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NCHS Data cheap kamagra oral jelly uk 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 cheap kamagra oral jelly uk diabetes (2).

Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the loss of ovarian activity” cheap kamagra oral jelly uk (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status.

The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% are perimenopausal, cheap kamagra oral jelly uk and 22.1% are postmenopausal. Keywords.

Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely cheap kamagra oral jelly uk than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 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 oral jelly 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 quadratic trend by menopausal status (p cheap kamagra oral jelly 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 cheap kamagra oral jelly uk 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 1pdf cheap kamagra oral jelly uk icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who had trouble cheap kamagra oral jelly uk 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%) (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 oral jelly 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 cheap kamagra oral jelly uk 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 cheap kamagra oral jelly uk and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data cheap kamagra oral jelly uk table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of cheap kamagra oral jelly uk 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 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 oral jelly 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, cheap kamagra oral jelly uk 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 cheap kamagra oral jelly uk 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 cheap kamagra oral jelly uk table for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well cheap kamagra oral jelly uk 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 oral jelly 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.

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Sen. Dick Durbin (D-IL) kamagra sildenafil 50mg recently sent a letter to FDA Commissioner Stephen Hahn urging the Food and Drug Administration to enforce its own regulations regarding e-cigarettes and youth. In January, the FDA committed to removing all new tobacco products that did not submit premarket tobacco product applications (PMTAs) by Sept. 9. The FDA stated it would publicly make available a list of the new products on the market as of Aug.

8, 2016, and submitted a PMTA by the deadline. Any e-cigarette company wanting to keep or put a device or flavor product onto the market was required to submit an application.Durbin said he was concerned more than a month had passed, yet the FDA had yet to publish its list.“Thousands of the products that FDA will begin regulating have been on the market for years, including those responsible for fueling the current epidemic of youth e-cigarette use—which has resulted in nearly four million children vaping, including one in five high school students. Many of these products were illegally introduced to the market after August 8, 2016, without an FDA marketing order,” Durbin said. €œFor years, I have been troubled by FDA’s inadequate enforcement of this deeming rule requirement, stemming from the fact that the agency never maintained a list of which products were on the market by August 8, 2016.”Shutterstock Perdue Pharma, the maker of OxyContin, pleaded guilty to three federal charges on Wednesday and agreed to $8 billion in penalties as part of a settlement with the U.S. Department of Justice (DOJ) over the company’s role in the opioid epidemic.

The settlement between the DOJ and Perdue resolves the government’s criminal and civil investigations into the company. €œThe abuse and diversion of prescription opioids has contributed to a national tragedy of addiction and deaths, in addition to those caused by illicit street opioids,” said Deputy Attorney General Jeffrey A. Rosen. €œWith criminal guilty pleas, a federal settlement of more than $8 billion, and the dissolution of a company and repurposing its assets entirely for the public’s benefit, the resolution in today’s announcement re-affirms that the Department of Justice will not relent in its multi-pronged efforts to combat the opioids crisis.”Perdue will pay $3.544 billion in criminal fines and pay an additional $2 billion in forfeiture of past profits as part of the settlement. The company will also pay $2.8 billion to resolve the company’s civil liabilities.

Because the company filed for bankruptcy in Sept. 2019, the company will be dissolved and reformed as a Public Benefit Company (PBC). As a PBC, the company would continue to operate, however, the focus would be on benefiting the American people instead of maximizing profit. Proceeds from the sales of legitimate drugs would be forwarded to state and local abatement programs. Additionally, the PBC will donate or provide steep discounts for overdose rescue drugs and medically assisted treatment medications to communities, the DOJ said.

The company pleaded guilty to one charge of dual-object conspiracy to defraud the United States and to violate the Food, Drug, and Cosmetic Act, and two counts of conspiracy to violate the Federal Anti-Kickback Statute. The federal government alleged that between May 2007 and March 2017, Perdue defrauded the U.S. Government by misrepresenting to the DEA that the company had an effective anti-diversion program, when, in fact, the company continued to market its opioid products to more than 100 health care providers the company had good reason to believe were diverting opioids to patients for non-medical purposes. Additionally, the DOJ said Perdue between June 2009 and March 2017, the company paid doctors through its doctor speaker program to induce them to write more prescriptions for opioid products, as well as making payments to Practice Fusion Inc., an electronic health records company, in exchange for referring, recommending and arranging for the ordering of Perdue’s extended release opioid products, both violations of the Federal Anti-Kickback Statute. €œToday’s resolution is the result of years of hard work by the FBI and its partners to combat the opioid crisis in the U.S.,” said Steven M.

D’Antuono, Assistant Director in Charge of the FBI Washington Field Office. €œPurdue, through greed and violation of the law, prioritized money over the health and well-being of patients. The FBI remains committed to holding companies accountable for their illegal and inexcusable activity and to seeking justice, on behalf of the victims, for those who contributed to the opioid crisis.”.

Shutterstock The Substance Abuse cheap kamagra oral jelly uk and Mental Health Services Administration (SAMHSA) recently awarded the American Academy of Addiction Psychiatry (AAAP) $32 million over two years to address opioid-use disorders and stimulant-use disorders. Funding will be used for the Opioid Response Network initiative, which has provided more than 3 million people with education and training to mitigate opioid use since its founding in 2018.Individuals, organizations, and governments can request education and training tailored specifically to meet their needs.The initiative is a coalition of AAAP and 40 national professional organizations. The coalition is lead by the Columbia University Division on Substance Use Disorders and the Addiction Technology Transfer Center cheap kamagra oral jelly uk at the University of Missouri-Kansas City.

