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26 in the journal cialis for sale online Cancer. The researchers noted that clinics in cialis for sale online the study were part of an American Cancer Society grant to improve breast cancer screening rates. It's unclear how the cialis affected screening services in community health centers nationwide.Programs that were introduced before and continued through 2020 may have reduced the cialis's effects on breast cancer screening services, the study authors suggested.Declining screening rates in clinics serving lower-income areas with barriers to health care access and higher breast cancer death rates underscore the need for additional resources to identify women in need of screening, the team noted in a journal news release."These actions will be critical as communities and clinics return to screening with hopes of reaching pre-cialis breast cancer screening rates in the communities they serve," Fedewa and colleagues concluded.More informationThe U.S.

National Cancer Institute has more on breast cancer screening.SOURCE cialis for sale online. Cancer, news cialis for sale online release, Aug. 26, 2021.

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Last week’s deadly collapse of a 12-story oceanfront condominium in a small town cialis internet purchase on the same barrier island as Miami Beach, Fla., is raising concerns among structural engineers cialis for sale online and designers about how to prevent future building failures. Such unplanned collapses are rare in the modern history of structural design, experts say. But engineers and planners are keen to learn what caused the June 24 failure of Champlain Towers South in Surfside, Fla.

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Structural engineers aim to design buildings cialis for sale online that can withstand the loads from forces and hazards such as gravity and weather. Engineers routinely update design practices, often in response to advances in technology or hard-won insights from failures. Nearly all the building stock in the U.S.

Is not cialis for sale online newly designed. Champlain Towers South, for example, was erected in 1981. These buildings may face loads and other threats that designers did not anticipate, including those linked to climate change.

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Collapses in the late 1970s and cialis for sale online early 1980s, including the Kemper Arena roof collapse and walkway collapses at the Hyatt Regency Hotel, both in Kansas City, Mo., made the field question its design processes and led to improvements in construction and how we utilize computerized structural analysis. When earthquakes occur, we have a history of trying to get to the bottom of what happened and then changing our field in response. What’s disturbing about this latest failure in Florida is that even early conjectures about what went wrong don’t give us a lot of clues yet as to what we need to be doing differently.

If this is cialis for sale online just a corrosion issue, then, my goodness, the number of buildings that have corrosion issues in the U.S. Is high. If this is a foundation issue, then perhaps we can figure out the more detailed cause and then go from there.

There are cialis for sale online lots of uncertainties that may have not been considered in 1981, when the design of Champlain Towers South was completed. Is potential corrosion of the building’s columns, rebar or reinforced concrete likely to be closely examined?. One hundred percent.

This is an older concrete building with sea-salt exposure cialis for sale online and what sounds like a lot of flooding. Too much resulting corrosion eventually will bring a building down. But you still wonder, “Why right now?.

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So this is a significantly complex project even without trying to understand cialis for sale online the failure—just trying to get back to square one. As the U.S. Building stock continues to age, might we see a rise in the number and severity of events like the Surfside building collapse?.

We can’t ignore our infrastructure, and we need to invest cialis for sale online in it. Experts have been telling us that for 40 years. A major bridge between Memphis, Tenn., and Arkansas on Interstate 40 had to be shut down last month after a huge fracture was found in a beam.

These examples are going to keep coming more frequently cialis for sale online. They won’t all be a result of us ignoring our infrastructure, but many will be. And climate change isn’t helping.

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We design cialis for sale online them for that environment. But what are you going to do with an area that never had high snow loads before, and suddenly, one winter, there’s a storm in the South like one you’d normally get in Boston?. We design roofs based on historical records for snow, but those rare events aren’t so rare anymore.

We have cialis for sale online bigger hurricanes. We have longer heat waves. It’s a challenge for us, as structural engineers, to keep up with those changing demands.

At the end of the day, gravity is still cialis for sale online gravity. We can get much more precise these days in understanding the basic forces on a building. And we can trace what happens after something starts to fail much more precisely now than we could in past decades.

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The 1994 Northridge earthquake [in California] changed a lot of thinking around how we design buildings in earthquake-prone areas in the U.S cialis for sale online. And around the world. In 1968 in [England], a resident’s gas stove explosion took out 22 stories of a building called Ronan Point, killing four people.

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Are some cities headed for a built environment like that depicted in Kim Stanley Robinson’s New York cialis for sale online 2140?. That science-fiction novel describes a post-climate-disaster Manhattan, N.Y., where residents live in skyscrapers with heavily waterproofed foundations and commute by watercraft in a constantly flooded street grid. The level of adaptation that he suggests is essentially that we can keep all our building infrastructure and just magically protect the bottom of it with some extension of current technologies for repairing concrete that suddenly becomes exposed to persistent salt water.

