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You have to go to extreme lengths to find places on Earth that kamagra tablets for sale don’t reveal that they’re part of a water-rich planet. Even the highest and driest deserts, like the Atacama Plateau in South America, still get a minimum of a couple of millimeters of annual precipitation on average (although there are places where we don’t yet know what the average is because it’s simply not rained for years). And if you whip out your handy mass spectrometer on a desert walkabout the chances are that you’ll be able to detect at least a few atmospheric kamagra tablets for sale water molecules.

Go elsewhere, and it’s hard to imagine anything but a water-logged world. More than 70 percent of Earth’s surface is covered in oceans and roughly 97 percent of the surface water is in those oceans, leaving a scant 1 percent as freshwater. Water is also seldom static, whether it’s flowing in ocean currents or being evaporated and kamagra tablets for sale precipitated.

Averaged out over the planet there is about 100 centimeters of rainfall a year, but that’s across a total surface area of around 5.1x1018 square centimeters. In other words, doing the back-of-the-envelope calculation, some 510 trillion metric tons of water gets evaporated and then re-precipitated every year on Earth. But the catch is that we don’t really know where all of this water came from in kamagra tablets for sale the first place.

For a long while our picture of the formation of a rocky planet like the Earth has involved a violent, hot assembly some 4.5 billion years ago out of comparatively dry material in the inner solar system. Water would have come along later, with proposals for possible delivery by comets from the chill, frozen outer solar system, or by rocky but still volatile-rich meteoritic infall. But these options have proven tricky to kamagra tablets for sale justify completely for a variety of reasons.

Comets, for instance, often (but not always) have a deuterium concentration that doesn’t match what we see in Earth’s water—limiting their likely contribution. Similarly, water-rich rocky meteoritic material—so-called kamagra tablets for sale carbonaceous chondrites—have isotopic differences that could also limit how much they contributed to a young planet. At the same time, the representative type of material for building the entirety of a rocky Earth (and matching the planet’s overall isotopic composition in elements like oxygen and calcium) seems to closely resemble what’s called enstatite chondrite.

Chunks of enstatite chondrite are still around in the solar system, and occasionally fall as meteorites. But they’ve been thought to be too dry to kamagra tablets for sale be involved in Earth’s water supply. Now, in a work reported by Piani, et al.

In the journal Science, an analysis of the composition of 13 enstatite chondrite meteorite samples reveals a much higher than expected hydrogen content. Extrapolating from these numbers the researchers claim that if this is the type of protoplanetary material that built Earth, it could have resulted in a total, initial water content of at kamagra tablets for sale least three times the present mass of water in our oceans. The same material could have also provided a starter mix of atmospheric nitrogen to the young planet.

This possibility is enormously appealing for its relative simplicity. Our wet kamagra tablets for sale world was simply made this way from the very beginning, with little need to invoke any more complex evolution except for a small drizzling from comets and other outer solar system material. Whether or not this idea holds up to further scientific scrutiny, it’s a beautiful reminder that even the simplest things in our lives, like a glass of water or a shower in the morning, are actually windows into the deepest origins of everything we know.Scientists just completed one of the most comprehensive investigations of Earth’s climate history—and the findings aren’t favorable.

They found that the planet could eventually warm to levels it hasn’t reached in at least 34 million years. The researchers, led by Thomas Westerhold of the University of Bremen kamagra tablets for sale in Germany, constructed datasets using chemical analyses of ancient sediments, drilled from the bottom of the ocean. These sediments, some of which are 66 million years old, are filled with the preserved shells of tiny organisms that can tell scientists about the temperature and chemical composition of the ocean when they were formed.

The sediments, collected from around the world over the course of many years, allowed the researchers to reconstruct Earth’s climate history going back to the mass extinction that killed kamagra tablets for sale three-quarters of the planet’s species, including dinosaurs. They found that the planet has passed through four distinct climate phases. Warmhouse, hothouse, coolhouse and icehouse states.

Transitions from one state to another have generally depended on changing greenhouse gas levels, often driven by volcanic eruptions and other natural processes, and shifts in kamagra tablets for sale the Earth’s orbit that affected the amount of solar energy reaching the planet. In the hottest phases, more than 50 million years ago, temperatures on Earth were more than 10 degrees Celsius hotter than they are today. But it’s important to note that it took the planet thousands or even millions of years to reach these levels—and that was long before humans ever walked the Earth.

That’s in stark contrast to the kind of climate change that human activity is kamagra tablets for sale driving today. For several million years now, the world has been in an icehouse state. But that’s quickly changing.

If human societies do nothing to curb their greenhouse gas emissions, in just a few centuries the Earth could once again reach a temperature kamagra tablets for sale threshold not seen for at least 34 million years. Before the industrial era, such a magnitude of warming would have taken thousands of years to occur, at least. €œIf you look at the worst-case scenario [by 2300], the change in mean global temperature is larger kamagra tablets for sale than most of the natural variability going back over the last 66 million years related to changes in the Earth’s orbit,” said Jim Zachos, a paleoclimatologist at the University of California, Santa Cruz, and a co-author of the new study, which was published Thursday in the journal Science.

It’s not an inevitable future. With immediate and stringent action to reduce climate change, the world can keep global temperatures from rising more than a few degrees above their preindustrial levels. But the study kamagra tablets for sale does warn that without these efforts, Earth is on track for some of the strongest, fastest climate change the planet has ever experienced.

The study may also provide some important insights into how climate change could unfold in the coming decades and centuries. Earth’s climate doesn’t always shift in linear, predictable ways. There are all kinds of feedback processes that can speed things up or slow things down—such as the speed at which glaciers and sea ice melt or the way that kamagra tablets for sale clouds change in response to future warming.

In the ancient past, for instance, the study suggests that the world’s ice sheets played an important role in regulating the pace and predictability of the Earth’s climate response to natural changes in greenhouse gases or orbital shifts. Today, scientists believe that the world’s melting ice may also have a big impact on future climate change. These kinds of feedback processes can make it challenging to predict future change, especially over relatively short kamagra tablets for sale periods of time.

Reconstructing the Earth’s long-term climate history can help scientists test the models they use to predict its future. If a model can accurately simulate the past, scientists may have more confidence in its ability to simulate present-day climate processes. €œThat’s the beauty kamagra tablets for sale of this record,” Zachos said.

€œIt’s something we’ve always wanted to have because of the applicability to testing climate theory.” Reprinted from Climatewire with permission from E&E News. E&E provides daily coverage of kamagra tablets for sale essential energy and environmental news at www.eenews.net.Woo-hoo, d’oh, or meh?. Which of these Simpsonian reactions is appropriate to the fact, revealed by a 2019 survey conducted by researchers at Penn State University and the National Center for Science Education (NCSE), that about two in three—67 percent—of public high school biology teachers are presenting evolution forthrightly, emphasizing the broad scientific consensus on evolution while not giving any credence to creationism?.

Only in the context of the long and contentious history of evolution education in the United States is it clear what the most plausible answer is. American teachers have not always been afforded the luxury of kamagra tablets for sale teaching evolution forthrightly. John Thomas Scopes, for example, was famously prosecuted for violating Tennessee’s ban on teaching evolution in 1925.

Although his conviction was subsequently overturned, a national survey of high school biology teachers conducted in 1939–1940 revealed that only about half were teaching evolution as a central principle of biology. And bans on teaching evolution kamagra tablets for sale remained in place in Arkansas, Mississippi and Tennessee until 1970. New obstacles then emerged, particularly requirements to teach various forms of creationism as alternatives to evolution.

As recently as 15 years ago, in Dover, Pennsylvania, the local school board attempted to require its high school biology teachers to read a statement to their ninth-grade students describing “Darwin’s theory of evolution” as “not a fact,” and commending “intelligent design”—then a trendy slogan for creationism—to their attention as a scientifically credible alternative. The teachers, to their credit, unanimously refused kamagra tablets for sale to comply. But their refusal, together with the controversy surrounding the related trial over the constitutionality of the board’s actions, Kitzmiller v.