€œFunding to address the opioid epidemic through localized, evidence-based approaches in the prevention, treatment, and recovery of opioid use disorders, stimulant use, and other substance use disorders is critical to real change,” Kathryn Cates-Wessel, Opioid Response Network principal investigator and AAAP CEO, said. €œOpioid use disorder remains a serious public health concern and appears to have been exacerbated during cheap kamagra oral jelly uk the current erectile dysfunction treatment crisis, which is believed to have caused increases in substance use, overdose, depression, anxiety, and suicide.” SAMHSA requires the network to expand its resources to provide more educational services on stimulant use.Shutterstock U.S. Sen.

Dick Durbin (D-IL) recently sent a letter to FDA Commissioner Stephen Hahn urging the Food and Drug cheap kamagra oral jelly uk Administration to enforce its own regulations regarding e-cigarettes and youth. In January, the FDA committed to removing all new tobacco products that did not submit premarket tobacco product applications (PMTAs) by Sept. 9.

The FDA stated it would publicly make available a list of the new products on the market as of Aug. 8, 2016, and submitted a PMTA by the deadline. Any e-cigarette company wanting to keep or put a device or flavor product onto the market was required to submit an application.Durbin said he was concerned more than a month had passed, yet the FDA had yet to publish its list.“Thousands of the products that FDA will begin regulating have been on the market for years, including those responsible for fueling the current epidemic of youth e-cigarette use—which has resulted in nearly four million children vaping, including one in five high school students.

Many of these products were illegally introduced to the market after August 8, 2016, without an FDA marketing order,” Durbin said. €œFor years, I have been troubled by FDA’s inadequate enforcement of this deeming rule requirement, stemming from the fact that the agency never maintained a list of which products were on the market by August 8, 2016.”Shutterstock Perdue Pharma, the maker of OxyContin, pleaded guilty to three federal charges on Wednesday and agreed to $8 billion in penalties as part of a settlement with the U.S. Department of Justice (DOJ) over the company’s role in the opioid epidemic.

The settlement between the DOJ and Perdue resolves the government’s criminal and civil investigations into the company. €œThe abuse and diversion of prescription opioids has contributed to a national tragedy of addiction and deaths, in addition to those caused by illicit street opioids,” said Deputy Attorney General Jeffrey A. Rosen.

€œWith criminal guilty pleas, a federal settlement of more than $8 billion, and the dissolution of a company and repurposing its assets entirely for the public’s benefit, the resolution in today’s announcement re-affirms that the Department of Justice will not relent in its multi-pronged efforts to combat the opioids crisis.”Perdue will pay $3.544 billion in criminal fines and pay an additional $2 billion in forfeiture of past profits as part of the settlement. The company will also pay $2.8 billion to resolve the company’s civil liabilities. Because the company filed for bankruptcy in Sept.

2019, the company will be dissolved and reformed as a Public Benefit Company (PBC). As a PBC, the company would continue to operate, however, the focus would be on benefiting the American people instead of maximizing profit. Proceeds from the sales of legitimate drugs would be forwarded to state and local abatement programs.

Additionally, the PBC will donate or provide steep discounts for overdose rescue drugs and medically assisted treatment medications to communities, the DOJ said. The company pleaded guilty to one charge of dual-object conspiracy to defraud the United States and to violate the Food, Drug, and Cosmetic Act, and two counts of conspiracy to violate the Federal Anti-Kickback Statute. The federal government alleged that between May 2007 and March 2017, Perdue defrauded the U.S.

Government by misrepresenting to the DEA that the company had an effective anti-diversion program, when, in fact, the company continued to market its opioid products to more than 100 health care providers the company had good reason to believe were diverting opioids to patients for non-medical purposes. Additionally, the DOJ said Perdue between June 2009 and March 2017, the company paid doctors through its doctor speaker program to induce them to write more prescriptions for opioid products, as well as making payments to Practice Fusion Inc., an electronic health records company, in exchange for referring, recommending and arranging for the ordering of Perdue’s extended release opioid products, both violations of the Federal Anti-Kickback Statute. €œToday’s resolution is the result of years of hard work by the FBI and its partners to combat the opioid crisis in the U.S.,” said Steven M.

D’Antuono, Assistant Director in Charge of the FBI Washington Field Office. €œPurdue, through greed and violation of the law, prioritized money over the health and well-being of patients. The FBI remains committed to holding companies accountable for their illegal and inexcusable activity and to seeking justice, on behalf of the victims, for those who contributed to the opioid crisis.”.

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NCHS Data https://gbs2018.com/kamagra-oral-jelly-wholesalers/ Brief kamagra now fake 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 kamagra now fake increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is “the permanent cessation of menstruation that kamagra now fake 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 are premenopausal, 3.7% kamagra now fake 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 40–59 slept less than 7 hours, kamagra now fake 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 now fake. 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 kamagra now fake 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 kamagra now fake 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 kamagra now fake 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 kamagra now fake by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 kamagra now fake. 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 kamagra now fake 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 kamagra now fake 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 now fake 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 kamagra now fake 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 now fake. 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 now fake <. 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 kamagra now fake 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 kamagra now fake table for Figure 3pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week increased from 47.0% among kamagra now fake 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 now fake. 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 oral jelly 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 chronic conditions such as cardiovascular disease (1) and diabetes (2) cheap kamagra oral jelly uk. Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the loss of ovarian cheap kamagra oral jelly uk 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 cheap kamagra oral jelly uk 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 period.More than one in cheap kamagra oral jelly uk 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 oral jelly 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 quadratic trend by cheap kamagra oral jelly uk 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 cheap kamagra oral jelly uk less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf icon.SOURCE cheap kamagra oral jelly uk.

