title: CGI Inc.

text: The Patient Protection and Affordable Care Act was signed into law in 2010, and called for the creation of health insurance marketplaces for US citizens. In 2011 CGI Federal won a $93.7 million contract with the United States Department of Health and Human Services to help establish the software back-end of a new federal health insurance marketplace. For the next two years the Centers for Medicare and Medicaid Services oversaw the website's design, outsourcing to 55 federal contractors such as Experian and Quality Software Services, Inc. CGI Federal subcontracted the back-end work to other companies, as is common on large government contracts, and was also responsible for building some of the state-level healthcare exchanges. The Obama administration repeatedly modified policies pertaining to the Patient Protection and Affordable Care Act until the summer of 2013, meaning contractors had to adapt the software to changing requirements and delay aspects of development.


title: CGI Inc.

text: Following the public launch of HealthCare.gov on October 1, 2013, technical issues surfaced which prevented many users from logging in. As one of primary contractors involved, CGI Federal came under scrutiny for the difficulties, with the Lexington Institute later concluding that "CGI Federal was raked over the coals in congressional hearings because it was responsible for the portal — even though many of the early problems with its part of the project were traceable to a front-end feature assembled by a different contractor for which CGI wasn't responsible." By the December 2013 deadline the HealthCare.gov problems had largely been fixed, and within several weeks enrollment via the federal website was at 1.1 million people. Analysis of the situation by journalists, government officials, and think tanks has varied, and the Government Accountability Office released a non-partisan study in July 2014 concluding that the Obama administration failed to provide "effective planning or oversight practices" during development. Other analysts argued that the Centers for Medicare and Medicaid Services (CMS) was ill-suited for a systems integration role, and that US regulations pertaining to large government contracts stifled agile software development.


title: CGI Inc.

text: The state governments of Vermont and Massachusetts also contracted with CGI to work on their health insurance marketplaces, and both experienced difficulties with their launches in late 2013. CGI was also responsible for developing Hawaii Health Connector, and though the site did launch as planned on October 1, 2013, underlying technical issues prevented registered users from comparing and shopping insurance plans until October 15, 2013. The Colorado health insurance market system, Connect for Health Colorado, which unlike the federal website had development led by CGI, has been running relatively smoothly and as of May 6, 2014, it was announced that 129,000 Coloradans signed up for commercial health insurance through the state's health insurance marketplace since opening October 1, 2013. CGI also developed a successful exchange website for Kentucky.


title: CGI Inc.

text: CGI is one of 34 members of MOBiNET, a European consortium that aims to introduce mobile transport services across Europe. CGI branched into the electric car market early in the industry's growth cycle, and by 2010 CGI's Charge-Point Interactive Management System (CiMS) was in use by car companies such as Foundation ElaadNL, which was using the open communication protocol to deploy electric car charging stations throughout the Netherlands. In July 2014, CGI began working with Volvo to provide "authentication certificate services" for each new Volvo car.


title: CGI Inc.

text: CGI also developed the SIGMA program for ProRail. According to the organization Esri, "the application is based on ArcGIS for Servers and enables employees to manage the condition of the rail lines and combine design and measurement-data of the railroad track in multiple dimensions." As of 2013, CGI's train occupancy mobile app, iNStAPP, had won a number of industry awards, and was being used by several train companies and institutions in Europe. Other projects relating to passenger experience include a travel journey planner CGI developed for the city of Helsinki, Finland. As of 2014 the app was used by around 150,000 people daily.


title: CGI Inc.

text: In July 2014, CGI's Space, Defence and National Security division in the UK was awarded a contract by the European Commission Directorate General for Enterprise and Industry (DG ENTR) to build the "core infrastructure" for the first demonstrator of the Galileo Commercial Service, which is a new service to be created as part of the European Global Navigation Satellite System (GNSS). The service is intended for satellite navigation, and "was introduced with the goal of creating a potential revenue source to support the future maintenance of EU satellite navigation services." Wrote "GPS Daily", "once complete, the demonstrator will be made available to other GNSS service providers to test across vertical markets, including transport, insurance and personal mobility." As of 2014 CGI was also involved with developing software for the ESTCube-1, which is the first satellite in the world with electric solar wind sail (e-sail). A Mission Control System is currently being developed by the students of Tartu University under the supervision of CGI.


title: CGI Inc.

text: In November 2014, CGI was awarded a new contract by the British satellite telecommunications company Inmarsat to "support data communications between the pilot and air traffic controller within the European airspace." Inmarsat brought CGI in to help develop the Iris Precursor, particularly "key safety and security features needed for future European air traffic management communications." Also, "CGI will develop ground-based gateways" that will allow the SwiftBroadband system and the Single European Sky ATM Research program to interface. In 2015, CGI's contract to provide IT services to Airbus was extended.


title: CGI Inc.

text: CGI Federal is ranked 26th on the 2018 Washington Technology Top 100, and 72nd on the 2019 Bloomberg Government 200 (BGOV200). The company also was a finalist for the 2018 Greater Washington Government Contractor Awards, Contractor of the Year ($300 million+), and a 2017 ACT-IACT Igniting Innovation Award.


title: CGI Inc.

text: A number of CGI Federal executives are recognized for leadership in their sectors, including: Tim Hurlebaus, President: 2019 Wash100, 2018 Fed100 and GovCon 2018 Executive of the Year finalist; Stephanie Mango, Senior Vice President: 2018 Pinnacle Awards, National Security Executive of the Year  and 2018 Top 10 Executives to Watch In National Security; Malcolm Harden, Vice President: 2019 Fed100; and Steve Soussa, Senior Vice President: 2018 Top 10 Health Care Leaders to Watch.


Depersonalization-derealization disorder (DPDR, DPD) is a mental disorder in which the person has persistent or recurrent feelings of depersonalization or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike/surreal, or visually distorted.


Depersonalization-derealization disorder is thought to be caused largely by interpersonal trauma such as childhood abuse. Adverse early childhood experiences, specifically emotional abuse and neglect have been linked to the development of depersonalization symptoms. Triggers may include significant stress, panic attacks, and drug use. Those who do have this disorder could be in a depersonalized state for as long as a regular panic attack lasts. However, in some certain situations this state of mind could last either hours, days, and possibly even weeks at a time. In rare cases, symptoms can last for years.


title: Depersonalization-derealization disorder

text: Diagnostic criteria for depersonalization-derealization disorder includes persistent or recurrent feelings of detachment from one's mental or bodily processes or from one's surroundings. A diagnosis is made when the dissociation is persistent and interferes with the social or occupational functions of daily life.


text: While depersonalization-derealization disorder was once considered rare, lifetime experiences with it occur in about 1–2% of the general population. The chronic form of the disorder has a reported prevalence of 0.8 to 1.9%. While brief episodes of depersonalization or derealization can be common in the general population, the disorder is only diagnosed when these symptoms cause substantial distress or impair social, occupational, or other important areas of functioning.


text: The core symptoms of depersonalization-derealization disorder is the subjective experience of "unreality in one's self", or detachment from one's surroundings. People who are diagnosed with depersonalization also often experience an urge to question and think critically about the nature of reality and existence.


text: Individuals with depersonalization describe feeling disconnected from their physicality; feeling as if they are not completely occupying their own body; feeling as if their speech or physical movements are out of their control; feeling detached from their own thoughts or emotions; and experiencing themselves and their lives from a distance. While depersonalization involves detachment from one's self, individuals with derealization feel detached from their surroundings, as if the world around them is foggy, dreamlike, or visually distorted. Individuals with the disorder commonly describe a feeling as though time is passing them by and they are not in the notion of the present. In some cases, individuals may be unable to accept their reflection as their own, or they may have out-of-body experiences. One-third to one-half of patients with DPDR also experience hearing internal voices. This is to differentiate from external voices which are more commonly found in psychosis. Additionally some individuals experience difficulty concentrating and problems with memory retrieval. These individuals sometimes lack the "feeling" of a memory where they are able to recall a memory but feel as if they did not personally experience it. These experiences which strike at the core of a person's identity and consciousness may cause a person to feel uneasy or anxious. The inner turmoil created by the disorder can also result in depression.


text: First experiences with depersonalization may be frightening, with patients fearing loss of control, dissociation from the rest of society and functional impairment. The majority of people with depersonalization-derealization disorder misinterpret the symptoms, thinking that they are signs of serious psychosis or brain dysfunction. This commonly leads to an increase of anxiety and obsession, which contributes to the worsening of symptoms.


text: Factors that tend to diminish symptoms are comforting personal interactions, intense physical or emotional stimulation, and relaxation. Distracting oneself (by engaging in conversation or watching a movie, for example) may also provide temporary relief. Some other factors that are identified as relieving symptom severity are diet or exercise, while alcohol and fatigue are listed by some as worsening their symptoms.


text: Occasional, brief moments of mild depersonalization can be experienced by many members of the general population; however, depersonalization-derealization disorder occurs when these feelings are strong, severe, persistent, or recurrent and when these feelings interfere with daily functioning. DPDR episodes tend to be transient but duration is highly variable with some lasting as long as several weeks.


text: A growing number of users participating in virtual reality (VR) are facing the hazard of DPDR with dissociative experiences after use. Higher levels of a lessened sense of reality and being easily immersed can occur.


text: The exact cause of depersonalization is unknown, although biopsychosocial correlations and triggers have been identified. It has been thought that depersonalization can be caused by a biological response to dangerous or life-threatening situations which causes heightened senses and emotional numbing.


text: There is growing evidence linking physical and sexual abuse in childhood with the development of dissociative disorders. Childhood interpersonal trauma – emotional abuse in particular – is a significant predictor of a diagnosis of DPDR. Compared to other types of childhood trauma, emotional abuse has been found to be the most significant predictor both of a diagnosis of depersonalization disorder and of depersonalization scores, but not of general dissociation scores. Some studies suggest that greater emotional abuse and lower physical abuse predict depersonalization in adult women with post-traumatic stress disorder (PTSD). Patients with high interpersonal abuse histories (HIA) show significantly higher scores on the Cambridge Depersonalization Scale, when compared to a control group. Earlier age of abuse, increased duration and parental abuse tend to correlate with severity of dissociative symptoms. Besides traumatic experiences, other common precipitators of the disorder include severe stress, major depressive disorder, panic attacks, and psychoactive substances. People who live in highly individualistic cultures may be more vulnerable to depersonalization, due to threat hypersensitivity and an external locus of control.


