How to get prescribed cialis

Some of the how to get prescribed cialis oldest art in human history is disintegrating, scientists say. And climate change may be hastening its demise. New research reports that ancient rock art in Indonesian caves is degrading over time, as bits of rock slowly flake away from the walls. It's a tremendous loss for how to get prescribed cialis human history — some of these paintings, which depict everything from animals to human figures to abstract symbols, date back about 40,000 years. Salt crystals building up on the walls are a key part of the problem, the study suggests.

These salt deposits seep into the cave walls, then proceed to expand and contract as temperatures rise and fall. This process causes how to get prescribed cialis the rock to slowly disintegrate. Changes in the weather may be helping the process along, scientists say. Salt crystals may expand more readily when they're exposed to repeated shifts between wet, humid conditions and periods of prolonged drought. Indonesia is already a dynamic region to begin with, split how to get prescribed cialis between the rainy monsoon season and the annual dry season.

But these kinds of shifts are expected to become more dramatic as the climate continues to warm. In particular, the researchers say, climate change may spur more intense El Niño events in the future. These events can amplify the kinds how to get prescribed cialis of conditions that help the damaging salt crystals form. Scientists are still debating the exact influence of climate change on El Niño, a natural climate cycle that drives shifting patterns of warming and cooling in the Pacific Ocean. But some studies do suggest that El Niño events may be more severe going forward.

The new study, led how to get prescribed cialis by Jillian Huntley at Australia's Griffith University, examined 11 ancient cave art sites in South Sulawesi, Indonesia. The researchers found evidence of salt formation at all 11 sites. At three of the sites, they found the types of crystals that most notoriously cause rocks to break apart. It's a how to get prescribed cialis small sample. There are more than 300 known cave art sites scattered around the region.

But the research suggests that salt crystals may indeed be part of the problem. In recent years, archaeologists have reported that the art appears to be rapidly deteriorating — at some sites, experts how to get prescribed cialis have reported as much as an inch of art vanishing every couple of months. Scientists have proposed multiple theories about what might be causing it. Along with climate change, they've suggested that pollution and other disturbances from nearby limestone mining operations might be degrading the fragile paintings. It's probably how to get prescribed cialis all of the above, Huntley and her colleagues suggest.

But they add that climate change is a growing threat, one that deserves more attention. In fact, they argue, salt-related degradation is "the most pressing threat to rock art preservation in this region" aside from mining. Reprinted from how to get prescribed cialis E&E News with permission from POLITICO, LLC. Copyright 2021. E&E News provides essential news for energy and environment professionals..

Cialis and ssri

Media AdvisoryFriday, March 25, 2022What The amygdala — a brain structure enlarged in two-year-old children diagnosed get a prescription for cialis with autism spectrum disorder (ASD) — begins cialis and ssri its accelerated growth between 6 and 12 months of age, suggests a study funded by the National Institutes of Health. The amygdala is involved in processing emotions, such as interpreting facial expressions or feeling afraid when exposed to a threat. The findings indicate that therapies to reduce the symptoms of ASD might have the greatest cialis and ssri chance of success if they begin in the first year of life, before the amygdala begins its accelerated growth.

The study included 408 infants, 270 of whom were at higher likelihood of ASD because they had an older sibling with ASD, 109 typically developing infants, and 29 infants with Fragile X syndrome, an inherited form of developmental and intellectual disability. The researchers conducted MRI scans of the children at 6, 12 cialis and ssri and 24 months of age. They found that the 58 infants who went on to develop ASD had a normal-sized amygdala at 6 months, but an enlarged amygdala at 12 months and 24 months.

Moreover, the faster the rate of amygdala overgrowth, the greater the severity of ASD symptoms at 24 months. The infants with Fragile X syndrome had a distinct pattern of brain cialis and ssri growth. They had no differences in amygdala growth but enlargement of another brain structure, the caudate, which was linked to increased repetitive behaviors.

The research team, part of the NIH Autism Centers of Excellence Infant Brain Imaging Study network, was cialis and ssri led by Mark Shen, Ph.D., of the University of North Carolina at Chapel Hill and the Infant Brain Imaging Study. The study appears in the American Journal of Psychiatry. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and cialis and ssri Human Development (NICHD), National Institute of Environmental Health Sciences and National Institute of Mental Health.

The authors suggested that difficulty processing sensory information during infancy may stress the amygdala, leading to its overgrowth. ASD is a complex developmental disorder that affects how a person behaves, interacts with others, communicates and learns. Who Alice Kau, Ph.D., of the NICHD Intellectual and Developmental Disabilities Branch, is available for cialis and ssri comment.

Article Shen, MD. Subcortical brain development in autism and fragile X cialis and ssri syndrome. Evidence for dynamic, age-and disorder-specific trajectories in infancy.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). NICHD leads research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all. For more information, visit https://www.nichd.nih.gov.About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S.

Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®###Children in the Greater Philadelphia area face a number of environmental threats to their health, including lead poisoning, asthma from air pollution, and exposure to endocrine disrupting chemicals. Now, with funding from the National Institute of Environmental Health Sciences, researchers from Children’s Hospital of Philadelphia (CHOP) and Penn Medicine have come together to address these hazards and protect children who live in the region’s most vulnerable communities.The Philadelphia Regional Center for Children's Environmental Health (PRCCEH) is a new children's center that will provide the infrastructure to integrate expertise from the two institutions, along with colleagues from Drexel University, Temple University, Thomas Jefferson University, Lehigh University, Franklin &. Marshall College, Villanova University and University of Delaware.

This is the first time that the region has been awarded funding for a Center for Children’s Environmental Health.“The center is an outgrowth of research from Penn’s Center of Excellence in Environmental Toxicology (CEET), its long-term collaborators, and its community partners. It has long been a vision to bring such a center to the region,” said CEET Director Trevor Penning, PhD.The mission of the center is threefold. To disseminate children's environmental health knowledge to health care providers, community members, and policy makers.

To develop, test and implement new programs. And to engage researchers and community partners to make policy, practice, and behavioral changes to reduce environmental exposures in early life. It will be led by directors Rebecca Simmons, MD, a professor of Pediatrics in the Perelman School of Medicine at the University of Pennsylvania and a neonatologist at CHOP, and Aimin Chen, MD, PhD, a professor of Epidemiology at Penn, along with deputy director Marilyn Howarth, MD, director of the Community Engagement Core in CEET.“This center will build on years of extensive research in environmental toxicology and pediatric health at both Penn and CHOP to make real, positive change in the lives of children throughout the region,” said Simmons.

€œWe already have many established connections within communities throughout Philadelphia, Delaware, and other counties, and this grant will allow us to strengthen and expand on those partnerships.”The center will focus on four primary research and translation areas. Asthma prevention, lead exposure and harm reduction, air pollution, and reduction of exposure to endocrine disrupting chemicals. Building on CHOP’s Community Asthma Prevention Program (CAPP) — a program designed by its Medical Director Tyra Bryant Stephens, MD, that has supported families of children with asthma in Philadelphia for more than 20 years — the center will expand the initiative to the city of Chester, providing education and supplies to help families mitigate asthma triggers in the home, with the goal of improving asthma outcomes in children.Research from CEET has exposed a significant disparity in elevated blood lead levels in children, depending on zip code.

