Treating unexplained infertility: Answers still needed

Men who have slow growing, low-risk prostate cancer may not live long enough to die of their illness. And since there’s no conclusive evidence that treating low risk prostate cancer extends survival, doctors might recommend monitoring the cancer and treating it only when it begins to spread.

That’s called active surveillance. It’s generally reserved for men with small, slow-growing tumors and a normal life expectancy of less than 10 to 15 years after diagnosis. Older men in particular are far more likely to die of heart disease and other causes than low-risk prostate cancer. That’s fueled mounting concerns that low-risk cases are being overtreated, with too many men experiencing side effects without benefits.

Doctors monitor men on active surveillance in three ways:

    periodically measuring the amounts of prostate-specific antigen in blood
    checking for tumor growth with digital rectal exams
    giving repeat biopsies at varying intervals.

Active surveillance takes off

Though it has a long history, active surveillance has only recently broadened its reach from academic cancer centers into the wider community. Now a new study shows its adoption is accelerating. “The trend is real and it’s a step in the right direction,” said Matthew Cooperberg, an associate professor of urology, biostatistics, and epidemiology at the University of California, San Francisco Medical Center, and the study’s lead author.

Cooperberg and his co-author Peter Carroll, chair of the UCSF urology department, reviewed data from more than 10,000 men with low-risk prostate cancer treated at 45 urology practices throughout the United States. From 1990 to 2009, the rate of using active surveillance among men who were an average of 66 years old when diagnosed hovered at just under 15%. But between 2010 and 2013, the rates spiked suddenly, to more than 40%. A similar trend was observed for men 75 years or older at diagnosis — active surveillance rates increased from 54% to 76% over the same time period.

“Over-treatment of low-risk prostate cancer is a significant problem, and these results suggest that it’s abating,” Cooperberg said.

With studies from Sweden, Australia, Michigan, and elsewhere showing similar increases, active surveillance “appears to be gaining traction as a standard management practice,” said Stacy Loeb, a urologist and researcher at New York University School of Medicine in New York City.
 The future of prostate cancer monitoring

Long-term data attest to the safety of active surveillance for low-risk disease. For instance, a Canadian study published this year showed that only 1.5% of 993 men enrolled in an active surveillance protocol in 1995 had died of prostate cancer two decades later. The men were 69 years old on average when diagnosed. “But active surveillance is not just for older men,” Cooperberg emphasized. “Our data show that it can be effective in younger men too.”

Scientists are also looking for less invasive ways to monitor tumor progression — for instance, with imaging tests or more accurate markers in blood and urine. These alternative approaches could make active surveillance far less burdensome in time.

“Active surveillance serves as a middle-ground option,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and Editor in Chief of HarvardProstateKnowledge.org. “For example, men who are uncertain about considering PSA testing in the first place and who are concerned about overtreatment if they are diagnosed with prostate cancer may find the option of active surveillance attractive. That’s especially true given the lack of evidence that treating early-stage prostate cancer extends lives. Hopefully research will one day provide ways to predict if a given treatment will work based on the genetic makeup of a man’s tumor.” This week, a patient came in reporting two awful urinary tract infections that she had this summer while traveling on vacation. She is in her 50s, postmenopausal, and fit and healthy. After having sex with her partner, she woke up with burning and pain with urination. She was treated for a urinary tract infection with antibiotics and felt better in a few days. She did fine for two weeks until they had sex again, when the same symptoms returned. Although antibiotics worked again, and quickly, at this point she felt consumed by the whole thing. She was unable to enjoy her vacation, and she was afraid to have sex. It took several weeks before she felt normal “down there.”

If this sounds familiar, then you may be suffering from recurrent urinary tract infection (UTI). Recurrent UTIs are defined as either three episodes of infection in the previous 12 months or two episodes in the previous 6 months.

Recurrent UTIs are common among both young healthy women and healthy women at midlife. Here’s why. There are many types of bacteria that normally live in the vagina and happily coexist. And they keep each other in check, like a mini-ecosystem. The hormone estrogen allows the “good” bacteria called Lactobacillus to thrive. These bacteria produce acid, which lowers the pH in the vagina, which helps keep the “bad” bacteria in check.

For younger women, frequent sex is one of the biggest risk factors for a UTI. Sexual intercourse can cause the bacteria in the vagina and rectum to get into the urinary tract, since they are close neighbors. But at midlife, the main culprits behind recurrent UTIs are physical changes, including thinning of vaginal tissue, pelvic organ prolapse, incontinence, and trouble completely emptying the bladder. The lower levels of estrogen after menopause are also a factor.

There are effective prevention strategies for healthy women at midlife who are struggling with recurrent UTIs. A good place to start is with urination habits. When sitting on the toilet, make yourself as comfortable as possible in a relaxed seated position (not squatting). Start the stream of urine by relaxing the pelvic floor muscles, rather than straining to urinate. Allow enough time for your bladder to completely empty. Also empty your bladder after intercourse. This can help wash away any bacteria that might have been introduced into the urinary tract during sex. Some studies suggest that cranberry extracts can help prevent UTIs by decreasing the “stickiness” of the bacteria. I prefer cranberry supplements to cranberry juice, which tends to be very high in sugar and calories.

Vaginal estrogen creams or rings can help restore the normal bacterial balance of the vagina. Ask your doctor about taking antibiotics preventively, either after sex, or regularly at a low dose. Your doctor can also check to see if you have pelvic organ prolapse, which can be associated with an inability to fully empty your bladder.

Take charge of your bladder health, and don’t let recurrent UTIs get in the way of your active lifestyle. If you are struggling with recurrent UTIs, see your doctor for a thorough check-up — and know that this condition is both entirely preventable and easily treatable. Unexplained infertility is frustrating for couples and their doctors. Without a clear reason why a woman is having trouble becoming pregnant, it is difficult to choose a treatment that has a high rate of success but doesn’t increase the chances of a high-risk multiple pregnancy. A study published today in The New England Journal of Medicine compared three drugs commonly used to treat unexplained infertility. Unfortunately, there was no clear winner.

Infertility is defined as the inability to become pregnant after about a year of appropriate and well-timed efforts. Infertility affects about 10% of women ages 15 to 44. For those desiring a child, the inability to become pregnant can be devastating, and the drive to seek treatment is understandable. The usual first step along that path is a detailed evaluation of the couple. Almost half the time, when an issue is identified, it is with the male partner, usually a problem with his sperm. Sometimes we discover a woman has blocked fallopian tubes (so eggs can’t be fertilized and travel to the uterus) or abnormalities of the uterine cavity, such as fibroids (which may prevent a fertilized egg from implanting).

But in 15-20% of cases, no reason is identified — so-called “unexplained infertility.”

Many with unexplained infertility will become pregnant on their own simply with more time. But for those reluctant to just wait, a first step is to try using medicines to push the ovaries to mature more than just one egg (this is called ovulation induction). With more eggs available for fertilization per cycle, the hope is that at least one will result in a pregnancy. This therapy is simpler and much less expensive than in vitro fertilization (IVF). Cost is an important issue because finances can be a huge barrier to infertility treatment. Very few states mandate that insurance plans provide coverage for IVF, which can easily run more than $10,000 for each cycle, or “try.”

But every time you drive the ovaries to produce more eggs, you run the risk of “super-ovulation,” or making many eggs available for fertilization. This in turn means you run the risk of a “multiple pregnancy” — twins, triplets, and beyond. For couples desperate to build a family, more babies may sound like hitting the jackpot. But multiple pregnancies are the biggest risk of infertility treatments, and arguably should be counted as failures rather than successes. These pregnancies — even with “just” twins — mean the babies are more likely to be born prematurely and the mothers are more likely to experience complications. Both these situations can be serious and have long-term consequences.

So which drugs are best at meeting the goals of infertility treatment — that is, achieving a pregnancy with one baby? In this study, a national network of investigators looked at how the drug letrozole compared with two standard drugs to stimulate ovulation. Letrozole works to stimulate ovulation through a different path than traditional fertility medications.

Investigators assigned cver a thousand couples with unexplained infertility to as many as four rounds of treatment with either letrozole or one of two “standard treatments”: gonadotropin (Menopur is one brand name) or clomiphene (Clomid is a common brand name). The results: live birth rates were lower in the women who took letrozole (19%) as compared with gonadotropin (32%), but were statistically similar to clomiphene (23%). On the other hand, rates of multiple pregnancies (all twins and triplets in this study) were higher in the gonadotropin group (all the triplets in were in this treatment group) than in the letrozole and clomiphene groups (which had about the same rate).

Hardly a home run for those who were hoping letrozole would be the answer. Over all, the numbers indicate that for couples with unexplained infertility, these alternatives to IVF may help them achieve a pregnancy — but success is hardly a sure thing. The drugs that bring a higher chance of pregnancy, also bring a greater chance that pregnancy will be a high-risk one.

While disappointing, the results argue for more work to optimize fertility therapies. A very important part of this work — whether we’re talking about ovulation induction or IVF — are continued efforts to reduce the unsatisfactorily high rate of multiple pregnancies that current treatment options carry. Until we have answers, judicious therapy means appropriately limiting the doses of ovulation induction drugs, and in the case of IVF, limiting the number of embryos transferred. That means doctors need to help patients make wise decisions, especially when there is more than one embryo available for transfer.

The true and heartfelt goal of couples and their doctors isn’t just a pregnancy, but a pregnancy with a good outcome—a healthy mom and a healthy baby. Here, more does not translate into better.
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Do you really need a yearly physical?

We begin with the 'section level' form. It is a spending framework for those hoping to make a delicate invasion into the universe of PC gaming. If it's not too much trouble remember, at this financial plan, your experience (in a few, not all) diversions will be either associated or somewhat superior to one of the base consoles from Sony or Microsoft. So, I feel defended in influencing these suggestions as a 500 Euro PC to can do things that these consoles can't:

It is as yet a PC: At the day's end, this 500 Euro PC is as yet a PC, and along these lines it has a layer of usefulness and utilize that you don't have with the consoles from Sony/Microsoft. Besides, equipment much the same as what I will suggest will guarantee that it is likewise an extremely decent PC. OK to diversion, and similarly tolerable for whatever else.

The alternative of 60 FPS: The principle frustration of this support age was the decision of CPU, a more established Jaguar based Octa-Core setup from AMD. It was an odd decision, without a doubt.

An overhaul way: Like or not, parts age. In any case, with the consoles, your alternatives are genuinely constrained. Either become tied up with the generational and steady overhauls expedited by the PS4 Pro or Xbox One X, or redesign your PC a little bit at a time. At Guru3D, we guarantee that these PC's have tolerable redesign ways.

Before I start... all of you recollect those APU's (Raven Ridge) that I referenced prior? Indeed, they're going to show up now, as I really trust they are the best current spending suggestion and 'esteem for cash' out there. A vigorously overclocked R3 2200G can destroy Nvidia's committed GT 1030 GPU, which truly is genuinely amazing for incorporated designs. There will be a 100-125ish EUR value distinction between the two levels of spending fabricate we will suggest, in any case, with the majority of that setting off to a committed GPU in the more costly PC.

