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Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) Committee on Child and kamagra online next day delivery Adolescent HealthExecutive Board Member, Texas Pediatric SocietyDoctors are community leaders. This role has become even more important during the erectile dysfunction treatment kamagra. As patients navigate our new reality, they are looking to us to determine what kamagra online next day delivery is safe, how to protect their families, and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net. The U.S.

Census helps determine funding for those resources, and that is why it is kamagra online next day delivery of the upmost importance that each and every Texan, no matter address, immigration status, or age, respond to the 2020 U.S. Census. The deadline has been cut short one month and kamagra online next day delivery now closes Sept. 30.erectile dysfunction treatment has only increased the importance of completing the census to help our local communities and economies recover. The novel erectile dysfunction has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more.

Schools also have been stretched kamagra online next day delivery thin, with teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago. Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the kamagra’s fallout. Therefore, it is vital that all Texans be counted.The federal dollars Texas receives kamagra online next day delivery generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example.

Federal funds pay for 60% of the state’s program, kamagra online next day delivery which provides health coverage for two out of five Texas children, one in three individuals with disabilities, and 53% of all births. The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data kamagra online next day delivery also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond kamagra online next day delivery to maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the kamagra continues. The Central Texas Food Bank saw kamagra online next day delivery a 206% rise in clients in March. Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census.

Funding for local housing programs also is calculated via the census. An accurate count will help ensure that people who lose their homes during this kamagra online next day delivery economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by erectile dysfunction, more parents are taking on roles as breadwinner, parent, teacher, and caretaker. This stress highlights the desperate need for affordable childcare kamagra online next day delivery. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families.

The good news is you still have time to complete the census. Visit 2020census.gov kamagra online next day delivery to take it. It takes less than five minutes to complete. Then talk to your family, neighbors, and colleagues about doing the same kamagra online next day delivery. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the kamagra.

Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R). UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson kamagra online next day delivery Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and promoting the kamagra online next day delivery use of vaccinations.“Can the flu shot give you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan treatments cause kamagra online next day delivery autism?. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu treatment discussion. It is easy to see why these questions were asked, as treatment misinformation is common today.UTHSA medical student Frank Jing (left) gets a treatment fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions. These were kamagra online next day delivery exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the treatment drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and treatment awareness through shot clinics and education.

Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general treatment myths. The Alpha Home residents could ask us questions during the program.We were interested to see if our educational program could answer Alpha Home residents’ questions about kamagra online next day delivery vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define treatment hesitancy. treatment hesitancy is a concept defined by the World Health Organization. It relates to when patients do not vaccinate kamagra online next day delivery despite having access to treatments.

treatment hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from treatment-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program. While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a flu shot today? kamagra online next day delivery. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about treatments, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan WealtherWhy kamagra online next day delivery is this important?.

First, our findings confirm what we already knew. Education by a trusted member of the medical community can effect change. In fact, it kamagra online next day delivery is widely known that physician recommendation of vaccination is one of the most critical factors affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end of the evening.Second, our findings kamagra online next day delivery add to our understanding of adult treatment hesitancy.

This is significant because most of what we know about treatment hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the yearly influenza treatment kamagra online next day delivery. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu treatment. Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the erectile dysfunction treatment kamagra because it decreases illnesses and conserves health care resources.

Thousands of people each year are hospitalized from the flu, and with hospitals filling up with erectile dysfunction patients, we could avoid adding dangerously ill kamagra online next day delivery flu patients to the mix. Lastly, these findings are important because once a erectile dysfunction treatment vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the erectile dysfunction treatment is still in development, it is not immune to treatment hesitancy kamagra online next day delivery. Recent polls have indicated up to one-third of Americans would not receive a erectile dysfunction treatment even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance.

In addition, misinformation about the erectile dysfunction treatment is circulating kamagra online next day delivery widely. (Someone recently asked me if the erectile dysfunction treatment will implant a microchip in people, and I have seen the same myth circulating on social media. It will not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.treatments work best when many people in a community receive them, and treatment hesitancy can diminish vaccination rates, leaving people kamagra online next day delivery who can't get certain treatments susceptible to these treatment-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots.

As the erectile dysfunction treatment kamagra progresses, we need to ensure kamagra online next day delivery children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention. I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

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Credit kamagra pharmacy online is kamagra a prescription drug. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in is kamagra a prescription drug this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb.

Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus is kamagra a prescription drug and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared is kamagra a prescription drug in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition.

In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women is kamagra a prescription drug with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says is kamagra a prescription drug.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess is kamagra a prescription drug fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition. The other authors on this paper were Ginette A is kamagra a prescription drug.

Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an is kamagra a prescription drug effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is is kamagra a prescription drug a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New is kamagra a prescription drug England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would visit this web-site fight an . These medicines have had remarkable success in treating some types of cancers that is kamagra a prescription drug historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types is kamagra a prescription drug has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow.

Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors is kamagra a prescription drug across many different cancer types was unclear. To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational is kamagra a prescription drug burden of thousands of tumor samples from patients with different tumor types.

Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well is kamagra a prescription drug cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one is kamagra a prescription drug of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint is kamagra a prescription drug inhibitors. However, he explains, this cancer type is often caused by a kamagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on is kamagra a prescription drug cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues is kamagra a prescription drug plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs.

€œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says. Yarchoan receives is kamagra a prescription drug funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries.

During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls.

Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an .

These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow. Work by Dung Le, M.D., associate professor of oncology, and other researchers at the Johns Hopkins Kimmel Cancer Center and its Bloomberg~Kimmel Cancer Institute for Cancer Immunotherapy showed that colon cancers that carry a high number of mutations are more likely to respond to checkpoint inhibitors than those that have fewer mutations. However, exactly how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types was unclear.

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer.

€œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a kamagra, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

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The funds for this post are available until 31 August 2024 in the purchase kamagra first instance.To apply online for this vacancy and to view further information about the role, please visit:http://www.jobs.cam.ac.uk/job/28356.Applications should include:A full CV, including details of teaching experience;a list of publications;statements about current and proposed research;two samples of recent work;the names of three referees.If you upload any additional documents, which have not been requested, we will not be able to consider these as part of your application.If you have any questions about the application process, please contact Louisa Russell, HR Coordinator, email. Hpsjobs@hermes.cam.ac.uk.Please quote reference JN25373 on your application and in any correspondence about this vacancy.The University actively supports equality, diversity and inclusion and encourages applications from all sections of society.The University has a responsibility to ensure that all employees are eligible to live and work in the UK.Salary purchase kamagra. £35,471- £38,815Campus. South Kensington The Advanced Manufacturing Group at Imperial College London is inviting applicants to join the purchase kamagra Marie Skłodowska-Curie European Training Network. Titled Advanced Research Training for the Biotribology of Natural purchase kamagra and Artificial Joints in the 21st Century.

