title: White Castle (restaurant)

text: The earliest buildings, such as Indianapolis White Castle #3, built in 1927, had exteriors of white enamel-glazed brick and interiors of enameled steel. The Indianapolis unit was in operation until 1979, making it, at the time of its closure, the longest-operating fast food restaurant in the country. The company constructed this style of building from 1924 to 1929. White Castle Building No. 8, in Minneapolis, Minnesota, originally built in 1936 and remodeled (photo in infobox above), is an example of the chain's buildings with prefabricated white porcelain enamel on steel exteriors. The building measured by and was designed to resemble the Chicago Water Tower, with octagonal buttresses, crenelated towers, and a parapet wall.


title: White Castle (restaurant)

text: The success of White Castle led to numerous imitators. Restaurants copied the distinctive architecture of White Castle buildings, as well as created confusion for consumers by using a similar name. The first of these imitators in Wichita was Little Kastle. Many competitors created their names with a play on the White Castle name. Some restaurant chains just replaced the word "Castle" with their own word (Cabin, Cap, Clock, Crescent, Diamond, Dome, Fortress, Grille, House, Hut, Kitchen, Knight, Log, Manna, Mill, Palace, Plaza, Shop, Spot, Tavern, Tower, Turret, Wonder), while others chose to replace "White" with another color or adjective (Blue, King's, Little, Magic, Modern, Prince's, Red, Royal, Silver). Some of the other imitators included Castle Blanca, Blue Beacon, Blue Bell, Blue Tower, Krystal, Red Barn, Red Lantern, and Klover Kastle. Despite all the competition, few of the competitors were able to match the success of White Castle.


title: White Castle (restaurant)

text: Since fast food was unknown in the United States at the time of White Castle's founding, there was no infrastructure to support the business, as is common with today's fast-food restaurants. The company established centralized bakeries, meat supply plants, and warehouses to supply itself. It was said that the only things that they did not do themselves were raise the cows and grow their own wheat. Ingram developed a device to produce previously unheard of paper hats (for employees to wear as part of the uniform).


title: White Castle (restaurant)

text: In 1932, Ingram set up a subsidiary, Paperlynen, to produce these hats and other paper products used in his restaurants as well as for many other purposes. At the time, White Castle's distribution stretched from Wichita to New York. Ingram decided the central office should be in the center of the distribution area, and in 1936, relocated the central office to Columbus, Ohio. That same year, Ingram decided to close all of the restaurants in the two smallest-profit markets, Wichita and Omaha.


title: White Castle (restaurant)

text: In 1955, Paperlynen produced over 42 million paper hats worldwide with more than 25,000 different inscriptions.


title: White Castle (restaurant)

text: White Castle also created a subsidiary in 1934 named Porcelain Steel Buildings that manufactured movable, prefabricated, steel frame structures with porcelain enamel interior and exterior panels that could be assembled at any of its restaurant sites. This is the first known use of this material in a building design.


title: White Castle (restaurant)

text: In 1933, Anderson sold his half of the business to Ingram, and the following year the company moved its corporate headquarters to Columbus, Ohio. Co-founder Billy Ingram was followed as head of the firm by his son E. W. Ingram Jr. and grandson E. W. Ingram III.


title: White Castle (restaurant)

text: In 1959, White Castle expanded into new markets for the first time since the 1920s. Billy Ingram, who had retired to Miami in 1958, built three White Castle restaurants there. The company closed the Florida operations in 1967 due to inefficient supply distribution.


title: White Castle (restaurant)

text: Throughout its existence, White Castle has been a private company and relied on company-owned stores. It remains privately held today, and its restaurants are all company-owned; none is franchised, except very briefly in Japan during the 1980s and more recently in China since 2017.


title: White Castle (restaurant)

text: The first White Castle in the far western United States opened at the Casino Royale Hotel & Casino on the Las Vegas Strip on January 27, 2015. This was the first expansion for White Castle into a region outside the Midwest and Northeast in 56 years. On the first day of business, demand for food was so great that the restaurant had to temporarily close for two hours to restock. White Castle Vice President Jamie Richardson said that the store sold 4,000 sliders per hour in its first 12 hours. He was not aware of any similar closing due to unexpected demand in White Castle's 94-year history. A second White Castle location opened in Las Vegas on September 22, 2017, on Fremont Street, and a third opened in Jean not long after.


title: White Castle (restaurant)

text: In September 2015, White Castle began to offer Veggie Sliders with dairy-free buns to provide a vegan option.


title: White Castle (restaurant)

text: In December 2015, White Castle announced that chief executive officer (CEO) E.W. “Bill” Ingram III would step down at the end of the year, but continue to be chairman of the board. His daughter, Lisa Ingram, then became the fourth CEO of the company.


title: White Castle (restaurant)

text: In 2018, White Castle began offering plant-based meat Impossible Burgers designed to closely mimic the flavor and texture of beef burgers.


title: White Castle (restaurant)

text: White Castle announced on November 25, 2019, that the chain would return to Florida after previously leaving the state in 1968, with plans to open the first restaurant in Orlando. A ghost kitchen, operated out of the restaurant while it was under construction, overloaded Uber Eats when it opened for one day on February 24, 2021. The Orlando location opened on May 3, 2021. It is the world's largest White Castle, located on Daryl Carter Parkway off Interstate 4. The opening coincided with White Castle's 100th anniversary.


title: White Castle (restaurant)

text: In 2020, White Castle began testing an automated cooking robot called Flippy in its Chicagoland location, and then equipped a larger number of locations with the updated Flippy 2 model in November of 2021. The system is able to discriminate amongst burgers, chicken fingers, and french fries), pick them up, cook them through automated temperature detection and flipping action, place the cooked item in a fry basket, and in turn place the basketed food in an area for holding hot items. The Flippy 2 model can operate without human intervention and produce 60 baskets of food per hour. By the end of 2022, approximately one in three White Castle locations are expected to be equipped with the device.


title: White Castle (restaurant)

text: The Ingram family's steadfast refusal to franchise or take on debt throughout the company's existence has kept the chain relatively small, with a more discontinuous geography than its principal competitors. There are 377 White Castle outlets, predominantly in the Midwest, Kentucky, and Tennessee. The exceptions are about 50 in the New York - New Jersey metropolitan area, three locations around Las Vegas, Nevada, one in Scottsdale, Arizona, one in Orlando, Florida, and two in Shanghai, China. By comparison, there are over 36,000 McDonald's locations globally, with approximately 14,000 of those in the United States. The chain does, however, sell frozen sliders at supermarkets nationwide, with availability varying by chain.


title: White Castle (restaurant)

text: In New York City, the number of locations has declined significantly in recent years. As of 2020, there were only 20 White Castle locations in the area.


title: White Castle (restaurant)

text: Louisville and Columbus also house bulk-manufacturing (grocery-store sales, meat, and bun production) divisions. Company headquarters and the Porcelain Steel Buildings division are in Columbus, Ohio.


title: White Castle (restaurant)

text: In the early 2000s, White Castle tried expanding into three new cities, Philadelphia, Kansas City, and Cleveland-Akron. Those restaurants closed within several years. White Castle exited Cleveland-Akron effective December 25, 2014.


title: White Castle (restaurant)

text: Through franchise deals with local corporate business partners, White Castle briefly had restaurants outside of the United States in Singapore, Malaysia, and Japan during the late 1980s and early 1990s, but the concept never caught on in those countries. During the same time period, White Castle also tried to establish franchised operations in Mexico and South Korea, but these restaurants also failed. The lone Korean restaurant in Seoul was quietly closed by 1993.


title: White Castle (restaurant)

text: In 1986, White Castle opened its first Japanese restaurant in the city of Osaka via a franchise deal with a Japanese company. There are no reliable records that show when this location closed and when the company finally left the Japanese marketplace. By the end of 1986, the Japanese franchise had six restaurants with a seventh opened by the following year.


title: White Castle (restaurant)

text: In June 1989, White Castle and its local franchise partner Innovest Bhd. opened seven restaurants in Malaysia. Innovest franchise territory included Malaysia and Singapore, and the company had plans to open three more restaurants by the end of the year, with the possibility of having a total of 20 restaurants within its two country region by the following year.


title: White Castle (restaurant)

text: The first White Castle franchised location in Mexico opened in Mexico City in 1996, but it also closed after a brief trial run.


title: White Castle (restaurant)

text: In 2017, White Castle opened its first and second restaurants in China in the city of Shanghai through a partnership with Shanghai-based ClearVue Partners. In addition to beef sliders, the Shanghai location also sells a spicy tofu slider and a cherry duck slider, which is smoked duck topped with a sweet cherry sauce. At the time of their openings, these two restaurants were the only White Castle restaurants located outside of the United States.


title: White Castle (restaurant)

text: Although White Castle has never opened any restaurants in Canada, Canadians have been able to purchase White Castle hamburgers from the frozen foods section in select Canadian grocery and convenience stores since 2015 and more recently at Walmart.


