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Rated 5 out of 5 by Anonymous from Best vacuum A very functional vacuum fantastic suction from carpet to vinyl to tiles quick and so easy to use charge is plenty to do a 3 bedroom home very happy with my purchase Date published: Rated 5 out of 5 by Jas from Electrolux Well Q7 Animal Cordless It is very light and easy to use plus it has great suction for such a small price.

Rated 5 out of 5 by Anonymous from Good for a small apartment! Its a good vacuum for a small apartment. Rated 5 out of 5 by Mark paterson from Vacuum Best vacum I have had powerful easy to push quiet and home base is great Date published: Rated 5 out of 5 by Anonymous from Great product! Picked up twice as much dirt as my old Dyson vacuum. The light from the bottom helps miss spots of dirt. Good build quality, feels very sturdy, strong sucking power.

Very easy to unclick the small part from the big part and just as easy to put back in place too, but is snug and secure once in and doesn't seem like it'll fall out while in place. LED Light really works well to show up dust on wood and other flat flooring. Very happy with this so far! Date published: Rated 5 out of 5 by Anonymous from Happy Great product. So easy to use and great for all areas.

Rated 5 out of 5 by Shaninder from The best portable vacuum! Absolutely a gem to use, easy to use and quick charging time. Abe to Vacuum the whole house in one go! Rated 1 out of 5 by Deanoz from Don't buy this vac In under 5 months use I consider this q7 cordless vacuum a lemon. Mainly used on carpet, the bottom brush roller has stopped working; the accessory brush is difficult to dislodge; the handheld vac is even harder to remove from it's frame; at times the whole unit won't start; only approx 15mins running time on full power; not to mention how un-ergonomic it is to use as the handle doesn't fit your hand properly to maneuver the vac easily over carpet.

Widely recognised as the mask used during the Vietnam war. It was black in colour and looked menacing. The Americans did away with it a long time ago. Enter the cold war and the Soviet copying machine. The latter having the best features and build quality. The M wasn't the only mask to get duplicated by the reds.

United States M from the 's. Not only was it a faff to change the filters, it would also prove to be a safety issue as the mask has to be completely removed before filter changes. The poor fella wearing the mask had to totally expose himself to the very noxious crap he was trying to get away from! If your filters got clogged or wet then you were in a worse situation. An oversight on the design table. As Cheek filter masks were inherently impractical it wasn't long before the mask was replaced.

The Face piece. This unpleasant looking thing looks familiar? Overall the mask itself is very nice. It fits well and doesn't seem to weigh too heavy on the face. Drinking Straw. The drinking straw is made from good quality rubber with a metal coupling at the end. Unlike the drinking straws on the GP-7V twhich are exposed to the elements, The straw on the M10M is totally hidden behind a flap of rubber.

You wouldn't think so if you saw the eBay sellers photos of the mask. They just leave it looped up on the side of the mask, just ready to get snagged up on something and ripped out!

He has shown us that everything we went through to get him here was more than worth it. Rob and I are overwhelmed, not only with the love we feel for him, but also in this new and wild way we love one another as parents. Jul 9. K has been the kindest, funniest, best support through our ups and downs. Jul 7. Jul 4. Happy 4th of July! Jul 1. That smile! Jun Babygirl is moving like crazy and making me hungry way more now.

Happy Monday!! We could not have asked for a better experience. Western Fertility Institute is your guide in every step of your path to parenthood. Our goal is to make the process as easy as possible. We are here to provide you with the tools needed to have a clear path to follow so that you have the confidence that your needs and concerns are being met each and every step of the way.

Western Fertility Institute firmly believes that any person who wishes to have a family has the right to pursue their dreams of becoming a family, regardless of marital status or sexual orientation. We offer the opportunity to choose from various family building options in a continuously attentive and welcoming environment. Each Amulet is created with Love and Care. Bring out the mermaid in you with this lovely seashell hair clip, Items are made to order and all orders fulfilled quickly.

You can change the colors or the fonts or even create another color palette altogether. Makes up to 4 Yorkshire puddings for your roast dinner. The whole structure is made of high quality solid wood, bright pops of colour and elegant finishes for a touch of refined feminine opulence, They don't need any pruning and will stay beautiful for a long time.

Both chest and waist straps are adjustable and open with strong Duraflex branded buckles. Time span: 12 months January - December , 1 dual-band Wii can effectively avoid signal interference. Tangs for use with optional handles sold separately. We rely on the most cutting-edge technology to treat infertility, complemented by third-party reproduction methods such as in vitro fertilization, surrogacy and artificial insemination.

No other fertility clinics in Los Angeles can match our warmth and compassion. We know you have been through an ordeal dealing with infertility or frustrations over not being able to start a family.

When you come to us, you get someone in your corner. We will fight for you until you reach the result you have hoped for.






















Here are a few of the typical provisions as laid out by NOLO. Depending on the state, landlords may be required to include certain disclosures on their lease or rental agreements such as asbestos, mold, and registered sex offender information.

When drafting your lease or rental agreement, always be sure to comply with your state and federal laws. If stability is your main priority, a lease may be the right option. Many landlords prefer leases to rental agreements because they are structured for stable, long-term occupancy. Placing a tenant in a property for at least a year may offer a more predictable rental income stream and cut down on turnover costs. That said, once a lease agreement is signed, the rental cost is set in stone until the end of the agreement.

In an up-and-coming area with consistently growing property values, 12 months of a fixed rental cost could mean you miss out on substantial incremental income from market increases. According to Home Buying Institute , the median home price in the U. This forecast was issued in July and extends into the summer of Bottom line on Leases: A lease is a great option for landlords looking to make stable income, but may negatively impact profitability should property value grow within that year span.

Due to the short term of a rental agreement, they allow much more flexibility when it comes to rent increases. Moving to El Paso. Moving to Fort Lauderdale. Moving to Fort Wayne. Moving to Grand Rapids. Moving to Hartford. Moving to Houston. Moving to Indianapolis. Moving to Jacksonville.

Moving to Kansas City, MO. Moving to Knoxville. Moving to Lansing. Moving to Las Vegas. Moving to Los Angeles. Moving to Miami. Moving to Milwaukee. Moving to Music City? Nashville Moving Guide. Moving to Omaha. Moving to Orlando Guide.

New Brunswick Moving Guide. Orange County Moving Guide. San Antonio, Texas Moving Guide. San Diego Moving Guide for Renters. Santa Fe Moving Guide. Louis, Missouri Moving Guide. Washington D. Moving Guide. Apartment Staging Tips. Student Furniture Rental. Mobile Newsletter chat avatar. Mobile Newsletter chat subscribe. Real Estate. How Apartment Leases Work. You've found the perfect pad -- but now it's time to sift through the lease. General Apartment Lease Rules and Regulations An apartment lease tells you your rights, your responsibilities and those of the landlord.

Save a Copy. Including Your Pet on an Apartment Lease " ". If you own a pet, ask your landlord if it's all right to have one in the apartment. Early Termination of an Apartment Lease A lease is term-specific, usually lasting one year.

In the Army. What is a simple lease? A lease can be from one to many pages, but in general, it defines exactly how long you'll be renting the apartment six months, one year, two years and so on and exactly how much money you'll pay in rent each month and on what day. Do you need a lawyer to write a lease agreement?

Not necessarily, but you can if you want to. The lease is your legal record of the terms of living in the apartment — read it, date it, initial it. Is an apartment lease a contract? A lease contractually ensures that the landlord will have a source of revenue each month and will receive it at a specific time. How can I get out of a lease?

Sources ApartmentLiving. June 20, Pendola, Rocco. You can also check your current lease to see if any information about lease renewals is included; there may be some standard terms or requirements that are stated even before a lease renewal agreement is offered.

As with any new legal contract, make sure you carefully read the terms of any lease renewals and are prepared to fully agree before signing! Instead of paying the full amount for a month when you only lived there half the time, your landlord would charge you half the monthly rent. Check your lease and talk to your landlord or apartment complex manager if you need to pursue this option, and be prepared to pay all required fees.

In some cases, you may be able to sublet your apartment to another tenant rather than break the lease. If your landlord gives you permission to sublet your unit, make sure you get it in writing before you proceed.






















Standing benches: Players who are not currently in the game may stand behind the blue line, allowing for easy subbing. Players must substitute during live ball situations providing the following conditions: Players entering the ice after an expired penalty may not participate in a play until touching the centerline along the sideline Players entering the game must wait until the player leaving the floor is completely off the ice before entering the playing area.

Players leaving the ice must exit the same place that the substitute is entering the ice. Goalies must notify the referee or supervisor when substituting. Goalies They must use a broom, but may not lay their entire stick horizontally on the ice to make a save. If completely out of the crease and ball is frozen, an indirect shot is awarded to the opponent at the spot of the infraction.

A goalie in possession of the ball has five seconds to get rid of it. Opponents must back off enough to allow the goalie to pass the ball. The goalie may not roll or throw a ball outside their half of the ice.

If this occurs, possession of the ball will be given to the opponent at center ice for an indirect shot. A goalie leaving the crease loses all goalie privileges.

The goalie may be pulled or put back into goal at any time, as long as the officials have been notified.

No player offensive or defensive , except the goalie, is allowed in the crease area. A goal is scored by an offensive players in the crease is disallowed, unless the player was pushed by a defensive player into the crease.

A defensive player, other than the goalie stopping the ball in the crease, will be penalized by awarding a penalty shot to the opponent. The goal crease is a four foot radius making a half-circle and extends from the center point of the goal line perpendicular from the front of the goal. Goalies will serve all penalties they receive. Please bring your student ID with you, it is required in order to play. Each team must have 3 of each gender on the ice at all times or the game is defaulted.

The goalie is included in the minimum requirement of either gender. CSA helmets are mandatory. Goalies must have full face masks, but may not wear goalie pads. Broomball shoes or clean-soled running shoes must be worn. There is no body contact. All penalties will be 3 minutes. No sliding. All dangerous slides and sliding to block a shot will be whistled down.

Penalty On face-offs, the stick must make contact with the ball before it may be touched with the feet. Sticks should be kept below shoulder height.

Sticks may be above shoulder height to shoot, only if there is no one at risk of being hit. If the ball is touched by a stick above shoulder height, it will be whistled dead, and a face-off will occur. Remove the skates, put the players in street clothes, and replace the puck with a ball. Log in Social login does not work in incognito and private browsers.