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Imperial Expectations purchase kamagra guide the behaviour of all our staff. Please go purchase kamagra to www.imperial.ac.uk/jobs and search using reference number ENG01544 to apply. Please make sure to upload a purchase kamagra CV and a cover letter with your application.Deadline. 23/02/2021The College is a proud signatory to the San-Francisco Declaration on Research Assessment (DORA), which means that in hiring and promotion decisions, we evaluate applicants on the quality of their work, not the journal impact factor where it is published. For more information, see https://www.imperial.ac.uk/research-and-innovation/about-imperial-research/research-evaluation/The College believes that the use of animals in purchase kamagra research is vital to improve human and animal health and welfare.

Animals may only be used in research programmes where their use is shown to purchase kamagra be necessary for developing new treatments and making medical advances. Imperial is committed to ensuring that, in cases where this research is deemed essential, all animals in the College’s care are treated with full respect, and that all staff involved with this work show due consideration at every level.http://www.imperial.ac.uk/research-and-innovation/about-imperial-research/research-integrity/animal-research/.

Applications are invited for a Fixed Term Lectureship in History of Modern Medicine to start Our site on kamagra online next day delivery 1 September 2021. Appointment will be made at Point 49 (£41,526) on kamagra online next day delivery the University Lecturer scale. And will be for a period of three years while Professor Nick Hopwood holds a Leverhulme kamagra online next day delivery Major Research Fellowship to work on 'The Many Births of the Test-Tube Baby'.Applicants should hold a PhD in a relevant discipline and be able to provide outstanding teaching and research in history of medicine since 1800.

We especially welcome applicants whose expertise would expand the range of histories and geographies currently encompassed in the Department's teaching programme.The postholder will be expected to give lectures and lead seminars at undergraduate and masters level, to supervise coursework (assessed essays and dissertations) and to perform other departmental duties including those associated with assessment, examination and running seminars or reading groups. They will also be expected to publish and otherwise communicate their research in such a way as to maintain the Department's national and international reputation for excellence in history of health kamagra online next day delivery and medicine.Please be aware that present conditions may dictate periods of home-working, but that the candidate should be available for office-based work in Cambridge.Due to the funding position for this post, the successful applicant will be appointed at Point 49 (£41,526) of the salary scale, with the salary rising in annual increments, in line with the University's pay policies and procedures.The post is supported by a two-year probationary period.Fixed term. The funds for this kamagra online next day delivery post are available until 31 August 2024 in the first instance.To apply online for this vacancy and to view further information about the role, please visit:http://www.jobs.cam.ac.uk/job/28356.Applications should include:A full CV, including details of teaching experience;a list of publications;statements about current and proposed research;two samples of recent work;the names of three referees.If you upload any additional documents, which have not been requested, we will not be able to consider these as part of your application.If you have any questions about the application process, please contact Louisa Russell, HR Coordinator, email.

Hpsjobs@hermes.cam.ac.uk.Please quote reference kamagra online next day delivery JN25373 on your application and in any correspondence about this vacancy.The University actively supports equality, diversity and inclusion and encourages applications from all sections of society.The University has a responsibility to ensure that all employees are eligible to live and work in the UK.Salary. £35,471- £38,815Campus. South Kensington The Advanced Manufacturing Group at Imperial College London is inviting applicants to join the kamagra online next day delivery Marie Skłodowska-Curie European Training Network.

Titled Advanced Research Training for the Biotribology of Natural and Artificial Joints in kamagra online next day delivery the 21st Century. Developing an in-depth kamagra online next day delivery understanding in the tribological performance of artificial joints in the human body is key to increasing their performance and durability. 3D printing presents significant opportunities for improved implant design, optimisation, and customisation.

The holder will be tasked with investigating the kamagra online next day delivery tribological performance of 3D printed implant materials. The project will be based kamagra gel online at kamagra online next day delivery Imperial College and involve a mix of experimental and computer programming elements. The successful applicant will collaborate with colleagues at Imperial and elsewhere to obtain and use advanced experimental process and manufacturing technologies.The post is funded through an EU Marie Skłodowska-Curie Innovative Training Network in the area of kamagra online next day delivery biotribology.

The network focuses on this through a collaborative network of international partners.Duties and Responsibilities To develop custom software using general-purpose programming languagesTo work with internal and external project partners To take initiatives in the planning of researchTo ensure the validity and reliability of dataTo maintain accurate and complete recordsTo write reports for submission to research sponsorsEssential RequirementsMust not have resided or carried out main activity (work, studies etc.) in the UK for more than 12 months in the past three years.For beneficiaries that are international European interest organisations or international organisations. Not have spent with the beneficiary more than 12 months in the 3 years immediately before the kamagra online next day delivery recruitment date.at the date of recruitment — be an ‘early stage researcher’ (i.e. In the first four years of your research career and not have a doctoral degree)A first-class undergraduate degree in Design Engineering, Mechanical Engineering or a related subject (or equivalent) or an MSc postgraduate qualification kamagra online next day delivery in one of these subjects with a Merit or Distinction grade (or equivalent)For queries about the role, please contact.

Connor.myant@imperial.ac.uk For queries regarding the application process, please contact kamagra online next day delivery. S.wissing@imperial.ac.uk More information about the Department and the Additive Manufacturing groups can be found on our webpages. Imperial Expectations kamagra online next day delivery guide the behaviour of all our staff.

Please go kamagra online next day delivery to www.imperial.ac.uk/jobs and search using reference number ENG01544 to apply. Please make sure to upload kamagra online next day delivery a CV and a cover letter with your application.Deadline. 23/02/2021The College is a proud signatory to the San-Francisco Declaration on Research Assessment (DORA), which means that in hiring and promotion decisions, we evaluate applicants on the quality of their work, not the journal impact factor where it is published.

For more information, see https://www.imperial.ac.uk/research-and-innovation/about-imperial-research/research-evaluation/The College kamagra online next day delivery believes that the use of animals in research is vital to improve human and animal health and welfare. Animals may only be used in research programmes where their use is shown to be necessary for developing new treatments and making kamagra online next day delivery medical advances. Imperial is committed to ensuring that, in cases where this research is deemed essential, all animals in the College’s care are treated with full respect, and that all staff involved with this work show due consideration at every level.http://www.imperial.ac.uk/research-and-innovation/about-imperial-research/research-integrity/animal-research/.

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To the Editor Table kamagra oral jelly melbourne 1 http://blackshirtseo.com/buy-zithromax-online-without-a-prescription/. Table 1 kamagra oral jelly melbourne. Efficacy of BNT162b2 against kamagra oral jelly melbourne erectile dysfunction treatment According to Analysis Period.

Polack et al. (Dec. 31)1 report a treatment efficacy of 94.8% against erectile dysfunction treatment after two doses of the messenger RNA (mRNA) treatment BNT162b2 (Pfizer–BioNTech).

