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EAU CLAIRE, cheap kamagra pills uk kamagra oral jelly wholesalers WI – The success of the partnership between the U.S. Department of Labor’s Occupational Safety and Health Administration and Chippewa Valley Technical College has led OSHA to reaffirm its commitment to training employers and workers on workplace safety, and in recognizing the college by elevating CVTC to Ambassador Alliance status. OSHA and Chippewa Valley Technical College will sign a new Ambassador cheap kamagra pills uk Alliance on Thursday, July 29, at the college’s Business Education Center, 620 W. Clairemont Ave.

(Room 100D) cheap kamagra pills uk at 9 a.m. CDT. The Ambassador relationship will remain in effect for the duration of an ongoing cooperative association and while both parties maintain a good-faith effort to meet the program’s intent and policies. OSHA and CVTC signed its first alliance in 2006 to focus on promoting a culture of worker safety and health within the general industry, construction and agricultural industries – including small businesses cheap kamagra pills uk and non-English and limited English-speaking workers – by developing and sharing information on preventing workplace hazards, such as falls, struck-by, caught-in-between and electrical.

“Through our collaboration, Chippewa Valley Technical College has trained thousands of employers and workers on preventable workplace injuries,” said OSHA Area Director Mitzy Wright in Eau Claire, Wisconsin. €œAdding the college to our Ambassador Alliance Program allows us to continue collaborating to enhance education cheap kamagra pills uk and training and improve worker safety throughout Chippewa Valley.” In addition, CVTC and OSHA will continue promoting awareness of OSHA’s rulemakings, enforcement initiatives and safety campaigns, including an understanding of workers’ rights and employer responsibilities. Chippewa Valley Technical College is part of the Wisconsin Technical College System and serves an 11-county area. CVTC has eight campus locations in Eau Claire, and in Chippewa Falls, Menomonie, Neillsville and River Falls.

OSHA’s Alliance Program works with groups committed to worker safety and health cheap kamagra pills uk to prevent workplace fatalities, injuries and illnesses. These groups include unions, consulates, trade or professional organizations, businesses, faith- and community-based organizations, and educational institutions. OSHA and the groups work together to cheap kamagra pills uk develop compliance assistance tools and resources, share information with workers and employers, and educate workers and employers about their rights and responsibilities. Learn more about OSHA.TRENTON, FL – On just his third week working for a Trenton manufacturer, a 21-year-old machine operator’s life changed forever.

On Feb cheap kamagra pills uk. 1, 2021, the operator suffered a partial hand amputation because the company allowed protective guards to be removed from a machine that cuts sheet metal for the roofing industry.An investigation by the U.S. Department of Labor’s Occupational Safety and Health Administration found that Blac Investments Inc. €“ operating as Tri County Metals – removed protective cheap kamagra pills uk guards from the machine because the guards caused imperfections to newly manufactured roofing panels.

OSHA cited the company for a willful violation for removing the guards and exposing workers to amputations hazards. The agency proposed cheap kamagra pills uk $122,879 in penalties. “Blac Investments’ management made a conscious decision to remove guards on three machines that exposed workers to dangerous metal shears,” said OSHA Area Office Director Michelle Gonzalez in Jacksonville, Florida. €œThey put profits over their employees’ safety and a young worker is permanently disabled.” Headquartered in Trenton, Blac Investments Inc.

Manufactures commercial and residential metal-roofing materials at six other locations in cheap kamagra pills uk Live Oak, Ocala, Tallahassee, Brooksville, Deland and Jacksonville. The company has 15 business days from receipt of its citations and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission. Learn more about the hazards of mechanical cheap kamagra pills uk motion and techniques for protecting workers. Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees.

OSHA’s role is to ensure these conditions for America’s workers by setting and enforcing standards, and providing training, education and assistance..

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TeamSTEPPS is an evidence-based set of tools aimed at improving https://www.nationalfranchise.com/franchising-win-win-for-all/ patient outcomes by improving communication and teamwork among the members of healthcare sildamax and kamagra teams. Communication gaps among healthcare professionals are linked to poor patient safety outcomes. Conversely, effective teamwork, collaboration, and active communication are considered essential to safer healthcare.

Strengthening teamwork and communication among healthcare personnel is a key initiative within the sildamax and kamagra patient safety domain and can transform the culture of safety within healthcare. The TeamSTEPPS training program offers a plethora of methods to build team skills and improve teamwork in healthcare. The training videos are an important tool to demonstrate those methods and how they can be used to achieve the best possible outcomes.

For more than 15 years, the TeamSTEPPS sildamax and kamagra curriculum has been widely used by the healthcare industry in various settings (including hospitals, outpatient clinics, nursing homes, and surgery centers). Medical and nursing schools routinely teach the TeamSTEPPS curricula as part of their core courses, and a variety of healthcare institutions and organizations promote TeamSTEPPS principles and techniques in their efforts to create skilled and cohesive teams. Several years have passed since many of the TeamSTEPPS videos were developed or last revised.

In a fast-paced environment such as healthcare, this is a substantial sildamax and kamagra amount of time. With advancements in health information technology, changes in how care is delivered, and an increased emphasis on engaging patients and families as members of the healthcare team, many of the current TeamSTEPPS videos need to be updated to align more closely with current clinical practice, standards of care, and improved methods of adult training and education. Challenge Goal Healthcare has evolved and advanced since the original TeamSTEPPS videos were created, and many of the current TeamSTEPPS videos no longer meet current healthcare setting needs.

AHRQ plans to replace their sildamax and kamagra content to capture the innovations and practices observed in the healthcare landscape today. This AHRQ Challenge seeks innovators to update the current TeamSTEPPS videos to provide improved TeamSTEPPS tools for communication and collaboration among healthcare team members. All existing TeamSTEPPS videos currently on the AHRQ website may be considered for updating.

This Challenge sildamax and kamagra consists of two phases. Phase 1. Elicit written proposals on innovatively modernizing current TeamSTEPPS videos in an equitable, culturally sensitive, and health literate manner ( e.g., including diverse patients and providers, choice of clinical topics that affect diverse populations, modeling plain language).

Each proposal is to be sildamax and kamagra written in the form of a narrative story or a plan that briefly provides details about how to update an applicable TeamSTEPPS video topic, including video style, type of graphics, use of live or animated actors and/or narrator, and music, and plans for audience testing. An organization may choose to update between 1 and 3 TeamSTEPPS video topics, submitting a separate proposal for each one. Each proposal will be considered and evaluated on its own merit.

Organizations may wish to consider the following while deciding on which video(s) to select for sildamax and kamagra refreshing. 1. The organization deems a video or videos to be of most urgency to update and 2.

The organization sildamax and kamagra has experience in that particular area. A total of 10 proposals will be selected as winners for Phase 1. Phase 2.

Organizations selected as winners in Phase 1 will be invited to produce a replacement for the existing TeamSTEPPS video identified in sildamax and kamagra their proposal. Examples of products to consider that may replace a TeamSTEPPS video include animation videos, motion graphics videos, whiteboard videos, live action videos, Start Printed Page 25021 live action screencast, or video showcases. This is not an exhaustive list.

Innovative ideas of how to apply TeamSTEPPS training sildamax and kamagra strategies appropriate for a healthcare environment are encouraged. Each video shall be up to 5 minutes in length. Each video shall be accompanied by a short debrief guide—a series of prompts to the learners who watch the video—in written format to support learners in adopting new practices.

The debrief guide may include, for example, questions about how the sildamax and kamagra learner would have handled the situation, how the learner would use the TeamSTEPPS tool featured in the video, and similar probing questions. Timeline and Prize Amounts AHRQ is hosting this challenge as a two-phase competition. All costs associated with both submitting proposals and creating the videos will be the responsibility of the Challenge participant.

Cash prizes will be awarded only after the videos are evaluated and determined acceptable at the end of Phase 2 sildamax and kamagra. Timeline April 27, 2022—Challenge launch. June 20, 2022—Submissions for Phase 1 (written proposals) are due.

AHRQ will complete sildamax and kamagra the review of the proposals within 6-8 weeks of closing the announcement. August 2022—AHRQ will announce the Phase 1 winners at the end of August 2022. Phase 2 of the Challenge will commence once the Phase 1 winners are announced and notified by August 31, 2022.

