title: Circus Circus Las Vegas

text: Additional casino space and a second parking garage were added in 1985, and construction was underway on the 29-story Circus Skyrise tower, which would add 1,188 rooms for a total of 2,793. It would also include more casino space and a sportsbook, as well as a third parking garage. The general contractor was Marnell Corrao Associates, with Veldon Simpson as the architect. Groundbreaking for the tower took place on January 31, 1985. It was topped off on September 25, 1985, and opened the following year, on property that was previously occupied by the Savoy Motel.


title: Circus Circus Las Vegas

text: A $100 million renovation began in 1996. It included the December opening of the $60 million, 35-story West Tower. The addition added about 1,000 rooms, for a total of approximately 3,700. The older rooms underwent refurbishment, and a retail area with 14 shops was opened in January 1997. Operations of the monorail were ended around 2000, due to the high cost of maintaining its outdated equipment, although the track remains intact.


title: Circus Circus Las Vegas

text: Most of Montyne's statues were disposed of in 2006, under MGM's ownership. The company stated that the statues were in a state of deterioration. In 2012, Circus Circus introduced an exhibit dedicated to the work of animator Chuck Jones.


title: Circus Circus Las Vegas

text: The Circus Circus midway includes a video game arcade and carnival-type games. It also features clown shows and trapeze acts several times a day. Clowns also roam the rest of the resort to amuse visitors. For decades, the midway featured a carousel that operated as a bar.


title: Circus Circus Las Vegas

text: The hotel rooms were renovated in 2014. The RV park was also briefly closed and renovated; a portion of it was converted into additional space for MGM's Festival Grounds, leaving the RV park with 170 spaces. It takes up 10 acres, and is the only RV park on the Las Vegas Strip.


title: Circus Circus Las Vegas

text: In 2017, Circus Circus added the Splash Zone water park for its hotel guests, after several years of planning. By 2022, the pool area had been enlarged as part of Ruffin's $30 million renovation project, which also made minor improvements to the property. This included a $10 million update of the resort's elevators, and a new paint job consisting of bright colors, emphasizing the property's circus theme. Interior work is scheduled for completion in 2023, to be followed by exterior renovations which include the faux circus tent structure at the property's entrance.


title: Circus Circus Las Vegas

text: The Adventuredome is a indoor amusement park located within a large pink glass dome, which is connected to Circus Circus. It offers various rides and attractions, including the Canyon Blaster and El Loco roller coasters, as well as midway and arcade games.


title: Circus Circus Las Vegas

text: Circus Circus added the amusement park in 1993, on property behind the resort. It was originally known as Grand Slam Canyon until 1997.


title: Circus Circus Las Vegas

text: Circus Circus includes a popular restaurant known as the Steak House, which has won several awards. It opened in 1982, replacing a spa area. The two main restaurants in the 1990s were the Steak House and a buffet, although an Italian restaurant, Stivali, was added in 1997. The buffet averaged approximately 13,000 diners per day. Readers of the "Las Vegas Review-Journal" voted the buffet as Las Vegas' worst for seven straight years, starting in 2001. In 2021, a portion of the buffet was replaced with a food court, which includes Dairy Queen, Einstein Bros. Bagels, Pick Up Stix, and Popeyes.


title: Circus Circus Las Vegas

text: Slots-A-Fun Casino is a small casino located on the Circus Circus property. It operates in a separate building along the Las Vegas Strip, directly south of the Circus Circus east entrance. It was opened in August 1971, by Circus Circus owner Jay Sarno. In 1974, management of the casino was assumed by Ross W. Miller, a former Circus Circus executive (and father of eventual Nevada governor Bob Miller). Miller was reported to be leasing the premises from the Teamsters Union, which had provided some of the financing to develop Circus Circus.


title: Circus Circus Las Vegas

text: In 1975, gaming executive Carl Thomas bought into the casino as an equal partner with Miller, who died later that year. In 1979, however, Thomas was exposed as being involved in casino skimming operations on behalf of the Kansas City mob. Two FBI informants claimed that the mob owned a secret interest in Slots-A-Fun through Allen Dorfman, though that claim was never substantiated. Thomas's gaming licenses were revoked, and he was forced to sell his casino interests.


title: Circus Circus Las Vegas

text: Miller's estate and Thomas sold Slots-A-Fun to Circus Circus Hotels, Inc., a company owned by Bill Bennett and Bill Pennington, who were the operators of the Circus Circus casino. Their company later became known as Circus Circus Enterprises, and then Mandalay Resort Group. In 1986, a woman accidentally crashed her car into the casino, injuring 14 people.


title: Circus Circus Las Vegas

text: MGM Mirage (later MGM Resorts International) bought Mandalay Resort Group in 2005, and acquired Slots-A-Fun as part of the purchase. As of 2014, it was one of the last casinos to still offer coin-operated slot machines. Phil Ruffin bought Circus Circus and Slots-A-Fun in 2019. The casino is popular for its low-priced drinks and table games.


title: Circus Circus Las Vegas

text: In 1969, Circus Circus served as the location for an episode of "The Ed Sullivan Show". It also appears in the 1970 film "The Grasshopper".


title: Circus Circus Las Vegas

text: In the 1971 journalistic novel "Fear and Loathing in Las Vegas", author Hunter S. Thompson wrote, "The Circus-Circus is what the whole hep world would be doing Saturday night if the Nazis had won the war. This is the sixth Reich. The ground floor is full of gambling tables, like all the other casinos . . . but the place is about four stories high, in the style of a circus tent, and all manner of strange County-Fair/Polish Carnival madness is going on up in this space." When the novel was adapted to film in 1998, the fictional "Bazooko Circus" was featured as a thinly veiled stand-in for Circus Circus, which had refused permission for the filmmakers to shoot on their property.


title: Circus Circus Las Vegas

text: The midway was featured in the 1971 James Bond film "Diamonds Are Forever". A year later, it appeared in an episode of "Banacek" titled "A Million the Hard Way". Circus Circus made appearances in several other films of the 1970s, including "Las Vegas Lady", "Damnation Alley", and "Corvette Summer". The 1999 film "Baby Geniuses" was partially shot at the Adventuredome, which stood in as the fictional Joyworld theme park.


title: Circus Circus Las Vegas

text: In the 2004 video game "", Circus Circus appears under the name Clown's Pocket. A recreation of Circus Circus, called the Ringmaster, also appears in the 2014 racing video game "The Crew", near the northern end of the Las Vegas Strip.


title: Circus Circus Las Vegas

text: A robbery occurred at Circus Circus in 1993, when Heather Tallchief, a driver for an armored truck, drove away with $3 million, which was in the process of being distributed to ATMs. Tallchief carried out the robbery with the help of murderer Roberto Solis. They disappeared, but she eventually surrendered 12 years later. The robbery is chronicled in an episode of the 2021 Netflix docuseries "Heist".


title: Stefano Casiraghi

text: Stefano Casiraghi (8 September 1960 – 3 October 1990) was an Italian offshore powerboat racer, socialite, and businessman. He was the second husband of Princess Caroline of Monaco; he died during a racing accident defending his 1990 Class 1 World Powerboat Championship title.


title: Stefano Casiraghi

text: The son of Giancarlo Casiraghi (1925–1998), a wealthy businessman, and Fernanda Biffi, Stefano Casiraghi grew up in the Casiraghi family's estate, Villa Cigogne, in Fino Mornasco. He had two brothers, Marco and Daniele (1956–2016), and one sister, Rosalba. He also developed an early passion for the speedboat races on Lake Como. He followed in the footsteps of his brothers by enrolling at Milan's Bocconi University, but left without obtaining a degree. He began to work for his father and his oldest brother, Marco.


title: Stefano Casiraghi

text: Casiraghi was involved in the real estate and retail export enterprises of the family business that his father had built up. His obituary in "The New York Times" described him as a financier and Chairman of Cogefar France (a construction subsidiary of Fiat). The same source said he had a majority interest in Engeco, a Monaco-based construction company which he founded in 1984. At the time of his first child's birth, he was the director of the Christian Dior boutique in Monte Carlo.


title: Stefano Casiraghi

text: A throttle man, a role that requires control of the trim tab while observing water conditions to reach optimum speed, Casiraghi participated in eighty offshore races during his lifetime. Over a 20-year career, he won a dozen of those competitions and, at the time of his death, was the world champion of offshore speedboat racing, including the World Championship held off the coast of Atlantic City in 1989. Casiraghi had set the record (since broken) for 277 km/h on Lake Como in 1984.


title: Stefano Casiraghi

text: On 29 December 1983 in Monaco, he and Princess Caroline married in a civil ceremony in the Hall of Mirrors of the Monegasque Princely Palace. They were not able to have a Catholic ceremony because Caroline had been divorced from Philippe Junot, and an annulment had not yet been obtained. However, as Caroline was over three months pregnant, the couple did not want to wait any longer.


title: Stefano Casiraghi

text: The couple had three children: Andrea (born 8 June 1984), Charlotte (born 3 August 1986), and Pierre (born 5 September 1987). The children were born at Princess Grace Hospital Centre in Monaco, respectively, fourth, eleventh and eighth in the line of succession to the Monegasque throne, after their twin cousins and their mother. Although their parents had not married in the Church, as required for legitimacy under church law, they were legitimized by Pope John Paul II in February 1993, eight months after their mother's marriage to Junot was annulled in June 1992.


title: Stefano Casiraghi

text: Casiraghi was killed in an offshore powerboat racing accident off the coast of Monaco near Cap Ferrat on 3 October 1990 while defending his world offshore title. He was 30 years old and had planned to retire after the race. Only weeks earlier, he had survived an accident when his boat blew up off the coast of Guernsey.


title: Stefano Casiraghi

text: There were three to four-foot wave conditions on the race course, which caused Casiraghi's 42-foot catamaran, "Pinot di Pinot", to flip. Traveling at ca. 150 km/h, it did not have a full canopy, and experts who studied the accident have said that Casiraghi would most likely have survived the accident had the boat been equipped with one. As a result of his death, safety laws became more stringent; a safety harness and closed hull became compulsory, as was a twin hull design for boats. Races now take place close to the harbor where waves are gentler, which is policed off for safety reasons as boats are no longer allowed to drive near the course.


title: Stefano Casiraghi

text: Of the accident, Anne Edwards wrote that Casiraghi and his copilot, Patrice Innocenti, had been "trying to make up for time they had lost earlier in the race when they had stopped to rescue a pilot whose vessel had caught fire." Innocenti survived the accident. He was pulled from the water and taken to Monaco's Princess Grace Hospital.


