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New York City Mayor Michael Bloomberg announced today the findings of a study financed by the Mayor and conducted by the Berkeley Science and Health Institute of Technology (B.S.H.I.T.). The study, called Big Gulps and Guns, A Deadly Combination, found a statistical relationship between the drinking of oversize sodas, commonly referred to as Big Gulps, and gun violence.  According to study, over 99% of all gun-related murders in t his country over the last five years have been committed by someone who drank a Big Gulp or similar sized soda less than four hours before the murder. The study goes on to demonstrate that there is a 40% chance of a person committing a serious crime before bedtime on any day that he/she consumes a plus sized soda. According to the mayor, “This demonstrates why it is so important to ban both guns and Big Gulps.  By taking action on these two issues at the same time, we can with great certainty eliminate gun violence in America.  But the benefits don’t need to be limited to just the United States.  That’s why I’m taking my Guns and Big Gulps campaign overseas to the Middle East, both to Israel and the Arab nations.  Perhaps we finally have within in our power the tool to solve the Middle East conflict for once and for all.”

©Obamabeans  4.25.2013

How to get a flagyl prescription from your doctor

Pfizer and BioNTech are moving to enlarge the Phase 3 trial of their buy antibiotics treatment by 50%, which could allow the companies to how to get a flagyl prescription from your doctor collect more safety and efficacy data and to increase the diversity of the study’s participants.The companies said in a press release that they would increase the size of the study to 44,000 participants, up from an initial recruitment goal of 30,000 individuals.The U.S. Food and Drug Administration will have to approve the change before it goes into effect.advertisement “The companies continue to expect that a conclusive readout on efficacy is likely by the end of October,” the press release said. The Pfizer and BioNTech study is likely to be among the first how to get a flagyl prescription from your doctor in the U.S.

To report efficacy data from a Phase 3 trial. Expanding the trial will likely make it easier for the company to demonstrate whether the treatment is effective against antibiotics, the flagyl how to get a flagyl prescription from your doctor that causes buy antibiotics. The companies also said that the change will allow the study to include a more diverse population.

The companies said the study will now include adolescents as young as 16, people with stable HIV, and how to get a flagyl prescription from your doctor those with hepatitis C or hepatitis B.advertisement The companies said that the trial is expected to reach its initial target of 30,000 patients next week. Moderna, which started its trial on the same day as Pfizer, said on Sept. 4 that it is working to increase the diversity of trial participants in its study, “even if those efforts impact the speed of enrollment.” The Pfizer/BioNTech study could finish sooner than Moderna’s, how to get a flagyl prescription from your doctor even though the two began on the same day, for other reasons, as well.

Both treatments require a second shot. Pfizer’s is given after three weeks, while how to get a flagyl prescription from your doctor Moderna’s is given after four. The Pfizer trial also starts to count cases of buy antibiotics sooner after participants receive their shots than the Moderna study.But the Pfizer/BioNTech treatment could also prove to be one of the most difficult of the experimental treatments to distribute, should they prove effective.

The treatment must be kept at a temperature of -70 degrees Celsius.There has been political pressure to move a treatment quickly, with President Trump saying how to get a flagyl prescription from your doctor that one could be available before election day. Last week, several drugmakers, including Pfizer, issued a pledge not to move a treatment forward sooner than was justified by the results of their clinical trials..

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BackgroundReproductive aged women low cost flagyl are at risk of both pregnancy and flagyl depression sexually transmitted s (STI). The modern contraceptive prevalence among married and unmarried women in South Africa is 54% and 64%, respectively, with injectable progestins being most widely used.1 Moreover, current global efforts aim towards all women having access to a flagyl depression range of reliable contraceptives options.2 The prevalences of chlamydia and gonorrhoea are high among women in Africa, particularly among younger women. A recent meta-analysis of over 37 000 women estimated prevalences for chlamydia and gonorrhoea by region and population type (South Africa clinic/community-based, Eastern Africa higher-risk and Southern/Eastern Africa clinic community-based). High chlamydia and flagyl depression gonorrhoea prevalences were found among 15–24 year-old South African women and high risk populations in East Africa.3 Both chlamydia and gonorrhoea are associated with numerous comorbidities including pelvic inflammatory disease (PID), ectopic pregnancy, infertility, increased risk of HIV and other STIs, as well as significant social harm.4While STIs are a significant global health burden, data on STI prevalence by gender and drivers of are limited, hindering an effective public health response.5 Moreover, data on the association between contraceptive use and risk of non-HIV STIs are limited.

The WHO recently reported stagnation in efforts to decrease global STI incidence.5 Understanding drivers of STI acquisition, including any possible associations with widely used contraceptive methods, is necessary to effectively target public health responses that reduce STI incidence and associated comorbidities.The ECHO Trial (ClinicalTrials.gov Identifier. NCT02550067) was a multicentre, open-label randomised trial of flagyl depression 7829 HIV-seronegative women seeking effective contraception in Eswatini, Kenya, South Africa and Zambia. Detailed trial methods and results have been published.6 7 We conducted a secondary analysis of ECHO trial data to evaluate absolute and relative chlamydia and gonorrhoea final visit prevalences among women randomised to intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUD) and a levonorgestrel (LNG) implant.MethodsStudy design, participants and ethicsWomen were enrolled in the ECHO trial from December 2015 through September 2017. Institutional review boards at flagyl depression each site approved the study protocol and women provided written informed consent before any study procedures.

In brief, women who were not pregnant, HIV-seronegative, aged 16–35 years, seeking effective contraception, without medical contraindications, willing to use the assigned method for 18 months, reported not using injectable, intrauterine or implantable contraception for the previous 6 months and reported being sexually active, were enrolled. At every visit, participants received HIV risk reduction counselling, HIV testing and STI management, condoms and, as it became a part of national standard of care, flagyl depression HIV pre-exposure prophylaxis. Counselling messages related to HIV risk were implemented consistently across the three groups throughout the trial.6The trial was implemented in accordance with the Declaration of Helsinki and Good Clinical Practice. Informed consent was obtained from participants or their parents/guardians and human experimentation guidelines of the United States Department of Health and Human Services and those of the authors' institution(s) were followed.Contraceptive exposureAt enrolment, women were randomly flagyl depression assigned (1:1:1) to DMPA-IM, copper IUD or LNG implant.6 Participants received an injection of 150 mg/mL DMPA-IM (Depo Provera.

Pfizer, Puurs, Belgium) at enrolment and every 3 months until the final visit at 18 months after enrolment, a copper IUD (Optima TCu380A. Injeflex, Sao Paolo, Brazil) or a LNG implant (Jadelle flagyl depression. Bayer, Turku, Finland) at enrolment. Women returned for follow-up visits at 1 month after enrolment to address initial contraceptive side-effects and every 3 months thereafter, for up to 18 months with later enrolling participants contributing 12 to 18 flagyl depression months of follow-up.

Visits included HIV serological testing, contraceptive counselling, syndromic STI management and safety monitoring.STI outcomesThe primary outcomes of this secondary analysis were prevalent chlamydia and gonorrhoea at the final visit. Syndromic STI management flagyl depression was provided at screening and all follow-up visits. Nucleic acid amplification testing (NAAT) for Chlamydia trachomatis and Neisseria gonorrhoeae was conducted at screening and final visits, at the visit of HIV detection for participants who became HIV infected and at clinical discretion. Any untreated participants with positive flagyl depression NAAT results were contacted to return to the study clinic for treatment.CovariatesAt baseline (inclusive of screening and enrolment visits), we collected demographic, sexual and reproductive risk behaviour and reproductive and contraceptive history data.

Baseline risk flagyl depression factors evaluated as covariates included age, whether the participant earned her own income, chlamydia and gonorrhoea status, herpes simplex flagyl type 2 (HSV-2) sero-status and suspected PID. Final visit factors evaluated as covariates included number of sex partners in the past 3 months, number of new sex partners in the past 3 months, HIV serostatus, HSV-2 serostatus, condom use in the past 3 months, sex exchanged for money/gifts, sex during vaginal bleeding, follow-up time and number of pelvic examinations during follow-up. Age and HSV-2 serostatus were evaluated for effect measure modification.Statistical analysisWe conducted analyses using R V.3.5.3 (Vienna, Austria), and flagyl depression log-binomial regression to estimate chlamydia and gonorrhoea prevalences within each contraceptive group and pairwise prevalence ratios (PR) between each arm in as-randomised and consistent use analyses.In the as-randomised analysis, we analysed participants by the contraceptive method assigned at randomisation independent of method adherence. We estimated crude point prevalences by arm and study site and pairwise adjusted PRs.In the consistent use analysis, we only included women who initiated use of their randomised contraceptive method and maintained randomised method adherence throughout follow-up.

We estimated crude point prevalences by arm and pairwise adjusted PRs, with evaluation of age and HSV-2 status first as potential effect measure modifiers, and all covariates above as potential confounders flagyl depression. Study site and age were retained in the final model. Other covariates were retained if their inclusion in the base model led to a 10% change in the effect estimate through backwards selection.Supplementary analysesAdditional supporting analyses to assess postrandomisation potential flagyl depression sources of bias were conducted to inform interpretation of results. These include evaluation of recent sexual behaviour at enrolment, month 9 and the final visit.

Cohort participation (ie, follow-up time, early discontinuation and timing of randomised method discontinuation) and health outcomes (ie, final visit HIV and HSV-2 status) and frequency and results of pelvic examinations by STI status, site and visit month by flagyl depression randomised arm.ResultsA total of 7829 women were randomly assigned as follows. 2609 to the DMPA-IM group, 2607 to the copper IUD group and 2613 to the LNG implant group (figure 1). Participants were excluded if flagyl depression they were HIV positive at enrolment, did not have at least one HIV test or did not have chlamydia and gonorrhoea test results at the final visit. Overall, 90%, 94% and 93% from the DMPA-IM, copper IUD and LNG implant groups, respectively, were included in analyses.Study profile.

DMPA-IM, depot flagyl depression medroxy progesterone acetate. IUD, intrauterine device. LNG, levonorgestrel." data-icon-position data-hide-link-title="0">Figure 1 Study profile flagyl depression. DMPA-IM, depot medroxy progesterone acetate.

IUD, intrauterine flagyl depression device. LNG, levonorgestrel.Participant characteristicsBaseline characteristics were similar across groups (table 1). Nearly two-third of enrolled women (63%) flagyl depression were aged 24 and younger and 5768 (74%) of the study population resided in South Africa.View this table:Table 1 Participant baseline and final visit characteristicsThe duration of participation averaged 16 months with no differences between randomised groups (table 1). A total of 1468 (19%) women either did not receive their randomised method or discontinued use during follow-up.

