Use of Health Care Services
Most older Americans have health insurance through Medicare. Medicare covers a variety of services, including inpatient hospital care, physician services, hospital outpatient care, home health care, skilled nursing facility care, hospice services, and (beginning in January 2006) prescription drugs. Utilization rates for many services change over time because of changes in physician practice patterns, medical technology, Medicare payment policies, and patient demographics.
- Between 1992 and 1999, the hospitalization rate increased from 306 hospital stays per 1,000 Medicare enrollees to 365 per 1,000. The rate then decreased to 350 per 1,000 enrollees in 2005. The average length of a hospital stay decreased from 8.4 days in 1992 to 5.7 days in 2005.
- Skilled nursing facility stays increased significantly from 28 per 1,000 Medicare enrollees in 1992 to 79 per 1,000 in 2005. Much of the increase occurred from 1992 to 1997.
- Between 1992 and 2005, the number of physician visits and consultations increased. There were 11,359 visits and consultations per 1,000 Medicare enrollees in 1992, compared with 13,914 in 2005.
- The number of home health care visits per 1,000 Medicare enrollees increased rapidly from 3,822 in 1992 to 8,227 in 1997. Home health care use increased during this period in part because of an expansion in the coverage criteria for the Medicare home health care benefit.40 Home health care visits declined after 1997 to 2,295 per 1,000 enrollees in 2001. The decline coincided with changes in Medicare payment policies for home health care resulting from implementation of the Balanced Budget Act of 1997. The visit rate increased thereafter to 2,770 per 1,000 enrollees in 2005.
- Use of skilled nursing facility and home health care increased markedly with age. In 2005, there were 30 skilled nursing facility stays per 1,000 Medicare enrollees age 65–74, compared with 228 per 1,000 enrollees age 85 or over. Home health agencies made 1,333 visits per 1,000 enrollees age 65–74, compared with 6,549 per 1,000 for those age 85 and over.
Data for this indicator’s charts and bullets can be found in Tables 29a and 29b.
Health Care Expenditures
Older Americans use more health care than any other age group. Health care costs are increasing rapidly at the same time the Baby Boom generation is approaching retirement age.
- After adjusting for inflation, health care costs increased significantly among older Americans from 1992 to 2004. Average costs were substantially higher at older ages.
- Average health care costs varied by demographic characteristics. Average costs among non-Hispanic blacks were $14,989 in 2004, compared with $13,101 among non-Hispanic whites and $11,962 among Hispanics. Low income individuals incurred higher health care costs; those with less than $10,000 in income averaged $16,766 in health care costs, whereas those with more than $30,000 in income averaged only $10,676.
- Costs also varied by health status. Individuals with no chronic conditions incurred $4,718 in health care costs on average. Those with five or more conditions incurred $20,334. Average costs among residents of long-term care facilities were $52,958, compared with only $10,448 among community residents.
- Access to health care is determined by a variety of factors related to the cost, quality, and availability of health care services. The percentage of older Americans who reported they delayed getting care because of cost declined from 9.8 percent in 1992 to about 5 percent in 1997 and remained relatively constant thereafter. The percentage who reported difficulty obtaining care varied between 2 percent and 3 percent.
Health care costs can be broken down into different types of goods and services. The amount of money older Americans spend on health care and the type of health care that they receive provide an indication of the health status and needs of older Americans in different age and income groups.
- Hospital and physician services are the largest components of health care costs. Long-term care facilities accounted for 14 percent of total costs in 2004. Prescription drugs accounted for 15 percent of health care costs.
- The mix of health care services changed between 1992 and 2004. Inpatient hospital care accounted for a lower share of costs in 2004 (25 percent compared to 32 percent in 1992). Prescription drugs increased in importance from 8 percent of costs in 1992 to 15 percent in 2004. “Other” costs (short term institutions, hospice and dental care) also increased as a percentage of all costs (4 percent to 8 percent).
- The mix of services varied with age. The biggest difference occurred for long-term care facility services; average costs were $7,057 among people age 85 and over, compared with just $431 among those age 65–74. Costs of home health care and “other” services also were higher at older ages. Costs of physician/outpatient services and prescription drugs did not show a strong pattern by age.
Data for this indicator’s charts and bullets can be found in Tables 30a, 30b, 30c, 30d, and 30e.
Prescription drug costs have increased rapidly in recent years, as more new drugs become available. Lack of prescription drug coverage has created a financial hardship for many older Americans. Medicare coverage of prescription drugs began in January 2006, including a low income subsidy for beneficiaries with low incomes and assets.
- Average prescription drug costs for older Americans have increased rapidly in recent years. Average costs per person were $2,107 in 2004.
- Average out-of-pocket costs also increased, though not as rapidly as total costs because private and public insurance covered more of the cost over time. Older Americans paid 60 percent of prescription drug costs out of pocket in 1992, compared with 36 percent in 2004. Private insurance covered 38 percent of prescription drug costs in 2004; public programs covered 25 percent.
- Costs varied significantly among individuals. Approximately 8 percent of older Americans incurred no prescription drug costs in 2004. About 24 percent incurred $2,500 or more in prescription drug costs that year.
The purpose of this indicator is to provide a count of Medicare enrollees age 65 and over receiving drug coverage through Part D or in plans of former employers subsidized by Part D. Under Medicare Part D, beneficiaries may join a stand alone prescription drug plan or a Medicare Advantage plan that provides prescription drug coverage in addition to other Medicare-covered services. In situations where beneficiaries receive drug coverage from a former employer, the former employer may be eligible to receive a retiree drug subsidy from Medicare to help cover the cost of the drug benefit.
- The number of Medicare beneficiaries enrolled in Part D prescription drug plans increased from 18.2 million in June 2006 to 19.7 million in September 2007. In September 2007, two-thirds of enrollees were in stand-alone plans and one-third were in Medicare Advantage plans. In addition, approximately 6.5 million beneficiaries were covered by the Retiree Drug Subsidy in both years. Beneficiaries who were not in Part D plans and not covered by the Retiree Drug Subsidy either had drug coverage through another source (e.g., Tricare, Federal Employees Health Benefits plan, Department of Veterans Affairs, or current employer) or did not have drug coverage.
- In September 2007, 5.9 million Part D enrollees were receiving low income sub-sidies. Many of these beneficiaries had drug coverage through the Medicaid program prior to enrollment in Part D.
- Chronic conditions are associated with high prescription drug costs. In 2004, older Americans with no chronic conditions incurred average prescription drug costs of $800. Those with five or more chronic conditions incurred $3,862 in prescription drug costs on average.
Data for this indicator’s charts and bullets can be found in Tables 31a, 31b, 31c, and 31d.
Sources of Health Insurance
Nearly all older Americans have Medicare as their primary source of health insurance coverage. Medicare covers mostly acute care services and requires beneficiaries to pay part of the cost, leaving about one-half of health spending to be covered by other sources. Many beneficiaries have supplemental insurance to fill these gaps and pay for services not covered by Medicare. Since January 2006, beneficiaries have had the option of receiving prescription drug coverage through stand-alone prescription drug plans or through some Medicare Advantage health plans.
- Most Medicare enrollees have a private insur-ance supplement, approximately equally split between employer sponsored and Medigap policies. The percentage with Medicaid cover-age has increased slightly over the last several years to about 12 percent in 2005. Enrollment in Medicare HMOs and similar health plans, which are usually equivalent to Medicare supplements because they offer extra benefits, varied between 6 percent and 21 percent. About 12 percent of Medicare enrollees report having no health insurance supplement.
- Enrollment in HMOs and similar health plans increased rapidly throughout the 1990s, then decreased beginning in 2000 as many HMOs withdrew from the Medicare program. The percent with Medigap policies decreased in the late 1990s as HMO enrollment increased. There was a slight increase in the percentage of Medicare enrollees without a supplement in 2002.
Data for this indicator’s chart and bullets can be found in Tables 32a and 32b.
Out-of-Pocket Health Care Expenditures
Large out-of-pocket expenditures for health care service use have been shown to encumber access to care, affect health status and quality of life, and leave insufficient resources for other necessities.41,42 The percentage of household income that is allocated to health care expenditures is a measure of health care expense burden placed on older people.
