who receives medicare part d prescription drug coverage

Individuals on Medicare are eligible for prescription drug coverage under a Part D plan if they are signed up for benefits under Medicare Part A and/or Part B. Beneficiaries obtain the Part D drug benefit through two types of plans administered by private insurance companies: the beneficiaries can join a standalone Prescription Drug Plan (PDP) for drug coverage only or they can join a public Part C health plan that jointly covers all hospital and medical services covered by Medicare Part A and Part B at a minimum, and typically covers additional healthcare costs not covered by Medicare Parts A and B including prescription drugs (MA-PD).[2] (NOTE: Medicare beneficiaries need to be signed up for both Parts A and B to select Part C whereas they need only A or B to select Part D.)

Medicare Part D

Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums (the cost of almost all professionally administered prescriptions is covered under optional Part B of United States Medicare). Part D was originally proposed by President Clinton in 2000 and enacted as part of the Medicare Modernization Act of 2003 (which also made changes to the public Part C Medicare health plan program) and went into effect on January 1, 2006.[1]

About two-thirds of all Medicare beneficiaries are enrolled directly in Part D or get Part-D-like benefits through a public Part C Medicare health plan.[3] Another large group of Medicare beneficiaries get prescription drug coverage under plans offered by former employers or through the Veterans Administration. It is also possible that a former employer or union might sponsor a Part D plan for former employees/members (such plans are called Employer Group Waiver Plans).

Medicare beneficiaries can enroll directly through the plan's administrator, or indirectly via an insurance broker or the exchange -- called Medicare Plan Finder -- run by the Centers for Medicare and Medicaid Services (CMS) for this purpose; the beneficiary's benefits and any additional assistance payments and rights are the same regardless of enrollment channel. Beneficiaries already on a plan can choose a different plan or drop Part C/D during the annual enrollment period or during other times during the year. For some time, the annual enrollment period has lasted from October 15 to December 7 of each year but that is changing for Part C in 2019.[2] Low-income seniors on Social Security Extra Help/LIS and many middle-income seniors on state pharmaceutical assistance programs can choose a different plan or drop Part C/D (or join Part C/D plan for that matter) as often as once a month. Other special enrollment circumstances apply.

Medicare beneficiaries who were eligible for but did not enroll in a Part D when they were first eligible and later want to enroll, pay a late-enrollment penalty, basically a premium surtax, if they did not have acceptable coverage through another source such as an employer or the U.S. Veterans Administration. This penalty is equal to 1% of the national premium index times the number of full calendar months that they were eligible for but not enrolled in Part D and did not have creditable coverage through another source. The penalty raises the premium of Part D for beneficiaries, when and if they elect coverage.[4][5]

In May 2018, enrollment exceeded 44 million, including both those on standalone Part D and those enrolled in Part C plan (which includes Part-D-like coverage). About 20% of those beneficiaries are on a EGWP drug plan where a former employer receives a Part D subsidy on his or her behalf. The latter two groups lack the same freedom of choice that the standalone Part D group has because they must use the Part D plan chosen by the Part C plan's administrator or their former employer.

As of May 2018, over 700 drug plan contracts had been signed between CMS and administrators, which in turn means multiple thousand plans because administrators can vary plans by county. Individual counties might have as few as three to as many 30 plans from which beneficiaries can choose. This allows participants to choose a plan that best meets their individual needs. Although the number of plans available has been trending down since the inception of the program, almost all counties offer many choices.

Plan administrators are required to offer  a plan with at least the "standard" minimum benefit or one that is actuarially equivalent to the standard, and they may also offer plans with more generous benefits (e.g., no deductible during the initial spend phase). The terms "standard," "actuarially equivalent," and "more generous" relate to the plan's deductible/co-pay/formulary/"donut-hole" (see Note)/pharmacy-preference aspects and has no direct relevance to the beneficiary other than increasing or decreasing personal choice. Each plan is approved by the CMS before being marketed.

(NOTE: It is often said the donut hole will be eliminated; that is not technically true. The "donut hole" is also called the gap phase of spending; at one time the co-pay in the gap was 100%. As of 2019, the "standard" co-pay in the gap will be 25%, the same as in the initial spend phase. It is also important to note that relatively few people as a percent of the total number of people on Medicare are ever financially affected by either the donut hole or catastrophic phases of spending.)

Medicare offers an interactive online tool called the Medicare Plan Finder[6] that allows for comparison of coverage and costs for all plans in a geographic area. The tool lets users enter a list of medications along with pharmacy preferences and Social-Security-Extra-Help/LIS and related status. The Finder can show the beneficiary's total annual costs for each plan along with a detailed breakdown of the plans' monthly premiums, deductibles and prices for each drug during each phase of spending (initial, gap, catastrophic). Plans are required to update this site with current prices and formulary information every other week throughout the year.

The Medicare Modernization Act (MMA) established a standard drug benefit that all Part D plans must offer. The standard benefit is defined in terms of the benefit structure and without mandating the drugs that must be covered. For example, in 2013, the standard benefit required payment by the beneficiary of a $325 deductible, then required 25% coinsurance payment by the beneficiary of drug costs up to an initial coverage limit of $2,970 (the full retail cost of prescriptions). Once this initial coverage limit is reached, the beneficiary had to pay the full cost of his/her prescription drugs up until the total out-of-pocket expenses reached $4,750 (excluding premiums and any expense paid by the insurance company) minus a 52.5% discount in this gap, referred to as the "Donut Hole". Once the beneficiary reaches the Out-of-Pocket Threshold, he/she becomes eligible for catastrophic coverage. During catastrophic coverage, he or she pays the greater of 5% coinsurance, or $2.65 for generic drugs and $6.60 for brand-name drugs. The catastrophic coverage amount is calculated on a yearly basis and a beneficiary who reaches catastrophic coverage by the end of the benefit year will start his or her deductible anew at the beginning of the next benefit year. Although uncommon, not all benefit years coincide with the calendar year.[2] The donut-hole and catastrophic-coverage thresholds dropped slightly in 2014.

The standard benefit is not the most common benefit mix offered by Part D plans. Only 11% of plans in 2010 offered the defined standard benefit described above. Plans vary widely in formularies and cost-sharing. Most eliminate the deductible and use tiered drug co-payments rather than coinsurance.[2] The only out-of-pocket costs that count toward getting out of the coverage gap and into catastrophic coverage are True Out-Of-Pocket (TrOOP) expenditures. TrOOP expenditures accrue only when drugs on plan's formulary are purchased in accordance with the restrictions on those drugs. Monthly premium payments do not count towards TrOOP.

Under the Patient Protection and Affordable Care Act of 2010, the effect of the "Donut Hole" coverage gap was to be gradually reduced through a combination of measures including brand-name prescription drug discounts, generic drug discounts and a gradual increase in the percentage of out-of-pocket costs covered while in the donut hole. The "Donut Hole" will continue to exist after 2020 but its effect will be changed in some way yet to be determined, because plan  administrators must treat out of pocket costs below the catastrophic level the same whether or not the insured is in the donut hole or not.[7] That is, under the "standard benefit" design all prescriptions in all tiers could be subject to a 25% co-pay whereas as of 2014 hundreds of drugs in Tier 1 are available with no co-pay.

Most plans use specialty drug tiers, and some have a separate benefit tier for injectable drugs.  Beneficiary cost sharing can be higher for drugs in these tiers.[8]

The average (weighted) monthly premium paid by the beneficiary for PDPs was $35.09 in 2009, which is an increase from $29.89 in 2008. Premiums were projected to increase to $38.94 for 2010 as well.[3] In 2014, the average is around $30 a month. The average premium is a misleading statistic because it averages the premiums offered, not the premiums paid. Most insurers offer a very low-cost plan (e.g., $15 a month) that few choose. This lowers the average, but does not reflect what is happening in the market.

In 2007, 8% of beneficiaries enrolled in a PDP chose one with some gap coverage. Among beneficiaries in MA-PD plans, enrollment in plans offering gap coverage was 33% (up from 27% in 2006).[9] Premiums are significantly higher for plans with gap coverage. These plans are becoming less common as the gap closes. The fact that beneficiaries on Social Security Extra Help/LIS were never affected by the gap and the fact that many state pharmaceutical assistance programs protected middle income seniors in the gap are the reasons this gap benefit was never especially popular.

Major Part D plan sponsors are dropping their more expensive options, and developing lower-cost ones.[10]

One option for those struggling with drug costs is the low-income subsidy. Beneficiaries with income below 150% of the poverty line are eligible for the low-income subsidy, which helps pay for all or part of the monthly premium, annual deductible and co-pays. CMS estimated that 12.5 million Part D beneficiaries were eligible for low-income subsidies in 2009.[2]

The subsidy award is given a level with the following effects for the 2013 benefit year:[citation needed]

Probably the most important benefits of Social Security Extra Help/LIS other than "free" is the fact that the beneficiary has no exposure to "donut hole" costs and can change plans monthly. In addition, in many states, state pharmaceutical assistance programs provide similar protection in the gap to middle-income seniors and allow beneficiaries to change plans one other time during the year in addition to the annual enrollment/re-enrollment period.

While CMS does not have an established formulary, Part D drug coverage excludes drugs not approved by the Food and Drug Administration, those prescribed for off-label use, drugs not available by prescription for purchase in the United States, and drugs for which payments would be available under Part B.[11]

Part D coverage excludes drugs or classes of drugs that may be excluded from Medicaid coverage. These may include:

While these drugs are excluded from basic Part D coverage, drug plans can include them as a supplemental benefit, provided they otherwise meet the definition of a Part D drug. However plans that cover excluded drugs are not allowed to pass on those costs to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.[12] Part D plans may cover all benzodiazepines and those barbiturates used in the treatment of epilepsy, cancer or a chronic health disorder. These two drug classes were originally excluded, until their reassignment in 2008 by the Medicare Improvements for Patients and Providers Act.

