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Aubrey de Grey, the anti-aging research pioneer who was removed last month as chief scientific officer of the SENS Research Foundation, made offensive sexual comments to two prominent, young entrepreneurs in the longevity community, according to the findings of an independent investigation conducted at the request of the organization.Released Friday night, an 18-page executive summary of the report from the law buy generic levitra in usa firm Van Dermyden Makus gave corroborating evidence for previous allegations made by Laura Deming and Celine Halioua. Though they are not named in the report, the women confirmed to STAT that they are the two complainants. In early August, they came forward in a pair of blog posts, claiming that de Grey had sexually harassed them when they were just buy generic levitra in usa starting out their careers in longevity research.

Unlock this article by subscribing to STAT+ and enjoy your first 30 days free!. GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth buy generic levitra in usa biotech, pharma, policy, and life science coverage and analysis.

Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond. What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.A new analysis finds that the clinical trials conducted by Biogen (BIIB) for its buy generic levitra in usa controversial Alzheimer’s treatment would have excluded as many as 92% of Medicare beneficiaries — a key portion of the targeted patient population — based on their age or existing medical conditions.Breaking it down, a total of 92% of patients with Alzheimer’s and related disorders, 91% with Alzheimer’s specifically, and 85.5% with mild cognitive impairment met at least one of the criteria for exclusion from the studies, according to the analysis published in JAMA.

The most common criteria were heart disease, conditions associated with blood clots, chronic kidney disease, and an age of 85 years or older. Most people actually met more than two of the criteria used for excluding participants. Unlock this article by subscribing to STAT+ and enjoy your first 30 buy generic levitra in usa days free!.

GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early buy generic levitra in usa science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

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Lawmakers considered using some of the unspent money to pay for infrastructure projects, but ultimately decided against it.advertisement The grants announced on Friday are divided into two different portions. $17 billion for providers generally who can prove they have losses, and $8.5 billion for rural health care providers. Providers can apply for a share of $17 billion in grants if they can prove they had losses or expenses due to erectile dysfunction treatment between July 2020 and the end of March — a time frame that leaves out hospitals struggling due to the ongoing surge, largely fueled by the Delta variant, that’s currently filling emergency rooms and delaying elective procedures.advertisement Smaller providers will be reimbursed at a higher rate than larger ones, the buy generic levitra in usa department said.The release will include the first grants from the fund for rural health care providers championed by Sen.

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This time around, we note that Eloxx Pharmaceuticals (ELOX) hired Ali Hariri as chief medical officer. Previously, he worked at Sanofi (SNY), where he was senior global project head in rare disease clinical development. Unlock this article by subscribing to STAT+ and enjoy your first 30 days buy generic levitra in usa free!.

GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley buy generic levitra in usa and beyond.

What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr.And so, another working week will soon draw to a close. Not a buy generic levitra in usa moment too soon, yes?.

This is, you may recall, our treasured signal to daydream about weekend plans. Our agenda is rather modest. We plan to indulge our favorite hobby — promenading buy generic levitra in usa with the official mascot.

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But be safe. Enjoy, and see you soon. €¦Senate lawmakers are actively considering pegging the prices Medicare pays for drugs to those drug makers offer to other government programs like the veterans buy generic levitra in usa health program, according to STAT.

The proposal, known internally as domestic reference pricing, could have a multibillion-dollar impact on drug makers, which have long opposed allowing Medicare to negotiate over drug prices. Setting prices to what the Department of Veterans Affairs pay for medicines was one of seven options outlined in a June 7 slide deck by a Senate committee. Unlock this article by subscribing to buy generic levitra in usa STAT+ and enjoy your first 30 days free!.

GET STARTED Log In | Learn More What is it?. STAT+ is STAT's premium subscription service for in-depth biotech, pharma, policy, and life science coverage and analysis. Our award-winning team covers news on Wall Street, policy developments in Washington, early science breakthroughs and clinical trial results, and health care disruption in Silicon Valley and beyond.

What's included?. Daily reporting and analysis The most comprehensive industry coverage from a powerhouse team of reporters Subscriber-only newsletters Daily newsletters to brief you on the most important industry news of the day STAT+ Conversations Weekly opportunities to engage with our reporters and leading industry experts in live video conversations Exclusive industry events Premium access to subscriber-only networking events around the country The best reporters in the industry The most trusted and well-connected newsroom in the health care industry And much more Exclusive interviews with industry leaders, profiles, and premium tools, like our CRISPR Trackr..

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For further information about the role including the essential and desirable criteria please visit www.qub.ac.uk/jobs or click to ApplyKey DatesClosing date. Monday, 25 October 2021Anticipated buy generic levitra in usa interview date. Monday, 06 December 2021Further informationInformation about the School buy generic levitra in usa can be found at – http://www.qub.ac.uk/schools/psy/ Further information on school’s research centres can be found at. Https://www.qub.ac.uk/schools/psy/Research/ResearchCentres/ Information on our attractive reward package can be found at.

Https://www.qub.ac.uk/directorates/HumanResources/pay-reward-and-benefits/ The University is committed to equality of opportunity and welcomes applications from all.However, our employment monitoring data tells us that individuals from the Protestant faith are also currently under-represented in this category of buy generic levitra in usa work. As such, we particularly welcome applications for this role from individuals who identify with these backgrounds and / or communities.As you may be aware, Queen’s is recognised as one of the most diverse buy generic levitra in usa organisations in Northern Ireland. We are committed to ensuring our workplace is a safe, welcoming and inclusive place to work, which is why we subscribe to Equality Charter Marks such as Stonewall Workplace Equality Index, Diversity Charter Mark NI and Athena SWAN.It is also why we have established award winning Staff Networks such as PRISM and iRise. These networks provide an opportunity for staff to meet in a friendly, informal way to support buy generic levitra in usa each other.

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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 levitra, 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..

Credit http://illastrated.com/website-design/ buy generic levitra in usa. 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 buy generic levitra in usa 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, buy generic levitra in usa 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 buy generic levitra in usa 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 buy generic levitra in usa 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 buy generic levitra in usa 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 buy generic levitra in usa. 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 buy generic levitra in usa 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 buy generic levitra in usa 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 buy generic levitra in usa 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 buy generic levitra in usa 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 can i buy levitra cancer in the same way that it would fight an .

These medicines buy generic levitra in usa 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 buy generic levitra in usa 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 buy generic levitra in usa 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 buy generic levitra in usa 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 buy generic levitra in usa 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,” buy generic levitra in usa 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 buy generic levitra in usa extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a levitra, 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 buy generic levitra in usa 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 buy generic levitra in usa 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 & buy generic levitra in usa. 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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A new school in Northern Westchester is transitioning to remote https://ioin.co.uk/zithromax-cost-no-insurance/ learning after erectile dysfunction treatment cases.Three people, two at Westlake Middle School is levitra as good as viagra and one at Hawthorne Elementary School, are being treated as positive for erectile dysfunction treatment in the Mount Pleasant Central School District, Superintendent Kurtis M. Kotes announced is levitra as good as viagra in an email to the community early Sunday night, Nov. 15."The individual related to Hawthorne Elementary School has not been in or around the building since Oct. 29," Kotes is levitra as good as viagra said. "Therefore no additional quarantine orders will be necessary for Hawthorne Elementary School and the building will remain open for hybrid, in-person instruction."The two individuals related to Westlake Middle School were both in the building on Friday, Nov.

13. There will be 100 students, 12 teachers, and potentially more support staff who will be subject to quarantine orders. "We will not be able to safely staff the building with this many people not in attendance."Beginning Monday, Nov. 16, Westlake Middle School will transition to full remote learning for a period of two weeks. Pending no further issues, the middle school will reopen for hybrid, in-person instruction on Monday, Nov.

30, Kotes said. The middle school administration will follow up with additional communication to families to ensure that students have the needed resources for this time period. Click here to sign up for Daily Voice's free daily emails and news alerts.There are now numbers behind the mass exodus of New York City residents to the suburbs and beyond amid the erectile dysfunction treatment levitra.From March 1 through Oct. 31 this year, a total of 295,103 NYC residents have made change-of-address requests.That's according to data The New York Post obtained from the US Postal Service.Most went to Long Island -- a total of more than 40,000 (21,362 to Suffolk County, with 6,500 of that number in six zip codes on the East End, and 18,731 to Nassau County), followed by Westchester County (15,850) and 9,356 to Hudson County, New Jersey (which includes Jersey City and Hoboken), the Post reported.Between July and September, nearly a billion dollars worth of property along the East End of Long Island was sold, according to a Brown Harris Stevens.According to Miller Samuel Real Estate Appraisers &. Consultants:Westchester County saw a 112 percent increase in home sales in July.In Connecticut, Fairfield County saw a 73-percent increase in July home sales.Farther north of the city, Putnam and Dutchess counties both saw double-digit percent increases.The Brown Harris Stevens report found that sales prices in the Hamptons averaged $2.17 million during the third quarter, which is up 33.2 percent from the same time last year.

The median price jumped 26.2 percent to $1.26 million. Click here to sign up for Daily Voice's free daily emails and news alerts.The erectile dysfunction treatment levitra has forced one of the country’s largest retailers to reevaluate how it does business in a “new era of retail.” Walmart announced that after being forced to adjust on the fly during the erectile dysfunction treatment outbreak, it is testing out four new stores across the country that will serve as “both physical shopping destinations and online fulfillment centers.” John Crecelius, Walmart’s Senior Vice President of Associate Product and Next Generation Stores, said that the four stores willl serve as “test centers” where they will rotate different prototype technology in and out of the store to determine what will be most convenient for in-person and online shoppers.“To increase the speed at which we learn, product and technology teams will be embedded in the stores to prototype, test and iterate solutions in real-time, scaling what works and scrapping what doesn’t, creating a true rapid prototype environment,” Crecelius added.In the first test store, Walmart is moving most of the in-store apparel assortment online, in an effort to identify other hard-to-manage categories that stores can work to make more readily available.Crecelius said that Walmart has also developed an app that speeds up the time it takes to get items from the backroom to the sales floor. Instead of scanning each box individually, associates instead hold up a handheld device, and the app uses augmented reality to highlight the boxes that are ready to go out.At the test stores, they’re also researching how to speed up the time for picking up online orders and reimagining the checkout experience to “transform a transactional experience into a relational one.” The first two test centers have been set up in Arkansas. The other store’s locations will be determined later.“In this new era of retail, assets that used to serve a single purpose will transform into flexible, scalable assets that can be used in multiple ways to serve customers how, when, and where they need,” Crecelius said. €œEvolving our stores is just the beginning,” he added.

€œIn the coming weeks and months, we’ll share more about how we’re reimagining our other physical assets to better serve the needs of customers today and into the future.” Click here to sign up for Daily Voice's free daily emails and news alerts.A school district in Northern Westchester with dozens of staff members under erectile dysfunction treatment quarantine is closing for in-person education.Ossining High School and Park School will switch to remote learning Monday, Nov. 16 through Friday, Nov. 20.The Anne M. Dorner Middle School and elementary schools will be fully remote from Monday, Nov. 16 to Wednesday, Nov.

18, before reopening for hybrid learning on Thursday, Nov. 19, and Friday, Nov. 20.A total of 34 staff members are under quarantine in the district, Superintendent of Schools Ray Sanchez said in a video posted on the district's Facebook page."We chose to pause and go to a full remote for the next week," Sanchez said. "It's solely related to staffing issues that we're dealing with." Click here to sign up for Daily Voice's free daily emails and news alerts.A New York Republican councilman is defiantly pushing back against Gov. Andrew Cuomo’s mandate that there should be no gatherings of more than 10 people over the holidays, despite a new spike in erectile dysfunction treatment cases.

Will You Be Observing The 10-Person Mandate?. Yes75%No25%Back to VoteSubscribe to the resultsStaten Island Republican Councilman Joe Borelli, the city council minority whip, declared that he will not be adhering to Cuomo’s mandates, even promoting inter-state travel against the state’s orders.

“I’ll be having more than 10 ppl at my house on Thanksgiving,” Borelli tweeted on Wednesday, Nov. 11. €œSome family will come from (gasp!. ) New Jersey.

Kids will see their grandparents, cousins will play in the yard, sis in law will bring strawberry rhubarb pie, &. A turkey will be overcooked.“My Thanksgiving party which hasn’t happened yet gets blamed for today's (sic) erectile dysfunction treatment numbers but suggesting maybe massive gatherings in NYC 7-10 days ago are partly responsible is just crazy you guys,” he later added.Both New York and New Jersey have seen spikes in rate, erectile dysfunction treatment hospitalizations, and new cases since fall hit, after the state “flattened the curve” over the summer.According to a press release announcing the rules, the limit of 10 is being implemented "due to the recent prevalence of erectile dysfunction treatment spread resulting from small indoor gatherings which have become a major cause of cluster activity across the state."Borelli doubled down in an op-ed piece in the New York Daily News on Friday, Nov. 13, stating that Cuomo and New York City Mayor Bill de Blasio have “crossed a line.” “Let me be clear about this. Government should have no role in determining how many family members you may lawfully have in your own home,” he wrote. €œNot even in the midst of a deadly levitra.

€œSuggestions, recommendations or guidelines are all fine, but our governor’s and mayor’s new regulation requiring 10 or fewer people in a private residence crosses a line. My family, my house, and, so long as we obey fire and zoning codes, my rules.”In response, Rich Azzopardi, a Cuomo spokesperson, admonished Borelli for his rigid stance that defies the advice of scientists as erectile dysfunction treatment cases continue to climb. "Nothing says Thanksgiving like putting loved ones in harm's way to own the libs," Azzopardi wrote. "Don't be a Borelli. Stay smart this holiday.

Follow the rules, they're there to keep people from getting sick. Also, socially distance, wear a mask, and wash your hands!. " Click here to sign up for Daily Voice's free daily emails and news alerts..

A new school in Northern Westchester is transitioning to remote learning after erectile dysfunction treatment cases.Three people, two at Westlake Middle Zithromax cost no insurance School and one at Hawthorne Elementary School, are being treated as positive for erectile dysfunction treatment in buy generic levitra in usa the Mount Pleasant Central School District, Superintendent Kurtis M. Kotes announced in an email buy generic levitra in usa to the community early Sunday night, Nov. 15."The individual related to Hawthorne Elementary School has not been in or around the building since Oct. 29," Kotes buy generic levitra in usa said.

