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VIEWS: 72 PAGES: 12 CATEGORY: Business POSTED ON: 12/15/2010 Public Domain
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Episodes 1. Peepshow Pioneers (1889-1907) Audiences were watching projected images as early as the 18 th century. But the pictures were drawings, and they didn't move. That would come in the 1880s. The first movie pioneers were self-taught engineers and tinkerers, itinerate entertainers and street-smart showmen. The first film producer was probably the man known as "The Wizard of Menlo Park," Thomas Edison. He perfected a machine that created pictures that moved, although much of the credit belongs to his assistant, W.K.L. Dickson, the industry's first director. From the beginning, American movies were special, but they were influenced by breakthroughs overseas. From France, the brothers Lumiere, owners of a family photography lab, brought scenes of everyday life to the screen, while an ingenious magician, George Melies, created special visual effects that still have the power to amaze. In America, early moviegoers were astonished and amused by almost anything that moved – from vaudeville acts and boxing matches to three-minute gag reels. After a series of odd jobs, ambitious Edwin S. Porter found motion pictures in the early 1890s. While working for Edison, Porter was soon shooting and selling his own. Porter would create one of the first movies with a story, The Great Train Robbery. At the turn of the 19th century, while the movies were being born, America was experiencing a burst of technological ingenuity. The country's social fabric was being transformed by millions of new immigrants. The newcomers arrived with dreams, and many came with the will and imagination to make those dreams come true. The first generation of American moviemakers joined with other innovators and entrepreneurs to create a totally new kind of entertainment and an art form that would transform the world. Adolph Zukor, once a successful furrier, joined with Marcus Loew in 1905 to establish a string of "penny arcades." Zukor would eventually found Paramount Pictures, and Loew would create a major theater chain. Carl Laemmle, the future founder of Universal Pictures, was another immigrant entrepreneur who saw promise in making a penny or nickel at a time. The Warner family settled in Youngstown, Ohio. Four brothers – Harry, Albert, Sam and Jack – started their movie careers as itinerate showmen, screening movies from town to town. From Hungary came William Fox, who was raised in poverty but found movies a path to success. Louis B. Mayer was the son of an immigrant junk dealer who, like other founding moguls, began as a theater owner. New York quickly became a business and distribution center, but the first "Hollywood" was in Ft. Lee, N.J. Here, the first great American film director, D.W. Griffith, learned his trade and began to develop the foundations of motion picture storytelling. The popularity of movies was unprecedented, and so was the profit potential. Realizing this, Edison joined a group of investors and equipment manufacturers, including Eastman Kodak, to corner the market. They established the Motion Picture Patents Company and demanded royalties from anyone who made movies. The pressures of the trust forced independents to look elsewhere, to the far-reaches of Los Angeles, with the safety of the Mexican border a short distance away. An unlikely southern California hamlet was about to become the world famous capital of motion pictures. 2. The Birth of Hollywood (1907-1920) The U.S. Supreme Court eventually declared the motion picture trust an illegal monopoly but, by then, movie production was firmly established in Los Angeles and the semi-rural suburb of Hollywood. The earliest studios emerged from sites as diverse as a former downtown Chinese laundry to barns and open farmland. Early movies were short, at 10 to 20 minutes, but Adolph Zukor saw the promise in longer films. Inspired by the theater, he conceived of a company based on "Famous Players in Famous Plays" and made longer movies with higher ticket prices, setting a new standard. In 1913, Jesse Lasky, a musician and successful vaudeville producer, created a partnership with his brother-in-law Samuel Goldfish (better known by the name he adopted later, Goldwyn), a glove-maker, and Cecil B. DeMille, an actor and theater manager. The three formed a company and started making movies. In California, their first production was The Squaw Man, a successful Broadway play. It became one of the movie-capital-to-be's first, feature-length productions. At the same time, the movies were developing distinctive kinds of stories. Animation was one of the earliest, led by newspaper cartoonist Winsor McCay. Comedies were always popular. The streets of the city were regularly turned into makeshift locations, where Mack Sennett's Keystone Kops careened and damsels in distress awaited a last minute rescue. Comely Mable Normand was the first great screen comedienne. Rotund Roscoe "Fatty" Arbuckle was another pioneering comedy star. In 1913, Sennett made his most famous discovery: a minor English music hall performer, Charlie Chaplin. In a few short years, Chaplin was the most famous and highest paid actor in the world. The long-lasting appeal of westerns was established by 1910 with the adventures of G.M. "Broncho Billy" Anderson, square-jawed William S. Hart and dashing Tom Mix, who captivated a growing movie audience that was eager for fresh product. While the motion picture business was being born, so was a new kind of model for industrial production: the assembly line. The pioneering moguls took the mass production model to heart and built facilities to handle all aspects of movie production. They called them studios, but they were really factories for manufacturing dreams. Producer Thomas Ince built one of the earliest dream factories near the beach at Santa Monica. In 1915, Carl Laemmle topped Ince by constructing an entire town in the San Fernando Valley dedicated to motion picture production. It was called Universal City. Although Hollywood was emerging as a movie capital, Ft. Lee, N.J., was still churning out pictures, many of them low- budget serials shot on the cliffs of the Palisades, overlooking the Hudson River. Literally "cliffhangers," these episodic adventures often featured female stars like Pearl White. They were an inspiration to a new generation of women looking for freedom and independence. Behind the cameras, women also played major roles during the early days of movie making. French-born Alice Guy-Blache was directing as early as 1896, and she owned a Ft. Lee studio in the early teens. Lois Weber was a successful director at Universal, and Frances Marion was one of Hollywood's most prolific and influential screenwriters. When Francis Marion joined with Mary Pickford, motion picture history was made, and the foundations of the star system were laid. With the help of Marion's scripts, Pickford became one of the most famous women in the world. Soon, stars were demanding fortunes for their work. Charlie Chaplin commanded $125,000 a picture during a time when the average American schoolteacher took home $1,000 a year. Like all the founding moguls, Samuel Goldfish was tough and determined, and he knew an opportunity when he saw it. But he wasn't a man who worked well with others. He formed a partnership with two producers from the theater, the Selwyn brothers, and created a company that combined syllables from their names – Goldwyn Productions. Goldfish also took the name for himself, becoming Samuel Goldwyn. As the early movie moguls were building the movie business, D.W. Griffith was leading the way in refining and expanding motion picture storytelling. The Birth of a Nation was a major landmark and a startling indication of the power of the new medium. Its racist imagery resulted in protests but, for the vast majority of Americans, the movie was an enormous hit. President Woodrow Wilson called it "history written with lightning." As a New England theater owner, the profits from showing The Birth of a Nation allowed Louis B. Mayer to move from exhibition to production. He set up his new company on the site of a former zoo on the east side of Los Angeles. He joined other fledgling companies, all eager to profit from the motion picture boom. Theater owners like Marcus Loew were building the first picture palaces, and D.W. Griffith challenged audiences with complex epics like Intolerance. But audiences were looking more for entertainment and new stars. William Fox turned the daughter of a Cincinnati tailor into exotic Theda Bara, the Vamp, and one of Hollywood's first sex symbols. Less mysterious, Douglas Fairbanks represented a generation ready for action and eager to climb the ladder of success. Although most in the industry preferred to project positive images, there were filmmakers in the teens that didn't hesitate to deal in controversy to push social reform or to sell tickets. Such "message movies" would be a small but persistent staple of motion pictures for decades to come. Thomas Ince tried to sell a peace message as World War I raged in Europe. When the United States entered the conflict, Hollywood joined, and often led, the patriotic parade. Movie stars raised billions in war bonds, and the moguls hoped their efforts would stave off criticism of their business and threats of government censorship. With the end of the war, America and its allies emerged victorious. With the European economy and film production in shambles, it was also a victory for Hollywood. American movies soon dominated national and international markets, and the nation's moguls and movie stars were poised for a golden era of art and profit. 