Part D plans are not required to pay for all covered Part D drugs.[13] They establish their own formularies, or list of covered drugs for which they will make payment, as long as the formulary and benefit structure are not found by CMS to discourage enrollment by certain Medicare beneficiaries. Part D plans that follow the formulary classes and categories established by the United States Pharmacopoeia will pass the first discrimination test. Plans can change the drugs on their formulary during the course of the year with 60 days' notice to affected parties.

The Plan's tiered co-pay amounts for each drug only generally apply during the initial period before the coverage gap.

The primary differences between the formularies of different Part D plans relate to the coverage of brand-name drugs.

Typically, each Plan's formulary is organized into tiers, and each tier is associated with a set co-pay amount. Most formularies have between 3 and 5 tiers. The lower the tier, the lower the co-pay. For example, Tier 1 might include all of the Plan's preferred generic drugs, and each drug within this tier might have a co-pay of $5 to $10 per prescription. Tier 2 might include the Plan's preferred brand drugs with a co-pay of $40 to $50, while Tier 3 may be reserved for non-preferred brand drugs which are covered by the plan at a higher co-pay, perhaps $70 to $100. Tiers 4 and higher typically contain specialty drugs, which have the highest co-pays because they are generally more expensive. By 2011 in the United States a growing number of Medicare Part D health insurance plans had added the specialty tier.[14]:1

CMS funds a national program of counselors to assist all Medicare beneficiaries, including duals, with their plan choices. The program is called State Health Insurance Assistance Program (SHIP).[15]

Medicare Part D was originally proposed by President Clinton in 2000. It was based on earlier proposals developed by Congresswoman Nancy Pelosi and Senator Tom Dashcle. These late-1990s/2000 proposals -- with the exception of the spend phase structure but including the fact that Medicare itself would not do the negotiating -- are substantially the same as the current Part D.

At the start of the program in January 2006, it was expected that eleven million people would be covered by Medicare Part D; of those, six million would be dual eligible. About two million people who were covered by employers would likely lose their employee benefits.

As of January 30, 2007, nearly 24 million individuals were receiving prescription drug coverage through Medicare Part D (PDPs and MA-PDs combined), according to CMS.[16] Medicare offers other methods of receiving drug coverage, including the Retiree Drug Subsidy. Federal retiree programs such as TRICARE and Federal Employees Health Benefits Program (FEHBP) or alternative sources, such as the Department of Veterans Affairs. Including people in these categories, more than 39 million Americans are covered for prescriptions by the federal government.

A survey released by AARP in November 2007 found that 85% of enrollees reported satisfaction with their drug plan, and 78% said that they had made a good choice in selecting their plan.[17]

As of the end of 2008, the average annual per beneficiary cost spending for Part D was $1,517,[18] making the total expenditures of the program for 2008 $49.3 billion.

From a budget perspective, Part D is effectively three different programs. Based on 2012 budget numbers:

Medicare Part D Cost Utilization Measures refer to limitations placed on medications covered in a specific insurer's formulary for a plan. Cost utilization consists of techniques that attempt to reduce insurer costs. The three main cost utilization measures are quantity limits, prior authorization and step therapy.

Quantity limits refer to the maximum amount of a medication that may be dispensed during a given calendar period. For example, a plan may dictate that it will cover 90 pills of a given drug within a 30-day period.

A prior authorization requirement requires a health care worker to receive formal approval from a plan before it agrees to cover a specific prescription. It may be used by insurers for drugs that are often misused. Prior authorization helps ensure that patients receive correct medications.

Step therapy is a process in which a plan requires an individual to try, and prove ineffective, one or more specified lower-cost drugs before a higher-cost drug in the same therapeutic class is approved.

A 2008 study found that the percentage of Medicare beneficiaries who reported forgoing medications due to cost dropped with Part D, from 15.2% in 2004 and 14.1% in 2005 to 11.5% in 2006.  The percentage who reported skipping other basic necessities to pay for drugs also dropped, from 10.6% in 2004 and 11.1% in 2005 to 7.6% in 2006.  The very sickest beneficiaries reported no reduction, but fewer reported forgoing other necessities to pay for medicine.[20][21]

A parallel study found that Part D beneficiaries skip doses or switch to cheaper drugs and that many do not understand the program.[20] Another study found that Part D resulted in modest increases in average drug utilization and decreases in average out-of-pocket expenditures. [22] Further studies by the same group of researchers found that the net impact among beneficiaries was a decrease in the use of generic drugs.[23]

A further study concludes that although a substantial reduction in out-of-pocket costs and a moderate increase in utilization among Medicare beneficiaries during the first year after Part D, there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D during its first year of implementation.[24] It was also found that there were no significant changes in trends in the dual eligibles' out-of-pocket expenditures, total monthly expenditures, pill-days, or total number of prescriptions due to Part D.[25]

The federal government is not permitted to negotiate Part D drug prices with drug companies, as federal agencies do in other programs. The Department of Veterans Affairs, which is allowed to negotiate drug prices and establish a formulary, has been estimated to pay between 40%[26] and 58%[27] less for drugs, on average, than Part D.

Although generic versions of [frequently prescribed to the elderly] drugs are now available, plans offered by three of the five [exemplar Medicare Part D] insurers currently exclude some or all of these drugs from their formularies.â€¦Further, prices for the generic versions are not substantially lower than their brand-name equivalents. The lowest price for simvastatin (generic Zocor) 20 mg is 706 percent more expensive than the VA price for brand-name Zocor. The lowest price for sertraline HCl (generic Zoloft) is 47 percent more expensive than the VA price for brand-name Zoloft."

Estimating how much money could be saved if Medicare had been allowed to negotiate drug prices, economist Dean Baker gives a "most conservative high-cost scenario" of $332 billion between 2006 and 2013 (approximately $50 billion a year). Economist Joseph Stiglitz in his book entitled The Price of Inequality estimated a "middle-cost scenario" of $563 billion in savings "for the same budget window".[28]:48

Former Congressman Billy Tauzin, Râ€“La., who steered the bill through the House, retired soon after and took a $2 million a year job as president of Pharmaceutical Research and Manufacturers of America (PhRMA), the main industry lobbying group. Medicare boss Thomas Scully, who threatened to fire Medicare Chief Actuary Richard Foster if he reported how much the bill would actually cost, was negotiating for a new job as a pharmaceutical lobbyist as the bill was working through Congress.[29][30] 14 congressional aides quit their jobs to work for related lobbies immediately after the bill's passage.[31]

In response, free-market think tank Manhattan Institute issued a report by professor Frank Lichtenberg that said the VA National Formulary excludes many new drugs. Only 38% of drugs approved in the 1990s and 19% of the drugs approved since 2000 were on the formulary.[citation needed]

In 2012, the plan required Medicare beneficiaries whose total drug costs reach $2,930 to pay 100% of prescription costs until $4,700 is spent out of pocket.  (The actual threshold amounts change year-to-year and plan-by-plan, and many plans offered limited coverage during this phase.) While this coverage gap does not affect the majority of program participants, about 25% of beneficiaries enrolled in standard plans find themselves in this gap.[32]

As a candidate, Barack Obama proposed "closing the 'doughnut hole'" and subsequently proposed a plan to reduce costs for recipients from 100% to 50% of these expenses.[33] The cost of the plan would be borne by drug manufacturers for name-brand drugs and by the government for generics.[33]


what is it called when a baby is born with male and female parts

Intersex people are born with any of several variations in sex characteristics including chromosomes, gonads, sex hormones, or genitals that, according to the UN Office of the High Commissioner for Human Rights, "do not fit the typical definitions for male or female bodies".[1][2] Such variations may involve genital ambiguity, and combinations of chromosomal genotype and sexual phenotype other than XY-male and XX-female.[3][4]

Intersex

Intersex people were previously referred to as hermaphrodites, "congenital eunuchs",[5][6] or congenitally "frigid".[7] Such terms have fallen out of favor; in particular, the term "hermaphrodite" is considered to be misleading, stigmatizing, and scientifically specious.[8] Medical description of intersex traits as disorders of sex development has been controversial[9][10][11] since the label was introduced in 2006.[12]

Intersex people may face stigmatization and discrimination from birth or discovery of an intersex trait. This may include infanticide, abandonment and the stigmatization of families.[13][14][15] Globally, some intersex infants and children, such as those with ambiguous outer genitalia, are surgically or hormonally altered to create more socially acceptable sex characteristics. However, this is considered controversial, with no firm evidence of good outcomes.[16] Such treatments may involve sterilization. Adults, including elite female athletes, have also been subjects of such treatment.[17][18] Increasingly these issues are considered human rights abuses, with statements from international[19][20] and national human rights and ethics institutions.[21][22] Intersex organizations have also issued statements about human rights violations, including the Malta declaration of the third International Intersex Forum.[23]

In 2011, Christiane Völling became the first intersex person known to have successfully sued for damages in a case brought for non-consensual surgical intervention.[24] In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people.[25][26]

Some intersex persons may be assigned and raised as a girl or boy but then identify with another gender later in life, while most continue to identify with their assigned sex.[4][2][27][28][29]

According to the UN Office of the High Commissioner for Human Rights:

Intersex people are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies.

