text:
Principal Proposed Uses
Other Proposed Uses
- Anxiety
- Complications of Diabetes
- Depression
- Glaucoma
- Macular Degeneration
- Multiple Sclerosis
- Premenstrual System (PMS)
- Raynaud's Phenomenon
- Vertigo
- Vitiligo
- Increasing Efficacy and Reducing Side Effects of Phenothiazines and Atypical Antipsychotics
Probably Not Effective Uses
- Altitude Sickness
- Sexual Dysfunction in Women or Men Caused by SSRI Antidepressant Drugs
- Tinnitus
Traceable back 300 million years, the ginkgo is the oldest surviving species of tree. Although it died out in Europe during the Ice Age, ginkgo survived in China, Japan, and other parts of East Asia. It has been cultivated extensively for both ceremonial and medical purposes, and some particularly revered trees have been lovingly tended for more than 1,000 years.
In traditional Chinese herbology, tea made from ginkgo seeds has been used for numerous problems, most particularly asthma and other respiratory illnesses. The leaf was not used. But in the 1950s, German researchers started to investigate the medical possibilities of ginkgo leaf extracts rather than remedies using the seeds. Thus, modern ginkgo preparations are not the same as the traditional Chinese herb, and the comparisons often drawn are incorrect.
What Is Ginkgo Used for Today?
Fairly good evidence indicates that ginkgo is effective for Alzheimer's disease and other severe forms of memory and mental function decline; when used for this purpose, it appears to be as effective as standard drugs. 1,2-7,48,50,109,149,163,171
Inconsistent evidence hints that ginkgo might be helpful for enhancing memory and mental function in seniors without severe memory loss as well. 8-14,73,103,110,111,112 Weak evidence hints that ginkgo (alone or in combination with ginseng or vinpocetine ) may be helpful for enhancing memory or alertness in younger people. 15-18,90,113 Combining phosphatidylserine (another substance used to enhance mental function) along with ginkgo might increase its efficacy. 153
In addition, ginkgo may be effective for the treatment of restricted circulation in the legs due to hardening of the arteries known as intermittent claudication . 19-22,114
One substantial, well-designed double-blind, placebo-controlled study found evidence that ginkgo extract taken at a dose of 480 mg or 240 mg daily may be helpful for anxiety . 148
Weak and, in some cases inconsistent, evidence from preliminary double-blind trials hints that ginkgo might be helpful for glaucoma , 72macular degeneration , 68,71conjunctivitis , 168PMS , 29Raynaud's disease , 69sudden hearing loss , 32,33vertigo , 31 and vitiligo . 115
Although study results conflict, on balance the evidence suggests that ginkgo is not helpful for tinnitus (ringing in the ear). 34-39,96,116
Three small, double-blind trials enrolling a total of about 100 people found preliminary evidence that use of the herb Ginkgo biloba can help prevent altitude sickness . 30,102,159 However, a large scale, double-blind study enrolling 614 people, failed to find benefit. 117 (The drug acetazolamide, however, did provide significant benefits compared to placebo.) A similarly designed smaller study enrolling 57 people also failed to find ginkgo effective. 160 Overall, the balance of evidence suggests that ginkgo is not effective for this purpose.
Numerous case reports and uncontrolled studies raised hopes that ginkgo might be an effective treatment for sexual dysfunction in men or women , particularly in those cases related to certain antidepressant medications. 23-27 However, the results of a number of double-blind studies (see Why Does this Database Rely on Double-blind Studies? ) indicate that ginkgo is no more effective than placebo, whether or not subjects are taking antidepressants. 70,129,161
One small study failed to find ginkgo helpful for the treatment of cocaine dependence . 118 Two studies failed to find ginkgo helpful in multiple sclerosis . 128,154 In addition, another study found ginkgo biloba did not improve cognitive function on neuropsychological test scores compared to placebo in a randomized trial of 121 patients with multiple sclerosis. 172 This was also supported in a review of 4 studies. However, ginkgo was associated with improving fatigue symptoms after 4 weeks when compared to placebo. 174
Chinese research suggests that ginkgo might enhance the effects of drugs used for schizophrenia (both phenothiazines as well as atypical antipsychotic drugs). 28,93 Antipsychotic drugs can cause a neurological condition called tardive dyskinesia , which involves troubling, uncontrollable body movements. 170 One randomized study found that ginkgo (240 mg/day for 12 weeks) was more helpful than placebo in reducing tardive dyskinesia symptoms in people with schizophrenia.
An open study evaluated combination therapy with ginkgo extract and the chemotherapy drug 5FU for the treatment of pancreatic cancer, on the theory that ginkgo might enhance blood flow to the tumor and thereby help 5FU penetrate better. 40 The results were promising, but much better research must be performed before ginkgo can be recommended for this use. Similarly inadequate evidence hints at benefits in dyslexia. 156
Ginkgo has also been proposed as a treatment for depression and diabetic retinopathy , but there is little evidence that it is effective for these conditions.
Note : There are some theoretical safety concerns regarding ginkgo and diabetes . See Safety Issues for more information.
What Is the Scientific Evidence for Ginkgo?
Alzheimer's Disease and Non-Alzheimer's Dementia
In the past, European physicians believed that the cause of mental deterioration with age (senile dementia) was reduced circulation in the brain due to atherosclerosis. Since ginkgo is thought to improve circulation, 42-44 they assumed that ginkgo was simply getting more blood to brain cells and thereby making them work better.
However, the contemporary understanding of age-related memory loss and mental impairment no longer considers chronically restricted circulation the primary issue. Ginkgo (and other drugs used for dementia) may instead function by directly stimulating nerve-cell activity and protecting nerve cells from further injury, 45 although improvement in circulatory capacity may also play a role.
Numerous double-blind, placebo-controlled studies have found ginkgo extract effective for dementia; among these, studies rated as "high quality" by accepted scientific norms included a total of more than 2,000 people. 46-48,50,109,152 For example, one major US trial published in 1997 enrolled more than 300 people with Alzheimer's disease or non-Alzheimer's dementia. 6 Participants were given either 40 mg of Ginkgo biloba extract or placebo 3 times daily for a period of 52 weeks. The results showed significant but not entirely consistent improvements in the treated group.
Another study, published in 2007, followed 400 people for 22 weeks, and used twice the dose of ginkgo. 157 The results of this trial indicated that ginkgo was significantly superior to placebo. (Technically, it was superior in the primary outcome measure, the SKT cognitive test battery, as well as on all secondary outcome measures.) The areas in which ginkgo showed the most marked superiority as compared to placebo included "apathy/indifference, anxiety, irritability/lability, depression/dysphoria and sleep/nighttime behaviour." In addition, a 6-month study found ginkgo equally effective as the drug donepezil (taken at a dose of 5 mg daily). 149
On the other hand, one fairly large study drew headlines for finding ginkgo extract ineffective. 51 This 24-week, double-blind, placebo-controlled study of 214 people with either mild to moderate dementia or ordinary age-associated memory loss found no effect with ginkgo extract at a dose of 240 mg or 160 mg daily. However, this study has been sharply criticized for a number of serious flaws in its design. 94 But in another community-based study among 176 elderly subjects with early-stage dementia, researchers found no beneficial effect for 120 mg of ginkgo extract given daily for six months. 164
But, a 2011 systematic review of 9 placebo-controlled, randomized trials found more promising evidence for ginkgo. 171 The trials, which involved 2,372 people with Alzheimer's disease or another form of dementia, ranged from 12-52 weeks. Those in the ginkgo group did have improvements in their cognition scores. And, a subgroup of people with Alzheimer's disease also showed improvements in their activities of daily living.
The ability of ginkgo to prevent or delay a decline in cognitive function is less clear. In a placebo-controlled trial of 118 cognitively-intact adults 85 years or older, ginkgo extract seemed to effectively slow the decline in memory function over 42 months. The researchers also reported a higher incidence of stroke in the group that took ginkgo, a finding that requires more investigation (see Safety Issues below). 162
In a 2009 review of 36 randomized trials involving 4,423 patients with declining mental function (including dementia), researchers concluded ginkgo appears safe. But, there is inconsistent evidence regarding whether it works. 166
In a secondary analysis of a randomized trial with 828 patients with mild-to-moderate Alzheimer's disease, the addition of gingko to cholinesterase inhibitors produced little cognitive benefit and did not improve functional abilities. 175
Enhancing Mental Function in Healthy People
Ginkgo has shown less consistent promise for enhancing mental function in people who experience the relatively slight decline in cognitive function that typically accompanies increased age.
For example, in a double-blind, placebo-controlled trial, 241 seniors complaining of mildly impaired memory were given either placebo or ginkgo for 24 weeks. 52 The results showed that ginkgo produced modest improvements in certain types of memory.
Another double-blind, placebo-controlled trial examined the effects of ginkgo extract in 40 men and women (ages 55 to 86) who did not suffer from any mental impairment. 53 Over a 6-week period, the results showed improvements in measurements of mental function.
Possible benefits were seen in six other trials as well, involving a total of about 250 people. 54-57,110,119,112
Set against these positive findings is the 24-week study mentioned above, which found no benefit in ordinary age-related memory loss. 58 The reason for this negative outcome may be flaws in this trial's design, as noted above. 94 However, three other studies enrolling a total of about 400 seniors also failed to find significant benefit with daily use of ginkgo. 103,130-131 Another double-blind, placebo-controlled study used a one-time dose of ginkgo, and again found no benefits. 73
Besides these negative trials, there is another weakness in the evidence: inconsistency even among positive trials. There are numerous measurable aspects of memory and mental function, and studies of ginkgo have examined a great many of these. Unfortunately the exact areas of benefits seen vary widely.
