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Hirsutism is treated with a combination of approaches, including oral contraceptives with or without an antiandrogen, such as spironolactone, to lower levels or block actions of androgen on hair follicles. Oral contraceptives are often combined with antiandrogens to improve their clinical effect and to prevent pregnancy, since accidental exposure of the male fetus to antiantrogens can harm fetal development. A topical cream (eflornithine hydrochloride) also can be applied to treat facial hirsutism.
Shahin [68] Non-blinded randomised controlled trial. Women with PCOS and infertility, n = 194. All participants received pharmaceutical ovulation induction (Clomiphene citrate 150 mg on days 3–7 of cycle); trigger injection (HCG 10000 IU Pregnyl), timed intercourse and progesterone support (oral micronized progesterone). A randomly selected group additional took Cimicifuga racemosa 120 mg per day (Klimadynon®) Primary outcomes pregnancy rates. Secondary outcomes: Pregnancy rates were 33 out of 192 cycles (17.2%) for the clomiphene alone group and 71 out of 204 cycles (34.8%) for the clomiphene plus Cimicifuga racemosa group. Non-blinding compromised the internal validity of the findings in this study. Confounding variables include variations in participant's and clinicians attitudes and may have led to differences which were unaccounted for between the two groups. However the outcomes are objective with a statistically powered sample size.
Bergmann J, Luft B, et al. [62] Randomised, placebo controlled double blind study. Three months or 3 menstrual cycles. Women with fertility disorders, (n = 67). Two sub-groups. Herbal extract Phyto-Hypophyson® by Steril-Pharma GmbH Herrsching, Germany; contains Vitex agnus-castus plus Chelledonium majus and Silybum marianum (St Mary's thistle) in homeopathic form. Additional herbal extracts have reported activity in hepatic function. There are no reports for direct reproductive effects. 150 drops per day (7.5 ml per day). Primary outcome for participants with amenorrhoea: at least one spontaneous menses. Oligomenorrhoeic subgroup - clinical outcomes were significantly improved in the treatment arm at 82% compared to 45% in placebo arm P = 0.021. When the amenorrheic group were included in analysis, differences were not significant p = 0.19. Diagnosis for anovulatory amenorrhoea is not well described. Non-statistically significant take home baby rates were complicated by insufficient sample size. 366 patients are required to have a 95% chance, as significant at the 5% level, an increase in take home baby rates from 6% in the placebo group to 18% in the experimental group. The authors conclude that this preparation may be useful if given 3–6 months, yet they only tested for 3 months.
If the patient does not present with ovulatory cycles at three months after ovarian drilling, then the procedure should be combined with CC treatment. The use of gonadotropins should be considered after 6 months of anovulatory cycles following the ovarian drilling procedure. Ovarian drilling should not be indicated as a treatment for menstrual irregularity, metabolic complications or hyperandrogenism in PCOS 29.
Dahil lamang ikaw ay ilagay sa ilang timbang dahil sa ang simula ng PCOS, ay hindi nangangahulugan na dapat mong itapon ang lahat ng mga mapagkukunan ng mataba pagkain mula sa iyong pagkain! Ang katotohanan ay na walang ang paggamit ng malusog na taba sa iyong katawan ay hindi maaaring makabuo ng hormones sa ninanais na halaga. Maaari mong isama butter o olive oil sa iyong pagkain.
For women who don't receive timely, appropriate care for PCOS in early adolescence, the development of symptoms such as facial-hair growth can become more challenging to treat. Brandy Cramer, 33, a program officer at The Cameron Foundation, from Midlothian, Virginia says her doctors told her she just wasn't trying hard enough to lose weight and dismissed her when she requested they run blood tests or suggest alternatives to the birth-control pills that gave her intense migraines. Cramer grew facial hair and has only been able to remove 50 percent of it, even after expensive laser hair-removal treatment.
Some have tried to utilize ultrasound to detect IR. Of note, normoglycemic women often have the phenotypic criteria for polycystic ovaries on ultrasound[54], consistent with other data in young adolescents showing that polycystic ovaries by ultrasound appearance often does not correlate with either anovulatory menstrual cycles or metabolic abnormalities[55]. Therefore ultrasound is too non-specific to use with any reliability in measuring IR.
Chromium is an essential mineral that helps the body regulate insulin and blood sugar levels. Some research suggests that chromium supplements can help people with diabetes lower their blood glucose levels. One study examined the role of the mineral in women with PCOS. The results indicated that 200 mcg daily of chromium picolinate significantly reduced fasting blood sugar and insulin levels in subjects — enough that the effects were comparable to the pharmaceutical, metformin. While metformin was also associated with lower levels of testosterone, taking a daily dose of 200 mcg of chromium picolinate could help regulate blood sugar levels.
Even though the name suggests that the ovaries are central to disease pathology, cysts are a symptom instead of the cause of the disease. Some symptoms of PCOS will persist even if both ovaries are removed; the disease can appear even if cysts are absent. Since its first description by Stein and Leventhal in 1935, the criteria of diagnosis, symptoms, and causative factors are subject to debate. Gynecologists often see it as a gynecological problem, with the ovaries being the primary organ affected. However, recent insights show a multisystem disorder, with the primary problem lying in hormonal regulation in the hypothalamus, with the involvement of many organs. The name PCOD is used when there is ultrasonographic evidence. The term PCOS is used since there is a wide spectrum of symptoms possible, and cysts in the ovaries are seen only in 15% of people.[33]
PCOS-related hormonal dysfunction can result in irregular or absent ovulation (anovulation). A variety of drugs can be used to treat this, enhancing the quality of both the egg (oocyte) and ovulation. Typical, first-line treatments include the fertility drugs Clomid (clomiphene citrate) and Femara (letrozole). While Clomid is commonly used to enhance ovulation, Femara may work better in women with PCOS as it neither raises estrogen levels nor increases the risk of multiple births to the same degree as Clomid.