text: There is converging evidence that the prefrontal cortex may inhibit neural circuits that normally form the basis of emotional experience. In an fMRI study of DPD patients, emotionally aversive scenes activated the right ventral prefrontal cortex. Participants demonstrated a reduced neural response in emotion-sensitive regions, as well as an increased response in regions associated with emotional regulation. In a similar test of emotional memory, depersonalization disorder patients did not process emotionally salient material in the same way as did healthy controls. In a test of skin conductance responses to unpleasant stimuli, the subjects showed a selective inhibitory mechanism on emotional processing.


text: Studies are beginning to show that the temporoparietal junction has a role in multisensory integration, embodiment, and self-other distinction. Several studies analyzing brain MRI findings from DPDR patients found decreased cortical thickness in the right middle temporal gyrus, reduction in grey matter volume in the right caudate, thalamus, and occipital gyri, as well as lower white matter integrity in the left temporal and right temporoparietal regions. However, no structural changes in the amygdala were observed.


text: A PET scan found functional abnormalities in the visual, auditory, and somatosensory cortex, as well as in areas responsible for an integrated body schema.


text: One study examining EEG readings found frontal alpha wave overactivation and increased theta activity waves in the temporal region of the left hemisphere.


text: It is unclear whether genetics plays a role; however, there are many neurochemical and hormonal changes in individuals with depersonalization disorder. DPDR may be associated with dysregulation of the hypothalamic-pituitary-adrenal axis, the area of the brain involved in the "fight-or-flight" response. Patients demonstrate abnormal cortisol levels and basal activity. Studies found that patients with DPD could be distinguished from patients with clinical depression and posttraumatic stress disorder.


text: The vestibular system may also play a role in DPDR. The vestibular system helps control balance, spatial orientation, motor coordination, but also plays a role in self-awareness. Disruption to this system can potentially cause a feeling of detachment from surroundings. Several studies have shown that patients with peripheral vestibular disease are also more likely to have dissociative symptoms when compared to healthy individuals.


text: Dissociative symptoms are sometimes described by those with neurological diseases, such as amyotrophic lateral sclerosis, Alzheimer's, multiple sclerosis (MS), etc., that directly affect brain tissue.


text: Diagnosis is based on the self-reported experiences of the person followed by a clinical assessment. Psychiatric assessment includes a psychiatric history and some form of mental status examination. Since some medical and psychiatric conditions mimic the symptoms of DPD, clinicians must differentiate between and rule out the following to establish a precise diagnosis: temporal lobe epilepsy, panic disorder, acute stress disorder, schizophrenia, migraine, drug use, brain tumor or lesion. No laboratory test for depersonalization-derealization disorder currently exists. As patients with dissociative disorders likely experienced intense trauma in the past, concomitant dissociative disorders should be considered in patients diagnosed with a stress disorder (i.e. PTSD or acute stress disorder).


text: The diagnosis of depersonalization disorder can be made with the use of the following interviews and scales:


text: In the DSM-5, the word "derealization" was added to "depersonalization disorder" and renamed "depersonalization/derealization disorder" ("DPDR"). It remains classified as a dissociative disorder.


text: The ICD-11 has relisted DPDR as a disorder rather than a syndrome as previously, and has also reclassified it as a dissociative disorder from its previous listing as a neurotic disorder. The description used in the ICD-11 is similar to the criteria found in the DSM-5. Individuals with DPDR are described as having persistent/recurrent symptoms of depersonalization/derealization, have intact reality testing, and symptoms are not better explained by another psychiatric/neural disorder, substance, medication, or head trauma. Symptoms are severe enough to cause distress or impairment in functioning.


text: DPDR differentials include neurologic and psychiatric conditions as well as side effects from illicit substances or medications.


text: Depersonalization-derealization disorder may be prevented by connecting children who have been abused with professional mental health help. Some trauma specialists suggest increasing inquiry into information about children's trauma history and exposure to violence, since the majority of people (about 80%) responsible for child maltreatment are the child's own parents. Trauma-specific intervention for children may be useful in preventing future symptoms. Another way to help prevent symptoms is by using "grounding techniques". Grounding techniques involve identifying objects, entities etc... using your six senses. For example, some psychologists recommend identifying five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can hear. Doing this brings the patient 'back to reality' as it helps relieve the anxiety that comes from the 'unknowingness' of one's DPDR.


text: Treatment of DPDR is often difficult and refractory. Some clinicians speculate that this could be due to a delay in diagnosis by which point symptoms tend to be constant and less responsive to treatment. Additionally, symptoms tend to overlap with other diagnoses. Some results have been promising, but are hard to evaluate with confidence due to the small size of trials. However, recognizing and diagnosing the condition may in itself have therapeutic benefits, considering many patients express their problems as baffling and unique to them, but are in fact: one, recognized and described by psychiatry; and two, those affected by it are not the only individuals to be affected from the condition. However, symptoms are often transient and can remit on their own without treatment.


text: Treatment is primarily non-pharmacological and can include paradoxical intention, record keeping, positive reward, flooding, psychotherapy, cognitive-behavioral therapy, psychoeducation, self-hypnosis, and meditation. Meditation with the focus on the body has been used to achieve self awareness as it allows feelings, which otherwise are put aside or neutralized by the DPD condition. Self-hypnosis training can be helpful and entails training patients to induce dissociative symptoms and respond in an alternative manner. Psychoeducation involves counseling regarding the disorder, reassurance, and emphasis on DPDR as a perceptual disturbance rather than a true physical experience. Clinical pharmacotherapy research continues to explore a number of possible options, including selective serotonin reuptake inhibitors (SSRI), benzodiazepines, stimulants and opioid antagonists (ex: naltrexone).


text: An open study of cognitive behavioral therapy has aimed to help patients reinterpret their symptoms in a nonthreatening way, leading to an improvement on several standardized measures. A standardized treatment for DPD based on cognitive behavioral principles was published in the Netherlands in 2011.


text: Neither antidepressants nor antipsychotics have been found to be useful; additionally, antipsychotics can worsen symptoms of depersonalisation. Tentative evidence supports use of naloxone and naltrexone.


text: A combination of an SSRI and a benzodiazepine has been proposed to be useful for DPD patients with anxiety.


text: Modafinil used alone has been reported to be effective in a subgroup of individuals with depersonalization disorder (those who have attentional impairments, under-arousal and hypersomnia). However, clinical trials have not been conducted.


text: Some studies have found repetitive transcranial magnetic stimulation (rTMS) to be helpful. One study examined 12 patients with DPD that were treated with right temporoparietal junction (TPJ) rTMS and found that 50% showed improvement after three weeks of treatment. Five of the participants received an additional three weeks of treatment and reported overall a 68% improvement in their symptoms. Treating patients with rTMS specifically at the TPJ may be an alternative treatment.


text: DPDR is typically chronic and continuous though some individuals report experiencing periods of remission. Exacerbations can be caused by psychologically stressful situations. Michal et al. (2016) analyzed a 2 case series on patients with DPDR and agreed that the condition tended to be chronic.


text: Men and women are diagnosed in equal numbers with depersonalization disorder. A 1991 study on a sample from Winnipeg, Manitoba estimated the prevalence of depersonalization disorder at 2.4% of the population. A 2008 review of several studies estimated the prevalence between 0.8% and 1.9%. This disorder is episodic in about one-third of individuals, with each episode lasting from hours to months at a time. Depersonalization can begin episodically, and later become continuous at constant or varying intensity.


text: Onset is typically during the teenage years or early 20s, although some report being depersonalized as long as they can remember, and others report a later onset. The onset can be acute or insidious. With acute onset, some individuals remember the exact time and place of their first experience of depersonalization. This may follow a prolonged period of severe stress, a traumatic event, an episode of another mental illness, or drug use. Insidious onset may reach back as far as can be remembered, or it may begin with smaller episodes of lesser severity that become gradually stronger. Patients with drug-induced depersonalization do not appear to be a clinically separate group from those with a non-drug precipitant.


text: Depersonalization exists as both a primary and secondary phenomenon, although making a clinical distinction appears easy, it is not absolute. The most common comorbid disorders are depression and anxiety, although cases of depersonalization disorder without symptoms of either do exist. Comorbid obsessive and compulsive behaviours may exist as attempts to deal with depersonalization, such as checking whether symptoms have changed and avoiding behavioural and cognitive factors that exacerbate symptoms. Many people with personality disorders such as schizoid personality disorder, schizotypal personality disorder, and borderline personality disorder will have high chances of having depersonalization disorder.


text: The word depersonalization itself was first used by Henri Frédéric Amiel in "The Journal Intime". The 8 July 1880 entry reads:


text: Depersonalization was first used as a clinical term by Ludovic Douglas in 1898 to refer to "a state in which there is the feeling or sensation that thoughts and acts elude the self and become strange; there is an alienation of personality – in other words a depersonalization". This description refers to personalization as a psychical synthesis of attribution of states to the self.


text: Early theories of the cause of depersonalization focused on sensory impairment. Maurice Krishaber proposed depersonalization was the result of pathological changes to the body's sensory modalities which lead to experiences of "self-strangeness" and the description of one patient who "feels that he is no longer himself". One of Carl Wernicke's students suggested all sensations were composed of a sensory component and a related muscular sensation that came from the movement itself and served to guide the sensory apparatus to the stimulus. In depersonalized patients, these two components were not synchronized, and the myogenic sensation failed to reach consciousness. The sensory hypothesis was challenged by others who suggested that patient complaints were being taken too literally and that some descriptions were metaphors – attempts to describe experiences that are difficult to articulate in words. Pierre Janet approached the theory by pointing out his patients with clear sensory pathology did not complain of symptoms of unreality, and that those who have depersonalization were normal from a sensory viewpoint.