The authors also report a treatment efficacy of 52.4% from after the first dose to before the second dose, but in their calculation, they included data that were collected during the first 2 weeks after the first dose, when immunity would have still been mounting.1 We used documents submitted to the Food and Drug Administration2 to derive the treatment efficacy beginning from 2 weeks after the first dose to before the second dose (Table 1). Even before the second dose, BNT162b2 was highly efficacious, with a treatment efficacy of 92.6%, a finding similar to the first-dose efficacy of 92.1% reported for the mRNA-1273 treatment (Moderna).3 With such a highly protective first dose, the benefits derived from a scarce supply of treatment could be maximized by deferring second doses until all priority group members are offered at least one dose. There may be uncertainty about the duration of protection with a single dose, but the administration of a second dose within 1 month after the first, as recommended, provides little added benefit in the short term, while high-risk persons who could have received a first dose with that treatment supply are left completely unprotected.

Given the current treatment shortage, postponement of the second dose is a matter of national security that, if ignored, will certainly result in thousands of erectile dysfunction treatment–related hospitalizations and deaths this winter in the United States — hospitalizations and deaths that would have been prevented with a first dose of treatment. Danuta M. Skowronski, M.D.British Columbia Centre for Disease Control, Vancouver, BC, Canada [email protected]Gaston De Serres, M.D., Ph.D.Institut National de Santé Publique du Québec, Quebec City, QC, Canada Dr.

De Serres reports having received grant support from Pfizer for an unrelated study of meningococcal antibody seroprevalence. No other potential conflict of interest relevant to this letter was reported. This letter was published on February 17, 2021, at NEJM.org.3 ReferencesTo the Editor In their trial, Polack et al.

Found that the treatment efficacy of the erectile dysfunction treatment mRNA treatment BNT162b2 was 95%. They reported similar efficacy across different subgroups. It is well known that subgroup analyses in randomized clinical trials are both important and challenging,1 and the authors rightly pointed out that their trial was not powered to definitively assess efficacy according to subgroup.

In their article, however, questionable results are reported in Table 3. In each trial group, the sum of the number of cases across age groups (9 in the treatment group and 186 in the placebo group) does not equal the overall number of cases (8 and 162, respectively). This discrepancy does not appear for any other variables in Table 3 and in Table S4 in the Supplementary Appendix.

The reasons for the discrepancy are not clearly explained in the article. This is all the more problematic because of the between-group difference in the extent of the discrepancy, which could be interpreted as an overestimation of the treatment efficacy in the age groups. At a time when national public health programs are defining immunization policies that are age-sensitive,2-4 it would be important to clarify these findings.

Jean-Noel Vergnes, D.M.D., Ph.D.Paul Sabatier University, Toulouse, France [email protected] No potential conflict of interest relevant to this letter was reported. This letter was published on February 17, 2021, at NEJM.org.4 ReferencesTo the Editor Polack et al. May have erroneously concluded that the differences in the absolute numbers of severe erectile dysfunction treatment cases between the treatment group and the placebo group provide preliminary evidence of protection against the development of severe erectile dysfunction treatment illness.

The percentage of erectile dysfunction treatment–positive patients in whom severe illness developed was 5.6% (9 of 162 patients) in the placebo group and 12.5% (1 of 8 patients) in the treatment group — a difference of 6.9 percentage points (95% confidence interval [CI], 6.4 to 7.6) (P<0.001 by the chi-square test of proportions).1 Thus, the preliminary data do not appear to support the conclusion that this treatment offers protection against severe erectile dysfunction treatment illness or alleviate the theoretical concern over treatment-mediated disease enhancement, given that the percentage of erectile dysfunction treatment–positive patients in whom severe illness developed was significantly higher in the treatment group than in the placebo group. Xiang Wang, Pharm.D.Ottawa Hospital Research Institute, Ottawa, ON, Canada [email protected] No potential conflict of interest relevant to this letter was reported. This letter was published on February 17, 2021, at NEJM.org.1 Reference1.

Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Stat Med 2007;26:3661-3675.Response The authors reply.

In response to Skowronski and De Serres. We would like to emphasize that alternative dosing regimens of BNT162b2 have not been evaluated. The decision to implement alternative dosing regimens resides with health authorities.

However, we at Pfizer believe that it is critical for health authorities to conduct surveillance on implemented alternative dosing schedules to ensure that treatments provide the maximum possible protection. Vergnes questions the results of the subgroup analyses in our article and notes that the total number of erectile dysfunction treatment cases in the age groups exceeds the overall number of cases presented in Table 3. The author incorrectly summed the erectile dysfunction treatment cases in the age groups.

Among the participants who received the BNT162b2 treatment, five cases occurred in the age group of 16 to 55 years and three cases in the age group of more than 55 years. The numbers of cases among the older age groups are listed for those 65 years of age and older (1 case) and for those 75 years of age and older (0 cases). Therefore, the author’s assertion that the data overestimate treatment efficacy in the age groups is unsubstantiated.

Wang suggests that, on the basis of an analysis that used a chi-square test of proportions, a treatment efficacy of 95% was not demonstrated. We would like to clarify that it is not appropriate to use the proportion of erectile dysfunction treatment–positive patients in whom severe disease developed to assess treatment protection against severe erectile dysfunction treatment. Protection against severe illness is an integrated effect of reducing the chance that any erectile dysfunction treatment symptom will develop and reducing the risk that severe symptoms will develop after .

The calculation provided by Wang considers only the second effect, and the estimate for the treatment group is very imprecise owing to the small sample size (only 8 cases in this group). More importantly, the first effect was completely ignored. The estimation of treatment efficacy against severe illness should be based on the incidence of severe illness in the total study population.

After the first dose, treatment efficacy against the development of severe erectile dysfunction treatment, calculated as 100×(1–IRR), where IRR is the ratio of confirmed cases of severe erectile dysfunction treatment illness per 1000 person-years of follow-up for the active treatment group to the corresponding illness rate in the placebo group, was 88.9% (95% CI, 20.1 to 99.7). This result provides evidence of protection against severe erectile dysfunction treatment illness, thereby alleviating concern about the potential for treatment-enhanced disease. Judith Absalon, M.D., M.P.H.Kenneth Koury, Ph.D.William C.

Gruber, M.D.Pfizer, Pearl River, NY [email protected] Since publication of their article, the authors report no further potential conflict of interest. This letter was published on February 17, 2021, at NEJM.org.10.1056/NEJMc2036242-sa1t1Table 1. Efficacy of BNT162b2 against erectile dysfunction treatment According to Analysis Period.

Analysis Periodtreatment(N=21,669)Placebo(N=21,686)treatment Efficacy,% (95% CI)*no. Of casesAfter dose 1 to before dose 2 (per Polack et al.1)398252.4 (29.5–68.4)Beginning 7 days after dose 1 to before dose 2 (derived†)‡185768.5 (46.5–81.5)Beginning 14 days after dose 1 to before dose 2 (derived†)§22792.6 (69.0–98.3)≥7 Days after dose 2 (per Polack et al.1)917294.8 (89.8–97.6).