Please log in with your username or email to continue. No account yet? Create an account. Edit this Article. We use cookies to make wikiHow great. By using our site, you agree to our cookie policy. Cookie Settings. Learn why people trust wikiHow. Download Article Explore this Article parts. Tips and Warnings. Related Articles. Part 1. Set up your court. An official broomball court is feet 61 m long and 85 feet wide, with your goals placed at either end.

If you are playing outside, it is important to clear the ice of bumps, snow, and any other debris, if possible. A semi-circle, called the goal crease, should extend out around the goal. A player cannot make contact with the broomball while inside the goal crease, and the goaltender cannot leave this area.

Find a referee. This step is optional if you are playing recreationally. The referee will start and stop the clock, call penalties, and conduct face-offs. Of course, this ref should be very knowledgeable about the official rules of broomball.

The most up-to-date rule book can be found on the USA Broomball website. Set up a timer. An official game of broomball consists of two halves of at least 30 minutes each. Teams should switch sides at the end of each half. Depending on the rules your team is following, an overtime can be called if there is a tie game at the end.

Teams are allowed a minimum of two breaks between periods, and can use one sixty second time out per game. Start each period with a face-off in the center of the rink.

In a face-off, a player from each team meets in a circle in the middle of the rink. A referee drops the ball, and each player attempts to gain possession to start out the period. Every goal scored will also be followed by a face-off. Their brooms cannot touch the ball until it has made contact with the ice. If your court does not have a center-court circle, just make sure that the players not participating in the face-off are at least fifteen feet away.

If there is a stoppage of play for any reason, such as a penalty, the face-off will occur wherever the stoppage was called. This can be accomplished by running the ball or passing with your teammates. The team with the most goals at the end of the game is declared the winner. Part 2.






















Having sex on those days will give you the greatest odds of conceiving. During ovulation, your ovary releases a mature egg. That egg makes its way down the fallopian tube on its way to your uterus.

On this route, the sperm will hopefully meet up with and fertilize the egg. Sperm can live for about five days. Keep a calendar of your menstrual cycles or use an app to keep track. Each cycle starts on the first day of your period, and ends on the day before your next period starts. Look for the midpoint of your cycle.

Drugstores also sell over-the-counter ovulation kits. Refer to the test kit instructions for more information. With hundreds of millions of sperm released in each male orgasm, any unprotected sex around the time of ovulation could result in a pregnancy.

As long as sperm enter the vagina, you have a chance to conceive. No certain positions during sex have been proven to increase likelihood of conception. Yet certain positions may be better than others for ensuring those little swimmers find their way up to the egg. The missionary man on top and doggie-style positions man behind allow for deeper penetration — bringing sperm in closer proximity to the cervix.

In the standing and woman-on-top positions, gravity works against you. Sperm are pretty good swimmers. Once deposited in the vagina, they can reach the cervix within 15 minutes. Placing a pillow under your lower back will also keep the sperm swimming in the right direction.

You might have read that having sex too often reduces sperm quality and quantity. Some research has shown that sperm have better quality when collected after a day period of abstinence.

Studies have also shown that higher rates of conception are seen in couples who have sex every days. Making love once a day or every other day during your fertile window will increase your odds of getting pregnant.

It could lead to unnecessary stress. Ultimately, the ideal number of times to have sex is what feels comfortable to you. Just under two-thirds of women use a lubricant during sex, but there have been questions about whether these products might affect sperm quality.

In lab studies , water-based lubricants like Astroglide and K-Y Brand Jelly reduced sperm movement by 60 to percent. Progesterone transforms the uterine lining into a mature lining that will accept a pregnancy.

The follicle called a corpus luteum at this stage will make progesterone for about days. If pregnancy does not occur, progesterone production stops and this triggers a reaction in the uterus to shed the uterine lining. The menstrual material, which consists of blood, endometrial tissue, cervical mucus and vaginal secretions, passes out of the body through the vagina.

Normal menses lasts for two to seven days. Menstrual periods typically start when girls are between the age of 11 and 14, and continue until a woman reaches menopause, which often begins around age An average cycle is commonly 28 days long, although it is normal to have cycles that are shorter or longer. The commonly accepted normal range for menstrual cycles is every 24 to 35 days.

Women may not ovulate at the same time each month and they may have irregular cycles that make the timing of ovulation more challenging to calculate. The male reproductive system includes the penis, testicles testes , the system of ducts known as the epididymis and the vas deferens, and the accessory glands, which generate fluids that nourish sperm and lubricate the ducts.

The penis has three parts: the root, the shaft and the glans or head. All males are born with a foreskin covering the glans of the penis, which is sometimes removed by circumcision. The tip of the penis has an opening that leads to the urethra. The urethra is the tube that passes through the shaft of the penis and releases urine during urination or semen during ejaculation.

The penis contains cylinders of spongy, erectile tissue. During arousal, these become filled with blood, causing an erection, which is necessary for penetration. Semen, a fluid that contains sperm, is released ejaculated when a man reaches sexual climax.

Most men have two testicles, which are also responsible for producing testosterone, a hormone that helps the male reproductive system function. Normal body temperature is too hot for sperm to survive, which is why the testicles are located outside the body proper and in the scrotum, where the temperature is about 3.

Sperm move from the testes to the epididymis, which are coiled tubes one in each testicle where sperm are stored and reach maturity. The vas deferens is a muscular tube that transports semen from the epididymis into the urethra during ejaculation. Semen contains sperm along with mucus to protect the sperm from the acid secreted in the vagina , proteins and fructose the main energy source for the sperm , and prostaglandins that stimulate female uterine contractions, helping move the semen up into the uterus.

When the ovary ovulates, the egg is released and rests on the surface of the ovary. But women become less fertile as they get older. One study found that among couples having regular unprotected sex:. Some of these factors affect either women or men. The most common cause is ovulation failure which can be caused by lots of different things and sperm disorders.

Read more detailed information about the causes of infertility. Page last reviewed: 4 September Next review due: 4 September Home Pregnancy Trying for a baby Back to Trying for a baby. How long does it usually take to get pregnant?






















The Constitution provides Congress not only enumerated powers, but also the ability to pass laws to make such powers effective. While such a power might have been implied of necessity even without an explicit textual basis in the Constitution, the Founding Fathers specifically included congressional authority to "make all Laws which shall be necessary and proper" 73 to effectuate its powers.

Although the extension of congressional power under this clause is not an independent basis for legislation, the provision has been integral to a broad interpretation of other congressional powers. For instance, as discussed below, the expansive nature of modern Commerce Clause doctrine may actually be a reflection of Necessary and Proper Clause jurisprudence. Sometimes, the Court's reliance on the Necessary and Proper Clause in a particular case is only briefly noted, or may even exist sub silentio.

For instance, the majority opinion in the case of Gonzales v. Raich discussed above emphasized that, in evaluating the scope of Congress's authority under the Commerce Clause to regulate medicinal marijuana, the Court need only find that Congress had a "rational basis" to find a link between the legislation and the Commerce Clause.

The Court then went on to note that in such cases "Congress was acting well within its authority to 'make all Laws which shall be necessary and proper' to 'regulate Commerce This passing reference to the Necessary and Proper Clause may obscure its historical significance to Commerce Clause litigation.

Writing in concurrence in Raich , Justice Scalia argued that it is more accurate to characterize the expansive "substantial effects" prong of Commerce Clause analysis as predominantly based on the Necessary and Proper Clause. He noted that the current description of the "substantial effects" prong is misleading because, unlike the channels, instrumentalities, and agents of interstate commerce, activities that substantially affect interstate commerce are not themselves part of interstate commerce, and thus the power to regulate them cannot come from the Commerce Clause alone.

Rather, "as this Court has acknowledged Congress's regulatory authority over intrastate activities that are not themselves part of interstate commerce including activities that have a substantial effect on interstate commerce derives from the Necessary and Proper Clause. Another area where the Court has provided a similarly broad interpretation of an Article I congressional power based on the Necessary and Proper Clause is the Spending Clause.

The defendant, who was convicted of attempting to bribe a city councilman to facilitate the building of a hotel and retail structure in Minneapolis, argued that the statute in question had no federal nexus. The Court rejected this argument, holding that Congress's authority under the Spending Clause, when supplemented by the Necessary and Proper Clause, allowed Congress to ensure that federal dollars not be diverted or undermined by corruption.

The Court held that it was not important if the federal funds received by the governmental entity in question were not directly involved in a particular scheme, because "money is fungible, bribed officials are untrustworthy stewards of federal funds, and corrupt contractors do not deliver dollar-for-dollar value.

An even more expansive interpretation of the Necessary and Proper Clause, in this case as applied to the entire federal criminal penal system which derives from a variety of congressional powers , is found in the Court's opinion in United States v.

The statute contained no requirement that the threatened future conduct would fall under federal jurisdiction, raising the question of what constitutional basis could be cited for the enforcement of the statute.

The majority opinion in Comstock upheld the statute after considering five factors: 1 the historic breadth of the Necessary and Proper Clause; 2 the history of federal involvement in this area; 3 the reason for the statute's enactment; 4 the statute's accommodation of state interests; and 5 whether the scope of the statute was too attenuated from Article I powers.

Maryland , 81 where the Chief Justice wrote: "Let the end be legitimate, let it be within the scope of the Constitution, and all means which are appropriate, which are plainly adapted to that end, which are not prohibited, but consist with the letter and spirit of the Constitution, are Constitutional.

Previous federal involvement in the area included not only the civil commitment of defendants who were incompetent to stand trial or who became insane during the course of their imprisonment, but, starting in , the continued confinement of those adjudged incompetent or insane past the end of their prison term.

In upholding the sex offender statute, the Court found that protection of the public and the probability that such prisoners would not be committed by the state represented a rational basis for the passage of such legislation. The Court further found that the state interests were protected by the legislation, as the statute provided for transfer of the committed individuals to state authorities willing to accept them. Finally, the Court found that the statute was not too attenuated from the Article I powers underlying the criminal laws which had been the basis for incarceration, as it related to the responsible administration of the United States prison system.

Another significant source of congressional power is Section 5 of the Fourteenth Amendment. The Fourteenth Amendment provides that states shall not deprive citizens of "life, liberty or property" without due process of law nor deprive them of equal protection of the laws. Section 5 provides that Congress has the power to legislate to enforce the amendment. The Fourteenth Amendment represented a significant shift of power in the nation's federal system.