"Therefore no additional quarantine orders will be necessary for Hawthorne Elementary School and the building will remain open for hybrid, in-person instruction."The two individuals related to Westlake Middle School were both in the building on Friday, Nov. 13. There will be 100 students, 12 teachers, and potentially more support staff who will be subject to quarantine orders. "We will not be able to safely staff the building with this many people not in attendance."Beginning Monday, Nov.

16, Westlake Middle School will transition to full remote learning for a period of two weeks. Pending no further issues, the middle school will reopen for hybrid, in-person instruction on Monday, Nov. 30, Kotes said. The middle school administration will follow up with additional communication to families to ensure that students have the needed resources for this time period.

Click here to sign up for Daily Voice's free daily emails and news alerts.There are now numbers behind the mass exodus of New York City residents to the suburbs and beyond amid the erectile dysfunction treatment levitra.From March 1 through Oct. 31 this year, a total of 295,103 NYC residents have made change-of-address requests.That's according to data The New York Post obtained from the US Postal Service.Most went to Long Island -- a total of more than 40,000 (21,362 to Suffolk County, with 6,500 of that number in six zip codes on the East End, and 18,731 to Nassau County), followed by Westchester County (15,850) and 9,356 to Hudson County, New Jersey (which includes Jersey City and Hoboken), the Post reported.Between July and September, nearly a billion dollars worth of property along the East End of Long Island was sold, according to a Brown Harris Stevens.According to Miller Samuel Real Estate Appraisers &. Consultants:Westchester County saw a 112 percent increase in home sales in July.In Connecticut, Fairfield County saw a 73-percent increase in July home sales.Farther north of the city, Putnam and Dutchess counties both saw double-digit percent increases.The Brown Harris Stevens report found that sales prices in the Hamptons averaged $2.17 million during the third quarter, which is up 33.2 percent from the same time last year. The median price jumped 26.2 percent to $1.26 million.

Click here to sign up for Daily Voice's free daily emails and news alerts.The erectile dysfunction treatment levitra has forced one of the country’s largest retailers to reevaluate how it does business in a “new era of retail.” Walmart announced that after being forced to adjust on the fly during the erectile dysfunction treatment outbreak, it is testing out four new stores across the country that will serve as “both physical shopping destinations and online fulfillment centers.” John Crecelius, Walmart’s Senior Vice President of Associate Product and Next Generation Stores, said that the four stores willl serve as “test centers” where they will rotate different prototype technology in and out of the store to determine what will be most convenient for in-person and online shoppers.“To increase the speed at which we learn, product and technology teams will be embedded in the stores to prototype, test and iterate solutions in real-time, scaling what works and scrapping what doesn’t, creating a true rapid prototype environment,” Crecelius added.In the first test store, Walmart is moving most of the in-store apparel assortment online, in an effort to identify other hard-to-manage categories that stores can work to make more readily available.Crecelius said that Walmart has also developed an app that speeds up the time it takes to get items from the backroom to the sales floor. Instead of scanning each box individually, associates instead hold up a handheld device, and the app uses augmented reality to highlight the boxes that are ready to go out.At the test stores, they’re also researching how to speed up the time for picking up online orders and reimagining the checkout experience to “transform a transactional experience into a relational one.” The first two test centers have been set up in Arkansas. The other store’s locations will be determined later.“In this new era of retail, assets that used to serve a single purpose will transform into flexible, scalable assets that can be used in multiple ways to serve customers how, when, and where they need,” Crecelius said. €œEvolving our stores is just the beginning,” he added.

€œIn the coming weeks and months, we’ll share more about how we’re reimagining our other physical assets to better serve the needs of customers today and into the future.” Click here to sign up for Daily Voice's free daily emails and news alerts.A school district in Northern Westchester with dozens of staff members under erectile dysfunction treatment quarantine is closing for in-person education.Ossining High School and Park School will switch to remote learning Monday, Nov. 16 through Friday, Nov. 20.The Anne M. Dorner Middle School and elementary schools will be fully remote from Monday, Nov.

16 to Wednesday, Nov. 18, before reopening for hybrid learning on Thursday, Nov. 19, and Friday, Nov. 20.A total of 34 staff members are under quarantine in the district, Superintendent of Schools Ray Sanchez said in a video posted on the district's Facebook page."We chose to pause and go to a full remote for the next week," Sanchez said.

"It's solely related to staffing issues that we're dealing with." Click here to sign up for Daily Voice's free daily emails and news alerts.A New York Republican councilman is defiantly pushing back against Gov. Andrew Cuomo’s mandate that there should be no gatherings of more than 10 people over the holidays, despite a new spike in erectile dysfunction treatment cases. Will You Be Observing The 10-Person Mandate?. Yes75%No25%Back to VoteSubscribe to the resultsStaten Island Republican Councilman Joe Borelli, the city council minority whip, declared that he will not be adhering to Cuomo’s mandates, even promoting inter-state travel against the state’s orders.

“I’ll be having more than 10 ppl at my house on Thanksgiving,” Borelli tweeted on Wednesday, Nov.

11. €œSome family will come from (gasp!. ) New Jersey. Kids will see their grandparents, cousins will play in the yard, sis in law will bring strawberry rhubarb pie, &.

A turkey will be overcooked.“My Thanksgiving party which hasn’t happened yet gets blamed for today's (sic) erectile dysfunction treatment numbers but suggesting maybe massive gatherings in NYC 7-10 days ago are partly responsible is just crazy you guys,” he later added.Both New York and New Jersey have seen spikes in rate, erectile dysfunction treatment hospitalizations, and new cases since fall hit, after the state “flattened the curve” over the summer.According to a press release announcing the rules, the limit of 10 is being implemented "due to the recent prevalence of erectile dysfunction treatment spread resulting from small indoor gatherings which have become a major cause of cluster activity across the state."Borelli doubled down in an op-ed piece in the New York Daily News on Friday, Nov. 13, stating that Cuomo and New York City Mayor Bill de Blasio have “crossed a line.” “Let me be clear about this. Government should have no role in determining how many family members you may lawfully have in your own home,” he wrote. €œNot even in the midst of a deadly levitra.

€œSuggestions, recommendations or guidelines are all fine, but our governor’s and mayor’s new regulation requiring 10 or fewer people in a private residence crosses a line. My family, my house, and, so long as we obey fire and zoning codes, my rules.”In response, Rich Azzopardi, a Cuomo spokesperson, admonished Borelli for his rigid stance that defies the advice of scientists as erectile dysfunction treatment cases continue to climb. "Nothing says Thanksgiving like putting loved ones in harm's way to own the libs," Azzopardi wrote. "Don't be a Borelli.

Stay smart this holiday. Follow the rules, they're there to keep people from getting sick. Also, socially distance, wear a mask, and wash your hands!. " Click here to sign up for Daily Voice's free daily emails and news alerts..

Viagra levitra o cialis

We provide estimates of the effectiveness of administration of the CoronaVac treatment in a countrywide mass vaccination viagra levitra o cialis campaign for the prevention of laboratory-confirmed erectile dysfunction treatment and related hospitalization, admission to the ICU, and death. Among fully immunized persons, the adjusted treatment effectiveness was 65.9% for erectile dysfunction treatment and 87.5% for hospitalization, 90.3% viagra levitra o cialis for ICU admission, and 86.3% for death. The treatment-effectiveness results were maintained in both age-subgroup analyses, notably among persons 60 years of age or older, independent of variation in testing and independent of various factors regarding treatment introduction in Chile. The treatment-effectiveness results viagra levitra o cialis in our study are similar to estimates that have been reported in Brazil for the prevention of erectile dysfunction treatment (50.7%.

95% CI, 35.6 to 62.2), including estimates of cases that resulted in medical treatment (83.7%. 95% CI, 58.0 to 93.7) and estimates of a composite end point of hospitalized, severe, or fatal viagra levitra o cialis cases (100%. 95% CI, 56.4 to 100).27 The large confidence intervals for the trial in Brazil reflect the relatively small sample (9823 viagra levitra o cialis participants) and the few cases detected (35 cases that led to medical treatment and 10 that were severe). However, our estimates are lower than the treatment effectiveness recently reported in Turkey (83.5%.

95% CI, 65.4 to 92.1),27,28 possibly owing to the viagra levitra o cialis small sample in that phase 3 clinical trial (10,029 participants in the per-protocol analysis), differences in local transmission dynamics, and the predominance of older adults among the fully or partially immunized participants in our study. Overall, our results suggest that the CoronaVac treatment had high effectiveness against severe disease, hospitalizations, and death, findings that underscore the potential of this treatment to save lives and substantially reduce demands on the health care system. Our study has at least viagra levitra o cialis three main strengths. First, we used a rich administrative health care data set, combining data from an integrated vaccination system for the total population and from the Ministry of viagra levitra o cialis Health FONASA, which covers approximately 80% of the Chilean population.

These data include information on laboratory tests, hospitalization, mortality, onset of symptoms, and clinical history in order to identify risk factors for severe disease. Information on region of residence also allowed us to control for differences viagra levitra o cialis in incidence across the country. We adjusted for income and nationality, which correlate with socioeconomic status in Chile and are thus considered to be social determinants of health. The large population sample allowed us to estimate treatment effectiveness viagra levitra o cialis both for one dose and for the complete two-dose vaccination schedule.

It also allowed for a subgroup analysis involving adults 60 years viagra levitra o cialis of age or older, a subgroup that is at higher risk for severe disease3 and that is underrepresented in clinical trials. Second, data were collected during a rapid vaccination campaign with high uptake and during a period with one of the highest community transmission rates of the levitra, which allowed for a relatively short follow-up period and for estimation of the prevention of at least four essential outcomes. erectile dysfunction treatment cases viagra levitra o cialis and related hospitalization, ICU admission, and death. Finally, Chile has the highest testing rates for erectile dysfunction treatment in Latin America, universal health care access, and a standardized, public reporting system for vital statistics, which limited the number of undetected or unascertained cases and deaths.14 Our study has several limitations.

First, as an observational study, it is subject to viagra levitra o cialis confounding. To account for known confounders, we adjusted the analyses for relevant viagra levitra o cialis variables that could affect treatment effectiveness, such as age, sex, underlying medical conditions, region of residence, and nationality. The risk of misclassification bias that would be due to the time-dependent performance of the erectile dysfunction RT-PCR assay is relatively low, because the median time from symptom onset to testing in Chile is approximately 4 days (98.1% of the tests were RT-PCR assays). In this viagra levitra o cialis 4-day period, the sensitivity and specificity of the molecular diagnosis of erectile dysfunction treatment are high.38 However, there may be a risk of selection bias.

Systematic differences between the vaccinated and unvaccinated groups, such as health-seeking behavior or risk aversion, may affect the probability of exposure to the treatment and the risk of erectile dysfunction treatment and related outcomes.39,40 However, we cannot be sure about the direction of the effect. Persons may be hesitant to get the treatment viagra levitra o cialis for various reasons, including fear of side effects, lack of trust in the government or pharmaceutical companies, or an opinion that they do not need it, and they may be more or less risk-averse. Vaccinated persons may compensate by increasing their risky behavior (Peltzman effect).40 We addressed potential differences in health care access by restricting the analysis to persons who had undergone diagnostic testing, and we found results that were consistent with those of our main analysis. Second, owing to viagra levitra o cialis the relatively short follow-up in this study, late outcomes may not have yet developed in persons who were infected near the end of the study, because the time from symptom onset to hospitalization or death can vary substantially.3,15 Therefore, effectiveness estimates regarding severe disease and death, in particular, should be interpreted with caution.

Third, during the study period, ICUs in Chile were operating at 93.5% of their capacity on average (65.7% viagra levitra o cialis of the patients had erectile dysfunction treatment).32 If fewer persons were hospitalized than would be under regular ICU operation, our effectiveness estimates for protection against ICU admission might be biased downward, and our effectiveness estimates for protection against death might be biased upward (e.g., if patients received care at a level lower than would usually be received during regular health system operation). Fourth, although the national genomic surveillance for erectile dysfunction in Chile has reported the circulation of at least two viral lineages considered to be variants of concern, P.1 and B.1.1.7 (or the gamma and alpha variants, respectively),41 we lack representative data to estimate their effect on treatment effectiveness (Table S2). Results from a test-negative design study of the effectiveness of the CoronaVac treatment in health care workers in Manaus, Brazil, where the gamma variant is now predominant, showed that the efficacy of at least one dose of the treatment against erectile dysfunction treatment was 49.6% (95% CI, 11.3 to 71.4).30 Although the treatment-effectiveness estimates in Brazil are not directly comparable with our estimates owing to differences in the viagra levitra o cialis target population, the vaccination schedule (a window of 14 to 28 days between doses is recommended in Brazil42), and immunization status, they highlight the importance of continued treatment-effectiveness monitoring. Overall, our study results suggest that the CoronaVac treatment was highly effective in protecting against severe disease and death, findings that are consistent with the results of phase 2 trials23,24 and with preliminary efficacy data.27,28To the Editor.

Because of concerns about thrombotic events after vaccination with ChAdOx1 nCoV-19 (Oxford–AstraZeneca),1 several European countries have recommended heterologous messenger RNA (mRNA) boost strategies for persons younger than 60 or 65 viagra levitra o cialis years of age who have received one dose of ChAdOx1 nCoV-19.2 To date, data on the safety and immunogenicity of these regimens are limited. Through an ongoing clinical study of the longitudinal immunogenicity of erectile dysfunction disease 2019 (erectile dysfunction treatment) viagra levitra o cialis treatments (EudraCT number, 2021-000683-30. The protocol is available with the full text of this letter at NEJM.org), we were able to assess 88 health care workers who had received one dose of ChAdOx1 nCoV-19 treatment 9 to 12 weeks earlier. Among these participants, 37 chose a homologous boost with viagra levitra o cialis ChAdOx1 nCoV-19 and 51 chose a heterologous boost with mRNA-1273 (Moderna).

The median age of the participants was 46 years (range, 28 to 62) and 40 years (range, 23 to 59), respectively. Blood specimens were obtained at the time of boost, 7 to 10 days after the boost, and 30 days after viagra levitra o cialis the boost. Levels of severe viagra levitra o cialis acute respiratory syndrome erectile dysfunction 2 (erectile dysfunction) spike protein (S)–specific and receptor-binding domain (RBD)–specific IgG were assessed with the use of an enzyme-linked immunosorbent assay and expressed as the area under the curve. Serum neutralization of the original erectile dysfunction isolate from Sweden (erectile dysfunction/01/human/2020/SWE.

