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California and New York are on the cusp of going further than the FDA order kamagra in restricting the sale of non-prescription diet pills to minors as pediatricians and public health advocates try to protect kids from extreme weight-loss gimmicks online. A bill before Gov. Gavin Newsom would bar anyone under 18 in California from buying over-the-counter weight loss supplements — whether online or in shops order kamagra — without a prescription. A similar bill passed by New York lawmakers is on Gov. Kathy Hochul’s desk.

Neither Democrat has indicated order kamagra how he or she will act. If both bills are signed into law, proponents hope the momentum will build to restrict diet pill sales to children in more states. Massachusetts, New Jersey, and Missouri have introduced similar bills and backers plan to continue their order kamagra push next year. Nearly 30 million people in the United States will have an eating disorder in their lifetime. 95% of them are between ages 12 and 25, according to Johns Hopkins All Children’s Hospital.

The hospital adds that eating disorders pose the highest order kamagra risk of mortality of any mental health disorder. And it has become easier than ever for minors to get pills that are sold online or on drugstore shelves. All dietary supplements, which include those for weight loss, accounted for nearly 35% of the $63 billion over-the-counter health products industry in 2021, according to Vision Research Reports, a market research firm. Dietary supplements, which encompass a broad range of vitamins, herbs, and minerals, are classified by the FDA as food and don’t undergo scientific and order kamagra safety testing as prescription drugs and over-the-counter medicines do. EMAIL SIGN-Up Subscribe to California Healthline's free Daily Edition. Public health advocates want to keep weight loss products — with ads that may promise to “Drop 5 pounds a week!.

€ and pill names like Slim Sense — away from order kamagra young people, particularly girls, since some research has linked some products to eating disorders. A study in the American Journal of Public Health, which followed more than 10,000 women ages 14-36 over 15 years, found that “those who used diet pills had more than 5 times higher adjusted odds of receiving an eating disorder diagnosis from a health care provider within 1 to 3 years than those who did not.” Many pills have been found tainted with banned and dangerous ingredients that may cause cancer, heart attacks, strokes, and other ailments. For example, the FDA advised the public to avoid Slim Sense by Dr. Reade because it contains lorcaserin, which has been found order kamagra to cause psychiatric disturbances and impairments in attention or memory. The FDA ordered it discontinued and the company couldn’t be reached for comment.

€œUnscrupulous manufacturers are willing to take risks with consumers’ health — and they are lacing their products with illegal pharmaceuticals, banned pharmaceuticals, steroids, excessive stimulants, even experimental stimulants,” said Bryn Austin, founding director of the Strategic Training Initiative for the Prevention of Eating Disorders, or STRIPED, which supports the restrictions. €œConsumers have no idea that this is what’s in these types of products.” STRIPED is a public health initiative based at the Harvard order kamagra T.H. Chan School of Public Health and Boston Children’s Hospital. An industry trade group, the Natural Products Association, disputes that diet pills cause eating disorders, citing the lack of consumer order kamagra complaints to the FDA of adverse events from their members’ products. €œAccording to FDA data, there is no association between the two,” said Kyle Turk, the association’s director of government affairs.

The association contends that its members adhere to safe manufacturing processes, random product testing, and appropriate marketing guidelines. Representatives also order kamagra worry that if minors can’t buy supplements over the counter, they may buy them from “crooks” on the black market and undermine the integrity of the industry. Under the bills, minors purchasing weight loss products must show identification along with a prescription. Not all business groups oppose the ban. The American Herbal Products Association, a trade group representing dietary supplement manufacturers and retailers, dropped its opposition to California’s bill once it was amended to order kamagra remove ingredient categories that are found in non-diet supplements and vitamins, according to Robert Marriott, director of regulatory affairs.

