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SALT LAKE buy kamagra 100mg CITY, Nov http://www.pressesite.dk/lowest-price-kamagra/. 10, 2020 (GLOBE NEWSWIRE) -- Health Catalyst, Inc. (Nasdaq.

HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today reported financial results for the quarter ended September 30, 2020.“In the third quarter of 2020, I am pleased to share that we achieved strong performance across our business, including exceeding the mid-point of our quarterly guidance for both revenue and Adjusted EBITDA,” said Dan Burton, CEO of Health Catalyst. €œIn addition to this financial and operational execution, we are excited to announce the promotion of Patrick Nelli, our current Chief Financial Officer, to the role President of Health Catalyst, effective January 1, 2021. Patrick's responsibilities as President will include all the major growth functions of the company, including with existing customers, new customers, international expansion, sales operations, marketing and communications.

Additionally, I am pleased to announce the promotion of Bryan Hunt, our current Senior Vice President of Financial Planning &. Analysis to the role of Chief Financial Officer, effective January 1, 2021. Patrick and Bryan, in their newly appointed roles, have my full support and confidence and the unanimous support and confidence of our board of directors.

Lastly, I would also like to share two additional promotions related to these changes. Jason Alger, our Senior Vice President of Finance, has been promoted to Chief Accounting Officer, and Adam Brown, our Senior Vice President of Investor Relations, has been promoted to Senior Vice President of Investor Relations and Finance Planning &. Analysis.”Financial Highlights for the Three Months Ended September 30, 2020 Key Financial Metrics Three Months EndedSeptember 30, Year over Year Change 2020 2019 GAAP Financial Data.

(in thousands, except percentages) Technology revenue $ 27,964 $ 21,160 32% Professional services revenue $ 19,227 $ 18,263 5% Total revenue $ 47,191 $ 39,423 20% Loss from operations $ (23,458 ) $ (20,736 ) (13)% Net loss $ (27,326 ) $ (21,416 ) (28)% Other Non-GAAP Financial Data:(1) Adjusted Technology Gross Profit $ 19,115 $ 14,484 32% Adjusted Technology Gross Margin 68 % 68 % Adjusted Professional Services Gross Profit $ 4,823 $ 6,677 (28)% Adjusted Professional Services Gross Margin 25 % 37 % Total Adjusted Gross Profit $ 23,938 $ 21,161 13% Total Adjusted Gross Margin 51 % 54 % Adjusted EBITDA $ (6,434 ) $ (8,446 ) 24% ________________________(1) These measures are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). See the accompanying "Non-GAAP Financial Measures" section below for more information about these financial measures, including the limitations of such measures, and for a reconciliation of each measure to the most directly comparable measure calculated in accordance with GAAP.Financial OutlookHealth Catalyst provides forward-looking guidance on total revenue, a GAAP measure, and Adjusted EBITDA, a non-GAAP measure.For the fourth quarter of 2020, we expect:Total revenue between $50.5 million and $53.5 million, and Adjusted EBITDA between $(7.3) million and $(5.3) millionFor the full year of 2020, we expect:Total revenue between $186.1 million and $189.1 million, and Adjusted EBITDA between $(23.9) million and $(21.9) millionWe have not reconciled guidance for Adjusted EBITDA to net loss, the most directly comparable GAAP measure, and have not provided forward-looking guidance for net loss, because there are items that may impact net loss, including stock-based compensation, that are not within our control or cannot be reasonably predicted.Quarterly Conference Call DetailsThe company will host a conference call to review the results today, Tuesday, November 10, 2020 at 5:00 p.m. E.T.

The conference call can be accessed by dialing 1-877-295-1104 for U.S. Participants, or 1-470-495-9486 for international participants, and referencing participant code 7195951. A live audio webcast will be available online at https://ir.healthcatalyst.com/.

A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days.About Health CatalystHealth Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platform—powered by data from more than 100 million patient records and encompassing trillions of facts—as well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed.Available InformationHealth Catalyst intends to use its Investor Relations website as a means of disclosing material non-public information and for complying with its disclosure obligations under Regulation FD.Forward-Looking StatementsThis release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, as amended.

These forward-looking statements include statements regarding our future growth and our financial outlook for Q4 and fiscal year 2020. Forward-looking statements are subject to risks and uncertainties and are based on potentially inaccurate assumptions that could cause actual results to differ materially from those expected or implied by the forward-looking statements. Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance.Important risks and uncertainties that could cause our actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following.

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

(iv) the loss of one or more key customers or partners. (v) the impact of erectile dysfunction treatment on our business and results of operation. And (vi) changes to our abilities to recruit and retain qualified team members.

For a detailed discussion of the risk factors that could affect our actual results, please refer to the risk factors identified in our SEC reports, including, but not limited to the Annual Report on Form 10-K for the year ended December 31, 2019 filed with the SEC on February 28, 2020 and the Quarterly Report on Form 10-Q for the fiscal quarter ended September 30, 2020 expected to be filed with the SEC on or about November 10, 2020. All information provided in this release and in the attachments is as of the date hereof, and we undertake no duty to update or revise this information unless required by law. Condensed Consolidated Balance Sheets (in thousands, except share and per share data, unaudited) As ofSeptember 30, As ofDecember 31, 2020 2019 Assets Current assets.

Cash and cash equivalents $ 111,239 $ 18,032 Short-term investments 163,898 210,245 Accounts receivable, net 36,339 27,570 Prepaid expenses and other assets 11,290 8,392 Total current assets 322,766 264,239 Property and equipment, net 5,319 4,295 Intangible assets, net 105,926 25,535 Operating lease right-of-use assets 25,833 3,787 Goodwill 107,822 3,694 Other assets 2,997 810 Total assets $ 570,663 $ 302,360 Liabilities and stockholders’ equity Current liabilities. Accounts payable $ 5,189 $ 3,622 Accrued liabilities 14,061 8,944 Acquisition-related consideration payable 3,214 2,192 Deferred revenue 35,090 30,653 Operating lease liabilities 2,425 2,806 Contingent consideration liabilities 5,893 — Total current liabilities 65,872 48,217 Long-term debt, net of current portion 166,200 48,200 Acquisition-related consideration payable, net of current portion — 1,860 Deferred revenue, net of current portion 1,635 1,459 Operating lease liabilities, net of current portion 24,245 1,654 Contingent consideration liabilities, net of current portion 10,279 — Other liabilities 2,817 326 Total liabilities 271,048 101,716 Commitments and contingencies Stockholders’ equity. Common stock, $0.001 par value.

42,239,922 and 36,678,854 shares issued and outstanding as of September 30, 2020 and December 31, 2019, respectively 42 37 Additional paid-in capital 982,139 811,049 Accumulated deficit (682,632 ) (610,514 ) Accumulated other comprehensive income 66 72 Total stockholders' equity 299,615 200,644 Total liabilities and stockholders’ equity $ 570,663 $ 302,360 Condensed Consolidated Statements of Operations (in thousands, except per share data, unaudited) Three Months EndedSeptember 30, Nine Months EndedSeptember 30, 2020 2019 2020 2019 Revenue. Technology $ 27,964 $ 21,160 $ 78,150 $ 61,393 Professional services 19,227 18,263 57,416 50,047 Total revenue 47,191 39,423 135,566 111,440 Cost of revenue, excluding depreciation and amortization. Technology(1) 9,045 6,740 25,148 20,536 Professional services(1)(3) 15,307 11,892 46,401 33,132 Total cost of revenue, excluding depreciation and amortization 24,352 18,632 71,549 53,668 Operating expenses.

Sales and marketing(1)(3) 14,629 14,721 40,618 35,579 Research and development(1)(3) 13,390 13,477 38,539 33,209 General and administrative(1)(2)(4)(5) 13,297 11,013 31,111 23,333 Depreciation and amortization 4,981 2,316 10,952 6,844 Total operating expenses 46,297 41,527 121,220 98,965 Loss from operations (23,458 ) (20,736 ) (57,203 ) (41,193 ) Loss on extinguishment of debt — — (8,514 ) (1,670 ) Interest and other expense, net (3,854 ) (659 ) (7,500 ) (2,924 ) Loss before income taxes (27,312 ) (21,395 ) (73,217 ) (45,787 ) Income tax provision (benefit) 14 21 (1,218 ) 43 Net loss $ (27,326 ) $ (21,416 ) $ (71,999 ) $ (45,830 ) Less. Accretion of redeemable convertible preferred stock — 18,170 — 180,826 Net loss attributable to common stockholders $ (27,326 ) $ (39,586 ) $ (71,999 ) $ (226,656 ) Net loss per share attributable to common stockholders, basic and diluted $ (0.68 ) $ (1.40 ) $ (1.87 ) $ (17.78 ) Weighted-average shares outstanding used in calculating net loss per share attributable to common stockholders, basic and diluted 40,292 28,223 38,517 12,750 Adjusted net loss(6) $ (8,287 ) $ (9,817 ) $ (20,110 ) $ (26,014 ) Pro forma adjusted net loss per share, basic and diluted(6) $ (0.21 ) $ (0.27 ) $ (0.52 ) $ (0.72 ) Pro forma as adjusted weighted-average number of shares outstanding used in calculating Adjusted Net Loss per share, basic and diluted(6) 40,292 36,373 38,517 36,183 _______________(1) Includes stock-based compensation expense as follows. Three Months EndedSeptember 30, Nine Months EndedSeptember 30, 2020 2019 2020 2019 Stock-Based Compensation Expense.

(in thousands) (in thousands) Cost of revenue, excluding depreciation and amortization. Technology $ 196 $ 64 $ 575 $ 129 Professional services 903 306 2,609 593 Sales and marketing 3,233 1,358 9,724 2,639 Research and development 2,025 3,067 5,987 3,502 General and administrative 3,139 5,179 8,388 6,165 Total $ 9,496 $ 9,974 $ 27,283 $ 13,028 (2) Includes acquisition transaction costs as follows. Three Months EndedSeptember 30, Nine Months EndedSeptember 30, 2020 2019 2020 2019 Acquisition transaction costs.

(in thousands) (in thousands) General and administrative $ 1,399 $ — $ 2,670 $ — Total $ 1,399 $ — $ 2,670 $ — (3) Includes post-acquisition restructuring costs as follows. Three Months EndedSeptember 30, Nine Months EndedSeptember 30, 2020 2019 2020 2019 Post-Acquisition Restructuring Costs. (in thousands) (in thousands) Cost of revenue, excluding depreciation and amortization.

Professional services $ — $ — $ — $ 108 Sales and marketing — — — 306 Research and development — — — 32 Total $ — $ — $ — $ 446 (4) Includes the change in fair value of contingent consideration liabilities, as follows. Three Months EndedSeptember 30, Nine Months EndedSeptember 30, 2020 2019 2020 2019 Change in fair value of contingent consideration liabilities. (in thousands) (in thousands) General and administrative $ 564 $ — $ (1,004 ) $ — Total $ 564 $ — $ (1,004 ) $ — (5) Includes duplicate headquarters rent expense, as follows.

Three Months EndedSeptember 30, Nine Months EndedSeptember 30, 2020 2019 2020 2019 Duplicate Headquarters Rent Expense. (in thousands) (in thousands) General and administrative $ 584 $ — $ 709 $ — Total $ 584 $ — $ 709 $ — (6) Includes pro forma adjustments to net loss attributable to common stockholders and the weighted average number of common shares outstanding directly attributable to the closing of our initial public offering on July 29, 2019 as well as certain other non-GAAP adjustments. Refer to the "Non-GAAP Financial Measures—Pro Forma Adjusted Net Loss Per Share" section below for further details.

Condensed Consolidated Statements of Cash Flows (in thousands, unaudited) Nine Months EndedSeptember 30, Cash flows from operating activities 2020 2019 Net loss $ (71,999 ) $ (45,830 ) Adjustments to reconcile net loss to net cash used in operating activities. Depreciation and amortization 10,952 6,844 Loss on extinguishment of debt 8,514 1,670 Amortization of debt discount and issuance costs 5,260 797 Non-cash operating lease expense 2,865 2,696 Investment discount and premium amortization 854 (443 ) Provision for expected credit losses 822 — Stock-based compensation expense 27,283 13,028 Deferred tax (benefit) provision (1,280 ) — Change in fair value of contingent consideration liabilities (1,004 ) — Other 85 (36 ) Change in operating assets and liabilities. Accounts receivable, net (4,450 ) (3,323 ) Prepaid expenses and other assets (2,937 ) (1,362 ) Accounts payable, accrued liabilities, and other liabilities 6,567 1,661 Deferred revenue (838 ) 7,601 Operating lease liabilities (2,701 ) (2,426 ) Net cash used in operating activities (22,007 ) (19,123 ) Cash flows from investing activities Purchase of short-term investments (163,346 ) (221,444 ) Proceeds from the sale and maturity of short-term investments 208,467 37,277 Acquisition of businesses, net of cash acquired (102,471 ) — Purchase of property and equipment (2,071 ) (1,658 ) Purchase of intangible assets (1,249 ) (1,747 ) Proceeds from sale of property and equipment 10 40 Net cash used in investing activities (60,660 ) (187,532 ) Cash flows from financing activities Proceeds from convertible note securities, net of issuance costs 222,482 — Purchase of capped calls concurrent with issuance of convertible senior notes (21,743 ) — Proceeds from credit facilities, net of debt issuance costs — 47,169 Repayment of credit facilities (57,043 ) (21,821 ) Proceeds from exercise of stock options 29,393 2,177 Proceeds from employee stock purchase plan 3,528 1,216 Payments of acquisition-related consideration (748 ) (773 ) Proceeds from initial public offering, net of underwriters’ discounts and commissions — 194,649 Proceeds from the issuance of redeemable convertible preferred stock, net of issuance costs — 12,073 Payments of deferred offering costs — (4,407 ) Net cash provided by financing activities 175,869 230,283 Effect of exchange rate on cash and cash equivalents 5 — Net increase in cash and cash equivalents 93,207 23,628 Cash and cash equivalents at beginning of period 18,032 28,431 Cash and cash equivalents at end of period $ 111,239 $ 52,059 Non-GAAP Financial MeasuresTo supplement our financial information presented in accordance with GAAP, we believe certain non-GAAP measures, including Adjusted Gross Profit, Adjusted Gross Margin, Adjusted EBITDA, Adjusted Net Loss, and Adjusted Net Loss per share, basic and diluted, are useful in evaluating our operating performance.

We use this non-GAAP financial information to evaluate our ongoing operations, as a component in determining employee bonus compensation, and for internal planning and forecasting purposes. We believe that non-GAAP financial information, when taken collectively, may be helpful to investors because it provides consistency and comparability with past financial performance. However, non-GAAP financial information is presented for supplemental informational purposes only, has limitations as an analytical tool and should not be considered in isolation or as a substitute for financial information presented in accordance with GAAP.

In addition, other companies, including companies in our industry, may calculate similarly-titled non-GAAP measures differently or may use other measures to evaluate their performance. A reconciliation is provided below for each non-GAAP financial measure to the most directly comparable financial measure stated in accordance with GAAP. Investors are encouraged to review the related GAAP financial measures and the reconciliation of these non-GAAP financial measures to their most directly comparable GAAP financial measures, and not to rely on any single financial measure to evaluate our business.Adjusted Gross Profit and Adjusted Gross MarginAdjusted Gross Profit is a non-GAAP financial measure that we define as revenue less cost of revenue, excluding depreciation and amortization and excluding (i) stock-based compensation and (ii) post-acquisition restructuring costs (none during periods presented).

We define Adjusted Gross Margin as our Adjusted Gross Profit divided by our revenue. We believe Adjusted Gross Profit and Adjusted Gross Margin are useful to investors as they eliminate the impact of certain non-cash expenses and allow a direct comparison of these measures between periods without the impact of non-cash expenses and certain other non-recurring operating expenses. The following is a reconciliation of revenue, the most directly comparable GAAP financial measure, to Adjusted Gross Profit, for the three months ended September 30, 2020 and 2019.

Three Months Ended September 30, 2020 (in thousands, except percentages) Technology Professional Services Total Revenue $ 27,964 $ 19,227 $ 47,191 Cost of revenue, excluding depreciation and amortization (9,045 ) (15,307 ) (24,352 ) Gross profit, excluding depreciation and amortization 18,919 3,920 22,839 Add. Stock-based compensation 196 903 1,099 Adjusted Gross Profit $ 19,115 $ 4,823 $ 23,938 Gross margin, excluding depreciation and amortization 68 % 20 % 48 % Adjusted Gross Margin 68 % 25 % 51 % Three Months Ended September 30, 2019 (in thousands, except percentages) Technology Professional Services Total Revenue $ 21,160 $ 18,263 $ 39,423 Cost of revenue, excluding depreciation and amortization (6,740 ) (11,892 ) (18,632 ) Gross profit, excluding depreciation and amortization 14,420 6,371 20,791 Add. Stock-based compensation 64 306 370 Adjusted Gross Profit $ 14,484 $ 6,677 $ 21,161 Gross margin, excluding depreciation and amortization 68 % 35 % 53 % Adjusted Gross Margin 68 % 37 % 54 % Adjusted EBITDAAdjusted EBITDA is a non-GAAP financial measure that we define as net loss adjusted for (i) interest and other expense, net, (ii) loss on extinguishment of debt (none in periods presented), (iii) income tax (benefit) provision, (iv) depreciation and amortization, (v) stock-based compensation, (vi) acquisition transaction costs, (vii) change in fair value of contingent consideration liability, (viii) duplicate headquarters rent expense, and (ix) post-acquisition restructuring costs when they are incurred.