text: Psychodynamic theory formed the basis for the conceptualization of dissociation as a defense mechanism. Within this framework, depersonalization is understood as a defense against a variety of negative feelings, conflicts, or experiences. Sigmund Freud himself experienced fleeting derealization when visiting the Acropolis in person; having read about it for years and knowing it existed, seeing the real thing was overwhelming and proved difficult for him to perceive it as real. Freudian theory is the basis for the description of depersonalization as a dissociative reaction, placed within the category of psychoneurotic disorders, in the first two editions of the "Diagnostic and Statistical Manual of Mental Disorders".


text: Some argue that because depersonalization and derealization are both impairments to one's ability to perceive reality, they are merely two facets of the same disorder. Depersonalization also differs from delusion in the sense that the patient is able to differentiate between reality and the symptoms they may experience. The ability to sense that something is unreal is maintained when experiencing symptoms of the disorder. The problem with properly defining depersonalization also lies within the understanding of what reality actually is. In order to comprehend the nature of reality we must incorporate all the subjective experiences throughout and thus the problem of obtaining an objective definition is brought about again.


text: Depersonalization disorder has appeared in a variety of media. The director of the autobiographical documentary "Tarnation", Jonathan Caouette, had depersonalization disorder. The screenwriter for the 2007 film "Numb" had depersonalization disorder, as does the film's protagonist played by Matthew Perry. Norwegian painter Edvard Munch's famous masterpiece "The Scream" may have been inspired by depersonalization disorder. In Glen Hirshberg's novel "The Snowman's Children", main female plot characters throughout the book had a condition that is revealed to be depersonalization disorder. Suzanne Segal had an episode in her 20s that was diagnosed by several psychologists as depersonalization disorder, though Segal herself interpreted it through the lens of Buddhism as a spiritual experience, commonly known as "Satori" or "Samadhi". The song "Is Happiness Just a Word?" by hip hop artist Vinnie Paz describes his struggle with depersonalization disorder. Adam Duritz, of the band Counting Crows, has often spoken about his diagnosis of depersonalization disorder.


title: Tim Armstrong

text: Timothy Ross Armstrong (born November 25, 1965) is an American musician, singer, songwriter and producer. Known for his distinctive voice, he is the singer/guitarist for the punk rock band Rancid and hip hop/punk rock supergroup Transplants. Prior to forming Rancid, Armstrong was in the ska punk band Operation Ivy.


title: Tim Armstrong

text: In 1997, along with Brett Gurewitz of the band Bad Religion and owner of Epitaph Records, Armstrong founded Hellcat Records. In 2012, through his website, Armstrong started releasing music that influenced him, along with stripped-down cover songs of his own under the name Tim Timebomb. Armstrong is also a songwriter for other artists. Armstrong won a Grammy Award for his work with Jimmy Cliff and Pink, and has also worked with Joe Walsh.


title: Tim Armstrong

text: At the age of five, Armstrong met Matt Freeman while playing Little League Baseball. They grew up a few blocks apart in Albany, California, where Armstrong lived with his mother, police officer father, and older brother Jeff. Freeman and Armstrong formed bands many years later based on their shared love of bands such as The Clash and the Ramones. They both went to Albany High School.


title: Tim Armstrong

text: Armstrong's relationship with Bikini Kill drummer Tobi Vail inspired the Rancid song "Olympia, WA" from "...And Out Come the Wolves".


title: Tim Armstrong

text: He was married to musician Brody Dalle from 1997 to 2003. They met in 1995, when Dalle was 16 and Armstrong was 30, after Rancid and Dalle's band Sourpuss both played Summersault Festival in Australia. In 1997, when Dalle was 18, she moved to Los Angeles to live with Armstrong, and she formed the band The Distillers. The couple separated in 2003, after Armstrong saw a picture of Dalle kissing Queens of the Stone Age frontman Josh Homme in an issue of "Rolling Stone" magazine; she and Homme would later marry. Homme claimed he received death threats from Armstrong's fans. Dalle claimed Armstrong was very controlling of her and it took her three years to leave him. Some of Rancid's songs on 1998's "Life Won't Wait" ("Who Would've Thought", "Corazón de Oro") detail Armstrong and Dalle's relationship and songs on 2003's "Indestructible" ("Fall Back Down", "Ghost Band", "Tropical London") deal with Armstrong's feelings about his divorce.


title: Tim Armstrong

text: Armstrong's cousin, Scott, was the guitarist for Canadian punk band Desperate Minds, but they did not know each other until they were introduced at a show in Chicago in 1988 by John Jughead of Screeching Weasel.


title: Tim Armstrong

text: Basic Radio was founded in 1985 and included Matt Freeman and Tim Armstrong. The band never released any albums or EPs, but recorded demos and were featured on local compilations. Two years later they broke up and Operation Ivy was founded shortly after.


title: Tim Armstrong

text: In 1987, along with singer Jesse Michaels, bassist Matt Freeman and drummer Dave Mello, Armstrong formed the ska punk band Operation Ivy and enjoyed modest success before the group disbanded in 1989, the same night the album was released. The band would go on to achieve worldwide cult success in the years following its break-up.


title: Tim Armstrong

text: Dance Hall Crashers (named after the Alton Ellis song "Dance Crasher") was formed in 1989 by Armstrong and Matt Freeman after both musicians expressed an interest in starting a band rooted in more traditional ska and rocksteady than what they had been playing with Operation Ivy. The first line-up featured Armstrong on vocals and Freeman on guitar, as well as drummer Erik Larsen, keyboardist Joey Schaaf, vocalist Andrew Champion, guitarist Grant McIntire, and bassist Joel Wing. The band played their first show at 924 Gilman Street in Berkeley in 1989. Shortly after their debut, Freeman and Armstrong left to pursue other interests.


title: Tim Armstrong

text: Downfall featured Armstrong, Freeman, and Mello, as well as Mello's brother Pat, and Jason Hammon (also a later member of Dance Hall Crashers). Pat and Jason would both play guitar, while Armstrong took up duties on vocals. They lasted three months (December 1989 to March 1990), playing only at a few parties and twice at Gilman St. They released one song on Maximumrocknroll's "They Don't Get Paid, They Don't Get Laid, but Boy, Do They Work Hard!" compilation, one song on David Hayes' "Very Small World" compilation, one song on Lookout! Records' "Can of Pork" compilation, and recorded a demo. It disbanded when Freeman joined MDC on bass while Armstrong was a roadie for the band, while Pat and Dave went on to form Schlong.


title: Tim Armstrong

text: As time went on, Armstrong, suffering from depression and alcoholism, eventually became homeless. During this time, Freeman suggested the two start a new band together, partially in hopes of curbing Armstrong's alcohol addiction. Armstrong began writing songs that would appear on their first album. Their new band, Rancid, would eventually go on to become one of the most critically acclaimed and commercially successful punk rock bands of all time. Rancid has released nine studio albums since their formation.


title: Tim Armstrong

text: In 1999, Armstrong invited roadie Rob Aston ("Skinhead Rob") to add lyrics to some solo material that Armstrong had been creating in his basement, and the two worked together writing and recording music. They formed the group Transplants with drummer Travis Barker, of Blink-182, and released their self-titled debut album on October 22, 2002. A second Transplants album, "Haunted Cities", was released on June 21, 2005. The Transplants break-up was confirmed by Rob Aston on January 16, 2006, when he told a reporter that the group had split. However, Barker later announced that the trio was working on a new album. They played their first show since 2006 on Conan to promote Barker's new solo album, on which the song "Saturday Night" is featured. It was announced in November 2011 on the Transplants official Facebook page that their new album would be "finished" in December 2011. The latest album entitled "In A Warzone" was released June 25, 2013, on Epitaph Records.


title: Tim Armstrong

text: In 2007, he released his first solo album entitled "A Poet's Life" with The Aggrolites as his backing band. The track from that album "Into Action" was reported as the number one most played and requested in 2007 on then XM Satellite Radio channel Fungus 53.


title: Tim Armstrong

text: In 2012, he launched a side project under the name Tim Timebomb, initially releasing a download only album, entitled "Tim Timebomb Sings Songs from RocknNRoll Theater", containing songs from his musical film series. Since October 29, 2012, he has released a series of songs via YouTube, at a rate of one track each day starting on October 29, 2012. These songs make up a series of download only singles, to date more than 200 tracks have been released, a mixture of original compositions, covers, and re-workings of his previous songs, including those of Rancid.


title: Tim Armstrong

text: Armstrong produced and co-wrote eight songs with Pink for her 2003 album "Try This". Her song, "Trouble", a 2003 Rancid outtake, went on to win her a Grammy Award. He has also contributed guest vocals on songs for such bands as Bad Religion, Time Again, The Matches, Mest, Good Charlotte, Head Automatica, The Aggrolites, The Interrupters and Box Car Racer. He and Matt Freeman also play in a psychobilly band called Devils Brigade and he co-produced their debut album.


title: Tim Armstrong

text: It was announced on August 12, 2011, that Tim Armstrong was working on an album with reggae artist Jimmy Cliff. Their first single, a cover of The Clash song "The Guns of Brixton", was released on October 4, 2011. Sacred Fire EP was released late November 2011. Rebirth was released in July 2012 and won the Grammy Award for Best Reggae Album. And in 2012, Armstrong wrote and performed on Joe Walsh's song "Hi-Roller Baby" from his solo album Analog Man. Armstrong also helped with Anti-Flag's song "Brandenburg Gate".


title: Tim Armstrong

text: Though they share a last name and frequently collaborate, Armstrong and Green Day frontman Billie Joe Armstrong are not related. Green Day has covered Operation Ivy songs on their past albums, Billie Joe Armstrong co-wrote and performed on Rancid's song "Radio", and was invited by Tim Armstrong to join Rancid as a second guitarist in 1993. He declined, and Lars Frederiksen got the job. Tim directed the music video for Green Day's 2016 single "Bang Bang". He also plays a punk, seen during the song's bridge. In 2017, Tim Armstrong and Billie Joe Armstrong, together with Tim's nephew Rey Armstrong and Billie Joe's son Joey Armstrong formed the band The Armstrongs and released their first single "If There Was Ever a Time".


title: Tim Armstrong

text: In May 2021, Armstrong along with fellow Rancid bandmate Matt Freeman, Fletcher Dragge (Pennywise), Byron McMackin (Pennywise), and Mike Muir (Suicidal Tendencies) formed a punk rock supergroup called The Crew. The band's first single, "One Voice", was released on Epitaph Records.


