text: Intrigued by the alchemy used by the criminal and his connection with Julia, the Elrics board a train to Table City to investigate further, but the train is attacked by an unknown individual who transforms into a wolf-chimera and takes control of the locomotive. While trying to retake the train's control from the Wolf-Chimera, flying soldiers called the Black Bats attack the train, attempting to rescue what they think are ordinary citizens, but they fall back after finding out the prisoners were Amestrians posing as prisoners as a trap. Meanwhile, Melvin finds his opportunity and escapes, followed after by the Elric Brothers. Ed and Al arrive at a prison, where Melvin destroyed the prison walls to find Julia. Melvin attempts to retrieve Julia, but is interrupted by Miranda, the leader of the Black Bats, who tries to rescue Julia as well. Ed then challenges Melvin while Alphonse goes to save Julia. She and he fall into a village in a vast chasm (The Valley) that surrounds Table City, where Melvin follows and reveals his true identity as Julia's brother, Ashleigh Crichton. Ed then ventures down to The Valley in search of Alphonse, where he learns that Table City was originally the Hill of Milos, until Creta and later Amestris invaded the city and occupied it, forcing the Milosians to live in The Valley, in poverty.


title: Fullmetal Alchemist: The Sacred Star of Milos

text: Inside the Black Bats' secret base, Julia and Alphonse develop a friendship while Julia learns about Al and Ed's tragic past of human transmutation. Later, when Ed meets up with Al in the Black Bats base, they find themselves hunted down by wolf chimeras from the Cretan secret police dispatched by Colonel Herschel, the Cretan commander of the area, prompting them to retreat further. They and the Elrics arrive in a room with maps and locations of Table City, where Miranda explains to the Elrics their mission: to reclaim Milos by using the Sanguine Star to control a powerful heat source called Magma. Miranda also explains that the Sanguine Star was a 'red glowing stone of power'. Shocked by the description, the Elrics reveal that the Star might be a Philosopher's Stone, which requires human sacrifice to create. Though shocked at the revelation, Julia is determined to do anything to secure the Milosians' freedom, and Ashleigh agrees to help her.


text: Wanting to avoid a bloody war, Ed and Al return to Table City in an attempt to find the Star and destroy it. Later that night, the Black Bats begin their assault on Table City. Miranda, Ashleigh, and Julia then venture to the main tower, where, suddenly, Ashleigh fatally injures Miranda and explains to Julia that the use of Miranda's blood activates a three dimensional transmutation circle drawn in blood to create the Sanguine Star. Julia then realizes that he is an impostor, Security Chief Atlas, who was enveloped by alchemy's potential of creation and power and killed Julia's parents for it. He explains that he tore off the real Ashleigh's face and the skin from his lower left side to deceive Julia and create the Star. Ed and Al arrive to rescue Julia and confront Atlas, who escapes to the location of the Star. As Ed, Al, and Julia chase after Atlas, Herschel detonates a Cretan thermal power plant, pouring out a massive amount of lava towards the Valley. Al goes to help save the valley while Ed and Julia go after Atlas. Atlas nearly attempts to retrieve the Star, only to be confronted by Ed and Julia. Julia retrieves the star and decides to save the Valley by swallowing it to use its power.


text: Meanwhile, Alphonse's attempt to stop the lava are futile until Julia arrives to help him stop the lava. Atlas arrives to take back the Star, only to be confronted by Colonel Herschel, who reveals himself to be the real Ashleigh Crichton. He survived by swallowing a Star and using its power to heal his wounds. Ashleigh then kills Atlas in revenge for the death of his parents. Confirming his identity to Julia while apologizing for leaving her alone for so long to keep her safe from Atlas, Ashleigh tells Julia to come with him to Creta so they can make a world that no one had ever seen before. Julia refuses and decides to fight her brother, with Ed and Mustang arriving to provide assistance. Julia ends the fight by destroying one of Ashleigh's arms. Then, together with Ed and Al, she manages to stop the flow of magma into the Valley. With the Valley safe, Julia uses the rest of her power to heal Ashleigh, restoring his face and saving his life. However, both Ashleigh and Julia's Stars disintegrate, and Julia sacrifices her left leg and glimpses the Gate of Truth. Meanwhile, on the Cretan side of the border, Milosian resistance fighters seize Creta's main base and declare independence. Without Colonel Herschel to lead them, the Cretan forces retreat.


text: The next morning, Ashleigh wakes up in a hospital bed alongside Julia and is surprised to find his face restored. When Julia wakes up, she is informed that Ashleigh had already left, and is given an automail leg. She then meets Ed and Al as they prepare to leave Table City. Ed chastises Julia, saying that her decision to use the Star was wrong, but he doesn't think she's a bad person. Al promises to Julia that after he and his brother get their bodies back, they will be sure to visit. Julia tells them she will be waiting, as she must stay to lead the Milosians and preserve their newfound independence. Meanwhile, Ashleigh is seen donning his Cretan uniform and returning to Creta. Ed and Al then board a train to Central and take one last look at Table City before leaving.


text: The idea to create a "Fullmetal Alchemist" movie set during the second anime's storyline came from the series's producers. The movie's original plot was written by Yuichi Shinbo who also came up with the new characters' names. From there, director Kazuya Murata did research on Spain to develop Table City, intended as a contrast to Amestris, which was based on Germany. Because it was the only time in the series that the main characters traveled to another country, Murata had difficulties concluding it, wondering if it would affect the overarching storyline. Therefore, the story was set during the time Edward realized Alphonse's human body existed somewhere, with the logic that knowledge would encourage him to travel to another area to do research. (This likely places the events of the film somewhere around episode 21 of "Brotherhood". Alphonse has learned to transmute with only his hands, but Mustang's subordinates have not yet been split up, definitively placing it somewhere between episodes 15 and 24.) Hiromu Arakawa was not included as part of the staff but was still looking forward to the film.


text: The official theme song for the movie is "Good Luck My Way" by L'Arc-en-Ciel, which plays over the film's ending credits. The song is the band's fourth contribution to the franchise. On May 30, 2011, singer-songwriter miwa confirmed that she would sing for the opening credits theme, titled "Chasing Hearts".


text: To mark the July 2 opening of the "Fullmetal Alchemist: The Sacred Star of Milos" film, the Pia Eiga Seikatsu website posted an exclusive video "interview" with the stars of the film, Edward and Alphonse Elric (as voiced by Romi Park and Rie Kugimiya, respectively). In keeping with the spirit of Hiromu Arakawa's original manga and the two anime television series, the interviewer has trouble early on in figuring out who the "Fullmetal Alchemist" is. (The interview has cameos by the other stars of the anime.) Also includes 3 "Study" sessions with "Professor" Mustang, teaching Winry and Hawkeye about Creta and Milos.


text: In its first weekend, "Fullmetal Alchemist: The Sacred Star of Milos" earned $1,791,646 despite being exhibited in only 90 screens across Japan, ranking #4 in overall revenue. The film went on to gross $7,401,480 in Japan by the end of 2011. The film also grossed $177,802 in the United States in 2012, bringing the film's total gross to $7,579,282.


text: The film debuted in North America at the 2011 anime convention Otakon held at the Baltimore Convention Center on July 30. Funimation, in coordination with Aniplex, subtitled the film and held the premiere it the United States only four weeks after the theatrical release in Japan. Funimation licensed the film for the North American market and subsequently provided a limited theatrical release in the United States in early 2012; a home-video release on DVD and Blu-Ray followed. The film won three awards at the Burbank International Film Festival, which hosted the West Coast premiere of the film. It won awards for each of the three categories it was nominated in.


text: Reception from American critics has been generally positive. Based on reviews on review aggregator website Rotten Tomatoes, of critics have given the film a positive review, with an average rating of . It also received a weighted average score of 54 out of 100 on Metacritic based on 7 critics, denoting "mixed or average reviews".


title: Honda CR-V (third generation)

text: The third generation Honda CR-V was launched for the 2007 model year. It went on sale in the U.S. during late September 2006. Unlike preceding models, it features a rear liftgate rather than a side-opening rear door and no longer has the spare tire mounted on the rear door. The new CR-V is lower, wider and shorter than the previous models; the length decrease is attributed mostly to the fact that the spare wheel no longer adds length to the back of the vehicle. A lowering of the center of gravity is another benefit of the spare wheel being located underneath the rear cargo area. The center rear seat pass-through was also introduced as a new feature on the third generation.


title: Honda CR-V (third generation)

text: The third generation CR-V is powered by the latest version of Honda's standard K-series 2.4 L inline-four engine, similar variants were also found in the Honda Accord and Honda Element. In North American markets, this engine's power is rated at at 5,800 rpm and at 4,200 rpm. A 2.2 L i-CTDI diesel engine was offered in the European and Asian markets. The European market CR-V had the R20A 2.0 L petrol engine, based on the Honda R-series i-VTEC SOHC engine found in the Honda Civic, as opposed to the previous CR-V offering the K20A.


title: Honda CR-V (third generation)

text: Honda offered an integrated Navigation option on the EX-L model. The navigation unit was made for Honda by Alpine and includes voice activated control, XM radio in the US and Canada, and an in-dash CD player that can play MP3 and Windows Media Audio. The media offerings also included a six-disc CD changer in the center console and a PC Card (PCMCIA) slot in the Navigation unit for flash memory MP3 or WMA files. A second CD player is positioned behind the navigation screen, which plays MP3/WMA CDs. A rear backup camera was also included.


title: Honda CR-V (third generation)

text: An iPod adapter was to be an available option on US models, but was only available as an add-on accessory. All CR-V models retained the auxiliary audio input jack, which is either on the head unit itself (LX), on the central tray (EX) or inside the center console (all versions of the EX-L, with or without navigation).


title: Honda CR-V (third generation)

text: For 2007, Honda CR-V became one of the ten best selling vehicles of the year. It overtook Ford Explorer, which had held the title for fifteen years (1991–2006), to be the best selling SUV in the US. In Canada, the CR-V was the second best selling SUV in 2007, behind the Ford Escape.


title: Honda CR-V (third generation)

text: To meet demand, Honda shifted some Civic production from East Liberty, Ohio to Alliston Plant #2, Ontario (where some Pilot, Ridgeline and Odyssey production was located until production was consolidated at Honda's Lincoln, Alabama facility) to free up space for additional CR-V production. Currently, the East Liberty plant is building 400 CR-V models a day for the Canadian and US markets. The U.S. market CR-V models are imported primarily from Sayama, Saitama, Japan and El Salto, Jalisco, Mexico in increasing numbers. In 2008, CR-V continued to be top ten bestseller and best selling SUV of the year in the U.S. Since its introduction in 1997, there were more than 215,000 CR-V sold in Canada.


