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Nearly 540k violators caught by MMDA's no contact apprehension policy
MANILA, Philippines — More than 500,000 motorists have been caught by Metropolitan Manila Development Authority (MMDA)'s no contact apprehension policy for various violations.
According to the data released by the traffic agency on Thursday, a total of 539,022 traffic violators were recorded by the agency as of the end of November 2018.
The top violation committed by motorists is for violation of yellow lane policy with a total of 289,154 or more than 50 percent of the total figure.
The yellow lane policy of the MMDA prohibits private vehicles from using the said lane along the stretch of Epifanio de los Santos Avenue (Edsa) except when motorists are about to turn.
Provincial buses passing along Edsa are also not allowed to use the said lane and are encourage to use the third lane instead.
The yellow lanes, or the first and second lanes in Edsa, are intended for city buses alone. With this, city buses are not allowed to use any other lanes.
Drivers of city buses who used other lanes aside from the yellow lanes would be apprehended by traffic enforcers.
Second on the list of the top violations committed by drivers were loading and unloading of passengers in prohibited zones with 85,838 incidents were caught by MMDA's surveillance cameras.
Disregarding traffic signs came third with 42,277 violators caught by the agency.
One bus driver violated the bus segregation scheme of the MMDA, making it the last violation on the list of the agency. /je
Subscribe to INQUIRER PLUS to get access to The Philippine Daily Inquirer & other 70+ titles, share up to 5 gadgets, listen to the news, download as early as 4am & share articles on social media. Call 896 6000.


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On Oct. 17, 2017, on the heels of the national #MeToo movement, more than 140 women working in California politics signed on to a letter published in the Los Angeles Times describing a culture of sexual harassment and "dehumanizing behavior" by men with power at the state Capitol.
Here's a look back at key moments in the year since, including stories of misconduct and abuse, resignations of lawmakers and changes in how the Legislature handles sexual harassment investigations.
CapRadio provides a trusted source of news because of you. As a nonprofit organization, donations from people like you sustain the journalism that allows us to discover stories that are important to our audience. If you believe in what we do and support our mission, please donate today.

subset: commoncrawl


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Grand opera en cinq actes et sept tableaux. Running Time: 3 hours 55 minutes.
(Camille Roqueplan's portrait of the fourth act duet, pre-1855).
Here it is in all its splendour, the unparalleled fairy godmother of all opera! No, it isn't Massenet's Cendrillon. I knew that I would eventually have to review a much more complete recording of this opera, much as I like the 1962 recording, it is 80 minutes shorter. This is the greatest opera of all time, only Meyerbeer's later Le Prophete and Verdi's Don Carlos and Otello even hold a candle to it and yet Prophete is a much more intimate work and Otello, although musically superior in many ways because it is half a century younger, suffers from awkward character development. Huguenots is a very public work, even the love interest is a very public affair. Perhaps more so than in Wagner, this opera exists within its own eco-system. Apart from some similarities to Rossini, the score is oddly a combination of bel canto and something which at the time must have been totally new. Certainly Meyerbeer's orchestral effects at times were novel, and then there is the fact that he had already started to breakdown the difference between recitative and aria. The recitatives, although obviously different from the numbers, are dramatically aroused in comparison to say Donizetti or even Bellini and at times the orchestra seems to be reacting to what is happening on stage.
I chose this 2016 performance with Juan Diego Florez as Raoul and Patrizia Ciofi as Marguerite at the last minute because it is by far the longest recording available, even than the performance conducted in 1989 by Cyril Diederich.
SETTING: France, 1572. The opera depicts fictionalized events leading to the St. Bartholomew's Day Massacre in which Roman Catholics slaughtered Calvinist Huguenots in the streets of French cities.
ACT 1: Grand Hall in the chateau of the Count de Nevers, Touraine. (55 minutes)
0: The overture ***, or rather prelude is built around a singular theme, that of the Lutheran choral Ein Fest Borg ist unser Gott. I'm not completely certain how to read this because it is so regal that it glows. Does Meyerbeer use the hymn as a leitmotif, I am not sure although I for one have always laughed a little over the fact that he chose a Lutheran hymn (possibly one of the most famous German pieces of religious music) to introduce an opera about Calvinists.
