title: Radiance

text: Radiance is useful because it indicates how much of the power emitted, reflected, transmitted or received by a surface will be received by an optical system looking at that surface from a specified angle of view. In this case, the solid angle of interest is the solid angle subtended by the optical system's entrance pupil. Since the eye is an optical system, radiance and its cousin luminance are good indicators of how bright an object will appear. For this reason, radiance and luminance are both sometimes called "brightness". This usage is now discouraged (see the article Brightness for a discussion). The nonstandard usage of "brightness" for "radiance" persists in some fields, notably laser physics.


title: Radiance

text: The radiance divided by the index of refraction squared is invariant in geometric optics. This means that for an ideal optical system in air, the radiance at the output is the same as the input radiance. This is sometimes called "conservation of radiance". For real, passive, optical systems, the output radiance is "at most" equal to the input, unless the index of refraction changes. As an example, if you form a demagnified image with a lens, the optical power is concentrated into a smaller area, so the irradiance is higher at the image. The light at the image plane, however, fills a larger solid angle so the radiance comes out to be the same assuming there is no loss at the lens.


title: Radiance

text: Spectral radiance expresses radiance as a function of frequency or wavelength. Radiance is the integral of the spectral radiance over all frequencies or wavelengths. For radiation emitted by the surface of an ideal black body at a given temperature, spectral radiance is governed by Planck's law, while the integral of its radiance, over the hemisphere into which its surface radiates, is given by the Stefan–Boltzmann law. Its surface is Lambertian, so that its radiance is uniform with respect to angle of view, and is simply the Stefan–Boltzmann integral divided by π. This factor is obtained from the solid angle 2π steradians of a hemisphere decreased by integration over the cosine of the zenith angle.


title: Radiance

text: Radiance of a "surface", denoted "L" ("e" for "energetic", to avoid confusion with photometric quantities, and "Ω" to indicate this is a directional quantity), is defined as


title: Radiance

text: In general "L" is a function of viewing direction, depending on "θ" through cos "θ" and azimuth angle through . For the special case of a Lambertian surface, is proportional to cos "θ", and "L" is isotropic (independent of viewing direction).


title: Radiance

text: When calculating the radiance emitted by a source, "A" refers to an area on the surface of the source, and Ω to the solid angle into which the light is emitted. When calculating radiance received by a detector, "A" refers to an area on the surface of the detector and Ω to the solid angle subtended by the source as viewed from that detector. When radiance is conserved, as discussed above, the radiance emitted by a source is the same as that received by a detector observing it.


title: Radiance

text: As the light travels through an ideal optical system, both the étendue and the radiant flux are conserved. Therefore, "basic radiance" defined by


title: Radiance

text: is also conserved. In real systems, the étendue may increase (for example due to scattering) or the radiant flux may decrease (for example due to absorption) and, therefore, basic radiance may decrease. However, étendue may not decrease and radiant flux may not increase and, therefore, basic radiance may not increase.


title: In Darkness (2018 film)

text: In Darkness is a 2018 thriller film directed by Anthony Byrne and written by Byrne and Natalie Dormer. It stars Dormer, Ed Skrein, Emily Ratajkowski and Joely Richardson. The film was released on 25 May 2018 in the United States by Vertical Entertainment and on 6 July 2018 in the United Kingdom by Shear Entertainment.


title: In Darkness (2018 film)

text: Sofia McKendrick (Natalie Dormer) is a blind pianist who lives in an apartment in London, and is haunted by the murder of her family by Serbian paramilitaries. Her neighbor is Veronique (Emily Ratajkowski), the daughter of Serbian philanthropist Zoran Radic (Jan Bijvoet), who has committed war crimes during the Bosnian War, and currently suspected of running criminal organizations. Despite the controversy surrounding Veronique's family, Sofia appears to have an amicable relationship with her, although lately has been noticing something wrong with her. During a discussion in an elevator, Veronique slips Sofia a USB drive and tells her that the perfume is Liquid Gold. One night, Sofia overhears a struggle occurring in Veronique's room and witnesses Veronique fall to her death. Despite this, Sofia denies witnessing anything to the police Detective Mills (Neil Maskell), while discreetly holding the USB drive.


title: In Darkness (2018 film)

text: Later at an event hosted by Radic, Sofia performs and overhears Radic and his associates discussing the circumstances of Veronique's death, in the process revealing that he was the one behind it. Radic's head of security Alexandra Gordon (Joely Richardson) and her brother Marc (Ed Skrein) have a discreet conversation and it is revealed that Veronique was twelve weeks pregnant and that Marc was sent to kill her; it is also revealed that Marc was having an affair with her and is likely the father of her child. Radic forms a fixation on Sofia for her connection to Veronique, and Sofia ends up having to dodge police questions and Radic's men looking over Veronique's apartment.


title: In Darkness (2018 film)

text: Marc rescues Sofia from a rape attempt and later saves her from an attempted kidnapping and torture. Sofia spends some time with Marc and learns of his and Veronique's affair, and he explains to her that Veronique committed suicide out of paranoia. This in turn leads to an affair between Marc and Sofia. As it turns out Sofia has her own vendetta towards Radic, as she confides in her adopted father Niall (James Cosmo), and gives him the USB drive and reveals that Liquid Gold is the drive's password, which reveals Radic's assets and his criminal operations. Sofia recounts how while she was blind, she had a sister, Balma, who could see but would pretend to be blind for her sister's benefit. It's revealed that Sofia's family were once friends with Radic in Bosnia, but Radic betrayed her family and personally led the paramilitaries in the massacre of Sofia's family. Niall was a soldier who rescued and protected Sofia for years while she was planning revenge. In addition to this, it's discovered that Veronique has been planning to expose the truth of her father's crimes, but knew that her days were numbered; this was the reason she gave Sofia the USB drive.


title: In Darkness (2018 film)

text: Sofia learns that Alexandra is also looking for the USB drive, hoping to use the information to usurp Radic and his operations. Sofia hands Alexandra a copy of the drive in exchange for a private audience with Radic at Veronique's funeral. There, Sofia holds a blade to Radic's throat and he realizes the truth of Sofia's past and motives; Radic taunts Sofia by revealing he was in love with her mother, and that he raped her shortly before she gave birth to a daughter; Radic implies and is under the impression that Sofia is his biological daughter. Radic leaves the funeral as Sofia is emotionally devastated by these revelations. As Detective Mills looks into Sofia's past, it's also discovered that "Sofia" is an alias; the "real" Sofia was Niall's biological daughter who died in infancy, and Niall named Balma "Sofia" after taking her in. Niall soon passes away while in the hospital.


title: In Darkness (2018 film)

text: When Radic discovers Alexandra's treachery, and orders her to be killed; despite the appeal from his sister, Marc leaves Alexandra to die due to her indirect involvement with his unborn child's death. Radic drives to Sofia's apartment with the intent on personally killing her, while Marc rushes to her rescue. Meanwhile, Detective Mills is watching surveillance of Sofia's visit earlier in the front office and he notices Sofia looking at something. As he went to get coffee in the front office, he realizes she analyzed Marc's wanted poster and makes his way to her apartment. As a fight ensues, Marc takes out Radic's men, while Sofia initially holds her own despite her seeming disadvantage. Radic quickly gets the upper hand and prepares to kill Sofia, until Sofia reaches a piece of broken mirror and moves to impale Radic's neck with it. However, just then Marc barges in and shoves Radic out the window. Radic falls onto a spiked fence, where he's impaled and dies.


title: In Darkness (2018 film)

text: As Sofia tends to Marc's wounds, there is a final revelation; Sofia was never blind and could see the whole time. Flashbacks show that during the massacre of her family, her blind sister was the one who was killed while they were hiding. Sofia, real name Balma, took her deceased sister's identity and feigned blindness for years. Because she could see, she saw a "Wanted Poster" and realizes that Marc is a wanted fugitive. The film ends as Marc encourages her to run, while he takes the fall for Radic's death, and Sofia flees the apartment.


title: In Darkness (2018 film)

text: Sofia is depicted as living in Maida Vale, London, where scenes were shot for the film, including a flower shop on Lauderdale Road which was converted to act as a café. Sofia and Veronique's building is located in Bramham Gardens, Kensington. Other filming locations included Brompton Cemetery, Ealing Hospital, the Thames Embankment, New Zealand House and the National Gallery.


title: In Darkness (2018 film)

text: In February 2018, Vertical Entertainment acquired US distribution rights to the film. The film was released on 25 May 2018 in the United States. In the United Kingdom, the film was released on 6 July 2018 by Shear Entertainment.


title: In Darkness (2018 film)

text: On Rotten Tomatoes, the film has an approval rating of based on reviews from critics, with an average rating of . On Metacritic, it has a score of 59 out of 100 based on reviews from seven critics, indicating "mixed or average reviews".


title: In Darkness (2018 film)

text: The film, which features Dormer nude and contains a sex scene, has been criticised for what some critics called "gratuitous nudity". Dormer dismissed this in an interview with "The Guardian", saying, "There has to be sexuality in the power play of a thriller. We have all got bodies, after all. In this film the sex scene, which for me was a love-making scene, is a metaphor for the way my character connects with the part played by Ed Skrein. Nakedness is a good equaliser and the shower scene also shows the tattoos on my character's body and makes it clear she is not quite who you think."


title: Jeffrey Sprecher

text: Jeffrey Craig Sprecher (, , born February 23, 1955) is an American businessman, the founder, chairman, and CEO of Intercontinental Exchange, and chairman of the New York Stock Exchange.


title: Jeffrey Sprecher

text: Sprecher was born in Madison, Wisconsin, the son of insurance broker Peter Sprecher and medical technologist Phyllis (née Willingham). His sisters are the filmmakers Karen and Jill Sprecher. He attended Madison's James Madison Memorial High School, and was initiated to the Wisconsin Alpha Chapter of Sigma Alpha Epsilon. Sprecher received a bachelor's degree in chemical engineering from the University of Wisconsin–Madison in 1978 and a Master of Business Administration from Pepperdine University in 1984.


title: Jeffrey Sprecher

text: Sprecher's first job was at Trane, where he met William Prentice who was developing power plants following deregulation. Prentice offered him a job at Western Power Group in 1983.