Ultra Budget Build - CPU: AMD Ryzen R3 2200G

An APU is just the same old thing new. AMD has been discharging them for quite a while now. These new chips are, in any case, something new. The CPUs themselves depend on AMD's significantly more competent 'Zen' design, instead of the more established Bristol Ridge units of yesteryear. The GPUs are - actually - intensely chopped down Vega chips, Vega 8 and Vega 11 separately. This is altogether packed into a 65W bundle. Not awful, AMD. You can peruse our audit of AMD's R3 2200G here. While you will surely need to influence graphical trade offs when utilizing these APUs, to please tolerate as a main priority the accompanying:

It's an APU. It's a CPU and GPU on a little bundle. Tame your desires.

Regardless of this, they are as yet proficient units ready to diversion sensibly well at 1080p, yet get along nicely at 720p. E-Sports titles like CSGO, League of Legends, Dota 2, (etc) play superbly on this processors.

The 'Less Budget' Build - CPU: AMD Ryzen 3 2200G

Astounded? You shouldn't be. The 2200G is as yet a great quad-center CPU that is more than fit for taking care of even mid-run GPUs like the Radeon 580 and GTX 1060, when playing at sensible settings and goals (for example not attempting to falsely make a CPU confinement). I additionally feel like the double center/quad string contributions in the G5400 are to a greater degree an articulated issue going ahead. A few diversions essentially don't care for double center CPUs, and we are seeing an ever increasing number of titles that will play on a double center, yet not well. As I would see it, it is ideal to now abandon double centers to the workstation space, and spotlight just on quad centers and up for the work area space.

As a little note, the 'higher end' spending manufacture wo exclude a reseller's exchange cooler, in contrast to the ultra-spending one. This is on the grounds that the stock Wraith Stealth cooler on the R3 2200G is all that anyone could need for a moderate overclock of the CPU centers alone, though overclocking the GPU and CPU of the 2200G utilizing only the stock cooler is a terrible thought.

Ultra Budget Build ONLY - CPU Cooler: 120mm single fan demonstrate

Truly, the above is ambiguous, however intentionally so. The R3 2200G (and its greater 2400G sibling) both accompany sensibly great stock coolers yet will get immediately overpowered when you begin overclocking both the CPU centers and Vega designs past their industrial facility default speed. This is the place the additional cooling ability of a reseller's exchange unit comes in, and it doesn't need to be remotely top of the line. Overclocking Raven Ridge can result in some really wonderful gains in execution, so it's certainly justified regardless of your time.

You can scrutinize a rundown of our cooler surveys here. Generally, in any case, pursue this exhortation. Get a 120mm air cooler, and don't pay more than 25-30 EUR/USD. Keep to that, and the estimation of Raven Ridge still holds up. Would you be able to pull off the stock cooler on the 2200G? Without a doubt, however to capitalize on overclocking both the CPU and Vega GPU centers, you will require a secondary selling unit.

The 'Less Budget' assemble - Graphics Card (GPU): Nvidia GTX 1050 or AMD RX 560

To begin, Nvidia's GTX 1050 has dependably been promoted as an 'E-Sports' card, which should give you some thought of its target group. The card comes outfitted with 2GB of on-board GDDR5 video memory, which is unquestionably on the lower end in 2017. All things considered, given the general capability of this GPU, having more than 2GB of VRAM is - basically - altogether trivial. 1080p gaming is the point of the diversion here, and it is a job that - generally - it'll perform well in, particularly if your point is to play less requesting titles, or you are content with lower outlines rates/graphical settings. On the off chance that you are intrigued, you can look at our joined survey of the 1050/1050Ti (up next) here.

So, in the event that you can locate a better than average arrangement on a 1050Ti, at that point do go for that rather (however annoyingly, no doubt the post digital currency fever of 2017 is as yet influencing the 1050Ti more than it should, with regardless it be recorded for upward of 170 USD/EUR). It is a strikingly quicker GPU with more memory locally available. Anticipate that execution should be adequate for high caliber (as in 'high' in-amusement graphical settings, contingent upon the diversion) 1080p gaming at or around 60 FPS. Now and again you may experience a diversion that takes into account 1080p 'Ultra,' and once in a while an amusement may in any case require the letting of settings down toward 'medium', or even 'low'.

On the off chance that you would prefer to have a gander at AMD's financial plan GPU contributions, at that point look no more remote than the Radeon RX560. Once more, while this site has not yet completed an audit on AMD's RX 560, our survey of the RX 460 should reveal to you enough about the capability of both it and its greater sibling. The survey is connected here. The 560 is a marginally amplified 460, and very little more.

Motherboard - B350 motherboard (70-80 USD/EUR)

Financial plan is the point here, and both of the above decisions are the end extremely shabby end of their separate scale. In a perfect world, search for 4 RAM openings, however that is about it. All B350 loads up have support for fast DDR4 memory and the overclocking of all AM4 CPUs. Overclocking is important on AM4, as an expansion in speed on both the RAM and CPU can result in some pleasant 'free' execution gains. It is particularly expected to expand Raven Ridge's execution.

On the Intel side, we don't have to stress over overclocking, so the load up decision actually descended the least expensive B250 load up I could discover on PCPartPicker. Keep in mind that, we are going for an incentive here, not looks or showiness. On the off chance that you need RGB, highlight stuffed sheets, or military evaluation fabricate quality, go somewhere else (or spend more)!

A critical note with respect to Raven Ridge APUs and motherboards. The issue encompassing Raven Ridge APUs not locally chipping away at B350 motherboards is notable at this point, however - as a snappy outline - more seasoned 300 arrangement AMD chipset motherboards (otherwise known as. B350 and X370) may not deliver with a BIOS rendition that permits the booting of Raven Ridge APUs. In the event that you end up in this circumstance, AMD have you secured. If it's not too much trouble adhere to the guidelines at the base of the page connected here, so as to get your 'AMD boot pack', which will enable you to streak the BIOS of your board and utilize the new APU. Likewise please ensure that in the event that you are completing an APU manufacture, that your motherboard has video 'out' ports! A few, really, don't.

Framework Memory - 8GB DDR4 @ 2666-3200 MHz

As previously, another serious issue is DDR4 valuing. As the cost of RAM is so factor at the present time, I would unequivocally prompt just utilizing the above as a manual for what you ought to search for as a base, as far as speed. Truly, glance around, discover DDR4 8GB units (2x 4GB), and consider it daily. Remember my recommendation, be that as it may, with what I said at the very beginning of this present article's introduction. In the event that it is between a quicker GPU and quicker RAM, go for the quicker GPU. Without fail.

Capacity - 240GB SSD

I was enjoyably shocked when I looked on PCPartPicker at the costs of 240GB SSDs. They have dropped, at any rate to my psyche. In view of that, the buy and utilization of a 240-250GB SSD even in a spending construct is presently entirely feasible and is something everybody should simply purchase without the slightest hesitation. This dimension of capacity is effectively enough for the OS, 2 huge AAA diversions, and a sprinkling of littler titles/applications. Mass stockpiling as a 1TB HDD (or more SSDs) is anything but difficult to include down the line, all things considered. For a SSD, there are numerous brands. I would by and large encourage adhering to known ones, and - of these - organizations like SanDisk, OCZ, Toshiba, Micron/Crucial, Samsung, and Western Digital all make phenomenal and solid SSDs at average costs. In the event that you are keen on perusing some more inside and out audits of these drives, at that point they are connected here, essentially discover one that suits the limit you need.

Power supply (PSU) - 450-500W, 80+ or 80+ Bronze

The decision of intensity supply is never under any circumstance one you need to genuinely modest out on. I recognize that the underneath units are 'spending plan' (for absence of a superior illustrative term), however their unwavering quality is as yet sensible. For whatever length of time that you tune in to a word of wisdom, take a gander at audits, and purchase from legitimate brands, you will be alright. So, I will show a few units beneath that I believe are both legitimate and utilitarian, that additionally permit a potential GPU update down the line! All units underneath can overclock their individual frameworks also, with better than average headroom.

EVGA 500B (500W) 80+ Bronze PSU (non-particular).

XFX XT 500W 80+ Bronze PSU (non-particular).

Corsair CX450M 80+ Bronze PSU (semi-particular).

BeQuiet! Framework Power 8 500W 80+

There are different units, (many) different units, yet trust during the ones I have referenced above for spending manufactures. They will work well for you, and all are fit for a GPU overhaul (or two) down the line. In the event that you abruptly wish to stick a powerful card into your framework, get another PSU. Your glossy new GPU and CPU will bless your heart. Here is a rundown of all the PSUs we have checked on throughout the years on the off chance that you are keen on investigating some higher end units too.

Wrapping up, and some miscellaneous items.

We have basically completed the process of discussing the innards of section level, 'The Bit.' However, as said prior in the guide, I explicitly haven't referenced anything to do with the suspension or peripherals. I would exhort not going 'very shabby' here, as truly spending cases are regularly inadequately fabricated, have horrible wind current, and give little space to either work in or extend later on.

I'll likewise the 'do I need a sound card' question now. The appropriate response, for 99.9% of us... is 'No.' Modern motherboards have OK to 'exceptionally great' on-board sound, even at the spending end. The probability is that on the off chance that you do require a sound card, at that point you're likewise the kind of individual to realize you'll require one. With respect to a screen, this is - as expressed - up to you. In any case, I would basically go for a 21-24'' 1080p 60Hz board, and abandon it at that. Perhaps more toward 24'', on the off chance that you can?

Be that as it may, you extravagant something with a touch more drive? Indeed, how about we move towards a standard form at that point.
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The problem with prescription painkillers

Ocean of Thieves is a nerve racking and severe pot where ships conflict and players mercilessly take each other's well deserved prizes. It's likewise an insane online gathering where you can drink so much grog that you vomit in your mug and toss it in somebody's face amidst a move party. It is characterized by entrancing logical inconsistencies that are on the double an encapsulation of our web based gaming zeitgeist, while likewise challenging and undermining standard desires with an extreme spotlight on minute to-minute play over movement and the dopamine dribble feed of remunerations.
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Amazing designer Rare (Banjo-Kazooie, GoldenEye 007, Donkey Kong Country) has returned a major way, making a striking case on the eventual fate of internet gaming. The outcomes don't generally hang together totally, yet when it works, Sea of Thieves throws an exceptionally charming spell, and following seven days of genuine play, despite everything we discover our mind floating back to the guarantee of experience on the high oceans.

Robbery, for the sake of entertainment and benefit!

Ocean of Thieves is an open world online privateer sandbox. You play as a seventeenth-century privateer in the eponymous Sea of Thieves — a wide, open archipelago of for the most part little, tropical islands — cruising around in agreeable teams of one to four for loot and experience. The designers at Rare have depicted it as a "Mutual World Adventure Game" (SWAG), roused by online survival recreations like DayZ and Rust, yet planned to cultivate a friendlier and more available experience than its famously rebuffing motivations.