Until the passage of the Fourteenth Amendment, the Constitution was limited to establishing the powers and limitations of the federal government. However, the amendments passed immediately after the Civil War the Thirteenth, 82 Fourteenth, and Fifteenth 83 Amendments , dramatically altered this regime. Passage of these amendments subjected a state's control over its own citizens to oversight by either the federal judiciary or Congress.

The most significant impact of the Fourteenth Amendment has been its implementation by the federal courts, as state legislation came under scrutiny for having violated due process or equal protection. However, Congress has also seen fit to exercise its power under the Fourteenth Amendment to address issues such as voting rights and police brutality.

The scope of Congress's power under Section 5 of the Fourteenth Amendment, however, has been in flux over the years. In Katzenbach v. Morgan , 84 the Court held that Section 5 of the Fourteenth Amendment authorized Congress not just to enforce the provisions of the Fourteenth Amendment as defined by the courts, but to help define its scope.

In Katzenbach , the Court upheld a portion of the Voting Rights Act of that barred the application of English literacy requirements to persons who had reached 6 th grade in a Puerto Rican school taught in Spanish. In upholding the statute, the Court rejected the argument that Congress's power to legislate under the Fourteenth Amendment was limited to enforcing that which the Supreme Court found to be a violation of that amendment.

Rather, the Court held that Congress could enforce the Fourteenth Amendment by "appropriate" legislation consistent with the "letter and spirit of the constitution. The rationale for this holding appears to be that Congress has the ability to evaluate and address factual situations that it determines may lead to degradation of rights protected under the Fourteenth Amendment.

This is true even if a court would not find a constitutional violation to have occurred. In fact, what the Court appeared to have done was to require only that Congress establish a rational basis for why the legislation was necessary to protect a Fourteenth Amendment right.

Subsequent Supreme Court cases, however, have limited the reach of Katzenbach. In Oregon v. Mitchell , 85 the Court struck down a requirement that the voting age be lowered to 18 for state elections. In prohibiting Congress from dictating the voting age for state elections, a splintered Court appears to have supported Congress's power to pass laws that protect Fourteenth Amendment rights against state intrusions, but rejected the ability of Congress to extend the substantive content of those rights.

As year-olds are not a protected class under the Fourteenth Amendment, the Court found that Congress was attempting to create, rather than protect, Fourteenth Amendment rights.

More recently, in the case of Flores v. For many years prior to the passage of RFRA, a law of general applicability restricting the free exercise of religion, to be consistent with the Freedom of Exercise Clause of the First Amendment, had to be justified by a compelling governmental interest.

However, in the case of Oregon v. Smith , 87 the Court had lowered this standard. The Smith case involved members of the Native American Church who were denied unemployment benefits when they lost their jobs for having used peyote during a religious ceremony. The Smith case held that neutral generally applicable laws may be applied to religious practices even if the law is not supported by a compelling governmental interest.

RFRA, in response, was an attempt by Congress to overturn the Smith case, and to require a compelling governmental interest when a state applied a generally applied law to religion. The City of Boerne case arose when the City of Boerne denied a church a building permit to expand, because the church was in a designated historical district. The church challenged the zoning decision under RFRA. The Supreme Court reiterated that Section 5 of the Fourteenth Amendment gave Congress the power to enforce existing constitutional protections, but found that this did not automatically include the power to pass any legislation to protect these rights.

Instead, the Court held that there must be a "congruence and proportionality" between the injury to be remedied and the law adopted to that end. For instance, the Court's decision in Katzenbach v. Morgan of allowing the banning of literacy tests was justified based on an extensive history of minorities being denied suffrage in this country. In contrast, the Court found no similar pattern of the use of neutral laws of general applicability disguising religious bigotry and animus against religion.

The law focused on no one area of alleged harm to religion, but rather just broadly inhibited state and local regulations of all types. The scope of the enforcement power under Section 5 of the Fourteenth Amendment also has become important in cases where the Court has found that Congress has overreached its power under other provision of the Constitution, or is limited by some provision thereof.

For instance, as discussed in detail below, the Supreme Court has held that the Eleventh Amendment and state sovereign immunity generally prohibit individuals from suing states for damages under federal law. For instance, a significant amount of federal legislation is clearly supported by the commerce clause, but it might not be supported under Section 5. Recently, the Court decided two cases that illustrate the difficulties of establishing Fourteenth Amendment authority for such legislation.

In College Savings Bank v. The New Jersey savings bank had developed a patented program where individuals could use a certificate of deposit contract to save for college. The state of Florida set up a similar program, and the College Savings Bank sued Florida for false and misleading advertising under a provision of the Trademark Act of Lanham Act , 91 alleging that Florida had made misleading representations about its own product.

The Court first noted that under Seminole Tribe of Florida v. Florida , Article I, powers such as the power to regulate commerce were insufficient to abrogate Eleventh Amendment immunity. Thus, the Court next considered whether the Lanham Act could be characterized as an exercise of Congress's power under Section 5 of the Fourteenth Amendment.

Although the Fourteenth Amendment provides that no state shall "deprive a person of As the Court found that Congress had not established an authority under the Fourteenth Amendment to abrogate the state's immunity, the College Savings Bank could not proceed against the state of Florida for unfair trade practices.

Even if a property interest is established, it would still need to be determined that Congress had the authority to protect that property interest under the Fourteenth Amendment. College Savings Bank , 92 the Court, in a decision concerning the same parties as the case discussed above, considered whether the College Savings Bank could sue the state of Florida for patent infringement. Congress had passed a law specifically providing that states could be sued for patent violations, 93 citing three sources of constitutional authority: the Article I Patent Clause, 94 the Article I Interstate Commerce Clause, 95 and Section 5 of the Fourteenth Amendment.

As the Court had previously precluded abrogation of sovereign immunity through the exercise of Article I powers, the question became whether Congress had the authority to pass patent legislation under Section 5 of the Fourteenth Amendment. Unlike the previous case, the Court found that, under a long line of precedents, patents were considered property rights.

However, the Court had to further consider whether the protection of such a property right under Section 5 of the Fourteenth Amendment was "appropriate" under its ruling in City of Boerne. Consequently, the Court evaluated whether a federal right to enforce patents against states was appropriate remedial or preventive legislation aimed at securing the protections of the Fourteenth Amendment for patent owners.

Specifically, the Court sought to evaluate whether unremedied patent infringement by states rose to the level of a Fourteenth Amendment violation that Congress could redress. The Court noted that Congress had failed to identify a pattern of patent infringement by the states, and that only a handful of patent infringement cases had been brought against states in the last years.

The Court also noted that Congress had failed to establish that state remedies for patent infringement were inadequate for citizens to seek compensation for injury. In fact, the state of Florida argued that no constitutionally based violation had occurred, as it had procedures in place that would provide the necessary due process for patent infringement by the state to be challenged.

Consequently, the Court found that the exercise of Section 5 of the Fourteenth Amendment in this context would be out of proportion to the remedial objective. The Court engaged in a similar analysis, with like results, in evaluating the application of age discrimination laws to the states. In Kimel v. Florida Board of Regents , 96 the Court noted that the Age Discrimination in Employment Act of , while a valid exercise of Congress's commerce power, could not be applied to the states unless Congress also had the power to enact it under Section 5 of the Fourteenth Amendment.

The Kimel Court held, however, that age is not a suspect class, and that the provisions of the ADEA far surpassed the kind of protections that would be afforded such a class under the Fourteenth Amendment. Further, the Court found that an analysis of Congress's ability to legislate prophylactically under Section 5 required an examination of the legislative record to determine whether the remedies provided were proportional and congruent to the problem.

A review by the Court of the ADEA legislative record found no evidence of a pattern of state governments discriminating against employees on the basis of age. Garrett , 97 again with similar result. In Garrett, the Court evaluated whether two plaintiffs could bring claims for money damages against a state university for failing to make reasonable employment accommodations for their disabilities; one plaintiff was under treatment for cancer, the other for asthma and sleep apnea.

Although disability is not a suspect class and thus discrimination is evaluated under a rational basis test, the Court had previously shown a heightened sensitivity to arbitrary discrimination against the disabled. However, the Supreme Court declined to consider evidence of discrimination by either the private sector or local government, and dismissed the examples that did relate to the states as unlikely to rise to the level of constitutionally "irrational" discrimination.

Ultimately, the Court found that no pattern of unconstitutional state discrimination against the disabled had been established, and that the application of the ADA was not a proportionate response to any pattern that might exist. However, the Court reached a different conclusion in the case of Nevada Department of Human Resources v. The FMLA requires employers to provide employees up to 12 weeks of unpaid leave to care for a close relative with a "serious health condition. The Court found that Congress had established significant evidence of a long and extensive history of sex discrimination with respect to the administration of leave benefits by the states, and that history was sufficient to justify the enactment of the legislation under Section 5.

The standard for demonstrating the constitutionality of a gender-based classification is more difficult to meet than the rational-basis test, such was at issue in Kimel and Garrett , so it was easier for Congress to show a pattern of state constitutional violations.

Even where the Eleventh Amendment and state sovereign immunity are not at issue, the Court may be asked to consider whether the Fourteenth Amendment establishes a sufficient basis for a federal law that does not appear to have a constitutional basis elsewhere in the Constitution. For instance, in United States v. Morrison , discussed previously, the Court found that Congress, in creating a federal private right of action for victims of gender-motivated violence, had exceeded its authority under the Commerce Clause.

Consequently, the plaintiff in that case made the alternate argument that the federal private right of action could be sustained under Section 5 of the Fourteenth Amendment. Indeed, it was not until the Supreme Court ruled in Gitlow v.

New York that the Court began a systematic application of the Bill of Rights to the states and other subnational governments through a judicially constructed due process understanding of rights protected by the Fourteenth Amendment, which was ratified after the Civil War in But states had constitutions, statutes, and common law practices that predated the First Amendment and provided a broad area in which states could address policy in areas prohibited to the national government and could protect individual liberties from government interference.

In their constitutions, Virginia, Pennsylvania, Maryland, Delaware, and North Carolina all provided for enumerations of rights such as those found in the Bill of Rights.

These rights-based protections were later included in the constitutional preambles of Vermont, Massachusetts, and New Hampshire, and in the constitutional provisions of New York, New Jersey, South Carolina, and Georgia. As the Union grew during the two centuries after the founding, state constitutions increasingly included enumerations of rights. Even today, some states are more active than the national government in protecting individual rights. For example, at the national level the right to privacy is derived from implications in the First, Third, Fourth, Fifth, Ninth, and 14th Amendments.

