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You know it's spring when those long, lovely tulip stems start peeking out of the ground! There are more than 1,000 different tulip species, and each of them brings its own touch of charm to springtime. In fact, so many species exist that scientists have grouped them into 15 main categories of tulip types, just to keep them in order! So in honor of our Tulip Spectacular, we're celebrating the warmer weather by picking our six favorite tulip types. Read on to find out what makes each category of these spring blooms beautiful and unique!
Tulip Type No. 1: Single Tulip
The beautiful simplicity of these tulips is what makes them a favorite among gardeners and florists all over the world. In fact, our floral designers at 1-800-Flowers.com use Single tulips to create all of our spectacular tulip arrangements. Whether they're solid-colored or bicolored with two contrasting hues, these flowers bring a bold pop of color to any home or garden. They can be found in virtually any hue, including red, yellow, orange, pink, purple, blue, white and black. We love the gorgeous, deep color of the purple tulip so much that we even chose it as our signature flower!
Single tulips come in two varieties: early-blooming and late-blooming. Early bloomers start to spring up in late Mach and can grow up to 17 inches tall, and each flower can expand up to 3 inches wide. On the other hand, Single Late tulips typically bloom in May and can grow up to 30 inches tall, with a 3-inch-wide flower. Some of the most popular Single Early tulips include the Purple Prince, Diana, Prince of Austria, Cardinal Rampolla, Lac van Rijn and Keizerskroon. For Single Late tulips, favorites include the Antoinette, Blushing Lady, Queen of the Night, Avignon, Dreamland and Zomerschoon.
Tulip Type No. 2: Double Tulip
These tulips are double the fun! They come in pairs, and they have more than twice as many petals as the Single variety. They have so many petals that they're sometimes called Peony-Flowering tulips because their full blooms look so much like pretty peonies. Because they're so large, Double tulip blossoms are long-lasting, but they can also easily snap in bad weather. Staking is sometimes a must, especially during strong wind and rain.
Like their single-bloomed siblings, Double tulips exist in early and late varieties. Double Early tulips show off their blossoms in early April and grow up to 15 inches tall and 3 inches wide. Double Late tulips appear later in the season, around May, and can reach 24 inches in height. Some of the most beloved Double tulips include the Angelique, Peach Blossom, Uncle Tom, Orange Princess, Yellow Spider, Montreux, Crispion, MountTacoma, Miranda and Boule d'Or.
Tulip Type No. 3: Lily-Flowering Tulip
The most feminine of all tulips, these tall, curvy flowers are named for their lily-like shape. Their blossoms are narrower in the middle, and their long, pointy petals curl outward at the top. When they fully bloom, they form a star shape, just like the lily. Lily-Flowering tulips can reach a height of 24 inches, and they can come in any combination of pink, purple, peach, red, orange, yellow and white. They typically flaunt their full-bodied beauty in late spring, around May. The trendiest Lily-Flowering tulips are the Ballerina, Ballade, West Point, Mona Lisa, Holland Chic, China Pink, Tres Chic and White Triumphator—fitting names for such graceful and stylish flowers!
Tulip Type No. 4: Fringed (Crispa) Tulip
These tulips call for a celebration! Their fun, fringed petals make them look like adorable little party hats. The frayed edges of this flower can be either the same color as the rest of the blossom, or they can sometimes have their own exciting color that contrasts the petals. Their blooming season is usually in late spring, and they can reach up to a whopping 30 inches in height. The frilliest, best-loved varieties of the Fringed tulip include the Curly Sue, Fancy Frills, Fringed Elegance, Burgundy Lace, Cummins, Hamilton and Lambada. Continue Reading…


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- 240 total posts
- 2 reviews
- 238 comments
Reviews & Stories
ByeBye Batwings! - New York, NY
I've wanted this surgery for about 15 yrs! Lost over 100 lbs after GBS in '96. Finally, after many ups & downs, I am going to have my arm lift & tummy tuck on 2/20/13. I am very anxious and a bit nervous about the recovery period. But, I've thought long and hard about this and I know it is what I really want. **POD 8** Had my surgery on 2/20. I can honestly say that it was far... READ MORE
Finally! At Almost 50! - New York, NY
I was NEVER slim.......NEVER. Pretty, sexy, funny.....yes. But, slim? NEVER! As the years passed I struggled more & more to try and control my weight. After having a GBS in '96, I lost 130 lbs. Then started packing on the weight again during fertility treatment in '03. Was 190 lbs by the time I got pregnant, and 240 lbs when I delivered. Couldn't get the weight off!! Consulted with my... READ MORE
Recent comments from Lornadoone
I also had gastric bypass. There are 2 things I want to say about the anesthesia and it's effects. First, this surgery shouldn't take as long as the gastric bypass. Therefore, requiring less anesthesia. That will make a difference... READ COMMENT
Hi Carolyn! I am so glad to see you arrived safe & sound to the flat side! I so rarely am on the site, but, I check in every now & again. Anyway, you are looking GREAT!! And, I know that awesome feeling of that first morning glance.... READ COMMENT
I experienced that earlier on. Not anymore though. READ COMMENT
Hi Carolyn!! I haven't been posting on the site in a while. But, I'm so glad I popped in tonight!! You are just a day away!! I will be 4 mos PO on your surgery day. Had my final PO appt with ps on 6/6. He said he was happy... READ COMMENT
Anyone else experience a lot of swelling around weeks 10/11?? I am coming up on 11 wks this Thursday and I have been having a lot of swelling, especially in my upper abdomen. Anyone else? READ COMMENT

subset: commoncrawl


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Published 09-29-2010 8:16 PM | Fernanda Camargo
We are in the middle of the World Equestrian Games, which is the world competition for 8 equestrian sports. I worked on Saturday as an interpreter for the Brazilian teams. The reining competition started on Saturday. I watched the entire competition from the mixed zone, which is where the competitors go in and out the arena. It was amazing to say the least. The Italian competitor Stefano Massignan, riding a palomino quarter horse called Yellow Jersey, brought down the house when the rode an awesome pattern. The American rider Craig Schimersal, riding Mister Montana Nic also did a great job. His horse was beautiful! But Shawn Flarida and RC Fancy Step, also a quarter horse, won the individual qualifier with extremely high points. Team USA is in first place!
The cool thing about reining is that the horse is judged on how well behaved and under control the horse is at all times, on top of how well the horse performs each maneuver.
The National Reining Horse Association is having clinics throughout the day where regular people like me and you can "test ride a reiner". I signed up for it! The bad part is that it is a draw. The arena is right beside our UK pavilion, where the Saddle Up Safely booth is. I hope they draw my name!!!!


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After calls for "top-to-bottom" changes in the Police Federation and other criticism of England's police, Bradford's top police officer Simon Atkin says there is no crisis of confidence among his officers.
A damning report by an independent panel said the federation, which represents 127,000 rank and file officers, exhibited a "worrying loss of confidence and competence" and had suffered a "serious loss of influence" with members now seeing it as weak and unwilling to engage change.
But Chief Superintendent Atkin, who heads the Bradford district division, said he believes the Federation is positive about tackling tough challenges ahead.
"My working relationship with Federation colleagues in Bradford is exceptional and they are very much part of our team," Mr Atkin said.
"The Federation is massively supportive of our change programme and I think that overall they are doing a good job.
"All senior officers want to keep in touch with reality and even go out on patrol to keep 'hands on'.
"The new Chief Constable was out himself on New Year's Eve and making arrests in Leeds.
"And it's good to have the federation who can nudge us about what rank and file officers are thinking," he said.
However Chief Supt Atkin said he was aware that changes in work practices, such as restructuring the force with fewer senior detectives, had caused some uncertainty.
"But I don't think morale has been affected, not by that or by recent headlines surrounding the police.
"Officers and PCSOs are still going out and doing the job they joined up to do.
"Basically, across Bradford everybody is really getting stuck in," he said.
"Police officers aren't driven by money. The only reason they want promotion is because they each believe they can do the job better than it's been done before.
"I've just had our finest inspectors lining up for new jobs which involve more work than they currently do, but they really want the challenge of more responsibility," Mr Atkin said.
"All the changes we're looking at are about tackling crime more effectively.
"We now have two main hubs for detectives in Trafalgar House and Javelin House, Eccleshill, and that means less supervisors.
"Which means we can keep the numbers of 'do-ers' as high as possible.
"We are creating what they call a 'leaner leadership spine'. As a simple example of that, Bradford used to have two commanders, now there's one – me," Mr Atkin said.


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Prompting.com at NAB 2012
Kathleen Warner
New Ultra Light Teleprompters from Prompting.com at NAB 2012
At NAB 2012, Prompting.com is showing off new Ultra Light Camera Mount Teleprompters. At only 7 LBS, this 16 inch LED widescreen teleprompter is one of the best values in the market. The viewing area of this 16 inch LED widescreen is equivalent to a 17 inch standard screen.
A seven pound teleprompter and it includes highly reflective beam splitter glass, a fabric hood, and an ENG or DV camera mount.
Prompting.com will also be offering a new, larger 20 inch LED widescreen teleprompter. Like the seven pound, 16 inch model, this unit is also available with ENG or DV mounts.
Also unveiling at NAB 2012 is the new, PowerPrompter® International Software. PowerPrompter has enhanced, multi language capabilities, including Arabic, Russian, Spanish, and many more. This version of PowerPrompter ® has been optimized for Windows 7 and the I3, I5 & I7 processors. PowerPrompter® has been used at the Academy Awards, the Emmys, and the Grammys.
"Prompting: It's what we do."
Prompting.com is demonstrating these products at NAB 2012,
Booth C10418, April 14-19.