title: Jeffrey Sprecher

text: The Energy Policy Act of 1992 passed and deregulation in the electric industry began. Those working in the "electric industry realized the need for real-time, continentwide transactions", made possible by "Continental Power Exchange" technologies whereby "individual businesses and consumers may one day be able to select an energy provider in the same way that individuals shop for long-distance telephone service."


title: Jeffrey Sprecher

text: In 1996 he bought the Continental Power Exchange in Atlanta from MidAmerican Energy Holdings Company for $1 plus the assumption of debt, which became the foundation for Intercontinental Exchange (ICE).


title: Jeffrey Sprecher

text: In the 1990s energy trading was handled manually by "Continental Power Exchange, an electronic energy trading company. By 1997 Continental Power Exchange CPEX had "a federated software structure in place, CPEX... ready to expand to more servers as growth demands. CPEX's hardware and server architecture [were] capable of supporting foreseeable changes that may be necessary when the client load arrives. Continental [intended] to stay at least one step ahead of the marketplace."


title: Jeffrey Sprecher

text: Sprecher started Intercontinental Exchange (ICE) in 2000 as an online marketplace for energy trading in Atlanta.


title: Jeffrey Sprecher

text: Shortly after the company approached Enron to be a client, Enron started its own competing electricity trading platform, which dominated the market. Enron's market model was to buy from every seller and sell to every buyer. Wall Street bankers, particularly Goldman Sachs and Morgan Stanley backed him and he launched ICE in 2000 (giving 80 percent control to the two banks who, in turn spread out the control among Shell, Total, and British Petroleum). When Enron's exchange collapsed in 2001 in the Enron scandal, ICE's business exploded.


title: Jeffrey Sprecher

text: In 2018, Intercontinental Exchange formed Bakkt, “a pioneering marketplace in digital currency futures.” In January 2021, the company announced that “Bakkt’s being absorbed into a special purpose acquisition company (SPAC) sponsored by Chicago investment fund Victory Park Capital.” Sprecher was quoted in "Fortune" that “the lofty costs of processing payments by credit card [are] one of the prime targets for disruption in financial services. Bakkt . . . could play a central role in wrestling down costs.”


title: Jeffrey Sprecher

text: On March 19, 2020, the public release of federal financial-disclosure documents revealed that Sprecher and his wife, interim U.S. Senator Kelly Loeffler sold millions of dollars of stock the couple owned in companies vulnerable to the COVID-19 pandemic. The sales began the same day Loeffler and other senators received a private briefing from federal officials about the looming crisis. The documents also showed that the couple purchased stock in Citrix Systems, a company that would potentially benefit from the increase in remote work due to the stay-at-home orders issued to mitigate the COVID-19 pandemic. At least some of the stocks that Loeffler sold were owned jointly with Sprecher and would have required his knowledge and authorization to sell, documents show.


title: Jeffrey Sprecher

text: On March 20, 2020, the consumer advocacy group Common Cause filed complaints against Sprecher and Loeffler with the Securities and Exchange Commission, the United States Senate Ethics Committee, and the United States Justice Department, requesting from the latter a criminal investigation of the couple for violations of the STOCK Act.


title: Jeffrey Sprecher

text: On March 20, 2020, also reported by CNBC in the same article referenced above, Intercontinental Exchange said in a statement that the nearly 30 transactions involving the couple were “in compliance” with company policies. “Mr. Sprecher and Senator Loeffler have made clear that those transactions were executed by their financial advisors without Mr. Sprecher’s or Senator Loeffler’s input or direction.”


title: Jeffrey Sprecher

text: On June 16, 2020, it was reported that the Senate Ethics Committee ended its investigation into Sen. Kelly Loeffler's stock trades. The news came three weeks after Sen. Loeffler's office said the Justice Department had also dropped its probe into her stock trades. Deborah Sue Mayer, the Ethics Committee's chief counsel and staff director, wrote in the letter that the panel examined stock transactions made by both Loeffler and her husband Jeffrey Sprecher, chairman of the New York Stock Exchange.


title: Jeffrey Sprecher

text: Sprecher has been married to former U.S. Senator Kelly Loeffler since 2004. They reside in Tuxedo Park, Atlanta in a $10,500,000, 15,000 square foot estate named Descante, though the property was later reappraised for around $4 million, resulting in far lower property taxes.


title: Jeffrey Sprecher

text: During the COVID-19 pandemic, Sprecher and his wife donated $1 million to the Phoebe Foundation's COVID-19 Relief Fund of the Phoebe Putney Health System for personal protective equipment for Phoebe care team members.


title: Jane Sanders

text: Mary Jane O'Meara Sanders (née O'Meara, formerly Driscoll; born January 3, 1950) is an American social worker, college administrator, activist, and political strategist. Sanders was provost and interim president of Goddard College (1996–1997) and president of Burlington College (2004–2011). In June 2017, she founded the think tank The Sanders Institute. She has been married to U.S. Senator Bernie Sanders since May 28, 1988. She has also served as the first lady of Burlington, Vermont, during her husband's term as mayor.


title: Jane Sanders

text: Sanders was born Mary Jane O'Meara on January 3, 1950, and grew up in Brooklyn, as one of the five children of Bernadette Joan (Sheridan) and Benedict P. O'Meara. She is of Irish descent and was raised Catholic. She attended Catholic schools, including Saint Saviour High School, before attending the University of Tennessee. O'Meara dropped out of school and moved back to Brooklyn with her first husband, David Driscoll. In 1975, they moved to Vermont when Driscoll's employer, IBM, transferred him. The couple divorced in 1980. She has three children (Heather Titus, Carina Driscoll, and David Driscoll) from her marriage with Driscoll, who were later adopted by Sanders.


title: Jane Sanders

text: O'Meara finished her college degree at Goddard College in Plainfield, Vermont, with a bachelor's in social work. She met Bernie Sanders in 1981, ten days before his first campaign victory as Mayor of Burlington, and again at his victory party; the couple married in 1988.


title: Jane Sanders

text: In 1996, she earned a doctorate in leadership studies in politics and education from Union Institute & University headquartered in Cincinnati, Ohio.


title: Jane Sanders

text: Sanders is Roman Catholic. She does not regularly attend Mass, but sometimes visits Saint Anne's Shrine when facing problems.


title: Jane Sanders

text: Early in her career Sanders worked in the Juvenile Division of the Burlington Police Department, and then as a community organizer with the King Street Area Youth Center, and as a volunteer for AmeriCorps VISTA.


title: Jane Sanders

text: From 1981 to 1991, Sanders served as founding Director of the Mayor's Youth Office and Department Head in the City of Burlington. She was also active in K-12 education, elected as a School Board Commissioner, and was a founding member of the Women's Council & the Film Commission. In 1991, her husband, Bernie Sanders, was elected to the U.S. Congress. From 1991 to 1995, she worked in his office on a volunteer basis.


title: Jane Sanders

text: In 1996, Sanders was appointed as Provost and Interim President of her alma mater, Goddard College, to help the college through a difficult period. The Board, faculty, staff, students and Sanders worked together to improve the accreditation, finances and governance of the institution.


title: Jane Sanders

text: From 2004 through 2011, Sanders was President of Burlington College, a small liberal arts college founded in 1972 for non-traditional students. It closed due to financial problems in 2016.


title: Jane Sanders

text: As senior partner in the Burlington-based consulting firm, Leadership Strategies, O'Meara worked as a political and educational consultant for federal, state, and local political campaigns.


title: Jane Sanders

text: Sanders was instrumental in founding The Sanders Institute, a progressive think tank which launched in June 2017, and is one of its 11 original fellows. Like the other fellows, she does not receive payment for her work, although she does receive compensation for travel expenses.


title: Jane Sanders

text: Bernie Sanders has described his wife as "one of [his] key advisers", and he has employed her at various times as "an administrative assistant, spokeswoman, policy adviser, chief of staff, and media buyer". In a 1996 article in "The Washington Post", she was credited with helping him draft "more than 50 pieces of legislation".


title: Jane Sanders

text: She has served in Sanders's Congressional office as Chief of Staff and as Policy and Press Adviser, and also serves as an Alternate Commissioner for the Texas Low Level Radioactive Waste Disposal Compact Commission.


title: Jane Sanders

text: In 2004, Sanders was named President of Burlington College, a private, non-profit liberal arts school founded in 1972 in Vermont. She increased the small college's fundraising. During her tenure as President, Burlington had an endowment of "about $150,000", and fundraising revenue had increased from about $25,000 when Sanders first arrived to $1.25 million by 2011. In 2010, Sanders oversaw the purchase of property formerly owned and occupied by the Roman Catholic Diocese of Burlington. The College based the real estate purchase on projections that enrollment would rapidly grow from fewer than 200 to as many as 750 students, with a corresponding income increase from tuition fees.


title: Jane Sanders

text: In 2011, the College's Board of Trustees, while crediting Sanders with acquiring a permanent campus for the 200‑student college, called a meeting for September 2011 and accepted Sanders's resignation. "We reached a decision which I believe is best for both the College and me," Sanders said after the meeting, "The board and I have different visions for the future and that's perfectly fine." On departure, she received the title of President Emeritus and a $200,000 severance, consisting of one year's pay, along with certain retirement and bonus payments. With the College unable to collect on some promised pledges after Sanders had resigned, and the enrollment increase plans failing, the Diocese settled the loan debt with the College in 2015 for $996,000, less than the agreed amount, and with $1 million of the repayment made in shares of an unidentified LLC company.


title: Jan Švankmajer

text: Jan Švankmajer (; born 4 September 1934) is a Czech filmmaker and artist whose work spans several media. He is a self-labeled surrealist known for his stop-motion animations and features, which have greatly influenced other artists such as Terry Gilliam, the Brothers Quay, and many others.


title: Jan Švankmajer

text: Švankmajer was born in Prague. An early influence on his later artistic development was a puppet theatre he was given for Christmas as a child. He studied at the College of Applied Arts in Prague and later in the Department of Puppetry at the Prague Academy of Performing Arts, where he befriended Juraj Herz. He contributed to Emil Radok's film "Johanes doctor Faust" in 1958 and then began working for Prague's Semafor Theatre where he founded the Theatre of Masks. He then moved on to the Laterna Magika multimedia theatre, where he renewed his association with Radok.