GenBank accession number, MT093571.1) was measured in an viagra levitra o cialis immunofluorescence assay, with results expressed as the reciprocal of the 50% inhibitory dilution (ID50). Serum neutralization of the original erectile dysfunction isolate from Sweden and the B.1.351 (or beta) variant was also measured in a cytopathic effect assay. Information on reactogenicity before viagra levitra o cialis and after administration of the booster injection was reported by the study participants. Demographic characteristics of the participants and full details of the methods are viagra levitra o cialis provided in the Supplementary Appendix, available at NEJM.org.

On the day of the boost, the two groups had similar levels of erectile dysfunction S-specific and RBD-specific IgG and neutralizing antibodies. Levels of S-specific and RBD-specific IgG at 7 to 10 days after viagra levitra o cialis a ChAdOx1 nCoV-19 boost were 5 times as high as on the day of the boost (P<0.001). At 7 to 10 days after an mRNA-1273 boost, levels of S-specific IgG were 115 times as high and levels of RBD-specific IgG were 125 times as high as on the day of the boost (P<0.001) (Fig. S1 in the viagra levitra o cialis Supplementary Appendix).

After 30 days, levels of S-specific IgG remained similar viagra levitra o cialis to those at the 7-to-10-day time point in both groups. Figure 1. Figure 1 viagra levitra o cialis. In Vitro Neutralization of Original erectile dysfunction Isolate from Sweden and the B.1.351 Variant.

Panel A shows serum neutralization of the original severe acute respiratory syndrome erectile dysfunction 2 viagra levitra o cialis (erectile dysfunction) isolate from Sweden (erectile dysfunction/01/human/2020/SWE) on the day of the boost, 7 to 10 days later, and 1 month later. Data points are the reciprocals of the individual serum dilutions that achieved a 50% reduction in (reciprocal 50% inhibitory dilution) in an assay in which of Vero E6 cells was measured by levitra-specific immunofluorescence. Bars indicate geometric means, and 𝙸 bars indicate 95% viagra levitra o cialis confidence intervals. In the group that received a ChAdOx1 nCoV-19 boost, the numbers of participants with specimens analyzed were 35 for viagra levitra o cialis the day of the boost, 34 for days 7 to 10, and 34 for 1 month.

The corresponding numbers in the group that received an mRNA-1273 boost were 26, 28, and 20. As a reference, neutralizing antibody responses to erectile dysfunction in 4 persons who had had erectile dysfunction disease 2019 (erectile dysfunction treatment) and had received one dose of ChAdOx1 nCoV-19 treatment 9 to 12 weeks before sampling were also viagra levitra o cialis evaluated. Panel B shows serum neutralization of the original erectile dysfunction isolate from Sweden and the B.1.351 variant at the 7-to-10-day time point, with neutralization evaluated as the lowest reciprocal serum dilution at which the cytopathic effect of erectile dysfunction on Vero E6 cells was reduced by 50% or more (50% cytopathic effect). Specimens from 18 participants in the group that received a ChAdOx1 nCoV-19 boost and from 16 participants in the group that received an viagra levitra o cialis mRNA-1273 boost were analyzed.

All assays were performed under viagra levitra o cialis biosafety level 3 conditions at Umeå University (Panel A) or the Karolinska Institutet (Panel B).The potent induction of erectile dysfunction S-specific antibodies after a heterologous boost with mRNA-1273 was reflected by an increase in the in vitro reciprocal serum neutralization titer, with a reciprocal ID50 at 7 to 10 days after the boost that was 20 times as high as that on the day of the boost (P<0.001) (Figure 1A). In contrast, a homologous ChAdOx1 nCoV-19 boost led to a near doubling of the reciprocal ID50 within 7 to 10 days (P=0.09). At 1 month after the boost, an additional increase in neutralizing antibodies (to viagra levitra o cialis levels 1.6 to 1.7 times as high as the levels at 7 to 10 days) occurred in both groups, but the increase was not significant. We verified our results for neutralization of the original erectile dysfunction isolate from Sweden in another laboratory (Figure 1B).

In addition, we found that viagra levitra o cialis an mRNA-1273 boost had induced antibodies that could neutralize the B.1.351 variant of erectile dysfunction (Figure 1B). However, a ChAdOx1 nCoV-19 boost did not induce potent neutralizing antibodies against this variant, a finding consistent with findings from a previous study.3 In this relatively small cohort, the mRNA-1273 boost led to more frequent reports of fever, viagra levitra o cialis headache, chills, and muscle aches than the ChAdOx1 nCoV-19 boost. However, we found no significant difference between the groups when the events were graded according to intensity level (Fig. S2).

The reported adverse events are in line with what has been published previously for homologous ChAdOx1 nCoV-19 or mRNA-127 vaccination regimens.4,5 We conclude that the mRNA-1273 treatment can efficiently stimulate the erectile dysfunction–specific B-cell memory that has been generated by a prime dose of ChAdOx1 nCoV-19 treatment 9 to 12 weeks earlier and that it may provide better protection against the B.1.351 variant than a ChAdOx1 nCoV-19 boost. These data also suggest that mRNA treatments (here in the form of mRNA-1273) may be useful for vaccination strategies in which a third dose is to be administered to persons who have previously received two doses of ChAdOx1 nCoV-19. Johan Normark, M.D., Ph.D.Linnea Vikström, B.Sc.Yong-Dae Gwon, Ph.D.Ida-Lisa Persson, B.Sc.Alicia Edin, M.D., Ph.D.Tove Björsell, M.Sc.Andy Dernstedt, M.Sc.Umeå University, Umeå, SwedenWanda Christ, M.Sc.Karolinska Institutet, Stockholm, SwedenStaffan Tevell, M.D., Ph.D.Region Värmland, Karlstad, SwedenMagnus Evander, Ph.D.Umeå University, Umeå, SwedenJonas Klingström, Ph.D.Karolinska Institutet, Stockholm, SwedenClas Ahlm, M.D., Ph.D.Mattias Forsell, Ph.D.Umeå University, Umeå, Sweden [email protected] Supported by grants from Vetenskapsrådet (2020-06235, to Dr. Forsell, and 2020-05782, to Dr.

Klingström), SciLife Laboratories (VC-2020-0015, to Dr. Forsell), Region Västerbotten and Umeå University (RV-938855, to Dr. Ahlm), and the Center for Innovative Medicine (CIMED) (20200141, to Dr. Klingström).

Dr. Normark is a Wallenberg Center for Molecular Medicine Associated Researcher. Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. This letter was published on July 14, 2021, at NEJM.org.A data sharing statement provided by the authors is available with the full text of this letter at NEJM.org.5 References1.

Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384:2092-2101.2. European Centre for Disease Prevention and Control.

Overview of EU/EEA country recommendations on erectile dysfunction treatment vaccination with Vaxzevria, and a scoping review of evidence to guide decision-making. May 18, 2021 (https://www.ecdc.europa.eu/en/publications-data/overview-eueea-country-recommendations-erectile dysfunction treatment-vaccination-vaxzevria-and-scoping).Google Scholar3. Madhi SA, Baillie V, Cutland CL, et al. Efficacy of the ChAdOx1 nCoV-19 erectile dysfunction treatment against the B.1.351 variant.

N Engl J Med 2021;384:1885-1898.4. Baden LR, El Sahly HM, Essink B, et al. Efficacy and safety of the mRNA-1273 erectile dysfunction treatment. N Engl J Med 2021;384:403-416.5.

Folegatti PM, Ewer KJ, Aley PK, et al. Safety and immunogenicity of the ChAdOx1 nCoV-19 treatment against erectile dysfunction. A preliminary report of a phase 1/2, single-blind, randomised controlled trial. Lancet 2020;396:467-478.Participants Figure 1.

Figure 1. Enrollment and Randomization. The diagram represents all enrolled participants through November 14, 2020. The safety subset (those with a median of 2 months of follow-up, in accordance with application requirements for Emergency Use Authorization) is based on an October 9, 2020, data cut-off date.

The further procedures that one participant in the placebo group declined after dose 2 (lower right corner of the diagram) were those involving collection of blood and nasal swab samples.Table 1. Table 1. Demographic Characteristics of the Participants in the Main Safety Population. Between July 27, 2020, and November 14, 2020, a total of 44,820 persons were screened, and 43,548 persons 16 years of age or older underwent randomization at 152 sites worldwide (United States, 130 sites.

Argentina, 1. Brazil, 2. South Africa, 4. Germany, 6.

And Turkey, 9) in the phase 2/3 portion of the trial. A total of 43,448 participants received injections. 21,720 received BNT162b2 and 21,728 received placebo (Figure 1). At the data cut-off date of October 9, a total of 37,706 participants had a median of at least 2 months of safety data available after the second dose and contributed to the main safety data set.

Among these 37,706 participants, 49% were female, 83% were White, 9% were Black or African American, 28% were Hispanic or Latinx, 35% were obese (body mass index [the weight in kilograms divided by the square of the height in meters] of at least 30.0), and 21% had at least one coexisting condition. The median age was 52 years, and 42% of participants were older than 55 years of age (Table 1 and Table S2). Safety Local Reactogenicity Figure 2. Figure 2.

Local and Systemic Reactions Reported within 7 Days after Injection of BNT162b2 or Placebo, According to Age Group. Data on local and systemic reactions and use of medication were collected with electronic diaries from participants in the reactogenicity subset (8,183 participants) for 7 days after each vaccination. Solicited injection-site (local) reactions are shown in Panel A. Pain at the injection site was assessed according to the following scale.

Mild, does not interfere with activity. Moderate, interferes with activity. Severe, prevents daily activity. And grade 4, emergency department visit or hospitalization.

Redness and swelling were measured according to the following scale. Mild, 2.0 to 5.0 cm in diameter. Moderate, >5.0 to 10.0 cm in diameter. Severe, >10.0 cm in diameter.

And grade 4, necrosis or exfoliative dermatitis (for redness) and necrosis (for swelling). Systemic events and medication use are shown in Panel B. Fever categories are designated in the key. Medication use was not graded.

Additional scales were as follows. Fatigue, headache, chills, new or worsened muscle pain, new or worsened joint pain (mild. Does not interfere with activity. Moderate.

Some interference with activity. Or severe. Prevents daily activity), vomiting (mild. 1 to 2 times in 24 hours.

Moderate. >2 times in 24 hours. Or severe. Requires intravenous hydration), and diarrhea (mild.

2 to 3 loose stools in 24 hours. Moderate. 4 to 5 loose stools in 24 hours. Or severe.

6 or more loose stools in 24 hours). Grade 4 for all events indicated an emergency department visit or hospitalization. Н™¸ bars represent 95% confidence intervals, and numbers above the 𝙸 bars are the percentage of participants who reported the specified reaction.The reactogenicity subset included 8183 participants. Overall, BNT162b2 recipients reported more local reactions than placebo recipients.

Among BNT162b2 recipients, mild-to-moderate pain at the injection site within 7 days after an injection was the most commonly reported local reaction, with less than 1% of participants across all age groups reporting severe pain (Figure 2). Pain was reported less frequently among participants older than 55 years of age (71% reported pain after the first dose. 66% after the second dose) than among younger participants (83% after the first dose. 78% after the second dose).

A noticeably lower percentage of participants reported injection-site redness or swelling. The proportion of participants reporting local reactions did not increase after the second dose (Figure 2A), and no participant reported a grade 4 local reaction. In general, local reactions were mostly mild-to-moderate in severity and resolved within 1 to 2 days. Systemic Reactogenicity Systemic events were reported more often by younger treatment recipients (16 to 55 years of age) than by older treatment recipients (more than 55 years of age) in the reactogenicity subset and more often after dose 2 than dose 1 (Figure 2B).

The most commonly reported systemic events were fatigue and headache (59% and 52%, respectively, after the second dose, among younger treatment recipients. 51% and 39% among older recipients), although fatigue and headache were also reported by many placebo recipients (23% and 24%, respectively, after the second dose, among younger treatment recipients. 17% and 14% among older recipients). The frequency of any severe systemic event after the first dose was 0.9% or less.

Severe systemic events were reported in less than 2% of treatment recipients after either dose, except for fatigue (in 3.8%) and headache (in 2.0%) after the second dose. Fever (temperature, ≥38°C) was reported after the second dose by 16% of younger treatment recipients and by 11% of older recipients. Only 0.2% of treatment recipients and 0.1% of placebo recipients reported fever (temperature, 38.9 to 40°C) after the first dose, as compared with 0.8% and 0.1%, respectively, after the second dose. Two participants each in the treatment and placebo groups reported temperatures above 40.0°C.

Younger treatment recipients were more likely to use antipyretic or pain medication (28% after dose 1. 45% after dose 2) than older treatment recipients (20% after dose 1. 38% after dose 2), and placebo recipients were less likely (10 to 14%) than treatment recipients to use the medications, regardless of age or dose. Systemic events including fever and chills were observed within the first 1 to 2 days after vaccination and resolved shortly thereafter.

Daily use of the electronic diary ranged from 90 to 93% for each day after the first dose and from 75 to 83% for each day after the second dose. No difference was noted between the BNT162b2 group and the placebo group. Adverse Events Adverse event analyses are provided for all enrolled 43,252 participants, with variable follow-up time after dose 1 (Table S3). More BNT162b2 recipients than placebo recipients reported any adverse event (27% and 12%, respectively) or a related adverse event (21% and 5%).

This distribution largely reflects the inclusion of transient reactogenicity events, which were reported as adverse events more commonly by treatment recipients than by placebo recipients. Sixty-four treatment recipients (0.3%) and 6 placebo recipients (<0.1%) reported lymphadenopathy. Few participants in either group had severe adverse events, serious adverse events, or adverse events leading to withdrawal from the trial. Four related serious adverse events were reported among BNT162b2 recipients (shoulder injury related to treatment administration, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia).

Two BNT162b2 recipients died (one from arteriosclerosis, one from cardiac arrest), as did four placebo recipients (two from unknown causes, one from hemorrhagic stroke, and one from myocardial infarction). No deaths were considered by the investigators to be related to the treatment or placebo. No erectile dysfunction treatment–associated deaths were observed. No stopping rules were met during the reporting period.