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Ringgold (GNIS FID: 1499962) is a populated place located in Pittsylvania County at latitude 36.608 and longitude -79.295.
The elevation of Ringgold is 574 feet. Ringgold appears on the Ringgold U.S. Geological Survey Map. Pittsylvania County is in the Eastern Time Zone (UTC -5 hours).
Pittsylvania County: Cities & Towns | ZIP Codes | Features (airports, churches, hospitals, etc.)
BIG Map |
Driving Directions |
Data Source - USGS GNIS FID: 1499962
BOUNDARY MAPS: Dan River District | Pittsylvania County
Danville, VA
(5.8 miles WSW)
Blairs, VA (6.6 miles NW)
Milton, NC (6.8 miles SE)
Mount Hermon, VA
(8.5 miles NW)
Yanceyville, NC (14.3 miles S)
Lakewood, VA
(1.9 miles SSW)
Green Acres, VA (3.6 miles WSW)
Kentuck, VA (3.6 miles N)
Mountain Hill, VA
(3.9 miles SSW)
Glenwood, VA (4.1 miles WSW)


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Jason M Montgomery
Affiliation: Argonne National Laboratory
Country: USA
Detail Information
- SERS enhancements via periodic arrays of gold nanoparticles on silver film structuresJason M Montgomery
Center for Nanoscale Materials, Argonne National Laboratory, Argonne, IL 60439, USA
Opt Express 17:8669-75. 2009..6 g(SPP) g(LSP), where g(SPP) and g(LSP) are enhancement factors associated with the individual components. SERS enhancements for the structures can be as high as O(g(4)) = 10(8)...


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Mom Likes To Suck. 9:45
Elli Loves to Suck 2 3:09
Forced to suck 1:30
His mom came to cee me 15:09
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Dr. Douglas Beach MD
- Hematology and Oncology Philadelphia, PA
Patient Reviews
Reviews reflect patients' level of satisfaction with the care they received from this provider. Dr. Douglas Beach xhas an overall rating of 4.2.
Dr. Douglas Beach, MD is a Doctor primarily located in Philadelphia, PA. He has 8 years of experience. His specialties include Hematology and Oncology, Internal Medicine and Medical Oncology. Dr. Beach is affiliated with Pennsylvania Hospital. He speaks English.
Find out the languages this doctor/ or staff may speak.
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Learn where this doctor attended medical school.
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Specialties & Expertise
Dr. Douglas Beach has the following 18 areas of expertise and 3 specialties.
For the best health care, select a doctor who specializes in your medical condition.
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Lung Cancer
Get the facts about lung cancer, including how many people get it and what increases your risk for developing it.
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Dr. Douglas Beach, MD is similar to these 3 Doctors near Philadelphia, PA.


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May 13, 20172017 Dance Recital June 2nd
Contact Us
J&R Gymnastics Locations:
1437 S Walnut
New Braunfels , TX 78130
(830) 606-0375
Hip Hop
A 55 minute class that is an up-beat and outgoing form of dance that combines popping, locking, free style, and street funk. The class will begin with a brief warm up and follow me stretching exercize. This will help to improve flexibility among students and prepare their bodies for class. Hip Hop fundamentals such as popping, locking and attitude will be introduced in class combinations. Each class will focus on a longer combination in the hip hop dance style. The goal of this class is for students to learn hip hop combinations and further their technique in hip hop.
Attire: Jazz pants (black), a form fitting top and jazz shoes (black)


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St. Mary's Hospital - Madison
We all want long, healthy lives and SSM Health in Wisconsin can help you get there. The goal of SSM Health Heart & Vascular Care is to provide exemplary care through prompt evaluation and centralized treatment. Cardiologists here treat more hearts and save more lives than any other facility in the region.
As a patient, you will be assessed by a highly-qualified valve team comprised of cardiovascular & thoracic surgeons, interventional cardiologists, imaging cardiologists and trained nursing staff. From disease prevention to advanced treatments, our physicians offer world-class cardiology services.
Heart experts at SSM Health Heart & Vascular Care Center pride themselves on the speed and quality of care provided through the Level One Heart Attack Program. Partnerships with emergency service providers and regional hospitals eliminate delays and speed diagnosis and treatment of heart attack to patients in the region. Learn more
Surgeons at SSM Health Heart & Vascular Care Center perform over 400 procedures annually including:


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SOUTHEND United's on loan winger Jacob Murphy is a doubt for tomorrow's clash with Burton Albion at Roots Hall.
The 19-year-old, who is with the Shrimpers from Norwich City until the end of the season, picked up a calf problem in training at the start of the week.
And he has yet to return to action.
"Jacob has a calf injury and we're not too sure if he will be available or not for the game," said Blues boss Phil Brown.
"He got the injury in training on Tuesday and he hasn't been able to get back out there since.
"Whether or not he will be able to join in today I'm not sure but there's still time for him to throw his hat in the ring so we will have to wait and see."
If Murphy fails to recover, then Anthony Straker seems set to replace on the left flank after impressing when coming off the bench against Fleetwood Town last weekend.
The winger did well to create a late chance for Barry Corr and Brown is keen for Straker to be handed another opportunity.
"Strakes is in my thinking for the game and I thought he was excellent when he came on at Fleetwood, " said Brown.
"That's exactly the reaction we want from our players and we've seen it a few times in our last few games now.
"Freddy Eastwood scored after coming on against Torquay, Barry Corr did the same at Cheltenham and that's what we want to carry on happening."
Brown is considering making further changes to his team with Luke Prosser, Conor Clifford and Lee Barnard among those in contention to start.
But Brown has yet to finalise his line-up.
"It's a game of football not cards but you have to decide whether or not you show your full hand at this stage or not," said the Blues boss.
"There are lots of ifs, buts and maybes but we want to win the game and whoever is picked will be going out there trying to make sure that happens."


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An injury accident was reported in Gage County June 1st.
Dalton Traurnicht, 17, of Wymore, had stopped at the U. S. Highway 77 intersection at Spruce Road, about 5 miles south of Wymore. Failing to yield, he proceeded and collided with a vehicle driven by Brad Tennant. Tennant was transported to a Lincoln hospital with non-life threatening injuries. An airlift initially called for was called off.


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" Manufacturer: The North Face / Type: Synthetic "
The North Face Cats Meow Blue Woman. Climashield- Prism synthetic insulation and soft silken lining combine to make the Womens Cats Meow a classic bag for three-season mountaineering forays down to 20ºF. Specifically designed to mirror a womans physique, this bag delivers added creature-comforts for the female mountaineer.Features:- Buttery soft fabrics- Climashield® Prism shingled construction with Climashield® Apex layered against the body- Glow-in-the-dark pull-loop on zipper- Inspired fit and function- Internal draft tube pockets keep essentials warm and within reach- Light compression stuffsack


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Previous Challenge Entry (Level 1 – Beginner)
Topic: Orange (the color) (11/19/09)
TITLE: Today I am Orange
By Karen Macor
"Why won't you just look at this dog?" I angrily asked my husband. "You promised we could have a new dog and I have spent hours finding just the right one for our family", I pleaded.
"It's just a dog", he replied curtly, and with finality. He wasn't interested, and wasn't about to approve my choice of dogs.
I was livid and seeing red. I wondered if my husband saw my nostrils flare, or my eyes fill with unshed tears. The anger consumed my emotions, and my mind filled with old resentments that should have been long forgotten. Instead, I had somehow held on to them for such a time as this. I was ready to wage war. I loaded the bullets into my mouth ready to hit him with a barrage of hurtful words, and vicious accusations, but nothing came out. I choked on my own rage, and the Holy Spirit breathed new life into me. I heard "1But mark this: There will be terrible times in the last days. 2People will be lovers of themselves, lovers of money, boastful, proud, abusive, disobedient to their parents, ungrateful, unholy, 3without love, unforgiving, slanderous, without self-control, brutal, not lovers of the good, 4treacherous, rash, conceited, lovers of pleasure rather than lovers of God— 5having a form of godliness but denying its power. Have nothing to do with them." 2 Timothy 3 NIV
The warning had been given, and as my mind heeded the caution given me, the rage mellowed. I was guilty of all the warnings. How could I possibly not consider my husband's feelings? How could I insist on my wants without considering my husband's desires? The war was over, but the battle went underground. Evil thoughts attacked every time my guard was down. Self-control was short lived, and an appreciation of the wonderful man my husband really is, only started to shine through as I surrendered my will to God's. The Son was rising.
My whole being changed as the rage subsided, and the Son rose. No longer was I seeing red. The Son had cheered me up and the anger dissipated. As a new day dawned I became full of new positive energy. I heard the scripture "22Wives, submit to your husbands as to the Lord. 23For the husband is the head of the wife as Christ is the head of the church, his body, of which he is the Savior. 24Now as the church submits to Christ, so also wives should submit to their husbands in everything." Ephesians 5 NIV
Such hard words to swallow! "Lord, help me honor you", I pray.
It's the start of a new day. Today I am orange. The red rage is gone, the Son has shone, and new energy and warm love comes with the dawn.
The opinions expressed by authors may not necessarily reflect the opinion of FaithWriters.com.
If you died today, are you absolutely certain that you would go to heaven? You can be right now. CLICK HERE
JOIN US at FaithWriters for Free. Grow as a Writer and Spread the Gospel.


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After years of flying in private jets on Disney's dime, of wielding Disney's clout and of dipping into Disney's very deep pockets, Harvey and Bob Weinstein now have what they say they wanted: freedom from the constraints imposed by a global media conglomerate.
But unless they impose some restrictions on their spending, not to mention yelling, many say the tempestuous brothers may have trouble duplicating the kind of success they enjoyed at Disney.
The Weinsteins, whose contract with parent Walt Disney Co. expires in September, have six months to firm up plans for what they described Tuesday as a "fully integrated media company." They appear to have their work cut out for them. Among the things the duo lacks are a marquee name (Miramax Film Corp. stays with Disney), a staff (top Miramax people have been jumping ship for weeks) and a film library to fuel cash flow.
"Clearly, they've had enormous financial flexibility under the Disney umbrella, which is not likely to continue no matter how they design their independent company," said Jeffrey Logsdon, an analyst with Harris Nesbitt.