- The percentage of people age 65 and over with out-of-pocket spending for health care services increased between 1977 and 2004 (83 percent to 96 percent, respectively).
- From 1977 to 2004, the percentage of household income that people age 65 and over allocated to out-of-pocket spending for health care services increased among those in the poor/near poor income category (from 12 percent to 29 percent). Increases were also observed for those in poor or fair health, most notably among those age 85 and over (from 9 percent to 18 percent).
- In 2004, as in the 4 previous years, over one-half of out-of-pocket health care spending by people age 65 and over was used to purchase prescription drugs (from 54 percent in 2000 to 61 percent in 2004).
- In 2004, people age 85 and over were less likely than people age 65–74 to spend out-of-pocket dollars on dental services or ofﬁce-based medical provider visits but more likely to spend out-of-pocket dollars on other health care (e.g., home health care and eyeglasses).
Data for this indicator’s chart and bullets can be found in Tables 33a, 33b, and 33c.
Sources of Payment for Health Care Services
Medicare covers about one-half of the health care costs of Medicare enrollees age 65 and over. Medicare’s payments are focused on acute care services such as hospitals and physicians. Nursing home care, prescription drugs, and dental care have been primarily financed out-of-pocket or by other payers. Medicare coverage of prescription drugs began in January 2006, including a low income subsidy.
- Medicare paid for slightly more than one-half (53 percent) of the health care costs of Medicare enrollees age 65 and over in 2004. Medicare finances most of their hospital and physician costs, as well as a majority of short term institutional, home health, and hospice costs.
- Medicaid covered 9 percent of health care costs of Medicare enrollees age 65 and over, and other payers (primarily private insurers) covered another 19 percent. Medicare enrollees age 65 and over paid 19 percent of their health care costs out-of-pocket, not including insurance premiums.
- In 2004, 48 percent of long-term care facility costs for Medicare enrollees age 65 and over were covered by Medicaid; another 45 percent of these costs were paid out-of-pocket. Fifty-five percent of prescription drug costs were covered by third party payers other than Medicare and Medicaid, consisting mostly of private insurers. Thirty-two percent of prescription drug costs were paid out-of-pocket. Seventy-six percent of dental care received by older Americans was paid out-of- pocket.
- Sources of payment for health care vary by income. Lower income individuals rely heavily on Medicaid; those with higher incomes rely more on private insurance. Lower income individuals pay a lower percent of health care costs out-of-pocket, but have a higher average cost for services than individuals with higher incomes.
Data for this indicator’s chart and bullets can be found in Tables 34a and 34b
Veterans Health Care
The number of veterans age 65 and over who receive health care from the Veterans Health Administration (VHA) within the Department of Veterans Affairs has been steadily increasing. This increase may be because VHA fills important gaps in older veterans’ health care needs not currently covered or fully covered by Medicare, such as mental health services, long-term care (nursing home care and community-based care), and specialized services for the disabled.
- In 2006, approximately 2.4 million veterans age 65 and over received health care from VHA. An additional 1.1 million older veterans were enrolled to receive health care from VHA but did not use its services in 2006.
- Reforms and initiatives implemented by VA since 1996 have led to an increased demand for VHA services among veterans despite the short-term decline in the numbers of older veterans (see “Indicator 6: Older Veterans”). Some of the changes include opening the system to all veterans (1996), implementing enrollment for VHA health care (1999), and enhancing availability of outpatient and community based care.
- An increasing number of older veterans are turning to VHA for their health care needs despite their potential eligibility for other sources of health care, most notably prescription drug coverage through Medicare. VHA estimates that 94 percent of its enrollees age 65 and over are covered by Medicare Part A, 74 percent by Medicare Part B, 51 percent by Medigap, 13 percent by Medicaid, 20 percent by private insurance (excluding Medigap), and 10 percent by TRICARE for Life. About 4 percent have no other public or private coverage.43
Data for this indicator’s chart and bullets can be found in Table 35.
Nursing Home Utilization
Residence in a nursing home is an alternative to long-term care provided in one’s home or in other community settings. Recent declines in rates of nursing home residence may reflect broader changes in the health care system affecting older Americans. Other forms of residential care and services, such as assisted living and home health care, have become more prevalent as rates of nursing home admissions have declined.
- In 2004, 9 people per 1,000 age 65–74 resided in nursing homes, compared with 36 people per 1,000 age 75–84 and 139 people per 1,000 age 85 and over.
- The total rate of nursing home residence among the older population declined between 1985 and 2004. In 1985, the age adjusted nursing home residence rate was 54 people per 1,000 age 65 and over. By 2004 this rate had declined to 35 people per 1,000. Among people age 65–74, rates declined by 24 percent, compared with a 37 percent decline among people age 75–84 and age 85 and over.
- Despite the decline in rates of nursing home residence, the number of nursing home residents age 65 and over had been increasing until recently because of the rapid growth of the older population. Between 1985 and 1999, the number of current nursing home residents age 65 and over increased from 1.3 million to 1.5 million but then declined to 1.3 million in 2004. In 2004, almost three-fourths (980,000) of older nursing home residents were women.
- In 2004, the majority of nursing home residents age 65 and over received assistance with at least one activity of daily living (ADL). Levels of assistance provided for individual ADLs were high, from 94 percent for bathing to 73 percent for transferring. The only ADL for which the majority of residents received no assistance (65 percent) was eating.
- Among the nursing home population, women were more likely than men to require full assistance with daily activities. The percentage of women who were totally dependent in any one of the five activities was higher than that for men. Conversely, men were more likely to receive no assistance with daily activities.
- Older white nursing home residents were less likely than black residents or residents of other races to be dependent in daily activities. For example, nearly one-half of all black and other race residents were dependent in bathing, 46 percent for both, while 37 percent of white residents required total assistance. White residents were more likely to receive some intermediate level of assistance.
Data for this indicator’s charts and bullets can be found in Tables 36a, 36b, and 36c
Some older Americans living in the community have access to various services through their place of residence. Such services may include meal preparation, laundry and cleaning services, and help with medications. Availability of such services through the place of residence may help older Americans maintain their independence and avoid institutionalization.
- In 2005, 2 percent of the Medicare population aged 65 and over resided in community housing with at least one service available. Approximately 5 percent resided in long-term care facilities. The percentage of people residing in community housing with services and in long-term care facilities was higher for the older age groups; among individuals age 85 and over, 7 percent resided in community housing with services, and 17 percent resided in long-term care facilities. Among individuals age 65–74, 98 percent resided in traditional community settings.
- Among residents of community housing with services, 86 percent reported access to meal preparation services, 82 percent reported access to housekeeping/cleaning services, 70 percent reported access to laundry services, and 45 percent reported access to help with medications. These numbers reflect percentages reporting availability of specific services, but not necessarily the number that actually used these services.
- More than one-half (54 percent) of residents in community housing with services reported that there were separate charges for at least some services.
- People living in community housing with services had more functional limitations than traditional community residents, but not as many as those living in long term care facilities. Forty-six percent of individuals living in community housing with services had at least one activity of daily living (ADL) limitation compared with 26 percent of traditional community residents. Among long-term care facility residents, 82 percent had at least one ADL limitation. Forty percent of individuals living in community housing with services had no ADL or instrumental activities of daily living (IADL) limitations.
- The availability of personal services in residential settings may explain some of the observed decline in nursing home use (see “Indicator 36: Nursing Home Utilization”).
- Residents of community housing with services tended to have slightly lower incomes than traditional community residents, but higher incomes than long-term care facility residents. Twenty-two percent of residents of community housing with services had incomes of $10,000 or less in 2005, compared with 15 percent of traditional community residents and 40 percent of long-term care facility residents.
- Over one-half (52 percent) of people living in community housing with services reported they could continue living there if they needed substantial care.
Data for this indicator’s charts and bullets can be found in Tables 37a, 37b, 37c, 37d, and 37e.
Caregiving and Assistive Device Use
Possible reasons for the decline in nursing home rates (see “Indicator 36: Nursing Home Utilization”) include improvements in the health and functioning of the older population, changes in household living arrangements (e.g., the move toward assisted living and other residential care alternatives), and greater use of personal assistance and/or special equipment that help older people living in the community maintain their independence.