title: Honda CR-V (third generation)

text: All models came standard with Vehicle Stability Assist. The Honda CR-V was rated "good" in frontal and side-impact crash tests by the IIHS. However it was rated "marginal" in the roof strength test. An analysis conducted by the IIHS and released in June 2011, found that the 2007-08 MY CR-V had the lowest fatality rate in its class and among the lowest fatality rates among all vehicles.


title: Honda CR-V (third generation)

text: Since the introduction of a newer, five-speed automatic transmission, which sports a higher MPG rating and smoother shifting, the manual transmission was dropped from the US market. Fuel economy ratings from the EPA are city, highway. "Consumer Reports" rates fuel economy as city, highway.


title: Honda CR-V (third generation)

text: For the 2010 model year, the CR-V received style, powertrain and equipment changes. The exterior changes included a redesigned front fascia with a new horizontal-slat chrome grille and honeycomb-designed lower front grille, new front bumper, and revised tail lights. The rear bumper was redesigned, as well as new five split-spoke 17-inch alloy wheels for EX and EX-L models. The interior received minor changes, including seat fabrics, as well as wider driver and front-passenger armrests. The audio head unit controls were altered and the information display backlighting in the gauges was changed to blue, instead of the previous black. A USB audio input became standard in the EX-L trim while hands-free Bluetooth connectivity was exclusive to the EX-L trim equipped with navigation system. In 2011, a mid-level SE trim debuted with a 6-disc CD changer and 17-inch 7-spoke alloy wheels that came from the pre-facelift EX and EX-L trims.


title: Honda CR-V (third generation)

text: Power was increased from for 2010 and mileage improved by 1 mpg for both front-wheel and all-wheel drive models. The EPA ratings were / city/highway and / city/highway respectively. Recommended oil weight changed from 5W-20 to 0W-20 from previous years with a change to the K24Z6 engine.


title: Honda CR-V (third generation)

text: The 2010 Honda CR-V is nearly the same as the US model, but is provided with side-mirror turning signals. It is available in 4x4 (2.4 L) and 4x2 (2.0 L), the former having a five-speed automatic gearbox as standard. The top of the range 2.4 L 4x4 comes with leather upholstery and HID headlamps. All models have rear parking sensors as standard, but no sunroof or GPS fourth generation.


title: Honda CR-V (third generation)

text: The Honda CR-V has 4 trim levels: 2.0S (2WD), 2.0E (4WD), 2.4EL (2WD) and 2.4EL (4WD). All versions come with a 5-speed automatic transmission. Navigator, DVD and rear-view camera are standard equipment for 2.4EL (2WD) and 2.4EL (4WD) versions. The version with 2.0 engine has 150 Hps at 6200 rpms, while the version with 2.4 engine has 170 Hps at 5800 rpms.


title: Honda CR-V (third generation)

text: There were three variants of the Honda CR-V in this market: 2.0L M/T, 2.0L A/T and 2.4L A/T. The 2.4L A/T comes standard with single electric driver seat, dual automatic climate control, five-spoke rims, different level of interior trims and touch-screen enabled stereo system. All versions use a front-wheel drive configuration. In February 2010, the third-generation Honda CR-V was updated with new front grille and minor interior trims.


title: Honda CR-V (third generation)

text: In 2007, Honda Malaysia launched the third generation Honda CR-V that has only one variant 2.0L A/T (4WD) i-VTEC SOHC with a 5-speed automatic gearbox featuring 2 overdrive gears for better fuel economy during high speed cruising. This version 2.0L A/T (4WD) i-VTEC SOHC has 150 PS at 6,200rpm and a maximum torque of 190Nm at 4,200rpm. This CR-V come with dual i-SRS front airbags, rear parking sensors, active headrests, anti-lock brakes, electronic brake distribution and electric power steering. There is also ample trim level (17-inch alloy wheels), including cruise control, dual zone climate control, a 6-disc in-dash changer with MP3 and aux input, and steering wheel-mounted audio controls, however the seats are fabric, not leather. The Standard package includes a front aero bumper, rear aero bumper, tailgate spoiler, and a running board. The premium package includes a different tailgate spoiler, running board, and door visors. In early 2010, Honda CR-V Facelift officially launched with the one new colour call called Urban Titanium and new redesigned hood, sportier front bumper with fog lights, front grille, rear bumper with lens reflectors and new alloy wheels design (17-inch alloy wheels).This CR-V come with new fabric on the seats, a redesigned climate control knob, wider armrest on the front seats, and a new audio head unit with USB interface and in-dash 6 discs. This CR-V come with new features like Vehicle Stability Assist (VSA) and Dual side airbags with OPDS. This CR-V uses the efficient 150PS and a maximum torque of 190Nm with 2.0L A/T i-VTEC SOHC engine (R20A) mated with 5-Speed Automatic Transmission, Real-Time 4WD, rear parking sensors and Rack and Pinion (Electric Power Steering). One year after the launch of the new Honda CR-V facelift, Honda Malaysia launched the Honda CR-V “Limited” edition which is more expensive than the regular 2.0 i-VTEC CR-V but still uses the same 2.0L i-VTEC engine.


title: Honda CR-V (third generation)

text: The CR-V facelift made available to European markets (as well as South Africa) features new added luxuries not previously seen before, and not available to Japanese, Asian or American markets. Xenon (HID) headlights are available for the first time, as are 18-inch alloy wheels (19-inch optional), GPS/DVD navigation system and a premium sound system with USB audio input. A panoramic glass moonroof is standard on upper spec models and all models feature chrome exterior door handles. Externally, the vehicle also features complete body color-coding, on all lower body plastic cladding (models sold elsewhere in the world feature dark grey plastic lower cladding).


title: Honda CR-V (third generation)

text: The 2.2 L i-CTDI N22A turbo diesel engine was discontinued and replaced by the 2.2 L i-DTEC N22B engine, increasing power output to 150 PS and meeting Euro 5 emission standards.


title: Honda CR-V (third generation)

text: In Brazil, the third generation CR-V was sold (imported from Mexico) with a 2.0-liter, i-VTEC engine instead of the 2.4-liter used in other countries. The reason is that in Brazil the tax is higher for engines above 2.0 liters. The Honda Accord sold in Brazil had the same 2.0-liter engine.


title: Honda CR-V (third generation)

text: In Peru, the CR-V has different trim levels. The two most equipped ones are the Deluxe and the Platinum. These two, in contrast with the models sold in the US feature chrome door handles and HID headlamps. The Platinum version also comes with rear parking sensors and 18-inch alloy wheels. It does not feature heated front seats because it is considered unnecessary due to the type of climate in Peru. There is no trim level featuring GPS. Trim levels are 4x2-L, LX 4x4, EX 4x4, Deluxe, 4x4, Top and Platinum.


title: Cochise County, Arizona

text: Cochise County () is a county in the southeastern corner of the U.S. state of Arizona. It is named after the Native American chief Cochise.


title: Cochise County, Arizona

text: The population was 125,447 at the 2020 census. The county seat is Bisbee and the most populous city is Sierra Vista.


title: Cochise County, Arizona

text: Cochise County includes the Sierra Vista-Douglas, Arizona Metropolitan Statistical Area. The county borders southwestern New Mexico and the northwestern Mexican state of Sonora.


title: Cochise County, Arizona

text: In 1528 Spanish Explorers: Álvar Núñez Cabeza de Vaca, Estevanico, and Fray Marcos de Niza survived a shipwreck off the Texas coast. Captured by Native Americans, they spent eight years finding their way back to Mexico City, via the San Pedro Valley. Their journals, maps, and stories led to the Cibola, seven cities of gold myth. The Expedition of Francisco Vásquez de Coronado in 1539 using it as his route north through what they called the Guachuca Mountains of Pima (Tohono O'odham) lands and later part of the mission routes north, but was actually occupied by the Sobaipuri descendants of the Hohokam. They found a large Pueblo (described as a small city) between present-day Benson and Whetstone, and several smaller satellite villages and smaller pueblos including ones on Fort Huachuca, Huachuca City and North Eastern Fry. About 1657 Father Kino visited the Sobaipuris just before the Apache forced most from the valley, as they were struggling to survive due to increasing Chiricahua Apache attacks as they moved into the area of Texas Canyon of the Dragoon Mountains. In 1775, Presidio Santa Cruz de Terrenate was founded on the west bank of the San Pedro River to protect the natives as well as the Spanish settlers who supplied the mission stations. The presidio was chronically short on provisions due to raids, however, and lacked personnel to adequately patrol the eastern route due to wars with France and England, so the main route north shifted west to the Santa Cruz valley, farther from the range of the Chiricahua Apache who almost exclusively controlled the area by 1821.


title: Cochise County, Arizona

text: Cochise County was created on February 1, 1881, out of the eastern portion of Pima County. It took its name from the legendary Chiricahua Apache war chief Cochise. The county seat was Tombstone until 1929 when it moved to Bisbee. Notable men who once held the position of County Sheriff were Johnny Behan, who served as the first sheriff of the new county, and who was one of the main characters during the events leading to and following the Gunfight at the O.K. Corral. Later, in 1886, Texas John Slaughter became sheriff. Lawman Jeff Milton and lawman/outlaw Burt Alvord both served as deputies under Slaughter.


title: Cochise County, Arizona

text: A syndicated television series which aired from 1956 to 1958, "Sheriff of Cochise" starring John Bromfield, was filmed in Bisbee. The Jimmy Stewart movie "Broken Arrow" and subsequent television show of the same name starring John Lupton, which also aired from 1956 to 1958, took place (but was not filmed) in Cochise County.


title: Cochise County, Arizona

text: J.A. Jance's Joanna Brady mystery series takes place in Cochise County, with Brady being the sheriff.


title: Cochise County, Arizona

text: Beginning in the late 1950s, the small community of Miracle Valley was the site of a series of bible colleges and similar religious organizations, founded by television evangelist A. A. Allen. In 1982, Miracle Valley and neighboring Palominas were the site of a series of escalating conflicts between a newly arrived black religious community and the county sheriff and deputies that culminated in the Miracle Valley shootout.