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New student checklist
- Learn about the campus and its services
Become familiar with the student resources that are available on the campus. Awareness and knowledge of these services will help enrich your academic and personal experiences while at college.
- Be aware of your surroundings and your personal safety
DC Campus safety of all students and visitors on campus is a priority. Become knowledgeable about what Durham College is doing to keep students safe. In addition to these efforts, be responsible and avoid putting yourself in a risky situation.
- Get Involved
There are a variety of opportunities to get involved over the next year. For example, there are over 50 student clubs aimed at meeting the diverse needs of students on campus. If you have an idea for a club that Durham College does not currently offer, you can start a new club. Please visit the Student Association's website for details.
But that's not all. There are opportunities to get involved with your program or school, the Outreach Centre, tutoring, DC Crew for leadership development and so much more. Search through the Co-curricular Recognition Program portal to discover how you can get involved today.
You can also take advantage of social events such as: cheering for a varsity team, listening to guest speakers/lecturers on a variety of topics and attending a many different cultural activities throughout the academic year. There is something for everyone.
- Establish a schedule
The first year of college promises to be a busy one, so create a schedule to follow which includes time to study, work and have fun! This will ensure a balanced lifestyle as you prepare for tests and finish assignments on time. If you want to learn more about how to manage your time effectively, attend a Time Management workshop at the Student Academic Learning Services.
- Maintain a healthy lifestyle
When establishing a schedule don't forget to schedule in some time for taking care of yourself. Don't underestimate the importance of getting the right amount of sleep, eating healthy and exercising. Look for the Balanced Choices menu items on campus and take advantage of the fitness facilities on campus. Taking care of your body will help you stay focused, adding to your success. Exercise can also be a great stress reliever!
- Meet with your instructors
Don't wait until your last year of college to realize the importance of talking to your instructors. Instructors are open to answering questions and assisting students during their office hours. Use this opportunity to ask clarifying questions and discuss academic performance.
- Develop a financial plan
Financial Aid and Awards offer a number of services to full and part-time students with varying financial needs. Visit their website to learn about applying for OSAP (Ontario Student Assistance Program), scholarships, bursaries and donor awards and become familiar with the deadlines associated with all financial aid programs. It is important that you investigate any assistance that you may be eligible to receive.
- Make time to socialize
Forming new relationships is one of the best things about college, so take time to socialize and meet new people. If you are hesitant about meeting new people, try joining a club or asking your fellow classmates to study one evening over coffee.
- Get to know your student advisor
Student advisors are experts on your program and can offer assistance with course selection and many other academic decisions. If you find yourself with any questions about your program or are struggling with your courses be sure to contact your student advisor.
- Explore Durham Region
For students new to Oshawa or Whitby, it is important to get to know your new city and what it has to offer. Be sure to take the time to be a tourist in your new hometown.


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Police: Man's new friend enjoys long walks, robbing people
SEATTLE -- A Ballard man's new friend enjoys chatting over drinks, taking long walks around the neighborhood and robbing people he meets at bars, according to the Seattle Police Department.
According to police, the victim met the suspect at a bar near 11th Avenue and Pine Street in Capitol Hill Saturday night. The two talked and drank for a while before deciding to stroll around the neighborhood.
While still out and about around 4 a.m., the suspect told the victim he had a gun and needed the victim to go to an ATM and withdraw cash, according to police.
The victim complied, and the suspect reportedly ran off with the victim's cash and probably his faith in his fellow man.
The victim walked to the East Precinct to report the robbery, and detectives are investigating.
It's not the first time -- and certainly won't be the last time -- someone was victimized by a new drinking buddy.
Back in April 2013, a North Seattle resident found his home invaded by a man he had maybe been sharing a bottle of schnapps with the night before.
Last October, a man met two women at a Queen Anne bar and was only too happy when they agreed to make out with him in his apartment. He was less happy when they robbed him.


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Fire Destroys House in Roanoke
Roanoke, VA - A house in Roanoke has been declared unsafe after a fire moved through it very quickly Wednesday night.
The fire happened in a home in the 900 block of Hanover Avenue NW.
The fire department says it all began about 6:20 p.m., when someone inside left cooking unattended.
Four people in the home escaped, and one suffered minor injuries.
The damage is estimated at $40,000.


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The plans in this collection represent the work of KPS Group, a firm focused on sustainable planning and design with offices in Birmingham and Atlanta. The plans are the product of Darrell Meyer, the firm's director of planning and landscape architecture, Professor Emeritus at Auburn University and founder of the Master of Community Planning Program at Auburn and his staff of LEED accredited planners and landscape architects. The plans represent the best of city planning and urban design, downtown revitalization and preservation, and campus planning, and are essential documents in the continued development of communities across Alabama.
Darrell Meyer, Director of Planning and LandscapeArchitectureKPS Group
Alabama Community Planning Digital Collection, theme based off Viewport | Auburn University Digital Library © 2017 Auburn University Libraries | 231 Mell Street | Auburn University, AL 36849
Questions or Comments: 334-844-4500 or 800-446-0387 or contact the


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JERUSALEM (Jul. 9)
The Cabinet has asked its committee on wages to negotiate with the Histadrut on a law proposed by Finance Minister Pinhas Sapir which would abolish the practice of retroactive salary payments.
Sapir told the Cabinet Sunday that all future wage contracts should be ended before the existing contracts expire and salary contracts in all the various sectors of the economy should be for the same time period.
The Finance Minister said the economy was harmed by the existing practice of signing wage contracts late and then giving employes large sums in back pay. Labor relations also suffer because of the delayed contracts, Sapir added.


