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NCHS Data ventolin street price Brief 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 ventolin street price increased risk for 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 occurs after the loss of ovarian ventolin street price 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 ventolin street price postmenopausal. Keywords.

Insufficient sleep, menopause, National Health Interview Survey Perimenopausal 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 ventolin street price 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 ventolin street price. 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, ventolin street price 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 ventolin street price menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data ventolin street price 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 ventolin street price 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 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 ventolin street price. 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 ventolin street price 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 ventolin street price or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure ventolin street price 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 ventolin street price 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 ventolin street price. 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 < ventolin street price.

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 ventolin street price 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 ventolin street price 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 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% ventolin street price 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 ventolin street price. 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.

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Credit. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb.

Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries. During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition.

In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls. Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause of the link between the two conditions remains unclear,” she says.

However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition. The other authors on this paper were Ginette A.

Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells.

As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an . These medicines have had remarkable success in treating some types of cancers that historically have had poor prognoses, such as advanced melanoma and lung cancer. However, these therapies have had little effect on other deadly cancer types, such as pancreatic cancer and glioblastoma. The mutational burden of certain tumor types has previously been proposed as an explanation for why certain cancers respond better than others to immune checkpoint inhibitors says study leader Mark Yarchoan, M.D., chief medical oncology fellow.

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

Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of that cancer. €œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive.

It’s one of those things that doesn’t sound right when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a ventolin, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

In contrast, the most common type of colorectal cancer has moderate mutational burden, yet responds poorly to checkpoint inhibitors for reasons that are still unclear. Yarchoan notes that these findings could help guide clinical trials to test checkpoint inhibitors on cancer types for which these drugs haven’t yet been tried. Future studies might also focus on finding ways to prompt cancers with low mutational burdens to behave like those with higher mutational burdens so that they will respond better to these therapies. He and his colleagues plan to extend this line of research by investigating whether mutational burden might be a good predictor of whether cancers in individual patients might respond well to this class of immunotherapy drugs.

€œThe end goal is precision medicine—moving beyond what’s true for big groups of patients to see whether we can use this information to help any given patient,” he says. Yarchoan receives funding from the Norman &. Ruth Rales Foundation and the Conquer Cancer Foundation. Through a licensing agreement with Aduro Biotech, Jaffee has the potential to receive royalties in the future..

Credit http://www.em-sources-saverne.ac-strasbourg.fr/?p=5 ventolin street price. IStock Share Fast Facts New @HopkinsMedicine study finds African-American women with common form of hair loss at increased risk of uterine fibroids - Click to Tweet New study in @JAMADerm shows most common form of alopecia (hair loss) in African-American women associated with higher risks of uterine fibroids - Click to Tweet In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.In a report on the research, published in the December 27 issue of JAMA Dermatology, the researchers call on physicians who treat women with central centrifugal cicatricial alopecia (CCCA) to make patients aware that they may be at increased risk for fibroids and should be screened for the condition, particularly if they have symptoms such as heavy bleeding and pain. CCCA predominantly affects black women and is the most common form of permanent alopecia in this ventolin street price population. The excess scar tissue that forms as a result of this type of hair loss may also explain the higher risk for uterine fibroids, which are characterized by fibrous growths in the lining of the womb. Crystal Aguh, M.D., assistant professor of dermatology at the Johns Hopkins University School of Medicine, says the ventolin street price scarring associated with CCCA is similar to the scarring associated with excess fibrous tissue elsewhere in the body, a situation that may explain why women with this type of hair loss are at a higher risk for fibroids.People of African descent, she notes, are more prone to develop other disorders of abnormal scarring, termed fibroproliferative disorders, such as keloids (a type of raised scar after trauma), scleroderma (an autoimmune disorder marked by thickening of the skin as well as internal organs), some types of lupus and clogged arteries.

During a four-year period from 2013-2017, the researchers analyzed patient data from the Johns Hopkins electronic medical record system (Epic) of 487,104 black women ages 18 and over. The prevalence of those with fibroids was compared in patients with ventolin street price and without CCCA. Overall, the researchers found that 13.9 percent of women with CCCA also had a history of uterine fibroids compared to only 3.3 percent of black women without the condition. In absolute numbers, out of the 486,000 women who were reviewed, 16,212 had fibroids.Within that population, 447 had CCCA, of which 62 had fibroids. The findings ventolin street price translate to a fivefold increased risk of uterine fibroids in women with CCCA, compared to age, sex and race matched controls.

