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Heads Up - Changes Coming April 2021 Once again, NYS is changing the way people without Medicare access buy xalatan online without prescription prescription drugs. Since October 2011, most people who do not have Medicare obtained their drugs throug their Medicaid managed care plan. At that time, this drug benefit was "carved into" the Medicaid managed care benefit package. Before that date, people enrolled in a Medicaid managed care plan obtained all of their health care through the plan, but used their regular Medicaid card to access any drug available buy xalatan online without prescription on the state formulary on a "fee for service" basis without needing to utilize a restricted pharmacy network or comply with managed care plan rules.

COMING IN April 2021 - In the NYS Budget enacted in April 2020, the pharmacy benefit was "carved out" of "mainstream" Medicaid managed care plans. That means that members of managed care plans will access their drugs outside their plan, unlike the rest of their medical care, which is accessed from in-network providers. How Prescription Drugs are Obtained through buy xalatan online without prescription Managed Care plans No - Until April 2020 HOW DO MANAGED CARE PLANS DEFINE THE PHARMACY BENEFIT FOR CONSUMERS?. The Medicaid pharmacy benefit includes all FDA approved prescription drugs, as well as some over-the-counter drugs and medical supplies.

Under Medicaid managed care. Plan formularies will buy xalatan online without prescription be comparable to but not the same as the Medicaid formulary. Managed care plans are required to have drug formularies that are “comparable” to the Medicaid fee for service formulary. Plan formularies do not have to include all drugs covered listed on the fee for service formulary, but they must include generic or therapeutic equivalents of all Medicaid covered drugs.

The Pharmacy Benefit will vary by buy xalatan online without prescription plan. Each plan will have its own formulary and drug coverage policies like prior authorization and step therapy. Pharmacy networks can also differ from plan to plan. Prescriber Prevails applies in buy xalatan online without prescription certain drug classes.

Prescriber prevails applys to medically necessary precription drugs in the following classes. atypical antipsychotics, anti-depressants, anti-retrovirals, anti-rejection, seizure, epilepsy, endocrine, hemotologic and immunologic therapeutics. Prescribers will need to demonstrate buy xalatan online without prescription reasonable profession judgment and supply plans witht requested information and/or clinical documentation. Pharmacy Benefit Information Website -- http://mmcdruginformation.nysdoh.suny.edu/-- This website provides very helpful information on a plan by plan basis regarding pharmacy networks and drug formularies.

The Department of Health plans to build capacity for interactive searches allowing for comparison of coverage across plans in the near future. Standardized Prior Autorization (PA) Form -- The Department of Health worked with managed care plans, provider organizations and other state agencies to develop a standard prior authorization form buy xalatan online without prescription for the pharmacy benefit in Medicaid managed care. The form will be posted on the Pharmacy Information Website in July of 2013. Mail Order Drugs -- Medicaid managed care members can obtain mail order/specialty drugs at any retail network pharmacy, as long as that retail network pharmacy agrees to a price that is comparable to the mail order/specialty pharmacy price.

CAN CONSUMERS SWITCH PLANS IN buy xalatan online without prescription ORDER TO GAIN ACCESS TO DRUGS?. Changing plans is often an effective strategy for consumers eligible for both Medicaid and Medicare (dual eligibles) who receive their pharmacy service through Medicare Part D, because dual eligibles are allowed to switch plans at any time. Medicaid consumers will have this option only in the limited circumstances during the first year of enrollment in managed care. Medicaid managed care enrollees can only leave and buy xalatan online without prescription join another plan within the first 90 days of joining a health plan.

After the 90 days has expired, enrollees are “locked in” to the plan for the rest of the year. Consumers can switch plans during the “lock in” period only for good cause. The pharmacy benefit buy xalatan online without prescription changes are not considered good cause. After the first 12 months of enrollment, Medicaid managed care enrollees can switch plans at any time.

STEPS CONSUMERS CAN TAKE WHEN A MANAGED CARE PLAM DENIES ACCESS TO A NECESSARY DRUG As a first step, consumers should try to work with their providers to satisfy plan requirements for prior authorization or step therapy or any other utilization control requirements. If the plan still denies access, consumers can pursue review processes specific to buy xalatan online without prescription managed care while at the same time pursuing a fair hearing. All plans are required to maintain an internal and external review process for complaints and appeals of service denials. Some plans may develop special procedures for drug denials.

Information on these procedures should be provided in buy xalatan online without prescription member handbooks. Beginning April 1, 2018, Medicaid managed care enrollees whose plan denies prior approval of a prescription drug, or discontinues a drug that had been approved, will receive an Initial Adverse Determination notice from the plan - See Model Denial IAD Notice and IAD Notice to Reduce, Suspend or Stop Services The enrollee must first request an internal Plan Appeal and wait for the Plan's decision. An adverse decision is called a 'FInal Adverse Determination" or FAD. See model Denial FAD Notice and buy xalatan online without prescription FAD Notice to Reduce, Suspend or Stop Services.

The enroll has the right to request a fair hearing to appeal an FAD. The enrollee may only request a fair hearing BEFORE receiving the FAD if the plan fails to send the FAD in the required time limit, which is 30 calendar days in standard appeals, and 72 hours in expedited appeals. The plan may extend the time to decide both standard and expedited appeals by up to 14 days if more information is needed and it is buy xalatan online without prescription in the enrollee's interest. AID CONTINUING -- If an enrollee requests a Plan Appeal and then a fair hearing because access to a drug has been reduced or terminated, the enrollee has the right to aid continuing (continued access to the drug in question) while waiting for the Plan Appeal and then the fair hearing.

The enrollee must request the Plan Appeal and then the Fair Hearing before the effective date of the IAD and FAD notices, which is a very short time - only 10 days including mailing time. See more about the changes in Managed buy xalatan online without prescription Care appeals here. Even though that article is focused on Managed Long Term Care, the new appeals requirements also apply to Mainstream Medicaid managed care. Enrollees who are in the first 90 days of enrollment, or past the first 12 months of enrollment also have the option of switching plans to improve access to their medications.

Consumers who experience problems with access to buy xalatan online without prescription prescription drugs should always file a complaint with the State Department of Health’s Managed Care Hotline, number listed below. ACCESSING MEDICAID'S PHARMACY BENEFIT IN FEE FOR SERVICE MEDICAID For those Medicaid recipients who are not yet in a Medicaid Managed Care program, and who do not have Medicare Part D, the Medicaid Pharmacy program covers most of their prescription drugs and select non-prescription drugs and medical supplies for Family Health Plus enrollees. Certain drugs/drug categories require the prescribers to obtain prior authorization. These include brand name drugs that have a generic alternative under New York's mandatory generic drug program or prescribed drugs that are not on New York's preferred drug buy xalatan online without prescription list.

The full Medicaid formulary can be searched on the eMedNY website. Even in fee for service Medicaid, prescribers must obtain prior authorization before prescribing non-preferred drugs unless otherwise indicated. Prior authorization buy xalatan online without prescription is required for original prescriptions, not refills. A prior authorization is effective for the original dispensing and up to five refills of that prescription within the next six months.

Click here for more information on NY's prior authorization process. The New York State Board of Pharmacy publishes an annual list of the 150 most frequently prescribed drugs, in the most common buy xalatan online without prescription quantities. The State Department of Health collects retail price information on these drugs from pharmacies that participate in the Medicaid program. Click here to search for a specific drug from the most frequently prescribed drug list and this site can also provide you with the locations of pharmacies that provide this drug as well as their costs.

Click buy xalatan online without prescription here to view New York State Medicaid’s Pharmacy Provider Manual. WHO YOU CAN CALL FOR HELP Community Health Advocates Hotline. 1-888-614-5400 NY State Department of Health's Managed Care Hotline. 1-800-206-8125 buy xalatan online without prescription (Mon.

- Fri. 8:30 am - 4:30 pm) NY State Department of Insurance. 1-800-400-8882 NY State Attorney General's Health buy xalatan online without prescription Care Bureau. 1-800-771-7755Haitian individuals and immigrants from some other countries who have applied for Temporary Protected Status (TPS) may be eligible for public health insurance in New York State.

2019 updates - The Trump administration has taken steps to end TPS status. Two courts have temporarily enjoined the termination of TPS, one in New York State in April 2019 and one in California in October buy xalatan online without prescription 2018. The California case was argued in an appeals court on August 14, 2019, which the LA Times reported looked likely to uphold the federal action ending TPS. See US Immigration Website on TPS - General TPS website with links to status in all countries, including HAITI.

See also Pew Research March 2019 article buy xalatan online without prescription. Courts Block Changes in Public charge rule- See updates on the Public Charge rule here, blocked by federal court injunctions in October 2019. Read more about this change in public charge rules here. What is buy xalatan online without prescription Temporary Protected Status?.

TPS is a temporary immigration status granted to eligible individuals of a certain country designated by the Department of Homeland Security because serious temporary conditions in that country, such as armed conflict or environmental disaster, prevents people from that country to return safely. On January 21, 2010 the United States determined that individuals from Haiti warranted TPS because of the devastating earthquake that occurred there on January 12. TPS gives undocumented Haitian buy xalatan online without prescription residents, who were living in the U.S. On January 12, 2010, protection from forcible deportation and allows them to work legally.

It is important to note that the U.S. Grants TPS to individuals from other countries, as well, including individuals from El Salvador, Honduras, Nicaragua, Somalia buy xalatan online without prescription and Sudan. TPS and Public Health Insurance TPS applicants residing in New York are eligible for Medicaid and Family Health Plus as long as they also meet the income requirements for these programs. In New York, applicants for TPS are considered PRUCOL immigrants (Permanently Residing Under Color of Law) for purposes of medical assistance eligibility and thus meet the immigration status requirements for Medicaid, Family Health Plus, and the Family Planning Benefit Program.

Nearly all children in New York remain buy xalatan online without prescription eligible for Child Health Plus including TPS applicants and children who lack immigration status. For more information on immigrant eligibility for public health insurance in New York see 08 GIS MA/009 and the attached chart. Where to Apply What to BringIndividuals who have applied for TPS will need to bring several documents to prove their eligibility for public health insurance. Individuals will buy xalatan online without prescription need to bring.

1) Proof of identity. 2) Proof of residence in New York. 3) buy xalatan online without prescription Proof of income. 4) Proof of application for TPS.

5) Proof that U.S. Citizenship and Immigration Services (USCIS) has received the buy xalatan online without prescription application for TPS. Free Communication Assistance All applicants for public health insurance, including Haitian Creole speakers, have a right to get help in a language they can understand. All Medicaid offices and enrollers are required to offer free translation and interpretation services to anyone who cannot communicate effectively in English.

A bilingual worker or an interpreter, whether in-person or over the telephone, must be provided in all interactions with the office. Important documents, such as Medicaid applications, should be translated either orally or in writing. Interpreter services must be offered free of charge, and applicants requiring interpreter services must not be made to wait unreasonably longer than English speaking applicants. An applicant must never be asked to bring their own interpreter.

Related Resources on TPS and Public Health Insurance o The New York Immigration Coalition (NYIC) has compiled a list of agencies, law firms, and law schools responding to the tragedy in Haiti and the designation of Haiti for Temporary Protected Status. A copy of the list is posted at the NYIC’s website at http://www.thenyic.org. o USCIS TPS website with links to status in all countries, including HAITI. O For information on eligibility for public health insurance programs call The Legal Aid Society’s Benefits Hotline 1-888-663-6880 Tuesdays, Wednesdays and Thursdays.

9:30 am - 12:30 pm FOR IMMIGRATION HELP. CONTACT THE New York State New Americans Hotline for a referral to an organization to advise you. 212-419-3737 Monday-Friday, from 9:00 a.m. To 8:00 p.m.Saturday-Sunday, from 9:00 a.m.

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€œIf countries are serious about opening, they must be serious about suppressing transmission and saving lives”, get xalatan online said WHO chief Tedros Adhanom Ghebreyesus, briefing reporters from Geneva. “Opening up without having control, is a recipe for disaster.”We are 8 months into the #COVID19 pandemic &. We understand that people are tired & get xalatan online. Yearn to get on with their lives, but no country can just pretend the pandemic is over.

This virus spreads get xalatan online easily, &. We all must remain serious about suppressing its transmission &. Saving lives get xalatan online. Pic.twitter.com/1d2jR5FfvE— Tedros Adhanom Ghebreyesus (@DrTedros) August 31, 2020 While this may seem an impossible balance, it can be done if countries are in control of transmission, he said.

The more control they get xalatan online have, the more they can open. The reality is that coronavirus spreads easily, he said. It can be fatal for people of all ages and most people remain susceptible.Prevention, prevention, preventionTo control transmission, he said it is essential to get xalatan online prevent events that lead to outbreaks. COVID-19 spreads efficiently among clusters of people, with explosive outbreaks linked to gatherings at places such as sports stadiums, nightclubs and places of worship.

At the same time, there are ways to hold gatherings safely, get xalatan online Tedros said. Decisions about how and when must be made with a risk-based approach, tailored to local conditions. Tedros said countries experiencing significant community transmission may need to postpone such get xalatan online events. Those seeing sporadic cases or small clusters, on the other hand, can find creative ways to hold events while minimizing risk.He advocated a focus on reducing deaths by protecting the elderly, people with underlying conditions and essential workers.

Countries get xalatan online that do this well may be able to cope with low levels of transmission as they open.Individuals must play their part by staying at least one metre away from others, cleaning their hands regularly, practicing respiratory etiquette by wearing a mask and avoiding close-contact settings.For governments, widespread stay-at-home orders can be avoided if they take temporary, geographically targeted interventions. It is important to find, isolate, test and care for COVID-19 cases – and both trace and quarantine contacts. WHO guidance for safe reopeningThe UN get xalatan online health agency chief said WHO has a range of evidence-based guidance that can be applied in different transmission scenarios, most recently for hotels, cargo ships and fishing vessels.Meanwhile, the agency is working with its partners through the ACT Accelerator and COVAX Global Vaccines Facility to ensure that a vaccine, once developed, is available equitably to all communities. He thanked the European Commission, which announced today it would join the COVAX Facility, for its €400 million contribution.Health systems under pressureTo be sure, all countries are under extreme pressure, he declared.

A WHO survey on the impact of COVID-19 on health systems in 105 countries found that 90 per cent of those surveyed have experienced disruption to their health services, with low- and get xalatan online middle-income countries reporting the greatest difficulties. Most nations reported that routine and elective services have been suspended, while critical care – such as cancer screenings and treatment, and HIV therapies – have seen high-risk interruptions in low-income countries.While many countries are now implementing WHO-recommended strategies to mitigate service disruptions, only 14 per cent have reported the removal of user fees, which WHO recommends, offsetting potential financial difficulties for patients.He said WHO is also developing the COVID-19 Health Services Learning Hub, a web-based platform that will allow countries to share their experiences.Aftermath of Beirut explosionTedros also touched on WHO’s response to the 4 August blast in Beirut, which injured 6,500 people, left more than 300,000 homeless and severely damaged health infrastructure.He said the agency is ensuring access to basic health and mental health care for the injured. It is also expanding COVID-19 testing and treatments, buying medicines and protecting health workers.To sustain these efforts, Tedros said WHO had launched a $76 million get xalatan online appeal. The WHO Foundation on Monday launched a campaign into which any individual or organization can contribute.“This virus thrives when we are divided,” he said.

“When we are united, we can defeat it.”.

€œIf countries are serious about opening, they must be serious about suppressing transmission and buy xalatan online without prescription saving lives”, said WHO chief Tedros Adhanom Ghebreyesus, briefing reporters from Geneva. “Opening up without having control, is a recipe for disaster.”We are 8 months into the #COVID19 pandemic &. We understand that buy xalatan online without prescription people are tired &. Yearn to get on with their lives, but no country can just pretend the pandemic is over. This virus buy xalatan online without prescription spreads easily, &.

We all must remain serious about suppressing its transmission &. Saving lives buy xalatan online without prescription. Pic.twitter.com/1d2jR5FfvE— Tedros Adhanom Ghebreyesus (@DrTedros) August 31, 2020 While this may seem an impossible balance, it can be done if countries are in control of transmission, he said. The more control they have, the more they can buy xalatan online without prescription open. The reality is that coronavirus spreads easily, he said.

It can be fatal for people of all ages and most people remain susceptible.Prevention, prevention, preventionTo control transmission, he said it is buy xalatan online without prescription essential to prevent events that lead to outbreaks. COVID-19 spreads efficiently among clusters of people, with explosive outbreaks linked to gatherings at places such as sports stadiums, nightclubs and places of worship. At the same time, there are ways to hold gatherings safely, Tedros buy xalatan online without prescription said. Decisions about how and when must be made with a risk-based approach, tailored to local conditions. Tedros said countries experiencing significant community transmission may buy xalatan online without prescription need to postpone such events.

Those seeing sporadic cases or small clusters, on the other hand, can find creative ways to hold events while minimizing risk.He advocated a focus on reducing deaths by protecting the elderly, people with underlying conditions and essential workers. Countries that do this well may be able to cope with buy xalatan online without prescription low levels of transmission as they open.Individuals must play their part by staying at least one metre away from others, cleaning their hands regularly, practicing respiratory etiquette by wearing a mask and avoiding close-contact settings.For governments, widespread stay-at-home orders can be avoided if they take temporary, geographically targeted interventions. It is important to find, isolate, test and care for COVID-19 cases – and both trace and quarantine contacts. WHO guidance for safe reopeningThe UN health agency chief said WHO has a range of evidence-based guidance that can be applied in different buy xalatan online without prescription transmission scenarios, most recently for hotels, cargo ships and fishing vessels.Meanwhile, the agency is working with its partners through the ACT Accelerator and COVAX Global Vaccines Facility to ensure that a vaccine, once developed, is available equitably to all communities. He thanked the European Commission, which announced today it would join the COVAX Facility, for its €400 million contribution.Health systems under pressureTo be sure, all countries are under extreme pressure, he declared.

A WHO survey on the impact of COVID-19 on health systems in buy xalatan online without prescription 105 countries found that 90 per cent of those surveyed have experienced disruption to their health services, with low- and middle-income countries reporting the greatest difficulties. Most nations reported that routine and elective services have been suspended, while critical care – such as cancer screenings and treatment, and HIV therapies – have seen high-risk interruptions in low-income countries.While many countries are now implementing WHO-recommended strategies to mitigate service disruptions, only 14 per cent have reported the removal of user fees, which WHO recommends, offsetting potential financial difficulties for patients.He said WHO is also developing the COVID-19 Health Services Learning Hub, a web-based platform that will allow countries to share their experiences.Aftermath of Beirut explosionTedros also touched on WHO’s response to the 4 August blast in Beirut, which injured 6,500 people, left more than 300,000 homeless and severely damaged health infrastructure.He said the agency is ensuring access to basic health and mental health care for the injured. It is also expanding COVID-19 testing and treatments, buying medicines and protecting health workers.To sustain these efforts, Tedros said WHO had launched a $76 million appeal. The WHO Foundation on Monday launched a campaign into which any individual or organization can contribute.“This virus thrives when we are divided,” he said. “When we are united, we can defeat it.”.

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The past week has seen an explosion of media commentary cheap xalatan online canada about whether children in the UK should go back to school. Since ‘lockdown’ (23 March 2020) began schools have been open to vulnerable children and young people, and to the children of ‘key workers’ cheap xalatan online canada. Right from the start there have been differing opinions about the necessity or wisdom of closing schools. Viner et al1 produced cheap xalatan online canada a rapid systematic review that concludes that school closures have less impact on infection rate and mortality than other social distancing measures. Many countries have closed their schools for less time than the UK and have already started to reopen with several protective measures in place.2Concerns about the long-term economic, social and mental impact of lockdown led to the generation of plans to ‘get back to business’.

This was conveyed to the cheap xalatan online canada population of the UK on 10 May by the UK prime minister, Boris Johnson. He announced a range of measures to gradually reduce the level of lockdown. This is in keeping with modelling undertaken by various groups, including a preprint (not cheap xalatan online canada peer-reviewed) modelling exercise by Zhang et al.3Mr Johnson announced that there would be a phased return (in England) of some children to school from 1 June. There are no national guidelines as it is recognised that school have differences that require a flexible approach, but there are a broad set of principles relating to social distancing and hygiene.Government ministers and teachers’ unions have opposing views on the safety of reopening schools. In a joint statement nine unions representing teachers stated that they thought 1 June was too early to be safe.4 They recognise that the opening of schools is a vital part of restarting the UK economy, but they have concerns about the safety and welfare of children and others.Meanwhile, cheap xalatan online canada the education secretary, Gavin Williamson, spoke at a press conference on 16 May stating that scientific evidence backed their decision.