Children’s advocates have found worrisome trends among young people who envision their ideal body type based on what they see on social media. According to a study commissioned by Fairplay, a nonprofit that seeks to stop harmful marketing practices targeting children, kids as order kamagra young as 9 were found to be following three or more eating disorder accounts on Instagram, while the median age was 19. The authors called it a “pro-eating disorder bubble.” Meta, which owns Instagram and Facebook, said the report lacks nuance, such as recognizing the human need to share life’s difficult moments. The company argues that blanket censorship isn’t the answer. €œExperts and safety organizations have told us it’s important to strike a balance and allow people to share their personal stories while removing any content that encourages or promotes order kamagra eating disorders,” said Liza Crenshaw, a Meta spokesperson, in an email.

Dr. Jason Nagata, a pediatrician who cares for children and young adults with life-threatening eating disorders, believes that easy access to diet pills contributes to his patients’ order kamagra conditions at UCSF Benioff Children’s Hospital in San Francisco. That was the case for one of his patients, an emaciated 11-year-old girl. €œShe had basically entered a starvation state because she was not getting enough nutrition,” said Nagata, who provided supporting testimony for the California bill. €œShe was taking these pills and using other kinds of extreme behaviors to lose weight.” Nagata said the number of patients he sees with order kamagra eating disorders has tripled since the kamagra began.

They are desperate to get diet pills, some with modest results. €œWe’ve had patients who have been so dependent on these products that they will be hospitalized and they’re still ordering these products on Amazon,” he said. Public health advocates turned to state order kamagra legislatures in response to the federal government’s limited authority to regulate diet pills. Under a 1994 federal law known as the Dietary Supplement Health and Education Act, the FDA “cannot step in until after there is a clear issue of harm to consumers,” said Austin. No match for the supplement industry’s heavy order kamagra lobbying on Capitol Hill, public health advocates shifted to a state-by-state approach.

There is, however, a push for the FDA to improve oversight of what goes into diet pills. U.S. Sen. Dick Durbin of Illinois in April introduced a bill that would require dietary supplement manufacturers to register their products — along with the ingredients — with the regulator. Proponents say the change is needed because manufacturers have been known to include dangerous ingredients.

C. Michael White of the University of Connecticut’s School of Pharmacy found 35% of tainted health products came from weight loss supplements in a review of a health fraud database. A few ingredients have been banned, including sibutramine, a stimulant. €œIt was a very commonly used weight loss supplement that ended up being removed from the U.S. Market because of its elevated risk of causing things like heart attacks, strokes, and arrhythmias,” White said.

Another ingredient was phenolphthalein, which was used in laxatives until it was identified as a suspected carcinogen and banned in 1999. €œTo think,” he said, “that that product would still be on the U.S. Market is just unconscionable.” Related Topics Contact Us Submit a Story Tip.

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In response to Propecia online pharmacy a high-competition environment, Trinidadian killifish evolve larger brains, increasing their fitness and survival rates, according to a new study in Ecology Letters by biologists at The University of Texas at Arlington.The study, led by biology Professor Matthew Walsh and Kaitlyn Howell ('22 PhD, Biology), examined the connection between brain size and fitness when killifish are found in their native habitats and when they are transplanted from sites with predators to high-competition sites that lack predators.During a 30-day experiment near Arima, Trinidad, the researchers determined that when a fish is transplanted from a low- to a high-competition is kamagra a prescription drug environment, there is a strong relationship between larger brain size and faster growth. That growth demonstrates increased ability to forage for food, giving killifish a greater chance at survival.Furthermore, killifish from high-competition sites that remained in their native habitat for the duration of the experiment did not exhibit any change in is kamagra a prescription drug brain size. The transplanted fish that persisted until the end of the experiment exhibited a much larger brain size than those fish that were not observed again."Scientists have known about large differences in vertebrate brain size for more than 100 years, and there are many hypotheses about why the vertebrate brain evolves," Walsh said.