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This is a great article about the cost of NOT hiring women coaches. Great thoughts in this one!
Supports for Female Coaches: Part I
In past blogs I've written about the barriers female coaches at all levels face in pursuing, maintaining and thriving in their careers (read barriers Part I and Part II). It is important for women to know and understand the many barriers they face, so they don't feel alone, isolated, or blame themselves when barriers arise. Knowledge of barriers can help women understand the system of marginalization many of them face, so they can develop strategies, coping and support systems to combat them.
In my next series of blogs, I'm going to share evidence-based information about key things that help and support female coaches.
The most common support female coaches cite is feeling they possess adequate knowledge and skills to perform their job. This knowledge is acquired through formal educational means, coaching work shops, mentorship or by experience. When female coaches believe they are competent, they also feel more confident and are more likely to stay in the profession. Every human being, regardless of gender, persists in things she feels competent to do and will avoid or quit something in which she feels incompetent.
One study found that female coaches compared to male coaching peers were more likely to have earned an undergraduate degree or higher, and accrued elite level competitive experience…meaning they are highly competent and possess a high degree of educational and athletic capital (credit robert). But women often to not perceive they possess adequate knowledge, when they do!
Female coaches also state that attending all-female coaching clinics run by an all-female staff is highly beneficial to helping them develop confidence, knowledge, and skills—not to mention it is a great opportunity to network and find support. The Alliance of Women Coaches is a great organization that helps support female coaches and eliminates many of the barriers that impede and limit women who coach.
Star Athletes
One of the very first things I learned as a coach was to cater a training plan to a specific athlete. For example, it wouldn't make sense to use Allyson Felix's workout regimen for my sprinter athletes. However, while Olympic athletes are more likely to train differently than Division III athletes, there are some specific tools that we can take directly from them.
In the New York Times Well Blog this week, Gina Kolata speaks to several star athletes to ask them what "vaults them from the middle of the pack to the podium." Read along…I think you'll find some useful strategies that translate easily to any athlete:
1."STAY FOCUSED" – Natalie Coughlin (Olympic medalist in swimming) said that she used to daydream while swimming laps at practice. It wasn't until she changed her thoughts to her technique that she actually saw improvement. Using my sport as an example, I used to get lost in my thoughts a lot while out for a run (and still do!) However, ever since I became a coach, I now think more about my form – where are my arms? how are my feet hitting the ground? are my hips under me? Not only has this helped my running overall, but I also think it has lessened my chances of injury.
2. "MANAGE YOUR 'ENERGY PIE'" – "Energy pie? All the things that take time and energy — a job, hobbies, family, friends, and of course athletic training." Steve Spence, a self-coached distance runner who competed in the marathon in the 1992 Olympics and now coaches at Shippensburg University, said "There is only so much room in the pie." If your athletes are anything like mine, then this one might pose some challenges! I probably spend more of my time coaching athletes on time management than on our sport! However, it is time well spent and pertinent to those who juggle a demanding academic environment, a varsity sport, a job, etc. My mom once told me that "the stick doesn't burn at both ends." It is nearly impossible to put 100% effort into everything you want to do. Prioritize and focus on what's most important.
3. "STRUCTURE YOUR TRAINING" – Meredith Kessler began racing Ironman triathlons at the same time "she was working 60 hours a week at a San Francisco investment bank and trying to spend time with her husband and friends." While she eventually decided to quit her job to focus on training, some tactics she utilized while still at work included the structuring of her training, namely learning when it was appropriate to train endurance versus speed. Every workout should have a purpose (and one that you can explain to your athletes)!
4. "TAKE RISKS" – Helen Goodroad's childhood dream was to become an Olympic figure skater. Then she grew to be 5'11". "One day, when Helen was 17, a coach asked her to try a workout on an ergometer, a rowing machine. She was a natural — her power was phenomenal." To make a long story short, Helen ended up taking a risk by leaving her figure skating dream behind. In return, she was recruited as a rower at Brown, was invited to train with the junior national team, and won a world championship with the under-23 national team. She spoke about "leaving her comfort zone" which my high school coach used to tell us all of the time and is something I will never forget (he even had a poster with his own depiction of breaking down "walls").
5. "THE OTHER GUY IS HURTING TOO" – Brian Sell raced the half marathon at the US championship in 2006. With two miles to go, there were two other runners by his side. His realization was: "Those other guys must be hurting as much as he was, or else they would not be staying with him — they would be pulling away." So he made up his mind to stay with them no matter what. He won by 15 seconds (and went on to race the Olympic marathon in Beijing in 2008). This strategy works! I am a firm believer that a good chunk of one's performance comes from the mind and heart, the two parts of one's body that still fight even after everything else has given up. I can attest to this when I ran my 5K PR (personal record) last year. I had nothing left in my legs, and while it would have been much easier to stay at that pace where I felt comfortable, that's not how races are won (or PRs are broken). I had to step out of my comfort zone.
Work Cited:
Kolata, G. (2013, January 14). Training Insights from Star Athletes. The New York Times. Retrieved from http://well.blogs.nytimes.com/2013/01/14/training-insights-from-star-athletes/?emc=eta1
Female Coaches & Referees
Over the course of the last year I have heard a number of accounts from female coaches about their experiences with (mostly male) referees. In short, female coaches in a variety of different sports, feel they are treated differently by referees.
For example, many female coaches have told me they say one thing such as, "Hey Ref, watch the hands" and get carded or given a technical foul, while their male counterpart down the sideline says the same thing and the Ref doesn't even blink. One college soccer coach told me she swore about something on the field, not even about or to the Ref, and the sideline Ref turned around and told her that she was not being a good role model for her players…meanwhile the male coach of the other team is swearing a blue streak with no comment from the Ref.
Based on the experiences of female coaches I've spoke with, here is what I can summarize–In comparison to male colleague female coaches:
- get penalized harsher
- get penalized quicker
- get penalized for less
- get reprimanded or lectured to by referees
- are talked down to in a very condescending manner by referees
- are more often treated rudely by referees
Are these situations consistent with your experiences? Are there others I have missed? If so, I'd like to hear about it as I am beginning a new research project on this topic to bring awareness to this issue in order to create change.
KEY POINT: what these female coaches are experiencing is good old fashioned sexism….one of the many barriers that female coaches face in the workplace (which I've written about previously here and here). I will be writing more about this topic in the future so stay tuned…but in the meantime, if you have a good example, send it to me at email@example.com (don't worry I won't post it here, you'll remain anonymous).
It's not just us coaches…
As I read through my daily headlines this afternoon, I came across an article entitled "Sharing the Pain of Women in Medicine" and was inspired to write about it today. The author describes her doctor friend who "got tired of being a woman in medicine." She, more often than her male counterparts, was asked to work on more holidays, sit in on administrative meetings, and other things that kept her away from advancing in her career. When she raised these concerns to her chairman, "he listened – but never responded to her repeated requests for a raise or more support."
This sounds awfully familiar…I wrote about similar events in "The Women's Side of the Glass Wall."
In 2000, a survey put out by Annals of Internal Medicine found that gender bias was widespread among medical institutions. "More than half of the women professors surveyed reported being discriminated against or sexually harassed," women faculty made less money, were promoted more slowly, and fared worse in peer-review. A more recent study that focused on the emotional well-being of its survey takers showed that men were just as likely as women to feel ignored, discriminated against, and unsupported by their institution. As a result of these findings, some institutions have begun to offer mentoring programs aimed to develop leadership skills and to create a collaborative environment of trust. "While it remains to be seen whether these changes will endure, it has become clearer that men, as well as women, stand to benefit from any improvement." Here's to hoping!
Work Cited
Chen, P. (2012, November 29). Sharing the Pain of Women in Medicine. The New York Times. Retrieved from http://well.blogs.nytimes.com/2012/11/29/sharing-the-pain-of-women-in-medicine/?ref=healthupdate&nl=health&emc=edit_hh_20121204
Women in Sport Leadership Lecture
This fall at the Tucker Center for Research on Girls & Women in Sport we focused our fall Distinguished Lecture on the topic of gender and sport leadership. Specifically we invited two renown sport management scholars, Dr. Janet Fink (UMass Amherst) and Dr. Sally Shaw (U of Otago, New Zealand) to flush out why the numbers of women sport leaders is declining in the US, and why women in other countries have failed to ascend to positions of power. Their insights are compelling and thought provoking.
Female Leadership Development in Higher Education
In my Foundations in Higher Education class this week, we were asked to choose an article to critique and summarize. I chose a piece from Educational Management Administration & Leadership in which an online survey was conducted of twenty-six women among eight New Zealand universities in an effort to answer "What helps or hinders women to advance in university leadership roles, as reported by women?" (Airini et al., 2011, p.48).
The motivation for this research question is that "gender imbalance among senior university academics is an acknowledged problem in many countries, [and] women represent only 16.9 percent of professors and associate professors in New Zealand." Moreover, even when women do assume roles of leadership, they are put in a more precarious situation than men, and are more likely to be under close scrutiny. Just as there have been more female athletes since Title IX but fewer female coaches, "female student enrollment figures are increasing…but this is not reflected yet in a proportionate rise in female senior academics" (Airini et al., 2011, p.44-45).
Three main types of factors help or hinder the development of an academic woman's leadership potential: 1) personal, 2) professional, and 3) organizational factors. In regards to personal factors, "women may consider responsibilities, such as raising a family, and their physical and mental health to take priority over climbing the corporate ladder," or on the other hand, they may sacrifice this lifestyle and forgo having children in order to succeed in their career. From a professional perspective, women have a perceived notion to be tougher and to have competence in selling themselves. Lastly, universities have shifted "away from the modernist university," one of intellectual traditions, academic freedom, and backed by government investment, to a "corporate post-modern university," one of strategic focus, client service, and lower levels of government funding (Airini et al., 2011, p.46). If this is the case, then one can't help but compare the gender of current CEOs and executives of corporations to senior academics at universities and wonder if the latter will follow the same trend as the former in hiring mostly males.
Surprisingly, the results of the online survey revealed that women experience more "helpful" incidents than "non-helpful" (Airini et al., 2011, p.49). Therefore, even though facts may show that fewer women assume leadership roles in academia, it may not be because they are being hindered by external factors. Surveyed women discussed positive working relationships they have with those more senior (which led to bigger projects, increased confidence, and greater recognition); opportunities to attend conferences for professional development; and a family connection that actually produced a new client. Perhaps the most interesting positive finding was that one woman did not take on a managerial role since it would take time away from her research (which could also explain why fewer women are seen in those positions).
However, there were some findings that explain possible hindrance to women advancing in academia, including negative working relationships that involved intimidation and challenges to integrity; poor attitudes towards having children and taking maternity leave; stress, illness, bereavement, and low self-esteem. In these circumstances, advancement could be hindered due to restrictions on hours available to work or travel.
The issue of gender imbalance is important to higher education because often when a structure or organization changes, so do its people. As discussed above, if universities are becoming increasingly more like corporations, then the leaders of universities might be more like Chief Executive Officers. The article states that "recently, there has been an increase in emphasis on vision-building, strategic planning, financial management, accountability, and building leadership teams." This statement exudes the same message as that of a mission statement of a Fortune 100 company. The question is, therefore, are women having a harder time adapting to this "corporate post-modern university" model, or does the new model require a different type of leader that academics – both men and women – aren't yet prepared for?
Work Cited
Airini, Collings, S., Conner, L., McPherson, K., Midson, B., & Wilson, C. (2011). Learning to be leaders in higher education: What helps or hinders women's advancement as leaders in universities. Educational Management Administration & Leadership, 39(1), 44-62.