By contrast, half the states have enumerated constitutionally or by statute an explicit, and typically broader, right to privacy. Federalism gives the states latitude to experiment with policy areas under the First Amendment that it does not give to the national government, even though the latter retains an important role.

Daniel J. Elazar and other federalism scholars have observed that the states serve as laboratories for policy experimentation and for addressing the often unique needs arising from local and regional diversity. Even after a century of nationalizing policy authority, the states play a significant, meaningful, and constitutionally guaranteed role in the intergovernmental policy process that both affirms and extends the rights and limitations in the First Amendment and Bill of Rights.

Today, 38 State legislatures must approve an amendment for it to become a part of the Constitution. Informal amendments, unlike formal amendments which change the written word of the Constitution, are changes not affecting the written document. This vital process of constitutional change by means other than formal amendment has taken place—and con- tinues to occur—in five basic ways: through 1 the passage of basic legislation by Congress; 2 actions taken by the President; 3 key decisions of the Supreme Court; 4 the activities of polit- ical parties; ….

A formal change is called an amendment, or addition. To amend the Constitution, it has to be voted on by both houses of Congress by a two-thirds majority.

If approved, it becomes a formal proposal, and is sent to the state legislatures to be ratified. Begin typing your search term above and press enter to search.

Press ESC to cancel. A case can be made that the earliest constitutional amendments did matter. That would include the Bill of Rights, for example, and the Twelfth Amendment , which fixed a problem in the way the President and Vice President were originally chosen. And several amendments have been useful housekeeping measures, like the Twenty-Fifth Amendment , which says what happens if the President is disabled.

But if you really want to understand how the United States Constitution changes—in practice, not just on paper—constitutional amendments are a small part of the story. The real action—in many ways, our real Constitution—is elsewhere, in the way the courts, Congress, the President, and the people in their daily lives have brought us the Constitution we have today. The amendment process, however, has been criticized for having two defects.

One is that it is too strict and therefore makes it too difficult to enact amendments. The other is that it is biased in favor of the federal government and therefore does not allow amendments that would limit the national government.

If the original meaning were consistently followed, both of the defects would be eliminated. Some critics of originalism argue that the amendment process is too strict because it is difficult to secure approval by two-thirds of both Houses of Congress and three-quarters of the states. Therefore, these critics contend the Supreme Court should engage in nonoriginalist judicial interpretation to allow for modern circumstances and values to be incorporated into the Constitution.

The amendment process, however, is not too strict to allow for constitutional change. It is true that the process does require amendments to be supported by a consensus. See John O. Rappaport, Originalism and the Good Constitution The problem is not that the constitutional amendment process requires a consensus but that the Supreme Court often intervenes before a consensus can emerge.

A consensus often takes a long time to develop. As a result, no amendment will be enacted, since the Court has already made a change. By contrast, if the original meaning were followed, the amendment process would have the opportunity to enact changes in the Constitution that are supported by a consensus. This analysis helps to explain why so much constitutional change has occurred in the last three generations through judicial interpretation rather than the amendment process.

For example, during the New Deal, the Roosevelt Administration did not attempt to pass constitutional amendments to give the federal government more regulatory power. Instead, it attempted to pack the Supreme Court. There seems little doubt that the nation would have supported an amendment that conferred additional regulatory powers, but there is a good chance that the consensus requirement would have meant the federal government would have received less power than the Court eventually granted it.

A second problem with the amendment system is that its current operation is biased in favor of the federal government. The Constitution provides two methods for proposing amendments. While all of the existing amendments have been enacted through the congressional proposal method, in which two-thirds of each House of Congress proposes an amendment, no amendment has ever passed through the convention method. Under that method, two-thirds of the state legislatures can apply for Congress to call a convention that would then decide whether to propose an amendment.

The convention method was an essential part of the original Constitution. The drafters of the Constitution recognized that the congressional proposal method was controlled by the federal government. Consequently, it could not be relied upon to reform federal governmental abuses. The drafters therefore placed the convention method into the Constitution, since this method largely bypasses the federal government.

Michael B. Commentary 53






















Writing your own Waits-type lyrics takes time and a boatload of creativity. Get good accompaniment. It doesn't have to be a full band, but rather, a minimalist approach "Clap Hands" or just piano "Innocent When You Dream".

In these and other songs, percussion and instrumentation blend into a single stream of quirky sound. Find musicians who can keep up with composition in the spirit of the very diverse Tom Waits genre. When I think of a captivating voice, I begin thinking of a voice that immediately draws my attention in any situation.

His voice, though, is not main-stream captivating in the sense that it is an appealing, positive, or pretty voice. Instead, I argue that Waits's voice is captivating because the listener experiences an uncomfortable intimacy when listening to the guttural, raspy voice combined with an obscure, eerie atmosphere that he produces.

Tom Waits is an American singer-songwriter and performer. He is most well-known for his guttural, gravelly voice. He accentuates this raspy voice in many of his songs by switching from a modal, raspy voice to a vocal fry. This combination of raspy voice and vocal fry makes him sound as if he is growling in many of his songs. Furthermore, the listener may even feel Wait's voice is an intrusion as there is sibilance heard in many of his lyrics, giving the impression that he is speaking or singing very close to the listener.

This intimacy makes the listener uncomfortable as Waits's voice is growly and unsettling, and he generally sings of dark, sketchy, or disquieting themes. Active Oldest Votes. Improve this answer. Stephan A. Terre Stephan A. Terre 1 1 silver badge 4 4 bronze badges. Viking Children Viking Children 3 3 bronze badges. Glorfindel 3, 3 3 gold badges 20 20 silver badges 32 32 bronze badges. Scott Price Scott Price 7 1 1 bronze badge. Sign up or log in Sign up using Google.

Sign up using Facebook. Sign up using Email and Password. I try to pay attention to what people are doing the moment they come into the room. If they are just goofing around before we begin that may be the best thing they do all day. I have to be waiting. One of the tracks on the album finds him duetting with Richards.

In this sense you could be tempted to think that this is a glimpse of late-period Tom Waits, the home straight. The fact is, though, he has always liked the idea of being last man standing. If there has been a constant theme of his career — which has taken in two Grammy awards, scene-stealing acting roles for the likes of Robert Altman and Terry Gilliam , an Oscar nomination and a unique gift for performance that made his rare live shows just about the hottest ticket in any town — it is the constant sense of imminent dereliction.

His first album, Closing Time , made when he was 24, already saw him adopting the broken-down voice of a survivor of all that life and love might throw at him. The hats he has taken on and off since as a performer, late-night barfly, all American hobo, fairground huckster, have all suggested several lifetimes of hard-won experience. Now he is finally approaching the age he has always imagined himself to be, I wonder if it feels like he hoped it would? He gives his guttural half-laugh. When I was younger I wanted to be older," he says, "now I am older I am not quite so sure.

The album is the latest in his heroic one-man attempt to include the whole history of American song in his own voice — now bellowing like a deranged Louis Armstrong, now essaying a Marvin Gaye falsetto, now groaning like Lead Belly, always very much himself. Waits likes to divide his repertoire into "grand weepers and grim reapers" or "bawlers and brawlers"; Bad As Me is no exception to this. It starts with the most convincing runaway train you've ever heard, Waits shovelling coal insanely, and then shifts gears between desperate, defeated ballads and the kind of "rumpus" you imagine from the party scene of Where the Wild Things Are.

The band are required to do more than keep up. It seems beside the point to ask Waits whether he feels a keener sense of mortality. Death has never been far from his thoughts as a songwriter "I guess it's a pretty popular subject among those of us still breathing," he says.

But he signs off Bad As Me with a chilling little coda — "What's it like when you die? Is that the kind of thing that keeps him awake at nights? The other place that Waits has always gone to look for those surprises is in his own voice.

Does its scalded range still shock even him from time to time? I'm more the guy who says I look like hell but I'm going to see where it gets me. What started out for Waits as a stage act — the ultimate raddled crooner — became a compulsive caricature and is now a kind of larger-than-life persona that he can slip in and out of as he likes.

Looking back though, I wonder why, as a kid growing up in southern California, he was so keen to advance his years? It's pretty usual for a kid from a broken home. That latter fact has always seemed the most salient scrap of knowledge about Tom Waits's much mythologised background "I was conceived one night in April at the Crossroads Motel in La Verne, amidst the broken bottle of Four Roses, the smouldering Lucky Strike, half a tuna salad sandwich…" and so on.

When he was 10 or 11, his father — a Spanish teacher who used to drive his son from suburban Los Angeles over the Mexican border for haircuts and to listen to mariachi bands — walked out and didn't come back. Waits became, he told one interviewer, immediately fixated with dads.

He would go around to his friends' houses not to see them but so he could hang out with their old man. At 12, he carried his grandfather's walking stick and wore a trilby the hats have never gone away and he would clear his throat and ask his friends' fathers stuff like: "So how long you been at Aetna, Bob?

It was a natural progression to extend his search for adult wisdom to music, he suggests. I recall how he once described his childhood as "kneeling by a jukebox, praying to Ray Charles".






















The content on this page is a condensed version of our brochure, Canine Parvovirus, available in English and Spanish. Use the client information brochure Canine Parvovirus to educate your clients. Available in both English and Spanish Parvovirus Canino.

New veterinarian Answers to the questions you're facing as you start out in your professional life. Rising professional Early-career resources to continue your professional and personal growth. Diversity, equity, and inclusion Creating socially conscious work environments. Wellbeing Self-care and workplace wellbeing for the whole veterinary team. Practice management Profitability and finance, marketing, leadership, and team building. Personal finances Loans, budgets, financial planning, and more.

One Health Interprofessional collaboration across animal, human, and environmental health. Public resources Pet owners K educators. Calendar of events Live webinars Awareness events. Featured events Applications due: Wellbeing educator training November Animal Welfare Assessment Contest November 19 — Newsletters Get the latest updates on your choice of veterinary topics delivered straight to your inbox. View Larger Image. What is Parvo? How do dogs and puppies contract Parvo?

Shari Sims, Pembroke Animal Hospital. About the Author: Stacey. Related Posts. February 8th, 1 Comment. January 31st, 2 Comments.