title: White Castle (restaurant)

text: White Castle also markets its sandwiches in 20 or 30-hamburger boxes, called a Crave Clutch or Crave Case, respectively. The figure of 30 burgers represents the number that can be produced on one of its standard griddles at the same time. A "Crave Crate" is also offered, with the contents being 100 burgers.


title: White Castle (restaurant)

text: To celebrate its 100th year in operation, White Castle re-introduced their original burger, called the 1921 Slider. It features an addition of lettuce, tomato, and caramelized onions. Typically normal sliders have 5 holes in the patty while cooking on a griddle of onions and water to steam the sliders to completion. The 1921 is grilled directly on the griddle instead.


title: White Castle (restaurant)

text: Some locations had been cobranded with Church's Chicken until that co-branding arrangement ended around 2010.


title: White Castle (restaurant)

text: Around 2012, White Castle experimented with the Laughing Noodle brand that was to share space with White Castle restaurants. The Laughing Noodle concept was discarded a few years later. The Laughing Noodle brand was developed to offer supplemental variety to a White Castle Restaurant. At least one such location was constructed and operated in Sharonville, Ohio.


title: White Castle (restaurant)

text: Although White Castle originated in Wichita, Kansas, the city has not had a restaurant since 1938, nor is there a White Castle restaurant in the entire state of Kansas. White Castle is one of the few restaurant chains that does not have a location in its original city. In the early 2000s, White Castle tried expanding into the Kansas City market, with at least one location in Kansas, but those restaurants were closed several years later.


title: White Castle (restaurant)

text: In April 2020, White Castle responded to the COVID-19 pandemic by announcing that the chain would be delivering free meals to healthcare workers. White Castle also offered a free dessert in the month of May 2021 to anyone who showed a vaccination certificate. In certain regions, White Castle offers four hours of Paid Time Off for workers who get both doses of an eligible COVID-19 vaccination and present their vaccination certificate to management.


title: White Castle (restaurant)

text: Anderson is credited with the invention of the hamburger bun as well as "the kitchen as assembly line, and the cook as infinitely replaceable technician," hence giving rise to the modern fast-food phenomenon. Due to White Castle's innovation of having chain-wide standardized methods, customers could be sure that they would receive the same product and service in every White Castle restaurant.


title: White Castle (restaurant)

text: Ingram's business savvy not only was responsible for White Castle's success but for the popularization of the hamburger. "Time" ranked the White Castle slider "The Most Influential Burger of All Time" in their January 14, 2014, edition.


title: Symphony of the Seas

text: Symphony of the Seas is an owned and operated by Royal Caribbean International. She was built in 2018 in the Chantiers de l'Atlantique shipyard in Saint-Nazaire, France, the fourth in Royal Caribbean's "Oasis" class of cruise ships. At , she was the largest cruise ship in the world by gross tonnage when built, surpassing her sister ship "Harmony of the Seas", also owned by Royal Caribbean International, and surpassed by her sister ship "Wonder of the Seas" in 2022.


title: Symphony of the Seas

text: "Symphony of the Seas" measures in length and has a gross tonnage of 228,081 across 18 decks. She can accommodate 5,518 passengers at double occupancy up to a maximum capacity of 6,680 passengers, as well as a 2,200-person crew. There are 16 decks for guest use, 22 restaurants, 4 pools and 2,759 cabins.


title: Symphony of the Seas

text: "Symphony of the Seas" is about 30 metres (98 feet) longer than the largest military ships ever built, the U.S. "Nimitz"-class aircraft carriers.


title: Symphony of the Seas

text: Facilities include a children's water park, a full-size basketball court, an ice-skating rink, a zip line that is 10 decks high, a 1400-seat theater, an outdoor aquatic theater with Olympic-height platforms, and two rock-climbing walls. There is also a park containing over 20,000 tropical plants.


title: Symphony of the Seas

text: "Symphony of the Seas" is powered onboard by six marine-diesel sets each composed of three 16-cylinder Wärtsilä 16V46D common rail engines and three 12-cylinder Wärtsilä 12V46D engines.


title: Symphony of the Seas

text: The energy-efficient design of "Symphony of the Seas" requires less shipboard power generation, with 85 MW versus the 100 MW normally found on "Oasis" class ships. One of the key design features is the use of only LED or fluorescent lights in order to avoid the heat generation from incandescent bulbs, thereby reducing the load on air conditioning systems.


title: Symphony of the Seas

text: Additional energy efficiency is accomplished by using a 2 MW steam turbine to recover waste heat from the engines and converting it into energy to power a portion of the onboard hotel load.


title: Symphony of the Seas

text: For propulsion, "Symphony of the Seas" uses three 20,000 kilowatt azipod main engines, which are electric thrusters. These engines are mounted under the stern of the ship and they each drive 20 foot wide rotatable propellers. In addition to the three main engines, there are four bow thrusters used for docking, each with 5,500 kilowatts of power or 7,380 horsepower.


title: Symphony of the Seas

text: Among the "Oasis"-class ships, "Symphony of the Seas" uses 25% less fuel due to design changes. One of these is the implementation of a new system that releases tiny air bubbles under the hull to enable the vessel to glide more smoothly through the water. The air layer also reduces excitation from the propellers, which cuts noise and vibration levels in the aft part of the ship.


title: Symphony of the Seas

text: On 29 October 2015, the vessel's keel was laid by the Chantiers de l'Atlantique shipyard in Saint-Nazaire, France. "Symphony of the Seas" floated out on 9 June 2017. Actors Alexa Vega and Carlos Pena Jr., and their 23-month-old son Ocean were chosen as the "Godfamily" of the ship, marking the first time in the industry that a family was a ship sponsor. The christening ceremony took place in Miami in November 2018.


title: Symphony of the Seas

text: From 15 to 18 February 2018, the cruise ship underwent sea trials and was formally turned over to Royal Caribbean International on 23 March. On 24 March, the ship left Saint-Nazaire for Málaga under the command of Rob Hempstead, arriving on 27 March, and arrived at the vessel's first homeport of Barcelona, Spain on 29 March.


title: Symphony of the Seas

text: On 31 March 2018, "Symphony of the Seas" offered her first passenger cruise and began her maiden voyage on 7 April for a week-long trip through the Mediterranean.


title: Symphony of the Seas

text: During her first season, "Symphony of the Seas" continued to sail on seven-night Western Mediterranean cruises from Barcelona. She repositioned on 28 October and arrived on 9 November at her new home port at the Royal Caribbean terminal at PortMiami in Florida, United States to provide cruises of the Caribbean.


title: Symphony of the Seas

text: In January 2019, while the ship was docked in Nassau, Bahamas, a guest jumped overboard as part of a stunt and survived. He and his friends were turned over to law enforcement but were not charged, and they were required to return home at their own expense. Subsequently, Royal Caribbean announced that it would permanently ban the guests from sailing on any of its ships.


title: Symphony of the Seas

text: In August 2019, an Australian passenger died after going overboard during a seven-day cruise of the Caribbean. His body was recovered shortly afterwards by the ship's officials.


title: Symphony of the Seas

text: During the COVID-19 pandemic on cruise ships, Royal Caribbean suspended all services across most of its fleet, including "Symphony of the Seas". A 27-year old crew member from the housekeeping department was medically evacuated in March 2020 and subsequently died from COVID-19 in April 2020. The family later sued Royal Caribbean for wrongful death.


title: Symphony of the Seas

text: In 2020, Channel 4 in the United Kingdom aired a behind-the-scenes show featuring "Symphony of the Seas" called "Billion Pound Cruise". The three-part series was filmed at the end of 2019 and covers the on-board experiences"."


title: Aloha Airlines Flight 243

text: Aloha Airlines Flight 243 (IATA: AQ243, ICAO: AAH243) was a scheduled Aloha Airlines flight between Hilo and Honolulu in Hawaii. On April 28, 1988, a Boeing 737-297 serving the flight suffered extensive damage after an explosive decompression in flight, caused by part of the fuselage breaking due to poor maintenance and metal fatigue. The plane was able to land safely at Kahului Airport on Maui. The one fatality, flight attendant Clarabelle "C.B." Lansing, was ejected from the airplane. Another 65 passengers and crew were injured. The substantial damage inflicted by the decompression, the loss of one cabin crew member, and the safe landing of the aircraft established the incident as a significant event in the history of aviation, with far-reaching effects on aviation safety policies and procedures.


title: Aloha Airlines Flight 243

text: The aircraft involved was a Boeing 737 200 series and was the 152nd Boeing 737 airframe built at the Renton assembly plant. It was built in 1969 and delivered to Aloha Airlines as a new aircraft. Its registration was . When delivered to Aloha, it was named "King Kalaniopuu", after Kalaniʻōpuʻu, until it was leased to Air California/AirCal, after which the name was reassigned to N728AL. When N73711 returned to Aloha, it received its second name, "Queen Liliuokalani" after Liliʻuokalani. While the airframe had accumulated 35,496 flight hours prior to the accident, those hours included nearly 90,000 flight cycles (takeoffs and landings), owing to its use on short flights. This amounted to more than twice the number of flight cycles for which it was designed. At the time of the incident, Aloha Airlines operated the two highest flight-cycle Boeing 737s in the world, with the incident aircraft being number two.


