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SALT LAKE CITY, lowest price cipro May 06, cipro online canada 2021 (GLOBE NEWSWIRE) -- Health Catalyst, Inc. ("Health Catalyst," Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today reported financial results for the quarter ended March 31, 2021. ÂIn the first quarter of 2021, I am pleased to share that we achieved strong performance across our business, including exceeding the mid-point of our quarterly cipro online canada guidance for both revenue and Adjusted EBITDA,â said Dan Burton, CEO of Health Catalyst.
ÂI am also happy to report that in the most recent team member engagement and satisfaction survey, independently administered by the Gallup organization, team member satisfaction scores at Health Catalyst measured in the 96th percentile. This latest engagement level continues a pattern that has been in place for many years, of industry-leading engagement, consistently ranked between the 95th and 99th percentile in overall team member satisfaction scores. This latest result cipro online canada is of particular significance given that it comes during a period where we were required to adapt to global cipro necessitating a remote-only work environment, as well as having welcomed nearly two hundred new teammates who came to us primarily through multiple recent acquisitions.â Financial Highlights for the Three Months Ended March 31, 2021 Key Financial Metrics Three Months Ended March 31, Year over Year Change 2021 2020 GAAP Financial Data:(in thousands, except percentages, unaudited)Technology revenue$33,839 $24,699 37%Professional services revenue$22,007 $20,417 8%Total revenue$55,846 $45,116 24%Loss from operations$(24,317) $(18,105) (34)%Net loss$(28,370) $(17,490) (62)%Other Non-GAAP Financial Data:(1) Adjusted Technology Gross Profit$23,388 $16,969 38%Adjusted Technology Gross Margin69% 69% Adjusted Professional Services Gross Profit$6,929 $5,071 37%Adjusted Professional Services Gross Margin31% 25% Total Adjusted Gross Profit$30,317 $22,040 38%Total Adjusted Gross Margin54% 49% Adjusted EBITDA$(837) $(5,971) 86%________________________(1) These measures are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). See the accompanying "Non-GAAP Financial Measures" section below for more information about these financial measures, including the limitations of such measures, and for a reconciliation of each measure to the most directly comparable measure calculated in accordance with GAAP.
Financial Outlook Health Catalyst provides forward-looking guidance on total revenue, a GAAP measure, and Adjusted EBITDA, a non-GAAP measure. For the cipro online canada second quarter of 2021, we expect. Total revenue between $55.1 million and $58.1 million, andAdjusted EBITDA between $(4.8) million and $(2.8) millionFor the full year of 2021, we expect. Total revenue between $228.1 million and $231.1 million, andAdjusted EBITDA between $(15.0) million and $(13.0) millionWe have not reconciled guidance for Adjusted EBITDA to net loss, the most directly comparable GAAP measure, and have not provided forward-looking guidance for net loss, because there are items that may impact net loss, including stock-based compensation, that are not within our control or cannot be reasonably predicted.
Chair of the Board Transition On April 29, 2021, our board of directors cipro online canada (the board) accepted Dr. Tim Ferris's resignation from the board and all board committees, effective May 1, 2021. Dr. Ferris's resignation is not the result of any disagreement with Health Catalyst, but rather as a result of his new role as cipro online canada the National Director of Transformation for England's National Health Service (NHS).
NHS required Dr. Ferris to resign from our board in connection with his NHS appointment. ÂDr. Ferris provided a unique perspective that will continue to impact our company for years to come.
We are grateful for the opportunity to have benefited from his wisdom and experience, and we congratulate him on his new role as National Director of Transformation at NHS,â said Dan Burton, CEO. Health Catalyst is thrilled to announce that John A. (Jack) Kane has accepted the invitation to serve as chair of the board effective May 1, 2021. Mr.
Kane has been a director of the Company and has been the chair of the audit committee of the board since February 2016. Mr. Kane has more than 30 yearsâ experience in healthcare technology, including as a director and chairperson of the audit committee of Merchants Bancshares, Inc. (MBVT) from 2005 until 2014 and athenahealth, Inc.
From 2007 until February 2019. He previously occupied the position of CFO, Treasurer &. Senior VP-Administration at IDX Systems Corp. ÂJack has served on our board for many years.
His valuable guidance and feedback often challenges us to think deeply about our solutions. I am grateful for Jackâs dedication to our mission and his depth of financial leadership experience in healthcare and technology, which make him uniquely qualified to serve as our chair,â said Burton. Quarterly Conference Call Details The company will host a conference call to review the results today, Thursday, May 6, 2021, at 5:00 p.m. E.T.
The conference call can be accessed by dialing 1-877-295-1104 for U.S. Participants, or 1-470-495-9486 for international participants, and referencing participant code 9183315. A live audio webcast will be available online at https://ir.healthcatalyst.com/. A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days.
About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platformâpowered by data from more than 100 million patient records and encompassing trillions of factsâas well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed. Available Information Health Catalyst intends to use its Investor Relations website as a means of disclosing material non-public information and for complying with its disclosure obligations under Regulation FD.
Forward-Looking Statements This release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, as amended. These forward-looking statements include statements regarding our future growth and our financial outlook for Q2 and fiscal year 2021. Forward-looking statements are subject to risks and uncertainties and are based on potentially inaccurate assumptions that could cause actual results to differ materially from those expected or implied by the forward-looking statements. Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance.
Important risks and uncertainties that could cause our actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following. (i) changes in laws and regulations applicable to our business model. (ii) changes in market or industry conditions, regulatory environment and receptivity to our technology and services. (iii) results of litigation or a security incident.
(iv) the loss of one or more key customers or partners. (v) the impact of buy antibiotics on our business and results of operations. And (vi) changes to our abilities to recruit and retain qualified team members. For a detailed discussion of the risk factors that could affect our actual results, please refer to the risk factors identified in our SEC reports, including, but not limited to the Annual Report on Form 10-K for the year ended December 31, 2020 filed with the SEC on or about February 25, 2021 and the Quarterly Report on Form 10-Q for the fiscal quarter ended March 31, 2021 expected to be filed with the SEC on or about May 7, 2021.
All information provided in this release and in the attachments is as of the date hereof, and we undertake no duty to update or revise this information unless required by law. Condensed Consolidated Balance Sheets(in thousands, except share and per share data, unaudited) As ofMarch 31, As ofDecember 31, 2021 2020Assets Current assets. Cash and cash equivalents$132,627 $91,954 Short-term investments133,807 178,917 Accounts receivable, net45,905 48,296 Prepaid expenses and other assets12,404 10,632 Total current assets324,743 329,799 Property and equipment, net18,653 12,863 Intangible assets, net91,840 98,921 Operating lease right-of-use assets24,093 24,729 Goodwill107,822 107,822 Other assets4,068 3,606 Total assets$571,219 $577,740 Liabilities and stockholdersâ equity Current liabilities. Accounts payable$4,626 $5,332 Accrued liabilities12,946 16,510 Acquisition-related consideration payableâ 2,000 Deferred revenue51,634 47,145 Operating lease liabilities2,454 2,622 Contingent consideration liabilities15,902 14,427 Convertible senior notes, net171,864 â Total current liabilities259,426 88,036 Convertible senior notes, net of current portionâ 168,994 Deferred revenue, net of current portion1,135 1,878 Operating lease liabilities, net of current portion23,083 23,669 Contingent consideration liabilities, net of current portion16,509 16837 Other liabilities2,230 2227 Total liabilities302,383 301,641 Commitments and contingencies Stockholdersâ equity.
Common stock, $0.001 par value. 44,340,036 and 43,376,848 shares issued and outstanding as of March 31, 2021 and December 31, 2020, respectively44 43 Additional paid-in capital1,022,781 1,001,645 Accumulated deficit(754,020) (725,650)Accumulated other comprehensive income31 61 Total stockholders' equity268,836 276,099 Total liabilities and stockholdersâ equity$571,219 $577,740 Condensed Consolidated Statements of Operations(in thousands, except per share data, unaudited) Three Months EndedMarch 31, 2021 2020Revenue. Technology$33,839 $24,699 Professional services22,007 20,417 Total revenue55,846 45,116 Cost of revenue, excluding depreciation and amortization. Technology(1)10,825 7,906 Professional services(1)16,513 16,162 Total cost of revenue, excluding depreciation and amortization27,338 24,068 Operating expenses.
Sales and marketing(1)15,651 13,487 Research and development(1)14,345 13,088 General and administrative(1)(2)(3)15,015 9,701 Depreciation and amortization7,814 2,877 Total operating expenses52,825 39,153 Loss from operations(24,317) (18,105)Interest and other expense, net(3,952) (621)Loss before income taxes(28,269) (18,726)Income tax provision (benefit)101 (1,236)Net loss$(28,370) $(17,490)Net loss per share, basic and diluted$(0.65) $(0.47)Weighted-average shares outstanding used in calculating net loss per share, basic and diluted43,870 37,109 Adjusted net loss(4)$(2,753) $(6,083)Adjusted net loss per share, basic and diluted(4)$(0.06) $(0.16) _______________(1) Includes stock-based compensation expense as follows. Three Months EndedMarch 31, 2021 2020 Stock-Based Compensation Expense:(in thousands)Cost of revenue, excluding depreciation and amortization. Technology$374 $176 Professional services1,435 816 Sales and marketing4,818 3,182 Research and development2,257 1,882 General and administrative4,626 2,685 Total$13,510 $8,741 (2) Includes acquisition transaction costs as follows. Three Months EndedMarch 31, 2021 2020 Acquisition transaction costs:(in thousands)General and administrative$â $875 (3) Includes the change in fair value of contingent consideration liabilities, as follows.
Three Months EndedMarch 31, 2021 2020 Change in fair value of contingent consideration liabilities:(in thousands)General and administrative$2,156 $(359)(4) Includes non-GAAP adjustments to net loss. Refer to the "Non-GAAP Financial MeasuresâAdjusted Net Loss Per Share" section below for further details. Condensed Consolidated Statements of Cash Flows(in thousands, unaudited) Three Months Ended March 31,Cash flows from operating activities2021 2020Net loss$(28,370) $(17,490)Adjustments to reconcile net loss to net cash used in operating activities. Depreciation and amortization7,814 2,877 Amortization of debt discount and issuance costs2,870 285 Non-cash operating lease expense965 741 Investment discount and premium amortization417 (6)Provision for expected credit losses300 51 Stock-based compensation expense13,510 8,741 Deferred tax (benefit) provision2 (1,280)Change in fair value of contingent consideration liabilities2,156 (359)Other(34) (4)Change in operating assets and liabilities.
Accounts receivable, net2,090 (7,335)Deferred costsâ 444 Prepaid expenses and other assets(2,173) (2,244)Accounts payable, accrued liabilities, and other liabilities(5,352) (4,283)Deferred revenue3,745 3,936 Operating lease liabilities(1,083) (843)Net cash used in operating activities(3,143) (16,769) Cash flows from investing activities Purchase of short-term investments(8,621) â Proceeds from the sale and maturity of short-term investments53,240 66,653 Acquisition of businesses, net of cash acquiredâ (15,249)Purchase of property and equipment(5,882) (428)Capitalization of internal use software(887) (78)Purchase of intangible assets(480) (758)Proceeds from sale of property and equipment6 6 Net cash provided by investing activities37,376 50,146 Cash flows from financing activities Proceeds from exercise of stock options6,488 9,046 Proceeds from employee stock purchase plan1,349 1,289 Payments of acquisition-related consideration(1,391) (748)Net cash provided by financing activities6,446 9,587 Effect of exchange rate on cash and cash equivalents(6) (31)Net increase in cash and cash equivalents40,673 42,933 Cash and cash equivalents at beginning of period91,954 18,032 Cash and cash equivalents at end of period$132,627 $60,965 Non-GAAP Financial Measures To supplement our financial information presented in accordance with GAAP, we believe certain non-GAAP measures, including Adjusted Gross Profit, Adjusted Gross Margin, Adjusted EBITDA, Adjusted Net Loss, and Adjusted Net Loss per share, basic and diluted, are useful in evaluating our operating performance. For example, we exclude stock-based compensation expense because it is non-cash in nature and excluding this expense provides meaningful supplemental information regarding our operational performance and allows investors the ability to make more meaningful comparisons between our operating results and those of other companies. We use this non-GAAP financial information to evaluate our ongoing operations, as a component in determining employee bonus compensation, and for internal planning and forecasting purposes. We believe that non-GAAP financial information, when taken collectively, may be helpful to investors because it provides consistency and comparability with past financial performance.
However, non-GAAP financial information is presented for supplemental informational purposes only, has limitations as an analytical tool and should not be considered in isolation or as a substitute for financial information presented in accordance with GAAP. In addition, other companies, including companies in our industry, may calculate similarly-titled non-GAAP measures differently or may use other measures to evaluate their performance. A reconciliation is provided below for each non-GAAP financial measure to the most directly comparable financial measure stated in accordance with GAAP. Investors are encouraged to review the related GAAP financial measures and the reconciliation of these non-GAAP financial measures to their most directly comparable GAAP financial measures, and not to rely on any single financial measure to evaluate our business.
