Viagra 100mg online

John Rawls what is the normal dose of viagra begins a Theory of Justice with the observation that 'Justice is the first virtue of social institutions, as truth is of systems of thought… Each person possesses an inviolability founded on justice that even the welfare of society as a whole viagra 100mg online cannot override'1 (p.3). The erectile dysfunction treatment viagra has resulted in lock-downs, the restriction of liberties, debate about viagra 100mg online the right to refuse medical treatment and many other changes to the everyday behaviour of persons. The justice issues it raises are diverse, profound and will demand our attention for some time. How we can respect the Rawlsian commitment to the inviolability of each person, when the welfare of societies as a whole is under threat goes to the heart of some of the difficult ethical issues we face and are discussed in this issue of the Journal of Medical Ethics.The debate about ICU triage and erectile dysfunction treatment is quite well developed and this journal has published several articles that explore aspects of this issue and how different places approach it.2–5 Newdick et al add to the legal analysis of triage decisions and criticise the calls for respecting a narrow conception of a legal right to treatment and more detailed national guidelines for how triage decisions viagra 100mg online should be made.6They consider scoring systems for clinical frailty, organ failure assessment, and raise some doubts about the fairness of their application to erectile dysfunction treatment triage situations.

Their argument seems to highlight instances of what is called the McNamara fallacy. US Secretary of Defense Robert McNamara used enemy viagra 100mg online body counts as a measure of military success during the Vietnam war. So, the fallacy occurs when we rely solely on considerations that appear to be quantifiable, to the neglect of vital qualitative, difficult to measure or contestable features.6 Newdick et al point to variation in assessment, subtlety in condition and other factors as reasons why it is misleading to present scoring systems as ‘objective’ tests for triage. In doing so they draw a distinction between procedural and outcome consistency, which is important, and hints at viagra 100mg online distinctions Rawls drew between the different forms of procedural fairness.

While we might hope to come up with a triage protocol that is procedurally fair and arrives at a fair outcome (what Rawls calls perfect procedural justice, p. 85) there is little prospect viagra 100mg online of that. As they observe, reasonable people can disagree about the outcomes we should aim for in allocating health resources and ICU triage for erectile dysfunction treatment is no exception. Instead, we should work toward a transparent and fair process, what Rawls would describe as imperfect procedural justice viagra 100mg online (p.

85). His example of this is a criminal trial where we adopt processes that we have reason to believe are our best chance of determining guilt, but which do not guarantee the truth of a verdict, and this is a reason why they must be transparent and consistent (p. 85). Their proposal is to triage patients into three broad categories.

High, medium and low priority, with the thought that a range of considerations could feed into that evaluation by an appropriately constituted clinical group.Ballantyne et al question another issue that is central to the debate about erectile dysfunction treatment triage.4 They describe how utility measures such as QALYs, lives saved seem to be in tension with equity. Their central point is that ICU for erectile dysfunction treatment can be futile, and that is a reason for questioning how much weight should be given to equality of access to ICU for erectile dysfunction treatment. They claim that there is little point admitting someone to ICU when ICU is not in their best interests. Instead, the scope of equity should encompass preventing 'remediable differences among social, economic demographic or geographic groups' and for erectile dysfunction treatment that means looking beyond access to ICU.

Their central argument can be summarised as follows.Maximising utility can entrench existing health inequalities.The majority of those ventilated for erectile dysfunction treatment in ICU will die.Admitting frailer or comorbid patients to ICU is likely to do more harm than good to these groups.Therefore, better access to ICU is unlikely to promote health equity for these groups.Equity for those with health inequalities related to erectile dysfunction treatment should broadened to include all the services a system might provide.Brown et al argue in favour of erectile dysfunction treatment immunity passports and the following summarises one of the key arguments in their article.7erectile dysfunction treatment immunity passports are a way of demonstrating low personal and social risk.Those who are at low personal risk and low social risk from erectile dysfunction treatment should be permitted more freedoms.Permitting those with immunity passports greater freedoms discriminates against those who do not have passports.Low personal and social risk and preserving health system capacity are relevant reasons to discriminate between those who have immunity and those who do not.Brown et al then consider a number of potential problems with immunity passports, many of which are justice issues. Resentment by those who do not hold an immunity passport along with a loss of social cohesion, which is vital for responding to erectile dysfunction treatment, are possible downsides. There is also the potential to advantage those who are immune, economically, and it could perpetuate existing inequalities. A significant objection, which is a problem for the justice of many policies, is free riding.

Some might create fraudulent immunity passports and it might even incentivise intentional exposure to the viagra. Brown et al suggest that disincentives and punishment are potential solutions and they are in good company as the Rawlsian solution to free riding is for 'law and government to correct the necessary corrections.' (p. 268)Elves and Herring focus on a set of ethical principles intended to guide those making policy and individual level decisions about adult social care delivery impacted by the viagra.8 They criticize the British government’s framework for being silent about what to do in the face of conflict between principles. They suggest the dominant values in the framework are based on autonomy and individualism and argue that there are good reasons for not making autonomy paramount in policy about erectile dysfunction treatment.

These include that information about erectile dysfunction treatment is incomplete, so no one can be that informed on decisions about their health. The second is one that highlights the importance of viewing our present ethical challenges via the lens of justice or other ethical concepts such as community or solidarity that enable us to frame collective obligations and interests. They observe that erectile dysfunction treatment has demonstrated how health and how we live our lives are linked. That what an individual does can have profound impact on the health of many others.Their view is that appeals to self-determination ring hollow for erectile dysfunction treatment and their proposed remedy is one that pushes us to reflect on what the liberal commitment to the inviolability of each person means.

They explain Dworkin’s account of 'associative obligations' which occur within a group when they acknowledge special rights and responsibilities to each other. These obligations are a way of giving weight to community considerations, without collapsing into full-blown utilitarianism and while still respecting the inviolability of persons.The erectile dysfunction treatment viagra is pushing ethical deliberation in new directions and many of them turn on approaching medical ethics with a greater emphasis on justice and related ethical concepts.IntroductionAs erectile dysfunction treatment spread internationally, healthcare services in many countries became overwhelmed. One of the main manifestations of this was a shortage of intensive care beds, leading to urgent discussion about how to allocate these fairly. In the initial debates about allocation of scarce intensive care unit (ICU) resources, there was optimism about the ‘good’ of ICU access.

However, rather than being a life-saving intervention, data began to emerge in mid-April showing that most critical patients with erectile dysfunction treatment who receive access to a ventilator do not survive to discharge. The minority who survive leave the ICU with significant morbidity and a long and uncertain road to recovery. This reality was under-recognised in bioethics debates about ICU triage throughout March and April 2020. Central to these disucssions were two assumptions.

First, that ICU admission was a valuable but scarce resource in the viagra context. And second, that both equity and utility considerations were important in determining which patients should have access to ICU. In this paper we explain how scarcity and value were conflated in the early ICU erectile dysfunction treatment triage literature, leading to undue optimism about the ‘good’ of ICU access, which in turned fuelled equity-based arguments for ICU access. In the process, ethical issues regarding equitable access to end-of-life care more broadly were neglected.Equity requires the prevention of avoidable or remediable differences among social, economic, demographic, or geographic groups.1 How best to apply an equity lens to questions of distribution will depend on the nature of the resource in question.

Equitable distribution of ICU beds is significantly more complex than equitable distribution of other goods that might be scarce in a viagra, such as masks or treatments. ICU (especially that which involves intubation and ventilation i.e. Mechanical ventilation) is a burdensome treatment option that can lead to significant suffering—both short and long term. The degree to which these burdens are justified depends on the probability of benefit, and this depends on the clinical status of the patient.

People are rightly concerned about the equity implications of excluding patients from ICU on the grounds of pre-existing comorbidities that directly affect prognosis, especially when these align with and reflect social disadvantage. But this does not mean that aged, frail or comorbid patients should be admitted to ICU on the grounds of equity, when this may not be in their best interests.ICU triage debateThe erectile dysfunction treatment viagra generated extraordinary demand for critical care and required hard choices about who will receive presumed life-saving interventions such as ICU admission. The debate has focused on whether or not a utilitarian approach aimed at maximising the number of lives (or life-years) saved should be supplemented by equity considerations that attempt to protect the rights and interests of members of marginalised groups. The utilitarian approach uses criteria for access to ICU that focus on capacity to benefit, understood as survival.2 Supplementary equity considerations have been invoked to relax the criteria in order to give a more diverse group of people a chance of entering ICU.3 4Equity-based critiques are grounded in the concern that a utilitarian approach aimed at maximising the number (or length) of lives saved may well exacerbate inequity in survival rates between groups.

This potential for discrimination is heightened if triage tools use age as a proxy for capacity to benefit or are heavily reliant on Quality-Adjusted Life-Years (QALYs) which will deprioritise people with disabilities.5 6 Even if these pitfalls are avoided, policies based on maximising lives saved entrench existing heath inequalities because those most likely to benefit from treatment will be people of privilege who come into the viagra with better health status than less advantaged people. Those from lower socioeconomic groups, and/or some ethnic minorities have high rates of underlying comorbidities, some of which are prognostically relevant in erectile dysfunction treatment . Public health ethics requires that we acknowledge how apparently neutral triage tools reflect and reinforce these disparities, especially where the impact can be lethal.7But the utility versus equity debate is more complex than it first appears. Both the utility and equity approach to ICU triage start from the assumption that ICU is a valuable good—the dispute is about how best to allocate it.

Casting ICU admission as a scarce good subject to rationing has the (presumably unintended) effect of making access to critical care look highly appealing, triggering cognitive biases. Psychologists and marketers know that scarcity sells.8 People value a commodity more when it is difficult or impossible to obtain.9 When there is competition for scarce resources, people focus less on whether they really need or want the resource. The priority becomes securing access to the resource.Clinicians are not immune to scarcity-related cognitive bias. Clinicians treating patients with erectile dysfunction treatment are working under conditions of significant information overload but without the high quality clinical research (generated from large data sets and rigorous methodology) usually available for decision-making.