One time when I was in a&e this junkie was having withdrawals and literally shitting and puking everywhere. The stench was unreal to the point they had to move other patients out of the area, as it was making people sick. The nurses were fucking pissed off and disgusted, of course they couldn't say anything in front of him, but they were bitching about it when they came into my room. The world is not there to entertain and 'ooh' and 'aww' over your projectile shit, Tuna. Stop being a disgusting adult baby.
I've never believed that she could get together $1700 on rent ALONE. I don't know much about U.S benefits but in the UK for an under 25 year old unemployment check is just about £60 a week. Even disability allowance wouldnt support the cost of a house like that and their drug habit. Seems impossible that they'd be paying for the house without help from Roger or family members
You may feel that it is difficult to lose excess weight and keep it off, but it is important to continue the effort. Your efforts help reduce the risk for developing serious health complications that can impact women with PCOS much sooner than women without PCOS. The biggest health concerns are diabetes, heart disease, and stroke because PCOS is linked to having high blood pressure, pre-diabetes, and high cholesterol.
The IUI is performed with the same dose of gonadotropins recommended for timed intercourse (combined or not with clomiphene). However, for this treatment modality, the recombinant hCG is administered for final oocyte maturation when the dominant follicle has a mean diameter of 17 to 18 mm via US examination and capacitated sperm can be injected into the uterine cavity 36 hours later. Beta hCG is measured 14 days later to confirm pregnancy 25.
There's also a good and bad way to go about nitpicking, imo. For every person laughing at Momo's dimpled ass, there are ten anons going 'ewwwwww look at _____'s potato nose i'd kms if i had it' or 'omg she needs surgery on her chin' and other ridiculous overreactions to normal photos/facial features that seem like they're made by young teens who want to make themselves feel more attractive.
Dok goodevening po may pcos po ako pinainum po ako dati ng ob kp ng metformin at clomid saka folic acid po posible po ba kaya na mabuntia na po akO. At ok lang po ba pasabayin ko ung gamot na po un? 6Months ko na po kaso di nakakausap ob ko kasi po nandito ako sa saudi dinala po ako ng asawa ko dito para po sakali makabuo na kamo salamat po sana po masagot nyo po question ko. Godbless
Regular menstruation is important for the prevention of endometrial cancer. Women with PCOS are three times more likely to have endometrial cancer than women without. When a woman isn't menstruating on a frequent basis, the lining of the uterus (endometrium) can begin to grow excessively and undergo atypical cell changes resulting in a precancerous condition called endometrial hyperplasia. If left untreated, this can develop into full endometrial cancer. Hormonal birth-control pills are often prescribed to help women with PCOS shed their endometrium more regularly, an important measure for preventing the overgrowth of cells in the uterus.
PCOS treatment is different for different people. While there is no cure for PCOS, taking medicine and losing weight can help your symptoms. If you don't want to become pregnant, your doctor or nurse may recommend hormonal birth control, like the hormonal IUD, birth control implant, pill, patch, ring, or shot to treat your PCOS. The pill, patch, or ring may be particularly helpful if you're struggling with acne or want more regular periods. If you're trying to get pregnant, drugs that treat insulin resistance may help, as well as certain fertility drugs that can help you ovulate. Losing weight can also help with ovulation and fertility.
Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn't improve androgen levels and won't prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.
Side effects: Some people who are allergic to ragweed and other plants in the same family are also allergic to milk thistle so taking this herb might cause an allergic reaction. Occasionally people taking milk thistle will complain of gastrointestinal issues but this is rare. I t may also lower blood sugar levels so if you have hypoglycemia or diabetes you might want to try another herbal .
Selection of herbal medicines for the management of PCOS often includes the combined prescription of Glycyrrhiza spp. and Paeonia lactiflora[72–75]. We found preliminary evidence for this combination for hyperandrogenism only, and the evidence was more robust for Glycyrrhiza spp. alone than when combined with Paeonia lactiflora. Comparatively, our findings for the combination of Peaonia lactiflora and Cinnamomum cassia demonstrated no change in androgen concentration, suggesting that the anti-androgen activity in the Glycyrrhiza spp. and Paeonia lactiflora combination more likely attributable to Glycyrrhiza spp. However our findings may be complicated by the aqueous extraction methods used in the Paeonia lactiflora and Cinnamomum cassia combination and the preclinical studies into the Glycorrhizza spp and Paeonia lactiflora combination. More research into the anti-androgen effects of the combination Glycyrrhiza spp. and Paeonia lactiflora is needed to clarify the anti-androgen mechanism particularly if this herbal combination remains cornerstone herbal management for hyperandrogenism.
Limitations of direct insulin testing and cumbersome calculations have led to research for indirect serum markers to provide evidence of IR. SHBG correlations to IR as previously mentioned have been inconsistent. Adiponectin is a protein found in adipose tissue associated with both inflammation and insulin action. Recent studies have linked plasma adiponectin level to IR (but not hyperandrogenism) measured by HOMA[56-58]. Serum soluble glycoprotein-130 levels (local cytokine) have been inversely correlated to IR[59]. Resistin plasma levels have been correlated with fasting glucose and HOMA-IR in PCOS women[60]. Inhibin A levels in PCOS women were not found to correlate with IR in PCOS women[61]. Most of these serum markers share common limitations and have been poorly studied. How they might vary with different PCOS phenotypes is unknown. None are adequately compared to IR measured by clamp studies. Their usefulness serially in clinical practice to monitor patients over time and undergoing treatment is also unknown. Some genetic work has recently shown promise. Although far from clinical use, microarray analysis of genes in muscle, adipose tissue and the liver shows alterations in the setting of IR[62]. Serum genetic markers may lead to future genetic techniques to detect and monitor IR.