Aguh cautions that their study does not suggest any cause and effect relationship, or prove a common cause for both conditions. €œThe cause ventolin street price of the link between the two conditions remains unclear,” she says. However, the association was strong enough, she adds, to recommend that physicians and patients be made aware of it. Women with this type ventolin street price of scarring alopecia should be screened not only for fibroids, but also for other disorders associated with excess fibrous tissue, Aguh says. An estimated 70 percent of white women and between 80 and 90 percent of African-American women will develop fibroids by age 50, according to the NIH, and while CCCA is likely underdiagnosed, some estimates report a prevalence of rates as high as 17 percent of black women having this condition.

The other authors ventolin street price on this paper were Ginette A. Okoye, M.D. Of Johns Hopkins and Yemisi Dina of Meharry Medical College.Credit. The New England Journal of Medicine Share Fast Facts This study clears up how big an effect the mutational burden has on outcomes to ventolin street price immune checkpoint inhibitors across many different cancer types. - Click to Tweet The number of mutations in a tumor’s DNA is a good predictor of whether it will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors.

- Click to Tweet The “mutational burden,” or the number of mutations present in a tumor’s DNA, is a good predictor of whether that cancer type will respond to a class of cancer immunotherapy drugs known as checkpoint inhibitors, a new study led by Johns Hopkins Kimmel Cancer Center researchers shows ventolin street price. The finding, published in the Dec. 21 New England Journal of Medicine, could be used to guide future ventolin street price clinical trials for these drugs. Checkpoint inhibitors are a relatively new class of drug that helps the immune system recognize cancer by interfering with mechanisms cancer cells use to hide from immune cells. As a result, the drugs cause the immune system to fight cancer in the same way that it would fight an .

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

To investigate this question, Yarchoan and colleagues Alexander Hopkins, Ph.D., research fellow, and Elizabeth Jaffee, M.D., co-director of the Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care and associate director of the Bloomberg~Kimmel Institute, combed the medical literature for the results of clinical trials using checkpoint inhibitors on various different types of cancer. They combined these findings with data on the mutational burden ventolin street price of thousands of tumor samples from patients with different tumor types. Analyzing 27 different cancer types for which both pieces of information were available, the researchers found a strong correlation. The higher a cancer type’s mutational burden tends to be, the more likely it is to respond to checkpoint inhibitors. More than half of the differences in how well cancers responded to immune checkpoint inhibitors could be explained by the mutational burden of ventolin street price that cancer.

€œThe idea that a tumor type with more mutations might be easier to treat than one with fewer sounds a little counterintuitive. It’s one of those things that doesn’t sound right ventolin street price when you hear it,” says Hopkins. €œBut with immunotherapy, the more mutations you have, the more chances the immune system has to recognize the tumor.” Although this finding held true for the vast majority of cancer types they studied, there were some outliers in their analysis, says Yarchoan. For example, Merkel cell cancer, a rare and highly aggressive skin cancer, tends to have a moderate number of mutations yet responds extremely well to checkpoint inhibitors. However, he explains, this cancer type is often caused by a ventolin, which seems to encourage a strong immune response despite the cancer’s lower mutational burden.

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

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

What is ventolin hfa 90 mcg used for

ELK CITY — One student throws his classmates’ pencil box on the what is ventolin hfa 90 mcg used for floor in anger. Another bites her own arm out of frustration. Others run screaming from their what is ventolin hfa 90 mcg used for classrooms. Some Elk City Elementary School students are celebrating as summer break approaches. Others are dreading the end of the school year, acting out in fear of what the next three months could bring.

School counselor Kim Hamm worries about students who won’t have enough to eat this summer what is ventolin hfa 90 mcg used for. And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs. And who will spend their days anticipating what is ventolin hfa 90 mcg used for the next attack from an abusive family member. Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home.

“They know that, here, they’re safe and what is ventolin hfa 90 mcg used for we’re not going to hurt them,” Hamm said. €œAnd a lot of our kids, unfortunately, don’t go home to that every day.” About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry. The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students what is ventolin hfa 90 mcg used for face rates of poverty, special needs and suicide higher than the state average. Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office.

Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent. (Courtesy photo) In her what is ventolin hfa 90 mcg used for six years as a school counselor, Hamm has learned to anticipate these needs, making more time towards the end of the school year to meet with students one-on-one. But she doesn’t always have the bandwidth. School counselors’ duties range from helping develop individualized learning plans for students with special needs to proctoring the third-grade what is ventolin hfa 90 mcg used for reading test. They enroll students in classes and ensure they meet state math and science requirements.

They provide college and career advice and help them find and apply for scholarships. They wrangle students during morning what is ventolin hfa 90 mcg used for drop-off and afternoon pick-up, run school-sponsored food and clothes pantries and teach breathing techniques to those with test anxiety. Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. Counselors refer the most troubled kids to community mental health counselors. But they are also in short supply especially in rural areas like Elk City where what is ventolin hfa 90 mcg used for the ratio of mental healthcare providers to residents is 1 to 150,000.

Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed. A federal program is increasing support for students in six rural school districts in what the state mental health and education departments call “mental health what is ventolin hfa 90 mcg used for deserts.” But schools are finding it difficult to hire qualified caregivers and asthma treatment restrictions have halted programs and limited in-person treatment. Students are seen leaving Elk City Elementary School at the end of the school day. School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma Watch) A Response Inspired By Sandy Hook Since 2018, the State Department of Education has received two U.S what is ventolin hfa 90 mcg used for.

Department of Health and Human Services grants totaling $18 million. Oklahoma’s Project AWARE, short for Advancing Wellness and Resiliency in Education, is in its third year of the five-year grant at Woodward, Elk City and Weatherford Public Schools and its first year at Ada, Atoka and Checotah Public Schools. Subscribe to Jennifer Palmer's Education Watch newsletter Processing… Success! what is ventolin hfa 90 mcg used for. You're on the list. Whoops! what is ventolin hfa 90 mcg used for.

There was an error and we couldn't process your subscription. Please reload the page and try again. The districts were chosen by the what is ventolin hfa 90 mcg used for state department for their lack of treatment providers and high-risk student populations. Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University. But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application.

These students are more susceptible to mental what is ventolin hfa 90 mcg used for illness. And without treatment, they can face even more dangerous obstacles as they age, often leading to their own violent encounters, substance abuse or incarceration. Subscribe to our First Watch newsletter Processing… Success! what is ventolin hfa 90 mcg used for. You're on the list. Whoops!.

There was an what is ventolin hfa 90 mcg used for error and we couldn't process your subscription. Please reload the page and try again. In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012. Since then, the Substance Abuse and Mental Health Services Administration has sent millions what is ventolin hfa 90 mcg used for to schools nationwide with high-risk students to prevent violence perpetrated by young people. This story was reported in partnership with the Solutions Journalism Network.

For more information, go to what is ventolin hfa 90 mcg used for solutionsjournalism.org. In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff. At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the ventolin. Community events aim to reduce stigma around what is ventolin hfa 90 mcg used for mental health challenges and treatment and teach parents and students about healthy habits like the importance of sleep and recommendations for social media use. Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation.

Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out. Community mental health what is ventolin hfa 90 mcg used for counselors had started to meet with troubled students in some of the Western Oklahoma schools. Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of what is ventolin hfa 90 mcg used for these services were paused due to asthma treatment. Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent.

The grant also trained educators at all six districts in a classroom program that teaches conflict resolution and empathy. Liz Henthorn, a what is ventolin hfa 90 mcg used for kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. Henthorn checks in with her students twice a day through a program known as Circles that she says teaches students coping skills and empathy. (Whitney Bryen/Oklahoma Watch) Just before the bell rang on a Monday afternoon, kindergarteners sat in a circle on a rug at the front of Liz Henthorn’s classroom at Elk City Elementary School. One-by-one the students rated how they’re feeling as they what is ventolin hfa 90 mcg used for prepared to go home.

They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice. One student said he was feeling sad because his dog ran away that morning. Another student was feeling red because she had what is ventolin hfa 90 mcg used for a bad dream. Other students spoke up saying they could relate or that they’re sorry that happened. “We’re teaching kids to identify their feelings and giving suggestions to cope,” Henthorn what is ventolin hfa 90 mcg used for said.

€œAnd when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.” Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch) Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation. But few are qualified to help more what is ventolin hfa 90 mcg used for critical students, like those with mental illness or who have experienced trauma. Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%.

In Elk City, 140 of the district’s 2,110 students had a parent who was what is ventolin hfa 90 mcg used for incarcerated. And all three Western Oklahoma districts had higher than average suicide rates. Those districts rely on school counselors to support these students, though most lack the what is ventolin hfa 90 mcg used for training. And the grant does not address the ratio of counselors to students, which is far above national recommendations. Districts also planned to increase referrals to community treatment centers facilitated by the grant.

Demand for mental health care spiked during the what is ventolin hfa 90 mcg used for ventolin, further straining the area’s providers and leaving families with few options. Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch) The Complicated Search for Counselors School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors can provide therapy and diagnose students with what is ventolin hfa 90 mcg used for mental illness. Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors.

Each district hired what is ventolin hfa 90 mcg used for one licensed mental health provider who serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed. The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams. Training for licensed professional what is ventolin hfa 90 mcg used for counselors requires an additional 60 graduate-level college hours and 3,000 hours of supervised counseling. Counselors must also pass an exam before being licensed.

Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include fees for supervision or the licensing what is ventolin hfa 90 mcg used for exam. The grant will pay tuition costs for school counselors to get their license. Only two of 16 school counselors in Elk City, Weatherford and Woodward what is ventolin hfa 90 mcg used for have taken the offer. School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion.

“I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old. €œIf I was going to what is ventolin hfa 90 mcg used for make more as a school counselor with it then maybe I would, but I’m not going to so I’m just not going to spend a whole lot of time to get that.” For school counselors who do get their license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the ventolin. Oklahoma has 1,841 school counselors and nearly 695,000 students, according to State Department what is ventolin hfa 90 mcg used for of Education reports.

The department does not track how many school counselors have their professional counseling license. The American School Counselor Association recommends what is ventolin hfa 90 mcg used for a ratio of 1 school counselor to 250 students. Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools. Not every school has what is ventolin hfa 90 mcg used for a dedicated counselor.

Some have teams depending on student population, how schools prioritize funding and disperse tasks. The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch what is ventolin hfa 90 mcg used for interviewed 10 counselors across the state. Most said they spend the majority of their day doing clerical work. Depending on the time of year, about 20 to 50% of what is ventolin hfa 90 mcg used for their time is spent with students.

Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration. Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation. €œA lot of what I deal with are the results of families who are in crisis, where there’s addiction, other issues that are related to poverty and the kids show what is ventolin hfa 90 mcg used for up to school and there’s a lot of fallout from that,” Moss said. €œAnd so we have kids who are depressed. We’ve had kids who are suicidal.

Anxieties are really high.” Lora Anderson, a school counselor at Ada Junior High School, talks to students about online enrollment and how to what is ventolin hfa 90 mcg used for choose classes for next school year. (Courtesy photo) Moss is one of two school counselors taking advantage of Project AWARE funding to get her professional counseling license. Her principal took over her ACT and pre-ACT what is ventolin hfa 90 mcg used for testing, scheduling and enrollment duties allowing Moss to spend more time with students in crisis. “I would love to see even more taken off of the shoulders of counselors so that we could take care of our kids’ needs better,” Moss said. €œBut I truly feel blessed here that I am not overwhelmed, like so many counselors.” At Ada Junior High School, counselor Lora Anderson spends about 25% of her time working with troubled students.

Many school counselors go into the job to propel students’ academic success, not what is ventolin hfa 90 mcg used for to provide therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs. €œThat’s not what I want to do,” Anderson said after returning to her desk from lunch duty. €œI do what is ventolin hfa 90 mcg used for so many different things to help students. If I wanted to be a mental health counselor, I wouldn’t work in a school.” Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students.

(Courtesy photo) Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license. But based what is ventolin hfa 90 mcg used for on training she’s attended and led over the years, Taylor said it’s likely that about 1 in 5 school counselors goes on to become licensed. School counselors are serving dual roles whether they want to or not. Like swim instructors at a pool, most school counselors see their role as building stronger swimmers what is ventolin hfa 90 mcg used for. But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids.

“Counselors in rural schools tend to be treading more water,” Taylor said. €œSome folks are so overwhelmed with the job they have, they don’t have the time or what is ventolin hfa 90 mcg used for the motivation to seek out additional training. It’s just not accessible for folks.” Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. She said the job has changed a lot since what is ventolin hfa 90 mcg used for she started.

Test requirements are constantly evolving. College admissions what is ventolin hfa 90 mcg used for and scholarship applications seem to get longer every year. And students want to talk more. Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the ventolin, Taylor said. And school counselors have what is ventolin hfa 90 mcg used for to be ready to listen and help.

“I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said. €œThat’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.” Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said since the asthma ventolin began, what is ventolin hfa 90 mcg used for her students seem more anxious and depressed than ever. (Whitney Bryen/Oklahoma Watch) Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by asthma treatment. Contact her what is ventolin hfa 90 mcg used for at (405) 201-6057 or wbryen@oklahomawatch.org.

Follow her on Twitter @SoonerReporter. Support our publicationEvery day we strive to produce journalism that matters — stories that strengthen accountability and transparency, provide value and resonate with readers like you.This work is essential to a better-informed community and a healthy democracy. But it what is ventolin hfa 90 mcg used for isn’t possible without your support. Donate nowMore than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The ventolin has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire.

It may have the smallest population in America, but what is ventolin hfa 90 mcg used for when it comes to land, Wyoming is the ninth-largest. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here. While there is vast open space, the nearest major what is ventolin hfa 90 mcg used for trauma hospital is more than 2.5 hours away. On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival.

