what are the fentanyl dosages?

The bioavailability of intranasal fentanyl is about 70–90%, but with some imprecision due to clotted nostrils, pharyngeal swallow and incorrect administration. For both emergency and palliative use, intranasal fentanyl is available in doses of 50, 100, and 200 µg. In emergency medicine, safe administration of intranasal fentanyl with a low rate of side effects and a promising pain reducing effect was demonstrated in a prospective observational study in about 900 out-of-hospital patients.

Fentanyl

"From Wikipedia, the free encyclopedianavigation search Fentanyl Clinical data Trade names Actiq, Duragesic, Fentora, others AHFS / Drugs.com Monograph License data EU EMA : by INNPregnancy category AU: CUS: C (Risk not ruled out)Dependence liability Very high Routes of administration Buccal, epidural, IM, IT, IV, sublingual, skin patch Drug class Opioid ATC code N01AH01 ( WHO) N02AB03 ( WHO)Legal status Legal status AU: S8 (Controlled)CA: Schedule IDE: Anlage III (Special prescription form required)UK: Class AUS: Schedule IIPharmacokinetic data Bioavailability 92% (transdermal) 89% (intranasal) 50% (buccal) 33% (ingestion)Protein binding 80–85%Metabolism hepatic, primarily by CYP3A4Onset of action 5 minutes [1]Biological half-life IV: 6 mins (T1/2 α) 1 hours (T1/2 β) 16 hours (T1/2 ɣ) Intranasal: 6.5 hours Transdermal: 20–27 hours [2] Sublingual/buccal (single dose): 2.6–13.5 hours [2]Duration of action IV: 30–60 minutes [3] [1]Excretion Mostly urinary (metabolites, <10% unchanged drug) [2]Identifiers IUPAC name CAS Number437-38-7Pub Chem CID3345IUPHAR/BPS1626Drug Bank DB00813Chem Spider3228UNIIUF599785JZKEGGD00320Ch EBICHEBI:119915Ch EMBLCHEMBL596ECHA Info Card 100.006.468Chemical and physical data Formula C 22 H 28 N 2 OMolar mass 336.471 g/mol3D model ( JSmol)Interactive image Melting point 87.5 °C (189.5 °F)SMILESIn Ch I (verify)Fentanyl, also known as fentanil, is an opioid which is used as a pain medication and together with other medications for anesthesia. [2] It has a rapid onset and effects generally last less than an hour or two. [2] Fentanyl is available in a number of forms including by injection, as a skin patch, and to be absorbed through the tissues inside the mouth. [2]Common side effects include nausea, constipation, sleepiness, and confusion. [2] Serious side effects may include a decreased effort to breathe (respiratory depression), serotonin syndrome, low blood pressure, or addiction. [2] Fentanyl works in part by activating μ-opioid receptors. [2] It is about 75 times stronger than morphine for a given amount. [4] Some fentanyl analogues may be as much as 10,000 times stronger than morphine. [5]Fentanyl was first made by Paul Janssen in 1960 and approved for medical use in the United States in 1968. [2] [6] It was developed by testing chemicals similar in structure to pethidine (meperidine) for opioid activity. [7] In 2015, 1,600 kilograms (3,500 lb) were used globally. [8] As of 2017, fentanyl was the most widely used synthetic opioid in medicine. [9]Fentanyl patches are on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. [10] The wholesale cost in the developing world as of 2015 is between 0.08 and 0.81 USD per 100 micrograms vial. [11] In the United States this amount costs about 0.40 USD as of 2017. [12] Fentanyl is also made illegally and used as a recreational drug often mixed with heroin or cocaine. [13] In 2016 more than 20,000 deaths occurred in the United States due to overdoses of fentanyl and its analogues. [14]Contents1 Medical uses1.1 Intravenous and intrathecal1.2 Patches1.3 Intranasal1.4 Sublingual1.5 Lozenges1.6 Other2 Adverse effects3 Overdose4 Pharmacology4.1 Detection in biological fluids5 History6 Society and culture6.1 Brand names6.2 Cost6.3 Legal status6.4 Legal action6.5 Public health advisories6.6 Recreational use6.7 Incapacitating agent7 Veterinary use8 References9 External links Medical uses [ edit]Intravenous and intrathecal [ edit]Intravenous fentanyl is often used for anaesthesia and analgesia. During anaesthesia it is often used along with a hypnotic agent like propofol. It is also administered in combination with a benzodiazepine, such as midazolam, to produce sedation for procedures such as endoscopy, cardiac catheterization, and oral surgery, or in emergency rooms. [15] [16] It is often used in the management of chronic pain including cancer pain. [17]Fentanyl is sometimes given intrathecally as part of spinal anaesthesia or epidurally for epidural anaesthesia and analgesia. Because of fentanyl's high lipid solubility, its effects are more localized than morphine, and some clinicians prefer to use morphine to get a wider spread of analgesia. [18]Patches [ edit]A fentanyl transdermal patch with a release rate of 12 micrograms / hour, on a person's arm. Fentanyl transdermal patches (Durogesic/Duragesic) are used in chronic pain management.

The patches work by slowly releasing fentanyl through the skin into the bloodstream over 48 to 72 hours, allowing for long-lasting pain management. [19] Dosage is based on the size of the patch, since, in general, the transdermal absorption rate is constant at a constant skin temperature.

[19] Rate of absorption is dependent on a number of factors. Body temperature, skin type, amount of body fat, and placement of the patch can have major effects. The different delivery systems used by different makers will also affect individual rates of absorption. Under normal circumstances, the patch will reach its full effect within 12 to 24 hours; thus, fentanyl patches are often prescribed with a fast-acting opioid (such as morphine or oxycodone) to handle breakthrough pain. [19]It is unclear if fentanyl gives long-term pain relief to people with neuropathic pain. [20]In palliative care, transdermal fentanyl has a definite, but limited, role for:people already stabilized on other opioids who have persistent swallowing problems and cannot tolerate other parenteral routes such as subcutaneous administration.people with moderate to severe kidney failure.troublesome side effects of oral morphine, hydromorphone, or oxycodone. [ citation needed]Care must be taken to guard against the application of external heat sources (such as direct sunlight, heating pads, etc.) which in certain circumstances can trigger the release of too much medication and cause life-threatening complications. Duragesic was first approved by the College ter Beoordeling van Geneesmiddelen, the Medicines Evaluation Board in the Netherlands, on July 17, 1995, as 25, 50, 75 and 100 µg/h formulations after a set of successful clinical trials, and on October 27, 2004, the 12 µg/h (actually 12.5 µg/h) formulation was approved as well. On January 28, 2005, the U. S. Food and Drug Administration approved first-time generic formulations of 25, 50, 75, and 100 µg/h fentanyl transdermal systems (made by Mylan Technologies, Inc.; brand name Duragesic, made by Alza Corp.) through an FTC consent agreement derailing the possibility of a monopoly in the treatment of breakthrough chronic pain by Alza Corp. In some cases, physicians instruct patients to apply more than one patch at a time, giving a much wider range of possible dosages. For example, a patient may be prescribed a 37.5 µg dosage by applying one 12.5 µg patch and one 25 µg patch simultaneously, or contingent on the large size of the (largest) 100 μg/h patch, multiple patches are commonly prescribed for doses exceeding 100μg/h, such as two 75 μg/h patches worn to afford a 150 μg/h dosage regimen. Although the commonly referred to dosage rates are 12/25/50/75/100 µg/h, the ""12 µg"" patch actually releases 12.5 µg/h. [21] It is designed to release half the dose of the 25 µg/h dose patch. As of July 2009, construction of the Duragesic patch had been changed from the gel pouch and membrane design to ""a drug-in-adhesive matrix designed formulation"", as described in the prescribing information. [21] This construction makes illicit use of the fentanyl more difficult. Storage and disposal [ edit]The fentanyl patch is one of a small number of medications that may be especially harmful, and in some cases fatal, with just one dose, if used by someone other than the person for whom the medication was prescribed. [22] Unused fentanyl patches should be kept in a secure location that is out of children’s sight and reach, such as a locked cabinet. When patches cannot be disposed of through a medication take-back program, flushing is recommended for fentanyl patches because it is the fastest and surest way to remove them from the home so they cannot harm children, pets and others who were not intended to use them. [22] [23] [24]Recalls [ edit]In February 2004, a leading fentanyl supplier, Janssen Pharmaceutica Products, L. P., recalled one lot, and then later, additional lots of fentanyl (brand name: Duragesic) patches because of seal breaches which might have allowed the medication to leak from the patch. A series of Class II recalls was initiated in March 2004, and in February 2008 ALZA Corporation recalled their 25 µg/h Duragesic patches due to a concern that small cuts in the gel reservoir could result in accidental exposure of patients or health care providers to the fentanyl gel. [25]In February 2011, the manufacturer suspended production of all Duragesic patches due to quality control issues involving unspecified ""microscopic crystallization"" detected during the manufacturing process of the 100 µg/h strength. [ citation needed]Intranasal [ edit]