Intersex is an umbrella term used to describe a wide range of natural bodily variations. In some cases, intersex traits are visible at birth while in others, they are not apparent until puberty. Some chromosomal intersex variations may not be physically apparent at all.[2]

In biological terms, sex may be determined by a number of factors present at birth, including:[30]

People whose characteristics are not either all typically male or all typically female at birth are intersex.[31]

Some intersex traits are not always visible at birth; some babies may be born with ambiguous genitals, while others may have ambiguous internal organs (testes and ovaries). Others will not become aware that they are intersex unless they receive genetic testing, because it does not manifest in their phenotype.

Whether or not they were socially tolerated or accepted by any particular culture, the existence of intersex people was known to many ancient and pre-modern cultures. The Greek historian Diodorus Siculus wrote of "hermaphroditus" in the first century BCE that Hermaphroditus "is born with a physical body which is a combination of that of a man and that of a woman", and with supernatural properties.[32]

In European societies, Roman law, post-classical canon law, and later common law, referred to a person's sex as male, female or hermaphrodite, with legal rights as male or female depending on the characteristics that appeared most dominant.[33] The 12th-century Decretum Gratiani states that "Whether an hermaphrodite may witness a testament, depends on which sex prevails".[34][35][36] The foundation of common law, the 17th Century Institutes of the Lawes of England described how a hermaphrodite could inherit "either as male or female, according to that kind of sexe which doth prevaile."[37][38] Legal cases have been described in canon law and elsewhere over the centuries.

In some non-European societies, sex or gender systems with more than two categories may have allowed for other forms of inclusion of both intersex and transgender people. Such societies have been characterized as "primitive", while Morgan Holmes states that subsequent analysis has been simplistic or romanticized, failing to take account of the ways that subjects of all categories are treated.[39]

During the Victorian era, medical authors introduced the terms "true hermaphrodite" for an individual who has both ovarian and testicular tissue, "male pseudo-hermaphrodite" for a person with testicular tissue, but either female or ambiguous sexual anatomy, and "female pseudo-hermaphrodite" for a person with ovarian tissue, but either male or ambiguous sexual anatomy. Some later shifts in terminology have reflected advances in genetics, while other shifts are suggested to be due to pejorative associations.[40]

The term intersexuality was coined by Richard Goldschmidt in 1917.[41] The first suggestion to replace the term 'hermaphrodite' with 'intersex' was made by Cawadias in the 1940s.[42]

Since the rise of modern medical science, some intersex people with ambiguous external genitalia have had their genitalia surgically modified to resemble either female or male genitals. Surgeons pinpointed intersex babies as a "social emergency" when born.[43] An 'optimal gender policy', initially developed by John Money, stated that early intervention helped avoid gender identity confusion, but this lacks evidence,[44] and early interventions have adverse consequences for psychological and physical health.[22] Since advances in surgery have made it possible for intersex conditions to be concealed, many people are not aware of how frequently intersex conditions arise in human beings or that they occur at all.[45]

Dialog between what were once antagonistic groups of activists and clinicians has led to only slight changes in medical policies and how intersex patients and their families are treated in some locations.[46] In 2011, Christiane Völling became the first intersex person known to have successfully sued for damages in a case brought for non-consensual surgical intervention.[24] In April 2015, Malta became the first country to outlaw non-consensual medical interventions to modify sex anatomy, including that of intersex people.[25] Many civil society organizations and human rights institutions now call for an end to unnecessary "normalizing" interventions, including in the Malta declaration.[47][1]

Human rights institutions are placing increasing scrutiny on harmful practices and issues of discrimination against intersex people. These issues have been addressed by a rapidly increasing number of international institutions including, in 2015, the Council of Europe, the United Nations Office of the United Nations High Commissioner for Human Rights and the World Health Organization. These developments have been accompanied by International Intersex Forums and increased cooperation amongst civil society organizations. However, the implementation, codification and enforcement of intersex human rights in national legal systems remains slow.

Areas of concern include: non-consensual medical interventions; stigma, discrimination and equal treatment; access to reparations and justice; access to information and support, and legal recognition.

Stigmatization and discrimination from birth may include infanticide, abandonment and the stigmatization of families. Mothers in east Africa may be accused of witchcraft, and the birth of an intersex child may be described as a curse.[13][14] Abandonments and infanticides have been reported in Uganda,[13] Kenya,[48] south Asia,[49] and China.[15]

Infants, children and adolescents also experience "normalising" interventions on intersex persons that are medically unnecessary and the unnecessary pathologisation of variations in sex characteristics. Medical interventions to modify the sex characteristics of intersex people, without the consent of the intersex person have taken place in all countries where the human rights of intersex people have been studied.[50] These interventions have frequently been performed with the consent of the intersex person's parents, when the person is legally too young to consent. Such interventions have been criticized by the World Health Organization, other UN bodies such as the Office of the High Commissioner for Human Rights, and an increasing number of regional and national institutions due to their adverse consequences, including trauma, impact on sexual function and sensation, and violation of rights to physical and mental integrity.[1] In April 2015, Malta became the first country to outlaw surgical intervention without consent.[25][26] In the same year, the Council of Europe became the first institution to state that intersex people have the right not to undergo sex affirmation interventions.[25][26][51][52][53]

Inclusion in equal treatment and hate crime law. Because people born with intersex bodies are seen as different, intersex infants, children, adolescents and adults "are often stigmatized and subjected to multiple human rights violations", including discrimination in education, healthcare, employment, sport, and public services.[2][1][54] Several countries have so far explicitly protected intersex people from discrimination, with landmarks including South Africa,[26][55] Australia,[56][57] and, most comprehensively, Malta.[58][59][60][61][62]

Facilitating access to justice and reparations. Access to reparation appears limited, with a scarcity of legal cases, such as the 2011 case of Christiane Völling in Germany.[24][63] A second case was adjudicated in Chile in 2012, involving a child and his parents.[64][65] A further successful case in Germany, taken by Michaela Raab, was reported in 2015.[66] In the United States, the "M.C." legal case, advanced by Interact Advocates for Intersex Youth with the Southern Poverty Law Centre is still before the courts.[67][68]

Access to information, medical records, peer and other counselling and support. With the rise of modern medical science in Western societies, a secrecy-based model was also adopted, in the belief that this was necessary to ensure "normal" physical and psychosocial development.[21][22][69][70][71][72]

The Asia Pacific Forum of National Human Rights Institutions states that legal recognition is firstly "about intersex people who have been issued a male or a female birth certificate being able to enjoy the same legal rights as other men and women."[23] In some regions, obtaining any form of birth certification may be an issue. A Kenyan court case in 2014 established the right of an intersex boy, "Baby A", to a birth certificate.[73]

Like all individuals, some intersex individuals may be raised as a certain sex (male or female) but then identify with another later in life, while most do not.[3][4][28][29] Recognition of third sex or gender classifications occurs in several countries,[74][75][76][77] however, it is controversial when it becomes assumed or coercive, as is the case with some German infants.[78][79][80] Sociological research in Australia, a country with a third 'X' sex classification, shows that 19% of people born with atypical sex characteristics selected an "X" or "other" option, while 52% are women, 23% men, and 6% unsure.[27][81]

Research in the late 20th century led to a growing medical consensus that diverse intersex bodies are normal, but relatively rare, forms of human biology.[4][82][83][84] Clinician and researcher Milton Diamond stresses the importance of care in the selection of language related to intersex people:

Foremost, we advocate use of the terms "typical", "usual", or "most frequent" where it is more common to use the term "normal." When possible avoid expressions like maldeveloped or undeveloped, errors of development, defective genitals, abnormal, or mistakes of nature. Emphasize that all of these conditions are biologically understandable while they are statistically uncommon.[85]

Some people with intersex traits self-identify as intersex, and some do not.[86][87] Australian sociological research published in 2016, found that 60% of respondents used the term "intersex" to self-describe their sex characteristics, including people identifying themselves as intersex, describing themselves as having an intersex variation or, in smaller numbers, having an intersex condition. A majority of 75% of survey respondents also self-described as male or female.[27] Respondents also commonly used diagnostic labels and referred to their sex chromosomes, with word choices depending on audience.[27][81] Research by the Lurie Children's Hospital, Chicago, and the AIS-DSD Support Group published in 2017 found that 80% of affected Support Group respondents "strongly liked, liked or felt neutral about intersex" as a term, while caregivers were less supportive.[88] The hospital reported that "disorders of sex development" may negatively affect care.[89]

Some intersex organizations reference "intersex people" and "intersex variations or traits"[90] while others use more medicalized language such as "people with intersex conditions",[91] or people "with intersex conditions or DSDs (differences of sex development)" and "children born with variations of sex anatomy".[92] In May 2016, Interact Advocates for Intersex Youth published a statement recognizing "increasing general understanding and acceptance of the term "intersex"".[93]

A hermaphrodite is an organism that has both male and female reproductive organs. Until the mid-20th century, "hermaphrodite" was used synonymously with "intersex".[42] The distinctions "male pseudohermaphrodite", "female pseudohermaphrodite" and especially "true hermaphrodite"[94] are vestiges of outdated 19th-century thinking, reflecting histology (microscopic appearance) of the gonads.[95][96][97] Medical terminology has shifted not only due to concerns about language, but also a shift to understandings based on genetics.

Currently, hermaphroditism is not to be confused with intersex, as the former refers only to a specific phenotypical presentation of sex organs and the latter to more complex combination of phenotypical and genotypical presentation. Using "hermaphrodite" to refer to intersex individuals is considered to be stigmatizing and misleading.[98] Hermaphrodite is used for animal and vegetal species in which the possession of both ovaries and testes is either serial or concurrent, and for living organisms without such gonads but present binary form of reproduction, which is part of the typical life history of those species; intersex has come to be used when this is not the case.