We believe Adjusted EBITDA provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance. The following is a reconciliation of our net loss, the most directly comparable GAAP financial measure, to Adjusted EBITDA, for the three months ended September 30, 2020 and 2019. Three Months EndedSeptember 30, 2020 2019 (in thousands) Net loss $ (27,326 ) $ (21,416 ) Add.

Interest and other expense, net 3,854 659 Income tax (benefit) provision 14 21 Depreciation and amortization 4,981 2,316 Stock-based compensation 9,496 9,974 Acquisition transaction costs 1,399 — Change in fair value of contingent consideration liability 564 — Duplicate headquarters rent expense 584 — Adjusted EBITDA $ (6,434 ) $ (8,446 ) Pro Forma Adjusted Net Loss Per ShareAdjusted Net Loss is a non-GAAP financial measure that we define as net loss attributable to common stockholders adjusted for (i) accretion of redeemable convertible preferred stock, (ii) stock-based compensation, (iii) amortization of acquired intangibles, (iv) loss on debt extinguishment, (v) acquisition transaction costs, (vi) change in fair value of contingent consideration liability, (vii) non-cash interest expense related to our convertible senior notes, (viii) duplicate headquarters rent expense (see explanation above), and (ix) post-acquisition restructuring costs. Non-cash interest expense related to our convertible senior notes relates to the convertible senior notes that were issued in a private placement in April 2020. Under GAAP, we are required to separately account for liability (debt) and equity (conversion option) components of the convertible senior notes.

Accordingly, for GAAP purposes we are required to recognize the effective interest expense on our convertible senior notes and amortize the issuance costs over the term of the notes. The difference between the effective interest expense and the contractual interest expense, and the amortization expense of issuance costs are excluded from management’s assessment of our operating performance because management believes that these non-cash expenses are not indicative of ongoing operating performance.We believe Adjusted Net Loss provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance.On July 29, 2019, we closed our initial public offering (our IPO) in which we issued and sold 8,050,000 shares (inclusive of the underwriters’ option to purchase an additional 1,050,000 shares) of common stock at $26.00 per share. We received net proceeds of $194.6 million after deducting underwriting discounts and commissions and before deducting offering costs of $4.6 million.

Upon the closing of our IPO, all shares of our outstanding redeemable convertible preferred stock converted into 23,151,481 shares of common stock on a one-for-one basis. We have prepared the below adjusted condensed consolidated statement of operations data to present pro forma adjusted net loss per share amounts that will be comparable between the current and prior periods presented as if the conversion of all outstanding shares of redeemable convertible preferred stock and the issuance of the IPO shares had occurred as of the beginning of the prior year comparative periods. Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Numerator.

(in thousands, except share and per share amounts) Net loss attributable to common stockholders $ (27,326 ) $ (39,586 ) $ (71,999 ) $ (226,656 ) Add Accretion of redeemable convertible preferred stock — 18,170 — 180,826 Stock-based compensation 9,496 9,974 27,283 13,028 Amortization of acquired intangibles 4,276 1,625 8,786 4,672 Loss on extinguishment of debt — — 8,514 1,670 Acquisition transaction costs 1,399 — 2,670 — Change in fair value of contingent consideration liability 564 — (1,004 ) — Non-cash interest expense related to convertible senior notes 2,720 — 4,931 — Duplicate headquarters rent expense 584 — 709 — Post-acquisition restructuring costs — — — 446 Adjusted Net Loss $ (8,287 ) $ (9,817 ) $ (20,110 ) $ (26,014 ) Denominator. Weighted-average number of shares used in calculating net loss per share attributable to common stockholders, basic and diluted 40,292,380 28,222,555 38,517,272 12,749,903 Pro forma adjustments Pro forma adjustment to reflect issuance and conversion of redeemable convertible preferred stock to common stock, assuming the conversion took place as of the beginning of the 2019 period — 6,039,517 — 17,384,812 Pro forma adjustment to reflect issuance of shares of common stock as part of IPO, assuming the issuance took place as of the beginning of the 2019 period — 2,111,413 — 6,048,718 Pro forma as adjusted weighted-average number of shares used in calculating Adjusted Net Loss per share, basic and diluted 40,292,380 36,373,485 38,517,272 36,183,433 Pro forma adjusted net loss per share, basic and diluted $ (0.21 ) $ (0.27 ) $ (0.52 ) $ (0.72 ) Health Catalyst Investor Relations Contact:Adam BrownSenior Vice President, Investor Relations+1 (855)-309-6800ir@healthcatalyst.comHealth Catalyst Media Contact:Amanda Hundtamanda.hundt@healthcatalyst.com+1 (575) 491-0974 Source. Health Catalyst, Inc..

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GREAT FALLS, Mont order kamagra gel Levitra pharmacy online. €” For months, the jail in central Montana’s Cascade County was free of the erectile dysfunction, which seemed as distant a threat as it did in much of the nation’s rural Mountain West.Then a few people who had the kamagra were arrested. By the order kamagra gel time Paul Krogue, the jail’s medical director, realized there was a problem, nearly 50 inmates were infected in the jail, where some had been sleeping on mats on an overcrowded floor. After several weeks, Mr. Krogue got a call that s were spreading to a side of the jail that had been kamagra-free.He hung up the phone and put his head in his hands.“I just kind of lost it, like, ‘My God, I don’t know how much longer I can do order kamagra gel this,’” Mr.

Krogue, a nurse practitioner, recalled. €œI was just scared that I’m not going to be able to see it through, that I’m going to get sick — you just feel so exhausted and it’s just a lot.”The Mountain West, which for months avoided the worst of the kamagra, has rapidly devolved into one of the most alarming hot spots in a country that recorded its eight millionth confirmed case on Thursday, a day when more than 65,000 cases were announced nationwide, the most in a single day since July.Seventeen states, including many in the Mountain West, have added more cases in the past week than any other week of the kamagra. And the spread through sparsely populated areas of rural America has created problems order kamagra gel in small towns that lack critical resources — including doctors — even in ordinary times.Wyoming, which did not have 1,000 total cases until June, recently added more than 1,000 in a single week. Reports of new s have recently reached record levels in Alaska, Colorado and Idaho. And Montana, where more than half of the state’s cases have been announced since August, is averaging more than 500 cases per day.In Cascade County, more than 300 inmates and staff members have order kamagra gel been infected in a facility meant to hold 365 people, the county’s first major outbreak in a region where the kamagra is suddenly surging.The county seat, Great Falls, is seeing its worst case numbers yet.

The local hospital and its 27-bed erectile dysfunction treatment unit is at capacity. The county health department is racing to hire new contact tracers. And Mr order kamagra gel. Krogue, who also teaches nursing at Montana State University’s Great Falls campus, has seen attendance in his classes dwindle as students fall ill or quarantine.“I was just scared that I’m not going to be able to see it through, that I’m going to get sick,” said Paul Krogue, the jail’s medical director.Credit...Tailyr Irvine for The New York TimesOne place where the s have spread has been local jails, which are confined, often crowded spaces. Jails are staples of local communities and order kamagra gel tend to have people coming and going more quickly than prisons.

Jails can hold everyone from people awaiting criminal trials for months to those picked up for a suspended driver’s license for a few hours. With so many people filtering in and out, jails pose extra risks for the kamagra’s spread — not only inside facilities but in potentially feeding outbreaks in the rest of the community.Nationally, jails and prisons have seen disproportionate rates of and death, with a mortality rate twice as high as in the general population and an rate more than four times as high, according to recent data.A New York order kamagra gel Times database has tracked clusters of at least 50 erectile dysfunction cases in a dozen rural jails in Montana, Idaho, Utah and New Mexico during the kamagra. Among them. The Purgatory Correctional Center in Hurricane, Utah, with 166 s. The jail in Twin Falls, Idaho, order kamagra gel with 279.

And, in New Mexico, the Cibola County Correctional Center, which has reported 357 cases.In Cascade County, s at the jail make up about a quarter of all known kamagra cases in the county. Health authorities say that the jail’s outbreak, which began in mid-August, order kamagra gel was not believed to be the main cause of the community’s recent surge, but that it had led to some cases. In the past two months, Mr. Krogue said, the jail released 29 people who were considered actively infected.s at the jail make up about a quarter of Cascade County’s known kamagra cases.Credit...Tailyr Irvine for The New York TimesGreat Falls, home to about 58,000 residents, is in the less mountainous part of Montana, with the Missouri River flowing through and a large oil refinery on its banks. The Cascade County Detention order kamagra gel Center sits along a highway at the edge of town.

Drive five miles in any direction and you are surrounded by wide-open plains.Montana requires that masks be worn inside businesses and indoor public spaces, and many people in Great Falls wear them when walking around downtown’s Central Avenue, where shops and cafes are still recovering from shutting down in the spring. Others go without masks, citing the open space and lack of crowds.Bob order kamagra gel Kelly, the mayor, said people had not been overly worried about how the jail outbreak might affect the rest of town when it started.“I think that by the very definition of a jail, hopefully, the disease will be incarcerated, as well as the patients,” he said. €œIs there concern?. Sure, there’s concern order kamagra gel. But is there overreaction?.

No.”The mayor of Great Falls said that residents had considered the jail’s outbreak a distant concern at first.Credit...Tailyr Irvine for The New York TimesSome residents’ nonchalance about the risks of the kamagra, said Mr. Krogue, the order kamagra gel jail’s medical director, can be traced to a spring and early summer when almost no one in Cascade County knew anyone who had been sickened.“We benefited from that early on,” he said. €œBut in some ways, I think it did us a disservice, too, because it also created a certain level of complacency.”That has quickly shifted now, he said, as cases have spiked.The number of active cases known to county officials on any given day has risen sharply to about 600, according to Trisha Gardner, Cascade County’s health officer. The county has seen 1,261 cases and six deaths during the kamagra, a Times database shows order kamagra gel. Some of the cases have been tied to the jail outbreak, she said, and others have been connected to bars and restaurants.

Even figuring out what has led to some cases has been complex, she said, as residents have been reluctant to cooperate with contact tracers.“Our hospitals are at capacity, our public health system is at capacity,” she said. €œIt’s not sustainable at this rate.”When the outbreak at the jail began, social order kamagra gel distancing was impossible, the authorities said. Three inmates shared cells designed for two. At night, men slept on thin order kamagra gel blue pads in every available space. On the floor in the day room, in shower stalls, in stairwells, in hallways outside of cells.Inmates did not receive masks until August, and jail officials said many have refused to wear them.In interviews with more than a dozen inmates and their family members, inmates described the jail during the outbreak as chaotic and unsanitary.

They said their pleas for help often went unanswered by nurses and guards.Newly arriving inmates were not always quarantined from one another before their test results were known because of a lack of space, inmates and jail officials said.Owen Hawley, 30, said every inmate in his living area of 38 men had tested positive for the kamagra. He said he had been unable to eat for three days, had intensive body aches and suffered from order kamagra gel a headache so powerful it felt as if it was “behind my eyes.”“After the fourth day of like, not eating and stuff, I just shut off, you know?. € he said.A jail area set aside for quarantining new inmates.Credit...Tailyr Irvine for The New York TimesAt one point, Mr. Hawley said, he and other prisoners protested the way the kamagra was being handled by refusing to leave their living areas order kamagra gel and by blocking new inmates from entering. Everyone was ultimately tested, Mr.

Hawley said, and each prisoner was given a disposable mask.Sierra Jasmine Wells, 25, another inmate, said women in her dormitory had grown ill, one after the next.“Everyone around me was getting sick and it was tough order kamagra gel on me,” she said. €œBy then, I had already accepted the fact that I was going to get sick.”When she became infected, she said, she was given cough syrup and Tylenol.“I kind of was just left alone to deal with it,” she said.Jesse Slaughter, the county sheriff who oversees the jail, said that the jail’s medical staff was doing everything it could, and that he had been seeking health care assistance from other counties. Officials defended their handling of the outbreak, noting that all inmates received standard medications including Tylenol twice a day and were taken to area hospitals when they needed added care. Seven inmates, order kamagra gel as well as some staff members, were hospitalized. No one from the jail has died from the kamagra, officials said.Sheriff Jesse Slaughter, who oversees the jail, said he had been seeking health care assistance from other counties.Credit...Tailyr Irvine for The New York TimesMr.

Krogue said that since the start of the outbreak he had been working up to 16 hours each day and sleeping in his basement, order kamagra gel away from his wife and children. He remains healthy but says he fears bringing the kamagra home. The kamagra has slowed some in the jail, and officials have moved some inmates to other facilities, but other prisons and jails in the state are now seeing outbreaks.“You can start to see what some of these other places experienced much earlier on, and we just didn’t have that experience, but it’s certainly happening now,” Mr. Krogue said order kamagra gel. €œIt’s just real in a way that it wasn’t.”Lucy Tompkins reported from Great Falls, Maura Turcotte from Chicago and Libby Seline from Lincoln, Neb.

Reporting was contributed by Izzy Colón from Columbia, Mo., Brendon Derr from Phoenix, Rebecca Griesbach order kamagra gel from Tuscaloosa, Ala., Danya Issawi and Timothy Williams from New York, Ann Hinga Klein from Des Moines, K.B. Mensah from Silver Spring, Md., and Mitch Smith from Chicago.Start Preamble Federal Transit Administration (FTA), DOT. Notice of order kamagra gel funding opportunity. The erectile dysfunction Disease 2019 (erectile dysfunction treatment) public health emergency Start Printed Page 63654has had a significant impact on transit operations. During a series of FTA listening sessions held over the last three months, transit agencies asked FTA to support research to identify solutions to address the operational challenges that they are facing as a result of erectile dysfunction treatment.

In response, FTA makes available through this Notice of Funding Opportunity (NOFO) funding to support research demonstration grants to public transit agencies to order kamagra gel develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the erectile dysfunction treatment public health emergency. Demonstration grants under this NOFO are authorized under FTA's Public Transportation Innovation Program (49 U.S.C. 5312). Eligible projects will demonstrate innovative solutions to improve the operational efficiencies of transit systems and enhance mobility for their communities in four major areas. (1) Vehicle, facility, equipment and infrastructure cleaning and dis.

(2) exposure mitigation measures. (3) innovative mobility such as contactless payments. And (4) measures that strengthen public confidence in transit services. The total funding available for awards under this NOFO is $10,000,000. FTA may supplement this amount if additional funding becomes available.

Applicants must submit completed proposals for funding opportunity FTA-2020-015-TRI through the GRANTS.GOV “APPLY” function by 11:59 p.m. Eastern Time on November 2, 2020. Prospective applicants should register as soon as possible on the GRANTS.GOV website to ensure they can complete the application process before the submission deadline. Application instructions are available on FTA's website at http://transit.dot.gov/​howtoapply and in the “FIND” module of GRANTS.GOV. FTA will not accept mail and fax submissions.

Start Further Info Please send any questions on this notice to Jamel El-Hamri email. Jamel.El-Hamri@dot.gov phone. 2020-366-8985. A Telecommunication Device for the Deaf (TDD) is available for individuals who are deaf or hard of hearing at 1-800-877-8339. End Further Info End Preamble Start Supplemental Information Table of Contents A.

Program Description B. Federal Award Information C. Eligibility Information D. Application and Submission Information E. Application Review Information F.

Federal Award Administration Information G. Federal Awarding Agency Contact Information A. Program Description The Public Transportation erectile dysfunction treatment Research Demonstration Grant Program is funded through the Public Transportation Innovation Program (49 U.S.C. 5312), with the goal to develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the erectile dysfunction treatment public health emergency. Eligible projects will propose to develop and deploy innovative solutions in four major areas.

(1) Vehicle, facility, equipment and infrastructure cleaning and dis. (2) exposure mitigation measures. (3) innovative mobility such as contactless payments. And (4) measures that strengthen public confidence in transit. As required by 49 U.S.C.

5312(e)(4), projects funded under this NOFO must participate in an evaluation by an independent outside entity that will conduct a comprehensive evaluation of the success or failure of the projects funded under this subsection and any plan for broad-based implementation of the innovation promoted by successful projects. B. Federal Award Information FTA makes available $10,000,000 in fiscal year (FY) 2020 funds under the Public Transportation Innovation Program (49 U.S.C. 5312) to finance the Public Transportation erectile dysfunction treatment Research Demonstration Grant Program. FTA may supplement the total funds available if additional funding becomes available at the time project selections are made.

FTA will grant pre-award authority starting on the date of the project award announcement for selected projects and should be completed within 24 months from the date of award. Funds are available only for eligible expenses incurred after the announcement of project selections. C. Eligibility Information (1) Eligible Applicants Eligible applicants include State and local governmental authorities, direct recipients of Urbanized Area (49 U.S.C. 5307) and Rural Area (49 U.S.C.

5311) formula funds, and Indian tribes. Eligible applicants are limited to FTA grantees or subrecipients who would be the primary beneficiaries of the innovative products and services that are developed—typically public transit agencies. Except for projects proposed by Indian tribes, proposals for projects in rural (non-urbanized) areas must be submitted as part of a consolidated State proposal. States and other eligible applicants also may submit consolidated proposals for projects in urbanized areas. The submission of the Statewide application will not preclude the submission and consideration of any application from other eligible recipients in an urbanized area in a State.

Proposals may contain projects to be implemented by the recipient or its subrecipients. Eligible subrecipients include public agencies, private nonprofit organizations, and private providers engaged in public transportation. Eligible applicants may submit consolidated proposals for projects. (2) Cost Sharing or Matching The maximum Federal share of project costs is 100 percent. FTA may give additional consideration to applicants that propose a local share and may view these applicants as more competitive.