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In response to a high-competition environment, Trinidadian killifish evolve larger brains, increasing their fitness and survival rates, according to a new study in Ecology Letters by biologists at The University of Texas at Arlington.The study, led by biology Professor Matthew Walsh and Kaitlyn Howell order kamagra ('22 PhD, Biology), examined the connection between brain size and fitness when killifish are found in their native habitats and when they are transplanted from sites with predators to high-competition sites that lack predators.During a 30-day experiment near Arima, Trinidad, the researchers determined that when a fish is transplanted from a low- to a high-competition environment, there is a strong relationship between larger brain size and faster growth. That growth demonstrates increased ability to forage for food, giving killifish a greater chance at survival.Furthermore, killifish from high-competition sites that remained in their native habitat for the duration of order kamagra the experiment did not exhibit any change in brain size. The transplanted fish that persisted until the end of the experiment exhibited a much larger brain size than those fish that were not observed again."Scientists have known about large differences in vertebrate brain size for more than 100 years, and there are many hypotheses about why the vertebrate brain evolves," Walsh said.

"This study highlights the important role that competition may play."The study provides some of the first experimental evidence for which factors could be driving brain-size variation.Howell said the experiment was prompted by the observation that killifish in sites without predators have larger brains than others."We knew there were differences in brain size between these two populations of fish, but we didn't know why," Howell order kamagra said. "These results provide experimental support that larger brains can be adaptive and increase fitness in environments that are characterized by high population densities, low resources and intense competition." Story Source. Materials provided by University of Texas order kamagra at Arlington.

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Notice of http://www.hofgutbeutig.de/viagra-online-in-canada/ request generic kamagra for information. The Agency for Healthcare Research and Quality (AHRQ) seeks public comment about comprehensive, longitudinal, person-centered care planning for people with Multiple Chronic Conditions (MCC). Specifically, the RFI seeks comment on the current state of comprehensive, longitudinal, person-centered care planning for people at risk for or living with MCC across settings of care ( e.g., health systems, primary care, home, and other ambulatory practices), including Start Printed Page 56951 existing models of person-centered care planning, their current scale, and barriers and facilitators to implementation. In addition, the RFI seeks comments about innovative models of care, approaches, promising strategies and solutions in order for clinicians and practices to routinely engage in comprehensive, longitudinal, person-centered care planning to generic kamagra improve the care of people at risk for or living with MCC. This request for information will inform AHRQ's work in improving care for people at risk for or living with MCC.

Comments on this notice must be received by November 15, 2022. AHRQ will generic kamagra not respond individually to responders but will consider all comments submitted by the deadline. Please submit all responses via email to. MCC@ahrq.hhs.gov. Start Further Info Poonam Pardasaney, ScD, DPT, generic kamagra MS, Staff Fellow, Phone.

(301) 427-1121. Email. Poonam.Pardasaney@ahrq.hhs.gov. End Further Info End Preamble Start Supplemental Information AHRQ is seeking public comment about comprehensive, longitudinal, person-centered care planning for people at risk for or living with Multiple Chronic Conditions (MCC). Specifically, AHRQ seeks comment on the current state of comprehensive, longitudinal, person-centered care planning for people at risk for or living with MCC across settings of care ( e.g., health systems, primary care, home, and other ambulatory practices) including existing models of person-centered care planning, their current scale, and barriers and facilitators to implementation.

In addition, AHRQ seeks information about innovative models of care, approaches, and promising strategies and solutions, in order for clinicians and practices to routinely engage in comprehensive, longitudinal, person-centered care planning to improve the care of people at risk for or living with MCC. Because it may be possible to prevent or delay the onset of MCC, AHRQ is interested in care planning for those at risk for MCC in addition to those who have MCC. Evidence for effectiveness of strategies for implementation and delivery of person-centered care planning, their impact on improving health outcomes, as well as evidence on how to adapt, scale, and spread the intervention are of interest. For the purposes of this RFI, the following working definitions apply. Comprehensive, Longitudinal, Person-Centered Care Planning (also known as shared care planning).