Interestingly, much of his statement was not about the scientific evidence but setting out an emotive argument that school was essential for safe and happy children.There is a consequence to this, the longer that schools are closed the more that children miss out. Teachers know that there are children out there that have not spoken or played with another child cheap xalatan online canada their own age for the last two months. They know there are children from difficult or very unhappy homes for whom school is the happiest moment in their week, and it’s also the safest place for them to be. The poorest cheap xalatan online canada children will be the ones who fall further behind if we keep school gates closed. This phased return is in line with what other European countries are doing.There ensued an at times ill-tempered debate and a flurry of tweets and news cheap xalatan online canada articles identifying problems in enacting the government plan and the illogical nature of Williamson’s statement.

The Institute for Fiscal Studies has produced a briefing note on children’s experiences of learning during lockdown.5 This is being widely cited as a rationale for reopening schools because children from vulnerable backgrounds are disproportionately affected by not being able to attend school. This has caused concern about the attainment gap, but as Quinn6 points out fewer children from disadvantaged backgrounds are likely to return to school than those from more affluent backgrounds.Government ministers and spokespeople reiterated that scientific evidence and observation of other European countries where schools had reopened demonstrated cheap xalatan online canada their decision was the correct one. However, there were no links provided to the scientific evidence and unions were quick to seize on this (eg, NASUWT7).The chief scientific advisor to the Department for Education, Osama Rahman, made a statement in a parliamentary science and technology committee meeting on 13 May that:There is a low degree of confidence in evidence that [children] might transmit it less.Carol Monaghan, the Scottish National Party education spokesperson, replied:We’re putting together hundreds of potential vectors that can then go on and transmit. Is that cheap xalatan online canada correct?. Osama Rahman responded:Possibly, depending on school sizes.His final statement contains layers of complexity but can be interpreted simply as ‘we don’t know’.

This provoked a cheap xalatan online canada great deal of disquiet. Rahman had already stated that the Scientific Advisory Group for Emergencies (SAGE) was collecting and considering evidence that was new and emerging, and that confidence was low in the evidence relating to transmission because there was very little evidence.8 However, this normal scientific caution in the evidence base was not discussed, and therefore it was assumed that low or moderate confidence in the evidence means a high-risk strategy is being mooted.There appear to be two major concerns about lifting the lockdown for children. First is the risk to children of developing coronavirus cheap xalatan online canada disease. The second is the risk to others of children transmitting coronavirus disease, either while being symptomatic or asymptomatic. Here are some of the available evidence.Morbidity and mortality in children from coronavirus diseaseChildren appear to be less likely to acquire coronavirus disease in various nations.9–11 Barton et al12 found that children account for 1.9% of confirmed cases (data collected from cheap xalatan online canada government websites and publications).

Of these 8113 paediatric cases, 14% required hospital admission. The admission rate to critical care was 2.2% of confirmed cases (7.2% of cheap xalatan online canada admitted children). Death was cheap xalatan online canada reported in 15 cases (0.18%). This adds to other evidence suggesting that children are at a relatively low risk from the virus, with other estimates coming in at around 0.01%.13 14 This is likely to be because they appear to have a stronger immune response to the virus.15There are concerns that children who have been infected with the virus can develop a postviral inflammatory reaction (Kawasaki disease) and this can be severe,16 but the research evidence for this is not well developed yet.Transmission by childrenChildren can be asymptomatic and test positive for COVID-19, and in the absence of effective community testing it will be impossible to know if they are carrying the virus. Children also can have normal or abnormal signs (eg, chest imaging) when they have tested positive.17 In short, it is difficult to determine without much more extensive testing if a child can transmit cheap xalatan online canada the infection.Arav et al18 found that the contact route was much more important than the airborne route, which they concluded had a negligible contribution.

They suggest protective measures would therefore be good hand hygiene, careful cleaning and avoiding physical contact.Given that there are quite low numbers of symptomatic cases and an unknown quantity of asymptomatic cases, it is very difficult to determine whether children are a significant vector for the disease. Studies cited by the Royal College of Paediatrics and Child Health that explored family clusters of infection suggest that the cheap xalatan online canada child was unlikely to be the index case.The riskThis evidence suggests that there is a case for reopening schools to limited numbers of pupils—the risk to pupils and the adults they come into contact with seems to be small, and the potential gains for children may outweigh them. There is a big proviso with this however, and that is that the overall incidence of COVID-19 has fallen below specified threshold. This is quite a contentious issue and depends on us meeting the five key tests for easing lockdown.Making sure the National Health Service can cope.A cheap xalatan online canada sustained and consistent fall in the daily death rate.Rate of infection decreasing to manageable levels.Ensuring that personal protective equipment supply can meet demand.Being confident that any adjustments would not risk a second peak.These conditions are open to interpretation, and there appears to be a lack of trust by the public and by professionals from education and health in the information that the government and their scientific advisors are sharing. An example of this is a group of scientists who have come together to challenge the government about their decision-making.19 The concern about whether the evidence and advice that we are given are biased in any way has also been increased by concerns that a government advisor (Dominic Cummings) has attended what were supposed to be politically independent meetings of the SAGE.Scientific evidence continues to emerge, but weighing up the risks and benefits is not easy.

Decisions about whether to reopen schools are taken on a cheap xalatan online canada national level with a distance from personal concerns and fears. Individuals who are making decisions often rely on media translations of the evidence, and there is a level of mistrust in politicians and the media.20 Individuals are often irrational in their risk perception and management (eg, continuing to smoke or drink alcohol despite strong scientific evidence about the risk).21 22Overall, we are information-poor and opinion-rich. It is a cheap xalatan online canada difficult path to navigate. The debate about whether the benefits outweigh the risks of returning to school reminds me of the post-Wakefield Measles Mumps and Rubella vaccination situation. Parents were being asked to believe that MMR was a safe vaccine cheap xalatan online canada in the face of a massive and emotive campaign that promoted the ‘risk’ of having the vaccine above all else.

This situation is even more cheap xalatan online canada complex than that as we have increased access to opinion and difficulty in understanding if or how much that information is biased. It is no wonder that decision-making is difficult. It is likely that evidence will continue to emerge and gradually the choice cheap xalatan online canada will become easier to make. For now, however, we can understand the difficulties that parents, teachers and councils face.IntroductionWhenever developing training competencies, tools to support clinical practice or a response to a professional issue, seeking the opinion of experts is a common approach. By working to identify a consensus position, researchers can report findings on a specific question (or set of questions) that are based on cheap xalatan online canada the knowledge and experience of experts in their field.However, there are challenges to this approach.

For example, what should be done when consensus cannot be reached?. How can experts be engaged in a way that allows them cheap xalatan online canada to consider objectively the views of others and—where appropriate—change their own opinions in response?. One approach that attempts to provide a clear method for gathering expert opinion is the Delphi technique.The Delphi technique was first developed in the 1950s by Norman Dalkey and Olaf Helmer in an attempt to gain reliable expert consensus. Specifically, they developed an approach—named after the Ancient Greek Oracle of Delphi, who could predict the future—which promoted anonymity and avoided direct confrontation between experts, so that the methods employed “…appear to be more conducive to independent thought on the part of the experts and to aid them in the gradual formation of a considered opinion”.1 Though the original Delphi study was linked to the defence industry, the technique has spread to other research areas, including nursing.2Characteristics cheap xalatan online canada of Delphi studiesAs with all research methods, the Delphi technique has evolved since it was first reported on in the 1960s. However, many of the fundamental characteristics of the approach still remain from Dalkey and Helmer’s original outline.

First, the overarching approach is based on a series of ‘rounds’, where a set of experts are asked their opinions on a particular cheap xalatan online canada issue. The questions for each round are based in part of the findings of the previous one, allowing the study to evolve over time in response to earlier findings.Second, participants are able to see the results of previous rounds—including their own responses—allowing them to reflect on the views of others and reposition their own opinions accordingly.2 This also gives them the opportunity to consider and feedback on what they perceive to be the strengths and weaknesses of other’s responses. Finally, the findings cheap xalatan online canada of each round are always shared with the broader group anonymously. This avoids any bias that might result from participants being concerned about their own views being viewed negatively or from their own cheap xalatan online canada opinions being biased by personal factors. This framework of expert opinion rounds, with each round built on previous findings and each allowing for responses to be reconsidered by participants, is designed to allow the development of a consensus view that answers the research question.Within this broad approach, there can be variation in areas such as how many rounds there are, how the questions are delivered and responses collected, and how ‘consensus’ is judged.

For example, a study of human factors cheap xalatan online canada that contributed to nursing errors used only two rounds. The first took the form of an online survey asking 25 experts to list all the ‘human’ causes of nursing errors that they could. Analysis of responses resulted in a list of 28 potential reasons—this list was sent back to the same group of experts for the second round, asking them to cheap xalatan online canada score each one for importance. Analysis of this scoring then allowed for consensus conclusions on the top 10 human factors that contributed to nursing errors (with fatigue, heavy workload and communication problems the top three).3In another example, nurse practitioners (NPs) were recruited to participate in a Delphi study to achieve consensus related to NP advance care planning competencies. In round 1, draft competencies were developed from the findings of a survey of NP beliefs, knowledge and level of cheap xalatan online canada implementation of advance care planning.

Round 2 included engagement with 29 NPs who evaluated the draft competencies and their components. Revisions were made based on the original feedback, and a third round was conducted where 15 of the original cheap xalatan online canada NP participants confirmed their consensus with the final document. The final document includes four competencies, each with several elements. Clinical Practice, Consultation and Communication, Advocacy and Therapeutic Management.4Strengths and weaknesses of Delphi studiesThe Delphi technique offers a flexible approach to gathering the views of experts on an cheap xalatan online canada area of interest. The ability for participants to reconsider their views in light of the contribution of others allows for an element of reflection that is missing from studies based on single interviews or focus groups.

The anonymity among the expert groups that underpins Delphi studies promotes honesty among participants and reduces the risk of cheap xalatan online canada the ‘halo effect’ where views from dominant or high-profile members of the group are given extra credence.5However, Delphi studies can—by their very nature—be complex and time consuming. The need for participants to complete multiple rounds can lead to high drop-out rates which impacts on cheap xalatan online canada validity of the study. The ability of participants to amend or alter their views at each round is also something of a double-edged sword. It provides those taking part with the opportunity to cheap xalatan online canada reflect and reconsider their position in response to additional information, which is an important part of nursing practice. Conversely though, there is a danger that this flexibility introduces bias, with participants altering their response to comply with what they view to be the majority view (sometime called the ‘bandwagon effect’).5Delphi studies can be criticised due to a lack of clarity on what is meant by ‘consensus’.

Even with the level of flexibility and reflexivity cheap xalatan online canada present in Delphi studies, it is still unlikely that a group of experts will demonstrate 100% agreement on issues. However, because consensus is a requirement of a Delphi study, there does need to be a judgement on when this point is reached. This is where there is inconsistency across studies and authors, with the suggested level of consensus ranging cheap xalatan online canada from 51% to 100%.2 In addition, it has been identified that in some areas, consensus is not predefined as part of the study method. For example, a review of Delphi studies in nurse education found that fewer than half of the papers appraised included a predefined level at which consensus was judged to have been achieved.6 In addition, the identification of an objective level consensus is only possible when gathering quantifiable data—the judgement on consensus being reached in some qualitative Delphi studies will always be rather more subjective on the part of the researcher, and therefore potentially open to bias.By their nature, Delphi studies often rely purely on expert opinion to generate findings. A further limitation is therefore related to the quality of evidence, with expert opinion viewed as providing a poor basis for making judgements on healthcare interventions.7 cheap xalatan online canada This does not mean that the findings of Delphi studies are intrinsically unreliable or invalid.

It does mean that researchers should consider whether their research question is one that can be answered through expert consensus or whether other approaches (such as a systematic review of research evidence) are more appropriate.ConclusionThe Delphi technique is a well-established approach to answering a research question through the identification of a consensus view across subject experts. It allows for reflection among participants, who are able to nuance and reconsider their cheap xalatan online canada opinion based on the anonymised opinions of others. However, researchers must take steps to enhance robustness of the studies. It is important to try and prevent participants from simply resorting to agreeing with cheap xalatan online canada the majority view. Studies must also predefine what is meant by ‘consensus’ and how it will be established.With careful and clear design though, Delphi studies can make a valuable contribution to the nursing evidence base by tapping into the profession’s most precious resource—the knowledge and expertise of its practitioners..

The past week has buy xalatan online without prescription seen an explosion of media commentary about whether children in the UK should go back to school. Since ‘lockdown’ (23 March 2020) began schools have buy xalatan online without prescription been open to vulnerable children and young people, and to the children of ‘key workers’. Right from the start there have been differing opinions about the necessity or wisdom of closing schools. Viner et al1 produced a buy xalatan online without prescription rapid systematic review that concludes that school closures have less impact on infection rate and mortality than other social distancing measures.

Many countries have closed their schools for less time than the UK and have already started to reopen with several protective measures in place.2Concerns about the long-term economic, social and mental impact of lockdown led to the generation of plans to ‘get back to business’. This was conveyed to the buy xalatan online without prescription population of the UK on 10 May by the UK prime minister, Boris Johnson. He announced a range of measures to gradually reduce the level of lockdown. This is in keeping with modelling undertaken by various groups, including a preprint (not peer-reviewed) modelling exercise by Zhang et al.3Mr Johnson announced that there would buy xalatan online without prescription be a phased return (in England) of some children to school from 1 June.

There are no national guidelines as it is recognised that school have differences that require a flexible approach, but there are a broad set of principles relating to social distancing and hygiene.Government ministers and teachers’ unions have opposing views on the safety of reopening schools. In a joint statement nine unions representing teachers stated that they thought 1 June was too early to be safe.4 They recognise that the opening of schools is a vital part of restarting the UK economy, but they have concerns about the safety and welfare of children and others.Meanwhile, the education secretary, Gavin Williamson, spoke at a press conference on 16 May stating that scientific buy xalatan online without prescription evidence backed their decision. Interestingly, much of his statement was not about the scientific evidence but setting out an emotive argument that school was essential for safe and happy children.There is a consequence to this, the longer that schools are closed the more that children miss out. Teachers know that there are children out there that have not spoken or played buy xalatan online without prescription with another child their own age for the last two months.

They know there are children from difficult or very unhappy homes for whom school is the happiest moment in their week, and it’s also the safest place for them to be. The poorest children will be the ones who fall further behind if we keep school gates buy xalatan online without prescription closed. This phased return is in line with what other European countries are doing.There ensued an at times ill-tempered debate and a flurry of tweets buy xalatan online without prescription and news articles identifying problems in enacting the government plan and the illogical nature of Williamson’s statement. The Institute for Fiscal Studies has produced a briefing note on children’s experiences of learning during lockdown.5 This is being widely cited as a rationale for reopening schools because children from vulnerable backgrounds are disproportionately affected by not being able to attend school.

This has caused concern about the attainment gap, buy xalatan online without prescription but as Quinn6 points out fewer children from disadvantaged backgrounds are likely to return to school than those from more affluent backgrounds.Government ministers and spokespeople reiterated that scientific evidence and observation of other European countries where schools had reopened demonstrated their decision was the correct one. However, there were no links provided to the scientific evidence and unions were quick to seize on this (eg, NASUWT7).The chief scientific advisor to the Department for Education, Osama Rahman, made a statement in a parliamentary science and technology committee meeting on 13 May that:There is a low degree of confidence in evidence that [children] might transmit it less.Carol Monaghan, the Scottish National Party education spokesperson, replied:We’re putting together hundreds of potential vectors that can then go on and transmit. Is that buy xalatan online without prescription correct?. Osama Rahman responded:Possibly, depending on school sizes.His final statement contains layers of complexity but can be interpreted simply as ‘we don’t know’.

This provoked a great deal buy xalatan online without prescription of disquiet. Rahman had already stated that the Scientific Advisory Group for Emergencies (SAGE) was collecting and considering evidence that was new and emerging, and that confidence was low in the evidence relating to transmission because there was very little evidence.8 However, this normal scientific caution in the evidence base was not discussed, and therefore it was assumed that low or moderate confidence in the evidence means a high-risk strategy is being mooted.There appear to be two major concerns about lifting the lockdown for children. First is the risk to buy xalatan online without prescription children of developing coronavirus disease. The second is the risk to others of children transmitting coronavirus disease, either while being symptomatic or asymptomatic.

Here are some of the available evidence.Morbidity and mortality in children from coronavirus diseaseChildren appear to be less likely to acquire coronavirus disease in various nations.9–11 Barton buy xalatan online without prescription et al12 found that children account for 1.9% of confirmed cases (data collected from government websites and publications). Of these 8113 paediatric cases, 14% required hospital admission. The admission rate to critical care was 2.2% of confirmed cases (7.2% of admitted buy xalatan online without prescription children). Death was reported in 15 cases buy xalatan online without prescription (0.18%).

This adds to other evidence suggesting that children are at a relatively low risk from the virus, with other estimates coming in at around 0.01%.13 14 This is likely to be because they appear to have a stronger immune response to the virus.15There are concerns that children who have been infected with the virus can develop a postviral inflammatory reaction (Kawasaki disease) and this can be severe,16 but the research evidence for this is not well developed yet.Transmission by childrenChildren can be asymptomatic and test positive for COVID-19, and in the absence of effective community testing it will be impossible to know if they are carrying the virus. Children also can buy xalatan online without prescription have normal or abnormal signs (eg, chest imaging) when they have tested positive.17 In short, it is difficult to determine without much more extensive testing if a child can transmit the infection.Arav et al18 found that the contact route was much more important than the airborne route, which they concluded had a negligible contribution. They suggest protective measures would therefore be good hand hygiene, careful cleaning and avoiding physical contact.Given that there are quite low numbers of symptomatic cases and an unknown quantity of asymptomatic cases, it is very difficult to determine whether children are a significant vector for the disease. Studies cited by the Royal College of Paediatrics and Child Health that explored family clusters of infection suggest that the child was unlikely to be the index case.The riskThis evidence suggests that there is a case for reopening schools to limited numbers of pupils—the risk to pupils and buy xalatan online without prescription the adults they come into contact with seems to be small, and the potential gains for children may outweigh them.

There is a big proviso with this however, and that is that the overall incidence of COVID-19 has fallen below specified threshold. This is quite a contentious issue and depends on us meeting the five key tests for easing lockdown.Making sure the National Health Service can cope.A sustained and consistent fall buy xalatan online without prescription in the daily death rate.Rate of infection decreasing to manageable levels.Ensuring that personal protective equipment supply can meet demand.Being confident that any adjustments would not risk a second peak.These conditions are open to interpretation, and there appears to be a lack of trust by the public and by professionals from education and health in the information that the government and their scientific advisors are sharing. An example of this is a group of scientists who have come together to challenge the government about their decision-making.19 The concern about whether the evidence and advice that we are given are biased in any way has also been increased by concerns that a government advisor (Dominic Cummings) has attended what were supposed to be politically independent meetings of the SAGE.Scientific evidence continues to emerge, but weighing up the risks and benefits is not easy. Decisions about whether to reopen schools are taken on buy xalatan online without prescription a national level with a distance from personal concerns and fears.

Individuals who are making decisions often rely on media translations of the evidence, and there is a level of mistrust in politicians and the media.20 Individuals are often irrational in their risk perception and management (eg, continuing to smoke or drink alcohol despite strong scientific evidence about the risk).21 22Overall, we are information-poor and opinion-rich. It is a difficult path buy xalatan online without prescription to navigate. The debate about whether the benefits outweigh the risks of returning to school reminds me of the post-Wakefield Measles Mumps and Rubella vaccination situation. Parents were being asked to believe that MMR was a safe vaccine in the buy xalatan online without prescription face of a massive and emotive campaign that promoted the ‘risk’ of having the vaccine above all else.

This situation is even more complex than that as we have buy xalatan online without prescription increased access to opinion and difficulty in understanding if or how much that information is biased. It is no wonder that decision-making is difficult. It is likely that buy xalatan online without prescription evidence will continue to emerge and gradually the choice will become easier to make. For now, however, we can understand the difficulties that parents, teachers and councils face.IntroductionWhenever developing training competencies, tools to support clinical practice or a response to a professional issue, seeking the opinion of experts is a common approach.

By working to identify a consensus position, researchers can report findings on a specific buy xalatan online without prescription question (or set of questions) that are based on the knowledge and experience of experts in their field.However, there are challenges to this approach. For example, what should be done when consensus cannot be reached?. How can experts be engaged in a way that allows them to consider objectively the views of others and—where appropriate—change buy xalatan online without prescription their own opinions in response?. One approach that attempts to provide a clear method for gathering expert opinion is the Delphi technique.The Delphi technique was first developed in the 1950s by Norman Dalkey and Olaf Helmer in an attempt to gain reliable expert consensus.

