Esketamine Uses, Side Effects, Dosages, and Precautions

Esketamine Uses, Side Effects, Dosages, and Precautions Depression Treatment Medication Print What to Know About Esketamine A fast-acting nasal spray can be an effective treatment for depression By Amy Morin, LCSW facebook twitter instagram Amy Morin, LCSW, is a psychotherapist, author of the bestselling book 13 Things Mentally Strong People Dont Do, and a highly sought-after speaker. Learn about our editorial policy Amy Morin, LCSW Medically reviewed by Medically reviewed by Steven Gans, MD on July 13, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on January 09, 2020 Depression Overview Types Symptoms Causes & Risk Factors Diagnosis Treatment Coping ADA & Your Rights Depression in Kids In This Article Table of Contents Expand Uses Before Taking Dosage Side Effects Warning and Interactions View All Esketamine was approved by the FDA in 2019 to treat depression that hasn’t responded to other treatment. Unlike oral antidepressants, which often take four to six weeks to take effect, esketamine is administered via nasal spray and is effective within hours. It’s estimated that 5 million people in the United States have a depressive disorder that hasn’t resolved with current treatments. Esketamine may help those with treatment-resistant depression experience much-needed relief. Esketamine is marketed by the brand names Ketanest and Spravato. Its effectiveness was evaluated in three short-term clinical trials and one longer-term maintenance trial. While it does carry some risks, the FDA determined that the benefits outweigh the risks, citing the need for additional effective treatments for treatment-resistant depression, a serious and potentially life-threatening condition. In the United States, suicide is the 10th-leading cause of death. In 2016, it claimed the lives of almost 45,000 people. Many of those individuals had untreated depression. Uses Despite decades of research, the molecular mechanisms underlying depression are poorly understood. Consequently, scientists aren’t exactly certain how esketamine reduces depression. What is clear is that it is fast-acting. Within hours, people may experience changes to the brain that reduce symptoms of depression. Currently available antidepressants target the monoamine neurotransmitter systemsâ€"predominantly serotonin, norepinephrine, and dopamine levels in the brain. Antidepressants often take four to six weeks to become fully effective, and they are not always effective. It’s thought that esketamine affects the function of the brains glutamate neurotransmitter system while most oral antidepressants affect the serotonin neurotransmitter system. Esketamine is derived from ketamine. The only difference is that ketamine is a mixture of two mirror images of a molecule and esketamine is just one of those molecules. Off-Label Uses Esketamine isn’t a new drug. It’s been around for a long time, but it is only recently that it has been used as a nasal spray to treat depression. Ketamine hydrochloride is a selective NMDAR antagonist that has been used primarily as an anesthetic drug since the 1960s. It may also be used for pain management in low doses. Emergency departments may use it to manage acute pain or to control pain during a procedure. Ketamine Ketamine is known as a party drugâ€"often referred to as “Special K.” People who misuse ketamine report dissociative effects as well as a sense of detachment, saying they felt an “out-of-body experience.” When misused, ketamine distorts perceptions of sight and sound. Some people on ketamine experience euphoria, while others report hallucinations or temporary paralysis. Initial Drug Trials In 2000, a pilot trial reported a rapid and robust antidepressant effect following a single IV dose of ketamine at a lower dose than is used for anesthetic purposes. Following the trial, several more studies supported the findings. Most of the trials focused on a 40-minute IV fusion of ketamine. Following the infusion, the majority of patients experienced significant relief in symptoms such as depressed mood, anhedonia, and suicidal thoughts. Improvements were often noted within two hours of ketamine administration. The therapeutic effects peaked at 24 hours and lasted up to two weeks. Despite the positive results, IV ketamine was associated with mild and transient dissociative effects, neurocognitive and sensorimotor disturbances, and short-lasting elevations in heart rate and blood pressure. It also wasn’t widely available in IV form. Without FDA approval, off-label use of ketamine infusions for the treatment of depression wasn’t covered by insurance, and it often cost more than $500 per treatment. In clinical trials, esketamine nasal spray has been effective in reducing symptoms for individuals with treatment-resistant depression. One randomized trial involved adults under 65 who were also taking an oral antidepressant. After one month, roughly 70% of patients responded to treatment, compared to just over half in the placebo group. Before Taking Esketamine isn’t likely to be used as a first-line of treatment. Instead, it is intended for individuals with treatment-resistant depression, meaning they have had adequate trials of two other antidepressant medications first and didn’t experience relief. Research suggests that around 30% of people who receive treatment for depression do