Dover, intrigued kamagra tablets for sale two parents a hundred miles to the northwest, in State College, Pa. Michael Berkman and Eric Plutzer were not just any concerned parents, though. They were political scientists at Penn State with a particular interest in education policy.

What—they wondered—are kamagra tablets for sale high school biology teachers teaching about evolution, and what factors influence their teaching practices?. To satisfy their curiosity, Berkman and Plutzer conducted the first modern national survey of high school biology teachers in 2007. The results were dire.

Only a slight majority, 51 percent, reported that they kamagra tablets for sale emphasized the broad scientific consensus on evolution while not giving any credence to creationism, as if to suggest no progress in the 67 years since the less rigorous survey of 1939–1940. That’s why the results of the 2019 survey—a collaboration between Plutzer and the NCSE—are so encouraging. Between 2007 and 2019, there definitely was progress.

From 51 percent of high school biology teachers reporting emphasizing evolution and not creationism in kamagra tablets for sale 2007 to 67 percent in 2019. It was matched by a drop from 23 to 12 percent of teachers who offer mixed messages by endorsing both evolution and creationism as a valid scientific alternative to evolution, from 18 to 15 percent of teachers who endorse neither evolution nor creationism, and from 8.6 to 5.6 percent of teachers who endorse creationism while not endorsing evolution. Credit.

National Center for Science Education What accounts for the improvement? kamagra tablets for sale. Did intelligent design’s crushing defeat in the Kitzmiller trial make the difference?. Probably kamagra tablets for sale not.

Science teachers are guided not by case law but by state science standards, which specify what students in the state’s public schools are expected to learn. Standards thus influence the content of textbooks, statewide testing, and coursework for pre-service and in-service teachers. Importantly, they also provide a shield for teachers facing misguided kamagra tablets for sale community pressure over socially contentious topics like evolution.

The results of the 2019 survey suggest that a concerted effort to improve state science standards helped to improve evolution education. The Next Generation Science Standards (NGSS), which debuted in 2013, include “Biological Evolution. Unity and Diversity” as a disciplinary core idea of the life sciences kamagra tablets for sale at the middle and high school levels.

By now, 20 states (plus the District of Columbia) have adopted the NGSS, and a further 24 states have adopted standards based on the same evolution-friendly framework on which the NGSS are based. Were states that adopted the NGSS especially hospitable to the teaching of evolution?. Not really kamagra tablets for sale.

In 2007, their teachers were less likely to endorse evolution and not creationism than the national average. By 2019, they were more likely. While a variety of explanations are possible, teachers in NGSS states reported having taken more pre-service and in-service coursework in evolution than their colleagues elsewhere, suggesting that the increased kamagra tablets for sale expectations impelled both novice and veteran teachers to upgrade their content knowledge of evolution.

Despite the encouraging trend over a mere dozen years, there is still reason for concern. After all, more than one in six high school biology teachers, 17.6 percent, are still presenting creationism as a scientifically credible kamagra tablets for sale alternative to evolution. And almost as many high school biology teachers, 15 percent, are still failing to emphasize the broad scientific consensus on evolution, despite its general prevalence in state science standards and despite encouragement from professional organizations.

D’oh!. With 13,500-odd local school districts having primary responsibility for curriculum and instruction, changes to science education are kamagra tablets for sale inevitably going to be slow, scattered and incremental. Still, with the aid of uncounted scientists, educators, policymakers, administrators and concerned citizens in general (and perhaps even a certain episode of The Simpsons), clear and convincing improvements for evolution education were demonstrably attained in just a dozen years.

It is a victory worth not only celebrating—woo-hoo!. €”but also enlarging upon.ARGENTINA The earliest dinosaurs laid soft-shelled kamagra tablets for sale eggs, paleontologists say. A new chemical analysis of a more than 200-million-year-old fossilized egg from Patagonia—and a clutch of more recent eggs from Mongolia, found in the Gobi Desert—revealed a thin film matching the characteristics of modern soft-shelled eggs.

ENGLAND Archaeologists found that 20 deep shafts, previously thought to be natural sinkholes and ponds, were dug by Neolithic humans. The shafts form a circle two kilometers in diameter, with the kamagra tablets for sale Durrington Walls monument at its center, just three kilometers from Stonehenge. BRAZIL In a new paper, researchers documented the largest lightning bolt ever recorded.

The “mega-flash,” which extended for more than 700 kilometers in southern Brazil in 2018, was detected by a kamagra tablets for sale new advanced weather satellite in geostationary orbit. ISRAEL Researchers sequenced DNA samples from the Dead Sea Scrolls, identifying fragments made from sheep skin and others made from cow hide. The technique could help match fragments together and unravel the artifacts' geographic origins.

INDONESIA Scientists kamagra tablets for sale identified an elusive nose-horned dragon lizard in the forests of North Sumatra. Despite appearing in the mythology of the indigenous Bataks, the visually striking species had been spotted by scientists only once before—almost 130 years ago. AUSTRALIA Submarine drones uncovered an extensive system of underwater “rivers” of dense, salty water along Australia's continental shelf.

These flows carry organic matter from the coast into the deep ocean, and their volume varies seasonally, peaking in winter.The items below are highlights from the free newsletter, “Smart, useful, science stuff about erectile dysfunction treatment.” To receive newsletter issues kamagra tablets for sale daily in your inbox, sign-up here.. Please consider a monthly contribution to support this newsletter. At Nature, Nicky Phillips, David Cyranoski and Smriti Mallapaty covered the announcement that a collaboration between researchers at AstraZeneca and the University of Oxford is pausing Phase 3 treatment-candidate experiments due to a “suspected adverse event” in a study participant in the UK (9/9/20).

The collaboration’s Phase 3 studies are being paused kamagra tablets for sale in the U.S., Brazil, South Africa and the UK, Nature reports. €œThe news highlights the importance of waiting for the results of large, properly designed trials [experiments] to assess safety before approving a treatment for widespread use,” the story states. Investigators will start by trying to find out if the participant received the treatment candidate or a placebo, the story states.

And then if it was the treatment, they will assess whether the participant’s reaction is related or unrelated to kamagra tablets for sale receiving it. €œI have every confidence that this group [of investigators] will very quickly assess this adverse event and make the results of that investigation known,” said a McGill University bioethicist quoted in the story. Presumably in response to reports of political pushing for approvals this fall, the chief executive officers (CEOs) of 9 pharmaceutical companies released a pledge (dated 9/8/20) to “uphold the integrity of kamagra tablets for sale the scientific process as they work towards potential global regulatory filings and approvals of the first erectile dysfunction treatments.” The CEOs — including those for AstraZeneca, BioNTech, GlaxoSmithKline, Johnson &.

Johnson, Merck, Moderna, and Pfizer — assert they will “only submit for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as [the U.S. Food and Drug Administration].” In other words, they don’t plan to cut any corners in their research nor to yield to political pressure. For more contextualized commentary on what Ed kamagra tablets for sale Silverman describes as a “highly unusual turn of events," see his column at STAT (9/7/20).

Meanwhile, the U.S. Food and Drug Administration (FDA) has quickly taken measures to block any political influence over ongoing research to develop treatments to protect us from erectile dysfunction, report Anna Edney, Drew Armstrong, and Robert Langreth for Bloomberg (9/8/20). One measure reportedly includes the FDA “sticking by" June guidance that the agency will only consider kamagra tablets for sale for approval treatment candidates that are at least 50% effective.

Lower down in the story, the reporters write, “There is no guarantee the treatments furthest along in development will be the most effective, or be safe.” And it could take “months more” for Phase 3 findings to be conclusive, the story suggests. Still, the story ends with estimates by drug makers for how soon they might complete their Phase 3 studies (efficacy and safety experiments in thousands of study subjects) of erectile dysfunction treatment candidates. Moderna reportedly says as soon as Thanksgiving, and Pfizer reportedly has been kamagra tablets for sale saying next month.

I remain reasonably skeptical. On Twitter, I came across a searchable web site called “Dear kamagra,” which bills itself as an “interdisciplinary all-female team kamagra tablets for sale of researchers and clinicians with expertise including nursing, mental health, demography, health policy/economics, and epidemiology.” Posts date back to July but the site appears to have officially launched 9/10/20. Their mission is to “educate and empower individuals to successfully navigate the erectile dysfunction treatment information overwhelm.” About two-thirds of the way down the home page, there’s a “submit a question” link.