This led the researchers to experiment with blocking the body from responding to this excess GnRH. They treated a separate group of pregnant mice with AMH but also another drug that blocks the body from responding to the higher levels of GnRH (called a "GnRH antagonist"). They followed the daughter pups born to these mothers, and turns out they didn't develop PCOS-like symptoms! They also wanted to see if they could give GnRH antagonist to daughter pups who had already developed PCOS-like symptoms (because their mothers only received high levels of AMH while pregnant). After treatment with the GnRH antagonist, the daughter pups' hormone levels started to normalize and they ovulated more than those who didn't get the antagonist treatment.
Dok. Magandang tanghali po. May PCOS din po ako. 19 years old po ako nung nalaman kong may sakit akong Polycystic. Nagkaroon po ako ng kalive in nun dati aman po e okay yung regla ko tas nung nagsasama na kami nung bf ko hndi na ko nagkakameron akala namin buntis ako 1year akong hndi niregla nun. Hiwalay na kami ng ka live in ko ngayon . Niresetahan ako ng doktor ko ng Provera 5 days kong iinumin tas magtake din daw ako ng althea pills pag nagkaregla na. Okay aman sya nagkakaregla naman na ako. Kaso lang pahinto hinto yung pag inom ko kasi mejjo mahal yung pills . At dahil nga pahinto hinto yung pag inom ko ng pills hndi na din ako nagkakamens . Kaya nagtatake ulit ako ng provera.
Teens with PCOS may have slightly different signs and symptoms. Irregular cycles are common in normal girls in the first years after periods start (menarche). Therefore, signs of ovulation problems for girls include irregular periods more than 2 years after menarche, absence of cycles for more than 3 months, or never having a first period by the time puberty is completed. Also, heavy or overly frequent periods may be a sign of problems related to PCOS. Adolescents do not require an ultrasound for the evaluation of PCOS, since large ovaries with many follicles develop as part of normal puberty.
The Center for Young Women's Health (CYWH) is a collaboration between the Division of Adolescent and Young Adult Medicine and the Division of Gynecology at Boston Children's Hospital. The Center is an educational entity that exists to provide teen girls and young women with carefully researched health information, health education programs, and conferences.
The prescription cream eflornithine HCl can slow the growth of new hair when applied as directed on the face and other areas – but it won't remove existing hair. 20,21 Your doctor may also prescribe a medication called an anti-androgen. In the United States, a medication called spironolactone is used to slow new hair growth. In other countries, cyproterone acetate is widely used but it is not available in the United States.
Although these agents have shown significant efficacy in clinical trials (for oral contraceptives, in 60–100% of individuals[74]), the reduction in hair growth may not be enough to eliminate the social embarrassment of hirsutism, or the inconvenience of plucking or shaving. Individuals vary in their response to different therapies. It is usually worth trying other medications if one does not work, but medications do not work well for all individuals.
Why does she act like everyone is either rich or dirt poor… She complains about being hungry than regularly spends $50+ on Amazon shit instead of food… Some people can live in big houses but still have to budget. Being clean and somewhat functional of a human being doesn't make someone rich & privileged. Using opportunities instead of squandering them doesn't mean being privileged. It's called not being a sack of lazy shit like you, Tuna.
Well, I see it as nitpicking because it's not funny, boring and over talked about. We all know she has saggy tits, it doesn't need to be pointed out every time a new pic is posted. and I've always thought and said she hated herself before the tit thing, it's not that people are suddenly jumping to this conclusion now, it just started a discussion about it.
Un síntoma clave del síndrome de ovario poliquístico es tener periodos menstruales irregulares o faltas de la menstruación, porque las consecuencias de esta afección sobre los ovarios pueden hacer que se deje de ovular. De todos modos, puesto que una chica puede tardar hasta dos años en presentar períodos menstruales regulares desde su primera menstruación, puede costar mucho reconocer este síntoma en las adolescentes. El desequilibrio hormonal propio de este síndrome puede desencadenar cambios en todo el cuerpo, no solo en los ovarios.
Habang remedyo sa bahay ay maaaring maging isang mahusay na pagpipilian para sa paggamot ng PCOS, naghahanap ng medikal na tulong ay din napakahalaga sa karamihan ng mga oras. Makipag-usap sa iyong doktor tungkol sa iyong mga plano upang bigyan ng bahay remedyong subukan mo upang ang mga pinakamahusay na posibleng mga kumbinasyon ng paggamot ay maaaring devised para sa iyo. Gayundin, PCOS ay madalas na nauugnay sa isang hindi malusog lifestyle at diyeta. Para sa ito, kami ay compiled ng isang listahan ng mga maingat mga panukala na maaari mong sundin upang labanan ang kundisyong ito.
Preclinical and clinical studies provide evidence that six herbal medicines may have beneficial effects for women with oligo/amenorrhea, hyperandrogenism and PCOS. However the quantity of pre-clinical data was limited, and the quality of clinical evidence was variable. Further pre-clinical studies are needed to explain the effects of herbal medicines not included in this review with current clinical evidence but an absence of pre-clinical data.
