text:
Ask the Half M.D.: what's the best stethoscope?
All around the country premeds everywhere are anxiously awaiting the start of medical school at the beginning of August. They will bring with them many hopes and aspirations as they begin their careers toward becoming future MD's. They will have many questions such as which organizations to join, whether or not to go to class, and who is going to kill the first patient. But nothing is more anxiety provoking at this time then trying to decide which stethoscope to purchase.
While there are many options to choose from, I would caution fresh medical students to stay away from the electronic stethoscopes. I have never use these devices. While I'm sure that their built-in microphones will help listeners catch even the faintest heart murmur, there is something to be said about learning the physical exam the old fashion way.
First and foremost you must buy a cardiology grade stethoscope. That includes a diaphragm, a bell, and a dual lumen tube. Instantly disqualified are the nursing-grade stethoscopes that your parents got you as a gift when you were accepted to medical school. You should plan to spend at least $100 on a quality model.
Currently, the most popular stethoscope amongst medical students is the Littman Cardiology III. there is no shortage of users willing to sing its praises. It comes in numerous colors, drug companies give away accessory products specifically designed for it, and it has the appeal of being able to say, "I went with the Littman."
I don't like it. I haven't been able to hear as well with it as the marketing propaganda would claim. The fans will instantly cry out, "But it has a tunable diaphragm." To which I would respond, "Do you even know what a tunable diaphragm is? And furthermore, if you pay any attention to the research that was conducted on stethoscopes beginning over 50 years ago, you'd realize that a tunable diaphragm is the exact feature that a stethoscope should not have."
I prefer the Welch Allyn Tycos DLX. The sound quality is much, much better compared to the Littman. It has interchangeable ear pieces that come in various varieties of stiffness so that the user can choose based on comfort level. Finally, the diaphragm can be easily changed to a pediatric version. All I have to do is unscrew the adult version and then replace it with a pediatric one to convert my stethoscope into a listening device for the kids.
Take a look at the pictures below:
What now bitches? I'd like to see you pull that off with a Littman. Its users will be required to buy two stethoscopes to follow both adult and pediatric patients. I know several people who purchased new stethoscopes just to go through the peds rotation. I took a more sensible approach.
Edit: I just found this exhaustive article that goes into detail about properly using a stethoscope. There is also this article that gives a comparison of multiple scopes.
63 Comments
joe said,
What now bitches?
Haha, really didn't see that coming.
Corey Gilmore said,
I disagree with you on the electronics tip. I bought a Thinklabs off of Amazon and love it. Sound quality is great and you can even turn it into an acoustic scope.
kiddyshrink said,
Nope, you win. I can't do that with my Littman.
(Yes, psychiatrists use stethoscopes. At least, this one does.) 🙂
eneri said,
you obviously haven't tried running around on call with the welch allen — its damn heavy and hits against your chest with every step you take. as the night wears on, you feel its leaden weight more and more. besides the tubing's of poor quality, it cracked after my first yr as an intern. Used to use the welch allen and now i swear by litmann Cardio III
eneri said,
btw the littman III can be converted to a paeds steth – the bell can be fitted with a diaphragm to become a paeds diaphragm
Scrub Notes said,
Another vote for Littmann Cardio III, and yes, I used it on my peds rotation and it worked fine using the conversion eneri notes above.
EMT intern said,
freak'n hilarous. Awesome ariticle. I am taking a class now, and was stressing about what stethoscope to purchase. I was wondering what the difference was between pediatrics and adult was, now I know. I have read other forums saying that Tycos & DRG Puretone (Doctor Research Group, also Bose designed the acoustics for this one) Stethoscopes were better than Littman's acoustics.
What do you think about the ultrascopes? I heard they are comparable to cardiology stethoscopes and lighter too boot. Unfortunately, I do not see the option to swap to pediatrics if you get the adult version for it (unless i missed something). Great tips for duel lumen, bell, and diaphragm. I'll keep that in mind while shopping around.
EMT intern said,
nevermind, ultrascopes do have the option for pediatrics as well as neonatal.
aw md said,
First off, your right electronic is definatley not the way to go. However if you knew what a tunable diaphram was youd probably be using one. Also with the Littmann Master Cardiology (which littmann touts as its top of the line best cardiology scope) comes with an attatchment for pediatrics. Easy to use, and far superior to any scope Ive ever used tunable or not. A.W. MD 22 years in cardiology
Critical Care said,
The Littmann Cardiology III is not an acutal diaphram and bell stethoscope. It has two tunable diaphrams. One side is a pediatric and one side is an adult. This is the same as the master cardiology scope but gives you the option of having a peds scope available.
Norman O Moser, DO, Pharm D, R.Ph said,
I am an older physician who has tried many stethoscopes trying to find the best one. I finally tried the following test. Borrowing various stethoscopes from friends, I assembled quite a number of different stethoscopes. I then listened to just one patient and compared all scopes. I rated each scope on ease of use, durability and quality of sounds to "MY EARS".
I did the same experiment with 5 more patients refining my list of stethoscopes that worked best with me and "MY EARS".
I am now using the Littman electronic model 3100. I never listen to pediatric patients, so a pediatric scope is a mute point for me. The 3100 to me sounds great, looks great and is very durable. I have heard things with the electronic that I have never heard with an accoustic. By the way, my hearing is not failing.
Choose the scope that works the best with "YOUR EARS". Try many. Listening to advice from your friends and advertisements will help guide you, but your friends do not have "YOUR EARS" or your habits. you will probably have mutiple scopes throughout your career.
Norman O. Moser DO
Christophorus said,
Littmann Cardiology III is the best!!! The electronic ones are for lazy guys.
jurian said,
my friends got another version of Littman and looks like the scope can rotate 180degree. The first side for adults and the back smaller side for paediatrics..
hahahahaha… LOL.
zsigaman said,
I've got the Welch Allyn, too and I think it's great. Very loud and clear. But the bell is a bit small and accordingly quiter, though crisp. So I've had a bigger one made and now it's probably the best scope ever.
But the best buy is the good old Sprague. Why? Because they're cheap, have loud and crisp sound that practically rivals that of the Welch Allyn and come with much longer tubing, which makes for a more convenient examination.
Littmans are much quieter than the above two, even the Cardiology III and Master Cardiology and gallops are a bit blurred.
So that's my take on the matter.
Nick said,
I have to agree with Dr Moser. Try lots of stethoscopes and find what works best for you. I'm a paramedic and have worked on ambulances, in airplanes and in hospital. After 11 years I swear by the Littmann Cardiology III. The thick tubing is very effective at canceling out background noise. The tunable diaphram does work very well (maby not quite as well as seperate bell and diaphram, but very well), and I often use the smaller side on peds and small, thin or frail elderly patients. I would probably make the jump to an electronic model (though I agree it's best to start off acustic) except I have had the need on numerous occasions to disassemble and disinfect the entire thing. Another important feature often forgotten about is tubing length. The longer the better if your patients may include the bleeding, vommiting, coughing, stinky or unclean. Make sure you label your sthethoscope many websites offer engraving. The unwritten rule seems to be "the more expensive the ears, the more likely I am to set them down and walk off"
A, RN said,
Wow, thanks for the degrading comment about nurses, "Instantly disqualified are the nursing-grade stethoscopes". I am an RN and currently also use a Littman Cardiology III specifically because it was required by my nursing school. Do you think it's strange that RNs and MDs would use the same stethoscope? I don't.
CCU Nurse said,
What is a nurse-grade stethoscope anyway? I work at a teaching hospital and apparently all students and most doctors have nurse-grade stethoscopes…What a bunch of BS.
I have the same stethoscope as my husband who in fact is a cardiologist. Depending on what kind of nurse or doctor you are depends on what kind of stethoscope you should consider. My husband has lost his stethoscope to plenty of residents and medical students so don't spend to much money as you will eventually need to buy another. We have always had littmanns and I would recommend the brand. Maybe are next purchase will be a Welch-Allyn to compare.
CCU Nurse said,
Apparently there is something called a single head nursing stethoscope…"interesting" you can buy it for about $6. Pretty sure these are the stethoscopes they put on isolation carts that get thrown away. I don't know any NURSE who would ever purchase this.
CCU Nurse said,
this is an actual study, read conclusions and recommendation on page 7
Reader said,
Calm down. The remark obviously wasn't intended to degrade nurses, only to show the the wide scope of stethoscopes available. As CCU stated, there is a "nursing stethoscope" and it is often given as a gift from people who don't know any better.
JJ said,
Dear CCU nurse:
Please go to medical school and become a doctor because you are obviously too insecure as a nurse.
BB RN said,
I am a peds onc RN and I came across this site to find a recommendation for a decent scope. I don't think that MDs and RNs should be clashing here, aren't we all working toward the same goal of performing the best assessment possible? In fact nurses spend the entire day with the patient and do multiple assessments throughout the day and share any changes with the MD. So it makes sense that a nurse should have an excellent stethoscope as well. The MD of course also needs the right tool to make a correct and accurate diagnosis. It's just disappointing to see negativity whereas we should be focusing on how best to work together to improve pt outcomes. It seems that the Littman III is popular with physicians. I've been using a basic littman for a while until a resident snatched it! Kidding! But really it's time I invested in a decent scope so I will try it. Thanks
emt dude said,
personally, l've tried several brands of scopes in my ambulance,and i swear by the adscope by ADC. Sound quality is awesome and the price is very reasonable as well. lts definitely worth trying.