The combination of overwhelming numbers of patients, high acuity and uncertainty regarding best practice is deeply anxiety provoking. In this context it is unsurprising that, at least in the early stages of the viagra, they may not have the psychological bandwidth to challenge assumptions about the benefits of ICU admission for patients with severe disease. Zagury-Orly and Schwartzstein have recently argued that the health sector must accept that doctors’ reasoning and decision-making are susceptible to human anxieties and in the “…effort to ‘do good’ for our patients, we may fall prey to cognitive biases and therapeutic errors”.10We suggest the global publicity and panic regarding ICU triage distorted assessments of best interests and decision-making about admittance to ICU and slanted ethical debate. This has the potential to compromise important decisions with regard to care for patients with erectile dysfunction treatment.The emerging reality of ICUIn general, the majority of patients who are ventilated for erectile dysfunction treatment in ICU will die.

Although comparing data from different health systems is challenging due to variation in admission criteria for ICU, clear trends are emerging with regard to those critically unwell and requiring mechanical ventilation. Emerging data show case fatality rates of 50%–88% for ventilated patients with erectile dysfunction treatment. In China11 and Italy about half of those with erectile dysfunction treatment who receive ventilator support have not survived.12 In one small study in Wuhan the ICU mortality rate among those who received invasive mechanical ventilation was 86% (19/22).13 Interestingly, the rate among those who received less intensive non-invasive ventilation (NIV)1 was still 79% (23/29).13 Analysis of 5700 patients in the New York City area showed that the mortality for those receiving mechanical ventilation was 88%.14 In the UK, only 20% of those who have received mechanical ventilation have been discharged alive.15 Hence, the very real possibility of medical futility with regard to ventilation in erectile dysfunction treatment needs to be considered.It is also important to consider the complications and side effects that occur in an ICU context. These patients are vulnerable to hospital acquired s such as ventilator associated pneumonias with high mortality rates in their own right,16 neuropathies, myopathies17 and skin damage.

Significant long term morbidity (physical, mental and emotional challenges) can also be experienced by people who survive prolonged ventilation in ICU.12 18 Under normal (non-viagra) circumstances, many ICU patients experience significant muscle atrophy and deconditioning, sleep disorders, severe fatigue,19 post-traumatic stress disorder,20 cognitive deficits,21 depression, anxiety, difficulty with daily activities and loss of employment.22 Although it is too soon to have data on the long term outcomes of ICU survivors in the specific context of erectile dysfunction treatment, the UK Chartered Society of Physiotherapy predicts a ‘tsunami of rehabilitation needs’ as patients with erectile dysfunction treatment begin to be discharged.23 The indirect effects of carer-burden should also not be underestimated, as research shows that caring for patients who have survived critical illness results in high levels of depressive symptoms for the majority of caregivers.24The emerging mortality data for patients with erectile dysfunction treatment admitted to ICU—in conjunction with what is already known about the morbidity of ICU survivors—has significant implications for the utility–equity debates about allocating the scarce resource of ICU beds. First, they undermine the utility argument as there seems to be little evidence that ICU admission leads to better outcomes for patients, especially when the long term morbidity of extended ICU admission is included in the balance of burdens and benefits. For some patients, perhaps many, the burdens of ICU will not outweigh the limited potential benefits. Second, the poor survival rates challenge the equity-based claim for preferential access to treatment for members of disadvantaged groups.

In particular, admitting frailer or comorbid patients to ICU to fulfil equity goals is unlikely to achieve greater survival for these population groups, but will increase their risk of complications and may ultimately exacerbate or prolong their suffering.The high proportions of people who die despite ICU admission make it particularly important to consider what might constitute better or worse experiences of dying with erectile dysfunction treatment, and how ICU admission affects the likelihood of a ‘good’ death. Critical care may compromise the ability of patients to communicate and engage with their families during the terminal phase of their lives—in the context of an intubated, ventilated patient this is unequivocal.Given the high rates of medical futility with patients with erectile dysfunction treatment in ICU, the very significant risks for further suffering in the short and long term and the compromise of important psychosocial needs—such as communicating with our families—in the terminal phase of life, our ethical scope must be wider than ICU triage. Ho and Tsai argue that, “In considering effective and efficient allocation of healthcare resources as well as physical and psychological harm that can be incurred in prolonging the dying process, there is a critical need to reframe end-of-life care planning in the ICU.”25 We propose that the focus on equity concerns during the viagra should broaden to include providing all people who need it with access to the highest possible standard of end-of-life care. This requires attention to minimising barriers to accessing culturally safe care in the following interlinked areas.

Palliative care, and communication and decision support and advanced care planning.Palliative careScaling up palliative and hospice care is an essential component of the erectile dysfunction treatment viagra response. Avoiding non-beneficial or unwanted high-intensity care is critical when the capacity of the health system is stressed.26 Palliative care focuses on symptom management, quality of life and death, and holistic care of physical, psychological, social and spiritual health.27 Evidence from Italy has prompted recommendations that, “Governments must urgently recognise the essential contribution of hospice and palliative care to the erectile dysfunction treatment viagra, and ensure these services are integrated into the healthcare system response.”28 Rapid palliative care policy changes were implemented in response to erectile dysfunction treatment in Italy, including more support in community settings, change in admission criteria and daily telephone support for families.28 To meet this increased demand, hospice and palliative care staff should be included in personal protective equipment (PPE) allocation and provided with appropriate preventon and control training when dealing with patients with erectile dysfunction treatment or high risk areas.Attention must also be directed to maintaining supply lines for essential medications for pain, distress and sedation. Patients may experience pain due to existing comorbidities, but may also develop pain as a result of excessive coughing or immobility from erectile dysfunction treatment. Such symptoms should be addressed using existing approaches to pain management.27 Supply lines for essential medications for distress and pain management, including fentanyl and midazolam are under threat in the USA and propofol—used in terminal sedation—may also be in short supply.29 The challenges are exacerbated when people who for various reasons eschew or are unable to secure hospital admission decline rapidly at home with erectile dysfunction treatment (the time frame of recognition that someone is dying may be shorter than that through which hospice at home services usually support people).

There is growing debate about the fair allocation of novel drugs—sometimes available as part of ongoing clinical trials—to treat erectile dysfunction treatment with curative intent.2 30 But we must also pay attention to the fair allocation of drugs needed to ease suffering and dying.Communication and end-of-life decision-making supportEnd-of-life planning can be especially challenging because patients, family members and healthcare providers often differ in what they consider most important near the end of life.31 Less than half of ICU physicians—40.6% in high income countries and 46.3% in low–middle income countries—feel comfortable holding end-of-life discussions with patients’ families.25 With ICUs bursting and health providers under extraordinary pressure, their capacity to effectively support end-of-life decisions and to ease dying will be reduced.This suggests a need for specialist erectile dysfunction treatment communication support teams, analogous to the idea of specialist ICU triage teams to ensure consistency of decision making about ICU admissions/discharges, and to reduce the moral and psychological distress of health providers during the viagra.32 These support teams could provide up to date information templates for patients and families, support decision-making, the development of advance care plans (ACPs) and act as a liaison between families (prevented from being in the hospital), the patient and the clinical team. Some people with disabilities may require additional communication support to ensure the patients’ needs are communicated to all health providers.33 This will be especially important if carers and visitors are not able to be present.To provide effective and appropriate support in an equitable way, communication teams will need to include those with the appropriate skills for caring for diverse populations including. Interpreters, specialist social workers, disability advocates and cultural support liaison officers for ethnic and religious minorities. Patient groups that already have comparatively poor health outcomes require dedicated resources.

These support resources are essential if we wish to truly mitigate equity concerns that arisingduring the viagra context. See Box 1 for examples of specific communication and care strategies to support patients.Box 1 Supporting communication and compassionate care during erectile dysfunction treatmentDespite the sometimes overwhelming pressure of the viagra, health providers continue to invest in communication, compassionate care and end-of-life support. In some places, doctors have taken photos of their faces and taped these to the front of their PPE so that patients can ‘see’ their face.37 In Singapore, patients who test positive for erectile dysfunction are quarantined in health facilities until they receive two consecutive negative tests. Patients may be isolated in hospital for several weeks.

To help ease this burden on patients, health providers have dubbed themselves the ‘second family’ and gone out of their way to provide care as well as treatment. Elsewhere, medical, nursing and multi-disciplinary teams are utilising internet based devices to enable ‘virtual’ visits and contact between patients and their loved ones.38 Some centres are providing staff with masks with a see-through window panel that shows the wearer’s mouth, to support effective communication with patient with hearing loss who rely on lip reading.39Advance care planningACPs aim to honour decisions made by autonomous patients if and when they lose capacity. However, talking to patients and their loved ones about clinical prognosis, ceilings of treatment and potential end-of-life care is challenging even in normal times. During erectile dysfunction treatment the challenges are exacerbated by uncertainty and urgency, the absence of family support (due to visitor restrictions) and the wearing of PPE by clinicians and carers.

Protective equipment can create a formidable barrier between the patient and the provider, often adding to the patient’s sense of isolation and fear. An Australian palliative care researcher with experience working in disaster zones, argues that the “PPE may disguise countenance, restrict normal human touch and create an unfamiliar gulf between you and your patient.”34 The physical and psychological barriers of PPE coupled with the pressure of high clinical loads do not seem conducive to compassionate discussions about patients’ end-of-life preferences. Indeed, a study in Singapore during the 2004 SARS epidemic demonstrated the barrier posed by PPE to compassionate end-of-life care.35Clinicians may struggle to interpret existing ACPs in the context of erectile dysfunction treatment, given the unprecedented nature and scale of the viagra and emerging clinical knowledge about the aetiology of the disease and (perhaps especially) about prognosis. This suggests the need for erectile dysfunction treatment-specific ACPs.

Where possible, proactive planning should occur with high-risk patients, the frail, those in residential care and those with significant underlying morbidities. Ideally, ACP conversations should take place prior to illness, involve known health providers and carers, not be hampered by PPE or subject to time constraints imposed by acute care contexts. Of note here, a systematic review found that patients who received advance care planning or palliative care interventions consistently showed a pattern toward decreased ICU admissions and reduced ICU length of stay.36ConclusionHow best to address equity concerns in relation to ICU and end-of-life care for patients with erectile dysfunction treatment is challenging and complex. Attempts to broaden clinical criteria to give patients with poorer prognoses access to ICU on equity grounds may result in fewer lives saved overall—this may well be justified if access to ICU confers benefit to these ‘equity’ patients.

But we must avoid tokenistic gestures to equity—admitting patients with poor prognostic indicators to ICU to meet an equity target when intensive critical care is contrary to their best interests. ICU admission may exacerbate and prolong suffering rather than ameliorate it, especially for frailer patients. And prolonging life at all costs may ultimately lead to a worse death. The capacity for harm not just the capacity for benefit should be emphasised in any triage tools and related literature.

