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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 diflucan, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried.

Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs. €œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says.

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

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About This TrackerThis tracker provides the number of confirmed cases look at here and deaths from novel antifungals by country, the trend in confirmed online doctor diflucan case and death counts by country, and a global map showing which countries have confirmed cases and deaths. The data are drawn from the Johns Hopkins University (JHU) antifungals Resource Center’s antifungal medication Map and the World Health Organization’s (WHO) antifungals Disease (antifungal medication-2019) situation reports.This tracker will be updated regularly, as new data are released.Related Content. About antifungal medication antifungalsIn late 2019, a new antifungals emerged in online doctor diflucan central China to cause disease in humans. Cases of this disease, known as antifungal medication, have since been reported across around the globe. On January 30, 2020, online doctor diflucan the World Health Organization (WHO) declared the diflucan represents a public health emergency of international concern, and on January 31, 2020, the U.S.

Department of Health and Human Services declared it to be a health emergency for the United States.Key PointsOn January 23, 2017, President Donald Trump reinstated and expanded the Mexico City Policy via presidential memorandum, renaming it “Protecting Life in Global Health Assistance.” This explainer provides an overview of the policy, including its history, changes over time, and current application.First announced in 1984 by the Reagan administration, the policy has been rescinded and reinstated by subsequent administrations along party lines and has now been in effect for 19 of the past 34 years.The policy requires foreign non-governmental organizations (NGOs) to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. Funds) as a condition online doctor diflucan of receiving U.S. Government global family planning assistance and, as of Jan. 23, 2017, most other U.S online doctor diflucan. Global health assistance.The Trump administration’s application of the policy extends to the vast majority of U.S.

Bilateral global health assistance, including funding for HIV under online doctor diflucan PEPFAR, maternal and child health, malaria, nutrition, and other programs. This marks a significant expansion of its scope, potentially encompassing $7.3 billion in FY 2020, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly (family planning assistance accounts for approximately $600 million of that total).Additionally, as a result of a March 2019 policy announcement and subsequent information released in June 2019, the policy, for the first time, prohibits foreign NGOs who accept the policy from providing any financial support using any source of funds and for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning. This greatly extends its reach to other areas of online doctor diflucan U.S. Development assistance beyond global health and to other non-U.S. Funding streams.More recently, in September 2020, a proposed rule to online doctor diflucan extend the policy to contracts was published.

If finalized, it would greatly extend the reach of the policy beyond grants and cooperative agreements to also include contracts.KFF analyses have found that:more than half of the countries in which the U.S. Provides bilateral online doctor diflucan global health assistance allow for legal abortion in at least one case not permitted by the policy (analysis). Andhad the expanded policy been in effect during the FY 2013 – FY 2015 period, at least 1,275 foreign NGOs would have been subject to the policy (analysis).What is the Mexico City Policy?. The Mexico online doctor diflucan City Policy is a U.S. Government policy that – when in effect – has required foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S.

Funds) as a online doctor diflucan condition of receiving U.S. Global family planning assistance and, as of Jan. 23, 2017, most online doctor diflucan other U.S. Global health assistance.The policy was first announced by the Reagan administration at the 2nd International Conference on Population, which was held in Mexico City, Mexico, on August 6-14, 1984 (hence its name. See Box online doctor diflucan 1).

Under the Trump administration, the policy has been renamed “Protecting Life in Global Health Assistance” (PLGHA). Among opponents, it is also known as the “Global Gag Rule,” because among other activities, it prohibits online doctor diflucan foreign NGOs from using any funds (including non-U.S. Funds) to provide information about abortion as a method of family planning and to lobby a foreign government to legalize abortion. €œ[T]he United States does not consider abortion an acceptable element of family planning programs and will no longer contribute to those of which it online doctor diflucan is a part. €¦[T]he United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.”When first instituted in 1984, the Mexico City Policy marked an expansion of existing legislative restrictions that already prohibited U.S.

Funding for abortion online doctor diflucan internationally, with some exceptions (see below). Prior to the policy, foreign NGOs could use non-U.S. Funds to engage in certain voluntary online doctor diflucan abortion-related activities as long as they maintained segregated accounts for any U.S. Money received, but after the Mexico City Policy was in place, they were no longer permitted to do so if they wanted to receive U.S. Family planning assistance.The Trump administration’s application of the policy to online doctor diflucan the vast majority of U.S.

Bilateral global health assistance, including funding for HIV under the U.S. President’s Emergency Plan for AIDS Relief online doctor diflucan (PEPFAR), maternal and child health, malaria, nutrition, and other programs, marks a significant expansion of its scope, potentially encompassing $7.3 billion in FY 2020, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly (family planning assistance accounted for approximately $600 million of that total). The Administration’s more recent extension of the policy to include any financial support (health or otherwise) provided by foreign NGOs for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning is likely to encompass significant additional funding.When has it been in effect?. The Mexico City Policy has been in effect for 19 of the past 34 years, primarily through executive action, and has been instated, rescinded, and reinstated by presidential administrations along party lines (see Table 1).The policy was first instituted in 1984 (taking effect in 1985) by President Ronald Reagan and continued to be in effect through President George H.W. Bush’s administration online doctor diflucan.

It was rescinded by President Bill Clinton in 1993 (although it was reinstated legislatively for one year during his second term. See below) online doctor diflucan. The policy was reinstated by President George W. Bush in 2001 and then rescinded by President online doctor diflucan Barack Obama in 2009. It is currently in effect, having been reinstated by President Trump in 2017.

YearsIn Effect? online doctor diflucan. Presidential Administration (Party Affiliation)Executive (E) or Congressional (C) Action?. 1985-1989YesReagan (R)E1989-1993YesBush (R)E1993-1999 Sept.NoClinton online doctor diflucan (D)E1999 Oct.-2000 Sept.Yes*Clinton (D)C2000 Oct.-2001NoClinton (D)E2001-2009YesBush (R)E2009-2017NoObama (D)E2017-presentYesTrump (R)ENOTES. Shaded blue indicate periods when policy was in effect. * There was a temporary, one-year legislative imposition of the policy, which included a portion of the restrictions in effect in other years and an option for online doctor diflucan the president to waive these restrictions in part.

However, if the waiver option was exercised (for no more than $15 million in family planning assistance), then $12.5 million of this funding would be transferred to maternal and child health assistance. The president did exercise online doctor diflucan the waiver option.SOURCES. €œPolicy Statement of the United States of America at the United Nations International Conference on Population (Second Session), Mexico City, Mexico, August 6-14, 1984,” undated. Bill Clinton online doctor diflucan Administration, “Subject. AID Family Planning Grants/Mexico City Policy,” Memorandum for the Acting Administrator of the Agency for International Development, January 22, 1993, Clinton White House Archives, https://clintonwhitehouse6.archives.gov/1993/01/1993-01-22-aid-family-planning-grants-mexico-city-policy.html.

FY 2000 online doctor diflucan Consolidated Appropriations Act, P.L. 106-113. George W online doctor diflucan. Bush Administration, “Subject. Restoration of the Mexico City Policy,” Memorandum for the Administrator of the United States Agency for International Development, January 22, 2001, Bush Administration online doctor diflucan White House Archives, https://georgewbush-whitehouse.archives.gov/news/releases/20010123-5.html.

€œSubject. Restoration of the Mexico City Policy,” Memorandum for the Administrator of the United States Agency for International Development, online doctor diflucan March 28, 2001, Federal Register, https://www.federalregister.gov/documents/2001/03/29/01-8011/restoration-of-the-mexico-city-policy. George W. Bush Administration, online doctor diflucan “Subject. Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, August 29, 2003, Bush Administration White House Archives, http://georgewbush-whitehouse.archives.gov/news/releases/2003/08/20030829-3.html.

Barack Obama Administration, “Mexico City Policy and Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, the Administrator of the United States Agency online doctor diflucan for International Development, January 23, 2009, Obama White House Archives, https://obamawhitehouse.archives.gov/the-press-office/mexico-city-policy-and-assistance-voluntary-population-planning. White House, “The Mexico City Policy,” Memorandum for the Secretary of State, the Secretary of Health and Human Services, the Administrator of the Agency for International Development, Jan. 23, 2017, https://www.whitehouse.gov/the-press-office/2017/01/23/presidential-memorandum-regarding-mexico-city-policy.How online doctor diflucan is it instituted (and rescinded)?. The Mexico City Policy has, for the most part, been instituted or rescinded through executive branch action (typically via presidential memoranda). While Congress online doctor diflucan has the ability to institute the policy through legislation, this has happened only once in the past.

A modified version of the policy was briefly applied by Congress during President Clinton’s last year in office as part of a broader arrangement to pay the U.S. Debt to the United Nations online doctor diflucan. (At that time, President Clinton was able to partially waive the policy’s restrictions.) Other attempts to institute the policy through legislation have not been enacted into law, nor have legislative attempts to overturn the policy. See Table 1.Who online doctor diflucan does the policy apply to?. The policy, when in effect, applies to foreign NGOs as a condition for receiving U.S.

Family planning support and, now, other global health assistance, either directly (as the main – or prime – recipient of U.S. Funding) or indirectly (as a recipient of U.S online doctor diflucan. Funding through an agreement with the prime recipient. Referred to as online doctor diflucan a sub-recipient). Specifically, a foreign NGO “recipient agrees that it will not, during the term of this award, perform or actively promote abortion as a method of family planning in foreign countries or provide financial support to any other foreign non-governmental organization that conducts such activities.”Foreign NGOs include:international NGOs that are based outside the U.S.,regional NGOs that are based outside the U.S., andlocal NGOs in assisted countries.U.S.

NGOs, while not directly subject to online doctor diflucan the Mexico City Policy, must also agree to ensure that they do not provide funding to any foreign NGO sub-recipients unless those sub-recipients have first certified adherence to the policy. Specifically, a U.S. NGO “recipient (A) agrees that it will not furnish health assistance under this award to any foreign non-governmental organization that performs or actively promotes abortion as a method online doctor diflucan of family planning in foreign countries. And (B) further agrees to require that such sub-recipients do not provide financial support to any other foreign non-governmental organization that conducts such activities.”As in the past, the current policy does not apply to funding provided by the U.S. Government to foreign governments (national or sub-national), public international organizations, and other online doctor diflucan multilateral entities, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the treatment Alliance.

However, this funding is subject to the policy if it flows through a foreign NGO that has accepted the policy. See “What is ‘financial support’? online doctor diflucan. € below.To what assistance does it apply?. In the online doctor diflucan past, foreign NGOs have been required to adhere to the Mexico City Policy – when it was in effect – as a condition of receiving support through certain U.S. International funding streams.

Family planning assistance through online doctor diflucan the U.S. Agency for International Development (USAID) and, beginning in 2003, family planning assistance through the U.S. Department of online doctor diflucan State. In the 2003 memorandum announcing the policy’s expansion to include the Department of State, President Bush stated that the policy did not apply to funding for global HIV/AIDS programs and that multilateral organizations that are associations of governments are not included among “foreign NGOs.”The current policy, reinstated in 2017, applies to the vast majority of U.S. Bilateral global health assistance furnished by all agencies online doctor diflucan and departments.

“Assistance” includes “the provision of funds, commodities, equipment, or other in-kind global health assistance.” Specifically, the expanded policy applies to nearly all bilateral global health assistance, including. family planning and reproductive healthfor the first time:maternal and child health (including household-level water, sanitation, and hygiene (WASH))nutritionHIV under online doctor diflucan PEPFARtuberculosismalaria under the President’s Malaria Initiative (PMI)neglected tropical diseasesglobal health securitycertain types of research activitiesThe policy applies to the assistance described above that is appropriated directly to three agencies and departments. USAID. The Department of State, including the Office of the Global AIDS online doctor diflucan Coordinator, which oversees and coordinates U.S. Global HIV funding under PEPFAR.

And for the online doctor diflucan first time, the Department of Defense (DoD). When such funding is transferred to another agency, including the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), it remains subject to the policy, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly.The policy applies to three types of funding agreements for such assistance. Grants. Cooperative agreements. And, for the first time, contracts, pending necessary rule-making that would be needed to do so (a proposed rule to accomplish this was published in September 2020).The policy does not apply to U.S.

Assistance for. Water supply and sanitation activities, which is usually focused on infrastructure and systems. Humanitarian assistance, including activities related to migration and refugee assistance activities as well as disaster and humanitarian relief activities. The American Schools and Hospitals Abroad (ASHA) program. And Food for Peace (FFP).

However, this funding is subject to the policy if it flows through a foreign NGO that has accepted the policy. See “What is ‘financial support’?. € below.What activities are prohibited?. The policy prohibits foreign NGOs that receive U.S. Family planning assistance and, now, most other U.S.

Bilateral global health assistance from using funds from any source (including non-U.S. Funds) to “perform or actively promote abortion as a method of family planning.” In addition to providing abortions with non-U.S. Funds, restricted activities also include the following:providing advice and information about and offering referral for abortion – where legal – as part of the full range of family planning options,promoting changes in a country’s laws or policies related to abortion as a method of family planning (i.e., engaging in lobbying), andconducting public information campaigns about abortion as a method of family planning.The prohibition of these activities are why the policy has been referred to by its critics as the “Global Gag Rule.”Additionally, for the first time, the policy prohibits foreign NGOs from providing any financial support with any source of funds (including non-U.S. Funding) and for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning. See “What is “financial support?.

€ below.The policy, however, does not prohibit foreign NGOs from:providing advice and information about, performing, or offering referral for abortion in cases where the pregnancy has either posed a risk to the life of the mother or resulted from incest or rape. Andresponding to a question about where a safe, legal abortion may be obtained when a woman who is already pregnant clearly states that she has already decided to have a legal abortion (passively providing information, versus actively providing medically-appropriate information).In addition, the expanded policy does not apply to healthcare providers who have an affirmative duty required under local law to provide counseling about and referrals for abortion as a method of family planning.Does it restrict direct U.S. Funding for abortion overseas?. U.S. Funding for abortion is already restricted under several provisions of the law.

Specifically, before the Mexico City Policy was first announced in 1984, U.S. Law already prohibited the use of U.S. Aid:to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion (the Helms Amendment, 1973, to the Foreign Assistance Act);for biomedical research related to methods of or the performance of abortion as a means of family planning (the Biden Amendment, 1981, to the Foreign Assistance Act). Andto lobby for or against abortion (the Siljander Amendment, first included in annual appropriations in 1981 and included each year thereafter).Then, shortly after the policy was announced in 1984, the Kemp-Kasten Amendment was passed in 1985, prohibiting the use of U.S. Aid to fund any organization or program, as determined by the president, that supports or participates in the management of a program of coercive abortion or involuntary sterilization (it is now included in annual appropriations).Before the Mexico City Policy, U.S.

Aid recipients could use non-U.S. Funds to engage in certain abortion-related activities but were required to maintain segregated accounts for U.S. Assistance. The Mexico City Policy reversed this practice. No longer were foreign NGOs allowed to use non-U.S.

Funds, maintained in segregated accounts, for voluntary abortion-related activities if they wished to continue to receive or be able to receive U.S. Family planning funds.Does the policy prohibit post-abortion care?. The Mexico City Policy does not restrict the provision of post-abortion care, which is a supported activity of U.S. Family planning assistance. Whether or not the Mexico City Policy is in effect, recipients of U.S.

Family planning assistance are allowed to use U.S. And non-U.S. Funding to support post-abortion care, no matter the circumstances of the abortion (whether it was legal or illegal).What has been the impact of the policy?. Several studies have looked at the impact of the policy. A 2011 quantitative analysis by Bendavid, et.

Al, found a strong association between the Mexico City Policy and abortion rates in sub-Saharan Africa. This study was recently updated to include several more years of data, again identifying a strong association. Specifically, the updated study found that during periods when the policy was in place, abortion rates rose by 40% in countries with high exposure to the Mexico City Policy compared to those with low exposure, while the use of modern contraceptives declined by 14% and pregnancies increased by 12% in high exposure compared to low exposure countries. In other words, it found patterns that “strengthen the case for the role played by the policy” in “a substantial increase in abortions across sub-Saharan Africa among women affected by the U.S. Mexico City Policy … [and] a corresponding decline in the use of modern contraception and increase in pregnancies,” likely because foreign NGOs that declined U.S.