MG said,
Do you still agree with your stethoscope recommendations? Curious b/c I am researching one for my partner who is graduating in may.
JN said,
EMT dude…you are not even remotely qualified to comment on the topic at hand. Carry on handing out band aids and 02
Dr. Jackie said,
I have been a RN for 40 years (nearly 30 years spent as a Navy Nurse) and I am buying this stethoscope as a gift for one of my students who will become a physician. His MCAT scores and GPA are exceptional. I have never known such a highly intelligent, warm, friendly person who wants to become a physician-his goal is to 'help others.' Thank all of you for being so sincere with your comments; your comments have truly helped me to make the appropriate selection based on my research. Thanks again!
RN in Virginia who is now a College Prof
Kaitlin Sherman said,
Sir, you mentioned in your article, "…tunable diaphragm is the exact feature that a stethoscope should not have." Can you explain it in a nutshell? I'm sure it would be time-consuming to look back at those 50 years of research. So, a brief summary from you would be great (or perhaps you can share the most notable ones?). Currently, I have the Littman Cardiology III (which I bought at http://www.stethoscopesforstudents.com) and it's working greatly for me. I love the convenience that the tunable diaphragm gives me (not having to turn the chestpiece over). But you know, I would gladly consider other steths if the feature compromises accuracy of detecting important sounds. Thanks. 🙂
Greg said,
Hahaha! You hurt the sensitive nurses. Why shouldn't they get the same stethoscopes as doctors? They do the same things. Oh, wait, they don't? 😀
NICU RN said,
Have any MD try living 1 day without nurses and then come back and tell us how it went. kr
Greg said,
Ha! Another nurse overcome by emotion. Thus, you missed the point of the argument. Don't worry, not your fault. It's your IQ's. 😀
bynaturalmeans said,
POMPOUS DRS! Nurse's are not inferior. a lapse in judgment but all of you it seems. No, they don't do the same things as drs but they certainly need to be able to hear a patient properly. how ignorant to assume that the nurses on this chatboard are "overcome with emotion". And no, I am not a nurse. just a student, a very educated and informed student who appreciates what nurses do and what they will do for the future of healthcare. their job is beyond critical. every person who works in hospital is a critical component to the bottom line – helping others.
sam said,
I am an emergency department Dr, with a particular skill set. I have nothing but respect for nurses and EMTs who have their own unique skills and areas of expertise. To the gentleman above 'JN', I am assuming that you are a student and/ or an idiot, therefore have absolutely no idea what you are talking about. It takes incredible skill to rapidly assess, triage and initiate appropriate emergency therapy in a prehospital environment. Take a ride with some EMTs and see what they do, that is if they'll have you.
As for stethoscopes, I've owned a few – if you are a cardiologist, and need to be able to hear subtle murmurs and soft opening clicks, then spend a small fortune. If you need just need to take BPs, check HS, and ausculate the lungs, then a medium grade steth will do fine.
the classic sprague rapport scopes are good in terms of sound quality, but the dual tubing can rub together producing artifact – not so good in the back of a moving ambulance. The maxiscopes from Ultrascopes are not bad – easily cleanable, and good when it's noisy (EMTs), and only about 40 bucks.
so there you go.
PS a 'Nursing stethoscope' simple refers to the inexpensive scopes that hospitals buy en masse which sit on the BP machines to take blood pressures, which is usually a nursing responsibility.
Dave said,
Well. Loved all the comments. Now I'm I a different boat all together. I'm a flight nurse..and before the few egotistical doctors go all stupid on here, I'm a Gulf medic veteran, (part one), emergency and ICU nurse with 5 post grad cert's and a masters, so please don't belittle my skill as an RN, I have more skill in left toe than most residence have fumbling through their first 5 years. So my question is… I know my heart and lung sounds, but I'm in the back of a noisy chopper or fixed wing air craft. Do ano of you know if the electronic littmann 3100 are affective in this noisy environment? Cheers
Dave said,
And I'm typing this on an iPad a 3 in the morning so excuse the typos !
Jamie said,
This has been so incredibly entertaining! Thank you Dr Sam for your awesome words. I happen to be a nurse in the ER. There are so many EMT's, paramedics, RN's, LVN's, and Dr's I would trust with my life independently. The team I work with is close knit and stellar. We all have to work together to get the job done. I appreciate pointers and thoughts, and my Doc's appreciate the same from their Nurses (well, most of the nurses, lol. You always have the dummies). Dr's with the attitudes and belittling comments have some major ego issues. You spend 12 hours with the same patients dealing with all sorts of issues, in addition to their current health complaints. And isn't the nurses who calls the Doc to say, "This guy is about to crash, and this is my reasoning behind my hunch…" and then state assessment findings, which require stethoscopes. I'm just saying. I don't want to be a Doctor. I chose to not be a Doctor. I work 3 12-hr shifts and go home at the end of the night/day. No one calls me. I get to live my life :). But I thank all of my Doctors, someone has to do the job, and luckily it is not me!
claire said,
Hey, just wondering how much was your adult and pediatric one that you prefer better?
Donver said,
please send me email at email@example.com, so that we can talk privately. thank you.
Corinna said,
I am an ICU nurse and I was given a welch allyn by a an MD that was sweet on me. The relationship didn't last but my stethoscope is still going strong. I have to admit, Welch Allyn is the best stethoscope I have EVER had. I will NEVER go back to a littman again. I have been currently using this one for 6 years now and haven't had to replace the tubing like I had to yearly with my littman. I have the dual head, it is light weight and has been very resilant. HIGHLY recommend a Welch Allyn. I will buy one again and again.
Jane said,
Hey there…I'm a real nerdy post-acute care nurse. I have an excellent ear and I hate my Littman low end model. I have been contemplating a Thinklabs digital that I can record waveforms with. Anyone have comments on this? Thanks! Jane
DrWort said,
As a paramedic the hardest part for me is finding a model that will keep the outside noise to a minimum as the back of an ambulance gets pretty loud. Especially if were priority 1. The litman did not do it for me I tried my friends WA and it was perfect. Even in my BSN classes it seems to be easier for me to hear abnormalities than my peers but that may be experience who knows.
Simple Jane said,
I just want to thank the garbage man for picking up the trash with my old stethoscope . Just being grateful in life for what matters!
Daniel said,
I was looking recently at purchasing a stethoscope and your article was spot on. Although electrical stethoscopes are much easier to use and detect even the faintest sounds with, i too appreciate the craftsmanship of using a stethoscope the old fashioned way and the richer experience you get.
Steven @ Best Stethoscopes said,
It's rare to see someone recommending Welch-Allyn over Littmann when it comes to the best stethoscopes, but congrats for sticking to your own guns. As far as electronic stethoscopes are concerned, their price is on a downward spiral recently, and once they match the price of an acoustic stethoscope i do not see anyone who would not give them a serious thought. In my opinion the price is the only reason you should not get an electronic stethoscope at the moment.
H. E. Sawyer, Jr. said,
Hello, Folks. Well, I was a pretty good Psychiatrist in the U.S
Armed Services, and got into the healing arts ( it ain't a science ),
as a respiratory therapist, then, just a little later, was a Physician's Associate. Since 1970, I've owned about 50 ( fifty ) stethocopes. My first scope, was the Littmann Magnascope. I believe 3M's
item number was 2185. Compared to the original, the 2100, this
was a much bigger guy, with a 40 % bigger diaphragm, and a
HUGE, deep, bell. It was a sales failure, but it really did the job.
It was the original Cardiology Littmann model. But, I also owned
the 2100, and the chrome-plated feather-weight version of that
scope. I purchased the H-P Sprague-Rappaport scope for $60 bucks in 1972, and chewed my nails, waiting to get mine. This
H-P Sprague was a beautiful scope, but when I finally got mine,
I actually could not hear spit with it; I literally could hear nothing
with it. I gave it to a girlfriend, and went back to my Magnascope. Later, A now-defunct little company in Florida, Buffalo Medical, made a very fine, good-looking, heavy duty scope they called the ALLEN Mark X. It was $40 bucks, and I bought three. It was loud. And,
accurate. In 1975, I bought a very expensive, well made scope
that I'd read about: The Taylor-Harvey Triple Head, with double tubes, and the rotating turret chestpiece was HEAVY, and it was designed to be just that – heavy. It is chrome-plated brass. IT was designed by the late, W. Proctor Harvey. At $250 bucks, I expected this to do double-back flips, and believe me, it did !! This guy is WAY LOUD ! They sold several of these guys. If you've ever
tried the Harvey types, you know they are loud, and accurate.
They sold the Harvey designs to Welch-Allyn. Recently, I had
a chance to purchase the Harvey Elite Cardiology model, for
a tiny fraction of the MSRP, from an E-BAY seller. It's a great
scope. Very loud. Very accurate.
Also, I bought a $13.95 Chinese knock-off of the Littmann
Master Cardiology scope. It's a beauty. It"s not as heavy,
but in terms of loudness, it's EQUAL to the original Littmann.
I've used the Littmann Cardiology I, II and III. I thought, and still think, that they are FABULOUSLY over-priced.
About three weeks ago, I bought a totally like-new HEINE Model 10, stethoscope, for $30, from an E-BAY seller in New Orleans. It's a very fine instrument. Really loud and accurate.