Equity can be addressed more robustly if viagra responses scale up investment in palliative care services, communication and decision-support services and advanced care planning to meet the needs of all patients with erectile dysfunction treatment. Ultimately, however, equity considerations will require us to move even further from a critical care framework as the social and economic impact of the viagra will disproportionately impact those most vulnerable. Globally, we will need an approach that does not just stop an exponential rise in s but an exponential rise in inequality.AcknowledgmentsWe would like to thank Tracy Anne Dunbrook and David Tripp for their helpful comments, and NUS Medicine for permission to reproduce the erectile dysfunction treatment Chronicles strip..

Viagra contraindications

Viagra
Extra super p force
Levitra
Aurogra
Cialis strips
Filitra professional
Best price for brand
50mg 20 tablet $34.95
100mg + 100mg 32 tablet $143.95
20mg 90 tablet $224.95
100mg 10 tablet $29.95
20mg 90 strips $249.95
20mg 180 sublingual tablet $494.95
Brand
No
No
Online
No
Online
No
Does work at first time
130mg
Consultation
Consultation
Consultation
Ask your Doctor
Ask your Doctor
Buy with american express
RX pharmacy
At walgreens
RX pharmacy
Drugstore on the corner
Indian Pharmacy
Indian Pharmacy
For womens
Online
Yes
Yes
Yes
Yes
No

See a full-page version of the map The delta variant of erectile dysfunction treatment surged viagra contraindications across the southern Midwest and South for the fifth How to buy cheap cialis online consecutive week last week, raising new rural s to a rate not seen since the middle of February. New rural s jumped by more than 50% last week after climbing by more than 60% the week before. In the past six viagra contraindications weeks, new cases in rural counties have increased five-fold. The metropolitan new- rate has climbed at a slightly higher rate over the same period.

Nonmetropolitan counties logged just under 70,000 new erectile dysfunction treatment s last week, viagra contraindications the highest number of weekly new cases since the end of the winter surge. (Hover over the vertical bars in the graph below to show the number of new s per week.) The number of erectile dysfunction treatment-related deaths climbed slightly last week, up 25 deaths for a total of 368 last week. That’s an viagra contraindications increase of about 7%. The rate of new deaths in metropolitan counties climbed about 22% last week.

(Hover over the vertical bars in the graph below to show the number of deaths that occurred in weekly increments going back to June 2020.) The number of rural red-zone counties viagra contraindications also surged last week, climbing by more than two-thirds to 945. That means nearly half of all the nation’s 1,976 nonmetropolitan counties are in the red-zone, a three-fold increase in the past three weeks. Red-zone counties are defined as having 100 or more new s per 100,000 residents in a viagra contraindications one-week period – a rate at which local areas should take additional measures to contain the viagra, according to the White House erectile dysfunction Response Team. The Daily Yonder’s erectile dysfunction treatment analysis covers Sunday, July 25, through Saturday, July 31.

The data set is administered by the nonprofit viagra contraindications USA Facts. Regional Patterns Like this story?. Sign up for our newsletter. The delta variant of erectile dysfunction treatment first established itself in Missouri and has spread into adjoining states over the past six viagra contraindications weeks.

Iowa, where the rural vaccination rate is in the top third in the nation, has suffered far fewer s than states like Arkansas, Illinois, Kansas, and Oklahoma.The major changes this week are the spread of hotspot counties into Kentucky and Tennessee and more entrenched numbers of cases in nearby Mississippi, Louisiana, and Texas, Oklahoma, and Kansas. erectile dysfunction treatment viagra contraindications is also resurging in states farther outside the southern Midwest. The southern Atlantic seaboard saw an increase in new s, as have Arizona, New Mexico, Wyoming, Utah, California, and Oregon. State Rates Florida had the highest rural rate for the week -- viagra contraindications 516 new cases per 100,000 in population for a seven-day period.Louisiana had the second highest rate – 500 cases per 100,000.

(Louisiana had the highest metropolitan rate in the U.S. €“ 643 new cases viagra contraindications for the week per 100,000 residents).South Dakota had the best rural new- rate – 20 new cases per 100,000 for the week. The five states with the worst rates of new s last week all ranked near the bottom of the U.S. In their viagra contraindications rural vaccination rates.

Florida ranked 39th in rural vaccination out of 47 states that have rural counties. Louisiana ranked viagra contraindications 42nd in rural vaccinations. Arkansas, which ranked third in rural s, ranked 41st in rural vaccinations. Mississippi ranked fifth in rural s and 37th in vaccinations.Of the 10 states with the highest rates of rural s, only one was in the top half of states for rural vaccination rates.

Alaska, which viagra contraindications had the sixth highest rate of rural s last week, ranks eighth in the U.S. For rural vaccinations. Red-Zone Counties All but four states with nonmetropolitan viagra contraindications counties saw an uptick in their rural red-zone counties.Georgia more than doubled its rural red-zone counties, from 20 to 47 last week.Kansas nearly doubled its rural red-zone counties, rising from 29 two weeks ago to 55 last week. Seventy-two of the state's 105 counties (both metro and nonmetro) are in the red zone.Kentucky added 24 rural red-zone counties.

Only 25 of the state's viagra contraindications 120 counties were not in the red zone last week. Texas added 44, and Oklahoma added 26 rural red-zone counties. Four-fifths of all the counties in those states are viagra contraindications in the red zone.Tennessee added 25 rural red-zone counties. Only 14 of the state's 95 counties are not in the red zone.All of Louisiana's 63 parishes and all of Arkansas' 75 counties were in the red zone.All but one of Florida's counties was in the red zone, and all but two of Mississippi's were.South Carolina had 42 of 46 counties statewide in the red zone.

Missouri had 108 of 114 counties in the red zone statewide.Red-zone counties also increased in several Western states last week. Three-fourths of Wyoming's 21 rural counties were in the red zone. Oregon's rural red-zone counties doubled from eight to 16. Montana added 10 red-zone rural counties.

See a viagra 100mg online full-page version of the map The delta variant of erectile dysfunction treatment surged across the southern Midwest and my site South for the fifth consecutive week last week, raising new rural s to a rate not seen since the middle of February. New rural s jumped by more than 50% last week after climbing by more than 60% the week before. In the past six weeks, new cases viagra 100mg online in rural counties have increased five-fold. The metropolitan new- rate has climbed at a slightly higher rate over the same period. Nonmetropolitan counties logged just under 70,000 new erectile dysfunction treatment s last week, the highest number of weekly viagra 100mg online new cases since the end of the winter surge.

(Hover over the vertical bars in the graph below to show the number of new s per week.) The number of erectile dysfunction treatment-related deaths climbed slightly last week, up 25 deaths for a total of 368 last week. That’s an increase of about 7% viagra 100mg online. The rate of new deaths in metropolitan counties climbed about 22% last week. (Hover over the vertical bars in the graph below to show the number of deaths that occurred in weekly increments going back to June 2020.) The number of rural red-zone counties also surged last week, climbing by more than two-thirds to viagra 100mg online 945. That means nearly half of all the nation’s 1,976 nonmetropolitan counties are in the red-zone, a three-fold increase in the past three weeks.

Red-zone counties are defined as having 100 or more new s per 100,000 residents in a one-week period – viagra 100mg online a rate at which local areas should take additional measures to contain the viagra, according to the White House erectile dysfunction Response Team. The Daily Yonder’s erectile dysfunction treatment analysis covers Sunday, July 25, through Saturday, July 31. The data set is viagra 100mg online administered by the nonprofit USA Facts. Regional Patterns Like this story?. Sign up for our newsletter.

The delta variant of erectile dysfunction treatment first established itself in viagra 100mg online Missouri and has spread into adjoining states over the past six weeks. Iowa, where the rural vaccination rate is in the top third in the nation, has suffered far fewer s than states like Arkansas, Illinois, Kansas, and Oklahoma.The major changes this week are the spread of hotspot counties into Kentucky and Tennessee and more entrenched numbers of cases in nearby Mississippi, Louisiana, and Texas, Oklahoma, and Kansas. erectile dysfunction treatment is also resurging in states farther viagra 100mg online outside the southern Midwest. The southern Atlantic seaboard saw an increase in new s, as have Arizona, New Mexico, Wyoming, Utah, California, and Oregon. State Rates Florida had the highest rural rate for the week -- 516 new cases per 100,000 in population for a seven-day period.Louisiana had the second highest rate – viagra 100mg online 500 cases per 100,000.

(Louisiana had the highest metropolitan rate in the U.S. €“ 643 new cases for the week per 100,000 residents).South Dakota had the best rural new- rate – 20 new cases per 100,000 for the viagra 100mg online week. The five states with the worst rates of new s last week all ranked near the bottom of the U.S. In their viagra 100mg online rural vaccination rates. Florida ranked 39th in rural vaccination out of 47 states that have rural counties.

Louisiana ranked viagra 100mg online 42nd in rural vaccinations. Arkansas, which ranked third in rural s, ranked 41st in rural vaccinations. Mississippi ranked fifth in rural s and 37th in vaccinations.Of the 10 states with the highest rates of rural s, only one was in the top half of states for rural vaccination rates. Alaska, which viagra 100mg online had the sixth highest rate of rural s last week, ranks eighth in the U.S. For rural vaccinations.

Red-Zone Counties All but four states with nonmetropolitan counties saw an uptick in their rural red-zone counties.Georgia more than doubled its rural red-zone counties, from 20 to 47 last week.Kansas nearly doubled its rural red-zone counties, rising from viagra 100mg online 29 two weeks ago to 55 last week. Seventy-two of the state's 105 counties (both metro and nonmetro) are in the red zone.Kentucky added 24 rural red-zone counties. Only 25 of the state's 120 counties were not in the red zone viagra 100mg online last week. Texas added 44, and Oklahoma added 26 rural red-zone counties. Four-fifths of all the counties in those states are in the red zone.Tennessee added 25 viagra 100mg online rural red-zone counties.