The AHRQ team will schedule a live, virtual technical assistance webinar with all winners of Phase 1 to discuss scope of content, end-product quality, accessibility/compliance with Section sildamax and kamagra 508, and address questions that the winners may have. October 31, 2022—Phase 2 participants will have 60 calendar days from notification to create and submit their production(s) as described in their proposal(s). The deadline to submit the videos is October 31, 2022.

December 2022—The sildamax and kamagra final winners of Phase 2 of the competition will be announced in December of 2022. Prize Amounts Only the participants selected as winners of Phase 1 will be eligible to enter Phase 2. Phase 1 winners will not be awarded cash prizes.

Winners of Phase 2 will be awarded $10,000 per sildamax and kamagra successful video. Up to 10 cash prizes will be awarded. Participants in Phase 2 may be disqualified if their submitted video deviates from their winning proposal or if the production quality does not meet standards per the assessment criteria stated in this announcement and the technical assistance standards.

In case any Phase 2 sildamax and kamagra proposals are disqualified, another proposal(s) from Phase 1 may be considered. Any additional winner(s) will be contacted about submitting a video and will be given a new 60-day deadline to do so. How To Enter the Challenge Participants can register by visiting the Challenge.gov website or the AHRQ website ( https://www.ahrq.gov/​challenges/​teamstepps-video/​index.html ).

Participants should carefully review Challenge information and submission requirements on the website, including the intellectual property sildamax and kamagra rules and assessment criteria. Submission Requirements Phase 1 The submitted proposals must be written in US English and submitted using the Challenge.gov website or the AHRQ website no later than June 20, 2022. Participants shall submit no more than three (3) video proposals —one proposal to replace one existing TeamSTEPPS video topic.

No proposal sildamax and kamagra shall describe more than one video. Each proposal will be no more than two pages, double spaced, in Calibri font, 11-point type size, with 1-inch margins. AHRQ encourages participants to include with their proposal a link to a short (no longer than 5 minutes) sample of a previously created video on a site that does not require a password.

Sample videos do not need sildamax and kamagra to address TeamSTEPPS principles. They should demonstrate the submitter's ability to produce an acceptable training video that will meet the specifications of this Challenge. Include in proposals plans for meeting WCAG 2.0 and Section 508 compliance standards.

Phase 2 Video submissions shall be in US English and shall not include any branding or endorsements such as logos, wording, title slides, or other designs on posters, signs, clothing, equipment, or any sildamax and kamagra other objects that can be seen in the video. Participants must secure permission releases from each and all individuals who appear in the video. Location releases for any shooting location that is not controlled by the participant.

Music licenses for any music used sildamax and kamagra in the video. And permission releases/licenses to use copyrighted property, if applicable. Participants must be prepared to provide AHRQ with these releases and licenses if their videos are chosen as winners of the Challenge.

Prior to submission, Challenge participants shall ensure that the product(s) include closed-captioning and audio description sildamax and kamagra in compliance with WCAG 2.0 and Section 508. The video(s) must be in a YouTube format with the proper codecs. MP4 (H.264 or H.265), MOV, AVI, WMV with an aspect of 16:9.

Participants shall submit their product(s) online using the Challenge.gov website or the AHRQ website sildamax and kamagra. Https://www.ahrq.gov/​challenges/​teamstepps-video/​index.html. Each video is required to be accompanied by a guide that is no longer than 250 words.

The guide will function as a sildamax and kamagra resource for debriefing on the TeamSTEPPS concept or tool demonstrated in the video. Review Process All submissions will be reviewed by at least two individuals who will score them based on the assessment criteria and provide a brief comment about the submission. The scores/comments on Phase 1 and Phase 2 submissions will be compiled, and a ranked summary provided to AHRQ staff.

AHRQ will select winners based on sildamax and kamagra quantitative and qualitative assessments. Evaluation Criteria for Selecting Winning Applications Assessment Criteria for Phase 1 TeamSTEPPS Video Proposal Compliance (pass/fail) —Does the Phase 1 proposal adequately address required compliance standards (WCAG 2.0 and Section 508)?. Overall Approach (40 pts) —Does the proposal sufficiently describe why a particular TeamSTEPPS video has been chosen for updating?.

Does the proposal clearly, concisely, and adequately describe the approach chosen to update the TeamSTEPPS video? sildamax and kamagra. Does the proposal describe how the new video would be effective in augmenting the TeamSTEPPS program to train healthcare team members on communication and collaboration, and does it describe how the video will address equity, cultural sensitivity and health literacy?. Does the proposal include a sample of past video work completed by the Challenge participants?.

Does sildamax and kamagra the proposal include conducting audience testing?. Impact (20 pts) —Does the proposal tell a compelling and impactful story to Start Printed Page 25022 demonstrate how the new production would be aligned with the current healthcare landscape to fully support the TeamSTEPPS training program?. Innovation and Creativity (25 pts) —Does the proposal include innovative and appropriate methods for adult learning?.

Does the proposal use creative ways to update the existing TeamSTEPPS videos? sildamax and kamagra. Does the proposal include new insight and approaches to broadening diversity in TeamSTEPPS?. Healthcare needs (15 pts) —Does the approach clearly address healthcare needs, current issues, approaches to improve patient safety ( e.g., patient family engagement), changes in HIPAA laws and healthcare settings, and/or emerging trends ( e.g., artificial intelligence in healthcare, telemedicine)?.

Assessment Criteria for Phase 2 TeamSTEPPS Video Product Compliance (pass/fail) sildamax and kamagra —Does the completed Phase 2 video meet the compliance standards?. Approach (30 pts) —Does the production clearly follow the approach in the proposal?. Is the message consistent with the proposal?.

Does the production sildamax and kamagra clearly communicate the content/theme?. Is it focused on the topic and organized?. Is it captivating and edifying?.

Content sildamax and kamagra (30 pts) —Is it appropriate for healthcare?. Does it address diversity, equity, and inclusion?. Is it tailored to diverse audiences from cultural, technological, and healthcare setting perspectives?.

Creativity (20 pts) —How creatively does the new product convey the message? sildamax and kamagra. Is it innovative?. Is it well designed?.

Quality sildamax and kamagra (20 pts) —How is the quality of the production?. Is the lighting, sound, editing, and contrast appropriate?. Is the dialogue clear and easy to understand?.

Is sildamax and kamagra it visually appealing and effective?. Is the captioning accurate?. Eligibility Rules for Participating in the Challenge To be eligible under this Challenge, an individual (whether participating singly or in a group) or entity.

1 sildamax and kamagra. Shall have registered ( Challenge.gov ) to participate in the Challenge. 2.

Shall have complied with sildamax and kamagra the rules set forth in this announcement for participation in this Challenge. 3. Shall be incorporated and maintain a primary place of business in the United States (in the case of a private entity), and in the case of an individual, whether participating singly or in a group, shall be a citizen or permanent resident of the United States.

4. May not be a Federal entity or Federal employee acting within the scope of their employment. (All Federal employees should consult with their agency Ethics Official to determine whether the federal ethics rules will limit or prohibit the acceptance of a prize).

5. May not be an employee of AHRQ or any other company, organization, or individual involved with the design, production, execution, judging, or distribution of the Challenge, or their immediate family (spouse, parents and step-parents, siblings and step-siblings, and children and step-children), or household members (people who share the same residence at least 3 months out of the year). 6.

May not use Federal funds from a grant to develop Challenge applications unless consistent with the purpose of the grant award. 7. May not use Federal funds from a contract to develop Challenge applications or to fund efforts in support of a Challenge submission.

8. Shall not be deemed ineligible because the individual or entity used Federal facilities or consulted with Federal employees during a competition if the facilities and employees are made equitably available to all individuals and entities participating in the competition. 9.

Shall not be required to purchase liability insurance as a condition of participation in this competition. Additional Rules of Participation By participating in this Challenge, each individual (whether participating singly or in a group) or entity. 1.

Agrees to follow all applicable Federal, State, and local laws, regulations, and policies. 2. Agrees to comply with all terms and conditions of participation in this Challenge.

3. Agrees that the submission will not use HHS or AHRQ logos or official seals, except as required by AHRQ. Videos submitted in response to this announcement must contain AHRQ/HHS branding as provided by AHRQ during the technical assistance session.

Notwithstanding this authorized use of AHRQ/HHS branding, participants will not claim endorsement by AHRQ/HHS. 4. Videos must not contain branding of submitting organization, group, or individual.

This includes logos, wording, or other designs on posters, signs, clothing, equipment, or any other objects that can be seen in the video. 5. Understands that all materials submitted to AHRQ as part of a submission become AHRQ records.

Any confidential commercial or financial information contained in a submission must be clearly designated as such at the time of submission. 6. Submitters of winning videos may announce their status and may link to the final video posted on the AHRQ website, as well as share promotional materials and social media posts created by AHRQ/HHS about the competition and winning videos.

However, except as a link to AHRQ, winners may not post the final video, or any draft version or any portion of the video, on their own website or through social media platforms. 7. Agrees that the submission must not infringe upon copyright or any other rights of any third party.

8. Agrees to assume any and all risks and waive claims against the Federal Government and its related entities, except in the case of willful misconduct, for any injury, death, damage, or loss of property, revenue, or profits, whether direct, indirect, or consequential, arising from participation in this prize contest, whether the injury, death, damage, or loss arises through negligence or otherwise. 9.

Agrees to indemnify the Federal Government against third-party claims for damages arising from or related to Challenge activities. 10. Phase 2 video submitters understand that circulation of winning videos could be worldwide, and that the Federal Government will not compensate the submitters for this use.

Winners shall receive a one-time cash prize as set forth in this announcement. 11. Understands that AHRQ reserves the right to cancel, suspend, and/or modify this prize contest, or any part of it, for any reason, at AHRQ's sole discretion.

AHRQ also reserves the right not to award any prizes if no entries are deemed worthy. 12. Understands that AHRQ will not select a winner that is named on the Excluded Parties List System (EPLS).

Intellectual Property (IP) Rights To be eligible to win this Challenge, a submission must meet the following requirements. 1. Each participant retains title and full ownership in and to their submission.

Participants expressly reserve all intellectual property rights not expressly granted. 2. By participating in the Challenge, each participant (whether participating singly or in a group) acknowledges that he or she is the sole author or owner of, or has a right to use, any copyrightable works that the submission comprises, that the works are wholly original with Start Printed Page 25023 the participant (or is an improved version of an existing work that the participant has sufficient rights to use and improve), and that the submission does not infringe any copyright or any other rights of any third party of which participant is aware.

In addition, each participant (whether participating singly or in a group) grants to the U.S. Government a paid-up, nonexclusive, royalty-free, irrevocable worldwide license in perpetuity and the right to reproduce, publish, post, link to, share, display publicly (on the web or elsewhere) and prepare derivative works, including the right to authorize others to do so on behalf of the U.S. Government.

3. Each participant must clearly delineate any intellectual property and/or confidential commercial information contained in a submission that the participant wishes to protect as proprietary data, in accordance with Additional Rules of Participation No. 5.

The videos are an buy kamagra tablets online integral part cheap kamagra pills uk of AHRQ's TeamSTEPPS training program. The statutory authority for this challenge competition is Section 105 of the America COMPETES Reauthorization Act of 2010. TeamSTEPPS is an evidence-based set of tools aimed at improving patient outcomes by improving communication and teamwork among the members of healthcare teams. Communication gaps among healthcare professionals are cheap kamagra pills uk linked to poor patient safety outcomes. Conversely, effective teamwork, collaboration, and active communication are considered essential to safer healthcare.

Strengthening teamwork and communication among healthcare personnel is a key initiative within the patient safety domain and can transform the culture of safety within healthcare. The TeamSTEPPS training program offers a plethora of methods to build team skills and improve teamwork cheap kamagra pills uk in healthcare. The training videos are an important tool to demonstrate those methods and how they can be used to achieve the best possible outcomes. For more than 15 years, the TeamSTEPPS curriculum has been widely used by the healthcare industry in various settings (including hospitals, outpatient clinics, nursing homes, and surgery centers). Medical and nursing schools routinely teach the TeamSTEPPS curricula as part of their core courses, and a variety of cheap kamagra pills uk healthcare institutions and organizations promote TeamSTEPPS principles and techniques in their efforts to create skilled and cohesive teams.

Several years have passed since many of the TeamSTEPPS videos were developed or last revised. In a fast-paced environment such as healthcare, this is a substantial amount of time. With advancements in health information technology, changes in how care is delivered, and an increased cheap kamagra pills uk emphasis on engaging patients and families as members of the healthcare team, many of the current TeamSTEPPS videos need to be updated to align more closely with current clinical practice, standards of care, and improved methods of adult training and education. Challenge Goal Healthcare has evolved and advanced since the original TeamSTEPPS videos were created, and many of the current TeamSTEPPS videos no longer meet current healthcare setting needs. AHRQ plans to replace their content to capture the innovations and practices observed in the healthcare landscape today.

This AHRQ Challenge seeks innovators to update the cheap kamagra pills uk current TeamSTEPPS videos to provide improved TeamSTEPPS tools for communication and collaboration among healthcare team members. All existing TeamSTEPPS videos currently on the AHRQ website may be considered for updating. This Challenge consists of two phases. Phase 1 cheap kamagra pills uk. Elicit written proposals on innovatively modernizing current TeamSTEPPS videos in an equitable, culturally sensitive, and health literate manner ( e.g., including diverse patients and providers, choice of clinical topics that affect diverse populations, modeling plain language).

Each proposal is to be written in the form of a narrative story or a plan that briefly provides details about how to update an applicable TeamSTEPPS video topic, including video style, type of graphics, use of live or animated actors and/or narrator, and music, and plans for audience testing. An organization may choose to update between 1 and 3 TeamSTEPPS video topics, submitting a separate proposal for cheap kamagra pills uk each one. Each proposal will be considered and evaluated on its own merit. Organizations may wish to consider the following while deciding on which video(s) to select for refreshing. 1.

The organization deems a video or videos to be of most urgency to update and 2. The organization has experience in that particular area. A total of 10 proposals will be selected as winners for Phase 1. Phase 2. Organizations selected as winners in Phase 1 will be invited to produce a replacement for the existing TeamSTEPPS video identified in their proposal.

Examples of products to consider that may replace a TeamSTEPPS video include animation videos, motion graphics videos, whiteboard videos, live action videos, Start Printed Page 25021 live action screencast, or video showcases. This is not an exhaustive list. Innovative ideas of how to apply TeamSTEPPS training strategies appropriate for a healthcare environment are encouraged. Each video shall be up to 5 minutes in length. Each video shall be accompanied by a short debrief guide—a series of prompts to the learners who watch the video—in written format to support learners in adopting new practices.

The debrief guide may include, for example, questions about how the learner would have handled the situation, how the learner would use the TeamSTEPPS tool featured in the video, and similar probing questions. Timeline and Prize Amounts AHRQ is hosting this challenge as a two-phase competition. All costs associated with both submitting proposals and creating the videos will be the responsibility of the Challenge participant. Cash prizes will be awarded only after the videos are evaluated and determined acceptable at the end of Phase 2. Timeline April 27, 2022—Challenge launch.

June 20, 2022—Submissions for Phase 1 (written proposals) are due. AHRQ will complete the review of the proposals within 6-8 weeks of closing the announcement. August 2022—AHRQ will announce the Phase 1 winners at the end of August 2022. Phase 2 of the Challenge will commence once the Phase 1 winners are announced and notified by August 31, 2022. The AHRQ team will schedule a live, virtual technical assistance webinar with all winners of Phase 1 to discuss scope of content, end-product quality, accessibility/compliance with Section 508, and address questions that the winners may have.

October 31, 2022—Phase 2 participants will have 60 calendar days from notification to create and submit their production(s) as described in their proposal(s). The deadline to submit the videos is October 31, 2022. December 2022—The final winners of Phase 2 of the competition will be announced in December of 2022. Prize Amounts Only the participants selected as winners of Phase 1 will be eligible to enter Phase 2. Phase 1 winners will not be awarded cash prizes.

Winners of Phase 2 will be awarded $10,000 per successful video. Up to 10 cash prizes will be awarded. Participants in Phase 2 may be disqualified if their submitted video deviates from their winning proposal or if the production quality does not meet standards per the assessment criteria stated in this announcement and the technical assistance standards. In case any Phase 2 proposals are disqualified, another proposal(s) from Phase 1 may be considered. Any additional winner(s) will be contacted about submitting a video and will be given a new 60-day deadline to do so.

How To Enter the Challenge Participants can register by visiting the Challenge.gov website or the AHRQ website ( https://www.ahrq.gov/​challenges/​teamstepps-video/​index.html ). Participants should carefully review Challenge information and submission requirements on the website, including the intellectual property rules and assessment criteria. Submission Requirements Phase 1 The submitted proposals must be written in US English and submitted using the Challenge.gov website or the AHRQ website no later than June 20, 2022. Participants shall submit no more than three (3) video proposals —one proposal to replace one existing TeamSTEPPS video topic. No proposal shall describe more than one video.

Each proposal will be no more than two pages, double spaced, in Calibri font, 11-point type size, with 1-inch margins. AHRQ encourages participants to include with their proposal a link to a short (no longer than 5 minutes) sample of a previously created video on a site that does not require a password. Sample videos do not need to address TeamSTEPPS principles. They should demonstrate the submitter's ability to produce an acceptable training video that will meet the specifications of this Challenge. Include in proposals plans for meeting WCAG 2.0 and Section 508 compliance standards.

Phase 2 Video submissions shall be in US English and shall not include any branding or endorsements such as logos, wording, title slides, or other designs on posters, signs, clothing, equipment, or any other objects that can be seen in the video. Participants must secure permission releases from each and all individuals who appear in the video. Location releases for any shooting location that is not controlled by the participant. Music licenses for any music used in the video. And permission releases/licenses to use copyrighted property, if applicable.

Participants must be prepared to provide AHRQ with these releases and licenses if their videos are chosen as winners of the Challenge. Prior to submission, Challenge participants shall ensure that the product(s) include closed-captioning and audio description in compliance with WCAG 2.0 and Section 508. The video(s) must be in a YouTube format with the proper codecs. MP4 (H.264 or H.265), MOV, AVI, WMV with an aspect of 16:9. Participants shall submit their product(s) online using the Challenge.gov website or the AHRQ website.

Https://www.ahrq.gov/​challenges/​teamstepps-video/​index.html. Each video is required to be accompanied by a guide that is no longer than 250 words. The guide will function as a resource for debriefing on the TeamSTEPPS concept or tool demonstrated in the video. Review Process All submissions will be reviewed by at least two individuals who will score them based on the assessment criteria and provide a brief comment about the submission. The scores/comments on Phase 1 and Phase 2 submissions will be compiled, and a ranked summary provided to AHRQ staff.

AHRQ will select winners based on quantitative and qualitative assessments. Evaluation Criteria for Selecting Winning Applications Assessment Criteria for Phase 1 TeamSTEPPS Video Proposal Compliance (pass/fail) —Does the Phase 1 proposal adequately address required compliance standards (WCAG 2.0 and Section 508)?. Overall Approach (40 pts) —Does the proposal sufficiently describe why a particular TeamSTEPPS video has been chosen for updating?. Does the proposal clearly, concisely, and adequately describe the approach chosen to update the TeamSTEPPS video?. Does the proposal describe how the new video would be effective in augmenting the TeamSTEPPS program to train healthcare team members on communication and collaboration, and does it describe how the video will address equity, cultural sensitivity and health literacy?.

Does the proposal visit include a sample of past video work completed by the Challenge participants?. Does the proposal include conducting audience testing?. Impact (20 pts) —Does the proposal tell a compelling and impactful story to Start Printed Page 25022 demonstrate how the new production would be aligned with the current healthcare landscape to fully support the TeamSTEPPS training program?. Innovation and Creativity (25 pts) —Does the proposal include innovative and appropriate methods for adult learning?. Does the proposal use creative ways to update the existing TeamSTEPPS videos?.

Does the proposal include new insight and approaches to broadening diversity in TeamSTEPPS?. Healthcare needs (15 pts) —Does the approach clearly address healthcare needs, current issues, approaches to improve patient safety ( e.g., patient family engagement), changes in HIPAA laws and healthcare settings, and/or emerging trends ( e.g., artificial intelligence in healthcare, telemedicine)?. Assessment Criteria for Phase 2 TeamSTEPPS Video Product Compliance (pass/fail) —Does the completed Phase 2 video meet the compliance standards?. Approach (30 pts) —Does the production clearly follow the approach in the proposal?. Is the message consistent with the proposal?.

Does the production clearly communicate the content/theme?. Is it focused on the topic and organized?. Is it captivating and edifying?. Content (30 pts) —Is it appropriate for healthcare?. Does it address diversity, equity, and inclusion?.

Is it tailored to diverse audiences from cultural, technological, and healthcare setting perspectives?. Creativity (20 pts) —How creatively does the new product convey the message?. Is it innovative?. Is it well designed?. Quality (20 pts) —How is the quality of the production?.

Is the lighting, sound, editing, and contrast appropriate?. Is the dialogue clear and easy to understand?. Is it visually appealing and effective?. Is the captioning accurate?. Eligibility Rules for Participating in the Challenge To be eligible under this Challenge, an individual (whether participating singly or in a group) or entity.

1. Shall have registered ( Challenge.gov ) to participate in the Challenge. 2. Shall have complied with the rules set forth in this announcement for participation in this Challenge. 3.

Shall be incorporated and maintain a primary place of business in the United States (in the case of a private entity), and in the case of an individual, whether participating singly or in a group, shall be a citizen or permanent resident of the United States. 4. May not be a Federal entity or Federal employee acting within the scope of their employment. (All Federal employees should consult with their agency Ethics Official to determine whether the federal ethics rules will limit or prohibit the acceptance of a prize). 5.

May not be an employee of AHRQ or any other company, organization, or individual involved with the design, production, execution, judging, or distribution of the Challenge, or their immediate family (spouse, parents and step-parents, siblings and step-siblings, and children and step-children), or household members (people who share the same residence at least 3 months out of the year). 6. May not use Federal funds from a grant to develop Challenge applications unless consistent with the purpose of the grant award. 7. May not use Federal funds from a contract to develop Challenge applications or to fund efforts in support of a Challenge submission.

8. Shall not be deemed ineligible because the individual or entity used Federal facilities or consulted with Federal employees during a competition if the facilities and employees are made equitably available to all individuals and entities participating in the competition. 9. Shall not be required to purchase liability insurance as a condition of participation in this competition. Additional Rules of Participation By participating in this Challenge, each individual (whether participating singly or in a group) or entity.

1. Agrees to follow all applicable Federal, State, and local laws, regulations, and policies. 2. Agrees to comply with all terms and conditions of participation in this Challenge. 3.

Agrees that the submission will not use HHS or AHRQ logos or official seals, except as required by AHRQ. Videos submitted in response to this announcement must contain AHRQ/HHS branding as provided by AHRQ during the technical assistance session. Notwithstanding this authorized use of AHRQ/HHS branding, participants will not claim endorsement by AHRQ/HHS. 4. Videos must not contain branding of submitting organization, group, or individual.

This includes logos, wording, or other designs on posters, signs, clothing, equipment, or any other objects that can be seen in the video. 5. Understands that all materials submitted to AHRQ as part of a submission become AHRQ records. Any confidential commercial or financial information contained in a submission must be clearly designated as such at the time of submission. 6.

Submitters of winning videos may announce their status and may link to the final video posted on the AHRQ website, as well as share promotional materials and social media posts created by AHRQ/HHS about the competition and winning videos. However, except as a link to AHRQ, winners may not post the final video, or any draft version or any portion of the video, on their own website or through social media platforms. 7. Agrees that the submission must not infringe upon copyright or any other rights of any third party. 8.

Agrees to assume any and all risks and waive claims against the Federal Government and its related entities, except in the case of willful misconduct, for any injury, death, damage, or loss of property, revenue, or profits, whether direct, indirect, or consequential, arising from participation in this prize contest, whether the injury, death, damage, or loss arises through negligence or otherwise. 9. Agrees to indemnify the Federal Government against third-party claims for damages arising from or related to Challenge activities. 10. Phase 2 video submitters understand that circulation of winning videos could be worldwide, and that the Federal Government will not compensate the submitters for this use.

Winners shall receive a one-time cash prize as set forth in this announcement. 11. Understands that AHRQ reserves the right to cancel, suspend, and/or modify this prize contest, or any part of it, for any reason, at AHRQ's sole discretion. AHRQ also reserves the right not to award any prizes if no entries are deemed worthy. 12.

Understands that AHRQ will not select a winner that is named on the Excluded Parties List System (EPLS). Intellectual Property (IP) Rights To be eligible to win this Challenge, a submission must meet the following requirements. 1. Each participant retains title and full ownership in and to their submission. Participants expressly reserve all intellectual property rights not expressly granted.

2. By participating in the Challenge, each participant (whether participating singly or in a group) acknowledges that he or she is the sole author or owner of, or has a right to use, any copyrightable works that the submission comprises, that the works are wholly original with Start Printed Page 25023 the participant (or is an improved version of an existing work that the participant has sufficient rights to use and improve), and that the submission does not infringe any copyright or any other rights of any third party of which participant is aware. In addition, each participant (whether participating singly or in a group) grants to the U.S. Government a paid-up, nonexclusive, royalty-free, irrevocable worldwide license in perpetuity and the right to reproduce, publish, post, link to, share, display publicly (on the web or elsewhere) and prepare derivative works, including the right to authorize others to do so on behalf of the U.S. Government.

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As I write this editorial, it is almost 14 months since I first developed erectile dysfunction treatment symptoms and my journey kamagra quick with long erectile dysfunction treatment continues. In their guideline on long erectile dysfunction treatment NICE/SIGN define post-erectile dysfunction treatment syndrome as signs and symptoms that develop during or after a erectile dysfunction treatment , continuing for more than 12 weeks, and not explained kamagra quick by an alternative diagnosis. More information about long erectile dysfunction treatment can be found in the blog written by @jakesuett and me in September 2020. Data from kamagra quick the Office for National Statistics in April 2021 estimated that 1.1 million people in the UK reported experiencing some form of long erectile dysfunction treatment symptoms.

Despite this, the UK Government continues to focus on the outcomes of erectile dysfunction treatment being binary. Dying or surviving kamagra quick. Box 1 provides details about some useful sources of information on long erectile dysfunction treatment.Box 1 Useful sources of information about long erectile dysfunction treatmentNICE/SIGN rapid guideline published in December 2020.The NIHR review of evidence. Living with erectile dysfunction treatment—second Review (March 2021).Paper in nature in April 2021 provides a summary of how post acute erectile dysfunction treatment (long erectile dysfunction treatment) can affect different organ systems.Paper published in March 2021 describing the range of signs and symptoms experienced by people with long erectile dysfunction treatment via a kamagra quick social media survey.Everyone’s long erectile dysfunction treatment journey is different.

Recovery is not linear with many relapses along the way. Fourteen months kamagra quick on, I am better than I was but still not fit enough to return to work and need to be careful not to do too much. My ongoing symptoms include:Breathlessness—e.g. After having a shower or walking short distances.Brain fog—unable to read for more than 15–20 kamagra quick min or concentrate on anything for more than 30 min.Headache.Fatigue.Poor temperature control and hot flushes.Deterioration in my eyesight—potentially due to steroids.Tingling in faceSwollen glands.Nausea.I am one of the lucky ones—I was reviewed at a (virtual) long erectile dysfunction treatment clinic in February 2021.

As suggested by the NICE/SIGN guidelines, I had some tests ordered to rule out any organic causes for my symptoms. The blood tests kamagra quick showed that I had developed type 2 diabetes. A brain MRI indicated I have had a stroke at some point.Nowadays, there is an expectation that most illnesses can be cured. This makes kamagra quick it more difficult when there are no answers.

As a patient group we struggled, and in many cases, are still struggling, to get access to the tests we kamagra quick needed which exacerbated this situation. This is perhaps not surprising in the middle of a kamagra. I always felt slightly uncomfortable fighting for access to kamagra quick tests when I knew the NHS was at crisis point but as a registered nurse had some knowledge as to where to turn for help. This was particularly helpful when I was rung with the results of my tests following my long erectile dysfunction treatment clinic appointment.

Having been told I had developed type 2 diabetes, the advice was to ‘go on a low sugar diet’ and have my kamagra quick bloods tested again in a few months. However, I was able to reach out to friends for advice as well as referring myself to the diabetes nurse at my GP practice. I am now on a low carb diet and have been prescribed kamagra quick metformin that would not have happened if I had just followed the initial advice. Getting advice about my stroke has not been so easy.

Over 6 weeks down the line, I am still awaiting my referral kamagra quick to the stroke clinic.On an intellectual level, as someone who has spent much of their nursing career promoting evidence-based practice, it has been interesting having a new disease and observing as information about potential treatments emerge. People within the long erectile dysfunction treatment community were willing to try almost anything in an attempt to get better. A scene from the recent TV series It’s a sin struck a chord—someone who thought they had AIDS/HIV in the mid 1980s ringing a hotline and asking whether a list of potential cures, including drinking bleach, would cure him.As a registered nurse and editor of Evidence Based Nursing, I kamagra quick found it challenging when other people with long erectile dysfunction treatment appeared to me to be ‘grasping at straws’ and trying any treatment that was available despite a lack of evidence to support it. I understand this is a reaction to the lack of available treatments as well as many people being told by the medical profession their symptoms were ‘all in their head’.

But, on occasion, it made it kamagra quick difficult being part of these groups. Going forward, we need robust research to identify treatments for long erectile dysfunction treatment. An international multistakeholder forum has kamagra quick recently produced a list of research priorities for long erectile dysfunction treatment. Governments are beginning to allocate money for research into long erectile dysfunction treatment—for example, in the USA, the NIH has put US$1.15 billion aside.

These are definitely steps in the right direction but more needs to be done worldwide to care for those of us with Long erectile dysfunction treatment.Ethics statementsPatient consent for publicationNot required.Using interpretative phenomenological analysis to explore multiperspectivesInterpretative phenomenological analysis (IPA) was originally developed in 1995 by Johnathan Smith as a method to undertake experiential research in psychology and has gained prominence across health and social sciences as a way to understand and interpret topics that are complex and emotionally laden, kamagra quick such as chronic illness experiences.1 2 IPA aims to uncover what a lived experience means to the individual through a process of in-depth reflective inquiry.3 The IPA draws on phenomenological thinking, with the purpose to return ‘to the things themselves’3 (p168). However, IPA also acknowledges that we are kamagra quick each influenced by the worlds in which we live and the experiences we encounter. Therefore, IPA is an interpretative process between the researcher and researched, influenced predominantly by Heidegger’s interpretive phenomenology, hermeneutics and idiography. Within IPA, it is typical for researchers to select a kamagra quick small homogenous sample to explore the shared perspectives on a single phenomenon of interest4.

Within IPA studies, the focus has been on individual people living within diverse settings and populations such as chronic or long-term illnesses. The focus is on understandings of rich, lived experiences, and, given the small samples, IPA studies have kamagra quick typically not focused on those connected to the person living with diversity or disease. Recently, there has been an interest within IPA to suggest the value of capturing more complex data through multiple perspectives using designs and processes to address this shortcoming in IPA.4 This may involve the use of multiple participants and a range of data collection methods such as the use of dyads or focus groups. The aim of this paper is to explore the utility of IPA approaches using multiperspectives through focusing on a specific case study to illustrate this approach.Case studyThis case study focuses on an IPA study that focused on the lived experiences of adolescents and kamagra quick young adults (AYA) and their family/significant other living with malignant melanoma (MM).

Families and other people important to the experience can provide a logical and insightful perspectives on a shared psychosocial phenomenon. Multiperspective designs are kamagra quick gaining increasing prominence among researchers who recognise that an experience such as living with a long-term disease ‘is not solely located within the accounts of those with the diagnosis’4 (p182). For the purposes of this case study, the family/significant others were seen as integral to the experience for the AYA living with MM and their journey together in supporting one another through this experience.During the 1970s, melanoma in AYA was rare, but over the intervening decades, there has been a marked increase in the reported incidence of MM in AYA around the globe.5–7 There is a significant amount of biomedical empirical research evidence on melanoma but a dearth of qualitative research around the lived experience for AYA and their family/significant other living with this disease.A purposive sample of young participants, 16–26 years, were identified by the Clinical Nurse Specialists that ensured the participants were experiencing the same phenomenon.8–10 Although the intention was to carry out individual interviews with all the participants following the typical IPA approach, most of the AYA lived at home and the young participants expressed the desire for a shared interview, which was accommodated by the first author. The four individuals (n=4) and three-dyad interviews (n=6) allowed for the shared experience and the phenomena to be captured and understood through data analysis and interpretation.4 Although the use of individual and joint interviews had implications for data collection and analysis—such as the parent wishing to have their voice heard over their child—the researcher had to ensure that questions were also directed kamagra quick to the young participant in order to capture both voices.

In depth, semistructured interviews were undertaken within the AYAs primary treatment centre on the day of the outpatient appointment and they were often accompanied with someone who was significant in their journey. Interviews lasted between 90 and kamagra quick 120 min.This study was novel to the experiences of AYA and family/significant other living with MM, which offers a new perspective on the dynamics that are present within the MM experience. Our findings can be valuable for both an AYA, family/significant other and health and social care professionals. Both AYA and the family/significant other seemed to consider the emotional implications of talking about the kamagra quick disease.

Throughout this process, participants seemed to strive for a shared understanding of the MM experience, a story that unified rather than divided them.Strengths and challengesA social phenomenological perspective demands an emphasis on understanding the participant’s experience of the world from their situation and then interpreting how that understanding is intersubjectively constructed.4 11 In-depth semistructured interviews, therefore, offered an appropriate and compelling method to generate data that permitted such insights and reflections, allowing kamagra quick participants to reconstruct their understandings of a phenomenon3 through narrative. Qualitative researchers are increasingly using ‘oint interviews’ (dyad) to explore the lived experiences in health and capture the multiperspective. However, the decision of whether to interview participants separately or together as a dyad is kamagra quick an important consideration because it influences the nature of the data collected and having two different types of data. Each transcript was analysed separately both for the AYA and then the family/significant other, whether as an individual or dyad.

This was kamagra quick important as the researcher (first author) was not sure whether the findings for the AYA would be different from that of the family/significant other. There also needs to be time built into the study for the data analysis and IPA founders suggest following the IPA methodology, researchers should follow the key steps.3 Analysing the data individually allowed the narrative to ‘open up’ and reveal the experiences of the participant’s as various ‘individual parts’ and then as a ‘whole’.2 3 Throughout the data analysis, the six key steps supported the rigour, transparency and coherence of the findings.Findings of the case studyThis study was organised hierarchically into themes and following the iterative process of analysis, the 'Life interrupted' meta-narrative was identified from all the participant’s lives. €˜Life interrupted’ speaks to the kamagra quick various ways that participants’ lives were interrupted due to the cancer diagnosis, and the journey this disease took them on as well as the unsettling emotions that were experienced during this journey. This is woven into the whole journey experience and figure 1 illustrates the core conceptual thread and the interconnection between AYA and the family/significant other.

The interconnection between the four super-ordinate and the 12 kamagra quick subthemes is also shown. The ebb and flow of familial relationships can, in some situations, magnify the impact of the physical disease, with the emotional turmoil often rivalling the physical manifestation of the disease.8 11 Conversely, relationships may help the AYA and the family/significant other cope with the disease in a more positive and supportive way. The importance of these unique and kamagra quick changing relationships in living with MM should not be underestimated, and psychosocial research about YPs experiences of cancer would be enhanced through the further use and development of the multiperspective approach underpinned by IPA as used in this study, which is able to capture these dynamic inter-relationships. A visual representation is provided within figure 1 and how the individual voices were captured through the individual and dyad interview.Visual multi-perspective IPA design.

IPA, interpretative kamagra quick phenomenological analysis." data-icon-position data-hide-link-title="0">Figure 1 Visual multi-perspective IPA design. IPA, interpretative phenomenological analysis.ConclusionsThis paper presents experiences of life events and processes that are intersubjective and relational. Meaning is ‘in between’ us but is rarely studied that way in phenomenological inquiry.4 The meanings of events and processes are often contested and can sometimes be understood in a more kamagra quick complex manner when viewed from the multiple perspectives involved in the system that constitutes them. Multiple perspective designs can be a useful way for IPA researchers to address research questions that engage with these phenomena.Ethics statementsPatient consent for publicationNot required..

As I write this editorial, it is almost 14 months since I first developed erectile dysfunction treatment symptoms and my journey with long cheap kamagra pills uk erectile dysfunction treatment continues. In their cheap kamagra pills uk guideline on long erectile dysfunction treatment NICE/SIGN define post-erectile dysfunction treatment syndrome as signs and symptoms that develop during or after a erectile dysfunction treatment , continuing for more than 12 weeks, and not explained by an alternative diagnosis. More information about long erectile dysfunction treatment can be found in the blog written by @jakesuett and me in September 2020.

Data from the Office for National Statistics in April 2021 estimated that 1.1 million people in the UK reported experiencing some form of cheap kamagra pills uk long erectile dysfunction treatment symptoms. Despite this, the UK Government continues to focus on the outcomes of erectile dysfunction treatment being binary. Dying or surviving cheap kamagra pills uk.

Box 1 provides details about some useful sources of information on long erectile dysfunction treatment.Box 1 Useful sources of information about long erectile dysfunction treatmentNICE/SIGN rapid guideline published in December 2020.The NIHR review of evidence. Living with erectile dysfunction treatment—second Review (March 2021).Paper in nature in April 2021 provides a summary of cheap kamagra pills uk how post acute erectile dysfunction treatment (long erectile dysfunction treatment) can affect different organ systems.Paper published in March 2021 describing the range of signs and symptoms experienced by people with long erectile dysfunction treatment via a social media survey.Everyone’s long erectile dysfunction treatment journey is different. Recovery is not linear with many relapses along the way.

Fourteen months on, I am cheap kamagra pills uk better than I was but still not fit enough to return to work and need to be careful not to do too much. My ongoing symptoms include:Breathlessness—e.g. After having a shower or walking short distances.Brain fog—unable to read for more than 15–20 min or concentrate on anything for more than 30 min.Headache.Fatigue.Poor temperature control and hot flushes.Deterioration in my eyesight—potentially due to steroids.Tingling in faceSwollen glands.Nausea.I am one of the lucky ones—I was reviewed at cheap kamagra pills uk a (virtual) long erectile dysfunction treatment clinic in February 2021.

As suggested by the NICE/SIGN guidelines, I had some tests ordered to rule out any organic causes for my symptoms. The blood tests cheap kamagra pills uk showed that I had developed type 2 diabetes. A brain MRI indicated I have had a stroke at some point.Nowadays, there is an expectation that most illnesses can be cured.

This makes it more difficult when there are cheap kamagra pills uk no answers. As a patient group we struggled, and in many cases, are still struggling, to get access cheap kamagra pills uk to the tests we needed which exacerbated this situation. This is perhaps not surprising in the middle of a kamagra.

I always felt slightly uncomfortable fighting for access to tests when I knew the NHS was at crisis point but as a registered nurse had some knowledge as to where to turn for help cheap kamagra pills uk. This was particularly helpful when I was rung with the results of my tests following my long erectile dysfunction treatment clinic appointment. Having been told I had developed type 2 cheap kamagra pills uk diabetes, the advice was to ‘go on a low sugar diet’ and have my bloods tested again in a few months.

However, I was able to reach out to friends for advice as well as referring myself to the diabetes nurse at my GP practice. I am now on a low carb diet and have been prescribed metformin that would not have happened if I had just followed cheap kamagra pills uk the initial advice. Getting advice about my stroke has not been so easy.

Over 6 weeks down the cheap kamagra pills uk line, I am still awaiting my referral to the stroke clinic.On an intellectual level, as someone who has spent much of their nursing career promoting evidence-based practice, it has been interesting having a new disease and observing as information about potential treatments emerge. People within the long erectile dysfunction treatment community were willing to try almost anything in an attempt to get better. A scene from the recent TV series It’s a sin struck a chord—someone who thought they had AIDS/HIV in the mid 1980s ringing a cheap kamagra pills uk hotline and asking whether a list of potential cures, including drinking bleach, would cure him.As a registered nurse and editor of Evidence Based Nursing, I found it challenging when other people with long erectile dysfunction treatment appeared to me to be ‘grasping at straws’ and trying any treatment that was available despite a lack of evidence to support it.

I understand this is a reaction to the lack of available treatments as well as many people being told by the medical profession their symptoms were ‘all in their head’. But, on occasion, it made it difficult being part of these groups cheap kamagra pills uk. Going forward, we need robust research to identify treatments for long erectile dysfunction treatment.

An international multistakeholder forum cheap kamagra pills uk has recently produced a list of research priorities for long erectile dysfunction treatment. Governments are beginning to allocate money for research into long erectile dysfunction treatment—for example, in the USA, the NIH has put US$1.15 billion aside. These are definitely steps in the right direction but more needs to be done worldwide to care for those of cheap kamagra pills uk us with Long erectile dysfunction treatment.Ethics statementsPatient consent for publicationNot required.Using interpretative phenomenological analysis to explore multiperspectivesInterpretative phenomenological analysis (IPA) was originally developed in 1995 by Johnathan Smith as a method to undertake experiential research in psychology and has gained prominence across health and social sciences as a way to understand and interpret topics that are complex and emotionally laden, such as chronic illness experiences.1 2 IPA aims to uncover what a lived experience means to the individual through a process of in-depth reflective inquiry.3 The IPA draws on phenomenological thinking, with the purpose to return ‘to the things themselves’3 (p168).

However, IPA cheap kamagra pills uk also acknowledges that we are each influenced by the worlds in which we live and the experiences we encounter. Therefore, IPA is an interpretative process between the researcher and researched, influenced predominantly by Heidegger’s interpretive phenomenology, hermeneutics and idiography. Within IPA, it is typical for researchers to cheap kamagra pills uk select a small homogenous sample to explore the shared perspectives on a single phenomenon of interest4.

Within IPA studies, the focus has been on individual people living within diverse settings and populations such as chronic or long-term illnesses. The focus is on understandings of rich, lived experiences, and, given the small samples, IPA studies have typically not focused on those connected to the person living with diversity cheap kamagra pills uk or disease. Recently, there has been an interest within IPA to suggest the value of capturing more complex data through multiple perspectives using designs and processes to address this shortcoming in IPA.4 This may involve the use of multiple participants and a range of data collection methods such as the use of dyads or focus groups.

The aim of this paper is to explore the utility of IPA approaches using multiperspectives through focusing on a specific case study to illustrate this approach.Case studyThis case study focuses on an IPA study that focused cheap kamagra pills uk on the lived experiences of adolescents and young adults (AYA) and their family/significant other living with malignant melanoma (MM). Families and other people important to the experience can provide a logical and insightful perspectives on a shared psychosocial phenomenon. Multiperspective designs are gaining increasing prominence among researchers who recognise that an experience such as cheap kamagra pills uk living with a long-term disease ‘is not solely located within the accounts of those with the diagnosis’4 (p182).

For the purposes of this case study, the family/significant others were seen as integral to the experience for the AYA living with MM and their journey together in supporting one another through this experience.During the 1970s, melanoma in AYA was rare, but over the intervening decades, there has been a marked increase in the reported incidence of MM in AYA around the globe.5–7 There is a significant amount of biomedical empirical research evidence on melanoma but a dearth of qualitative research around the lived experience for AYA and their family/significant other living with this disease.A purposive sample of young participants, 16–26 years, were identified by the Clinical Nurse Specialists that ensured the participants were experiencing the same phenomenon.8–10 Although the intention was to carry out individual interviews with all the participants following the typical IPA approach, most of the AYA lived at home and the young participants expressed the desire for a shared interview, which was accommodated by the first author. The four individuals (n=4) and three-dyad interviews (n=6) allowed for the shared experience and the phenomena to be captured and understood through data analysis and interpretation.4 Although the use of individual and joint interviews had implications for data collection and analysis—such as the parent wishing to have their voice heard over their child—the researcher had to ensure cheap kamagra pills uk that questions were also directed to the young participant in order to capture both voices. In depth, semistructured interviews were undertaken within the AYAs primary treatment centre on the day of the outpatient appointment and they were often accompanied with someone who was significant in their journey.

Interviews lasted between 90 and 120 min.This study was novel to the experiences of AYA and family/significant other living with MM, which offers a new perspective on the dynamics that are cheap kamagra pills uk present within the MM experience. Our findings can be valuable for both an AYA, family/significant other and health and social care professionals. Both AYA and the family/significant other seemed to consider the emotional implications cheap kamagra pills uk of talking about the disease.

Throughout this process, participants seemed to strive for a shared understanding of the MM experience, a story that unified rather than divided them.Strengths and challengesA social phenomenological perspective demands an emphasis on understanding the participant’s experience of the world from their situation and then interpreting how that understanding is intersubjectively constructed.4 11 In-depth semistructured interviews, therefore, offered an appropriate and compelling method to generate data that cheap kamagra pills uk permitted such insights and reflections, allowing participants to reconstruct their understandings of a phenomenon3 through narrative. Qualitative researchers are increasingly using ‘oint interviews’ (dyad) to explore the lived experiences in health and capture the multiperspective. However, the decision of whether to interview participants separately or together as a dyad is an important consideration because it influences the nature of cheap kamagra pills uk the data collected and having two different types of data.

Each transcript was analysed separately both for the AYA and then the family/significant other, whether as an individual or dyad. This was important as the researcher (first author) was not sure whether the findings for the AYA would be different from that cheap kamagra pills uk of the family/significant other. There also needs to be time built into the study for the data analysis and IPA founders suggest following the IPA methodology, researchers should follow the key steps.3 Analysing the data individually allowed the narrative to ‘open up’ and reveal the experiences of the participant’s as various ‘individual parts’ and then as a ‘whole’.2 3 Throughout the data analysis, the six key steps supported the rigour, transparency and coherence of the findings.Findings of the case studyThis study was organised hierarchically into themes and following the iterative process of analysis, the 'Life interrupted' meta-narrative was identified from all the participant’s lives.

€˜Life interrupted’ speaks to the cheap kamagra pills uk various ways that participants’ lives were interrupted due to the cancer diagnosis, and the journey this disease took them on as well as the unsettling emotions that were experienced during this journey. This is woven into the whole journey experience and figure 1 illustrates the core conceptual thread and the interconnection between AYA and the family/significant other. The interconnection between the four super-ordinate cheap kamagra pills uk and the 12 subthemes is also shown.

The ebb and flow of familial relationships can, in some situations, magnify the impact of the physical disease, with the emotional turmoil often rivalling the physical manifestation of the disease.8 11 Conversely, relationships may help the AYA and the family/significant other cope with the disease in a more positive and supportive way. The importance of these unique and cheap kamagra pills uk changing relationships in living with MM should not be underestimated, and psychosocial research about YPs experiences of cancer would be enhanced through the further use and development of the multiperspective approach underpinned by IPA as used in this study, which is able to capture these dynamic inter-relationships. A visual representation is provided within figure 1 and how the individual voices were captured through the individual and dyad interview.Visual multi-perspective IPA design.

IPA, interpretative phenomenological analysis." data-icon-position data-hide-link-title="0">Figure cheap kamagra pills uk 1 Visual multi-perspective IPA design. IPA, interpretative phenomenological analysis.ConclusionsThis paper presents experiences of life events and processes that are intersubjective and relational. Meaning is ‘in between’ us but is cheap kamagra pills uk rarely studied that way in phenomenological inquiry.4 The meanings of events and processes are often contested and can sometimes be understood in a more complex manner when viewed from the multiple perspectives involved in the system that constitutes them.