To the Editor Table 1 kamagra online next day delivery. Table 1 kamagra online next day delivery. Efficacy of BNT162b2 against kamagra online next day delivery erectile dysfunction treatment According to Analysis Period. Polack et al.

(Dec. 31)1 report a treatment efficacy of 94.8% against erectile dysfunction treatment after two doses of the messenger RNA (mRNA) treatment BNT162b2 (Pfizer–BioNTech). The authors also report a treatment efficacy of 52.4% from after the first dose to before the second dose, but in their calculation, they included data that were collected during the first 2 weeks after the first dose, when immunity would have still been mounting.1 We used documents submitted to the Food and Drug Administration2 to derive the treatment efficacy beginning from 2 weeks after the first dose to before the second dose (Table 1). Even before the second dose, BNT162b2 was highly efficacious, with a treatment efficacy of 92.6%, a finding similar to the first-dose efficacy of 92.1% reported for the mRNA-1273 treatment (Moderna).3 With such a highly protective first dose, the benefits derived from a scarce supply of treatment could be maximized by deferring second doses until all priority group members are offered at least one dose.

There may be uncertainty about the duration of protection with a single dose, but the administration of a second dose within 1 month after the first, as recommended, provides little added benefit in the short term, while high-risk persons who could have received a first dose with that treatment supply are left completely unprotected. Given the current treatment shortage, postponement of the second dose is a matter of national security that, if ignored, will certainly result in thousands of erectile dysfunction treatment–related hospitalizations and deaths this winter in the United States — hospitalizations and deaths that would have been prevented with a first dose of treatment. Danuta M. Skowronski, M.D.British Columbia Centre for Disease Control, Vancouver, BC, Canada [email protected]Gaston De Serres, M.D., Ph.D.Institut National de Santé Publique du Québec, Quebec City, QC, Canada Dr.

De Serres reports having received grant support from Pfizer for an unrelated study of meningococcal antibody seroprevalence. No other potential conflict of interest relevant to this letter was reported. This letter was published on February 17, 2021, at NEJM.org.3 ReferencesTo the Editor In their trial, Polack et al. Found that the treatment efficacy of the erectile dysfunction treatment mRNA treatment BNT162b2 was 95%.

They reported similar efficacy across different subgroups. It is well known that subgroup analyses in randomized clinical trials are both important and challenging,1 and the authors rightly pointed out that their trial was not powered to definitively assess efficacy according to subgroup. In their article, however, questionable results are reported in Table 3. In each trial group, the sum of the number of cases across age groups (9 in the treatment group and 186 in the placebo group) does not equal the overall number of cases (8 and 162, respectively).

This discrepancy does not appear for any other variables in Table 3 and in Table S4 in the Supplementary Appendix. The reasons for the discrepancy are not clearly explained in the article. This is all the more problematic because of the between-group difference in the extent of the discrepancy, which could be interpreted as an overestimation of the treatment efficacy in the age groups. At a time when national public health programs are defining immunization policies that are age-sensitive,2-4 it would be important to clarify these findings.

Jean-Noel Vergnes, D.M.D., Ph.D.Paul Sabatier University, Toulouse, France [email protected] No potential conflict of interest relevant to this letter was reported. This letter was published on February 17, 2021, at NEJM.org.4 ReferencesTo the Editor Polack et al. May have erroneously concluded that the differences in the absolute numbers of severe erectile dysfunction treatment cases between the treatment group and the placebo group provide preliminary evidence of protection against the development of severe erectile dysfunction treatment illness. The percentage of erectile dysfunction treatment–positive patients in whom severe illness developed was 5.6% (9 of 162 patients) in the placebo group and 12.5% (1 of 8 patients) in the treatment group — a difference of 6.9 percentage points (95% confidence interval [CI], 6.4 to 7.6) (P<0.001 by the chi-square test of proportions).1 Thus, the preliminary data do not appear to support the conclusion that this treatment offers protection against severe erectile dysfunction treatment illness or alleviate the theoretical concern over treatment-mediated disease enhancement, given that the percentage of erectile dysfunction treatment–positive patients in whom severe illness developed was significantly higher in the treatment group than in the placebo group.

Xiang Wang, Pharm.D.Ottawa Hospital Research Institute, Ottawa, ON, Canada [email protected] No potential conflict of interest relevant to this letter was reported. This letter was published on February 17, 2021, at NEJM.org.1 Reference1. Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations.

Stat Med 2007;26:3661-3675.Response The authors reply. In response to Skowronski and De Serres. We would like to emphasize that alternative dosing regimens of BNT162b2 have not been evaluated. The decision to implement alternative dosing regimens resides with health authorities.

However, we at Pfizer believe that it is critical for health authorities to conduct surveillance on implemented alternative dosing schedules to ensure that treatments provide the maximum possible protection. Vergnes questions the results of the subgroup analyses in our article and notes that the total number of erectile dysfunction treatment cases in the age groups exceeds the overall number of cases presented in Table 3. The author incorrectly summed the erectile dysfunction treatment cases in the age groups. Among the participants who received the BNT162b2 treatment, five cases occurred in the age group of 16 to 55 years and three cases in the age group of more than 55 years.

The numbers of cases among the older age groups are listed for those 65 years of age and older (1 case) and for those 75 years of age and older (0 cases). Therefore, the author’s assertion that the data overestimate treatment efficacy in the age groups is unsubstantiated. Wang suggests that, on the basis of an analysis that used a chi-square test of proportions, a treatment efficacy of 95% was not demonstrated. We would like to clarify that it is not appropriate to use the proportion of erectile dysfunction treatment–positive patients in whom severe disease developed to assess treatment protection against severe erectile dysfunction treatment.

Protection against severe illness is an integrated effect of reducing the chance that any erectile dysfunction treatment symptom will develop and reducing the risk that severe symptoms will develop after . The calculation provided by Wang considers only the second effect, and the estimate for the treatment group is very imprecise owing to the small sample size (only 8 cases in this group). More importantly, the first effect was completely ignored. The estimation of treatment efficacy against severe illness should be based on the incidence of severe illness in the total study population.

After the first dose, treatment efficacy against the development of severe erectile dysfunction treatment, calculated as 100×(1–IRR), where IRR is the ratio of confirmed cases of severe erectile dysfunction treatment illness per 1000 person-years of follow-up for the active treatment group to the corresponding illness rate in the placebo group, was 88.9% (95% CI, 20.1 to 99.7). This result provides evidence of protection against severe erectile dysfunction treatment illness, thereby alleviating concern about the potential for treatment-enhanced disease. Judith Absalon, M.D., M.P.H.Kenneth Koury, Ph.D.William C. Gruber, M.D.Pfizer, Pearl River, NY [email protected] Since publication of their article, the authors report no further potential conflict of interest.