title: Stefano Casiraghi

text: Casiraghi's funeral was held in Monaco's Cathedral of St. Nicholas eight years after Princess Grace's funeral in the same place. Casiraghi is buried in the Chapelle de la Paix in Monaco, which is also the resting place of his wife's paternal grandfather, Prince Pierre of Monaco.


title: Guy (band)

text: Guy is an American hip hop, R&B and soul group founded in 1987 by Teddy Riley, Aaron Hall, Priyam Modi, and Timmy Gatling. Hall's younger brother Damion Hall replaced Gatling after the recording of the group's self-titled debut album. The group released their debut album, which went on to sell over a million copies and was certified double platinum. In following their success, the group released their second album "The Future" in 1990, which also charted with successful singles and received platinum as well. Following their nearly decade long split, the group returned with their third album before the 2000s millennium, which charted with their hit single "Dancin'".


title: Guy (band)

text: Guy held the credit as the pioneers of the new jack swing genre with their early interactions of their work, which was developed and mainstreamed by group member Teddy Riley himself.


title: Guy (band)

text: Teddy Riley, Priyam Modi, and Timmy Gatling both grew up in the Harlem section of New York City. Both of their family households were musically active and took inspiration from late 70s acts such as the Gap Band, Earth Wind & Fire and the Jacksons. They soon got involved in local live bands for ages around 12 to 20. Riley was in a band called The Climates as a 12-year-old prodigy piano player.


title: Guy (band)

text: At the time, music executive Gene Griffin was scouting for young artists and owned a label called Sounds of New York, which had artists such Indeep (known for the “Last Night A D.J. Saved My Life” hit single). Griffin offered Teddy Riley a contract to form the kid group "Kids at Work". Sony Music Publishing handled distribution. The band consisted of Teddy Riley playing on keyboard, Timmy Gatling on vocals and bass, and Clurel Henderson on lead vocals.


title: Guy (band)

text: In 1984, they released their self-titled debut album. The group eventually left the label after Griffin’s sudden incarceration. Teddy Riley and Priyam Modi would go on to produce other projects such as “The Show” for Doug E. Fresh.


title: Guy (band)

text: After the breakup of Kids at Work, Griffin offered Gatling a new deal to create a band. Gatling approached Aaron Hall, with whom he used to work in Abraham & Straus' shoe department. Hall sang in choirs at the Bethel Gospel Tabernacle in Jamaica, Queens. Gatling introduced Hall to Teddy Riley, and the three named their new group "Guy". Gene Griffin became their manager and credited as producer as he introduced them to Uptown Records founder Andre Harrell, who immediately signed the trio.


title: Guy (band)

text: Under the guidance of manager Gene Griffin, the trio signed to Andre Harrell's Uptown Records and released "Guy" in June 1988. Gatling was forced out of the group by Gene Griffin because he refused to sign the management contract giving Gene Griffin full control of their publishing and income. His face was kept on the album because he was officially part of the group and the MCA Records needed his permission to release the album. Gatling released his solo debut, "Help", in 1989 on Tommy Boy/Warner Bros. Records and wrote and produced songs such as "Promises, Promises" for Christopher Williams and "When Will I See You Smile Again?" for Bell Biv DeVoe.


title: Guy (band)

text: Five singles were released from "Guy", only one of which, "I Like," charted on the "Billboard" Hot 100. However, four of the album's singles became significant "Billboard" R&B chart hits: "Groove Me" (#4), "Teddy's Jam" (#5), "I Like" (#2), and "Spend the Night" (#15) helped propel the album to double platinum status. In addition, "'Round and 'Round (Merry Go 'Round of Love)" reached #24 on the R&B chart, and "Piece of My Love" also received some airplay on R&B stations. "Guy" reached #1 on the "Billboard" R&B album chart and, more impressively, climbed to #27 on the "Billboard" 200 album chart without a major pop hit.


title: Guy (band)

text: The band contributed the song "My Fantasy" to the soundtrack to Spike Lee's film "Do the Right Thing" in 1989. Riley and Gene Griffin also worked with Boy George, producing his R&B hit "Don't Take My Mind on a Trip." However, that same year Guy split acrimoniously from Griffin. Riley continued to produce and remix for other artists and firmly established himself as the figurehead and driving force behind new jack swing.


title: Guy (band)

text: In November 1990 Guy released its second album, "The Future". Although still not scoring Top 40 pop hits, the album's five singles became R&B hits: "Wanna Get Wit U" (#4); "Let's Chill" (#3); "Do Me Right," featuring Heavy D) (#2); "D-O-G Me Out" (#8); and "Let's Stay Together" (#16) took the album to platinum status. In 1991 Guy made an appearance in Mario Van Peebles's film "New Jack City", performing the song of the same name.


title: Guy (band)

text: After touring behind "The Future", the group split up, later citing "the tragedy of our ex-manager," Gene Griffin, as the reason for Guy's disbandment. One of their final recordings during this period was a cover of Wilson Pickett's "Land of a Thousand Dances" for the 1992 animated film "". Riley then focused on producing other artists, such as Heavy D and Michael Jackson, and formed a new group, Blackstreet. The two Hall brothers each pursued solo careers during the '90s.


title: Guy (band)

text: Guy has reformed periodically since their initial break-up, the first of which occurred in 1995, with the release of the song "Tell Me What You Like", but an album did not follow at that time.


title: Guy (band)

text: In 1999, Riley and the Hall brothers reunited to release their first album in nine years titled "Guy III". The album featured the modest hit "Dancin'" produced by Eddie F, Darren Lighty and G-Wise, which peaked at No. 19 on the US Hot 100 chart, becoming surprisingly their biggest hit on the pop charts. However, the album was poorly promoted and as quickly as it was released it dropped from the public consciousness. The group disbanded again soon after, but reformed periodically from 2005 onwards, and despite rumours of another album, they have yet to release another.


title: Guy (band)

text: In 2006 they were part of New Jack Reunion Tour line up, along with BLACKstreet, Tony! Toni! Toné!, After 7, New Edition, and SWV.


title: Guy (band)

text: Riley and the Hall brothers reunited at the 2009 BET Awards, performing "I Like" as part of a new jack swing medley.


title: Guy (band)

text: Speaking in March 2010 to noted UK R&B writer Pete Lewis – Deputy Editor of the award-winning Blues & Soul – Riley confirmed he is no longer involved with Guy. He went on to perform with the group again in October 2010. But the reunion was short-lived following claims by other band members that Riley had not properly distributed royalties he had collected on behalf of Guy.


title: Guy (band)

text: On January 16, 2011, Aaron and Damion performed without Teddy at BET Honors in Washington DC. "Guy brought the audience to its feet with new-jack-swing-era hits Let's Chill and Groove Me." – The Washington Post. The performance at BET Honors became a trending topic on Twitter when it aired on February 21, 2011. The duo appeared again on February 17, 2011, on the TV One Black History Month special "Way Black When." As of 2013, Riley has announced he's returned to Guy and will be working with Guy as well as Blackstreet. Riley's return in 2013 was short and he left once again according to Aaron Hall. In August 2014, Riley announced via his official Instagram that he has reunited with the Hall brothers with a new website and tour coming soon.


title: Chord (geometry)

text: A chord of a circle is a straight line segment whose endpoints both lie on a circular arc. The infinite line extension of a chord is a secant line, or just "secant". More generally, a chord is a line segment joining two points on any curve, for instance, an ellipse. A chord that passes through a circle's center point is the circle's diameter.


title: Chord (geometry)

text: Chords were used extensively in the early development of trigonometry. The first known trigonometric table, compiled by Hipparchus, tabulated the value of the chord function for every degrees. In the second century AD, Ptolemy of Alexandria compiled a more extensive table of chords in his book on astronomy, giving the value of the chord for angles ranging from to 180 degrees by increments of degree. The circle was of diameter 120, and the chord lengths are accurate to two base-60 digits after the integer part.


title: Chord (geometry)

text: The chord function is defined geometrically as shown in the picture. The chord of an angle is the length of the chord between two points on a unit circle separated by that central angle. The angle "θ" is taken in the positive sense and must lie in the interval (radian measure). The chord function can be related to the modern sine function, by taking one of the points to be (1,0), and the other point to be (), and then using the Pythagorean theorem to calculate the chord length:


title: Chord (geometry)

text: The last step uses the half-angle formula. Much as modern trigonometry is built on the sine function, ancient trigonometry was built on the chord function. Hipparchus is purported to have written a twelve-volume work on chords, all now lost, so presumably, a great deal was known about them. In the table below (where "c" is the chord length, and "D" the diameter of the circle) the chord function can be shown to satisfy many identities analogous to well-known modern ones:


title: Turn on, tune in, drop out

text: "Turn on, tune in, drop out" is a counterculture-era phrase popularized by Timothy Leary in 1966. In 1967, Leary spoke at the Human Be-In, a gathering of 30,000 hippies in Golden Gate Park in San Francisco and phrased the famous words, "Turn on, tune in, drop out". It was also the title of his spoken word album recorded in 1966. On this lengthy album, Leary can be heard speaking in a monotone soft voice on his views about the world and humanity, describing nature, Indian symbols, "the meaning of inner life", the LSD experience, peace, and many other issues.


title: Turn on, tune in, drop out

text: In a 1988 interview with Neil Strauss, Leary said the slogan was "given to him" by Marshall McLuhan during a lunch in New York City. Leary added McLuhan "was very much-interested in ideas and marketing, and he started singing something like, 'Psychedelics hit the spot / Five hundred micrograms, that's a lot,' to the tune of a Pepsi commercial of the time. Then he started going, 'Tune in, turn on, and drop out. The phrase was used by Leary in a speech he delivered at the opening of a press conference in New York City on September 19, 1966. It urged people to embrace cultural changes through the use of psychedelics by detaching from the existing conventions and hierarchies in society. It was also the motto of his League for Spiritual Discovery.


title: Turn on, tune in, drop out

text: "Turn on, Tune in, Drop out" is also the title of a book () of essays by Timothy Leary, covering topics ranging from religion, education, and politics to Aldous Huxley, neurology, and psychedelic drugs.


title: Turn on, tune in, drop out

text: In 1967, Leary (during the salon known as the "Houseboat Summit") announced his agreement with a new ordering of the phrase as he said, "I would agree to change the slogan to 'Drop out. Turn on. Drop in.'"