title: Aloha Airlines Flight 243

text: The captain of the flight was 44-year-old Robert Schornstheimer, an experienced pilot with 8,500 flight hours, 6,700 of which were in Boeing 737s. The first officer was 36-year-old Madeline "Mimi" Tompkins, who also had significant experience flying the 737, having logged 3,500 of her total 8,000 flight hours in that particular Boeing model.


title: Aloha Airlines Flight 243

text: Flight 243 departed from Hilo International Airport at 13:25 HST on April 28, 1988, with six crew members and 89 passengers on board, bound for Honolulu. Nothing unusual was noted during the pre-departure inspection of the aircraft, which had already completed three round-trip flights from Honolulu to Hilo, Maui, and Kauai earlier that day, all uneventful. Meteorological conditions were checked, but no advisories for weather phenomena were reported along the air route, per AIRMETs or SIGMETs.


title: Aloha Airlines Flight 243

text: After a routine takeoff and ascent, the aircraft had reached its normal flight altitude of , when at around 13:48, about south-southeast of Kahului on the island of Maui, a small section on the left side of the roof ruptured with a "whooshing" sound. The captain felt the aircraft roll to the left and right, and the controls went loose; the first officer noticed pieces of grey insulation floating above the cabin. The cockpit door had broken away and the captain could see "blue sky where the first-class ceiling had been." The resulting explosive decompression had torn off a large section of the roof, consisting of the entire top half of the aircraft skin extending from just behind the cockpit to the fore-wing area, a length of about .


title: Aloha Airlines Flight 243

text: One fatality occurred, 58-year-old flight attendant Clarabelle "C.B." Lansing, who was swept out of the airplane while standing near the fifth-row seats; her body was never found. Lansing was a veteran flight attendant of 37 years at the time of the incident. Eight other people suffered serious injuries. All of the passengers had been seated and wearing their seat belts during the depressurization.


title: Aloha Airlines Flight 243

text: First Officer Tompkins was the pilot flying at the time of the incident; Captain Schornstheimer took over controls and performed an immediate emergency descent. The crew declared an emergency and diverted to Kahului Airport for an emergency landing. During the approach to the airport, the left engine failed, and the flight crew was unsure if the nose gear was lowered correctly. Nevertheless, they were able to land normally on Runway 2, thirteen minutes after the incident. Upon landing, the aircraft's emergency evacuation slides were deployed and passengers quickly evacuated from the aircraft. Sixty-five people were reported injured, eight of them with serious injuries. At the time, Maui had no plan in place for an emergency of this type. The injured were taken to the hospital in tour vans belonging to Akamai Tours, driven by office personnel and mechanics, as the island only had two ambulances. Air traffic control radioed Akamai and requested as many of their 15-passenger vans as they could spare to go to the airport (which was from their base) to transport the injured. Two of the Akamai drivers were former paramedics and established a triage on the runway. The aircraft was written off.


title: Aloha Airlines Flight 243

text: The aircraft was damaged beyond repair and was dismantled on site. Additional damage to the airplane included damaged and dented horizontal stabilizers, both of which had been struck by flying debris. Some of the metal debris had also struck the aircraft's vertical stabilizer, causing slight damage. The leading edges of both wings and both engine cowlings had also sustained damage.


title: Aloha Airlines Flight 243

text: The piece of the fuselage blown off the aircraft was never found. Investigation by the U. S. National Transportation Safety Board (NTSB) concluded that the accident was caused by metal fatigue exacerbated by crevice corrosion. The aircraft was 19 years old and operated in a coastal environment, with exposure to salt and humidity.


title: Aloha Airlines Flight 243

text: During an interview, passenger Gayle Yamamoto told investigators that she had noticed a crack in the fuselage upon boarding, but did not notify anyone.


title: Aloha Airlines Flight 243

text: The incident aircraft was line number 152. All 737s constructed after line number 291 included an additional outer layer of skin or doubler sheet at the lap joint of the fuselage. In the construction of the incident aircraft, this doubler sheet was not used. In the case of production line 292 and after, this doubler sheet gave an additional thickness of at the lap joint. For airplane line number 291 and before, cold bonding had been used, with fasteners used to maintain surface contact in the joint, allowing bonding adhesive to transfer load within the joint. This cold-bonded joint used an epoxy-impregnated woven scrim cloth to join the edges of skin panels. These epoxy cloths were reactive at room temperature, so they were stored at dry ice temperatures until used in manufacture. The bond cured at room temperature after assembly. The cold-bonding process reduced the overall weight and manufacturing cost. Fuselage hoop loads (circumferential loads within the skins due to pressurization of the cabin) were intended to be transferred through the bonded joint, rather than through the rivets, allowing the use of lighter, thinner fuselage skin panels with no degradation in fatigue life.


title: Aloha Airlines Flight 243

text: The NTSB investigation determined that the quality of inspection and maintenance programs was deficient. Fuselage examinations were scheduled during the night, which made carrying out an adequate inspection of the aircraft's outer skin more difficult.


title: Aloha Airlines Flight 243

text: Also, the fuselage failure initiated in the lap joint along S-10L; the failure mechanism was a result of multiple-site fatigue cracking of the skin adjacent to rivet holes along the lap joint upper rivet row and tear strap disbond, which negated the fail-safe characteristics of the fuselage. Finally, the fatigue cracking initiated from the knife edge associated with the countersunk lap joint rivet holes; the knife edge concentrated stresses that were transferred through the rivets because of lap joint disbonding.


title: Aloha Airlines Flight 243

text: The National Transportation Safety Board determines that the probable cause of this accident was the failure of the Aloha Airlines maintenance program to detect the presence of significant disbonding and fatigue damage which ultimately led to failure of the lap joint at S-10L and the separation of the fuselage upper lobe. Contributing to the accident were the failure of Aloha Airlines management to supervise properly its maintenance force; the failure of the FAA to require Airworthiness Directive 87-21-08 inspection of all the lap joints proposed by Boeing Alert Service Bulletin SB 737-53A1039; and the lack of a complete terminating action (neither generated by Boeing nor required by the FAA) after the discovery of early production difficulties in the B-737 cold-bond lap joint, which resulted in low bond durability, corrosion, and premature fatigue cracking.


title: Aloha Airlines Flight 243

text: One board member dissented, arguing that the fatigue cracking was clearly the probable cause, but that Aloha Airlines maintenance should not be singled out because failures by the FAA, Boeing, and Aloha Airlines maintenance each were contributing factors to the disaster.


title: 2022 CONCACAF Champions League

text: The 2022 CONCACAF Champions League (officially the 2022 Scotiabank CONCACAF Champions League) was the 14th edition of the CONCACAF Champions League under its current name, and overall the 57th edition of the premier football club competition organized by CONCACAF, the regional governing body of North America, Central America, and the Caribbean.


title: 2022 CONCACAF Champions League

text: Monterrey was the title holder but did not qualify for this tournament and was unable to defend its title. American team Seattle Sounders FC won its first CONCACAF Champions League title, defeating Mexican club UNAM 5–2 on aggregate in the final. The Sounders thus became the first team from Major League Soccer to win the title under its current format. It was the first time since the 2005 CONCACAF Champions' Cup, that a non-Mexican team won the Champions' Cup or Champions League, and the first time since 2000 that an American team won the Champions' Cup or League.


title: 2022 CONCACAF Champions League

text: "In the following table, the number of appearances, last appearance, and previous best result count only those in the CONCACAF Champions League era starting from 2008–09 (not counting those in the era of the Champions' Cup from 1962 to 2008)."


title: 2022 CONCACAF Champions League

text: The draw for the 2022 CONCACAF Champions League was held on 15 December 2021, in Miami, Florida, United States.


title: 2022 CONCACAF Champions League

text: The draw determined each tie in the round of 16 (numbered 1 through 8) between a team from Pot 1 and a team from Pot 2, each containing eight teams. The "Bracket Position Pots" (Pot A and Pot B) contains the bracket positions numbered 1 through 8 corresponding to each tie. The teams from Pot 1 are assigned a bracket position from Pot A and the teams from Pot 2 were assigned a bracket position from Pot B. Teams from the same association cannot be drawn against each other in the round of 16 except for "wildcard" teams which replace a team from another association.


title: 2022 CONCACAF Champions League

text: The seeding of teams were based on the CONCACAF Club Index. The CONCACAF Club Index, instead of ranking each team, was based on the on-field performance of the teams that occupied the respective qualifying slots in the previous five editions of the CONCACAF Champions League. To determine the total points awarded to a slot in any single edition of the CONCACAF Champions League, CONCACAF used the following formula:


title: 2022 CONCACAF Champions League

text: Each tie, including the final, was played over two legs, with each team playing on a home-and-away basis.


