title: Scharnhorst-class battleship

text: "Scharnhorst" was powered by three Brown, Boveri, & Co geared steam turbines, while "Gneisenau" was equipped with three Germania geared turbines. The turbines drove three-bladed screws that were in diameter. Steam was provided to the turbines by 12 Wagner ultra-high-pressure oil-fired water-tube boilers, which produced pressures up to and temperatures up to . The engines were rated at at 265 revolutions per minute (rpm), and on trials produced up to at 280 rpm. When steaming in reverse, the engines were rated for . The ships had a designed speed of ; on trials both vessels beat their designed speeds—"Scharnhorst" hit and "Gneisenau" made . The ships carried of fuel oil as designed; additional storage areas, including hull spaces between the belt and torpedo bulkhead, increased capacity to . At maximum fuel load, the ships were expected to steam for at a cruising speed of ; "Scharnhorst" reached only at 19 knots, while "Gneisenau" managed only at that speed.


title: Scharnhorst-class battleship

text: Electrical power was supplied to the ships by five electricity plants. Each plant consisted of four diesel generators and eight turbo-generators. The four diesel generators were divided into pairs: two provided 150 kilowatts each and two supplied 300 kW each. The eight turbo-generators were also of mixed capacity; six ran supplied 460 kW each and the remaining two provided 230 kW each. Total power output was 4,120 kW at 220 volts.


title: Scharnhorst-class battleship

text: The "Scharnhorst"-class ships were built with a main battery of nine 28.3 cm (11.1 inch) SK C/34 54.5 caliber quick-firing guns in three triple turrets, two forward and one aft. These guns were an improvement over the earlier 28.3 cm SK C/28 guns mounted on the "Deutschland"-class cruisers. While the 28.3 cm guns were of a smaller caliber than main guns of other navies, they were still preferred by a number of gunnery officers in the "Kriegsmarine" due to their higher rate of fire. The guns were equipped with three different types of shells, an armor-piercing (AP) L/4,4 shell that weighed 330 kg (727.5 lb) and two high explosive (HE) shells that both weighed 315 kg (694.4 lb)—an L/4,4 type with a base fuse and an L/4,5 version with a nose fuse. All three types of shells used the same propellant charges: an RPC/38 42.5 kg (93.7 lb) fore charge and an RPC/38 76.5 kg (168.6 lb) main charge. They fired these shells at a rate of fire of 3.5 rounds per minute. Muzzle velocity for the AP shells was 890 meters per second (2,920 feet per second); the guns were expected to fire 300 rounds before enough wear had been incurred to warrant replacement. "Scharnhorst"s and "Gneisenau"s guns were mounted in three Drh LC/34 turrets. The turrets were named, in alphabetical order from the bow of the ship: "Anton", "Bruno" and "Cäsar". Similarly to most other German installations, those turrets had an electric system of rotation, but all other operations were hydraulic systems. The rotating mass of the turret was 750 tons (internal barbette diameter 10.2 m), and traversing speed was 7.2 deg/sec. The turrets allowed depression of the guns to −8° and elevation to 40° for "A" and "C" turrets; "B" turret was capable of depressing to −9°. At maximum elevation, the guns could hit targets out to 40,930 m (44,760 yards).


title: Scharnhorst-class battleship

text: The ships carried a secondary battery of twelve 15 cm SK C/28 L/55 quick-firing guns. The guns were mounted in four Drh L. C/34 twin turrets and four MPL/35 pedestal mounts. Both the turrets and pedestal mounts enabled barrel depression to −10°; the turrets allowed elevation to 40° while the pedestals limited it to 35°. These guns fired 45.3 kg (99.87 lb) shells at a rate of 6–8 per minute. They were expected to fire 1,100 rounds before barrel wear made repair or replacement necessary. The guns in pedestals had a range of 22,000 m (24,060 yd), while those in the turrets, capable of 5 more degrees of elevation, had a slightly longer range, at 23,000 m (25,153 yd). They were supplied with between 1,600 and 1,800 shells, or 133–150 shells per gun.


title: Scharnhorst-class battleship

text: Their anti-aircraft battery consisted of fourteen 10.5 cm C/33 L/65 guns, sixteen 3.7 cm L/83 guns, and between ten and twenty 2 cm guns. The 10.5 cm guns fired at a rate of 15–18 rounds per minute, and had an effective ceiling of 12,500 m (41,010 feet). They were mounted in six Dop. L. C/31 twin mounts amidships, and one such mount superfiring over "C" turret, which allowed depression to −8° and elevation to 80°. When used to engage surface targets, the guns had a maximum range of 17,700 m (19,357 yd) at an elevation of 45°. The 3.7 cm guns were placed in eight manually operated Dopp LC/30 twin mounts. At 85°, they had an effective ceiling of 6,800 m (22,310 ft), though tracers were limited to 4,800 m (15,750 ft). They had a rate of fire of 30 rounds per minute.


title: Scharnhorst-class battleship

text: After 1942, six 53.3 cm deck-mounted torpedo tubes were taken from the light cruisers and and installed on the ships, with storage for 18 G7a torpedoes.


title: Scharnhorst-class battleship

text: Both "Scharnhorst" and "Gneisenau" were equipped with two sets of "Seetakt" radar. One was mounted on the forward gun director, which was located on top of the bridge. The second radar set was emplaced on the rear main battery gun director. The "Seetakt" sets operated at 368 megacycles (MHz.), initially at 14 kW. The sets were later upgraded to operate at 100 kW, on the 80 cm wavelength (375 MHz.).


title: Scharnhorst-class battleship

text: The "Scharnhorst"-class ships were equipped with Krupp armor. Their upper armored deck was thick, and backed by the main armor deck. This deck was thick aft, increased to 50 mm in the central portion of the ship that contained the ammunition magazines and machinery spaces, and decreased down to 20 mm in the bow. It was supported by thick slopes on either longitudinal side. The slopes connected to the lower edge of the main belt, an arrangement referred to as the "turtle deck." The slopes significantly increased armor protection in the critical areas of the ship. The ships' vitals were well armored against any caliber shell fired by battleships at the time at ranges where the shell would have to penetrate both the main belt and the sloping deck. At very long ranges, the deck armor could be easily penetrated by heavy-caliber shells. All of these sections were composed of "Wotan Hart" (Wotan Hard) steel. The armored belt was thick in the central portion of the ship, where the critical areas of the ship were located. Forward of the "A" turret the belt was reduced to , which tapered down to zero at the bow of the ship. Aft of the rear gun turret the belt decreased to , and eventually tapered down to nothing at the stern. The central portion of the belt was backed by thick shields. The belt armor was composed of Krupp Cemented steel (KC). The side protection system could not be penetrated by a 16 in (406 mm) shell at any range over .


title: Scharnhorst-class battleship

text: The forward conning tower had 350 mm-thick sides and a roof that was 200 mm-thick. The rear conning tower was less well armored, with sides and a roof that were only and 50 mm thick, respectively. The gun turrets for the main battery had thick faces, 200 mm thick sides, and 150 mm thick roofs. The barbettes that held the 28 cm gun turrets were also heavily armored; the sides were 350 mm thick and tapered down to 200 mm on the centerline, where they were shielded by the gun turrets above. The faces of the 15 cm turrets were thick, with thick sides and 50 mm thick roofs. The 10.5 cm gun mounts were equipped with gun shields. All of this armor was KC steel.


title: Scharnhorst-class battleship

text: The underwater protection system was designed to withstand a direct hit from a explosive warhead; British aerial torpedoes had smaller warheads than this, but their ship-launched weapons were more powerful. The navy conducted several full-scale underwater explosion tests with sections of armor cut from the old pre-dreadnought . The tests revealed that welded steel construction better withstood the impact of the 250 kg warhead than did riveted steel plates. The torpedo bulkhead, composed of "Wotan Weich" (Wotan, soft) steel, placed behind the armored belt was riveted; this was done because plate joints that had been incorrectly welded would not sufficiently withstand explosive shocks. The underwater protection system was constructed out of several layers: the outer layer that was between 12 and 66 mm (.47–2.6 in) thick, directly underneath the main armored belt, was designed to detonate the torpedo warhead. Behind the outer plate was a large void which would allow gases from the explosion to expand and dissipate. Beyond this was a fuel bunker with an thick outer wall; this would absorb any remaining explosive force. The bunker was supported by longitudinal stiffeners and transverse bulkheads.


title: Scharnhorst-class battleship

text: The underwater side protection had numerous faults. It was extremely strong amidships, but weakened on either end of the citadel. The underwater protection could stop only a warhead in these areas. Another significant weakness in the design was the arrangement of the torpedo bulkhead. It was connected to the lower portion of the sloped deck, at an angle of 10°; two riveted angled bars held it in place. The bars were constantly under a great deal of stress, due to normal bending forces in the hull. When combined with the explosive force of a torpedo warhead, the bars could not sustain the increased pressure and could fail. Also, the beam of 30 m meant that the protection system had to be weaker around the main battery turrets, as a significant amount of the hull space was taken up by the magazines and barbettes.


title: Scharnhorst-class battleship

text: "Gneisenau" was laid down on 3 May 1935 at the "Deutsche Werke" in Kiel. She was launched on 8 December 1936, and completed on 21 May 1938. During her launch, the ship sustained minor damage to her stern; the chains slowing her slide down the slipway broke, and the ship drifted too far and became beached on the opposite shore. After her commissioning, "Gneisenau" spent the first year of her career conducting trials and training cruises in the Baltic Sea. The cruises revealed the wetness of the bow and bridge; in January 1939 her "Atlantic bow" was installed. "Scharnhorst" was laid down at the "Kriegsmarinewerft" in Wilhelmshaven, on 16 May 1935. She was launched on 30 June 1936 and completed on 7 January 1939. In mid 1939, the ship conducted trials in the Baltic Sea; as with "Gneisenau", the ship's low freeboard necessitated the installation of the "Atlantic bow", which was completed in August 1939. During that refit, a large hangar for the ship's aircraft was added amidships. The ship emerged from the dockyard in October.