not have a response to standard, front-line treatment approaches.?? Alternative Treatment Options Esketamine may be an option for individuals who are at an acute risk of suicide. Individuals who are in crisis may need a fast-acting drug that can offer immediate relief. Esketamine isn’t the only option for individuals with treatment-resistant depression. Other options may include: A different antidepressant: Just because the first two antidepressants didn’t work doesn’t mean a third medication won’t be effective. A doctor may try a different type of antidepressant (such as changing from a SSRI to a SNRI) or add another medication that could make an antidepressant more effective (such as an antipsychotic or anticonvulsant medication).Talk therapy: Depression is often best treated with a combination of medication and therapy. A psychiatrist may refer a patient to psychotherapy to help reduce symptoms. Cognitive behavioral therapy (CBT) has been found to be especially effective in treating treatment-resistant depression.Electroconvulsive therapy (ECT): ECT produces electric currents through the brain to trigger a brief seizure. It seems to cause changes in brain chemistry that improve and stabilize mood. It can have side effects such as short-term memory loss and confusion, but is generally considered safe and currently the most effective treatment for trea tment-resistant depression. It may require six to 12 sessions of treatment.Vagus nerve stimulation (VNS): VNS involves implanting a pacemaker-like device that sends electrical currents to the vagus nerve. The vagus nerve is thought to stimulate parts of the brain that regulate mood. It can take up to several months for VNS to be effective.Repetitive transcranial magnetic stimulation (rTMS): rTMS uses a magnet to stimulate certain areas of the brain to reduce symptoms of depression. Although it doesnt carry some of the side effects of ECT, it is not generally thought to be as effective. Precautions and Contraindications Esketamine may cause an increase in blood pressure or heart rate, so it should be used with caution if an individual has angina, a history of stroke, or poorly-controlled blood pressure. Esketamine may cause fetal harm and women who are pregnant or considering becoming pregnant should talk to their doctors. Women should not breastfeed while undergoing treatment. In general, esketamine is contraindicated in individuals with psychotic depression, since psychotic symptoms are sometimes reported as side effects when it is administered at anesthetic doses. Esketamine is also contraindicated in those who have a hypersensitivity to esketamine or ketamine. Dosage Esketamine is delivered via nasal spray. Each device contains 28 milligrams (mg) and delivers two sprays. It must be administered under medical supervision and will not be available for patients to bring home. Patients must go to the doctor’s office or clinic to access the nasal spray, according to the conditions of FDA approval. If you are taking esketamine, you will likely receive a treatment one or two times per week. You will remain in the office setting for a couple of hours so you can be monitored closely by medical personnel for two hours. Medical providers will ensure you are not experiencing adverse reactions before allowing you to leave. Esketamine was approved for use in combination with oral antidepressants like Prozac (fluoxetine), Zoloft (sertraline), or Lexapro (escitalopram). Modifications The safety and efficacy of esketamine have not been established for pediatric use. Guidelines for use among people 65 and older are the same as those for other adults. How to Know Which Antidepressant Is Right for You Side Effects Like any new treatment, manufacturers will continue to monitor any adverse reactions. Johnson Johnson, who developed esketamine, is taking steps to ensure it will only be used as intended. Common In clinical trials, the most common side effects included the following: DisassociationDizzinessNauseaSedationVertigoDecreased feelingAnxietyLethargyIncreased blood pressureVomitingFeeling inebriated The label for esketamine will include a black box warningâ€"the most serious safety warning the FDA issues. It will caution users they may experience sedation, problems with attention, judgment, and thinking. It will also warn people that there’s potential for abuse and suicidal thoughts. Patients should not drive or operate heavy machinery after taking esketamine until the next day after a restful sleep as it can impair reaction time and motor skills. Severe Side Effects Call your doctor if you experience severe side effects including extreme drowsiness, changes in mood or behavior, worsening depression, hallucinations, or suicidal thoughts.    Call emergency services immediately if you have signs of an allergic reaction including hives, difficulty breathing, or swelling of the face, throat, lips, or tongue. Warning and Interactions Before taking esketamine nasal spray, you should tell your doctor about any other medications, both prescription and nonprescription, that you are taking, as well as any vitamins or herbal supplements that you currently take or plan on taking. You will be closely monitored for potential interactions with other medications you may be taking including: AmphetaminesAnti-anxiety medicationsMonoamine oxidase inhibitors (MAOIs)Opioid pain medicationsSeizure medicationsSedativesSleeping aidsTranquilizers The use of alcohol should be limited when taking esketamine, as combining the two may increase the severity of side effects including drowsiness, difficulty thinking, confusion, motor impairment, and dizziness. Esketamine also has the potential for misuse. Doctors are advised to weigh the potential benefits of this treatment against this risk, particularly in people who have a higher risk of substance misuse and addiction. The prolonged use of esketamine can cause physical dependence, which can lead to withdrawal symptoms when use is discontinued or when the dosage is reduced.   