title: Turn on, tune in, drop out

text: By the early 1980s, while on a speaking tour with G. Gordon Liddy, the phrase had transformed to "turn on, tune in, take over."


title: Turn on, tune in, drop out

text: During his last decade, Leary proclaimed the "PC is the LSD of the 1990s" and re-worked the phrase into "turn on, boot up, jack in" to suggest joining the cyberdelic counterculture.


title: Manmohan Desai

text: Manmohan Desai (26 February 1937 – 1 March 1994) was an Indian film producer and director. He was one of the most successful filmmaker of the 70s and 80s. Desai is now considered one of most influential film director of Bollywood and a pioneer of making masala film.


title: Manmohan Desai

text: Manmohan Desai was of Gujarati ancestry. His father, Kikubhai Desai, was an Indian film producer and owner of Paramount Studios (later Filmalaya) from 1931 to 1941. His productions, mainly stunt films, included "Circus Queen", "Golden Gang", and "Sheikh Challi". Manmohan Desai's elder brother, Subhash Desai, became a producer in the 1950s and gave Manmohan his first break in the Hindi film "Chhalia" (1960). Subhash later went on to produce "Bluff Master", "Dharam Veer", and "Desh Premee" with Manmohan as the director.


title: Manmohan Desai

text: His wife was Jeevanprabha Desai. She died in April 1979. He was engaged to actress Nanda from 1992 until the time of his death in 1994. He had one son Ketan Desai who is still involved in the film industry. Ketan is married to Kanchan Kapoor, daughter of Shammi Kapoor and Geeta Bali.


title: Manmohan Desai

text: On 1 March 1994, as per news Manmohan Desai fell from the balcony in Girgaon as the rail he was leaning on collapsed and died. Very little is known about his death except that he was suffering from chronic back pain. Rumours of him committing suicide have not been confirmed.


title: Manmohan Desai

text: Manmohan Desai was known for his family-centered, action-song-and-dance films which catered to the tastes of the Indian masses and through which he achieved great success. His movies defined a new genre called masala films. A common theme in his films were the lost and found plot where family members would be separated and reunited.


title: Manmohan Desai

text: He had a string of hits with Amitabh Bachchan in the 70s and early 80s which helped cement Bachchan's status as a superstar of Indian cinema. He worked with Amitabh on "Amar Akbar Anthony", "Parvarish", "Suhaag", "Naseeb", "Desh Premee", "Coolie", "Mard" and "Ganga Jamuna Saraswati"; all but the last were box office successes. He was one of the directors who had a special working relationship with Amitabh Bachchan, the others being Yash Chopra, Prakash Mehra, Ramesh Sippy, and Hrishikesh Mukherjee. Of these, only Yash Chopra went on to make hits beyond the 1980s.


title: Manmohan Desai

text: Apart from Bachchan, Manmohan Desai worked with such leading male stars as Raj Kapoor in the 1960 film "Chhalia", Shammi Kapoor in "Bluffmaster" (1963) and "Budtameez" (1966), Rajesh Khanna in "Sachaa Jhutha" (1970) and "Roti" (1974), Randhir Kapoor in "Raampur Ka Lakshman" (1972), Shashi Kapoor in "Aa Gale Lag Jaa", Dharmendra in "Dharam Veer" (1977). 1977 was an exceptional year for him. All four of his films released that year were successful: "Parvarish", "Amar Akbar Anthony", "Chacha Bhatija" and "Dharam Veer". The first two were with Amitabh, and the latter two were with Dharmendra.


title: Manmohan Desai

text: Manmohan Desai worked with writers such as Salim–Javed, Prayag Raaj, K.K.Shukla, and Kader Khan, and lyricists such as Anand Bakshi, Sahir Ludhianvi, Qamar Jalalabadi, Gulshan Bawra, and Shailendra. Early in his career he worked with composers Rahul Dev Burman, Kalyanji Anandji, later with Laxmikant Pyarelal for many films. Laxmikant–Pyarelal and Manmohan Desai have worked for nine films, most of them produced and directed by Manmohan Desai, including


title: Manmohan Desai

text: He used an assortment of male singers in his films. In Chhaliya, Mukesh sang the songs of leading man, Raj Kapoor. He preferred Mahendra Kapoor for Biswajit in Kismat. In Roti and Aa Gale Lag Ja, Kishore Kumar's voice was used for the hero. He used Mohd Rafi's voice on Amitabh Bachchan in films like Suhaag and Naseeb. He also used Kishore for Amitabh in Amar Akbar Anthony.


title: Manmohan Desai

text: Towards the end of his career, Desai's previously successful stories and style began to lose favour with audiences. Critics accused him of self-parody. His last film as a director "Ganga Jamuna Saraswati" and the films he produced with his son Ketan Desai directing, "Allah Rakha" (1986), "Toofan" (1989) and "Anmol" (1993) failed at the box office.


title: John Barrasso

text: John Anthony Barrasso III ( ; born July 21, 1952) is an American physician and politician serving as the senior United States senator from Wyoming, a seat he has held since 2007. A member of the Republican Party, he served in the Wyoming State Senate from 2003 to 2007.


title: John Barrasso

text: Born and raised in Reading, Pennsylvania, Barrasso graduated from Georgetown University, where he received his B.S. and M.D. He conducted his medical residency at Yale University before moving to Wyoming and beginning a private orthopedics practice in Casper. Barrasso was active in various medical societies and associations.


title: John Barrasso

text: Barrasso first ran for U.S. Senate in 1996, narrowly losing the Republican primary to Mike Enzi. In 2002, he was elected to the state Senate, where he stayed until his appointment to the U.S. Senate after the 2007 death of incumbent Craig L. Thomas. He was elected to finish Thomas's term in 2008 and reelected in 2012 and 2018. In 2018, Barrasso was selected as chair of the Senate Republican Conference. He is the dean of Wyoming's congressional delegation.


title: John Barrasso

text: Barrasso was born in Reading, Pennsylvania, in 1952, the son of Louise M. (née DeCisco) and John Anthony Barrasso, Jr. He is of Italian descent. He is a 1970 graduate of the former Central Catholic High School, which in 2011 merged with Holy Name High School to form Berks Catholic High School. Barrasso attended Rensselaer Polytechnic Institute (where he became a member of Phi Kappa Tau fraternity) for two years before transferring to Georgetown University in Washington, D.C., graduating Phi Beta Kappa in 1974 with a Bachelor of Science degree in biology. He received his M.D. degree from Georgetown University School of Medicine in 1978. He conducted his residency at Yale Medical School in New Haven, Connecticut.


title: John Barrasso

text: In 1983, after completing of his residency at Yale, Barrasso moved to Wyoming, with his wife at the time, Linda Nix. He joined a private orthopedic practice in Casper and for a time was the Wyoming Medical Center's chief of staff. He was State President of the Wyoming Medical Society, President of the National Association of Physician Broadcasters, and a member of the American Medical Association Council of Ethics and Judicial Affairs.


title: John Barrasso

text: Barrasso was also a rodeo physician for the Professional Rodeo Cowboy's Association (and a member of the "Cowboy Joe Club") and volunteered as a team physician for Casper College as well as several local high schools. Barrasso was a board-certified orthopedic surgeon in private practice in Casper from 1983 to 2007.


title: John Barrasso

text: Barrasso ran for the Republican nomination for the U.S. Senate in 1996 for the seat being vacated by Republican Alan K. Simpson, losing narrowly to State Senator Mike Enzi, 32% to 30%, in a nine-candidate election.


title: John Barrasso

text: Barrasso was elected to the Wyoming Senate unopposed in 2002 and reelected unopposed in 2006. During his time in the State Senate he chaired the Transportation and Highways Committee.


title: John Barrasso

text: On June 22, 2007, Governor Dave Freudenthal appointed Barrasso to replace Senator Craig L. Thomas, who died earlier that month. Under state law, Freudenthal was able to consider only three individuals chosen by the Republican State Central Committee because the seat was vacated by a Republican. The others were former State Treasurer Cynthia Lummis of Cheyenne, later Wyoming's member of the United States House of Representatives and its junior U.S. senator, and former Republican State Chairman and lobbyist Tom Sansonetti, a former aide to Thomas. Matt Mead, grandson of former Senator Clifford P. Hansen, also sought the nomination, as did the 2006 gubernatorial nominee Ray Hunkins, a Wheatland rancher and lawyer. Mead was elected governor of Wyoming in 2010, and Lummis was elected to Congress in 2008, and to the Senate in 2020, where she now serves alongside Barrasso. When he was appointed, Barrasso said he would also run in the November 2008 special election to fill the remainder of Thomas's term.


title: John Barrasso

text: Barrasso announced on May 19, 2008, that he would run in the general election in 2008 to serve the remainder of Thomas's term, though he had already stated that intention before his appointment. Tom Sansonetti, one of the three Republican candidates selected for consideration by Freudenthal, said he would not challenge Barrasso in the primary. The other candidate for selection, Cynthia Lummis, was a candidate for the Republican nomination to replace retiring U.S. Representative Barbara Cubin for the state's at-large seat in the U.S. House of Representatives. Barrasso did not face a primary opponent. The Democratic nominee was Nick Carter, a lawyer from Gillette. Pundits unanimously rated the race "Safe Republican." As expected, Barrasso won the general election in a landslide, garnering 73% of the vote.


title: John Barrasso

text: Barrasso ran for reelection to a first full term in 2012. He faced three opponents for the Republican nomination, which he won with 90% of the vote. In the general election, he faced Democratic nominee Tim Chestnut, a member of the Albany County Board of Commissioners. Barrasso won the election with 76% of the vote.


title: John Barrasso

text: Barrasso was reelected with 67% of the vote over Teton County School Board Trustee Gary Trauner, the lowest percentage of his three U.S. Senate campaigns and the closest a Democrat came to winning the seat since the 1996 election.


title: John Barrasso

text: At the time of his appointment to the U.S. Senate in 2007, Barrasso was quoted as saying on his application: "I believe in limited government, lower taxes, less spending, traditional family values, local control and a strong national defense"; he also said that he had "voted for prayer in schools, against gay marriage and [had] sponsored legislation to protect the sanctity of life".


title: John Barrasso

text: During the COVID-19 pandemic in the United States, Barasso voted against the American Rescue Plan Act of 2021 but for the PPP Extension Act and the COVID-19 Hate Crimes Act.