text:
Overview of immunosuppression regimen. Treatment with steroids was discontinued by 1 week posttransplantation. Tacrolimus and sirolimus doses were adjusted to target levels as outlined in the text. MMF indicates mycophenolate mofetil.
Kidney and pancreas rejection rates at 3 and 6 months. All rejections were biopsy proven.
Freise CE, Kang S, Feng S, Hirose R, Stock P. Excellent Short-term Results With Steroid-Free Maintenance Immunosuppression in Low-Risk Simultaneous Pancreas-Kidney Transplantation. Arch Surg. 2003;138(10):1121–1126. doi:10.1001/archsurg.138.10.1121
© 2017
Steroid avoidance is possible in simultaneous pancreas-kidney transplantation with the use of newer immunosuppressive agents and induction therapy.
A retrospective consecutive case review.
A university tertiary referral center.
Medical records of 40 consecutive patients who underwent pancreas-kidney transplantation from November 2000 to July 2002 were reviewed.
The immunosuppression protocol used in this series of patients consisted of Thymoglobulin induction combined with mycophenolate mofetil, tacrolimus, and sirolimus for maintenance immunosuppression. Steroids were used as pretreatment only, given with Thymoglobulin, and were typically discontinued by postoperative week 1.
Main Outcome Measures
Graft and patient survival rates, rejection rates of the kidney or pancreas, infection rates, and surgical complication rates.
Patient, kidney, and pancreas survival rates were 95.0%, 92.5%, and 87.5%, respectively. Biopsy-proven pancreas rejection rates at 1 and 3 months' posttransplantation were 2.5%. Kidney rejection rates at 1 and 3 months were 2.5%. Steroids were given only to patients with documented transplant rejection. Surgical and medical complications were no different from earlier protocols.
Immunosuppression protocols that do not include maintenance steroids have shown minimal rejection in the first 3 months and equivalent patient and graft survival rates compared with protocols that use steroids. The potential beneficial long-term impact of steroid avoidance will require further study.
SIMULTANEOUS pancreas-kidney transplantation is a well-accepted procedure for patients with type I diabetes mellitus and renal failure. Historically, rejection rates of the pancreas in this type of dual transplantation have been as high as 80%, typically requiring antibody therapy, with an accompanying high rate of graft dysfunction or graft loss due to a failed response.1 With the introduction of both tacrolimus and mycophenolate mofetil (MMF) in the later part of the last decade, rejection rates of the pancreas have dropped considerably.2 This has led several groups to alter both induction immunosuppression as well as maintenance immunosuppression.3- 5 With the introduction of sirolimus in the last 2 years, the potential for a protocol that avoids steroid use has been suggested. It is well known that steroids have diabetogenic potential. Additionally, protocols that avoid steroid use in islet cell transplantation have enjoyed good early results, with no obvious problems with rejection.6 Given these concepts, our center embarked on a steroid-free immunosuppression protocol for maintenance immunosuppression. The first 40 patients treated with this regimen are the subjects of this report.
This is a retrospective, single-center review of our experience with a steroid-avoidance immunosuppression protocol in recipients of simultaneous pancreas-kidney transplants at the University of California–San Francisco. The study was approved by the committee on human research at the University of California–San Francisco. Forty consecutive patients who underwent first-time simultaneous pancreas-kidney transplantation from November 2000 to July 2002 were included. Patients who underwent retransplantation or patients who were sensitized (panel reactive antibody >30%) were excluded from the protocol and were not included in this analysis. Patient records and clinic flow sheets, as well as pathology reports, microbiology reports, and immunosuppression doses, for a minimum follow-up of 6 months, were reviewed.
All patients underwent simultaneous pancreas-kidney transplantation through a midline incision. The pancreas was prepared as previously described and implanted in the right iliac fossa, with venous drainage to the external iliac vein and exocrine drainage to the terminal ileum.7 The kidney transplant was then placed in the left iliac fossa with an extravessicular bladder anastomosis. Patients were monitored postoperatively in the intensive care unit for 24 hours and then transferred to the regular care floor. Nasogastric tubes were removed with the first sign of bowel activity, typically on postoperative day (POD) 3 to 4, and an oral diet was started. Bladder catheters were routinely removed by POD 4. Perioperative broad-spectrum antibiotics were given until POD 5 and only continued if the donor duodenal culture grew an identified organism. Routine infection prophylaxis consisted of oral ganciclovir, trimethoprim-sulfamethoxazole, and weekly fluconazole. Oral ganciclovir was continued for 6 months posttransplantation, fluconazole for 3 months, and trimethoprim-sulfamethoxazole for life.
The immunosuppression protocol is summarized in Figure 1. All patients began receiving Thymoglobulin (SangStat, Fremont, Calif) at a dose of 1.5 mg/kg at the time of the incision, and it was infused for 6 hours. A dose of 1 mg/kg was then given daily, adjusted for white blood cell count. The Thymoglobulin was discontinued when an adequate tacrolimus level was reached, typically by POD 7. Solumedrol (500 mg) was given intravenously with the first Thymoglobulin dose, followed by 250 mg with the second dose, 2 mg/kg with the third dose, and 0.5 mg/kg with subsequent doses. The steroid was stopped as soon as the course of Thymoglobulin was discontinued. In patients who experienced profound leukopenia (white blood cell count <1.5 × 103/µL), the MMF dose was cut in half. If this did not improve the counts, the Thymoglobulin dose was held for 1 day and then restarted. This occurred in less than 20% of patients.
All patients with initial renal function started receiving oral tacrolimus when their creatinine levels began to fall, usually by POD 2. The dose was adjusted to achieve a target trough level of 12 to 15 ng/mL. When this level was achieved, the Thymoglobulin and steroids were discontinued. Levels were measured daily while patients were hospitalized. Patients with initial slow graft function or delayed graft function did not receive tacrolimus until there was evidence of improving renal function, and Thymoglobulin was continued during this period. This occurred in 2 patients.
Mycophenolate mofetil was administered preoperatively at an oral dose of 1000 mg, and then continued postoperatively at a dose of 500 mg twice daily, adjusted for leukopenia. Sirolimus was started on the day following discontinuation of Thymoglobulin at an oral loading dose of 6 mg and then continued at a maintenance dose of 3 mg/d, adjusted for leukopenia or anemia. Levels were obtained after 3 doses, and target trough levels were 8 to 10 ng/mL.
For outpatient management, laboratory values were measured twice weekly for the first 6 weeks, then weekly for another 6 weeks, then every other week for another month, and then monthly, assuming that the patient was stable. Total cholesterol levels were measured every 3 months. Drugs with the potential for causing leukopenia (MMF, sirolimus) were adjusted if white blood cell and hematocrit counts were low (<2.5 × 103/µL and <28%, respectively). Target trough levels for tacrolimus remained at 12 to 15 ng/mL for the first 3 months, then were lowered to 8 to 10 ng/mL until 6 months, and then maintained at 5 to 8 ng/mL. Sirolimus target levels remained at 8 to 10 ng/mL for the first 3 months, then fell to 6 to 8 ng/mL. Further adjustment in drug dosing was guided by specific toxic reactions, most commonly diarrhea, necessitating a lowering of MMF initially, and then sirolimus if the symptoms continued. Data are given as mean ± SD unless otherwise indicated.
The cohort consisted of 40 patients with a mean age of 39 ± 6 years and a male-female ratio of 24:16. All 40 patients had a minimum follow-up of 6 months. The mean follow-up time for the entire group was 474 days.
There were 2 early patient deaths, one of which occurred in a patient who had lost the pancreas to an early thrombosis. The other patient had lost the pancreas graft to infection after an attempt to repair a bowel anastomotic leak. Both patient deaths were attributed to uncontrollable sepsis. The 1-year patient survival rate was 95%. This is equivalent to our patient survival rate in a historic control group receiving steroids, MMF, and tacrolimus.
A total of 3 patients lost their pancreas grafts to an early thrombosis within 5 days of surgery, before sirolimus was started. The other pancreas graft loss was due to a mild rejection that occurred while the patient was still receiving Thymoglobulin. Because of ongoing fevers, the patient underwent exploration, and the decision was made to remove the graft based on its appearance. Pathologic analysis of the explant identified mild rejection. Therefore, the 1-year pancreas graft survival was 87.5%, which is also equivalent to pancreas survival rates in our earlier experience.
The reasons for loss of kidney grafts included death in 2 patients and a microangiopathy similar to hemolytic uremic syndrome in a third patient. No kidney grafts were lost to rejection. The 1-year kidney survival rate was 92.5%—also no different from graft survival of historic controls. The reasons for all graft losses are presented in Table 1.
Biopsies of the kidney were performed to detect any elevation in creatinine level that was not explained by a technical problem or drug toxicity. A total of 19 kidney biopsies were performed. Rejection of the kidney was seen only once in the first 6 months. Rejection was diagnosed on POD 27 in the same patient who had lost the pancreas to an early rejection; this was treated with a steroid pulse and maintenance steroids. Another patient had a biopsy-proven rejection at POD 393, also treated with a steroid pulse. Therefore, the kidney rejection rate at 3 and 6 months was 2.5%.
Pancreas biopsies were performed to detect a persistent rise in serum amylase. The one biopsy performed revealed rejection, which was treated with Thymoglobulin and prednisone. Treatment of this patient had already deviated from the protocol because of her intolerance to calcineurin inhibitors due to hemolytic uremic syndrome. Her maintenance immunosuppression consisted of prednisone, sirolimus, and MMF at the time of the rejection. The only other pancreas rejection occurred on POD 27 as described above, leading to graft loss. Therefore, the pancreas rejection rate was 2.5% at 3 months and 5% at 6 months. A summary of the rejection rates is shown in Figure 2.
All patients who were free of rejection continued to receive the steroid-avoidance protocol with the exception of 1 patient. Because of the patient's fever and elevated blood glucose level, and our inability to perform a biopsy of the pancreas secondary to the overlying bowel, this patient was treated empirically with Thymoglobulin and a steroid pulse. Of note, a kidney biopsy performed at the same time showed no rejection. There was no improvement in blood glucose level, and the patient was given cyclosporine on the chance that the elevated blood glucose level was related to tacrolimus toxicity. This resulted in normalization of blood glucose, but the patient continued to receive steroids at a dose of 10 mg/d. The 3 other patients with rejection had low-dose prednisone added to their maintenance regimen and were considered for eventual weaning of the prednisone at the time of this review.
In general, the combination of tacrolimus, sirolimus, and MMF was well tolerated. In addition to the patient previously described, one other patient was given cyclosporine as a replacement for tacrolimus because of hair loss. Over time, MMF was reduced in most patients, owing to either leukopenia or gastrointestinal distress. The mean MMF dose at 6 months posttransplantation was 242 ± 283 mg twice daily. In 14 patients (38%), MMF was stopped completely by 6 months. Sirolimus was well tolerated; the mean dose at 6 months was 3.3 ± 1 mg daily.
This immunosuppression regimen did not appear to have an increased surgical complication rate. The pancreas graft thrombosis rate was 7.5%, there were 2 peripancreatic abscesses that responded to percutaneous drainage, and there were 3 incisional hernias and 1 bowel anastomotic breakdown. The mean length of stay for the entire cohort for the initial transplantation was 13.9 ± 7 days (range, 8-36 days). There was an average of 0.94 readmissions per patient, but 17 patients never required another hospitalization after discharge.
In terms of infection-related complications, both deaths were related to sepsis. The first death occurred on POD 70 after the patient had been through emergency coronary artery bypass grafting for new-onset ischemia, and was related to overwhelming Aspergillus infection. The second patient died of overwhelming sepsis, likely related to peritonitis from vancomycin-resistant Enterococcus species, also in the setting of a perioperative myocardial infarction. Other infections included the 2 peripancreatic abscesses, successfully treated, and a renal abscess that occurred 10 months' posttransplantation. This was also treated successfully with percutaneous drainage. There was 1 mild cytomegaloviral infection, treated with valganciclovir. Of greatest concern were 2 polyoma infections in the transplanted kidney, both occurring more than 1 year after transplantation. At the time of this review, 1 patient was close to resuming dialysis, and the other patient had a marked decrease in immunosuppression and treatment with cidofivir, with some stabilization of renal function.
One patient was diagnosed as having posttransplantation lymphoproliferative disorder at 8 months' posttransplantation. He was taking tacrolimus and sirolimus at the time, and had symptoms of ongoing diarrhea. A colonoscopy and biopsies revealed monomorphic B-cell lymphoma consistent with posttransplantation lymphoproliferative disorder. He had no evidence of transplant dysfunction. Sirolimus treatment was discontinued, tacrolimus was decreased, and anti-CD20 monoclonal antibody (rituximab) therapy was started in this patient and continued to the present.
Another measure of the success of this protocol would be evidence that the classic adverse effects of steroids were diminished. We followed cholesterol levels, weight changes, and the need for antihypertensive medications. The mean cholesterol levels at 3 and 6 months were 188 ± 36 mg/dL (4.85 ± 0.93 mmol/L) and 191 ± 44 mg/dL (4.93 ± 1.14 mmol/L), respectively. Only 3 patients required the initiation of cholesterol-lowering agents, and statins were used in each case. The average weight gain at 6 months was 0.7 ± 4.1 kg. In patients who had a weight measurement at 1 year, the average gain was 3.5 ± 5 kg. At 6 months posttransplantation, there was an average of 0.68 antihypertensive medications per patient, with 16 patients requiring no antihypertensive treatment. The overall outcome data at 6 months are presented in Table 2.
This report summarizes our experience with a steroid-sparing protocol, which appears to be efficacious in terms of graft survival rates and rejection rates. The introduction of newer and more potent immunosuppressive agents, such as tacrolimus and sirolimus, has expanded the options for maintenance immunosuppression and allowed for steroid-avoidance protocols. The ultimate benefit of these strategies remains to be seen, although this series suggests favorable metabolic benefits in terms of lipid profiles, hypertension, and weight changes.
In any report claiming low rejection rates, one must be concerned about overimmunosuppression. While there was not an obvious increased problem with infection, the 2 patient deaths due to infection early in the postoperative period are of great concern. Both of these patients had perioperative cardiac events, which prolonged their hospitalization and complicated their course. Whether the potent combination of immunosuppression contributed to their death could be debated. Similarly, the increased incidence of polyoma seen in many centers seems to correlate with the introduction of these newer agents and may ultimately be responsible for more kidney graft loss than rejection. The polyoma infection rate of 5% seen in this series is higher than we have previously seen.
The problem of posttransplantation lymphoproliferative disorder is also a possible sign of overimmunosuppression. While we have seen cases of posttransplantation lymphoproliferative disorder in patients who have undergone simultaneous pancreas and kidney transplantation previously, longer-term follow-up will be needed with this cohort to determine if the incidence is increased.
The rational for eliminating steroids is sensible. Trials to eliminate steroid use in kidney transplantation or liver transplantation have demonstrated positive effects.8,9 However, with any new agent that fills the gap created by a steroid-free protocol comes a potential penalty. With the current protocol, tacrolimus levels were typically kept high during the first year. The potential toxic effects on renal function may outweigh the benefits of steroid avoidance. Tacrolimus has also been associated with abnormal lipid profiles, although less so than cyclosporine. Likewise, sirolimus has been shown to have its own negative effect on lipid profiles.10 We did not see any problem with triglyceride levels, and the measured total cholesterol levels were acceptable in this cohort. Of course, long-term experience with sirolimus is limited, and other potential risks, such as malignancy, have not been determined. The advantage of a regimen that uses a combination of these newer agents is the potential dosing of each agent at a level that may avoid its inherent toxicity. This also pertains to the potential toxic effect of tacrolimus on beta cells, which appears to be dose-dependent.
It is clear from our experience that patients are pleased to have an immunosuppression regimen that avoids steroids. However, it is not hassle free. Many patients required constant early adjustment of MMF and sirolimus to address their toxicity in gastrointestinal functioning. The average dose of MMF at 6 months was only 250 mg twice daily, and MMF was discontinued in 14 patients. As experience with this protocol evolves, discontinuation of MMF at 3 to 6 months in all patients may result in a more acceptable adverse effect profile and may potentially avoid infections, such as polyoma. An alternative is to simply use dual therapy with either sirolimus or MMF in combination with tacrolimus from the time of transplantation. This has been shown by other investigators to have excellent early results.11
One other consideration with these newer protocols is cost. Although it was not specifically analyzed, yearly drug costs will certainly be higher in a protocol that avoids the inexpensive prednisone and substitutes newer agents that are not available in generic forms. This increased drug cost may be offset by the decreased need for treatment related to rejection. The rehospitalization rate was quite low in this cohort. Other cost savings may result from decreased complications related to cardiovascular disease if steroid avoidance is able to alter this comorbidity.12
As newer agents are introduced into our armamentarium, we face the challenge of finding the combination of drugs that is well tolerated with good efficacy and reasonable cost. This will certainly lead to many variations in protocols, none of which will be easily validated in a controlled trial, since rejection rates have plummeted. However, focusing on different end points may yield information to elevate one protocol over another. Longer-term follow-up data on cardiovascular problems, toxicity to renal functioning, and the effect on beta cell function will likely become discriminating measures for these new drugs. This protocol appears to have excellent early results, and longer follow-up information will be forthcoming.
Corresponding author and reprints: Chris E. Freise, MD, Transplant Division, University of California–San Francisco, Box 0780, Room M896, San Francisco, CA 94143 (e-mail: firstname.lastname@example.com).
Accepted for publication April 27, 2003.
This study was presented at the 74th Annual Meeting of the Pacific Coast Surgical Association; February 18, 2003; Monterey, Calif; and is published after peer review and revision. The discussion is based on the originally submitted manuscript and not the revised manuscript.
Richard V. Perez, MD, Sacramento, Calif: Dr Freise and his coauthors have described a retrospective, single-center review of 40 consecutive patients undergoing kidney and pancreas transplantation. The problem that they face is essentially the general challenge of pancreas transplantation. This is a high-risk group of patients with advanced complications of diabetes and increased cardiovascular morbidity. As they mentioned, they traditionally have a higher incidence of rejection when compared to other transplant patients, and for this reason, they receive more immunosuppression. This and other factors leads in general to a higher incidence of infectious complications, especially in the setting of enteric drainage of the pancreas, a technique which was utilized in this series of patients.
So, the challenge that they face, and we as transplant physicians face in general, is the development of an immunosuppressive protocol which is potent enough to suppress rejection, tailored to minimize toxicity of immunosuppressive drugs, and yet gentle enough to avoid the complications of overimmunosuppression. To achieve these goals, they chose a protocol which they term steroid avoidance, patterned after recent protocols developed in kidney transplantation, and he mentioned the 5 different agents used: Thymoglobulin, tacrolimus, sirolimus, mycophenolate, and then a rapid steroid taper over 1 week. They reported excellent patient and graft outcomes, and they are to be commended for this.
Did they achieve the secondary goals as mentioned—that of efficacy, avoiding toxicity, and avoiding the complications of immunosuppression? In terms of efficacy, there is no question that the rejection rates that they report are amongst the lowest if not the lowest that has been reported in the literature—2.5% in kidney and 5% in the pancreas. So, it is a very potent drug therapy.
Did they minimize the adverse effects of the steroids? They mentioned the improvements in cholesterol, weight gain, and hypertension. I guess what we would have to ask is, and my first question is, are they really seeing improvements in the metabolic profile, and have they compared cholesterol, weight, and hypertension to their previous experience using their old immunosuppressive regimen?
We do know that with regard to bone changes, that the adverse effect of steroids on bone occurs during the first week, in large part due to the high doses of steroids, and so are they really benefiting the patients with regards to the bone disease? So, the second question I would ask is: are the steroids actually necessary in this protocol? The ideal protocol would be complete avoidance of steroids, which would not only have the metabolic benefits, but possibly, immunologic benefits as well because we know that steroids impede the development of tolerance and suppressor networks in some experimental models.
The third goal in terms of the immunosuppressive regimen is avoidance of the complications of overimmunosuppression. This area, as Dr Freise mentioned, is his biggest concern, and it would be mine as well if you are going to embrace such a protocol. The signs of overimmunosuppression as mentioned would be sepsis, and it is concerning that 2 of his patients died of overwhelming sepsis. Two very serious polyoma viral infections will probably lead to kidney graft loss in 2 other patients. He mentioned that bone marrow suppression was noted in a significant number of patients, so this may reflect that these patients may be overimmunosuppressed. As surgeons, we, of course, deal with wound healing issues and some complications may be a sign of overimmunosuppression. There were 3 hernias, 2 abscesses, and an anastomotic leak during the short term, possibly due to overimmunosuppression. Those of us that have used sirolimus have had the unpleasant experience of having late wound complications of having the patient come to clinic a month or 6 weeks posttransplant with a wound that is falling apart. I would ask, did you see any late wound problems that occurred on an outpatient basis?
Additionally, the mean hospital stay of 2 weeks would be a touch long in most series today, and especially, in the setting of these patients who had no rejection and kidneys that are working fine. I would ask, why was the length of stay so long? How does that compare to your previous length of stay?
Additionally, most of the readmissions for pancreas transplantation in the past have been secondary to metabolic and fluid problems related to bladder drainage of the pancreas. I am wondering what his readmissions in your enteric drained patients were for.
So, lastly, I would really commend the group for developing a strategy to deal with this difficult problem. The proof of the pudding though would be, and my last question is, what is your present standard of therapy? In other words, how would you treat your next 40 patients? Would you make any changes in your immunosuppression based on what you have learned with these patients?
Chris Shackleton, MD, Los Angeles, Calif: Again, I would like to commend the authors for an incremental contribution to immunosuppression in organ transplantation because most of our advances nowadays do have to be made incrementally. I wonder if the authors could just summarize the actual protocol that was used because I wasn't quite clear on the slide whether all of these patients received serolimus or whether it was introduced sequentially following use of tacrolimus in the induction therapy with immunoglobulin.
Dr Perez asked the question regarding the hernia issue with serolimus. But that is an emerging issue with this agent in addition to its potent immunosuppressive capabilities. There is increasing evidence that it does impair wound healing significantly. Although the trial in the United States with the use of serolimus in liver transplantation was halted, we probably had the greatest single-center experience in liver transplantation with serolimus of over 70 patients, and when we analyzed our own data, the only significant thing that we noted compared to retrospective, historical controls as treated with FK-based immunosuppression was an increased incidence of incisional hernias.
That leads me into my third comment, pertaining to the issue of vascular complications. As Dr Freise mentioned that they had 3 episodes of thrombosis in 40 patients for about an 8% incidence of thrombosis, I would submit that that is somewhat high. I don't think it is related to the use of serolimus, and in all forms of organ transplantation, my own mantra whenever these issues arise is that vascular thrombosis is always a technical issue except in the rare instance where the patient actually has a coagulopathy of some sort.
Dr Freise: I agree totally with what you had to say, Rick, in terms of metabolic parameters. It would be great if we had a good control group and good data to compare our current lipid profiles, too. Unfortunately, there are a lot of holes in the data when we look retrospectively at our previous experience. If one looks at the literature, certainly, the cholesterol levels that we are seeing in our patients in this series appear to be better than what has been reported, at least for kidney transplant alone patients who are on steroid in combination with calconeurin inhibitor.
In terms of the issue of bone disease and early prednisone, you are absolutely correct that there is good evidence that just a week's worth of prednisone may have its own set of complications. The use of prednisone in our protocol is mainly to decrease the potential side effects of Thymoglobulin when that agent is given over the first week's time. There are investigators who have used Thymoglobulin without steroid pretreatment and have actually had good results. The only potential issue is that those patients typically have very high fevers, and, as you well know, these pancreas patients are already a setup for infection. I would be nervous to watch fevers of 40° for the first 3 or 4 days postoperatively. So, that's our rationale behind the steroids. It may be that we could get by with a much lower dose during that induction time and avoid the Thymoglobulin complications.
In terms of overimmunosuppression, which is really the biggest issue with this type of protocol using 3 very potent drugs over a long period of time, there is no question that we have concerns about infection complications. And as I alluded to, this polyoma viral infection, I believe, is going to be the real problem for us in the next decade as we start to learn more how to use these drugs. In the 80s, of course, cytomegalovirus (CMV) was a big problem, and many patients died from overwhelming CMV infections. Of course, now, with good antiviral prophylaxis for CMV, it really isn't as much of an issue and has allowed us to make advances in how we use these even more potent drugs. But with any new drug regimen, there will be penalties, and infection such as polyoma is something that we are going to have to watch for.
In terms of the 2 early deaths from sepsis, that's an unusual occurrence in our overall program experience, and, certainly, it is possible that those early deaths were related to overimmunosuppression. I would also emphasize that those patients had complicated courses related primarily to cardiac problems. Of course, once a patient who has had diabetes for many years undergoes this complex operation and begins to have other complications related to their heart, their postoperative course always becomes much more difficult.
In terms of surgical complications, and this gets at Dr Shackleton's question as well, the 3 hernias that we saw were all picked up in the outpatient follow-up. Generally, early on in the experience, we used absorbable suture for wound closure and have now gone to prolene exclusively in a 2-layered closure of the midline incision. There is no question in my mind that this early regimen has had a slightly higher rate of hernia formation. Whether that will be resolved with switching to nonabsorbable suture remains to be seen.
In terms of length of stay, this series has a slightly longer length of stay than our earlier experience by about 1 day. I did calculate mean length of stay. The median might have been a little bit more appealing number since about 25% of the patients were actually able to go home between 8 and 10 days rather than the mean stay of about 14 days.
Dr Perez' final question is a very important one. We now have this series of 40 patients that we have had an opportunity to learn from, and what are we going to do in the future? These patients, to a certain degree, were slightly overimmunosuppressed, and a future protocol will start out exactly as we are doing here, which is to use Thymoglobulin induction with prednisone followed by maintenance with sirolimus, tacrolimus, and MMF in all patients, and then weaning the MMF by 3 to 6 months posttransplant. Of note, about half the patients were able to come down to very low doses or no dose of MMF by 6 months and maintained a very low rejection rate. So, variation in the regimen will work for us.
Lastly, in terms of Dr Shackleton's question about thrombosis, I agree with you. Our thrombosis rate of about 8% in this series is higher than one would expect in most modern series, and I also agree that every graft thrombosis should be considered technical unless proven otherwise. When those 3 patients were explored for their graft pancreatectomy, one was clearly technical. There was a kink in the vein. The other 2 I don't have an obvious technical explanation for, but I would consider technical. I also do not believe that this particular regimen will be associated with a higher graft thrombosis rate.