Specifically, they developed an approach—named after the Ancient Greek Oracle of Delphi, who could predict the future—which promoted anonymity and avoided direct confrontation between experts, buy xalatan online without prescription so that the methods employed “…appear to be more conducive to independent thought on the part of the experts and to aid them in the gradual formation of a considered opinion”.1 Though the original Delphi study was linked to the defence industry, the technique has spread to other research areas, including nursing.2Characteristics of Delphi studiesAs with all research methods, the Delphi technique has evolved since it was first reported on in the 1960s. However, many of the fundamental characteristics of the approach still remain from Dalkey and Helmer’s original outline. First, the overarching approach is based on a series of ‘rounds’, where a set of experts are asked their opinions on a buy xalatan online without prescription particular issue. The questions for each round are based in part of the findings of the previous one, allowing the study to evolve over time in response to earlier findings.Second, participants are able to see the results of previous rounds—including their own responses—allowing them to reflect on the views of others and reposition their own opinions accordingly.2 This also gives them the opportunity to consider and feedback on what they perceive to be the strengths and weaknesses of other’s responses.

Finally, the findings of each round are always shared with the broader group anonymously buy xalatan online without prescription. This avoids any bias that might result from participants being concerned about buy xalatan online without prescription their own views being viewed negatively or from their own opinions being biased by personal factors. This framework of expert opinion rounds, with each round built on previous findings and each allowing for responses to be reconsidered by participants, is designed to allow the development of a consensus view that answers the research question.Within this broad approach, there can be variation in areas such as how many rounds there are, how the questions are delivered and responses collected, and how ‘consensus’ is judged. For example, a study of human factors buy xalatan online without prescription that contributed to nursing errors used only two rounds.

The first took the form of an online survey asking 25 experts to list all the ‘human’ causes of nursing errors that they could. Analysis of buy xalatan online without prescription responses resulted in a list of 28 potential reasons—this list was sent back to the same group of experts for the second round, asking them to score each one for importance. Analysis of this scoring then allowed for consensus conclusions on the top 10 human factors that contributed to nursing errors (with fatigue, heavy workload and communication problems the top three).3In another example, nurse practitioners (NPs) were recruited to participate in a Delphi study to achieve consensus related to NP advance care planning competencies. In round 1, buy xalatan online without prescription draft competencies were developed from the findings of a survey of NP beliefs, knowledge and level of implementation of advance care planning.

Round 2 included engagement with 29 NPs who evaluated the draft competencies and their components. Revisions were made based on buy xalatan online without prescription the original feedback, and a third round was conducted where 15 of the original NP participants confirmed their consensus with the final document. The final document includes four competencies, each with several elements. Clinical Practice, Consultation and Communication, Advocacy and Therapeutic Management.4Strengths and weaknesses of Delphi studiesThe Delphi technique buy xalatan online without prescription offers a flexible approach to gathering the views of experts on an area of interest.

The ability for participants to reconsider their views in light of the contribution of others allows for an element of reflection that is missing from studies based on single interviews or focus groups. The anonymity among the expert groups that underpins Delphi studies promotes honesty among participants and reduces the risk of the ‘halo effect’ where views from dominant buy xalatan online without prescription or high-profile members of the group are given extra credence.5However, Delphi studies can—by their very nature—be complex and time consuming. The need for participants to complete multiple rounds can lead to high drop-out rates which impacts on buy xalatan online without prescription validity of the study. The ability of participants to amend or alter their views at each round is also something of a double-edged sword.

It provides those taking part with the opportunity to reflect and reconsider their position in response to additional information, which is an important part of nursing buy xalatan online without prescription practice. Conversely though, there is a danger that this flexibility introduces bias, with participants altering their response to comply with what they view to be the majority view (sometime called the ‘bandwagon effect’).5Delphi studies can be criticised due to a lack of clarity on what is meant by ‘consensus’. Even with the level buy xalatan online without prescription of flexibility and reflexivity present in Delphi studies, it is still unlikely that a group of experts will demonstrate 100% agreement on issues. However, because consensus is a requirement of a Delphi study, there does need to be a judgement on when this point is reached.

This is where there is inconsistency across buy xalatan online without prescription studies and authors, with the suggested level of consensus ranging from 51% to 100%.2 In addition, it has been identified that in some areas, consensus is not predefined as part of the study method. For example, a review of Delphi studies in nurse education found that fewer than half of the papers appraised included a predefined level at which consensus was judged to have been achieved.6 In addition, the identification of an objective level consensus is only possible when gathering quantifiable data—the judgement on consensus being reached in some qualitative Delphi studies will always be rather more subjective on the part of the researcher, and therefore potentially open to bias.By their nature, Delphi studies often rely purely on expert opinion to generate findings. A further limitation is therefore related to the quality of buy xalatan online without prescription evidence, with expert opinion viewed as providing a poor basis for making judgements on healthcare interventions.7 This does not mean that the findings of Delphi studies are intrinsically unreliable or invalid. It does mean that researchers should consider whether their research question is one that can be answered through expert consensus or whether other approaches (such as a systematic review of research evidence) are more appropriate.ConclusionThe Delphi technique is a well-established approach to answering a research question through the identification of a consensus view across subject experts.

It allows buy xalatan online without prescription for reflection among participants, who are able to nuance and reconsider their opinion based on the anonymised opinions of others. However, researchers must take steps to enhance robustness of the studies. It is important to try and prevent participants from simply resorting to agreeing with the majority view buy xalatan online without prescription. Studies must also predefine what is meant by ‘consensus’ and how it will be established.With careful and clear design though, Delphi studies can make a valuable contribution to the nursing evidence base by tapping into the profession’s most precious resource—the knowledge and expertise of its practitioners..

Xalatan generic cost walmart

Comfort and pain management have always been paramount in the child-centered approach xalatan generic cost walmart to care at UC Davis Children’s Hospital. A new hospital initiative called Comfort Commitment launched this month, which provides a standardized approach to xalatan generic cost walmart help pediatric patients better cope with distressing procedures and decrease pain and anxiety. Child life specialist Emily McDaniel and nurse Carter Todd discuss comfort planning with a patient.It involves four steps to managing a patient’s comfort:Ask the child and caregiver what they know and understand about the procedureShare more about the procedure in simple terms using honest, age-appropriate languagePlan for the procedure, considering medicine and numbing options, refocusing techniques (toys, electronics, music), comfort positions (chest-to-chest for small children with their caregiver, swaddle for infants and young toddlers) and a calming environment (with lights, noises and words)Follow the agreed-upon plan and ensure the child feels heard and modify comfort measures to meet the patient’s needs“Our ultimate goal is to establish an environment where hospital experiences can be growth-promoting for children and families,” said child life specialist Emily McDaniel. €œThrough individualizing procedural comfort plans with this collaborative four-step process, we are consistently able to provide coping support and empower the child to customize xalatan generic cost walmart a plan that uniquely meets their specific needs.”The initiative was funded by a Children's Miracle Network at UC Davis grant.

For more information, visit https://ucdavis.health/comfort.A pandemic is probably not the best time to refer to someone’s personality as ‘infectious.’ Shalaine Reddic has always believed she could do more than people thought she could.But you don’t have to talk with Shalaine Reddic for long, even on the phone, to feel the positive energy and can-do spirit of this UC Davis Medical Center nurse.Reddic’s desire to help patients blends perfectly with her strong drive to succeed, academic muscle and never-say-die attitude – all wrapped up in what she calls her fashion-forward style.A single mother of three, Reddic has never stopped moving up the career ladder. She started out doing clerical work on the Davis xalatan generic cost walmart campus years ago. Today, Reddic is on the verge of becoming a licensed nurse practitioner.“I always xalatan generic cost walmart like to stay busy,” said Reddic.That’s an understatement. She was deftly juggling the phone conversation after a long work week while providing cooking instruction to her 16-year-old son.

€œAnd I’ve always believed that I could do more than people thought I could,” she said.When she first started working, the Rancho Cordova resident didn’t xalatan generic cost walmart consider the patient side of health care. She didn’t enjoy the thought of seeing blood or being in the clinic environment. But after becoming a clinical quality improvement coordinator at UC Davis Health, she started working with nurses and quickly gained an appreciation for the profession.Reddic spent nearly 10 years slowly but steadily taking classes and moving xalatan generic cost walmart from one nursing degree to the next – from an associate of art’s degree at a community college to a bachelor’s degree (cum laude, of course) from Sacramento State – all while working and almost single-handedly raising her children.“I have seen her push through personal issues on numerous occasions,” said Darrell Desmond, nurse manager of Reddic’s hospital unit. €œBut she just keeps moving forward with an always positive attitude despite life’s many challenges.”It was while volunteering at a community clinic for underserved women in Sacramento that Reddic had what she calls an xalatan generic cost walmart epiphany.

It was a moment of intense clarity for someone who already had a rewarding nursing career.“I saw nurse practitioners working with patients, diagnosing health problems, prescribing medications,” Reddic said. €œThey were xalatan generic cost walmart providers. They had the autonomy to make patient-care decisions. For me, that xalatan generic cost walmart was it.

I was in tears because I knew then and there that was what I really wanted to do.”So, Reddic decided to add another academic achievement to her three nursing degrees and an AA degree in business administration. A graduate degree as a family nurse practitioner.Always on the move, Reddic never stops seeking new goals and achievements.Three years and many commute miles later, she recently completed her xalatan generic cost walmart master’s from Sonoma State and is now studying for her boards. While working full xalatan generic cost walmart time, of course.Reddic admits to being overwhelmed at times over the years. But she said strong faith and prayer helped her put things in perspective when she felt defeated and exhausted.“It’s been a journey and a learning process,” Reddic said.

€œI’ve got xalatan generic cost walmart a few bruises, but I’m still here and excited about each day. When I face adversity, I always step it up a notch.”As if it wasn’t enough to become a nurse practitioner, Reddic is considering going back to school for a certificate in psychiatry and, perhaps, a doctorate at some point.She’s also dreaming about plans for starting two independent clinics. One would be dedicated to xalatan generic cost walmart serving underprivileged communities. The other would be an IV hydration bar, a xalatan generic cost walmart trending intravenous therapy program for wellness, beauty and health.“Shalaine has organized her life for success,” said Joleen Lonigan, an executive director of Patient Care Services at UC Davis Medical Center.

€œShe’s turned her motivation into achievements and her pathway into inspiration that can benefit others.”Her story is undoubtedly motivational for anyone who knows Reddic. Colleagues say her xalatan generic cost walmart determination is impressive. Her attitude always stays positive, undoubtedly enhanced by that fashion-forward sensibility that can be seen, despite the required nursing apparel, in some colorful shoe choices and unique earrings. And those academic xalatan generic cost walmart and clinical accomplishments?.

They’re likely just steppingstones leading toward further personal and professional goals.In short, Shalaine Reddic and the spirit with which she approaches life seem – even in a pandemic age – wonderfully contagious..

Comfort and pain management have always been paramount in the child-centered approach to care at UC Davis Children’s buy xalatan online without prescription Hospital. A new hospital initiative called Comfort Commitment launched this month, which provides a standardized approach to help pediatric patients better cope with distressing procedures buy xalatan online without prescription and decrease pain and anxiety. Child life specialist Emily McDaniel and nurse Carter Todd discuss comfort planning with a patient.It involves four steps to managing a patient’s comfort:Ask the child and caregiver what they know and understand about the procedureShare more about the procedure in simple terms using honest, age-appropriate languagePlan for the procedure, considering medicine and numbing options, refocusing techniques (toys, electronics, music), comfort positions (chest-to-chest for small children with their caregiver, swaddle for infants and young toddlers) and a calming environment (with lights, noises and words)Follow the agreed-upon plan and ensure the child feels heard and modify comfort measures to meet the patient’s needs“Our ultimate goal is to establish an environment where hospital experiences can be growth-promoting for children and families,” said child life specialist Emily McDaniel. €œThrough individualizing procedural comfort plans with this collaborative four-step process, we are consistently able to provide coping support and empower the child to customize a plan that uniquely meets their specific needs.”The initiative was funded by a Children's Miracle buy xalatan online without prescription Network at UC Davis grant. For more information, visit https://ucdavis.health/comfort.A pandemic is probably not the best time to refer to someone’s personality as ‘infectious.’ Shalaine Reddic has always believed she could do more than people thought she could.But you don’t have to talk with Shalaine Reddic for long, even on the phone, to feel the positive energy and can-do spirit of this UC Davis Medical Center nurse.Reddic’s desire to help patients blends perfectly with her strong drive to succeed, academic muscle and never-say-die attitude – all wrapped up in what she calls her fashion-forward style.A single mother of three, Reddic has never stopped moving up the career ladder.

She started out doing clerical work on the Davis campus years buy xalatan online without prescription ago. Today, Reddic is on the verge of becoming a licensed nurse practitioner.“I buy xalatan online without prescription always like to stay busy,” said Reddic.That’s an understatement. She was deftly juggling the phone conversation after a long work week while providing cooking instruction to her 16-year-old son. €œAnd I’ve always believed that I could do more buy xalatan online without prescription than people thought I could,” she said.When she first started working, the Rancho Cordova resident didn’t consider the patient side of health care. She didn’t enjoy the thought of seeing blood or being in the clinic environment.

But after becoming a clinical quality improvement coordinator at UC Davis Health, she started working with nurses and quickly gained an appreciation for the profession.Reddic spent nearly 10 years slowly but steadily taking classes and moving from one nursing degree to the next – from an buy xalatan online without prescription associate of art’s degree at a community college to a bachelor’s degree (cum laude, of course) from Sacramento State – all while working and almost single-handedly raising her children.“I have seen her push through personal issues on numerous occasions,” said Darrell Desmond, nurse manager of Reddic’s hospital unit. €œBut she just buy xalatan online without prescription keeps moving forward with an always positive attitude despite life’s many challenges.”It was while volunteering at a community clinic for underserved women in Sacramento that Reddic had what she calls an epiphany. It was a moment of intense clarity for someone who already had a rewarding nursing career.“I saw nurse practitioners working with patients, diagnosing health problems, prescribing medications,” Reddic said. €œThey were buy xalatan online without prescription providers. They had the autonomy to make patient-care decisions.

For me, buy xalatan online without prescription that was it. I was in tears because I knew then and there that was what I really wanted to do.”So, Reddic decided to add another academic achievement to her three nursing degrees and an AA degree in business administration. A graduate degree as a family nurse practitioner.Always on the move, Reddic never stops seeking new goals and achievements.Three years and many commute miles later, she recently completed her master’s from Sonoma State and is now buy xalatan online without prescription studying for her boards. While working full time, of course.Reddic buy xalatan online without prescription admits to being overwhelmed at times over the years. But she said strong faith and prayer helped her put things in perspective when she felt defeated and exhausted.“It’s been a journey and a learning process,” Reddic said.

€œI’ve got a few bruises, but buy xalatan online without prescription I’m still here and excited about each day. When I face adversity, I always step it up a notch.”As if it wasn’t enough to become a nurse practitioner, Reddic is considering going back to school for a certificate in psychiatry and, perhaps, a doctorate at some point.She’s also dreaming about plans for starting two independent clinics. One would be buy xalatan online without prescription dedicated to serving underprivileged communities. The other would be an IV hydration bar, a trending intravenous therapy program for wellness, beauty and health.“Shalaine has organized her life for success,” said Joleen Lonigan, buy xalatan online without prescription an executive director of Patient Care Services at UC Davis Medical Center. €œShe’s turned her motivation into achievements and her pathway into inspiration that can benefit others.”Her story is undoubtedly motivational for anyone who knows Reddic.

Colleagues say buy xalatan online without prescription her determination is impressive. Her attitude always stays positive, undoubtedly enhanced by that fashion-forward sensibility that can be seen, despite the required nursing apparel, in some colorful shoe choices and unique earrings. And those buy xalatan online without prescription academic and clinical accomplishments?. They’re likely just steppingstones leading toward further personal and professional goals.In short, Shalaine Reddic and the spirit with which she approaches life seem – even in a pandemic age – wonderfully contagious..

Lowest price xalatan

The General Medical Council’s (GMC) motto of ‘Working with doctors, working for patients’ is at the heart of the work we carry out to ensure medical schools and postgraduate medical training is of the high standard that patients lowest price xalatan demand, and rightly deserve. However, we know delivering world-class healthcare is taking its toll on doctors and carrying out research into how we can ease the burden and find how burnout can be prevented is becoming a key focus of our work.While still delivering our important statutory functions of controlling access to the register and investigating when things go wrong, we are actively supporting professionals to maintain and improve standards of good medical practice. Additionally, there is a vast amount of work taking place behind the scenes at the GMC to adapt to the ever-evolving environment we are training doctors to work in.SHAPING TRAINING TO MEET THE NEEDS OF lowest price xalatan WORKFORCE AND PATIENTSThe UK population is continuously changing.

We have an ageing and consequently increasingly frail population with more people with complex and comorbid diseases. We have more patients with disabilities related to mental lowest price xalatan and physical health problems—which we expect will continue to rise due to the COVID-19 pandemic. In addition, more young people tend to live in urban areas, whereas there are more older people generally residing in more rural areas.This in turn places a demand on services meaning we need to train more doctors with more generalist, flexible skills and have doctors located in the right geographical areas to treat patients.

The ongoing COVID-19 pandemic has highlighted the importance of doctors working flexibly.The medical workforce is lowest price xalatan also ever-varying. Our most recent ‘The state of medical education and practice in the UK’1 report showed we are seeing more female doctors on the register. Increasingly, female doctors make up a higher proportion of the workforce as male ….

The General Medical Council’s (GMC) motto of ‘Working with buy xalatan online without prescription doctors, working for patients’ is at the heart of the work we carry out to ensure medical schools and postgraduate medical training is of the high standard that patients demand, and rightly deserve. However, we know delivering world-class healthcare is taking its toll on doctors and carrying out research into how we can ease the burden and find how burnout can be prevented is becoming a key focus of our work.While still delivering our important statutory functions of controlling access to the register and investigating when things go wrong, we are actively supporting professionals to maintain and improve standards of good medical practice. Additionally, there is a vast amount of work taking place behind the scenes at the GMC to adapt to the ever-evolving environment we are training doctors to work buy xalatan online without prescription in.SHAPING TRAINING TO MEET THE NEEDS OF WORKFORCE AND PATIENTSThe UK population is continuously changing. We have an ageing and consequently increasingly frail population with more people with complex and comorbid diseases.

We have more patients with disabilities related to mental and physical health buy xalatan online without prescription problems—which we expect will continue to rise due to the COVID-19 pandemic. In addition, more young people tend to live in urban areas, whereas there are more older people generally residing in more rural areas.This in turn places a demand on services meaning we need to train more doctors with more generalist, flexible skills and have doctors located in the right geographical areas to treat patients. The ongoing COVID-19 pandemic has highlighted buy xalatan online without prescription the importance of doctors working flexibly.The medical workforce is also ever-varying. Our most recent ‘The state of medical education and practice in the UK’1 report showed we are seeing more female doctors on the register.

Increasingly, female doctors make up a higher proportion of the workforce as male ….

Xalatan0.005

Global health leaders discussed the challenges of xalatan0.005 climate change and widening inequality during the closing keynote sssion, 'Climate Change, Social Determinants of Health. Leading Recovery and Preparing for the Future'.The speakers were xalatan0.005 Prof Jan Semenza, lead of the Health Determinants Programme, European Centre for Disease Prevention and Control (ECDC) in Sweden, Professor Prof Sam Shah, founder &. Director, Faculty of Future Health in the UK, Dr Hans Kluge, regional director for Europe, WHO in Denmark and Hal Wolf, president and CEO, HIMSS, US. WHY IT MATTERS HIMSS20 Digital Learn on-demand, earn credit, find xalatan0.005 products and solutions.

Get Started >>. It xalatan0.005 is predicted that climate change will cause around 250,000 additional annual deaths between 2030 and 2050. The combined effect of climate change, and increasing inequality, could lead to a more divided world. This could xalatan0.005 exacerbate the impact of social and environmental determinants of health, for example, clean air.

Safe drinking water. Sufficient quantity xalatan0.005 and quality of food. Secure shelter. And access to quality health and care services.ON THE RECORDProfessor Jan Semenza said climate change xalatan0.005 would impact health.

€œExtreme weather events such as heat or rising sea levels are modulated by a number of vulnerabilities, or factors, such as the human capital in the human population, social capital, financial capital, fiscal capital and natural capital. Exposure can cause injuries, xalatan0.005 fatalities, drownings, heat- related mortality, morbidity, displacement. A whole slew of different kinds of risks”. Semenza said xalatan0.005 a Matched Case Control Study was carried out between 1992 and 2012 in Denmark, Finland, Norway and Sweden to determine whether excess precipitation could mobilise and transport pathogens, leading to water-borne outbreaks.