title: Cochise County, Arizona

text: According to the United States Census Bureau, the county has a total area of , of which is land and (0.9%) is water. Cochise County is close to the size of the states of Rhode Island and Connecticut combined.


title: Cochise County, Arizona

text: As of the census of 2000, there were 117,755 people, 43,893 households, and 30,768 families residing in the county. The population density was 19 people per square mile (7/km). There were 51,126 housing units at an average density of 8 per square mile (3/km). The racial makeup of the county was 76.7% White, 4.5% Black or African American, 1.2% Native American, 1.7% Asian, 0.3% Pacific Islander, 12.1% from other races, and 3.7% from two or more races. 30.7% of the population were Hispanic or Latino of any race. 25.4% reported speaking Spanish at home, while 1.3% speak German .


title: Cochise County, Arizona

text: There were 43,893 households, out of which 32.0% had children under the age of 18 living with them, 55.1% were married couples living together, 11.1% had a female householder with no husband present, and 29.9% were non-families. 25.3% of all households were made up of individuals, and 10.1% had someone living alone who was 65 years of age or older. The average household size was 2.55 and the average family size was 3.07.


title: Cochise County, Arizona

text: In the county, the population was spread out, with 26.3% under the age of 18, 9.3% from 18 to 24, 26.0% from 25 to 44, 23.7% from 45 to 64, and 14.7% who were 65 years of age or older. The median age was 37 years. For every 100 females there were 101.60 males. For every 100 females age 18 and over, there were 101.20 males.


title: Cochise County, Arizona

text: The median income for a household in the county was $32,105, and the median income for a family was $38,005. Males had a median income of $30,533 versus $22,252 for females. The per capita income for the county was $15,988. About 13.5% of families and 17.7% of the population were below the poverty line, including 25.8% of those under age 18 and 10.4% of those age 65 or over.


title: Cochise County, Arizona

text: In 2000, the largest denominational group was the Catholics (with 25,837 adherents) and Evangelical Protestants (with 12,548 adherents). The largest religious bodies were The Catholic Church (with 25,837 members) and The Southern Baptist Convention (with 5,999 members).


title: Cochise County, Arizona

text: As of the census of 2010, there were 131,346 people, 50,865 households, and 33,653 families residing in the county. The population density was . There were 59,041 housing units at an average density of . The racial makeup of the county was 78.5% white, 4.2% black or African American, 1.9% Asian, 1.2% American Indian, 0.3% Pacific islander, 9.9% from other races, and 4.0% from two or more races. Those of Hispanic or Latino origin made up 32.4% of the population. The largest ancestry groups were:


title: Cochise County, Arizona

text: Of the 50,865 households, 30.4% had children under the age of 18 living with them, 50.0% were married couples living together, 11.5% had a female householder with no husband present, 33.8% were non-families, and 28.2% of all households were made up of individuals. The average household size was 2.46 and the average family size was 3.02. The median age was 39.7 years.


title: Cochise County, Arizona

text: The median income for a household in the county was $44,876 and the median income for a family was $53,077. Males had a median income of $42,164 versus $31,019 for females. The per capita income for the county was $23,010. About 11.8% of families and 15.7% of the population were below the poverty line, including 23.2% of those under age 18 and 10.7% of those age 65 or over.


title: Cochise County, Arizona

text: Cochise County leans strongly towards the Republican Party in presidential elections. Although Bill Clinton carried the county narrowly in 1992, it has supported the Republican nominee by large margins in every other election since 1968, except for 1996 and 1976 when Clinton and Jimmy Carter each lost only narrowly. Although the county includes the relatively liberal town of Bisbee, as well as the city of Douglas which has a large Latino population, this is outweighed by the heavily Republican tilt of the more populous Sierra Vista, which is adjacent to Fort Huachuca and thus has a heavy military presence.


title: Cochise County, Arizona

text: In the United States House of Representatives, the county is part of Arizona's 2nd congressional district, which is represented by Democrat Ann Kirkpatrick; the majority of the district's population is in Tucson and its suburbs, which are far more liberal than Cochise County. In the Arizona Legislature, the county is part of the 14th district and is represented by Republican David Gowan in the State Senate and Republicans Gail Griffin and Becky Nutt in the State House of Representatives. This district also includes the entirety of Graham County and Greenlee County, as well as portions of Pima County.


title: Cochise County, Arizona

text: Bisbee Municipal Airport is owned by the City of Bisbee and located five nautical miles (9 km) southeast of its central business district


title: Cochise County, Arizona

text: Sierra Vista Municipal Airport (IATA: FHU, ICAO: KFHU, FAA LID: FHU), a joint-use civil-military airport which shares facilities with Libby Army Airfield, is located on the U.S. Army installation Fort Huachuca in the city of Sierra Vista. The airport has three runways and one helipad. It is mostly used for military aviation for the surrounding military base.


title: Cochise County, Arizona

text: There are no commercial flights out of Cochise County; the nearest commercial airport is at Tucson, approximately 70 miles from Sierra Vista.


title: Cochise County, Arizona

text: The Rucker Elementary School district, in 2002, operated no schools and sent its elementary students to the Elfrida district. The Rucker district had a bus driver and an administrator as employees. The residents liked the arrangement as they could pay less tax.


title: Princess Bubblegum

text: Princess Bonnibel Bubblegum (also called Bonnie or PB, occasionally P-bubs), is a fictional character in the American animated television series "Adventure Time", created by Pendleton Ward. She is voiced by Hynden Walch.


title: Princess Bubblegum

text: Princess Bubblegum rules the Candy Kingdom, which other "Candy People" inhabit. She is good friends with the series' protagonists Finn the Human and Jake the Dog, first appearing with them in Ward's 2008 pilot. Bonnie's sexuality has not been officially confirmed. Reviewers have argued that she is either bisexual, non-binary, queer, lesbian, or a combination of some of the latter, as both live in a world where "sexuality is somewhat fluid." In the series finale of "Adventure Time", "Come Along with Me", Bonnie and Marcy shared on-screen kiss, confirming their relationship.


title: Princess Bubblegum

text: Bubblegum is typically very kind and compassionate, having a strong sense of justice, though she shows a dark side when provoked. She is brilliant, responsible for creating the Candy People and various devices, including a miniature time machine. She is fluent in German and Korean, using the latter language to communicate with her friend Lady Rainicorn. Bubblegum is skeptical of magic, refusing to acknowledge it as anything other than “scientific principles presented like mystical hoodoo.”


title: Princess Bubblegum

text: Bubblegum is highly protective of the Candy People and cares deeply for their safety, but is secretly strained by the pressures of ruling and expresses a desire for freedom. Following a near-death experience at the end of the second season, she starts to isolate herself and becomes overprotective of the Candy People, even exhibiting authoritarian tendencies temporarily in the fifth season. At the end of the sixth season, Bubblegum is deposed as ruler following an election, where she realizes she has made the Candy People too unintelligent. Following the miniseries "Stakes", Bubblegum is reinstated as ruler and becomes less overprotective.


title: Princess Bubblegum

text: Bubblegum has light pink skin and long magenta "hair," which is bubblegum. Her usual outfit is a puffy-sleeved pink gown with purple trim. Among many other outfits, she often wears a lab coat and glasses during science experiments.


title: Princess Bubblegum

text: Being made of candy, Bubblegum can deform and reform her biomass, through which she can regain lost body parts and fluctuate her biological age. She usually appears bodily to be eighteen years old, though her actual age is given as 827; she was born hundreds of years before the events of the series from a gum-like ooze, the "Mother Gum." Bubblegum temporarily becomes thirteen years old in the second season due to losing too much biomass after being attacked by the Lich.


title: Princess Bubblegum

text: In the seventh season, Bubblegum discovers that she is an incarnation of the "Candy Elemental," the living embodiment of candy as one of the "Adventure Time" universe's four classical elements (fire, ice, candy, and slime). Like the Elemental, she can materialize various quantities of candy through her hands and communicate with past incarnations of the Elemental. When Bubblegum's elemental powers consume her in the miniseries "Elements", she becomes psychically connected to all candy in the universe. She can transform others into candy, upon which they lose the memory of their life before their transformation.


title: Princess Bubblegum

text: Bubblegum is close friends with Finn and Jake, with Jake occasionally being referred to as Bubblegum's "knight". Finn has a crush on Bubblegum in early episodes, often saving her from Ice King, though he eventually realizes she is too old for him and that she sees him like a little brother. Finn is implied to have some residual feelings for a time afterwards, over which his lack of closure causes some conflict as he starts a romantic relationship with Flame Princess. Bubblegum frequently tasks Finn and Jake with quests in service of the Candy Kingdom, and is often seen socializing with them in a more casual way. Finn refers to Bubblegum as one of his "best friends in the world".


title: Princess Bubblegum

text: Bubblegum has a strong bond and complicated history with Marceline. Though they are initially shown as hostile toward each other, they are implied to have a past romantic relationship in the third season. This history was later confirmed off-screen by Olivia Olson, Marceline's voice actress. In the episode "What Was Missing", Bubblegum's most prized possession is revealed to be a t-shirt given to her by Marceline, a fact of which Marceline had been unaware. Bubblegum eventually trades the shirt for Marceline's beloved childhood toy, Hambo, in the episode "Sky Witch". In the season seven episode "Varmints", Bubblegum and Marceline reminisce about a past in which they would hang out and go on adventures together with more freedom, which they had eventually stopped doing. Bubblegum opens up to Marceline about the stress of her building responsibilities and laments that her obsession with work had previously caused her to push Marceline away. They are shown as close and amicable throughout most of the series, despite their personalities often being at odds. By the time of the season seven miniseries "Stakes", Bubblegum refers to Marceline as her "best friend", and expresses happiness when Marceline says that they will get to "hang out forever". In the final episode, they share a kiss after Marceline saves Bubblegum from GOLB, and are shown in a relationship in the epilogue. In "", the episode "Obsidian" focuses on the two's romantic relationship. It is confirmed that they were previously exes during the time of the main series, and several years after they are still together and live in Marceline's cave. The episode contains a love song titled "Monster" from Marceline to Bubblegum.


title: Princess Bubblegum

text: While Bubblegum seems to have dated a male character named Mr. Cream Puff, her exact sexuality, unlike Marceline's, has not been confirmed. As such, reviewers have argued she is either bisexual, non-binary, queer, lesbian, or a combination of the previously mentioned, as both live in a world where "sexuality is somewhat fluid."


