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In response to the faster-than-expected rate of vaccination, the NSW Government will further ease rules for those who flagyl price cvs are fully vaccinated by bringing forward many of the roadmap changes scheduled for 1 December to Monday, 8 November. From 8 November there will be no limit on visitors to a home, no rules for outdoor gatherings with fewer than 1,000 people, and indoor swimming pools will re-open for all purposes. Businesses will be able to flagyl price cvs welcome in more fully vaccinated customers with all premises to move to 1 person per 2 sqm rule, and nightclubs will be able to re-open dancefloors. Caps will be removed for settings other than gym and dance classes (where the 20 person cap for classes will remain) and replaced by density limits or 100 per cent fixed seated capacity for major recreation outdoor facilities (including stadiums, racecourses, theme parks and zoos) and entertainment facilities (including cinemas and theatres).

These freedoms will only be available for people who are fully vaccinated, including those who have medical exemptions and children under the age of 16. buy antibiotics Safe check-ins and proof of vaccination will still be flagyl price cvs required. Those who are not fully vaccinated must still abide by pre-roadmap restrictions until the State reaches the 95 per cent double vaccination target, or 15 December, whichever happens first. The current settings for masks, which apply to everyone, will remain in place until the State reaches the 95 per cent double vaccination target, or 15 December, flagyl price cvs whichever happens first.

To maintain high levels of immunity across the community, NSW Health has commenced rolling out a booster vaccination program at its clinics to individuals aged 18 and older who received their second dose of a buy antibiotics treatment 6 months or more ago. Pfizer will be used for boosters regardless of the buy antibiotics treatment received for the first or second dose. Premier Dominic Perrottet said bringing forward the easing of restrictions was only possible because of the State’s high vaccinations rates and the roll out of flagyl price cvs booster shots. €œEverybody has done an incredible job to ensure NSW can ease restrictions in a safe and considered way earlier than we planned,” Mr Perrottet said.

€œWe are on track to reach 90 per cent double vaccination weeks ahead of schedule and this is a testament to everybody across NSW and especially our health workers flagyl price cvs. €œThere is still a long way to go but the NSW Government is standing with the community and continuing to do everything that we can, including booster shots, to keep people safe as we open up.” Deputy Premier Paul Toole said regional NSW had rolled up their sleeves for vaccinations and we’re now ready to welcome back visitors. €œRegions across NSW answered the call when we asked them to come forward and get vaccinated. Thanks to the community for coming out and getting the jab,” Mr Toole said flagyl price cvs.

€œThe time is right now for regional businesses to welcome back visitors safely in every town across the state and get tills turning over.” Minister for Jobs, Investment, Tourism and Western Sydney Stuart Ayres said reaching the 90 per cent target will be a significant milestone in the state’s recovery. €œWe are inching closer and closer to returning flagyl price cvs to many of our pre-flagyl activities, and this latest easing of restrictions will be welcome news for hundreds of businesses ready to re-open, expand their operations, and welcome back more customers,” Mr Ayres said. Health Minister Brad Hazzard said NSW has amongst the most vaccinated populations in the world and rolling out booster shots would continue to maintain that advantage. €œWe are amongst the best in the world when it comes to vaccinations but we cannot forget that buy antibiotics will continue to circulate in the community and we must remain vigilant,” Mr Hazzard said.

€œBoosters are a key priority moving forward and we continue to work flagyl price cvs closely with the Commonwealth on the buy antibiotics vaccination roll out. I want to encourage anyone who is yet to be vaccinated to make a booking as soon as possible.” More information about the 90 per cent easing of restrictions at nsw.gov.au. You can book your buy antibiotics treatment or your booster shot, via NSW Government - Where and how to get your buy antibiotics vaccination..

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Countries must set ambitious national climate commitments if they are to sustain a healthy and green recovery from the buy antibiotics flagyl.The WHO COP26 Special Report on Climate Change and Health, launched today, in the lead-up to the United Nations Climate Change how can i buy flagyl Conference (COP26) in Glasgow, Scotland, spells out the global health community’s prescription for climate action based on a growing body of research that establishes the many and inseparable links between climate and health.“The buy antibiotics flagyl has shone a light on the intimate and delicate http://kerrtile.com/pricing/ links between humans, animals and our environment,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. €œThe same how can i buy flagyl unsustainable choices that are killing our planet are killing people. WHO calls on all countries to commit to decisive action at COP26 to limit global warming to 1.5°C – not just because it’s the right thing to do, but because it’s in our own interests. WHO’s new report highlights 10 priorities for safeguarding the health of people and the planet that sustains us.”The WHO report is launched at the same time as an open letter, signed by over two thirds of the global health workforce - 300 organizations representing at least 45 million doctors and health professionals worldwide, calling for national leaders and COP26 country delegations to step up climate action.“Wherever we deliver care, in our hospitals, clinics and communities around the world, we are already responding to the health harms caused how can i buy flagyl by climate change,” the letter from health professionals reads. €œWe call on the leaders of every how can i buy flagyl country and their representatives at COP26 to avert the impending health catastrophe by limiting global warming to 1.5°C, and to make human health and equity central to all climate change mitigation and adaptation actions.”The report and open letter come as unprecedented extreme weather events and other climate impacts are taking a rising toll on people’s lives and health.

Increasingly frequent extreme weather events, such as heatwaves, storms and floods, kill thousands and disrupt millions of lives, while threatening healthcare systems and facilities when they are needed most. Changes in weather and climate are threatening food security and driving up food-, water- and vector-borne diseases, such as malaria, how can i buy flagyl while climate impacts are also negatively affecting mental health. The WHO report how can i buy flagyl states. €œThe burning of fossil fuels is killing us. Climate change is the single biggest health how can i buy flagyl threat facing humanity.

While no one is safe from the health impacts of climate change, they are disproportionately felt by the most vulnerable and disadvantaged.”Meanwhile, air pollution, primarily the result of burning fossil fuels, which also drives climate change, causes 13 deaths per minute worldwide.The report concludes that protecting people’s health requires transformational action in every sector, including on energy, transport, nature, food systems and finance. And it states clearly that the public health benefits from implementing ambitious how can i buy flagyl climate actions far outweigh the costs.“It has never been clearer that the climate crisis is one of the most urgent health emergencies we all face,” said Dr Maria Neira, WHO Director of Environment, Climate Change and Health. €œBringing down air pollution to WHO guideline levels, for example, would reduce the total number of global deaths from air pollution by 80% while dramatically reducing the greenhouse gas emissions that fuel climate how can i buy flagyl change. A shift to more nutritious, plant-based diets in line with WHO recommendations, as another example, could reduce global emissions significantly, ensure more resilient food systems, and avoid up to 5.1 million diet-related deaths a year by 2050.”Achieving the goals of the Paris Agreement would save millions of lives every year due to improvements in air quality, diet, and physical activity, among other benefits. However, most climate decision-making processes currently do not account for these health co-benefits and their economic valuation how can i buy flagyl.

Notes to editors:WHO’s COP26 Special Report on Climate Change and Health, The Health Argument for Climate Action, provides 10 recommendations for governments how can i buy flagyl on how to maximize the health benefits of tackling climate change in a variety of sectors, and avoid the worst health impacts of the climate crisis.The recommendations are the result of extensive consultations with health professionals, organizations and stakeholders worldwide, and represent a broad consensus statement from the global health community on the priority actions governments need to take to tackle the climate crisis, restore biodiversity, and protect health.Climate and Health RecommendationsThe COP26 report includes ten recommendations that highlight the urgent need and numerous opportunities for governments to prioritize health and equity in the international climate regime and sustainable development agenda.Commit to a healthy recovery. Commit to a healthy, green and just recovery from buy antibiotics.Our health is not negotiable. Place health and social justice at the heart how can i buy flagyl of the UN climate talks.Harness the health benefits of climate action. Prioritize those climate interventions with the largest health-, social- and economic gains.Build health resilience to climate how can i buy flagyl risks. Build climate resilient and environmentally sustainable health systems and facilities, and support health adaptation and resilience across sectors.Create energy systems that protect and improve climate and health.

Guide a just and inclusive transition to renewable energy how can i buy flagyl to save lives from air pollution, particularly from coal combustion. End energy poverty in households and health care facilities.Reimagine urban environments, transport and mobility. Promote sustainable, how to get flagyl in the us healthy urban how can i buy flagyl design and transport systems, with improved land-use, access to green and blue public space, and priority for walking, cycling and public transport.Protect and restore nature as the foundation of our health. Protect and restore natural systems, how can i buy flagyl the foundations for healthy lives, sustainable food systems and livelihoods.Promote healthy, sustainable and resilient food systems. Promote sustainable and resilient food production and more affordable, nutritious diets that deliver on both climate and health outcomes.Finance a healthier, fairer and greener future to save lives.

Transition towards a wellbeing economy.Listen to the health community and prescribe how can i buy flagyl urgent climate action. Mobilize and support the health community on climate action.Open Letter – Healthy Climate PrescriptionThe health community around the world (300 organizations representing at least 45 million doctors and health professionals) signed an open letter to national leaders and COP26 country delegations, calling for real action to address the climate crisis.The letter states the following demands:“We call on all nations to update their national climate commitments under the Paris Agreement to commit to their fair share of limiting warming to 1.5°C how can i buy flagyl. And we call on them to build health into those plans;We call on all nations to deliver a rapid and just transition away from fossil fuels, starting with immediately cutting all related permits, subsidies and financing for fossil fuels, and to completely shift current financing into development of clean energy;We call on high income countries to make larger cuts to greenhouse gas emissions, in line with a 1.5°C temperature goal;We call on high income countries to also provide the promised transfer of funds to low-income countries to help achieve the necessary mitigation and adaptation measures;We call on governments to build climate resilient, low-carbon, sustainable health systems. AndWe call on governments to also ensure that flagyl recovery investments support climate action and reduce social and health inequities.”The World Health Organization’s new Mental Health Atlas paints a how can i buy flagyl disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the buy antibiotics flagyl is highlighting a growing need for mental health support.The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that is aligned with needs. Issued every three years, the Atlas is a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and how can i buy flagyl data collection systems.

It is also the mechanism for monitoring progress towards meeting the targets in WHO’s Comprehensive Mental Health Action Plan.“It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the buy antibiotics flagyl, good intentions are not being met with investment,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. €œWe must heed how can i buy flagyl and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because there is no health without mental health.”Lack of progress in leadership, governance and financingNone of the targets for effective leadership and governance for mental health, provision of mental health services in community-based settings, mental health promotion and prevention, and strengthening of information systems, were close to being achieved.In 2020, just 51% of WHO’s 194 Member States reported that their mental health policy or plan was in line with international and regional human rights instruments, way short of the 80% target. And only 52% of countries met the target relating to mental health promotion and prevention programmes, also well below the 80% target. The only 2020 target met was a reduction in the rate of how can i buy flagyl suicide by 10%, but even then, only 35 countries said they had a stand-alone prevention strategy, policy or plan.Steady progress was evident, however, in the adoption of mental health policies, plans and laws, as well as in improvements in capacity to report on a set of core mental health indicators. However, the percentage of government health budgets spent on mental health has scarcely changed during the last years, how can i buy flagyl still hovering around 2%.

Moreover, even when policies and plans included estimates of required human and financial resources, just 39% of responding countries indicated that the necessary human resources had been allocated and 34% that the required financial resources had been provided.Transfer of care to the community is slowWhile the systematic decentralization of mental health care to community settings has long been recommended by WHO, only 25% of responding countries met all the criteria for integration of mental health into primary care. While progress has been made in training and supervision in most countries, the supply of medicines for mental health conditions and psychosocial care in primary health-care services remains limited.This is also reflected in the way that government funds to mental health are allocated, highlighting the urgent need for deinstitutionalization how can i buy flagyl. More than 70% of total government expenditure on mental health was allocated to mental hospitals in middle-income countries, compared how can i buy flagyl with 35% in high-income countries. This indicates that centralized mental hospitals and institutional inpatient care still receive more funds than services provided in general hospitals and primary health-care centres in many countries. There was, however, an increase in the percentage of countries reporting that treatment of people with specific mental health conditions (psychosis, bipolar disorder and depression) is included in national health insurance or reimbursement schemes – from 73% in 2017 to 80% (or 55% of Member States) in 2020.Global estimates of people receiving care for specific mental health conditions (used as a proxy for mental health care as a whole) remained less than 50%, with a global median of 40% of people with depression and just 29% of people with psychosis receiving care.Increase in mental health promotion, but effectiveness questionableMore encouraging was how can i buy flagyl the increase in countries reporting mental health promotion and prevention programmes, from 41% of Member States in 2014 to 52% in 2020.