title: 2022 CONCACAF Champions League

text: In the round of 16, the matchups were decided by draw: R16-1 through R16-8. The teams from Pot 1 in the draw hosted the second leg.


title: 2022 CONCACAF Champions League

text: The first legs were played on 15–17 February, and the second legs were played on 22–24 February 2022.


title: 2022 CONCACAF Champions League

text: "New England Revolution advanced to the quarter-finals after Cavaly withdrew from the competition on 15 February 2022.


title: 2022 CONCACAF Champions League

text: The semi-finalists in each tie which had the better performance across all previous rounds hosted the second leg.


title: 2022 CONCACAF Champions League

text: In the final (Winner SF1 vs. Winner SF2), the finalist which had the better performances in previous rounds hosted the second leg.


title: 2022 CONCACAF Champions League

text: The first leg was played on 27 April, and the second leg was played on 4 May 2022. Unlike previous rounds, the away goals rule did not apply in the final round.


title: Anushka Shetty filmography

text: Anushka Shetty is an Indian actress who appears in 37 Telugu Films and 19 Tamil films . She made her acting debut in Puri Jagannadh's 2005 Telugu film "Super", and appeared in "Mahanandi", released later the same year. The following year, she had four releases, the first being S. S. Rajamouli's "Vikramarkudu", which helped her gain recognition, followed by "Astram" (a remake of the 1999 Hindi film "Sarfarosh"), the Sundar C.-directed "Rendu", (which marked her debut in Tamil cinema), and a special appearance in AR Murugadoss' Telugu film "Stalin". She had two releases in 2007: "Lakshyam" and "Don". In 2008, she appeared in six films, including "Okka Magaadu", "Swagatam" and "Souryam". In 2009, Shetty played two roles in the fantasy "Arundhati". She went on to win the Nandi Special Jury Award and the Filmfare Best Telugu Actress Award for this film. Her next release that year was "Billa", a Telugu remake of the 2007 Tamil film of the same name. Her final release in 2009 was her second Tamil feature film, the masala film "Vettaikaaran", where she appeared as a medical student.


title: Anushka Shetty filmography

text: Shetty had a string of releases in 2010. She portrayed a prostitute in Krish's "Vedam", which won her the Filmfare Award for Best Telugu Actress. Despite critical acclaim, the film failed at the box office. None of her other releases in 2010 succeeded commercially, except for her sole Tamil release of the year, the masala "Singam". The following year, Anushka had two releases, both in Tamil. She reprised her "Vedam" role in its remake "Vaanam", then appeared as an advocate in the A. L. Vijay-directed "Deiva Thirumagal", a loose adaptation of the American film "I Am Sam" (2001). The following year, she also had two releases: "Thaandavam" in Tamil, and "Damarukam" in Telugu. Her first release in 2013 was Suraj's Tamil masala "Alex Pandian", a critical and commercial failure. This was followed by "Mirchi" in Telugu, "Singam II" (where she reprised her role from "Singam"), and Selvaraghavan's Tamil romantic fantasy "Irandaam Ulagam" where she played three distinct roles. Her sole release of 2014 was K. S. Ravikumar's "Lingaa".


title: Anushka Shetty filmography

text: In 2015, Shetty appeared in Gautham Vasudev Menon's "Yennai Arindhaal", followed by Rajamouli's Telugu-Tamil bilingual "", where she played a queen named Devasena. Her performance as Rudrama Devi, a monarch of the Kakatiya dynasty in the eponymous film won her the Filmfare Award for Best Telugu Actress. She then appeared in the Telugu romantic comedy "Size Zero" (filmed simultaneously in Tamil as "Inji Iduppazhagi"), in a role for which she gained of weight. Her only roles in 2016 were cameos in "Soggade Chinni Nayana" and "Oopiri" (filmed in Tamil as "Thozha"). The following year, she appeared in "Si3" (the third film in the "Singam" series), the semi-biographical "Om Namo Venkatesaya", where she played a character inspired by Andal, and Rajamouli's Telugu-Tamil bilingual "", where she reprised her role from its predecessor. Her only release in 2018 was the Telugu-Tamil bilingual "Bhaagamathie".


title: Alternative medicine

text: Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine attempt to combine alternative practices with those of mainstream medicine. Alternative therapies share in common that they reside outside of medical science and instead rely on pseudoscience. Traditional practices become "alternative" when used outside their original settings and without proper scientific explanation and evidence. Frequently used derogatory terms for relevant practices are "new age" or "pseudo-" medicine, with little distinction from quackery.


title: Alternative medicine

text: Some alternative practices are based on theories that contradict the established science of how the human body works; others resort to the supernatural or superstitious to explain their effect or lack thereof. In others, the practice has plausibility but lacks a positive risk-benefit outcome probability. Alternative medicine is distinct from scientific medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect. Research into alternative therapies often fails to follow proper research protocols (such as placebo-controlled trials, blind experiments and calculation of prior probability), providing invalid results.


title: Alternative medicine

text: Much of the perceived effect of an alternative practice arises from a belief that it will be effective (the placebo effect), or from the treated condition resolving on its own (the natural course of disease). This is further exacerbated by the tendency to turn to alternative therapies upon the failure of medicine, at which point the condition will be at its worst and most likely to spontaneously improve. In the absence of this bias, especially for diseases that are not expected to get better by themselves such as cancer or HIV infection, multiple studies have shown significantly worse outcomes if patients turn to alternative therapies. While this may be because these patients avoid effective treatment, some alternative therapies are actively harmful (e.g. cyanide poisoning from amygdalin, or the intentional ingestion of hydrogen peroxide) or actively interfere with effective treatments.


title: Alternative medicine

text: The alternative medicine sector is a highly profitable industry with a strong lobby, and faces far less regulation over the use and marketing of unproven treatments. Its marketing often advertises the treatments as being "natural" or "holistic", in comparison to those offered by medical science. Billions of dollars have been spent studying alternative medicine, with few or no positive results. Some of the successful practices are only considered alternative under very specific definitions, such as those which include all physical activity under the umbrella of "alternative medicine".


title: Alternative medicine

text: The terms "alternative medicine", "complementary medicine", "integrative medicine," "holistic medicine", "natural medicine", "unorthodox medicine", "fringe medicine", "unconventional medicine", and "new age medicine" are used interchangeably as having the same meaning and are almost synonymous in most contexts. Terminology has shifted over time, reflecting the preferred branding of practitioners. For example, the United States National Institutes of Health department studying alternative medicine, currently named the National Center for Complementary and Integrative Health (NCCIH), was established as the "Office of Alternative Medicine" (OAM) and was renamed the "National Center for Complementary and Alternative Medicine" (NCCAM) before obtaining its current name. Therapies are often framed as "natural" or "holistic", implicitly and intentionally suggesting that conventional medicine is "artificial" and "narrow in scope".


title: Alternative medicine

text: The meaning of the term "alternative" in the expression "alternative medicine", is not that it is an effective alternative to medical science, although some alternative medicine promoters may use the loose terminology to give the appearance of effectiveness.<ref name="Sampson_6/1995"></ref> Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions "Western medicine" and "Eastern medicine" to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work.


title: Alternative medicine

text: Alternative medicine is defined loosely as a set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been established using scientific methods, or whose theory and practice is not part of biomedicine, or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine. "Biomedicine" or "medicine" is that part of medical science that applies principles of biology, physiology, molecular biology, biophysics, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice. Unlike medicine, an alternative product or practice does not originate from using scientific methods, but may instead be based on hearsay, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources.


title: Alternative medicine

text: Some other definitions seek to specify alternative medicine in terms of its social and political marginality to mainstream healthcare. This can refer to the lack of support that alternative therapies receive from medical scientists regarding access to research funding, sympathetic coverage in the medical press, or inclusion in the standard medical curriculum. For example, a widely used definition devised by the US NCCIH calls it ""a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine"". However, these descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and introductory courses or modules can be offered as part of standard undergraduate medical training; alternative medicine is taught in more than half of US medical schools and US health insurers are increasingly willing to provide reimbursement for alternative therapies.


title: Alternative medicine

text: Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with mainstream functional medical treatment in a belief that it improves the effect of treatments. For example, acupuncture (piercing the body with needles to influence the flow of a supernatural energy) might be believed to increase the effectiveness or "complement" science-based medicine when used at the same time. Instead, significant drug interactions caused by alternative therapies may make treatments less effective, notably in cancer therapy. Besides the usual issues with alternative medicine, integrative medicine has been described as an attempt to bring pseudoscience into academic science-based medicine, leading to the pejorative term "quackademic medicine". Due to its many names, the field has been criticized for intense rebranding of what are essentially the same practices.


title: Alternative medicine

text: CAM is an abbreviation of the phrase "complementary and alternative medicine". The 2019 World Health Organization (WHO) Global Report on Traditional and Complementary Medicine states that the terms complementary and alternative medicine "refer to a broad set of health care practices that are not part of that country's own traditional or conventional medicine and are not fully integrated into the dominant health care system. They are used interchangeably with traditional medicine in some countries."