title: Princess Bubblegum

text: Ice King has a strange fascination with Bubblegum and she is often the target of his kidnapping schemes and romantic advances; it is revealed that she reminds him of his fiancée Betty, whom he often referred to as his "princess." Bubblegum is frequently seen in the company of her close companion, Lady Rainicorn. Bubblegum is frequently depicted riding on Lady Rainicorn's back, and the two have a strong trust in each other. Bubblegum has a younger brother named Neddy, a "candy dragon" spawned alongside her from the Mother Gum. Neddy lives underneath the Candy Kingdom, where Bubblegum keeps him isolated, as he is very easily frightened. Bubblegum is highly protective of Neddy as she is with the other Candy People, claiming that Neddy is merely "built different... we just need to respect it". Most if not all citizens of the Candy Kingdom were created by Bubblegum. In "Bonny and Neddy", Bubblegum states that creating the Candy People was one of the first things she did after ensuring Neddy's safety, and that she had missed the experience of being surrounded by others as she had been before leaving the Mother Gum. Due to their easily scared and childlike nature, Bubblegum's relationship with her citizens is equal parts ruler and caretaker, something which occasionally leads to exasperation on the monarch's part. In an early episode it shows Bubblegum interacting with a leaf bunny, Anna (Anna Spurrier) who was a childhood friend of Jake the Dog, they became friend's in trying to help jake, although Anna mysteriously went missing and was never referenced by Bubblegum again. Bubblegum's first creation was her "Uncle" Gumbald, whom she created after feeling lonely and desiring a companion. Gumbald originated the idea of a Candy Kingdom but became tyrannical and attempted to turn her into a simple-minded candy person using "dum-dum juice." Bubblegum shatters the bottle in his hand out of self-defense, and he turns into a candy person. Bubblegum also created an "Aunt" Lolly and a "Cousin" Chicle, who were also turned into Candy People by Gumbald. Bubblegum decides to become Princess of the Candy Kingdom and uses the "dum-dum juice" to bring the candy people to life. Near the end of the series, Gumbald, Lolly, and Chicle are returned to their prior forms and seek revenge on Bubblegum, though Gumbald and Chicle are turned back into Candy People. Lolly repents and reconciles with Bubblegum, helping her look after Neddy as seen in the epilogue. Bubblegum's other creations include the Earl of Lemongrab and two "candy sphinxes" named Goliad and Stormo.


title: Princess Bubblegum

text: A male counterpart of Bubblegum, Prince Gumball, exists in Ice King's "Fionna and Cake" stories. Princess Bubblegum enjoys science and talks to Lady Rainicorn in Korean. Prince Gumball is fond of baking. He has a friend named Lord Monochromicorn with whom he communicates using Morse code. Prince Gumball is voiced by Neil Patrick Harris.


title: Princess Bubblegum

text: Bubblegum's relationship with Marceline has generated some controversy. Olivia Olson, who provides the voice of Marceline, once Tweeted that Ward told her the two "dated", though she later Tweeted that "I like to make things up at panels. Ya'll take my stories way too seriously". A video produced by Frederator Studios to offer a "recap" of "Adventure Time" further implied that Bubblegum and Marceline were in a relationship; the video was removed from YouTube, inciting further controversy. "Bitch" magazine saw Frederator's action as detrimental toward the acceptance of homosexuality in children's television. Executive producer Fred Seibert later admitted that "we got wrapped up by both fan conjecture and spicy fanart and went a little too far" in making the video, which was meant to provide an outlet for input from fans. Ward admitted he did not "really want to comment on it [because] it was a big hullaballoo."


title: Grammar–translation method

text: The grammar–translation method is a method of teaching foreign languages derived from the classical (sometimes called traditional) method of teaching Ancient Greek and Latin. In grammar–translation classes, students learn grammatical rules and then apply those rules by translating sentences between the target language and the native language. Advanced students may be required to translate whole texts word-for-word. The method has two main goals: to enable students to read and translate literature written in the source language, and to further students' general intellectual development. It originated from the practice of teaching Latin; in the early 16th century, students learned Latin for communication, but after the language died out it was studied purely as an academic discipline. When teachers started teaching other foreign languages in the 19th century, they used the same translation-based approach as had been used for teaching Latin. The method has been criticized for its shortcomings.


title: Grammar–translation method

text: The overall concept of "grammar–translation" has been criticized since few verifiable sources support the existence of such a method until the 19th century.


title: Grammar–translation method

text: The grammar–translation method originated from the practice of teaching Latin. In the early 16th century, Latin was the most widely studied foreign language because of its prominence in government, academia and business. However, the use of Latin then dwindled and was gradually replaced by English, French and Italian. After the decline of Latin, the purpose of learning it in schools changed. Previously, students had learned Latin for the purpose of communication, but it came to be learned as a purely academic subject .


title: Grammar–translation method

text: Throughout Europe in the 18th and the 19th centuries, the education system was formed primarily around a concept called faculty psychology. The theory dictated that the body and mind were separate and the mind consisted of three parts: the will, emotion and intellect. It was believed that the intellect could eventually be sharpened enough to control the will and emotions by learning Greek and Roman classical literature and mathematics. Additionally, an adult with such an education was considered mentally prepared for the world and its challenges.


title: Grammar–translation method

text: At first, it was believed that teaching modern languages was not useful for the development of mental discipline and so they were left out of the curriculum. When modern languages began to appear in school curricula in the 19th century, teachers taught them with the same grammar–translation method as was used for Classical Latin and Ancient Greek in the 18th century. Textbooks were therefore essentially copied for the modern language classroom. In the United States, the basic foundations of the method were used in most high school and college foreign language classrooms.


title: Grammar–translation method

text: There are two main goals to grammar–translation classes. One is to develop students' reading ability to a level where they can read literature in the target language. The other is to develop students' general mental discipline.


title: Grammar–translation method

text: Users of foreign language want to note things of their interest in the literature of foreign languages. Therefore, this method focuses on reading and writing and has developed techniques which facilitate more or less the learning of reading and writing only. As a result, speaking and listening are overlooked.


title: Grammar–translation method

text: Grammar–translation classes are usually conducted in the students' native language. Grammatical rules are learned ; students learn grammar rules by rote, and then practice the rules by doing grammar drills and translating sentences to and from the target language. More attention is paid to the form of the sentences being translated than to their content. When students reach more advanced levels of achievement, they may translate entire texts from the target language. Tests often involve translating classical texts.


title: Grammar–translation method

text: There is usually no listening or speaking practice, and very little attention is placed on pronunciation or any communicative aspects of the language. The skill exercised is reading and then only in the context of translation.


title: Grammar–translation method

text: The mainstay of classroom materials for the grammar–translation method is textbooks, which, in the 19th century, attempted to codify the grammar of the target language into discrete rules that students were to learn and memorize. A chapter in typical grammar–translation textbooks would begin with a bilingual vocabulary list and then grammatical rules for students to study and sentences for them to translate. Some typical sentences from 19th-century textbooks are as follows:


title: Grammar–translation method

text: The method by definition has a very limited scope. Because speaking and any kind of spontaneous creative output were excluded from the curriculum, students would often fail at speaking or even letter-writing in the target language. A noteworthy quote describing the effect of the method comes from Bahlsen, a student of Plötz, a major proponent of this method in the 19th century. In commenting about writing letters or speaking he said he would be overcome with "a veritable forest of paragraphs, and an impenetrable thicket of grammatical rules".


title: Grammar–translation method

text: According to Richards and Rodgers, the grammar–translation has been rejected as a legitimate language teaching method by modern scholars:


title: Grammar–translation method

text: [T]hough it may be true to say that the Grammar-Translation Method is still widely practiced, it has no advocates. It is a method for which there is no theory. There is no literature that offers a rationale or justification for it or that attempts to relate it to issues in linguistics, psychology, or educational theory.


title: Grammar–translation method

text: The grammar–translation method was the standard way languages were taught in schools from the 17th to the 19th centuries. Despite attempts at reform from Roger Ascham, Montaigne, Comenius and John Locke, no other methods then gained any significant popularity.


title: Grammar–translation method

text: Later, theorists such as Viëtor, Passy, Berlitz, and Jespersen began to talk about what a new kind of foreign language instruction needed, shedding light on what the grammar–translation was missing. They supported teaching the language, not about the language, and teaching in the target language, emphasizing speech as well as text. Through grammar–translation, students lacked an active role in the classroom, often correcting their own work and strictly following the textbook.


title: Grammar–translation method

text: Despite all of these drawbacks, the grammar–translation method is still the most used method all over the world in language teaching . That is unsurprising since most language proficiency books and tests are in the format of grammar–translation method.


title: Revue

text: A revue is a type of multi-act popular theatrical entertainment that combines music, dance, and sketches. The revue has its roots in 19th century popular entertainment and melodrama but grew into a substantial cultural presence of its own during its golden years from 1916 to 1932. Though most famous for their visual spectacle, revues frequently satirized contemporary figures, news or literature. Similar to the related subforms of operetta and musical theatre, the revue art form brings together music, dance and sketches to create a compelling show. In contrast to these, however, revue does not have an overarching storyline. Rather, a general theme serves as the motto for a loosely-related series of acts that alternate between solo performances and dance ensembles.


title: Revue

text: Owing to high ticket prices, ribald publicity campaigns and the occasional use of prurient material, the revue was typically patronized by audience members who earned more and felt even less restricted by middle-class social mores than their contemporaries in vaudeville. Like much of that era's popular entertainments, revues often featured material based on sophisticated, irreverent dissections of topical matter, public personae and fads, though the primary attraction was found in the frank display of the female body.


title: Revue

text: George Lederer's "The Passing Show" (1894) is usually held to be first successful American "review". The English spelling was used until 1907 when Florenz Ziegfeld Jr. popularized the French spelling. "Follies" is now sometimes (incorrectly) employed as an analog for "revue", though the term was proprietary to Ziegfeld until his death in 1932. Other popular proprietary revue names included George White's "Scandals", Earl Carroll's "Vanities", and John Murray Anderson's Greenwich Village Follies.


title: Revue

text: Revues are most properly understood as having amalgamated several theatrical traditions within the corpus of a single entertainment. Minstrelsy's olio section provided a structural map of popular variety presentation, while literary travesties highlighted an audience hunger for satire. Theatrical extravaganzas, in particular, moving panoramas, demonstrated a vocabulary of the spectacular. Burlesque, itself a bawdy hybrid of various theatrical forms, lent to classic revue an open interest in female sexuality and the masculine gaze.