However, 31% of total reported programmes did not have dedicated human and financial resources, 27% did not have a defined how can i buy flagyl plan, and 39% had no documented evidence of progress and/or impact.Slight increase in the mental health workforceThe global median number of mental health workers per 100 000 population has increased slightly from nine workers in 2014 to 13 workers per 100 000 population in 2020. However, there was a very high variation between countries of different income levels, with the number of mental health workers in high-income countries more than 40 times higher than in low-income countries.New targets for 2030The global targets reported on in the Mental Health Atlas are from WHO’s Comprehensive Mental Health Action Plan, which contained targets for 2020 endorsed by the World Health Assembly in 2013. This Plan has now been extended to 2030 and includes new targets for the inclusion how can i buy flagyl of mental health and psychosocial support in emergency preparedness plans, the integration of mental health into primary health care, and research on mental health.“The new data from the Mental Health Atlas shows us that we still have a very long way to go in making sure that everyone, everywhere, has access to quality mental health care,” said Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO. €œBut I am encouraged by the renewed vigour that we saw from governments as the new targets for 2030 were discussed and agreed and am confident that together we can do what is necessary to move from baby steps to giant leaps forward in the next 10 years.”Note for editors:The Atlas is being released in the lead-up to World Mental Health Day on 10 October, for which the focus this year is scaling up access to quality mental health care..

Countries must set ambitious national climate commitments if they are to sustain a healthy and flagyl price cvs green recovery from the buy antibiotics flagyl.The WHO COP26 Special Report on Climate Change and Health, look at here launched today, in the lead-up to the United Nations Climate Change Conference (COP26) in Glasgow, Scotland, spells out the global health community’s prescription for climate action based on a growing body of research that establishes the many and inseparable links between climate and health.“The buy antibiotics flagyl has shone a light on the intimate and delicate links between humans, animals and our environment,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. €œThe same unsustainable choices flagyl price cvs that are killing our planet are killing people. WHO calls on all countries to commit to decisive action at COP26 to limit global warming to 1.5°C – not just because it’s the right thing to do, but because it’s in our own interests. WHO’s new report highlights 10 priorities for safeguarding the health of people and the planet that sustains us.”The WHO report is launched at the same time as an open letter, signed by over two thirds of the global health workforce - 300 organizations representing at least 45 million doctors and flagyl price cvs health professionals worldwide, calling for national leaders and COP26 country delegations to step up climate action.“Wherever we deliver care, in our hospitals, clinics and communities around the world, we are already responding to the health harms caused by climate change,” the letter from health professionals reads. €œWe call on the leaders of every flagyl price cvs country and their representatives at COP26 to avert the impending health catastrophe by limiting global warming to 1.5°C, and to make human health and equity central to all climate change mitigation and adaptation actions.”The report and open letter come as unprecedented extreme weather events and other climate impacts are taking a rising toll on people’s lives and health.

Increasingly frequent extreme weather events, such as heatwaves, storms and floods, kill thousands and disrupt millions of lives, while threatening healthcare systems and facilities when they are needed most. Changes in weather and climate are threatening food security and driving up food-, water- and vector-borne flagyl price cvs diseases, such as malaria, while climate impacts are also negatively affecting mental health. The WHO report flagyl price cvs states. €œThe burning of fossil fuels is killing us. Climate change is the single biggest health threat facing flagyl price cvs humanity.

While no one is safe from the health impacts of climate change, they are disproportionately felt by the most vulnerable and disadvantaged.”Meanwhile, air pollution, primarily the result of burning fossil fuels, which also drives climate change, causes 13 deaths per minute worldwide.The report concludes that protecting people’s health requires transformational action in every sector, including on energy, transport, nature, food systems and finance. And it states clearly that the public health benefits from implementing ambitious climate actions far outweigh the costs.“It has never been clearer that the climate crisis is one of the most urgent health emergencies we all face,” said Dr Maria Neira, WHO Director of Environment, Climate Change and flagyl price cvs Health. €œBringing down air pollution to WHO guideline levels, for example, would reduce flagyl price cvs the total number of global deaths from air pollution by 80% while dramatically reducing the greenhouse gas emissions that fuel climate change. A shift to more nutritious, plant-based diets in line with WHO recommendations, as another example, could reduce global emissions significantly, ensure more resilient food systems, and avoid up to 5.1 million diet-related deaths a year by 2050.”Achieving the goals of the Paris Agreement would save millions of lives every year due to improvements in air quality, diet, and physical activity, among other benefits. However, most climate decision-making processes currently do not account for these health co-benefits flagyl price cvs and their economic valuation.

Notes to editors:WHO’s COP26 Special Report on Climate Change and Health, The Health Argument for Climate Action, provides 10 recommendations for governments on how to maximize the health benefits of tackling climate change in a variety of sectors, and avoid the worst health impacts of the climate crisis.The recommendations are the result of extensive consultations with health professionals, organizations and stakeholders worldwide, and represent a flagyl price cvs broad consensus statement from the global health community on the priority actions governments need to take to tackle the climate crisis, restore biodiversity, and protect health.Climate and Health RecommendationsThe COP26 report includes ten recommendations that highlight the urgent need and numerous opportunities for governments to prioritize health and equity in the international climate regime and sustainable development agenda.Commit to a healthy recovery. Commit to a healthy, green and just recovery from buy antibiotics.Our health is not negotiable. Place health and social justice at the heart of the UN climate talks.Harness the health flagyl price cvs benefits of climate action. Prioritize those climate interventions with the largest flagyl price cvs health-, social- and economic gains.Build health resilience to climate risks. Build climate resilient and environmentally sustainable health systems and facilities, and support health adaptation and resilience across sectors.Create energy systems that protect and improve climate and health.

Guide a flagyl price cvs just and inclusive transition to renewable energy to save lives from air pollution, particularly from coal combustion. End energy poverty in households and health care facilities.Reimagine urban environments, transport and mobility. Promote sustainable, healthy urban design and transport systems, with improved land-use, access to flagyl price cvs green and blue public space, and priority for walking, cycling http://www.ec-centre-lingolsheim.ac-strasbourg.fr/lecole/conseil-decole/ and public transport.Protect and restore nature as the foundation of our health. Protect and restore natural systems, the foundations for healthy lives, sustainable food systems flagyl price cvs and livelihoods.Promote healthy, sustainable and resilient food systems. Promote sustainable and resilient food production and more affordable, nutritious diets that deliver on both climate and health outcomes.Finance a healthier, fairer and greener future to save lives.

Transition towards flagyl price cvs a wellbeing economy.Listen to the health community and prescribe urgent climate action. Mobilize and support the health community on climate action.Open Letter – Healthy Climate PrescriptionThe health community around the world (300 organizations representing at least 45 million doctors and health professionals) signed an open letter to national leaders and COP26 country delegations, calling for real action to address the climate crisis.The letter states the following demands:“We call flagyl price cvs on all nations to update their national climate commitments under the Paris Agreement to commit to their fair share of limiting warming to 1.5°C. And we call on them to build health into those plans;We call on all nations to deliver a rapid and just transition away from fossil fuels, starting with immediately cutting all related permits, subsidies and financing for fossil fuels, and to completely shift current financing into development of clean energy;We call on high income countries to make larger cuts to greenhouse gas emissions, in line with a 1.5°C temperature goal;We call on high income countries to also provide the promised transfer of funds to low-income countries to help achieve the necessary mitigation and adaptation measures;We call on governments to build climate resilient, low-carbon, sustainable health systems. AndWe call on governments to also ensure that flagyl recovery investments support climate action and reduce social and health inequities.”The World Health Organization’s new Mental Health Atlas paints a disappointing picture of a worldwide failure to provide people with the mental health services they need, at a time when the buy antibiotics flagyl is highlighting a growing need for mental health support.The latest edition of the Atlas, which includes data from 171 countries, provides a clear indication that the increased attention given to mental health in recent years has yet to result in a scale-up of quality mental services that is aligned with flagyl price cvs needs. Issued every three years, the Atlas is flagyl price cvs a compilation of data provided by countries around the world on mental health policies, legislation, financing, human resources, availability and utilization of services and data collection systems.

It is also the mechanism for monitoring progress towards meeting the targets in WHO’s Comprehensive Mental Health Action Plan.“It is extremely concerning that, despite the evident and increasing need for mental health services, which has become even more acute during the buy antibiotics flagyl, good intentions are not being met with investment,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. €œWe must heed and act on this wake-up call and dramatically accelerate the scale-up of investment in mental health, because flagyl price cvs there is no health without mental health.”Lack of progress in leadership, governance and financingNone of the targets for effective leadership and governance for mental health, provision of mental health services in community-based settings, mental health promotion and prevention, and strengthening of information systems, were close to being achieved.In 2020, just 51% of WHO’s 194 Member States reported that their mental health policy or plan was in line with international and regional human rights instruments, way short of the 80% target. And only 52% of countries met the target relating to mental health promotion and prevention programmes, also well below the 80% target. The only 2020 target met was a reduction in the rate of suicide by 10%, but even then, only 35 countries said they had a stand-alone prevention strategy, policy or plan.Steady progress was evident, however, flagyl price cvs in the adoption of mental health policies, plans and laws, as well as in improvements in capacity to report on a set of core mental health indicators. However, the percentage of government health budgets spent on mental health has flagyl price cvs scarcely changed during the last years, still hovering around 2%.

Moreover, even when policies and plans included estimates of required human and financial resources, just 39% of responding countries indicated that the necessary human resources had been allocated and 34% that the required financial resources had been provided.Transfer of care to the community is slowWhile the systematic decentralization of mental health care to community settings has long been recommended by WHO, only 25% of responding countries met all the criteria for integration of mental health into primary care. While progress has been made in training and supervision in most countries, the supply of medicines for mental health conditions and psychosocial care in primary health-care services remains limited.This is also reflected in the way flagyl price cvs that government funds to mental health are allocated, highlighting the urgent need for deinstitutionalization. More than 70% of total government expenditure on mental health was allocated to mental hospitals in middle-income countries, compared with 35% flagyl price cvs in high-income countries. This indicates that centralized mental hospitals and institutional inpatient care still receive more funds than services provided in general hospitals and primary health-care centres in many countries. There was, however, an increase in the percentage of countries reporting that treatment of people with specific mental health conditions (psychosis, bipolar flagyl price cvs disorder and depression) is included in national health insurance or reimbursement schemes – from 73% in 2017 to 80% (or 55% of Member States) in 2020.Global estimates of people receiving care for specific mental health conditions (used as a proxy for mental health care as a whole) remained less than 50%, with a global median of 40% of people with depression and just 29% of people with psychosis receiving care.Increase in mental health promotion, but effectiveness questionableMore encouraging was the increase in countries reporting mental health promotion and prevention programmes, from 41% of Member States in 2014 to 52% in 2020.

However, 31% of total reported programmes did not have dedicated human and financial resources, 27% did not have a defined plan, and 39% had no documented evidence of progress and/or impact.Slight increase in the mental health workforceThe global median number of mental health workers per 100 000 population has increased slightly from nine flagyl price cvs workers in 2014 to 13 workers per 100 000 population in 2020. However, there was a very high variation between countries of different income levels, with the number of mental health workers in high-income countries more than 40 times higher than in low-income countries.New targets for 2030The global targets reported on in the Mental Health Atlas are from WHO’s Comprehensive Mental Health Action Plan, which contained targets for 2020 endorsed by the World Health Assembly in 2013. This Plan has now been extended to 2030 and includes new targets for the inclusion of mental health and psychosocial support in emergency preparedness plans, the integration of mental health into primary flagyl price cvs health care, and research on mental health.“The new data from the Mental Health Atlas shows us that we still have a very long way to go in making sure that everyone, everywhere, has access to quality mental health care,” said Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO. €œBut I am encouraged by the renewed vigour that we saw from governments as the new targets for 2030 were discussed and agreed and am confident that together we can do what is necessary to move from baby steps to giant leaps forward in the next 10 years.”Note for editors:The Atlas is being released in the lead-up to World Mental Health Day on 10 October, for which the focus this year is scaling up access to quality mental health care..

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Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec.

21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma.

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

Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right when you hear it,” says Hopkins.

€œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a flagyl, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried.

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

Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit view it flagyl price cvs. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it flagyl price cvs will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors. - Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows.

The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs flagyl price cvs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that flagyl price cvs it would fight an .

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

However, exactly how big an effect the mutational burden has on outcomes to flagyl price cvs immune checkpoint inhibitors across many different cancer types was unclear. To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers flagyl price cvs found a strong correlation.

The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one flagyl price cvs with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right when you hear it,” says Hopkins.

€œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of flagyl price cvs cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a flagyl, which seems to encourage a strong immune response despite the cancer’s lower mutational burden. In contrast, the most common type of colorectal cancer flagyl price cvs has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear.

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

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

Recovering from flagyl

Respiratory viral recovering from flagyl s present a major threat to global health and prosperity. Over the past century, several have developed into crippling flagyls, including the antibiotics flagyl. Although the generation of neutralizing serum antibodies in response to natural immunity and vaccination are considered to be hallmarks of viral immune protection, antibodies from long-lived plasma cells are subject to immune escape from heterologous clades of zoonotic, recombined, or mutated flagyles.