The applicant must document the source(s) of the local match, if any, in the grant application. For any applicants proposing match, eligible local match sources include the following. Cash from non-Government sources other than revenues from providing public transportation services. Revenues derived from the sale of advertising and concessions. Revenues generated from value capture financing mechanisms.

Funds from an undistributed cash surplus. Replacement or depreciation cash fund or reserve. New capital. Or in-kind contributions. (3) Eligible Projects Eligible projects will propose innovative solutions to improve operational efficiencies of transit agencies and enhance the mobility of transit users, through projects that demonstrate innovative solutions for.

Vehicle, facility, equipment and infrastructure cleaning and dis. Exposure mitigation measures such a real-time notification of rail and bus passenger loads. New multi-modal payment innovative mobility systems such as contactless payments. And measures that strengthen public confidence in transit. Each applicant may only submit one proposal.Start Printed Page 63655 D.

Application and Submission Information (1) Address and Form of Application Submission Applications must be submitted through GRANTS.GOV. Applicants can find general information for submitting applications through GRANTS.GOV at www.fta.dot.gov/​howtoapply, along with specific instructions for the forms and attachments required for submission. Mail and fax submissions will not be accepted. (2) Content and Form of Application Submission a. Proposal Submission A complete proposal submission consists of at least two forms.

1. The SF-424 Mandatory Form (downloadable from GRANTS.GOV) and 2. The supplemental form for the FY 2020 erectile dysfunction treatment Demonstration Program (downloadable from GRANTS.GOV), which is available on FTA's website at (placeholder for FTA erectile dysfunction treatment Demonstration Program). The application must include responses to all sections of the SF-424 mandatory form and the supplemental form unless a section is indicated as optional. FTA will use the information on the supplemental form to determine applicant and project eligibility for the program and to evaluate the proposal against the selection criteria described in part E of this notice.

FTA will accept only one supplemental form per SF-424 submission. FTA encourages applicants to consider submitting a single supplemental form that includes multiple activities to be evaluated as a consolidated proposal. Applicants may attach additional supporting information to the SF-424 submission, including but not limited to letters of support, project budgets, or excerpts from relevant planning documents. Supporting documentation must be described and referenced by file name in the appropriate response section of the supplemental form, or it may not be reviewed. Information such as applicant name, Federal amount requested, local match amount, description of areas served, etc., may be requested in varying degrees of detail on both the SF-424 form and supplemental form.

Applicants must fill in all fields unless stated otherwise on the forms. If applicants copy information into the supplemental form from another source, they should verify that the supplemental form has fully captured pasted text and that it has not truncated the text due to character limits built into the form. Applicants should use both the “Check Package for Errors” and the “Validate Form” validation buttons on both forms to check all required fields. Applicants should also ensure that the Federal and local amounts specified are consistent. Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage.

Consistent with the R.O.U.T.E.S. Initiative, the Department encourages applicants to consider how the project will address the challenges faced by rural areas. B. Application Content The SF-424 Mandatory Form and the supplemental form will prompt applicants for the required information, including. I.

Applicant Name ii. Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number iii. Key contact information (contact name, address, email address, and phone number) iv. Congressional district(s) where project will take place v. Project Information (title, executive summary, and type) vi.

A detailed description of the need for the project vii. A detailed description of how the project will support the Program objectives viii. Evidence that the applicant can provide the local cost shares ix. A description of the technical, legal, and financial capacity of the applicant x. A detailed project budget xi.

Details on the local matching funds xii. A detailed project timeline xiii. Whether the project impacts an Opportunity Zone (3) Unique Entity Identifier and System for Award Management (SAM) Each applicant is required to. (1) Be registered in SAM before submitting an application. (2) provide a valid unique entity identifier in its application.

And (3) continue to maintain an active SAM registration with current information at all times during which the applicant has an active Federal award or an application or plan under consideration by FTA. These requirements do not apply if the applicant. (1) Is excepted from the requirements under 2 CFR 25.110(b) or (c). Or (2) has an exception approved by FTA under 2 CFR 25.110(d). FTA may not make an award until the applicant has complied with all applicable unique entity identifier and SAM requirements.

If an applicant has not fully complied with the requirements by the time FTA is ready to make an award, FTA may determine that the applicant is not qualified to receive an award and use that determination as a basis for making a Federal award to another applicant. All applicants must provide a unique entity identifier provided by SAM. Registration in SAM may take as little as 3-5 business days, but there can be unexpected steps or delays. For example, the applicant may need to obtain an Employer Identification Number. FTA recommends allowing ample time, up to several weeks, to complete all steps.

For additional information on obtaining a unique entity identifier, please visit www.sam.gov. (4) Submission Dates and Times Project proposals must be submitted electronically through GRANTS.GOV by 11:59 p.m. Eastern on November 2, 2020. Mail and fax submissions will not be accepted. FTA urges applicants to submit applications at least 72 hours prior to the due date to allow time to correct any problems that may have caused either GRANTS.GOV or FTA systems to reject the submission.

Proposals submitted after the deadline will only be considered under extraordinary circumstances not within the applicant's control. Deadlines will not be extended due to scheduled website maintenance. GRANTS.GOV scheduled maintenance and outage times are announced on the GRANTS.GOV website. Within 48 hours after submitting an electronic application, the applicant should receive two email messages from GRANTS.GOV. (1) Confirmation of successful transmission to GRANTS.GOV.

And (2) confirmation of successful validation by GRANTS.GOV. If the applicant does not receive confirmation of successful validation or receives a notice of failed validation or incomplete materials, the applicant must address the reason for the failed validation, as described in the email notice, and resubmit before the submission deadline. If making a resubmission for any reason, applicants must include all original attachments regardless of which attachments were updated and check the box on the supplemental form indicating this is a resubmission. Applicants are encouraged to begin the process of registration on the GRANTS.GOV site well in advance of the submission deadline. Registration is Start Printed Page 63656a multi-step process, which may take several weeks to complete before an application can be submitted.

Registered applicants may still be required to update their registration before submitting an application. Registration in SAM is renewed annually and persons making submissions on behalf of the Authorized Organization Representative (AOR) must be authorized in GRANTS.GOV by the AOR to make submissions. (5) Funding Restrictions Funds may be used for post-award expenditures only. Funds under this NOFO cannot be used to reimburse projects for otherwise eligible expenses incurred prior to the date of project award announcements. (6) Other Submission Requirements FTA encourages applicants to identify scaled funding options in case insufficient funding is available to fund a project at the full requested amount.

If an applicant indicates that a project is scalable, the applicant must provide an appropriate minimum funding amount that will fund an eligible project that achieves the objectives of the program and meets all relevant program requirements. The applicant must provide a clear explanation of how a reduced award would affect the project budget and scope. FTA may award a lesser amount whether or not the applicant provides a scalable option. E. Application Review Information (1) Project Evaluation Criteria Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage.

Consistent with the R.O.U.T.E.S. Initiative, the Department will consider how the project will address the challenges faced by rural areas. In addition, the Department will review and consider applications for funding pursuant to this Notice in accordance with the President's September 2, 2020 memorandum, entitled Memorandum on Reviewing Funding to State and Local Government Recipients of Federal Funds that Are Permitting Anarchy, Violence, and Destruction in American Cities, consistent with guidance from the Office of Management and Budget and the Attorney General and with all applicable laws. FTA will evaluate proposals submitted according to the following criteria. (a) Project Innovation and Impact.

(b) Project Approach. (c) National Applicability. (d) Commercialization and/or Knowledge Transfer. And (e) Technical, Legal and Financial Capacity. FTA encourages each applicant to demonstrate how a project supports all criteria with the most relevant information the applicant can provide, regardless of whether such information has been specifically requested or identified in this notice.

A. Project Innovation and Impact i. Effectiveness of the project in achieving and demonstrating the specific objectives of this program. Ii. Demonstration of benefits in addressing the needs of the transit agency and industry and impacts to infrastructure, equipment, transit workforce, and riders.

Iii. Degree of improvement over current and existing technologies, designs, and/or practices applicable to the transit industry. B. Project Approach i. Quality of the project approach such as existing partnerships, collaboration strategies and level of commitment of the project partners.

Ii. Proposal is realistic in its approach to fulfill the milestones/deliverables, schedule and goals. C. National Applicability i. Degree to which the project could be replicated by other transit agencies regionally or nationally.

Ii. Ability to evaluate technologies, designs and/or practices in a wide variety of conditions and locales. Iii. Degree to which the technology, designs and/or practices can be replicated by other transportation modes. D.

Commercialization and/or Knowledge Transfer i. Demonstrates a realistic plan for moving the results of the project into the transit marketplace (patents, conferences, articles in trade magazines, webinar, site visits, etc.). Ii. How the project team plans to work with the industry on improving best practices, guidance and/or standards, if applicable. Iii.

Demonstrate a clear understanding and robust approach to data collection, access and management. E. Technical, Legal and Financial Capacity Capacity of the applicant and any partners to successfully execute the project effort. There should be no outstanding legal, technical, or financial issues with the applicant that would make this a high-risk project. (2) Review and Selection Process An FTA technical evaluation committee will evaluate proposals based on the published project evaluation criteria.

Members of the technical evaluation committee will rate the applications and may seek clarification about any statement in an application. The FTA Administrator will determine the final selection and amount of funding for each project after consideration of the findings of the technical evaluation committee. Geographic diversity, diversity of the project type, the amount of local match to be provided, and the applicant's receipt and management of other Federal transit funds may be considered in FTA's award decisions. Prior fare payment innovation efforts may receive priority consideration. The FTA Administrator will consider the following key DOT objectives.

A. Utilizing alternative funding sources and innovative financing models to attract non-Federal sources of investment. B. Whether the project is located in or supports public transportation service in a qualified opportunity zone designated pursuant to 26.U.S.C. 1400Z-1.

And c. The extent to which the project addresses challenges specific to the provision of rural public transportation. (3) FAPIIS Review Prior to making a grant award, FTA is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) accessible through SAM. An applicant may review and comment on information about itself that a Federal awarding agency previously entered. FTA will consider any comments by the applicant, in addition to the other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 2 CFR 200.205 Federal Awarding Agency Review of Risk Posed by Applicants.

F. Federal Award Administration Information (1) Federal Award Notices FTA will announce the final project selections on the FTA website. Project recipients should contact their FTA Regional Office for additional information regarding allocations for Start Printed Page 63657projects. At the time project selections are announced, FTA will extend pre-award authority for the selected projects. There is no blanket pre-award authority for these projects before announcement.

There is no minimum or maximum grant award amount, but FTA intends to fund as many meritorious projects as possible. FTA only will consider proposals from eligible recipients for eligible activities. Due to funding limitations, projects selected for funding may receive less than the amount originally requested. In those cases, applicants must be able to demonstrate that the proposed projects are still viable and can be completed with the amount awarded. (2) Administrative and National Policy Requirements a.

Pre-Award Authority FTA will issue specific guidance to recipients regarding pre-award authority at the time of selection. FTA does not provide pre-award authority for competitive funds until projects are selected, and there are Federal requirements that must be met before costs are incurred. For more information about FTA's policy on pre-award authority, see the FY 2020 Apportionments Notice published on June 3, 2020, at https://www.govinfo.gov/​content/​pkg/​FR-2020-06-03/​pdf/​2020-11946.pdf. b. Grant Requirements Selected applicants will submit a grant application through FTA's electronic grant management system and adhere to the customary FTA grant requirements for research project (insert Circular name).

All competitive grants, regardless of award amount, will be subject to the Congressional notification and release process. FTA emphasizes that third-party procurement applies to all funding awards, as described in FTA Circular 4220.1F, “Third Party Contracting Guidance.” However, FTA may approve applications that include a specifically identified partnering organization(s) (2 CFR 200.302(f)). When included, the application, budget, and budget narrative should provide a clear understanding of how the selection of these organizations is critical for the project and give sufficient detail about the costs involved. C. Planning FTA encourages applicants to engage the appropriate State Departments of Transportation, Regional Transportation Planning Organizations, or Metropolitan Planning Organizations in areas to be served by the project funds available under this program.

D. Standard Assurances The applicant assures that it will comply with all applicable Federal statutes, regulations, executive orders, FTA circulars, and other Federal administrative requirements in carrying out any project supported by the FTA grant. The applicant acknowledges that it is under a continuing obligation to comply with the terms and conditions of the grant agreement issued for its project with FTA. The applicant understands that Federal laws, regulations, policies, and administrative practices might be modified from time to time and may affect the implementation of the project. The applicant agrees that the most recent Federal requirements will apply to the project unless FTA issues a written determination otherwise.

The applicant must submit the Certifications and Assurances before receiving a grant if it does not have current certifications on file. E. Free Speech and Religious Liberty In connection with any program or activity conducted with or benefiting from funds awarded under this notice, recipients of funds must comply with all applicable requirements of Federal law, including, without limitation, the Constitution of the United States. Statutory, regulatory, and public policy requirements, including without limitation, those protecting free speech, religious liberty, public welfare, the environment, and prohibiting discrimination. The conditions of performance, non-discrimination requirements, and other assurances made applicable to the award of funds in accordance with regulations of the Department of Transportation.

And applicable Federal financial assistance and contracting principles promulgated by the Office of Management and Budget. In complying with these requirements, recipients must ensure that no concession agreements are denied or other contracting decisions made on the basis of speech or other activities protected by the First Amendment. If the Department determines that a recipient has failed to comply with applicable Federal requirements, the Department may terminate the award of funds and disallow previously incurred costs, requiring the recipient to reimburse any expended award funds. (3) Reporting The post-award reporting requirements include submission of the Federal Financial Report (FFR) and Milestone Progress Report in TrAMS. An evaluation of the grant will occur at various points in the demonstration process and at the end of the project.

In addition, FTA is responsible for producing an Annual Report to Congress that compiles evaluation of selected projects, including an evaluation of the performance measures identified by the applicants. All applicants must develop an evaluation plan to measure the success or failure of their projects and describe any plans for broad-based implementation of successful projects. FTA may request data and reports to support the evaluation and Annual Report. A. Independent Evaluation To achieve a comprehensive understanding of the impacts and implications of each proposed erectile dysfunction treatment Research Demonstration Program, projects funded under this announcement will require the recipient to conduct a third party independent evaluation of their project.

Recipients will be required to contract with a third party independent evaluator to assist in developing an evaluation plan, and collecting, storing and managing data required to fulfill the evaluation requirement. No more than 10 percent of the Federal share of the project may be used to hire the third-party independent evaluator and the inclusion of a third-party independent evaluation should be described in the grant application. If the project duration is more than two years, an interim evaluation report would need to be submitted to FTA, otherwise the evaluation report should be included as part of the final project report. B. erectile dysfunction treatment Research Demonstration Grant Program Evaluation Projects funded under this announcement will be required to establish a set of performance metrics set by the third-party independent evaluator and shared with FTA.

G. Federal Awarding Agency Contacts Information For questions about applying, please contact Jamel El-Hamri email. Jamel.El-Hamri@dot.gov phone. 202-366-8985. A TDD is available at 1-800-877-8339 (TDDFIRS).

To ensure that applicants receive accurate information about eligibility or the program, applicants are encouraged to contact FTA directly with questions, rather than through intermediaries or third parties.Start Printed Page 63658 FTA staff also may conduct briefings on the competitive grants selection and award process upon request. Start Signature K. Jane Williams, Deputy Administrator. End Signature End Supplemental Information [FR Doc. 2020-22316 Filed 10-7-20.

GREAT FALLS, buy kamagra 100mg Mont. €” For months, the jail in central Montana’s Cascade County was free of the erectile dysfunction, which seemed as distant a threat as it did in much of the nation’s rural Mountain West.Then a few people who had the kamagra were arrested. By the time Paul Krogue, the jail’s medical director, realized there was a problem, nearly 50 inmates were infected in the jail, where some had been sleeping on mats on an buy kamagra 100mg overcrowded floor. After several weeks, Mr.

Krogue got a call that buy kamagra 100mg s were spreading to a side of the jail that had been kamagra-free.He hung up the phone and put his head in his hands.“I just kind of lost it, like, ‘My God, I don’t know how much longer I can do this,’” Mr. Krogue, a nurse practitioner, recalled. €œI was just scared that I’m not going to be able to see it through, that I’m going to get sick — you just feel so exhausted and it’s just a lot.”The Mountain West, which for months avoided the worst of the kamagra, has rapidly devolved into one of the most alarming hot spots in a country that recorded its eight millionth confirmed case on Thursday, a day when more than 65,000 cases were announced nationwide, the most in a single day since July.Seventeen states, including many in the Mountain West, have added more cases in the past week than any other week of the kamagra. And the spread through sparsely populated areas of rural America has created problems in small towns that lack critical resources — including doctors — even buy kamagra 100mg in ordinary times.Wyoming, which did not have 1,000 total cases until June, recently added more than 1,000 in a single week.

Reports of new s have recently reached record levels in Alaska, Colorado and Idaho. And Montana, where more than half of the state’s cases have been announced since August, is averaging more than 500 cases per day.In Cascade County, more than 300 inmates and staff members have been infected in a facility meant to hold 365 people, the buy kamagra 100mg county’s first major outbreak in a region where the kamagra is suddenly surging.The county seat, Great Falls, is seeing its worst case numbers yet. The local hospital and its 27-bed erectile dysfunction treatment unit is at capacity. The county health department is racing to hire new contact tracers.