This review includes 18 preclinical laboratory based studies and 15 clinical trials. We found reproductive endocrine effects in oligo/amenorrhoea, hyperandrogenism and/or PCOS for six herbal medicines. The quality of evidence, as determined by the volume of pre-clinical studies and the methodological quality of clinical trials, was highest for the herbal medicines Vitex agnus-castus, Cimicifuga racemosa and Cinnamomum cassia, for which there were laboratory and/or animal studies demonstrating endocrine mechanisms of action consistent with clinical outcomes shown in RCT's with low risks for bias. However, replicated RCT data was only found for one herbal medicine, Cimicifuga racemosa.
Los medicamentos pueden ayudar a regular su ciclo menstrual y reducir el crecimiento anormal del cabello y el acné. Las píldoras anticonceptivas (para las mujeres que no intentan tener un bebé) y la metformina son dos medicamentos recetados que a menudo son útiles. Si usted tiene diabetes o presión arterial alta, esas afecciones también necesitan tratamiento. Si quiere tener un bebé, existen medicamentos que pueden ayudarla a quedar embarazada.
Gynecologic ultrasonography, specifically looking for small ovarian follicles. These are believed to be the result of disturbed ovarian function with failed ovulation, reflected by the infrequent or absent menstruation that is typical of the condition. In a normal menstrual cycle, one egg is released from a dominant follicle – in essence, a cyst that bursts to release the egg. After ovulation, the follicle remnant is transformed into a progesterone-producing corpus luteum, which shrinks and disappears after approximately 12–14 days. In PCOS, there is a so-called "follicular arrest"; i.e., several follicles develop to a size of 5–7 mm, but not further. No single follicle reaches the preovulatory size (16 mm or more). According to the Rotterdam criteria, which are widely used for diagnosis,[10] 12 or more small follicles should be seen in an ovary on ultrasound examination.[53] More recent research suggests that there should be at least 25 follicles in an ovary to designate it as having polycystic ovarian morphology (PCOM) in women aged 18–35 years.[59] The follicles may be oriented in the periphery, giving the appearance of a 'string of pearls'.[60] If a high resolution transvaginal ultrasonography machine is not available, an ovarian volume of at least 10 ml is regarded as an acceptable definition of having polycystic ovarian morphology instead of follicle count.[59]


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CISI partners NSE to boost finance professionals in Africa
November 13, 2018248 views0 comments
The Chartered Institute for Securities and Investment (CISI) Tuesday announced its partnership with The Nigerian Stock Exchange (NSE) to provide training for CISI's qualifications in Nigeria, with the support of X-Academy, the knowledge platform of NSE.
The partnership will see CISI accrediting X-Academy as its training partner in Nigeria for qualifications, including the International Introduction to Securities & Investment (IISI), International Certificate in Wealth & Investment Management and Certificate in Derivatives, and X-Academy will be offering both face-to-face and online training for these qualifications.
Speaking on the partnership, Helena Wilson, assistant director, CISI global business development said, "We are delighted to partner with the Nigerian Stock Exchange to provide training for CISI's internationally recognised qualifications in Nigeria, supporting the development of human capital within the fast-growing Nigerian capital markets. CISI qualifications are fast becoming a benchmark across Africa, and this partnership is symbolic of Nigeria's growing influence both within Africa and on the global stage."
According to Pai Gamde, chief human resource officer of NSE, the partnership is a testament to the years of investment the NSE have made in pushing the boundaries of financial education and stimulating investors' participation in the Nigerian capital market.
"In 2017, we launched X-Academy to offer our ecosystem a blended learning approach and the curriculum across CISI programs reflects the same intent. We are quite excited about this development and we look forward to a long lasting relationship with CISI,"she said.
The CISI is the 45,000 strong, global not-for-profit professional body with members in over 100 countries. It has been working in Africa since 2012 offering exams and membership across the continent, with regulatory approval for its examinations in eight countries. It opened its first African office in Kenya in June. Over the last 18 months, almost 3,500 CISI examinations have been sat for in Africa, making it CISI's fastest growing market. The CISI is an Associate Member of the Africa Securities Exchanges Association (ASEA) in a partnership, which aims to promote professionalism and develop channels for capacity building and knowledge sharing to support the growth of the capital markets profession in Africa.
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subset: commoncrawl


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Occupational therapy is a client-centred health profession concerned with promoting health and well-being through occupation. The Canadian Association of Occupational Therapists defines occupation to be everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (work/productivity). The primary goal of occupational therapy is to enable any person – regardless of injury, illness, disability or psychological dysfunction – to participate in the activities of everyday life.
The role of an occupational therapist is to assist patients in developing or regaining skills important for independent functioning, health and well-being. The World Federation of Occupational Therapists identifies four key areas in the work of an occupational therapist. These are: assessment, planning, intervention, and cooperation. Assessment: Initial and repeated ass
Occupational therapy treatment covers several areas of performance. All treatment plans and therapy goals are created and implemented based on the person's individual needs. Fine motor skills, which relate to movement and dexterity of the small muscles in the hands and fingers Gross motor skills, which cover movement of the large muscles in the arms, legs
If you are looking for associations that can help you, check out the following sites: American Occupational Therapy Association Inc British Association of Occupational Therapists and College of Occupational Therapists British Association of Occupational Therapists and College of Occupational Therapists, 'Occupational Therapy' NHS Choices, 'Occupa
© 2019 enritsch.com, All rights reserved
Enritsch does not provide medical advice, diagnosis, or treatment See additional information


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All children under 3 years stay free of charge when using existing beds. All children under 2 years are charged EUR 3 per person per night for children's cots/cribs.There is no capacity for extra beds in the room.The maximum number of children's cots/cribs in a room is 1.