Local immunity in the lung can be recovering from flagyl generated through resident memory immune subsets that rapidly respond to secondary and protect from heterologous . Although many immune cells are required to achieve the phenomenon of resident memory, herein we highlight the pleiotropic functions of CD4 tissue resident memory T cells in the lung and discuss the implications of resident memory for treatment design.Jean-Laurent Casanova Conceptualization, Funding acquisition, Project administration, Resources, Supervision, Visualization, Writing - original draft, Writing - review &. Editing 1St.

Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY10Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut national de la santé et de la recherche médicale Unité Mixte de Recherches 1163, Necker Hospital for Sick Children, Paris, France11University of Paris, Imagine Institute, Paris, France19Howard Hughes Medical Institute, New York, NY Search for other works by this author on:.

Respiratory viral flagyl price cvs s present visit our website a major threat to global health and prosperity. Over the past century, several have developed into crippling flagyls, including the antibiotics flagyl. Although the generation of neutralizing serum antibodies in response to natural immunity and vaccination are considered to be hallmarks of viral immune protection, antibodies from long-lived plasma cells are subject to immune escape from heterologous clades of zoonotic, recombined, or mutated flagyles. Local immunity can i buy flagyl online in the lung can be generated through resident memory immune subsets that rapidly respond to secondary and protect from heterologous flagyl price cvs .

Although many immune cells are required to achieve the phenomenon of resident memory, herein we highlight the pleiotropic functions of CD4 tissue resident memory T cells in the lung and discuss the implications of resident memory for treatment design.Jean-Laurent Casanova Conceptualization, Funding acquisition, Project administration, Resources, Supervision, Visualization, Writing - original draft, Writing - review &. Editing 1St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY10Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut national de la santé et de la recherche médicale Unité Mixte de Recherches 1163, Necker Hospital for Sick Children, Paris, France11University of Paris, Imagine Institute, Paris, France19Howard Hughes Medical Institute, New York, NY Search for other works by this author on:.

Flagyl 2gm dose for bv

A new analysis of health insurers’ flagyl 2gm dose for bv financial data suggests that they remained profitable across markets in 2020 due in part to an unprecedented decrease in health spending and utilization in the spring as the buy antibiotics flagyl led to massive shutdowns.The analysis examines insurers’ 2020 data for four distinct markets. Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer). Across the four markets, insurers showed higher gross margins per flagyl 2gm dose for bv enrollee per month in 2020 than the previous year, ranging from an average of $188 for Medicare Advantage plans to an average $71 for Medicaid managed care. Similarly, insurers across the board reported paying out a smaller percentage of the premiums they collected as claims in 2020 than they did in 2019. Generally, lower medical loss ratios mean that insurers have more income remaining after paying medical costs to use for administrative costs or keep as profits.The flagyl’s effect on health spending and insurer financial performance in flagyl 2gm dose for bv 2021 remains uncertain.

By the end of the 2020, health care utilization has largely returned to pre-flagyl levels, and there could be additional pent-up demand for care that had been missed or delayed last year.As the antibiotics flagyl took shape in the U.S. In the early months of 2020, there was some uncertainty about how it would impact the financial performance of health insurers. Hospitals, physicians, and other health care providers cancelled elective procedures to free up beds, staff and supplies early in the flagyl flagyl 2gm dose for bv and to limit unnecessary exposure and risk of . Patients also opted to forgo non-urgent care to limit risks and exposure to the flagyl. These dynamics led to an unprecedented flagyl 2gm dose for bv decrease in health care spending and utilization during the Spring of 2020.

Though spending rebounded through the second half of the year, health spending was somewhat lower in 2020 than it had been in 2019, making last year the first time in recorded history that health spending has dropped in the U.S. Simultaneously, the economic crisis and resulting job losses drove shifts in health coverage across multiple markets, including seemingly modest decreases in employer-based coverage through September but substantial enrollment increases in Medicaid managed care and Medicaid broadly. During this period, enrollment in Medicare Advantage plans offered by private insurers flagyl 2gm dose for bv continued to tick upward.In this brief, we analyze recent financial data to examine how insurance markets performed in 2020 as the flagyl emerged and progressed over the course of the year. We use financial data reported by insurance companies to the National Association of Insurance Commissioners (NAIC) and compiled by Mark Farrah Associates to look at medical loss ratios and gross margins in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully-insured group (employer) health insurance markets through the end of each year. A more detailed description of each market is included in the Appendix.We find that, by the end of 2020, gross margins per member per month across these flagyl 2gm dose for bv four markets remained relatively high and medical loss ratios were relatively low or flat compared to recent years.

These findings suggest that many insurers remained profitable through 2020. According to a flagyl 2gm dose for bv recent KFF analysis, commercial insurers are going to owe substantial rebates to consumers this year under the Affordable Care Act’s (ACA) Medical Loss Ratio provision. For Medicaid, application of risk sharing arrangements that many states have in place may ultimately reduce overall margins calculated using the annual NAIC data.Gross MarginsOne way to assess insurer financial performance is to examine gross margins per member per month, or the amount by which premium income exceeds claims costs per enrollee per month. Gross margins are an indicator of financial performance, but positive margins do not necessarily translate into profitability since they do not account for administrative expenses or tax liabilities. However, a flagyl 2gm dose for bv sharp increase in margins from one year to the next, without a commensurate increase in administrative costs, could indicate that these health insurance markets have become more profitable during the flagyl.Insurers were required to cover the full cost of antibiotics testing for enrollees in 2020.

(The Biden Administration has issued guidance that insurers must continue to cover buy antibiotics testing at no cost to enrollees). Further, many insurers voluntarily waived out-of-pocket costs for antibiotics treatment and certain telehealth services through the flagyl 2gm dose for bv end of 2020. Additionally, Medicare Advantage plans may have increased payments for buy antibiotics-related hospitalizations by 20% following the increase implemented by traditional Medicare, although these additional costs were offset by a temporary waiver during the public health emergency of the 2% sequestration, which would have otherwise reduced Medicare payments to Medicare Advantage plans. Taken together, insurers have seen their flagyl 2gm dose for bv claims costs fall and margins increase relative to 2019 (Figure 1). Through the end of 2020, gross margins among individual market and fully-insured group market plans were 4% and 16% higher, respectively, than they were in 2019.

However, gross margins among fully-insured group market plans remained relatively flat in 2020 when compared to 2018, and gross margins among individual market plans decreased by 14% in 2020 when compared to 2018, a year in which individual market insurers over-corrected when setting premiums following the loss of cost-sharing subsidy payments. Annual gross margins among Medicare Advantage plans were 24% higher in 2020 compared to 2019 and 31% higher when compared flagyl 2gm dose for bv to 2018. (Gross margins per member per month for Medicare Advantage plans tend to be higher than for other health insurance markets mainly because Medicare covers an older, sicker population with higher average costs).Annual gross margins per member per month for managed care organizations (MCOs) in the Medicaid market were 45% higher in 2020 than they were in 2019 and 34% higher than they were in 2018. However, compared to the other markets, margins in the Medicaid MCO market are lower because while rates must be actuarially sound, payment rates in Medicaid tend flagyl 2gm dose for bv to be lower than other markets. States also may use a variety of mechanisms to adjust plan risk, incentivize performance and ensure payments are not too high or too low, including various options to modify their capitation rates or use risk sharing mechanisms.

CMS has provided guidance about options to adjust payments for MCOs during the flagyl, since states and plans could not have reasonably predicted the changes in utilization and spending that have occurred. Many of the adjustments states can make may occur retrospectively and may not be reflected in the annual data.Medical Loss RatiosAnother way to assess insurer financial performance is to look at medical loss ratios, or the percent of premium income that insurers pay out in the form of flagyl 2gm dose for bv medical claims. Generally, lower medical loss ratios mean that insurers have more income remaining after paying medical costs to use for administrative costs or keep as profits. Each health insurance market has different administrative needs and costs, so flagyl 2gm dose for bv lower medical loss ratios in one market do not necessarily mean that market is more profitable than another market. However, in a given market, if administrative costs hold mostly constant from one year to the next, a drop in medical loss ratios would imply that plans are becoming more profitable.Medical loss ratios are used in state and federal insurance regulation in a variety of ways.

In the commercial insurance flagyl 2gm dose for bv (individual and group) markets, insurers must issue rebates to individuals and businesses if their loss ratios fail to reach minimum standards set by the ACA. Medicare Advantage insurers are required to report loss ratios at the contract level. They are also required to issue rebates to the federal government if their MLRs fall short of required levels and are subject to additional penalties if they fail to meet loss ratio requirements for multiple consecutive years. For Medicaid MCOs, CMS requires states to develop capitation rates for Medicaid to achieve an flagyl 2gm dose for bv MLR of at least 85%. There is no federal requirement for Medicaid plans to pay remittances if they fail to meet their MLR threshold, but a majority of states that contract with MCOs do require remittances in at least some cases.The medical loss ratios shown in this issue brief differ from the definition of MLR in the ACA and CMS Medicaid managed care final rule, which makes some adjustments for quality improvement and taxes, and do not account for reinsurance, risk corridors, or risk adjustment payments.

Notably, the health insurer flagyl 2gm dose for bv tax, which has been permanently repealed starting in 2021, was in effect in 2018 and 2020, but not 2019. The chart below shows simple medical loss ratios, or the share of premium income that insurers pay out in claims, without any modifications (Figure 2). Annual loss ratios in the Medicare Advantage market decreased two percentage points in 2020 compared to 2019 and 2018, and are now below the 85% minimum required under law, though once deductions from total revenue are factored in they may be above the required level. Annual loss ratios in the Medicaid managed care market in 2020 decreased by four percentage points flagyl 2gm dose for bv from 2019 (and three percentage points from 2018), but still met the 85% minimum even without accounting for potential adjustments. Fully-insured group market loss ratios decreased by two percentage points from 2019 to 2020 and are comparable to 2018 values.

Individual market loss ratios also decreased two percentage points in 2020 flagyl 2gm dose for bv compared to the previous year, but increased by four percentage points compared to 2018. Loss ratios in the individual market were already quite low before the flagyl and insurers in the market are expecting to issue more than $2 billion in rebates to consumers this fall based on their experience in 2018, 2019, and 2020. Insurers in the individual market have been profitable for several consecutive years as the market has flagyl 2gm dose for bv stabilized. Average premiums have decreased for three years in a row while insurer participation on the ACA exchanges has increased in many areas of the country.DiscussionUsing annual financial data reported by insurance companies to the NAIC, it appears that health insurers in most markets became more profitable during the flagyl, though we can’t measure profits directly without administrative cost data. Across the markets we examined, gross margins were higher and medical loss ratios were lower in 2020 than in 2019.

Loss ratios in the Medicaid flagyl 2gm dose for bv MCO market were lower in 2020 than 2019 and 2018. However, gross margins in the Medicaid MCO market are low relative to the other markets, and data do not reflect implementation of existing or newly imposed risk sharing mechanisms.Medicare Advantage insurers that fall short of required loss ratio requirements for multiple years face additional penalties, including the possibility of being terminated. To avoid flagyl 2gm dose for bv such a risk, some Medicare Advantage insurers with loss ratios below 85% may take this opportunity to offer new or more generous extra benefits, such as gym memberships and dental or vision benefits that are popular and help to attract new enrollees. For Medicaid MCOs, given the options that states have to modify payments and risk sharing agreements during the flagyl, plans may not be left with unexpected surpluses or fail to reach their state’s MLR threshold this year.A number of commercial insurers waived certain out-of-pocket costs for telehealth visits and buy antibiotics-related services or even offered premium holidays at some point in 2020, which had the effect of increasing their medical loss ratios and lowering margins. Earlier analysis published on the Peterson-Kaiser Health System Tracker found that nearly 90% of enrollees in the individual and fully-insured group markets were in a plan that waived cost-sharing for buy antibiotics treatment at some point during the flagyl, and about 40% of enrollees in these markets were in plans that offered some form of premium credit or reduction in 2020.

ACA medical loss ratio rebates in 2021 are expected to total in the billions of dollars for a third flagyl 2gm dose for bv consecutive year. Individual and group market insurers expect to pay out $2.1 billion in rebates to consumers this fall based on their financial performance in 2020, 2019, and 2018. Most of these rebates (an estimated flagyl 2gm dose for bv $1.5 billion) are accounted for by individual market insurers.The flagyl’s effect on health spending and insurer financial performance in 2021 remains uncertain. Health care utilization has mostly rebounded to pre-flagyl levels and there could be additional pent-up demand for care that had been missed or delayed last year. Additionally, while the cost of treatment doses has largely been borne by the federal government, the cost of administering shots will often be covered by private insurers..

A new analysis of http://jamessmithc21.com/ health insurers’ financial data suggests that they remained profitable across markets in 2020 due in part to an unprecedented decrease flagyl price cvs in health spending and utilization in the spring as the buy antibiotics flagyl led to massive shutdowns.The analysis examines insurers’ 2020 data for four distinct markets. Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured group (employer). Across the four markets, insurers showed higher gross margins per enrollee per month in 2020 than the previous year, ranging from an average of $188 flagyl price cvs for Medicare Advantage plans to an average $71 for Medicaid managed care.