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 cheap kamagra oral jelly uk 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 cheap kamagra oral jelly 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 cheap kamagra oral jelly uk 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 cheap kamagra oral jelly uk ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data table for Figure cheap kamagra oral jelly 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 cheap kamagra oral jelly uk 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 cheap kamagra oral jelly 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 oral jelly 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 cheap kamagra oral jelly uk 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 cheap kamagra oral jelly uk for Figure 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or cheap kamagra oral jelly uk 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 oral jelly 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.

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The Occupational Safety and cheap kamagra oral jelly uk Health Administration (OSHA) is turning 50!. On Dec. 29, 1970, the Occupational Safety and Health Act was signed cheap kamagra oral jelly uk to ensure safe and healthful working conditions for American’s workers. Since our agency’s launch, worker fatalities have decreased by about 60%, while work-related injuries and illnesses have decreased by nearly 80%.

Although we have helped significantly reduce workplace fatalities, injuries and illnesses, there’s still more work to be done.As we celebrate five decades of service to America’s workers, we’re reflecting on cheap kamagra oral jelly uk some of OSHA’s key milestones and standards.1970s. In its first decade of service, OSHA introduced consensus standards, protecting workers from the health risks associated with asbestos and chemical carcinogens. The Cotton Dust Standard of 1978 led cheap kamagra oral jelly uk to a 90% decrease in worker fatalities associated with brown lung disease. Additionally, the OSHA Training Institute was established to educate both inspectors and the public.1980s.

OSHA continued to implement safety standards during its second decade, including excavation and trenching, grain handling facilities, and cheap kamagra oral jelly uk the lockout/tagout of hazardous energy. OSHA also created the Voluntary Protection Programs to recognize employers with exemplary safety and health records.1990s. As science and technology progressed, OSHA issued new standards cheap kamagra oral jelly uk to protect workers, including on bloodborne pathogens and process safety management. The agency also issued standards to protect traditional workforces, including longshoring and marine terminals.

Additionally, the agency created the Strategic Partnership Program to improve cheap kamagra oral jelly uk safety and health within OSHA’s jurisdiction. To broaden its reach and protect more workers, OSHA launched its website, www.osha.gov. Every day, the site welcomes an average of more than 89,000 visitors and records an average of 168 workplace complaints.2000s. In response to the terrorist attacks of 9/11 and a series of natural disasters, OSHA provided resources to cheap kamagra oral jelly uk protect first responders.

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The agency investigated every complaint, removed more than 646,000 workers from erectile dysfunction hazards, and provided more than 20 guidance documents in multiple languages to help employers keep workers safe.To read more about OSHA’s first five decades, visit our OSHA at 50 webpage. Loren Sweatt is the Principal Deputy Assistant Secretary for cheap kamagra oral jelly uk the U.S. Department of Labor’s Occupational Safety and Health Administration. Follow OSHA on Twitter at @OSHA_DOL..

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erectile dysfunction treatment has exposed the cracks cheap kamagra jelly in the foundation of America’s rural community health http://cxnclinical.com/elements/ system. These cracks include increased risk of facility closures, loss of services, low investment in public health, maldistribution of health professionals, and payment policies ill-suited to low-volume rural providers.As a result, short-term relief to stabilize rural health systems and long-term strategies to rebuild their foundations are necessary. In this post, we propose four policy cornerstones on which to rebuild cheap kamagra jelly the rural health system.

They include new financing and delivery models, community engagement, local health planning, and regionalization of delivery systems.The Cracked FoundationThe cracks in the rural health system’s foundation impair system performance on many levels. Rural hospitals, clinics, and emergency medical services (EMS) report reduced revenues and utilization. Shortages of cheap kamagra jelly personal protective equipment, testing supplies, and ventilators.

And limited erectile dysfunction treatment surge capacity. The chronic underfunding of rural public health has also dismantled emergency response capacity. Finally, enhanced payment policies have slowed, but not prevented, cheap kamagra jelly rural hospital closures.While these cracks are not new, erectile dysfunction treatment has revealed how deep they are.

For example, 172 rural hospitals have closed since 2005. Due to chronic underfunding, cheap kamagra jelly rural public health departments employ staff with narrower skill sets and fewer epidemiologists than their urban peers. Low patient utilization and revenues have severely reduced the crisis response capacity of rural health systems.

Rural communities have fewer health resources to respond to erectile dysfunction treatment.Despite concerns about hospital closures, a large percentage of rural residents bypass their local health systems. These bypass patterns reveal tension between the desire to retain local services and the will to sustain these services through utilization and financial support.Weaknesses of Volume-Based Payment PoliciesFee-for-service payment policies fail to address rural providers’ high fixed costs, inadequate cash reserves, and high reliance cheap kamagra jelly on non-emergent care revenues. They also discourage delivery of high-value, low-margin services such as primary care, chronic care, and prevention.To sustain low-volume rural providers, Medicare provides enhanced reimbursement to critical access, sole community, and Medicare-dependent hospitals and Rural Health Clinics.

Still, these designation programs rely on fee-for-service payment cheap kamagra jelly methods insufficient for rural providers. They fail to mitigate the impact of Medicare sequestration and bad debt cuts, low Medicaid and commercial reimbursement, low dependence on inpatient care, and declining rural populations.At the same time, volume-based payment policies in our market-based health system favor the location of services in larger communities and encourage providers to compete for business. This reality does not serve rural areas well, particularly small and isolated areas.

A competitive market approach, in the absence of formal health cheap kamagra jelly planning, inhibits coordination, promotes wasteful competition, distributes services inefficiently, and shifts planning from local to corporate levels.Patching the Foundation. Short-Term Solutionserectile dysfunction treatment has widened the cracks in our rural health foundation. Short-term responses have included financial support as well as regulatory relief to expand telehealth use and increase hospital bed availability.