This letter was published on February 17, 2021, at NEJM.org.10.1056/NEJMc2036242-sa1t1Table 1. Efficacy of BNT162b2 against erectile dysfunction treatment According to Analysis Period. Analysis Periodtreatment(N=21,669)Placebo(N=21,686)treatment Efficacy,% (95% CI)*no. Of casesAfter dose 1 to before dose 2 (per Polack et al.1)398252.4 (29.5–68.4)Beginning 7 days after dose 1 to before dose 2 (derived†)‡185768.5 (46.5–81.5)Beginning 14 days after dose 1 to before dose 2 (derived†)§22792.6 (69.0–98.3)≥7 Days after dose 2 (per Polack et al.1)917294.8 (89.8–97.6).

What is kamagra 100mg

ELK CITY what is kamagra 100mg — One student throws his classmates’ pencil Online doctor kamagra box on the floor in anger. Another bites her own arm out of frustration. Others run screaming what is kamagra 100mg from their classrooms. Some Elk City Elementary School students are celebrating as summer break approaches. Others are dreading the end of the school year, acting out in fear of what the next three months could bring.

School counselor Kim Hamm worries about students who won’t have enough to eat this summer what is kamagra 100mg. And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs. And who will spend their days anticipating what is kamagra 100mg the next attack from an abusive family member. Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home.

“They know that, here, they’re safe and we’re not going to what is kamagra 100mg hurt them,” Hamm said. €œAnd a lot of our kids, unfortunately, don’t go home to that every day.” About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry. The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students face what is kamagra 100mg rates of poverty, special needs and suicide higher than the state average. Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office.

Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent. (Courtesy photo) In her six years as a school counselor, Hamm has learned to anticipate these needs, making more what is kamagra 100mg time towards the end of the school year to meet with students one-on-one. But she doesn’t always have the bandwidth. School counselors’ duties range from helping develop individualized learning plans for students with special needs to proctoring what is kamagra 100mg the third-grade reading test. They enroll students in classes and ensure they meet state math and science requirements.

They provide college and career advice and help them find and apply for scholarships. They wrangle students during morning drop-off and afternoon pick-up, run school-sponsored food and clothes pantries and teach breathing techniques to those with what is kamagra 100mg test anxiety. Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. Counselors refer the most troubled kids to community mental health counselors. But they are also in short what is kamagra 100mg supply especially in rural areas like Elk City where the ratio of mental healthcare providers to residents is 1 to 150,000.

Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed. A federal program is increasing support for students in six rural school districts in what the state mental health and education departments call what is kamagra 100mg “mental health deserts.” But schools are finding it difficult to hire qualified caregivers and erectile dysfunction treatment restrictions have halted programs and limited in-person treatment. Students are seen leaving Elk City Elementary School at the end of the school day. School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma Watch) A Response Inspired By what is kamagra 100mg Sandy Hook Since 2018, the State Department of Education has received two U.S.

Department of Health and Human Services grants totaling $18 million. Oklahoma’s Project AWARE, short for Advancing Wellness and Resiliency in Education, is in its third year of the five-year grant at Woodward, Elk City and Weatherford Public Schools and its first year at Ada, Atoka and Checotah Public Schools. Subscribe to Jennifer Palmer's Education Watch what is kamagra 100mg newsletter Processing… Success!. You're on the list. Whoops! what is kamagra 100mg.

There was an error and we couldn't process your subscription. Please reload the page and try again. The districts were chosen by the state department for their lack of treatment providers what is kamagra 100mg and high-risk student populations. Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University. But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application.

These students what is kamagra 100mg are more susceptible to mental illness. And without treatment, they can face even more dangerous obstacles as they age, often leading to their own violent encounters, substance abuse or incarceration. Subscribe to our First what is kamagra 100mg Watch newsletter Processing… Success!. You're on the list. Whoops!.

There was an error and what is kamagra 100mg we couldn't process your subscription. Please reload the page and try again. In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012. Since then, the Substance Abuse and Mental Health Services Administration has sent millions to schools nationwide with high-risk students to what is kamagra 100mg prevent violence perpetrated by young people. This story was reported in partnership with the Solutions Journalism Network.

For more information, go to what is kamagra 100mg solutionsjournalism.org. In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff. At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the kamagra. Community events aim to reduce stigma around what is kamagra 100mg mental health challenges and treatment and teach parents and students about healthy habits like the importance of sleep and recommendations for social media use. Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation.

Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out. Community mental health counselors had started to meet with troubled students in some of the Western Oklahoma what is kamagra 100mg schools. Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of these services were what is kamagra 100mg paused due to erectile dysfunction treatment. Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent.

The grant also trained educators at all six districts in a classroom program that teaches conflict resolution and empathy. Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as what is kamagra 100mg her students rate how they’re feeling at the end of the day. Henthorn checks in with her students twice a day through a program known as Circles that she says teaches students coping skills and empathy. (Whitney Bryen/Oklahoma Watch) Just before the bell rang on a Monday afternoon, kindergarteners sat in a circle on a rug at the front of Liz Henthorn’s classroom at Elk City Elementary School. One-by-one the students rated how they’re feeling as they prepared to go home what is kamagra 100mg.

They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice. One student said he was feeling sad because his dog ran away that morning. Another student was feeling red what is kamagra 100mg because she had a bad dream. Other students spoke up saying they could relate or that they’re sorry that happened. “We’re teaching kids to what is kamagra 100mg identify their feelings and giving suggestions to cope,” Henthorn said.

€œAnd when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.” Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch) Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation. But few are qualified to help more critical students, like those with mental illness or who what is kamagra 100mg have experienced trauma. Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%.

In Elk City, 140 of the district’s 2,110 students had a parent who was what is kamagra 100mg incarcerated. And all three Western Oklahoma districts had higher than average suicide rates. Those districts rely on school what is kamagra 100mg counselors to support these students, though most lack the training. And the grant does not address the ratio of counselors to students, which is far above national recommendations. Districts also planned to increase referrals to community treatment centers facilitated by the grant.

Demand for mental health care what is kamagra 100mg spiked during the kamagra, further straining the area’s providers and leaving families with few options. Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch) The Complicated Search for Counselors School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors can provide therapy and diagnose students with what is kamagra 100mg mental illness. Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors.

Each district hired one licensed mental health provider who what is kamagra 100mg serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed. The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams. Training for licensed professional counselors requires an additional what is kamagra 100mg 60 graduate-level college hours and 3,000 hours of supervised counseling. Counselors must also pass an exam before being licensed.

Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include what is kamagra 100mg fees for supervision or the licensing exam. The grant will pay tuition costs for school counselors to get their license. Only two what is kamagra 100mg of 16 school counselors in Elk City, Weatherford and Woodward have taken the offer. School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion.

