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The growing popularity of 3D printing for manufacturing all sorts of items, from customized where can i get kamagra medical devices to affordable homes, has created more demand for new 3D printing materials designed for very specific uses.To cut down on the time it takes to discover these new materials, researchers at MIT have developed a data-driven process that uses machine learning to optimize new 3D printing materials with multiple characteristics, like toughness and compression strength.By streamlining materials development, the system lowers costs and lessens the environmental impact by reducing the amount of chemical waste. The machine learning algorithm could also spur innovation by suggesting unique chemical formulations that human intuition might miss."Materials development is still very much a manual process. A chemist goes into a lab, mixes ingredients by hand, where can i get kamagra makes samples, tests them, and comes to a final formulation.

But rather than having a chemist who can only do a couple of iterations over a span of days, our system can do hundreds of iterations over the same time span," says Mike Foshey, a mechanical engineer and project manager in the Computational Design and Fabrication Group (CDFG) of the Computer Science and Artificial Intelligence Laboratory (CSAIL), and co-lead author of the paper.Additional authors include co-lead author Timothy Erps, a technical associate in CDFG. Mina Konakovi? where can i get kamagra. Lukovi?.

, a CSAIL postdoc where can i get kamagra. Wan Shou, a former MIT postdoc who is now an assistant professor at the University of Arkansas. Senior author Wojciech Matusik, where can i get kamagra professor of electrical engineering and computer science at MIT.

And Hanns Hagen Geotzke, Herve Dietsch, and Klaus Stoll of BASF. The research was published today in Science Advances.Optimizing discoveryIn the system the researchers developed, an optimization algorithm performs much of the where can i get kamagra trial-and-error discovery process. advertisement A material developer selects a few ingredients, inputs details on their chemical compositions into the algorithm, and defines the mechanical properties the new material should have.

Then the algorithm increases and decreases the amounts of those components (like turning knobs where can i get kamagra on an amplifier) and checks how each formula affects the material's properties, before arriving at the ideal combination.Then the developer mixes, processes, and tests that sample to find out how the material actually performs. The developer reports the results to the algorithm, which automatically learns from the experiment and uses the new information to decide on another formulation to test."We think, for a number of applications, this would outperform the conventional method because you can rely more heavily on the optimization algorithm to find the optimal solution. You wouldn't need where can i get kamagra an expert chemist on hand to preselect the material formulations," Foshey says.The researchers have created a free, open-source materials optimization platform called AutoOED that incorporates the same optimization algorithm.

AutoOED is a full software package that also allows researchers to conduct their own optimization.Making materialsThe researchers tested the system by using it to optimize formulations for a new 3D printing ink that hardens when it is exposed to uaviolet light. advertisement They identified where can i get kamagra six chemicals to use in the formulations and set the algorithm's objective to uncover the best-performing material with respect to toughness, compression modulus (stiffness), and strength.Maximizing these three properties manually would be especially challenging because they can be conflicting. For instance, the strongest material may not be the stiffest.

Using a manual process, a chemist would typically try to maximize one property at a time, resulting in many experiments and a lot of waste.The algorithm came up with 12 top performing materials that had optimal tradeoffs of the three different properties after testing only 120 samples.Foshey and his collaborators were surprised by the wide variety of materials the algorithm was able to generate, and say the results were far more varied than they where can i get kamagra expected based on the six ingredients. The system encourages exploration, which could be especially useful in situations when specific material properties can't be easily discovered intuitively.Faster in the futureThe process could be accelerated even more through the use of additional automation. Researchers mixed and tested each sample by hand, but robots could operate the dispensing and mixing systems in future versions of the system, Foshey says.Farther down the road, the researchers would also like to test this where can i get kamagra data-driven discovery process for uses beyond developing new 3D printing inks."This has broad applications across materials science in general.

For instance, if you wanted to design new types of batteries that were higher efficiency and lower cost, you could use a system like this to do it. Or if you wanted to optimize paint for a car that performed well and was environmentally friendly, where can i get kamagra this system could do that, too," he says.The research was supported by BASF."Our findings can help to better identify, understand and treat canine hyperactivity, impulsivity and inattention. Moreover, they indicated similarity with human ADHD, consolidating the role of dogs in ADHD-related research," says Professor Hannes Lohi, head of a canine gene research group at the University of Helsinki."Dogs share many similarities with humans, including physiological traits and the same environment.

In addition, where can i get kamagra ADHD-like behaviour naturally occurs in dogs. This makes dogs an interesting model for investigating ADHD in humans," says doctoral researcher Sini Sulkama.Professor Lohi's research group collected data on more than 11,000 dogs by conducting an extensive behavioural survey. Hyperactivity, impulsivity and inattention were examined using questions based on a survey utilised in where can i get kamagra human ADHD research.

The goal of the study was to identify environmental factors underlying canine ADHD-like behaviour and potential links to other behavioural traits.The dog's age and gender as well as the owner's experience of dogs make a difference"We found that hyperactivity, impulsivity and inattention were more common in young dogs and male dogs. Corresponding observations relating to age where can i get kamagra and gender in connection with ADHD have been made in humans too," says Jenni Puurunen, PhD.Dogs who spent more time alone at home daily were more hyperactive, impulsive and inattentive than dogs who spent less time on their own. advertisement "As social animals, dogs can get frustrated and stressed when they are alone, which can be released as hyperactivity, impulsivity and inattention.

It may be that dogs who spend where can i get kamagra longer periods in solitude also get less exercise and attention from their owners," Sulkama muses.The researchers discovered a new link between hyperactivity and impulsivity, and the owner's experience with dogs, as the two traits were more common in dogs who were not their owners' first dogs. The causality of this phenomenon remains unclear."People may pick as their first dog a less active individual that better matches the idea of a pet dog, whereas more active and challenging dogs can be chosen after gaining more experience with dogs," explains Sulkama.Significant differences between breeds Breeding has had a significant effect on the breed-specific behaviour of different dog breeds. Differences between breeds can also indicate genes underlying the relevant traits."Hyperactivity and impulsivity on the one hand, and good concentration on the where can i get kamagra other, are common in breeds bred for work, such as the German Shepherd and Border Collie.

In contrast, a more calm disposition is considered a benefit in breeds that are popular as pets or show dogs, such as the Chihuahua, Long-Haired Collie and Poodle, making them easier companions in everyday life. Then again, the ability to concentrate has not been considered as important a trait in where can i get kamagra these breeds as in working breeds, which is why inattention can be more common among pet dogs," Professor Lohi says.Link to other behavioural problemsThe study confirmed previously observed interesting links between hyperactivity, impulsivity and inattention, and obsessive-compulsive behaviour, aggressiveness and fearfulness. ADHD is also often associated with other mental disorders and illnesses.

