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Patient reported quality of life (QOL) measures showed significant improvement across all domains at 12 months cheap generic levitra online. In addition, QOL improvement was associated with a lower AF burden, measured by ambulatory monitoring. Overall, cardiovascular hospitalisations decreased by 42% after AF ablation. Patients with the lowest QOL measures at baseline had the most improvement after AF ablation (figure 1).Atrial fibrillation effect on quality of life survey (AFEQT) change versus baseline score." data-icon-position data-hide-link-title="0">Figure 1 Atrial fibrillation effect on quality of life cheap generic levitra online survey (AFEQT) change versus baseline score.In the accompanying editorial, Elvan2 comments. €˜Significant reduction of the impact of AF on healthcare utilisation and improvement of QOL metrics should be regarded as important and patient-relevant healthcare values gained by catheter ablation of paroxysmal AF.

Moreover, Gupta and colleagues1 report an inverse association between the extent of QOL improvement and residual AF burden post-ablation. These results emphasise the importance of incorporating AF-specific QOL metrics in AF ablation studies.’ Ongoing innovations in approaches to AF ablation are discussed as well.Identification of predictors of sudden cardiac death (SCD) at the cheap generic levitra online population level are needed for prevention because up to ½ of events occur in people with no prior history of heart disease. Ågesen and colleagues3 report the temporal trends in SCD in 14 562 participants followed in the Copenhagen City Heart Study from 1993 to 2016. Of the 8394 deaths with full information, 1335 (16%) were classified as SCD with a 41% decrease in SCD incident over the study period in persons aged 40–90 years (figure 2). There was a higher incidence of SCD in men, compared with women in those age 75 years or less with an incidence ratio of 1.99 (95% CI 1.62 to 2.46) with SCD being the first known manifestation of cardiac cheap generic levitra online disease in 50% of cases.The incidence rate of sudden cardiac death from 1993 to 2016 per age group stratified by sex.

Data are expressed as incidence rates and 95% CIs. PY, person-years." data-icon-position data-hide-link-title="0">Figure 2 The incidence rate of sudden cardiac death from 1993 to 2016 per age group stratified by sex. Data are expressed as incidence rates cheap generic levitra online and 95% CIs. PY, person-years.Tzeis urges in an editorial4 that. €˜Further actions should aim to reduce the rate of SCD by focusing on two priority areas.

The first one is prevention of cardiovascular disease by promoting the adoption cheap generic levitra online of healthy lifestyle and behavioural habits and by implementing comprehensive intervention programmes to tackle cardiovascular risk factors. The second priority area is primary and secondary prevention of SCD’ (figure 3).Priority areas and relevant actions needed to reduce the burden of SCD. BLS, basic life support. CPR, cardiopulmonary cheap generic levitra online resuscitation. CVD, cardiovascular disease.

EMS, emergency medical service. ICD, implantable cardioverter cheap generic levitra online defibrillator. OHCA, out-of-hospital cardiac arrest. PAD, public access defibrillator. SCD, sudden cardiac death." data-icon-position data-hide-link-title="0">Figure 3 Priority areas and relevant actions needed to reduce the burden of SCD cheap generic levitra online.

BLS, basic life support. CPR, cardiopulmonary resuscitation. CVD, cardiovascular disease cheap generic levitra online. EMS, emergency medical service. ICD, implantable cardioverter defibrillator.

OHCA, out-of-hospital cheap generic levitra online cardiac arrest. PAD, public access defibrillator. SCD, sudden cardiac death.The increasing recognition that some types of mild valve disease are associated with adverse clinical outcomes is highlighted in a study by Taylor and colleagues5 in this issue of Heart. In a population-based cohort from the OxVALVE (Oxford Valvular Heart Disease) study that included 3511 participants over age 65 years, advanced aortic valve sclerosis (present in 2.25%) and advanced mitral annular calcification (present in cheap generic levitra online 1.31%) were associated with a higher risk of death (HR 2.05, 95% CI 1.28 to 3.30 and HR 2.51, 95% CI 1.41 to 4.49, respectively) (figure 4).Kaplan-Meier curve demonstrating the unadjusted survival rates for people with advanced aortic sclerosis (Ao.Scl) or mitral annular calcification (MAC) compared with people with early or no disease. Participants are categorised as having advanced aortic sclerosis or mitral annular calcification (types of calcific valve disease without functional effect), irrespective of the presence of valvular heart disease.

Advanced disease describes moderate or significant sclerosis or calcification, although without functional impact" data-icon-position data-hide-link-title="0">Figure 4 Kaplan-Meier curve demonstrating the unadjusted survival rates for people with advanced aortic sclerosis (Ao.Scl) or mitral annular calcification (MAC) compared with people with early or no disease. Participants are categorised as having advanced aortic sclerosis or mitral annular cheap generic levitra online calcification (types of calcific valve disease without functional effect), irrespective of the presence of valvular heart disease. Advanced disease describes moderate or significant sclerosis or calcification, although without functional impactIung and Bouleti comment6 that ‘This analysis of the OxValve cohort suggests that more attention should be paid to the extent of the calcific valve lesion as assessed by echocardiography even at the early stages of valvular disease. Although this cannot translate in effective prevention measures at the present time, these findings further highlight the need for continuous research on the pathophysiology of calcific valve diseases, and the identification of metabolic pathways which may reduce the consequences of calcium deposits.’A systematic review on patient preferences and values related to the choice of prosthetic valve for treatment of severe aortic stenosis provides useful insights and also underlines the need to more fully integrate the patient point of view into future clinical trial designs.7 Identifying the factors important to patients in shared decision making and involving patients in defining relevant outcomes is essential for ensuring that medical care meets patient needs.The Education in Heart article in this issue reviews the causes, diagnosis and management of left ventricular non-compaction (figure 5).8Management algorithm of individuals with excessive LV trabeculation. ACE-I, ACE inhibitor cheap generic levitra online.

AF, atrial fibrillation. ARB, angiotensin II receptor blocker. ARNI, angiotensin receptor-neprilysin cheap generic levitra online inhibitor. AVC, arrhythmogenic ventricular cardiomyopathy. CHADS2, congestive heart failure, hypertension, age, diabetes, stroke or transient ischaemic attack.

CMR, cardiac magnetic resonance cheap generic levitra online. CRT, cardiac resynchronisation therapy. DCM, dilated cardiomyopathy. HCM, hypertrophic cheap generic levitra online cardiomyopathy. HFrEF, heart failure with reduced ejection fraction.

ICD, implantable cardioverter-defibrillator. LBBB, left cheap generic levitra online bundle branch block. LGE, late gadolinium enhancement. LV, left ventricular. LVEF, left ventricular ejection fraction cheap generic levitra online.

LVSD, left ventricular systolic dysfunction. MRA, mineralocorticoid receptor antagonist. NI-DCM, non-ischaemic dilated cardiomyopathy cheap generic levitra online. RCM, restrictive cardiomyopathy. RV, right ventricular.

SGLT2i, sodium-glucose cheap generic levitra online cotransporter 2 inhibitor. TIA, transient ischaemic attack." data-icon-position data-hide-link-title="0">Figure 5 Management algorithm of individuals with excessive LV trabeculation. ACE-I, ACE inhibitor. AF, atrial fibrillation cheap generic levitra online. ARB, angiotensin II receptor blocker.

ARNI, angiotensin receptor-neprilysin inhibitor. AVC, arrhythmogenic ventricular cardiomyopathy cheap generic levitra online. CHADS2, congestive heart failure, hypertension, age, diabetes, stroke or transient ischaemic attack. CMR, cardiac magnetic resonance.

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October is where can you get levitra Mental Health Awareness Month and World Mental Health Day takes place on 10 October 2020. This year, the erectile dysfunction treatment levitra has added a new dimension to concerns regarding mental health in our communities. Across the globe stories continue to emerge of people’s experiences of anxiety, fear and depression due to the uncertainty and stress brought on by the levitra.1–3 Job losses, financial and housing insecurity, the challenges of working from home, home schooling, restricted access to health and social care services and social isolation coupled with reduced support and contact with family and where can you get levitra friends have all impacted people’s well-being. There is particular concern about the mental health of healthcare workers during this difficult time.While most healthcare workers are resilient to the long-term effects of this period of stress and anxiety, there is the added worry about scarce resources, lack of cure or effective treatment options, isolation from family, coping with patient suffering and deaths and the moral and ethical impact of decisions as to who will receive acute care.