For example, in one positive study, ginkgo may speed the ability to memorize letters but not expand the number of letters that can be retained; while in another positive study, the reverse may be true. This type of inconsistency tends to decrease the confidence one can place in these apparently positive studies, because if ginkgo were really working, one would expect its effects to be more reproducible.
A total of about 15 controlled trials have examined the effects of ginkgo on memory and mental function in younger people. 59,60,90,104,113,134-136,155,158 However, again, results are inconsistent, with many negative results, and the positive ones failing to indicate a consistent pattern of benefit. 155,158
Several small double-blind, placebo-controlled studies have evaluated combined treatment with ginseng or vinpocetine for enhancing mental function in young people. 104-106,108,139 The results, overall, are unconvincing. Weak evidence suggests that combining phosphatidylserine with ginkgo might increase its efficacy. 153 In two studies, ginkgo combined with the Ayurvedic herb brahmi failed to improve mental function. 62,120
The bottom line: It is not clear whether ginkgo actually enhances memory and mental function in healthy seniors or healthy younger people. Benefits, if they do exist, are probably slight.
Intermittent Claudication
In intermittent claudication , impaired circulation can cause a severe, cramp-like pain in one's legs after walking only a short distance. According to 9 double-blind, placebo-controlled trials, ginkgo can significantly increase pain-free walking distance. 63,114 However, a second review of 11 randomized trials with 477 patients found that although gingko had greater pain-free walking distance than placebo, the improvemed distance was not considered clinically relevant. 173
One double-blind study enrolled 111 people for 24 weeks. 64 Subjects were measured for pain-free walking distance by walking up a 12% slope on a treadmill at 3 kilometers per hour (about 2 miles per hour). At the beginning of treatment, both the placebo and ginkgo (120 mg daily) groups were able to walk about 350 feet without pain. By the end of the trial, both groups had improved, although the ginkgo group improved significantly more. Participants taking ginkgo showed about a 40% increase in pain-free walking distance as compared to only a 20% improvement in the placebo group.
Similar improvements were also seen in a double-blind, placebo-controlled trial of 60 people who had achieved maximum benefit from physical therapy. 65
A 24-week, double-blind, placebo-controlled study of 74 people with intermittent claudication found that ginkgo at a dose of 240 mg per day was more effective than at 120 mg per day. 66 A 2009 review of 11 trials with 477 subjects suggested that those who took ginkgo biloba were able to walk further than control patients, although the results were limited by differences among the trials. 167 However, not all studies have been positive. In a randomized trail involving 62 individuals (averaging 70 years of age), 300 mg of ginkgo per day was no better than placebo at improving pain-free walking distance over 4 months of treatment. 165
PMS Symptoms
One double-blind, placebo-controlled study evaluated the benefits of ginkgo extract for women with PMS symptoms. 67 This trial enrolled 143 women, 18 to 45 years of age, and followed them for two menstrual cycles. Each woman received either the ginkgo extract (80 mg twice daily) or placebo beginning on day 16 of the first cycle. Treatment was continued until day 5 of the next cycle, and resumed again on day 16 of that cycle. As compared to placebo, ginkgo significantly relieved major symptoms of PMS, especially breast pain and emotional disturbance. In another similarly designed trial involving 85 university students, Ginkgo biloba L. significantly reduced PMS symptom severity compared to placebo. 169
In a double-blind, placebo-controlled study of 107 people with various forms of anxiety (specifically, generalized anxiety disorder or adjustment disorder with anxious mood), ginkgo extract taken at a dose of 240 mg or 480 mg daily proved significantly more effective than placebo. 148
Macular Degeneration
Macular degeneration , one of the most common causes of vision loss in seniors, may respond to ginkgo.
In a 6-month, double-blind, placebo-controlled study of 20 people with macular degeneration, use of ginkgo at a dose of 160 mg daily resulted in improved visual acuity. 68
A 24-week, double-blind study of 99 people with macular degeneration compared ginkgo extract at a dose of 240 mg per day with ginkgo at a dose of 60 mg daily. 71 The results showed that vision improved in both groups, but to a greater extent with the higher dose.
A 3-month, double-blind trial of 70 people with a variety of vertigo conditions found that ginkgo extract given at a dose of 160 mg twice daily produced results superior to placebo 75 By the end of the trial, 47% of the people given ginkgo had significantly recovered versus only 18% in the placebo group.
A small double-blind, placebo-controlled trial found that use of ginkgo extract at a dose of 120 mg daily for 8 weeks significantly improved the visual field in people with glaucoma . 72
Studies of Ginkgo biloba extract for treating tinnitus have yielded conflicting results. 76-81,96 While some small studies found benefit, the largest and best-designed of these trials failed to find ginkgo effective. In a 12-week, double-blind trial, 1,121 people with tinnitus were given either placebo or standardized ginkgo at a dose of 50 mg 3 times daily. 82 The results showed no difference between the treated and the placebo groups.
The standard dosage of ginkgo is 40 mg to 80 mg 3 times daily of a 50:1 extract standardized to contain 24% ginkgo-flavone glycosides. Levels of toxic ginkgolic acid and related alkylphenol constituents should be kept under 5 parts per million.
In an analysis performed in 2006 by the respected testing organization ConsumerLab.com , some tested ginkgo products were found to be contaminated with lead. 132
Safety Issues
Ginkgo appears to be relatively safe. Extremely high doses have been given to animals for long periods of time without serious consequences, and results from human trials are also generally reassuring. 83,121 Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease, however, has not been established.
In all the clinical trials of ginkgo up through 1991 combined, involving a total of almost 10,000 participants, the incidence of side effects produced by ginkgo extract was extremely small. There were 21 cases of gastrointestinal discomfort, and even fewer cases of headaches, dizziness, and allergic skin reactions. 84
However, there are few potential problems. Perhaps the most serious have been the numerous case reports of internal bleeding associated with use of ginkgo (spontaneous as well as following surgery). 85,86,97-99,107,122-123,133 Based on these reports, as well as previous evidence that ginkgo inhibits platelet function, 124 studies have been performed to determine whether ginkgo significantly affects bleeding time or other measures of blood coagulation, with somewhat inconsistent results. 125,126,127,140 Prudence suggests that ginkgo should not be used by anyone during the periods before or after surgery or labor and delivery, or by those with bleeding problems such as hemophilia.
It also seems reasonable to hypothesize that ginkgo might interact with blood-thinning drugs, amplifying their effects on coagulation. However, two studies found no interaction between ginkgo and warfarin (Coumadin), 100,141-142 and another found no interaction with clopidogrel. (Although, it did find a slight interaction with the related drug cilostazol.) 150 While these findings are reassuring, prudence indicates physician supervision before combining ginkgo with blood-thinning drugs.
One study found that when high concentrations of ginkgo were placed in a test tube with hamster sperm and ova, the sperm were less able to penetrate the ova. 87 However, since we have no idea whether this much ginkgo can actually come into contact with sperm and ova when they are in the body rather than a test tube, these results may not be meaningful in real life.
The ginkgo extracts approved for use in Germany are processed to remove alkylphenols, including ginkgolic acids, which have been found to be toxic. 88 The same ginkgo extracts are available in the United States. However, other ginkgo extracts and whole ginkgo leaf might contain appreciable levels of these dangerous constituents.
Seizures have also been reported with the use of ginkgo leaf extract in people with previously well-controlled epilepsy; in one case, the seizures were fatal. 89,143 It has been suggested that ginkgo might interfere with the effectiveness of some antiseizure medications, specifically phenytoin and valproic acid . 144 Another possible explanation is contamination of ginkgo leaf products with ginkgo seeds, the seeds of the ginkgo plant contain a neurotoxic substance called 4-methoxypyridoxine (MPN). 101 Finally, the drug tacrine (also used to improve memory) has been associated with seizures, and ginkgo may affect the brain in ways similar to tacrine. 92 Regardless of the explanation, prudence suggests that people with epilepsy should avoid ginkgo.
According to a study in rats, ginkgo extract may cause the body to metabolize the drug nicardipine (a calcium channel blocker ) more rapidly, thereby decreasing its effects. 49 In addition, this finding also suggests potential interactions with numerous other drugs, although more research is needed to know for sure which ones might be affected.
Antibiotics in the aminoglycoside family can cause hearing loss by damaging the nerve carrying hearing sensation from the ear. One animal study evaluated the potential benefits of ginkgo for preventing hearing loss, and found instead that the herb increased damage to the nerve. 41 Based on this finding, individuals using aminoglycosides should avoid ginkgo.
It has been suggested that ginkgo might cause problems for people with type 2 diabetes both by altering blood levels of medications as well as by directly affecting the blood-sugar regulating system of the body. 95,145 However, the most recent and best designed studies have failed to find any such actions. 146-147 Nonetheless, until this situation is clarified, people with diabetes should use ginkgo only under physician supervision.
Interactions You Should Know About
If you are taking:
- Blood-thinning drugs, such as aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen), cilostazol, clopidogrel (Plavix) , heparin , pentoxifylline (Trental) , ticlopidine (Ticlid) , and warfarin (Coumadin) : Simultaneous use of ginkgo could theoretically cause bleeding problems and should not be undertaken without physician supervision.
- Calcium channel blockers : Ginkgo might reduce their effectiveness.
- Antipsychotic medications in the phenothiazine family as well as atypical antipsychotic drugs (such as clozapine and olanzapene): Ginkgo might help them work better with fewer side effects.
- Aminoglycoside antibiotics: Use of ginkgo might increase risk of hearing loss.
- Medications to prevent seizures: Ginkgo might interfere with their effectiveness.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -


text:
You will be asked about your symptoms and medical history. A physical exam will be done.
Tests may include:
Blood tests —These tests may be used to find an infection, jaundice , pancreatitis , or an obstruction. For example, if bile flow is blocked, the bile will back up into the liver, which can be detected. Common tests include liver function tests, lipase, amylase, and complete blood count.
Abdominal ultrasound —A device will be held over the abdomen. It will bounce sound waves off the organs and the stones. The sound waves make electrical impulses that create a picture of the organ on a video monitor.
Magnetic resonance cholangiopancreatography (MRCP) —This is an imaging technique using MRI to let the doctor see the biliary and pancreatic ducts. Its purpose is to determine if there is a gallstone blocking any of these ducts. The test allows doctors to visualize the gall bladder, pancreas, and biliary ducts without the use of contrast dye, invasive procedures, or radiation exposure.
Hepatobiliary scintigraphy (HIDA) scan —This is an imaging test to check the function of the gallbladder. You will receive a tracer drug, which is taken up by the gallbladder. This test will help your doctor determine if the organ is functioning properly and if you may have acute cholecystitis.
Abdominal CT scan —This is an imaging test used to visualize the gall bladder, pancreas, and biliary ducts, but with contrast dye and radiation exposure.
Cholecystogram —You will be asked to swallow some tablets containing contrast material. The contrast material is then absorbed into bile, which fills the gallbladder. X-rays are then taken. The x-rays can show movement of the gallbladder, presence of gallstones, and any blockage of the bile ducts.
Endoscopic retrograde cholangiopancreatography (ERCP) —An endoscope is a long, flexible, lighted tube connected to a computer and monitor. The tube is guided through the stomach and into the small intestine. Dye is injected that stains the ducts in the biliary system. When the stones are located, they can also be removed. This method is effective for stones that have entered the common bile duct.
Endoscopic ultrasound —A long, flexible, lighted tube is inserted via the mouth or the rectum to visualize the different parts of digestive tract. A small ultrasound transducer is installed at the tip of the endoscope, which allows the doctor to get the device much closer to the internal organs of the body. This helps to obtain pictures of better quality and accuracy than those obtained through traditional ultrasound.
Revision Information
- Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
- Review Date: 09/2018 -
- Update Date: 09/17/2014 -