Overall method continuation rates were high with minimal differences between randomised groups when measured by person-years.6 The proportion, however, of method non-adherence as defined flagyl depression in this analysis (ie, did not receive randomised method at baseline or discontinued randomised method at any point during follow-up), was greater in the DMPA-IM group (26%), followed by the copper IUD (18%) and LNG implant (12%) groups. Timing of discontinuation flagyl depression also differed across methods. During the first 6 months, method discontinuation was highest in the copper IUD group (7%) followed closely by DMPA-IM (6%) and LNG implant (4%) groups. Between 7 flagyl depression and 12 months of follow-up, it was highest in DMPA-IM group (15%), with equivalent proportions in the LNG implant (5%) and copper IUD (5%) groups.Point prevalences of chlamydia and gonorrhoea at baseline and final visitsIn total, 18% of women had chlamydia at baseline (figure 2A) and 15% at the final visit.

Among women 24 years and younger, 22% and 20% had chlamydia at baseline and final visits, respectively. Women aged 25–35 at baseline were less likely to have chlamydia at both baseline flagyl depression (12%) and final visits (8%) compared with younger women. Baseline chlamydia prevalence ranged from 5% in Zambia to 28% in the Western Cape, South Africa (figure 2B).Point prevalence (per 100 persons) of chlamydia and gonorrhoea at baseline and final visit by age category and study site region. Y-axis scale differs for chlamydia and gonorrhoea figures." data-icon-position data-hide-link-title="0">Figure 2 Point prevalence (per 100 persons) of chlamydia and gonorrhoea at baseline and final visit by age category and study site region flagyl depression.

Y-axis scale differs for chlamydia and gonorrhoea figures.Among all women, 5% had gonorrhoea at baseline and the final visit (figure 2C). Women aged 24 and flagyl depression younger were more likely to have gonorrhoea compared with women aged 25 and older at both baseline (5% vs 4%, respectively) and the final visit (6% vs 3%, respectively). Baseline gonorrhoea prevalence ranged from 3% in Zambia and Kenya to 9% in the Western Cape, South Africa (figure 2D). Similar prevalences were observed at the final visit.Point prevalences of chlamydia and gonorrhoea at final visit by randomised contraceptive methodFourteen per cent of women randomised to DMPA-IM, 15% to copper IUD and 17% to LNG implant had chlamydia at the final visit (table 2).View this table:Table 2 Chlamydia trachomatis and Neisseria gonorrhoeae prevalence at final visitThe prevalence of chlamydia did not significantly differ between flagyl depression DMPA-IM and copper IUD groups (PR 0.90, 95% CI (0.79 to 1.04)) or between copper IUD and LNG implant groups (PR 0.92, 95% CI (0.81 to 1.04)).

Women in the DMPA-IM group, however, had a significantly lower risk of chlamydia compared with the LNG implant group (PR. 0.83, 95% CI flagyl depression (0.72 to 0.95)). Findings from the consistent use analysis were similar, and neither age nor HSV-2 status modified the observed associations.Four per cent of women randomised to DMPA-IM, 6% to copper IUD and 5% to LNG implant had gonorrhoea at the final visit (table 2). Gonorrhoea prevalence did not significantly differ between DMPA-IM and LNG implant groups (PR flagyl depression.

0.79, 95% CI (0.61 to 1.03)) or between copper IUD and LNG implant groups (PR. 1.18, 95% CI (0.93 to flagyl depression 1.49)). Women in the DMPA-IM group had a significantly lower risk of gonorrhoea compared with women in the copper IUD group (PR. 0.67, 95% CI (0.52 flagyl depression to 0.87)).

Results from flagyl depression as randomised and continuous use analyses did not differ. And again, neither age nor HSV-2 status modified the observed associations.Clinical assessment by randomised contraceptive methodTo assess the potential for outcome ascertainment bias, we evaluated the frequency of pelvic examinations and abdominal/pelvic pain and discharge by study arm. Women in the copper IUD group were generally more likely to receive a pelvic examination during follow-up as compared with flagyl depression women in the DMPA-IM and LNG implant groups (online supplemental appendix 1). Similarly, abdominal/pelvic pain on examination or abnormal discharge was observed most frequently in the copper IUD group.

The number of pelvic examinations met the prespecified criteria for retention in the adjusted gonorrhoea model but not in the chlamydia model.Supplemental materialFrequency of syndromic symptoms and potential reAmong flagyl depression women who had chlamydia at baseline, 23% were also positive at the final visit (online supplemental appendix 2, figure 3A). Nine per cent of gonorrhoea-positive women at baseline were also positive at the final visit (online supplemental appendix 2, figure 3B). Across both baseline and final visits, a minority of women with chlamydia or gonorrhoea presented with flagyl depression signs and/or symptoms. Among chlamydia-positive women, only 12% presented with either abnormal vaginal discharge and/or abdominal/pelvic pain at their test-positive visit (online supplemental appendix 2, figure 3C).

Similarly, only 15% of gonorrhoea-positive women presented with abnormal vaginal discharge and/or abdominal/pelvic pain at flagyl depression their test-positive visit (online supplemental appendix 2, figure 3D).Potential re and symptoms among women with chlamydia or gonorrhoea. Data are pooled across the screening and final visits in figures (C) and (D). Symptomatic is defined as presenting with abnormal vaginal discharge flagyl depression and/or abdominal/pelvic pain. Final visit is described as potential re because test of cure was not conducted following baseline diagnosis and treatment." data-icon-position data-hide-link-title="0">Figure 3 Potential re and symptoms among women with chlamydia or gonorrhoea.

Data are pooled across the screening and final visits flagyl depression in figures (C) and (D). Symptomatic is defined as presenting with abnormal vaginal discharge and/or abdominal/pelvic pain. Final visit is described as potential re because test of cure was not conducted following baseline diagnosis and treatment.DiscussionWe observed differences in final prevalences of chlamydia and gonorrhoea by contraceptive group in flagyl depression both as-randomised and consistent-use analyses. The DMPA-IM group had lower final visit chlamydia and gonorrhoea prevalences as compared with copper IUD and LNG implant groups, though only the DMPA-IM versus the copper IUD comparison of gonorrhoea and DMPA-IM versus LNG implant comparison of chlamydia reached statistical significance.

These are novel findings that flagyl depression have not previously been reported to our knowledge and were determined in a randomised trial setting with high participant retention, robust biomarker testing and high randomised method adherence. Interestingly, the copper IUD group had higher gonorrhoea and lower chlamydia prevalence compared with the LNG implant group, though neither finding was statistically significant.Two recent systematic reviews of the association between contraceptives and STIs found inconsistent and insufficient evidence on the association between the contraceptive methods under study in ECHO and chlamydia and gonorrhoea.8 9 Neither systematic review identified any randomised studies or any direct comparative evidence for DMPA-IM, copper IUD and LNG implant, thus enabling a unique scientific contribution from this secondary trial analysis. Nonetheless, these findings should be interpreted in light of biological plausibility, as well as the design strengths and limitations of this analysis.The emerging science on the biological mechanisms underlying HIV susceptibility demonstrates the complex relationship between the infectious pathogen, the host flagyl depression innate and adaptive immune response and the interaction of both with the vaginal microbiome and other -omes. Data on these factors in relationship to chlamydia and gonorrhoea acquisition are much more limited but can be assumed to be equally complex.

Vaginal microbiome composition, including microbial metabolic by-products, flagyl depression have been shown to significantly modify risk of HIV acquisition and to vary with exogenous hormone exposure, menstrual cycle phase, ethnicity and geography.10–12 These same biological principles likely apply to chlamydia and gonorrhoea susceptibility. While DMPA-IM has been associated with decreased bacterial vaginosis (BV), initiation of the copper IUD has been associated with increased BV prevalence, and BV is associated with chlamydia and gonorrhoea acquisition.13 14 Moreover, Lactobacillus crispatus, which is less abundant in BV, has been shown to inhibit HeLa cell by Chlamydia trachomatis and inhibits growth of Neisseria gonorrhoeae in animal models.15 16 In addition, microbial community state types that are deficient in Lactobacillus crispatus and/or flagyl depression dominated by dysbiotic species are associated with inflammation, which is a driver of both STI and HIV susceptibility. Thus, while the exact mechanisms of chlamydia and gonorrhoea in the presence of exogenous hormones and varying host microbiomes are unknown, it is biologically plausible that these complex factors may result in differential susceptibility to chlamydia and gonorrhoea among DMPA-IM, copper IUD and LNG implant users.An alternative explanation for these findings may be postrandomisation differences in clinical care and/or sexual behaviour. Participants in the copper IUD arm were more likely to have pelvic examinations and more likely to have discharge compared with women in the DMPA-IM and LNG implant groups flagyl depression.

While interim STI testing and/or treatment were not documented, women in the copper IUD arm may have been more likely to receive syndromic STI treatment during follow-up due to more examination and observed discharge. More frequent STI treatment in flagyl depression the copper IUD group would theoretically lower the final visit point prevalence relative to women in the DMPA-IM and LNG implant arms, suggesting that the observed lower risk of STI in the DMPA-IM arm is not due to differential examination, testing and treatment. Differential sexual risk behaviour may also have influenced the results. As reported previously, women in the DMPA-IM group less frequently reported condomless sex and multiple partners than women in the other groups, and both DMPA-IM and LNG implant users flagyl depression less frequently reported new partners and sex during menses than copper IUD users.6 Statistical control of self-reported sexual risk behaviour in the consistent-use analysis may have been inadequate if self-reported sexual behaviour was inaccurately or insufficiently reported.A second alternative explanation may be differences in randomised method non-adherence, which was greater in the DMPA-IM group, compared with copper IUD and LNG implant groups.

Yet, the consistency of findings in the as-randomised and continuous use analyses suggests that method non-adherence had minimal effect on study outcomes. Taken as a whole, these flagyl depression findings indicate that there may be real differences in chlamydia and gonorrhoea risk associated with use of DMPA-IM, the copper IUD and LNG implant. However, any true differential risk by method must be evaluated in light of the holistic benefits and risks of each method.The high observed chlamydia and gonorrhoea prevalences, despite intensive counselling and condom provision, warrants attention, particularly among women ages 24 years and younger and among women in South Africa and Eswatini. While the ECHO study was conducted in settings of high HIV/STI incidence, enrolment criteria did flagyl depression not purposefully target women at highest risk of HIV/STI in the trial communities, suggesting that the observed prevalences may be broadly applicable to women seeking effective contraception in those settings.