title: Scharnhorst-class battleship

text: On 21 November, "Scharnhorst", "Gneisenau", the light cruisers and "Leipzig", and several destroyers conducted a sweep between Iceland and the Faroe Islands; during the operation, the German ships encountered the British armed merchant cruiser ; "Scharnhorst" sank the ship, but in the process sustained a hit from one of "Rawalpindi"s 152 mm guns. "Scharnhorst" stopped to pick up survivors, but the arrival of the cruiser prompted the German ships to withdraw.


title: Scharnhorst-class battleship

text: On 7 April 1940, "Scharnhorst" and "Gneisenau" formed the primary covering force for the invasions of Narvik and Trondheim in Norway during Operation Weserübung. At 04:30 on 9 April, the "Seetakt" radar on "Gneisenau" picked up a contact, beginning the action off Lofoten; both ships went to battle stations. Half an hour later, muzzle flashes were observed, from what turned out to be the old battlecruiser which had been part of the cover for a British minelaying operation. The British battlecruiser initially targeted "Gneisenau", at a range of . In the span of five minutes, "Gneisenau" hit "Renown" twice, but sustained one 15" and two 4.5" hits in return. One of the two 4.5" hits disabled "Gneisenau"s A turret, The 15" hit destroyed the main armament fire control station, and knocked out her "Seetakt" radar. "Scharnhorst"s gunnery radar suffered technical problems, which prevented her from effectively engaging "Renown". The British ship engaged "Scharnhorst" for a brief period starting at 05:18, but effective maneuvering by "Scharnhorst" allowed her to escape unscathed. Fears that the destroyers escorting "Renown" might make a torpedo attack prompted the German commander to break off the engagement. By 07:15, the German ships had escaped from the slower "Renown". In the course of their escape "Scharnhorst" suffered from damage to her A turret caused by the heavy seas coming over her bows. "Scharnhorst" and "Gneisenau" rendezvoused with the heavy cruiser before proceeding to Wilhelmshaven.


title: Scharnhorst-class battleship

text: "Scharnhorst" and "Gneisenau", with "Admiral Hipper" and four destroyers, departed again on 4 June. After operations in the North Sea that resulted in the sinking of several British transports, "Admiral Hipper" and the destroyers were detached to refuel in occupied Norway. At 16:45 on 8 June, "Scharnhorst" and "Gneisenau" spotted the British aircraft carrier , which was escorted by the destroyers and , at a range of around . The destroyers laid a smoke screen in an attempt to hide the carrier, but the Germans quickly closed the distance. At 17:26, the range had decreased by half, to around , and both German ships opened fire. "Scharnhorst" struck "Glorious" at a range of approximately , one of the longest recorded hits in the history of naval gunfire. "Glorious" was hit by at least three shells and reduced to a burning hulk, and at 19:00 the carrier capsized and sank. "Scharnhorst" shifted fire to "Ardent" while "Gneisenau" engaged "Acasta"; both ships sank their targets. Before she sank, "Acasta" launched four torpedoes at "Scharnhorst"; the ship evaded three, but the fourth struck the starboard side near the rear gun turret. During the engagement, "Scharnhorst" fired 212 main battery shells. The torpedo hit caused significant damage to "Scharnhorst"; several watertight compartments, including parts of the starboard engine room, were flooded, she took on a list of 3°, and she was down by the stern.


title: Scharnhorst-class battleship

text: The two ships withdrew to Trondheim, though "Scharnhorst" was limited to a speed of —they arrived in the afternoon of 9 June. On 11 June, 12 Hudson bombers from the RAF attempted to bomb "Scharnhorst"; they all missed their target. Another air raid, this time 15 Blackburn Skuas launched by the Royal Navy's , followed on 13 June. The "Luftwaffe" intercepted the raid and shot down eight of the aircraft; seven made it through to the ship. Only one bomb found its mark, but it failed to explode. On 20 June, enough repair work had been done to permit the ship to sail down to Kiel. Two air attacks followed, but anti-aircraft fire from "Scharnhorst" and her escorts drove them both back. Reports of British ships in the area forced the ship to seek refuge in Stavanger for two days, before she resumed the journey to Kiel. Repairs were effected over the following six months.


title: Scharnhorst-class battleship

text: Under the command of Admiral Günther Lütjens, "Scharnhorst" and "Gneisenau" broke into the Atlantic in late January 1941 to raid convoys between North America and Great Britain. On 8 February, they spotted a convoy, HX 106, but it was escorted by the battleship , armed with eight 38 cm (15 in) guns. The German ships therefore broke off the attack. A second convoy was encountered on 22 February; "Scharnhorst" sank the tanker "Lustrous", while "Gneisenau" accounted for four cargo ships. On 8 March, "Scharnhorst" spotted another convoy, but it too had battleship protection, in the form of . A week later, on the 15th, another convoy was intercepted; "Scharnhorst" sank two vessels while "Gneisenau" captured three and sank one. Following the engagement, "Scharnhorst" and "Gneisenau" headed for Brest in occupied France; they arrived on 22 March. "Scharnhorst" had suffered repeated problems with defective superheater tubes in her boilers and this needed the repair facilities that existed in the French naval dockyard.


title: Scharnhorst-class battleship

text: Brest was comfortably within range for air attack from Britain. A series of raids started on 30 March. On 6 April, four Beaufort torpedo-bombers attacked "Gneisenau" after she had been moved to a buoy from dry dock. One of the attacking aircraft was successful; the hit did significant damage to the ship. "Gneisenau" shipped some of water, which caused her to list 2° and settle lower in the water. The shock force of the explosion also did a great deal of internal damage; fuel tanks were ruptured and electrical systems were damaged. A salvage tugboat was brought alongside to assist in flood control. "Gneisenau" was put into dry dock for repairs, which were prolonged by further British air raids. On the night of 9–10 April, British high-level bombers attacked both "Gneisenau" and "Scharnhorst". The latter escaped unscathed, but the former was struck four times; 72 men were killed and another 90 were wounded.


title: Scharnhorst-class battleship

text: "Scharnhorst" completed engine repairs and the retubing of the defective superheaters in July, and after engine trials, was dispersed to La Pallice on 23 July to avoid a concentration of heavy units in Brest. While moored there on 24 July, "Scharnhorst" was attacked by 15 Halifax bombers from 2 squadrons; five bombs—two high explosive and three semi-AP —found their mark. The two 454 kg bombs penetrated both armored decks, all the way down through the double bottom, before coming to rest on the sea floor; they failed to explode. The third also failed to detonate. One of the 227 kg bombs penetrated the upper deck just forward of the rear gun turret, and exploded on the main armored deck. The last bomb fell on the starboard side and also detonated on the main armor deck. The ship listed at 8°, after having taken in between and of water; the list was reduced to 2° by counter-flooding. Casualties amounted to two men killed and 15 wounded. The following day "Scharnhorst" arrived in Brest for repairs, which lasted for four months.


title: Scharnhorst-class battleship

text: In early 1942, the crews of "Scharnhorst", "Gneisenau", and the heavy cruiser made preparations for Operation Cerberus, a daylight dash up the English Channel. The ships were to be redeployed to Norway, to assist in the disruption of convoys to the Soviet Union, as well as the defense of occupied Norway. The risk of further damage from air raids, and the loss of the "Bismarck" and most of the supply ships had forced a change of thinking by the naval staff on the use of these ships for Atlantic sorties. If they could not be evacuated, Hitler ordered that they were to be decommissioned in Brest.


title: Scharnhorst-class battleship

text: The ships left Brest late on 11 February, and remained undetected for the majority of the operation. East of Dover, a flight of six Swordfish torpedo bombers attacked the ships without result. At 15:31, "Scharnhorst" detonated a magnetic mine, which damaged the ship's circuit breakers enough to shut down the entire electrical system. The ship was immobilized briefly—between 15:49 and 16:01, all three turbines were restarted and the ship resumed a speed of . A series of air attacks ensued; through evasive maneuvers, anti-aircraft fire, and "Luftwaffe" fighters, they were all repulsed. By noon on 13 February, "Scharnhorst" had reached Wilhelmshaven. After two days she was transferred to Kiel for repairs, which lasted until July 1942.


title: Scharnhorst-class battleship

text: "Gneisenau" and "Prinz Eugen" had continued their journey to Norway while "Scharnhorst" was immobilized. At 14:45, the ships were attacked by five Whirlwind fighter-bombers—German fighters beat them back. Several more air attacks followed over the next two hours, without success for the British. At 16:17, five British destroyers attempted to torpedo the German ships, but heavy fire from "Gneisenau" and "Prinz Eugen" mauled one and forced the others to turn away. Near Terschelling, "Gneisenau" struck a mine that did minor damage to the hull, and the explosive shock damaged one of her three turbines. Her captain ordered the ship to stop while temporary repairs were conducted, which lasted for about 30 minutes. By 03:50 on 13 February, the ship had reached Helgoland.


title: Scharnhorst-class battleship

text: In January 1943, it was decided to deploy "Scharnhorst" to Norway, along with "Prinz Eugen" and several destroyers. Attempts to sail on 7 and 23 January were aborted after the navy received reports of heavy activity at British air bases in Britain. A third try on 10 February terminated when "Scharnhorst" ran aground while trying to avoid collision with a U-boat. Repairs lasted until 26 February. On 8 March, "Scharnhorst" and four destroyers departed Gotenhafen; she arrived off Narvik on 14 March. For 6 months, fuel shortages curtailed any major operations by "Scharnhorst" or the other ships in Norway, which included the battleship and the heavy cruiser . On 25 November 1943 "Scharnhorst" carried out a two-hour full-power trial, achieving , and it was noted that her draught had increased by over from her 1940 trials, where she had attained .


title: Scharnhorst-class battleship

text: On 20 December 1943, "Scharnhorst" was ordered to intercept the next convoy to the Soviet Union, Convoy JW 55B. The ship was to operate only with five destroyers; "Tirpitz" had been damaged in a British raid in September, and "Lützow" was away for periodic repairs. On 25 December, the location of the convoy was ascertained, and at 19:00 the ship left port, under the command of Rear-Admiral Erich Bey. The British fleet had a significant advantage: they were able to decrypt German naval codes, and were aware of Bey's intentions. The cruisers , , and were positioned to block "Scharnhorst". Admiral Bruce Fraser, aboard the battleship , was some 270 miles away, and steaming to cut off "Scharnhorst" after she was engaged by the three cruisers. "Belfast" picked up "Scharnhorst" on radar at 08:40; forty minutes later lookouts on "Sheffield" spotted the ship, at a distance of . Shortly thereafter, "Belfast" fired star shells to illuminate the target, and "Norfolk" opened fire with her 20.3 cm (8 in) guns; in the span of 20 minutes, she hit "Scharnhorst" twice. The second hit destroyed "Scharnhorst"'s forward Seetakt radar.