subset: commoncrawl


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Many seniors today are interested in natural medicine options. In this article, we discuss the issues of particular importance to this age group.
Natural Treatments Advocated for Seniors in General
Marginal nutritional deficiencies occur more often in older people than in most other age groups. For this reason, many seniors could benefit from enhancing nutrition. For information on this topic, see general nutritional support .
Some proponents of alternative medicine advocate products and treatments for the purpose of life extension. However, despite some promising results in test tube and other preliminary studies, there is no meaningful evidence that any alternative treatment can prolong life.
Numerous natural supplements have been promoted as fountains-of-youth for seniors, said to enhance life in multiple ways, including restoring youthful levels of energy, well-being, and mental function. However, there is again no evidence to indicate that any of these are effective. One such hormone, the widely hyped DHEA , has actually been fairly convincingly shown ineffective for this purpose. 1–7,14,15
A study published in 1990 created hopes that the human growth hormone (somatotropin or HGH) could increase strength and reverse many symptoms of aging in men. 8 However, subsequent evidence suggests that HGH is not useful for this purpose. 9 In any case, despite widespread marketing, HGH cannot be successfully used as an oral supplement because it is destroyed by stomach acid. (In the positive trial just described, it was administered intravenously.) Various amino acids and other supplements are marketed as HGH-releasers on the premise that they cause the body to increase HGH production. However, there is no reliable evidence that they actually do so to any meaningful extent; in any case, since HGH itself is no fountain-of-youth, this potential effect is of little significance.
Anabolic hormones have also failed to prove useful for enhancing strength in older people. The supplements creatine10–12 and HMB (hydroxymethyl butyrate)13 have shown a bit of promise for this purpose, but the evidence for benefit remains weak.
Note that there is one natural approach guaranteed to enhance strength in seniors: exercise. There is little doubt that increasing exercise is one of the most health-positive steps available for people of any age.
Finally, some evidence suggests that vitamin D supplements may improve balance (technically, reduce body sway) in frail seniors, and thereby help prevent falls. 16,17 However, not all studies have found benefits. 18
Natural Treatments for Specific Conditions of Relevance to Seniors
Even though natural treatments have not been shown helpful for fighting the effects of aging in general, they have shown considerable promise for treating specific health conditions of relevance to older individuals. For information, see the following articles in this database:
For Men
- Aging Skin
- Alzheimer's Disease and Related Conditions
- Back Pain
- Cancer Prevention
- Cancer Treatment
- Cataracts
- Diverticular Disease
- Enhancing Memory and Mental Function
- Fatigue
- General Wellbeing
- Heart Attack
- Heart Disease Prevention
- Immune Support
- Insomnia
- Macular Degeneration
- Osteoarthritis
- Prostate Cancer
- Prostate Enlargement (BPH)
- Sciatica
- Sexual Dysfunction
For Women
- Aging Skin
- Alzheimer's Disease and Related Conditions
- Back Pain
- Cancer Prevention
- Cancer Treatment
- Cataracts
- Diverticular Disease
- Enhancing Memory and Mental Function
- Fatigue
- General Wellbeing
- Heart Attack
- Heart Disease Prevention
- Immune Support
- Insomnia
- Macular Degeneration
- Menopausal Symptoms
- Osteoarthritis
- Osteoporosis
- Sciatica
- Sexual Dysfunction
- Varicose Veins
Safety Concerns
Many people implicitly believe that "natural" means "safe." However, there is no scientific reason to believe that this should be the case. Many of today's drugs are highly safe, while some herbs and supplements present real safety risks. For information any on issues relevant to any particular substance, see it's entry in the Herbs & Supplements .
Perhaps the biggest issue of concern is interactions between natural supplements and medications. For more information on possible interactions with medications you are taking, see the Drug Interactions section.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 08/2013 -
- Update Date: 08/22/2013 -


text:
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text:
Approved Minutes December 17, 2013
Meeting called to order by: Terry Acton @ 7:00 pm
Pledge of Allegiance: By All in attendance
Roll Call: John Scherrer, yes, Nancy Austin, yes, TerryActon, yes, Mae
Rood, yes, Lee Dancer, yes. All Present
4. Public Comments: Terry Acton explained the Consent Agenda to
the public.
A. The Under Sheriff gave report . And that with Neighborhood Watch starting up with Stan Lewis as the Coordinator, a meeting will be held on January 23rd, 2014 for all interested
to attend and help get crime in Hayes Township down.
B. Jim Gelios - County Commissioner gave report and stated that the Airport Restaurant will
reopen after the first of the year sometime. It belongs to the County and will bring in
some revenue for the County. New owners have cleaned it up inside, looks great.
5. Consent Agenda: Motion to approve by Rood, 2nd by Acton, All in favor, aye, M/C.
6. Correspondence: None
7. Department Reports:
Terry Acton reported for Rod Williams ,the Ordinance Officer , that 67 files active files and
being followed up on with tickets and results are definite. The Togg Shop is being cleaned up.
Waste Management donated a dumpster there and Terry Acton himself
filled it with the last of the trash to clean up the area for a clean
presentation of the township.
8. Unfinished Business:
A) Resolution: 13-07 Credit Cards - needs to be amended with a cap on the spending limit. Presently being used for the telephone
system 8 x 8 and any other expenses that may require a credit card payment. Motion by Acton to amend and set limit to 00, 2nd
By Scherrer. All in favor, aye, M/C.
B) Arnold Lake Association: John Hood gave informative presentation again, regarding Aquatic nuisance control for Arnold Lake using public act 188. Attorney Fahey advise that the liability lies on the people in the special assessment district
and the company who does the work. Motion by Terry Acton to accept this special assessment under public act
188, 2nd by Rood, all in favor, M/C.
C) Special meeting held on Dec. 16th at the Hayes Community Bldg.
Terry Acton moved this to Public Comments below.
D) Personnel Pamphlet: Maye Rood explained that benefits have been drastically cut for all hourly employees in
our office. Austin and Rood have reviewed benefits and it has been determined that 24 hrs a week is not considered
a full time position with benefits.This has been compared to what other counties are offering to their employees. All are excellent workers but benefits have not been equal for all across the board in the past. Life insurance is still a benefit but holiday pay and vacation pay need to be eliminated.. Three benefit plans were implemented to choose from, some with benefits, one with only life insurance.
Motion by Rood to accept plan #3 with no benefits
offered except for life insurance, 2nd by Acton.
Roll call: Scherrer, no, Austin, no, Acton, yes, Rood,
yes,Dancer, yes. M/C.
9. Board Requests: Sprinkler System Service agreement (Prescription Rain Lawn
Sprinkling,Inc.) The board voted to keep the service as is which is service twice a year for opening and closing only. But not to accept the contract as presented to us.
Company to be notified of decision by mail.
10. Public Comments;
C) Special meeting held on Dec. 16th at the Hayes Community Bldg. Terry Acton and Maye Rood reported on the great attendance of 60 to 70 residents, largest ever to attend and give their input to the board members about the Civic Center. Architects, Goudreau and Associates gave a video presentation of all three plans.With a raise of hands the public showed support for a new build, and with no support for renovating the old building. Three plans were presented and the with a full court, senior center and township
offices was the most popular. The full basketball court building was most popular for many reasons as it would be more convenient to hold township residents in case of an emergency situation and the Red Cross, for the voting area in elections, for basketball,
area for residents, exercise room and many other "rental possibilities" that would renovate some revenue to cover operating costs.
Security cameras & extra lighting would be installed for security reasons and solar panels were brought up by a resident to cut operating costs. Terry Acton stated that solar panels have already saved the County 80 to 90% in operating costs. Maye Rood explained the cost of the building going from1.2 to 2.5 million as the first quote was a soft quote that did not include all the furniture, landscaping, generator and "commercial" kitchen.
Grants will be applied for to cover the commercial kitchen, solar paneling and other items to keep cost down thru USDA. Property taxes were discussed and will NOT be raised for
this building project. Once a plan has been voted on,
another special meeting will be held to discuss taking bids on the new building. Three bids per project will be accepted. Low bids are not always the winners as quality and on time work is what will be looked at. All in all it was a great ,informative meeting for all and we are hoping for more to attend the next meeting that will be posted in January, 2014. The
next Planning Committee meeting will be around January 15th and will be posted for public information.
Adjournment: 7:53 pm Motion to adjourn by Scherrer, 2nd by Dancer, all ayes, M/C.
Nancy Austin/ Hayes Township Clerk


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Trending Searches
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by: Katie
7 years ago
by: Katie
As some of you may have noticed Pornhub has been given a sleek new design.
The header has been made less cluttered and the language flags have been replaced with a drop down menu. You can now easily switch between English (EN), German (DE), French (FR), Spanish (ES), Italian (IT) and Portuguese (PO).
The "Like" and "Dislike" buttons have received a facelift. Clicking on the "Share" button results in a drop down box which allows you to select with social media platform you would like to use to share the video; as well as the option to embed the video.
The Pornstars feature has also been revamped. When a pornstar is listed you can hover the cursor over the name and her picture will appear, you can also click on this to do a search for this specific pornstar. You will be brought to a page with all of her/his videos which can be sorted by Most Recent, Most Viewed, Top Rated and Longest. There is also an option to view the Pornstar's profile which will give you the star's biography and stats.
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text:
The Mediterranean sea stretches across the coasts of many countries in Europe. The island nation of Cyprus is surrounded entirely by the Mediterranean as well as Malta, just off the coast of Sicily.
Malta and Cyprus are both small, affluent countries with few natural resources other than their climate. Tourists crash both islands each summer to soak up the rays and party through the warm nights on their month of vacation. Tourists from Europe have long considered the Mediterranean their own temperate vacation destination, similar to how Americans view Hawaii. Now, however, the rest of the world has discovered the Mediterranean and crowds are starting to form in the most popular spots.
It is this tradition of relaxation, warm temperatures and warm waters that most people think of when they consider the Mediterranean. Whether you're in Italy, Croatia, or on a warm island in Greece, the spirit of the Mediterranean is exactly what people mean when they say they just want to "chill."