Only 14 of the state's 95 counties are not in the red zone.All of Louisiana's 63 parishes and all of Arkansas' 75 counties were in the red zone.All but one of Florida's counties was in the red zone, and all but two of Mississippi's were.South Carolina had 42 of 46 counties statewide in the red zone. Missouri had 108 of 114 counties in the red zone statewide.Red-zone counties also increased in several viagra 100mg online Western states last week. Three-fourths of Wyoming's 21 rural counties were in the red zone. Oregon's rural red-zone viagra 100mg online counties doubled from eight to 16. Montana added 10 red-zone rural counties.

What may interact with Viagra?

Do not take Viagra with any of the following:

  • cisapride
  • methscopolamine nitrate
  • nitrates like amyl nitrite, isosorbide dinitrate, isosorbide mononitrate, nitroglycerin
  • nitroprusside
  • other sildenafil products (Revatio)

Viagra may also interact with the following:

  • certain drugs for high blood pressure
  • certain drugs for the treatment of HIV or AIDS
  • certain drugs used for fungal or yeast s, like fluconazole, itraconazole, ketoconazole, and voriconazole
  • cimetidine
  • erythromycin
  • rifampin

This list may not describe all possible interactions. Give your health care providers a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

Can you snort viagra

In doing http://franklysouthern.com/white-chicken-chili/ so, Arizona becomes only the seventh state to pass a law requiring its utilities generate all their electricity can you snort viagra from carbon-free sources. It is the first state where such a charge has been led by Republicans. Three Republicans joined the commission’s sole Democrat in voting for the rule, with one Republican commissioner in opposition. The shift says as much about the growth of the renewables industry can you snort viagra as it does a change in the political winds. Wind and solar costs have fallen dramatically, and technologies like battery storage, which were once viewed as a future alternative, are now being deployed in the field.

That opened the door to support from Republicans like Burns, who chairs the commission and will retire when his term ends on Jan. 4. €œWhen I came in, I was opposed to subsidies. I was a creature of legislature who didn’t like subsidies,” Burns said. €œIt wasn’t hard to vote against that.” Burns’ views began to shift as he attended conferences of utility regulators and learned about broader industry trends.

Particularly influential in his thinking was Colorado’s experience in 2018, when the state’s largest utility, Xcel Energy Inc., issued a request for new power generation and was flooded with plans for cheap renewables. A provision in Arizona’s rule passed last week mirrors Colorado’s approach. When Arizona utilities are contemplating plans for new power plants, they will need to put out a request for information on the cost of all new sources of electricity generation. €œIt’s been an evolutionary-type change of mine because of the additional information and technology advancements,” Burns said. Speaking of the new rule, he added, “I think it was a big deal to get that done.

I didn’t know if we could do it.” The Arizona Corporation Commission, or ACC as it is often called, is unique among state utility boards. Its members are elected, and its role in setting utility policy is spelled out in the state’s Constitution, meaning its rulings carry the force of law. Even so, there are limitations to the commission’s new standard. It only applies to the state’s investor-owned utilities, Arizona Public Service Co. (APS) and Tucson Electric Power.

It notably does not include the Salt River Project, the large electric cooperative that operates several large coal plants serving the state. The rule also does not call for an enhanced renewable portfolio standard, as initially contemplated. Instead, it requires carbon dioxide emissions fall 50% of average 2016-2018 levels by 2032, 75% by 2030 and 100% by 2050. Commissioners voted to nix the renewables standard last week, as it became clear two Republicans opposed to the renewables mandate would win election to the commission. The change has two important implications.

First, the standard will count electricity generated by nuclear, among other carbon-free sources, as well as renewables like wind and solar. Second, it was needed to earn the support of Republican Commissioner Lea Márquez Peterson, who opposed the renewable requirement but backed the carbon-free standard. Her support means a majority will continue to support the rule on the new commission. The rule will now go out for public comment before it is finalized. Amanda Ormond, a consultant who served as director of the Arizona Energy Office, said the state’s politics have tracked the economics.

€œI think the single biggest factor is clean energy cost reductions have completely flipped the economics of the utility such that the clean stuff is now the cheap stuff,” she said. €œI think there was a recognition two to three years ago that renewables are really, truly cheaper.” The shifting regulatory environment comes amid a sea change in how Arizona generates electricity. Where coal generated almost 40% of the state’s power a decade ago, it accounted for 20% of Arizona’s power production last year, according to federal figures. Most of that gap has been made up by natural gas, which surged from 27% to 41% of the state’s power generation over that time. But renewables are now coming on strong.

Solar barely registered in 2010. Last year, solar accounted for 5% of the state’s power production. Utilities, meanwhile, have plans to add much more. Tucson Electric Power aims to generate 70% of its power from renewables in a bid to lower emissions 80% by 2035. APS has targeted 45% renewables by 2030, as part of its plan to achieve net-zero emissions by midcentury (Climatewire, Jan.

23). Those moves represent a marked shift for APS in particular. The utility fiercely fought residential solar installers over the practice of net metering, and it spent $37.9 million to defeat a ballot measure in 2018 that sought to impose a 50% renewable standard by 2030. APS admitted last year it poured $12.9 million into a 2014 campaign to elect ACC members supportive of its agenda. That disclosure came after years of campaigning from Burns to force the company to disclose its role in that election.

€œI had a high level of respect for APS. When they did that, that is when things started to go south,” Burns said. The utility was singing a far different tune in the run-up to last week’s vote. In an earnings call with financial analysts in late October, APS executives stressed they were already planning to retire their coal plants earlier and invest heavily in renewables. €œI think it’s consistent with what we were saying as our plan,” said APS CEO Jeff Guldner.

Reprinted from Climatewire with permission from E&E News. E&E provides daily coverage of essential energy and environmental news at www.eenews.net.The future that NASA dared to dream of for a decade has finally become reality. Crew-1, SpaceX’s first operational mission to the International Station Station (ISS) for NASA, arrived at the orbiting lab late Monday night (Nov. 16), 27 hours after launching from Kennedy Space Center in Florida atop a Falcon 9 rocket. About two hours after the Crew Dragon capsule “Resilience” docked with the station, NASA astronauts Victor Glover, Mike Hopkins and Shannon Walker and Japan’s Soichi Noguchi floated from the private craft into the ISS, beginning their six-month stay on the orbiting lab.

That moment meant a lot to NASA, whose Commercial Crew Program began nurturing the development of private astronaut taxis way back in 2010. The goal was to fill the crew-carrying shoes of the agency’s space shuttle fleet, which was grounded in 2011, leaving Russian Soyuz spacecraft as the only ride to and from orbit available to astronauts. In 2014, the Commercial Crew Program inked multibillion-dollar contracts with SpaceX and Boeing to finish work on their vehicles and fly at least six crewed missions to and from the station apiece. Crew-1 is the first of those contracted flights to lift off, and its crewmembers have now made it safely onto the orbiting lab. €œThis mission was a dream,” NASA human spaceflight chief Kathy Lueders said during a news conference early Tuesday morning (Nov.

17). "It was a dream of us to be able to one day … have crew transportation services to the International Space Station. And today that dream became a reality.” “It’s the start of a new era,” Lueders added. That era will include crewed missions by Boeing, but the aerospace giant’s CST-100 Starliner capsule isn’t ready to carry astronauts just yet. Starliner must first refly an uncrewed test flight to the station, after failing to meet up with the ISS during a December 2019 attempt.

That second try is scheduled to launch early next year. SpaceX now has two crewed flights to the ISS under its belt. The first, the Demo-2 test mission, carried NASA astronauts Bob Behnken and Doug Hurley to the station for a two-month stay this past summer. Demo-2’s success paved the way for Crew-1 and other operational flights. €œHuge shoutouts to the NASA and SpaceX teams—excellent job.

Many hard years of work,” Ven Feng, deputy manager of NASA’s Commercial Crew Program, said during Tuesday morning’s news conference. €œAnd we’re looking forward to making this a very successful first operational mission, and many more to follow.” The Crew-1 astronauts joined three other spaceflyers already aboard the ISS—NASA astronaut Kate Rubins and cosmonauts Sergey Kud-Sverchkov and Sergey Ryzhikov, the latter of whom commands the station’s current Expedition 64 mission. Copyright 2020 Space.com, a Future company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.On September 9, 2018, a robotic telescope on its routine patrol of the night sky detected what looked like a new star.

Over the next few hours, the “star” grew 10 times brighter, triggering a flag by software I had written to identify unusual celestial events. It was nighttime in California, and I was asleep, but my colleagues on the other side of the world reacted quickly to the alert. Twelve hours later we had obtained enough additional data from telescopes on Earth and in space to confirm that this was the explosion of a star—a supernova—in a distant galaxy. But this was no ordinary supernova. Tying together the evidence from different telescopes, we concluded that after shining for millions of years, the star did something surprising and mysterious.

It abruptly cast off layers of gas from its surface, forming a cocoon around itself. A few days or a week later the star exploded. The debris from the blast collided with the cocoon, producing an unusually bright and short-lived flash of light. Because the explosion took place in a galaxy far away—the light took almost a billion years to reach Earth—it was too dim to be seen with the naked eye but bright enough for our observatories. Through a retrospective search of telescope data, we were even able to detect the star in the act of shedding two weeks before it exploded, when it was one one-hundredth as bright as the explosion itself.

This was just one of several recent discoveries that have shown us that stars die in surprisingly diverse ways. Sometimes, for example, the remnant of a star's core that is left over after a supernova remains active after the star has collapsed—it can launch a jet of material moving at hyperrelativistic speeds, and the jet itself can destroy the star with more energy than a normal supernova. Sometimes, in the final days to years of its life, a star blows away a significant fraction of its gas in a series of violent eruptions. These extreme deaths appear to be rare, but the fact that they happen at all tells us there is much we still do not understand about the basics of how stars live and die. Now my colleagues and I are amassing a collection of unusual stellar endings that challenge our traditional assumptions.

We are beginning to be able to ask and answer fundamental questions. Which factors determine how a star dies?. Why do some stars end their lives with eruptions or violent jets, while others simply explode?. A New Star The story of stellar birth, life and death is a tale of competing forces. Stars are formed in interstellar clouds of hydrogen gas when the force of gravity pulls part of the cloud inward strongly enough to overcome the outward push of magnetic fields and gas particles traveling at high speeds.

As the cloud fragment collapses, it becomes 20 orders of magnitude denser and heats up by millions of degrees—temperatures high enough for the hydrogen atoms to collide and stick together to form helium. Fusion has begun, and a new star is born. Like a cloud, a star is itself a battleground, with gravity pushing in and pressure from nuclear fusion pushing out. The evolution of a star depends on its temperature, which in turn depends on its mass. The heavier the star, the heavier the elements it can forge, and the faster it burns through its fuel.