Please note that a € 1.50 government tax per room per night is not included in the prices below.
Click to navigate
Pasiphae Hotel is located in a quiet part of Heraklion, just a 10-minute walk from the main port of Heraklion and 2.5 km away from Nikos Kazantzakis International airport. The historic center of Heraklion can be reached within 15 minutes on foot.
Castello City Hotel is located close to the center of the Heraklion town, the ancient Pantokrator Gate and near bus and taxi stations. The distance from the main port of Heraklion is 2,5 km and Nikos Kazantzakis airport is at 6 km. Castello City Hotel is just a short walk from Heraklion beach.
The Santo George Beach Resort is located in Amoudara, only a 2-minute walk from the beach. Heraklion Port and city centre are approximately 8 km away. Heraklion International Airport, "Nikos Kazantzakis", is 11.3 km away.
The Arolithos Traditional Village Hotel is located in a complex of buildings representing traditional Cretan village 12 km away from Heraklion. The distance from the Nikos Kazantzakis airport in Heraklion is 15 km. The distance from the beach is 5 km.


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Car rentals in Pauls Valley: All you need to know
You want a great vehicle to take you around Pauls Valley whether you're going for a business or pleasure. See the top sites around the area and pull up in front of the popular restaurants in Pauls Valley. We've answered your most popular questions about car rentals in Pauls Valley. Read on to discover which vehicle is perfect for your trip, and how to get the best rates.
Where do I find a great deal on a car rental in Pauls Valley?
CarRentals.com makes it a cinch to get the cheapest deals. Just type in your travel dates and scroll through the list of rental companies, choose the top rental locations, and find the best packages Pauls Valley has to offer. You should also:
- Read the mileage policy to prevent any surprise expenses
- Reserve your rental car as far in advance as you can
- Avoid airport pick-ups; they usually are pricier
- Compare weekly and daily rates; you might save more if you rent the car for longer
Even a little rental car know-how can go a long way to getting you the most savings.
What rental companies have agencies in Pauls Valley?
From global names like Advantage and Hertz to budget-friendly brands like Economy and Budget, CarRentals.com has some of the best brands in the business. Read through the reviews to get an idea of which is best for your next trip.
What type of rental car should I get for my trip to Pauls Valley?
That depends on how many people you are traveling with and what activities you want to do in Pauls Valley. If you're having a bit of trouble picking the right car, be sure to read over the table below. We have compared the most popular vehicle categories for you:
|Car Type
|Best for
|Category Includes
|Full Size SUV
|To take on any kind of terrain and enjoy great views
|Ford Edge, Kia Sorento, Jaguar F-Pace, or similar
|Full Size
|Need extra room and comfort, but with better handling and gas mileage than an SUV
|Hyundai Sonata, Ford Fusion, or similar
|Those looking for a fuel-efficient vehicle
|BMW i3, Toyota Prius, or similar
How old do you have to be to rent a car in Pauls Valley?
Usually, to rent a car in Pauls Valley you must be at least 21—the same as it is across the rest of the USA. If you are under 25, you might also need to pay a surcharge. Be sure to read over the supplier's terms to find what the total will be before you book your car.
Do I need insurance to rent a car in Pauls Valley?
Insurance is required, wherever you're renting a car. Nevertheless, your current car insurance may cover you. Additionally, if you pay using your credit card, the card's benefits may also insure you. Keep in mind, your policies might not totally cover your rental, and you'll have to add it to your booking for Pauls Valley. Check ahead of time and, if it's needed, you can conveniently include it at the CarRentals.com checkout.
What are the different fuel policies?
Most suppliers allow you to choose which policy you want. Below is a list of the most common ones.You will have to search for a gas station near the drop-off location
|Policy Type
|Policy Description
|Full to Full
|There will be a full tank of gas when you pick up your car. You can use as much fuel as you like and top it off when you return your car at the end. As long as you replace the fuel before returning the car, you won't face any extra fees
|You only refill the amount of fuel that you've used. Used a quarter of a tank? Simply fill it back up to full. You won't be paying for any gas you didn't use. You won't pay more than local fuel prices and you'll only pay service fees if you don't refill the tank
|Full to empty (pre-paid)
|You pay for a full tank upfront and bring the car back with the tank empty. Several rental car companies provide a refund for any unused fuel. Be sure to verify with them beforehand
|You won't need to find a petrol station near your rental drop-off location
|You usually pay more for a tank upfront then you would going to a nearby gas station
|Empty to empty
|You may not have a full tank when you collect the vehicle, and you won't need to fill the tank back up before you bring the car back
|You refill your tank yourself, so you won't pay more than local pump prices
|You'll have to fill up before you go on a long trip
What fuel policy do you recommend?
We usually advise that customers choose the full-to-full policy. This policy simply means you bring your rental back to the full, and you're all set.
Should I get unlimited miles when I rent a car in Pauls Valley?
Unlimited mileage is a good choice for those who don't want to worry about incurring any extra charges with the distance they drive. Just make sure that your policy really provides unlimited miles. Read the fine print before you book.