title: Tim Armstrong

text: Armstrong started Hellcat Records in 1997 as a sub-label of Epitaph, owned by Armstrong's friend and Bad Religion member Brett Gurewitz. Armstrong acts as a talent scout for Hellcat, and has final say concerning what groups are signed to the label. Armstrong was one of the owners the merchandise manufacturer Machete Mfg, which provides merchandise for bands on Hellcat Records.


title: Tim Armstrong

text: In 2010, Gretsch Guitars introduced the G5191BK Tim Armstrong Electromatic guitar. The single cutaway hollowbody electric guitar featured a 17" wide body in a flat-black urethane finish, parallel tone bars and sound post, two "Black Top" Filter'Tron pickups, Grover tuners, big block fretboard inlays, a harp tailpiece and gold-plated hardware. Gretsch advertising for the model prominently features Armstrong with the guitar. Armstrong's signature model is based on his 1971 Baldwin-era Gretsch Country Club which he spray-painted black and flipped to accommodate his left-handed playing.


title: Tim Armstrong

text: The signature model is available in both right and left-handed models. Fender also put out a signature acoustic model based on Armstrong's favorite 1960s era Fender acoustic guitar. The "Hellcat" has hellcat inlays in the 3rd, 5th, 7th and 9th fret positions and two skulls in the 12th fret. It is outfitted with a tortoise shell pick guard and Fishman brand electronics. It is available in right and left handed models, as well as a 12-string version.


title: Coffeehouse

text: A coffeehouse, coffee shop, or café is an establishment that primarily serves coffee of various types, notably espresso, latte, and cappuccino. Some coffeehouses may serve cold drinks, such as iced coffee and iced tea, as well as other non-caffeinated beverages. In continental Europe, cafés serve alcoholic drinks. A coffeehouse may also serve food, such as light snacks, sandwiches, muffins, fruit, or pastries. Coffeehouses range from owner-operated small businesses to large multinational corporations. Some coffeehouse chains operate on a franchise business model, with numerous branches across various countries around the world.


title: Coffeehouse

text: While "café" may refer to a coffeehouse, the term "café" generally refers to a diner, British café (colloquially called a "caff"), "greasy spoon" (a small and inexpensive restaurant), transport café, teahouse or tea room, or other casual eating and drinking place. A coffeehouse may share some of the same characteristics of a bar or restaurant, but it is different from a cafeteria. Many coffeehouses in the Middle East and in West Asian immigrant districts in the Western world offer "shisha" (actually called "nargile" in Levantine Arabic, Greek and Turkish), flavored tobacco smoked through a hookah. An espresso bar is a type of coffeehouse that specializes in serving espresso and espresso-based drinks.


title: Coffeehouse

text: From a cultural standpoint, coffeehouses largely serve as centers of social interaction: a coffeehouse provides patrons with a place to congregate, talk, read, write, entertain one another, or pass the time, whether individually or in small groups. Since the popularization of Wi-Fi, coffeehouses with this capability have also become places for patrons to access the Internet on their laptops and tablet computers. A coffeehouse can serve as an informal club for its regular members. As early as the 1950s Beatnik era and the 1960s folk music scene, coffeehouses have hosted singer-songwriter performances, typically in the evening.


title: Coffeehouse

text: The most common English spelling "café", is the French, Portuguese, and Spanish spelling, and was adopted by English-speaking countries in the late 19th century. The Italian spelling, "caffè", is also sometimes used in English. In Southern England, especially around London in the 1950s, the French pronunciation was often facetiously altered to and spelt "caff".


title: Coffeehouse

text: The English words "coffee" and "café" derive from the Italian word for coffee, "caffè"—first attested as "caveé" in Venice in 1570—and in turn derived from Arabic "qahwa" (). The Arabic term "qahwa" originally referred to a type of wine, but after the wine ban by Islam, the name was transferred to coffee because of the similar rousing effect it induced. European knowledge of coffee (the plant, its seeds, and the drink made from the seeds) came through European contact with Turkey, likely via Venetian-Ottoman trade relations.


title: Coffeehouse

text: The English word "café" to describe a restaurant that usually serves coffee and snacks rather than the word coffee that describes the drink, is derived from the French "café." The first café in France is believed to have opened in 1660. The first café in Europe is believed to have been opened in Belgrade, Serbia in 1522 as a Kafana (Serbian coffee house).


title: Coffeehouse

text: The translingual word root /kafe/ appears in many European languages with various naturalized spellings, including Portuguese, Spanish, and French ("café"); German ("Kaffee"); Polish ("kawa"); Serbian ("кафа / kafa"); Ukrainian ("кава", 'kava'); and others.


title: Coffeehouse

text: The first coffeehouses in the Islamic world, "qahveh khaneh" (Persian for coffee house), appeared in Damascus. These Ottoman coffeehouses also appeared in Mecca, in the Arabian Peninsula in the 15th century, then spread to the Ottoman Empire's capital of Istanbul in the 16th century. Coffeehouses became popular meeting places where people gathered to drink coffee, have conversations, play board games such as chess and backgammon, listen to stories and music, and discuss news and politics. They became known as "schools of wisdom" for the type of clientele they attracted, and their free and frank discourse.


title: Coffeehouse

text: Coffeehouses in Mecca became a concern of imams who viewed them as places for political gatherings and drinking, leading to bans between 1512 and 1524. However, these bans could not be maintained, due to coffee becoming ingrained in daily ritual and culture across the Islamic world. The Ottoman chronicler İbrahim Peçevi reports in his writings (1642–49) about the opening of the first coffeehouse in Istanbul:


title: Coffeehouse

text: Various legends involving the introduction of coffee to Istanbul at a "Kiva Han" in the late 15th century circulate in culinary tradition, but with no documentation.


title: Coffeehouse

text: The 17th century French traveler and writer Jean Chardin gave a lively description of the Persian coffeehouse scene:


title: Coffeehouse

text: In the 17th century, coffee appeared for the first time in Europe outside the Ottoman Empire, and coffeehouses were established, soon becoming increasingly popular. The first coffeehouses is said to have appeared in 1632 in Livorno by a Jewish merchant, or later in 1640, in Venice. In the 19th and 20th centuries in Europe, coffeehouses were very often meeting points for writers and artists.


title: Coffeehouse

text: The first coffeehouse in England was set up in Oxford in 1650–1651 by "Jacob the Jew". A second competing coffee house was opened across the street in 1654, by "Cirques Jobson, the Jew" (Queen's Lane Coffee House).


title: Coffeehouse

text: Anthony Wood observed of the coffee houses of Oxford in his "Life and Times" (1674) "The decay of study, and consequently of learning, are coffee houses, to which most scholars retire and spend much of the day in hearing and speaking of news". The proprietor was Pasqua Rosée, the servant of a trader in goods from the Ottoman Empire named Daniel Edwards, who imported the coffee and assisted Rosée in setting up the establishment there.


title: Coffeehouse

text: From 1670 to 1685, the number of London coffeehouses began to increase, and they also began to gain political importance due to their popularity as places of debate. English coffeehouses in the 17th and 18th centuries were significant meeting places, particularly in London. By 1675, there were more than 3,000 coffeehouses in England. Coffeehouses were also known as "penny universities" because of the crowd that they attracted. Scholars and students alike were regulars, and anyone with a penny could enter and sit in on a lecture or have access to books or print news. Coffeehouses boosted the popularity of print news culture and helped the growth of various financial markets including insurance, stocks, and auctions.


title: Coffeehouse

text: Though Charles II later tried to suppress London coffeehouses as "places where the disaffected met, and spread scandalous reports concerning the conduct of His Majesty and his Ministers", the public still flocked to them. For several decades following the Restoration, the Wits gathered around John Dryden at Will's Coffee House, in Russell Street, Covent Garden. As coffeehouses were believed to be areas where anti-government gossip could easily spread, Queen Mary and the London City magistrates tried to prosecute people who frequent coffeehouses as they were liable to "spread false and seditious reports". William III's privy council also suppressed Jacobite sympathizers in the 1680s and 1690s in coffeehouses as these were the places that they believed harbored plotters against the regimes.


title: Coffeehouse

text: The coffeehouses were great social levelers, open to all men and indifferent to social status, and as a result associated with equality and republicanism. The rich intellectual atmosphere of early London coffeehouses were available to anyone who could pay the sometimes one penny entry fee, giving them the name of 'Penny Universities'.


title: Coffeehouse

text: More generally, coffeehouses became meeting places where business could be carried on, news exchanged and the "London Gazette" (government announcements) read. Lloyd's of London had its origins in a coffeehouse run by Edward Lloyd, where underwriters of ship insurance met to do business. By 1739, there were 551 coffeehouses in London; each attracted a particular clientele divided by occupation or attitude, such as Tories and Whigs, wits and stockjobbers, merchants and lawyers, booksellers and authors, men of fashion or the "cits" of the old city center. According to one French visitor, Antoine François Prévost, coffeehouses, "where you have the right to read all the papers for and against the government", were the "seats of English liberty".


title: Coffeehouse

text: Jonathan's Coffee House in 1698 saw the listing of stock and commodity prices that evolved into the London Stock Exchange. Lloyd's Coffee House provided the venue for merchants and shippers to discuss insurance deals, leading to the establishment of Lloyd's of London insurance market, the Lloyd's Register classification society, and other related businesses. Auctions in salesrooms attached to coffeehouses provided the start for the great auction houses of Sotheby's and Christie's.


title: Coffeehouse

text: In Victorian England, the temperance movement set up coffeehouses (also known as coffee taverns) for the working classes, as a place of relaxation free of alcohol, an alternative to the public house.


title: Coffeehouse

text: Pasqua Rosée, an Armenian by the name Harutiun Vartian, also established the first coffeehouse in Paris in 1672 and held a citywide coffee monopoly until Procopio Cutò, his apprentice, opened the Café Procope in 1686. This coffeehouse still exists today and was a popular meeting place of the French Enlightenment; Voltaire, Rousseau, and Denis Diderot frequented it, and it is arguably the birthplace of the "Encyclopédie", the first modern encyclopedia.


title: Coffeehouse

text: In 1667, Kara Hamie, a former Ottoman Janissary from Constantinople, opened the first coffee shop in Bucharest (then the capital of the Principality of Wallachia), in the center of the city, where today sits the main building of the National Bank of Romania.