Projects at the new center will expand on this research and apply evidence-based solutions to reduce lead poisoning in children. Past research from this group has also revealed that the Philadelphia-Reading-Camden Metropolitan Statistical Area is among the 25 worst for air pollution in the U.S., which has motivated the PRCCEH to address solutions to this dangerous health hazard. Finally, studies at Penn, CHOP, and other institutions worldwide show an increasing disease burden from endocrine disrupting chemicals — compounds found in household products and the environment that have been linked to preterm birth, obesity and diabetes, and neurodevelopmental disorders.The center’s programmatic, evidence-based solutions will be implemented throughout the region through collaboration with numerous community groups and nonprofits, including Children First, The Chester Environmental Partnership, Women for a Healthy Environment, Clean Water Action, and the Philadelphia Healthy Schools Initiative.

This project is supported by the National Institute of Environmental Health Sciences (1P2CES033428-01)..

Media AdvisoryFriday, March 25, 2022What The amygdala — a brain structure enlarged in two-year-old children helpful resources diagnosed with autism spectrum disorder (ASD) — begins its accelerated growth between 6 and 12 months of age, suggests a study funded by the National Institutes how to get prescribed cialis of Health. The amygdala is involved in processing emotions, such as interpreting facial expressions or feeling afraid when exposed to a threat. The findings indicate how to get prescribed cialis that therapies to reduce the symptoms of ASD might have the greatest chance of success if they begin in the first year of life, before the amygdala begins its accelerated growth.

The study included 408 infants, 270 of whom were at higher likelihood of ASD because they had an older sibling with ASD, 109 typically developing infants, and 29 infants with Fragile X syndrome, an inherited form of developmental and intellectual disability. The researchers conducted MRI how to get prescribed cialis scans of the children at 6, 12 and 24 months of age. They found that the 58 infants who went on to develop ASD had a normal-sized amygdala at 6 months, but an enlarged amygdala at 12 months and 24 months.

Moreover, the faster the rate of amygdala overgrowth, the greater the severity of ASD symptoms at 24 months. The infants with Fragile X syndrome had a distinct pattern of brain how to get prescribed cialis growth. They had no differences in amygdala growth but enlargement of another brain structure, the caudate, which was linked to increased repetitive behaviors.

The research team, part of the NIH Autism Centers of Excellence Infant Brain Imaging Study network, was led by Mark Shen, Ph.D., of the University of North Carolina at how to get prescribed cialis Chapel Hill and the Infant Brain Imaging Study. The study appears in the American Journal of Psychiatry. Funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National how to get prescribed cialis Institute of Environmental Health Sciences and National Institute of Mental Health.

The authors suggested that difficulty processing sensory information during infancy may stress the amygdala, leading to its overgrowth. ASD is a complex developmental disorder that affects how a person behaves, interacts with others, communicates and learns. Who Alice Kau, Ph.D., of the NICHD Intellectual and Developmental Disabilities how to get prescribed cialis Branch, is available for comment.

Article Shen, MD. Subcortical brain development in how to get prescribed cialis autism and fragile X syndrome. Evidence for dynamic, age-and disorder-specific trajectories in infancy.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). NICHD leads research and training to understand human development, improve reproductive health, enhance the lives of children and adolescents, and optimize abilities for all. For more information, visit https://www.nichd.nih.gov.About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S.

Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®###Children in the Greater Philadelphia area face a number of environmental threats to their health, including lead poisoning, asthma from air pollution, and exposure to endocrine disrupting chemicals. Now, with funding from the National Institute of Environmental Health Sciences, researchers from Children’s Hospital of Philadelphia (CHOP) and Penn Medicine have come together to address these hazards and protect children who live in the region’s most vulnerable communities.The Philadelphia Regional Center for Children's Environmental Health (PRCCEH) is a new children's center that will provide the infrastructure to integrate expertise from the two institutions, along with colleagues from Drexel University, Temple University, Thomas Jefferson University, Lehigh University, Franklin &. Marshall College, Villanova University and University of Delaware.

This is the first time that the region has been awarded funding for a Center for Children’s Environmental Health.“The center is an outgrowth of research from Penn’s Center of Excellence in Environmental Toxicology (CEET), its long-term collaborators, and its community partners. It has long been a vision to bring such a center to the region,” said CEET Director Trevor Penning, PhD.The mission of the center is threefold. To disseminate children's environmental health knowledge to health care providers, community members, and policy makers.

To develop, test and implement new programs. And to engage researchers and community partners to make policy, practice, and behavioral changes to reduce environmental exposures in early life. It will be led by directors Rebecca Simmons, MD, a professor of Pediatrics in the Perelman School of Medicine at the University of Pennsylvania and a neonatologist at CHOP, and Aimin Chen, MD, PhD, a professor of Epidemiology at Penn, along with deputy director Marilyn Howarth, MD, director of the Community Engagement Core in CEET.“This center will build on years of extensive research in environmental toxicology and pediatric health at both Penn and CHOP to make real, positive change in the lives of children throughout the region,” said Simmons.

€œWe already have many established connections within communities throughout Philadelphia, Delaware, and other counties, and this grant will allow us to strengthen and expand on those partnerships.”The center will focus on four primary research and translation areas. Asthma prevention, lead exposure and harm reduction, air pollution, and reduction of exposure to endocrine disrupting chemicals. Building on CHOP’s Community Asthma Prevention Program (CAPP) — a program designed by its Medical Director Tyra Bryant Stephens, MD, that has supported families of children with asthma in Philadelphia for more than 20 years — the center will expand the initiative to the city of Chester, providing education and supplies to help families mitigate asthma triggers in the home, with the goal of improving asthma outcomes in children.Research from CEET has exposed a significant disparity in elevated blood lead levels in children, depending on zip code.

Projects at the new center will expand on this research and apply evidence-based solutions to reduce lead poisoning in children. Past research from this group has also revealed that the Philadelphia-Reading-Camden Metropolitan Statistical Area is among the 25 worst for air pollution in the U.S., which has motivated the PRCCEH to address solutions to this dangerous health hazard. Finally, studies at Penn, CHOP, and other institutions worldwide show an increasing disease burden from endocrine disrupting chemicals — compounds found in household products and the environment that have been linked to preterm birth, obesity and diabetes, and neurodevelopmental disorders.The center’s programmatic, evidence-based solutions will be implemented throughout the region through collaboration with numerous community groups and nonprofits, including Children First, The Chester Environmental Partnership, Women for a Healthy Environment, Clean Water Action, and the Philadelphia Healthy Schools Initiative.

This project is supported by the National Institute of Environmental Health Sciences (1P2CES033428-01)..

What side effects may I notice from Cialis?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• breathing problems
• changes in hearing
• chest pain
• fast, irregular heartbeat

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• back pain
• dizziness
• flushing
• headache
• indigestion
• muscle aches
• stuffy or runny nose

This list may not describe all possible side effects.