Improved approaches are needed to prevent STIs, including options for expedited partner treatment, to prevent re.As expected, few women testing positive for chlamydia or gonorrhoea presented with symptoms (12% and 15%, respectively), and a substantial proportion of women who were positive and treated at baseline were infected at the final visit despite syndromic management during the follow-up. Given that syndromic management is the standard of care within primary health facilities in most trial settings, these data suggest that a large flagyl depression proportion of among reproductive aged women is missed, exacerbating the burden of curable STIs and associated morbidities. Routine access to more reliable diagnostics, like NAAT and novel point-of-care diagnostic tests, will be key to managing asymptomatic STIs and reducing STI prevalence and related morbidities in these settings.17This secondary analysis of the ECHO trial has strengths and limitations. Strengths include the randomised design with comparator groups of equal STI baseline risk flagyl depression.

Participants had high adherence to their randomised contraceptive method.6 While all participants received standardised clinical care and counselling, the unblinded randomisation may have allowed postrandomisation differences in STI risk over time by method. It is possible that participants modified their risk-taking behaviour based on study counselling messages regarding the potential association between DMPA-IM and flagyl depression HIV.In conclusion, our analyses suggest that DMPA-IM users may have lower risk of chlamydia and gonorrhoea compared with LNG implant and copper IUD users, respectively. Further investigation is warranted to better understand the mechanisms of chlamydia and gonorrhoea susceptibility in the context of contraceptive use. Moreover, the high chlamydia and gonorrhoea prevalences in this population, independent of contraceptive method, warrants urgent attention.Key messagesThe prevalence of chlamydia and gonorrhoea varied by contraceptive method in this randomised trial.High chlamydia and gonorrhoea prevalences, despite intensive counselling and condom provision, warrants attention, particularly among young women in South Africa and Eswatini.Most chlamydia and gonorrhoea flagyl depression s were asymptomatic.

Therefore, routine access to reliable diagnostics are needed to effectively manage and prevent STIs in African women..

BackgroundReproductive aged women are at flagyl price comparison risk of both pregnancy how to get a flagyl prescription from your doctor and sexually transmitted s (STI). The modern contraceptive prevalence among married and unmarried how to get a flagyl prescription from your doctor women in South Africa is 54% and 64%, respectively, with injectable progestins being most widely used.1 Moreover, current global efforts aim towards all women having access to a range of reliable contraceptives options.2 The prevalences of chlamydia and gonorrhoea are high among women in Africa, particularly among younger women. A recent meta-analysis of over 37 000 women estimated prevalences for chlamydia and gonorrhoea by region and population type (South Africa clinic/community-based, Eastern Africa higher-risk and Southern/Eastern Africa clinic community-based). High chlamydia and gonorrhoea prevalences were found among 15–24 year-old South African women and high risk populations in East Africa.3 Both chlamydia and gonorrhoea are associated with numerous comorbidities how to get a flagyl prescription from your doctor including pelvic inflammatory disease (PID), ectopic pregnancy, infertility, increased risk of HIV and other STIs, as well as significant social harm.4While STIs are a significant global health burden, data on STI prevalence by gender and drivers of are limited, hindering an effective public health response.5 Moreover, data on the association between contraceptive use and risk of non-HIV STIs are limited.

The WHO recently reported stagnation in efforts to decrease global STI incidence.5 Understanding drivers of STI acquisition, including any possible associations with widely used contraceptive methods, is necessary to effectively target public health responses that reduce STI incidence and associated comorbidities.The ECHO Trial (ClinicalTrials.gov Identifier. NCT02550067) was a multicentre, open-label randomised trial of 7829 HIV-seronegative women seeking effective contraception in Eswatini, Kenya, South Africa and how to get a flagyl prescription from your doctor Zambia. Detailed trial methods and results have been published.6 7 We conducted a secondary analysis of ECHO trial data to evaluate absolute and relative chlamydia and gonorrhoea final visit prevalences among women randomised to intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUD) and a levonorgestrel (LNG) implant.MethodsStudy design, participants and ethicsWomen were enrolled in the ECHO trial from December 2015 through September 2017. Institutional review boards at each site approved the study protocol and women provided written informed consent before how to get a flagyl prescription from your doctor any study procedures.

In brief, women who were not pregnant, HIV-seronegative, aged 16–35 years, seeking effective contraception, without medical contraindications, willing to use the assigned method for 18 months, reported not using injectable, intrauterine or implantable contraception for the previous 6 months and reported being sexually active, were enrolled. At every visit, participants received HIV risk reduction counselling, HIV testing and STI management, condoms and, as it became a part of national standard of care, HIV how to get a flagyl prescription from your doctor pre-exposure prophylaxis. Counselling messages related to HIV risk were implemented consistently across the three groups throughout the trial.6The trial was implemented in accordance with the Declaration of Helsinki and Good Clinical Practice. Informed consent was obtained from participants or their parents/guardians and human experimentation guidelines of the United States Department of how to get a flagyl prescription from your doctor Health and Human Services and those of the authors' institution(s) were followed.Contraceptive exposureAt enrolment, women were randomly assigned (1:1:1) to DMPA-IM, copper IUD or LNG implant.6 Participants received an injection of 150 mg/mL DMPA-IM (Depo Provera.

Pfizer, Puurs, Belgium) at enrolment and every 3 months until the final visit at 18 months after enrolment, a copper IUD (Optima TCu380A. Injeflex, Sao how to get a flagyl prescription from your doctor Paolo, Brazil) or a LNG implant (Jadelle. Bayer, Turku, Finland) at enrolment. Women returned for follow-up visits at 1 month after enrolment to address initial contraceptive side-effects and every 3 months thereafter, for up to 18 months with how to get a flagyl prescription from your doctor later enrolling participants contributing 12 to 18 months of follow-up.

Visits included HIV serological testing, contraceptive counselling, syndromic STI management and safety monitoring.STI outcomesThe primary outcomes of this secondary analysis were prevalent chlamydia and gonorrhoea at the final visit. Syndromic STI management was provided at screening and how to get a flagyl prescription from your doctor all follow-up visits. Nucleic acid amplification testing (NAAT) for Chlamydia trachomatis and Neisseria gonorrhoeae was conducted at screening and final visits, at the visit of HIV detection for participants who became HIV infected and at clinical discretion. Any untreated participants with positive NAAT results were contacted to return to the study clinic for treatment.CovariatesAt baseline (inclusive of screening and enrolment how to get a flagyl prescription from your doctor visits), we collected demographic, sexual and reproductive risk behaviour and reproductive and contraceptive history data.

Baseline risk factors evaluated as covariates included age, whether the participant earned her own income, chlamydia and gonorrhoea status, herpes simplex flagyl how to get a flagyl prescription from your doctor type 2 (HSV-2) sero-status and suspected PID. Final visit factors evaluated as covariates included number of sex partners in the past 3 months, number of new sex partners in the past 3 months, HIV serostatus, HSV-2 serostatus, condom use in the past 3 months, sex exchanged for money/gifts, sex during vaginal bleeding, follow-up time and number of pelvic examinations during follow-up. Age and HSV-2 serostatus were evaluated for effect measure modification.Statistical analysisWe conducted analyses using R V.3.5.3 (Vienna, Austria), and log-binomial regression to estimate chlamydia and gonorrhoea prevalences within each contraceptive group and pairwise how to get a flagyl prescription from your doctor prevalence ratios (PR) between each arm in as-randomised and consistent use analyses.In the as-randomised analysis, we analysed participants by the contraceptive method assigned at randomisation independent of method adherence. We estimated crude point prevalences by arm and study site and pairwise adjusted PRs.In the consistent use analysis, we only included women who initiated use of their randomised contraceptive method and maintained randomised method adherence throughout follow-up.

We estimated crude point prevalences by arm and pairwise adjusted PRs, with evaluation of age and HSV-2 status how to get a flagyl prescription from your doctor first as potential effect measure modifiers, and all covariates above as potential confounders. Study site and age were retained in the final model. Other covariates were retained if their inclusion in the base model led to a 10% change in the effect estimate through backwards selection.Supplementary analysesAdditional supporting analyses to how to get a flagyl prescription from your doctor assess postrandomisation potential sources of bias were conducted to inform interpretation of results. These include evaluation of recent sexual behaviour at enrolment, month 9 and the final visit.

Cohort participation (ie, follow-up time, early discontinuation and timing of randomised how to get a flagyl prescription from your doctor method discontinuation) and health outcomes (ie, final visit HIV and HSV-2 status) and frequency and results of pelvic examinations by STI status, site and visit month by randomised arm.ResultsA total of 7829 women were randomly assigned as follows. 2609 to the DMPA-IM group, 2607 to the copper IUD group and 2613 to the LNG implant group (figure 1). Participants were excluded if they were HIV positive at enrolment, did not have at least one HIV test or did not have chlamydia how to get a flagyl prescription from your doctor and gonorrhoea test results at the final visit. Overall, 90%, 94% and 93% from the DMPA-IM, copper IUD and LNG implant groups, respectively, were included in analyses.Study profile.

DMPA-IM, depot medroxy progesterone acetate how to get a flagyl prescription from your doctor. IUD, intrauterine device. LNG, levonorgestrel." data-icon-position data-hide-link-title="0">Figure 1 Study how to get a flagyl prescription from your doctor profile. DMPA-IM, depot medroxy progesterone acetate.

IUD, intrauterine device how to get a flagyl prescription from your doctor. LNG, levonorgestrel.Participant characteristicsBaseline characteristics were similar across groups (table 1). Nearly two-third of enrolled women (63%) were aged 24 and younger and 5768 (74%) of the study population resided in South Africa.View this table:Table 1 Participant baseline and final visit characteristicsThe duration of participation averaged 16 months with no differences between how to get a flagyl prescription from your doctor randomised groups (table 1). A total of 1468 (19%) women either did not receive their randomised method or discontinued use during follow-up.

Overall method continuation rates were high with minimal differences between randomised groups when measured by person-years.6 The proportion, however, of how to get a flagyl prescription from your doctor method non-adherence as defined in this analysis (ie, did not receive randomised method at baseline or discontinued randomised method at any point during follow-up), was greater in the DMPA-IM group (26%), followed by the copper IUD (18%) and LNG implant (12%) groups. Timing of discontinuation also differed across how to get a flagyl prescription from your doctor methods. During the first 6 months, method discontinuation was highest in the copper IUD group (7%) followed closely by DMPA-IM (6%) and LNG implant (4%) groups. Between 7 and 12 months of follow-up, it was highest in DMPA-IM group (15%), with equivalent proportions in the LNG implant (5%) and copper IUD (5%) groups.Point prevalences of chlamydia and gonorrhoea at baseline and final visitsIn total, 18% how to get a flagyl prescription from your doctor of women had chlamydia at baseline (figure 2A) and 15% at the final visit.