Tips before you leave the lot
Before you get going on your Pauls Valley trip, go over a few items before you leave the lot. You should:
- Check out the vehicle and determine if there is any dents or scrapes. If you notice any, mark it down on the paperwork
- Inspect the trunk to determine if the spare is inflated and both the lug wrench and jack are there
- Get familiar with the controls of your car. Adjust the mirrors and seats to your liking, and figure out how to turn on the lights and windshield wipers
- Get comfortable operating the navigation and entertainment. You don't want any unneeded distractions in a new city
Book your Pauls Valley car rental today
Maybe you're traveling solo, maybe you're bringing your partner or kids, or maybe you're carpooling with co-workers to and from the hotel to the conference center. No matter who you're traveling with, CarRentals.com has a vehicle that can suit your requirement and not deplete your travel piggy bank.


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Piecewise Constant Orthogonal Functions and Their Application to Systems and Control pp 106-166 | Cite as
VIII Optimal control of time-lag systems
Part of the Lecture Notes in Control and Information Sciences book series (LNCIS, volume 55)
First Online:
KeywordsPerformance Index Riccati Equation Adjoint Equation Adjoint Vector Conventional Synthesis
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Unable to display preview. Download preview PDF.
Copyright information
© Springer-Verlag 1983


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Bombay HC Toughens Stance On Malnutrition Deaths Of Tribal Kids [Read Order]
The court mentioned reports that highlighted the fact that many child deaths went unreported and that only 18,000 deaths as against the actual number lying between 58,000 and 75,000 were reported.
The Bombay High Court toughened its stance on the death of malnourished children in the Tribal areas by seeking to know the funds allocated for the said purpose, but also the grant given to the State as for the total yearly budget allocation for these schemes/programmes and the total budget allocated by the Central Government to the State.
A division bench of Justice VM Kanade and Justice Swapna Joshi said this while hearing petitions of Bigar Adivasi Hakka Bachav Samiti, Shapur, Through Secretary, Mr. Subhash Harad vs. State of Maharashtra, Through Secretary, Tribal Development Dept. and Ors.
A compilation of documents disclosing statistical data regarding various schemes floated by the government and financial expenditure incurred for the schemes/projects were presented by the counsel of the State. The data showed that child deaths due to malnutrition had gone down in the last five years considerably, there was a reduction in pulse polio with some areas seeing a total eradication in some tribal areas due to the routine immunisation programmes initiated, malnourished children under these schemes are also admitted in hospital for 14 days where they are given proper care and treatment. The setting up of new Nutritional Rehabilitation Centres (NRCs), implementation of drives for De-worming and introduction of 'Vitamin A' were also mentioned by the State.
However, the court observed that on close scrutiny, it showed that money earmarked for the mentioned schemes/projects were not fully utilised and the money was siphoned off. The court mentioned reports that highlighted the fact that many child deaths went unreported and that only 18,000 deaths as against the actual number lying between 58,000 and 75,000 were reported.
The court proposed a systematic approach to tackle such issues by making an action plan earmarking funds, considering the current position and the steps to be taken to eradicate the problems and also the time likely to be taken to address the problems and the financial investment to be made by the state government.
The court said not only does it want to know the funds allocated for the said purpose, but also the grant given to the State as for the total yearly budget allocation for these schemes/programmes and the total budget allocated by the Central Government to the State.
Similarly, attention was brought to the 'Take Home Ration" (THR) food packets meant for distributing to Tribal children and take care of their dietary needs, weighing 1,170 gm and containing micro nutrients of wheat, gram, sugar and chickpeas. However, after lab tests, it was found that the nutritional value of the packets was far less than what was shown. The court directed the State Government to appoint an expert in the field like Ratan Tata Institute of Management and others, who shall give an expert's opinion on what kind of food is wanted and should be distributed.
On the basis of several reports in the press regarding child deaths due to malnutrition, the court was unsatisfied that no progress in this aspect was made.
The second issue was cases of sexual assaults on women. Taking into account the allegation of a male warden harassing a women in a female observation home and his subsequent acquittal by the sessions court, the high court observed that many a times, either proper investigation is not done or case is not presented before the court in a proper manner. Even when order of acquittal is passed, the State does not either take action against the delinquent investigation officer and/or it does not prefer an appeal against the order of acquittal. Thus, the court ordered:
"In this regard also, we direct the State Government shall submit a report to this court regarding total number of cases of sexual assault of rape on women, children and infant and the result of such cases and reasons for which appeals against acquittals have not been filed in such cases."
The matter has been listed for further hearing on 26th October 2016.
Image from here.
Read the order here.
This article has been made possible because of financial support from Independent and Public-Spirited Media Foundation.


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Do this: We can't harp on this advice too much: Eat at least 1g of protein per pound of bodyweight every day. Your major protein sources should be lean meats (chicken, steak, turkey breast, tuna), egg whites (the yolks contain the fat, so discard most of them when you're trying to lose fat), protein powder (whey or casein), and low-fat cottage cheese. As for fat, limit it to 20-30% of your total daily caloric intake.
If you find yourself cutting down your calories and doing cardio, yet your extra fat is still sticking around, it may be a good idea to focus on your lean body mass. Increasing lean body mass wakes up your resting metabolism. It also affects many different hormones in the body like insulin, leptin, and ghrelin. These hormones communicate with your cells and instruct them about whether it's time to store fat or release it.
Nuts. It's very easy to eat until the nuts are gone, regardless of how full you are. A tip: According to science, salted nuts are harder to stop eating than unsalted nuts. Salted nuts tempt you to more overeating. Good to know. Another tip: Avoid bringing the entire bag to the couch, preferably choose a small bowl instead. I often eat all the nuts in front of me, whether I'm hungry or not.