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Personalized 3ply cocktail napkins // foil stamped
*NAPKIN COLORS and SIZES*
Please scroll right though the listing photos for aviliable colors {click right on the listing photos to see more info}
- 1-color imprint included
- Made in the USA
- Recyclable
Minimum Order - 50
At this time we are not able to split colors between a set. Your order will consist of all the same napkin color, imprint color, and design layout.
1. Choose your amount from the AMOUNT drop down menu.
Ignore the "quantity" drop down menu (unless you would like various colors... example, 50 pink and 50 black. You would need to purchase 2 (quantity menu) sets of 50 (amount menu).
2. Include the following in the "message to sender" purchase notes section during checkout.
Personalization info for your design (Name, days until wedding)
Single color imprint
Napkin color
3. Please choose the design from the style drop down menu.
If you would like to see a digital proof of your order, before printing please add the below proof listing to your etsy cart prior to checkout. If you do not purchase a proof your order will be printed exactly like the listing picture, but with your name/date/personalization info.
Please allow 7-8 business days to process the order before shipping to avoid rush fees. Business days start from the day your order is submitted, or the date a proof is approved (if applicable).
If you would like to add a rush to your order please see the "Add ons" section of S&L Paper Co's shop.
*COLORS and SCREEN RESOLUTION*
All computer and cell phones screens are calibrated differently. Some display CMYK and others RBG color codes. S&L Paper Co. can not guarantee the color on your screen will match the actual item color. The pictures in our listings are the best portrayal of the items in person (or digitally, depending on the listing).
*If you are interested in cup sizes not included in this listing please message me for a quote :)
**If you are interested in custom artwork there is a fee to have your artwork printed.
What is "custom artwork"? A wedding logo, business logo, or graphic artist supplied vector artwork. These files need to be in Adobe Illustrator format.
What is not "custom artwork"? Changing fonts, spacing, or layout of a design already shown in S&L Paper Co's shop.
$30 fee for Adobe Illustrator format artwork:
Thank you for visiting Sequins & Lipstick Paper Company!
Be the first to know about new products and sales by following us on social media :)
Facebook | www.facebook.com/sequinsandlipstick
Instagram | @sequinsandlipstick
Pinterest | @slpaperco
Snapchat | @sequins&lipstick
Twitter | @slpaperco
Paypal, Credit/Debit, and Gift Cards Accepted
United States shipping only. SL Paper Co's utilizes the most reliable shipping options for our customers including Fed Ex, UPS, and USPS (depending on the item ordered). All items (except greeting cards) come with tracking information. Once an order has shipped, tracking information will be automatically emailed to the address associated with your checkout information. Please check your spam/junk folder.
--For the most up to date tracking info please copy and paste the tracking number into the carrier's website. Once an item has been shipped, any questions related to delivery or package whereabouts should be sent to that particular carrier (not SL Paper Co).
If you live near the metro Atlanta area and would like to pick up your order, simply message me and this can be arranged {only applicable for acrylic trays and non personalized napkins and cup sets}.
Please take a few moments to ensure your shipping address is correct prior to checkout. Any returned items due to incorrect shipping information will be reshipped at the expense of the buyer, not the seller.
Turn around time is 8-10 business days. If you need your order delivered sooner please add a production rush listing to your cart before checkout. Rush listings can be found in the "Add ons" section of S&L Paper Co's shop. Please also include a need by date when placing any order. If no need by date is included in your purchase notes, the 8-10 business day turn around will apply.
If an order with tracking/insurance is lost or not delivered on time, the responsibility to file a claim with the shipping carrier falls with the buyer, not the seller. The buyer takes possession once the goods leave our facility. The buyer can vouch for their address, delivery details (mailbox, front desk attendant, etc) better than a SL Paper Co. representative can. Feel free to use your SL Paper Co. receipt for proof of the value purchased. The package is the buyers responsibility during transit time. If your items are time sensitive, we suggest keeping a close eye on Fedex's tracking info via their website updates.
SL Paper Co can only control the design and manufacturing of your items. Once your items are in the possession of a shipping carrier we have zero control over delivery date. All delivery dates are our best estimates (provided by the shipping carrier) and can be delayed due to weather or local events. Please contact the carrier asap if you notice your package tracking is delayed. If an item is delayed while in the possession of the shipping carrier, SL Paper Co will not process a refund for your order. It is best to order early to avoid shipping delays affecting your delivery date.
-- Link to file a Fedex claim for lost or damaged items:
-- Link to file a UPS claim for lost or damaged items:
-- Link to file a USPS claim for lost of damaged items:
Shipping to HI and AK will incur added shipping charges. If you would like an estimate prior to purchase please message us for a quote.
But please contact me if you have any problems with your order.
-- All sales are final. Due to the nature of S & L's products being personalized, custom items we do not accept returns. Please take the time to include all necessary information in the "purchase notes" during checkout.
-- If an order has entered the production line we will not be able to cancel your order. If an order has NOT entered the production line, we can cancel your order. If cancellation is an option, you will be refunded minus a $10 order change fee. If a proof has been sent to a customer we will deduct the $5 proof free from your refund.
-- If an item is printed with an error we will gladly replace your order. Customers will need to send a photo to show evidence of the error.
-- If your item is damaged during shipment or if any part of your order is missing, please contact us within 3 days of receiving your order. Customers will need to send a photo to show evidence of the damage.
If you would like to see a digital proof of your order please add the proof listing to your cart prior to checkout. This listing can be found in the "Add ons" section of our shop. Proofs are sent after purchase through the Etsy messaging system. Proofs will not be sent for items purchased with a rush order.
-- Proofs are a wonderful tool to make sure your order in created just like you envision. Proofs add days on to the production time (standard production time without a proof is 8-10 business days). Example: You order on Monday but don't approve a proof until Thursday, your start of the 8-10 business day timeline would be the day a proof is approved (Day 1), not the original order date (Monday). Your order can not be placed in the production line until a proof is approved.
-----COLORS and SCREEN RESOLUTION-----
All computer and cell phones screens are calibrated differently. Some display CMYK and others RBG color codes. S&L Paper Co. cannot guarantee the color on your screen will match the actual item color. The pictures in our listings are the best portrayal of the items in person (or digitally, depending on the listing). The seller is not responsible if the colors show up differently in person.
Click right through listing pictures to see color options and sizing information.
Turn around time is 8-10 business days depending on your location. Nothing personalized can be shipped out on the same day. Please view the Rush listing in the "custom/add ons" shop section for more info about expediting your order. Please remember business days turn over at 12 noon.
Our ink, foil and all other color charts are the best representation of the items in personal (or digitally). Ordering a physical sample to check a color is always an option. Physical sample listings can be purchased through our custom shop section.
We mix ink using the Pantone color system. For the most accurate depiction of an ink color please consult a Pantone color deck. If that option is not available to you, please google the Pantone color code. Under the images tab in your browser you will see digital and in person swatches of the color.
Bulk is classified as over 1,000 units of one item. If this applies to your order please send us a message for more info.
Yes, ink can be PMS (Pantone) for cups, napkins and matches. We can match CMYK color codes for stationery items.
Feel free to message us for PMS color code info of cups and napkins. There is a $5 color match charge for cups, napkins, koozies, and matches.
There is no color match charge for stationery items.
Sorry, the smallest quantity available for cups is 25 and napkins is 50. All cups and napkins are professionally screen printed or foil stamped, not created individually with vinyl decals.
Stadium, foam, and shatterproof cups are listed by their full liquid capacity (when filled to the brim). Please check listing pictures for physical measurements of each cup style sold in the shop.
Our most popular size is the 16oz cup.
For example: A 16oz cup holds approximately 16 ounces of liquid when filled to the brim. When serving a beverage you would pour around 12oz of liquid in a 16oz cup and leave space for ice and empty space near the rim to avoid spillage.
The best way to know you are ordering the correct size cup is to measure out the size shown in our listing charts with a ruler or measuring tape.
S&L Paper Co is not the grammar police :) This FAQ is here to help offer advice but ultimately we will print exactly what you request in the notes associated with your order.
The Smiths is plural for "Smith" and means there is more than one person named Smith.
The Smith's (with an apostrophe) is the plural possessive of "Smith". The "Smith's" means the possession of more than one "Smith" of something like "The Smith's car is green".
If your order simply says "The Smiths" that is correct. If your order has a design showing possession (Ex: The Smith's Luau party 2019) then you need to add an 's.
If your name ends in a "s" you should add "es" to the end. Ex: The Harrises
Foil is stamped into matches and napkins. The only foil colors options are the ones shown in the foil color chart in our listing photos.
Ink is printed onto napkins, cups, matches, koozies, etc. Ink is mixed to match a color then printed. The color options are endless with ink.
All cups are screen printed with ink (not created with vinyl decals). Occasionally products have an odor. This order will dissipate once your items are taken out of the shipping box (and cello sleeve) and aired out for a short time. It is always suggested that you wash your cups before using them (top rack of your dishwasher or by hand). Simply letting your cups air dry after washing should eliminate the smell. Soaking your cups in water will not help but will actually
cause the ink smell to linger for a longer amount of time.