Safety monitoring will continue for 2 years after administration of the second dose of treatment. Efficacy Table 2. Table 2. treatment Efficacy against erectile dysfunction treatment at Least 7 days after the Second Dose.

Table 3. Table 3. treatment Efficacy Overall and by Subgroup in Participants without Evidence of before 7 Days after Dose 2. Figure 3.

Figure 3. Efficacy of BNT162b2 against erectile dysfunction treatment after the First Dose. Shown is the cumulative incidence of erectile dysfunction treatment after the first dose (modified intention-to-treat population). Each symbol represents erectile dysfunction treatment cases starting on a given day.

Filled symbols represent severe erectile dysfunction treatment cases. Some symbols represent more than one case, owing to overlapping dates. The inset shows the same data on an enlarged y axis, through 21 days. Surveillance time is the total time in 1000 person-years for the given end point across all participants within each group at risk for the end point.

The time period for erectile dysfunction treatment case accrual is from the first dose to the end of the surveillance period. The confidence interval (CI) for treatment efficacy (VE) is derived according to the Clopper–Pearson method.Among 36,523 participants who had no evidence of existing or prior erectile dysfunction , 8 cases of erectile dysfunction treatment with onset at least 7 days after the second dose were observed among treatment recipients and 162 among placebo recipients. This case split corresponds to 95.0% treatment efficacy (95% confidence interval [CI], 90.3 to 97.6. Table 2).

Among participants with and those without evidence of prior SARS CoV-2 , 9 cases of erectile dysfunction treatment at least 7 days after the second dose were observed among treatment recipients and 169 among placebo recipients, corresponding to 94.6% treatment efficacy (95% CI, 89.9 to 97.3). Supplemental analyses indicated that treatment efficacy among subgroups defined by age, sex, race, ethnicity, obesity, and presence of a coexisting condition was generally consistent with that observed in the overall population (Table 3 and Table S4). treatment efficacy among participants with hypertension was analyzed separately but was consistent with the other subgroup analyses (treatment efficacy, 94.6%. 95% CI, 68.7 to 99.9.

Case split. BNT162b2, 2 cases. Placebo, 44 cases). Figure 3 shows cases of erectile dysfunction treatment or severe erectile dysfunction treatment with onset at any time after the first dose (mITT population) (additional data on severe erectile dysfunction treatment are available in Table S5).

Between the first dose and the second dose, 39 cases in the BNT162b2 group and 82 cases in the placebo group were observed, resulting in a treatment efficacy of 52% (95% CI, 29.5 to 68.4) during this interval and indicating early protection by the treatment, starting as soon as 12 days after the first dose.To the Editor. Interim immunogenicity and efficacy data for the Ad26.COV2.S treatment (Johnson &. Johnson–Janssen) against erectile dysfunction disease 2019 (erectile dysfunction treatment) have recently been reported.1-3 We describe here the 8-month durability of humoral and cellular immune responses in 20 participants who received the Ad26.COV2.S treatment in one or two doses (either 5×1010 viral particles or 1011 viral particles) and in 5 participants who received placebo.2 We evaluated antibody and T-cell responses on day 239, which was 8 months after the single-shot treatment regimen (in 10 participants) or 6 months after the two-shot treatment regimen (in 10 participants), although the present study was not powered to compare the two regimens.3 We also report neutralizing antibody responses against the parental WA1/2020 strain of severe acute respiratory syndrome erectile dysfunction 2 (erectile dysfunction), as well as against the erectile dysfunction variants D614G, B.1.1.7 (alpha), B.1.617.1 (kappa), B.1.617.2 (delta), P.1 (gamma), B.1.429 (epsilon), and B.1.351 (beta). Figure 1.

Figure 1. Humoral and Cellular Immune Responses after Ad26.COV2.S Vaccination. Panel A shows binding antibody titers against the receptor-binding domain (RBD) of the parental WA1/2020 strain of severe acute respiratory syndrome erectile dysfunction 2 (erectile dysfunction) by enzyme-linked immunosorbent assays (ELISA), pseudolevitra neutralizing antibody assays, and intracellular cytokine staining assays showing spike-specific CD8+ and CD4+ T-cell responses on days 29, 57, 71 or 85, and 239. Participants received the Ad26.COV2.S treatment in one or two doses of either 1011 viral particles (vp) or 5×1010 vp.

Red arrows indicate one treatment recipient who had breakthrough erectile dysfunction (who had received a single dose of 1011 vp) and two recipients who had also received a messenger RNA treatment (who had received two doses of 5×1010 vp) between days 71 and 239. The horizontal dashed line indicates the lower limit of quantitation. Panel B shows pseudolevitra neutralizing antibody titers against the parental WA1/2020 strain as well as the erectile dysfunction variants D614G, B.1.1.7 (alpha), B.1.617.1 (kappa), B.1.617.2 (delta), P.1 (gamma), B.1.429 (epsilon), and B.1.351 (beta) on days 29 and 239. Panel C shows pseudolevitra neutralizing antibody titers on day 239 following Ad26.COV2.S vaccination after the exclusion of the three above-mentioned participants (at left) and after restriction of the analysis to participants who received a single dose of the Ad26.COV2.S treatment (at right).

In Panels B and C, the horizontal red bar indicates the median response. For the two-dose treatment, immunizations were administered on days 1 and 57.Antibody responses were detected in all treatment recipients on day 239 (Figure 1A, upper panels). The median binding antibody titer against the WA1/2020 receptor-binding domain was 645 on day 29, 1772 on day 57, 1962 on day 71, and 1306 on day 239. The median WA1/2020 pseudolevitra neutralizing antibody titer was 272 on day 29, 169 on day 57, 340 on day 71, and 192 on day 239.

Titers were similar when the analyses were restricted to participants who had received the single-shot treatment regimen (Fig. S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). Three treatment recipients had a sharp increase in antibody responses during this time period. 1 recipient had breakthrough erectile dysfunction that was minimally symptomatic, and 2 received a messenger RNA (mRNA) treatment.

After the exclusion of these 3 participants, antibody responses were relatively stable during the 8-month period, with a reduction in the median neutralizing antibody titer by a factor of 1.8 between peak response on day 71 and the time point for assessing durability on day 239. On day 29, the median neutralizing antibody titer against the B.1.351 variant was lower by a factor of 13 than the response against the parental WA1/2020 strain. However, by day 239, that factor difference had decreased to 3 (Figure 1B). After the exclusion of the above-mentioned 3 participants, treatment recipients who received the single-shot regimen had a median neutralizing antibody titer of 184 against the parental WA1/2020 strain, 158 against the D614G variant, 147 against the B.1.1.7 variant, 171 against the B.1.617.1 variant, 107 against the B.1.617.2 variant, 129 against the P.1 variant, 87 against the B.1.429 variant, and 62 against the B.1.351 variant on day 239 (Figure 1C and Table S1).

These data suggested an expansion of neutralizing antibody breadth associated with improved coverage of erectile dysfunction variants over time, including increased neutralizing antibody titers against these variants of concern. Spike-specific interferon-γ CD8+ and CD4+ T-cell responses were evaluated by intracellular cytokine staining assays and also showed durability and stability over this time period (Figure 1A, lower panels). The median CD8+ T-cell response was 0.0545% on day 57, 0.0554% on day 85, and 0.0734% on day 239. The median CD4+ T-cell responses were 0.0435%, 0.0322%, and 0.0176%, respectively.

These data show that the Ad26.COV2.S treatment elicited durable humoral and cellular immune responses with minimal decreases for at least 8 months after immunization. In addition, we observed an expansion of neutralizing antibody breadth against erectile dysfunction variants over this time period, including against the more transmissible B.1.617.2 variant and the partially neutralization-resistant B.1.351 and P.1 variants, which suggests maturation of B-cell responses even without further boosting. The durability of immune responses elicited by the Ad26.COV2.S treatment was consistent with the durability recently reported for an Ad26-based Zika treatment.4 Longitudinal antibody responses to mRNA erectile dysfunction treatments have also been reported for 6 months but with different kinetics of decreasing titers.5 The durability of humoral and cellular immune responses 8 months after Ad26.COV2.S vaccination with increased neutralizing antibody responses to erectile dysfunction variants over time, including after single-shot vaccination, further supports the use of the Ad26.COV2.S treatment to combat the global erectile dysfunction treatment levitra. Dan H.

Barouch, M.D., Ph.D.Kathryn E. Stephenson, M.D., M.P.H.Beth Israel Deaconess Medical Center, Boston, MA [email protected]Jerald Sadoff, M.D.Janssen treatments and Prevention, Leiden, the NetherlandsJingyou Yu, Ph.D.Aiquan Chang, M.S.Makda Gebre, M.S.Katherine McMahan, B.S.Jinyan Liu, Ph.D.Abishek Chandrashekar, M.S.Shivani Patel, B.S.Beth Israel Deaconess Medical Center, Boston, MAMathieu Le Gars, Ph.D.Anne M. De Groot, Ph.D.Janssen treatments and Prevention, Leiden, the NetherlandsDirk Heerwegh, Ph.D.Frank Struyf, M.D.Janssen Research and Development, Beerse, BelgiumMacaya Douoguih, M.D.Johan van Hoof, M.D.Hanneke Schuitemaker, Ph.D.Janssen treatments and Prevention, Leiden, the Netherlands Supported by Janssen treatments and Prevention. The Ragon Institute of MGH, MIT, and Harvard.

The Massachusetts Consortium on Pathogen Readiness. The Musk Foundation. And the National Institutes of Health (grant number, CA260476). This project was funded in part by a grant (HHSO100201700018C) from the Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response.

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. This letter was published on July 14, 2021, at NEJM.org.Requests for access to the study data can be submitted to Dr. Barouch at [email protected].5 References1. Sadoff J, Gray G, Vandebosch A, et al.

Safety and efficacy of single-dose Ad26.COV2.S treatment against erectile dysfunction treatment. N Engl J Med 2021;384:2187-2201.2. Stephenson KE, Le Gars M, Sadoff J, et al. Immunogenicity of the Ad26.COV2.S treatment for erectile dysfunction treatment.

JAMA 2021;325:1535-1544.3. Sadoff J, Le Gars M, Shukarev G, et al. Interim results of a phase 1–2a trial of Ad26.COV2.S erectile dysfunction treatment. N Engl J Med 2021;384:1824-1835.4.

Salisch NC, Stephenson KE, Williams K, et al. A double-blind, randomized, placebo-controlled phase 1 study of Ad26.ZIKV.001, an Ad26-vectored anti-Zika levitra treatment. Ann Intern Med 2021;174:585-594.5. Doria-Rose N, Suthar MS, Makowski M, et al.

Antibody persistence through 6 months after the second dose of mRNA-1273 treatment for erectile dysfunction treatment. N Engl J Med 2021;384:2259-2261..

We provide estimates of the effectiveness of administration buy generic levitra in usa of the CoronaVac treatment in a countrywide mass vaccination campaign for the prevention of laboratory-confirmed erectile dysfunction treatment and related hospitalization, admission to the ICU, and death cheap levitra no prescription. Among fully immunized persons, the adjusted treatment effectiveness was buy generic levitra in usa 65.9% for erectile dysfunction treatment and 87.5% for hospitalization, 90.3% for ICU admission, and 86.3% for death. The treatment-effectiveness results were maintained in both age-subgroup analyses, notably among persons 60 years of age or older, independent of variation in testing and independent of various factors regarding treatment introduction in Chile. The treatment-effectiveness results in our study are similar to estimates that have been reported in Brazil for the buy generic levitra in usa prevention of erectile dysfunction treatment (50.7%. 95% CI, 35.6 to 62.2), including estimates of cases that resulted in medical treatment (83.7%.

95% CI, 58.0 to 93.7) and buy generic levitra in usa estimates of a composite end point of hospitalized, severe, or fatal cases (100%. 95% CI, 56.4 to 100).27 The large confidence intervals for the trial in Brazil reflect the buy generic levitra in usa relatively small sample (9823 participants) and the few cases detected (35 cases that led to medical treatment and 10 that were severe). However, our estimates are lower than the treatment effectiveness recently reported in Turkey (83.5%. 95% CI, 65.4 to 92.1),27,28 possibly owing to the small sample in that phase 3 clinical trial (10,029 participants in the per-protocol analysis), differences in local transmission dynamics, and the buy generic levitra in usa predominance of older adults among the fully or partially immunized participants in our study. Overall, our results suggest that the CoronaVac treatment had high effectiveness against severe disease, hospitalizations, and death, findings that underscore the potential of this treatment to save lives and substantially reduce demands on the health care system.

Our study buy generic levitra in usa has at least three main strengths. First, we used a rich administrative health care data set, combining data from an integrated vaccination system for the total population and from the Ministry of Health FONASA, buy generic levitra in usa which covers approximately 80% of the Chilean population. These data include information on laboratory tests, hospitalization, mortality, onset of symptoms, and clinical history in order to identify risk factors for severe disease. Information on region of residence also buy generic levitra in usa allowed us to control for differences in incidence across the country. We adjusted for income and nationality, which correlate with socioeconomic status in Chile and are thus considered to be social determinants of health.

The large population sample allowed us to estimate treatment effectiveness both for one dose buy generic levitra in usa and for the complete two-dose vaccination schedule. It also allowed for a subgroup analysis involving adults 60 years of age or older, a subgroup that is at buy generic levitra in usa higher risk for severe disease3 and that is underrepresented in clinical trials. Second, data were collected during a rapid vaccination campaign with high uptake and during a period with one of the highest community transmission rates of the levitra, which allowed for a relatively short follow-up period and for estimation of the prevention of at least four essential outcomes. erectile dysfunction treatment cases buy generic levitra in usa and related hospitalization, ICU admission, and death. Finally, Chile has the highest testing rates for erectile dysfunction treatment in Latin America, universal health care access, and a standardized, public reporting system for vital statistics, which limited the number of undetected or unascertained cases and deaths.14 Our study has several limitations.