These interventions seek to stabilize rural providers and their ability to respond to cheap kamagra jelly community needs. erectile dysfunction treatment’s impact has also renewed interest in the Rural Hospital Closure Relief Act of 2019 [PDF] (H.R. 5481/S.

3103). The Act would allow additional struggling rural hospitals to become Critical Access Hospitals by restoring state authority to designate necessary providers.After erectile dysfunction treatment, we will face difficult decisions. Some rural providers may close, while many others will be weakened.

State and local governments may face growing service demands with fewer resources to meet those demands.Rebuilding the Foundation. Long Term SolutionsWhile helpful, traditional rural support policies have not fully repaired the foundation of rural community health. Thus, long-term strategies to rebuild, rather than patch, the rural health foundation are needed.

In response, we propose the following four policy cornerstones to anchor this approach.Cornerstone 1. New financing and delivery system modelsNew rural financing and delivery system models are needed to:Respond to individual community requirements;Rightsize services;Reduce reliance on utilization and patient volume;Cover the costs of care, including fixed costs;Sustain crisis response capacity;Support public and population health, team-based care, telehealth, and transportation. AndEnsure access to inpatient, outpatient, specialty, and primary care services.Demonstrations in Maryland, Pennsylvania, and Vermont are testing payment and delivery system models that may inform future rural health system development.

Revisiting lessons learned from past state and federal demonstrations can provide additional information to supplement the results of these demonstrations.Cornerstone 2. Community engagementImplementation of rural delivery system models will be less effective unless communities engage in selecting models that meets their needs. Effective community engagement includes cross-sector representation, participation of vulnerable populations, and education on the economics of local health care services.

Community members must understand that health systems are not “public utilities” but resources requiring local utilization and financial support. Effective community engagement seeks to identify and reflect local concerns, values, and priorities. It should also explore why residents bypass local services to seek care outside of the community.

Communities will need tools, technical assistance, and resources to support their community engagement processes.Cornerstone 3. Local health buy kamagra online uk planningCommunity engagement and local health planning are closely aligned. Local health planning processes are not the large-scale programs created under the National Health Planning and Resource Development Act of 1974.

Rather, they are local efforts that can leverage the community health needs assessments (CHNAs) required of tax-exempt hospitals or the Mobilizing for Action through Planning and Partnerships (MAPP) process, used by public health agencies for voluntary accreditation. These processes offer a framework to conduct community health planning and engagement focused on health rather than health services.Collaboration between hospitals and local health departments (LDHs) would result in more comprehensive community health assessments. Maryland, New York, North Carolina, and Ohio encourage collaboration between hospitals and LHDs and/or the alignment of their assessment cycles.

New York requires hospitals and LHDs to collaborate on CHNAs, prioritize community issues, and jointly implement initiatives to address health priorities. To maximize their effectiveness, these assessments and planning processes should reflect the health system and health improvement needs of the community.Cornerstone 4. Regionalization of delivery systemsRegionalization of high-cost services complements effective local health planning.

Rural health systems often compete in “medical arms races” for specialty and diagnostic services, resulting in duplication and inefficient resource use. In contrast, regionalization involves “rightsizing” health systems by organizing delivery of essential services locally and high-cost services regionally. The loss of rural obstetrical services is an opportunity to regionalize care by providing pre/postnatal services locally, performing deliveries at designated regional hospitals, and offering transportation to ensure access to regional services.Effective planning and regionalization require local and state-level input on the distribution of rural populations, needs, and services.

States can play an important role in encouraging regional health planning. Texas, for example, funded Regional Health Partnerships (RHPs) under a Medicaid 1115 waiver. RHPs, which include hospitals and LHDs.

RHPs must create plans to improve regional access, quality, cost-effectiveness and collaboration. Florida, as another example, established local health councils which are non-profit agencies that conduct regional health planning and implementation activities.Regional health planning can also support coordinated preparedness and response to local and global events. Minnesota, for example, established eight Health Care Coalitions that collaborate inter-regionally for planning and response purposes.

State Offices of Rural Health and other stakeholders can facilitate regional planning by convening health care, public health, and social service partners.With Crisis Comes OpportunityRural America has an exceptional history of resilience, innovation, and collaboration. Recovery from erectile dysfunction treatment requires new strategies to rebuild the crumbling rural health foundation. The four cornerstones – payment and delivery system reform, community engagement, local health planning, and regionalization – can provide the base for strong and vibrant health systems serving rural America.Tools and resources are needed to support rural communities in taking responsibility for their health systems.

Government and philanthropic organizations can be an important source of funding for development of these resources. We further recommend that states explore opportunities to create regional planning systems to improve the delivery of essential and specialty services in rural areas. While erectile dysfunction treatment has weakened rural health systems, it also provides an opportunity to pursue a new approach to engage rural communities in planning for and developing sustainable systems of care.

John Gale is a Senior Research Associate and the Director of Policy Engagement at the Maine Rural Health Research Center. His work concentrates on rural delivery systems including Rural Health Clinics. Critical Access Hospitals.

And mental health, substance use, primary care, and EMS services. The central focus of his work is on the development of systems of care that overcome the siloes inherent in our health care system and the development of programs and services to support rural providers. Latest posts by John Gale (see all) Alana KnudsonAlana Knudson, PhD, serves as a Program Area Director in the Public Health Department at NORC at the University of Chicago and is the Director of NORC’s Walsh Center for Rural Health Analysis.

Dr. Knudson has over 25 years of experience implementing and directing public health programs, leading health services and policy research projects, and evaluating program effectiveness. Latest posts by Alana Knudson (see all) Shena Popat, MHA, is a Research Scientist in the Walsh Center for Rural Health Analysis at NORC at the University of Chicago.