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Many people over the years have discussed their distress with the religious tone that cloaks the implementation of Agile practices. Particularly from the testing side of the world, there is a lot of "should," "should not," and "can do better next time" dialogue that sounds more like a man trying to fix ethical lapses than a developer writing code. When I speak with adherents of test-driven development (TDD) in particular, there is a seeming non-comprehension that truly excellent, reliable code was ever developed prior to the advent of this one practice. I sense their view that the long history of code that put man on the moon, ran phone switches, airline reservation systems, and electric grids was all the result of luck or unique talents, rather than the a function of careful discipline and development rigor.
The disconnect between today's Agile view and earlier reality is equally evident in the wanton bashing of the waterfall model. To get any programmer today to adopt your recommendation, simply state that not doing so is just a new way of doing waterfall. Watch his toes curl despite never having used waterfall, nor seemingly having any awareness that it served the industry really well for decades. What, was everyone in that bygone era a fool?
Alan Kay was entirely right when he said that programming today has become a pop culture: "Pop culture is all about identity and feeling like you're participating. It has nothing to do with cooperation, the past or the future it's living in the present. I think the same is true of most people who write code for money. They have no idea where [their culture came from] and the Internet was done so well that most people think of it as a natural resource like the Pacific Ocean, rather than something that was man-made. When was the last time a technology with a scale like that was so error-free?"
It will pain some readers to know that the vast, error-free Internet predates Agile and even predates TDD. Crazy, right?
What I'm saying here is certainly not new. The fascination with today's way of doing things and the view that it is the one true path to good code is a seemingly permanent part of the programming culture. But it has been greatly abetted by the legions of Agile consultants. By stressing the practices, they have corrupted what Agile was about. It's important to remember that the Agile manifesto stated values, not practices. Immediately, though, values were translated into programming practices by consultants and, quickly, the former was lost. One of the original formulators of the manifesto, Dave Thomas, whom I interviewed this week, states his realization that a month after the manifesto was written it was already being corrupted: "…it got immediately productized in many different ways. The whole point, to my mind, of the Agile Manifesto is that it's a set of personal practices that may scale to team level. You do not need a consultant to show you how to do that. It may help to have someone facilitate, but you do not need a consultant. And yet immediately what happened was that everyone and their dog hung out an Agile shingle and the whole thing turned into a branding exercise."
What's interesting in Thomas's account is the view that Agile was a personal practice. Implicit is a personal way of orienting oneself towards a development process that accepts, even welcomes, change.
By pure coincidence, Allen Holub has been driving this point home in several blog posts, the most recent of which is a brilliant little piece that reminds us that Agile is a culture, not a set of practices. As he has previously explained, just because an organization is using scrum, doesn't mean it's Agile. He could have said the same thing about TDD, continuous integration, pair programming, or the like.
Whether a site is Agile or not depends on its culture. Does the culture support the personal values of the manifesto? If so, it's Agile, if not, then it's doing something else. So, indeed you could have a fully Agile site without TDD, continuous integration, or scrum. Likewise, you can have a site that uses all three practices, but cannot adapt to changes and is wholly inflexible in its work so, not at all Agile. Yeah, I know, crazy, right?
Andrew Binstock
Editor in Chief
[email protected]
Twitter: platypusguy


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96 Mile End Road
96 Mile End Road, London E1 4UN
Mixed use
Description of 96 Mile End Road
96 Mile End Road is a mixed-use building in East London E1.
Connected Companies
News: (0)
*DISCLAIMER! Information on this page is for guidance only and remains subject to change. Buildington does not sell or let this property. For more information about this property please register your interest on the original website or get in touch with the Connected Companies.


text:
The goals of treatment are to eliminate the infection, and prevent hearing loss and other complications.
Antibiotics are generally used to treat ear infections in children under 2 years old, but these medications only work against bacterial infections. If the infection is caused by a virus, the antibiotics will not be effective. The only certain way to tell if the infection is caused by bacteria is to perform a myringotomy and culture the middle ear fluid, which are not frequently done.
In recent years, doctors have come to realize that antibiotic use for any reason causes bacteria to develop resistance to the antibiotic used. These resistant bacteria can then cause new infections in a child or be passed to family members or other children. Antibiotic resistance is a serious problem—particularly when, unlike most cases of otitis, the infection is serious or life threatening. Experts feel that our best protection against running out of antibiotics is to reduce prescribing these drugs for illnesses that are likely to get better on their own without treatment. Since many children with otitis will be much improved within 2 days—even without antibiotic treatment, reducing the use of antibiotics in children with otitis is an important health goal worldwide.
Many experts now believe that the risk of antibiotic treatment may be greater than its benefit for many children 2 years and older with an ear infection or suspected ear infection. In these children, symptoms of infection will often subside just as quickly without an antibiotic. A pain reliever is frequently all that older children need to recover fully from an ear infection.
It is important to keep in mind that antibiotics can cause a number of side effects. Nausea, stomach pain, and diarrhea are common. Also, there is a risk of having an allergic reaction to the antibiotic.
The doctor may prescribe an antibiotic if symptoms continue for more than a few days or worsen. Some doctors will give parents a prescription for antibiotics, but instruct them not to use the antibiotic unless pain or fever persists beyond an agreed-upon number of days.
When an antibiotic is prescribed, it is important that you carefully follow the dosage recommendations. Failure to finish the medication can make it less effective in the future. Sometimes the antibiotic initially prescribed does not clear the infection, and another medication may be recommended. Be sure to go to a follow-up visit with the doctor to determine whether the infection is resolved or requires further treatment.
Other medications that can help treat otitis media include nasal sprays or antihistamines in children with allergic rhinitis.
Treatment involves the following:MedicationsLifestyle changesSurgeryAlternative and complementary therapies
Revision Information
- Reviewer: EBSCO Medical Review Board Marcie L. Sidman, MD
- Review Date: 09/2018 -
- Update Date: 09/17/2014 -