That invitingness begins with the amusement looking completely stunning. Everything is brilliant, vivid, and adapted, typifying that signature Rare appeal. From ridiculous characters to sensational vistas and the most delightful in-amusement water we've at any point seen, Sea of Thieves is a visual dining experience. As a result of its idiosyncratic visual style that prizes brilliant hues and particular outlines over reasonable surfaces, it figures out how to look extraordinary on an awesome PC or Xbox One X, or a significantly more humbly specced machine. Each player we've addressed about it in-diversion concurred it was a standout amongst the most attractive titles they'd at any point seen on the Windows or Xbox stage.

Ocean of Thieves is a visual banquet.

Your experiences are organized into voyages (missions, in the speech of most diversions), obtained from one of three organizations. The Gold Hoarders send you out with X-denotes the-spot maps and site-explicit enigmas to uncover money boxes. The Order of Souls posts bounties for undead privateer commanders whom you battle with their skeleton groups to gather shining abundance skulls. Ultimately, the Merchant Alliance requests that you find and catch creatures from the islands and convey them to specific stations by a specific time and date: Chickens are the least demanding, which you just catch, trailed by pigs that should be encouraged occasionally, and snakes that chomp except if you quiet them by playing music.

Finishing voyages and trading in for cold hard currency their loot at any station will net you gold to spend on visual updates for your privateer, things, and ship. You likewise gain notoriety with each organization, which fills in as a free movement structure, since step up with each organization gives you access to progressively expound voyages and fancier titles that you can show under your name (like "Gold Bucko" or, the one we found most amusing, "Spiritualist Associate"). Significantly, these prizes are simply restorative — prepared mariners will almost certainly deck themselves out in amazing luxury, yet practically the main distinction between a fresh out of the box new swabbie and the most progressive raiders will be player expertise/learning and the capacity to buy more earnestly voyages, for which they can take anybody along.

Larger amount voyages are likewise not significantly more confounded than the essential ones. While they do present steady assortment, for example, uncommon, reviled chests and harder skeletons that request specific strategies (like shadow skeletons that are just powerless when presented to coordinate light, or plant-shrouded skeletons that recuperate in water), propelled voyages are generally recognized by hanging together business as usual, fundamental targets, either by giving you a few maps to seek after in any request, or doling them out in consecutive sections. The net impact is that you end up out adrift more, accumulating plunder, which makes you progressively helpless against different players.

Everything is splendid, beautiful, and adapted, exemplifying that signature Rare appeal.

Until you've traded out your prizes, your loot is a physical article that you need to convey with two hands and stow some place on your ship, which means you're defenseless. The organizations couldn't care less who hands what over, so anybody can grab the prizes of your hard work. That is the thing that makes Sea of Thieves a diversion about privateers — the title says everything.

Beside a bunch of non-player characters at the stations, every one of the boats and privateers you see on your movements are live players. The designers are cagey about precisely how players are combined on the planet, at the same time, in our movements, we kept running into different players with changing recurrence. Some of the time we'd cruise for extended lengths of peaceful isolation punctuated with the intermittent ship not too far off. Different occasions, we'd wind up dogged by a similar ship again and again for a considerable length of time. The two circumstances can be dazzling, however either hazard getting to be dull when it commands your play involvement. The job that different players had presently cruising the Sea of Thieves was the characterizing factor in our sessions, yet additionally the most unusual.

I'm not here to win; I'm here to make companions!

Other individuals are the most critical fixing in Sea of Thieves. The voyages are purposely straightforward, structured as a system for significant experiences with different players on the planet. Kicking the bucket or sinking your ship isn't particularly rebuffing: The dead basically sit tight for a moment before twisting back to their ship, and you can generally respawn a new ship at no expense. The prizes you need to bear are what give the stakes.

While that component of robbery gives Sea of Thieves an especially severe, brutal edge, it's intended to be a fun and well disposed spot. Before the engineers executed weapons and swords, they gave each privateer instruments to play (and naturally fit) and grog to drink, making them stagger around alcoholic and hurl. You can move and wave and such through a menu of acts out. Voice talk, both at boundless range with your very own group and in closeness to any other individual, is vital to the experience.

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Ocean Of Thieves Hands-on Preview | Getting eaten by a shark

Ocean of Thieves endeavors to offset the inalienably forceful nature of its subject with a light and senseless tone and the devices for social commitment. At the point when this equalization works out, it's interestingly convincing. At an early stage in our movements with a backbone group of three, one solo privateer more likely than not assaulted us seven or multiple times, snickering twistedly and provoking us the entire time. Sooner or later of this when we again observed a little ship slip out from behind a close-by shake and asked "Is that a similar person?" we heard a suppressed "No … It's another person … " from the other player directly before they assaulted. (All things considered: It was not another person). Later on, after we sank an alternate solo privateer's ship a few times in succession they moved toward us playing music and offered us a sellable carton of uncommon tea as a harmony advertising. We had a neighborly talk about how the amusement was proceeding to go our different courses in harmony.

Only one out of every odd experience is so exciting, however. Similarly as regularly, you will wind up being gotten out unprepared by quiet attackers that take your advancement without the kindness of a decent story to tell. Or then again perhaps you have a progression of provisional, half experiences with different players where you never fully draw in, however simply make each other restless and moderate your advancement. Player conduct is the variable that Rare has minimal power over, however since it is the most imperative segment in the amusement, that makes the general experience incredibly dependent upon something difficult to foresee or oversee.

Other individuals are the most imperative fixing in Sea of Thieves.

That applies as a lot to your own group as it does to players you experience. The ideal experience is cruise with a full group of three great companions, yet that won't be reasonable for a ton of players. Going solo is reasonable, and can be very charming in its very own right. The additional mobility of the littler ship carefully adjust the numbers preferred standpoint of a bigger team. It's additionally the most nerve racking approach to play, be that as it may, as a little ship and no reinforcement accentuates the dangers associated with gathering and trading in for cold hard currency treasure.

The cruising mechanics are a microcosm of what's extraordinary about Sea of Thieves' way to deal with collaboration. Groups of a couple of sail on a littler, single-cruised sloop that is anything but difficult to move, however bigger teams cruise on vessels with three poles and eight guns. Vessels are substantially more cumbersome to direct, so you truly need to cooperate so as to cruise productively. No individual errand in cruising a ship is complicated– altering the tallness or point of sails, directing, checking the charts– however organizing every one of them requires correspondence. Ocean of Thieves doesn't rebuff an absence of individual skill– nothing you do like cruising or battling is especially hard or punishing– yet it rewards cooperation great.

Tragically, for an amusement that is so reliant on positive social communications and joint effort, its social highlights are woefully underbaked. Inept, heedless or uncommunicative crewmates can make your experience significantly disappointing. Matchmaking is simply irregular, with no real way to sift or look for through different players that you don't definitely know. When you're in a diversion it's difficult for companions to sign up while you're in advancement on the grounds that the amusement consequently populates void spaces with irregular players, and in the event that you restart you lose current voyages and plunder that you haven't traded out.

The main in-amusement social control is that a larger part of the group can cast a ballot to secure players in the brig, which is an exacting enclosure in the base deck of your ship. It's planned as an approach to enable players to self-authorize great conduct, however without any tops on the time individuals can be bolted up or any guideline, it's ready for maltreatment. Since you can't hold spaces or generally boot players, gatherings of companions have been utilizing it to uninvolved forcefully lock up arbitrary joiners quickly until they leave. Social controls are particularly awful on PC since they go totally through the different Xbox application, as opposed to being bespoke and in-customer, which can be befuddling.

Uncommon's way to deal with player conduct is sincere, however maybe somewhat guileless. The amusement is unmistakably planned to energize positive associations, yet it doesn't give players enough control, thus on occasion can feel frustratingly irregular. Their plan is great, yet Rare requirements to find a way to structure the amusement's social experience and enable players.


The issue with looking into an amusement like Sea of Thieves is that, in light of the fact that the experience is so dependent upon different players, playing in the principal week may not portray how the metagame will develop. For the time being at that point, we will set aside the variable of different players and inspect the amusement itself under perfect conditions to perceive how it holds up.

Ocean Of Thieves Hands-on Preview | First individual steerage of ship

The most clear analysis is that there sufficiently isn't essential substance in the amusement at dispatch. While the universe of Sea of Thieves is reliably wonderful, it's likewise somewhat homogeneous. Starting with one corner of the Sea then onto the next you will see fundamentally a similar style of tropical island with palm trees, rocks, and sandy shorelines. There are apparently a couple named areas on the guide, with unpretentious changes like the water being an especially dynamic blue in one region, yet generally, everything feels a bit samey. The names of individual areas, for example, Shipwreck Bay, Plunder Valley, and Mutineer Rock are each of the somewhat conventional, as well. The world is dazzling, however it frequently does not have a feeling of genuine particularity.

The most clear analysis is that there sufficiently isn't essential substance in the amusement at dispatch.

The voyages, as well, begin to feel repetition decently fast, particularly without the flavor of different players. Pursuing costly restorative prizes offers a comparable, yet a lot littler rush than, state, winning new weapons and covering in Destiny 2 or Diablo 3. With no mechanical results to these prizes will it be sufficient to hold players' enthusiasm for the long run? Like most major internet diversions now, Sea of Thieves is basically a substantial Skinner box — yet one that is without the mechanical crunch that gives contemporary amusements their flavor.

A portion of the analysis about substance, be that as it may, is to a greater degree a confining issue with how players have been prepared to process AAA amusements. The plunder box debate is only one little feature of our undesirable relationship to content utilization. Playing off of our brain science, present day amusements have controlled us into concentrating on remunerations, once in a while to the detriment of getting a charge out of the real ongoing interaction, which just turns into an unfortunate chore. These diversions have a direct connection among substance and time spent, with players devouring bespoke interactivity encounters once and never again, hungry for curiosity.

When abnormal state players have devoured the majority of the standard ongoing interaction ("the crusade"), they are involved by player-versus-player rivalry and repeatable, expertise based substance (attacks). These are just a brief fix, in any case, to continue players until another substance imbuement. Universe of Warcraft is the work of art and most long-running precedent, however its impact can be felt all through contemporary gaming.

Ocean of Thieves receives that structure discount (PvP, Skeleton Fort strikes, and all), yet profoundly reframes it around individuals and openness. The majority of the prizes are simply restorative or shareable with anybody so as to abstain from apportioning the player network into an expertise and venture based chain of command. Seen through the simply mechanical focal point of substance utilization, Sea of Thieves is bizarrely slender and misleadingly extended. That kind of unfeeling perspective overlooks what's really important, be that as it may.

Move for activity

Despite the fact that Sea of Thieves clearly owes a great deal, basically, to present day, advanced RPGs, especially of the hugely multiplayer online assortment, a significant number of its obvious blemishes bode well when you see it as a pen and paper pretending amusement. Most video gamers have come to relate "RPG" with journeys, plunder, and building up the aptitudes and details of a constant character — the mechanical legacy of Dungeons and Dragons. What RPGs and amusements with "RPG components" frequently need in any significant manner is real pretend. They offer expand implies for mechanical articulations, for example, in what aptitudes you pick and how you battle fights, however they are exceptionally rough and on-rails by they way they enable you to fill another character's shoes and settle on decisions as them that influence the world and different characters around them.