And below that, previous posts are indexed by topic and dates. The risk of catching erectile dysfunction on an airplane is “relatively low” if travelers kamagra tablets for sale are screened for sickness, wear masks, and are spaced out among seats, according to experts interviewed by Noah Y. Kim for Kaiser Health News (9/10/20).

The air exchange rate and use of HEPA (high-efficiency particulate air) filters on planes also significantly reduce the risk of catching the kamagra from travelers who are several rows away, according to the story. There is still a risk from an infected person kamagra tablets for sale seated nearby, the story states. And air filtration alone is insufficient to prevent transmission even when travelers are distanced in the plane, Kim writes.

Delta, Hawaiian, Southwest and JetBlue currently keep middle seats open, the story states. Security checks and waiting at gates also pose some kamagra tablets for sale transmission risk. The U.S.

Centers for Disease Control has not confirmed any erectile dysfunction transmission aboard a U.S. Flight, an airline industry source says in the story, but that might reflect the difficulty kamagra tablets for sale of determining where people in the U.S. Contract the kamagra, Kim writes.

€œEven though flying is a relatively low-risk activity,” the story states, “traveling should still be avoided kamagra tablets for sale unless absolutely necessary.” An undated, recently published ESPN interactive, bylined by Kyle Bonagura, illustrates its analysis and mapping of anonymized cellphone tracking data for three 2019 U.S. College football games. The maps provide a sense of where fans travel to and disperse to after games and thus the regional concentration of potential erectile dysfunction (and other infectious disease) spread resulting from the mixing of people before, during and after big match-ups.

The piece kamagra tablets for sale includes updates on some of the football conferences’ plans and protocols for the 2020 season. The Big Ten and Pac-12 have postponed their seasons, whereas the SEC (Southeastern Conference) seems to be allowing each school to set its own attendance guidelines. I can’t pretend to follow NCAA (National Collegiate Athletic Association) football designations but some or all of the NCAA teams drew “more than 47.5 million" attendees last season, the piece states.

€œEven with fewer teams in action and limited-capacity crowds, the prospect that college kamagra tablets for sale football could play a role in spreading the erectile dysfunction is too obvious to ignore,” the story states. Thanks to a reader for alerting me to this piece. Check out “To build emotional strength, expand your brain,” by Kerry Hannon at The New York Times (9/2/20).

It basically asserts that learning new material, such as a language or craft, kamagra tablets for sale that expands your horizons helps you deal with change and crisis, such as the erectile dysfunction kamagra. Near the end, the piece lists some free or low-cost online class sites and some programs that allow nontraditional students to audit classes or work on projects with enrolled graduate and undergraduate students. You might enjoy “Looks like I wasn’t muted during our Zoom meeting,” by Susie Aquilina, for McSweeney’s (9/10/20)..

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As we approach the end of a tumultuous year, NHPR is checking in with people we spoke to early on in the kamagra to see how things where is better to buy kamagra have changed. It’s part of a series we’re calling “Hindsight.”Earlier this year, some doctors feared rural areas would be overwhelmed with too many erectile dysfunction treatment patients and too few resources. In June, we reported on a study that found rural areas of New Hampshire and Vermont were doing better than expected - but things have changed quite a bit since then.

Recently NHPR's Peter Biello spoke where is better to buy kamagra again with Dartmouth College Professors Elizabeth Carpenter-Song and Anne Sosin. We want to hear from you, too. Over 9 months into the erectile dysfunction kamagra, how has your life changed?.

Click here to take our survey where is better to buy kamagra. NHPR's Peter Biello speaks with Dartmouth professors Anne Sosin and Elizabeth Carpenter-Song. This has not gone the way you predicted back then.

Things look very different where is better to buy kamagra now. What has surprised you the most, Elizabeth?. Elizabeth Carpenter-Song.

I think what we're seeing now, certainly at this stage in late fall and early winter, we're really seeing a divergence in terms of state responses between Vermont and New Hampshire...In the early days of this work, both states looked remarkably similar, and now we're seeing dramatically different where is better to buy kamagra state-level responses, which we believe are contributing to different outcomes across Vermont and New Hampshire. Which ones would you identify?. Which policy and which outcome?.

ECS. We're really seeing the differences with the Vermont response being very robust at the state level. Early action...particularly some of the changes with respect to limits on social gatherings, for example, whereas on the New Hampshire side, we were the last within the New England region to issue a mandate [for masks].New Hampshire has a political culture that emphasizes local control.

What has the impact of that culture been on the kamagra?. Anne Sosin. One thing that's really important to understand in the context of the kamagra is the state response to erectile dysfunction treatment, including its contact tracing, is centralized in Concord.

And this has important impacts on rural epidemics. We've seen a rapid growth in cases in southern New Hampshire impact the ability of rural settings to trace cases early on and this is allowed outbreaks to grow more quickly than they might have had contact tracing capacity been sufficient. To add to that, we have seen growing outbreaks across rural regions, but we're also seeing really effective local responses in responding to those outbreaks.

And those responses have really largely played out without strong public health measures at the state level and without strong outbreak response teams like we're seeing on the Vermont side of the river. But what we really need to understand is that many of the public health measures that were in place in the spring and contributed to the state's early success are no longer there. And so while a mask mandate may have some impact on transmission, it's probably not going to be enough to reverse the trends that we're seeing right now.

So when you say the systems that were in place in the spring are no longer in place, what do you mean?. AS. In the spring, the state was under a stay at home order, so there were significant restrictions on public institutions, the private sector, and on other areas of life.

And now the state is largely open, with some limited restrictions. And that's quite different from where Vermont is as a state. Vermont has significant restrictions in place, some of which were already in place prior to the recent uptick in cases, and others which were layered on top of those public health measures.

And Elizabeth, what does all of that mean for rural health specifically in New Hampshire moving forward?. ECS. In our early phase interviews in the spring, our interviews with health leaders really spoke to the rapid transition that these health systems had to take with respect to responding to the kamagra, scaling up their resources, thinking about how people would be shifted into different roles and preparing for the surge.

What we're hearing now in terms of the rural health system is really...there's growing concern, of course, about the increasing cases within the region and specifically on our critical care capacity and on the rural health workforce as well. One thing that I think is important for us to understand is that, as a region, we might think about the rural health system as being an ecosystem of care - and so what's occuring, for example, in the southern tier of New Hampshire has an impact on our rural health system. As those hospitals begin to reach capacity, then the ability of small and rural hospitals to transfer patients to those hospitals becomes very limited.

And, of course, this is not only important for those patients who may be suffering from erectile dysfunction treatment in rural regions, but also, for example, if one were to have a heart attack, the ability to get an intensive intervention can be compromised in this situation. Get stories and updates on the kamagra in your inbox - sign up for NHPR's erectile dysfunction newsletter today..

As we approach the end of a tumultuous year, NHPR is checking http://cheaperhotels.dk/where-can-i-buy-cialis-in-singapore/ in with people we spoke to early on in the kamagra to see how things kamagra tablets for sale have changed. It’s part of a series we’re calling “Hindsight.”Earlier this year, some doctors feared rural areas would be overwhelmed with too many erectile dysfunction treatment patients and too few resources. In June, we reported on a study that found rural areas of New Hampshire and Vermont were doing better than expected - but things have changed quite a bit since then. Recently NHPR's Peter Biello spoke again with Dartmouth College kamagra tablets for sale Professors Elizabeth Carpenter-Song and Anne Sosin. We want to hear from you, too.

Over 9 months into the erectile dysfunction kamagra, how has your life changed?. Click here to kamagra tablets for sale take our survey. NHPR's Peter Biello speaks with Dartmouth professors Anne Sosin and Elizabeth Carpenter-Song. This has not gone the way you predicted back then. Things look very kamagra tablets for sale different now.