[26]In children, intranasal fentanyl is useful for the treatment of moderate and severe pain and is well tolerated. [27]Sublingual [ edit]Abstral dissolves quickly and is absorbed through the sublingual mucosa to provide rapid analgesia. [28] Fentanyl is a highly lipophilic compound, [28] [29] which is well absorbed sublingually and generally well tolerated. [28] Such forms are particularly useful for breakthrough cancer pain episodes, which are often rapid in onset, short in duration and severe in intensity. [30]Lozenges [ edit]Package and example of fentanyl lollipop (brand: Actiq), 400 micrograms. Fentanyl lozenges ( Actiq) are a solid formulation of fentanyl citrate on a stick in the form of a lollipop that dissolves slowly in the mouth for transmucosal absorption. These lozenges are intended for opioid-tolerant individuals and are effective in treating breakthrough cancer pain. [31] It has also been used for breakthrough pain for patients with nonmalignant (not cancer related) pain, but this application is controversial. [32] The unit is a berry-flavoured lozenge on a stick swabbed on the mucosal surfaces inside the mouth—inside of the cheeks, under and on the tongue and gums—to release the fentanyl quickly into the system. It is most effective when the lozenge is consumed within 15 minutes. About 25% of the medication is absorbed through the oral mucosa, resulting in a fast onset of action, and the rest is swallowed and absorbed in the small intestine, acting more slowly. The lozenge is less effective and acts more slowly if swallowed as a whole, as despite good absorbance from the small intestine there is extensive first-pass metabolism, leading to an oral bioavailability of about 33% as opposed to 50% when used correctly, (25% via the mouth mucosa and 25% via the gut). [31]Actiq is produced by the pharmaceutical company Cephalon on a plastic stick; this provides the means by which the medication can maintain its placement while it dissolves slowly in the mouth for absorption across the buccal mucosa, in a manner similar to sublingual buprenorphine/naloxone film strips. An Actiq lozenge contains two grams of sugar (eight calories). [33] [34] Actiq has been linked to dental decay, with some users who had no prior dental issues suffering tooth loss, and in the U. S many users have started their own Facebook pages to educate users about the severe dental issues caused by the so-called fentanyl lollipops. CBS News reported the issue 28 September 2009. The status of a sugar-free version, called Actiq-SF, is unclear. Since the release of Fentora —an effervescent buccal fentanyl tablet for breakthrough cancer pain —Cephalon has indefinitely postponed plans to release a sugar-free version of Actiq. [ citation needed]Beginning late September 2006, a generic ""oral transmucosal fentanyl citrate"" has been available, made by Barr Pharmaceuticals. [35]The United States Air Force Pararescue and Swedish armed forces combat medics utilize lollipops with fentanyl. [36] Navy corpsmen working with the United States Marine Corps in Afghanistan use Fentanyl lollipops on combat casualties from IED blasts and other mechanisms of injury. The lollipop is taped to the casualty's finger and inserted in between the teeth and cheek (buccal area) of the patient. When enough of the medication has been absorbed the finger will generally fall from the patient's mouth, thereby indicating that the medication has become effectively administered. Other [ edit]Some preparations such as nasal sprays and inhalers may result in a rapid response, but the fast onset of high blood levels may compromise safety. In addition, the expense of some of these appliances may greatly reduce their cost-effectiveness. In children it is unclear if intranasal fentanyl is as good as or the same as morphine. [37]A fentanyl patient-controlled transdermal system (PCTS) is under development, which aims to allow patients to control administration of fentanyl through the skin during the treatment of perioperative pain. [38]Adverse effects [ edit]Fentanyl's most common side effects (more than 10% of patients) include diarrhea, nausea, constipation, dry mouth, somnolence, confusion, asthenia (weakness), sweating, and less frequently (3 to 10% of patients) abdominal pain, headache, fatigue, anorexia and weight loss, dizziness, nervousness, hallucinations, anxiety, depression, flu-like symptoms, dyspepsia (indigestion), shortness of breath, hypoventilation, apnoea, and urinary retention. Fentanyl use has also been associated with aphasia. [39]Despite being a more potent analgesic, fentanyl tends to induce less nausea, as well as less histamine -mediated itching, than morphine. [40]Fentanyl may produce more prolonged respiratory depression than other opioid analgesics. [41] [42] [43] [44] [45] [46] [47] In 2006 the U. S. Food and Drug Administration (FDA) began investigating several respiratory deaths, but doctors in the United Kingdom were not warned of the risks with fentanyl until September 2008. [48] The FDA reported in April 2012 that twelve young children had died and twelve more made seriously ill from separate accidental exposures to fentanyl skin patches. [49]The precise reason for sudden respiratory depression is unclear, but there are several hypotheses: Saturation of the body fat compartment in patients with rapid and profound body fat loss (patients with cancer, cardiac or infection-induced cachexia can lose 80% of their body fat). Early carbon dioxide retention causing cutaneous vasodilation (releasing more fentanyl), together with acidosis, which reduces protein binding of fentanyl, releasing yet more fentanyl. Reduced sedation, losing a useful early warning sign of opioid toxicity and resulting in levels closer to respiratory-depressant levels. Fentanyl has a therapeutic index of 270. [50]Overdose [ edit]US yearly overdose deaths, and some of the drugs involved. Among the more than 64,000 deaths estimated in 2016, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogs ( synthetic opioids in the chart) with over 20,000 deaths. [51]See also: Opioid overdose In July 2014, the Medicines and Healthcare Products Regulatory Agency (MHRA) of the UK issued a warning about the potential for life-threatening harm from accidental exposure to transdermal fentanyl patches, particularly in children, [52] and advised that they should be folded, with the adhesive side in, before being discarded. The patches should be kept away from children, who are most at risk from fentanyl overdose. [53]Death from fentanyl overdose was declared a public health crisis in Canada in September 2015, and it continues to be a significant public health issue. [54] In 2016, deaths from fatal fentanyl overdoses in British Columbia, Canada, averaged two persons per day. [55] In 2017 the death rate rose over 100% with 368 overdose related deaths in British Columbia between January and April 2017. [56]Medical examiners concluded that musician Prince died on April 21, 2016, from an accidental fentanyl overdose. [57] Fentanyl was among many substances identified in counterfeit pills recovered from his home, especially some that were mislabeled as Watson 385, a combination of hydrocodone and paracetamol. [57] [58] American rapper Lil Peep also died of an accidental fentanyl overdose on November 15, 2017. [59] [60] On January 19, 2018, the medical examiner-coroner for the county of Los Angeles announced that Tom Petty died from an accidental drug overdose as a result of mixing medications that included fentanyl, acetyl fentanyl and despropionyl fentanyl (among others). He was reportedly treating ""many serious ailments"" that included a broken hip. [61]In the US, Fentanyl caused 20,100 deaths in 2016, a rise of 540% over the past 3 years. [62] [51]Pharmacology [ edit]Main article: Opioid § Pharmacology Fentanyl provides some of the effects typical of other opioids through its agonism of the opioid receptors. Its strong potency in relation to that of morphine is largely due to its high lipophilicity, per the Meyer-Overton correlation. Because of this, it can more easily penetrate the central nervous system. [40]Detection in biological fluids [ edit]Fentanyl may be measured in blood or urine to monitor for abuse, confirm a diagnosis of poisoning, or assist in a medicolegal death investigation. Commercially available immunoassays are often used as initial screening tests, but chromatographic techniques are generally used for confirmation and quantitation. Blood or plasma fentanyl concentrations are expected to be in a range of 0.3–3.0 μg/l in persons using the medication therapeutically, 1–10 μg/l in intoxicated patients and 3-300 μg/l in victims of acute overdosage. [63]History [ edit]Fentanyl was first synthesized by Paul Janssen under the label of his relatively newly formed Janssen Pharmaceutica in 1959. [64] The widespread use of fentanyl triggered the production of fentanyl citrate (the salt formed by combining fentanyl and citric acid in a 1:1 stoichiometric ratio ), [65] which entered medical use as a general anaesthetic under the trade name Sublimaze in the 1960s. [ citation needed]In the mid-1990s, Janssen Pharmaceutica developed and introduced into clinical trials the Duragesic patch, which is a formation of an inert alcohol gel infused with select fentanyl doses, which are worn to provide constant administration of the opioid over a period of 48 to 72 hours. After a set of successful clinical trials, Duragesic fentanyl patches were introduced into medical practice. Following the patch, a flavoured lollipop of fentanyl citrate mixed with inert fillers was introduced in 1998 under the brand name of Actiq, becoming the first quick-acting formation of fentanyl for use with chronic breakthrough pain. [66]In 2009, the US Food and Drug Administration approved Onsolis (fentanyl buccal soluble film), a fentanyl drug in a new dosage form for cancer pain management in opioid-tolerant subjects. [67] It uses a medication delivery technology called BEMA (Bio Erodible Muco Adhesive), a small dissolvable polymer film containing various fentanyl doses applied to the inner lining of the cheek. [67]Fentanyl has a US DEA ACSCN of 9801 and a 2013 annual aggregate manufacturing quota of 2,108.75 kg, unchanged from the prior year. Society and culture [ edit]Brand names [ edit]Brand names include Sublimaze, [39] Actiq, Durogesic, Duragesic, Fentora, Matrifen, Haldid, Onsolis, [68] Instanyl, [69] Abstral, [70] Lazanda [71] and others. [72] Subsys is a sublingual spray of fentanyl manufactured by Insys Therapeutics. [73]Cost [ edit]The wholesale cost in the developing world as of 2015 is between 0.08 and 0.81 USD per 100 micrograms vial. [11] In the United States this amount costs about 0.40 USD as of 2017. [12] In the United States the patches cost 11.22 USD for a 12 µg/hr version and 8.74 USD for a 100 µg/hr version. [12]Legal status [ edit]In the UK, fentanyl is classified as a controlled Class A drug under the Misuse of Drugs Act 1971. [74] In the Netherlands, fentanyl is a List I substance of the Opium Law. In the U. S., fentanyl is a Schedule II controlled substance per the Controlled Substance Act. Distributors of Abstral are required to implement an FDA-approved risk evaluation