Cialis best way to take

ELK CITY — One student throws http://www.alltra.co.uk/buy-amoxil-canada/ his classmates’ pencil box on cialis best way to take the floor in anger. Another bites her own arm out of frustration. Others run screaming from their classrooms cialis best way to take. Some Elk City Elementary School students are celebrating as summer break approaches.

Others are dreading the end of the school year, acting out in fear of what the next three months could bring. School counselor Kim Hamm worries about students who won’t have enough to eat this cialis best way to take summer. And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs.

And who will cialis best way to take spend their days anticipating the next attack from an abusive family member. Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home. “They know that, here, they’re safe and we’re not going cialis best way to take to hurt them,” Hamm said. €œAnd a lot of our kids, unfortunately, don’t go home to that every day.” About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry.

The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students face rates cialis best way to take of poverty, special needs and suicide higher than the state average. Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office. Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent.

(Courtesy photo) In her six years as a school counselor, Hamm has cialis best way to take learned to anticipate these needs, making more time towards the end of the school year to meet with students one-on-one. But she doesn’t always have the bandwidth. School counselors’ duties range from helping develop individualized cialis best way to take learning plans for students with special needs to proctoring the third-grade reading test. They enroll students in classes and ensure they meet state math and science requirements.

They provide college and career advice and help them find and apply for scholarships. They wrangle students during morning drop-off and afternoon pick-up, run school-sponsored food and clothes cialis best way to take pantries and teach breathing techniques to those with test anxiety. Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. Counselors refer the most troubled kids to community mental health counselors.

But they are cialis best way to take also in short supply especially in rural areas like Elk City where the ratio of mental healthcare providers to residents is 1 to 150,000. Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed. A federal program is increasing support for students in six rural school districts in what the state mental health and education departments call “mental health deserts.” But schools are finding it difficult to hire qualified cialis best way to take caregivers and erectile dysfunction treatment restrictions have halted programs and limited in-person treatment. Students are seen leaving Elk City Elementary School at the end of the school day.

School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma Watch) A Response Inspired By Sandy Hook Since 2018, the State Department of Education has received two U.S cialis best way to take. Department of Health and Human Services grants totaling $18 million. Oklahoma’s Project AWARE, short for Advancing Wellness and Resiliency in Education, is in its third year of the five-year grant at Woodward, Elk City and Weatherford Public Schools and its first year at Ada, Atoka and Checotah Public Schools.

Subscribe to Jennifer cialis best way to take Palmer's Education Watch newsletter Processing… Success!. You're on the list. Whoops! cialis best way to take. There was an error and we couldn't process your subscription.

Please reload the page and try again. The districts were chosen by the state department for cialis best way to take their lack of treatment providers and high-risk student populations. Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University. But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application.

These students are more susceptible to mental illness cialis best way to take. And without treatment, they can face even more dangerous obstacles as they age, often leading to their own violent encounters, substance abuse or incarceration. Subscribe to our First Watch cialis best way to take newsletter Processing… Success!. You're on the list.

Whoops!. There was an error and we cialis best way to take couldn't process your subscription. Please reload the page and try again. In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012.

Since then, cialis best way to take the Substance Abuse and Mental Health Services Administration has sent millions to schools nationwide with high-risk students to prevent violence perpetrated by young people. This story was reported in partnership with the Solutions Journalism Network. For more cialis best way to take information, go to solutionsjournalism.org. In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff.

At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the cialis. Community events aim to reduce stigma around mental health challenges and treatment cialis best way to take and teach parents and students about healthy habits like the importance of sleep and recommendations for social media use. Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation. Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out.

Community mental health counselors had started to meet with troubled students in cialis best way to take some of the Western Oklahoma schools. Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of cialis best way to take these services were paused due to erectile dysfunction treatment. Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent.

The grant also trained educators at all six districts in a classroom program that teaches conflict resolution and empathy. Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens cialis best way to take as her students rate how they’re feeling at the end of the day. Henthorn checks in with her students twice a day through a program known as Circles that she says teaches students coping skills and empathy. (Whitney Bryen/Oklahoma Watch) Just before the bell rang on a Monday afternoon, kindergarteners sat in a circle on a rug at the front of Liz Henthorn’s classroom at Elk City Elementary School.

One-by-one the students rated cialis best way to take how they’re feeling as they prepared to go home. They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice. One student said he was feeling sad because his dog ran away that morning. Another student was feeling red cialis best way to take because she had a bad dream.

Other students spoke up saying they could relate or that they’re sorry that happened. “We’re cialis best way to take teaching kids to identify their feelings and giving suggestions to cope,” Henthorn said. €œAnd when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.” Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch) Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation.

But few are qualified to help more critical students, cialis best way to take like those with mental illness or who have experienced trauma. Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%. In Elk City, 140 of the district’s 2,110 students had a cialis best way to take parent who was incarcerated.

And all three Western Oklahoma districts had higher than average suicide rates. Those districts rely on school counselors to support these students, though cialis best way to take most lack the training. And the grant does not address the ratio of counselors to students, which is far above national recommendations. Districts also planned to increase referrals to community treatment centers facilitated by the grant.

Demand for mental cialis best way to take health care spiked during the cialis, further straining the area’s providers and leaving families with few options. Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch) The Complicated Search for Counselors School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors can provide therapy and diagnose students with cialis best way to take mental illness.

Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors. Each district hired one licensed mental health cialis best way to take provider who serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed. The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams.

Training for licensed professional counselors requires an additional 60 graduate-level college hours and 3,000 hours of cialis best way to take supervised counseling. Counselors must also pass an exam before being licensed. Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include fees cialis best way to take for supervision or the licensing exam.

The grant will pay tuition costs for school counselors to get their license. Only two of 16 school counselors in Elk City, Weatherford and Woodward have taken the offer cialis best way to take. School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion. “I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old.

€œIf I was going to make more as a school counselor with it then maybe I would, but I’m not going to so I’m just not going to spend a whole lot of time to get that.” For school counselors who do get cialis best way to take their license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the cialis. Oklahoma has 1,841 school counselors cialis best way to take and nearly 695,000 students, according to State Department of Education reports.

The department does not track how many school counselors have their professional counseling license. The American School Counselor Association recommends a ratio of cialis best way to take 1 school counselor to 250 students. Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools.

Not cialis best way to take every school has a dedicated counselor. Some have teams depending on student population, how schools prioritize funding and disperse tasks. The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch interviewed 10 counselors across cialis best way to take the state.

Most said they spend the majority of their day doing clerical work. Depending on cialis best way to take the time of year, about 20 to 50% of their time is spent with students. Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration. Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation.

€œA lot of what I deal with are the results of families who are in crisis, where there’s addiction, other issues that are related to poverty and the kids show up to school and there’s cialis best way to take a lot of fallout from that,” Moss said. €œAnd so we have kids who are depressed. We’ve had kids who are suicidal. Anxieties are really high.” Lora Anderson, a school counselor at Ada Junior High School, talks to students cialis best way to take about online enrollment and how to choose classes for next school year.

