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A dormitory-wide quarantine in Marist College's Champagnat buy amoxil Hall, its largest housing unit, has been lifted after students' COVID tests came back negative. The quarantine was put in place after an off-campus student tested positive for the virus, according to a letter that the college sent to students, and that student "came into contact with several Marist students, including residents of Champagnat Hall, at an off-campus party." According to the college's Executive Vice President Geoff Brackett, only test results from students that were quarantined in the dorm have been received. Other students who attended the party whose results have yet to be produced are reportedly quarantining off-campus, and buy amoxil prohibited from college grounds until they complete a 14-day quarantine.According to Julia Fishman, the college's director of media relations, this most recent party was a separate incident from another off-campus party that flouted social distancing guidelines and led to the suspension of 15 students.Marist will now launch a surveillance testing program, according to college Executive Vice President Geoff Brackett, and has "robust testing protocols" in place with MidHudson Regional Hospital for future incidents.

"While our local health officials recognized the College for its 'swift and impressive response' to this incident," wrote Brackett in a letter to students, "it should serve as a reminder to all members of the Marist community that we must uphold our shared responsibility to protect our community by wearing masks, washing hands, and maintaining social distance."Attending parties or large gatherings is prohibited. Individuals who do not follow these guidelines will face disciplinary action." Click here to buy amoxil sign up for Daily Voice's free daily emails and news alerts.A man has been accused of recording his sexual abuse of a child, state police said.On Friday, Aug. 28, State Police from the Poughkeepsie barracks responded to an address in the town of Stanford for a report of sexual assault.

An investigation revealed Santiago A. Andujar, 41, of Stanford, recorded his sexual assault of a child Andujar was familiar with, state police said.Andujar was arrested and charged with:use of a child in a buy amoxil sexual performance, a Class C felony, promoting the sexual performance of a child, a Class D felony, and rape in the third degree, a Class E felony.Andujar was arraigned before the town of Stanford Court and remanded to the Dutchess County Jail without bail. He is next scheduled to appear before the court on Wednesday, Sept.

2. Click here to sign up for Daily Voice's free daily emails and news alerts.New York has suspended liquor licenses for six more businesses after finding what it labeled "egregious violations" of COVID-19 pandemic-related executive orders. Businesses found in violation of COVID-19 regulations face fines up to $10,000 per violation, while egregious violations can result in the immediate suspension of a bar or restaurant's liquor license.

The locations of the six establishments, located on Long Island, in New York City and Central New York, are as follows:Brooklyn, 3Nassau, 1Suffolk, 1Oswego, 1The six bars suspended are listed below, along with information on their violations and the date of their suspensions, provided by the state."Blu Mar" at 136 Main Street in Southampton, on Tuesday, Aug. 25. At approximately 6 p.m.

On Saturday, Aug. 22, investigators with the state's multi-agency task force and officers with the Suffolk County Sheriff's Department observed a line of patrons waiting to enter the establishment while ignoring social distancing and 11 patrons standing and drinking on the patio. Investigators returned one hour later, documenting several patrons standing around the bar.

Multiple patrons and staff were observed throughout the night without facial coverings. That same evening, an 18-year-old underage agent was able to purchase alcohol on two separate occasions without being asked for identification. The business is a repeat offender, with the Suffolk County Sheriff's Department previously finding the restaurant operating as a nightclub on Sunday, Aug.

16, with a DJ, patrons dancing, not wearing facial coverings and ignoring social distancing. And an exotic entertainer dancing on top of the bar, in violation of the establishment's license, which does not permit adult entertainment."Sazon Ramirez II" at 241 Nassau Road in Roosevelt, on Tuesday, Aug. 25.

On Sunday, Aug. 23, investigators with the state's multi-agency task force, the Nassau County Police Department and the Nassau County Fire Marshall conducted a joint investigation, finding the grocery store -- which is not permitted to serve alcohol for on-premises consumption at all -- was operating as a nightclub, with 14 patrons drinking beer inside the premises and six employees and the owner not wearing facial coverings. In the basement, investigators discovered 10 patrons drinking alcohol in a concealed room with a large-screen TV, jukebox and electronic gambling devices.

The grocery store was issued five criminal court summonses by the Nassau County Police Department, four criminal court summonses from the Nassau County Fire Marshall, 20 building code violations, and six fire and life safety violations."House of Yes" at 408 Jefferson Street in Brooklyn, on Thursday, Aug. 27. On Saturday, Aug.

21, investigators with the state's multi-agency task force observed an overcrowded nightclub-like atmosphere directly in front of the premises, with music blasting, and at least 30 patrons consuming alcohol at tables set up less than six feet apart. No food was being served, with the manager admitting the kitchen was non-operational -- a violation of state law since 1964.Investigators also documented an employee without a facial covering and numerous fire and life safety violations."Nancy Restaurant" at 2961 Fulton Street in Brooklyn, on Thursday, Aug. 27.

On Wednesday, Aug. 26, NYPD officers observed approximately 10 patrons inside the premises consuming alcohol, in violation of the indoor dining restrictions that have been in effect since March 16, 2020. Officers report no food was being served, in violation of the food requirement guidelines, and that patrons were consuming liquor, even though the location is only licensed to sell beer and wine."The Ferris Wheel" at 6 Market Street in Oswego, on Friday, Aug.

28. Based on numerous complaints that the bar was overcrowded with no social distancing, SLA Investigators visited the establishment on Thursday, Aug. 27 and observed approximately 15 patrons lined up outside the bar waiting to enter.

The line quickly grew to approximately 25 individuals, several of whom were observed without facial coverings and all ignoring social distancing. Investigators disclosed their identity and entered the premises, discovering between 40 and 50 patrons on the second floor, dancing and consuming alcohol, in complete disregard of the social distancing and face-covering regulations. Investigators also noted that no food was being served during the inspection.

The Ferris Wheel's liquor license had just been issued on July 8, 2020."Lover's Rock" at 419 Tompkins Avenue in Brooklyn, on Friday, Aug. 28. On Thursday, Aug.

27, investigators with the state's multi-agency task force observed four patrons standing directly in front of the premises consuming alcohol and the establishment's outdoor dining area extending in front of a neighboring business. Eight patrons were also observed consuming alcohol in the rear yard without food. The owner admitted to having no food service -- a violation of state law since 1964 -- and investigators determined the business did not have a permit from the New York City Department of Health to serve food.

Investigators also observed an unlicensed security guard without a facial covering."We are seeing better compliance across the state as a direct result of the hard work of the task force and the actions of conscientious business owners that are putting public health and safety first," State Liquor Authority Chair Vincent Bradley said. "But we're still in the middle of a global pandemic, and the task force will continue taking action against the small number of establishments who willfully violate the coronavirus-related regulations." Click here to sign up for Daily Voice's free daily emails and news alerts..

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SALT LAKE cheap amoxil canada CITY, Sept. 8, 2020 /PRNewswire/ -- Health Catalyst, Inc. ("Health Catalyst," Nasdaq cheap amoxil canada. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that it has completed its seventh annual and first ever virtual Healthcare Analytics Summit (HAS), with record registration of more than 3,500 attendees. Keynotes included cheap amoxil canada Dr.

Amy Abernethy, Principal Deputy Commissioner and Acting CIO of the U.S. Food and Drug Administration, Michael Dowling, CEO cheap amoxil canada of Northwell Health, Vice Admiral Raquel Bono, MD, and many others. Other business updates include:The Vitalware, LLC ("VitalWare"), transaction has closed, and integration is underway of the Yakima, Washington-based provider of revenue workflow optimization and analytics SaaS technology solutions for health organizations. This is another example of Health Catalyst's ability to scale software on top of its cloud-based Data Operating System cheap amoxil canada (DOS™). DOS will further enhance the analytics insights made available by Vitalware's technology by combining charge and revenue data with claims, cost, and quality data.

Vitalware's flagship offering is a Best in KLAS chargemaster management solution that delivers results for the complex regulatory and compliance functions needed by all healthcare provider systems. "As announced on August 11, 2020, we entered cheap amoxil canada into an acquisition agreement to acquire Vitalware and expected to close the acquisition in Q3 or Q4 of 2020. We are pleased to announce that we closed the acquisition on September 1, 2020. We are thrilled to formalize the combination of our solutions for the benefit of our customers and the cheap amoxil canada industry," said CEO Dan Burton. On its upcoming Q3 2020 earnings call, Health Catalyst will share the impact of Vitalware on its Q3 2020 financial performance, which will not be significant given the timing of the acquisition, as well as update its full year 2020 guidance to include the impact of Vitalware.

Health Catalyst Co-Founder Steve Barlow has returned from his three-year full-time volunteer mission for the Church of Jesus Christ of Latter-Day Saints, having served as Mission President of the Ecuador Quito cheap amoxil canada Mission. He has rejoined Health Catalyst's companywide Leadership Team as a Senior Vice President, responsible for some of the company's largest customer relationships. Dan cheap amoxil canada Burton said, "We couldn't be more excited about Steve's return to Health Catalyst. His energy, dedication and commitment to transforming healthcare launched our journey and will continue to make us better and stronger. Steve is leading and overseeing all aspects of our partnerships with some of our largest and longest-standing customers.