At this moment, I have a DRG Pure-Tone Adult Combination scope coming…. I remember years ago, when this thing hit the market
in the States…they were the most expensive scope you could buy, except for the Harvey line, and the HP Sprague. I will be more
than curious to see what the quality of this DRG scope.
But, I agree with the other writer, in this thread: FOR THE MONEY, the little chinese generic Sprague-Rappaport is the BEST scope in the World. $9.95, to $19.95. Huge value.
But, there is no substitute for knowing what you are doing when you are ausculting the human thoracic anatomy. Harvey taught his system of auscultation, and it's the world bench-mark.
If you don't know the Harvey System, learn it. It's certainly
worth the time and trouble.
best stethoscope said,
I always trust Littmann. Had one since I was in college and tested colleagues and glad I don't have cheaper ones.
Nurseman said,
I own a littmann 3100. Excellent auscultation of breath sounds and heart sounds in a quiet setting. If you turn the volume past 50% the slightest bump to the tubing, a patient cough, and background talking gets picked up and it hurts. I keep mine between 1 & 3 on the volume, and it works perfectly. Volume set at 3 bars is equivalent to the littmann master cardiology volume wise, I borrowed my friend's master for a few days. The electronic is nice but isn't worth the money IMO.
Peter R said,
I own a Littmann cardiology II SE stethoscope that I bought in 1997 after losing my Littman Classic II. It did not perform as well as the Classic II, and my listening experience went up when the tunable diaphragm disintegrated (left steth in sunlight for too long, I think) and I replaced it with a standard Littmann diaphragm. But it is still a rumbly stethoscope.
My other stethoscope is an ADC Sprague Rappaport, which does well… and even better once I replaced the adult diaphragm with a thin aluminum alloy disc (salvaged from a thin walled soft drinks can – large diaphragm 39.5mm diameter, small diaphragm 26m diameter). You can't hear a bruit? Difficult to hear a pleural rub or make out that both S1 and S2 are normally slightly split? Go play with your Sprague and a soft drink. The trendy mini-cans are better as thinner walled btw. I would ideally use thin stainless steel for a diaphragm, but dunno where I can McGyver that from!
Next modification I did was daring to modify my Littman Cardiology II SE. I could not get myself to discard that lovely "L" for littmann diaphragm, but I did some high frequency preference mods to the diaphragm side. It involved gluing a piece of aluminium (aka aluminum) sheet over the sound hole, with a 1mm diameter hole bored through it. I filled excess space under the diaphragm with several layers of PVA glue, laid a few hours apart, to maximise internal pressure differences with diaphragm movement. I also cored out the ear olive exit hole so that it did not represent a narrowing in the sound path – so as not to selective attenuate high frequency sounds (cf. why we use the diaphragm in the first place!) The nature of the head modifications are suggested in this British article from the 1960s: heart.bmj.com/content/23/4/447.full.pdf
Reading this article btw was what spurred me on to go have the balls to play with the modifications.
Peter R said,
Here is a TEST for the ability of your stethoscope to conduct sounds faithfully.
It is a fact that the low frequency sounds do not need amplification, and they travel nicely through most tubing. In other words, most stethoscopes, at least if you use the bell, will let you hear the rumbles. It is therefore crucial how a stethoscope carries and protects the fragile high frequency sounds.
1. Rub your fingers against each other by your ear. Note the high pitched rustle as well as the lower pitch rubbing.
2. Put your stethoscope on. If the ear pieces fit you should not be able to hear your fingers rubbing against each other.
3. Turn your stethoscope head to the OPEN BELL side and, without touching the stethoscope head, rub two fingers against one another by the bell opening.
How well can you hear the high pitched component of the rubbing?
If "no", then that stethoscope is working against itself. It has a diaphragm to attenuate low pitch sounds (which otherwise drown out high pitched sounds), but then, further up the stethoscope, something attenuates those precious high pitch sounds! Duh!
It is of course not a completely telling test cf. the airtight system behind the diaphragm, but all the same, I have noted much difference between stethoscopes.
Sean said,
Question for you, does the tycos come with the peds head or did you order that separately?
Dr. Sachin said,
I never used Welch Allyn Tycos DLX, but I have Littmann Cardiology stethoscope and it works great for me. Though it is bit expensive but have great acoustic quality and many other features.
I think I should have one Tycos DLX if my Littmann get lost or something like that.
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Future ARNP said,
I purchased the Littmann Cardiology III at the beginning of nursing school, yes I was snookered in by all the hype, it is good, but not great by any stretch. A while back I purchased a late 70's or very early 80's original Littmann Cardiology (some call it the Cardiology I, but it's not marked so) after reading an in-depth stethoscope review (http://www.forusdocs.com/reviews/Acoustic_Stethoscope_Review.htm), the original Littmann Cardiology acoustically came out on top, but 5 points was deducted from its score for having shorter binaurals (tubing) making the cardio III the review winner[tubing length is an easy fix], but WOW what a difference the hard, floating diaphragm makes vs the tunable, it is secured to the chest piece with a threaded stainless steel ring not a stretchy piece of rubber like the newer Littmann's; it really is a much better stetho than the cardio III, its louder, and heart sound are not nearly as muffled, they are more crisp, I also love having a dedicated bell. I have grown very tired of the tunable diaphragm on the Cardio III, so much so that my 30+ year old original Cardiology is my daily scope, the cardio III sits home collecting dust and even with the pediatric diaphragm gone so I have a bell, it is still not as clear or loud as the much older original Cardiology. I have a call into Littmann regarding swapping out the tunable diaphragm on the cardio III for one of their same size, replacement floating diaphragms used on the original Cardiology as to whether there would be any sound detriment, could it really get worse? Personally I think it could only be an improvement. I may just try it anyway no matter what Littmann says; I want to hear what 'my own ears' think!
I have always had my eye on the Welch Allyn Tycos DLX, but its a lot of cash, I have read mixed reviews, and I don't need another disappointment like the cardio III, so right now its on the back burner, the way back burner!
linh april said,
I vote for Littmann Cardiology III, my uncle is a pediatrician, and he used this stethoscope for 10 years
AR said,
Honestly, on the inpatient and ICU side where I work as long as you can tell something is grossly abnormal you will end up with a confirmatory test. I use an electronic because I find that with the vent sound the noise cancellation helps, but if I had to choose between it and the bedside US I would choose the US every day, especially with ventilatory and capnography waveform.
Future ARNP said,
I received a reply from Tim Chismar of Littmann's technical services regarding my query about swapping out the tunable diaphragm on the Cardiology III for the older style floating diaphragm used in the Cardiology and early Cardiology II's; here is his exact response "Unfortunately, the answer is no, you cannot use the older floating diaphragm on the Littmann Cardiology III stethoscope. The reason is from both a technical and regulatory perspective. The tunable diaphragm has a flexible membrane around the diaphragm that contributes to the tunability, but that membrane also serves as an appropriate interface to the Cardiology III chestpiece structure. If you tried to use a floating diaphragm on the Cardiology III, you would likely have an acoustically leaky seal, which would diminish the sound quality. The regulatory aspect is that the stethoscope is a FDA Class I medical device, and is verified and validated to perform with the tunable diaphragm. Using the Cardiology III with the floating diaphragm would be outside of it's specification i.e. off-label." I did end up testing my theory from my prior post and the non-tunable floating diaphragm mounted on the Cardiology III is definitely louder, a little crisper (higher pitched) and less muffled and I do not detect any air leak/seal problems as Tim mentions. I will keep my scope in this configuration even though this may be 'off-label' use only for the fact that if "my ears" can hear heart and lung sound more clear it serves to benefit my patients. For only $5, the cost for a new floating diaphragm (Littmann part# 36559) and a couple minutes of your time you can swap out your diaphragm too, it's easy, then you can be the judge whether "your ears" think it sound better. You really have nothing to lose!
I also lucked out on eBay last week and picked up a New Old Stock Tycos Original (double tube) Harvey double head and a barely used, like-new Tycos/Welch Allyn DLX double head for ridiculously low prices; I guess the DLX wasn't on the back burner after all! I auscultated my own heart and both scopes sound really good, however I will be testing these more thoroughly over the next few weeks in the ER adults pts. and hopefully ped's as well and will post my subjective results in several weeks.
dr. john howard said,
I am an emergency department Dr, with a particular skill set. I have nothing but respect for nurses and EMTs who have their own unique skills and areas of expertise. To the gentleman above 'JN', I am assuming that you are a student and/ or an idiot, therefore have absolutely no idea what you are talking about. It takes incredible skill to rapidly assess, triage and initiate appropriate emergency therapy in a prehospital environment. Take a ride with some EMTs and see what they do, that is if they'll have you.
As for stethoscopes, I've owned a few – if you are a cardiologist, and need to be able to hear subtle murmurs and soft opening clicks, then spend a small fortune. If you need just need to take BPs, check HS, and ausculate the lungs, then a medium grade steth will do fine.
Dr.Natish Shah said,
I totally Agree with you Dr. MD . we always need to choose the best stethoscope very carefully from the market. by Profession i am a doctor and when ever once a year i bought a stethoscope , i search on the internet, read the best reviews and then purchase it. i highly recommend to other people to check the price from the market and also compare with the internet price. then go for Purchase.
best of luck Guys
Aman said,
Littmann Cardiology III is the best!!! The electronic ones are for lazy guys.