These factors have significant potential for negative repercussions on the mental health and well-being of healthcare staff.4 5 There have been reports where can you get levitra of high levels of stress, depression and even suicides,6 and long-term effects include a higher risk for post-traumatic stress disorder or moral injury.5Healthcare organisations need to plan for the inevitable consequence of this levitra and ensure that resources are in place for their workers. Screening for mental health issues and treatment, including counselling, should be made available. In addition, nurses and other healthcare staff should be encouraged to reflect on their experiences where can you get levitra and consider how to implement self-care strategies that will enhance their well-being. This includes staying informed of the current data and information and being aware of the risks to themselves and others while caring for patients with the levitra.

By monitoring and enacting strategies to reduce stress and develop support systems, staff can minimise longer-term impacts.4Whether organisational support and self-care monitoring have achieved better mental health outcomes for healthcare workers is, as yet, unknown. Research across where can you get levitra the globe is underway not only related to the levitra itself but also to the mental health consequences of the levitra. We do not yet know the extent of the issues or how best to support healthcare providers. In order to better understand the issues and to support nurses at this time, evidence-based nursing will focus our social media to where can you get levitra mental health issues during the month of October.

We will highlight and share relevant resources and information and encourage discussion of the key challenges facing healthcare workers.During October, we will showcase the experiences of four key groups—patients, nurses, students and informal carers and families. Be sure to log into evidence-based nursing each week where can you get levitra for the following blogs:October 4. Impact of erectile dysfunction treatment on patient mental health.October 11. Impact of erectile dysfunction treatment on nurses’ mental where can you get levitra health and.Twitter Chat on Wednesday October 14 at 20:00 UK time.Oct.

18. Impact of erectile dysfunction treatment on student nursing.Oct. 25. Impact of erectile dysfunction treatment on informal carers and families.A PhD is a globally recognised postgraduate degree and typically the highest degree programme awarded by a University, with students usually required to expand the boundaries of knowledge by undertaking original research.

The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce. In this paper—the first of two linked Research Made Simple articles—we explore what the foundations of a high-quality PhD are, and how a Doctoral candidate can develop a study which is successful, original and impactful.Foundations of a ‘good’ PhD studySupervision and supportCentral to the development and completion of a good PhD is the supervisory relationship between the student and supervisor. The supervisor guides the student by directing them to resources and training to ensure continuous learning, provides opportunity to engage with experts in the field, and facilitates the development of critical thinking through questioning and providing constructive criticism.1The support needs of students will be different, so a flexible yet quality assured approach to PhD research training is required. A good supervisory team (usually includes at least two postdoctoral academics) provide experienced guidance and mentorship and will offer students academic support, with regular meetings and timely feedback on written submissions, will assist the student to develop a peer network and help them access research communities relative to their field.

Effective supervision has beneficial outcomes for students, including encouraging a positive work ethic and influencing engagement in a stimulating environment, allowing students to pursue their own ideas with educated encouragement. The quality of the supervisory relationship can impact greatly on the PhD experience and ultimately sets the student on the road to producing excellent Doctoral work.1An environment that promotes personal and professional development is further aided by positive peer interactions. If students feel part of a community and have contact with others also working on doctoral studies, there is the scope for peer compassion and understanding during both challenging and rewarding periods. Students who access personal and professional support and guidance through mentoring models during their studies are more likely to succeed.

These models include one-to-one peer mentoring or activities for example journal discussion or methods learning groups. Often, groups of students naturally come together and give each other support and advice about research process expectations and challenges, and offer friendship, and guidance.2 Given the usefulness of different types of mentoring models, all can create a supportive and collaborative environment within a PhD programme of study, to minimise working in isolation and enable students to achieve their greatest potential.Characteristics of a good study. Originality and theoretical underpinningA PhD should make an original contribution to knowledge. Originality can be achieved through the study design, the nature or outcomes of the knowledge synthesis, or the implications for research and/or practice.3 Disciplinary variation, however, influences the assessment of originality.

For example, originality in science, technology, engineering and mathematics subjects is often inferred if the work is published/publishable, in comparison to intellectual originality in the social sciences.4 Although PhD originality assumes different nuances in different contexts, there is a general acceptance across disciplines that there should be evidence of the following within the thesis:An interplay between old and new—any claims of originality are developed from existing knowledge and practices.There are degrees of originality, relating to more than one aspect of the thesis.Any claims for originality are accompanied by clear articulation of significance.A good PhD should be also underpinned by theoretical and/or conceptual frameworks (that include philosophical and methodological models) that give clarity to the approach, structure and vision of the study.5 These theoretical and conceptual frameworks can explain why the study is pertinent and how the research addresses gaps in the literature.6 Table 1 provides a distinction of what construes theoretical and conceptual frameworks.View this table:Table 1 Characteristics of theoretical and conceptual frameworks7Theoretical/conceptual frameworks must align with the research question/aims, and the student must be able to articulate how conceptual/theoretical framework were chosen. Key points for consideration include:Are the research questions/aim and objectives well defined?. What theory/theories/concepts are being operationalised?. How are the theories/concepts related?.

Are the ontological and epistemological perspectives clearly conveyed and how do they relate to theories and concepts outlined?. What are the potential benefits and limitations of the theories and concepts outlined?. Are the ways the theories/concepts are outlined and being used original?. A PhD thesis (and demonstrable in viva) must be able to offer cohesion between the choice of research methods that stems from the conceptual/theoretical framework, the related ontological and epistemological decisions, the theoretical perspective and the chosen methodology (table 2).

PhD students must be able to articulate the methodological decisions made and be critical of methods employed to answer their research questions.View this table:Table 2 Relationship between research paradigms, perspectives, methodologies and methods.8 9ConclusionIn summary, we offer considerations of what the foundations of a good PhD should be. We have considered some of the key ingredients of quality PhD supervision, support and research processes and explored how these will contribute to the development of a study that leads to student success and which makes a valuable contribution to the evidence base. In the next paper, we will look in more detail at the assessment of the PhD through the submission of a thesis and an oral viva..

October is Mental Health Awareness Month and World Mental Health Day cheap generic levitra online takes place on 10 October http://www.ec-griesheim-pres-molsheim.ac-strasbourg.fr/copains-qui-dansent/ 2020. This year, the erectile dysfunction treatment levitra has added a new dimension to concerns regarding mental health in our communities. Across the globe stories continue to emerge of people’s experiences of anxiety, fear and depression due to the uncertainty and stress brought on by the levitra.1–3 Job losses, financial and housing insecurity, the challenges of working from home, home schooling, restricted access to health and social care services and social isolation coupled with reduced support and contact with family and friends have all impacted people’s cheap generic levitra online well-being. There is particular concern about the mental health of healthcare workers during this difficult time.While most healthcare workers are resilient to the long-term effects of this period of stress and anxiety, there is the added worry about scarce resources, lack of cure or effective treatment options, isolation from family, coping with patient suffering and deaths and the moral and ethical impact of decisions as to who will receive acute care. These factors have significant potential for negative repercussions on the mental health and well-being of healthcare staff.4 5 There have been reports of high levels of stress, depression and even suicides,6 and long-term effects include a higher risk for post-traumatic stress disorder or moral injury.5Healthcare organisations need to plan for the inevitable consequence of this levitra cheap generic levitra online and ensure that resources are in place for their workers.

Screening for mental health issues and treatment, including counselling, should be made available. In addition, nurses and other healthcare staff should be encouraged to reflect on their experiences and consider how to implement self-care strategies cheap generic levitra online that will enhance their well-being. This includes staying informed of the current data and information and being aware of the risks to themselves and others while caring for patients with the levitra. By monitoring and enacting strategies to reduce stress and develop support systems, staff can minimise longer-term impacts.4Whether organisational support and self-care monitoring have achieved better mental health outcomes for healthcare workers is, as yet, unknown. Research across the cheap generic levitra online globe is underway not only related to the levitra itself but also to the mental health consequences of the levitra.

We do not yet know the extent of the issues or how best to support healthcare providers. In order to better understand the cheap generic levitra online issues and to support nurses at this time, evidence-based nursing will focus our social media to mental health issues during the month of October. We will highlight and share relevant resources and information and encourage discussion of the key challenges facing healthcare workers.During October, we will showcase the experiences of four key groups—patients, nurses, students and informal carers and families. Be sure to log cheap generic levitra online into evidence-based nursing each week for the following blogs:October 4. Impact of erectile dysfunction treatment on patient mental health.October 11.

Impact of erectile dysfunction treatment on nurses’ mental health and.Twitter Chat on Wednesday October 14 cheap generic levitra online at 20:00 UK time.Oct. 18. Impact of erectile dysfunction treatment on student nursing.Oct. 25. Impact of erectile dysfunction treatment on informal carers and families.A PhD is a globally recognised postgraduate degree and typically the highest degree programme awarded by a University, with students usually required to expand the boundaries of knowledge by undertaking original research.