Steve's extraordinary experience and capability enable him to be a critical partner and leader in enabling these customers' continued improvement and success." "My experience over the past three years cheap amoxil canada in Ecuador reinforced for me how fortunate I am to be in a country with high-quality healthcare," said Barlow. "It has been invigorating to return to Health Catalyst and witness the incredible growth and expansion that has occurred over the past few years. We are better positioned than ever before to achieve our mission of being the catalyst for cheap amoxil canada massive, measurable, data-informed healthcare improvement. I am grateful to be reunited with our longstanding team members and customers, and I'm thrilled to get to know and work alongside our new customers and teammates in this critical work." Effective October 1, 2020, Chief Technology Officer Dale Sanders will be transitioning to a Senior Advisor role with Health Catalyst, and the company is pleased to announce that one of Dale's longtime protégés and colleagues, Bryan Hinton, will serve as Health Catalyst's next Chief Technology Officer. Hinton joined Health Catalyst in 2012 and currently serves as the Senior Vice President and General Manager of the cheap amoxil canada DOS Platform Business.

He will continue to lead this business in addition to assuming the responsibilities of CTO. He has been instrumental in the development and integration of DOS and has been working directly with Dale and other technology leaders at Health Catalyst for cheap amoxil canada many years. His experience prior to joining Health Catalyst includes four years with the .NET Development Center of Excellence at The Church of Jesus Christ of Latter-Day Saints, where he established the architectural guidance of all .NET projects. Previously, at Intel, he was responsible for the development and implementation of Intel's factory data warehouse product installed at Intel global factories. Hinton graduated from cheap amoxil canada Brigham Young University with a BS in Computer Science.

"Dale has been central to Health Catalyst's growth and success and we are grateful to him for his many years of service to our company and to the broader healthcare industry," said Dan Burton, CEO of Health Catalyst. "Thanks to Dale's vision, passion, innovative thinking and broad-based industry cheap amoxil canada experience and perspective, Health Catalyst has grown from a handful of clients to a large number of organizations relying on us as their digital transformation partner, helping the healthcare ecosystem to constantly learn and improve. Dale's technology leadership was critical to the company's overall maturation, and I am convinced that we could not have grown and scaled as we have without Dale's foundational leadership and contributions. We are grateful to continue our association with Dale in the months and years ahead in his next role as a Senior Advisor to the company." Burton added, "We are thrilled to see Bryan Hinton take on this added cheap amoxil canada role after having demonstrated his technology leadership prowess during the course of his tenure at Health Catalyst and having been mentored by Dale for many years. Bryan is well-prepared and ready for this additional responsibility, and we extend our congratulations to him." "I feel like a parent saying goodbye to my kids at their college graduation," said Dale Sanders.

"Many of the cheap amoxil canada concepts we first developed and applied over 20 years ago at Intermountain and then later refined during my tenure as CIO at Northwestern had a big influence on our technology and products at Health Catalyst. The vision of the Data Operating System and its application ecosystem originated in the real-world healthcare operations and research trenches of Northwestern. At Health Catalyst, I had the wonderful opportunity to lead the teams who made that vision a reality for the benefit of the entire industry. None of it would have been possible without Bryan Hinton leading the DOS team and Eric Just and Dan Unger leading the application development teams cheap amoxil canada. We've been working side-by-side for many years to make the vision real.

Bryan is the consummate modern CTO from outside of healthcare that healthcare needs cheap amoxil canada. I've always described Eric as having a manufacturing engineer's mindset with a healthcare data and software engineer's skills, with Dan Unger leveraging his deep domain expertise in financial transformation to oversee the development of meaningful applications and solutions so relevant for CFOs. I'm honored and thrilled to step aside and turn the future over cheap amoxil canada to their very capable hands. Under their leadership, the best is yet to come for Health Catalyst's technology." About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations, and is committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions cheap amoxil canada of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial and operational improvements.

Health Catalyst envisions a future in which all healthcare decisions are data informed.Health Catalyst Media Contact:Kristen BerrySenior Vice President, Public Relations+1 (617) 234-4123HealthCatalyst@we-worldwide.com View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-completes-hosting-of-the-largest-ever-healthcare-analytics-summit-and-announces-the-close-of-the-vitalware-acquisition-301125125.htmlSOURCE Health CatalystNEW YORK and SALT LAKE CITY, Aug. 12, 2020 /PRNewswire/ -- Northwell Health today joined Health Catalyst, Inc. ("Health Catalyst," cheap amoxil canada Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, in announcing a long-term strategic partnership to transform the quality of patient care by using data and analytics to better anticipate and respond to the evolving needs of patients, providers and payers in today's rapidly evolving healthcare ecosystem. In this partnership, Health Catalyst will provide solutions to allow for increased cloud-based reliance on data and analytics, while sharing insights and best practices from a decade cheap amoxil canada of support to hundreds of other healthcare clients.

This will accelerate greater efficiency in data mapping and data storage to/with the Electronic Medical Record (EMR) and the affordable emergence of an enterprise solution for meaningful and measurable clinical, financial and operational improvements. The solutions will be used across the Northwell Health enterprise, which includes the Feinstein Institute and Donald and Barbara Zucker School of Medicine cheap amoxil canada at Hofstra. "Northwell Health's goal is a simple one that has not changed since our inception. Be better tomorrow cheap amoxil canada than we are today. Partnering with Health Catalyst will allow us to accelerate the generation of critical insights for one of the world's most diverse patient populations which includes more than 11 million individuals who will potentially turn to us for care," said Michael Dowling, President and CEO of Northwell Health.

"Health Catalyst's Augmented Intelligence (AI) and data science experience and expertise, along with our shared cultural attributes and mission alignment, will allow us to use data-informed decision making to achieve our shared commitment of transforming healthcare for the communities we serve."Northwell Health is New York State's largest health care provider and private employer, with 23 hospitals, nearly 800 outpatient facilities and more than 18,500 affiliated physicians. More than 11,000 COVID-19 patients have received care from Northwell's 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners, and using 1,600 additional COVID-19 focused beds."We are honored to have the opportunity to join Northwell Health on its mission-driven journey to transform healthcare," said cheap amoxil canada Dan Burton, CEO of Health Catalyst. "We have deep respect for our Northwell colleagues and are excited about combining our Solution with Northwell's team members' experience, knowledge and passion for improvement. We are also honored to have Northwell's CEO Michael Dowling as a keynote cheap amoxil canada speaker at Health Catalyst's upcoming Healthcare Analytics Summit (HAS), where we'll hear his important perspectives on the COVID-19 pandemic and the future of healthcare delivery." This partnership will be built using Health Catalyst's DOS™ technology, a data-first analytics and application platform, to capture and map raw data into meaningful, actionable insights. Northwell Health will also immediately have access to Health Catalyst's growing suite of COVID-19 solutions, including but not limited to a registry, staff and patient tracker and capacity planning tool.

Broadly sharing Northwell Health's data driven insights from its COVID-19 work is another significant opportunity for transformational care."Health Catalyst will become our data and analytics backbone, cheap amoxil canada as their Solutions will enable our organization to take our current data adoption and transformation to entirely new heights," said John Bosco, Senior Vice President and Chief Information Officer at Northwell Health. "We are looking forward to leaning on DOS to create an affordable, yet innovative enterprise solution that will further enable transformative care to the patients we serve."About Northwell HealthNorthwell Health is New York State's largest health care provider and private employer, with 23 hospitals, 665 outpatient facilities and more than 18,500 affiliated physicians. We care for over two million cheap amoxil canada people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 66,000 employees – 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We are making breakthroughs in medicine at the Feinstein Institute for Medical Research cheap amoxil canada.

We are training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. For information on our more than 100 medical specialties, visit Northwell.edu.About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations, and is committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 cheap amoxil canada million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed. Northwell Health Media Contact:Michelle Pinto516-321-6708mpinto@northwell.edu Health Catalyst Media Contact:Kristen BerrySenior Vice President, Public Relations+1 (617) 234-4123+1 (774) 573-0455 (m)kberry@we-worldwide.com View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-and-northwell-health-partner-to-transform-patient-care-with-cloud-based-data-and-analytics-enterprise-solution-301110803.htmlSOURCE Health CatalystPeople tried to escape a heat wave baking the West by heading to Castaic Lake in California on Saturday.Credit...Marcio Jose Sanchez/Associated PressFor many Americans, Labor Day is a goodbye to summer cheap amoxil canada before children go back to school and cold weather arrives.

But public health experts are worried that in the midst of a pandemic, the traditional last blast of summer could translate into disaster this fall.After the Memorial Day and Fourth of July weekends, cases of Covid-19 surged around the country after people held family gatherings or congregated in large groups. Dr. Anthony S. Fauci, the country’s top infectious disease expert, said he wanted people to enjoy Labor Day weekend but urged them to take precautions to avoid a post-holiday spike in cases. Take the fun outdoors.

Avoid crowds, keep gatherings to 10 people or fewer. And even outdoors, where transmission risk is much lower, you still need to wear a mask and practice physical distancing if you’re spending time with people outside your household.“We’ve been through this before,” Dr. Fauci said. €œWe see what happens over holiday weekends, and we want to make sure we don’t have an uptick. What I have been saying is kind of a plea to the American public, and to the younger people, that they can enjoy themselves over Labor Day weekend, but please be aware of and adhere to public health guidelines.”In terms of daily case counts, the United States over all was in worse shape going into Labor Day weekend than it was for Memorial Day weekend.

The nation is now averaging about 40,000 new confirmed cases per day, up from about 22,000 per day ahead of Memorial Day weekend. Dr. Fauci said that the number of daily cases in the United States was “unacceptably high” and that a spike in Covid-19 infections following Labor Day would make it far tougher to control the spread of the disease in the fall as people head indoors.“We’d like to get a good head start into the fall by getting our daily cases and our test positivity as low as possible,” Dr. Fauci said. €œIf we get another resurgence of infections after Labor Day, it will make it that much more difficult to get that baseline down and make it much more problematic as we enter the fall season.”Public health experts said it might be even more challenging to persuade people to curtail their Labor Day weekend plans, compared with past holiday weekends, because so many people are suffering from pandemic fatigue after six months of social-distancing restrictions, closures and separation from loved ones.“People are getting tired of taking these precautions and of having their lives upended,” said Eleanor J.