That’s probably cialis for sale online unrealistic. Much of our infrastructure is underground. Underground infrastructure that becomes underwater infrastructure is unusable.

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Nightmares that occurred twice a week or more were linked with cardiovascular disease in relatively young military veterans, even after controlling for post-traumatic stress disorder (PTSD), a cross-sectional study showed.Frequent distressing dreams were associated with hypertension (OR 1.51, 95% CI 1.28-1.78), heart problems (OR 1.50, 95% CI 1.11-2.02), and myocardial infarction (OR 2.32, 95% CI 1.18-4.54), after adjusting for age, race, and sex, reported Christi Ulmer, PhD, of the Durham VA Health Services Research and Development ADAPT Center and Duke University Medical Center, both in North Carolina."After also adjusting for PTSD, depression, and current smoking, severely distressing dreams continued to be associated cialis 5 with heart problems, hypertension, and other heart trouble," Ulmer said in a presentation at virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society."Research on heart rate variability supports the likelihood of abnormal autonomic function during sleep among those with PTSD. However, we haven't taken a look at what role nightmares specifically might play in contributing to increased risk in this population," Ulmer noted."While some have suggested that the association between PTSD and cardiovascular disease is solely due to poor health behaviors among those with PTSD, our cialis 5 findings suggest an important role for sleep and that there may be an independent role for nightmares, in particular for conferring cardiovascular disease," she said.In this analysis, Ulmer and colleagues studied 3,468 U.S. Military veterans with an average age of cialis 5 38 who served since Sept. 11, 2001 cialis 5.

The majority (73.5%) had one or two tours of cialis 5 duty and most (77.4%) were men. Most (65.0%) had moderate-to-heavy combat exposure.The researchers assessed nightmare frequency and severity with the Davidson cialis 5 Trauma Scale. Nightmares were classified as frequent if they occurred two or more times cialis 5 per week and moderate-to-severe if they were at least moderately distressing. Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study questionnaire and other measures cialis 5.

Diagnoses of PTSD and depression were established through structured clinical interviews.About a third of veterans cialis 5 in the study reported nightmares in the past week, and 41% had poor sleep quality scores as measured by the Pittsburgh Sleep Quality Index. In total, 31% of the veterans cialis 5 met criteria for current PTSD and 32.7% reported at least one cardiovascular condition.Diagnosed depression was more common in the PTSD group. Veterans with PTSD served more tours of duty, had greater combat exposure, poorer sleep quality, and more frequent and more severe distressing cialis 5 dreams.After controlling for depression, PTSD, and current smoking, risks for hypertension (OR 1.43, 95% 1.17-1.73) and heart problems (OR 1.43, 95% CI 1.00-2.05) persisted among veterans with frequent nightmares.The findings set the stage for future research examining the possibility that nightmares may confer cardiovascular disease risks beyond those conferred by PTSD diagnosis alone, Ulmer noted."If longitudinal research demonstrates a causal role for nightmares in cardiovascular disease risk, nightmare treatment could be a strategy for improving cardiovascular health," she said. Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and cialis 5 more.