title: Jan Švankmajer

text: This theatrical experience is reflected in Švankmajer's first film "The Last Trick", which was released in 1964. Under the influence of theoretician Vratislav Effenberger, Švankmajer moved from the mannerism of his early work to classic surrealism, first manifested in his film "The Garden" (1968), and joined the Czechoslovak Surrealist Group.


title: Jan Švankmajer

text: Švankmajer has gained a reputation over several decades for his distinctive use of stop-motion technique, and his ability to make surreal, nightmarish, and yet somehow funny pictures. Švankmajer's trademarks include very exaggerated sounds, often creating a very strange effect in all eating scenes. He often uses fast-motion sequences when people walk or interact. His movies often involve inanimate objects being brought to "life" through stop motion. Many of his films also include clay objects in stop motion, otherwise known as claymation. Food is a common subject and medium. Švankmajer also uses pixilation in many of his films, including Food (1992) and Conspirators of Pleasure (1996).


title: Jan Švankmajer

text: Stop-motion features in most of his work, though his feature films have included much more live-action sequences than animation.


title: Jan Švankmajer

text: Many of his movies, like the short film "Down to the Cellar", are made from a child's perspective, while at the same time often having a truly disturbing and even aggressive nature. In 1972 the communist authorities banned him from making films, and many of his later films were suppressed. He was almost unknown in the West until the early 1980s. Writing in The New York Times, Andrew Johnston praised Švankmajer's artistry, stating "while his films are rife with cultural and scientific allusions, his unusual imagery possesses an accessibility that feels anchored in the shared language of the subconscious, making his films equally rewarding to the culturally hyperliterate and to those who simply enjoy visual stimulation."


title: Jan Švankmajer

text: Among his best known works are the feature films "Alice" (1988), "Faust" (1994), "Conspirators of Pleasure" (1996), "Little Otik" (2000) and "Lunacy" (2005), a surreal comic horror based on two works of Edgar Allan Poe and the life of Marquis de Sade. The two stories by Poe, "The System of Doctor Tarr and Professor Fether" and "The Premature Burial", provide "Lunacy" its thematic focus, whereas the life of Marquis de Sade provides the film's blasphemy. His short film "Dimensions of Dialogue" (1982) was selected by Terry Gilliam as one of the ten best animated films of all time. His films have been called "as emotionally haunting as Kafka's stories." In 2010 he released "Surviving Life", a live-action and cutout animation story about a married man who meets another woman in his dreams.


title: Jan Švankmajer

text: His most recent release is called "Insects" ("Hmyz"). It had a projected budget of 40 million CZK, which was partially funded through an Indiegogo campaign which reached more than double its goal, and was released in January 2018. The film is based on the play "Pictures from the Insects' Life" by Josef and Karel Čapek, which Švankmajer describes as following: ""From the Life of Insects" is a misanthropic play. My screenplay only extends this misanthropy, as man is more like an insect and this civilisation is more like an anthill. One should also remember the message in Kafka’s "Metamorphosis"."


title: Jan Švankmajer

text: His life's works, inimitable style and voice have had far-reaching influences on the world of animation. Those whose work he has influenced include Brothers Quay, Caroline Leaf, Vera Neubauer, Terry Gilliam, Tomasz Bagiński, Nina Gantz and Phil Lord and Christopher Miller among many others.


title: Jan Švankmajer

text: He won the Golden Bear for Best Short Film at the Berlin International Film Festival in 1983 for "Dimensions of Dialogue."


title: Jan Švankmajer

text: In 2000, Švankmajer received Lifetime Achievement Award at the World Festival of Animated Film - Animafest Zagreb.


title: Jan Švankmajer

text: On 27 July 2013 he received the Innovation & Creativity Prize by Circolino dei Films, an independent Italian cultural organization.


title: Jan Švankmajer

text: On 10 July 2014, he received the 2014 FIAF Award during a special ceremony of the Karlovy Vary International Film Festival.


title: Jan Švankmajer

text: On 27 September 2018, he received the Raymond Roussel Society Medal in recognition of his extraordinary contribution: an inspiring, unique and universal work.


title: Jan Švankmajer

text: He was married to Eva Švankmajerová, an internationally known surrealist painter, ceramicist, and writer until her death in October 2005. Švankmajerová collaborated on several of her husband's movies, including "Alice", "Faust", and "Otesánek". They had two children, Veronika (b. 1963) and Václav (b. 1975, an animator).


title: Polypharmacy

text: Polypharmacy (polypragmasia) is the simultaneous use of multiple medicines by a patient for their conditions. Most commonly it is defined as regularly taking five or more medicines but definitions vary in where they draw the line for the minimum number of drugs. Polypharmacy is often the consequence of having multiple long-term conditions, also known as multimorbidity. An excessive number of medications is worrisome, especially for older patients with many chronic health conditions, because this increases the risk of an adverse event in those patients.


title: Polypharmacy

text: The prevalence of polypharmacy is estimated to be between 10% and 90% depending on the definition used, the age group studied, and the geographic location. Polypharmacy continues to grow in importance because of aging populations. Many countries are experiencing a fast growth of the older population, 65 years and older. This growth is a result of the baby-boomer generation getting older and an increased life expectancy as a result of ongoing improvement in health care services worldwide. About 21% of adults with intellectual disability are also exposed to polypharmacy. Additionally, studies show that the percentage of patients greater than 65 years-old using more than 5 medications increased from 24% to 39% between 1999 and 2012.


title: Polypharmacy

text: Polypharmacy is not necessarily ill-advised, but in many instances can lead to negative outcomes or poor treatment effectiveness, often being more harmful than helpful or presenting too much risk for too little benefit. Therefore, health professionals consider it a situation that requires monitoring and review to validate whether all of the medications are still necessary. Concerns about polypharmacy include increased adverse drug reactions, drug interactions, prescribing cascade, and higher costs. A prescribing cascade occurs when a patient is prescribed a drug and experiences an adverse drug effect that is misinterpreted as a new medical condition, so the patient is prescribed another drug.


title: Polypharmacy

text: Polypharmacy is often associated with a decreased quality of life, including decreased mobility and cognition. Patient factors that influence the number of medications a patient is prescribed include a high number of chronic conditions requiring a complex drug regimen. Other systemic factors that impact the number of medications a patient is prescribed include a patient having multiple prescribers and multiple pharmacies that may not communicate.


title: Polypharmacy

text: Whether or not the advantages of polypharmacy (over taking single medications or monotherapy) outweigh the disadvantages or risks depends upon the particular combination and diagnosis involved in any given case. The use of multiple drugs, even in fairly straightforward illnesses, is not an indicator of poor treatment and is not necessarily overmedication. Moreover, it is well accepted in pharmacology that it is impossible to accurately predict the side effects or clinical effects of a combination of drugs without studying that particular combination of drugs in test subjects. Knowledge of the pharmacologic profiles of the individual drugs in question does not assure accurate prediction of the side effects of combinations of those drugs; and effects also vary among individuals because of genome-specific pharmacokinetics. Therefore, deciding whether and how to reduce a list of medications (deprescribe) is often not simple and requires the experience and judgment of a practicing physician, as the physician must weigh the pros and cons of keeping the patient on the medication. However, such thoughtful and wise review is an ideal that too often does not happen, owing to problems such as poorly handled care transitions (poor continuity of care, usually because of siloed information), overworked physicians, and interventionism.


title: Polypharmacy

text: While polypharmacy is typically regarded as undesirable, prescription of multiple medications can be appropriate and therapeutically beneficial in some circumstances. “Appropriate polypharmacy” is described as prescribing for complex or multiple conditions in such a way that necessary medicines are used based on the best available evidence at the time to preserve safety and well-being. Polypharmacy is clinically indicated in some chronic conditions, including diabetes mellitus, but should be discontinued when evidence of benefit from the prescribed drugs no longer outweighs potential for harm (described below in Contraindications).


title: Polypharmacy

text: Often certain medications can interact with others in a positive way specifically intended when prescribed together, to achieve a greater effect than any of the single agents alone. This is particularly prominent in the field of anesthesia and pain management – where atypical agents such as antiepileptics, antidepressants, muscle relaxants, NMDA antagonists, and other medications are combined with more typical analgesics such as opioids, prostaglandin inhibitors, NSAIDS and others. This practice of pain management drug synergy is known as an "analgesia sparing" effect.


title: Polypharmacy

text: People who are at greatest risk for negative polypharmacy consequences include elderly people, people with psychiatric conditions, patients with intellectual or developmental disabilities, people taking five or more drugs at the same time, those with multiple physicians and pharmacies, people who have been recently hospitalized, people who have concurrent comorbidities, people who live in rural communities, people with inadequate access to education, and those with impaired vision or dexterity. Marginalized populations may have a greater degrees of polypharmacy, which can occur more frequently in younger age groups.


title: Polypharmacy

text: It is not uncommon for people who are dependent or addicted to substances to enter or remain in a state of polypharmacy misuse. About 84% of prescription drug misusers reported using multiple drugs. Note, however, that the term "polypharmacy" and its variants generally refer to legal drug use as-prescribed, even when used in a negative or critical context.


title: Polypharmacy

text: Measures can be taken to limit polypharmacy to its truly legitimate and appropriate needs. This is an emerging area of research, frequently called deprescribing. This reduction in medications has been shown to reduce the number of medications and is safe as it does not significantly alter health outcomes. Clinical pharmacists can perform drug therapy reviews and teach physicians and their patients about drug safety and polypharmacy, as well as collaborating with physicians and patients to correct polypharmacy problems. Similar programs are likely to reduce the potentially deleterious consequences of polypharmacy such as adverse drug events, non-adherence, hospital admissions, drug-drug interactions, geriatric syndromes, and mortality. Such programs hinge upon patients and doctors informing pharmacists of other medications being prescribed, as well as herbal, over-the-counter substances and supplements that occasionally interfere with prescription-only medication. Staff at residential aged care facilities have a range of views and attitudes towards polypharmacy that, in some cases, may contribute to an increase in medication use.