And Mr buy kamagra 100mg. Krogue, who also teaches nursing at Montana State University’s Great Falls campus, has seen attendance in his classes dwindle as students fall ill or quarantine.“I was just scared that I’m not going to be able to see it through, that I’m going to get sick,” said Paul Krogue, the jail’s medical director.Credit...Tailyr Irvine for The New York TimesOne place where the s have spread has been local jails, which are confined, often crowded spaces. Jails are staples of local communities and tend buy kamagra 100mg to have people coming and going more quickly than prisons. Jails can hold everyone from people awaiting criminal trials for months to those picked up for a suspended driver’s license for a few hours.

With so many people filtering in and out, jails pose extra risks for the kamagra’s spread — not only inside facilities but in potentially feeding outbreaks in the rest of the community.Nationally, jails and prisons have seen disproportionate rates of and death, with a mortality rate twice as high as in the general population and an rate more than four times as high, according to recent data.A New York Times buy kamagra 100mg database has tracked clusters of at least 50 erectile dysfunction cases in a dozen rural jails in Montana, Idaho, Utah and New Mexico during the kamagra. Among them. The Purgatory Correctional Center in Hurricane, Utah, with 166 s. The jail buy kamagra 100mg in Twin Falls, Idaho, with 279.

And, in New Mexico, the Cibola County Correctional Center, which has reported 357 cases.In Cascade County, s at the jail make up about a quarter of all known kamagra cases in the county. Health authorities say that the jail’s outbreak, which buy kamagra 100mg began in mid-August, was not believed to be the main cause of the community’s recent surge, but that it had led to some cases. In the past two months, Mr. Krogue said, the jail released 29 people who were considered actively infected.s at the jail make up about a quarter of Cascade County’s known kamagra cases.Credit...Tailyr Irvine for The New York TimesGreat Falls, home to about 58,000 residents, is in the less mountainous part of Montana, with the Missouri River flowing through and a large oil refinery on its banks.

The Cascade County Detention Center buy kamagra 100mg sits along a highway at the edge of town. Drive five miles in any direction and you are surrounded by wide-open plains.Montana requires that masks be worn inside businesses and indoor public spaces, and many people in Great Falls wear them when walking around downtown’s Central Avenue, where shops and cafes are still recovering from shutting down in the spring. Others go without masks, citing the open space and lack of crowds.Bob Kelly, the mayor, said people had not been overly worried about how the jail outbreak might affect the rest of town when it started.“I think that by the very definition of a buy kamagra 100mg jail, hopefully, the disease will be incarcerated, as well as the patients,” he said. €œIs there concern?.

Sure, there’s concern buy kamagra 100mg. But is there overreaction?. No.”The mayor of Great Falls said that residents had considered the jail’s outbreak a distant concern at first.Credit...Tailyr Irvine for The New York TimesSome residents’ nonchalance about the risks of the kamagra, said Mr. Krogue, the jail’s medical director, can be traced to a spring and early summer when almost no one in Cascade County knew anyone who had been sickened.“We benefited buy kamagra 100mg from that early on,” he said.

€œBut in some ways, I think it did us a disservice, too, because it also created a certain level of complacency.”That has quickly shifted now, he said, as cases have spiked.The number of active cases known to county officials on any given day has risen sharply to about 600, according to Trisha Gardner, Cascade County’s health officer. The county buy kamagra 100mg has seen 1,261 cases and six deaths during the kamagra, a Times database shows. Some of the cases have been tied to the jail outbreak, she said, and others have been connected to bars and restaurants. Even figuring out what has led to some cases has been complex, she said, as residents have been reluctant to cooperate with contact tracers.“Our hospitals are at capacity, our public health system is at capacity,” she said.

€œIt’s not sustainable buy kamagra 100mg at this rate.”When the outbreak at the jail began, social distancing was impossible, the authorities said. Three inmates shared cells designed for two. At night, men slept on thin blue pads buy kamagra 100mg in every available space. On the floor in the day room, in shower stalls, in stairwells, in hallways outside of cells.Inmates did not receive masks until August, and jail officials said many have refused to wear them.In interviews with more than a dozen inmates and their family members, inmates described the jail during the outbreak as chaotic and unsanitary.

They said their pleas for help often went unanswered by nurses and guards.Newly arriving inmates were not always quarantined from one another before their test results were known because of a lack of space, inmates and jail officials said.Owen Hawley, 30, said every inmate in his living area of 38 men had tested positive for the kamagra. He said he had been unable to eat for three days, had intensive body buy kamagra 100mg aches and suffered from a headache so powerful it felt as if it was “behind my eyes.”“After the fourth day of like, not eating and stuff, I just shut off, you know?. € he said.A jail area set aside for quarantining new inmates.Credit...Tailyr Irvine for The New York TimesAt one point, Mr. Hawley said, he and other prisoners protested the way the kamagra was being handled by refusing to leave their living areas and buy kamagra 100mg by blocking new inmates from entering.

Everyone was ultimately tested, Mr. Hawley said, and each prisoner was given a buy kamagra 100mg disposable mask.Sierra Jasmine Wells, 25, another inmate, said women in her dormitory had grown ill, one after the next.“Everyone around me was getting sick and it was tough on me,” she said. €œBy then, I had already accepted the fact that I was going to get sick.”When she became infected, she said, she was given cough syrup and Tylenol.“I kind of was just left alone to deal with it,” she said.Jesse Slaughter, the county sheriff who oversees the jail, said that the jail’s medical staff was doing everything it could, and that he had been seeking health care assistance from other counties. Officials defended their handling of the outbreak, noting that all inmates received standard medications including Tylenol twice a day and were taken to area hospitals when they needed added care.

Seven inmates, as well as some staff members, were hospitalized buy kamagra 100mg. No one from the jail has died from the kamagra, officials said.Sheriff Jesse Slaughter, who oversees the jail, said he had been seeking health care assistance from other counties.Credit...Tailyr Irvine for The New York TimesMr. Krogue said that since the start of the outbreak he had buy kamagra 100mg been working up to 16 hours each day and sleeping in his basement, away from his wife and children. He remains healthy but says he fears bringing the kamagra home.

The kamagra has slowed some in the jail, and officials have moved some inmates to other facilities, but other prisons and jails in the state are now seeing outbreaks.“You can start to see what some of these other places experienced much earlier on, and we just didn’t have that experience, but it’s certainly happening now,” Mr. Krogue said buy kamagra 100mg. €œIt’s just real in a way that it wasn’t.”Lucy Tompkins reported from Great Falls, Maura Turcotte from Chicago and Libby Seline from Lincoln, Neb. Reporting was contributed by Izzy Colón from Columbia, buy kamagra 100mg Mo., Brendon Derr from Phoenix, Rebecca Griesbach from Tuscaloosa, Ala., Danya Issawi and Timothy Williams from New York, Ann Hinga Klein from Des Moines, K.B.

Mensah from Silver Spring, Md., and Mitch Smith from Chicago.Start Preamble Federal Transit Administration (FTA), DOT. Notice of buy kamagra 100mg funding opportunity. The erectile dysfunction Disease 2019 (erectile dysfunction treatment) public health emergency Start Printed Page 63654has had a significant impact on transit operations. During a series of FTA listening sessions held over the last three months, transit agencies asked FTA to support research to identify solutions to address the operational challenges that they are facing as a result of erectile dysfunction treatment.

In response, FTA makes available through this Notice of Funding Opportunity (NOFO) funding to support research demonstration grants to public transit agencies to develop, buy kamagra 100mg deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the erectile dysfunction treatment public health emergency. Demonstration grants under this NOFO are authorized under FTA's Public Transportation Innovation Program (49 U.S.C. 5312). Eligible projects will demonstrate innovative solutions to improve the operational efficiencies of transit systems and enhance mobility for their communities in four major areas.

(1) Vehicle, facility, equipment and infrastructure cleaning and dis. (2) exposure mitigation measures. (3) innovative mobility such as contactless payments. And (4) measures that strengthen public confidence in transit services.

The total funding available for awards under this NOFO is $10,000,000. FTA may supplement this amount if additional funding becomes available. Applicants must submit completed proposals for funding opportunity FTA-2020-015-TRI through the GRANTS.GOV “APPLY” function by 11:59 p.m. Eastern Time on November 2, 2020.

Prospective applicants should register as soon as possible on the GRANTS.GOV website to ensure they can complete the application process before the submission deadline. Application instructions are available on FTA's website at http://transit.dot.gov/​howtoapply and in the “FIND” module of GRANTS.GOV. FTA will not accept mail and fax submissions. Start Further Info Please send any questions on this notice to Jamel El-Hamri email.

Jamel.El-Hamri@dot.gov phone. 2020-366-8985. A Telecommunication Device for the Deaf (TDD) is available for individuals who are deaf or hard of hearing at 1-800-877-8339. End Further Info End Preamble Start Supplemental Information Table of Contents A.

Program Description B. Federal Award Information C. Eligibility Information D. Application and Submission Information E.

Application Review Information F. Federal Award Administration Information G. Federal Awarding Agency Contact Information A. Program Description The Public Transportation erectile dysfunction treatment Research Demonstration Grant Program is funded through the Public Transportation Innovation Program (49 U.S.C.

5312), with the goal to develop, deploy, and demonstrate innovative solutions that improve the operational efficiency of transit agencies, as well as enhance the mobility of transit users affected by the erectile dysfunction treatment public health emergency. Eligible projects will propose to develop and deploy innovative solutions in four major areas. (1) Vehicle, facility, equipment and infrastructure cleaning and dis. (2) exposure mitigation measures.

(3) innovative mobility such as contactless payments. And (4) measures that strengthen public confidence in transit. As required by 49 U.S.C. 5312(e)(4), projects funded under this NOFO must participate in an evaluation by an independent outside entity that will conduct a comprehensive evaluation of the success or failure of the projects funded under this subsection and any plan for broad-based implementation of the innovation promoted by successful projects.

B. Federal Award Information FTA makes available $10,000,000 in fiscal year (FY) 2020 funds under the Public Transportation Innovation Program (49 U.S.C. 5312) to finance the Public Transportation erectile dysfunction treatment Research Demonstration Grant Program. FTA may supplement the total funds available if additional funding becomes available at the time project selections are made.

FTA will grant pre-award authority starting on the date of the project award announcement for selected projects and should be completed within 24 months from the date of award. Funds are available only for eligible expenses incurred after the announcement of project selections. C. Eligibility Information (1) Eligible Applicants Eligible applicants include State and local governmental authorities, direct recipients of Urbanized Area (49 U.S.C.

5307) and Rural Area (49 U.S.C. 5311) formula funds, and Indian tribes. Eligible applicants are limited to FTA grantees or subrecipients who would be the primary beneficiaries of the innovative products and services that are developed—typically public transit agencies. Except for projects proposed by Indian tribes, proposals for projects in rural (non-urbanized) areas must be submitted as part of a consolidated State proposal.

States and other eligible applicants also may submit consolidated proposals for projects in urbanized areas. The submission of the Statewide application will not preclude the submission and consideration of any application from other eligible recipients in an urbanized area in a State. Proposals may contain projects to be implemented by the recipient or its subrecipients. Eligible subrecipients include public agencies, private nonprofit organizations, and private providers engaged in public transportation.

Eligible applicants may submit consolidated proposals for projects. (2) Cost Sharing or Matching The maximum Federal share of project costs is 100 percent. FTA may give additional consideration to applicants that propose a local share and may view these applicants as more competitive. The applicant must document the source(s) of the local match, if any, in the grant application.

For any applicants proposing match, eligible local match sources include the following. Cash from non-Government sources other than revenues from providing public transportation services. Revenues derived from the sale of advertising and concessions. Revenues generated from value capture financing mechanisms.

Funds from an undistributed cash surplus. Replacement or depreciation cash fund or reserve. New capital. Or in-kind contributions.

(3) Eligible Projects Eligible projects will propose innovative solutions to improve operational efficiencies of transit agencies and enhance the mobility of transit users, through projects that demonstrate innovative solutions for. Vehicle, facility, equipment and infrastructure cleaning and dis. Exposure mitigation measures such a real-time notification of rail and bus passenger loads. New multi-modal payment innovative mobility systems such as contactless payments.

And measures that strengthen public confidence in transit. Each applicant may only submit one proposal.Start Printed Page 63655 D. Application and Submission Information (1) Address and Form of Application Submission Applications must be submitted through GRANTS.GOV. Applicants can find general information for submitting applications through GRANTS.GOV at www.fta.dot.gov/​howtoapply, along with specific instructions for the forms and attachments required for submission.

Mail and fax submissions will not be accepted. (2) Content and Form of Application Submission a. Proposal Submission A complete proposal submission consists of at least two forms. 1.

The SF-424 Mandatory Form (downloadable from GRANTS.GOV) and 2. The supplemental form for the FY 2020 erectile dysfunction treatment Demonstration Program (downloadable from GRANTS.GOV), which is available on FTA's website at (placeholder for FTA erectile dysfunction treatment Demonstration Program). The application must include responses to all sections of the SF-424 mandatory form and the supplemental form unless a section is indicated as optional. FTA will use the information on the supplemental form to determine applicant and project eligibility for the program and to evaluate the proposal against the selection criteria described in part E of this notice.

FTA will accept only one supplemental form per SF-424 submission. FTA encourages applicants to consider submitting a single supplemental form that includes multiple activities to be evaluated as a consolidated proposal. Applicants may attach additional supporting information to the SF-424 submission, including but not limited to letters of support, project budgets, or excerpts from relevant planning documents. Supporting documentation must be described and referenced by file name in the appropriate response section of the supplemental form, or it may not be reviewed.

Information such as applicant name, Federal amount requested, local match amount, description of areas served, etc., may be requested in varying degrees of detail on both the SF-424 form and supplemental form. Applicants must fill in all fields unless stated otherwise on the forms. If applicants copy information into the supplemental form from another source, they should verify that the supplemental form has fully captured pasted text and that it has not truncated the text due to character limits built into the form. Applicants should use both the “Check Package for Errors” and the “Validate Form” validation buttons on both forms to check all required fields.

Applicants should also ensure that the Federal and local amounts specified are consistent. Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage. Consistent with the R.O.U.T.E.S. Initiative, the Department encourages applicants to consider how the project will address the challenges faced by rural areas.

B. Application Content The SF-424 Mandatory Form and the supplemental form will prompt applicants for the required information, including. I. Applicant Name ii.

Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number iii. Key contact information (contact name, address, email address, and phone number) iv. Congressional district(s) where project will take place v. Project Information (title, executive summary, and type) vi.

A detailed description of the need for the project vii. A detailed description of how the project will support the Program objectives viii. Evidence that the applicant can provide the local cost shares ix. A description of the technical, legal, and financial capacity of the applicant x.

A detailed project budget xi. Details on the local matching funds xii. A detailed project timeline xiii. Whether the project impacts an Opportunity Zone (3) Unique Entity Identifier and System for Award Management (SAM) Each applicant is required to.

(1) Be registered in SAM before submitting an application. (2) provide a valid unique entity identifier in its application. And (3) continue to maintain an active SAM registration with current information at all times during which the applicant has an active Federal award or an application or plan under consideration by FTA. These requirements do not apply if the applicant.

(1) Is excepted from the requirements under 2 CFR 25.110(b) or (c). Or (2) has an exception approved by FTA under 2 CFR 25.110(d). FTA may not make an award until the applicant has complied with all applicable unique entity identifier and SAM requirements. If an applicant has not fully complied with the requirements by the time FTA is ready to make an award, FTA may determine that the applicant is not qualified to receive an award and use that determination as a basis for making a Federal award to another applicant.

All applicants must provide a unique entity identifier provided by SAM. Registration in SAM may take as little as 3-5 business days, but there can be unexpected steps or delays. For example, the applicant may need to obtain an Employer Identification Number. FTA recommends allowing ample time, up to several weeks, to complete all steps.

For additional information on obtaining a unique entity identifier, please visit www.sam.gov. (4) Submission Dates and Times Project proposals must be submitted electronically through GRANTS.GOV by 11:59 p.m. Eastern on November 2, 2020. Mail and fax submissions will not be accepted.

FTA urges applicants to submit applications at least 72 hours prior to the due date to allow time to correct any problems that may have caused either GRANTS.GOV or FTA systems to reject the submission. Proposals submitted after the deadline will only be considered under extraordinary circumstances not within the applicant's control. Deadlines will not be extended due to scheduled website maintenance. GRANTS.GOV scheduled maintenance and outage times are announced on the GRANTS.GOV website.

Within 48 hours after submitting an electronic application, the applicant should receive two email messages from GRANTS.GOV. (1) Confirmation of successful transmission to GRANTS.GOV. And (2) confirmation of successful validation by GRANTS.GOV. If the applicant does not receive confirmation of successful validation or receives a notice of failed validation or incomplete materials, the applicant must address the reason for the failed validation, as described in the email notice, and resubmit before the submission deadline.

If making a resubmission for any reason, applicants must include all original attachments regardless of which attachments were updated and check the box on the supplemental form indicating this is a resubmission. Applicants are encouraged to begin the process of registration on the GRANTS.GOV site well in advance of the submission deadline. Registration is Start Printed Page 63656a multi-step process, which may take several weeks to complete before an application can be submitted. Registered applicants may still be required to update their registration before submitting an application.

Registration in SAM is renewed annually and persons making submissions on behalf of the Authorized Organization Representative (AOR) must be authorized in GRANTS.GOV by the AOR to make submissions. (5) Funding Restrictions Funds may be used for post-award expenditures only. Funds under this NOFO cannot be used to reimburse projects for otherwise eligible expenses incurred prior to the date of project award announcements. (6) Other Submission Requirements FTA encourages applicants to identify scaled funding options in case insufficient funding is available to fund a project at the full requested amount.