title: Coffeehouse

text: The traditional tale of the origins of the Viennese café begins with the mysterious sacks of green beans left behind when the Turks were defeated in the Battle of Vienna in 1683. All the sacks of coffee were granted to the victorious Polish king Jan III Sobieski, who in turn gave them to one of his officers, Jerzy Franciszek Kulczycki, a Ukrainian cossack and Polish diplomat of Ruthenian descent. Kulczycki, according to the tale, then began the first coffeehouse in Vienna with the hoard, also being the first to serve coffee with milk. There is a statue of Kulczycki on a street also named after him.


title: Coffeehouse

text: However, it is now widely accepted that the first Viennese coffeehouse was actually opened by an Armenian merchant named Johannes Diodato (Asdvadzadur). Johannes Diodato (also known as Johannes Theodat) opened a registered coffeehouse in Vienna in 1685. Fifteen years later, four other Armenians owned coffeehouses. The culture of drinking coffee was itself widespread in the country in the second half of the 18th century.


title: Coffeehouse

text: Over time, a special coffee house culture developed in Habsburg Vienna. On the one hand, writers, artists, musicians, intellectuals, bon vivants and their financiers met in the coffee house, and on the other hand, new coffee varieties were always served. In the coffee house, people played cards or chess, worked, read, thought, composed, discussed, argued, observed and just chatted. A lot of information was also obtained in the coffee house, because local and foreign newspapers were freely available to all guests. This form of coffee house culture spread throughout the Habsburg Empire in the 19th century.


title: Coffeehouse

text: Scientific theories, political plans but also artistic projects were worked out and discussed in Viennese coffee houses all over Central Europe. James Joyce even enjoyed his coffee in a Viennese coffee house on the Adriatic in Trieste, then and now the main port for coffee and coffee processing in Italy and Central Europe. From there, the Viennese Kapuziner coffee developed into today's world-famous cappuccino. This special multicultural atmosphere of the Habsburg coffee houses was largely destroyed by the later National Socialism and Communism and can only be found today in a few places that have long been in the slipstream of history, such as Vienna or Trieste.


title: Coffeehouse

text: During the 18th century, the oldest extant coffeehouses in Italy were established: Caffè Florian in Venice, Antico Caffè Greco in Rome, Caffè Pedrocchi in Padua, Caffè dell'Ussero in Pisa and Caffè Fiorio in Turin.


title: Coffeehouse

text: The first known cafes in Pest date back to 1714 when a house intended to serve as a Cafe (Balázs Kávéfőző) was purchased. Minutes of the Pest City Council from 1729 mention complaints by the Balázs cafe and Franz Reschfellner Cafe against the Italian-originated cafe of Francesco Bellieno for selling underpriced coffee.


title: Coffeehouse

text: In the 18th century, Dublin coffeehouses functioned as early reading centers and the emergence of circulation and subscription libraries that provided greater access to printed material for the public. The interconnectivity of the coffeehouse and virtually every aspect of the print trade were evidenced by the incorporation of printing, publishing, selling, and viewing of newspapers, pamphlets and books on the premises, most notably in the case of Dick's Coffee House, owned by Richard Pue; thus contributing to a culture of reading and increased literacy. These coffeehouses were a social magnet where different strata of society came together to discuss topics covered by the newspapers and pamphlets. Most coffeehouses of the 18th century would eventually be equipped with their own printing presses or incorporate a book shop.


title: Coffeehouse

text: Today, the term "café" is used for most coffeehouses - this can be spelled both with and without an acute accent, but is always pronounced as two syllables. The name café has also come to be used for a type of diners that offers cooked meals (again, without alcoholic beverages) which can be standalone or operating within in shopping centres or department stores. In Irish usage, the presence or absence of the acute accent does not signify the type of establishment (coffeehouse versus diner), and is purely a decision by the owner: for instance, the two largest diner-style café chains in Ireland during in the 1990s were named "Kylemore Cafe" and "Bewley’s Café" - i.e., one written without, and one with, the acute accent.


title: Coffeehouse

text: The exclusion of women from coffeehouses was not universal, but does appear to have been common in Europe. In Germany, women frequented them, but in England and France they were banned. Émilie du Châtelet purportedly cross-dressed to gain entrance to a coffeehouse in Paris.


title: Coffeehouse

text: In a well-known engraving of a Parisian café c. 1700, the gentlemen hang their hats on pegs and sit at long communal tables strewn with papers and writing implements. Coffee pots are ranged at an open fire, with a hanging cauldron of boiling water. The only woman present presides, separated in a canopied booth, from which she serves coffee in tall cups.


title: Coffeehouse

text: In most European countries, such as Spain, Austria, Denmark, Germany, Norway, Sweden, Portugal, and others, the term "café" means a restaurant primarily serving coffee, as well as pastries such as cakes, tarts, pies, or buns. Many cafés also serve light meals such as sandwiches. European cafés often have tables on the pavement (sidewalk) as well as indoors. Some cafés also serve alcoholic drinks (e.g., wine), particularly in Southern Europe. In the Netherlands and Belgium, a "café" is the equivalent of a bar, and also sells alcoholic drinks. In the Netherlands a "koffiehuis" serves coffee, while a coffee shop (using the English term) sells "soft" drugs (cannabis and hashish) and is generally not allowed to sell alcoholic drinks. In France, most cafés serve as lunch restaurants in the day, and bars in the evening. They generally do not have pastries except in the mornings, when a croissant or pain au chocolat can be purchased with breakfast coffee. In Italy, cafés are similar to those found in France and known as "bar". They typically serve a variety of espresso coffee, cakes and alcoholic drinks. Bars in city centers usually have different prices for consumption at the bar and consumption at a table.


title: Coffeehouse

text: Coffeehouses are part of the culture of Buenos Aires and the customs of its inhabitants. They are traditional meeting places for 'porteños' and have inspired innumerable artistic creations. Some notable coffeehouses include Confitería del Molino, Café Tortoni, , Café La Biela.


title: Coffeehouse

text: The first coffeehouse in America opened in Boston, in 1676. However, Americans did not start choosing coffee over tea until the Boston Tea Party and the Revolutionary War. After the Revolutionary War, Americans momentarily went back to drinking tea until after the War of 1812 when they began importing high-quality coffee from Latin America and expensive inferior-quality tea from American shippers instead of Great Britain. Whether they were drinking coffee or tea, coffeehouses served a similar purpose that they did in Great Britain as places where business was done. In the 1780s, Merchant's Coffee House located on Wall Street in New York City was home to the organization of the Bank of New York and the New York Chamber of Commerce.


title: Coffeehouse

text: Coffeehouses in the United States arose from the espresso- and pastry-centered Italian coffeehouses of the Italian American immigrant communities in the major U.S. cities, notably New York City's Little Italy and Greenwich Village, Boston's North End, and San Francisco's North Beach. From the late 1950s onward, coffeehouses also served as a venue for entertainment, most commonly folk performers during the American folk music revival. Both Greenwich Village and North Beach became major haunts of the Beats, who were highly identified with these coffeehouses. As the youth culture of the 1960s evolved, non-Italians consciously copied these coffeehouses. The political nature of much of 1960s folk music made the music a natural tie-in with coffeehouses with their association with political action. A number of well-known performers like Joan Baez and Bob Dylan began their careers performing in coffeehouses. Blues singer Lightnin' Hopkins bemoaned his woman's inattentiveness to her domestic situation due to her overindulgence in coffeehouse socializing in his 1969 song "Coffeehouse Blues".


title: Coffeehouse

text: In 1966, Alfred Peet began applying the dark roast style to high quality beans and opened up a small shop in Berkeley, California to educate customers on the virtues of good coffee. Starting in 1967 with the opening of the historic Last Exit on Brooklyn coffeehouse, Seattle became known for its thriving countercultural coffeehouse scene; the Starbucks chain later standardized and mainstreamed this espresso bar model.


title: Coffeehouse

text: From the 1960s through the mid-1980s, churches and individuals in the United States used the coffeehouse concept for outreach. They were often storefronts and had names like "The Lost Coin" (Greenwich Village), "The Gathering Place" (Riverside, CA), "Catacomb Chapel" (New York City), and "Jesus For You" (Buffalo, NY). Christian music (often guitar-based) was performed, coffee and food was provided, and Bible studies were convened as people of varying backgrounds gathered in a casual setting that was purposefully different from traditional churches. An out-of-print book, published by the ministry of David Wilkerson, titled, "A Coffeehouse Manual", served as a guide for Christian coffeehouses, including a list of name suggestions for coffeehouses.


title: Coffeehouse

text: They are popular to this day with coffeehouses such as Starbucks seeming to be on every corner of streets in several major American cities including Los Angeles and Seattle.


title: Coffeehouse

text: Cafés may have an outdoor section (terrace, pavement or sidewalk café) with seats, tables and parasols. This is especially the case with European cafés. Cafés offer a more open public space compared to many of the traditional pubs they have replaced, which were more male dominated with a focus on drinking alcohol.


title: Coffeehouse

text: One of the original uses of the café, as a place for information exchange and communication, was reintroduced in the 1990s with the Internet café or Hotspot. The spread of modern-style cafés to urban and rural areas went hand-in-hand with the rising use of mobile computers. Computers and Internet access in a contemporary-styled venue help to create a youthful, modern place, compared to the traditional pubs or old-fashioned diners that they replaced.


title: Coffeehouse

text: In the Middle East, the coffeehouse ( "maqha"; "qahveh-khaneh"; or "kırâthane") serves as an important social gathering place for men. Men assemble in coffeehouses to drink coffee (usually Arabic coffee) and tea. In addition, men go there to listen to music, read books, play chess and backgammon, watch TV and enjoy other social activities around the Arab world and in Turkey. Hookah (shisha) is traditionally served as well.


title: Coffeehouse

text: Coffeehouses in Egypt are colloquially called "ahwah" , which is the dialectal pronunciation of "qahwah" (literally "coffee") (). Also commonly served in "ahwah" are tea ("shāy") and herbal teas, especially the highly popular hibiscus blend (Egyptian Arabic: "karkadeh" or "ennab"). The first "ahwah" opened around the 1850s and were originally patronized mostly by older people, with youths frequenting but not always ordering. There were associated by the 1920s with clubs (Cairo), "bursa" (Alexandria) and "gharza" (rural inns). In the early 20th century, some of them became crucial venues for political and social debates.