and mitigation strategy (REMS) program. [75] [76] In order to curb misuse, many health insurers have begun to require precertification and/or quantity limits for Actiq prescriptions. [77] [78] [79]Legal action [ edit]On June 19, 2007, a $5.5 million jury verdict was awarded in a US case against Johnson & Johnson subsidiaries, Alza Corporation and Janssen Pharmaceutica Products, the manufacturers of the Duragesic fentanyl transdermal pain patch. This case, the first Federal trial involving the Duragesic fentanyl patch, was tried in the Federal District Court for the Southern District of Florida, West Palm Beach Division. Public health advisories [ edit]The US Food and Drug Administration (FDA) has issued public health advisories related to fentanyl patch dangers. Among these, in July 2005, the FDA issued a Public Health Advisory, [80] which advised that ""deaths and overdoses have occurred in patients using both the brand name product Duragesic and the generic product."" In December 2007, as part of this continuing investigation, the FDA issued a second Public Health Advisory [80] stating, ""The FDA has continued to receive reports of deaths and life-threatening side effects in patients who use the fentanyl patch. The reports indicate that doctors have inappropriately prescribed the fentanyl patch... In addition, the reports indicate that patients are continuing to incorrectly use the fentanyl patch...""Recreational use [ edit]Fentanyl powder seized by a sheriff. [81]Illicit use of pharmaceutical fentanyl and its analogues first appeared in the mid-1970s in the medical community and continues in the present. More than 12 different analogues of fentanyl, all unapproved and clandestinely -produced, have been identified in the U. S. drug traffic. The biological effects of the fentanyl analogues are similar to those of heroin, with the exception that many users report a noticeably less euphoric high associated with the drug and stronger sedative and analgesic effects. [ citation needed]Fentanyl analogues may be hundreds of times more potent than street heroin, and tend to produce significantly more respiratory depression, making it much more dangerous than heroin to users. Fentanyl is used orally, smoked, snorted, or injected. Fentanyl is sometimes sold as heroin or oxycodone, often leading to overdoses. Many fentanyl overdoses are initially classified as heroin overdoses. [82] Estonia has the highest rate of 3-methylfentanyl overdose deaths in the EU, due to its high rate of recreational use. [83]Fentanyl is sometimes sold on the black market in the form of transdermal fentanyl patches such as Duragesic, diverted from legitimate medical supplies. The gel from inside the patches may be ingested or injected. [84]Another form of fentanyl that has appeared on the streets is the Actiq lollipop formulation. The pharmacy retail price ranges from $15 to $50 per unit based on the strength of the lozenge, with the black market cost ranging from $5 to $25, depending on the dose. [85] The attorneys general of Connecticut and Pennsylvania have launched investigations into its diversion from the legitimate pharmaceutical market, including Cephalon's ""sales and promotional practices for Provigil, Actiq and Gabitril "". [85]Non-medical use of fentanyl by individuals without opiate tolerance can be very dangerous and has resulted in numerous deaths. [84] Even those with opiate tolerances are at high risk for overdoses. Once the fentanyl is in the user's system, it is extremely difficult to stop its course because of the nature of absorption. Illicitly synthesized fentanyl powder has also appeared on the United States market. Because of the extremely high strength of pure fentanyl powder, it is very difficult to dilute appropriately, and often the resulting mixture may be far too strong and, therefore, very dangerous. [ citation needed]Some heroin dealers mix fentanyl powder with heroin to increase potency or compensate for low-quality heroin. In 2006, illegally manufactured, non-pharmaceutical fentanyl often mixed with cocaine or heroin caused an outbreak of overdose deaths in the United States and Canada, heavily concentrated in the cities of Dayton, Ohio; Chicago; Detroit; and Philadelphia. [86]Several large quantities of illicitly produced fentanyl have been seized by U. S. law enforcement agencies. In June 2006, 945 grams (2.08 lbs) of 83%-pure fentanyl powder was seized by Border Patrol agents in California from a vehicle that had entered from Mexico. [87] Mexico is the source of much of the illicit fentanyl for sale in the U. S. However, in April 2006, there was one domestic fentanyl lab discovered by law enforcement in Azusa, California. The lab was a source of counterfeit 80 mg Oxy Contin tablets containing fentanyl instead of oxycodone, as well as bulk fentanyl and other drugs. [88] [89] In November 2016, the DEA uncovered an operation making counterfeit oxycodone and Xanax from a home in Cottonwood Heights, Utah. They found about 70,000 pills in the appearance of oxycodone and more than 25,000 in the appearance of Xanax. The DEA reported that millions of pills could have been distributed from this location over the course of time. The accused owned a pill press and ordered fentanyl in powder form from China. [90] [91]The ""China White"" form of fentanyl refers to any of a number of clandestinely produced analogues, especially α-methylfentanyl (AMF). [92] This Department of Justice document lists ""China White"" as a synonym for a number of fentanyl analogues, including 3-methylfentanyl and α-methylfentanyl, [93] which today are classified as Schedule I drugs in the United States. [92] Part of the motivation for AMF is that, despite the extra difficulty from a synthetic standpoint, the resultant drug is relatively more resistant to metabolic degradation. This results in a drug with an increased duration. [94]In June 2013, the United States Centers for Disease Control and Prevention (CDC) issued a health advisory [95] to emergency departments alerting to 14 overdose deaths among intravenous drug users in Rhode Island associated with acetylfentanyl, a synthetic opioid analog of fentanyl that has never been licensed for medical use. In a separate study conducted by the CDC, 82% of fentanyl overdose deaths involved illegally manufactured fentanyl, while only 4% were suspected to originate from a prescription. [96]Beginning in 2015, Canada has seen a widespread number of fentanyl overdoses. Authorities suspect that the drug is being imported from Asia to the western coast by organized crime groups in powder form and being pressed into pseudo-Oxy Contin tablets. [97] Traces of the drug have also been found in other recreational drugs including cocaine, MDMA, and heroin. The drug has been implicated in multiple deaths from the homeless to young professionals, including multiple teens and young parents. [98] Because of the rising deaths across the country, especially in British Columbia where the deaths for 2016 is 668 and deaths for 2017 (Jan-Oct) is 999, [99] Health Canada is putting a rush on a review of the prescription-only status of naloxone in an effort to combat overdoses of the drug. [100]Incapacitating agent [ edit]Main article: Moscow hostage crisis chemical agent Russian spetsnaz security forces used a ""fentanyl gas"" to incapacitate people rapidly in the Moscow theater hostage crisis in 2002. The siege was ended, but about 130 of the 850 hostages died from the gas. The Russian Health Minister later stated that the gas was based on fentanyl, [101] but the exact chemical agent has not been identified. Veterinary use [ edit]Fentanyl in injectable formulation is commonly used for analgesia and as a component of balanced sedation and general anaesthesia in small animal patients. Its potency and short duration of action make it particularly useful in critically ill patients. In addition, it tends to cause less vomiting and regurgitation than other pure-opioid agonists (morphine, hydromorphone) when given as a continuous post-operative infusion. As with other pure opioids, fentanyl can be associated with dysphoria in both dogs and cats. Transdermal fentanyl has also been used for many years in dogs and cats for post-operative analgesia. This is usually done with off-label fentanyl patches manufactured for humans with chronic pain. In 2012 a highly concentrated (50 mg/ml) transdermal solution, trade name Recuvyra, has become commercially available for dogs only. It is FDA approved to provide four days of analgesia after a single application prior to surgery. 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""Current evidence for spinal opioid selection in postoperative pain"". The Korean journal of pain. 27 (3): 200–9. doi: 10.3344/kjp.2014.27.3.200. PMC 4099232. PMID 25031805.^ a b c Jasek, W, ed. (2007). Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 2621f. ISBN 978-3-85200-181-4.^ Derry, Sheena; Stannard, Cathy; Cole, Peter; Wiffen, Philip J.; Knaggs, Roger; Aldington, Dominic; Moore, R. Andrew (2016-10-11). ""Fentanyl for neuropathic pain in adults"". The Cochrane Database of Systematic Reviews. 10: CD011605. doi: 10.1002/14651858. CD011605.pub2. PMID 27727431.^ a b ""Official Duragesic Full Prescribing Information"" (PDF). Archived from the original (PDF) on 2008-08-28.^ a b ""Disposal of Unused Medicines: What You Should Know"". U. S. Food and Drug Administration. Retrieved 2013-09-10.^ ""Medicines Recommended for Disposal by Flushing"". U. S. Food and Drug Administration. Retrieved 2013-09-10.^ ""Medication Guide and Instructions for Use – Duragesic (fentanyl) Transdermal System"" (PDF). U. S. Food and Drug Administration. Retrieved 2013-09-10.^ ""PRICARA RECALLS 25 mcg/hr DURAGESIC (fentanyl transdermal system) CII PAIN PATCHES"". FDA. 2008-02-12.^ Karlsen, A. P.; Pedersen, D. M.; Trautner, S; Dahl, J. B.; Hansen, M. S. (2014). ""Safety of intranasal fentanyl in the out-of-hospital setting: A prospective observational study"". Annals of Emergency Medicine. 63 (6): 699–703. doi: 10.1016/j.annemergmed.2013.10.025. PMID 24268523.^ Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, Mc Coy SC, Hom J, Kandamany N (Oct 10, 2014). ""Intranasal fentanyl for the management of acute pain in children"". The Cochrane Database of Systematic Reviews. 10: CD009942. doi: 10.1002/14651858. CD009942.pub2. PMID 25300594.^ a b c ""Abstral Sublingual Tablets - Summary of Product Characteristics"". UK Electronic Medicines Compendium. May 2016. Retrieved 1 May 2017.^ ""Abstral (Fentanyl Sublingual Tablets for Breakthrough Cancer Pain)"". P T. 36 (2): 2–28. February 2011. PMC 3086091. PMID 21560267.^ Ward, J.; Laird, B.; Fallon, M. (1 April 2011). ""The UK breakthrough cancer pain registry: origin, methods and preliminary data"". BMJ Support Palliat Care. 1 (Suppl 1): A24–A24. doi: 10.1136/bmjspcare-2011-000020.71 – via spcare.bmj.com.^ a b Jasek, W, ed. (2007). Austria-Codex (in German) (62nd ed.). Vienna: Österreichischer Apothekerverlag. pp. 89–92. ISBN 978-3-85200-181-4.^ O'Connor AB (2008). ""Is actiq use in noncancer-related pain really ""a recipe for success""?"". Pain Medicine. 9 (2): 258–60; author reply 261–5. doi: 10.1111/j.1526-4637.2008.00413.x. PMID 18298711.