A Word From Verywell If you or a loved one has treatment-resistant depression, talk to your doctor about the potential risks and benefits of esketamine versus other treatment options. While esketamine may not be right for everyone, it may provide much-needed relief for some individuals who haven’t been able to get relief from their depression from other treatment methods. Overview of the Treatments for Depression

The Origin Of Ancient Africa - 1082 Words

Africa is the origin of mankind, the early civilizations that migrated throughout the continent set a basis for studying and understanding why humans will migrate. When examining the people of ancient Africa, historians identified the fact that many groups migrated throughout the continent. It became evident that the different societies had some similarities and influences from one another. The Bantu people shared a common foundational language, which was a main factor in their expansion to the west as well as the south. In the northern part of the continent there was a colonial powerhouse forming. The Egyptian empire migrated along the Nile River in search for trade routes, which expanded their kingdom and made them stronger. To develop a†¦show more content†¦The same strategies that helped them become so large, and powerful, led to their downfall. â€Å"The process of Egyptian colonial expansion in Africa involved three major stages. The first was a period of more or less uncoordinated exploration and plundering, which served to make the Egyptians aware of the economic resources and opportunities beyond their southern frontier. This was followed by the establishment of trade relations with a powerful interior chiefdom, backed up by an Egyptian monopoly of trade on the lower Nile.† The Egyptians explored beyond the borders of their primary colonization, as stated the first period was uncoordinated; it was simply human nature to explore, and see what there was beyond their borders. This led to trade relations, and the Egyptians developed a trade monopoly along the Nile. In turn this helped their economy grow, and expand as a result of their migration southward. When a historian looks at ancient Egypt he or she can see that by studying it’s migration patterns south, it was able to extend its influence on the culture and societies that it encountered. In the south the people of Nubia were the most directly affected by Egyptian occupation. The various natural resources that were sought after in Nubia by the Egyptians were what led to the empires initial purpose for migrating further south. As a result, Nubian culture showed evidence of

Abraham Lincoln And The Civil War Comparison Essay

Abraham Lincoln, the great president of the United States, is one of the most influential men in the history of America. He is not only the commander-in-chief of the Union army that takes the victory from the Confederacy in the Civil War but also a leader who ends up the existence of slavery and a hero of the United States of America. On the other hand, Nathan Bedford Forrest is the lieutenant general of the Confederate army during the Civil War. He is a real genius and the great leadership of the Southern which help them to fight for the Northern. Nonetheless, Nathan rises from the rank of private to lieutenant general by his talents through wars with smart strategies and become the biggest trouble for the Union army. Nathan and†¦show more content†¦In general, Abraham Lincoln save the United of America’s citizens from slavery, domination of the south and build a stronger government that help the people to get a better life. On the contrary, Nathan Bed Forrest started his humble background with a low-income family which is carried by him at the age of seventeen. After joining the business with his uncle, Forrest becomes one of the richest people in the South as the businessman. During the Civil War, Forrest offered to buy new equipment and horses for the Confederate army. With that generousness, he was promoted to be lieutenant-colonel, even though, Nathan did not have any military’s training, he still did an outstanding job with smart strategies and talented skills. With a lot of merits from the wars such as the victories in the Battle of Sacramento, Fort Donelson, Shiloh, Fallen Timbers, Nathan Bed Forrest become the real genius of the Southerners, and step by step, lieutenant general of the Confederate Army comes to him as a reward for being a genius. All of his actions were supported by his basic idea about the slavery. He was a slave trader who owns more than 200 slaves. 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Tobacco Industry Csr Malaysia Free Essays