This showed there was an association between heavy precipitation events and water-borne outbreaks.Dr Hans Kluge, WHO, said. €œThe relationship between health and economic development and xalatan0.005 social cohesion, is linked to climate change. An economy of wellbeing is a fair and environmentally friendly society where everyone has his social safety protector and where health does not put on an economic burden but is a job creator.What citizens legitimately, and reasonably, expect from the health authorities is to guarantee the fundamental right to universal health coverage. But for xalatan0.005 that you need solidarity.

If solidarity does not come from the heart, it should come from the brain because no-one is safe until everyone is safe”.Hal Wolf, HIMSS, said. €œThe stark realisation from COVID-19 is that borders xalatan0.005 have nothing to with the spread of disease and no-one is safe until everyone is safe. We do not understand how to bring the most basic healthcare and the most basic service to each and every village, and every country, around the world. We are going to continue to create vulnerabilities that will start someplace else, spread across the borders and really put everyone in jeopardy, so this idea that strong economies will remain strong and invulnerable to the hardships of individuals, who don’t have the same capabilities, or luxuries, just isn’t true.”He said digital health might xalatan0.005 help.

€œIt is one of the big equalisers. We will face shortages of primary care physicians and clinicians so we have to create, through xalatan0.005 digital health, some of those equalisers, which can spread all the way down to the most basic phone in the most basic village and that’s a positive step forward.“ Professor Sam Shah, faculty of Future Health in the UK also recognised the potential impact of digital to help citizens access services. However, he questioned whether the right technology was reaching the right people but concluded that the digital divide was “probably just a transitory state”. However, he warned that wider society was becoming increasingly divided xalatan0.005.

€œCOVID-19, if anything, has exacerbated, highlighted and exposed the widening of inequalities in society. The gap between those xalatan0.005 who have and those who have not. The results of this are very different, in everything from life expectancy, outcomes and access to services.”Shah said that climate change could cause a range of problems such as respiratory illness, cardiovascular disease, injuries, and premature death. He also believed it xalatan0.005 would have an impact on mental health and wellbeing.

He said the wider social determinants of health, such as education, employment and housing, could significantly affect health, particularly mental health.Access sessions from the HIMSS &. Health 2.0 European Digital Conference 'On Demand' and find all the latest news and deveopments from the event here.Hyland, a Westlake, Ohio-based content services and enterprise imaging technology vendor, signed a definitive agreement to acquire content services platform Alfresco this week.The move follows Hyland's acquisition of German robotic process automation software developer Another Monday this past month."We continue to grow our business and advance our platform organically and via acquisitions," said Bill Priemer, president and CEO of Hyland, in a statement.WHY IT MATTERSHyland, which provides content services for a variety of industries – including financial services, government, higher education, insurance and healthcare – has products in use at more than half of Fortune 100 companies, says the vendor.Its cloud-based, SaaS platform includes security features such as version control, data classification and at-rest data encryption, according to the company's website.Expected to close in the fourth quarter of 2020, Alfresco's entire business of cloud-native content services solutions for enterprises with large volumes of unstructured content will likely be managed under Hyland."With this acquisition Alfresco brings significant geographic and industry experience to Hyland as well as an open source community as a new source xalatan0.005 of product innovation," said Jay Bhatt, president and CEO of Alfresco. Another Monday, meanwhile, houses four complementary software products for automation, including tools for automatic process documentation, development, conduction and monitoring."The RPA market is an exciting and challenging space with rapid growth and a vast number of possible applications that organizations can easily combine and integrate for better and more flexible business processes support," said Hans Martens, CEO of Another Monday, in a statement."We see Hyland as the best fit to embed our RPA technology into their powerful automation platform, to truly implement easy, end-to-end automation for everyone," Martens continued.Hyland also this past month announced new enhancements to its platform, including updated mobile capabilities and an improved upgrade process.THE LARGER TRENDSusan deCathelineau, senior vice president of healthcare sales and services at Hyland, told Healthcare IT News earlier this year that unstructured information – such as clinical documents, narratives, consents and images – has largely been overlooked when it comes to interoperability concerns. She also pointed to artificial intelligence as a needed complement xalatan0.005 to physicians overwhelmed by data and noted that moving to the cloud was an essential shift for the healthcare industry."The hesitancy that used to surround cloud adoption in healthcare now is being replaced by the realization of its ultimate inevitability.

Once again, this shift in mindset largely has to do with data overload," she said.Hyland had at the time recently acquired the blockchain-credentialing vendor LearningMachine, another in a string of acquisitions dating back years.ON THE RECORD"This acquisition will expand our global reach, enabling us to help more organizations achieve their digital transformation goals and become more informed, empowered and connected," said Priemer in a statement. Kat Jercich is xalatan0.005 senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.With the increasing spread of COVID-19 xalatan0.005 infections, the governor of Arizona declared a moratorium on “elective surgeries” on March 19, 2020, in order to conserve hospital PPE supplies and build capacity for potential COVID-19 patients needing hospitalization.The moratorium lasted for six weeks and was finally lifted on May 1, 2020.

The end of the suspension resulted in a xalatan0.005 backlog of more than 3,000 surgical procedures at Phoenix Children’s Hospital.THE PROBLEM HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. “While it is true that xalatan0.005 elective surgeries are typically nonurgent, many of these are medically necessary and important for a child’s health and well-being,” explained Dr. Vinay Vaidya, chief medical information officer at Phoenix Children’s Hospital.“Besides the delay in surgery for the patient, deferring all elective surgeries put a major financial strain on hospitals across the country.

The challenge we had to address was how to resume the thousands of deferred surgeries, in addition to the new surgeries that were being added each day.”These operations needed to xalatan0.005 be conducted in a timely and efficient manner while ensuring utmost safety for patients and healthcare providers. The scheduling of surgeries is a complex process that involves many players and requires a series of sequential and interdependent actions. The COVID-19 pandemic added magnitudes of complexity to each step in this process.“This was an unprecedented situation that needed coordination across our entire system of care, from executive leadership to surgeons, anesthesiologists, nursing staff, operating room staff, schedulers, and ultimately patients and their families,” Vaidya said.“We needed to build a common communication highway, based on information technology, that would provide real-time visibility through the entire scheduling process, and to all stakeholders.”PROPOSALOnce the moratorium on elective surgeries was lifted, the process of rescheduling the backlog of more than 3,000 cases could begin.Clearly, what was xalatan0.005 needed was much more than simply throwing additional scheduling staff to work through the backlog one patient at a time, Vaidya said. Amidst a pandemic, staff had to rewrite the rules of how a surgical scheduling process would unfold.“Based on our previous experience of successfully using information technology in general, and data analytic dashboards in particular, it was evident at the very outset that we would need a similar approach to address the complex logistics,” he said.

€œThe solution to resuming these surgeries was the development of a proprietary dashboard, which could facilitate the entire triage of operations.”MEETING THE CHALLENGEGiven the challenges posed by xalatan0.005 COVID-19, it was important to take into consideration a number of factors such as. The type of surgery, medical necessity and need for hospital/ICU stay, Vaidya explained. These elements needed to be balanced with the availability of PPE, adequate staffing, general and ICU bed availability, and ventilator availability, while ensuring the highest xalatan0.005 standards of safety for patients and hospital staff.“Using a careful and well-planned approach, a surgical prioritization was developed and uniformly communicated to all surgical teams,” Vaidya said. €œTo support the assignment of surgical priority for 3,000-plus cases, a new dashboard was created.

This technology xalatan0.005 allowed each surgeon to review all their respective cases, and rapidly assign a priority of high, medium or low to all the backlogged cases, as well as new cases.”As this data was captured electronically, it was used to feed a separate dashboard created specifically for the schedulers, who found it easy to work through the list, based on surgical priority. This significantly improved the efficiency of the process, allowing staff to schedule a much higher number of patients each day than previously possible."The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations."Dr. Vinay Vaidya, Phoenix Children’s Hospital“For those patients who were successfully scheduled for surgery, it was mandatory to test them for COVID-19 in the 72 hours preceding the date of surgery,” Vaidya noted.“This process xalatan0.005 was also facilitated using the dashboard, which displayed the patients who were scheduled for COVID-19 testing, those who completed the test, and those who tested negative and were finally cleared for surgery. It also identified patients who tested positive for COVID-19 and needed to have their surgeries postponed.”The entire end-to-end electronic process provided a single enterprise-wide view that allowed streamlined tracking of the patient throughout the multiple steps, not unlike that of an Amazon package, right from ordering to final delivery, Vaidya described.“This also obviated the need for inefficient and time-consuming internal communication via emails, phone calls and spreadsheets between the surgeons, operating room staff and the schedulers,” Vaidya said.

€œThe dashboard thus became the de facto central hub and the single source of truth, updated in real time, and extensively used across the entire organization, from the frontline staff right up to senior leadership.”Vaidya added that it is important to point out that the hospital was able to accomplish all of this very quickly.“We already had in place an existing robust xalatan0.005 data warehouse structure that was receiving feeds from almost every information system used in the hospital, including live feeds from our EHR,” he said. €œIn addition, much of the data needed for the dashboards had already been prepackaged into ready-to-use analysis cubes that had been previously built for other surgical projects preceding COVID-19.”Finally, a couple of data analysts who were already proficient in rapidly building visually informative, interactive, actionable dashboards using Microsoft’s Power BI software, were able to deliver the dashboards in record time.RESULTSThe one success metric of this project that stands out is that the hospital was not only able to catch up quickly on the backlog of surgeries, but actually ended up performing 166 more surgeries in June and July of this year, compared with the same period last year – 4,199 versus 4,033 – Vaidya reported. This volume xalatan0.005 speaks to the approach. An extensive use of data, analytics and dashboards to support every stage of the process, from surgeon prioritization to scheduling, testing and finally surgery, he added.“Among the numerous types of surgeries performed during this challenging period, it is worth highlighting the results of our surgical volumes for two very complex surgeries,” he said.“Phoenix Children’s Hospital is nationally recognized as a center of excellence, and draws patients from all across the country for Pectus surgery, done to correct chest wall deformities, and Scoliosis surgery, to correct abnormal spine curvature.

Both are complex, long-duration surgeries that require a hospital stay, and are often planned months in advance to coincide with school summer break.”In the case of Scoliosis surgery, the hospital succeeded in performing more surgeries xalatan0.005 this year during May through August compared with the same period last year, 95 versus 91. The results for Pectus repair surgery were even more noteworthy. The surgical teams outperformed by 41% the number of surgeries xalatan0.005 performed this year from May to August compared with the same period last year, 72 versus 51.“The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations,” Vaidya said. €œThroughout this project, given that patient and provider safety was our highest priority, it is important to point out that no surgeon or anesthesiologist has tested positive for COVID-19 since surgery restarted – a testament to extensive safety protocols that were supported by dashboard usage at every stage.”ADVICE FOR OTHERSThe success of this project no doubt depended on the collaboration and cooperation of many different teams, Vaidya said.

However, its foundation was built upon the optimum use of data analytics, and dashboard technology, to provide precise, real-time, actionable information to all the key players, he added.“Fortunately, most hospitals and health xalatan0.005 systems have developed their electronic capabilities over the last 10 years and are sitting on a trove of data,” he said.“Ensuring that the multiple, often disparate, information systems in a hospital setting all feed their data to a common data warehouse platform allows for optimum use of this data,” he explained. €œMining the data, and providing it to frontline users via intuitive interfaces, turns it into actionable intelligence that produces results.“As IT professionals, we have been promising our health providers that data can be used to produce higher quality outcomes,” he added. €œUsing technology in the resumption of surgeries is a perfect example of delivering on this xalatan0.005 promise.”Twitter. @SiwickiHealthITEmail the writer.

Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.A woman living in Woodstock, New York, has filed suit against HealthAlliance Hospital and the information management vendor Ciox Health for allegedly declining to release her deceased husband's electronic health records in a non-paper format.The lawyer for the plaintiff, Sherry Russell, said that xalatan0.005 HealthAlliance Hospital's Broadway campus (formerly known as Kingston Hospital) has repeatedly directed her to Ciox for the records, which in turn allegedly told her she will have to pay 75 cents a page for photocopied paper versions."The maximum charge for electronic medical records under federal law is $6.50," said Russell's lawyer, John Fisher, in an interview with Healthcare IT News. "But if they charge for the paper copy of the records, it could be thousands of dollars." According to a 2016 guidance from the U.S. Department of Health and Human Services, HIPAA-covered entities and business associates should either charge $6.50 to fulfill a record request or calculate fees based on the labor cost of xalatan0.005 doing so.Earlier this year, the U.S. Department of Health and Human Services lifted that cap on fees when it comes to organizations charging third parties, such as law firms, when releasing copies of electronic records.

The fee cap for patients, however, remains in xalatan0.005 place. Fisher says that Russell's alleged treatment is a violation of the HITECH Act, which – among other provisions – requires HIPAA-covered entities to provide patients with an electronic copy of their records. According to Fisher, after the death of Russell's husband, Charlie, in October 2019, she requested his electronic health records xalatan0.005 in order to file a separate malpractice lawsuit against the hospital. Without the records, said Fisher, Russell cannot identify the physician involved in her husband's care.

Ciox said that it xalatan0.005 could not comment on pending litigation. The Westchester Medical Health Network, of which HealthAlliance is a part, said it did not comment on ongoing litigation. WHY IT MATTERSAccording to Fisher, in March 2017, Charlie Russell underwent a chest X-ray as part of xalatan0.005 a routine procedure. That X-ray showed a mass in his lung, but as Fisher told Healthcare IT News, neither Russell nor his wife were informed of it.

The next March, Fisher said, Russell went in for another chest X-ray xalatan0.005. This time, doctors xalatan0.005 found a six-centimeter mass in his lung. Further imaging showed cancer in his brain and liver.Sherry Russell believes her husband's cancer could have been treated sooner, had the mass been identified and communicated about in 2017. She is planning to file a xalatan0.005 medical malpractice lawsuit.

The deadline to sue is September 14, said Fisher, but Russell is relying on the electronic health records for her case. Fisher said he has xalatan0.005 other clients with similar experiences at HealthAlliance concerning their records, and that clients whose cases qualify could join onto Russell's class-action suit filed this past week. "We know firsthand that there are others" that have experienced problems obtaining their electronic health records, said Fisher. THE LARGER TREND The HIPAA Privacy Right Rule of Access guarantees patient access to physical xalatan0.005 or digital copies of healthcare records – and noncompliant health systems can face hefty fines.

In 2019, Bayfront Health St. Petersburg had to pay the HHS Office of Civil Rights $85,000 and promise remediation after failing to give a pregnant woman timely access to her medical records.Meanwhile, Ciox has been xalatan0.005 at the center of a number of lawsuits concerning the costs of electronic health records. In 2018, the company sued HHS over the $6.50 flat fee Fisher invoked, saying that it "bears no rational relationship to the actual costs associated with processing such requests." HHS, in turn, said that it couldn't actually enforce that flat fee against Ciox, because Ciox is a business associate, not a covered entity.This lawsuit eventually led to the agency lifting the cap on fees for third-party organizations' requests for records. And last year, Ciox Health and the Wisconsin-based Aurora Health paid $35.4 million to settle a class-action lawsuit that accused xalatan0.005 the companies of overcharging for records requests.Studies have shown other hospitals not complying with the HHS-recommended $6.50, with one reportedly charging more than $500 for a 200-page record.

ON THE RECORD HealthAlliance, said Fisher, is "stonewalling our client and affecting her ability to bring a lawsuit." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.While some of the more obvious barriers to digital therapeutics adoption in Europe have come crashing down recently, adoption is still hampered by cultural momentum. That was the conclusion of a group of digital therapeutics stakeholders who presented at HIMSS &.

Health 2.0 Europe Digital Event today, in a session moderated by YourCoach Health chairman and COO Eugene Borukhovich.“Once a product is CE Marked, has all the clinical evidence, has gone through even an HTA process, that even isn’t enough,” said Jessica Shull, European lead at the Digital Therapeutics Alliance. €œSo what we’re looking at is countries where there are these frameworks, products have been approved, they’ve been shown to be effective, they’ve even been shown to have healthy economic data, but physicians still aren’t prescribing at the rates that we would hope.”A number of European governments have rolled-out the red carpet for digital therapeutics, including Germany, which has announced broad reimbursement for digital therapeutics. HIMSS20 DigitalLearn on-demand, earn credit, find products and solutions. Get Started >>.

€œAll eyes are on Germany,” Borukhovich said. €œThere’s a lot of entrepreneurs and large companies that are saying ‘Cool, we’re going to get reimbursed, let’s hop on over to Germany.’ But I know the picture’s not that simple.”“That’s what we wanted,” Julia Hagen, director, regulatory and politics, at Health Innovation Hub. €œWe want to attract great digital solutions to the German healthcare system. So yes, welcome.

Come on over.”The rest of the panelists represented people who either used or made digital therapeutics. Ken Cahill, CEO of digital mental health company SilverCloud, Alejandro Suero, whose company ReHand offers a digital therapeutic for physical rehab for hand injuries, and Dr César Morcillo Serra, medical director of internal medicine at Sanitas Digital Hospital.Panelists agreed on two major takeaways for how to improve adoption of digital therapeutics. The need to integrate these new devices into old workflows and processes and the importance of working with providers.“Digital transformation must focus on the patient and the healthcare professionals, because as you know people and culture are the main barrier for this kind of transformation,” Serra said. €œWe must focus on how to prescribe these digital tools to help our patients.

Everything must help with these workflows — not giving us more work, but trying to help us.”As such, Serra encouraged digital therapeutics innovators to focus on chronic conditions, which take up so much of the time of physicians like him.Suero’s chosen focus — hand injuries, are a $5.8 billion per year problem, he said, and one that doesn’t lend itself well to the intermittent contact of traditional medicine.To bring providers on board, Shull shared that the DtX alliance is working with medical societies as well as creating webinars and continuing education opportunities. Cahill has another approach. SilverCloud has found success by getting them invested first as patients.“One of the most powerful workstreams is to deploy the programme within the health system’s own staff,” he said. €œThey’re one of the most heavily challenged workforces that are out there in terms of stigma for mental healthcare, in terms of actually being able to take time away and go and do it.

So them almost taking their own medicine has been a huge way of creating champions within these organisations.”Panelists warned that there are other challenges still awaiting digital therapeutics beyond adoption."The ongoing challenge of EHR interoperability, for instance, will impact the long-term success of digital health and digital therapeutics," Shull said. "Because of the influx of data digital health products can produce, most legacy EHR systems aren't yet enabled to incorporate data from several sources at once.”Additionally, building a clinical evidence base is no small thing, Suero and Cahill said.“The challenge in terms of building that evidence base is to build it in the right way,” Cahill said. If you are building an evidence-base, it has to mirror what the protocol design was, what the research design was. It may seem simple, but in fact it’s reasonably complicated.

€¦ We’ve got five active randomised control trials today even though we’re 10 years out [of launch]. That will be one of the biggest challenges for us to show that proof.”But one thing is for sure. It’s time to move beyond the rudimentary conversations about digital therapeutics and get into the nitty-gritty.“I want to see real discussion, not about the broad ‘Should we have a data privacy discussion?. €™, but I want to get the discussion to the level where it’s about the medical application and its effects and not this general digital health blah blah is it great or not and can we stop it?.

€ Hagen said. €œNo, we can’t.”Register now to attend the HIMSS &. Health 2.0 European Digital Conference and keep up with the latest news and deveopments from the event here..

Global health leaders discussed the buy xalatan online without prescription challenges of climate change and widening inequality during the closing keynote sssion, 'Climate Change, Social Determinants of Health. Leading Recovery and Preparing for the Future'.The speakers were Prof Jan Semenza, lead of the Health Determinants Programme, European Centre for Disease Prevention and Control (ECDC) in Sweden, Professor buy xalatan online without prescription Prof Sam Shah, founder &. Director, Faculty of Future Health in the UK, Dr Hans Kluge, regional director for Europe, WHO in Denmark and Hal Wolf, president and CEO, HIMSS, US. WHY IT MATTERS HIMSS20 Digital Learn on-demand, earn credit, find buy xalatan online without prescription products and solutions.

Get Started >>. It is predicted that climate change buy xalatan online without prescription will cause around 250,000 additional annual deaths between 2030 and 2050. The combined effect of climate change, and increasing inequality, could lead to a more divided world. This could exacerbate the impact of social and buy xalatan online without prescription environmental determinants of health, for example, clean air.