Among women 24 years and younger, 22% and 20% had chlamydia at baseline and final visits, respectively. Women aged 25–35 at baseline were less likely to have chlamydia at both baseline (12%) and final visits (8%) how to get a flagyl prescription from your doctor compared with younger women. Baseline chlamydia prevalence ranged from 5% in Zambia to 28% in the Western Cape, South Africa (figure 2B).Point prevalence (per 100 persons) of chlamydia and gonorrhoea at baseline and final visit by age category and study site region. Y-axis scale differs for chlamydia and gonorrhoea figures." data-icon-position data-hide-link-title="0">Figure 2 Point prevalence (per 100 persons) of how to get a flagyl prescription from your doctor chlamydia and gonorrhoea at baseline and final visit by age category and study site region.

Y-axis scale differs for chlamydia and gonorrhoea figures.Among all women, 5% had gonorrhoea at baseline and the final visit (figure 2C). Women aged 24 and younger were more likely to have gonorrhoea compared with women aged 25 and older at both baseline (5% how to get a flagyl prescription from your doctor vs 4%, respectively) and the final visit (6% vs 3%, respectively). Baseline gonorrhoea prevalence ranged from 3% in Zambia and Kenya to 9% in the Western Cape, South Africa (figure 2D). Similar prevalences were observed at the final visit.Point prevalences of chlamydia and gonorrhoea at how to get a flagyl prescription from your doctor final visit by randomised contraceptive methodFourteen per cent of women randomised to DMPA-IM, 15% to copper IUD and 17% to LNG implant had chlamydia at the final visit (table 2).View this table:Table 2 Chlamydia trachomatis and Neisseria gonorrhoeae prevalence at final visitThe prevalence of chlamydia did not significantly differ between DMPA-IM and copper IUD groups (PR 0.90, 95% CI (0.79 to 1.04)) or between copper IUD and LNG implant groups (PR 0.92, 95% CI (0.81 to 1.04)).

Women in the DMPA-IM group, however, had a significantly lower risk of chlamydia compared with the LNG implant group (PR. 0.83, 95% CI how to get a flagyl prescription from your doctor (0.72 to 0.95)). Findings from the consistent use analysis were similar, and neither age nor HSV-2 status modified the observed associations.Four per cent of women randomised to DMPA-IM, 6% to copper IUD and 5% to LNG implant had gonorrhoea at the final visit (table 2). Gonorrhoea prevalence did not significantly differ how to get a flagyl prescription from your doctor between DMPA-IM and LNG implant groups (PR.

0.79, 95% CI (0.61 to 1.03)) or between copper IUD and LNG implant groups (PR. 1.18, 95% CI how to get a flagyl prescription from your doctor (0.93 to 1.49)). Women in the DMPA-IM group had a significantly lower risk of gonorrhoea compared with women in the copper IUD group (PR. 0.67, 95% CI (0.52 to 0.87)) how to get a flagyl prescription from your doctor.

Results from as randomised and how to get a flagyl prescription from your doctor continuous use analyses did not differ. And again, neither age nor HSV-2 status modified the observed associations.Clinical assessment by randomised contraceptive methodTo assess the potential for outcome ascertainment bias, we evaluated the frequency of pelvic examinations and abdominal/pelvic pain and discharge by study arm. Women in how to get a flagyl prescription from your doctor the copper IUD group were generally more likely to receive a pelvic examination during follow-up as compared with women in the DMPA-IM and LNG implant groups (online supplemental appendix 1). Similarly, abdominal/pelvic pain on examination or abnormal discharge was observed most frequently in the copper IUD group.

The number of pelvic examinations met the how to get a flagyl prescription from your doctor prespecified criteria for retention in the adjusted gonorrhoea model but not in the chlamydia model.Supplemental materialFrequency of syndromic symptoms and potential reAmong women who had chlamydia at baseline, 23% were also positive at the final visit (online supplemental appendix 2, figure 3A). Nine per cent of gonorrhoea-positive women at baseline were also positive at the final visit (online supplemental appendix 2, figure 3B). Across both baseline and final visits, a minority of women with chlamydia or gonorrhoea presented how to get a flagyl prescription from your doctor with signs and/or symptoms. Among chlamydia-positive women, only 12% presented with either abnormal vaginal discharge and/or abdominal/pelvic pain at their test-positive visit (online supplemental appendix 2, figure 3C).

Similarly, only 15% of gonorrhoea-positive women presented with abnormal vaginal discharge and/or abdominal/pelvic pain at their test-positive visit (online supplemental appendix 2, figure how to get a flagyl prescription from your doctor 3D).Potential re and symptoms among women with chlamydia or gonorrhoea. Data are pooled across the screening and final visits in figures (C) and (D). Symptomatic is defined as presenting with abnormal vaginal discharge how to get a flagyl prescription from your doctor and/or abdominal/pelvic pain. Final visit is described as potential re because test of cure was not conducted following baseline diagnosis and treatment." data-icon-position data-hide-link-title="0">Figure 3 Potential re and symptoms among women with chlamydia or gonorrhoea.

Data are how to get a flagyl prescription from your doctor pooled across the screening and final visits in figures (C) and (D). Symptomatic is defined as presenting with abnormal vaginal discharge and/or abdominal/pelvic pain. Final visit is described as potential re because test of cure was not conducted following baseline diagnosis and treatment.DiscussionWe observed differences in final how to get a flagyl prescription from your doctor prevalences of chlamydia and gonorrhoea by contraceptive group in both as-randomised and consistent-use analyses. The DMPA-IM group had lower final visit chlamydia and gonorrhoea prevalences as compared with copper IUD and LNG implant groups, though only the DMPA-IM versus the copper IUD comparison of gonorrhoea and DMPA-IM versus LNG implant comparison of chlamydia reached statistical significance.

These are novel findings that have not previously been reported to our knowledge and were how to get a flagyl prescription from your doctor determined in a randomised trial setting with high participant retention, robust biomarker testing and high randomised method adherence. Interestingly, the copper IUD group had higher gonorrhoea and lower chlamydia prevalence compared with the LNG implant group, though neither finding was statistically significant.Two recent systematic reviews of the association between contraceptives and STIs found inconsistent and insufficient evidence on the association between the contraceptive methods under study in ECHO and chlamydia and gonorrhoea.8 9 Neither systematic review identified any randomised studies or any direct comparative evidence for DMPA-IM, copper IUD and LNG implant, thus enabling a unique scientific contribution from this secondary trial analysis. Nonetheless, these findings should be interpreted in light of biological plausibility, as well as the design strengths and limitations of this analysis.The emerging science on the biological mechanisms underlying HIV susceptibility demonstrates the how to get a flagyl prescription from your doctor complex relationship between the infectious pathogen, the host innate and adaptive immune response and the interaction of both with the vaginal microbiome and other -omes. Data on these factors in relationship to chlamydia and gonorrhoea acquisition are much more limited but can be assumed to be equally complex.

Vaginal microbiome composition, including microbial metabolic by-products, how to get a flagyl prescription from your doctor have been shown to significantly modify risk of HIV acquisition and to vary with exogenous hormone exposure, menstrual cycle phase, ethnicity and geography.10–12 These same biological principles likely apply to chlamydia and gonorrhoea susceptibility. While DMPA-IM how to get a flagyl prescription from your doctor has been associated with decreased bacterial vaginosis (BV), initiation of the copper IUD has been associated with increased BV prevalence, and BV is associated with chlamydia and gonorrhoea acquisition.13 14 Moreover, Lactobacillus crispatus, which is less abundant in BV, has been shown to inhibit HeLa cell by Chlamydia trachomatis and inhibits growth of Neisseria gonorrhoeae in animal models.15 16 In addition, microbial community state types that are deficient in Lactobacillus crispatus and/or dominated by dysbiotic species are associated with inflammation, which is a driver of both STI and HIV susceptibility. Thus, while the exact mechanisms of chlamydia and gonorrhoea in the presence of exogenous hormones and varying host microbiomes are unknown, it is biologically plausible that these complex factors may result in differential susceptibility to chlamydia and gonorrhoea among DMPA-IM, copper IUD and LNG implant users.An alternative explanation for these findings may be postrandomisation differences in clinical care and/or sexual behaviour. Participants in the copper how to get a flagyl prescription from your doctor IUD arm were more likely to have pelvic examinations and more likely to have discharge compared with women in the DMPA-IM and LNG implant groups.

While interim STI testing and/or treatment were not documented, women in the copper IUD arm may have been more likely to receive syndromic STI treatment during follow-up due to more examination and observed discharge. More frequent STI treatment in the copper IUD group would theoretically lower the final visit point prevalence relative to women in the DMPA-IM and LNG implant arms, suggesting that the observed lower risk of STI in the DMPA-IM arm is how to get a flagyl prescription from your doctor not due to differential examination, testing and treatment. Differential sexual risk behaviour may also have influenced the results. As reported previously, women in the DMPA-IM group less frequently reported condomless sex and multiple partners than women in the other groups, how to get a flagyl prescription from your doctor and both DMPA-IM and LNG implant users less frequently reported new partners and sex during menses than copper IUD users.6 Statistical control of self-reported sexual risk behaviour in the consistent-use analysis may have been inadequate if self-reported sexual behaviour was inaccurately or insufficiently reported.A second alternative explanation may be differences in randomised method non-adherence, which was greater in the DMPA-IM group, compared with copper IUD and LNG implant groups.

Yet, the consistency of findings in the as-randomised and continuous use analyses suggests that method non-adherence had minimal effect on study outcomes. Taken as a whole, these findings indicate that there may be real differences in chlamydia and gonorrhoea risk associated with use of DMPA-IM, the copper how to get a flagyl prescription from your doctor IUD and LNG implant. However, any true differential risk by method must be evaluated in light of the holistic benefits and risks of each method.The high observed chlamydia and gonorrhoea prevalences, despite intensive counselling and condom provision, warrants attention, particularly among women ages 24 years and younger and among women in South Africa and Eswatini. While the ECHO study was conducted in settings of high HIV/STI incidence, enrolment criteria did not purposefully target women at highest risk of HIV/STI in the trial communities, suggesting that the observed prevalences may be broadly applicable how to get a flagyl prescription from your doctor to women seeking effective contraception in those settings.