Murray, an assistant professor of epidemiology at the Boston University School of Public Health. €œThey’re missing their friends and family, and everyone wishes things were back to normal. That’s totally understandable, but unfortunately we don’t get a say, really.”Dr. Murray said it was important for people to remember that just one gathering could lead to spikes in cases that would affect many more people. She noted that a wedding in Maine with an estimated 65 guests had resulted in 147 infections, including three deaths among people who didn’t even attend the wedding.Dr.

Murray said that if people decided to ignore public health guidelines this weekend, at the very least they should place themselves in quarantine for two weeks after the event. €œIf those people at the wedding had said, ‘This is a risk I’m personally willing to take,’ but after the wedding they had quarantined, then the maximum number of cases would have been the 65 wedding attendees,” she said.Although it’s safer to gather outside than indoors, the virus can still be transmitted in outdoor spaces when people gather in large groups or stand close to one another for long periods of time. Alcohol can loosen inhibitions, prompting people to forget about social distancing. Loud music can prompt people to stand closer and speak louder, which can spew more viral particles and put you at risk even if you’re wearing a mask, health experts say.Dr. Murray said that whatever plan you have for the holiday weekend, ask yourself how you can make it safer for everyone.“People need to socialize and to see people who are important to them,” Dr.

Murray said. €œIf you were thinking of being indoors, go outdoors. If you were thinking about being outdoors, spread out further. Wear masks. Think about what you can do to move down the risk continuum.”While many people feel safer socializing with family members, a number of outbreaks have been traced back to family parties that included relatives from more than one household.

In Maryland, 44 percent of the state’s new cases were traced back to family gatherings, compared with 23 percent from house parties and 21 percent to outdoor events, according to a tweet posted by Gov. Larry Hogan.After a family gathering of two dozen people in Catawba County, N.C., 14 people who attended became ill, but it didn’t end there. €œBefore they started to show symptoms, they continued with their daily lives, such as going to work or taking a beach trip with other families,” Jennifer McCracken, Catawba County’s public health director, wrote in a case study of the event. €œThis set into motion a person-to-person contact chain that to date has spread COVID-19 to 41 people in nine different families and eight different workplaces.”Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said the holiday weekend would multiply the number of family gatherings around the country.“A family gathering one weekend in August that sets off cases in a given county or town is one thing,” Dr. Gonsalves said.

€œOne hundred family gatherings in that county on Labor Day weekend makes it a much larger epidemiological impact.”Dr. Gonsalves said concerns about Labor Day celebrations were being compounded by the fact that there are already large outbreaks on college campuses. €œWe’ve had this gigantic migration event over the past few weeks where students are moving all over the country from homes to universities,” Dr. Gonsalves said. €œThe relative calm of places like New York and Connecticut has to be now thought of in the context of all this big jumble of people crisscrossing the country to get back to college.”ABC News posted a video on Twitter showing crowds of people gathering at a sports bar near the University of South Carolina.

The university has reported more than 1,735 cases since Aug. 1, including 1,461 active cases, according to its Covid-19 dashboard.Brian Pace, a 35-year old psychologist in Phoenix, said he and his friends in Salt Lake City had talked about getting together for a socially distanced outdoor barbecue this weekend. He decided it was smarter to stay home, so he will get takeout from a local barbecue restaurant, JL Smokehouse, instead.“I debated with friends,” Mr. Pace said. €œBut in the end, my decision boiled down to.

Will I look back five years from now and say, ‘That was pretty stupid,’ or regret that I didn’t do it?. It probably would be that it was stupid to do that, so we’re pretty much hunkered down here. When I go out, I wear a mask, and it’s takeout only.”Dr. Fauci said he didn’t want his words of caution about Labor Day celebrations to stop people from enjoying the holiday. He said he personally planned to spend the weekend with his wife, fishing in the Potomac and having dinner with two friends, for a total of four people, on his backyard deck.“You don’t want to tell people on a holiday weekend that even outdoors is bad — they will get completely discouraged,” Dr.

Fauci said. €œWhat we try to say is enjoy outdoors, but you can do it with safe spacing. You can be on a beach, and you don’t have to be falling all over each other. You can be six, seven, eight, nine or 10 feet apart. You can go on a hike.

You can go on a run. You can go on a picnic with a few people. You don’t have to be in a crowd with 30, 40 or 50 people all breathing on each other.”The medical mistakes that befell the 87-year-old mother of a North Carolina pharmacist should not happen to anyone, and my hope is that this column will keep you and your loved ones from experiencing similar, all-too-common mishaps.As the pharmacist, Kim H. DeRhodes of Charlotte, N.C., recalled, it all began when her mother went to the emergency room two weeks after a fall because she had lingering pain in her back and buttocks. Told she had sciatica, the elderly woman was prescribed prednisone and a muscle relaxant.

Three days later, she became delirious, returned to the E.R., was admitted to the hospital, and was discharged two days later when her drug-induced delirium resolved.A few weeks later, stomach pain prompted a third trip to the E.R. And a prescription for an antibiotic and proton-pump inhibitor. Within a month, she developed severe diarrhea lasting several days. Back to the E.R., and this time she was given a prescription for dicyclomine to relieve intestinal spasms, which triggered another bout of delirium and three more days in the hospital. She was discharged after lab tests and imaging studies revealed nothing abnormal.“Review of my mother’s case highlights separate but associated problems.

Likely misdiagnosis and inappropriate prescribing of medications,” Ms. DeRhodes wrote in JAMA Internal Medicine. €œDiagnostic errors led to the use of prescription drugs that were not indicated and caused my mother further harm. The muscle relaxer and prednisone led to her first incidence of delirium. Prednisone likely led to the gastrointestinal issues, and the antibiotic likely led to the diarrhea, which led to the prescribing of dicyclomine, which led to the second incidence of delirium.”The doctors who wrote the woman’s prescriptions apparently never consulted the Beers Criteria, a list created by the American Geriatrics Society of drugs often unsafe for the elderly.In short, Ms.

DeRhodes’s mother was a victim of two medical problems that are too often overlooked by examining doctors and unrecognized by families. The first is giving an 87-year-old medications known to be unsafe for the elderly. The second is a costly and often frightening medically induced condition called “a prescribing cascade” that starts with drug-induced side effects which are then viewed as a new ailment and treated with yet another drug or drugs that can cause still other side effects.I’d like to think that none of this would have happened if instead of going to the E.R. The older woman had seen her primary care doctor. But experts told me that no matter where patients are treated, they are not immune to getting caught in a prescribing cascade.

The problem also can happen to people who self-treat with over-the-counter or herbal remedies. Nor is it limited to the elderly. Young people can also become victims of a prescribing cascade, Ms. DeRhodes said.“Doctors are often taught to think of everything as a new problem,” Dr. Timothy Anderson, internist at Beth Israel Deaconess Medical Center in Boston, said.

€œThey have to start thinking about whether the patient is on medication and whether the medication is the problem.”“Doctors are very good at prescribing but not so good at deprescribing,” Ms. DeRhodes said. €œAnd a lot of times patients are given a prescription without first trying something else.”A popular treatment for high blood pressure, which afflicts a huge proportion of older people, is a common precipitant of the prescribing cascade, Dr. Anderson said.He cited a Canadian study of 41,000 older adults with hypertension who were prescribed drugs called calcium channel blockers. Within a year after treatment began, nearly one person in 10 was given a diuretic to treat leg swelling caused by the first drug.

Many were inappropriately prescribed a so-called loop diuretic that Dr. Anderson said can result in dehydration, kidney problems, lightheadedness and falls.Type 2 diabetes is another common condition in which medications are often improperly prescribed to treat drug-induced side effects, said Lisa M. McCarthy, doctor of pharmacy at the University of Toronto who directed the Canadian study. Recognizing a side effect for what it is can be hampered when the effect doesn’t happen for weeks or even months after a drug is started. While patients taking opioids for pain may readily recognize constipation as a consequence, Dr.

McCarthy said that over time, patients taking metformin for diabetes can develop diarrhea and may self-treat with Lomotil, which in turn can cause dizziness and confusion.Dr. Paula Rochon, geriatrician at Women’s College Hospital in Ontario, said patients taking a drug called a cholinesterase inhibitor to treat early dementia can develop urinary incontinence, which is then treated with another drug that can worsen the patient’s confusion.Complicating matters is the large number of drugs some people take. €œOlder adults frequently take many medications, with two-fifths taking five or more,” Dr. Anderson wrote in JAMA Internal Medicine. In cases of polypharmacy, as this is called, it can be hard to determine which, if any, of the drugs a person is taking is the cause of the current symptom.Dr.

Rochon emphasized that a prescribing cascade can happen to anybody. She said, “Everyone needs to consider the possibility every time a drug is prescribed.”Before accepting a prescription, she recommended that patients or their caregivers should ask the doctor a series of questions, starting with “Am I experiencing a symptom that could be a side effect of a drug I’m taking?. € Follow-up questions should include:Is this new drug being used to treat a side effect?. Is there a safer drug available than the one I’m taking?. Could I take a lower dose of the prescribed drug?.