Gabriela Elena said,
My parent let me choose stethoscope for my birthday. Which one is better welch allyn proffessional stethoscope or litmann classic 3?
Diver Doc said,
I've used the Hewlett Packard Rappaport-Sprague with the aluminum shot glass Pellham bell, Littmann Cardiology I through III, and a Littmann Classic II. To MY OWN ears, the best was an original 1960s Littmann Cardiosonics (before Littmann was acquired by 3M). I do admit that I miss the HP, having sold it during residency when money was tight. I'm wondering if any of the current Sprague copies even come close to the HP? I've heard that Omron and Prestige Medical (the 120 version, not the 122) come close?


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subset: commoncrawl


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With regrets, indeed: confessions of a one-time Iraq war supporter
Posted by Thomas Nephew on 19th March 2013
On the 10th anniversary of the single worst decision in U.S. history, my longtime online friend Aziz Poonawalla asked me to let him post a blog posting of mine from February 13, 2003 — With regrets: For war on Saddam — along with a few comments about how I came to repudiate my former position on Iraq …yet again… and what I know now. I've done so a few times before — here, here, and here to name a few. But the occasion, and honesty, and sorrow at the debacle I too was a part of — however small — demand of me that I do so again. Aziz is extremely gracious, and sees in my essay the culmination of an honest debate with myself that I came down on the wrong side of. I don't know. All I know is lots of other people didn't make my mistake, I shouldn't have made it, and I wish I hadn't.
I began realizing how wrong I was the day of the invasion. One of my main reasons for supporting the war — after initial skepticism — was Iraq's alleged stockpiles of chemical, biological, perhaps even nuclear "weapons of mass destruction" in the hands of a ruthless dictator and in defiance of UN resolutions. Yet now that Iraq was being invaded, where were they? So my support for the war was decaying from the outset, despite a rather elaborate set of arguments for the war — often merely counterarguments to peace, really — that I now see I was using as hedges. Having made the leap to the "other side" of the argument, though, I was stubbornly unwilling to go all the way back; that seemed dishonest. Yet over time new doubts reached a crescendo, from the uncontrolled looting after the fall of Baghdad, to the Shia uprisings of 2004 in a supposedly mending Iraq, to finally, irreconcilably, Abu Ghraib,which left me literally immobilized with shame, fury, and regret the morning I heard about it. All of these things, but especially Abu Ghraib, convinced me I had nothing in common with the people who commanded and countenanced any of what had been done, by omission and commission, in Iraq, and by extension the policies they supported.
All I can say is: I'm so very, very sorry. I'll never do it again. That's no consolation whatsoever to the thousands of US soldiers who died, or the tens and hundreds of thousands of Iraqis who died, so I don't say it much, it's inadequate and weak. What is it I'll never do again? I'll never accept at face value any administration's claims for the need for war: given that there were no WMD to disarm Saddam of, the evidence for them should not have been accepted. I'll also never accept at face value again the idea that there's an effective political opposition in Washington, or that the Beltway consensus represents some wisest possible sifting of the evidence, at least when things are as deadly serious as going to war. In this respect, it was nearly as unforgiveable for Senators like Clinton, Edwards, or Kerry not to even look at intelligence estimates doubting Iraq's WMD program as it was for Bush and Cheney to go to war.
And if I ever again find myself writing — or reading — elaborate, hedging arguments for a war of choice, with pompously unforgiveable phrases like "come what may," I'll remember 2003 and think: please, stop. Just stop. Just shut up. Right now.
UPDATE, 3/21: crossposted at Aziz Poonawalla's "City of Brass" blog; his prior post, "Iraq War retrospective: the liberal case for war #iraq10," sets up the crosspost: "The debate over the Iraq war was not polarized according to liberal/conservative fault lines, but stretched across them. In fact, many liberals found themselves reluctantly swayed by the arguments for war, especially after Kenneth Pollack's book "The Threatening Storm: The Case for Invading Iraq was published in September 2002, roughly the one-year anniversary of 9-11 and 6 months prior to when the actual invasion began. In a nutshell, liberals were convinced by fear over the threat of Saddam Hussein possessing WMDs – nuclear and chemical; as well as humanitarian concerns. Both of these issues are still relevant in the recent and ongoing debates about action towards North Korea, Iran, Syria and Libya. […] Far from being reflexively anti-Bush, or as warblogger Steven den Beste claimed, "wanting America to lose", liberals were genuinely driven by patriotism and humanitarian concern for the muslims of Iraq under Saddam's rule. The betrayal of that trust in authority, exemplified by Colin Powell's presentation at the UN, has led to a deep-seated skepticism on the liberal left against Barack Obama's policies. Liberals such as Glenn Greenwald are far more critical of Obama than they ever were of Bush, in part because of their experience a decade ago." Aziz's entire "#iraq10" series is well worth any reader's time; I thank him both for that series and for his kind words about me.
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Yesterday I bashed up a guy in the bus. I slapped him twice, out-shouted him, and made him get down from the bus. This is the second time in two weeks this has happened.
I no longer expect appreciation for this. My parents and my boyfriend have made it very clear that they want me to desist from such dangerous behavior. Their lack of support apparently stems from their concern about my safety. Ma is going on about acid-throwers. Anik seems to be worried about a situation in which the eve-teaser actually hits me back.
Needless to say, I did not take their admonitions in a very accepting frame of mind. But in retrospect, I do appreciate what they are trying to say.
Jaipur is, to put it mildly, not a good place for women. Unlike the evilly reputed Delhi, where a guy can heckle you in public but you can heckle him right back and expect public support, or the more excitable Kolkata, where Anik tell me a girl has to raise her voice carefully because if she does, the janta will bash the eve-teaser to within an inch of his life, in Jaipur women stay down. If you raise your voice against an eve-teaser, there is a good chance that members of the public will support him and not you. You will hear comments like This girl has no modesty or what is a girl from a good family doing outside her home anyway? And of course, the eve-teaser not only gets away with it but can fearlessly hit you back or call you a slut or whatever. And there is of course the worry that he might mark you down and get back at you later, on the streets.
This disrespect for women, while it has some notable exceptions, is quiet an ubiquitous mentality in Jaipur. You will find it among the labour class, shop-keepers, and high-profile executives( eg- monster boss). I have a feeling it is older than centuries, and is too deeply set to really do anything about. My apologies to my Rajasthani readers, but this is from someone, who is doing Jaipur's underbelly everyday and knows what she is talking about.
Just the other day, I was reading about Chief Minister Gehlot's rant on the pub culture and public display of affection which are against Rajasthani culture. Mr. Gehlot, sir, why don't you do your state a favour, and instead of spouting political inanities, do something about the very real problem of eve-teasing in the city? Unless, of course, you feel that it is totally in accordance to Rajasthani culture.
Friday, January 30, 2009
Everybody Loves a Good Eve-teaser
Yesterday I bashed up a guy in the bus. I slapped him twice, out-shouted him, and made him get down from the bus. This is the second time in two weeks this has happened.
Floated gently by Amritorupa Kanjilal at 5:12 AM 7 paper boats came floating back to me
Labels: Jaipur
Wednesday, January 21, 2009
Mooccho Obliged…
Overheard at a school bus stop near my house.
Schoolkid 1 - Yaar suna hai Rab Ne Bana Di Jodi bahut boring gayi hai?
Schoolkid 2- Arre yaar uski first part bahut hi boring thi, lekin fir baad me accha rehta hai jab Shahrukh mooccho ho jaata hai
Schoolkid 1- Mooccho? Magar Mooch to uske shuru me hota hai na? End me thodi hota hai?
Schoolkid 2- Abe dhakkan mooch nahi mooccho! Mooccho ya ni ki strong.
Floated gently by Amritorupa Kanjilal at 9:44 PM 4 paper boats came floating back to me
Of Bhais and Names
I've always been a fan of Sanjay Dutt. I've loved him in Munnabhai, Kaante, Vastav, and most of his other movies, and I used to see him as a man who has had to repent more than he has sinned. All my sympathies have been with him in spite of all that people say about him. But something changed yesterday morning while I was reading the morning papers and came across an interview of my hero.
Mr. Dutt was asked about his sisters' publicly negative reactions to his wife Manyata. His answer was - " Good women change their surnames to that of their husbands after marriage. I have no sympathy with women who cling on to their father's names even after marriage. If Manyata had told me she wanted to keep her last name, I would have been extremely offended and would not have permitted this in any circumstances."
My reaction was simply "EXCUSE ME???" I just couldn't believe what I was reading! The NERVES on this audacious bastard!!
His dig was obviously at his sister Priya who remains a Dutt though she is married. Priya Dutt has inherited her father's political mantle, much to her brother's chagrin.
I don't want to go into their murky family feuds. But I just want to put this on record that I believe this expectation that men have that of course their wives will take their names after marriage is a CROCK OF CRAP. And its disgusting how so many girls go along with this expectation, as if it is the culmination of all their dreams have their identity redefined.
Don't get me wrong. Most ladies I know use their husbands' last names. Most of my friends do too. In fact someone who I know is reading this post uses both her husband's first and last name (his first name as her middle name). But I sincerely hope, at least in case of women my age, that this change of name was a choice they made voluntarily, and not because of the expectaions of society.
A woman does not become her husband's property after marriage, so what is this deal about stamping your wife with your identity. What is wrong with her own? And if you feel you and your wife should have the same last name, why don't you consider changing to hers?