text:
Historic Windows
A version of this article appears in the November/December 2011 issue of Home Energy Magazine.
November 01, 2011
Problems and Solutions
Windows are widely viewed as being essential to retaining the integrity of historic structures, and most historic structures have single-glazed, wood-frame windows. Yet in most climates, these windows waste energy and let in cold air. Modern windows that can improve energy performance fourfold while keeping the occupants comfortable are now widely available. However, unlike enhanced attic insulation or condensing furnaces, replacement windows are visible — sometimes very visible. So the question is, Should historic windows be restored or replaced? This is a major issue in much of the United States.
To read complete online articles, you need to sign up for an Online Subscription.
Once an order has been placed there is an automatic $10 processing fee that will be deducted with any cancellation.
The Home Energy Online articles are for personal use only and may not be printed for distribution. For permission to reprint, please send an e-mail to firstname.lastname@example.com.


text:
Patronage & donations
If you use this service on a regular basis, and would like to make a continuing patronage towards the ongoing running costs and in support of the Slackware UK service, please use the Patreon page to sign up - Patreons receive special benefits for their support! For one-off donations or if you do not wish to use Patreon, please Paypal an amount you feel is appropriate using this link or to: donate (at) slackware.uk. A list of previous Paypal supporters can be found here.
All donations will be gratefully received - thank you!
Name Last modified Size Description
Parent Directory - slackware64-13.0-install-dvd.iso.txt 2009-08-26 17:52 337K slackware64-13.0-install-dvd.iso.md5 2009-08-26 17:59 67 slackware64-13.0-install-dvd.iso.asc 2009-08-26 18:00 197 slackware64-13.0-install-dvd.iso 2009-08-26 17:57 3.7G


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You can follow the discussion on Chicago Style Deep Dish Pizza without having to leave a comment. Cool, huh? Just enter your email address in the form here below and you're all set.
Hi! I'm Karly, and I have buns in my oven! But, not the baby kind. The yeasty kind. What I'm trying to say is, I like to bake. (more)
Sign up for my FREE 5 day course and you'll learn my FAVORITE kitchen hacks!


text:
Select The POS Software First
Tips for Selecting POS System Software
Questions to Ask Yourself About POS Systems
What to Do Before You Buy POS Software
POS System Components 1
POS System Components 2
POS System Components 3
POS System Components 4
Why use a POS system to manage my store?
One of the focal points of any retail or hospitality business is the cash register. The ability to process transactions and tender cash are essential to the efficient operation of the enterprise. If you have a lot of cash transactions, replacing the cash registers with a Point-Of-Sale (POS) system save you money. A POS system is computer software and hardware networked together to track sales and inventory as they occur. POS systems will solve a multitude of problems in your business.
Since implementation of a POS system is requires a large investment in time and money, the selection of software and hardware requires careful research into the features available and associated costs.
Generally, if your business has annual sales of $500k or more, you can achieve considerable savings and benefits from a POS system. From a Return-On-Investment perspective, it should pay for itself in between 1 and 2 years. For the new business, a POS system is a smart investment. The savings in labor hours and increase in efficiency makes balancing staffing easier, and the POS system automates many time-intensive tasks. Most POS software helps you stay aware of how your business is performing.
Many owners and manages find that the reports generated from the POS system invaluable in the day-to-day and long term management of the business. From revenue and profit reports, ordering reports and product sales reports, the POS system offers a perspective of the total business that is difficult to grasp in other ways.
Here are some of the advantages of using a POS system to track and manage your business:
Next, we'll talk about the need to Select the POS Software First when implementing a POS system.
© Copyright 2020 by Carolina Barcode Inc.


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Ball 01 drawn 13 time(s).
Ball 02 drawn 10 time(s).
Ball 03 drawn 9 time(s).
Ball 04 drawn 19 time(s).
Ball 05 drawn 17 time(s).
Ball 06 drawn 14 time(s).
Ball 07 drawn 16 time(s).
Ball 08 drawn 13 time(s).
Ball 09 drawn 9 time(s).
Ball 10 drawn 8 time(s).
Ball 11 drawn 9 time(s).
Ball 12 drawn 12 time(s).
Ball 13 drawn 9 time(s).
Ball 14 drawn 13 time(s).
Ball 15 drawn 7 time(s).
Ball 16 drawn 12 time(s).
Ball 17 drawn 9 time(s).
Ball 18 drawn 11 time(s).
Ball 19 drawn 7 time(s).
Ball 20 drawn 9 time(s).
Ball 21 drawn 11 time(s).
Ball 22 drawn 15 time(s).
By looking at the number of times drawn in 2020, in the last quarter or in the last 30 draws, how do you decide and choose which Double Daily Grand numbers to play?
If ball 22 has been drawn 15 time(s) in 2020, does it mean that it will likely be drawn or unlikely to be drawn in the next draw? Honestly, I do not know.
It is not possible to make any conclusion merely based on the number of times drawn in any time period. You will need to know the trends by identifying the minimum and maximum thresholds first before looking at the number of times drawn.
The minimum and maximum thresholds are the most frequently occurring lowest and highest frequency of times drawn over a period of time respectively. This is determined by iterating into the history of the draw in a consistent manner using a fixed time bucket.
Once you have established the minimum and maximum thresholds, you can then look at the number of times drawn in the same time bucket up to the most recent draw, and make a calculated and informed decision on which Double Daily Grand numbers to play.
Any ball with the number of times drawn at or below the minimum threshold is likely to be drawn in the next draw. Conversely, any ball with the number of times drawn at or above the maximum threshold is unlikely to be drawn in the next draw.
By applying the same principle to various statistics for Double Daily Grand, you can play Double Daily Grand intelligently and improve your chances of winning.
magayo Lotto software provides you with the insights into the trends and it will also recommend you the pool of Double Daily Grand numbers to play.
"I played the recommendation... and I won the first prize!"
See the winning lottery tickets of magayo Lotto users!
magayo Lotto is FREE and 100% clean.
See the winning tickets of our lottery winners!
See the awards for magayo Lotto!
Why choose magayo Lotto?
Supports nearly 500 Lotto games in over 80 countries


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The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Screening Tests
The digital rectal exam can detect BPH. This involves your doctor inserting a gloved finger into the lower rectum. From here, your doctor can estimate the size of your prostate, identify some (but not all) cancers, and find anal diseases.
A prostate specific antigen (PSA) test may be done as a screening tool for prostate cancer (not for BPH). Unfortunately, men with prostate cancer or BPH can have high PSA levels. Other prostate conditions such as prostatitis can also lead to high PSA levels. More tests or studies may need to be done to determine that exact cause of the high PSA level.
Revision Information
- Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
- Review Date: 09/2018 -
- Update Date: 09/17/2014 -


text:
To request a quote, fill out our Contact F要么m and we'll call you 要么 Call Us now at800.992.3522
Monday thru Friday . 8:00 AM - 8:00 PM EST
An Aflac agent will call you
within 15 minutes.
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Bernalillo Private Schools - starts with A
The 50States Bernalillo private school directory. Find Bernalillo, New Mexico private school addresses, phone numbers and other private school info.
Go To: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
No Listings