title: Polypharmacy

text: The risk of polypharmacy increases with age, although there is some evidence that it may decrease slightly after age 90 years. Poorer health is a strong predictor of polypharmacy at any age, although it is unclear whether the polypharmacy causes the poorer health or if polypharmacy is used because of the poorer health. It appears possible that the risk factors for polypharmacy may be different for younger and middle-aged people compared to older people.


title: Polypharmacy

text: The use of polypharmacy is correlated to the use of potentially inappropriate medications. Potentially inappropriate medications are generally taken to mean those that have been agreed upon by expert consensus, such as by the Beers Criteria. These medications are generally inappropriate for older adults because the risks outweigh the benefits. Examples of these include urinary anticholinergics, which can prevent up to one episode of incontinence every 48 hours on average. However, they can also cause constipation, dry eyes, dry mouth, impaired cognition, and increase the risk of falls. For older people living in long term care facilities, almost all older people are using polypharmacy and also are affected by under-prescribing of potentially indicated medicines and use high risk medicines.


title: Polypharmacy

text: Polypharmacy is associated with an increased risk of falls in elderly people. Certain medications are well known to be associated with the risk of falls, including cardiovascular and psychoactive medications. There is some evidence that the risk of falls increases cumulatively with the number of medications. Although often not practical to achieve, withdrawing all medicines associated with falls risk can halve an individual's risk of future falls.


title: Polypharmacy

text: Every medication has potential adverse side-effects. With every drug added, there is an additive risk of side-effects. Also, some medications have interactions with other substances, including foods, other medications, and herbal supplements. 15% of older adults are potentially at risk for a major drug-drug interaction. Older adults are at a higher risk for a drug-drug interaction due to the increased number of medications prescribed and metabolic changes that occur with aging. When a new drug is prescribed, the risk of interactions increases exponentially. Doctors and pharmacists aim to avoid prescribing medications that interact; often, adjustments in the dose of medications need to be made to avoid interactions. For example, warfarin interacts with many medications and supplements that can cause it to lose its effect.


title: Polypharmacy

text: Pill burden is the number of pills (tablets or capsules, the most common dosage forms) that a person takes on a regular basis, along with all associated efforts that increase with that number - like storing, organizing, consuming, and understanding the various medications in one's regimen. The use of individual medications is growing faster than pill burden. A recent study found that older adults in long term care are taking an average of 14 to 15 tablets every day.


title: Polypharmacy

text: Poor medical adherence is a common challenge among individuals who have increased pill burden and are subject to polypharmacy. It also increases the possibility of adverse medication reactions (side effects) and drug-drug interactions. High pill burden has also been associated with an increased risk of hospitalization, medication errors, and increased costs for both the pharmaceuticals themselves and for the treatment of adverse events. Finally, pill burden is a source of dissatisfaction for many patients.


title: Polypharmacy

text: High pill burden was commonly associated with antiretroviral drug regimens to control HIV, and is also seen in other patient populations. For instance, adults with multiple common chronic conditions such as diabetes, hypertension, lymphedema, hypercholesterolemia, osteoporosis, constipation, inflammatory bowel disease, and clinical depression can often be prescribed more than a dozen different medications daily. The combination of multiple drugs has been associated with an increased risk of adverse drug events.


title: Polypharmacy

text: Reducing pill burden is recognized as a way to improve medication compliance. This is done through "deprescribing", where the risks and benefits are weighed when considering whether to continue a medication. This includes drugs such as bisphosphonates (for osteoporosis), which are often taken indefinitely although there is only evidence to use it for five to ten years. Patient educational programs, reminder messages, medication packaging, and the use of memory tricks has also been seen to improve adherence and reduce pill burden in several countries. These include associating medications with mealtimes, recording the dosage on the box, storing the medication in a special place, leaving it in plain sight in the living room, or putting the prescription sheet on the refrigerator. The development of applications has also shown some benefit in this regard. The use of a polypill regimen, such as combination pill for HIV treatment, as opposed to a multi-pill regimen, also alleviates pill burden and increases adherence.


title: Polypharmacy

text: The selection of long-acting active ingredients over short-acting ones may also reduce pill burden. For instance, ACE inhibitors are used in the management of hypertension. Both captopril and lisinopril are examples of ACE inhibitors. However, lisinopril is dosed once a day, whereas captopril may be dosed 2-3 times a day. Assuming that there are no contraindications or potential for drug interactions, using lisinopril instead of captopril may be an appropriate way to limit pill burden.


title: Polypharmacy

text: The most common intervention to help people who are struggling with polypharmacy is deprescribing. Deprescribing can be confused with medication simplification, which does not attempt to reduce the number of medicines but rather reduce the number of dose forms and administration times. It is important to acknowledge that medication use does not appear to be influenced by paper-based or electronic prescribing. Deprescribing refers to reducing the number of medications that a person is prescribed and includes the identification and discontinuance of medications when the benefit no longer outweighs the harm. In elderly patients, this can commonly be done as a patient becomes more frail and treatment focus needs to shift from preventative to palliative. Deprescribing was also deemed feasible and effective in other settings such as residential care, communities and hospitals. This preventative measure should be considered for anyone who exhibits one of the following: (1) a new symptom or adverse event arises, (2) when the person develops an end-stage disease, (3) if the combination of drugs is risky, or (4) if stopping the drug does not alter the disease trajectory.


title: Polypharmacy

text: Several tools exist to help physicians decide when to deprescribe and what medications can be added to a pharmaceutical regimen. The Beers Criteria and the STOPP/START criteria help identify medications that have the highest risk of adverse drug events (ADE) and drug-drug interactions. The Medication appropriateness tool for comorbid health conditions during dementia (MATCH-D) is the only tool available specifically for people with dementia, and also cautions against polypharmacy and complex medication regimens.


title: Polypharmacy

text: Barriers faced by both physicians and people taking the medications have made it challenging to apply deprescribing strategies in practice. For physicians, these include fear of consequences of deprescribing, the prescriber's own confidence in their skills and knowledge to deprescribe, reluctance to alter medications that are prescribed by specialists, the feasibility of deprescribing, lack of access to all of patients' clinical notes, and the complexity of having multiple providers. For patients who are prescribed or require the medication, barriers include attitudes or beliefs about the medications, inability to communicate with physicians, fears and uncertainties surrounding deprescribing, and influence of physicians, family, and the media. Barriers can include other health professionals or carers, such as in residential care, believing that the medicines are required.


title: Polypharmacy

text: The effectiveness of specific interventions to improve the appropriate use of polypharmacy such as pharmaceutical care and computerised decision support is unclear. This is due to low quality of current evidence surrounding these interventions. High quality evidence is needed to make any conclusions about the effects of such interventions in care homes. Deprescribing rounds has been proposed as a potentially successful methodology in reducing polypharmacy. Sharing of positive outcomes from physicians who have implemented deprescribing, increased communication between all practitioners involved in patient care, higher compensation for time spent deprescribing, and clear deprescribing guidelines can help enable the practice of deprescribing. Despite the difficulties, a recent blinded study of deprescribing reported that participants used an average of two fewer medicines each after 12 months showing again that deprescribing is feasible.


title: California State University, Chico

text: California State University, Chico, or commonly, Chico State, is a public university in Chico, California. Founded in 1887, it is the second oldest campus in the California State University system. As of the fall 2020 semester, the university had a total enrollment of 16,630 students. The university offers 126 bachelor's degree programs, 35 master's degree programs, and four types of teaching credentials. Chico is a Hispanic-serving institution (HSI).


title: California State University, Chico

text: On March 12, 1887, a legislative act was enacted to create the Northern Branch of the California State Normal School. Less than a month later, Chico was chosen as the location. On June 24, 1887, General John Bidwell donated of land from his cherry orchard. Then on July 4, 1888, the first cornerstone was laid. On September 3, 1889, doors opened for the 90 enrolled students. The library opened on January 11, 1890, with 350 books. On June 20, 1891, the first graduation took place, a class of 15.


title: California State University, Chico

text: In 1910, Annie Kennedy Bidwell donated an additional of land to be used for work with elementary agriculture. The next year Mrs. Bidwell donated an orange orchard lot 55 × as the children's playground, which is connected to the Training School. Twenty years later in 1921, legislation was enacted to change the school's name to Chico State Teacher's College. In 1922, Chico State Teacher's College added a junior college curriculum and awarded a certificate after two years. Also in 1922, Bidwell Mansion was turned into a women's dormitory, Bidwell Hall. In 1923 the first college paper, "The Collegian", was published. In 1924, the state Board of Education allowed the school to grant baccalaureate degrees. Also in 1924, the wildcat was chosen as the mascot. In 1925 the alumni organization was founded. In 1927 a fire destroyed the Normal Building. That same year a gym was built on the grounds of Bidwell Mansion. In 1929, the cornerstone for the new administration building was laid on top of Normal Building's original cornerstone. In 1929 the student bookstore was established.


title: California State University, Chico

text: In 1935, Bidwell Hall was turned into a recreation and student center—the first student union. Also in 1935 a legislative act changed the college name from Chico State Teachers College to Chico State College. In 1937 evening classes started on campus and athletic fields were purchased from the Chico Board of Education. In 1939, chimes were installed in library tower. Sororities held a fund drive to raise $600 for them. In 1940 the college offered civilian pilot classes.


title: California State University, Chico

text: In 1948, dorms for 500 male students were set up on west side of Warner Street. The buildings were built during World War II and were used as bachelor quarters for a Marine Hospital in Klamath Falls, Oregon. They were brought to Chico State in sections and reconstructed in the spring of 1948. The two-story barrack-like structures had 36 rooms, each occupied by 4 students. North Hall later became a female dormitory. The speech and debate team was founded by Herbert Rae, Speech & Drama Department Chair.


title: California State University, Chico

text: In 1950, California's governor allowed state colleges to grant Master of Arts degrees. In 1951 the college reorganized from 18 departments into seven divisions with chairmen. Then in 1956 a new flagpost and sign in front of Kendall Hall was donated by the class of 1956. In the following year, 1957, a new cafeteria was built and the rose gardens were planted. In 1958 the first "telecourse" was taught, Psychology 51.


title: California State University, Chico

text: KCSC, a student-run radio station, launched, broadcasting old-time radio dramas on the campus public address system in 1951.