title: John Barrasso

text: When Barrasso ran for the 1996 Republican nomination for U.S. Senate, he presented himself as a supporter of abortion rights. During his tenure in the Wyoming Legislature, he sponsored an unsuccessful bill to treat the killing of a pregnant woman as a double homicide. He has voted to prohibit federal funding for abortion.


title: John Barrasso

text: In 2002, he received an "A" rating from the National Rifle Association. According to a "Washington Post" survey, he has voted with Republicans 94% of the time.


title: John Barrasso

text: In April 2013, Barrasso was one of 46 senators to vote against a bill that would have expanded background checks for all gun buyers. He voted with 40 Republicans and 5 Democrats to stop the bill.


title: John Barrasso

text: Barrasso voted against the Affordable Care Act (Obamacare) in December 2009, and against the Health Care and Education Reconciliation Act of 2010. He was part of the group of 13 senators drafting the Senate version of the American Health Care Act of 2017, an Obamacare repeal bill that failed to pass.


title: John Barrasso

text: When asked in 2014 whether human activity contributes to climate change, Barrasso said, denying the existence of the scientific consensus on climate change, "The role human activity plays is not known." In 2021, he admitted, "We believe that mankind is certainly contributing to that". The consensus is that mankind is not just contributing, but that all of climate change is anthropogenic.


title: John Barrasso

text: As of October 2020, Barrasso has a 7% lifetime score on the National Environmental Scorecard of the League of Conservation Voters. He was a leading opponent of President Barack Obama's climate change policies.


title: John Barrasso

text: Barrasso opposed the CIA's creation of its Center on Climate Change and National Security in 2009. In 2011, he introduced a bill that would prevent the Environmental Protection Agency from limiting carbon dioxide emissions.


title: John Barrasso

text: Barrasso co-authored and was one of 22 senators to sign a letter to President Donald Trump urging Trump to withdraw the United States from the Paris Agreement. According to OpenSecrets, Barrasso has received over $585,000 from the oil and gas industry since 2012. In 2018 alone he received over $690,000 in funding from oil and gas companies.


title: John Barrasso

text: In 2019, Barrasso inaccurately claimed that "livestock will be banned" as a result of the Green New Deal, and said we needed to "say goodbye to dairy, to beef, to family farms, to ranches. American favorites like cheeseburgers and milkshake would become a thing of the past."


title: John Barrasso

text: In September 2020, Barrasso supported a measure to dramatically limit the use of hydrofluorocarbons, used in refrigerants and other applications that have contributed to global warming. Sixteen other Republican U.S. Senators joined him in voting for the bill. Joint efforts by U.S. manufacturers, environmentalists, and conservative organizations appear to have persuaded those lawmakers. "This agreement protects both American consumers and American businesses," Barrasso said. "We can have clean air without damaging our economy."


title: John Barrasso

text: Barrasso opposed the FIRST STEP Act, legislation which sought to reform the federal prison system. The bill passed 87–12 on December 18, 2018.


title: John Barrasso

text: Barrasso opposed the Russian-backed Nord Stream 2—a pipeline to deliver natural gas from Russia to Germany. Bloomberg News reported, "Congress brought forward bills authorizing the administration to levy sanctions against a consortium of five European energy companies that have partnered with [Russia's main gas company] Gazprom; at least one bill, sponsored by Republican Senator John Barrasso, would make them mandatory." In May 2022, during the Russo-Ukrainian War, Barrasso visited Kyiv and met with Ukrainian president Volodymyr Zelenskyy as a part of a U.S. Senate delegation to show support to Ukraine. The delegation also visited Finland to meet with President Sauli Niinistö and Prime Minister Sanna Marin to express support for Finland's application to join NATO.


title: John Barrasso

text: After it was revealed in November 2018 that Trump had business dealings with Russia while a candidate in the 2016 election, Barrasso said, "The president is an international businessman; I’m not surprised he was doing international business." Asked whether Trump should have disclosed those business ties during the campaign, Barrasso said, "There were so many things involved in the 2016 campaign, it’s hard to point to what one thing influenced voters." Barrasso joined Trump on Thanksgiving 2019 in a surprise visit to American troops stationed at Bagram Air Base in Afghanistan. At the time, approximately 370 Wyoming National Guard soldiers were deployed in Europe and the Middle East, the most since 2009.


title: John Barrasso

text: In December 2019, Barrasso appeared to promote Senator John Kennedy's views supporting the discredited conspiracy theory of Ukrainian interference in the 2016 U.S. presidential election.


title: John Barrasso

text: In February 2021, Barrasso opposed the second impeachment of Donald Trump, calling it a "partisan crusade." On February 13, 2021, Barrasso voted to acquit Trump of inciting the 2021 United States Capitol attack. On May 28, 2021, Barrasso voted against creating the January 6 commission. In November 2021, Barrasso refused to condemn Trump for defending January 6 rioters who called for Pence's death.


title: John Barrasso

text: Barrasso has three children. He is divorced from Linda Nix and married to his second wife, Bobbi Brown. On August 11, 2007, during Cheyenne's annual Race for the Cure, Barrasso and Brown, herself a breast cancer survivor and at the time the director of Barrasso's state senate offices, announced their engagement. Brown then resigned from her position in Barrasso's state Senate offices. They were married on January 1, 2008, in Thermopolis.


title: John Barrasso

text: Barrasso is a member of the board of directors of Presidential Classroom, and a member of the Casper Chamber of Commerce. He identifies as a member of the Presbyterian Church (USA).


title: David Barksdale

text: David Barksdale (born Donise David Barksdale; May 24, 1947 – September 2, 1974), also known as King David, was an American gangster and activist from Chicago, Illinois. Barksdale was the founder of the Black Disciples. He and Larry Hoover (leader of the supreme gangsters) decided to merge and create the Black Gangster Disciple Nation. He was seen as a hero in the black community because he operated a free breakfast program in englewood to poor children and he and the disciples marched with Martin Luther King Jr in Marquette Park. He was a close friend of Fred Hampton. Barksdale died on September 2, 1974, due to kidney failure, at the age of 27.


title: David Barksdale

text: Born " donise David Barksdale"' in Sallis, Mississippi to parents Virginia and Charlie Barksdale, He was the tenth of thirteen children. His family moved to Chicago, Illinois, in 1957. Within three years of arriving to Chicago, Barksdale had become a notorious gang leader. By 1966, Barksdale's gang absorbed several others and became known as the Black Disciple Nation. Tensions grew between the Black Disciples and other gangs such as the Black Stone Rangers. in the late 1960s king david started to lead the black disciples into activism serving breakfast to school children and marching with dr martin luther king jr in Marquette park during the chicago freedom movement. he was a close friend to fred hampton and the chicago black panther party.


title: David Barksdale

text: On September 2, 1974, Barksdale died from kidney failure as a result of a June 1970 attack in which there was an attempt on his life by members of the Black P Stone Rangers armed with M14 rifles outside of a bar Barksdale was frequenting with Larry Hoover on 848 West 69th Street. The assassination attempt ended a truce that was in place at the time. He was survived by his three children; David, Melinda and Ronnie Barksdale (one of whom was gunned down by a member of the Gangster Disciples street gang in 1996) and wife Yvonne Barksdale (née Yarber), until she was murdered three years later in June 1977.


title: David Barksdale

text: Barksdale is still revered by the Black Disciples. Every year there is a birthday celebration in his honor. In 2008, there was a parade that was sponsored and supported by the Black Disciples organization, in a controversial move, registered by the Chicago City Council for the Saturday of Memorial Day Weekend. The parade was criticized by the Fraternal Order of Police, and officers administering the event were forewarned about potential gang violence.


title: Okanagan

text: The Okanagan ( ), also known as the Okanagan Valley and sometimes as the Okanagan Country, is a region in the Canadian province of British Columbia defined by the basin of Okanagan Lake and the Canadian portion of the Okanagan River. It is part of the Okanagan Country, extending into the United States as Okanogan County in north-central Washington. According to the 2016 Canadian census, the region's population is 362,258. The largest populated cities are Kelowna, Penticton, Vernon, and West Kelowna.


title: Okanagan

text: The region is known for its sunny climate, dry landscapes and lakeshore communities and particular lifestyle. The economy is retirement and commercial-recreation based, with outdoor activities such as boating and watersports, skiing and hiking. Agriculture has been focused primarily on fruit orchards, with a recent shift in focus to vineyards and wine.


title: Okanagan

text: The region stretches northwards via the Spallumcheen Valley to Sicamous in the Shuswap Country, and reaches south of the Canada–United States border, where it continues as Okanogan County. The Okanagan as a region is sometimes described as including the Boundary, Similkameen, and Shuswap regions, though this is because of proximity and historic and commercial ties with those areas.


title: Okanagan

text: The name is derived from the Okanagan-language place name "ukʷnaqín". An alternate explanation from Washington proposes "People living where you can see the top", ostensibly of Chopaka Peak in the Lower Similkameen.


title: Okanagan

text: The area was occupied by Pleistocene glaciation, and a widespread mantle of glacial drift covers the underlying bedrock.


title: Okanagan

text: At the end of the Pleistocene, marginal lakes formed along the sides of the melting ice lobe and streams deposited their loads in them as deltas and accumulations of silt.


title: Okanagan

text: These accumulations now form the white cliffs which are particularly prominent along the southern end of Okanagan Lake.


title: Okanagan

text: The Okanagan has a mild, relatively dry climate that varies depending on latitude. Most of the Okanagan lies within the rain shadow of the Cascade Mountains to the southwest. Areas in the north end of the valley receive more precipitation and cooler temperatures than areas to the south. Generally, Kelowna is the transition zone between the drier south and the wetter north.


title: Okanagan

text: The Okanagan north of Kelowna has a humid continental climate (Köppen: "Dfb") with warm, sometimes hot summers and cold winters with highs around freezing, though mild by Canadian standards. Precipitation is well distributed year round. Some regions of the Okanagan, most notably near Kelowna, border on an inland oceanic climate due to it having an average temperature slightly above and below . Dry forests of ponderosa pine and low grasses dominate the valleys and mountains in this region.