If an applicant indicates that a project is scalable, the applicant must provide an appropriate minimum funding amount that will fund an eligible project that achieves the objectives of the program and meets all relevant program requirements. The applicant must provide a clear explanation of how a reduced award would affect the project budget and scope. FTA may award a lesser amount whether or not the applicant provides a scalable option. E.

Application Review Information (1) Project Evaluation Criteria Addressing the deteriorating conditions and disproportionately high fatality rates on our rural transportation infrastructure is of critical interest to the Department, as rural transportation networks face unique challenges in safety, infrastructure condition, and passenger and freight usage. Consistent with the R.O.U.T.E.S. Initiative, the Department will consider how the project will address the challenges faced by rural areas. In addition, the Department will review and consider applications for funding pursuant to this Notice in accordance with the President's September 2, 2020 memorandum, entitled Memorandum on Reviewing Funding to State and Local Government Recipients of Federal Funds that Are Permitting Anarchy, Violence, and Destruction in American Cities, consistent with guidance from the Office of Management and Budget and the Attorney General and with all applicable laws.

FTA will evaluate proposals submitted according to the following criteria. (a) Project Innovation and Impact. (b) Project Approach. (c) National Applicability.

(d) Commercialization and/or Knowledge Transfer. And (e) Technical, Legal and Financial Capacity. FTA encourages each applicant to demonstrate how a project supports all criteria with the most relevant information the applicant can provide, regardless of whether such information has been specifically requested or identified in this notice. A.

Project Innovation and Impact i. Effectiveness of the project in achieving and demonstrating the specific objectives of this program. Ii. Demonstration of benefits in addressing the needs of the transit agency and industry and impacts to infrastructure, equipment, transit workforce, and riders.

Iii. Degree of improvement over current and existing technologies, designs, and/or practices applicable to the transit industry. B. Project Approach i.

Quality of the project approach such as existing partnerships, collaboration strategies and level of commitment of the project partners. Ii. Proposal is realistic in its approach to fulfill the milestones/deliverables, schedule and goals. C.

National Applicability i. Degree to which the project could be replicated by other transit agencies regionally or nationally. Ii. Ability to evaluate technologies, designs and/or practices in a wide variety of conditions and locales.

Iii. Degree to which the technology, designs and/or practices can be replicated by other transportation modes. D. Commercialization and/or Knowledge Transfer i.

Demonstrates a realistic plan for moving the results of the project into the transit marketplace (patents, conferences, articles in trade magazines, webinar, site visits, etc.). Ii. How the project team plans to work with the industry on improving best practices, guidance and/or standards, if applicable. Iii.

Demonstrate a clear understanding and robust approach to data collection, access and management. E. Technical, Legal and Financial Capacity Capacity of the applicant and any partners to successfully execute the project effort. There should be no outstanding legal, technical, or financial issues with the applicant that would make this a high-risk project.

(2) Review and Selection Process An FTA technical evaluation committee will evaluate proposals based on the published project evaluation criteria. Members of the technical evaluation committee will rate the applications and may seek clarification about any statement in an application. The FTA Administrator will determine the final selection and amount of funding for each project after consideration of the findings of the technical evaluation committee. Geographic diversity, diversity of the project type, the amount of local match to be provided, and the applicant's receipt and management of other Federal transit funds may be considered in FTA's award decisions.

Prior fare payment innovation efforts may receive priority consideration. The FTA Administrator will consider the following key DOT objectives. A. Utilizing alternative funding sources and innovative financing models to attract non-Federal sources of investment.

B. Whether the project is located in or supports public transportation service in a qualified opportunity zone designated pursuant to 26.U.S.C. 1400Z-1. And c.

The extent to which the project addresses challenges specific to the provision of rural public transportation. (3) FAPIIS Review Prior to making a grant award, FTA is required to review and consider any information about the applicant that is in the Federal Awardee Performance and Integrity Information System (FAPIIS) accessible through SAM. An applicant may review and comment on information about itself that a Federal awarding agency previously entered. FTA will consider any comments by the applicant, in addition to the other information in FAPIIS, in making a judgment about the applicant's integrity, business ethics, and record of performance under Federal awards when completing the review of risk posed by applicants as described in 2 CFR 200.205 Federal Awarding Agency Review of Risk Posed by Applicants.

F. Federal Award Administration Information (1) Federal Award Notices FTA will announce the final project selections on the FTA website. Project recipients should contact their FTA Regional Office for additional information regarding allocations for Start Printed Page 63657projects. At the time project selections are announced, FTA will extend pre-award authority for the selected projects.

There is no blanket pre-award authority for these projects before announcement. There is no minimum or maximum grant award amount, but FTA intends to fund as many meritorious projects as possible. FTA only will consider proposals from eligible recipients for eligible activities. Due to funding limitations, projects selected for funding may receive less than the amount originally requested.

In those cases, applicants must be able to demonstrate that the proposed projects are still viable and can be completed with the amount awarded. (2) Administrative and National Policy Requirements a. Pre-Award Authority FTA will issue specific guidance to recipients regarding pre-award authority at the time of selection. FTA does not provide pre-award authority for competitive funds until projects are selected, and there are Federal requirements that must be met before costs are incurred.

For more information about FTA's policy on pre-award authority, see the FY 2020 Apportionments Notice published on June 3, 2020, at https://www.govinfo.gov/​content/​pkg/​FR-2020-06-03/​pdf/​2020-11946.pdf. b. Grant Requirements Selected applicants will submit a grant application through FTA's electronic grant management system and adhere to the customary FTA grant requirements for research project (insert Circular name). All competitive grants, regardless of award amount, will be subject to the Congressional notification and release process.

FTA emphasizes that third-party procurement applies to all funding awards, as described in FTA Circular 4220.1F, “Third Party Contracting Guidance.” However, FTA may approve applications that include a specifically identified partnering organization(s) (2 CFR 200.302(f)). When included, the application, budget, and budget narrative should provide a clear understanding of how the selection of these organizations is critical for the project and give sufficient detail about the costs involved. C. Planning FTA encourages applicants to engage the appropriate State Departments of Transportation, Regional Transportation Planning Organizations, or Metropolitan Planning Organizations in areas to be served by the project funds available under this program.

D. Standard Assurances The applicant assures that it will comply with all applicable Federal statutes, regulations, executive orders, FTA circulars, and other Federal administrative requirements in carrying out any project supported by the FTA grant. The applicant acknowledges that it is under a continuing obligation to comply with the terms and conditions of the grant agreement issued for its project with FTA. The applicant understands that Federal laws, regulations, policies, and administrative practices might be modified from time to time and may affect the implementation of the project.

The applicant agrees that the most recent Federal requirements will apply to the project unless FTA issues a written determination otherwise. The applicant must submit the Certifications and Assurances before receiving a grant if it does not have current certifications on file. E. Free Speech and Religious Liberty In connection with any program or activity conducted with or benefiting from funds awarded under this notice, recipients of funds must comply with all applicable requirements of Federal law, including, without limitation, the Constitution of the United States.

Statutory, regulatory, and public policy requirements, including without limitation, those protecting free speech, religious liberty, public welfare, the environment, and prohibiting discrimination. The conditions of performance, non-discrimination requirements, and other assurances made applicable to the award of funds in accordance with regulations of the Department of Transportation. And applicable Federal financial assistance and contracting principles promulgated by the Office of Management and Budget. In complying with these requirements, recipients must ensure that no concession agreements are denied or other contracting decisions made on the basis of speech or other activities protected by the First Amendment.

If the Department determines that a recipient has failed to comply with applicable Federal requirements, the Department may terminate the award of funds and disallow previously incurred costs, requiring the recipient to reimburse any expended award funds. (3) Reporting The post-award reporting requirements include submission of the Federal Financial Report (FFR) and Milestone Progress Report in TrAMS. An evaluation of the grant will occur at various points in the demonstration process and at the end of the project. In addition, FTA is responsible for producing an Annual Report to Congress that compiles evaluation of selected projects, including an evaluation of the performance measures identified by the applicants.

All applicants must develop an evaluation plan to measure the success or failure of their projects and describe any plans for broad-based implementation of successful projects. FTA may request data and reports to support the evaluation and Annual Report. A. Independent Evaluation To achieve a comprehensive understanding of the impacts and implications of each proposed erectile dysfunction treatment Research Demonstration Program, projects funded under this announcement will require the recipient to conduct a third party independent evaluation of their project.

Recipients will be required to contract with a third party independent evaluator to assist in developing an evaluation plan, and collecting, storing and managing data required to fulfill the evaluation requirement. No more than 10 percent of the Federal share of the project may be used to hire the third-party independent evaluator and the inclusion of a third-party independent evaluation should be described in the grant application. If the project duration is more than two years, an interim evaluation report would need to be submitted to FTA, otherwise the evaluation report should be included as part of the final project report. B.

erectile dysfunction treatment Research Demonstration Grant Program Evaluation Projects funded under this announcement will be required to establish a set of performance metrics set by the third-party independent evaluator and shared with FTA. G. Federal Awarding Agency Contacts Information For questions about applying, please contact Jamel El-Hamri email. Jamel.El-Hamri@dot.gov phone.

202-366-8985. A TDD is available at 1-800-877-8339 (TDDFIRS). To ensure that applicants receive accurate information about eligibility or the program, applicants are encouraged to contact FTA directly with questions, rather than through intermediaries or third parties.Start Printed Page 63658 FTA staff also may conduct briefings on the competitive grants selection and award process upon request. Start Signature K.

Jane Williams, Deputy Administrator. End Signature End Supplemental Information [FR Doc. 2020-22316 Filed 10-7-20. 8:45 am]BILLING CODE 4910-57-P.

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IntroductionThis paper is dedicated to Andrew Price Smith for his extensive analysis of the impact of the 1918 influenza and for being the first to investigate the Austrian Spanish Influenza Archives to demonstrate that the kamagra struck the Axis troops prior to the Alliance, which forced Kaiser to opt for peace.The erectile dysfunction treatment kamagra has altered the lives of people kamagra 100 gold tablets around the world, with significant death toll in addition to global social, political and economic impact. Many people have wondered how it compares to the kamagra 100 gold tablets seasonal influenza and prior kamagras. In order to better understand and manage the current kamagra, it is useful to compare it to historical kamagras, such as the Spanish influenza of 1918.1Brief historical overview of 1918 Spanish influenzaThe 1918 Spanish influenza is caused by an H1N1 influenza A kamagra postulated to be of avian origin.2 The 1918 Spanish influenza lasted from 1918 to 1920 and consisted of four waves. The first wave lasted kamagra 100 gold tablets approximately from 15 February 1918 to 1 June 1918.

The second lasted approximately from 1 August 1918 to 2 December 1918. The third lasted approximately from 3 kamagra 100 gold tablets December 1918 to 30 April 1919. And the fourth wave lasted approximately from 1 December 1919 to 30 April 1920.3 It infected about 500 million people, roughly one-third of the world’s population at that time, and resulted in the deaths of 50 million, kamagra 100 gold tablets including 675 000 Americans.2 The first public news of the epidemic appeared in Madrid on 22 May 1918 in Madrid’s ABC newspaper. Hence, it became known as the Spanish influenza.4 However, there is no definite evidence of origination, and most epidemiologists and virologists believe that the kamagra originated in either the USA or France.4 A week later on 28 May 1918, King Alfonso XIII, the Prime Minister and some cabinet members became ill.4 As the influenza spread, basic services such as the postal service, telegraph services and some banks were forced to temporarily close operations.4Comparison between erectile dysfunction treatment and 1918 influenzaFirst, the patient population differs.

While the 1918 influenza killed a disproportionate number of 25–40 year olds, erectile dysfunction treatment mostly affects those over the age kamagra 100 gold tablets of 65, especially those also with comorbidities.2 5 In particular, the mortality rate for the influenza rose to 8%–10% for younger people compared with a 2.5% overall mortality whereas the mortality rate for the 25–40-year-old age range is a mere 0.2% in contrast to the 2.4% overall mortality rate.2 5 Those aged 25–40 year olds accounted for 40% of deaths from the 1918 influenza, whereas those in the 18–44-year-old range account for only 3.9% of deaths from erectile dysfunction treatment.2 5 More countries were spared in the 1918 kamagra, whereas only the smaller Pacific Islands (Soloman Islands and Vanuata) remain erectile dysfunction treatment free.2 6 The mortality rate for pregnant women with the Spanish influenza was 23%–37% and 26% of those who survived but lost their child, whereas the mortality rate of pregnant women with erectile dysfunction treatment is unknown.2 7 The Spanish influenza resulted in acute illness in 25%–30% of the world population, with over 50 million deaths, whereas erectile dysfunction treatment has infected nearly 55 million to date, with 1.3 million deaths.2 5 In the USA alone, erectile dysfunction treatment cases are at over 11 million as of 16 November 2020, which is nearly a 40% increase from the month prior.5Second, the two diseases kill via different mechanisms. While those with the influenza died of secondary bacterial pneumonia, those with erectile dysfunction treatment died from an overactive immune response that resulted in multiple organ failure.2 8 Acute respiratory distress syndrome (ARDS) can develop in both cases.2 8 As a complication from the influenza, ARDS had an 100% fatality rate compared with a 53.4% mortality rate as a complication from erectile dysfunction treatment.2 9The projected economic impact of erectile dysfunction treatment on the US economy is a $5.76–$6.17 trillion decrease in gross domestic product (GDP), based on Fitch Ratings and the US GDP according to the World Bank. The economic data during the 1918 kamagra is scarce, but it was noted that Mexico suffered a $9 billion loss.2Diagnoses, treatments and treatments were delayed in both kamagra 100 gold tablets cases. States developed different erectile dysfunction treatment diagnostic tests, since the initial one by Centers for Disease Control and Prevention (CDC) could not be confirmed.

Currently, there are no erectile dysfunction treatments approved by the Food and Drug Administration, but antivirals like remdesivir, antibody and interleukin 33 blockers kamagra 100 gold tablets are currently under investigation. treatments are also kamagra 100 gold tablets in development. In 1918, bleeding was initially used as treatment, since such minimal progress had been made against pneumonia that even renowned William Osler still recommended it to relieve symptoms.2 In 1917, Dr Rufus Cole, Dr Oswald Avery and Dr Alphonse Dochez, with help from six other Rockefeller researchers, developed and tested a vaccination to prevent pneumonia caused by types I, II and III pneumococci. In March 1918, this treatment was given to 12 000 troops on Long Island, with no kamagra 100 gold tablets vaccinated solder developing pneumonia from those strains.

In contrast, 101 out of 19 000 soldiers serving as controls, developed pneumonia from those strains.2Yet, since neither an influenza treatment nor antibiotics to treat associated secondary bacterial s were available, worldwide containment efforts relied heavily on isolation and quarantine similar to the current efforts against erectile dysfunction treatment.2In terms of duration and origination, there is controversy over the origination of both kamagraes, and both consist of multiple waves. The 1918 influenza lasted 25 months, and may have originated in Spain, France or the USA with no definite evidence of origination.3 4 The first wave lasted approximately from 15 February 1918 to 1 June 1918 and the fourth and final kamagra 100 gold tablets wave lasted approximately from 1 December 1919 to 30 April 1920.3 erectile dysfunction treatment originated in Wuhan China on 31 December 2019, with controversy over whether it originated in a wet market or at the Wuhan Institute of Virology. Unlike in 1918, DNA sequencing of erectile dysfunction treatment can kamagra 100 gold tablets predict whether infected individuals will be symptomatic or asymptomatic, based on a single base change (11 083G>T).10ConclusionsBoth the erectile dysfunction treatment and 1918 influenza kamagra similarly caused significant negative impacts on the global economy, affecting international relations and had considerable delay in its diagnosis, treatment and treatments. The kamagras largely differed in the highest risk population and the mechanism of death.

The 1918 kamagra 100 gold tablets influenza affected less than half of the countries and the most vulnerable groups are healthy adults between the ages of 25 years and 40 years, while erectile dysfunction treatment has affected nearly all countries and the most vulnerable group are adults above 65 years of age with comorbidities. Victims of the 1918 influenza mostly died from secondary bacterial pneumonia, while victims of erectile dysfunction treatment mostly died from an overactive immune response resulting in organ failure. The key major differences between the kamagras are highlighted kamagra 100 gold tablets in table 1.View this table:Table 1 Summary of major differences. erectile dysfunction treatment versus 1918 influenzaThese comparisons are important to understanding and predicting the long-term effects of the new erectile dysfunction treatment kamagra.

The smaller number of deaths may be a result of our advances in the medical field over kamagra 100 gold tablets the century, such as diagnostic tools and extracorporeal membrane oxygenation machines.By using synthetic biology, diagnosis could be done using full sequencing of erectile dysfunction treatment strains, which would also reveal the number of strains. Additionally, obtaining data on patient genotypes would determine its impact on kamagra 100 gold tablets viral expression. Furthermore, treatments developed with synthetic biology and then made with nanotechnology can be made in unlimited quantities compared with present methods of treatment production, which use fertilised chicken eggs. Synthetic treatments can be made to each strain with a unique sensor on each monoclonal antibody, which would indicate the presence of a particular strain, allowing efficient and timely vaccinations in each population.We should also kamagra 100 gold tablets be able to begin to unravel the mystery of this kamagra.