The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce. In this paper—the first of two linked Research Made Simple articles—we explore what the foundations of a high-quality PhD are, and how a Doctoral candidate can develop a study which is successful, original and impactful.Foundations of a ‘good’ PhD studySupervision and supportCentral to the development and completion http://bridgetgleeson.com/on-the-road/ of a good PhD is the supervisory relationship between the student and supervisor. The supervisor guides the student by directing them to resources and training to ensure continuous learning, provides opportunity to engage with experts in the field, and facilitates the development of critical thinking through questioning and providing constructive criticism.1The support needs of students will be different, so a flexible yet quality assured approach to PhD research training is required. A good supervisory team (usually includes at least two postdoctoral academics) provide experienced guidance and mentorship and will offer students academic support, with regular meetings and timely feedback on written submissions, will assist the student to develop a peer network and help them access research communities relative to their field. Effective supervision has beneficial outcomes for students, including encouraging a positive work ethic and influencing engagement in a stimulating environment, allowing students to pursue their own ideas with educated encouragement.

The quality of the supervisory relationship can impact greatly on the PhD experience and ultimately sets the student on the road to producing excellent Doctoral work.1An environment that promotes personal and professional development is further aided by positive peer interactions. If students feel part of a community and have contact with others also working on doctoral studies, there is the scope for peer compassion and understanding during both challenging and rewarding periods. Students who access personal and professional support and guidance through mentoring models during their studies are more likely to succeed. These models include one-to-one peer mentoring or activities for example journal discussion or methods learning groups. Often, groups of students naturally come together and give each other support and advice about research process expectations and challenges, and offer friendship, and guidance.2 Given the usefulness of different types of mentoring models, all can create a supportive and collaborative environment within a PhD programme of study, to minimise working in isolation and enable students to achieve their greatest potential.Characteristics of a good study.

Originality and theoretical underpinningA PhD should make an original contribution to knowledge. Originality can be achieved through the study design, the nature or outcomes of the knowledge synthesis, or the implications for research and/or practice.3 Disciplinary variation, however, influences the assessment of originality. For example, originality in science, technology, engineering and mathematics subjects is often inferred if the work is published/publishable, in comparison to intellectual originality in the social sciences.4 Although PhD originality assumes different nuances in different contexts, there is a general acceptance across disciplines that there should be evidence of the following within the thesis:An interplay between old and new—any claims of originality are developed from existing knowledge and practices.There are degrees of originality, relating to more than one aspect of the thesis.Any claims for originality are accompanied by clear articulation of significance.A good PhD should be also underpinned by theoretical and/or conceptual frameworks (that include philosophical and methodological models) that give clarity to the approach, structure and vision of the study.5 These theoretical and conceptual frameworks can explain why the study is pertinent and how the research addresses gaps in the literature.6 Table 1 provides a distinction of what construes theoretical and conceptual frameworks.View this table:Table 1 Characteristics of theoretical and conceptual frameworks7Theoretical/conceptual frameworks must align with the research question/aims, and the student must be able to articulate how conceptual/theoretical framework were chosen. Key points for consideration include:Are the research questions/aim and objectives well defined?. What theory/theories/concepts are being operationalised?.

How are the theories/concepts related?. Are the ontological and epistemological perspectives clearly conveyed and how do they relate to theories and concepts outlined?. What are the potential benefits and limitations of the theories and concepts outlined?. Are the ways the theories/concepts are outlined and being used original?. A PhD thesis (and demonstrable in viva) must be able to offer cohesion between the choice of research methods that stems from the conceptual/theoretical framework, the related ontological and epistemological decisions, the theoretical perspective and the chosen methodology (table 2).

PhD students must be able to articulate the methodological decisions made and be critical of methods employed to answer their research questions.View this table:Table 2 Relationship between research paradigms, perspectives, methodologies and methods.8 9ConclusionIn summary, we offer considerations of what the foundations of a good PhD should be. We have considered some of the key ingredients of quality PhD supervision, support and research processes and explored how these will contribute to the development of a study that leads to student success and which makes a valuable contribution to the evidence base. In the next paper, we will look in more detail at the assessment of the PhD through the submission of a thesis and an oral viva..

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If you notice any changes in your vision while taking this drug, notify your prescriber or health care professional as soon as possible. Stop using vardenafil right away if you have a loss of sight in one or both eyes. Contact your healthcare provider immediately. Contact your physician immediately if the erection lasts longer than 4 hours or if it becomes painful. This may be a sign of priapism and must be treated immediately to prevent permanent damage. If you experience symptoms of nausea, dizziness, chest pain or arm pain upon initiation of sexual activity after vardenafil use, you should refrain from further activity and should discuss the episode with your prescriber or health care professional as soon as possible. Do not change the dose of your medication. Please call your prescriber or health care professional to determine if your dose needs to be reevaluated. Using vardenafil does not protect you or your partner against HIV (the levitra that causes AIDS) or other sexually transmitted diseases.

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A Gateway to Coverage for Immigrants The report levitra pills online includes a new tool -- Immigrant Eligibility Crosswalk -- Eligibility by Immigration Status-- designed to help advocates and policymakers sort through the tangle of immigrant eligibility categories to determine who is eligible for which health care programs in 2014 and beyond. The report was made possible with support from the United Hospital Fund and benefited from the advice and input from many of our national partners in the effort to ensure maximum participation of immigrants in the nation's healthcare system as well as experts from the New York State Department of Health and the Centers for Medicare and Medicaid Services. SEE more about "PRUCOL" immigrant eligibility for Medicaid in this article. "Undocumented" immigrants are, with some exceptions for pregnant women and Child Health Plus, only eligible for "emergency Medicaid."NYS announced the 2020 Income and levitra pills online Resource levels in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates ) and levels based on the Federal Poverty Level are in GIS 20 MA/02 – 2020 Federal Poverty Levels Here is the 2020 HRA Income and Resources Level Chart Non-MAGI - 2020 Disabled, 65+ or Blind ("DAB" or SSI-Related) and have Medicare MAGI (2020) (<.

65, Does not have Medicare)(OR has Medicare and has dependent child <. 18 or <. 19 in school) 138% FPL*** Children < levitra pills online. 5 and pregnant women have HIGHER LIMITS than shown ESSENTIAL PLAN For MAGI-eligible people over MAGI income limit up to 200% FPL No long term care.

See info here 1 2 1 2 3 1 2 Income $875 (up from $859 in 201) $1284 (up from $1,267 in 2019) $1,468 $1,983 $2,498 $2,127 $2,873 Resources $15,750 (up from $15,450 in 2019) $23,100 (up from $22,800 in 2019) NO LIMIT** NO LIMIT SOURCE for 2019 figures is GIS 18 MA/015 - 2019 Medicaid Levels and Other Updates (PDF). All of the attachments with levitra pills online the various levels are posted here. NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS?. Which household size applies?.

The levitra pills online rules are complicated. See rules here. On the HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels. Box 10 levitra pills online on page 3 are the MAGI income levels -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers.

People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit. Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 8 has the levitra pills online Transfer Penalty rates for nursing home eligibility Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65 (still 2017 levels til April 2018) Box 6 are Medicare Savings Program levels (will be updated in April 2018) MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R.

§ 435.4. Certain populations have an even higher income limit - 224% FPL for levitra pills online pregnant women and babies <. Age 1, 154% FPL for children age 1 - 19. CAUTION.

What is counted levitra pills online as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI). There are good levitra pills online changes and bad changes.

GOOD. Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. BAD. There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) levitra pills online and some other rules.

For all of the rules see. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size are not intuitive or even levitra pills online logical. There are different rules depending on the "category" of the person seeking Medicaid.

Here are the 2 basic categories and the rules for calculating their household size. People who are Disabled, Aged 65+ or Blind - levitra pills online "DAB" or "SSI-Related" Category -- NON-MAGI - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article. Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population.

Their household size will be levitra pills online determined using federal income tax rules, which are very complicated. New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size. See slides 28-49.

Also seeLegal Aid Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may be excluded from the household if that child's income causes other family members to lose Medicaid eligibility. See 18 NYCRR 360-4.2, MRG p.

573, NYS GIS 2000 MA-007 CAUTION. Different people in the same household may be in different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI. The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid.

Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% FPL). Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples. This category had lower income limits than DAB/ADC-related, but had no asset limits.

It did not allow "spend down" of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL. Family Health Plus - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL.