It's a fact Luke Sypherd knows what is ventolin hfa 90 mcg used for all too well. For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve. "We just saw that we what is ventolin hfa 90 mcg used for didn't have the personnel to continue," Sypherd said. "It was an ongoing problem made worse by asthma treatment with fewer people interested in volunteering with EMS during a ventolin and patients afraid of getting taken to a hospital."A nearby hospital system, Cody Regional Health, has agreed to provide ambulance service for Washakie County, averting a crisis.

But it's a problem what is ventolin hfa 90 mcg used for playing out across rural America. Ambulance crews are running out of money and volunteers.Phillip Franklin, the EMS Director for Cody Regional Health, said the crisis is a result of several problems."The majority of the ambulance service staff are not paid so if you don't have your volunteers, they can't run calls," Franklin said. "Another problem is that there's simply just not enough volume to keep ambulance service afloat and in the state of Wyoming, EMS is not essential, which means there's nobody responsible to fund these entities."Sypherd said the funding model for EMS is fundamentally flawed, with most service providers reimbursed only if they take patients to a hospital or clinic. In rural areas like Washakie County, smaller populations mean fewer calls, and consequently, less money what is ventolin hfa 90 mcg used for. "You're reimbursed based on the number of patients that you transport to a hospital so you could get called 1,000 times a year and only transport 750 patients -- those other 250 calls you made no money on," Sypherd said.

Plea for federal assistanceThe American Ambulance Association sent a letter earlier this month to the US Department of Health and Human Services asking the agency to earmark $1.425 billion in federal aid for its members, warning that emergency medical systems across the US are "on the brink of collapse.""It is critical that we not let the financial hardship caused by the ventolin to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National what is ventolin hfa 90 mcg used for Association of State EMS Officials, just eight states consider local emergency medical services "essential" by law, as they do for fire and police. "That mandate means that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said. "If you're in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might what is ventolin hfa 90 mcg used for be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year away from closure."'A matter of life and death'One of those is Fremont County -- home to the Wind River Indian Reservation.

Fremont is roughly the size of the state of Vermont. An economic downturn and what is ventolin hfa 90 mcg used for budget cuts prompted the county to privatize its ambulance service in 2016. But the private company, American Medical Response, says it can't afford to keep going after losing $1.5 million in revenue last year. AMR announced it won't renew its contract when it runs out on June 30. No others have bid what is ventolin hfa 90 mcg used for.

"We just couldn't renew that current contract because it was set up for a financial failure," said Matt Strauss, Regional Director for AMR parent company, Global Medical Response. One of the problems, according what is ventolin hfa 90 mcg used for to Fremont County Commissioner Larry Allen, is the so-called payer mix. Many of the county's residents rely on Medicare, Medicaid and Indian Health Services, which reimburse ambulance providers at a lower rate. And without state or federal designation of EMS as an essential service, Allen said "there's no source of revenue to operate an ambulance.""Because of the distance and the ruralness of this county, we just don't have people standing in line wanting to provide ambulance service," Allen said. The Wind River Indian Reservation stretches across more than 2 million acres and is shared by two Native American tribes, the Eastern Shoshone and the Northern Arapaho.

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

ELK CITY — One student throws his classmates’ ventolin street price pencil box on the floor in anger. Another bites her own arm out of frustration. Others run screaming ventolin street price from their classrooms. Some Elk City Elementary School students are celebrating as summer break approaches. Others are dreading the end of the school year, acting out in fear of what the next three months could bring.

School counselor Kim Hamm worries about students ventolin street price who won’t have enough to eat this summer. And those without air conditioning or running water. She wonders how many will be left alone while their caretakers are working two or three jobs. And who will spend their days anticipating the next attack from an abusive family member ventolin street price. Hamm has spent most of May helping students ages 4 to 9 identify and cope with their feelings, which can be triggered by instability at home.

“They know that, here, they’re ventolin street price safe and we’re not going to hurt them,” Hamm said. €œAnd a lot of our kids, unfortunately, don’t go home to that every day.” About 100 miles west of Oklahoma City on Interstate 40, Elk City is home to nearly 12,000 residents whose financial stability ebbs and flows with the volatile oil and gas industry. The nearby North Fork Correctional Facility brought some families to town to be close to a loved one. And students face rates of poverty, special needs and suicide higher than the state average ventolin street price. Kim Hamm, an Elk City Elementary School counselor, talks to a pre-kindergarten student who is playing with sensory toys purchased with Project AWARE funds in her office.