Ms. Popat has extensive experience working on rural and frontier health program evaluations and policy analysis projects, collaborating with partners and stakeholders to develop policy recommendations for federal agencies. Previously, Ms.

Popat served as a manager at a rural critical access hospital. Ms. Popat received her master’s in health administration from the George Washington University.

Latest posts by Shena Popat (see all) Share this:Like this:Like Loading... Listen to this post.

erectile dysfunction treatment has exposed the cracks cheap kamagra oral jelly uk in the foundation of America’s rural community health http://scaeyc.net/local-chapters/ system. These cracks include increased risk of facility closures, loss of services, low investment in public health, maldistribution of health professionals, and payment policies ill-suited to low-volume rural providers.As a result, short-term relief to stabilize rural health systems and long-term strategies to rebuild their foundations are necessary. In this post, we propose cheap kamagra oral jelly uk four policy cornerstones on which to rebuild the rural health system.

They include new financing and delivery models, community engagement, local health planning, and regionalization of delivery systems.The Cracked FoundationThe cracks in the rural health system’s foundation impair system performance on many levels. Rural hospitals, clinics, and emergency medical services (EMS) report reduced revenues and utilization. Shortages of personal protective equipment, testing supplies, and ventilators cheap kamagra oral jelly uk.

And limited erectile dysfunction treatment surge capacity. The chronic underfunding of rural public health has also dismantled emergency response capacity. Finally, enhanced cheap kamagra oral jelly uk payment policies have slowed, but not prevented, rural hospital closures.While these cracks are not new, erectile dysfunction treatment has revealed how deep they are.

For example, 172 rural hospitals have closed since 2005. Due to chronic underfunding, rural public health departments cheap kamagra oral jelly uk employ staff with narrower skill sets and fewer epidemiologists than their urban peers. Low patient utilization and revenues have severely reduced the crisis response capacity of rural health systems.

Rural communities have fewer health resources to respond to erectile dysfunction treatment.Despite concerns about hospital closures, a large percentage of rural residents bypass their local health systems. These bypass patterns reveal tension between the desire to retain local services and the will to sustain these services through utilization and financial support.Weaknesses of Volume-Based Payment PoliciesFee-for-service payment policies fail to address rural cheap kamagra oral jelly uk providers’ high fixed costs, inadequate cash reserves, and high reliance on non-emergent care revenues. They also discourage delivery of high-value, low-margin services such as primary care, chronic care, and prevention.To sustain low-volume rural providers, Medicare provides enhanced reimbursement to critical access, sole community, and Medicare-dependent hospitals and Rural Health Clinics.

Still, these designation programs rely on fee-for-service payment methods insufficient for cheap kamagra oral jelly uk rural providers. They fail to mitigate the impact of Medicare sequestration and bad debt cuts, low Medicaid and commercial reimbursement, low dependence on inpatient care, and declining rural populations.At the same time, volume-based payment policies in our market-based health system favor the location of services in larger communities and encourage providers to compete for business. This reality does not serve rural areas well, particularly small and isolated areas.

A competitive market approach, in the absence of formal health planning, inhibits coordination, promotes wasteful competition, distributes services inefficiently, and cheap kamagra oral jelly uk shifts planning from local to corporate levels.Patching the Foundation. Short-Term Solutionserectile dysfunction treatment has widened the cracks in our rural health foundation. Short-term responses have included financial support as well as regulatory relief to expand telehealth use and increase hospital bed availability.

These interventions seek to cheap kamagra oral jelly uk stabilize rural providers and their ability to respond to community needs. erectile dysfunction treatment’s impact has also renewed interest in the Rural Hospital Closure Relief Act of 2019 [PDF] (H.R. 5481/S.

3103). The Act would allow additional struggling rural hospitals to become Critical Access Hospitals by restoring state authority to designate necessary providers.After erectile dysfunction treatment, we will face difficult decisions. Some rural providers may close, while many others will be weakened.

State and local governments may face growing service demands with fewer resources to meet those demands.Rebuilding the Foundation. Long Term SolutionsWhile helpful, traditional rural support policies have not fully repaired the foundation of rural community health. Thus, long-term strategies to rebuild, rather than patch, the rural health foundation are needed.

In response, we propose the following four policy cornerstones to anchor this approach.Cornerstone 1. New financing and delivery system modelsNew rural financing and delivery system models are needed to:Respond to individual community requirements;Rightsize services;Reduce reliance on utilization and patient volume;Cover the costs of care, including fixed costs;Sustain crisis response capacity;Support public and population health, team-based care, telehealth, and transportation. AndEnsure access to inpatient, outpatient, specialty, and primary care services.Demonstrations in Maryland, Pennsylvania, and Vermont are testing payment and delivery system models that may inform future rural health system development.

Revisiting lessons learned from past state and federal demonstrations can provide additional information to supplement the results of these demonstrations.Cornerstone 2. Community engagementImplementation of rural delivery system models will be less effective unless communities engage in selecting models that meets their needs. Effective community engagement includes cross-sector representation, participation of vulnerable populations, and education on the economics of local health care services.

Community members must understand that health systems are not “public utilities” but resources requiring local utilization and financial support. Effective community engagement seeks to identify and reflect local concerns, values, and priorities. It should also explore why residents bypass local services to seek care outside of the community.

Communities will need tools, technical assistance, and resources to support their community engagement processes.Cornerstone 3. Local health planningCommunity engagement and local health planning are closely aligned. Local health planning processes are not the large-scale programs created under the National Health Planning and Resource Development Act of 1974.