^ ""Actiq (fentanyl citrate) Uses, Dosage, Side Effects - Drugs.com"".^ Fentanyl citrate (oral transmucosal) (FEN ta nil SIT rayt). ""Actiq"". drugs.com.^ ""Barr Launches Generic ACTIQ (R) Cancer Pain Management Product – Life Sciences World"".^ Shachtman, Noah (September 10, 2009). ""Airborne EMTs Shave Seconds to Save Lives in Afghanistan"". Danger Room. Wired. Retrieved July 1, 2010.^ Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, Mc Coy SC, Hom J, Kandamany N (10 October 2014). ""Intranasal fentanyl for the management of acute pain in children"". The Cochrane Database of Systematic Reviews. 10: CD009942. doi: 10.1002/14651858. CD009942.pub2. PMID 25300594.^ Peter J. S. Koo (2005). ""Postoperative Pain Management With a Patient-Controlled Transdermal Delivery System for Fentanyl"". American Journal of Health-System Pharmacy. 62 (11): 1171–1176. Retrieved 28 March 2016.^ a b ""fentanyl"". Drugs@FDA: FDA Approved Drug Products. U. S. Food and Drug Administration.^ a b Stacey Mayes, Pharm D MS, Marcus Ferrone, Pharm D BCNSP, 2006. Fentanyl HCl Patient-Controlled Iontophoretic Transdermal System for Pain: Pharmacology The Annals of Pharmacotherapy.^ Smydo, J. (1979). ""Delayed respiratory depression with fentanyl"". Anesth Prog. 26 (2): 47–8. PMC 2515983. PMID 295585.^ van Leeuwen, L.; Deen, L.; Helmers, J. H. (August 1981). ""A comparison of alfentanil and fentanyl in short operations with special reference to their duration of action and postoperative respiratory depression"". Anaesthesist. 30 (8): 397–9. PMID 6116461.^ Brown, D. L. (November 1985). ""Postoperative analgesia following thoracotomy. Danger of delayed respiratory depression"". Chest. 88 (5): 779–80. doi: 10.1378/chest.88.5.779. PMID 4053723.^ Bülow, H. H.; Linnemann, M.; Berg, H.; Lang-Jensen, T.; La Cour, S.; Jonsson, T. (August 1995). ""Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl"". Acta Anaesthesiol Scand. 39 (6): 835–9. doi: 10.1111/j.1399-6576.1995.tb04180.x. PMID 7484044.^ Nilsson, C.; Rosberg, B. (June 1982). ""Recurrence of respiratory depression following neurolept analgesia"". Acta Anaesthesiol Scand. 26 (3): 240–1. doi: 10.1111/j.1399-6576.1982.tb01762.x. PMID 7113633.^ Mc Loughlin, R.; Mc Quillan, R. (September 1997). ""Transdermal fentanyl and respiratory depression"". Palliat Med. 11 (5): 419–421. doi: 10.1177/026921639701100515. PMID 9472602.^ Regnard, C.; Pelham, A. (December 2003). ""Severe respiratory depression and sedation with transdermal fentanyl: four case studies"". Palliat Med. 17 (8): 714–6. PMID 14694924.^ ""Fentanyl patches: serious and fatal overdose from dosing errors, accidental exposure, and inappropriate use"". Drug Safety Update. 2 (2): 2. September 2008. Archived from the original on 2015-01-01.^ ""Fentanyl Patch Can Be Deadly to Children"". U. S. FDA (Drugs.com). April 19, 2012. Retrieved July 30, 2013.^ Stanley, Theodore Henry; Petty, William Clayton (1983-03-31). New Anesthetic Agents, Devices, and Monitoring Techniques. Springer. ISBN 978-90-247-2796-4. Retrieved 20 October 2007.^ a b ""Overdose Death Rates"". National Institute on Drug Abuse. 15 September 2017. Retrieved 23 November 2017.^ ""Fentanyl patches warning"". Pharmaceutical Journal. Retrieved 28 March 2016.^ ""MHRA warns about fentanyl patches after children exposed"". Pharmaceutical Journal. Retrieved 28 March 2016.^ ""Fentanyl Overdose"". Huffington Post. May 20, 2016.^ ""Fentanyl-Detected in Illicit Drug Overdose Deaths January 1, 2012 to April 30, 2016"" (PDF). British Columbia Coroners Service.^ ""Fentanyl contributed to hundreds of deaths in Canada so far this year"".^ a b Eligon, John; Kovaleski, Serge F. (June 2, 2016). ""Prince Died From Accidental Overdose of Opioid Painkiller"". The New York Times.^ ""Official: Mislabeled pills found at Prince's estate contained fentanyl"". Chicago Tribune. Retrieved August 22, 2016.^ ""Report: Toxic Combo of Prescription Drugs Killed Rapper"".^ Brown, August (November 16, 2017). ""Lil Peep, hero to the emo and hip-hop scenes, dies of suspected overdose at 21"". Los Angeles Times. Retrieved November 16, 2017.^ Coscarelli, Joe (2018). ""Tom Petty Died From Accidental Drug Overdose Involving Opioids, Coroner Says"". The New York Times. ISSN 0362-4331. Retrieved 2018-01-20.^ Katz, Josh (September 2, 2017). ""The First Count of Fentanyl Deaths in 2016- Up 540% in Three Years"". The New York Times.^ Baselt, R. (2017) Disposition of Toxic Drugs and Chemicals in Man, 11th edition, Biomedical Publications, Foster City, CA, pp. 883–886.^ Lopez-Munoz, Francisco; Alamo, Cecilio (2009). ""The Consolidation of Neuroleptic Therapy: Janssen, the Discovery of Haloperidol and Its Introduction into Clinical Practice"". Brain Research Bulletin. 79 (2): 130–141. doi: 10.1016/j.brainresbull.2009.01.005. PMID 19186209.^ ""Daily Med: About Daily Med"". Dailymed.nlm.nih.gov. Retrieved 2010-07-28.^ ""ACTIQ® (fentanyl citrate) oral transmucosal lozenge (1968 version revised in 2011)"" (PDF). US Food and Drug Administration. December 2011. Retrieved 26 December 2017.^ a b ""Questions and Answers about Onsolis (fentanyl buccal soluble film)"". US Food and Drug Administration. 16 July 2009. Retrieved 26 December 2017.^ ""Introducing Onsolis"". Onsolis.com. Retrieved 2010-07-28.^ ""EPAR summary for the public: Instanyl"" (PDF). European Medicines Agency. Retrieved 2010-07-28.^ ""Abstral: Prescribing Information"". Retrieved 2011-01-07.^ ""Lazanda (fentanyl nasal spray) CII"". Lazanda.com. Retrieved 2012-05-14.^ ""Fentanyl"". International Drug Names. Drugs.com.^ Worstall, Tim (11 May 2014). ""The Short Case For Insys Therapeutics"". Forbes. Retrieved 12 May 2015.^ ""Misuse of Drugs Act 1971"".^ ""Relay Health's pharmacy connectivity network and reach, aligned with Mc Kesson Specialty Care Solutions' REMS expertise, expands cancer patients' access to pain therapy"". Atlanta. 20 January 2011. Retrieved 5 November 2015.^ Shelley, Suzanne (22 April 2011). ""With a Few Stumbles, REMS Begins to Hit Its Stride"". Pharmaceutical Commerce. Retrieved 5 November 2015.^ "" Aetna notice regarding precertification requirement [ permanent dead link] "", Aetna, May, 2007^ "" Blue Cross Blue Shield of Arizona notice regarding precertification requirement Archived August 28, 2008, at the Wayback Machine . "", Blue Cross Blue Shield of Arizona, November 5, 2007^ "" Medications Requiring Precertification Archived October 15, 2006, at the Wayback Machine . "", Oxford Health Plans^ a b ""Fentanyl Transdermal System (marketed as Duragesic) Information"". U. S. Food and Drug Administration. Retrieved 2013-09-10.^ ""DEA Microgram Bulletin, June 2006"". US Drug Enforcement Administration, Office of Forensic Sciences Washington, D. C. 20537. June 2006. Archived from the original on 21 July 2009. Retrieved 22 June 2009.^ Boddiger, D. (2006, August 12). Fentanyl-laced street drugs ""kill hundreds"". The Lancet. Retrieved June 15, 2010.^ ""Synthetic drug fentanyl causes overdose boom in Estonia"". BBC News. 30 March 2012.^ a b ""Fentanyl"" (PDF). Drug Enforcement Administration. March 2015.^ a b "" Painkiller is topic of inquiry "", Bob Mims, The Salt Lake Tribune, 11 November 2004^ ""CDC Nonpharmaceutical Fentanyl-Related Deaths – Multiple States, April 2005 – March 2007"". Cdc.gov. Retrieved 2010-07-28.^ Intelligence alert: High purity fentanyl seized near Westmoreland, California Archived 2009-07-21 at the Wayback Machine ., DEA Microgram, June 2006^ Intelligence alert: Large fentanyl / MDA / TMA laboratory in Azuza, California – possibly the ""OC-80"" tablet source Archived 2006-09-02 at the Wayback Machine ., DEA Microgram, April 2006.^ Intelligence alert: Oxycontin mimic tablets (containing fentanyl) near Atlantic, Iowa Archived 2006-08-20 at the Wayback Machine ., DEA Microgram, January 2006.^ Tribune, Courtney Tanner. ""Thousands of fentanyl pills confiscated in Utah drug raid"". The Salt Lake Tribune. Retrieved 2016-11-23.^ ""Cottonwood Heights drug bust one of the largest in Utah history"". fox13now.com. 2016-11-22. Retrieved 2016-11-23.^ a b List of Schedule I Drugs, U. S. Department of Justice. Archived January 9, 2010, at the Wayback Machine.^ Behind the Identification of China White Analytical Chemistry, 53 (12), 1379A–1386A (1981)^ Van Bever, Willem F. M.; Niemegeers, Carlos J. E.; Janssen, Paul A. J. (October 1974). ""Synthetic analgesics. Synthesis and pharmacology of the diastereoisomers of N- (3-methyl-1- (2-phenylethyl)-4-piperidyl)-N-phenylpropanamide and N- (3-methyl-1- (1-methyl-2-phenylethyl)-4-piperidyl)-N-phenylpropanamide"". J. Med. Chem. 17 (10): 1047–51. doi: 10.1021/jm00256a003. PMID 4420811.^ CDC Health Alert Network (June 20, 2013). ""Recommendations for Laboratory Testing for Acetyl Fentanyl and Patient Evaluation and Treatment for Overdose with Synthetic Opioids"". Centers for Disease Control and Prevention. Retrieved June 20, 2013.^ Characteristics of Fentanyl Overdose — Massachusetts, 2014–2016 (Report). Centers for Disease Control and Prevention. April 14, 2017.^ Lethal fentanyl profiting gangs in Western Canada while deaths climb, Metro News Edmonton, August 6, 2015.^ Fentanyl doesn’t discriminate, killing the homeless and young professionals, Edmonton Journal, August 22, 2015.^ ""Fentanyl - Detected Illicit Drug Overdose Deaths"" (PDF). British Columbia Government.^ ""Winnipeg Naloxone-distribution program could prevent fentanyl deaths | CBC News"". CBC. Retrieved 16 January 2018.^ ""Russia names Moscow Siege Gas"". BBC. October 31, 2002.^ ""Original new animal drug application: Recuvyra"" (PDF).^ ""European Medicines Agency – Veterinary medicines – Recuvyra"". Retrieved 28 March 2016. External links [ edit]Wikimedia Commons has media related to Fentanyl. Listen to this article ( info/dl )This audio file was created from a revision of the article "" Fentanyl "" dated 2011-12-01, and does not reflect subsequent edits to the article. ( Audio help)More spoken articles National Institute of Health (NIH) Medline Plus: Fentanyl Buccal (Transmucosal)US DEA information: Fentanyl Fentanyl: Emergency Response Database. National Institute for Occupational Safety and Health U. S. National Library of Medicine: Drug Information Portal – Fentanylv t e General anesthetics ( N01A)Inhalational Chloroethane (ethyl chloride) ‡ Chloroform ‡ Cyclopropane ‡ Desflurane Diethyl ether ‡ Enflurane Ethylene ‡Fluroxene ‡ Halothane # Isoflurane # Methoxyflurane Methoxypropane ‡ Nitrous oxide # Sevoflurane Trichloroethylene ‡Vinyl ether ‡ Xenon Injection Phenols Fospropofol Propofol #Opioids Morphine Oxycodone Anileridine ‡ Embutramide ‡ Fentanyl Alfentanil Phenoperidine Remifentanil ÷ Sufentanil Arylcyclohexylamines Esketamine Ketamine # Phencyclidine ‡ Tiletamine Neuroactive steroids Alfadolone Alfaxalone Hydroxydione Others Propanidid ‡# WHO-EM ‡ Withdrawn from market Clinical trials :† Phase III §Never to phase IIIv t e Analgesics ( N02A, N02B)v t e Opioid receptor modulatorsv t e Xenobiotic-sensing receptor modulators Pharmacy and pharmacology portal Medicine portal Categories: General anesthetics Synthetic opioids Piperidines Anilides Propionamides Mu-opioid agonists Janssen Pharmaceutica Belgian inventions Euphoriants Analgesics Citrates Alza brands Transdermal patches World Health Organization essential medicines Fentanyl "