The lightest stars fuse hydrogen to helium and stop there—the sun is more than four billion years old and is still burning its hydrogen. Heavier stars live much shorter lives, only 10 million years or so, yet manufacture a much longer chain of elements. Oxygen, carbon, neon, nitrogen, magnesium, silicon and even iron. A star's mass also determines how it will die. Lightweight stars—those that weigh less than around eight times the mass of the sun—die relatively peacefully.

After exhausting their supplies of nuclear fuel, the outer layers of these stars blow out into space, forming beautiful planetary nebulae and leaving the stars' cores exposed as white dwarfs—hot, dense objects with about half the mass of the sun that are only slightly larger than Earth. Heavier stars, however, meet a violent end because of the enormous temperatures and pressures in their cores. Around the time they reach iron in the nuclear burning chain, conditions are so hot that things fall apart—iron atoms can start breaking into smaller pieces. The chain of fusion is cut off, and the star loses its internal pressure. Gravity takes over, and the core collapses until its constituent atoms are so close together that another opposing force steps in.

The strong nuclear force. Now the core has become a neutron star, an exotic and dense state of matter made mostly of neutrons. If the star is massive enough—say, more than 20 times the mass of the sun—gravity overcomes even the strong nuclear force, and the neutron star collapses further into a black hole. Either way, some of the energy released when the core collapses pushes the outer layers of the star into space, creating an explosion so bright that for a few days it outshines the rest of the stars in the galaxy combined. Human beings have spotted supernovae by eye for thousands of years.

In 1572 a Danish astronomer named Tycho Brahe noticed a new star in the constellation Cassiopeia. It was as bright as Venus and stayed that bright for months before fading away. He wrote that he was so shocked that he doubted his own eyes. Today the aftermath of the explosion—the debris—is still visible and is known as Tycho's Supernova Remnant. For a supernova to be bright enough to be seen by the unaided eye, it must be in the Milky Way, as Tycho's supernova was, or in one of its satellite galaxies, and this is rare.

I might not see a supernova without the help of a telescope in my lifetime, although I can hope. In the past century astronomers began using telescopes to find supernovae beyond the Milky Way by taking repeated observations of the same set of galaxies and looking for changes, called transients. Our telescopes are now roboticized and outfitted with modern cameras, enabling us to discover thousands of supernovae every year. An early sign that some stars die in extreme ways was the 1960s discovery of gamma-ray bursts (GRBs), so named because of the bright blasts of gamma-ray light they emit. We believe we see them when a massive star collapses into a neutron star or a black hole, the newborn compact object launches a narrow jet of matter, that jet successfully tunnels from the core through what remains of the star, and the jet just happens to be pointing at Earth.

What might create such a jet?. The basic idea is the following. When a normal star runs out of fuel and dies, its core collapses into a neutron star or a black hole, and that is the end of that. In a gamma-ray burst, however, the corpse stays active. Perhaps the nascent black hole is absorbing mass from a disk of material around it, releasing energy in the process.

Or maybe the newly created neutron star is rotating quickly, and a powerful magnetic field acts as a brake, releasing energy as the star slows down. Either way, this “central engine” pumps out energy that gets funneled into a jet of extremely hot plasma that tunnels from the center of the star out through the infalling material, glowing in gamma rays. The passage of the jet through the star causes it to explode in a special supernova dubbed “Type Ic-BL,” which is 10 times more energetic than ordinary supernovae. As the jet plows into the surrounding gas and dust, it produces light all across the electromagnetic spectrum, called an afterglow. Afterglows are difficult to find because although they are 1,000 times brighter than typical supernovae, they are 100 times more fleeting, appearing and disappearing in just a few hours.

The best hope for finding an afterglow is to wait for a gamma-ray burst to be discovered by a satellite and then immediately point your telescope to the reported location of the burst. By waiting for a satellite to discover a burst, though, you limit the kinds of phenomena you can discover. A lot of things have to go right for a GRB to be produced. The jet has to be launched, make it through the star, and be pointing at you. In fact, it seems extremely unlikely for GRBs to occur.

The gamma-ray photons emitted by the jet should get trapped unless the jet is moving at 99.995 percent of the speed of light. But to reach such speeds, the jet would need to somehow make it through the star without dragging along the star's matter with it. What if most jets actually do get slowed down by the star, and we see only the small fraction that make it through unscathed?. In other words, perhaps gamma-ray bursts represent the rare occasions that jets escape their stars and don't slow down too much. If that were true, there would be a huge number of extreme stellar deaths out there that are totally invisible to gamma-ray satellites.

For my thesis, I set out to find afterglows without relying on a trigger from a satellite. My plan was to use the Zwicky Transient Facility, a robotic telescope at the Palomar Observatory in California, to patrol the sky for unusually fleeting, unusually bright points of light—and then react quickly. When I presented my thesis proposal in May 2018, my faculty advisers warned me that I might not find what I was looking for. They urged me to keep an open mind because new avenues of inquiry might arise. One month later that is exactly what happened.

And two years later when I graduated, my thesis looked very different from what I had expected. Credit. Ron Miller Holy Cow When I began my work, I wrote a program to find celestial phenomena that were changing in brightness more rapidly than ordinary supernovae. On a normal day I examined 10 to 100 different candidates and concluded that none of them were what I was looking for. On some days, though, I encountered something that gave me pause.

In June 2018 I saw a report from a robotic telescope facility called ATLAS, reporting a strange event dubbed AT2018cow. €œAT” stood for “astronomical transient,” the prefix automatically given to all new transients, “2018” for the year of discovery, and “cow” was a unique string of letters. In the next couple of days there were reports of similarities between this event and gamma-ray bursts, yet there had been no detected show of gamma rays. €œAha,” I thought, “this is it!. € Because AT2018cow was so bright and so nearby, there was intense worldwide interest in this object, and astronomers observed it all across the electromagnetic spectrum.

I immediately made plans to observe AT2018cow using a radio telescope in Hawaii called the Submillimeter Array. AT2018cow stunned just about everyone. It unfolded completely differently than any cosmic explosion seen before. We were like the people in a classic parable who are trying to identify an elephant in the dark. One person feels its trunk and says it is a waterspout, whereas another feels the ear and thinks it must be a fan, and a third feels the leg and says it is a tree.

Similarly, AT2018cow shared characteristics with several different classes of phenomena, but it has been difficult to put a complete picture together. My collaborators and I spent long days and nights going over our data repeatedly, trying to figure out how to interpret them. Some of those moments—calculating the properties of the shock wave together on a chalkboard, a team member running down the hallway waving a piece of paper with new results, and meeting a colleague's eyes in shock when a beautiful new measurement came in—remain my most treasured memories from graduate school. In the end, we concluded that there were two important components to AT2018cow. The first was a central engine, as in a gamma-ray burst, but lasting for much longer—weeks rather than the typical days.

X-rays shining from the heart of the explosion stayed bright for much longer than expected. The second was that for some reason, when the star burst apart, it was surrounded by a cocoon of gas and dust with about one one-thousandth the mass of the sun. Our evidence for the cocoon is indirect. When the star exploded, we saw a flash of optical light and radio waves that seemed to indicate debris hitting a mass surrounding the star. Such cocoons have been seen in other types of explosions, but we do not know how they get there—it may be that the material is shed by the star shortly before exploding.

If this theory is correct, it would be the first time astronomers have directly witnessed the birth of a compact object like a neutron star or a black hole. Most of the time the corpse is completely shrouded by what remains of the star. In the case of AT2018cow, we think we could actually see down to the compact object that produced all of this amazingly variable and bright x-ray emission. Still, we are left with many questions. What kind of star exploded?.

Was the central engine a neutron star or a black hole?. Why did the star shed mass shortly before exploding?. To make progress, we needed to find similar events, so my colleagues and I set out to find another AT2018cow using the Zwicky Transient Facility. Three months later I thought we found one—the bright, fast-rising explosion of September 9, 2018. Initially it looked very similar to AT2018cow.

Within a week, however, it became clear that this event was a Type Ic-BL supernova—the kind associated with gamma-ray bursts. Its name was SN2018gep. I was excited. Sure, it was not another AT2018cow, but we finally had something that looked like a gamma-ray burst. Within five days we had collected detailed observations all across the electromagnetic spectrum.

We searched the data for evidence of a jet—but we found none. Instead, yet again, my collaborators and I concluded that we were seeing bright, fast-evolving optical emission from the collision of explosion debris with a cocoon of material. This was a surprise. Although cocoons have been seen surrounding other types of stars, they are not commonly observed in the types of supernovae associated with gamma-ray bursts. Our discovery implies that more stars shed gas at the end of their lives than we thought.

We know the gas was lost in the final moments of the star's life because it was so close to the star at the time of the explosion. If it had been cast off earlier, it would have had time to get farther away. That means the star lost a significant chunk of its outer atmosphere in the final days to weeks of its life, after shining for millions to tens of millions of years. It seems, then, that this shedding heralds the death of the star. Once again, we were left with questions.

How prevalent are these death omens in different types of stars?. What is the physical mechanism that produces them?. I realized that I had a new direction to my research now—not just gamma-ray bursts and jets but also the warning signs of soon-to-explode massive stars. And perhaps these different phenomena were even connected. It was not until the final six months of my Ph.D.

Program that I finally found a gamma-ray burst afterglow. On January 28, 2020, I did my usual candidate review when I saw something that looked promising. I knew better than to get excited—there had been many, many false starts over the years. I immediately requested additional observations with a telescope in La Palma in the Canary Islands, and they confirmed that this source was fading away quickly, as would be expected for an afterglow. That night I requested urgent observations on the 200-inch Hale Telescope at the Palomar Observatory that showed the source was still fading.

The next night I obtained observations with the Swift X-ray space telescope and detected x-rays from the event, all but confirming this was truly a GRB afterglow. The night after that I got a brief window of time on the Keck Telescope on Mauna Kea in Hawaii, with the hope of measuring how far away the explosion was. I slept in a sleeping bag in the remote observing room at my university, the California Institute of Technology, and set an alarm for 4 A.M. When the time came, I felt panicked—I was squeezing in this observation right at the end of the night, the sky was getting brighter quickly, the source was very faint, and I was terrified of being too late. I did the best that I could.