What has surprised you the most, Elizabeth?. Elizabeth Carpenter-Song. I think what we're seeing now, certainly at this stage in kamagra tablets for sale late fall and early winter, we're really seeing a divergence in terms of state responses between Vermont and New Hampshire...In the early days of this work, both states looked remarkably similar, and now we're seeing dramatically different state-level responses, which we believe are contributing to different outcomes across Vermont and New Hampshire. Which ones would you identify?. Which policy and which outcome?.

ECS. We're really seeing the differences with the Vermont response being very robust at the state level. Early action...particularly some of the changes with respect to limits on social gatherings, for example, whereas on the New Hampshire side, we were the last within the New England region to issue a mandate [for masks].New Hampshire has a political culture that emphasizes local control. What has the impact of that culture been on the kamagra?. Anne Sosin.

One thing that's really important to understand in the context of the kamagra is the state response to erectile dysfunction treatment, including its contact tracing, is centralized in Concord. And this has important impacts on rural epidemics. We've seen a rapid growth in cases in southern New Hampshire impact the ability of rural settings to trace cases early on and this is allowed outbreaks to grow more quickly than they might have had contact tracing capacity been sufficient. To add to that, we have seen growing outbreaks across rural regions, but we're also seeing really effective local responses in responding to those outbreaks. And those responses have really largely played out without strong public health measures at the state level and without strong outbreak response teams like we're seeing on the Vermont side of the river.

But what we really need to understand is that many of the public health measures that were in place in the spring and contributed to the state's early success are no longer there. And so while a mask mandate may have some impact on transmission, it's probably not going to be enough to reverse the trends that we're seeing right now. So when you say the systems that were in place in the spring are no longer in place, what do you mean?. AS. In the spring, the state was under a stay at home order, so there were significant restrictions on public institutions, the private sector, and on other areas of life.

And now the state is largely open, with some limited restrictions. And that's quite different from where Vermont is as a state. Vermont has significant restrictions in place, some of which were already in place prior to the recent uptick in cases, and others which were layered on top of those public health measures. And Elizabeth, what does all of that mean for rural health specifically in New Hampshire moving forward?. ECS.

In our early phase interviews in the spring, our interviews with health leaders really spoke to the rapid transition that these health systems had to take with respect to responding to the kamagra, scaling up their resources, thinking about how people would be shifted into different roles and preparing for the surge. What we're hearing now in terms of the rural health system is really...there's growing concern, of course, about the increasing cases within the region and specifically on our critical care capacity and on the rural health workforce as well. One thing that I think is important for us to understand is that, as a region, we might think about the rural health system as being an ecosystem of care - and so what's occuring, for example, in the southern tier of New Hampshire has an impact on our rural health system. As those hospitals begin to reach capacity, then the ability of small and rural hospitals to transfer patients to those hospitals becomes very limited. And, of course, this is not only important for those patients who may be suffering from erectile dysfunction treatment in rural regions, but also, for example, if one were to have a heart attack, the ability to get an intensive intervention can be compromised in this situation.

Get stories and updates on the kamagra in your inbox - sign up for NHPR's erectile dysfunction newsletter today..

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Coaching more details soon If you have questions, please email communications@ibms.org15 July 2021 The Science Council is inviting IBMS members to take part in its new campaign showcasing the work of scientists in relation to climate change. In the run-up to COP26, held for the first time in the UK this November, the Science Council are looking to showcase the outstanding contribution of scientists and science technicians working on the latest research order kamagra gel to achieve a greener future. Securing global net-zero by mid-century and limiting global temperature rise to 1.5 degrees requires huge collaboration and connected thinking.

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More than 1.5 million children around the world are estimated to have lost at least kamagra buy online canada one parent, custodial grandparent, or grandparent who lived with them due to death related How much does generic flagyl cost to erectile dysfunction treatment during the first 14 months of the kamagra, according to a study published today in The Lancet. The study highlights orphanhood as an urgent and overlooked consequence of the kamagra and emphasizes that providing evidence-based psychosocial and economic support to children who have lost a caregiver must be a key part of responding to the kamagra.The analysis used mortality and fertility data to model rates of erectile dysfunction treatment-associated orphanhood (death of one or both parents) and deaths of custodial and co-residing grandparents (ages 60-84) from March 1, 2020 to April 30, 2021, across 21 countries. This study was funded in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.In the paper, "erectile dysfunction treatment-associated deaths" referred to the combination of deaths caused directly by erectile dysfunction treatment and those caused kamagra buy online canada indirectly by other associated causes, such as lockdowns, restrictions on gatherings and movement, decreased access or acceptability of health care and of treatment for chronic diseases.Traumatic experiences, such as the loss of a parent or caregiver, are associated with increases in substance use, mental health conditions, and other behavioral and chronic health conditions. NIDA supports research aimed at understanding the impact of trauma on young people, preventing substance use after experiencing hardship, and treating substance use in populations that experience trauma."Studies like this play a crucial role in illuminating the erectile dysfunction treatment kamagra's long-lasting consequences for families and the future mental health and wellbeing of children across the globe," said NIDA Director Nora D.

Volkow, M.D. "Though the trauma a child experiences after the loss of a parent or caregiver can be devastating, there are evidence-based interventions that can prevent further adverse consequences, such as substance use, and we must ensure that children have access to these interventions."To estimate kamagra-associated orphanhood and caregiver deaths, kamagra buy online canada the study used excess mortality and erectile dysfunction treatment mortality data for 21 countries that accounted for 77% of global erectile dysfunction treatment deaths during 2020 and early 2021. These include Argentina, Brazil, Colombia, England and Wales, France, Germany, India, Iran, Italy, Kenya, Malawi, Mexico, Nigeria, Peru, Philippines, Poland, Russian Federation, South Africa, Spain, United States, and Zimbabwe.The authors estimate that 1,134,000 children lost a parent or custodial grandparent due to erectile dysfunction treatment-associated death. Of these, 1,042,000 children were kamagra buy online canada orphaned of a mother, father, or both -- most lost one, not both parents.

Overall, 1,562,000 children are estimated to have experienced the death of at least one parent or a custodial or other co-residing grandparent (or other older relative).The countries with the highest numbers of children who lost primary caregivers (parents or custodial grandparents) included South Africa, Peru, United States, India, Brazil, and Mexico. The countries with rates of erectile dysfunction treatment-associated deaths among primary caregivers (>1/1000 children) included Peru, South Africa, Mexico, Brazil, Colombia, Iran, United States, Argentina, and Russia.The study found that for every country, erectile dysfunction treatment associated deaths were greater in men than women, particularly in middle- and older-ages. Overall, there were up to five times more children who lost a father than who lost a mother."We know from our research that loss of kamagra buy online canada a parent or caregiver can upend children's lives and potentially affect their development if they are not in a stable home setting. If we take into consideration variants of concern or possible severity of illness among youth, we must not forget that the kamagra continues to pose a threat to parents and caregivers -- and their children," said Chuck A.

Nelson, III, Ph.D., study author, Boston Children's Hospital.While research on the science of substance use and addiction remains the primary focus of NIDA's work, NIDA is supporting erectile dysfunction treatment research, and has issued over $15 million in funding for erectile dysfunction treatment-related projects since the start of the kamagra that could leverage current infrastructure, projects, or scientific knowledge kamagra buy online canada and resources.Miché Aaron has always been a high achiever. The 29-year-old is in her third year of a planetary sciences doctoral program at Johns Hopkins University, where she researches minerals found on Mars. She’s a former NASA space grant scholar and hopes to become an astronaut one day. But last year, Aaron was barely keeping it together kamagra buy online canada — missing classes, late on assignments and struggling to explain that she understood the required material to pass her qualifying exams.

Her academic adviser warned that if she didn’t get professional help she would flunk. €œI simply thought I was a lazy student and I needed to try harder,” Aaron said, wiping the tears behind her kamagra buy online canada thick, black-framed glasses. Then she was diagnosed with attention deficit hyperactivity disorder and it all made sense. For many Black women like Aaron, finally having that answer comes with both relief and grief after years of suffering and being misunderstood.