treatment of varicose veins in legs

Apple cider vinegar is a wonderful treatment for varicose veins. It is a natural body cleansing product and it also improves blood flow and circulation. When the blood starts flowing naturally, the heaviness and swelling of varicose veins will decrease to a great extent.

Home Remedies for Varicose Veins

Home Remedies for Varicose Veins (82)Prev 1 of 3 Next Varicose veins are a common problem in which abnormally enlarged veins appear close to the skin’s surface. They usually occur in the calves and thighs when the veins develop weakened walls or poorly functioning valves, which regulate blood flow. According to the U. S. Department of Health and Human Services, varicose veins affect an estimated 25 percent of women and 10 percent of men. The condition can cause pain, fatigue, restlessness, and feelings of burning, throbbing, tingling, or heaviness in the legs. The appearance of bulging veins is also a concern for many people. Common factors contributing to varicose veins are heredity, occupations that require a lot of standing, obesity, use of birth control pills, constipation and hormonal changes in the body during pregnancy, puberty, and menopause. Medical and surgical treatments for varicose veins can be very expensive. You can try some home remedies to decrease the severity of varicose veins as well as reduce some of the discomfort they can cause. Here are the top 10 home remedies for varicose veins.1. Apple Cider Vinegar

Apply undiluted apple cider vinegar on the skin over the varicose veins and gently massage the area. Do it every day before going to bed and again in the morning. Follow this remedy for a few months to reduce the size of varicose veins. Add two teaspoons of apple cider vinegar to a glass of water and stir well. Drink the mixture twice a day for at least one month to see positive results

.2. Cayenne Pepper Cayenne pepper is considered a miracle treatment for varicose veins. Being a very rich source of vitamin C and bioflavonoids, it increases blood circulation and eases the pain of congested, swollen veins. Add one teaspoon of cayenne pepper powder to a cup of hot water and stir it well.

Drink this mixture three times a day for one or two months.3. Olive Oil Increasing blood circulation is essential to treating varicose veins. Massaging with olive oil can help increase circulation, thereby reducing pain and inflammation. Mix equal amounts of olive oil and vitamin E oil and warm it slightly. Massage the veins with the warm oil for several minutes. Do this twice daily for one to two months. You can also mix four drops of cypress essential oil in two teaspoons of warm olive oil and massage with this mixture.4. Garlic Garlic is an excellent herb for reducing inflammation and the symptoms of varicose veins. It also helps break up harmful toxins in the blood vessels and improve circulation. Slice up six garlic cloves and put them in a clean glass jar. Extract the juice from three oranges and add it to the jar. Also add two tablespoons of olive oil. Let the mixture sit for about 12 hours. Shake the jar and then put a few drops of the solution on your fingers. Massage the inflamed veins with the solution in a circular motion for 15 minutes. Wrap the area with a cotton cloth and leave it on overnight. Repeat daily for several months. Also, include fresh garlic in your diet.5. Butcher’s Broom Butcher’s broom is very helpful for relieving the aches and discomfort of varicose veins. This herb contains compounds known as ruscogenins that help reduce inflammation while constricting the veins due to its anti-inflammatory and anti-elastase activity. Take 100 mg of butcher’s broom supplements three times a day. Created from the roots and seeds of the plant, butcher’s broom supplements have vitamins B and C along with calcium, chromium, magnesium, manganese, potassium, selenium, silicon and zinc. These nutrients will help tighten, strengthen and decrease inflammation in the veins as well as improve blood flow up the legs. Note: People with high blood pressure or benign prostate hyperplasia should not take this herb without consulting a doctor.6. Witch Hazel Witch hazel is a very effective herb for strengthening blood vessels and hence can reduce symptoms of varicose veins. Apart from being an astringent, it also contains gallic acid and several essential oils that can help reduce the swelling as well as the pain. Soak a washcloth in witch hazel and place it on the affected area. Do this two or three times a day for one or two months. Alternatively, fill a tub with lukewarm water and add 10 to 20 drops of distilled witch hazel. Soak your legs in the solution for at least 15 minutes. Then wash your legs with clean water and pat them dry. Follow this remedy once daily for one or two months. Prev 1 of 3 Next';SHARE ONTwitter Facebook Whats App Google+ Pinterest By Top10Home Remedies Last modified on February 5th, 2014

Home Remedies for Varicose Veins


how much caffeine is in lipton tea bags

ng. Caffeine In Green Tea Lipton 100 Percent Green Tea contains about the same amount of caffeine as Lipton Black Tea: 45 mg per serving. Lipton flavored green teas contain between 15 and 30 mg of caffeine per serving.

Does Lipton Tea Have Caffeine?

Does Lipton Tea Have Caffeine?by TRICIA BALLAD Oct. 03, 2017

Most Lipton teas contain some caffeine. Decaffeinated teas contain very little, only 4 mg per serving. If you want to avoid caffeine completely, herbal teas are a good choice. They are not made from tea leaves, so they do not contain caffeine.

If you are used to drinking large amounts of caffeine each day, try to cut back slowly rather than stopping abruptly. This will minimize any withdrawal symptoms you experience. Video of the Day Error setting up player: Invalid license key Effects of Caffeine Caffeine is a popular stimulant that can help you wake up in the morning and remain alert throughout the day. Its effects can last for several hours, so if you enjoy a late afternoon cup of tea, the caffeine could impact your ability to sleep. Some people are more sensitive to caffeine than others. If you have been consuming caffeinated beverages for years, you probably have built up a tolerance to the drug and a cup of tea at four or five in the afternoon may not have any effect at all on your ability to sleep. However, if you are highly sensitive to caffeine or are not used to it, the same cup of tea may leave you feeling jittery. Safe Levels According to guidelines published by the Mc Kinley Health Center at the University of Illinois, 300 mg of caffeine per day is a moderate amount. Children should be limited to much less—35 to 40 mg per day, according to guidelines published by the South Dakota Department of Health. Brew Time There are two major variables that affect how much caffeine you consume in your —brew time and cup size. The longer you allow your tea to steep, the more caffeine is extracted from the tea leaves. Lipton recommends a brew time of two to five minutes, depending on how strong you like your tea. Caffeine In Black Tea A cup of Lipton Cup Size Black Tea brewed for three minutes contains 55 mg of caffeine. A cup of Family Size Black Tea contains only 40 mg. Lipton decaffeinated black tea contains four to five mg of caffeine per servi

Caffeine In Iced Tea Iced tea contains caffeine, although it generally contains less than its hot counterparts. Lipton Original Unsweetened Iced Tea contains 24 mg of caffeine per serving. Iced Green Tea contains only 9 mg of caffeine per serving. Lose Weight. Feel Great!Change your life with My Plate by LIVE STRONG . COMGOALGENDER AGEWEIGHT HEIGHTGET MY CALORIE GOALYOU MIGHT ALSO LIKEDoes Unsweetened Tea Elevate Blood Sugar? Does Lipton Green Tea Cause Bowel Movements? Drinking Decaf Green Tea While Pregnant How Much Caffeine Is Contained in a Tea Bag? Does Tea Give You Indigestion? Does Oolong Tea Have Caffeine? What Types of Tea Are Caffeine Free? Does Tea Have a Dehydrating Effect? Lipton Brisk Peach Iced Green Tea Ingredients Can Green Tea Affect Liver Function Test Results? Do Herbal Teas Contain Caffeine? Lipton Decaffeinated Tea Nutrition The Best Green Tea Capsules Non-Caffeine Fruit Teas Can Tea Help Calm an Upset Stomach? How Does Caffeine Treat Migraines? Caffeine Withdrawal & Blurred Vision Lipton Iced Tea Nutritional Facts Spearmint Tea and Caffeine Can I Drink Oolong Tea During Pregnancy?


which soils are prone to erosion

d). Soils most susceptible to erosion are those with the largest amount of medium (silt)-size particles. Clay and sandy soils are less prone to erosion.4) Ground slope – its combined length, grade, and surface quality (rough or smooth) – affects erodibility. The longer the slope, the steeper the grade, and the smoother the surface, the larger is the potential for erosion.