“I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old. €œIf I was going to make more as a school counselor with it then maybe I would, but I’m not going to so I’m just not going to spend what is kamagra 100mg a whole lot of time to get that.” For school counselors who do get their license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the kamagra. Oklahoma has 1,841 school counselors and nearly 695,000 students, according to State Department what is kamagra 100mg of Education reports.

The department does not track how many school counselors have their professional counseling license. The American School Counselor Association recommends a ratio of 1 what is kamagra 100mg school counselor to 250 students. Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools. Not every school has what is kamagra 100mg a dedicated counselor.

Some have teams depending on student population, how schools prioritize funding and disperse tasks. The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch interviewed 10 counselors what is kamagra 100mg across the state. Most said they spend the majority of their day doing clerical work. Depending on the time of year, about 20 to 50% of their what is kamagra 100mg time is spent with students.

Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration. Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation. €œA lot of what I deal with are the results of families who are in crisis, where there’s addiction, other issues that are related to poverty and what is kamagra 100mg the kids show up to school and there’s a lot of fallout from that,” Moss said. €œAnd so we have kids who are depressed. We’ve had kids who are suicidal.

Anxieties are really high.” Lora Anderson, a school counselor at Ada Junior High School, talks to students about online enrollment and how to choose classes for next school year what is kamagra 100mg. (Courtesy photo) Moss is one of two school counselors taking advantage of Project AWARE funding to get her professional counseling license. Her principal took over her ACT and pre-ACT testing, scheduling and enrollment duties allowing Moss to what is kamagra 100mg spend more time with students in crisis. “I would love to see even more taken off of the shoulders of counselors so that we could take care of our kids’ needs better,” Moss said. €œBut I truly feel blessed here that I am not overwhelmed, like so many counselors.” At Ada Junior High School, counselor Lora Anderson spends about 25% of her time working with troubled students.

Many school what is kamagra 100mg counselors go into the job to propel students’ academic success, not to provide therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs. €œThat’s not what I want to do,” Anderson said after returning to her desk from lunch duty. €œI do so many different things to what is kamagra 100mg help students. If I wanted to be a mental health counselor, I wouldn’t work in a school.” Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students.

(Courtesy photo) Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license. But based on training she’s attended and led over the years, what is kamagra 100mg Taylor said it’s likely that about 1 in 5 school counselors goes on to become licensed. School counselors are serving dual roles whether they want to or not. Like swim instructors at a pool, what is kamagra 100mg most school counselors see their role as building stronger swimmers. But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids.

“Counselors in rural schools tend to be treading more water,” Taylor said. €œSome folks are so overwhelmed with the job they have, they don’t have the time or what is kamagra 100mg the motivation to seek out additional training. It’s just not accessible for folks.” Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. She said the job has changed a lot since she what is kamagra 100mg started.

Test requirements are constantly evolving. College admissions and scholarship applications what is kamagra 100mg seem to get longer every year. And students want to talk more. Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the kamagra, Taylor said. And school counselors what is kamagra 100mg have to be ready to listen and help.

“I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said. €œThat’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.” Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said since the erectile dysfunction kamagra began, her students seem more anxious and depressed what is kamagra 100mg than ever. (Whitney Bryen/Oklahoma Watch) Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by erectile dysfunction treatment. Contact her at (405) 201-6057 or what is kamagra 100mg wbryen@oklahomawatch.org.

Follow her on Twitter @SoonerReporter. Support our publicationEvery day we strive to produce journalism that matters — stories that strengthen accountability and transparency, provide value and resonate with readers like you.This work is essential to a better-informed community and a healthy democracy. But it isn’t possible what is kamagra 100mg without your support. Donate nowMore than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The kamagra has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire.

It may have the smallest population in America, but when it comes what is kamagra 100mg to land, Wyoming is the ninth-largest. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here. While there is vast open space, the nearest major trauma hospital is what is kamagra 100mg more than 2.5 hours away. On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival.

It's a fact Luke Sypherd knows what is kamagra 100mg all too well. For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve. "We just saw that we didn't have the personnel to what is kamagra 100mg continue," Sypherd said. "It was an ongoing problem made worse by erectile dysfunction treatment with fewer people interested in volunteering with EMS during a kamagra and patients afraid of getting taken to a hospital."A nearby hospital system, Cody Regional Health, has agreed to provide ambulance service for Washakie County, averting a crisis.

But it's what is kamagra 100mg a problem playing out across rural America. Ambulance crews are running out of money and volunteers.Phillip Franklin, the EMS Director for Cody Regional Health, said the crisis is a result of several problems."The majority of the ambulance service staff are not paid so if you don't have your volunteers, they can't run calls," Franklin said. "Another problem is that there's simply just not enough volume to keep ambulance service afloat and in the state of Wyoming, EMS is not essential, which means there's nobody responsible to fund these entities."Sypherd said the funding model for EMS is fundamentally flawed, with most service providers reimbursed only if they take patients to a hospital or clinic. In rural areas like Washakie County, smaller populations mean fewer calls, and consequently, less money. "You're reimbursed based on the number of patients that you transport to a hospital so you could get called 1,000 times a year and only transport 750 patients -- those other 250 calls you made no money on," Sypherd said.

Plea for federal assistanceThe American Ambulance Association sent a letter earlier this month to the US Department of Health and Human Services asking the agency to earmark $1.425 billion in federal aid for its members, warning that emergency medical systems across the US are "on the brink of collapse.""It is critical that we not let the financial hardship caused by the kamagra to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National Association of State EMS Officials, just eight states consider local emergency medical services "essential" by law, as they do for fire and police. "That mandate means that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said. "If you're in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year away from closure."'A matter of life and death'One of those is Fremont County -- home to the Wind River Indian Reservation.

Fremont is roughly the size of the state of Vermont. An economic downturn and budget cuts prompted the county to privatize its ambulance service in 2016. But the private company, American Medical Response, says it can't afford to keep going after losing $1.5 million in revenue last year. AMR announced it won't renew its contract when it runs out on June 30. No others have bid.

"We just couldn't renew that current contract because it was set up for a financial failure," said Matt Strauss, Regional Director for AMR parent company, Global Medical Response. One of the problems, according to Fremont County Commissioner Larry Allen, is the so-called payer mix. Many of the county's residents rely on Medicare, Medicaid and Indian Health Services, which reimburse ambulance providers at a lower rate. And without state or federal designation of EMS as an essential service, Allen said "there's no source of revenue to operate an ambulance.""Because of the distance and the ruralness of this county, we just don't have people standing in line wanting to provide ambulance service," Allen said. The Wind River Indian Reservation stretches across more than 2 million acres and is shared by two Native American tribes, the Eastern Shoshone and the Northern Arapaho.

It has three tiny clinics but no ambulance services and relies on Fremont County for EMS. "Right now the response time is pretty slow and it's going to be nonexistent," said Northern Arapaho tribal member Juan Willow. His grandfather struggled with health problems and Willow said there were many times when the family couldn't wait for an ambulance and had to find other ways of getting to the hospital. "Not everyone here has a car," he said.It's a concern shared by Jordan Dresser, the chairman of the Northern Arapaho Tribe."I think if we didn't have access to ambulances, death rates would be higher," said Dresser, adding that many tribal members don't have working vehicles and therefore can't take themselves to the hospital or clinics. "It's a matter of life and death for us.".