By studying each base of its positive-sense messenger RNA and determining its individual function, we can then predict patient prognosis and be better prepared to treat patients as they become ill. The prognosis of patients in kamagra 100 gold tablets the intensive care unit is currently poor, with high mortality rates and risk of permanent lung damage.As we better understand the functional phenotypic expression of the erectile dysfunction treatment, we can start to predict the expression of viral mRNA and begin treatment earlier. This is a race between using our most advanced synthetic biology of the 21st kamagra 100 gold tablets century against a 21st-century kamagra. We are 100 years away from 1918 and the tools that the scientists and clinicians had at their disposal in the last century.

Let’s hope that we can win this battle kamagra 100 gold tablets against this kamagra. It is difficult to predict how long this battle will continue but with synthetic biology in conjunction with social distancing, we should achieve victory.Table 1 highlights the key differences between erectile dysfunction treatment and the 1918 influenza.AbstractMedical migration has become a global phenomenon, partly led by easier air travel, economic factors and the expansion of medical technology. New Zealand has gradually evolved from being ‘bicultural’ to a kamagra 100 gold tablets multicultural, multitextured society. The movement of the Indian people, particularly Indian physicians, will be the focus of this paper.

In the last three decades, migration eligibility in New Zealand has changed from countries of origin kamagra 100 gold tablets or ability to speak English, to profession and skills. Despite struggling with its own issues, New kamagra 100 gold tablets Zealand has proven to be a preferred destination for Indian medical graduates (IMGs). India is widely recognised as the largest ‘donor country’ for doctors, many of whom go on to establish themselves as leaders and prominent figures in their field. This migration involves three parties kamagra 100 gold tablets.

India as a donor country, New Zealand as a recipient country and IMGs as the drivers of this process. Factors behind kamagra 100 gold tablets this growing phenomenon are examined and recommendations are made so that all three parties can benefit from it.Ethics (see medical ethics)health services administration &. Managementhealth policymedical law.

IntroductionThis paper is dedicated to Andrew http://www.ljss.ie/wispa_promo/microwave-emissions-testing/ Price Smith for his extensive analysis of the impact of the 1918 influenza and for being the first to investigate the Austrian Spanish Influenza Archives to demonstrate that the kamagra struck the Axis troops prior to the Alliance, which forced Kaiser buy kamagra 100mg to opt for peace.The erectile dysfunction treatment kamagra has altered the lives of people around the world, with significant death toll in addition to global social, political and economic impact. Many people have wondered buy kamagra 100mg how it compares to the seasonal influenza and prior kamagras. In order to better understand and manage the current kamagra, it is useful to compare it to historical kamagras, such as the Spanish influenza of 1918.1Brief historical overview of 1918 Spanish influenzaThe 1918 Spanish influenza is caused by an H1N1 influenza A kamagra postulated to be of avian origin.2 The 1918 Spanish influenza lasted from 1918 to 1920 and consisted of four waves. The first wave buy kamagra 100mg lasted approximately from 15 February 1918 to 1 June 1918.

The second lasted approximately from 1 August 1918 to 2 December 1918. The third lasted approximately from 3 December 1918 to buy kamagra 100mg 30 April 1919. And the fourth wave lasted approximately from 1 December 1919 to 30 April 1920.3 It infected about 500 million people, roughly one-third of the world’s population at that time, and resulted in the deaths of 50 million, including 675 000 Americans.2 The first public news of the epidemic appeared in buy kamagra 100mg Madrid on 22 May 1918 in Madrid’s ABC newspaper. Hence, it became known as the Spanish influenza.4 However, there is no definite evidence of origination, and most epidemiologists and virologists believe that the kamagra originated in either the USA or France.4 A week later on 28 May 1918, King Alfonso XIII, the Prime Minister and some cabinet members became ill.4 As the influenza spread, basic services such as the postal service, telegraph services and some banks were forced to temporarily close operations.4Comparison between erectile dysfunction treatment and 1918 influenzaFirst, the patient population differs.

While the 1918 influenza killed a disproportionate number of 25–40 year olds, erectile dysfunction treatment mostly affects those over the age of 65, especially those also with comorbidities.2 5 In particular, the mortality rate for the influenza rose to 8%–10% for younger people compared with a 2.5% overall mortality whereas the mortality rate for the 25–40-year-old age range is a mere 0.2% in contrast to the 2.4% overall mortality rate.2 5 Those aged 25–40 year olds accounted for 40% of deaths from the 1918 influenza, whereas those in the 18–44-year-old range account for only 3.9% of deaths from erectile dysfunction treatment.2 5 More countries were spared in the 1918 kamagra, whereas only the smaller Pacific Islands (Soloman Islands and Vanuata) remain erectile dysfunction treatment free.2 6 The mortality rate for pregnant women with the Spanish influenza was 23%–37% and 26% buy kamagra 100mg of those who survived but lost their child, whereas the mortality rate of pregnant women with erectile dysfunction treatment is unknown.2 7 The Spanish influenza resulted in acute illness in 25%–30% of the world population, with over 50 million deaths, whereas erectile dysfunction treatment has infected nearly 55 million to date, with 1.3 million deaths.2 5 In the USA alone, erectile dysfunction treatment cases are at over 11 million as of 16 November 2020, which is nearly a 40% increase from the month prior.5Second, the two diseases kill via different mechanisms. While those with the influenza died of secondary bacterial pneumonia, those with erectile dysfunction treatment died from an overactive immune response that resulted in multiple organ failure.2 8 Acute respiratory distress syndrome (ARDS) can develop in both cases.2 8 As a complication from the influenza, ARDS had an 100% fatality rate compared with a 53.4% mortality rate as a complication from erectile dysfunction treatment.2 9The projected economic impact of erectile dysfunction treatment on the US economy is a $5.76–$6.17 trillion decrease in gross domestic product (GDP), based on Fitch Ratings and the US GDP according to the World Bank. The economic data during the 1918 kamagra is scarce, but it was noted that Mexico suffered a $9 buy kamagra 100mg billion loss.2Diagnoses, treatments and treatments were delayed in both cases. States developed different erectile dysfunction treatment diagnostic tests, since the initial one by Centers for Disease Control and Prevention (CDC) could not be confirmed.

Currently, there are no buy kamagra 100mg erectile dysfunction treatments approved by the Food and Drug Administration, but antivirals like remdesivir, antibody and interleukin 33 blockers are currently under investigation. treatments are buy kamagra 100mg also in development. In 1918, bleeding was initially used as treatment, since such minimal progress had been made against pneumonia that even renowned William Osler still recommended it to relieve symptoms.2 In 1917, Dr Rufus Cole, Dr Oswald Avery and Dr Alphonse Dochez, with help from six other Rockefeller researchers, developed and tested a vaccination to prevent pneumonia caused by types I, II and III pneumococci. In March 1918, this treatment was given to 12 000 buy kamagra 100mg troops on Long Island, with no vaccinated solder developing pneumonia from those strains.

In contrast, 101 out of 19 000 soldiers serving as controls, developed pneumonia from those strains.2Yet, since neither an influenza treatment nor antibiotics to treat associated secondary bacterial s were available, worldwide containment efforts relied heavily on isolation and quarantine similar to the current efforts against erectile dysfunction treatment.2In terms of duration and origination, there is controversy over the origination of both kamagraes, and both consist of multiple waves. The 1918 influenza lasted 25 months, and may have originated in Spain, France or the USA with no definite evidence of origination.3 4 The first wave lasted approximately from 15 February 1918 to 1 June 1918 buy kamagra 100mg and the fourth and final wave lasted approximately from 1 December 1919 to 30 April 1920.3 erectile dysfunction treatment originated in Wuhan China on 31 December 2019, with controversy over whether it originated in a wet market or at the Wuhan Institute of Virology. Unlike in 1918, DNA sequencing of erectile dysfunction treatment can predict whether infected individuals will be symptomatic or asymptomatic, based on a single base change (11 083G>T).10ConclusionsBoth the erectile dysfunction treatment and 1918 influenza kamagra similarly caused significant negative impacts on the buy kamagra 100mg global economy, affecting international relations and had considerable delay in its diagnosis, treatment and treatments. The kamagras largely differed in the highest risk population and the mechanism of death.

The 1918 influenza affected less than half of the countries and the most vulnerable groups are healthy adults between the ages of 25 years and 40 years, while erectile dysfunction treatment has affected nearly all buy kamagra 100mg countries and the most vulnerable group are adults above 65 years of age with comorbidities. Victims of the 1918 influenza mostly died from secondary bacterial pneumonia, while victims of erectile dysfunction treatment mostly died from an overactive immune response resulting in organ failure. The key major differences between the kamagras are highlighted in table 1.View this table:Table 1 buy kamagra 100mg Summary of major differences. erectile dysfunction treatment versus 1918 influenzaThese comparisons are important to understanding and predicting the long-term effects of the new erectile dysfunction treatment kamagra.

The smaller number of deaths may be a result of our advances in the medical field over the century, such as diagnostic tools and extracorporeal membrane oxygenation machines.By using synthetic biology, diagnosis could be done using full sequencing of erectile dysfunction treatment strains, which would also reveal the buy kamagra 100mg number of strains. Additionally, obtaining data on patient genotypes would buy kamagra 100mg determine its impact on viral expression. Furthermore, treatments developed with synthetic biology and then made with nanotechnology can be made in unlimited quantities compared with present methods of treatment production, which use fertilised chicken eggs. Synthetic treatments can be made to each strain with a unique sensor on each monoclonal antibody, which would indicate the presence of a particular strain, allowing efficient and timely vaccinations in each population.We should also be able to begin buy kamagra 100mg to unravel the mystery of this kamagra.

By studying each base of its positive-sense messenger RNA and determining its individual function, we can then predict patient prognosis and be better prepared to treat patients as they become ill. The prognosis of patients in the intensive care unit buy kamagra 100mg is currently poor, with high mortality rates and risk of permanent lung damage.As we better understand the functional phenotypic expression of the erectile dysfunction treatment, we can start to predict the expression of viral mRNA and begin treatment earlier. This is a race between using our most advanced synthetic biology of the 21st century against buy kamagra 100mg a 21st-century kamagra. We are 100 years away from 1918 and the tools that the scientists and clinicians had at their disposal in the last century.

Let’s hope that we can win buy kamagra 100mg this battle against this kamagra. It is difficult to predict how long this battle will continue but with synthetic biology in conjunction with social distancing, we should achieve victory.Table 1 highlights the key differences between erectile dysfunction treatment and the 1918 influenza.AbstractMedical migration has become a global phenomenon, partly led by easier air travel, economic factors and the expansion of medical technology. New Zealand has gradually evolved from buy kamagra 100mg being ‘bicultural’ to a multicultural, multitextured society. The movement of the Indian people, particularly Indian physicians, will be the focus of this paper.

In the last three decades, migration eligibility in New Zealand has changed from countries of buy kamagra 100mg origin or ability to speak English, to profession and skills. Despite struggling with its own issues, New Zealand has proven to be a preferred destination for Indian medical buy kamagra 100mg graduates (IMGs). India is widely recognised as the largest ‘donor country’ for doctors, many of whom go on to establish themselves as leaders and prominent figures in their field. This migration buy kamagra 100mg involves three parties.

India as a donor country, New Zealand as a recipient country and IMGs as the drivers of this process. Factors behind this growing phenomenon are examined and recommendations are made so that all three parties can benefit from it.Ethics buy kamagra 100mg (see medical ethics)health services administration &. Managementhealth policymedical law.

Kamagra oral jelly women

MDEL Bulletin, June 24 2021, from the Medical Devices Compliance Program On this page Fees for Medical Device Establishment Licences (MDELs) We http://draecampbell.com/a-story-telling-event/ issue Medical Device kamagra oral jelly women Establishment Licences (MDELs) to. class I manufacturers importers or distributors of all device classes for human use in Canada The MDEL fee is a flat fee, regardless of when we receive your initial application. The same kamagra oral jelly women fee applies to applications for. a new MDEL the reinstatement of a suspended MDEL the annual licence review (ALR) of an MDEL If you submit any of these applications, you must pay the MDEL fee when you receive an invoice. See Part 3, Division 2 of the Fees in Respect of Drugs and Medical Devices Order.

Normally, we collect kamagra oral jelly women the MDEL fee before we review an application. However, to help meet the demand for medical devices during the erectile dysfunction treatment kamagra, we have been reviewing and processing MDEL applications before collecting the fees. As a result, some MDEL holders still haven't paid the fees for their 2020 initial MDEL application, despite multiple reminders. Authority to withhold services in case of non-payment As stated in the Food and Drug Act, Health Canada kamagra oral jelly women has the authority to withhold services, approvals, rights and/or privileges, if the fee for an MDEL application is not paid. Non-payment of fees 30.64.

The Minister may withdraw or withhold a service, the use of a facility, a regulatory process or approval or a product, right or privilege under this Act from any person who fails to pay the fee fixed for it under subsection 30.61(1). For more information, please kamagra oral jelly women refer to. Cancellation of existing MDELs We will cancel MDELs for existing MDEL holders with outstanding fees for. initial applications or annual licence review applications If your establishment licence is cancelled, you are no longer authorized to conduct licensable activities (such as manufacturing, distributing or importing medical devices). You must stop licensable activities as soon as you receive your kamagra oral jelly women cancellation notice.

Resuming activities after MDEL cancellation To resume licensable activities, you must re-apply for a new establishment licence and pay the MDEL fee. See section 45 of the Medical Device Regulations. To find out how to re-apply for a MDEL, please refer to our Guidance on medical device establishment licensing kamagra oral jelly women (GUI-0016). In line with the Compliance and Enforcement Policy (POL-0001), Health Canada monitors activities for compliance. If your MDEL has been cancelled, you may be subject to compliance and enforcement actions if you conduct non-compliant activities.

If you have questions about a MDEL or the application process, please contact the Medical Device Establishment Licensing Unit kamagra oral jelly women at hc.mdel.questions.leim.sc@canada.ca. If you have questions about invoicing and fees for an MDEL application, please contact the Cost Recovery Invoicing Unit at hc.criu-ufrc.sc@canada.ca. Related linksMDEL Bulletin, June 15, 2021, from the Medical Devices Compliance Program On this page Rapid antigen tests and the workplace screening program There are currently various technologies to detect SARS CoV-2, the kamagra that causes erectile dysfunction treatment. Antigen-based testing devices detect specific proteins on the surface of the kamagra and typically provide results in less kamagra oral jelly women than 1 hour. While some rapid antigen detection tests (RADTs) have been approved for people without symptoms, most RADTs are indicated for use on people with symptoms and are to be conducted by laboratory personnel, healthcare professionals or trained operators.

Health Canada has authorized several RADTs under two interim orders. The indications and conditions of use of authorized products may change kamagra oral jelly women over time as manufacturers continue to collect data. Screening asymptomatic individuals for SARS CoV-2 is proving to be effective in high-risk settings where social distancing and other measures are not feasible. Through the workplace screening program, Canada is supplying RADTs to eligible workplaces across the country. The program will help companies detect early cases of erectile dysfunction treatment, for kamagra oral jelly women people who are asymptomatic.

This program is being administered in collaboration with the provinces and territories. Interim enforcement approach In the interest of public health, Health Canada is placing less priority on enforcing off-label distribution of RADTs under the following circumstances. This enforcement discretion will be kamagra oral jelly women in effect until December 31, 2021. The exception is if. post-market monitoring identifies new risks or there’s no longer a need to apply this discretion based on public health status Related links.

MDEL Bulletin, June 24 buy kamagra 100mg 2021, from the Medical Devices Compliance Program On this page Fees for kamagra price per pill Medical Device Establishment Licences (MDELs) We issue Medical Device Establishment Licences (MDELs) to. class I manufacturers importers or distributors of all device classes for human use in Canada The MDEL fee is a flat fee, regardless of when we receive your initial application. The same fee buy kamagra 100mg applies to applications for. a new MDEL the reinstatement of a suspended MDEL the annual licence review (ALR) of an MDEL If you submit any of these applications, you must pay the MDEL fee when you receive an invoice. See Part 3, Division 2 of the Fees in Respect of Drugs and Medical Devices Order.

Normally, we collect the MDEL fee before we review an buy kamagra 100mg application. However, to help meet the demand for medical devices during the erectile dysfunction treatment kamagra, we have been reviewing and processing MDEL applications before collecting the fees. As a result, some MDEL holders still haven't paid the fees for their 2020 initial MDEL application, despite multiple reminders. Authority to withhold services in case of non-payment As stated in the Food and Drug Act, Health Canada has the buy kamagra 100mg authority to withhold services, approvals, rights and/or privileges, if the fee for an MDEL application is not paid. Non-payment of fees 30.64.

The Minister may withdraw or withhold a service, the use of a facility, a regulatory process or approval or a product, right or privilege under this Act from any person who fails to pay the fee fixed for it under subsection 30.61(1). For more information, please refer to buy kamagra 100mg. Cancellation of existing MDELs We will cancel MDELs for existing MDEL holders with outstanding fees for. initial applications or annual licence review applications If your establishment licence is cancelled, you are no longer authorized to conduct licensable activities (such as manufacturing, distributing or importing medical devices). You must stop licensable activities as buy kamagra 100mg soon as you receive your cancellation notice.

Resuming activities after MDEL cancellation To resume licensable activities, you must re-apply for a new establishment licence and pay the MDEL fee. See section 45 of the Medical Device Regulations. To find out how to re-apply for buy kamagra with free samples a MDEL, please refer to our Guidance on medical device buy kamagra 100mg establishment licensing (GUI-0016). In line with the Compliance and Enforcement Policy (POL-0001), Health Canada monitors activities for compliance. If your MDEL has been cancelled, you may be subject to compliance and enforcement actions if you conduct non-compliant activities.