When it was too bright to observe any longer, I called my colleague Dan Perley of Liverpool John Moores University in England on Skype, and we looked at the data together. I was lucky. The source was faint, but there was a big, booming, obvious feature in the light from the event that enabled us to measure the distance, which was vast. A redshift of 2.9, which means its light had significantly reddened during its journey through the cosmos. When this star exploded, the universe was only 2.3 billion years old.

The photons from the blast took 11.4 billion years to reach Earth. Today the physical location of the burst is 21 billion light-years away—the explosion happened so long ago that the universe has expanded significantly since then. This was the real deal. A few months after finding our first afterglow, we found a second. To put that in perspective, prior to the Zwicky Transient Facility, only three afterglows had ever been found without a gamma-ray burst first occurring and telling astronomers where to look, and we found two in just a few months.

Now that we have our search strategy ironed out and working, I hope we can find these routinely. Still, even with two afterglows in hand, I cannot definitively answer the questions I originally set out to answer. It is difficult to tell whether any given afterglow is something new or just a normal gamma-ray burst that high-energy satellites happened to miss. We will need to find more events before we can tell if we are witnessing truly different phenomena. Expanding the Catalog Since the discovery of an unexpected new type of engine-driven explosion in AT2018cow, my search has uncovered a variety of unusual stellar displays.

There was the weird Ic-BL supernova (the kind associated with GRBs) crashing into a cocoon of material but showing no evidence for a powerful jet (the hallmark of a GRB). Then there was another event similar to AT2018cow. There were also two Ic-BL supernova that probably had jets, but these were less energetic and wider than those in traditional gamma-ray bursts. And finally, right at the end of graduate school, two actual cosmological afterglows, one of which turned out to have an associated gamma-ray burst. So far we astronomers have been like zoologists, going out into relatively uncharted territory and characterizing all the different creatures (in this case, explosions) that we see.

The next stage will be to look for patterns. What are the relative rates of each type of blast?. Do they seem to occur in one type of galaxy but not another?. Are these different categories actually different “species” or just different manifestations of the same phenomenon?. To answer these questions, we will need a much larger catalog.

Beginning in a few years, the Vera C. Rubin Observatory, currently under construction in Chile, will use the largest digital camera ever constructed (three billion pixels) to spot 10 million potential transients every night—10 times more than the Zwicky Transient Facility does now. With more data, I would like to investigate which stars lose some of their mass right before they die and how often. I want to study how we can tell if there was a jet that got choked inside a star and how to recognize the kind of faint emission emitted during a star's death throes to predict where and when a star will explode. Ultimately I would like to probe questions about the factors that lead to these unusual deaths—perhaps it is something about a star's rate of spin or its history of interactions with other stars that causes it to die in such a spectacular and rare way.One of the joys of being a science journalist is that it's your job to talk with people who are doing mind-bending and world-changing research and to ask them goofy questions.

We ask them serious questions, too, of course, but we also encourage scientists to share the funny, tense, disappointing, surprising, human sides of their work. The goal is not to make an expert seem ridiculous but to demonstrate that we're all just people trying to figure out how to make sense of the world. This month's cover story on new discoveries about how stars explode and die is an exciting look at a rapidly growing field that is studying phenomena at awesome time and size scales. But it's also a human drama about how Anna Y. Q.

Ho had to sleep in a sleeping bag in a remote observing lab, wake up at 4 A.M. And race the dawn to get a reading on an exploding star 21 billion light-years away. See Explosions at the Edge for more about her pursuit of strange star endings. One reason we urge scientists to show us the personal side of research is that we hope it demystifies what they do. Increasingly, we're seeing the danger of people rejecting scientific findings and claiming that certain fields are all a hoax or a conspiracy.

It's distressing but mostly harmless when people fall for fake documentaries claiming the earth is flat. It's life-threatening when they fall for misinformation about the erectile dysfunction treatment viagra. Starting here, Filippo Menczer and Thomas Hills detail the ways conspiracy theories spread—including a disinformation campaign targeted at their own research group. The delicate surgery required to transplant a hand is just the start of the process. The recipient must then relearn how to use it.

The brain reroutes neural signals in many different areas, showing how nimble and adaptable it can be. Scott H. Frey describes how his early interest in neuroscience was inspired by his mother's multiple sclerosis and her loss of motor control. He shares this research starting here. The human body is actually a superorganism teeming with bacteria, fungi and hundreds of trillions of viagraes.

The study of the human virome is only about a decade old, and the research is accelerating as scientists respond to erectile dysfunction, the viagra that causes erectile dysfunction treatment. These viagraes aren't all bad. Some are harmless, and some might help treat diseases or fight antibiotic resistance. Turn here for David Pride's fascinating discoveries about the viagraes that live in and among us. The idea of an international collaboration to build a fusion reactor that could produce clean energy came out of a Superpower Summit in Geneva in 1985 featuring Ronald Reagan and Mikhail Gorbachev.

Now the International Thermonuclear Experimental Reactor is being built. The project feels like a series of marathons, the ITER director tells senior editor Clara Moskowitz. Parts have been made all over the world, and beginning here, you can see the stunning facility coming together. We're delighted to have editor in chief emerita Mariette DiChristina back in our pages this issue.

Shortly after he was elected to the Arizona Corporation Commission in 2012, the conservative Republican voted to viagra 100mg online kill what remained of the state’s subsidy for rooftop solar installations. But last week Burns managed something only a few blue-state climate hawks have pulled off. He helped pass a rule calling for the state to eliminate carbon emissions from its power grid by 2050.

In doing viagra 100mg online so, Arizona becomes only the seventh state to pass a law requiring its utilities generate all their electricity from carbon-free sources. It is the first state where such a charge has been led by Republicans. Three Republicans joined the commission’s sole Democrat in voting for the rule, with one Republican commissioner in opposition.

The shift says as much viagra 100mg online about the growth of the renewables industry as it does a change in the political winds. Wind and solar costs have fallen dramatically, and technologies like battery storage, which were once viewed as a future alternative, are now being deployed in the field. That opened the door to support from Republicans like Burns, who chairs the commission and will retire when his term ends on Jan.

4. €œWhen I came in, I was opposed to subsidies. I was a creature of legislature who didn’t like subsidies,” Burns said.

€œIt wasn’t hard to vote against that.” Burns’ views began to shift as he attended conferences of utility regulators and learned about broader industry trends. Particularly influential in his thinking was Colorado’s experience in 2018, when the state’s largest utility, Xcel Energy Inc., issued a request for new power generation and was flooded with plans for cheap renewables. A provision in Arizona’s rule passed last week mirrors Colorado’s approach.

When Arizona utilities are contemplating plans for new power plants, they will need to put out a request for information on the cost of all new sources of electricity generation. €œIt’s been an evolutionary-type change of mine because of the additional information and technology advancements,” Burns said. Speaking of the new rule, he added, “I think it was a big deal to get that done.

I didn’t know if we could do it.” The Arizona Corporation Commission, or ACC as it is often called, is unique among state utility boards. Its members are elected, and its role in setting utility policy is spelled out in the state’s Constitution, meaning its rulings carry the force of law. Even so, there are limitations to the commission’s new standard.

It only applies to the state’s investor-owned utilities, Arizona Public Service Co. (APS) and Tucson Electric Power. It notably does not include the Salt River Project, the large electric cooperative that operates several large coal plants serving the state.

The rule also does not call for an enhanced renewable portfolio standard, as initially contemplated. Instead, it requires carbon dioxide emissions fall 50% of average 2016-2018 levels by 2032, 75% by 2030 and 100% by 2050. Commissioners voted to nix the renewables standard last week, as it became clear two Republicans opposed to the renewables mandate would win election to the commission.

The change has two important implications. First, the standard will count electricity generated by nuclear, among other carbon-free sources, as well as renewables like wind and solar. Second, it was needed to earn the support of Republican Commissioner Lea Márquez Peterson, who opposed the renewable requirement but backed the carbon-free standard.

Her support means a majority will continue to support the rule on the new commission. The rule will now go out for public comment before it is finalized. Amanda Ormond, a consultant who served as director of the Arizona Energy Office, said the state’s politics have tracked the economics.

€œI think the single biggest factor is clean energy cost reductions have completely flipped the economics of the utility such that the clean stuff is now the cheap stuff,” she said. €œI think there was a recognition two to three years ago that renewables are really, truly cheaper.” The shifting regulatory environment comes amid a sea change in how Arizona generates electricity. Where coal generated almost 40% of the state’s power a decade ago, it accounted for 20% of Arizona’s power production last year, according to federal figures.

Most of that gap has been made up by natural gas, which surged from 27% to 41% of the state’s power generation over that time. But renewables are now coming on strong. Solar barely registered in 2010.

Last year, solar accounted for 5% of the state’s power production. Utilities, meanwhile, have plans to add much more. Tucson Electric Power aims to generate 70% of its power from renewables in a bid to lower emissions 80% by 2035.

APS has targeted 45% renewables by 2030, as part of its plan to achieve net-zero emissions by midcentury (Climatewire, Jan. 23). Those moves represent a marked shift for APS in particular.

The utility fiercely fought residential solar installers over the practice of net metering, and it spent $37.9 million to defeat a ballot measure in 2018 that sought to impose a 50% renewable standard by 2030. APS admitted last year it poured $12.9 million into a 2014 campaign to elect ACC members supportive of its agenda. That disclosure came after years of campaigning from Burns to force the company to disclose its role in that election.

€œI had a high level of respect for APS. When they did that, that is when things started to go south,” Burns said. The utility was singing a far different tune in the run-up to last week’s vote.

In an earnings call with financial analysts in late October, APS executives stressed they were already planning to retire their coal plants earlier and invest heavily in renewables. €œI think it’s consistent with what we were saying as our plan,” said APS CEO Jeff Guldner. Reprinted from Climatewire with permission from E&E News.

E&E provides daily coverage of essential energy and environmental news at www.eenews.net.The future that NASA dared to dream of for a decade has finally become reality. Crew-1, SpaceX’s first operational mission to the International Station Station (ISS) for NASA, arrived at the orbiting lab late Monday night (Nov. 16), 27 hours after launching from Kennedy Space Center in Florida atop a Falcon 9 rocket.