Follow Disclosures The study was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System.In chronic kidney disease (CKD), dapagliflozin (Farxiga) reduced renal events and substantially improved overall survival, regardless of diabetes status, the DAPA-CKD trial showed.The SGLT2 drug reduced by a relative 39% the primary endpoint of worsening kidney function (more than 50% sustained decline in estimated glomerular filtration rate [eGFR] or onset of end-stage kidney disease) or death due to kidney disease or cardiovascular disease (312 vs 197 events at a median 2.4 years, HR 0.61, 95% CI 0.51-0.72).The number needed to treat to prevent one such event was just 19, reported Hiddo Heerspink, PharmD, PhD, of the University Medical Center Groningen, the Netherlands, at the European Society of Cardiology virtual meeting.The effect was significant for those with type 2 diabetes and without it (HR 0.64 and 0.50, P=0.24 for interaction).Most notable among the secondary endpoints was the 31% relative reduction in all-cause mortality (P=0.0035, with 101 vs 146 events with placebo).Clinical Implications"For nephrologists who are struggling with the epidemic of kidney disease and the few options available to treat its progression effectively, the possibility of this new effective treatment is cause to celebrate," commented Ladan Golestaneh MD, a nephrologist at Montefiore Medical Center in New York City, predicting changes to the CKD care guidelines.Until recently, ACE inhibitors and angiotensin receptor blockers (ARBs) were the only medications specifically proven to slow CKD progression, Heerspink noted at the ESC hot-line session.But the effect size with dapagliflozin was higher than seen with the ACE/ARB drugs versus placebo in patients with and without cialis 5 type 2 diabetes for composite CKD events, noted Holly Kramer, MD, president of the National Kidney Foundation.It was larger than the relative effects of lower blood pressure targets on composite CKD outcomes in adults with and without type 2 diabetes, she pointed out. The trial "greatly increases the impact these drugs will have on reducing end-stage renal disease," she told MedPage Today.Golestaneh noted that SGLT2 inhibitors have already been increasingly used in nephrologist clinic practice as a means to decrease the progression of diabetic nephropathy and predicted that the demonstration of efficacy in non-diabetic kidney disease would drive that higher.For cardiologists, too, "it's really exciting," even if not surprising, commented Milton Packer, MD, of the Baylor Heart and Vascular Institute in Dallas, who presented cialis 5 at the conference positive findings in heart failure with reduced ejection fraction with fellow SGLT2 inhibitor empagliflozin (Jardiance), including benefits for renal endpoints."We know that SGLT2 inhibitors protect the heart and the kidney," he said. "In many ways, chronic kidney disease trials are cialis 5 in parallel to chronic heart failure trials, because SGLT2 inhibitors benefit both organs."ESC session moderator Frank Ruschitzka, MD, of the Heart Center at University Hospital Zurich, agreed, calling DAPA-CKD fantastic."We are thinking as cardiologists probably too much into boxes, compartmentalization," he said. "Maybe we need a more holistic cialis 5 view...

They're certainly cialis 5 not just glucose-lowering drugs. They're not cialis 5 just only diuretics. Maybe we should just move to organ cialis 5 protection."Trial DetailsThe trial included 4,304 adults with CKD (eGFR 25 to 75 mL/min/1.73 m2 and urine albumin to creatinine ratio of 200 to 5,000 mg/g), about 67% of whom had type 2 diabetes, and all on a maximally-tolerated dose of an ACE inhibitor or ARB. They were randomized to cialis 5 10 mg dapagliflozin once daily or matching placebo.

People with type 1 diabetes were excluded.The trial was stopped early for efficacy after a median follow-up of cialis 5 2.4 years with 60% of the planned events.Dapagliflozin also significantly improved each component of the primary composite (with the exception of a nonsignificant trend for cardiovascular death) as well as secondary composite outcomes:44% lower risk of worsening renal function or renal death34% lower risk of chronic dialysis, kidney transplantation, or renal death29% lower risk of CV death or heart failure hospitalizationNo cases of diabetic ketoacidosis occurred in the dapagliflozin group. Serious adverse events were actually numerically less common with the drug, which Heerspink said was in keeping with cialis 5 dapagliflozin's established safety profile.The Future for SGLT2 InhibitorsPacker noted that a similar CKD trial is underway with empagliflozin (EMPA-KIDNEY, with data expected in 2022) in a population with and without diabetes. The drug has FDA fast track designation for an cialis 5 indication in that regard. The CREDENCE trial previously showed that SGLT2 inhibitor canagliflozin (Invokana) improved outcomes in CKD patients with type 2 diabetes."The thing really amazing about SGLT2 inhibitors is that it's not like our evidence is one or two trials -- it's going to be like nine or 10 large cialis 5 scale trials, which is extraordinary," Packer said.

"For most classes of drugs, we don't have that kind of evidence base cialis 5. ... Physicians have to start using SGLT2 inhibitors across the board for these patients. It's not only the consistency of these results, it's the magnitude."And with multiple agents in the class proving their chops for organ protection, "it's going to be very hard for insurers to say no to drugs like this," commented Dipti Itchhaporia, MD, vice president of the American College of Cardiology.

"The more data, the easier it is for us to get these covered.""Patients balk at the idea of all these additional drugs and the cost of all these drugs," she acknowledged, noting that SGLT2 inhibitors are looking to be the fourth cornerstone of heart failure therapy. "But if you make the case, and you explain to them why they need to take these drugs, they usually are amenable. When you say you're going to live longer, feel better, you're not going to come into the hospital as much, it's hard to argue against that." Disclosures Heerspink disclosed relevant relationships with AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Chinook, CSL Pharma, Gilead, Janssen, Merck, Mundipharma, Mitsubishi Tanabe, Novo Nordisk, and Retrophin.Golestaneh disclosed relevant relationships with Horizon Pharmaceuticals and being a member of the clinical events committee for trials sponsored by Medtronic..