Most important, Dr. Rochon said, patients should ask “Do I need to take this drug at all?. €Patients and doctors alike often overlook or resist alternatives to medication that may be more challenging to adopt than swallowing a pill. For example, among well-established nondrug remedies for hypertension are weight loss, increasing physical activity, consuming less salt and other sources of sodium, and eating more potassium-rich foods like bananas and cantaloupe.For some patients, frequent use of a nonsteroidal anti-inflammatory drug sold over-the-counter, like ibuprofen or naproxen, is responsible for their elevated blood pressure.The risk of getting caught in a prescribing cascade is increased when patients are prescribed medications by more than one provider. It’s up to patients to be sure every doctor they consult is given an up-to-date list of every drug they take, whether prescription or over-the-counter, as well as nondrug remedies and dietary supplements.

Dr. Rochon recommended that patients maintain an up-to-date list of when and why they started every new drug, along with its dose and frequency, and show that list to the doctor as well..

SALT LAKE buy amoxil how can i buy amoxil CITY, Sept. 8, 2020 /PRNewswire/ -- Health Catalyst, Inc. ("Health Catalyst," Nasdaq buy amoxil.

HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today announced that it has completed its seventh annual and first ever virtual Healthcare Analytics Summit (HAS), with record registration of more than 3,500 attendees. Keynotes included buy amoxil Dr. Amy Abernethy, Principal Deputy Commissioner and Acting CIO of the U.S.

Food and Drug Administration, Michael Dowling, CEO of Northwell Health, Vice Admiral buy amoxil Raquel Bono, MD, and many others. Other business updates include:The Vitalware, LLC ("VitalWare"), transaction has closed, and integration is underway of the Yakima, Washington-based provider of revenue workflow optimization and analytics SaaS technology solutions for health organizations. This is buy amoxil another example of Health Catalyst's ability to scale software on top of its cloud-based Data Operating System (DOS™).

DOS will further enhance the analytics insights made available by Vitalware's technology by combining charge and revenue data with claims, cost, and quality data. Vitalware's flagship offering is a Best in KLAS chargemaster management solution that delivers results for the complex regulatory and compliance functions needed by all healthcare provider systems. "As announced on August 11, 2020, we entered into an acquisition agreement to acquire Vitalware and expected to close the buy amoxil acquisition in Q3 or Q4 of 2020.

We are pleased to announce that we closed the acquisition on September 1, 2020. We are thrilled to formalize the combination of our solutions buy amoxil for the benefit of our customers and the industry," said CEO Dan Burton. On its upcoming Q3 2020 earnings call, Health Catalyst will share the impact of Vitalware on its Q3 2020 financial performance, which will not be significant given the timing of the acquisition, as well as update its full year 2020 guidance to include the impact of Vitalware.

Health Catalyst Co-Founder Steve Barlow has returned from his three-year full-time volunteer mission for the Church of Jesus Christ of Latter-Day Saints, having served as Mission buy amoxil President of the Ecuador Quito Mission. He has rejoined Health Catalyst's companywide Leadership Team as a Senior Vice President, responsible for some of the company's largest customer relationships. Dan Burton said, "We couldn't be more excited about buy amoxil Steve's return to Health Catalyst.

His energy, dedication and commitment to transforming healthcare launched our journey and will continue to make us better and stronger. Steve is leading and overseeing all aspects of our partnerships with some of our largest and longest-standing customers. Steve's extraordinary experience and capability enable him to be a critical buy amoxil partner and leader in enabling these customers' continued improvement and success." "My experience over the past three years in Ecuador reinforced for me how fortunate I am to be in a country with high-quality healthcare," said Barlow.

"It has been invigorating to return to Health Catalyst and witness the incredible growth and expansion that has occurred over the past few years. We are better positioned than ever before to buy amoxil achieve our mission of being the catalyst for massive, measurable, data-informed healthcare improvement. I am grateful to be reunited with our longstanding team members and customers, and I'm thrilled to get to know and work alongside our new customers and teammates in this critical work." Effective October 1, 2020, Chief Technology Officer Dale Sanders will be transitioning to a Senior Advisor role with Health Catalyst, and the company is pleased to announce that one of Dale's longtime protégés and colleagues, Bryan Hinton, will serve as Health Catalyst's next Chief Technology Officer.

Hinton joined Health Catalyst in 2012 and currently serves as the Senior Vice President and General buy amoxil Manager of the DOS Platform Business. He will continue to lead this business in addition to assuming the responsibilities of CTO. He has buy amoxil been instrumental in the development and integration of DOS and has been working directly with Dale and other technology leaders at Health Catalyst for many years.

His experience prior to joining Health Catalyst includes four years with the .NET Development Center of Excellence at The Church of Jesus Christ of Latter-Day Saints, where he established the architectural guidance of all .NET projects. Previously, at Intel, he was responsible for the development and implementation of Intel's factory data warehouse product installed at Intel global factories. Hinton graduated from buy amoxil Brigham Young University with a BS in Computer Science.

"Dale has been central to Health Catalyst's growth and success and we are grateful to him for his many years of service to our company and to the broader healthcare industry," said Dan Burton, CEO of Health Catalyst. "Thanks to Dale's vision, passion, innovative thinking and broad-based buy amoxil industry experience and perspective, Health Catalyst has grown from a handful of clients to a large number of organizations relying on us as their digital transformation partner, helping the healthcare ecosystem to constantly learn and improve. Dale's technology leadership was critical to the company's overall maturation, and I am convinced that we could not have grown and scaled as we have without Dale's foundational leadership and contributions.

We are grateful to continue our association with Dale in the months and years ahead in his next role as a Senior Advisor to the company." Burton added, "We are thrilled to see Bryan Hinton take on this added role after having demonstrated his technology leadership prowess buy amoxil during the course of his tenure at Health Catalyst and having been mentored by Dale for many years. Bryan is well-prepared and ready for this additional responsibility, and we extend our congratulations to him." "I feel like a parent saying goodbye to my kids at their college graduation," said Dale Sanders. "Many of the concepts we first developed and applied over 20 years ago at Intermountain and then later refined during my tenure as CIO at Northwestern buy amoxil had a big influence on our technology and products at Health Catalyst.

The vision of the Data Operating System and its application ecosystem originated in the real-world healthcare operations and research trenches of Northwestern. At Health Catalyst, I had the wonderful opportunity to lead the teams who made that vision a reality for the benefit of the entire industry. None of it would have been possible without Bryan Hinton leading the DOS team and Eric Just and Dan Unger buy amoxil leading the application development teams.

We've been working side-by-side for many years to make the vision real. Bryan is the consummate modern CTO from buy amoxil outside of healthcare that healthcare needs. I've always described Eric as having a manufacturing engineer's mindset with a healthcare data and software engineer's skills, with Dan Unger leveraging his deep domain expertise in financial transformation to oversee the development of meaningful applications and solutions so relevant for CFOs.

I'm honored and thrilled to step aside and turn the future over to their very capable hands buy amoxil. Under their leadership, the best is yet to come for Health Catalyst's technology." About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations, and is committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers buy amoxil leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial and operational improvements.

Health Catalyst envisions a future in which all healthcare decisions are data informed.Health Catalyst Media Contact:Kristen BerrySenior Vice President, Public Relations+1 (617) 234-4123HealthCatalyst@we-worldwide.com View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-completes-hosting-of-the-largest-ever-healthcare-analytics-summit-and-announces-the-close-of-the-vitalware-acquisition-301125125.htmlSOURCE Health CatalystNEW YORK and SALT LAKE CITY, Aug. 12, 2020 /PRNewswire/ -- Northwell Health today joined Health Catalyst, Inc. ("Health Catalyst," Nasdaq buy amoxil.

HCAT), a leading provider of data and analytics technology and services to healthcare organizations, in announcing a long-term strategic partnership to transform the quality of patient care by using data and analytics to better anticipate and respond to the evolving needs of patients, providers and payers in today's rapidly evolving healthcare ecosystem. In this partnership, Health Catalyst will provide solutions to allow for increased cloud-based reliance on data and analytics, buy amoxil while sharing insights and best practices from a decade of support to hundreds of other healthcare clients. This will accelerate greater efficiency in data mapping and data storage to/with the Electronic Medical Record (EMR) and the affordable emergence of an enterprise solution for meaningful and measurable clinical, financial and operational improvements.

The solutions will be used across the Northwell Health enterprise, which includes buy amoxil the Feinstein Institute and Donald and Barbara Zucker School of Medicine at Hofstra. "Northwell Health's goal is a simple one that has not changed since our inception. Be better buy amoxil tomorrow than we are today.

Partnering with Health Catalyst will allow us to accelerate the generation of critical insights for one of the world's most diverse patient populations which includes more than 11 million individuals who will potentially turn to us for care," said Michael Dowling, President and CEO of Northwell Health. "Health Catalyst's Augmented Intelligence (AI) and data science experience and expertise, along with our shared cultural attributes and mission alignment, will allow us to use data-informed decision making to achieve our shared commitment of transforming healthcare for the communities we serve."Northwell Health is New York State's largest health care provider and private employer, with 23 hospitals, nearly 800 outpatient facilities and more than 18,500 affiliated physicians. More than 11,000 COVID-19 patients have received buy amoxil care from Northwell's 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners, and using 1,600 additional COVID-19 focused beds."We are honored to have the opportunity to join Northwell Health on its mission-driven journey to transform healthcare," said Dan Burton, CEO of Health Catalyst.