"Undocumented" immigrants are, with some exceptions for pregnant women and Child Health Plus, only eligible for "emergency Medicaid."NYS announced the 2020 Income and Resource levels in GIS 19 MA/12 – 2020 Medicaid Levels and Other Updates ) and levels based on the Federal Poverty Level are in GIS 20 MA/02 – 2020 Federal Poverty Levels Here is the 2020 HRA Income and Resources Level Chart Non-MAGI - 2020 Disabled, 65+ cheap generic levitra online or Blind ("DAB" or SSI-Related) and have Medicare MAGI (2020) (<. 65, Does not have Medicare)(OR has Medicare and has dependent child <. 18 or <. 19 in school) 138% FPL*** Children cheap generic levitra online <.

5 and pregnant women have HIGHER LIMITS than shown ESSENTIAL PLAN For MAGI-eligible people over MAGI income limit up to 200% FPL No long term care. See info here 1 2 1 2 3 1 2 Income $875 (up from $859 in 201) $1284 (up from $1,267 in 2019) $1,468 $1,983 $2,498 $2,127 $2,873 Resources $15,750 (up from $15,450 in 2019) $23,100 (up from $22,800 in 2019) NO LIMIT** NO LIMIT SOURCE for 2019 figures is GIS 18 MA/015 - 2019 Medicaid Levels and Other Updates (PDF). All of cheap generic levitra online the attachments with the various levels are posted here. NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS?.

Which household size applies?. The cheap generic levitra online rules are complicated. See rules here. On the HRA Medicaid Levels chart - Boxes 1 and 2 are NON-MAGI Income and Resource levels -- Age 65+, Blind or Disabled and other adults who need to use "spend-down" because they are over the MAGI income levels.

Box 10 on page 3 are the MAGI income levels cheap generic levitra online -- The Affordable Care Act changed the rules for Medicaid income eligibility for many BUT NOT ALL New Yorkers. People in the "MAGI" category - those NOT on Medicare -- have expanded eligibility up to 138% of the Federal Poverty Line, so may now qualify for Medicaid even if they were not eligible before, or may now be eligible for Medicaid without a "spend-down." They have NO resource limit. Box 3 on page 1 is Spousal Impoverishment levels for Managed Long Term Care &. Nursing Homes and Box 8 has the Transfer Penalty rates for nursing home eligibility Box 4 has Medicaid Buy-In for Working People with Disabilities Under Age 65 (still 2017 levels til April 2018) Box 6 are Medicare Savings Program levels (will be updated in April 2018) MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to cheap generic levitra online adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school.

42 C.F.R. § 435.4. Certain populations have an even higher income limit cheap generic levitra online - 224% FPL for pregnant women and babies <. Age 1, 154% FPL for children age 1 - 19.

CAUTION. What is counted cheap generic levitra online as income may not be what you think. For the NON-MAGI Disabled/Aged 65+/Blind, income will still be determined by the same rules as before, explained in this outline and these charts on income disregards. However, for the MAGI population - which is virtually everyone under age 65 who is not on Medicare - their income will now be determined under new rules, based on federal income tax concepts - called "Modifed Adjusted Gross Income" (MAGI).

There are good changes and bad cheap generic levitra online changes. GOOD. Veteran's benefits, Workers compensation, and gifts from family or others no longer count as income. BAD cheap generic levitra online.

There is no more "spousal" or parental refusal for this population (but there still is for the Disabled/Aged/Blind.) and some other rules. For all of the rules see. ALSO SEE 2018 Manual on Lump Sums and Impact on Public Benefits - with resource rules The income limits increase with the "household size." In other words, the income limit for a family of 5 may be higher than the income limit for a single person. HOWEVER, Medicaid rules about how to calculate the household size cheap generic levitra online are not intuitive or even logical.

There are different rules depending on the "category" of the person seeking Medicaid. Here are the 2 basic categories and the rules for calculating their household size. People who are Disabled, Aged 65+ or Blind - "DAB" or "SSI-Related" Category -- NON-MAGI cheap generic levitra online - See this chart for their household size. These same rules apply to the Medicare Savings Program, with some exceptions explained in this article.

Everyone else -- MAGI - All children and adults under age 65, including people with disabilities who are not yet on Medicare -- this is the new "MAGI" population. Their household size cheap generic levitra online will be determined using federal income tax rules, which are very complicated. New rule is explained in State's directive 13 ADM-03 - Medicaid Eligibility Changes under the Affordable Care Act (ACA) of 2010 (PDF) pp. 8-10 of the PDF, This PowerPoint by NYLAG on MAGI Budgeting attempts to explain the new MAGI budgeting, including how to determine the Household Size.

See slides cheap generic levitra online 28-49. Also seeLegal Aid Society and Empire Justice Center materials OLD RULE used until end of 2013 -- Count the person(s) applying for Medicaid who live together, plus any of their legally responsible relatives who do not receive SNA, ADC, or SSI and reside with an applicant/recipient. Spouses or legally responsible for one another, and parents are legally responsible for their children under age 21 (though if the child is disabled, use the rule in the 1st "DAB" category. Under this rule, a child may cheap generic levitra online be excluded from the household if that child's income causes other family members to lose Medicaid eligibility.

See 18 NYCRR 360-4.2, MRG p. 573, NYS GIS 2000 MA-007 CAUTION. Different people in the same household may be in cheap generic levitra online different "categories" and hence have different household sizes AND Medicaid income and resource limits. If a man is age 67 and has Medicare and his wife is age 62 and not disabled or blind, the husband's household size for Medicaid is determined under Category 1/ Non-MAGI above and his wife's is under Category 2/MAGI.

The following programs were available prior to 2014, but are now discontinued because they are folded into MAGI Medicaid. Prenatal Care Assistance Program (PCAP) was Medicaid for pregnant women and children under age 19, with higher income limits for pregnant woman and infants under one year (200% FPL for pregnant women receiving perinatal coverage only not full Medicaid) than for children ages 1-18 (133% cheap generic levitra online FPL). Medicaid for adults between ages 21-65 who are not disabled and without children under 21 in the household. It was sometimes known as "S/CC" category for Singles and Childless Couples.

This category had lower income limits than DAB/ADC-related, but had no asset limits. It did not allow "spend down" of excess income. This category has now been subsumed under the new MAGI adult group whose limit is now raised to 138% FPL. Family Health Plus - this was an expansion of Medicaid to families with income up to 150% FPL and for childless adults up to 100% FPL.

This has now been folded into the new MAGI adult group whose limit is 138% FPL. For applicants between 138%-150% FPL, they will be eligible for a new program where Medicaid will subsidize their purchase of Qualified Health Plans on the Exchange. PAST INCOME &.

Levitra buy australia

The recent discoveries of more than 1,300 levitra buy australia unmarked graves at the More hints sites of four former residential schools in western Canada have shocked and horrified Canadians. Indigenous peoples, whose families and lives have been haunted by the legacy of Canada’s Indian residential school system, have long expected such revelations. But the news levitra buy australia has still reopened painful wounds. Residential school survivor testimony has long been filled with stories of students digging graves for their classmates, of unmarked burials on school grounds, and of children who disappeared in suspicious circumstances. Many of these stories were heard by the Truth and Reconciliation Commission of Canada (TRC), which was formed in 2008 and collected testimonies from over 6,750 survivors.

The TRC’s 2015 Final Report made it quite clear levitra buy australia that further recoveries of unmarked graves at the schools were inevitable. The goal of Canada’s Indian residential school system, after all, shared that of its U.S. Indian boarding school counterpart levitra buy australia. €œKill the Indian, and save the man.” More than 150,000 children were taken from their homes between 1883 and 1997, often forcibly, and placed in distant boarding schools where the focus was on manual labour, religious instruction and cultural assimilation. The TRC Final Report concluded that the Indian Residential School system was an attempted “cultural genocide,” but the escalating number of recovered unmarked graves points to something even darker.

Given that more than 1,300 graves have been identified using ground-penetrating radar at only four of the 139 federally run residential schools, the current official number of 4,120 students known to have levitra buy australia died in the schools will end up being only a fraction of the actual total. Apologists for the residential school system have argued in recent weeks that the children buried at these schools largely died of diseases like tuberculosis (TB) and that the schools did the best they could to provide education and medical care to First Nations, Inuit and Métis children during a time when their communities were being devastated by similar diseases. But even a cursory reading of the historical literature on residential schools shows just how wrong this line of thinking is. The reality levitra buy australia is that the conditions in the schools themselves were the leading contributor to the often-shocking death rates among the students. In 1907, Indian Affairs chief medical officer Peter Bryce reported some truly disturbing findings to his superiors.

After having visited 35 government funded schools in western Canada, Bryce reported that 25 percent of all children who had attended levitra buy australia these schools had died. At one school, the number was 69 percent. While Bryce reported that “the almost invariable cause of death given is tuberculosis,” he by no means saw this as natural or inevitable. Bryce, instead, placed the blame for these appalling death rates on the schools themselves, which were poorly constructed, lacked proper ventilation and frequently housed sick students in the dormitories alongside their levitra buy australia healthy classmates. Bryce wasn’t alone in sounding the warnings about the schools.