Nightmares that occurred twice a week or more were linked with cardiovascular disease in relatively young military veterans, even cialis for sale online after controlling for post-traumatic stress disorder (PTSD), a cross-sectional study showed.Frequent distressing dreams were associated with hypertension (OR 1.51, 95% CI 1.28-1.78), heart problems (OR 1.50, 95% CI 1.11-2.02), and myocardial infarction (OR 2.32, 95% CI 1.18-4.54), after adjusting for age, race, and sex, reported Christi Ulmer, PhD, of the Durham VA Health Services Research and Development ADAPT Center and Duke University Medical Center, both in North Carolina."After also adjusting for PTSD, depression, and current smoking, severely distressing dreams continued to visite site be associated with heart problems, hypertension, and other heart trouble," Ulmer said in a presentation at virtual SLEEP 2020, a joint meeting of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society."Research on heart rate variability supports the likelihood of abnormal autonomic function during sleep among those with PTSD. However, we haven't taken a look at what role nightmares specifically might play in contributing to increased risk in this population," Ulmer noted."While some have suggested that the association between PTSD and cardiovascular disease is cialis for sale online solely due to poor health behaviors among those with PTSD, our findings suggest an important role for sleep and that there may be an independent role for nightmares, in particular for conferring cardiovascular disease," she said.In this analysis, Ulmer and colleagues studied 3,468 U.S. Military veterans with an average age of 38 who cialis for sale online served since Sept. 11, 2001 cialis for sale online. The majority (73.5%) had one or two tours of duty and cialis for sale online most (77.4%) were men.

Most (65.0%) had moderate-to-heavy combat exposure.The researchers assessed nightmare frequency and severity with cialis for sale online the Davidson Trauma Scale. Nightmares were cialis for sale online classified as frequent if they occurred two or more times per week and moderate-to-severe if they were at least moderately distressing. Self-reported medical issues were cialis for sale online assessed using the National Vietnam Veterans Readjustment Study questionnaire and other measures. Diagnoses of PTSD and depression were established through structured clinical interviews.About a third of veterans in the study reported nightmares in the past week, and 41% had poor sleep quality scores as measured by cialis for sale online the Pittsburgh Sleep Quality Index. In total, 31% of the veterans met criteria for current PTSD and cialis for sale online 32.7% reported at least one cardiovascular condition.Diagnosed depression was more common in the PTSD group.

Veterans with PTSD served more tours of duty, had greater combat exposure, poorer sleep quality, and more frequent and more severe distressing dreams.After controlling for depression, PTSD, and current smoking, risks for hypertension (OR 1.43, 95% 1.17-1.73) and heart problems (OR 1.43, 95% CI 1.00-2.05) persisted among veterans with frequent nightmares.The findings set the stage for future research examining the possibility that nightmares may confer cardiovascular disease risks beyond those conferred by PTSD diagnosis alone, Ulmer noted."If longitudinal research demonstrates a causal role for nightmares in cardiovascular disease risk, nightmare treatment cialis for sale online could be a strategy for improving cardiovascular health," she said. Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, cialis for sale online CTE, sleep, pain, and more. Follow Disclosures The study was supported by the Department of Veterans VISN 6 MIRECC and ADAPT Centers at the Durham VA Health Care System.In chronic kidney disease (CKD), dapagliflozin (Farxiga) reduced renal events and substantially improved overall survival, regardless of diabetes status, the DAPA-CKD trial showed.The SGLT2 drug reduced by a relative 39% the primary endpoint of worsening kidney function (more than 50% sustained decline in estimated glomerular filtration rate [eGFR] or onset of end-stage kidney disease) or death due to kidney disease or cardiovascular disease (312 vs 197 events at a median 2.4 years, HR 0.61, 95% CI 0.51-0.72).The number needed to treat to prevent one such event was just 19, reported Hiddo Heerspink, PharmD, PhD, of the University Medical Center Groningen, the Netherlands, at the European Society of Cardiology virtual meeting.The effect was significant for those with type 2 diabetes and without it (HR 0.64 and 0.50, P=0.24 for interaction).Most notable among the secondary endpoints was the 31% relative reduction in all-cause mortality (P=0.0035, with 101 vs 146 events with placebo).Clinical Implications"For nephrologists who are struggling with the epidemic of kidney disease and the few options available to treat its progression effectively, the possibility of this new effective treatment is cause to celebrate," commented Ladan Golestaneh MD, a nephrologist at Montefiore Medical Center in New York City, predicting changes to the CKD care guidelines.Until recently, ACE inhibitors and angiotensin receptor blockers (ARBs) were the only medications specifically proven to slow CKD progression, Heerspink noted at the ESC hot-line session.But the effect size with dapagliflozin was higher than seen with the ACE/ARB drugs versus placebo in patients with and without type 2 diabetes for composite CKD events, noted Holly Kramer, MD, president of the National Kidney Foundation.It was larger than the relative effects cialis for sale online of lower blood pressure targets on composite CKD outcomes in adults with and without type 2 diabetes, she pointed out. The trial "greatly increases the impact these drugs will have on reducing end-stage renal disease," she told MedPage Today.Golestaneh noted that SGLT2 inhibitors have already been increasingly used in nephrologist clinic practice as a means to decrease the progression of diabetic nephropathy and predicted that the demonstration of efficacy in non-diabetic kidney disease would drive that higher.For cardiologists, too, "it's really exciting," even if not surprising, commented cialis for sale online Milton Packer, MD, of the Baylor Heart and Vascular Institute in Dallas, who presented at the conference positive findings in heart failure with reduced ejection fraction with fellow SGLT2 inhibitor empagliflozin (Jardiance), including benefits for renal endpoints."We know that SGLT2 inhibitors protect the heart and the kidney," he said. "In many ways, chronic kidney disease trials are in parallel to chronic heart failure trials, because SGLT2 inhibitors benefit both organs."ESC session moderator Frank Ruschitzka, cialis for sale online MD, of the Heart Center at University Hospital Zurich, agreed, calling DAPA-CKD fantastic."We are thinking as cardiologists probably too much into boxes, compartmentalization," he said.