1. 0 INTRODUCTION Major tobacco firms in Malaysia have begun investing aggressively Corporate Social Responsibility activities to build a positive public image and brand activities via large contributions into social programs nationwide, and to be recognised as contributors to the greater common good. Although CSR is considered as a corporate entity along standards of business ethics, tobacco industry philanthropic activities encounter much criticism and threat of a comprehensive ban on CSR atop present legislations for Tobacco Advertising, Promotion Sponsorship worldwide. We will write a custom essay sample on Tobacco Industry Csr Malaysia or any similar topic only for you Order Now Many concerns have been raised over the practice; alleging that the motives behind tobacco industry CSR are to manipulate public perception of responsible marketing practices and gain favourable position for the individual firms in Malaysia. 2. 0 CSR AND ITS STRATEGIC ADVANTAGES Holme and Watts define CSR as an ongoing pledge by corporations to conduct themselves in an ethical manner and contribute to economic growth while developing the quality of workforce livelihood and their families, and the overall local community and societies. CSR programs were developed to answer public urges for corporations to advocate ethical, environmental, health and labour regulations. The Sustainability Entrepreneurship Model by Young and Tilley, as shown in Appendix I, comprises of six decisive factors: eco-efficiency, socio-efficiency, eco-effectiveness, socio-effectiveness and sufficiency and ecological equity; for corporate sustainability which adds to the business’s social responsibilities and enhances its effectiveness, bringing higher cost savings and better profit margins. 8% of consumers said they were more likely to purchase from companies that engages in initiatives to develop society. 3. 0 TOBACCO INDUSTRY AND TOBACCO USE IN MALAYSIA Malaysia is a major cigarette-manufacturing showpiece for tobacco transnational corporations operating in the South East Asian region. Among 92 sectors, the tobacco industry ranks 5th with an economic output totaling to RM11. 7 billion or 3% of Malaysia’s GDP. The tobacco indu stry in Malaysia comprises of large corporations such as British American Tobacco, market share 68%; Japan Tobacco Inc. 17. 7%; and Philip Morris International, 15. 3%. The industry considers itself a vital contributor in developing Malaysia’s socio-economic condition of the rural population. Tobacco is Malaysia’s most largely cultivated non-food crop, with 12,148 hectares and 1,200 hectares of land solely for tobacco cultivation in Peninsular Malaysia and East Malaysia respectively. The industry’s activities range from tobacco leaf cultivation and curing, tobacco production to marketing and distribution. Records show that more than 190,000 people are employed in the industry, and 120,000 people involved in tobacco farming and curing. Smoking statistics show that 10,000 Malaysians succumb to smoking-related ailments annually, making it the top killers in the country since the 1980s. According to Global Adult Tobacco Survey based in Malaysia, 23. 1% or 4. 75 million adults currently smoke, 43. 9% (4. 64 million) being men and 1. 0% (0. 10 million) women. The study also suggested that the expenditure on manufactures cigarettes cover 3. % of the GDP in 2011, its data showing present smokers using an average of RM 178. 80 monthly on manufactured cigarettes. 4. 0 PRACTICE OF TOBACCO INDUSTRY CSR IN MALAYSIA The industry engages CSR in various methods to achieve maximum public exposure and influence. The common approach of tobacco industry CSR is corporate philanthropy in which the firms provide monetary aids in areas such as culture and arts, education, shelter, social welfare and the envi ronment. In addition, they offer support to government policies and sponsorship of events such as youth smoking prevention programs. Several firms have even established charitable foundations to fund their initiatives, such as the British American Tobacco Foundation which was set up with the aim to obtain and manage funds for education, scientific and other charitable purposes. In conjunction with National Kenaf and Tobacco Board, the foundation has rewarded over 2,000 recipients RM 1. 1 million since its initiation in 2002. Formation of alliances between tobacco firms with non-governmental organizations exist as well. Yayasan Salam Malaysia is a long-term NGO partner of Philip Morris since 2006, both supporting a variety of CSR programs concerning poverty and society’s wellbeing. Their annual partnership had revolved around building information and communication technology (ICT) centres in rural places and providing financial aids for the underprivileged. BAT is also the first local tobacco company to publish Social Reports since 2001; these reports highlighting the firms CSR activities conducted year-round, looking forward to aligning itself with other businesses that conduct CSR activities. The company had received the Malaysian Sustainability Reporting Award from the Association of Chartered Certified Accountants for BAT’s efforts in cancer research. 5. 