The apparent hole left by the Sea of Thieves' apparently slender substance is space for the player to round out with assuming the job of a privateer. It's a wide prime example with a great deal of squirm space for identity, regardless of whether you need to be the savage solitary wolf pillager, the critical officer, or the alcoholic and beguiling scoundrel. Players have tossed around "sandbox" for a considerable length of time to portray open, reenacted universes loaded up with an assortment of exercises for the player to seek after at their relaxation. Ocean of Thieves encapsulates the rule more entirely and sincerely than any of its companions. It furnishes you with a suite of toys for playing out a privateer dream and after that releases you wild with that in the manner you need.

The fun you find in Sea of Thieves relies upon the vitality that you and the general population around you are eager to put into it.

Like a tabletop RPG, at that point, the fun you find in Sea of Thieves relies upon the fun and vitality that you and the general population around you are happy to put into it. It rewards venture and a feeling of self-inspired fun, which will truly reverberate with certain players, however its free structure will unavoidably push a few players away. Ocean of Thieves makes a special effort to abstain from showing you its essential mechanics, dropping you into the world with practically no clarification and requesting that you make sense of it. Accommodating players and additionally an eagerness to waste time and figure it around will get you through, however neither of those is incorporated with the amusement itself.

Uncommon's endeavor to take a famously rebuffing type of interactivity and influence it so anybody to can play is genuinely honorable, however it feels like the studio's sanded off a couple of such a large number of edges all the while. It isn't difficult to envision how they arrived, either. Ocean of Thieves gives astonishing "tissue testing" for fresh out of the plastic new players, since it's anything but difficult to get and mess about in, and essentially everybody has a mutual vocabulary for the fundamental privateer dream. It likewise should stun play when everybody has truly put resources into the amusement officially, for example, among engineers or in a shut beta network. Most players will fall somewhere close to those two posts by and by, in any case, and it's uncertain that Sea of Thieves does what's necessary yet to connect that hole.


For every one of its blemishes, despite everything we wind up interestingly constrained via Sea of Thieves. Most by far of current multiplayer amusements have bored down into a monomaniacal spotlight on the mechanics of battle, rivalry, and predominance. Ocean of Thieves remains solitary since it has maneuvered back the edge into a gentler, increasingly all encompassing spotlight on experience and play. There are no different diversions very like it that make a space where you can have freely objective situated play with your companions that additionally leaves so much breathing space for simply hanging out and messing about. That is the genuine reason that many individuals keep on playing Destiny, for example, however Sea of Thieves makes that its express reason, rather than likewise endeavoring to be an epic and testing story and aggressive diversion.

It doesn't generally work, yet when it does Sea of Thieves is genuinely extraordinary. Uncommon has been receptive to its locale all through advancement, and has guaranteed real, free substance refreshes beginning a while after discharge, when the majority of the unavoidable specialized hiccups have been worked out (we encountered a lot of bugs in the initial couple of days, yet the diversion settled pleasantly throughout the week). The general experience is a little no frills presently, however to a degree, that is by structure: Rare has constructed Sea of Thieves as an establishment that will develop and advance dependent on what the network needs. Structure executive Mike Chapman revealed to us a while prior that "the brilliant time of theft is yet to go to the Sea of Thieves." Now that we've invested some energy cruising it, we need to yield that the brilliant age in fact isn't there yet, yet there's a promising flash of experience seemingly within easy reach, and we're truly pulling for that brilliant age to arrive.

Is there a superior option?

No. While Sea of Thieves imparts a ton in like manner to a large number of the most well known multiplayer diversions, its specific tone and spotlight on calm fun and openness is interesting. DJI's Phantoms are regularly called "the iPhones of automatons" — and that is a reasonable depiction. They're a standout amongst the most mainstream rambles on earth, pressed with top of the line highlights and usefulness, and the most recent models are dependably at the highest point of their class. What's more, DJI likewise discharges new models at a relentless rate, pressing shockingly better highlights into an almost indistinguishable structure factor. A valid example? The outstanding new DJI Phantom 4 Pro.
DJI Phantom 4 Pro+

Highlights and Specs

As an advancement of the first Phantom 4, the Pro flaunts various little yet critical enhancements. A considerable lot of the first Phantom 4's configuration properties, electronic parts, and highlights have been ported over to the ace model, while others have been redesigned, and a couple of new highlights have been included.

The first and most evident expansion is the Pro's new 5-course impediment shirking framework. Though the P4 just highlighted front oriented sense and dodge, the as good as ever form has sensors on its front back, left, right, and underside. These sensors effectively filter the earth around the automaton and enable it to independently stay away from things like trees, structures, and whatever else you may experience amid flight.

The Pro looks almost indistinguishable to the first Phantom 4.

The other champion improvement is the Pro's camera. The Pro uses all-new equipment with a 1-inch picture sensor — which is multiple times the size as what's utilized in the first Phantom 4. In addition, the camera can shoot 4K video at up to 60 outlines for each second, and still pictures at up to 20 megapixels. DJI additionally hurled in opening control and a mechanical shade. Regardless of what you look like at it, the P4's new camera is greater, better, and more adjustable than any time in recent memory.

DJI has likewise included a much progressively luxurious, discretionary variant, called the Phantom 4 Pro Plus. It's precisely the same automaton, however with a controller that has a worked in touchscreen show. It'll cost you an additional 300 bucks, yet you won't need to interface your telephone to the controller with a link, stress over your cell phone's battery life, or have your flights impolitely hindered by approaching instant messages and calls.

Fabricate Quality and Design

The P4 Pro is almost indistinguishable to the first P4 as far as both structure and fabricate quality. It holds a similar frame shape as its forerunner, put something aside for a couple of minor contrasts where the new sensors are put. Accordingly, it's just as solid and strong as the P4, which stays among the most appealing and automatons accessible.

It's noteworthy that DJI has figured out how to furnish the automaton with such a significant number of new highlights, while as yet keeping up an indistinguishable structure factor. The extra sensors have been tucked into the automaton's legs, while infrared and optical sensors are fitted into the automaton's left and right sides. Indeed, even the camera, which is radically superior to the one found on the first P4, is slightly bigger than it was previously. Except if you acquainted with DJI's automatons, the P4 and P4 Pro are on a par with indistinguishable, regardless of Phantom's various improvement.

DJI Phantom 4 Pro+

DJI Phantom 4 Pro+

DJI Phantom 4 Pro+

DJI Phantom 4 Pro+

The main drawback to the P4 Pro is that, sadly, the Phantom line still isn't so compact as DJI's Mavic Pro. The arms and props aren't intended to overlay down, and the arrival rigging can neither withdraw, nor be fell. It's not planned in light of versatility — however it's still little enough to be full inside a knapsack if the need emerges.

Battery life and revive time

Under ideal conditions, DJI says the Phantom 4 Pro can remain airborne for as long as 30 minutes — obviously, true conditions aren't constantly ideal.

To put these cases under a magnifying glass, we ran the P4 Pro through our standard arrangement of perseverance tests. First up was a drift test, where we let the automaton float set up until the battery life turned out to be "fundamentally low," and the automaton naturally landed. Our drift test went on for 28 minutes and 8 seconds — which isn't extremely far away from DJI's guaranteed 30-minute flight time.

Next, to get a feeling of to what extent P4 Pro will last under all the more requesting conditions, we recorded the flight times from each other flight test we led and found the middle value of everything out. Throughout 10 distinct flights that spread over from 100 percent battery charge to the crisis low-battery programmed getting, the Phantom 4 Pro found the middle value of a flight time of 26 minutes and 50 seconds.

While you shouldn't expect an entire 30 minutes of broadcast appointment, the perseverance is great – the best we've seen up until this point. A DJI Mavic Pro endured 23 minutes and 19 seconds in our float test, and the Yuneec Typhoon H kept going 23 minutes, 20 seconds. A littler, progressively reasonable, more straightforward automaton will last far not exactly any of these. The Hover Camera Passport, for example, kept going under 10 minutes.

With respect to battery revive times, we found that an almost unfilled battery (around 10 percent remaining) takes about 1.5 hours to juice up to 100 percent. All things considered, more often than not you'll be constrained to arrive before you achieve fundamentally low battery levels, so the majority of our revives took around a hour and 15 minutes or less. That is not terrible for a cell that offers about 27 minutes of broadcast appointment. The Yuneec Typhoon H required more than two hours to top off its tank.

Flight Performance

The flight execution of the Phantom 4 hasn't changed in this new form. The P4 Pro flaunts about indistinguishable flight specs to the first P4, with regards to things like speed and spryness. Fortunately, this isn't a lot of a disappointment, since the P4 is still among the most agile quad-cutting edge rambles sold.


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DJI Mavic 2 Pro and Zoom

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Yuneec Mantis Q

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DJI Mavic Air

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DJI Spark

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Yuneec Breeze

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Radiance Drone Pro

DJI Phantom 2

DJI Inspire 2

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Float Camera Passport

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Move Star Wars Battle Drones

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Parrot Bebop 2 FPV

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3DR Solo Drone

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eHang Ghostdrone 2.0

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Yuneec Typhoon H ramble

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Yuneec Typhoon Q500 4K

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dji Phantom 2 Vision+

Speed and nimbleness are essentially unaltered in the P4 Pro. Both the P4 and P4 Pro best out at 45 miles for each hour (72 kph) — however you can without much of a stretch achieve higher velocities with a decent tailwind behind you. It's not the quickest automaton available (some can go 55 or even 60 mph), however it's speedy enough for generally employments.

Be that as it may, in contrast to its antecedent, the P4 can fly up to 31 mph with full multi-directional impediment evasion. That is imperative. Rapid moves are the point at which you need hindrance shirking the most. This new model can fly at decent speeds while additionally evading and weaving without anyone else.


The absolute greatest upgrades in the P4 Pro are identified with DJI's new autopilot highlights. Notwithstanding porting over a large portion of the "standard" self-ruling flight modes from the first P4, DJI additionally obtained a couple of the Pro's highlights from the as of late discharged Mavic, and even included a couple of additional items that we haven't seen previously.

You can set the P4 Pro to circle a point in space with Point of Interest Mode, rehash flights along a preset way with Waypoints, pursue your developments by means of Follow Me mode, or even change the manner in which it reacts to joystick control with Course Lock and Home Lock. These modes are incorporated into the Phantom 4, yet the Pro form has a couple new traps at its disposal: Terrain Follow, Tripod Mode, and a scope of new Active Track capacities.

It's not crash-verification, however it's nearby.

In Terrain Follow (which was beforehand just accessible in the Mavic Pro), the automaton utilizes its Downward Vision System to keep up a specific separation starting from the earliest stage, is awesome for taping over territory that differs in rise.

For static shots, the Pro's new Tripod mode permits you pick a point in space, at that point keep the automaton secured that position while you shoot – similar to a flying tripod. In this mode, joystick controls are hosed so that panning/yawing developments are less extraordinary, and the automaton utilizes a mix of GPS and sensors to hold its situation without floating.