title: Coffeehouse

text: In India, coffee culture has expanded in the past twenty years. Chains like Indian Coffee House, Café Coffee Day, Barista Lavazza have become very popular. Cafes are considered good venues to conduct office meetings and for friends to meet.


title: Coffeehouse

text: In China, an abundance of recently started domestic coffeehouse chains may be seen accommodating business people for conspicuous consumption, with coffee prices sometimes even higher than in the West.


title: Coffeehouse

text: In Malaysia and Singapore, traditional breakfast and coffee shops are called "kopi tiam". The word is a portmanteau of the Malay word for coffee (as borrowed and altered from English) and the Hokkien dialect word for shop (; POJ: tiàm). Menus typically feature simple offerings: a variety of foods based on egg, toast, and coconut jam, plus coffee, tea, and Milo, a malted chocolate drink that is extremely popular in Southeast Asia and Australasia, particularly Singapore and Malaysia.


title: Coffeehouse

text: In the Philippines, coffee shop chains like Starbucks have become the prevalent hangouts for upper and middle class professionals in such districts as the Makati CBD. However, carinderias (small eateries) continue to serve coffee alongside breakfast and snack dishes. Events called "Kapihan" (fora) are often held inside bakeshops or restaurants that also serve coffee for breakfast or merienda.


title: Coffeehouse

text: In Thailand, the term "café" is not only a coffeehouse in the international definition, as in other countries, but in the past was considered a night restaurant that serves alcoholic drinks during a comedy show on stage. The era in which this type of business flourished was the 1990s, before the 1997 financial crisis.


title: Coffeehouse

text: The first real coffeehouse in Thailand opened in 1917 at the Si Kak Phraya Si in the area of Rattanakosin Island, by Madam Cole, an American woman who living in Thailand at that time, Later, Chao Phraya Ram Rakop (เจ้าพระยารามราฆพ), Thai aristocrat, opened a coffeehouse named "Café de Norasingha" (คาเฟ่นรสิงห์) located at Sanam Suea Pa (สนามเสือป่า), the ground next to the Royal Plaza. At present, Café de Norasingha has been renovated and moved to within Phayathai Palace. In the southern region, a traditional coffeehouse or "kopi tiam" is popular with locals, like many countries in the Malay Peninsula.


title: Coffeehouse

text: In the 19th Century, coffee houses such as the Collingwood Coffee Palace or the Federal Coffee Palace in the centre of Melbourne were established and were part of the temperance movement to reduce the consumption of alcohol in society.


title: Coffeehouse

text: In modern Australia, coffee shops are ubiquitously known as "cafés". Since the post-World War II influx of Italian immigrants introduced the first espresso coffee machines to Australia in the 1950s, there was initially a slow rise in café culture, particularly in Melbourne, until a boom in locally owned cafés Australia-wide began in the 1990s. Alongside the rise in the number of cafés there has been a rise in demand for locally (or on-site) roasted specialty coffee, particularly in Sydney and Melbourne. A local favourite is the "flat white" which remains a popular coffee drink.


title: Coffeehouse

text: In Cairo, the capital of Egypt, most cafés have shisha (waterpipe). Most Egyptians indulge in the habit of smoking shisha while hanging out at the café, watching a match, studying, or even sometimes finishing some work. In Addis Ababa, the capital of Ethiopia, independent coffeehouses that struggled prior to 1991 have become popular with young professionals who do not have time for traditional coffee roasting at home. One establishment that has become well-known is the Tomoca coffee shop, which opened in 1953.


title: Coffeehouse

text: The patrons of the first coffeehouse in England, The Angel, which opened in Oxford in 1650, and the mass of London coffee houses that flourished over the next three centuries, were far removed from those of modern Britain. Haunts for teenagers in particular, Italian-run espresso bars and their formica-topped tables were a feature of 1950s Soho that provided a backdrop as well as a title for Cliff Richard's 1960 film "Expresso Bongo". The first was The Moka in Frith Street, opened by Gina Lollobrigida in 1953. With their "exotic Gaggia coffee machine[s]... Coke, Pepsi, weak frothy coffee and... Suncrush orange fountain[s]" they spread to other urban centers during the 1960s, providing cheap, warm places for young people to congregate and an ambience far removed from the global coffee bar standard that would be established in the final decades of the century by chains such as Starbucks and Pret a Manger.


title: Coffeehouse

text: The espresso bar is a type of coffeehouse that specializes in coffee drinks made from espresso. Originating in Italy, the espresso bar has spread throughout the world in various forms. Prime examples that are internationally known are Starbucks Coffee, based in Seattle, U.S., and Costa Coffee, based in Dunstable, U.K. (the first and second largest coffeehouse chains respectively), although the espresso bar exists in some form throughout much of the world.


title: Coffeehouse

text: The espresso bar is typically centered around a long counter with a high-yield espresso machine (usually bean to cup machines, automatic or semiautomatic pump-type machine, although occasionally a manually operated lever-and-piston system) and a display case containing pastries and occasionally savory items such as sandwiches. In the traditional Italian bar, customers either order at the bar and consume their drinks standing or, if they wish to sit down and be served, are usually charged a higher price. In some bars there is an additional charge for drinks served at an outside table. In other countries, especially the United States, seating areas for customers to relax and work are provided free of charge. Some espresso bars also sell coffee paraphernalia, candy, and even music. North American espresso bars were also at the forefront of widespread adoption of public WiFi access points to provide Internet services to people doing work on laptop computers on the premises.


title: Coffeehouse

text: The offerings at the typical espresso bar are generally quite Italianate in inspiration; biscotti, cannoli and pizzelle are a common traditional accompaniment to a caffe latte or cappuccino. Some upscale espresso bars even offer alcoholic drinks such as grappa and sambuca. Nevertheless, typical pastries are not always strictly Italianate and common additions include scones, muffins, croissants, and even doughnuts. There is usually a large selection of teas as well, and the North American espresso bar culture is responsible for the popularization of the Indian spiced tea drink masala chai. Iced drinks are also popular in some countries, including both iced tea and iced coffee as well as blended drinks such as Starbucks' Frappucino.


title: Coffeehouse

text: A worker in an espresso bar is referred to as a barista. The barista is a skilled position that requires familiarity with the drinks being made (often very elaborate, especially in North American-style espresso bars), a reasonable facility with some equipment as well as the usual customer service skills.


title: Short film

text: A short film is any motion picture that is short enough in running time not to be considered a feature film. The Academy of Motion Picture Arts and Sciences defines a short film as "an original motion picture that has a running time of 40 minutes or less, including all credits". In the United States, short films were generally termed short subjects from the 1920s into the 1970s when confined to two 35 mm reels or less, and featurettes for a film of three or four reels. "Short" was an abbreviation for either term.


title: Short film

text: The increasingly rare industry term "short subject" carries more of an assumption that the film is shown as part of a presentation along with a feature film. Short films are often screened at local, national, or international film festivals and made by independent filmmakers with either a low budget or no budget at all. They are usually funded by film grants, nonprofit organizations, sponsor, or personal funds. Short films are generally used for industry experience and as a platform to showcase talent to secure funding for future projects from private investors, a production company, or film studios. They can also be released with feature films, and can also be included as bonus features on some home video releases.


title: Short film

text: All films in the beginning of cinema were very short, sometimes running only a minute or less. It was not until the 1910s when films started to get longer than about ten minutes. The first set of films were presented in 1894 and it was through Thomas Edison's device called a kinetoscope. It was made for individual viewing only. Comedy short films were produced in large numbers compared to lengthy features such as D. W. Griffith's 1915 "The Birth of a Nation". By the 1920s, a ticket purchased a varied program including a feature and several supporting works from categories such as second feature, short comedy, 5–10 minute cartoon, travelogue, and newsreel.


title: Short film

text: Short comedies were especially common, and typically came in a serial or series (such as the "Our Gang" movies, or the many outings of Charlie Chaplin's Little Tramp character).


title: Short film

text: Animated cartoons came principally as short subjects. Virtually all major film production companies had units assigned to develop and produce shorts, and many companies, especially in the silent and very early sound era, produced mostly or only short subjects.


title: Short film

text: In the 1930s, the distribution system changed in many countries, owing to the Great Depression. Instead of the cinema owner assembling a program of their own choice, the studios sold a package centered on a main and supporting feature, a cartoon and little else. With the rise of the double feature, two-reel shorts went into decline as a commercial category. Hal Roach, for example, moved Laurel and Hardy full-time into feature films after 1935, and halved his popular "Our Gang" films to one reel. By the 1940s, he had moved out of short films altogether (though Metro-Goldwyn-Mayer continued the Our Gang shorts until 1944).


title: Short film

text: Later shorts include George O'Hanlon's "Joe McDoakes" movies, and the animated work of studios such as Walt Disney Productions and Warner Bros. Cartoons. By the mid-1950s, with the rise of television, the commercial live-action short was virtually dead, The Three Stooges work being the last major series of 2-reelers, ending in 1959. Short films had become a medium for student, independent and specialty work.


title: Short film

text: Cartoon shorts had a longer life, due in part to the implementation of lower-cost limited animation techniques and the rise of television animation, which allowed shorts to have both theatrical runs and a syndication afterlife. Warner Bros., one of the most prolific of the golden era, underwent several reorganizations in the 1960s before exiting the short film business in 1969 (by which point the shorts had been in televised reruns for years). MGM continued "Tom and Jerry" (first with a series of poorly-received Eastern European shorts by Gene Deitch, then a better-received run by Warner Bros. alumnus Chuck Jones) until 1967, and Woody Woodpecker lasted to 1972; the creative team behind MGM's 1940s and 1950s cartoons formed Hanna-Barbera Productions in 1957, mainly focusing on television. "The Pink Panther" was the last regular theatrical cartoon short series, having begun in 1964 (and thus having spent its entire existence in the limited animation era) and ended in 1980. By the 1960s, the market for animated shorts had largely shifted to television, with existing theatrical shorts being syndicated to television.