4: Des beaux jours de la jeunesse Nevers and his guests celebrate ** (eventually the scene is labelled an orgie in the score so I suppose they org or whatever). A series of toasts from the Catholic noblemen leads in to the anticipated arrival of Raoul de Nangis. If Ein Fest Borg isn't a leitmotif, this orgie tune definitely is repeated enough over the course of the act to be one.
9, 12: Non loin des vieilles/ Á table! The arrival of Raoul ** has a most dapper orchestral introduction. It is possibly the most elegant entrance in opera, and certainly one of the most subtle. Nevers and his guests make way to the fest rather furiously to their orgy tune.
18: Quelle spectacle echanteur Raoul's romance *** is the sexy equivalent of Rienzi's prayer. Utilizing a single period instrument (a viola d'amore, then still commonly used), he recounts how he rescued a beautiful maiden whose name he does not know (obviously Valentine, but we do not know this yet). Much of it is sung a cappella, or at least very close to a cappella, relying on the beauty of the tenor voice to present much of the psychology. Thank you Giacomo.
27: Seigneur, rempart et seul soutien Marcel's grand hymn ***, admittedly it is Ein Fest Borg, which makes little sense because he is a Calvinist, not a Lutheran, but who cares really, it is wonderful!
31: Pour les couvents, c'est fini! Marcel's war song about the siege of LaRochelle by the Catholics **, a very minimalist piece, accompanied essentially by flute, military drum, and finally the strings and brass. It goes into a second verse.
37: L'aventure est singulière! A silent woman arrives looking for Nevers. An ensemble develops *, mostly to string accompaniment, although it gets more ampt up as Raoul discovers the maiden he rescued earlier and Never informs him that she is his fiancée Valentine.
43: Honneur au conquérant Yet another "thinks" ensemble choral number this one very upbeat ** as we move into the act finale.
45: Nobles seigneurs salut! Urbain greets Raoul in waltz time *** and gives him the Queen's message (a sealed document which is read aloud by Raoul). He is to be blindfolded and brought to Marguerite.
50, 52: Trop de mérite aussi A bit of agitated chromaticism as Raoul contemplates what the Queen might want with him * leading directly into the act finale which is lead by Urbain and makes for some grand act closure ***.
ACT 2: The gardens at Château Touraine. (49 minutes)
2: Ô beau pays de la Touraine! After a prelude in which the flute takes a primary solo we come upon la Reine Margot herself Marguerite de Valois and we get one of the grandest arias in all opera *** a fourteen minute long sequence of bel canto coloratura loveliness
8, 12: Urbain arrives to tell her that Raoul has been brought and they embark on a plus charmante duet *** about how love will triumph over religious rivalries (wishful thinking but it is lovely). Marguerite has one last outing (directly mentioning Luther and Calvin), bringing the aria to a magnificent flute and harp accompanied coloratura conclusion ***.
19: Jeunes beautés, sous ce feuillage And now, with all the delicacy of a medieval madrigal, the bathers chorus ***. Admittedly a divertissement, but a very beautiful one as Urbain spies Cherubino-style on the minimally clad female courtiers.
23: Le voici! Urbain presents Raoul to the Queen. He is still blindfolded. The female courtiers mock him mildly *.
27: Ah! Si j'étais coquette The Marguerite-Raoul duet starts off with the power of a movement from a Beethoven symphony ***. She convinces Raoul to marry a certain young woman (although she admits in an aside that she is tempted to seduce Raoul for herself). Raoul for his part is enraptured by the beauty of the castle gardens and of Marguerite, but promises to do as she asks. Marguerite wants Raoul to marry Valentine (the young maiden he fell in love with) in order to cement peace between Catholics and Huguenots.
35: Madame! – Honneur à la plus belle, honneur! The Catholics arrive *.
40: Par l'honneur, par le nom que portaient mes ancêtres Marguerite orders that they all swear peace amongst themselves. All except Marcel comply as he believes his master should not socialize with the wicked Catholics. A very solemn scene **.
45: Trahison, perfidie! The act finale *** as Raoul rejects Valentine (who makes her first actual appearance in the opera at this moment), believing her to be Nevers' mistress and thus a hand-me-down. Everyone else is either stupefied or enraged, except Marcel who scolds Raoul for bothering to involve himself with those wicked Catholics.
ACT 3: The pre aux clercs, Paris. Taverns on either side and a chapel on the left. (59 minutes)
A long scenic divertissement starts the act:
1: C'est le jour du dimanche! Townspeople let us know that it is Sunday in a boisterous chorus! *
3: Rataplan, rataplan plan plan A chorus of Huguenot soldiers * comes on led by one Bois-Rosé.