Safe drinking water. Sufficient quantity buy xalatan online without prescription and quality of food. Secure shelter. And access to quality health and care services.ON THE RECORDProfessor Jan Semenza said climate change buy xalatan online without prescription would impact health.

€œExtreme weather events such as heat or rising sea levels are modulated by a number of vulnerabilities, or factors, such as the human capital in the human population, social capital, financial capital, fiscal capital and natural capital. Exposure can cause buy xalatan online without prescription injuries, fatalities, drownings, heat- related mortality, morbidity, displacement. A whole slew of different kinds of risks”. Semenza said a Matched Case Control Study was carried out between 1992 and 2012 in Denmark, Finland, Norway and Sweden to determine whether excess precipitation could buy xalatan online without prescription mobilise and transport pathogens, leading to water-borne outbreaks.

This showed there was an association between heavy precipitation events and water-borne outbreaks.Dr Hans Kluge, WHO, said. €œThe relationship between health and economic development and social cohesion, is linked to buy xalatan online without prescription climate change. An economy of wellbeing is a fair and environmentally friendly society where everyone has his social safety protector and where health does not put on an economic burden but is a job creator.What citizens legitimately, and reasonably, expect from the health authorities is to guarantee the fundamental right to universal health coverage. But for that buy xalatan online without prescription you need solidarity.

If solidarity does not come from the heart, it should come from the brain because no-one is safe until everyone is safe”.Hal Wolf, HIMSS, said. €œThe stark buy xalatan online without prescription realisation from COVID-19 is that borders have nothing to with the spread of disease and no-one is safe until everyone is safe. We do not understand how to bring the most basic healthcare and the most basic service to each and every village, and every country, around the world. We are going to continue to create vulnerabilities that will start someplace else, spread across the borders and really put everyone in jeopardy, so this idea that strong economies will remain strong and invulnerable to the hardships buy xalatan online without prescription of individuals, who don’t have the same capabilities, or luxuries, just isn’t true.”He said digital health might help.

€œIt is one of the big equalisers. We will face shortages of primary care physicians and clinicians so we have to create, through digital health, some of those equalisers, which can spread all the way down to the most basic phone in the most basic village and that’s a positive step forward.“ Professor Sam Shah, faculty of Future Health in the UK also buy xalatan online without prescription recognised the potential impact of digital to help citizens access services. However, he questioned whether the right technology was reaching the right people but concluded that the digital divide was “probably just a transitory state”. However, he warned that wider society was becoming increasingly buy xalatan online without prescription divided.

€œCOVID-19, if anything, has exacerbated, highlighted and exposed the widening of inequalities in society. The gap buy xalatan online without prescription between those who have and those who have not. The results of this are very different, in everything from life expectancy, outcomes and access to services.”Shah said that climate change could cause a range of problems such as respiratory illness, cardiovascular disease, injuries, and premature death. He also believed it would buy xalatan online without prescription have an impact on mental health and wellbeing.

He said the wider social determinants of health, such as education, employment and housing, could significantly affect health, particularly mental health.Access sessions from the HIMSS &. Health 2.0 European Digital Conference 'On Demand' and find all the latest news and deveopments from the event here.Hyland, a Westlake, Ohio-based content services and enterprise imaging technology vendor, signed a definitive agreement to acquire content services platform Alfresco this week.The move follows Hyland's acquisition of German robotic process automation software developer Another Monday this past month."We continue to grow buy xalatan online without prescription our business and advance our platform organically and via acquisitions," said Bill Priemer, president and CEO of Hyland, in a statement.WHY IT MATTERSHyland, which provides content services for a variety of industries – including financial services, government, higher education, insurance and healthcare – has products in use at more than half of Fortune 100 companies, says the vendor.Its cloud-based, SaaS platform includes security features such as version control, data classification and at-rest data encryption, according to the company's website.Expected to close in the fourth quarter of 2020, Alfresco's entire business of cloud-native content services solutions for enterprises with large volumes of unstructured content will likely be managed under Hyland."With this acquisition Alfresco brings significant geographic and industry experience to Hyland as well as an open source community as a new source of product innovation," said Jay Bhatt, president and CEO of Alfresco. Another Monday, meanwhile, houses four complementary software products for automation, including tools for automatic process documentation, development, conduction and monitoring."The RPA market is an exciting and challenging space with rapid growth and a vast number of possible applications that organizations can easily combine and integrate for better and more flexible business processes support," said Hans Martens, CEO of Another Monday, in a statement."We see Hyland as the best fit to embed our RPA technology into their powerful automation platform, to truly implement easy, end-to-end automation for everyone," Martens continued.Hyland also this past month announced new enhancements to its platform, including updated mobile capabilities and an improved upgrade process.THE LARGER TRENDSusan deCathelineau, senior vice president of healthcare sales and services at Hyland, told Healthcare IT News earlier this year that unstructured information – such as clinical documents, narratives, consents and images – has largely been overlooked when it comes to interoperability concerns. She also pointed to artificial intelligence as a needed complement to physicians overwhelmed by data and noted that moving to the cloud was an essential shift for buy xalatan online without prescription the healthcare industry."The hesitancy that used to surround cloud adoption in healthcare now is being replaced by the realization of its ultimate inevitability.

Once again, this shift in mindset largely has to do with data overload," she said.Hyland had at the time recently acquired the blockchain-credentialing vendor LearningMachine, another in a string of acquisitions dating back years.ON THE RECORD"This acquisition will expand our global reach, enabling us to help more organizations achieve their digital transformation goals and become more informed, empowered and connected," said Priemer in a statement. Kat Jercich buy xalatan online without prescription is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.With the increasing spread of COVID-19 infections, the governor of Arizona declared a moratorium on “elective surgeries” on March 19, 2020, in order to conserve hospital PPE supplies and build capacity for potential COVID-19 patients needing hospitalization.The moratorium buy xalatan online without prescription lasted for six weeks and was finally lifted on May 1, 2020.

The end of the suspension resulted in a backlog of more than 3,000 surgical procedures at Phoenix Children’s Hospital.THE PROBLEM HIMSS20 buy xalatan online without prescription Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. “While it is true buy xalatan online without prescription that elective surgeries are typically nonurgent, many of these are medically necessary and important for a child’s health and well-being,” explained Dr. Vinay Vaidya, chief medical information officer at Phoenix Children’s Hospital.“Besides the delay in surgery for the patient, deferring all elective surgeries put a major financial strain on hospitals across the country.

The challenge we had to address was how buy xalatan online without prescription to resume the thousands of deferred surgeries, in addition to the new surgeries that were being added each day.”These operations needed to be conducted in a timely and efficient manner while ensuring utmost safety for patients and healthcare providers. The scheduling of surgeries is a complex process that involves many players and requires a series of sequential and interdependent actions. The COVID-19 pandemic added magnitudes of complexity to each step in this process.“This was an unprecedented situation that needed coordination across our entire system of care, from executive leadership to surgeons, anesthesiologists, nursing staff, operating room staff, schedulers, and ultimately patients and their families,” Vaidya said.“We needed to build a common communication highway, based on information technology, that would provide real-time visibility through the entire scheduling process, and to all stakeholders.”PROPOSALOnce the moratorium on elective surgeries was lifted, the process of rescheduling the backlog of more than 3,000 cases could begin.Clearly, what was needed was much more than simply throwing additional scheduling staff to work through the backlog one patient at a time, Vaidya buy xalatan online without prescription said. Amidst a pandemic, staff had to rewrite the rules of how a surgical scheduling process would unfold.“Based on our previous experience of successfully using information technology in general, and data analytic dashboards in particular, it was evident at the very outset that we would need a similar approach to address the complex logistics,” he said.

€œThe solution to resuming these buy xalatan online without prescription surgeries was the development of a proprietary dashboard, which could facilitate the entire triage of operations.”MEETING THE CHALLENGEGiven the challenges posed by COVID-19, it was important to take into consideration a number of factors such as. The type of surgery, medical necessity and need for hospital/ICU stay, Vaidya explained. These elements needed to be balanced with the availability of PPE, adequate staffing, general and ICU bed availability, and ventilator availability, while ensuring the highest standards of safety for patients buy xalatan online without prescription and hospital staff.“Using a careful and well-planned approach, a surgical prioritization was developed and uniformly communicated to all surgical teams,” Vaidya said. €œTo support the assignment of surgical priority for 3,000-plus cases, a new dashboard was created.

This technology allowed each surgeon to review all their respective cases, and rapidly assign a priority of high, medium or low to all the backlogged cases, as well as new cases.”As buy xalatan online without prescription this data was captured electronically, it was used to feed a separate dashboard created specifically for the schedulers, who found it easy to work through the list, based on surgical priority. This significantly improved the efficiency of the process, allowing staff to schedule a much higher number of patients each day than previously possible."The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations."Dr. Vinay Vaidya, Phoenix Children’s Hospital“For those patients who were successfully scheduled for surgery, it was mandatory to test them for COVID-19 in the 72 hours preceding the date buy xalatan online without prescription of surgery,” Vaidya noted.“This process was also facilitated using the dashboard, which displayed the patients who were scheduled for COVID-19 testing, those who completed the test, and those who tested negative and were finally cleared for surgery. It also identified patients who tested positive for COVID-19 and needed to have their surgeries postponed.”The entire end-to-end electronic process provided a single enterprise-wide view that allowed streamlined tracking of the patient throughout the multiple steps, not unlike that of an Amazon package, right from ordering to final delivery, Vaidya described.“This also obviated the need for inefficient and time-consuming internal communication via emails, phone calls and spreadsheets between the surgeons, operating room staff and the schedulers,” Vaidya said.

€œThe dashboard thus became the de facto central hub and the single source of truth, updated in real time, and buy xalatan online without prescription extensively used across the entire organization, from the frontline staff right up to senior leadership.”Vaidya added that it is important to point out that the hospital was able to accomplish all of this very quickly.“We already had in place an existing robust data warehouse structure that was receiving feeds from almost every information system used in the hospital, including live feeds from our EHR,” he said. €œIn addition, much of the data needed for the dashboards had already been prepackaged into ready-to-use analysis cubes that had been previously built for other surgical projects preceding COVID-19.”Finally, a couple of data analysts who were already proficient in rapidly building visually informative, interactive, actionable dashboards using Microsoft’s Power BI software, were able to deliver the dashboards in record time.RESULTSThe one success metric of this project that stands out is that the hospital was not only able to catch up quickly on the backlog of surgeries, but actually ended up performing 166 more surgeries in June and July of this year, compared with the same period last year – 4,199 versus 4,033 – Vaidya reported. This volume speaks to buy xalatan online without prescription the approach. An extensive use of data, analytics and dashboards to support every stage of the process, from surgeon prioritization to scheduling, testing and finally surgery, he added.“Among the numerous types of surgeries performed during this challenging period, it is worth highlighting the results of our surgical volumes for two very complex surgeries,” he said.“Phoenix Children’s Hospital is nationally recognized as a center of excellence, and draws patients from all across the country for Pectus surgery, done to correct chest wall deformities, and Scoliosis surgery, to correct abnormal spine curvature.

Both are complex, long-duration surgeries that require a hospital stay, and are often planned months in advance to coincide with school summer break.”In the case of Scoliosis surgery, the hospital succeeded in performing more surgeries this year during May through August compared with the same period buy xalatan online without prescription last year, 95 versus 91. The results for Pectus repair surgery were even more noteworthy. The surgical teams buy xalatan online without prescription outperformed by 41% the number of surgeries performed this year from May to August compared with the same period last year, 72 versus 51.“The technology allowed for synergies across the enterprise in addressing the multifaceted challenges of resuming these operations,” Vaidya said. €œThroughout this project, given that patient and provider safety was our highest priority, it is important to point out that no surgeon or anesthesiologist has tested positive for COVID-19 since surgery restarted – a testament to extensive safety protocols that were supported by dashboard usage at every stage.”ADVICE FOR OTHERSThe success of this project no doubt depended on the collaboration and cooperation of many different teams, Vaidya said.

However, its foundation was built upon the optimum use of data analytics, and dashboard technology, to provide precise, real-time, actionable information to all the key players, he added.“Fortunately, most hospitals and health systems have developed their electronic capabilities over the last 10 years and buy xalatan online without prescription are sitting on a trove of data,” he said.“Ensuring that the multiple, often disparate, information systems in a hospital setting all feed their data to a common data warehouse platform allows for optimum use of this data,” he explained. €œMining the data, and providing it to frontline users via intuitive interfaces, turns it into actionable intelligence that produces results.“As IT professionals, we have been promising our health providers that data can be used to produce higher quality outcomes,” he added. €œUsing technology buy xalatan online without prescription in the resumption of surgeries is a perfect example of delivering on this promise.”Twitter. @SiwickiHealthITEmail the writer.

Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.A woman living in Woodstock, New York, has filed suit against HealthAlliance Hospital and the information management vendor Ciox Health for allegedly declining to release her deceased husband's electronic health records in a non-paper format.The lawyer for the plaintiff, Sherry Russell, said that HealthAlliance Hospital's Broadway campus (formerly known as Kingston Hospital) has repeatedly directed her to Ciox for the records, which in turn allegedly told her she will have to pay buy xalatan online without prescription 75 cents a page for photocopied paper versions."The maximum charge for electronic medical records under federal law is $6.50," said Russell's lawyer, John Fisher, in an interview with Healthcare IT News. "But if they charge for the paper copy of the records, it could be thousands of dollars." According to a 2016 guidance from the U.S. Department of Health and Human Services, HIPAA-covered entities and business associates should either charge $6.50 to fulfill a record request or calculate buy xalatan online without prescription fees based on the labor cost of doing so.Earlier this year, the U.S. Department of Health and Human Services lifted that cap on fees when it comes to organizations charging third parties, such as law firms, when releasing copies of electronic records.

The fee cap for patients, buy xalatan online without prescription however, remains in place. Fisher says that Russell's alleged treatment is a violation of the HITECH Act, which – among other provisions – requires HIPAA-covered entities to provide patients with an electronic copy of their records. According buy xalatan online without prescription to Fisher, after the death of Russell's husband, Charlie, in October 2019, she requested his electronic health records in order to file a separate malpractice lawsuit against the hospital. Without the records, said Fisher, Russell cannot identify the physician involved in her husband's care.

Ciox said buy xalatan online without prescription that it could not comment on pending litigation. The Westchester Medical Health Network, of which HealthAlliance is a part, said it did not comment on ongoing litigation. WHY IT MATTERSAccording to Fisher, in March 2017, Charlie Russell underwent a chest X-ray as buy xalatan online without prescription part of a routine procedure. That X-ray showed a mass in his lung, but as Fisher told Healthcare IT News, neither Russell nor his wife were informed of it.

The next March, Fisher said, Russell went buy xalatan online without prescription in for another chest X-ray. This time, buy xalatan online without prescription doctors found a six-centimeter mass in his lung. Further imaging showed cancer in his brain and liver.Sherry Russell believes her husband's cancer could have been treated sooner, had the mass been identified and communicated about in 2017. She is buy xalatan online without prescription planning to file a medical malpractice lawsuit.

The deadline to sue is September 14, said Fisher, but Russell is relying on the electronic health records for her case. Fisher said he has other clients with similar experiences at HealthAlliance concerning their records, and that clients whose buy xalatan online without prescription cases qualify could join onto Russell's class-action suit filed this past week. "We know firsthand that there are others" that have experienced problems obtaining their electronic health records, said Fisher. THE LARGER TREND The HIPAA Privacy buy xalatan online without prescription Right Rule of Access guarantees patient access to physical or digital copies of healthcare records – and noncompliant health systems can face hefty fines.

In 2019, Bayfront Health St. Petersburg had to pay the HHS Office of Civil Rights $85,000 and promise remediation after failing to buy xalatan online without prescription give a pregnant woman timely access to her medical records.Meanwhile, Ciox has been at the center of a number of lawsuits concerning the costs of electronic health records. In 2018, the company sued HHS over the $6.50 flat fee Fisher invoked, saying that it "bears no rational relationship to the actual costs associated with processing such requests." HHS, in turn, said that it couldn't actually enforce that flat fee against Ciox, because Ciox is a business associate, not a covered entity.This lawsuit eventually led to the agency lifting the cap on fees for third-party organizations' requests for records. And last year, Ciox Health and the Wisconsin-based Aurora Health paid $35.4 million to settle a class-action lawsuit that buy xalatan online without prescription accused the companies of overcharging for records requests.Studies have shown other hospitals not complying with the HHS-recommended $6.50, with one reportedly charging more than $500 for a 200-page record.

ON THE RECORD HealthAlliance, said Fisher, is "stonewalling our client and affecting her ability to bring a lawsuit." Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.While some of the more obvious barriers to digital therapeutics adoption in Europe have come crashing down recently, adoption is still hampered by cultural momentum. That was the conclusion of a group of digital therapeutics stakeholders who presented at HIMSS &.

Health 2.0 Europe Digital Event today, in a session moderated by YourCoach Health chairman and COO Eugene Borukhovich.“Once a product is CE Marked, has all the clinical evidence, has gone through even an HTA process, that even isn’t enough,” said Jessica Shull, European lead at the Digital Therapeutics Alliance. €œSo what we’re looking at is countries where there are these frameworks, products have been approved, they’ve been shown to be effective, they’ve even been shown to have healthy economic data, but physicians still aren’t prescribing at the rates that we would hope.”A number of European governments have rolled-out the red carpet for digital therapeutics, including Germany, which has announced broad reimbursement for digital therapeutics. HIMSS20 DigitalLearn on-demand, earn credit, find products and solutions. Get Started >>.

€œAll eyes are on Germany,” Borukhovich said. €œThere’s a lot of entrepreneurs and large companies that are saying ‘Cool, we’re going to get reimbursed, let’s hop on over to Germany.’ But I know the picture’s not that simple.”“That’s what we wanted,” Julia Hagen, director, regulatory and politics, at Health Innovation Hub. €œWe want to attract great digital solutions to the German healthcare system. So yes, welcome.

Come on over.”The rest of the panelists represented people who either used or made digital therapeutics. Ken Cahill, CEO of digital mental health company SilverCloud, Alejandro Suero, whose company ReHand offers a digital therapeutic for physical rehab for hand injuries, and Dr César Morcillo Serra, medical director of internal medicine at Sanitas Digital Hospital.Panelists agreed on two major takeaways for how to improve adoption of digital therapeutics. The need to integrate these new devices into old workflows and processes and the importance of working with providers.“Digital transformation must focus on the patient and the healthcare professionals, because as you know people and culture are the main barrier for this kind of transformation,” Serra said. €œWe must focus on how to prescribe these digital tools to help our patients.

Everything must help with these workflows — not giving us more work, but trying to help us.”As such, Serra encouraged digital therapeutics innovators to focus on chronic conditions, which take up so much of the time of physicians like him.Suero’s chosen focus — hand injuries, are a $5.8 billion per year problem, he said, and one that doesn’t lend itself well to the intermittent contact of traditional medicine.To bring providers on board, Shull shared that the DtX alliance is working with medical societies as well as creating webinars and continuing education opportunities. Cahill has another approach. SilverCloud has found success by getting them invested first as patients.“One of the most powerful workstreams is to deploy the programme within the health system’s own staff,” he said. €œThey’re one of the most heavily challenged workforces that are out there in terms of stigma for mental healthcare, in terms of actually being able to take time away and go and do it.

So them almost taking their own medicine has been a huge way of creating champions within these organisations.”Panelists warned that there are other challenges still awaiting digital therapeutics beyond adoption."The ongoing challenge of EHR interoperability, for instance, will impact the long-term success of digital health and digital therapeutics," Shull said. "Because of the influx of data digital health products can produce, most legacy EHR systems aren't yet enabled to incorporate data from several sources at once.”Additionally, building a clinical evidence base is no small thing, Suero and Cahill said.“The challenge in terms of building that evidence base is to build it in the right way,” Cahill said. If you are building an evidence-base, it has to mirror what the protocol design was, what the research design was. It may seem simple, but in fact it’s reasonably complicated.

€¦ We’ve got five active randomised control trials today even though we’re 10 years out [of launch]. That will be one of the biggest challenges for us to show that proof.”But one thing is for sure. It’s time to move beyond the rudimentary conversations about digital therapeutics and get into the nitty-gritty.“I want to see real discussion, not about the broad ‘Should we have a data privacy discussion?. €™, but I want to get the discussion to the level where it’s about the medical application and its effects and not this general digital health blah blah is it great or not and can we stop it?.

€ Hagen said. €œNo, we can’t.”Register now to attend the HIMSS &. Health 2.0 European Digital Conference and keep up with the latest news and deveopments from the event here..