Hamm said disadvantaged, abused and neglected students’ behavior deteriorates toward the end of the school year because they’re afraid or stressed about spending months away from school, which provides safety when life at home is turbulent. (Courtesy photo) In her six years as a school counselor, Hamm has learned to anticipate these needs, making more time towards the ventolin street price end of the school year to meet with students one-on-one. But she doesn’t always have the bandwidth. School counselors’ duties range from helping develop individualized learning plans for students with special needs to proctoring the third-grade reading test ventolin street price. They enroll students in classes and ensure they meet state math and science requirements.

They provide college and career advice and help them find and apply for scholarships. They wrangle students during morning drop-off and afternoon pick-up, run school-sponsored food and clothes pantries and teach breathing techniques ventolin street price to those with test anxiety. Low pay and increasing obligations have left Oklahoma with a teacher shortage, which means counselors like Hamm are taking on more work leaving less time for struggling students. Counselors refer the most troubled kids to community mental health counselors. But they are also in short supply ventolin street price especially in rural areas like Elk City where the ratio of mental healthcare providers to residents is 1 to 150,000.

Without adequate local resources, the responsibility of students’ mental health care is falling to school counselors who are outnumbered and overwhelmed. A federal program is increasing support for students in six rural school districts in what the state mental health and education departments call “mental health deserts.” ventolin street price But schools are finding it difficult to hire qualified caregivers and asthma treatment restrictions have halted programs and limited in-person treatment. Students are seen leaving Elk City Elementary School at the end of the school day. School counselor Kim Hamm said for some students school is a safe place and leaving is not a happy but fearful time of day for students who don’t have enough to eat or are abused by family members at home. (Whitney Bryen/Oklahoma Watch) A Response Inspired By Sandy Hook Since 2018, the State Department of Education has ventolin street price received two U.S.

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

There was an error and we couldn't process your subscription. Please reload the page and try again. The districts were chosen by the state department for ventolin street price their lack of treatment providers and high-risk student populations. Oklahoma students are some of the most traumatized in the nation, according to several national health rankings including a recent survey conducted by a group based at Johns Hopkins University. But kids in these rural districts were more likely to have access to firearms, live in poverty, have an incarcerated parent, use drugs, experience depression and die by suicide, according to the state’s grant application.

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

There ventolin street price was an error and we couldn't process your subscription. Please reload the page and try again. In one of the country’s deadliest school shootings, a 20-year-old killed six adults and 20 students at Sandy Hook Elementary School in 2012. Since then, the Substance Abuse and Mental Health Services Administration ventolin street price has sent millions to schools nationwide with high-risk students to prevent violence perpetrated by young people. This story was reported in partnership with the Solutions Journalism Network.

For more information, go ventolin street price to solutionsjournalism.org. In their first year of the grant, Atoka, Ada and Checotah schools in Eastern Oklahoma spent most of the year assessing student needs and training staff. At Elk City, Weatherford and Woodward schools in Western Oklahoma, Project AWARE forged ahead despite changes to programs that were derailed by the ventolin. Community events aim to reduce stigma around ventolin street price mental health challenges and treatment and teach parents and students about healthy habits like the importance of sleep and recommendations for social media use. Elk City paused events in the spring of 2020 while Weatherford took its online and saw a spike in participation.

Fifth through 12th grade students at all six districts completed mental health assessments, which helps educators identify students who are distracted, unhappy, scared, lonely or are prone to acting out. Community mental health counselors had ventolin street price started to meet with troubled students in some of the Western Oklahoma schools. Parents have to agree to therapy but bringing professionals into the schools reduces barriers for families who lack transportation or who feel embarrassed visiting a local treatment facility. Many of ventolin street price these services were paused due to asthma treatment. Some Project AWARE schools started group therapy sessions led by licensed mental health professionals for students with chronic stress often triggered by traumatic experiences like an absent or abusive parent.

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

They describe their feelings as green, yellow or red if they’re having a difficult day and their peers offer comfort and advice. One student said he was feeling sad because his dog ran away that morning. Another student was feeling red because she had a bad dream ventolin street price. Other students spoke up saying they could relate or that they’re sorry that happened. “We’re teaching kids ventolin street price to identify their feelings and giving suggestions to cope,” Henthorn said.

€œAnd when we do it as a group the kids are learning about empathy and thinking about ways to help each other and that is just as important.” Liz Henthorn, a kindergarten teacher at Elk City Elementary School, listens as her students rate how they’re feeling at the end of the day. (Whitney Bryen/Oklahoma Watch) Teachers, counselors and administrators were trained to provide coping skills to students who face universal challenges like disagreements with classmates or stress about what to do after graduation. But few are qualified to ventolin street price help more critical students, like those with mental illness or who have experienced trauma. Woodward Public Schools reported 82 homeless students during the 2017-18 school year – more than twice the state average. Nearly two-thirds of students at Woodward and Elk City Public Schools qualified for free and reduced lunches, compared to the state’s average of 50%.