Adjusted Gross Profit and Adjusted Gross Margin Adjusted Gross Profit is a non-GAAP financial measure that we define as revenue less cost of revenue, excluding depreciation and amortization and excluding stock-based compensation. We define Adjusted Gross Margin as our Adjusted Gross Profit divided by our revenue. We believe Adjusted Gross Profit and Adjusted Gross Margin are useful to investors as they eliminate the impact of certain non-cash expenses and allow a direct comparison of these measures between periods without the impact of non-cash expenses and certain other non-recurring operating expenses. The following is a reconciliation of revenue, the most directly comparable GAAP financial measure, to Adjusted Gross Profit, for the three months ended March 31, 2021 and 2020.
Three Months Ended March 31, 2021 (in thousands, except percentages) Technology Professional Services TotalRevenue$33,839 $22,007 $55,846 Cost of revenue, excluding depreciation and amortization(10,825) (16,513) (27,338)Gross profit, excluding depreciation and amortization23,014 5,494 28,508 Add. Stock-based compensation374 1,435 1,809 Adjusted Gross Profit$23,388 $6,929 $30,317 Gross margin, excluding depreciation and amortization68% 25% 51%Adjusted Gross Margin69% 31% 54% Three Months Ended March 31, 2020 (in thousands, except percentages) Technology Professional Services TotalRevenue$24,699 $20,417 $45,116 Cost of revenue, excluding depreciation and amortization(7,906) (16,162) (24,068)Gross profit, excluding depreciation and amortization16,793 4,255 21,048 Add. Stock-based compensation176 816 992 Adjusted Gross Profit$16,969 $5,071 $22,040 Gross margin, excluding depreciation and amortization68% 21% 47%Adjusted Gross Margin69% 25% 49% Adjusted EBITDA Adjusted EBITDA is a non-GAAP financial measure that we define as net loss adjusted for (i) interest and other expense, net, (ii) income tax (benefit) provision, (iii) depreciation and amortization, (iv) stock-based compensation, (v) acquisition transaction costs, and (vi) change in fair value of contingent consideration liabilities when they are incurred. We view acquisition-related expenses when applicable, such as transaction costs and changes in the fair value of contingent consideration liabilities that are directly related to business combinations as events that are not necessarily reflective of operational performance during a period.
We believe Adjusted EBITDA provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance. The following is a reconciliation of our net loss, the most directly comparable GAAP financial measure, to Adjusted EBITDA, for the three months ended March 31, 2021 and 2020. Three Months EndedMarch 31, 2021 2020 (in thousands)Net loss$(28,370) $(17,490)Add. Interest and other expense, net3,952 621 Income tax (benefit) provision101 (1,236)Depreciation and amortization7,814 2,877 Stock-based compensation13,510 8,741 Acquisition transaction costsâ 875 Change in fair value of contingent consideration liabilities2,156 (359)Adjusted EBITDA$(837) $(5,971) Adjusted Net Loss Per Share Adjusted Net Loss is a non-GAAP financial measure that we define as net loss attributable to common stockholders adjusted for (i) stock-based compensation, (ii) amortization of acquired intangibles, (iii) acquisition transaction costs, (iv) change in fair value of contingent consideration liabilities, and (v) non-cash interest expense related to our convertible senior notes.
We believe Adjusted Net Loss provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance. Three Months Ended March 31, 2021 2020 Numerator:(in thousands, except share and per share amounts)Net loss attributable to common stockholders$(28,370) $(17,490)Add. Stock-based compensation13,510 8,741 Amortization of acquired intangibles7,081 2,150 Acquisition transaction costsâ 875 Change in fair value of contingent consideration liabilities2,156 (359)Non-cash interest expense related to convertible senior notes2,870 â Adjusted Net Loss$(2,753) $(6,083)Denominator. Weighted-average number of shares used in calculating net loss, basic and diluted43,870,288 37,108,998 Adjusted net loss per share, basic and diluted$(0.06) $(0.16) Health Catalyst Investor Relations Contact:Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact:Amanda HundtVice President, Corporate Communicationsamanda.hundt@healthcatalyst.com+1 (575) 491-0974SALT LAKE CITY, April 20, 2021 (GLOBE NEWSWIRE) -- Health Catalyst, Inc.
("Health Catalyst", Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, will release its 2021 first quarter operating results on Thursday, May 6, 2021, after market close. In conjunction, the company will host a conference call to review the results at 5 p.m. E.T.
On the same day. Conference Call Details The conference call can be accessed by dialing 1-877-295-1104 for U.S. Participants, or 1-470-495-9486 for international participants, and referencing participant code 9183315. A live audio webcast will be available online at https://ir.healthcatalyst.com/.
A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days. About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platformâpowered by data from more than 100 million patient records and encompassing trillions of factsâas well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial and operational improvements. Health Catalyst envisions a future in which all healthcare decisions are data informed.
Health Catalyst Investor Relations Contact. Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact:Amanda Hundt+1 (575)-491-0974amanda.hundt@healthcatalyst.com.
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As part of our ongoing commitment to prioritizing healing and humanity as we cipro consumer settlement stand against social http://middleburghigh89.com/friday-evening-social/ injustice, Mathematica is pleased to announce that President and CEO Paul Decker is joining more than 1,300 CEOs and business leaders as a member of CEO Action for Diversity and Inclusionâ¢. This coalition represents the largest CEO-driven business commitment to advancing workplace diversity, equity, and inclusion, while working to ensure opportunity at the highest levels of corporate leadership.âDuring a time when the nation continues to be tested by unresolved issues of social justice, Mathematica has taken significant strides toward centering diversity, equity, and inclusion in our interactions with each other and in our approach to our work,â said Decker. ÂToday, weâre taking another important step forward by joining CEO Action for Diversity and Inclusion, an organization that unites business leaders from around the world to advance DEI initiatives in our own workplaces cipro consumer settlement and beyond.
Iâm honored to represent Mathematica in this coalition fighting for meaningful change.âCEO Action represents approximately 13 million employees across more than 85 industries. As a member through its CEO, Mathematica has committed to dedicating time and resources to advancing diversity, equity, and inclusion both within Mathematica and as part of the CEO Action network. Decker has also taken the CEO Action pledge to âcheck my bias, speak up for others and show up for all.âA 100% employee-owned company, Mathematica works with private- and public-sector agencies, corporations, and foundations around the world, using data and evidence to cipro consumer settlement improve the lives of people and communities.
About CEO Action for Diversity &. Inclusion⢠CEO Action for Diversity &. Inclusion⢠is the largest CEO-driven business commitment to advance cipro consumer settlement diversity and inclusion within the workplace.
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For more information, please contact:Jennifer de Vallancejdevallance@mathematica-mpr.com202-484-4692Mathematica is committed to advancing public health by applying our expertise across disciplines that constitute some of the most critical areas of public health today. The following focus areas highlight how weâre working to progress together to improve public well-being.APHA Public Health Film Festival. Helping Families Affected by Substance UseThe APHA selected a short film that Mathematica produced with support from the Administration for Children and Families to show at the APHA Public Health Film Festival.
The film focuses on how the Regional Partnership Grant program improves the safety, permanency, and well-being of children affected by parentâs substance use disorders. Starting October 19, registered APHA Annual Meeting attendees can watch the film on demand. Registered attendees can also submit questions to Debra Strong a senior researcher for the Regional Partnership Grant National Cross-Site http://crossfitvtg.com/wods/thursday-150205/ Evaluation, using a discussion board that will be available with the film.
Please visit APHAâs page about public health films focusing on substance use and addiction treatment for more information. Diversity, Equity, and InclusionWhat does it take for organizations to progress together?. It takes a common purpose, shared values, a complementary array of resources and capabilities, and a mutual desire to learn from and with each other.
Our ongoing diversity, equity, and inclusion journey is driving necessary changes in who we are. How we relate to each other, our partners, and our communities. And how we approach our work.
Social Determinants of HealthPolicymakers and practitioners are increasingly interested in social determinants of healthâthe conditions in which people are born, grow, live, work, and ageâto address upstream social risks, such as food insecurity and lack of affordable housing, that, in turn, improve health care outcomes. Mathematica data and policy experts recently produced a series of blog posts and research on how different stakeholders can improve and leverage data on social determinants of health to maximize the health and well-being of children and adults in the United States.buy antibiotics ServicesResponding to the current public health crisis and illuminating the path forward to safely re-open businesses, schools, workplaces, and community services requires a seasoned partner with trusted solutions. Built on our foundation of rigorous data and evidence, Mathematicaâs scalable services provide state and local agencies, as well as private-sector employers, with the confidence and clarity they need to take on the complex challenges of buy antibiotics.
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As part of our ongoing commitment to prioritizing healing and humanity as we stand against social injustice, Mathematica is pleased to announce that President and CEO Paul Decker cipro online canada is joining more than 1,300 CEOs and business leaders as a member of CEO Action for Diversity and Inclusionâ¢. This coalition represents the largest CEO-driven business commitment to advancing workplace diversity, equity, and inclusion, while working to ensure opportunity at the highest levels of corporate leadership.âDuring a time when the nation continues to be tested by unresolved issues of social justice, Mathematica has taken significant strides toward centering diversity, equity, and inclusion in our interactions with each other and in our approach to our work,â said Decker. ÂToday, weâre taking another important step forward by joining CEO Action for cipro online canada Diversity and Inclusion, an organization that unites business leaders from around the world to advance DEI initiatives in our own workplaces and beyond.
Iâm honored to represent Mathematica in this coalition fighting for meaningful change.âCEO Action represents approximately 13 million employees across more than 85 industries. As a member through its CEO, Mathematica has committed to dedicating time and resources to advancing diversity, equity, and inclusion both within Mathematica and as part of the CEO Action network. Decker has also taken cipro online canada the CEO Action pledge to âcheck my bias, speak up for others and show up for all.âA 100% employee-owned company, Mathematica works with private- and public-sector agencies, corporations, and foundations around the world, using data and evidence to improve the lives of people and communities.
About CEO Action for Diversity &. Inclusion⢠CEO Action for Diversity &. Inclusion⢠is the largest CEO-driven cipro online canada business commitment to advance diversity and inclusion within the workplace.
Bringing together more than 1,000 CEOs of Americaâs leading organizations, the commitment outlines actions that participating companies pledge to take to cultivate a workplace where diverse perspectives and experiences are welcomed and respected, employees feel comfortable and encouraged to discuss diversity and inclusion, and where best knownâand successfulâactions can be shared across organizations. Learn more at CEOAction.com and connect with them on Twitter. @CEOAction.
For more information, please contact:Jennifer de Vallancejdevallance@mathematica-mpr.com202-484-4692Mathematica is committed to advancing public health by applying our expertise across disciplines that constitute some of the most critical areas of public health today. The following focus areas highlight how weâre working to progress together to improve public well-being.APHA Public Health Film Festival. Helping Families Affected by Substance UseThe APHA selected a short film that Mathematica produced with support from the Administration for Children and Families to show at the APHA Public Health Film Festival.
The film focuses on how the Regional Partnership Grant program improves the safety, permanency, and well-being of children affected by parentâs substance use disorders. Starting October 19, registered APHA Annual Meeting attendees can watch the film on demand. Registered attendees can also submit questions to Debra Strong a senior researcher for the Regional Partnership Grant National Cross-Site Evaluation, using a discussion board that will be available with the film.
Please visit APHAâs page about public health films focusing on substance use and addiction treatment for more information. Diversity, Equity, and InclusionWhat does it take for organizations to progress together?. It takes a common purpose, shared values, a complementary array of resources and capabilities, and a mutual desire to learn from and with each other.
Our ongoing diversity, equity, and inclusion journey is driving necessary changes in who we are. How we relate to each other, our partners, and our communities. And how we approach our work.
Social Determinants of HealthPolicymakers and practitioners are increasingly interested in social determinants of healthâthe conditions in which people are born, grow, live, work, and ageâto address upstream social risks, such as food insecurity and lack of affordable housing, that, in turn, improve health care outcomes. Mathematica data and policy experts recently produced a series of blog posts and research on how different stakeholders can improve and leverage data on social determinants of health to maximize the health and well-being of children and adults in the United States.buy antibiotics ServicesResponding to the current public health crisis and illuminating the path forward to safely re-open businesses, schools, workplaces, and community services requires a seasoned partner with trusted solutions. Built on our foundation of rigorous data and evidence, Mathematicaâs scalable services provide state and local agencies, as well as private-sector employers, with the confidence and clarity they need to take on the complex challenges of buy antibiotics.
Some of our services include contact tracing, workforce planning, modeling and forecasting, and wastewater testing and analysis.Data Analytics and Survey ExpertiseAt Mathematica, we apply our expertise at the intersection of data science and social science to produce efficient, high quality, and action-oriented analysis that advances your mission.Using advanced technologies, reusable and scalable platforms, and high-performance secure cloud infrastructure, we enable our partners to target areas of opportunity and make the most of their data. We collect the data you need, manage data as a secure asset, analyze to surface insights, and place this knowledge in the hands of those who need it most.Mental Health and Substance UseMathematica understands the pressing challenges faced by our partners working to improve the delivery system, innovative value-based service models, and financing strategies that states and payers are testingâstrategies that could improve the prevention and treatment of behavioral health conditions. Weâre leading efforts to address the opioid crisis, increase access to care while controlling costs, and support the integration of behavioral health services with other health care and social services.Our staff have in-depth knowledge of the complex array of intersecting public and private programs and eligibility requirements that create challenges for consumers to get the help they need.