DJI has likewise added a couple of updates to its Active Track framework. Picture mode, for instance, enables you to follow a subject while the automaton flies evenly and matches pace. Spotlight, then again, enables you to bolt onto a subject, however enables you to fly the automaton toward any path around it. There's even a 360 mode that will effectively circle any subject you pick, paying little heed to where that subject may move.

DJI Phantom 4 Pro+

Bill Roberson/Digital Trends

Also, obviously, there's the new omnidirectional sense-and-stay away from framework. Utilizing its new sensors, the P4 Pro ceaselessly filters the earth around it, and either alarms you when you fly excessively near a snag, or dodges it self-sufficiently. Best of all, this capacity can be turned on or off, so it's there when you need it, yet doesn't act as a burden when you need to stroll on the wild side and fly near something.
Our most loved component, nonetheless, is DJI's new unique come back to home capacity. In past ages of the Phantom, when you hit the "arrival to home'" catch, the automaton would travel to a foreordained stature, at that point make a direct path straight back to where it took off from. God prohibit there were any impediments in the way — if there were, the automaton would smack into them like a visually impaired feathered creature.

When you utilize the arrival to home catch on the new P4 Pro, the automaton will essentially follow its means and endeavor to "switch" along a similar way it used to get where it is — powerfully staying away from any obstructions that may show up en route, obviously. It's not crash-evidence, however it's nearby.


Range is additionally significantly superior to the first P4. Much the same as the Mavic Pro, the P4 Pro is furnished with DJI's new OcuSync video transmission innovation, which extends the automaton's most extreme range and gives a live HD video feed from the camera from up to 4.3 miles away. That, notwithstanding, is just conceivable in the most ideal conditions.

This is ostensibly the most ideal approach to burn through $1,500.

We took it out to the one mile mark on a bunch of various events without even a jitter in the video feed — yet transmission remove differs broadly relying upon nature you're flying in. In the event that there's a great deal of obstruction, the feed can remove at or before the half-mile mark. Everything relies upon where you're flying, however even with the intermittent feed pattern, the Phantom 4 Pro still flaunts the absolute best range we've at any point found in an automaton.

Most contenders we've attempted can scarcely make it 75% of a mile with their stock arrangements, and many require reseller's exchange run extenders to achieve the reaches that the P4 Pro can.

Camera and Accessories

On the off chance that there's any single motivation to purchase the P4 Pro rather than the standard P4, it's the camera. DJI put some genuine work into the Pro's picture catch framework, and the outcome is a standout amongst the best cameras we've at any point seen on a quad.

DJI Phantom 4 Pro+

DJI Phantom 4 Pro+

The greatest improvement is the span of the camera's sensor. The Pro flaunts a 1-inch CMOS sensor — which is around multiple times the extent of the more run of the mill 1/2.3-inch class utilized by most automatons (counting the Phantom 3 arrangement and the Phantom 4), leader cell phones, and simple to use cameras. This additional surface region enables it to catch unmistakably more detail, and look after picture/video quality at higher ISOs.

Notwithstanding a bigger sensor, DJI additionally furnished the Pro with a mechanical shade and gap control. As it were, you're not stuck shooting in f/2.8 constantly (you can go the whole distance to f/11), and never again need to stress over the feared "moving screen impact' spoiling your pictures.

With regards to shooting video, the P4 Pro offers a reiteration of alternatives. You can shoot in realistic 4K DCI at 24, 25, or 30 outlines for each second, or 4K UHD at 24, 25, 30, or 60 outlines for every second. On the off chance that that is excessively for your eyeballs (or SD card) to deal with, you can likewise downsize to 2.7K, 1080p, and 720p — the last of which can be caught at 120 edges for each second and used to make moderate mo film.

On the off chance that you spring for the Phantom 4 Pro Plus (an additional $300), DJI will toss in a controller that accompanies its very own implicit touchscreen show. It's a bit on the spendy side without a doubt, however that additional scratch implies you won't need to associate your telephone to the controller with a link, which is something that is required for almost every other automaton that DJI makes.

DJI Phantom 4 Pro+

Bill Roberson/Digital Trends

We don't know whether it's value $300, yet it's really pleasant to fly without agonizing over your cell phone's battery life, or having your flights discourteously hindered by approaching instant messages or calls.

Nonetheless, we think DJI should've incorporated this alternative years back, or if nothing else tossed this into the $1,500 group. Yuneec offers a touchscreen Typhoon H controller for no additional charge, and that makes paying additional for it from DJI an unpleasant pill to swallow.


In actuality, DJI's Phantom 4 Pro is a standout amongst the best automatons in presence today — if not the best. It's the main automaton with omnidirectional obstruction evasion, and the camera exceeds each other automaton in this class. Inevitably it'll be dominated, yet it's the best top of the line buyer ramble we've tried up until this point.

Are there better choices accessible?

In this value extend, no. In case you're in the market for an automaton and $1,500 is inside your financial plan, there's no better method to spend your cash.


Wise Battery Charging Hub


Case Club Waterproof Wheeled Case


Propeller Guards


The nearest contender to the P4 Pro is likely the DJI Mavic Pro, or fresher Mavic Air. Both are littler, undeniably progressively versatile, and gloat a considerable lot of a similar flight modes and highlights — aside from, obviously, omnidirectional hindrance evasion, and a camera with a one-inch picture sensor. Besides, at $999 and $799 separately, the Mavic Air and Mavic Pro are additionally extensively less expensive, so in case you're searching for something more moderate yet at the same time very competent, you'd be shrewd to go for the Mavic.

On the off chance that you couldn't care less such a great amount about transportability, Yuneec's Typhoon H is additionally a commendable contender, and is progressively reasonable at $999. It brags numerous similar highlights, and has a 4K camera that swivels an entire 360 degrees. This, alongside double pilot capacities, make it a fair contender. Be that as it may, the Typhoon H's camera isn't as cutting edge, the battery doesn't keep going very as long, and it needs more opportunity to charge.

To what extent will it last?

Most likely a couple of years or more. DJI continually takes off updates to a large portion of its items, and we have no motivation to think the P4 Pro will be any unique. Firmware refreshes come through all the time, and DJI as of now has a suite of redesigns, connections, and frill in progress. Along these lines, accepting you don't fly it into a lake, the P4 Pro should last you for a long while.

Would it be a good idea for you to get it?

Indeed. This is ostensibly a standout amongst the most ideal approaches to burn through $1,500.
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Hey my friend. This is Darnell clock your industry leader in his career gang. Hey the answer man Hey, today’s topic is how to prep for a in person interview in today’s marketplace before I really get started I have something special for you I have a cheat sheet for interviewing is the interviewing cheat sheet is exactly what you need is perfect for anybody who really doesn’t have a good sense of what a interview is how you actually prep for I have a cheat sheet for you will love it. It is packed with information but you had stayed to the end to get it I promise you it is well worth so now how do you actually prep for an in person interview you know I have had opportunity to be on stages of conferences and workshops and seminars to thousands of people I have also done one on one consulting one on one contracting one on one clients that I have that I that I work with them one on one and

All the people that I have come across thousands of people on stage or workshops and seminars, hundreds of people want a little consulting and coaching. I have recognized that about 95% of people don’t really know how to prep for an interview. I asked people all the time, you know, are you ready for an interview as a yes. Well, how much and how long have you prep? Hey, I’ve only prefer to 1520 minutes or I didn’t prep at all. I’m just gonna go just talk off the cuff. Those type of people go to interviews. And don’t prep does not do well my friend so I’m not sure if you know me. See, I’m different than most career coaches. Most career coaches come from HR or recruiter cited off the side of the fence. Not me. I was the back in hiring authority working for IBM urging Yun Jie Coca Cola. I have a computer science degree and an MBA I was the back in hiring.

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These HR people will get with you. You have that discussion. You have to get through them before you get with me. But I was the backend hiring authority in my career. I have interview well over 300 people and I have personally hired over 250 people to work directly for me. I know what a good interview is. I know what a bad one is. I know exactly what I hire managers looking for.

Because I was one of all those many years. So now I’m going to tell you from the hiring managers perspective, what am I looking for? When I asked you certain questions, I’m going to give you the perspective of hiring authorities not HR, see if you can really think how a interview goes interview is really broken down in four stages. And if you can master those four stages, you will always be in a game for the interview those four stages is the stage number one is is is the introduction stage number two is the employer

Questions stays. Number three is the candidates questions and stays. Number four is the closing. And if you can understand those four stages and see what is expected of you, you will be able to have a high probability and high chance to be selected when you do an interview. So I’m going to break down the four stages and tell you exactly what it is how do you prep for it, and what do you need to do to master each stage stage one is in his introduction, the introduction is this is not the decision part where this this date is not where the employer or the interviewer will make a decision to hire you if that’s not that stage yet, but it is the stage if you patch it. If you blow this introduction stage. This is the stage where they will decide

Not to hire you is not the stage will they will they will decide to hire you but it is the stage will they decide not to hire you as a hiring authority I hired for two reasons to reason only one for likability and to fitness I will have to like you somewhere in this process of the interview, I would have to start liking you to see if I’m going to hire you.

I will never hire anybody I don’t like so that first introduction stage is all around into introducing yourself is the stage where the interview will ask you that question that freaks everybody out. Tell me about yourself, right? That’s the question that everybody starts with because we want to know a little bit about you. Now listen to me, my friend. When I asked you the question, tell me about yourself. I am not asking you where you from? What do you like to do? Do how many brothers and sisters you have are not efficient.

Interested in all that? I’m not. Also I’m not interested in hearing your 15 32nd

elevator pitch. You know the elevator pitch is a high level commercial or who you are a 15 2030

seconds high level general elevator pitch know when I asked you the question Tell me about yourself. I am looking for your value proposition. So what the heck is you have a value proposition in a nutshell your value proposition is a clear statement that explains how you will solve a company’s problem here, how you will improve their situation, what the liquid What do you deliver, what value and what strength Do you deliver to that organization as it connects to the job announcement and why should I hire you over someone else is specific. It is not general. Here’s the crust of it. When I asked you the question, why should I hire you?

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You I’m looking for who you are, what are you have your strength, your benefits as it connects to the actual job and mouse. That’s the key. The elevator pitch is general. It’s a general introduction of yourself. The value proposition is not gender specific of who you are, what do you bring to the table as the connects to the actual job? And now that’s the key. So if you have no idea how to craft your value proposition, when somebody asks you the question, tell me about yourself. Go below in the description field. I have created one of my first YouTube videos of how to address and handle Tell me about yourself. Question The title is, tell me, tell me about yourself. It is not a rendition of your resume. So here’s my tell you tell me about yourself that you have proposition. All right, Darnell, tell me about yourself. Hey, I am a lawyer.

Long learner, I take what I have learned in the past and I transition it to what I do now. I learned from my mistakes and my successes and I’m make sure that it I put it in play. So I can always learn from everything I do. I’m a high say, do I say what I do, and I do what I say. And that will make me a great asset to you and your organization. I’m dependable, reliable, and accountable for getting things done. I love to get to work to get things done. Because I believe in results. It is results and execution that I love so much. Most people say I get things done faster than most there’s no substitution for speed I call the speed of business results.