title: California State University, Chico

text: In 1972, Chico State College became California State University, Chico as a result of legislation passed in 1971.


title: California State University, Chico

text: In 1975, broadcasts of classes through closed circuit TV were used for the first time by residents in Oroville, Marysville and Colusa. Also in 1975," The Orion", the campus student newspaper, published its first issue. In 1977, the other campus paper, "The Wildcat", changed its name to "Chico News and Review" and moved off campus to become an independent publication. In 1978 bike riding was restricted on campus.


title: California State University, Chico

text: Chico State's library was renamed in 1981 for father and son Morrison E. Meriam, professor of psychology from 1902 to 1934, and Theodore "Ted" Meriam, community leader, alumnus, and friend of the university, a member of the California State University Board of Trustees from 1961 to 1971, and its chair from 1968 to 1969.


title: California State University, Chico

text: In 1987, Chico State was ranked as the top party school in the nation by "Playboy." Chico State is no longer included on Playboy's list of party schools.


title: California State University, Chico

text: In 2005, student Matt Carrington was hazed to death at the Chi Tau (local) house, which had previously been expelled from the university in 2001 due to violations. Carrington died as a result of water intoxication during a hazing session involving the victim being forced to exercise and drink large quantities of water.


title: California State University, Chico

text: In 2010, the President of the Associated Student body, Joseph Igbineweka, was stabbed in a racially motivated attack.


title: California State University, Chico

text: In 2011, CSU, Chico received a Civic Learning Initiative Grant from the W. M. Keck Foundation to extend its efforts to establish civic engagement as a key component of students' academic success.


title: California State University, Chico

text: The university has more than 75 departments and offers more than 150 undergraduate degrees. It is organized into seven colleges and four schools:


title: California State University, Chico

text: The university's library, the Meriam Library, has several special collections of Native American and Californian history.


title: California State University, Chico

text: According to the "U.S. News & World Report" 2023 college rankings, Chico State was ranked at 13th for "Best Colleges for Veterans", tied 10 in Top Public Schools, 22 in Top Performers on Social Mobility, 70 in Best Undergraduate Engineering Programs teeing 12 in Civil Engineering and 206 in Nursing.


title: California State University, Chico

text: According to the "U.S. News & World Report" 2022 college rankings, Chico State was ranked tied at 17th for "Best Colleges for Veterans", tied 18 in Top Public Schools, tied 24 in Top Performers on Social Mobility, tied 75 in Best Undergraduate Engineering Programs and tied for 251 in Nursing.


title: California State University, Chico

text: According to the "U.S. News & World Report" 2021 college rankings, Chico State was ranked tied for 9th among 66 western regional public universities, tied at 16th for "Best Colleges for Veterans", tied at 22nd for "Best Undergraduate Teaching", tied at 41st for "Social Mobility", and tied for 26th overall among 127 regional universities in the western United States. Lastly it tied at 91 in Best Undergraduate Engineering Program at a schools where doctorate not offered.


title: California State University, Chico

text: Chico State was ranked 335th out of 650 colleges, universities, and service academies in the U.S. in the 2019 "Forbes" America's Top Colleges list, and was ranked 68th in the West, 73rd for "Best Value", and 113th among all public universities.


title: California State University, Chico

text: The California State University, Chico campus consists of a 119-acre main campus, the 800-acre Paul L. Byrne Memorial University Farm, and 2,330-acres of ecological reserves. These reserves include the Big Chico Creek Ecological Reserve (BCCER) and the Butte Creek Ecological Preserve (BCEP).


title: California State University, Chico

text: The construction of the normal school building was begun in September, 1887. It was a large brick building, consisting of three stories and full basement. It was of Romanesque design with Elizabethan gables and artificial stone trimmings. The building was destroyed by a fire in 1927. The current administration building Kendall Hall was built on the site of the normal school in 1929.


title: California State University, Chico

text: Colusa Hall, completed in 1921 is the oldest building on campus. It was used for purposes related to the industrial arts, but now the building is now used as a conference and public events facility.


title: California State University, Chico

text: The Campus Arboretum is located across the campus of California State University, Chico along Big Chico Creek.


title: California State University, Chico

text: Nearby Bidwell Park includes of a former arboretum, now run somewhat wild, which contains trees such as English oaks, hawthorn, cherry plum, bay laurel, cork oak, ponderosa, aleppo, and Monterey pines, willow, mulberry, linden, maple, catalpa, pine, and eucalyptus, collected from around the world.


title: California State University, Chico

text: Currently, the university can accommodate 2,150 or approximately 13% of the student body in seven on-campus residential halls. Sutter, Whitney, Shasta and Lassen halls are on the main campus, while Esken, Mechoopda and Konkow are near the athletic fields about a block and a half away from the main campus. Whitney, Shasta and Lassen are the names of major mountains in Northern California, and the others are named after Native American tribes which used to inhabit the area. Most buildings that make up the campus are named after counties in California. University Village or "UV" is a university-owned dorm about a mile off campus. The university opened its newest dorm, Sutter Hall, for the fall 2010 semester. It is located between Whitney and Shasta and Lassen halls. For much of the fall 2010 semester, Sutter Hall's dining area remained closed. However, it opened in the spring 2011 semester, featuring new dining options for students.


title: California State University, Chico

text: Meriam Library started out as an unnamed library in 1887, housed in what was then known as Chico State Normal School. In 1927, the Normal School building and its library burned down in a fire. The library found a new home in 1933 when a new building, Trinity Hall, was constructed. In 1959, Chico State College Library was built. The library was expanded and renamed to the "Learning Activities Resource Center" (LARC) in 1975. It was in 1985 when the library gained another expansion and its current name, Meriam Library. This name was dedicated after the family of Ted Meriam. A fourth floor of the library was constructed in 1985.


title: California State University, Chico

text: Associated Students, Chico is the student government at California State University, Chico. Associated Students, Chico owns and operates several student services on-campus including all vending machines, and foodservices, as well as the campus bookstore. The students of CSU, Chico also own their own student union building named the Bell Memorial Union which houses the "Marketplace Cafe", the "Chico State Wildcat Store", and the student government offices. Student officers are elected annually from among and by the students. Students are assessed a mandatory Activity Fee at registration which funds the student government and other programs.


title: California State University, Chico

text: The AS is generally divided into three areas, each the responsibility of one of three Associated Students standing committees. The AS' role as a government is manifested in the Government Affairs Committee. The student union is administered under the original authority of the Bell Memorial Union Committee. The administration of the businesses is under the original authority of the Business Committee. All of these areas are under the ultimate authority of the AS Board of Directors.


title: California State University, Chico

text: Student Life and Leadership, formally the Student Activities Office, incorporates four programs: Student Organizations and Leadership Education (SOLE), Fraternity and Sorority Affairs (FSA), Rec Sports, and the Cross-Cultural Leadership Center (CCLC).


title: California State University, Chico

text: Chico State formed an event where Chico State students gather in a public area and discuss most current policy issues with their peers. Faculty members are also involved in this event. This event happens annually and students look forward to it all year. Once the opening comments and the welcome occur in the Bell Memorial Union Auditorium, the participants explore different locations on campus for "breakout sessions". These sessions give students a chance to share their research with their peers. Students have commented saying this event has inspired them to get more involved in the community and stay educated about current politics.


title: California State University, Chico

text: The Great Debate was created to drive members of both the campus and the community to take part in a conversation about issues that have the ability to divide the community. There is a different topic that takes place every semester. An example of a topic is Climate Change. The event requires a full day where presentations and debates take place. Students partake in active listening and respectful communication exchange. Students from Communication Studies classes are the students who give presentations based on a previously chosen topic. At 6:15 pm, a formal debate is held by CSU, Chico Debate Team members and stakeholder Community Members.


title: California State University, Chico

text: Chico State has 26 fraternities and sororities, making up approximately 12 percent of the student population.


title: California State University, Chico

text: The Fraternity and Sorority Affairs (FSA) program embodies three Greek governed councils: the Interfraternity Council (IFC), the Multicultural Greek Council, and the Panhellenic Council.


title: California State University, Chico

text: Fraternities in the IFC include Alpha Sigma Phi, Kappa Sigma, Delta Chi, Lambda Chi Alpha, Phi Delta Theta, Phi Kappa Tau, Tau Kappa Epsilon, Sigma Nu and Sigma Pi. The Panhellenic Council includes Alpha Delta Pi, Alpha Gamma Delta, Alpha Omicron Pi, Alpha Phi, Gamma Phi Beta and Sigma Kappa. The Multicultural Greek Council includes Delta Xi Phi, Lambda Theta Nu, Lambda Theta Alpha, Lambda Sigma Gamma, Sigma Omega Phi, Upsilon Kappa Delta, Epsilon Sigma Rho, Nu Alpha Kappa and Gamma Zeta Alpha.


title: California State University, Chico

text: CSU Chico along with CSU Bakersfield has the second largest enrollment percentage of Native Americans in the Cal State system.


title: California State University, Chico

text: KCSC Radio was founded in 1951. The university's student-run weekly newspaper, "The Orion" first began publishing in 1975. In 1989, "The Orion" won the National Pacemaker Award, the first of nine times the paper has won the top prize in college journalism. In 2009, "The Orion" won the National Pacemaker Award for the 11th time at the College Media Convention.


title: California State University, Chico

text: In 1997 Wild Oak Music Group, an independent record company, was founded and is run by the Music Industry students within the College of Humanities and Fine Arts.


title: California State University, Chico

text: The university's athletic teams are known as the Chico State Wildcats. The school sponsors soccer, basketball, golf, cross country, and track and field for both men and women. The school sponsors softball and volleyball for women, and baseball for men. The school's athletic director is Anita Barker. The school competes in Division II of the National Collegiate Athletic Association (NCAA) in the California Collegiate Athletic Association (CCAA). Since 1998, Chico State's athletic teams have won 99 NCAA Championship berths, 40 CCAA titles, 24 West Region titles, and 15 NCAA national titles. The Wildcats softball team won the first AIAW Division III national championship in 1980, led by pitcher Kathy Arendsen. Chico excels in cross country and track and field in the California Collegiate Athletic Association.