A point made out by many of course is that even if you are not taking your husband's name, you are holding on to your father's, so how is that any better. But look, my family name is the one I've had for more than two decades. Why will it have to change all of a sudden? To what purpose? A wedding is NOT supposed to be a transfer of property. A wife is also a human being, and she has the right to hold on to the name the world has known her by. Your name is your identity, or at least a part of it.
And it is a RUBBISH concept that a woman's family changes after marriage. Sure, her husband's family becomes her own, but there is no logical reason that she should stop being a part of the family she has known since birth.
People, the gender equation in our country is totally screwed. What has existed for generations is not neccessarily right or just. At least think about change sometime.
And oh, as you can probably tell by the photograph I've edited as above, I am no longer a fan of Mr. Sanjay "Keep your womenfolk in control" Dutt.
I can just hear Anik snickering "reactionary!". :-D
Floated gently by Amritorupa Kanjilal at 4:27 AM 17 paper boats came floating back to me
Labels: feminism
Sunday, January 11, 2009
How NOT To Be A Bore
Floated gently by Amritorupa Kanjilal at 4:25 AM 15 paper boats came floating back to me
Thursday, January 8, 2009
A Rainbow For Free
This is probably not a big deal, but I looked forward to this view every morning for nine days while being ferried to the examination centre at the Commerce College. It was like chicken soup for my frayed nerves.
Oh , and now suckers who might try (though I can't imagine why) to copy paste the stuff I write here will just have to copy it out manually if they want it so badly. I've fiddled it so you can't Ctrl C Ctrl V me again… This is courtesy my friend Pragg., so if you want to find out how to do this you might ask her.
It's 11.30 in the morning now and the monster isn't here yet. Does this mean I can go home?
Floated gently by Amritorupa Kanjilal at 10:07 PM 1 paper boats came floating back to me
Labels: Jaipur
Wednesday, January 7, 2009
Floated gently by Amritorupa Kanjilal at 3:23 AM 6 paper boats came floating back to me
Labels: me


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Luxurious Rolex Swiss Watches
Last year I bought myself a replica Rolex. I have been searching for a long time a timepiece that will meet all of my needs and still maintain its class as far as appearance. Being a person that travels frequently, it is extremely important for me to be able to keep time anywhere I go, and also, to have a watch that is dependable in any situation.
During my research I came across the Rolex Daytona. A favorite of Paul Newman, this watch was exactly what I was looking for. This replica Rolex came in many styles and colors so it was easy to find the model that fits me best, without having to compromise anything, like the strap color, dial color and so on. Not only that, but they had the masculine, tasteful appearance I was longing for, without the exorbitant price tag of the genuine article.
From my research prior to buying my replica Rolex, I found out that Rolex Daytona is very hard to duplicate. That's why these models go through strict quality control tests, just to make sure they look and function just like the originals do. These are top quality fake watches. Beside the fact that precious metals are replaced with top grade steel in the manufacturing process, there is no difference at all between a replica Rolex and a genuine one.
After a full year of wearing my replica Rolex Daytona, it came to mind that not only I had no problems with it, but it had more than lived up to the company's promises. Functionality? Yes! Style? Yes! Compliments? I only wish they would stop, I started to feel a little embarrassed. Even now, my close friends thank me for sharing with them my discovery. We are all more than satisfied with our purchase.
Show me a man who doesn't like the idea of owning a Rolex and I'll show you a liar. Let's face it, there are millions of men across the globe that dream of owning one of the many luxury Swiss watches. Why is it a dream and not reality, some may ponder. Well, the answer is an obvious one: the majority of people are not rich, and even if they can afford one, they put their hard earned money to much better use.
Since Rolex is the benchmark for luxurious watches, it's safe to say that it's more than a tool used to keep track of time. It is a status symbol, an important fashion accessory and, why not, a jewel in its' own right. Men who wear appealing, expensive time pieces are known to be successful professionals and by purchasing a watch that is attractive, functional and durable, they make a smart investment. Even if the price tag in restrictive, to say the least, the man that wears a Rolex on his wrist has a certain allure, a certain je ne sais quoi about him.
The quality construction behind the Rolex Swiss watches brand is very hard to find among other competitors. Take the Yacht Master II for example. Its' movement took nearly 4 years (35,000 hours) to create and is made up from 360 parts. No one can argue against the fact that the brand is synonymous with top quality and it offers, as a bonus, unequaled aesthetics alongside its dependable functionality.
Rolex watches offer functions that may come as a surprise to some. The Rolex Daytona, for example, can be used by racing drivers. The Yacht Master is perfectly suited for anyone interested in navigating boats or ships. Perpetual calendar options, various types of chronographs, and water resistant features can be found in these superb Swiss watches.
For all of you dreaming about possessing one, but simply not having the budget for it, buying a replica is your best bet. And you can rest assured, Rolex imitation watches are flawlessly crafted and offer the same numerous benefits that the original do. And all that, at a notably lower price.
Renowned worldwide for their unique design and high quality craftsmanship, Rolex luxury watches have always been associated with extravagance. Alfred Davis and Hans Wilsdorf founded Wilsdorf and Davis, the company that would eventually become Rolex SA, in London, England in 1905. After moving in Switzerland, the company name "Rolex" was registered on 15 November 1915. Since then, the brand has become extremely popular.
Many A-list celebrities and athletes can be spotted wearing a Rolex. One example is Roger Federer, considered by most the greatest tennis player of all time can be seen wearing a Rolex Day Date.
Nothing is finer than having one of the many Rolex luxury watches on your own wrist, too bad most people just can't afford them. If you are one, try a Rolex replica and convince everyone that the exact duplicate is an original Rolex fine watch. The replicas carry the same features and quality of the originals.
You can choose one from any collection you like, be it the GMT Master, Day Date, Daytona or other. Fake Rolex luxury watches have it all covered, even the limited editions. You will find that people will notice and comment on your imitation Rolex, because it is a watch of distinction that needs no introduction. Rolex is one of the oldest watch manufacturers in the world who are still in business today. Your replica watch will feature the same fine styling, but without the expensive luxury price tag.
Replica watches are a great alternative for people who enjoy luxury and finer things in life but cannot afford the steep prices. Try adding two or three replica watches to your collection, don't be afraid to make a statement, you can't go wrong with Rolex luxury watches. Your imitation Rolex features the same updated look as the acclaimed watchmaker. You will be the only one knowing your watch is not genuine.
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Replica Rolex Milgauss Watches Are No Joke
If you're interested in vintage Rolex watches, it means you know exactly what you want. They're not common, and they're not cheap, but they're worth it all. What makes them so special? Well, they come not only with prestige, but also with a piece of history that will definitely catch people's attention.
They are great because they never go out of fashion and can be the perfect accessory to reflect your boheme personality. If they're just what you want, but they're far too expensive, then you should definitely consider Rolex replica watches: they look just as good, but they're much more affordable. Remember, you don't have to spend a fortune to build the image that best suits you. Money should not stand in the way of that.
Because vintage Rolex watches have become more and more popular, you can find plenty of replica watches, making it easier for you to find that exact model that meets all your requirements. But keep in mind that even with replicas, you need to make sure you don't make a bad choice. A replica vintage Rolex watch has to pay just as much respect to details as an original. So don't settle for a poorly made replica that will definitely say something nasty about you.
If it's still not clear for you why you should buy a vintage Rolex watch replica, let me put it simple for you: it oozes charisma and individuality, it's an unique fashion statement and, even more, with so many distinctive vintage watches to choose from, it's unlikely to ever meet someone who wears the same timepiece. And, most importantly of all, you get all that at a really good price. I don't really see any disadvantage, do you? It's all about fashion, baby! But you can always be smart about it when it comes to your money.
What's your opinion on vintage watches? What do you think that makes them so special?
Since 1945 the Rolex Datejust watch has been stunning both the jewelry industry and the various watchmaker standards. The perpetual and self-winding movement live up to the Rolex standards and the crisp oyster white face of the dial is both eye-catching and functional, making the numbers and symbols easy to see any time of day.
Perhaps the only drawback of this magnificent timepiece is the exorbitant price tag. Now anyone can own a Rolex Datejust replica and enjoy the confidence and style of this classic model. The sparkling gold and silver tone band definitely captures attention and the precise mechanical movement have all the quality and style of the original.
Those who wear a convincing Rolex Datejust replica will never be late for an appointment or have to check a calendar or smartphone for the correct date. A quick flash of the wrist will reveal the current date and the most accurate time possible. Aside from the accuracy, the Rolex name is synonymous with wealth and power. In professional settings, a man or woman who wears this brand name is considered a dignified and respected individual. A stylish watch is considered a must for interview candidates.
Perhaps it seems unfair that the style of watch or jewelry or even clothing that people wear can dictate how they are viewed by others, but that is the reality of the society in which we live. Especially in social settings, people subconsciously evaluate others based on their overall appearance. Instead of feeling insecure or even inferior, men and women can easily raise their status level by choosing a high-quality replica watch. The Rolex Datejust replica is just one example of the many different types and styles of famous name watches that can be purchased for a fraction of the manufacturer's suggested price.
I personally owned one Rolex watch. The one I just happened to own was a silver Milgauss. Had I known about quality replica Rolexes, for example replica Rolex Milgauss watches in particular, I would have never wasted my money on the real thing.