Improved approaches are needed to prevent STIs, including options for expedited partner treatment, to prevent re.As expected, few women testing positive for chlamydia or gonorrhoea presented with symptoms (12% and 15%, respectively), and a substantial proportion of women who were positive and treated at baseline were infected at the final visit despite syndromic management during the follow-up. Given that how to get a flagyl prescription from your doctor syndromic management is the standard of care within primary health facilities in most trial settings, these data suggest that a large proportion of among reproductive aged women is missed, exacerbating the burden of curable STIs and associated morbidities. Routine access to more reliable diagnostics, like NAAT and novel point-of-care diagnostic tests, will be key to managing asymptomatic STIs and reducing STI prevalence and related morbidities in these settings.17This secondary analysis of the ECHO trial has strengths and limitations. Strengths include the randomised design with comparator groups how to get a flagyl prescription from your doctor of equal STI baseline risk.

Participants had high adherence to their randomised contraceptive method.6 While all participants received standardised clinical care and counselling, the unblinded randomisation may have allowed postrandomisation differences in STI risk over time by method. It is possible that participants modified their risk-taking behaviour based on study counselling messages regarding the potential association between DMPA-IM and HIV.In conclusion, our analyses suggest that DMPA-IM users may have lower how to get a flagyl prescription from your doctor risk of chlamydia and gonorrhoea compared with LNG implant and copper IUD users, respectively. Further investigation is warranted to better understand the mechanisms of chlamydia and gonorrhoea susceptibility in the context of contraceptive use. Moreover, the high chlamydia and gonorrhoea prevalences in this population, independent of contraceptive method, warrants urgent attention.Key messagesThe prevalence of how to get a flagyl prescription from your doctor chlamydia and gonorrhoea varied by contraceptive method in this randomised trial.High chlamydia and gonorrhoea prevalences, despite intensive counselling and condom provision, warrants attention, particularly among young women in South Africa and Eswatini.Most chlamydia and gonorrhoea s were asymptomatic.

Therefore, routine access to reliable diagnostics are needed to effectively manage and prevent STIs in African women..

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METRONIDAZOLE is an antiinfective. Flagyl is used to treat many kinds of s, like respiratory, skin, gastrointestinal, and bone and joint s. It will not work for colds, flu, or other viral s.

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In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here. While there is vast open space, the nearest major trauma hospital is more than 2.5 flagyl price 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 flagyl price -- paramedics and an ambulance -- can be a matter of survival. It's a fact Luke Sypherd knows all too well. For the past three flagyl price 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 the personnel to flagyl price continue," Sypherd said. "It was an ongoing problem made worse by buy antibiotics with fewer people interested in volunteering with EMS during a flagyl 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 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 flagyl price 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 flagyl price Washakie County, smaller populations mean fewer calls, and consequently, less 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 flagyl price 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 flagyl to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said.

According to the National Association of State EMS Officials, just eight states consider local emergency medical services "essential" by law, as they do for fire and police. "That mandate means that somebody has to consciously think and plan and flagyl price ensure that EMS is available," Sypherd said. "If you're in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin.

"There's other flagyl price 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 flagyl price 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 flagyl price.

"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 flagyl price 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 flagyl price 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 flagyl price 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 flagyl price 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.

More than one-third of all rural EMS how to get a flagyl prescription from your doctor are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The flagyl has further stretched the resources of our nation's rural EMS."In Wyoming, the problem is especially dire. It may have the smallest population in America, but when how to get a flagyl prescription from your doctor it comes to land, Wyoming is the ninth-largest. In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here. While there is vast open space, the nearest major trauma hospital is more than 2.5 hours away how to get a flagyl prescription from your doctor.

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 how to get a flagyl prescription from your doctor silently in the distance.But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival. It's a fact Luke Sypherd knows all too well. For the past three years, he has overseen Washakie County's volunteer ambulance how to get a flagyl prescription from your doctor service. But on May 1, the organization was forced to dissolve.

"We just saw that we didn't how to get a flagyl prescription from your doctor have the personnel to continue," Sypherd said. "It was an ongoing problem made worse by buy antibiotics with fewer people interested in volunteering with EMS during a flagyl 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 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 how to get a flagyl prescription from your doctor 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 how to get a flagyl prescription from your doctor populations mean fewer calls, and consequently, less 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 how to get a flagyl prescription from your doctor critical that we not let the financial hardship caused by the flagyl to permanently deteriorate our EMS systems, especially in rural areas where an ambulance service may be the only emergency medical service provider, and ensure that all Americans continue to have access to vital emergency 9-1-1 and medically necessary non-emergency ground ambulance services," the letter said. According to the National Association of State EMS Officials, just eight states consider local emergency medical services "essential" by law, as they do for fire and police. "That mandate means how to get a flagyl prescription from your doctor that somebody has to consciously think and plan and ensure that EMS is available," Sypherd said.

"If you're in one of the states that doesn't mandate EMS as an essential service and your local ambulance provider shuts down because they lost funding or there weren't enough volunteers -- that means if you call 911 it might be that nobody shows up." "When you look at what's happening here (in Washakie County, it) is just the tip of the iceberg," said Franklin. "There's other services throughout the state that are just one bad year how to get a flagyl prescription from your doctor 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 how to get a flagyl prescription from your doctor 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 how to get a flagyl prescription from your doctor 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 how to get a flagyl prescription from your doctor 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 how to get a flagyl prescription from your doctor 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 how to get a flagyl prescription from your doctor 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 how to get a flagyl prescription from your doctor 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.".

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Open enrollment for 2022 individual/family flagyl canine side effects health coverage began on November 1. The enrollment flagyl canine side effects window is longer this year, continuing until at least January 15 in nearly every state. (For now, Idaho still plans to end the open enrollment period on December 15.)The longer open enrollment period does give people some extra wiggle room during the busy holiday season. But for most people, December 15 is still the soft deadline you’re going to want flagyl canine side effects to keep in mind.

In most states, that’s the last day you can enroll in coverage that will take effect January 1. Which states have open enrollment dates past flagyl canine side effects December 15 – but still have January 1 effective dates?. There are some exceptions, however. The following state-run exchanges are giving people extra time to sign up for a plan flagyl canine side effects that takes effect January 1.

But in the rest of the country, you need to enroll by December 15 to have your plan start on January 1. And that’s important for flagyl canine side effects several reasons.1. Currently uninsured?. Delaying your enrollment will mean no coverage in January.If you’re flagyl canine side effects not already enrolled in ACA-compliant coverage in 2021, the current open enrollment period is your chance to change that for 2022.But if you wait until the last minute to enroll, you won’t have coverage in place when the new year begins.

Instead, you’ll be waiting until February 1 — or March 1 – if you enroll at the last minute in a few states with longer enrollment windows.2. Currently uninsured flagyl canine side effects or enrolled in a non-marketplace plan?. Delayed enrollment might mean missing out on free money.If you considered marketplace coverage in the past and found it to be unaffordable, you might currently be uninsured or enrolled in a plan that isn’t regulated by the ACA. Or you might have opted to buy ACA-compliant coverage outside the exchange, if you weren’t eligible for premium tax credits (subsidies) the last time you looked.But thanks to the American Rescue Plan, many people who weren’t eligible for subsidies in previous flagyl canine side effects years will find that they are now.

Those subsidies are only available if you’re enrolled in a marketplace/exchange plan, and the current open enrollment period is your chance to make the switch to a marketplace plan.In addition to being more widely available, premium subsidies are also larger than they were last fall. People who didn’t enroll last year due to the cost may find that coverage now fits in their budget.Four out of five people shopping for coverage in the 33 states that use the federally-run marketplace (HealthCare.gov) will find flagyl canine side effects that they can get coverage for $10/month or less. And millions of uninsured Americans are eligible for premium-free coverage in the marketplace, but may not realize this.Waiting until the last minute to enroll in coverage will mean that you leave all that money on the table for January. You can flagyl canine side effects use our subsidy calculator to get an idea of how much your subsidy will be for 2022.

Then, make sure you enroll by December 15 so that you’re eligible to claim the subsidy for all 12 months of the year.3. Letting your plan auto-renew? flagyl canine side effects. You might be in for a surprise.If you already have coverage through the marketplace in 2021 and are planning to just let it auto-renew for 2021, you might wake up on January 1 with coverage and a premium that aren’t what you expected.Even if you’re 100% happy with the plan you have now, you owe it to yourself to spend at least a little time checking out the available options before December 15. The premium that flagyl canine side effects your insurer charges is likely changing for 2022.

And your subsidy amount might also be changing, especially if there are new insurers joining the marketplace in your area.Your insurer might also be making changes to your benefits, provider network, or covered drug list — or even discontinuing the plan altogether and replacing it with a new one. In short, the plan and price you have on January 1 might be quite different flagyl canine side effects from what you have now.This is part of the reason HHS opted to extend the open enrollment period – in order to give people a chance for a “do-over” if their auto-renewed plan isn’t what they expected. In nearly every state, you’ll have until at least January 15 to pick a new plan. But that flagyl canine side effects plan selection won’t be retroactive to January 1.4.

Out-of-pocket expenses won’t transfer in February or March.What if you’re enrolled in a marketplace plan in 2021, let it auto-renew for 2022, and then decide after December 15 that you’d rather have a different plan?. Thanks to flagyl canine side effects the extended open enrollment period, you can do that, and your new plan will take effect in February (or potentially March, if you’re in one of the state-run exchanges with the latest enrollment deadlines).But it’s important to understand that you’ll be starting over with a new plan in February or March. This means the out-of-pocket costs counted against your deductible and out-of-pocket maximum will reset to $0, even if you ended up with out-of-pocket expenses in January.Out-of-pocket expenses reset to $0 on January 1 for all marketplace plans, so your auto-renewed policy will start over with a new deductible at that point. But if you need medical care in January (and have associated out-of-pocket costs) before your new plan takes effect in February, you’ll potentially have a higher out-of-pocket exposure for the whole year than you would have if flagyl canine side effects you’d picked your new plan by December 15 and had it start January 1.All of this is a reminder that while most enrollees have until at least mid-January to sign up for 2022 coverage, it’s in your best interest to get your plan selection sorted out by December 15.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates flagyl canine side effects are regularly cited by media who cover health reform and by other health insurance experts.For millions of Americans, the open enrollment period (OEP) to shop for 2022 ACA-compliant coverage will be unlike any of the previous eight OEPs. The reason?. These consumers will – for the first time – be able to tap into the Affordable Care Act’s premium tax credits (more commonly referred to as health insurance subsidies).Thanks to the American Rescue Plan, consumers who in previous years might have found themselves outside the eligible level for subsidies – or who may have found flagyl canine side effects that subsidy amounts were so low as to not be enticing – are now among those eligible for premium tax credits.