For example, obsessive-compulsive disorder (OCD) often occurs where can i get kamagra in conjunction with ADHD. In dogs, OCD-like obsessive-compulsive behaviour can appear as, among other things, tail chasing, continuous licking of surfaces or themselves, or staring at 'nothing'."The findings suggest that the same brain regions and neurobiological pathways regulate activity, impulsivity and concentration in both humans and dogs. This strengthens the promise where can i get kamagra that dogs show as a model species in the study of ADHD.

In other words, the results can both make it easier to identify and treat canine impulsivity and inattention as well as promote ADHD research," Sulkama sums up.If you have heart disease or risk factors for heart disease, you already know about the increased risk of heart attack and stroke. But did you know that coming down with the flu can substantially increase the risk of a serious where can i get kamagra or even fatal cardiac event?. Or that getting the influenza treatment can substantially reduce that risk, even if you do wind up contracting the seasonal kamagra?.

Probably not, if annual influenza vaccination rates are any indication, especially if you're under the age of 65. According to a Houston Methodist where can i get kamagra review published in the Journal of the American Heart Association, Americans with heart disease continue to have low vaccination rates every year despite higher rates of death and complications from influenza.The flu vaccination rate for American adults who are less than 65 years of age and have heart disease is less than 50%, compared to 80% in older adults with heart disease."It seems that younger Americans with high-risk conditions have not gotten the same memo that their older counterparts have received about the importance of getting the influenza treatment," says Dr. Priyanka Bhugra, internal medicine specialist at Houston Methodist and lead author of the JAHA article.

"That's dangerous, considering people with heart conditions are particularly vulnerable to influenza-related heart complications, whether they've reached where can i get kamagra retirement age or not."It's well-known that the flu can lead to significant respiratory symptoms such as pneumonia, bronchitis and bacterial of the lungs. The kamagra' effects on the heart have historically been harder to parse out, in part because many patients already have a known predisposition to cardiac events and in part because the cardiac event often occurs weeks after the onset of the flu.But here's what recent research has shown. Cardiovascular deaths and influenza epidemics spike around the same where can i get kamagra time.

Patients are six times more likely to experience a heart attack the week after influenza than they are at any point during the year prior or the year after the . In one study looking at 336,000 hospital admissions for flu, 11.5% experienced a serious where can i get kamagra cardiac event. Another study looking at 90,000 lab-confirmed influenza s showed a strikingly similar rate of 11.7% experiencing an acute cardiovascular event.

One in eight patients, or 12.5%, admitted to the hospital with influenza experienced a cardiovascular event, with 31% of those requiring intensive care and 7% dying as a result of the event, another study found.The reason where can i get kamagra influenza stresses the heart and vascular system so much has to do with the body's inflammatory response to the . advertisement Inflammation occurs when your body's "first responders" -- white blood cells and what they produce in order to protect you -- convene in an area and get to work fighting an , bacteria or kamagra. When you're sick, you can typically feel the effects of these "combat zones" in the swelling, tenderness, pain, weakness and sometimes redness and increased temperature of your joints, muscles and lymph nodes.The increased activity can also cause a traffic jam of sorts, leading to blood clots, elevated blood pressure and even swelling or scarring within the heart where can i get kamagra.

The added stressors make plaque within your arteries more vulnerable to rupture, causing a blockage that cuts off oxygen to the heart or brain and results in heart attacks or strokes, respectively.Additionally, non-cardiac complications from the viral illness, including pneumonia and respiratory failure, can make heart failure symptoms or heart arrhythmia much worse.In short, the added stress on the cardiovascular system could be overwhelming to an already weakened heart muscle.Because influenza kamagraes are constantly mutating, scientists alter the treatment each year to match the likely prevalent strands. On average, where can i get kamagra it's effective at preventing 40% of the time. While that might not sound great -- especially in comparison to the highly effective mRNA erectile dysfunction treatments -- it's enough to significantly lower the risk of severe illness in most people.

advertisement Lately, studies have been able to show that not only is the treatment effective at protecting the general population and the most vulnerable where can i get kamagra age groups (over 65 and under 2) from severe cases of the flu, but it's also protective against cardiovascular mortality as well, especially among the high-risk population.Some of the recent findings. Adults who received the treatment were 37% less likely to be hospitalized for the flu and 82% less likely to be admitted to the ICU because of it. Among people where can i get kamagra admitted to the hospital with the flu, those vaccinated were 59% less likely to be admitted to the ICU.

Vaccinated patients admitted to the ICU spent four fewer days in the ICU than unvaccinated patients. Vaccination was associated with a lower risk where can i get kamagra of cardiovascular events (2.9% vs 4.7%) if the patient got the flu. Among the highest-risk patients with more active coronary disease, vaccination was associated with considerably better outcomes.

Patients admitted to the hospital with acute coronary syndrome were randomly assigned to either receive a flu where can i get kamagra treatment or not before discharge. Major cardiovascular events occurred less frequently in the treatment group than the control group (9.5% vs. 19%).As a result of the demonstrated benefits conferred where can i get kamagra by influenza vaccination and the risks posed by flu among those with cardiovascular disease, the CDC and numerous other international societies strongly recommend annual influenza vaccination in patients with cardiovascular disease.Clinicians should ensure high rates of influenza vaccination, especially in those with underlying chronic conditions, to protect against acute cardiovascular events associated with influenza.Unfortunately, many heart patients visit their cardiologist more frequently than their primary care providers, and cardiology practices typically do not provide flu vaccinations, though proposed recommendations may change in the future.

Until then, it is incumbent upon both the cardiology provider and the primary care provider to communicate the increased risk to their patients and the importance of getting vaccinated.For patients with heart conditions, there are two important steps you can take to reduce your risk. Make sure you do obtain your influenza treatment from your local pharmacy or where can i get kamagra primary care provider. The earlier you get it, the better it is at protecting you, as you never know when the kamagra may begin to spread.

Make sure you where can i get kamagra are taking your medications and following your recommended diet, exercise and stress reduction plans. If your heart condition is stable and you end up with the flu, chances are you'll experience fewer, less severe complications than if your heart condition is poorly managed.Stressful experiences are usually remembered more easily than neutral experiences. Researchers at Ruhr-Universität Bochum where can i get kamagra (RUB) have analysed the reasons why this is the case.

They put people in stressful situations during simulated job interviews and then recorded their memory of objects from these interviews. Using functional magnetic resonance imaging, they analysed brain activity while the where can i get kamagra participants saw the objects again. Memories of objects from stressful situations seem to rely on similar brain activity as memories of the stress trigger itself.The team headed by Anne Bierbrauer, Professor Oliver Wolf and Professor Nikolai Axmacher from the RUB Institute of Cognitive Neuroscience describes the findings in the journal Current Biology, published online on 14 October 2021.Different theories"We usually have detailed images in your mind's eye of stressful experiences, such as taking the driving test, even after many years," says Oliver Wolf.

"Whereas a walk through the park on the same day is quickly forgotten." The neuroscientists at where can i get kamagra RUB would like to understand the reasons for this phenomenon.Earlier studies and theoretical considerations had led to different predictions about how memories of stressful experiences differ from neutral ones. "One idea was that very different memory representations might have been the key to more powerful memories. On the other hand, there were indications that stress memories have resembled each other more where can i get kamagra closely," explains Anne Bierbrauer.