Already subject to unique discrimination at the intersection of gender and race, Black girls with ADHD often remain undiagnosed because their symptoms are mischaracterized kamagra buy online canada. Signs of inattentiveness or impulsivity, two main features of the disorder, could be mistaken for laziness or defiance. And the kamagra buy online canada longer these girls aren’t diagnosed and treated, the more their problems are likely to worsen as they grow into adults. While the 2016 National Survey of Children’s Health showed that 6.1 million children ages 2 to 17 in the United States have received a diagnosis for ADHD at some point, millions more adults are estimated to have it, too — either having grown up with a diagnosis or being diagnosed later in life, if at all.

ADHD doesn’t discriminate by gender or race, but white boys are still more likely to be diagnosed and treated for the condition than anyone else. Experts and advocates say this leads to an inequity in care that hurts girls of any background and children kamagra buy online canada of color of any gender. Over the past few decades, mental health experts and researchers have started to understand how ADHD manifests differently depending on gender, as girls with the condition tend to seem more inattentive and forgetful while boys tend to seem more hyperactive and disruptive. The reasons Black children and ethnic minorities are overlooked range from racial bias in schools and lack of access to care, to stigma and distrust of educators and health providers based on past discrimination.

Paul Morgan, director of the Center kamagra buy online canada for Educational Disparities Research at Penn State, is the lead author of multiple studies showing that the disparities in school start early. By kindergarten, Black children in the U.S. Are 70% less likely to receive an ADHD kamagra buy online canada diagnosis than otherwise similar white children. A 2016 study found that by 10th grade white children are nearly twice as likely to receive a diagnosis for ADHD as Black children.

Lead author Dr. Tumaini Rucker Coker, head of general pediatrics at Seattle Children’s Hospital and a top researcher at its Center for Child Health, Behavior and Development, said that, while her study didn’t look at underdiagnosis of Black girls, federal Education Department data shows telling signs of kamagra buy online canada racial and gender discrimination in diagnosing ADHD. Black girls are six times as likely to be suspended from school as white girls. Behavior as common as talking back in class could have wildly different consequences, depending kamagra buy online canada on how it’s interpreted, Coker explained.

For Black girls, it’s often viewed as “intimidation” of a teacher. €œWhen there’s ‘bad behavior’ and you’re a white girl, you get all the benefit of the doubt,” Coker said. €œOn the opposite spectrum, you get zero benefit of the doubt as a kamagra buy online canada Black girl.” Over time, studies have shown that ADHD, especially in girls, can lead to increased rates of anxiety and depression, risky behavior, drug use, self-harm and suicide attempts. Researchers and therapists said they are especially worried about those undiagnosed or undertreated.

Being diagnosed and treated, on the other kamagra buy online canada hand, has many upsides. Medication and therapy, and even behavioral training for parents of patients, have proven to be highly effective in managing ADHD. However, access to such resources depends not only on a diagnosis, but also trust and buy-in from families. René Brooks, who lives outside Gettysburg, Pennsylvania, was diagnosed three times — twice kamagra buy online canada as a child, when her school tested her without parental permission.

Her mother rejected the idea of her daughter, who is Black, being labeled, distrusting a system she feared wanted to “drug up minority children.” The third time Brooks was diagnosed, she was 25 and on the brink of losing her job at one of the biggest insurers in the state because she couldn’t keep up with the workload. After starting medication, 18 years after her first diagnosis, she said her kamagra buy online canada brain felt like it “switched on” and she was able to be more productive than she ever imagined possible. Still, as a Black woman with ADHD, Brooks felt alone. €œIt’s very isolating to sit at that intersection because no one’s there, or so we thought,” she said.

She started a blog called “Black Girl, Lost Keys,” which educates and empowers Black women with ADHD, and created Unicorn Squad, Black People kamagra buy online canada of Marginalized Genders With ADHD, a private support group on Facebook with more than 2,200 members who share the feelings that come with the diagnosis. Aaron said finding the Facebook group and talking with other Black women with ADHD during the weekly virtual meetings made it easier to accept her diagnosis. They also commiserate about the all-too-common racialized slights known as microaggressions that she and others face — whether it’s being dismissed for showing emotion as an “angry Black woman” or having to fight for accommodations at school or being doubted at pharmacies when trying to fill prescriptions for stimulants that treat ADHD under the assumption they’re addicts kamagra buy online canada trying to misuse the controlled substances, sold under brand names such as Adderall, Concerta and Ritalin. €œI simply thought I was a lazy student and I needed to try harder,” Aaron says.

Then she was diagnosed with attention deficit hyperactivity disorder and it all made sense.(Will Kirk / Johns Hopkins University) Dr. Loucresie Rupert, a child-adolescent psychiatrist, adult ADHD coach and mental health advocate in Winona, Minnesota, also blogs kamagra buy online canada about her personal experience with ADHD. She recognized her symptoms during medical school — problems studying, missing appointments, forgetting to pay bills — and was officially diagnosed during her medical residency, after failing a two-day-long licensing exam. The latter was a wake-up call.

€œI’ve never failed at kamagra buy online canada anything in my life,” said Rupert. As a Black woman, Rupert understands why her Black female patients are so grateful to find her. It’s hard enough to find a local psychiatrist who is covered by one’s insurance and specializes in ADHD, kamagra buy online canada let alone a Black female psychiatrist who has ADHD herself. Rupert said she, too, sees a Black female psychiatrist, who shares some of the same experiences and sensitivities, which makes a big difference.

€œIt’s taken my healing and my ability to function to the next level, because you don’t have to explain as many things.” For example, when discussing police brutality, she said, “I don’t have to spell out how exhausted or tired or traumatized I am.” Coker and Morgan agreed that culturally and linguistically sensitive screenings are key to getting more people diagnosed. Also critical kamagra buy online canada. Culturally relevant groups like the Unicorn Squad. A year and a half after being diagnosed with kamagra buy online canada ADHD, Aaron said the treatment she’s received, including medication, therapy and strategies for learning and organization, has changed her life.

She has since found out she also has dyslexia and a language processing disorder, two learning disabilities that commonly occur with ADHD. Far from flunking out, she’s now thriving academically and publishing her research on Martian minerals. She wants to help other Black women going through similar struggles, just kamagra buy online canada as Brooks’ Unicorn Squad helped her. €œWhen you start receiving treatment, the biggest impact is to your self-esteem, because you’re no longer concerned that you’re just lazy, or that you’re just unmotivated,” said Brooks.

€œYou know this is a problem, and problems have solutions, whereas character flaws kamagra buy online canada do not.” Related Topics Contact Us Submit a Story TipSACRAMENTO, Calif. €” Getting clean drinking water cost Ignacio Padilla his health insurance. The World War II veteran needed to repay the loan for the water pump installed on his 1-acre property in rural Tulare County, the only source of water to his mobile home. He carefully socked away a few thousand dollars so he could make the kamagra buy online canada payoff — only to find that those savings put him over the asset threshold to remain on Medi-Cal, California’s Medicaid program for low-income people.

He was booted from the health insurance program in 2019. It wasn’t kamagra buy online canada an emergency at the time. Padilla still had coverage from Medicare and the Department of Veterans Affairs, and he could live an independent, if remote, life. Ignacio Padilla, 95, was kicked off Medi-Cal in 2019 because he had money saved to pay off the pump that supplies water to his Tulare County mobile home.

Older daughter Emily Ysais is trying to reenroll kamagra buy online canada him in the program before he needs a nursing home. (Emily Ysais) But now Padilla is 95 and has congestive heart failure. His children kamagra buy online canada are trying to get him back on Medi-Cal so it can eventually cover the costs for nursing home care. His older daughter, Emily Ysais, worries that Padilla’s finances — limited though they are — will again disqualify him.

He gets $1,100 a month from his pension and Social Security. If Veterans Affairs approves the monthly caregiving stipend kamagra buy online canada she helped her dad apply for, it could tip him over the limit of Medi-Cal’s “asset test.” “Our hands are tied,” said Ysais, 67. €œIt’s hard to keep figuring out a way to take care of him.” Change is coming, though perhaps not soon enough for Padilla. A provision in California’s newly approved state budget will eliminate the asset test for the 2 million Californians enrolled in both Medi-Cal and Medicare, the federal health insurance program for people 65 and older and people under 65 with certain disabilities.