(Courtesy photo) Moss is one of two school counselors taking advantage of Project AWARE funding to get her professional counseling license. Her principal took over her ACT and pre-ACT testing, scheduling and enrollment duties allowing Moss to spend more time cialis best way to take with students in crisis. “I would love to see even more taken off of the shoulders of counselors so that we could take care of our kids’ needs better,” Moss said. €œBut I truly feel blessed here that I am not overwhelmed, like so many counselors.” At Ada Junior High School, counselor Lora Anderson spends about 25% of her time working with troubled students.

Many school counselors go into the job to propel students’ academic success, not to cialis best way to take provide therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs. €œThat’s not what I want to do,” Anderson said after returning to her desk from lunch duty. €œI do so many different things cialis best way to take to help students.

If I wanted to be a mental health counselor, I wouldn’t work in a school.” Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students. (Courtesy photo) Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license. But based on training she’s attended and led over the years, cialis best way to take Taylor said it’s likely that about 1 in 5 school counselors goes on to become licensed. School counselors are serving dual roles whether they want to or not.

Like swim instructors at a pool, most school counselors see their role as building stronger cialis best way to take swimmers. But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids. “Counselors in rural schools tend to be treading more water,” Taylor said. €œSome folks are so overwhelmed with the job they have, cialis best way to take they don’t have the time or the motivation to seek out additional training.

It’s just not accessible for folks.” Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. She said the job has changed a lot since she cialis best way to take started. Test requirements are constantly evolving.

College admissions and scholarship cialis best way to take applications seem to get longer every year. And students want to talk more. Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the cialis, Taylor said. And school cialis best way to take counselors have to be ready to listen and help.

“I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said. €œThat’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.” Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said cialis best way to take since the erectile dysfunction cialis began, her students seem more anxious and depressed than ever. (Whitney Bryen/Oklahoma Watch) Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by erectile dysfunction treatment.

Contact her at (405) 201-6057 or cialis best way to take wbryen@oklahomawatch.org. Follow her on Twitter @SoonerReporter. Support our publicationEvery day we strive to produce journalism that matters — stories that strengthen accountability and transparency, provide value and resonate with readers like you.This work is essential to a better-informed community and a healthy democracy. But it isn’t cialis best way to take possible without your support.

Donate nowMore than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The cialis has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire. It may have the smallest population in America, but cialis best way to take when it comes to land, Wyoming is the ninth-largest. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here.

While there is vast open space, the nearest major trauma hospital is more than 2.5 cialis best way to take hours away. On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival. It's a fact Luke Sypherd knows all too cialis best way to take well.

For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve. "We just cialis best way to take saw that we didn't have the personnel to continue," Sypherd said. "It was an ongoing problem made worse by erectile dysfunction treatment with fewer people interested in volunteering with EMS during a cialis and patients afraid of getting taken to a hospital."A nearby hospital system, Cody Regional Health, has agreed to provide ambulance service for Washakie County, averting a crisis.

But it's a problem playing out cialis best way to take across rural America. Ambulance crews are running out of money and volunteers.Phillip Franklin, the EMS Director for Cody Regional Health, said the crisis is a result of several problems."The majority of the ambulance service staff are not paid so if you don't have your volunteers, they can't run calls," Franklin said. "Another problem is that there's simply just not enough volume to keep ambulance service afloat and in the state of Wyoming, EMS is not essential, which means there's nobody responsible to fund these entities."Sypherd said the funding model for EMS is fundamentally flawed, with most service providers reimbursed only if they take patients to a hospital or clinic. In rural areas like Washakie County, smaller populations mean fewer calls, and consequently, less cialis best way to take money.

"You're reimbursed based on the number of patients that you transport to a hospital so you could get called 1,000 times a year and only transport 750 patients -- those other 250 calls you made no money on," Sypherd said. Plea for federal assistanceThe American Ambulance Association sent a letter earlier this month to the US Department of Health and Human Services asking the agency to earmark $1.425 billion in federal aid for its members, warning that emergency medical systems across the US are "on the brink of collapse.""It is critical that we not let the financial hardship caused by the cialis to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National Association of State EMS Officials, just eight states consider local emergency medical services "essential" by law, as they do for fire and cialis best way to take police. "That mandate means that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said.

"If you're in one of cialis best way to take the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year away from closure."'A matter of life and death'One of those is Fremont County -- home to the Wind River Indian Reservation. Fremont is roughly the size of the state of Vermont. An economic downturn and budget cuts prompted the county to privatize its ambulance service in 2016.

But the private company, American Medical Response, says it can't afford to keep going after losing $1.5 million in revenue last year. AMR announced it won't renew its contract when it runs out on June 30. No others have bid. "We just couldn't renew that current contract because it was set up for a financial failure," said Matt Strauss, Regional Director for AMR parent company, Global Medical Response.

One of the problems, according to Fremont County Commissioner Larry Allen, is the so-called payer mix. Many of the county's residents rely on Medicare, Medicaid and Indian Health Services, which reimburse ambulance providers at a lower rate. And without state or federal designation of EMS as an essential service, Allen said "there's no source of revenue to operate an ambulance.""Because of the distance and the ruralness of this county, we just don't have people standing in line wanting to provide ambulance service," Allen said. The Wind River Indian Reservation stretches across more than 2 million acres and is shared by two Native American tribes, the Eastern Shoshone and the Northern Arapaho.

It has three tiny clinics but no ambulance services and relies on Fremont County for EMS. "Right now the response time is pretty slow and it's going to be nonexistent," said Northern Arapaho tribal member Juan Willow. His grandfather struggled with health problems and Willow said there were many times when the family couldn't wait for an ambulance and had to find other ways of getting to the hospital. "Not everyone here has a car," he said.It's a concern shared by Jordan Dresser, the chairman of the Northern Arapaho Tribe."I think if we didn't have access to ambulances, death rates would be higher," said Dresser, adding that many tribal members don't have working vehicles and therefore can't take themselves to the hospital or clinics.

ELK CITY how to get prescribed cialis next page — One student throws his classmates’ pencil box on the floor in anger. Another bites her own arm out of frustration. Others run screaming how to get prescribed cialis from their classrooms.

Some Elk City Elementary School students are celebrating as summer break approaches. Others are dreading the end of the school year, acting out in fear of what the next three months could bring. School counselor Kim Hamm worries about students who won’t have enough to how to get prescribed cialis eat this summer.

And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs. And who will spend their days anticipating how to get prescribed cialis the next attack from an abusive family member.

Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home. “They know that, here, they’re safe how to get prescribed cialis and we’re not going to hurt them,” Hamm said. €œAnd a lot of our kids, unfortunately, don’t go home to that every day.” About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry.

The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students face rates of poverty, special needs and suicide how to get prescribed cialis higher than the state average. Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office.

Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent. (Courtesy photo) In her six years as a school counselor, Hamm has learned to anticipate these needs, making more time towards the end of the how to get prescribed cialis school year to meet with students one-on-one. But she doesn’t always have the bandwidth.