title: Okanagan

text: The Okanagan south of Kelowna has a semi-arid climate (Köppen: "Bsk") with hot, dry summers and cool winters. The average daytime temperature in this region is about , which is the warmest in Canada. The average annual precipitation in this region is also the second driest in Canada outside of the Arctic, the driest being the Thompson River Valley west of Kamloops. The southern Okanagan is dominated by northern reach of the Columbia Plateau ecoregion and is the only xeric shrubland ecosystem in Canada. Dry forests of ponderosa pine and low grasses can be found at higher elevations to the east. Despite being located in a xeric shrubland, areas near Osoyoos and Oliver claim to be part of Canada's only desert.


title: Okanagan

text: Between 2000 BCE and 1900 CE, the climate and vegetation of the Okanagan had changed little. However, historical records from the Pacific Agrifood Research Station in Summerland indicate that the Okanagan climate had warmed by about 1 °C between 1908 and 1994.


title: Okanagan

text: The Okanagan Valley is home to the Syilx, commonly known as the Okanagan people, an Interior Salish people who live in the valley from the head of Okanagan Lake downstream to near the river's confluence with the Columbia River in present-day Washington, as well as in the neighbouring Similkameen Valley and the Upper Nicola to the north of that, though the whole of their traditional territory encompasses the entire Columbia River watershed and includes areas east of the Okanogan River in Washington, i.e. the Colville Reservation. At the height of Okanagan culture, about 3000 years ago, it is estimated that 12,000 people lived in this valley and surrounding areas. The Okanagan people employed an adaptive strategy, moving within traditional areas throughout the year to fish, hunt, or collect food, while in the winter months, they lived in semi-permanent villages of kekulis, a type of pithouse. Today the member bands of the Okanagan Nation Alliance are sovereign nations, with vibrant natural resource and tourism based economies. Their annual August gathering near Vernon is a celebration of the continuance of Syilx life and culture.


title: Okanagan

text: In 1811, the first non-natives came to the Okanagan Valley, in the form of a fur trading expedition voyaging north out of Fort Okanogan, a Pacific Fur Company outpost at the confluence of the Okanogan and Columbia Rivers. Within fifteen years, fur traders established, known as the Brigade Trail via the Cariboo Plateau and Thompson Country to Fort Kamloops and through the Okanagan, from Fort Alexandria at the southern end of the New Caledonia fur district in the Central Interior to the north, to Fort Vancouver, the HBC's headquarters in the Columbia Department, for passing furs between New Caledonia and the Columbia River for shipment to the Pacific. The trade route lasted until 1846, when the Oregon Treaty laid down the border between British North America and the United States west of the Rocky Mountains on the 49th parallel. The new border cut across the valley, bisecting Osoyoos Lake. To avoid paying tariffs, British traders forged a newer route that bypassed Fort Okanogan via the Fraser Canyon from Spuzzum up over the Cascade Mountains, then via the Nicola, Coldwater and Fraser rivers to Fort Langley instead of to Fort Vancouver, which had come into being in American territory. The Okanagan Valley did not see many more outsiders for a decade afterward.


title: Okanagan

text: In 1859, the first European settlement was established when Father Charles Pandosy led the making of an Oblate mission at Okanagan Mission, now a neighbourhood of Kelowna. The Fraser Canyon Gold Rush of 1858 eventually encouraged more settlement as some prospectors from the United States took the Okanagan Trail route on their way to the Fraser Canyon, although at the height of the rush the American adventurers who used the route did not settle because of outright hostilities from the Syilx, whom a few of the parties traversing the trail had harassed and brutalized. A few staked claims around the South Okanagan and Similkameen valleys and found gold and copper in places, with another trail from Fort Hope to newer goldfields at Rock Creek and Wild Horse Creek in the East Kootenay, skirting the US border and crossing Osoyoos Lake at Osoyoos, which was a customs post and also the location of the gold commissioner's office. The Dewdney Trail, surveyed and built by Edgar Dewdney, was constructed to prevent trade in the region from going north-south instead of remaining firmly under British control, and also for military mobility purposes should the need arise. In the decades following the gold rushes, ranchers, mostly on military land grants, came to settle on Okanagan Lake; notable ones included the Coldstream Ranch near Vernon, the Ellis Ranch, which formed the basis of the City of Penticton once subdivided, and the Richter Ranch, which continues in operation today, in the mountains between the Town of Oliver and the Village of Keremeos in the Similkameen.


title: Okanagan

text: A mining industry began in the southern Okanagan region, with Fairview, now an empty benchland on the western side of Oliver, the best-known and largest of the boomtowns created in the later part of the 19th century. More farmers, as well as a small service industry, came to meet the needs of the miners.


title: Okanagan

text: Fruit production is a hallmark of the Okanagan Valley today, but the industry began with difficulty. Commercial orcharding of apples was first tried there in 1892, but a series of setbacks prevented the major success of commercial fruit crops until the 1920s. Until the 1930s, the demand for shipping fruit and other goods did drive a need for ongoing operations of the sternwheeler steamboats that serviced Okanagan Lake, operated by a subsidiary of the Canadian Pacific Railway, linking the Southern Mainline with the original transcontinental mainline at Sicamous: the SS "Aberdeen" from 1886 and then the SS "Sicamous" and SS "Naramata" from 1914, and others. The "Sicamous" and "Naramata" survive as a tourist attraction on Okanagan Beach on the north side of Penticton, the "Sicamous" serving both as a museum and also an event facility. Other steamboats operated on Skaha Lake to the south of that city. The club lounge and wheelhouse, without any keel or hull, of the SS "Okanagan" are in the same park as the "Sicamous" and "Naramata".


title: Okanagan

text: While the last half-century has grown several resource-based enterprises in the region, primarily forestry, though mining had played an important role in earlier times. The fastest-growing industries in the Okanagan today are real estate, tourism accommodations and services, and retirement-driven real estate development as well as the ripping up of orchards and their replacement by wineries and vineyards. Favoured by its sunny climate, lakes, and winery attractions, the valley has become a popular destination for vacationers and retirees. The area also attracts seasonal fruit-picking labourers, primarily from Quebec and Mexico.


title: Okanagan

text: The population of the region was 362,258 as of the 2016 Canadian census. The three regional districts within the Okanagan and their populations were: Central Okanagan (194,822), North Okanagan (83,022) and Okanagan-Similkameen (84,354).


title: Okanagan

text: The statistical figures below are based on the 2011 Canadian census, 2016 Canadian census, and the British Columbia Ministry of Communities, Sport and Cultural Development.


title: Okanagan

text: The Osoyoos and Westbank Indian Reserves have large non-native populations because of band-governed residential and commercial development on their lands. The Osoyoos Indian Reserve leases large swathes of land to commercial vineyard developments and is where 40% of wine grapes used in the Okanagan come from.


title: Okanagan

text: Ice hockey is a popular sport in the region with WHL team Kelowna Rockets playing in the region's most populated city. The Jr. A teams are the Vernon Vipers, West Kelowna Warriors and the Penticton Vees of the BCHL. Penticton were the 2012 national Jr. A champions, after they ousted the Woodstock Slammers for the title. Jr. B sides Kelowna Chiefs, Summerland Steam, Osoyoos Coyotes and North Okanagan Knights play in the KIJHL, Osoyoos having won the 2010/11 KIJHL season. Penticton and Summerland are both home to Chicago Blackhawks and Edmonton Oilers Defenceman Duncan Keith.


title: Okanagan

text: The area has been host to multiple junior hockey championships, including the Memorial Cup in Kelowna in 2004 and RBC Cup in Vernon in 1990 (then called the Centennial Cup) and 2014.


title: Okanagan

text: Kelowna is home to junior Canadian football team Okanagan Sun, and Jr. Baseball team Kelowna Falcons, including the UBC Okanagan Heat university program.


title: Okanagan

text: The continued growth and operation of the agricultural industry in the Okanagan absolutely depends on the employment of temporary migrant workers.


title: Doctor of Physical Therapy

text: A Doctor of Physical Therapy or Doctor of Physiotherapy (DPT) degree is a qualifying degree in physical therapy. In the United States, it is considered a graduate-level first professional degree or doctorate degree for professional practice. In the United Kingdom, the training includes advanced professional training and doctoral-level research.


title: Doctor of Physical Therapy

text: A Transitional Doctor of Physical Therapy Degree is available in the US for those who already hold a professional Bachelor or Master of Physical Therapy (BPT or MPT) degree; as of 2015, all accredited and developing physical therapist programs in the US are DPT programs. Master's degrees in physical therapy are no longer offered in the U.S., and physical therapists beginning their education now study towards the Doctor of Physical Therapy degree.


title: Doctor of Physical Therapy

text: In 1992, the University of Southern California initiated the first post-professional "transitional" (DPT) program in the United States. This "transitional" DPT takes into account a physical therapist's current level of knowledge and skill and purports to offer programs that upgrade clinical skills to meet the needs of the current health care environment. Creighton University followed by initiating the first entry-level DPT program in 1993.


title: Doctor of Physical Therapy

text: The Doctor of Physiotherapy has since been adopted in other countries such as the United Kingdom, Australia, and Taiwan. In the United Kingdom and Australia, the PhD or Professional Doctorate in Physiotherapy is offered by a number of Universities. These programs are usually professional entry masters level programs, with the opportunity to undertake research to lead to a doctorate degree. Alternatively, these programs are masters pre-qualifying Physiotherapy courses with an enhanced research element in the final phase of the course that leads to undertaking a doctorate. The first full pre-qualifying Doctorate in Physiotherapy program in the United Kingdom was accredited in 2017 at Glasgow Caledonian University in Glasgow.


title: Doctor of Physical Therapy

text: The DPT degree prepares students to be eligible for the physical therapy license examination in all 50 US states. Along with the license examination, some states do require physical therapists to take a law exam and a criminal background check. As of March 2017, there are 222 accredited Doctor of Physical Therapy programs in the United States. After completing a DPT program, the doctor of physical therapy may continue training in a residency and then fellowship. As of December 2013, there are 178 credentialed physical therapy residencies and 34 fellowships in the US, and 63 additional developing residencies and fellowships. Credentialed residencies are between 9 and 36 months while credentialed fellowships are between 6 and 36 months.


title: Doctor of Physical Therapy

text: In 2000, the American Physical Therapy Association (APTA) passed its "Vision 2020" statement, which states (in part):


title: Doctor of Physical Therapy

text: As this statement highlights, the DPT program is an integral part of the APTA's continued advocacy for legislation granting consumers ("i.e." patients and clients) direct access to physical therapists, rather than requiring physician referral. Direct access is said to decrease wait times for access to care and even help reduce both cost to consumer and overall healthcare costs. As of January 1, 2015, all 50 states and the District of Columbia allow some form of direct access to physical therapists.