"Disorders of sex development" (DSD) is a contested term,[9][10] defined to include congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical. Members of the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology adopted this term in their "Consensus statement on management of intersex disorders".[12][44] While it adopted the term, to open "many more doors", the now defunct Intersex Society of North America itself remarked that intersex is not a disorder.[99] Other intersex people, activists, supporters, and academics have contested the adoption of the terminology and its implied status as a "disorder", seeing this as offensive to intersex individuals who do not feel that there is something wrong with them, regard the DSD consensus paper as reinforcing the normativity of early surgical interventions, and criticizing the treatment protocols associated with the new taxonomy.[100]

Sociological research in Australia, published in 2016, found that 3% of respondents used the term "disorders of sex development" or "DSD" to define their sex characteristics, while 21% use the term when accessing medical services. In contrast, 60% used the term "intersex" in some form to self-describe their sex characteristics.[81] U.S. research by the Lurie Children's Hospital, Chicago, and the AIS-DSD Support Group published in 2017 found that "disorders of sex development" terminology may negatively affect care, give offence, and result in lower attendance at medical clinics.[89][88]

Alternatives to categorizing intersex conditions as "disorders" have been suggested, including "variations of sex development".[11] Organisation Intersex International (OII) questions a disease/disability approach, argues for deferral of intervention unless medically necessary, when fully informed consent of the individual involved is possible, and self-determination of sex/gender orientation and identity.[101] The UK Intersex Association is also highly critical of the label 'disorders' and points to the fact that there was minimal involvement of intersex representatives in the debate which led to the change in terminology.[102] In May 2016, Interact Advocates for Intersex Youth also published a statement opposing pathologizing language to describe people born with intersex traits, recognizing "increasing general understanding and acceptance of the term "intersex"".[93]

Intersex can be contrasted with homosexuality or same-sex attraction. Numerous studies have shown higher rates of same sex attraction in intersex people,[103][104] with a recent Australian study of people born with atypical sex characteristics finding that 52% of respondents were non-heterosexual,[27][81] thus research on intersex subjects has been used to explore means of preventing homosexuality.[103][104] However, current studies do not support a statistical correlation between genetic intersex traits and transsexual persons.[105][106]

Intersex can therefore be contrasted with transgender,[107] which describes the condition in which one's gender identity does not match one's assigned sex.[107][108][109] Some people are both intersex and transgender.[110] A 2012 clinical review paper found that between 8.5% and 20% of people with intersex variations experienced gender dysphoria.[28] In an analysis of the use of preimplantation genetic diagnosis to eliminate intersex traits, Behrmann and Ravitsky state: "Parental choice against intersex may... conceal biases against same-sex attractedness and gender nonconformity."[111]

The relationship of intersex to lesbian, gay, bisexual and trans, and queer communities is complex,[112] but intersex people are often added to LGBT to create an LGBTI community. Emi Koyama describes how inclusion of intersex in LGBTI can fail to address intersex-specific human rights issues, including creating false impressions "that intersex people's rights are protected" by laws protecting LGBT people, and failing to acknowledge that many intersex people are not LGBT.[113] Organisation Intersex International Australia states that some intersex individuals are same sex attracted, and some are heterosexual, but "LGBTI activism has fought for the rights of people who fall outside of expected binary sex and gender norms."[114][115] Julius Kaggwa of SIPD Uganda has written that, while the gay community "offers us a place of relative safety, it is also oblivious to our specific needs".[116] Mauro Cabral has written that transgender people and organizations "need to stop approaching intersex issues as if they were trans issues" including use of intersex as a means of explaining being transgender; "we can collaborate a lot with the intersex movement by making it clear how wrong that approach is".[117]

An intersex character is the narrator in Jeffrey Eugenides' Pulitzer Prize-winning novel Middlesex.

Television works about intersex and films about intersex are scarce. The Spanish-language film XXY won the Critics' Week grand prize at the 2007 Cannes Film Festival and the ACID/CCAS Support Award.[118] Faking It is notable for providing the first intersex main character in a television show,[119] and television's first intersex character played by an intersex actor.[120]

Intersex peer support and advocacy organizations have existed since at least 1985, with the establishment of the Androgen Insensitivity Syndrome Support Group Australia in 1985.[121] The Androgen Insensitivity Syndrome Support Group (UK) established in 1988.[122] The Intersex Society of North America (ISNA) may have been one of the first intersex civil society organizations to have been open to people regardless of diagnosis; it was active from 1993 to 2008.[123]

Intersex Awareness Day is an internationally observed civil awareness day designed to highlight the challenges faced by intersex people, occurring annually on 26 October. It marks the first public demonstration by intersex people, which took place in Boston on October 26, 1996, outside a venue where the American Academy of Pediatrics was holding its annual conference.[124]

Intersex Day of Remembrance, also known as Intersex Solidarity Day, is an internationally observed civil awareness day designed to highlight issues faced by intersex people, occurring annually on 8 November. It marks the birthday of Herculine Barbin, a French intersex person whose memoirs were later published by Michel Foucault in Herculine Barbin: Being the Recently Discovered Memoirs of a Nineteenth-century French Hermaphrodite.

The intersex flag was created by Organisation Intersex International Australia in July 2013 to create a flag "that is not derivative, but is yet firmly grounded in meaning". The organization aimed to create a symbol without gendered pink and blue colors. It describes yellow and purple as "hermaphrodite" colors. The organization describes it as freely available "for use by any intersex person or organization who wishes to use it, in a human rights affirming community context".[125]

In Hinduism, Sangam literature uses the word pedi to refer to people born with an intersex condition; it also refers to antharlinga hijras and various other hijras.[126] Warne and Raza argue that an association between intersex and hijra people is mostly unfounded but provokes parental fear.[49]

In Islam, scholars of Islamic jurisprudence have detailed discussions on the status and rights of intersex based on what mainly exhibits in their external sexual organs. Yet, modern Islamic jurisprudence scholars turn to medical screening to determine the dominance of their sex. The intersex rights includes rights of inheritance, rights to marriage, rights to live like any other male or female. The rights are generally based on whether they are true hermaphrodites, or pseudo hermaphrodite. Scholars of Islamic jurisprudence generally consider their rights based on the majority of what appears from their external sexual organs.[citation needed]

In Judaism, the Talmud contains extensive discussion concerning the status of two intersex types in Jewish law; namely the androginus, which exhibits both male and female external sexual organs, and the tumtum which exhibits neither. In the 1970s and 1980s, the treatment of intersex babies started to be discussed in Orthodox Jewish medical halacha by prominent rabbinic leaders, for example Eliezer Waldenberg and Moshe Feinstein.[127]

Multiple athletes have been humiliated, excluded from competition or been forced to return medals following discovery of an intersex trait. Examples include Erik Schinegger, Foekje Dillema, Maria José Martínez-Patiño and Santhi Soundarajan. In contrast, Stanisława Walasiewicz (also known as Stella Walsh) was the subject of posthumous controversy.[128]

The South African middle-distance runner Caster Semenya won gold at the World Championships in the women's 800 meter and won silver in the 2012 Summer Olympics. When Semenya won gold in the World Championships, the International Association of Athletics Federations (IAAF) requested sex verification tests. The results were not released, but Semenya was cleared to race with other women.[129] Katrina Karkazis, Rebecca Jordan-Young, Georgiann Davis and Silvia Camporesi argued that new IAAF policies on "hyperandrogenism" in female athletes (applied for example to the case of Dutee Chand), established in response to the Semenya case, are "significantly flawed", arguing that the policy will not protect against breaches of privacy, will require athletes to undergo unnecessary treatment in order to compete, and will intensify "gender policing". They recommend that athletes be able to compete in accordance with their legal gender.[130]

In April 2014, the BMJ reported that four elite women athletes with 5-ARD were subjected to sterilization and "partial clitoridectomies" in order to compete in sport. The authors noted that "partial clitoridectomy" was "not medically indicated, does not relate to real or perceived athletic "advantage".[17] Intersex advocates regard this intervention as "a clearly coercive process".[131] In 2016, the United Nations Special Rapporteur on health, Dainius PÅ«ras, criticized "current and historic" sex verification policies, describing how "a number of athletes have undergone gonadectomy (removal of reproductive organs) and partial clitoridectomy (a form of female genital mutilation) in the absence of symptoms or health issues warranting those procedures."[132]

There are few firm estimates of the number of intersex people. While human rights institutions have called for the demedicalisation of intersex traits, as far as possible,[21][51][133][134] medical definitions are often still used. The now-defunct Intersex Society of North America stated that:

If you ask experts at medical centers how often a child is born so noticeably atypical in terms of genitalia that a specialist in sex differentiation is called in, the number comes out to about 1 in 1500 to 1 in 2000 births. But a lot more people than that are born with subtler forms of sex anatomy variations, some of which won't show up until later in life.[135]

According to Blackless, Fausto-Sterling et al., 1.7 percent of human births are intersex, including variations that may not become apparent until, for example, puberty, or until attempting to conceive.[136][137] Some clinicians do not favor such definitions. According to Leonard Sax, intersex should be "restricted to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female", around 0.018%. This definition excludes Klinefelter syndrome and many other variations.[138] He in turn criticizes Fausto-Sterling for counting Late-Onset Congenital Adrenal Hyperplasia for 88% of her figure. His rebuttal concludes,

"The most original feature of Fausto-Sterling's book is her reluctance to classify true intersex conditions as pathological (Fausto-Sterling, 2000, p. 113)... She often uses the word natural synonymously with normal. However, natural and normal are not synonyms. A cow may give birth to a two-headed or Siamese calf by natural processes, natural being understood as per Fausto-Sterling's definition as "produced by nature." Nevertheless, that two-headed calf unarguably manifests an abnormal condition. Fausto-Sterling's insistence that all combinations of sexual anatomy be regarded as normal... follows that classifications of normal and abnormal sexual anatomy are mere social conventions, prejudices which can and should be set aside by an enlightened intelligentsia. This type of extreme social constructionism is confusing and is not helpful to clinicians, to their patients, or to their patients' families. Diluting the term intersex to include "any deviation from the Platonic ideal of sexual dimorphism" (Blackless et al., 2000, p. 152), as Fausto-Sterling suggests, deprives the term of any clinically useful meaning."[139]

However, many conditions excluded from Sax's analysis are currently regarded as disorders of sex development. Individuals with those diagnoses may experience stigma and discrimination due to their sex characteristics, including sex "normalizing" interventions, and so those diagnoses and life experiences meet definitions of intersex in use by UN and other bodies. As a result, the statistical analyses by Blackless and Fausto-Sterling, despite her outdated and perceived offensive use of the term hermaphrodite,[140] have become widely quoted,[51][141] including by other clinicians.[142] The following summarizes those frequency statistics:

Population figures can vary due to genetic causes. In the Dominican Republic, 5-alpha-reductase deficiency is not uncommon in the town of Las Salinas resulting in social acceptance of the intersex trait.[147] Men with the trait are called "guevedoces" (Spanish for "eggs at twelve"). 12 out of 13 families had one or more male family members that carried the gene. The overall incidence for the town was 1 in every 90 males were carriers, with other males either non-carriers or non-affected carriers.[148]

Ambiguous genitalia may appear as a large clitoris or as a small penis.