The quality that comes with replica Rolex Milgauss watches more than rivals the real deal. I would even go as far as to say that I prefer the replica over the real thing. Not only are the replica watches inexpensive compared to the real product, but they are also just as well (if not better) made. You won't have to worry about dropping a whole lot of money for one watch, and you'll still feel the Rolex quality in the replica watches.
I wear my replica Milgauss all the time now after selling back my real Rolex and I constantly get compliments on my watch from everyone that happens to glance at it. I have had absolutely no one ask me if it is a replica, since it looks so identical to the real deal. The best proof was that not even my significant other didn't know that I sold my real one to wear the replica. I told her that I had sold my real watch and the day after, she had found my replica Milgauss on the dresser and was asking me why I still had the original one I had spent a considerable amount of money on!
Rolex watches signify class and power, and with my replica Rolex Milgauss on, I feel that power and class for a fraction of the price. Buying a replica Rolex was one of the best financial moves I have ever made, and I absolutely love how confident it makes me feel when I wear it.
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The Best Rolex Submariner Replica Watches Available!
Those that have found that they need to have a new watch or simply want one that says a little more about their sense of style tend to start looking at the top watches that are available. For most, that means turning to the Rolex brand as it is one of the most well respected and highly regarded watch brands in existence. The Rolex name has been at the top of style lists for decades and with good reason as the watches are eye catching and stylish
The one drawback in regards to a Rolex is the cost. This is why more and more people are turning to replica Rolex watches for sale as they are an ideal solution. The watches are well made and have the exact same look and style as the originals. The only difference is the cost. This is where one can have that chance to own a watch that has that infamous look that everyone adores.
Those quality replica Rolex watches for sale are ideal for everyone, and even those that could conceivably afford a real Rolex. This is because the way in which the replicas look are so similar that one would never even wager a guess that it was not in fact the real deal. This makes those replica Rolex watches for sale a perfect choice for everyone. From men who want high style at a better price to women who want to give a gift that will outshine all others, replicas are the top option today as they are a sensible yet fashionable choice for everyone as they are just as well made and designed as the originals.
Men has very distinct taste when it comes to clothing and accessory items and that is why they tend to only have very key items that they wear time and time again. This is most often true when it comes to watches as all well-dressed men know that a good watch is a symbol of good taste and manners.
Many prefer the look of Rolex mens watches but the cost is quite prohibitive for the majority. This is perhaps why more and more men, and women buying gifts for men, have turned to high quality replicas that are now found in all styles. In fact, a replica Rolex is visually and functionally the same and only one who truly has a keen eye for the smallest of details can truly tell the real from the replica. Replicas of today are far superior compared to the past and that too helps explain why they have become in demand items for one to have as a viable alternative to the real thing.
This is why replica Rolex mens watches have become the mainstay fashion purchase for men with good taste and a penchant for the finer things in life. The replica version gives them that well known Rolex look and style yet at a price that is highly affordable. It is the best of both worlds for those that crave those top end brands yet do not feel that the price tag is a justified purchase. Rolex mens watches that are high quality replicas truly are a wise and feasible investment and one that will have any man looking his absolute best at all times since they are so sleek, noticeable and stylish.
I think the Rolex Submariner Replica is as good as the real thing. You can't tell the different between a real, and a fake if it is a high quality fake. If you do not want to spend the money on the real thing, and still want one, then buying a replica is perfect for you. These Rolex Submariner Replicas are made to look, and feel like the real thing, most can't tell the difference between the real deal, and the replica.
You save money, and still get a good quality watch when you buy a replica. You can splurge without spending the extra money on a real Rolex, when you buy a replica. The Rolex Submariner Replica has a sweeping motion, and 2 X magnification. The markings, and lettering resemble that of a real Rolex. The replica weights about the same as a real Rolex, so your arm won't be able to tell the difference, but you wallet won't be as empty.
The replicas that are better quality don't use pins in the bracelet, they use screws instead. These replica watches comes in many different styles, to fit your needs, and fashion appearance. These replicas are also available in many different colors, to fit your likes, and tastes. Some of the colors include; grey, black, blue, silver, and gold. Brand new models of the replicas are released, and made every single year. The styles are always up to date with the real deal. When you want to buy a watch, and want good quality at decent price I suggest you go buy a Rolex Submariner Replica. It will look, and feel just as good as the real thing, plus your wallet will be happy. Next time you're in need of a watch, or a present you should go buy this.
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Replica Rolex Submariner Watch Makes A Fantastic Gift
Ever since I was a young boy I was infatuated with James Bond. The British secret agent had style, charm, and class. He got to travel around the world to visit exotic locals, rendezvous with beautiful women in luxurious hotels, and put a stop to others' attempts at world domination. He did most of this wearing a Rolex and I knew I had to have one if I wanted to be like 007.
Modern Rolex watches are made with more advanced technologies that those Sean Connery sported back in the 1960′s; the degree to which they are resistant to water has increased and accuracy has been improved. However, the same classic styling is present in modern Rolex watches as those made decades ago. One can still achieve the same effect of displaying achievement and good taste as in the past. The one caveat is: Rolex watches are expensive. In fact, they are out many people's price range especially the younger generation that is still working towards becoming established.
Luckily for the masses, there are now many replicas available of modern Rolex watches; replicas that mimic the real deal to such a high degree that most could not tell the difference between them. Of course the movement will not be exactly the same but how many people will dissect your watch to see its insides? The important factor is that the exterior matches the real thing so closely that everyone will believe it is the real thing. I own both a genuine Rolex along with a replica of a similar model and no one in my group of friends can tell the difference. They all think I just have two beautiful watches that I spent a lot of money on. I finally achieved the elegance displayed by my childhood hero!
Authentic jewelry makers have been a type of a monopoly for several years. They have created brands of jewelry that are extremely high in quality, fashion, and prestige. Unfortunately, the majority of such name brand jewelry items are extremely high priced. In fact, some of the price tags make it nearly impractical for the majority of people to invest in and wear.
What can a hard working individual do to embellish themselves with some of these brand name, high priced, items? They can resort to investing in a replica model. Now, one may think that investing in a replica item seems rather tacky. How can anyone pull off a replica item as being authentic, right? The truth is, many of today's replica manufacturing firms have figured out ways to replicate such items with the most precise techniques of design and engineering to arrive at a product that is basically indistinguishable from the authentic versions. Even the most well versed jewelry enthusiast will not be able to tell the difference between some of these replica and authentic products when placed side by side.
Rolex Milgauss replica watches are a great example of achieving high qualities of replica pieces that greatly resemble the authentic versions. The biggest difference between the two products is the price. One can cost the equivalent of a vehicle, while the other one is much more practical for individuals to invest in. The Rolex Milgauss replica watches are sold at a price that watches should be sold at. Many people have complained that the Rolex brand price ranges are ridiculous, and that they should lower them. However, Rolex has built itself a reputation that is hard to argue against. They have been known to manufacture some of the highest qualities of jewelry. Therefore, they have earned the right to set the prices where they seem fit. Due to the power of authentic brands, replica producers have offered better options for the consumers of high-end jewelry.
The replica Rolex Submariner watch for both men and women makes a fantastic gift idea for those people that are important in someone's life. It is a way to show them that they are cared about at any time of the year. The watches make wonderful birthday and holiday gifts because they are sharp and look great when someone wears them.
Since it is a replica, the costs are a lot lower than the real watch. It still works the same and has the same benefits as the real one but it is far less expensive. Many people like to have the look and use of the watch for a far lower price.
People that get this type of watch will love how well and long it wears. They will see that it will have many different options for using it. It is a watch that looks great but also offers people a great timepiece. Some people like to get different styles so they can wear them for all different kinds of occasions. They should store them in a safe, dry place so that they can't get damaged. Many people keep them in a jewelry box or other such item to keep them safe from harm.
Getting a replica Rolex Submariner watch is something that many people love to do because they enjoy the versatility of the watch and like how it operates. They will find that they can find them online by doing a simple search. There are several companies that offer them to the public. They are easy to purchase with safe and easy ordering platforms where a customer can get the watch as soon as possible so that they can begin wearing.
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Rolex Daytona Replica Watches, The Best Among Others
There's no hiding the fact that Rolex mens watches have more style and appeal than the average mens watch. The only problem with that is the extremely high price tag of a luxury watch. Thankfully we have taken this into account and now offer an affordable alternative to Rolex mens watches.
We have designed a product that looks, feels and even ticks like a genuine Rolex. The only difference you'll notice is the price you pay. We've master crafted our replica watches down to the very last detail. Our watches could easily be set next to a genuine Rolex without being distinguished. Our replicas are impossible to tell apart from the name brand.
There's no wonder why we've taken up the task of replicating Rolex watches. The Rolex company started up back in 1905, in the city of London, England. After 14 years of operating in the United Kingdom the company ventured off to Geneva, Switzerland in 1919. Since then the company has been ever expanding and has continued to refine their watches year after year. Today, it has been estimated that Rolex manufactures roughly 2,000 watches per day.
The price range of Rolex mens watches is something really extraordinary. The lower end of Rolex watches fetch right around $4,000 per watch. The higher end models sell for more that $50,000. Some custom watches can go for an even more staggering amount of $60,000 or higher! It's easy to see where replicas come into the picture. With a price tag only a percentage or two of what the Rolex would be, our replicas really put the money back into your wallet. We offer the same models, colors and sizes for only a fraction of the cost!