- Between 1992 and 2005, the age adjusted proportion of people age 65 and over who had difficulty with one or more ADLs and who did not receive personal assistance or use special equipment with these activities decreased from 42 percent to 35 percent. More people are using equipment only—the percentage increased from 28 percent to 36 percent. The percentage of people who used personal assistance only decreased from 9 percent to 7 percent.
- In 2005, nearly two-thirds (65 percent) of people who had difficulty with one or more ADLs received personal assistance or used special equipment: 7 percent received personal assistance only, 36 percent used equipment only, and 22 percent used both personal assistance and equipment.
- In 2005, more than three-fifths of people age 65 and over who had difficulty with one or more IADLs received personal assistance. The percentage of people receiving personal assistance was higher for people age 85 and over (74 percent) than it was for people age 75–84 (67 percent) or people age 65–74 (63 percent).
- There was no significant change between 1992 and 2005 in the percentage of people (in any age group) who had difficulty with one or more IADLs and who received personal assistance. Men and women were equally likely to receive assistance.
Data for this indicator’s charts and bullets can be found in Tables 38a and 38b.


Molecular Physiology of Pain and Analgesia
Our laboratory is interested in the pathophysiology of chronic pain. The long-term goal is to discover novel analgesics providing effective pain relief without the serious side effects of opiates. The general approach we have taken is to study the molecular and cellular mechanisms that regulate the hyperexcitability of neuronal circuits involved in pain perception. Ion channels are key specialized membrane proteins expressed at the surface of neurons that control their responses and their synaptic communications. Modulation of the function of ion channels (voltage-gated or ligand-gated) is a powerful and efficient way to modulate neuronal excitability and synaptic plasticity in pain pathways. Over the years we have demonstrated the relevance of a number of important ion channels in pain or analgesia: P2X ATP-gated channels, ASIC proton-gated channels, TRPV1 capsaicin-gated channels, Nav1.8 and HCN voltage-gated ion channels (see our publications in PubMed).
Our multisciplinary research projects take advantage of several powerful techniques: molecular biology, histochemistry, pharmacology, electrophysiology, calcium imaging, transgenic models, quantitative behavioral analysis. We are currently focusing our efforts on the interrogation of specific genetically-identified peripheral and central neurons to probe their contribution to the circuits of chronic pain in vivo using optogenetics and chemogenetics.


While choosing a pediatric dentist, you need to be aware of the factors that determine whether or not they are suitable for your child. There are a few things to consider before you choose a dentist – the location of the office, the qualifications of the dentist, the facilities, and the personality of the doctor. You need a dentist who will put your child at ease and make the whole process less stressful. You should also look for someone who is approachable, since a frightened child might be hesitant to visit a dentist.
Oral hygiene is essential for overall wellness. The health of your teeth and gums reveals a lot about your overall health. Unfortunately, most people fear the dentist. If the dentist threatens a visit, they become penitent. To prevent this from happening, you should make it a point to visit your child’s dentist at least twice a year. Make sure that your child visits a dentist that offers high-quality care and is a part of a dental practice in the Belmont area.
In addition to the skills and training needed to treat your child, a pediatric dentist should enjoy working with children. A caring dentist will go above and beyond to build a relationship with your child and create a pleasant dental experience. If you don’t build trust with a pediatric dentist, your child will likely develop dental phobia, and may not seek medical care in their adulthood. It’s important to create a dental home from an early age, because a dental home is essential for a child’s oral health.
A pediatric dentist should have a high level of training in anesthesia. Dr. Cangemi is a Diplomate of the National Dental Board of Anesthesiology and Fellow of the American Dental Society of Anesthesiology. She is a member of the Anesthesia Advisory Committee of the North Carolina Board of Dental Examiners and is a published author in dental journals and publications. She is also certified in Basic Life Support and Pediatric Advanced Life Support.
A good pediatric dentist will be able to assess the development of your child’s teeth. Your child’s primary teeth are necessary for proper jaw development and the proper placement of permanent teeth. The dentist can make many corrections while your child is still young, such as fitting a space maintainer to ensure proper placement of permanent teeth. This will help prevent costly orthodontic work down the road. However, a dentist should never let a child fall asleep with a bottle or a sippy cup.
Comprehensive oral evaluations will include teeth cleaning. A dentist will clean and polish the teeth to remove plaque and tartar and create a smooth surface. A dentist will also apply dental sealants to the teeth, which are BPA-free resins that cover crevices and prevent cavities. This is a low-cost treatment but a proven cavity-prevention solution. When applied correctly, dental sealants will protect your child’s teeth from future problems.
Choosing a pediatric dentist is also important for your child’s health and well-being. A dentist who specializes in pediatric dentistry has the knowledge and skills to provide excellent care to your child. They also use kid-friendly equipment that can be sized specifically for children. If your child is afraid of the dentist, make sure to choose a dentist who understands this concern. A dentist who specializes in pediatric dentistry will be able to show you the proper way to clean your child’s mouth.


Any citizen above the age of 45 years can now get Covid-19 vaccine in India. The entire vaccination drive in India is digitally managed starting from the registration process to getting the vaccinated. Here’s a detailed step-by-step process to register for Covid-19 vaccine online, schedule an appointment and how to download a vaccine certificate.
What you need for registering for Covid-19 vaccination online
There’s no app for Covid-19 vaccine. You would need a PC with working internet or use any internet browser on your mobile like Google Chrome or Safari. You would need a working mobile number and photo ID proof like Aadhaar card, Driving License, etc.
How to register: Visit CoWIN website to register with your mobile phone
You can register for Covid-19 vaccine by logging on “www.cowin.gov.in”’. Enter your mobile number to receive OTP for verification via SMS. Click on the ‘Verify’ button to complete the registration process.
How to confirm vaccine registration on CoWIN website
After registering on the CoWIN website, a new ‘Registration of Vaccination’ page will appear. Enter details like Photo ID type, Photo ID Proof number, name, date of birth, gender and other details. Then click on the Register button. You will receive necessary details regarding vaccination via an SMS. Check the details properly. You will get a Beneficiary Reference ID at the time of registering for the vaccine, save this ID.
You can add 3 more people with the same mobile number for Covid-19 vaccine simultaneously
You can add 3 more people linked to the same account on CoWIN website. To do this, click the ‘Add More’ button at the bottom right side of the Account Details page. You will need to enter similar details for other people to register them for vaccination.
How to find the nearest Covid-19 vaccination centre
On any web browser, visit www.cowin.gov.in. Scroll down and you will see a Map and dialogue box that reads ‘Enter place/address/eLoc’. Enter location details and hit the Go button.
How to schedule an appointment online for Covid-19 vaccine
You can schedule Appointment from the Account Details page on CoWIN website. Click on the Calendar icon placed in front of each registered user or directly click on the Schedule Appointment button. You will get redirected to Book Appointment for Vaccination page. On this page, search the vaccination centre of choice by State, District, Block and Pin code.
Click on Center name and it will show available slots (date and capacity). Then click on the Book button and after that a new ‘Appointment Confirmation’ page will appear. Check all the details properly and click the Confirm button.
After you have got the Covid-19 vaccine, you can download the vaccination certificate online
You can only download the vaccination certificate after you have got the first vaccine shot. The certificate will contain Name, date of birth, Beneficiary Reference ID, Photo ID, vaccine name, hospital name, date and other details. Note that Beneficiary Reference ID is very important for getting the certificate.
Where can you download the Covid-19 vaccination certificate
You can download the vaccination certificate from Co-WIN portal (cowin.gov.in) or the Aarogya Setu app or through Digi-Locker . You may do so by using the mobile number used at the time of registration.
How to download Covid-19 vaccine certificate from Aarogya Setu app
Use the same mobile number on Aarogya Setu app that was used during vaccine registration. Make sure you get the latest version of Aarogya Setu app. Open the app and tap on the Cowin tab. Tap on Vaccination Certificate option. Enter your Beneficiary Reference ID and tap on ‘Get Certificate’ button.
How to download Covid-19 vaccine certificate using CoWin website
Visit ‘https://selfregistration.cowin.gov.in/vaccination-certificate’ website using any web browser. Enter Beneficiary Reference ID and click Search button to download the certificate.


Commercially available microphysiological systems.