Funding as a result of the Mexico City Policy – often key providers of women’s health services in these areas – had fewer resources to support family planning services, particularly contraceptives. Increased access to and use of contraception have been shown to be key to preventing unintended pregnancies and thereby reducing abortion, including unsafe abortion. The study also found patterns that “suggest that the effects of the policy are reversible” when the policy is not in place.Additionally, there has been anecdotal evidence and qualitative data on the impact of the policy, when it has been in force in the past, on the work of organizations that have chosen not to agree to the policy and, therefore, forgo U.S. Funding that had previously supported their activities. For example, they have reported that they have fewer resources to support family planning and reproductive health services, including family planning counseling, contraceptive commodities, condoms, and reproductive cancer screenings.While it is likely too early to assess the full effects of the current policy on NGOs and the individuals they serve, as the policy is applied on a rolling basis as new funding agreements or modifications to existing agreements are made, some early data are available.

Several early qualitative and quantitative studies have been released, and at least one long-term, quantitative assessment is underway. Additionally, an official assessment by the U.S. Department of State on implementation during the first six months of the policy has been released (see below). This review acknowledged that it took “place early in the policy’s implementation, when affected U.S. Government departments and agencies have added a significant portion of the funding affected by the policy to grants and cooperative agreements only recently [i.e., after the period the review examined].

A follow-on analysis would allow an opportunity to address one of the primary concerns presented in feedback from third-party stakeholder organizations, namely that six months is insufficient time to gauge the impacts of” the policy.Nonetheless, it is already clear that the reinstated and expanded version of the policy applies to a much greater amount of U.S. Global health assistance, and greater number of foreign NGOs, across many program areas. KFF has found that more than half (37) of the 64 countries that received U.S. Bilateral global health assistance in FY 2016 allow for legal abortion in at least one case not permitted by the policy and that had the expanded Mexico City Policy been in effect during the FY 2013 – FY 2015 period, at least 1,275 foreign NGOs would have been subject to the policy. In addition, at least 469 U.S.

NGOs that received U.S. Global health assistance during this period would have been required to ensure that their foreign NGO sub-recipients were in compliance. Additional foreign NGOs are likely to be impacted by the policy due to the revised interpretation of “financial support” announced in March 2019 and implemented beginning June 2019. See “What is ‘financial support’?. € below.A report released in March 2020 by the U.S.

Government Accountability Office (GAO) provided new information on the number of projects (awards) and NGOs affected. It found that from May 2017 through FY 2018:the policy had been applied to over 1,300 global health projects, with the vast majority of these through USAID and CDC, andNGOs declined to accept the policy in 54 instances, totaling $153 million in declined funding – specifically, seven prime awards amounting to $102 million and 47 sub-awards amounting to $51 million (more than two-thirds of sub-awards were intended for Africa) – across USAID and CDC. The Department of State and DoD did not identify any instances where NGOs declined to accept the policy conditions.What have the U.S. Government’s reviews of the policy found?. The U.S.

Government has published two reviews of the policy to date, with the first examining the initial six months of the policy released in February 2018 and the second examining the first 18 months of the policy released in August 2020.First ReviewIn February 2018, the Department of State announced the findings of an initial six-month review of implementation of the policy through the end of FY 2017 (September 2017). The report directed agencies to provide greater support for improving understanding of implementation among affected organizations and provided guidance to clarify terms included in standard provisions of grants and cooperative agreements. In the six-month review report, the Department of State report identified a number of “actions” for implementing agencies, such as a need for:more central and field-based training and implementation tools,a clearer explanation of termination of awards for NGOs found to be in violation of the policy, anda clarification of “financial support,” which was not defined in the standard provisions (see “What is financial support?. € below).The six month review also identified the number of affected agreements with prime implementing partners and the number of those that have accepted the Mexico City Policy as part of their agreements through September 2017 (see Table 2). U.S.

Agency or DepartmentPolicy Implementation DateOverall # of Grants and Cooperative Agreements with Global Health Assistance FundingOf Overall #:(From the Policy Implementation Date through 9/30/2017)# That Received New Funding and Accepted Policy# That Received New Funding and Declined to Accept Policy^# That Had Not Received New Funding YetUSAIDMay 15, 20175804193158State*May 15, 2017142108034HHS+May 31, 20174991600339DoDMay 15, 20177742134TOTAL12987294565NOTES. * reflects PEPFAR funding implemented through the Department of State. Other departments and agencies implement the majority of PEPFAR funding. + At HHS agencies, only certain assistance funding transferred from USAID, State, and DoD are subject to the policy. ^ As of September 30, 2017, USAID reported it was aware of three centrally funded prime partners, and 12 sub-awardee implementing partners, that declined to agree to the Protecting Life in Global Health Assistance (PLGHA) terms in their awards.

DoD reported that one DoD partner, a U.S. NGO, declined to agree in one country but accepted the PLGHA standard provision in other countries. And HHS reported that no HHS partners declined to agree.SOURCES. KFF analysis of data from Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb. 6, 2018, https://www.state.gov/protecting-life-in-global-health-assistance-six-month-review/.Second ReviewOn August 17, 2020, the Department of State released its second review of the policy, updating its initial six-month review (as an action item in the six-month review report, the department stated it would “conduct a further review of implementation of the policy by December 15, 2018, when more extensive experience will enable a more thorough examination of the benefits and challenges”).

The long-anticipated review, which examines the period from May 2017 through September 2018, found:the awards declined spanned a variety of program areas, including family planning and reproductive health (FP/RH), HIV and AIDS (HIV/AIDS), maternal and child health (MCH), tuberculosis (TB), and nutrition, in addition to cross-cutting awards;the awards declined spanned geographic areas but many were for activities in sub-Saharan Africa;agencies and departments made efforts to transition projects to another implementer in order to minimize disruption. Butnevertheless, among USAID awards involving health service delivery where prime and sub-award recipients declined to accept the policy, gaps or disruptions in service delivery were sometimes reported.The second review also identified the number of affected agreements with prime implementing partners and the number of those that have accepted the Mexico City Policy as part of their agreements through September 2018 (see Table 3). U.S. Agency or DepartmentPolicy Implementation Date# of Grants and Cooperative Agreements with Global Health Assistance Funding# of Prime Awardees That Declined to Accept Policy^USAIDMay 15, 20174866State*May 15, 20173350HHS+May 31, 20174661DoDMay 15, 2017531TOTAL13408NOTES. * reflects PEPFAR funding implemented through the Department of State.

Other departments and agencies implement the majority of PEPFAR funding. + At HHS agencies, only certain assistance funding transferred from USAID, State, and DoD are subject to the policy. ^ As of September 30, 2018, USAID reported it was aware of six centrally funded prime partners, and 47 sub-awardee implementing partners, that declined to agree to the Protecting Life in Global Health Assistance (PLGHA) terms in their awards. DoD reported that one DoD partner, a U.S. NGO, declined to agree in one country but accepted the PLGHA standard provision in other countries.

And HHS reported that one HHS partner declined to agree.SOURCES. KFF analysis of data from Department of State, “Review of the Implementation of the Protecting Life in Global Health Assistance Policy ,” report, Aug. 17, 2020, https://www.state.gov/wp-content/uploads/2020/08/PLGHA-2019-Review-Final-8.17.2020-508.pdf, and Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb. 6, 2018, https://www.state.gov/protecting-life-in-global-health-assistance-six-month-review/.Additionally, the review reports that 47 sub-awardees, all under USAID awards, declined to accept the policy. It is important to note that the review also states that information on sub-awards is not systematically collected by departments and agencies and that DoD was not able to collect information on sub-awards.What is “financial support”?.

In February 2018, in the initial six-month review issued when Secretary of State Tillerson led the department, the Department of State report included an “action” statement to clarify the definition of “financial support” as used in the standard provisions for grants and cooperative agreements. At issue was whether it applied more narrowly to certain funding provided by foreign NGOs (i.e., funding other than U.S. Global health funding) to other foreign NGOs specifically for the purpose of performing or actively promoting abortion as a method of family planning or if it applied more broadly to certain funding provided by foreign NGOs to other foreign NGOs for any purpose, if that foreign NGO happened to perform or actively promote abortion as a method of family planning. The State Department clarified that it was the more narrow interpretation.However, on March 26, 2019, Secretary of State Pompeo reversed this interpretation, announcing further “refinements” to the policy to clarify that it applied to the broader definition of financial support. Specifically, under the policy, U.S.-supported foreign NGOs agree to not provide any financial support (global health-related as well as other support), no matter the source of funds, to any other foreign NGO that performs or actively promotes abortion as a method of family planning.

In June 2019, USAID provided additional information to reflect this broader interpretation of the standard provisions.This marks the first time the policy has been applied this broadly, as it can now affect funding provided by other donors (such as other governments and foundations) and non-global health funding provided by the U.S. Government for a wide range of purposes if this funding is first provided to foreign NGOs who have accepted the policy (as recipients of U.S. Global health assistance) that then in turn provide that donor or U.S. Non global health funding for any purpose to foreign NGOs that perform or actively promote abortion as a method of family planning. For example, under the prior interpretation, a foreign NGO recipient of U.S.

Global health funding could not provide any non-U.S. Funding to another foreign NGO to perform or actively promote abortion as a method of family planning but could provide funding for other activities, such as education, even if the foreign NGO carried out prohibited activities. Under the broader interpretation, a foreign NGO could not provide any non-U.S. Funding for any activity to a foreign NGO that carried out prohibited activities. Similarly, while under the prior interpretation a foreign NGO recipient of U.S.

Global health funding could provide other U.S. Funding (such as humanitarian assistance) to another foreign NGO for non-prohibited activities, even if the foreign NGO carried out prohibited activities, now under the broader interpretation, it could not do so.What are the next steps in implementing the expanded policy?. The policy went into effect in May 2017 (see Table 2), although it is applied on a rolling basis, as new funding agreements and modifications to existing agreements occur. While it applies to all grants and cooperative agreements, the Trump administration has indicated that it intends the policy to apply to contracts, which would require a rule-making process (it began this process by publishing a proposed rule in September 2020)..

About This TrackerThis http://crisptours.com/zithromax-online-prescription/ tracker provides the number of confirmed cases and deaths from novel antifungals by country, the can you buy diflucan in usa trend in confirmed case and death counts by country, and a global map showing which countries have confirmed cases and deaths. The data are drawn from the Johns Hopkins University (JHU) antifungals Resource Center’s antifungal medication Map and the World Health Organization’s (WHO) antifungals Disease (antifungal medication-2019) situation reports.This tracker will be updated regularly, as new data are released.Related Content. About antifungal medication antifungalsIn late 2019, a new antifungals emerged in central can you buy diflucan in usa China to cause disease in humans. Cases of this disease, known as antifungal medication, have since been reported across around the globe.

On January 30, 2020, the World Health Organization (WHO) declared the diflucan represents a public health emergency of international concern, can you buy diflucan in usa and on January 31, 2020, the U.S. Department of Health and Human Services declared it to be a health emergency for the United States.Key PointsOn January 23, 2017, President Donald Trump reinstated and expanded the Mexico City Policy via presidential memorandum, renaming it “Protecting Life in Global Health Assistance.” This explainer provides an overview of the policy, including its history, changes over time, and current application.First announced in 1984 by the Reagan administration, the policy has been rescinded and reinstated by subsequent administrations along party lines and has now been in effect for 19 of the past 34 years.The policy requires foreign non-governmental organizations (NGOs) to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S. Funds) as a condition can you buy diflucan in usa of receiving U.S. Government global family planning assistance and, as of Jan.

23, 2017, can you buy diflucan in usa most other U.S. Global health assistance.The Trump administration’s application of the policy extends to the vast majority of U.S. Bilateral global health assistance, including funding for HIV under PEPFAR, maternal and child health, can you buy diflucan in usa malaria, nutrition, and other programs. This marks a significant expansion of its scope, potentially encompassing $7.3 billion in FY 2020, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly (family planning assistance accounts for approximately $600 million of that total).Additionally, as a result of a March 2019 policy announcement and subsequent information released in June 2019, the policy, for the first time, prohibits foreign NGOs who accept the policy from providing any financial support using any source of funds and for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning.

This greatly extends its reach can you buy diflucan in usa to other areas of U.S. Development assistance beyond global health and to other non-U.S. Funding streams.More recently, in September 2020, a can you buy diflucan in usa proposed rule to extend the policy to contracts was published. If finalized, it would greatly extend the reach of the policy beyond grants and cooperative agreements to also include contracts.KFF analyses have found that:more than half of the countries in which the U.S.

Provides bilateral global can you buy diflucan in usa health assistance allow for legal abortion in at least one case not permitted by the policy (analysis). Andhad the expanded policy been in effect during the FY 2013 – FY 2015 period, at least 1,275 foreign NGOs would have been subject to the policy (analysis).What is the Mexico City Policy?. The Mexico City can you buy diflucan in usa Policy is a U.S. Government policy that – when in effect – has required foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source (including non-U.S.

Funds) as a condition of receiving U.S can you buy diflucan in usa. Global family planning assistance and, as of Jan. 23, 2017, most other can you buy diflucan in usa U.S. Global health assistance.The policy was first announced by the Reagan administration at the 2nd International Conference on Population, which was held in Mexico City, Mexico, on August 6-14, 1984 (hence its name.

See Box can you buy diflucan in usa 1). Under the Trump administration, the policy has been renamed “Protecting Life in Global Health Assistance” (PLGHA). Among opponents, it is also known as the “Global Gag Rule,” because among other can you buy diflucan in usa activities, it prohibits foreign NGOs from using any funds (including non-U.S. Funds) to provide information about abortion as a method of family planning and to lobby a foreign government to legalize abortion.

€œ[T]he United States does can you buy diflucan in usa not consider abortion an acceptable element of family planning programs and will no longer contribute to those of which it is a part. €¦[T]he United States will no longer contribute to separate nongovernmental organizations which perform or actively promote abortion as a method of family planning in other nations.”When first instituted in 1984, the Mexico City Policy marked an expansion of existing legislative restrictions that already prohibited U.S. Funding for abortion internationally, with some exceptions (see can you buy diflucan in usa below). Prior to the policy, foreign NGOs could use non-U.S.

Funds to engage in certain can you buy diflucan in usa voluntary abortion-related activities as long as they maintained segregated accounts for any U.S. Money received, but after the Mexico City Policy was in place, they were no longer permitted to do so if they wanted to receive U.S. Family planning assistance.The Trump administration’s application of the policy to the vast can you buy diflucan in usa majority of U.S. Bilateral global health assistance, including funding for HIV under the U.S.

President’s Emergency Plan for AIDS Relief (PEPFAR), maternal and child health, malaria, nutrition, and other programs, marks a significant expansion of its scope, potentially encompassing $7.3 billion in can you buy diflucan in usa FY 2020, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly (family planning assistance accounted for approximately $600 million of that total). The Administration’s more recent extension of the policy to include any financial support (health or otherwise) provided by foreign NGOs for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning is likely to encompass significant additional funding.When has it been in effect?. The Mexico City Policy has been in effect for 19 of the past 34 years, primarily through executive action, and has been instated, rescinded, and reinstated by presidential administrations along party lines (see Table 1).The policy was first instituted in 1984 (taking effect in 1985) by President Ronald Reagan and continued to be in effect through President George H.W. Bush’s administration can you buy diflucan in usa.

It was rescinded by President Bill Clinton in 1993 (although it was reinstated legislatively for one year during his second term. See below) can you buy diflucan in usa. The policy was reinstated by President George W. Bush in 2001 and then rescinded by President Barack can you buy diflucan in usa Obama in 2009.