So if you haven’t shopped for health insurance lately, you might be surprised to see how affordable your health coverage options are this fall (starting November 1), and how many plan options are available in your area.Millions have already tapped into the subsidiesMost people who currently have coverage through the health insurance exchanges have seen improved affordability this year thanks to the American Rescue Plan (ARP). That includes millions of people who were already enrolled in plans when the ARP was enacted last March, as well as millions of others who signed up during the special enrollment period that flagyl canine side effects continued through mid-August in most states (and is still ongoing in some states).Use our updated subsidy calculator to estimate how much you can save on your 2021 health insurance premiums.But there are still millions of others who are either uninsured or have obtained coverage elsewhere. And there are also people who already had coverage in the exchange in 2021 but didn’t take the option to switch to a more robust plan after the ARP was implemented. If you’re in either of these categories, you don’t want to miss the open enrollment period in the fall of 2021.The Build flagyl canine side effects Back Better Act, which is still under consideration in Congress, would extend the ARP’s subsidies and ensure that health insurance stays affordable in 2023 and beyond.

But even without any new legislative action, most of the ARP’s subsidy enhancements will remain in place for 2022.That means there will continue to be no upper income limit for premium tax credit (subsidy) eligibility, and the percentage of income that people have to pay flagyl canine side effects for the benchmark plan will continue to be lower than it was in prior years. The overall result is that subsidies are larger than they were in the past, and available to more people.Who should make a point to review their subsidy eligibility?. So who needs to pay close attention this fall, flagyl canine side effects during open enrollment?. In reality, anyone who doesn’t have access to Medicare, Medicaid, or an employer-sponsored health plan – because even if you’re already enrolled and happy with the plan you have, auto-renewal is not in your best interest.But there are several groups of people who really need to shop for coverage this fall.

Let’s take a look at what flagyl canine side effects each of these groups can expect, and why you shouldn’t let open enrollment pass you by if you’re in one of these categories:1. The uninsured – eligible for low-cost or NO-cost coverageThe majority of uninsured Americans cite the cost of coverage as the reason they don’t have health insurance. Yet millions of those individuals are flagyl canine side effects eligible for free or very low-cost health coverage but haven’t yet enrolled. This has been the case in prior years as well, but premium-free or very low-cost health plans are even more widely available as a result of the ARP.If you’re uninsured because you don’t think health insurance is affordable, know that more than a third of the people who enrolled via HealthCare.gov during the buy antibiotics/ARP special enrollment period this year purchased plans for less than $10/month.Even if you’ve checked in previous years and couldn’t afford the plans that were available, you’ll want to check again this fall, since the subsidy rules have changed since last year.2.

Consumers enrolled in non-ACA-compliant plansThere are millions of Americans who have purchased health coverage that isn’t compliant flagyl canine side effects with the ACA. Most of these plans are either less robust than ACA-compliant plans, or use medical underwriting, or both. They include flagyl canine side effects. People purchase or keep these plans for a variety of reasons.

But chief among them has long been the fact that ACA-compliant coverage was unaffordable – or was assumed to be unaffordable.There are also people who prefer some of the flagyl canine side effects benefits that some of these plans offer (the fellowship of being part of a health care sharing ministry, for instance, or the abundantly available primary care with a DPC membership). But by and large, the reason people choose coverage that isn’t ACA-compliant, or that isn’t even insurance at all, is because ACA-compliant coverage doesn’t fit in their budgets.This has long included a few main groups of people. Those who earned too much to qualify for subsidies, those affected by the “family glitch,” and those who qualified for only minimal subsidy assistance and still felt that the coverage available in the exchange wasn’t affordable.(Another group of people unable to afford coverage are those who earn less than the poverty level in 11 states that have refused to expand Medicaid and thus flagyl canine side effects have a coverage gap. Some people in the coverage gap purchase non-ACA-compliant coverage, but this population is also likely to not have any coverage at all.

If you or a loved one are in the coverage gap, we encourage you to read this article.)The ARP has not fixed the family glitch or the coverage gap, flagyl canine side effects although there are legislative and administrative solutions under consideration for each of these.But the ARP has addressed the other two issues, and those provisions remain in place for 2022. The income cap for subsidy eligibility has been eliminated, which means that some applicants can qualify for subsidies with income far above 400% of the poverty level. And for those who were already eligible for subsidies, the subsidy amounts are larger than they used to flagyl canine side effects be, making coverage more affordable.So if you are enrolled in any sort of self-purchased health plan that isn’t compliant with the ACA, you owe it to yourself to check your on-exchange options this fall, during the open enrollment period. Keep in mind that you can do that through the exchange, through an enhanced direct enrollment entity, or with the assistance of a health insurance broker.3.

Buyers enrolled in off-exchange health plansThere are also people who have “off-exchange” ACA-compliant plans that they’ve purchased directly from an flagyl canine side effects insurance company, without using the exchange. (Note that this is not the same thing as enrolling in an on-exchange plans through an enhanced direct enrollment entity, many of which are insurance companies).There are a variety of reasons people have chosen to enroll in off-exchange health plans over the last several years. And for some of those enrollees, 2022 might be the year to flagyl canine side effects switch to an on-exchange plan.Since 2018, some people have opted for off-exchange plans if they weren’t eligible for premium subsidies and wanted to enroll in a Silver-level plan. This was a very rational choice, encouraged by state insurance commissioners and marketplaces alike.

But if you’ve been buying off-exchange coverage in order to get a Silver plan with a lower price tag, the primary point to keep in mind for 2022 is that you might find that you’re now eligible for premium subsidies.Just like the people described above, who have enrolled in various non-ACA-compliant plans in an effort to obtain affordable coverage, the elimination of the income limit for subsidy eligibility is a game flagyl canine side effects changer for people who were buying off-exchange coverage to get a lower price on a Silver plan.Some people have opted for off-exchange coverage because their preferred health insurer wasn’t participating in the exchange in their area. This might have been a deciding factor for an applicant who was only eligible for a very small subsidy — or no subsidy at all — and was willing to pay full price for an off-exchange plan from the insurer of their choice.But 2022 is the fourth year in a row with increasing insurer participation in the exchanges, and some big-name insurers are joining or rejoining the exchanges in quite a few states. So if flagyl canine side effects you haven’t checked your on-exchange options in a while, this fall is definitely the time to do so. You might be surprised to see how many options you have, and again, how affordable they are.4.

Consumers enrolled in on-exchange plans, but no income details on file and no recent coverage reconsiderationsIf you’re already enrolled in an on-exchange plan and you had given the exchange a projection of your income flagyl canine side effects for 2021, you probably saw your subsidy amount increase at some point this year.But if the exchange didn’t have an income on file for you, they wouldn’t have been able to activate a subsidy on your behalf (on the HealthCare.gov platform, subsidy amounts were automatically updated in September for people who hadn’t updated their accounts by that point, but only if you had provided a projected income to the exchange when you enrolled in coverage for 2021). And even if your subsidy amount did get updated, you might have remained on the plan you had picked last fall, despite the option to pick a different one after the ARP was enacted.The good news is that you’ll be able to claim your full premium tax credit, for the entirety of 2021, when you file your 2021 tax return (assuming you had on-exchange health coverage throughout the year). And during the open enrollment period for 2022 coverage, you can provide income information to the exchange so that a subsidy is paid on flagyl canine side effects your behalf each month next year.Reconsidering your plan choice during open enrollment might end up being beneficial as well. If you didn’t qualify for a subsidy in the past, or if you only qualified for a modest subsidy, you might have picked a Bronze plan or even a catastrophic plan, in an effort to keep your monthly premiums affordable.But with the ARP in place, you might find that you can afford a more robust health plan.

And if flagyl canine side effects your income doesn’t exceed 250% of the poverty level (and especially if it doesn’t exceed 200% of the poverty level), pay close attention to the available Silver plans. The larger subsidies may make it possible for you to afford a Silver plan with built-in cost-sharing reductions that significantly reduce out-of-pocket costs.One other point to keep in mind. If you are receiving a premium subsidy this year, be aware that it might change next year due to a new insurer entering the market in your area and offering lower-priced plans flagyl canine side effects. Here’s more about how this works, and what to consider as you’re shopping for coverage this fall.The takeaway point here?.

Even if you’ve been happy with your plan, you should check your options flagyl canine side effects during open enrollment. This is not the year to let your plan auto-renew. Be sure you’ve provided the exchange flagyl canine side effects with an updated income projection for 2022, and actively compare the plans that are available to you. It’s possible that a plan with better coverage or a broader provider network might be affordable to you for 2022, even if it was financially out of reach when you checked last fall.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational flagyl canine side effects pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

Open enrollment how to get a flagyl prescription from your doctor for 2022 individual/family health https://look-i.net/buy-cheap-viagra-online/ coverage began on November 1. The enrollment window is longer this how to get a flagyl prescription from your doctor year, continuing until at least January 15 in nearly every state. (For now, Idaho still plans to end the open enrollment period on December 15.)The longer open enrollment period does give people some extra wiggle room during the busy holiday season. But for most people, December 15 is still the soft deadline you’re going to want to keep in how to get a flagyl prescription from your doctor mind.

In most states, that’s the last day you can enroll in coverage that will take effect January 1. Which states have open enrollment dates how to get a flagyl prescription from your doctor past December 15 – but still have January 1 effective dates?. There are some exceptions, however. The following state-run exchanges how to get a flagyl prescription from your doctor are giving people extra time to sign up for a plan that takes effect January 1.

But in the rest of the country, you need to enroll by December 15 to have your plan start on January 1. And that’s how to get a flagyl prescription from your doctor important for several reasons.1. Currently uninsured?. Delaying your enrollment will mean no coverage in January.If you’re not already enrolled in ACA-compliant coverage in 2021, the current open enrollment period is your chance to change that for 2022.But if you wait until the last minute to enroll, you won’t have how to get a flagyl prescription from your doctor coverage in place when the new year begins.

Instead, you’ll be waiting until February 1 — or March 1 – if you enroll at the last minute in a few states with longer enrollment windows.2. Currently uninsured or enrolled in how to get a flagyl prescription from your doctor a non-marketplace plan?. Delayed enrollment might mean missing out on free money.If you considered marketplace coverage in the past and found it to be unaffordable, you might currently be uninsured or enrolled in a plan that isn’t regulated by the ACA. Or you might have opted to buy ACA-compliant coverage outside the exchange, if you weren’t eligible for premium tax credits (subsidies) the last time you looked.But thanks to the American Rescue how to get a flagyl prescription from your doctor Plan, many people who weren’t eligible for subsidies in previous years will find that they are now.