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Loop electrosurgical excision procedure (LEEP) uses a thin wire loop to precisely cut out areas of the cervix. The cervix is the lowest part of the uterus and . LEEP is done to remove abnormal cervical cells.
Reasons for Procedure
LEEP is often done after abnormal cells have been found on the cervix. These abnormal cells are often found on a Pap test . If the cells found on a Pap test show cervical dysplasia (abnormal cells) or cancer cells, a LEEP may be done.
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Bleeding
- Abdominal cramping
- Infection
- Future pregnancy problems (small increased risk of premature birth and having a low birth weight baby)
- Incomplete removal of the abnormal tissue
- Accidental cutting or burning of normal tissue
- Narrowing of the cervix (rare)
If there is time before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
The following may also increase the risk of complications:
- Menstruation at the time of the procedure—It is best to have LEEP done when you do not have your period.
- History of pelvic inflammatory disease
- Inflammation of the cervix
- Pregnancy or possible pregnancy
What to Expect
Prior to Procedure
Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
The day of the procedure:
- If your doctor will be giving you a sedative, arrange for someone to drive you home from the clinic.
- If directed by your doctor, take a pain reliever before the LEEP.
- Bring sanitary napkins to use after the procedure.
Local anesthesia is often used for a LEEP. This will keep you from feeling pain during the procedure. You will be awake during the procedure. The anesthesia may be applied with a lotion or injected into the area.
Description of the Procedure
You will lie on your back on a table with your feet up in footrests. A speculum will be inserted into your vagina. This tool will separate the vaginal walls. This will allow the cervix to be viewed. Anesthesia will be applied to the cervix to numb the area.
A solution will be applied to the cervical area to show the abnormal area that needs to be removed. A thin wire will be inserted into the vagina toward the cervix. The abnormal tissue will be removed with the thin wire. The area will be cauterized. This process heats the blood vessels to stop bleeding. A paste may also be applied to stop bleeding.
How Long Will It Take?
LEEP only takes a few minutes.
How Much Will It Hurt?
You may feel cramping during LEEP. You should not feel any sharp pain.
Post-procedure Care
Your blood pressure and heart rate will be checked.
During your stay, the care center staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
After the procedure, you may have:
- Dark brown-black vaginal discharge for several days
- Mild cramping
- Watery pink discharge
When you return home, do the following to help ensure a smooth recovery:
It will take a few weeks for your cervix to heal. For 4 weeks:
- Do not use tampons or douches.
- Refrain from sexual intercourse.
- Do not do any heavy lifting.
- It is okay for you take baths and showers.
- If advised by your doctor, have a Pap test and pelvic exam every 6 months.
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- Heavy bleeding (more than your normal period)
- Bleeding with clots
- Severe abdominal pain
- Fever or chills
- Unusual odor or discharge
If you think you have an emergency, call for emergency medical services right away.
Revision Information
- Reviewer: EBSCO Medical Review Board Beverly Siegal, MD, FACOG
- Review Date: 09/2018 -
- Update Date: 01/28/2014 -


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1 - 12 of 5650 results.


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See also Antibiotics (General)
Trimethoprim (Proloprim, Trimpex) is commonly combined with sulfamethoxazole (Gantanol) for an antibiotic combination that gives a one-two punch against bacteria.
Both trimethoprim and sulfamethoxazole interfere with folate: The sulfamethoxazole makes it hard for invading bacteria to manufacture folate, and the trimethoprim makes it hard for bacteria to use the folate. The net effect is to starve the bacteria of this necessary vitamin.
Humans and other mammals are much less affected by these antibiotics than are bacteria, due to the different way we process folate. However, trimethoprim can still interfere to some extent in your body's ability to utilize this essential nutrient. Folate supplementation may be helpful if you take this antibiotic for a long period of time (to prevent urinary tract infections, for example). 1
The supplement PABA may make trimethoprim/sulfamethoxazole less effective. If you are being treated with this drug, do not take PABA except on medical advice. 2,3
Trimethoprim/sulfamethoxazole might increase levels of potassium in the body. 4 Therefore, if you are on long-term treatment with this antibiotic, you should not take potassium supplements except on the advice of a physician.
The herb white willow contains substances very similar to aspirin. On this basis, it might not be advisable to combine white willow with trimethoprim or sulfamethoxazole.
Sulfa drugs can cause increased sensitivity to the sun. Various herbs, including St. John's wort and dong quai , can also cause this problem. Combined treatment with herb and drug might increase the risk further.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 08/2013 -
- Update Date: 08/22/2013 -


text:
Tympanic membrane perforation, or a ruptured eardrum, is a hole in the eardrum (tympanic membrane).
The eardrum is a very thin membrane made of tissue that separates the middle ear from the ear canal. The eardrum aids in hearing and in preventing bacteria and other foreign matter from entering the middle ear.
Eardrums may rupture from a variety of causes, including:
- Ear infections
- Puncture from use of a cotton swab or other device inserted in the ear canal
- Damage to the ear, such as being slapped over ear or and explosion
- Pressure building up inside the middle ear, as may occur with scuba diving
- Accidental perforation during ear irrigation or foreign body removal
Risk Factors
Factors that may increase your chance of a ruptured eardrum include:
- Having an ear infection
- History of eardrum ruptures, or ear surgery, such as ear tubes
- Scuba diving
- Injury to the ear
- Inserting objects in the ear
You may not have any symptoms. For those that have symptoms, a ruptured eardrum may cause:
- Earache, severe and increasing in its severity
- Earache, severe, then subsides, then is followed by discharge from the ear
- Drainage from the ear—may have blood or pus
- Hearing loss or difficulty hearing out of the affected ear
- Buzzing or other noise in the ear
People who have traumatic ruptures to the eardrum may be at an increased risk of an ear infection. Infection may occur because the opening in the membrane allows bacteria to enter the middle ear and cause infection.
You will be asked about your symptoms and medical history. A physical exam will be done. During the exam, the doctor will examine the ear with an otoscope and look to see if the eardrum has been perforated. The perforation is sometimes difficult to see because of the thick drainage in the ear.
Doctors may also perform an audiology test to determine if any hearing loss has occurred.
While many ruptured eardrums will heal on their own, many may also require treatment to heal properly. Options may include:
Medications may include:
- Oral antibiotics or antibiotic eardrops if an infection is present or possible
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
If the eardrum does not heal itself, surgery may be required to repair the perforation, usually with a patch.
To help reduce your chance of a ruptured eardrum:
- Do not stick cotton swabs or other objects inside the ear
- Treat ear infections promptly and thoroughly
- Avoid scuba diving when you have cold or allergy symptoms
Revision Information
- Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
- Review Date: 09/2018 -
- Update Date: 09/30/2013 -


text:
Changed your mind? Decided not to comment right now?
Return to burning in groin and buttock.
Join in and write your own page! It's easy to do. How? Simply click here to return to Chiropractic help Questions (Low back pain).
Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.
Interesting challenges of the day
1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.
2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.
3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free.
Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.
4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.
He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.
5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.
6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.
7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.
8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.
9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.
10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.
11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.
12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.
13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?
And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.
Do you have a problem that is not getting better?
Are you looking for a different slant on your pain?
Do you want to pose a question?
CLS writes:
Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.
Your own unresolved problem. Pose a question
Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.
You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what a DC does.
The quickest and most interesting way is to read one of my eBooks of anecdotes. Described by a reader as gems, both funny and healthful from the life and work of a chiropractor, you will love them. Priced right at $2.99, though Kindle fiddles the amount without telling me.


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