Microphysiological Systems (MPS) are in vitro models composed of cells, tissue explants, or stem-cell derived ‘organoid’ formations of human or animal origin. These models provide translational biochemical, electrical, and/or physiomechanical responses to represent organ and tissue function, with great potential to replace some animals used in research.
Below you can explore Microphysiological System Companies offering commercially available advanced in vitro models across a variety of organs as well as enabling technologies. This includes organ-on-a-chip, organoid, and spheroid companies. Individual technology providers may offer products or services, share key publications, and encourage contact and questions via the outreach buttons.
To learn more about a particular organ system, check out our MPS presentation page. So far we’ve hosted presentations on liver, kidney, neuro, blood-brain-barrier, and vascular MPS.


Facts About Multiples
A Few Facts and Figures about Multiple Births
Types of Twins
Basically there are two different types of twins – monozygotic or identical (MZ) and dizygotic, fraternal and non-identical (DZ).
Monozygotic twins develop when a single egg is fertilised by a single sperm and at some stage in the first two weeks the developing embryo splits in two, with the result that two, genetically identical babies develop.
Dizygotic twins occur when two eggs are released at a single ovulation and are fertilised by two different sperm. These two fertilised eggs then implant independently in the uterus. Dizygotic twins share the same type of genetic relationships as non-twin siblings, hence the term fraternal.
MZ or DZ?
Male / female twin pairs, which make up approximately 1/3 of all twins births, are obviously dizygotic. Determining zygosity of same sex pairs can be more problematic. In the past, attending physicians have often diagnosed zygosity at the time of a twin birth based on the number of placentas found, the assumption made being that once placenta indicates that the pair is monozygotic, while two placentas are a sign that the pair must be dizygotic.
If the cleavage of the embryo that produces MZ twins occurs before about the fifth day of foetal life, there will be two chorions (outer membranes), two amnions (inner membranes) and two placentas (fig. A). If cleavage occurs between the fifth and tenth day (approx.) of foetal life, there will be one chorion, two amnions; and one placenta (fig. B). About 64% of MZ twins are of this type. If cleavage occurs between the tenth and the fourteenth day of development, the twins will have one chorion, one amnion, and one placenta (fig. D), but this happens in only around 4% of MZ twin births. If cleavage occurs after the fourteenth day, there is an increased risk that the twins will be conjoined or what is often called ‘Siamese’.
All DZ twins have two chorions (fig. A), as do some MZ twins. Pairs with separate chorions are called dichorionic, and in about 42% of twins of this type, the twins implant themselves so close together in the uterus that the placentas fuse, making it appear to the naked eye that there is only a single placenta (fig. B). Thus 42% of DZ twins would appear to have only one placenta at birth, while 19% of MZ twins will have two placentas.
The number of placentas at a twin birth is therefore almost useless as a guide to whether the twins are identical or fraternal.
The most objective way to assess zygosity is to use DNA fingerprinting, that is, testing the twins’ blood or another form of physical sample, such as cheek are usually reported as a likelihood ratio of the twins being MZ versus DZ. At the moment, DNA zygosity is specialised and expensive. There are a limited number of places in Australia which offer DNA testing as a service to twins. If you would like a contact for one of these companies, you can ask your local Multiple Birth Association or contact the Australian Twin Registry.


COVID-19 Policies for HarmonyCon 2022
HarmonyCon takes the safety and well-being of our attendees very seriously. In addition to following all applicable laws and regulations, we are implementing temporary policies this year to reduce the risk of spreading COVID-19 during the convention. While these new policies will be enforced within the convention spaces, please note that these policies do not apply to other areas of the Sheraton. Other areas of the hotel are subject to their own rules and policies. Attendees are expected to comply with hotel staff and guidelines as well.
All policies are subject to change as conditions and official guidance continue to evolve.
These policies have been added as an extension of our Code of Conduct, which are agreed to when your badge is purchased.
Vaccination & Testing Policy
The vaccines developed and approved for inoculation against COVID-19 are some of the best tools available to limit the spread of the coronavirus. However, the vaccines are not currently approved for all populations. Rather than excluding those who cannot be vaccinated at this time, all attendees old enough to receive a FDA or WHO approved COVID-19 vaccine (currently 12 and older, though subject to change) will be required to select from one of the following two options before receiving their badge. Those too young to receive a COVID-19 vaccine must select the second option:
- Show proof of vaccination - Attendees must verify they are fully vaccinated by presenting proof of full vaccination at registration when picking up their badges, with the last shot at least 14 days prior to badge pickup. Either physical or electronic copies of documentary proof from the administering healthcare provider will be accepted (e.g., physical vaccination card, digital photo, screenshot, or QR code). Copies and photographs must include the full front of the document and must clearly show the name of the vaccinated individual and the dates of each shot. Proof of vaccination must also clearly show the vaccinated individual has received one of the vaccines approved by the FDA or WHO. Proof of prior COVID-19 infection and recovery will not be accepted as an alternative to proof of vaccination.
- Show a negative test result - NOTE THAT SOME EVENTS OR EXPERIENCES MAY BE UNAVAILABLE TO THOSE THAT ARE NOT FULLY VACCINATED. Attendees may provide a negative test result from an antigen (also known as a rapid test) or PCR (also known as a lab test) COVID-19 test taken within 3 days prior to picking up their badges at registration. Testing must be performed by a healthcare provider (including clinics and stand-alone testing sites), and full test results and the name of the tested individual must be visible. Either physical or electronic copies of test results from the health care provider will be accepted (e.g., physical test report or digital photo or screenshot). Notification SMS text messages will not be accepted as an alternative to full test results from a testing health care provider. Self-certification or at-home test results will not be accepted as an alternative to full test results from a testing health care provider.
HarmonyCon will treat all health-related information provided as confidential and will not retain copies of such information.
If any attendee is discovered to have presented a fake proof of vaccination or fake negative COVID-19 test, authorities will be alerted and the individual in question will be permanently banned from all future events.
Questions regarding this Vaccination & Testing Policy should be directed to [email protected].
Regardless of vaccination status, all attendees above 2 years of age will be required to wear masks or other face coverings at all times during the convention. Masks and other face coverings must fit snugly against the wearer, must cover all airways (e.g., must be worn over the nose), and must be consistent with CDC guidelines (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html). As an exception to the general rule of continuous mask-wearing, attendees may temporarily remove their masks in the following situations:
- Actively eating/drinking in areas where food/beverage are allowed (Food is not allowed anywhere in event space unless purchased directly from the hotel. Non-alcoholic beverages are allowed in all event spaces.)
- Actively hosting/participating as a guest in a panel or other official event
The following types of masks and face coverings are not acceptable due to insufficient ability to reduce transmission of the coronavirus:
- Masks with exhalation valves or vents
- Face shields (without a separately compliant mask underneath)
- Costume/cosplay masks that do not meet our general mask guidance of fitting snugly and covering all airways
- Mesh masks or masks with damage or visible holes
- Neck gaiters (unless folded into two layers)
Questions regarding the mask policies or requests for accommodations due to disabilities that interfere with compliance with this Mask Policy should be directed to [email protected]. Exceptions will only be granted in accordance with CDC guidance (https://www.cdc.gov/quarantine/masks/mask-travel-guidance.html#disability-exemptions), and alternative protective measures may be required if an exception is granted.
Physical Distancing & Capacity Policy
Please be responsible and maintain ample distance from other attendees when possible, and obey all posted capacity and distancing signs and staff instructions. As conditions evolve, changes may be made to the capacity of certain events and the physical distancing requirements or recommendations.
At this point, HarmonyCon does not anticipate enforcing physical distance requirements during the convention.
Sickness Policy & Risk Acknowledgement
For the health and well-being of all attendees, please do not attend HarmonyCon 2022 if you are or have reason to believe you may be sick or infected with COVID-19. If you develop symptoms while at the convention, please self-quarantine and follow CDC guidelines for those who are or may be sick (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/index.html). All attendees will be required to certify they do not reasonably believe themselves (and any minors for whom they are responsible during the convention) to be infected with COVID-19 when picking up their badges at registration.
Attendees will also agree to a COVID-19 Risks and Responsibilities Acknowledgement requiring the following:
- Attendees acknowledge that a risk of infection with COVID-19 is inherent and unavoidable at HarmonyCon 2022.
- Attendees agree to obey all policies, signs, and staff directions relating to health and safety.
- Attendees agree not to attend HarmonyCon 2022 if they have reason to believe they are or may be infected with COVID-19 (whether or not symptomatic), including without limitation if they have been in close contact with any individuals known to be infected within 14 days prior to start of the convention.
- Attendees agree to leave the HarmonyCon convention spaces immediately if they develop symptoms of COVID-19 or otherwise have reason to believe they are or may be infected with COVID-19. They should then leave the Sheraton DFW as soon as reasonably possible. Attendees who are guests of the Sheraton should quarantine in their rooms until they are able to leave and should notify hotel staff in order to allow the Sheraton to take appropriate precautions and perform a thorough cleaning of their rooms.
- Attendees agree to notify HarmonyCon at [email protected] if they learn they have become infected with COVID-19 at any time during the convention. Notifying attendee identity and personal information will be held in strict confidence, but HarmonyCon may notify other attendees of the occurrence of a known or suspected infection.
More information regarding COVID-19 symptoms is available from the CDC at https://www.cdc.gov/coronavirus/2019-ncov/symptomstesting/symptoms.html.
While we are sorry if you choose to not join us this year at HarmonyCon 2022, we understand that certain health and safety protocols may prevent you from attending. Requests for refunds may be sent to [email protected] until the end of January 28th, 2022. After January 28th, 2022, refunds will be handled on a case by case basis, though our best effort will be made to accommodate those unable to attend due to a possibility of infection.


CA Data last updated: Tue Mar 15
However, both intrinsic and acquired mechanisms of resistance to aminoglycosides have occurred. Aminoglycoside resistance among gram-negative organisms can occur through acquisition or upregulation of genes that encode inactivating enzymes or efflux systems. The resistance of gram-negative organisms to aminoglycosides occurs by two major mechanisms: Bacterial production of inactivating enzymes.
Methylation of 16S ribosomal RNA. This effect is mediated by an enzyme encoded by the rmtA gene and has been associated with high-level resistance to all parenteral aminoglycosides in current use.
Binding to the aminoacyl site on 16S ribosomal RNA is the mechanism by which aminoglycosides normally interfere with protein synthesis.
Enterococci are intrinsically resistant to low to moderate levels of aminoglycosides. However, the potential for synergy exists when enterococci with low-level resistance to an aminoglycoside are exposed to a combination of the aminoglycoside with a cell wall active agent, such as penicillin or vancomycin.
The significance of such high-level resistance is that it eliminates the synergism expected between an aminoglycoside and a cell wall active agent. Different genetic mutations are responsible for high-level resistance to different aminoglycosides. While cross-resistance between the specific aminoglycoside agents does occur, it is incomplete.
Therefore, individual agents should be tested for susceptibility against the isolated pathogen whenever possible. Dose adjustments need to be made in a variety of special populations. Renal Impaired Patients Peritoneal dialysis Gentamicin and tobramycin are frequently used for empiric treatment of continuous ambulatory peritoneal dialysis CAPD related peritonitis.
Patients Acc 206 week 1 dq 2 systemic illness may receive an intravenous loading dose. Therefore, patients undergoing intermittent hemodialysis generally require supplemental doses of gentamicin or tobramycin after each dialysis depending on the time lapsed after the first dose and characteristics of the dialysis delivered.
Continuous AV hemofiltration Similar to that observed in patients with intermittent hemodialysis, significant inter-patient variability exists among patients undergoing continuous arteriovenous AV hemofiltration. Empiric initial daily gentamicin or tobramycin doses of 2.
Cystic Fibrosis Patients Both the volume of distribution and clearance of aminoglycosides are greatly increased in patients with cystic fibrosis, necessitating higher starting doses with both traditional intermittent and extended-interval dosing to achieve target serum concentrations.
Burn Patients Patients with significant burns may exhibit larger volumes of distribution when compared with most patient populations.
As a result, larger maintenance doses of gentamicin and tobramycin per day in divided doses may be needed to attain therapeutic serum aminoglycoside concentrations. Serum concentration monitoring and individualized dosing correlates with survival in this patient population.
Septic Patients Septic patients undergoing aggressive fluid resuscitation in the setting of resolving or evolving acute renal failure often warrant especially close monitoring.
Some suggest individualized monitoring for such patients. Peak concentrations of aminoglycosides may be affected by high volumes of intravenous fluids or extravascular fluid shifts, requiring adjustments in the determination of pharmacokinetic parameters such as volume of distribution.
Reduced muscle mass and the resulting reductions in serum creatinine concentration in the elderly may result in overestimation of renal function when formulas such as the Cockcroft-Gault equation are utilized.
Therefore, a relatively normal serum creatinine may be associated with a substantial loss of renal function in this patient population. Synergy for Gram-Positive Infections Lower concentrations of aminoglycosides are targeted when used in combination with other agents to treat serious gram-positive infections, whether traditional intermittent or extended-interval dosing intervals are used.
Ideal body weight IBW also may be used to determine doses for patients who are neither underweight nor obese. Hepatic Impairment No dosage adjustment for aminoglycosides is necessary since they do not undergo hepatic metabolism. Administration Administer by intermittent infusion over 30 to 60 minutes.
Higher doses are generally administered over 60 minutes. Flush line with appropriate solution both before and after administration of the aminoglycoside.
Inject deep IM into large muscle mass, e. The first steps in aminoglycoside administration include determination of the dosing weight and estimation of renal function.
Parenteral aminoglycosides can be administered using a traditional intermittent dosing strategy which uses smaller doses given several times each day or an extended-interval dosing strategy which uses high doses administered at an extended interval. These two strategies have comparable efficacy and safety.
High dose extended-interval administration takes advantage of the pharmacodynamic properties of aminoglycosides and offers greater ease of preparation, administration and monitoring. For most patients with suspected or documented moderate to severe infections due to gram-negative aerobic bacteria in whom an aminoglycoside is being used and who are expected to exhibit more predictable aminoglycoside pharmacokinetics, extended-interval rather than traditional intermittent dosing is preferred.
Certain patient groups may exhibit altered aminoglycoside pharmacokinetics that could render extended-interval dosing less useful or effective.SOC SOC Week 3 Quiz ANSWERS. Secularism: Since the s, the highest percentage of immigrants to the United States have come from: In a presidential system:vetconnexx.com · reviews of Ashford University written by vetconnexx.com Collaborating doctor list List of collaborating doctors likely to be open to working with a reproductive immunologist.
Information gathered from Reproductive Immunology Support Group discussions Completely updated and revised 7/16/vetconnexx.com QNT UOP COURSE TUTORIAL/ SHOPTUTORIAL. QNT Entire Course For more course tutorials visit vetconnexx.com QNT Week 1 Individual Assignment Business Research Case Study QNT Week 1 DQ 1 QNT Week 1 DQ 2 QNT Week 2 Learning Team Assignment Research Proposal Part I QNT Week 2 Learning Team.
Welcome to Buffalo Airways Virtual, The official VA Partner of Buffalo Airways LTD. Buffalo Airways Virtual is one of the worlds Leading Virtual Airlines! With a unique fleet, real world counterpart and an active community, you will certainly be impressed!
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Quality is a top priority. Every product is third party tested for quality and transparency
Relyf Premium CBD Tinctures are made with our 99+% CBD and MCT oil in a concentration of 500mg with less than 0.3% THC. Safe, affordable, easy to use and legal, each hemp-derived CBD tincture contains 30 servings and can be taken day or night, sublingually.
CBD Tincture Bottle Size: 1 fl oz (30 ml)
Servings per Container: 30
Serving Size: 1ml
Ingredients: MCT Oil, Hemp-Derived CBD Extract
THC Content: < 0.3% THC
Safety: Child Safety Cap, Oil Resistant Label
Suggested Use: Place 3-5 drops under tongue. Hold for 45-60 seconds and swallow.