title: Revue

text: Revues enjoyed great success on Broadway from the World War I years until the Great Depression, when the stock market crash forced many revues from cavernous Broadway houses into smaller venues. (The shows did, however, continue to infrequently appear in large theatres well into the 1950s.) The high ticket prices of many revues helped ensure audiences distinct from other live popular entertainments during their height of popularity (late 1910s–1940s). In 1914, the "Follies" charged $5.00 for an opening night ticket ($130 in 2020 dollars); at that time, many cinema houses charged from $0.10 to 0.25, while low-priced vaudeville seats were $0.15. Among the many popular producers of revues, Florenz Ziegfeld played the greatest role in developing the classical revue through his glorification of a new theatrical "type", "the American girl". Famed for his often bizarre publicity schemes and continual debt, Ziegfeld joined Earl Carroll, George White, John Murray Anderson, and the Shubert Brothers as the leading producing figure of the American revue's golden age. Revues also had a presence in Germany during the 1930s and 1940s, with films such as "Frau meiner Träume" being made.


title: Revue

text: Revues took advantage of their high revenue stream to lure away performers from other media, often offering exorbitant weekly salaries without the unremitting travel demanded by other entertainments. Performers such as Eddie Cantor, Anna Held, W. C. Fields, Bert Williams, Ed Wynn, the Marx Brothers and the Fairbanks Twins found great success on the revue stage. One of Cole Porter's early shows was Raymond Hitchcock's revue "Hitchy-Koo of 1919". Composers or lyricists such as Richard Rodgers, Lorenz Hart, Irving Berlin, and George M. Cohan also enjoyed a tremendous reception on the part of audiences. Sometimes, an appearance in a revue provided a key early entry into entertainment. Largely due to their centralization in New York City and their adroit use of publicity, revues proved particularly adept at introducing new talents to the American theatre. Rodgers and Hart, one of the great composer/lyricist teams of the American musical theatre, followed up their early Columbia University student revues with the successful "Garrick Gaieties" (1925). Comedian Fanny Brice, following a brief period in burlesque and amateur variety, bowed to revue audiences in Ziegfeld's "Follies of 1910". Specialist writers and composers of revues have included Sandy Wilson, Noël Coward, John Stromberg, George Gershwin, Earl Carroll, and the British team Flanders and Swann. In Britain predominantly, Tom Arnold also specialized in promoting series of revues and his acts extended to the European continent and South Africa.


title: Revue

text: With the introduction of talking pictures, in 1927, studios immediately began filming acts from the stage. Such film shorts gradually replaced the live entertainment that had often accompanied cinema exhibition. By 1928, studios began planning to film feature-length versions of popular musicals and revues from the stage. The lavish films, noted by many for a sustained opulence unrivaled in Hollywood until the 1950s epics, reached a breadth of audience never found by the stage revue, all while significantly underpricing the now-faltering theatrical shows. A number of revues were released by the studios, many of which were filmed entirely (or partly) in color. The most notable examples of these are "The Show of Shows" (Warner Brothers, 1929), "The Hollywood Revue of 1929" (Metro-Goldwyn-Mayer, 1929), "Fox Movietone Follies of 1929" (Fox Film Corporation, 1929), "Paramount on Parade" (Paramount, 1930), "New Movietone Follies of 1930" (Fox, 1930) and "King of Jazz" (Universal, 1930). Even Britain jumped on the bandwagon and produced expensive revues such as "Harmony Heaven" (British International Pictures, 1929), "Elstree Calling" (BIP, 1930) and "The Musical Revue Of 1959" (BIP, 1960).


title: Revue

text: Revues are often common today as student entertainment (with strong traditions in many universities in UK, Canada, Australia, New Zealand, Norway and Denmark). These use pastiche, in which contemporary songs are re-written in order to comment on the college or courses in a humorous nature. While most comic songs will only be heard within the revue they were written for, sometimes they become more widely known—such as "A Transport of Delight", about the big red London bus, by Flanders and Swann, who first made their name in a revue titled "At the Drop of a Hat".


title: Revue

text: The Rolling Thunder Revue was a famed U.S. concert tour in the mid-1970s consisting of a traveling caravan of musicians, headed by Bob Dylan, that took place in late 1975 and early 1976.


title: Revue

text: Towards the end of the 20th century, a subgenre of revue largely dispensed with the sketches, founding narrative structure within a song cycle in which the material is culled from varied works. This type of revue may or may not have identifiable characters and a rudimentary storyline but, even when it does, the songs remain the focus of the show (for example, "Closer Than Ever" by Richard Maltby Jr. and David Shire). This type of revue usually showcases songs written by a particular composer or songs made famous by a particular performer. Examples of the former are "Side By Side By Sondheim" (music/lyrics Stephen Sondheim), "Eubie!" (Eubie Blake) "Tom Foolery" (Tom Lehrer), and "Five Guys Named Moe" (songs made popular by Louis Jordan). The eponymous nature of these later revues suggest a continued embrace of a unifying authorial presence in this seemingly scattershot genre, much as was earlier the case with Ziegfeld, Carrol, "et al".


title: Revue

text: With different artistic emphases, the revue genre is today above all upheld at traditional variety theatres such as the Le Lido, Moulin Rouge and Friedrichstadt-Palast Berlin, as well as in shows in Las Vegas.


title: Revue

text: It is a current and fairly longstanding tradition of medical, dental, engineering, legal and veterinary schools within the UK, Canada, New Zealand and Australia to put on revues each year, combining comedy sketches, songs, parodies, films and sound-bites.


title: Revue

text: As well as performing at their respective universities, shows will often be performed at the Edinburgh Festival Fringe. The Cambridge Medics Revue, St George's Medics Revue, and Birmingham Medics Revues have all performed at the Festival, with St. George's Medics Revue having been performing annually at the Fringe for 18 years and have sold-out their show for the last nine years. The BSMS Medic Revue has performed sellout shows in the Brighton Fringe Festival since 2008. The MDs Comedy Revue performed at the Fringe for the first time in 2015, to a sell-out audience, repeating this feat their second show in 2016 and their third in 2018. The Cambridge clinical school also now run a competing revue to the undergraduates, called variably Revue and Integration or Revue and Imitation.


title: Revue

text: The Moira Stuart Cup is competed for annually at the United Hospitals Comedy Revue, by all five of the University of London Medical Schools. It has been won by all medical schools at least once, with St George's Hospital Medical School achieving the most victories, winning the trophy six times. The cup is not officially endorsed by Moira Stuart herself.


title: Hokkaido (dog)

text: The is a breed of dog originating from Japan. Other names for the breed include Ainu-ken, Seta, Ainu dog, Hokkaidog. In Japan, its name is sometimes shortened to Dō-ken (道犬). The Hokkaido is native to the prefecture of the same name in Japan.


title: Hokkaido (dog)

text: The dog is medium in size, with small, triangular, upright ears. The small eyes have a rising triangular outline. The Hokkaido has a coat of long, stiff fur, and a second, shorter coat of soft fur. Colors include red, white, black, brindle, sesame, black and tan, and wolf-gray. Males are typically 50 cm (20 in) tall at the withers, females slightly shorter, with body masses in the 20 kg (44 lb) range. Dogs bred on continents outside of their native Japan may be smaller.


title: Hokkaido (dog)

text: The Hokkaido dog is thought to have originated from the medium-sized dogs brought by immigrants from the main island of Honshu in the 1140s. In 1869, the English zoologist Thomas W. Blakiston gave the breed the name Hokkaido. The breed was useful in the search for survivors of an Army expedition that was caught in heavy snow crossing the Hakkōda Mountains of Aomori Prefecture in 1902.


title: Hokkaido (dog)

text: In 1937, the Ainu dog was designated in Japan as "a rare species protected by law" by the Ministry of Education and it was decided that the official name of the breed would be Hokkaido-Inu. However, the dogs are almost always called Hokkaido-Ken among the Japanese people.


title: Hokkaido (dog)

text: The Hokkaido dog has a very high rate of Collie eye anomaly (CEA). About 1/3 of Hokkaidos are affected by CEA while 2/3 are carriers.


title: Opioid overdose

text: An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils (with the exception of pethidine, where there may be dilated pupils), and unconsciousness, however its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.


title: Opioid overdose

text: Opioid overdoses are diagnosed based on symptoms and examination. Risk factors for opioid overdose include high levels of opioid dependence, use of opioids via injection, high dosed opioid usage, having a mental disorder or having a predisposition for one, and use of opioids in combination with other substances, such as alcohol, benzodiazepines, or cocaine. Dependence on prescription opioids can occur from their use to treat chronic pain in individuals. Additionally, if following a period of detoxification, which allows the tolerance level to fall, the risk of overdose upon return to use is high.


title: Opioid overdose

text: Initial treatment of an overdose involves supporting the person's breathing and providing oxygen to reduce the risk of hypoxia. Naloxone is then recommended to those who cannot reverse the opioid's effects through breathing. Giving naloxone via nasal administration or as an injection into a muscle has shown to be equally effective. Other efforts to prevent deaths from overdose include increasing access to naloxone and treatment for opioid dependence.


title: Opioid overdose

text: Drug use contributes to 500,000 deaths worldwide, with opioid overdose resulting in approximately 115,000 of these deaths in 2018. This is up from 18,000 deaths in 1990. In 2018, approximately 269 million people had engaged in drug usage at least once, 58 million of which used opioids. Drug use disorders have affected around 35.6 million people worldwide in 2018. The WHO estimates that 70% of deaths due to drug use are in relation to opioids, with 30% being due to overdose. It is believed that the opioid epidemic has partly been caused due to assurances that prescription opioids were safe, by the pharmaceutical industry in the 1990s. This led to unwarranted trust and a subsequent heavy reliance on opioids. Though there are treatment interventions which can effectively reduce the risk of overdose in people with opioid dependence, less than 10% of affected individuals receive it.


title: Opioid overdose

text: Opiate overdose symptoms and signs can be referred to as the "opioid toxidrome triad": decreased level of consciousness, pinpoint pupils and respiratory depression. Other symptoms include seizures and muscle spasms. Sometimes an opiate overdose can lead to such a decreased level of consciousness such that the person will not wake up.