I truly love getting things done on time and within budget. I am a leader and I believe in delegation of authority because that drives individual accountability and at the bottom line, it grows people and make them be able to handle things at this

level and I’m truly excited by the opportunity that this position presents. You hear that? That’s my value proposition. Did you hear anything about my resume? Did you even hear the word resume? I say anything about my resume. I didn’t say anything about my accomplishments. I see say anything about where I worked at. When I asked you the question, tell me about yourself. I am not asking you for rendition of your resume. Because the very next question I will ask you right now, take me your resume. So that’s stage one. Stage one you must be able to address. Tell me about yourself. Why should I hire you? What’s your differentiation? What’s your strengths and your weaknesses and where you see yourself in five years? Right. Those are the introduction questions. Remember, I hire for two reasons likability and fitness. It’s an 8020 split. 20% of my questions is for likeability and then 80%

My question for fitness and then it transitioned from stage one to stage to stage two is employers questions? Yeah, that’s what I asked the question. All right. Not take me through your resume. Now, I need you to understand this. My friend, I need you to understand and know your resume called when I asked you to take me through your resume. The worst thing I can honestly say, that I see people do is that when I say, all right, take me through your resume. They open up their portfolio and they start reading their resume. I need you to script your resume. What the, what the heck does that mean? Yeah, script your resume. I need you to be able to script it you like as a person as an actor or a a, a actress, you know, so when in the movies or sitcoms, whatever they tell you their lives no different I need to script your resume. So how does it work? So

When I sat down to take me through your resume, I say while working for IBM from 2005 to 2017, you know, I was the program manager director. My responsibility was that because people always want to hear numbers and percentages, I was responsible for 25 people. And my budget was about $15 million our disposal for p&l to the organization and I was driving roughly about 100 million dollars to our to our services are from our products and services to our customers and our clients worldwide. Then my responsibilities XYZ, ABC, you see that and then when I finished with that, I say what my next position was, was what what Gee, I was working for GE from this time to this time for this position, my responsibility that I have 45 people reporting up to me, I had a budget of $65 million I responsible for my p&l to the business over 100 to $200 million to the business.

My responsibility was program project management I built a pm or office either Nana Nana, Nana and when I get finished with that I did this position that’s how you script it right? Do not spend a lot of time on your resume I want you to spend no more than two to five minutes maximum on your resume. So your resume got you in the door. The resume got UNIDO. Your resume was submitted for one reason. And one reason to get a call back for the interview. Your resume worked, your resume will not get you higher. The interview will get you high. So don’t spend a lot of time on your resume my friend to the five minutes get through it as fast as you can. If they want more information. They’ll ask their answer the question but get through it. By scripting your resume. Do not commit it to chance that you know what’s on your resume. I freaked people out and doing I was in interviews you know, I will have my friends.

resume it’ll be my portfolio but I would never pulled it out this. All right, Darnell, take me through your resume. And I just scripted and there’ll be looking at the resume while I’m talking. I hit our numbers and is exactly what they need. So stage two stars, where the question is, take me through your resume. Now most interviewers have a standard set questions that they want to ask. Remember, the second part of me, heart is fitness. I am trying to ascertain that you can do the job by because you have done it already. In today’s marketplace. We don’t hire people to train I know the millennials are having issues with that for sure. But I don’t have a budget to train so we don’t train what we want to do is hire you hit the ground running, learn it on a job so on the job training and hit the ground running when you hear that that means we are not training you whatsoever and only way you can hit the ground running because you have done it.

Before so so most employers are most most interview have standard interview questions they are trying to attach that whatever you have done before you have done it again now in these second stage there’s a two part interview process is your traditional interview questions and behavioral interview questions the majority of the marketplace now is going to majority of is going to behavior interview question if you don’t know what behavioral interview questions is all about. I crafted a four part series of how to handle behavioral interview questions go below in the description field and you’ll see a four stage process of handling How do you handle behavior interview question and when you handle behavior. Any question is all about behavior interview question is is a predictor is a predictor of what you did in the

Past is a predictor of what you have can can do in the present interviewer does not want to know what you think you can do the interviewer note wants to know what you actually have done and prove it and the way you do it by using the behavioral interview using the star method st AR s for situation to attach a for action are for results and throw one more in their lessons learned. So when they ask you a question and you will always know a behavior interview question when they started out like this. Tell me about a time when you did x y z show me a time when you did this. How did you did this? How did you handle that? So a one interview question is Tell me about a time when you had a conflict with a co worker at work. How did you handle it you will have to use the star method s you must tell the situation innocent party is it isn’t here to

tardy, tardy it’s Eric Can you say the word out right? You must tell the situation T for task you must tell the task that you had to do a for action what action that you had to do to handle that task and are for result what results came from your actions and what lessons did you learn for that whole thing a normal traditional interview question if you talk in longer than 3545 seconds you’re talking too long but a behavior interview answer could be anywhere from a minute to two minutes, the three minutes the more detail you are the better it is for behavior interview question down below. Go find out how to do because they will ask you the question you know those behavioral interview questions and if you cannot handle it, it would destroy that part. This stage is the stage that it that the interviewer will decide if you are the person

That they want to hire. The first stage gives them the ability to who you are. Now I’m starting to like you. The second stage, which is the second part is a fitness. I am now trying to ascertain that you can do the job because you show me how to do it. That’s the fitness part. Listen, there is a big difference between traditional interview questions and the behavioral interview questions every time you open your mouth to add to answer any question, you must connect what you have done in the past to what the job announcement is. So I asked you the question, my friend when you see a job announcement to you, like how long and how often do you read it? I need you now to understand it is the job announcement that connects to your resume that connects what you do that you what you have done that will get you the job you spend at least 25 to 32 hour on that job description when I look at

job description. I spend roughly about two or three hours I get my markers, I get my pins, I carve it out. I try to find the what the requirements and I tried to get those requirements as it connects to something in my resume accomplishments, the things that I have done in my resume like connect the dots you must connect the dots. As a hiring manager we are looking for somebody that can get the job done you my friend must be in a solving problem business you must be able to solve businesses solve problems I’m hiring you not just because I want to hire you I’m hiring you because I got some problem that needed to get done and you my friend in the interview stage to the interview the employers questions you must connect what you have done in the past to the actual job announcement. So I can see you have done it already. I can’t tell you how many millennials have issues with that because they want training they want mentorship and in the month

marketplace we just don’t do that right now. I’m sorry millennials but we just don’t do that right now. So you will have to understand that whatever you have done in the past is a predictor of what you can do in the future that is stage to employers questions, you must be able to connect what you have done in the past to the actual job announcement. I need you to spin Elisa hour on that job announcement so they can so you can connect the dots so you can see the job announcement and you can see how it connects to the actual job And now’s your resume connected you must connected that stage three tours in of all of the interview. The interviewer will always say, all right, Daniel, I have everything I need by I have everything I need. And so now

Do you have any questions for Me and I can tell you how many times I have interview people remember I have interview over 300 people. I can’t tell you how many times an interview interview will come in. I said, Do you have any questions for me? And they say, No, listen, my friend

at this stage, the interviewer is trying to ascertain what

how do you determine how much interest do you have for this position? See, if you really wanted that position, you will spend some time and craft some interview questions. So when they said do you have some interview questions for me? I want you to say yes, and I want you to pick your portfolio up just like this. I want you to open it

I want you to pull your questions out there looks just like this

right here on in here on my interview questions. I want you to make sure they have the text

is large enough so so they can see that you have crafted up, I want you to put it back on your portfolio. I want you to take your input. And I want you to now read that first question. And the first question is, what kind of person? Are you looking to fill this position? And what is your ideal candidate looks like get ready, my friend, get ready to write down because the interviewer is getting ready to tell you exactly what they are looking for. They might have said it sometime in the interview. They might not. But now they’re getting ready to tell you exactly what they are looking for. You write it down because this is the beginning of your clothes, right? And so always be able to add that is the first question you ask. And then some of the other questions you can ask is on here. And then this last question the second from last question, I want you to always ask this question this guy

licenses. Now that you had a chance to meet and interview me, what reservations would you have for putting me in this position? Yeah, Margaret, you put them on the spot. Yes. You have put them on the spot. Hey, I need you to conquer your fear. Don’t worry about it. See, number question number one. If they say Yeah, well, we’re looking for XYZ, ABC. And then you hear Hey, that’s me. I have either done that before. It is part of my strength package. Never go to an interview. When you know the position is in your weakness package. You only go to interviews that you know as part of your strengths. That’s why you need to know what your strengths are what your weaknesses are. Never ever ever ever go to a interview when you know it’s not part of your strength package. Never go to interview when you know as part of your weaknesses. No, no, no, no,

you can never perform at a high level.

Doing things that you’re not good at, because it’s part of your weaknesses. No, don’t do that. So the first question is, will, hey, we’re looking for this. We’re looking for that. Hey, then you got to hear that. Is that part of me? That’s part of my strength packet. I have done that before. When you hear that, that question,

let’s, you know, you let you think that you are a good fit, you are a good fit for the position that ate that. That’s that question before. The last question is that hey, what

said you had a chance to meet and interview me? What reservation do you have? And put me in this position? Yeah, you put them on the spot. Listen to that. Because if the interview start talking to negative, well, you don’t have this. You don’t have that you don’t have this, hey,

you are not in the game. Wrap that interview up as fast as you can, and get the heck out of there because you are not going to get that job. But if they say, well, Darnell, I don’t have any

any reservations? We’re looking for x, y. z. You had that? Would you describe it? Pretty good. We are still interviewing but I don’t have no reservations. Now you know that they think you are a good fit. Remember, the first question is positive, it lets you know that you are a good fit. Now, that second question lets you know they think you are a good fit, and if it’s a good fit, and if is the position that you will love to do then transition into the fourth stage, which is closing, you ask this last question of what’s the next step? What’s the next step in the timeline, they’ll ask, they’ll tell you the next step. And then if they if you like it, it’s a good fit. Then I want you to transition into the clothing by asking for the job. Yes, my friend.

You ask for the job you have. Not because you ask not what shoot man what a job you do this So you asked what the next step. So you say, all right, Mr. Clark, I got the next step. I appreciate the opportunity this interview, right? I think I did a great job. I wait patiently for the next step. Because you say, in the next couple of weeks, you’ll have an answer. So now let me leave you with this. In closing, this is your clothes. Let me leave you with this.

Yeah, I am very interested what I have learned here today and the opportunity that this position present right I believe I will love working with working here and learning from you as well. Is there anything else you need to know about my background to determine that I go to the next step in the interview process? Because I want this job that strive you just ask for the job. Some people like okay as what a job I’m scared. Listen, I need you to conquer your fear. I need you to to feel the fear and do it. Anyway, conquer your fear. conquer your fear.

And if you conquer your fear, you’ll be the captain of your ship and a master your destiny. conquer your fear and ask that question and ask for the job. You ask for the job. Listen, listen. Listen. Listen. Listen. Listen.If you don’t hear me, listen now.