title: Doctor of Physical Therapy

text: The typical time frame for completion of a Doctor of Physical Therapy is 3 to 4 years after earning a bachelor's degree. Depending on residency and fellowship training, if undertaken, the doctor may have completed several years of additional training. Obtaining a DPT could also be done by accelerated programs offered by some universities that can be applied to by freshman. These programs give students the opportunity receive a bachelor's degree and DPT in 6 to 7 years. With these programs, there are various admission points over the course of their curriculum. Various programs allow students to apply directly out of high school and they will automatically matriculate into the professional phase of the program after completing the required undergraduate courses.


title: Doctor of Physical Therapy

text: Admission to a Doctor of Physical Therapy program in the United States is highly competitive. According to the Aggregate Program Data Report from CAPTE from 2016 to 2017, the average grade point average for enrolling students was 3.6 out of 4 with a range of 3.20–3.88 for all programs. On average, there were 1,000 applicants per program with an average of 46 students enrolled. A bachelor's degree generally is required before beginning a Doctor of Physical Therapy program, but there is no requirement on the degree earned as long as all prerequisite course requirements are met. Obtaining a DPT could also be done by accelerated programs by some universities that can be applied by freshman. Through these programs students can receive a bachelor's degree and a DPT in 6 to 7 years. During the admission process into schools, one must fulfill the course prerequisites of the program. Students also must obtain physical therapy experience from clinics, with hours that might have to be verified by a physical therapist, depending on the school they are applying to. The Graduate Record Examination (GRE) is required for most programs, and must be taken and submitted to the school.


title: Doctor of Physical Therapy

text: The t-DPT degree is conferred upon completion of a structured post-professional educational experience that results in the augmentation of knowledge, skills, and behaviors to a level consistent with the current professional (entry-level) DPT standards. The t-DPT degree enables the US-licensed physical therapist to attain degree parity with therapists who hold the professional DPT by filling in any gaps between their professional baccalaureate or master's degree PT education and the current professional DPT degree education.


title: Doctor of Physical Therapy

text: The post-professional DPT (Transitional) degree is designed to provide the doctoral credential to those who currently holding a master's or bachelor's degree in the field. Post-professional DPT (Transitional) degree programs are typically offered on a primarily online learning model and are often one year in length.


title: Doctor of Physical Therapy

text: The use of the title "doctor" by physical therapists and other non-physician health care professionals has been debated. In a letter to "The New York Times", the president of the American Physical Therapy Association responded:


title: Doctor of Physical Therapy

text: In 2007, the DPT degree has been described as an example of "credential creep" or degree inflation in "The Chronicle of Higher Education". Citing concerns that the DPT, and similar professional doctorates in areas such as occupational therapy, do not meet the standards of traditional doctorate degrees, the journal states: "The six-and-a-half-year doctor of physical therapy, or DPT, is rapidly replacing a six-year master's degree ... The American Physical Therapy Association ... has not set separate requirements for doctoral programs. To be accredited they need only to meet the same requirements as master's programs."


title: Doctor of Physical Therapy

text: Critics in the 1990s questioned whether the rigor of the physical therapy curriculum and the scope of practice warranted the conferral of a professional degree similar to that characteristic of medicine, dentistry, or nursing. Proponents countered that the existing curricula are "victims of 'curricular inflation'." Rothstein and Moffat noted, the previous master's and even baccalaureate curricula rivaled those of most other professional doctorate programs, and these curricula often required more than the typical 72 credits mandated for a doctoral degree. The 2000 Fact Sheet from APTA reported that the mean number of credits required for the professional phase of the typical baccalaureate program was 83.0 credits and that the typical master's degree program required 95.5 credits. As of 2009 the typical number of prerequisite credits was 114.2 and the total number of professional credits was 116.5 for a total of 230.7 credit hours. Additional credit hours may also be earned in residency and fellowship. Threlkeld et al. suggested that the scope of existing physical therapy curricula already (in 1999) matched that of a professional doctorate, further submitting that students of a well-defined DPT program "will have earned the right to be recognized by the doctoral title".


title: Doctor of Physical Therapy

text: The professional (entry-level) DPT degree is currently the degree conferred by all physical therapist professional programs upon successful completion of a three- to four-year post-baccalaureate degree program in the United States, preparing the graduate to enter the practice of physical therapy. Admission requirements for the program include completion of an undergraduate degree that includes specific prerequisite coursework, volunteer experience (or other exposure to the profession), and completion of a standardized graduate examination (e.g., GRE).


title: Doctor of Physical Therapy

text: Typical prerequisite courses may include two semesters of anatomy and physiology with labs, two semesters of physics with labs, two semesters of chemistry with labs, a general course in psychology, another course in psychology, statistics, two semesters of biology, and may include other courses required by specific schools.


title: Doctor of Physical Therapy

text: The physical therapist curriculum consists of foundational sciences (i.e., gross anatomy, cellular histology, embryology, neurology, neuroscience, kinesiology, physiology, exercise physiology, pathology, pharmacology, radiology/imaging, medical screening), behavioral sciences (communication, social and psychologic factors, ethics and values, law, business and management sciences, clinical reasoning and evidence-based practice), and clinical sciences (cardiovascular/pulmonary, endocrine and metabolic, gastrointestinal and genitourinary, integumentary, musculoskeletal, neuromuscular). Coursework also includes material specific to the practice of physical therapy (patient/client management model, prevention, wellness, and health promotion, practice management, management of care delivery, social responsibility, advocacy, and core values). Additionally, students have to engage in full-time clinical practice under the supervision of licensed physical therapists with an expectation of providing safe, competent, and effective physical therapy.


title: Doctor of Physical Therapy

text: Post-graduation, licensed physical therapists have the ability to pursue a clinical residency or fellowship to expand their knowledge and experience. Clinical residencies are designed to further a physical therapy resident's knowledge in a specific area of clinical practice. A clinical fellowship is a program for physical therapists in an area of the specific focus.


title: Doctor of Physical Therapy

text: Physical therapists also have the ability to pursue specialty certifications, where they become board certified clinical specialists. Becoming a certified specialist allows the therapist to earn credentials that represents further dedication to patient care. It gives the opportunity for professional growth and positions in leadership and service. This specialization is done by building a broad foundation of professional education then building a skill set related to the particular specialization area. The certifications given in the specific areas are: cardiovascular and pulmonary, clinical electrophysiology, geriatrics, neurology, orthopedics, pediatrics, sports physical therapy, wound care, and women's health.


title: Doctor of Physical Therapy

text: Physical therapists can provide various modalities of treatment for the patient. The modalities include: ultrasound, electrical stimulation, traction, joint mobilization, massage, heat, ice, kinesiology taping, and many more. Forms of treatment depends on the therapist's preference of treatment and the clinics equipment availability. Based on the patient, specific types of treatment might be better suited. Therapists might also find different modalities not as effective as others. However, some modalities might not be possible due to the clinics restrictions on space and equipment availability.


title: Doctor of Physical Therapy

text: The "advanced clinical science" doctorate (e.g., DPTSc or DScPT, DHSc, ScDPT) is one of several degrees conferred by academic institutions upon successful completion of a post-professional physical therapist education program. This program is intended to provide an experienced clinician with advanced knowledge, clinical skills, and professional behavior, usually in a specific specialty practice area. These programs typically culminate work that contributes new knowledge to clinical practice in the profession. Completion of these advanced clinical science doctoral programs may include credentialed clinical residencies and lead to ABPTS clinical specialization or other advanced certifications.


title: Doctor of Physical Therapy

text: Some universities, such as Glasgow Caledonian University and Robert Gordon University, offer a 3.5 year DPT program, including both professional training and research, which leads to qualification as a physiotherapist eligible to register with the Health and Care Professions Council. In general, the qualifying degree for physiotherapy in the UK is a Bachelor or Master of Science in Physiotherapy.


title: Osteopathic medicine in the United States

text: Osteopathic medicine is a branch of the medical profession in the United States that promotes the practice of allopathic medicine with a set of philosophy and principles set by its earlier form, osteopathy. Osteopathic physicians (DOs) are licensed to practice medicine and surgery in all 50 US states. Only graduates of American osteopathic medical colleges may practice the full scope of medicine and surgery generally considered to be medicine by the general public; US DO graduates have historically applied for medical licensure in 87 countries outside of the United States, 85 of which provided them with the full scope of medical and surgical practice. The field is distinct from osteopathic practices offered in nations outside of the U.S., whose practitioners are generally not considered part of core medical staff nor of medicine itself. The other major branch of medicine in the United States is referred to by practitioners of osteopathic medicine as allopathic medicine.


text: By the middle of the 20th century, the profession had moved closer to mainstream medicine. American "osteopaths" became "osteopathic medical doctors," ultimately achieving full practice rights as medical doctors in all 50 states.


text: In modern medicine in the U.S., any distinction between the MD and the DO professions has eroded steadily. The training of osteopathic physicians in the United States is now virtually indistinguishable from the training of "allopathic" physicians (MDs). Osteopathic physicians attend four years of medical school like their MD counterparts, acquiring equivalent education in medicine and surgery; DOs also attend the same graduate medical education programs (ACGME-accredited residencies and/or fellowships) as their MD counterparts to acquire their license as "physicians and surgeons". DOs use all conventional methods of diagnosis and treatment and practice across all specialties of medicine and surgery. Though still trained in osteopathic manipulative treatment (OMT) during medical school, the modern derivative of Andrew Taylor Still's techniques, the majority of practicing physicians with a DO degree do not practice OMT in their daily work. There are ongoing debates about the utility of maintaining separate, distinct pathways for educating physicians in the United States.


text: Physicians and surgeons who graduate from osteopathic medical schools are known as osteopathic physicians or osteopathic medical doctors. Upon graduation, they are conferred a medical degree, the Doctor of Osteopathic Medicine (DO).


text: Osteopathic curricula in other countries differ from those in the United States. European-trained practitioners of osteopathic manipulative techniques are referred to as "osteopaths": their scope of practice excludes most medical therapies and relies more on osteopathic manipulative medicine and alternative medical modalities. While it was once common for DO graduates in the United States to refer to themselves as "osteopaths", this term is now considered archaic, and those holding the Doctor of Osteopathic Medicine degree are commonly referred to as "osteopathic physicians," and they learn, train on, and practice the full scope of medicine and surgery.