The current study provides evidence for the second theory.Analysing stressful experiences in the labUnlike in many laboratory studies, the researchers set out to record the memory trace of a real event in their experiments, using the so-called Trier Social Stress Test for this purpose. This test requires the participants to speak in front where can i get kamagra of an application committee, all of whom wear a neutral expression and don't give any positive feedback. The test unfailingly triggers stress in the participants.During the job interview simulation, the committee used a number of everyday objects.

For example, one of the committee members took a sip from where can i get kamagra a coffee cup. The control group was confronted with the same objects, but the participants were not subjected to any stress. One day later, the researchers showed the objects to where can i get kamagra participants in both groups while recording brain activity in a magnetic resonance imaging scanner.

The stressed participants remembered the objects better than members of the control group.The researchers analysed primarily the brain activity in the amygdala, a region whose main functions include emotional learning. They compared the neuronal traces of objects that had been used by the committee members in the stress situation with those of objects that hadn't been used. The result was where can i get kamagra.

The memory traces of objects that had been used resembled each other more closely than those of objects that hadn't been used. This was not the case in the control group where can i get kamagra. In other words, the brain representations of the objects from the stressful situations were very closely linked, and they were thus clearly set apart from other experiences.Stressful memories are based on their resemblance to the stressorOne day after the stress test, the researchers showed the participants not only pictures of the objects from the job interview, but also photos of members of the committee.

The participants mainly remembered objects where can i get kamagra where the brain activity was similar to the activity triggered by the presentation of the committee members. "The committee members triggered the stress in the interview situation. Accordingly, it seems that the link between the objects and the stress triggers was crucial for the enhanced memory," concludes Nikolai Axmacher.The findings obtained in this study argue against the theory that stronger memories are triggered by memory representations that differ from each other as much as possible -- at least when it comes to emotional or where can i get kamagra stressful memories.

Rather, the mechanism that reinforces emotional memories appears to be rooted in the fact that the important aspects of the episode are linked at the neural level and become more closely related to the stress trigger. "This result where can i get kamagra could be an important building block to better understand emotional and traumatic memories," points out Anne Bierbrauer. Story Source.

Materials provided by Ruhr-University where can i get kamagra Bochum. Note. Content may be edited for style and length.Researchers from where can i get kamagra the Okinawa Institute of Science and Technology Graduate University (OIST) have identified a protein that plays a key role in how the brain regulates appetite and metabolism.

Loss of the protein, XRN1, from the forebrain, resulted in obese mice with an insatiable appetite, according to a new study published in the journal, iScience.Obesity is a growing public health concern, with over 650 million adults worldwide designated as obese. The condition has been linked to many disorders, including cardiovascular disease, type 2 diabetes and cancer."Fundamentally, obesity is caused by an where can i get kamagra imbalance between food intake and energy expenditure," said Dr. Akiko Yanagiya, a researcher in the Cell Signal Unit at OIST, headed by Professor Tadashi Yamamoto.

"But we still understand very little about how appetite or metabolism is regulated by communication between the brain and parts of the body, such as the pancreas, liver and adipose tissues."In the study, the scientists created mice that were unable to produce the protein, XRN1, in a subset of neurons in where can i get kamagra the forebrain. This brain region includes the hypothalamus, an almond-sized structure that releases hormones into the body, helping to regulate body temperature, sleep, thirst and hunger.At 6-weeks-old, the scientists noticed that the mice without XRN1 in the brain rapidly began to gain weight and became obese by 12 weeks of age. Fat accumulated in the mice's body, including within adipose tissue and the liver.When they monitored feeding behavior, the team found that the mice without XRN1 ate almost twice as much each day as the control where can i get kamagra mice.

advertisement "This finding was really surprising," said Dr. Shohei Takaoka, a former PhD student from the OIST where can i get kamagra Cell Signal Unit. "When we first knocked out XRN1 in the brain, we didn't know exactly what we would find, but this drastic increase in appetite was very unexpected."To investigate what might be causing the mice to overeat, the scientists measured the blood levels of leptin -- a hormone that suppresses hunger.

Compared to the controls, the level of leptin where can i get kamagra in the blood was abnormally high, which would normally stop the mice from feeling hungry. But unlike the control mice, the mice without XRN1 didn't respond to the presence of leptin -- a condition known as leptin resistance.The scientists also found that 5-week-old mice were resistant to insulin, a hormone that is released by beta cells in the pancreas in response to the high levels of blood glucose that occur after eating. This type of failure in how the body responds to glucose and insulin can where can i get kamagra ultimately lead to diabetes.

As the mice got older, levels of glucose and insulin in the blood rose significantly alongside the increased leptin levels."We think that the levels of glucose and insulin rose due to the lack of response to leptin," explained Dr. Yanagiya. "Leptin resistance meant that the mice kept eating, keeping the level of glucose in the blood high, and therefore increasing insulin in the blood."The scientists then checked whether the obesity was also driven by the mice using less energy.

They placed each mouse in a special cage that measured how much oxygen the mice used to indirectly work out their metabolic rate. advertisement In the mice aged 6 weeks, the scientists didn't find an overall difference in energy expenditure. However, they found something very surprising.

The mice without XRN1 were mainly using carbohydrates as an energy source, while the control mice were able to switch between burning carbohydrate at night, when they were most active, and fat during the day, when less active."For some reason, this means that without XRN1, the mice cannot use fat as a fuel effectively," said Dr. Yanagiya. "Why this occurs though, we still don't know."Once the mice reached 12 weeks of age, their energy expenditure decreased compared to control mice.

But, the scientists believed, this was an effect of obesity, due to the mice being less active, rather than a cause."Overall, we think overeating due to leptin resistance was the driving cause behind why these mice became obese," said Dr. Yanagiya.To further investigate how loss of XRN1 results in leptin resistance and an increased appetite, the scientists looked at whether the activity of appetite-regulating genes changed within the hypothalamus.XRN1 plays a crucial role in gene activity, as it is involved in the last step of degrading messenger RNA (mRNA). When a gene is active, DNA is used to make a molecule of mRNA, which can then be used to build a specific protein.

Cells have many ways of regulating the activity of genes, one of which is by degrading mRNA more slowly or more quickly, which results in more or less protein being made, respectively.In the hypothalamus, the scientists found that the mRNA used to make the protein Agouti-related peptide (AgRP) -- one of the most potent stimulators of appetite -- was elevated in the obese mice, leading to higher amounts of AgRP protein."It's still only speculation, but we think that an increase of this protein, and abnormal activation of the neuron that produces it, might be the cause of leptin resistance in these mice," said Dr. Yanagiya. "Leptin normally suppresses activity of the AgRP neuron, but if loss of XRN1 results in this neuron remaining highly active, it could override the leptin signal."However, the exact mechanism of how loss of XRN1 leads to increased activation of AgRP neurons remains unclear.

XRN1 was removed only in a specific subset of neurons in the forebrain, and AgRP neurons were not among them. This suggests that another neuron that did lose XRN1 may be involved and could be signaling incorrectly to the AgRP neurons and keeping them active.Moving forward, the lab hopes to collaborate with neuroscience research units, in order to pinpoint exactly how XRN1 impacts the activity of neurons in the hypothalamus to regulate appetite."Identifying which neurons and proteins in the brain are involved in regulating appetite, and fully determining how resistance to leptin is caused, could eventually lead to a targeted treatment for obesity," said Dr. Yanagiya..

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

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

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

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

The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce. In this paper—the first of two linked Research Made Simple articles—we explore what the foundations of a high-quality PhD are, and how a Doctoral candidate can develop a study which is successful, original and impactful.Foundations of a ‘good’ PhD http://dsdtips.com/how-to-automate-the-import-of-invoices-into-mas-90/ studySupervision and supportCentral to the development and completion of a good PhD is the supervisory relationship between the student and supervisor. The supervisor guides the student by directing them to resources and training to ensure continuous learning, provides opportunity to engage with experts in the field, and facilitates the development of critical thinking through questioning and providing constructive criticism.1The support needs of students will be different, so a flexible yet quality assured approach to PhD research training is required. A good supervisory team (usually includes at least two postdoctoral academics) provide experienced guidance and mentorship and will offer students academic support, with regular meetings and timely feedback on written submissions, will assist the student to develop a peer network and help them access research communities relative to their field. Effective supervision has beneficial outcomes for students, including encouraging a positive work ethic and influencing engagement in a stimulating environment, allowing students to pursue their own ideas with educated encouragement.

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

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

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

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

October is http://dsdtips.com/how-to-automate-the-import-of-invoices-into-mas-90/ Mental Health Awareness Month and where can i get kamagra World Mental Health Day takes place on 10 October 2020. This year, the erectile dysfunction treatment kamagra has added a new dimension to concerns regarding mental health in our communities. Across the globe stories continue to emerge of people’s experiences of anxiety, fear and depression due to the uncertainty and stress brought on by where can i get kamagra the kamagra.1–3 Job losses, financial and housing insecurity, the challenges of working from home, home schooling, restricted access to health and social care services and social isolation coupled with reduced support and contact with family and friends have all impacted people’s well-being.

There is particular concern about the mental health of healthcare workers during this difficult time.While most healthcare workers are resilient to the long-term effects of this period of stress and anxiety, there is the added worry about scarce resources, lack of cure or effective treatment options, isolation from family, coping with patient suffering and deaths and the moral and ethical impact of decisions as to who will receive acute care. These factors have significant potential for negative repercussions on the mental health and well-being of healthcare staff.4 5 There have been reports of high levels of stress, depression and even suicides,6 and long-term effects include a higher risk for post-traumatic stress disorder or moral where can i get kamagra injury.5Healthcare organisations need to plan for the inevitable consequence of this kamagra and ensure that resources are in place for their workers. Screening for mental health issues and treatment, including counselling, should be made available.

In addition, nurses and other healthcare staff should be encouraged to reflect on their experiences and consider how where can i get kamagra to implement self-care strategies that will enhance their well-being. This includes staying informed of the current data and information and being aware of the risks to themselves and others while caring for patients with the kamagra. By monitoring and enacting strategies to reduce stress and develop support systems, staff can minimise longer-term impacts.4Whether organisational support and self-care monitoring have achieved better mental health outcomes for healthcare workers is, as yet, unknown.

Research across the globe is underway not only related to the kamagra itself but where can i get kamagra also to the mental health consequences of the kamagra. We do not yet know the extent of the issues or how best to support healthcare providers. In order to better understand the issues and to support nurses at this time, evidence-based nursing will focus our where can i get kamagra social media to mental health issues during the month of October.

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

Impact of erectile dysfunction treatment on nurses’ mental health and.Twitter Chat on Wednesday October 14 at 20:00 where can i get kamagra UK time.Oct. 18. Impact of erectile dysfunction treatment on student nursing.Oct.

25. Impact of erectile dysfunction treatment on informal carers and families.A PhD is a globally recognised postgraduate degree and typically the highest degree programme awarded by a University, with students usually required to expand the boundaries of knowledge by undertaking original research. The purpose of PhD programmes of study is to nurture, support and facilitate doctoral students to undertake independent research to expected academic and research standards, culminating in a substantial thesis and examined by viva voce.

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

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

Students who access personal and professional support and guidance through mentoring models during their studies are more likely to succeed. These models include one-to-one peer mentoring or activities for example journal discussion or methods learning groups. Often, groups of students naturally come together and give each other support and advice about research process expectations and challenges, and offer friendship, and guidance.2 Given the usefulness of different types of mentoring models, all can create a supportive and collaborative environment within a PhD programme of study, to minimise working in isolation and enable students to achieve their greatest potential.Characteristics of a good study.

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

Key points for consideration include:Are the research questions/aim and objectives well defined?. What theory/theories/concepts are being operationalised?. How are the theories/concepts related?.

Are the ontological and epistemological perspectives clearly conveyed and how do they relate to theories and concepts outlined?. What are the potential benefits and limitations of the theories and concepts outlined?. Are the ways the theories/concepts are outlined and being used original?.

A PhD thesis (and demonstrable in viva) must be able to offer cohesion between the choice of research methods that stems from the conceptual/theoretical framework, the related ontological and epistemological decisions, the theoretical perspective and the chosen methodology (table 2). PhD students must be able to articulate the methodological decisions made and be critical of methods employed to answer their research questions.View this table:Table 2 Relationship between research paradigms, perspectives, methodologies and methods.8 9ConclusionIn summary, we offer considerations of what the foundations of a good PhD should be. We have considered some of the key ingredients of quality PhD supervision, support and research processes and explored how these will contribute to the development of a study that leads to student success and which makes a valuable contribution to the evidence base.

In the next paper, we will look in more detail at the assessment of the PhD through the submission of a thesis and an oral viva..

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NCHS Data kamagra how long does it last who can buy kamagra Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes kamagra how long does it last (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the loss of kamagra how long does it last ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% kamagra how long does it last are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, kamagra how long does it last on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 kamagra how long does it last. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend by menopausal status (p kamagra how long does it last <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was kamagra how long does it last 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE kamagra how long does it last.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep kamagra how long does it last four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 kamagra how long does it last.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by kamagra how long does it last menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had kamagra how long does it last a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data kamagra how long does it last table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had kamagra how long does it last trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 kamagra how long does it last. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image kamagra how long does it last icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last kamagra how long does it last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data kamagra how long does it last table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling kamagra how long does it last well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 kamagra how long does it last. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. € kamagra oral jelly thailand price. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

NCHS Data where can i get kamagra Brief No buy kamagra online next day delivery. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk where can i get kamagra for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is “the permanent cessation of menstruation that occurs after where can i get kamagra the loss of ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, where can i get kamagra 3.7% are perimenopausal, and 22.1% are postmenopausal.

Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a where can i get kamagra 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 where can i get kamagra. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant quadratic trend where can i get kamagra by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last where can i get kamagra menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table where can i get kamagra for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly where can i get kamagra one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 where can i get kamagra. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p where can i get kamagra <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last where can i get kamagra menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table where can i get kamagra for Figure 2pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal where can i get kamagra status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 where can i get kamagra. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear where can i get kamagra trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer where can i get kamagra had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure where can i get kamagra 3pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age where can i get kamagra group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 where can i get kamagra. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5).

Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?.

€ you can try these out. 2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less.

Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS.

For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States. The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS.

Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No.

141. Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N. Perimenopause.

From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult.

A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software].

2012. Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286.

Hyattsville, MD. National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J. Blumberg, Ph.D., Associate Director for Science.

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Sen. Rick Scott (R-Fla.) issued a press release Nov. 16 suggesting that rising kamagra what is it general inflation was behind the large increase in next year’s standard premiums for Medicare Part B, which covers physician and some drug costs and other outpatient services. €œSen. Rick Scott kamagra what is it.

America’s Seniors Are Paying the Price for Biden’s Inflation Crisis” was the headline. The senator’s statement within that press release said, “We need to be LOWERING health care and drug prices and strengthening this vital program for seniors and future generations, not crippling the system and leaving families to pay the cost.” The press release from Scott says he is “slamming Biden’s inaction to address the inflation crisis he and Washington Democrats have created with reckless spending and socialist policies, which is expected to cause significant price increases on [senior] citizens and Medicare recipients.” Scott’s statement in that same press release also says the administration’s “reckless spending” will leave U.S. Seniors “paying HUNDREDS more for the care they kamagra what is it need.” We wondered whether these points were true. Was the climbing annual inflation rate over the past several months to blame for the increase in Medicare Part B premiums?. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. We reached out to Scott’s office for more detail but kamagra what is it received no reply.

Upon further investigation, we found there is little, if any, connection between general inflation in the past few months and the increase in Medicare Part B premiums. What’s the Status of kamagra what is it Medicare Premiums?. Medicare Part B premiums have been growing steadily for decades to keep up with rising health spending. The U.S. Inflation rate, for years held at bay, has been above 4% since April, hitting 6.2% in October, the highest kamagra what is it rate in decades.

On Nov. 12, the Centers for kamagra what is it Medicare &. Medicaid Services announced that the standard monthly premium for Medicare Part B would rise to $170.10 in 2022, from $148.50 this year. The 14.5% increase is the largest one-year increase in the program’s history. Scott’s press release refers to the CMS kamagra what is it report.

CMS cited three main factors for the increase. Rising health care costs, a move by Congress last year that held the premium increase to just $3 a month because of the kamagra, and the need to raise money for kamagra what is it a possible unprecedented surge in drug costs. Inflation was not on that list. In fact, half of the premium increase was due to making sure the program was ready in case Medicare next year decides to start covering Aduhelm, a new Alzheimer’s drug priced at $56,000 per year, per patient. It’s been estimated that total Medicare spending for kamagra what is it the drug for one year alone would be nearly $29 billion, far more than any other drug.

How Big a Hit Will Seniors Feel?. The Part B premium is kamagra what is it typically subtracted automatically from enrollees’ Social Security checks. Because Social Security recipients will receive a 5.9% cost-of-living increase next year — about $91 monthly for the average beneficiary — they’ll still see a net gain, though a chunk will be eaten away by the hike in Medicare premiums. Some Medicare beneficiaries won’t face a 14.5% increase, however, kamagra what is it because a “hold-harmless” provision in federal law protects them from a decrease in their Social Security payments. But that rule won’t apply for most enrollees in 2022 because the increase in their monthly benefit checks will cover the higher monthly premium, said Juliette Cubanski, deputy director of the program on Medicare policy at KFF.

What Role Does Inflation Play?. Several Medicare experts said kamagra what is it the spike in the general inflation rate has little or nothing to do with the Medicare premium increase. In fact, Medicare is largely immune from inflation, because the program sets prices for hospitals and doctors. €œThis is so false that it is annoying,” Paul Ginsburg, a professor of health policy at the Sol Price School of Public Policy at the University of Southern California, said of Scott’s claim that general inflation kamagra what is it is behind the premium increase. €œThe effect of the inflation spike so far on prices is zero because Medicare controls prices.” Medicare Part B premiums, he said, reflect changes in the amount of health services delivered and a more expensive mix of drugs.

€œPremiums are tracking spending, only a portion of which reflects prices,” Ginsburg said. €œI can’t see that the administration really kamagra what is it had any discretion” in setting the premium increase due to the need to build a reserve to pay for the Alzheimer’s drug and make up for the reduced increase last year, he said. Stephen Zuckerman, co-director of the Urban Institute’s health policy center, said a rise in wages caused by inflation could spur a small boost in Medicare spending because wages help determine how much the program pays providers. But, he said, such an increase would have to occur for more than a few months kamagra what is it to affect premiums. Continued soaring inflation could influence 2023 Medicare premiums, not those for 2022.

€œThe claim that premium increases are due to inflation in the last couple of months doesn’t make sense,” Zuckerman said. CMS faced kamagra what is it the challenge of trying to estimate costs for an expensive drug not yet covered by Medicare. €œIt is a very difficult projection to make, and they want to have enough contingency reserved,” said Gretchen Jacobson, a vice president of the nonpartisan Commonwealth Fund. Our Ruling Scott said in a press release about the 2022 increase in Medicare Part B premiums that “America’s seniors are paying the price for Biden’s inflation crisis.” Though his statement contains a sliver of truth, Scott’s assertion kamagra what is it ignores critical facts that create a different impression. For instance, Medicare policy experts said, current general inflation has little, if anything, to do with the increase in premiums.

CMS said the increase was needed to put away money in case Medicare starts paying for an Alzheimer’s drug that could add tens of billions in costs in one year and to make up for kamagra what is it congressional action last year that held down premiums. We rate the claim Mostly False. SOURCES:Telephone interview and emails with Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, Nov. 24, 2021.Telephone interview with Stephen Zuckerman, co-director of kamagra what is it the Health Policy Center at the Urban Institute, Nov. 19, 2021.Telephone interview with Paul Ginsburg, professor of health policy at the Sol Price School of Public Policy at the University of Southern California, Nov.

18, 2021.Telephone interview with Gretchen Jacobson, vice president of the Medicare kamagra what is it program at the Commonwealth Fund, Nov. 18, 2021.Telephone interview with Joe Antos, senior fellow with American Enterprise Institute, Nov. 18, 2021.Sen. Rick Scott’s kamagra what is it press release, Nov. 16, 2021.Statista, monthly inflation rates, accessed Nov.

19, 2021.Centers for Medicare & kamagra what is it. Medicaid Services press release about Medicare Part B premiums, accessed Nov. 19, 2021.Medicareresources.org’s fact sheet about the Medicare hold-harmless provision, accessed Nov. 19, 2021.Medicareresources.org fact sheet about high earners not subject to the hold-harmless kamagra what is it provision, accessed Nov. 19, 2021.Social Security blog about the hold-harmless provision, accessed Nov.

19, 2021.AARP blog about the biggest-ever increase in Medicare kamagra what is it Part B premiums, accessed Nov. 18, 2021.Medicare Trustees Report, 2021 (see page 90 for Medicare Part B premiums by year since program inception).KFF brief on the impact Aduhelm could have on Medicare costs, accessed Nov. 18, 2021.CMS’ kamagra what is it “2022 Medicare Parts A &. B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts” report, accessed Nov. 12, 2021.

This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism kamagra what is it about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is kamagra what is it an endowed nonprofit organization providing information on health issues to the nation. [Correction. This article was corrected at 1:25 p.m.

PT on kamagra what is it Nov. 24, 2021. A previous version of this story misstated the effect of kamagra what is it a hold-harmless provision in federal law. That measure protects people from a reduction in Social Security payments caused by higher Medicare premiums in years when the cost-of-living adjustment to Social Security is not enough to cover the premium hike. The earlier story’s reference to 70% of Medicare beneficiaries being protected in kamagra what is it 2022 was incorrect.

The rating remains the same.] Phil Galewitz. pgalewitz@kff.org, @philgalewitz Related Topics Contact Us Submit a Story TipThe decisions have been gut-wrenching. Should she try another round of chemotherapy, even though she barely tolerated kamagra what is it the last one?. Should she continue eating, although it’s getting difficult?. Should she take more painkillers, even if she ends kamagra what is it up heavily sedated?.

Dr. Susan Massad, 83, has been making these choices with a group of close friends and family — a “health team” she created in 2014 after learning her breast cancer had metastasized to her spine. Since then, kamagra what is it doctors have found cancer in her colon and pancreas, too. Now, as Massad lies dying at home in New York City, the team is focused on how she wants to live through her final weeks. It’s understood this is a mutual kamagra what is it concern, not hers alone.

Or, as Massad told me, “Health is about more than the individual. It’s something that people do together.” Originally, five of Massad’s team members lived with her in a Greenwich Village brownstone she bought with friends in 1993. They are in their 60s kamagra what is it or 70s and have known one another a long time. Earlier this year, Massad’s two daughters and four other close friends joined the team when she was considering another round of chemotherapy. Massad ended up saying “no” to that option in September after weighing the team’s input and consulting with a physician who researches treatments on her kamagra what is it behalf.

Several weeks ago, she stopped eating — a decision she also made with the group. A hospice nurse visits weekly, and an kamagra what is it aide comes five hours a day. Anyone with a question or concern is free to raise it with the team, which meets now “as needed.” The group does not exist just for Massad, explained Kate Henselmans, her partner, “it’s about our collective well-being.” And it’s not just about team members’ medical conditions. It’s about “wellness” much more broadly defined. Massad, a primary care physician, kamagra what is it first embraced the concept of a “health team” in the mid-1980s, when a college professor she knew was diagnosed with metastatic cancer.

Massad was deeply involved in community organizing in New York City, and this professor was part of those circles. A self-professed loner, the professor said she wanted deeper connections to other people during the last kamagra what is it stage of her life. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. Massad joined with the woman’s social therapist and two of her close friends to provide assistance. (Social therapy is a form of group therapy.) Over the next three years, they helped manage the woman’s physical and emotional symptoms, accompanied her to doctors’ visits and mobilized friends to make sure she was rarely alone. As word got out about this “let’s do this together” model, dozens of Massad’s friends and colleagues formed health teams lasting from a few months kamagra what is it to a few years.

Each is unique, but they all revolve around the belief that illness is a communal experience and that significant emotional growth remains possible for all involved. €œMost health teams have been organized around people who have fairly serious illness, and their overarching goal is to help people live the kamagra what is it most fulfilling life, the most giving life, the most social life they can, given that reality,” Massad told me. An emphasis on collaborative decision-making distinguishes them from support groups. Emilie Knoerzer, 68, who lives next door to Massad and Henselmans and is a member of the health team, gives an example from a couple of years ago. She and kamagra what is it her partner, Sandy Friedman, were fighting often and “that was bad for the health of the whole house,” she told me.

€œSo, the whole house brought us together and said, ‘‘This isn’t going well, let’s help you work on this.’ And if we started getting into something, we’d go ask someone for help. And it’s kamagra what is it much better for us now.” Dr. Susan Massad first created a “health team” to help a professor she knew who was dying of cancer. Today, she relies on a similar kamagra what is it team to guide her through the end of life. (Janet Wootten) Mary Fridley, 67, a close friend of Massad’s and another health team member, offered another example.

After experiencing serious problems with her digestive system this past year, she pulled together a health team to help her make sense of her experiences with the medical system. None of the many doctors Fridley kamagra what is it consulted could tell her what was wrong, and she felt enormous stress as a result. €œMy team asked me to journal and to keep track of what I was eating and how I was responding. That was helpful,” Fridley told me kamagra what is it. €œWe worked on my not being so defensive and humiliated every time I went to the doctor.

At some point, I said, ‘All I want to do is cry,’ and we cried together for a long time. And it wasn’t kamagra what is it just me. Other people shared what was going on for them as well.” Dr. Hugh Polk, kamagra what is it a psychiatrist who’s known Massad for 40 years, calls her a “health pioneer” who practiced patient-centered care long before it became a buzzword. €œShe would tell patients, ‘We’re going to work together as partners in creating your health.

I have expertise as a doctor, but I want to hear from you. I want you to tell me how you feel, what your symptoms are, what kamagra what is it your life is like,’” he said. As Massad’s end has drawn near, the hardest but most satisfying part of her teamwork is “sharing emotionally what I’m going through and allowing other people to share with me. And asking for help kamagra what is it. Those aren’t things that come easy,” she told me by phone conversation.

€œIt’s very challenging to watch her dying,” said her daughter kamagra what is it Jessica Massad, 54. €œI don’t know how people do this on their own.” Every day, a few people inside or outside her house stop by to read to Massad or listen to music with her — a schedule her team is overseeing. €œIt is a very intimate experience, and Susan feels loved so much,” said Henselmans. For Massad, being surrounded by this kind of support kamagra what is it is freeing. €œI don’t feel compelled to keep living just because my friends want me to,” she said.

€œWe cry together, we feel sad together, and that kamagra what is it can be difficult. But I feel so well taken care of, not alone at all with what I’m going through.” We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips. This story was produced by KHN (Kaiser Health News), kamagra what is it a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation).

KFF is an endowed nonprofit organization kamagra what is it providing information on health issues to the nation. Judith Graham. khn.navigatingaging@gmail.com, @judith_graham Related Topics Contact Us Submit a Story Tip.

€œAmerica’s Seniors Are Paying the Price for Biden’s Inflation Crisis” — The headline of a press Where to buy female viagra release from Sen where can i get kamagra. Rick Scott (R-Fla.) [UPDATED at 1:25 p.m. PT] Republicans blame President Joe Biden for this year’s historic surge in inflation, reflected in higher prices for almost everything — from cars and where can i get kamagra gas to food and housing.

They see last month’s 6.2% annual inflation rate — the highest in decades and mostly driven by an increase in consumer spending and supply issues related to the erectile dysfunction treatment kamagra — as a ticket to taking back control of Congress in next year’s midterm elections. A key where can i get kamagra voting bloc will be older Americans, and the GOP aims to illustrate how much worse life has grown for them under the Biden administration. Sen.

Rick Scott (R-Fla.) issued a press release Nov. 16 suggesting that rising general inflation was behind the large increase in next year’s standard premiums for Medicare Part B, which covers physician and where can i get kamagra some drug costs and other outpatient services. €œSen.

Rick Scott where can i get kamagra. America’s Seniors Are Paying the Price for Biden’s Inflation Crisis” was the headline. The senator’s statement within that press release said, “We need to be LOWERING health care and drug prices and strengthening this vital program for seniors and future generations, not crippling the system and leaving families to pay the cost.” The press release from Scott says he is “slamming Biden’s inaction to address the inflation crisis he and Washington Democrats have created with reckless spending and socialist policies, which is expected to cause significant price increases on [senior] citizens and Medicare recipients.” Scott’s statement in that same press release also says the administration’s “reckless spending” will leave U.S.

Seniors “paying HUNDREDS where can i get kamagra more for the care they need.” We wondered whether these points were true. Was the climbing annual inflation rate over the past several months to blame for the increase in Medicare Part B premiums?. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. We where can i get kamagra reached out to Scott’s office for more detail but received no reply.

Upon further investigation, we found there is little, if any, connection between general inflation in the past few months and the increase in Medicare Part B premiums. What’s the Status where can i get kamagra of Medicare Premiums?. Medicare Part B premiums have been growing steadily for decades to keep up with rising health spending.

The U.S. Inflation rate, for years held at bay, has been above 4% since April, where can i get kamagra hitting 6.2% in October, the highest rate in decades. On Nov.

12, the where can i get kamagra Centers for Medicare &. Medicaid Services announced that the standard monthly premium for Medicare Part B would rise to $170.10 in 2022, from $148.50 this year. The 14.5% increase is the largest one-year increase in the program’s history.

Scott’s press release refers to the CMS where can i get kamagra report. CMS cited three main factors for the increase. Rising health care costs, a move by Congress last year that held the premium increase to just $3 a month because of the kamagra, and the need to raise money for a possible where can i get kamagra unprecedented surge in drug costs.

Inflation was not on that list. In fact, half of the premium increase was due to making sure the program was ready in case Medicare next year decides to start covering Aduhelm, a new Alzheimer’s drug priced at $56,000 per year, per patient. It’s been estimated that total Medicare spending for the drug for one where can i get kamagra year alone would be nearly $29 billion, far more than any other drug.

How Big a Hit Will Seniors Feel?. The Part B premium is typically where can i get kamagra subtracted automatically from enrollees’ Social Security checks. Because Social Security recipients will receive a 5.9% cost-of-living increase next year — about $91 monthly for the average beneficiary — they’ll still see a net gain, though a chunk will be eaten away by the hike in Medicare premiums.

Some Medicare beneficiaries won’t face a 14.5% increase, however, because a “hold-harmless” provision in where can i get kamagra federal law protects them from a decrease in their Social Security payments. But that rule won’t apply for most enrollees in 2022 because the increase in their monthly benefit checks will cover the higher monthly premium, said Juliette Cubanski, deputy director of the program on Medicare policy at KFF. What Role Does Inflation Play?.

Several Medicare experts said the spike in the general where can i get kamagra inflation rate has little or nothing to do with the Medicare premium increase. In fact, Medicare is largely immune from inflation, because the program sets prices for hospitals and doctors. €œThis is so false that it is annoying,” Paul Ginsburg, a where can i get kamagra professor of health policy at the Sol Price School of Public Policy at the University of Southern California, said of Scott’s claim that general inflation is behind the premium increase.

€œThe effect of the inflation spike so far on prices is zero because Medicare controls prices.” Medicare Part B premiums, he said, reflect changes in the amount of health services delivered and a more expensive mix of drugs. €œPremiums are tracking spending, only a portion of which reflects prices,” Ginsburg said. €œI can’t see that the administration really had any discretion” in setting the premium increase due to the need to build a reserve to pay for the Alzheimer’s drug where can i get kamagra and make up for the reduced increase last year, he said.

Stephen Zuckerman, co-director of the Urban Institute’s health policy center, said a rise in wages caused by inflation could spur a small boost in Medicare spending because wages help determine how much the program pays providers. But, he where can i get kamagra said, such an increase would have to occur for more than a few months to affect premiums. Continued soaring inflation could influence 2023 Medicare premiums, not those for 2022.

€œThe claim that premium increases are due to inflation in the last couple of months doesn’t make sense,” Zuckerman said. CMS faced the challenge of trying to estimate where can i get kamagra costs for an expensive drug not yet covered by Medicare. €œIt is a very difficult projection to make, and they want to have enough contingency reserved,” said Gretchen Jacobson, a vice president of the nonpartisan Commonwealth Fund.

Our Ruling Scott said in a press release about the 2022 increase in Medicare Part B premiums that “America’s seniors are paying where can i get kamagra the price for Biden’s inflation crisis.” Though his statement contains a sliver of truth, Scott’s assertion ignores critical facts that create a different impression. For instance, Medicare policy experts said, current general inflation has little, if anything, to do with the increase in premiums. CMS said the where can i get kamagra increase was needed to put away money in case Medicare starts paying for an Alzheimer’s drug that could add tens of billions in costs in one year and to make up for congressional action last year that held down premiums.

We rate the claim Mostly False. SOURCES:Telephone interview and emails with Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, Nov. 24, 2021.Telephone interview with Stephen Zuckerman, co-director of the Health Policy Center at the Urban Institute, where can i get kamagra Nov.

19, 2021.Telephone interview with Paul Ginsburg, professor of health policy at the Sol Price School of Public Policy at the University of Southern California, Nov. 18, 2021.Telephone where can i get kamagra interview with Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund, Nov. 18, 2021.Telephone interview with Joe Antos, senior fellow with American Enterprise Institute, Nov.

18, 2021.Sen. Rick Scott’s press release, where can i get kamagra Nov. 16, 2021.Statista, monthly inflation rates, accessed Nov.

19, 2021.Centers for Medicare & where can i get kamagra. Medicaid Services press release about Medicare Part B premiums, accessed Nov. 19, 2021.Medicareresources.org’s fact sheet about the Medicare hold-harmless provision, accessed Nov.

19, 2021.Medicareresources.org fact sheet where can i get kamagra about high earners not subject to the hold-harmless provision, accessed Nov. 19, 2021.Social Security blog about the hold-harmless provision, accessed Nov. 19, 2021.AARP where can i get kamagra blog about the biggest-ever increase in Medicare Part B premiums, accessed Nov.

18, 2021.Medicare Trustees Report, 2021 (see page 90 for Medicare Part B premiums by year since program inception).KFF brief on the impact Aduhelm could have on Medicare costs, accessed Nov. 18, 2021.CMS’ where can i get kamagra “2022 Medicare Parts A &. B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts” report, accessed Nov.

12, 2021. This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism where can i get kamagra about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation).

KFF is an endowed nonprofit organization providing information on where can i get kamagra health issues to the nation. [Correction. This article was corrected at 1:25 p.m.

PT on Nov where can i get kamagra. 24, 2021. A previous version of this story misstated the effect of where can i get kamagra a hold-harmless provision in federal law.

That measure protects people from a reduction in Social Security payments caused by higher Medicare premiums in years when the cost-of-living adjustment to Social Security is not enough to cover the premium hike. The earlier story’s where can i get kamagra reference to 70% of Medicare beneficiaries being protected in 2022 was incorrect. The rating remains the same.] Phil Galewitz.

pgalewitz@kff.org, @philgalewitz Related Topics Contact Us Submit a Story TipThe decisions have been gut-wrenching. Should she try another round of chemotherapy, even though she barely tolerated where can i get kamagra the last one?. Should she continue eating, although it’s getting difficult?.

Should she take more painkillers, even if where can i get kamagra she ends up heavily sedated?. Dr. Susan Massad, 83, has been making these choices with a group of close friends and family — a “health team” she created in 2014 after learning her breast cancer had metastasized to her spine.

Since then, doctors where can i get kamagra have found cancer in her colon and pancreas, too. Now, as Massad lies dying at home in New York City, the team is focused on how she wants to live through her final weeks. It’s understood this is a mutual where can i get kamagra concern, not hers alone.

Or, as Massad told me, “Health is about more than the individual. It’s something that people do together.” Originally, five of Massad’s team members lived with her in a Greenwich Village brownstone she bought with friends in 1993. They are in their 60s or where can i get kamagra 70s and have known one another a long time.

Earlier this year, Massad’s two daughters and four other close friends joined the team when she was considering another round of chemotherapy. Massad ended up saying “no” to that option in September after weighing the team’s input where can i get kamagra and consulting with a physician who researches treatments on her behalf. Several weeks ago, she stopped eating — a decision she also made with the group.

A hospice nurse visits weekly, and where can i get kamagra an aide comes five hours a day. Anyone with a question or concern is free to raise it with the team, which meets now “as needed.” The group does not exist just for Massad, explained Kate Henselmans, her partner, “it’s about our collective well-being.” And it’s not just about team members’ medical conditions. It’s about “wellness” much more broadly defined.

Massad, a primary care physician, first embraced the concept of a “health team” in the mid-1980s, when a college professor she where can i get kamagra knew was diagnosed with metastatic cancer. Massad was deeply involved in community organizing in New York City, and this professor was part of those circles. A self-professed where can i get kamagra loner, the professor said she wanted deeper connections to other people during the last stage of her life.

EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. Massad joined with the woman’s social therapist and two of her close friends to provide assistance. (Social therapy is a form of group therapy.) Over the next three years, they helped manage the woman’s physical and emotional symptoms, accompanied her to doctors’ visits and mobilized friends to make sure she was rarely alone. As word got out about this “let’s do this together” model, dozens of Massad’s friends and colleagues formed health teams lasting from a few months to where can i get kamagra a few years.

Each is unique, but they all revolve around the belief that illness is a communal experience and that significant emotional growth remains possible for all involved. €œMost health teams have been organized around people where can i get kamagra who have fairly serious illness, and their overarching goal is to help people live the most fulfilling life, the most giving life, the most social life they can, given that reality,” Massad told me. An emphasis on collaborative decision-making distinguishes them from support groups.

Emilie Knoerzer, 68, who lives next door to Massad and Henselmans and is a member of the health team, gives an example from a couple of years ago. She and her partner, Sandy Friedman, were fighting often and “that was bad where can i get kamagra for the health of the whole house,” she told me. €œSo, the whole house brought us together and said, ‘‘This isn’t going well, let’s help you work on this.’ And if we started getting into something, we’d go ask someone for help.

And it’s much where can i get kamagra better for us now.” Dr. Susan Massad first created a “health team” to help a professor she knew who was dying of cancer. Today, she relies on a similar team where can i get kamagra to guide her through the end of life.

(Janet Wootten) Mary Fridley, 67, a close friend of Massad’s and another health team member, offered another example. After experiencing serious problems with her digestive system this past year, she pulled together a health team to help her make sense of her experiences with the medical system. None of the many doctors Fridley where can i get kamagra consulted could tell her what was wrong, and she felt enormous stress as a result.

€œMy team asked me to journal and to keep track of what I was eating and how I was responding. That was helpful,” where can i get kamagra Fridley told me. €œWe worked on my not being so defensive and humiliated every time I went to the doctor.

At some point, I said, ‘All I want to do is cry,’ and we cried together for a long time. And it wasn’t just me where can i get kamagra. Other people shared what was going on for them as well.” Dr.

Hugh Polk, a psychiatrist who’s known Massad for 40 years, calls her a “health pioneer” who practiced patient-centered where can i get kamagra care long before it became a buzzword. €œShe would tell patients, ‘We’re going to work together as partners in creating your health. I have expertise as a doctor, but I want to hear from you.

I want you to tell me how you feel, what where can i get kamagra your symptoms are, what your life is like,’” he said. As Massad’s end has drawn near, the hardest but most satisfying part of her teamwork is “sharing emotionally what I’m going through and allowing other people to share with me. And asking for where can i get kamagra help.

Those aren’t things that come easy,” she told me by phone conversation. €œIt’s very challenging to watch her dying,” said her daughter Jessica where can i get kamagra Massad, 54. €œI don’t know how people do this on their own.” Every day, a few people inside or outside her house stop by to read to Massad or listen to music with her — a schedule her team is overseeing.

€œIt is a very intimate experience, and Susan feels loved so much,” said Henselmans. For Massad, being where can i get kamagra surrounded by this kind of support is freeing. €œI don’t feel compelled to keep living just because my friends want me to,” she said.

€œWe cry together, we feel sad together, and where can i get kamagra that can be difficult. But I feel so well taken care of, not alone at all with what I’m going through.” We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

This story where can i get kamagra was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit where can i get kamagra organization providing information on health issues to the nation.

Judith Graham. khn.navigatingaging@gmail.com, @judith_graham Related Topics Contact Us Submit a Story Tip.