Similarly, insurers across the board reported paying out a smaller percentage of the premiums they collected as claims in 2020 than they did in 2019. Generally, lower medical loss ratios mean that insurers have more income remaining after paying medical costs to use for administrative costs or keep as profits.The flagyl’s effect on health flagyl price cvs spending and insurer financial performance in 2021 remains uncertain. By the end of the 2020, health care utilization has largely returned to pre-flagyl levels, and there could be additional pent-up demand for care that had been missed or delayed last year.As the antibiotics flagyl took shape in the U.S.

In the early months of 2020, there was some uncertainty about how it would impact the financial performance of health insurers. Hospitals, physicians, and other health care providers cancelled elective procedures to free up flagyl price cvs beds, staff and supplies early in the flagyl and to limit unnecessary exposure and risk of . Patients also opted to forgo non-urgent care to limit risks and exposure to the flagyl.

These dynamics led to an unprecedented decrease in health care spending and flagyl price cvs utilization during the Spring of 2020. Though spending rebounded through the second half of the year, health spending was somewhat lower in 2020 than it had been in 2019, making last year the first time in recorded history that health spending has dropped in the U.S. Simultaneously, the economic crisis and resulting job losses drove shifts in health coverage across multiple markets, including seemingly modest decreases in employer-based coverage through September but substantial enrollment increases in Medicaid managed care and Medicaid broadly.

During this period, enrollment in Medicare Advantage plans offered by private insurers continued to tick upward.In this brief, we analyze recent financial data to examine how insurance markets performed in 2020 as the flagyl emerged and flagyl price cvs progressed over the course of the year. We use financial data reported by insurance companies to the National Association of Insurance Commissioners (NAIC) and compiled by Mark Farrah Associates to look at medical loss ratios and gross margins in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully-insured group (employer) health insurance markets through the end of each year. A more detailed description of each market is included flagyl price cvs in the Appendix.We find that, by the end of 2020, gross margins per member per month across these four markets remained relatively high and medical loss ratios were relatively low or flat compared to recent years.

These findings suggest that many insurers remained profitable through 2020. According to a recent KFF analysis, commercial insurers are going to owe substantial rebates flagyl price cvs to consumers this year under the Affordable Care Act’s (ACA) Medical Loss Ratio provision. For Medicaid, application of risk sharing arrangements that many states have in place may ultimately reduce overall margins calculated using the annual NAIC data.Gross MarginsOne way to assess insurer financial performance is to examine gross margins per member per month, or the amount by which premium income exceeds claims costs per enrollee per month.

Gross margins are an indicator of financial performance, but positive margins do not necessarily translate into profitability since they do not account for administrative expenses or tax liabilities. However, a sharp increase in margins from one year to the next, without a commensurate increase in administrative costs, could indicate that these health insurance markets have become more profitable during the flagyl.Insurers were required to cover the full cost flagyl price cvs of antibiotics testing for enrollees in 2020. (The Biden Administration has issued guidance that insurers must continue to cover buy antibiotics testing at no cost to enrollees).

Further, many flagyl price cvs insurers voluntarily waived out-of-pocket costs for antibiotics treatment and certain telehealth services through the end of 2020. Additionally, Medicare Advantage plans may have increased payments for buy antibiotics-related hospitalizations by 20% following the increase implemented by traditional Medicare, although these additional costs were offset by a temporary waiver during the public health emergency of the 2% sequestration, which would have otherwise reduced Medicare payments to Medicare Advantage plans. Taken together, flagyl price cvs insurers have seen their claims costs fall and margins increase relative to 2019 (Figure 1).

Through the end of 2020, gross margins among individual market and fully-insured group market plans were 4% and 16% higher, respectively, than they were in 2019. However, gross margins among fully-insured group market plans remained relatively flat in 2020 when compared to 2018, and gross margins among individual market plans decreased by 14% in 2020 when compared to 2018, a year in which individual market insurers over-corrected when setting premiums following the loss of cost-sharing subsidy payments. Annual gross margins among Medicare Advantage plans were 24% higher in 2020 compared to 2019 and 31% higher when compared to 2018 flagyl price cvs.

(Gross margins per member per month for Medicare Advantage plans tend to be higher than for other health insurance markets mainly because Medicare covers an older, sicker population with higher average costs).Annual gross margins per member per month for managed care organizations (MCOs) in the Medicaid market were 45% higher in 2020 than they were in 2019 and 34% higher than they were in 2018. However, compared to the other markets, margins in the Medicaid MCO market are lower because while rates must be actuarially sound, payment rates flagyl price cvs in Medicaid tend to be lower than other markets. States also may use a variety of mechanisms to adjust plan risk, incentivize performance and ensure payments are not too high or too low, including various options to modify their capitation rates or use risk sharing mechanisms.

CMS has provided guidance about options to adjust payments for MCOs during the flagyl, since states and plans could not have reasonably predicted the changes in http://www.klimaschutzolympiade.at/allgemein/sieger-201516/ utilization and spending that have occurred. Many of the adjustments states can make may occur retrospectively flagyl price cvs and may not be reflected in the annual data.Medical Loss RatiosAnother way to assess insurer financial performance is to look at medical loss ratios, or the percent of premium income that insurers pay out in the form of medical claims. Generally, lower medical loss ratios mean that insurers have more income remaining after paying medical costs to use for administrative costs or keep as profits.

Each health insurance market has different administrative needs and costs, so lower medical loss ratios in one market do not necessarily mean that flagyl price cvs market is more profitable than another market. However, in a given market, if administrative costs hold mostly constant from one year to the next, a drop in medical loss ratios would imply that plans are becoming more profitable.Medical loss ratios are used in state and federal insurance regulation in a variety of ways. In the commercial insurance (individual and group) markets, insurers must flagyl price cvs issue rebates to individuals and businesses if their loss ratios fail to reach minimum standards set by the ACA.

Medicare Advantage insurers are required to report loss ratios at the contract level. They are also required to issue rebates to the federal government if their MLRs fall short of required levels and are subject to additional penalties if they fail to meet loss ratio requirements for multiple consecutive years. For Medicaid MCOs, CMS requires states to develop capitation rates for Medicaid to achieve an flagyl price cvs MLR of at least 85%.

There is no federal requirement for Medicaid plans to pay remittances if they fail to meet their MLR threshold, but a majority of states that contract with MCOs do require remittances in at least some cases.The medical loss ratios shown in this issue brief differ from the definition of MLR in the ACA and CMS Medicaid managed care final rule, which makes some adjustments for quality improvement and taxes, and do not account for reinsurance, risk corridors, or risk adjustment payments. Notably, the health insurer tax, which has been permanently repealed starting in 2021, flagyl price cvs was in effect in 2018 and 2020, but not 2019. The chart below shows simple medical loss ratios, or the share of premium income that insurers pay out in claims, without any modifications (Figure 2).

Annual loss ratios in the Medicare Advantage market decreased two percentage points in 2020 compared to 2019 and 2018, and are now below the 85% minimum required under law, though once deductions from total revenue are factored in they may be above the required level. Annual loss ratios in the Medicaid managed care market flagyl price cvs in 2020 decreased by four percentage points from 2019 (and three percentage points from 2018), but still met the 85% minimum even without accounting for potential adjustments. Fully-insured group market loss ratios decreased by two percentage points from 2019 to 2020 and are comparable to 2018 values.

Individual market loss ratios also decreased two percentage points in 2020 flagyl price cvs compared to the previous year, but increased by four percentage points compared to 2018. Loss ratios in the individual market were already quite low before the flagyl and insurers in the market are expecting to issue more than $2 billion in rebates to consumers this fall based on their experience in 2018, 2019, and 2020. Insurers in the individual market have been profitable for several consecutive years as the market has stabilized flagyl price cvs.

Average premiums have decreased for three years in a row while insurer participation on the ACA exchanges has increased in many areas of the country.DiscussionUsing annual financial data reported by insurance companies to the NAIC, it appears that health insurers in most markets became more profitable during the flagyl, though we can’t measure profits directly without administrative cost data. Across the markets we examined, gross margins were higher and medical loss ratios were lower in 2020 than in 2019. Loss ratios in the Medicaid MCO market were lower in 2020 than flagyl price cvs 2019 and 2018.

However, gross margins in the Medicaid MCO market are low relative to the other markets, and data do not reflect implementation of existing or newly imposed risk sharing mechanisms.Medicare Advantage insurers that fall short of required loss ratio requirements for multiple years face additional penalties, including the possibility of being terminated. To avoid such a risk, some Medicare Advantage insurers flagyl price cvs with loss ratios below 85% may take this opportunity to offer new or more generous extra benefits, such as gym memberships and dental or vision benefits that are popular and help to attract new enrollees. For Medicaid MCOs, given the options that states have to modify payments and risk sharing agreements during the flagyl, plans may not be left with unexpected surpluses or fail to reach their state’s MLR threshold this year.A number of commercial insurers waived certain out-of-pocket costs for telehealth visits and buy antibiotics-related services or even offered premium holidays at some point in 2020, which had the effect of increasing their medical loss ratios and lowering margins.

Earlier analysis published on the Peterson-Kaiser Health System Tracker found that nearly 90% of enrollees in the individual and fully-insured group markets were in a plan that waived cost-sharing for buy antibiotics treatment at some point during the flagyl, and about 40% of enrollees in these markets were in plans that offered some form of premium credit or reduction in 2020. ACA medical loss ratio rebates in 2021 are expected to total in the billions of dollars flagyl price cvs for a third consecutive year. Individual and group market insurers expect to pay out $2.1 billion in rebates to consumers this fall based on their financial performance in 2020, 2019, and 2018.

Most of these rebates (an estimated $1.5 billion) are accounted for by flagyl price cvs individual market insurers.The flagyl’s effect on health spending and insurer financial performance in 2021 remains uncertain. Health care utilization has mostly rebounded to pre-flagyl levels and there could be additional pent-up demand for care that had been missed or delayed last year. Additionally, while the cost of treatment doses has largely been borne by the federal government, the cost of administering shots will often be covered by private insurers..

4 flagyl pills at once

The federal 4 flagyl pills at once government needs a tailor. At least, that’s how John Balbus sees it. As the interim director of the first-ever Office of Climate Change and Health Equity at the Department of Health and Human Services, Balbus says the federal government already has many of the pieces it needs to help 4 flagyl pills at once communities become more resilient to climate change.

It also has what it needs to support communities that have been marginalized for too long and seen their health suffer as a result. He just needs to stitch them together. €œThere is no need to say, ‘OK, you are working on 4 flagyl pills at once health equity, now come in this other room and work on climate change,’” he told E&E News last week.

€œThe work is the same. It needs to be completely integrated and unified.” After a summer in which heat waves, wildfires and hurricanes have underscored just how deadly climate change can be — especially among vulnerable populations — the need for a federal office focused on climate change and equity has perhaps never been greater, officials said. €œThe West is burning, Louisiana is being 4 flagyl pills at once pummeled, in one place it’s a deluge of water and in another place there is a lack of it — clearly these extremes are hurting our health, so we have to do everything we can,” HHS Secretary Xavier Becerra said at a press conference establishing the office two weeks ago.

Indeed, just a few days after that, EPA published a peer-reviewed report detailing all the ways that climate change would disproportionately affect people of color. Among other findings, the report outlined how Black Americans are 40 percent more likely 4 flagyl pills at once to live in areas with the highest projected increases in extreme temperature-related deaths, and how Hispanics and Latinos are 43 percent more likely to live in areas with the highest projected reductions in labor hours due to extreme temperatures. The same populations living in climate-vulnerable places also are more likely to suffer from chronic health conditions that make them even more at risk when extreme weather happens.

Balbus himself is no stranger to these issues. He’s leading the office on detail from his post as a senior adviser for public health at the National Institute 4 flagyl pills at once of Environmental Health Sciences and authored the Fourth National Climate Assessment’s chapter on human health impacts. His former boss, Linda Birnbaum, who directed NIEHS for a decade, called Balbus’ work in the field “inspirational.” “Climate change has always been his baby,” she said, adding that it is “very exciting that there is finally recognition at the department level that there needs to be attention looking at the human health effects of climate change.” Two weeks into the job, and Balbus says he already has a “very big plate.” Office priorities include everything from fostering innovation on climate adaptation and resilience in disadvantaged communities, to promoting training opportunities within the climate and health workforce, to partnering with nonprofit, private sector and community groups, and even assisting with regulatory efforts to reduce greenhouse gas emissions throughout the health care sector.

Already in the works is a collaboration with NOAA to ensure the agency’s seasonal forecast for health is “connected to response mechanisms,” which allows for local health systems to be prepared for extreme weather. The office is also partnering with the National Academy of Medicine, which recently 4 flagyl pills at once started its own climate change and health initiative. Balbus told E&E News that he plans for office staff to assist in ensuring that infrastructure investments made by the federal government will increase climate resilience and reduce health disparities.