title: Alternative medicine

text: The Integrative Medicine Exam by the American Board of Physician Specialties includes the following subjects: Manual Therapies, Biofield Therapies, Acupuncture, Movement Therapies, Expressive Arts, Traditional Chinese Medicine, Ayurveda, Indigenous Medical Systems, Homeopathic Medicine, Naturopathic Medicine, Osteopathic Medicine, Chiropractic, and Functional Medicine.


title: Alternative medicine

text: Traditional medicine refers to the pre-scientific practices of a certain culture, in contrast to what is typically practiced in cultures where medical science dominates. The 2019 WHO report defines traditional medicine as "the sum total of the knowledge, skill and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness."


title: Alternative medicine

text: Holistic medicine is another rebranding of alternative medicine. In this case, the words "balance" and "holism" are often used alongside "complementary" or "integrative", claiming to take into account a "whole" person, in contrast to the supposed reductionism of medicine.


title: Alternative medicine

text: Prominent members of the science and biomedical science community say that it is not meaningful to define an alternative medicine that is separate from a conventional medicine because the expressions "conventional medicine", "alternative medicine", "complementary medicine", "integrative medicine", and "holistic medicine" do not refer to any medicine at all. Others say that alternative medicine cannot be precisely defined because of the diversity of theories and practices it includes, and because the boundaries between alternative and conventional medicine overlap, are porous, and change. Healthcare practices categorized as alternative may differ in their historical origin, theoretical basis, diagnostic technique, therapeutic practice and in their relationship to the medical mainstream. Under a definition of alternative medicine as "non-mainstream", treatments considered alternative in one location may be considered conventional in another.


title: Alternative medicine

text: Critics say the expression is deceptive because it implies there is an effective alternative to science-based medicine, and that "complementary" is deceptive because it implies that the treatment increases the effectiveness of (complements) science-based medicine, while alternative medicines that have been tested nearly always have no measurable positive effect compared to a placebo. John Diamond wrote that "there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't", a notion later echoed by Paul Offit: "The truth is there's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't. And the best way to sort it out is by carefully evaluating scientific studies—not by visiting Internet chat rooms, reading magazine articles, or talking to friends."


title: Alternative medicine

text: Alternative medicine consists of a wide range of health care practices, products, and therapies. The shared feature is a claim to heal that is not based on the scientific method. Alternative medicine practices are diverse in their foundations and methodologies. Alternative medicine practices may be classified by their cultural origins or by the types of beliefs upon which they are based. Methods may incorporate or be based on traditional medicinal practices of a particular culture, folk knowledge, superstition, spiritual beliefs, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning, propaganda, fraud, new or different concepts of health and disease, and any bases other than being proven by scientific methods. Different cultures may have their own unique traditional or belief based practices developed recently or over thousands of years, and specific practices or entire systems of practices.


title: Alternative medicine

text: Alternative medicine, such as using naturopathy or homeopathy in place of conventional medicine, is based on belief systems not grounded in science.


title: Alternative medicine

text: Alternative medical systems may be based on traditional medicine practices, such as traditional Chinese medicine (TCM), Ayurveda in India, or practices of other cultures around the world. Some useful applications of traditional medicines have been researched and accepted within ordinary medicine, however the underlying belief systems are seldom scientific and are not accepted.


title: Alternative medicine

text: Traditional medicine is considered alternative when it is used outside its home region; or when it is used together with or instead of known functional treatment; or when it can be reasonably expected that the patient or practitioner knows or should know that it will not work – such as knowing that the practice is based on superstition.


title: Alternative medicine

text: Bases of belief may include belief in existence of supernatural energies undetected by the science of physics, as in biofields, or in belief in properties of the energies of physics that are inconsistent with the laws of physics, as in energy medicine.


title: Alternative medicine

text: Substance based practices use substances found in nature such as herbs, foods, non-vitamin supplements and megavitamins, animal and fungal products, and minerals, including use of these products in traditional medical practices that may also incorporate other methods. Examples include healing claims for non-vitamin supplements, fish oil, Omega-3 fatty acid, glucosamine, echinacea, flaxseed oil, and ginseng. Herbal medicine, or phytotherapy, includes not just the use of plant products, but may also include the use of animal and mineral products. It is among the most commercially successful branches of alternative medicine, and includes the tablets, powders and elixirs that are sold as "nutritional supplements". Only a very small percentage of these have been shown to have any efficacy, and there is little regulation as to standards and safety of their contents.


title: Alternative medicine

text: The US agency NCCIH has created a classification system for branches of complementary and alternative medicine that divides them into five major groups. These groups have some overlap, and distinguish two types of energy medicine: "veritable" which involves scientifically observable energy (including magnet therapy, colorpuncture and light therapy) and "putative", which invokes physically undetectable or unverifiable energy. None of these energies have any evidence to support that they affect the body in any positive or health promoting way.


title: Alternative medicine

text: The history of alternative medicine may refer to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment.<ref name="RiseRise_6/2004"></ref><ref name="Whorton_9/2002"></ref> It includes the histories of complementary medicine and of integrative medicine. Before the 1970s, western practitioners that were not part of the increasingly science-based medical establishment were referred to "irregular practitioners", and were dismissed by the medical establishment as unscientific and as practicing quackery. Until the 1970s, irregular practice became increasingly marginalized as quackery and fraud, as western medicine increasingly incorporated scientific methods and discoveries, and had a corresponding increase in success of its treatments. In the 1970s, irregular practices were grouped with traditional practices of nonwestern cultures and with other unproven or disproven practices that were not part of biomedicine, with the entire group collectively marketed and promoted under the single expression "alternative medicine".


title: Alternative medicine

text: Use of alternative medicine in the west began to rise following the counterculture movement of the 1960s, as part of the rising new age movement of the 1970s. This was due to misleading mass marketing of "alternative medicine" being an effective "alternative" to biomedicine, changing social attitudes about not using chemicals and challenging the establishment and authority of any kind, sensitivity to giving equal measure to beliefs and practices of other cultures (cultural relativism), and growing frustration and desperation by patients about limitations and side effects of science-based medicine. At the same time, in 1975, the American Medical Association, which played the central role in fighting quackery in the United States, abolished its quackery committee and closed down its Department of Investigation. By the early to mid 1970s the expression "alternative medicine" came into widespread use, and the expression became mass marketed as a collection of "natural" and effective treatment "alternatives" to science-based biomedicine. By 1983, mass marketing of "alternative medicine" was so pervasive that the British Medical Journal (BMJ) pointed to "an apparently endless stream of books, articles, and radio and television programmes urge on the public the virtues of (alternative medicine) treatments ranging from meditation to drilling a hole in the skull to let in more oxygen".


title: Alternative medicine

text: An analysis of trends in the criticism of complementary and alternative medicine (CAM) in five prestigious American medical journals during the period of reorganization within medicine (1965–1999) was reported as showing that the medical profession had responded to the growth of CAM in three phases, and that in each phase, changes in the medical marketplace had influenced the type of response in the journals. Changes included relaxed medical licensing, the development of managed care, rising consumerism, and the establishment of the USA Office of Alternative Medicine (later National Center for Complementary and Alternative Medicine, currently National Center for Complementary and Integrative Health).


title: Alternative medicine

text: Mainly as a result of reforms following the Flexner Report of 1910 medical education in established medical schools in the US has generally not included alternative medicine as a teaching topic. Typically, their teaching is based on current practice and scientific knowledge about: anatomy, physiology, histology, embryology, neuroanatomy, pathology, pharmacology, microbiology and immunology. Medical schools' teaching includes such topics as doctor-patient communication, ethics, the art of medicine, and engaging in complex clinical reasoning (medical decision-making). Writing in 2002, Snyderman and Weil remarked that by the early twentieth century the Flexner model had helped to create the 20th-century academic health center, in which education, research, and practice were inseparable. While this had much improved medical practice by defining with increasing certainty the pathophysiological basis of disease, a single-minded focus on the pathophysiological had diverted much of mainstream American medicine from clinical conditions that were not well understood in mechanistic terms, and were not effectively treated by conventional therapies.


title: Alternative medicine

text: By 2001 some form of CAM training was being offered by at least 75 out of 125 medical schools in the US. Exceptionally, the School of Medicine of the University of Maryland, Baltimore, includes a research institute for integrative medicine (a member entity of the Cochrane Collaboration). Medical schools are responsible for conferring medical degrees, but a physician typically may not legally practice medicine until licensed by the local government authority. Licensed physicians in the US who have attended one of the established medical schools there have usually graduated Doctor of Medicine (MD). All states require that applicants for MD licensure be graduates of an approved medical school and complete the United States Medical Licensing Exam (USMLE).


title: Alternative medicine

text: There is a general scientific consensus that alternative therapies lack the requisite scientific validation, and their effectiveness is either unproved or disproved. Many of the claims regarding the efficacy of alternative medicines are controversial, since research on them is frequently of low quality and methodologically flawed. Selective publication bias, marked differences in product quality and standardisation, and some companies making unsubstantiated claims call into question the claims of efficacy of isolated examples where there is evidence for alternative therapies.