Because there is variation in all of the processes of the development of the sex organs, a child can be born with a sexual anatomy that is typically female or feminine in appearance with a larger-than-average clitoris (clitoral hypertrophy) or typically male or masculine in appearance with a smaller-than-average penis that is open along the underside. The appearance may be quite ambiguous, describable as female genitals with a very large clitoris and partially fused labia, or as male genitals with a very small penis, completely open along the midline ("hypospadic"), and empty scrotum. Fertility is variable.

The Orchidometer is a medical instrument to measure the volume of the testicles. It was developed by Swiss pediatric endocrinologist Andrea Prader. The Prader scale[149] and Quigley scale are visual rating systems that measure genital appearance.

In order to help in classification, methods other than a genitalia inspection can be performed. For instance, a karyotype display of a tissue sample may determine which of the causes of intersex is prevalent in the case.

The common pathway of sexual differentiation, where a productive human female has an XX chromosome pair, and a productive male has an XY pair, is relevant to the development of intersex conditions.

During fertilization, the sperm adds either an X (female) or a Y (male) chromosome to the X in the ovum. This determines the genetic sex of the embryo.[150] During the first weeks of development, genetic male and female fetuses are "anatomically indistinguishable", with primitive gonads beginning to develop during approximately the sixth week of gestation. The gonads, in a "bipotential state", may develop into either testes (the male gonads) or ovaries (the female gonads), depending on the consequent events.[150] Through the seventh week, genetically female and genetically male fetuses appear identical.

At around eight weeks of gestation, the gonads of an XY embryo differentiate into functional testes, secreting testosterone. Ovarian differentiation, for XX embryos, does not occur until approximately week 12 of gestation. In normal female differentiation, the M端llerian duct system develops into the uterus, Fallopian tubes, and inner third of the vagina. In males, the M端llerian duct-inhibiting hormone MIH causes this duct system to regress. Next, androgens cause the development of the Wolffian duct system, which develops into the vas deferens, seminal vesicles, and ejaculatory ducts.[150] By birth, the typical fetus has been completely "sexed" male or female, meaning that the genetic sex (XY-male or XX-female) corresponds with the phenotypical sex; that is to say, genetic sex corresponds with internal and external gonads, and external appearance of the genitals.

There are a variety of opinions on what conditions or traits are and are not intersex, dependent on the definition of intersex that is used. Current human rights based definitions stress a broad diversity of sex characteristics that differ from expectations for male or female bodies.[2] During 2015, the Council of Europe,[51] the European Union Agency for Fundamental Rights[133] and Inter-American Commission on Human Rights[134] have called for a review of medical classifications on the basis that they presently impede enjoyment of the right to health; the Council of Europe expressed concern that "the gap between the expectations of human rights organisations of intersex people and the development of medical classifications has possibly widened over the past decade".[51][133][134]

Meta-analysis of the studies supporting the use of dexamethasone on CAH at-risk fetuses found "less than one half of one percent of published'studies' of this intervention were regarded as being of high enough quality to provide meaningful data for a meta-analysis. Even these four studies were of low quality"... "in ways so slipshod as to breach professional standards of medical ethics"[151] and "there were no data on long-term follow-up of physical and metabolic outcomes in children exposed to dexamethasone".[152]

In XX-females, this can range from partial masculinization that produces a large clitoris, to virilization and male appearance. The latter applies in particular to congenital adrenal hyperplasia due to 21-hydroxylase deficiency, which is the most common form of CAH.

Individuals born with XX chromosomes affected by 17Î±-hydroxylase deficiency are born with female internal and external anatomy, but, at puberty, neither the adrenals nor the ovaries can produce sex-hormones, inhibiting breast development and the growth of pubic hair.

See below for XY CAH 17Î±-hydroxylase deficiency.

Cases with typically female appearance and genitalia are said to have complete androgen insensitivity syndrome (CAIS). People with CAIS have a vagina and no uterus, cervix, or ovaries, and are infertile. The vagina may be shorter than usual, and, in some cases, is nearly absent. Instead of female internal reproductive organs, a person with CAIS has undescended or partially descended testes, of which the person may not even be aware.

In mild and partial androgen insensitivity syndrome (MAIS and PAIS), the body is partially receptive to androgens, so there is virilization to varying degrees. PAIS can result in genital ambiguity, due to limited metabolization of the androgens produced by the testes. Ambiguous genitalia may present as a large clitoris, known as clitoromegaly, or a small penis, which is called micropenis or microphallus; hypospadias and cryptorchidism may also be present, with one or both testes undescended, and hypospadias appearing just below the glans on an otherwise typical male penis, or at the base of the shaft, or at the perineum and including a bifid (or cleft) scrotum.

In alternative fashion, it is simply a mixture between XX and XY, and does not have to involve any less-common genotypes in individual cells. This, too, can occur both as chimerism and as a result of one sex chromosome having mutated into the other.[156]

Mosaicism and chimerism may involve chromosomes other than the sex chromosomes, and not result in intersex traits.

Medical interventions take place to address physical health concerns, and psychosocial risks. Both types of rationale are the subject of debate, particularly as the consequences of surgical (and many hormonal) interventions are lifelong and irreversible. Questions regarding physical health include accurately assessing risk levels, necessity and timing. Psychosocial rationales are particularly susceptible to questions of necessity as they reflect social and cultural concerns.

There remains no clinical consensus about an evidence base, surgical timing, necessity, type of surgical intervention, and degree of difference warranting intervention.[159][160][161] Such surgeries are the subject of significant contention due to consequences that include trauma, impact on sexual function and sensation, and violation of rights to physical and mental integrity.[1] This includes community activism,[40] and multiple reports by international human rights[19][51][23][162] and health[72] institutions and national ethics bodies.[22][163]

In the cases where gonads may pose a cancer risk, as in some cases of androgen insensitivity syndrome,[164] concern has been expressed that treatment rationales and decision-making regarding cancer risk may encapsulate decisions around a desire for surgical normalization.[21]


what are the numbers of the quadrants on a graph

These are often numbered from 1st to 4th and denoted by Roman numerals: I (where the signs of the (x,y) coordinates are (+,+)), II (−,+), III (−,−), and IV (+,−). When the axes are drawn according to the mathematical custom, the numbering goes counter-clockwise starting from the upper right ("northeast") quadrant.

Quadrant (plane geometry)

The axes of a two-dimensional Cartesian system divide the plane into four infinite regions, called quadrants, each bounded by two half-axes.

In the above graphic, the words in quotation marks are a mnemonic for remembering which three trigonometric functions (sine, cosine and tangent) are positive in each quadrant.  The expression reads "All Science Teachers Crazy" and proceeding counterclockwise from the upper right quadrant, we see that "All" functions are positive in quadrant I, "Science" (for sine) is positive in quadrant II,  "Teachers" (for tangent) is positive in quadrant III, and "Crazy" (for cosine) is positive in quadrant IV. There are several variants of this mnemonic.


who plays nurse rose on grey's anatomy

Lauren Stamile (born September 12, 1976) is an American actress. She is best known for portraying Nurse Rose on the ABC series Grey's Anatomy, Michelle Slater on the NBC series Community, and CIA Agent Dani Pearce on the USA Network series Burn Notice.

Lauren Stamile

Stamile was born in Tulsa, Oklahoma, the third of five siblings. During college, she worked in restaurants. She graduated from Cascia Hall Preparatory School.[1] Her father is a physician and her mother is a nurse.[1] She majored in theater at Northwestern University in Evanston, Illinois, and then moved to New York City, New York to pursue an acting career.[2]

Stamile has appeared in commercials for Old Spice, JC Penney, Summer's Eve, Tassimo, and Volkswagen. She appeared in a 2000 episode of The Drew Carey Show, then co-starred in the WB sitcom Off Centre. After that show's cancellation, she had a series of guest roles in television shows such as Drop Dead Diva,[3] Without a Trace, CSI: Miami, Cold Case, Boston Legal, Community, Grey's Anatomy, The Good Guys, Crossing Jordan, Tru Calling, The West Wing, Summerland, and Scrubs.[2] She also starred in the 2009 film Midnight Bayou. Stamile joined the cast of Burn Notice for the fifth and sixth seasons.[4] Her stage credits include The Miser, Murder on the Nile, Lion in Winter, and Lounge Act.[5]

Stamile married writer Randy Zamcheck in April 2009.[6][7]


why does kansas city have a texas logo

When the Texans began playing in 1960, the team's logo consisted of the state of Texas in white with a yellow star marking the location of the city of Dallas. Originally, Hunt chose Columbia Blue and Orange for the Texans' uniforms, but Bud Adams chose the colors for his Houston Oilers franchise.[1] Hunt reverted to red and gold for the Texans' uniforms, which even after the team relocated to Kansas City, remain as the franchise's colors to this day.[1]

Logos and uniforms of the Kansas City Chiefs

The Kansas City Chiefs, a professional American football franchise from the National Football League, are known for their unique "KC" arrowhead logo and red and white uniformsâ€”both almost unchanged since the franchise's relocation in 1963. From 1960 to 1962, the team was known as the Dallas Texans and had very similar team logos and uniforms.