Our work involves evaluating a wide range of behavioral health service delivery and payment models, helping partners establish programs that implement new services and policies and fill data gaps, fielding large-scale behavioral health surveys, developing and implementing behavioral health quality measures, and analyzing policy to guide decision making. For more than two decades, weâve conducted national surveys of every known mental health and substance use disorder treatment facility in the country. Our analyses of T-MSIS data for the Centers for Medicare &.
Medicaid Services provide critical information on patterns of substance use disorders and treatment across states as evidenced by the T-MSIS Substance Use Disorder (SUD) Data Book and a series of supporting data quality briefs..
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About This TrackerThis tracker provides the number of confirmed cases and deaths from novel antibiotics by country, the trend in confirmed case and death counts by country, and a global map showing which countries have cipro cause c diff confirmed cases and deaths. The data are drawn from the Johns Hopkins University (JHU) antibiotics Resource Centerâs buy antibiotics Map and the World Health Organizationâs (WHO) antibiotics Disease (buy antibiotics-2019) situation reports.This tracker will be updated regularly, as new data are released.Related Content. About buy antibiotics cipro cause c diff antibioticsIn late 2019, a new antibiotics emerged in central China to cause disease in humans. Cases of this disease, known as buy antibiotics, have since been reported across around the globe. On January 30, 2020, the World Health Organization (WHO) declared the cipro represents a public health emergency cipro cause c diff of international concern, and on January 31, 2020, the U.S.
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If Bidenâs health proposals are stymied by a divided Congress, he may look to use administrative actions beyond whatâs detailed here to advance his health care agenda.In this table, we note whether executive actions require regulatory change, as an indication of how much time it may take the Biden Administration to implement these changes. For some regulatory changes, the Biden Administration will need to cipro cause c diff issue a new Notice of Proposed Rule Making (NPRM) and allow a public comment period before revising the regulation. Rules made through annual payment notices, such as the Notice of Benefit and Payment Parameters (NBPP) may be revised annually.By contrast, the Biden Administration may more quickly be able to reverse Trump Administration regulations that are proposed but not yet final as well as policies made through sub-regulatory agency guidance or executive order. Some sub-regulatory actions, such as renewing the buy antibiotics Public Health cipro cause c diff Emergency Declaration that is currently set to expire on Inauguration Day, will require attention on Bidenâs first day in office. Biden would also likely rescind pending rules that would sunset HHS regulations if not reviewed every 10 years (which could increase administrative burden for the agency and result in regulations with beneficiary protections expiring).
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Department of Health and Human Services declared it to be a health emergency for the United States.President-elect Joe Biden campaigned on supporting and building upon the Affordable Care Act (ACA), better managing the antibiotics cipro and lowering prescription drug costs. However, with the political balance cipro online canada of the Senate uncertain, some Biden proposals, like creating a new public option and lowering the Medicare age to 60, are less likely to be enacted. Even so, as president, Biden could exercise executive branch authority to move forward on a variety of policy changes he has advocated through administrative action without Congress.The table below includes potential administrative actions under the incoming Biden Administration, based on campaign pledges, and actions that would reverse or modify controversial regulations or guidance issued by the Trump Administration. The table also describes actions Biden could take as president that have received a great deal of attention from other prominent Democrats or are generally consistent with his campaign proposals, and that may therefore be priorities in Bidenâs Administration. This table is cipro online canada not an exhaustive list of possible Biden Administration actions and does not include potential administrative actions pertaining to all health policy areas, including Medicare and prescription drug costs, where there is no clear indication of whether or how the Biden Administration would modify Trump Administration policies.
If Bidenâs health proposals are stymied by a divided Congress, he may look to use administrative actions beyond whatâs detailed here to advance his health care agenda.In this table, we note whether executive actions require regulatory change, as an indication of how much time it may take the Biden Administration to implement these changes. For some regulatory changes, the Biden Administration will need to issue a new Notice of Proposed Rule Making (NPRM) cipro online canada and allow a public comment period before revising the regulation. Rules made through annual payment notices, such as the Notice of Benefit and Payment Parameters (NBPP) may be revised annually.By contrast, the Biden Administration may more quickly be able to reverse Trump Administration regulations that are proposed but not yet final as well as policies made through sub-regulatory agency guidance or executive order. Some sub-regulatory cipro online canada actions, such as renewing the buy antibiotics Public Health Emergency Declaration that is currently set to expire on Inauguration Day, will require attention on Bidenâs first day in office. Biden would also likely rescind pending rules that would sunset HHS regulations if not reviewed every 10 years (which could increase administrative burden for the agency and result in regulations with beneficiary protections expiring).
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August 28, difference between cipro and bactrim 2020Contact. Office of CommunicationsPhone. 202-693-1999U.S. Department of Labor Issues Revised Final Beryllium StandardsFor Construction and Shipyards WASHINGTON, DC - The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) today published a final rule revising the beryllium standards for construction and shipyards.
The final rule includes changes designed to clarify the standards and simplify or improve compliance. These changes maintain protection for workers while ensuring that the standard is well understood and compliance is simple and straightforward. The final rule amends the following paragraphs in the beryllium standards for construction and shipyards. Definitions, Methods of Compliance, Respiratory Protection, Personal Protective Clothing and Equipment, Housekeeping, Hazard Communication, Medical Surveillance, and Recordkeeping. OSHA has removed the Hygiene Areas and Practices paragraph from the final standards because the necessary protections are provided by existing OSHA standards for sanitation.
The effective date of the revisions in this final rule is September 30, 2020. OSHA began enforcing the new permissible exposure limits in the 2017 beryllium standards for construction and shipyards in May 2018. OSHA will begin enforcing the remaining provisions of the standards on September 30, 2020. The final standard will affect approximately 12,000 workers employed in nearly 2,800 establishments in the construction and shipyard industries. The final standards are estimated to yield $2.5 million in total annualized cost savings to employers.
Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to help ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education, and assistance. For more information, visit www.osha.gov. The mission of the Department of Labor is to foster, promote, and develop the welfare of the wage earners, job seekers, and retirees of the United States. Improve working conditions.
Advance opportunities for profitable employment. And assure work-related benefits and rights. # # # U.S. Department of Labor news materials are accessible at http://www.dol.gov. The Department's Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print.
For alternative format requests, please contact the Department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay)..
August 28, Buy generic lasix online 2020Contact cipro online canada. Office of CommunicationsPhone. 202-693-1999U.S.
Department of Labor Issues Revised Final Beryllium StandardsFor Construction and Shipyards WASHINGTON, DC - The U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) today published a final rule revising the beryllium standards for construction and shipyards. The final rule includes changes designed to clarify the standards and simplify or improve compliance.
These changes maintain protection for workers while ensuring that the standard is well understood and compliance is simple and straightforward. The final rule amends the following paragraphs in the beryllium standards for construction and shipyards. Definitions, Methods of Compliance, Respiratory Protection, Personal Protective Clothing and Equipment, Housekeeping, Hazard Communication, Medical Surveillance, and Recordkeeping.
OSHA has removed the Hygiene Areas and Practices paragraph from the final standards because the necessary protections are provided by existing OSHA standards for sanitation. The effective date of the revisions in this final rule is September 30, 2020. OSHA began enforcing the new permissible exposure limits in the 2017 beryllium standards for construction and shipyards in May 2018.
OSHA will begin enforcing the remaining provisions of the standards on September 30, 2020. The final standard will affect approximately 12,000 workers employed in nearly 2,800 establishments in the construction and shipyard industries. The final standards are estimated to yield $2.5 million in total annualized cost savings to employers.
Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA's role is to help ensure these conditions for America's working men and women by setting and enforcing standards, and providing training, education, and assistance. For more information, visit www.osha.gov.
The mission of the Department of Labor is to foster, promote, and develop the welfare of the wage earners, job seekers, and retirees of the United States. Improve working conditions. Advance opportunities for profitable employment.
And assure work-related benefits and rights. # # # U.S. Department of Labor news materials are accessible at http://www.dol.gov.
The Department's Reasonable Accommodation Resource Center converts departmental information and documents into alternative formats, which include Braille and large print. For alternative format requests, please contact the Department at (202) 693-7828 (voice) or (800) 877-8339 (federal relay)..
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SALT LAKE http://heonptg.com/welcome-to-the-new-heonptg-com/ CITY, cipro and yeast May 06, 2021 (GLOBE NEWSWIRE) -- Health Catalyst, Inc. ("Health Catalyst," Nasdaq. HCAT), a leading provider of data and analytics technology and services to healthcare organizations, today reported financial results for the quarter ended cipro and yeast March 31, 2021.
ÂIn the first quarter of 2021, I am pleased to share that we achieved strong performance across our business, including exceeding the mid-point of our quarterly guidance for both revenue and Adjusted EBITDA,â said Dan Burton, CEO of Health Catalyst. ÂI am also happy to report that in the most recent team member engagement and satisfaction survey, independently administered by the Gallup organization, team member satisfaction cipro and yeast scores at Health Catalyst measured in the 96th percentile. This latest engagement level continues a pattern that has been in place for many years, of industry-leading engagement, consistently ranked between the 95th and 99th percentile in overall team member satisfaction scores.
This latest result is of particular significance given that it comes during a period where we were required to adapt to global cipro necessitating a remote-only work environment, as well as having welcomed nearly two hundred new teammates who came to us primarily through multiple recent acquisitions.â Financial Highlights for the Three Months Ended March 31, 2021 Key Financial Metrics Three Months Ended March 31, Year over Year Change 2021 2020 GAAP Financial Data:(in thousands, except percentages, unaudited)Technology revenue$33,839 $24,699 37%Professional services revenue$22,007 $20,417 8%Total revenue$55,846 $45,116 24%Loss from operations$(24,317) $(18,105) (34)%Net loss$(28,370) $(17,490) (62)%Other Non-GAAP Financial Data:(1) cipro and yeast Adjusted Technology Gross Profit$23,388 $16,969 38%Adjusted Technology Gross Margin69% 69% Adjusted Professional Services Gross Profit$6,929 $5,071 37%Adjusted Professional Services Gross Margin31% 25% Total Adjusted Gross Profit$30,317 $22,040 38%Total Adjusted Gross Margin54% 49% Adjusted EBITDA$(837) $(5,971) 86%________________________(1) These measures are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). See the accompanying "Non-GAAP Financial Measures" section below for more information about these financial measures, including the limitations of such measures, and for a reconciliation of each measure to the most directly comparable measure calculated in accordance with GAAP. Financial Outlook Health Catalyst provides forward-looking guidance on total revenue, a GAAP measure, and Adjusted EBITDA, a non-GAAP measure.
For the cipro and yeast second quarter of 2021, we expect. Total revenue between $55.1 million and $58.1 million, andAdjusted EBITDA between $(4.8) million and $(2.8) millionFor the full year of 2021, we expect. Total revenue between $228.1 million and $231.1 million, andAdjusted cipro and yeast EBITDA between $(15.0) million and $(13.0) millionWe have not reconciled guidance for Adjusted EBITDA to net loss, the most directly comparable GAAP measure, and have not provided forward-looking guidance for net loss, because there are items that may impact net loss, including stock-based compensation, that are not within our control or cannot be reasonably predicted.
Chair of the Board Transition On April 29, 2021, our board of directors (the board) accepted Dr. Tim Ferris's cipro and yeast resignation from the board and all board committees, effective May 1, 2021. Dr.
Ferris's resignation is not the result of any disagreement with Health Catalyst, but rather as a result of his new role as the National Director of Transformation for England's National Health Service (NHS). NHS required cipro and yeast Dr. Ferris to resign from our board in connection with his NHS appointment.
ÂDr. Ferris provided a unique perspective that will continue to impact our company for years to come. We are grateful for the opportunity to have benefited from his wisdom and experience, and we congratulate him on his new role as National Director of Transformation at NHS,â said Dan Burton, CEO.
Health Catalyst is thrilled to announce that John A. (Jack) Kane has accepted the invitation to serve as chair of the board effective May 1, 2021. Mr.
Kane has been a director of the Company and has been the chair of the audit committee of the board since February 2016. Mr. Kane has more than 30 yearsâ experience in healthcare technology, including as a director and chairperson of the audit committee of Merchants Bancshares, Inc.
(MBVT) from 2005 until 2014 and athenahealth, Inc. From 2007 until February 2019. He previously occupied the position of CFO, Treasurer &.
Senior VP-Administration at IDX Systems Corp. ÂJack has served on our board for many years. His valuable guidance and feedback often challenges us to think deeply about our solutions.
I am grateful for Jackâs dedication to our mission and his depth of financial leadership experience in healthcare and technology, which make him uniquely qualified to serve as our chair,â said Burton. Quarterly Conference Call Details The company will host a conference call to review the results today, Thursday, May 6, 2021, at 5:00 p.m. E.T.
The conference call can be accessed by dialing 1-877-295-1104 for U.S. Participants, or 1-470-495-9486 for international participants, and referencing participant code 9183315. A live audio webcast will be available online at https://ir.healthcatalyst.com/.
A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days. About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platformâpowered by data from more than 100 million patient records and encompassing trillions of factsâas well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements.
Health Catalyst envisions a future in which all healthcare decisions are data informed. Available Information Health Catalyst intends to use its Investor Relations website as a means of disclosing material non-public information and for complying with its disclosure obligations under Regulation FD. Forward-Looking Statements This release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, as amended.