He noted that a lack of access to 4 flagyl pills at once green space, adequate transportation and nutrition are all things that negatively impact the health of communities of color and make them more vulnerable to climate change impacts. He also wants the office to focus on reducing emissions from the health sector itself — which is responsible for roughly 8.5 percent of the nation’s greenhouse gas emissions. The federal government is a major health care provider in its own right, running hospitals through the Department of Veterans Affairs and the Indian Health Service.

HHS is already tasked with reducing emissions from those facilities to meet President Biden’s goals of reducing federal 4 flagyl pills at once greenhouse gas emissions. HHS also holds considerable sway over private sector hospitals. Balbus and Becerra have indicated they would seriously consider proposals from climate-minded health policy wonks who have said the agency should leverage reimbursement policies at the Centers for Medicare &.

Medicaid Services to pressure hospitals to reduce their own emissions 4 flagyl pills at once (Greenwire, Dec. 8, 2020). €œWe will use every authority to its greatest advantage because it’s time to tackle climate change now.

And if we think there is a way to do it and if we have the tools and 4 flagyl pills at once authorities to do it, we will move,” Becerra said at a press conference last month. Similarly, Balbus said the new office is coordinating with the Administration for Children and Families office to see how their Low Income Home Energy Assistance Program — which traditionally has focused on heating needs — could be used to provide more access to air conditioning for economically disadvantaged families (Greenwire, Aug. 23).

€œThat is an example of the kind of thing that we are looking to do,” he said. 'Little engine that could' While the Office of Climate Change and Health Equity has seemingly endless priorities, some fear it doesn’t have enough resources to get the job done. The Biden administration has requested $3 million from Congress to fund the office, which would pay for roughly eight employees.

As of now, many members of the office are like Balbus — on detail from other parts of HHS in order to fund their posts. €œIt is a teeny-weeny budget for what needs to be done,” Birnbaum said. Ed Maibach, who directs George Mason University’s Center for Climate Change Communication, agreed.

€œThe amount of work they need to do to make HHS and our federal government ready for climate change is simply greater than what this tiny new office is capable of doing,” he said. €œIt should be doubled or quadrupled immediately and be given a budget commensurate with the tasks they are being given.” That’s not lost on Becerra, who last month called the office “the little engine that could” and said that he hopes to see the office grow over time. €œThis office will become a permanent fixture within HHS, and it will grow because the need, the challenges, are absolutely there,” he said.

Balbus added that he hoped to “supplement” that staff with fellows and interns — and that some fellowships with the office would be specifically offered to minorities to ensure the office “reflects the diversity of the people we are servicing.” Maibach also wondered how much success the office could achieve, given that — according to surveys his Center for Climate Change Communication has conducted — “most people think of climate change as a penguin and polar bears problem.” “They don’t understand that our skin is in the game, literally, in our own health,” he said. But Kathy Baughman McLeod, director of the Adrienne Arsht-Rockefeller Foundation Resilience Center, said that sometimes having a small group of people dedicated to a cause can be enough. Her organization has sponsored “heat officer” positions in cities around the globe, including Miami, under that philosophy (Greenwire, June 1).

€œHaving someone that wakes up every day to think about climate change, specifically for vulnerable people, it will have positive impacts on health,” she said. €œThese communities have not had a voice, and to put this eight-person team in the federal government, that is a big deal.” Arsenio Mataka, senior adviser for climate change and health equity at HHS’s Office of the Assistant Secretary for Health, echoed that perspective. He likened the new climate change office to his experience in California government, where he worked with Becerra at the California Department of Justice and served as the top environmental justice official at California’s EPA between 2011 and 2017.

€œWhen I got to CalEPA the first thing on their mind wasn’t environmental justice — it was the traditional look at the environment and 'don’t talk about race or poor people,'” he said. €œIt took an internal effort to move and shift that.” Having an office within HHS dedicated to climate change and equity, he said, would have a similar effect on the health sector. €œYou have to build the infrastructure inside government to address these issues,” he said.

€œAnd we are just getting started.” Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals.As with most things related to people, the food we eat comes with a carbon cost.

Soil tillage, crop and livestock transportation, manure management and all the other aspects of global food production generate greenhouse gas emissions to the tune of more than 17 billion metric tons per year, according to a new study published on Monday in Nature Food. Animal-based foods account for 57 percent of those emissions, and plant-based ones make up 29 percent. The researchers hope the paper’s detailed breakdown of how much each agricultural practice, animal product, crop and country contributes to carbon emissions can help focus and fine-tune reduction efforts.

Though previous studies have estimated emissions from agriculture, the authors say this work is more detailed and comprehensive. It uses data on 171 crops and 16 animal products from more than 200 countries, along with computer modeling, to calculate the amounts of carbon dioxide, methane and nitrous oxide that are contributed by individual elements of the global food system, including consumption and production. If we want to control those emissions, “we needed to calculate a good baseline,” says study co-author Atul Jain, a climate scientist at the University of Illinois at Urbana-Champaign.

€œGlobal Greenhouse Gas Emissions from Animal-Based Foods Are Twice Those of Plant-Based Foods,” by Xiaoming Xu et al., in Nature Food. Published online September 13, 2021 The results align with other research, says Liqing Peng, a food and agriculture modeler at the nonprofit World Resources Institute, which published its own report on agricultural emissions in 2019. The new study’s estimate of total emissions is on the higher side of the range of previous ones, she says.

This is partly because it includes data on farmland management practices, such as irrigation and planting, as well as activities beyond the farm, such as processing and packaging—numbers which are difficult to obtain. €œIt’s really important to get as detailed as possible on these breakdowns” in order to know where to concentrate emissions-reduction research and policies, Peng adds. Of the food products the study examined, beef production was the top emissions contributor by a wide margin, accounting for 25 percent of the total.

Among animal-based products, it was followed by cow milk, pork and chicken meat, in that order. In the category of crops, rice farming was the top contributor—and it was the second-highest contributor among all products, accounting for 12 percent of the total. Rice’s relatively high ranking comes from the methane-producing bacteria that thrive in the anaerobic conditions of flooded paddies.

After rice, the highest emissions associated with plant production came from wheat, sugarcane and maize. As for contributions from individual regions, South and Southeast Asia comprised the overall top emitter of greenhouse gases related to food production and the only region where plant-based emissions were higher than animal-based ones because of rice cultivation. Among countries, China, India and Indonesia had the highest plant-based food production emissions.

This, again, was linked to rice farming, as well as large populations that create a high demand for food—which drives more conversion of land to agricultural production. Because of their large populations, these areas registered relatively low per capita production emissions. The highest per capita emissions (and the second-highest regional emissions overall) were found in South America because of its relatively large production of meat, particularly beef.

North America had the second-highest per capita production emissions, followed by Europe. The study also broke down emissions caused by various aspects of food production and consumption. Farm activities, such as plowing soil or using other types of equipment—along with the conversion of land from forests or other natural landscapes into pasture and cropland—collectively accounted for two thirds of emissions.

Jain and his colleagues want to use these results, along with computer modeling, to examine how changing farmland management (reducing fertilizer use or employing no-till soil methods, for example) could reduce emissions. They also want to study how to balance the food requirements of a growing global population with the need to halt deforestation. €œThat’s why we put so much effort” into being so comprehensive in the new paper’s accounting, Jain says.

His co-author Xiaoming Xu, also at the University of Illinois at Urbana-Champaign, is optimistic about the prospects of making a dent in food-based emissions. €œI think there are a lot of options we can do,” he says. But Peng notes that meeting the current—and ambitious—international emissions-reduction targets will mean figuring out which approaches not only make the most economic sense but also provide the biggest bang for the buck in terms of getting results.

€œYou want to do everything,” she says, “but you can’t do everything at the same time.”Every now and then, our star produces immense flares of particles and radiation that can wreak havoc on Earth. For more than 150 years, scientists studying these outbursts and how they affect our planet have placed great focus on a single, seemingly pinnacle example. The Carrington Event of 1859.

Here, an eruption from the sun walloped Earth, pumping enough energy into our planet’s magnetic field to set off a massive geomagnetic storm that created beautiful auroral displays but also sparked electrical fires in telegraph lines. Our electronic infrastructure at the time was so primitive that the storm was seen as an odd minor inconvenience. But along with another storm of comparable strength in 1921, researchers today recognize the Carrington Event as an ominous warning of future catastrophes.

Both storms, however, pale in comparison to an ancient event discovered in 2012. A historic megastorm of humongous proportions that occurred around A.D. 775, which was likely 10 to 100 times stronger.

€œIt was really, really astounding,” says Nicolas Brehm of the Swiss Federal Institute of Technology Zurich. €œWe didn’t think something of this magnitude could happen.” The ancient megastorm was so strong that scientists thought it might have come from a once-in-10,000-years “superflare” erupting from the sun, an event that was thousands of times more powerful than a regular solar flare. A direct hit by such a superflare today would likely have devastating consequences for our modern, globally wired society.

Fortunately, they are rare events—right?. Maybe not. Researchers investigating the geochemical annals of Earth’s recent history have now found evidence for two more.

In a preprint paper led by Brehm, available on Research Square and submitted to Nature Communications, scientists reveal the possible discovery of two frightfully strong solar events. One occurred in 7176 B.C., as nomadic hunter-gatherer societies gave way to agrarian settlements, and the other did so in 5259 B.C., as the planet emerged from the final throes of its latest ice age. Both events are thought to be at least as strong as the one in A.D.

775, making the trio possibly the strongest known solar flares on record. For the past decade, scientists have been on the hunt for additional extreme events like that eighth century one. Brehm’s team is the first to find some.

€œIt’s a great achievement,” says Fusa Miyake of Nagoya University in Japan, who led the study in 2012 that revealed the 775 event. Scientists now refer to such superflares as “Miyake events.” To look so far back in time, researchers rely on chemical analyses of samples from polar ice caps, as well as from ancient trees preserved in waterlogged bogs or high on mountaintops. When solar particles hit our atmosphere, they can produce unstable radioactive forms of various elements that accumulate in such places.

In the case of carbon, the solar activity can form carbon 14, which is absorbed by tree rings as they grow. Because each ring corresponds to a single year of growth, this gives an incredibly precise date of any spikes caused by increased solar activity. The more carbon 14 there is in one, the more solar particles were hitting our atmosphere at a given time.

Such rings “allow us to reconstruct patterns of radiocarbon through time,” says Charlotte Pearson of the Laboratory of Tree-Ring Research at the University of Arizona, who is a co-author on the paper. €œOne of the key things that drives those fluctuations is the activity of the sun.” Ice cores allow for a similar, albeit slightly less accurate, measurement via their concentrations of beryllium 10 and chlorine 36. Taken together, these methods can provide a very precise account of historical events.

We have tree ring data for most of the Holocene—our current geologic epoch, which began about 12,000 years ago. Poring through them for events such as carbon 14 spikes is time-consuming, however. Looking at just a single year typically requires weeks of analyzing and cross-correlating multiple tree-ring samples.

€œThere’s 12,000 years of the Holocene to do, and we’ve done 16 percent of it,” says Alexandra Bayliss, head of scientific dating at Historic England and a co-author on the paper. €œIt’s a matter of time and money.” Brehm and his team got somewhat lucky in their study. For the event in 7176 B.C., preliminary evidence for a beryllium 10 spike was first seen in ice cores.

The researchers followed up with tree rings and saw a corresponding spike of carbon 14. For the event in 5259 B.C., Bayliss had noticed there was a gap in archaeological data around this time period. Studying carbon 14 data in tree rings from this era, the team found another spike.

€œWe found this huge increase” for both dates, Brehm says, each similar in magnitude to the spikes Miyake found in the samples that clinched the A.D. 775 event. Following Miyake’s paper in 2012, scientists were at first unsure what was causing these spikes.

Some even thought solar events were unlikely. A 2013 study led by Brian Thomas of Washburn University, however, showed solar flares were the probable culprit. €œThere were people making suggestions [that the 775 spike] could be from a supernova or even a gamma-ray burst,” says Thomas, who was not involved in the latest paper by Brehm and his colleagues.

€œBut they’re just too rare to cause this kind of frequency. It doesn’t fit as well as the solar explanation.” Such large, frequent spikes, he argues, were more likely the result of increased solar activity—possibly accompanied by a geomagnetic storm similar to the Carrington Event but far more powerful. €œThe Carrington Event isn’t even detectable” in tree rings and ice cores, Bayliss notes, which suggests it was minuscule by comparison.

Even so, the exact correlation between spikes in solar particles and the intensity of any accompanying geomagnetic storm remains unclear. €œA big particle event is often associated with a geomagnetic storm, but it doesn’t necessarily have to be,” Thomas says. It may even be that geomagnetic storms like the Carrington Event do not cause carbon 14 spikes at all, explaining its absence from tree-ring and ice-core data.