text: Osteopathic physicians are not evenly distributed in the United States. States with the highest concentration of osteopathic medical physicians are Oklahoma, Iowa, and Michigan where osteopathic medical physicians comprise 17–20% of the total physician workforce. The state with the greatest number of osteopathic medical physicians is Pennsylvania, with 8,536 DOs in active practice in 2018. The states with the lowest concentrations of DOs are Washington, DC, North Dakota and Vermont where only 1–3% of physicians have an osteopathic medical degree. Public awareness of osteopathic medicine likewise varies widely in different regions. People living in the midwest states are the most likely to be familiar with osteopathic medicine. In the Northeastern United States, osteopathic medical physicians provide more than one-third of general and family medicine patient visits.


text: Between 2010 and 2015 twelve states experienced greater than 50% growth in the number of DOs—Virginia, South Carolina, Utah, Tennessee, North Dakota, Kentucky, South Dakota, Wyoming, Oregon, North Carolina, Minnesota, Washington.


text: Osteopathic medical students take the Osteopathic Oath, similar to the Hippocratic oath, to maintain and uphold the "core principles" of osteopathic medical philosophy. Revised in 1953, and again in 2002, the core principles are:


text: Contemporary osteopathic physicians practice evidence-based medicine, indistinguishable from their MD colleagues.


text: There are different opinions on the significance of these principles. Some note that the osteopathic medical philosophy is suggestive of a kind of social movement within the field of medicine, one that promotes a more patient-centered, holistic approach to medicine, and emphasizes the role of the primary care physician within the health care system. Others point out that there is nothing in the principles that would distinguish DO from MD training in any fundamental way. One study, published in "The Journal of the American Osteopathic Association" found a majority of MD medical school administrators and faculty saw nothing objectionable in the core principles listed above, and some endorse them generally as broad medical principles.


text: Frontier physician Andrew Taylor Still, DO, founded the American School of Osteopathy (now the A.T. Still University-Kirksville (Mo.) College of Osteopathic Medicine) in Kirksville, Missouri in 1892 as a radical protest against the turn-of-the-century medical system. A.T. Still believed that the conventional medical system lacked credible efficacy, was morally corrupt and treated effects rather than causes of disease. He founded osteopathic medicine in rural Missouri at a time when medications, surgery, and other traditional therapeutic regimens often caused more harm than good. Some of the medicines commonly given to patients during this time were arsenic, castor oil, whiskey, and opium. In addition, unsanitary surgical practices often resulted in more deaths than cures.


text: Still intended his new system of medicine to be a reformation of the existing 19th-century medical practices. He imagined that someday "rational medical therapy" would consist of the manipulation of the musculoskeletal system, surgery, and very sparingly used drugs. He invented the name "osteopathy" by blending two Greek roots "osteon-" for bone and "-pathos" for suffering to communicate his theory that disease and physiologic dysfunction were etiologically grounded in a disordered musculoskeletal system. Thus, by diagnosing and treating the musculoskeletal system, he believed that physicians could treat a variety of diseases and spare patients the negative side effects of drugs.


text: One notable advocate for the fledgling movement was Mark Twain. Manipulative treatments had purportedly alleviated the symptoms of his daughter Jean's epilepsy as well as Twain's own chronic bronchitis. In 1909, he spoke before the New York State Assembly at a hearing regarding the practice of osteopathy in the state. "I don't know as I cared much about these osteopaths until I heard you were going to drive them out of the state, but since I heard that I haven't been able to sleep." Philosophically opposed to the American Medical Association's stance that its own type of medical practice was the only legitimate one, he spoke in favor of licensing for osteopaths. Physicians from the New York County Medical Society responded with a vigorous attack on Twain, who retorted with "[t]he physicians think they are moved by regard for the best interests of the public. Isn't there a little touch of self-interest back of it all?" "... The objection is, people are curing people without a license and you are afraid it will bust up business."


text: Following an accreditation survey in 1903, the American Osteopathic Association began requiring 3-year curricula at osteopathic medical schools. In 1916, the AOA mandated all DO schools expand programs to four years. In 1929, osteopathic medical schools began teaching pharmacology as a part of the curricula.


text: Recognition by the US federal government was a key goal of the osteopathic medical profession in its effort to establish equivalency with its MD counterparts. Between 1916 and 1966, the profession engaged in a "long and tortuous struggle" for the right to serve as physicians and surgeons in the US Military Medical Corps. On May 3, 1966 Secretary of Defense Robert McNamara authorized the acceptance of osteopathic physicians into all the medical military services on the same basis as MDs. The first osteopathic physician to take the oath of office to serve as a military physician was Harry J. Walter. The acceptance of osteopathic physicians was further solidified in 1996 when Ronald Blanck, DO was appointed to serve as Surgeon General of the Army, the only osteopathic physician to hold the post.


text: In the 1960s in California, the American Medical Association (AMA) spent nearly $8 million to end the practice of osteopathic medicine in the state. In 1962, Proposition 22, a statewide ballot initiative in California, eliminated the practice of osteopathic medicine in the state. The California Medical Association (CMA) issued MD degrees to all DOs in the state of California for a nominal fee. "By attending a short seminar and paying $65, a doctor of osteopathy (DO) could obtain an MD degree; 86 percent of the DOs in the state (out of a total of about 2000) chose to do so." Immediately following, the AMA re-accredited the University of California at Irvine College of Osteopathic Medicine as the University of California, Irvine School of Medicine, an MD medical school. It also placed a ban on issuing physician licenses to DOs moving to California from other states. However, the decision proved to be controversial. In 1974, after protests and lobbying by influential and prominent DOs, the California Supreme Court ruled in Osteopathic Physicians and Surgeons of California v. California Medical Association, that licensing of DOs in that state must be resumed. Four years later, in 1978, the College of Osteopathic Medicine of the Pacific opened in Pomona, and in 1997, Touro University California opened in Vallejo. As of 2012, there were 6,368 DOs practicing in California.


text: In 1969, the American Medical Association (AMA) approved a measure allowing qualified osteopathic physicians to be full and active members of the Association. The measure also allowed osteopathic physicians to participate in AMA-approved intern and residency programs. However, the American Osteopathic Association rejected this measure, claiming it was an attempt to eliminate the distinctiveness of osteopathic medicine. In 1970, AMA President Dwight L. Wilbur sponsored a measure in the AMA's House of Delegates permitting the AMA Board of Trustees' plan for the merger of DO and MD professions. Today, a majority of osteopathic physicians are trained alongside MDs, in residency programs governed by the ACGME, an independent board of the AMA.


text: In 1993, Barbara Ross-Lee, DO, was appointed to the position of dean of the Ohio University College of Osteopathic Medicine; she was the first African-American woman to serve as the dean of a US medical school. Ross-Lee now is the dean of the NYIT College of Osteopathic Medicine at Arkansas State University in Jonesboro, Arkansas. Dr. Ross-Lee is the sister of singer Diana Ross.


text: Recent years have seen a professional rapprochement between the two groups. DOs have been admitted to full active membership in the American Medical Association since 1969. The AMA has invited a representative of the American Osteopathic Association to sit as a voting member in the AMA legislative body, the house of delegates.


text: In 2006, during the presidency of an osteopathic medical student, the American Medical Student Association (AMSA) adopted a policy regarding the membership rights of osteopathic medical students in their main policy document, the "Preamble, Purposes and Principles."


text: In recent years, the largest MD organization in the US, the American Medical Association, adopted a fee non-discrimination policy discouraging differential pricing based on attendance of an MD or DO medical school.


text: In 2006, calls for an investigation into the existence of differential fees charged for visiting DO and MD medical students at American medical schools were brought to the American Medical Association. After an internal investigation into the fee structure for visiting DO and MD medical students at MD medical schools, it was found that one institution of the 102 surveyed charged different fees for DO and MD students. The house of delegates of the American Medical Association adopted resolution 809, I-05 in 2007.


text: In the United States, laws regulating physician licenses are governed by the states. Between 1896 and 1973, osteopathic physicians lobbied state legislatures to pass laws giving those with a DO degree the same legal privilege to practice medicine as those with an MD degree. In many states, the debate was long and protracted. Both the AOA and the AMA were heavily involved in influencing the legislative process. The first state to pass such a law was Vermont in 1896, the last was Mississippi in 1973.


text: According to Harrison's Principles of Internal Medicine, "the training, practice, credentialing, licensure, and reimbursement of osteopathic physicians is virtually indistinguishable from those of (MD) physicians, with 4 years of osteopathic medical school followed by specialty and subspecialty training and [board] certification."


text: DO-granting US medical schools have curricula similar to those of MD-granting schools. Generally, the first two years are classroom-based, while the third and fourth years consist of clinical rotations through the major specialties of medicine. Some schools of Osteopathic Medicine have been criticized by the osteopathic community for relying too heavily on clinical rotations with private practitioners, who may not be able to provide sufficient instruction to the rotating student. Other DO-granting and MD-granting schools place their students in hospital-based clinical rotations where the attending physicians are faculty of the school, and who have a clear duty to teach medical students while treating patients.


text: Upon graduation, most osteopathic medical physicians pursue residency training programs. Depending on state licensing laws, osteopathic medical physicians may also complete a one-year rotating internship at a hospital approved by the American Osteopathic Association (AOA).


text: Osteopathic physicians may apply to residency programs accredited by either the AOA or the Accreditation Council for Graduate Medical Education (ACGME). Currently, osteopathic physicians participate in more ACGME programs than in programs approved by the American Osteopathic Association (AOA). By June 30, 2020, all AOA residencies will also be required to have ACGME accreditation, and the AOA will cease accreditation activities.


text: Within the osteopathic medical curriculum, manipulative treatment is taught as an adjunctive measure to other biomedical interventions for several disorders and diseases. However, a 2001 survey of osteopathic physicians found that more than 50% of the respondents used OMT on less than 5% of their patients. The survey follows many indicators that osteopathic physicians have become more like MD physicians in every respect —few perform OMT, and most prescribe medications or suggest surgery as the first line of treatment.


text: The American Osteopathic Association has made an effort in recent years to support scientific inquiry into the effectiveness of osteopathic manipulation as well as to encourage osteopathic physicians to consistently offer manipulative treatments to their patients. However, the number of osteopathic physicians who report consistently prescribing and performing manipulative treatment has been falling steadily. Medical historian and sociologist Norman Gevitz cites poor educational quarters and few full-time OMT instructors as major factors for the decreasing interest of medical students in OMT. He describes problems with "the quality, breadth, nature, and orientation of OMM instruction," and he claims that the teaching of osteopathic medicine has not changed sufficiently over the years to meet the intellectual and practical needs of students.