School counselors’ how to get prescribed cialis duties range from helping develop individualized learning plans for students with special needs to proctoring the third-grade reading test. They enroll students in classes and ensure they meet state math and science requirements. They provide college and career advice and help them find and apply for scholarships.

They wrangle students during morning drop-off and afternoon pick-up, run school-sponsored food and clothes pantries and teach how to get prescribed cialis breathing techniques to those with test anxiety. Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. Counselors refer the most troubled kids to community mental health counselors.

But they are also in short supply especially in rural areas how to get prescribed cialis like Elk City where the ratio of mental healthcare providers to residents is 1 to 150,000. Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed. A federal program is increasing support for students in six rural school districts in what the state mental how to get prescribed cialis health and education departments call “mental health deserts.” But schools are finding it difficult to hire qualified caregivers and erectile dysfunction treatment restrictions have halted programs and limited in-person treatment.

Students are seen leaving Elk City Elementary School at the end of the school day. School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma Watch) A Response how to get prescribed cialis Inspired By Sandy Hook Since 2018, the State Department of Education has received two U.S.

Department of Health and Human Services grants totaling $18 million. Oklahoma’s Project AWARE, short for Advancing Wellness and Resiliency in Education, is in its third year of the five-year grant at Woodward, Elk City and Weatherford Public Schools and its first year at Ada, Atoka and Checotah Public Schools. Subscribe to Jennifer how to get prescribed cialis Palmer's Education Watch newsletter Processing… Success!.

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Please reload the page and try again. The districts were chosen by the state department for their lack of treatment providers and high-risk how to get prescribed cialis student populations. Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University.

But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application. These students are more how to get prescribed cialis susceptible to mental illness. And without treatment, they can face even more dangerous obstacles as they age, often leading to their own violent encounters, substance abuse or incarceration.

Subscribe to how to get prescribed cialis our First Watch newsletter Processing… Success!. You're on the list. Whoops!.

There was how to get prescribed cialis an error and we couldn't process your subscription. Please reload the page and try again. In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012.

Since then, the Substance Abuse and Mental Health Services Administration has sent millions to schools nationwide with high-risk students to prevent violence how to get prescribed cialis perpetrated by young people. This story was reported in partnership with the Solutions Journalism Network. For more information, how to get prescribed cialis go to solutionsjournalism.org.

In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff. At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the cialis. Community events aim to reduce stigma around how to get prescribed cialis mental health challenges and treatment and teach parents and students about healthy habits like the importance of sleep and recommendations for social media use.

Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation. Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out. Community mental health counselors had started to meet with how to get prescribed cialis troubled students in some of the Western Oklahoma schools.

Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of these services were paused due how to get prescribed cialis to erectile dysfunction treatment. Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent.

The grant also trained educators at all six districts in a classroom program that teaches conflict resolution and empathy. Liz Henthorn, a kindergarten teacher at Elk City how to get prescribed cialis Elementary School, listens as her students rate how they’re feeling at the end of the day. Henthorn checks in with her students twice a day through a program known as Circles that she says teaches students coping skills and empathy.

(Whitney Bryen/Oklahoma Watch) Just before the bell rang on a Monday afternoon, kindergarteners sat in a circle on a rug at the front of Liz Henthorn’s classroom at Elk City Elementary School. One-by-one the students how to get prescribed cialis rated how they’re feeling as they prepared to go home. They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice.

One student said he was feeling sad because his dog ran away that morning. Another student how to get prescribed cialis was feeling red because she had a bad dream. Other students spoke up saying they could relate or that they’re sorry that happened.

“We’re teaching kids to identify their feelings and how to get prescribed cialis giving suggestions to cope,” Henthorn said. €œAnd when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.” Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch) Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation.

But few are qualified to how to get prescribed cialis help more critical students, like those with mental illness or who have experienced trauma. Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%.

In Elk City, 140 of the district’s how to get prescribed cialis 2,110 students had a parent who was incarcerated. And all three Western Oklahoma districts had higher than average suicide rates. Those districts rely on school counselors to support these how to get prescribed cialis students, though most lack the training.

And the grant does not address the ratio of counselors to students, which is far above national recommendations. Districts also planned to increase referrals to community treatment centers facilitated by the grant. Demand for mental health care spiked during the cialis, further straining the area’s how to get prescribed cialis providers and leaving families with few options.

Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch) The Complicated Search for Counselors School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors can provide therapy and diagnose students with mental illness how to get prescribed cialis.

Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors. Each district hired one licensed mental health provider who how to get prescribed cialis serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed.

The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams. Training for licensed how to get prescribed cialis professional counselors requires an additional 60 graduate-level college hours and 3,000 hours of supervised counseling. Counselors must also pass an exam before being licensed.

Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include fees for supervision or the licensing exam how to get prescribed cialis. The grant will pay tuition costs for school counselors to get their license.

Only two of 16 school counselors how to get prescribed cialis in Elk City, Weatherford and Woodward have taken the offer. School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion. “I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old.

€œIf I was going to make more as a school counselor with it then maybe I would, but I’m not going to so I’m just not how to get prescribed cialis going to spend a whole lot of time to get that.” For school counselors who do get their license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the cialis.

Oklahoma has 1,841 school counselors and nearly 695,000 students, according to State Department how to get prescribed cialis of Education reports. The department does not track how many school counselors have their professional counseling license. The American how to get prescribed cialis School Counselor Association recommends a ratio of 1 school counselor to 250 students.

Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools. Not every how to get prescribed cialis school has a dedicated counselor.

Some have teams depending on student population, how schools prioritize funding and disperse tasks. The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch how to get prescribed cialis interviewed 10 counselors across the state.

Most said they spend the majority of their day doing clerical work. Depending on the time of year, about 20 to 50% of their time how to get prescribed cialis is spent with students. Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration.

Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation. €œA lot of what I deal with are the results of families who are in crisis, where there’s addiction, other issues that how to get prescribed cialis are related to poverty and the kids show up to school and there’s a lot of fallout from that,” Moss said. €œAnd so we have kids who are depressed.

We’ve had kids who are suicidal. Anxieties are really high.” Lora Anderson, a school counselor at Ada Junior High School, talks to students about online enrollment and how to choose classes for next school how to get prescribed cialis year. (Courtesy photo) Moss is one of two school counselors taking advantage of Project AWARE funding to get her professional counseling license.

Her principal took over how to get prescribed cialis her ACT and pre-ACT testing, scheduling and enrollment duties allowing Moss to spend more time with students in crisis. “I would love to see even more taken off of the shoulders of counselors so that we could take care of our kids’ needs better,” Moss said. €œBut I truly feel blessed here that I am not overwhelmed, like so many counselors.” At Ada Junior High School, counselor Lora Anderson spends about 25% of her time working with troubled students.

Many school counselors go into the job to propel how to get prescribed cialis students’ academic success, not to provide therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs. €œThat’s not what I want to do,” Anderson said after returning to her desk from lunch duty.

€œI do so many different things how to get prescribed cialis to help students. If I wanted to be a mental health counselor, I wouldn’t work in a school.” Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students. (Courtesy photo) Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license.

But based on training she’s attended and led over the years, Taylor how to get prescribed cialis said it’s likely that about 1 in 5 school counselors goes on to become licensed. School counselors are serving dual roles whether they want to or not. Like swim instructors at a pool, most school counselors see their role as building how to get prescribed cialis stronger swimmers.

But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids. “Counselors in rural schools tend to be treading more water,” Taylor said. €œSome folks are so overwhelmed with the job they have, they how to get prescribed cialis don’t have the time or the motivation to seek out additional training.

It’s just not accessible for folks.” Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. She said the job has changed a lot since how to get prescribed cialis she started.

Test requirements are constantly evolving. College admissions how to get prescribed cialis and scholarship applications seem to get longer every year. And students want to talk more.

Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the cialis, Taylor said. And school counselors have to be ready to listen and help how to get prescribed cialis. “I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said.

€œThat’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.” Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said since the erectile dysfunction cialis began, her students seem how to get prescribed cialis more anxious and depressed than ever. (Whitney Bryen/Oklahoma Watch) Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by erectile dysfunction treatment.

Contact her at how to get prescribed cialis (405) 201-6057 or wbryen@oklahomawatch.org. Follow her on Twitter @SoonerReporter. Support our publicationEvery day we strive to produce journalism that matters — stories that strengthen accountability and transparency, provide value and resonate with readers like you.This work is essential to a better-informed community and a healthy democracy.

But it how to get prescribed cialis isn’t possible without your support. Donate nowMore than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The cialis has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire.

It may have the smallest population in America, but when it comes to land, how to get prescribed cialis Wyoming is the ninth-largest. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here. While there is vast open space, the nearest major trauma hospital is more than 2.5 hours how to get prescribed cialis away.

On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival. It's a fact Luke how to get prescribed cialis Sypherd knows all too well.

For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve. "We just saw how to get prescribed cialis that we didn't have the personnel to continue," Sypherd said.

"It was an ongoing problem made worse by erectile dysfunction treatment with fewer people interested in volunteering with EMS during a cialis and patients afraid of getting taken to a hospital."A nearby hospital system, Cody Regional Health, has agreed to provide ambulance service for Washakie County, averting a crisis. But it's a problem playing out how to get prescribed cialis across rural America. Ambulance crews are running out of money and volunteers.Phillip Franklin, the EMS Director for Cody Regional Health, said the crisis is a result of several problems."The majority of the ambulance service staff are not paid so if you don't have your volunteers, they can't run calls," Franklin said.

"Another problem is that there's simply just not enough volume to keep ambulance service afloat and in the state of Wyoming, EMS is not essential, which means there's nobody responsible to fund these entities."Sypherd said the funding model for EMS is fundamentally flawed, with most service providers reimbursed only if they take patients to a hospital or clinic. In rural areas like Washakie County, smaller populations mean fewer calls, and consequently, less money how to get prescribed cialis. "You're reimbursed based on the number of patients that you transport to a hospital so you could get called 1,000 times a year and only transport 750 patients -- those other 250 calls you made no money on," Sypherd said.

Plea for federal assistanceThe American Ambulance Association sent a letter earlier this month to the US Department of Health and Human Services asking the agency to earmark $1.425 billion in federal aid for its members, warning that emergency medical systems across the US are "on the brink of collapse.""It is critical that we not let the financial hardship caused by the cialis to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National Association how to get prescribed cialis of State EMS Officials, just eight states consider local emergency medical services "essential" by law, as they do for fire and police. "That mandate means that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said.

"If you're in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year away from closure."'A matter of life and death'One of those is Fremont County -- home to the Wind River Indian Reservation. Fremont is roughly the size of the state of Vermont.

An economic downturn and budget cuts prompted the county to privatize its ambulance service in 2016. But the private company, American Medical Response, says it can't afford to keep going after losing $1.5 million in revenue last year. AMR announced it won't renew its contract when it runs out on June 30.

No others have bid. "We just couldn't renew that current contract because it was set up for a financial failure," said Matt Strauss, Regional Director for AMR parent company, Global Medical Response. One of the problems, according to Fremont County Commissioner Larry Allen, is the so-called payer mix.

Many of the county's residents rely on Medicare, Medicaid and Indian Health Services, which reimburse ambulance providers at a lower rate. And without state or federal designation of EMS as an essential service, Allen said "there's no source of revenue to operate an ambulance.""Because of the distance and the ruralness of this county, we just don't have people standing in line wanting to provide ambulance service," Allen said. The Wind River Indian Reservation stretches across more than 2 million acres and is shared by two Native American tribes, the Eastern Shoshone and the Northern Arapaho.

It has three tiny clinics but no ambulance services and relies on Fremont County for EMS. "Right now the response time is pretty slow and it's going to be nonexistent," said Northern Arapaho tribal member Juan Willow. His grandfather struggled with health problems and Willow said there were many times when the family couldn't wait for an ambulance and had to find other ways of getting to the hospital.

"Not everyone here has a car," he said.It's a concern shared by Jordan Dresser, the chairman of the Northern Arapaho Tribe."I think if we didn't have access to ambulances, death rates would be higher," said Dresser, adding that many tribal members don't have working vehicles and therefore can't take themselves to the hospital or clinics. "It's a matter of life and death for us.".

Cialis 40mg

In rural areas, some cialis 40mg small hospitals have closed or shut down services in recent years, partly because they haven’t been able to attract and retain doctors, nurses, and other clinicians. Despite loan forgiveness and other incentives, clinicians are hesitant to venture into unknown territory, remaining instead in areas of the country where they were raised or trained. And many of those who do go to rural areas don’t stay long. Across the cialis 40mg country, clinician complaints have historically landed on payment for services, but the problem goes far beyond money.

Indeed, caring for patients during the cialis has drawn attention to quality of life, mental health, physical health, and safety issues. During the cialis, hospital nurses, for example, have routinely worked long hours to cover for sick colleagues, donned uncomfortable PPE, and been exposed to an unpredictable cialis. BPC’s April 2020 report, Confronting Rural America’s Health Care cialis 40mg Crisis, demonstrates how workforce shortages can impact a community—particularly rural communities, which are especially hard hit by shortages. While urban areas have 53 primary care physicians for every 100,000 people, rural areas have only 40 primary care physicians to care for the same number of people.

The numbers are similar for nurse practitioners, physician assistants, and dentists. For specialists, cialis 40mg the discrepancy is alarming. While urban areas have 263 specialists per 100,000 people, rural areas struggle with only 30 specialists. Part of the problem is aging.

Nearly one-third of primary care providers in rural cialis 40mg areas were older than 56 in 2009. Because rural communities rely heavily on primary care clinicians, it is troublesome that only 12% of medical students are entering primary care residencies, and most of those graduates will not choose rural America as their home. Fast forward to the cialis. Rural hospital CEOs tell BPC that the nursing exodus is leaving them in dire cialis 40mg straits.

Many rural hospitals already experience year over year losses and even if they don’t close, many are considering ceasing important services, such as obstetrics and maternal care, if they haven’t already done so. While some hospitals are already struggling to make ends meet, one rural hospital CEO indicated that the nursing shortage is costing them an additional $2 to $3 million a year because they must pay for travel nurses, which costs them two to three times more than staff nurses.Start Preamble National Telecommunications and Information Administration, U.S. Department of cialis 40mg Commerce. Start Printed Page 7824 Notice.

The National Telecommunications and Information Administration (NTIA) issues this Notice to initiate the annual process to seek expressions of interest from individuals who would like to serve on the Board of the First Responder Network Authority (FirstNet Authority Board or Board). The term of one of the 12 non-permanent members cialis 40mg to the FirstNet Authority Board will be available for appointment or reappointment in 2022. To be considered for the calendar year 2022 appointment, expressions of interest must be electronically transmitted on or before March 14, 2022. Applicants should submit expressions of interest as described below to.

Michael Dame, Acting Associate Administrator, Office of Public Safety Communications, National Telecommunications cialis 40mg and Information Administration, by email to FirstNetBoardApplicant@ntia.gov. Start Further Info Michael Dame, Acting Associate Administrator, Office of Public Safety Communications, National Telecommunications and Information Administration. Telephone. (202) 482-1181 cialis 40mg.

Email. Mdame@ntia.gov. Please direct media inquiries to cialis 40mg NTIA's Office of Public Affairs, (202) 482-7002. End Further Info End Preamble Start Supplemental Information I.

Background and Authority The Middle Class Tax Relief and Job Creation Act of 2012 (Act) created the First Responder Network Authority (FirstNet Authority) as an independent authority within NTIA. The Act charged the FirstNet Authority with ensuring the building, deployment, and operation of a nationwide, interoperable public safety broadband network, based on a single, national network architecture.[] The cialis 40mg FirstNet Authority holds the single nationwide public safety license granted for wireless public safety broadband deployment. The FirstNet Authority Board is responsible for providing overall policy direction and oversight of FirstNet to ensure that the nationwide network continuously meets the needs of public safety. II.

Structure The FirstNet Authority cialis 40mg Board is composed of 15 voting members. The Act names the Secretary of Homeland Security, the Attorney General of the United States, and the Director of the Office of Management and Budget as permanent members of the FirstNet Authority Board. The Secretary of Commerce (Secretary) appoints the 12 non-permanent members of the FirstNet Authority Board.[] The Act requires each Board member to have experience or expertise in at least one of the following substantive areas. Public safety, network, technical, and/or financial.[] Additionally, the composition of the cialis 40mg FirstNet Authority Board must satisfy the other requirements specified in the Act, including that.

(i) At least three members have served as public safety professionals. (ii) at least three members represent the collective interests of states, localities, tribes, and territories. And (iii) its members reflect geographic and regional, as cialis 40mg well as rural and urban, representation.[] An individual Board member may satisfy more than one of these requirements. The current non-permanent FirstNet Authority Board members are (noting expiration of term).

Karima Holmes, Senior Director, ShotSpotter, Inc.. 911 professional (Term expires cialis 40mg. August 2022) Board Chair Stephen Benjamin, Former Mayor, Columbia, SC (Term expires. September 2024) Richard Carrizzo, Fire Chief, Southern Platte Fire Protection District, MO (Term expires.

September 2024) Brian Crawford, cialis 40mg SVP/Chief Administrative Officer for Willis-Knighton Health System and retired Fire Chief and Municipal Government Executive (Term expires. September 2024) Alexandra Fernandez Navarro, Former Associate Member, Puerto Rico Public Service Regulatory Board (Term expires. September 2024) Kristin Graziano, Sheriff, Charleston County, SC (Term expires. September 2024) Billy Hewes, Mayor, Gulfport, MS cialis 40mg (Term expires.

September 2024) Peter Koutoujian, Sheriff, Middlesex County, MA (Term expires. September 2024) Warren Mickens, Retired technology executive (Term expires. September 2024) Sylvia Moir, cialis 40mg Retired Police Chief (Term expires. September 2024) Jocelyn Moore, Independent Director, DraftKings (Term expires.

September 2024) Paul Patrick, Division Director, Family Health and Preparedness, Utah Department of Health (Term expires. September 2024) Any Board member whose term has expired may serve until such member's successor has taken office, or until the end of the calendar year in which cialis 40mg such member's term has expired, whichever is earlier.[] Board members will be appointed for a term of three years.[] Board members may not serve more than two consecutive full three-year terms.[] More information about the FirstNet Authority Board is available at www.firstnet.gov/​about/​Board. III. Compensation and Status as Government Employees FirstNet Authority Board members are appointed as government employees.

FirstNet Authority Board members are compensated at the daily rate of basic pay for level IV of the Executive Schedule (approximately $176,300 per year) for each day worked on the FirstNet Authority Board.[] Board members work intermittent schedules and may not work more than 130 days cialis 40mg per year during their term. Each Board member must be a United States citizen, cannot be a registered lobbyist, and cannot be a registered agent of, employed by, or receive payments from, a foreign government.[] IV. Financial Disclosure and Conflicts of Interest FirstNet Authority Board members must comply with certain federal conflict of interest statutes and ethics regulations, including some financial disclosure requirements. A FirstNet Authority Board member will generally be prohibited from participating on any particular FirstNet Authority matter that will have a cialis 40mg direct and predictable effect on his or her personal financial interests or on the interests of the appointee's spouse, minor children, or non-federal employer.

V. Selection Process At the direction of the Secretary, NTIA will conduct outreach to the public safety community, state and local organizations, and industry to solicit nominations for candidates to the Board who satisfy the statutory requirements for membership. In addition, the Secretary, through NTIA, will cialis 40mg accept expressions of interest from any Start Printed Page 7825 individual, or from any organization proposing a candidate who satisfies the statutory requirements for membership on the FirstNet Authority Board. To be considered for a calendar year 2022 appointment, expressions of interest must be electronically transmitted on or before March 14, 2022.

All parties submitting an expression of interest should submit the candidate's (i) full name, title, organization, address, telephone number, email address. (ii) current resume.

Across the how to get prescribed cialis country, clinician complaints have historically landed on payment for services, but the problem goes far beyond money. Indeed, caring for patients during the cialis has drawn attention to quality of life, mental health, physical health, and safety issues. During the cialis, hospital nurses, for example, have routinely worked long hours to cover for sick colleagues, donned uncomfortable PPE, and been exposed to an unpredictable cialis. BPC’s April 2020 report, Confronting Rural America’s Health Care Crisis, demonstrates how workforce shortages how to get prescribed cialis can impact a community—particularly rural communities, which are especially hard hit by shortages. While urban areas have 53 primary care physicians for every 100,000 people, rural areas have only 40 primary care physicians to care for the same number of people.

The numbers are similar for nurse practitioners, physician assistants, and dentists. For specialists, the discrepancy is how to get prescribed cialis alarming. While urban areas have 263 specialists per 100,000 people, rural areas struggle with only 30 specialists. Part of the problem is aging. Nearly one-third of primary care providers in rural areas were older than 56 in 2009 how to get prescribed cialis.

Because rural communities rely heavily on primary care clinicians, it is troublesome that only 12% of medical students are entering primary care residencies, and most of those graduates will not choose rural America as their home. Fast forward to the cialis. Rural hospital CEOs tell BPC that the nursing exodus is leaving how to get prescribed cialis them in dire straits. Many rural hospitals already experience year over year losses and even if they don’t close, many are considering ceasing important services, such as obstetrics and maternal care, if they haven’t already done so. While some hospitals are already struggling to make ends meet, one rural hospital CEO indicated that the nursing shortage is costing them an additional $2 to $3 million a year because they must pay for travel nurses, which costs them two to three times more than staff nurses.Start Preamble National Telecommunications and Information Administration, U.S.

Department of how to get prescribed cialis Commerce. Start Printed Page 7824 Notice. The National Telecommunications and Information Administration (NTIA) issues this Notice to initiate the annual process to seek expressions of interest from individuals who would like to serve on the Board of the First Responder Network Authority (FirstNet Authority Board or Board). The term of one of the 12 non-permanent members to the FirstNet Authority Board will be available for appointment or reappointment in 2022 how to get prescribed cialis. To be considered for the calendar year 2022 appointment, expressions of interest must be electronically transmitted on or before March 14, 2022.

Applicants should submit expressions of interest as described below to. Michael Dame, Acting Associate Administrator, Office of Public Safety Communications, National Telecommunications and Information Administration, how to get prescribed cialis by email to FirstNetBoardApplicant@ntia.gov. Start Further Info Michael Dame, Acting Associate Administrator, Office of Public Safety Communications, National Telecommunications and Information Administration. Telephone. (202) 482-1181 how to get prescribed cialis.

Email. Mdame@ntia.gov. Please direct media inquiries how to get prescribed cialis to NTIA's Office of Public Affairs, (202) 482-7002. End Further Info End Preamble Start Supplemental Information I. Background and Authority The Middle Class Tax Relief and Job Creation Act of 2012 (Act) created the First Responder Network Authority (FirstNet Authority) as an independent authority within NTIA.

The Act charged the FirstNet Authority with ensuring the building, deployment, and operation of a nationwide, how to get prescribed cialis interoperable public safety broadband network, based on a single, national network architecture.[] The FirstNet Authority holds the single nationwide public safety license granted for wireless public safety broadband deployment. The FirstNet Authority Board is responsible for providing overall policy direction and oversight of FirstNet to ensure that the nationwide network continuously meets the needs of public safety. II. Structure The FirstNet Authority Board is composed of 15 voting how to get prescribed cialis members. The Act names the Secretary of Homeland Security, the Attorney General of the United States, and the Director of the Office of Management and Budget as permanent members of the FirstNet Authority Board.

The Secretary of Commerce (Secretary) appoints the 12 non-permanent members of the FirstNet Authority Board.[] The Act requires each Board member to have experience or expertise in at least one of the following substantive areas. Public safety, network, technical, and/or financial.[] Additionally, the composition of the FirstNet Authority Board must satisfy the other requirements specified in how to get prescribed cialis the Act, including that. (i) At least three members have served as public safety professionals. (ii) at least three members represent the collective interests of states, localities, tribes, and territories. And (iii) its members reflect geographic and regional, as well as rural and urban, representation.[] An individual Board member may satisfy more than how to get prescribed cialis one of these requirements.

The current non-permanent FirstNet Authority Board members are (noting expiration of term). Karima Holmes, Senior Director, ShotSpotter, Inc.. 911 professional how to get prescribed cialis (Term expires. August 2022) Board Chair Stephen Benjamin, Former Mayor, Columbia, SC (Term expires. September 2024) Richard Carrizzo, Fire Chief, Southern Platte Fire Protection District, MO (Term expires.

September 2024) Brian Crawford, SVP/Chief Administrative Officer for Willis-Knighton Health System and retired Fire Chief and Municipal how to get prescribed cialis Government Executive (Term expires. September 2024) Alexandra Fernandez Navarro, Former Associate Member, Puerto Rico Public Service Regulatory Board (Term expires. September 2024) Kristin Graziano, Sheriff, Charleston County, SC (Term expires. September 2024) Billy Hewes, Mayor, Gulfport, MS (Term expires how to get prescribed cialis. September 2024) Peter Koutoujian, Sheriff, Middlesex County, MA (Term expires.

September 2024) Warren Mickens, Retired technology executive (Term expires. September 2024) Sylvia Moir, how to get prescribed cialis Retired Police Chief (Term expires. September 2024) Jocelyn Moore, Independent Director, DraftKings (Term expires. September 2024) Paul Patrick, Division Director, Family Health and Preparedness, Utah Department of Health (Term expires. September 2024) Any Board member whose term how to get prescribed cialis has expired may serve until such member's successor has taken office, or until the end of the calendar year in which such member's term has expired, whichever is earlier.[] Board members will be appointed for a term of three years.[] Board members may not serve more than two consecutive full three-year terms.[] More information about the FirstNet Authority Board is available at www.firstnet.gov/​about/​Board.

III. Compensation and Status as Government Employees FirstNet Authority Board members are appointed as government employees. FirstNet Authority Board members are compensated at the daily rate of basic pay for level IV of the Executive Schedule (approximately $176,300 per year) for each day worked on the FirstNet Authority Board.[] Board members how to get prescribed cialis work intermittent schedules and may not work more than 130 days per year during their term. Each Board member must be a United States citizen, cannot be a registered lobbyist, and cannot be a registered agent of, employed by, or receive payments from, a foreign government.[] IV. Financial Disclosure and Conflicts of Interest FirstNet Authority Board members must comply with certain federal conflict of interest statutes and ethics regulations, including some financial disclosure requirements.

A FirstNet Authority Board member will generally be prohibited from participating on any particular FirstNet Authority matter that will have a direct and predictable effect on his or her personal financial how to get prescribed cialis interests or on the interests of the appointee's spouse, minor children, or non-federal employer. V. Selection Process At the direction of the Secretary, NTIA will conduct outreach to the public safety community, state and local organizations, and industry to solicit nominations for candidates to the Board who satisfy the statutory requirements for membership. In addition, the Secretary, through NTIA, will accept expressions of interest from any Start Printed Page 7825 individual, or from any organization proposing a candidate who satisfies the statutory requirements for membership on how to get prescribed cialis the FirstNet Authority Board. To be considered for a calendar year 2022 appointment, expressions of interest must be electronically transmitted on or before March 14, 2022.

All parties submitting an expression of interest should submit the candidate's (i) full name, title, organization, address, telephone number, email address. (ii) current resume how to get prescribed cialis. (iii) brief bio. (iv) statement of qualifications that references how the candidate satisfies the Act's expertise, representational, and geographic requirements for FirstNet Authority Board membership, as described in this Notice. And (v) a statement describing why the candidate wants to serve on the FirstNet Authority Board, affirming their ability and availability to take a regular and active role in the Board's work.