title: Short film

text: A few animated shorts continue within the mainstream commercial distribution. For instance, Pixar has screened a short along with each of its feature films during its initial theatrical run since 1995 (producing shorts permanently since 2001). Since Disney acquired Pixar in 2006, Disney has also produced animated shorts since 2007 with the Goofy short "How to Hook Up Your Home Theater" and produced a series of live-action ones featuring The Muppets for viewing on YouTube as viral videos to promote the 2011 movie of the same name.


title: Short film

text: DreamWorks Animation often produces a short sequel to include in the special edition video releases of major features, and are typical of a sufficient length to be broadcast as a TV special, a few films from the studio have added theatrical shorts as well. Warner Bros. often includes old shorts from its considerable library, connected only thematically, on the DVD releases of classic WB movies. From 2010-2012, Warner Bros. also released new "Looney Tunes" shorts before family films.


title: Short film

text: Shorts International and Magnolia Pictures organize an annual release of Academy Award-nominated short films in theatres across the US, UK, Canada and Mexico throughout February and March.


title: Short film

text: Shorts are occasionally broadcast as filler when a feature film or other work doesn't fit the standard broadcast schedule. ShortsTV was the first television channel dedicated to short films.


title: Short film

text: However, short films generally rely on film festival exhibition to reach an audience. Such movies can also be distributed via the Internet. Certain websites which encourage the submission of user-created short films, such as YouTube and Vimeo, have attracted large communities of artists and viewers. Sites like Omeleto, FILMSshort, Short of the Week, Short Films Matter, Short Central and some apps showcase curated shorts.


title: Short film

text: Short films are a typical first stage for new filmmakers, but professional actors and crews often still choose to create short films as an alternative form of expression. Amateur filmmaking has grown in popularity as equipment has become more accessible.


title: Short film

text: The lower production costs of short films often mean that short films can cover alternative subject matter as compared to higher budget feature films. Similarly, unconventional filmmaking techniques such as Pixilation or narratives that are told without dialogue, are more often seen in short films than features.


title: Short film

text: Tropfest claims to be the world's largest short film festival. Tropfest now takes place in Australia (its birthplace), Arabia, the US and elsewhere. Originating in 1993, Tropfest is often credited as being at least partially responsible for the recent popularity of short films internationally. Also Couch Fest Films, part of Shnit Worldwide Filmfestival, claimed to be the world´s largest single-day short film festival.


title: Short film

text: Among the oldest film festivals dedicated to short films are Clermont-Ferrand International Short Film Festival, France (since 1979), Tampere Film Festival, Finland (since 1969) and International Short Film Festival Oberhausen, Germany (since 1954). All of them are still considered the most important short film festival in the world to date.


title: Short film

text: Short Film Conference (SFC) has been in existence since 1970 as a non-profit organization to unite the global short film community. Its network consists of hundreds of members representing over 40 countries from all over the globe. SFC’s activities range from organizing industry events and the annual conference to monitoring and researching the short film industry, informing its professionals & lobbying for the rights of short films and their creators. The Short Film Conference’s Code of Ethics offers guidelines for short film festivals to consider.


title: Short film

text: Very short films, often referred to as "short shorts", are sometimes considered in a category of their own. The International Festival of Very Shorts, based in Paris, only shows movies less than three minutes long. Filminute, the international one-minute film festival, has presented and promoted a collection of one-minute films across multiple media since September 2006.


title: Naver

text: Naver (Hangul: 네이버) is a South Korean online platform operated by the Naver Corporation. It was launched in 1999 as the first web portal in South Korea to develop and use its own search engine. It was also the world's first operator to introduce the comprehensive search feature, which compiles search results from various categories and presents them in a single page. Naver has since added a multitude of new services ranging from basic features such as e-mail and news to the world's first online Q&A platform Knowledge iN.


title: Naver

text: As of September 2017, the search engine handled 74.7% of all web searches in South Korea and had 42 million enrolled users. More than 25 million Koreans have Naver as the start page on their default browser and the mobile application has 28 million daily visitors. Naver has also been referred to as 'the Google of South Korea'.


title: Naver

text: Owing to its rising popularity in Japan, Naver is now competing with Kakao to claim position in Japanese market of web novel and web comic.


title: Naver

text: Naver was created in June 1999 as the first South Korean portal website with a self-developed search engine. In August 2000, Naver began the 'comprehensive search' service, which allows users to get a variety of results from a search query on a single page, organized by type, including blogs, websites, images, web communities, etc. This was five years before Google launched a similar offer with its 'universal search' function.


title: Naver

text: In the early days of Naver's operation, there was a relative dearth of web pages available in the Korean language. To fill this void, Naver became an early pioneer in user-generated content through the creation of the 'Knowledge iN (Hangul: 네이버 지식인)' service in 2002. In Knowledge iN, users can pose questions on any subject and select among answers provided by other users, awarding points to the users who gives the best answers. Knowledge iN was launched three years before Yahoo! launched its similar 'Yahoo! Answers' service, and now possesses a database of over 200 million answers.


title: Naver

text: Over the years, Naver has continued to expand its services. It launched its Web comic service 'Webtoon' in 2004 and its personal Blog service in 2005. From 2005 to 2007, Naver expanded its multimedia search services, including music and video search as well as mobile search.


title: Naver

text: In 2019, Naver reorganized its mobile version of the main screen, excluding search windows and some menus. In response more than 3,000 comments opposing the change have been posted.


title: Naver

text: Naver introduced new restrictions on comments to protect celebrities from malicious comments by anonymous online audiences in March, 2020. This followed a 2019 incident where a famous singer-actress Sulli committed suicide due to depression after facing a huge amount of malicious comments. Naver also replaced the comment box with facial emojis after criticisms of mental health implications for celebrities.


title: Naver

text: In October 2020, Naver was fined 26.7 billion won ($22.9 million) by South Korea's Fair Trade Commission (FTC) for manipulating its algorithm between 2012 and 2015 in favor of its own services such as Smart Store and Naver TV over services provided by rivals. Naver's share in the open market sector increased from 4.97% in 2015 to 21.08% in 2018, while competitors' market shares went down.


title: Naver

text: Junior Naver (Hangul: 쥬니어 네이버), also known as Juniver (Hangul: 쥬니버), is a portal website for children considered similar to Yahooligans. Junior Naver offers services such as avatars, educational content, quizzes, videos, Q&A, and a homework helper. Junior Naver uses a panel of experts and educators to filter out harmful content in order to ensure a safe internet environment for children. Ever since its competitors Daum Kids and Yahoo Kids have closed down, Junior Naver is the only children's portal site operating in Korea.


title: Naver

text: Naver Webtoon (Hangul: 네이버 웹툰), later simply WEBTOON, is a webcomic platform where users have free access to a variety of webtoons created by professional artists. Users can also pay publishers to view comic books and genre fiction contents online. Naver has incorporated a 'Challenge' section which allows amateurs to post and promote their own works. These days, there are a number of k-dramas that are motivated by these webtoons.


title: Naver

text: Naver Cafe (Hangul: 네이버 카페) is a service that allows Naver users to create their own internet communities. There were 10.5 million cafes running as of May 2017. One person can make up to 300 cafes.


title: Naver

text: Naver Blog (Hangul: 네이버 블로그) started with the name 'paper' in June 2003, and evolved to 'blog' in October 2003. It had 23 million users as of April 2016.


title: Naver

text: For two weeks from May 1, 2021, Naver held an event to pay up to 16,000 won to people who posted on Naver blog every day. However, this event was ended early due to a number of incidents where people with multiple IDs. Most people who participated in the event criticized Naver's response.Naver announced on its official blog that it would resume its "Today's Diary Challenge (Korean: #오늘일기챌린지)" event, which ended early in three days, from May 24. However, only those who participated in the previously discontinued event (who completed the three-day record) can participate in the event.Naver announced on May 13, 2021, that it would show profile pictures as well if it posts comments on Naver news articles. Previously, it was difficult to recognize users because only four digits in front of the author's ID who commented on Naver news articles were disclosed. Naver expected that it would be easier to recognize users and solve the problem of malicious comments by implementing such services. Critics criticized the company for its censorship of comments.


title: Naver

text: Naver NOW (formerly Naver TV) is a video streaming and share platform which mainly provides web dramas distributed by Naver. Naver NOW was served as the replacement for the Naver TV mobile app while Naver TV was currently serve as web portal.


title: Naver

text: Naver Pay (네이버페이) is an payment service by Naver Financial, a subsidiary company of Naver launched on June 25, 2021. It first started as a payment service for Naver Shopping, but now offers payments in over 97,000 stores both online, and offline and in December 20, started supporting Zero Pay in-app, a government funded payment service. In May 2019, Naver started supporting oversea payment in Japan via Line Pay, allowing users to make payments in stores in Japan without exchanging currencies.


title: Naver

text: Knowledge iN (Hangul: 지식iN), formerly Knowledge Search (Korean:지식검색), is an online Q&A platform launched in October 2002. The tool allows users to ask any question and to receive answers from other users. Knowledge iN was an early example of harnessing user-generated content to expand the amount of information available on the web, particularly in the Korean language. Bradley Horowitz, former Vice President of Product Strategy at Yahoo!, has cited Knowledge iN as the inspiration for Yahoo! Answers, which was launched three years after Naver introduced the original service.


title: Naver

text: Naver helps with unauthorized publishing in order to attract users to its Knowledge iN service. This contributes to poor quality content on Knowledge iN, as prior answers to a question are left unaltered, and old questions are only allowed small modifications by other netizens. Criticism is also growing as Naver unilaterally controls comments, and edits information that may be against its political positions.


title: Naver

text: Naver Encyclopedia (Hangul: 네이버 사전) consists of a professional database with over 3 million entries from many different encyclopedias. More than 1000 experts in physics, food, film, and other fields are producing 45 kinds of specialized content in the encyclopedia of Naver knowledge, and 50,000 headwords are accumulated. The Naver Knowledge Encyclopedia also deals with more than 100 public institutions and has received over 900 kinds of DBs.


title: Naver

text: Naver Mail (Hangul: 네이버 메일) is an e-mail service that anyone who is a user of Naver can use. Each person is given up to 5GB of storage.