I have interviewed over 300 people and only one person at all those people ever asked for the job. And he’s the only one I hired on the spot. Those other over 250 people I hired I still took him through the whole process in made him an offer, but he’s the only one I interview and he asked for the job. He’s the only one I hired on the spot. I can’t tell you how many times I have used that since he did it to me. He did it to me early in my career. So cool. I start in doing it myself. Now. I told you on one side of the fence. I was a higher authority working

for IBM at Ernst young a GE and Coca Cola hire people but early in my career I got my computer science degree in an MBA and all these it certification and I became a perpetual job hopper I noticed right now the marketplace doesn’t mind that you job haha we have become a nation of job hoppers from the Bureau of Labor Statistics says for the first time in our nation’s history more people have quit their jobs thing got laid off. The average life cycle of a job is only five years every three to five years. My friend you’re going to be looking for we can be looking for a job but we are nation the job I don’t call them job hoppers. I call it free agent we are a free agent nation unbounded, untethered to one organization taken our talents to the whole marketplace instead of one boss in one one company. That’s what we do now. Right? But I was doing it before this was cool. I was going from job to job every 24 months every 18 to 24 months I would job hopping because I was trying to go get that K.

Every job opportunity came up to get more money. I left one company and went to another why I was in a job search mode.

Other side of the fence I submitted over 5000 resumes. What a dark, you know, up to 5000 resume because I keep track of everything I know who I submitted it to when I submitted to what information I got from it. What company I submitted you I know everything from those 5000 resume. I have had over 200 interviews. Yeah. Does that mean every interview possible that you know that it had a Skype interview in person interview a phone interview interview with HR interview as a group interview as a panel, I have interview all of it and mastered all of them. And early in my career. I recognize the ability to ask for the job. I can’t tell you how many times I’ve used it.

And it worked for me. You know, as a director, senior director over the past 1015 years in the marketplace, I was always interviewing when I go to an interview the person was interviewing me was either general managers, vice presidents, CIOs, CEOs, or see in a minute medium or small medium companies. They were big baller shot callers and I have used the each and every time Excuse me,

I can’t tell you how many people stopped and say, Wow, Darnell, you just asked me for the job. Outstanding Young man. I’m a man a vice president. She was so impressed that I asked for a job. She hired me on the spot. Yes, yes. Yes, sir. So I always use it. Now when you ask somebody for the job. One or two things are going to happen either they can like wow, I’m so impressed. That’s what a job or you’re going to have somebody like man is do just as before the job How dare he have enough.

goon is encouraged as for the job now I’m not giving you for a job when you come across those people who are put up because you asked for the job listen you don’t want to work for those type of people anyway they’re scared you have enough courage and fortitude to ask for what you want and they’re scared to hire you because you think you’re going to take their job you got all right I’m gonna take your job if you think that I’m going to be scared to not ask for the job and you’re not going to give it to cuz cuz you got scared that I’ve had enough fortitude and confident as for you better believe I’m going to ask I’m going to take your position Oh buster, it Hey, but don’t worry about it. So you ask for the job. And then I want you to give them your personal guarantee. Listen, my friend, I can’t tell you how many people scared to put them cell phone line. You give me a personal guarantee. And you say after you say I want this job. Listen, Mr. Clark.

If you hire me I give you my personal guarantee that if you select me

You will not be sorry or disappointed. You hired me. So when you go in the back and you start talking to your team, and you decide who is the best person for the job. Think of me. Mr. Clark. When you go on your team and say, who can hit the ground running because they’ve done it before, and they don’t need little to no supervision. Think of me. Best o’clock. Hi, my name is the clock because I want this job. That’s right. And you shut up and let them talk. Listen, my friend, that is your differentiation.

That right there will put you over the top with anybody. I’m telling you right here right now. My friend. nobody’s doing this. No one is going to be asking for the job because they told freaking scared but not you. You raise up your courage and boldness and you come before us for the job. I want that job if you hire me, Mr. Clark. I guarantee you won’t be sorry or unhappy that you hired me I promise you so there you go for it.

So let me recap. let me recap. There’s four stages of interview. The first day is introduction. This is where you must be able to answer the question. Tell me about yourself. Stage Two is the employers questions. Employers question will give you traditional interview questions and behavioral interview question you must be able to handle both. And stage three is the candidates question.

You always come with questions and you always ask the question what they’re looking for and you capture it. You always ask the question now you had a chance to interview me what reservation we have put me in this position. You always ask that question. And then the final question you always ask for next steps. And then you transition right into the closing by asking for the job which is days for my friend. So then you go, I told you in the beginning, I have something special for you. I have an interview cheat sheet. The interviewing cheat sheet is everything I talked about here. Plus

Much much more it tells you how you supposed to dress in today’s marketplace before in a bit and back in the day it was always suit and tie knot in more my friend you must understand the culture of the organization would tell you how you dress for interview it tells you about how to address and handle the question to tell me about yourself. It talks about the the ability to handle behavior interview questions, it gives you the top 20 most common asked questions in an interview and it gives you the answers to it gives you everything right. It also gives you the ability to understand that your salary it tells you how to find your salary. Never, ever ever go to an interview and you don’t know what the salary is for this position. Down below my friend. I made a video of how to address salary question is down there too. Now lastly,

I can’t tell you how. How many people that I know go to an interview it doesn’t go well any questions them this in my friend, you are not responsible to go to the interview to make somebody like you know what they’re going to do you don’t know why they’re going to hire you.

Why not you are not responsible to find out if they like you are not you are not responsible if they give you the job offer not your responsibility is my friend is to come to the interview and deliver the package What the heck is the package everything I taught you how to prep how to prep and prepare for an interview.

That’s the package your responsibility is to prep and practice everything I showed you here come to the interview and the liver what you practice that’s it you’re not responsible for if they like you. You’re not responsible for if they made your offer. That’s not what you’re supposed to do. Your responsibility is to get to that to the interview.

delivered a package if you get the offer great if you don’t so what is not your responsibility listen no man can open a door to anything any door closes and no man could close any door God opens in that position is for you is for you and there’s nothing they could do about it it will be for you my friend. So if you don’t get it, learn from it, go to another interview and keep learning and you keep doing it until you get hired my friend so there you go.

So if you like this video, click on the like button I truly love when you click on the like button and share with four or five friends I need you to share this with five friends this is how I get my content out I I do it. The way I get my content out is when you share it with five friends so I asking you to share with all five friends and more but minimum five friends in in the comment field. Give me a comment or your feedback or any questions you have.

Have because I’m Darnell clock the answer man there’s no question that you can ask me that I will not have an answer for and I answer every comment every feedback and every question down there I personally answer it and as always if you haven’t subscribed to my YouTube channel subscribe to my channel on the side is that bill click on that bail my friend so you can be notified every time I come out with fresh new content so there you go my friend this is how you prep for in person interview you spend hours so if the interview is four or five days out I want you to spend one hour a day prepping it will serve you well when you get into that interview. So this is Darnell Clark you your your your industry leader, your career coach say hey there’s one thing I recognized for sure that is whatever you want in life. You got to go get it now go get that interview because I showed you how to do it. I see you later. Today we’ve cooked up a video where we teach you know less than 50 wicked football skills and while you might have seen a few of them before you can still use the video as your personal skills Bible that you can pull out before training or match so sit back dealer number one the fake classical facing the defendant you saw him in by pushing the ball forward then you know quick scooping motion dragon away from it’s a bit like the elastic only done with inside of your step

number two the street running with speed you get ready to take on the defendant. And just before reaching in you slow down only to explode away. Again. Lowering the pace for a moment is key because the defendant will sleep the same

Number three, the fake shot. This is what you would call all school move probably the most effective dribble and football set yourself up for a shot and slide to all you have to do now is to not follow through all around the defense.

Step number four is the stop and go running down the line with the defender in your back. You stop the ball with the outside of your foot. Then do a quick body thing and drag the ball with you in the opposite direction. Great, simple and effective move.

Read also: How to Improve Study Skills and Memory

Number five the rollback. Roll the ball back to the side of your body and wait for the defendant to come rushing in. When the timing is right, quickly drag the fall back again and accelerate the way

number six is the outside touch receiving a pass with a defendant chasing you down. This is the perfect skill to send him for a hot dog. Just before touching the ball. There was more money fame tap the ball with the outside of your first in the opposite direction and seventh place is the stop and shop running with the defender on your side.

Do this step on the ball with one foot into a chop with your other it’s a great way to buy yourself some time number eight the zigzag if you’ve got some speeding you This move is even better. T

ake on the defendant and take a shop touch to one side. Now run a bit past the pool so you can top it again outside of your foot in the opposite direction. Thank You for reading
This past August, her exuberance, emotion and enthusiasm had already made Fu Yuanhui the most famous Chinese athlete at the Olympics. After winning a bronze medal in the women’s 100-meter backstroke with a personal best, she nearly exploded with excitement: “I was so fast! I’m really pleased! I’ve already… expended my primordial powers!” Her interview went viral with millions of hits worldwide.

Then she said something truly shocking: she was having her period. Noticing that the swimmer was grimacing after her relay team narrowly missed medaling, an interviewer asked if she had a stomachache. Yuanhui answered “It’s because I just got my period yesterday, so I’m still a bit weak and really tired. But this isn’t an excuse for not swimming well.”

When the New York Times, NPR and other media outlets covered the story of the Chinese swimmer who dared to mention that she was having her period as if it were the perfectly natural thing that it is, they focused on the fact that she’d violated a cultural taboo — indeed, it is virtually unheard of for women in China to publicly mention menstruation. But, they also missed an opportunity to counter the common misconception that menstruation impairs athletic performance or that it’s unsafe or inappropriate to swim while having your period.
Menstruation and athletics

I recall classmates in high school sitting out basketball practice because they had their periods. I assumed it was just because they weren’t feeling well. In fact, many girls have been told they are more likely to be injured, less likely to perform well, and that the best way to handle menses is to take it easy. Maybe. But the evidence for each of these is weak.

Much has been made about the apparent increased incidence of significant injuries — ankle sprains, anterior cruciate ligament (ACL) tears and others — in female athletes compared with their male counterparts. Blaming it on “hormones” is common. A 1989 study interviewed 84 female soccer players and found more reports of injuries during the premenstrual period and menstrual period, especially among those with premenstrual symptoms (such as irritability or breast discomfort). A 2007 study found that ACL injuries tended to occur more often during the first half of the menstrual cycle (in the week or two after the period). A 2009 study found that among eight healthy volunteers, hamstring flexibility increased at the mid-point of the menstrual cycle. That’s the point in the cycle that estrogen levels are rising or at their highest.