The state of Texas on the team's helmet was replaced by a design originally sketched by Lamar Hunt on a napkin.[1] Hunt's inspiration for the interlocking "KC" design was the "SF" inside of an oval on the San Francisco 49ers helmets.[1] Kansas City's overlapping initials appear inside a white arrowhead instead of an oval and are surrounded by a thin black outline.[1] From 1960 to 1973, the Chiefs had grey facemask bars on their helmets, but changed to white bars for 1974.[1]

Prior to the inaugural American Football League season in 1960, Hunt's Texans were represented by a whirling, spur-clad, 10-gallon-hat-wearing character that was featured on various promotional items. The logo eventually gave way to a more polished football-toting gunslinger set over the state of Texas, a design created by Bob Taylor, a cartoonist for the now-defunct Dallas Times Herald. Although never part of the club's uniform, Taylor's updated Texans logo adorned everything from the club's stationery to the billboard outside the team's offices.

When the franchise moved in 1963, Taylor was commissioned to produce a new logo that remained strikingly similar to his original incarnation. Taylor's new rendition featured a Native American figure running with the same stride and holding the pigskin in the same manner as the gunslinger with the states of Missouri, Kansas, Nebraska, Oklahoma, Iowa and Arkansas serving as his backdrop. This logo was utilized prominently during the 1960s and was affixed to the club's Swope Park headquarters on 63rd Street before the club moved to Arrowhead Stadium in 1972. The logo, embedded in the grass, still remains off the highway to this day.

Unlike several NFL franchises, the Chiefs' uniform design has essentially remained the same throughout the club's history.[1] It consists of a red helmet, and either red or white jerseys with the opposite color numbers and names.[1] White pants were used with both jerseys from 1960–1967 and 1989–1999.[1] After a brief disappearance, the Chiefs re-introduced the all-white uniform combinations for the 2006 season.

Although many NFL teams in recent years have worn their dark jerseys with their dark pants, the Chiefs unveiled their all-red combination for their 2013 home opener against the Dallas Cowboys. When the Chiefs wear their red uniforms, they had always worn white pants, until September 15, 2013. The Chiefs have never worn an alternate jersey in a game, although gold jerseys with red numbers trimmed in white, and black jerseys with red numbers trimmed in gold, are sold for retail.

The white jerseyâ€“red pants combination was not used between 1989 and 1999, primarily during the period when Marty Schottenheimer was the team's head coach. In 2006, under new head coach Herman Edwards, the Chiefs wore white uniforms with white pants at home against the Cincinnati Bengals.

Following Lamar Hunt's death on December 13, 2006, the Chiefs wore the all-white combination for road games against the San Diego Chargers on December 17 and Oakland Raiders on December 23. It is said the all-white combination was a tribute to Hunt, who reportedly favored the all-white uniforms. The team wore the all-white combination in their playoff game versus the Indianapolis Colts. The team did not wear the all-white combination during the 2007 and 2008 seasons.

In 2009, the Chiefs wore the all-white Dallas Texans throwback uniform in an AFL Legacy game against the Oakland Raiders November 15. They wore the modern all-white uniform against the Cincinnati Bengals December 27.

In 2007, the Kansas City Chiefs honored the late Lamar Hunt and the AFL with a special patch. In 2008, the patch became permanently affixed to the left chest of both Kansas City's home and away jerseys.[2]

In select games for the 2009 season, the Chiefs—as well as the other founding teams of the American Football League—wore "throwback" uniforms to celebrate the AFL's 50th anniversary and the 1962 Dallas Texans team that won the AFL Championship.[3]

Home red jersey white pants

Road white jersey red pants

Road all white alternate


what's so good about swiss bank account

According to the 2018 Financial Secrecy Index, Switzerland's banking secrecy laws have rendered it a premier tax haven since the 1900s.[25] One of the most prominent attractions to the disclosure protection laws is the distinction between tax evasion (non-reporting of income) and tax fraud (active deception).[57] Akin to the distinction between legal tax avoidance and illegal tax evasion in the U.S., the non-reporting of income is only a civil offense in Switzerland while tax fraud is a financial crime.[57] When foreign clients deposit holdings into a Swiss bank account, the bank is legally prohibited from disclosing balances or client information to tax authorities.[57] This prohibition can only be waved if the client has produced a written statement of consent or a financial crime has been directly linked to the bank account.[57] More often than not,[16] clients don't consent to foreign tax authorities which leaves only the latter circumstance available.[55] Many client services available in Switzerland (e.g. numbered bank accounts) are used to shield client data from tax authorities.[55]

Banking in Switzerland

Banking in Switzerland began in the early 18th century through Switzerland's merchant trade and has, over the centuries, grown into a complex, regulated, and international industry. Along with the Swiss Alps, chocolate, watchmaking and mountaineering, banking is seen as emblematic of Switzerland. Switzerland has a long, kindred history of banking secrecy and client confidentiality reaching back to the early 1700s. Started as a way to protect wealthy European banking interests, Swiss banking secrecy was codified in 1934 with the passage of the landmark federal law, the Federal Act on Banks and Savings Banks.

Controversial protection of foreign accounts and assets during World War II sparked a series of proposed financial regulations seeking to temper bank secrecy to little success. Switzerland, considered the "grandfather of bank secrecy", has been one of the largest offshore financial centers and tax havens in the world since the mid-20th century. Despite an international push to meaningfully roll back banking secrecy laws in the country, Swiss social and political forces have minimized and reverted much of proposed roll backs. Disclosing client information has been considered a serious social and criminal offence since the early 1900s. Employees working in Switzerland and abroad at Swiss banks "have long adhered to an unwritten code similar to that observed by doctors or priests".[1] The Swiss Bankers Association (SBA) estimated in 2018 that Swiss banks held US$6.5 trillion in assets or 25% of all global cross-border assets. Switzerland's main lingual hubs, Geneva (for French), Lugano (for Italian), and Zürich (for German) service the different geographical markets. It consistently ranks in the top three states on the Financial Secrecy Index and was named first many times, most recently in 2018.

The three largest banks–UBS, Credit Suisse, Julius Bär–are all regulated by the Swiss Financial Market Supervisory Authority (FINMA), and the Swiss National Bank (NSB) which derives its authority from a series of federal statutes. Banking in Switzerland has historically played, and still continues to play, a dominant role in the Swiss economy and society. According to the Organization for Economic Co-operation and Development (OECD), total banking assets amount to 467% of total gross domestic product.[2] Banking in Switzerland has been portrayed, to varying degrees of accuracy, in overall popular culture, books, movies, and television shows.

During the 18th century, Swiss mercenaries brought home funds from their contracts that helped Swiss banks begin.[3] Banking began in the eighteenth century by way of the riches of merchants. Wegelin & Co., established in 1741, was the oldest bank in Switzerland[4] until it restructured into a new legal entity in 2013.[5] Hy Hentsch & Co. bank[6] and Lombard Odier, were both founded in 1796 in Geneva as private banks, and The Pictet Group[7] was established in 1805 as a merchant bank.[8] Hentsch & Cie was a founding member of the Swiss National bank during 1852.[9]

Switzerland is a prosperous nation with a per capita gross domestic product higher than that of most Western European nations. In addition, the value of the Swiss franc (CHF) has been relatively stable compared with that of other currencies.[10] Swiss neutrality and national sovereignty, long recognized by foreign nations, have fostered a stable environment in which the banking sector was able to develop and thrive. Switzerland has maintained neutrality through both World Wars, is not a member of the European Union, and was not a member of the United Nations until 2002.[11][12] The Bank of International Settlements, an organization that facilitates cooperation among the world's central banks, is headquartered in the city of Basel. Founded in 1930, the BIS chose to locate in Switzerland because of the country's neutrality, which was important to an organization founded by countries that had been on both sides of World War I.[13]

Banking in Switzerland has historically played, and still continues to play, a dominant role in the Swiss economy.[2] According to the Organization for Economic Co-operation and Development (OECD), total banking assets amount to 467% of total gross domestic product.[2]

The Swiss Financial Market Supervisory Authority (FINMA) is a public law institution that supervises most banking-related activities as well as securities markets and investment funds.[14] Regulatory authority is derived from the Swiss Financial Market Supervision Act (FINMASA) and Article 98 of the Swiss Federal Constitution. The office of the Swiss Banking Ombudsman, founded in 1993, is sponsored by the Swiss Banking Ombudsman Foundation, which was established by the Swiss Bankers Association. The ombudsman's services, which are offered free of charge, include mediation and assistance to persons searching for dormant assets. The ombudsman handles about 1,500 complaints raised against banks yearly.[15]

The first renditions of banking secrecy in the Swiss region reaches back to the early 1700s.[16] The Great Council of Geneva outlawed the disclosure information relating to the European upper class, mostly of French origin, in 1713.[16] As a way of avoiding the Protestant banking system, Catholic French Kings deposited their holdings in Geneva accounts.[16] During the 1780s, Swiss bank accounts began insuring deposits which contributed to a wide spread reputation for financial security.[16] In 1815, the Congress of Vienna formally established Switzerland's international neutrality which led to a large capital influx.[16] The wealthy of Switzerland, landlocked, saw banking secrecy as a way to build an empire similar to that of France, Spain, and the United Kingdom.[16] Swiss historian Sébastian Guex notes in The Origins of Secret Swiss Bank Accounts:

This is what the Swiss bourgeoisie are thinking: 'That’s our future. We will play on the contradictions between the European powers and, protected by the shield of our neutrality, our arm will be industry and finance.’[17]

After a small scale civil war in the 1840s between the Swiss cantons, the Swiss Federation was founded in 1848.[16] The formation of the state, through a direct democracy, contributed to the political stability needed for banking secrecy.[16] The mountainous terrain of Switzerland also provided a natural environment to store gold and diamonds underground and in mountains.[16] During the 1910s, Swiss bankers traveled to France to advertise its banking secrecy during World War I.[16] The war's contribution to political and economic instability, sparked a rapid capital movement into Switzerland.[16] As European countries began to increase taxes to finance the war, wealthy clients moved their holdings into Swiss accounts to avoid taxation.[16] The French banked in Geneva, the Italians in Lugano, and the Germans in Zurich.[16] While disclosing client information was a civil offence in Switzerland for centuries, the Swiss Federal Assembly made it a federal criminal offence in 1934 with the passage of the landmark legislation, the Federal Act on Banks and Savings Banks.[16] Colloquially known as the "Banking Law of 1934" or the "Swiss Banking Law of 1934", it codified banking secrecy in the eyes of Swiss law.[18] The Federal Assembly enacted the law to quell controversy over the alleged tax evasion of wealthy French businessmen, military generals, and Catholic bishops.[19] An additional provision of the law, Article 47(b), was drafted before its ratification to protect Jewish assets against Nazi forces during World War II.[18][20]

Along with protecting German Jewish assets, Swiss banks collaborated with Nazi Germany and their allies by storing their gold and cash balances in underground vaults.[18] It is estimated that Adolf Hitler maintained an account at the Union Bank of Switzerland (UBS) worth 1.1 billion Reichsmarks.[18][21] After the United States formally asked the bank to transfer the money in the 1990s, UBS wired US$400 to 700 million worth of Reichsmarks to U.S. authorities.[18] Banking regulations in Switzerland places a limit on the amount of orphaned assets allowed to leave a bank's custody.[18] UBS, with consent from the Swiss government, placed the remainder of Hitler's assets underground, indefinitely froze the account, and clipped the Reichsmarks, stripping the currency of value.[21] During World War II, UBS also maintained accounts for hundreds of German Jewish businesspeople and households.[20] After the Banking Law of 1934 was passed, the bank aggressively protected assets of the "enemies of Nazi Germany".[20] When Hitler announced his invasion of Switzerland in 1940, UBS contracted the Swiss Armed Forces to blockade their retail banks and transport Jewish assets to underground military bunkers.[22] Other Swiss banks, namely the Swiss Bank Corporation (SBC) and Credit Suisse, did likewise and along with UBS, were fined hundreds of millions of dollars in reparations for their dealings with Nazi Germany.[18] All throughout the 1980s and 1990s, numerous international proposals for bank secrecy rollbacks were proposed by foreign states to little success.[18]

After the 2008 financial crisis, Switzerland signed the European Union Savings Tax Directive (EUSTD) which obliges Swiss banks to report to 43 European countries non-identifying annual tax statistics.[23] On December 3, 2008, the Federal Assembly increased the prison sentence for violations of banking secrecy from a maximum of six months to a maximum of five years.[24] In late 2008, after an international, multi-state investigation into Switzerland's role in U.S. tax evasion, the Swiss government entered into a limited, Deferred Prosecution Agreement (DPA) with the U.S. Department of Justice.[25] The agreement saw to the controversial Birkenfeld Disclosure, a release of information on more than 4,000 clients, a landmark disclosure.[25]

In another step toward loosening banking secrecy, Switzerland signed the U.S. Foreign Account Tax Compliance Act (FATCA), after rejecting it twice in parliament.[25] The FACTA requires Swiss banks to disclose non-identifying U.S. client information to the Internal Revenue Service, annually.[25] This agreement, however, does not guarantee Swiss cooperation, merely semi-automatic information transfers, at the discretion of Swiss authorities.[27] If a client does not consent to having their information shared with the IRS, Swiss banking secrecy laws prohibit the disclosure of client information to the IRS.[27] If a client does consent, Swiss bank are allowed to send the IRS tax-related information about the account holder but are prohibited from disclosing identities pursuant to Article 47 of the Banking Law of 1934.[27] The 2018 Financial Secrecy Index stated: "this [does] not mean that Swiss banking secrecy was finished, as some excitable news reports suggestâ€¦ the breach was a partial [dent]".[28]

In March 2015, the Swiss government entered into bilateral "Rubik Agreements" with Germany, Austria, and the United Kingdom allowing foreign holders of Swiss bank accounts to retain the anonymity in exchange for paying predetermined back taxes.[29] Switzerland formally adopted the International Convention on the Automatic Exchange of Banking Information (AEOI) in 2017, agreeing to automatically release limited financial information to a limited amount of certain countries for the sole purpose of tax auditing.[30] This agreement includes the Common Reporting Standard (CRS) which obliges Swiss banks to automatically send foreign tax authorities the following information: a client's name, address, domicile, tax number, date of birth, account number, account balance at years end, and the gross investment income.[31] The CRS can not, however, override the Swiss Banking Law of 1934, so what clients spend their money on (e.g. their withdrawals) and what they invest in are not disclosed to tax authorities.[32] In other words, tax authorities can not "go fishing" for tax evaders, they must directly establish a link between a financial crime and a client account.[32] Furthermore, the disclosed information can only be used for tax auditing and Swiss authorities can stop disclosing whenever and if ever they wish.[33]

In December 2017, the Swiss parliament launched a standing initiative and expressed an interest in formally embedding banking secrecy within the Swiss Constitution making it a federally-protected constitutional right.[34][35] In January, 2018, a U.S. district court ruled that Swiss bankers "[have] nothing to do with the choice that an American taxpayer makes to not declare offshore assets", later clarifying they should not be seen as facilitating tax evasion but rather providing a legal service that is made illegal by the client.[36] The Swiss Justice Ministry announced in March 2018 that anyone who disclosed client information in a pending court case involving a Swiss bank is subject to federal espionage and extortion charges in addition to charges relating to the violation of banking secrecy laws.[37]

Switzerland, considered the "grandfather of bank secrecy", has been one of the largest offshore financial centers and tax havens in the world since the mid-20th century.[39] Despite an international push to meaningfully roll back banking secrecy laws in the country, Swiss social and political forces have minimized and reverted much of the proposed roll backs.[39] Disclosing client information has been considered a serious social and criminal offense since the early 1900s.[39] Whistleblowers, despite legal protections, have been treated with hostility from the public and often face professional set backs in Switzerland.[39][40] Swiss bankers who maintain offices exclusively in Switzerland are shielded from a foreign state's lawsuits, extradition requests, and criminal charges, as long as they remain within the country's legal jurisdiction.[41] In spite of minor adjustments to bank secrecy, bankers working in Switzerland and abroad at Swiss banks "have long adhered to an unwritten code similar to that observed by doctors or priests".[1] Switzerland's main lingual hubs, Geneva (for French), Lugano (for Italian), and Zürich (for German) service the different geographical markets.[39] It consistently ranks in the top three states on the Financial Secrecy Index and was named first many times, most recently in 2018.[39] The Swiss Bankers Association estimated in 2018 that Swiss banks held US$6.5 trillion in assets or 25% of all global cross-border assets.[39]

A handful of larger Swiss banks operate undisclosed or otherwise secretive bank vaults, storage facilities or underground bunkers for gold bars, diamonds, or other valuable physical assets.[42][43] Most of these underground bunkers are located near or at the foothills of the mountainous regions of the Swiss Alps.[44] These facilitates are not subject to the same banking regulations as banks in Switzerland and do not have to report holdings to regulatory agencies.[44][45] The Swiss defense department estimates that of the ten former military bunkers available for sale, six of them were sold to Swiss banks to house assets during the 1980s and 1990s.[46][47] Storage in these underground bunkers and bank vaults is typically reserved for clients that pass a multi-stage security clearance.[44] Some of these bunkers are not accessible by road or foot and require aircraft transportation.[48]

Many banks in Switzerland offer clients numbered bank accounts, accounts where the identity of the holder is replaced with a multi-digit number known only to the client and select private bankers.[49][50] Although these accounts do add another layer of banking secrecy, they are not completely anonymous as the name of the client is still recorded by the bank and subject to limited, warranted disclosure.[49] Some Swiss banks supplement the number with a code name such as "Cardinal",[41] "Octopussy"[51] or "Cello"[51] that identifies the client, alternatively.[52] However, to open this type of account in Switzerland, clients must pass a multi-stage clearance procedure and prove to the bank the lawful origins of their assets.[53]