First, as an observational study, it buy generic levitra in usa is subject to confounding. To account for known confounders, we adjusted the analyses for relevant variables that could affect treatment effectiveness, such as age, sex, underlying medical conditions, region of residence, and buy generic levitra in usa nationality. The risk of misclassification bias that would be due to the time-dependent performance of the erectile dysfunction RT-PCR assay is relatively low, because the median time from symptom onset to testing in Chile is approximately 4 days (98.1% of the tests were RT-PCR assays). In this 4-day period, the sensitivity and specificity of the molecular diagnosis of buy generic levitra in usa erectile dysfunction treatment are high.38 However, there may be a risk of selection bias. Systematic differences between the vaccinated and unvaccinated groups, such as health-seeking behavior or risk aversion, may affect the probability of exposure to the treatment and the risk of erectile dysfunction treatment and related outcomes.39,40 However, we cannot be sure about the direction of the effect.

Persons may be hesitant to get the treatment for various reasons, including fear of side effects, lack of trust in buy generic levitra in usa the government or pharmaceutical companies, or an opinion that they do not need it, and they may be more or less risk-averse. Vaccinated persons may compensate by increasing their risky behavior (Peltzman effect).40 We addressed potential differences in health care access by restricting the analysis to persons who had undergone diagnostic testing, and we found results that were consistent with those of our main analysis. Second, owing to the relatively buy generic levitra in usa short follow-up in this study, late outcomes may not have yet developed in persons who were infected near the end of the study, because the time from symptom onset to hospitalization or death can vary substantially.3,15 Therefore, effectiveness estimates regarding severe disease and death, in particular, should be interpreted with caution. Third, during the study period, ICUs in Chile were operating at 93.5% of their capacity on average (65.7% of the patients had erectile dysfunction treatment).32 If fewer persons were hospitalized than would be under regular ICU operation, our effectiveness estimates for protection against ICU admission might be biased downward, and our effectiveness estimates for protection against death might be biased upward (e.g., if patients received care at a level lower than would buy generic levitra in usa usually be received during regular health system operation). Fourth, although the national genomic surveillance for erectile dysfunction in Chile has reported the circulation of at least two viral lineages considered to be variants of concern, P.1 and B.1.1.7 (or the gamma and alpha variants, respectively),41 we lack representative data to estimate their effect on treatment effectiveness (Table S2).

Results from a test-negative design study of the effectiveness of the CoronaVac treatment in health care workers buy generic levitra in usa in Manaus, Brazil, where the gamma variant is now predominant, showed that the efficacy of at least one dose of the treatment against erectile dysfunction treatment was 49.6% (95% CI, 11.3 to 71.4).30 Although the treatment-effectiveness estimates in Brazil are not directly comparable with our estimates owing to differences in the target population, the vaccination schedule (a window of 14 to 28 days between doses is recommended in Brazil42), and immunization status, they highlight the importance of continued treatment-effectiveness monitoring. Overall, our study results suggest that the CoronaVac treatment was highly effective in protecting against severe disease and death, findings that are consistent with the results of phase 2 trials23,24 and with preliminary efficacy data.27,28To the Editor. Because of concerns about thrombotic events after vaccination with ChAdOx1 nCoV-19 (Oxford–AstraZeneca),1 several European countries have recommended heterologous messenger RNA (mRNA) boost strategies for buy generic levitra in usa persons younger than 60 or 65 years of age who have received one dose of ChAdOx1 nCoV-19.2 To date, data on the safety and immunogenicity of these regimens are limited. Through an ongoing clinical study of the longitudinal immunogenicity of erectile dysfunction disease 2019 buy generic levitra in usa (erectile dysfunction treatment) treatments (EudraCT number, 2021-000683-30. The protocol is available with the full text of this letter at NEJM.org), we were able to assess 88 health care workers who had received one dose of ChAdOx1 nCoV-19 treatment 9 to 12 weeks earlier.

Among these participants, 37 buy generic levitra in usa chose a homologous boost with ChAdOx1 nCoV-19 and 51 chose a heterologous boost with mRNA-1273 (Moderna). The median age of the participants was 46 years (range, 28 to 62) and 40 years (range, 23 to 59), respectively. Blood specimens buy generic levitra in usa were obtained at the time of boost, 7 to 10 days after the boost, and 30 days after the boost. Levels of severe acute respiratory syndrome erectile dysfunction 2 (erectile dysfunction) spike protein (S)–specific and receptor-binding domain buy generic levitra in usa (RBD)–specific IgG were assessed with the use of an enzyme-linked immunosorbent assay and expressed as the area under the curve. Serum neutralization of the original erectile dysfunction isolate from Sweden (erectile dysfunction/01/human/2020/SWE.

GenBank accession number, MT093571.1) was measured in an immunofluorescence assay, with results expressed as the reciprocal of the 50% inhibitory dilution buy generic levitra in usa (ID50). Serum neutralization of the original erectile dysfunction isolate from Sweden and the B.1.351 (or beta) variant was also measured in a cytopathic effect assay. Information on reactogenicity before and after administration of the booster injection was reported buy generic levitra in usa by the study participants. Demographic characteristics buy generic levitra in usa of the participants and full details of the methods are provided in the Supplementary Appendix, available at NEJM.org. On the day of the boost, the two groups had similar levels of erectile dysfunction S-specific and RBD-specific IgG and neutralizing antibodies.

Levels of S-specific and RBD-specific IgG at 7 buy generic levitra in usa to 10 days after a ChAdOx1 nCoV-19 boost were 5 times as high as on the day of the boost (P<0.001). At 7 to 10 days after an mRNA-1273 boost, levels of S-specific IgG were 115 times as high and levels of RBD-specific IgG were 125 times as high as on the day of the boost (P<0.001) (Fig. S1 in buy generic levitra in usa the Supplementary Appendix). After 30 days, levels of S-specific buy generic levitra in usa IgG remained similar to those at the 7-to-10-day time point in both groups. Figure 1.

Figure 1 buy generic levitra in usa. In Vitro Neutralization of Original erectile dysfunction Isolate from Sweden and the B.1.351 Variant. Panel A shows serum neutralization of the original severe buy generic levitra in usa acute respiratory syndrome erectile dysfunction 2 (erectile dysfunction) isolate from Sweden (erectile dysfunction/01/human/2020/SWE) on the day of the boost, 7 to 10 days later, and 1 month later. Data points are the reciprocals of the individual serum dilutions that achieved a 50% reduction in (reciprocal 50% inhibitory dilution) in an assay in which of Vero E6 cells was measured by levitra-specific immunofluorescence. Bars indicate geometric buy generic levitra in usa means, and 𝙸 bars indicate 95% confidence intervals.

In the group that received a ChAdOx1 nCoV-19 boost, the numbers of participants with specimens analyzed were 35 for the day of the boost, 34 for days 7 to 10, and 34 for buy generic levitra in usa 1 month. The corresponding numbers in the group that received an mRNA-1273 boost were 26, 28, and 20. As a reference, neutralizing buy generic levitra in usa antibody responses to erectile dysfunction in 4 persons who had had erectile dysfunction disease 2019 (erectile dysfunction treatment) and had received one dose of ChAdOx1 nCoV-19 treatment 9 to 12 weeks before sampling were also evaluated. Panel B shows serum neutralization of the original erectile dysfunction isolate from Sweden and the B.1.351 variant at the 7-to-10-day time point, with neutralization evaluated as the lowest reciprocal serum dilution at which the cytopathic effect of erectile dysfunction on Vero E6 cells was reduced by 50% or more (50% cytopathic effect). Specimens from 18 participants in the group that buy generic levitra in usa received a ChAdOx1 nCoV-19 boost and from 16 participants in the group that received an mRNA-1273 boost were analyzed.

All assays were performed under biosafety level 3 conditions at Umeå University (Panel A) or the Karolinska Institutet (Panel B).The potent induction of erectile dysfunction S-specific antibodies after a heterologous boost with mRNA-1273 was reflected by an increase in the in vitro reciprocal serum neutralization titer, with a reciprocal ID50 at 7 to buy generic levitra in usa 10 days after the boost that was 20 times as high as that on the day of the boost (P<0.001) (Figure 1A). In contrast, a homologous ChAdOx1 nCoV-19 boost led to a near doubling of the reciprocal ID50 within 7 to 10 days (P=0.09). At 1 month after the boost, an additional increase in neutralizing antibodies (to levels 1.6 to 1.7 times as high as the levels buy generic levitra in usa at 7 to 10 days) occurred in both groups, but the increase was not significant. We verified our results for neutralization of the original erectile dysfunction isolate from Sweden in another laboratory (Figure 1B). In addition, we found that an mRNA-1273 boost buy generic levitra in usa had induced antibodies that could neutralize the B.1.351 variant of erectile dysfunction (Figure 1B).

However, a ChAdOx1 nCoV-19 boost did not induce potent neutralizing antibodies against this variant, a finding consistent with findings buy generic levitra in usa from a previous study.3 In this relatively small cohort, the mRNA-1273 boost led to more frequent reports of fever, headache, chills, and muscle aches than the ChAdOx1 nCoV-19 boost. However, we found no significant difference between the groups when the events were graded according to intensity level (Fig. S2). The reported adverse events are in line with what has been published previously for homologous ChAdOx1 nCoV-19 or mRNA-127 vaccination regimens.4,5 We conclude that the mRNA-1273 treatment can efficiently stimulate the erectile dysfunction–specific B-cell memory that has been generated by a prime dose of ChAdOx1 nCoV-19 treatment 9 to 12 weeks earlier and that it may provide better protection against the B.1.351 variant than a ChAdOx1 nCoV-19 boost. These data also suggest that mRNA treatments (here in the form of mRNA-1273) may be useful for vaccination strategies in which a third dose is to be administered to persons who have previously received two doses of ChAdOx1 nCoV-19.

Johan Normark, M.D., Ph.D.Linnea Vikström, B.Sc.Yong-Dae Gwon, Ph.D.Ida-Lisa Persson, B.Sc.Alicia Edin, M.D., Ph.D.Tove Björsell, M.Sc.Andy Dernstedt, M.Sc.Umeå University, Umeå, SwedenWanda Christ, M.Sc.Karolinska Institutet, Stockholm, SwedenStaffan Tevell, M.D., Ph.D.Region Värmland, Karlstad, SwedenMagnus Evander, Ph.D.Umeå University, Umeå, SwedenJonas Klingström, Ph.D.Karolinska Institutet, Stockholm, SwedenClas Ahlm, M.D., Ph.D.Mattias Forsell, Ph.D.Umeå University, Umeå, Sweden [email protected] Supported by grants from Vetenskapsrådet (2020-06235, to Dr. Forsell, and 2020-05782, to Dr. Klingström), SciLife Laboratories (VC-2020-0015, to Dr. Forsell), Region Västerbotten and Umeå University (RV-938855, to Dr. Ahlm), and the Center for Innovative Medicine (CIMED) (20200141, to Dr.

Klingström). Dr. Normark is a Wallenberg Center for Molecular Medicine Associated Researcher. Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. This letter was published on July 14, 2021, at NEJM.org.A data sharing statement provided by the authors is available with the full text of this letter at NEJM.org.5 References1.

Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021;384:2092-2101.2. European Centre for Disease Prevention and Control. Overview of EU/EEA country recommendations on erectile dysfunction treatment vaccination with Vaxzevria, and a scoping review of evidence to guide decision-making.

May 18, 2021 (https://www.ecdc.europa.eu/en/publications-data/overview-eueea-country-recommendations-erectile dysfunction treatment-vaccination-vaxzevria-and-scoping).Google Scholar3. Madhi SA, Baillie V, Cutland CL, et al. Efficacy of the ChAdOx1 nCoV-19 erectile dysfunction treatment against the B.1.351 variant. N Engl J Med 2021;384:1885-1898.4. Baden LR, El Sahly HM, Essink B, et al.

Efficacy and safety of the mRNA-1273 erectile dysfunction treatment. N Engl J Med 2021;384:403-416.5. Folegatti PM, Ewer KJ, Aley PK, et al. Safety and immunogenicity of the ChAdOx1 nCoV-19 treatment against erectile dysfunction. A preliminary report of a phase 1/2, single-blind, randomised controlled trial.

Lancet 2020;396:467-478.Participants Figure 1. Figure 1. Enrollment and Randomization. The diagram represents all enrolled participants through November 14, 2020. The safety subset (those with a median of 2 months of follow-up, in accordance with application requirements for Emergency Use Authorization) is based on an October 9, 2020, data cut-off date.

The further procedures that one participant in the placebo group declined after dose 2 (lower right corner of the diagram) were those involving collection of blood and nasal swab samples.Table 1. Table 1. Demographic Characteristics of the Participants in the Main Safety Population. Between July 27, 2020, and November 14, 2020, a total of 44,820 persons were screened, and 43,548 persons 16 years of age or older underwent randomization at 152 sites worldwide (United States, 130 sites. Argentina, 1.

Brazil, 2. South Africa, 4. Germany, 6. And Turkey, 9) in the phase 2/3 portion of the trial. A total of 43,448 participants received injections.

21,720 received BNT162b2 and 21,728 received placebo (Figure 1). At the data cut-off date of October 9, a total of 37,706 participants had a median of at least 2 months of safety data available after the second dose and contributed to the main safety data set. Among these 37,706 participants, 49% were female, 83% were White, 9% were Black or African American, 28% were Hispanic or Latinx, 35% were obese (body mass index [the weight in kilograms divided by the square of the height in meters] of at least 30.0), and 21% had at least one coexisting condition. The median age was 52 years, and 42% of participants were older than 55 years of age (Table 1 and Table S2). Safety Local Reactogenicity Figure 2.

Figure 2. Local and Systemic Reactions Reported within 7 Days after Injection of BNT162b2 or Placebo, According to Age Group. Data on local and systemic reactions and use of medication were collected with electronic diaries from participants in the reactogenicity subset (8,183 participants) for 7 days after each vaccination. Solicited injection-site (local) reactions are shown in Panel A. Pain at the injection site was assessed according to the following scale.

Mild, does not interfere with activity. Moderate, interferes with activity. Severe, prevents daily activity. And grade 4, emergency department visit or hospitalization. Redness and swelling were measured according to the following scale.

Mild, 2.0 to 5.0 cm in diameter. Moderate, >5.0 to 10.0 cm in diameter. Severe, >10.0 cm in diameter. And grade 4, necrosis or exfoliative dermatitis (for redness) and necrosis (for swelling). Systemic events and medication use are shown in Panel B.