So it’s possible that variations in female hormones through the menstrual cycle change the function of bones, joints, tendons, or ligaments, and that these changes could have an impact on performance or likelihood of injury. Then again, these studies are simply observations of certain patterns — they don’t prove a connection between phases of the menstrual cycle and injury. In fact, we don’t know for sure whether the phase of the menstrual cycle truly has an important effect on tendency for injury. And if there is an effect, it’s not clear what to do about it.
Athletic performance

Studies find inconsistent effects on the impact of menstrual periods on athletic performance. For example:

    a group of swimmers were found to have poorer performance just before their periods started, and improved times during menstruation
    cross-country skiers were best just after their periods and after ovulation (which occurs midway between periods)

in yet another study, strength of handgrip and standing long jump distance were best during menstrual periods compared with other parts of the menstrual cycle.

A 1994 analysis reviewing the available research concluded that when it comes to having your period, “…for most women there is no significant effect… medals have been won and world records set in any phase of the menstrual cycle.”

Even so, many women don’t feel well just before or during their periods and it seems reasonable that this could affect athletic performance. Anyone who is in pain, tired, or just not as sharp as usual may not perform at their highest potential. And in elite athletics (such as Olympic events) in which the difference between a gold medal and last place may be fractions of a second, surely feeling poorly could make a big difference. A 2009 study concluded that taking an anti-inflammatory medication (called diclofenac, a drug that’s similar to ibuprofen) led to reduced menstrual cramps and improved exercise performance. In fact, some athletes try to avoid the issue altogether: they take oral contraceptive pills or other hormones to avoid having their periods during important athletic events.
The bottom line

There is much we don’t understand about the relationship between the menstrual cycle and athletic injuries or athletic performance in women. It’s probably true that individual factors, including overall health, type of exercise, degree of conditioning, and nutritional status matter more than the phase of the menstrual cycle.

Clearly, women with premenstrual or menstrual symptoms may not feel like exercising. But there is no compelling evidence that exercise or athletic activities should be avoided or altered based only on what part of the menstrual cycle you’re in. Good training may reduce the risks of injury and enhance performance much more than trying to time exercise around one’s periods.

Many have commended Fu Yuanhui for being so forthright about having her period even though it violated a longstanding taboo, but she could also be commended for avoiding the temptation to blame her period for a disappointing performance. “It’s a definite that you’re all going to screw up, but it’s not a definite that any of you will learn from that,” declared one of our medical school instructors, years ago. “Cultivate the attitude that allows you to own your mistakes, and then, not repeat them.”
How common are medical errors?

Medical errors are, frankly, rampant. A recent study used data analysis and extrapolation to estimate that “communication breakdowns, diagnostic errors, poor judgment, and inadequate skill” as well as systems failures in clinical care result in between 200,000 to 400,00 lives lost per year. What this means is that if medical error was a disease, it would be the third leading cause of death in the United States.

The article is specifically about fatalities secondary to medical errors, and how these are vastly underreported. They point out many reasons for this, the first being that cause of death on a certificate is usually listed as the physiologic cause of death. For example, “myocardial infarction” may be listed as cause of death for a patient who was sent home from the emergency room with chest pain and a diagnosis of acid reflux. We have no direct way of knowing that their fatal heart attack was due to misdiagnosis.

In the course of my training over a decade ago I saw many errors, such as a punctured lung during central intravenous line placement in the intensive care unit, postoperative morphine overdose requiring emergency intervention, cancer seen on an emergency room CT scan and never reported to the patient… I could go on. What was most common then was a culture of silence: there was not consistent nor complete disclosure to the patient. People would whisper about mistakes, never directly addressing the issue for fear of litigation, or even retaliation by the involved physician.
Preventing medical errors—and learning from the ones that do occur

As the BMJ article authors point out, we can’t develop safer healthcare without identifying and analyzing medical errors when they happen. They call for a national database of medical errors, so that the information can be compiled for quality improvement and prevention research.

Thankfully, I now work at an institution that recognizes this, and openly embraces errors reporting. We even have an easy-to-use online safety reporting system which my colleagues and I have used many times, for everything from blood test tubes being sent to the lab without labels, to the wrong vaccine being administered, to falls suffered by our patients while in the hospital.

Worried that these types of reports reflect more mistakes being made than normal? Think again: as the data supports, the vast majority of medical mistakes simply go unreported. The true number of medical errors, both fatal and non-fatal, is unknown. What we do know is that healthcare delivery cannot improve if these are not examined.

How does this work? I can pull an example easily from among my own recent mistakes:

A lovely patient of mine* in her late forties complained of fatigue, depression, and body aches, which I attributed to perimenopause and arthritis. She did have slightly elevated calcium levels, but I didn’t think much of it. I blamed it on her calcium supplements.

After more than a year, we finally discussed checking her calcium level OFF of supplements, and lo and behold, it was still high. We discovered that she had hyperparathyroidism, an overactive parathyroid gland that causes calcium to leach out of the bones. Indeed, hyperparathyroidism and high blood calcium levels can cause fatigue, depression, and body aches, among other things that she had, such as osteopenia (weak bones).

She asked for a referral to a surgeon and had her overactive parathyroid gland surgically removed. Her complaints resolved within a day after surgery.

I apologized for my error which had resulted in a delay of diagnosis of about two years, during which time she had not only felt awful, but also developed weakened bones. I offered to facilitate her transfer to a new primary care doctor. She declined, and said that she was appreciative of my honesty in discussing the error, and hoped it could serve as a valuable lesson.

I shared this error with my colleagues and in the system. I, for one, will never let any slight elevation in calcium go uninvestigated, and my colleagues have learned from my example.

My med school instructor was right: if we don’t own our errors, we are destined to repeat them. In medicine, honesty is truly the best policy.The 2016 summer Olympics had its share of exciting performances, upsets, and photo finishes. But for days after Michael Phelps’s first appearance at the games, it seemed all anyone could talk about was “cupping.” It’s an ancient therapy that left multiple circular discolorations on his skin. During “dry cupping,” suction is applied to the skin for several minutes; sometimes it is combined with massage, acupuncture, or other alternative therapies. (“Wet cupping” is similar except that blood is removed by making small cuts in the skin.)

Cupping is supposed to draw fluid into the area; the discoloration is due to broken blood vessels just beneath the skin, much like a bruise. Cupping has been popular in Egyptian, Chinese, and Middle Eastern cultures going back thousands of years, but increasing numbers of people worldwide have been adopting it. Celebrities and athletes have popularized it in the U.S. in recent years.
What is cupping supposed to do?

According to its advocates, cupping is supposed to promote healing and has been used extensively for sore muscles. But that’s only the beginning. Cupping has also been used for

    back and neck pain
    skin diseases such as acne and hives
    lowering cholesterol
    knee arthritis
    improving immune function.

And there are many others. If cupping does help with these problems, it’s worth asking: how? From a biological perspective, it’s not clear how the application of suction and drawing blood into an area under the skin would provide all these benefits. A recent review of the treatment describes cupping as a treatment that can strengthen the body’s resistance, restore balance between positive and negative forces, remove disease-causing factors, and promote blood circulation. But exactly how is unclear.
Does cupping work?

A number of studies have examined this question, but unfortunately don’t seem to have  convincingly answered it. In fact, a 2015 review of the evidence found that cupping might provide some relief for chronic neck or back pain, but that the quality of the evidence was too limited to draw firm conclusions.

One problem is that it’s tough to perform a high-quality study on cupping. The best studies are “blinded placebo-controlled trials” in which neither the patient nor the researcher knows which treatment (real or placebo) has been given to a study subject. When medications are studied, coming up with a placebo pill is not difficult; it can be much more difficult to create a convincing placebo comparator for cupping. In addition, pain can be a difficult thing to measure and the placebo effect — improvement related to an expectation of benefit — can be quite powerful.

Still, there have been studies comparing actual acupuncture with convincing but fake (or “sham”) acupuncture.  Similar studies of cupping could be possible. And if cupping truly helped, you may not care if it’s due to the placebo effect.
Are there risks involved with cupping?

Most experts agree that cupping is safe. As long as those treated don’t mind the circular discolorations (which fade over a number of days or weeks), side effects tend to be limited to the pinch experienced during skin suction. It’s quite unusual that cupping causes any serious problems (though, rarely, skin infections have been reported).
So, what’s next?

If you want convincing evidence of effectiveness before trying a treatment, you may want to pass on cupping for now. But if you’d like to try something that’s safe and might help with certain aches and pains (and possibly other ailments), the main downsides seem to be the temporary skin discoloration and the cost — I found estimates online of $30 to $80 per treatment. Some people have it only “as needed” but others may have it monthly or even more often. Future research could prove that cupping is as good as the claims say it is — but we’ll have to wait for the results of high-quality studies to know if it’s true. Men have to accept many changes as they age — less hair, less muscle — but less sex doesn’t have to be one of them. In fact, 54% of men over age 70 are still sexually active, according to research in the January 2016 issue of Archives of Sexual Behavior.

What many men do need to change, however, is their mindset about this next phase of their sex lives. “Many continue to focus only on the physical aspect, so when issues like erectile dysfunction or unpredictable sex drives arise, it can trigger guilt, anxiety, and frustration,” says Dr. Sharon Bober, director of the Sexual Health Program at Harvard-affiliated Dana-Farber Cancer Center.

One way to overcome this barrier is to think less about intercourse and more about “outercourse.” This means to direct your attention and energy more on foreplay and manual stimulation with your partner. “The emphasis is on intimacy and closeness rather than performance,” says Dr. Bober. “This allows men to become less stressed and more engaged in connecting with their partner.”
What you can do

Here are some ways to better embrace outercourse:

Recreate date night. Make an effort to go out on a scheduled basis and experience something new together. It could be a hobby or an event you both have always wanted to check out, or even a quick day or overnight trip. “Doing something different can offer a sense of excitement that can bring you and your partner closer together,” says Dr. Bober. “Couples need to have romance and novelty to be emotionally, mentally, and physically stimulated.”

Focus on the nonsexual. When was the last time you and your partner just hugged, kissed, and explored each other’s bodies without the goal of sex? “Couples may say they don’t do that anymore because they are married, but do not underestimate the excitement of re-exploring the early rituals of courtship,” she says.

Mix up your sex routine. “Give each other a massage as part of foreplay, or try a different setting or time of day, like having sex in the morning when you both may be well rested,” says Dr. Bober. “Just having a conversation about how to change up the regular routine can be fun and exciting.”
Changes in desire

Men can lose interest in sex at times, but that is normal, says Dr. Bober. It often occurs because the sexual connection between your mind and body is out of sync. During these periods, it can be helpful to engage more in the mental side of sex, such as erotic thoughts, fantasy, and memories, says Dr. Bober. “This kind of mental engagement can be quite pleasurable for men without needing physical stimulation, and eventually it can help the mind and body reconnect.”

Desire also can wane if you are not involved with anyone. But again, do not feel under pressure to fill that part of your life. “You need to ask yourself if it bothers you,” says Dr. Bober. “If it is not something on your radar right now, no need to worry about it. You will know when you are ready for affection.”

Do not forget to take care of yourself so you can continue to enjoy your sex life. Many medical conditions can affect sexual drive and performance, such as obesity, diabetes, heart disease, high blood pressure, and high cholesterol. “If you want to be active, you have to stay active, and that means focusing on your exercise routine and being diligent about a proper diet and medical check-ups,” says Dr. Bober.
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