If you have questions about a buy kamagra 100mg MDEL or the application process, please contact the Medical Device Establishment Licensing Unit at hc.mdel.questions.leim.sc@canada.ca. If you have questions about invoicing and fees for an MDEL application, please contact the Cost Recovery Invoicing Unit at hc.criu-ufrc.sc@canada.ca. Related linksMDEL Bulletin, June 15, 2021, from the Medical Devices Compliance Program On this page Rapid antigen tests and the workplace screening program There are currently various technologies to detect SARS CoV-2, the kamagra that causes erectile dysfunction treatment. Antigen-based testing buy kamagra 100mg devices detect specific proteins on the surface of the kamagra and typically provide results in less than 1 hour. While some rapid antigen detection tests (RADTs) have been approved for people without symptoms, most RADTs are indicated for use on people with symptoms and are to be conducted by laboratory personnel, healthcare professionals or trained operators.

Health Canada has authorized several RADTs under two interim orders. The indications and conditions of buy kamagra 100mg use of authorized products may change over time as manufacturers continue to collect data. Screening asymptomatic individuals for SARS CoV-2 is proving to be effective in high-risk settings where social distancing and other measures are not feasible. Through the workplace screening program, Canada is supplying RADTs to eligible workplaces across the country. The program will help companies detect early cases of erectile dysfunction treatment, for people buy kamagra 100mg who are asymptomatic.

This program is being administered in collaboration with the provinces and territories. Interim enforcement approach In the interest of public health, Health Canada is placing less priority on enforcing off-label distribution of RADTs under the following circumstances. This enforcement discretion will be in effect until December 31, buy kamagra 100mg 2021. The exception is if. post-market monitoring identifies new risks or there’s no longer a need to apply this discretion based on public health status Related links.

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Rather than treating the mechanical consequences of severe CAVS, identification of causal disease pathways Buy viagra online without a prescription at the tissue level might lead to medical therapies that could actually low price kamagra prevent or delay the pathological changes in the valve leaflets. Serum levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity are associated with the presence of CAVS. However, it has been unclear whether this association is due to a cause–effect relationship.

In this low price kamagra issue of Heart, Perrot and colleagues1 used genetic association studies from eight cohorts to show that CAVS was not associated with any of four single nucleotide polymorphisms that are associated with Lp-PLA2 activity or mass. These findings suggest that although Lp-PLA2 activity is a biomarker for CAVS unfortunately, it is unlikely to be a therapeutic target (figure 1).Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study. CAVS, calcific aortic valve stenosis.

Lp-PLA2, lipoprotein-associated phospholipase A2." data-icon-position data-hide-link-title="0">Figure 1 Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but low price kamagra variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study. CAVS, calcific aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2.In an editorial, Zheng and Dweck2 discuss this article, summarise current ongoing trials of medical therapy for CAVS (table 1) and comment.

€˜Strong evidence points towards elevated Lp(a) levels and its associated low price kamagra oxidised phospholipids (OxPL) as causal risk factors for CAVS, suggesting that targeting this lipid-driven, inflammatory pathway has a real chance to translate into therapy capable of mitigating disease. The current study suggests that this association is not mediated by Lp-PLA2 and underlines the importance of scrutinising whether biological factors within pathophysiological pathways are merely biomarkers or actually represent a feasible and causal target.’View this table:Table 1 Ongoing randomised clinical trials of medical therapies in aortic stenosisRheumatic heart disease (RHD) remains the primary cause of valve disease worldwide and contributes significantly to maternal and fetal morbidity and mortality. In a study by Baghel and colleagues3 of 681 pregnant women with RHD, adverse cardiovascular evens occurred in about 15% of pregnancies.

Multivariable predictors of adverse outcomes during pregnancy were prior adverse cardiovascular events, lack of appropriate medical therapy, severity of mitral stenosis, valve low price kamagra replacement and pulmonary hypertension. Based on this analysis, the authors propose a risk score from pregnant women with RHD (table 2).View this table:Table 2 New prognostic score (DEVI’s score) to predict composite adverse cardiac outcome in pregnant women with rheumatic valvular heart diseaseCommenting on this paper, Elkayam and Shmueli4 point out that in about one-fourth of women, the diagnosis of RHD was not known prior to pregnancy and that a late diagnosis often was associated with adverse outcomes. Their editorial provides a concise summary of optimal management of pregnant women with RHD.

They conclude ‘With proper evaluation and risk stratification prior to pregnancy, a close multidisciplinary follow-up during pregnancy, and close monitoring during labour and delivery as well as the early postpartum period most complications can be prevented.’The importance low price kamagra of psychosocial factors in cardiovascular disease (CVD) prevalence and outcomes is increasingly recognised. Using data from the English Longitudinal Study of Ageing, Bu and colleagues5 found that loneliness was associated with CVD, independent of possible confounders and other risk factors, with a 30% higher risk of a new CVD diagnosis in the most lonely people compared with the least lonely people. As O’Keefe and colleagues6 point out, this data is especially important now in the context of social distancing and stay-at-home recommendations and they offer several approaches to mitigating loneliness during the erectile dysfunction treatment kamagra.The Education in Heart article7 in this issue focuses on the clinical use and prognostic implications of echocardiographic speckle tracking measurements of global longitudinal strain to detect and quantify early systolic dysfunction of the left ventricle (figure 2).Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis.

(A) Apical low price kamagra four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%).

(C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain low price kamagra amyloidosis. There is concentric hypertrophy of the left ventricle and the ejection fraction is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D).

ANT, anterior low price kamagra. ANT SEPT, anteroseptal. GS, global strain.

INF, inferior. LAT, lateral low price kamagra. POST, posterior.

SEPT, septal." data-icon-position data-hide-link-title="0">Figure 2 Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a low price kamagra 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was 55%.

(B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%). (C) Apical four-chamber view of a 75-year-old patient diagnosed with light low price kamagra chain amyloidosis. There is concentric hypertrophy of the left ventricle and the ejection fraction is 56%.

Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior low price kamagra. ANT SEPT, anteroseptal.

GS, global strain. INF, inferior low price kamagra. LAT, lateral.

POST, posterior. SEPT, septal.Our Cardiology-in-Focus article by Hudson and Pettit8 provides a clear-eyed but brief discussion and outstanding graphic of the challenges in reconciling the varying definitions of the ‘normal’ low price kamagra values for left ventricular ejection fraction, as stated in different guidelines (figure 3).Categories of left ventricular ejection fraction. EF, ejection fraction.

HF, heart failure. LVEF, left ventricular ejection low price kamagra fraction." data-icon-position data-hide-link-title="0">Figure 3 Categories of left ventricular ejection fraction. EF, ejection fraction.

HF, heart failure. LVEF, left low price kamagra ventricular ejection fraction.Loneliness is an unpleasant emotional state induced by perceived isolation. Until about 200 years ago, the English word for being on one’s own was ‘oneliness’, a term that connoted solitude, and was generally considered an essential and positive experience in life.

However, solitude and loneliness are not synonymous. Loneliness is also described as ‘social pain’ low price kamagra from an unwanted lack of connection and intimacy. Artists have likened loneliness to hunger, not only because we can feel it physically, sometimes described as an ache, a hollowness or a sense of coldness, but also because these physical sensations might be the body’s way of telling us that we are missing something that is important to our survival and flourishing.In this issue of Heart, Bu and colleagues,1 in a prospective observational study that comprised approximately 5000 adults followed for about 10 years, found that individuals reporting high levels of loneliness had 30%–48% increased risks of developing cardiovascular disease (CVD) and CVD-related hospital admission, respectively, even after adjusting for the usual cardiovascular risk factors.1 This major study has three implications.

(1) loneliness should be considered among the most dangerous CVD risk factors. (2) feeling lonely is a highly modifiable state that would seemingly respond to lifestyle adjustments as compared with the other foremost psychosocial CVD risk factors—depression and stress/anxiety—which typically require prescription medication or exercise2.

Serum levels of lipoprotein-associated buy kamagra 100mg phospholipase A2 (Lp-PLA2) http://markolewis.com/buy-viagra-online-without-a-prescription activity are associated with the presence of CAVS. However, it has been unclear whether this association is due to a cause–effect relationship. In this issue of Heart, Perrot and colleagues1 used genetic association studies from eight cohorts to show that CAVS was not associated with any of four single nucleotide polymorphisms that are associated with Lp-PLA2 activity or mass.

These findings suggest that although Lp-PLA2 activity is a biomarker for CAVS unfortunately, it is unlikely to be a therapeutic target (figure 1).Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study buy kamagra 100mg. CAVS, calcific aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2." data-icon-position data-hide-link-title="0">Figure 1 Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study.

CAVS, calcific aortic buy kamagra 100mg valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2.In an editorial, Zheng and Dweck2 discuss this article, summarise current ongoing trials of medical therapy for CAVS (table 1) and comment. €˜Strong evidence points towards elevated Lp(a) levels and its associated oxidised phospholipids (OxPL) as causal risk factors for CAVS, suggesting that targeting this lipid-driven, inflammatory pathway has a real chance to translate into therapy capable of mitigating disease.

The current study suggests that this association is not mediated by Lp-PLA2 and underlines the importance of scrutinising whether biological factors within buy kamagra 100mg pathophysiological pathways are merely biomarkers or actually represent a feasible and causal target.’View this table:Table 1 Ongoing randomised clinical trials of medical therapies in aortic stenosisRheumatic heart disease (RHD) remains the primary cause of valve disease worldwide and contributes significantly to maternal and fetal morbidity and mortality. In a study by Baghel and colleagues3 of 681 pregnant women with RHD, adverse cardiovascular evens occurred in about 15% of pregnancies. Multivariable predictors of adverse outcomes during pregnancy were prior adverse cardiovascular events, lack of appropriate medical therapy, severity of mitral stenosis, valve replacement and pulmonary hypertension.

Based on this analysis, the authors propose a risk score from pregnant women with RHD (table 2).View this table:Table 2 New prognostic score (DEVI’s score) to predict composite adverse cardiac outcome in pregnant women buy kamagra 100mg with rheumatic valvular heart diseaseCommenting on this paper, Elkayam and Shmueli4 point out that in about one-fourth of women, the diagnosis of RHD was not known prior to pregnancy and that a late diagnosis often was associated with adverse outcomes. Their editorial provides a concise summary of optimal management of pregnant women with RHD. They conclude ‘With proper evaluation and risk stratification prior to pregnancy, a close multidisciplinary follow-up during pregnancy, and close monitoring during labour and delivery as well as the early postpartum period most complications can be prevented.’The importance of psychosocial factors in cardiovascular disease (CVD) prevalence and outcomes is increasingly recognised.

Using data from the English Longitudinal Study of Ageing, Bu and colleagues5 found that loneliness was associated with CVD, buy kamagra 100mg independent of possible confounders and other risk factors, with a 30% higher risk of a new CVD diagnosis in the most lonely people compared with the least lonely people. As O’Keefe and colleagues6 point out, this data is especially important now in the context of social distancing and stay-at-home recommendations and they offer several approaches to mitigating loneliness during the erectile dysfunction treatment kamagra.The Education in Heart article7 in this issue focuses on the clinical use and prognostic implications of echocardiographic speckle tracking measurements of global longitudinal strain to detect and quantify early systolic dysfunction of the left ventricle (figure 2).Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy.

The thickness of buy kamagra 100mg the septum was 28 mm and the left ventricular ejection fraction was 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%). (C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis.

There is concentric hypertrophy of the left ventricle and buy kamagra 100mg the ejection fraction is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior.

ANT SEPT, buy kamagra 100mg anteroseptal. GS, global strain. INF, inferior.

LAT, lateral. POST, posterior buy kamagra 100mg. SEPT, septal." data-icon-position data-hide-link-title="0">Figure 2 Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis.

(A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was 55% buy kamagra 100mg. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%).

(C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric hypertrophy of the left ventricle and the ejection fraction buy kamagra 100mg is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D).

ANT, anterior. ANT SEPT, buy kamagra 100mg anteroseptal. GS, global strain.

INF, inferior. LAT, lateral buy kamagra 100mg. POST, posterior.

SEPT, septal.Our Cardiology-in-Focus article by Hudson and Pettit8 provides a clear-eyed but brief discussion and outstanding graphic of the challenges in reconciling the varying definitions of the ‘normal’ values for left ventricular ejection fraction, as stated in different guidelines (figure 3).Categories of left ventricular ejection fraction. EF, ejection fraction buy kamagra 100mg. HF, heart failure.

LVEF, left ventricular ejection fraction." data-icon-position data-hide-link-title="0">Figure 3 Categories of left ventricular ejection fraction. EF, ejection buy kamagra 100mg fraction. HF, heart failure.

LVEF, left ventricular ejection fraction.Loneliness is an unpleasant emotional state induced by perceived isolation. Until about buy kamagra 100mg 200 years ago, the English word for being on one’s own was ‘oneliness’, a term that connoted solitude, and was generally considered an essential and positive experience in life. However, solitude and loneliness are not synonymous.

Loneliness is also described as ‘social pain’ from an unwanted lack of connection and intimacy. Artists have likened loneliness to hunger, not only because we can feel it physically, sometimes described as an ache, a hollowness or a sense of coldness, but also because these physical sensations might be the body’s way of telling us that we are missing something that is important to our survival and flourishing.In this issue of Heart, Bu and colleagues,1 in a prospective observational study that comprised approximately 5000 adults followed for about 10 years, found that individuals reporting high levels of loneliness had 30%–48% buy kamagra 100mg increased risks of developing cardiovascular disease (CVD) and CVD-related hospital admission, respectively, even after adjusting for the usual cardiovascular risk factors.1 This major study has three implications. (1) loneliness should be considered among the most dangerous CVD risk factors.

(2) feeling lonely is a highly modifiable state that would seemingly respond to lifestyle adjustments as compared with the other foremost psychosocial CVD risk factors—depression and stress/anxiety—which typically require prescription medication or exercise2. And (3) social isolation without the anguish of loneliness does not appear to increase CVD risk.The current study confirms prior data showing that self-reported loneliness is significantly correlated with increased healthcare utilisation and heightened morbidity and mortality risks.3 4 Advanced age, poor health, fewer ….

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Aug check my blog kamagra 100mg. 6, 2021 -- Find it. Kill it kamagra 100mg. This is the simple premise behind new biomaterial-based treatments that experts are designing to fend off future pathogens, or germs that could threaten human health.

As they plan next-generation treatments, scientists are banking on the idea that the structure of kamagra 100mg a future kamagra-scale pathogen will be like the ones they already know about. The new class of treatments are being developed to supercharge the immune system to help the body quickly respond to a range of pathogens. The new biomaterial-based treatments are also shelf-stable, meaning they wouldn’t have to be refrigerated like some the erectile dysfunction treatment shots. This is encouraging news for faster treatment rollouts, and it will help poorer countries that lack refrigeration kamagra 100mg for supplies.

New biomaterial treatments tap into the body's natural immune response, explains Michael Super, PhD, from the Wyss Institute at Harvard University in Boston, who is first author on a new study exploring what the treatments can do. Previous research has shown that scientists can create a depository under the skin that acts like a protective lymph node, or a small bean-shaped structure that works as part of the body's immune system to help fight kamagra 100mg and disease. Supercharging the Immune System This opens the possibility that a biomaterial, such as silica, an important trace mineral already in connective tissues of the body, could be used to inject a pathogen to help the body produce antibodies to it and support how the immune system rallies, explains Super. "We recruit the immune system to that site, and then the dendritic cells pick up the antigen you put in that biomaterial," he says.

"That creates a danger signal that activates those dendritic cells in a very kamagra 100mg natural manner. The immune system doesn't overproduce, but it does respond, and we've found that it responds very quickly. We are essentially recapturing what the immune system normally does." As cells mature at the deposit site, they learn what signals kamagra 100mg to send to the rest of the immune system so that it responds to the pathogen targeted by the treatment. Those cells then travel through the body, stimulating other immune-responsive cells.

In their study, Super and his research team took this process a step further and used their biomaterial treatment to introduce live attenuated pathogens into the body. This process kamagra 100mg kept the pathogen viable, but harmless. This process is different from the recombinant spike protein treatments used for erectile dysfunction treatment that use genetically engineered agents to produce antibodies that target the erectile dysfunction. "We found we could take live pathogens and kill them with an kamagra 100mg antibiotic or something else and use that directly as part of the treatment of our choice," says Super.

"You don't have to do that complex manufacturing. You can simply take it, capture it, kill it, and mix it with the biomaterial and inject or implant it. We've seen that you've then got these native kamagra 100mg antigens to fight the pathogen." The team used this process to target a form of E. Coli, a type of bacteria that’s scientifically known as Escherichia coli that is particularly dangerous in livestock.

They infected a pig and then gave kamagra 100mg it an antibiotic to kill the . They extracted that dead bacteria from the pig's blood and combined it with a biomaterial, in this case mesoporous silica, to create a treatment. After they gave this treatment to mice, they exposed the mice to a different strain of E. Coli, and the kamagra 100mg mice fought off the .

"It's not just the pig-to-mouse aspect that is exciting, it's that we were able to protect against a lethal challenge from a different strain," Super says. Results were similar when they tested the treatment on kamagra 100mg mice infected with Staphylococcus aureus, he says. Most of this study, which focused on immune responses to bacteria, was completed before the erectile dysfunction treatment kamagra started. But the researchers say the work has important implications for preparing kamagra 100mg for future kamagras.