Fever categories are designated in the key. Medication use was not graded. Additional scales were as follows. Fatigue, headache, chills, new or worsened muscle pain, new or worsened joint pain (mild. Does not interfere with activity.

Moderate. Some interference with activity. Or severe. Prevents daily activity), vomiting (mild. 1 to 2 times in 24 hours.

Moderate. >2 times in 24 hours. Or severe. Requires intravenous hydration), and diarrhea (mild. 2 to 3 loose stools in 24 hours.

Moderate. 4 to 5 loose stools in 24 hours. Or severe. 6 or more loose stools in 24 hours). Grade 4 for all events indicated an emergency department visit or hospitalization.

Н™¸ bars represent 95% confidence intervals, and numbers above the 𝙸 bars are the percentage of participants who reported the specified reaction.The reactogenicity subset included 8183 participants. Overall, BNT162b2 recipients reported more local reactions than placebo recipients. Among BNT162b2 recipients, mild-to-moderate pain at the injection site within 7 days after an injection was the most commonly reported local reaction, with less than 1% of participants across all age groups reporting severe pain (Figure 2). Pain was reported less frequently among participants older than 55 years of age (71% reported pain after the first dose. 66% after the second dose) than among younger participants (83% after the first dose.

78% after the second dose). A noticeably lower percentage of participants reported injection-site redness or swelling. The proportion of participants reporting local reactions did not increase after the second dose (Figure 2A), and no participant reported a grade 4 local reaction. In general, local reactions were mostly mild-to-moderate in severity and resolved within 1 to 2 days. Systemic Reactogenicity Systemic events were reported more often by younger treatment recipients (16 to 55 years of age) than by older treatment recipients (more than 55 years of age) in the reactogenicity subset and more often after dose 2 than dose 1 (Figure 2B).

The most commonly reported systemic events were fatigue and headache (59% and 52%, respectively, after the second dose, among younger treatment recipients. 51% and 39% among older recipients), although fatigue and headache were also reported by many placebo recipients (23% and 24%, respectively, after the second dose, among younger treatment recipients. 17% and 14% among older recipients). The frequency of any severe systemic event after the first dose was 0.9% or less. Severe systemic events were reported in less than 2% of treatment recipients after either dose, except for fatigue (in 3.8%) and headache (in 2.0%) after the second dose.

Fever (temperature, ≥38°C) was reported after the second dose by 16% of younger treatment recipients and by 11% of older recipients. Only 0.2% of treatment recipients and 0.1% of placebo recipients reported fever (temperature, 38.9 to 40°C) after the first dose, as compared with 0.8% and 0.1%, respectively, after the second dose. Two participants each in the treatment and placebo groups reported temperatures above 40.0°C. Younger treatment recipients were more likely to use antipyretic or pain medication (28% after dose 1. 45% after dose 2) than older treatment recipients (20% after dose 1.

38% after dose 2), and placebo recipients were less likely (10 to 14%) than treatment recipients to use the medications, regardless of age or dose. Systemic events including fever and chills were observed within the first 1 to 2 days after vaccination and resolved shortly thereafter. Daily use of the electronic diary ranged from 90 to 93% for each day after the first dose and from 75 to 83% for each day after the second dose. No difference was noted between the BNT162b2 group and the placebo group. Adverse Events Adverse event analyses are provided for all enrolled 43,252 participants, with variable follow-up time after dose 1 (Table S3).

More BNT162b2 recipients than placebo recipients reported any adverse event (27% and 12%, respectively) or a related adverse event (21% and 5%). This distribution largely reflects the inclusion of transient reactogenicity events, which were reported as adverse events more commonly by treatment recipients than by placebo recipients. Sixty-four treatment recipients (0.3%) and 6 placebo recipients (<0.1%) reported lymphadenopathy. Few participants in either group had severe adverse events, serious adverse events, or adverse events leading to withdrawal from the trial. Four related serious adverse events were reported among BNT162b2 recipients (shoulder injury related to treatment administration, right axillary lymphadenopathy, paroxysmal ventricular arrhythmia, and right leg paresthesia).

Two BNT162b2 recipients died (one from arteriosclerosis, one from cardiac arrest), as did four placebo recipients (two from unknown causes, one from hemorrhagic stroke, and one from myocardial infarction). No deaths were considered by the investigators to be related to the treatment or placebo. No erectile dysfunction treatment–associated deaths were observed. No stopping rules were met during the reporting period. Safety monitoring will continue for 2 years after administration of the second dose of treatment.

Efficacy Table 2. Table 2. treatment Efficacy against erectile dysfunction treatment at Least 7 days after the Second Dose. Table 3. Table 3.

treatment Efficacy Overall and by Subgroup in Participants without Evidence of before 7 Days after Dose 2. Figure 3. Figure 3. Efficacy of BNT162b2 against erectile dysfunction treatment after the First Dose. Shown is the cumulative incidence of erectile dysfunction treatment after the first dose (modified intention-to-treat population).

Each symbol represents erectile dysfunction treatment cases starting on a given day. Filled symbols represent severe erectile dysfunction treatment cases. Some symbols represent more than one case, owing to overlapping dates. The inset shows the same data on an enlarged y axis, through 21 days. Surveillance time is the total time in 1000 person-years for the given end point across all participants within each group at risk for the end point.

The time period for erectile dysfunction treatment case accrual is from the first dose to the end of the surveillance period. The confidence interval (CI) for treatment efficacy (VE) is derived according to the Clopper–Pearson method.Among 36,523 participants who had no evidence of existing or prior erectile dysfunction , 8 cases of erectile dysfunction treatment with onset at least 7 days after the second dose were observed among treatment recipients and 162 among placebo recipients. This case split corresponds to 95.0% treatment efficacy (95% confidence interval [CI], 90.3 to 97.6. Table 2). Among participants with and those without evidence of prior SARS CoV-2 , 9 cases of erectile dysfunction treatment at least 7 days after the second dose were observed among treatment recipients and 169 among placebo recipients, corresponding to 94.6% treatment efficacy (95% CI, 89.9 to 97.3).

Supplemental analyses indicated that treatment efficacy among subgroups defined by age, sex, race, ethnicity, obesity, and presence of a coexisting condition was generally consistent with that observed in the overall population (Table 3 and Table S4). treatment efficacy among participants with hypertension was analyzed separately but was consistent with the other subgroup analyses (treatment efficacy, 94.6%. 95% CI, 68.7 to 99.9. Case split. BNT162b2, 2 cases.

Placebo, 44 cases). Figure 3 shows cases of erectile dysfunction treatment or severe erectile dysfunction treatment with onset at any time after the first dose (mITT population) (additional data on severe erectile dysfunction treatment are available in Table S5). Between the first dose and the second dose, 39 cases in the BNT162b2 group and 82 cases in the placebo group were observed, resulting in a treatment efficacy of 52% (95% CI, 29.5 to 68.4) during this interval and indicating early protection by the treatment, starting as soon as 12 days after the first dose.To the Editor. Interim immunogenicity and efficacy data for the Ad26.COV2.S treatment (Johnson &. Johnson–Janssen) against erectile dysfunction disease 2019 (erectile dysfunction treatment) have recently been reported.1-3 We describe here the 8-month durability of humoral and cellular immune responses in 20 participants who received the Ad26.COV2.S treatment in one or two doses (either 5×1010 viral particles or 1011 viral particles) and in 5 participants who received placebo.2 We evaluated antibody and T-cell responses on day 239, which was 8 months after the single-shot treatment regimen (in 10 participants) or 6 months after the two-shot treatment regimen (in 10 participants), although the present study was not powered to compare the two regimens.3 We also report neutralizing antibody responses against the parental WA1/2020 strain of severe acute respiratory syndrome erectile dysfunction 2 (erectile dysfunction), as well as against the erectile dysfunction variants D614G, B.1.1.7 (alpha), B.1.617.1 (kappa), B.1.617.2 (delta), P.1 (gamma), B.1.429 (epsilon), and B.1.351 (beta).

Figure 1. Figure 1. Humoral and Cellular Immune Responses after Ad26.COV2.S Vaccination. Panel A shows binding antibody titers against the receptor-binding domain (RBD) of the parental WA1/2020 strain of severe acute respiratory syndrome erectile dysfunction 2 (erectile dysfunction) by enzyme-linked immunosorbent assays (ELISA), pseudolevitra neutralizing antibody assays, and intracellular cytokine staining assays showing spike-specific CD8+ and CD4+ T-cell responses on days 29, 57, 71 or 85, and 239. Participants received the Ad26.COV2.S treatment in one or two doses of either 1011 viral particles (vp) or 5×1010 vp.

Red arrows indicate one treatment recipient who had breakthrough erectile dysfunction (who had received a single dose of 1011 vp) and two recipients who had also received a messenger RNA treatment (who had received two doses of 5×1010 vp) between days 71 and 239. The horizontal dashed line indicates the lower limit of quantitation. Panel B shows pseudolevitra neutralizing antibody titers against the parental WA1/2020 strain as well as the erectile dysfunction variants D614G, B.1.1.7 (alpha), B.1.617.1 (kappa), B.1.617.2 (delta), P.1 (gamma), B.1.429 (epsilon), and B.1.351 (beta) on days 29 and 239. Panel C shows pseudolevitra neutralizing antibody titers on day 239 following Ad26.COV2.S vaccination after the exclusion of the three above-mentioned participants (at left) and after restriction of the analysis to participants who received a single dose of the Ad26.COV2.S treatment (at right). In Panels B and C, the horizontal red bar indicates the median response.

For the two-dose treatment, immunizations were administered on days 1 and 57.Antibody responses were detected in all treatment recipients on day 239 (Figure 1A, upper panels). The median binding antibody titer against the WA1/2020 receptor-binding domain was 645 on day 29, 1772 on day 57, 1962 on day 71, and 1306 on day 239. The median WA1/2020 pseudolevitra neutralizing antibody titer was 272 on day 29, 169 on day 57, 340 on day 71, and 192 on day 239. Titers were similar when the analyses were restricted to participants who had received the single-shot treatment regimen (Fig. S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).

Three treatment recipients had a sharp increase in antibody responses during this time period. 1 recipient had breakthrough erectile dysfunction that was minimally symptomatic, and 2 received a messenger RNA (mRNA) treatment. After the exclusion of these 3 participants, antibody responses were relatively stable during the 8-month period, with a reduction in the median neutralizing antibody titer by a factor of 1.8 between peak response on day 71 and the time point for assessing durability on day 239. On day 29, the median neutralizing antibody titer against the B.1.351 variant was lower by a factor of 13 than the response against the parental WA1/2020 strain. However, by day 239, that factor difference had decreased to 3 (Figure 1B).

After the exclusion of the above-mentioned 3 participants, treatment recipients who received the single-shot regimen had a median neutralizing antibody titer of 184 against the parental WA1/2020 strain, 158 against the D614G variant, 147 against the B.1.1.7 variant, 171 against the B.1.617.1 variant, 107 against the B.1.617.2 variant, 129 against the P.1 variant, 87 against the B.1.429 variant, and 62 against the B.1.351 variant on day 239 (Figure 1C and Table S1). These data suggested an expansion of neutralizing antibody breadth associated with improved coverage of erectile dysfunction variants over time, including increased neutralizing antibody titers against these variants of concern. Spike-specific interferon-γ CD8+ and CD4+ T-cell responses were evaluated by intracellular cytokine staining assays and also showed durability and stability over this time period (Figure 1A, lower panels). The median CD8+ T-cell response was 0.0545% on day 57, 0.0554% on day 85, and 0.0734% on day 239. The median CD4+ T-cell responses were 0.0435%, 0.0322%, and 0.0176%, respectively.

These data show that the Ad26.COV2.S treatment elicited durable humoral and cellular immune responses with minimal decreases for at least 8 months after immunization. In addition, we observed an expansion of neutralizing antibody breadth against erectile dysfunction variants over this time period, including against the more transmissible B.1.617.2 variant and the partially neutralization-resistant B.1.351 and P.1 variants, which suggests maturation of B-cell responses even without further boosting. The durability of immune responses elicited by the Ad26.COV2.S treatment was consistent with the durability recently reported for an Ad26-based Zika treatment.4 Longitudinal antibody responses to mRNA erectile dysfunction treatments have also been reported for 6 months but with different kinetics of decreasing titers.5 The durability of humoral and cellular immune responses 8 months after Ad26.COV2.S vaccination with increased neutralizing antibody responses to erectile dysfunction variants over time, including after single-shot vaccination, further supports the use of the Ad26.COV2.S treatment to combat the global erectile dysfunction treatment levitra. Dan H. Barouch, M.D., Ph.D.Kathryn E.

Stephenson, M.D., M.P.H.Beth Israel Deaconess Medical Center, Boston, MA [email protected]Jerald Sadoff, M.D.Janssen treatments and Prevention, Leiden, the NetherlandsJingyou Yu, Ph.D.Aiquan Chang, M.S.Makda Gebre, M.S.Katherine McMahan, B.S.Jinyan Liu, Ph.D.Abishek Chandrashekar, M.S.Shivani Patel, B.S.Beth Israel Deaconess Medical Center, Boston, MAMathieu Le Gars, Ph.D.Anne M. De Groot, Ph.D.Janssen treatments and Prevention, Leiden, the NetherlandsDirk Heerwegh, Ph.D.Frank Struyf, M.D.Janssen Research and Development, Beerse, BelgiumMacaya Douoguih, M.D.Johan van Hoof, M.D.Hanneke Schuitemaker, Ph.D.Janssen treatments and Prevention, Leiden, the Netherlands Supported by Janssen treatments and Prevention. The Ragon Institute of MGH, MIT, and Harvard. The Massachusetts Consortium on Pathogen Readiness. The Musk Foundation.

And the National Institutes of Health (grant number, CA260476). This project was funded in part by a grant (HHSO100201700018C) from the Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response. Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org. This letter was published on July 14, 2021, at NEJM.org.Requests for access to the study data can be submitted to Dr. Barouch at [email protected].5 References1.

Sadoff J, Gray G, Vandebosch A, et al. Safety and efficacy of single-dose Ad26.COV2.S treatment against erectile dysfunction treatment. N Engl J Med 2021;384:2187-2201.2. Stephenson KE, Le Gars M, Sadoff J, et al. Immunogenicity of the Ad26.COV2.S treatment for erectile dysfunction treatment.