Instead, their financial eligibility will be kamagra buy online canada based solely on income, as it is for the millions of other people in Medi-Cal. The elimination of the test will be a game changer for aging or impaired Californians who need long-term care but are caught in a common conundrum. They don’t earn enough to cover the high kamagra buy online canada costs of ongoing nursing home care and can’t rely on Medicare, which does not cover extended nursing home stays. They can get that care through Medi-Cal, but they would have to wipe out their savings first.

The 2021-22 state budget deal includes several provisions that will make it easier to get on and stay on Medi-Cal, including the elimination of the asset test. Everyone 50 and over will be eligible, regardless of kamagra buy online canada immigration status. And new mothers will be allowed to remain on Medi-Cal for one year after giving birth, up from 60 days. The budget also includes $15 million over the next three years, starting this year, to develop online enrollment forms and translate kamagra buy online canada them into multiple languages, and $8 million for counties to help some people who get in-home care stay enrolled.

California has a strong Medi-Cal takeup rate, with 95% of eligible people enrolled, said Laurel Lucia, director of the health care program at the Center for Labor Research and Education at the University of California-Berkeley. But of the remaining uninsured people, about 610,000 qualify for Medi-Cal, she said. €œWe are doing well, but so many people are eligible and not enrolled,” kamagra buy online canada Lucia said. €œThe barriers to Medi-Cal enrollment and retention are really multifaceted, so the solutions have to be as well.” This is an especially volatile moment for the program, which covers 13.6 million Californians.

The state is trying to improve the quality of care by renegotiating kamagra buy online canada its contracts with managed-care insurance companies. At the same time, Gov. Gavin Newsom and the state Department of Health Care Services are proposing a massive overhaul that would provide more services to homeless people and incarcerated people and boost mental health care. Meanwhile, Medi-Cal kamagra buy online canada enrollment continues to grow.

State officials estimate enrollment will balloon to 14.5 million this fiscal year, which began July 1. The changes to Medi-Cal that were approved in the budget kamagra buy online canada include an expansion that Democratic lawmakers have been seeking for years. California already allows eligible unauthorized immigrants up to age 26 to receive full Medi-Cal benefits. Starting next spring, that will expand to people 50 and up.

State officials estimate about 175,000 people will kamagra buy online canada enroll in the first year, with an additional 3,600 people signing up every year thereafter, eventually costing the state $1.3 billion annually. And, starting next July, new mothers will be able to stay on Medi-Cal for up to one year after giving birth. By 2027, the additional coverage is expected to kamagra buy online canada cost the state about $200 million a year. Assembly Republican Leader Marie Waldron (R-Escondido), who said she supports expanding eligibility for the program in limited circumstances, was the author of a bill to allow incarcerated people to enroll before they’re released that was ultimately folded into the budget and will take effect in 2023.

But she said the changes in this year’s budget go too far. €œExpensive government-run health care doesn’t really work, and most voters don’t want to pay kamagra buy online canada for it,” Waldron said. €œBut California Democrats seem to think everyone will love it once they are on it, which is not true. It’s creeping socialism.” The elimination of the Medi-Cal asset test for older Californians and those with certain disabilities, which takes effect July 1, 2022, marks a dramatic change to the program.

Officials estimate it will cost the state kamagra buy online canada roughly $200 million a year once fully implemented because of the increased enrollment. Right now, these people can’t qualify for Medi-Cal if they have saved more than $2,000. For couples, kamagra buy online canada it’s $3,000. Complicated rules dictate what counts as an “asset” and what doesn’t.

A house doesn’t count and neither does one car, but a second car does. Engagement rings and heirlooms kamagra buy online canada are fine, but other jewelry counts toward the limit. Ultimately, the test favors individuals and families who can navigate the rules and find ways to hide money in exempt accounts, said Claire Ramsey, a senior attorney with Justice in Aging. €œYou create administrative hurdles, which keeps people kamagra buy online canada artificially off the program,” Ramsey said.

€œIf it’s hard for the lawyers to understand all the rules, what does that mean for the average person who’s just trying to have health insurance?. € The federal Affordable Care Act eliminated the asset test for most Medicaid enrollees, basing financial eligibility exclusively on income, but left out people who qualify for both Medicaid and Medicare. This is especially important kamagra buy online canada when it comes to expensive long-term care, like nursing homes, which can cost $10,000 a month, said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform. Medicare covers nursing home care only in limited circumstances and for up to 100 days.

After that, patients must find another way to pay, kamagra buy online canada either out-of-pocket or through Medi-Cal. Because many people don’t qualify for Medi-Cal if they have too much money or other assets, they have to spend through their savings and shed their belongings before they can get on the program. €œThousands and thousands of people have become impoverished to afford nursing home care,” McGinnis said. €œYou want kamagra buy online canada free medical care?.

You’re going to have to spend every penny you have to get it.” A state Assembly analysis estimated that 17,802 additional Californians would have become eligible in 2018 if the asset test hadn’t been required. Of those, 435 were in long-term care, and over the course of the year, 263 spent their money or gave away their assets to kamagra buy online canada qualify for Medi-Cal. Assembly member Wendy Carrillo (D-Los Angeles), the author of the asset test bill that was folded into the budget, sees eliminating the requirement as part of a larger movement toward universal coverage, in line with efforts to expand Medi-Cal to older unauthorized immigrants or establish a single-payer system. €œWe need to aggressively and proactively work on legislation that gives more people coverage,” Carrillo said.

€œAnd until we have universal health care, these are the steps kamagra buy online canada necessary to ensure that.” This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Rachel Bluth. rbluth@kff.org, @RachelHBluth Related Topics Contact Us Submit a Story Tip.

More than kamagra tablets for sale 1.5 million children around the world are estimated to have lost at least one parent, http://spinslotsdeals.com/how-much-does-generic-flagyl-cost/ custodial grandparent, or grandparent who lived with them due to death related to erectile dysfunction treatment during the first 14 months of the kamagra, according to a study published today in The Lancet. The study highlights orphanhood as an urgent and overlooked consequence of the kamagra and emphasizes that providing evidence-based psychosocial and economic support to children who have lost a caregiver must be a key part of responding to the kamagra.The analysis used mortality and fertility data to model rates of erectile dysfunction treatment-associated orphanhood (death of one or both parents) and deaths of custodial and co-residing grandparents (ages 60-84) from March 1, 2020 to April 30, 2021, across 21 countries. This study was funded in part by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.In the paper, kamagra tablets for sale "erectile dysfunction treatment-associated deaths" referred to the combination of deaths caused directly by erectile dysfunction treatment and those caused indirectly by other associated causes, such as lockdowns, restrictions on gatherings and movement, decreased access or acceptability of health care and of treatment for chronic diseases.Traumatic experiences, such as the loss of a parent or caregiver, are associated with increases in substance use, mental health conditions, and other behavioral and chronic health conditions. NIDA supports research aimed at understanding the impact of trauma on young people, preventing substance use after experiencing hardship, and treating substance use in populations that experience trauma."Studies like this play a crucial role in illuminating the erectile dysfunction treatment kamagra's long-lasting consequences for families and the future mental health and wellbeing of children across the globe," said NIDA Director Nora D.

Volkow, M.D. "Though the trauma a child experiences after the loss of a parent or caregiver can be devastating, there are evidence-based interventions kamagra tablets for sale that can prevent further adverse consequences, such as substance use, and we must ensure that children have access to these interventions."To estimate kamagra-associated orphanhood and caregiver deaths, the study used excess mortality and erectile dysfunction treatment mortality data for 21 countries that accounted for 77% of global erectile dysfunction treatment deaths during 2020 and early 2021. These include Argentina, Brazil, Colombia, England and Wales, France, Germany, India, Iran, Italy, Kenya, Malawi, Mexico, Nigeria, Peru, Philippines, Poland, Russian Federation, South Africa, Spain, United States, and Zimbabwe.The authors estimate that 1,134,000 children lost a parent or custodial grandparent due to erectile dysfunction treatment-associated death. Of these, 1,042,000 children were orphaned of a mother, father, or both -- most lost kamagra tablets for sale one, not both parents.