About two hours after the Crew Dragon capsule “Resilience” docked with the station, NASA astronauts Victor Glover, Mike Hopkins and Shannon Walker and Japan’s Soichi Noguchi floated from the private craft into the ISS, beginning their six-month stay on the orbiting lab. That moment meant a lot to NASA, whose Commercial Crew Program began nurturing the development of private astronaut taxis way back in 2010. The goal was to fill the crew-carrying shoes of the agency’s space shuttle fleet, which was grounded in 2011, leaving Russian Soyuz spacecraft as the only ride to and from orbit available to astronauts.

In 2014, the Commercial Crew Program inked multibillion-dollar contracts with SpaceX and Boeing to finish work on their vehicles and fly at least six crewed missions to and from the station apiece. Crew-1 is the first of those contracted flights to lift off, and its crewmembers have now made it safely onto the orbiting lab. €œThis mission was a dream,” NASA human spaceflight chief Kathy Lueders said during a news conference early Tuesday morning (Nov.

17). "It was a dream of us to be able to one day … have crew transportation services to the International Space Station. And today that dream became a reality.” “It’s the start of a new era,” Lueders added.

That era will include crewed missions by Boeing, but the aerospace giant’s CST-100 Starliner capsule isn’t ready to carry astronauts just yet. Starliner must first refly an uncrewed test flight to the station, after failing to meet up with the ISS during a December 2019 attempt. That second try is scheduled to launch early next year.

SpaceX now has two crewed flights to the ISS under its belt. The first, the Demo-2 test mission, carried NASA astronauts Bob Behnken and Doug Hurley to the station for a two-month stay this past summer. Demo-2’s success paved the way for Crew-1 and other operational flights.

€œHuge shoutouts to the NASA and SpaceX teams—excellent job. Many hard years of work,” Ven Feng, deputy manager of NASA’s Commercial Crew Program, said during Tuesday morning’s news conference. €œAnd we’re looking forward to making this a very successful first operational mission, and many more to follow.” The Crew-1 astronauts joined three other spaceflyers already aboard the ISS—NASA astronaut Kate Rubins and cosmonauts Sergey Kud-Sverchkov and Sergey Ryzhikov, the latter of whom commands the station’s current Expedition 64 mission.

Copyright 2020 Space.com, a Future company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.On September 9, 2018, a robotic telescope on its routine patrol of the night sky detected what looked like a new star.

Over the next few hours, the “star” grew 10 times brighter, triggering a flag by software I had written to identify unusual celestial events. It was nighttime in California, and I was asleep, but my colleagues on the other side of the world reacted quickly to the alert. Twelve hours later we had obtained enough additional data from telescopes on Earth and in space to confirm that this was the explosion of a star—a supernova—in a distant galaxy.

But this was no ordinary supernova. Tying together the evidence from different telescopes, we concluded that after shining for millions of years, the star did something surprising and mysterious. It abruptly cast off layers of gas from its surface, forming a cocoon around itself.

A few days or a week later the star exploded. The debris from the blast collided with the cocoon, producing an unusually bright and short-lived flash of light. Because the explosion took place in a galaxy far away—the light took almost a billion years to reach Earth—it was too dim to be seen with the naked eye but bright enough for our observatories.

Through a retrospective search of telescope data, we were even able to detect the star in the act of shedding two weeks before it exploded, when it was one one-hundredth as bright as the explosion itself. This was just one of several recent discoveries that have shown us that stars die in surprisingly diverse ways. Sometimes, for example, the remnant of a star's core that is left over after a supernova remains active after the star has collapsed—it can launch a jet of material moving at hyperrelativistic speeds, and the jet itself can destroy the star with more energy than a normal supernova.

Sometimes, in the final days to years of its life, a star blows away a significant fraction of its gas in a series of violent eruptions. These extreme deaths appear to be rare, but the fact that they happen at all tells us there is much we still do not understand about the basics of how stars live and die. Now my colleagues and I are amassing a collection of unusual stellar endings that challenge our traditional assumptions.

We are beginning to be able to ask and answer fundamental questions. Which factors determine how a star dies?. Why do some stars end their lives with eruptions or violent jets, while others simply explode?.

A New Star The story of stellar birth, life and death is a tale of competing forces. Stars are formed in interstellar clouds of hydrogen gas when the force of gravity pulls part of the cloud inward strongly enough to overcome the outward push of magnetic fields and gas particles traveling at high speeds. As the cloud fragment collapses, it becomes 20 orders of magnitude denser and heats up by millions of degrees—temperatures high enough for the hydrogen atoms to collide and stick together to form helium.

Fusion has begun, and a new star is born. Like a cloud, a star is itself a battleground, with gravity pushing in and pressure from nuclear fusion pushing out. The evolution of a star depends on its temperature, which in turn depends on its mass.

The heavier the star, the heavier the elements it can forge, and the faster it burns through its fuel. The lightest stars fuse hydrogen to helium and stop there—the sun is more than four billion years old and is still burning its hydrogen. Heavier stars live much shorter lives, only 10 million years or so, yet manufacture a much longer chain of elements.

Oxygen, carbon, neon, nitrogen, magnesium, silicon and even iron. A star's mass also determines how it will die. Lightweight stars—those that weigh less than around eight times the mass of the sun—die relatively peacefully.

After exhausting their supplies of nuclear fuel, the outer layers of these stars blow out into space, forming beautiful planetary nebulae and leaving the stars' cores exposed as white dwarfs—hot, dense objects with about half the mass of the sun that are only slightly larger than Earth. Heavier stars, however, meet a violent end because of the enormous temperatures and pressures in their cores. Around the time they reach iron in the nuclear burning chain, conditions are so hot that things fall apart—iron atoms can start breaking into smaller pieces.

The chain of fusion is cut off, and the star loses its internal pressure. Gravity takes over, and the core collapses until its constituent atoms are so close together that another opposing force steps in. The strong nuclear force.

Now the core has become a neutron star, an exotic and dense state of matter made mostly of neutrons. If the star is massive enough—say, more than 20 times the mass of the sun—gravity overcomes even the strong nuclear force, and the neutron star collapses further into a black hole. Either way, some of the energy released when the core collapses pushes the outer layers of the star into space, creating an explosion so bright that for a few days it outshines the rest of the stars in the galaxy combined.

Human beings have spotted supernovae by eye for thousands of years. In 1572 a Danish astronomer named Tycho Brahe noticed a new star in the constellation Cassiopeia. It was as bright as Venus and stayed that bright for months before fading away.

He wrote that he was so shocked that he doubted his own eyes. Today the aftermath of the explosion—the debris—is still visible and is known as Tycho's Supernova Remnant. For a supernova to be bright enough to be seen by the unaided eye, it must be in the Milky Way, as Tycho's supernova was, or in one of its satellite galaxies, and this is rare.

I might not see a supernova without the help of a telescope in my lifetime, although I can hope. In the past century astronomers began using telescopes to find supernovae beyond the Milky Way by taking repeated observations of the same set of galaxies and looking for changes, called transients. Our telescopes are now roboticized and outfitted with modern cameras, enabling us to discover thousands of supernovae every year.

An early sign that some stars die in extreme ways was the 1960s discovery of gamma-ray bursts (GRBs), so named because of the bright blasts of gamma-ray light they emit. We believe we see them when a massive star collapses into a neutron star or a black hole, the newborn compact object launches a narrow jet of matter, that jet successfully tunnels from the core through what remains of the star, and the jet just happens to be pointing at Earth. What might create such a jet?.

The basic idea is the following. When a normal star runs out of fuel and dies, its core collapses into a neutron star or a black hole, and that is the end of that. In a gamma-ray burst, however, the corpse stays active.

Perhaps the nascent black hole is absorbing mass from a disk of material around it, releasing energy in the process. Or maybe the newly created neutron star is rotating quickly, and a powerful magnetic field acts as a brake, releasing energy as the star slows down. Either way, this “central engine” pumps out energy that gets funneled into a jet of extremely hot plasma that tunnels from the center of the star out through the infalling material, glowing in gamma rays.

The passage of the jet through the star causes it to explode in a special supernova dubbed “Type Ic-BL,” which is 10 times more energetic than ordinary supernovae. As the jet plows into the surrounding gas and dust, it produces light all across the electromagnetic spectrum, called an afterglow. Afterglows are difficult to find because although they are 1,000 times brighter than typical supernovae, they are 100 times more fleeting, appearing and disappearing in just a few hours.

The best hope for finding an afterglow is to wait for a gamma-ray burst to be discovered by a satellite and then immediately point your telescope to the reported location of the burst. By waiting for a satellite to discover a burst, though, you limit the kinds of phenomena you can discover. A lot of things have to go right for a GRB to be produced.

The jet has to be launched, make it through the star, and be pointing at you. In fact, it seems extremely unlikely for GRBs to occur. The gamma-ray photons emitted by the jet should get trapped unless the jet is moving at 99.995 percent of the speed of light.

But to reach such speeds, the jet would need to somehow make it through the star without dragging along the star's matter with it. What if most jets actually do get slowed down by the star, and we see only the small fraction that make it through unscathed?. In other words, perhaps gamma-ray bursts represent the rare occasions that jets escape their stars and don't slow down too much.

If that were true, there would be a huge number of extreme stellar deaths out there that are totally invisible to gamma-ray satellites. For my thesis, I set out to find afterglows without relying on a trigger from a satellite. My plan was to use the Zwicky Transient Facility, a robotic telescope at the Palomar Observatory in California, to patrol the sky for unusually fleeting, unusually bright points of light—and then react quickly.

When I presented my thesis proposal in May 2018, my faculty advisers warned me that I might not find what I was looking for. They urged me to keep an open mind because new avenues of inquiry might arise. One month later that is exactly what happened.

And two years later when I graduated, my thesis looked very different from what I had expected. Credit. Ron Miller Holy Cow When I began my work, I wrote a program to find celestial phenomena that were changing in brightness more rapidly than ordinary supernovae.

On a normal day I examined 10 to 100 different candidates and concluded that none of them were what I was looking for. On some days, though, I encountered something that gave me pause. In June 2018 I saw a report from a robotic telescope facility called ATLAS, reporting a strange event dubbed AT2018cow.

€œAT” stood for “astronomical transient,” the prefix automatically given to all new transients, “2018” for the year of discovery, and “cow” was a unique string of letters. In the next couple of days there were reports of similarities between this event and gamma-ray bursts, yet there had been no detected show of gamma rays. €œAha,” I thought, “this is it!.