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Any solution ?
THX in advance, 3Lambda
I flashed MIUI V3 and when I want to download a theme there's a toast message telling me "no network connection" (something like that as my phone is in french) I tried with wifi and mobile data... wiped cahe and dalvik, wiped app cahe and force close...
Any solution ?
THX in advance, 3Lambda
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man after jumping
man after jumping
What's going on with his hands and feet?
I really like the style. But to me his chest is too upright. If he had really just landed, I think he would be leaning or bent forward more.
It might help if you tell us what you are looking for a crit on specifically
Right now, I feel like this was referenced from Naruto or something--he looks more like he is coming up from the ground rather than landing.
If he was landing--there would be a ton of tension in his body from absorbing shock of hitting the ground.
Par Cor (I don't remember if that's how it's spelled) is a type of "Sport" for lack of a better word, where people jump from building to building--try finding reference pics from that and study their poses for when they land. Usually, you aren't going to have your knee pressed on the ground like this guy has--you will break your knee xD
Anyway, I hope that is what you were looking for.
"Be either full-assed or no-assed. There is no half assed."
KT | Reutte | Darkmoon |Asatira | AnthonyV
My Website
~ My Sketchbook ~ My Blog ~ My Twitter ~ My Deviantart ~
Thank you very much to all for your coments, specially Hala.
I will watch the Par Cor references and try to make it better. I used no reference at all for this drawing, and i recognise is not a good thing to do. At least when you are starting.
I think you should get the largest resolution first, then downsize it into the foreground figure, rather than upsize it as you have here. The way it is right now makes it look very low-res. Or, you could blur the larger one (and eliminate the red on the edges) to complete the effect. Still, perhaps you could do without the second image to begin with. The style of the person doesn't really mesh well with it.
Secondly, I think his hair looks kind of odd. No shading, and it kind of looks like a spiky 2D shape attached to the top.
Also, there's a lot probably unwanted things in here. Like those teal bits in the bottom right corner, and some other artifacts.
Developed Actively by the makers of the Best Amazon Podcast