January 17th, 3 Comments. September 23rd, 0 Comments. One Comment. Leave A Comment Cancel reply Comment. Call Now Button. Go to Top. They are vulnerable to the disease until they have received all three shots in their vaccination series, which means owners need to take extra precaution during this time to prevent their puppies from contracting the virus. Puppies should receive a dose of canine parvovirus vaccine between 14 and 16 weeks of age, regardless of how many doses they received earlier, to develop adequate protection.

The severity of parvo cases varies. The stress of weaning can lead to a more severe case of parvo n puppies, as stress weakens the immune system. A combination of parvo and a secondary infection or a parasite can also lead to a more severe case of parvo in puppies.

Puppies and adult dogs with parvo start shedding the virus within 4-to-5 days of exposure. Unfortunately for conscientious owners, this time period does not always coincide with the first parvo symptoms, which means dogs can be contagious before owners even realize that they are sick. Puppies with parvo continue to shed the virus for up to 10 days after a clinical recovery, so be sure to keep any puppies recovering from parvo away from unvaccinated and partially vaccinated dogs.

Outside of your dog, the virus can survive indoors for at least one month, and outdoors it can survive for many months and even a year under the right conditions.

Use a cleaner proven to kill parvovirus. Talk to your vet about the best way to remove the parvovirus from your home environment or kennels. A puppy with parvo is a very sick dog. The sooner you catch the early signs of the virus in puppies, the sooner you can get your dog to the vet. Since parvo is common in young puppies, you should call your vet any time your puppy is feeling under the weather, but you should also be aware of the specific symptoms of parvo in puppies:. All of these symptoms are serious by themselves and could be a sign of parvo or another serious illness.

Your vet will diagnose parvo based on clinical signs and through blood work. Veterinarians usually administer the CPV vaccine as part of a combination shot which includes, among others, the distemper, canine adenovirus, and parainfluenza vaccines. These shots are given every 3 to 4 weeks from the time a puppy is 6 weeks old until he is at least 16 weeks of age.

A booster vaccination is recommended one year later, and then at one at three year intervals thereafter. The tiny parvovirus is extraordinarily hardy. They are capable of surviving for months outside an animal, even through the winter, and are resistant to most household cleaning products. Infected dogs can shed vast numbers of viruses, making it difficult to disinfect an area once it has been exposed to an infected dog. These facts highlight the importance of isolating any dog that is infected with CPV from other dogs.

Given the fact that most environments including dog parks, lawns, and even homes are not cleaned with disinfecting products regularly, a puppy can be exposed to CPV without any warning, making the vaccine protection all the more important. If your home and yard have been contaminated by an infected dog, there are steps you can take to disinfect them before introducing a new dog or puppy. Despite its relative resistance to cleaning agents, we do know that CPV can be inactivated by bleach.

There is evidence suggesting that CPV loses some of its ability to infect an animal after one month in an indoor environment. Outside, you cannot and should not bleach your lawn, but rain or watering can dilute the concentration of the virus over time.

This dilution, combined with the sanitizing effects of sunlight can bring the numbers of viruses down to an acceptable level in a few weeks. The AVMA brochure on parvovirus provides a brief overview of what pet owners can expect in canine parvovirus infections. A more detailed resource for owners can be found at VeterinaryPartner. For veterinarians, the Merck Veterinary Manual provides a comprehensive chapter on parvoviral infection.

The Baker Institute for Animal Health has a long history of working to prevent and treat canine parvovirus infection. The virus first emerged in the United States, Europe, Asia and Australia in , when a virus similar to feline panleukopenia virus crossed over from cats to cause a new type of disease among domestic dogs. Within two years the virus had spread worldwide, killing thousands of dogs and possibly infecting millions more. Baker Institute scientists, including Drs.






















Slice a pie into five pieces, and remove one piece. That slice represents the roughly 20 percent of clinical-care practices for which solid randomized, controlled trial evidence exists. The remaining four-fifths represent medical care delivered based upon a combination of less reliable studies, unsystematic observation, informed guesswork and conformity to prevailing treatments and procedures used by most other clinicians in a local community.

To illustrate how little scientific evidence often exists to justify well-established medical treatments, David Eddy researched the scientific evidence underlying a standard and widely used glaucoma treatment designed to lower pressure in the eyeball.

He searched published medical reports back to and could not find one randomized, controlled trial of the treatment. That was despite decade after decade of confident statements about it in textbooks and medical journals, statements which Eddy found had simply been handed down from generation to generation. The kicker was that the treatment was harmful to patients, actually causing more cases of blindness rather than fewer. Similar evidence deficits exist for other common medical practices, including colorectal screening with regular fecal-occult-blood tests and sigmoidoscopy; annual chest x-rays; surgery for enlarged prostates; bone-marrow transplants for breast cancer; and common approaches to pain control, depression, immunizations, cancer screening, alcohol and drug abuse, smoking and functional disabilities.

The problem is rampant across medicine; a huge amount of what physicians do lacks a solid base of scientific evidence. In the past, many standard and accepted practices for clinical problems were simpler and more straightforward than those that today's clinicians face—and these practices seem to have worked, despite the paucity of good research evidence.

Physicians simply made subjective, intuitive decisions about what worked based on what they observed. The problem today is that the growing complexity of medicine bombards clinicians with a chaotic array of clinical choices, ambiguities and uncertainties that exceeds the inherent limitations of the unaided human mind.

As a result, many of today's standard clinical practices bear no relation to any evidence of effectiveness. Instead, physicians frequently base their decisions on shortcuts, such as the actions of the average practitioner "if everyone is doing it, the intervention must be appropriate" ; the commonness of the disease "if the disease is common, we have no choice but to use whatever treatment is available" ; the seriousness of the outcome "if the outcome without treatment is very bad, we have to assume the treatment will work" ; the need to do something "this intervention is all we have" ; and the novelty or technical appeal of the intervention "if the machine takes a pretty picture, it must have some use".

Drug prescribing is another blatant example of medical practice that is often evidence-free. Drugs that are known to be effective may work well for only 60 percent of people who take them. But about 21 percent of drug prescriptions in the United States are for "off-label" use, that is, to treat conditions for which they have not been approved by the U.

Food and Drug Administration. That's more than million prescriptions per year. Off-label use is most common among cardiac medications 46 percent and anticonvulsants 46 percent. Here's the real punch line: in 73 percent of the cases where drugs are used in unapproved ways, there is little or no evidence that they work. Physicians prescribe drugs well over a million times a year with little or no scientific support. These are fighting words, saying that such a big chunk of medical practice is not based on science.

To illustrate just how provocative this topic is, look at what happened in the s when the Federal Agency for Health Care Policy and Research now the Agency for Healthcare Research and Quality released findings from a five-year investigation of the effectiveness of various treatments for low back pain—one of the leading reasons that Americans see physicians. Led by back expert Richard A. Deyo, MD, MPH, the team included orthopedic surgeons, primary-care physicians, physical therapists, epidemiologists and economists.

Together, they examined the relative value of various diagnostic tests and surgical procedures. They conducted a comprehensive review of clinical literature on back pain. They exhaustively examined variations in the rates at which different procedures were being used to diagnose and treat back pain. Their chief finding was deeply disturbing: what physicians thought worked well for treating low back pain doesn't. The implication was that a great many standard interventions for low back pain may not be justified.

And that was immensely threatening to physicians, especially surgeons who perform back operations for a living. Among the researchers' specific findings: no evidence shows that spinal-fusion surgery is superior to other surgical procedures for common spine problems, and such surgery leads to more complications, longer hospital stays and higher hospital charges than other types of back surgery. Disgruntled orthopedic surgeons and neurosurgeons reacted vigorously to the researchers' conclusion that not enough scientific evidence exists to support commonly performed back operations.

The surgeons joined with Congressional critics of the Clinton health plan to attack federal funding for such research and for the agency that sponsored it. Consequently, the Agency for Healthcare Policy and Research had its budget for evaluative research slashed drastically. The back panel's guidelines were published in Since then, even though there are still no rigorous, independently funded clinical trials showing that back surgery is superior to less invasive treatments, surgeons continue to perform a great many spinal fusions.

The number increased from about, in to , in What are physicians to do? They need a great deal more reliable information than they have, especially when offering patients life-changing treatment options.

Before recommending surgery or radiation treatment for prostate cancer, for example, physicians and their patients must compare the benefits, harms and costs of the two treatments and decide which is the more desirable. One treatment might deliver a higher probability of survival but also have bad side effects and high costs, while the alternative treatment might deliver a lower probability of survival but have no side effects and lower costs.

Without valid scientific evidence about those factors, the patient may receive unnecessary and ineffective care, or fail to receive effective care, because neither he nor his physician can reliably weigh the benefits, potential harm and costs of the decision. Recognizing that the quality and reliability of clinical-research information vary greatly, entities like the U. The strongest evidence is the scarcest and comes from systematic review of studies randomized, controlled trials that are rigorously designed to factor out biases and extraneous influences on results.

Weaker evidence comes from less rigorously designed studies that may let bias creep into the results for example, trials without randomization or cohort or case-control analytic studies. The weakest evidence comes from anecdotal case reports or expert opinion that is not grounded in careful testing. There are a lot more "maybes" than "do's. Guidelines are not rigid mandates or "cookie-cutter" recommendations that tell physicians what to do.

They are intended to be flexible tools to help physicians and their patients make informed decisions about their care. Even guidelines that are rooted in randomized, controlled trial research do not make clinical decisions for physicians; rather, they must be applied to individual patients and clinical situations based on value judgments, both by physicians and their patients.

Clinical decision-making must entail value judgments about the costs and benefits of available treatments. What strong guidelines do is to change the anchor point for the decision from beliefs about what works to evidence of what works. Declaration This is my original unpublished piece, not under consideration for publication elsewhere.

Questions That This Paper Raises What needs to be done to bring about the paradigm shift from control and palliation to prevention and cure? Is cure at all possible? Will mainstream medicine ever be able to incorporate the beneficial findings of CAM? What needs to be done to promote wellness with longevity?

About the Author. References 1. Alexander C. N, Langer E. J, Newman R. I, Chandler H. M, Davies J. Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly. J Pers Soc Psychol. T, Bachmann M. A vaccine for hypertension based on virus-like particles: preclinical efficacy and phase I safety and immunogenicity.