Replica Rolex watches for sale, they look like the real thing. So you want a Rolex watch. Not only do they look great, they give you a certain amount of prestige. Why pay thousands of dollars for a Rolex when you get a watch that looks exactly like the genuine product. There are a lot of benefits to getting a replica watch.
Even though the watch is a replica, it looks just like a genuine Rolex watch. You can have the prestige of having a Rolex without the steep price. I buy replica watches and jewelry all the time, and no one can tell that they are not real. So as a result I save a lot of money. I have wanted a Rolex watch for a long time. They are beautiful, and grab attention. They also work really well. I went to google and started looking, as I was not going to spend thousands of dollars on a watch. I found this site that had replica Rolex watches for sale. Now I could get the watch of my dreams without spending the price of a Rolex watch. The other benefit of replica Rolex watches is that I can wear it every day and don't have to worry about losing it or something happening to it. If something did happen to it, I could replace it easily and cost efficiently. If I had a genuine Rolex watch I would never wear it as I would be concerned that something would happen to it. The site offers a great selection and I can find exactly what I am looking for with ease.
So why spend thousands on a Rolex watch when you can buy a replica Rolex.
A Rolex watch has long been considered the ultimate in a luxury time piece. Quality time pieces that have adorned the wrists of the rich and famous for decades, these watches cost a significant portion of an average worker's yearly salary. For those who have a taste for finer things, but who don't have the funds for them it's a good idea to buy a high quality replica.
The trade in Rolex Daytona replica watches is just one example of the popularity of replica watches among those who want luxury style even if they can't afford the price tag. Rolex, Omega, and other watches have had their styles imitated for years, but it's important for those who are in the market for a replica to make sure they still get a quality time piece. After all, just because a watch is a replica doesn't mean it shouldn't still be held to a standard.
Lots of people may assume that if a watch isn't the genuine article that it's worthless, but that isn't true. Knock off brands are cheap watches that bear a passing resemblance to a Rolex. Rolex Daytona replica watches on the other hand are watches that are deliberately made to resemble a Rolex (or other luxury watches), but they still stands alone as good timepieces. For these reasons replicas may be expensive to purchase, but they will only be a fraction of the cost of the genuine article. On the other hand though, individuals get what they pay for when it comes to watches. A cheap watch, no matter how expensive it has been made to look, is still going to be a cheap watch when all is said and done at the end of the day.
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Rolex Discount Watches For The Smart And Savvy
Going on a shopping spree doesn't mean the individual is obligated with spending a huge chunk of cash. However, in some cases it does. When looking to buy certain name brand designer items, people well often shell out hundreds to thousands of dollars. One may wonder, what kind of satisfaction does one get from spending such a great amount of their paycheck on something that is just for show? The answer is…well, there is no exact answer.
Everyone has their reasons and preferences. However, there is a fact that is probably universal for everyone, and that is everyone would love to save as much money as possible. Unfortunately, some designer brands do not allow people to do that.
The Rolex brand is a company that has dominated the industry of watches for many years. It has certainly earned its right as being one of the most well renowned watch companies in the whole world. Those are probably enough reasons for them to provide their products at such high prices. There is no doubt about the fact that if everyone could, they would purchase a Rolex watch. However, the price isn't quite accommodating for a large percentage of the population. Buying a Rolex watch is a huge decision of investment.
Rolex Milgauss replica watches are a great choice for anyone that wants to trend the fashion of wearing a designer name brand while saving a great amount of money from purchasing it. Rolex Milgauss replica watches are made of high quality materials that are nearly identical to the authentic makes. Rolex Milgauss replica watches can easily be mistaken for the real make, as the precision of design and manufacturing is second to none. There are many other replica models available for the buyer that wants to look fabulous while simultaneously keeping their money where it belongs, in their wallet and bank account.
Owning a Rolex watch is the ultimate status symbol. A Rolex is more than just a way to tell time, it's a way to give others a peek into the wearer's background before they even speak a word. However, owning a genuine Rolex is quite expensive, often prohibitively so. Fortunately, a replica Rolex is nearly indiscernible from the real thing to 99 percent of the population. Purchasing a replica Rolex affords the opportunity to exude opulence without the cost.
Replica Rolex watches for sale are hundreds, if not thousands, of dollars cheaper than the real thing, and the difference between a well-made replica and a genuine Rolex is almost unnoticeable. On the low end a Rolex watch will run for a minimum of $2,000, while most replica Rolex watches for sale start at a fraction of that cost.
Don't worry; you won't miss out on quality with a replica Rolex. The reason a Rolex watch is so expensive has less to do with the quality of craftsmanship and more to do with the company artificially inflating prices by limiting its supply. High quality replicas are very well made by expert hands. Ultimately, when buying a genuine Rolex you're paying for the name more than anything.
The differences in a Rolex and a replica are almost negligible in most practical ways. A replica may have a slightly different magnification then the real deal, and the engraving will be slightly different, but only the trained eye of a watch expert will be able to tell the difference at first glance. Some replicas are so good that they'd have to be taken apart to delineate a replica from a genuine Rolex.
When considering a Rolex watch or a replica Rolex for sale, make a smart decision. Don't over pay for the real thing when you can get a replica without breaking the bank and without anyone knowing the difference.
There is no doubt about the fact that certain pieces of jewelry hold some sort of sentimental value for some people. However, most jewelry items are worn for the sake of fashion. Many designer brands of jewelry know that the majority of people will purchase their product, because fashion is a way of expressing oneself.
Fashion and trendy styles will never be a diminishing factor in the consumer markets. Many designer brands are also very well aware of the name they have created for themselves, and set their prices according to their reputation.
Some designer brands have certainly earned their spot as being a top producer and distributor. One brand that has certainly earned its spot as being an exquisite carrier of products is Rolex. Rolex has been a genuine manufacturer of high-end watches for the past century, and has dominated the market for most of that time. Their uniqueness in design, quality, and durability goes a long way in separating itself from other brands. However, their prices can also be mentioned as being separate from other manufacturers.
Rolex watch buyers can expect to pay an upwards of thousands of dollars on a single watch alone. There are many models of Rolex watches that cost more than a brand new vehicle! What is an individual to do when they want to stay up to date on the latest fashion trends, but cannot afford to do so? There answer is simple. They can browse through the vast selection of Rolex discount watches and pick whichever they like without having to worry about paying a down payment on a home for it. Rolex discount watches are made with superb qualities of materials, and outstanding precision and accuracy in comparison to the authentic brands. Even the most avid watch collectors will not be able to distinguish the discounted watches from the authentic makes.


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Ivey appoints Stanley Nelson, Rep. Rod Scott to Alabama Commission on Higher Education
Ainsworth opposes Mobile River toll bridge plan
Gov. Ivey holds ceremonial bill signing
Sweet Grown Alabama is new branding initiative to boost Alabama-grown foods
Opinion | Mobile River Bridge and Bayway Project: The cost of doing nothing is too high
Merrill and APR columnist dispute over voter ID laws
Alabama Forestry Association endorses House candidate Van Smith
"Fair tax" legislation would replace income, sales tax with consumption tax
Van Smith picks up endorsement in House District 42 special election
McClendon does not think there will be a special session on prisons
Opinion | Lawmakers failed children in their darkest hours
McClendon says Supreme Court ruling on gerrymandering resolves many questions
One human trafficking bill signed, another pocket vetoed
Department of Agriculture to begin weekly listening sessions
Ivey attends DaikyoNishikawa U.S. groundbreaking in Huntsville
Roughly half of Trump voters would at least partially blame him for a recession
Unemployment in Alabama drops to a new record low
2019 foreign direct investment announcements already promise 3,300 new jobs
Limestone County sheriff indicted on 13 counts of theft, ethics charges.
Marshall announces attorney Billy Underwood has pleaded guilty to jury tampering
Jorge Ruiz probably fell asleep at the wheel and caused a fatal crash. An Autauga County judge sentenced him to 99 years.
Leeds man convicted on federal gun and ammunition charges
Medicaid work requirements struck down for NH, still pending for Alabama
Boeing's Minuteman III ICBM's near 50 years in service
21st Century Moon lander team will be headquartered at Marshall Space Flight Center
Brooks impressed with the work done in the Tennessee Valley to help keep the nation secure
Brooks votes against defense authorization act
NASA moves closer to Space Launch System and a return to the moon
Potential congressional candidate Chris Countryman discusses the issues facing 2nd Congressional District
House District 42 special Republican primary is today
Civic Engagement Summit to be held in Birmingham
Enterprise voters approve Sunday alcohol sales
Tuberville addresses St. Clair Farmer's Federation
Opinion | Changes to the Alabama Democratic Party are long overdue
New study ranks Alabama 44th in women's equality
Mobile MPO temporarily takes the Mobile River bridge project off Transportation Improvement Plan
Hooper wants all state GOPs to offer resolution to expel Omar
ADPH is awarding competitive grants to public water systems
Opinion | I-10 bridge turns into unprincipled political theater
Opinion | Bloviator uses old racist meme in fight over I-10 toll bridge
In the end, consensus
Opinion | A forgotten 40 percent
Opinion | Hubbard still free, it's time for justice, not more delays
Opinion | If GOP economics work, why do Alabama leaders tax the working class?