Soil Erosion and Sedimentation

Millers Creek has numerous eroding banks. Soil erosion results in soil being detached, carried away, and eventually deposited elsewhere. It is a natural process, and rivers and creeks naturally hold soil, deposit it in some places and pick it up in other places. In the Huron River Watershed, soil erosion is a problem when it is accelerated because of high water flow and human disturbance (i.e. farming, construction) of the land surrounding our streams. When the amount of soil in the creek exceeds the ability of the water to transport it downstream, the excess soil can clog rocks and gravel beds, which are important habitat for fish, insects, and other river life. When excess soil drops out of the water and remains in the stream, the process is known as sedimentation. Erosion and sedimentation can also have these affects: Loss of fertile top soil Flooding from clogged ditches, culverts, and storm sewers Muddy or turbid streams Damaged plant and animal life Clogged ponds, lakes, and reservoirs Damaged aquatic and other habitats Decreased recreational value and use Structural damage to buildings and roads Naturally occurring factors also influence both the rate and the amount of erosion and deposition into streams.1) Vegetation is the most important physical factor influencing soil erosion. A good vegetative cover binds the soil together, infuses it with organic matter, shields it from rain, makes it resistant to runoff, and filters sediment. A robust vegetative cover is one of the best protections against erosion.2) Climatic conditions influencing erosion include the amount, intensity, and frequency of rainfall, and hot and cold temperatures. For example, during periods of frequent rainfall there is a greater percentage of runoff. And, while frozen soil is highly resistant to erosion, rapidly thawing soil can lead to increased erosion.3) Soil characteristics also determine erodibility. One of these characteristics is texture – the size or combination of sizes of soil particles. They fall into three broad classifications ranging across small (clay), medium (silt), and large (san

Along with quantity of rainfall, slope characteristics determine the speed of flow. The faster the water flows, the greater the potential for erosion and sedimentation. Environmental scientists estimate that, from all sources, more than 4.5 billion tons of sediment pollute the rivers of this country each year. This volume is equivalent to 25,000 100-yard football fields stacked 100 feet high. Experts also estimate that we spend somewhere between $6 and $13 billion in the United States each year to correct the effects of erosion and sedimentation.


which number is upc?

In short, the UPC is a 12-digit unique code for your product represented by scannable bars. Universal Product Codes (also known as GTIN-12) appear as lines (bars) of varying widths representing the series of numbers commonly shown below the bars.

UPC Barcodes for Retail and Wholesale Products Sold in the U.S. and Canada

"UPC Barcodes for Retail and Wholesale Products Sold in the U. S. and Canada (UPC Codes, also known as UPC-A or GTIN-12)The Challenge of Selling Retail Products in the U. S. and Canada Simply Barcodes understands the unique challenges facing barcode buyers. With so many options available, where do you go, and who is a legitimate upc codes provider? Customers often share with us that the process of obtaining upc barcodes seems complicated and expensive. Others share that they didn’t know they would have to barcode their product and now they need a solution quickly. Innovative Barcoding Solutions for Selling Retail Products in the U. S. and Canada Simply Barcodes makes barcoding simple. You face numerous challenges when working to get your products to the market, so barcoding should not be one of them. Our service helps you achieve business success by ensuring that your product is barcoded when you need it. Simply Barcodes, established to help those who would otherwise be excluded from the market due to the cost of barcode services, offers affordable solutions for various types of barcoding requirements. You own your upc code as an asset of your company. We do not collect ongoing fees, making the total cost of ownership significantly lower. We understand with all of the confusing information about upc codes available on the web that you might be concerned about the authenticity of your barcode vendor. Our company, in business for over a decade, maintains an A+ rating with the BBB. All of our upc codes originate with the governing body, GS1 and have never been previously used. Our experienced and knowledgeable staff stands ready to answer your questions and do more than just sell you a barcode. We work with you to help your company successfully market your products. Would you like to receive your upc code today? Order Your UPC Code Now! Single Barcodes for $89 or call us at +1 404-869-0701 or 877-872-2060 (toll free)Frequently Asked Questions What is a UPC? How do UPC codes work? Do I really need a UPC code on my product? How do I get UPC codes for products sold within the United States? What do I get when I order my UPC code? In what format are my UPC codes created? When do I get my UPC codes? How do I get my UPC code on my product? What do I need to know about the standards organization for UPC codes? Does the UPC Code tell me (or others) in which country a product was manufactured? Do I need to have a company prefix? What if I am selling to The Kroger Co., Macys, Inc., Wal-Mart Stores, Sears Brands, LLC or other stores that require GS1 membership? What is a UPC? ""UPC"" stands for Universal Product Code. Retail products sold within the U. S. and Canada feature a single standard UPC barcode. The exceptions to this rule are: barcodes for alcohol ( beer, liquor, wine ), books, greeting cards, magazines, and prescription drugs. Retail products sold outside of North America feature an EAN barcode. How do UPC codes work?

Barcode scanners read the bars and convert them back to the 12-digit UPC number that they represent. When you reach an agreement with a retailer to carry your product (s), they request the information required by their unique proprietary sales and inventory tracking systems. Your 12-digit UPC number, when looked up within the retailer’s inventory system, finds the corresponding product name and price. This information helps the retailer keep accurate inventory data, review sales, and reorder. Do I really need a UPC code on my product? Most stores have electronic point of sale (e POS) systems that enable them to keep track of their sales and stocks and to reorder products by scanning the UPC code. Most retailers refuse to accept products that are not barcoded. In addition, many distributors make use of barcodes in their warehouse systems. How do I get UPC codes for products sold within the United States?1 st Go to our UPC Codes Order Page or call us at +1 404-869-0701 or toll free at 877-872-2060.2 nd Place your order. We only require that you provide contact and billing information. You are not required to provide product information. Your retailer collects your product information, which they associate with your barcode at the Point of Sale. Note: We also accept checks, money orders, and wire transfers. If you wish to use one of those payment methods, please print and complete this form. What do I get when I order my UPC code?1 st Upon completion of your order, you will receive an email confirmation of your UPC barcode purchase.2 nd Simply Barcodes then assigns your official UPC numbers from our database of official codes issued by the UCC (now called GS1).3 rd The digital barcode images are generated from the numbers you purchased.4 th Your UPC barcodes are emailed to you as an attachment. In what format are my UPC codes created? For your convenience, you receive your UPC barcode graphic in three different formats so that your graphic artist, printing company, or manufacturing facility can work with the graphic in their preferred software. EPS Format - This layered, vector EPS file is the preferred format of most graphic designers due to its quality and versatility, particularly for resizing. EPS is an ""exchange"" format, not necessarily associated with one specific graphics program. An exchange format is one intended for multiple applications to be able to open. TIFF Format - This raster TIFF file is not suitable for significant resizing. It is popular among graphic artists. JPEG Format - This uncompressed, high-quality JPEG file is the most common file format. All computers can open a JPEG. However, it is not suitable for resizing. When do I get my UPC codes? The turn-around time is often within an hour. All orders received before 4 p.m. Eastern Time on business days are completed the same day. Orders placed after 4 p.m. will be processed next business day. If you require RUSH completion, please call 877-872-2060 (toll-free) or +1 404-869-0701 (international) to make arrangements. How do I get my UPC code on my product? Providing the barcode image to your graphic artist and including it in the design of your packaging prior to manufacturing is the easiest and most economical way of getting your barcode on your product. If your product packaging has already been printed, you will need barcode labels. If you would like to order pre-printed barcode labels, please select this option when ordering your UPC code. If you have already completed your order, then click label printing to order labels. All orders received before 2 p.m. Eastern Time on business days are completed the same day and shipped for free within the continental U. S. What do I need to know about the standards organization for UPC codes? GS1, formerly called the UCC (Uniform Code Council) and EAN International, manages Universal Product Code standards. UPC codes can be obtained in two ways...1. Leasing directly from GS1 for a considerable initial fee plus ongoing annual fees2. Purchasing for a one-time fee from Simply Barcodes Does the UPC Code tell me (or others) in which country a product was manufactured? We are asked this question daily. Unfortunately, there is a lot of misinformation on the internet and in e-mails that are going around. This happens especially frequently at times of product recalls or food safety scares. The truth of the matter is very simple: No, it is absolutely not possible to tell in which country a product has been made by looking at the barcode. We have put together a very detailed explanation of why this is not possible along with a recommendation on how you might tell where a product comes from here . Do I need to have a company prefix? The only reasons that you might need a company prefix are that 1) you have thousands of unique products or 2) you are selling to The Kroger Co., Macys, Inc., Wal-Mart Stores, or Sears Brands, LLC. What is a company prefix? In the past, UPC bar codes consisted of a manufacturer’s number (also called a company prefix), a product number, and a check digit. The first six digits of a UPC bar code were referred to as the manufacturing number that always remained constant on all of a company’s products. The manufacturing number was followed by a five digit product number that is unique to each product. The 12th digit was a mathematically calculated digit, called a check digit. That system in its original form was abandoned some time ago. Currently, it is no longer possible to look at any given Universal Product Code and determine which portion of the 12 digit number is a fixed manufacturer’s number and which portion is a product number. Why is this? The first reason is variable length prefixing. GS1 changed its business model and began issuing 7, 8, 9, and even 10-digit manufacturer’s prefixes in addition to the original 6-digit manufacturer’s number. The result of this is that it is no longer possible to look at any given UPC code and break it up into a company’s prefix and product ID number. The second reason is that GS1 leased single UPC numbers for a short time in 2008, a program they’ve since discontinued in the U. S. but still offer in other GS1 member country organizations. Since these single UPC codes do not technically have a prefix, Universal Product Codes need to be taken as the whole unique 12-digit number that is associated with your product/company information at the Point of Sale. What if I am selling to The Kroger Co., Macys, Inc., Wal-Mart Stores, Sears Brands, LLC or other stores that require GS1 membership? In the case of these few retailers, you will have no choice but to lease your UPC numbers directly from GS1. These stores require that you have your own GS1 membership. However, once you have obtained your prefix number from GS1, you can still return to us to have your digital UPC barcode images created using the GS1 numbers. You would also want to use our firm to have your master carton barcodes (SCC-14 codes) created. Large retailers generally require that you properly label your shipments with SCC-14 barcodes . Apart from UPC Codes we also offer EAN Codes, Barcodes for Amazon, Barcodes for Music, ISBN Barcodes, Magazine Barcodes, Barcodes for Produce, Barcodes for Greeting Cards, Barcodes for Alcohol, SCC-14 Codes, SSCC-18 Codes, QR Codes, Coupon Barcodes, GTIN Codes, UPN Barcodes, Code 128 Barcodes, Code 39 Barcodes, and many other barcode types. We also provide barcode graphic creation, label printing, and other barcoding services. Call 877-872-2060 (toll-free) or +1 404-869-0701 (international) or live chat with our Experts for more information regarding our barcoding services. Our multilingual customer service team welcomes the opportunity to speak with you about your unique situation. "


what does the suresight vision screener screen for?

ts. The breakdown: Healthcare professionals use the Sure Sight Vision Screener for screening of visual acuity, and you should report it with 99173 (Screening test of visual acuity, quantitative, bilateral), explains Cindy Paddock’s assistant at Welch Allyn.