"Maybe we need a more cialis for sale online holistic view... They're certainly cialis for sale online not just glucose-lowering drugs. They're not cialis for sale online just only diuretics. Maybe we should just move to organ protection."Trial DetailsThe trial included 4,304 adults with CKD (eGFR 25 to 75 mL/min/1.73 m2 and urine cialis for sale online albumin to creatinine ratio of 200 to 5,000 mg/g), about 67% of whom had type 2 diabetes, and all on a maximally-tolerated dose of an ACE inhibitor or ARB. They were randomized to 10 cialis for sale online mg dapagliflozin once daily or matching placebo.

People with type 1 diabetes were excluded.The trial was stopped early for efficacy after a median follow-up of 2.4 years with 60% of the planned events.Dapagliflozin also significantly improved each component of the primary composite (with the exception of a nonsignificant trend for cardiovascular death) as well as secondary composite outcomes:44% lower risk of worsening renal function or renal death34% lower risk of chronic dialysis, kidney transplantation, or renal death29% lower risk of CV death or heart failure hospitalizationNo cases of diabetic ketoacidosis occurred in the dapagliflozin group cialis for sale online. Serious adverse events were actually numerically less common with the drug, which Heerspink said was in keeping with dapagliflozin's established safety profile.The Future for SGLT2 InhibitorsPacker noted that a similar CKD trial is cialis for sale online underway with empagliflozin (EMPA-KIDNEY, with data expected in 2022) in a population with and without diabetes. The drug has FDA fast track designation for an indication in cialis for sale online that regard. The CREDENCE trial previously showed that SGLT2 inhibitor canagliflozin (Invokana) improved outcomes in CKD patients with type 2 diabetes."The thing really amazing about SGLT2 inhibitors is that it's not like our evidence is one or two trials -- it's going to be like nine or 10 large scale cialis for sale online trials, which is extraordinary," Packer said. "For most classes of cialis for sale online drugs, we don't have that kind of evidence base.

... Physicians have to start using SGLT2 inhibitors across the board for these patients. It's not only the consistency of these results, it's the magnitude."And with multiple agents in the class proving their chops for organ protection, "it's going to be very hard for insurers to say no to drugs like this," commented Dipti Itchhaporia, MD, vice president of the American College of Cardiology. "The more data, the easier it is for us to get these covered.""Patients balk at the idea of all these additional drugs and the cost of all these drugs," she acknowledged, noting that SGLT2 inhibitors are looking to be the fourth cornerstone of heart failure therapy. "But if you make the case, and you explain to them why they need to take these drugs, they usually are amenable.

When you say you're going to live longer, feel better, you're not going to come into the hospital as much, it's hard to argue against that." Disclosures Heerspink disclosed relevant relationships with AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Chinook, CSL Pharma, Gilead, Janssen, Merck, Mundipharma, Mitsubishi Tanabe, Novo Nordisk, and Retrophin.Golestaneh disclosed relevant relationships with Horizon Pharmaceuticals and being a member of the clinical events committee for trials sponsored by Medtronic..