When I signed up for this program, I was in a pretty dark place. I was using all kinds of unhealthy coping mechanisms to deal with (hide from) hurts and insecurities that had piled up over the last few years. I was approaching my highest pregnancy weight- and I wasn't even pregnant. Every day was a struggle, and my poor habits were spiraling out of control. I didn't like or recognize the shell of a woman who looked back at me in the mirror. Something had to change, for myself, and also for my husband and 3 kids. They deserve better.
Of course, not all carbohydrates are equal. In short, fast-digesting carbs tend to create a large insulin burst, leading to more potential fat gain. These carbs include white bread, most cold cereals, any sweets, rice cakes, white rice, and white potatoes. Conversely, slow-digesting carbs (found in whole-grain breads, oatmeal, sweet potatoes, and legumes) don't cause much of an insulin rise, so these should make up the vast majority of your carb consumption.
Don't let extra hours lounging in bed stand between you and a flatter belly. While getting enough sleep can help boost your metabolic rate, sleeping in may undo any benefit you'd enjoy from catching a few extra winks. One study reveals that late sleepers who snoozed past 10:45 in the morning ate nearly 250 more calories over the course of the day, despite eating half as many fruits and vegetables as their early bird counterparts. Even worse, they chowed down on more salty, sugary, and trans fat-laden fast food than those who woke up earlier. If you happen to head out of the house early, you're in for an additional metabolic boost; researchers at Northwestern University have found that people exposed to just a short period of early morning sunlight had lower BMIs than their late-waking counterparts.
The Women's Health Diet isn't about eating less; it's about eating more—more nutrient-dense food, to crowd out the empty calories and keep you full all day. That's important, because restricting food will kill your metabolism. It sends a signal to your body that says, "I'm starving here!" And your body responds by slowing your metabolic rate to hold on to existing energy stores.
Do this: One way to slow digestion is to eat carbs with protein and small amounts of fat. Never eat carbs alone. Accompany that bowl of cereal, for example, with scrambled egg whites or cottage cheese. Alternatively, you could eat plenty of vegetables, such as broccoli, cauliflower, green beans, and green salads, with your meals. These foods actually slow the breakdown and digestion rate of all carbohydrates.
The fat on this program makes you feel MUCH better than you do on a fast or a low fat diet. Most people can continue to work (in office jobs) at normal levels. In fact, most people feel like rock stars, with even more energy than normal. This is not a diet to use while you're working out excessively, although a short workout once a week right before you eat will help.
You don't have to go low-carb to ditch those extra pounds around your waist in a short period of time. In fact, opting for more whole grains might just get you there faster. Researchers at Tufts University have linked eating three or more daily servings of whole grains to as much as a 10 percent reduction in visceral body fat, the kind that ups your risk for chronic diseases, like diabetes, heart disease, and high blood pressure.
This is one of the most important keys to weight loss and fat burning. You've heard it so many times before but the reality is – most people still don't drink as much as the human body craves to function optimally! Drink water throughout the day and make your daily goal 64-80 ounces, during summer months you will lose more water through sweat so to hydrate during summer you may need to consumer more. The little tip you may not be aware of is that it is ideal to limit water intake while you're eating meals – drink most of it between! If you drink too much while you're eating, you're making it harder for your body to digest and absorb the food which will make you much more hungry later. Your digestion works optimally when you are seated, and most of us tend not to be seated long enough. So do everything you can to help your digestion work optimally so you get the full absorption of what you are eating.
When you start reducing your calories to create a healthy calorie deficit, you may start to feel hungry as you adjust to your new calorie intake. You don't want to ignore physical cues of hunger such as dizziness, headaches, the inability to concentrate, and extreme fatigue, but one of the reasons people struggle to lose weight is because they don't eat satiating meals and instead allow themselves to feel hungry all day. This isn't sustainable and such restriction often ends in binge-eating or giving up.
The 3 branched chain amino acids are leucine, isoleucine, and valine. It has long been known that these three amino acids are great for preventing muscle tissue breakdown and building new muscle tissue. What most people do not know is that BCAA supplementation can increase fatty acid utilization for energy by decreasing protein breakdown for energy use.
BCAA's work with a double sided attack on fat loss. First by increasing muscle growth which will eventually lead to an increased metabolism, secondly by increasing fat utilization within the body. This makes BCAA's one of the most effective supplements on the market. To get the most benefit out of your BCAA supplementation it is best to consume 8-12 grams during training and another 10-20 grams throughout the day in between meals. This will optimize both muscle retention and fat loss.
Sure, ketchup is tasty, but it's also a serious saboteur when it comes your weight loss efforts. Ketchup is loaded with sugar — up to four grams per tablespoon — and bears little nutritional resemblance to the fruit from which it's derived. Luckily, swapping out your ketchup for salsa can help you shave off that belly fat fast. Fresh tomatoes, like those used in salsa, are loaded with lycopene, which a study conducted at China Medical University in Taiwan links to reductions in both overall fat and waist circumference. If you like your salsa spicy, all the better; the capsaicin in hot peppers, like jalapeños and chipotles, can boost your metabolism, too.
There are those that claim HIIT is less effective than low intensity longer duration cardio. Their reasoning is that most of the calories burned during HIIT come from stored muscle glycogen (carbs) rather than coming from stored adipose tissue. This is true but this is not a bad thing. Research has absolutely proven that it does not make any difference whether stored carbohydrates or stored fats are used as the fuel source. The only thing that matters is how many total calories are burned and more total calories are expended through HIIT as opposed to low intensity low duration cardio.