J Hypertens. Anand P, Kunnumakkara A. B, Sundaram C, Harikumar K. Cancer is a preventable disease that requires major lifestyle changes. Pharm Res. Healthy centenarians do not exist, but autonomous centenarians do: a population-based study of morbidity among Danish centenarians. J Am Geriatr Soc. Dementia is not inevitable: a population-based study of Danish centenarians. Antonini F. M, Magnolfi S. Arch Gerontol Geriatr.

Epub Jun 4. Bijlani R. Yoga: an ancient tool in modern medicine. Natl Med J India. Bower J. Yoga for cancer patients and survivors. Cancer Control. Brown R. P, Gerbarg P. Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II--clinical applications and guidelines. J Altern Complement Med.

Yoga breathing, meditation, and longevity. Ann N Y Acad Sci. Bushell W. Longevity: potential life span and health span enhancement through practice of the basic yoga meditation regimen. C, Theise N. Toward a unified field of study: longevity, regeneration, and protection of health through meditation and related practices.

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Corliss R. The power of yoga. Time Apr Culos-Reed S. N, Carlson L. E, Daroux L. M, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Danhauer S. C, Mihalko S. L, Russell G. B, Campbell C. Restorative yoga for women with breast cancer: findings from a randomized pilot study. Int J Aging Hum Dev. W, Christensen K. Centenarians--a useful model for healthy aging?

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Foster E. The spiritual encounter within a complementary therapy treatment. Complement Ther Clin Pract. Epub Oct 5. M, Carru C, Desole M. Do men and women follow different trajectories to reach extreme longevity? Gooneratne N. Complementary and alternative medicine for sleep disturbances in older adults. Clin Geriatr Med.

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A Lancet analysis revealed that if rising life expectancy means years in good health, then health expenditure is expected to increase by only 0. The greatest stress on the NHS comes from managing almost entirely preventable chronic conditions such as heart disease, high blood pressure and type 2 diabetes. Yet rather than address the root cause of these conditions through lifestyle changes, we prioritise drugs that give — at best — only a marginal chance of long-term benefit for individuals, most of whom will derive no health outcome improvement.

The reality is that lifestyle changes not only reduce the risk of future disease, their positive effects on quality of life happen within days to weeks. However, those patients unlucky enough to suffer side effects from prescribed medicines may find their quality of life will deteriorate in order to enjoy small longer term benefits from the medication. But more than saving money, it will be about redistributing resources within the system to where they are needed most, in acute and social care.

If it were not for the discoveries of these companies, many of the people reading the Atlantic as well as this blog would not be here today. The efforts of the industry should not be sacrificed for the ideals of better care from physicians. As noted above, changes in care are more about the reimbursement system, and less about the 10 cents of every dollar spent on health care in America.

Ultimately, if it were not for the declines in death rates from heart disease and stroke, created by the drug device industry, we would lose 1 million more Americans every year. Just ask yourself, what are the chances that you or someone you loved would be in that 1 million, this year or the next. Thomas Sullivan is Editor of Policy and Medicine, President of Rockpointe Corporation, founded in to provide continuing medical education to healthcare professionals around the world.

Prior to founding Rockpointe, Thomas worked as a political consultant. Its impossible to those who did not knowabout to judge the others culture or belives. Nevertheless if they were professors in modern sscinces! Here comes the golden say: The best medicine, is that covers nutrition needs , and the best food, is that covers medication needs. Finally , Bees honey deveoped out of herbal sources! If others are of nothing in such belifth or knowledge,this will not means the current medicine is the best or the bioneer one ,For Islamic culture historically came first … But the progress,preference or Excellence will cot be of fair justice valus if other compititors are excluded.

Leave A Reply Cancel Reply. Save my name, email, and website in this browser for the next time I comment. Home Media Modern Medicine vs. Alternative Medicine: Different Levels of Evidence. Modern Medicine vs. By Thomas Sullivan Last updated May 6,






















You are free to change up how you invest your money at any time, and you can switch custodians as well by rolling your Roth IRA over to a new account. There's also no rule that says you can only have a single Roth IRA, though juggling multiple accounts with different custodians can make it more difficult to see what you have and to keep track of how close you are to the annual contribution limits. Follow the steps below if you hope to get the most value out of your Roth IRA. What you invest in is largely up to you, but you need to consider your investing experience and your risk tolerance.

Some types of investments are well-suited to beginners, while others are difficult to turn a profit unless you have specialized knowledge of the industry. Some investments are also riskier than others. Usually, you can afford to invest heavily in riskier assets, like stocks, while you're younger because your portfolio will have decades to recover from a loss before you need to draw upon it.

But as you age, your risk tolerance declines, and then you'll want to move more of your money into less volatile assets, like bonds. You also have to make sure you're diversified between many investments and sectors. This reduces the risk of serious loss if one of your investments starts performing poorly. Mutual funds, including low-cost index funds , provide a simple way to diversify your investments quickly.

Once you have some idea of what you want to invest in, you need to look for a Roth IRA custodian that offers these options. If you think you may want to open other types of investment accounts, like a traditional IRA , a taxable brokerage account, or a college savings account , in the future, look for a custodian that offers these as well. Pay attention to fees associated with your account as these can eat into your profits over time.

Your custodian should provide a list of fees, or you can reach out to the company and ask questions about the costs. You technically have up until the tax deadline for the year -- usually April 15 of the next year -- to contribute to your IRA, but waiting this long deprives you of months of potential investment growth. You're better off making a lump-sum contribution at the beginning of the year or contributing a regular amount each month.

Because Roth IRA contributions don't reduce your taxable income for the year, you could end up in a higher tax bracket than you're used to if you've contributed to a tax-deferred account in years past. In that case, you may want to put a little money in a tax-deferred account to keep yourself in a lower tax bracket so you can pay a smaller percentage in taxes on your Roth savings.

If you're earning less this year than normal, consider converting some of your tax-deferred retirement savings to Roth savings. You will pay taxes in the year you do the conversion, but this may not affect your tax bracket if you're careful about how much you convert at a time. Roth IRAs give you a lot of freedom to invest in a way that aligns with you preferences. But if you want to get the most out of yours, it helps to understand how they work and what steps you can take to maximize your savings.

Review your Roth IRA contributions and asset allocation at least once a year and make any changes you feel are necessary to keep yourself on track for the retirement you want. Discounted offers are only available to new members. Stock Advisor will renew at the then current list price.

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Burstein D. MRI for development of disease-modifying osteoarthritis drugs. NMR Biomed. Samy J. Products Images ; Mart K. Canon Lens Magnification Value. John A. Nationa Paranomal Society. Atabo SM. The Science of Imaging: An Introduction. Developmental anatomic studies on the triceps brachii and biceps brachii muscles in red sokoto goat Capra hircus.

Annual Research and Review in Biology. Steve D. California: Steve's Digicams; Ben J. Surgical Microscopes. Greg P. Xhirzys C. Advantages and disadvantages of digital camera. Mike G. Advantages of digital camera. Light microscopy techniques for live cell imaging.

Introduction to stereomicroscopy. Nikon Microscopy. William R. Spectacles and other vision aids: a history and guide to collecting. Oklahoma: Norman Publishing; Photon-sparse microscopy: visible light imaging using infrared illumination. The Origins of the telescope. Amsterdam: Amsterdam University Press; Ian MW. The principles and practice of electron microscopy. England: Cambridge University Press; Sam J. How does a light microscope.

Microscope world. Stereo zoom microscope. Practical aspects of photoactivated localization microscopy PALM. Ken A. Comparison scope 2 microscope. Ken-a-vision international. John HD. Comparison microscopy: the origins of firearms identification, a practical application of forensic science, technology and engineering to case linkage in shooting. Celestron J. Cordless digital microscope. Conventional endodontic and the operating microscope.

Dental Clinics of North America. Richard PF. Electron microscope. Origin and background of the invention of the electron microscope. Advances in Imaging and Electron Physics. Elderberry S. Electron microscopes vs. Pamela S. Microscopic structure. Guws medical. Danilatos GD. Colour micrographs for backscattered electron signals in the SEM. Cheville NF, Stasko J. Techniques in electron microscopy of animal tissue.

Vet Pathol. Rose HH. Optics of high-performance electron microscopes. Sci Technol Adv Mater. The first CT scanner for medical use dates from The resulting images provide greater information than regular X-rays, allowing doctors to examine individual slices within the 3-D images.

Contrast agents are commonly used in combination with CT scans to perform angiographies and other specific tissue examinations. Technological improvements in CT such as dose modulation acquisition techniques and iterative reconstruction algorithms dramatically reduce the required X-Ray dose, improve hospital efficiency and clinical effectiveness and reduce costs.

Molecular Imaging is a diagnostic tool where metabolic processes can be visualised by administering small amounts of radioactive pharmaceuticals to patients. These accumulate in a specific part of the body in a controlled way. Unlike other ionizing radiation techniques, which can only generate anatomical images, this technique generates functional images.

Some conditions initially have a physiological effect, rather than an anatomical change in the body. Molecular imaging allows for an earlier diagnosis. AIPES has developed a comprehensive tool on nuclear medicine. See website for further information. Doctors often use this scan to determine the size and location of a tumor. The machine looks like a large, white, doughnut-shaped tunnel that a patient slides into on a table for imaging.

An MRI uses a different type of energy to create images. A magnetic field affects the water molecules in the body and radio frequency RF waves pulse through the field to change how the aligned molecules move. This combination of magnetic waves and RF allows the creation of incredibly detailed 3D images.

An MRI is usually performed in a long tube where the patient lies still for the minutes required for the scan. Open MRIs are sometimes used for patients who are claustrophobic. A special camera records how the tracer moves through the body, which can show irregular tissue that can indicate cancer, a tumor, or infection.

The tracer is injected only at the area where the test is needed and it is eliminated from the body within a few days. A PET scan is a type of nuclear imaging that follows how a radioactive tracer is metabolized by the body. The information received from the PET scan is superimposed with the detailed X-rays of a CT scan to provide context for the patient. Fluoroscopy: This technique uses radiographs in combination with a contrast agent that is either injected or swallowed.

The path of the contrast agent is followed via radiographs to determine obstructions, ulcers, and other pathological processes. In this technique, the patient lies within a CT chamber, which contains both the detector and the source. The source and detector lie opposite each other and travel in an arc around the patient, obtaining images serially. Images are taken in slices of a few millimeters each and in three different axes—producing coronal, axial, and sagittal sections.