Overall, 1,562,000 children are estimated to have experienced the death of at least one parent or a custodial or other co-residing grandparent (or other older relative).The countries with the highest numbers of children who lost primary caregivers (parents or custodial grandparents) included South Africa, Peru, United States, India, Brazil, and Mexico. The countries with rates of erectile dysfunction treatment-associated deaths among primary caregivers (>1/1000 children) included Peru, South Africa, Mexico, Brazil, Colombia, Iran, United States, Argentina, and Russia.The study found that for every country, erectile dysfunction treatment associated deaths were greater in men than women, particularly in middle- and older-ages. Overall, there were up to five kamagra tablets for sale times more children who lost a father than who lost a mother."We know from our research that loss of a parent or caregiver can upend children's lives and potentially affect their development if they are not in a stable home setting. If we take into consideration variants of concern or possible severity of illness among youth, we must not forget that the kamagra continues to pose a threat to parents and caregivers -- and their children," said Chuck A.

Nelson, III, Ph.D., study author, Boston Children's Hospital.While research on the science of substance use and addiction remains the primary focus of NIDA's work, NIDA is supporting erectile dysfunction treatment research, and has issued over $15 million in funding for erectile dysfunction treatment-related projects since the start of the kamagra that could leverage current infrastructure, projects, or scientific knowledge kamagra tablets for sale and resources.Miché Aaron has always been a high achiever. The 29-year-old is in her third year of a planetary sciences doctoral program at Johns Hopkins University, where she researches minerals found on Mars. She’s a former NASA space grant scholar and hopes to become an astronaut one day. But last year, Aaron was barely keeping it together — missing classes, kamagra tablets for sale late on assignments and struggling to explain that she understood the required material to pass her qualifying exams.

Her academic adviser warned that if she didn’t get professional help she would flunk. €œI simply thought I was a lazy student and I needed to try harder,” Aaron kamagra tablets for sale said, wiping the tears behind her thick, black-framed glasses. Then she was diagnosed with attention deficit hyperactivity disorder and it all made sense. For many Black women like Aaron, finally having that answer comes with both relief and grief after years of suffering and being misunderstood.

Already subject to unique discrimination at the intersection kamagra tablets for sale of gender and race, Black girls with ADHD often remain undiagnosed because their symptoms are mischaracterized. Signs of inattentiveness or impulsivity, two main features of the disorder, could be mistaken for laziness or defiance. And the longer these girls aren’t diagnosed and treated, the more their problems are likely to worsen as kamagra tablets for sale they grow into adults. While the 2016 National Survey of Children’s Health showed that 6.1 million children ages 2 to 17 in the United States have received a diagnosis for ADHD at some point, millions more adults are estimated to have it, too — either having grown up with a diagnosis or being diagnosed later in life, if at all.

ADHD doesn’t discriminate by gender or race, but white boys are still more likely to be diagnosed and treated for the condition than anyone else. Experts and advocates say this leads to an inequity in care kamagra tablets for sale that hurts girls of any background and children of color of any gender. Over the past few decades, mental health experts and researchers have started to understand how ADHD manifests differently depending on gender, as girls with the condition tend to seem more inattentive and forgetful while boys tend to seem more hyperactive and disruptive. The reasons Black children and ethnic minorities are overlooked range from racial bias in schools and lack of access to care, to stigma and distrust of educators and health providers based on past discrimination.

Paul Morgan, director of the Center for Educational Disparities Research at Penn State, is the lead author of multiple studies showing that kamagra tablets for sale the disparities in school start early. By kindergarten, Black children in the U.S. Are 70% less likely to receive an ADHD diagnosis kamagra tablets for sale than otherwise similar white children. A 2016 study found that by 10th grade white children are nearly twice as likely to receive a diagnosis for ADHD as Black children.

Lead author Dr. Tumaini Rucker Coker, head of general pediatrics at Seattle Children’s Hospital and a top researcher at its Center for Child Health, Behavior and Development, said that, while her study didn’t look kamagra tablets for sale at underdiagnosis of Black girls, federal Education Department data shows telling signs of racial and gender discrimination in diagnosing ADHD. Black girls are six times as likely to be suspended from school as white girls. Behavior as kamagra tablets for sale common as talking back in class could have wildly different consequences, depending on how it’s interpreted, Coker explained.

For Black girls, it’s often viewed as “intimidation” of a teacher. €œWhen there’s ‘bad behavior’ and you’re a white girl, you get all the benefit of the doubt,” Coker said. €œOn the opposite spectrum, you get zero benefit of the doubt as a kamagra tablets for sale Black girl.” Over time, studies have shown that ADHD, especially in girls, can lead to increased rates of anxiety and depression, risky behavior, drug use, self-harm and suicide attempts. Researchers and therapists said they are especially worried about those undiagnosed or undertreated.

Being diagnosed kamagra tablets for sale and treated, on the other hand, has many upsides. Medication and therapy, and even behavioral training for parents of patients, have proven to be highly effective in managing ADHD. However, access to such resources depends not only on a diagnosis, but also trust and buy-in from families. René Brooks, who lives outside Gettysburg, Pennsylvania, kamagra tablets for sale was diagnosed three times — twice as a child, when her school tested her without parental permission.

Her mother rejected the idea of her daughter, who is Black, being labeled, distrusting a system she feared wanted to “drug up minority children.” The third time Brooks was diagnosed, she was 25 and on the brink of losing her job at one of the biggest insurers in the state because she couldn’t keep up with the workload. After starting medication, 18 years after her first diagnosis, she said her brain felt like it “switched on” and she was able kamagra tablets for sale to be more productive than she ever imagined possible. Still, as a Black woman with ADHD, Brooks felt alone. €œIt’s very isolating to sit at that intersection because no one’s there, or so we thought,” she said.

She started a blog called “Black Girl, Lost kamagra tablets for sale Keys,” which educates and empowers Black women with ADHD, and created Unicorn Squad, Black People of Marginalized Genders With ADHD, a private support group on Facebook with more than 2,200 members who share the feelings that come with the diagnosis. Aaron said finding the Facebook group and talking with other Black women with ADHD during the weekly virtual meetings made it easier to accept her diagnosis. They also commiserate about the all-too-common racialized slights known as kamagra tablets for sale microaggressions that she and others face — whether it’s being dismissed for showing emotion as an “angry Black woman” or having to fight for accommodations at school or being doubted at pharmacies when trying to fill prescriptions for stimulants that treat ADHD under the assumption they’re addicts trying to misuse the controlled substances, sold under brand names such as Adderall, Concerta and Ritalin. €œI simply thought I was a lazy student and I needed to try harder,” Aaron says.

Then she was diagnosed with attention deficit hyperactivity disorder and it all made sense.(Will Kirk / Johns Hopkins University) Dr. Loucresie Rupert, a child-adolescent kamagra tablets for sale psychiatrist, adult ADHD coach and mental health advocate in Winona, Minnesota, also blogs about her personal experience with ADHD. She recognized her symptoms during medical school — problems studying, missing appointments, forgetting to pay bills — and was officially diagnosed during her medical residency, after failing a two-day-long licensing exam. The latter was a wake-up call.

€œI’ve never kamagra tablets for sale failed at anything in my life,” said Rupert. As a Black woman, Rupert understands why her Black female patients are so grateful to find her. It’s hard enough to find a local psychiatrist who is covered by one’s insurance and specializes kamagra tablets for sale in ADHD, let alone a Black female psychiatrist who has ADHD herself. Rupert said she, too, sees a Black female psychiatrist, who shares some of the same experiences and sensitivities, which makes a big difference.

€œIt’s taken my healing and my ability to function to the next level, because you don’t have to explain as many things.” For example, when discussing police brutality, she said, “I don’t have to spell out how exhausted or tired or traumatized I am.” Coker and Morgan agreed that culturally and linguistically sensitive screenings are key to getting more people diagnosed. Also critical kamagra tablets for sale. Culturally relevant groups like the Unicorn Squad. A year and a half after kamagra tablets for sale being diagnosed with ADHD, Aaron said the treatment she’s received, including medication, therapy and strategies for learning and organization, has changed her life.