JAMA 2021;325:1535-1544.3. Sadoff J, Le Gars M, Shukarev G, et al. Interim results of a phase 1–2a trial of Ad26.COV2.S erectile dysfunction treatment. N Engl J Med 2021;384:1824-1835.4. Salisch NC, Stephenson KE, Williams K, et al.

A double-blind, randomized, placebo-controlled phase 1 study of Ad26.ZIKV.001, an Ad26-vectored anti-Zika levitra treatment. Ann Intern Med 2021;174:585-594.5. Doria-Rose N, Suthar MS, Makowski M, et al. Antibody persistence through 6 months after the second dose of mRNA-1273 treatment for erectile dysfunction treatment. N Engl J Med 2021;384:2259-2261..

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July 7, 2021 -- Kevin best generic levitra Gendreau, MD, a weight loss doctor at Southcoast Health in Fall River, MA, lets patients know that he was once obese. He says this knowledge inspires and motivates them to lose weight. After dropping 125 pounds over 18 months, “I can relate to their binges, hardships, and best generic levitra plateaus on a very personal level,” he says. Peminda Cabandugama, MD, an endocrinologist and obesity medicine specialist at Truman Medical Center at the University of Missouri-Kansas City, has weighed between 180 and 240 pounds in the past decade.

He now weighs 225 pounds and has a healthy lifestyle. €œI have had patients come to me saying, ‘I used to see a different weight best generic levitra loss doctor who was not heavy. But how can he understand what I’m going through?. €™â€ he says.

Cabandugama shares his weight loss struggles with patients best generic levitra “to dispel this myth that weight management is as simple as just eating too much and not exercising. It involves a smorgasbord of emotions and hormones, some within and outside of our control. I hope that sharing this allows me to connect more with my patients so that they know that even their health care professional goes through the same challenges that they do.” “Patients are more likely to make behavior changes when doctors are supportive and have had similar experiences and talk about their stories,” says Wendy Bennett, MD, an obesity researcher and associate professor of medicine at Johns Hopkins University in Baltimore. Do Patients best generic levitra Respect Overweight Doctors?.

While Gendreau and Cabandugama have lost weight, some doctors who would like to shed unwanted pounds have been unable to do so. What impact does this have on best generic levitra patients?. Doctors sometimes have biased attitudes toward overweight patients, but few studies have looked at whether patients have biases towards overweight doctors. The results vary and may depend on whether or not the patients are overweight.

A random online survey of 358 best generic levitra participants suggested that regardless of their own weight, people had biases about doctor weight gain. They viewed the overweight or obese doctors as less trustworthy and credible, which could lead the participants to reject their medical advice and change doctors. “Patients expect doctors who are providing health care to be doing everything they can to take care of their own health and well-being,” says Pamela Peeke, MD, an assistant clinical professor of medicine at the University of Maryland in Baltimore. €œI am a physician who believes you have to walk the talk -- that the best teachers are those who best generic levitra live it,” she says.

Still, “I don't think based on this one experimental study that we can conclude that overweight physicians are harming patients’ efforts to change their behavior,” notes Bennett, who was not involved in the study. €œI think that patients do often want to connect with their physicians on more personal levels, but without the story behind where the advice is coming from, patients may struggle to trust a provider who seems to be contradicting the messages,” she says. A study that Bennett helped lead suggests that patients are not biased against overweight doctors if they themselves need to lose weight best generic levitra. A national survey of 600 overweight patients showed that 87% trusted diet advice from overweight primary care doctors, compared to 77% who trusted diet advice from doctors who had a healthy weight.

€œThis shows that patients were more trusting of physicians who are more like them, which can lead to better relationships. We know from the studies on race best generic levitra that patients are often more trusting of physicians from the same race as them,” says Bennett. Gendreau says that when he was severely obese, some patients questioned whether to trust his weight loss advice. €œIt was very awkward when they turned to me and said, ‘What best generic levitra about you?.

€™ I would respond that it’s my job to inform them about the risks to their health,” he says. Nearly half (48%) of doctors said they are trying to lose weight, according to the 2021 Medscape Physician Lifestyle and Happiness Report. As a result, many doctors may end up in the position of seemingly best generic levitra advising to “do what I say, not what I do.” Nearly 3 in 5 Americans are trying to lose weight, according to Gelesis poll results released in December 2020. Should Doctors Pay More Attention to Wellness?.

Doctors have an ethical duty to maintain their own health and wellness so they can provide safe and effective medical care. If they don’t have a best generic levitra healthy lifestyle, they need to make adjustments, the American Medical Association Code of Ethics advises. Peeke agrees with the AMA. €œWe signed on to do this -- we have to go out of our way to carve out time, even if it’s just 15 minutes where we hide away and eat that healthy lunch that we brought with us,” she says.

Gendreau suggests busy doctors do what he best generic levitra did. €œI started by bringing healthy snacks -- small Ziploc bags filled with mixed nuts and berries -- and expanded from there. This way, if I got hungry or stressed between patients, I would have easy access to something nutritious,” he says. He and best generic levitra Peeke also suggest making protein shakes or berry smoothies that are low in sugar.

€œThese can keep you full for hours as you sip them between patients,” says Gendreau. Convincing busy doctors to make lifestyle changes may best generic levitra be challenging. Sixty-five percent of those who responded to the Physician Lifestyle and Happiness Report say that they sometimes, rarely, or never focus on their health and wellness. Only 45% said they are eating healthy, and 65% said they exercise.

€œSelf-care isn’t a priority for most physicians because best generic levitra we are taught to take care of others and to put them first,” says Gendreau. €œLike many doctors, I had so many other priorities -- family, friends, career. Also, my last year of medical school was so difficult that my priority was finishing. I pushed my health to the side and told myself that I could fix this later.” Only about 1 in 5 medical schools best generic levitra require students to take a nutrition course, according to David Eisenberg, MD, an adjunct associate professor of nutrition at the Harvard T.H.

Chan School of Public Health. €œI didn’t get one ounce of nutrition training, which is the reason I became a Pew Foundation scholar in nutrition and metabolism. I had to go outside of my best generic levitra traditional training,” says Peeke. “Physicians are not adequately trained to do the behavioral counseling and motivational interviewing that is needed,” says Bennett.

€œWe do a good job of diagnosing obesity based on body mass index and understanding the relationship with future health conditions. But most doctors struggle with both a lack of time and the skill set to make significant behavior changes.” “Medical school curriculum is focused so best generic levitra heavily on the pathology and pathophysiology of obesity, rather than how to prevent it with the appropriate diet and exercise regimen,” Gendreau says. €œMy physician patients often tell me that their own education in the field of nutrition is lacking, which can affect their weight loss journey and what they teach their patients.” Gendreau, crediting his own weight loss journey as well as his obesity medicine fellowship, says his confidence in discussing weight loss with patients has soared. Reframing Obesity as best generic levitra a Chronic Disease Rather than criticizing overweight people, including doctors, for their personal health choices, a better approach is to think of weight or obesity as a chronic illness, says Bennett.

€œIf we understand that obesity is a chronic health condition that people are struggling with, we can empathize with them,” she says, recommending that more providers share their weight loss journeys with patients they give lifestyle advice to, which may help address and repair potential biases. WebMD Health News Sources Kevin Gendreau, MD, weight loss doctor, Southcoast Health, Fall River, MA. Peminda Cabandugama, best generic levitra MD, endocrinologist and obesity medicine specialist, Truman Medical Center, University of Missouri-Kansas City. Wendy Bennett, MD, MPH, obesity researcher, associate professor of medicine, Johns Hopkins University, Baltimore.

Pamela Peeke, MD, MPH, assistant clinical professor of medicine, University of Maryland, Baltimore. Gelesis. €œNew Survey Finds 71 Million Americans Have Gained Weight Throughout the levitra.” American Medical Association. €œCode of Medical Ethics Opinion 9.3.1.” David Eisenberg, MD, adjunct associate professor of nutrition, Harvard T.H.

Chan School of Public Health. © 2021 WebMD, LLC. All rights reserved..

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Peminda Cabandugama, MD, an endocrinologist and obesity medicine specialist at Truman Medical Center at the University of Missouri-Kansas City, has weighed between 180 and 240 pounds in the past decade. He now weighs 225 pounds and has a healthy lifestyle. €œI have had patients come to me saying, ‘I used to buy generic levitra in usa see a different weight loss doctor who was not heavy.

But how can he understand what I’m going through?. €™â€ he says. Cabandugama shares his weight loss struggles with patients “to dispel this myth that weight buy generic levitra in usa management is as simple as just eating too much and not exercising.

It involves a smorgasbord of emotions and hormones, some within and outside of our control. I hope that sharing this allows me to connect more with my patients so that they know that even their health care professional goes through the same challenges that they do.” “Patients are more likely to make behavior changes when doctors are supportive and have had similar experiences and talk about their stories,” says Wendy Bennett, MD, an obesity researcher and associate professor of medicine at Johns Hopkins University in Baltimore. Do buy generic levitra in usa Patients Respect Overweight Doctors?.

While Gendreau and Cabandugama have lost weight, some doctors who would like to shed unwanted pounds have been unable to do so. What impact buy generic levitra in usa does this have on patients?. Doctors sometimes have biased attitudes toward overweight patients, but few studies have looked at whether patients have biases towards overweight doctors.

The results vary and may depend on whether or not the patients are overweight. A random online survey of 358 participants suggested that regardless of their own buy generic levitra in usa weight, people had biases about doctor weight gain. They viewed the overweight or obese doctors as less trustworthy and credible, which could lead the participants to reject their medical advice and change doctors.

“Patients expect doctors who are providing health care to be doing everything they can to take care of their own health and well-being,” says Pamela Peeke, MD, an assistant clinical professor of medicine at the University of Maryland in Baltimore. €œI am a physician who believes you have to walk the talk -- that the best buy generic levitra in usa teachers are those who live it,” she says. Still, “I don't think based on this one experimental study that we can conclude that overweight physicians are harming patients’ efforts to change their behavior,” notes Bennett, who was not involved in the study.

€œI think that patients do often want to connect with their physicians on more personal levels, but without the story behind where the advice is coming from, patients may struggle to trust a provider who seems to be contradicting the messages,” she says. A study that Bennett helped lead buy generic levitra in usa suggests that patients are not biased against overweight doctors if they themselves need to lose weight. A national survey of 600 overweight patients showed that 87% trusted diet advice from overweight primary care doctors, compared to 77% who trusted diet advice from doctors who had a healthy weight.

€œThis shows that patients were more trusting of physicians who are more like them, which can lead to better relationships. We know from the studies on race that buy generic levitra in usa patients are often more trusting of physicians from the same race as them,” says Bennett. Gendreau says that when he was severely obese, some patients questioned whether to trust his weight loss advice.

€œIt was very awkward when they turned to me and said, ‘What about buy generic levitra in usa you?. €™ I would respond that it’s my job to inform them about the risks to their health,” he says. Nearly half (48%) of doctors said they are trying to lose weight, according to the 2021 Medscape Physician Lifestyle and Happiness Report.

As a result, many doctors may end up in the position of seemingly advising to “do what I say, not what I do.” Nearly 3 in 5 Americans are trying buy generic levitra in usa to lose weight, according to Gelesis poll results released in December 2020. Should Doctors Pay More Attention to Wellness?. Doctors have an ethical duty to maintain their own health and wellness so they can provide safe and effective medical care.

If they don’t have a healthy lifestyle, they need to make buy generic levitra in usa adjustments, the American Medical Association Code of Ethics advises. Peeke agrees with the AMA. €œWe signed on to do this -- we have to go out of our way to carve out time, even if it’s just 15 minutes where we hide away and eat that healthy lunch that we brought with us,” she says.

Gendreau suggests busy buy generic levitra in usa doctors do what he did. €œI started by bringing healthy snacks -- small Ziploc bags filled with mixed nuts and berries -- and expanded from there. This way, if I got hungry or stressed between patients, I would have easy access to something nutritious,” he says.

He and Peeke also suggest making protein shakes or berry smoothies that are low in buy generic levitra in usa sugar. €œThese can keep you full for hours as you sip them between patients,” says Gendreau. Convincing busy buy generic levitra in usa doctors to make lifestyle changes may be challenging.

Sixty-five percent of those who responded to the Physician Lifestyle and Happiness Report say that they sometimes, rarely, or never focus on their health and wellness. Only 45% said they are eating healthy, and 65% said they exercise. €œSelf-care isn’t a priority buy generic levitra in usa for most physicians because we are taught to take care of others and to put them first,” says Gendreau.

€œLike many doctors, I had so many other priorities -- family, friends, career. Also, my last year of medical school was so difficult that my priority was finishing. I pushed my buy generic levitra in usa health to the side and told myself that I could fix this later.” Only about 1 in 5 medical schools require students to take a nutrition course, according to David Eisenberg, MD, an adjunct associate professor of nutrition at the Harvard T.H.

Chan School of Public Health. €œI didn’t get one ounce of nutrition training, which is the reason I became a Pew Foundation scholar in nutrition and metabolism. I had to go buy generic levitra in usa outside of my traditional training,” says Peeke.

“Physicians are not adequately trained to do the behavioral counseling and motivational interviewing that is needed,” says Bennett. €œWe do a good job of diagnosing obesity based on body mass index and understanding the relationship with future health conditions. But most doctors struggle with both a lack of time and the skill set to buy generic levitra in usa make significant behavior changes.” “Medical school curriculum is focused so heavily on the pathology and pathophysiology of obesity, rather than how to prevent it with the appropriate diet and exercise regimen,” Gendreau says.

€œMy physician patients often tell me that their own education in the field of nutrition is lacking, which can affect their weight loss journey and what they teach their patients.” Gendreau, crediting his own weight loss journey as well as his obesity medicine fellowship, says his confidence in discussing weight loss with patients has soared. Reframing Obesity as a Chronic Disease Rather than criticizing overweight people, including doctors, for their personal health choices, a better approach is to think of weight or obesity as a chronic buy generic levitra in usa illness, says Bennett. €œIf we understand that obesity is a chronic health condition that people are struggling with, we can empathize with them,” she says, recommending that more providers share their weight loss journeys with patients they give lifestyle advice to, which may help address and repair potential biases.