These sections can then be reconstructed to form a three-dimensional image. CT images possess far greater detail compared with traditional radiographs.

However, CT scanning delivers a substantially higher dose of radiation to the body. This diagnostic medical imaging technology makes use of radio-waves within a magnetic field. The human body is largely composed of water.

When placed in the MRI scanner, the hydrogen ions within the water molecules align themselves according to the field. When radiofrequency waves are applied, this alignment changes and after that the ions return to their original position.

These changes in alignment are recorded and processed to create an image. The MRI is useful for visualizing soft tissue structures such as muscles, tendons, and joint spaces.

Although there is no radiation hazard, MRI can be dangerous for people who have metal implants because of the use of a strong magnetic field. This includes patients who have artificial joints, pacemakers, or other types of implants. The tracers are either swallowed or injected into the bloodstream. Once within the body, tracers are taken up by specific tissues. The gamma rays emitted by these tracers are captured on a gamma camera and converted into digitized images.

Tracers may be chosen based on the region of interest. For instance, imaging of the thyroid gland requires radioactive iodine, as this compound is preferentially taken up by thyroid cells. Bone scanning for infectious disease uses technetium, gallium or indium. A special type of nuclear imaging is positron emission tomography PET. It can use a radioactive form of glucose. Glucose is preferentially taken up by cells which have a high rate of metabolism, such as cancer cells. Thus, this advanced diagnostic imaging technique can help to identify distant metastases in cancer patients.






















Here are the eleven non-profits that you can choose from when giving a gift, including the American Red Cross, which is now focusing on helping those affected by the horrific Hurricane Sandy aftermath on the East Coast:. The company tells me that it plans on rolling it out to more users proactively, as well.

Jared Morgenstern, the person who spearheaded this initiative at Facebook, told me about how this came about:. We believe that adding charitable giving to the Facebook Gifts platform will make it easier for people on Facebook to discover and connect with nonprofits that are doing important work around the world.

In addition to aiding in the aftermath of the hurricane, we believe that making it easier for people using Facebook to give a charitable donation through Facebook Gifts will introduce many Facebook users to exciting and worthy nonprofit organizations they may not have discovered otherwise. Amazon also announced that customers can now purchase Visa Gift Cards on Amazon.

How do you send Starbucks on Facebook? To "Give a Gift," app users are walked through a six-step process where they select a friend, specify an amount, choose a theme, pen a personal note, pay for the gift and then can share their generosity via status update with the rest of their Facebook friends. Where can I get a Facebook gift card?

You can buy digital gift cards on Facebook for businesses example: restaurants, shops. Can you send gift cards online? Please remember, the recipient must use Visa egift cards online or over the phone. If you send a merchant brand gift card, then it can likely be used in stores.

Of course, virtual gift cards also work seamlessly online. How do I sell a gift card on Facebook? Transcript: Sell Facebook gift cards and start driving additional revenue through your social media platforms. Add to your business's Facebook page. Confirm through Facebook. How do I redeem a Facebook gift card? Enter the PIN code found on the back of your card and click Redeem. Select your preferred currency and click Continue.

Can I send a gift card? When you're crunched for time and don't want to pay expedited shipping charges to get a gift card delivered quickly, then send a digital gift card.

Shipping is free because the virtual card or a link to claim the card is delivered electronically via text, email, social media, mobile wallet or gift card app. Can you use a Visa gift card on Facebook? Different banks maintain different hold time rules for electronic deposits. Meta imposes no charge to send or receive money via Facebook Messenger. The company makes no money directly with this feature. However, the financial incentive of this first move was to encourage and ease users into storing their payment information on the site, as well as process transactions.

On Nov. Rolled out the week it was announced, the service was available "for fundraisers, in-game purchases, event tickets, person-to-person payments, and select Pages and businesses on Facebook Marketplace" with plans to extend services. Those users who took advantage of the send and receive money feature, and thus have their payment information stored on the site, can buy the advertised product with a single click of the mouse or tap of the screen.

Impulse buying becomes easier and much more tempting when users do not have to fish their credit cards from their wallets and enter payment information for every purchase. In this regard, Meta stands to make a lot of money, albeit indirectly, from its send and receive money feature.

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I Accept Show Purposes. Your Money. Personal Finance. Your Practice. Popular Courses. Business Company Profiles. Key Takeaways Sending money through Facebook is simple: users simply need to enter a debit card or PayPal account through the in-app payment feature on Facebook Messenger.

In November , Facebook now Meta announced the launch of Facebook Pay, making it possible to process transactions across its platforms to purchase things such as games, event tickets, and certain Facebook Marketplace items. Article Sources. Investopedia requires writers to use primary sources to support their work. These include white papers, government data, original reporting, and interviews with industry experts.

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The trek to the summit takes months of physical preparation and weeks of acclimatization to get climbers used to the mountain's oxygen-starved altitudes.

Last month, tragedy struck on the peak. At least 11 people died , 10 of whom were on their way down from the summit. Some expedition companies and officials blamed lines near the summit, which caused climbers to spend more time in the mountain's "death zone": altitudes above 26, feet, where the body cannot get enough oxygen.

But other experienced climbers said most problems arise when climbers don't leave themselves enough energy to get back down the mountain. Read More: Crowds, costs, and corpses: 16 misconceptions about what it's like to climb Everest. Here's what it's like to climb the world's highest peak, according to 10 people who've experienced Everest. Crystal said his fitness regimen focused on core and general strength training. In addition to the personal training and stair climbing, he woke up at a.

Lukla has a reputation among climbers for being the world's scariest airport; the planes that transport climbers are quite small. Horrell , who has made the trip to Lukla seven times, described one accident in when a pilot misjudged the landing. People often pass through Namche Bazaar, a mountain village, to stock up on supplies. When Sprayregen arrived at Base Camp, she said , "I high-fived my group and took in the sight of dozens of yellow tents pitched across the ice, tents belonging to those preparing for their ascent.

Most of the regulars at Base Camp are sherpas who make their living guiding climbers up the mountain and transporting goods between Kathmandu, Base Camp, and other higher camps on the peak. Often, they receive a bonus for helping clients reach the top.

Sherpa previously told Business Insider that climbing Everest is "a little bit" scary, even for him. He added that another trip up would allow him to complete his 25th summit during his 50th year of life. Crystal realized that he was developing high-altitude pulmonary edema HAPE , in which dangerous levels of fluid build-up in the lungs.

He decided to leave the mountain. If climbers don't give their bodies enough time to adjust to the lung-crushing conditions in the Himalayas, they could experience swelling in their brain and lungs.

For this reason, expeditions generally make at least three trips up the mountain from Base Camp, going a few thousand feet higher each time before making a push for the top.

The Khumbu Icefall consists of layers of gigantic ice blocks that are constantly shifting, creating giant crevasses in between them. Climbers use metal ladders to span these cracks. Climbers perished after they fell into crevasses, sections of the Icefall melted and collapsed around them, or avalanches smothered them.

A mountain rescue team was able to evacuate Webster to Base Camp, then to Kathmandu for treatment. Burke kept climbing — the next step after Base Camp is Camp One, at 19, feet — and she eventually reached the summit. According to mountaineer and filmmaker David Breashears, the air has so little oxygen in it that even with supplementary air tanks, it can feel like "running on a treadmill and breathing through a straw.

She added: "It's absolutely crucial that you pay attention to what's going on around you and inside your body. You need to pay attention to small signals that your body is giving you. Some expedition companies have blamed these lines for the deaths that occurred last month, since the wait caused people to spend more time in the part of Everest known as the "death zone," which starts 26, feet up.

But Kami Rita Sherpa said these traffic jams are nothing new. That's why some climbers sit down and don't get back up. Over time, your extremities go numb, which indicates the beginning of frostbite. If not covered in additional layers and warmed swiftly, your skin turns a grayish-yellow and becomes hard and waxy. At this point, your joints may stop working as the affected areas become increasingly susceptible to irreversible tissue death, which requires amputation.

The best way to prevent frostbite is to ensure you have the highest-quality mittens, socks, boots, and headgear. And since windchill can dramatically speed up the onset and worsening of frostbite , do what you can to minimize wind exposure, like staying in your tent as often as possible. When you buy something using the retail links in our stories, we may earn a small commission. Outside does not accept money for editorial gear reviews. Read more about our policy. Search Search.

Your body on Everest is working overtime. Twitter Icon. Illustration by Erin K Wilson Brain As you ascend, less oxygen in your blood means less oxygen in your brain. Illustration by Erin K Wilson Lungs Starting at around 9, feet, your lungs may begin to swell due to a constriction of blood vessels , which can cause fluid to leak and accumulate. Illustration by Erin K Wilson Heart To supply your organs and muscles with enough oxygen to maintain functioning, your heart must work harder at altitude.

Illustration by Erin K Wilson Gut Digestion slows at altitude due to a lack of oxygen in the intestines and the body diverting blood to more critical organs and the muscles that are being used to climb. Read this next. By: The Editors. By: Alex Hutchinson. This allows you to climb at your own pace and enjoy the mountain on your own terms. The costs vary depending on how many climbers there in your private group. Please contact the office for details or see our Private Customised Expeditions page for more detail.

Why are you sometimes more expensive than other operators? Many of our trips are very similar in price to our competitors. Some companies even wait for us to set our prices and use ours as a guideline! Some of our main selling points, which sometimes do cost more, are internationally qualified Western guides, proven dependable local operators, small group sizes and safe client-to-guide ratios, quality equipment and high summit success rates, among other things.

You do get what you pay for which is why we stand out from the rest. Which route? North or South? The South Col route from Nepal offers the best chance of success for most climbers.

High royalty fees by the Nepalese Government have created a large disparity between the costs of Everest expeditions from Nepal and Tibet. We encourage you to research details about both sides of the mountain. People will argue the virtues of either of the two approaches. The Khumbu Icefall has a fearsome reputation and it is indeed, a phenomenal route to climb. Our Camp 2 is situated directly beneath the imposing black hulk of the notorious Southwest Face.

As one climbs higher up the route to South Col, the views become even more outstanding with incredible vistas along the Himalayan chain and out towards the lowlands of Nepal. As we approach the South Summit, the dawn breaks to reveal astounding views from Kanchenjunga in the east to Shishapangma off to the west, with all the peaks of the Khumbu well below us.