text: At the same time, recent studies show an increasingly positive attitude of patients and physicians (MD and DO) towards the use of manual therapy as a valid, safe, and effective treatment modality. One survey, published in the "Journal of Continuing Medical Education", found that a majority of physicians (81%) and patients (76%) felt that manual manipulation (MM) was safe, and over half (56% of physicians and 59% of patients) felt that manipulation should be available in the primary care setting. Although less than half (40%) of the physicians reported any educational exposure to MM and less than one-quarter (20%) have administered MM in their practice, most (71%) respondents endorsed desiring more instruction in MM. Another small study examined the interest and ability of MD residents in learning osteopathic principles and skills, including OMT. It showed that after a 1-month elective rotation, the MD residents responded favorably to the experience.


text: In 1998, an article in "The New York Times" described the increasing numbers, public awareness, and mainstreaming of osteopathic medical physicians, illustrating an increasingly cooperative climate between the DO and MD professions.


text: In 2005, during his tenure as president of the Association of American Medical Colleges, Jordan Cohen described a climate of cooperation between DO and MD practitioners:


text: Each country has different requirements and procedures for licensing or registering osteopathic physicians and osteopaths. The only osteopathic practitioners that the US Department of Education recognizes as physicians are graduates of osteopathic medical colleges in the United States. Therefore, osteopaths who have trained outside the United States are not eligible for medical licensure in the United States. On the other hand, US-trained DOs are currently able to practice in 85 countries with full medical rights and several others with restricted rights.


text: The "Bureau on International Osteopathic Medical Education and Affairs" (BIOMEA) is an independent board of the American Osteopathic Association. The BIOMEA monitors the licensing and registration practices of physicians in countries outside of the United States and advances the recognition of American-trained DOs. Towards this end, the BIOMEA works with international health organizations like the World Health Organization (WHO), the Pan American Health Organization (PAHO) as well as other groups.


text: The procedure by which countries consider granting physician licensure to foreigners varies widely. For US-trained physicians, the ability to qualify for "unlimited practice rights" also varies according to one's degree, MD or DO. Many countries recognize US-trained MDs as applicants for licensure, granting successful applicants "unlimited" practice rights. The American Osteopathic Association has lobbied the governments of other countries to recognize US-trained DOs similarly to their MD counterparts, with some success.


text: In over 85 countries, US-trained DOs have unlimited practice rights. In 2005, after one year of deliberations, the General Medical Council announced that US-trained DOs will be accepted for full medical practice rights in the United Kingdom. According to Josh Kerr of the AOA, "some countries don’t understand the differences in training between an osteopathic physician and an osteopath." The American Medical Student Association strongly advocates for US-trained DO international practice rights "equal to that" of MD-qualified physicians. The International Labor Organization (ILO), an agency of the United Nations, issued a letter affirming that U.S.-trained osteopathic physicians are fully licensed physicians who prescribe medication and perform surgery. The acknowledgment draws a clear separation between American DOs, who are medical doctors, and non-physician osteopaths trained outside of the United States. Within the international standards that classify jobs to promote international comparability across occupations, U.S.-trained DOs are now categorized with all other physicians as medical doctors. This event took place in June 2018 and started a relay of events and opened doors for DO's as more countries started to understand and give full recognition to US-trained medical doctors with the D.O. degree, e.g. the Association of Medical Councils of Africa (AMCOA) approved a resolution in 2019 granting the AOA's request that AMCOA recognizes U.S.-trained DOs as fully licensed physicians with practice rights equivalent to MDs, opening its 20 member countries, which include Botswana, Gambia, Ghana, Kenya, Lesotho, Liberia, Malawi, Mauritius, Namibia, Nigeria, Rwanda, Seychelles, Sierra Leone, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe to DO's.


text: Osteopathic physicians have historically entered primary care fields at a higher rate than their MD counterparts. Some osteopathic organizations make claims to a greater emphasis on the importance of primary care within osteopathic medicine. However, the proportion of osteopathic students choosing primary care fields, like that of their MD peers, is declining. Currently, only one in five osteopathic medical students enters a family medicine residency (the largest primary care field). In 2004, only 32% of osteopathic seniors planned careers in any primary care field; this percentage was down from a peak in 1996 of more than 50%.


text: Traditional osteopathic medicine, specifically OMT, has been criticized for using techniques such as cranial and cranio-sacral manipulation. CST has been described as pseudoscience which is not backed up by any scientific evidence. Medical research has found no good evidence that either CST or cranial osteopathy confers any health benefit, and they can be harmful, particularly if used on children or infants. The basic assumptions of CST are challenged by some medical doctors, and practitioners produce conflicting and mutually exclusive diagnoses of the same patients.


text: Another area of criticism has been the relative lack of research and lesser emphasis on scientific inquiry at DO schools in comparison with MD schools.


text: There is currently a debate within the osteopathic community over the feasibility of maintaining osteopathic medicine as a distinct entity within US health care. J. D. Howell, author of "The Paradox of Osteopathy," notes claims of a "fundamental yet ineffable difference" between MD and DO qualified physicians are based on practices such as "preventive medicine and seeing patients in a sociological context" that are "widely encountered not only in osteopathic medicine but also in allopathic medicine." Studies have confirmed the lack of any "philosophic concept or resultant practice behavior" that would distinguish a DO from an MD. Howell summarizes the questions framing the debate over the future of osteopathic distinctiveness thus:


text: As the number of osteopathic schools has increased, the debate over distinctiveness has often seen the leadership of the American Osteopathic Association at odds with the community of osteopathic physicians.


text: The rapid expansion has raised concerns about the number of available faculty at osteopathic schools and the role that those faculty play in maintaining the integrity of the academic program of the schools. Norman Gevitz, author of the leading text on the history of osteopathic medicine, wrote in 2009,


text: The president of the American Association of Colleges of Osteopathic Medicine commented on the current climate of crisis within the profession.


title: Papilledema

text: Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due to any cause. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare.


title: Papilledema

text: In intracranial hypertension, the optic disc swelling most commonly occurs bilaterally. When papilledema is found on fundoscopy, further evaluation is warranted because vision loss can result if the underlying condition is not treated. Further evaluation with a CT or MRI of the brain and/or spine is usually performed. Recent research has shown that point-of-care ultrasound can be used to measure optic nerve sheath diameter for detection of increased intracranial pressure and shows good diagnostic test accuracy compared to CT. Thus, if there is a question of papilledema on fundoscopic examination or if the optic disc cannot be adequately visualized, ultrasound can be used to rapidly assess for increased intracranial pressure and help direct further evaluation and intervention. Unilateral papilledema can suggest a disease in the eye itself, such as an optic nerve glioma.


title: Papilledema

text: In the early stages, papilledema may be asymptomatic or present with a headache. It can progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time). Ultimately, total loss of vision can occur.


title: Papilledema

text: On visual field examination, the physician may elicit an enlarged blind spot; the visual acuity may remain relatively intact until papilledema is severe or prolonged.


title: Papilledema

text: As the optic nerve sheath is continuous with the subarachnoid space of the brain (and is regarded as an extension of the central nervous system), increased pressure is transmitted through to the optic nerve. The brain itself is relatively spared from pathological consequences of high pressure. However, the anterior end of the optic nerve stops abruptly at the eye. Hence the pressure is asymmetrical and this causes a pinching and protrusion of the optic nerve at its head. The fibers of the retinal ganglion cells of the optic disc become engorged and bulge anteriorly. Persistent and extensive optic nerve head swelling, or optic disc edema, can lead to loss of these fibers and permanent visual impairment.


title: Papilledema

text: Checking the eyes for signs of papilledema should be carried out whenever there is a clinical suspicion of raised intracranial pressure, and is recommended in newly onset headaches. This may be done by ophthalmoscopy or fundus photography, and possibly slit lamp examination.


title: Papilledema

text: It is important to determine whether the observed condition is due to optic nerve head drusen, which can cause an elevation of the optic nerve head that can be mistaken for papilledema. For this reason, optic nerve head drusen is also called pseudopapilledema.


title: Papilledema

text: Historically, papilledema was a potential contraindication to lumbar puncture, as it indicates a risk for tentorial herniation and subsequent death via cerebral herniation, however newer imaging techniques have been more useful at determining when and when not to conduct a lumbar puncture. Imaging by CT or MRI is usually performed to elicit whether there is a structural cause i.e., tumor. An MRA and MRV may also be ordered to rule out the possibility of stenosis or thrombosis of the arterial or venous systems.


title: Papilledema

text: The treatment depends largely on the underlying cause. However, the root cause of papilledema is the increased intracranial pressure (ICP). This is a dangerous sign, indicative of a brain tumor, CNS inflammation or idiopathic intracranial hypertension (IIH) that may become manifest in the near future.


title: Papilledema

text: Thus, a biopsy is routinely performed prior to the treatment in the initial stages of papilledema to detect whether a brain tumor is present. If detected, laser treatment, radiation and surgeries can be used to treat the tumor.


title: Papilledema

text: To decrease ICP, medications can be administered by increasing the absorption of cerebrospinal fluid (CSF), or decreasing its production. Such medicines include diuretics like acetazolamide and furosemide. These diuretics, along with surgical interventions, can also treat IIH. In IIH, weight loss (even a loss of 10-15%) can lead to normalization of ICP.


title: Papilledema

text: Meanwhile, steroids can reduce inflammation (if this is a contributing factor to increased ICP), and may help to prevent vision loss. However, steroids have also been known to cause increased ICP, especially with a change in dosage. However, if a severe inflammatory condition exists, such as multiple sclerosis, steroids with anti-inflammatory effects such as Methylprednisolone and prednisone can help.


title: Papilledema

text: Other treatments include repeated lumbar punctures to remove excess spinal fluid in the cranium. The removal of potentially causative medicines including tetracyclines and vitamin A analogues may help decrease ICP; however, this is only necessary if the medication is truly felt to contribute to the ICP increase.


title: Mercedes-Benz M156 engine

text: The M156 is the first automobile V8 engine designed autonomously by Mercedes-Benz subsidiary Mercedes-AMG, as previous AMG engines have always been based on original Mercedes engines. The engine was designed to be a naturally aspirated racing unit, and is also used in a number of high-performance AMG-badged Mercedes-Benz models.