title: Scharnhorst-class battleship

text: By 10:00, "Scharnhorst", using her 4–6 knot speed advantage, broke off the engagement and resumed searching for the convoy. At 12:00, "Belfast" again picked up "Scharnhorst", and in 20 minutes were again in range. This time, "Scharnhorst" had better luck with her gunnery; at 12:23, "Norfolk" was hit twice by 28.3 cm shells. One hit disabled a gun turret, and the second tore a hole in the hull and disabled her radar. Near-misses rained shell splinters down on "Sheffield". At 12:41, "Scharnhorst" again increased speed and broke off the engagement. The British shadowed her, and relayed position reports to Admiral Fraser in "Duke of York". At 13:15, Admiral Bey decided to call off the search and return to port. Shortly before 17:00, the British ships closed in: "Belfast" again illuminated the ship with star shells, while "Duke of York" fired salvos from her main battery. A hit from "Duke of York" disabled "A" turret, and at 18:00, another hit penetrated the upper portion of the belt and caused significant damage to the engine room. This hit temporarily reduced her speed to , but repairs quickly allowed her to steam at .


title: Scharnhorst-class battleship

text: Shells from "Scharnhorst's" main guns struck "Duke of York"s mast and disabled her surface radars. The lack of radar forced "Duke of York" to cease fire at 18:24, after having hit "Scharnhorst" at least 13 times. The hits from "Duke of York" disabled most of "Scharnhorst"s armament in the process. Admiral Fraser ordered his destroyers to approach the ship and torpedo her. "Scharnhorst" was hit at least four times by torpedoes fired by and . The hits caused extensive flooding and slowed the ship to . "Duke of York" then closed to to hammer away at the ship. At the time, only "C" turret on "Scharnhorst" remained operational; surviving gun crews transferred ammunition from the disabled "A" and "B" turrets to "C" turret. As more water entered "Scharnhorst", her speed continued to fall to . At 19:25, the light cruiser fired three torpedoes, followed by six from "Belfast". Several destroyers closed in and fired torpedoes as well, though in the smoke and haze, it was unknown how many hit the crippled ship. "Scharnhorst" was listing severely and very low in the water. At 19:45, the ship capsized to starboard and sank, with her propellers still spinning. She sank at the position . Of the crew of 1,968 officers and men, only 36 survived. Rear-Admiral Erich Bey was lost with his ship.


title: Scharnhorst-class battleship

text: "Gneisenau" was also scheduled to deploy to Norway, but she suffered heavy damage during a bombing raid on the night of 26–27 February 1942. A 1000 lb bomb penetrated the armored deck just ahead of the forward turret; shell splinters detonated the ammunition magazine, which did tremendous damage to the bow of the ship and burnt out "A" turret; 112 men were killed and another 21 were injured. It was estimated that it would take two years to make the ship ready for service. Since this was such a long period, it was determined that it would be more efficient if during the repair work, the ship was reconstructed to mount six 38 cm (15 in) guns in place of her 28.3 cm weapons. To accomplish this, the hull would need to be lengthened by to provide additional buoyancy and the electrical system would have to be overhauled. Turrets "B" and "C" were to be removed and transferred to Norway to serve as coastal defense guns.


title: Scharnhorst-class battleship

text: On 4 April, "Gneisenau", along with the icebreaker "Castor" and the old pre-dreadnought departed Kiel for Gotenhafen. Once there, conversion work began: the wrecked bow was removed and her "B" and "C" turrets were removed and disassembled for transport. Krupp would build the new 38 cm turrets, which required strengthening of the barbette structures to support their weight. By early 1943, repair work was largely completed and the ship was ready to receive the improved bow and 38 cm turrets, but this was not to be. The failure of surface units to intercept and destroy a convoy in the Arctic on 31 December 1942 prompted Hitler to order all major surface units to be scrapped. Work on "Gneisenau" ceased, and materials that had been allocated for her repair were diverted to other projects.


title: Scharnhorst-class battleship

text: The ship was then disarmed and all but abandoned in the harbor. Her 15 cm guns were placed as coastal batteries in Denmark. When the Soviet army approached in early 1945, the ship was towed out into the outer harbor and sunk as a block ship, on 23 March 1945. A Polish salvage firm raised the wreck on 12 September 1951 and subsequently broke the ship up for scrap metal. "C" Turret remains in Trondheim, Norway at Austrått Fort; the Norwegian government offered without success to return the turret to Germany for display in a museum. The 15 cm guns in Denmark were taken over by the Danish military; two of the turrets were moved to Stevnsfort in 1952. The guns were put into reserve in 1984, but continued to be fired during annual training. They fired their last shot in 2000, after which the fortress was turned into a museum.


title: The Game discography

text: The discography of American rapper the Game consists of 11 studio albums, six compilation albums, two soundtrack albums, 15 mixtapes, 31 singles (including 15 as a featured artist) and 39 music videos. His music has been released on major record labels Interscope Records, Geffen Records and DGC Records, along with subsidiaries Aftermath Entertainment and G-Unit Records, including independent record labels Get Low Recordz and Fast Life Music, Inc. Records which has released some of his early material.


title: The Game discography

text: The Game's major label debut album, "The Documentary", was released in January 2005 and it produced five singles, including the two US "Billboard" Hot 100 top five singles "How We Do" and "Hate It or Love It", with rapper 50 Cent in which both singles reached gold sales status. The other three singles include "Westside Story" with rapper 50 Cent, "Dreams" and "Put You on the Game". The album reached number one in the US, and shipped over 2 million copies and was certified double platinum by the Recording Industry Association of America (RIAA). After the album's release the Game was considered to be a driving force in reviving and bringing back the West Coast hip hop scene, which had been overshadowed by artists from the East and South. The Game was nominated for two 2006 Grammy Awards: Grammy Award for Best Rap Song and Grammy Award for Best Rap Performance by a Duo or Group for the hit single "Hate It or Love It".


title: The Game discography

text: After the Game had a falling out from Aftermath Entertainment and G-Unit Records, he retained his deal with Interscope Records while merely swapping roofs with subsidiary, Geffen Records. The Game's second album, "Doctor's Advocate", debuted at number one on the US "Billboard" 200 albums chart making it his second number one album in a row, also making it another commercial success with shipping just under 358,000 sales in its first week. "Doctor's Advocate" produced three singles "It's Okay (One Blood)" with reggae singer Junior Reid, "Let's Ride" and "Wouldn't Get Far" with rapper Kanye West. The album was set out by the Game to prove that he was still able to make good music and be a successful artist as he did on "The Documentary" without the help of Dr. Dre or 50 Cent.


title: The Game discography

text: The Game's third album, "LAX", went head to head with heavy metal and nu metal band Slipknot's "All Hope Is Gone" on the "Billboard" 200, as both albums were released on August 26, 2008. "LAX" ended up debuting at Number two on the "Billboard" 200, at first it looked like "LAX" had debuted ahead of "All Hope Is Gone" by 13 copies, with such a close difference. Initially, "Billboard" published an article stating that the Game had secured the top spot with a margin of 13 units, in what was described as the "closest race for number one since Nielsen SoundScan began tracking Data in 1991". Slipknot's labels Warner Music Group and Roadrunner Records asked for a soundscan recount, a historic first. Nielsen proceeded to the recount, which placed "LAX" at number two with 238,382 copies, and Slipknot in first position with 239,516 copies scanned, a margin of 1,134 copies. After the recount 12 hours later, the article was rewritten and Slipknot was awarded the number one spot, having sold 239,516 units. "LAX" produced four singles "Game's Pain" with R&B singer Keyshia Cole, "Dope Boys" with Blink-182 drummer Travis Barker, "My Life" with rapper Lil Wayne and "Camera Phone" with R&B singer Ne-Yo.


title: Phalanx bone

text: The phalanges (singular: "phalanx" ) are digital bones in the hands and feet of most vertebrates. In primates, the thumbs and big toes have two phalanges while the other digits have three phalanges. The phalanges are classed as long bones.


title: Phalanx bone

text: The phalanges are the bones that make up the fingers of the hand and the toes of the foot. There are 56 phalanges in the human body, with fourteen on each hand and foot. Three phalanges are present on each finger and toe, with the exception of the thumb and large toe, which possess only two. The middle and far phalanges of the fifth toes are often fused together (symphalangism). The phalanges of the hand are commonly known as the finger bones. The phalanges of the foot differ from the hand in that they are often shorter and more compressed, especially in the proximal phalanges, those closest to the torso.


title: Phalanx bone

text: A phalanx is named according to whether it is proximal, middle, or distal and its associated finger or toe. The proximal phalanges are those that are closest to the hand or foot. In the hand, the prominent, knobby ends of the phalanges are known as knuckles. The proximal phalanges join with the metacarpals of the hand or metatarsals of the foot at the metacarpophalangeal joint or metatarsophalangeal joint. The intermediate phalanx is not only intermediate in location, but usually also in size. The thumb and large toe do not possess a middle phalanx. The distal phalanges are the bones at the tips of the fingers or toes. The proximal, intermediate, and distal phalanges articulate with one another through interphalangeal joints of hand and interphalangeal joints of the foot.


title: Phalanx bone

text: In the foot, the proximal phalanges have a body that is compressed from side to side, convex above, and concave below. The base is concave, and the head presents a trochlear surface for articulation with the second phalanx. The middle are remarkably small and short, but rather broader than the proximal. The distal phalanges, as compared with the distal phalanges of the finger, are smaller and are flattened from above downward; each presents a broad base for articulation with the corresponding bone of the second row, and an expanded distal extremity for the support of the nail and end of the toe.