title: Alternative medicine

text: "The Scientific Review of Alternative Medicine" points to confusions in the general population – a person may attribute symptomatic relief to an otherwise-ineffective therapy just because they are taking something (the placebo effect); the natural recovery from or the cyclical nature of an illness (the regression fallacy) gets misattributed to an alternative medicine being taken; a person not diagnosed with science-based medicine may never originally have had a true illness diagnosed as an alternative disease category.


title: Alternative medicine

text: Edzard Ernst characterized the evidence for many alternative techniques as weak, nonexistent, or negative and in 2011 published his estimate that about 7.4% were based on "sound evidence", although he believes that may be an overestimate. Ernst has concluded that 95% of the alternative therapies he and his team studied, including acupuncture, herbal medicine, homeopathy, and reflexology, are "statistically indistinguishable from placebo treatments", but he also believes there is something that conventional doctors can usefully learn from the chiropractors and homeopath: this is the therapeutic value of the placebo effect, one of the strangest phenomena in medicine.


title: Alternative medicine

text: In 2003, a project funded by the CDC identified 208 condition-treatment pairs, of which 58% had been studied by at least one randomized controlled trial (RCT), and 23% had been assessed with a meta-analysis. According to a 2005 book by a US Institute of Medicine panel, the number of RCTs focused on CAM has risen dramatically.


title: Alternative medicine

text: , the Cochrane Library had 145 CAM-related Cochrane systematic reviews and 340 non-Cochrane systematic reviews. An analysis of the conclusions of only the 145 Cochrane reviews was done by two readers. In 83% of the cases, the readers agreed. In the 17% in which they disagreed, a third reader agreed with one of the initial readers to set a rating. These studies found that, for CAM, 38.4% concluded positive effect or possibly positive (12.4%), 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence. An assessment of conventional treatments found that 41.3% concluded positive or possibly positive effect, 20% concluded no effect, 8.1% concluded net harmful effects, and 21.3% concluded insufficient evidence. However, the CAM review used the more developed 2004 Cochrane database, while the conventional review used the initial 1998 Cochrane database.


title: Alternative medicine

text: Alternative therapies do not "complement" (improve the effect of, or mitigate the side effects of) functional medical treatment. Significant drug interactions caused by alternative therapies may instead negatively impact functional treatment by making prescription drugs less effective, such as interference by herbal preparations with warfarin.


title: Alternative medicine

text: In the same way as for conventional therapies, drugs, and interventions, it can be difficult to test the efficacy of alternative medicine in clinical trials. In instances where an established, effective, treatment for a condition is already available, the Helsinki Declaration states that withholding such treatment is unethical in most circumstances. Use of standard-of-care treatment in addition to an alternative technique being tested may produce confounded or difficult-to-interpret results.


title: Alternative medicine

text: Anything classified as alternative medicine by definition does not have a proven healing or medical effect. However, there are different mechanisms through which it can be perceived to "work". The common denominator of these mechanisms is that effects are mis-attributed to the alternative treatment.


title: Alternative medicine

text: A placebo is a treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like sham surgery. The "placebo effect" is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect is the "nocebo effect", when patients who expect a treatment to be harmful will perceive harmful effects after taking it.


title: Alternative medicine

text: Placebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea. A 1955 study suggested that a substantial part of a medicine's impact was due to the placebo effect. However, reassessments found the study to have flawed methodology. This and other modern reviews suggest that other factors like natural recovery and reporting bias should also be considered.


title: Alternative medicine

text: All of these are reasons why alternative therapies may be credited for improving a patient's condition even though the objective effect is non-existent, or even harmful. David Gorski argues that alternative treatments should be treated as a placebo, rather than as medicine. Almost none have performed significantly better than a placebo in clinical trials. Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication.


title: Alternative medicine

text: A patient who receives an inert treatment may report improvements afterwards that it did not cause. Assuming it was the cause without evidence is an example of the regression fallacy. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition. The concept of regression toward the mean implies that an extreme result is more likely to be followed by a less extreme result.


title: Alternative medicine

text: There are also reasons why a placebo treatment group may outperform a "no-treatment" group in a test which are not related to a patient's experience. These include patients reporting more favourable results than they really felt due to politeness or "experimental subordination", observer bias, and misleading wording of questions. In their 2010 systematic review of studies into placebos, Asbjørn Hróbjartsson and Peter C. Gøtzsche write that "even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of blinding." Alternative therapies may also be credited for perceived improvement through decreased use or effect of medical treatment, and therefore either decreased side effects or nocebo effects towards standard treatment.


title: Alternative medicine

text: Practitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.


title: Alternative medicine

text: In addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe, cognitive biases that help maintain self-esteem and promote harmonious social functioning, and the "post hoc, ergo propter hoc" fallacy.


title: Alternative medicine

text: Alternative medicine is a profitable industry with large media advertising expenditures. Accordingly, alternative practices are often portrayed positively and compared favorably to "big pharma".


title: Alternative medicine

text: The popularity of complementary & alternative medicine (CAM) may be related to other factors that Edzard Ernst mentioned in an interview in "The Independent":


title: Alternative medicine

text: Paul Offit proposed that "alternative medicine becomes quackery" in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients' bank accounts, or by promoting "magical thinking." Promoting alternative medicine has been called dangerous and unethical.


title: Alternative medicine

text: Authors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the minority using them "in lieu" of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of scientific literacy among the public at large and a concomitant increase in antiscientific attitudes and new age mysticism. Related to this are vigorous marketing of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics. Alternative medicine is criticized for taking advantage of the least fortunate members of society.


title: Alternative medicine

text: There is also an increase in conspiracy theories toward conventional medicine and pharmaceutical companies, mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have led patients to seek out alternative medicine to treat a variety of ailments. Many patients lack access to contemporary medicine, due to a lack of private or public health insurance, which leads them to seek out lower-cost alternative medicine. Medical doctors are also aggressively marketing alternative medicine to profit from this market.


title: Alternative medicine

text: Patients can be averse to the painful, unpleasant, and sometimes-dangerous side effects of biomedical treatments. Treatments for severe diseases such as cancer and HIV infection have well-known, significant side-effects. Even low-risk medications such as antibiotics can have potential to cause life-threatening anaphylactic reactions in a very few individuals. Many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out alternative therapies to avoid the adverse effects of conventional treatments.


title: Alternative medicine

text: According to recent research, the increasing popularity of the CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.


title: Alternative medicine

text: In developing nations, access to essential medicines is severely restricted by lack of resources and poverty. Traditional remedies, often closely resembling or forming the basis for alternative remedies, may comprise primary healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.


title: Alternative medicine

text: In Latin America, inequities against BIPOC communities keep them tied to their traditional practices and therefore, it is often these communities that constitute the majority of users of alternative medicine. Racist attitudes towards certain communities disable them from accessing more urbanized modes of care. In a study that assessed access to care in rural communities of Latin America, it was found that discrimination is a huge barrier to the ability of citizens to access care; more specifically, women of Indigenous and African descent, and lower-income families were especially hurt. Such exclusion exacerbates the inequities that minorities in Latin America already face. Consistently excluded from many systems of westernized care for socioeconomic and other reasons, low-income communities of color often turn to traditional medicine for care as it has proved reliable to them across generations.


title: Alternative medicine

text: Some have proposed adopting a prize system to reward medical research. However, public funding for research exists. In the US increasing the funding for research on alternative medicine is the purpose of the US National Center for Complementary and Alternative Medicine (NCCAM). NCCAM has spent more than US$2.5 billion on such research since 1992 and this research has not demonstrated the efficacy of alternative therapies. The NCCAM's sister organization in the NIC Office of Cancer Complementary and Alternative Medicine gives grants of around $105 million every year. Testing alternative medicine that has no scientific basis has been called a waste of scarce research resources.


title: Alternative medicine

text: That alternative medicine has been on the rise "in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and 'evidence-based' practice is the dominant paradigm" was described as an "enigma" in the "Medical Journal of Australia". A 15-year systematic review published in 2022 on the global acceptance and use of CAM among medical specialists found the overall acceptance of CAM at 52% and the overall use at 45%.


title: Alternative medicine

text: In the United States, the 1974 Child Abuse Prevention and Treatment Act (CAPTA) required that for states to receive federal money, they had to grant religious exemptions to child neglect and abuse laws regarding religion-based healing practices. Thirty-one states have child-abuse religious exemptions.


title: Alternative medicine

text: The use of alternative medicine in the US has increased, with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America. According to a national survey conducted in 2002, "36 percent of U.S. adults aged 18 years and over use some form of complementary and alternative medicine." Americans spend many billions on the therapies annually. Most Americans used CAM to treat and/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain. In America, women were more likely than men to use CAM, with the biggest difference in use of mind-body therapies including prayer specifically for health reasons". In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004. More than 70% of the hospitals offering CAM were in urban areas.