These forward-looking statements include statements regarding our future growth and our financial outlook for Q2 and fiscal year 2021. Forward-looking statements are subject to risks and uncertainties and are based on potentially inaccurate assumptions that could cause actual results to differ materially from those expected or implied by the forward-looking statements. Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance.
Important risks and uncertainties that could cause our actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following. (i) changes in laws and regulations applicable to our business model. (ii) changes in market or industry conditions, regulatory environment and receptivity to our technology and services.
(iii) results of litigation or a security incident. (iv) the loss of one or more key customers or partners. (v) the impact of buy antibiotics on our business and results of operations.
And (vi) changes to our abilities to recruit and retain qualified team members. For a detailed discussion of the risk factors that could affect our actual results, please refer to the risk factors identified in our SEC reports, including, but not limited to the Annual Report on Form 10-K for the year ended December 31, 2020 filed with the SEC on or about February 25, 2021 and the Quarterly Report on Form 10-Q for the fiscal quarter ended March 31, 2021 expected to be filed with the SEC on or about May 7, 2021. All information provided in this release and in the attachments is as of the date hereof, and we undertake no duty to update or revise this information unless required by law.
Condensed Consolidated Balance Sheets(in thousands, except share and per share data, unaudited) As ofMarch 31, As ofDecember 31, 2021 2020Assets Current assets. Cash and cash equivalents$132,627 $91,954 Short-term investments133,807 178,917 Accounts receivable, net45,905 48,296 Prepaid expenses and other assets12,404 10,632 Total current assets324,743 329,799 Property and equipment, net18,653 12,863 Intangible assets, net91,840 98,921 Operating lease right-of-use assets24,093 24,729 Goodwill107,822 107,822 Other assets4,068 3,606 Total assets$571,219 $577,740 Liabilities and stockholdersâ equity Current liabilities. Accounts payable$4,626 $5,332 Accrued liabilities12,946 16,510 Acquisition-related consideration payableâ 2,000 Deferred revenue51,634 47,145 Operating lease liabilities2,454 2,622 Contingent consideration liabilities15,902 14,427 Convertible senior notes, net171,864 â Total current liabilities259,426 88,036 Convertible senior notes, net of current portionâ 168,994 Deferred revenue, net of current portion1,135 1,878 Operating lease liabilities, net of current portion23,083 23,669 Contingent consideration liabilities, net of current portion16,509 16837 Other liabilities2,230 2227 Total liabilities302,383 301,641 Commitments and contingencies Stockholdersâ equity.
Common stock, $0.001 par value. 44,340,036 and 43,376,848 shares issued and outstanding as of March 31, 2021 and December 31, 2020, respectively44 43 Additional paid-in capital1,022,781 1,001,645 Accumulated deficit(754,020) (725,650)Accumulated other comprehensive income31 61 Total stockholders' equity268,836 276,099 Total liabilities and stockholdersâ equity$571,219 $577,740 Condensed Consolidated Statements of Operations(in thousands, except per share data, unaudited) Three Months EndedMarch 31, 2021 2020Revenue. Technology$33,839 $24,699 Professional services22,007 20,417 Total revenue55,846 45,116 Cost of revenue, excluding depreciation and amortization.
Technology(1)10,825 7,906 Professional services(1)16,513 16,162 Total cost of revenue, excluding depreciation and amortization27,338 24,068 Operating expenses. Sales and marketing(1)15,651 13,487 Research and development(1)14,345 13,088 General and administrative(1)(2)(3)15,015 9,701 Depreciation and amortization7,814 2,877 Total operating expenses52,825 39,153 Loss from operations(24,317) (18,105)Interest and other expense, net(3,952) (621)Loss before income taxes(28,269) (18,726)Income tax provision (benefit)101 (1,236)Net loss$(28,370) $(17,490)Net loss per share, basic and diluted$(0.65) $(0.47)Weighted-average shares outstanding used in calculating net loss per share, basic and diluted43,870 37,109 Adjusted net loss(4)$(2,753) $(6,083)Adjusted net loss per share, basic and diluted(4)$(0.06) $(0.16) _______________(1) Includes stock-based compensation expense as follows. Three Months EndedMarch 31, 2021 2020 Stock-Based Compensation Expense:(in thousands)Cost of revenue, excluding depreciation and amortization.
Technology$374 $176 Professional services1,435 816 Sales and marketing4,818 3,182 Research and development2,257 1,882 General and administrative4,626 2,685 Total$13,510 $8,741 (2) Includes acquisition transaction costs as follows. Three Months EndedMarch 31, 2021 2020 Acquisition transaction costs:(in thousands)General and administrative$â $875 (3) Includes the change in fair value of contingent consideration liabilities, as follows. Three Months EndedMarch 31, 2021 2020 Change in fair value of contingent consideration liabilities:(in thousands)General and administrative$2,156 $(359)(4) Includes non-GAAP adjustments to net loss.
Refer to the "Non-GAAP Financial MeasuresâAdjusted Net Loss Per Share" section below for further details. Condensed Consolidated Statements of Cash Flows(in thousands, unaudited) Three Months Ended March 31,Cash flows from operating activities2021 2020Net loss$(28,370) $(17,490)Adjustments to reconcile net loss to net cash used in operating activities. Depreciation and amortization7,814 2,877 Amortization of debt discount and issuance costs2,870 285 Non-cash operating lease expense965 741 Investment discount and premium amortization417 (6)Provision for expected credit losses300 51 Stock-based compensation expense13,510 8,741 Deferred tax (benefit) provision2 (1,280)Change in fair value of contingent consideration liabilities2,156 (359)Other(34) (4)Change in operating assets and liabilities.
Accounts receivable, net2,090 (7,335)Deferred costsâ 444 Prepaid expenses and other assets(2,173) (2,244)Accounts payable, accrued liabilities, and other liabilities(5,352) (4,283)Deferred revenue3,745 3,936 Operating lease liabilities(1,083) (843)Net cash used in operating activities(3,143) (16,769) Cash flows from investing activities Purchase of short-term investments(8,621) â Proceeds from the sale and maturity of short-term investments53,240 66,653 Acquisition of businesses, net of cash acquiredâ (15,249)Purchase of property and equipment(5,882) (428)Capitalization of internal use software(887) (78)Purchase of intangible assets(480) (758)Proceeds from sale of property and equipment6 6 Net cash provided by investing activities37,376 50,146 Cash flows from financing activities Proceeds from exercise of stock options6,488 9,046 Proceeds from employee stock purchase plan1,349 1,289 Payments of acquisition-related consideration(1,391) (748)Net cash provided by financing activities6,446 9,587 Effect of exchange rate on cash and cash equivalents(6) (31)Net increase in cash and cash equivalents40,673 42,933 Cash and cash equivalents at beginning of period91,954 18,032 Cash and cash equivalents at end of period$132,627 $60,965 Non-GAAP Financial Measures To supplement our financial information presented in accordance with GAAP, we believe certain non-GAAP measures, including Adjusted Gross Profit, Adjusted Gross Margin, Adjusted EBITDA, Adjusted Net Loss, and Adjusted Net Loss per share, basic and diluted, are useful in evaluating our operating performance. For example, we exclude stock-based compensation expense because it is non-cash in nature and excluding this expense provides meaningful supplemental information regarding our operational performance and allows investors the ability to make more meaningful comparisons between our operating results and those of other companies. We use this non-GAAP financial information to evaluate our ongoing operations, as a component in determining employee bonus compensation, and for internal planning and forecasting purposes.
We believe that non-GAAP financial information, when taken collectively, may be helpful to investors because it provides consistency and comparability with past financial performance. However, non-GAAP financial information is presented for supplemental informational purposes only, has limitations as an analytical tool and should not be considered in isolation or as a substitute for financial information presented in accordance with GAAP. In addition, other companies, including companies in our industry, may calculate similarly-titled non-GAAP measures differently or may use other measures to evaluate their performance.
A reconciliation is provided below for each non-GAAP financial measure to the most directly comparable financial measure stated in accordance with GAAP. Investors are encouraged to review the related GAAP financial measures and the reconciliation of these non-GAAP financial measures to their most directly comparable GAAP financial measures, and not to rely on any single financial measure to evaluate our business. Adjusted Gross Profit and Adjusted Gross Margin Adjusted Gross Profit is a non-GAAP financial measure that we define as revenue less cost of revenue, excluding depreciation and amortization and excluding stock-based compensation.
We define Adjusted Gross Margin as our Adjusted Gross Profit divided by our revenue. We believe Adjusted Gross Profit and Adjusted Gross Margin are useful to investors as they eliminate the impact of certain non-cash expenses and allow a direct comparison of these measures between periods without the impact of non-cash expenses and certain other non-recurring operating expenses. The following is a reconciliation of revenue, the most directly comparable GAAP financial measure, to Adjusted Gross Profit, for the three months ended March 31, 2021 and 2020.
Three Months Ended March 31, 2021 (in thousands, except percentages) Technology Professional Services TotalRevenue$33,839 $22,007 $55,846 Cost of revenue, excluding depreciation and amortization(10,825) (16,513) (27,338)Gross profit, excluding depreciation and amortization23,014 5,494 28,508 Add. Stock-based compensation374 1,435 1,809 Adjusted Gross Profit$23,388 $6,929 $30,317 Gross margin, excluding depreciation and amortization68% 25% 51%Adjusted Gross Margin69% 31% 54% Three Months Ended March 31, 2020 (in thousands, except percentages) Technology Professional Services TotalRevenue$24,699 $20,417 $45,116 Cost of revenue, excluding depreciation and amortization(7,906) (16,162) (24,068)Gross profit, excluding depreciation and amortization16,793 4,255 21,048 Add. Stock-based compensation176 816 992 Adjusted Gross Profit$16,969 $5,071 $22,040 Gross margin, excluding depreciation and amortization68% 21% 47%Adjusted Gross Margin69% 25% 49% Adjusted EBITDA Adjusted EBITDA is a non-GAAP financial measure that we define as net loss adjusted for (i) interest and other expense, net, (ii) income tax (benefit) provision, (iii) depreciation and amortization, (iv) stock-based compensation, (v) acquisition transaction costs, and (vi) change in fair value of contingent consideration liabilities when they are incurred.
We view acquisition-related expenses when applicable, such as transaction costs and changes in the fair value of contingent consideration liabilities that are directly related to business combinations as events that are not necessarily reflective of operational performance during a period. We believe Adjusted EBITDA provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance. The following is a reconciliation of our net loss, the most directly comparable GAAP financial measure, to Adjusted EBITDA, for the three months ended March 31, 2021 and 2020.
Three Months EndedMarch 31, 2021 2020 (in thousands)Net loss$(28,370) $(17,490)Add. Interest and other expense, net3,952 621 Income tax (benefit) provision101 (1,236)Depreciation and amortization7,814 2,877 Stock-based compensation13,510 8,741 Acquisition transaction costsâ 875 Change in fair value of contingent consideration liabilities2,156 (359)Adjusted EBITDA$(837) $(5,971) Adjusted Net Loss Per Share Adjusted Net Loss is a non-GAAP financial measure that we define as net loss attributable to common stockholders adjusted for (i) stock-based compensation, (ii) amortization of acquired intangibles, (iii) acquisition transaction costs, (iv) change in fair value of contingent consideration liabilities, and (v) non-cash interest expense related to our convertible senior notes. We believe Adjusted Net Loss provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance.
Three Months Ended March 31, 2021 2020 Numerator:(in thousands, except share and per share amounts)Net loss attributable to common stockholders$(28,370) $(17,490)Add. Stock-based compensation13,510 8,741 Amortization of acquired intangibles7,081 2,150 Acquisition transaction costsâ 875 Change in fair value of contingent consideration liabilities2,156 (359)Non-cash interest expense related to convertible senior notes2,870 â Adjusted Net Loss$(2,753) $(6,083)Denominator. Weighted-average number of shares used in calculating net loss, basic and diluted43,870,288 37,108,998 Adjusted net loss per share, basic and diluted$(0.06) $(0.16) Health Catalyst Investor Relations Contact:Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact:Amanda HundtVice President, Corporate Communicationsamanda.hundt@healthcatalyst.com+1 (575) 491-0974AdvertisementContinue reading the main storySupported byContinue reading the main storyWhen Your Job Harms Your Mental HealthNaomi Osaka advocated for her well-being at work.
Hereâs how you can too.Credit...Getty ImagesJune 2, 2021Havenât we all been Naomi Osaka at some point in our lives?. OK, we may never know what itâs like to be the second-ranked woman in tennis, or the worldâs highest-paid female athlete.But like the sports star, many of us have been stuck in situations that were detrimental to our mental health â at work or in our personal lives â feeling torn between societal expectations and self-preservation.Ms. Osaka chose to care for herself ahead of the French Open, when she announced she would not âdo any pressâ because the news conferences could be damaging to the mental health of the players.
True to her word, after winning her first-round match on Sunday, she skipped her postmatch news conference. As she later explained in an Instagram post, she was feeling vulnerable and anxious, and press events give her âhuge waves of anxiety.âHer decision to avoid the press did not go over well with tennis officials. Ms.
Osaka was fined $15,000, and the leaders of the four Grand Slam tournaments â the Australian, French and United States Opens, and Wimbledon â threatened to expel her from the French Open.Instead, Ms. Osaka announced she would withdraw from the tournament. ÂThe truth is that I have suffered long bouts of depression since the U.S.