title: Phalanx bone

text: In the hand, the distal phalanges are flat on their palmar surface, small, and with a roughened, elevated surface of horseshoe form on the palmar surface, supporting the finger pulp. The flat, wide expansions found at the tips of the distal phalanges are called apical tufts. They support the fingertip pads and nails. The phalanx of the thumb has a pronounced insertion for the flexor pollicis longus (asymmetric towards the radial side), an ungual fossa, and a pair of unequal ungual spines (the ulnar being more prominent). This asymmetry is necessary to ensure that the thumb pulp is always facing the pulps of the other digits, an osteological configuration which provides the maximum contact surface with held objects.


title: Phalanx bone

text: In the foot, the distal phalanges are flat on their dorsal surface. It is largest proximally and tapers to the distal end. The proximal part of the phalanx presents a broad base for articulation with the middle phalanx, and an expanded distal extremity for the support of the nail and end of the toe. The phalanx ends in a crescent-shaped rough cap of bone epiphysis — the apical tuft (or ungual tuberosity/process) which covers a larger portion of the phalanx on the volar side than on the dorsal side. Two lateral ungual spines project proximally from the apical tuft. Near the base of the shaft are two lateral tubercles. Between these a V-shaped ridge extending proximally serves for the insertion of the flexor pollicis longus. Another ridge at the base serves for the insertion of the extensor aponeurosis. The flexor insertion is sided by two fossae — the ungual fossa distally and the proximopalmar fossa proximally.


title: Phalanx bone

text: The number of phalanges in animals is often expressed as a "phalangeal formula" that indicates the numbers of phalanges in digits, beginning from the innermost medial or proximal. For example, humans have a 2-3-3-3-3 formula for the hand, meaning that the thumb has two phalanges, whilst the other fingers each have three.


title: Phalanx bone

text: In the distal phalanges of the hand the centres for the bodies appear at the distal extremities of the phalanges, instead of at the middle of the bodies, as in the other phalanges. Moreover, of all the bones of the hand, the distal phalanges are the first to ossify.


title: Phalanx bone

text: The distal phalanges of ungulates carry and shape nails and claws and these in primates are referred to as the "ungual phalanges".


title: Phalanx bone

text: The term phalanx or phalanges refers to an ancient Greek army formation in which soldiers stand side by side, several rows deep, like an arrangement of fingers or toes.


title: Phalanx bone

text: Most land mammals including humans have a 2-3-3-3-3 formula in both the hands (or paws) and feet. Primitive reptiles usually had the formula 2-3-4-4-5, and this pattern, with some modification, remained in many later reptiles and in the mammal-like reptiles. The phalangeal formula in the flippers of cetaceans (marine mammals) varies widely due to hyperphalangy (the increase in number of phalanx bones in the digits). In humpback whales, for example, the phalangeal formula is 0/2/7/7/3; in pilot whales the formula is 1/10/7/2/1.


title: Phalanx bone

text: In vertebrates, proximal phalanges have a similar placement in the corresponding limbs, be they paw, wing or fin. In many species, they are the longest and thickest phalanx ("finger" bone). The middle phalanx also a corresponding place in their limbs, whether they be paw, wing, hoof or fin.


title: Phalanx bone

text: The distal phalanges are cone-shaped in most mammals, including most primates, but relatively wide and flat in humans.


title: Phalanx bone

text: The morphology of the distal phalanges of human thumbs closely reflects an adaptation for a refined precision grip with pad-to-pad contact. This has traditionally been associated with the advent of stone tool-making. However, the intrinsic hand proportions of australopiths and the resemblance between human hands and the short hands of Miocene apes, suggest that human hand proportions are largely plesiomorphic (as found in ancestral species) — in contrast to the derived elongated hand pattern and poorly developed thumb musculature of other extant hominoids.


title: Phalanx bone

text: In Neanderthals, the apical tufts were expanded and more robust than in modern and early upper Paleolithic humans. A proposal that Neanderthal distal phalanges was an adaptation to colder climate (than in Africa) is not supported by a recent comparison showing that in hominins, cold-adapted populations possessed smaller apical tufts than do warm-adapted populations.


title: Phalanx bone

text: In non-human, living primates the apical tufts vary in size, but they are never larger than in humans. Enlarged apical tufts, to the extent they actually reflect expanded digital pulps, may have played a significant role in enhancing friction between the hand and held objects during Neolithic toolmaking.


title: Phalanx bone

text: Among non-human primates phylogenesis and style of locomotion appear to play a role in apical tuft size. Suspensory primates and New World monkeys have the smallest apical tufts, while terrestrial quadrupeds and Strepsirrhines have the largest.


title: Phalanx bone

text: A study of the fingertip morphology of four small-bodied New World monkey species, indicated a correlation between increasing small-branch foraging and reduced flexor and extensor tubercles in distal phalanges and broadened distal parts of distal phalanges, coupled with expanded apical pads and developed epidermal ridges. This suggests that widened distal phalanges were developed in arboreal primates, rather than in quadrupedal terrestrial primates.


title: Phalanx bone

text: Whales exhibit hyperphalangy. Hyperphalangy is an increase in the number of phalanges beyond the plesiomorphic mammal condition of three phalanges-per-digit. Hyperphalangy was present among extinct marine reptiles -- ichthyosaurs, plesiosaurs, and mosasaurs -- but not other marine mammals, leaving whales as the only marine mammals to develop this characteristic. The evolutionary process continued over time, and a very derived form of hyperphalangy, with six or more phalanges per digit, evolved convergently in rorqual whales and oceanic dolphins, and was likely associated with another wave of signaling within the interdigital tissues.


title: Phalanx bone

text: In ungulates (hoofed mammals) the forelimb is optimized for speed and endurance by a combination of length of stride and rapid step; the proximal forelimb segments are short with large muscles, while the distal segments are elongated with less musculature. In two of the major groups of ungulates, odd-toed and even-toed ungulates, what remain of the "hands" — the metacarpal and phalangeal bones — are elongated to the extent that they serve little use beyond locomotion. The giraffe, the largest even-toed ungulate, has large terminal phalanges and fused metacarpal bones able to absorb the stress from running.


title: Phalanx bone

text: The sloth spends its life hanging upside-down from branches, and has highly specialized third and fourth digits for the purpose. They have short and squat proximal phalanges with much longer terminal phalanges. They have vestigial second and fifth metacarpals, and their palm extends to the distal interphalangeal joints. The arboreal specialization of these terminal phalanges makes it impossible for the sloth to walk on the ground where the animal has to drag its body with its claws.


title: Ben McKee

text: Benjamin Arthur McKee (born April 7, 1985) is an American musician, songwriter, and record producer. He is the bassist for the pop rock band Imagine Dragons.


title: Ben McKee

text: McKee was raised in Forestville, California, and graduated from El Molino High School. He grew up playing acoustic guitar and violin, before picking up acoustic bass in fifth grade. In high school, he continued learning bass guitar as a member of a jazz trio, which influenced his decision to attend Berklee College of Music. While at Berklee, McKee played in a guitar performance ensemble with future Imagine Dragons bandmates Wayne Sermon and Daniel Platzman.


title: Ben McKee

text: In 2009, McKee was invited by Wayne Sermon to join Imagine Dragons, based out of Las Vegas. McKee dropped out of his final semester at Berklee to join the band, inviting Daniel Platzman to play drums, completing the lineup. The band relocated to Las Vegas performing and honing their craft nearly nightly as a lounge act. The band proceeded to earn a number of local accolades including "Best CD of 2011" (Vegas SEVEN), "Best Local Indie Band 2010" (Las Vegas Weekly), and "Las Vegas' Newest Must See Live Act" (Las Vegas CityLife). In November 2011 they signed with Interscope Records and began working with producer Alex da Kid.


title: Ben McKee

text: In 2012 their debut album "Night Visions" brought the band mainstream success. It reached #2 on the "Billboard" 200 chart and won the Billboard Music Award for Best Rock Album (2014). Single "It's Time" became the band's first single reaching #15 Billboard Hot 100 and certified multi-platinum by the RIAA. Second single "Radioactive" reached #3 Billboard Hot 100 and was certified diamond by the RIAA, becoming the best selling rock song in the history of Nielsen SoundScan. Third single "Demons" reached #6 Billboard Hot 100 and was certified multi-platinum by the RIAA. Their album made the highest debut for a new rock band in six years (since 2006) and single Radioactive set a new record for longest time atop the Billboard Hot Rock Songs chart with 23 consecutive weeks. Tracks from the album topped the Billboard Rock Songs, Billboard Alternative Songs, and Billboard Pop Songs charts. Radioactive was also nominated for two Grammy Awards, winning the Grammy Award for Best Rock Performance.


title: Ben McKee

text: In 2015, Imagine Dragons' second album "Smoke + Mirrors" reached #1 on the "Billboard" 200, UK Albums Chart, and Canadian Albums Chart. Singles include "I Bet My Life" and "Shots".


title: Ben McKee

text: The band has contributed songs to several film soundtracks, including "Ready Aim Fire" for "Iron Man 3", "Who We Are" for "" and "Battle Cry" for "". In addition, in September 2014, "Warriors" was released by Riot Games along with an animated music video promoting the League of Legends World Championships.


title: Ben McKee

text: In February 2021, McKee pledged to donate $1,000 a day to worthy causes for a year. Some of his donations have been to causes that aid Latino families (UndocuFund), that mentor LGBTQIA+ youth (Positive Images), food providers (Redwood Empire Food Bank and Food for Thought), and wildlife rescue (Bird Rescue Center).


title: Nitrogen narcosis

text: Narcosis while diving (also known as nitrogen narcosis, inert gas narcosis, raptures of the deep, Martini effect) is a reversible alteration in consciousness that occurs while diving at depth. It is caused by the anesthetic effect of certain gases at high pressure. The Greek word (narkōsis), "the act of making numb", is derived from (narkē), "numbness, torpor", a term used by Homer and Hippocrates. Narcosis produces a state similar to drunkenness (alcohol intoxication), or nitrous oxide inhalation. It can occur during shallow dives, but does not usually become noticeable at depths less than .


title: Nitrogen narcosis

text: Except for helium and probably neon, all gases that can be breathed have a narcotic effect, although widely varying in degree. The effect is consistently greater for gases with a higher lipid solubility, and although the mechanism of this phenomenon is still not fully clear, there is good evidence that the two properties are mechanistically related. As depth increases, the mental impairment may become hazardous. Divers can learn to cope with some of the effects of narcosis, but it is impossible to develop a tolerance. Narcosis can affect all divers, although susceptibility varies widely among individuals and from dive to dive. The main class of diving that deals with its prevention and treatment is scuba diving at substantial depth.