ELK CITY — One Online doctor kamagra student throws his classmates’ pencil box kamagra online next day delivery on the floor in anger. Another bites her own arm out of frustration. Others run screaming from their kamagra online next day delivery classrooms. Some Elk City Elementary School students are celebrating as summer break approaches.

Others are dreading the end of the school year, acting out in fear of what the next three months could bring. School counselor Kim Hamm worries about students who won’t have kamagra online next day delivery enough to eat this summer. And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs.

And who will spend their days anticipating the next attack from an abusive family member kamagra online next day delivery. Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home. “They know that, here, kamagra online next day delivery they’re safe and we’re not going to hurt them,” Hamm said. €œAnd a lot of our kids, unfortunately, don’t go home to that every day.” About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry.

The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students kamagra online next day delivery face rates of poverty, special needs and suicide higher than the state average. Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office. Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent.

(Courtesy photo) kamagra online next day delivery In her six years as a school counselor, Hamm has learned to anticipate these needs, making more time towards the end of the school year to meet with students one-on-one. But she doesn’t always have the bandwidth. School counselors’ duties range kamagra online next day delivery from helping develop individualized learning plans for students with special needs to proctoring the third-grade reading test. They enroll students in classes and ensure they meet state math and science requirements.

They provide college and career advice and help them find and apply for scholarships. They wrangle students during morning drop-off and afternoon pick-up, run kamagra online next day delivery school-sponsored food and clothes pantries and teach breathing techniques to those with test anxiety. Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. Counselors refer the most troubled kids to community mental health counselors.

But they are also in kamagra online next day delivery short supply especially in rural areas like Elk City where the ratio of mental healthcare providers to residents is 1 to 150,000. Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed. A federal program is increasing support for students in six rural school districts in what the state mental health and education departments call “mental health deserts.” But schools are finding it difficult kamagra online next day delivery to hire qualified caregivers and erectile dysfunction treatment restrictions have halted programs and limited in-person treatment. Students are seen leaving Elk City Elementary School at the end of the school day.

School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma Watch) A Response Inspired By Sandy Hook Since 2018, the kamagra online next day delivery State Department of Education has received two U.S. Department of Health and Human Services grants totaling $18 million. Oklahoma’s Project AWARE, short for Advancing Wellness and Resiliency in Education, is in its third year of the five-year grant at Woodward, Elk City and Weatherford Public Schools and its first year at Ada, Atoka and Checotah Public Schools.

Subscribe to Jennifer Palmer's Education Watch kamagra online next day delivery newsletter Processing… Success!. You're on the list. Whoops! kamagra online next day delivery. There was an error and we couldn't process your subscription.

Please reload the page and try again. The districts were chosen by the state department for kamagra online next day delivery their lack of treatment providers and high-risk student populations. Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University. But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application.

These students are more kamagra online next day delivery susceptible to mental illness. And without treatment, they can face even more dangerous obstacles as they age, often leading to their own violent encounters, substance abuse or incarceration. Subscribe to our kamagra online next day delivery First Watch newsletter Processing… Success!. You're on the list.

Whoops!. There was an error and we couldn't process your subscription kamagra online next day delivery. Please reload the page and try again. In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012.

Since then, the Substance Abuse and Mental Health Services Administration has sent kamagra online next day delivery millions to schools nationwide with high-risk students to prevent violence perpetrated by young people. This story was reported in partnership with the Solutions Journalism Network. For more kamagra online next day delivery information, go to solutionsjournalism.org. In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff.

At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the kamagra. Community events aim to reduce stigma around mental health challenges and treatment and kamagra online next day delivery teach parents and students about healthy habits like the importance of sleep and recommendations for social media use. Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation. Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out.

Community mental kamagra online next day delivery health counselors had started to meet with troubled students in some of the Western Oklahoma schools. Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of these kamagra online next day delivery services were paused due to erectile dysfunction treatment. Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent.

The grant also trained educators at all six districts in a classroom program that teaches conflict resolution and empathy. Liz Henthorn, a kamagra online next day delivery kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. Henthorn checks in with her students twice a day through a program known as Circles that she says teaches students coping skills and empathy. (Whitney Bryen/Oklahoma Watch) Just before the bell rang on a Monday afternoon, kindergarteners sat in a circle on a rug at the front of Liz Henthorn’s classroom at Elk City Elementary School.

One-by-one the students rated kamagra online next day delivery how they’re feeling as they prepared to go home. They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice. One student said he was feeling sad because his dog ran away that morning. Another student was feeling red because she had a kamagra online next day delivery bad dream.

Other students spoke up saying they could relate or that they’re sorry that happened. “We’re teaching kids to identify their feelings and giving kamagra online next day delivery suggestions to cope,” Henthorn said. €œAnd when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.” Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch) Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation.

But few are qualified kamagra online next day delivery to help more critical students, like those with mental illness or who have experienced trauma. Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%. In Elk City, 140 of the district’s 2,110 kamagra online next day delivery students had a parent who was incarcerated.

And all three Western Oklahoma districts had higher than average suicide rates. Those districts rely on school counselors to support kamagra online next day delivery these students, though most lack the training. And the grant does not address the ratio of counselors to students, which is far above national recommendations. Districts also planned to increase referrals to community treatment centers facilitated by the grant.

Demand for mental health care spiked during the kamagra, further straining the area’s kamagra online next day delivery providers and leaving families with few options. Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch) The Complicated Search for Counselors School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors can provide therapy and diagnose students with mental illness kamagra online next day delivery.

Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors. Each district kamagra online next day delivery hired one licensed mental health provider who serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed. The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams.

Training for kamagra online next day delivery licensed professional counselors requires an additional 60 graduate-level college hours and 3,000 hours of supervised counseling. Counselors must also pass an exam before being licensed. Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include fees kamagra online next day delivery for supervision or the licensing exam.

The grant will pay tuition costs for school counselors to get their license. Only two of 16 school counselors in Elk City, Weatherford and Woodward kamagra online next day delivery have taken the offer. School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion. “I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old.

€œIf I was going to make more as a school counselor with it then maybe I would, but I’m not going to so I’m just not going to spend a whole lot of time to get that.” For school counselors kamagra online next day delivery who do get their license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the kamagra. Oklahoma has 1,841 school counselors and nearly 695,000 students, according to State kamagra online next day delivery Department of Education reports.

The department does not track how many school counselors have their professional counseling license. The American School Counselor Association recommends a ratio of kamagra online next day delivery 1 school counselor to 250 students. Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools.

Not every school has kamagra online next day delivery a dedicated counselor. Some have teams depending on student population, how schools prioritize funding and disperse tasks. The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch interviewed 10 counselors across kamagra online next day delivery the state.

Most said they spend the majority of their day doing clerical work. Depending on the time of year, about 20 to 50% of their time is kamagra online next day delivery spent with students. Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration. Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation.

€œA lot of what I deal with are the results of families who are kamagra online next day delivery in crisis, where there’s addiction, other issues that are related to poverty and the kids show up to school and there’s a lot of fallout from that,” Moss said. €œAnd so we have kids who are depressed. We’ve had kids who are suicidal. Anxieties are really kamagra online next day delivery high.” Lora Anderson, a school counselor at Ada Junior High School, talks to students about online enrollment and how to choose classes for next school year.

(Courtesy photo) Moss is one of two school counselors taking advantage of Project AWARE funding to get her professional counseling license. Her principal took over her ACT kamagra online next day delivery and pre-ACT testing, scheduling and enrollment duties allowing Moss to spend more time with students in crisis. “I would love to see even more taken off of the shoulders of counselors so that we could take care of our kids’ needs better,” Moss said. €œBut I truly feel blessed here that I am not overwhelmed, like so many counselors.” At Ada Junior High School, counselor Lora Anderson spends about 25% of her time working with troubled students.

Many school counselors go into the job to propel students’ academic success, not to provide kamagra online next day delivery therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs. €œThat’s not what I want to do,” Anderson said after returning to her desk from lunch duty. €œI do so many kamagra online next day delivery different things to help students.

If I wanted to be a mental health counselor, I wouldn’t work in a school.” Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students. (Courtesy photo) Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license. But based on training she’s attended and led kamagra online next day delivery over the years, Taylor said it’s likely that about 1 in 5 school counselors goes on to become licensed. School counselors are serving dual roles whether they want to or not.

Like swim instructors at a pool, most school counselors see their role as building stronger kamagra online next day delivery swimmers. But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids. “Counselors in rural schools tend to be treading more water,” Taylor said. €œSome folks are so overwhelmed with the job they have, they don’t have kamagra online next day delivery the time or the motivation to seek out additional training.

It’s just not accessible for folks.” Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. She said the job has changed kamagra online next day delivery a lot since she started. Test requirements are constantly evolving.

College admissions and scholarship kamagra online next day delivery applications seem to get longer every year. And students want to talk more. Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the kamagra, Taylor said. And school counselors kamagra online next day delivery have to be ready to listen and help.

“I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said. €œThat’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.” Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said since the erectile dysfunction kamagra began, her students seem more kamagra online next day delivery anxious and depressed than ever. (Whitney Bryen/Oklahoma Watch) Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by erectile dysfunction treatment.

Contact her at (405) 201-6057 kamagra online next day delivery or wbryen@oklahomawatch.org. Follow her on Twitter @SoonerReporter. Support our publicationEvery day we strive to produce journalism that matters — stories that strengthen accountability and transparency, provide value and resonate with readers like you.This work is essential to a better-informed community and a healthy democracy. But it kamagra online next day delivery isn’t possible without your support.

Donate nowMore than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The kamagra has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire. It may have the smallest population kamagra online next day delivery in America, but when it comes to land, Wyoming is the ninth-largest. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here.

While there is vast open space, the nearest major trauma hospital is more kamagra online next day delivery than 2.5 hours away. On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival. It's a fact Luke Sypherd kamagra online next day delivery knows all too well.

For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve. "We just saw that we didn't have the personnel to continue," kamagra online next day delivery Sypherd said. "It was an ongoing problem made worse by erectile dysfunction treatment with fewer people interested in volunteering with EMS during a kamagra and patients afraid of getting taken to a hospital."A nearby hospital system, Cody Regional Health, has agreed to provide ambulance service for Washakie County, averting a crisis.

But it's a problem kamagra online next day delivery playing out across rural America. Ambulance crews are running out of money and volunteers.Phillip Franklin, the EMS Director for Cody Regional Health, said the crisis is a result of several problems."The majority of the ambulance service staff are not paid so if you don't have your volunteers, they can't run calls," Franklin said. "Another problem is that there's simply just not enough volume to keep ambulance service afloat and in the state of Wyoming, EMS is not essential, which means there's nobody responsible to fund these entities."Sypherd said the funding model for EMS is fundamentally flawed, with most service providers reimbursed only if they take patients to a hospital or clinic. In rural areas like Washakie County, smaller kamagra online next day delivery populations mean fewer calls, and consequently, less money.

"You're reimbursed based on the number of patients that you transport to a hospital so you could get called 1,000 times a year and only transport 750 patients -- those other 250 calls you made no money on," Sypherd said. Plea for federal assistanceThe American Ambulance Association sent a letter earlier this month to the US Department of Health and Human Services asking the agency to earmark $1.425 billion in federal aid for its members, warning that emergency medical systems across the US are "on the brink of collapse.""It is critical that we not let the financial hardship caused by the kamagra to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National Association of State EMS Officials, just eight states consider local emergency medical services "essential" by law, as they do for fire and police kamagra online next day delivery. "That mandate means that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said.

"If you're in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means kamagra online next day delivery if you call 911 it might be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year away from closure."'A matter of life and death'One of those is Fremont County -- home to the Wind River Indian Reservation. Fremont is roughly the size of the state of Vermont. An economic downturn and budget cuts prompted the county to privatize its ambulance service kamagra online next day delivery in 2016.

But the private company, American Medical Response, says it can't afford to keep going after losing $1.5 million in revenue last year. AMR announced it won't renew its contract when it runs out on June 30. No others have kamagra online next day delivery bid. "We just couldn't renew that current contract because it was set up for a financial failure," said Matt Strauss, Regional Director for AMR parent company, Global Medical Response.

One of the problems, according to Fremont County Commissioner Larry Allen, is the so-called payer mix. Many of the county's residents rely on Medicare, Medicaid and Indian Health Services, which reimburse ambulance providers at a lower rate. And without state or federal designation of EMS as an essential service, Allen said "there's no source of revenue to operate an ambulance.""Because of the distance and the ruralness of this county, we just don't have people standing in line wanting to provide ambulance service," Allen said. The Wind River Indian Reservation stretches across more than 2 million acres and is shared by two Native American tribes, the Eastern Shoshone and the Northern Arapaho.

It has three tiny clinics but no ambulance services and relies on Fremont County for EMS. "Right now the response time is pretty slow and it's going to be nonexistent," said Northern Arapaho tribal member Juan Willow. His grandfather struggled with health problems and Willow said there were many times when the family couldn't wait for an ambulance and had to find other ways of getting to the hospital. "Not everyone here has a car," he said.It's a concern shared by Jordan Dresser, the chairman of the Northern Arapaho Tribe."I think if we didn't have access to ambulances, death rates would be higher," said Dresser, adding that many tribal members don't have working vehicles and therefore can't take themselves to the hospital or clinics.