After the summit, we descend via the same route, losing height quickly and generally we arrive back at the South Col some hours after leaving the summit. On the north side, climbers must do a long traverse and it is this feature where climbers cannot lose elevation quickly that can cause the demise of tired climbers, especially those who have run out of oxygen.

We only climb on Everest during the spring season because the weather becomes progressively warmer and the days longer. Winter winds have already scoured away much of the snow, which significantly reduces the snow avalanche hazard as well. Contrast this with the autumn. Typically as the expedition goes on, the days get shorter and colder with more snowfall.

Consequently very few expeditions are undertaken in the fall and those that do have quite a low percentage chance of success. By the time you first arrive at Base Camp at the foot of the Khumbu Icefall, a route will already be established with ropes and ladders through to Camp 1.

The following day, you will continue up the more gentle slopes of the Western Cwm to Camp 2 to rest and acclimatise for several more days. During this time the guides and Sherpa climbers will be establishing the higher camps and stocking these with bottled oxygen for the summit climb. The second trip on to the mountain will involve sleeping one night at Camp 3 for acclimatisation before returning to base camp for a rest period. You cannot just decide to write a cheque and go and climb Everest!

A comprehensive climbing resume is required to join our team. Usually, we look for a few minimum requirements such as Denali for the cold and glacier travel experience and Aconcagua for the altitude experience. Beyond that, we look for well-rounded climbers with a wealth of experience.

Summit day experience on an 8,m peak such as Cho Oyu , prior to going to Everest is highly beneficial. Contact the office for further details and to discuss your individual background. What is the Fast Track programme? The itinerary follows a shortened day schedule, rather than the longer day schedule that our standard departure follows. It still requires a large commitment in terms of dedication, determination and discipline, ensuring that you follow a strict pre-acclimatisation programme prior to your arrival in Nepal to ensure your best chance of success.

How long is a typical day on the mountain? It depends on the day and your level of acclimatisation. At the beginning of the trip, everything seems slower and longer, but as you get more adjusted to the mountain, the days go quicker. Average days can be hours long. Summit day can be up to 20 hours long. What sort of hotels do we stay at in the city? We stay at the Radisson Hotel in Kathmandu which features a rooftop swimming pool and on-site dining.

Ideally located in Lazmipat, the hotel is adjacent to the Narayanhiti Palace Museum and is within walking distance of popular attractions including Durbar Marg and Thamel.

Will I be sharing a tent or room with other climbers? Is there a single room option on this trip? You will have your own tent in Base Camp, similar to the one pictured, but on the mountain, you will be sharing a tent with others. We generally book you into a single room in the hotel in Kathmandu whilst it is twin-share in the lodges on the trek into Base Camp.

A single supplement is available and please contact our office for further details. What kind of food do you have on the mountain and at Base Camp? This will depend on what camp we are in. On the mountain we usually have a wide variety of MREs Meals, Ready-to-Eat which are significantly tastier than freeze-dried food, as they are real food vacuum sealed and ready to heat and eat!

We work really hard to make sure our food is second to none. As evidence of this, other companies have tried to steal our master chefs over to their companies!

What is the best way to get to Nepal? From US? From there, Thai Airways fly direct to Kathmandu once a day. When should I book my ticket? Generally, we ask you to wait until 90 days prior to your trip start date to ensure your trip has met the minimum numbers and will operate. If you see a good deal and want to book your flights, then please ensure that you can make changes to your tickets or you run the risk of losing your ticket if we do have to cancel the trip.

In such situations, we are usually able to help you book on to an alternate departure, either with us or another operator. Can I get a cheap ticket online? The problem with these tickets is that you usually end up having to pay quite a lot more if you have to make any changes to your ticket.

We highly recommend using a travel agent for your travel as there are many intricacies that they can help you with. In the long run, they save you money! We use professional travel agents for all our staff and guides' travel bookings. What if I arrive early or depart late? Of course. On a trip as long as this, we request that you arrive in Kathmandu on the assigned date to assure your baggage makes it on time and you have time to recover from jet lag before trekking. It is hard to catch the group if you are arriving late and still waiting for lost baggage!

Many people depart from our Nepal expeditions later so that they enjoy the sights and sounds of Kathmandu, but do keep in mind that this is long expedition and we find that people want to head home as quickly as possible after the climb finishes.

We are happy to help arrange any extra hotel nights that are required. Where do we meet? Will I be picked up? An Adventure Consultants guide or agent will be waiting at Kathmandu Airport to pick you up off your flight on your arrival date. Are there any entry or visa requirements? Yes there are. You can apply online or you can complete the form on the plane as they are handed out on your arrival flight into Kathmandu. Be sure to have the suggested USD amount in cash for your visa application and have a passport photo for your arrival in Kathmandu.

Do you have a recommended list of clothing we should bring? Yes, you will be sent a personal clothing and equipment list once our office has received your trip registration form and deposit. Do I really need all the equipment on the equipment list? Yes, these lists have been carefully prepared.

Please bring everything on the list! How heavy will my pack be? The trip is so long The more comfortable you are, the more energy you have for the climb, so every little thing helps! What altitude medication will be available? All our guides carry extensive medical kits including Diamox, Dexamethasone, Nifedipine and Sildenafil for altitude illness. Some of our bigger expeditions even have their own doctor. Generally, there is no need to take prophylactic altitude medication before or during your expedition but if you have a previous history of altitude illness, then please discuss this with us and your physician.

Also, bring a small first aid kit including a blister kit and mild headache medication for the normal altitude headaches. Is bottled oxygen included? What sort of O2 masks do you use? We use Summit and Topout masks plus regulators for all our Sherpas, guides and climbers. What is the oxygen bottle size? We use 4-litre Poisk bottles, which are the lightest available at 3. What are the benefits of bottled oxygen?

Climbers have reported having better energy levels, a better appetite, more warmth, a higher degree of strength and greater enjoyment on summit day than those without.

They also enjoy a higher rate of success! How many climbers will be on this expedition? We have a maximum of 12 members with 3 guides on our Everest expedition, but we have most often had a group size of around 8 members with 2 guides. This is to ensure we can maintain safety and our attention to detail. There may be more in Base Camp and in the camps on the mountain if there are private expeditions, but they will generally travel separately from the main team.

Can I contact other climbers or guides for this expedition? Yes, we encourage that. Perhaps there is someone in your area that can become a training partner, perhaps they can help you source some hard-to-find gear. We respect the privacy of each team member and check with each person before releasing any contact details. Can my friends and family come along to Base Camp for the expedition? This is one of the best parts of the start of the expedition, having family and friends trek to Base Camp to see you off on your journey.

Base Camp for non-climbers is not a very hospitable place, but we strive to make your guests comfortable and welcome. Guests for the duration of the expedition are allowed on a case by case basis.

The reason for this is simple Contact us for more details. How much should I tip my guide staff? What about the Sherpa staff? This is a difficult thing to gauge.

It is worth remembering that you will have a high degree of contact with some of the Sherpa staff, while others will be working away in the background providing necessary services to keep the expedition running and therefore we feel it is appropriate to include them in the tipping pool. What is the conditioning level needed for this climb?

You should be in the best shape of your life! This is our longest expedition of the year. It requires patience, stamina, mental fortitude, and a strong will. Summit day can sometimes be over 20 hours long! Day by day the challenges are different, but the more prepared you are, both mentally and physically, the smoother your trip will go. Check out our training page for more information on fitness for climbing.

How do you train for a trip like this? Our standard response to this question is that for Everest, you become a climber first, and everything else during this portion of your life comes second. This is the level of dedication to your training, both mental and physical, that you need to have. We have specific ideas around training and great book suggestions to help you along. Please look over our training page for details. If you require more information, please contact our office and we will be happy to put you in touch with one of our senior guides for a consultation and we can also link you with our training coach to design a training programme for you.

What type of communication is available on the expedition? We have one of the most sophisticated communication systems around.

A Wi-Fi connection is available at Base Camp and included in the expedition fee fair-use policy applies. We power all our communications equipment with solar, using generators only as backup. On the mountain, we discourage phone calls as they distract from the climb and we often are limited by our power availability.

If you need a private communications setup, this is also possible for a fee. Contact our office for details. I want to contact my friend or relative, who is on one of your trips, how can I reach them? We send daily internet dispatches , and we receive updates from our guides while they are in the field. The best place to reach a loved one is through our office. Will there be any power source for charging batteries and electronic equipment throughout the expedition? What voltage requirements?

We take solar panels and battery power packs on our expeditions. Our first priority is to charge our computers, satellite phones and expedition electrical equipment. There is usually enough power to then charge your personal electrical equipment. If your equipment has a cigarette lighter type car charger, bring that and you can plug it in to charge. We do NOT recommend bringing rechargeable digital cameras; they tend to run out when power is not available.

Use cameras with replaceable batteries and we recommend lithium batteries. We can cater for special power requirements at an extra cost—please enquire with our office.

Many of the lodges also have power available with typical Asian plugs two horizontal prongs and they have battery recharging systems and pricing on offer. What weather report service do you use?

We receive comprehensive weather forecasts from our Swiss meteorologists which enable us to plan our ascent around favourable weather. Additional meteorological interpretation provided by veteran high altitude guides through our head office in New Zealand helps manage the decision-making process.

What insurance will I need? In addition to evacuation and medical insurance, we recommend that our expedition members buy trip cancellation insurance upon sign up for the expedition. We also highly recommend purchasing a comprehensive travel insurance policy to provide cover for trip interruption, baggage loss, damage or theft, delayed flights or other such incidents that may occur during your trip.

Contact us or see our webpage on expedition insurance advice. Do I need evacuation insurance? Evacuation from the mountain can be expensive and you need to be insured accordingly, as well as having coverage for repatriation and travel medical expenses. Read your policy's fine print to make sure it covers you for mountaineering and helicopter evacuation. Who do you recommend for insurance? You will be sent information specific to your expedition as part of your welcome package and requirements differ depending on where you are travelling and your home location.

What is trip cancellation insurance? Trip cancellation insurance is an option that may allow you to cancel your trip without losing the total cost of the trip. Adventure Consultants highly recommends cancellation insurance for all of our trips. If circumstances cause us to cancel a trip minimum numbers are not reached or travel to a country becomes too dangerous then we refund your fees paid but trip cancellation insurance covers your airfare and any other costs you may have incurred.

How much should I budget for this expedition? How much cash should I plan to bring? This will cover everything from gifts to bottled drinks, tips and anything else that catches your eye on the trail.