title: California State University, Chico

text: The Wildcats of Chico State earned six team NCAA championships at the Division II level. NCAA Division II individual championships by Scott Bauhs (2008) Men's cross country and J. J. Jakovac (2002, 2004) and Kyle Souza (2011) Men's Golf Championships.


title: California State University, Chico

text: Chico State also has many club sports teams, including the Chico State Men's Rugby Club which plays in the division 1AA Pacific Western Rugby Conference. The team has won the title of 15's Champions in 2013, 2018, and 2019. They went on in their 2019 season to compete against Dartmouth for the 15's National Spring Championship, but fell short with Dartmouth winning the title.


title: California State University, Chico

text: Chico State made "The Princeton Review" 2011 "Guide to Green Colleges", honoring campuses that "demonstrate a strong commitment to sustainability in their academic offerings, campus infrastructure, activities, and career preparation."


title: Rohan Sippy

text: Rohan Sippy is an Indian film director and producer, he worked as a director in films like "Kuch Naa Kaho" (2003), "Bluffmaster!" (2005), "Dum Maaro Dum" (2011) and "Nautanki Saala" (2013).


title: Rohan Sippy

text: He is the son of Ramesh Sippy, the director of the Hindi blockbuster film "Sholay", and grandson of producer G. P. Sippy. Sippy studied at the Aiglon College in Switzerland and pursued his undergraduate degree at Stanford University.


title: Rohan Sippy

text: Rohan Sippy was married to Rohena Gera, who also went to Stanford and is now a screenwriter. They got divorced in 2003. He then married Roopa in 2009 and had a baby girl named Inaya on 27 November 2012.


title: Rohan Sippy

text: His latest directorial venture was "Nautanki Saala!" starring Ayushmann Khurrana and Kunaal Roy Kapur was released on 12 April 2013, in India.


title: Anna Silk

text: Anna Silk (born 31 January 1974) is a Canadian actress best known for her role as Bo Dennis, the protagonist of the Showcase television series "Lost Girl" (2010–2015).


title: Anna Silk

text: Silk was born in Fredericton, New Brunswick, Canada, the daughter of Peter Silk, an academic, and Ilkay Silk, an actress, director, producer, playwright, educator, and Director of Drama at St. Thomas University. Her father is British and her mother a "Turkish Cypriot-English expat". Some of Anna's earliest memories were of going to play rehearsals and watching her mother work. Silk appeared in several commercials as a child. She graduated from St. Thomas University with a Bachelor of Arts degree in 1997. Early theater work includes at least two productions with Theatre St. Thomas: Seven Menus and The Kitchen.


title: Anna Silk

text: In November 1999, she moved to Toronto to further her acting career and during the following decade relocated to Los Angeles, California. She met Seth Cooperman in 2007 at an actor's workshop in Los Angeles; they became engaged in 2009, and married in a civil ceremony in December of the same year. On April 10, 2011, they renewed their vows in a Jewish ceremony in Fredericton after she converted to Judaism.


title: Anna Silk

text: During a Showcase "Lost Girl" pre-show special on January 6, 2013, Silk announced that she was pregnant. On June 20, 2013, she announced via Twitter that she was ready to return to work on the series.


title: Anna Silk

text: Silk gave birth to a son, Samuel Jerome Cooperman, in May 2013. Her second son, Levi Aaron Cooperman, was born on May 13, 2016.


title: Anna Silk

text: Silk's television work includes the role of Cassidy Holland in "Being Erica," for which she received a Gemini Awards nomination in 2009.


title: Anna Silk

text: In 2009, she landed the principal role of Bo Dennis, a succubus, in the Canadian television series "Lost Girl." The same-sex-lover pair of Bo (Silk's character) and Lauren (played by co-star Zoie Palmer) was included in news network CNN's list of all-time "Favorite TV Couples"; and declared "Top TV Couple of 2013" by E! Entertainment Television. As a result of the show's popularity, Silk garnered a prominent online following on social media.


title: CD-RW

text: CD-RW (Compact Disc-Rewritable) is a digital optical disc storage format introduced in 1997. A CD-RW compact disc (CD-RWs) can be written, read, erased, and re-written.


title: CD-RW

text: CD-RWs, as opposed to CDs, require specialized readers that have sensitive laser optics. Consequently, CD-RWs cannot be read in many CD readers built prior to the introduction of CD-RW. CD-ROM drives with a "MultiRead" certification are compatible.


title: CD-RW

text: CD-RWs must be erased or blanked before reuse. Erasure methods include full blanking where the entire surface of the disc is erased and fast blanking where only metadata areas, such as PMA, TOC and pregap, are cleared. Fast blanking is quicker and usually sufficient to allow rewriting the disc. Full blanking removes all traces of the previous data, and is often used for confidentiality purposes.


title: CD-RW

text: CD-RWs can sustain fewer re-writes compared to other storage media (ca. 1,000 compared up to 100,000). Ideal use is for test discs (e.g. for CD authoring), temporary backups, and as a middle-ground between online and offline storage schemes.


title: CD-RW

text: Before CD-RW technology, in 1990 a standard for magneto-optical recordable and erasable CDs called CD-MO was introduced and set in the Orange Book, part 1 as a CD with a magneto-optical recording layer. The CD-MO standard allowed for an optional non-erasable zone on the disc that could be read by CD-ROM units.


title: CD-RW

text: Data recording (and erasing) was achieved by heating the magneto-optical layer's material (e.g. DyFeCo or less often TbFeCo or GdFeCo) to its Curie point and then using a magnetic field to write the new data, in a manner essentially identical to Sony's MiniDisc and other magneto-optical formats. Reading the discs relied on the Kerr effect a major format flaw. The rewrite could only be read in special drives and was incompatible with non-magneto-optical enabled drives. The format was never released commercially, mostly because of incompatibility with standard CD reading units. Early CD-R media contained a similar compatibility flaw.


title: CD-RW

text: Since the CD-MO was otherwise identical to CDs, the format still adopted a spiral-groove recording scheme, rendering the disc poorly suited as a removable medium for repeated, small-scale deletions and recordings. Some magneto-optical drives and media with the same form factor don't have this limitation. Unlike modern CD-RWs, CD-MO allowed for hybrid discs containing both an unmodifiable, pressed section, readable in standard drives, and a writable MO section.


title: CD-RW

text: The early introduction and no standards for disc recording software, file systems, and formats, physical incompatibility, coupled with more economical CD-R discs, led to abandoning the format. Other magneto-optical media, unbound by limitations of the typical CD-ROM filesystems, replaced the CD-MO.


title: CD-RW

text: Rewritable media can, with suitable hardware, be re-written up to . The CD-RW is based on phase change technology, with a degree of reflection at , compared to for CD-R discs. The properties of the medium and the write and erase procedure is defined in the Orange Book Part III.


title: CD-RW

text: To maintain a precise rotation speed, tracks have a slight superimposed sinusoidal excursion of at a frequency of . In addition a frequency modulation is applied to provide the recorder with an absolute time reference. Groove width is and pitch of .


title: CD-RW

text: The media for CD-RW has the same layers as CD-R media. The reflective layer is, however, a silver-indium-antimony-tellurium (AgInSbTe) alloy with a polycrystalline structure and reflective properties in its original state. When writing the laser beam uses its maximum power () to heat the material to causing material liquefaction. In this state, the alloy loses its polycrystalline structure and reflectivity and assumes an amorphous state. The lost reflectivity serves the same function as bumps on manufactured CDs and the opaque spots on a CD-R are read as a "0". The polycrystalline state of the disc forms the trenches, which are read as "1". The scanning signal when reading is created by strong or weak reflection of the laser beam. To erase the disc, the write beam heats the amorphous regions with low power to about . The alloy is not melted, but returns to the polycrystalline state and is again reflective.


title: CD-RW

text: During and after a disc authoring the distribution of data on the CD-RW varies. The following areas are present:


title: CD-RW

text: Each session on a multi-session disc has a corresponding lead-in, PMA, PA and lead-out. When the session is closed TOC information in the PMA is written into a lead-in area and the PCA and PMA are logically eliminated. The lead-out is created to mark the end of the data in the session.


title: CD-RW

text: Like a CD-R, a CD-RW has hardcoded speed specifications which limit recording speeds to fairly restrictive ranges. Unlike a CD-R, a CD-RW has a minimum writing speed under which the discs cannot be recorded, based on the phase change material's heating and cooling time constants and the required laser energy levels. Despite this, some professional audio CD recorders, such as those made by Tascam, use special techniques to bypass these limitations and can record high speed (but not ultra speed) discs in realtime.


title: CD-RW

text: Since the CD-RW discs need to be blanked before recording data, writing too slowly or with too low energy on a high speed unblanked disc will cause the phase change layer to cool before blanking is achieved, preventing the data from being written.


title: CD-RW

text: Similarly, using inappropriately high amounts of laser energy will cause the material to overheat and be "insensitive" to the data, a situation typical of slower discs used in a high powered and fast specification drive.


title: CD-RW

text: For these reasons, older CD-RW drives that lack appropriate firmware and hardware are not compatible with newer, high-speed CD-RW discs, while newer drives can record to older CD-RW discs, provided their firmware correct speed, delay, and power settings can be appropriately set.


title: CD-RW

text: The actual reading speed of CD-RW discs, however, is not directly correlated or bound to speed specification, but depends primarily on the reading drive's capabilities.


title: CD-RW

text: Many half-height CD and DVD writers released between 2004 and 2010, including the "TSSTcorp SH-M522" combo drive (2004), Pioneer "DVR-110D" (2005), Hitachi-LG "GSA-4167" (2005)"," TSSTcorp "SH-S182/S183" (2006) and "SH-S203/TS-H653B" (2007) have officially adapted support for CD-RW "UltraSpeed Plus" (32× Z-CLV), while more recent DVD writers such as the "SH-224DB" (2013) and Blu-Ray writers such as the "LG BE16NU50" (2016) have downgraded the backwards compatibility to CD-RW "UltraSpeed" (24× Z-CLV).