title: Alternative medicine

text: A survey of Americans found that 88 percent thought that "there are some good ways of treating sickness that medical science does not recognize". Use of magnets was the most common tool in energy medicine in America, and among users of it, 58 percent described it as at least "sort of scientific", when it is not at all scientific. In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies. "Therapeutic touch" was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.


title: Alternative medicine

text: The most common CAM therapies used in the US in 2002 were prayer (45%), herbalism (19%), breathing meditation (12%), meditation (8%), chiropractic medicine (8%), yoga (5–6%), body work (5%), diet-based therapy (4%), progressive relaxation (3%), mega-vitamin therapy (3%) and Visualization (2%)


title: Alternative medicine

text: In Britain, the most often used alternative therapies were Alexander technique, aromatherapy, Bach and other flower remedies, body work therapies including massage, Counseling stress therapies, hypnotherapy, meditation, reflexology, Shiatsu, Ayurvedic medicine, nutritional medicine, and Yoga. Ayurvedic medicine remedies are mainly plant based with some use of animal materials. Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.


title: Alternative medicine

text: According to the National Health Service (England), the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.


title: Alternative medicine

text: Complementary therapies are often used in palliative care or by practitioners attempting to manage chronic pain in patients. Integrative medicine is considered more acceptable in the interdisciplinary approach used in palliative care than in other areas of medicine. "From its early experiences of care for the dying, palliative care took for granted the necessity of placing patient values and lifestyle habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies, and as long as such treatments provided additional support and did not endanger the patient, they were considered acceptable." The non-pharmacologic interventions of complementary medicine can employ mind-body interventions designed to "reduce pain and concomitant mood disturbance and increase quality of life."


title: Alternative medicine

text: The alternative medicine lobby has successfully pushed for alternative therapies to be subject to far less regulation than conventional medicine. Some professions of complementary/traditional/alternative medicine, such as chiropractic, have achieved full regulation in North America and other parts of the world and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all. In some cases, promotion of alternative therapies is allowed when there is demonstrably no effect, only a tradition of use. Despite laws making it illegal to market or promote alternative therapies for use in cancer treatment, many practitioners promote them.


title: Alternative medicine

text: Regulation and licensing of alternative medicine ranges widely from country to country, and state to state. In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with MDs, and half or more of the American alternative practitioners are licensed MDs. In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.


title: Alternative medicine

text: Government bodies in the US and elsewhere have published information or guidance about alternative medicine. The U.S. Food and Drug Administration (FDA), has issued online warnings for consumers about medication health fraud. This includes a section on Alternative Medicine Fraud, such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.


title: Alternative medicine

text: According to the Institute of Medicine, use of alternative medical techniques may result in several types of harm:


title: Alternative medicine

text: Forms of alternative medicine that are biologically active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems. An example of these dangers was reported by Associate Professor Alastair MacLennan of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking "natural" potions to "build up her strength" before the operation, including a powerful anticoagulant that nearly caused her death.


title: Alternative medicine

text: Conventional treatments are subjected to testing for undesired side-effects, whereas alternative therapies, in general, are not subjected to such testing at all. Any treatment – whether conventional or alternative – that has a biological or psychological effect on a patient may also have potential to possess dangerous biological or psychological side-effects. Attempts to refute this fact with regard to alternative therapies sometimes use the "appeal to nature" fallacy, i.e., "That which is natural cannot be harmful." Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.


title: Alternative medicine

text: An exception to the normal thinking regarding side-effects is homeopathy. Since 1938, the FDA has regulated homeopathic products in "several significantly different ways from other drugs." Homeopathic preparations, termed "remedies", are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count, but "their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength", and their alcohol concentration may be much higher than allowed in conventional drugs.


title: Alternative medicine

text: Alternative medicine may discourage people from getting the best possible treatment. Those having experienced or perceived success with one alternative therapy for a minor ailment may be convinced of its efficacy and persuaded to extrapolate that success to some other alternative therapy for a more serious, possibly life-threatening illness. For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott Lilienfeld in 2002, "unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments" and refers to this as opportunity cost. Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative outcomes. Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies.


title: Alternative medicine

text: There have always been "many therapies offered outside of conventional cancer treatment centers and based on theories not found in biomedicine. These alternative cancer cures have often been described as 'unproven,' suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown." However, "many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective... The label 'unproven' is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been 'disproven'."


title: Alternative medicine

text: Complementary and alternative medicine (CAM) is not as well researched as conventional medicine, which undergoes intense research before release to the public. Practitioners of science-based medicine also discard practices and treatments when they are shown ineffective, while alternative practitioners do not. Funding for research is also sparse making it difficult to do further research for effectiveness of CAM. Most funding for CAM is funded by government agencies. Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable. The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet. Even with the little research done on it, CAM has not been proven to be effective. Studies that have been done will be cited by CAM practitioners in an attempt to claim a basis in science. These studies tend to have a variety of problems, such as small samples, various biases, poor research design, lack of controls, negative results, etc. Even those with positive results can be better explained as resulting in false positives due to bias and noisy data.


title: Alternative medicine

text: Alternative medicine may lead to a false understanding of the body and of the process of science. Steven Novella, a neurologist at Yale School of Medicine, wrote that government-funded studies of integrating alternative medicine techniques into the mainstream are "used to lend an appearance of legitimacy to treatments that are not legitimate." Marcia Angell considered that critics felt that healthcare practices should be classified based solely on scientific evidence, and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered "alternative" to begin with. It is possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. Prominent supporters of this position are George D. Lundberg, former editor of the "Journal of the American Medical Association" ("JAMA") and the journal's interim editor-in-chief Phil Fontanarosa.


title: Alternative medicine

text: Writing in 1999 in "CA: A Cancer Journal for Clinicians" Barrie R. Cassileth mentioned a 1997 letter to the US Senate Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the National Institutes of Health (NIH).)


title: Alternative medicine

text: In March 2009, a staff writer for "the Washington Post" reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine. They quoted one of these scientists, Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, as saying "One of our concerns is that NIH is funding pseudoscience." They noted that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and had shown little or no effect.


title: Alternative medicine

text: Writers such as Carl Sagan, a noted astrophysicist, advocate of scientific skepticism and the author of "The Demon-Haunted World: Science as a Candle in the Dark" (1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.


title: Alternative medicine

text: Sampson has also pointed out that CAM tolerated contradiction without thorough reason and experiment. Barrett has pointed out that there is a policy at the NIH of never saying something does not work, only that a different version or dose might give different results. Barrett also expressed concern that, just because some "alternatives" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.


title: Alternative medicine

text: Some critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably Wallace Sampson and Paul Kurtz founders of Scientific Review of Alternative Medicine and Stephen Barrett, co-founder of The National Council Against Health Fraud and webmaster of Quackwatch. Grounds for opposing alternative medicine include that:


title: Alternative medicine

text: Many alternative medical treatments are not patentable, which may lead to less research funding from the private sector. In addition, in most countries, alternative therapies (in contrast to pharmaceuticals) can be marketed without any proof of efficacy – also a disincentive for manufacturers to fund scientific research.


title: Alternative medicine

text: English evolutionary biologist Richard Dawkins, in his 2003 book "A Devil's Chaplain", defined alternative medicine as a "set of practices that cannot be tested, refuse to be tested, or consistently fail tests." Dawkins argued that if a technique is demonstrated effective in properly performed trials then it ceases to be alternative and simply becomes medicine.


title: Alternative medicine

text: CAM is also often less regulated than conventional medicine. There are ethical concerns about whether people who perform CAM have the proper knowledge to treat patients. CAM is often done by non-physicians who do not operate with the same medical licensing laws which govern conventional medicine, and it is often described as an issue of non-maleficence.


title: Alternative medicine

text: According to two writers, Wallace Sampson and K. Butler, marketing is part of the training required in alternative medicine, and propaganda methods in alternative medicine have been traced back to those used by Hitler and Goebels in their promotion of pseudoscience in medicine.


title: Alternative medicine

text: In November 2011 Edzard Ernst stated that the "level of misinformation about alternative medicine has now reached the point where it has become dangerous and unethical. So far, alternative medicine has remained an ethics-free zone. It is time to change this."


title: Alternative medicine

text: Some commentators have said that special consideration must be given to the issue of conflicts of interest in alternative medicine. Edzard Ernst has said that most researchers into alternative medicine are at risk of "unidirectional bias" because of a generally uncritical belief in their chosen subject. Ernst cites as evidence the phenomenon whereby 100% of a sample of acupuncture trials originating in China had positive conclusions. David Gorski contrasts evidence-based medicine, in which researchers try to disprove hyphotheses, with what he says is the frequent practice in pseudoscience-based research, of striving to confirm pre-existing notions. Harriet Hall writes that there is a contrast between the circumstances of alternative medicine practitioners and disinterested scientists: in the case of acupuncture, for example, an acupuncturist would have "a great deal to lose" if acupuncture were rejected by research; but the disinterested skeptic would not lose anything if its effects were confirmed; rather their change of mind would enhance their skeptical credentials.