Get These Facts Before Buying SureSight for Vision Screening

"Get These Facts Before Buying Sure Sight for Vision Screening- Published on Thu, Nov 29, 2007u Caution: Product info could misdirect you to 92015 If you’re considering replacing technically difficult and time consuming Snellen eye chart testing with new technology equipment, weigh these pros and cons. Pro 1: Save Time With Handheld Frustrated by vision screening for 3- and 4-year-olds using traditional eye charts? You’re not alone. ""Barriers to office screening reported by pediatricians include lack of cooperation by children (49 percent), screening being too time-consuming (23 percent) and lack of training (15 percent),"" notes Robert W. Hered, MD, in ""Children’s Eye Screening in the Primary Care Office: Rationale and Methods,"" referring to a Clinical Pediatrics study. Newer screening technology using a machine, such as the Sure Sight Vision Screener, seems to conquer these challenges by providing results faster with an easier method that staff can perform. The instrument automatically screens vision in seconds without requiring the child to respond, according to School Health Corporation, a medical supplier. ""The portable unit requires little time to learn; and nurses, technicians, and other trained personnel can administer tests."" Pro 2: Stick With Common Pediatric Code Sure Sight reimbursement information suggests you have two coding options for the equipment. But there’s only one solution. ""You should choose the code based on which unit you’re using,"" instructs one of the manufacturer’s reimbursement specialis

You should reserve 92015 (Determination of refractive state) -- the other coding choice Sure Sight reimbursement information lists -- for auto refraction performed with an autorefractor device, such as the Sure Sight Autorefractor or Retinomax. Experts confirm this advice. An auditor working with pediatrics in our area stated that ""if our pediatricians used the instrument to screen, her recommendation would be to bill 99173,"" reports Lynn A. Brown, CPC, director of physician coding and reimbursement for Children’s Health System in Birmingham, Ala. Reporting the screener with 99173 lets you use a common pediatric code. ""I’m skeptical about using 92015 because it falls under special ophthalmological services,"" notes Carrol Kozerinsky, CPC, at THN Physicians Association in El Paso, Texas. Insurers may question pediatricians reporting an atypical pediatric code. Con 1: Realize 92015 Requires Treatment Interpretation of the word ""determination"" in 92015’s descriptor might make you consider using this code. But does it mean screening or treatment? ""The code was originally intended for use by eye doctors when determining the correct glasses prescription for their patients,"" reports Hered, who is also chief of the division of ophthalmology at Nemours Children’s Clinic in Jacksonville, Fla. Do this: Stick with the correction requirement. Taber’s Medical Dictionary defines ""determination of refractive state"" [...]SIGN UP / LOGIN to read the article. "


difference between protime and inr

e”. INR and APTT are two types of test conducted to measure the coagulation of blood in the patient. INR stands for “International Normalized Ratio”. It is also called “Pro Time INR” and “INR PT”. APTT, on the other hand, stands for “Activated Partial Thromboplastin Time”. The international normalized ratio is derived form the prothrombin time (PT) and the prothrombin ratio (PR). These are used to measure the extrinsic pathway of coagulation.

Difference between INR and APTT

Difference between INR and APTTTweet Key difference: INR and APTT are two types of test conducted to measure the coagulation of blood in the patient. INR stands for “International Normalized Ratio”. APTT, on the other hand, stands for “Activated Partial Thromboplastin Tim

Coagulation is the clotting ability of blood. INR is usually used to measure the effectiveness of warfarin dosage, and the statuses of liver damage and vitamin K. If the result shows a prolonged INR, it means that clotting of blood is taking too long. Hence, steps may be taking to address the issue. INR is mainly ordered to get a better view for diagnosing the unexplained bleeding of a patient. It also serves as a screening test for people who will undergo surgical procedures. It measures if the person undergoing surgery has a normal clotting ability. A low INR may result in postponing the surgery. An INR test may also be ordered if a patient shows signs and symptoms of unusual bleeding despite not taking any anticoagulant drugs. An INR test may also be ordered, if the patient exhibits nosebleeds, heavy menstrual periods, bleeding gums, bruises, and the presence of blood in the stool. Activated partial thromboplastin time (a PTT or APTT) is a performance indicator used to measure the efficacy of the contact activation pathway and the common coagulation pathways. It measures the amount of time taken by blood to clot in a patient. It is mainly used to detect any abnormalities in blood clotting, such as unusual bleeding or bruising. It can be used to screen the deficiency of some blood clotting factor leading to bleeding disorders like hemophilia. It may also be used to determine the blood clotting time before surgery. Furthermore, APTT is also used to monitor the treatment effects with heparin. Heparin is an anticoagulant which delays the clotting of blood. It is usually performed after a patient has regularly taken blood-thinning medicines for a specific period of time. This is done so that the exact dose and dosage of the medicine can be determined for the patient. INR and APTT are often used in conjunction, in order to get a complete picture of the blood coagulation in the patient. Image Courtesy: featsoffeasts.com, wikipedia.org Tweet Add new comment Your name Comment *

ees In brief: Uniform standered Pt is prothrombin time, inr is international normalized ratio, both measure cloting tendency in disease and in health. In pt each time you need contol which varies place to place and some what unpredictble. So inr solves the problem by uniform standred all over the world.

What's the difference between pt and inr?

Dr. Addagada Rao Surgery1 doctor agr

Inr of 2 to 3 if 3 or more means will bleed , under 2 means need more medication ( like coumidine ). Thank Want a second opinion? Consult a top doctor for additional insights Get a second opinion Get help from a real doctor now Continue108,000 doctors available Related questions What is the difference between pt, ptt, and INR tests?1 doctor responded Could you explain to me the difference between pt, ptt, and inr?1 doctor responded Could a doctor please explain to me the difference between pt, ptt, and inr?1 doctor responded People Also Viewed Baclofen cause blood thinning Botox blood thinning medication Pt ptt inr blood test Pro time blood test inr Alternatives to aspirin for thinning blood Glucosamine cause blood thinning What is the normal inr levels in blood? Alternative to aspirin for blood thinning What is a pt inr blood test? Piriton blood thinning Related Topics Prothrombin time Inr Get help from a real doctor now Continue108,000 doctors available

In healthy people an INR of 1.1 or below is considered normal. An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung. In certain situations, such as having a mechanical heart valve, you might need a slightly higher INR.

Overview

Overview A prothrombin time test measures how quickly your blood clots. Sometimes called a PT or pro time test, a prothrombin time test uses a sample of your blood. Prothrombin is a protein produced by your liver. It is one of many factors in your blood that help it to clot appropriately. If you take a blood-thinning medication such as warfarin (Coumadin), your prothrombin time test results will be expressed as a ratio called the international normalized ratio (INR). Why it's done Your doctor might recommend a prothrombin time test to: Monitor the effectiveness of a blood-thinning medication that you're taking Diagnose liver problems Assess your blood's ability to clot before you have surgery The prothrombin time test is one of several tests used to screen people waiting for liver transplants. That screening — known as the model for end-stage liver disease (MELD) — is a scoring system for assessing the severity of chronic liver disease. When you have a prothrombin time test, you might also have: Additional testing to assess the health of your liver, if your doctor suspects you have liver problems Additional clotting-function tests, if your doctor suspects you have a bleeding disorder Request an Appointment at Mayo Clinic Risks A prothrombin time test is similar to any other blood test. You might experience soreness or minor bruising at the site in the arm where your blood is drawn. What you can expect During the test Obtaining the blood sample for prothrombin time testing usually takes just a few minutes, like any other blood test. After the test Your blood might be sent to a laboratory for analysis. If the laboratory analysis is done on-site, you could have your test results within hours. If your doctor sends your blood to an off-site laboratory, it may take several days to receive the results. In some anticoagulation clinics, a nurse will take a sample of your blood with a finger stick, and give you the test result within minutes, while you are still in the exam room. Home testing Home testing kits are available for people who have to take blood thinners for long periods and who have been trained in taking blood samples and testing them. Results Prothrombin time test results can be presented in two ways. In seconds The average time range for blood to clot is about 10 to 14 seconds. A number higher than that range means it takes blood longer than usual to clot. A number lower than that range means blood clots more quickly than normal. As INRThis ratio — which allows for easier comparisons of test results from different laboratories — is used if you take blood-thinning medications.

When the INR is higher than the recommended range, it means that your blood clots more slowly than desired, and a lower INR means your blood clots more quickly than desired. What your results mean Clotting too slowly Blood that clots too slowly can be caused by: Blood-thinning medications Liver problems Inadequate levels of proteins that cause blood to clot Vitamin K deficiency Other substances in your blood that hinder the work of clotting factors Clotting too fast Blood that clots too quickly can be caused by: Supplements that contain vitamin KHigh intake of foods that contain vitamin K, such as liver, broccoli, chickpeas, green tea, kale, turnip greens and products that contain soybeans Estrogen-containing medications, such as birth control pills and hormone replacement therapy By Mayo Clinic Staff Request an Appointment at Mayo Clinic Jan. 03, 2018Share on: Facebook Twitter References Prothrombin time test About Advertisement Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Advertising & Sponsorship Policy Opportunities Ad Choices Mayo Clinic Marketplace Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. FREE TRIAL – Mayo Clinic Health Letter Best Treatment Strategies for Arthritis Mayo Clinic on Digestive Health Effective Home Remedies from Mayo Clinic The Mayo Clinic Diet Online PRC-20157229Patient Care & Health Information Tests & Procedures Prothrombin time test


when was the last major immigration overhaul done by ronald reagan?

l President Reagan and Vice President Bush on January 20, 1989, in Washington, D. C. WASHINGTON (AP) – Two presidents have acted unilaterally on immigration — and both were Republican. Ronald Reagan and his successor George H. W. Bush extended amnesty to family members who were not covered by the last major overhaul of immigration law in 1986. ADVERTISEMENTN