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Start Preamble best place to buy xalatan online Centers for Medicare &. Medicaid Services (CMS), HHS. Extension of 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 best place to buy xalatan online allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O.

Wilson, (410) 786-8852 best place to buy xalatan online. 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 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 best place to buy xalatan online or HHS) Regulatory Sprint to Coordinated Care. In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician.

A new exception for donations of cybersecurity technology and best place to buy xalatan online 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 and regulations.

This notice announces an extension of the timeline for publication best place to buy xalatan online 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 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 best place to buy xalatan online a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020. 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 best place to buy xalatan online August 31, 2021. Start Signature Dated. August 24, 2020.

Wilma M best place to buy xalatan online. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental Information [FR Doc.

2020-18867 Filed 8-26-20 best place to buy xalatan online. 8:45 am]BILLING CODE 4120-01-PThe Centers for Medicare &. Medicaid Services (CMS) today announced efforts underway to support Louisiana and Texas in response to Hurricane Laura.

On August 26, 2020, Department of Health and Human Services (HHS) Secretary Alex Azar declared public health emergencies (PHEs) in these states, retroactive to August 22, 2020 for the state of Louisiana and to August 23, 2020 best place to buy xalatan online for the state of Texas. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of Hurricane Laura. CMS provided numerous waivers to health care providers during the current coronavirus disease 2019 (COVID-19) pandemic to meet the needs of beneficiaries and providers.

The waivers already in place best place to buy xalatan online will be available to health care providers to use during the duration of the COVID-19 PHE determination timeframe and for the Hurricane Laura PHE. CMS may waive certain additional Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements, create special enrollment opportunities for individuals to access healthcare quickly, and take steps to ensure dialysis patients obtain critical life-saving services. “Our thoughts are with everyone who is in the path of this powerful and dangerous hurricane and CMS is doing everything within its authority to provide assistance and relief to all who are affected,” said CMS Administrator Seema Verma.

€œWe will partner and coordinate with state, federal, and local officials to make sure that in the midst of all of the uncertainty a natural disaster can bring, our beneficiaries will not have to worry about access to healthcare and other crucial life-saving best place to buy xalatan online and sustaining services they may need.” Below are key administrative actions CMS will be taking in response to the PHEs declared in Louisiana and Texas. Waivers and Flexibilities for Hospitals and Other Healthcare Facilities. CMS has already waived many Medicare, Medicaid, and CHIP requirements for facilities.

The CMS Dallas Survey best place to buy xalatan online &. Enforcement Division, under the Survey Operations Group, will grant other provider-specific requests for specific types of hospitals and other facilities in Louisiana and Texas. These waivers, once issued, will help provide continued access to care for beneficiaries.

For more information on the waivers CMS has granted, visit. Www.cms.gov/emergency. Special Enrollment Opportunities for Hurricane Victims.

CMS will make available special enrollment periods for certain Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This gives people impacted by the hurricane the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the Exchange if eligible for the special enrollment period. For more information, please visit.

Disaster Preparedness Toolkit for State Medicaid Agencies. CMS developed an inventory of Medicaid and CHIP flexibilities and authorities available to states in the event of a disaster. For more information and to access the toolkit, visit.

Https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/index.html. Dialysis Care. CMS is helping patients obtain access to critical life-saving services.

The Kidney Community Emergency Response (KCER) program has been activated and is working with the End Stage Renal Disease (ESRD) Network, Network 13 – Louisiana, and Network 14 - Texas, to assess the status of dialysis facilities in the potentially impacted areas related to generators, alternate water supplies, education and materials for patients and more. The KCER is also assisting patients who evacuated ahead of the storm to receive dialysis services in the location to which they evacuated. Patients have been educated to have an emergency supply kit on hand including important personal, medical and insurance information.

Contact information for their facility, the ESRD Network hotline number, and contact information of those with whom they may stay or for out-of-state contacts in a waterproof bag. They have also been instructed to have supplies on hand to follow a three-day emergency diet. The ESRD Network 8 – Mississippi hotline is 1-800-638-8299, Network 13 – Louisiana hotline is 800-472-7139, the ESRD Network 14 - Texas hotline is 877-886-4435, and the KCER hotline is 866-901-3773.

Additional information is available on the KCER website www.kcercoalition.com. During the 2017 and 2018 hurricane seasons, CMS approved special purpose renal dialysis facilities in several states to furnish dialysis on a short-term basis at designated locations to serve ESRD patients under emergency circumstances in which there were limited dialysis resources or access-to-care problems due to the emergency circumstances. Medical equipment and supplies replacements.

Under the COVD-19 waivers, CMS suspended certain requirements necessary for Medicare beneficiaries who have lost or realized damage to their durable medical equipment, prosthetics, orthotics and supplies as a result of the PHE. This will help to make sure that beneficiaries can continue to access the needed medical equipment and supplies they rely on each day. Medicare beneficiaries can contact 1-800-MEDICARE (1-800-633-4227) for assistance.

Ensuring Access to Care in Medicare Advantage and Part D. During a public health emergency, Medicare Advantage Organizations and Part D Plan sponsors must take steps to maintain access to covered benefits for beneficiaries in affected areas. These steps include allowing Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities and waiving, in full, requirements for gatekeeper referrals where applicable.

Emergency Preparedness Requirements. Providers and suppliers are expected to have emergency preparedness programs based on an all-hazards approach. To assist in the understanding of the emergency preparedness requirements, CMS Central Office and the Regional Offices hosted two webinars in 2018 regarding Emergency Preparedness requirements and provider expectations.

One was an all provider training on June 19, 2018 with more than 3,000 provider participants and the other an all-surveyor training on August 8, 2018. Both presentations covered the emergency preparedness final rule which included emergency power supply. 1135 waiver process.

Best practices and lessons learned from past disasters. And helpful resources and more. Both webinars are available at https://qsep.cms.gov/welcome.aspx.

CMS also compiled a list of Frequently Asked Questions (FAQs) and useful national emergency preparedness resources to assist state Survey Agencies (SAs), their state, tribal, regional, local emergency management partners and health care providers to develop effective and robust emergency plans and tool kits to assure compliance with the emergency preparedness rules. The tools can be located at. CMS Regional Offices have provided specific emergency preparedness information to Medicare providers and suppliers through meetings, dialogue and presentations.

The regional offices also provide regular technical assistance in emergency preparedness to state agencies and staff, who, since November 2017, have been regularly surveying providers and suppliers for compliance with emergency preparedness regulations. Additional information on the emergency preparedness requirements can be found here.

This notice announces an extension of the timeline for publication buy xalatan online without prescription of a Medicare final rule in accordance with the Social Security Act, which allows us to extend the timeline for publication of the final rule. As of August 26, 2020, the timeline for publication of the final rule to finalize the provisions of the October 17, 2019 proposed rule (84 FR 55766) is extended until August 31, 2021. Start Further Info Lisa O. Wilson, (410) 786-8852 buy xalatan online without prescription. 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 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 buy xalatan online without prescription Coordinated Care. In the proposed rule, we proposed exceptions to the physician self-referral law for certain value-based compensation arrangements between or among physicians, providers, and suppliers. A new exception for certain arrangements under which a physician receives limited remuneration for items or services actually provided by the physician. A new exception for donations of cybersecurity technology buy xalatan online without prescription 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 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 buy xalatan online without prescription. 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 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 buy xalatan online without prescription initial targeted publication date of the final regulation if the Secretary, no later than the regulation's previously established proposed publication date, publishes a notice with the new target date, and such notice includes a brief explanation of the justification for the variation. We announced in the Spring 2020 Unified Agenda (June 30, 2020, www.reginfo.gov) that we would issue the final rule in August 2020. 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 buy xalatan online without prescription the timeline for publication of the final rule until August 31, 2021. Start Signature Dated.

August 24, 2020. Wilma M buy xalatan online without prescription. Robinson, Deputy Executive Secretary to the Department, Department of Health and Human Services. End Signature End Supplemental Information [FR Doc. 2020-18867 Filed buy xalatan online without prescription 8-26-20.

8:45 am]BILLING CODE 4120-01-PThe Centers for Medicare &. Medicaid Services (CMS) today announced efforts underway to support Louisiana and Texas in response to Hurricane Laura. On August 26, 2020, Department of Health and Human Services (HHS) Secretary Alex Azar declared public health emergencies (PHEs) in these states, retroactive to August 22, 2020 for the state of Louisiana and to August 23, buy xalatan online without prescription 2020 for the state of Texas. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of Hurricane Laura. CMS provided numerous waivers to health care providers during the current coronavirus disease 2019 (COVID-19) pandemic to meet the needs of beneficiaries and providers.

The waivers already in place will be available to health care providers to use during the duration of the COVID-19 PHE determination timeframe and for the Hurricane Laura buy xalatan online without prescription PHE. CMS may waive certain additional Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements, create special enrollment opportunities for individuals to access healthcare quickly, and take steps to ensure dialysis patients obtain critical life-saving services. “Our thoughts are with everyone who is in the path of this powerful and dangerous hurricane and CMS is doing everything within its authority to provide assistance and relief to all who are affected,” said CMS Administrator Seema Verma. €œWe will partner and coordinate with state, federal, and local officials to make sure that in the midst buy xalatan online without prescription of all of the uncertainty a natural disaster can bring, our beneficiaries will not have to worry about access to healthcare and other crucial life-saving and sustaining services they may need.” Below are key administrative actions CMS will be taking in response to the PHEs declared in Louisiana and Texas. Waivers and Flexibilities for Hospitals and Other Healthcare Facilities.

CMS has already waived many Medicare, Medicaid, and CHIP requirements for facilities. The CMS Dallas buy xalatan online without prescription Survey &. Enforcement Division, under the Survey Operations Group, will grant other provider-specific requests for specific types of hospitals and other facilities in Louisiana and Texas. These waivers, once issued, will help provide continued access to care for beneficiaries. For more information on the waivers CMS buy xalatan online without prescription has granted, visit.

Www.cms.gov/emergency. Special Enrollment Opportunities for Hurricane Victims. CMS will make available special enrollment periods for certain Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This gives people impacted buy xalatan online without prescription by the hurricane the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the Exchange if eligible for the special enrollment period. For more information, please visit.

Disaster Preparedness Toolkit for State Medicaid Agencies. CMS developed an inventory of Medicaid and buy xalatan online without prescription CHIP flexibilities and authorities available to states in the event of a disaster. For more information and to access the toolkit, visit. Https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/index.html. Dialysis Care buy xalatan online without prescription.

CMS is helping patients obtain access to critical life-saving services. The Kidney Community Emergency Response (KCER) program has been activated and is working with the End Stage Renal Disease (ESRD) Network, Network 13 – Louisiana, and Network 14 - Texas, to assess the status of dialysis facilities in the potentially impacted areas related to generators, alternate water supplies, education and materials for patients and more. The KCER is also assisting patients who evacuated ahead of the storm to receive buy xalatan online without prescription dialysis services in the location to which they evacuated. Patients have been educated to have an emergency supply kit on hand including important personal, medical and insurance information. Contact information for their facility, the ESRD Network hotline number, and contact information of those with whom they may stay or for out-of-state contacts in a waterproof bag.

They have also been instructed to have supplies on buy xalatan online without prescription hand to follow a three-day emergency diet. The ESRD Network 8 – Mississippi hotline is 1-800-638-8299, Network 13 – Louisiana hotline is 800-472-7139, the ESRD Network 14 - Texas hotline is 877-886-4435, and the KCER hotline is 866-901-3773. Additional information is available on the KCER website www.kcercoalition.com. During the 2017 and 2018 hurricane buy xalatan online without prescription seasons, CMS approved special purpose renal dialysis facilities in several states to furnish dialysis on a short-term basis at designated locations to serve ESRD patients under emergency circumstances in which there were limited dialysis resources or access-to-care problems due to the emergency circumstances. Medical equipment and supplies replacements.

Under the COVD-19 waivers, CMS suspended certain requirements necessary for Medicare beneficiaries who have lost or realized damage to their durable medical equipment, prosthetics, orthotics and supplies as a result of the PHE. This will help to make sure that beneficiaries can continue to access the needed medical equipment and supplies they rely on each buy xalatan online without prescription day. Medicare beneficiaries can contact 1-800-MEDICARE (1-800-633-4227) for assistance. Ensuring Access to Care in Medicare Advantage and Part D. During a public health emergency, Medicare Advantage Organizations and Part D Plan sponsors must take steps buy xalatan online without prescription to maintain access to covered benefits for beneficiaries in affected areas.

These steps include allowing Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities and waiving, in full, requirements for gatekeeper referrals where applicable. Emergency Preparedness Requirements. Providers and suppliers are expected to have buy xalatan online without prescription emergency preparedness programs based on an all-hazards approach. To assist in the understanding of the emergency preparedness requirements, CMS Central Office and the Regional Offices hosted two webinars in 2018 regarding Emergency Preparedness requirements and provider expectations. One was an all provider training on June 19, 2018 with more than 3,000 provider participants and the other an all-surveyor training on August 8, 2018.

Both presentations covered buy xalatan online without prescription the emergency preparedness final rule which included emergency power supply. 1135 waiver process. Best practices and lessons learned from past disasters. And helpful resources buy xalatan online without prescription and more. Both webinars are available at https://qsep.cms.gov/welcome.aspx.

CMS also compiled a list of Frequently Asked Questions (FAQs) and useful national emergency preparedness resources to assist state Survey Agencies (SAs), their state, tribal, regional, local emergency management partners and health care providers to develop effective and robust emergency plans and tool kits to assure compliance with the emergency preparedness rules. The tools can be located at buy xalatan online without prescription. CMS Regional Offices have provided specific emergency preparedness information to Medicare providers and suppliers through meetings, dialogue and presentations. The regional offices also provide regular technical assistance in emergency preparedness to state agencies and staff, who, since November 2017, have been regularly surveying providers and suppliers for compliance with emergency preparedness regulations. Additional information on the emergency preparedness requirements can be found here.

Https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_z_emergprep.pdf CMS will continue to work with all geographic areas impacted by Hurricane Laura. We encourage beneficiaries and providers of healthcare services that have been impacted to seek help by visiting CMS’ emergency webpage (www.cms.gov/emergency). For more information about the HHS PHE, please visit.

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Elon Musk on Friday unveiled a coin-sized prototype of a brain implant developed by his startup Neuralink to enable people who are paralyzed to operate smartphones and robotic limbs with their thoughts — and said the company had worked to “dramatically simplify” the device since presenting an earlier version last summer.In an event live-streamed on YouTube to more than 150,000 viewers at one point, the company staged a demonstration in which it trotted out a pig named Gertrude that was said to have had xalatan logo the company’s device implanted in its head two months ago. The live stream showed what Musk claimed to be Gertrude’s real-time brain activity as it sniffed around a pen. At no point, though, did he provide evidence that the signals — rendered in beeps and bright blue xalatan logo wave patterns on screen — were, in fact, emanating from the pig’s brain.A pig presented at a Neuralink demonstration was said to have one of the company’s brain implants in its head.

YouTube screenshot“This is obviously sounding increasingly like a Black Mirror episode,” Musk said at one point during the event as he responded affirmatively to a question about whether the company’s implant could eventually be used to save and replay memories. €œThe future’s xalatan logo going to be weird.”advertisement Musk said that in July Neuralink received a breakthrough device designation from the Food and Drug Administration — a regulatory pathway that could allow the company to soon start a clinical trial in people with paraplegia and tetraplegia. The big reveal came after four former Neuralink employees told STAT that the company’s leaders have long fostered an internal culture characterized by rushed timelines and the “move fast and break things” ethos of a tech company — a pace sometimes at odds with the slow and incremental pace that’s typical of medical device development.

Advertisement Friday’s event began, 40 minutes late, with a glossy video about the company’s work — and then panned to Musk, standing in front of a blue curtain beside a gleaming new version xalatan logo of the company’s surgical “sewing machine” robot that could easily have been mistaken for a giant Apple device. Musk described the event as a “product demo” and said its primary purpose was to recruit potential new employees. It was unclear whether the demonstration was taking place at the xalatan logo company’s Fremont, Calif., headquarters or elsewhere.

Musk proceeded to reveal the new version of Neuralink’s brain implant, which he said was designed to fit snugly into the top of the skull. Neuralink’s technological design has changed significantly xalatan logo since its last big update in July 2019. At that time, the company’s brain implant system involved a credit-card sized device designed to be positioned behind the back of a person’s ear, with several wires stretching to the top of the skull.

After demonstrating the pig’s brain activity at Friday’s event, Musk showed video footage of a pig walking on a treadmill and said Neuralink’s device could be used to “predict the position of limbs with high accuracy.” That capability would be critical to allowing someone using the device xalatan logo to do something like controlling a prosthetic limb, for example.Neuralink for months has signaled that it initially plans to develop its device for people who are paralyzed. It said at its July 2019 event that it wanted to start human testing by the end of 2020. Receiving the breakthrough device designation from xalatan logo the FDA — designed to speed up the lengthy regulatory process — is a step forward, but it by no means guarantees that a device will receive a green light, either in a short or longer-term time frame.

After Musk’s presentation, a handful of the company’s employees — all wearing masks, but seated only inches apart — joined him to take questions submitted on Twitter or from the small audience in the room.In typical fashion for a man who in 2018 sent a Tesla Roadster into space, Musk didn’t hesitate to use the event to cross-promote his electric car company. Asked whether the xalatan logo Neuralink chip would allow people to summon their Tesla telepathically, Musk responded. €œDefinitely — of course.”Matthew MacDougall, the company’s head neurosurgeon, appearing in scrubs, said the company had so far only implanted its technology into the brain’s cortical surface, the coaster-width layer enveloping the brain, but added that it hoped to go deeper in the future.

Still, Musk xalatan logo said. €œYou could solve blindness, you could solve paralysis, you could solve hearing — you can solve a lot just by interfacing with the cortex.”Musk and MacDougall said they hoped to eventually implant Neuralink’s devices — which they referred to on stage simply as “links” — in the deeper structures of the brain, such as in the hypothalamus, which is believed to play a critical role in mental illnesses including depression, anxiety, and PTSD.There were no updates at the event of Neuralink’s research in monkeys, which the company has been conducting in partnership with the University of California, Davis since 2017. At last July’s event, Musk said — without providing evidence — that a monkey had controlled a computer with its brain.At that same July 2019 event, Neuralink xalatan logo released a preprint paper — published a few months later — that claimed to show that a series of Neuralink electrodes implanted in the brains of rats could record neural signals.

Critically, the work did not show where in the brain the implanted electrodes were recording from, for how long they were recording, or whether the recordings could be linked to any of the rats’ bodily movements.In touting Friday’s event — and Neuralink’s technological capabilities — on Twitter in recent weeks, Musk spoke of “AI symbiosis while u wait” and referenced the “matrix in the matrix” — a science-fiction reference about revealing the true nature of reality. The progress the company reported xalatan logo on Friday fell far short of that. Neuralink’s prototype is ambitious, but it has yet to show evidence that it can match up to the brain-machine interfaces developed by academic labs and other companies.

Other groups have shown that they can listen in on neural activity and xalatan logo allow primates and people to control a computer cursor with their brain — so-called “read-out” technology — and have also shown that they can use electrical stimulation to input information, such as a command or the heat of a hot cup of coffee, using “write-in” technology. Neuralink said on Friday that its technology would have both read-out and write-in capabilities.Musk acknowledged that Neuralink still has a long way to go. In closing the event after more xalatan logo than 70 minutes, Musk said.

€œThere’s a tremendous amount of work to be done to go from here to a device that is widely available and affordable and reliable.”Following the news this week of what appears to have been the first confirmed case of a Covid-19 reinfection, other researchers have been coming forward with their own reports. One in Belgium, another in the Netherlands. And now, one in Nevada.What caught experts’ attention about the case of the 25-year-old Reno man was not that he appears to have contracted SARS-CoV-2 (the name of the xalatan logo virus that causes Covid-19) a second time.

Rather, it’s that his second bout was more serious than his first.Immunologists had expected that if the immune response generated after an initial infection could not prevent a second case, then it should at least stave off more severe illness. That’s what occurred with the first known reinfection case, in a 33-year-old Hong Kong man.advertisement Still, despite what happened to the man in Nevada, researchers are stressing this is not a sky-is-falling situation or xalatan logo one that should result in firm conclusions. They always presumed people would become vulnerable to Covid-19 again some time after recovering from an initial case, based on how our immune systems respond to other respiratory viruses, including other coronaviruses.

It’s possible that these early cases of reinfection are outliers and have features that won’t apply to the tens of millions of other people who have already shaken off Covid-19.“There are millions and millions of cases,” said Michael xalatan logo Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health. The real question that should get the most focus, xalatan logo Mina said, is, “What happens to most people?.

€advertisement But with more reinfection reports likely to make it into the scientific literature soon, and from there into the mainstream press, here are some things to look for in assessing them.What’s the deal with the Nevada case?. The Reno xalatan logo resident in question first tested positive for SARS-CoV-2 in April after coming down with a sore throat, cough, and headache, as well as nausea and diarrhea. He got better over time and later tested negative twice.

But then, some 48 days later, the man started experiencing headaches, xalatan logo cough, and other symptoms again. Eventually, he became so sick that he had to be hospitalized and was found to have pneumonia.Researchers sequenced virus samples from both of his infections and found they were different, providing evidence that this was a new infection distinct from the first. What happens xalatan logo when we get Covid-19 in the first case?.

Researchers are finding that, generally, people who get Covid-19 develop a healthy immune response replete with both antibodies (molecules that can block pathogens from infecting cells) and T cells (which help wipe out the virus). This is what happens after other viral infections.In addition xalatan logo to fending off the virus the first time, that immune response also creates memories of the virus, should it try to invade a second time. It’s thought, then, that people who recover from Covid-19 will typically be protected from another case for some amount of time.

With other coronaviruses, protection is thought to last for perhaps a little less than a year to about three years.But researchers can’t tell how long immunity will last with a new pathogen (like xalatan logo SARS-CoV-2) until people start getting reinfected. They also don’t know exactly what mechanisms provide protection against Covid-19, nor do they know what levels of antibodies or T cells are required to signal that someone is protected through a blood test. (These are called the “correlates of protection.”) xalatan logo Why do experts expect second cases to be milder?.

With other viruses, protective immunity doesn’t just vanish one day. Instead, it wanes over xalatan logo time. Researchers have then hypothesized that with SARS-CoV-2, perhaps our immune systems might not always be able to prevent it from getting a toehold in our cells — to halt infection entirely — but that it could still put up enough of a fight to guard us from getting really sick.

Again, this is what happens with xalatan logo other respiratory pathogens.And it’s why some researchers actually looked at the Hong Kong case with relief. The man had mild to moderate Covid-19 symptoms during the first case, but was asymptomatic the second time. It was a demonstration, experts said, of xalatan logo what you would want your immune system to do.

(The case was only detected because the man’s sample was taken at the airport when he arrived back in Hong Kong after traveling in Europe.)“The fact that somebody may get reinfected is not surprising,” Malik Peiris, a virologist at the University of Hong Kong, told STAT earlier this week about the first reinfection. €œBut the reinfection didn’t cause disease, so that’s the first point.”The Nevada case, then, provides a counterexample to that. What kind of immune response did the person who was xalatan logo reinfected generate initially?.

Earlier, we described the robust immune response that most people who have Covid-19 seem to mount. But that was xalatan logo a generalization. Infections and the immune responses they induce in different people are “heterogeneous,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago.Older people often generate weaker immune responses than younger people.

Some studies have also indicated that milder cases of Covid-19 induce tamer immune responses xalatan logo that might not provide as lasting or as thorough of a defense as stronger immune responses. The man in Hong Kong, for example, did not generate antibodies to the virus after his first infection, at least to the level that could be detected by blood tests. Perhaps that explains why he contracted the virus again just about 4 1/2 months after recovering from his initial infection.In the Nevada case, researchers did not test xalatan logo what kind of immune response the man generated after the first case.“Infection is not some binary event,” Cobey said.

And with reinfection, “there’s going to be some viral replication, but the question is how much is the immune system getting engaged?. €What might be broadly meaningful is when people who mounted robust immune responses start getting xalatan logo reinfected, and how severe their second cases are. Are people who have Covid-19 a second time infectious?.

As discussed, immune memory can xalatan logo prevent reinfection. If it can’t, it might stave off serious illness. But there’s a third aspect of this, too.“The most xalatan logo important question for reinfection, with the most serious implications for controlling the pandemic, is whether reinfected people can transmit the virus to others,” Columbia University virologist Angela Rasmussen wrote in Slate this week.Unfortunately, neither the Hong Kong nor the Reno studies looked at this question.

But if most people who get reinfected don’t spread the virus, that’s obviously good news. What happens when people xalatan logo broadly become susceptible again?. Whether it’s six months after the first infection or nine months or a year or longer, at some point, protection for most people who recover from Covid-19 is expected to wane.

And without the arrival of xalatan logo a vaccine and broad uptake of it, that could change the dynamics of local outbreaks.In some communities, it’s thought that more than 20% of residents have experienced an initial Covid-19 case, and are thus theoretically protected from another case for some time. That is still below the point of herd immunity — when enough people are immune that transmission doesn’t occur — but still, the fewer vulnerable people there are, the less likely spread is to occur.On the flip side though, if more people become susceptible to the virus again, that could increase the risk of transmission. Modelers are xalatan logo starting to factor that possibility into their forecasts.A crucial question for which there is not an answer yet is whether what happened to the man in Reno, where the second case was more severe than the first, remains a rare occurrence, as researchers expect and hope.

As the Nevada researchers wrote, “the generalizability of this finding is unknown.”An advocacy group has asked the Department of Defense to investigate what it called “an apparent failure” by Moderna (MRNA) to disclose millions of dollars in awards received from the Defense Advanced Research Projects Agency in patent applications the company filed for vaccines.In a letter to the agency, Knowledge Ecology International explained that a review of dozens of patent applications found the company received approximately $20 million from the federal government in grants several years ago and the funds “likely” led to the creation of its vaccine technology. This was used to develop vaccines to combat different viruses, such as Zika and, later, the virus that xalatan logo causes Covid-19.In arguing for an investigation, the advocacy group maintained Moderna is obligated under federal law to disclose the grants that led to nearly a dozen specific patent applications and explained the financial support means the U.S. Government would have certain rights over the patents.

In other words, U.S xalatan logo. Taxpayers would have an ownership stake in vaccines developed by the company.advertisement “This clarifies the public’s right in the inventions,” said Jamie Love, who heads Knowledge Ecology International, a nonprofit that tracks patents and access to medicines issues. €œThe disclosure (also) changes the narrative about who has financed xalatan logo the inventive activity, often the most risky part of development.” One particular patent assigned to Moderna concerns methods and compositions that can be used specifically against coronaviruses, including COVID-19.

The patent names a Moderna scientist and a former Moderna scientist as inventors, both of which acknowledged performing work under the DARPA awards in two academic papers, according to the report by the advocacy group.advertisement The group examined the 126 patents assigned to Moderna or ModernaTx as well as 154 patent applications. €œDespite the evidence that multiple inventions were conceived in the course of research supported by the DARPA awards, not a single one of the patents or applications assigned to Moderna disclose U.S. Federal government funding,” xalatan logo the report stated.[UPDATE.

A DARPA spokesman sent us this over the weekend. €œIt appears that all past and present DARPA awards to Moderna include the requirement to report the role xalatan logo of government funding for related inventions. Further, DARPA is actively researching agency awards to Moderna to identify which patents and pending patents, if any at all, may be associated with DARPA support.

This effort is ongoing.”]We xalatan logo asked Moderna for comment and will update you accordingly.The missive to the Department of Defense follows a recent analysis by Public Citizen, another advocacy group, indicating the National Institutes of Health may own mRNA-1273, the Moderna vaccine candidate for Covid-19. The advocacy group noted the federal government filed multiple patents covering the vaccine and two patent applications, in particular, list federal scientists as co-inventors.The analyses are part of a larger campaign among advocacy groups and others in the U.S. And elsewhere to ensure that Covid-19 xalatan logo medical products are available to poor populations around the world.

The concern reflects the unprecedented global demand for therapies and vaccines, and a race among wealthy nations to snap up supplies from vaccine makers. In the U.S., the effort has focused on the extent to which the federal government has provided taxpayer dollars to different companies to help xalatan logo fund their discoveries. In some cases, advocates argue that federal funding matters because it clarifies the rights that the U.S.

Government has to ensure a therapy or vaccine is available to Americans on reasonable terms.One example has been xalatan logo remdesivir, the Gilead Sciences (GILD) treatment being given to hospitalized Covid-19 patients. The role played by the U.S. Government in developing remdesivir to combat coronaviruses involved xalatan logo contributions from government personnel at such agencies as the U.S.

Army Medical Research Institute of Infectious Diseases.As for the Moderna vaccine, earlier this month, the company was awarded a $1.525 billion contract by the Department of Defense and the Department of Health and Human Services to manufacture and deliver 100 million doses of its Covid-19 vaccine. The agreement also includes an option to purchase another 400 million doses, xalatan logo although the terms were not disclosed. In announcing the agreement, the government said it would ensure Americans receive the Covid-19 vaccine at no cost, although they may be charged by health care providers for administering a shot.In this instance, however, Love said the “letter is not about price or profits.

It’s about (Moderna) not owning xalatan logo up to DARPA funding inventions. If the U.S. Wants to pay for all of the development xalatan logo of Moderna’s vaccine, as Moderna now acknowledges, and throw in a few more billion now, and an option to spend billions more, it’s not unreasonable to have some transparency over who paid for their inventions.”This is not the first time Moderna has been accused of insufficient disclosure.

Earlier this month, Knowledge Ecology International and Public Citizen maintained the company failed to disclose development costs in a $955 million contract awarded by BARDA for its Covid-19 vaccine. In all, the federal government has awarded the company approximately $2.5 billion to develop the vaccine.The coming few weeks represent a crucial moment for an ambitious plan to try to secure Covid-19 vaccines for roughly 170 countries around the world without the deep pockets to compete for what will be scarce initial supplies.Under the plan, countries that want to pool resources to buy vaccines must notify the World Health Organization and other organizers — Gavi, the Vaccine Alliance, as xalatan logo well as the Coalition for Epidemic Preparedness Innovations — of their intentions by Monday. That means it’s fish-or-cut-bait time for the so-called COVAX facility.Already, wealthy countries — the United States, the United Kingdom, Japan, Canada, and Australia, among others, as well as the European Union — have opted to buy their own vaccine, signing bilateral contracts with manufacturers that have secured billions of doses of vaccine already.

That raises the possibility that less wealthy countries will be boxed out of supplies.advertisement And yet Richard Hatchett, the CEO of CEPI, insists there is a path to billions xalatan logo of doses of vaccine for the rest of the world in 2021. STAT spoke with Hatchett this week. A transcript of the conversation, lightly edited for clarity and length, follows xalatan logo.

You said this is a critical time for CEPI. Can you explain what needs to happen between now and mid-September for this joint purchasing approach to be a success?. Advertisement The critical moment is now for countries to commit to the COVAX xalatan logo facility, because that will enable us to secure ample quantities of vaccine and then to be able to convey when that vaccine is likely to become available based on current information.What we’re now here asking countries to do is to indicate their intent to participate by Aug.

31, and to make a binding commitment by Sept. 18. And to provide funds in support of that binding commitment by early October.

Our negotiations with companies are already taking place and it will be important for us from a planning purpose that countries indicate their intent to participate.Those binding commitments we think will be sufficient to allow us to then secure the advance purchase agreements, particularly with those companies that don’t have a prior contractual obligation to COVAX. And then obviously, we need the funds to live up to those advance purchase agreements.Is it possible this thing could still fall apart?. There appears to be some concern COVAX has been boxed out by rich countries.

There was always a possibility that there wouldn’t be sufficient uptake. But I think we’re very encouraged at this point by the level of commitment, both from countries that would be beneficiaries of the advance market commitment — that’s the lower-income, lower-middle-income countries — as well as the self-financing countries. To have over 170 countries expressing interest in participating — they see the value.We’re much more encouraged now that it’s not going to fall apart.

We still need to bring it off to maximize its value. And we’re right at the crunch moment where countries are going to have to make these commitments. So, the next month is really absolutely critical to the facility.

I am confident at this point that the world recognizes the value and wants it to work.I’ve been keeping tabs on advance purchase agreements that have been announced. And at this point, a small number of rich countries have nailed down a lot of vaccine — more than 3 billion doses. How hard does that make your job?.

The fact that they’re doing it creates anxiety among other countries. And that in itself can accelerate the pace. So, I’m not going to say that we’re not watching that with concern.I will say that for COVAX and the facility, this is absolutely critical moment.

I think we still have a window of opportunity between now and mid-September — when we’re asking that the self-financing countries to make their commitments — to make the facility real and to make it work. Between doses that are committed to COVAX through the access agreements and other agreements — these are discussions with partners that CEPI has funded as well as partners that CEPI has not funded — we still see a pathway for COVAX to well over 3 billion doses in 2021.I think it’s really important to bear in mind is that there are at least a few countries — and I think the U.S. And the U.K.

Most publicly — that may be in a situation of significant oversupply. I believe the U.S. And U.K.

Numbers, if you add them together, would result in enough vaccine for 600 million people to receive two doses of vaccine each. And, you know, there is no possible way that the U.S. Or the U.K.

Can use that much vaccine.So, there may be a lot of extra supply that looks like it’s been tied up sloshing around later. I don’t think that the bilateral deals that have been struck are going to prevent COVAX from achieving its goals.But if so much vaccine has been pre-ordered by rich countries, can countries in the COVAX pool get enough for their needs?. One of the things that we’ve argued through COVAX is that to control the pandemic or to end the acute phase of the pandemic to allow normalcy to start to reassert itself, you don’t have to vaccinate 100% of your population.You need to vaccinate those at greatest risk for bad outcomes and you need to vaccinate certain critical workers, particularly your health care workforce.

And if you can achieve that goal, which for most countries means vaccinating between 20% and maybe 30% of the population, then you can transform the pandemic into something that is much more manageable. Then you can buy yourself time to vaccinate everybody who wants to be vaccinated.We’ve argued the COVAX facility really offers the world the best shot at doing that globally in the fastest possible way, as well as providing for equitable access. This is a case where doing the equitable thing is also doing the efficient thing.CEPI has provided funding to nine vaccines.

Is it true that all those manufacturers aren’t required to provide the COVAX facility with vaccine?. That is correct. One of the things that we did, and I think it was an important role that CEPI played early on, was that we moved money very, very quickly, in small increments.

You know, some of the early contracts were only $5 million or $10 million, to get programs up and running while we potentially put in place much larger-scale, longer-term contracts.If you were doing it over again, would you have given money without strings attached?. Yes, I think I would have. I think that was critically important to initiating programs.Our contract with Moderna was established in about 48 hours.

And that provided critical funding to them to manufacture doses that got them into clinical trials within nine weeks of the genetic sequences [of the SARS-CoV-2 virus] being released.And if you look at the nine programs that we’ve invested in, seven are in clinical trials. Two — the AstraZeneca program now and the Moderna program — are among the handful in Phase 3 clinical trials. And, I think the number of projects that that we funded initially, which started in kind of a biotech or academic phase that have now been picked up by large multinational corporations, there’s at least four.

The Themis program being picked up by Merck, Oxford University by AstraZeneca, the University of Queensland by CSL, and Clover being in partnership with GSK, I think that speaks to the quality of the programs that we selected.So, I think that combination of rapid review, speed of funding, getting those programs started, getting them oriented in the right direction, I think all of that is critical to where we are now.Companies that got money from CEPI to build out production capacity — that money came with strings attached, right?. Yes, exactly. So, where CEPI has made investments that create manufacturing, or secure manufacturing capacity, the commitment has been that the capacity that is attributable to the CEPI investment is committed — at least right of first refusal — to the global procurement facility.WASHINGTON — The Trump administration removed a top Food and Drug Administration communications official from her post on Friday in the wake of several controversial agency misstatements, a senior administration official confirmed to STAT.The spokeswoman, Emily Miller, had played a lead role in defending the FDA commissioner, Stephen Hahn, after he misrepresented data regarding the use of blood plasma from recovered Covid-19 patients.

The New York Times first reported Miller’s ouster. Miller’s tenure at as the top FDA spokeswoman lasted only 11 days. Her appointment was viewed with alarm by agency officials who felt her presence at the agency was emblematic of broader political pressure from the Trump administration, STAT first reported earlier this week.advertisement Before joining the FDA, Miller had no experience in health or medicine.

Her former role as assistant commissioner for media affairs is typically not an appointment filled by political appointees. The FDA’s communications arm typically maintains a neutral, nonpolitical tone.Miller’s appointment particularly alarmed FDA staff and outside scientists given her history in right-wing political advocacy and conservatism journalism. Her résumé included a stint as a Washington Times columnist, where she penned columns with titles that include “New Obamacare ads make young women look like sluts,” and a 2013 book on gun rights titled “Emily Gets Her Gun.

But Obama Wants to Take Yours.”advertisement She also worked as a reporter for One America News Network, a right-wing cable channel that frequently espouses conspiracy theories and has declared an open alliance with President Trump.Miller quickly made her presence known at the FDA. In the wake of Hahn’s misstatements on blood plasma, she aggressively defended the commissioner, falsely claiming in a tweet that the therapy “has shown to be beneficial for 35% of patients.” An FDA press release on blood plasma, issued less than a week after her appointment, similarly alarmed agency insiders by trumpeting the emergency authorization as “Another Achievement in Administration’s Fight Against [the] Pandemic.”.

Elon Musk on Friday unveiled a coin-sized prototype of a brain implant developed by his startup Neuralink to enable people who are paralyzed to operate smartphones and robotic limbs with their thoughts — and said the company had worked to “dramatically simplify” the device since buy xalatan online without prescription presenting an earlier version last summer.In an event live-streamed on YouTube to more than 150,000 viewers at one point, the company staged a demonstration in which it trotted out a pig named Gertrude that was said to have had the company’s device implanted in its head two months ago. The live stream showed what Musk claimed to be Gertrude’s real-time brain activity as it sniffed around a pen. At no point, though, did he provide evidence that the signals — rendered in beeps buy xalatan online without prescription and bright blue wave patterns on screen — were, in fact, emanating from the pig’s brain.A pig presented at a Neuralink demonstration was said to have one of the company’s brain implants in its head.

YouTube screenshot“This is obviously sounding increasingly like a Black Mirror episode,” Musk said at one point during the event as he responded affirmatively to a question about whether the company’s implant could eventually be used to save and replay memories. €œThe future’s going to be weird.”advertisement Musk said that in July Neuralink received a breakthrough device designation from the Food and Drug Administration — a regulatory pathway that could allow buy xalatan online without prescription the company to soon start a clinical trial in people with paraplegia and tetraplegia. The big reveal came after four former Neuralink employees told STAT that the company’s leaders have long fostered an internal culture characterized by rushed timelines and the “move fast and break things” ethos of a tech company — a pace sometimes at odds with the slow and incremental pace that’s typical of medical device development.

Advertisement Friday’s event began, 40 minutes late, with a glossy video buy xalatan online without prescription about the company’s work — and then panned to Musk, standing in front of a blue curtain beside a gleaming new version of the company’s surgical “sewing machine” robot that could easily have been mistaken for a giant Apple device. Musk described the event as a “product demo” and said its primary purpose was to recruit potential new employees. It was unclear whether the demonstration was taking place at the company’s Fremont, Calif., headquarters or elsewhere buy xalatan online without prescription.

Musk proceeded to reveal the new version of Neuralink’s brain implant, which he said was designed to fit snugly into the top of the skull. Neuralink’s technological design has changed significantly since its last big update in July buy xalatan online without prescription 2019. At that time, the company’s brain implant system involved a credit-card sized device designed to be positioned behind the back of a person’s ear, with several wires stretching to the top of the skull.

After demonstrating the pig’s brain activity at Friday’s event, Musk showed video footage of a pig walking on a treadmill and said Neuralink’s device buy xalatan online without prescription could be used to “predict the position of limbs with high accuracy.” That capability would be critical to allowing someone using the device to do something like controlling a prosthetic limb, for example.Neuralink for months has signaled that it initially plans to develop its device for people who are paralyzed. It said at its July 2019 event that it wanted to start human testing by the end of 2020. Receiving the breakthrough device designation from the FDA — designed to speed up the lengthy regulatory process — is a step forward, but it by no means guarantees that a device buy xalatan online without prescription will receive a green light, either in a short or longer-term time frame.

After Musk’s presentation, a handful of the company’s employees — all wearing masks, but seated only inches apart — joined him to take questions submitted on Twitter or from the small audience in the room.In typical fashion for a man who in 2018 sent a Tesla Roadster into space, Musk didn’t hesitate to use the event to cross-promote his electric car company. Asked whether the Neuralink chip would allow people buy xalatan online without prescription to summon their Tesla telepathically, Musk responded. €œDefinitely — of course.”Matthew MacDougall, the company’s head neurosurgeon, appearing in scrubs, said the company had so far only implanted its technology into the brain’s cortical surface, the coaster-width layer enveloping the brain, but added that it hoped to go deeper in the future.

Still, Musk buy xalatan online without prescription said. €œYou could solve blindness, you could solve paralysis, you could solve hearing — you can solve a lot just by interfacing with the cortex.”Musk and MacDougall said they hoped to eventually implant Neuralink’s devices — which they referred to on stage simply as “links” — in the deeper structures of the brain, such as in the hypothalamus, which is believed to play a critical role in mental illnesses including depression, anxiety, and PTSD.There were no updates at the event of Neuralink’s research in monkeys, which the company has been conducting in partnership with the University of California, Davis since 2017. At last July’s event, Musk said — without providing evidence — that a monkey had controlled a computer with its brain.At that same July 2019 event, Neuralink released a preprint paper — published a few months later — that claimed to show that a series of Neuralink electrodes implanted in the brains of rats buy xalatan online without prescription could record neural signals.

Critically, the work did not show where in the brain the implanted electrodes were recording from, for how long they were recording, or whether the recordings could be linked to any of the rats’ bodily movements.In touting Friday’s event — and Neuralink’s technological capabilities — on Twitter in recent weeks, Musk spoke of “AI symbiosis while u wait” and referenced the “matrix in the matrix” — a science-fiction reference about revealing the true nature of reality. The progress the company reported on Friday fell buy xalatan online without prescription far short of that. Neuralink’s prototype is ambitious, but it has yet to show evidence that it can match up to the brain-machine interfaces developed by academic labs and other companies.

Other groups have shown that they can listen in on neural activity and allow primates and people to control a buy xalatan online without prescription computer cursor with their brain — so-called “read-out” technology — and have also shown that they can use electrical stimulation to input information, such as a command or the heat of a hot cup of coffee, using “write-in” technology. Neuralink said on Friday that its technology would have both read-out and write-in capabilities.Musk acknowledged that Neuralink still has a long way to go. In closing the event after more than 70 minutes, buy xalatan online without prescription Musk said.

€œThere’s a tremendous amount of work to be done to go from here to a device that is widely available and affordable and reliable.”Following the news this week of what appears to have been the first confirmed case of a Covid-19 reinfection, other researchers have been coming forward with their own reports. One in Belgium, another in the Netherlands. And now, one in Nevada.What caught experts’ attention about the case of the 25-year-old Reno man buy xalatan online without prescription was not that he appears to have contracted SARS-CoV-2 (the name of the virus that causes Covid-19) a second time.

Rather, it’s that his second bout was more serious than his first.Immunologists had expected that if the immune response generated after an initial infection could not prevent a second case, then it should at least stave off more severe illness. That’s what occurred with the first known reinfection case, in a 33-year-old Hong Kong man.advertisement Still, despite what happened to the man in Nevada, researchers are stressing this is not a sky-is-falling situation or one that should result in firm conclusions buy xalatan online without prescription. They always presumed people would become vulnerable to Covid-19 again some time after recovering from an initial case, based on how our immune systems respond to other respiratory viruses, including other coronaviruses.

It’s possible that these early cases of reinfection are outliers and have features that won’t apply to the tens of millions of other people who have already shaken off Covid-19.“There buy xalatan online without prescription are millions and millions of cases,” said Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health. The real question that should get the most focus, Mina said, buy xalatan online without prescription is, “What happens to most people?.

€advertisement But with more reinfection reports likely to make it into the scientific literature soon, and from there into the mainstream press, here are some things to look for in assessing them.What’s the deal with the Nevada case?. The Reno resident in question first tested positive buy xalatan online without prescription for SARS-CoV-2 in April after coming down with a sore throat, cough, and headache, as well as nausea and diarrhea. He got better over time and later tested negative twice.

But then, some 48 days buy xalatan online without prescription later, the man started experiencing headaches, cough, and other symptoms again. Eventually, he became so sick that he had to be hospitalized and was found to have pneumonia.Researchers sequenced virus samples from both of his infections and found they were different, providing evidence that this was a new infection distinct from the first. What happens when we get Covid-19 in the first buy xalatan online without prescription case?.

Researchers are finding that, generally, people who get Covid-19 develop a healthy immune response replete with both antibodies (molecules that can block pathogens from infecting cells) and T cells (which help wipe out the virus). This is what happens after other viral infections.In buy xalatan online without prescription addition to fending off the virus the first time, that immune response also creates memories of the virus, should it try to invade a second time. It’s thought, then, that people who recover from Covid-19 will typically be protected from another case for some amount of time.

With other coronaviruses, protection is thought to last for perhaps a little less than a year to about three years.But researchers can’t tell how long buy xalatan online without prescription immunity will last with a new pathogen (like SARS-CoV-2) until people start getting reinfected. They also don’t know exactly what mechanisms provide protection against Covid-19, nor do they know what levels of antibodies or T cells are required to signal that someone is protected through a blood test. (These are called buy xalatan online without prescription the “correlates of protection.”) Why do experts expect second cases to be milder?.

With other viruses, protective immunity doesn’t just vanish one day. Instead, it wanes over time buy xalatan online without prescription. Researchers have then hypothesized that with SARS-CoV-2, perhaps our immune systems might not always be able to prevent it from getting a toehold in our cells — to halt infection entirely — but that it could still put up enough of a fight to guard us from getting really sick.

Again, this is what happens with buy xalatan online without prescription other respiratory pathogens.And it’s why some researchers actually looked at the Hong Kong case with relief. The man had mild to moderate Covid-19 symptoms during the first case, but was asymptomatic the second time. It was buy xalatan online without prescription a demonstration, experts said, of what you would want your immune system to do.

(The case was only detected because the man’s sample was taken at the airport when he arrived back in Hong Kong after traveling in Europe.)“The fact that somebody may get reinfected is not surprising,” Malik Peiris, a virologist at the University of Hong Kong, told STAT earlier this week about the first reinfection. €œBut the reinfection didn’t cause disease, so that’s the first point.”The Nevada case, then, provides a counterexample to that. What kind of immune response did the person buy xalatan online without prescription who was reinfected generate initially?.

Earlier, we described the robust immune response that most people who have Covid-19 seem to mount. But that buy xalatan online without prescription was a generalization. Infections and the immune responses they induce in different people are “heterogeneous,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago.Older people often generate weaker immune responses than younger people.

Some studies have also indicated that milder cases of Covid-19 induce tamer immune responses that might buy xalatan online without prescription not provide as lasting or as thorough of a defense as stronger immune responses. The man in Hong Kong, for example, did not generate antibodies to the virus after his first infection, at least to the level that could be detected by blood tests. Perhaps that explains why he contracted buy xalatan online without prescription the virus again just about 4 1/2 months after recovering from his initial infection.In the Nevada case, researchers did not test what kind of immune response the man generated after the first case.“Infection is not some binary event,” Cobey said.

And with reinfection, “there’s going to be some viral replication, but the question is how much is the immune system getting engaged?. €What might be broadly meaningful is when people who mounted robust immune buy xalatan online without prescription responses start getting reinfected, and how severe their second cases are. Are people who have Covid-19 a second time infectious?.

As discussed, buy xalatan online without prescription immune memory can prevent reinfection. If it can’t, it might stave off serious illness. But there’s a third aspect of this, too.“The most important question for reinfection, with the most serious implications for controlling the pandemic, is whether reinfected people can transmit buy xalatan online without prescription the virus to others,” Columbia University virologist Angela Rasmussen wrote in Slate this week.Unfortunately, neither the Hong Kong nor the Reno studies looked at this question.

But if most people who get reinfected don’t spread the virus, that’s obviously good news. What happens when buy xalatan online without prescription people broadly become susceptible again?. Whether it’s six months after the first infection or nine months or a year or longer, at some point, protection for most people who recover from Covid-19 is expected to wane.

And without the arrival of a vaccine and broad uptake of it, that could change the dynamics buy xalatan online without prescription of local outbreaks.In some communities, it’s thought that more than 20% of residents have experienced an initial Covid-19 case, and are thus theoretically protected from another case for some time. That is still below the point of herd immunity — when enough people are immune that transmission doesn’t occur — but still, the fewer vulnerable people there are, the less likely spread is to occur.On the flip side though, if more people become susceptible to the virus again, that could increase the risk of transmission. Modelers are starting to factor that possibility into their forecasts.A crucial question for which there is not an answer yet is whether what happened to the man in Reno, where the second case was more severe than the buy xalatan online without prescription first, remains a rare occurrence, as researchers expect and hope.

As the Nevada researchers wrote, “the generalizability of this finding is unknown.”An advocacy group has asked the Department of Defense to investigate what it called “an apparent failure” by Moderna (MRNA) to disclose millions of dollars in awards received from the Defense Advanced Research Projects Agency in patent applications the company filed for vaccines.In a letter to the agency, Knowledge Ecology International explained that a review of dozens of patent applications found the company received approximately $20 million from the federal government in grants several years ago and the funds “likely” led to the creation of its vaccine technology. This was buy xalatan online without prescription used to develop vaccines to combat different viruses, such as Zika and, later, the virus that causes Covid-19.In arguing for an investigation, the advocacy group maintained Moderna is obligated under federal law to disclose the grants that led to nearly a dozen specific patent applications and explained the financial support means the U.S. Government would have certain rights over the patents.

In other words, buy xalatan online without prescription U.S. Taxpayers would have an ownership stake in vaccines developed by the company.advertisement “This clarifies the public’s right in the inventions,” said Jamie Love, who heads Knowledge Ecology International, a nonprofit that tracks patents and access to medicines issues. €œThe disclosure (also) changes the narrative about buy xalatan online without prescription who has financed the inventive activity, often the most risky part of development.” One particular patent assigned to Moderna concerns methods and compositions that can be used specifically against coronaviruses, including COVID-19.

The patent names a Moderna scientist and a former Moderna scientist as inventors, both of which acknowledged performing work under the DARPA awards in two academic papers, according to the report by the advocacy group.advertisement The group examined the 126 patents assigned to Moderna or ModernaTx as well as 154 patent applications. €œDespite the evidence that multiple inventions were conceived in the course of research supported by the DARPA awards, not a single one of the patents or applications assigned to Moderna disclose U.S. Federal government funding,” the report stated.[UPDATE buy xalatan online without prescription.

A DARPA spokesman sent us this over the weekend. €œIt appears that all past and present DARPA awards to Moderna buy xalatan online without prescription include the requirement to report the role of government funding for related inventions. Further, DARPA is actively researching agency awards to Moderna to identify which patents and pending patents, if any at all, may be associated with DARPA support.

This effort is ongoing.”]We asked Moderna for comment and will update you accordingly.The missive to the Department of Defense follows a recent analysis by Public Citizen, buy xalatan online without prescription another advocacy group, indicating the National Institutes of Health may own mRNA-1273, the Moderna vaccine candidate for Covid-19. The advocacy group noted the federal government filed multiple patents covering the vaccine and two patent applications, in particular, list federal scientists as co-inventors.The analyses are part of a larger campaign among advocacy groups and others in the U.S. And elsewhere to ensure that buy xalatan online without prescription Covid-19 medical products are available to poor populations around the world.

The concern reflects the unprecedented global demand for therapies and vaccines, and a race among wealthy nations to snap up supplies from vaccine makers. In the U.S., the effort has focused on the extent buy xalatan online without prescription to which the federal government has provided taxpayer dollars to different companies to help fund their discoveries. In some cases, advocates argue that federal funding matters because it clarifies the rights that the U.S.

Government has to ensure a therapy or vaccine is available to Americans on reasonable terms.One example has been buy xalatan online without prescription remdesivir, the Gilead Sciences (GILD) treatment being given to hospitalized Covid-19 patients. The role played by the U.S. Government in developing remdesivir to combat coronaviruses involved contributions from government personnel at such agencies as the U.S buy xalatan online without prescription.

Army Medical Research Institute of Infectious Diseases.As for the Moderna vaccine, earlier this month, the company was awarded a $1.525 billion contract by the Department of Defense and the Department of Health and Human Services to manufacture and deliver 100 million doses of its Covid-19 vaccine. The agreement buy xalatan online without prescription also includes an option to purchase another 400 million doses, although the terms were not disclosed. In announcing the agreement, the government said it would ensure Americans receive the Covid-19 vaccine at no cost, although they may be charged by health care providers for administering a shot.In this instance, however, Love said the “letter is not about price or profits.

It’s about (Moderna) not owning up to DARPA funding buy xalatan online without prescription inventions. If the U.S. Wants to pay for all of the development of Moderna’s vaccine, as Moderna now acknowledges, buy xalatan online without prescription and throw in a few more billion now, and an option to spend billions more, it’s not unreasonable to have some transparency over who paid for their inventions.”This is not the first time Moderna has been accused of insufficient disclosure.

Earlier this month, Knowledge Ecology International and Public Citizen maintained the company failed to disclose development costs in a $955 million contract awarded by BARDA for its Covid-19 vaccine. In all, the federal government has awarded the company approximately $2.5 billion to develop the vaccine.The coming few weeks represent a crucial moment for an ambitious plan to try to secure Covid-19 vaccines for roughly 170 countries around the world without the deep pockets to compete for what will be scarce initial supplies.Under the plan, countries that want to pool resources to buy vaccines must notify the World Health Organization and other organizers — Gavi, the Vaccine Alliance, as well buy xalatan online without prescription as the Coalition for Epidemic Preparedness Innovations — of their intentions by Monday. That means it’s fish-or-cut-bait time for the so-called COVAX facility.Already, wealthy countries — the United States, the United Kingdom, Japan, Canada, and Australia, among others, as well as the European Union — have opted to buy their own vaccine, signing bilateral contracts with manufacturers that have secured billions of doses of vaccine already.

That raises the possibility buy xalatan online without prescription that less wealthy countries will be boxed out of supplies.advertisement And yet Richard Hatchett, the CEO of CEPI, insists there is a path to billions of doses of vaccine for the rest of the world in 2021. STAT spoke with Hatchett this week. A transcript of the conversation, lightly edited for clarity and length, buy xalatan online without prescription follows.

You said this is a critical time for CEPI. Can you explain what needs to happen between now and mid-September for this joint purchasing approach to be a success?. Advertisement The critical moment is now for countries to commit to the COVAX facility, because that will enable us to buy xalatan online without prescription secure ample quantities of vaccine and then to be able to convey when that vaccine is likely to become available based on current information.What we’re now here asking countries to do is to indicate their intent to participate by Aug.

31, and to make a binding commitment by Sept. 18. And to provide funds in support of that binding commitment by early October.

Our negotiations with companies are already taking place and it will be important for us from a planning purpose that countries indicate their intent to participate.Those binding commitments we think will be sufficient to allow us to then secure the advance purchase agreements, particularly with those companies that don’t have a prior contractual obligation to COVAX. And then obviously, we need the funds to live up to those advance purchase agreements.Is it possible this thing could still fall apart?. There appears to be some concern COVAX has been boxed out by rich countries.

There was always a possibility that there wouldn’t be sufficient uptake. But I think we’re very encouraged at this point by the level of commitment, both from countries that would be beneficiaries of the advance market commitment — that’s the lower-income, lower-middle-income countries — as well as the self-financing countries. To have over 170 countries expressing interest in participating — they see the value.We’re much more encouraged now that it’s not going to fall apart.

We still need to bring it off to maximize its value. And we’re right at the crunch moment where countries are going to have to make these commitments. So, the next month is really absolutely critical to the facility.

I am confident at this point that the world recognizes the value and wants it to work.I’ve been keeping tabs on advance purchase agreements that have been announced. And at this point, a small number of rich countries have nailed down a lot of vaccine — more than 3 billion doses. How hard does that make your job?.

The fact that they’re doing it creates anxiety among other countries. And that in itself can accelerate the pace. So, I’m not going to say that we’re not watching that with concern.I will say that for COVAX and the facility, this is absolutely critical moment.

I think we still have a window of opportunity between now and mid-September — when we’re asking that the self-financing countries to make their commitments — to make the facility real and to make it work. Between doses that are committed to COVAX through the access agreements and other agreements — these are discussions with partners that CEPI has funded as well as partners that CEPI has not funded — we still see a pathway for COVAX to well over 3 billion doses in 2021.I think it’s really important to bear in mind is that there are at least a few countries — and I think the U.S. And the U.K.

Most publicly — that may be in a situation of significant oversupply. I believe the U.S. And U.K.

Numbers, if you add them together, would result in enough vaccine for 600 million people to receive two doses of vaccine each. And, you know, there is no possible way that the U.S. Or the U.K.

Can use that much vaccine.So, there may be a lot of extra supply that looks like it’s been tied up sloshing around later. I don’t think that the bilateral deals that have been struck are going to prevent COVAX from achieving its goals.But if so much vaccine has been pre-ordered by rich countries, can countries in the COVAX pool get enough for their needs?. One of the things that we’ve argued through COVAX is that to control the pandemic or to end the acute phase of the pandemic to allow normalcy to start to reassert itself, you don’t have to vaccinate 100% of your population.You need to vaccinate those at greatest risk for bad outcomes and you need to vaccinate certain critical workers, particularly your health care workforce.

And if you can achieve that goal, which for most countries means vaccinating between 20% and maybe 30% of the population, then you can transform the pandemic into something that is much more manageable. Then you can buy yourself time to vaccinate everybody who wants to be vaccinated.We’ve argued the COVAX facility really offers the world the best shot at doing that globally in the fastest possible way, as well as providing for equitable access. This is a case where doing the equitable thing is also doing the efficient thing.CEPI has provided funding to nine vaccines.

Is it true that all those manufacturers aren’t required to provide the COVAX facility with vaccine?. That is correct. One of the things that we did, and I think it was an important role that CEPI played early on, was that we moved money very, very quickly, in small increments.

You know, some of the early contracts were only $5 million or $10 million, to get programs up and running while we potentially put in place much larger-scale, longer-term contracts.If you were doing it over again, would you have given money without strings attached?. Yes, I think I would have. I think that was critically important to initiating programs.Our contract with Moderna was established in about 48 hours.

And that provided critical funding to them to manufacture doses that got them into clinical trials within nine weeks of the genetic sequences [of the SARS-CoV-2 virus] being released.And if you look at the nine programs that we’ve invested in, seven are in clinical trials. Two — the AstraZeneca program now and the Moderna program — are among the handful in Phase 3 clinical trials. And, I think the number of projects that that we funded initially, which started in kind of a biotech or academic phase that have now been picked up by large multinational corporations, there’s at least four.

The Themis program being picked up by Merck, Oxford University by AstraZeneca, the University of Queensland by CSL, and Clover being in partnership with GSK, I think that speaks to the quality of the programs that we selected.So, I think that combination of rapid review, speed of funding, getting those programs started, getting them oriented in the right direction, I think all of that is critical to where we are now.Companies that got money from CEPI to build out production capacity — that money came with strings attached, right?. Yes, exactly. So, where CEPI has made investments that create manufacturing, or secure manufacturing capacity, the commitment has been that the capacity that is attributable to the CEPI investment is committed — at least right of first refusal — to the global procurement facility.WASHINGTON — The Trump administration removed a top Food and Drug Administration communications official from her post on Friday in the wake of several controversial agency misstatements, a senior administration official confirmed to STAT.The spokeswoman, Emily Miller, had played a lead role in defending the FDA commissioner, Stephen Hahn, after he misrepresented data regarding the use of blood plasma from recovered Covid-19 patients.

The New York Times first reported Miller’s ouster. Miller’s tenure at as the top FDA spokeswoman lasted only 11 days. Her appointment was viewed with alarm by agency officials who felt her presence at the agency was emblematic of broader political pressure from the Trump administration, STAT first reported earlier this week.advertisement Before joining the FDA, Miller had no experience in health or medicine.

Her former role as assistant commissioner for media affairs is typically not an appointment filled by political appointees. The FDA’s communications arm typically maintains a neutral, nonpolitical tone.Miller’s appointment particularly alarmed FDA staff and outside scientists given her history in right-wing political advocacy and conservatism journalism. Her résumé included a stint as a Washington Times columnist, where she penned columns with titles that include “New Obamacare ads make young women look like sluts,” and a 2013 book on gun rights titled “Emily Gets Her Gun.

But Obama Wants to Take Yours.”advertisement She also worked as a reporter for One America News Network, a right-wing cable channel that frequently espouses conspiracy theories and has declared an open alliance with President Trump.Miller quickly made her presence known at the FDA. In the wake of Hahn’s misstatements on blood plasma, she aggressively defended the commissioner, falsely claiming in a tweet that the therapy “has shown to be beneficial for 35% of patients.” An FDA press release on blood plasma, issued less than a week after her appointment, similarly alarmed agency insiders by trumpeting the emergency authorization as “Another Achievement in Administration’s Fight Against [the] Pandemic.”.

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