title: Alternative medicine

text: Research into alternative therapies has been criticized for "diverting research time, money, and other resources from more fruitful lines of investigation in order to pursue a theory that has no basis in biology." Research methods expert and author of "Snake Oil Science", R. Barker Bausell, has stated that "it's become politically correct to investigate nonsense." A commonly cited statistic is that the US National Institute of Health had spent $2.5 billion on investigating alternative therapies prior to 2009, with none being found to be effective.


title: 4X

text: 4X (abbreviation of "Explore, Expand, Exploit, Exterminate") is a subgenre of strategy-based computer and board games, and include both turn-based and real-time strategy titles. The gameplay involves building an empire. Emphasis is placed upon economic and technological development, as well as a range of military and non-military routes to supremacy.


title: 4X

text: The earliest 4X games borrowed ideas from board games and 1970s text-based computer games. The first 4X computer games were turn-based, but real-time 4X games are common. Many 4X computer games were published in the mid-1990s, but were later outsold by other types of strategy games. Sid Meier's "Civilization" is an important example from this formative era, and popularized the level of detail that later became a staple of the genre. In the new millennium, several 4X releases have become critically and commercially successful.


title: 4X

text: In the board (and card) game domain, 4X is less of a distinct genre, in part because of the practical constraints of components and playing time. The "Civilization" board game that gave rise to Sid Meier's "Civilization" computer game, for instance, includes neither exploration nor extermination. Unless extermination is targeted at non-player entities, it tends to be either nearly impossible (because of play balance mechanisms, since player elimination is usually considered an undesirable feature) or certainly unachievable (because victory conditions are triggered before extermination can be completed) in board games.


title: 4X

text: The term "4X" originates from a 1993 preview of "Master of Orion" in "Computer Gaming World" by game writer Alan Emrich where he rated the game "XXXX" as a pun on the XXX rating for pornography. The four Xs were an abbreviation for "EXplore, EXpand, EXploit and EXterminate". By February 1994, another author in the magazine said that "Command Adventures: Starship" "only pays lip service to the four Xs", and other game commentators adopted the "4X" label to describe similar games.


title: 4X

text: These gameplay elements may happen in separate phases of gameplay, or may overlap with each other over varying lengths of game time depending on game design. For example, the "Space Empires" series and "" have a long expansion phase, because players must make large investments in research to explore and expand into all areas.


title: 4X

text: Emrich later expanded his concept for designing "Master of Orion 3" with a fifth X, eXperience, an aspect that came with the subject matter of the game.


title: 4X

text: In modern-day usage, 4X games are different from other strategy games such as" Command & Conquer" by their greater complexity and scale, and their complex use of diplomacy.


title: 4X

text: Reviewers have also said that 4X games feature a range of diplomatic options, and that they are well known for their large detailed empires and complex gameplay. In particular, 4X games offer detailed control over an empire's economy, while other computer strategy games simplify this in favor of combat-focused gameplay.


title: 4X

text: 4X computer and board games are a subgenre of strategy games, and include both turn-based and real-time strategy titles. The gameplay involves building an empire, which takes place in a setting such as Earth, a fantasy world, or in space. Each player takes control of a different civilization or race with unique characteristics and strengths. Most 4X games represent these racial differences with a collection of economic and military bonuses.


title: 4X

text: 4X games typically feature a technology tree, which represents a series of advancements that players can unlock to gain new units, buildings, and other capabilities. Technology trees in 4X games are typically larger than in other strategy games, featuring a larger selection of different choices. Empires must generate research resources and invest them in new technology. In 4X games, the main prerequisite for researching an advanced technology is knowledge of earlier technology. This is in contrast to non-4X real-time strategy games, where technological progress is achieved by building structures that grant access to more advanced structures and units.


title: 4X

text: Research is important in 4X games because technological progress is an engine for conquest. Battles are often won by superior military technology or greater numbers, with battle tactics playing a smaller part. In contrast, military upgrades in non-4X games are sometimes small enough that technologically basic units remain important throughout the game.


title: 4X

text: Combat is an important part of 4X gameplay, because 4X games allow a player to win by exterminating all rival players, or by conquering a threshold amount of the game's universe. Some 4X games, such as "Galactic Civilizations", resolve battles automatically, whenever two units from warring sides meet. This is in contrast to other 4X games, such as "Master of Orion", that allow players to manage battles on a tactical battle screen. Even in 4X games with more detailed control over battles, victory is usually determined by superior numbers and technology, with battle tactics playing a smaller part. 4X games differ from other combat-focused strategy games by putting more emphasis on research and economics. Researching new technology will grant access to new combat units. Some 4X games even allow players to research different unit components. This is more typical of space 4X games, where players may assemble a ship from a variety of engines, shields, and weaponry.


title: 4X

text: 4X games allow rival players to engage in diplomacy. While some strategy games may offer shared victory and team play, diplomatic relations tend to be restricted to a binary choice between an ally or enemy. 4X games often allow more complex diplomatic relations between competitors who are not on the same team. Aside from making allies and enemies, players are also able to trade resources and information with rivals.


title: 4X

text: In addition to victory through conquest, 4X games offer peaceful victory conditions or goals that involve no extermination of rival players (although war may still be a necessary by-product of reaching said goal). For example, a 4X game may offer victory to a player who achieves a certain score or the highest score after a certain number of turns. Many 4X games award victory to the first player to master an advanced technology, accumulate a large amount of culture, or complete an awe-inspiring achievement. Several 4X games award "diplomatic victory" to anyone who can win an election decided by their rival players, or maintain peace for a specified number of turns.


title: 4X

text: Galactic Civilizations has a diplomatic victory which involves having alliances with at least four factions, with no factions outside of one's alliance; there are two ways to accomplish this: ally with all factions, or ally with at least the minimum number of factions and destroy the rest.


title: 4X

text: 4X games are known for their complex gameplay and strategic depth. Gameplay usually takes priority over elaborate graphics. Whereas other strategy games focus on combat, 4X games also offer more detailed control over diplomacy, economics, and research; creating opportunities for diverse strategies. This also challenges the player to manage several strategies simultaneously, and plan for long-term objectives.


title: 4X

text: To experience a detailed model of a large empire, 4X games are designed with a complex set of game rules. For example, the player's productivity may be limited by pollution. Players may need to balance a budget, such as managing debt, or paying down maintenance costs. 4X games often model political challenges such as civil disorder, or a senate that can oust the player's political party or force them to make peace.


title: 4X

text: Such complexity requires players to manage a larger amount of information than other strategy games. Game designers often organize empire management into different interface screens and modes, such as a separate screen for diplomacy, managing individual settlements, and managing battle tactics. Sometimes systems are intricate enough to resemble a minigame. This is in contrast to most real-time strategy games. "Dune II", which arguably established the conventions for the real-time strategy genre, was fundamentally designed to be a "flat interface", with no additional screens.


title: 4X

text: Since 4X games involve managing a large, detailed empire, game sessions usually last longer than other strategy games. Game sessions may require several hours of play-time, which can be particularly problematic for multiplayer matches. For example, a small-scale game in "Sins of a Solar Empire" can last longer than twelve hours. However, fans of the genre often expect and embrace these long game sessions; Emrich wrote that "when the various parts are properly designed, other X's seem to follow. Words like EXcite, EXperiment and EXcuses (to one's significant others)". Turn-based 4X games typically divide these sessions into hundreds of turns of gameplay.


title: 4X

text: Because of repetitive actions and long-playing times, 4X games have been criticized for excessive micromanagement. In early stages of a game this is usually not a problem, but later in a game directing an empire's numerous settlements can demand several minutes to play a single turn. This increases playing-times, which are a particular burden in multiplayer games. 4X games began to offer AI governors that automate the micromanagement of a colony's build orders, but players criticized these governors for making poor decisions. In response, developers have tried other approaches to reduce micromanagement, and some approaches have been more well received than others. Commentators generally agree that "Galactic Civilizations" succeeds, which GamingNexus.com attributes to the game's use of programmable governors. "Sins of a Solar Empire" was designed to reduce the incentives for micromanagement, and reviewers found that the game's interface made empire management more elegant. On the other hand, "Master of Orion III" reduced micromanagement by limiting complete player control over their empire.


title: 4X

text: Most 4X and similar strategy games feature multiple possible ways to win the game. For example, in "Civilization", players may win through total domination of all opposing players by conquest of their cities, but may also win through technological achievements (being the first to launch a spacecraft to a new planet), diplomacy (achieving peace agreements with all other nations), or other means. Multiple victory conditions help to support the human player who may have to shift strategies as the game progresses and opponents secure key resources before the player can. However, these multiple conditions can also give the computer-controlled opponents multiple pathways to potentially outwit the player, who is generally going to be over-powered in certain areas over the computer opponents. A component of the late-game design in 4X games is forcing the player to commit to a specific victory condition by making the cost and resources required to secure it so great that other possible victory conditions may need to be passed over.