Rather, they are local efforts that can leverage the community health needs assessments (CHNAs) required of tax-exempt hospitals or the Mobilizing for Action through Planning and Partnerships (MAPP) process, used by public health agencies for voluntary accreditation. These processes offer a framework to conduct community health planning and engagement focused on health rather than health services.Collaboration between hospitals and local health departments (LDHs) would result in more comprehensive community health assessments. Maryland, New York, North Carolina, and Ohio encourage collaboration between hospitals and LHDs and/or the alignment of their assessment cycles.

New York requires hospitals and LHDs to collaborate on CHNAs, prioritize community issues, and jointly implement initiatives to address health priorities. To maximize their effectiveness, these assessments and planning processes should reflect the health system and health improvement needs of the community.Cornerstone 4. Regionalization of delivery systemsRegionalization of high-cost services complements effective local health planning.

Rural health systems often compete in “medical arms races” for specialty and diagnostic services, resulting in duplication and inefficient resource use. In contrast, regionalization involves “rightsizing” health systems by organizing delivery of essential services locally and high-cost services regionally. The loss of rural obstetrical services is an opportunity to regionalize care by providing pre/postnatal services locally, performing deliveries at designated regional hospitals, and offering transportation to ensure access to regional services.Effective planning and regionalization require local and state-level input on the distribution of rural populations, needs, and services.

States can play an important role in encouraging regional health planning. Texas, for example, funded Regional Health Partnerships (RHPs) under a Medicaid 1115 waiver. RHPs, which include hospitals and LHDs.

RHPs must create plans to improve regional access, quality, cost-effectiveness and collaboration. Florida, as another example, established local health councils which are non-profit agencies that conduct regional health planning and implementation activities.Regional health planning can also support coordinated preparedness and response to local and global events. Minnesota, for example, established eight Health Care Coalitions that collaborate inter-regionally for planning and response purposes.

State Offices of Rural Health and other stakeholders can facilitate regional planning by convening health care, public health, and social service partners.With Crisis Comes OpportunityRural America has an exceptional history of resilience, innovation, and collaboration. Recovery from erectile dysfunction treatment requires new strategies to rebuild the crumbling rural health foundation. The four cornerstones – payment and delivery system reform, community engagement, local health planning, and regionalization – can provide the base for strong and vibrant health systems serving rural America.Tools and resources are needed to support rural communities in taking responsibility for their health systems.

Government and philanthropic organizations can be an important source of funding for development of these resources. We further recommend that states explore opportunities to create regional planning systems to improve the delivery of essential and specialty services in rural areas. While erectile dysfunction treatment has weakened rural health systems, it also provides an opportunity to pursue a new approach to engage rural communities in planning for and developing sustainable systems of care.

John Gale is a Senior Research Associate and the Director of Policy Engagement at the Maine Rural Health Research Center. His work concentrates on rural delivery systems including Rural Health Clinics. Critical Access Hospitals.

And mental health, substance use, primary care, and EMS services. The central focus of his work is on the development of systems of care that overcome the siloes inherent in our health care system and the development of programs and services to support rural providers. Latest posts by John Gale (see all) Alana KnudsonAlana Knudson, PhD, serves as a Program Area Director in the Public Health Department at NORC at the University of Chicago and is the Director of NORC’s Walsh Center for Rural Health Analysis.

Dr. Knudson has over 25 years of experience implementing and directing public health programs, leading health services and policy research projects, and evaluating program effectiveness. Latest posts by Alana Knudson (see all) Shena Popat, MHA, is a Research Scientist in the Walsh Center for Rural Health Analysis at NORC at the University of Chicago.

Ms. Popat has extensive experience working on rural and frontier health program evaluations and policy analysis projects, collaborating with partners and stakeholders to develop policy recommendations for federal agencies. Previously, Ms.

Popat served as a manager at a rural critical access hospital. Ms. Popat received her master’s in health administration from the George Washington University.

Latest posts by Shena Popat (see all) Share this:Like this:Like Loading... Listen to this post.

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RESEARCH

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My research is interdisciplinary and multi-level, and it coalesces around the broad areas of strategy, technology and innovation. Strategic innovation is the process by which an organization reinvents or redesigns its strategy to drive change, enhance value creation across stakeholders, and, ultimately, to sustain itself. Thus, it focuses on the art, science, and process of building, implementing, and constantly evaluating strategy in organizational settings. It integrates traditional approaches to strategic management, with the tools, frameworks, and values related to design thinking and innovation. As my record indicates, most of my research focuses specifically on the way information technology is used in organizational settings to help organizations achieve competitive advantage. I look toward the future, it is at this intersection and integration of disciplines and “schools of thought” that great opportunity for impact and contribution exists.

My passion is to understand how organizations can improve their capacity to innovate, change, and reinvent themselves through a more effective strategic innovation process, and re-conceptualizing the role of information technology. By developing and cultivating their strategic innovation capability, organizations will sustain themselves and create greater value for a broader range of stakeholders. While using theories and frameworks from diverse disciplines (strategy, social and cognitive psychology, innovation management, information systems), I examine how strategy and innovation occur within individuals, teams, organizations, inter-firm relationships, and even value chains and how it ultimately impacts value creation for diverse stakeholders. In doing so, I explore strategic innovation in both established and entrepreneurial firms and at multiple levels of analysis (network, inter-firm, organizational, and individual).

I resist reductionism when studying strategic innovation, and have a strong bias toward holistic and systems orientations to understand organizational systems and the inherently complex process of strategic innovation. In most cases, I explore these issues through in-depth, longitudinal qualitative case studies and have a strong action research orientation, though I believe strongly in the power of both qualitative and quantitative techniques if adequately applied. My current and future research streams are mentioned below.

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  1. Strategy Making Processes – In this stream I investigate the process of strategy making. and utilize an action research approach to examine it in its real world context and contribute to our collective understanding of how we can do it better.
  2. Innovation Management Processes – I focus specifically on design thinking and also utilize an action research methodology to contribute to our collective understanding of its efficacy and explore methods for making it even more useful in organizational settings.
  3. Strategic Innovation – This stream focuses on the linkages between strategy making and innovation management in organizational settings.


PUBLICATIONS

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Lewis, M., Hayward, S., Baxter, R., & Coffey, B.  “Stakeholder Enrolment and Business Network Formation: A Process Perspective on Technology Innovation.” International Journal of Technoentrepeneurship. Forthcoming.

Hornyay, R., Lewis, M., & Sankaranarayanan, B. “Radio Frequency Identification–Enabled Capabilities in a Healthcare Context: An Exploratory Study.” Health Informatics Journal, vol. 22, no. 3, 562–578.

Lewis, M., Hayward, S., & Kasi, V. 2015. “The Peril of One: Architecting a Sourcing Strategy at Edwards Paper Co.” Business Case Journal, vol. 22, no. 1.

Lewis, M., & Elevar, R. 2014. “Managing and Fostering Creativity: An Integrated Approach.” International Journal of Management Education, vol. 12, no. 3, 235–247.

Lewis, M., Hayward, S., & Kasi, V. 2013. “The Hazards of Sole Sourcing Relationships: Challenges, Practices, and Insights.” Advanced Management Journal, vol. 78, no. 3, 28–37.

Lewis, M., Baxter, R., & Pouder, R. 2013. “The Development and Deployment of Electronic Personal Health Records: A Strategic Positioning Perspective.” Journal of Health Organization and Management, vol. 27, no. 5, 577–600.

Lewis, M., Sankaranarayanan, B., & Rai, A. 2012. “Technology and Context: A Sociomaterial Perspective on Technology Enabled Change.” Academy of Management Annual Meeting Proceedings. 

Lewis, M. 2011. “An Integrated Approach to Teaching the Capstone Strategic Management Course: A Left- and Right-Brained Approach.” Business Education Innovation Journal, vol. 3, no. 2, 66–72.

Lewis, M., Mathiassen, L., & Rai, A. 2011. “Scalable Growth in IT-enabled Service Provisioning: A Sensemaking Perspective.” European Journal of Information Systems, vol. 20, no. 3, 285–302.

Gogan, J., & Lewis, M. 2011. “Peak Experiences and Strategic IT alignment at Vermont Teddy Bear.” Journal of Information Technology Teaching Cases.  No. JIT031-PDF-ENG

Rai, A., Venkatesh, V., Bala, H., & Lewis, M. 2010. “Transitioning to a Modular Enterprise Architecture: Drivers, Constraints, and Actions.” Management Information Systems Quarterly Executive, vol. 9, no. 2.

Lewis, M., Hornyak, R., Patnayakuni, R., & Rai, A. 2008. “Business Network Agility for Global Demand–Supply Synchronization: A Comparative Case Study in the Apparel Industry.” Journal of Global Information Technology Management, vol. 11, no. 2, 5–29.

Lewis, M., Young, B., Mathiassen, L., Rai, A., & Welke, R. 2007. “Business Process Innovation Based on Stakeholder Perceptions.” Information, Knowledge, and Systems Management, vol. 6, nos. 1-2, 7–27.

Lewis, M., Rai, A., Forquer, D., & Quinter, D. 2007. UPS and HP: Value Creation Through Supply Chain Partnerships. London, ON: Ivey Publishing. No. 907D02-PDF-ENG (Over 8,000 copies sold to date.)

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Lewis, M., Rai, A., & Mathiassen, L. 2016. The Enactment of Interorganizational Relational Strategy and the Dynamics of Governance. Academy of Management National Meeting, Anaheim, CA.

Lewis, M., & Pouder, R. 2015. Highland Brewing Company: Nipping at our Heels and Sitting on our Heads. North American Case Research Association Annual Conference, Orlando, FL.

Lewis, M., Hayward, S., & Baxter. R. 2013. Architecting a Sourcing Strategy: The Peril of One and the Downside of Many at Atlantico. North American Case Research Association Annual Conference, Victoria, BC.

Lewis, M., Sankaranarayanan, B., & Rai, A. 2012. Technology and Context: A Sociomaterial Perspective on Technology Enabled Change. Academy of Management National Meeting, Boston, MA.

Lewis, M., Sankaranarayanan, B., & Rai, A. 2011. RFID-Enabled Innovation and Its Impact on Healthcare Process Performance: A Multilevel Analysis. International Conference on Information Systems, St. Louis, MO.

Lewis, M., & Baxter, R. 2010. Negotiating the Pack: The Development and Deployment of Electronic Personal Health Records. TIM Track, Academy of Management National Meeting, Montréal, QC.

Gogan, J., Lewis, M., Sankaranaryanan, B., & Johnson, E. 2010. Aiming at a Moving Target: IT Alignment in Toy Companies. European Conference on Information Systems, Perto, South Africa.

Lewis, M., Sankaranarayanan, B., & Rai, A. 2009. Exploring Transition in Healthcare Information Systems: A Process Perspective on RFID Enabled Change. 29th Annual International Conference on Information Systems, Phoenix, AZ.

Baxter, R., & Lewis, M. 2009. The Influence of Industry Structure on the Development and Deployment of a Personal Health Record System. Organizations and Society in Information Systems (OASIS) Conference, Phoenix, AZ.