"We have deep respect for our Northwell colleagues and are excited about combining our Solution with Northwell's team members' experience, knowledge and passion for improvement. We are also honored to have Northwell's CEO Michael Dowling as a keynote speaker at Health Catalyst's upcoming Healthcare Analytics Summit (HAS), buy amoxil where we'll hear his important perspectives on the COVID-19 pandemic and the future of healthcare delivery." This partnership will be built using Health Catalyst's DOS™ technology, a data-first analytics and application platform, to capture and map raw data into meaningful, actionable insights. Northwell Health will also immediately have access to Health Catalyst's growing suite of COVID-19 solutions, including but not limited to a registry, staff and patient tracker and capacity planning tool.

Broadly sharing Northwell Health's data driven insights from its COVID-19 work is another significant opportunity for transformational care."Health Catalyst will become our data and analytics backbone, as their Solutions will buy amoxil enable our organization to take our current data adoption and transformation to entirely new heights," said John Bosco, Senior Vice President and Chief Information Officer at Northwell Health. "We are looking forward to leaning on DOS to create an affordable, yet innovative enterprise solution that will further enable transformative care to the patients we serve."About Northwell HealthNorthwell Health is New York State's largest health care provider and private employer, with 23 hospitals, 665 outpatient facilities and more than 18,500 affiliated physicians. We care for over two million people annually in the New York metro area and beyond, thanks to buy amoxil philanthropic support from our communities.

Our 66,000 employees – 16,000-plus nurses and 4,000 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We are making breakthroughs in medicine buy amoxil at the Feinstein Institute for Medical Research. We are training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies.

For information on our more than 100 medical specialties, visit Northwell.edu.About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations, and is committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial and operational buy amoxil improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed.

Northwell Health Media Contact:Michelle Pinto516-321-6708mpinto@northwell.edu Health Catalyst Media Contact:Kristen BerrySenior Vice President, Public Relations+1 (617) 234-4123+1 (774) 573-0455 (m)kberry@we-worldwide.com View original content to download multimedia:http://www.prnewswire.com/news-releases/health-catalyst-and-northwell-health-partner-to-transform-patient-care-with-cloud-based-data-and-analytics-enterprise-solution-301110803.htmlSOURCE Health CatalystPeople tried to escape a heat wave baking the West by heading to Castaic Lake in California on Saturday.Credit...Marcio Jose Sanchez/Associated PressFor many Americans, Labor Day buy amoxil is a goodbye to summer before children go back to school and cold weather arrives. But public health experts are worried that in the midst of a pandemic, the traditional last blast of summer could translate into disaster this fall.After the Memorial Day and Fourth of July weekends, cases of Covid-19 surged around the country after people held family gatherings or congregated in large groups. Dr.

Anthony S. Fauci, the country’s top infectious disease expert, said he wanted people to enjoy Labor Day weekend but urged them to take precautions to avoid a post-holiday spike in cases. Take the fun outdoors.

Avoid crowds, keep gatherings to 10 people or fewer. And even outdoors, where transmission risk is much lower, you still need to wear a mask and practice physical distancing if you’re spending time with people outside your household.“We’ve been through this before,” Dr. Fauci said.

€œWe see what happens over holiday weekends, and we want to make sure we don’t have an uptick. What I have been saying is kind of a plea to the American public, and to the younger people, that they can enjoy themselves over Labor Day weekend, but please be aware of and adhere to public health guidelines.”In terms of daily case counts, the United States over all was in worse shape going into Labor Day weekend than it was for Memorial Day weekend. The nation is now averaging about 40,000 new confirmed cases per day, up from about 22,000 per day ahead of Memorial Day weekend.

Dr. Fauci said that the number of daily cases in the United States was “unacceptably high” and that a spike in Covid-19 infections following Labor Day would make it far tougher to control the spread of the disease in the fall as people head indoors.“We’d like to get a good head start into the fall by getting our daily cases and our test positivity as low as possible,” Dr. Fauci said.

€œIf we get another resurgence of infections after Labor Day, it will make it that much more difficult to get that baseline down and make it much more problematic as we enter the fall season.”Public health experts said it might be even more challenging to persuade people to curtail their Labor Day weekend plans, compared with past holiday weekends, because so many people are suffering from pandemic fatigue after six months of social-distancing restrictions, closures and separation from loved ones.“People are getting tired of taking these precautions and of having their lives upended,” said Eleanor J. Murray, an assistant professor of epidemiology at the Boston University School of Public Health. €œThey’re missing their friends and family, and everyone wishes things were back to normal.

That’s totally understandable, but unfortunately we don’t get a say, really.”Dr. Murray said it was important for people to remember that just one gathering could lead to spikes in cases that would affect many more people. She noted that a wedding in Maine with an estimated 65 guests had resulted in 147 infections, including three deaths among people who didn’t even attend the wedding.Dr.

Murray said that if people decided to ignore public health guidelines this weekend, at the very least they should place themselves in quarantine for two weeks after the event. €œIf those people at the wedding had said, ‘This is a risk I’m personally willing to take,’ but after the wedding they had quarantined, then the maximum number of cases would have been the 65 wedding attendees,” she said.Although it’s safer to gather outside than indoors, the virus can still be transmitted in outdoor spaces when people gather in large groups or stand close to one another for long periods of time. Alcohol can loosen inhibitions, prompting people to forget about social distancing.

Loud music can prompt people to stand closer and speak louder, which can spew more viral particles and put you at risk even if you’re wearing a mask, health experts say.Dr. Murray said that whatever plan you have for the holiday weekend, ask yourself how you can make it safer for everyone.“People need to socialize and to see people who are important to them,” Dr. Murray said.

€œIf you were thinking of being indoors, go outdoors. If you were thinking about being outdoors, spread out further. Wear masks.

Think about what you can do to move down the risk continuum.”While many people feel safer socializing with family members, a number of outbreaks have been traced back to family parties that included relatives from more than one household. In Maryland, 44 percent of the state’s new cases were traced back to family gatherings, compared with 23 percent from house parties and 21 percent to outdoor events, according to a tweet posted by Gov. Larry Hogan.After a family gathering of two dozen people in Catawba County, N.C., 14 people who attended became ill, but it didn’t end there.

€œBefore they started to show symptoms, they continued with their daily lives, such as going to work or taking a beach trip with other families,” Jennifer McCracken, Catawba County’s public health director, wrote in a case study of the event. €œThis set into motion a person-to-person contact chain that to date has spread COVID-19 to 41 people in nine different families and eight different workplaces.”Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health, said the holiday weekend would multiply the number of family gatherings around the country.“A family gathering one weekend in August that sets off cases in a given county or town is one thing,” Dr. Gonsalves said.

€œOne hundred family gatherings in that county on Labor Day weekend makes it a much larger epidemiological impact.”Dr. Gonsalves said concerns about Labor Day celebrations were being compounded by the fact that there are already large outbreaks on college campuses. €œWe’ve had this gigantic migration event over the past few weeks where students are moving all over the country from homes to universities,” Dr.

Gonsalves said. €œThe relative calm of places like New York and Connecticut has to be now thought of in the context of all this big jumble of people crisscrossing the country to get back to college.”ABC News posted a video on Twitter showing crowds of people gathering at a sports bar near the University of South Carolina. The university has reported more than 1,735 cases since Aug.

1, including 1,461 active cases, according to its Covid-19 dashboard.Brian Pace, a 35-year old psychologist in Phoenix, said he and his friends in Salt Lake City had talked about getting together for a socially distanced outdoor barbecue this weekend. He decided it was smarter to stay home, so he will get takeout from a local barbecue restaurant, JL Smokehouse, instead.“I debated with friends,” Mr. Pace said.

€œBut in the end, my decision boiled down to. Will I look back five years from now and say, ‘That was pretty stupid,’ or regret that I didn’t do it?. It probably would be that it was stupid to do that, so we’re pretty much hunkered down here.

When I go out, I wear a mask, and it’s takeout only.”Dr. Fauci said he didn’t want his words of caution about Labor Day celebrations to stop people from enjoying the holiday. He said he personally planned to spend the weekend with his wife, fishing in the Potomac and having dinner with two friends, for a total of four people, on his backyard deck.“You don’t want to tell people on a holiday weekend that even outdoors is bad — they will get completely discouraged,” Dr.

Fauci said. €œWhat we try to say is enjoy outdoors, but you can do it with safe spacing. You can be on a beach, and you don’t have to be falling all over each other.

You can be six, seven, eight, nine or 10 feet apart. You can go on a hike. You can go on a run.

You can go on a picnic with a few people. You don’t have to be in a crowd with 30, 40 or 50 people all breathing on each other.”The medical mistakes that befell the 87-year-old mother of a North Carolina pharmacist should not happen to anyone, and my hope is that this column will keep you and your loved ones from experiencing similar, all-too-common mishaps.As the pharmacist, Kim H. DeRhodes of Charlotte, N.C., recalled, it all began when her mother went to the emergency room two weeks after a fall because she had lingering pain in her back and buttocks.

Told she had sciatica, the elderly woman was prescribed prednisone and a muscle relaxant. Three days later, she became delirious, returned to the E.R., was admitted to the hospital, and was discharged two days later when her drug-induced delirium resolved.A few weeks later, stomach pain prompted a third trip to the E.R. And a prescription for an antibiotic and proton-pump inhibitor.

Within a month, she developed severe diarrhea lasting several days. Back to the E.R., and this time she was given a prescription for dicyclomine to relieve intestinal spasms, which triggered another bout of delirium and three more days in the hospital. She was discharged after lab tests and imaging studies revealed nothing abnormal.“Review of my mother’s case highlights separate but associated problems.

Likely misdiagnosis and inappropriate prescribing of medications,” Ms. DeRhodes wrote in JAMA Internal Medicine. €œDiagnostic errors led to the use of prescription drugs that were not indicated and caused my mother further harm.

The muscle relaxer and prednisone led to her first incidence of delirium. Prednisone likely led to the gastrointestinal issues, and the antibiotic likely led to the diarrhea, which led to the prescribing of dicyclomine, which led to the second incidence of delirium.”The doctors who wrote the woman’s prescriptions apparently never consulted the Beers Criteria, a list created by the American Geriatrics Society of drugs often unsafe for the elderly.In short, Ms. DeRhodes’s mother was a victim of two medical problems that are too often overlooked by examining doctors and unrecognized by families.

The first is giving an 87-year-old medications known to be unsafe for the elderly. The second is a costly and often frightening medically induced condition called “a prescribing cascade” that starts with drug-induced side effects which are then viewed as a new ailment and treated with yet another drug or drugs that can cause still other side effects.I’d like to think that none of this would have happened if instead of going to the E.R. The older woman had seen her primary care doctor.

But experts told me that no matter where patients are treated, they are not immune to getting caught in a prescribing cascade. The problem also can happen to people who self-treat with over-the-counter or herbal remedies. Nor is it limited to the elderly.

Young people can also become victims of a prescribing cascade, Ms. DeRhodes said.“Doctors are often taught to think of everything as a new problem,” Dr. Timothy Anderson, internist at Beth Israel Deaconess Medical Center in Boston, said.

€œThey have to start thinking about whether the patient is on medication and whether the medication is the problem.”“Doctors are very good at prescribing but not so good at deprescribing,” Ms. DeRhodes said. €œAnd a lot of times patients are given a prescription without first trying something else.”A popular treatment for high blood pressure, which afflicts a huge proportion of older people, is a common precipitant of the prescribing cascade, Dr.

Anderson said.He cited a Canadian study of 41,000 older adults with hypertension who were prescribed drugs called calcium channel blockers. Within a year after treatment began, nearly one person in 10 was given a diuretic to treat leg swelling caused by the first drug. Many were inappropriately prescribed a so-called loop diuretic that Dr.

Anderson said can result in dehydration, kidney problems, lightheadedness and falls.Type 2 diabetes is another common condition in which medications are often improperly prescribed to treat drug-induced side effects, said Lisa M. McCarthy, doctor of pharmacy at the University of Toronto who directed the Canadian study. Recognizing a side effect for what it is can be hampered when the effect doesn’t happen for weeks or even months after a drug is started.

While patients taking opioids for pain may readily recognize constipation as a consequence, Dr. McCarthy said that over time, patients taking metformin for diabetes can develop diarrhea and may self-treat with Lomotil, which in turn can cause dizziness and confusion.Dr. Paula Rochon, geriatrician at Women’s College Hospital in Ontario, said patients taking a drug called a cholinesterase inhibitor to treat early dementia can develop urinary incontinence, which is then treated with another drug that can worsen the patient’s confusion.Complicating matters is the large number of drugs some people take.

€œOlder adults frequently take many medications, with two-fifths taking five or more,” Dr. Anderson wrote in JAMA Internal Medicine. In cases of polypharmacy, as this is called, it can be hard to determine which, if any, of the drugs a person is taking is the cause of the current symptom.Dr.

Rochon emphasized that a prescribing cascade can happen to anybody. She said, “Everyone needs to consider the possibility every time a drug is prescribed.”Before accepting a prescription, she recommended that patients or their caregivers should ask the doctor a series of questions, starting with “Am I experiencing a symptom that could be a side effect of a drug I’m taking?. € Follow-up questions should include:Is this new drug being used to treat a side effect?.

Is there a safer drug available than the one I’m taking?. Could I take a lower dose of the prescribed drug?. Most important, Dr.

Rochon said, patients should ask “Do I need to take this drug at all?. €Patients and doctors alike often overlook or resist alternatives to medication that may be more challenging to adopt than swallowing a pill. For example, among well-established nondrug remedies for hypertension are weight loss, increasing physical activity, consuming less salt and other sources of sodium, and eating more potassium-rich foods like bananas and cantaloupe.For some patients, frequent use of a nonsteroidal anti-inflammatory drug sold over-the-counter, like ibuprofen or naproxen, is responsible for their elevated blood pressure.The risk of getting caught in a prescribing cascade is increased when patients are prescribed medications by more than one provider.

It’s up to patients to be sure every doctor they consult is given an up-to-date list of every drug they take, whether prescription or over-the-counter, as well as nondrug remedies and dietary supplements. Dr. Rochon recommended that patients maintain an up-to-date list of when and why they started every new drug, along with its dose and frequency, and show that list to the doctor as well..

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The pilot, which is being delivered by the University of Newcastle in partnership with NSW Health, will run over the next amoxil pediatric drops year with results helping to improve the program. Men living in the trial site areas will be eligible for the program if they are over the age of 18, their partner is at least 16 weeks pregnant or their baby is up to 24 weeks of age. They must have a mobile phone capable of receiving and sending text messages. Associate Professor Elisabeth Murphy, Senior Clinical Advisor, Child and Family Health, said self-care for new fathers is extremely important amoxil pediatric drops as the mental and physical wellbeing of both parents has a direct effect on their children.

€œReceiving help with health issues early on ensures dads are in the best possible position to care for their new baby and partner,” Associate Professor Murphy said. €œWe also understand expecting and new parents may experience more worries about their health and wellbeing in relation amoxil pediatric drops to COVID-19. We encourage expectant and new parents, particularly at this time, to reach out for support to their healthcare provider or GP.” ​​​​​​Regional and rural patients now have access to 24-hour critical care under a $21.7 million telestroke service being rolled out across NSW.Patients at Port Macquarie and Coffs Harbour hospitals are the first to benefit from the NSW Telestroke Service, based at Sydney’s Prince of Wales Hospital. Health Minister Brad Hazzard said the revolutionary service will expand to up to 23 sites over amoxil pediatric drops the next three years.

€œThe NSW Telestroke Service will remove geographical barriers and improve outcomes for thousands of regional and rural stroke patients every year, giving them a much greater chance of surviving and leading a normal life,” Mr Hazzard said. €œPeople in regional and rural areas have a far greater risk of hospitalisation from stroke and this vital service will provide them with immediate, life-saving diagnosis and treatment from the state’s leading clinicians.” In 2018-19, 13,651 people were hospitalised for a stroke in NSW. Of those, 32 per amoxil pediatric drops cent were from regional, rural or remote areas. A successful pilot project in the Hunter New England, Central Coast and Mid North Coast local health districts since 2017 has already helped 1200 patients.

The Stroke Foundation’s amoxil pediatric drops Chief Executive Officer Sharon McGowan welcomed the launch of the statewide service, jointly funded by the State and Federal governments. €œWhen a stroke strikes, it kills up to 1.9 million brain cells per minute. This service will have an enormous impact by providing time-critical, best-practice treatment amoxil pediatric drops that saves lives and reduces lifelong disability,” Ms McGowan said. Prince of Wales Hospital’s Director of Clinical Neuroscience Professor Ken Butcher said.

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A free pilot program to help new and expectant fathers navigate the physical, mental and emotional challenges of becoming a dad will be rolled out in four regions in NSW from today.Health Minister Brad Hazzard said the ‘Focus on New Fathers’ program will be trialled with buy amoxil men in Northern NSW, Northern and Western Sydney and the Murrumbidgee area. €œAsk any father and they will tell you, becoming a parent is an equally joyous and terrifying experience because your entire routine is turned on its head,” Mr Hazzard said. €œIt is a considerable adjustment which can put tremendous stress buy amoxil on you and on your relationship, so it’s important to know you are not alone and help is at hand – literally. €œThis pilot will see texts sent to dads, offering valuable health advice and links into pathways to ensure support options are available, particularly in these uncertain COVID times.” Research has shown men are often reluctant to engage with the health system to get support, despite around one in 10 dads experiencing depression and anxiety in the postnatal period. The pilot, which is being delivered by the University of Newcastle in partnership with NSW Health, will run over the next year with buy amoxil results helping to improve the program.

Men living in the trial site areas will be eligible for the program if they are over the age of 18, their partner is at least 16 weeks pregnant or their baby is up to 24 weeks of age. They must have a mobile phone capable of receiving and sending text messages. Associate Professor Elisabeth Murphy, Senior Clinical Advisor, Child and Family buy amoxil Health, said self-care for new fathers is extremely important as the mental and physical wellbeing of both parents has a direct effect on their children. €œReceiving help with health issues early on ensures dads are in the best possible position to care for their new baby and partner,” Associate Professor Murphy said. €œWe also understand expecting and new parents may experience more worries about their health and wellbeing in relation to COVID-19 buy amoxil.

We encourage expectant and new parents, particularly at this time, to reach out for support to their healthcare provider or GP.” ​​​​​​Regional and rural patients now have access to 24-hour critical care under a $21.7 million telestroke service being rolled out across NSW.Patients at Port Macquarie and Coffs Harbour hospitals are the first to benefit from the NSW Telestroke Service, based at Sydney’s Prince of Wales Hospital. Health Minister Brad Hazzard said the revolutionary service will expand to up to 23 buy amoxil sites over the next three years. €œThe NSW Telestroke Service will remove geographical barriers and improve outcomes for thousands of regional and rural stroke patients every year, giving them a much greater chance of surviving and leading a normal life,” Mr Hazzard said. €œPeople in regional and rural areas have a far greater risk of hospitalisation from stroke and this vital service will provide them with immediate, life-saving diagnosis and treatment from the state’s leading clinicians.” In 2018-19, 13,651 people were hospitalised for a stroke in NSW. Of those, 32 per cent were from regional, rural or remote areas buy amoxil.

A successful pilot project in the Hunter New England, Central Coast and Mid North Coast local health districts since 2017 has already helped 1200 patients. The Stroke Foundation’s Chief Executive Officer Sharon McGowan welcomed the launch of the statewide service, jointly funded by the State and Federal buy amoxil governments. €œWhen a stroke strikes, it kills up to 1.9 million brain cells per minute. This service will have an enormous impact by providing time-critical, best-practice treatment that saves lives and reduces lifelong disability,” buy amoxil Ms McGowan said. Prince of Wales Hospital’s Director of Clinical Neuroscience Professor Ken Butcher said.

€œThe service links expert stroke clinicians with local emergency physicians to quickly determine the best possible treatment plan for a patient.” ​.

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Start Preamble where to buy amoxil pills Centers for Medicare &. Medicaid Services (CMS), HHS. Extension of where to buy amoxil pills timeline for publication of final rule.

This notice announces an extension of the timeline for publication of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, where to buy amoxil pills the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O.

Wilson, (410) 786-8852. End Further Info End Preamble Start Supplemental Information In the October 17, 2019 Federal Register (84 FR 55766), we published a proposed where to buy amoxil pills rule that addressed undue regulatory impact and burden of the physician self-referral law. The proposed rule was issued in conjunction with the Centers for Medicare &.

Medicaid Services' (CMS) Patients over Paperwork initiative and the Department of Health and Human Services' (the Department or HHS) Regulatory Sprint to where to buy amoxil pills Coordinated Care. In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician.

A new exception where to buy amoxil pills for donations of cybersecurity technology and related services. And amendments to the existing exception for electronic health records (EHR) items and services. The proposed rule also provides critically necessary guidance for physicians and health care providers and suppliers whose financial relationships are governed by the physician self-referral statute where to buy amoxil pills and regulations.

This notice announces an extension of the timeline for publication of the final rule and the continuation of effectiveness of the proposed rule. Section 1871(a)(3)(A) of the Social Security Act (the Act) requires us to establish and publish a regular timeline for the publication of final regulations based on the previous publication of a where to buy amoxil pills proposed regulation. In accordance with section 1871(a)(3)(B) of the Act, the timeline may vary among different regulations based on differences in the complexity of the regulation, the number and scope of comments received, and other relevant factors, but may not be longer than 3 years except under exceptional circumstances.

In addition, in accordance with section 1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified where to buy amoxil pills Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020. However, we are still working through the Start Printed Page 52941complexity of the issues raised by comments received on the proposed rule and therefore we are not able to meet the announced publication target date.

This notice extends the timeline for publication of the final rule until August where to buy amoxil pills 31, 2021. Start Signature Dated. August 24, 2020.

Wilma M where to buy amoxil pills. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature where to buy amoxil pills End Supplemental Information [FR Doc.

2020-18867 Filed 8-26-20. 8:45 am]BILLING CODE 4120-01-PStart Preamble Notice of amendment. The Secretary issues this amendment pursuant to section 319F-3 of the where to buy amoxil pills Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures.

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

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

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

These sections are codified at 42 U.S.C. 247d-6d and 42 U.S.C. 247d-6e, respectively.

Section 319F-3 of the PHS Act has been amended by the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the COVID-19 outbreak.

Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against COVID-19 (85 FR 15198, Mar. 17, 2020) (the Declaration).

On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm COVID-19 might otherwise cause.

The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any vaccine that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended vaccines).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure.

€œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C.

247d-6d(i)(8).[] By this amendment to the Declaration, the Secretary identifies an additional category of persons who are qualified persons under section 247d-6d(i)(8)(B).[] On May 8, 2020, CDC reported, “The identified declines in routine pediatric vaccine ordering and doses administered might indicate that U.S. Children and their communities face increased risks for outbreaks of vaccine-preventable diseases,” and suggested that a decrease in rates of routine childhood vaccinations were due to changes in healthcare access, social distancing, and other COVID-19 mitigation strategies.[] The report also stated that “[p]arental concerns about potentially exposing their children to COVID-19 during well child visits might contribute to the declines observed.” [] On July 10, 2020, CDC reported its findings of a May survey it conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the COVID-19 pandemic. The survey, which was limited to practices participating in the Vaccines for Children program, found that, as of mid-May, 15 percent of Northeast pediatric practices were closed, 12.5 percent of Midwest practices were closed, 6.2 percent of practices in the South were closed, and 10 percent of practices in the West were closed.

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

If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations. Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the COVID-19 pandemic, including. Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations.

Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other infection-control practices, such as the use of masks. The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by COVID-19.

Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates. We must quickly do so to avoid preventable infections in children, additional strains on our healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with additional resurgence of COVID-19. Together with pediatricians and other healthcare professionals, pharmacists are positioned to expand access to childhood vaccinations.

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

For example, pharmacists already play a significant role in annual influenza vaccination. In the early 2018-19 season, they administered the influenza vaccine to nearly a third of all adults who received the vaccine.[] Given the potential danger of serious influenza and continuing COVID-19 outbreaks this autumn and the impact that such concurrent outbreaks may have on our population, our healthcare system, and our whole-of-nation response to the COVID-19 pandemic, we must quickly expand access to influenza vaccinations. Allowing more qualified pharmacists to administer the influenza vaccine to children will make vaccinations more accessible.

Therefore, the Secretary amends the Declaration to identify State-licensed pharmacists (and pharmacy interns acting under their supervision if the pharmacy intern is licensed or registered by his or her State board of pharmacy) as qualified persons under section 247d-6d(i)(8)(B) when the pharmacist orders and either the pharmacist or the supervised pharmacy intern administers vaccines to individuals ages three through 18 pursuant to the following requirements. The vaccine must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE).

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

Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended vaccines according to ACIP's standard immunization schedule. All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return.

Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended vaccines and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended vaccines ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified pandemic and epidemic products that “limit the harm such pandemic or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140COVID-19 as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration. Nothing in this Declaration shall be construed to affect the National Vaccine Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National Vaccine Injury Compensation Program authorized under 42 U.S.C.

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

Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by COVID-19. The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against COVID-19. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against COVID-19, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar.

17, 2020) and amended at 85 FR 21012 (Apr. 15, 2020) and 85 FR 35100 (June 8, 2020). 1.

Covered Persons, section V, delete in full and replace with. V. Covered Persons 42 U.S.C.

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

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

Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met. The vaccine must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule.

The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines. The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE.

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

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

Covered countermeasures that are subject to the National Vaccine Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program.

All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2. Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with.

VIII. Category of Disease, Health Condition, or Threat 42 U.S.C. 247d-6d(b)(2)(A) The category of disease, health condition, or threat for which I recommend the administration or use of the Covered Countermeasures is not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Start Authority 42 U.S.C. 247d-6d. End Authority Start Signature Dated.

August 19, 2020. Alex M. Azar II, Secretary of Health and Human Services.

End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20. 4:15 pm]BILLING CODE 4150-03-PNCHS Data Brief No.

286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

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

In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1.

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

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

Access data table for Figure 1pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2).

The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2.

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

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

Access data table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3).

The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3.

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

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

Access data table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4).

The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4.

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

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

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S.

Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women. In contrast, postmenopausal women were most likely to have poor-quality sleep.

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

Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women.

1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €.

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

Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration.

Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?. €Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?.

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

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

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

Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level.

About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES.

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

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology.

ACOG Practice Bulletin No. 141. Management of menopausal symptoms.

Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep.

National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N. Perimenopause.

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

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2.

2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015. National Center for Health Statistics.

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

2012. Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status.

NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H.

Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J. Blumberg, Ph.D., Associate Director for Science.

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

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

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

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

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

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

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

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

247d-6d and 42 U.S.C. 247d-6e, respectively. Section 319F-3 of the PHS Act has been amended by the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the COVID-19 outbreak.

Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against COVID-19 (85 FR 15198, Mar. 17, 2020) (the Declaration). On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020).

On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm COVID-19 might otherwise cause. The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any vaccine that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended vaccines).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed.

Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C. 247d-6d(i)(8).[] By this amendment to the Declaration, the Secretary identifies an additional category of persons who are qualified persons under section 247d-6d(i)(8)(B).[] On May 8, 2020, CDC reported, “The identified declines in routine pediatric vaccine ordering and doses administered might indicate that U.S. Children and their communities face increased risks for outbreaks of vaccine-preventable diseases,” and suggested that a decrease in rates of routine childhood vaccinations were due to changes in healthcare access, social distancing, and other COVID-19 mitigation strategies.[] The report also stated that “[p]arental concerns about potentially exposing their children to COVID-19 during well child visits might contribute to the declines observed.” [] On July 10, 2020, CDC reported its findings of a May survey it conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the COVID-19 pandemic. The survey, which was limited to practices participating in the Vaccines for Children program, found that, as of mid-May, 15 percent of Northeast pediatric practices were closed, 12.5 percent of Midwest practices were closed, 6.2 percent of practices in the South were closed, and 10 percent of practices in the West were closed.

Most practices had reduced office hours for in-person visits. When asked whether their practices would likely be able to accommodate new patients for immunization services through August, 418 practices (21.3 percent) either responded that this was not likely or the practice was permanently closed or not resuming immunization services for all patients, and 380 (19.6 percent) responded that they were unsure. Urban practices and those in the Northeast were less likely to be able to accommodate new patients compared with rural practices and those in the South, Midwest, or West.[] In response to these troubling developments, CDC and the American Academy of Pediatrics have stressed, “Well-child visits and vaccinations are essential services and help make sure children are protected.” [] The Secretary re-emphasizes that important recommendation to parents and legal guardians here. If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations. Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the COVID-19 pandemic, including.

Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations. Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other infection-control practices, such as the use of masks. The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by COVID-19. Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates.

We must quickly do so to avoid preventable infections in children, additional strains on our healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with additional resurgence of COVID-19. Together with pediatricians and other healthcare professionals, pharmacists are positioned to expand access to childhood vaccinations. Many States already allow pharmacists to administer vaccines to children of any age.[] Other States permit pharmacists to administer vaccines to children depending on the age—for example, 2, 3, 5, 6, 7, 9, 10, 11, or 12 years of age and older.[] Few States restrict pharmacist-administered vaccinations to only adults.[] Many States also allow properly trained individuals under the supervision of a trained pharmacist to administer those vaccines.[] Pharmacists are well positioned to increase access to vaccinations, particularly in certain areas or for certain populations that have too few pediatricians and other primary-care providers, or that are otherwise medically underserved.[] As of 2018, nearly 90 percent of Americans lived within five miles of a community pharmacy.[] Pharmacies often offer extended hours and added convenience. What is more, pharmacists are trusted healthcare professionals with established relationships with their patients. Pharmacists also have strong relationships with local medical providers and hospitals to refer patients as appropriate.

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

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

All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return. Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended vaccines and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended vaccines ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified pandemic and epidemic products that “limit the harm such pandemic or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140COVID-19 as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration. Nothing in this Declaration shall be construed to affect the National Vaccine Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National Vaccine Injury Compensation Program authorized under 42 U.S.C.

300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures. Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by COVID-19.

The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against COVID-19. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against COVID-19, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar. 17, 2020) and amended at 85 FR 21012 (Apr.

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

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

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

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

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

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

Category of Disease, Health Condition, or Threat 42 U.S.C. 247d-6d(b)(2)(A) The category of disease, health condition, or threat for which I recommend the administration or use of the Covered Countermeasures is not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Start Authority 42 U.S.C. 247d-6d. End Authority Start Signature Dated.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Western NSW residents will have even greater access to mental health support with the opening of a new Lifeline centre in Dubbo.Minister for Mental Health Bronnie Taylor will open the new, purpose-built centre today, buy amoxil without a prescription thanks to $600,000 in special funding from the NSW Government.“We want people living in the Central West to be able to access timely support from counsellors who understand their local community and the pressures they might be under,” Mrs Taylor said.“As well as establishing a dedicated Lifeline presence in Dubbo, the funding will also allow Lifeline Central West to triple the number of crisis telephone calls answered in Dubbo and its surrounds.”Member for Dubbo Dugald Saunders said the centre comes at a critical time for his community.“The brutal forces of drought, COVID-19 and financial uncertainty are taking a toll on the strongest and most resilient among us,” Mr Saunders said.“One of my priorities after being elected was to see Lifeline’s local footprint expanded and supported, and funding for an appropriate building has been a key component of that.“It’s important for people to know they can lean on trained counsellors who live in the area and know the situations confronting people in central west NSW.”The new centre will also be the base for the Rapid Community Support Program (Rapid) – an outreach program which goes directly to towns hit by significant events such as drought and bushfire to provide counselling and support within their own community.The service received a $500,000 boost from the NSW Government to enable it to continue operations as part of an additional $6 million investment provided to Lifeline in response to the COVID-19 pandemic.CEO of Lifeline Central West Stephanie Robinson said the Dubbo-based team willserve a vast area, including Wellington, Narromine, Mendooran, Coonabarabran, Coonamble, Walgett, Bourke and Lightning Ridge.“Our new centre will be a safe space for people to have group or one-on-one counselling sessions and will also serve as a base for our trained volunteers to provide community outreach,” Ms Robinson said.Lifeline Central West is a not-for-profit organisation with offices in Bathurst, Orange and Dubbo with nine full-time staff and approximately 130 trained volunteers. The NSW Government has invested over $25 million in Lifeline over 4 years.As part of SafeWork Month 2020, a number of prominent business and industry leaders have been appointed to help drive positive change by breaking down the barriers and stigma associated with mental health in NSW workplaces.Minister for Better Regulation and Innovation Kevin Anderson and Minister for Mental Health Bronnie Taylor today announced the NSW Government has appointed 12 ambassadors to champion the importance of good mental health in the workplace.Mr Anderson said the ambassadors will play a critical role in assisting the NSW Government meet its target of 90,000 business taking effective action to create work environments which benefit mental health by 2022.“Statistically we know that one-in-six people struggle with their mental health, and I would suggest those figures are conservative given the current challenging social and economic environment,” Mr Anderson said.“The ambassadors will work alongside us to send a message to employees in every corner of NSW that if you are struggling and need help, we will be there for you.”Among the new mental health ambassadors are Landcom CEO and Lifeline Chairman John Brogden AM, Westpac Group Chief Mental Health Officer David Burroughs and Business Chicks CEO Olivia Ruello.Mr Anderson said there will also be significant financial benefits for businesses.“The financial cost of mental health to NSW employers is $2.8 billion a year, but for every dollar invested into improving culture and outcomes for those living with mental ill-health, there is a return on investment of up to four dollars,” Mr Anderson said.“Our ambassadors recognise that a mentally healthy workplace is good business, buy amoxil without a prescription and have committed to continuing the great work they do to support their workers and to encourage others in their industry to do the same.”Mrs Taylor said the event is another example of the NSW Government’s commitment to leading the nation in mental health reform.“Most of us spend about one-third or more of our waking lives at work. It’s a huge part of what we do and can have a huge impact on our mental health in a positive or negative way,” Mrs Taylor said.“Everyone in the workplace can contribute to a culture where people feel safe and supported to talk about mental health and buy amoxil without a prescription it’s really encouraging to see so many leaders from NSW’s business sector stepping up.” For more information please visit SafeWork NSW..

Western NSW residents will have even greater access to mental health support with the opening of a new Lifeline centre in Dubbo.Minister for Mental Health Bronnie Taylor will open the new, purpose-built centre today, thanks to $600,000 in special funding from the NSW Government.“We want people living in the Central West to be able to access timely support from counsellors who understand their local community and the pressures they might be under,” Mrs Taylor said.“As well as establishing a dedicated Lifeline presence in Dubbo, the funding will also allow Lifeline Central West to triple the number of crisis telephone calls answered in Dubbo and its surrounds.”Member for Dubbo Dugald Saunders said the centre comes at a critical time for his community.“The brutal forces of drought, COVID-19 and financial uncertainty are taking a toll on the strongest and most resilient among us,” Mr Saunders said.“One of my priorities after being elected was to see Lifeline’s local footprint expanded and supported, and funding for an appropriate building has been a key component of that.“It’s important for people to know they can lean on trained counsellors who live in the area and know the situations confronting people in central west NSW.”The new centre will also be the base for the Rapid Community Support Program (Rapid) – an outreach program which goes directly to towns hit by significant events such as drought and bushfire to provide counselling and support within their own community.The service received a $500,000 boost from the NSW Government to enable it to continue operations as part of an additional $6 million investment provided to Lifeline in response to the find more info COVID-19 pandemic.CEO of Lifeline Central West Stephanie Robinson said the Dubbo-based team willserve a vast area, including Wellington, buy amoxil Narromine, Mendooran, Coonabarabran, Coonamble, Walgett, Bourke and Lightning Ridge.“Our new centre will be a safe space for people to have group or one-on-one counselling sessions and will also serve as a base for our trained volunteers to provide community outreach,” Ms Robinson said.Lifeline Central West is a not-for-profit organisation with offices in Bathurst, Orange and Dubbo with nine full-time staff and approximately 130 trained volunteers. The NSW Government has invested over $25 million in Lifeline over 4 years.As part of SafeWork Month 2020, a number of prominent business and industry leaders have been appointed to help drive positive change by breaking down the barriers and stigma associated with mental health in NSW workplaces.Minister for Better Regulation and Innovation Kevin Anderson and Minister for Mental Health Bronnie Taylor today announced the NSW Government has appointed 12 ambassadors to champion the importance of good mental health in the workplace.Mr Anderson said the ambassadors will play a critical role in assisting the NSW Government meet its target of 90,000 business taking effective action to create work environments which benefit mental health by 2022.“Statistically we know that one-in-six people struggle with their mental health, and I would suggest those figures are conservative given the current challenging social and economic environment,” Mr Anderson said.“The ambassadors will work alongside us to send a message to employees in every corner of NSW that if you are struggling and need help, we will be there for you.”Among the new mental health ambassadors are Landcom CEO and Lifeline Chairman John Brogden AM, Westpac Group Chief Mental Health Officer David Burroughs buy amoxil and Business Chicks CEO Olivia Ruello.Mr Anderson said there will also be significant financial benefits for businesses.“The financial cost of mental health to NSW employers is $2.8 billion a year, but for every dollar invested into improving culture and outcomes for those living with mental ill-health, there is a return on investment of up to four dollars,” Mr Anderson said.“Our ambassadors recognise that a mentally healthy workplace is good business, and have committed to continuing the great work they do to support their workers and to encourage others in their industry to do the same.”Mrs Taylor said the event is another example of the NSW Government’s commitment to leading the nation in mental health reform.“Most of us spend about one-third or more of our waking lives at work. It’s a huge part of what we do and can have a huge impact on our mental health in a positive or negative way,” Mrs Taylor said.“Everyone in the workplace can contribute to a culture where people feel safe and supported to talk about mental health and it’s really encouraging to see so many leaders from NSW’s business sector stepping up.” For more buy amoxil information please visit SafeWork NSW..