Open in 2018 and I have had a really hard time coping with that,â she wrote in her social media post.Regardless of the type of work you do, your job can affect your mental health and vice versa. And like Ms. Osaka, you have choices when it comes to preserving and improving your well-being.âWe would not fault her if she had a sprained ankle,â said Benjamin F.
Miller, the chief strategy officer for Well Being Trust, a national foundation focusing on mental health and well-being. ÂBut when it comes to mental health â which we know is equally, if not more, important than your physical health â we have this arbitrary standard of whatâs acceptable and whatâs not.âA survey of over 5,000 employees conducted last year by the advocacy group Mental Health America found that 83 percent of respondents felt emotionally drained from work and 71 percent strongly agreed that the workplace affects their mental health. While the respondents were not representative of the general population â they most likely found the survey when visiting the organizationâs mental health screening tools â their responses show just how anxious some workers have become.Women and people of color may shoulder a disproportionate amount of emotional stress both in and outside of the workplace.
Women are at least twice as likely to have had depression as men, according to federal data. And Black people are less likely than non-Hispanic white people to receive treatment for depression or prescription medications for mental health. A 2020 report from Lean In and McKinsey &.
Company noted that Black women were less likely to get the support they needed to advance in their fields than white women.Ms. Osaka, who is of Black and Asian descent, acted admirably when she stood up for her needs, several mental health experts said. It can benefit all of us to be on the lookout for signs that we might need to make changes at work or get professional help, they added.Evaluate your feelings.âEveryone has some awareness of their baseline functioning at work,â said Dr.
Jessi Gold, a psychiatrist at Washington University in St. Louis. So if you start to notice youâre losing interest in your job or your productivity plummets, itâs an indication that something is off, she said.For example, you might notice that you dread starting work each day, or you feel so anxious that you have trouble thinking about everything that youâre supposed to do.
Perhaps your emails are piling up and you arenât communicating with people as much as you typically would. If youâre feeling ineffective in your job, you may also start to engage in more negative self-talk, like. ÂIâm no good at my job anyway.
Iâm useless,â Dr. Gold said.An even bigger warning sign that work is affecting your mental health is if work tanks your mood to the point that it starts to damage your personal relationships, she added. For example, you might find that youâre picking more fights with your partner, becoming more irritated by your children or avoiding social activities in ways that you normally wouldnât.Think about what might be causing these feelings.
Is there one aspect of your job responsibilities that is causing most of your distress?. Do you have an underlying health problem like depression that has not been treated?. Is it some combination of the two?.
Get support.Once you realize you need help, seek out a trusted friend, mentor, co-worker, peer group or therapist, said Inger Burnett-Zeigler, an associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine who researches Black womenâs mental health.This should be a place âwhere you can feel seen, heard and validated, a place where you are able to be your fully authentic self without fear of judgment or negative repercussions,â she added.Many employers also offer employee assistance programs that have a variety of services, including short-term counseling from licensed therapists or referrals to outside experts who can help with the specific problem youâre having. (These services are often touted as confidential, but even so, some employees may feel uncomfortable using them.)Your company may also have partnerships with other organizations that provide wellness classes or free career coaching. Itâs worth investigating all the options, the experts said.âEmployers have become much more aware and frankly progressive in how theyâve been managing and treating issues of mental health over the last several years,â said Michael Thompson, president and chief executive of the National Alliance of Healthcare Purchaser Coalitions.
ÂThe cipro has actually reinforced that in spades.âMr. Thompsonâs organization recently did an online survey of 151 employers who buy health care services and found that 72 percent were seeking to improve mental health access for their employees and 16 percent were considering doing this in the next one to two years.Set boundaries.Once youâve found a supportive person to hear you out, together you can start to come up with a game plan to improve your work life and emotional well-being.Think about what you need most. Is it an accommodation like a short-term disability leave, or would it simply help to have more flexibility in your work schedule?.
Do go to my blog you need to set limits as to when and how often you respond to work messages?. Before addressing any of this with your supervisor, be sure to consider how your proposed solution would work within the context of your team, because thatâs what your employer will want to know as well. In other words, show how your idea will benefit the group as a whole.âIf youâre really stressed out and have a mental heath issue that youâre wrestling with, itâs very difficult to think about the team more broadly,â said John Quelch, dean of the Miami Herbert Business School in Coral Gables, Fla., and co-author of the book âCompassionate Management of Mental Health in the Modern Workplace.â Even so, he added, âyou have to try to get in the head of your employer.âDuring the cipro, mental health problems have been pervasive.
A Centers for Disease Control and Prevention report concluded that in June of 2020, 40 percent of adults in the United States had been struggling with mental health or substance abuse issues.Itâs OK to be open and admit to yourself and those you trust that youâre struggling right now, said Paul Gionfriddo, the president and chief executive of Mental Health America. In fact, he added, âMost good employers are going to be asking, âWhat can I do to help you?. ÂâYou may also decide to keep your concerns private and address them with your therapist, and thatâs OK, too.
Creating healthy work boundaries is vital, experts said.âRemember that you are a worthy and valuable human being, separate from your job function, productivity and even how you might be evaluated by others,â Dr. Burnett-Zeigler said. ÂWhen feelings of self-doubt and not belonging show up, donât lose sight of the unique talents and ideas that you bring to the workplace.âBut say your efforts to address your emotional well-being at your job have fallen flat, or the work environment has become toxic.
In that case, the experts said, itâs probably best to start looking for another job, especially if you have become the target of ridicule, threats or abusive comments by a manager. It is illegal for an employer to discriminate against you simply because you have a mental health condition. And according to the U.S.
Equal Employment Opportunity Commission, if you have a qualifying condition like major depression or post-traumatic stress disorder, you have a legal right to a reasonable accommodation that would help you do your job â for example, the ability to schedule work around therapy appointments, a quiet office space or permission to work from home.âWhat we need to do is to recognize that anxiety is real, depression is real,â Mr. Gionfriddo said. ÂThis is a really good time for people to do that personal assessment, because there are opportunities to find more meaningful work out there.âAdvertisementContinue reading the main storyVirtual Reality Therapy Plunges Patients Back Into Trauma.
Here Is Why Some Swear by It.An experimental treatment seems poised to address a dire mental health crisis.Credit...Supported byContinue reading the main storyJune 3, 2021When a Veterans Affairs therapist first suggested that Chris Merkle try a virtual reality simulation that would mimic his days in combat, he was horrified. ÂI was like, you want to put me in a virtual world, reliving my worst days, my worst nightmares?. Â he said.It was the winter of 2013, and after three tours in Iraq and four in Afghanistan, Mr.
Merkle had spent years struggling with the invasive symptoms of post-traumatic stress disorder. He felt constantly on edge, bracing for an attack. He got angry easily.
He avoided thinking or talking about his time as a Marine. He tried traditional talk therapy, but didnât feel ready to discuss his past.Months later, after his symptoms intensified and he felt desperate for a salve, he decided to give virtual reality exposure therapy a try at a Department of Veterans Affairs hospital in Long Beach, Calif. The treatment uses V.R.
Technology to immerse a patient in a three-dimensional environment that mimics a traumatic memory. He strapped into a headset and sank into the past.The details in the simulation were extremely precise, Mr. Merkle said.
The military-issue truck, the weight of the model gun in his hand, the dark swath of sand in the night. He narrated one particularly troubling incident out loud to a clinician, who adjusted the simulation as he spoke. ÂI was seeing that person shooting at me, that I hadnât thought about in 10-plus years,â he said.
His muscles tensed. His heart raced. He was terrified.âMy body was physically reacting, because my mind was saying, this is happening to us.â But when he took the goggles off, he said, the sense of accomplishment became its own form of comfort.
For years, his memories had terrified him. Confronting the past in V.R. Proved to him that he could survive revisiting his memories.
ÂThat was the biggest leap,â he said.After about seven runs through the simulation, Mr. Merkle started uncovering fragments of memory his mind had blacked out, which is a common response to trauma. He remembered the name of the soldier who had been next to him in a truck during combat.
He remembered the clear feeling that he was going to die. Mr. Merkle walked out in the hall after he was done, grappling with what his brain had revealed.He felt like he was in a fantasy novel, he said.
As he left the session, he imagined that âthere was this black smoke pouring out of my mouth, oozing out of me. Like this evil, for lack of a better word for it, was slipping outâ of his body. He got to the parking lot and sat in his car for an hour.
The treatment was working, he thought. He was less scared of his memories, less scared of himself. He was getting better.Why V.R.?.
Why Now?. The most significant disorders that virtual reality therapy has shown success in treating â PTSD, anxiety, phobias â are on the rise. An April survey by the Centers for Disease Control and Prevention cited significant increases in respondents showing symptoms of anxiety disorders.
Health care workers have reported high rates of PTSD during the cipro â a February study of 1,000 frontline workers reported that nearly one-quarter showed likely signs of the disorder. In contrast, only 6.8 percent of the general population ever experiences PTSD in their lifetime, according to National Institute of Mental Health estimates.âbuy antibiotics has been traumatizing to so many people in so many ways,â said Dr. Nomi Levy-Carrick, a psychiatrist who leads outpatient psychiatric services at Brigham and Womenâs Hospital in Boston.
Grief, isolation, economic upheaval, housing and food insecurity, the âtoxic stressâ of lockdown and the surge in domestic violence during the cipro can all be traumatic stressors, she said. And the constant uncertainty of the past cipro year created conditions for widespread anxiety.Academics have studied virtual realityâs potential to treat anxiety disorders since the â90s, and the practice has incrementally gathered momentum, as the technology has improved and headsets have become more affordable. JoAnn Difede, a psychology professor at Weill Cornell Medicine in New York and one of the leading experts in virtual reality treatment for PTSD, said the headset she used for research with Sept.
11 survivors cost $25,000 at the time and weighed 10 pounds. Now, an average headset retails under $300.A virtual reality mindfulness exercise to soothe anxiety.CreditCredit...By CenteredVRRecreational V.R. Headset sales to the general public have grown during the cipro, but the technology has yet to fully enter the mainstream.
Experts who study the therapy argue thatâs about to change for the medical establishment, as clinicians look for effective and accessible ways to treat anxiety disorders.Mr. Merkle likened his experience in the virtual reality simulations to a child confronting imaginary monsters in a closet. Each time you open the door, he said, you see thereâs nothing to fear.
Your body whirs down from fight or flight mode. And each time, the virtual reality treatment gets easier.Many V.R. Therapies build on a sometimes-divisive therapeutic technique called prolonged exposure, developed by Edna Foa, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine.
Prolonged exposure is a cognitive intervention therapy. Patients first describe a traumatic event to a therapist, in detail and in the present tense, and then confront triggers of the traumatic event in the real world. While some experts have worried the practice might overwhelm or re-traumatize patients, prolonged exposure is now widely accepted as an effective tool to treat chronic PTSD.
Patients become desensitized to their memories. They prove to themselves that their thoughts can be safe.âIf you overcome something in V.R., you overcome it in real life,â said Daniel Freeman, a professor of clinical psychiatry at Oxford University who runs virtual reality therapies at 10 public clinics across England.Direct-to-consumer virtual reality therapy products, for now, remain rare, and only a few are covered by insurance. Companies that sell V.R.
Therapy software often explicitly state their products should only be used in the presence of a clinician. Experts like Andrew Sherrill, an assistant professor of psychiatry at Emory University in Atlanta who specializes in virtual reality therapy., worry that, as virtual reality expands, people seeking treatment might try out a program for themselves and not consult a therapist. They might shrug off the treatment after not getting results or aggravate trauma symptoms.
ÂItâs the closest thing our field has to just making opioids available over the counter,â he said.âV.R. Is not going to be the solution,â said Jonathan Rogers, a researcher at University College London who has studied rates of anxiety disorders during the cipro. ÂIt may be part of the solution, but itâs not going to make medications and formal therapies obsolete.âDoes V.R.
Therapy Work?. Virtual reality treatments arenât necessarily more effective than traditional prolonged exposure therapy, said Dr. Sherrill.
But for some patients, V.R. Offers convenience and can immerse a patient in scenes that would be hard to replicate in real life. For some people, the treatment can mimic video game systems theyâre already familiar with.
Thereâs also a dual awareness in patients who use virtual reality â the images on the screen are almost lifelike, but the headset itself functions as proof that theyâre not real.Months after the Sept. 11 terrorist attacks, Dr. Difede and Dr.
Hunter Hoffman, who is the director of the Virtual Reality Research Center at the University of Washington, tested virtual reality treatments in one survivor with acute PTSD, one of the first reported applications of the therapy. Dr. Difede said that the first time the patient put on the headset, she started crying.
ÂI never thought Iâd see the World Trade Center again,â she told Dr. Difede. After six hourlong sessions, the patient experienced a 90 percent decrease in PTSD symptoms.
Dr. Difede later tested V.R. Exposure therapy in Iraq War veterans.
16 out of the first 20 patients no longer met the diagnostic criteria for PTSD after completing treatment.At the University of Central Florida, a team called U.C.F. Restores has been building trauma therapies using V.R. That allows clinicians to control the level of detail in a simulation, down to the color of a bedspread or a TV that can be clicked on or off, in order to more easily trigger traumatic memories.