In Elk City, ventolin street price 140 of the district’s 2,110 students had a parent who was incarcerated. And all three Western Oklahoma districts had higher than average suicide rates. Those ventolin street price districts rely on school counselors to support these students, though most lack the training. And the grant does not address the ratio of counselors to students, which is far above national recommendations. Districts also planned to increase referrals to community treatment centers facilitated by the grant.

Demand for mental health care spiked during the ventolin, ventolin street price further straining the area’s providers and leaving families with few options. Weatherford elementary students are seen eating lunch in the school’s cafeteria. (Whitney Bryen/Oklahoma Watch) The Complicated Search for Counselors School counselors can listen to students and offer coping techniques, but their ability to help is limited. Licensed counselors can provide therapy and diagnose students with mental ventolin street price illness. Elk City, Woodward and Weatherford districts hoped to bring more licensed professional counselors into schools by hiring new staff and using Project AWARE funds to pay for training for current school counselors.

Each district ventolin street price hired one licensed mental health provider who serves all students. The districts have been unable to hire any new school counselors and no existing counselors have been licensed. The state requires school counselors to have a master’s degree in a related field or two years of experience, and pass the state’s general education, professional teaching and school counseling exams. Training for licensed professional counselors requires an additional 60 graduate-level college hours and 3,000 hours of supervised counseling ventolin street price. Counselors must also pass an exam before being licensed.

Education costs are likely to total $21,000 to $33,000 depending on the school, according to the most recent state averages. And that doesn’t include fees ventolin street price for supervision or the licensing exam. The grant will pay tuition costs for school counselors to get their license. Only two of 16 school counselors in Elk ventolin street price City, Weatherford and Woodward have taken the offer. School counselors said it is still an expensive and lengthy endeavour that results in more work without a boost in pay or a promotion.

“I know that it would give me more in depth counseling training, but I think at this time in my life with small children it’s just probably not going to happen,” said Hamm, who has a 10-month-old and a 3-year-old. €œIf I was going to make more as a school counselor with ventolin street price it then maybe I would, but I’m not going to so I’m just not going to spend a whole lot of time to get that.” For school counselors who do get their license, the job doesn’t change much. They often have the same paperwork, testing responsibilities and recess duty. But they’re also counseling the school’s most traumatized kids, a group that is growing following the ventolin. Oklahoma has 1,841 school counselors and nearly ventolin street price 695,000 students, according to State Department of Education reports.

The department does not track how many school counselors have their professional counseling license. The American School Counselor Association recommends ventolin street price a ratio of 1 school counselor to 250 students. Oklahoma mandates 1 school counselor per 450 middle and high school students. The state does not have a threshold for elementary schools. Not every ventolin street price school has a dedicated counselor.

Some have teams depending on student population, how schools prioritize funding and disperse tasks. The Association also recommends counselors spend at least 80% of their time working directly with or for individual students. Oklahoma Watch interviewed ventolin street price 10 counselors across the state. Most said they spend the majority of their day doing clerical work. Depending on the time of year, about 20 to 50% of their time is spent with students ventolin street price.

Elizabeth Moss, a seventh and eighth grade counselor at Woodward Middle School, said she is one of the fortunate ones because she spends about 50% of her time meeting with students one-on-one thanks to the help of her administration. Even with the group sessions she leads, Moss said she still hasn’t been able to meet the national recommendation. €œA lot of what I deal with are the results of families ventolin street price who are in crisis, where there’s addiction, other issues that are related to poverty and the kids show up to school and there’s a lot of fallout from that,” Moss said. €œAnd so we have kids who are depressed. We’ve had kids who are suicidal.

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

Many school counselors go into the job to propel students’ academic success, not to ventolin street price provide therapy. Anderson does her best to help students but said she isn’t trained to help kids with acute needs. €œThat’s not what I want to do,” Anderson said after returning to her desk from lunch duty. €œI do so many different things ventolin street price to help students. If I wanted to be a mental health counselor, I wouldn’t work in a school.” Michelle Taylor, President-Elect of the Oklahoma School Counselor Association and counselor at Adair High School, said the job has changed a lot since she started and counselors at smaller schools like hers are often overwhelmed juggling paperwork, test proctoring and counseling students.

(Courtesy photo) Michelle Taylor, President-Elect of the Oklahoma School Counselor Association, said the organization doesn’t track how many school counselors have their license. But based on training she’s attended and led over the years, Taylor said it’s likely that about 1 in 5 school counselors goes ventolin street price on to become licensed. School counselors are serving dual roles whether they want to or not. Like swim instructors at a pool, most school counselors see their role as building stronger swimmers ventolin street price. But as mental health challenges continue to grow, counselors also have to serve as lifeguards, diving into the deep end to rescue drowning kids.