Intentional weight loss is the loss of total body mass as a result of efforts to improve fitness and health, or to change appearance through slimming. Weight loss in individuals who are overweight or obese can reduce health risks,[1] increase fitness,[2] and may delay the onset of diabetes.[1] It could reduce pain and increase movement in people with osteoarthritis of the knee.[2] Weight loss can lead to a reduction in hypertension (high blood pressure), however whether this reduces hypertension-related harm is unclear.[1][not in citation given]
We also love yoga, hula-hooping (yep, great for the abs) and the good standby "Abs of Steel" videos, and trust me the outfits in the 1990's video will increase the cardio aspect just from laughter alone! There are also a slew of videos online, find one you love and can stick to every few days and you'll be toning as you shed the unwanted belly fat.
When I signed up for this program, I was in a pretty dark place. I was using all kinds of unhealthy coping mechanisms to deal with (hide from) hurts and insecurities that had piled up over the last few years. I was approaching my highest pregnancy weight- and I wasn't even pregnant. Every day was a struggle, and my poor habits were spiraling out of control. I didn't like or recognize the shell of a woman who looked back at me in the mirror. Something had to change, for myself, and also for my husband and 3 kids. They deserve better.
Another crucial time for protein is before bed. While sleeping the body releases a flood of anabolic hormones such as growth hormone and testosterone. This is yet another time when steps can be taken to preserve muscle while dieting. During the night we typically go several hours without eating. For this reason a slowly digesting protein would be best. This will allow a longer steady flow of amino acids that will continue to feed muscle tissue for hours.
Those trans fats on your menu are hiding out in plain sight and sabotaging your lean belly plans every time you eat them. If a food product says it contains partially hydrogenated oils, you're eating trans fat, which can increase your risk of heart disease, high cholesterol, and obesity with every bite. In fact, research conducted at Wake Forest University reveals that monkeys whose diets contained eight percent trans fat upped their body fat by 7.2 percent over a six-year study, while those who ate monounsaturated fat gained just a fraction of that amount. Instead of letting harmful trans fat take up space on your menu, fill up with the 20 Healthy Fats to Make You Thin.
Build more muscle: Cardio gets all the glory for melting fat, but it's actually far more important to focus on building muscle. It's pretty simple: Lipolysis happens in the mitochondria of the muscles, so the more muscle you have, the more mitochondria, and the more potential to burn. Plus, the more muscle mass you carry, the more your BMR is burning calories at rest. Strength training is also one of the strongest ways to spark production of testosterone and growth hormone, which both help to break down fat, Seedman adds.


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Louis Jankel, 73, from London, a member of the Inland Waterways Association
I've spent 120 days working as a volunteer lock keeper for the Environment Agency, and I've been using the Thames for 25 years so I know how these things work.
I also understand the problems that can occur because of lock manning and lock servicing.
The agency wishes to take away certain safety facilities, but it has used the excuse that ladders are too heavy for lock staff to use, and it seems that without fire extinguishers staff should just leave boaters to burn if there is an accident.
If you are filling up the lock you must leave the gates closed. If a boat catches fire when the lock is empty, there is no way of people getting out of the lock. The only way would be to use a ladder so what are they supposed to do now?
I just cannot believe that anyone involved with the agency could be so incompetent and ignorant.
Imagine you are by the lock, a boat comes in and bursts into flames.
The staff haven't got a fire extinguisher so all they can do is watch the people burn, and try to call for an ambulance.
Of course some sites have very difficult access, ambulance staff might have problems getting to the lock and by then it may be too late. This plan they have come up with is just not feasible.
The agency seems to expect keepers to stand there and do nothing, but they are human and it is not in their nature.
I have four fire extinguishers in my boat and they are all attached to the wall, as is required for safety.
But if your boat catches fire, you do not want to walk down your boat, through smoke and flames, just to get to an extinguisher.
The people who make these decisions clearly know nothing about boating, and if they say that they have the backing of lock-keepers they are just lying.
There is not a single person I know who would agree; all the agency wants to do is keep cutting costs.
This is the most terrible indictment of the management of the Environment Agency – these people are making idiots out of themselves.
If they are to solve this problem, they must listen to people who actually understand the river.
Andrew Graham, Environment Agency waterway manager for the non-tidal Thames, based in Wallingford
There are two things here. One is the lock ladders. This is something that has been in discussion between management and staff health & safety representatives for some years.
It was brought to our attention by staff reps. Some of these ladders are very long and heavy and difficult to manoeuvre. While some staff members are large and strong, some are smaller. The ladders are very big and very heavy.
We are finding a way to resolve this. We have a lot of safety equipment around – the lock ladder is not the only safety equipment we have there.
But it's something potentially hazardous to staff when they try to use it.
It has to conform with all British Standards as a piece of working equipment. We can't just go out and buy a flimsy ladder from a home store. We agreed with the external consultants when they said we should stop using the ladders. When your managing health and safety for your own staff, and when someone tells us to stop doing something, then it's quite important to stop doing that. Unfortunately staff and customers are concerned. But what we will emphasise is there is plenty of safety equipment.
With the fire extinguishers, we only put them out when people are on duty, and lock them up as they might otherwise get vandalised. For many years, the instructions given to lock-keepers was ring the emergency services if there is a fire and keep everyone away.
They have never been asked to fight a fire.
They should be helping the people on the boat.
Every boat on the river must have sufficient fire extinguishers, to allow boaters to make their escape. Our lock keepers' role is to make sure everyone else is safe. We are not in the game of trying to put out a boat fire if nobody is on it.
We want people to be safe, not the boat.
Boaters have to look after their own safety.
That's why it's so important for them to have their own emergency plan and fire extinguisher. People need to take responsibility for their own safety.