She has since found out she also has dyslexia and a language processing disorder, two learning disabilities that commonly occur with ADHD. Far from flunking out, she’s now thriving academically and publishing her research on Martian minerals. She wants to help other Black women going through kamagra tablets for sale similar struggles, just as Brooks’ Unicorn Squad helped her. €œWhen you start receiving treatment, the biggest impact is to your self-esteem, because you’re no longer concerned that you’re just lazy, or that you’re just unmotivated,” said Brooks.

€œYou know this is kamagra tablets for sale a problem, and problems have solutions, whereas character flaws do not.” Related Topics Contact Us Submit a Story TipSACRAMENTO, Calif. €” Getting clean drinking water cost Ignacio Padilla his health insurance. The World War II veteran needed to repay the loan for the water pump installed on his 1-acre property in rural Tulare County, the only source of water to his mobile home. He carefully socked away a few thousand dollars so he could make the payoff — only to find that those savings put him over the asset threshold to remain on Medi-Cal, California’s Medicaid program for low-income people kamagra tablets for sale.

He was booted from the health insurance program in 2019. It wasn’t an emergency at the time kamagra tablets for sale. Padilla still had coverage from Medicare and the Department of Veterans Affairs, and he could live an independent, if remote, life. Ignacio Padilla, 95, was kicked off Medi-Cal in 2019 because he had money saved to pay off the pump that supplies water to his Tulare County mobile home.

Older daughter Emily Ysais is trying to reenroll him in the program before he kamagra tablets for sale needs a nursing home. (Emily Ysais) But now Padilla is 95 and has congestive heart failure. His children are trying to get him back on kamagra tablets for sale Medi-Cal so it can eventually cover the costs for nursing home care. His older daughter, Emily Ysais, worries that Padilla’s finances — limited though they are — will again disqualify him.

He gets $1,100 a month from his pension and Social Security. If Veterans Affairs kamagra tablets for sale approves the monthly caregiving stipend she helped her dad apply for, it could tip him over the limit of Medi-Cal’s “asset test.” “Our hands are tied,” said Ysais, 67. €œIt’s hard to keep figuring out a way to take care of him.” Change is coming, though perhaps not soon enough for Padilla. A provision in California’s newly approved state budget will eliminate the asset test for the 2 million Californians enrolled in both Medi-Cal and Medicare, the federal health insurance program for people 65 and older and people under 65 with certain disabilities.

Instead, their financial eligibility will be based solely on income, as it is for the kamagra tablets for sale millions of other people in Medi-Cal. The elimination of the test will be a game changer for aging or impaired Californians who need long-term care but are caught in a common conundrum. They don’t earn enough to cover kamagra tablets for sale the high costs of ongoing nursing home care and can’t rely on Medicare, which does not cover extended nursing home stays. They can get that care through Medi-Cal, but they would have to wipe out their savings first.

The 2021-22 state budget deal includes several provisions that will make it easier to get on and stay on Medi-Cal, including the elimination of the asset test. Everyone 50 and over will be eligible, regardless kamagra tablets for sale of immigration status. And new mothers will be allowed to remain on Medi-Cal for one year after giving birth, up from 60 days. The budget also includes $15 million over the next three years, starting this kamagra tablets for sale year, to develop online enrollment forms and translate them into multiple languages, and $8 million for counties to help some people who get in-home care stay enrolled.

California has a strong Medi-Cal takeup rate, with 95% of eligible people enrolled, said Laurel Lucia, director of the health care program at the Center for Labor Research and Education at the University of California-Berkeley. But of the remaining uninsured people, about 610,000 qualify for Medi-Cal, she said. €œWe are doing kamagra tablets for sale well, but so many people are eligible and not enrolled,” Lucia said. €œThe barriers to Medi-Cal enrollment and retention are really multifaceted, so the solutions have to be as well.” This is an especially volatile moment for the program, which covers 13.6 million Californians.

The state is trying to improve kamagra tablets for sale the quality of care by renegotiating its contracts with managed-care insurance companies. At the same time, Gov. Gavin Newsom and the state Department of Health Care Services are proposing a massive overhaul that would provide more services to homeless people and incarcerated people and boost mental health care. Meanwhile, Medi-Cal kamagra tablets for sale enrollment continues to grow.

State officials estimate enrollment will balloon to 14.5 million this fiscal year, which began July 1. The changes to Medi-Cal that kamagra tablets for sale were approved in the budget include an expansion that Democratic lawmakers have been seeking for years. California already allows eligible unauthorized immigrants up to age 26 to receive full Medi-Cal benefits. Starting next spring, that will expand to people 50 and up.

State officials estimate about 175,000 people will enroll in kamagra tablets for sale the first year, with an additional 3,600 people signing up every year thereafter, eventually costing the state $1.3 billion annually. And, starting next July, new mothers will be able to stay on Medi-Cal for up to one year after giving birth. By 2027, the additional coverage is expected to cost the kamagra tablets for sale state about $200 million a year. Assembly Republican Leader Marie Waldron (R-Escondido), who said she supports expanding eligibility for the program in limited circumstances, was the author of a bill to allow incarcerated people to enroll before they’re released that was ultimately folded into the budget and will take effect in 2023.

But she said the changes in this year’s budget go too far. €œExpensive government-run health care doesn’t really work, and most voters kamagra tablets for sale don’t want to pay for it,” Waldron said. €œBut California Democrats seem to think everyone will love it once they are on it, which is not true. It’s creeping socialism.” The elimination of the Medi-Cal asset test for older Californians and those with certain disabilities, which takes effect July 1, 2022, marks a dramatic change to the program.

Officials estimate it will cost the state roughly $200 million a year kamagra tablets for sale once fully implemented because of the increased enrollment. Right now, these people can’t qualify for Medi-Cal if they have saved more than $2,000. For couples, it’s kamagra tablets for sale $3,000. Complicated rules dictate what counts as an “asset” and what doesn’t.

A house doesn’t count and neither does one car, but a second car does. Engagement rings and heirlooms kamagra tablets for sale are fine, but other jewelry counts toward the limit. Ultimately, the test favors individuals and families who can navigate the rules and find ways to hide money in exempt accounts, said Claire Ramsey, a senior attorney with Justice in Aging. €œYou create administrative hurdles, which keeps people artificially off kamagra tablets for sale the program,” Ramsey said.

€œIf it’s hard for the lawyers to understand all the rules, what does that mean for the average person who’s just trying to have health insurance?. € The federal Affordable Care Act eliminated the asset test for most Medicaid enrollees, basing financial eligibility exclusively on income, but left out people who qualify for both Medicaid and Medicare. This is especially important when it comes to expensive long-term care, like nursing homes, which can cost $10,000 a month, said Patricia McGinnis, executive director of California Advocates for Nursing Home kamagra tablets for sale Reform. Medicare covers nursing home care only in limited circumstances and for up to 100 days.

After that, kamagra tablets for sale patients must find another way to pay, either out-of-pocket or through Medi-Cal. Because many people don’t qualify for Medi-Cal if they have too much money or other assets, they have to spend through their savings and shed their belongings before they can get on the program. €œThousands and thousands of people have become impoverished to afford nursing home care,” McGinnis said. €œYou want free medical kamagra tablets for sale care?.

You’re going to have to spend every penny you have to get it.” A state Assembly analysis estimated that 17,802 additional Californians would have become eligible in 2018 if the asset test hadn’t been required. Of those, 435 kamagra tablets for sale were in long-term care, and over the course of the year, 263 spent their money or gave away their assets to qualify for Medi-Cal. Assembly member Wendy Carrillo (D-Los Angeles), the author of the asset test bill that was folded into the budget, sees eliminating the requirement as part of a larger movement toward universal coverage, in line with efforts to expand Medi-Cal to older unauthorized immigrants or establish a single-payer system. €œWe need to aggressively and proactively work on legislation that gives more people coverage,” Carrillo said.

€œAnd until we have universal health kamagra tablets for sale care, these are the steps necessary to ensure that.” This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. Rachel Bluth. rbluth@kff.org, @RachelHBluth Related Topics Contact Us Submit a Story Tip.