0 CRITICISMS TOWARD TOBACCO INDUSTRY CSR The tobacco industry is one of the most criticised members of the modern business community. Several disputes have arisen worldwide declaring that tobacco industry products are lethal to their consumers, and the CSR activities will be unable to resolve the fundamental contradiction with ethical corporate citizenship. WHO defines tobacco industry tactics utilizing CSR as a tool â€Å"to promote voluntary measures as an effective way to address tobacco control and create an illusion of being a ‘changed’ company and to establish partnerships with health interests. † These charitable campaigns purposefully influence the perception among youths and adults that the tobacco industry is deceitful and guilty for advocating smoking among youths and adults. Tobacco companies’ internal documents have revealed the motives behind industry-sponsored programs, aimed to increase profits and stimulate company investments. It is alleged that by conducting CSR, tobacco firms aim to build favourable views regarding the industry and tobacco issues by demonstrating their responsibility and concern about the wellbeing of consumers and stakeholders. Another tobacco industry goal is to achieve political influence with the intention of obstruct government efforts to regulate tobacco control, as evident in Malaysia. These CSR initiatives also pose as protection against litigations or lawsuits. The sponsorship of tobacco firms in youth anti-smoking campaigns is claimed to be a scheme to access youths for market research, to normalise brands and to avert success of anti-tobacco campaigns. A report by the British Medical Association stated that tobacco industry CSR as a form of marketing for firms, and as such it should be prohibited under the terms of Article 13 of the Framework Convention on Tobacco Control, which calls for Parties to impose a full ban on tobacco advertising, promotion and advertising, including CSR. CSR functions in favour of the industry by creating goodwill with lawmakers and the public, crushing bad publicity for its lethal goods, and resolving conflict from tobacco control advocates. The tobacco-caused death and disease suffered by societies and families contradict the advantages of charity or sponsorship for social interests. Tobacco consumption offers zero merits to the underprivileged, and any financial aid offered by tobacco firms accountable for smoking-related ailments and financial woes of the nation fails to relieve poverty, environmental, or health problems. . 0 POLITICAL ECONOMY AND CONTROL OF TOBACCO IN MALAYSIA Advocacy for tobacco control in Malaysia had begun in the 1970s, with gradual growing initiatives to institute specific legislations to regulate tobacco manufacturing and consumption. Compliant to the FCTC, Malaysia enacts legislation compliant with the FCTC by providing extensive regulation and banning of advertising, promotion and sponsorship. Presently, Malaysia allows tobacco industry CSR, and it has been abused by the industry as a strategic tool to change its public image. Measures to undertake the Malaysian smoking epidemic is inconsistent – from one point of view, the cost of lives and health interests; while the other, the critical consequences of tobacco control on tobacco farmers and alleviating poverty. The Malaysian government is an active shareholder and advocate of tobacco. They are major partners in two of Malaysia’s largest tobacco corporations with direct financial interests in the industry. Major shareholders of BAT and JTI include statutory bodies such as the Skim Amanah Saham Bumiputera, Employees Provident Fund, and Amanah Saham Malaysia, demonstrating the Malaysian state controlled ownership of shares in the tobacco industry. A large number of Bumiputeras partake in tobacco cultivation with Bumiputera partners being of key importance in the ownership of tobacco firms. Corresponding to the government policy to promote foreign investment, BAT, Philip Morris, and R. J. Reynolds Tobacco Company have set up their subsidiaries and established manufacturing facilities within the country. 7. 0 CONCLUSION In averting the overall poor public image, weak knowledge regarding individual tobacco firms, and more litigations and restraints, the tobacco industry CSR activities are meant to improve public perception of the industry. CSR activities by tobacco firms purposefully highlight their philanthropic contributions to the society and also promote youth smoking prevention programs. As long as there is absence of major restraints and public criticism, the tobacco industry will continue to operate unreservedly, utilising CSR to promote its â€Å"responsible† marketing practices and to receive favorable ratings for individual firms within the country. The tobacco industry’s public relation efforts may possibly influence Malaysian audiences to develop further resistance against the objections faced by the industry, alleviate jurors’ negative scrutiny toward the industry, and thus deteriorating public or legislative support for tobacco control policies in Malaysia. How to cite Tobacco Industry Csr Malaysia, Essay examples

The Ex free essay sample

