cialis and tylenol interaction $15,000 for new bedside nurses. Monument Health in Rapid City, Iowa, is offering experienced nurses up to $40,000, in order to fill several ICU and operating room nurse positions.But smaller rural hospitals cannot afford to pay nurses a competitive salary, said Shannon Cannon, a professor with Texas Tech University School of Nursing. The counties where rural hospitals are located sometimes have only a couple of thousand residents, which means taxes are lower, she said.“If you live in a community in rural west Texas with 1,500 to 2,000 people, trying to find a nurse still within that community is hard,” she said. €œThey get cialis and tylenol interaction lured away to go to larger cities because the pay is better and there are more attractions, especially for young nurses.”Patricia Gonzales Meserole, 50, has worked in healthcare in the rural city of Washington, Iowa for over 8 years, currently making about $30 an hour as a nurse. She says she’s been spoiled by the quiet and small town culture of the town.

But now she’s on the hunt for a travel nurse position that will give her the hospital experience she craves from a well-resourced institution and provide the salary she needs to stabilize her finances.“It hurts my heart to tell my boss she’s going to have to replace me, because its hard to find people right now,” she said. €œBut this is my opportunity to cialis and tylenol interaction use those skills and make this level of money. My goal is to pay off debt and loans and build a future, because I can’t do that right now.”Start Preamble Notice of amendment. The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to expand the authority for certain Qualified Persons authorized to prescribe, dispense, and administer erectile dysfunction treatment therapeutics that are covered countermeasures under section VI of this Declaration. This amendment is effective as of September 14, cialis and tylenol interaction 2021.

Start Further Info L. Paige Ezernack, Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201. 202-260-0365, paige.ezernack@hhs.gov cialis and tylenol interaction. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes Start Printed Page 51161the 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 cialis and tylenol interaction 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 cialis and tylenol interaction. 247d-6e, respectively.

Section 319F-3 of the PHS Act has been amended by the cialis and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013, and the erectile dysfunction Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, 2020, to expand Covered Countermeasures under the PREP Act. On January cialis and tylenol interaction 31, 2020, the former Secretary, Alex M. Azar II, 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 erectile dysfunction treatment outbreak. Pursuant to section 319 of the PHS Act, the cialis and tylenol interaction Secretary renewed that declaration effective on April 26, 2020, July 25, 2020, October 23, 2020, January 21, 2021, April 21, 2021 and July 20, 2021.

On March 10, 2020, former Secretary Azar issued a Declaration under the PREP Act for medical countermeasures against erectile dysfunction treatment (85 FR 15198, Mar. 17, 2020) (the Declaration). On April 10, the former Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 cialis and tylenol interaction FR 21012, Apr. 15, 2020). On June 4, the former Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm erectile dysfunction treatment might otherwise cause.

(85 FR 35100, June 8, 2020) cialis and tylenol interaction. On August 19, the former Secretary amended the declaration to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommended the administration or use of the Covered Countermeasures. (85 FR 52136, Aug. 24, 2020) cialis and tylenol interaction. On December 3, 2020, the former Secretary amended the declaration to incorporate Advisory Opinions of the General Counsel interpreting the PREP Act and the Secretary's Declaration and authorizations issued by the Department's Office of the Assistant Secretary for Health as an Authority Having Jurisdiction to respond.

Added an additional category of qualified persons under Section V of the Declaration. Made explicit that the Declaration covers all qualified cialis and epidemic products as defined cialis and tylenol interaction under the PREP Act. Added a third method of distribution to provide liability protections for, among other things, private distribution channels. Made explicit that there can be situations where not administering a covered countermeasure to a particular individual can fall within the PREP Act and the Declaration's liability protections. Made explicit that there are substantive federal legal and policy issues and interests cialis and tylenol interaction in having a unified whole-of-nation response to the erectile dysfunction treatment cialis among federal, state, local, and private-sector entities.

Revised the effective time period of the Declaration. And republished the declaration in full. (85 FR cialis and tylenol interaction 79190, Dec. 9, 2020). On February 2, 2021, the Acting Secretary Norris Cochran amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer erectile dysfunction treatments that are covered countermeasures under the Declaration (86 FR 7872, Feb.

2, 2021) cialis and tylenol interaction. On February 16, 2021, the Acting Secretary amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer erectile dysfunction treatments that are covered countermeasures under the Declaration (86 FR 9516, Feb. 16, 2021) and on February 22, 2021, the Department filed a notice of correction to the February 2 and February 16 notices correcting effective dates stated in the Declaration, and correcting the description of qualified persons added by the February 16, 2021 amendment. (86 FR cialis and tylenol interaction 10588, Feb. 22, 2021).

On March 11, 2021, the Acting Secretary amended the Declaration to add additional Qualified Persons authorized to prescribe, dispense, and administer covered countermeasures under the Declaration. (86 FR cialis and tylenol interaction 14462, Mar. 16, 2021). On August 4, 2021, Secretary Xavier Becerra amended the Declaration to clarify categories of Qualified Persons and to expand the scope of authority for certain Qualified Persons to administer seasonal influenza treatments to adults. (86 FR 41977, Aug cialis and tylenol interaction.

4, 2021). Secretary Xavier Becerra now amends section V of the Declaration to add subsection (i) to expand the scope of authority for licensed pharmacists to order and administer and qualified pharmacy technicians and pharmacy interns to administer erectile dysfunction treatment therapeutics subcutaneously, intramuscularly, or orally as authorized, approved, or licensed by the U.S. Food and Drug Administration cialis and tylenol interaction (FDA). Accordingly, subsection V(i) authorizes. (i) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy) [] FDA authorized, approved, or licensed erectile dysfunction treatment therapeutics.

Such State-licensed cialis and tylenol interaction pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met. I. The erectile dysfunction treatment therapeutic must be authorized, approved, or licensed by the FDA. Ii. In the case of a licensed pharmacist ordering a erectile dysfunction treatment therapeutic, the therapeutic must be ordered for subcutaneous, intramuscular, or oral administration and in accordance with the FDA approval, authorization, or licensing;Start Printed Page 51162 iii.

In the case of licensed pharmacists, qualified pharmacy technicians, and licensed or registered pharmacy interns administering the erectile dysfunction treatment therapeutic, the therapeutic must be administered subcutaneously, intramuscularly, or orally in accordance with the FDA approval, authorization, or licensing. Iv. In the case of qualified pharmacy technicians, the supervising pharmacist must be readily and immediately available to the qualified pharmacy technician. V. In the case of erectile dysfunction treatment therapeutics administered through intramuscular or subcutaneous injections, the licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program 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 erectile dysfunction treatment therapeutics, the recognition and treatment of emergency reactions to erectile dysfunction treatment therapeutics, and any additional training required in the FDA approval, authorization, or licensing. Vi. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] vii. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers erectile dysfunction treatment therapeutics, including informing the patient's primary-care provider when available and complying with requirements with respect to reporting adverse events. Viii.

The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) that apply to the administration of erectile dysfunction treatment therapeutics. 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 the PREP Act 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 clarifies and expands the authorization for a category of persons who are qualified persons under section 247d-6d(i)(8)(B). First, the amendment clarifies that licensed pharmacists are authorized to order and administer and licensed or registered pharmacy interns and qualified pharmacy technicians are authorized to administer erectile dysfunction treatment therapeutics that are Covered Countermeasures under section VI of this Declaration. The Secretary anticipates that there will be a need to increase the available pool of providers able to order and administer erectile dysfunction treatment therapeutics to address rising erectile dysfunction treatment cases, to expand patient access to these critical therapies, and to keep as many patients out of the hospital as possible.

Rising erectile dysfunction treatment cases, largely attributable to the Delta variant, is a public health threat caused by erectile dysfunction treatment, placing additional strains on our healthcare system. Pharmacists, pharmacy technicians, and pharmacy interns are well positioned to increase access to therapeutics and have played a critical role in this cialis in overseeing erectile dysfunction treatment testing and treatment administration. Given their skill set and training, as well as looming provider shortages, pharmacists, pharmacy technicians, and pharmacy interns will quickly expand access to erectile dysfunction treatment therapeutics. erectile dysfunction treatment therapeutics may be administered as intramuscular injections, subcutaneous injections, or orally and would require minimal, if any, additional training to administer beyond training pharmacists, pharmacy technicians, and pharmacy interns have already received for treatment administration, and would not place any undue training burden on providers. As qualified persons, these licensed pharmacists, qualified pharmacy technicians and interns will be afforded liability protections in accordance with the PREP Act and the terms of this amended Declaration.