Throughout the system’s 100-plus-year history, school inspectors, school principals, medical officials and Indian agents repeatedly issued warnings about the unhealthy conditions in the schools. This archival record details the schools’ inadequate medical facilities, nonexistent levitra buy australia isolation rooms and lack of school nurses. It also documents perennially overcrowded and dilapidated buildings with poor ventilation and insufficient heating as well as the woefully inadequate nutrition provided to students. The issue of food and nutrition, in particular, speaks to the ways in which the poor conditions in the schools undermined student health levitra buy australia. As residential school historian J.R.

Miller has written, “‘We were always hungry’ could serve as the slogan for any organization of former residential school students.” The TRC collected haunting testimony from survivors, including Andrew Paul, who described his time at the Aklavik Roman Catholic Residential School in the Northwest Territories. €œWe cried to have something good to eat before levitra buy australia we sleep. A lot of the times the food we had was rancid, full of maggots, stink.” Malnutrition, of course, compromised children’s immune systems, making them more vulnerable to TB and other infectious diseases. In the case of TB, studies have consistently shown that malnutrition of the type commonly described by Paul and other survivors leads to significantly higher mortality among infected individuals levitra buy australia. And, as our own research has shown, it would also have led to a much higher lifetime risk of a whole range of chronic conditions including obesity, type 2 diabetes and hypertension.

Government and church authorities were well aware of the extent of hunger and malnutrition in the schools, both before and after Bryce’s damning report. In the 1940s, for instance, a series of levitra buy australia school inspections by the federal Nutrition Division found almost universally poor food service in the schools and widespread malnutrition. After attempts to improve the training for school cooks ended in failure, the head of the Nutrition Division, L.B. Pett, chose to use the poor health of the children as an opportunity to study the effectiveness of a variety of experimental nutrition interventions (and noninterventions, as it turned out) into the diets of malnourished children. The result was a series of nutrition experiments conducted levitra buy australia on nearly 1,000 children in six residential schools between 1948 and 1952.

These included a double-blind, randomized experiment examining of the effects of nutrition supplements on children showing clinical signs of vitamin C deficiency, with half of the students receiving placebos and the other half receiving vitamin tablets. An examination of the impact of an experimental fortified flour mixture that included levitra buy australia ground bonemeal, among other things, at St. Mary’s School in Kenora, Ontario. And an examination of the effects of both inadequate and adequate milk consumption on a population of children with clinical signs of riboflavin deficiency at the Alberni School in British Columbia. None of levitra buy australia these experiments did anything to address the underlying causes of malnutrition at the schools, which was simply that the food being provided to the students was insufficient in both quantity and quality.

By Pett’s own calculations, after all, the per capita federal grant provided for food in most schools was often half that required to maintain a balanced diet. And the same was true for nearly every aspect of the residential school system, which, from its inception to the closure of the last school in 1997, was structurally underfunded. In comparison with levitra buy australia provincially funded public and boarding schools, residential schools received sparse funding. In Manitoba, Indian Affairs paid $180 per year for students in residential school in 1938, while boarding schools like the Manitoba School for the Deaf and the Manitoba Home for Boys received $642 and $550 per annum, respectively, from the provincial government. American Indian boarding schools, by comparison, were funded at a per capita rate levitra buy australia of $350.

A similar picture emerges when we look at the kind of health care provided to residential school students who were diagnosed with TB—a disease with effects that were made worse by the conditions within residential schools. By the 1940s, students with TB were sent from residential schools to racially segregated Indian Hospitals or TB sanatoria—typically without their parents’ knowledge or consent—where they often remained for years at a time. Indian hospitals and sanatoriums, like residential schools, were funded at a much lower rate—often just 50 percent of the per capita cost for non-Indigenous patients in provincial and municipal hospitals and sanatoria—meaning that the levitra buy australia health care provided to Indigenous child patients with TB was substandard. Indigenous patients, some as young as newborns, were also more likely to receive permanently debilitating surgeries and were kept in hospital for much longer than non-Indigenous patients. This was partly a result of the belief that Indigenous patients could not be “trusted” to follow a drug regime at home, and partly because the hospitals were an arm of the federal government’s program of assimilation for Indigenous peoples.

The longer patients, and particularly levitra buy australia child patients, remained in the Indian hospital, the more likely they were to lose their Indigenous languages and connections to their home communities. Similar to common practice in residential schools, hospital and sanatoria administrators were lax in informing families about the conditions of a child’s death, where they were buried or, disturbingly, that the child patient had passed away at all. Many families still have no idea what happened to loved ones who left for levitra buy australia these institutions and never returned. It’s clear, then, that the claim of residential school apologists that these children “only” died of TB is, ultimately, an attempt to whitewash what many residential school survivors and a growing number of scholars—ourselves included—have characterized as genocide, full stop. Many children did die of TB as well as epidemics of measles, influenza and other infectious diseases.

But it is clear that these chronically and intentionally underfunded institutions actually caused the high death rates levitra buy australia among students. What is also indisputable, based on the government’s own records, is that generations of federal government officials and politicians knew that the subpar conditions in the schools were killing children and chose to do nothing. This is levitra buy australia an opinion and analysis article. The views expressed by the author or authors are not necessarily those of Scientific American.1971 How Locusts Control Yaw “Like an airplane, an insect can roll around its longitudinal axis, pitch around a horizontal axis or yaw around a vertical axis. It appears that locusts have two different yaw-correcting strategies.

(1) a rapid change in wing twist, abdomen position and leg position controlled by levitra buy australia wind-sensitive hairs on the head, and (2) a slower, subtler movement of the same general character evoked by cervical receptors. It seems that the change in wind angle, indicating a yaw, is integrated somewhere in the locust’s central nervous system, and is followed by independent motor commands to the wings, legs, abdomen and head.” 1921 Tasty Radio “Two engineers recently conducted experiments to determine the feasibility of reception of radio signals by the sense of taste. Electrodes were placed under the tongue to cause a taste sensation when a source of [electrical] potential was connected to them. Tests were made, using low-potential direct current and 60-cycle alternating current, to ascertain the amount of energy and potential necessary for taste levitra buy australia reception. The reception of actual signals from an antenna was tried.

It was found impossible, [even with] four levitra buy australia stages of amplification. The results indicate that while from an electrical standpoint it is possible to receive radio signals by the sense of taste, it is much inferior to that of hearing, or even of sight.” Orange Tree Never Quits “An ever-bearing orange tree which citrus fruit growers believe is destined to revolutionize the orange industry has been discovered by horticulturists in a small grove at Avon Park, Florida. To protect the specimen, its purchasers have placed around it a heavy wire fence 20 feet in height and stationed guards day and night. The tree has been in bearing continuously eight years, but until recently its existence was known only to the owner and several neighbors, who, according to citrus levitra buy australia experts, did not realize its value but regarded it merely as a freak of nature. A syndicate has been formed to propagate the tree so that a large number of trees may be set out in groves in 1923.” 1871 Early Fake Leather “Enameled cloth enters into many uses as a substitute for leather.

Its most important use is that of covering for carriage tops, for traveling bags and trunks, and not rarely is it worked up into rainproof coats and pants. The foundation is cotton cloth, which is slowly passed through a levitra buy australia machine’s iron cylinders. It first receives a coating of a black, disagreeable-looking substance composed of oil, lampblack, resin and other ingredients, boiled together till about the consistency of melted tar. Then the cloth is wound upon a huge wooden frame that levitra buy australia is passed into a heater to dry. It then is laid on long tables, and workers sprinkle with water and rub with pumice stone, till the whole surface is made perfectly smooth.

The fabric is thoroughly varnished, and again passed through the heater. It is now a piece of cloth with a thick, shining coat of black, very much resembling patent leather.” Wonders of Chloroform “Chloroform is the levitra buy australia best known solvent for camphor, resins and sealing wax. It also dissolves the vegetable alkaloids. As a solvent it will remove greasy spots from fabrics of all kinds, levitra buy australia but its chief use is as an anesthetic. There are several other volatile organic bodies which possess similar properties, but none produce the total unconsciousness and muscular relaxation that follow the inhalation of chloroform.”Bobby Monacella was tired of sending her two kids to school on buses filled with diesel fumes.