Many users work up to .25ml or .5ml as they feel comfortable
SUSTAINABLY-GROWN | NON-GMO | MADE IN USA | NATURAL | ODORLESS | NO PESTICIDES | NO HEAVY METALS | LABORATORY TESTED | ORGANIC PROCESSES
Grown and extracted from the USA, our CBD products are legal and shipped to all 50 states and internationally. We utilize a whole plant CO2 extraction that allows us to draw the CBD from the plant material and filter out unnatural substances, maximizing pure CBD concentration. Each and every product that leaves the facility is third-party tested to ensure consistency and quality.
All CBD Tinctures, regardless of strength, are 1 fluid oz and contain 30 servings at 1ml each. The dropper in the cap has measurement markers of .25, .5, .75 and 1ml to help with serving size.
We stand by our 30 day money back guarantee if you are unsatisfied with our product.
Orders placed Monday - Friday will be shipped within 1-2 business days.
One of the benefits of CBD oil is that it relieves pain and inflammation. Some people believe that it offers a more natural alternative to over-the-counter medicine, and researchers suggest that the non-psychoactive compounds in CBD could provide a new treatment for chronic pain.
A 2012 study published in the Journal of Experimental Medicine found that CBD significantly reduced pain and chronic inflammation in some rats and mice.
in 2018, the FDA approved the use of CBD as therapy for two conditions characterized by epileptic seizures, namely Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS), after researching the safety and effectiveness of CBD oil.
This means that in the United States, a doctor can prescribe CBD for both of these conditions, as the type of seizures that characterize them are very difficult to control by other medicines.
Although doctors often advise people with chronic anxiety to completely avoid cannabis, SDHC can amplify their feelings of paranoia or anxiousness, the authors of a review from Neurotherapeutics found that CBD may actually be very helpful in reducing anxiety people with certain disorders.
According to this review, CBD may be able to reduce anxiety-related behaviors in people who suffer from conditions such as:
A 2014 study published by the Journal of Clinical Investigation found that CBD may be able to prevent the development of social recognition deficit participants. This means that CBD may be able to help people that are in the early stages of Alzheimer’s to maintain their ability to recognize familiar people and faces.
Researchers believe that CBD oil may help to combat cancer. A 2012 review published in the British Journal of Clinical Pharmacology found that CBD can significantly help to prevent the spread of cancer in patients.
Studies suggest that CBD oil can help to relieve pain from arthritis, which affects more than 50 million people in the United States alone. CBD can help to relieve pain and inflammation associated with arthritis and is considered to be a safe treatment.
Animal and test-tube studies have shown that CBD may decrease inflammation and help prevent the neurodegeneration associated with Alzheimer’s disease. Researchers also found that it helped prevent cognitive decline in mice genetically predisposed to Alzheimer’s disease.
Although research is limited as a treatment for a migraine, a 2017 study published in Cannabis and Cannabinoid Research found that CBD oil may help all forms of chronic pain, including a migraine. This was done with a study including 26 people over the course of six months.
Researchers believe that CBD has the ability to act on the endocannabinoid system and other brain signalling systems which can result in benefits for people with neurological disorders. One study found that Sativex reduced spasms in 75% of 276 people with multiple sclerosis who were experiencing muscle spasticity that was resistant to medications.
Huntington’s disease is a fatal genetic condition that causes seizures and a progressive loss of neurological function. Experimental evidence has found antioxidant and neuroprotective effects of CBD, which may be helpful in preventing the destruction of neurons in Huntington’s disease.
Several studies have shown that treatment with CBD improved quality of life and sleep quality for people with Parkinson’s disease. Although there are various studies suggesting the benefits of CBD for Parkinson’s disease, more research is needed to confirm this.
CBD oil has a list of other health benefits to offer, including suppressing hunger, making skin healthier, and promoting a healthy cardiovascular system.
Recent studies have shown that CBD oil can help with cardiac health and the circulatory system. CBD oil can also help to reduce blood pressure, which is linked to heart failure, and metabolic syndrome.
Studies have shown that CBD oil may be able to reduce glaucoma, a common eye condition that often causes optical nerve damage and, in some cases, blindness. Studies suggest that several cannabinoids including CBD may be good candidates to develop as therapeutic agents as they are very well tolerated.
A 2018 study has found that using CBD for substance addiction helps to prevent relapses. In the study, researchers administered transdermal CBD to animal subjects who had a history of self-administering cocaine or alcohol and exhibited characteristics of a relapsing addict such as dependency, anxiety, and impulsivity. They found that CBD prevented relapses even after it had cleared the brain for three days.
Studies also indicate that CBD oil may help patients who suffer from diabetes, as it can help to relieve oxidative stress and prevent heart damage, according to a 2010 study.
The interest in CBD, or cannabidiol, has never been higher. But what exactly is CBD? To get down to basics, CBD is an all-natural compound derived from the cannabis plant’s resinous flowers. While it’s one of over a hundred other compounds produced within the therapeutically versatile plant, CBD is now the subject of extensive scientific research to explore its health and wellness potential.
CBD works within the body primarily by reacting with the endocannabinoid system, a network of receptors and internally-produced cannabinoid-like substances. The endocannabinoid system plays a vital role in regulating a wide range of physiological functions including appetite, immunity, memory, sleep, and more.
A healthy endocannabinoid system is essential for maintaining internal homeostasis, and when it’s off balance, you may experience issues with mood, blood pressure, digestion, and a host of other matters. Its receptors are active throughout the nervous system and the entire body, and multiple studies suggest CBD reacts with these receptors to help regulate its related functions.
CBD shouldn’t be confused with another well-known phytocannabinoid, THC, as the two compounds interreact with receptors in very different ways. THC is the cannabis compound that causes the intoxicating “high” commonly associated with cannabis. CBD, on the other hand, is not psychotropic and delivers a mellowing mood lift without any distracting psychoactive effects.
By reinforcing a healthy endocannabinoid system, safe, non-addicting CBD may promote mental acuity, improved mood, and a clear mind, among a host of other wellness benefits.
The cannabis plants used to make CBD products are classified as industrial hemp, with a THC content of less than .3 percent. The 2018 Farm Bill officially identifies industrial hemp as a legal agricultural commodity, and CBD is now legal to grow and distribute in all 50 states.
In high doses, CBD could affect the way the body metabolizes certain compounds, and therefore may increase the effects of some medications, necessitating an adjustment in dosage. While dosage will vary based on the individual and desired effect, a 2006 study in the Brazilian Journal of Medical and Biological Research determined that CBD was generally safe in low to high doses taken by healthy and epileptic subjects.
Research on CBD’s possible benefits is ongoing, and studies already suggest that the compound may potentially offer considerable relief for a wide variety of common issues.
According to a survey in The Journal of Headache and Pain, chronic pain is the most common reason Americans have tried wellness products derived from cannabis. Persistent issues like inflammation can impact the quality of life and contribute to serious illnesses. In 2012, the Journal of Experimental Medicine reported that CBD treatment suppressed chronic inflammation and neuropathic pain in lab rats and mice. Other recent studies have also explored CBD’s potential for the treatment of inflammation, high blood pressure, and more.
In 2018, the FDA approved the use of CBD to treat two forms of epilepsy. A review by Neurotherapeutics also examines the compound’s potential to offer relief for individuals suffering from a variety of anxiety disorders.
At Relyf, all our hemp plants are grown in the U.S. and GMO-free. Our CBD products are derived through CO2 extraction, allowing us to filter out unnatural substances and maximize the purity of CBD concentration. Every product we deliver has been lab tested by a third party for quality assurance.
If you’d like to learn more about how CBD and its impact on health, you can schedule a 15-minute call with one of our experts!
Quality is a top priority. Every product is third party tested for quality and transparency
Our goal is to provide any educational resource customers need to make informed decisions and dosages
We want you involved in Relyf™ events for healthy living. We believe community education is vital to learning!
We take our customer support seriously. Email or call anytime with Relyf™ comments or questions


- 62% of new patients search for dentists online before selecting a practice. Being found on the Internet will give you an advantage over other practices in your area who will appear outdated and archaic without a web presence.
- You are able to offer information to your patients when it is convenient for them whether it be during the day or in the middle of the night. You practice is never closed.
- Patients can become educated about your treatments and services and get answers to many of their questions which will help to minimise the number of phone calls you receive.
- Your website can provide further support to existing patients by offering online appointment requests, updating their medical information and help with emergencies.