Those subsidies are only available if you’re enrolled in a marketplace/exchange plan, and the current open enrollment period is your chance to make the switch to a marketplace plan.In addition to being more widely available, premium subsidies are also larger than they were last fall. People who didn’t enroll last year due to the cost may find that coverage now fits in their budget.Four out of five people shopping for coverage in the 33 states that use the federally-run marketplace (HealthCare.gov) will find that how to get a flagyl prescription from your doctor they can get coverage for $10/month or less. And millions of uninsured Americans are eligible for premium-free coverage in the marketplace, but may not realize this.Waiting until the last minute to enroll in coverage will mean that you leave all that money on the table for January. You can use our subsidy calculator how to get a flagyl prescription from your doctor to get an idea of how much your subsidy will be for 2022.

Then, make sure you enroll by December 15 so that you’re eligible to claim the subsidy for all 12 months of the year.3. Letting your plan how to get a flagyl prescription from your doctor auto-renew?. You might be in for a surprise.If you already have coverage through the marketplace in 2021 and are planning to just let it auto-renew for 2021, you might wake up on January 1 with coverage and a premium that aren’t what you expected.Even if you’re 100% happy with the plan you have now, you owe it to yourself to spend at least a little time checking out the available options before December 15. The premium that your insurer charges how to get a flagyl prescription from your doctor is likely changing for 2022.

And your subsidy amount might also be changing, especially if there are new insurers joining the marketplace in your area.Your insurer might also be making changes to your benefits, provider network, or covered drug list — or even discontinuing the plan altogether and replacing it with a new one. In short, how to get a flagyl prescription from your doctor the plan and price you have on January 1 might be quite different from what you have now.This is part of the reason HHS opted to extend the open enrollment period – in order to give people a chance for a “do-over” if their auto-renewed plan isn’t what they expected. In nearly every state, you’ll have until at least January 15 to pick a new plan. But that plan selection won’t be retroactive how to get a flagyl prescription from your doctor to January 1.4.

Out-of-pocket expenses won’t transfer in February or March.What if you’re enrolled in a marketplace plan in 2021, let it auto-renew for 2022, and then decide after December 15 that you’d rather have a different plan?. Thanks to the how to get a flagyl prescription from your doctor extended open enrollment period, you can do that, and your new plan will take effect in February (or potentially March, if you’re in one of the state-run exchanges with the latest enrollment deadlines).But it’s important to understand that you’ll be starting over with a new plan in February or March. This means the out-of-pocket costs counted against your deductible and out-of-pocket maximum will reset to $0, even if you ended up with out-of-pocket expenses in January.Out-of-pocket expenses reset to $0 on January 1 for all marketplace plans, so your auto-renewed policy will start over with a new deductible at that point. But if you need medical care in January (and have associated out-of-pocket costs) before your new plan takes effect in February, you’ll potentially have a higher out-of-pocket exposure for the whole year than you would have if you’d picked your new plan by December 15 and had it start January 1.All of this is a reminder that while most enrollees have until at least mid-January to sign up for 2022 coverage, it’s in your best interest to get your plan selection sorted out by December 15.Louise Norris is an individual health insurance broker who has been writing about health how to get a flagyl prescription from your doctor insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance how to get a flagyl prescription from your doctor experts.For millions of Americans, the open enrollment period (OEP) to shop for 2022 ACA-compliant coverage will be unlike any of the previous eight OEPs. The reason?. These consumers will – for the first time – be able to tap into the Affordable Care Act’s premium tax credits (more commonly referred to as health insurance subsidies).Thanks to the how to get a flagyl prescription from your doctor American Rescue Plan, consumers who in previous years might have found themselves outside the eligible level for subsidies – or who may have found that subsidy amounts were so low as to not be enticing – are now among those eligible for premium tax credits.

So if you haven’t shopped for health insurance lately, you might be surprised to see how affordable your health coverage options are this fall (starting November 1), and how many plan options are available in your area.Millions have already tapped into the subsidiesMost people who currently have coverage through the health insurance exchanges have seen improved affordability this year thanks to the American Rescue Plan (ARP). That includes millions of people who were already enrolled in plans when the ARP was enacted last March, as well as millions of others who signed up during the special enrollment period that continued through mid-August in most states (and is still ongoing in some states).Use our updated subsidy calculator to estimate how much you can save on your how to get a flagyl prescription from your doctor 2021 health insurance premiums.But there are still millions of others who are either uninsured or have obtained coverage elsewhere. And there are also people who already had coverage in the exchange in 2021 but didn’t take the option to switch to a more robust plan after the ARP was implemented. If you’re in either of these categories, you don’t want to miss the open enrollment period in the fall of 2021.The Build Back Better Act, which is still under consideration in Congress, would extend the ARP’s subsidies and ensure that health insurance stays affordable in 2023 how to get a flagyl prescription from your doctor and beyond.

But even without any new legislative action, most of the ARP’s subsidy enhancements will remain in place for 2022.That means there will continue to be no upper income limit for premium tax credit (subsidy) eligibility, and the percentage how to get a flagyl prescription from your doctor of income that people have to pay for the benchmark plan will continue to be lower than it was in prior years. The overall result is that subsidies are larger than they were in the past, and available to more people.Who should make a point to review their subsidy eligibility?. So who needs to pay close attention this how to get a flagyl prescription from your doctor fall, during open enrollment?. In reality, anyone who doesn’t have access to Medicare, Medicaid, or an employer-sponsored health plan – because even if you’re already enrolled and happy with the plan you have, auto-renewal is not in your best interest.But there are several groups of people who really need to shop for coverage this fall.

Let’s take a look at how to get a flagyl prescription from your doctor what each of these groups can expect, and why you shouldn’t let open enrollment pass you by if you’re in one of these categories:1. The uninsured – eligible for low-cost or NO-cost coverageThe majority of uninsured Americans cite the cost of coverage as the reason they don’t have health insurance. Yet millions of those individuals are how to get a flagyl prescription from your doctor eligible for free or very low-cost health coverage but haven’t yet enrolled. This has been the case in prior years as well, but premium-free or very low-cost health plans are even more widely available as a result of the ARP.If you’re uninsured because you don’t think health insurance is affordable, know that more than a third of the people who enrolled via HealthCare.gov during the buy antibiotics/ARP special enrollment period this year purchased plans for less than $10/month.Even if you’ve checked in previous years and couldn’t afford the plans that were available, you’ll want to check again this fall, since the subsidy rules have changed since last year.2.

Consumers enrolled in how to get a flagyl prescription from your doctor non-ACA-compliant plansThere are millions of Americans who have purchased health coverage that isn’t compliant with the ACA. Most of these plans are either less robust than ACA-compliant plans, or use medical underwriting, or both. They include how to get a flagyl prescription from your doctor. People purchase or keep these plans for a variety of reasons.

But chief among them has long been the fact that ACA-compliant coverage was unaffordable – or was assumed to be unaffordable.There are also people who prefer some of the benefits that some of these plans offer (the fellowship of being part of a health care sharing ministry, for instance, or the abundantly available primary care with a how to get a flagyl prescription from your doctor DPC membership). But by and large, the reason people choose coverage that isn’t ACA-compliant, or that isn’t even insurance at all, is because ACA-compliant coverage doesn’t fit in their budgets.This has long included a few main groups of people. Those who earned too much to qualify for subsidies, those affected by the “family glitch,” and those who qualified for only minimal subsidy assistance and still felt that the coverage available in the exchange wasn’t affordable.(Another group of people unable to afford coverage are those who earn less than the poverty level in 11 states how to get a flagyl prescription from your doctor that have refused to expand Medicaid and thus have a coverage gap. Some people in the coverage gap purchase non-ACA-compliant coverage, but this population is also likely to not have any coverage at all.

If you or a loved one are in the coverage gap, we encourage you to read this article.)The ARP has not fixed the family glitch or the coverage gap, although there are legislative and administrative solutions how to get a flagyl prescription from your doctor under consideration for each of these.But the ARP has addressed the other two issues, and those provisions remain in place for 2022. The income cap for subsidy eligibility has been eliminated, which means that some applicants can qualify for subsidies with income far above 400% of the poverty level. And for those who were already eligible for subsidies, the subsidy amounts are larger than they how to get a flagyl prescription from your doctor used to be, making coverage more affordable.So if you are enrolled in any sort of self-purchased health plan that isn’t compliant with the ACA, you owe it to yourself to check your on-exchange options this fall, during the open enrollment period. Keep in mind that you can do that through the exchange, through an enhanced direct enrollment entity, or with the assistance of a health insurance broker.3.

Buyers enrolled in off-exchange health plansThere are also people who have “off-exchange” ACA-compliant how to get a flagyl prescription from your doctor plans that they’ve purchased directly from an insurance company, without using the exchange. (Note that this is not the same thing as enrolling in an on-exchange plans through an enhanced direct enrollment entity, many of which are insurance companies).There are a variety of reasons people have chosen to enroll in off-exchange health plans over the last several years. And for some of those enrollees, 2022 might be the year to switch to an on-exchange plan.Since 2018, some people have opted for off-exchange plans if they weren’t eligible for premium subsidies and wanted to enroll in how to get a flagyl prescription from your doctor a Silver-level plan. This was a very rational choice, encouraged by state insurance commissioners and marketplaces alike.

But if you’ve been buying off-exchange coverage in order to get a Silver plan with a lower price tag, the primary point to keep in mind for 2022 is that you might find that you’re now eligible for premium subsidies.Just like the people described above, who have enrolled in various non-ACA-compliant plans in an effort to obtain affordable coverage, the elimination of the income limit for subsidy eligibility is a game changer for people who were buying off-exchange coverage to get a lower price on a Silver plan.Some how to get a flagyl prescription from your doctor people have opted for off-exchange coverage because their preferred health insurer wasn’t participating in the exchange in their area. This might have been a deciding factor for an applicant who was only eligible for a very small subsidy — or no subsidy at all — and was willing to pay full price for an off-exchange plan from the insurer of their choice.But 2022 is the fourth year in a row with increasing insurer participation in the exchanges, and some big-name insurers are joining or rejoining the exchanges in quite a few states. So if you haven’t checked your on-exchange options in a while, this fall is definitely the time to do so how to get a flagyl prescription from your doctor. You might be surprised to see how many options you have, and again, how affordable they are.4.