3. The Dream Merchants (1920-1928) By the 1920s, making movies was the fifth biggest business in America and about to become bigger. In 1921, Hollywood studios enjoyed a record year, producing 854 features. By 1922, nearly 40 percent of Americans went to a picture show every week. The 1920s saw the first flowering of the major studios that would dominate the business for decades. Each was headed by strong-willed leaders, many of whom were little more than small-time entrepreneurs just years before. One early movie mogul came from a very different background. William Randolph Hearst inherited a mining fortune and turned his profits into a newspaper empire. By the 1920s, he'd added movies to his media portfolio and mixed business with pleasure with a lifelong love affair with actress Marion Davies. Hearst's studios produced movies, while his newspapers provided the publicity that Hollywood needed. The moguls were careful to keep on his good side. The 1920s also marked the first great era of mass-market fame, with movie stars at the heart of a celebrity-infused society. One of the greatest stars of the period was Rudolph Valentino. Valentino tangoed his way to the top of Hollywood in The Four Horseman of the Apocalypse. As a male sex symbol, he was the center of an industry that was pushing boundaries of propriety, a heritage of Hollywood's peepshow past. Despite their humble beginnings, it was clear that Hollywood movies were more than simple entertainment. They were setting standards in fashion and everyday attitudes and behavior. If the era was called the Roaring '20s, it was also a time of moral backlash. Prohibition attempted to bring sobriety to the party, and morality watchdogs were angered and concerned by what they saw on screen. Their worst fears seemed to be confirmed when comedian Roscoe "Fatty" Arbuckle was accused of raping a young starlet during a boozy San Francisco party. The press, led by William Randolph Hearst, convicted Arbuckle well before the jury in a third trial pronounced him innocent. Another scandal surrounding the unsolved murder of director William Desmond Taylor tarnished the images of fun-loving Mabel Normand and virginal-looking Mary Miles Minter. Hollywood responded to growing calls for censorship by establishing their own arbiter of good taste, Will Hays. Hays established a list of do's and don'ts. Hollywood filmmakers, especially Cecil B. DeMille with his biblical epics, promised to be good, even though they found ways to mix sin and salvation to keep audiences interested, with a minimum of offense to high moral standards. As moguls and their all-inclusive studio system grew more powerful, their control over all aspects of the business – from story creation, production, distribution and exhibition – increased. Of all the great studios of the 1920s, MGM was known as "the class act," under the leadership of Louis B. Mayer and "boy wonder" producer Irving Thalberg. Even in his 20s, Thalberg's taste, story sense and executive skills made him widely admired. Though plagued by poor health, that didn't stop the young studio chief from taking on independent and imperious director Erich von Stroheim – and firmly putting himself, the producer, in charge. Audiences went to see stars, not studios. But without studios, there could be no stars. It was a source of a conflict that runs through the history of Hollywood. To maintain control over their work – and the profits from their pictures – Charlie Chaplin, Mary Pickford, Douglas Fairbanks and D.W. Griffith formed a new distribution company, United Artists, in 1919. But the moguls and their studio monopolies were hard to break. Even so, stars like Chaplin thrived, and a new generation of comic icons emerged with individual styles and audience appeal. If Mack Sennett started the laughter, Hal Roach, a former faro dealer and Yukon gold prospector, kept it going when he established a studio and hired his friend Harold Lloyd as his first star. Unlike the exaggerated humor of the Sennett studios, Lloyd was an everyman with a pair of glasses as his trademark. An expressionless face personified Buster Keaton's intricate brand of physical humor. The silent comedy of Chaplin, Lloyd and Keaton set standards that are still emulated, and rarely topped, today. By the 1920s, motion pictures had created a world of their own in the imaginations of millions of theatergoers. Movie fantasy and real life came together with the unexpected death of Rudolph Valentino in 1926. The outpouring of public grief was greater than that for the passing of U.S. President Warren G. Harding three years before. The pervasive power and influence of the movies began to attract financiers as well as showmen. One of the most successful was Joseph P. Kennedy, father of a future president and two distinguished U.S. senators. Joe Kennedy helped forge the future of the movie business with mergers, focusing Hollywood power and East Coast money. With radio magnate David Sarnoff and other investors, he formed RKO from a consortium of theater, radio and motion picture interests. An affair with superstar Gloria Swanson also gave him a more intimate view of the business, but not enough savvy to avoid a chastening experience as a producer of Queen Kelley, a disastrous Swanson film, directed by ever over-reaching Erich von Stroheim. The founding moguls may not have been sophisticated financiers like Joseph Kennedy, but they had the gut instincts of showmen. One of Louis B. Mayer's most successful finds was Greta Garbo, perhaps the most luminous star of the 1920s and '30s. Clara Bow was another studio discovery who captured the spirit of the 1920s with her energy and unapologetic lifestyle. Not all Hollywood discoveries were actors. Like Irving Thalberg, Darryl F. Zanuck came from a humble background. Fter starting as a screenwriter for canine movie star Rin Tin Tin, Zanuck's drive and story sense took him to the top at Warner Bros. By 1927, the moguls and movies stars celebrated their success and influence with a new organization, The Academy of Motion Picture Arts and Sciences. Publically dedicated to honoring Hollywood excellence, the Academy was also an effort to stave off a growing union movement by providing an in-house organization to deal with disputes over credit and salaries. The first Academy Awards was a modest affair. There were two Best Picture winners, the lyrical Sunrise and William Wellman's air combat adventure Wings. Wellman's struggles with his studio bosses would be rerun with other directors in the years to come, but Sunrise and Wings also showed how silent films had matured, reaching toward a new kind of visual language. Then, at its height of expressive power and profits, the silent era came to an unexpected end. 4. Brother, Can You Spare a Dream? (1929-1941) There had been sound movies as early as Thomas Edison's experiments in the 1890s. But, in 1927 synchronized sound films like The Jazz Singer loudly declared an end to an era that was truly larger than life. William Fox and Sam Warner and others envisioned the era of sound, even as almost every other movie chieftain hoped the talkies would simply go away. In the end, what went away were thousands of silent films, lost or discarded in the rush into a new era. An international economic depression compounded the confusion during the first years of the talkies. Burdened by debt and theater mortgages, the Hollywood moguls were not immune. William Fox was the first to fall. Despite a string of memorable horror films such as Frankenstein and Dracula, Carl Laemmle was forced to sell Universal Studios in 1935. The movie business was hit hard, but Depression-era America needed escape and entertainment more than ever. With major investments from Wall Street and far-sighted bankers like the Italian immigrants the Giannini brothers, founders of Bank of America, Hollywood staged a comeback. Radio, however, had also become an important source of entertainment. Radio was free and, during the hard times of the 1930s, broadcasts offered a low-cost alternative to Hollywood movies, producing a new generation of stars who talked. At first, movie moguls tried to ignore the challenge of radio. In the end, they absorbed it, adding new faces and recognizable voices like Bing Crosby to the new age of sound. Perhaps the most prominent victims of the era of sound were great silent comics like Buster Keaton and Harold Lloyd. Only Charlie Chaplin maintained the creative and financial control over his work that allowed him to survive. The talkies introduced a new generation of comedians, notably the Marx Brothers, whose anarchic humor was perfect for the turmoil of the 1930s. While silent stars such as Greta Garbo survived the transition to talk, others like Clara Bow faded and new ones rose, including Katharine Hepburn, Bette Davis, James Cagney and Edward G. Robinson. To supply words, the moguls, many of them semi-literate, needed writers. Playwrights, novelists and hard-boiled newspapermen like Herman Mankiewicz and Ben Hecht were drafted to deliver punchy dialogue. The arrival of sound also led to a flood of musicals. The films of Busby Berkeley were filled with energy and visual dazzle, while Fred Astaire introduced a kind of song and dance that focused on head-to-toe virtuosity, rather than Berkeley's kaleidoscopic spectacles. Shirley Temple was another 1930s singing and dancing movie superstar. Her charm and talent was a tonic for Depression times. For floundering Fox studios, she was a godsend. Her films were relatively inexpensive to make and enormously profitable. Paramount was struggling during the 1930s, but a quite different actress sashayed to the rescue. Mae West was known for overblown sex appeal and double entendres that pushed the boundaries of a new Production Code. In 1935, West was the highest paid woman in America but, as Hollywood self-censors clamped down, West's career began to fade, another example that fame could be fleeting. Former jeweler Lewis J. Selznick learned about the perils of fame when he entered the motion picture business in the 1910s. It wasn't long before tough competitors like Adolph Zukor and Louis B. Mayer forced him into bankruptcy. But his sons, David and Myron, were not so easily defeated. David O. Selznick would go on to lead a new generation of Hollywood moguls, and Myron Selznick would become a powerful and influential agent. Movie power extended far beyond studio walls. Washington politicians coveted Hollywood money and on screen influence. The moguls courted elected representatives to keep the government out of their business. When novelist and avowed socialist Upton Sinclair looked like he might win the race for California governor in 1934, the conservative studio chiefs launched a political counterattack. MGM, led by Irving Thalberg, produced a series of fake newsreels, giving the impression that a Sinclair victory would lead to a flood of freeloaders that would bankrupt the state. Sinclair was defeated. It was the kind of surreptitious power play well-known among the moguls, as Thalberg would experience first hand. Hollywood's "boy wonder" was widely admired for the quality of his work, but his delicate health and growing power were a source of concern for Louis B. Mayer and his New York bosses. After Thalberg experienced a serious heart attack in 1932, they took the opportunity to limit his influence while he was recuperating in Europe. It was a coup that Thalberg couldn't fight. Even so, when he died at age 37, the MGM producer was honored and mourned as an industry icon, a rare example of the meeting of art and commerce that was the ideal, if not the reality, of Hollywood success. Breaking into the ranks of Hollywood power wasn't easy, but the heir of a Texas oilman had enough money to make it easier. Howard Hughes arrived in the movie capital in the 1920s and spent four million dollars on his 1930 aerial epic Hells Angels. From the beginning, Hughes understood that action was important, but sex could sell even more tickets. He featured slinky Jean Harlow, who became a major star of the 1930s at MGM. Harlow was a reminder that movie fame was based on illusion. On-screen, she was the epitome of playful sexiness. Off- screen, Harlow enjoyed cooking, hemstitching and looked forward to being a mother. But Louis B. Mayer was master of manipulating imagery. He paired Harlow with a star with male sex appeal. Unpretentious and manly Clark Gable was a star who appealed to both men and women. While most Hollywood moguls emphasized glamour and good times, Darryl Zanuck at Warner Bros. was convinced that controversy could sell tickets. I Am a Fugitive from a Chain Gang was a devastating indictment of the Southern penal system and led to prison reform, proving the power of motion pictures beyond simple entertainment. From the beginning, moviemaking was a gambler's game, and it attracted the tough and driven. For independent Samuel Goldwyn, a former glove salesman, it was usually "my way or no way." Unlike other moguls who surrounded themselves with huge staffs and vast studio facilities, Goldywn was virtually a one-man band. He often mortgaged his house to raise money to make his movies. But that didn't stop him from being an important Hollywood player. Harry Cohn was another studio chief who demanded total control. Columbia Pictures started as a low-budget enterprise in a Hollywood neighborhood known as Poverty Row. Foul-mouthed and abusive, Cohn cursed and fought with everyone, but director Frank Capra could talk back. It Happened One Night took Columbia and Harry Cohn to the respectability of the Academy Awards, and the populist comedy-dramas of Frank Capra were emblematic of Depression-era America. Even at the peak of power and influence, the movies still allowed room for ambitious entrepreneurs who worked at the margins of the business. One of the most notable was Oscar Micheaux, an African-American who thrived in the world of "race" pictures, films made for an often stereotyped or ignored black audience. Like women and Jewish immigrant moguls, Micheaux projected his image of the American dream. A far more famous independent moviemaker, who shaped and reflected the American Dream of the 1930s, was a former Kansas City commercial artist. Walt Disney's ink and paint hero, Mickey Mouse, quickly became world famous. His cartoon short, The Three Little Pigs, provided a cheeky anthem for the era – "Who's Afraid of the Big Bad Wolf?" Disney was the first animation producer to win an Academy Award, and his feature-length Snow White and the Seven Dwarfs was one of the most profitable films of all time. He is considered a true visionary, more comparable to Thomas Edison than to Louis B. Mayer or Adolph Zukor. In 1939, Hollywood enjoyed a peak year, with great pictures and great profits. The Wizard of Oz was not an immediate hit, but its growing fame represented the creative power of the Hollywood studio system and the persistence of movie magic. David O. Selznick's Gone with the Wind was the most successful movie of its time. Even though it was set in the Civil War, the trials of Scarlett O'Hara mirrored the dislocations and uncertainty of the Depression for 1930s audiences. It was an unsettling time for the mostly Jewish movie moguls. With the rise of Nazism and anti-Semitism, they hesitated to speak out, fearing the loss of European markets and calling attention to their Jewish roots in an America with anti-Semitism of its own. In the end, history decided. A war in Europe overtook the United States, and America and the movie business would never be the same. 5. Warriors and Peacemakers (1941-1950) In 1940, America was poised on the edge of war, but the Depression refused to release its grip on the country. The Grapes of Wrath, based on the novel by John Steinbeck, directed by John Ford and starring Henry Fonda, captured the time with powerful imagery as movies had done before and would do again in the decades to come. With the Hollywood studio system at its peak, a young outsider arrived to shake things up. In his early 20s, Orson Welles was already a legendary theater actor, director and radio innovator. Given unprecedented independence at RKO, Welles produced Citizen Kane, a motion picture landmark. A thinly veiled biography of magnate William Randolph Hearst, Citizen Kane created a backlash from Hollywood's elite, especially Louis B. Mayer, who feared offending Hearst and his influential newspapers. In a staunchly anti-war America, Charlie Chaplin was independent and brave enough to ridicule Hitler and Mussolini in The Great Dictator. But all hesitancies in Hollywood and America ended on Dec. 7, 1941. The attack on Pearl Harbor thrust the United States into a world war, and moguls and movie stars joined the fight. Warner Bros.' Casablanca debuted, even though the picture might not have been made months before, when anti-war spirit was high. Humphrey Bogart's change of heart from cynicism to idealism reflected a new mood in America. Jack Warner and other movie moguls paraded around their studios in tailor-made uniforms as Hollywood Colonels. Popular stars such as Jimmy Stewart, Tyrone Power and Clark Gable volunteered for the war for real, while other actors, such as Ronald Reagan, made training films. Some of Hollywood's most distinguished directors, including John Ford, George Stevens, William Wyler, John Huston, and especially Frank Capra, made propaganda films and documentaries. Led by Bette Davis and John Garfield, many actors participated in the war effort by supporting the Hollywood Canteen, where off-duty servicemen could meet and dance with their on-screen idols. The Hollywood moguls offered versions of combat and life in the military. John Wayne, a civilian who rarely participated in war-support efforts, exemplified the American fighting man – brave, honest and devoted to his combat buddies. On the home front, Louis B. Mayer envisioned the ideal America in the MGM Andy Hardy series, starring talented and versatile Mickey Rooney. The team of Rooney and young Judy Garland created an inspiring vision of young America, singing and dancing their hearts out on behalf of the American Way. In Meet Me in St. Louis, starring Garland, MGM celebrated family and home, offering hope for a post-war America. Movie stars like Garland not only entertained, they were familiar icons during uncertain times. Cary Grant was one of the most versatile actors of 1930s and 40s Hollywood, equally adept at comedy, drama and romance. On-screen, Grant was the very image of suave self-confidence but, in fact, had come from humble roots, born Archie Leach in Bristol, England. Hollywood gave him an image that even he envied. "I wish I was Cary Grant," he once said. With a rising death toll featured in newspaper headlines, wartime audiences looked for laughs. They were provided by the irreverent writer/director Preston Sturges. In films like Hail, the Conquering Hero, Sturges enjoyed tweaking overblown patriotism and, in The Miracle of Morgan's Creek, slipped past the censors with the comic dilemma of young girl who finds herself pregnant after a patriot party with no idea of who is her husband. Sullivan's Travels mocked Hollywood pretensions to deal with serious issues rather than popular entertainment. With the end of World War II, America celebrated the sacrifices and successes of the past four years. Samuel Goldwyn's The Best Years of Our Lives captured the poignancy and complexity of the new, post-war nation. The 40s were a decade of major changes. The transformation of Humphrey Bogart from a tough hood in High Sierra to romantic hero in To Have and To Have Not represented the power of possibilities that had driven America from its earliest days. In 1946, a peak year for the Hollywood box office, the moguls were confident they had mastered the movie business. But audiences had changed. Film Noir represented a darker vision that was born during the Depression and war. At the same time, women had tasted independence as defense workers while men were away. Joan Crawford had once been a carefree flapper; in the 1940s, she portrayed a conflicted but strong willed career woman. In the movies, women may have been exploring new roles in American life. Behind the cameras, it was very much a man's world. As stars, women were pampered, but they were prized property. The moguls borrowed and traded studio stars like valuable playing cards. Contracts were ironclad. If a star balked on taking a role, the lost time was added to their seven-year commitment. One actress, Olivia de Havilland, was brave enough to challenge the system in court, and she won. It was a major victory for Hollywood stars and the beginning of the end of unchallenged mogul power. Agents like Myron Selznick and Charles Feldman also took on the moguls, but the greatest threat was centered in a new player, Music Corporation of America, MCA, led by Jules Stein and Lew Wasserman. A former optometrist, Stein entered the entertainment business by representing dance bands in mob-ruled Chicago. His Cleveland-born protégé, Wasserman, impressed the entrenched movie moguls with his cool manner and quick intelligence. Through mergers and buyouts of other agencies, Stein and Wasserman began to build a new kind of Hollywood power base, built on talent, not production or theaters. The United States and its allies were victorious during World War II and "saved the world for democracy," but there was a lot of unfinished business in American life. As they searched for new audiences, moviemakers began to explore plotlines that reflected continuing injustices in "the land of the free." Home of the Brave exposed racial prejudice, and Gentleman's Agreement faced the realities of anti-Semitism in the United States. In Gentleman's Agreement, Gregory Peck represented a new generation of politically active and principled leading men and a new spirit that would bring conflict to Hollywood and America. In the late 1940s, a growing labor movement added to the threats to mogul power, while the fear of Communism was spreading. The House Committee on Un-America Activities was formed and turned its attention to the powerful image- makers of Hollywood. Investigators were convinced that Communists were poisoning American movies with Red propaganda. When 10 writers, most notably Dalton Trumbo, refused to cooperate with the committee, they were sent to jail. Again, concerned about their image and government interference in their business, the moguls promised to rid the movies of radicals. The Black List had begun to haunt Hollywood. But there was an even greater threat coming from the U.S. Supreme Court. In 1948, in a decision known as the Paramount Decree, the court declared studio control of production and exhibition through theaters an illegal monopoly. The moguls would have to divest themselves of their highly profitable theaters. The days of guaranteed screenings were a thing of the past. Then, if that wasn't enough, a blinking little box began to appear in American households. Television had arrived, and Hollywood was staring at a small-screen giant killer. 6. Attack of the Small Screens (1950-1960) During the 1950s, with war behind and prosperity all around, moguls and movie stars should have felt confident and secure, but the ground was already shifting beneath their studio empires. The Paramount Decree had stripped them of their lucrative theater chains, while audiences were on the move to the suburbs, leaving big-city theaters behind. Despite this, moguls were convinced that business as usual could see them through. Hollywood was a close-knit society that had changed little since the 1920s. Old-fashioned entertainment like Singin' In The Rain was an example of American movie entertainment at its best. But it also featured a new star, dancer/director Gene Kelly. Unlike elegant Fred Astaire, Kelly was an everyman hero, a product of the war years and a suggestion that audience tastes were changing. Even though Hollywood moguls refused to see television as a serious threat, the movie business wasn't standing still. In 1951, to his stunned surprise, Louis B. Mayer learned that his regular contract as MGM's production chief would not be renewed by his New York boss. Once the highest paid executive in America and one of Hollywood's most powerful men, Mayer was out of a job. He was the first of the founding moguls to feel the impact of a newly emerging entertainment era. Others would follow. "Bigger is better" had long been a mantra in Hollywood. To counterattack the popularity of TV, moviemakers produced widescreen epics, enhanced with stereo sound. They turned to technical tricks like 3-D to sell tickets, though audiences soon tired of their glasses and were still glued to their TVs. While former studio contract players like Lucille Ball were triumphing on television, Hollywood's moguls were still convinced that only the big screen could produce a major star like Judy Garland. Ironically, Garland's career was on a downward slide when she made A Star is Born in 1954. By then, television was producing a new generation of talent that would begin to transform movie making. With talent from TV and the Broadway stage, New York was re-emerging as a motion picture creative center, a position it hadn't held since the rise of Hollywood in the 1920s. Writer Paddy Chayefsky wrote a television drama called Marty that became an Academy Award-winning film. Starring Ernest Borgnine and Betsy Blair, Marty was far from glamorous, but audiences responded to the black-and-white movie's simplicity and romantic realism. Stars like Elizabeth Taylor and newcomer Montgomery Clift had old-fashioned, big-screen appeal, but the arrival of Marlon Brando was a game-changer. His raw energy and emotional intensity peeled the veneer off traditional Hollywood glamour. A Streetcar Named Desire and On the Waterfront were tough and gritty. The screenwriter for On the Waterfront was Budd Schulberg, son of Paramount studio chief B.P. Schulberg. The younger Schulberg was a rebel. His 1941 novel, What Makes Sammy Run?, was the unapologetic story of an amoral, backstabbing screenwriter. For the moguls, Schulberg was a traitor whose fiction was too close to fact. Schulberg also cast a jaundiced eye on the growing power and manipulative influence of television in A Face in the Crowd. The younger, post-war generation was more independent and demanding than their parents. And they had money to spend. During the '50s, with films such as Blackboard Jungle, a powerful youth audience emerged. Moody and mercurial James Dean expressed their sense of alienation and idealistic frustration. Dean's untimely death in 1955 brought a budding career to an end, but the young audience would only grow in power and influence. Despite a persistent image of innocence and conformity, the 1950s were a time of turmoil and uncertainty. On-screen, this was reflected in a breakdown of old censorship rules, but there was a continuing ambiguity about sex. Eccentric Howard Hughes was unabashed in promoting Jane Russell's bosom in 3-D, but the appeal of Marilyn Monroe was more complex. Her child-like persona was sexy but unthreatening to men, and she had a voluptuousness that real women found hard to compete with. Like before, Hollywood tried to have it both ways with sex – featuring flesh and risqué behavior whenever possible but professing to travel the moral high road. In fact, studio "casting couches" were common, and many aspiring young actresses had to pay a personal price to get a chance in Hollywood. At the same time, The Moon Is Blue was banned in many cities when a character used the word "virgin." The ban was overturned in court, a sign that heavy-handed censorship was on the wane. If Hollywood treated sex with an unsettling mix of public moralizing and private hypocrisy, in the 1950s there were even scarier things to worry about. With the Hollywood blacklist still in full force, there was the shadow of the atomic bomb and a new Cold War with the Soviet Union that produced an atmosphere ripe for fear and recrimination. Politically outspoken Charlie Chaplin was a surprising victim of a moral and political backlash. Challenged in a nasty paternity suit and criticized for avoiding American taxes by never becoming a citizen, Chaplin was barred from returning to the United States during a trip to Europe. Outraged, he decided to live in exile in Switzerland. Chaplin had first come to the United States as an ambitious immigrant. Many of the founding movie moguls were immigrants, and transplants from Europe provided a regular infusion of new talent in Hollywood. There were stars such as Greta Garbo, Marlene Dietrich and Peter Lorre and director Ernst Lubitsch and writer/director Billy Wilder. Wilder's insider/outsider point of view gave his films a rare mix of cynicism and sentiment. In Sunset Blvd., he took an unvarnished look at Hollywood fame. Starring silent-era legend Gloria Swanson, Wilder's film also featured former director Erich von Stroheim and former comic great Buster Keaton, who were living reminders of the often abrupt rise and fall of Hollywood success. Alfred Hitchcock was another immigrant success story. Mixing suspense, the macabre and sublimated sex, Hitchcock's films had a distinct personality. Many featured cool blond heroines like Grace Kelly, but his demure wife Alma was the English director's off-camera anchor and an important influence on his work. An acknowledged master producer/director by the 1940s, during the 1950s Hitchcock was more widely known as the host and producer of a successful television series. Another movie mogul, Walt Disney, was even more influential on the small screen and a major visionary for the future of American entertainment. While he was realizing his dream of Disneyland, Disney made a deal with ABC for a television series that promoted the theme park as it recycled old Disney movies. Movie audiences in the 1950s were still unwilling to give up old stories and stars, but they demanded something new. Established Hollywood icon Gary Cooper appeared in High Noon, an example of one of the oldest movie genres, the Western, but with a new twist that reflected contemporary issues and uncertainties. No longer a fearless hero, Cooper played a sheriff with doubts and anxieties that matched 1950s sensibilities. High Noon was produced by Stanley Kramer, an independent movie maker attracted to social and political issues. In the late '50s, a new civil rights movement was rising. Kramer responded with The Defiant Ones, starring Tony Curtis and Sidney Poitier as escaped prisoners who were handcuffed together. The Defiant Ones was a dramatic appeal for a bond between the races, and Poitier stood for a proud, new generation of African-Americans. More than a message movie about racial equality, The Defiant Ones also represented a shift in Hollywood's producing power. It was released by United Artists, an old company founded in 1919 by Mary Pickford, D.W. Griffith, Charlie Chaplin and Douglas Fairbanks, but reborn in 1951 under new leadership and a vision that challenged the old monopolies. UA was known as "the studio without walls," a company that provided funding and distribution to independent producers and then split the profits. As old studio dominance in Hollywood weakened, actors like John Wayne and Burt Lancaster started their own production companies, eager to make the movies they wanted and play the parts that appealed to them. Lancaster's Sweet Smell of Success was a dark view of the power of newspaper columnists, and the life-and-death role of publicity in the often-cutthroat world of American entertainment. If the success of UA suggested the end of the old studio system, the fate of RKO was a confirmation. By 1957, RKO – the former home of Katharine Hepburn, Astaire, Rogers and King Kong – was sold to General Tire and Rubber Company, which was eager to acquire the studio's films to sell to television. During the 1950s, a new source of Hollywood power and a new mogul were changing the course of motion-picture history. Battles for control between stars and studios were well established, but agency MCA and super-agent Lew Wasserman added an influential new victory by convincing Universal to pay Jimmy Stewart a lower acting fee in exchange for half of the profits from the Western Winchester '73. It marked a redistribution of income of a major kind in Hollywood. Wasserman and MCA had even greater ambitions to transform the movie business. Working with one of their early clients, Ronald Reagan, who was the president of the Screen Actors Guild, the agency got a waver that allowed them to represent talent and also produce television programs. In 1962, when MCA bought Universal Studios outright, the agency was the most powerful force in Hollywood. By the late 1950s, Lew Wasserman was at the top of his game, just as the old founding moguls began to pass from the scene. William Fox died in 1952. Louis B. Mayer followed in 1957. The next to go was Paramount co-founder Jesse Lasky. A surprisingly large crowd showed up for the funeral of Harry Cohn in 1958. Harry Warner, the brother who controlled the purse strings at Warner Bros., also passed away the same year as Cohn. Jack Warner, Sam Goldwyn, Darryl Zanuck and David O. Selznick survived, but a scrappy new generation of low budget independent producers was leading the way to a new future for Hollywood. The movies of Roger Corman were made cheap and fast, featured up-and-coming stars, writers and directors and had huge appeal for the youth market. More important for the standards of motion picture success, they made money at the box office. With the 1960s looming, movie insiders surveyed the Hollywood landscape and wondered: Would Hollywood have a sequel and, if so, who would make it? 7. Fade Out, Fade In (1960-1969) During the 1960s, America experienced jarring changes not seen since the 1930s. In many ways, the movies were caught in a social, political and artistic crossfire. It was a time of the last of the old and the first of the new. President John F. Kennedy was as handsome as a movie star and natural in the powerful new medium of television. He also knew Hollywood power firsthand. His father, Joseph, was a co-founder of RKO Pictures in 1928. The mix of politics and movie making was decades old, an uneasy legacy of self-interest and influence. In 1960, another political legacy still shadowed Hollywood – the anti-Communist Black List. To survive, black-listed writers were forced to work undercover, using pseudonyms and "fronts." This tragic charade reached an absurd peak when an unknown writer named Robert Rich received an Academy Award for the story of The Brave One. In fact, Robert Rich was Dalton Trumbo. It finally took the courage of actor/producer Kirk Douglas and others to publically acknowledge the sham. When Douglas credited Dalton Trumbo as the writer of Spartacus, the death grip of the Black List was broken. The gradual end of the Black List didn't mean the end of the importance of politics in Hollywood and of movies in Washington, D.C. Agent Lew Wasserman and his astute wife, Edie, were major power brokers between the movie capital and Pennsylvania Avenue. Wasserman may have been a progressively minded Democrat, but he was coolly pragmatic, never allowing political preferences to affect an important deal. Wasserman realized that the new world of entertainment being born in the 1960s was more than movies. He envisioned a modern, multimedia empire. When MCA tried to purchase Universal Studios in 1962 and combine talent representation and production, U.S. Attorney General Robert Kennedy saw a monopoly in the making and issued a cease-and-desist order. Faced with legal action, Wasserman chose the production business. It was a shrewd move, and Wasserman began to rebuild Universal as a movie and television powerhouse. One of Wasserman's most famous clients was director Alfred Hitchcock. The low-budget films of the 1950s that pushed the borders of sex and violence attracted Hitchcock, and his success in television had given experience in economical production methods. The result was Psycho. Another early 60s film with edgy violence was Whatever Happened to Baby Jane? Veteran actors Bette Davis and Joan Crawford were known for their daring, and they weren't afraid to take risks to stay in the spotlight. A violent and gleefully grotesque film, Whatever Happened to Baby Jane? was an indication that the search for success in 1950s Hollywood could sometimes look desperate. Tragedy continued to haunt the history of motion picture fame. In 1962, Marilyn Monroe was found dead, an empty bottle of sedatives nearby. Hearing the news, half-forgotten 1920s sex symbol Clara Bow said, "A sex symbol is a heavy burden when one is tired, hurt and bewildered." While Monroe was dead, in the 1960s, star power still seemed immortal. While struggling 20 th Century Fox was looking for a hit, they turned to one of the biggest stars of the day, Elizabeth Taylor. The project was Cleopatra, and Taylor's star power didn't come cheap. Neither did a lavish historical drama. Soon, the budget was almost out of control, and Fox was teetering on the edge of insolvency. Semi-retired Darryl Zanuck, the studio's largest stockholder, was called in. He pushed aside longtime president Spyros Skouras, another immigrant mogul who started as a theater owner, and took charge. One of his first decisions was to install his 27-year-old son, Richard, as studio production chief. Slowly, young Zanuck backed Fox away from the precipice – a corporate cliff-hanger worthy of a Pearl White serial. The world was hanging on a cliff of its own in the 1960s with the growing threat of nuclear war. One young filmmaker, Stanley Kubrick, turned the situation into a black-humored farce, Dr. Strangelove, that captured a new irreverence in 1960s Hollywood. Kubrick was fiercely independent and moved to England as his fame and power grew. At the corporate level, the revival of United Artists, led by brothers Harold, Walter and Marvin Mirisch, marked a major shift in Hollywood power and another blow to the old studio monopolies. UA was a place where independent producers could get their films financed and distributed while maintaining maximum creative control. A spirit of independence had emerged in post-war Europe as well, and it influenced and inspired young American filmmakers. The Mirisch brothers translated Japanese director Akira Kurosawa's Seven Samurai into a Western, The Magnificent Seven. In France, rebellious new directors, including Francois Truffaut and Jean-Luc Godard, rejected staid stories and production methods and launched "the New Wave." Ironically, the young European radicals admired studio masters like John Ford and Alfred Hitchcock. They called them "auteurs," the true authors of their films. Their Hollywood idols were both flattered and amused. Who's Afraid of Virginia Woolf? signaled a new era in Hollywood. Based on the play by Edward Albee, and starring Elizabeth Taylor and Richard Burton, the movie was filled with profanity and violence that was unthinkable in an American film only a few years before. Director Mike Nichols was theater-trained and thoroughly American in his style, but his work also reflected the new maturity of European films. An increasing seriousness and complexity gave rise to unlikely new players in Hollywood's power structure – critics. Andrew Sarris and Pauline Kael were two of the most prominent. Kael made an important contribution to the success of Bonnie and Clyde. Developed as a project for Truffaut by two novice screenwriters, David Newman and Robert Benton, Bonnie and Clyde was championed by a first time producer, up-and-coming movie star Warren Beatty. When Beatty succeeded in getting the movie made and paid for by a reluctant Jack Warner, old Hollywood was astonished. Filled with violence and a jagged cutting style, the film took the gangster movie that was a staple of the 1930s and made it new – too new for traditional critics like Bosley Crowther of The New York Times. Pauline Kael's reviews in The New Yorker and elsewhere reached a more open-minded movie audience. Soon, less hidebound critics joined in to help make Bonnie and Clyde a surprise hit with a growing younger audience. Mike Nichols tapped this young audience in his second film, The Graduate, a romantic love story set against an environment of uncertainty and alienation. Nichol's success showed other filmmakers and stars that there were broader horizons for American movie makers. During the 1960s, in the search for ever-bigger profits and new audiences, American movies were becoming increasingly international – with exotic locations and multinational funding. Lawrence of Arabia was a major example. So was the hugely profitable James Bond series. The adventures of 007 also exemplified a new way to maximize profits and audiences – a series of sequels that became known as a film franchise. With all the social change of the 1960s, it wasn't surprising that message movie producer Stanley Kramer would attempt to reflect the times. Guess Who's Coming to Dinner starred Hollywood veterans Spencer Tracy and Katharine Hepburn, but it attempted to be cutting-edge by telling the story of a cross-racial romance, starring Sidney Poitier and Hepburn's niece, Kathryn Houghton. Kramer may have seen his film as daring and controversial, but traditional audiences loved it and rebellious youth thought it was ridiculous. Change came faster than ever before. At Fox, Richard Zanuck found this out when he brought his studio back with blockbuster hits like The Sound of Music, one of the most profitable movies of all time. But all it took was a couple of overblown misfires like Star, Hello, Dolly and most of all, Dr. Doolittle, to put Fox and Zanuck on a downward slide. Showing that Hollywood power has no time for sentiment where profits are concerned, Richard Zanuck's father, Darryl, the studio's chairman, returned from France and fired his son. It wasn't long before the old man was gone, too, a powerless figurehead who would die nine years later. By the end of the 1960s, perhaps the only man who wielded old-style mogul power was Lew Wasserman, now in charge at Universal. He was a widely respected and feared Hollywood force. At the same time, the foundations of old Hollywood were being absorbed and subdivided. Cash-strapped studios began to sell off their back lots to real estate developers. If studio power was no longer concentrated in sound stages, it added a new dimension with the election of Ronald Reagan as governor of California and his first run for the presidency. His overwhelming rise to the White House in the 1980s was the peak of a long relationship between movie imagery and politics. In the 1960s, as governor, Reagan faced down student protestors at the University of California at Berkeley as an escalating war in Vietnam threatened to tear the country apart. From the earliest days, traditional Hollywood hesitated to confront controversy. In the '60s, only ionic motion picture warrior John Wayne was willing to issue a call to arms in The Green Berets. The 1968 Academy Awards Ceremony represented the stability of an old and honored Hollywood tradition as well as a divided film community. Best Picture nominees The Graduate and Bonnie and Clyde represented a new Hollywood influenced by Europe. The old guard was Dr. Doolittle. The more current liberal film was In the Heat of the Night, and the traditional message movie was Guess Who's Coming to Dinner? In the last two films, Sidney Poitier also represented a shifting image of African-Americans on screen. In Guess Who's Coming to Dinner? he was polite and perfect. In In the Heat of the Night, he confronts racism head-on, and his film was a big Oscar winner. With all its timeliness, In the Heat of the Night was still a big studio film. In 1968, a black-and-white zombie movie budgeted at $114,000, Night of the Living Dead, became a $42 million, international hit. The threat to the survival of old Hollywood wasn't zombies; it was from a very alive and very young generation, eager to break down studio walls. They found a way in by proving their skills with low budget producers like Roger Corman. Inspired by Corman's example, actors Dennis Hopper and Peter Fonda produced Easy Rider in 1969, a drug-addled biker movie that was everything old Hollywood was not – irreverent, outspoken, undisciplined. The only thing Easy Rider shared with Gone with the Wind was big profits. Midnight Cowboy also broke old Hollywood precedents and won an Academy Award. This X-rated adventures of a male prostitute roaming the alleys and backstreets of underground New York – perhaps more than any other film of the 60s – announced that 50 years of old-fashioned filmmaking was coming to an end The wave of buyouts and takeovers that marked the 1960s provide more tangible evidence of the changes. Giant conglomerates, with little experience in entertainment or moviemaking, took over Paramount, UA, Warner Bros. and eventually even MGM. Disney was one of the few studios that remained untouched. As the studios lost their old identities, the last of the founding moguls passed from the scene. But their legends had just begun. For Hollywood, it was both a fade-out and a fade-in. A new generation with names such as Coppola, Spielberg, Lucas and Scorsese was about to emerge, bringing new movies – along with new respect for the films and the filmmakers of the past. The history of the movies and the generations of men and women who made them had led the world on an amazing journey. A mix of art and commerce, technology and emotion, the world of Hollywood could be as crass and cruel as it was inspiring, influential and entertaining. To some, making movies was simply a means to money and fame. To others – producers, directors, writers, performers, and teams of studio artisans and technicians – it was the pleasure and passion of turning frames of film into an evocation of life itself and a powerful kind of mythology that reflected and shaped the history of America and the world.
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Publications (205)1017.41 Total impact
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Article: Trends, Clinical Outcomes, and Cost Implications of Mitral Valve Repair Versus Replacement Concomitant With Aortic Valve Replacement[Show abstract] [Hide abstract]
ABSTRACT: This study evaluated national trends, clinical outcomes, and cost implications of mitral valve (MV) repair, versus replacement, concomitant with aortic valve replacement (AVR). Patients who underwent MV surgery concomitant with AVR, between 1999 and 2008, were identified in the Nationwide Inpatient Sample (NIS) registry. Mitral stenosis, endocarditis, and emergency cases were excluded. Inpatient clinical outcomes and costs were compared. Costs were derived using cost-to-charge ratios supplied by the dataset for each individual hospital. Multivariable logistic and linear regression analyses were used for risk adjustment. A total of 41,417 concomitant cases were identified, of which 11,472 (28%) were MV repairs. Repair rates increased from 15.3% in 1999 to 43.5% in 2008 (P < .001). Major postoperative morbidity rates were similar with MV repair, versus replacement, concomitant with AVR (each 29%, P = .54). Unadjusted inpatient mortality (7.9% vs 10.1%, P = .005); length of hospital stay (median: 8 vs 9 days, P < .001); and costs (median: $45,455 vs $49,648, P < .001) were lower with MV repair. After risk adjustment, MV repair was associated with lower odds of inpatient mortality, and with lower costs (each P < .001). Mitral valve repair concomitant with AVR is associated with reduced inpatient mortality and costs, compared with MV replacement, supporting its use when technically feasible. Although use has increased substantially, MV repair continues to comprise a minority of concomitant AVR cases, in centers reporting to the NIS registry. Increasing repair rates, particularly in NIS-participating hospitals, seems prudent. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.Journal of Thoracic and Cardiovascular Surgery 02/2015; 149(6). DOI:10.1016/j.jtcvs.2015.02.044 · 3.99 Impact Factor
- The Annals of Thoracic Surgery 02/2015; 99(4). DOI:10.1016/j.athoracsur.2014.11.034 · 3.63 Impact Factor
Conference Paper: 387332 Dendrimer Nanotherapies for the Treatment of Brain Injury Following Hypothermic Circulatory Arrest in a Large Animal Model[Show abstract] [Hide abstract]
ABSTRACT: Hypothermic circulatory arrest (HCA) can lead to neurological complications including stroke, seizures, neurocognitive dysfunction, and delayed neuropsychomotor development in many patients. Neuroinflammation and excitotoxicity have been identified as key factors leading to the brain injury after HCA. The treatment has remained a challenge, with no suitable therapeutic options. Valproic acid (VPA) has been explored in this model, and offers some neuroprotection against excitotoxicity with a large dose, but leads to systemic side effects. Similarly N-Acetylcysteine (NAC) is known to be effective in reducing neuroinflammation, but large doses are required due to poor blood-brain barrier (BBB) penetration and insufficient brain localization. To overcome these challenges, we are exploring systemic, combination therapies targeted to activated microglia and injured neurons, using dendrimers. We use a well-established, clinically relevant canine model.1 Using fluorescently labeled, hydroxyl-terminated polyamidoamine (PAMAM) dendrimers, we showed that systemically administered dendrimers can cross the impaired blood-brain-barrier, and target activated microglia and injured neurons, with minimal uptake in the healthy cells in the brain.1,2 Based on above mentioned findings, we developed glutathione-sensitive dendrimer-NAC (D-NAC) and dendrimer-VPA (D-VPA) conjugates in multi-gram quantities for fast intracellular release. In preliminary efficacy studies, combination therapy with D-NAC and D-VPA produced improvement in 24-hour neurological deficit score comparable to combination therapy with VPA and NAC at 10-30 fold higher doses, while significantly reducing the adverse side effects. This study highlights the potential of dendrimer-drug therapies of two clinically approved drugs in HCA-indued large animal model.1These are the first dendrimer nanotherapy studies in a large animal brain injury model. References * Dendrimer brain uptake and targeted therapy for brain injury in a large animal model of hypothermic circulatory arrest.Mishra MK, Beaty CA, Lesniak WG, Kambhampati SP, Zhang F, Wilson MA, Blue ME, Troncoso JC, Kannan S, Johnston MV, Baumgartner WA, Kannan RM. ACS Nano. 2014 Mar 25;8(3):2134-47. * Dendrimer-based postnatal therapy for neuroinflammation and cerebral palsy in a rabbit model. Kannan S, Dai H, Navath RS, Balakrishnan B, Jyoti A, Janisse J, Romero R, Kannan RM. Sci Transl Med. 2012 Apr 18;4(130):130ra46.14 AIChE Annual Meeting; 11/2014
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ABSTRACT: Neuropathology and neurologic impairment were characterized in a clinically relevant canine model of hypothermic (18°C) circulatory arrest (HCA) and cardiopulmonary bypass (CPB). Adult dogs underwent 2 hours of HCA (n = 39), 1 hour of HCA (n = 20), or standard CPB (n = 22) and survived 2, 8, 24, or 72 hours. Neurologic impairment and neuropathology were much more severe after 2-hour HCA than after 1-hour HCA or CPB; histopathology and neurologic deficit scores were significantly correlated. Apoptosis developed as early as 2 hours after injury and was most severe in the granule cells of the hippocampal dentate gyrus. Necrosis evolved more slowly and was most severe in amygdala and pyramidal neurons in the cornu ammonis hippocampus. Neuronal injury was minimal up to 24 hours after 1-hour HCA, but 1 dog that survived to 72 hours showed substantial necrosis in the hippocampus, suggesting that, with longer survival time, the injury was worse. Although neuronal injury was minimal after CPB, we observed rare apoptotic and necrotic neurons in hippocampi and caudate nuclei. These results have important implications for CPB in humans and may help explain the subtle cognitive changes experienced by patients after CPB.Journal of Neuropathology and Experimental Neurology 11/2014; DOI:10.1097/NEN.0000000000000134 · 4.37 Impact Factor
Article: Increased Exposure Improves Recruitment: Early Results of a Program Designed to Attract Medical Students Into Surgical Careers[Show abstract] [Hide abstract]
ABSTRACT: In recent years, general surgery and surgical subspecialty residency interests have remained somewhat static among medical students, casting some doubt on recruitment of the best students. A summer research program was designed to introduce interested medical students to surgical careers. In 2003, the division of cardiac surgery instituted an 8-week structured summer research experience for second-year medical students. Three students were competitively chosen from a pool of 20 to 30 interested applicants every year. They were taught basic operative suturing and knot-tying techniques. Students participated in large animal research projects, witnessed clinical operations, and developed individual clinical projects with an attending cardiac surgeon. The summer experience culminated with oral presentations to the cardiac surgery division, with many students producing manuscripts for publication or presentation at national meetings. From 2003 to 2012, 30 students participated in the program. Of 23 participants who had applied for residency, 12 (52.2%) matched into general surgery or a surgical subspecialty, including 3 into plastic surgery, 2 into cardiothoracic surgery, 1 into orthopedic surgery, and 1 into neurosurgery. These students produced 64 publications and presented at 51 national and regional meetings. These results suggest that an 8-week, structured program introducing students to cardiothoracic surgery can successfully attract students into surgical careers. The percentage (52%) of these students entering a surgical career compares favorably with national residency match results (16%) and graduating Johns Hopkins medical students (22%). Increased effort for early exposure to surgery may be a key factor in generating and securing surgical interest among medical students.The Annals of thoracic surgery 04/2014; DOI:10.1016/j.athoracsur.2014.02.029 · 3.65 Impact Factor
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ABSTRACT: This study evaluated changes in physical functional performance after orthotopic heart transplantation (OHT) with particular attention to the impact of recipient age on functional outcomes. Retrospective review of all first-time, single-organ adult OHTs in the United States between 2005 and 2010. Patients were primarily stratified by age. The validated Karnofsky performance scale, which ranges from 0 (death) to 100 (fully independent with no evidence of disease and no complaints), was used to measure functional status. A total of 10,049 OHT recipients were identified, with 1,431 (14%) aged 65 years or greater. Mean Karnofsky score prior to OHT was comparable between cohorts (younger: 50.7 ± 25.2 versus older: 50.1 ± 25.0; p = 0.38). At a median follow-up of 2.1 years (interquartile range 0.7 to 3.3 years), 64% of OHT recipients had improved functional performance. The mean improvement in Karnofsky score was similar between younger and older patients (19.6 ± 42.0 vs 17.5 ± 41.8; p = 0.10). Twenty percent of younger patients were functionally independent prior to OHT, with 67% being functionally independent at last follow-up (p < 0.001). Similarly, in the older cohort, 20% were functionally independent prior to OHT, with 66% being functionally independent at last follow-up (p < 0.001). Multivariable analysis adjusting for potential confounders confirmed that age, both as a continuous and categoric variable, did not impact odds of functional improvement after OHT. Subanalysis using 70 years as the age cutoff produced similar results. In the modern era, OHT is associated with improvements in functional performance in most recipients, and this beneficial effect is preserved across the age spectrum. These data provide a benchmark for functional outcomes after OHT and may have important implications in organ allocation.The Annals of thoracic surgery 03/2014; 97(5). DOI:10.1016/j.athoracsur.2013.12.048 · 3.65 Impact Factor
Article: Dendrimer Brain Uptake and Targeted Therapy for Brain Injury in a Large Animal Model of Hypothermic Circulatory Arrest[Show abstract] [Hide abstract]
ABSTRACT: Treatment of brain injury following circulatory arrest is a challenging health issue with no viable therapeutic options. Based on studies in a clinically-relevant large animal (canine) model of hypothermic circulatory arrest (HCA)-induced brain injury, neuroinflammation and excitotoxicity have been identified as key players in mediating the brain injury after HCA. Therapy with large doses of valproic acid (VPA) showed some neuroprotection, but was associated with adverse side effects. For the first time in a large animal model, we explored whether systemically administered polyamidoamine (PAMAM) dendrimers could be effective in reaching target cells in the brain and deliver therapeutics. We showed that, upon systemic administration, hydroxyl-terminated PAMAM dendrimers are taken up in the brain of injured animals, and selectively localize in the injured neurons and microglia in the brain. The biodistribution in other major organs was similar to that seen in small animal models. We studied systemic dendrimer-drug combination therapy with two clinically approved drugs, N-acetyl cysteine (NAC) (attenuating neuroinflammation) and valproic acid (attenuating excitotoxicity), building on positive outcomes in a rabbit model of perinatal brain injury. We prepared and characterized dendrimer-NAC (D-NAC) and dendrimer-VPA (D-VPA) conjugates in multi-gram quantities, in which a glutathione-sensitive linker is used for fast intracellular release. In preliminary efficacy studies, combination therapy with D-NAC and D-VPA showed promise in this large animal model, producing 24-hour neurological deficit score improvements comparable to high dose combination therapy with VPA and NAC, or free VPA, but at one-tenth the dose, while significantly reducing the adverse side effects. Since adverse side effects of drugs are exaggerated in HCA, the reduced side effects with dendrimer conjugates and suggestions of neuroprotection offer promise for these nanoscale drug delivery systems.ACS Nano 02/2014; 8(3). DOI:10.1021/nn404872e · 12.03 Impact Factor
Article: The STS Annual MeetingThe Annals of thoracic surgery 01/2014; 97(1 Suppl):S9-S15. DOI:10.1016/j.athoracsur.2013.10.014 · 3.65 Impact Factor
Article: General and Acute Care Surgical Procedures in Patients with Left Ventricular Assist Devices[Show abstract] [Hide abstract]
ABSTRACT: Left ventricular assist devices (LVADs) have become common as a bridge to heart transplant as well as destination therapy. Acute care surgical (ACS) problems in this population are prevalent but remain ill-defined. Therefore, we reviewed our experience with ACS interventions in LVAD patients. A total of 173 patients who received HeartMate(®) XVE or HeartMate(®) II (HMII) LVADs between December 2001 and March 2010 were studied. Patient demographics, presentation of ACS problem, operative intervention, co-morbidities, transplantation, complications, and survival were analyzed. A total of 47 (27 %) patients underwent 67 ACS procedures at a median of 38 days after device implant (interquartile range 15-110), with a peri-operative mortality rate of 5 % (N = 3). Demographics, device type, and acuity were comparable between the ACS and non-ACS groups. A total of 21 ACS procedures were performed emergently, eight were urgent, and 38 were elective. Of 29 urgent and emergent procedures, 28 were for abdominal pathology. In eight patients, the cause of the ACS problem was related to LVADs or anticoagulation. Cumulative survival estimates revealed no survival differences if patients underwent ACS procedures (p = 0.17). Among HMII patients, transplantation rates were unaffected by an ACS intervention (p = 0.2). ACS problems occur frequently in LVAD patients and are not associated with adverse outcomes in HMII patients. The acute care surgeon is an integral member of a comprehensive approach to effective LVAD management.World Journal of Surgery 12/2013; 38(4). DOI:10.1007/s00268-013-2403-0 · 2.35 Impact Factor
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ABSTRACT: Patients undergoing aortic operations with hypothermic circulatory arrest (HCA) may require prolonged rewarming, a maneuver associated with impaired cerebral blood flow (CBF) autoregulation. The purpose of this study was to determine the effects of HCA on CBF autoregulation with a validated method based on near-infrared spectroscopy. Regional cerebral oxygen saturation (rSco2) was monitored in 25 patients undergoing aortic reconstructive operations. HCA was used in 13 patients. Autoregulation was measured continuously during the operation by calculating the linear correlation coefficient between low-frequency changes in rSco2 and mean arterial pressure (MAP), generating the variable cerebral oximetry index (COx). When CBF autoregulation is functional, COx is near 0, because CBF and MAP are not correlated, but approaches 1 when autoregulation is impaired (ie, CBF is pressure passive). On the basis of prior studies, impaired autoregulation was defined as COx exceeding 0.3. COx did not differ between HCA and non-HCA groups before cardiopulmonary bypass or during the cooling phase of the operation, although the lower limit of autoregulation tended to be lower in patients before HCA (p = 0.053). During patient rewarming, COx was lower in the HCA group (p = 0.045), and abnormal COx was less frequent (31% vs 75%, p = 0.047) compared with the non-HCA group. During aortic reconstructive operations, CBF autoregulation is preserved during the cooling phase of the procedure in patients undergoing HCA. Perfusion maneuvers associated with HCA may be protective against impaired autoregulation during rewarming compared with the non-HCA group.The Annals of thoracic surgery 12/2013; 96(6):2045. DOI:10.1016/j.athoracsur.2013.07.086 · 3.65 Impact Factor
Article: Understanding variability in hospital-specific costs of coronary artery bypass grafting represents an opportunity for standardizing care and improving resource use[Show abstract] [Hide abstract]
ABSTRACT: This study was undertaken to examine interhospital variability in inpatient costs of coronary artery bypass grafting (CABG). The Nationwide Inpatient Sample was used to identify isolated CABGs performed between 2005 and 2008 in the United States. Charges for inpatient care were supplied by the data set, and hospital charge-to-cost ratios were used to derive inpatient costs for each patient and aggregated at the hospital level. Mixed-effect linear regression models were created to evaluate variability in costs between hospitals adjusting for 34 patient, operative, complication, and hospital-related variables. A total of 633 hospitals performed isolated CABG in 183,973 patients. In unadjusted analysis, there was significant baseline variability in average inpatient costs of CABG between hospitals (SD, $12,130; P < .001). This variability represented 30% of the overall unadjusted average cost of performing CABG per hospital ($40,424). After risk adjustment, significant variability in average costs between hospitals persisted (P < .001). Of the 34 additional variables included in the model, only hospital region, postoperative sepsis, in-hospital mortality, and need for ventricular assist device, extracorporeal membrane oxygenation, permanent pacemaker, or implantable cardioverter-defibrillator were stronger predictors of increased costs compared with the hospital effect. There is a wide variation in the cost of performing CABG in the United States. We determined that individual hospital centers, independent of multiple patient- and outcome-specific factors, are drivers of these differences. Comparison of hospital-specific behavior with identification of the causes of cost discrepancies represents an opportunity for standardization of care and improvement in resource use.The Journal of thoracic and cardiovascular surgery 10/2013; 147(1). DOI:10.1016/j.jtcvs.2013.08.024 · 3.99 Impact Factor
- The Journal of thoracic and cardiovascular surgery 03/2013; 145(6). DOI:10.1016/j.jtcvs.2013.02.059 · 3.99 Impact Factor
Article: Ventricular Assist Device Implantation in the Elderly: Nationwide Outcomes in the United States[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: The aim of this study was to evaluate nationwide outcomes of ventricular assist device (VAD) implantation in elderly patients in the United States. METHODS: Patients undergoing VAD implantation between 2003 and 2008 were identified in the Nationwide Inpatient Sample. The primary outcome was inpatient mortality following VAD implantation. Secondary outcomes included disposition following discharge and costs of care. After stratification based on primary versus postcardiotomy VAD support, outcomes were compared between controls aged 60-69 years and elderly patients aged ≥70 years. RESULTS: A total of 2787 patients aged 60-69 years and 1472 patients aged ≥70 years underwent VAD implantation during the study period. Unadjusted mortality rates were comparable between elderly and control patients in both primary support (35.7% vs. 32.1%, p = 0.61) and postcardiotomy support (58.1% vs. 56.1%, p = 0.70). Similarly, in risk-adjusted multivariable logistic regression analysis incorporating clinically relevant variables, age ≥70 did not exert an independent effect on inpatient mortality for either indication. Inpatient costs in the elderly were lower than controls in the primary support cohort, although costs per day were similar, with comparable overall costs between age groups in the postcardiotomy cohort. Elderly survivors were discharged to a facility more frequently than control survivors (primary: 49.9% vs. 29.6%, p = 0.007; postcardiotomy: 67.4% vs. 45.7%, p = 0.03). CONCLUSIONS: This large-cohort population-based analysis provides a useful framework for inpatient prognosis and resource utilization in elderly patients undergoing VAD implantation. Although mortality rates and costs were found to be comparable between elderly patients and those aged 60-69 years, these rates were nonetheless significant. This combined with more frequent discharge-to-facility in elderly survivors underscores the importance of careful patient selection in this population.Journal of Cardiac Surgery 02/2013; 28(2). DOI:10.1111/jocs.12066 · 0.89 Impact Factor
Article: The Role of Head Computed Tomography Imaging in the Evaluation of Postoperative Neurologic Deficits in Cardiac Surgery Patients[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: Computed tomography (CT) scans of the head without contrast are routinely obtained to evaluate neurologic deficits after cardiac surgery, but their utility is unknown. We evaluated our experience with this imaging modality to determine its value. METHODS: We retrospectively identified cardiac surgery patients with postoperative neurologic deficits occurring during the first week after surgery between January 2000 and December 2012. Stroke was defined by neurologist's determination, whereas a nonfocal deficit (NFD) was defined by the presence of seizure, delirium, or cognitive impairment. We defined early noncontrast head CT as occurring within 7 days of surgery. Outcomes included positive findings on CT, in-hospital mortality, and length of stay. Multivariate logistic regression identified predictors of positive findings on head CT. RESULTS: Within the population of 11,070 postoperative patients, 451 had early noncontrast head CT scans (4%). Two hundred two (44.7%) were associated with stroke, and 249 (55.2%) were associated with NFD. Among stroke patients, 40 of 202 (20%) showed acute infarction, 17 of 202 (8%) showed subacute infarction, and 5 of 202 (2%) showed hemorrhage. Among NFD patients, 1 of 248 (0.4%) showed acute infarction, 4 of 248 (1.6%) showed subacute infarction, and 1 of 248 (0.4%) showed hemorrhage. There was no difference in in-hospital mortality (stroke, 42 of 201 [21%] versus NFD, 41 of 248 [16%]; p = 0.2) or length of stay (stroke, 24 d versus NFD, 22 d; p = 0.5). On multivariable logistic regression, only focal deficits and aortic procedures predicted a positive finding on CT scan. CONCLUSIONS: This study reviewed the utility of early postoperative noncontrast head CT in cardiac surgery patients. With focal neurologic deficits, this imaging modality was positive for approximately one third of patients, but rarely positive for NFD. Its use in this setting has limited utility.The Annals of thoracic surgery 12/2012; 95(2). DOI:10.1016/j.athoracsur.2012.11.006 · 3.65 Impact Factor
Article: Institutional Factors Beyond Procedural Volume Significantly Impact Center Variability in Outcomes After Orthotopic Heart Transplantation[Show abstract] [Hide abstract]
ABSTRACT: : To evaluate the contribution of institutional volume and other unmeasured institutional factors beyond volume to the between-center variability in outcomes after orthotopic heart transplantation (OHT). : It is unclear if institutional factors beyond volume have a significant impact on OHT outcomes. : The United Network for Organ Sharing registry was used to identify OHTs performed between 2000 and 2010. Separate mixed-effect logistic regression models were constructed, with the primary endpoint being post-OHT mortality. Model A included only individual centers, model B added validated recipient and donor risk indices as well as the year of transplantation, and model C added institutional volume as a continuous variable to model B. The reduction in between-center variability in mortality between models B and C was used to define the contribution of institutional volume. Kaplan-Meier survival curves were also compared after stratifying patients into equal-size tertiles based on center volume. : A total of 119 centers performed OHT in 19,156 patients. After adjusting for transplantation year and differences in recipient and donor risk, decreasing center volume was associated with an increased risk of 1-year mortality (P < 0.001). However, procedural volume only accounted for 16.7% of the variability in mortality between centers, and significant between-center variability persisted after adjusting for institutional volume (P<0.001). In Kaplan-Meier analysis, there was significant variability in 1-year survival between centers within each volume category: low-volume (66.7%-96.6%), intermediate-volume (80.7%-97.3%), and high-volume (83.8%-93.9%). These trends were also observed with 5-year mortality. : This large-cohort analysis demonstrates that although institutional volume is a significant predictor of post-OHT outcomes, there are other unmeasured institutional factors that contribute substantially to the between-center variability in outcomes. Institutional volume should therefore not be the sole indicator of "center quality" in OHT.Annals of surgery 09/2012; 256(4):616-23. DOI:10.1097/SLA.0b013e31826b4bc9 · 7.19 Impact Factor
Article: Operative outcomes in mitral valve surgery: Combined effect of surgeon and hospital volume in a population-based analysis[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE: We evaluated the combined effect of hospital and surgeon volume on operative outcomes of mitral valve surgery in the United States. METHODS: The Nationwide Inpatient Sample was used to identify adult patients undergoing isolated mitral valve surgery for mitral regurgitation from 2003 to 2008. Hospitals and surgeons were separately stratified into equal-size tertiles according to annual overall mitral valve operative volumes. Multivariate logistic regression analysis was conducted, adjusting for multiple patient, hospital, and operative data, to determine the separate and combined effects of hospital and surgeon volume on operative outcomes. RESULTS: A total of 50,152 eligible patients were identified during the study period. Although both hospital and surgeon volume correlated significantly with operative mortality in separate risk-adjusted analyses, only lower surgeon volume persisted as a significant risk factor in the combined risk-adjusted analysis. Moreover, although hospital volume only accounted for 10.7% of the surgeon volume effect on increased mortality for low-volume surgeons, surgeon volume accounted for 74.5% of the hospital volume effect on increased mortality in low-volume hospitals. Surgeon, but not hospital, volume correlated with inpatient costs. Also, significant trends were seen with repair rates, with increasing surgeon volume demonstrating a relatively stronger correlation with the odds of repair (P < .001) than hospital volume (P = .01). CONCLUSIONS: The effect of hospital volume on operative outcomes of mitral valve surgery was largely driven by the individual surgeon volumes within that hospital. Conversely, surgeon volume affected these outcomes independently of hospital volume. Identifying the processes by which higher volume surgeons attain better outcomes in mitral valve surgery would therefore be prudent.The Journal of thoracic and cardiovascular surgery 08/2012; 146(3). DOI:10.1016/j.jtcvs.2012.07.070 · 3.99 Impact Factor
Article: Risks for impaired cerebral autoregulation during cardiopulmonary bypass and postoperative stroke[Show abstract] [Hide abstract]
ABSTRACT: Impaired cerebral autoregulation may predispose patients to cerebral hypoperfusion during cardiopulmonary bypass (CPB). The purpose of this study was to identify risk factors for impaired autoregulation during coronary artery bypass graft, valve surgery with CPB, or both and to evaluate whether near-infrared spectroscopy (NIRS) autoregulation monitoring could be used to identify this condition. Two hundred and thirty-four patients were monitored with transcranial Doppler and NIRS. A continuous, moving Pearson's correlation coefficient was calculated between mean arterial pressure (MAP) and cerebral blood flow (CBF) velocity, and between MAP and NIRS data, to generate the mean velocity index (Mx) and cerebral oximetry index (COx), respectively. Functional autoregulation is indicated by an Mx and COx that approach zero (no correlation between CBF and MAP); impaired autoregulation is indicated by an Mx and COx approaching 1. Impaired autoregulation was defined as an Mx ≥0.40 at all MAPs during CPB. Twenty per cent of patients demonstrated impaired autoregulation during CPB. Based on multivariate logistic regression analysis, time-averaged COx during CPB, male gender, Pa(CO(2)), CBF velocity, and preoperative aspirin use were independently associated with impaired CBF autoregulation. Perioperative stroke occurred in six of 47 (12.8%) patients with impaired autoregulation compared with five of 187 (2.7%) patients with preserved autoregulation (P=0.011). Impaired CBF autoregulation occurs in 20% of patients during CPB. Patients with impaired autoregulation are more likely than those with functional autoregulation to have perioperative stroke. Non-invasive monitoring autoregulation may provide an accurate means to predict impaired autoregulation. Clinical trials registration. www.clinicaltrials.gov (NCT00769691).BJA British Journal of Anaesthesia 06/2012; 109(3):391-8. DOI:10.1093/bja/aes148 · 4.35 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The aim of this study was to derive and validate a risk score for rejection after orthotopic heart transplantation. The United Network for Organ Sharing registry was used to identify patients undergoing orthotopic heart transplantation between 1998 and 2008. A total of 14 265 eligible patients were randomly divided into derivation (80%; n=11 412) and validation (20%; n=2853) cohorts. The primary outcome was drug-treated rejection within 1 year of orthotopic heart transplantation. Covariates found to be associated (exploratory univariate P<0.2) with rejection were entered into a multivariable logistic regression model. Inclusion of each variable in the model was assessed by improvement in the McFadden pseudo-R(2), likelihood ratio test, and c index. A risk score was then generated through the use of relative magnitudes of the odds ratios from the derivation cohort, and its ability to predict rejection was tested independently in the validation cohort. A 13-point risk score incorporating 4 variables (age, race, sex, HLA matching) was created. The mean scores in the derivation and validation cohorts were 8.3±2.2 and 8.4±2.1, respectively. Predicted 1-year rejection rates based on the derivation cohort ranged from 16.2% (score=0) to 50.7% (score=13; P<0.001). In weighted regression analysis, there was a strong correlation between these predicted rates of rejection and actual, observed rejection rates in the validation cohort (r(2)=0.96, P<0.001). Logistic regression analysis also demonstrated a significant association (odds ratio, 1.13; P<0.001). The c index of the composite score was equivalent in both the derivation and validation cohorts (c=0.67). This novel 13-point risk score is highly predictive of clinically significant rejection episodes within 1 year of orthotopic heart transplantation. It has potential utility in tailoring immunosuppressive regimens and in research stratification in orthotopic heart transplantation.Circulation 05/2012; 125(24):3013-21. DOI:10.1161/CIRCULATIONAHA.111.066431 · 14.95 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The leading causes of constrictive pericarditis have changed over time leading to a commensurate change in the indications and complexity of surgical pericardiectomy. We evaluated our single-center experience to define the etiologies, risk factors, and outcomes of pericardiectomy in a modern cohort. We retrospectively reviewed our institutional database for all patients who underwent total or partial pericardiectomy. Demographic, comorbid, operative, and outcome data were evaluated. Survival was assessed by the Kaplan-Meier method. Multivariable Cox proportional hazards regression models examined risk factors for mortality. From 1995 to 2010, 98 adults underwent pericardiectomy for constrictive disease. The most common etiologies were idiopathic (n=44), postoperative (n=30), and post radiation (n=17). Total pericardiectomy was performed in 94 cases, most commonly through a sternotomy (n=93). Thirty-three cases were redo sternotomies, 34 underwent a concomitant procedure, and 34 required cardiopulmonary bypass. Overall in-hospital, 1-year, 5-year, and 10-year survival rates were 92.9%, 82.5%, 64.3%, and 49.2%, respectively. Survival differed sharply by etiology with idiopathic, postoperative, and post-radiation 5-year survivals of 79.8%, 55.9%, and 11.0%, respectively (p<0.001). On multivariable analysis, only the need for cardiopulmonary bypass (hazard ratio [HR]: 21.2, p=0.02) was predictive of 30-day mortality while post-radiation etiology (HR: 3.19, p=0.02) and hypoalbuminemia (HR: 0.57, p=0.03) were associated with increased 10-year mortality. Although survival varies significantly by etiology, pericardiectomy continues to be a safe operation for constrictive pericarditis. Post-radiation pericarditis and hypoalbuminemia are significant risk factors for decreased long-term survival.The Annals of thoracic surgery 05/2012; 94(2):445-51. DOI:10.1016/j.athoracsur.2012.03.079 · 3.65 Impact Factor
Article: 159 Impact of Bridging with Ventricular Assist Devices on Long-Term Survival Following Heart TransplantationThe Journal of Heart and Lung Transplantation 04/2012; 31(4):S62. DOI:10.1016/j.healun.2012.01.163 · 5.61 Impact Factor
Top Journals
Johns Hopkins University
Baltimore, Maryland, United States
- • Division of Cardiac Surgery
- • Department of Surgery
- • Department of Neurology
Johns Hopkins Medicine
Baltimore, Maryland, United States
- • Division of Cardiac Surgery
- • Department of Surgery
- • Department of Medicine
Kennedy Krieger InstituteBaltimore, Maryland, United States
University of AmsterdamAmsterdamo, North Holland, Netherlands
National Heart, Lung, and Blood InstituteMaryland, United States
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
- Department of Biostatistics
Oxford University Hospitals NHS TrustOxford, England, United Kingdom
Stanford MedicineStanford, California, United States
Stanford UniversityPalo Alto, California, United States

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NuvoTv Signs Mario Lopez To Development DealGreenlights Second Season of 'Mario Lopez One-On-One' 11/25/2013 12:56 PM Eastern
Hispanic-targeted cable network NuvoTV has signed actor, host and television personality Mario Lopez to an overall development deal, the network announced Monday.
Under the deal, the English-language network has greenlit a second season of interview series Mario Lopez One-on-One, as well as a new dance competition series Salsa In The City (working title). In addition, Lopez will develop three new series for the network, according to officials.
NUVOtv, the premiere English-language network created for the modern Latino audience, today announced that the network has entered into an overall development deal with actor, host and television personality Mario Lopez. Lopez's development efforts for NUVOtv are exclusive in regards to Latino-oriented programming in English.
"I'm absolutely thrilled to expand my relationship with NuvoTV through this development deal," Lopez said. "My creative goals are totally aligned with NuvoTV's commitment to deliver culturally relevant programming for the English-speaking Latino audience."
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