Lewis, M., Sankaranarayanan, B., & Rai, A. 2009. RFID-Enabled Process Capabilities and Their Impacts on Healthcare Process Performance: A Multilevel Analysis. European Conference on Information Systems, Verona, Italy.

Lewis, M., Mathiassen, L., & Rai, A. 2009. Developing IS-Enabled Capabilities for a Vendor: A Case Study. Americas Conference on Information Systems, San Francisco, CA.

Lewis, M., & Rai, A. 2007. Building Sustainable Partnerships. MISQ-Executive Workshop.

Lewis, M. 2005. Sensemaking in Strategic Outsourcing Partnerships: A Multilevel Investigation of IT enabled Dynamic Capabilities. Research Poster in the IFIP TC 8 WG 8.6 International Working Conference Notebook, Atlanta, GA.

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Lewis, M., & Rai, A. 2006. Building Sustainable Partnerships: Ensuring Your Supply Chain Partnerships are Built to Last. Supply Chain Strategy, MIT.

Rai, A., Sambamurthy, V., & Lewis, M. 2002. Adaptive Logistics and Transportation. SAP Sponsored Thought Leadership Forum on Adaptive Supply Chain Networks.

Rai, A., Ruppel, C., & Lewis, M. 2002. Sense and Respond. SAP Sponsored Thought Leadership Forum on Adaptive Supply Chain Networks.

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Lewis, M., Hornyak, R., & Pouder, R. 2016. Highland Brewing Company: A Case of Product and Experience Design. Craft Beverages and Tourism, Volume 1: The Rise of Breweries and Distilleries in the United States. Forthcoming.

 



COURSES

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AppLab is multidisciplinary course that uses design thinking to solve real world problems. It is team taught with a diverse group of faculty across the university and draws students from an equally diverse set of disciplinary backgrounds. It his highly experiential, problem based, and adopts a action learning pedagogy. Click here for course brochure and click here for press related to AppLab.

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I teach Strategic Management by integrating traditional strategic management frameworks and design thinking. The traditional strategic management frameworks are useful for helping students understand what strategy is and for assessing “as-is” states of organizations, but in my mind it falls short when helping to guide the creation of strategic priorities, initiatives, and measures (that move beyond incremental adjustments) as part of a strategic planning process. Therefore, to fill this gap, I utilize design thinking in the formulation stages to support ideation and support implementation efforts. Within strategic management I teach the following courses:

  • MBA 5750 – At the graduate level I push much of the content online and focus class time on the class project. Students are divided into teams and have an external client for which they are responsible for developing a strategic plan.
  • MGT 4750 – At the Undergraduate level I divide the course in two halves. The first focuses on learning the traditional strategic management frameworks. The second half focuses on applying the frameworks to a real life strategic planning project.

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This course explores individual level factors that can impede and enhance creativity, and then does a deep dive on the design thinking process. We conclude with a short module on the impact of the organizational environment for supporting design oriented work. Like most of my classes, this is also centered on a real world project with external clients.

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  • Managerial Decision Making
  • Introduction to Information Systems


CONSULTING

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My consulting is delivered through Trailhead Design Co. Trailhead’s purpose is to help organizations achieve Peak Performance by integrating innovation and strategy. We do this by helping you drive innovation throughout your organization and carve out a unique position in your industry to create competitive advantage. This integration of innovation and strategy leads to a powerful engine that drives sustainable growth. To achieve this, we focus on two key practice areas:

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Innovation Workshops: Our innovation workshops focus on helping you build the internal capabilities to continuously innovate. We offer them at three levels:

  • Design Thinking- At the process level we focus on design thinking, a problem framing and solving process that drives innovation. If we can help everyone in your organization learn design process and share a common vocabulary for innovation, great things can happen. Click here for our current design thinking workshop.
  • Innovative Environment – Great processes need to be embedded in organizational environment that support them. So we work with organizations to evaluate and then enhance their culture, organizational design, and leadership practices through our Innovative Environment offering.
  • Personal Mastery – Innovation is hard work, organizations need individuals that understand their unique role in enabling innovation to occur. So our third area of focus relates to personal mastery, or helping individuals develop the capacities to become positive change makers in their organizations.

Innovation Consulting:

  • Design Studio – Our design studio offering takes the hard work of design and innovation off of your shoulders. Come to us with a design challenge that you simply don’t have bandwidth to tackle internally, and we will assemble a diverse team of experts to deliver solutions at a fraction of the cost of larger design firms.

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Strategy Workshop: Our strategy workshop focuses on helping you build internal strategic planning capabilities so you can drive the process yourself, continuously.

  • Strategic Planning – This workshop teaches a novel approach to strategic planning that integrates traditional strategic planning frameworks with design thinking. Doing so helps clients challenge the status quo and discover novel ways to position themselves in their competitive industries, respond to environment changes, and create value for all stakeholders. The process culminates with clearly defined strategic priorities, initiatives, and measures to help your organization achieve Peak Performance.

Strategy Consulting: Let’s face it. You are busy. In this offering we do the heavy lifting. Where the most renowned strategic consultancies have MBAs, our team generally has PhDs. Yet, given lower overhead, we work for a fraction of the cost.

  • Strategy Consulting – We collect the data, we analyze and interpret it, and we formulate into a set of actionable priorities, initiates, and measures that help your company move forward. Of course, we do this while working side-by-side with you. We are experts in the process, in collecting and analyzing data to generate important insights, and framing it in actionable ways so you can move forward. You are experts in your business. Let’s work together.

Trailhead’s website is currently underdevelopment and will go live in Summer, 2017. Until then, contact me at markolewis@gmail.com for more information. We would love to help your organization become alive again, by enhancing its capacity to innovate and positioning it for continued success!

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