The program offers free trauma therapy, often using V.R., to Florida residents and focuses on treating PTSD.Dr. Deborah Beidel, a professor of psychology and executive director of U.C.F. Restores, has broadened the treatments beyond visuals, customizing sounds and even smells to create an augmented reality for patients.Jonathan Tissue, 35, a former Marine, sought treatment at U.C.F.
Restores in early 2020 after talk therapy and medication failed to alleviate his PTSD symptoms, which included flashbacks, anxiety and mood swings. In the end, it was the smells pumped into the room while he described his military service to a clinician that helped unlock his memories. There was the stench of burning tires, diesel fumes, the smell of decaying bodies.
He heard the sounds of munitions firing. His chair rumbled, thanks to the centerâs simulated vibrations.âIt unlocked certain doors that I could start speaking about,â he said. He talked through his newly uncovered memories with a therapist and a support group, processing the terror that had built in his body for years.Within three days, he said, he started feeling better.
By the end of the three-week treatment, his symptoms had mostly faded. ÂIt made me comfortable in my own self,â he said.âReady for Prime TimeâWhile a significant amount of funding â and consequentially, the bulk of research â on virtual realityâs therapeutic potential has focused on military veterans, âweâre ready for prime time to treat civilian trauma,â said Albert âSkipâ Rizzo, a clinical psychologist who specializes in virtual reality and worked with Mr. Merkle at the Department of Veterans Affairs.Several companies and clinicians are using V.R.
To treat other disorders. During the cipro, Johns Hopkins researchers have used it to reduce stress and burnout in medical workers. In one unpublished study, 50 nurses from a buy antibiotics ward tested virtual reality mindfulness exercises â guided meditations beside animated fields and waterfalls â and all but one participant reported reduced stress levels.Researchers are also testing whether they can alleviate childhood social anxiety with virtual reality programs, one of which uses animated artificial intelligence bullies that growl things like, âGive me your lunch money.â BehaVR, which currently sells therapeutic software on pre-loaded headsets to health care providers, plans to expand to direct-to-consumer products for social anxiety and other stress-related disorders, anticipating widespread post-cipro fears, Aaron Gani, the companyâs founder and chief executive, said in an interview.Virtual reality looks promising for treating phobias, according to Dr.
Howard Gurr, a psychologist in Long Island, N.Y. Heâs been interested in virtual reality for more than 20 years, since he saw Dr. Rizzo discuss a virtual classroom environment to diagnose and treat childhood attention-deficit/hyperactivity disorder.
But the technology has improved drastically in recent years, he said.In 2016, Dr. Gurr tried a simulation to treat patientsâ fear of heights that convinced him of V.R.âs therapeutic potential. A glass elevator steadily rose over a city, the roofs of the buildings below growing smaller and smaller.
A balcony appeared, and he was supposed to take a step onto it, over the chasm. Even though he didnât have a phobia of heights, Dr. Gurr couldnât do it.
ÂPart of my brain was hijacked,â he said. ÂI was like, âI got it. This works.ââBefore he found virtual reality, Dr.
Gurr would accompany a patient with a phobia of flying on an actual flight â a short distance, like New York to Philadelphia, over and over again. Now, he said, itâs more efficient and convenient to talk them through a virtual plane ride five or six times in a given session, on and off a pixelated runway. About one-third of his patients now come to his psychology practice specifically for virtual reality, he said, referred from other clinicians who donât offer the treatment.That number may grow as the cipro wanes in the United States, he said, and more people grapple with its aftermath.
He expects anxiety disorders will continue to rise, that the demand for effective treatments to tackle fear and trauma will only expand. Mr. Merkle, whoâs in the process of getting a degree in clinical psychology, mostly relies on traditional talk therapy these days.
PTSD has no clear end point. Even in recovery, it can trap you, cycling and churning. But for now, he said, thanks to the V.R.
Treatment, he feels something close to free.AdvertisementContinue reading the main story.
SALT LAKE CITY, cipro online canada May 06, 2021 (GLOBE NEWSWIRE) -- Health Catalyst, Inc you can look here. ("Health Catalyst," Nasdaq. HCAT), a leading provider of data and analytics technology and cipro online canada services to healthcare organizations, today reported financial results for the quarter ended March 31, 2021.
ÂIn the first quarter of 2021, I am pleased to share that we achieved strong performance across our business, including exceeding the mid-point of our quarterly guidance for both revenue and Adjusted EBITDA,â said Dan Burton, CEO of Health Catalyst. ÂI am also cipro online canada happy to report that in the most recent team member engagement and satisfaction survey, independently administered by the Gallup organization, team member satisfaction scores at Health Catalyst measured in the 96th percentile. This latest engagement level continues a pattern that has been in place for many years, of industry-leading engagement, consistently ranked between the 95th and 99th percentile in overall team member satisfaction scores.
This latest result is of particular significance given that it comes during a period where we were required to adapt to global cipro necessitating a remote-only work environment, as well as having welcomed nearly two hundred new teammates who came to us primarily through multiple recent acquisitions.â Financial Highlights for the Three Months Ended March 31, 2021 Key Financial Metrics Three Months Ended March 31, Year over Year Change 2021 2020 GAAP Financial Data:(in thousands, except percentages, unaudited)Technology revenue$33,839 $24,699 37%Professional services revenue$22,007 $20,417 cipro online canada 8%Total revenue$55,846 $45,116 24%Loss from operations$(24,317) $(18,105) (34)%Net loss$(28,370) $(17,490) (62)%Other Non-GAAP Financial Data:(1) Adjusted Technology Gross Profit$23,388 $16,969 38%Adjusted Technology Gross Margin69% 69% Adjusted Professional Services Gross Profit$6,929 $5,071 37%Adjusted Professional Services Gross Margin31% 25% Total Adjusted Gross Profit$30,317 $22,040 38%Total Adjusted Gross Margin54% 49% Adjusted EBITDA$(837) $(5,971) 86%________________________(1) These measures are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). See the accompanying "Non-GAAP Financial Measures" section below for more information about these financial measures, including the limitations of such measures, and for a reconciliation of each measure to the most directly comparable measure calculated in accordance with GAAP. Financial Outlook Health Catalyst provides forward-looking guidance on total revenue, a GAAP measure, and Adjusted EBITDA, a non-GAAP measure.
For the cipro online canada second quarter of 2021, we expect. Total revenue between $55.1 million and $58.1 million, andAdjusted EBITDA between $(4.8) million and $(2.8) millionFor the full year of 2021, we expect. Total revenue between $228.1 million and $231.1 million, andAdjusted EBITDA between $(15.0) million and $(13.0) millionWe have not reconciled guidance for Adjusted EBITDA to net loss, the most cipro online canada directly comparable GAAP measure, and have not provided forward-looking guidance for net loss, because there are items that may impact net loss, including stock-based compensation, that are not within our control or cannot be reasonably predicted.
Chair of the Board Transition On April 29, 2021, our board of directors (the board) accepted Dr. Tim Ferris's resignation from the board and all board committees, effective May 1, 2021 cipro online canada. Dr.
Ferris's resignation is not the result of any disagreement with Health Catalyst, but rather as a result of his new role as the National Director of Transformation for England's National Health Service (NHS). NHS required cipro online canada Dr. Ferris to resign from our board in connection with his NHS appointment.
ÂDr. Ferris provided a unique perspective that will continue to impact our company for years to come. We are grateful for the opportunity to have benefited from his wisdom and experience, and we congratulate him on his new role as National Director of Transformation at NHS,â said Dan Burton, CEO.
Health Catalyst is thrilled to announce that John A. (Jack) Kane has accepted the invitation to serve as chair of the board effective May 1, 2021. Mr.
Kane has been a director of the Company and has been the chair of the audit committee of the board since February 2016. Mr. Kane has more than 30 yearsâ experience in healthcare technology, including as a director and chairperson of the audit committee of Merchants Bancshares, Inc.
(MBVT) from 2005 until 2014 and athenahealth, Inc. From 2007 until February 2019. He previously occupied the position of CFO, Treasurer &.
Senior VP-Administration at IDX Systems Corp. ÂJack has served on our board for many years. His valuable guidance and feedback often challenges us to think deeply about our solutions.
I am grateful for Jackâs dedication to our mission and his depth of financial leadership experience in healthcare and technology, which make him uniquely qualified to serve as our chair,â said Burton. Quarterly Conference Call Details The company will host a conference call to review the results today, Thursday, May 6, 2021, at 5:00 p.m. E.T.
The conference call can be accessed by dialing 1-877-295-1104 for U.S. Participants, or 1-470-495-9486 for international participants, and referencing participant code 9183315. A live audio webcast will be available online at https://ir.healthcatalyst.com/.
A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call, at the same web link, and will remain available for approximately 90 days. About Health Catalyst Health Catalyst is a leading provider of data and analytics technology and services to healthcare organizations committed to being the catalyst for massive, measurable, data-informed healthcare improvement. Its customers leverage the cloud-based data platformâpowered by data from more than 100 million patient records and encompassing trillions of factsâas well as its analytics software and professional services expertise to make data-informed decisions and realize measurable clinical, financial, and operational improvements.
Health Catalyst envisions a future in which all healthcare decisions are data informed. Available Information Health Catalyst intends to use its Investor Relations website as a means of disclosing material non-public information and for complying with its disclosure obligations under Regulation FD. Forward-Looking Statements This release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, as amended.
These forward-looking statements include statements regarding our future growth and our financial outlook for Q2 and fiscal year 2021. Forward-looking statements are subject to risks and uncertainties and are based on potentially inaccurate assumptions that could cause actual results to differ materially from those expected or implied by the forward-looking statements. Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance.
Important risks and uncertainties that could cause our actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following. (i) changes in laws and regulations applicable to our business model. (ii) changes in market or industry conditions, regulatory environment and receptivity to our technology and services.
(iii) results of litigation or a security incident. (iv) the loss of one or more key customers or partners. (v) the impact of buy antibiotics on our business and results of operations.
And (vi) changes to our abilities to recruit and retain qualified team members. For a detailed discussion of the risk factors that could affect our actual results, please refer to the risk factors identified in our SEC reports, including, but not limited to the Annual Report on Form 10-K for the year ended December 31, 2020 filed with the SEC on or about February 25, 2021 and the Quarterly Report on Form 10-Q for the fiscal quarter ended March 31, 2021 expected to be filed with the SEC on or about May 7, 2021. All information provided in this release and in the attachments is as of the date hereof, and we undertake no duty to update or revise this information unless required by law.
Condensed Consolidated Balance Sheets(in thousands, except share and per share data, unaudited) As ofMarch 31, As ofDecember 31, 2021 2020Assets Current assets. Cash and cash equivalents$132,627 $91,954 Short-term investments133,807 178,917 Accounts receivable, net45,905 48,296 Prepaid expenses and other assets12,404 10,632 Total current assets324,743 329,799 Property and equipment, net18,653 12,863 Intangible assets, net91,840 98,921 Operating lease right-of-use assets24,093 24,729 Goodwill107,822 107,822 Other assets4,068 3,606 Total assets$571,219 $577,740 Liabilities and stockholdersâ equity Current liabilities. Accounts payable$4,626 $5,332 Accrued liabilities12,946 16,510 Acquisition-related consideration payableâ 2,000 Deferred revenue51,634 47,145 Operating lease liabilities2,454 2,622 Contingent consideration liabilities15,902 14,427 Convertible senior notes, net171,864 â Total current liabilities259,426 88,036 Convertible senior notes, net of current portionâ 168,994 Deferred revenue, net of current portion1,135 1,878 Operating lease liabilities, net of current portion23,083 23,669 Contingent consideration liabilities, net of current portion16,509 16837 Other liabilities2,230 2227 Total liabilities302,383 301,641 Commitments and contingencies Stockholdersâ equity.
Common stock, $0.001 par value. 44,340,036 and 43,376,848 shares issued and outstanding as of March 31, 2021 and December 31, 2020, respectively44 43 Additional paid-in capital1,022,781 1,001,645 Accumulated deficit(754,020) (725,650)Accumulated other comprehensive income31 61 Total stockholders' equity268,836 276,099 Total liabilities and stockholdersâ equity$571,219 $577,740 Condensed Consolidated Statements of Operations(in thousands, except per share data, unaudited) Three Months EndedMarch 31, 2021 2020Revenue. Technology$33,839 $24,699 Professional services22,007 20,417 Total revenue55,846 45,116 Cost of revenue, excluding depreciation and amortization.
Technology(1)10,825 7,906 Professional services(1)16,513 16,162 Total cost of revenue, excluding depreciation and amortization27,338 24,068 Operating expenses. Sales and marketing(1)15,651 13,487 Research and development(1)14,345 13,088 General and administrative(1)(2)(3)15,015 9,701 Depreciation and amortization7,814 2,877 Total operating expenses52,825 39,153 Loss from operations(24,317) (18,105)Interest and other expense, net(3,952) (621)Loss before income taxes(28,269) (18,726)Income tax provision (benefit)101 (1,236)Net loss$(28,370) $(17,490)Net loss per share, basic and diluted$(0.65) $(0.47)Weighted-average shares outstanding used in calculating net loss per share, basic and diluted43,870 37,109 Adjusted net loss(4)$(2,753) $(6,083)Adjusted net loss per share, basic and diluted(4)$(0.06) $(0.16) _______________(1) Includes stock-based compensation expense as follows. Three Months EndedMarch 31, 2021 2020 Stock-Based Compensation Expense:(in thousands)Cost of revenue, excluding depreciation and amortization.
Technology$374 $176 Professional services1,435 816 Sales and marketing4,818 3,182 Research and development2,257 1,882 General and administrative4,626 2,685 Total$13,510 $8,741 (2) Includes acquisition transaction costs as follows. Three Months EndedMarch 31, 2021 2020 Acquisition transaction costs:(in thousands)General and administrative$â $875 (3) Includes the change in fair value of contingent consideration liabilities, as follows. Three Months EndedMarch 31, 2021 2020 Change in fair value of contingent consideration liabilities:(in thousands)General and administrative$2,156 $(359)(4) Includes non-GAAP adjustments to net loss.
Refer to the "Non-GAAP Financial MeasuresâAdjusted Net Loss Per Share" section below for further details. Condensed Consolidated Statements of Cash Flows(in thousands, unaudited) Three Months Ended March 31,Cash flows from operating activities2021 2020Net loss$(28,370) $(17,490)Adjustments to reconcile net loss to net cash used in operating activities. Depreciation and amortization7,814 2,877 Amortization of debt discount and issuance costs2,870 285 Non-cash operating lease expense965 741 Investment discount and premium amortization417 (6)Provision for expected credit losses300 51 Stock-based compensation expense13,510 8,741 Deferred tax (benefit) provision2 (1,280)Change in fair value of contingent consideration liabilities2,156 (359)Other(34) (4)Change in operating assets and liabilities.
Accounts receivable, net2,090 (7,335)Deferred costsâ 444 Prepaid expenses and other assets(2,173) (2,244)Accounts payable, accrued liabilities, and other liabilities(5,352) (4,283)Deferred revenue3,745 3,936 Operating lease liabilities(1,083) (843)Net cash used in operating activities(3,143) (16,769) Cash flows from investing activities Purchase of short-term investments(8,621) â Proceeds from the sale and maturity of short-term investments53,240 66,653 Acquisition of businesses, net of cash acquiredâ (15,249)Purchase of property and equipment(5,882) (428)Capitalization of internal use software(887) (78)Purchase of intangible assets(480) (758)Proceeds from sale of property and equipment6 6 Net cash provided by investing activities37,376 50,146 Cash flows from financing activities Proceeds from exercise of stock options6,488 9,046 Proceeds from employee stock purchase plan1,349 1,289 Payments of acquisition-related consideration(1,391) (748)Net cash provided by financing activities6,446 9,587 Effect of exchange rate on cash and cash equivalents(6) (31)Net increase in cash and cash equivalents40,673 42,933 Cash and cash equivalents at beginning of period91,954 18,032 Cash and cash equivalents at end of period$132,627 $60,965 Non-GAAP Financial Measures To supplement our financial information presented in accordance with GAAP, we believe certain non-GAAP measures, including Adjusted Gross Profit, Adjusted Gross Margin, Adjusted EBITDA, Adjusted Net Loss, and Adjusted Net Loss per share, basic and diluted, are useful in evaluating our operating performance. For example, we exclude stock-based compensation expense because it is non-cash in nature and excluding this expense provides meaningful supplemental information regarding our operational performance and allows investors the ability to make more meaningful comparisons between our operating results and those of other companies. We use this non-GAAP financial information to evaluate our ongoing operations, as a component in determining employee bonus compensation, and for internal planning and forecasting purposes.
We believe that non-GAAP financial information, when taken collectively, may be helpful to investors because it provides consistency and comparability with past financial performance. However, non-GAAP financial information is presented for supplemental informational purposes only, has limitations as an analytical tool and should not be considered in isolation or as a substitute for financial information presented in accordance with GAAP. In addition, other companies, including companies in our industry, may calculate similarly-titled non-GAAP measures differently or may use other measures to evaluate their performance.
A reconciliation is provided below for each non-GAAP financial measure to the most directly comparable financial measure stated in accordance with GAAP. Investors are encouraged to review the related GAAP financial measures and the reconciliation of these non-GAAP financial measures to their most directly comparable GAAP financial measures, and not to rely on any single financial measure to evaluate our business. Adjusted Gross Profit and Adjusted Gross Margin Adjusted Gross Profit is a non-GAAP financial measure that we define as revenue less cost of revenue, excluding depreciation and amortization and excluding stock-based compensation.
We define Adjusted Gross Margin as our Adjusted Gross Profit divided by our revenue. We believe Adjusted Gross Profit and Adjusted Gross Margin are useful to investors as they eliminate the impact of certain non-cash expenses and allow a direct comparison of these measures between periods without the impact of non-cash expenses and certain other non-recurring operating expenses. The following is a reconciliation of revenue, the most directly comparable GAAP financial measure, to Adjusted Gross Profit, for the three months ended March 31, 2021 and 2020.
Three Months Ended March 31, 2021 (in thousands, except percentages) Technology Professional Services TotalRevenue$33,839 $22,007 $55,846 Cost of revenue, excluding depreciation and amortization(10,825) (16,513) (27,338)Gross profit, excluding depreciation and amortization23,014 5,494 28,508 Add. Stock-based compensation374 1,435 1,809 Adjusted Gross Profit$23,388 $6,929 $30,317 Gross margin, excluding depreciation and amortization68% 25% 51%Adjusted Gross Margin69% 31% 54% Three Months Ended March 31, 2020 (in thousands, except percentages) Technology Professional Services TotalRevenue$24,699 $20,417 $45,116 Cost of revenue, excluding depreciation and amortization(7,906) (16,162) (24,068)Gross profit, excluding depreciation and amortization16,793 4,255 21,048 Add. Stock-based compensation176 816 992 Adjusted Gross Profit$16,969 $5,071 $22,040 Gross margin, excluding depreciation and amortization68% 21% 47%Adjusted Gross Margin69% 25% 49% Adjusted EBITDA Adjusted EBITDA is a non-GAAP financial measure that we define as net loss adjusted for (i) interest and other expense, net, (ii) income tax (benefit) provision, (iii) depreciation and amortization, (iv) stock-based compensation, (v) acquisition transaction costs, and (vi) change in fair value of contingent consideration liabilities when they are incurred.
We view acquisition-related expenses when applicable, such as transaction costs and changes in the fair value of contingent consideration liabilities that are directly related to business combinations as events that are not necessarily reflective of operational performance during a period. We believe Adjusted EBITDA provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance. The following is a reconciliation of our net loss, the most directly comparable GAAP financial measure, to Adjusted EBITDA, for the three months ended March 31, 2021 and 2020.
Three Months EndedMarch 31, 2021 2020 (in thousands)Net loss$(28,370) $(17,490)Add. Interest and other expense, net3,952 621 Income tax (benefit) provision101 (1,236)Depreciation and amortization7,814 2,877 Stock-based compensation13,510 8,741 Acquisition transaction costsâ 875 Change in fair value of contingent consideration liabilities2,156 (359)Adjusted EBITDA$(837) $(5,971) Adjusted Net Loss Per Share Adjusted Net Loss is a non-GAAP financial measure that we define as net loss attributable to common stockholders adjusted for (i) stock-based compensation, (ii) amortization of acquired intangibles, (iii) acquisition transaction costs, (iv) change in fair value of contingent consideration liabilities, and (v) non-cash interest expense related to our convertible senior notes. We believe Adjusted Net Loss provides investors with useful information on period-to-period performance as evaluated by management and comparison with our past financial performance and is useful in evaluating our operating performance compared to that of other companies in our industry, as this metric generally eliminates the effects of certain items that may vary from company to company for reasons unrelated to overall operating performance.
Three Months Ended March 31, 2021 2020 Numerator:(in thousands, except share and per share amounts)Net loss attributable to common stockholders$(28,370) $(17,490)Add. Stock-based compensation13,510 8,741 Amortization of acquired intangibles7,081 2,150 Acquisition transaction costsâ 875 Change in fair value of contingent consideration liabilities2,156 (359)Non-cash interest expense related to convertible senior notes2,870 â Adjusted Net Loss$(2,753) $(6,083)Denominator. Weighted-average number of shares used in calculating net loss, basic and diluted43,870,288 37,108,998 Adjusted net loss per share, basic and diluted$(0.06) $(0.16) Health Catalyst Investor Relations Contact:Adam BrownSenior Vice President, Investor Relations and FP&A+1 (855)-309-6800ir@healthcatalyst.com Health Catalyst Media Contact:Amanda HundtVice President, Corporate Communicationsamanda.hundt@healthcatalyst.com+1 (575) 491-0974AdvertisementContinue reading the main storySupported byContinue reading the main storyWhen Your Job Harms Your Mental HealthNaomi Osaka advocated for her well-being at work.
Hereâs how you can too.Credit...Getty ImagesJune 2, 2021Havenât we all been Naomi Osaka at some point in our lives?. OK, we may never know what itâs like to be the second-ranked woman in tennis, or the worldâs highest-paid female athlete.But like the sports star, many of us have been stuck in situations that were detrimental to our mental health â at work or in our personal lives â feeling torn between societal expectations and self-preservation.Ms. Osaka chose to care for herself ahead of the French Open, when she announced she would not âdo any pressâ because the news conferences could be damaging to the mental health of the players.
True to her word, after winning her first-round match on Sunday, she skipped her postmatch news conference. As she later explained in an Instagram post, she was feeling vulnerable and anxious, and press events give her âhuge waves of anxiety.âHer decision to avoid the press did not go over well with tennis officials. Ms.
Osaka was fined $15,000, and the leaders of the four Grand Slam tournaments â the Australian, French and United States Opens, and Wimbledon â threatened to expel her from the French Open.Instead, Ms. Osaka announced she would withdraw from the tournament. ÂThe truth is that I have suffered long bouts of depression since the U.S.
Open in 2018 and I have had a really hard time coping with that,â she wrote in her social media post.Regardless of the type of work you do, your job can affect your mental health and vice versa. And like Ms. Osaka, you have choices when it comes to preserving and improving your well-being.âWe would not fault her if she had a sprained ankle,â said Benjamin F.
Miller, the chief strategy officer for Well Being Trust, a national foundation focusing on mental health and well-being. ÂBut when it comes to mental health â which we know is equally, if not more, important than your physical health â we have this arbitrary standard of whatâs acceptable and whatâs not.âA survey of over 5,000 employees conducted last year by the advocacy group Mental Health America found that 83 percent of respondents felt emotionally drained from work and 71 percent strongly agreed that the workplace affects their mental health. While the respondents were not representative of the general population â they most likely found the survey when visiting the organizationâs mental health screening tools â their responses show just how anxious some workers have become.Women and people of color may shoulder a disproportionate amount of emotional stress both in and outside of the workplace.
Women are at least twice as likely to have had depression as men, according to federal data. And Black people are less likely than non-Hispanic white people to receive treatment for depression or prescription medications for mental health. A 2020 report from Lean In and McKinsey &.
Company noted that Black women were less likely to get the support they needed to advance in their fields than white women.Ms. Osaka, who is of Black and Asian descent, acted admirably when she stood up for her needs, several mental health experts said. It can benefit all of us to be on the lookout for signs that we might need to make changes at work or get professional help, they added.Evaluate your feelings.âEveryone has some awareness of their baseline functioning at work,â said Dr.
Jessi Gold, a psychiatrist at Washington University in St. Louis. So if you start to notice youâre losing interest in your job or your productivity plummets, itâs an indication that something is off, she said.For example, you might notice that you dread starting work each day, or you feel so anxious that you have trouble thinking about everything that youâre supposed to do.
Perhaps your emails are piling up and you arenât communicating with people as much as you typically would. If youâre feeling ineffective in your job, you may also start to engage in more negative self-talk, like. ÂIâm no good at my job anyway.
Iâm useless,â Dr. Gold said.An even bigger warning sign that work is affecting your mental health is if work tanks your mood to the point that it starts to damage your personal relationships, she added. For example, you might find that youâre picking more fights with your partner, becoming more irritated by your children or avoiding social activities in ways that you normally wouldnât.Think about what might be causing these feelings.
Is there one aspect of your job responsibilities that is causing most of your distress?. Do you have an underlying health problem like depression that has not been treated?. Is it some combination of the two?.
Get support.Once you realize you need help, seek out a trusted friend, mentor, co-worker, peer group or therapist, said Inger Burnett-Zeigler, an associate professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine who researches Black womenâs mental health.This should be a place âwhere you can feel seen, heard and validated, a place where you are able to be your fully authentic self without fear of judgment or negative repercussions,â she added.Many employers also offer employee assistance programs that have a variety of services, including short-term counseling from licensed therapists or referrals to outside experts who can help with the specific problem youâre having. (These services are often touted as confidential, but even so, some employees may feel uncomfortable using them.)Your company may also have partnerships with other organizations that provide wellness classes or free career coaching. Itâs worth investigating all the options, the experts said.âEmployers have become much more aware and frankly progressive in how theyâve been managing and treating issues of mental health over the last several years,â said Michael Thompson, president and chief executive of the National Alliance of Healthcare Purchaser Coalitions.
ÂThe cipro has actually reinforced that in spades.âMr. Thompsonâs organization recently did an online survey of 151 employers who buy health care services and found that 72 percent were seeking to improve mental health access for their employees and 16 percent were considering doing this in the next one to two years.Set boundaries.Once youâve found a supportive person to hear you out, together you can start to come up with a game plan to improve your work life and emotional well-being.Think about what you need most. Is it an accommodation like a short-term disability leave, or would it simply help to have more flexibility in your work schedule?.
Do you need to set cheap cipro pills limits as to when and how often you respond to work messages?. Before addressing any of this with your supervisor, be sure to consider how your proposed solution would work within the context of your team, because thatâs what your employer will want to know as well. In other words, show how your idea will benefit the group as a whole.âIf youâre really stressed out and have a mental heath issue that youâre wrestling with, itâs very difficult to think about the team more broadly,â said John Quelch, dean of the Miami Herbert Business School in Coral Gables, Fla., and co-author of the book âCompassionate Management of Mental Health in the Modern Workplace.â Even so, he added, âyou have to try to get in the head of your employer.âDuring the cipro, mental health problems have been pervasive.
A Centers for Disease Control and Prevention report concluded that in June of 2020, 40 percent of adults in the United States had been struggling with mental health or substance abuse issues.Itâs OK to be open and admit to yourself and those you trust that youâre struggling right now, said Paul Gionfriddo, the president and chief executive of Mental Health America. In fact, he added, âMost good employers are going to be asking, âWhat can I do to help you?. ÂâYou may also decide to keep your concerns private and address them with your therapist, and thatâs OK, too.
Creating healthy work boundaries is vital, experts said.âRemember that you are a worthy and valuable human being, separate from your job function, productivity and even how you might be evaluated by others,â Dr. Burnett-Zeigler said. ÂWhen feelings of self-doubt and not belonging show up, donât lose sight of the unique talents and ideas that you bring to the workplace.âBut say your efforts to address your emotional well-being at your job have fallen flat, or the work environment has become toxic.
In that case, the experts said, itâs probably best to start looking for another job, especially if you have become the target of ridicule, threats or abusive comments by a manager. It is illegal for an employer to discriminate against you simply because you have a mental health condition. And according to the U.S.
Equal Employment Opportunity Commission, if you have a qualifying condition like major depression or post-traumatic stress disorder, you have a legal right to a reasonable accommodation that would help you do your job â for example, the ability to schedule work around therapy appointments, a quiet office space or permission to work from home.âWhat we need to do is to recognize that anxiety is real, depression is real,â Mr. Gionfriddo said. ÂThis is a really good time for people to do that personal assessment, because there are opportunities to find more meaningful work out there.âAdvertisementContinue reading the main storyVirtual Reality Therapy Plunges Patients Back Into Trauma.
Here Is Why Some Swear by It.An experimental treatment seems poised to address a dire mental health crisis.Credit...Supported byContinue reading the main storyJune 3, 2021When a Veterans Affairs therapist first suggested that Chris Merkle try a virtual reality simulation that would mimic his days in combat, he was horrified. ÂI was like, you want to put me in a virtual world, reliving my worst days, my worst nightmares?. Â he said.It was the winter of 2013, and after three tours in Iraq and four in Afghanistan, Mr.
Merkle had spent years struggling with the invasive symptoms of post-traumatic stress disorder. He felt constantly on edge, bracing for an attack. He got angry easily.
He avoided thinking or talking about his time as a Marine. He tried traditional talk therapy, but didnât feel ready to discuss his past.Months later, after his symptoms intensified and he felt desperate for a salve, he decided to give virtual reality exposure therapy a try at a Department of Veterans Affairs hospital in Long Beach, Calif. The treatment uses V.R.
Technology to immerse a patient in a three-dimensional environment that mimics a traumatic memory. He strapped into a headset and sank into the past.The details in the simulation were extremely precise, Mr. Merkle said.
The military-issue truck, the weight of the model gun in his hand, the dark swath of sand in the night. He narrated one particularly troubling incident out loud to a clinician, who adjusted the simulation as he spoke. ÂI was seeing that person shooting at me, that I hadnât thought about in 10-plus years,â he said.
His muscles tensed. His heart raced. He was terrified.âMy body was physically reacting, because my mind was saying, this is happening to us.â But when he took the goggles off, he said, the sense of accomplishment became its own form of comfort.
For years, his memories had terrified him. Confronting the past in V.R. Proved to him that he could survive revisiting his memories.
ÂThat was the biggest leap,â he said.After about seven runs through the simulation, Mr. Merkle started uncovering fragments of memory his mind had blacked out, which is a common response to trauma. He remembered the name of the soldier who had been next to him in a truck during combat.
He remembered the clear feeling that he was going to die. Mr. Merkle walked out in the hall after he was done, grappling with what his brain had revealed.He felt like he was in a fantasy novel, he said.
As he left the session, he imagined that âthere was this black smoke pouring out of my mouth, oozing out of me. Like this evil, for lack of a better word for it, was slipping outâ of his body. He got to the parking lot and sat in his car for an hour.
The treatment was working, he thought. He was less scared of his memories, less scared of himself. He was getting better.Why V.R.?.
Why Now?. The most significant disorders that virtual reality therapy has shown success in treating â PTSD, anxiety, phobias â are on the rise. An April survey by the Centers for Disease Control and Prevention cited significant increases in respondents showing symptoms of anxiety disorders.
Health care workers have reported high rates of PTSD during the cipro â a February study of 1,000 frontline workers reported that nearly one-quarter showed likely signs of the disorder. In contrast, only 6.8 percent of the general population ever experiences PTSD in their lifetime, according to National Institute of Mental Health estimates.âbuy antibiotics has been traumatizing to so many people in so many ways,â said Dr. Nomi Levy-Carrick, a psychiatrist who leads outpatient psychiatric services at Brigham and Womenâs Hospital in Boston.
Grief, isolation, economic upheaval, housing and food insecurity, the âtoxic stressâ of lockdown and the surge in domestic violence during the cipro can all be traumatic stressors, she said. And the constant uncertainty of the past cipro year created conditions for widespread anxiety.Academics have studied virtual realityâs potential to treat anxiety disorders since the â90s, and the practice has incrementally gathered momentum, as the technology has improved and headsets have become more affordable. JoAnn Difede, a psychology professor at Weill Cornell Medicine in New York and one of the leading experts in virtual reality treatment for PTSD, said the headset she used for research with Sept.
11 survivors cost $25,000 at the time and weighed 10 pounds. Now, an average headset retails under $300.A virtual reality mindfulness exercise to soothe anxiety.CreditCredit...By CenteredVRRecreational V.R. Headset sales to the general public have grown during the cipro, but the technology has yet to fully enter the mainstream.
Experts who study the therapy argue thatâs about to change for the medical establishment, as clinicians look for effective and accessible ways to treat anxiety disorders.Mr. Merkle likened his experience in the virtual reality simulations to a child confronting imaginary monsters in a closet. Each time you open the door, he said, you see thereâs nothing to fear.
Your body whirs down from fight or flight mode. And each time, the virtual reality treatment gets easier.Many V.R. Therapies build on a sometimes-divisive therapeutic technique called prolonged exposure, developed by Edna Foa, a professor of psychiatry at the University of Pennsylvania Perelman School of Medicine.
Prolonged exposure is a cognitive intervention therapy. Patients first describe a traumatic event to a therapist, in detail and in the present tense, and then confront triggers of the traumatic event in the real world. While some experts have worried the practice might overwhelm or re-traumatize patients, prolonged exposure is now widely accepted as an effective tool to treat chronic PTSD.
Patients become desensitized to their memories. They prove to themselves that their thoughts can be safe.âIf you overcome something in V.R., you overcome it in real life,â said Daniel Freeman, a professor of clinical psychiatry at Oxford University who runs virtual reality therapies at 10 public clinics across England.Direct-to-consumer virtual reality therapy products, for now, remain rare, and only a few are covered by insurance. Companies that sell V.R.
Therapy software often explicitly state their products should only be used in the presence of a clinician. Experts like Andrew Sherrill, an assistant professor of psychiatry at Emory University in Atlanta who specializes in virtual reality therapy., worry that, as virtual reality expands, people seeking treatment might try out a program for themselves and not consult a therapist. They might shrug off the treatment after not getting results or aggravate trauma symptoms.
ÂItâs the closest thing our field has to just making opioids available over the counter,â he said.âV.R. Is not going to be the solution,â said Jonathan Rogers, a researcher at University College London who has studied rates of anxiety disorders during the cipro. ÂIt may be part of the solution, but itâs not going to make medications and formal therapies obsolete.âDoes V.R.
Therapy Work?. Virtual reality treatments arenât necessarily more effective than traditional prolonged exposure therapy, said Dr. Sherrill.
But for some patients, V.R. Offers convenience and can immerse a patient in scenes that would be hard to replicate in real life. For some people, the treatment can mimic video game systems theyâre already familiar with.
Thereâs also a dual awareness in patients who use virtual reality â the images on the screen are almost lifelike, but the headset itself functions as proof that theyâre not real.Months after the Sept. 11 terrorist attacks, Dr. Difede and Dr.
Hunter Hoffman, who is the director of the Virtual Reality Research Center at the University of Washington, tested virtual reality treatments in one survivor with acute PTSD, one of the first reported applications of the therapy. Dr. Difede said that the first time the patient put on the headset, she started crying.
ÂI never thought Iâd see the World Trade Center again,â she told Dr. Difede. After six hourlong sessions, the patient experienced a 90 percent decrease in PTSD symptoms.
Dr. Difede later tested V.R. Exposure therapy in Iraq War veterans.
16 out of the first 20 patients no longer met the diagnostic criteria for PTSD after completing treatment.At the University of Central Florida, a team called U.C.F. Restores has been building trauma therapies using V.R. That allows clinicians to control the level of detail in a simulation, down to the color of a bedspread or a TV that can be clicked on or off, in order to more easily trigger traumatic memories.
The program offers free trauma therapy, often using V.R., to Florida residents and focuses on treating PTSD.Dr. Deborah Beidel, a professor of psychology and executive director of U.C.F. Restores, has broadened the treatments beyond visuals, customizing sounds and even smells to create an augmented reality for patients.Jonathan Tissue, 35, a former Marine, sought treatment at U.C.F.
Restores in early 2020 after talk therapy and medication failed to alleviate his PTSD symptoms, which included flashbacks, anxiety and mood swings. In the end, it was the smells pumped into the room while he described his military service to a clinician that helped unlock his memories. There was the stench of burning tires, diesel fumes, the smell of decaying bodies.
He heard the sounds of munitions firing. His chair rumbled, thanks to the centerâs simulated vibrations.âIt unlocked certain doors that I could start speaking about,â he said. He talked through his newly uncovered memories with a therapist and a support group, processing the terror that had built in his body for years.Within three days, he said, he started feeling better.
By the end of the three-week treatment, his symptoms had mostly faded. ÂIt made me comfortable in my own self,â he said.âReady for Prime TimeâWhile a significant amount of funding â and consequentially, the bulk of research â on virtual realityâs therapeutic potential has focused on military veterans, âweâre ready for prime time to treat civilian trauma,â said Albert âSkipâ Rizzo, a clinical psychologist who specializes in virtual reality and worked with Mr. Merkle at the Department of Veterans Affairs.Several companies and clinicians are using V.R.
To treat other disorders. During the cipro, Johns Hopkins researchers have used it to reduce stress and burnout in medical workers. In one unpublished study, 50 nurses from a buy antibiotics ward tested virtual reality mindfulness exercises â guided meditations beside animated fields and waterfalls â and all but one participant reported reduced stress levels.Researchers are also testing whether they can alleviate childhood social anxiety with virtual reality programs, one of which uses animated artificial intelligence bullies that growl things like, âGive me your lunch money.â BehaVR, which currently sells therapeutic software on pre-loaded headsets to health care providers, plans to expand to direct-to-consumer products for social anxiety and other stress-related disorders, anticipating widespread post-cipro fears, Aaron Gani, the companyâs founder and chief executive, said in an interview.Virtual reality looks promising for treating phobias, according to Dr.
Howard Gurr, a psychologist in Long Island, N.Y. Heâs been interested in virtual reality for more than 20 years, since he saw Dr. Rizzo discuss a virtual classroom environment to diagnose and treat childhood attention-deficit/hyperactivity disorder.
But the technology has improved drastically in recent years, he said.In 2016, Dr. Gurr tried a simulation to treat patientsâ fear of heights that convinced him of V.R.âs therapeutic potential. A glass elevator steadily rose over a city, the roofs of the buildings below growing smaller and smaller.
A balcony appeared, and he was supposed to take a step onto it, over the chasm. Even though he didnât have a phobia of heights, Dr. Gurr couldnât do it.
ÂPart of my brain was hijacked,â he said. ÂI was like, âI got it. This works.ââBefore he found virtual reality, Dr.
Gurr would accompany a patient with a phobia of flying on an actual flight â a short distance, like New York to Philadelphia, over and over again. Now, he said, itâs more efficient and convenient to talk them through a virtual plane ride five or six times in a given session, on and off a pixelated runway. About one-third of his patients now come to his psychology practice specifically for virtual reality, he said, referred from other clinicians who donât offer the treatment.That number may grow as the cipro wanes in the United States, he said, and more people grapple with its aftermath.
He expects anxiety disorders will continue to rise, that the demand for effective treatments to tackle fear and trauma will only expand. Mr. Merkle, whoâs in the process of getting a degree in clinical psychology, mostly relies on traditional talk therapy these days.
PTSD has no clear end point. Even in recovery, it can trap you, cycling and churning. But for now, he said, thanks to the V.R.
Treatment, he feels something close to free.AdvertisementContinue reading the main story.
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