title: Nitrogen narcosis

text: Narcosis may be completely reversed in a few minutes by ascending to a shallower depth, with no long-term effects. Thus narcosis while diving in open water rarely develops into a serious problem as long as the divers are aware of its symptoms, and are able to ascend to manage it. Diving much beyond is generally considered outside the scope of recreational diving. In order to dive at greater depths, as narcosis and oxygen toxicity become critical risk factors, specialist training is required in the use of various helium-containing gas mixtures such as trimix or heliox. These mixtures prevent narcosis by replacing some or all of the inert fraction of the breathing gas with non-narcotic helium.


title: Nitrogen narcosis

text: Narcosis results from breathing gases under elevated pressure, and may be classified by the principal gas involved. The noble gases, except helium and probably neon, as well as nitrogen, oxygen and hydrogen cause a decrement in mental function, but their effect on psychomotor function (processes affecting the coordination of sensory or cognitive processes and motor activity) varies widely. The effect of carbon dioxide is a consistent diminution of mental and psychomotor function. The noble gases argon, krypton, and xenon are more narcotic than nitrogen at a given pressure, and xenon has so much anesthetic activity that it is a usable anesthetic at 80% concentration and normal atmospheric pressure. Xenon has historically been too expensive to be used very much in practice, but it has been successfully used for surgical operations, and xenon anesthesia systems are still being proposed and designed.


title: Nitrogen narcosis

text: Due to its perception-altering effects, the onset of narcosis may be hard to recognize. At its most benign, narcosis results in relief of anxiety – a feeling of tranquillity and mastery of the environment. These effects are essentially identical to various concentrations of nitrous oxide. They also resemble (though not as closely) the effects of alcohol and the familiar benzodiazepine drugs such as diazepam and alprazolam. Such effects are not harmful unless they cause some immediate danger to go unrecognized and unaddressed. Once stabilized, the effects generally remain the same at a given depth, only worsening if the diver ventures deeper.


title: Nitrogen narcosis

text: The most dangerous aspects of narcosis are the impairment of judgement, multi-tasking and coordination, and the loss of decision-making ability and focus. Other effects include vertigo and visual or auditory disturbances. The syndrome may cause exhilaration, giddiness, extreme anxiety, depression, or paranoia, depending on the individual diver and the diver's medical or personal history. When more serious, the diver may feel overconfident, disregarding normal safe diving practices. Slowed mental activity, as indicated by increased reaction time and increased errors in cognitive function, are effects which increase the risk of a diver mismanaging an incident. Narcosis reduces both the perception of cold discomfort and shivering and thereby affects the production of body heat and consequently allows a faster drop in the core temperature in cold water, with reduced awareness of the developing problem.


title: Nitrogen narcosis

text: The relation of depth to narcosis is sometimes informally known as "Martini's law", the idea that narcosis results in the feeling of one martini for every below depth. Professional divers use such a calculation only as a rough guide to give new divers a metaphor, comparing a situation they may be more familiar with.


title: Nitrogen narcosis

text: Reported signs and symptoms are summarized against typical depths in meters and feet of sea water in the following table, closely adapted from "Deeper into Diving" by Lippman and Mitchell:


title: Nitrogen narcosis

text: The cause of narcosis is related to the increased solubility of gases in body tissues, as a result of the elevated pressures at depth (Henry's law). Modern theories have suggested that inert gases dissolving in the lipid bilayer of cell membranes cause narcosis. More recently, researchers have been looking at neurotransmitter receptor protein mechanisms as a possible cause of narcosis. The breathing gas mix entering the diver's lungs will have the same pressure as the surrounding water, known as the ambient pressure. After any change of depth, the pressure of gases in the blood passing through the brain catches up with ambient pressure within a minute or two, which results in a delayed narcotic effect after descending to a new depth. Rapid compression potentiates narcosis owing to carbon dioxide retention.


title: Nitrogen narcosis

text: A divers' cognition may be affected on dives as shallow as , but the changes are not usually noticeable. There is no reliable method to predict the depth at which narcosis becomes noticeable, or the severity of the effect on an individual diver, as it may vary from dive to dive even on the same day.


title: Nitrogen narcosis

text: Significant impairment due to narcosis is an increasing risk below depths of about , corresponding to an ambient pressure of about . Most sport scuba training organizations recommend depths of no more than because of the risk of narcosis. When breathing air at depths of  – an ambient pressure of about  – narcosis in most divers leads to hallucinations, loss of memory, and unconsciousness. A number of divers have died in attempts to set air depth records below . Because of these incidents, "Guinness World Records" no longer reports on this figure.


title: Nitrogen narcosis

text: Narcosis has been compared with altitude sickness regarding its variability of onset (though not its symptoms); its effects depend on many factors, with variations between individuals. Thermal cold, stress, heavy work, fatigue, and carbon dioxide retention all increase the risk and severity of narcosis. Carbon dioxide has a high narcotic potential and also causes increased blood flow to the brain, increasing the effects of other gases. Increased risk of narcosis results from increasing the amount of carbon dioxide retained through heavy exercise, shallow or skip breathing, or because of poor gas exchange in the lungs.


title: Nitrogen narcosis

text: Narcosis is known to be additive to even minimal alcohol intoxication. Other sedative and analgesic drugs, such as opiate narcotics and benzodiazepines, add to narcosis.


title: Nitrogen narcosis

text: The precise mechanism is not well understood, but it appears to be the direct effect of gas dissolving into nerve membranes and causing temporary disruption in nerve transmissions. While the effect was first observed with air, other gases including argon, krypton and hydrogen cause very similar effects at higher than atmospheric pressure. Some of these effects may be due to antagonism at NMDA receptors and potentiation of GABA receptors, similar to the mechanism of nonpolar anesthetics such diethyl ether or ethylene. However, their reproduction by the very chemically inactive gas argon makes them unlikely to be a strictly chemical bonding to receptors in the usual sense of a chemical bond. An indirect physical effect – such as a change in membrane volume – would therefore be needed to affect the ligand-gated ion channels of nerve cells. Trudell "et al." have suggested non-chemical binding due to the attractive van der Waals force between proteins and inert gases.


title: Nitrogen narcosis

text: Similar to the mechanism of ethanol's effect, the increase of gas dissolved in nerve cell membranes may cause altered ion permeability properties of the neural cells' lipid bilayers. The partial pressure of a gas required to cause a measured degree of impairment correlates well with the lipid solubility of the gas: the greater the solubility, the less partial pressure is needed.


title: Nitrogen narcosis

text: An early theory, the Meyer-Overton hypothesis, suggested that narcosis happens when the gas penetrates the lipids of the brain's nerve cells, causing direct mechanical interference with the transmission of signals from one nerve cell to another. More recently, specific types of chemically gated receptors in nerve cells have been identified as being involved with anesthesia and narcosis. However, the basic and most general underlying idea, that nerve transmission is altered in many diffuse areas of the brain as a result of gas molecules dissolved in the nerve cells' fatty membranes, remains largely unchallenged.


title: Nitrogen narcosis

text: The management of narcosis is simply to ascend to shallower depths; the effects then disappear within minutes. In the event of complications or other conditions being present, ascending is always the correct initial response. Should problems remain, then it is necessary to abort the dive. The decompression schedule can still be followed unless other conditions require emergency assistance.


title: Nitrogen narcosis

text: The symptoms of narcosis may be caused by other factors during a dive: ear problems causing disorientation or nausea; early signs of oxygen toxicity causing visual disturbances; or hypothermia causing rapid breathing and shivering. Nevertheless, the presence of any of these symptoms should imply narcosis. Alleviation of the effects upon ascending to a shallower depth will confirm the diagnosis. Given the setting, other likely conditions do not produce reversible effects. In the rare event of misdiagnosis when another condition is causing the symptoms, the initial management – ascending closer to the surface – is still essential.


title: Nitrogen narcosis

text: The most straightforward way to avoid nitrogen narcosis is for a diver to limit the depth of dives. The other main preventive measure is properly informed selection/choice of which gas to use for the particular dive under consideration.


title: Nitrogen narcosis

text: Since narcosis becomes more severe as depth increases, a diver keeping to shallower depths can avoid serious narcosis. Most recreational dive schools will only certify entry level divers to depths of , and at these depths narcosis does not present a significant risk. Further training is normally required for certification up to on air, and this training should include a discussion of narcosis, its effects, and management. Some diver training agencies offer specialized training to prepare recreational divers to go to depths of , often consisting of further theory and some practice in deep dives under close supervision. Scuba organizations that train for diving beyond recreational depths, may forbid diving with gases that cause too much narcosis at depth in the average diver (such as the typical widely used nitrox mixtures suitable for most recreational diving), and strongly encourage the use of other breathing gas mixes containing helium in place of some or all of the nitrogen in air – such as trimix and heliox – because helium has no narcotic effect. The use of these gases forms part of technical diving and requires further training and certification.


title: Nitrogen narcosis

text: While the individual diver cannot predict exactly at what depth the onset of narcosis will occur on a given day, the first symptoms of narcosis for any given diver are often more predictable and personal. For example, one diver may have trouble with eye focus (close accommodation for middle-aged divers), another may experience feelings of euphoria, and another feelings of claustrophobia. Some divers report that they have hearing changes, and that the sound their exhaled bubbles make becomes different. Specialist training may help divers to identify these personal onset signs, which may then be used as a signal to ascend to avoid the narcosis, although severe narcosis may interfere with the judgement necessary to take preventive action.


title: Nitrogen narcosis

text: Deep dives should be made only after a gradual training to test the individual diver's sensitivity to increasing depths, with careful supervision and logging of reactions. Scientific evidence does not show that a diver can train to overcome any measure of narcosis at a given depth or become tolerant of it.