A process of collaboration among people at risk for or living with MCC, clinicians, and healthcare teams to proactively discuss and record. (1) roles and tasks among care team members, including the individual, their family and caregivers. (2) plans for coordinating care within and across organizations and settings. (3) strategies for supporting and empowering patients to manage their own health. (4) plans for engaging in shared decision making.[] The care plan should.

Include all conditions including biomedical and behavioral health conditions. Facilitate screening for and/or diagnosing co-existing conditions that impact care management and outcomes, as well as social risks and supports. Support evidence-based care. Include an individual's goals and preferences. Be dynamic and incorporate an approach to updating, as necessary.

Person-Centered Care Plan. A single record of care shared among people at risk for or living with MCC and their clinicians that. (1) is accessible to persons with MCC and their caregivers. (2) puts the person's goals at the center of decision-making. (3) is holistic, including somatic and behavioral health, clinical and nonclinical data, including the social determinants of health.

(4) follows the person through both high-need episodes and periods of health improvement and maintenance. (5) allows care team coordination.[] Multiple Chronic Conditions (MCC) are defined here as the co-occurrence of two or more chronic physical or behavioral health conditions (including mental health and/or substance use disorders). Some use the term multimorbidity as synonymous with MCC, while others define MCC as including additional factors that contribute to the burden of illness, including disease severity, functional impairments and disabilities, syndromes such as frailty, and sometimes social factors such as homelessness. Importance of Care Planning for People at Risk for or Living With MCC Comprehensive, longitudinal, person-centered care planning is central to models of care that deliver high quality care that meet the needs of people at risk for or living with MCC. Person-centered care planning should be designed to achieve the following objectives.

Prioritize care that maximizes benefits and minimizes harms. • Incorporate and prioritize competing demands and people's preferences ( e.g., morbidity, mortality, burden of care, quality of life). Identify roles and tasks among care team members, including the person with MCC. • Coordinate planning, management and treatment with the whole care network across time and setting ( e.g., a multi-disciplinary team, specialty care, community and social services, people with MCC and caregivers) to create and maintain a single plan for each person. Elicit and reflect choices and values of people at risk for or living with MCC in the context of their lives.

Share decision making in a manner that is preferred by people at risk for or living with MCC and caregivers, considering individual values, preferences, cultural, and social contexts. Support and empower people at risk for or living with MCC to manage their own health and initiate and sustain behavior change, with the support of their health care team. Document specific goals of both people at risk for or living with MCC and their clinicians and health care team and reconcile when necessary. Continuously monitor and track progress on goals and preferences through high-need episodes, as well as during periods of health improvement and maintenance, with modification as necessary. Is supported by evidence-based clinical guidelines that optimize care for coexisting conditions.

Ensure equity is adequately addressed to deliver effective person-centered care to all and actively reduce health inequities including among Black, Indigenous, and people of color (BIPOC). Socioeconomically disadvantaged individuals. Across Sexual Orientation and Gender Identity (SOGI)). For those with low levels of health literacy or limited English proficiency. And for persons with disabilities.

Implementing comprehensive, longitudinal, person-centered care planning requires fundamental changes in the way care is organized and delivered in order to ensure. The active engagement and shared learning of diverse stakeholders. The capacity for timely implementation of rapidly evolving evidence. And innovative approaches to care transformation. While person-centered care planning is practiced in some care settings, it is not routine practice and there are significant evidence gaps regarding the most effective approaches for implementation, scale, and spread.

Start Printed Page 56952 Additionally, the use of shared electronic care plans (e-care plans) can facilitate coordination and communication among people at risk for or living with MCC and their clinicians and health care teams, and provide a shared resource for documenting goals, treatments and supports, education and self-management, along with other patient-generated health data to support care management.[] Who should respond?. AHRQ seeks information from. Clinicians and other health care personnel who perform some or all key components of comprehensive, longitudinal person-centered care planning for people at risk for or living with MCC, including clinicians and personnel from across all care settings (primary care, specialty care, mental and behavioral health, post-acute care, rehabilitative care, and home and community-based services). Researchers and implementers developing interventions to implement person-centered care planning in practice. Clinical decision support developers who develop tools for comprehensive, longitudinal person-centered care planning.

• Quality and other measure developers ( e.g., metrics, indicators) of person-centered care planning, including process, implementation, and outcomes. Patient advocacy groups and organizations. Clinical professional societies. Payers. Healthcare delivery organizations.

IT Directors who implement and manage health IT and other systems that may support person-centered care planning by people with MCC and their clinicians and health care teams. Vendors who develop health IT solutions that facilitate person-centered care planning, including traditional EHR systems, care planning platforms, consumer apps, and other products. • Organizations that facilitate health information exchange ( i.e., regional or local health information exchanges, vendor-driven networks, and others) who may support sharing of care plan information across systems. Device developers who incorporate comprehensive longitudinal person-centered care planning into device software. People at risk for or living with MCC, their families and caregivers.

Representatives from human service agencies and/or community organizations, or people with experience in addressing the social determinants of health and reducing disparities for people at risk for or living with MCC. Higher education institutions that train clinicians and healthcare personnel and/or train those involved in community health and education. Specific questions of interest to AHRQ include, but are not limited to, the following. What terms, strategies, and models of care are used to describe and deliver care planning for the whole person (not just for individual health conditions) that records. (1) roles and tasks among care team members, including the individual, their family and caregivers.

(2) plans for coordinating care within and across organizations and settings. (3) strategies for supporting and empowering patients to manage their own health. (4) plans for engaging in shared decision making?. What key components are necessary to fully deliver on the promise of person-centered care planning?. How is comprehensive, longitudinal, person-centered care planning for people at risk for or living with MCC currently being done in health systems, primary care, and other ambulatory practices?.

Which organizations are successfully engaged in person-centered care planning for people at risk for or living with MCC?. Who are the thought leaders in this area and/or where would leaders go to seek information about how to begin this work?. What are examples of innovative models of care, approaches, promising strategies and solutions that could support clinicians and practices in routinely engaging in comprehensive, longitudinal, person-centered care planning to improve the care of people at risk for or living with MCC?.

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The capacity for timely order kamagra implementation of rapidly evolving evidence. And innovative approaches to care transformation. While person-centered care planning is practiced in some care settings, it is not routine practice and there are significant evidence gaps regarding the most effective approaches for implementation, scale, and spread.

Start Printed Page 56952 Additionally, the use of shared electronic care plans (e-care plans) can facilitate coordination and communication among people at risk for or living with MCC and their clinicians and health care teams, and provide a shared resource for documenting goals, treatments and supports, education and self-management, along with other patient-generated health data to order kamagra support care management.[] Who should respond?. AHRQ seeks information from. Clinicians and other health care personnel who perform some or all key components of comprehensive, longitudinal person-centered care planning for people at risk for or living with MCC, including clinicians and personnel from across all care settings (primary care, specialty care, mental and behavioral health, post-acute care, rehabilitative care, and home and community-based services).

Researchers and implementers developing interventions to implement order kamagra person-centered care planning in practice. Clinical decision support developers who develop tools for comprehensive, longitudinal person-centered care planning. • Quality and other measure developers ( e.g., metrics, indicators) of person-centered care planning, including process, implementation, and outcomes.

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What terms, strategies, and models of care are used to describe and deliver care planning order kamagra for the whole person (not just for individual health conditions) that records. (1) roles and tasks among care team members, including the individual, their family and caregivers. (2) plans for coordinating care within and across organizations and settings.

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How is comprehensive, longitudinal, person-centered care planning for people at risk for or living with MCC order kamagra currently being done in health systems, primary care, and other ambulatory practices?. Which organizations are successfully engaged in person-centered care planning for people at risk for or living with MCC?. Who are the thought leaders in this area and/or where would leaders go to seek information about how to begin this work?.