title: Opioid overdose

text: Because of their effect on the part of the brain that regulates breathing, opioids can cause very slow or stopped breathing, during overdoses, leading to hypoxia or death if left untreated. Hypoxia is typically caused by respiratory depression. The brain uses oxygen to regulate the homeostasis of the body. In animal studies, it was found that opioids act on specific regions of the central nervous system associated with respiratory regulation, including the medulla and pons. During cerebral hypoxia, there is a lack of sufficient oxygen supply to the brain. Prolonged lack of oxygenation from respiratory depression can lead to detrimental damage to the brain and spinal cord and can leave the person unable to walk or function normally, even if treatment with naloxone is given.


title: Opioid overdose

text: Alcohol also causes respiratory depression and therefore when taken with opioids can increase the risk of respiratory depression and death.


title: Opioid overdose

text: In young children, opioid overdose may not be apparent right away. This is due to absorption, distribution, and metabolism differences between young children and adults, and the higher amount of opioid ingestion per kilogram of body weight.


title: Opioid overdose

text: Risk factors for opioid overdose include opioid dependence, injecting opioids, using high doses of opioids, and use together with alcohol, benzodiazepines, or cocaine. The risk is particularly high following detoxification. Dependence on prescription opioids can occur from their use to treat chronic pain. In young children an overdose is usually due to opioids that are intended for their parents, older siblings, or grandparents. In mothers who take codeine during breastfeeding, opioid overdoses have occurred in their baby. Codeine is therefore not recommended in those who are breastfeeding.


title: Opioid overdose

text: Opioid overdoses are often associated with benzodiazepines, tranquilisers (e.g. xylazine) or alcohol use. Other CNS depressants, muscle relaxers, pain relievers, anti-convulsants, anxiolytics, treatment drugs of a psychoactive or epileptic variety or any other such drug with its active function meant to calm or mitigate neuronal signaling (barbiturates, etc.) can additionally cause a worsened condition with less likelihood of recovery cumulative to each added drug. This includes drugs less immediately classed to a slowing of the metabolism such as with GABAergic like GHB or glutamatergic antagonists like PCP or ketamine.


title: Opioid overdose

text: Opioids are primarily metabolized in the liver, before being excreted through urine. Opioids are metabolized by phase 1 and/or phase 2 metabolism, which can lead to the activation or inhibition of these drugs. Phase 1 metabolism is the CYP pathway which consists of different cytochrome P450s – a set of enzymes that catalyze hydrolysis, reduction, and oxidation reactions – to create an active metabolite. In contrast, Phase 2 metabolism causes the opioids to undergo conjugation, with little to no interaction with the CYP pathway. The opioids undergo phase 1 and phase 2 metabolism until they are hydrophilic enough to be renally excreted.


title: Opioid overdose

text: There are various factors that play a role in how an  opioid is metabolized. In phase 1 metabolism, the CYP family has several polymorphisms, which can account for the difference in therapeutic responses within each individual. This diversification leads to opioids being modified at varying rates, which can cause the drug to remain in the bloodstream for either a longer or shorter period of time. Therefore, these polymorphisms control opioid tolerance and facilitate overdose.


title: Opioid overdose

text: Evidence suggests that mental health can be a significant facilitator for opioid abuse. Given that opioids are prescribed for pain management, mental health disorders, such as depression, have been shown to increase use of opioids when treating conditions associated with chronic pain. Evidence has shown that individuals with mood and anxiety disorders have an increased likelihood of being prescribed opioids and continuing usage for lengthy periods of time, consequently increasing likelihood for dependence. As such, affected individuals have almost double the risk of using opioids for pain relief in the long-term. Additionally, mental health challenges associated with trauma, economic depression, social environments conducive to substance abuse and risk-taking behaviours have been shown to increase opioid misuse. Furthermore, mental health challenges associated with cardiovascular disease, sleep disorders, and HIV can cause opioid dependence and subsequent overdose. Notably, cyclic behaviours can be observed between mental illness and opioid abuse where individuals with mental health diagnoses engage in opioid use which further perpetuates mental health challenges and increased drug usage.


title: Opioid overdose

text: Opioids bind with neurological opioid receptors to provoke analgesic, sedative, and euphoric effects. Opioids function by stimulating specific G-protein coupled receptors distributed throughout the body—including the brain, skin and spinal cord. Three of the major opioid receptors include mu, kappa, delta, and nociception, each playing a role in eliciting the effects associated with opioids. An opioid overdose results from over-activation of these receptors, which can cause permanent brain damage from cerebral hypoxia or neurotoxicity.


title: Opioid overdose

text: Mu receptors have an analgesic effect on the brain, and are found in various parts of the nervous system including the cerebral cortex and thalamus. They can be found in the nucleus accumbens, the pleasure centre of the brain, as well as the amygdala. Kappa receptors, in the hypothalamus, produce a similar analgesic effect. They bind with dynorphins to stimulate anti-reward effects —dysphoria— and other negative effects of withdrawal. While mu receptors are the source of addiction, kappa receptors contribute to continued abuse. They generate dysphoria in response to increasing stress levels via corticotropin-releasing factor (CRF). This increases erratic shifts in mood during withdrawal period and can prompt relapse. Delta receptors, found in the basal ganglia of the limbic system, have been shown to reduce anxiety by binding with enkephalins, although this requires further research. The most recent addition to these receptors are nociception opioid receptors. Although they have been determined to be receptors to certain ligands from opioids, their role has not yet fully understood.


title: Opioid overdose

text: When opioids are ingested, the ligand binds to these constitutively active receptors to reduce neural activity. This is accomplished by inhibiting adenylyl cyclase and cyclic AMP, which are necessary for communication within the central nervous system. There is research indicating that opioids reduce pain by disrupting ion channels and vesicle fusion.


title: Opioid overdose

text: Prolonged exposure to opioids can cause these receptors to become internalized, leading to increased tolerance and increased opioid use.


title: Opioid overdose

text: Opioid overdoses can often be prevented. Clear protocols for staff at emergency departments and urgent care centers can reduce opioid prescriptions for individuals presenting in these settings who engage in drug seeking behaviors or who have a history of substance abuse. Drug seeking behaviors include but are not limited to obsessiveness or impatience when it comes to attaining medications, seeking multiple pain adjunct medications, and inconsistent physiological presentation. A prescription monitoring program may help determine if an individual is receiving a high doses of opioids or combinations of medications such as benzodiazepines and opioids that put them at high risk. Limited amount of evidence suggests opioid therapy with extended-release or long-acting formulations may increase the risk of an unintentional overdose compared to shorter-acting agents. Routinely screening using tools such as the CAGE-AID and the Drug Abuse Screening Test (DAST-10) in adults and the CRAFFT in those aged 14–18 years is recommended. Other "drug seeking" behaviors and physical indications of drug use should be used as clues to perform formal screenings.


title: Opioid overdose

text: There are several medication-assisted treatments available for people with opioid use disorder or opioid dependence, who are at higher risk for opioid overdose. The selection of treatment depends on various factors, such as a person's preference, accessibility, and history of treatment. Examples of medication-assisted treatments are buprenorphine (with or without naloxone), naltrexone, and methadone. Peer support groups have tentative evidence of benefit. There is also some evidence indicating benefits in community-based overdose education and naloxone distribution programs. Buprenorphine and methadone can help decrease drug cravings. Combining pharmacologic treatments with behavioral therapy, such as support or recovery groups, can increase likelihood of overcoming addiction and reduce the risk of an opioid overdose.


title: Opioid overdose

text: Individuals diagnosed with opioid dependence should be prescribed naloxone to prevent overdose and should be directed to one of treatment options available, such as needle exchange programs and treatment centers. A naloxone prescription is also recommended when risk factors for opioid overdose are present such as history of overdose, substance use disorder, or higher doses of opioids. Brief motivational interviewing can also be performed and has been shown to improve people's motivation to change their behavior. Despite these opportunities, the dissemination of prevention interventions in the US has been hampered by the lack of coordination and sluggish federal government response.


title: Opioid overdose

text: In the United States, 49 states and the District of Columbia have expanded naloxone access at a pharmacy level via standing order, protocol order, naloxone-specific collaborative practice agreement, or pharmacist prescriptive authority.


title: Opioid overdose

text: If someone is suspected to have overdosed on opioids, call for medical attention, administer naloxone, and provide basic life support as soon as possible.


title: Opioid overdose

text: Naloxone works by temporarily blocking the effects of opioids, including respiratory depression and sedation. Naloxone is safe and side effects are rare, generally limited to allergic reactions. It should be given if there is any suspicion of an opioid overdose. Naloxone is available to the public in the United States in two routes of administration: intranasal and intramuscular/subcutaneous. Intranasal forms include Narcan, approved in 2015, and Kloxxado, approved in 2021. Formulations that are injectable into the intramuscular or subcutaneous spaces include Evzio, approved in 2014, and Zimhi, approved in 2021. The doses are approved for both children and adults and may be repeated every 2-3 minutes. Synthetic opioids like fentanyl and carfentanil are much more potent than prescription opioids and heroin. There is some debate about whether increased doses of naloxone are required to reverse overdose from synthetic opioids, however this concern has prompted FDA approval of higher dose naloxone formulations such as Kloxxado and Zimhi. If a person suspected of overdose regains consciousness, medical attention is still necessary. Naloxone is temporary and people revived with the medication can stop breathing again.


title: Opioid overdose

text: Opioid overdose should be reversed as soon as possible. To shorten the time between overdose and naloxone administration, multiple programs have been enacted to improve naloxone access for drug users, caregivers, and first responders. These efforts include FDA approval of intranasal and injectable naloxone over the counter, professional organizations recommending physicians to co-prescribe naloxone when opioids are used for pain management, free community overdose education and naloxone distribution (OEND) programs, and efforts to train non-medical first responders such as firefighters and police to use naloxone. These actions have reduced opioid-related deaths at the state and national levels and are cost-effective.


title: Opioid overdose

text: Opioid overdose leads to death when people stop breathing. Bystanders trained in first aid can evaluate people who have overdosed and provide basic life support including rescue breathing via bag valve mask or mouth to mouth. If the person who has overdosed does not have a pulse, rescuers should begin CPR.


title: Opioid overdose

text: Another medication that can be used to treat opioid overdoses is Nalmefene, Which is an opioid derivative structurally similar to Naltrexone. It works similarly to Naloxone but has a longer half life. It is approved for intravenous, intramuscular, and subcutaneous administration by prescription only, unlike the over the counter formulations of naloxone.