title: CD-RW

text: "Slim type" optical drives are subject to physical limitations, thus are not able to attain rotation speeds of half-height (desktop) optical drives. They usually support CD-RW writing speeds of 16× or 24× Z-CLV in zones of 10× CLV, 16× CLV, 20× CLV and 24× CLV towards the outer edge, of which the highest speed zone depends on availability.


title: The Silenced

text: The Silenced (; lit. "Gyeongseong School: The Lost Girls") is a 2015 South Korean mystery-thriller film written and directed by Lee Hae-young, starring Park Bo-young and Uhm Ji-won.


title: The Silenced

text: Set in Gyeongseong in 1938 during the Japanese occupation, the film centers on Ju-ran/ Shizuko (Park Bo-young), a sickly young girl who gets transferred to a sanatorium/girls' boarding school to recover her health. Her physical condition improves thanks to her new friend Yeon-deok, and the headmistress' special treatment program. But she soon notices that students are disappearing one by one and that her own body is undergoing abnormal changes. Determined to uncover the truth, Ju-ran starts to investigate the mysterious happenings and the school's possible role in them.


title: The Silenced

text: Shizuko begins seeing a couple of her classmates in terrible positions; bleeding out or having severe seizures. The school denies that anything unusual is happening in an effort to convince Shizuko that it is all in her head. After being confronted by her classmate Yuka, Shizuko snaps and in a violent rage almost strangles Yuka to death with a single hand showing incredible strength. Shizuko does not understand what is happening to her or to the other girls in the school and with the help of Yeon-deok, who now recalls other horrors from her time there, decides to investigate by breaking into the headmistress' office. While in the headmistress' office, they overhear an argument between her and a young man dressed in a Japanese military uniform. The argument is about a new drug and apparently losing test subjects, referring to Shizuko's disappearing classmates. When the headmistress and the soldier leave the office, Shizuko and Yeon-deok continue their snooping eventually finding an experiment proposal written in Japanese describing a performance-enhancing drug that aims to alter the human condition making the subjects super strong but also heightening their emotions and causing many adverse side-effects. This reveals that The Imperial Japan is using the girls as lab rats to create drugs to enhance performance of Japanese troops against the allies. Shizuko and Yeon-deok also find movies of themselves and a previous cohort that demonstrate the effects of the drug. The two students then hear a commotion outside culminating in the attempted suicide of Yuka. In the ensuing chaos they try to escape the school by running into the forest, only to find that they are at the edge of a massive Japanese military base. Shizuko and Yeon-deok are then captured by Japanese commander and brought back to the facility.


title: The Silenced

text: The Japanese commander states to the principal that he will take over the experimentation from now, much to her dismay. Yeon-deok drowned in a tank, causing Shizuko to wake up after hearing her screams. Shizuko then goes on a rampage and kills all the Japanese soldiers at the facility. The councilor is brutalized by the girls as Shizuko tells them about everything. The principal tries to kill Shizuko but hits the water tank with Yeon-deok in it. Shizuko, distraught at her friend's demise, throws the principal at a spike hanging on the wall, which kills her. Shizuko then proceeds to attack the Japanese base in a fit of rage.


title: The Silenced

text: "The Silenced" was released on June 18, 2015. It opened at third place, grossing () from 258,000 admissions in its first four days.


title: Mandy Takhar

text: Mandy Takhar is a British actress who works in Indian cinema, predominantly in Punjabi with roles in Hindi and Tamil films as well.


title: Mandy Takhar

text: Mandy Takhar was born and raised in the city of Wolverhampton in the UK. She traces her roots to Maliana, a small village near Phagwara in Punjab, India. She moved to London from her family home when she was 17, to study drama at the Kingston University and then left the UK in 2009 to work as an actor in the Indian film industry.


title: Mandy Takhar

text: Mandy moved to Mumbai and landed the role opposite renowned Punjabi singer Babbu Mann in the 2010 film, "Ekam - Son of Soil". She played the lead role opposite the superstar Gippy Grewal in the film "Mirza - The Untold Story". She played Sahiba in this modern adaptation of the love story of Mirza-Sahiba. Her portrayal of Sahiba got her nominated for the best actress at the PTC Punjabi Film Awards.


title: Mandy Takhar

text: In 2013, she starred in "Tu Mera 22 Main Tera 22" a comedy alongside Amrinder Gill and Honey Singh. She played the role of a teacher and won hearts again and got the award for most prominent & popular face and youth Icon of 2012-2013 at the 6th Punjabi Film and Music Festival.


title: Mandy Takhar

text: She made her debut in Tamil cinema with Venkat Prabhu's "Biriyani" starring Karthi. She won the award for best supporting actor at PTC Punjabi Film Awards.


title: Queen's Gambit Accepted

text: The Queen's Gambit Accepted is the third most popular option on Black's second move, after 2...e6 (the Queen's Gambit Declined) and 2...c6 (the Slav Defense).


title: Queen's Gambit Accepted

text: The Queen's Gambit is not considered a true gambit, in contrast to the King's Gambit, because the pawn is either regained, or can only be held unprofitably by Black. Black usually allows the pawn to be recaptured, and uses the time expended to play against White's centre.


title: Queen's Gambit Accepted

text: As Black's 2...dxc4 surrenders the centre, White will try to seize space in the centre and use it to launch an attack on Black's position. Black's game is not devoid of counterchances, however. If the white centre can be held at bay, Black will try to weaken White's centre pawns to gain an advantage in the ensuing endgame by playing ...c5 and ...cxd4 at some stage. If White responds with exd4, the result will be an isolated pawn on d4 – which can also lead to a keen middlegame battle. If White recaptures with a piece at d4 instead, the centre will be liquidated and a fairly even game will usually ensue.


title: Queen's Gambit Accepted

text: The "Encyclopaedia of Chess Openings" ("ECO") classifies the Queen's Gambit Accepted under codes D20 to D29.


title: Queen's Gambit Accepted

text: While the Queen's Gambit Accepted was mentioned in literature as early as the 15th century, it was the World Chess Championship 1886 between Wilhelm Steinitz and Johannes Zukertort which introduced the first modern ideas in this opening. Black's play had, until then, centred on holding on to the c4-pawn. Steinitz's plan was to return the pawn, but inflict White with an isolated pawn on d4, then play to exploit the weakness.


title: Queen's Gambit Accepted

text: Even with the modern treatment, the opening suffered from a slightly dubious reputation in the early 20th century, even as Alexander Alekhine introduced further ideas for Black and it was played at the highest levels, beginning in the 1930s, though becoming less popular after World War II, as the Indian Defenses were heavily played. At the end of the 1990s, a number of players among the world elite included the Queen's Gambit Accepted in their repertoires, and the line is currently considered sound.


title: Queen's Gambit Accepted

text: After 1.d4 d5 2.c4 dxc4, the most popular move is 3.Nf3, but there are other moves which have been played by strong grandmasters. The main variations below are in order of popularity.


title: Queen's Gambit Accepted

text: The main lines of the QGA begin with this move. White delays measures to regain the pawn for the moment and prevents Black from striking at the centre with ...e5. The recovery of the pawn will usually be done through 4.e3 and 5.Bxc4. Black's most common rejoinder is 3...Nf6, though the variation 3...a6 was introduced by Alexander Alekhine and bears his name.


title: Queen's Gambit Accepted

text: This is the Alekhine Variation. White usually continues 4.e3. 4...Nf6 tends to return to the main line. This is an uncommon line that mainly focuses on rapid development of pieces along with domination of the centre. This variation was debuted by Alexander Alekhine against Efim Bogoljubov in 1929.


title: Queen's Gambit Accepted

text: White can try to establish a strong pawn centre with 3.e4, an old move that became popular again in the 1990s. Rizzitano calls it the Central Variation and notes its increase in popularity and strategic and tactical complexity. Raetsky and Chetverik consider the line straightforward and critical, and remark that anyone playing the Queen's Gambit Accepted must be prepared to meet it.


title: Queen's Gambit Accepted

text: Trying to protect the pawn with 3...b5 is fairly risky and rarely seen. The main reply against the Central Variation is to oppose the pawn centre with 3...e5, which is a highly theoretical system. Other replies aimed at challenging the centre are 3...Nc6 with ideas akin to the Chigorin Defense, 3...Nf6, provoking 4.e5, and 3...c5 undermining the centre at d4.


title: Queen's Gambit Accepted

text: The apparently modest 3.e3 prepares immediate recovery of the pawn and has often been employed by strong players, including Anatoly Karpov. The line long had a harmless reputation due to the early discovery of 3...e5 which strikes back at the centre. A typical continuation is then 4.Bxc4 exd4 5.exd4, leading to an isolated queen's pawn position. However, the open positions which ensue have not proved easy for Black to handle in practice, and many players simply play 3...e6 to transpose back to the main lines. Nonetheless, 3...e5 was Rizzitano's recommendation in his repertoire against 3.e3.


title: Queen's Gambit Accepted

text: An opening trap where Black tries clinging onto the c4-pawn was pointed out by Alessandro Salvio in 1604. If Black defends the pawn with 3...b5? 4.a4 c6 5.axb5 cxb5??, the a8–h1 diagonal has been fatally weakened and 6.Qf3 wins a . Trying to defend the pawn by 3...Be6 may hold on to the pawn, but White has good compensation after 4.Ne2.


title: Queen's Gambit Accepted

text: 3.Nc3 was labelled "misguided" by Raetsky and Chetverik, because the development does not control d4 and e5, and the knight is vulnerable to a b-pawn advance from Black. 3...e5, 3...Nf6, and 3...a6 are all reasonable replies, and 3...Nc6 leads to a standard line in the Chigorin Defense. 3. Nc3 was recommended by Keene and Jacobs in their opening repertoire for White.


title: Queen's Gambit Accepted

text: The queen check by 3.Qa4+ Nc6 4.Nf3 will quickly regain the pawn with Qxc4, but the early development of the queen allows Black to win time by harassing it, so this line is rarely played.


title: Nina Temple

text: Nina Claire Temple (born 21 April 1956) is a British politician who was the last Secretary of the Communist Party of Great Britain and was formerly a think-tank director in the United Kingdom.