Pollution levels inside those iconic yellow buses can be up to 10 times higher than outside. €œThey're sitting on the bus levitra buy australia for over an hour a day, and when you learn that the emissions are concentrated inside the bus, it’s scary,” said Monacella, who volunteers with the climate advocacy group Mothers out Front. So she teamed up with other moms in Fairfax County, Va., to do something about it. The school district, which is the second largest in the country, agreed to replace its 1,650 diesel buses with electric ones by 2035. But other families face longer levitra buy australia waits.

The infrastructure package proposed by the Senate and the White House on Wednesday offers significantly less funding for electric school buses than what President Biden was seeking. And without a federal infusion of cash and incentives, advocates fear zero-emissions school buses—which can cost three times more than those with internal-combustion engines—could be distributed unevenly, potentially leaving behind low-income families and students levitra buy australia of color who already bear the brunt of environmental pollution. "Those schools that can afford to make the transition and cover the costs of not just the school bus, but the charging infrastructure that's needed, are in the predominantly wealthier communities," said Trisha DelloIacono, the legislative manager for Moms Clean Air Force. "So federal investment is so needed." Electric school buses would receive $2.5 billion in funding under the package, enough for approximately 11,000 zero-emissions buses. Another $2.5 billion would go toward what lawmakers and the White House are levitra buy australia calling low-emissions buses.

The lump sum is substantially less than the $174 billion Biden initially proposed last March to boost the overall EV market, including cars, trucks and buses. That plan aimed to electrify 96,000 school buses, or about 20% of the U.S. Fleet. €œWe need the full funding,” said Sybil Azur, a mom and community organizer who has been working to expand the use of electric school buses in Los Angeles. €œWhat’s at stake is my children’s future, my children’s health and their ability to live productive, healthy lives.” She and other advocates are concerned that the allocation for “low-emissions” school buses in the infrastructure package could prioritize other fuel types over electric technology.

"Essentially, this is a tiny drop in the bucket of what is needed to protect our children from harmful diesel pollution," said DelloIacono. "To make matters worse, it won't help our kids at all if it's used for polluting fossil fuel buses under the guise of improving our nation's infrastructure." There are 480,000 school buses across the country, 95% of which run on high-polluting diesel fuel. And more than half the nation’s public school students, about 25 million children, ride the bus to school and back each day. Research conducted by Environment &. Human Health Inc.

Has shown that pollution levels on those school buses often exceed surrounding areas by five to 10 times, endangering students' health and contributing to greenhouse gas emissions. The transportation sector is the single largest source of carbon pollution in the country. While scientists have long known that diesel pollution can cause a host of health problems, among them asthma and bronchitis, developmental disabilities, and cancer, recent research suggests the health impacts could be worse than previously thought. A meta-analysis of hundreds of studies, published in 2018 in the American Journal of Public Health, found strong links between pollution exposure and cardiorespiratory diseases. Another study, issued by the National Bureau of Economic Research in 2018, found that air pollution significantly exacerbates dementia.

Even a slight increase in air pollution from a single car can send more kids to the hospital and lead to premature births, according to a 2019 working paper from the Federal Reserve Bank of Chicago. Environmental pollution is worse for children, whose brains are still developing, than for adults. And Black children are hospitalized from asthma twice as often as white children and are four times as likely to die from the disease. Latino children are also at higher risk. That’s why Cinthia Moore, a mother and advocate living in a predominately Latino neighborhood in East Las Vegas, won’t let her son, Liam, ride the school bus.

€œHe has breathing issues,” she explained. €œWhenever we have a bad air quality day, like today, if he spends any time outside, he comes back already with a runny nose and sneezing, and he also has rashes around his body because of the extreme heat.” Monacella of Mothers out Front said the details around funding, and where charging infrastructure is placed, can determine whether electric school buses are distributed equitably. She pointed to a Virginia pilot program in which Dominion Energy has deployed 50 electric school buses as part of broader vehicle-to-grid plan. Monacella said she worries that the utility may not prioritize low-income school districts. €œDominion will help pay for some buses.

Maybe our state grant fund will help pay for some buses. And, you know, the more, the better,” she said. €œBut the way the Dominion program was set up, they wanted to own the batteries and the charging infrastructure, and they wanted to say where it could be sited. So it didn't matter where the highest asthma rates were. It didn't matter the lowest air quality.

It just mattered what worked for them.” A Dominion spokesperson said the utility has deployed its 50 electric school buses in geographically and economically diverse districts and intends to weigh equity concerns when expanding its vehicle-to-grid program. €œEvery student in the commonwealth deserves access to a safe, emissions-free school transportation, and our goal is to help school districts make that transition,” spokesperson Samantha Moore wrote in an email. As health impacts related to climate-fueled events like extreme heat or wildfires become more common among children, parents are increasingly calling on their elected officials to take action. €œIf your child is struggling to breathe because of wildfire smoke due to climate change, to have the opportunity to put a child on an electric school bus and not be exposed to that additional pollution is critical for these families,” said DelloIacono of Moms Clean Air Force. €œAnd so they have really been at the forefront of advocating for this transition to electric school buses.” Curbing emissions from school buses would eliminate as much as 5.3 million tons of greenhouse gas emissions each year.

And while electric buses are currently more expensive to purchase than their diesel counterparts, schools could save hundreds of thousands of dollars on fuel and maintenance costs, according to a recent report led by the U.S. PIRG Education Fund. €œSo a new infusion of federal funds is so important because it can really help with financing the upfront costs,” said John Stout, a transportation advocate with U.S. PIRG. Despite funding hurdles, momentum for electric school buses is growing as the infrastructure debate intensifies on Capitol Hill.

Last year, a school district in Sacramento, Calif., became the owner of the largest electric school bus fleet in the country, with 40 zero-emissions buses. A county in Tennessee secured the state's first all-electric school bus last month. In Maryland, Montgomery County Public Schools announced a contract earlier this year to replace all of its diesel buses with electric ones, starting with 326 buses over four years. The list goes on. A recent poll from the American Lung Association found that 68 percent of American voters, across all major demographic groups, support Congress' investing in zero-emission school buses nationwide.

This month, over 100 local school board officials across the country signed a letter to Biden and Congress calling for a $30 billion federal investment over 10 years to replace half the nation’s school bus fleet with electric buses. Several lawmakers have introduced similar legislation. A recent measure from Reps. Tony Cárdenas (D-Calif.) and Jahana Hayes (D-Conn.) and from Sens. Alex Padilla (D-Calif.) and Raphael Warnock (D-Ga.) would authorize $25 billion to transition the nation’s school bus fleet over 10 years, giving priority to low-income and front-line communities.

Sen. Patty Murray (D-Wash.) also floated a bill earlier this year, which was originally introduced by former Sen. Kamala Harris in 2019, that would enable school districts to replace diesel buses with electric ones. While many uncertainties remain—like how best to install charging infrastructure—Monacella said electrifying the nation’s school bus fleet is a crucial step not only to protect children’s health, but also to reduce carbon emissions. There are four times more school buses on the road than public transit buses.

€œClimate change is happening all around us. It’s beyond crisis time,” she said. Electrifying school buses “is just one piece of the puzzle, but I think it can have a big impact, and it’s something I can do to try to make a difference.” Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals..

The recent discoveries of more browse around this site than 1,300 unmarked graves at the sites of four former residential schools in cheap generic levitra online western Canada have shocked and horrified Canadians. Indigenous peoples, whose families and lives have been haunted by the legacy of Canada’s Indian residential school system, have long expected such revelations. But the news has cheap generic levitra online still reopened painful wounds.

Residential school survivor testimony has long been filled with stories of students digging graves for their classmates, of unmarked burials on school grounds, and of children who disappeared in suspicious circumstances. Many of these stories were heard by the Truth and Reconciliation Commission of Canada (TRC), which was formed in 2008 and collected testimonies from over 6,750 survivors. The TRC’s 2015 Final Report made it quite clear that further recoveries of unmarked graves at the cheap generic levitra online schools were inevitable.

The goal of Canada’s Indian residential school system, after all, shared that of its U.S. Indian boarding school counterpart cheap generic levitra online. €œKill the Indian, and save the man.” More than 150,000 children were taken from their homes between 1883 and 1997, often forcibly, and placed in distant boarding schools where the focus was on manual labour, religious instruction and cultural assimilation.

The TRC Final Report concluded that the Indian Residential School system was an attempted “cultural genocide,” but the escalating number of recovered unmarked graves points to something even darker. Given that more than 1,300 graves have been identified using ground-penetrating radar at only four of the 139 federally cheap generic levitra online run residential schools, the current official number of 4,120 students known to have died in the schools will end up being only a fraction of the actual total. Apologists for the residential school system have argued in recent weeks that the children buried at these schools largely died of diseases like tuberculosis (TB) and that the schools did the best they could to provide education and medical care to First Nations, Inuit and Métis children during a time when their communities were being devastated by similar diseases.