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iStock.com/AleksandarGeorgiev When you are 37.5 weeks pregnant and contracting constantly and wishing for maternity leave to begin, the absolute last thing you can possibly imagine is going for another two weeks. But, as we all know, there is no guarantee as labor can happen any time between the 37 and 40 week mark.
So I am here, waiting. Waiting. Waiting. Twiddling my thumbs. And waiting still. I know it's early and I want this baby to be as healthy as possible, so I am willing to wait longer. But in about a week or so, I am going to lose my patience.
More from CafeMom: 6 Rules For My Husband During Labor & Delivery
As a home birth mama who has no plans to induce or try to any non-natural means to get things going, I am curious about the natural ways moms-to-be get things started without drugs or IVs. Here are 10 natural ways moms-to-be can jump start their labor.


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[Update: 3 p.m. -- According to Anonymous Content, Jonathan Demme is no longer attached to direct "Old Fires."]
Anonymous Content's family dramedy "Old Fires" is heating back up, as Golden Globe winner Richard Gere is now attached to star in the indie movie, TheWrap has learned.
Heather McGowan ("Tadpole") wrote the script, which follows a world-renowned architect (Gere) who emerges from a coma in need of both physical and mental rehabilitation. With the help of his snarky female physical therapist, he tries to repair his damaged relationship with his children and win back his wife's love.
Rosalie Swedlin will produce for Anonymous Content along with Caroline Kaplan. There is no firm start date in place.
Also Read: 'Divergent' Star Theo James, Dakota Fanning Join Richard Gere in 'Franny'
Jonathan Demme became attached to direct in October 2012, when producers were planning a summer 2013 start date. The Oscar-winning filmmaker began lining up an impressive ensemble including Bryan Cranston, Jason Segel and Jennifer Ehle.
Ehle revealed in May via Twitter that "Old Fires" had been "indefinitely postponed," hinting that the project was struggling to secure financing.
Gere, who won a Golden Globe for "Chicago" and received another nomination for "Arbitrage," is currently filming Andrew Renzi's directorial debut "Franny" with Dakota Fanning and Theo James. He's also being eyed for a role in "The Best Exotic Marigold Hotel 2."
Also Read: The Metamorphosis of Richard Gere
Gere is represented by WME and Hirsch Wallerstein.
The post Richard Gere to Star in Anonymous Content's Dramedy 'Old Fires' (Exclusive) appeared first on TheWrap.
Related stories from TheWrap:
'Divergent' Star Theo James, Dakota Fanning Join Richard Gere in 'Franny'


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IGraveDigger Gameplay 1 iOS / Android
By: iD EAST
Genre: Arcade
Video Tips
Let's play IGraveDigger! This is part 1 of my walkthrough guide for the iOS game, IGraveDigger by iD EAST.
I will update this post with more tips and tricks, so please bookmark this page and keep on checking in!
If you have any questions, feel free to ask for extra help in the comments section.
Hit like if this helped you!
Visit IGraveDigger walkthrough page for level videos, tutorials, cheats and more.
Gameplay Questions
Questions related to gameplay of IGraveDigger iPhone game.


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You Know You Want This 60-Inch HD Arcade Machine with Built-In Kegerator
What if you combined your three favorite things into one big toy? What's that? You would combine beer, video games, and high definition TV? No need to imagine, folks. Such a machine exists, and it only costs $5,000.


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HAMBLEN, Robert Mann Hamblen
Date of death: 25 Sep 1933 Franklin, Johnson County, Indiana
Franklin Daily Journal, September 25, 1933
Well Known Franklin Grocer
Passes Away at His Home
on N. Yandes Street
Robert Mann Hamblen, age 55, for many years a highly respected merchant, passed away at his home, on North Yandes Street, Monday morning, at eight o'clock. Mr. Hamblen had been ill for several weeks, but was able to be up Sunday. He died in bed Monday morning.
Mr. Hamblen was born in Brown County on Oct. 22, 1877, and after spending several years in Oklahoma, came to Franklin twenty-three years ago. He had been in the grocery business since that time and had gained many friends, to whom the news of his passing comes as a distinct shock.
He was the son of Williamson and Eunice L. Collins Hamblen. The surviving relatives are his mother, Mrs. Eunice Hamblen; two brothers, A. P. Hamblen and Emmett Hamblen, of Franklin; a sister, Hetty A. Hamblen, of Franklin; two nephews, J. B. Hamblen, of Whiting, and Estel Lamb, of Boswell, and two nieces, Mrs. Mabel Mayfield, of Franklin, and Mrs. T. G. Westfall, of Detroit, Mich. One sister, Mrs. Leona Lamb, preceded him in death.
Members of the family have requested that no flowers be sent. Mr. Hamblen was a member of the Methodist Church of Oklahoma and of several fraternal orders, including the Red Men, Haymakers, L.O.O.M. and Pocahontas.
Funeral services will be held Wednesday afternoon at two o'clock from the Grace M.E. Church.
Submitted by Mark Wiley


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COAL MINE FATALITY - On Tuesday, June 3, 2008, a 33-year old tree cutter (contractor) with 10 years experience was fatally injured while cutting trees in advance of a surface mining operation. The victim had made a notch cut on a 24" diameter tree and was in the process of completing the back cut when the tree slabbed from the stump approximately 16 feet high then fell on the victim. The tree contained a hollow center which promoted the slabbing.
Best Practices
Examine the area around the tree to be cut for hazards from previously felled trees, vines, underbrush, etc. Ensure that a clear escape route is present at a 45 degree angle away from the tree. Always make an open face (notch) cut in the direction the tree should fall. This cut should be of adequate depth (25% of tree diameter) and the two cut angles should total 90 degrees. Use bore cutting whenever possible, leaving a hinge equaling 10% of the tree diameter to guide the fall of the tree and hold it to the stump during the majority of the tree's fall. The final cut should be level. Chainsaw bar should be of sufficient length to reach through the diameter of the tree.
|Submit your own suggestion for a remedy to prevent this type of accident in the future.
Please specify if you wish your submission to be anonymous or whether your name may be used. Please include the year of the fatality and the fatality number.
This is the 13th fatality reported in calendar year 2008 in the coal mining industry. As of this date in 2007, there were seven fatalities reported in the coal mining industry. This is the fourth Machinery fatality in 2008. At this time in 2007, there was one fatality in this classification.
The information provided in this notice is based on preliminary data ONLY and does not represent final determinations regarding the nature of the incident or conclusions regarding the cause of the fatality.
For more information:
MSHA's Fatal Accident Investigation Report


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The heat and humidity was rising in Accra yesterday and the air itself seemed to sweat. Yet there was a palpable crackle too, as the city, like the rest of the country, pulsed with passion and paranoia ahead of one of the most intense derbies in world football. Ghana meet Nigeria today, in the quarter-final of the African Cup of Nations to boot. For both teams victory would be as delicious as defeat would be ignominious.
At the Nigerian team hotel yesterday morning, anger burned as officials sought to thwart a perceived Ghanaian sabotage attempt. Originally scheduled to train at the Ohene Djan Stadium, the venue for today's clash, at 4pm, the Super Eagles received a phone call from the Ghanaian FA at 8am in the morning telling them that their session had been brought forward to 9am. "They knew very well that there's no way we could be ready and there within 60 minutes," barked one of the Nigerian delegation. Around him stood a phalanx of guards whose scowls, so at odds with Friday night's singing and smiles, testified to the mounting tension.
One Super Eagles supporter who was fluttering around outside the hotel reckoned he knew exactly what was going: "I've lived here for many years and it's obvious - they don't want us to use the stadium because they want time to lay down all their juju," he gnashed. Others scoffed, but he railed on: "I'm telling you, they want to curse us! They will do anything to beat us!" Well, if that was the plan it didn't work - after a lengthy pow-wow between the parties, Nigeria were given the go-ahead to train.
Ghanaians fear trickery too. Talk all week has been of the difficulty of finding tickets for the battle, with designated points of sale not receiving their allocations and riot police having to intervene to quell deprived fans. The Mystery of the Disappearing Tickets cost one Ghanaian administrator his job, but Friday night's evening news on TV peddled the suggestion that Nigerians were somehow involved - and that, humiliatingly, the hosts will be outnumbered in their own ground.
Ahead of the rumble, key protagonists have dispensed with the usual diplomacy and instead launched into boxer-esque bravado. "I am certain we will beat Nigeria and we will win the Cup," declared West Ham's Ghanaian defender John Painstil, neglecting to mention that he himself, as a right-back who so far this tournament has looked about as convincing as an electoral promise, constitutes a weak link that Nigeria may seek to exploit.
The Nigerians themselves, who'll each scoop a $15,000 bonus if they reach the semis, point out that Ghana have beaten them only once in the last 15 years; Ghanaians counter by pointing out that the Black Stars have the better overall record (having won 24 of the countries' 59 meeting, to Nigeria's 16) and that the last time the two sides met - last year in a London friendly - Michael Essien devoured Obi John Mikel as the Super Eagles were demolished 4-1.
"Essien had a good laugh the last time," admitted Nigerian midfielder Seyi Olofinjana. "But now I have the opportunity to prove to him how important this game is to my country. It will be an explosive game and we are very, very confident."
Austin Eguavoen, who was manager for the London debacle and is now assistant to Berti Vogts, expressed his determination for vengeance by vowing: "We have the plan to prick the eyes of the Black Stars to gather enough clouds to cover their glitter."
The Ghanaian media are equally confident. Headlines from the last two days include: "Black Stars to deliver! (The Ghanaian Times)"; Black Stars to crush Super Chickens! ( Daily Graphic)" and "Disgrace Nigeria for us!!!" (Kotoko Express).
In the Kotoko Express, satirical columnist Kofi Amoako Duodu called on Ghana fans not to boo Nigeria but to heap pressure on their own players, reasoning that the Black Stars' improved performance against Morocco (following jittery displays against Guinea and Namibia) came after fans hurled so much abuse at striker Asamoah Gyan that he and his brother, midfielder Bafour, threatened to quit the team.
"The carefully-hidden-but-nevertheless-there 'we'll skin you alive if you slack on us' undertones came to bear on the whole team and they realised that what was being done to Asamoah could be done to them," reckoned Duodu. "This illustrates 'killer's' power to take hostages and makes people's liver quiver," he added, after explaining that fans needed to make sure that Ghana played as though "'killer', the villain from the movies, had kidnapped their mums, wives and children."
Duodu admitted such behaviour was "a below-the-belt move that must be condemned utterly", adding: "but do movie villains play by the rules?"


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See the Cast of 'Tank Girl' Then and Now
The punk-y 1995 flick 'Tank Girl' followed an anti-heroine out to save the world's water supply from an evil corporation. Based on the British cult comic book character of the same name, the film featured a very '90s cast, including Lori Petty and Ice-T. Let's take a look back at the cast of 'Tank Girl' then, and see what they're up to now.
Lori Petty, Tank Girl
Then: Spice Girls Emma Bunton, Geri Halliwell and Victoria Beckham all auditioned for the role of 'Tank Girl' before it went to Lori Petty, star of 'Point Break' and 'A League of Their Own.' When director Rachel Talalay showed Petty the comic book, she looked at the book and laughed, saying, "I'm Tank Girl!"
Now: The 49-year-old actress has made several TV appearances on shows, including 'House, M.D.' and 'Prison Break.' In addition to acting, Petty is also an artist and designs positive-message clothing.
Ice-T, T-Saint
Then: Rapper and former Body Count frontman Ice-T landed the role of T-Saint, a member of a mutant species of kangaroo men. He had previously appeared in 'Breakin' and 'New Jack City.'
Now: Seems the acting bug really infected Ice-T, who currently stars on 'Law and Order: Special Victims Unit.' He also has a reality show on the E! network called 'Ice Loves Coco,' which follows his marriage to model Nicole "Coco" Austin.
Naomi Watts, Jet Girl
Then: A successful actress in her home country of Australia, Naomi Watts struggled a bit when she moved to the US. 'Tank Girl' was one of her first gigs and one she only earned after auditioning nine times.
Now: It's hard to believe Naomi Watts would have to audition for anything more than once these days. Last year she was nominated for an Academy Award for her role in disaster drama 'The Impossible.' You can see her next in 'Diana,' a biopic of the late Princess Diana.
Reg E. Cathey, Deetee
Then: Reg E. Cathey wasn't a huge name at the time of 'Tank Girl"s release — he'd appeared on the children's series 'Square One' and on 'Homicide: Life on the Street.' A musician in addition to being an actor, Cathey brought his saxophone along for the audition even though the script didn't call for it. Cathey's creativity paid off, though, and the character of Deetee was changed to be a jazz man. Er, jazz kangaroo-man.
Now: Cathey continued his working relationship with 'Homicide' scribe David Simon, appearing in two seasons of the HBO series 'The Wire' as Norman Wilson. More recently, Cathey had a role as Freddy, the owner of Freddy's BBQ on the Netflix original series 'House of Cards.'
Malcolm McDowell, Kesslee
Then: Acclaimed actor Malcolm McDowell ('A Clockwork Orange,' 'Caligula') played the film's main villain who sought to control all of the Earth's water and power.
Now: McDowell has always had a proclivity for campy villain roles, and his recent resume includes 'Antiviral,' the 'Silent Night' remake, the heavy-metal animated show 'Metalocalypse' and a recurring spot on 'Community.' Seriously, the guy is down to star in just about anything.
Stacy Linn Ramsower, Sam
Then: Child actress Stacy Linn Ramsower had previously starred on Nickelodeon's country camp show 'Hey Dude' before landing the role of Sam, Tank Girl's young pal who is kidnapped and forced to work in a brothel. (Pretty dark stuff for a campy comic book movie.) That same year she also starred in 'The Baby-Sitters Club,' which evens things out a bit.
Now: Ramsower pretty much quit acting after 1995. These days she's a yoga instructor with a business called Yoga with Stacey in Brooklyn, NY.
Iggy Pop, Rat Face
Then: Enduring punk icon Iggy Pop had a small role in the film as Rat Face, a guy who purchases the, uh, services of Sam from a madame. Gross. Pop was no stranger to acting, having already appeared in 'Cry-Baby' and 'The Crow: City of Angels.'
Now: Pop continues to tour and perform live music, and he's made some appearances on film and in television. Recently he had a small part in the campy vampire music flick (campire music flick?) 'Suck.'


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- 3 total posts
- 3 questions
Questions from Hoppykit
Internal scar tissue from an skin abscess? (photo)
A few years ago I had an abscess on my face and I think the sac is still inside. I can feel some scar tissues, my smile is crooked. what is the best way to remove it? Thanks READ MORE
Loose facial skin? How can I tighten it? (photo)
I'm 19 and my face is more lose than ever. I didn't really lose weight but rather gained from lifting weights. the only thing that changed is my body fat percentage. The rest... READ MORE
What is the best procedure for scar tissues resulted from infected skin abscess? (photo)
I had an infected skin abscess in my face a few years ago and now there are hard balls and swelled up tissues inside my right cheek. When I smile, the lines are not symmetrical... READ MORE