title: Opioid overdose

text: In 2016, the World Health Organization estimates 34 million people used opioids and 19 million used opiates. Of these, about 27 million people had opioid dependence, with the majority—but a decreasing number—using illicit heroin. In 2015, 118,000 people died from opioid use disorders, causing almost one third of all drug related deaths.


title: Opioid overdose

text: Of the 70,200 overdose deaths in the US in 2017, opioids were involved in 47,600 with three male deaths for each female death. This is an increase from 2016 where over 64,000 died from drug overdose, and opioids were involved in over 42,000. In 2017, the five states with the highest rates of death due to drug overdose were West Virginia (57.8 per 100,000), Ohio (46.3 per 100,000), Pennsylvania (44.3 per 100,000), Kentucky (37.2 per 100,000), and New Hampshire (37.0 per 100,000).


title: Opioid overdose

text: Concerning the 2017 data in the charts below, deaths from the various drugs add up to more than 70,200 because multiple drugs are involved in many of the deaths. According to the National Safety Council, the lifetime odds of dying from an overdose in the United States is 1 in 96.


title: Opioid overdose

text: The Substance Abuse and Mental Health Services Administration hosts an annual health observance known as National Prevention Week. Every third week of May, they encourage communities across the country to unite to share stories about positive mental and behavioral health and the importance of implementing prevention methods. They also sponsor recovery Month every September. Recovery Month aims to raise awareness about mental and substance use disorders and to honor individuals who recover, promoting the positive message that prevention works and that treatment is effective.


title: Opioid overdose

text: International Overdose Awareness Day is on 31 August to remember those who have died from an overdose, to decrease stigma of drug-related deaths, and to promote prevention of overdose.


title: COVID-19 vaccination in the Philippines

text: The COVID-19 vaccination program in the Philippines is an ongoing mass immunization campaign against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), in response to the ongoing pandemic in the country. The vaccination program was initiated by the Duterte administration on March 1, 2021, a day after the arrival of the country's first vaccine doses which were donated by the Chinese government.


title: COVID-19 vaccination in the Philippines

text: The Food and Drug Administration (FDA) has issued emergency use authorizations (EUA) to 10 COVID-19 vaccines (in chronological order): Pfizer–BioNTech, Oxford–AstraZeneca, Sinovac, Sputnik V, Janssen, Covaxin, Moderna, Sinopharm BIBP, Sputnik Light and Novavax.


title: COVID-19 vaccination in the Philippines

text: As of September 20, 2022, 165,005,000 total vaccine doses have been administered throughout the country, with 72,932,489 being fully vaccinated, 18,989,775 1st booster doses and 2,703,838 2nd booster doses administered.


title: COVID-19 vaccination in the Philippines

text: The "COVID-19 Immunization Program Management Organizational Structure" was formed on October 26, 2020, to facilitate the distribution of COVID-19 vaccines in the Philippines, however this was replaced by a vaccine cluster within the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID) by November 6, 2020. Carlito Galvez Jr. was appointed to lead the cluster under the title of vaccine czar. The Philippine National Vaccination Program and Implementation Plan was also approved by November 6, 2020.


title: COVID-19 vaccination in the Philippines

text: The COVID-19 Immunization Program Management Organizational Structure was formed on October 26 with the intention of it overseeing the distribution of COVID-19 vaccines once these became available. However, by November 6, the vaccine body was abolished and replaced with a vaccine cluster within the National Task Force Against COVID-19 of the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID). The vaccine cluster is distinct from the national task force's COVID-19 response cluster.


title: COVID-19 vaccination in the Philippines

text: The Food and Drug Administration (FDA) on their part is the agency tasked to review and approve the use and commercial distribution of COVID-19 vaccines in the Philippines as well as the issuance of an emergency use authorization for the same.


title: COVID-19 vaccination in the Philippines

text: The national government planned to rollout its vaccination program around February expecting the delivery of vaccines from Pfizer's vaccines sourced from the COVAX facility and the first batch of Sinovac's vaccines, consisting of 50,000 doses. The delivery of Pfizer's vaccines was delayed due to documentary issues.


title: COVID-19 vaccination in the Philippines

text: The government plans to start a full rollout or mass vaccination for the general populace around late 2021.


title: COVID-19 vaccination in the Philippines

text: Under normal circumstances, drugs and vaccines are reviewed for approval by the Food and Drug Administration (FDA) under a period of six months. President Rodrigo Duterte to fast-track the government's medical response to the pandemic signed an executive order on December 2, 2020, which allowed the FDA to grant emergency-use authorization (EUA) to COVID-19 vaccines and treatments. An EUA for a particular vaccine would authorize the government to buy said vaccine and allow to use the same for the vaccination program. An EUA would not authorize the commercial use of such vaccines or consent the use of the vaccine for personal use.


title: COVID-19 vaccination in the Philippines

text: The EUAs validity ends one year from the lifting of the public health emergency status declared in response to the pandemic or one year from the date it was registered if a COVID-19 drug or vaccine gets fully registered with the FDA.


title: COVID-19 vaccination in the Philippines

text: Among the conditions for a vaccine manufacturer to secure an EUA in the Philippines is to obtain prior EUA in its country of origin or other countries with a "mature" regulator. No manufacturer would be allowed to obtain an EUA in the Philippines first. For the purpose of the FDA's EUA approval process, the following foreign regulators are considered as "mature":


title: COVID-19 vaccination in the Philippines

text: The FDA announced that three vaccine manufacturers namely Pfizer–BioNTech, AstraZeneca, and Sinovac have inquired on the process of obtaining an EUA in the Philippines.


title: COVID-19 vaccination in the Philippines

text: The Philippines' vaccination officially began on March 1, 2021, shortly after the arrival of the first batch of vaccines from Sinovac. Prior to the official roll-out, a dry run was conducted to ensure that the vaccines, especially temperature-sensitive ones, would be rolled-out with minimal problems.


title: COVID-19 vaccination in the Philippines

text: In February 2021, the Food and Drug Association recommended against the usage of Sinovac vaccines for health care workers due to its low efficacy rates in trials on health care workers in other countries. It has recommended its usage instead to the vaccine to the working population and military personnel.


title: COVID-19 vaccination in the Philippines

text: The National Immunization Technical Advisory Group (NITAG) on February 26 has approved the use of the Sinovac vaccine to health care workers. Health care workers are still allowed to not take the vaccine and wait for a more effective vaccine. Philippine General Hospital (PGH) employees demanded for a better vaccine and an increase with their hazard pays.


title: COVID-19 vaccination in the Philippines

text: At a press conference, Presidential Spokesperson Harry Roque stated that health care workers can refuse the Sinovac vaccine and wait for the vaccines from Pfizer–BioNTech, Moderna, and Oxford–AstraZeneca while still being prioritized but other prioritized groups shall only get what is available in their locality.


title: COVID-19 vaccination in the Philippines

text: The rollout for the Philippines' national vaccine program began on March 1, 2021, shortly after the arrival of 600,000 doses of Sinovac's vaccine. Philippine General Hospital director and doctor Gerardo Legaspi officially became the first recipient of a COVID-19 vaccine in the country. The initial batch will cover around 50,000 military personnel and 250,000 health workers. As of March 3, 2021, vaccinations has been limited to Metro Manila and to health workers. However, select government officials were vaccinated in a bid to boost confidence on the vaccine.


title: COVID-19 vaccination in the Philippines

text: On March 6, 2021, Oxford–AstraZeneca, under the COVAX facility, began the rollout. Health workers who refused Sinovac's vaccines were prioritized.


title: COVID-19 vaccination in the Philippines

text: In May 2021, the rollout of vaccines from two manufacturers began. The rollout of the Sputnik V vaccines began on May 3 with five cities of Metro Manila; namely Makati, Manila, Taguig, Parañaque, and Muntinlupa. The deployment of Pfizer started on May 12, beginning in two cities in Metro Manila (San Juan and Makati). On June 30, 2021, the Moderna vaccine began its rollout in Metro Manila including San Juan. On July 20, 2021, the Janssen vaccine began being rolled out in Tacloban. On August 12, 2021, Vaccine Czar Carlito Galvez Jr. announced that recipients of the Sputnik V vaccine as their first dose can receive the AstraZeneca vaccine as their second dose provided that the shipment of Sputnik V is delayed due to logistical issues.


title: COVID-19 vaccination in the Philippines

text: Vaccination of minors began in mid-October 2021. At that time, emergency use authorizations for the use of Moderna and Pfizer vaccines for minors (ages 12–15 for Pfizer; age 12-17 for Moderna) has been granted.


title: COVID-19 vaccination in the Philippines

text: To hasten the immunization program, the government announced that it was holding "National Vaccination Days" on November 29 until December 1. November 29 and December 1 will be special working days. Initially targeted to immunize 15 million people, it was reduced to 9 million due to logistics issues surrounding the syringes for Pfizer vaccines.


title: COVID-19 vaccination in the Philippines

text: Upon being vaccinated with a COVID-19 vaccine, the local government unit (LGU) or recognized private healthcare providers issue a vaccine card that shall act as proof of vaccination. Later on, the Department of Information and Communications Technology (DICT) in coordination and the Department of Health along with the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF-EID) for a centralized registry for COVID-19 vaccinated residents under a common digital vaccine ID that shall feature a unique QR code.


title: COVID-19 vaccination in the Philippines

text: Since September 6, 2021, the VaxCERTPH, the national digital COVID-19 vaccination certificate was launched to serve as the official COVID-19 vaccination certificate for international and domestic travel for fully vaccinated Philippine citizens and residents. The digital certificate is based on the international standards as prescribed by World Health Organization (WHO). Vaccination records for the VaxCERTPH certificate are based on the Vaccination Information Management System (VIMS), managed by the Department of Information and Communications Technology (DICT) based on the uploads by the local government units in the Philippines. In 2022, the VaxCERTPH has since updated vaccination certificates that would include additional booster shots.


title: COVID-19 vaccination in the Philippines

text: At the same time since July 2021, the Bureau of Quarantine in the Philippines has begun issuing a new format of the International Certificate of Vaccination (ICV) to fully vaccinated Philippine citizens and residents for international travel provided that the COVID-19 vaccine is listed under the Emergency Use Listing (EUL) by the World Health Organization (WHO).


title: COVID-19 vaccination in the Philippines

text: On July 4, 2021, the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) has permitted domestic travel within the Philippines for fully vaccinated individuals that have been vaccinated with a COVID-19 vaccine under the Emergency Use Listing (EUL) by the World Health Organization (WHO) or have been granted an emergency use authorization (EUA) or a compassionate special permit (CSP) issued by the Food and Drug Administration (FDA). The same rules applies for fully vaccinated international travelers from countries and territories deemed as "low-risk" and can receive a reduced quarantine period of seven days.