We do have hints, however, that at least the event in 775 was accompanied by powerful aurora, recorded in China, pointing to a strong geomagnetic storm alongside this huge influx of solar particles. €œIt’s safer to assume all of these events were big geomagnetic storms,” Thomas says. If that link is correct, it suggests that in the past 10,000 years alone, Earth has been battered by at least three solar superflares.

(Evidence of more may eventually be found in the four fifths of available tree-ring data that has yet to be analyzed for carbon 14 spikes.) “For there only to be one in the last 10,000 years didn’t really seem realistic,” Pearson says. €œBut up until this point, it could have just been a one-off. Now that we’ve found two more, I’m not sure that it’s surprising—but it may be concerning.” The major worry is that if such an event happened today, it could be devastating to satellites in orbit and infrastructure on the ground.

In March 1989 a geomagnetic storm caused a 12-hour blackout in Quebec when it overloaded the entire province’s power grid despite the fact that it was much weaker than even the Carrington Event. Today a geomagnetic storm resulting from a Miyake event would likely see much more widespread effects, including potentially catastrophic power grid and satellite failures. Sangeetha Abdu Jyothi of the University of California, Irvine, recently calculated that a Carrington Event–level storm today could cause an “Internet apocalypse.” Energetic particles from such a storm could knock out undersea cables between countries, disrupting worldwide Internet traffic for weeks or even months.

In the U.S. Alone, such a disaster could cost $7 billion per day, Abdu Jyothi estimates. Something stronger, such as a Miyake event, could cause damages so great that they would be almost incalculable.

€œFor something at a Carrington-scale, we could possibly recover, because our data itself will not be erased,” Abdu Jyothi says. €œWith something 10 or 100 times stronger, I don’t know. I don’t think anybody has simulated that.

I suspect it would cause significant data loss. We could lose all our records, bank information, and critical health information and not have anything to go back to.” The chance that our global civilization shall suffer a new dark age from a Miyake event seems remote for the time being. But some estimates suggest the odds of a Carrington-level event may be as much as 12 percent in the next decade.

We can prepare for something of this level by monitoring solar activity and shutting down satellites and power grids ahead of the arrival of a superflare and its ensuing geomagnetic storm. But something much stronger, a Miyake event, may be more difficult to protect against. As we continue to find evidence of additional extreme events in ancient tree rings and ice cores, the prospect that one might occur in the near future should not be discounted.

€œWe’re just starting to realize that the sun can be a whole lot more energetic and active than we thought,” Thomas says. €œWhen people were studying these superflares on other stars, one of the discussions was whether the sun could do this. From these historical records, it seems the sun is capable of getting into that range.

There’s quite a lot of reason for concern.”Both cigarettes and opioids are highly addictive—and potentially deadly. Both substances are sold by profiteering companies using science distorted by spin or outright lies. And both have been the subjects of multi-billion-dollar lawsuits.

But opioids are not cigarettes. And as the opioid settlements finally near completion, it is crucial not to misapply lessons learned from tobacco. Fundamentally, this means accepting that—unlike cigarettes—opioids have genuine uses in both pain and addiction medicine.

So far, however, we are doing the opposite. Rather than recognizing that some people with intractable pain benefit from opioids, we continue to reduce access— typically without offering affordable and effective alternatives. Rather than acknowledging that closing “pill mills” and identifying “doctor shoppers” more often drives people to dangerous street drugs than to recovery, we frequently abandon patients in withdrawal.

And instead of admitting that the best treatment for opioid addiction—the only one proved to cut the death rate by 50 percent or more—is medical opioids (typically buprenorphine or methadone, but some countries use heroin), we primarily offer abstinence-based treatment. Understanding where the analogy between opioids and cigarettes holds—and where it goes astray—can guide better policy. First, unlike for cigarettes, interrupting the opioid supply can kill rather than cure.

One recent study of more than 100,000 patients published in JAMA examined dose reductions among people who had taken opioids for at least a year. Researchers expected these cuts to lower overdose risk. Instead, regardless of how quickly or slowly drugs were tapered, opioid reduction nearly doubled the odds that patients would overdose.

And compared with those whose dosages were stable, these patients had more than twice the risk of hospitalization for psychiatric problems, including suicide attempts. Earlier research bolsters these findings. One study found that patients who had their doses lowered rapidly were nearly four times more likely to die by suicide.

Another study, conducted with veterans, showed that abrupt cessation hiked suicide risk by a factor of seven for those who had received opioids long term. Because five million to eight million Americans currently take opioids for chronic pain, these data suggest that many of today’s overdose and suicide cases may actually result from our attempts to ameliorate the crisis. By contrast, quitting smoking enhances life expectancy (though it can sometimes increase depression in vulnerable populations).

And even so, our strategies for fighting Big Tobacco have not involved making cigarettes legally inaccessible to current smokers. Indeed, banning cigarettes outright—or making them available only by increasingly difficult to obtain prescriptions—was not even on the table during settlement talks because regulators appreciated that this would create a large, dangerous black market. The same caution was not applied to opioids.

Since 2011 prescribing has fallen by at least 60 percent, largely thanks to ramped up prescription-monitoring databases and prosecution of “pill mill” physicians. The crackdown scared even legitimate doctors into dropping chronic pain patients—as well as anyone else who might possibly be addicted. Not surprisingly, this created a bonanza for dealers—whose products, unlike legal drugs, are unregulated and vary widely in dosage and purity.

Consequently, as prescribing dropped, overdose deaths more than doubled, reaching a record high of more than 93,000 in 2020. Yet antiopioid crusaders have dug in their heels, continuing to take the wrong lessons from tobacco’s history. Big Pharma lied about opioid benefits, just as Big Tobacco lied about cigarettes.

Therefore, they argued, any positive claims about opioids must be squelched and the medical supply must fall even further. This approach obscures facts about addiction that are critical to prevention and treatment. For one, most opioid addiction does not start with medical care.

Eighty percent of people who begin misusing prescription opioids get them from friends, family or other illegal sources, not physicians—and nearly all those who become addicted have already used other drugs such as cocaine or methamphetamine. Moreover, addictions typically start in youth, with 90 percent beginning as experimentation in adolescence or early adulthood. Chronic pain, in contrast, tends to arise in middle or late life.

As a result, fewer than 8 percent of people who take opioids long term for pain develop new addictions, according to a review co-authored by the director of the National Institute on Drug Abuse. In fact, the age group prescribed opioids at the highest rate—those older than 65—has the lowest rate of addiction and overdose. (And no, this research was not funded by Big Pharma, even though they used some of it extremely dishonestly.) It is difficult to stop drug-seeking teens by leaving grandma in agony.

Policies aimed at minimizing leftover pills prescribed for acute pain make sense—as does providing secure storage for needed meds. But our current strategy of reducing prescribing for chronic pain has failed. While care is needed when applying tobacco history to opioid policy, the settlements do offer one clear cautionary lesson.

Use the money well. Some $246 billion has already been paid out by cigarette makers—but nearly all of it falls into states’ general funds. In the 2021 fiscal year, for instance, less than 3 percent of the $27 billion allocated goes directly to smoking cessation and prevention.

To do better, we must target opioid funds narrowly and spend them smartly. This means moving away from cutting supply and toward offering help. First, doctors must be allowed to continue prescribing for patients who already take opioids—without fear that doing so responsibly will cost them their license or their freedom.

The millions of “legacy patients”—and future patients who have exhausted other options—need a legal safe haven so that they are not killed by dose reductions intended to save them. Second, people with addiction need better care. Arrest or expulsion from medical practices because of suspicion of misuse is not treatment.

When physicians diagnose opioid addiction, they should legally be able to prescribe methadone or buprenorphine on the spot rather than having to send patients to restrictive clinics. In addition, no rehab that fails to offer medications or disparages them should receive government or insurance funding. In short, we need to spend settlement funds on proved, effective care—and stop prioritizing prescription monitoring and enforcement.

Despite their dangers, there is currently no substitute for these drugs. While a world without smoking is desirable, one without opioids is a world of pain. This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.The Social Instinct.

How Cooperation Shaped the Worldby Nichola RaihaniSt. Martin’s Press, 2021 ($29.99) Society is built on a foundation of cooperation, with lessons on its importance starting as early as Sesame Street. It may be tempting to look at our ability to cooperate—however imperfectly—as evidence that humans have transcended our baser instincts.

But in her energetic analysis, psychologist Nichola Raihani recontextualizes cooperation within the framework of evolution and reveals the competition for survival that still bubbles below its surface. According to Raihani, cooperation is “not just about what we do, but who and what we are.” As multicellular beings, we literally embody cooperation. As individuals, we gravitate toward others.

The same instincts that lead us to live in tight-knit family groups drive us to help those who are not part of our immediate circles, even when our assistance will never be reciprocated. While this may not seem to square with “survival of the fittest,” Raihani accounts for this evolutionary puzzle and illuminates how cooperation has shaped such disparate phenomena as cancer, monogamy, menopause, hatred toward vegans, and people leaving dirty dishes in the office sink. Raihani explains the breathtaking intricacies of natural selection yet does not shy away from addressing the field’s current controversies (such as whether human societies should share the status of “superorganisms” with bee and ant colonies) or touching on its outermost frontiers, including the “mind-bendingly bonkers” possibilities of microchimerism, the presence of cells of two individuals in one body.

She compares human behaviors with those of other intensely social animals. For instance, meerkats teach their young how to handle food safely through scaffolded lessons, and the bluestreak cleaner wrasse polices its cleaning station to prevent conflict that might scare off fussy client fish. Raihani offers insight into how our hardwired drive to cooperate could help us meet the challenges rushing at us, from flagyls to climate change.

We can “change the rules” of our society to favor large-scale cooperation—a welcome idea as we confront living in the Anthropocene.—Dana Dunham Secret Worlds. The Extraordinary Senses of Animalsby Martin Stevens Oxford University Press, 2021 ($25.95) Ecologist Martin Stevens catalogs animals’ sensory systems and how they exceed our own while informing—and challenging—our reality as humans. The book has a narrative and inquisitive style that will appeal to a wide audience.

Stevens explores dozens of sensory systems through examples of the amazing capabilities they allow, from nocturnal dung beetles that orientate by using the Milky Way to sea turtles that navigate currents by reading the earth’s magnetic fields. Secret Worlds is filled with lessons on how different species evolved to perceive the world. €”Jen St.

Jude Once There Were Wolvesby Charlotte McConaghyFlatiron Books, 2021 ($27.99) Australian writer Charlotte McConaghy (author of Migrations) delivers a suspenseful and poignant novel about a woman named Inti Flynn and her team of biologists who reintroduce gray wolves into Scotland’s remote Highlands. At first, the wolves seem to thrive, but when a farmer gets mauled, locals blame the animals. Inti, however, reaches a different—and tragic—conclusion.

She suspects the man she loves. Her story unfolds as a meditation on the social and scientific consequences of influencing ecosystems, while reminding us that humans and animals alike can break our hearts. €”Amy Brady The Shimmering Stateby Meredith WestgateAtria Books, 2021 ($27) Memoroxin, a personalized pill that replaces memories in people with Alzheimer’s, is being abused as a recreational drug.

Unmoored from reality, Lucien and Sophie meet at a “Mem” rehab center in Los Angeles, where personal traumas can be snipped away along with foreign memories. They feel drawn to each other. Have they met before?.

Like the film Eternal Sunshine of the Spotless Mind, The Shimmering State explores whether the joys and pains of love can ever be fully erased. Through interconnected relationships, the novel delves into some of the moral dilemmas of a technology that can catalog and edit consciousness. €”Jen Schwartz.

The federal flagyl price cvs government needs a tailor. At least, that’s how John Balbus sees it. As the interim director of the first-ever Office of Climate Change and Health Equity at the Department of Health and Human Services, Balbus says the federal government already has many of the pieces it needs to help communities become more resilient flagyl price cvs to climate change. It also has what it needs to support communities that have been marginalized for too long and seen their health suffer as a result.

He just needs to stitch them together. €œThere is no need to say, ‘OK, you are working on flagyl price cvs health equity, now come in this other room and work on climate change,’” he told E&E News last week. €œThe work is the same. It needs to be completely integrated and unified.” After a summer in which heat waves, wildfires and hurricanes have underscored just how deadly climate change can be — especially among vulnerable populations — the need for a federal office focused on climate change and equity has perhaps never been greater, officials said.

€œThe West is burning, Louisiana is being pummeled, in one place it’s a deluge of water and in another place there is a lack of it flagyl price cvs — clearly these extremes are hurting our health, so we have to do everything we can,” HHS Secretary Xavier Becerra said at a press conference establishing the office two weeks ago. Indeed, just a few days after that, EPA published a peer-reviewed report detailing all the ways that climate change would disproportionately affect people of color. Among other findings, the report outlined how Black Americans are 40 percent more likely to live in areas with the highest projected increases in extreme temperature-related deaths, and how Hispanics and Latinos are flagyl price cvs 43 percent more likely to live in areas with the highest projected reductions in labor hours due to extreme temperatures. The same populations living in climate-vulnerable places also are more likely to suffer from chronic health conditions that make them even more at risk when extreme weather happens.

Balbus himself is no stranger to these issues. He’s leading the office on detail from his post as a senior adviser for public health at the National Institute of Environmental Health flagyl price cvs Sciences and authored the Fourth National Climate Assessment’s chapter on human health impacts. His former boss, Linda Birnbaum, who directed NIEHS for a decade, called Balbus’ work in the field “inspirational.” “Climate change has always been his baby,” she said, adding that it is “very exciting that there is finally recognition at the department level that there needs to be attention looking at the human health effects of climate change.” Two weeks into the job, and Balbus says he already has a “very big plate.” Office priorities include everything from fostering innovation on climate adaptation and resilience in disadvantaged communities, to promoting training opportunities within the climate and health workforce, to partnering with nonprofit, private sector and community groups, and even assisting with regulatory efforts to reduce greenhouse gas emissions throughout the health care sector. Already in the works is a collaboration with NOAA to ensure the agency’s seasonal forecast for health is “connected to response mechanisms,” which allows for local health systems to be prepared for extreme weather.

The office is also partnering with flagyl price cvs the National Academy of Medicine, which recently started its own climate change and health initiative. Balbus told E&E News that he plans for office staff to assist in ensuring that infrastructure investments made by the federal government will increase climate resilience and reduce health disparities. He noted that a lack of access to green flagyl price cvs space, adequate transportation and nutrition are all things that negatively impact the health of communities of color and make them more vulnerable to climate change impacts. He also wants the office to focus on reducing emissions from the health sector itself — which is responsible for roughly 8.5 percent of the nation’s greenhouse gas emissions.

The federal government is a major health care provider in its own right, running hospitals through the Department of Veterans Affairs and the Indian Health Service. HHS is already tasked with reducing emissions from those facilities to meet President Biden’s goals flagyl price cvs of reducing federal greenhouse gas emissions. HHS also holds considerable sway over private sector hospitals. Balbus and Becerra have indicated they would seriously consider proposals from climate-minded health policy wonks who have said the agency should leverage reimbursement policies at the Centers for Medicare &.

Medicaid Services to pressure hospitals to reduce flagyl price cvs their own emissions (Greenwire, Dec. 8, 2020). €œWe will use every authority to its greatest advantage because it’s time to tackle climate change now. And if we think there is a way to do it and if we have the tools flagyl price cvs and authorities to do it, we will move,” Becerra said at a press conference last month.

Similarly, Balbus said the new office is coordinating with the Administration for Children and Families office to see how their Low Income Home Energy Assistance Program — which traditionally has focused on heating needs — could be used to provide more access to air conditioning for economically disadvantaged families (Greenwire, Aug. 23). €œThat is an example of the kind of thing that we are looking to do,” he said. 'Little engine that could' While the Office of Climate Change and Health Equity has seemingly endless priorities, some fear it doesn’t have enough resources to get the job done.

The Biden administration has requested $3 million from Congress to fund the office, which would pay for roughly eight employees. As of now, many members of the office are like Balbus — on detail from other parts of HHS in order to fund their posts. €œIt is a teeny-weeny budget for what needs to be done,” Birnbaum said. Ed Maibach, who directs George Mason University’s Center for Climate Change Communication, agreed.

€œThe amount of work they need to do to make HHS and our federal government ready for climate change is simply greater than what this tiny new office is capable of doing,” he said. €œIt should be doubled or quadrupled immediately and be given a budget commensurate with the tasks they are being given.” That’s not lost on Becerra, who last month called the office “the little engine that could” and said that he hopes to see the office grow over time. €œThis office will become a permanent fixture within HHS, and it will grow because the need, the challenges, are absolutely there,” he said. Balbus added that he hoped to “supplement” that staff with fellows and interns — and that some fellowships with the office would be specifically offered to minorities to ensure the office “reflects the diversity of the people we are servicing.” Maibach also wondered how much success the office could achieve, given that — according to surveys his Center for Climate Change Communication has conducted — “most people think of climate change as a penguin and polar bears problem.” “They don’t understand that our skin is in the game, literally, in our own health,” he said.

But Kathy Baughman McLeod, director of the Adrienne Arsht-Rockefeller Foundation Resilience Center, said that sometimes having a small group of people dedicated to a cause can be enough. Her organization has sponsored “heat officer” positions in cities around the globe, including Miami, under that philosophy (Greenwire, June 1). €œHaving someone that wakes up every day to think about climate change, specifically for vulnerable people, it will have positive impacts on health,” she said. €œThese communities have not had a voice, and to put this eight-person team in the federal government, that is a big deal.” Arsenio Mataka, senior adviser for climate change and health equity at HHS’s Office of the Assistant Secretary for Health, echoed that perspective.

He likened the new climate change office to his experience in California government, where he worked with Becerra at the California Department of Justice and served as the top environmental justice official at California’s EPA between 2011 and 2017. €œWhen I got to CalEPA the first thing on their mind wasn’t environmental justice — it was the traditional look at the environment and 'don’t talk about race or poor people,'” he said. €œIt took an internal effort to move and shift that.” Having an office within HHS dedicated to climate change and equity, he said, would have a similar effect on the health sector. €œYou have to build the infrastructure inside government to address these issues,” he said.

€œAnd we are just getting started.” Reprinted from E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals.As with most things related to people, the food we eat comes with a carbon cost. Soil tillage, crop and livestock transportation, manure management and all the other aspects of global food production generate greenhouse gas emissions to the tune of more than 17 billion metric tons per year, according to a new study published on Monday in Nature Food.

Animal-based foods account for 57 percent of those emissions, and plant-based ones make up 29 percent. The researchers hope the paper’s detailed breakdown of how much each agricultural practice, animal product, crop and country contributes to carbon emissions can help focus and fine-tune reduction efforts. Though previous studies have estimated emissions from agriculture, the authors say this work is more detailed and comprehensive. It uses data on 171 crops and 16 animal products from more than 200 countries, along with computer modeling, to calculate the amounts of carbon dioxide, methane and nitrous oxide that are contributed by individual elements of the global food system, including consumption and production.

If we want to control those emissions, “we needed to calculate a good baseline,” says study co-author Atul Jain, a climate scientist at the University of Illinois at Urbana-Champaign. Credit. Amanda Montañez. Source.

€œGlobal Greenhouse Gas Emissions from Animal-Based Foods Are Twice Those of Plant-Based Foods,” by Xiaoming Xu et al., in Nature Food. Published online September 13, 2021 The results align with other research, says Liqing Peng, a food and agriculture modeler at the nonprofit World Resources Institute, which published its own report on agricultural emissions in 2019. The new study’s estimate of total emissions is on the higher side of the range of previous ones, she says. This is partly because it includes data on farmland management practices, such as irrigation and planting, as well as activities beyond the farm, such as processing and packaging—numbers which are difficult to obtain.

€œIt’s really important to get as detailed as possible on these breakdowns” in order to know where to concentrate emissions-reduction research and policies, Peng adds. Of the food products the study examined, beef production was the top emissions contributor by a wide margin, accounting for 25 percent of the total. Among animal-based products, it was followed by cow milk, pork and chicken meat, in that order. In the category of crops, rice farming was the top contributor—and it was the second-highest contributor among all products, accounting for 12 percent of the total.

Rice’s relatively high ranking comes from the methane-producing bacteria that thrive in the anaerobic conditions of flooded paddies. After rice, the highest emissions associated with plant production came from wheat, sugarcane and maize. As for contributions from individual regions, South and Southeast Asia comprised the overall top emitter of greenhouse gases related to food production and the only region where plant-based emissions were higher than animal-based ones because of rice cultivation. Among countries, China, India and Indonesia had the highest plant-based food production emissions.

This, again, was linked to rice farming, as well as large populations that create a high demand for food—which drives more conversion of land to agricultural production. Because of their large populations, these areas registered relatively low per capita production emissions. The highest per capita emissions (and the second-highest regional emissions overall) were found in South America because of its relatively large production of meat, particularly beef. North America had the second-highest per capita production emissions, followed by Europe.

The study also broke down emissions caused by various aspects of food production and consumption. Farm activities, such as plowing soil or using other types of equipment—along with the conversion of land from forests or other natural landscapes into pasture and cropland—collectively accounted for two thirds of emissions. Jain and his colleagues want to use these results, along with computer modeling, to examine how changing farmland management (reducing fertilizer use or employing no-till soil methods, for example) could reduce emissions. They also want to study how to balance the food requirements of a growing global population with the need to halt deforestation.

€œThat’s why we put so much effort” into being so comprehensive in the new paper’s accounting, Jain says. His co-author Xiaoming Xu, also at the University of Illinois at Urbana-Champaign, is optimistic about the prospects of making a dent in food-based emissions. €œI think there are a lot of options we can do,” he says. But Peng notes that meeting the current—and ambitious—international emissions-reduction targets will mean figuring out which approaches not only make the most economic sense but also provide the biggest bang for the buck in terms of getting results.

€œYou want to do everything,” she says, “but you can’t do everything at the same time.”Every now and then, our star produces immense flares of particles and radiation that can wreak havoc on Earth. For more than 150 years, scientists studying these outbursts and how they affect our planet have placed great focus on a single, seemingly pinnacle example. The Carrington Event of 1859. Here, an eruption from the sun walloped Earth, pumping enough energy into our planet’s magnetic field to set off a massive geomagnetic storm that created beautiful auroral displays but also sparked electrical fires in telegraph lines.

Our electronic infrastructure at the time was so primitive that the storm was seen as an odd minor inconvenience. But along with another storm of comparable strength in 1921, researchers today recognize the Carrington Event as an ominous warning of future catastrophes. Both storms, however, pale in comparison to an ancient event discovered in 2012. A historic megastorm of humongous proportions that occurred around A.D.

775, which was likely 10 to 100 times stronger. €œIt was really, really astounding,” says Nicolas Brehm of the Swiss Federal Institute of Technology Zurich. €œWe didn’t think something of this magnitude could happen.” The ancient megastorm was so strong that scientists thought it might have come from a once-in-10,000-years “superflare” erupting from the sun, an event that was thousands of times more powerful than a regular solar flare. A direct hit by such a superflare today would likely have devastating consequences for our modern, globally wired society.

Fortunately, they are rare events—right?. Maybe not. Researchers investigating the geochemical annals of Earth’s recent history have now found evidence for two more. In a preprint paper led by Brehm, available on Research Square and submitted to Nature Communications, scientists reveal the possible discovery of two frightfully strong solar events.

One occurred in 7176 B.C., as nomadic hunter-gatherer societies gave way to agrarian settlements, and the other did so in 5259 B.C., as the planet emerged from the final throes of its latest ice age. Both events are thought to be at least as strong as the one in A.D. 775, making the trio possibly the strongest known solar flares on record. For the past decade, scientists have been on the hunt for additional extreme events like that eighth century one.

Brehm’s team is the first to find some. €œIt’s a great achievement,” says Fusa Miyake of Nagoya University in Japan, who led the study in 2012 that revealed the 775 event. Scientists now refer to such superflares as “Miyake events.” To look so far back in time, researchers rely on chemical analyses of samples from polar ice caps, as well as from ancient trees preserved in waterlogged bogs or high on mountaintops. When solar particles hit our atmosphere, they can produce unstable radioactive forms of various elements that accumulate in such places.

In the case of carbon, the solar activity can form carbon 14, which is absorbed by tree rings as they grow. Because each ring corresponds to a single year of growth, this gives an incredibly precise date of any spikes caused by increased solar activity. The more carbon 14 there is in one, the more solar particles were hitting our atmosphere at a given time. Such rings “allow us to reconstruct patterns of radiocarbon through time,” says Charlotte Pearson of the Laboratory of Tree-Ring Research at the University of Arizona, who is a co-author on the paper.

€œOne of the key things that drives those fluctuations is the activity of the sun.” Ice cores allow for a similar, albeit slightly less accurate, measurement via their concentrations of beryllium 10 and chlorine 36. Taken together, these methods can provide a very precise account of historical events. We have tree ring data for most of the Holocene—our current geologic epoch, which began about 12,000 years ago. Poring through them for events such as carbon 14 spikes is time-consuming, however.

Looking at just a single year typically requires weeks of analyzing and cross-correlating multiple tree-ring samples. €œThere’s 12,000 years of the Holocene to do, and we’ve done 16 percent of it,” says Alexandra Bayliss, head of scientific dating at Historic England and a co-author on the paper. €œIt’s a matter of time and money.” Brehm and his team got somewhat lucky in their study. For the event in 7176 B.C., preliminary evidence for a beryllium 10 spike was first seen in ice cores.

The researchers followed up with tree rings and saw a corresponding spike of carbon 14. For the event in 5259 B.C., Bayliss had noticed there was a gap in archaeological data around this time period. Studying carbon 14 data in tree rings from this era, the team found another spike. €œWe found this huge increase” for both dates, Brehm says, each similar in magnitude to the spikes Miyake found in the samples that clinched the A.D.

775 event. Following Miyake’s paper in 2012, scientists were at first unsure what was causing these spikes. Some even thought solar events were unlikely. A 2013 study led by Brian Thomas of Washburn University, however, showed solar flares were the probable culprit.

€œThere were people making suggestions [that the 775 spike] could be from a supernova or even a gamma-ray burst,” says Thomas, who was not involved in the latest paper by Brehm and his colleagues. €œBut they’re just too rare to cause this kind of frequency. It doesn’t fit as well as the solar explanation.” Such large, frequent spikes, he argues, were more likely the result of increased solar activity—possibly accompanied by a geomagnetic storm similar to the Carrington Event but far more powerful. €œThe Carrington Event isn’t even detectable” in tree rings and ice cores, Bayliss notes, which suggests it was minuscule by comparison.

Even so, the exact correlation between spikes in solar particles and the intensity of any accompanying geomagnetic storm remains unclear. €œA big particle event is often associated with a geomagnetic storm, but it doesn’t necessarily have to be,” Thomas says. It may even be that geomagnetic storms like the Carrington Event do not cause carbon 14 spikes at all, explaining its absence from tree-ring and ice-core data. We do have hints, however, that at least the event in 775 was accompanied by powerful aurora, recorded in China, pointing to a strong geomagnetic storm alongside this huge influx of solar particles.

€œIt’s safer to assume all of these events were big geomagnetic storms,” Thomas says. If that link is correct, it suggests that in the past 10,000 years alone, Earth has been battered by at least three solar superflares. (Evidence of more may eventually be found in the four fifths of available tree-ring data that has yet to be analyzed for carbon 14 spikes.) “For there only to be one in the last 10,000 years didn’t really seem realistic,” Pearson says. €œBut up until this point, it could have just been a one-off.

Now that we’ve found two more, I’m not sure that it’s surprising—but it may be concerning.” The major worry is that if such an event happened today, it could be devastating to satellites in orbit and infrastructure on the ground. In March 1989 a geomagnetic storm caused a 12-hour blackout in Quebec when it overloaded the entire province’s power grid despite the fact that it was much weaker than even the Carrington Event. Today a geomagnetic storm resulting from a Miyake event would likely see much more widespread effects, including potentially catastrophic power grid and satellite failures. Sangeetha Abdu Jyothi of the University of California, Irvine, recently calculated that a Carrington Event–level storm today could cause an “Internet apocalypse.” Energetic particles from such a storm could knock out undersea cables between countries, disrupting worldwide Internet traffic for weeks or even months.

In the U.S. Alone, such a disaster could cost $7 billion per day, Abdu Jyothi estimates. Something stronger, such as a Miyake event, could cause damages so great that they would be almost incalculable. €œFor something at a Carrington-scale, we could possibly recover, because our data itself will not be erased,” Abdu Jyothi says.

€œWith something 10 or 100 times stronger, I don’t know. I don’t think anybody has simulated that. I suspect it would cause significant data loss. We could lose all our records, bank information, and critical health information and not have anything to go back to.” The chance that our global civilization shall suffer a new dark age from a Miyake event seems remote for the time being.

But some estimates suggest the odds of a Carrington-level event may be as much as 12 percent in the next decade. We can prepare for something of this level by monitoring solar activity and shutting down satellites and power grids ahead of the arrival of a superflare and its ensuing geomagnetic storm. But something much stronger, a Miyake event, may be more difficult to protect against. As we continue to find evidence of additional extreme events in ancient tree rings and ice cores, the prospect that one might occur in the near future should not be discounted.

€œWe’re just starting to realize that the sun can be a whole lot more energetic and active than we thought,” Thomas says. €œWhen people were studying these superflares on other stars, one of the discussions was whether the sun could do this. From these historical records, it seems the sun is capable of getting into that range. There’s quite a lot of reason for concern.”Both cigarettes and opioids are highly addictive—and potentially deadly.

Both substances are sold by profiteering companies using science distorted by spin or outright lies. And both have been the subjects of multi-billion-dollar lawsuits. But opioids are not cigarettes. And as the opioid settlements finally near completion, it is crucial not to misapply lessons learned from tobacco.

Fundamentally, this means accepting that—unlike cigarettes—opioids have genuine uses in both pain and addiction medicine. So far, however, we are doing the opposite. Rather than recognizing that some people with intractable pain benefit from opioids, we continue to reduce access— typically without offering affordable and effective alternatives. Rather than acknowledging that closing “pill mills” and identifying “doctor shoppers” more often drives people to dangerous street drugs than to recovery, we frequently abandon patients in withdrawal.

And instead of admitting that the best treatment for opioid addiction—the only one proved to cut the death rate by 50 percent or more—is medical opioids (typically buprenorphine or methadone, but some countries use heroin), we primarily offer abstinence-based treatment. Understanding where the analogy between opioids and cigarettes holds—and where it goes astray—can guide better policy. First, unlike for cigarettes, interrupting the opioid supply can kill rather than cure. One recent study of more than 100,000 patients published in JAMA examined dose reductions among people who had taken opioids for at least a year.

Researchers expected these cuts to lower overdose risk. Instead, regardless of how quickly or slowly drugs were tapered, opioid reduction nearly doubled the odds that patients would overdose. And compared with those whose dosages were stable, these patients had more than twice the risk of hospitalization for psychiatric problems, including suicide attempts. Earlier research bolsters these findings.

One study found that patients who had their doses lowered rapidly were nearly four times more likely to die by suicide. Another study, conducted with veterans, showed that abrupt cessation hiked suicide risk by a factor of seven for those who had received opioids long term. Because five million to eight million Americans currently take opioids for chronic pain, these data suggest that many of today’s overdose and suicide cases may actually result from our attempts to ameliorate the crisis. By contrast, quitting smoking enhances life expectancy (though it can sometimes increase depression in vulnerable populations).

And even so, our strategies for fighting Big Tobacco have not involved making cigarettes legally inaccessible to current smokers. Indeed, banning cigarettes outright—or making them available only by increasingly difficult to obtain prescriptions—was not even on the table during settlement talks because regulators appreciated that this would create a large, dangerous black market. The same caution was not applied to opioids. Since 2011 prescribing has fallen by at least 60 percent, largely thanks to ramped up prescription-monitoring databases and prosecution of “pill mill” physicians.

The crackdown scared even legitimate doctors into dropping chronic pain patients—as well as anyone else who might possibly be addicted. Not surprisingly, this created a bonanza for dealers—whose products, unlike legal drugs, are unregulated and vary widely in dosage and purity. Consequently, as prescribing dropped, overdose deaths more than doubled, reaching a record high of more than 93,000 in 2020. Yet antiopioid crusaders have dug in their heels, continuing to take the wrong lessons from tobacco’s history.

Big Pharma lied about opioid benefits, just as Big Tobacco lied about cigarettes. Therefore, they argued, any positive claims about opioids must be squelched and the medical supply must fall even further. This approach obscures facts about addiction that are critical to prevention and treatment. For one, most opioid addiction does not start with medical care.

Eighty percent of people who begin misusing prescription opioids get them from friends, family or other illegal sources, not physicians—and nearly all those who become addicted have already used other drugs such as cocaine or methamphetamine. Moreover, addictions typically start in youth, with 90 percent beginning as experimentation in adolescence or early adulthood. Chronic pain, in contrast, tends to arise in middle or late life. As a result, fewer than 8 percent of people who take opioids long term for pain develop new addictions, according to a review co-authored by the director of the National Institute on Drug Abuse.

In fact, the age group prescribed opioids at the highest rate—those older than 65—has the lowest rate of addiction and overdose. (And no, this research was not funded by Big Pharma, even though they used some of it extremely dishonestly.) It is difficult to stop drug-seeking teens by leaving grandma in agony. Policies aimed at minimizing leftover pills prescribed for acute pain make sense—as does providing secure storage for needed meds. But our current strategy of reducing prescribing for chronic pain has failed.

While care is needed when applying tobacco history to opioid policy, the settlements do offer one clear cautionary lesson. Use the money well. Some $246 billion has already been paid out by cigarette makers—but nearly all of it falls into states’ general funds. In the 2021 fiscal year, for instance, less than 3 percent of the $27 billion allocated goes directly to smoking cessation and prevention.

To do better, we must target opioid funds narrowly and spend them smartly. This means moving away from cutting supply and toward offering help. First, doctors must be allowed to continue prescribing for patients who already take opioids—without fear that doing so responsibly will cost them their license or their freedom. The millions of “legacy patients”—and future patients who have exhausted other options—need a legal safe haven so that they are not killed by dose reductions intended to save them.

Second, people with addiction need better care. Arrest or expulsion from medical practices because of suspicion of misuse is not treatment. When physicians diagnose opioid addiction, they should legally be able to prescribe methadone or buprenorphine on the spot rather than having to send patients to restrictive clinics. In addition, no rehab that fails to offer medications or disparages them should receive government or insurance funding.

In short, we need to spend settlement funds on proved, effective care—and stop prioritizing prescription monitoring and enforcement. Despite their dangers, there is currently no substitute for these drugs. While a world without smoking is desirable, one without opioids is a world of pain. This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.The Social Instinct.

How Cooperation Shaped the Worldby Nichola RaihaniSt. Martin’s Press, 2021 ($29.99) Society is built on a foundation of cooperation, with lessons on its importance starting as early as Sesame Street. It may be tempting to look at our ability to cooperate—however imperfectly—as evidence that humans have transcended our baser instincts. But in her energetic analysis, psychologist Nichola Raihani recontextualizes cooperation within the framework of evolution and reveals the competition for survival that still bubbles below its surface.

According to Raihani, cooperation is “not just about what we do, but who and what we are.” As multicellular beings, we literally embody cooperation. As individuals, we gravitate toward others. The same instincts that lead us to live in tight-knit family groups drive us to help those who are not part of our immediate circles, even when our assistance will never be reciprocated. While this may not seem to square with “survival of the fittest,” Raihani accounts for this evolutionary puzzle and illuminates how cooperation has shaped such disparate phenomena as cancer, monogamy, menopause, hatred toward vegans, and people leaving dirty dishes in the office sink.

Raihani explains the breathtaking intricacies of natural selection yet does not shy away from addressing the field’s current controversies (such as whether human societies should share the status of “superorganisms” with bee and ant colonies) or touching on its outermost frontiers, including the “mind-bendingly bonkers” possibilities of microchimerism, the presence of cells of two individuals in one body. She compares human behaviors with those of other intensely social animals. For instance, meerkats teach their young how to handle food safely through scaffolded lessons, and the bluestreak cleaner wrasse polices its cleaning station to prevent conflict that might scare off fussy client fish. Raihani offers insight into how our hardwired drive to cooperate could help us meet the challenges rushing at us, from flagyls to climate change.

We can “change the rules” of our society to favor large-scale cooperation—a welcome idea as we confront living in the Anthropocene.—Dana Dunham Secret Worlds. The Extraordinary Senses of Animalsby Martin Stevens Oxford University Press, 2021 ($25.95) Ecologist Martin Stevens catalogs animals’ sensory systems and how they exceed our own while informing—and challenging—our reality as humans. The book has a narrative and inquisitive style that will appeal to a wide audience. Stevens explores dozens of sensory systems through examples of the amazing capabilities they allow, from nocturnal dung beetles that orientate by using the Milky Way to sea turtles that navigate currents by reading the earth’s magnetic fields.

Secret Worlds is filled with lessons on how different species evolved to perceive the world. €”Jen St. Jude Once There Were Wolvesby Charlotte McConaghyFlatiron Books, 2021 ($27.99) Australian writer Charlotte McConaghy (author of Migrations) delivers a suspenseful and poignant novel about a woman named Inti Flynn and her team of biologists who reintroduce gray wolves into Scotland’s remote Highlands. At first, the wolves seem to thrive, but when a farmer gets mauled, locals blame the animals.

Inti, however, reaches a different—and tragic—conclusion. She suspects the man she loves. Her story unfolds as a meditation on the social and scientific consequences of influencing ecosystems, while reminding us that humans and animals alike can break our hearts. €”Amy Brady The Shimmering Stateby Meredith WestgateAtria Books, 2021 ($27) Memoroxin, a personalized pill that replaces memories in people with Alzheimer’s, is being abused as a recreational drug.

Unmoored from reality, Lucien and Sophie meet at a “Mem” rehab center in Los Angeles, where personal traumas can be snipped away along with foreign memories. They feel drawn to each other. Have they met before?. Like the film Eternal Sunshine of the Spotless Mind, The Shimmering State explores whether the joys and pains of love can ever be fully erased.

Through interconnected relationships, the novel delves into some of the moral dilemmas of a technology that can catalog and edit consciousness. €”Jen Schwartz.