Welcome to the land of sorrow and disappointment, otherwise known as theBREAK UP. We’ve all been there, right? We meet someone that is completely amazing, perhaps not as amazing as Brad Pitt or, say, young Leonardo Dicaprio; but he’s certainly up there. Kind of. Anyway, here’s this perfect guy (in your eyes) and you’ve been with him for about four years. FOUR YEARS. That’s 48 months, 208 weeks, and 1,460 days of your precious time devoted to this one individual in our massive universe. I’m going to marry him. He will father my children. We’re going to grow old together. Hate to burst your bubble, but you are not going to marry him, he will not father your children, and you are not going to grow old together. I don’t mean to be a negative Nancy but trust me, I know how the story goes, and I’ve heard it far too many times. We will write a custom essay sample on The Ex or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Friday night date night rolls around and, as usual, at approximately 7:06, there’s a light knock at the door. You give your hair one last fluff while glancing quickly at the mirror as you grab the purse off of the hallway table. A soft kiss greets you, and you love birds fly off to the 8 o’ clock reservation at Olive Garden (that he insisted was ridiculously difficult to get even though everyone knows you don’t need to make a reservation at Olive Garden.) While awaiting the chocolate dipping sauce for your favorite zeppoles (you’re a sucker for fried delicacies) he clears his throat and gently caresses your hands. â€Å"Listen, babe, we need to talk.† He pauses while you take a sip of your peach iced tea and nod in encouragement. â€Å"We’ve been together for a long time now. I love you so much, and I’ve been doing a lot of thinking lately about us and our future.† This is it. It’s actually happening. You flash a subtle smile and lean in a bit closer. He continues, â€Å"I’ve thought about it. I love you; you’re the most important person in my life-† â€Å"YES! Yes, I do, I do!† â€Å"Really? I’m so relieved to hear that!† â€Å"Of course! I love you too everything has been amazing but-† â€Å"We’ve been together for too long. It’s time to see other people, see what else is out there. I’m so relieved to know that you feel the same way,† he finishes. You give him a puzzled look. What? â€Å"No. I was going to say, but it’s time to take our relationship to the next level. Wait. You’re breaking up with me?† This never once crossed your mind; after all, if not today, then he was probably going to propose, like, next week. This is insane. I mean after all the time you’ve been together, how could he do this to you? The conversation ends with â€Å"I’m sorry’s† and â€Å"I understand’s†. All the while you’re trying to keep your cool because there’s no way he can know that you’re actually a mess inside and that part of you wants to rip his head off. The car ride home is awkward and tense. There’s so much you want to say but you keep it inside, knowing that as soon as you open your mouth, you’ll break down in tears. You exchange a quick goodbye and almost fall out of the car in an attempt to get out of there as soon as possible. As soon as you shut the door behind you, there’s no holding you back. The sobs become louder and louder as the minutes tick by. You crawl onto the couch with a pint of Oreo cookie ice cream and manage to swallow large spoonfuls in between sobs. Cupid is a jerk. After an hour of nonstop eating, crying and an overplayed episode of America’s most loved family, Keeping Up with the Kardashians, you call it a night and doze off right there on the couch. At around 3am anxiety kicks in and you’re awakened to the sound of your rapidly beating heart. This isn’t over, Henry. In an effort to mend the broken relationship, you go ahead and give him a call. After all, this isn’t a break up. It’s merely a misunderstanding between two people who love each other deeply. This was definitely not mutual, which means that you didn’t really bre ak up. After thirty calls and fifteen voicemails there is still no response. That’s okay. You can always call him in the morning. Better yet, why don’t you stop by his office with his favorite chocolate donut and a coffee? Do whatever it is that you have to do. If you can’t catch him there, that’s fine, just drop by his apartment after work with a box of pepperoni pizza. How about you send him a quick text explaining how you want to return all of the gifts you’ve received from him over the years because you â€Å"just can’t stand to see them†? He’ll definitely respond to that! He’ll be forced to talk to you. He’s obviously just confused and doesn’t know what he wants, and it’s your job to let him know that this isn’t acceptable. After all, you didn’t waste 48 months, 208 weeks, and 1,460 days of your precious time devoted to this one individual in our massive universe, just to end up getting d umped. There is a double standard between men and women (as with everything else in life) regarding love and relationships. When a woman decides to fight for lost love she is labeled as the â€Å"crazy ex-girlfriend†. Maybe she doesn’t want the relationship back, maybe she just wants to get closure, try to understand what went wrong. Did you ever think about that? No, because you were too busy complaining to your friends and family about how crazy she is. When a guy fights for lost love he’s â€Å"a hopeless romantic.† Let women fight for love in peace without having to be labeled crazy for doing so. Let them cry into their double chocolate chip ice cream as they watch The Titanic for the hundredth time. Let them call twenty times at four in the morning. Let them stalk you on social media as their heart desires. Let them plan casual run-ins at your favorite local bar so you can see how totally awesome they’re doing without you. Worst case scenario is you have to file a restraining order.