It is currently in effect, having been reinstated by President Trump in 2017. YearsIn Effect? can you buy diflucan in usa. Presidential Administration (Party Affiliation)Executive (E) or Congressional (C) Action?. 1985-1989YesReagan (R)E1989-1993YesBush (R)E1993-1999 can you buy diflucan in usa Sept.NoClinton (D)E1999 Oct.-2000 Sept.Yes*Clinton (D)C2000 Oct.-2001NoClinton (D)E2001-2009YesBush (R)E2009-2017NoObama (D)E2017-presentYesTrump (R)ENOTES.

Shaded blue indicate periods when policy was in effect. * There was a temporary, one-year legislative imposition of the policy, which included a portion of the restrictions in effect in other years and an option for the president can you buy diflucan in usa to waive these restrictions in part. However, if the waiver option was exercised (for no more than $15 million in family planning assistance), then $12.5 million of this funding would be transferred to maternal and child health assistance. The president did exercise can you buy diflucan in usa the waiver option.SOURCES.

€œPolicy Statement of the United States of America at the United Nations International Conference on Population (Second Session), Mexico City, Mexico, August 6-14, 1984,” undated. Bill Clinton Administration, can you buy diflucan in usa “Subject. AID Family Planning Grants/Mexico City Policy,” Memorandum for the Acting Administrator of the Agency for International Development, January 22, 1993, Clinton White House Archives, https://clintonwhitehouse6.archives.gov/1993/01/1993-01-22-aid-family-planning-grants-mexico-city-policy.html. FY 2000 Consolidated Appropriations can you buy diflucan in usa Act, P.L.

106-113. George W can you buy diflucan in usa. Bush Administration, “Subject. Restoration of the Mexico City Policy,” Memorandum for the Administrator of the United States Agency for International Development, January 22, 2001, can you buy diflucan in usa Bush Administration White House Archives, https://georgewbush-whitehouse.archives.gov/news/releases/20010123-5.html.

€œSubject. Restoration of the Mexico City Policy,” Memorandum for the Administrator of the United States Agency for International Development, March 28, 2001, Federal Register, can you buy diflucan in usa https://www.federalregister.gov/documents/2001/03/29/01-8011/restoration-of-the-mexico-city-policy. George W. Bush Administration, can you buy diflucan in usa “Subject.

Assistance for Voluntary Population Planning,” Memorandum for the Secretary of State, August 29, 2003, Bush Administration White House Archives, http://georgewbush-whitehouse.archives.gov/news/releases/2003/08/20030829-3.html. Barack Obama Administration, “Mexico City Policy and Assistance for Voluntary Population Planning,” Memorandum for the Secretary of can you buy diflucan in usa State, the Administrator of the United States Agency for International Development, January 23, 2009, Obama White House Archives, https://obamawhitehouse.archives.gov/the-press-office/mexico-city-policy-and-assistance-voluntary-population-planning. White House, “The Mexico City Policy,” Memorandum for the Secretary of State, the Secretary of Health and Human Services, the Administrator of the Agency for International Development, Jan. 23, 2017, can you buy diflucan in usa https://www.whitehouse.gov/the-press-office/2017/01/23/presidential-memorandum-regarding-mexico-city-policy.How is it instituted (and rescinded)?.

The Mexico City Policy has, for the most part, been instituted or rescinded through executive branch action (typically via presidential memoranda). While Congress has the ability to can you buy diflucan in usa institute the policy through legislation, this has happened only once in the past. A modified version of the policy was briefly applied by Congress during President Clinton’s last year in office as part of a broader arrangement to pay the U.S. Debt to the United can you buy diflucan in usa Nations.

(At that time, President Clinton was able to partially waive the policy’s restrictions.) Other attempts to institute the policy through legislation have not been enacted into law, nor have legislative attempts to overturn the policy. See Table 1.Who does the policy apply can you buy diflucan in usa to?. The policy, when in effect, applies to foreign NGOs as a condition for receiving U.S. Family planning support and, now, other global health assistance, either directly (as the main – or prime – recipient of U.S.

Funding) or indirectly (as a recipient can you buy diflucan in usa of U.S. Funding through an agreement with the prime recipient. Referred to as a can you buy diflucan in usa sub-recipient). Specifically, a foreign NGO “recipient agrees that it will not, during the term of this award, perform or actively promote abortion as a method of family planning in foreign countries or provide financial support to any other foreign non-governmental organization that conducts such activities.”Foreign NGOs include:international NGOs that are based outside the U.S.,regional NGOs that are based outside the U.S., andlocal NGOs in assisted countries.U.S.

NGOs, while not directly subject to the Mexico City Policy, can you buy diflucan in usa must also agree to ensure that they do not provide funding to any foreign NGO sub-recipients unless those sub-recipients have first certified adherence to the policy. Specifically, a U.S. NGO “recipient (A) agrees that it will can you buy diflucan in usa not furnish health assistance under this award to any foreign non-governmental organization that performs or actively promotes abortion as a method of family planning in foreign countries. And (B) further agrees to require that such sub-recipients do not provide financial support to any other foreign non-governmental organization that conducts such activities.”As in the past, the current policy does not apply to funding provided by the U.S.

Government to foreign governments (national can you buy diflucan in usa or sub-national), public international organizations, and other multilateral entities, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the treatment Alliance. However, this funding is subject to the policy if it flows through a foreign NGO that has accepted the policy. See “What can you buy diflucan in usa is ‘financial support’?. € below.To what assistance does it apply?.

In the past, can you buy diflucan in usa foreign NGOs have been required to adhere to the Mexico City Policy – when it was in effect – as a condition of receiving support through certain U.S. International funding streams. Family planning assistance through the can you buy diflucan in usa U.S. Agency for International Development (USAID) and, beginning in 2003, family planning assistance through the U.S.

Department of can you buy diflucan in usa State. In the 2003 memorandum announcing the policy’s expansion to include the Department of State, President Bush stated that the policy did not apply to funding for global HIV/AIDS programs and that multilateral organizations that are associations of governments are not included among “foreign NGOs.”The current policy, reinstated in 2017, applies to the vast majority of U.S. Bilateral global health assistance furnished by all agencies and departments can you buy diflucan in usa. “Assistance” includes “the provision of funds, commodities, equipment, or other in-kind global health assistance.” Specifically, the expanded policy applies to nearly all bilateral global health assistance, including.

family planning and reproductive healthfor the first time:maternal and child health (including household-level water, sanitation, and can you buy diflucan in usa hygiene (WASH))nutritionHIV under PEPFARtuberculosismalaria under the President’s Malaria Initiative (PMI)neglected tropical diseasesglobal health securitycertain types of research activitiesThe policy applies to the assistance described above that is appropriated directly to three agencies and departments. USAID. The Department of State, can you buy diflucan in usa including the Office of the Global AIDS Coordinator, which oversees and coordinates U.S. Global HIV funding under PEPFAR.

And for the first time, can you buy diflucan in usa the Department of Defense (DoD). When such funding is transferred to another agency, including the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), it remains subject to the policy, to the extent that such funding is ultimately provided to foreign NGOs, directly or indirectly.The policy applies to three types of funding agreements for such assistance. Grants. Cooperative agreements.

And, for the first time, contracts, pending necessary rule-making that would be needed to do so (a proposed rule to accomplish this was published in September 2020).The policy does not apply to U.S. Assistance for. Water supply and sanitation activities, which is usually focused on infrastructure and systems. Humanitarian assistance, including activities related to migration and refugee assistance activities as well as disaster and humanitarian relief activities.

The American Schools and Hospitals Abroad (ASHA) program. And Food for Peace (FFP). However, this funding is subject to the policy if it flows through a foreign NGO that has accepted the policy. See “What is ‘financial support’?.

€ below.What activities are prohibited?. The policy prohibits foreign NGOs that receive U.S. Family planning assistance and, now, most other U.S. Bilateral global health assistance from using funds from any source (including non-U.S.

Funds) to “perform or actively promote abortion as a method of family planning.” In addition to providing abortions with non-U.S. Funds, restricted activities also include the following:providing advice and information about and offering referral for abortion – where legal – as part of the full range of family planning options,promoting changes in a country’s laws or policies related to abortion as a method of family planning (i.e., engaging in lobbying), andconducting public information campaigns about abortion as a method of family planning.The prohibition of these activities are why the policy has been referred to by its critics as the “Global Gag Rule.”Additionally, for the first time, the policy prohibits foreign NGOs from providing any financial support with any source of funds (including non-U.S. Funding) and for any purpose to other foreign NGOs that perform or actively promote abortion as a method of family planning. See “What is “financial support?.

€ below.The policy, however, does not prohibit foreign NGOs from:providing advice and information about, performing, or offering referral for abortion in cases where the pregnancy has either posed a risk to the life of the mother or resulted from incest or rape. Andresponding to a question about where a safe, legal abortion may be obtained when a woman who is already pregnant clearly states that she has already decided to have a legal abortion (passively providing information, versus actively providing medically-appropriate information).In addition, the expanded policy does not apply to healthcare providers who have an affirmative duty required under local law to provide counseling about and referrals for abortion as a method of family planning.Does it restrict direct U.S. Funding for abortion overseas?. U.S.

Funding for abortion is already restricted under several provisions of the law. Specifically, before the Mexico City Policy was first announced in 1984, U.S. Law already prohibited the use of U.S. Aid:to pay for the performance of abortion as a method of family planning or to motivate or coerce any person to practice abortion (the Helms Amendment, 1973, to the Foreign Assistance Act);for biomedical research related to methods of or the performance of abortion as a means of family planning (the Biden Amendment, 1981, to the Foreign Assistance Act).

Andto lobby for or against abortion (the Siljander Amendment, first included in annual appropriations in 1981 and included each year thereafter).Then, shortly after the policy was announced in 1984, the Kemp-Kasten Amendment was passed in 1985, prohibiting the use of U.S. Aid to fund any organization or program, as determined by the president, that supports or participates in the management of a program of coercive abortion or involuntary sterilization (it is now included in annual appropriations).Before the Mexico City Policy, U.S. Aid recipients could use non-U.S. Funds to engage in certain abortion-related activities but were required to maintain segregated accounts for U.S.

Assistance. The Mexico City Policy reversed this practice. No longer were foreign NGOs allowed to use non-U.S. Funds, maintained in segregated accounts, for voluntary abortion-related activities if they wished to continue to receive or be able to receive U.S.

Family planning funds.Does the policy prohibit post-abortion care?. The Mexico City Policy does not restrict the provision of post-abortion care, which is a supported activity of U.S. Family planning assistance. Whether or not the Mexico City Policy is in effect, recipients of U.S.

Family planning assistance are allowed to use U.S. And non-U.S. Funding to support post-abortion care, no matter the circumstances of the abortion (whether it was legal or illegal).What has been the impact of the policy?. Several studies have looked at the impact of the policy.

A 2011 quantitative analysis by Bendavid, et. Al, found a strong association between the Mexico City Policy and abortion rates in sub-Saharan Africa. This study was recently updated to include several more years of data, again identifying a strong association. Specifically, the updated study found that during periods when the policy was in place, abortion rates rose by 40% in countries with high exposure to the Mexico City Policy compared to those with low exposure, while the use of modern contraceptives declined by 14% and pregnancies increased by 12% in high exposure compared to low exposure countries.

In other words, it found patterns that “strengthen the case for the role played by the policy” in “a substantial increase in abortions across sub-Saharan Africa among women affected by the U.S. Mexico City Policy … [and] a corresponding decline in the use of modern contraception and increase in pregnancies,” likely because foreign NGOs that declined U.S. Funding as a result of the Mexico City Policy – often key providers of women’s health services in these areas – had fewer resources to support family planning services, particularly contraceptives. Increased access to and use of contraception have been shown to be key to preventing unintended pregnancies and thereby reducing abortion, including unsafe abortion.

The study also found patterns that “suggest that the effects of the policy are reversible” when the policy is not in place.Additionally, there has been anecdotal evidence and qualitative data on the impact of the policy, when it has been in force in the past, on the work of organizations that have chosen not to agree to the policy and, therefore, forgo U.S. Funding that had previously supported their activities. For example, they have reported that they have fewer resources to support family planning and reproductive health services, including family planning counseling, contraceptive commodities, condoms, and reproductive cancer screenings.While it is likely too early to assess the full effects of the current policy on NGOs and the individuals they serve, as the policy is applied on a rolling basis as new funding agreements or modifications to existing agreements are made, some early data are available. Several early qualitative and quantitative studies have been released, and at least one long-term, quantitative assessment is underway.

Additionally, an official assessment by the U.S. Department of State on implementation during the first six months of the policy has been released (see below). This review acknowledged that it took “place early in the policy’s implementation, when affected U.S. Government departments and agencies have added a significant portion of the funding affected by the policy to grants and cooperative agreements only recently [i.e., after the period the review examined].

A follow-on analysis would allow an opportunity to address one of the primary concerns presented in feedback from third-party stakeholder organizations, namely that six months is insufficient time to gauge the impacts of” the policy.Nonetheless, it is already clear that the reinstated and expanded version of the policy applies to a much greater amount of U.S. Global health assistance, and greater number of foreign NGOs, across many program areas. KFF has found that more than half (37) of the 64 countries that received U.S. Bilateral global health assistance in FY 2016 allow for legal abortion in at least one case not permitted by the policy and that had the expanded Mexico City Policy been in effect during the FY 2013 – FY 2015 period, at least 1,275 foreign NGOs would have been subject to the policy.

In addition, at least 469 U.S. NGOs that received U.S. Global health assistance during this period would have been required to ensure that their foreign NGO sub-recipients were in compliance. Additional foreign NGOs are likely to be impacted by the policy due to the revised interpretation of “financial support” announced in March 2019 and implemented beginning June 2019.

See “What is ‘financial support’?. € below.A report released in March 2020 by the U.S. Government Accountability Office (GAO) provided new information on the number of projects (awards) and NGOs affected. It found that from May 2017 through FY 2018:the policy had been applied to over 1,300 global health projects, with the vast majority of these through USAID and CDC, andNGOs declined to accept the policy in 54 instances, totaling $153 million in declined funding – specifically, seven prime awards amounting to $102 million and 47 sub-awards amounting to $51 million (more than two-thirds of sub-awards were intended for Africa) – across USAID and CDC.

The Department of State and DoD did not identify any instances where NGOs declined to accept the policy conditions.What have the U.S. Government’s reviews of the policy found?. The U.S. Government has published two reviews of the policy to date, with the first examining the initial six months of the policy released in February 2018 and the second examining the first 18 months of the policy released in August 2020.First ReviewIn February 2018, the Department of State announced the findings of an initial six-month review of implementation of the policy through the end of FY 2017 (September 2017).

The report directed agencies to provide greater support for improving understanding of implementation among affected organizations and provided guidance to clarify terms included in standard provisions of grants and cooperative agreements. In the six-month review report, the Department of State report identified a number of “actions” for implementing agencies, such as a need for:more central and field-based training and implementation tools,a clearer explanation of termination of awards for NGOs found to be in violation of the policy, anda clarification of “financial support,” which was not defined in the standard provisions (see “What is financial support?. € below).The six month review also identified the number of affected agreements with prime implementing partners and the number of those that have accepted the Mexico City Policy as part of their agreements through September 2017 (see Table 2). U.S.

Agency or DepartmentPolicy Implementation DateOverall # of Grants and Cooperative Agreements with Global Health Assistance FundingOf Overall #:(From the Policy Implementation Date through 9/30/2017)# That Received New Funding and Accepted Policy# That Received New Funding and Declined to Accept Policy^# That Had Not Received New Funding YetUSAIDMay 15, 20175804193158State*May 15, 2017142108034HHS+May 31, 20174991600339DoDMay 15, 20177742134TOTAL12987294565NOTES. * reflects PEPFAR funding implemented through the Department of State. Other departments and agencies implement the majority of PEPFAR funding. + At HHS agencies, only certain assistance funding transferred from USAID, State, and DoD are subject to the policy.

^ As of September 30, 2017, USAID reported it was aware of three centrally funded prime partners, and 12 sub-awardee implementing partners, that declined to agree to the Protecting Life in Global Health Assistance (PLGHA) terms in their awards. DoD reported that one DoD partner, a U.S. NGO, declined to agree in one country but accepted the PLGHA standard provision in other countries. And HHS reported that no HHS partners declined to agree.SOURCES.

KFF analysis of data from Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb. 6, 2018, https://www.state.gov/protecting-life-in-global-health-assistance-six-month-review/.Second ReviewOn August 17, 2020, the Department of State released its second review of the policy, updating its initial six-month review (as an action item in the six-month review report, the department stated it would “conduct a further review of implementation of the policy by December 15, 2018, when more extensive experience will enable a more thorough examination of the benefits and challenges”). The long-anticipated review, which examines the period from May 2017 through September 2018, found:the awards declined spanned a variety of program areas, including family planning and reproductive health (FP/RH), HIV and AIDS (HIV/AIDS), maternal and child health (MCH), tuberculosis (TB), and nutrition, in addition to cross-cutting awards;the awards declined spanned geographic areas but many were for activities in sub-Saharan Africa;agencies and departments made efforts to transition projects to another implementer in order to minimize disruption. Butnevertheless, among USAID awards involving health service delivery where prime and sub-award recipients declined to accept the policy, gaps or disruptions in service delivery were sometimes reported.The second review also identified the number of affected agreements with prime implementing partners and the number of those that have accepted the Mexico City Policy as part of their agreements through September 2018 (see Table 3).

U.S. Agency or DepartmentPolicy Implementation Date# of Grants and Cooperative Agreements with Global Health Assistance Funding# of Prime Awardees That Declined to Accept Policy^USAIDMay 15, 20174866State*May 15, 20173350HHS+May 31, 20174661DoDMay 15, 2017531TOTAL13408NOTES. * reflects PEPFAR funding implemented through the Department of State. Other departments and agencies implement the majority of PEPFAR funding.

+ At HHS agencies, only certain assistance funding transferred from USAID, State, and DoD are subject to the policy. ^ As of September 30, 2018, USAID reported it was aware of six centrally funded prime partners, and 47 sub-awardee implementing partners, that declined to agree to the Protecting Life in Global Health Assistance (PLGHA) terms in their awards. DoD reported that one DoD partner, a U.S. NGO, declined to agree in one country but accepted the PLGHA standard provision in other countries.

And HHS reported that one HHS partner declined to agree.SOURCES. KFF analysis of data from Department of State, “Review of the Implementation of the Protecting Life in Global Health Assistance Policy ,” report, Aug. 17, 2020, https://www.state.gov/wp-content/uploads/2020/08/PLGHA-2019-Review-Final-8.17.2020-508.pdf, and Department of State, “Protecting Life in Global Health Assistance Six-Month Review,” report, Feb. 6, 2018, https://www.state.gov/protecting-life-in-global-health-assistance-six-month-review/.Additionally, the review reports that 47 sub-awardees, all under USAID awards, declined to accept the policy.

It is important to note that the review also states that information on sub-awards is not systematically collected by departments and agencies and that DoD was not able to collect information on sub-awards.What is “financial support”?. In February 2018, in the initial six-month review issued when Secretary of State Tillerson led the department, the Department of State report included an “action” statement to clarify the definition of “financial support” as used in the standard provisions for grants and cooperative agreements. At issue was whether it applied more narrowly to certain funding provided by foreign NGOs (i.e., funding other than U.S. Global health funding) to other foreign NGOs specifically for the purpose of performing or actively promoting abortion as a method of family planning or if it applied more broadly to certain funding provided by foreign NGOs to other foreign NGOs for any purpose, if that foreign NGO happened to perform or actively promote abortion as a method of family planning.

The State Department clarified that it was the more narrow interpretation.However, on March 26, 2019, Secretary of State Pompeo reversed this interpretation, announcing further “refinements” to the policy to clarify that it applied to the broader definition of financial support. Specifically, under the policy, U.S.-supported foreign NGOs agree to not provide any financial support (global health-related as well as other support), no matter the source of funds, to any other foreign NGO that performs or actively promotes abortion as a method of family planning. In June 2019, USAID provided additional information to reflect this broader interpretation of the standard provisions.This marks the first time the policy has been applied this broadly, as it can now affect funding provided by other donors (such as other governments and foundations) and non-global health funding provided by the U.S. Government for a wide range of purposes if this funding is first provided to foreign NGOs who have accepted the policy (as recipients of U.S.

Global health assistance) that then in turn provide that donor or U.S. Non global health funding for any purpose to foreign NGOs that perform or actively promote abortion as a method of family planning. For example, under the prior interpretation, a foreign NGO recipient of U.S. Global health funding could not provide any non-U.S.

Funding to another foreign NGO to perform or actively promote abortion as a method of family planning but could provide funding for other activities, such as education, even if the foreign NGO carried out prohibited activities. Under the broader interpretation, a foreign NGO could not provide any non-U.S. Funding for any activity to a foreign NGO that carried out prohibited activities. Similarly, while under the prior interpretation a foreign NGO recipient of U.S.

Global health funding could provide other U.S. Funding (such as humanitarian assistance) to another foreign NGO for non-prohibited activities, even if the foreign NGO carried out prohibited activities, now under the broader interpretation, it could not do so.What are the next steps in implementing the expanded policy?. The policy went into effect in May 2017 (see Table 2), although it is applied on a rolling basis, as new funding agreements and modifications to existing agreements occur. While it applies to all grants and cooperative agreements, the Trump administration has indicated that it intends the policy to apply to contracts, which would require a rule-making process (it began this process by publishing a proposed rule in September 2020)..

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The American Rescue Plan (ARP) is the single biggest improvement in health insurance affordability since diflucan 150mg 1 capsule the Affordable Care Act was implemented. For 2021 and 2022, it has increased the size of premium subsidies in the marketplace/exchange, and eliminated the “subsidy cliff.” The ARP ensures that Americans who receive unemployment compensation at any time in 2021 can enroll in a premium-free Silver plan with full cost-sharing reductions. (If you’re eligible for this benefit but enrolled in a non-Silver plan, you’ll need to switch to a Silver plan diflucan 150mg 1 capsule in order to take advantage of the cost-sharing reductions. In most states, you have until August 15, 2021 to make this change.) It also provides subsidies to cover the full cost of COBRA or state continuation coverage, through September 2021, for people who involuntarily lose their jobs or have their hours reduced.

To allow people an opportunity to access the enhanced premium subsidies in the marketplace, there’s a one-time special enrollment window that continues through August 15, 2021 in most states. Largely as a result of this enrollment opportunity and the ARP’s subsidy enhancements, effectuated enrollment diflucan 150mg 1 capsule in the marketplaces nationwide has almost certainly reached a record high, with an estimated 1.65 million people enrolling during the first three-and-a-half months of the special enrollment period. ARP subsidies particularly valuable for older plan buyers People of all ages, including the “young and invincible” population, are finding that coverage is more affordable now that the American Rescue Plan has been implemented. But because the full-price cost of health insurance is based on age — and is therefore higher for older enrollees — the ARP’s additional subsidies are particularly valuable for older Americans.

Some older consumers have been purchasing their own individual-market health insurance diflucan 150mg 1 capsule for years, and are now finding that their premiums are lower than they were before the ARP was enacted. (This is true only if these consumers update their marketplace application to activate the new subsidies or claim them later on their tax returns. People who have off-exchange coverage will need to transition to the exchange in order to take advantage of the new subsidies, either upfront or on a tax return.) But the ARP is also making it easier for people to transition from employer-sponsored health insurance to a diflucan 150mg 1 capsule self-purchased health plan. This is especially true for older applicants, since their subsidies are larger (to offset the higher premiums they would otherwise have to pay).

So if you’re still a few years out from Medicare eligibility and facing the loss of your employer-sponsored health plan, rest assured that you’ll have options for health coverage. And thanks to the ACA and the ARP, it’s more likely you’ll diflucan 150mg 1 capsule be able to afford it. A closer look. Age 60 and transitioning to the individual market You can use this spreadsheet to get a sense of how much the ARP has boosted premium subsidies, particularly for older Americans who didn’t previously qualify for a subsidy due to income.

(See the second section, with examples for a 60-year-old.) But here’s an example to help diflucan 150mg 1 capsule illustrate the point. Let’s consider Giuseppe, a 60-year-old who lives in Dallas and has chosen to retire despite having another five years before he’s eligible for Medicare. To show just how much the American diflucan 150mg 1 capsule Rescue Plan has improved the situation, we’ll assume that he’s already earned $55,000 in 2021 before leaving his job. Because his income level is above 400% of the federal poverty level for a single person, Giuseppe would not have been eligible for a premium subsidy at all under the pre-ARP rules, even for the months after he ceased to earn an income.

And since Texas has refused to expand Medicaid eligibility under the ACA, he would also be ineligible for Medicaid – even if his monthly income drops to $0 due to the job loss. (This is still the diflucan 150mg 1 capsule case, even with the American Rescue Plan in place.) Thanks to the ARP, Giuseppe will qualify for a premium tax credit (premium subsidy) of nearly $500/month once he transitions from his employer-sponsored plan to a plan in the Texas marketplace. (That’s based on the assumption that he won’t have any additional income for the remainder of the year, and that his annual income for 2021 will end up being $55,000.) Giuseppe will be able to choose from among 83 different plans, with after-subsidy premiums that start at just $84/month. That’s a plan with a high deductible.

Depending on his expected medical needs, it might make sense to pay diflucan 150mg 1 capsule more to get a more robust plan. But no matter what plan he chooses, out-of-pocket costs for in-network care won’t exceed $8,550 in 2021, essential health benefits will be covered on all of the available plans, and pre-existing conditions will also be covered. Before the American Rescue Plan was implemented, Giuseppe would have had to pay a minimum of $584/month for individual health insurance in 2021 (the full-price cost for the cheapest Bronze-level plan available in the marketplace), because he would have been ineligible for premium subsidies due to the income he earned earlier in the year. ACA + diflucan 150mg 1 capsule ARP subsidy is particularly valuable for older enrollees If Giuseppe were 30 instead of 60, the full-price cost for the least expensive Bronze plan would only be $243/month.

That disparity highlights the importance of the ACA/ARP subsidies. Without any subsidies, Giuseppe diflucan 150mg 1 capsule would be paying almost two and a half times as much as a 30-year-old. But thanks to the subsidies, Giuseppe has access to plans that are significantly less expensive than the options he would have if he were 30 years old. If he were 30 and earning the same $55,000 in income this year, he would not qualify for a subsidy at all, even with the ARP in place.

That’s because the cost of the benchmark plan would diflucan 150mg 1 capsule already be less than 8.5% of his income, which is the cap imposed by the ARP. (For a 30-year-old in Dallas, the full-price cost of the benchmark plan is $371/month. It would have to be more than $390/month to trigger a subsidy.) But as we saw above, 60-year-old Giuseppe’s subsidy is large enough that it brings down the cost of the least expensive plan to just $84/month. (It will make the diflucan 150mg 1 capsule benchmark plan equal to about $390/month, which is 8.5% of his income.) Location matters Subsidy amounts vary from one place to another, as do the number of available plans and the pricing for the lowest-cost plans.

If 60-year-old Giuseppe lives in Orlando, for example, he’ll qualify for a subsidy of about $600/month, and will be able to choose from among 124 health plans. But the lowest-cost plan will be about diflucan 150mg 1 capsule $150/month. (Without the American Rescue Plan, it would have been about $750/month.) But in both Dallas and Orlando — and anywhere else in the country — Giuseppe will pay no more than $390/month (8.5% of his income) for the benchmark Silver plan. Before the ARP was implemented, Giuseppe’s cost for the benchmark plan would simply have been the full-price cost for that plan — which varies from one place to another — as he wouldn’t have qualified for a subsidy since his income is more than 400% of the poverty level.

Even if Giuseppe had an income below 400% of the poverty level, and would have been eligible for a subsidy before the ARP, his subsidy is now larger than it would have been (as diflucan 150mg 1 capsule illustrated in the other income scenarios here), since he’s now expected to pay a smaller percentage of his income in premiums. For many enrollees, plans are available with no premiums at all. If you haven’t checked your subsidy eligibility lately, now’s a good time to do that!. Good subsidy news if you’re being laid off For Americans who involuntarily lose (or recently lost) their job or involuntarily have their work hours reduced and no longer qualify for employer-sponsored health insurance, the American Rescue Plan provides a full subsidy for diflucan 150mg 1 capsule COBRA or state continuation (mini-COBRA) plans through the end of September 2021.

Assuming your coverage can be continued with COBRA or state continuation, you’ll have an option to do so regardless of whether you’re leaving your job voluntarily or involuntarily. But if you’re diflucan 150mg 1 capsule being laid off, you’ll be able to continue your coverage for free through September. (If you’re choosing to retire, you’ll still be able to elect COBRA or state continuation, but you’ll have to pay the premiums yourself.) You’ll have 60 days to decide whether to extend your employer-sponsored coverage using the ARP’s COBRA subsidy (There is normally a 60-day window to elect COBRA in general, but that’s been extended during the antifungal medication emergency period, which is expected to remain in place throughout 2021. But the ARP’s COBRA subsidy does have to be elected within 60 days of the person being notified of eligibility for COBRA and the subsidy.) An option to take COBRA or state continuation coverage does not make a person ineligible for premium subsidies in the marketplace (as opposed to an offer of coverage from a current employer, which does generally make a person ineligible for marketplace subsidies).

But it has diflucan 150mg 1 capsule to be one or the other. You can either enroll in a marketplace plan with ACA/ARP subsidies, or extend your employer-sponsored plan using COBRA or mini-COBRA with the federal subsidy through September 2021. But if you choose to extend your employer-sponsored coverage and take the COBRA subsidy, HHS has confirmed that you’ll qualify for a special enrollment period to transition to a marketplace plan after the COBRA subsidy ends in the fall. The ARP’s additional premium subsidies for marketplace plans will be in effect throughout 2022 as well (and could be extended by Congress at a later date), so that’s an option that will remain affordable for the time being diflucan 150mg 1 capsule.

You’ll also have the option to keep the COBRA or state continuation coverage until it expires, but you’ll have to pay full price starting in October 2021. A marketplace plan may end up being much more affordable at that point, but it’s important to consider things like starting over with a new deductible when you transition from an employer-sponsored plan to an individual plan, as well as the different provider networks and drug formularies for the individual market plans. The ARP’s COBRA subsidy and additional marketplace diflucan 150mg 1 capsule subsidies are available regardless of age. But because health insurance premiums are based on age — including, in most cases, premiums for employer-sponsored coverage — the ARP’s subsidies are particularly valuable for older Americans.

Since the cost of coverage is higher, the subsidies are larger as well diflucan 150mg 1 capsule. A couple of other points to keep in mind if you’re using the ARP’s COBRA subsidy. You’ll want to check the cost of individual coverage through the marketplace during the open enrollment period that starts November 1, 2021. You’ll be seeing prices for 2022 coverage, so use your 2022 income projection to see what your after-subsidy premium diflucan 150mg 1 capsule will be.

Even if you keep your COBRA coverage until the end of 2021, you might find that you’re better off switching to a marketplace plan as of January 2022. If you’ll become eligible for Medicare during the time your COBRA will be in place, be sure you understand the rules regarding enrollment in Medicare Part B and D. You can delay Medicare Part B if you’re covered under diflucan 150mg 1 capsule an active employee plan, but not if you’re covered under COBRA. And your COBRA coverage may or may not be considered creditable coverage for Medicare Part D.

Guaranteed-issue coverage makes a smooth transition to Medicare Thanks to the Affordable Care Act, older Americans can rely on individual market coverage in the years prior to Medicare, without having to worry about diflucan 150mg 1 capsule pre-existing medical conditions. €œJob lock” — continuing to work just for the health insurance benefits — doesn’t exist with the same level of urgency that it once did. And the individual/family plans that are available to early retirees are comprehensive, without the sort of coverage holes that often existed in individual market plans prior to the ACA. The ACA already provided premium subsidies diflucan 150mg 1 capsule to many individuals who needed coverage prior to aging into Medicare.

And the ARP has made those subsidies more substantial and more widely available — particularly for older enrollees. If you’re nearing Medicare eligibility but not quite there yet, health insurance may not be as much of a retirement obstacle as you thought it would be. You might diflucan 150mg 1 capsule be pleasantly surprised to see how affordable the coverage options are. And if you’re already in need of coverage, time is of the essence.

The antifungal medication-related special enrollment period ends diflucan 150mg 1 capsule in most states on August 15, 2021. After that, unless you experience a qualifying event, you’ll have to wait until open enrollment to sign up for individual health insurance, with coverage effective January 1. But during the antifungal medication-related special enrollment period, you can enroll in health coverage through the marketplace and take advantage of the ACA/ARP subsidies, even if you don’t have a qualifying life event. Louise Norris is an individual health insurance broker who has been writing about health insurance diflucan 150mg 1 capsule and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Most of the American Rescue Plan’s (ARP) additional premium subsidies have been available since April, and an estimated 1.65 million people have enrolled in health plans through the exchange (marketplace) during the antifungal medication-related special enrollment period that’s been ongoing since February. But a major provision of the law will take effect on July 1, when HealthCare.gov makes additional subsidies available to people who have received unemployment compensation this diflucan 150mg 1 capsule year. DC and 14 states run their own exchanges, and some of them had already activated the additional unemployment-based subsidies in May or June.

But in the 36 states that use HealthCare.gov, as well as some of the state-based exchanges, the additional subsidies will become available this Thursday, July 1. Here’s what you need to know about these additional diflucan 150mg 1 capsule unemployment-based subsidies. The subsidies apply to both premiums and out-of-pocket costs The unemployment-based subsidies are two-fold. They provide diflucan 150mg 1 capsule full premium subsidies, which means they fully cover the cost of the benchmark plan (second-lowest-cost Silver plan) in your area.

They provide the most robust level of cost-sharing reductions, which means they’ll boost the benefits of any Silver-level plan so that it’s better than a Platinum plan. Who is eligible for unemployment-based subsidies?. The unemployment-based subsidies are diflucan 150mg 1 capsule available to anyone who has received or been approved to receive unemployment compensation at any time this year. (If you’re eligible to receive unemployment compensation but haven’t applied or haven’t been approved to receive it, you’re not eligible for the additional health insurance subsidies.) Eligibility for the unemployment-based subsidies includes people whose income is under the federal poverty level, as long as they’re not eligible for Medicaid.

(If a person is eligible for Medicaid or CHIP, they aren’t eligible for subsidies in the exchange. Nothing has changed about that.) People with income under the poverty level are normally not eligible for subsidies, which means there’s a coverage gap in the states that have refused to diflucan 150mg 1 capsule accept federal funding to expand Medicaid. But a person who would otherwise be in the coverage gap can receive a full premium subsidy and full cost-sharing reductions in 2021, if they receive unemployment compensation at any time during the year. CMS has diflucan 150mg 1 capsule confirmed that the full premium subsidies are only available if it’s a taxpayer who is receiving the unemployment compensation.

If it’s a dependent who is receiving it, the household is eligible for the cost-sharing reductions (assuming the household is otherwise also eligible for premium tax credits), but not the full premium subsidies. Even if you only received unemployment compensation for one week of 2021, you’re potentially eligible for the enhanced subsidies for the entire year. But subsidy diflucan 150mg 1 capsule eligibility would end if and when you become eligible for employer-sponsored health coverage (that’s considered affordable and provides minimum value), or premium-free Medicare Part A. The ARP has not fixed the family glitch, so family members would also lose access to any subsidies in the exchange if they become eligible for employer-sponsored coverage that’s considered affordable for the employee.

How to claim the extra subsidies HealthCare.gov will not be able to automatically update these subsidies (although that’s something that may become available later on), so you’ll need to log back into your account and update your application to activate the subsidies. You can do this through HealthCare.gov, or through diflucan 150mg 1 capsule an enhanced direct enrollment entity if you use one. Some of the state-run exchanges are automatically applying the additional subsidies to accounts where applicants indicated that they’re receiving unemployment compensation this year. But if you’re in a state that runs its own exchange, diflucan 150mg 1 capsule it’s in your best interest to log back into your account to confirm that you’re receiving all of the benefits for which you’re eligible.

If you enroll or update your account between July 1 and July 31, your new subsidies will take effect August 1. The antifungal medication-related special enrollment period continues through August 15 in most states, but enrollments or updates completed in August won’t take effect until September. If you’ve already got coverage through the exchange but you don’t update your application to diflucan 150mg 1 capsule start receiving the additional unemployment-based subsidies, you’ll be able to claim the premium subsidy on your 2021 tax return. However, there is no way to claim cost-sharing reductions after the fact.

So it’s important to make sure you’re enrolled in a Silver plan as soon as possible, if you want to take advantage of that benefit. You might need to switch plans to get the full benefit You can get the additional premium subsidies diflucan 150mg 1 capsule applied to any metal-level plan, although your subsidy can never be more than the cost of your plan. So if you’re enrolled in a plan that’s less expensive than the benchmark plan, you might find that you’re able to upgrade to a better plan without paying any additional premium. But you can only get the enhanced cost-sharing reductions if you’re enrolled in a Silver plan.

So if you currently have a Bronze or Gold plan, you might choose to diflucan 150mg 1 capsule switch to a Silver plan to get the full benefits available under the ARP. Although switching to a new plan mid-year usually means starting over with a new deductible and out-of-pocket maximum, many states and insurers are allowing enrollees to keep their accumulated out-of-pocket costs, as long as they switch to a new plan from the same insurer. What you’ll pay each month The unemployment-based subsidies will cover the full cost of the diflucan 150mg 1 capsule benchmark plan. So you’ll have access to two Silver plans that have no premium, and you’ll likely have access to a variety of Bronze plans — and possibly some Gold plans — that have no premium.

If you pick a plan that’s more expensive than the benchmark plan, including the higher-cost Silver plans, you’ll pay at least some premium each month. If you’re in a state diflucan 150mg 1 capsule that has additional state-mandated benefits that aren’t covered by premium subsidies, you may find that you have to pay at least a dollar or two each month in premiums, regardless of which plan you select. What you’ll pay when you need medical care If you enroll in a Silver plan, you’ll get the full benefits of the unemployment-based subsidies, meaning that you’ll have fairly low out-of-pocket costs if you need medical care later this year. Any Silver plan you choose will have a maximum out-of-pocket of no more than $2,850 in 2021, and it’s common to see these plans with deductibles that range from $0 to $500.

Copays for office visits and many prescriptions also tend to be fairly diflucan 150mg 1 capsule low. If you choose a non-Silver plan, the normal cost-sharing will apply. No matter what plan you select, your out-of-pocket maximum for in-network care won’t exceed $8,550 this year, but the specifics of the coverage will vary considerably from one plan to diflucan 150mg 1 capsule another. How big will your subsidy be?.

You can use our subsidy calculator to see the subsidy amount that will be available to you. For people receiving unemployment compensation, the exchange will disregard any income above 139% of the poverty level for diflucan 150mg 1 capsule 2021. The 2020 poverty level numbers are used to determine subsidy eligibility for 2021, so you can find the poverty level for your household size, multiply it by 1.39, and enter that number into the subsidy calculator. And if you need help finding a plan, our direct enrollment entity can provide assistance.

Louise Norris is an individual health insurance broker who diflucan 150mg 1 capsule has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

The American Rescue Plan (ARP) is can you buy diflucan in usa the Buy cipro canada single biggest improvement in health insurance affordability since the Affordable Care Act was implemented. For 2021 and 2022, it has increased the size of premium subsidies in the marketplace/exchange, and eliminated the “subsidy cliff.” The ARP ensures that Americans who receive unemployment compensation at any time in 2021 can enroll in a premium-free Silver plan with full cost-sharing reductions. (If you’re eligible for this benefit but enrolled in a non-Silver plan, you’ll need to switch to a Silver plan in order can you buy diflucan in usa to take advantage of the cost-sharing reductions.

In most states, you have until August 15, 2021 to make this change.) It also provides subsidies to cover the full cost of COBRA or state continuation coverage, through September 2021, for people who involuntarily lose their jobs or have their hours reduced. To allow people an opportunity to access the enhanced premium subsidies in the marketplace, there’s a one-time special enrollment window that continues through August 15, 2021 in most states. Largely as a result of this enrollment opportunity and the ARP’s subsidy enhancements, can you buy diflucan in usa effectuated enrollment in the marketplaces nationwide has almost certainly reached a record high, with an estimated 1.65 million people enrolling during the first three-and-a-half months of the special enrollment period.

ARP subsidies particularly valuable for older plan buyers People of all ages, including the “young and invincible” population, are finding that coverage is more affordable now that the American Rescue Plan has been implemented. But because the full-price cost of health insurance is based on age — and is therefore higher for older enrollees — the ARP’s additional subsidies are particularly valuable for older Americans. Some older consumers have been purchasing their own individual-market health insurance for years, and are now finding that their premiums are lower than they were before the can you buy diflucan in usa ARP was enacted.

(This is true only if these consumers update their marketplace application to activate the new subsidies or claim them later on their tax returns. People who have off-exchange coverage will need to transition to the exchange in order to take advantage of the new subsidies, either upfront or on a tax return.) But the ARP is also making it easier for people to transition from employer-sponsored health insurance can you buy diflucan in usa to a self-purchased health plan. This is especially true for older applicants, since their subsidies are larger (to offset the higher premiums they would otherwise have to pay).

So if you’re still a few years out from Medicare eligibility and facing the loss of your employer-sponsored health plan, rest assured that you’ll have options for health coverage. And thanks to the ACA and the ARP, it’s more likely you’ll be able to can you buy diflucan in usa afford it. A closer look.

Age 60 and transitioning to the individual market You can use this spreadsheet to get a sense of how much the ARP has boosted premium subsidies, particularly for older Americans who didn’t previously qualify for a subsidy due to income. (See the second section, can you buy diflucan in usa with examples for a 60-year-old.) But here’s an example to help illustrate the point. Let’s consider Giuseppe, a 60-year-old who lives in Dallas and has chosen to retire despite having another five years before he’s eligible for Medicare.

To show just how much the American Rescue Plan has improved the situation, we’ll assume that can you buy diflucan in usa he’s already earned $55,000 in 2021 before leaving his job. Because his income level is above 400% of the federal poverty level for a single person, Giuseppe would not have been eligible for a premium subsidy at all under the pre-ARP rules, even for the months after he ceased to earn an income. And since Texas has refused to expand Medicaid eligibility under the ACA, he would also be ineligible for Medicaid – even if his monthly income drops to $0 due to the job loss.

(This is still the case, even with the American Rescue Plan in place.) Thanks to the ARP, Giuseppe will qualify for a premium tax credit (premium subsidy) of nearly $500/month once he can you buy diflucan in usa transitions from his employer-sponsored plan to a plan in the Texas marketplace. (That’s based on the assumption that he won’t have any additional income for the remainder of the year, and that his annual income for 2021 will end up being $55,000.) Giuseppe will be able to choose from among 83 different plans, with after-subsidy premiums that start at just $84/month. That’s a plan with a high deductible.

Depending on his expected medical needs, it might can you buy diflucan in usa make sense to pay more to get a more robust plan. But no matter what plan he chooses, out-of-pocket costs for in-network care won’t exceed $8,550 in 2021, essential health benefits will be covered on all of the available plans, and pre-existing conditions will also be covered. Before the American Rescue Plan was implemented, Giuseppe would have had to pay a minimum of $584/month for individual health insurance in 2021 (the full-price cost for the cheapest Bronze-level plan available in the marketplace), because he would have been ineligible for premium subsidies due to the income he earned earlier in the year.

ACA + ARP subsidy is particularly valuable for older enrollees If Giuseppe can you buy diflucan in usa were 30 instead of 60, the full-price cost for the least expensive Bronze plan would only be $243/month. That disparity highlights the importance of the ACA/ARP subsidies. Without any subsidies, Giuseppe would be paying almost two and a half can you buy diflucan in usa times as much as a 30-year-old.

But thanks to the subsidies, Giuseppe has access to plans that are significantly less expensive than the options he would have if he were 30 years old. If he were 30 and earning the same $55,000 in income this year, he would not qualify for a subsidy at all, even with the ARP in place. That’s because the cost of the benchmark plan would already be less than 8.5% of his income, which is can you buy diflucan in usa the cap imposed by the ARP.

(For a 30-year-old in Dallas, the full-price cost of the benchmark plan is $371/month. It would have to be more than $390/month to trigger a subsidy.) But as we saw above, 60-year-old Giuseppe’s subsidy is large enough that it brings down the cost of the least expensive plan to just $84/month. (It will make the benchmark plan equal to about $390/month, which is 8.5% of his income.) Location matters Subsidy amounts vary from can you buy diflucan in usa one place to another, as do the number of available plans and the pricing for the lowest-cost plans.

If 60-year-old Giuseppe lives in Orlando, for example, he’ll qualify for a subsidy of about $600/month, and will be able to choose from among 124 health plans. But the can you buy diflucan in usa lowest-cost plan will be about $150/month. (Without the American Rescue Plan, it would have been about $750/month.) But in both Dallas and Orlando — and anywhere else in the country — Giuseppe will pay no more than $390/month (8.5% of his income) for the benchmark Silver plan.

Before the ARP was implemented, Giuseppe’s cost for the benchmark plan would simply have been the full-price cost for that plan — which varies from one place to another — as he wouldn’t have qualified for a subsidy since his income is more than 400% of the poverty level. Even if Giuseppe had an income below 400% of the poverty level, and would have can you buy diflucan in usa been eligible for a subsidy before the ARP, his subsidy is now larger than it would have been (as illustrated in the other income scenarios here), since he’s now expected to pay a smaller percentage of his income in premiums. For many enrollees, plans are available with no premiums at all.

If you haven’t checked your subsidy eligibility lately, now’s a good time to do that!. Good subsidy news if you’re can you buy diflucan in usa being laid off For Americans who involuntarily lose (or recently lost) their job or involuntarily have their work hours reduced and no longer qualify for employer-sponsored health insurance, the American Rescue Plan provides a full subsidy for COBRA or state continuation (mini-COBRA) plans through the end of September 2021. Assuming your coverage can be continued with COBRA or state continuation, you’ll have an option to do so regardless of whether you’re leaving your job voluntarily or involuntarily.

But if you’re being laid off, you’ll be able can you buy diflucan in usa to continue your coverage for free through September. (If you’re choosing to retire, you’ll still be able to elect COBRA or state continuation, but you’ll have to pay the premiums yourself.) You’ll have 60 days to decide whether to extend your employer-sponsored coverage using the ARP’s COBRA subsidy (There is normally a 60-day window to elect COBRA in general, but that’s been extended during the antifungal medication emergency period, which is expected to remain in place throughout 2021. But the ARP’s COBRA subsidy does have to be elected within 60 days of the person being notified of eligibility for COBRA and the subsidy.) An option to take COBRA or state continuation coverage does not make a person ineligible for premium subsidies in the marketplace (as opposed to an offer of coverage from a current employer, which does generally make a person ineligible for marketplace subsidies).

But it has to be one can you buy diflucan in usa or the other. You can either enroll in a marketplace plan with ACA/ARP subsidies, or extend your employer-sponsored plan using COBRA or mini-COBRA with the federal subsidy through September 2021. But if you choose to extend your employer-sponsored coverage and take the COBRA subsidy, HHS has confirmed that you’ll qualify for a special enrollment period to transition to a marketplace plan after the COBRA subsidy ends in the fall.

The ARP’s additional premium subsidies for marketplace plans will be in effect throughout 2022 as well (and can you buy diflucan in usa could be extended by Congress at a later date), so that’s an option that will remain affordable for the time being. You’ll also have the option to keep the COBRA or state continuation coverage until it expires, but you’ll have to pay full price starting in October 2021. A marketplace plan may end up being much more affordable at that point, but it’s important to consider things like starting over with a new deductible when you transition from an employer-sponsored plan to an individual plan, as well as the different provider networks and drug formularies for the individual market plans.

The ARP’s COBRA subsidy and can you buy diflucan in usa additional marketplace subsidies are available regardless of age. But because health insurance premiums are based on age — including, in most cases, premiums for employer-sponsored coverage — the ARP’s subsidies are particularly valuable for older Americans. Since the can you buy diflucan in usa cost of coverage is higher, the subsidies are larger as well.

A couple of other points to keep in mind if you’re using the ARP’s COBRA subsidy. You’ll want to check the cost of individual coverage through the marketplace during the open enrollment period that starts November 1, 2021. You’ll be can you buy diflucan in usa seeing prices for 2022 coverage, so use your 2022 income projection to see what your after-subsidy premium will be.

Even if you keep your COBRA coverage until the end of 2021, you might find that you’re better off switching to a marketplace plan as of January 2022. If you’ll become eligible for Medicare during the time your COBRA will be in place, be sure you understand the rules regarding enrollment in Medicare Part B and D. You can delay Medicare Part B if you’re covered under an active can you buy diflucan in usa employee plan, but not if you’re covered under COBRA.

And your COBRA coverage may or may not be considered creditable coverage for Medicare Part D. Guaranteed-issue coverage makes a smooth transition to Medicare Thanks to the Affordable Care Act, older can you buy diflucan in usa Americans can rely on individual market coverage in the years prior to Medicare, without having to worry about pre-existing medical conditions. €œJob lock” — continuing to work just for the health insurance benefits — doesn’t exist with the same level of urgency that it once did.

And the individual/family plans that are available to early retirees are comprehensive, without the sort of coverage holes that often existed in individual market plans prior to the ACA. The ACA already provided premium subsidies to many individuals who needed coverage prior can you buy diflucan in usa to aging into Medicare. And the ARP has made those subsidies more substantial and more widely available — particularly for older enrollees.

If you’re nearing Medicare eligibility but not quite there yet, health insurance may not be as much of a retirement obstacle as you thought it would be. You might be pleasantly surprised to see how affordable the coverage options are can you buy diflucan in usa. And if you’re already in need of coverage, time is of the essence.

The antifungal medication-related can you buy diflucan in usa special enrollment period ends in most states on August 15, 2021. After that, unless you experience a qualifying event, you’ll have to wait until open enrollment to sign up for individual health insurance, with coverage effective January 1. But during the antifungal medication-related special enrollment period, you can enroll in health coverage through the marketplace and take advantage of the ACA/ARP subsidies, even if you don’t have a qualifying life event.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform can you buy diflucan in usa since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Most of the American Rescue Plan’s (ARP) additional premium subsidies have been available since April, and an estimated 1.65 million people have enrolled in health plans through the exchange (marketplace) during the antifungal medication-related special enrollment period that’s been ongoing since February.

But a major provision of the law will take effect can you buy diflucan in usa on July 1, when HealthCare.gov makes additional subsidies available to people who have received unemployment compensation this year. DC and 14 states run their own exchanges, and some of them had already activated the additional unemployment-based subsidies in May or June. But in the 36 states that use HealthCare.gov, as well as some of the state-based exchanges, the additional subsidies will become available this Thursday, July 1.

Here’s what you need to know about can you buy diflucan in usa these additional unemployment-based subsidies. The subsidies apply to both premiums and out-of-pocket costs The unemployment-based subsidies are two-fold. They provide full premium subsidies, which can you buy diflucan in usa means they fully cover the cost of the benchmark plan (second-lowest-cost Silver plan) in your area.

They provide the most robust level of cost-sharing reductions, which means they’ll boost the benefits of any Silver-level plan so that it’s better than a Platinum plan. Who is eligible for unemployment-based subsidies?. The unemployment-based subsidies are available to anyone who has received or been approved to receive unemployment compensation at any time this year can you buy diflucan in usa.

(If you’re eligible to receive unemployment compensation but haven’t applied or haven’t been approved to receive it, you’re not eligible for the additional health insurance subsidies.) Eligibility for the unemployment-based subsidies includes people whose income is under the federal poverty level, as long as they’re not eligible for Medicaid. (If a person is eligible for Medicaid or CHIP, they aren’t eligible for subsidies in the exchange. Nothing has changed about that.) People with income under the poverty level are normally not eligible for subsidies, which means there’s a coverage gap in the states that have refused to accept federal funding can you buy diflucan in usa to expand Medicaid.

But a person who would otherwise be in the coverage gap can receive a full premium subsidy and full cost-sharing reductions in 2021, if they receive unemployment compensation at any time during the year. CMS has confirmed that the can you buy diflucan in usa full premium subsidies are only available if it’s a taxpayer who is receiving the unemployment compensation. If it’s a dependent who is receiving it, the household is eligible for the cost-sharing reductions (assuming the household is otherwise also eligible for premium tax credits), but not the full premium subsidies.

Even if you only received unemployment compensation for one week of 2021, you’re potentially eligible for the enhanced subsidies for the entire year. But subsidy eligibility would end if and when you become eligible for employer-sponsored health coverage (that’s considered affordable and provides can you buy diflucan in usa minimum value), or premium-free Medicare Part A. The ARP has not fixed the family glitch, so family members would also lose access to any subsidies in the exchange if they become eligible for employer-sponsored coverage that’s considered affordable for the employee.

How to claim the extra subsidies HealthCare.gov will not be able to automatically update these subsidies (although that’s something that may become available later on), so you’ll need to log back into your account and update your application to activate the subsidies. You can do this through HealthCare.gov, or through can you buy diflucan in usa an enhanced direct enrollment entity if you use one. Some of the state-run exchanges are automatically applying the additional subsidies to accounts where applicants indicated that they’re receiving unemployment compensation this year.

But if you’re in a state that runs its own exchange, it’s in your best interest to log back into your account to confirm that you’re receiving all of the benefits can you buy diflucan in usa for which you’re eligible. If you enroll or update your account between July 1 and July 31, your new subsidies will take effect August 1. The antifungal medication-related special enrollment period continues through August 15 in most states, but enrollments or updates completed in August won’t take effect until September.

If you’ve already got coverage through the exchange but you don’t update your can you buy diflucan in usa application to start receiving the additional unemployment-based subsidies, you’ll be able to claim the premium subsidy on your 2021 tax return. However, there is no way to claim cost-sharing reductions after the fact. So it’s important to make sure you’re enrolled in a Silver plan as soon as possible, if you want to take advantage of that benefit.

You might need to switch plans to get the full benefit You can get the additional premium subsidies applied can you buy diflucan in usa to any metal-level plan, although your subsidy can never be more than the cost of your plan. So if you’re enrolled in a plan that’s less expensive than the benchmark plan, you might find that you’re able to upgrade to a better plan without paying any additional premium. But you can only get the enhanced cost-sharing reductions if you’re enrolled in a Silver plan.

So if you currently have a Bronze or Gold plan, you might choose to switch to a Silver plan to get the full can you buy diflucan in usa benefits available under the ARP. Although switching to a new plan mid-year usually means starting over with a new deductible and out-of-pocket maximum, many states and insurers are allowing enrollees to keep their accumulated out-of-pocket costs, as long as they switch to a new plan from the same insurer. What you’ll pay each month The unemployment-based subsidies will cover the full can you buy diflucan in usa cost of the benchmark plan.

So you’ll have access to two Silver plans that have no premium, and you’ll likely have access to a variety of Bronze plans — and possibly some Gold plans — that have no premium. If you pick a plan that’s more expensive than the benchmark plan, including the higher-cost Silver plans, you’ll pay at least some premium each month. If you’re in a state that has additional state-mandated benefits that aren’t covered by premium subsidies, you may find that you have to pay at least a dollar or two each month can you buy diflucan in usa in premiums, regardless of which plan you select.

What you’ll pay when you need medical care If you enroll in a Silver plan, you’ll get the full benefits of the unemployment-based subsidies, meaning that you’ll have fairly low out-of-pocket costs if you need medical care later this year. Any Silver plan you choose will have a maximum out-of-pocket of no more than $2,850 in 2021, and it’s common to see these plans with deductibles that range from $0 to $500. Copays for office visits and many prescriptions also can you buy diflucan in usa tend to be fairly low.

If you choose a non-Silver plan, the normal cost-sharing will apply. No matter what plan you select, your out-of-pocket maximum for in-network care won’t exceed $8,550 this year, but the specifics of the coverage will can you buy diflucan in usa vary considerably from one plan to another. How big will your subsidy be?.

You can use our subsidy calculator to see the subsidy amount that will be available to you. For people receiving unemployment compensation, the exchange will disregard any income above 139% of the poverty level can you buy diflucan in usa for 2021. The 2020 poverty level numbers are used to determine subsidy eligibility for 2021, so you can find the poverty level for your household size, multiply it by 1.39, and enter that number into the subsidy calculator.

And if you need help finding a plan, our direct enrollment entity can provide assistance. Louise Norris is an individual health can you buy diflucan in usa insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.

Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

Diflucan without prescription

antifungal medication antibodies preferentially target a different part of the diflucan in mild cases of antifungal medication than they do in severe cases, and wane significantly diflucan without prescription within several months of , according to a new study by researchers at Stanford Medicine.The findings identify new links between the course of the http://half-witpoet.com/?p=7 disease and a patient's immune response. They also raise concerns about whether people can be re-infected, whether antibody tests to detect prior may underestimate the breadth of the diflucan and whether vaccinations may need to be repeated at regular intervals to maintain a protective immune response."This is one of the most comprehensive studies to date of the antibody immune response to antifungals in people across the entire spectrum of disease severity, from asymptomatic to fatal," said Scott Boyd, MD, PhD, associate professor of pathology. "We assessed multiple time points and sample types, and also analyzed levels of viral RNA diflucan without prescription in patient nasopharyngeal swabs and blood samples.

It's one of the first big-picture looks at this illness."The study found that people with severe antifungal medication have low proportions of antibodies targeting the spike protein used by the diflucan to enter human cells compared with the number of antibodies targeting proteins of the diflucan's inner shell.Boyd is a senior author of the study, which was published Dec. 7 in diflucan without prescription Science Immunology. Other senior authors are Benjamin Pinsky, MD, PhD, associate professor of pathology, and Peter Kim, PhD, the Virginia and D.

K. Ludwig Professor diflucan without prescription of Biochemistry. The lead authors are research scientist Katharina Röltgen, PhD.

Postdoctoral scholars diflucan without prescription Abigail Powell, PhD, and Oliver Wirz, PhD. And clinical instructor Bryan Stevens, MD.diflucan binds to ACE2 receptorThe researchers studied 254 people with asymptomatic, mild or severe antifungal medication who were identified either through routine testing or occupational health screening at Stanford Health Care or who came to a Stanford Health Care clinic with symptoms of antifungal medication. Of the people with symptoms, 25 were treated as outpatients, 42 were hospitalized outside the intensive care unit and 37 were treated in the intensive care unit.

Twenty-five people in the study died of diflucan without prescription the disease. advertisement antifungals binds to human cells via a structure on its surface called the spike protein. This protein binds to a receptor on diflucan without prescription human cells called ACE2.

The binding allows the diflucan to enter and infect the cell. Once inside, the diflucan sheds its outer coat to reveal an inner shell encasing its genetic material. Soon, the diflucan co-opts the cell's protein-making machinery to churn out more viral particles, which are then released to infect other cells.Antibodies that recognize and bind to the spike protein block its ability to bind to ACE2, preventing the diflucan diflucan without prescription from infecting the cells, whereas antibodies that recognize other viral components are unlikely to prevent viral spread.

Current treatment candidates use portions of the spike protein to stimulate an immune response.Boyd and his colleagues analyzed the levels of three types of antibodies -- IgG, IgM and IgA -- and the proportions that targeted the viral spike protein or the diflucan's inner shell as the disease progressed and patients either recovered or grew sicker. They also measured the levels of viral genetic material in diflucan without prescription nasopharyngeal samples and blood from the patients. Finally, they assessed the effectiveness of the antibodies in preventing the spike protein from binding to ACE2 in a laboratory dish."Although previous studies have assessed the overall antibody response to , we compared the viral proteins targeted by these antibodies," Boyd said.

"We found that the severity of the illness correlates with the ratio of antibodies recognizing domains of the spike protein compared with other nonprotective viral targets. Those people with mild illness tended to have a higher proportion of diflucan without prescription anti-spike antibodies, and those who died from their disease had more antibodies that recognized other parts of the diflucan."Substantial variability in immune responseThe researchers caution, however, that although the study identified trends among a group of patients, there is still substantial variability in the immune response mounted by individual patients, particularly those with severe disease. advertisement "Antibody responses are not likely to be the sole determinant of someone's outcome," Boyd said.

"Among people diflucan without prescription with severe disease, some die and some recover. Some of these patients mount a vigorous immune response, and others have a more moderate response. So, there are a lot of other things going on.

There are also other branches diflucan without prescription of the immune system involved. It's important to note that our results identify correlations but don't prove causation."As in other studies, the researchers found that people with asymptomatic and mild illness had lower levels of antibodies overall than did those with severe disease. After recovery, the levels of IgM and IgA decreased steadily to low or undetectable levels in most patients over a period diflucan without prescription of about one to four months after symptom onset or estimated date, and IgG levels dropped significantly."This is quite consistent with what has been seen with other antifungalses that regularly circulate in our communities to cause the common cold," Boyd said.

"It's not uncommon for someone to get re-infected within a year or sometimes sooner. It remains to be seen whether the immune response to antifungals vaccination is stronger, or persists longer, than that caused by natural . It's quite diflucan without prescription possible it could be better.

But there are a lot of questions that still need to be answered."Boyd is a co-chair of the National Cancer Institute's SeroNet Serological Sciences Network, one of the nation's largest coordinated research efforts to study the immune response to antifungal medication. He is the principal investigator of Center of Excellence in SeroNet at diflucan without prescription Stanford, which is tackling critical questions about the mechanisms and duration of immunity to antifungals."For example, if someone has already been infected, should they get the treatment?. If so, how should they be prioritized?.

" Boyd said. "How can diflucan without prescription we adapt seroprevalence studies in vaccinated populations?. How will immunity from vaccination differ from that caused by natural ?.

And how diflucan without prescription long might a treatment be protective?. These are all very interesting, important questions."Other Stanford co-authors of the study are visiting pathology instructor Catherine Hogan, MD. Postdoctoral scholars Javaria Najeeb, PhD, and Ana Otrelo-Cardoso, PhD.

Medical resident Hannah diflucan without prescription Wang, MD. Research scientist Malaya Sahoo, PhD. Research professional diflucan without prescription ChunHong Huang, PhD.

Research scientist Fumiko Yamamoto. Laboratory director Monali Manohar, PhD. Senior clinical diflucan without prescription laboratory scientist Justin Manalac.

Tho Pham, MD, clinical assistant professor of pathology. Medical fellow Arjun Rustagi, diflucan without prescription MD, PhD. Angela Rogers, MD, assistant professor of medicine.

Nigam Shah, PhD, professor of medicine. Catherine Blish, MD, PhD, associate professor of medicine diflucan without prescription. Jennifer Cochran, PhD, chair and professor of bioengineering.

Theodore Jardetzky, PhD, professor of diflucan without prescription structural biology. James Zehnder, MD, professor of pathology and of medicine. Taia Wang, MD, PhD, assistant professor of medicine and of microbiology and immunology.

Senior research scientist Balasubramanian Narasimhan, PhD diflucan without prescription. Pathology instructor Saurabh Gombar, MD, PhD. Robert Tibshirani, PhD, professor of biomedical data diflucan without prescription science and of statistics.

And Kari Nadeau, MD, PhD, professor of medicine and of pediatrics.The study was supported by the National Institutes of Health (grants RO1AI127877, RO1AI130398, 1U54CA260517, T32AI007502-23, U19AI111825 and UL1TR003142), the Crown Family Foundation, the Stanford Maternal and Child Health Research Institute, the Swiss National Science Foundation, and a Coulter antifungal medication Rapid Response award.Boyd, Röltgen, Kim and Powell have filed provisional patent applications related to serological tests for antifungals antibodies.By transferring mouse aged hematopoietic stem cells (aged HSCs, *1) to the environment of young mice (bone marrow niche, *2), it was demonstrated that the pattern of stem cell gene expression was rejuvenated to that of young hematopoietic stem cells. On the other hand, the function of aged HSCs did not recover in the young bone marrow niche. The epigenome (DNA methylation, *3) of aged HSCs did not change significantly even in the young bone marrow niche, and DNA methylation profiles were found to be a better index than the gene expression pattern of aged HSCs.A research group led by Professor Atsushi Iwama at the Division of Stem Cell and Molecular Medicine, The Institute of Medical Science, The University of Tokyo (IMSUT) announced these world-first results and was published in the Journal of Experimental Medicine (online) on November 24th."The results will contribute to the development of treatments diflucan without prescription for age-related blood diseases," states lead scientist, Professor Iwama at IMSUT.Focus on changes in aged HSCs in the bone marrow nicheThe research group investigated whether rejuvenating aged HSCs in a young bone marrow niche environment would rejuvenate.Tens of thousands of aged hematopoietic stem/progenitor cells collected from 20-month-old mice were transplanted into 8-week-old young mice without pretreatment such as irradiation.

After two months of follow-up, they collected bone marrow cells and performed flow cytometric analysis.The research team also transplanted 10-week-old young mouse HSCs for comparison. In addition, engrafted aged HSCs were fractionated and RNA sequence analysis and DNA methylation analysis were performed.They found that diflucan without prescription engrafted aged HSCs were less capable of producing hematopoietic cells than younger HSCs. They also showed that differentiation of aged HSCs into multipotent progenitor cells was persistently impaired even in the young bone marrow niche, and that the direction of differentiation was biased.

It was found that the transfer of aged try these out HSCs to the young bone marrow niche does not improve their stem cell function.A more detailed analysis may reveal mechanisms that irreversibly affect aged HSC functionAging studies focusing on HSCs have been actively pursued in mice using a bone marrow transfer model. However, the effect of aging on HSCs remains to be clarified.Professor Iwama states as follows."This study has a significant diflucan without prescription impact because it clarified the effect of aging on HSCs. Our results are expected to contribute to further elucidation of the mechanism of aging in HSCs and understanding of the pathogenic mechanism of age-related blood diseases." Story Source.

Materials provided by The Institute of Medical diflucan without prescription Science, The University of Tokyo. Note. Content may be edited for style and length.Tohoku University scientists have, for the first time, provided experimental evidence that cell stickiness helps them stay sorted within correct compartments during development.

How tightly cells clump together, diflucan without prescription known as cell adhesion, appears to be enabled by a protein better known for its role in the immune system. The findings were detailed in the journal Nature Communications.Scientists have long observed that not-yet-specialized cells move in a way that ensures that cell groups destined for a specific tissue stay together. In 1964, American biologist Malcolm Steinberg proposed that cells with diflucan without prescription similar adhesiveness move to come in contact with each other to minimize energy use, producing a thermodynamically stable structure.

This is known as the differential adhesion hypothesis."Many other theoretical works have emphasized the importance of differences in cell-to-cell adhesion for separating cell populations and maintaining the boundaries between them, but this had not yet been demonstrated in living animal epithelial tissues," says Erina Kuranaga of Tohoku University's Laboratory for Histogenetic Dynamics, who led the investigations. "Our study showed, for the first time, that cell sorting is regulated by changes in adhesion."Kuranaga and her team conducted experiments in fruit fly pupae, finding that a gene, called Toll-1, played a major role in this adhesion process.As fruit flies develop from the immature larval stage into the mature adult, epithelial tissue-forming cells, called histoblasts, cluster together into several 'nests' in the abdomen. Each nest contains an diflucan without prescription anterior and a posterior compartment.

Histoblasts are destined to replace larval cells to form the adult epidermis, the outermost layer that covers the flies. The cells in each compartment form discrete cell populations, so they need to stick together, with a distinct boundary forming between them.Using fluorescent tags, Kuranaga and her team observed the Toll-1 protein is expressed mainly in diflucan without prescription the posterior compartment. Its fluorescence also showed a sharp boundary between the two compartments.Further investigations showed Toll-1 performs the function of an adhesion molecule, encouraging similar cells to stick together.

This process keeps the boundary between the two compartments straight, correcting distortions that arise as the cells divide to increase the number.Interestingly, Toll proteins are best known for recognizing invading pathogens, and little is known about their work beyond the immune system. "Our work improves understanding of the non-immune roles of Toll proteins," says diflucan without prescription Kuranaga. She and her team next plan to study the function of other Toll genes in fruit fly epithelial cells.

Story Source diflucan without prescription. Materials provided by Tohoku University. Note.

Content may be edited for style and length.This summer, when bars and restaurants and stores began to reopen across the United States, people headed out despite the continuing threat of antifungal medication.As diflucan without prescription a result, many areas, including the St. Louis region, saw increases in cases in July.Using mathematical modeling, new interdisciplinary research from the lab of Arye Nehorai, the Eugene &. Martha Lohman diflucan without prescription Professor of Electrical Engineering in the Preston M.

Green Department of Electrical &. Systems Engineering at Washington University in St. Louis, determines the best course diflucan without prescription of action when it comes to walking the line between economic stability and the best possible health outcomes.The group -- which also includes David Schwartzman, a business economics PhD candidate at Olin Business School, and Uri Goldsztejn, a PhD candidate in biomedical engineering at the McKelvey School of Engineering -- published their findings Dec.

22 in PLOS ONE.The model indicates that of the scenarios they consider, communities could maximize economic productivity and minimize disease transmission if, until a treatment were readily available, seniors mostly remained at home while younger people gradually returned to the workforce."We have developed a predictive model for antifungal medication that considers, for the first time, its intercoupled effect on both economic and health outcomes for different quarantine policies," Nehorai said. "You can have an optimal quarantine policy that minimizes the effect both on health and on the economy."The diflucan without prescription work was an expanded version of a Susceptible, Exposed, Infectious, Recovered (SEIR) model, a commonly used mathematical tool for predicting the spread of s. This dynamic model allows for people to be moved between groups known as compartments, and for each compartment to influence the other in turn.

advertisement At their most basic, these models divide the population into four compartments. Those who diflucan without prescription are susceptible, exposed, infectious and recovered. In an innovation to this traditional model, Nehorai's team included infected but asymptomatic people as well, taking into account the most up-to-date understanding of how transmission may work differently between them as well as how their behaviors might differ from people with symptoms.

This turned out to be highly influential in the model's outcomes.People were then divided into different diflucan without prescription "sub-compartments," for example age (seniors are those older than 60), or by productivity. This was a measure of a person's ability to work from home in the case of quarantine measures. To do this, they looked at college degrees as a proxy for who could continue to work during a period of quarantine.Then they got to work, developing equations which modeled the ways in which people moved from one compartment to another.

Movement was affected by policy as well as the decisions diflucan without prescription an individual made.Interestingly, the model included a dynamic mortality rate -- one that shrunk over time. "We had a mortality rate that accounted for improvements in medical knowledge over time," said Uri Goldsztejn, a PhD candidate in biomedical engineering. "And we see that now diflucan without prescription.

Mortality rates have gone down.""For example," Goldsztejn said, "if the economy is decreasing, there is more incentive to leave quarantine," which might show up in the model as people moving from the isolated compartment to the susceptible compartment. On the other hand, moving from infectious to recovered was based less on a person's actions and can be better determined by recovery or mortality rates. Additionally, the researchers modeled the mortality rate as decreasing over time, due to medical knowledge about how to treat antifungal medication becoming diflucan without prescription better over time.

advertisement The team looked at three scenarios, according to Schwartzman. In all three scenarios, the given timeline was 76 weeks -- at which time it assumed diflucan without prescription a treatment would be available -- and seniors remained mostly quarantined until then. If strict isolation measures were maintained throughout.

If, after the curve was flattened, there was a rapid relaxation of isolation measures by younger people to normal movement. If, after the curve was flattened, diflucan without prescription isolation measures were slowly lifted for younger people."The third scenario is the case which was the best in terms of economic damage and health outcomes," he said. "Because in the rapid relaxation scenario, there was another disease spread and restrictions would be reinstated."Specifically, they found in the first scenario, there are 235,724 deaths and the economy shrinks by 34%.In the second scenario, where there was a rapid relaxation of isolation measures, a second outbreak occurs for a total of 525,558 deaths, and the economy shrinks by 32.2%.With a gradual relaxation, as in the third scenario, there are 262,917 deaths, and the economy shrinks by 29.8%."We wanted to show there is a tradeoff," Nehorai said.

"And we diflucan without prescription wanted to find, mathematically, where is the sweet spot?. " As with so many things, the "sweet spot" was not at either extreme -- total lockdown or carrying on as if there was no diflucan.Another key finding was one no one should be surprised to hear. "People's' sensitivity to contagiousness is related to the precautions they take," Nehorai said.

"It's still critical to use precautions -- masks, social distancing, avoiding crowds and washing hands."Developing brains constantly sprout new neuronal connections called synapses as diflucan without prescription they learn and remember. Important connections -- the ones that are repeatedly introduced, such as how to avoid danger -- are nurtured and reinforced, while connections deemed unnecessary are pruned away. Adult brains undergo similar pruning, but it was unclear how or why synapses in the adult brain get eliminated.Now, a team of researchers based in Korea diflucan without prescription has found the mechanism underlying plasticity and, potentially, neurological disorders in adult brains.

They published their findings on December 23 in Nature."Our findings have profound implications for our understanding of how neural circuits change during learning and memory, as well as in diseases," said paper author Won-Suk Chung, an assistant professor in the Department of Biological Sciences at KAIST. "Changes in synapse number have strong association with the prevalence of various neurological disorders, such as autism spectrum disorder, schizophrenia, frontotemporal dementia, and several forms of seizures."Gray matter in the brain contains microglia and astrocytes, two complementary cells that, among other things, support neurons and synapses. Microglial are a frontline immunity defense, responsible for diflucan without prescription eating pathogens and dead cells, and astrocytes are star-shaped cells that help structure the brain and maintain homeostasis by helping to control signaling between neurons.

According to Professor Chung, it is generally thought that microglial eat synapses as part of its clean-up effort in a process known as phagocytosis."Using novel tools, we show that, for the first time, it is astrocytes and not microglia that constantly eliminate excessive and unnecessary adult excitatory synaptic connections in response to neuronal activity," Professor Chung said. "Our paper diflucan without prescription challenges the general consensus in this field that microglia are the primary synapse phagocytes that control synapse numbers in the brain."Professor Chung and his team developed a molecular sensor to detect synapse elimination by glial cells and quantified how often and by which type of cell synapses were eliminated. They also deployed it in a mouse model without MEGF10, the gene that allows astrocytes to eliminate synapses.

Adult animals with this defective astrocytic phagocytosis had unusually increased excitatory synapse numbers in the hippocampus. Through a diflucan without prescription collaboration with Dr. Hyungju Park at KBRI, they showed that these increased excitatory synapses are functionally impaired, which cause defective learning and memory formation in MEGF10 deleted animals."Through this process, we show that, at least in the adult hippocampal CA1 region, astrocytes are the major player in eliminating synapses, and this astrocytic function is essential for controlling synapse number and plasticity," Chung said.Professor Chung noted that researchers are only beginning to understand how synapse elimination affects maturation and homeostasis in the brain.

In his group's preliminary data diflucan without prescription in other brain regions, it appears that each region has different rates of synaptic elimination by astrocytes. They suspect a variety of internal and external factors are influencing how astrocytes modulate each regional circuit, and plan to elucidate these variables."Our long-term goal is understanding how astrocyte-mediated synapse turnover affects the initiation and progression of various neurological disorders," Professor Chung said. "It is intriguing to postulate that modulating astrocytic phagocytosis to restore synaptic connectivity may be a novel strategy in treating various brain disorders.".

antifungal medication antibodies preferentially target http://www.jamiegianna.com/2019/12/18/697/ a different part of the diflucan in mild cases of antifungal medication than they do in severe cases, and wane significantly within several can you buy diflucan in usa months of , according to a new study by researchers at Stanford Medicine.The findings identify new links between the course of the disease and a patient's immune response. They also raise concerns about whether people can be re-infected, whether antibody tests to detect prior may underestimate the breadth of the diflucan and whether vaccinations may need to be repeated at regular intervals to maintain a protective immune response."This is one of the most comprehensive studies to date of the antibody immune response to antifungals in people across the entire spectrum of disease severity, from asymptomatic to fatal," said Scott Boyd, MD, PhD, associate professor of pathology. "We assessed can you buy diflucan in usa multiple time points and sample types, and also analyzed levels of viral RNA in patient nasopharyngeal swabs and blood samples.

It's one of the first big-picture looks at this illness."The study found that people with severe antifungal medication have low proportions of antibodies targeting the spike protein used by the diflucan to enter human cells compared with the number of antibodies targeting proteins of the diflucan's inner shell.Boyd is a senior author of the study, which was published Dec. 7 in can you buy diflucan in usa Science Immunology. Other senior authors are Benjamin Pinsky, MD, PhD, associate professor of pathology, and Peter Kim, PhD, the Virginia and D.

K. Ludwig Professor can you buy diflucan in usa of Biochemistry. The lead authors are research scientist Katharina Röltgen, PhD.

Postdoctoral scholars Abigail Powell, PhD, and Oliver can you buy diflucan in usa Wirz, PhD. And clinical instructor Bryan Stevens, MD.diflucan binds to ACE2 receptorThe researchers studied 254 people with asymptomatic, mild or severe antifungal medication who were identified either through routine testing or occupational health screening at Stanford Health Care or who came to a Stanford Health Care clinic with symptoms of antifungal medication. Of the people with symptoms, 25 were treated as outpatients, 42 were hospitalized outside the intensive care unit and 37 were treated in the intensive care unit.

Twenty-five people in can you buy diflucan in usa the study died of the disease. advertisement antifungals binds to human cells via a structure on its surface called the spike protein. This protein binds to a receptor on human cells can you buy diflucan in usa called ACE2.

The binding allows the diflucan to enter and infect the cell. Once inside, the diflucan sheds its outer coat to reveal an inner shell encasing its genetic material. Soon, the diflucan co-opts the cell's protein-making machinery to churn out more viral particles, which are then released to infect other cells.Antibodies that recognize and bind to the spike protein block its ability to bind to ACE2, preventing the can you buy diflucan in usa diflucan from infecting the cells, whereas antibodies that recognize other viral components are unlikely to prevent viral spread.

Current treatment candidates use portions of the spike protein to stimulate an immune response.Boyd and his colleagues analyzed the levels of three types of antibodies -- IgG, IgM and IgA -- and the proportions that targeted the viral spike protein or the diflucan's inner shell as the disease progressed and patients either recovered or grew sicker. They also measured the levels of viral can you buy diflucan in usa genetic material in nasopharyngeal samples and blood from the patients. Finally, they assessed the effectiveness of the antibodies in preventing the spike protein from binding to ACE2 in a laboratory dish."Although previous studies have assessed the overall antibody response to , we compared the viral proteins targeted by these antibodies," Boyd said.

"We found that the severity of the illness correlates with the ratio of antibodies recognizing domains of the spike protein compared with other nonprotective viral targets. Those people with mild illness tended to have a higher proportion of anti-spike antibodies, and those who died from their disease had can you buy diflucan in usa more antibodies that recognized other parts of the diflucan."Substantial variability in immune responseThe researchers caution, however, that although the study identified trends among a group of patients, there is still substantial variability in the immune response mounted by individual patients, particularly those with severe disease. advertisement "Antibody responses are not likely to be the sole determinant of someone's outcome," Boyd said.

"Among people with severe can you buy diflucan in usa disease, some die and some recover. Some of these patients mount a vigorous immune response, and others have a more moderate response. So, there are a lot of other things going on.

There are can you buy diflucan in usa also other branches of the immune system involved. It's important to note that our results identify correlations but don't prove causation."As in other studies, the researchers found that people with asymptomatic and mild illness had lower levels of antibodies overall than did those with severe disease. After recovery, the levels of IgM can you buy diflucan in usa and IgA decreased steadily to low or undetectable levels in most patients over a period of about one to four months after symptom onset or estimated date, and IgG levels dropped significantly."This is quite consistent with what has been seen with other antifungalses that regularly circulate in our communities to cause the common cold," Boyd said.

"It's not uncommon for someone to get re-infected within a year or sometimes sooner. It remains to be seen whether the immune response to antifungals vaccination is stronger, or persists longer, than that caused by natural . It's quite possible it could be can you buy diflucan in usa better.

But there are a lot of questions that still need to be answered."Boyd is a co-chair of the National Cancer Institute's SeroNet Serological Sciences Network, one of the nation's largest coordinated research efforts to study the immune response to antifungal medication. He is the principal investigator of Center of Excellence in SeroNet at Stanford, which is tackling critical questions about the mechanisms and duration of immunity to antifungals."For example, if someone has already been infected, should they get the can you buy diflucan in usa treatment?. If so, how should they be prioritized?.

" Boyd said. "How can we adapt seroprevalence studies can you buy diflucan in usa in vaccinated populations?. How will immunity from vaccination differ from that caused by natural ?.

And how long might a treatment be can you buy diflucan in usa protective?. These are all very interesting, important questions."Other Stanford co-authors of the study are visiting pathology instructor Catherine Hogan, MD. Postdoctoral scholars Javaria Najeeb, PhD, and Ana Otrelo-Cardoso, PhD.

Medical resident can you buy diflucan in usa Hannah Wang, MD. Research scientist Malaya Sahoo, PhD. Research professional can you buy diflucan in usa ChunHong Huang, PhD.

Research scientist Fumiko Yamamoto. Laboratory director Monali Manohar, PhD. Senior clinical can you buy diflucan in usa laboratory scientist Justin Manalac.

Tho Pham, MD, clinical assistant professor of pathology. Medical fellow Arjun Rustagi, MD, PhD can you buy diflucan in usa. Angela Rogers, MD, assistant professor of medicine.

Nigam Shah, PhD, professor of medicine. Catherine Blish, MD, PhD, can you buy diflucan in usa associate professor of medicine. Jennifer Cochran, PhD, chair and professor of bioengineering.

Theodore Jardetzky, can you buy diflucan in usa PhD, professor of structural biology. James Zehnder, MD, professor of pathology and of medicine. Taia Wang, MD, PhD, assistant professor of medicine and of microbiology and immunology.

Senior research scientist Balasubramanian can you buy diflucan in usa Narasimhan, PhD. Pathology instructor Saurabh Gombar, MD, PhD. Robert Tibshirani, PhD, professor of biomedical data science and of can you buy diflucan in usa statistics.

And Kari Nadeau, MD, PhD, professor of medicine and of pediatrics.The study was supported by the National Institutes of Health (grants RO1AI127877, RO1AI130398, 1U54CA260517, T32AI007502-23, U19AI111825 and UL1TR003142), the Crown Family Foundation, the Stanford Maternal and Child Health Research Institute, the Swiss National Science Foundation, and a Coulter antifungal medication Rapid Response award.Boyd, Röltgen, Kim and Powell have filed provisional patent applications related to serological tests for antifungals antibodies.By transferring mouse aged hematopoietic stem cells (aged HSCs, *1) to the environment of young mice (bone marrow niche, *2), it was demonstrated that the pattern of stem cell gene expression was rejuvenated to that of young hematopoietic stem cells. On the other hand, the function of aged HSCs did not recover in the young bone marrow niche. The epigenome (DNA methylation, *3) of aged HSCs did not change significantly even in the young bone marrow niche, and DNA methylation profiles were found to be can you buy diflucan in usa a better index than the gene expression pattern of aged HSCs.A research group led by Professor Atsushi Iwama at the Division of Stem Cell and Molecular Medicine, The Institute of Medical Science, The University of Tokyo (IMSUT) announced these world-first results and was published in the Journal of Experimental Medicine (online) on November 24th."The results will contribute to the development of treatments for age-related blood diseases," states lead scientist, Professor Iwama at IMSUT.Focus on changes in aged HSCs in the bone marrow nicheThe research group investigated whether rejuvenating aged HSCs in a young bone marrow niche environment would rejuvenate.Tens of thousands of aged hematopoietic stem/progenitor cells collected from 20-month-old mice were transplanted into 8-week-old young mice without pretreatment such as irradiation.

After two months of follow-up, they collected bone marrow cells and performed flow cytometric analysis.The research team also transplanted 10-week-old young mouse HSCs for comparison. In addition, engrafted aged HSCs were can you buy diflucan in usa fractionated and RNA sequence analysis and DNA methylation analysis were performed.They found that engrafted aged HSCs were less capable of producing hematopoietic cells than younger HSCs. They also showed that differentiation of aged HSCs into multipotent progenitor cells was persistently impaired even in the young bone marrow niche, and that the direction of differentiation was biased.

It was found that the transfer of aged HSCs to the young bone marrow niche does not improve their stem cell function.A more detailed analysis may reveal mechanisms that irreversibly affect aged HSC functionAging studies focusing on HSCs have been actively pursued in mice using a bone marrow transfer model. However, the effect of aging can you buy diflucan in usa on HSCs remains to be clarified.Professor Iwama states as follows."This study has a significant impact because it clarified the effect of aging on HSCs. Our results are expected to contribute to further elucidation of the mechanism of aging in HSCs and understanding of the pathogenic mechanism of age-related blood diseases." Story Source.

Materials provided by The Institute of Medical can you buy diflucan in usa Science, The University of Tokyo. Note. Content may be edited for style and length.Tohoku University scientists have, for the first time, provided experimental evidence that cell stickiness helps them stay sorted within correct compartments during development.

How tightly cells clump together, known as cell adhesion, appears to be enabled by a protein better known for its role in the can you buy diflucan in usa immune system. The findings were detailed in the journal Nature Communications.Scientists have long observed that not-yet-specialized cells move in a way that ensures that cell groups destined for a specific tissue stay together. In 1964, can you buy diflucan in usa American biologist Malcolm Steinberg proposed that cells with similar adhesiveness move to come in contact with each other to minimize energy use, producing a thermodynamically stable structure.

This is known as the differential adhesion hypothesis."Many other theoretical works have emphasized the importance of differences in cell-to-cell adhesion for separating cell populations and maintaining the boundaries between them, but this had not yet been demonstrated in living animal epithelial tissues," says Erina Kuranaga of Tohoku University's Laboratory for Histogenetic Dynamics, who led the investigations. "Our study showed, for the first time, that cell sorting is regulated by changes in adhesion."Kuranaga and her team conducted experiments in fruit fly pupae, finding that a gene, called Toll-1, played a major role in this adhesion process.As fruit flies develop from the immature larval stage into the mature adult, epithelial tissue-forming cells, called histoblasts, cluster together into several 'nests' in the abdomen. Each nest contains an anterior and can you buy diflucan in usa a posterior compartment.

Histoblasts are destined to replace larval cells to form the adult epidermis, the outermost layer that covers the flies. The cells in each compartment form discrete cell populations, so they need to stick together, with a distinct boundary forming between them.Using fluorescent tags, Kuranaga and her team observed the Toll-1 protein is expressed mainly in the can you buy diflucan in usa posterior compartment. Its fluorescence also showed a sharp boundary between the two compartments.Further investigations showed Toll-1 performs the function of an adhesion molecule, encouraging similar cells to stick together.

This process keeps the boundary between the two compartments straight, correcting distortions that arise as the cells divide to increase the number.Interestingly, Toll proteins are best known for recognizing invading pathogens, and little is known about their work beyond the immune system. "Our work improves understanding of the can you buy diflucan in usa non-immune roles of Toll proteins," says Kuranaga. She and her team next plan to study the function of other Toll genes in fruit fly epithelial cells.

Story Source can you buy diflucan in usa. Materials provided by Tohoku University. Note.

Content may be edited for style and length.This summer, when bars and restaurants and stores began to reopen across the United States, people headed out despite can you buy diflucan in usa the continuing threat of antifungal medication.As a result, many areas, including the St. Louis region, saw increases in cases in July.Using mathematical modeling, new interdisciplinary research from the lab of Arye Nehorai, the Eugene &. Martha Lohman Professor of Electrical Engineering in the Preston can you buy diflucan in usa M.

Green Department of Electrical &. Systems Engineering at Washington University in St. Louis, determines the best course of action when it comes to walking the line between economic stability and the best possible health outcomes.The group -- which also includes David Schwartzman, a business economics PhD candidate at Olin Business School, can you buy diflucan in usa and Uri Goldsztejn, a PhD candidate in biomedical engineering at the McKelvey School of Engineering -- published their findings Dec.

22 in PLOS ONE.The model indicates that of the scenarios they consider, communities could maximize economic productivity and minimize disease transmission if, until a treatment were readily available, seniors mostly remained at home while younger people gradually returned to the workforce."We have developed a predictive model for antifungal medication that considers, for the first time, its intercoupled effect on both economic and health outcomes for different quarantine policies," Nehorai said. "You can have an optimal quarantine policy that minimizes the effect both on health and on the economy."The work was an expanded version of a Susceptible, Exposed, can you buy diflucan in usa Infectious, Recovered (SEIR) model, a commonly used mathematical tool for predicting the spread of s. This dynamic model allows for people to be moved between groups known as compartments, and for each compartment to influence the other in turn.

advertisement At their most basic, these models divide the population into four compartments. Those who are susceptible, can you buy diflucan in usa exposed, infectious and recovered. In an innovation to this traditional model, Nehorai's team included infected but asymptomatic people as well, taking into account the most up-to-date understanding of how transmission may work differently between them as well as how their behaviors might differ from people with symptoms.

This turned out to be highly can you buy diflucan in usa influential in the model's outcomes.People were then divided into different "sub-compartments," for example age (seniors are those older than 60), or by productivity. This was a measure of a person's ability to work from home in the case of quarantine measures. To do this, they looked at college degrees as a proxy for who could continue to work during a period of quarantine.Then they got to work, developing equations which modeled the ways in which people moved from one compartment to another.

Movement was affected by policy as well as the decisions an individual can you buy diflucan in usa made.Interestingly, the model included a dynamic mortality rate -- one that shrunk over time. "We had a mortality rate that accounted for improvements in medical knowledge over time," said Uri Goldsztejn, a PhD candidate in biomedical engineering. "And we see can you buy diflucan in usa that now.

Mortality rates have gone down.""For example," Goldsztejn said, "if the economy is decreasing, there is more incentive to leave quarantine," which might show up in the model as people moving from the isolated compartment to the susceptible compartment. On the other hand, moving from infectious to recovered was based less on a person's actions and can be better determined by recovery or mortality rates. Additionally, the researchers modeled the mortality rate as decreasing over time, due can you buy diflucan in usa to medical knowledge about how to treat antifungal medication becoming better over time.

advertisement The team looked at three scenarios, according to Schwartzman. In all three scenarios, the given timeline was 76 weeks -- at which time can you buy diflucan in usa it assumed a treatment would be available -- and seniors remained mostly quarantined until then. If strict isolation measures were maintained throughout.

If, after the curve was flattened, there was a rapid relaxation of isolation measures by younger people to normal movement. If, after the curve was flattened, isolation measures were slowly can you buy diflucan in usa lifted for younger people."The third scenario is the case which was the best in terms of economic damage and health outcomes," he said. "Because in the rapid relaxation scenario, there was another disease spread and restrictions would be reinstated."Specifically, they found in the first scenario, there are 235,724 deaths and the economy shrinks by 34%.In the second scenario, where there was a rapid relaxation of isolation measures, a second outbreak occurs for a total of 525,558 deaths, and the economy shrinks by 32.2%.With a gradual relaxation, as in the third scenario, there are 262,917 deaths, and the economy shrinks by 29.8%."We wanted to show there is a tradeoff," Nehorai said.

"And we wanted to find, mathematically, where is the can you buy diflucan in usa sweet spot?. " As with so many things, the "sweet spot" was not at either extreme -- total lockdown or carrying on as if there was no diflucan.Another key finding was one no one should be surprised to hear. "People's' sensitivity to contagiousness is related to the precautions they take," Nehorai said.

"It's still critical to use precautions -- masks, social distancing, avoiding crowds and washing hands."Developing brains constantly sprout new neuronal connections called synapses can you buy diflucan in usa as they learn and remember. Important connections -- the ones that are repeatedly introduced, such as how to avoid danger -- are nurtured and reinforced, while connections deemed unnecessary are pruned away. Adult brains undergo similar pruning, but it was unclear how or why synapses in the adult brain can you buy diflucan in usa get eliminated.Now, a team of researchers based in Korea has found the mechanism underlying plasticity and, potentially, neurological disorders in adult brains.

They published their findings on December 23 in Nature."Our findings have profound implications for our understanding of how neural circuits change during learning and memory, as well as in diseases," said paper author Won-Suk Chung, an assistant professor in the Department of Biological Sciences at KAIST. "Changes in synapse number have strong association with the prevalence of various neurological disorders, such as autism spectrum disorder, schizophrenia, frontotemporal dementia, and several forms of seizures."Gray matter in the brain contains microglia and astrocytes, two complementary cells that, among other things, support neurons and synapses. Microglial are a frontline immunity defense, responsible for eating pathogens and dead cells, and astrocytes are star-shaped cells that help structure the brain and maintain homeostasis by helping to control signaling can you buy diflucan in usa between neurons.

According to Professor Chung, it is generally thought that microglial eat synapses as part of its clean-up effort in a process known as phagocytosis."Using novel tools, we show that, for the first time, it is astrocytes and not microglia that constantly eliminate excessive and unnecessary adult excitatory synaptic connections in response to neuronal activity," Professor Chung said. "Our paper challenges the general consensus in this field that microglia are the primary synapse phagocytes that control synapse numbers in the brain."Professor Chung and his team developed a molecular sensor to detect synapse elimination by glial cells and quantified how often and by which type of cell synapses were eliminated can you buy diflucan in usa. They also deployed it in a mouse model without MEGF10, the gene that allows astrocytes to eliminate synapses.

Adult animals with this defective astrocytic phagocytosis had unusually increased excitatory synapse numbers in the hippocampus. Through a can you buy diflucan in usa collaboration with Dr. Hyungju Park at KBRI, they showed that these increased excitatory synapses are functionally impaired, which cause defective learning and memory formation in MEGF10 deleted animals."Through this process, we show that, at least in the adult hippocampal CA1 region, astrocytes are the major player in eliminating synapses, and this astrocytic function is essential for controlling synapse number and plasticity," Chung said.Professor Chung noted that researchers are only beginning to understand how synapse elimination affects maturation and homeostasis in the brain.

In his group's preliminary data in other brain regions, it appears that each region has different rates of synaptic elimination by astrocytes. They suspect a variety of internal and external factors are influencing how astrocytes modulate each regional circuit, and plan to elucidate these variables."Our long-term goal is understanding how astrocyte-mediated synapse turnover affects the initiation and progression of various neurological disorders," Professor Chung said. "It is intriguing to postulate that modulating astrocytic phagocytosis to restore synaptic connectivity may be a novel strategy in treating various brain disorders.".

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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.

********************

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

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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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