Opinion | Violence is THE American value
Opinion | Centennial birthday offers opportunity to reflect upon parallel journeys of Gov. George C. Wallace and the State of Alabama
Opinion | ADP Committee member addresses Omar, King controversy
Opinion | 'School choice' also means 'tax choice' in Alabama
Opinion | Hot political summer in the City of Montgomery
Opinion | To end violence, return to American values
Tuesday, a federal jury convicted a Tuscaloosa County man of possessing methamphetamine. The verdict was announced U.S. Attorney Jay E. Town and Bureau of Alcohol, Tobacco...


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NEW YORK, Jan. 14 (UPI) -- Victor Hedman and Nikita Kucherov scored 9 seconds apart in the second period Tuesday, lifting the Tampa Bay Lightning over the New York Rangers 2-1.
The Lightning were on a power play 1:10 into the middle period when Hedman scored to forge a 1-1 tie.
On the ensuing face-off, Radko Gudas found a streaking Kucherov alone at center ice and the Tampa Bay winger broke in on Henrik Lundqvist to score the decisive goal.
Ben Bishop saved 33-of-34 shots as Tampa Bay finished a three-game road trip with a 2-1-0 mark.
Brad Richards scored and Lundqvist finished with 23 saves for the Rangers, whose three-game winning streak was ended.


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Release Date: June 2, 2014
BUFFALO, N.Y. – Three more University at Buffalo faculty members have been appointed SUNY Distinguished Professors, the highest faculty rank in the SUNY system.
Named Distinguished Professors in recognition of their national or international prominence in their fields were Margarita L. Dubocovich, professor and chair of the Department of Pharmacology and Toxicology, School of Medicine and Biomedical Sciences; Jerold C. Frakes, professor in the Department of English, College of Arts and Sciences; and Aidong Zhang, UB Distinguished Professor and chair of the Department of Computer Science and Engineering, School of Engineering and Applied Sciences.
The trio was among 19 SUNY faculty members appointed to the distinguished professor ranks by the SUNY Board of Trustees at its meeting last month.
"SUNY's highest faculty honor, the distinguished ranking, is reserved for the best of the best," said SUNY Board Chairman H. Carl McCall. "Each professor, to earn this distinction, has advanced their field while teaching and mentoring their students, often collaborating and innovating with their colleagues and serving society at large through their work."
Added SUNY Chancellor Nancy L. Zimpher: "We are deeply proud to recognize our faculty with these prestigious rankings, and to have the opportunity to honor the work they do on behalf of the students, campuses and communities they serve throughout New York State and around the globe."
Margarita Dubocovich is the world's foremost authority on the brain hormone melatonin and the regulation of melatonin receptors, her work significantly broadening the scientific understanding of melatonin's impact on circadian rhythms, sleep disorders and depression. She is credited with discovering melatonin receptor subtypes, which revolutionized the field, as well as pioneering the pharmacology of melatonin receptors agonist and antagonist agents.
The owner or co-owner of three patents related to agents developed through her research, Dubocovich has received continuous funding support since 1985 from the National Institutes of Health, National Science Foundation (NSF) and major pharmaceutical companies, among them Glaxo Inc. and Eli Lilly and Co.
She has received numerous international honors, including the 2005 Award for Outstanding Scientific Contributions from the Latin-American Congress of Pharmacology, the 2011 Aaron B. Lerner Pioneer Award and the 2012 PhARMA Foundation Award in Excellence in Pharmacology and Toxicology.
Dubocovich, who was recruited to UB in 2008 from Northwestern University, was named UB's inaugural senior associate dean for inclusion and cultural enhancement in 2012 to lead the medical school's diversity efforts.
Jerold Frakes is a scholar of medieval European literatures who joined the UB faculty in 2006 after many years as a professor of German and comparative literature at the University of Southern California. He is internationally renowned for his groundbreaking contributions to the field of Early Yiddish and for his work on Jewish, Christian and Muslim intercultural relations as revealed in their respective literary traditions.
Within the past year alone he has won four major fellowships: a Guggenheim, a National Humanities Center Fellowship, Harvard University's Radcliffe Institute Fellowship and a research fellowship in Paris. He also is the recipient of a National Endowment for the Arts research fellowship and two fellowships from Germany's Alexander von Humboldt Foundation.
In 2011, he published three books — a monograph, an edited collection on Latin and German medieval perceptions of the "Muslim Other" and a "cultural history of Litvak Jewry" — all considered seminal contributions to Yiddish studies and comparative literary scholarship.
He has edited or translated nine other books, including several on Yiddish literature, and has given many invited lectures and conference papers.
A UB faculty member since 1994, Aidong Zhang is an internationally recognized expert in the fields of databases, multimedia databases and bioinformatics. She has been instrumental in forging new research directions in the information retrieval (IR) community, and has pioneered novel techniques for semantic clustering and querying that are widely accepted as the standard in image database design.
Author or co-author of more than 100 research publications, she has attracted continuous external funding for two decades, with federal grants totaling more than $12 million.
A fellow of the Institute of Electrical and Electronic Engineers (IEEE), the world's largest professional association for the advancement of technology, Zhang has received numerous other awards, including a prestigious NSF CAREER Award, a SUNY Chancellor's Research Recognition Award and a UB Exceptional Scholar-Sustained Achievement Award.
She has been instrumental in organizing the annual meetings of the ACM Special Interest Group on Bioinformatics, Computational Biology and Biomedical Informatics, and held an appointment in 2012-13 on the SUNY Research Council, an advisory board to the SUNY Board of Trustees, the SUNY Research Foundation Board of Directors, the SUNY provost and campus presidents.


text: A big congrats goes out to Frank and Charron,team Parmachenee for getting over 500 finds. I can remember when we first met last spring at Hinckley School cache and then we continued on to Perkins Sanctuary cache for your #150. Here I am at a measley 224 ,,,sheeesh what have I been doing anyway?... :o lol. It has been a pleasure making friends with you guys and I hope only the best for you two and may you get 100's more. :D


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ROCKFORD (WIFR) -- A generous donation to the Rosecance Foundation in Rockford means the rehab facility will be able to provide better care for patients.
Rosecance received a $1,000 check from AT&T Thursday. It's part of the company's "Investing in Illinois Award" which recognizes organizations and programs that are improving the lives of people in their communities.
Rosecrance's Senior Vice President Lynne Vass says the money will be used to expand the music therapy program for adult patients.
"We know if our patients in treatment find that they can have fun in recovery they can enjoy themselves with out using drugs and alcohol. They'll be much more successful in their recovery and music is one of the ways that when they leave treatment they can find joy and contentment," Vass said.
State Senator Dave Syverson nominated Rosecrance for the award.


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The 15 micron (approx. 1000x) removes steel quite quickly; the 5 micron (approx. 2500x) refines the edge to usable keenness; and the 0.5 micron (approx. 9000x) gives it a mirror finish.
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We feel that these are revolutionary sharpening materials.
Made in the USA.


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NEW YORK (Reuters) - Stock index futures edged higher on Tuesday, indicating equities would partially rebound from the previous session's steep drop, though concerns persisted over the state of Italy's economy and government makeup.
In Italy's election, groups opposed to economic reforms posted a strong showing, resulting in a political deadlock with a comedian's protest party leading the poll and no group securing a clear majority in parliament.
Major indexes plunged more than 1 percent on Monday, with the S&P 500 having its biggest daily drop since November as investors fretted that if Italy does not undertake reforms, that could once again destabilize the euro zone. The CBOE Volatility Index <.vix> surged 34 percent in its biggest jump since August 18, 2011.
The rise in futures indicates that a recent trend of investors buying on dips will continue. Last week, concerns over whether the Federal Reserve might roll back its stimulus policy earlier than expected prompted a sharp two-day decline, though equities recovered most of ther lost ground by the end of the week. Weakness continued in Europe on Tuesday, with shares <.fteu3> down 1.2 percent.
Financial shares may be among the most volatile on Tuesday, as the group is closely tied to the pace of global economic growth. Morgan Stanley
Dow component Home Depot Inc
S&P 500 futures rose 2.6 points and were above fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures added 49 points and Nasdaq 100 futures rose 3.25 points.
In the S&P, the 1,500 will be watched as a key level after the index closed below it on Monday for the first time since February 4, with selling accelerating after falling below the level that had acted as support. An inability to break back above it could portend a weaker technical backdrop. The index remains 4.3 percent higher on the year.
Gains this year have largely been driven by strong corporate earnings. With 83 percent of the S&P 500 having reported so far, 69 percent beat profit expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters, according to Thomson Reuters data. Fourth-quarter S&P earnings are seen having risen 6 percent, above a 1.9 percent forecast at the start of the earnings season.
Companies scheduled to report results on Tuesday include Macy's Inc
Cyclical shares, including financials and materials, have been among the strongest performers in 2013, lifted by signs of improved economic growth. That could leave the sectors vulnerable to a pullback as events in Italy progress. Goldman Sachs on Tuesday cut its 2013 gold price forecast to $1,600 an ounce from $1,810, citing an increase in U.S. real interest rates.
While the political uncertainty from Italy may be the primary driver for markets, domestic government concerns will also be in focus. U.S. equities will face a test with the looming debate over so-called sequestration - U.S. government budget cuts that will take effect starting on Friday if lawmakers fail to reach an agreement over spending and taxes. The White House issued warnings about the harm the cuts are likely to inflict on the economy if enacted.
(Editing by Chizu Nomiyama)
Stock futures tick up after sell-off, Italy woes remain
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