6: Vierge Marie They get interrupted by a chorus of girls singing praises to the Virgin Mary **. Marcel comes on with a letter from Raoul to Valentine's father Saint-Bris and interrupts the procession in order to give it to him which enrages the Catholics but the Huguenots defend him.
9: Venez ! – Vous qui voulez savoir d'avance Some Romani come on and defuse the situation with fortunetelling an a dance * (the only real ballet in the opera). This is an interesting example of Meyerbeer using a third party to defuse the tension between two warring factions (similar to a Jew=Meyerbeer writing an opera about religious bloodshed between French Catholics and Protestants?). Anyway enough theory, Marcel delivers Raoul's challenge of a duel to Saint-Bris for trying to pass off his apparently soiled goods daughter on him. Meanwhile soiled goods has married Nevers in the chapel and comes out after praying to find her father plotting to murder Raoul.
18: Rentrez, habitants de Paris The Nightwatchman's curfew scene **, the prototype of Wagner's similar scene in Act II of Meistersinger.
22: Veille sur nous, grand Dieu du ciel After a brief introduction by a cello we get something I have never heard before: apparently a choral for Marcel *** in which he begs for divine mercy. Notice the striking cello solo (reminder of the viola d'amore from act 1, this cello effect returns in the recitatives of the fifth act as well). It continues as Valentine comes on in disguise and decides to warn Marcel. (Thanks to OperaScribe for identifying this for me, I hadn't a clue!).
29: Dans la nuit Marcel experiences a transformation in a long duet with Valentine as she reveals her father's murderous plan against his master and he realizes that this Catholic woman isn't such a bad human being ***.
42: En mon bon droit j'ai confiance! Marcel informs Raoul of Valentine's news about her rather dishonourable father. At first the duel ** is conducted to a septette of the most comedic of accompaniments (bright and sunny, one would never guess it was around seven in the evening).
48: Nous voilà, félons, arrière! The fight is brutal but eventually Marcel calls for Huguenot reenforcements (Bois-Rose's men in the inn on the right) to Ein Fest Burg and Saint-Bris calls for Catholic reenforcements (from the inn on the left) along with some women to make for a rousing ensemble **. Everything is stopped by the arrival of Marguerite whose presence calls for immediate cease-fighting.
52: Ma fille! The act finale *** in which Saint-Bris and Raoul realize that Valentine informed Marcel. Divided reactions, Saint-Bris is enraged, Raoul realizes he has completely mistreated a woman who genuinely loves him. Nevers arrives to claim his wife (which sort of negates anything her father might want to do to her seeing that she isn't his property anymore). The act ends with their bridal processional and the Catholics and Protestants once more passingly declaring their mutual hatred as the Queen leaves.
ACT 4: A room in Nevers' Parisian town-house, the night of St. Bartholomew.
2: Parmi les pleurs mon rêve Valentine contemplates her miserable situation ***: married to Nevers but desperately in love with Raoul (made worse by the fact that Nevers really is a kind person). The aria is understated orchestrally but vocally the torment is all there. Raoul suddenly appears begging to just speak to her one last time. They hear voices and he hides behind a curtain.
8, 11, 16, 19, 22: Oui, ordre de la reine/Gloire, gloire au grand Dieu vengeur!/Des troubles renaissants We now enter into the best section of the opera *** which might be hyperbole given how great the rest of the opera is as Saint-Bris arrives with Nevers and other Catholic noblemen and they swear to kill the Protestants (all except Nevers who decides he will take no part in the killing). For some reason even Valentine gets in on this passively, probably because her father is the universally lauded leader of the murderers. Three monks arrive and bless the swords and daggers to be used for the slaughtering ***. It ends in a climactic death oath which is generally seen as the finest passage in the entire opera ***.
26, 31, 37: Ô ciel! où courez-vous ?/Le danger presse/ Tu m'aimes?/Etends-tu! The act ends with a seventeen minute long duet for Valentine and Raoul *** as she tries to keep him from leaving (and mostly likely getting killed by the bloodthirsty Catholics outside). After the opening recitative it consists of four parts: 1) Allegretto, in which Raoul begs her to release him and let him warn his fellow Huguenots but she refuses because she loves him. 2) This prompts a cavatina from Raoul which seems like a separate number entirely as he falls into total ecstasy over her confession ***. 3) Suddenly the bells of Saint-Germain l'Auxerrois ring signally the start of the massacre and Raoul comes to his senses and realizes he needs to warn his friends and fight ***. 4) Valentine continues to struggle with him but fails and he jumps from the window as she passes out ***.