“Counselors in rural schools tend to be treading more water,” Taylor said. €œSome folks are so overwhelmed with the job they have, they don’t have the time or the motivation to seek out additional ventolin street price training. It’s just not accessible for folks.” Taylor has been a school counselor for more than 20 years and has her professional counseling license. She currently works with students at Adair High School in northeast Oklahoma. She said the job ventolin street price has changed a lot since she started.

Test requirements are constantly evolving. College admissions ventolin street price and scholarship applications seem to get longer every year. And students want to talk more. Kids are more willing to open up about their issues, especially since mental health is talked about more openly since the ventolin, Taylor said. And school counselors ventolin street price have to be ready to listen and help.

“I think we should be the ones doing this work because we already know the students and they already know us so it’s quicker to get to that trust that can take a long time to develop,” Taylor said. €œThat’s when it becomes about priorities and we have to respond to what the students need first and then worry about everything else.” Elk City Middle School students took a mental health screening at the beginning of Lana Graham’s geography class in March. Graham said since the asthma ventolin began, her ventolin street price students seem more anxious and depressed than ever. (Whitney Bryen/Oklahoma Watch) Whitney Bryen is an investigative reporter and visual storyteller at Oklahoma Watch with an emphasis on domestic violence, mental health and nursing homes affected by asthma treatment. Contact her ventolin street price at (405) 201-6057 or wbryen@oklahomawatch.org.

Follow her on Twitter @SoonerReporter. Support our publicationEvery day we strive to produce journalism that matters — stories that strengthen accountability and transparency, provide value and resonate with readers like you.This work is essential to a better-informed community and a healthy democracy. But it ventolin street price isn’t possible without your support. Donate nowMore than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The ventolin has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire.

It may have the smallest population in ventolin street price America, but when it comes to land, Wyoming is the ninth-largest. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here. While there is vast open space, the nearest major ventolin street price trauma hospital is more than 2.5 hours away. On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival.

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

But it's a problem playing out across ventolin street price rural America. Ambulance crews are running out of money and volunteers.Phillip Franklin, the EMS Director for Cody Regional Health, said the crisis is a result of several problems."The majority of the ambulance service staff are not paid so if you don't have your volunteers, they can't run calls," Franklin said. "Another problem is that there's simply just not enough volume to keep ambulance service afloat and in the state of Wyoming, EMS is not essential, which means there's nobody responsible to fund these entities."Sypherd said the funding model for EMS is fundamentally flawed, with most service providers reimbursed only if they take patients to a hospital or clinic. In rural areas like Washakie County, smaller populations mean fewer calls, and consequently, less ventolin street price money. "You're reimbursed based on the number of patients that you transport to a hospital so you could get called 1,000 times a year and only transport 750 patients -- those other 250 calls you made no money on," Sypherd said.

Plea for federal assistanceThe American Ambulance Association sent a letter earlier this month to the US Department of Health and Human Services asking the agency to earmark $1.425 billion in federal aid for its members, warning that emergency medical systems across the US are "on the brink of collapse.""It is critical that we not let the financial hardship caused by the ventolin to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National Association of State EMS Officials, just ventolin street price eight states consider local emergency medical services "essential" by law, as they do for fire and police. "That mandate means that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said. "If you're in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might be that nobody shows up." "When you look ventolin street price at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year away from closure."'A matter of life and death'One of those is Fremont County -- home to the Wind River Indian Reservation.

Fremont is roughly the size of the state of Vermont. An economic downturn and budget cuts prompted the county to privatize its ambulance service in 2016. But the private company, American Medical Response, says it can't afford to keep going after losing $1.5 million in revenue last year. AMR announced it won't renew its contract when it runs out on June 30. No others have bid.

"We just couldn't renew that current contract because it was set up for a financial failure," said Matt Strauss, Regional Director for AMR parent company, Global Medical Response. One of the problems, according to Fremont County Commissioner Larry Allen, is the so-called payer mix. Many of the county's residents rely on Medicare, Medicaid and Indian Health Services, which reimburse ambulance providers at a lower rate. And without state or federal designation of EMS as an essential service, Allen said "there's no source of revenue to operate an ambulance.""Because of the distance and the ruralness of this county, we just don't have people standing in line wanting to provide ambulance service," Allen said. The Wind River Indian Reservation stretches across more than 2 million acres and is shared by two Native American tribes, the Eastern Shoshone and the Northern Arapaho.

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