Ça vaut le coup - Valoir le coup - French Expression

Ça vaut le coup - Valoir le coup - French Expression Expression: Valoir le coup Pronunciation: [vah lwar leu koo] Meaning: to be worth it (its worth it) Literal translation: to be worth the effort Register: normal Notes The French expression valoir le coup is very often used impersonally, as in à §a vaut le coup (its worth it) and à §a valait le coup (it was worth it). But valoir le coup can also be used with any third person singular or plural subject, including people. Examples   Ã‚  Ã‚  Ãƒâ€¡a vaut le coup dÅ“il.   Ã‚  Ã‚  Its worth a look, worth seeing.   Ã‚  Ã‚  Ce sont des classes qui valent le coup.   Ã‚  Ã‚  Theyre worthwhile classes, Theyre classes worth taking.   Ã‚  Ã‚  Jespà ¨re que ce  voyage va valoir le coup.   Ã‚  Ã‚  I hope this trip is worth it. Ça vaut le coup de infinitive:   Ã‚  Ã‚  Ãƒâ€¡a vaut le coup dessayer.   Ã‚  Ã‚  Its worth trying, worth a try.   Ã‚  Ã‚  Ãƒâ€¡a vaut le coup de prendre la voiture.   Ã‚  Ã‚  Its worth bringing the car. Il / Elle vaut le coup que subjunctive (informal):   Ã‚  Ã‚  Il vaut le coup quon essaie.   Ã‚  Ã‚  Its worth a try.   Ã‚  Ã‚  Ma voiture nest pas trop vieille- elle vaut le coup que je la fasse rà ©parer.   Ã‚  Ã‚  My car isnt too old- its worth getting it repaired.   Ã‚  Ã‚  Lise a un bon potentiel- elle vaut le coup quon la patronne.   Ã‚  Ã‚  Lise has a lot of potential- its worth our while to sponsor her. Synonymous expression: Valoir la peine, Ça vaut la peine - literally, To be worth the pain, Its worth the pain More Expressions with coupMost common French phrases

History of US Naval Station at Pearl Harbor

History of US Naval Station at Pearl Harbor The early 1800s: Known to native Hawaiians as Wai Momi, meaning water of pearl, Pearl Harbor was believed to be the home of the shark goddess Kaahupahau and her brother, Kahiuka. Beginning in the first half of the 19th century, Pearl Harbor was identified as the possible location for a naval base by the United States, Great Britain, and France. Its desirability was reduced however by the shallow water and reefs that blocked its narrow entrance. This restriction led to it largely being overlooked in favor of other locations in the islands. US Annexation: In 1873, the Honolulu Chamber of Commerce petitioned King Lunalilo to negotiate a reciprocal treaty with the United States to further the bond between the two nations. As an inducement, the King offered the cessation of Pearl Harbor to the United States. This element of the proposed treaty was dropped when it became clear the Lunalilos legislature would not approve the treaty with it included. The Reciprocity Treaty was ultimately concluded in 1875, by Lunalilos successor, King Kalakaua. Pleased by the treatys economic benefits, the King soon sought to extend the treaty beyond its term of seven years. The effort to renew the treaty met with resistance in the United States. After several years of negotiation, the two nations agreed to renew the treaty through the Hawaii-United States Convention of 1884. Ratified by both nations in 1887, the convention granted to the Government of the US the exclusive right to enter the harbor of Pearl River, in the Island of Oahu, and to establish and maintain there a coaling and repair station for the use of vessels of the US and to that end the US may improve the entrance to said harbor and do all things useful to the purpose aforesaid. The Early Years: The acquisition of Pearl Harbor met with criticism from Britain and France, who had signed a compact in 1843, agreeing not compete over the islands. These protests were ignored and the US Navy took possession of the harbor on November 9, 1887. Over the next twelve years, no efforts were made to enhance Pearl Harbor for naval use as the harbors shallow channel still prevented the entrance of larger ships. Following Hawaiis annexation to the United States in 1898, efforts were made to enhance the Navys facilities to support operations in the Philippines during the Spanish-American War. These improvements were focused on the Navys facilities in Honolulu Harbor, and it was