Second, to the extent that any State law that would otherwise prohibit these healthcare professionals who are a “qualified person” from prescribing, dispensing, or administering erectile dysfunction treatment therapeutics or other Covered Countermeasures, such law is preempted. On May 19, 2020, the Office of the General Counsel issued an advisory opinion concluding that, because licensed pharmacists are “qualified persons” under this declaration, the PREP Act preempts state law that would otherwise prohibit such pharmacists from ordering and administering authorized erectile dysfunction treatment diagnostic tests.[] The opinion relied in part on the fact that the Congressional delegation of authority to the Secretary under the PREP Act to specify a class of persons, beyond those who are authorized to administer a covered countermeasure under State law, as “qualified persons” would be rendered a nullity in the absence of such preemption. This opinion is incorporated by reference into this declaration. Based on the reasoning set forth in the May 19, 2020 advisory opinion, any State law that would otherwise prohibit a member of any of the classes of “qualified persons” specified in this declaration from administering a covered countermeasure is likewise preempted. In accordance with section 319F-3(i)(8)(A) of the Public Health Service Act, a State remains free to expand the universe of individuals authorized to administer Start Printed Page 51163covered countermeasures within its jurisdiction under State law.

The plain language of the PREP Act makes clear that there is preemption of state law as described above. Furthermore, preemption of State law is justified to respond to the nation-wide public health emergency caused by erectile dysfunction treatment as it will enable States to quickly expand the vaccination, treatment and prevention workforces with additional qualified healthcare professionals where State or local requirements might otherwise inhibit or delay allowing these healthcare professionals to participate in the erectile dysfunction treatment countermeasure program. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against erectile dysfunction treatment. Section V of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against erectile dysfunction treatment, as amended April 10, 2020, June 4, 2020, August 19, 2020, as amended and republished on December 3, 2020, as amended on February 2, 2021, as amended March 11, 2021, and as amended on August 4, 2021, is 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 republished at 85 FR 79190 (Dec.

9, 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. €œOrder” as used herein and in guidance issued by the Office of the Assistant Secretary for Health [] means a provider medication order, which includes prescribing of treatments, or a laboratory order, which includes prescribing laboratory orders, if required. 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, as that term is defined in Section VII of this Declaration;[] (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.

(d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed erectile dysfunction treatments to persons ages three or older. Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met. I. The treatment must be authorized, approved, or licensed by the FDA.

Ii. In the case of a erectile dysfunction treatment, the vaccination must be ordered and administered according to ACIP's erectile dysfunction treatment recommendation(s). Iii. In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. Iv.

In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. V. In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi. The licensed pharmacist must have completed the immunization Start Printed Page 51164training that the licensing State requires for pharmacists to order and administer treatments.

If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the ACPE to order and administer treatments. Such a 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. Vii. The licensed or registered pharmacy intern and qualified pharmacy technician 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.

Viii. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period. X. 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.

Xi. 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. And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) erectile dysfunction treatment vaccination provider agreement and any other federal requirements that apply to the administration of erectile dysfunction treatment- 19 treatment(s). (e) Healthcare personnel using telehealth to order or administer Covered Countermeasures for patients in a state other than the state where the healthcare personnel are licensed or otherwise permitted to practice.

When ordering and administering Covered Countermeasures by means of telehealth to patients in a state where the healthcare personnel are not already permitted to practice, the healthcare personnel must comply with all requirements for ordering and administering Covered Countermeasures to patients by means of telehealth in the state where the healthcare personnel are permitted to practice. Any state law that prohibits or effectively prohibits such a qualified person from ordering and administering Covered Countermeasures by means of telehealth is preempted.[] Nothing in this Declaration shall preempt state laws that permit additional persons to deliver telehealth services. (f) Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration, who prescribes, dispenses, or administers erectile dysfunction treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies, other than the State in which the license or certification is held, in association with a erectile dysfunction treatment vaccination effort by a federal, State, local Tribal or territorial authority or by an institution in the State in which the erectile dysfunction treatment covered countermeasure is administered, so long as the license or certification of the healthcare professional has not been suspended or restricted by any licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General, subject to. (i) Documentation of completion of the Centers for Disease Control and Prevention erectile dysfunction treatment (CDC) treatment Training Modules [] and, for healthcare providers who are not currently practicing, documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering intramuscular injections is in their ordinary scope of practice, who confirms competency of the healthcare provider in preparation and administration of the erectile dysfunction treatment(s) to be administered. (g) Any member of a uniformed service (including members of the National Guard in a Title 32 duty status) (hereafter in this paragraph “service member”) or Federal government, employee, contractor, or volunteer who prescribes, administers, delivers, distributes or dispenses a Covered Countermeasure.

Such Federal government service members, employees, contractors, or volunteers are qualified persons if the following requirement is met. The executive department or agency by or for which the Federal service member, employee, contractor, or volunteer is employed, contracts, or volunteers has authorized or could authorize that service member, employee, contractor, or volunteer to prescribe, administer, deliver, distribute, or dispense the Covered Countermeasure as any part of the duties or responsibilities of that service member, employee, contractor, or volunteer, even if those authorized duties or responsibilities ordinarily would not extend to members of the public or otherwise would be more limited in scope than the activities such service member, employees, contractors, Start Printed Page 51165or volunteers are authorized to carry out under this declaration. And (h) The following healthcare professionals and students in a healthcare profession training program subject to the requirements of this paragraph. 1. Any midwife, paramedic, advanced or intermediate emergency medical technician (EMT), physician assistant, respiratory therapist, dentist, podiatrist, optometrist or veterinarian licensed or certified to practice under the law of any state who prescribes, dispenses, or administers erectile dysfunction treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a erectile dysfunction treatment vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the erectile dysfunction treatment covered countermeasure is administered.

2. Any physician, advanced practice registered nurse, registered nurse, practical nurse, pharmacist, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, respiratory therapist, dentist, physician assistant, podiatrist, optometrist, or veterinarian who has held an active license or certification under the law of any State within the last five years, which is inactive, expired or lapsed, who prescribes, dispenses, or administers erectile dysfunction treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a erectile dysfunction treatment vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the erectile dysfunction treatment covered countermeasure is administered, so long as the license or certification was active and in good standing prior to the date it went inactive, expired or lapsed and was not revoked by the licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General. 3. Any medical, nursing, pharmacy, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, physician assistant, respiratory therapy, dental, podiatry, optometry or veterinary student with appropriate training in administering treatments as determined by his or her school or training program and supervision by a currently practicing healthcare professional experienced in administering intramuscular injections who administers erectile dysfunction treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a erectile dysfunction treatment vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the erectile dysfunction treatment covered countermeasure is administered. Subject to the following requirements.

I. The treatment must be authorized, approved, or licensed by the FDA. Ii. Vaccination must be ordered and administered according to ACIP's erectile dysfunction treatment recommendation(s). Iii.

The healthcare professionals and students must have documentation of completion of the Centers for Disease Control and Prevention erectile dysfunction treatment Training Modules and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering erectile dysfunction treatments. Iv. The healthcare professionals and students must have documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering vaccinations is in their ordinary scope of practice, who confirms competency of the healthcare provider or student in preparation and administration of the erectile dysfunction treatment(s) to be administered and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering erectile dysfunction treatments. V. The healthcare professionals and students must have a current certificate in basic cardiopulmonary resuscitation; [] vi.

The healthcare professionals and students 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. And vii. The healthcare professionals and students comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) erectile dysfunction treatment vaccination provider agreement and any other federal requirements that apply to the administration of erectile dysfunction treatment(s). (i) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy) [] FDA authorized, approved, or licensed erectile dysfunction treatment therapeutics. Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are Start Printed Page 51166qualified persons only if the following requirements are met.

Ix. The erectile dysfunction treatment therapeutic must be authorized, approved, or licensed by the FDA. X. In the case of a licensed pharmacist ordering a erectile dysfunction treatment therapeutic, the therapeutic must be ordered for subcutaneous, intramuscular, or oral administration and in accordance with the FDA approval, authorization, or licensing. Xi.

In the case of licensed pharmacists, qualified pharmacy technicians, and licensed or registered pharmacy interns administering the erectile dysfunction treatment therapeutic, the therapeutic must be administered subcutaneously, intramuscularly, or orally in accordance with the FDA approval, authorization, or licensing. Xii. In the case of qualified pharmacy technicians, the supervising pharmacist must be readily and immediately available to the qualified pharmacy technician. Xiii. In the case of erectile dysfunction treatment therapeutics administered through intramuscular or subcutaneous injections, the licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician 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 erectile dysfunction treatment therapeutics, the recognition and treatment of emergency reactions to erectile dysfunction treatment therapeutics, and any additional training required in the FDA approval, authorization, or licensing. Xiv. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] xv. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers erectile dysfunction treatment therapeutics, including informing the patient's primary-care provider when available and complying with requirements with respect to reporting adverse events. Xvi.

The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) that apply to the administration of erectile dysfunction treatment therapeutics. 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. 2. Effective Time Period, section XII, delete in full and replace with. Liability protections for any respiratory protective device approved by NIOSH under 42 CFR part 84, or any successor regulations, through the means of distribution identified in Section VII(a) of this Declaration, begin on March 27, 2020 and extend through October 1, 2024. Liability protections for all other Covered Countermeasures identified in Section VI of this Declaration, through means of distribution identified in Section VII(a) of this Declaration, begin on February 4, 2020 and extend through October 1, 2024.

Liability protections for all Covered Countermeasures administered and used in accordance with the public health and medical response of the Authority Having Jurisdiction, as identified in Section VII(b) of this Declaration, begin with a Declaration of Emergency as that term is defined in Section VII (except that, with respect to qualified persons who order or administer a routine childhood vaccination that ACIP recommends to persons ages three through 18 according to ACIP's standard immunization schedule, liability protections began on August 24, 2020), and last through (a) the final day the Declaration of Emergency is in effect, or (b) October 1, 2024, whichever occurs first. Liability protections for all Covered Countermeasures identified in Section VII(c) of this Declaration begin on December 9, 2020 and last through (a) the final day the Declaration of Emergency is in effect or (b) October 1, 2024 whichever occurs first. Liability protections for Qualified Persons under section V(d) of the Declaration who are qualified pharmacy technicians and interns to seasonal influenza treatment to persons aged 19 and older begin on August 4, 2021. Liability protections for Qualified Persons under section V(f) of the Declaration begin on February 2, 2021, and last through October 1, 2024. Liability protections for Qualified Persons under section V(g) of the Declaration begin on February 16, 2021, and last through October 1, 2024.

Liability protections for Qualified Persons who are physicians, advanced practice registered nurses, registered nurses, or practical nurses under section V(h) of the Declaration begins on February 2, 2021 and last through October 1, 2024, with additional conditions effective as of March 11, 2021and liability protections for all other Qualified persons under section V(h) begins on March 11, 2021 and last through October 1, 2024.

Its travel nurse staffing business alone grew by 37 percent, it reported.Cross Country Healthcare CEO Kevin Clark told investors in an earnings call last month buy cialis through paypal that travel nurse orders across the staffing agency’s clients increased by nearly buy cialis daily online 50 percent over the course of the second quarter. Revenue for its travel nurse business rose by 58 percent, he said.“We are coming out of the cialis with, I think, flying colors,” he said. €œFirst time travelers are up significantly this year. That trend continued through the second quarter.”Many nurses are turning to travel nursing in buy cialis daily online large part because of pay, but also the opportunity to hone their skills and advance their careers, said Nicole Rouhana, director of the graduate nursing program at the Decker School of Nursing at Binghamton University.

Nurses in rural areas are considered jacks of all trades, she said. One night they could be working the emergency room and another night they could be assisting with a birth.“[Travel nursing] is more popular right now and I think it’s partially because we're also a mobile society and there is some attractiveness in going to Southern California and working six weeks and going to the northeast and working in the summer,” she said.Rouhana, along with other nursing programs and clinics, have rolled out new fellowships and short-term educational experiences for nurses to learn new skills in a rural hospital setting, in hopes that they continue to serve the community. Some state programs will forgive college debt for nurses who spend a certain number of years working in buy cialis daily online rural hospitals. At the same time, health care companies are offering bonuses.

Unity Health in Newport, Arkansas, increased its signing bonus to $15,000 for new bedside nurses. Monument Health in Rapid City, Iowa, is offering experienced nurses up to $40,000, in order to fill several ICU and operating room nurse positions.But smaller rural hospitals cannot afford to pay nurses a competitive salary, said Shannon Cannon, a professor with Texas Tech University School buy cialis daily online of Nursing. The counties where rural hospitals are located sometimes have only a couple of thousand residents, which means taxes are lower, she said.“If you live in a community in rural west Texas with 1,500 to 2,000 people, trying to find a nurse still within that community is hard,” she said. €œThey get lured away to go to larger cities because the pay is better and there are more attractions, especially for young nurses.”Patricia Gonzales Meserole, 50, has worked in healthcare in the rural city of Washington, Iowa for over 8 years, currently making about $30 an hour as a nurse.

She says she’s been spoiled by the quiet buy cialis daily online and small town culture of the town. But now she’s on the hunt for a travel nurse position that will give her the hospital experience she craves from a well-resourced institution and provide the salary she needs to stabilize her finances.“It hurts my heart to tell my boss she’s going to have to replace me, because its hard to find people right now,” she said. €œBut this is my opportunity to use those skills and make this level of money. My goal is to pay off debt and loans and build a future, buy cialis daily online because I can’t do that right now.”Start Preamble Notice of amendment.

The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to expand the authority for certain Qualified Persons authorized to prescribe, dispense, and administer erectile dysfunction treatment therapeutics that are covered countermeasures under section VI of this Declaration. This amendment is effective as of September 14, 2021. Start Further Info L buy cialis daily online. Paige Ezernack, Office of the Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201.

202-260-0365, paige.ezernack@hhs.gov. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes Start Printed Page 51161the Secretary of Health and Human buy cialis daily online 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, buy cialis daily online which creates a compensation program. These sections are codified at 42 U.S.C. 247d-6d and 42 U.S.C. 247d-6e, respectively buy cialis daily online.

Section 319F-3 of the PHS Act has been amended by the cialis and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013, and the erectile dysfunction Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, 2020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the former Secretary, Alex M. Azar II, buy cialis daily online 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 erectile dysfunction treatment outbreak.

Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration effective on April 26, 2020, July 25, 2020, October 23, 2020, January 21, 2021, April 21, 2021 and July 20, 2021. On March 10, 2020, former Secretary Azar issued a Declaration buy cialis daily online under the PREP Act for medical countermeasures against erectile dysfunction treatment (85 FR 15198, Mar. 17, 2020) (the Declaration). On April 10, the former 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) buy cialis daily online. On June 4, the former Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm erectile dysfunction treatment might otherwise cause. (85 FR 35100, June 8, 2020). On August 19, the former Secretary amended the declaration to buy cialis daily online add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommended the administration or use of the Covered Countermeasures.

(85 FR 52136, Aug. 24, 2020). On December 3, 2020, the former Secretary amended the declaration to incorporate Advisory Opinions of the General Counsel interpreting the PREP Act and the Secretary's buy cialis daily online Declaration and authorizations issued by the Department's Office of the Assistant Secretary for Health as an Authority Having Jurisdiction to respond. Added an additional category of qualified persons under Section V of the Declaration.

Made explicit that the Declaration covers all qualified cialis and epidemic products as defined under the PREP Act. Added a third method of distribution to buy cialis daily online provide liability protections for, among other things, private distribution channels. Made explicit that there can be situations where not administering a covered countermeasure to a particular individual can fall within the PREP Act and the Declaration's liability protections. Made explicit that there are substantive federal legal and policy issues and interests in having a unified whole-of-nation response to the erectile dysfunction treatment cialis among federal, state, local, and private-sector entities.

Revised the effective time period buy cialis daily online of the Declaration. And republished the declaration in full. (85 FR 79190, Dec. 9, 2020) buy cialis daily online.

On February 2, 2021, the Acting Secretary Norris Cochran amended the Declaration to add additional categories of Qualified Persons authorized to prescribe, dispense, and administer erectile dysfunction treatments that are covered countermeasures under the Declaration (86 FR 7872, Feb. 2, 2021). On February 16, 2021, the Acting Secretary amended the Declaration to add additional categories of buy cialis daily online Qualified Persons authorized to prescribe, dispense, and administer erectile dysfunction treatments that are covered countermeasures under the Declaration (86 FR 9516, Feb. 16, 2021) and on February 22, 2021, the Department filed a notice of correction to the February 2 and February 16 notices correcting effective dates stated in the Declaration, and correcting the description of qualified persons added by the February 16, 2021 amendment.

(86 FR 10588, Feb. 22, 2021) buy cialis daily online. On March 11, 2021, the Acting Secretary amended the Declaration to add additional Qualified Persons authorized to prescribe, dispense, and administer covered countermeasures under the Declaration. (86 FR 14462, Mar.

16, 2021) buy cialis daily online. On August 4, 2021, Secretary Xavier Becerra amended the Declaration to clarify categories of Qualified Persons and to expand the scope of authority for certain Qualified Persons to administer seasonal influenza treatments to adults. (86 FR 41977, Aug. 4, 2021) buy cialis daily online.

Secretary Xavier Becerra now amends section V of the Declaration to add subsection (i) to expand the scope of authority for licensed pharmacists to order and administer and qualified pharmacy technicians and pharmacy interns to administer erectile dysfunction treatment therapeutics subcutaneously, intramuscularly, or orally as authorized, approved, or licensed by the U.S. Food and Drug Administration (FDA). Accordingly, subsection V(i) authorizes buy cialis daily online. (i) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy) [] FDA authorized, approved, or licensed erectile dysfunction treatment therapeutics.

Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met. I. The erectile dysfunction treatment therapeutic must be authorized, approved, or licensed by the FDA. Ii.

In the case of a licensed pharmacist ordering a erectile dysfunction treatment therapeutic, the therapeutic must be ordered for subcutaneous, intramuscular, or oral administration and in accordance with the FDA approval, authorization, or licensing;Start Printed Page 51162 iii. In the case of licensed pharmacists, qualified pharmacy technicians, and licensed or registered pharmacy interns administering the erectile dysfunction treatment therapeutic, the therapeutic must be administered subcutaneously, intramuscularly, or orally in accordance with the FDA approval, authorization, or licensing. Iv. In the case of qualified pharmacy technicians, the supervising pharmacist must be readily and immediately available to the qualified pharmacy technician.

V. In the case of erectile dysfunction treatment therapeutics administered through intramuscular or subcutaneous injections, the licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must complete a practical training program 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 erectile dysfunction treatment therapeutics, the recognition and treatment of emergency reactions to erectile dysfunction treatment therapeutics, and any additional training required in the FDA approval, authorization, or licensing. Vi.

The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] vii. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers erectile dysfunction treatment therapeutics, including informing the patient's primary-care provider when available and complying with requirements with respect to reporting adverse events. Viii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) that apply to the administration of erectile dysfunction treatment therapeutics.

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 the PREP Act 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 clarifies and expands the authorization for a category of persons who are qualified persons under section 247d-6d(i)(8)(B). First, the amendment clarifies that licensed pharmacists are authorized to order and administer and licensed or registered pharmacy interns and qualified pharmacy technicians are authorized to administer erectile dysfunction treatment therapeutics that are Covered Countermeasures under section VI of this Declaration.

The Secretary anticipates that there will be a need to increase the available pool of providers able to order and administer erectile dysfunction treatment therapeutics to address rising erectile dysfunction treatment cases, to expand patient access to these critical therapies, and to keep as many patients out of the hospital as possible. Rising erectile dysfunction treatment cases, largely attributable to the Delta variant, is a public health threat caused by erectile dysfunction treatment, placing additional strains on our healthcare system. Pharmacists, pharmacy technicians, and pharmacy interns are well positioned to increase access to therapeutics and have played a critical role in this cialis in overseeing erectile dysfunction treatment testing and treatment administration. Given their skill set and training, as well as looming provider shortages, pharmacists, pharmacy technicians, and pharmacy interns will quickly expand access to erectile dysfunction treatment therapeutics.

erectile dysfunction treatment therapeutics may be administered as intramuscular injections, subcutaneous injections, or orally and would require minimal, if any, additional training to administer beyond training pharmacists, pharmacy technicians, and pharmacy interns have already received for treatment administration, and would not place any undue training burden on providers. As qualified persons, these licensed pharmacists, qualified pharmacy technicians and interns will be afforded liability protections in accordance with the PREP Act and the terms of this amended Declaration. Second, to the extent that any State law that would otherwise prohibit these healthcare professionals who are a “qualified person” from prescribing, dispensing, or administering erectile dysfunction treatment therapeutics or other Covered Countermeasures, such law is preempted. On May 19, 2020, the Office of the General Counsel issued an advisory opinion concluding that, because licensed pharmacists are “qualified persons” under this declaration, the PREP Act preempts state law that would otherwise prohibit such pharmacists from ordering and administering authorized erectile dysfunction treatment diagnostic tests.[] The opinion relied in part on the fact that the Congressional delegation of authority to the Secretary under the PREP Act to specify a class of persons, beyond those who are authorized to administer a covered countermeasure under State law, as “qualified persons” would be rendered a nullity in the absence of such preemption.

This opinion is incorporated by reference into this declaration. Based on the reasoning set forth in the May 19, 2020 advisory opinion, any State law that would otherwise prohibit a member of any of the classes of “qualified persons” specified in this declaration from administering a covered countermeasure is likewise preempted. In accordance with section 319F-3(i)(8)(A) of the Public Health Service Act, a State remains free to expand the universe of individuals authorized to administer Start Printed Page 51163covered countermeasures within its jurisdiction under State law. The plain language of the PREP Act makes clear that there is preemption of state law as described above.

Furthermore, preemption of State law is justified to respond to the nation-wide public health emergency caused by erectile dysfunction treatment as it will enable States to quickly expand the vaccination, treatment and prevention workforces with additional qualified healthcare professionals where State or local requirements might otherwise inhibit or delay allowing these healthcare professionals to participate in the erectile dysfunction treatment countermeasure program. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against erectile dysfunction treatment. Section V of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against erectile dysfunction treatment, as amended April 10, 2020, June 4, 2020, August 19, 2020, as amended and republished on December 3, 2020, as amended on February 2, 2021, as amended March 11, 2021, and as amended on August 4, 2021, is 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 republished at 85 FR 79190 (Dec.

9, 2020) http://dsdtips.com/dsd-support-tips-blog/. 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. €œOrder” as used herein and in guidance issued by the Office of the Assistant Secretary for Health [] means a provider medication order, which includes prescribing of treatments, or a laboratory order, which includes prescribing laboratory orders, if required. 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, as that term is defined in Section VII of this Declaration;[] (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. (d) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy),[] (1) treatments that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule or (2) seasonal influenza treatment administered by qualified pharmacy technicians and interns that the ACIP recommends to persons aged 19 and older according to ACIP's standard immunization schedule. Or (3) FDA authorized or FDA licensed erectile dysfunction treatments to persons ages three or older.

Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are qualified persons only if the following requirements are met. I. The treatment must be authorized, approved, or licensed by the FDA. Ii.

In the case of a erectile dysfunction treatment, the vaccination must be ordered and administered according to ACIP's erectile dysfunction treatment recommendation(s). Iii. In the case of a childhood treatment, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. Iv.

In the case of seasonal influenza treatment administered by qualified pharmacy technicians and interns, the vaccination must be ordered and administered according to ACIP's standard immunization schedule. V. In the case of pharmacy technicians, the supervising pharmacist must be readily and immediately available to the immunizing qualified pharmacy technician. Vi.

The licensed pharmacist must have completed the immunization Start Printed Page 51164training that the licensing State requires for pharmacists to order and administer treatments. If the State does not specify training requirements for the licensed pharmacist to order and administer treatments, the licensed pharmacist must complete a vaccination training program of at least 20 hours that is approved by the ACPE to order and administer treatments. Such a 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. Vii.

The licensed or registered pharmacy intern and qualified pharmacy technician 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. Viii. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] ix.

The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period. X. 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. Xi.

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. And xii. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) erectile dysfunction treatment vaccination provider agreement and any other federal requirements that apply to the administration of erectile dysfunction treatment- 19 treatment(s). (e) Healthcare personnel using telehealth to order or administer Covered Countermeasures for patients in a state other than the state where the healthcare personnel are licensed or otherwise permitted to practice.

When ordering and administering Covered Countermeasures by means of telehealth to patients in a state where the healthcare personnel are not already permitted to practice, the healthcare personnel must comply with all requirements for ordering and administering Covered Countermeasures to patients by means of telehealth in the state where the healthcare personnel are permitted to practice. Any state law that prohibits or effectively prohibits such a qualified person from ordering and administering Covered Countermeasures by means of telehealth is preempted.[] Nothing in this Declaration shall preempt state laws that permit additional persons to deliver telehealth services. (f) Any healthcare professional or other individual who holds an active license or certification permitting the person to prescribe, dispense, or administer treatments under the law of any State as of the effective date of this amendment, or a pharmacist or pharmacy intern as authorized under the section V(d) of this Declaration, who prescribes, dispenses, or administers erectile dysfunction treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies, other than the State in which the license or certification is held, in association with a erectile dysfunction treatment vaccination effort by a federal, State, local Tribal or territorial authority or by an institution in the State in which the erectile dysfunction treatment covered countermeasure is administered, so long as the license or certification of the healthcare professional has not been suspended or restricted by any licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General, subject to. (i) Documentation of completion of the Centers for Disease Control and Prevention erectile dysfunction treatment (CDC) treatment Training Modules [] and, for healthcare providers who are not currently practicing, documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering intramuscular injections is in their ordinary scope of practice, who confirms competency of the healthcare provider in preparation and administration of the erectile dysfunction treatment(s) to be administered.

(g) Any member of a uniformed service (including members of the National Guard in a Title 32 duty status) (hereafter in this paragraph “service member”) or Federal government, employee, contractor, or volunteer who prescribes, administers, delivers, distributes or dispenses a Covered Countermeasure. Such Federal government service members, employees, contractors, or volunteers are qualified persons if the following requirement is met. The executive department or agency by or for which the Federal service member, employee, contractor, or volunteer is employed, contracts, or volunteers has authorized or could authorize that service member, employee, contractor, or volunteer to prescribe, administer, deliver, distribute, or dispense the Covered Countermeasure as any part of the duties or responsibilities of that service member, employee, contractor, or volunteer, even if those authorized duties or responsibilities ordinarily would not extend to members of the public or otherwise would be more limited in scope than the activities such service member, employees, contractors, Start Printed Page 51165or volunteers are authorized to carry out under this declaration. And (h) The following healthcare professionals and students in a healthcare profession training program subject to the requirements of this paragraph.

1. Any midwife, paramedic, advanced or intermediate emergency medical technician (EMT), physician assistant, respiratory therapist, dentist, podiatrist, optometrist or veterinarian licensed or certified to practice under the law of any state who prescribes, dispenses, or administers erectile dysfunction treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a erectile dysfunction treatment vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the erectile dysfunction treatment covered countermeasure is administered. 2. Any physician, advanced practice registered nurse, registered nurse, practical nurse, pharmacist, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, respiratory therapist, dentist, physician assistant, podiatrist, optometrist, or veterinarian who has held an active license or certification under the law of any State within the last five years, which is inactive, expired or lapsed, who prescribes, dispenses, or administers erectile dysfunction treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a erectile dysfunction treatment vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the erectile dysfunction treatment covered countermeasure is administered, so long as the license or certification was active and in good standing prior to the date it went inactive, expired or lapsed and was not revoked by the licensing authority, surrendered while under suspension, discipline or investigation by a licensing authority or surrendered following an arrest, and the individual is not on the List of Excluded Individuals/Entities maintained by the Office of Inspector General.

3. Any medical, nursing, pharmacy, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, physician assistant, respiratory therapy, dental, podiatry, optometry or veterinary student with appropriate training in administering treatments as determined by his or her school or training program and supervision by a currently practicing healthcare professional experienced in administering intramuscular injections who administers erectile dysfunction treatments that are Covered Countermeasures under section VI of this Declaration in any jurisdiction where the PREP Act applies in association with a erectile dysfunction treatment vaccination effort by a State, local, Tribal or territorial authority or by an institution in which the erectile dysfunction treatment covered countermeasure is administered. Subject to the following requirements. I.

The treatment must be authorized, approved, or licensed by the FDA. Ii. Vaccination must be ordered and administered according to ACIP's erectile dysfunction treatment recommendation(s). Iii.

The healthcare professionals and students must have documentation of completion of the Centers for Disease Control and Prevention erectile dysfunction treatment Training Modules and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering erectile dysfunction treatments. Iv. The healthcare professionals and students must have documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering vaccinations is in their ordinary scope of practice, who confirms competency of the healthcare provider or student in preparation and administration of the erectile dysfunction treatment(s) to be administered and, if applicable, such additional training as may be required by the State, territory, locality, or Tribal area in which they are prescribing, dispensing, or administering erectile dysfunction treatments. V.

The healthcare professionals and students must have a current certificate in basic cardiopulmonary resuscitation; [] vi. The healthcare professionals and students 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. And vii. The healthcare professionals and students comply with any applicable requirements (or conditions of use) as set forth in the Centers for Disease Control and Prevention (CDC) erectile dysfunction treatment vaccination provider agreement and any other federal requirements that apply to the administration of erectile dysfunction treatment(s).

(i) A State-licensed pharmacist who orders and administers, and pharmacy interns and qualified pharmacy technicians who administer (if the pharmacy intern or technician acts under the supervision of such pharmacist and the pharmacy intern or technician is licensed or registered by his or her State board of pharmacy) [] FDA authorized, approved, or licensed erectile dysfunction treatment therapeutics. Such State-licensed pharmacists and the State-licensed or registered interns or technicians under their supervision are Start Printed Page 51166qualified persons only if the following requirements are met. Ix. The erectile dysfunction treatment therapeutic must be authorized, approved, or licensed by the FDA.

X. In the case of a licensed pharmacist ordering a erectile dysfunction treatment therapeutic, the therapeutic must be ordered for subcutaneous, intramuscular, or oral administration and in accordance with the FDA approval, authorization, or licensing. Xi. In the case of licensed pharmacists, qualified pharmacy technicians, and licensed or registered pharmacy interns administering the erectile dysfunction treatment therapeutic, the therapeutic must be administered subcutaneously, intramuscularly, or orally in accordance with the FDA approval, authorization, or licensing.

Xii. In the case of qualified pharmacy technicians, the supervising pharmacist must be readily and immediately available to the qualified pharmacy technician. Xiii. In the case of erectile dysfunction treatment therapeutics administered through intramuscular or subcutaneous injections, the licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician 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 erectile dysfunction treatment therapeutics, the recognition and treatment of emergency reactions to erectile dysfunction treatment therapeutics, and any additional training required in the FDA approval, authorization, or licensing. Xiv. The licensed pharmacist, licensed or registered pharmacy intern and qualified pharmacy technician must have a current certificate in basic cardiopulmonary resuscitation; [] xv. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers erectile dysfunction treatment therapeutics, including informing the patient's primary-care provider when available and complying with requirements with respect to reporting adverse events.

Xvi. The licensed pharmacist, the licensed or registered pharmacy intern and the qualified pharmacy technician must comply with any applicable requirements (or conditions of use) that apply to the administration of erectile dysfunction treatment therapeutics. 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. 2.

Effective Time Period, section XII, delete in full and replace with. Liability protections for any respiratory protective device approved by NIOSH under 42 CFR part 84, or any successor regulations, through the means of distribution identified in Section VII(a) of this Declaration, begin on March 27, 2020 and extend through October 1, 2024. Liability protections for all other Covered Countermeasures identified in Section VI of this Declaration, through means of distribution identified in Section VII(a) of this Declaration, begin on February 4, 2020 and extend through October 1, 2024. Liability protections for all Covered Countermeasures administered and used in accordance with the public health and medical response of the Authority Having Jurisdiction, as identified in Section VII(b) of this Declaration, begin with a Declaration of Emergency as that term is defined in Section VII (except that, with respect to qualified persons who order or administer a routine childhood vaccination that ACIP recommends to persons ages three through 18 according to ACIP's standard immunization schedule, liability protections began on August 24, 2020), and last through (a) the final day the Declaration of Emergency is in effect, or (b) October 1, 2024, whichever occurs first.

Liability protections for all Covered Countermeasures identified in Section VII(c) of this Declaration begin on December 9, 2020 and last through (a) the final day the Declaration of Emergency is in effect or (b) October 1, 2024 whichever occurs first. Liability protections for Qualified Persons under section V(d) of the Declaration who are qualified pharmacy technicians and interns to seasonal influenza treatment to persons aged 19 and older begin on August 4, 2021. Liability protections for Qualified Persons under section V(f) of the Declaration begin on February 2, 2021, and last through October 1, 2024. Liability protections for Qualified Persons under section V(g) of the Declaration begin on February 16, 2021, and last through October 1, 2024.

Liability protections for Qualified Persons who are physicians, advanced practice registered nurses, registered nurses, or practical nurses under section V(h) of the Declaration begins on February 2, 2021 and last through October 1, 2024, with additional conditions effective as of March 11, 2021and liability protections for all other Qualified persons under section V(h) begins on March 11, 2021 and last through October 1, 2024. Liability protections for Qualified Persons under section V(i) of the Declaration who are licensed pharmacists to order and administer and qualified pharmacy technicians and licensed or registered pharmacy interns to administer erectile dysfunction treatment therapeutics begin on September 9, 2021. Authority. 42 U.S.C.

247d-6d. Start Signature Dated. September 9, 2021. Xavier Becerra, Secretary, U.S.

What side effects may I notice from Cialis?

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

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• breathing problems
• changes in hearing
• chest pain
• fast, irregular heartbeat

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

• back pain
• dizziness
• flushing
• headache
• indigestion
• muscle aches
• stuffy or runny nose

This list may not describe all possible side effects.

Can i take 40mg of cialis

NIH scientists say the approach may be can i take 40mg of cialis a novel way to treat pneumonia in humans. The image shows S. Pneumoniae bacteria, shown in can i take 40mg of cialis green, that have been engulfed by a macrophage from a wild-type mouse. (Photo courtesy of Hong Li, Ph.D.

/ NIEHS) Researchers at the can i take 40mg of cialis National Institutes of Health have discovered a therapy that targets host cells rather than bacterial cells in treating bacterial pneumonia in rodents. The method involves white blood cells of the immune system called macrophages that eat bacteria, and a group of compounds that are naturally produced in mice and humans called epoxyeicosatrienoic acids or EETs. The research was published in the Journal of Clinical Investigation.According to the World Health Organization, pneumonia caused by Streptococcus pneumoniae, or pneumococcal pneumonia, is the leading cause can i take 40mg of cialis of pneumonia deaths worldwide each year. While physicians usually prescribe antibiotics to treat this severe lung , treatment is not always successful, and in some cases, the bacteria become resistant.Matthew Edin, Ph.D., a scientist at the National Institute of Environmental Health Sciences (NIEHS), part of NIH, wanted to find a way to augment the body’s immune system to resolve the .To keep tissues healthy, EETs work to limit inflammation, but during s caused by S.

Pneumoniae and other microorganisms, inflammation ramps up after lung cells induce certain substances that prompt can i take 40mg of cialis macrophages to gobble up the bacteria. Edin and colleagues found that one way to get macrophages to eat more bacteria is to decrease the ability of EETs to do what they normally do, which is limit inflammation.Edin led the team that found induces a protein called soluble epoxide hydrolase (sEH) that degrades EETs. In contrast, when sEH is blocked, EET levels skyrocket, hampering the macrophages’ ability to sense and eat bacteria. As a result, the bacteria continue to reproduce in the lung, which leads to severe lung and death.At the other can i take 40mg of cialis end of the spectrum, blocking EETs using a synthetic molecule called EEZE boosted the eating capacity of the macrophages, leading to reduced numbers of bacteria in the lungs of mice.

The scientists saw the same result when they placed bacteria and macrophages harvested from lung and blood samples of human volunteers in test tubes at the NIEHS Clinical Research Unit.“EEZE is safe and effective in mice, but scientists could develop similar compounds to give to humans,” said Edin, who is co-lead author of the paper. €œThese new molecules could be used in an inhaler or pill to promote bacterial killing and make the can i take 40mg of cialis antibiotics more effective.”NIEHS Scientific Director Darryl Zeldin, M.D., corresponding author of the research, has spent several years studying EETs and their impact on the human body. He and his research group determined that EETs provide beneficial cardiovascular effects, such as lowering blood pressure and inflammation, and improving cell survival after a stroke or heart attack. He stressed, however, that the involvement of EETs in the process of inflammation can be good or bad depending on the context.“EETs can suppress the inflammatory response, which is good, but if they block it too can i take 40mg of cialis much, they’re going to make it so the macrophages can’t eat the bacteria, which is bad,” said Zeldin.Edin added that some researchers have tested sEH inhibitors — compounds that prevent sEH from degrading EETs — in clinical trials to see if they could help with pain, chronic obstructive pulmonary disease, and high blood pressure.

He cautioned that the scientists performing these studies consider the influence of sEH inhibitors on bacterial clearance.“They should be careful and stop using them if the individual develops pneumonia,” said Edin. €œOur study demonstrated that blocking sEH means EETs may hamstring macrophages, making a lung worse.”Co-author Stavros Garantziotis, M.D., medical director of the NIEHS Clinical Research Unit, was instrumental in collecting human macrophages for the research.“Since our study utilized lung immune cells can i take 40mg of cialis from healthy volunteers, we have confidence that our findings are relevant to human health,” said Garantziotis.Grant Number. Z01ES025034Reference. Li H, Bradbury JA, Edin ML, Graves JP, Gruzdev A, Cheng J, Hoopes SL, DeGraff LM, Fessler MB, Garantziotis S, Schurman SH, Zeldin DC.

2021. SEH promotes macrophage phagocytosis and lung clearance of Streptococcus pneumoniae. J Clin Invest. Doi.

10.1172/JCI129679 [Online 30 September 2021]. [Abstract Li H, Bradbury JA, Edin ML, Graves JP, Gruzdev A, Cheng J, Hoopes SL, DeGraff LM, Fessler MB, Garantziotis S, Schurman SH, Zeldin DC. 2021. SEH promotes macrophage phagocytosis and lung clearance of Streptococcus pneumoniae.

J Clin Invest. Doi. 10.1172/JCI129679 [Online 30 September 2021].]News ReleaseTuesday, October 26, 2021New program will establish data science research and training network across the continent. The National Institutes of Health is investing about $74.5 million over five years to advance data science, catalyze innovation and spur health discoveries across Africa.

Under its new Harnessing Data Science for Health Discovery and Innovation in Africa (DS-I Africa) program, the NIH is issuing 19 awards to support research and training activities. DS-I Africa is an NIH Common Fund program that is supported by the Office of the Director and 11 NIH Institutes, Centers and Offices. Awards will establish a consortium consisting of a data science platform and coordinating center, seven research hubs, seven data science research training programs and four projects focused on studying the ethical, legal and social implications of data science research. Awardees have a robust network of partnerships across the African continent and in the United States, including numerous national health ministries, nongovernmental organizations, corporations, and other academic institutions.

€œThis initiative has generated tremendous enthusiasm in all sectors of Africa’s biomedical research community,” said NIH Director Francis S. Collins, M.D., Ph.D. €œBig data and artificial intelligence have the potential to transform the conduct of research across the continent, while investing in research training will help to support Africa’s future data science leaders and ensure sustainable progress in this promising field.” The University of Cape Town (UCT) will develop and manage the initiative’s open data science platform and coordinating center, building on previous NIH investments in UCT’s data and informatics capabilities made through the Human Heredity and Health in Africa (H3Africa) program. UCT will provide a flexible, scalable platform for the DS-I Africa researchers, so they can find and access data, select tools and workflows, and run analyses through collaborative workspaces.

UCT will also administer and support core resources, as well as coordinate consortium activities. The research hubs, all of which are led by African institutions, will apply novel approaches to data analysis and AI to address critical health issues including. Scientists in Kenya will leverage large, existing data sets to develop and validate AI models to identify women at risk for poor pregnancy outcomes. And to identify adolescents and young healthcare workers at risk of depression and suicide ideation.

A hub in Nigeria will study erectile dysfunction and HIV with the goal of using data to improve cialis preparedness. In Uganda, researchers will advance data science for medical imaging with efforts to improve diagnoses of eye disease and cervical cancer. Scientists in Nigeria will also study anti-microbial resistance and the dynamics of disease transmission, develop a portable screening tool for bacterial s and test a potential anti-microbial compound. A project based in Cameroon will investigate ways to decrease the burden of injuries and surgical diseases, as well as improve access to quality surgical care across the continent.

From a hub in South Africa, researchers will study multi-disease morbidity by analyzing clinical and genomic data with the goal of providing actionable insights to reduce disease burden and improve overall health. A project in South Africa will develop innovative solutions to mitigate the health impacts of climate change throughout the region, with initial studies of clinical outcomes of heat exposure on pregnant women, newborns and people living in urban areas.The research training programs, which leverage partnerships with U.S. Institutions, will create multi-tiered curricula to build skills in foundational health data science, with options ranging from master’s and doctoral degree tracks, to postdoctoral training and faculty development. A mix of in-person and remote training will be offered to build skills in multi-disciplinary topics such as applied mathematics, biostatistics, epidemiology, clinical informatics, analytics, computational omics, biomedical imaging, machine intelligence, computational paradigms, computer science and engineering.

Trainees will receive intensive mentoring and participate in practical internships to learn how to apply data science concepts to medical and public health areas including the social determinants of health, climate change, food systems, infectious diseases, noncommunicable diseases, health surveillance, injuries, pediatrics and parasitology. Recognizing that data science research may uncover potential ethical, legal and social implications (ELSI), the consortium will include dedicated ELSI research addressing these topics. This will include efforts to develop evidence-based, context specific guidance for the conduct and governance of data science initiatives. Evaluate current legal instruments and guidelines to develop new and innovative governance frameworks to support data science health research in Africa.

Explore legal differences across regions of the continent in the use of data science for health discovery and innovation. And investigate public perceptions and attitudes regarding the use of data science approaches for healthcare along with the roles and responsibilities of different stakeholder groups regarding intellectual property, patents, and commercial use of genomics data in health. In addition, the ELSI research teams will be embedded in the research hubs to provide important and timely guidance. A second phase of the program is being planned to encourage more researchers to join the consortium, foster the formation of new partnerships and address additional capacity building needs.

Through the combined efforts of all its initiatives, DS-I Africa is intended to use data science to develop solutions to the continent’s most pressing public health problems through a robust ecosystem of new partners from academic, government and private sectors. In addition to the Common Fund (CF), the DS-I Africa awards are being supported by the Fogarty International Center (FIC), the National Cancer Institute (NCI), the National Human Genome Research Institute (NHGRI), the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute of Environmental Health Sciences (NIEHS), the National Institute of Mental Health (NIMH), the National Library of Medicine (NLM) and the NIH Office of Data Science Strategy (ODSS). The initiative is being led by the CF, FIC, NIBIB, NIMH and NLM. More information is available at https://commonfund.nih.gov/AfricaData.

Photos depicting data science activities at awardee institutions are available for downloading at https://commonfund.nih.gov/africadata/images. About the NIH Common Fund. The NIH Common Fund encourages collaboration and supports a series of exceptionally high-impact, trans-NIH programs. Common Fund programs are managed by the Office of Strategic Coordination in the Division of Program Coordination, Planning, and Strategic Initiatives in the NIH Office of the Director in partnership with the NIH Institutes, Centers, and Offices.

More information is available at the Common Fund website. Https://commonfund.nih.gov.About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.

For more information about NIH and its programs, visit www.nih.gov. NIH…Turning Discovery Into Health®###.

NIH scientists say the approach may be a novel buy cialis daily online way to treat pneumonia in humans. The image shows S. Pneumoniae bacteria, buy cialis daily online shown in green, that have been engulfed by a macrophage from a wild-type mouse. (Photo courtesy of Hong Li, Ph.D. / NIEHS) Researchers at the National Institutes of Health have discovered a therapy that targets host cells buy cialis daily online rather than bacterial cells in treating bacterial pneumonia in rodents.

The method involves white blood cells of the immune system called macrophages that eat bacteria, and a group of compounds that are naturally produced in mice and humans called epoxyeicosatrienoic acids or EETs. The research was published in the Journal of Clinical Investigation.According to the World Health Organization, pneumonia caused by Streptococcus pneumoniae, or pneumococcal pneumonia, buy cialis daily online is the leading cause of pneumonia deaths worldwide each year. While physicians usually prescribe antibiotics to treat this severe lung , treatment is not always successful, and in some cases, the bacteria become resistant.Matthew Edin, Ph.D., a scientist at the National Institute of Environmental Health Sciences (NIEHS), part of NIH, wanted to find a way to augment the body’s immune system to resolve the .To keep tissues healthy, EETs work to limit inflammation, but during s caused by S. Pneumoniae and other microorganisms, inflammation ramps up after lung cells induce certain substances that prompt macrophages to gobble up the buy cialis daily online bacteria. Edin and colleagues found that one way to get macrophages to eat more bacteria is to decrease the ability of EETs to do what they normally do, which is limit inflammation.Edin led the team that found induces a protein called soluble epoxide hydrolase (sEH) that degrades EETs.

In contrast, when sEH is blocked, EET levels skyrocket, hampering the macrophages’ ability to sense and eat bacteria. As a result, the bacteria continue to reproduce in the lung, which leads to severe lung and death.At the other end of the spectrum, blocking EETs using a synthetic molecule called EEZE boosted the eating capacity of the macrophages, buy cialis daily online leading to reduced numbers of bacteria in the lungs of mice. The scientists saw the same result when they placed bacteria and macrophages harvested from lung and blood samples of human volunteers in test tubes at the NIEHS Clinical Research Unit.“EEZE is safe and effective in mice, but scientists could develop similar compounds to give to humans,” said Edin, who is co-lead author of the paper. €œThese new molecules could be used in an inhaler or pill to promote bacterial killing and make the antibiotics more effective.”NIEHS Scientific Director Darryl buy cialis daily online Zeldin, M.D., corresponding author of the research, has spent several years studying EETs and their impact on the human body. He and his research group determined that EETs provide beneficial cardiovascular effects, such as lowering blood pressure and inflammation, and improving cell survival after a stroke or heart attack.

He stressed, however, that the involvement of EETs in the process of inflammation can be good or bad depending on the context.“EETs can suppress the inflammatory response, which is good, but if they block it too much, they’re going to make it so the macrophages can’t eat the bacteria, which is bad,” said Zeldin.Edin added buy cialis daily online that some researchers have tested sEH inhibitors — compounds that prevent sEH from degrading EETs — in clinical trials to see if they could help with pain, chronic obstructive pulmonary disease, and high blood pressure. He cautioned that the scientists performing these studies consider the influence of sEH inhibitors on bacterial clearance.“They should be careful and stop using them if the individual develops pneumonia,” said Edin. €œOur study demonstrated that blocking sEH means EETs may hamstring macrophages, making a lung worse.”Co-author Stavros Garantziotis, M.D., medical director of the NIEHS Clinical Research Unit, buy cialis daily online was instrumental in collecting human macrophages for the research.“Since our study utilized lung immune cells from healthy volunteers, we have confidence that our findings are relevant to human health,” said Garantziotis.Grant Number. Z01ES025034Reference. Li H, Bradbury JA, Edin ML, Graves JP, Gruzdev A, Cheng J, Hoopes SL, DeGraff LM, Fessler MB, Garantziotis S, Schurman SH, Zeldin DC.

2021. SEH promotes macrophage phagocytosis and lung clearance of Streptococcus pneumoniae. J Clin Invest. Doi. 10.1172/JCI129679 [Online 30 September 2021].

[Abstract Li H, Bradbury JA, Edin ML, Graves JP, Gruzdev A, Cheng J, Hoopes SL, DeGraff LM, Fessler MB, Garantziotis S, Schurman SH, Zeldin DC. 2021. SEH promotes macrophage phagocytosis and lung clearance of Streptococcus pneumoniae. J Clin Invest. Doi.

10.1172/JCI129679 [Online 30 September 2021].]News ReleaseTuesday, October 26, 2021New program will establish data science research and training network across the continent. The National Institutes of Health is investing about $74.5 million over five years to advance data science, catalyze innovation and spur health discoveries across Africa. Under its new Harnessing Data Science for Health Discovery and Innovation in Africa (DS-I Africa) program, the NIH is issuing 19 awards to support research and training activities. DS-I Africa is an NIH Common Fund program that is supported by the Office of the Director and 11 NIH Institutes, Centers and Offices. Awards will establish a consortium consisting of a data science platform and coordinating center, seven research hubs, seven data science research training programs and four projects focused on studying the ethical, legal and social implications of data science research.

Awardees have a robust network of partnerships across the African continent and in the United States, including numerous national health ministries, nongovernmental organizations, corporations, and other academic institutions. €œThis initiative has generated tremendous enthusiasm in all sectors of Africa’s biomedical research community,” said NIH Director Francis S. Collins, M.D., Ph.D. €œBig data and artificial intelligence have the potential to transform the conduct of research across the continent, while investing in research training will help to support Africa’s future data science leaders and ensure sustainable progress in this promising field.” The University of Cape Town (UCT) will develop and manage the initiative’s open data science platform and coordinating center, building on previous NIH investments in UCT’s data and informatics capabilities made through the Human Heredity and Health in Africa (H3Africa) program. UCT will provide a flexible, scalable platform for the DS-I Africa researchers, so they can find and access data, select tools and workflows, and run analyses through collaborative workspaces.

UCT will also administer and support core resources, as well as coordinate consortium activities. The research hubs, all of which are led by African institutions, will apply novel approaches to data analysis and AI to address critical health issues including. Scientists in Kenya will leverage large, existing data sets to develop and validate AI models to identify women at risk for poor pregnancy outcomes. And to identify adolescents and young healthcare workers at risk of depression and suicide ideation. A hub in Nigeria will study erectile dysfunction and HIV with the goal of using data to improve cialis preparedness.

In Uganda, researchers will advance data science for medical imaging with efforts to improve diagnoses of eye disease and cervical cancer. Scientists in Nigeria will also study anti-microbial resistance and the dynamics of disease transmission, develop a portable screening tool for bacterial s and test a potential anti-microbial compound. A project based in Cameroon will investigate ways to decrease the burden of injuries and surgical diseases, as well as improve access to quality surgical care across the continent. From a hub in South Africa, researchers will study multi-disease morbidity by analyzing clinical and genomic data with the goal of providing actionable insights to reduce disease burden and improve overall health. A project in South Africa will develop innovative solutions to mitigate the health impacts of climate change throughout the region, with initial studies of clinical outcomes of heat exposure on pregnant women, newborns and people living in urban areas.The research training programs, which leverage partnerships with U.S.

Institutions, will create multi-tiered curricula to build skills in foundational health data science, with options ranging from master’s and doctoral degree tracks, to postdoctoral training and faculty development. A mix of in-person and remote training will be offered to build skills in multi-disciplinary topics such as applied mathematics, biostatistics, epidemiology, clinical informatics, analytics, computational omics, biomedical imaging, machine intelligence, computational paradigms, computer science and engineering. Trainees will receive intensive mentoring and participate in practical internships to learn how to apply data science concepts to medical and public health areas including the social determinants of health, climate change, food systems, infectious diseases, noncommunicable diseases, health surveillance, injuries, pediatrics and parasitology. Recognizing that data science research may uncover potential ethical, legal and social implications (ELSI), the consortium will include dedicated ELSI research addressing these topics. This will include efforts to develop evidence-based, context specific guidance for the conduct and governance of data science initiatives.

Evaluate current legal instruments and guidelines to develop new and innovative governance frameworks to support data science health research in Africa. Explore legal differences across regions of the continent in the use of data science for health discovery and innovation. And investigate public perceptions and attitudes regarding the use of data science approaches for healthcare along with the roles and responsibilities of different stakeholder groups regarding intellectual property, patents, and commercial use of genomics data in health. In addition, the ELSI research teams will be embedded in the research hubs to provide important and timely guidance. A second phase of the program is being planned to encourage more researchers to join the consortium, foster the formation of new partnerships and address additional capacity building needs.

Through the combined efforts of all its initiatives, DS-I Africa is intended to use data science to develop solutions to the continent’s most pressing public health problems through a robust ecosystem of new partners from academic, government and private sectors. In addition to the Common Fund (CF), the DS-I Africa awards are being supported by the Fogarty International Center (FIC), the National Cancer Institute (NCI), the National Human Genome Research Institute (NHGRI), the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute of Environmental Health Sciences (NIEHS), the National Institute of Mental Health (NIMH), the National Library of Medicine (NLM) and the NIH Office of Data Science Strategy (ODSS). The initiative is being led by the CF, FIC, NIBIB, NIMH and NLM. More information is available at https://commonfund.nih.gov/AfricaData. Photos depicting data science activities at awardee institutions are available for downloading at https://commonfund.nih.gov/africadata/images.

About the NIH Common Fund. The NIH Common Fund encourages collaboration and supports a series of exceptionally high-impact, trans-NIH programs. Common Fund programs are managed by the Office of Strategic Coordination in the Division of Program Coordination, Planning, and Strategic Initiatives in the NIH Office of the Director in partnership with the NIH Institutes, Centers, and Offices. More information is available at the Common Fund website. Https://commonfund.nih.gov.About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S.

Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov. NIH…Turning Discovery Into Health®###.

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"The fact that these arrests came from many different facets of this situation says a lot about how comprehensive and in-depth this investigation has been along with the where can you get cialis different aspects of accountability and criminality we are dealing with."Walsh said the investigation is ongoing. Click here to sign up for Daily Voice's free daily emails and where can you get cialis news alerts.Claims that booster shots could be required in several months for those receiving the Moderna and Pfizer erectile dysfunction treatment may have been overblown, according to new reports.New findings in a study published this week showed that both erectile dysfunction treatments have shown a “persistent” immune response to the cialis that could potentially last years.The last looming question is how effective the treatments are against variants of the cialis, specifically the more transmissible Delta strain that has become dominant in the US and is present in 49 states."We remain committed to studying emerging variants, generating data, and sharing it as it becomes available,” Moderna CEO Stephane Bancel said in a statement. €œThese new data are encouraging and reinforce our belief that the Moderna erectile dysfunction treatment should remain protective against newly detected variants.”According to the newly released research, months after receiving their first dose of the treatment, test subjects “still had so-called germinal centers” that were “churning out immune cells” directed against erectile dysfunction treatment. €œGerminal centers where can you get cialis are where our immune memories are formed. And the longer we have a germinal center, the stronger and more durable our immunity will be because there’s a fierce selection process happening where can you get cialis there, and only the best immune cells survive,” senior author Ali Ellebedy, an associate professor of pathology and immunology, of medicine and of molecular microbiology at the Washington University School of Medicine in St.

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Four people have been arrested, including two facing manslaughter charges, and two others face arrest warrants in connection with a fatal fire at a Rockland County home for elderly residents.The arrests were announced on Tuesday, June 29 by Rockland County District Attorney Thomas Walsh during a press conference following a three-month investigation into the Tuesday, March 23, fire at Evergreen Court Home for Adults in Spring Valley.The fire, which caused the building to partially collapse, killed Spring Valley Volunteer Firefighter Jared Lloyd as he was rescuing residents and a 79-year-old resident of the home.Spring Valley buy cialis daily online Firefighter Jared LloydSpring Valley Fire Department"Today is the culmination of a multi-agency investigation that left no stone unturned," Walsh said. "I informed the Lloyd family today of the arrests made buy cialis daily online today. While we can't bring Jared back, today is a step buy cialis daily online in the right direction."Those arrested for their actions that allegedly caused the fire include Aaron Sommer and his son, Nathaniel Sommer, who were both charged with:Two counts of manslaughterNine counts of assaultArsonTwo counts of reckless endangermentBoth men were arraigned and are being held at that the Rockland County Jail. Their next court appearance is scheduled for Friday, July 2.Also arrested were Spring Valley building inspectors Wayne Ballard and Raymond Canario who were both charged with filing false reports to the state in connection with fire inspections. They were officially charged with offering a false instrument of filing and falsifying business records.They were processed and released.Walsh said arrest warrants were also issued for Denise Kerr buy cialis daily online of New York City and Manuel Lema of Pomona.Kerr is facing a charge of reckless endangerment, and Lema faces charges of criminal impersonation and obstructing governmental administration.Walsh, who declined to answer any questions regarding the role each of those arrested played in the fire and deaths as to "not taint a grand jury," said his goal was to hold those arrested responsible for the fire and their actions.Rockland County Executive Ed Day said.

"The fact that these arrests came from many different facets of this situation says a lot about how comprehensive and in-depth this investigation has been along with the different aspects of accountability and criminality we are dealing with."Walsh said the buy cialis daily online investigation is ongoing. Click here to sign up for Daily Voice's free daily emails and news alerts.Claims that booster shots could be required in several months for those receiving the Moderna and Pfizer erectile dysfunction treatment may buy cialis daily online have been overblown, according to new reports.New findings in a study published this week showed that both erectile dysfunction treatments have shown a “persistent” immune response to the cialis that could potentially last years.The last looming question is how effective the treatments are against variants of the cialis, specifically the more transmissible Delta strain that has become dominant in the US and is present in 49 states."We remain committed to studying emerging variants, generating data, and sharing it as it becomes available,” Moderna CEO Stephane Bancel said in a statement. €œThese new data are encouraging and reinforce our belief that the Moderna erectile dysfunction treatment should remain protective against newly detected variants.”According to the newly released research, months after receiving their first dose of the treatment, test subjects “still had so-called germinal centers” that were “churning out immune cells” directed against erectile dysfunction treatment. €œGerminal centers are where our immune memories are formed buy cialis daily online. And the longer we have a germinal center, buy cialis daily online the stronger and more durable our immunity will be because there’s a fierce selection process happening there, and only the best immune cells survive,” senior author Ali Ellebedy, an associate professor of pathology and immunology, of medicine and of molecular microbiology at the Washington University School of Medicine in St.

Louis said.“We found that germinal centers were still going strong 15 weeks buy cialis daily online after the treatment’s first dose. We’re still monitoring the germinal centers, and they’re not declining. In some people, they’re buy cialis daily online still ongoing. This is truly remarkable.” Click here to sign up for Daily buy cialis daily online Voice's free daily emails and news alerts.State and county officials were called to a Northern Westchester condominium complex where there was a new report of a bear sighting.Westchester County Police received a call at approximately 10:40 a.m. On Tuesday, June 29, where there was a report of a buy cialis daily online bear near a dumpster in the area of Victoria Drive and the Guard Hill condo complex in Mount Kisco.A County Police spokesperson said that the bear was then spotted scaling a fence and making the rounds through a backyard before heading into a nearby wooded area.There were no reports of any altercations with the bear and any nearby residents.Westchester County Police responded to the scene and notified the New York State Department of Environmental Conservation, which also sent crews to the area to investigate.According to environment officials, residents should not leave garbage cans or any food outside to help avoid an encounter with a bear.

Bears should never be approached, surrounded, or cornered, as bears will “aggressively defend themselves if they feel threatened."“Be especially cautious around cubs, as mother bears are very protected,” officials said. €œNever run buy cialis daily online from a bear. Stay calm, speak in a loud and calm voice, and slowly back away from a safe distance buy cialis daily online. Make loud noises by shouting or banging pots to scare the bear away." Click here to sign up for Daily Voice's free daily emails and news alerts..