title: Nitrogen narcosis

text: Equivalent narcotic depth (END) is a commonly used way of expressing the narcotic effect of different breathing gases. The National Oceanic and Atmospheric Administration (NOAA) Diving Manual now states that oxygen and nitrogen should be considered equally narcotic. Standard tables, based on relative lipid solubilities, list conversion factors for narcotic effect of other gases. For example, hydrogen at a given pressure has a narcotic effect equivalent to nitrogen at 0.55 times that pressure, so in principle it should be usable at more than twice the depth. Argon, however, has 2.33 times the narcotic effect of nitrogen, and is a poor choice as a breathing gas for diving (it is used as a drysuit inflation gas, owing to its low thermal conductivity). Some gases have other dangerous effects when breathed at pressure; for example, high-pressure oxygen can lead to oxygen toxicity. Although helium is the least intoxicating of the breathing gases, at greater depths it can cause high pressure nervous syndrome, a still mysterious but apparently unrelated phenomenon. Inert gas narcosis is only one factor influencing the choice of gas mixture; the risks of decompression sickness and oxygen toxicity, cost, and other factors are also important.


title: Nitrogen narcosis

text: Because of similar and additive effects, divers should avoid sedating medications and drugs, such as cannabis and alcohol before any dive. A hangover, combined with the reduced physical capacity that goes with it, makes nitrogen narcosis more likely. Experts recommend total abstinence from alcohol for at least 12 hours before diving, and longer for other drugs.


title: Nitrogen narcosis

text: Narcosis is potentially one of the most dangerous conditions to affect the scuba diver below about . Except for occasional amnesia of events at depth, the effects of narcosis are entirely removed on ascent and therefore pose no problem in themselves, even for repeated, chronic or acute exposure. Nevertheless, the severity of narcosis is unpredictable and it can be fatal while diving, as the result of illogical behavior in a dangerous environment.


title: Nitrogen narcosis

text: Tests have shown that all divers are affected by nitrogen narcosis, though some experience lesser effects than others. Even though it is possible that some divers can manage better than others because of learning to cope with the subjective impairment, the underlying behavioral effects remain. These effects are particularly dangerous because a diver may feel they are not experiencing narcosis, yet still be affected by it.


title: Nitrogen narcosis

text: French researcher Victor T. Junod was the first to describe symptoms of narcosis in 1834, noting "the functions of the brain are activated, imagination is lively, thoughts have a peculiar charm and, in some persons, symptoms of intoxication are present." Junod suggested that narcosis resulted from pressure causing increased blood flow and hence stimulating nerve centers. Walter Moxon (1836–1886), a prominent Victorian physician, hypothesized in 1881 that pressure forced blood to inaccessible parts of the body and the stagnant blood then resulted in emotional changes. The first report of anesthetic potency being related to lipid solubility was published by Hans H. Meyer in 1899, entitled "Zur Theorie der Alkoholnarkose". Two years later a similar theory was published independently by Charles Ernest Overton. What became known as the Meyer-Overton hypothesis may be illustrated by a graph comparing narcotic potency with solubility in oil.


title: Nitrogen narcosis

text: In 1939, Albert R. Behnke and O. D. Yarborough demonstrated that gases other than nitrogen also could cause narcosis. For an inert gas the narcotic potency was found to be proportional to its lipid solubility. As hydrogen has only 0.55 the solubility of nitrogen, deep diving experiments using hydrox were conducted by Arne Zetterström between 1943 and 1945. Jacques-Yves Cousteau in 1953 famously described it as "l'ivresse des grandes profondeurs" or the "rapture of the deep".


title: Nitrogen narcosis

text: Further research into the possible mechanisms of narcosis by anesthetic action led to the "minimum alveolar concentration" concept in 1965. This measures the relative concentration of different gases required to prevent motor response in 50% of subjects in response to stimulus, and shows similar results for anesthetic potency as the measurements of lipid solubility. The (NOAA) Diving Manual was revised to recommend treating oxygen as if it were as narcotic as nitrogen, following research by Christian J. Lambertsen "et al." in 1977 and 1978.


title: Medical school

text: A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery (MBBS, MBChB, MBBCh, BMBS), Master of Medicine (MM, MMed), Doctor of Medicine (MD), or Doctor of Osteopathic Medicine (DO). Many medical schools offer additional degrees, such as a Doctor of Philosophy (PhD), master's degree (MSc) or other post-secondary education.


title: Medical school

text: Medical schools can also carry out medical research and operate teaching hospitals. Around the world, criteria, structure, teaching methodology, and nature of medical programs offered at medical schools vary considerably. Medical schools are often highly competitive, using standardized entrance examinations, as well as grade point averages and leadership roles, to narrow the selection criteria for candidates.


title: Medical school

text: In most countries, the study of medicine is completed as an undergraduate degree not requiring prerequisite undergraduate coursework. However, an increasing number of places are emerging for graduate entrants who have completed an undergraduate degree including some required courses. In the United States and Canada, almost all medical degrees are second entry degrees, and require several years of previous study at the university level.


title: Medical school

text: Medical degrees are awarded to medical students after the completion of their degree program, which typically lasts five or more years for the undergraduate model and four years for the graduate model. Many modern medical schools integrate clinical education with basic sciences from the beginning of the curriculum (e.g.). More traditional curricula are usually divided into preclinical and clinical blocks. In preclinical sciences, students study subjects such as biochemistry, genetics, pharmacology, pathology, anatomy, physiology and medical microbiology, among others. Subsequent clinical rotations usually include internal medicine, general surgery, pediatrics, psychiatry, and obstetrics and gynecology, among others.


title: Medical school

text: Although medical schools confer upon graduates a medical degree, a physician typically may not legally practice medicine until licensed by the local government authority. Licensing may also require passing a test, undergoing a criminal background check, checking references, paying a fee, and undergoing several years of postgraduate training. Medical schools are regulated by each country and appear in the World Directory of Medical Schools which was formed by the merger of the AVICENNA Directory for Medicine and the FAIMER International Medical Education Directory.


title: Medical school

text: By 2005 there were more than 100 medical schools across Africa, most of which had been established after 1970.


title: Medical school

text: Medical schools within Egypt are five-year programs. Education is conducted in English and leads to a Bachelor of Medicine and Surgery (MBBCh). Graduates must finish a two-year internship program at the end of their studies to obtain their general practitioner license. Clinical training happens in each school teaching hospital with few exceptions. A small number of schools use Ministry of Health hospitals.


title: Medical school

text: Admission into Egyptian private and public medical schools is centrally managed by the government. After students submit their applications, they are distributed among different institutions according to both their order of preference and their high school performance.


title: Medical school

text: In Egypt, there are two main pathways to postgraduate studies in medicine. The academic pathway, leading to a scientific degree: either MSc. or PhD The second is the Fellowship of the Egyptian Board (FEB) program. About 20% of medical graduates pursue post-graduate studies, the rest join the healthcare workforce as general practitioners.


title: Medical school

text: There are seven medical schools in Ghana: The University of Ghana Medical School in Accra, the KNUST School of Medical Sciences in Kumasi, University for Development Studies School of Medicine in Tamale, University of Cape Coast Medical School and the University of Allied Health Sciences in Ho, Volta Region, the private Accra College of Medicine, and Family Health Medical School, another private medical school.


title: Medical school

text: Basic Medical education lasts 6 years in all medical schools. Entry into these medical schools is highly competitive and it is usually based on successful completion of the Senior High School Examinations. The University of Ghana Medical School and the University of Cape Coast have, however, introduced a graduate entry medical program to admit students with mainly science-related degrees into a 4-year medical school program (four and half years for the University of Cape Coast).


title: Medical school

text: Students graduating from any of these medical schools get the MBChB degree and the title "Dr". For the first 3 years, students are awarded BSc in the field of Medical Sciences from the University of Ghana medical school; and Human biology for KNUST and UDS medical schools.


title: Medical school

text: The University of Ghana Medical School and KNUST School of Medical Sciences in Kumasi use a traditional medical education model whiles the University for Development Studies School of Medicine and School of Medical science of the University of Cape Coast use the problem-based learning model.


title: Medical school

text: Medical graduates are then registered provisionally with the Medical and Dental Council (MDC) of Ghana as House Officers (Interns). Upon completion of the mandatory 2-year housemanship, these medical doctors are permanently registered with the MDC and can practice as medical officers (General Practitioners) anywhere in the country. The housemanship training is done only in hospitals accredited for such purposes by the Medical and Dental Council of Ghana.


title: Medical school

text: Following the permanent registration with the Medical and Dental Council, doctors can specialize in any of the various fields that is organized by either the West African College of Physicians and Surgeons or the Ghana College of Physician and Surgeons.


title: Medical school

text: Medical officers are also sometimes hired by the Ghana Health Service to work in the District/Rural areas as Primary Care Physicians.


title: Medical school

text: In Kenya, medical schools are faculties of a university. Medical education lasts for 6 years after which the student graduates with an undergraduate (MBChB) degree. This is followed by a mandatory 12-month full-time internship at an approved hospital after which one applies for registration with the Kenya Medical Practitioners and Dentists Board if they intend to practice medicine in the country. The first two years of medical school cover the basic medical (preclinical) sciences while the last four years are focused on the clinical sciences and internship.


title: Medical school

text: Completion of formal specialty training in Kenya is followed by two years of supervised clinical work before one can apply for recognition as a specialist, in their respective field, by the medical board.


title: Medical school

text: There are no medical school entry examinations or interviews and admission is based on the student's performance in the high school exit examination (Kenya Certificate of Secondary Education - KCSE). Students who took the AS Level or the SAT can also apply but there is a very strict quota limiting the number of students that get accepted into public universities. This quota does not apply to private universities.


title: Medical school

text: There are several medical schools in Nigeria. Entrance into these schools is highly competitive. Candidates graduating from high school must attain high scores on the West African Examination Council's (WAEC) Senior School Certificate Exam (SSCE/GCE) and high scores in five subjects (Physics, Mathematics, English, Chemistry, and Biology) in the University Matriculation Examination (UME). Students undergo rigorous training for 6 years and culminate with a Bachelor of Medicine and Bachelor of Surgery (MBBS/MBChB). The undergraduate program is six years and one year of work experience in government hospitals. After medical school, graduates are mandated to spend one year of housemanship (internship) and one year of community service before they are eligible to be fully licensed by the Medical and Dental Council.


title: Medical school

text: Candidates are required to score at least 280 in the UME. Though this score may vary due to different performances per year and it also depends on the college standards.