What are examples of innovative models of order kamagra care, approaches, promising strategies and solutions that could support clinicians and practices in routinely engaging in comprehensive, longitudinal, person-centered care planning to improve the care of people at risk for or living with MCC?. How are health systems, primary care, and other ambulatory care practices using innovative approaches to implement person-centered care planning for people at risk for or living with MCC?. What are best practices for designing, implementing, and evaluating person-centered care planning for people at risk for or living with MCC?.

What implementation challenges order kamagra are clinicians and systems likely to face?. • What are suggested strategies for effective implementation of person-centered care planning at multiple levels ( e.g., policy, system, practice, clinical team, people with MCC)?. What kinds of information, tools, resources, or support are most needed to address barriers and challenges to implementation?.

Which order kamagra payment models might enable and sustain person-centered care planning?. • What quality of care measurements ( e.g., metrics, indicators) exist or are emerging for assessing process, implementation, and outcomes associated with person-centered care planning?. • Which personnel or roles within systems or practice settings would know most about person-centered care planning efforts, challenges, and successes ( e.g., IT directors, c-suite, care coordinators, etc.)?.

Within systems/practice settings, who takes the lead, or would be expected order kamagra to take the lead, in coordinating efforts to implement person-centered care planning?. What credentials and/or training of the team members, including paraprofessionals such as community health workers and/or persons with lived experience such as peer recovery specialists are necessary?. Are there or should there be competency requirements for people engaged in facilitating person-centered planning processes, and what should those entail?.

What are suggested order kamagra methods for recruiting and retaining the workforce to staff such programs?. What are the impacts of different models of person-centered care planning on the experience of clinicians and other healthcare personnel, and are increased demands posed by some models precipitating practitioner burnout?. How have shared electronic care plans (e-care plans) been developed, implemented, and shared with the care team?.

What are best practices for sharing e-care plans across sites order kamagra and settings of care?. What existing and emerging data standards are effectively supporting the interoperability of e-care plans?. What key standards gaps around e-care plans should be prioritized by industry and other stakeholders?.

What policy levers should HHS use to order kamagra further advance the adoption of standards-based e-care plans?. • How can technical approaches using Fast Healthcare Interoperability Resources (FHIR) standards better support sharing of e-care plans across care teams?. What are major barriers to advancing these approaches?.

Start Printed Page 56953 What are best practices for using e-care plans to facilitate communication among people at risk for or living with order kamagra MCC, their caregivers, clinicians, and health care teams, and provide a shared resource for documenting goals, treatments and supports, education and self-management, along with other patient-generated health data?. What are promising approaches for systematically identifying and addressing social determinants of health?. Are there any programmatic adaptations that would address the cultural and linguistic considerations when working with minority populations?.

How can equity be ensured in person-centered order kamagra care planning?. What are active areas of research and gaps in knowledge?. AHRQ is interested in all of the questions listed above, but respondents are welcome to address as many or as few as they choose and to address additional areas of interest regarding comprehensive longitudinal person-centered care planning not listed.

It is helpful to identify the question to which a order kamagra particular answer corresponds. This RFI is for planning purposes only and should not be construed as a policy, solicitation for applications, or as an obligation on the part of the Government to provide support for any ideas in response to it. AHRQ will use the information submitted in response to this RFI at its discretion and will not provide comments to any respondent's submission.

However, responses order kamagra to this RFI may be reflected in future solicitation(s) or policies. The information provided will be analyzed and may appear in reports. Respondents will not be identified in any published reports.

Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect order kamagra to any information submitted. No proprietary, classified, confidential or sensitive information should be included in your response. The contents of all submissions will be made available to the public upon request.

Submitted materials must be publicly available or able to be made public. Start Signature Dated. September 12, 2022.