title: Nina Temple

text: Temple was born in Westminster, London, the daughter of Barbara J. (Rainnie) and Landon Roy Temple. Born into a communist family (her father ran Progressive Tours and was a Communist Party of Great Britain member), she joined the Young Communist League when she was 13, later protesting in London against the Vietnam War. She has a degree in materials science from Imperial College, London. She is the sister of film director Julien Temple and the aunt of actress Juno Temple.


title: Nina Temple

text: During the late 1970s she was general secretary of the Young Communist League and became a prominent member of the Eurocommunist grouping within the party. She became a member of the CPGB executive in 1979, and then a member of the Political Committee in January 1982.


title: Nina Temple

text: She was the Press and Publicity Officer of the CPGB from January 1983 until 1989, when she became the last (General) Secretary of the party in January 1990, aged 33. She pledged to make the party "feminist and green, as well as democratically socialist." In this role Temple became one of the leading proponents of the dissolution of the CPGB in November 1991 and the founding of its legal successor, the Democratic Left.


title: Nina Temple

text: The Democratic Left continued through the 1990s, becoming the New Politics Network in 1999. Temple was its first director and worked for five years for the Make Votes Count Coalition.


title: Nina Temple

text: In June 2005 she started work as head of Development and Communications at the Social Market Foundation, a role she held until 2008.


title: Nina Temple

text: Temple became ill with Parkinson's disease in 2000. She trained in counselling at the Gestalt Centre in Old Street, and in September 2003 founded Sing For Joy, a choir of people with chronic degenerative diseases.


title: Health care systems by country

text: In this system (also known as single-payer healthcare) government-funded healthcare is available to all citizens regardless of their income or employment status. Some countries may provide healthcare to non-citizen residents, while some may require them to buy private insurance:


title: Health care systems by country

text: In these countries workers have social insurance. Usually government withholds part of their wage, which is divided between employee and employer. People who don't have legal contract of employment and/or can't register as unemployed may be ineligible for free health care:


title: Health care systems by country

text: In this system some people receive healthcare via primary private insurance, while people who are ineligible for it, from government:


title: Health care systems by country

text: In this system people receive healthcare via mandatory private insurance, usually subsidized by the government for low-income citizens:


title: Health care systems by country

text: In this system some citizens have private health insurance, some are eligible for subsidized public health care, while some are not insured at all:


title: Health care systems by country

text: When Algeria gained its independence from France in 1962, there were only around 300 doctors across the whole country and no proper system of healthcare. Over the next few decades, great progress was made in building up the health sector, with the training of doctors and the creation of many health facilities. Today, Algeria has an established network of hospitals (including university hospitals), clinics, medical centres and small health units or dispensaries. While equipment and medicines may not always be the latest available, staffing levels are high and the country has one of the best healthcare systems in Africa. Access to health care is enhanced by the requirement that doctors and dentists work in public health for at least five years. The government provides universal health care.


title: Health care systems by country

text: Medical facilities in Cape Verde are limited, and some medicines are in short supply or unavailable. There are hospitals in Praia and Mindelo, with smaller medical facilities in other places. The islands of Brava and Santo Antão no longer have functioning airports so air evacuation in the event of a medical emergency is nearly impossible from these two islands. Brava also has limited inter-island ferry service.


title: Health care systems by country

text: Eritrea is one of the few countries to be on target to meet its Millennium Development Goal (MDG) targets for health. Researchers at the Overseas Development Institute have identified the high prioritisation of health and education both within the government and amongst Eritreans at home and abroad. Innovative multi-sectoral approaches to health were also identified with the success. About one-third of the population lives in extreme poverty, and more than half survives on less than US$1 per day. Health care and welfare resources generally are believed to be poor, although reliable information about conditions is often difficult to obtain. In 2001, the most recent year for which figures are available, the Eritrean government spent 5.7 percent of gross domestic product on national health accounts. The World Health Organization (WHO) estimated that in 2004 there were only three physicians per 100,000 people in Eritrea. The two-year war with Ethiopia, coming on the heels of a 30-year struggle for independence, negatively affected the health sector and the general welfare. The rate of prevalence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), in Eritrea is believed to be at 0.7%(2012)which is reasonably low. In the decade since 1995, impressive results have been achieved in lowering maternal and child mortality rates and in immunizing children against childhood diseases. In 2008 average life expectancy was slightly less than 63 years, according to the WHO. Immunisation and child nutrition has been tackled by working closely with schools in a multi-sectoral approach; the number of children vaccinated against measles almost doubled in seven years, from 40.7% to 78.5% and the underweight prevalence among children decreased by 12% in 1995–2002 (severe underweight prevalence by 28%). This has helped to some small extent even out rural-urban and rich-poor inequity in health.


title: Health care systems by country

text: Throughout the 1990s, the government, as part of its reconstruction program, devoted ever-increasing amounts of funding to the social and health sectors, which brought corresponding improvements in school enrollments, adult literacy, and infant mortality rates. These expenditures stagnated or declined during the 1998–2000 war with Eritrea, but in the years since, outlays for health have grown steadily. In 2000–2001, the budget allocation for the health sector was approximately US$144 million; health expenditures per capita were estimated at US$4.50, compared with US$10 on average in sub-Saharan Africa. In 2000 the country counted one hospital bed per 4,900 population and more than 27,000 people per primary health care facility. The physician to population ratio was 1:48,000, the nurse to population ratio, 1:12,000. Overall, there were 20 trained health providers per 100,000 inhabitants. These ratios have since shown some improvement. Health care is disproportionately available in urban centers; in rural areas where the vast majority of the population resides, access to health care varies from limited to nonexistent. As of the end of 2003, the United Nations (UN) reported that 4.4 percent of adults were infected with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); other estimates of the rate of infection ranged from a low of 7 percent to a high of 18 percent. Whatever the actual rate, the prevalence of HIV/AIDS has contributed to falling life expectancy since the early 1990s. According to the Ministry of Health, one-third of current young adult deaths are AIDS-related. Malnutrition is widespread, especially among children, as is food insecurity. Because of growing population pressure on agricultural and pastoral land, soil degradation, and severe droughts that have occurred each decade since the 1970s, per capita food production is declining. According to the UN and the World Bank, Ethiopia at present suffers from a structural food deficit such that even in the most productive years, at least 5 million Ethiopians require food relief.


title: Health care systems by country

text: In 2002 the government embarked on a poverty reduction program that called for outlays in education, health, sanitation, and water. A polio vaccination campaign for 14 million children has been carried out, and a program to resettle some 2 million subsistence farmers is underway. In November 2004, the government launched a five-year program to expand primary health care. In January 2005, it began distributing antiretroviral drugs, hoping to reach up to 30,000 HIV-infected adults.


title: Health care systems by country

text: In Ghana, most health care is provided by the government, but hospitals and clinics run by religious groups also play an important role. Some for-profit clinics exist, but they provide less than 2% of health services. Health care is very variable through the country. The major urban centres are well served, but rural areas often have no modern health care. Patients in these areas either rely on traditional medicine or travel great distances for care. In 2005, Ghana spent 6.2% of GDP on health care, or US$30 per capita. Of that, approximately 34% was government expenditure.


title: Health care systems by country

text: Guinea has been reorganizing its health system since the Bamako Initiative of 1987 formally promoted community-based methods of increasing accessibility of primary health care to the population, including community ownership and local budgeting, resulting in more efficient and equitable provision of drugs and other essential health care resources.


title: Health care systems by country

text: In June 2011, the Guinean government announced the establishment of an air ticket solidarity levy on all flights taking off from national soil, with funds going to UNITAID to support expanded access to treatment for HIV/AIDS, tuberculosis and malaria. Guinea is among the growing number of countries and development partners using market-based transactions taxes and other innovative financing mechanisms to expand financing options for health care in resource-limited settings.


title: Health care systems by country

text: Health in Mali, one of the world's poorest nations, is greatly affected by poverty, malnutrition, and inadequate hygiene and sanitation. Mali's health and development indicators rank among the worst in the world. In 2000 only 62–65 percent of the population was estimated to have access to safe drinking water and only 69 percent to sanitation services of some kind; only 8 percent was estimated to have access to modern sanitation facilities. Only 20 percent of the nation's villages and livestock watering holes had modern water facilities.


title: Health care systems by country

text: Mali is dependent on international development organizations and foreign missionary groups for much of its health care. In 2001 general government expenditures on health constituted 6.8 percent of total general government expenditures and 4.3 percent of gross domestic product (GDP), totaling only about US$4 per capita at an average exchange rate. Medical facilities in Mali are very limited, especially outside of Bamako, and medicines are in short supply. There were only 5 physicians per 100,000 inhabitants in the 1990s and 24 hospital beds per 100,000 in 1998. In 1999 only 36 percent of Malians were estimated to have access to health services within a five-kilometer radius.


title: Health care systems by country

text: According to the United States government, Morocco has inadequate numbers of physicians (0.5 per 1,000 people) and hospital beds (1.0 per 1,000 people) and poor access to water (82 percent of the population) and sanitation (75 percent of the population). The health care system includes 122 hospitals, 2,400 health centers, and 4 university clinics, but they are poorly maintained and lack adequate capacity to meet the demand for medical care. Only 24,000 beds are available for 6 million patients seeking care each year, including 3 million emergency cases. The health budget corresponds to 1.1 percent of gross domestic product and 5.5 percent of the central government budget.


title: Health care systems by country

text: Health care system of Niger has a chronic lack of resources and a small number of health providers relative to population. Some medicines are in short supply or unavailable. There are government hospitals in Niamey (with three main hospitals in Niamey, including the "Hôpital National de Niamey" and the "Hôpital National De Lamordé"), Maradi, Tahoua, Zinder and other large cities, with smaller medical clinics in most towns. Medical facilities are limited in both supplies and staff, with a small government health care system supplemented by private, charitable, religious, and Non-government organisation operated clinics and public health programs (such as Galmi Hospital near Birnin Konni and Maradi). Government hospitals, as well as public health programmes, fall under the control of the Nigerien Ministry of Health. A number of private for profit clinics (""Cabinets Médical Privé"") operate in Niamey. The total expenditure on health per capita in 2005 was Intl $25. There were 377 Physicians in Niger in 2004, a ratio of 0.03 per 10,000 population. In 2003, 89.2 percent of individual expenditures on health care were "out-of-pocket" (paid by the patient).