- There is potential for your website to become a resource of information for the public. By supplying helpful tips and articles that are relevant to your area of expertise in dentistry, you will give visitors a reason to come back to your website and to your practice.
- Patients have more confidence in seeking treatment from professionals that they know something about. Inform visitors to your website about the people in your practice, of your community involvement and why your practice is right for them.
As an information source for your patients
How often do you feel that you cannot explain procedures adequately to your patients? Whether it be endodontics, third molar surgery, ceramic veneers or implants, all the procedures that you perform on a daily basis are often perplexing to your patients and need further explanation.
By simply referring to your practice website patients can readily ascertain all the information they require to be able to choose treatments which are most suitable for themselves.
Attracting new patients
DentalPracticesOnline sites use the latest Search Engine Optimisation procedures which ensure that your website will appear near the front of any search for dentists in your area or relating to specific procedures that you offer in your practice. Patients will not only notice your site in the search but be attracted by the innovative, uncluttered and professional nature of your site.
Built for dentists by dentists
These sites have been designed by Dr David Penn BDS MBA with a team of world class designers in Australia, the US and UK. The mission statement is to provide dynamic, state of the art sites for practices around the world that reflect the style and culture of each practice. In addition, the ability to self manage the content, change designs and establish a quality web presence at a reasonable fee is paramount.
Please feel free to visit Dr Penn's practice site www.alignedsmiles.com.
A wide selection of professional designs for you to choose from
Easy to switch to another design with a few clicks of your mouse
Fully detailed text accurately
describes treatments and services
DPO provides a huge variety of quality intra-oral images
for your patient to browse
Your patient can access relevant information relating to their treatment
New patients data is accurately recorded for your staff to access.
Patient would be able to fill the Medical History form before they come to your practice.
Online map for your website
- A state of the art website that reflects your practice and culture!
- Show patients exactly what your practice offers
- Utilise the world class gallery of "Before and After" images
- Educate your patient on what to expect
- Online appointment request forms
- Online medical history uploaded into your practice
- Google map for easy access to your practice


CORI · PLAT
Vaccine against infectious coryza in birds.
It contains Avibacterium paragallinarum ( A, B; C serovars) strains chemically inactivated and absorbed in aluminium hydroxide.
It is indicated for the prevention of avian coryza in layer and breeding hens.
Conservation: Keep refrigerated between 4 and 8ºC. Do not freeze.
Mode of use: shake well before use. At the moment of application, it is recommended that the product is at room temperature.
Doses: 0,5 ml per bird
For good immunity, 2 doses need to be applied, separated by 3 to 5 weeks.
Way of application: subcutaneous in the posterior region of the neck or intramuscular in breast or leg muscle.
Validity period: 24 months since elaboration date.
Presentation: Bottle containing 500 ml (1000 doses)
SENASA certificate N° 95002


Pregnancy is a roller coaster ride. There are times when you as a pregnant mother feels ecstatic but there are times when you feel low because of the changes that your body experiences. However, nothing beats the happiness you feel knowing that you will see your baby after 40 weeks. In order to have a healthy baby, you also need to stay fit and healthy. These are some of the helpful tips you need on how to stay a healthy momma while you’re on your pregnancy journey.
1. See your doctor regularly.
Going to your doctor for checkups on a regular basis is important. From the moment you find out you’re pregnant, it’s best to get prenatal care as soon as possible. You can schedule an appointment with your doctor to receive the medical you and your baby need. Be sure to keep track of your appointments to avoid missing one. You can try creating a pregnancy journal to take note of all your doctor’s advice and your following checkups.
This Expecting You journal from Hanna Andersson doubles as a pregnancy journal and a keepsake. Get it for $14.95 at Hanna Andersson.
2. Eat right.
When you’re pregnant, you’re eating for two. Therefore, you cannot just eat anything you want. You have to be conscious of your diet to ensure that you and your baby are getting the right nutrition. You can include more fruits and vegetables in your diet. You can also include carbohydrates such as bread, rice, and pasta. For protein, stick to healthy meats such as chicken and fish. Shop for healthier food options here:
3. Take your supplements.
Pregnant mothers need additional supplements for them and their babies. Consult with your doctor to know what type of supplements you need. You may be advised to take fish oil supplements, Vitamin D, Calcium, Folic Acid, Iron, and Multivitamins to keep you and your child healthy. Be sure to follow doctor’s advice before taking any medication or other food supplements. You can shop for them below:
1. Caltrate 600+D3 Calcium and Vitamin D Supplement, $10.17 at Amazon | 2. Nature Made Multi Prenatal Tablets Rich in Folic Acid, Iron & Zinc, $18.52 at Amazon | 3. Omega 3 for Women, Pure Sea Harvested Pelagic Fish Oil, $13.97 at Amazon
4. Keep away from unsanitary foods.
There are several types of food that pregnant women must avoid. They pose a health risk for you and your baby. These foods include undercooked meat, raw fish, raw shellfish, undercooked meals, sunny side up eggs, unpasteurized milk, unwashed fruits and vegetables, and more. Try your best to avoid these to keep you and your baby away from illnesses such as salmonella, listeriosis, and toxoplasmosis.
It’s always best to keep yourself hydrated. Always bring a water bottle with you to keep your body cool. Staying hydrated will help you fuel your body whenever you need to.
This Klean Kanteen Classic Stainless Steel Water Bottle is all you need to keep you hydrated for the day. Purchase it for $21 at Urban Outfitters.
6. Do some exercises.
It’s also advisable to do some exercise during your pregnancy. However, you need to consult your doctor first before participating in any type of exercise regimen. Some of the most common exercises that pregnant women do are brisk walking, swimming, pilates, yoga, and aquanatal classes. You can try doing some simple breathing and yoga exercises at home.
Get a yoga mat and do exercises in the living room or your bedroom, wherever you feel comfortable. You can purchase this Yeti Yoga Dora Jungle Yoga Mat for $60 at ShopBop.com.
7. Get plenty of sleep and relaxation.
Lastly, it’s important to get enough sleep. Sleep allows your body to recharge and rest. It’s a great way to relieve you from stress and fatigue. You can also try to pamper yourself. Get a foot massage or treat yourself to a spa. However, consult your doctor and ask for advice on what type of massages and treatments you’re allowed to have. To get a good night’s sleep, try using a pregnancy pillow.
Try the Boyban E-Shaped Pregnancy Pillow to help you get more comfortable while sleeping. It provides support for pregnant women using its flexible design. Grab it for $31.75 at Walmart.
Learning how to stay a healthy momma is beneficial for you and your baby. It prevents you as well as your baby from having pregnancy complications. Enjoy your pregnancy by staying positive and healthy.
Just a disclaimer – We have partnered with these companies because we use their products and/or proudly trust and endorse them – so we do receive a commission if you make a purchase or sign up for services. Often, we are able to negotiate special discounts and/or bonuses, which we will pass on to you via our links. We often get short notice on sale items available for 24-48 hours as we will pass these savings onto you.


In a world where medical advancements dominate discussions about healthcare, we often overlook the power of a humble healer that stands tall and breathes life into our surroundings - the tree.
As we celebrate Doctor's Day, it is crucial to recognize the profound connection between nature and well-being. Planting trees on this special occasion not only pays homage to healthcare professionals but also symbolizes the essential role trees play in healing our planet and nurturing healthier communities.
The Healing Power of Trees: Trees have a remarkable ability to improve our physical and mental well-being. They serve as nature's air purifiers, filtering harmful pollutants and replenishing the atmosphere with oxygen.
By reducing air pollution, trees directly contribute to respiratory health, preventing respiratory ailments and improving overall lung function.
Beyond the tangible benefits, trees have a calming effect on our minds. Research has shown that spending time in green spaces can reduce stress, anxiety, and even accelerate healing processes.
The presence of trees in healthcare facilities and surrounding neighborhoods creates a soothing environment that promotes recovery and rejuvenation.
Planting Seeds of Hope: By planting trees on Doctor's Day, we plant seeds of hope and resilience. Each tree serves as a living testament to the healing power of nature, reminding us that healthcare extends beyond hospitals and clinics. It encompasses our environment, the air we breathe, and the communities we inhabit.