Stockpiling for Future Threats "One of the problems is that, very often, you don't know what the pathogen is that you're dealing with, especially in the case of a biothreat," Super points out. But "we believe the structure of a microbial pathogen will be similar to the native, normal pathogens we already know about." If that holds true -- and the research suggests it will -- then a treatment for a little-studied pathogen could be created using pathogens that target structurally similar but well-studied bacteria. Biomaterials can be made in bulk at low kamagra 100mg cost and dried for future use. "We see this as something that could be made and stored and ready to use whenever it is needed," Super explains.

WebMD kamagra 100mg Health News Sources Nature Biomedical Engineering. €œBiomaterial treatments capturing pathogen-associated molecular patterns protect against bacterial s and septic shock.” Michael Super, PhD, lead senior staff scientist, Wyss Institute, Harvard University, Boston. © 2021 WebMD, LLC. All rights reserved.Sean kamagra 100mg Callaghan, senior consultant, Ayaan Hirsi Ali Foundation.

News release, United Nations. CNN. €œMelinda Gates. erectile dysfunction treatment will be horrible in the developing world.” Amref Health Africa.

Shiphrah Kuria, MD, regional manager, reproductive maternal newborn child and adolescent health/family planning, Amref Health Africa. Brenda Mubita, project lead, Amref Health Africa. UNICEF. €œMaternal Mortality.” Sunita Caminha, policy specialist, Ending Violence Against Women, UN Women East and Southern Africa Regional Office.

Reuters. €œTeenage pregnancies rise in parts of Kenya as lockdown shuts schools.” Vivian Onano, humanitarian, social entrepreneur. Simeon Nanama, PhD, regional adviser of nutrition, UNICEF West and Central Africa Regional Office. Rehema Chengo, project coordinator, Amref Health Africa.

Equality Now. €œA conversation on safe spaces in Kenya in the midst of erectile dysfunction treatment.” Tammary Esho, PhD, director, Amref Health Africa End FGM/C Centre of Excellence. Reuters. €œKenya pledges to end FGM by 2022 -- ahead of global target.” Republic of Kenya.

€œEnding FGM Will Empower The Girl Child To Participate Fully In National Dvpt, President Kenyatta Says.” United Nations. UNICEF. €œNo Time To Waste.” World Health Organization. United Nations Development Program.

€œerectile dysfunction treatment Global Gender Response Tracker.” UNICEF USA. €œWhat Is Ready-to-Use Therapeutic Food?. € UN Women. €œThe Shadow kamagra.

Violence against women during erectile dysfunction treatment.” Global Sisters Report. €œWith no school amid kamagra, Kenyan girls fall prey to pregnancy risks.” The Guardian. €œ'Sex for sanitary pads'. How Kenya's lockdown led to a rise in teenage pregnancy.” The New Humanitarian.

€œKenya’s teen pregnancy crisis. More than erectile dysfunction treatment is to blame.” United Nations Population Fund.By Robert PreidtHealthDay ReporterFRIDAY, Aug. 6, 2021 (HealthDay News) -- It's long been know that pollution can damage the heart and lungs, but new research finds that it's bad for your brain, too.A long-term study by a Seattle team linked exposure to higher levels of fine particulate air pollution to an increased risk of dementia."We found that an increase of 1 microgram per cubic meter of exposure corresponded to a 16% greater hazard of all-cause dementia," said lead author Rachel Shaffer. "There was a similar association for Alzheimer's-type dementia."Shaffer did the research as a doctoral student in the University of Washington's Department of Environmental and Occupational Health Sciences.She and her colleagues analyzed data from more than 4,000 Seattle-area residents enrolled in the Adult Changes in Thought study run by Kaiser Permanente Washington Research Institute in collaboration with the university.More than 1,000 participants had been diagnosed with dementia since the study's start in 1994.

A slight increase in levels of fine particle pollution (PM2.5) averaged over a decade in specific neighborhoods was associated with a greater risk of dementia for residents, according to findings published Aug. 4 in the journal Environmental Health Perspectives.To put the difference into perspective, the traffic-filled Pike Street Market in downtown Seattle and the residential areas around Discovery Park, the city's largest natural-area park, had about a 1 microgram per cubic meter difference in PM2.5 pollution in 2019, Shaffer said."We know dementia develops over a long period of time," she said in a university news release. "It takes years -- even decades -- for these pathologies to develop in the brain, and so we needed to look at exposures that covered that extended period."Air pollution is recognized as one of the major potentially modifiable risk factors for dementia.The study adds to a body of research suggesting that air pollution may harm the brain and that reducing people's exposure to dirty air could help lower dementia rates, according to the authors."How we've understood the role of air pollution exposure on health has evolved from first thinking it was pretty much limited to respiratory problems, then that it also has cardiovascular effects, and now there's evidence of its effects on the brain," said senior author Lianne Sheppard, a professor in UW's Departments of Environmental and Occupational Health Sciences and Biostatistics. Shaffer noted that one way individuals can lower their risk is a common one in the erectile dysfunction treatment age.

Wearing a mask."But it is not fair to put the burden on individuals alone," Shaffer added. "These data can support further policy action on the local and national level to control sources of particulate air pollution."More informationThe U.S. National Institute on Aging has more about dementia.SOURCE. University of Washington, news release, Aug.

2, 2021By Robert PreidtHealthDay ReporterFRIDAY, Aug. 6, 2021 (HealthDay News) -- A kind of 'zap' to the brain -- a technique called noninvasive brain stimulation -- may help hardcore smokers cut back, a new research review suggests.Nicotine can trigger changes in the brain that make it hard to quit, so researchers have been looking for ways to use noninvasive brain stimulation (NIBS) techniques to counter abnormal brain activity caused by nicotine addiction.In this review, researchers analyzed 12 trials of different NIBS methods on a combined total of 710 people addicted to nicotine.Several techniques showed promising results, but high-frequency repetitive transcranial magnetic stimulation (rTMS) of a brain area involved in memory and decision-making was associated with the greatest reduction in number of cigarettes smoked per day.None of the NIBS techniques reviewed appeared to reduce the severity of nicotine craving or addiction.NIBS may boost dopamine release and counterbalance the brain's reward system, helping smokers deal with craving and withdrawal symptoms, according to study author Dr. Cheng-Ta Li, of Taipei Veterans General Hospital in Taiwan, and his colleagues. The findings were published Aug.

4 in the journal Addiction.Li and his team noted that trial dropout rates among participants undergoing any of the NIBS methods were not significantly different from control groups. That suggests these treatments are well-tolerated, the researchers said in a journal news release.Nicotine affects the release of neurotransmitters in the brain, increasing brain activity and the release of dopamine. Higher levels of dopamine provide feelings of pleasure for smokers, the authors said.Long-term nicotine exposure causes the brain to produce more receptors to handle the increased brain activity. When a smoker tries to quit and nicotine levels fall, a decrease in activity in the brain's reward system causes withdrawal symptoms that make it hard to cut back or quit smoking.More informationThe U.S.

Centers for Disease Control and Prevention offers a guide for quitting smoking.SOURCE. Addiction, news release, Aug. 4, 2021.

Aug http://akrai.org/it/support-it/ buy kamagra 100mg. 6, 2021 -- Find it. Kill it buy kamagra 100mg. This is the simple premise behind new biomaterial-based treatments that experts are designing to fend off future pathogens, or germs that could threaten human health.

As they plan next-generation buy kamagra 100mg treatments, scientists are banking on the idea that the structure of a future kamagra-scale pathogen will be like the ones they already know about. The new class of treatments are being developed to supercharge the immune system to help the body quickly respond to a range of pathogens. The new biomaterial-based treatments are also shelf-stable, meaning they wouldn’t have to be refrigerated like some the erectile dysfunction treatment shots. This is encouraging news for faster buy kamagra 100mg treatment rollouts, and it will help poorer countries that lack refrigeration for supplies.

New biomaterial treatments tap into the body's natural immune response, explains Michael Super, PhD, from the Wyss Institute at Harvard University in Boston, who is first author on a new study exploring what the treatments can do. Previous research has shown that scientists can create a depository under the skin that acts like a protective lymph node, or a small bean-shaped structure that works as part of the buy kamagra 100mg body's immune system to help fight and disease. Supercharging the Immune System This opens the possibility that a biomaterial, such as silica, an important trace mineral already in connective tissues of the body, could be used to inject a pathogen to help the body produce antibodies to it and support how the immune system rallies, explains Super. "We recruit the immune system to that site, and then the dendritic cells pick up the antigen you put in that biomaterial," he says.

"That creates a danger signal that buy kamagra 100mg activates those dendritic cells in a very natural manner. The immune system doesn't overproduce, but it does respond, and we've found that it responds very quickly. We are essentially recapturing what the immune system normally does." As cells buy kamagra 100mg mature at the deposit site, they learn what signals to send to the rest of the immune system so that it responds to the pathogen targeted by the treatment. Those cells then travel through the body, stimulating other immune-responsive cells.

In their study, Super and his research team took this process a step further and used their biomaterial treatment to introduce live attenuated pathogens into the body. This process kept buy kamagra 100mg the pathogen viable, but harmless. This process is different from the recombinant spike protein treatments used for erectile dysfunction treatment that use genetically engineered agents to produce antibodies that target the erectile dysfunction. "We found we could take live pathogens and kill them with an antibiotic or something else and use that directly as part of the treatment buy kamagra 100mg of our choice," says Super.

"You don't have to do that complex manufacturing. You can simply take it, capture it, kill it, and mix it with the biomaterial and inject or implant it. We've seen that you've then got these native antigens to fight the pathogen." The team used this process buy kamagra 100mg to target a form of E. Coli, a type of bacteria that’s scientifically known as Escherichia coli that is particularly dangerous in livestock.

They infected buy kamagra 100mg a pig and then gave it an antibiotic to kill the . They extracted that dead bacteria from the pig's blood and combined it with a biomaterial, in this case mesoporous silica, to create a treatment. After they gave this treatment to mice, they exposed the mice to a different strain of E. Coli, and buy kamagra 100mg the mice fought off the .

"It's not just the pig-to-mouse aspect that is exciting, it's that we were able to protect against a lethal challenge from a different strain," Super says. Results were similar when they tested the treatment on mice buy kamagra 100mg infected with Staphylococcus aureus, he says. Most of this study, which focused on immune responses to bacteria, was completed before the erectile dysfunction treatment kamagra started. But the buy kamagra 100mg researchers say the work has important implications for preparing for future kamagras.

Stockpiling for Future Threats "One of the problems is that, very often, you don't know what the pathogen is that you're dealing with, especially in the case of a biothreat," Super points out. But "we believe the structure of a microbial pathogen will be similar to the native, normal pathogens we already know about." If that holds true -- and the research suggests it will -- then a treatment for a little-studied pathogen could be created using pathogens that target structurally similar but well-studied bacteria. Biomaterials can be made in bulk at low cost and dried buy kamagra 100mg for future use. "We see this as something that could be made and stored and ready to use whenever it is needed," Super explains.

WebMD Health News buy kamagra 100mg Sources Nature Biomedical Engineering. €œBiomaterial treatments capturing pathogen-associated molecular patterns protect against bacterial s and septic shock.” Michael Super, PhD, lead senior staff scientist, Wyss Institute, Harvard University, Boston. © 2021 WebMD, LLC. All rights reserved.Sean Callaghan, senior consultant, Ayaan buy kamagra 100mg Hirsi Ali Foundation.

News release, United Nations. CNN. €œMelinda Gates. erectile dysfunction treatment will be horrible in the developing world.” Amref Health Africa.

Shiphrah Kuria, MD, regional manager, reproductive maternal newborn child and adolescent health/family planning, Amref Health Africa. Brenda Mubita, project lead, Amref Health Africa. UNICEF. €œMaternal Mortality.” Sunita Caminha, policy specialist, Ending Violence Against Women, UN Women East and Southern Africa Regional Office.

Reuters. €œTeenage pregnancies rise in parts of Kenya as lockdown shuts schools.” Vivian Onano, humanitarian, social entrepreneur. Simeon Nanama, PhD, regional adviser of nutrition, UNICEF West and Central Africa Regional Office. Rehema Chengo, project coordinator, Amref Health Africa.

Equality Now. €œA conversation on safe spaces in Kenya in the midst of erectile dysfunction treatment.” Tammary Esho, PhD, director, Amref Health Africa End FGM/C Centre of Excellence. Reuters. €œKenya pledges to end FGM by 2022 -- ahead of global target.” Republic of Kenya.

€œEnding FGM Will Empower The Girl Child To Participate Fully In National Dvpt, President Kenyatta Says.” United Nations. UNICEF. €œNo Time To Waste.” World Health Organization. United Nations Development Program.

€œerectile dysfunction treatment Global Gender Response Tracker.” UNICEF USA. €œWhat Is Ready-to-Use Therapeutic Food?. € UN Women. €œThe Shadow kamagra.

Violence against women during erectile dysfunction treatment.” Global Sisters Report. €œWith no school amid kamagra, Kenyan girls fall prey to pregnancy risks.” The Guardian. €œ'Sex for sanitary pads'. How Kenya's lockdown led to a rise in teenage pregnancy.” The New Humanitarian.

€œKenya’s teen pregnancy crisis. More than erectile dysfunction treatment is to blame.” United Nations Population Fund.By Robert PreidtHealthDay ReporterFRIDAY, Aug. 6, 2021 (HealthDay News) -- It's long been know that pollution can damage the heart and lungs, but new research finds that it's bad for your brain, too.A long-term study by a Seattle team linked exposure to higher levels of fine particulate air pollution to an increased risk of dementia."We found that an increase of 1 microgram per cubic meter of exposure corresponded to a 16% greater hazard of all-cause dementia," said lead author Rachel Shaffer. "There was a similar association for Alzheimer's-type dementia."Shaffer did the research as a doctoral student in the University of Washington's Department of Environmental and Occupational Health Sciences.She and her colleagues analyzed data from more than 4,000 Seattle-area residents enrolled in the Adult Changes in Thought study run by Kaiser Permanente Washington Research Institute in collaboration with the university.More than 1,000 participants had been diagnosed with dementia since the study's start in 1994.

A slight increase in levels of fine particle pollution (PM2.5) averaged over a decade in specific neighborhoods was associated with a greater risk of dementia for residents, according to findings published Aug. 4 in the journal Environmental Health Perspectives.To put the difference into perspective, the traffic-filled Pike Street Market in downtown Seattle and the residential areas around Discovery Park, the city's largest natural-area park, had about a 1 microgram per cubic meter difference in PM2.5 pollution in 2019, Shaffer said."We know dementia develops over a long period of time," she said in a university news release. "It takes years -- even decades -- for these pathologies to develop in the brain, and so we needed to look at exposures that covered that extended period."Air pollution is recognized as one of the major potentially modifiable risk factors for dementia.The study adds to a body of research suggesting that air pollution may harm the brain and that reducing people's exposure to dirty air could help lower dementia rates, according to the authors."How we've understood the role of air pollution exposure on health has evolved from first thinking it was pretty much limited to respiratory problems, then that it also has cardiovascular effects, and now there's evidence of its effects on the brain," said senior author Lianne Sheppard, a professor in UW's Departments of Environmental and Occupational Health Sciences and Biostatistics. Shaffer noted that one way individuals can lower their risk is a common one in the erectile dysfunction treatment age.

Wearing a mask."But it is not fair to put the burden on individuals alone," Shaffer added. "These data can support further policy action on the local and national level to control sources of particulate air pollution."More informationThe U.S. National Institute on Aging has more about dementia.SOURCE. University of Washington, news release, Aug.

2, 2021By Robert PreidtHealthDay ReporterFRIDAY, Aug. 6, 2021 (HealthDay News) -- A kind of 'zap' to the brain -- a technique called noninvasive brain stimulation -- may help hardcore smokers cut back, a new research review suggests.Nicotine can trigger changes in the brain that make it hard to quit, so researchers have been looking for ways to use noninvasive brain stimulation (NIBS) techniques to counter abnormal brain activity caused by nicotine addiction.In this review, researchers analyzed 12 trials of different NIBS methods on a combined total of 710 people addicted to nicotine.Several techniques showed promising results, but high-frequency repetitive transcranial magnetic stimulation (rTMS) of a brain area involved in memory and decision-making was associated with the greatest reduction in number of cigarettes smoked per day.None of the NIBS techniques reviewed appeared to reduce the severity of nicotine craving or addiction.NIBS may boost dopamine release and counterbalance the brain's reward system, helping smokers deal with craving and withdrawal symptoms, according to study author Dr. Cheng-Ta Li, of Taipei Veterans General Hospital in Taiwan, and his colleagues. The findings were published Aug.

4 in the journal Addiction.Li and his team noted that trial dropout rates among participants undergoing any of the NIBS methods were not significantly different from control groups. That suggests these treatments are well-tolerated, the researchers said in a journal news release.Nicotine affects the release of neurotransmitters in the brain, increasing brain activity and the release of dopamine. Higher levels of dopamine provide feelings of pleasure for smokers, the authors said.Long-term nicotine exposure causes the brain to produce more receptors to handle the increased brain activity. When a smoker tries to quit and nicotine levels fall, a decrease in activity in the brain's reward system causes withdrawal symptoms that make it hard to cut back or quit smoking.More informationThe U.S.

Centers for Disease Control and Prevention offers a guide for quitting smoking.SOURCE. Addiction, news release, Aug. 4, 2021.

Page updated: 01.06.2010 21:00