title: COVID-19 vaccination in the Philippines

text: On October 8, 2021, the IATF introduced revised guidelines that fully vaccinated travelers from "low-risk" (green list) and "moderate-risk" (yellow list) jurisdictions can receive a reduced facility-based quarantine up to five days upon presentation of a national digital certificate issued by a foreign government with a reciprocal agreement with the Philippines.


title: COVID-19 vaccination in the Philippines

text: On October 13, 2021, the IATF subsequently permitted the entry of fully vaccinated travelers from "low-risk" (green list) countries and jurisdictions to skip facility-based quarantine provided there is a presentation of negative RT-PCR test result within 72 hours before departure from their country. This policy was later to the presentation of a negative RT-PCR test result within 48 hours before departure from their country.


title: COVID-19 vaccination in the Philippines

text: The Philippines presently recognizes the vaccination certificates issued by the following countries: Albania, Armenia, Argentina, Azerbaijan, Australia, Austria, Bahrain, Belgium, Brazil, Brunei, Cambodia, Canada, Chile, Colombia, Czech Republic, Denmark, Ecuador, Egypt, Estonia, France, Georgia, Germany, Greece, Hong Kong, India, Indonesia, Iraq, Ireland, Israel, Italy, Japan, Kazakhstan, Kuwait, Macau, Malaysia, Maldives, Malta, Myanmar, Monaco, the Netherlands, New Zealand, Oman, Palau, Papua New Guinea, Peru, Portugal, Qatar, Samoa, Singapore, Slovenia, Spain, Syria, Switzerland, South Korea, Sri Lanka, Thailand, Timor–Leste, Tunisia, Turkey, the United Arab Emirates, the United Kingdom, the United States, Uruguay, and Vietnam.


title: COVID-19 vaccination in the Philippines

text: The Health Technology Assessment Council (HTAC), the independent advisory council issued its recommendation for the administering of a third dose of the COVID-19 vaccine as a booster shot with a priority towards health care workers and other priority groups.


title: COVID-19 vaccination in the Philippines

text: Booster shots were rolled for frontline healthcare workers on November 16, 2021. Similarly, the IATF has approved the administration of booster shots for Overseas Filipino Workers who are set for deployment within four months provided their second dosage was taken six months prior. Senior citizens and immunocompromised persons were rolled out on November 22, 2021. These groups can choose their preferred vaccine brand in comparison to their primary series.


title: COVID-19 vaccination in the Philippines

text: On December 3, 2021, the Philippine Department of Health announces the expansion of the booster shot program stating all adults aged 18 years and above can receive additional booster shots at least six months from the primary series or three months after receiving the single-dose Janssen COVID-19 vaccine.


title: COVID-19 vaccination in the Philippines

text: Due to the threat of the SARS-CoV-2 Omicron variant, the Department of Health announced on December 22, 2021, the shortening of the interval of the booster doses for all adults aged 18 years and above at three months from their primary series or two months after receiving the single-dose Janssen vaccine.


title: COVID-19 vaccination in the Philippines

text: The Philippine government has been negotiating with various foreign vaccine manufacturers to secure the country's COVID-19 vaccine supply. These manufacturers include Sinovac Biotech (China), Gamaleya Research Institute of Epidemiology and Microbiology (Russia), Moderna (United States), and Pfizer (United States). The private sector, with government sanction, has secured at least 2.6 million vaccine doses from British-Swedish manufacturer AstraZeneca. The government also has secured 10 million doses from American firm Novavax which would be supplied from the Serum Institute of India.


title: COVID-19 vaccination in the Philippines

text: The government plans to secure 171 million doses from at least seven firms by the end of 2021. The procurement efforts of the national government have been a subject of various controversies.


title: COVID-19 vaccination in the Philippines

text: The national government through the Department of Foreign Affairs responding to the request of Germany and the United Kingdom to be exempted from the Philippines' prevailing cap on the deployment of nurses abroad in exchange for vaccines. The United Kingdom declined the offer refusing to link the vaccines to negotiations on the deployment of Filipino health workers to their country. The proposal was also opposed by labor group Migrante International.


title: COVID-19 vaccination in the Philippines

text: The Philippine government is negotiating with four pharmaceutical firms for the supply of COVID-19 booster shots.


title: COVID-19 vaccination in the Philippines

text: Local government units in the Philippines, from individual municipalities and cities and provinces has allocated part of their budgets to procure their own supply of COVID-19 vaccines.


title: COVID-19 vaccination in the Philippines

text: Along with private companies, local governments had to procure vaccines through cooperation with the national government which led to some members of the Congress questioning urging the national government to allow local governments to procure vaccines unilaterally. However, the government pointed out that only national governments could directly procure vaccines through the World Health Organization's COVAX facility and that third-party private firms and local governments had to sign a tripartite deal with the national government and member vaccine manufacturer.


title: COVID-19 vaccination in the Philippines

text: The first vaccines acquired by the Philippine national government was from Sinovac. The first batch of Sinovac's vaccines consisting of 600,000 doses were received by the Philippines on February 28, 2021, with the country expected to receive a total of 26 million doses. Vaccines sourced through the COVAX facility is also funded through donations by foreign countries. The IATF-EID approved the Philippines' participation in COVAX on July 24, 2020. The country is the recipient of vaccines from Pfizer–BioNTech and Oxford–AstraZeneca through the platform.


title: COVID-19 vaccination in the Philippines

text: The Philippines also engaged in talks with Israel to obtain a possible donation of excess vaccines from the Middle Eastern country.


title: COVID-19 vaccination in the Philippines

text: The Philippines has received 1,124,100 Oxford–AstraZeneca COVID-19 vaccine donations from Japan on July 8.


title: COVID-19 vaccination in the Philippines

text: The Philippines has received about 3,239,400 Janssen COVID-19 vaccine donations from the United States on July 16–17 through COVAX.


title: COVID-19 vaccination in the Philippines

text: The Philippines has received 415,040 Oxford–AstraZeneca COVID-19 vaccine doses donations from the United Kingdom on August 2.


title: COVID-19 vaccination in the Philippines

text: The Philippines has received 3,000,060 Moderna COVID-19 vaccine donations from the United States on August 3 through COVAX.


title: COVID-19 vaccination in the Philippines

text: The Philippines has received 100,000 doses of the Sinopharm BIBP vaccine from the United Arab Emirates.


title: COVID-19 vaccination in the Philippines

text: The Philippines has received a donation of about 1,000,000 doses of the Sinopharm BIBP vaccine on August 20–21 from China.


title: COVID-19 vaccination in the Philippines

text: Five local firms are in negotiations with foreign organizations to set up vaccine manufacturing sites in the Philippines as of March 2021. The origin of these foreign organization include China, India, South Korea, Russia, and the United States. South Korean firm EU Biologics has a partnership with Philippine vaccine distributor Glovax Biotech Corp. since 2012. The two companies plan to set-up their own vaccine production hub in Clark. Other interested foreign parties include the Gamaleya Research Institute of Epidemiology and Microbiology of Russia and a university research unit based in the United States.


title: COVID-19 vaccination in the Philippines

text: Philippine company United Laboratories launched a program known as "Vaccine Self Reliant Philippines" which includes plans to set up a vaccine manufacturing plant by 2023.


title: COVID-19 vaccination in the Philippines

text: The delivery of Pfizer–BioNTech COVID-19 vaccines to the Philippines has been subject to delays. Health Secretary Francisco Duque has been alleged to have "dropped the ball" on a Pfizer vaccine deal which could have secured 10 million doses by as early as January 2021. On June 19, the Philippine government has signed an agreement for the procurement of 40 million doses of Pfizer-BioNTech vaccine.


title: COVID-19 vaccination in the Philippines

text: The first batch of the Pfizer vaccine, consisting of 193,050 doses through the COVAX facility, arrived on May 10. 2,279,160 additional doses arrived in the country from COVAX's facility on June 10.


title: COVID-19 vaccination in the Philippines

text: The first batch of procured Pfizer–BioNTech vaccine, consisting of 562,770 doses, arrived on July 21.


title: COVID-19 vaccination in the Philippines

text: On January 14, the Philippines has secured 17 million doses of coronavirus disease 2019 (COVID-19) vaccines from British-Swedish pharmaceutical and biopharmaceutical firm AstraZeneca.


title: COVID-19 vaccination in the Philippines

text: A shipment of 487,200 Oxford–AstraZeneca COVID-19 vaccines under COVAX's facility arrived in the country on March 4, 2021. An additional shipment of 38,400 doses arrived in the country on March 7, totalling a number of 525,600 doses from COVAX's facility. 2 million additional doses arrived in the country from COVAX's facility on May 8.


title: COVID-19 vaccination in the Philippines

text: The first batch of procured Oxford–AstraZeneca vaccine, consisting of 1,150,800 doses, arrived on July 16.


title: COVID-19 vaccination in the Philippines

text: Plans to secure 36 million doses from China's Sinovac have also been subjected to scrutiny in Congress due to its reported efficacy rate. The efficacy rate of the Sinovac vaccine has varied by country; Turkey has reported an efficacy rate of 91% while Brazil has reported an efficacy rate of 78%. The Department of Health said that Sinovac's vaccine satisfy the World Health Organization standards of at least 50 percent efficacy rate while the FDA pointed out that Sinovac is yet to publish an official and published scientific report on their vaccines efficacy rate and that the clinical trial for the vaccine is conducted in different countries and the efficacy rate per country will vary.


title: COVID-19 vaccination in the Philippines

text: Following the approval for emergency use authorization on February 22, the first batch of Sinovac vaccines, consisting of 600,000 doses, from China's donation to the country arrived on February 28.


title: COVID-19 vaccination in the Philippines

text: The first batch of procured vaccines by the government reached the Philippines on March 29 came from Sinovac with previous received vaccines coming from donations.


title: COVID-19 vaccination in the Philippines

text: Russia commits to deliver the first doses of Gamaleya's Sputnik V COVID-19 vaccine to the Philippines around April 2021. The Philippines and Russia are also negotiating regarding a plan to set up a production facility for Sputnik V vaccines in the Philippines. The first batch of Gamaleya's vaccine, consisting of 15,000 doses, arrived on May 1.