title: Medical school

text: There are eight medical schools in South Africa, each under the auspices of a public university. As the country is a former British colony, most institutions follow the British-based undergraduate method of instruction, admitting students directly from high school into 6 or 5-year programs. Some universities such as the University of the Witwatersrand in Johannesburg have started offering post-graduate medical degrees that run concurrently with their undergraduate programs. In this instance, a student having completed an appropriate undergraduate degree with basic sciences can enter into a four-year postgraduate program.


title: Medical school

text: South African medical schools award the MB ChB degree, except the University of the Witwatersrand, which styles its degree MB BCh. Some universities allow students to earn an intercalated degree, completing a BSc (Medical) with an additional year of study after the second or third year of the MBChB. The University of Cape Town, in particular, has spearheaded a recent effort to increase the level of medical research training and exposure of medical students through an Intercalated Honours Programme, with the option to extend this to a PhD.


title: Medical school

text: Following successful completion of study, all South African medical graduates must complete a two-year internship as well as a further year of community service in order to register with the Health Professions Council and practice as a doctor in the country.


title: Medical school

text: Specialisation is usually a five- to seven-year training process (depending on the specialty) requiring registering as a medical registrar attached to an academic clinical department in a large teaching hospital with appropriate examinations. The specialist qualification may be conferred as a Fellowship by the independent Colleges of Medicine of South Africa (CMSA), following British tradition, or as a Magisterial degree by the university (usually the M Med, Master of Medicine, degree). The Medical schools and the CMSA also offer Higher Diplomas in many fields. Research degrees are the MMed and PhD or MD, depending on the university.


title: Medical school

text: Medical students from all over the world come to South Africa to gain practical experience in the country's many teaching hospitals and rural clinics. The language of instruction is English but a few indigenous languages are studied briefly. The University of the Free State has a parallel medium policy, meaning all English classes are also presented in Afrikaans, therefore students who choose to study in Afrikaans, do so separately from the English class.


title: Medical school

text: In Sudan, a medical school is a faculty of a university. Medical school is usually 5–6 years, and by the end of the 5–6 years, the students acquire a bachelor's degree in Medicine and Surgery. Post graduating there is a mandatory one-year full-time internship at one of the universities or Government Teaching hospitals in the four major Specialty in 3 months rotation, then a license is issued after a written exam conducted by the Sudan medical council (SMC).


title: Medical school

text: During the first 3–4 years the curriculum is completed, and throughout the next 2 years it is repeated with clinical training. Students with high grades in high school are accepted for free in Government Universities. Private faculty accept low grades than governmental faculty but their grades still high. Students who take foreign examinations other than the Sudanese High School Examination are also accepted in Universities, students taking IGCSE/SATs and other Arabian countries.


title: Medical school

text: All medical students who want to be enrolled in an internship program should undergo registration under the Sudanese Medical Council. Postgraduate training is conducted by Sudan medical specialisation board (SMSB) and the degree obtained is medical doctor (MD). The duration of training varies from 4–6 years depend on the scientific Council of the specific speciality.


title: Medical school

text: In Tanzania, medical school is a school within a university or can be an independent university dealing with health related courses only affiliated with a large sized hospital. Medical education lasts for 5 years after which the student graduates with an undergraduate (MD) degree. This is followed by a mandatory 12-month full-time internship at an approved hospital after which one applies for registration with the Medical Council of Tanzania (MCT) if they intend to practice medicine in the country. The first two years of medical school cover the Bio medical sciences or simply basic (pre-clinical) sciences while the last three years are focused on the clinical sciences.


title: Medical school

text: There are no medical school entry examinations or interviews and admission is based on students' performance in the high school exit examination (Advanced Certificate of Secondary Education Examination - ACSEE). Alternatively are student who took diploma in clinical medicine with an average of G.P.A 3.5 distinction who have very few seats.


title: Medical school

text: In Tunisia, education is free for all Tunisian citizens and for foreigners who have scholarships. The oldest Medical school is the Medicine School of Tunis. There are four medicine faculties situated in the major cities of Tunis, Sfax, Sousse and Monastir. Admission is bound to the success and score in the Tunisian Baccalaureate examination. Admission score threshold is very high, based on competition among all applicants throughout the nation. Medical school curriculum consists of seven years; five years as an 'extern' and two years of internship or 'intern trainee' :


title: Medical school

text: In contrast, studies in dental medicine (general practitioner) and pharmaceutical studies last only 6 years. Courses throughout the university curriculum in both medicine and pharmacy are taught in French.


title: Medical school

text: There are four universities of general medicine: the Faculty of Medicine of Tunis, the Faculty of Medicine Ibn El Jazzar of Sousse, the Faculty of Medicine of Monastir and the Faculty of Medicine of Sfax.


title: Medical school

text: On the other hand, there is only one university of dentistry and pharmacy in Monastir: the faculty of dentistry of Monastir and the faculty of pharmacy of Monastir.


title: Medical school

text: , there are nine accredited medical schools in Uganda. Training leading to the award of the degree of Bachelor of Medicine and Bachelor of Surgery (MBChB) lasts five years, if there are no re-takes. After graduating, a year of internship in a hospital designated for that purpose, under the supervision of a specialist in that discipline is required before an unrestricted license to practice medicine and surgery is granted by the Uganda Medical and Dental Practitioners Council (UMDPC).


title: Medical school

text: There is Postgraduate training such as the degree of Master of Medicine (MMed) which is a three-year programme, available at Makerere University School of Medicine in several disciplines. Makerere University School of Public Health, offers the degree of Master of Public Health (MPH) following a twenty-two (22)-month period of study, which includes field work.


title: Medical school

text: In Zimbabwe there are three medical schools is offering Medical degrees. For undergrads, these are University of Zimbabwe - College of Health Sciences {MBChB}, National University of Science and Technology (NUST) Medical school {MBBS} and Midlands State University (MSU) {MBChB}. Only UZ is offering postgrad degrees in the Medical faculty.


title: Medical school

text: Internship is 2 years duration, with the first year spent in medicine and surgery and the second year doing pediatrics, anesthesia/psychiatry and obstetrics and gynecology. Thereafter one can apply for MMED at the university which last 4–5 years depending on specialty. Currently no subspecialist education is available.


title: Medical school

text: In 1821 the first school of medicine was formed in the capital city Buenos Aires, where the bulk of the medical schools are located. As of 2006, there were 29 medical schools in Argentina. Medical degree programs in Argentina typically are six years long, with some universities opting for 7 year programs. The six years usually consist of 3 years of basic sciences, 2 years of clinical sciences, and one internship year (in Spanish "internado anual rotatorio"). The internship is completed in Hospital associated to the university. In some provinces (especially round the more developed South) there are government-funded hospitals who pay for the internship. Some universities have cultural exchange programmes that allow a medical student in their final year to serve their community time overseas.


title: Medical school

text: In Argentina, there are public and private medical schools. By law entrance into public institutions is open and tuition-free to all who have a high school diploma, and universities are expressly forbidden from restricting access with difficult entrance exams. Point in case, in 2016 the National University of La Plata was forced by governing bodies to stop forcing its students to write an entrance exam. As a result, that university experienced a major increase in the size of its student population. Another consequence is that schools have a high drop-out rate during the first years that approach 90%. When it comes to educational quality, the University of Buenos Aires Faculty of Medical Sciences, a public university, is widely recognised as the top medical school in the country.


title: Medical school

text: Upon graduation, one of the following degrees is obtained, according to the university: Doctor of Medicine, or both Doctor of Medicine and Doctor of Surgery. Public universities usually confer both degrees, and private universities bestow only Doctor of Medicine. In daily practice, however, there is no substantial difference between what a Doctor of Medicine or a Doctor of Medicine and Doctor of Surgery are allowed to do. When the degree is obtained, a record is created for that new doctor in the index of the National Ministry of Education ("Ministerio Nacional de Educación"), and the physician is given their corresponding medical practitioner's ID, which is a number that identifies him and his academic achievements. In addition, there is a provincial ID, i. e. a number to identify doctors in the province they practice medicine in. Completion of a residency program is not required for medical licensing.


title: Medical school

text: There is no central system for applying to medical residency. Doctors wishing to pursue a specialty must take rigorous entrance exams at the public/private institution of their choice that offers them. Programs admit approximately half of each year's graduates after a lengthy selection process. Most specialty courses last four years, depending on the branch of medicine the physician has chosen.


title: Medical school

text: In Bolivia, all medical schools are Faculties within a university and follow the European model of a six-year curriculum (9 000 ECTS or more) divided into three cycles. The first two years are called biomedical or pre-clinical cycle. During this time students are instructed in the basic sciences (anatomy, anthropology, biochemistry, biophysics, cell biology, embryology, histology, physiology, pharmacology, biostatistics, etc.). The next three years are the clinical cycle and consist of medical specialties instruction at the faculty and hospital practice. The last year consists of an internship from 3 months each of surgery, internal medicine, gynecology and pediatrics. To acquire the license from the government to practice medicine, at the end of internship must be done a Honorary Mandatory Socialist Service (SSSRO) in a rural area of the country during at least three months.


title: Medical school

text: After getting the degree and license as "Graduate of Medicine and Surgery" or Médico Cirujano (MC) may take a post-graduate residency from 3 to 6 years in order to acquire a specialty.


title: Medical school

text: The Brazilian medical schools follow the European model of a six-year curriculum, divided into three cycles of two years each. The first two years are called basic cycle ("ciclo básico"). During this time students are instructed in the basic sciences (anatomy, physiology, pharmacology, immunology etc.) with activities integrated with the medical specialties, allowing the student an overview of the practical application of such content. After its completion, the students advance to the clinical cycle ("ciclo clinico"). At this stage contacts with patients intensify and work with tests and diagnostics, putting into practice what was learned in the first two years. The last two are called internship "(internato"). In this last step the students focus on clinical practice, through training in teaching hospitals and clinics. The teaching of this last step respecting an axis of increasing complexity, enabling students to make decisions and participate effectively in form and operative care under the direct supervision of faculty and qualified to act as teaching aids physicians.