€ Because AT2018cow was so bright and so nearby, there was intense worldwide interest in this object, and astronomers observed it all across the electromagnetic spectrum. I immediately made plans to observe AT2018cow using a radio telescope in Hawaii called the Submillimeter Array. AT2018cow stunned just about everyone.

It unfolded completely differently than any cosmic explosion seen before. We were like the people in a classic parable who are trying to identify an elephant in the dark. One person feels its trunk and says it is a waterspout, whereas another feels the ear and thinks it must be a fan, and a third feels the leg and says it is a tree.

Similarly, AT2018cow shared characteristics with several different classes of phenomena, but it has been difficult to put a complete picture together. My collaborators and I spent long days and nights going over our data repeatedly, trying to figure out how to interpret them. Some of those moments—calculating the properties of the shock wave together on a chalkboard, a team member running down the hallway waving a piece of paper with new results, and meeting a colleague's eyes in shock when a beautiful new measurement came in—remain my most treasured memories from graduate school.

In the end, we concluded that there were two important components to AT2018cow. The first was a central engine, as in a gamma-ray burst, but lasting for much longer—weeks rather than the typical days. X-rays shining from the heart of the explosion stayed bright for much longer than expected.

The second was that for some reason, when the star burst apart, it was surrounded by a cocoon of gas and dust with about one one-thousandth the mass of the sun. Our evidence for the cocoon is indirect. When the star exploded, we saw a flash of optical light and radio waves that seemed to indicate debris hitting a mass surrounding the star.

Such cocoons have been seen in other types of explosions, but we do not know how they get there—it may be that the material is shed by the star shortly before exploding. If this theory is correct, it would be the first time astronomers have directly witnessed the birth of a compact object like a neutron star or a black hole. Most of the time the corpse is completely shrouded by what remains of the star.

In the case of AT2018cow, we think we could actually see down to the compact object that produced all of this amazingly variable and bright x-ray emission. Still, we are left with many questions. What kind of star exploded?.

Was the central engine a neutron star or a black hole?. Why did the star shed mass shortly before exploding?. To make progress, we needed to find similar events, so my colleagues and I set out to find another AT2018cow using the Zwicky Transient Facility.

Three months later I thought we found one—the bright, fast-rising explosion of September 9, 2018. Initially it looked very similar to AT2018cow. Within a week, however, it became clear that this event was a Type Ic-BL supernova—the kind associated with gamma-ray bursts.

Its name was SN2018gep. I was excited. Sure, it was not another AT2018cow, but we finally had something that looked like a gamma-ray burst.

Within five days we had collected detailed observations all across the electromagnetic spectrum. We searched the data for evidence of a jet—but we found none. Instead, yet again, my collaborators and I concluded that we were seeing bright, fast-evolving optical emission from the collision of explosion debris with a cocoon of material.

This was a surprise. Although cocoons have been seen surrounding other types of stars, they are not commonly observed in the types of supernovae associated with gamma-ray bursts. Our discovery implies that more stars shed gas at the end of their lives than we thought.

We know the gas was lost in the final moments of the star's life because it was so close to the star at the time of the explosion. If it had been cast off earlier, it would have had time to get farther away. That means the star lost a significant chunk of its outer atmosphere in the final days to weeks of its life, after shining for millions to tens of millions of years.

It seems, then, that this shedding heralds the death of the star. Once again, we were left with questions. How prevalent are these death omens in different types of stars?.

What is the physical mechanism that produces them?. I realized that I had a new direction to my research now—not just gamma-ray bursts and jets but also the warning signs of soon-to-explode massive stars. And perhaps these different phenomena were even connected.

It was not until the final six months of my Ph.D. Program that I finally found a gamma-ray burst afterglow. On January 28, 2020, I did my usual candidate review when I saw something that looked promising.

I knew better than to get excited—there had been many, many false starts over the years. I immediately requested additional observations with a telescope in La Palma in the Canary Islands, and they confirmed that this source was fading away quickly, as would be expected for an afterglow. That night I requested urgent observations on the 200-inch Hale Telescope at the Palomar Observatory that showed the source was still fading.

The next night I obtained observations with the Swift X-ray space telescope and detected x-rays from the event, all but confirming this was truly a GRB afterglow. The night after that I got a brief window of time on the Keck Telescope on Mauna Kea in Hawaii, with the hope of measuring how far away the explosion was. I slept in a sleeping bag in the remote observing room at my university, the California Institute of Technology, and set an alarm for 4 A.M.

When the time came, I felt panicked—I was squeezing in this observation right at the end of the night, the sky was getting brighter quickly, the source was very faint, and I was terrified of being too late. I did the best that I could. When it was too bright to observe any longer, I called my colleague Dan Perley of Liverpool John Moores University in England on Skype, and we looked at the data together.

I was lucky. The source was faint, but there was a big, booming, obvious feature in the light from the event that enabled us to measure the distance, which was vast. A redshift of 2.9, which means its light had significantly reddened during its journey through the cosmos.

When this star exploded, the universe was only 2.3 billion years old. The photons from the blast took 11.4 billion years to reach Earth. Today the physical location of the burst is 21 billion light-years away—the explosion happened so long ago that the universe has expanded significantly since then.

This was the real deal. A few months after finding our first afterglow, we found a second. To put that in perspective, prior to the Zwicky Transient Facility, only three afterglows had ever been found without a gamma-ray burst first occurring and telling astronomers where to look, and we found two in just a few months.

Now that we have our search strategy ironed out and working, I hope we can find these routinely. Still, even with two afterglows in hand, I cannot definitively answer the questions I originally set out to answer. It is difficult to tell whether any given afterglow is something new or just a normal gamma-ray burst that high-energy satellites happened to miss.

We will need to find more events before we can tell if we are witnessing truly different phenomena. Expanding the Catalog Since the discovery of an unexpected new type of engine-driven explosion in AT2018cow, my search has uncovered a variety of unusual stellar displays. There was the weird Ic-BL supernova (the kind associated with GRBs) crashing into a cocoon of material but showing no evidence for a powerful jet (the hallmark of a GRB).

Then there was another event similar to AT2018cow. There were also two Ic-BL supernova that probably had jets, but these were less energetic and wider than those in traditional gamma-ray bursts. And finally, right at the end of graduate school, two actual cosmological afterglows, one of which turned out to have an associated gamma-ray burst.

So far we astronomers have been like zoologists, going out into relatively uncharted territory and characterizing all the different creatures (in this case, explosions) that we see. The next stage will be to look for patterns. What are the relative rates of each type of blast?.

Do they seem to occur in one type of galaxy but not another?. Are these different categories actually different “species” or just different manifestations of the same phenomenon?. To answer these questions, we will need a much larger catalog.

Beginning in a few years, the Vera C. Rubin Observatory, currently under construction in Chile, will use the largest digital camera ever constructed (three billion pixels) to spot 10 million potential transients every night—10 times more than the Zwicky Transient Facility does now. With more data, I would like to investigate which stars lose some of their mass right before they die and how often.

I want to study how we can tell if there was a jet that got choked inside a star and how to recognize the kind of faint emission emitted during a star's death throes to predict where and when a star will explode. Ultimately I would like to probe questions about the factors that lead to these unusual deaths—perhaps it is something about a star's rate of spin or its history of interactions with other stars that causes it to die in such a spectacular and rare way.One of the joys of being a science journalist is that it's your job to talk with people who are doing mind-bending and world-changing research and to ask them goofy questions. We ask them serious questions, too, of course, but we also encourage scientists to share the funny, tense, disappointing, surprising, human sides of their work.

The goal is not to make an expert seem ridiculous but to demonstrate that we're all just people trying to figure out how to make sense of the world. This month's cover story on new discoveries about how stars explode and die is an exciting look at a rapidly growing field that is studying phenomena at awesome time and size scales. But it's also a human drama about how Anna Y.

Q. Ho had to sleep in a sleeping bag in a remote observing lab, wake up at 4 A.M. And race the dawn to get a reading on an exploding star 21 billion light-years away.

See Explosions at the Edge for more about her pursuit of strange star endings. One reason we urge scientists to show us the personal side of research is that we hope it demystifies what they do. Increasingly, we're seeing the danger of people rejecting scientific findings and claiming that certain fields are all a hoax or a conspiracy.

It's distressing but mostly harmless when people fall for fake documentaries claiming the earth is flat. It's life-threatening when they fall for misinformation about the erectile dysfunction treatment viagra. Starting here, Filippo Menczer and Thomas Hills detail the ways conspiracy theories spread—including a disinformation campaign targeted at their own research group.

The delicate surgery required to transplant a hand is just the start of the process. The recipient must then relearn how to use it. The brain reroutes neural signals in many different areas, showing how nimble and adaptable it can be.

Scott H. Frey describes how his early interest in neuroscience was inspired by his mother's multiple sclerosis and her loss of motor control. He shares this research starting here.

The human body is actually a superorganism teeming with bacteria, fungi and hundreds of trillions of viagraes. The study of the human virome is only about a decade old, and the research is accelerating as scientists respond to erectile dysfunction, the viagra that causes erectile dysfunction treatment. These viagraes aren't all bad.

Some are harmless, and some might help treat diseases or fight antibiotic resistance. Turn here for David Pride's fascinating discoveries about the viagraes that live in and among us. The idea of an international collaboration to build a fusion reactor that could produce clean energy came out of a Superpower Summit in Geneva in 1985 featuring Ronald Reagan and Mikhail Gorbachev.

Now the International Thermonuclear Experimental Reactor is being built.

Viagra triangle chicago

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NCHS Data Brief https://gbs2015.com/where-can-i-buy-female-viagra/ No viagra 100mg online. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for chronic conditions such as cardiovascular viagra 100mg online disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is viagra 100mg online “the permanent cessation of menstruation that occurs after the loss of ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are viagra 100mg online postmenopausal.

Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal viagra 100mg online women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 viagra 100mg online. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, viagra 100mg online 2015image icon1Significant quadratic trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle viagra 100mg online was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data viagra 100mg online table for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past viagra 100mg online week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 viagra 100mg online. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, viagra 100mg online 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle viagra 100mg online was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data viagra 100mg online table for Figure 2pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in viagra 100mg online the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 viagra 100mg online. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p viagra 100mg online <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they viagra 100mg online no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table viagra 100mg online for Figure 3pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage viagra 100mg online of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 viagra 100mg online. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

.