But even a cursory reading of the historical literature on residential schools shows just how wrong this line of thinking is. The reality is that the conditions in the schools cheap generic levitra online themselves were the leading contributor to the often-shocking death rates among the students. In 1907, Indian Affairs chief medical officer Peter Bryce reported some truly disturbing findings to his superiors.

After having visited 35 government funded schools in western Canada, Bryce reported that 25 percent of all children cheap generic levitra online who had attended these schools had died. At one school, the number was 69 percent. While Bryce reported that “the almost invariable cause of death given is tuberculosis,” he by no means saw this as natural or inevitable.

Bryce, instead, placed the blame for these appalling death rates on the cheap generic levitra online schools themselves, which were poorly constructed, lacked proper ventilation and frequently housed sick students in the dormitories alongside their healthy classmates. Bryce wasn’t alone in sounding the warnings about the schools. Throughout the system’s 100-plus-year history, school inspectors, school principals, medical officials and Indian agents repeatedly issued warnings about the unhealthy conditions in the schools.

This archival record details the schools’ inadequate medical facilities, nonexistent isolation rooms and cheap generic levitra online lack of school nurses. It also documents perennially overcrowded and dilapidated buildings with poor ventilation and insufficient heating as well as the woefully inadequate nutrition provided to students. The issue of food and nutrition, in particular, speaks to the cheap generic levitra online ways in which the poor conditions in the schools undermined student health.

As residential school historian J.R. Miller has written, “‘We were always hungry’ could serve as the slogan for any organization of former residential school students.” The TRC collected haunting testimony from survivors, including Andrew Paul, who described his time at the Aklavik Roman Catholic Residential School in the Northwest Territories. €œWe cried to have something good to eat cheap generic levitra online before we sleep.

A lot of the times the food we had was rancid, full of maggots, stink.” Malnutrition, of course, compromised children’s immune systems, making them more vulnerable to TB and other infectious diseases. In the case of TB, studies have consistently shown that malnutrition of the type commonly described by Paul and other survivors cheap generic levitra online leads to significantly higher mortality among infected individuals. And, as our own research has shown, it would also have led to a much higher lifetime risk of a whole range of chronic conditions including obesity, type 2 diabetes and hypertension.

Government and church authorities were well aware of the extent of hunger and malnutrition in the schools, both before and after Bryce’s damning report. In the 1940s, for instance, a series of school inspections by the federal Nutrition Division found almost universally poor food service in cheap generic levitra online the schools and widespread malnutrition. After attempts to improve the training for school cooks ended in failure, the head of the Nutrition Division, L.B.

Pett, chose to use the poor health of the children as an opportunity to study the effectiveness of a variety of experimental nutrition interventions (and noninterventions, as it turned out) into the diets of malnourished children. The result was cheap generic levitra online a series of nutrition experiments conducted on nearly 1,000 children in six residential schools between 1948 and 1952. These included a double-blind, randomized experiment examining of the effects of nutrition supplements on children showing clinical signs of vitamin C deficiency, with half of the students receiving placebos and the other half receiving vitamin tablets.

An examination of the impact of an experimental fortified flour mixture cheap generic levitra online that included ground bonemeal, among other things, at St. Mary’s School in Kenora, Ontario. And an examination of the effects of both inadequate and adequate milk consumption on a population of children with clinical signs of riboflavin deficiency at the Alberni School in British Columbia.

None of these experiments did anything to address the underlying causes of malnutrition at the schools, which was simply that the food cheap generic levitra online being provided to the students was insufficient in both quantity and quality. By Pett’s own calculations, after all, the per capita federal grant provided for food in most schools was often half that required to maintain a balanced diet. And the same was true for nearly every aspect of the residential school system, which, from its inception to the closure of the last school in 1997, was structurally underfunded.

In comparison with provincially funded public cheap generic levitra online and boarding schools, residential schools received sparse funding. In Manitoba, Indian Affairs paid $180 per year for students in residential school in 1938, while boarding schools like the Manitoba School for the Deaf and the Manitoba Home for Boys received $642 and $550 per annum, respectively, from the provincial government. American Indian boarding cheap generic levitra online schools, by comparison, were funded at a per capita rate of $350.

A similar picture emerges when we look at the kind of health care provided to residential school students who were diagnosed with TB—a disease with effects that were made worse by the conditions within residential schools. By the 1940s, students with TB were sent from residential schools to racially segregated Indian Hospitals or TB sanatoria—typically without their parents’ knowledge or consent—where they often remained for years at a time. Indian hospitals and sanatoriums, like residential schools, were funded at a much lower rate—often just 50 percent of the per capita cost for cheap generic levitra online non-Indigenous patients in provincial and municipal hospitals and sanatoria—meaning that the health care provided to Indigenous child patients with TB was substandard.

Indigenous patients, some as young as newborns, were also more likely to receive permanently debilitating surgeries and were kept in hospital for much longer than non-Indigenous patients. This was partly a result of the belief that Indigenous patients could not be “trusted” to follow a drug regime at home, and partly because the hospitals were an arm of the federal government’s program of assimilation for Indigenous peoples. The longer patients, and particularly child patients, remained in the Indian hospital, the more likely cheap generic levitra online they were to lose their Indigenous languages and connections to their home communities.

Similar to common practice in residential schools, hospital and sanatoria administrators were lax in informing families about the conditions of a child’s death, where they were buried or, disturbingly, that the child patient had passed away at all. Many families still have no idea what happened to loved ones who left for cheap generic levitra online these institutions and never returned. It’s clear, then, that the claim of residential school apologists that these children “only” died of TB is, ultimately, an attempt to whitewash what many residential school survivors and a growing number of scholars—ourselves included—have characterized as genocide, full stop.

Many children did die of TB as well as epidemics of measles, influenza and other infectious diseases. But it is clear cheap generic levitra online that these chronically and intentionally underfunded institutions actually caused the high death rates among students. What is also indisputable, based on the government’s own records, is that generations of federal government officials and politicians knew that the subpar conditions in the schools were killing children and chose to do nothing.

This is an cheap generic levitra online opinion and analysis article. The views expressed by the author or authors are not necessarily those of Scientific American.1971 How Locusts Control Yaw “Like an airplane, an insect can roll around its longitudinal axis, pitch around a horizontal axis or yaw around a vertical axis. It appears that locusts have two different yaw-correcting strategies.

(1) a rapid change in wing twist, abdomen position and leg position controlled by cheap generic levitra online wind-sensitive hairs on the head, and (2) a slower, subtler movement of the same general character evoked by cervical receptors. It seems that the change in wind angle, indicating a yaw, is integrated somewhere in the locust’s central nervous system, and is followed by independent motor commands to the wings, legs, abdomen and head.” 1921 Tasty Radio “Two engineers recently conducted experiments to determine the feasibility of reception of radio signals by the sense of taste. Electrodes were placed under the tongue to cause a taste sensation when a source of [electrical] potential was connected to them.

Tests were made, using low-potential direct current and 60-cycle alternating current, to ascertain cheap generic levitra online the amount of energy and potential necessary for taste reception. The reception of actual signals from an antenna was tried. It was found impossible, [even with] cheap generic levitra online four stages of amplification.

The results indicate that while from an electrical standpoint it is possible to receive radio signals by the sense of taste, it is much inferior to that of hearing, or even of sight.” Orange Tree Never Quits “An ever-bearing orange tree which citrus fruit growers believe is destined to revolutionize the orange industry has been discovered by horticulturists in a small grove at Avon Park, Florida. To protect the specimen, its purchasers have placed around it a heavy wire fence 20 feet in height and stationed guards day and night. The tree has been cheap generic levitra online in bearing continuously eight years, but until recently its existence was known only to the owner and several neighbors, who, according to citrus experts, did not realize its value but regarded it merely as a freak of nature.

A syndicate has been formed to propagate the tree so that a large number of trees may be set out in groves in 1923.” 1871 Early Fake Leather “Enameled cloth enters into many uses as a substitute for leather. Its most important use is that of covering for carriage tops, for traveling bags and trunks, and not rarely is it worked up into rainproof coats and pants. The foundation is cotton cloth, cheap generic levitra online which is slowly passed through a machine’s iron cylinders.

It first receives a coating of a black, disagreeable-looking substance composed of oil, lampblack, resin and other ingredients, boiled together till about the consistency of melted tar. Then the cheap generic levitra online cloth is wound upon a huge wooden frame that is passed into a heater to dry. It then is laid on long tables, and workers sprinkle with water and rub with pumice stone, till the whole surface is made perfectly smooth.