Many sovereign states do not legally require private bankers to confirm whether or not a client has or has not paid their taxes, in any capacity.[54] On top of this, Switzerland's banking secrecy laws prohibit the disclosure of client information under a variety of federal, cantonal, and civil policies.[39] Many foreign nationals open Swiss bank accounts to take advantage of these laws and tax distinctions.[55] While citizens of Switzerland retain the full force of banking secrecy protections, foreign clients are afforded some of the most stringent bankâ€“client confidentiality protections in the world.[55] In exchange for banking services, the Swiss government charges "a low, lump-sum option on the money they bank", after which Swiss tax authorities consider client tax burdens "settled".[56] After the Banking Law of 1934 was passed, Swiss bankers traveled across Europe to advertise its banking secrecy during World War II.[16] As European countries began to increase taxes to finance the war, wealthy clients moved their holdings into Swiss accounts to avoid taxation.[16]

Breaches of banking secrecy laws in Switzerland are automatically processed pursuant to Article 47 of the Banking Law of 1934: those who disclose client information are subject to a maximum of five years imprisonment and 250,000 francs (€215,000 or US$250,000) in fines.[55] Whistleblowers and leakers of client information often face hostility from the public and sustain professional set backs.[40][39] Denounced as a criminal in Switzerland, a federal arrest warrant has been in place for Bradley Birkenfeld since 2008, after he disclosed UBS client information to the U.S. Internal Revenue Service in 2007.[58] After the 2008 financial crisis, the Swiss Parliament initiated a series of international tax treaties that rolled back banking secrecy protections for foreign clients in response to pressure from the European Union, United States, and United Kingdom.[16] Despite implementing nearly 50 information transfer agreements and numerous limitations to banking secrecy protections for foreign clients, Switzerland has been ranked among the top three tax havens in the world every single year since the financial crisis, most recently in 2018.[39]

As of 2018, there are more than 400 securities dealers and banking instituons in Switzerland, ranging from the "Two Big Banks" down to small banks serving the needs of a single community or a few special clients.[59] The largest and second largest Swiss banks are UBS Group AG and Credit Suisse Group AG, respectively. They account for over 50% of all deposits in Switzerland; each has extensive branch networks throughout the country and most international centers. Due to their size and complexity, UBS and Credit Suisse are subject to an extra degree of supervision from the Federal Banking Commission.[60]

UBS Group AG came into existence in June 1998, when Union Bank of Switzerland, founded in 1862, and Swiss Bank Corporation, founded in 1872, merged.[61] Headquartered in Zurich and Basel, it is Switzerland's largest bank.[61] It maintains seven main offices around the world (four in the United States and one each in London, Tokyo, and Hong Kong) and branches on five continents.[61]

Credit Suisse Group is the second-largest Swiss bank.[62] Based in Zurich and founded in 1856, Credit Suisse offers private banking, investment banking and asset management services.[62] It acquired the First Boston Corporation in 1988 and merged with the Winterthur insurance company in 1997; the latter was sold to AXA in 2006.[63] The asset management services were sold to Aberdeen Asset Management during the 2008 financial crisis.[62]

The Swiss National Bank (SNB) serves as the country's central bank. Founded by the Federal Act on the Swiss National Bank (16 January 1906), it began conducting business on 20 June 1907. Its shares are publicly traded, and are held by the cantons, cantonal banks, and individual investors; the federal government does not hold any shares.[64] Although a central bank often has regulatory authority over the country's banking system, the SNB does not; regulation is solely the role of the Federal Banking Commission.[65]

Raiffeisen Banks "assumes the role of central bank" in providing treasury services, and is the third largest group consisting of 328 banks in 2011, 390 in 2012 with 1,155 branches.[66][67] During February 2012, P. Vincenz was chief executive.[68] During January, an announcement was made that the non-U.S. businesses of Wegelin & Co, the oldest Swiss bank, would be bought by the Raiffeisen group. The group has 3 million plus clients within Switzerland.[69][70]

The term private bank refers to a bank that offers private banking services and in its legal form is a partnership.[71] The first private banks were created in St. Gallen in the mid-18th century and in Geneva in the late 18th century as partnerships, and some are still in the hands of the original families such as Hottinger and Mirabaud.[71] In Switzerland, such private banks are called private bankers (a protected term) to distinguish them from the other private banks which are typically shared corporations.[71] Historically in Switzerland a minimum of CHF1Â million was required to open an account, however, over the last years many private banks have lowered their entry hurdles to CHF250,000 for private investors.[71]

There are, as of 2006, 24 cantonal banks; these banks are state-guaranteed semi-governmental organizations controlled by one of Switzerland's 26 cantons that engage in all banking businesses.[72] The largest cantonal bank, the Zurich Cantonal Bank, had a 2005 net income of CHF810Â million.[73]

Banking in Switzerland, in particular Swiss banking secrecy practices, has been detailed in global popular culture to varying degrees of accuracy. According to official statements from the Swiss National Film Archives, inaccurate or exaggerated portrayals negatively impact Switzerland by reducing bankers to unflattering "caricatures" that are "ever disposed to accept funds from questionable sources".[74] In 2014, Sindy Schmiegel, a spokeswoman for the Swiss Bankers Association (SBA) stressed that financial regulation in Switzerland is dramatically more strict than portrayed fictionally.[74] The Economic Times noted that popular culture portrays Swiss bank accounts as "completely anonymous" later adding "this is simply not true."[75]

Swiss banking was prominently featured in the following films and television shows:


who has the most ties in an nfl season

There have been 24 tied games since the 1974 rule change; 17 ties occurred from 1974 to 2011 under the original overtime rules, while seven ties have occurred since the overtime rules were modified in 2012. Four seasons (1986, 1997, 2016, 2018) had two ties since the introduction of overtime.The most recent tie game occurred on September 16, 2018, when the Minnesota Vikings and Green Bay Packers played to a 29â€“29 tie. The Houston Texans and Jacksonville Jaguars are the only current NFL teams that have never recorded a tied game; the New England Patriots have never recorded a tie in an NFL game, but recorded nine ties as members of the American Football League (AFL). The Chicago Bears have played to 42 ties (all prior to 1974), the most of any NFL team,[10] while the Green Bay Packers have recorded the most ties since the 1974 introduction of overtime, with six.

List of NFL tied games

In the National Football League (NFL), a tied game occurs when a regular season game ends with both teams having an equal score after one ten minute overtime period.[1] Ties have counted as a half-win and half-loss in league standings since 1972; before that, ties were not counted in the standings at all.[2] Since the National Hockey League eliminated ties by adopting the shootout following the 2004–05 NHL lockout, the NFL is the only one of the four major professional sports leagues in North America to have tied games in regular-season play, as Major League Baseball (in the modern era since 1900) and the National Basketball Association have historically played until there is a winner. NFL teams rarely play for ties. In general, tied games in the NFL are frowned upon by both teams and fans.[3] Because tied games are rare, some players have not known they were allowed in the NFL, such as former Philadelphia Eagles quarterback Donovan McNabb, who said after a tie game against the Cincinnati Bengals that he did not know a tie was a possible result.[1][4]

Tie games were frequent in the NFL from its inaugural season in 1920 through 1973, when the league did not have overtime during the regular season. During this period, the NFL had a total of 258 tied games. Only three seasons (1934, 1950, 1952) went without a tied game, while five seasons (1920, 1923, 1926, 1929, 1932) had at least ten ties. The most ties, 17, occurred in the 1920 season.[5]

Ties became uncommon after a 1974 rule change added one sudden death overtime period (15 minutes) to regular-season and preseason games if they were tied after regulation.[6] Under the original overtime rules, any score by either team in overtime would win the game.[7] The rules were modified in 2012; if the team that received the opening kickoff scores a field goal, the other team has an opportunity to tie or surpass that score, and if they are able to tie the score the next team to score any points wins.[8] The overtime rules were further modified in 2017, shortening the extra period from 15 minutes to 10 minutes for preseason and regular season games.[9]

From 1920 to 1973, there were no overtime rules during the NFL regular season.

In 1974, the NFL introduced a single sudden death overtime period for all games that were tied at the end of regulation. During these seasons, a total of 494 regular season games went to overtime, 17 (7000340000000000000â™ 3.4%) of which ended in ties.[12]

In 2012, the league instituted a modified sudden death overtime system. A total of 83 regular season games went to overtime during these seasons, 5 (7000600000000000000â™ 6.0%) of which ended in a tie.[25]

In 2017, NFL shortened overtime from 15 minutes to 10 minutes for preseason and regular season games with the intent of reducing the risk of injury, despite concerns that this would lead to more ties.[31]


what is a maxi ford in tap dance

The Maxie Ford is a tap dance step consisting of four movements: step, shuffle, leap, toe.

Maxie Ford

To perform a basic Maxie Ford starting with the right foot:

The Maxie Ford is famous for its use of the pullback (or graboff) after the shuffle and best known as the Maxie Ford Break: 2 executions of the basic Maxie Ford and a stamp:

(1) stamp+ R forward, (&2&a3) shuffle L IN from back L, pull R, land flat on L in place of R, toe R straight back (4) stamp+ R forward (in place of L foot) (&5&a6)shuffle L IN from back L, pull R, land flat on L in place of R, toe R straight back (7)stamp R forward (in place of L foot) - L leg extended in back

This form of the Maxie Ford Break is standard use (see the Nicholas Brothers, Henry LeTang and almost every tap teacher)

(1) stamp+ R forward (&2&a3)shuffle L IN from back L, pull R, land flat on L in place of R, toe R straight back (&4) pull L, stamp+ R forward (in place of L foot) (&5&a6) shuffle L IN from back L, pull R, land flat on L in place of R, toe R straight back (&7) pull L, stamp R forward (in place of L foot) - L leg extended in back

This form of the Maxie Ford Break provides an additional pullback after the toe and was a favourite of many dancers (Gene Kelly, the Nicholas Brothers, Coles & Atkins, The Four Step Brothers, Tip, Tap & Toe etc.)

Maxie Fords may also be done turning across the floor, such that each one is performed in a single rotation (with or without the pullback).