title: Medical school

text: After six years of training, students graduate and are awarded the title of physician ("Médico") allowing them to register with the Regional Council of Medicine ("Conselho Regional de Medicina"). The recent graduate will be able to exercise the medical profession as a general practitioner and may apply to undertake postgraduate training. In 2012, the Regional Council of Medicine of São Paulo ("Conselho Regional de Medicina do Estado de São Paulo") established that physicians who graduate from this year must pass a test to obtain professional registration. Passing the exam, however, is not linked to obtaining registration. It required only the presence of the candidate and the test performance. Already at the national level, pending in the Senate a bill creating the National Proficiency Examination in Medicine ("Exame Nacional de Proficiência em Medicina"), which would make the race a prerequisite for the exercise of profession.


title: Medical school

text: Physicians who want to join a specialization program must undergo a new selection examination considered as competitive as that required to join a medical school. The specialization programs are divided into two categories: direct access and prerequisite. The specialties with direct access are those in which the doctor can enroll without having any prior expertise. Any physicians can apply to examinations for these specialties, regardless of time of training or prior experience. To apply to proprietary pre-requisite, the doctor should have already completed a specialty prior. The programs may range from 2 to 6 years. In Brazil are currently recognized by the Federal Council of Medicine, the Brazilian Medical Association and the National Commission of Medical Residency 53 residency programs. Fully complied with, gives the title of resident physician specialist.


title: Medical school

text: In 2013, the Association of American Medical Colleges lists 17 accredited MD-granting medical schools in Canada.


title: Medical school

text: In Canada, a medical school is a faculty or school of a university that offers a three- or four-year Doctor of Medicine (MD) degree. Generally, medical students begin their studies after receiving a bachelor's degree in another field, often one of the biological sciences. However, admittance can still be granted during third and fourth year. Minimum requirements for admission vary by region from two to four years of post-secondary study. The Association of Faculties of Medicine of Canada publishes a detailed guide to admission requirements of Canadian faculties of medicine on a yearly basis.


title: Medical school

text: Admission offers are made by individual medical schools, generally on the basis of a personal statement, undergraduate record (GPA), scores on the Medical College Admission Test (MCAT), and interviews. Volunteer work is often an important criterion considered by admission committees. All four medical schools in Quebec and two Ontario schools (University of Ottawa, Northern Ontario School of Medicine) do not require the MCAT. McMaster requires that the MCAT be written, though they only look for particular scores (6 or better) on the verbal reasoning portion of the test.


title: Medical school

text: The first half of the medical curriculum is dedicated mostly to teaching the basic sciences relevant to medicine. Teaching methods can include traditional lectures, problem-based learning, laboratory sessions, simulated patient sessions, and limited clinical experiences. The remainder of medical school is spent in clerkship. Clinical clerks participate in the day-to-day management of patients. They are supervised and taught during this clinical experience by residents and fully licensed staff physicians.


title: Medical school

text: Students enter into the Canadian Resident Matching Service, commonly abbreviated as "CaRMS" in the fall of their final year. Students rank their preferences of hospitals and specialties. A computerized matching system determines placement for residency positions. 'Match Day' usually occurs in March, a few months before graduation. The length of post-graduate training varies with choice of specialty.


title: Medical school

text: During the final year of medical school, students complete part 1 of the Medical Council of Canada Qualifying Examination (MCCQE). Upon completion of the final year of medical school, students are awarded the degree of MD Students then begin training in the residency program designated to them by CaRMS. Part 2 of the MCCQE, an Objective Structured Clinical Examination, is taken following completion of twelve months of residency training. After both parts of the MCCQE are successfully completed, the resident becomes a "Licentiate of the Medical Council of Canada". However, in order to practice independently, the resident must complete the residency program and take a board examination pertinent to his or her intended scope of practice. In the final year of residency training, residents take an exam administered by either the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada, depending on whether they are seeking certification in family medicine or another specialty.


title: Medical school

text: In 2011, the International Medical Education Directory listed 59 current medical schools in the Caribbean. 54 grant the MD degree, 3 grant the MBBS degree, and 2 grant either the MD or MBBS degree.


title: Medical school

text: 30 of the medical schools in the Caribbean are regional, which train students to practice in the country or region where the school is located. The remaining 29 Caribbean medical schools are known as offshore schools, which primarily train students from the United States and Canada who intend to return home for residency and clinical practice after graduation. At most offshore schools, basic sciences are completed in the Caribbean while clinical clerkships are completed at teaching hospitals in the United States.


title: Medical school

text: Several agencies may also accredit Caribbean medical schools, as listed in the FAIMER Directory of Organizations that Recognize/Accredit Medical Schools (DORA). 25 of the 29 regional medical schools in the Caribbean are accredited, while 14 of the 30 offshore medical schools are accredited.


title: Medical school

text: Medical schools in Haiti conduct training in French. The universities offering medical training in Haiti are the Université Notre Dame d'Haïti, Université Quisqueya, Université d'Etat d'Haïti and Université Lumière.


title: Medical school

text: The Université Notre Dame d'Haïti (UNDH) is a private Catholic university established by the Episcopal Conference of Haiti. According to the UNDH website, "the UNDH is not just about academic degrees, it is mainly the formation of a new type of Haiti, which includes in its culture and moral values of the Gospel, essential for serious and honest people that the country needs today."


title: Medical school

text: The other two private schools offering medical degrees are Université Quisqueya and Université Lumière. The Université d'Etat d'Haïti is a public school.


title: Medical school

text: Attending medical school in Haiti may be less expensive than attending medical universities located in other parts of the world, but the impact of the country's political unrest should be considered, as it affects the safety of both visitors and Haitians.


title: Medical school

text: Medical registration/license to practice: Registration is obligatory with the Ministère de la Santé publique


title: Medical school

text: et de la Population, Palais des Ministères, Port-au-Prince. The license to practice medicine is granted to


title: Medical school

text: As of 2021, Curaçao has 5 medical schools registered in the World Directory of Medical Schools: Avalon University School of Medicine, Caribbean Medical University School of Medicine,


title: Medical school

text: John F. Kennedy University School of Medicine, New York Medical University School of Medicine and St. Martinus University Faculty of Medicine. All are located within the city of Willemstad. These schools provide education in Basic Medical Science (BMS) which goes towards the degree of Medical Doctor or Doctor of Medicine. Presently, none of the medical schools offer other degrees, such as MBBS or PhD (2016).


title: Medical school

text: All students after completing their medical school's Basic Medical Science program in Curaçao; will then have to apply to either take USMLE Step Exams, The Canadian or UK Board Exams.


title: Medical school

text: Medical studies in the Dominican Republic start after graduation from high school. The programs typically take around 6 years to complete and are generally in Spanish with a few U.S.-style 4-year programs in English geared to American students (e.g. UNIBE).


title: Medical school

text: Programs are typically divided into pre-medicine, basic sciences and clinical sciences (also called pre-internship). At the end of the pre-internship period the aspiring doctors need to complete a 1-year compulsory internship in a Dominican hospital to obtain their medical license.


title: Medical school

text: In Chile, there are 21 medical schools. Principal medical schools are Universidad de Chile, Pontificia Universidad Católica de Chile, Universidad de Concepción, Universidad de Valparaíso and Universidad de Santiago de Chile. The pre-grade studies are distributed in 7 years, where the last 2 are the internship, that include at least surgery, internal medicine, gynecology and pediatrics. After getting the degree of Licenciate in Medicine (General Medicine) the MD must pass a medicine knowledge exam called the Unique National Exam of Medical Knowledge (EUNACOM "Examen Único Nacional de Conocimientos de Medicina" in Spanish) and can take a direct specialty or work before in primary attention in order to gain access to a residency.


title: Medical school

text: In Colombia, there are 50 medical schools listed in the World Directory of Medical Schools, 27 of which have active programs and are currently registered and accredited as high-quality programs by the Colombian Ministry of Education. The main medical programs are offered by the Universidad Nacional de Colombia, Pontificia Universidad Javeriana, Universidad del Rosario, Universidad El Bosque, Universidad de los Andes, Universidad del Valle, Universidad de Antioquia, Universidad de Santander, Universidad del Norte and Universidad de la Sabana. Most programs require between 6–7 years of study, and all offer a Doctor of Medicine (MD) degree. In some cases the school also allows for a second degree to be studied for at the same time (this is chosen by the student, though most students end up needing to do alternate semesters between their degrees, and mostly in careers like microbiology or biomedical engineering). For example, the Universidad de los Andes has a program whereby the medical student could graduate with both an MD and a Master of Business Administration (MBA) degree, or an MD and a master's degree in public health. Admission to medical school varies with the school, but is usually dependent on a combination of a general application to the university, an entrance exam, a personal statement or interview, and secondary (high) school performance mostly as reflected on the ICFES score (the grade received on the state exam in the final year of secondary/high school).


title: Medical school

text: In most medical programs, the first two years deal with basic scientific courses (cellular and molecular biology, chemistry, organic chemistry, mathematics, and physics), and the core medical sciences (anatomy, embryology, histology, physiology, and biochemistry). The following year may change in how it is organized in different schools, but is usually organ system-based pathophysiology and therapeutics (general and systems pathology, pharmacology, microbiology, parasitology, immunology, and medical genetics are also taught in this block). In the first two years, the programs also usually begin the courses in the epidemiology track (which may or may not include biostatistics), a clinical skills track (semiology and the clinical examination), a social medicine/public health track, and a medical ethics and communication skills track. Modes of training vary, but are usually based on lectures, simulations, standardized-patient sessions, problem-based learning sessions, seminars, and observational clinical experiences. By year three, most schools have begun the non-elective, clinical-rotation block with accompanying academic courses (these include but are not limited to internal medicine, pediatrics, general surgery, anaesthesiology, orthopaedics, gynaecology and obstetrics, emergency medicine, neurology, psychiatry, oncology, urology, physical medicine and rehabilitation, ophthalmology, and otorhinolaryngology). Elective rotations are usually introduced in the fourth or fifth year, though as in the case of the non-elective rotations, "the hospitals the medical students may be placed in or apply to for a given rotation depend entirely on the medical schools". This is important in terms of the medical training, given the particular distinction of patients, pathologies, procedures, and skills seen and learned in private vs. public hospitals in Colombia. Most schools, however, have placements in both types of hospitals for many specialties.