"POLITICSObama is not the first: Two Republican presidents have acted unilaterally on immigration Published November 17, 2014 Fox News Facebook Twitter livefyre Emai

either faced the political uproar widely anticipated if and when President Barack Obama uses his executive authority to protect millions of immigrants from deportation. Reagan's and Bush's actions were conducted in the wake of a sweeping, bipartisan immigration overhaul and at a time when ""amnesty"" was not a dirty word. Obama is acting as the country — and Washington — are bitterly divided over a broken immigration system and what to do about 11 million people living in the U. S. illegally. Obama wants to extend protection from deportation to millions of immigrant parents and spouses of U. S. citizens and permanent residents, and expand his 2-year-old program that shields immigrants brought illegally to this country as children. A tea party-influenced GOP is poised to erupt, if and when Obama follows through on his promise. ""The audacity of this president to think he can completely destroy the rule of law with the stroke of a pen is unfathomable to me,"" said GOP Rep. Steve King of Iowa, an outspoken opponent of relaxing U. S. immigration law. ""It is unconstitutional, it is cynical, and it violates the will of the American people. ""Some Republicans have even raised the possibility of impeachment. Here's a timeline of then and now:—1986. Congress and Reagan enacted a sweeping overhaul that gave legal status to up to 3 million immigrants without authorization to be in the country, if they had come to the U. S. before 1982. Spouses and children who could not meet that test did not qualify, which incited protests that the new law was breaking up families.—1987. Early efforts in Congress to amend the law to cover family members failed. Reagan's Immigration and Naturalization Service commissioner announced that minor children of parents granted amnesty by the law would get protection from deportation. Spouses and children of couples in which one parent qualified for amnesty but the other did not remained subject to deportation, leading to efforts to amend the 1986 law.—1989. By a sweeping 81-17 vote, the Senate in July voted to prohibit deportations of family members of immigrants covered by the 1986 law. The House failed to act.—1990. In February, President George H. W. Bush, acting through the Immigration and Naturalization Service, established a ""family fairness"" in which family members living with a legalizing immigrant and who were in the U. S. before passage of the 1986 law were granted protection from deportation and authorized to seek employment. The administration estimated up to 1.5 million people would be covered by the policy. Congress in October passed a broader immigration law that made the protections permanent.—2012. In July, the Obama administration announces a new policy curbing deportations for certain immigrants brought illegally to the country as kids. The policy, Deferred Action for Childhood Arrivals, applies to people younger than 30 who were brought to the U. S. before they turned 16 and meet other criteria such as graduating high school. It has now granted two-year deportation reprieves and work permits to nearly 600,000 people.—2013-2014 (Congress). After months of work, the Senate in June of 2013 passes, 68-32, a huge immigration overhaul bill that includes a path to citizenship for immigrants who meet strict criteria. The House fails to act.—2014 Frustrated by Congress' inability to act on immigration, Obama announces in June that he'll use executive powers to cover as many as 5 million people. Like Bush, Obama is expected to extend deportation protections to families of U. S. citizens or permanent residents. Obama's anticipated action would not award legal status, but it would offer temporary protection from deportation and the possibility of obtaining a work permit. On Monday, Democratic leaders sent a letter to Obama saying they strongly support his plans to take executive action on immigration. Follow us on twitter.com/foxnewslatino Like us at facebook.com/foxnewslatino "


how much does a permit cost to climb mount everest

Nepal slashes cost of climbing Everest Fees for single climbers cut from $25,000 to $11,000, but veterans warn of increased cost of safer group expeditions Will Coldwell and agencies

Nepal slashes cost of climbing Everest

"Mount Everest

@will_coldwell Fri 14 Feb 2014 11.48 EST11.48 ESTThis article is over 4 years old Mount Everest rises 8,848m through the clouds. Photograph: Desmond Boylan/Reuters Nepal is slashing the climbing fees for Mount Everest to attract more mountaineers to the world's highest peak, despite concerns about the environmental and safety implications of more climbers joining the thousands who already crowd the mountain in high season. Madhusudan Burlakoti, head of Nepal's department of mountains, said on Friday that from next year licence fees for single foreigners will be cut from $25,000 to $11,000 (£6,500). However, discounted fees for group expeditions to Everest will be abolished, to discourage large numbers climbing together and reduce tensions on the mountain during peak months. Last year a brawl between European climbers and Nepalese guides made headlines. Under existing rules, a group of seven pays $70,000, which officials say encourages climbers of varying abilities to club together. But under the new fee structure, the same group will pay$77,000, as the government charges a flat, per-person fee regardless of the group's size. The government has also, for the first time, set separate fees for Nepalese climbers, who will pay $750 for a permit during the spring. ""We hope to attract more climbers and at the same time better manage the climbing teams,"" Burlakoti said. ""This will allow the smaller teams and individuals more freedom when they climb Everest. ""However, those with experience of the dangers of climbing Everest have said the prospect of more smaller groups attempting the summit is terrifying. ""These changes open the possibility of individuals going up without being part of a big team anymore,"" says Simon Lowe, managing director of Jagged Globe, the first British organisation to lead a commercial trip up the mountain. ""I find that terrifying frankly; safety comes from being in a team. ""This will open the floodgates for anyone to say 'I'm an expert mountaineer', get a client and away they go. If something goes wrong they'll have to reach out to other teams. Help is always given, but it's frustrating when you end up having to help people who shouldn't be on the mountain. ""Simon Lowe fears the cheaper fees will 'open the floodgates' to the already busy summit of Everest at peak periods. (AFP/Getty)Still, Lowe is sympathetic to the desire of the Nepalese government to reduce the financial barrier to climbing the mountain, as long as proper vetting is done to ensure people are capable of the expedition and sanctions are placed on companies that allow people to get into dangerous situations. The cost of climbing Mount Everest has drawn criticism from those who say the sky-high prices allow only the very rich to climb the peak. ""From a Nepalese point of view, they want to make the mountain more accessible for their own citizens, and I can't argue with that. I don't think the Nepalese government should deprive themselves of an income. ""Responsible organisations should be able to take people up and there shouldn't be a financial bar on people like that going. ""Mark Watson, executive director of Tourism Concern, which has campaigned to improve working conditions for sherpas, says it is important that increases to the number of climbers on the mountain are properly managed. ""Last year there was a concern about the number of climbers going up, with people literally queueing to go up the mountain,"" he says. ""We don't want this to increase the number of climbers so it isn't sustainable or end up creating a worse deal for the sherpas. And for the climbers too, we want to make sure it's not a disappointing experience. ""The environmental impact of increased tourism on Everest has been a growing concern. Waste, including food wrappers, climbing gear and oxygen cylinders, has littered the mountain, with some referring to Everest as the world's highest garbage dump. The Italian climbing legend Reinhold Messner has called for Nepal to close access to Everest for a few years to allow the mountain to rest and recover, but Nepal has refused. The country collects $3.3m annually from climbing fees. Tens of thousands of Nepalese hotel owners, trekking guides and porters depend on these climbers for their livelihoods. Nepal has eight of the 14 highest mountains in the world. The fees for other peaks are already much lower, but are also being reduced for the thousands of climbers who come to the country each year to scale those mountains. Ang Tshering, who headed a government committee to review mountain tourism in Nepal, said the government plans to more strictly monitor climbers to make sure they bring down all their climbing gear, food wrappings and oxygen cylinders. ""Our focus has been on minimising the negative impact on the environment in the Everest region,"" Tshering said. Topics Mount Everest Nepal Climbing holidays Adventure travel news Reuse this content "


when was ft mcnair established?

iew About Fort Lesley J Mc Nair Established in `1791 as reservation #05 when Charles Pierre L’Enfant laid out the new Capital City, it has been defending the city of Washington DC since. It is the third oldest US Army Post in continuous operation where the Military District of Washington (MDW), National Defense University (NDU) and several of its colleges and the US Army Center of Military History (CMH) call home.

BOOK REVIEW â On Point Magazine

Jul21BOOK REVIEW – On Point Magazine By John Michael // Images of America - Fort Lesley J Mc Nair // No Comments JOURNAL of THE ARMY HISTORICAL FOUNDATIONOn Point Magazine: The Journal of Army History has been published as the Foundation’s quarterly journal since 1995. In addition to publishing various articles and book reviews on U. S. Army history, On Point also provides information on the Foundation’s activities, including the status of the National Museum of the U. S. Army. On Point is provided to all AHF members. In the Summer 2016 issue of this outstanding and award-winning journal it was an honor to have a book review of”Images of America – Fort Lesley J. Mc Nair”. The review speaks for itself . Thank you, Dr. Alice A Booher!In the Summer 2016 issue of this outstanding and award-winning journal it was an honor to have a book review of”Images of America – Fort Lesley J. Mc Nair”. The review speaks for itself . Thank you, Dr. Alice A Booher!On Point Magazine – Book Rev

DOWNLOAD THE REVIEWA PDF version of the On Point Magazine review is available for download – Fort Mc Nair Book Review SPECIAL OFFER — BUY THE BOOK!FREE SHIPPING Author Autographed COPY OF Images of America – Fort Lesley J. Mc Nair Until SUNDAY, AUGUST 14, 2016 an author autographed copy of the book is available for purchase …Inscription Dedicated to whom? ABOUT THE ARMY HISTORICAL FOUNDATIONThe foundation was established in 1983 with the purpose of promoting the history of the US Army and ultimately build the National Museum of the US Army. That latter purpose is finally becoming a reality. The museum will be located in Fairfax County, Virginia at Fort Belvoir … an easy access from Interstate 95.


how thick is the concrete in a garage floor?

The standard concrete garage floor is 15 cm (6 inches) thick and, with use of proper control joints, should be thick enough to withstand normal use.

How thick should a concrete garage floor be?2012-06-26 Views:48Body Advertisement Pouring your own garage floor is an attainable goal with enough time and manpower. To ensure the strength and durability of your floor, you need to know how thick to pour your concrete. Standard thickness The standard concrete garage floor is 15 cm (Pouring your own garage floor is an attainable goal with enough time and manpower. To ensure the strength and durability of your floor, you need to know how thick to pour your concrete. Standard thickness

Type of use How thick you pour your concrete floor can be determined by how the floor is going to be used. This is largely based on the types and the number of vehicles you plan to park on it. Light use For one to two light cars or trucks, you can generally get away with pouring less concrete. For small cars the concrete should be at least 10 cm (4 inches) thick. Medium use If you intend to use the area for average-sized vehicles and/or medium to heavy trucks, the concrete needs to be 15 cm (6 inches) thick. Heavy If your garage floor is going to see constant traffic from heavy vehicles, it is recommended that you pour your floor at least 15 to 20 cm (6 to 8 inches) thick. Your floor must also be treated and sealed properly so that heavy loads like large trucks do not cause the concrete to crack.