WebMD Health News Sources Kevin Gendreau, MD, weight loss doctor, Southcoast Health, Fall River, MA. Peminda Cabandugama, MD, endocrinologist and obesity medicine specialist, Truman buy generic levitra in usa Medical Center, University of Missouri-Kansas City. Wendy Bennett, MD, MPH, obesity researcher, associate professor of medicine, Johns Hopkins University, Baltimore.

Pamela Peeke, MD, MPH, assistant clinical professor of medicine, University of Maryland, Baltimore. Gelesis. €œNew Survey Finds 71 Million Americans Have Gained Weight Throughout the levitra.” American Medical Association.

€œCode of Medical Ethics Opinion 9.3.1.” David Eisenberg, MD, adjunct associate professor of nutrition, Harvard T.H. Chan School of Public Health. © 2021 WebMD, LLC.

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Autodesk deployed it’s Octo-Copter in Africa for high resolution reality capture.  This was done in support of Louis Leakey in Kenya in search of our ancestral trails


Additonally, they deployed it on their head quarters in San Rafael.

From the Gizmag Website:

The Mikrokopter Octocopter is an 8-rotor flying platform which has a 2 kg (4.4 lbs) capacity to carry cameras. It can be flown using an internal camera to give the operator a copter-based vantage point on video glasses, or can be programmed to follow a GPS-controlled flight path. An Octocopter can fly autonomously at altitudes up to 1000 meters (3280 feet), or can be manually flown as high as 3500 meters (11,480 feet). In the Autodesk tests video was captured using a GOPro Hero 2 camera, and the still pictures from which the 3D model was later built were taken by a remotely triggered Canon SLR camera.

Autodesk 123D is a suite of programs which allow a user to create, manipulate, and construct 3D objects using a 3D printer. Catch is part of the 123D suite, and offers a standalone software package that helps you create 3D models from a series of 2D digital images of an object or a scene. The spatial resolution available using 123D Catch is about 1 part in 600, or 0.167% of the total size of the object pictured, so you would be able to accurately place individual windows on a 3D model of a Boeing 747.

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Get to the Beach and then Treat Yourself

Cranes Beach & Wingaersheek Beech, Head north on 128.  Enjoy the water, and then take the short drive to Essex and go get fried clams and soft serve, call in your fried clam order if you can.  Try Woodman’s, Farnham’s (they got picnic tables over looking the tidal marsh) or try the Village, and Essex Seafood, which has always been a solid go to.

Horseneck Beach, terrific beach going south on 24, Westport, MA almost always less traffic, then go to the Back Eddy for something to cold to drink and a snack.

You’re in and around the city.

Find a Roof Deck and/or Pool, a variety of posts on the subject from Boston.com, but it seems the Colonade for a pool stop is always mentioned. And outside of the city, Indigo in Newton is pretty nice stop.

Walk the Greenway, play in the fountains, get gelatto, try the Gelateria  in the North End.

Have a cold drink in a well air conditioned bar by the Garden, then walk over the river, across the locks into Charlestown and do the same thing there.  Your choice for locations, there are many.  But go ahead and stop at Emack and Bolio’s on the walk back.

Play in the Fountain at the Christian Science Center, walk into the Pru and Copley to soak in the air conditioning, play “how much are these shoes” at Nordstrom.  Have a friend stand back from the shoe tables, have them guess.  Most likely off by a factor of 10, go get a coolata at Dunkin.

If you are feeling particularly flush and it’s after 5, go get a martini at the Oak Room, used to come with side car sitting in ice.  That will frame the rest of your day.  Air Conditioning set on igloo.

Take your dog for a walk at the Middlesex Fells Reservation, or bring him/her to a pond, throw a stick. Jamaica Pond, Spy Pond, Fresh Pond, etc.  You might not get cool, but look at the dog, so happy.  And now I’ve seen Canoe and Kayak Rentals at Spy Pond.

So there’s a start, generally, a cold drink, cone or a slush, water, you get the idea.

 

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With Microsoft’s announcement of Windows 8, and the unveiling of the Surface Tablet, it finally appears there will be a tablet form factor that will run Revit in the field.  According to the press release there will be two versions, one based on the ARM chip and another based on the Intel i5 chip running Windows 8 Pro.  The iPad, as much it is great for so many tasks, simply does not have the horsepower to run Revit in the field, and delivering the type of user experience one would want with heavyweight programs is a real limitation in the ‘cloud.’  I understand Autodesk is now counting solely on Citrix to provide its remote platform but even if you are driving Revit remotely would you want to rely on whatever internet connection you have?  That’s just not a funnel I would want to count on in the field.

At first glance you might say so what, not a big deal.  However, if I can have a device that toggles between my heavyweight AEC programs, and delivers content the way my my iPad does then I might have an iPad to sell you; because frankly I am sick of devices, I live between the Mac and Windows camp, I’m tired of it.  I used to be an Apple fanatic, even being the only kid in business school with a Mac, the disastrous PowerPC model, but what was not to like about Apple.  Now, how did we get to the point where Microsoft is the little guy, relatively speaking.  Now if they could get their content management into a spot that works the way you want.  Imagine the central Revit model up on the sky drive, you check it out in the field, do your work, update it, booyah.

I think single purpose, highly specific apps are great to digest data,  not for the creation of it so I am real interested in the melding of tablet like functionality with horsepower.  I’m rooting for the little guy, I’m rooting for Microsoft.

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BTW anyone else bother to notice the blending and vertical integration of software/hardware.  Apple, obviously.  Google buys Motorola. Microsoft with multiple attempts, Zune, XBox, etc.  and now Surface. And more germane to AEC Trimble buys Tekla and SketchUp.  Seems to be the biz strategy du jour, watch for more.

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Tweet about PKNail Pro’s Proven Field to BIM Technology, Get Entered Automatically

PointKnown is giving away a free Apple iPad to one lucky Twitterer…er, tweeter, i.e.  one who uses the service twitter to disseminate clever, witty, informative text burst in 140 characters or less.  PointKnown does not claim to be clever, witty or informative, but will claim producing kick ahh…whup ahh…Excellent productivity software tools for documenting existing buildings.

 

 

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To participate, simply tweet using the hash tags below:

#pknail #revit #bim and mention ‘PKNail Pro’

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PKNail Pro turbo charges Revit and modeling existing buildings #pknail #revit #bim

or “Capture Existing Buildings Directly In Revit with PKNail Pro, 5x-10x faster #pknail #revit #bim

less pertinent but still acceptable “We came, we saw, we conquered with PKNail Pro, #pknail, #bim , #revit

less pertinent verging to the non-sequitur but still acceptable…

beautiful software for happy people PKNail Pro, #pknail, #bim, #revit

or certainly and you are most welcome and encouraged to tweet your own stuff; as we will have a separate drawing of $100 VISA Card for best/most creative tweet as judged by anyone at our next BBQ.

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We are on the road with Microcad and have other excellent resellers including,  Seiler Instrument (ask for Harvey) and CADDFX

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1. This giveaway is offered by PointKnown LLC and is open to anyone with a Twitter account who is at least 16 years of age. Employees of PointKnown, LLC. and/or its affiliated companies and family members of such employees may enter the contest but are not eligible to win.

2. The giveaway will begin at the time of this post and end 62 days after initial post, a winner will be randomly chosen, much like the number 62, and announced via twitter through @pointknown

3. One giveaway will be available: a 16GB Wi-Fi Apple iPad or $499 Apple Store Credit, winner’s choice.

4. You must prove ownership of the winning entry and provide your email address to collect the prize.

5. To enter the giveaway you must send out a tweet from your own Twitter account that includes the #hash tags above in your message.

6. Entries using automated tweets will be disqualified, however there is no limit on the number of tweets you may enter.

7. PointKnown LLC will choose a winner randomly from all the entries within the specified period. The winner will be announced from our twitter account (@pointknown) once the contest ends.

8. Entrants agree to allow @pointknown to use their twitter handles and entry tweets for marketing purposes.

9. Neither PointKnown LLC. nor its affiliated companies shall have any liability for (i) any technical failures of any kind, including but not limited to malfunctions, interruptions or disconnections in phone lines or network hardware or software; (ii) technical or human error which may occur in the administration of the giveaway; (iii) any malfunction of or damage to the prize; (iv) any corruption, typos or hacking of prize winners email accounts; or (v) any restrictions or delays imposed by any customs authorities or any import or other taxes of any kind imposed by any taxation authority in respect of the prizes.

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Announced today, Autodesk Acquires Vela Systems.  If you are developing products within the Building Life Cycle somewhere between and including design to demolition, you are in play.  Trimble has been going on an acquisition rampage with its acquisition of Tekla and Sketch Up and Autodesk never one to be a wallflower has just acquired Vela.  This is almost 2 years to the date that Vela was unveiled publicly.  No idea of their market size but their own press releases state that they are more than ‘twice as big’ as any competitive Field BIM Systems.  Regardless, market penetration means little at this point now that the Autodesk marketing/sales system is behind it.  How big was Revit in 2006 when they were purchased.  A primer of Vela’s Key Features below.  Congrats Vela folks, job well done.

Vela Field Management Suite Key Features
The Vela Field Management Suite of Web, Mobile and Reports enables everyone throughout the enterprise to access documents, field activities and reports in the office and in the field. Since its release a year ago, and to further broaden the usability throughout the enterprise, Vela Systems has expanded upon the following features:

  • Field BIM® for commissioning and handover that ties BIM to the field for data and document exchange
  • Company-level checklist and issue template capabilities to implement and enforce quality and safety programs
  • Increased accessibility via the Internet on multiple devices like iPads and Smart Phones
  • Better web-based reporting that turns field data into powerful information for managing quality, safety and risk at the project and company level
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As reported by Industry Week, ‘The world’s most sophisticated malware had a ‘high interest in AutoCAD drawings,’ Kaspersky Lab said.  The Flame Virus, which mainly affected computers in the Middle East used a loophole in Microsoft software tricking computers into thinking they are downloading a legitimate Windows update.  This fact, being reported by Reuters, The Times, CNET, and others. CNN reported that Flame can turn on your microphone, webcam, log e-mails, etc.  I have not read if it can do anything malicious itself as the Stuxnet Virus did to Iran Uranium enrichment facilities by having centrifuges essentially tear themselves apart.  However, going after CAD, essentially engineering and building documents can let whoever is collecting this information know what you are designing and building, and possibly have the blueprints of the building you are designing and building in.  And you thought google knowing that you smoke cigars and eat ice cream on your back porch at 5:23 PM was intrusive.

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File under cool.   The City of New York has unveiled an initiative for the electronic submission of BIM safety plans; you can learn more here; and a  Turner Press Release yesterday stated they used both 2D and 3D BIM submissions to get approval for their construction project at the Energy Building at NYU Langone Medical Center.

“The digital submission of 3D, BIM-based site safety plans reduced the approval times from weeks to days,” said Di Fillipo, Turner Senior Vice President.

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The more demos I go on, the more I get asked about our field kit, so I wanted to post what’s in my bag and what we use on a day to day basis when surveying/modeling in the field with PKNail Pro.  Those of you not interested in the day-in day-out particulars of surveying buildings may want to hit your back button now… Anyway an individual equally equipped will be ready for knocking out BIM Building Surveys, and this kit, all in, costs a fraction of most other technology solutions, plus the added benefit of surveying/modeling directly in the platform you or your clients are most likely working in.  However, always choose the tool/service that fits your needs.  In fact, we’ll be posting shortly where we combined workflows of PKNail Pro and pointclouds.  But here you go, what’s in my bag or my complete kit.

So it might seem like a lot but all fits in the bag except for the tripods.  The laptop tripod is excellent when mobility/portability with your gear is at a premium but I will use a laptop cart with wheels if the space allows;  it is easier with wheels and has more surface area to put stuff.

The real minimum you need to have with you is a laptop/tablet PC running the appropriate software, a Disto D8 or 330i, a measuring tape, and something to use for a target when needed, like an outside corner.  Stickynotes (larger size) are excellent for shorter distances, a reflective Leica Target attached with Painter’s Tape is better for longer ones.  Rechargeable batteries for both the laptop and Disto.  I prefer an external battery pack for the laptop as it can be used on any laptop and it is self contained unlike an extra battery for a specific laptop.

I  like Eneloop rechargeables for devices, my preference, they come preloaded with a charge, and seem to carry it longer when not being used.  You need a measuring tape on occasion for distances to short or sometimes nice to hook something with a tape when finding a distance manually.  I like thick banded measuring tapes because they will extend longer without ‘breaking’ but find they are just as prone to wear down as any other so sometimes not worth the expense.  LED flashlight because they are bright and do not use as much juice as others, and are always nice to have.  I also have an LED light that you can wear on your head, which is my preferred.  Diameter tape is a luxury but one side is graduated the other will measure the diameter of any round column which is helpful.

The tripod attachment from Leica allows it to pivot properly on the its axis so the measurements stay as accurate as possible.  This is great to have for exterior work  when you might not have access to the interior of the building.  Building chalk or a marking crayon can be helpful but usually would want to mark with painters tape or sticky pad because they are easily removed, however, the former comes in handy sometimes, especially in basements.

And bring food and drink, nothing clouds your mind like being hungry, so eat.

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Interioreview, utilized PKNail Pro, an add in to Revit, combined with Leica Disto D8 laser range finders as the main surveying tool and software for capturing and modeling the 28 Story DuBois Library at UMass Amherst.  The structure designed by Durell Stone in 1966 is tallest library in the United States.  While intially considering combining LIDAR and creating a pointcloud for the exterior and utilizing PKNail Pro for the interior it turned out the exterior was the easiest part of the job and it was interior that was the most difficult.  Every 3rd floor contained  90+ rooms  with study carrels combined with classrooms where very few technologies would work well.  Nico Martinez, a Project Manager with Interioreview, commented,”Without PKNail the survey work could have taken  5 times, 10 times what it was.”

The project was completed to support the design and retrofitting a fire protection system.

Interioreview, an architecural surveying firm founded in 2003 specialzies in documenting the built environment in both 2D CAD and 3D Revit formats.

PointKnown, a software firm, founded in 2008 develops productivity tools for the built environment / AEC (Architectural, Engineering, and Construction) Industry

PKNail Pro, allows a user to measure and model objects in real time directly in Revit.

Autodesk® Revit® software is specifically built for Building Information Modeling (BIM), helping building professionals design, build, and maintain higher-quality, more energy-efficient buildings.

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