title: Naver

text: PRISM Live Studio (Hangul: 프리즘 라이브 스튜디오) is a live streaming application for both mobile and PC. Streamers can simultaneously broadcast to multiple platforms, also known as simulcasting, while using up to 1080p HD all without increasing the network usage. Platforms supported includes YouTube, Facebook, Twitch, Periscope, V Live, Naver TV, afreecaTV, KakaoTV and RTMP channels. The application can also be used for video editing purposes.


title: Naver

text: Naver's closed platform is frequently mentioned. Other search engines are not allowed to search their knowledge base and blogs, monopolizing Naver's control over its properties. In April 2011, the second and third portal sites in Korea, Daum and Nate, signed a Memorandum of Understanding (MoU) to open their search for services such as cafe and blogs. Naver did not choose to participate in this MoU.


title: Naver

text: Naver had been criticized because they abused Real-time Search Terms (Korean: 급상승 검색어) to create public opinion. Therefore, Naver abolished Real-time Search Terms on 25 February 2021.


title: Naver

text: Person-related Search Terms (Korean: 인물 연관 검색어) of Naver had been criticized because of the tendency to include defamatory searches. Naver abolished Person-related Search Terms in March 2021.


title: Naver

text: Comparison between Google and Naver (Korean: 구글 네이버 비교) A Korean reporter is giving a detailed comparison between Google and Naver. There are differences with each advantage.


title: Obstetrics and gynaecology

text: Obstetrics and Gynaecology (also spelled as Obstetrics and Gynecology; abbreviated as Obs and Gynae, O&G, OB-GYN and OB/GYN) is the medical specialty that encompasses the two subspecialties of obstetrics (covering pregnancy, childbirth, and the postpartum period) and gynecology (covering the health of the female reproductive system – vagina, uterus, ovaries, and breasts).


title: Obstetrics and gynaecology

text: Postgraduate training programs for both fields are usually combined, preparing the practising obstetrician-gynecologist to be adept both at the care of female reproductive organs' health and at the management of pregnancy, although many doctors go on to develop subspecialty interests in one field or the other.


title: Obstetrics and gynaecology

text: According to the American Board of Obstetrics and Gynecology (ABOG), which is responsible for issuing OB-GYN certifications in the United States, the first step to OB-GYN certification is completing medical school to receive an MD or DO degree. From there doctors must complete a four-year OB-GYN residency program approved by the Accreditation Council for Graduate Medical Education (ACGME). For the 2021 Electronic Residency Application Service (ERAS) match, there were 277 OB-GYN residency programs accepting applicants.


title: Obstetrics and gynaecology

text: In their fourth year of residency, with an affidavit from their director to confirm program completion, OB-GYN residents can choose whether to begin the board certification process by applying to take the ABOG Qualifying Exam, which is a written test. If residents pass the Qualifying Exam, demonstrating they possess the knowledge and skills to potentially become certified OB-GYNs, they are then eligible to sit for the oral Certification Exam. Prior to the Certification Exam, residents must also gather a list of patient cases they've worked on throughout their residency in order to demonstrate their competence and experience in OB-GYN patient care.


title: Obstetrics and gynaecology

text: Residents then sit for the three-hour oral exam at ABOG's test center, and if they pass the exam they become "board certified" OB-GYNs. Since 2013 at least 82% of all Certifying Exam examinees have passed.


title: Obstetrics and gynaecology

text: This adds up to 11–14 years of education and practical experience. The first 7–9 years are general medical training.


title: Obstetrics and gynaecology

text: Experienced OB-GYN professionals can seek certifications in sub-specialty areas, including maternal and fetal medicine. See Fellowship (medicine).


title: Obstetrics and gynaecology

text: All doctors must first complete medical school and obtain a MBBS or equivalent certification. This portion typically takes five years. Following this, they are eligible for provisional registration with the General Medical Council. They then must complete a two years of foundation training. After the first year of training is complete, trainees are eligible for full registration with the General Medical Council. After the foundation training is complete applicants take the Part 1 MRCOG examination administered by the Royal College of Obstetricians and Gynaecologists. There are an additional seven years of training after this, and two more exams (Part 2 and Part 3 MRCOG exams) which adds up to nine years total minimum in training, although some trainees may take longer.


title: Obstetrics and gynaecology

text: Of these, only the first four are truly recognized sub-specialties by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Obstetrics and Gynecology (ABOG). The other subspecialties are recognized as informal concentrations of practice. To be recognized as a board-certified subspecialist by the American Board of Obstetrics and Gynecology or the American Osteopathic Board of Obstetrics and Gynecology, a practitioner must have completed an ACGME or AOA-accredited residency and obtained a Certificate of Added Qualifications (CAQ) which requires an additional standardized examination.


title: Obstetrics and gynaecology

text: Additionally, physicians of other specialties may become trained in Advanced Life Support in Obstetrics (ALSO), a short certification that equips them to better manage emergent OB/GYN situations.


title: Obstetrics and gynaecology

text: There is no global standard, or national U.S. standard, for OB-GYN curricula, during or after residency. Hospitals and universities implement their care and provider education with different priorities in mind, some institutions focusing on following the requirements from their governing body while others go beyond the set standards to set a precedent with the care they offer.


title: Obstetrics and gynaecology

text: However, the American College of Obstetrics and Gynecology (ACOG) encourages OB-GYN care providers to offer care that is inclusive to all individuals, in the context of providing a safe space for lesbian and bisexual women, and transgender and gender diverse individuals. ACOG shares this recommendation through a series of Committee Opinions, the latest of which are #525 and #823, published 2012 and 2021 respectively. ACOG's first comment on the need for LGBTQ+ inclusive care from OB-GYNs came in 2011 through Committee Opinion #512, "Healthcare for Transgender Individuals", which has since been withdrawn and replaced by 2021 opinion #823.


title: Obstetrics and gynaecology

text: Transgender, nonbinary people, and lesbian or bisexual women frequently face additional challenges—including structural and overt discrimination, accessing insurance coverage stigma, and cisnormativity—when attempting to access gynecologic and reproductive healthcare services and providers. Obstetrics and gynecology is a field thought of as traditionally serving women because of its focus on the female reproductive system, leading care providers to make assumptions about patients' gender identity and expression in "women's health clinics" when many transgender or nonbinary patients may also seek care from OB-GYNs. Additionally, LGBTQ+ patients are at risk for and experience unique health conditions which care providers may not be prepared to address—i.e. the providers lack cultural competence—without LGBTQ+ specific healthcare training.


title: Obstetrics and gynaecology

text: Interactions with care providers who are not prepared or knowledgeable enough to offer comprehensive and effective care can compound the "negative and traumatic experiences that many nonbinary and transgender people have had when accessing care", and drive them away from seeking necessary healthcare in the future. Even if transgender or nonbinary patients have not had a personally negative of traumatic experience, collective trauma can also play into a fear of medical settings and providers. This results in nearly 25% of transgender or nonbinary people reporting avoidance of healthcare services out of fear of being mistreated for their gender. Care typically offered by OB-GYNs, like pelvic exams and procedures, can be "particularly difficult or traumatic" for transgender and nonbinary patients, which the provider can offset by engaging a trauma-informed care approach to exams.


title: Obstetrics and gynaecology

text: More research is gradually being done to establish the need for an LGBTQ+ healthcare curriculum for all medical students, residents, and doctors. Multiple researchers have also suggested that obstetrics & gynecology is the ideal field for this education to initially be implemented, since the nature of OB-GYN work ties it more directly to gender than other medical specialties. OB-GYNs also historically have more cultural competency training around gender based issues.


title: Obstetrics and gynaecology

text: If providers are not educated on LGBTQ+ healthcare they will not be aware of some of the health risks LGBTQ+ patients may be more vulnerable too, placing their patients at greater risk. Common chronic diseases the LGBTQ+ population is at risk for:


title: Obstetrics and gynaecology

text: Most OB-GYN programs have a flexible curriculum that offers learning in a variety of contexts, including small group discussions, case study discussions, and structured patient exams. The multifaceted nature of this teaching structure makes it easier for programs to begin initiating LGBTQ+ healthcare instruction in informal voluntary contexts, while simultaneously advocating for long-term structural change that would incorporate LGBTQ+ healthcare into all OB-GYN and medical school curricula.


title: Obstetrics and gynaecology

text: When initially instituting a LGBTQ+ healthcare curricula for OB-GYN residents or professionals, the Association of Professors of Gynecology and Obstetrics' (APGO) Undergraduate Medical Education Committee (UMEC) recommends that topics like patient education, screening standards, and common chronic diseases in the LGBTQ+ population are prioritized to ensure comprehensive and effective care for LGBTQ+ patients.


title: Obstetrics and gynaecology

text: APGO's UMCE poses that academic health centers are in an ideal position to drive the "curricular change that is needed to remove health disparities" for all patient populations in the LGBTQ+ community.


title: Obstetrics and gynaecology

text: Although not a requirement within the ACGME's standards for American OB-GYN residency programs curriculum, LGBTQ+ healthcare education is established in some OB-GYN residency programs throughout America. A web-based survey of approximately 100 Illinois OB-GYN residents a survey study found that 62% of their programs had spent 1-5 hours in the past year educating residents about lesbian and bisexual health, and 63% of the their programs had spent 1-5 hours in the past year educating residents about transgender health.


title: Obstetrics and gynaecology

text: APGO's UMEC identifies the third year of residency or "clerkship" as an ideal time to institute education if it hasn't already occurred, and ideally to reinforce competencies with LGBTQ+ patients through clinical experiences.


title: Obstetrics and gynaecology

text: In addition to instituting new educational policies for current and future OB-GYN residents, many programs are also looking to educate OB-GYNs that are already certified.


title: Obstetrics and gynaecology

text: For example, the University of Michigan OB-GYN program utilizes what they name "Continuing Medical Education" to instruct their OB-GYN care providers on the nuances of caring for transgender patients. Daphna Strousma, MD, MPH, is responsible for instituting and developing UM's transgender healthcare curriculum—"Improving Care for Transgender & Non-Binary Individuals"—in coordination with Michigan Medicine and the Council on Resident Education in Obstetrics and Gynecology (CREOG). The curriculum is offered to UM's OB-GYNs through a series of video modules covering the following topics: