text:
Published online Feb 14, 2008. doi: 10.3748/wjg.14.966
Revised: December 12, 2007
Published online: February 14, 2008
Duplications of the alimentary tract are uncommon congenital malformations that can present diagnostic difficulties. We report a rare case of a cystic colonic duplication in a female adult. Preoperative investigations were suggestive of pancreatic tumor. The diagnosis was established based on the histopathological examination of the resected specimen. We concluded that, though uncommon, intestinal duplication should be considered in differential diagnosis of abdominal mass.
Citation: Carneiro FP, Sobreira MDN, Azevedo AEBD, Alves APR, Campos KM. Colonic duplication in an adult mimicking a tumor of pancreas. World J Gastroenterol 2008; 14(6): 966-968
Duplications of the alimentary tract are uncommon congenital malformations that can occur anywhere in the tract, and are most commonly detected in childhood. Depending on the age of patient, localization, size and shape of the duplications, they may present a diagnostic challenge[1]. We report a rare case of a cystic colonic duplication in an adult mimicking a tumor of the pancreas.
A 43-year-old woman was admitted with a 2-mo history of abdominal pain and mass. Ultrasonography (US) and computerized tomography (CT) showed a cystic mass (Figure 1) in left upper abdomen. In laboratory studies, serum amylase level was elevated at 332 U/L (normal, 0-125 U/L). The preoperative diagnosis was pancreatic tumor and fine needle aspiration biopsy was not performed preoperatively. At laparotomy, a mass was found in the mesenteric border of the transverse colon attached to the colon and pancreas. A distal pancreatectomy was performed with resection of the cyst. On gross examination, the cyst was 6 cm in diameter and contained a serous fluid (Figure 2). Microscopically, the cyst was lined by ulcerated gastric mucosa, submucosa and muscular wall (Figure 3); pancreatic tissue was normal. The patient's pain improved following surgical resection of the mass.
Duplications of the alimentary tract are characterized by attachment to at least one part of the tract, a layer of smooth muscle and epithelial lining resembling some part of the tract[2]. These malformations are formed before differentiation of the lining epithelium, and therefore, are named depending on the associated part of the bowel and not according to the mucosal lining[3]. Gastric mucosa, for example, is frequently observed in the wall of duplications, irrespective of their site of origin in the alimentary tract[4]. The duplications are located on the mesenteric border of the associated native bowel, vary in size and shape (cystic or tubular) and communicate or not with the lumen of the adjacent bowel; the duplication of cystic type usually does not communicate with the lumen of the adjacent bowel and contains serous fluid[1]. In the present case, the duplication was cystic and there was no communication with lumen of the colon.
The diagnosis of intestinal duplication may be difficult and usually is not made preoperatively. The patient may remain asymptomatic or present with a variety of nonspecific signs and symptoms[5]. Similar to our case, these signs and symptoms usually include abdominal mass and pain, often confusing colonic duplication with other diagnoses. Intestinal obstruction[6], bleeding[7] and malignant transformation[8] are all recognized complications. Ulceration, perforation and peritonitis may also occur in cases with ectopic gastric mucosa[9], which is probably the cause of ulceration in our case. In addition, various urogenital and vertebral malformations have been reported but, in the present report, no associated congenital abnormality was observed[5].
In our case, elevated serum amylase, probably owing to compression of the pancreatic duct, associated with the findings of US and CT were suggestive of pancreatic cyst, but some image findings may be helpful in establishing preoperative diagnosis of intestinal duplication. On US, the duplication is characterized by "gut signature" which refers to the hiperechoic inner layer produced by the mucosa surrounded by a hypoechoic outer layer caused by smooth muscle[10]. Peristalsis of the cyst wall has also been noted on ultrasound scan[11]. Contrast barium enema may show communication between the duplication and the normal bowel, with opacification of the two colons[12]; the communication between the duplication cyst and main pancreatic duct may be seen by endoscopic retrograde cholangiopancreatography[13]. Besides this, technetium scan may demonstrate ectopic gastric mucosa in duplication[14].
Previous reports[15–17] have described gastrointestinal duplications mimicking pancreatic tumor. Among them, a case of transverse colon duplication in a child, like in our case, was not suspected before surgery[18]. The differential diagnosis includes in these cases, all neoplastic and non-neoplastic cystic lesions of the pancreas as intraductal papillary-mucinous neoplasm and pseudocyst[19].
The recommended treatment for duplication is complete resection. Sometimes resection of normal intestine must accompany removal of the lesion because of the intimate attachment of the common wall or because isolated resection would compromise blood flow to the adjacent intestine segment[20]. Generally, duplications of the cystic type are easily removed from their attachments to the surrounding tissues[21]. During surgery, diagnosis may be made based on the frozen sections examination of the wall of the duplication[22] but, in our case, it was not performed.
On histopathological examination, ectopic gastric mucosa showed chronic inflammation, lymphoid follicles and ulceration but no H pylori was identified in haematoxilin-eosin and Warthin-Starry silver stains. Previous reports about the role of H pylori in complications of the ectopic gastric mucosa in intestinal duplication were not found. But in most cases of ectopic gastric mucosa in Meckel's Diverticulum, H pylori also is not identified and seems that its presence is not essential to induce "heterotopic gastritis" and its complications[23–25]. In our case, the endoscopic examination was normal, and gastric biopsy was not performed.
In conclusion, we reported a case of cystic colonic duplication in an adult and illustrated the difficulties in making this rare diagnosis that should be considered in differential diagnosis of abdominal mass.
|Iyer CP, Mahour GH. Duplications of the alimentary tract in infants and children. J Pediatr Surg. 1995;30:1267-1270.
|Macpherson RI. Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics. 1993;13:1063-1080.
|O'Neil J, Rowe M. Duplications of the gastrointestinal tract. In: Essentials of Pediatric Surgery. St. Louis, Mo. MosbyYearbook; 1995;520-525.
|Bajpai M, Mathur M. Duplications of the alimentary tract: clues to the missing links. J Pediatr Surg. 1994;29:1361-1365.
|Blickman JG, Rieu PH, Buonomo C, Hoogeveen YL, Boetes C. Colonic duplications: clinical presentation and radiologic features of five cases. Eur J Radiol. 2006;59:14-19.
|Jimenez SG, Oliver MR, Stokes KB, Morreau PN, Chow CW. Case report: Colonic duplication: a rare cause of obstruction. J Gastroenterol Hepatol. 1999;14:889-892.
|Fotiadis C, Genetzakis M, Papandreou I, Misiakos EP, Agapitos E, Zografos GC. Colonic duplication in adults: report of two cases presenting with rectal bleeding. World J Gastroenterol. 2005;11:5072-5074.
|Shivnani AT, Small W Jr, Benson A 3rd, Rao S, Talamonti MS. Adenocarcinoma arising in rectal duplication cyst: case report and review of the literature. Am Surg. 2004;70:1007-1009.
|Bazlul Karim AS, Matiur Rahman MD, Kamal M. Perforation of jejunal duplication lined with ectopic gastric mucosa. J Paediatr Child Health. 2004;40:649-650.
|Barr LL, Hayden CK Jr, Stansberry SD, Swischuk LE. Enteric duplication cysts in children: are their ultrasonographic wall characteristics diagnostic? Pediatr Radiol. 1990;20:326-328.
|Spottswood SE. Peristalsis in duplication cyst: a new diagnostic sonographic finding. Pediatr Radiol. 1994;24:344-345.
|Rathi V, Singh S, Bhargava SK, Kaur N, Seth N. Diagnosis of tubular colonic duplication by barium follow-through study. Australas Radiol. 2005;49:157-159.
|Luckmann KF, Welch RW, Schwesinger W, Oswalt C, Bannayan G. Symptomatic duodenal duplication cyst in an adult demonstrated by endoscopic retrograde cholangiopancreatography. Case report and literature review. Am J Gastroenterol. 1979;72:153-159.
|Emamian SA, Shalaby-Rana E, Majd M. The spectrum of heterotopic gastric mucosa in children detected by Tc-99m pertechnetate scintigraphy. Clin Nucl Med. 2001;26:529-535.
|D'Journo XB, Moutardier V, Turrini O, Guiramand J, Lelong B, Pesenti C, Monges G, Giovannini M, Delpero JR. Gastric duplication in an adult mimicking mucinous cystadenoma of the pancreas. J Clin Pathol. 2004;57:1215-1218.
|Niehues R, Dietl KH, Bettendorf O, Domschke W, Pohle T. Duodenal duplication cyst mimicking pancreatic cyst in a patient with pancreatitis. Gastrointest Endosc. 2005;62:190-192.
|Glaser C, Kuzinkovas V, Maurer C, Glattli A, Mouton WG, Baer HU. A large duplication cyst of the stomach in an adult presenting as pancreatic pseudocyst. Dig Surg. 1998;15:703-706.
|Dutheil-Doco A, Ducou Le Pointe H, Larroquet M, Ben Lagha N, Montagne J. A case of perforated cystic duplication of the transverse colon. Pediatr Radiol. 1998;28:20-22.
|Kosmahl M, Pauser U, Peters K, Sipos B, Luttges J, Kremer B, Kloppel G. Cystic neoplasms of the pancreas and tumor-like lesions with cystic features: a review of 418 cases and a classification proposal. Virchows Arch. 2004;445:168-178.
|Holcomb GW 3rd, Gheissari A, O'Neill JA Jr, Shorter NA, Bishop HC. Surgical management of alimentary tract duplications. Ann Surg. 1989;209:167-174.
|Ildstad ST, Tollerud DJ, Weiss RG, Ryan DP, McGowan MA, Martin LW. Duplications of the alimentary tract. Clinical characteristics, preferred treatment, and associated malformations. Ann Surg. 1988;208:184-189.
|Siddiqui AM, Shamberger RC, Filler RM, Perez-Atayde AR, Lillehei CW. Enteric duplications of the pancreatic head: definitive management by local resection. J Pediatr Surg. 1998;33:1117-1120; discussion 1120-1121.
|Ackerman Z, Peston D, Cohen P. Role of Helicobacter pylori infection in complications from Meckel's diverticulum. Dig Dis Sci. 2003;48:1068-1072.
|Ergun O, Celik A, Akarca US, Sen T, Alkanat M, Erdener A. Does colonization of Helicobacter pylori in the heterotopic gastric mucosa play a role in bleeding of Meckel's diverticulum? J Pediatr Surg. 2002;37:1540-1542.
|Chan GS, Yuen ST, Chu KM, Ho JW, Leung SY, Ho JC. Helicobacter pylori in Meckel's diverticulum with heterotopic gastric mucosa in a population with relatively high H. pylori prevalence rate. J Gastroenterol Hepatol. 1999;14:313-316.


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Detached two storey town house in quiet location. Family home and B&B. Mature gardens. Easy walking distance to centre of planned town of Westport with opportunities to experience its numerous pubs, restaurants and leisure facilities.
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text:
Eversheds has continued to expand its Hong Kong offering with the hire of former Slaughter and May litigation partner Mark Yeadon.
Yeadon, who had worked for Slaughters for 22 years in London and Hong Kong, retired from the firm earlier this summer.
Eversheds Hong Kong managing director Nick Seddon said the firm was still in growth mode in the region, with the goal of becoming a 50-lawyer office by the end of 2011.
He added that he expects to strengthen the corporate and banking teams "in the course of the next few months".
Yeadon, who will work alongside Hong Kong litigation chief Ivan Ng, has strong relationships with the major banks and regulators in Hong Kong.
Seddon commented: "What Yeadon brings is his specialist expertise in regulation, financial services litigation and judicial review work. He'll add to and complement our skill set."
Yeadon said: "Eversheds has an impressive record in dispute resolution and an innovative approach to serving clients, which will enable it to continue to develop from strength to strength."
Slaughters, meanwhile, has moved to augment its dispute resolution offering in Hong Kong following Yeadon's departure by relocating senior associate Mark Hughes to the jurisdiction.


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Level: 31 Subscribe
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Geente hooje vaai ter show dos meninoos ??
great link: http://www.kiss108.com/common/shareme5..
You "Share me" People are really lame, we can obviously see link before we click it. -_-
is this happening or not?
@kaileama AMEN
Its bad enough security won't let us see the boys in person now we can't even see them online!
https://twitter.com/#!/noivadomalik <3
another twitcam! http://www.kiss108.com/common/shareme5..
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Israel upgrades missile-killer Iron Dome
Tel Aviv, Israel (UPI) Jan 22, 2013
Israel's Defense Ministry is testing an upgraded version of Rafael Advanced Defense Systems' combat-tested Iron Dome counter-rocket system that will have "improved capabilities against an unprecedented range of threats." The ministry didn't identify the threats but the upgrade, Iron Dome's second in recent months, follows reports that the Palestinian militants in the Gaza Strip have been test-firing a new long-range missile that could threaten cities in southern and central Israel. The I ... read more
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Welcome to this site dedicated to
La Corporación Latina de PR
For bookings call: 787-902-8367 y 787-982-1677. email: firstname.lastname@example.com
Corporacion Latina was one of the most popular bands of the 70s. Three of their productions won GOLD record awards. These were Orquesta Corporación Latina (1974), Try it and You'll Like It (1975), y Llego Pa' Quedarse (1976). We all remember the hits Desengaño I, II, and III and their singers Melo, Belo, y Guelo.
Lets remember this great band who definetly has won a place in Salsa Clasica.
I invite everyone to get to know their music through this site. Here you'll find information like history, discography, and photos. You'll also find a song index to easily locate the lyrics to any of his songs.
Special thanks to Joe Campanella, trumpet player member of original band for authorizing us to reproduce the history of the band and the use of some of the photos. Also provided us with some of the song lyrics.
If you see an incomplete area and have the lyrics you can send it to me via email to
Thank you and enjoy,


text:
Mary Poppins Reviews
Seen this show? Why not help your fellow Costa Mesa Theater visitors.Write a review
Anonymous from Tucson
Broadway comes to Tucson Go see it!
Helpful? Yes - 1440No - 1448 Report
Suzanne A. NJ transplant from Memphis, Tennessee
I saw Mary Poppins 3 times in NY. Loved it every time. The cast, the music, the scenes and excellent display of talent and visual effects. Going in February, can't wait. So Excited!
Helpful? Yes - 1397No - 1441 Report
Anonymous from Calgary
We went to see Mary Poppins on its opening night in Calgary and we loved the production! We sat in the 2nd Balcony and our seats were good enough as the sound is wonderful anywhere you sit. We especially liked "Supercalifragilisticexpialidocious" with the great dancing as well as "Step In Time" - again with the dancing. There was lots of humor in it, great singing and just nice to see a play from a movie you saw many years ago. There were quite a few children at the Jubilee and they must have all enjoyed it because we only heard a wee bit of chattering near the end. I would take kids to it but probably not under 5 years old as it is a long production even though it does have an intermission. There were a few changes from the movie - "I Love To Laugh" was not in there but there were a few new songs I hadn't heard and it all flowed very well. Highly recommend seeing!
Helpful? Yes - 1437No - 1415 Report
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Fresh off winning billions of dollars in oil tax cuts for the state's big producers, the Parnell administration is now looking at what it may take to finally get a pipeline to bring Alaska's huge natural gas reserves to world markets.
A new report commissioned by the state says natural gas tax cuts, to either royalties or production taxes, will be needed to make that pipeline happen, but Parnell's Department of Natural Resources is drawing attention to a third option: The state owning part of the pipeline, frequently called an "equity" stake.
"An equity alternative, at least from what we see here, would be better in our view ... than a reduction in royalty or a reduction in taxes," said Joe Balash, the department's newly appointed commissioner.
The new look at state ownership of a pipeline comes with the Monday release of a report commissioned from petroleum industry consulting firm of Black & Veatch at a cost of $424,000. The report said the pipeline project -- likely carrying 3 billion cubic feet of natural gas per day and costing about $45 billion -- could be economically viable, and in some scenarios highly profitable. But it would take state changes to make it work.
What's being called the AKLNG project is different from a smaller-volume pipeline proposed by the state's Alaska Natural Gas Development Corp. It would have an LNG export terminal in Nikiski, and provide low-cost gas to Southcentral customers.
"AKLNG project could be economically feasible with changes to the project's cost structure and the state's fiscal framework," the report said.
While the report looked at the possible elimination of royalty and production taxes, Balash said that was not a proposal. "We looked at them for comparison purposes. We're not advocating those steps at all. I think reducing our royalty is the very last thing we should consider," Balash said.
Owning part of a pipeline, maybe a fourth, would give Alaska and the producers a common interest, what Balash called "alignment." But owning part of the pipeline would also provide Alaska with important information, he said.
Some legislators from opposite sides of the oil-tax debate were briefed by Balash on the Black & Veatch report and said Monday they found it intriguing.
"We've been high-centered on natural gas for a long time, this is a real interesting proposal at first take," said Rep. Beth Kerttula, Democratic leader in the Alaska House of Representatives. Sen. Cathy Giessel, R-Anchorage, issued a press release Monday supporting the state owning part of the pipeline, saying it was a particularly useful strategy on such as capital intensive, complex multi-stakeholder investment.
"How a project is structured and how risk and reward are allocated can make or break a project," said Giessel, chair of the Senate Natural Resources Committee.
The Black & Veatch report highlights the benefits of state ownership, but also focuses on potential risks. Those include falling prices, and the chance that the producers might shift costs or revenues to benefit themselves. "These decisions could potentially be to the detriment of the state," the report said.
Under traditional royalties and taxes, state losses are unlikely, but with ownership it is an inherent risk. One of those risks could be in the unregulated LNG liquefaction plant at the pipeline's end. Alaska would also want to make sure its ownership gave it a role in making decisions such as whether to expand the plant if new explorers find more gas on the North Slope.
"If we are not going to be able to expand the facilities when we need to, we will start to question the benefits of equity participation," Balash said. That possibility of new information is why some Alaskans have been long advocating for state ownership, Kerttula said.
"Wally Hickel has been saying for a long time that if we are going to be an owner state perhaps it is time we owned part of it," she said.
Another benefit to state ownership Balash acknowledged: One of the aspects of state ownership is reducing the amount of taxes that go to the federal government, making it truly a win-win for the state and the producers.
"There's a federal tax effect here that plays a part," he said.
Balash said it was too soon to say whether the Parnell administration would propose new legislation next year to implement the report's recommendations.
Contact Pat Forgey at pat(at)alaskadispatch.com


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I have inspiron 15R laptop I wan't to install windows 7 32 bit on my laptop for that I needs drivers which I am trying to get from "http://www.dell.com/support/drivers/in/en/inbsd1/DriversHome/NeedProductSelection" but when I put my service tag "<Admin Note:service tag removed per privacy policy~RK>" it didn't show any drivers for 32 bit
Help me out of this
Welcome to the Community. The Inspiron 15R N5110 only has drivers for Windows 7 64bit on the Dell Support site. So for drivers you will need to go to the manufacturer's site, like Intel, Sigmatel, Nvida and download them.
Thank you


text:
Best Western Plus Irvine Spectrum Hotel
Select your stay dates to check availability
Best Western Plus Irvine Spectrum Hotel
About the hotel
Property Location
With a stay at Best Western Plus Irvine Spectrum Hotel in Lake Forest (Mission Viejo - South Orange County), you'll be close to The Orchard at Saddleback and Verizon Wireless Amphitheater. This hotel is within close proximity of Laguna Hills Mall and Saddleback Memorial Medical Center.
Make yourself at home in one of the 99 air-conditioned rooms featuring refrigerators and microwaves. Rooms have private balconies. Cable programming and video-game consoles are provided for your entertainment, while complimentary wireless Internet access keeps you connected. Private bathrooms with shower/tub combinations feature deep soaking bathtubs and complimentary toiletries.
Rec, Spa, Premium Amenities
Don't miss out on the many recreational opportunities, including an outdoor pool, a spa tub, and a fitness center. Additional features include complimentary wireless Internet access, concierge services, and a television in the lobby.
A complimentary continental breakfast is served daily.
Business, Other Amenities
Featured amenities include complimentary high-speed (wired) Internet access, a 24-hour business center, and express check-in. Free self parking is available onsite.
Hotel Facilities
- Free self parking
- Terrace
- Elevator/lift
- Spa tub
- Express check-in
- Concierge services
- Outdoor pool
- Number of floors - 4
- Year Built 1988
- Luggage storage
- Free WiFi
- Free wired high-speed Internet
- Television in lobby
- Dry cleaning/laundry service
- Total number of rooms - 99
- Express check-out
- Fitness facilities
- Free breakfast
- Multilingual staff
- Laundry facilities
- Free newspapers in lobby
- 24-hour business center
- Number of buildings/towers - 3
Room Facilities
- Free toiletries
- Cribs/infant beds available
- Desk
- Video-game console
- Phone
- Daily housekeeping
- Sofa bed
- Cable TV service
- Refrigerator
- Microwave
- Rollaway/extra beds available
- Iron/ironing board
- Pay movies
- Climate control
- Shower/tub combination
- Hair dryer
- In-room safe
- Deep soaking bathtub
- Separate living room
- Air conditioning
- Free local calls
- Blackout drapes/curtains
- Premium TV channels
- Separate bedroom
- Television
- Balcony
- Free WiFi
- Premium bedding
- Private bathroom
- Coffee/tea maker
Hotel Policy
The following fees and deposits are charged by the property at time of service, check-in, or check-out.
- Pet fee: USD 25 per pet, per night
- Late check-out fee: USD 20.00
The above list may not be comprehensive. Fees and deposits may not include tax and are subject to change.
Mandatory Fees and Taxes
You'll be asked to pay the following charges at the hotel:
- Deposit: USD 100.00 per stay
We have included all charges provided to us by the property. However, charges can vary, for example, based on length of stay or the room you book.Show all hotel policy Show less hotel policy


text:
It's no shock that I love to color my hair and like to experiment. I have been everything from fire engine red to blonde. I figured today, I'd do a post showcasing some of my favorite looks, for what's a possibility for next I absolutely LOVE this color: GORGEOUS!! This ones is fun Read More »»
Get Funky With Your Hair Color, Have Some Fun!
Tea Time With Sophia Grace And Rosie Giveaway
The famous tutu duo made famous on Ellen are coming to you in a whole new way, in a new self titled book called "Tea Time With Sophia Grace & Rosie". I have to admit I have been a bit obsessed with these two cuties watching them on Ellen and when they covered the red carpet. They are so full Read More »»
Keep Covered During Summer Fun. No Show Active Top Review
Summer is here and for us that means lots of time at the local water park as well as the beach. At the water park it's fun to lay in the lazy river but my kids also want to go down the fast slides and hit the body board are, being the cool mom that I am I join in with them. When we are at the Read More »»
Wordless (or Not) Wednesday: View From The 14th Floor
I just returned from a wonderful event at the Hilton Sandestin Beach Golf Resort and Spa. My family and I had a room on the 14th floor (next to top) and the view was amazing. This is just one part of my view, coming later next week I will start sharing more about the trip. Until then, enjoy the Read More »»
New Crystal Light Mocktails
What? A mocktail by Crystal Light? Why yes, it sure is. I will freely admit I don't do alcoholic drinks. I don't like the taste of any alcohol (yes even those sweet dessert wines). If I drink the flavor of the alcohol has to be totally masked so I may as well save myself the money and get mocktails Read More »»
Old Navy *Best Tees* Review
I am a huge fan of old navy for my family. One of our favorite items are their tees. We have tees from Old Navy that are several years old. I just can't bear to get rid of them because they are so comfy. When they wear out their welcome as "places to go" clothes due to stains or whatever they stick Read More »»


text:
More than just about any program in the country Bob Stoops' tenure in Norman has been marked by little known players finding starring roles. From Quentin Griffin to Aaron Colvin Oklahoma has done w...
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text:
TONY McEvoy is dismissing Jimando's last run as a bad day at the office.
And he says he would not push ahead with the Victoria Derby if he was unhappy with the son of Commands.
The horse was in a strop prior to the Norman Robinson Handicap (2000m) at Caulfield last start and finished a flop in the traditional Derby lead-up.
"He was perfect until the jockey got up on him, then he was sweating up and frothing up between his hind legs," McEvoy said.
"All the horses came out and went left up to the barriers, whereas he turned right and just took off with Craig (Williams).
"He was really agitated behind the barriers and it was obvious from then on that he just didn't want to play."
McEvoy had the colt vetted twice without finding a physical explanation for his abject failure.
"His blood picture is perfect, so there are no answers there," McEvoy said.
"Going into a major race, it's a long way from ideal but I've seen this a million times before.
"Jeune ran last in the Cox Plate and came out to win the Melbourne Cup (1994).
"The same year Glastonbury ran last in the Colin Stephen and won the Metro.
"It can happen and sometimes there are just no answers."
Stable jockey Matthew Neilson replaces Williams for the 2500m classic, who has joined forces with Mick Kent maiden, Malabar Man.
McEvoy might be forgiving of his horse but punters have jumped off big time.
The son of Commands is out to $26 with the confidence returning to the chances of It's A Dundeel.
The New Zealand raider was out to $3 after his last week's defeat in the AAMI Vase by Super Cool but has been heavily backed in to $2.60 favourite.
The Mark Kavanagh trained Super Cool is next best in the market at $6.
McEvoy - who has been involved in six Victoria Derby wins with the Hayes family - Unaware (1976), Dulcify (1978), King's High (1988), Blevic (1994), Blackfriars (1999) and Kibbutz (2007) - agrees punters would be silly to write off the Derby favourite.
"He (It's A Dundeel) just couldn't get around the Valley in the Vase," he observed.
"He's built like a real stayer.
"I think Flemington is going to suit him."
Originally published as Jimando set to defy the critics


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mechanic ma
45 points
single ma. not stupid under the hood.
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Question Asked: when system is reset, vehicle dies at when slowed or stopped, does restart
June 12, 2013, 05:28 AM
the battery also dies every year. have had car for almost 3 years and have replaced 2 batteries. the the issue with keeping it running after the system reset, then after 2-4 weeks of stalling out every time it stops at light or sign or when it drops below 1000 rpm, it goes away. it also has an issue with pulling on the battery. add lights, pull then let go, add radio, pull and let go, add the a/c pull, pull, pull, die!
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text:
Los Angeles County Arboretum and Botanic Garden: If your date is a nature lover, head over to the Arboretum. It's a beautiful and peaceful place for a stroll, a picnic, and maybe a nap! There are peacocks roaming free and rare foliage as far as the eye can see. Make sure to bring your camera! You'll definitely want to snap some photos to remember this date.
Fairfax Farmer's Market: We're HUGE fans of this historic LA landmark. The Farmer's Market is a permanent partially outdoor smorgasbord of food and drink. Situated right next to the famed Grove shopping center, you'll have celeb sightings aplenty! There is everything from Mexican, Chinese, Louisiana-style, and Spanish cuisine. Dig in!
Silverlake Wine – Do you feel like classin' it up a little? If you want to impress your date but don't want to break open your piggy bank, scoot over to Silverlake Wine. They have a superb wine tasting package that only around $20. They hand-pick wines and small plates of food especially for you!
Backstage Bar & Grill – If a pitcher of beer is more up your alley than a pairing of wine and cheese, this bar is just your style. In addition to the variety of brews on tap, Backstage Bar has something going on every single night of the week. There is trivia, karaoke, sports, and more. Be sure to hit up the photo booth in the back!
Angels Flight Railway – This uniquely LA piece of transit is just 50 cents to ride. Board one of the two cars and ride "The Shortest Railway in the World"! Take the short journey up the rails that connect Hill Street and California Plaza on one of the two funicular cars: Sinai and Olivet. This short date is one you surely won't forget!


text:
From OLPC
http://dev.laptop.org/~mncharity/olpc_xo_qemu/ makes it easier to create and control QEMU emulated laptops. It can also control real XO's, with the same interface.
- Current status: not working. (2008 Q4)
- Last image known to work: unknown
- Dbarral reports 0.009 working with ship.2
Current issues:
- Unreleased QEMU 0.9.2 is required by the current OLPC kernel. HEAD works.
- olpc_xo_qemu-0.009 is disabled by a broken LATEST link on dev.laptop.org.
- olpc_xo_qemu-0.009 can't find XAuthority files on current images.
- The current (2008 Nov) version of gnome ssh key handling has a bug (pops up a passphrase request window for passphrase-less keys), which makes xo-qemu's ssh'ing painful.
- Isn't 1200x900 by default, even though qemu now supports that.
Expectation management
This is/was one person's attempt to make OLPC emulation easily usable.
xo-qemu's purpose is to insulate you from difficulties. However, the difficulties still exist. OLPC institutional support for emulation has always been flakey. And xo-qemu needs to do various things (set up ssh keys, enable XTest, get X cookies) whose details repeatedly change.
So xo-qemu releases are only able to create emulated xo's from OLPC qemu images dating from around the same time. But once created, they should continue to work.
OLPC's qemu images have repeatedly ceased to be usable, often for months. Or to require unreleased SVN qemu.
Also, qemu-based emulation has always had limitations: no USB, no sound, no camera.
So... when it works, it's quite useful. But it often doesn't work, and always has limitations.
xo-qemu -help
xo-qemu is a script for downloading, managing, and running OLPC QEMU disk images on linux. The One Laptop Per Child (OLPC)<http://wiki.laptop.org/> project creates a linux distribution for its laptop. It is released as numbered builds (ie, "versions"), in several streams (eg, separate streams for developers and end users). These builds are available in several forms, one of which is a disk image that can be run on the QEMU virtual machine. This script makes it easier to obtain, manage, alter, and run these disk images on linux. It provides virtual, slightly broken, emulated OLPC XO laptops. --help Shows this help. --new-user Checks that qemu and kqemu are working, and suggests how to get started. --report Summarizes the currently available streams and builds. (The report format is likely to change). --get-build STREAM BUILD DIRECTORY Downloads STREAM's BUILD disk image into DIRECTORY. The build's devel_ext3/ .img.bz2 disk image is used. If there is already a copy of the image in DIRECTORY, it is not downloaded again. The filename of the image in DIRECTORY is printed. BUILD can be "latest" instead of a number. Example: $ xo-qemu --get-build joyride latest builds/ builds/olpc-redhat-stream-joyride-build-1418-20071213_1608-devel_ext3.img.bz2 $ xo-qemu --get-build joyride 1418 builds/ builds/olpc-redhat-stream-joyride-build-1418-20071213_1608-devel_ext3.img.bz2 --make-laptop LAPTOP DISK_IMAGE Creates a new laptop named LAPTOP, from a build DISK_IMAGE. A new directory named LAPTOP is created, and must not already exist. The DISK_IMAGE is copied into it. Each laptop is about 1 GB. As part of setting up the laptop, qemu is automatically run, some configuration done, and then qemu is automatically shut down. No user action is needed. The LAPTOP/xo file is used to control it. Examples: $ xo-qemu --make-laptop laptops/one builds/olpc-redhat-stream-joyride-build-1418-20071213_1608-devel_ext3.img.bz2 $ xo-qemu --make-laptop laptops/one `xo-qemu --get-build joyride latest builds/ |tail -1` And then: $ laptops/one on --xo-api0 LAPTOP ACTION Controls the LAPTOP. This is usually called indirectly using LAPTOP/xo ACTION. Examples: $ laptops/one/xo on $ laptops/one/xo off on off is-running ssh [olpc|root] [COMMAND-LINE] scp [SCP_ARGS] FROM TO Copies FROM to TO, where both are either a local path, or [olpc|root]:path/on/the/laptop. env Prints "LAPTOP=xxx DISPLAY=xxx XAUTHORITY=xxx". These environment variables let you run X windows programs on the laptop's X server, from the host. This is mostly used for automated testing. Examples: $ bash # start up a new shell, since we're about to modifiy it $ export `laptops/one/xo env` $ xterm # somewhat useless, but illustrates the concept. $ import screenshot_of_laptop.png do COMMAND [ARGS] Sets up the same environment variables as /xo env, and then runs COMMAND. If and environment variable XO_QEMU_DO_PATH is defined, it is used instead of PATH to find COMMAND. Examples: $ laptops/one/xo do xterm $ laptops/one/xo do sh -c 'echo $DISPLAY' xephyr on|off Switches between using the laptop's normal X server, and using an external Xephyr X server. The real OLPC laptop hardware has a 1200x900 display, Until qemu supports having a 1200x900 display (the release after 0.9.0), Xephyr can be used when one is needed. Example: $ laptops/one/xo on $ laptops/one/xo xephyr on sugar restart Restarts sugar. This is needed after some configuration changes. mount [WHAT WHERE USER] | -u [WHERE] mount [WHAT WHERE USER] Mounts laptop directory WHAT on host directory WHERE, with the host user mapped to laptop USER olpc or root. If no arguments are given, / is mounted on LAPTOP/root with the user as root, and /home/olpc is mounted on LAPTOP/olpc with the user as olpc. mount -u WHERE Unmounts whatever is mounted on WHERE. Equivalent to "fusermount -u WHERE". If no WHERE is given, then LAPTOP/root and LAPTOP/olpc are unmounted. "/xo off" unmounts everything mounted. Example: $ laptops/one/xo on $ laptops/one/xo mount $ ls laptops/one/root activities bin boot dev... $ ls -a laptops/one/olpc .AbiSuite .bash_history ... .sugar ... $ laptops/one/xo mount -u --enlarge-disk-image IMAGE SIZE_MB Enlarges the LAPTOP's disk to MB megabytes. The laptop's disk is normally 1000 MB, with only 1/3 used. But when doing development, and installing lots of things like gcc, it sometimes helps to make it bigger. --make-laptop-remote LAPTOP Like make-laptop, but for remote access to a real XO laptop. Example steps: (1) Create a remote access laptop: $ xo-qemu --make-laptop-remote laptops/two (2) Move the laptop to a usb drive. $ mv laptops/two /media/whatever/two $ sync (3) On the real XO laptop, run setup_real_xo_for_remote_access, as root. [olpc@xo-...]$ sudo /media/something/two/setup_real_xo_for_remote_access [olpc@xo-...]$ sync (4) Back on the host, move the laptop back from the usb drive. $ mv /media/whatever/two laptops/two $ sync The laptop should now work: $ laptops/two/xo ssh whoami When the real XO laptop gets a new ip address from dhcp, you tell the remote access laptop about it by: $ laptops/two/xo ip 192.whatever ip ADDRESS Set the IP address on a remote access laptop. It is an error to request this action on a QEMU laptop.


text:
Atari - D&D rights extended to 2017
View Single Post
July 20th, 2007, 21:12
sorry but i don't do tom clancy
cold fear, king kong, beyond good and evil, wild earth safari, hopefully call of juarez when i get a cheap copy,
dark messiah were all the ubisoft games i've played in recent years. all of them were at least a 7.5 in my book, and none of them suffered from bad console controls.
and you hate alot of stuff with a passion
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text:
Convert SpreadSheets to CSV files with Python and pyuno
Using the OORunner class that we developed last week we'll now create a Python class for converting spreadsheets into CSV files. The converter supports any type of input spreadsheet that is supported by OpenOffice.
When run the program takes pairs of input and output files, for example:
$ python ssconverter.py file1.xls file1.csv file2.ods file2.csv
Each input file is a spreadsheet and it is converted into the corresponding output file as a CSV file.
The meat of the operation happens in the convert function from the SSConverter class. The first thing it does is start OpenOffice running using the OORunner class. It then converts the input and output file names to URLs and uses the desktop object returned by OORunner to create and load a document object. Converting the spreadsheet to a CSV file is merely a matter of saving the document to the output URL. The source code for the SSConverter class follows:
# Convert spreadsheet to CSV file.
# Based on:
# PyODConverter (Python OpenDocument Converter) v1.0.0 - 2008-05-05
# Copyright (C) 2008 Mirko Nasato <firstname.lastname@example.com>
# Licensed under the GNU LGPL v2.1 - or any later version.
# http://www.gnu.org/licenses/lgpl-2.1.html
import os
import ooutils
import uno
from com.sun.star.task import ErrorCodeIOException
class SSConverter:
Spreadsheet converter class.
Converts spreadsheets to CSV files.
def __init__(self, oorunner=None):
self.desktop = None
self.oorunner = None
def convert(self, inputFile, outputFile):
Convert the input file (a spreadsheet) to a CSV file.
# Start openoffice if needed.
if not self.desktop:
if not self.oorunner:
self.oorunner = ooutils.OORunner()
self.desktop = self.oorunner.connect()
inputUrl = uno.systemPathToFileUrl(os.path.abspath(inputFile))
outputUrl = uno.systemPathToFileUrl(os.path.abspath(outputFile))
document = self.desktop.loadComponentFromURL(inputUrl, "_blank", 0, ooutils.oo_properties(Hidden=True))
# Additional property option:
# FilterOptions="59,34,0,1"
# 59 - Field separator (semicolon), this is the ascii value.
# 34 - Text delimiter (double quote), this is the ascii value.
# 0 - Character set (system).
# 1 - First line number to export.
# For more information see:
# http://wiki.services.openoffice.org/wiki/Documentation/DevGuide/Spreadsheets/Filter_Options
document.storeToURL(outputUrl, ooutils.oo_properties(FilterName="Text - txt - csv (StarCalc)"))
if __name__ == "__main__":
from sys import argv
from os.path import isfile
if len(argv) == 2 and argv[1] == '--shutdown':
if len(argv) < 3 or len(argv) % 2 != 1:
print "USAGE:"
print " python %s INPUT-FILE OUTPUT-FILE INPUT-FILE OUTPUT-FILE..." % argv[0]
print "OR"
print " python %s --shutdown" % argv[0]
if not isfile(argv[1]):
print "File not found: %s" % argv[1]
i = 1
converter = SSConverter()
while i+1 < len(argv):
print '%s => %s' % (argv[i], argv[i+1])
converter.convert(argv[i], argv[i+1])
i += 2
except ErrorCodeIOException, exception:
print "ERROR! ErrorCodeIOException %d" % exception.ErrCode
As with OORunner, this code is based on PyODConverter. Next week we'll write a converter function that creates the CSV file automatically from the corresponding spreadsheet if the CSV file does not exist. In addition it will re-create the CSV file if the spreadsheet is newer than the CSV file. This way you can essentially use spreadsheets and CSV files interchangeably in your code.
Mitch Frazier is an Associate Editor for Linux Journal.
Great article
This is really exciting, keep this columns coming. Python is such a great language. For more information please write on the Python wikipage within OpenOffice.org:
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Living in the sandy beaches of Cancun
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text:
Welcome to Hyperion Records, an independent British classical label devoted to presenting high-quality recordings of music of all styles and from all periods from the twelfth century to the twenty-first.
Hyperion offers both CDs, and downloads in a number of formats. The site is also available in several languages.
Please use the dropdown buttons to set your preferred options, or use the checkbox to accept the defaults.
|The New York Collegium, James Litton (conductor)» More
|Haydn: Mass & Vespers for the Feast of Holy Innocents
With a sound to rival their Viennese counterparts, the American Boychoir directed by James Litton deliver here a pure and innocent performance with a traditional feel of Haydn's Mass and Vespers.» More


text: Browse Our Toys Brand By Category Ages By Gender Award Winning Fingerling Maze BUY Securely fasten the 2 suction cups to any smooth surface in or out of the tub. By helping the baby fish swim from side to side fine motor skills and imagination are devleoped! Age: 12+ months[> Features Back to Top


text:
'Glee': Michael Jackson Tribute Episode Song List
Two of the world's biggest superpowers — Michael Jackson fans and 'Glee' fans — will join forces in an upcoming MJ tribute episode of the hit FOX show.
Justin Bieber's Grandparents Injured in Car Accident
Justin Bieber's happy Christmas at home was muddied on Tuesday when his maternal grandparents were injured in a horrific car accident. Bruce and Diane Dale totaled their car after it overturned in a ditch.
'Real Housewives of Atlanta' Star NeNe Leakes Joins 'Glee' for Recurring Role
The news is out! 'Real Housewives of Atlanta' will blend with 'Glee' next season when star NeNe Leakes joins the cast as the new swim coach at McKinley High.
Taylor Swift Dishes on Her 'Frumpy' Look for Ours' Video
"This is how you take on the world," Taylor Swift says as she leads into her latest 'Ours' behind-the-scenes webisode. "This is what it looks like."
'Glee' to Take on 'Star Wars' During Christmas Episode
Nicki Minaj Unveils New OPI Nail Polish Line in New Promo Video
Nicki Minaj is known for her wacky nail colors, hair styles, clothing choices and undying love of Barbie. While it would be virtually impossible to truly recreate her look, it couldn't be any easier to grab her signature bright nails with her brand new OPI nail polish line.
Soulja Boy Arrested for Weed Possession
Soulja Boy cranked his way into a jail cell early this morning after being arrested for weed possession in Templa, Ga., which is just west of Atlanta.


text:
Food Lifeline
Once again, Food Lifeline is preparing to staff The Alley Hosted by Tom Douglas at the Seattle Center, July 20-22, 2012 as part of the annual Comcast Bite of Seattle. This important annual fundraising event will help us to support our daily efforts to end hunger and provide the people of Western Washington with nutritious food. Thank you for your interest in taking part.
Volunteers are needed to help with greeting guests, taking tickets, passing out plates and utensils, busing tables, assisting in the food booths, passing out water, collecting event surveys, etc…. Your specific volunteer assignment will be made on site. This is a fun volunteer activity for folks who are age 16 or older, providing you are able to be standing much of the time, and that you are willing to be on site, rain or shine! Join us as an individual volunteer, or gather a group of family/friends together…either way you are sure to have a good time, and help to support Food Lifeline.
Volunteer shift options include the following…..
Friday, July 20 10:30-3:30 2:30-7:30
Saturday, July 21 10:30-3:30 2:30-7:30
Sunday, July 22 10:30-3:30 2:30-6:30
Volunteers that register to help are expected to join us for the entire 5 hour shift, and we are not able to have multiple volunteers "share" a shift. If you are planning your schedule to include the Bite of Seattle and other activities, be sure to calculate for the typically congested downtown Seattle traffic. We can't emphasize enough how important it is that volunteers arrive on time, and are expected to be with us for the entire 5 hour shift.
Our mission is to end hunger in Western Washington by engaging communities and mobilizing resources.
Join millions of people on Eventbrite.
In order to purchase these tickets in installments, you'll need an Eventbrite account. Log in or sign up for a free account to continue.


text:
The Politics Hour – November 17, 2017
Virginia Democratic Party Chairwoman Susan Swecker is in studio. And Aisha Braveboy, candidate for Prince George's State's Attorney, joins us.
As the number of patients waiting for kidney transplants rises, the network overseeing how donated kidneys are allocated is considering changes. Currently, those longest on the waitlist usually have priority, but age could soon be a factor, with younger patients favored in some cases. We explore the ethical and medical factors in the debate.
MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. Nearly 85,000 Americans are waiting for a kidney transplant. Only around 17,000 of them are likely to get one this year. The group that oversees organ transplants says changes are needed. One possibility is to try to give younger patients the healthiest, youngest kidneys. Many say the system we have now is fair but flawed. A number of factors weigh in the debate, including ethical issues. It's a life or death scenario not just for the patient given priority but for that patient who does not get the kidney, and there will no doubt be unintended consequences from any changes.
MR. KOJO NNAMDISo joining us to discuss all of these in our Washington studio is Robert Veatch. He's a professor of medical ethics at the Kennedy Institute of Ethics. He is on the board of directors of the Washington Regional Transplant Community and a member of the United Network for Organ Sharing or UNOS. He is on the ethics committee. Robert Veatch, thank you very much for joining us.
DR. ROBERT VEATCHThank you. It's a pleasure to be here.
NNAMDIJoining us from studios at WCBE in Columbus, Ohio, is Dr. Kenneth Andreoni. He's a professor of surgery at Ohio State University and chair of UNOS's kidney committee. Dr. Andreoni, thank you for joining us.
DR. KENNETH ANDREONIAnd thank you. It's a pleasure to be here today.
NNAMDII'll start with you. What are the basics? What do our kidneys do, and what affects their health?
ANDREONIWell, your kidneys are responsible for many functions in your body. When most lay people think of kidney function, they think of the ability to clean out toxic substances from your body. That is break down products of things we use and also to remove excess fluid from our body. Our kidney has many other more complicated functions, such as helping us make red blood cells et cetera.
NNAMDIWhat are the main causes of chronic kidney disease?
ANDREONIWell, in this country, there are several different peaks of when different diseases affect people with kidney problems. People who are older tend to have most of their kidney disease from years of diabetes and hypertension. Folks who are younger have many types of urological and anatomical problems or autoimmune diseases that can affect their kidneys.
NNAMDIAre there some groups that are at higher risk for kidney disease than others?
ANDREONIThere are in this country people who are more apt to get high blood pressure and diabetes are more likely to also get kidney disease. In this country, that does include the African-American community.
NNAMDIHow about Hispanics?
ANDREONIHispanics also have a bit of an increased risk again with their increased risk of diabetes.
NNAMDITell us what UNOS is, the United Network for Organ Sharing, and what role it plays in the transplant system.
ANDREONIWell, I'm a volunteer for UNOS. UNOS is a non-for-profit organization that administers a contract from the federal government to help oversee the issues of transplantation. So they do not actually -- they're not a government agency, per se, but they administer a contract through HRSA to try to get the transplant community together and decide on fair and equitable allocation issues.
NNAMDIWe've all heard of dialysis. What is it, and when does dialysis enter the picture?
ANDREONIWell, dialysis is an artificial way of, again, trying to reproduce the function of the kidney to clean out our blood and also to remove excess fluid. There's different types of dialysis. The most common being the hemodialysis, where someone is attached to a machine and the blood is removed from their body and run through special filters. There's also what we call peritoneal dialysis, where a special fluid is placed inside someone's abdomen, and that helps also to remove excess fluid and waste products.
NNAMDIThen the stage we're talking about today is kidney failure, also known as renal failure. What does that mean for the patient?
ANDREONIWhat that means is that the kidneys are not working well enough to provide these necessary functions through the day. That is to clean out their blood and to remove fluid, so they cannot go on in a healthy fashion.
NNAMDIIn case you're just joining the conversation, we're talking about suggested changes to the system of organ donation, especially when it comes to kidney transplants. Inviting your calls at 800-433-8850, or you can go to our website, kojoshow.org. Ask a question or make a comment there. Send us an e-mail to firstname.lastname@example.com or a tweet, @kojoshow. Robert Veatch, because of dialysis, renal failure isn't a death sentence, but is there a limit as to how long someone can wait for a kidney?
VEATCHA person who's in renal failure without a kidney transplant can be dialyzed for a fairly long period of time, years perhaps, but as a general rule, dialysis patients don't do as well as kidney transplant recipients. So that life is generally better for people in -- with kidney disease if they can get a transplant. It's, in a way, a kind of lifesaving surgical intervention in spite of dialysis.
NNAMDIKen Andreoni, how many Americans right now are waiting a kidney transplant?
ANDREONIThere are approximately 88,000 people on the list now waiting at the (unintelligible) transplant.
NNAMDIRobert Veatch, there are two kinds of kidney donations, those from a living donor and those from a deceased donor. Can you talk about the distinction?
VEATCHYes. The majority of transplants historically have come from people who've died in automobile accidents or otherwise been declared dead by brain criteria. We're getting better and better, however, at procuring kidneys from living donors. We all have -- most of us have two kidneys. We really can get by with one, so often, a family member is willing to step forward and have a kidney surgically removed and transplanted. If that can be done, we get an even better result than from a deceased donor.
NNAMDIAnd I guess kidneys are different from other organs in terms of transplants and allocation is because, one, most of us can live with one kidney, and that, we mentioned earlier, that people can live for some time on dialysis.
VEATCHThat's right.
NNAMDISince this is a discussion about allocation of kidneys, we're focusing on those from deceased donors today, because those from living donors are usually being donated for a specific patient, a family member or friend called directed donation, while deceased donor kidneys go to those on the waiting list for a transplant. Robert Veatch, UNOS is developing a proposal to change how donated kidneys are allocated. Before we get into that, I'd like to get an understanding of how the system works now in terms of who needs a kidney and who gets one.
VEATCHRight now, if you meet the criteria for being listed for a kidney transplant, your name goes into a computer with all the others who are waiting, and an allocation formula is used based on a computerized model that gives some attention to the degree to which the recipient matches the donor, pays attention to whether a potential recipient has been sensitized to other foreign tissues. But right now and for the past 20 years or so, the key factor in deciding how kidneys is allocated is time on the waiting list.
NNAMDIOne concern is the disparity in access to kidneys in different regions. How does that work currently?
VEATCHIf a kidney becomes available, it is allocated according to the computerized algorithm, but priority goes to patients on the waiting list in the local area from which the kidney was received. And for various reasons, the demand for kidneys varies from one geographical area to another, and the supply varies. The net result is that there are many more waiting on the waiting list in some cities than in other cities.
NNAMDIKen Andreoni, care to comment on that?
ANDREONIWell, that is correct. I would say that the current system now, as Dr. Veatch has said, is based mostly on wait time. However, what we need to remember is when this system was originally created many decades ago, the large majority of points that went to deciding who would receive a kidney was based on -- more on the medical criteria of how well someone matched, and that was due to the fact that our medications were not as good to prevent rejection. So this current allocation policy, which is in play today, was originally based more on medical matching, and then, time was pretty much a tiebreaker. And as our medications have gotten better and our outcomes have gotten better, the medical criteria has been whittled away to a very small minority of the points given to how our organs are now allocated.
NNAMDIBecause now anti-rejection drugs are much better, and therefore, the transplant surgery is much more common so being a perfect match is no longer a major issue. Is that correct?
ANDREONIYou are correct.
NNAMDIYou can join this conversation. Call us at 800-433-8850. Are you a transplant patient or donor? What has been your experience? We're talking with Dr. Kenneth Andreoni. He's a professor of surgery at Ohio State University and chair of the kidney committee of UNOS, the United Network for Organ Sharing. Also with us in our Washington studio is Robert Veatch, a professor of medical ethics at the Kennedy Institute of Ethics. Dr. Veatch is on the board of directors of the Washington Regional Transplant Community. He's also a member of the ethics committee of UNOS. We can go to Steve in Silver Spring. Steve, you're on the air. Go ahead, please.
STEVEOh, thank you. I have a question that I've never heard asked before. Why do people who aren't signed up as organ donors themselves become eligible for an organ? Shouldn't we say to people if you aren't a registered organ donor, you don't get one? Because right now, there's no incentive for people to sign up to be an organ donor, other than altruism.
NNAMDIRobert Veatch?
STEVEIt sounds kind of -- go ahead.
NNAMDIRobert Veatch, how ethical is that?
VEATCHWell, some of us have, in fact, advocated that we take into account whether someone has been an organ donor. But the allocation decision is a very complicated one. Many people can't be organ donors because they're not mentally competent to donate. They may be children, for example. So right now, since we get organs from everyone, we also allocate organs to everyone.
NNAMDIThank you very much for your call, Steve. Robert Veatch, the National Transplant Act of 1984 mandated that the system be both fair and efficient. You've said that initially the system was focused on efficiency, but it was not very fair. What do you mean by that?
VEATCHWell, as Dr. Andreoni suggested, originally we used medical criteria, primarily the extent to which the donor and the recipient match up. When we put that policy in place, we thought it only made sense to use organs as efficiently as possible. Unfortunately, we discovered that that arrangement discriminated against certain groups. For instance, blacks did not match up with the donor pool as well as Caucasians, so we very quickly developed a system that was unfair in favoring one group, one ethnic group over another. That's what led to the correction to add time on the waiting list as a critical decisive factor in allocation.
VEATCHWe're now debating whether we need to shift back again and also take into account efficiency criteria. The real problem is, in the new proposal, there's very careful, detailed complex analysis showing we could be more efficient, for instance, by matching people on the basis of age. There is, in the concept paper, no comparable detailed and complex analysis to see whether the present system is -- meets the criterion of fairness or equity.
NNAMDIKenneth Andreoni, UNOS has not been very happy with how the media have been reporting on this. So can you explain for us what are the changing being -- changes being considered now?
ANDREONISure. The three concepts that we have put out here that we want feedback on -- and the truth is we actually do want good, positive and negative criticisms with ideas -- is to try to make the system both more efficient and, especially to try to use the gifted organ better. The big picture, which I hope you will take home today, is if we had enough donated organs for all the people who could benefit from them, then the allocation issue would be much less worrisome right now than it is. And that is really number one key to the whole day conversation.
ANDREONIThe concepts that we have come up with here is, number one, to change the way we look at the estimated quality of the gifted organ. So right now, when someone is kind enough to donate an organ, we -- the system looks at the qualities of the donor, their age, their diseases, how they passed away, et cetera, and we decide if that kidney is what we now call a standard-criteria kidney or an extended-criteria donor kidney. And the difference is that an extended-criteria donor kidney has a higher risk of not functioning as well as the larger pool of the standard kidneys. And right now, this is about 17 percent of the organs.
ANDREONIThis was originally conceived a number of years ago so that people who may benefit from these higher-risk organs would be educated about them ahead of time, informed properly, actually sign a consent form, and they would then be put on a shorter list of people who are willing to take these organs. Again, have knowledge about the quality as well as have better efficiency so that transplant would happen more quickly. That system really hasn't played out as well as it should have for a number of reasons, which can take several hours to go through.
ANDREONISo what we're looking at now is a more continuous scale of the quality of a kidney. Is it approximately in the top 10 percent, the top 40 percent, 60 percent, et cetera? And with that sliding scale, we believe people can make better, informed decisions, and we can allocate organs more efficiently.
NNAMDIWe're gonna take a short break. When we come back, we will continue this conversation about suggestions to the -- for changes to the system of organ donation where kidney transplants are concerned. But we still have the phones open, so you can call us at 800-433-8850. Do you think people on the wait list longer should get priority for a kidney? Or do you think another system would be better? 800-433-8850, or go to our website, kojoshow.org, and participate in the conversation there. I'm Kojo Nnamdi.
NNAMDIWelcome back. We are looking at the system for kidney donation and kidney transplants. And in studio with us is Dr. Robert Veatch. He's a professor of medical ethics at the Kennedy Institutes of -- Kennedy Institute of Ethics. He also serves on the board of directors of the Washington Regional Transplant Community. He's a member of the United Network for Organ Sharing's ethics committee. Joining us from studios in Columbus, Ohio, is Dr. Kenneth Andreoni. He is a professor of surgery at Ohio State University and chair of UNOS's kidney committee. Joining us now by telephone from Chicago is Dr. Bryan Becker. He is the former president of the National Kidney Foundation. Dr. Becker, thank you for joining us.
DR. BRYAN BECKER...for having me.
NNAMDIThe National Kidney Foundation agrees with many of the changes that Ken Andreoni described. What are some of the ways you think those changes would benefit kidney patients?
BECKERWell, I think it has been important, from the perspective of the National Kidney Foundation, to work with Dr. Andreoni's committee. UNOS is an organization with the primary focus on how to increase the number of organs available for transplantation and increase the number of organs used for transplantation. The proposal and the allocation concept paper that was drafted by UNOS raises these thoughts in the context of several different perspectives that are trying to apply use of our, as accurate as possible, historical information to better understand how a kidney, going into someone who needs it, will last the longest for that person.
BECKERAnd by lasting the longest, we not only hope that person will just not live longer but feel more comfortable in his or her own life and feel more comfortable in making a contribution back to society in ways that they want to do. I would say the proposal has emphasized some ways we can focus on that by measuring how a kidney looks, if you will, through a measure called the kidney donor profile index and by trying to make -- match up kidneys that are close to but not necessarily entirely like the person who is getting them, a kidney that looks like the recipient.
BECKERAnd the opportunities that that may lead to in using organs that are previously not being used and encouraging others to donate, we believe, from the perspective of the National Kidney Foundation, has an opportunity to expand, in some way, the number of people who ultimately will receive a deceased donor kidney.
NNAMDIRegional access was one area of concern, and you don't think that these changes -- these suggested changes would address that problem. What are other concerns the National Kidney Foundation has?
BECKERCertainly, I would reemphasize that one of the concerns the National Kidney Foundation put out there is that addressing disparities and access to transplantation is important, and this paper does not do that in its present construct. There are some other aspects on how kidneys could be or should be allocated in medical emergencies that really is very important. There are people who are running out of ways that they can dialyze and certainly need to have and should be offered the benefit of the opportunity of a transplant. And that's not something that's been discussed in the context of this particular paper.
BECKERAnd there are some other aspects of the entire process that I think are important pursuant to the unintended consequences seen. What are the ramifications of this as we look at it? In particular, how do we advocate, for instance, for enhancing living donation in other ways, even though we're also advocating deceased donation? Those are some of the things that the National Kidney Foundation has explored in its own discussions in looking at this particular allocation concept paper.
NNAMDIHere is Tom in Beltsville, Md. Tom, you're on the air. Go ahead, please.
TOMHi, Kojo.
NNAMDIHi, Tom.
TOMI wanted to share with everyone that I'm a kidney transplant patient. I had it in 1992 after four years on dialysis. I received a perfect match, and I've had relatively little problems with my kidney for the almost 19 years that I have it. I'd like to endorse, one of the doctors had mentioned, that probably one of the best things that can be done in every initiative that's taking place is to make people aware of the fact that if we increase the number of donations, 16,000 people plus that are on the list would probably be dealt with a great deal quicker than any other mechanisms that we're trying to put in place.
NNAMDIThank you very much for your call, Tom. The increase in the number of donations seems to be one thing that all of our panelists agree on, so I would like to share with you an email that we got from Carolina who says, "In order to increase the number of available kidneys, why not have an opt-out system, meaning your organs will be removed once you are determined to be brain dead? If you do not want your organs donated, you would have had to specifically designate in a document that you did not want your organs donated." How do you feel about that from an ethical standpoint, Robert Veatch?
VEATCHThe debate between opt-out and opt-in systems goes back to the 1960s. Some countries, usually countries that focus less on individual liberty, have actually endorsed opt-out systems, particularly in Southern Europe, in Scandinavia, and Asia. The countries in the Anglo-American and Germanic World that give great emphasis to individual rights and individual liberty have been very hesitant to change, mainly because if we go to an opt-out system, we have to do something to assure that everybody knows exactly what's at stake, and that would be an enormous educational process. We've opposed opt-out systems in the United States, although increasingly, people are giving serious consideration to that alternative.
NNAMDICare to comment on that opt-out system, Bryan?
BECKERI think -- I would note that Dr. Veatch has really pointed out some of the conundrums associated with opt-out as it would be applied in, certainly, the United States as we focus on how we view choice. I would also note that there are areas where, what are called donor service areas or where organ procurement is -- organ donation is encouraged and organ procurement occurs through an organ procurement organization. And in many areas in the United States, we have achieved, not in the majority, but in some very high organ donation rates that approximate the organ donation rates that are, for instance, achieved in Southern Europe, which are using opt-out types of approaches.
BECKERSo we have ways in the United States to encourage organ donation, and the success of the organ donor breakthrough collaborative process had a significant uptick in organ donation only a few years ago through concerted and focused efforts and consistent methodology across multiple entities.
NNAMDIHere is Ed in Pikesville, Md., talking about other countries again. Ed, your turn.
EDYes. Thank you very much. I wanna point out that a significant point was missed a few minutes ago with regards to the ethics associated with donating. There are several countries, I believe Israel is one them, that have a rule or perhaps it's even a law, that you must give to get, period. You must give in order to get.
EDAnd maybe it comes from the kibbutz mentality. I don't know. But that's how the donation system works there. And I'd like to hear your comments. Thank you.
NNAMDIWell, Robert Veatch did comment on that earlier. But we'll ask him to comment on it again.
VEATCHI have supported the idea that having been willing to donate organs should be one factor in deciding priorities. I think it would be a mistake to make it the only factor. There are too many people who would be left out, for instance, children, who are not competent people so they can't donate, would have to make arrangements. We'd also have to make arrangements to short circuit the idea that once people are diagnosed with kidney failure that run out and quickly sign up so that they would get a priority. Giving in order to get -- your term -- is a complicated idea that's worthy of some consideration. I would give it some points in the allocation formula, but I wouldn't make it an all-or-none factor.
NNAMDIKen Andreoni, care to comment on give to get?
ANDREONIWell, that's an interesting concept. There actually are some organizations out there that are putting this forward. And again, I agree with Dr. Veatch, there are some interesting arguments on both sides. The Israel system from what I understand, and I did read up on this recently, simply gives the people who have signed a donor card some increased opportunity. But if you have not signed a donor card, you, then, are in kind of the second group, and if no one in the first group wants, you still can receive. So the caller has a point. It wasn't, I believe, exactly correct. But the point is well taken.
NNAMDIHere is Melina (sp?) in Annandale, Va. Melina or Melina, go ahead, please.
MELINAIt's Melina. Thank you, Kojo, for taking my call, and greetings to your expert panel. I am an organ donor, in part, because my father received a kidney transplant in 1990. At the time, he had been on dialysis for three years, and he was not a good candidate for a transplant. In fact, I know this because a relative of mine was the head of the transplant decision committee. He recused himself, of course, because he was a relation. And the committee eventually decided to give my father a kidney because his transplant nephrologist knew that my father had an incredible fighting spirit.
MELINAHe went on to have 17 years of incredibly productive life, despite the fact that he was blind and suffering from other consequences of diabetes. He volunteered with the United Way, the Red Cross, the library board of his community, the mayor's traffic commission. I mean, he spent basically the last 17 years of his life giving back to his community. I wondered, under any new proposed guidelines for kidney transplants, what weight would be given to knowledge of the patient, what they can give back to their community and their, I guess, level of willingness to fight for that better life.
NNAMDIDr. Bryan Becker.
BECKERIt's -- first of all, I'm glad, Melina, that your father had done so well. There was a great deal of interest in a previous iteration of revising kidney allocation to look at measures of that exact type of contribution or productivity, if you will. And it started with a focus on living life years, and it tried to encompass quality of life and indeed other measures of activity.
BECKERUnfortunately, we probably lack the key pieces of data in a serial monitoring way to really evaluate that successfully. It is a very important component of looking at a candidate's benefit for a transplant, but we lack some of the critical information to be able to use that effectively in decision making at this point in time. Hopefully, we'll be able to do a better job with that as we learn how to accrue such information in the future.
NNAMDIGot to take a short break. Dr. Becker, thank you so much for joining us.
BECKERThank you very much, Kojo.
NNAMDIDr. Bryan Becker is the former president of the National Kidney Foundation. We're talking about suggested changes in the system of kidney donation for organ transplants and taking your calls at 800-433-8850. Dr. Andreoni and Dr. Veatch will be staying with us. And when we come back, we'll be joined by Dr. Benjamin Hippen, who is a transplant nephrologist at the Carolinas Medical Center in Charlotte, N.C. But you can still call us, 800-433-8850. Or if that line is busy, go to our website, kojoshow.org. Join the conversation there. I'm Kojo Nnamdi.
NNAMDIWelcome back to our conversation about suggested changes to organ donation in kidney transplants. We are joined from studios at WCBE in Columbus, Ohio, by Dr. Kenneth Andreoni. He is a professor of surgery at Ohio State University and chair of the kidney committee of the United Network for Organ Sharing or UNOS. In our Washington studio is Dr. Robert Veatch. He is a professor of medical ethics at the Kennedy Institute of Ethics. He's on the board of directors of the Washington Regional Transplant Community and a member of the ethics committee of UNOS. And joining us now from studios at WFAE in Charlotte, N.C., is Dr. Benjamin Hippen. He is a transplant nephrologist at the Carolinas Medical Center in Charlotte, N.C. Dr. Hippen, thank you very much for joining us.
DR. BENJAMIN HIPPENNice to be with you, Kojo.
NNAMDIYou have outlined some issues with the changes suggested by UNOS, possible unintended consequences of the changes that concern you. What would those be?
HIPPENWell, there are three basic ones, Kojo. The first one is that good ethical analysis really requires good data, and I think what's really lacking in this concepts proposal and its prior iterations is that data. The real concern here is that the statistical models that have been created out of this data to predict which kidneys are gonna be in the top 20 percent or the bottom 80 percent, or which candidates are gonna be in the top 20 percent or bottom 80 percent in terms of graft and patient survival, have a high rate of error, perhaps as much as a third of the time.
HIPPENIt's not clear whether or not when those kidneys or those candidates are being mistriaged, whether those mistriages will actually be randomly distributed across every kidney or every potential candidate, or whether those will -- those errors in triage will disadvantage particular candidates. And that's important, because kidney disease is not randomly distributed across the U.S. population. As Dr. Veatch observed, although African-Americans make up about 11 percent of the U.S. population, they make up about a third of patients on the waiting list and who are currently on dialysis. So that's one general concern, that we have to get the data straight first.
HIPPENBut in terms of the more -- particularly ethical concerns -- I've real worries about the unintended consequences of preferentially allocating kidneys from the top 20 percent of quality to the top 20 percent of candidates who are thought to be able to do better or live longer. And in particular, we have to keep in mind that this is a proposal focused strictly on kidneys from deceased donors, those make up about two-thirds of the kidneys that are donated every year. The other third is made up of kidneys who are donated from living donors. And we now, from a rule that was passed in 2004, that when you change allocation preferences for kidneys from deceased donors, it has an impact on living donor patterns.
HIPPENSo back in 2004, a rule was enacted through UNOS called the Share 35 Rule. And what this rule did was, it preferentially allocated kidneys from deceased donors under the age of 35 to pediatric recipients. The thought there was that pediatric recipients tended to do very poorly on dialysis and so transplanting them as quickly as possible was a real priority. And so, after Share 35 was implemented, we did, in fact, see, over the next five years, an increase in the number of deceased donor kidneys that went to pediatric recipients, but we also saw, though -- and it really wasn't expected -- was a drop off in the number of kidneys donated to pediatric recipients from living donors.
HIPPENAnd that's important because kidneys from living donors tend to last longer and have fewer complications than kidneys from deceased donors. So the Share 35 Rule did indeed increase the number of kidneys from deceased donors that went to pediatric recipients, but it came at the expense of living donation. And the point of this whole concepts document is to try and increase the number of life years from transplant. In the case of Share 35, that didn't happen. The import for the larger allocation system is that recipients who are aged 18 to 34, which make up about 10 percent of the list, get about 50 percent of their kidneys from living donors.
HIPPENPatients who are 35 to 49 get about 40 percent of their kidneys from living donors. So if the unintended consequences of Share 35 for pediatric recipients are based upon the 18 to 34-year-olds or the 35 to 49-year-olds, well, then yes, they would be getting preferences for kidneys -- for better kidneys from deceased donors, assuming we can predict that, but would probably come at the expense of living donation, and that would be a terrible problem. Finally, although there's been a lot of talk about the potential benefits from this system, what there hasn't been so much talk about are the potential risks and harms from the system.
HIPPENIn the concepts document, it's clear that at least based on the statistical models, the concept -- the proposal would end up taking about 10 percent of kidneys that would otherwise be allocated to recipients over the age of 50 and preferentially allocating them to younger recipients in general. There are few more variables involved, but in general, that's the case. Well, it turns out that 50 to 60 (unintelligible) made up -- make up the bulk of the list. They make up over 40 percent of the list currently, and they make up over 40 percent of the new patients added to the list every year.
HIPPENSo, as a consequence, one potential harm of the new system would be that the majority of patients on the waiting list would, first of all, have fewer opportunities to get a kidney from a deceased donor. And secondly and more importantly, there would be more of those patients who would wait longer on the waiting list, conceivably die waiting for a kidney or have to be removed from the waiting list without a transplant because they become too sick.
NNAMDISo to deal with your last point first, what you seemed to be suggesting is that 50 to 64-years-olds would be, in a way, discriminated against if these suggested changes are put into effect?
HIPPENI wouldn't put it quite that way. They would have fewer opportunities for transplant, at least that's how it's been modeled.
NNAMDIWell, we got a post on our website from Jack who says, "I am both an organ recipient, cornea, and donor, kidney. In general, I strongly believe that organs should go to younger recipients. I have had the gift of sight for over 30 years. The other recipient was 80 and lived for six years." How would you respond to that, Ben Hippen?
HIPPENWell, I think the way in which to think about benefit after transplantation is whether an individual benefits from a transplant versus not receiving a transplant. That 80-year-old may not have lived as long, but the remaining years that that 80-year-old lived were likely good years, years that they didn't otherwise have. That's how we approach patients in our clinic. I think that's how we should approach allocation. We don't have enough kidneys. There's a growing disparity between the demand for and the supply of kidneys.
HIPPENAnd the way in which to address that is to increase the number of available organs primarily from living donors because, as Dr. Becker alluded to through the efforts of the Organ Donor Collaborative, we have done just about all we can do to maximize the number of kidneys from deceased donors.
NNAMDIAnd I'd like our other panelists, Dr. Robert Veatch and Dr. Kenneth Andreoni, to respond to another point that you made, Dr. Hippen, and that is that if there is in fact -- as a result of these suggested changes, if they are affected -- if there is in fact an increase in the number of deceased donations then you said it would quote unquote "probably come at the expense of living donation based on what you saw with pediatric kidney transplant." The word probably, Kenneth Andreoni, first.
ANDREONIWell, thank you. Again, I've heard Dr. Hippen's points before, and actually we know each other and have discussed this in the past. I think one major point that Dr. Hippen is overlooking in the concepts here, especially in the top 20 percent of kidneys to the longest living 20 percent, versus the pediatric Share 35, is what actually happens in the system. So in the Share 35 pediatric, there are many areas of the country, where, when a child is placed on the list, they may be the only child in that blood group that day. So they, of course, will get the next kidney.
ANDREONIAnd there are only about 450 pediatric kidney transplants done per year around the entire country. So because of that fact that in some areas of the country, when a child is listed, they may be first on the list, that probably has led to that concept of some small decrease in living donation for these children. However, in the policy in which we put out these concepts to discuss, 20 percent of an adult wait list of 500 people will still be 100 people. Those 100 people will then need to be rank ordered, based on variables we haven't yet determined, but will most likely be heavily weighted toward wait time.
ANDREONISo, again, if you're the person added to the list today, and you're quote "in the top 20 percent," if there's 100 people, you're likely to be somewhere between 95 and 100. So you're still gonna need to wait a significant period of time for your disease donor organ offer. That should not decrease living donation to a significant amount. Again, education is a big part here. And also educating people as to how much better the average live donor kidney does than deceased donor kidney transplants is an important topic.
NNAMDIRobert Veatch, same question.
VEATCHI would agree that we need a much clearer understanding of exactly how the system will work, and we have to qualify our comments with probably in such words. To me, the really significant ethical issue in the concept paper is age matching and giving priority to those who will get the most benefit. Quite frankly, we haven't done the work necessary to figure out whether it is fair to give increased priority to younger people. Some would argue that fairness requires everybody get the same right of access.
VEATCHI happen to believe that fairness, in fact, requires giving younger priority -- younger people priority. I like that part of the concept paper. There are other people who, I believe, will end up being treated unfairly as the concept paper is written. Primarily, people with unusual genotypes -- that is, racial minorities -- and also patients with diseases like diabetes are likely not to do well. And we need to have a long, clear discussion over whether those implications increase or decrease the fairness. The paper is motivated primarily out of a concern to use kidneys more efficiently. And it often happens if we make the system more efficient, we also make it less fair. That's where the work hasn't been done.
NNAMDIDr. Hippen, would it be an oversimplification of your position to say that you come down on the side of everyone getting the same access?
HIPPENNo, that's a pretty good summary of my position. I think that trying to compare life years after transplant for different people is fraught with difficulty. A lot of that has to do with the fact that comparing years after transplant between individuals is quite difficult. A 55-year-old who gets an additional six years after transplant may value those six years greatly. As one of your callers pointed out, her father was an elderly recipient who could conceivably be disadvantaged under this proposed system.
HIPPENI think that her -- I mean, her story clearly demonstrates that her father got a lot of benefit from transplant. And, on the other hand, there are some young recipients who may not either enjoy the projected number of years from transplant, or -- and, frankly, comparing a 25-year-old to a 55-year-old in terms of, you know, what their benefits are going to be from transplant strikes me as fraught with peril. I did wanna come back and address one of Dr. Andreoni's concerns with regard to Share 35.
HIPPENDr. Andreoni observed that at least some of the 18- to 34-year-olds would have to continue to wait on the waiting list because the number of kidneys wouldn't actually go up. That presumes, though, that the number of 18- to 34-year-olds is uniformly distributed around the country and across donor service areas. That's unlikely to be the case. In fact, what's likely to happen is that, in some donor service areas, there will be a 20 percent cohort that is much more favorable to young people. And there will be other ones in which it's a wash.
HIPPENThose areas, those donor service areas where it's much more favorable to be young, will attract the young. And you'll find -- not unlike what we have now, where people multi-list in centers where there are disparities in waiting time -- people will preferentially -- particularly if they are likely to fall into that 20 percent range in a given donor service area -- go there and be listed there.
NNAMDIOn to Carol in Easton, Md. Carol, you're on the air. Go ahead, please.
CAROL...taking my call. My question is twofold. Listening to your show and your guests, I'm clearly motivated to be or become an organ donor. However, I have a reservation that I've always had whenever I'm asked about becoming an organ donor. My husband actually pointed this out to me and said, if you become an organ donor, does that mean that should I be in an accident, or a car accident or in something that puts me into critical condition? Knowing that I'm an organ donor and obviously the need and demand for organs, is a doctor more likely to terminate me or to say that I'm, you know, on my last leg than -- you know, we really -- am I more likely to be let go because I'm an organ donor, or will a doctor do everything he can to try to save me regardless whether I'm an organ donor or not?
NNAMDIRobert Veatch, that under the no good deed goes unpunished category.
VEATCHYes. I've always been a militant proponent of patient's rights, and I would be concerned of this if there were any evidence that it, in fact, occurred. In fact, the transplant system goes to great lengths to make sure that patients will be treated aggressively. There's a division of labor where the emergency room doctors will fight as long as possible. And then a new team will come in to do organ procurement. I don't think there's any evidence whatsoever that patients are not treated aggressively if they're organ donors. In fact, sometimes the emergency room doctors don't even know whether the patient is a donor or not.
NNAMDIAnd we're running out of time fairly quickly, Dr. Andreoni. But we got this email from Constance in Silver Spring. "According to a letter I read in The New York Times, kidney donors automatically acquire a preexisting condition, and, for the rest of their lives, will not be able to get private medical insurance. To increase the supply of organs, don't let insurance companies define donating a kidney as a preexisting condition, and make sure they don't cheat by finding some other trivial reason to deny insurance to donors." Is that true, Dr. Andreoni?
ANDREONIWell, it is true that we need to do everything we can to remove the obstacles to living donation. Whether some insurance companies consider it a preexisting condition can be a true statement, but not all insurance companies do this.
NNAMDIAnd I'm afraid that's all the time we have. Dr. Kenneth Andreoni is a professor of surgery at Ohio State University and chair of the Kidney Committee of the United Network for Organ Sharing or UNOS. Robert Veatch is a professor of medical ethics at the Kennedy Institute of Ethics. He's on the board of directors of the Washington Regional Transplant Community and a member of the Ethics Committee of UNOS. And Dr. Benjamin Hippen is a transplant nephrologist at the Carolinas Medical Center in Charlotte, N.C. Thank you all so much for joining us, and thank you all for listening. I'm Kojo Nnamdi.
Virginia Democratic Party Chairwoman Susan Swecker is in studio. And Aisha Braveboy, candidate for Prince George's State's Attorney, joins us.
The number of people living in D.C. is booming, and so too is the number of rats. Kojo talks about how D.C.'s rodent problem is affecting the city and what's being done to fight off the pests.
The federal court judge who ruled that Maryland's public universities were unlawfully segregated rejected solutions proposed by the state's Higher Education Commission and a group representing a coalition of Maryland Historically Black Colleges and Universities for redressing that segregation. We get an update on the case.
A new book, "Chocolate City: A History of Race and Democracy in the Nation's Capital," presents a sweeping view of how race impacted Washington, D.C. for the past four centuries.


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The partnership between the region of Brittany and the Free State of Saxony was formed on 30th November 1995 and continues to make a solid contribution to German-French friendship. Saxony is the first of the eastern German states to form a partnership with a French region.
With a Memorandum of Understanding on 15th November 2005, the partnership was focused on the fields of education and training, universities, science and agriculture.
Portrait of the region
Brittany covers the northwest peninsula of France, with a total area of around 27.200 km². The total length of coastline of over 1,200 kilometres makes Brittany one of the most popular holiday regions in France.
Around three million people live in Brittany, making up 5% of the total French population. The minority language Breton can be encountered particularly in the western part of the region. Breton, like Scottish and Gaelic, belongs to the Celtic language group and is currently spoken by around 250,000 people. In recent years, the regional language has enjoyed a renaissance and it is now being taught in primary schools again.
In a time when industry has become dominant, agriculture continues to play a fundamental role in Brittany. This is primarily because of the lack of important raw materials and sources of energy. The main industries of Brittany, which concentrate around the large cities, include shipbuilding, with the world-famous ports of Brest and Lorient and the automobile industry around Rennes, where PSA Peugeot manufactures the Citroën.
Recent efforts have been made to develop new technologies in the region. Rennes, Brest and Lannion are becoming important centres in the field of electronics und communication. An unusual feature of the Breton economy is its relative independence: 60% of jobs in industry depend on firms whose headquarters are based in Brittany.


text: This week Henry actually talked more than normal and they all loved it! I love hearing my Daddy laugh at my child through the phone. It makes my heart feel good. I love to hear my Mama smile through the phone when my sweet boy says her name. It is medicine for my soul. When Henry finally said "Juju pretty" to my favorite sister after months of poking and begging, my insides danced a little jig. Seriously, there is nothing cuter than him knowing his "people" even though he rarely sees them in person. He knows who David "Day Day", Daniel "Danel", and Anna "An-ne-na" are from our photo in the den and our occasional Skype sessions. I am sorry, Samuel, but he looks at you and says "baby"! I say all this to say, even if you live away from your family, you can still be as close as you want to be. It just takes a little time and offers a great reward package! Call someone you love today, shoot them an email or even better....send them snail mail. I challenge you.