Multiple perspective designs can be a useful way for IPA researchers to address research questions that engage with these phenomena.Ethics statementsPatient consent for publicationNot required..

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Mathematica is kamagra 100mg price in canada committed to advancing public health by applying our expertise across disciplines that constitute some of the most critical areas of public health today. The following focus areas highlight how we’re working to progress together to improve public well-being.APHA Public Health Film Festival. Helping Families Affected by Substance UseThe APHA selected a short film that Mathematica produced with support from the Administration for Children and Families to show at the APHA Public Health Film Festival kamagra 100mg price in canada. The film focuses on how the Regional Partnership Grant program improves the safety, permanency, and well-being of children affected by parent’s substance use disorders.

Starting October 19, registered APHA Annual Meeting attendees can watch the film on demand. Registered attendees can also submit questions to Debra Strong a senior researcher for the Regional Partnership Grant National Cross-Site Evaluation, kamagra 100mg price in canada using a discussion board that will be available with the film. Please visit APHA’s page about public health films focusing on substance use and addiction treatment for more information. Diversity, Equity, and InclusionWhat does it take for organizations to progress together?.

It takes a common purpose, shared values, a complementary array of resources and capabilities, kamagra 100mg price in canada and a mutual desire to learn from and with each other. Our ongoing diversity, equity, and inclusion journey is driving necessary changes in who we are. How we relate to each other, our partners, and kamagra 100mg price in canada our communities. And how we approach our work.

Social Determinants of HealthPolicymakers and practitioners are increasingly interested in social determinants of health—the conditions in which people are born, grow, live, work, and age—to address upstream social risks, such as food insecurity and lack of affordable housing, that, in turn, improve health care outcomes. Mathematica data and policy experts recently produced a series of blog posts and research on how different stakeholders can improve and leverage data on social determinants of health to maximize the health and well-being of children and adults in the United States.erectile dysfunction treatment ServicesResponding to the current kamagra 100mg price in canada public health crisis and illuminating the path forward to safely re-open businesses, schools, workplaces, and community services requires a seasoned partner with trusted solutions. Built on our foundation of rigorous data and evidence, Mathematica’s scalable services provide state and local agencies, as well as private-sector employers, with the confidence and clarity they need to take on the complex challenges of erectile dysfunction treatment. Some of our services include contact tracing, workforce planning, modeling and forecasting, and wastewater testing and analysis.Data Analytics and Survey ExpertiseAt Mathematica, we apply our expertise at the intersection of data science and social science to produce efficient, high quality, and action-oriented analysis that advances your mission.Using advanced technologies, reusable and scalable platforms, and high-performance secure cloud infrastructure, we enable our partners to target areas of opportunity and make the most of their data.

We collect the data you need, manage data as a secure asset, analyze to surface insights, and place this knowledge in the hands of those who need it most.Mental Health and Substance UseMathematica understands the pressing challenges faced by our partners working to improve the delivery system, innovative value-based service models, and financing strategies kamagra 100mg price in canada that states and payers are testing—strategies that could improve the prevention and treatment of behavioral health conditions. We’re leading efforts to address the opioid crisis, increase access to care while controlling costs, and support the integration of behavioral health services with other health care and social services.Our staff have in-depth knowledge of the complex array of intersecting public and private programs and eligibility requirements that create challenges for consumers to get the help they need. Our work involves evaluating a wide range of behavioral health kamagra 100mg price in canada service delivery and payment models, helping partners establish programs that implement new services and policies and fill data gaps, fielding large-scale behavioral health surveys, developing and implementing behavioral health quality measures, and analyzing policy to guide decision making. For more than two decades, we’ve conducted national surveys of every known mental health and substance use disorder treatment facility in the country.

Our analyses of T-MSIS data for the Centers for Medicare &. Medicaid Services provide critical information on patterns of substance use disorders and treatment across states kamagra 100mg price in canada as evidenced by the T-MSIS Substance Use Disorder (SUD) Data Book and a series of supporting data quality briefs.Publisher. Regional Educational Laboratory Mid‑Atlantic Oct 13, 2020 Authors Regional Educational Laboratory Mid‑Atlantic Teacher turnover is a widespread issue. High turnover rates may be costly to the district, disrupt operations, and lower student achievement.

Project Mathematica Leads the Regional Educational Laboratory (REL) kamagra 100mg price in canada for the Mid-Atlantic Region Funders U.S. Department of Education, National Center for Education Evaluation U.S. Department of Education, Institute of Education Sciences Time Frame 2017-2022.

Mathematica is committed to advancing public health by applying our expertise across disciplines that cheap kamagra pills uk constitute some of the most critical areas http://scaeyc.net/public-policy-committee-newsletter-and-resources/ of public health today. The following focus areas highlight how we’re working to progress together to improve public well-being.APHA Public Health Film Festival. Helping Families Affected by Substance UseThe APHA selected a short film that Mathematica produced with support from the Administration for Children and Families to show at the APHA Public Health Film cheap kamagra pills uk Festival. The film focuses on how the Regional Partnership Grant program improves the safety, permanency, and well-being of children affected by parent’s substance use disorders.

Starting October 19, registered APHA Annual Meeting attendees can watch the film on demand. Registered attendees can also submit questions to Debra cheap kamagra pills uk Strong a senior researcher for the Regional Partnership Grant National Cross-Site Evaluation, using a discussion board that will be available with the film. Please visit APHA’s page about public health films focusing on substance use and addiction treatment for more information. Diversity, Equity, and InclusionWhat does it take for organizations to progress together?.

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We collect the data you need, manage data as a secure asset, analyze to surface insights, and place this knowledge in the hands of those who need it most.Mental Health and Substance UseMathematica understands the pressing challenges faced by our partners working to improve the delivery system, innovative value-based service models, and financing strategies that states and payers are testing—strategies cheap kamagra pills uk that could improve the prevention and treatment of behavioral health conditions. We’re leading efforts to address the opioid crisis, increase access to care while controlling costs, and support the integration of behavioral health services with other health care and social services.Our staff have in-depth knowledge of the complex array of intersecting public and private programs and eligibility requirements that create challenges for consumers to get the help they need. Our work involves evaluating a wide range of behavioral health service delivery and payment models, helping partners establish programs that implement new services and policies and fill data gaps, fielding large-scale behavioral health surveys, developing and implementing behavioral health quality measures, and analyzing policy cheap kamagra pills uk to guide decision making. For more than two decades, we’ve conducted national surveys of every known mental health and substance use disorder treatment facility in the country.

Our analyses of T-MSIS data for the Centers for Medicare &. Medicaid Services provide critical information on patterns of substance use disorders and treatment across states as cheap kamagra pills uk evidenced by the T-MSIS Substance Use Disorder (SUD) Data Book and a series of supporting data quality briefs.Publisher. Regional Educational Laboratory Mid‑Atlantic Oct 13, 2020 Authors Regional Educational Laboratory Mid‑Atlantic Teacher turnover is a widespread issue. High turnover rates may be costly to the district, disrupt operations, and lower student achievement.

Project Mathematica Leads the Regional Educational cheap kamagra pills uk Laboratory (REL) for the Mid-Atlantic Region Funders U.S. Department of Education, National Center for Education Evaluation U.S. Department of Education, Institute of Education Sciences Time Frame 2017-2022.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NCHS Data Brief cheap kamagra pills uk No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with an increased risk for cheap kamagra pills uk chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cheap kamagra pills uk cessation of menstruation that occurs after the loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this cheap kamagra pills uk analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour cheap kamagra pills uk period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 cheap kamagra pills uk. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant cheap kamagra pills uk quadratic trend by menopausal status (p <.

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

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

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p < cheap kamagra pills uk. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 cheap kamagra pills uk year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure cheap kamagra pills uk 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure cheap kamagra pills uk 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 cheap kamagra pills uk. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image cheap kamagra pills uk icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 cheap kamagra pills uk year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf icon.SOURCE cheap kamagra pills uk. NCHS, National Health Interview Survey, 2015.

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

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

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

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.