Additionally, tree plantation aligns with the principles of preventive healthcare. By addressing environmental issues, such as air pollution and climate change, at their roots, we take proactive steps to prevent future health risks. It is a holistic approach that combines the efforts of medical professionals and environmentalists to safeguard the well-being of current and future generations.
Get Involved: Planting Trees for a Healthier Future
Organize Tree Plantation Drives: Collaborate with local healthcare institutions, community organizations, and environmental groups to organize tree plantation drives on Doctor's Day. Engage doctors, healthcare professionals, and volunteers to actively participate in the initiative.
Greening Healthcare Facilities: Advocate for the integration of green spaces and tree planting initiatives within healthcare facilities. Encourage hospitals to create healing gardens, rooftop gardens, and indoor plant installations to enhance the well-being of patients, staff, and visitors.
Education and Awareness: Promote awareness about the importance of tree plantation for health by organizing workshops, seminars, and awareness campaigns. Educate the public, patients, and healthcare professionals about the numerous benefits of trees and inspire them to take action.
On Doctor's Day, let us embrace the healing power of trees and acknowledge their vital role in promoting health and well-being. By planting trees, we honor the dedication and compassion of healthcare professionals while recognizing the symbiotic relationship between nature and human health.
Let us join hands in creating a greener and healthier future, where doctors and trees work hand in hand to nurture and heal our world.


Surgical procedures may be performed when tremor does not respond to medications or severely impacts daily life. Generally, tremor is caused by a problem in the parts of the brain that control movements. Most types have no known genetic cause, although there are some forms that appear to be inherited and run in families. In the below video, our medical director, Dr. Calarco, explains how alcohol can cause shakes and tremors. The severity of your tremors may stay relatively the same or may get worse over time.
Your healthcare provider is the best person to tell you what side effects or complications are possible in your specific situation, and what you can do to manage or avoid them. If you suffer from essential tremor and are looking for an effective solution, check out Cala Trio therapy. The first-in-class Cala Trio therapy offers individualized alcohol and essential tremor treatment for hand tremors with a wrist-worn device that sends electrical stimulation to nerves in the wrist. This stimulation is believed to help with tremors by disrupting the network activity that causes them. The therapy is calibrated for your specific tremor and is part of an essential tremor treatment plan to help you manage symptoms.
Diagnostic imaging may help determine if the tremor is the result of damage in the brain. An electromyogram, which measures involuntary muscle activity and muscle response to nerve stimulation, may identify muscle or nerve problems. Some research suggests that people with essential tremor have a higher risk of developing Parkinson’s disease or sensory problems, like a loss of smell or hearing. However, these associations are still being investigated. Surgery is performed when other treatments fail to provide relief.
- Additionally, NINDS scientists are researching the impact of genetic changes on the development of essential tremor.
- Extremes in temperature may also make the tremor more severe.
- However, as with Inderal, a percentage of people may develop tolerance to the treatment after about a year.
It also may affect a person’s head, voice, or lower limbs. Although the tremor can start at any age, it most often first appears during adolescence or in middle age (between ages 40 and 50). It can be mild and stay mild, or slowly get worse over time. Essential tremor is often mistaken for Parkinson’s disease, but the two conditions differ in several ways. Essential tremor is an action tremor, meaning that the involuntary shaking increases when you move and try to use your hands. In Parkinson’s disease, tremors occur mainly at rest, and activity reduces the symptoms.
There are two main surgical procedures that may be considered – thalamotomy and thalamic deep brain stimulation. This is a deep part of the brain that organises messages travelling between the body and brain. Essential tremor is known to be familial condition, meaning that it runs in families. At least 5-7 out of 10 people with essential tremor have other members of the family with the same condition. Genes are passed on to a child from each parent and determine what we look like, how our body functions and even what diseases we get. Particular genes have been shown to have certain changes present in families with essential tremor.
It’s essential to seek medical attention to ensure the issue is unrelated to DTs. Experts use gabapentin (Neurontin) for short-term treatment of Essential Tremor affecting the hands, although it is not known how the drug works. In most cases, it is not used in conjunction with other drugs.
How does essential tremor affect my body?
Experts don’t know exactly why essential tremor happens or if there are triggers that cause them to happen. However, there’s evidence that it happens because of the changes in certain parts of your brain. For severe tremors, a stimulating device (deep brain stimulator) surgically implanted in your brain may help. Gabapentin and topiramate are two other anti-seizure medicines that are sometimes prescribed for essential tremor. In some cases, benzodiazepines such as alprazolam or clonazepam might be suggested.
The tremor is identified as an isolated postural or kinetic tremor if it has been present for less than three years. No signs of other neurologic disease such as dystonia, ataxia, or parkinsonism are allowed to be designated as essential tremor. Essential tremor is also called familial essential tremor. It can sometimes become quite severe so that everyday activities like holding a cup can be difficult.
This condition isn’t dangerous but can become severe enough to disrupt everyday activities. There are multiple ways to treat this condition, most of which aren’t necessary until you’ve had the condition for several years. Essential tremor is most common among people older than 65, but it can affect people at any age. If you opt for outpatient treatment, you’ll likely be given sedative drugs to take at home to ease withdrawal symptoms and have to get routine blood tests to make sure you’re staying on track. You may also need to get tested for other medical problems that could be connected to your alcohol abuse.


Emetophobia is a fear of vomiting or seeing others being sick. Those who experience emetophobia may also fear being out of control while they are being sick or fear being sick in public, which can trigger avoidance behaviours. It is a condition that is not widely diagnosed even though it is a fairly prevalent anxiety disorder., It is more common for women to have a fear of vomiting than men. An estimated 1.7-3.1% of males and 6-7% of females experience emetophobia.
Emetophobia varies enormously in how it effects people; most worry excessively about being sick even though they are less likely than the general population to be sick because of all the steps they take to avoid being ill. For instance, some people may be unable to leave home if there are any tummy bugs going around and they will avoid family and friends who have an illness. (SOURCE: WWW.AnxietyUK.co.uk)
My Emetophobia stems from when I was seven and I had a sickness and diarrhoea bug and I was sick over myself and when I coughed or sneezed I messed myself and having my mum clean me up which despite my mum having the patience of a saint, frustrated both of us.
Being disabled meant I needed help getting on and off the toilet and whilst I could crawl to the bathroom I couldn’t get there in time resulting in me feeling deeply ashamed.
Since then every time I’ve had a stomach bug or diarrhoea I end up really tearful and anxious. When I was 20 I had a stomach bug whilst my mum was at work I messed myself and needed my Nan to clean me up. Embarrassing right?
Ever since I was seven I’ve done lots of things to prevent myself being sick or diarrhoea:
- I tell my Carers not to talk about if they’ve had a bug in front of me because it causes anxiety.
- I don’t eat from certain restaurants or takeaways
- I take anti sickness tablets when needed
- When I feel ill or sick I won’t eat until it’s passed.
- I check the side effects of any meds I take and won’t take them if they cause sickness or diarrhoea.
- Once I’ve been to the toilet I wipe really hard to make sure I’m clean especially if I have a bad tummy because it makes me feel dirty.
- If I’m going on holiday I’ll avoid trigger foods so I’m not ill abroad.
- If I see my mum or anyone cooking I have to ask if their ingredients are in date (even though I know they wouldn’t use bad ingredients deliberately)
The reason I’m writing this is so people know they are not alone in battling with this anxious trigger. I also want people to recognise it is a real disorder and it affects a lot of people. it’s even been recognised by The Speakmans on This Morning.


Effective in January of 2023, Hancock Public Health will be offering COVID-19 and flu vaccines for adults, adolescents, and children each Friday from 9 – 11:30 a.m. and 1 – 3:30 p.m.
No appointment is necessary. People should bring a form of identification, insurance cards and COVID-19 vaccination card.
Adolescent and children vaccinations are available for COVID beginning at age 6 months. Hancock Public Health currently has the Pfizer BioNTech bivalent vaccine for ages 6 months to 17 years old, Moderna bivalent vaccine ages 12-17 years old, and Novavax vaccine ages 12-17 years old.
Anyone under the age of 18 must have a parent/guardian present to receive a vaccination.
For questions or concerns, contact the health department at 419-424-7441.