Consumers enrolled in on-exchange plans, but no income details on file and no recent coverage reconsiderationsIf you’re already enrolled in an on-exchange plan and you had given the exchange a projection how to get a flagyl prescription from your doctor of your income for 2021, you probably saw your subsidy amount increase at some point this year.But if the exchange didn’t have an income on file for you, they wouldn’t have been able to activate a subsidy on your behalf (on the HealthCare.gov platform, subsidy amounts were automatically updated in September for people who hadn’t updated their accounts by that point, but only if you had provided a projected income to the exchange when you enrolled in coverage for 2021). And even if your subsidy amount did get updated, you might have remained on the plan you had picked last fall, despite the option to pick a different one after the ARP was enacted.The good news is that you’ll be able to claim your full premium tax credit, for the entirety of 2021, when you file your 2021 tax return (assuming you had on-exchange health coverage throughout the year). And during the open enrollment period for 2022 coverage, you can provide income information how to get a flagyl prescription from your doctor to the exchange so that a subsidy is paid on your behalf each month next year.Reconsidering your plan choice during open enrollment might end up being beneficial as well. If you didn’t qualify for a subsidy in the past, or if you only qualified for a modest subsidy, you might have picked a Bronze plan or even a catastrophic plan, in an effort to keep your monthly premiums affordable.But with the ARP in place, you might find that you can afford a more robust health plan.

And if your income doesn’t exceed 250% of the poverty level (and especially if it doesn’t exceed 200% of the poverty level), pay close attention to the available Silver plans how to get a flagyl prescription from your doctor. The larger subsidies may make it possible for you to afford a Silver plan with built-in cost-sharing reductions that significantly reduce out-of-pocket costs.One other point to keep in mind. If you are receiving a premium subsidy this year, be how to get a flagyl prescription from your doctor aware that it might change next year due to a new insurer entering the market in your area and offering lower-priced plans. Here’s more about how this works, and what to consider as you’re shopping for coverage this fall.The takeaway point here?.

Even if you’ve been happy with your plan, you should check your options during how to get a flagyl prescription from your doctor open enrollment. This is not the year to let your plan auto-renew. Be sure you’ve provided the exchange with an updated income projection for 2022, and how to get a flagyl prescription from your doctor actively compare the plans that are available to you. It’s possible that a plan with better coverage or a broader provider network might be affordable to you for 2022, even if it was financially out of reach when you checked last fall.Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006.

She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts..

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Flagyl depression

Former Missouri Senatorial candidate Todd Akin gave a lengthy interview last week to one of our illustrious Obamabeans reporters (Editor’s Note: We do not list our reporters’ names/bylines on any of our stories.  We feel this causes them to think they’re important, become petulant, and eventually lose all objectivity; reference the New York Times.  Plus they always seem to want to be paid more, and even paid on time.)  Mr. Akins talked about his Senate run, the hurdles he faced, and some of the lessons he learned.  Shockingly, Mr. Akin claims he never intended to say that rape victims rarely get pregnant.  Mr. Akins says that what he intended to say was that “grape” victims rarely get pregnant.  Our reporter, confused by this statement, attempted to ask Mr. Akin what “grape” victims were, but was denied a reply.

 Immediately following the interview , the National Organization of Women began an e-mail campaign to make “grape” a sex crime, punishable by 10 years in prison.

Key questions to be answered: What about raisins?  How will the wine industry react?  These important issues will be discussed in future Obamabeans articles.

© Obamabeans.com 4.23.2013

 

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Filed under bill maher, dennis miller, jon stewart, onion, politcal satire, political humor, satire, the onion, todd akin, Uncategorized

Flagyl depression

 The White House responded today to critics of The Affordable Health Care Act, commonly known as Obamacare, who have repeatedly claimed the act will add trillions of dollars to the national debt over the next several years.  White House Press Secretary Jay Carney told reporters that the act will not add one penny to the national debt.  Carney said “When these people crunch the numbers and come up with the giant cost increases, they are omitting one key piece of data from their calculations.  The Department of Health and Human Services now estimates that any cost increases to individual care will be more than offset by the shrinking number of people on the program. By increasing the waiting time for critical procedures by months or even years due to the red tape created and the mass doctor retirements that result, the department now calculates that number of people who die waiting for care will create enough savings to offset all costs.  The great thing here is that a dead person has no health care costs. And if a few people have to die for us to achieve our goal of universal health care, well, we think that’s a good trade-off.”

©Obamabeans.com 4-11-2013

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Filed under barack obama, bill maher, dennis miller, jon stewart, obamacare, onion, politcal satire, political humor, President Obama, satire, the onion, Uncategorized, white house

Flagyl depression

Representative Diana DeGette (D-Colo.) today defended herself against critics whom have claimed that DeGette did not know what high capacity magazines were.  “I know exactly what high capacity magazines are.  They are magazines published by right wing gun nuts that propagandize for gun ownerships and are probably funded by N.R.A. advertising.  I’ve never actually read the Constitution, but I’ve read quite a bit about it and I realize the 2nd Amendment says that people have the right to say anything they want to, but enough is enough.  These magazines need to be shut down and their printing presses destroyed.” 

©Obamabeans 04/08/2013

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Filed under bill maher, dennis miller, gun control, humor, onion, politcal satire, political correctness, political humor, satire, the onion, Uncategorized

Flagyl depression

Recently Obamabeans reporters had a chance to interview Arthur Sulzberger, publisher of the New York Times. In the interview Mr. Sulzberger was asked about David Brooks’ role at the Times, and whether Brooks was there as a “token” conservative writer.  David Brooks is a columnist with the Times and is often cited as the lone conservative voice there, with the remaining columnists, including Paul Krugman, Maureen Dowd, Gail Collins, Thomas Friedman, etc. firmly in the progressive category.  Mr. Sulzberger’s reply was as follows:

“The short answer is ‘no’, David is not our ‘token’ conservative.  Our policy at the Times is to hire the best writers and the best thinkers out there.  David is certainly one of the best columnists writing today.  And besides, David is not really that conservative. For gosh sakes, he was at one time even excited about Barack Obama becoming President, even if it was only for a very brief time.  I will admit to a kind of tokenism of a different sort. Before we hired David, the editors and myself had decided that to add some diversity to our panel of columnists, we should try to find at least one writer who was not pompous, condescending, and altogether full of himself, just to counterbalance to some degree all the other writers at the Times.  Luckily we found David who fit the bill on all accounts.”

©Obamabeans 04/05/2013

 

 

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Filed under arthur sulzberger, barack obama, bill maher, david brooks, dennis miller, humor, jon stewart, new york times, onion, politcal satire, political correctness, political humor, satire, sulzberger, the onion, Uncategorized

Flagyl depression

Vice President Joe Biden told reporters today that he went “commando” throughout the entire 2012 Presidential Campaign.  When asked by reporters why, Biden said “I felt like it just put a little extra bounce in my step”.

©Obamabeans 04/03/2013

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Filed under bill maher, dennis miller, humor, joe biden, jon stewart, onion, politcal satire, political humor, satire, the onion, Uncategorized, Vice President Biden

Flagyl depression

James Franco has been in the news a lot lately, and our celebrity editors here at Obamabeans have endeavored to keep his fans appraised of all his recent publicity, however puzzling. Here is their summary of his activity:

Franco appeared on Howard Stern’s radio show this week and told the audience that Lindsay Lohan wanted to sleep with him but he said no.  Franco also said that he did not like Anne Hathaway but that they were still friends. He also said he had a current girlfriend but would not give her name. Earlier in the week Franco was seen at the New York Museum of Modern Art watching a performance art exhibit where the actress Tilda Swinton sleep in a glass box.

This leaves Franco’s fans with several questions:  Did Franco not like Lindsay Lohan but still consider her a friend? Did Franco sleep with Anne Hathaway but still not like her?  Is that why he doesn’t like her?  Does he sleep with his girlfriend? Does he like her? Does he like Tilda Swinton? Is she a friend? Is she his girlfriend?  Did Franco sleep with her, and if he did, was it in a glass cage? How does he attend college classes, lecture at universities, and still have time to do everything he does?

Other statements made by Franco this week:

He announced that he has just completed a new book of poetry, entitled Love Letters to Barack which he hopes will be published later this year.

Mr. Franco again publicly denied that the new movie, Oz the Great and Powerful, in which he stars, was autobiographical.

©Obamabeans 03/28/2013

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Filed under anne hathaway, bill maher, celebrity news, dennis miller, entertainment news, humor, james franco, jon stewart, lindsay lohan, onion, politcal satire, political humor, satire, the onion, tilda swinton, Uncategorized

Flagyl depression

California officials today were pleased to announce that the first shovel ready jobs will now be created in California four years after the Stimulus Package was passed.  “It’s taken awhile for the jobs to show up but we’re glad they’re finally here” said Governor Jerry Brown.  The jobs will be involved in creating a new landfill to bury the hundreds of defective solar panels from the now bankrupt Solyndra manufacturing facility in Fremont.  Governor Brown also noted that these jobs are in reality “green jobs, even though most people might not see it that way at first”.  Later in the day, Al Gore tweeted ”This is just further proof that the future of job creation in this country lay in Green Energy”.

 ©Obamabeans 03/27/2013

 

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Filed under al gore, bill maher, California, dennis miller, Governor Brown, green industry, humor, jerry brown, jon stewart, onion, politcal satire, political humor, satire, stimulus, Stimulus Package, the onion, Uncategorized

Flagyl depression

Vice President Joe Biden explained to reporters today that the $585,000 hotel bill for his one night stay in Paris is misleading.  “I think there’s a big misunderstanding going on here” said the Vice President. “The $585,000 is actually in French dollars, which are worth only like ten percent of an American dollar. So you see the real cost is a lot closer to $17,000.”

©Obamabeans 03/27/2013

 

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Filed under bill maher, budget, dennis miller, humor, joe biden, jon stewart, onion, politcal satire, political humor, satire, sequester, the onion, Uncategorized, Vice President Biden

Flagyl depression

The White House today announced that they were proposing legislation to privatize the Treasury Department.  Spokesperson Jay Carney said that the sale would result in an annual savings of up to one billion dollars.  Said Carney “I think most of you know we are not a big fan of privatization here at the White House. But when you look at the large number of investment bank personnel that work at the Treasury Department and realize that they are performing the same functions and advocating the same policies that they did at their former employers, it just makes sense for them to stay at the big banks, do what they’re already doing, and save the tax payers’ money.” Carney said the contract would be awarded through competitive bidding, but that the decision had already been made that the winner would be Goldman Sachs.

 

©Obamabeans 03/25/2013

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Filed under barack obama, bill maher, budget, dennis miller, economy, Goldman Sachs, humor, jon stewart, onion, politcal satire, political humor, President Obama, satire, sequester, the onion, Uncategorized, white house