The fabric is thoroughly varnished, and again passed through the heater. It is now a piece of cloth with a thick, shining coat of black, very much resembling patent leather.” Wonders of Chloroform “Chloroform is the best known solvent for camphor, resins cheap generic levitra online and sealing wax. It also dissolves the vegetable alkaloids.

As a solvent it will remove greasy spots from fabrics of all kinds, but its chief use is as an anesthetic cheap generic levitra online. There are several other volatile organic bodies which possess similar properties, but none produce the total unconsciousness and muscular relaxation that follow the inhalation of chloroform.”Bobby Monacella was tired of sending her two kids to school on buses filled with diesel fumes. Pollution levels inside those iconic yellow buses can be up to 10 times higher than outside.

€œThey're sitting on the bus for over an hour a day, and when you learn that the emissions are concentrated inside the bus, it’s scary,” said Monacella, cheap generic levitra online who volunteers with the climate advocacy group Mothers out Front. So she teamed up with other moms in Fairfax County, Va., to do something about it. The school district, which is the second largest in the country, agreed to replace its 1,650 diesel buses with electric ones by 2035.

But other families face cheap generic levitra online longer waits. The infrastructure package proposed by the Senate and the White House on Wednesday offers significantly less funding for electric school buses than what President Biden was seeking. And without a federal infusion of cash and cheap generic levitra online incentives, advocates fear zero-emissions school buses—which can cost three times more than those with internal-combustion engines—could be distributed unevenly, potentially leaving behind low-income families and students of color who already bear the brunt of environmental pollution.

"Those schools that can afford to make the transition and cover the costs of not just the school bus, but the charging infrastructure that's needed, are in the predominantly wealthier communities," said Trisha DelloIacono, the legislative manager for Moms Clean Air Force. "So federal investment is so needed." Electric school buses would receive $2.5 billion in funding under the package, enough for approximately 11,000 zero-emissions buses. Another $2.5 billion would go toward what lawmakers cheap generic levitra online and the White House are calling low-emissions buses.

The lump sum is substantially less than the $174 billion Biden initially proposed last March to boost the overall EV market, including cars, trucks and buses. That plan aimed to electrify 96,000 school buses, or about 20% of the U.S. Fleet.

€œWe need the full funding,” said Sybil Azur, a mom and community organizer who has been working to expand the use of electric school buses in Los Angeles. €œWhat’s at stake is my children’s future, my children’s health and their ability to live productive, healthy lives.” She and other advocates are concerned that the allocation for “low-emissions” school buses in the infrastructure package could prioritize other fuel types over electric technology. "Essentially, this is a tiny drop in the bucket of what is needed to protect our children from harmful diesel pollution," said DelloIacono.

"To make matters worse, it won't help our kids at all if it's used for polluting fossil fuel buses under the guise of improving our nation's infrastructure." There are 480,000 school buses across the country, 95% of which run on high-polluting diesel fuel. And more than half the nation’s public school students, about 25 million children, ride the bus to school and back each day. Research conducted by Environment &.

Human Health Inc. Has shown that pollution levels on those school buses often exceed surrounding areas by five to 10 times, endangering students' health and contributing to greenhouse gas emissions. The transportation sector is the single largest source of carbon pollution in the country.

While scientists have long known that diesel pollution can cause a host of health problems, among them asthma and bronchitis, developmental disabilities, and cancer, recent research suggests the health impacts could be worse than previously thought. A meta-analysis of hundreds of studies, published in 2018 in the American Journal of Public Health, found strong links between pollution exposure and cardiorespiratory diseases. Another study, issued by the National Bureau of Economic Research in 2018, found that air pollution significantly exacerbates dementia.

Even a slight increase in air pollution from a single car can send more kids to the hospital and lead to premature births, according to a 2019 working paper from the Federal Reserve Bank of Chicago. Environmental pollution is worse for children, whose brains are still developing, than for adults. And Black children are hospitalized from asthma twice as often as white children and are four times as likely to die from the disease.

Latino children are also at higher risk. That’s why Cinthia Moore, a mother and advocate living in a predominately Latino neighborhood in East Las Vegas, won’t let her son, Liam, ride the school bus. €œHe has breathing issues,” she explained.

€œWhenever we have a bad air quality day, like today, if he spends any time outside, he comes back already with a runny nose and sneezing, and he also has rashes around his body because of the extreme heat.” Monacella of Mothers out Front said the details around funding, and where charging infrastructure is placed, can determine whether electric school buses are distributed equitably. She pointed to a Virginia pilot program in which Dominion Energy has deployed 50 electric school buses as part of broader vehicle-to-grid plan. Monacella said she worries that the utility may not prioritize low-income school districts.

€œDominion will help pay for some buses. Maybe our state grant fund will help pay for some buses. And, you know, the more, the better,” she said.

€œBut the way the Dominion program was set up, they wanted to own the batteries and the charging infrastructure, and they wanted to say where it could be sited. So it didn't matter where the highest asthma rates were. It didn't matter the lowest air quality.

It just mattered what worked for them.” A Dominion spokesperson said the utility has deployed its 50 electric school buses in geographically and economically diverse districts and intends to weigh equity concerns when expanding its vehicle-to-grid program. €œEvery student in the commonwealth deserves access to a safe, emissions-free school transportation, and our goal is to help school districts make that transition,” spokesperson Samantha Moore wrote in an email. As health impacts related to climate-fueled events like extreme heat or wildfires become more common among children, parents are increasingly calling on their elected officials to take action.

€œIf your child is struggling to breathe because of wildfire smoke due to climate change, to have the opportunity to put a child on an electric school bus and not be exposed to that additional pollution is critical for these families,” said DelloIacono of Moms Clean Air Force. €œAnd so they have really been at the forefront of advocating for this transition to electric school buses.” Curbing emissions from school buses would eliminate as much as 5.3 million tons of greenhouse gas emissions each year. And while electric buses are currently more expensive to purchase than their diesel counterparts, schools could save hundreds of thousands of dollars on fuel and maintenance costs, according to a recent report led by the U.S.

PIRG Education Fund. €œSo a new infusion of federal funds is so important because it can really help with financing the upfront costs,” said John Stout, a transportation advocate with U.S. PIRG.

Despite funding hurdles, momentum for electric school buses is growing as the infrastructure debate intensifies on Capitol Hill. Last year, a school district in Sacramento, Calif., became the owner of the largest electric school bus fleet in the country, with 40 zero-emissions buses. A county in Tennessee secured the state's first all-electric school bus last month.

In Maryland, Montgomery County Public Schools announced a contract earlier this year to replace all of its diesel buses with electric ones, starting with 326 buses over four years. The list goes on. A recent poll from the American Lung Association found that 68 percent of American voters, across all major demographic groups, support Congress' investing in zero-emission school buses nationwide.

This month, over 100 local school board officials across the country signed a letter to Biden and Congress calling for a $30 billion federal investment over 10 years to replace half the nation’s school bus fleet with electric buses. Several lawmakers have introduced similar legislation. A recent measure from Reps.

Tony Cárdenas (D-Calif.) and Jahana Hayes (D-Conn.) and from Sens. Alex Padilla (D-Calif.) and Raphael Warnock (D-Ga.) would authorize $25 billion to transition the nation’s school bus fleet over 10 years, giving priority to low-income and front-line communities. Sen.

Patty Murray (D-Wash.) also floated a bill earlier this year, which was originally introduced by former Sen. Kamala Harris in 2019, that would enable school districts to replace diesel buses with electric ones. While many uncertainties remain—like how best to install charging infrastructure—Monacella said electrifying the nation’s school bus fleet is a crucial step not only to protect children’s health, but also to reduce carbon emissions.

There are four times more school buses on the road than public transit buses. €œClimate change is happening all around us. It’s beyond crisis time,” she said.

Electrifying school buses “is just one piece of the puzzle, but I think it can have a big impact, and it’s something I can do to try to make a difference.” Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals..

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Shutterstock https://www.maralegal.com/buy-seroquel/ An event in cheap generic levitra online Smyrna, Del., provided opioid rescue kits to residents and free training Wednesday. The event was aimed at those who are at risk of experiencing an overdose or for the loved ones of those at risk.Each rescue kit contained two doses of Naloxone, an opioid overdose reversal drug.The training lasted approximately 10 cheap generic levitra online minutes. Attendees were taught how to recognize and respond to an opioid overdose emergency. They also were informed about local treatment and support resources.“Amidst the cheap generic levitra online erectile dysfunction treatment levitra, we can’t forget about the opioid epidemic. Addiction has its grip on our community, and with this event and others, we can make sure that Naloxone gets to individuals and families who may need it during an opioid overdose emergency,” Trinidad Navarro, the insurance commissioner, said.

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