not until 1901, that attention was turned to Pearl Harbor. In that year, appropriations were made to acquire land around the port and improve the entrance channel into the harbors lochs. After efforts to purchase the adjacent land failed, the Navy obtained the present site of the Navy Yard, Kauhua Island, and a strip on the southeast coast of Ford Island through eminent domain. Work also began dredging the entrance channel. This progressed quickly and in 1903, USS Petral became the first vessel to enter the harbor. Growing the Base: Though improvements had begun at Pearl Harbor, the bulk of the Navys facilities remained in Honolulu through the first decade of the 20th century. As other governmental agencies began encroaching on the Navys property in Honolulu, the decision was made to begin shifting activities to Pearl Harbor. In 1908, Naval Station, Pearl Harbor was created and construction began on the first drydock the following year. Over the next ten years, the base grew steadily with new facilities being constructed and the channels and lochs deepened to accommodate the Navys largest ships. The only major setback involved the construction of the dry dock. Begun in 1909, the drydock project angered locals who believed the shark god lived in caves on the site. When the drydock collapsed during construction due to seismic disturbances, Hawaiians claimed that the god was angry. The project was finally completed in 1919, at cost of $5 million. In August 1913, the Navy abandoned its facilities in Honolulu and began to solely focus on developing Pearl Harbor. Allocated $20 million to turn the station into a first-rate base, the Navy completed the new physical plant in 1919. Expansion: While work was moving along on shore, Ford Island in the middle of the harbor was purchased in 1917, for joint Army-Navy use in developing military aviation. The first aircrews arrived at new Luke Field in 1919, and the following year the Naval Air Station was established. While the 1920s were largely a time of austerity at Pearl Harbor as post-World War I appropriations decreased, the base continued to grow. By 1934, the Minecraft Base, Fleet Air Base, and Submarine Base had been added to the existing Navy Yard and Naval District. In 1936, work began to further improve the entrance channel and to construct repair facilities to make Pearl Harbor a major overhaul base on par with Mare Island and Puget Sound. With the increasingly aggressive nature of Japan in the late 1930s and the outbreak of World War II in Europe, further efforts were made to expand and improve the base. With tensions heightening, the decision was made to hold the US Pacific Fleets fleet exercises off Hawaii in 1940. Following these maneuvers, the fleet remained at Pearl Harbor, which became its permanent base in February 1941. World War II and After: With the shift of the US Pacific Fleet to Pearl Harbor, the anchorage was expanded to accommodate the entire fleet. On the morning of Sunday, December 7, 1941, Japanese aircraft launched a surprise attack on Pearl Harbor. Crippling the US Pacific Fleet, the raid killed 2,368 and sank four battleships and heavily damaged four more. Forcing the United States into World War II, the attack placed Pearl Harbor on the front lines of the new conflict. While the attack had been devastating to the fleet, it did little damage to the bases infrastructure. These facilities, which continued to grow during the war, proved vital to ensuring that US warships remained in fighting condition throughout the conflict. It was from his headquarters at Pearl Harbor that Admiral Chester Nimitz oversaw the American advance across the Pacific and the ultimate defeat of Japan. Following the war, Pearl Harbor remained the homeport of the US Pacific Fleet. Since that time it has served to support naval operations during the Korean and Vietnam Wars, as well as during the Cold War. Still in full use today, Pearl Harbor is also home to the USS Arizona Memorial as well as the museum ships USS Missouri and USS Bowfin. Selected Sources A Brief History of Pearl Harbor Prior to World War IINaval Station Pearl Harbor