ACT 5: (27 minutes)
No twenty-seven minutes in opera have been more abused than these. Standard practice for almost a century was the cut this act completely as it was somehow seen as dramatically irrelevant. Later it was decided to reinstate around half of it. Although I think I know why this act was so frequently cut (it doesn't portray Catholics in a positive light at all and one of the Catholic characters converts to Calvinism for love) this is based on an actual historical event. Since it is also musically great, get over it people!
Scene 1: Ballroom, Hotel de Nesle, the same night.
1: Aux armes, mes amis! The first scene consists of a ballet performed in the presence of Marguerite de Valois and Henri de Navarre as the massacre starts followed by Raoul bursting in and going into some rather horrific detail *** of the slaughtering that has already occurred outside. The Protestant nobles rush out to avenge their murdered brethren.
Scene 2: The cemetery of a Protestant church, stained glass windows.
8, 18: Savez-vous qu'en joignant Meyerbeer uses a single rushing theme to denote physical action in this scene ***. Basically from this point on the opera takes a post-apocalyptic turn. Raoul encounters an injured Marcel in the cemetery. He has brought the Calvinist women and children into the church for shelter. Valentine arrives and begs Raoul to wear a white band which will allow him to pass for Catholic. She also reveals that she has been widowed, Nevers having been murdered by the Catholics for not being willing to murder Protestants. When Raoul refuses to pretend to be a Catholic, Valentine makes one of opera's most remarkably shocking religious conversions by immediately renouncing Catholicism and becoming a Calvinist for the man she loves. Marcel then marries them *** as the women and children can be heard in the church singing Ein fest burg. By the second time we hear this, the Catholic soldiers have arrived and broken into the church and they slaughter the women and children amid musket fire as our three overhear everything from outside. This is terrifying!
23: Le ciel s'ouvre et rayonne ! The trio realize that death is imminent *** and believe they can see heaven. The Catholic soldiers invade the cemetery and capture them, dragging them into the nearby street.
Scene 3: A street in Paris, the night of 23-24 August, 1572 some time before dawn.
25: Par le fer et par l'incendie The last three minutes *** are the play out: The three are brought before Saint-Bris (who does not at first recognize his daughter) and orders that they all be shot as Calvinists. After the two men are instantly killed and Valentine is dying, he realizes he has just murdered his own child but she promises to pray to God for his soul as she also dies. Urbain arrives announcing that Queen Marguerite is coming and the Catholics sing "God wants blood!" as she fails to stop the massacre and they continue killing long after the curtain falls.
Since I already wrote a tome when I reviewed the Sutherland/Corelli performance from 1961 I will be relatively brief here:
Although Prophete is both more psychologically compelling and musically advanced, Huguenots is the measure by which all other tragic operas must be judged. (It has practically everything, except possibly a long ballet sequence (we are treated to two helpings totalling just five minutes). The scenario provides a uniquely regal experience which future operas would attempt to emulate but even Meyerbeer failed later to repeat. Gone are the somewhat awkward naked high notes found in the score of Robert le diable, here Meyerbeer even out does the Italians in terms of sheer vocal ornamentalism. And yet in spite of all the greatness, I keep feeling, am I overblowing how good this opera is? I mean there is a point where adulation becomes idiotic. It is an incredibly apocalyptic work: all the good guys get slaughtered and by the end this opera which started off with an amusing sequence entitled an orgy ends in a level of literal carnage that makes hell seem like a vacation to Aruba. This recording in particular alerted me to elements of the score I didn't recognize before, such as the usage of the cello in recitatives as well as the incredibly dark chromatic elements. In any case an A+.


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Hair Loss From Mirena IUD: Ways to Promote Regrowth
Kitty is a registered nurse. She uses what she has learned on the job to inspire and encourage others to take control of their health.
The Mirena IUD's Side Effect of Hair Loss
The manufacturers of the Mirena IUD will tell you that less than five percent of women will experience hair loss while taking or after taking this form of birth control. The reality is that 1,300 women do a Google search for "hair loss + Mirena IUD" every month. That's at least 15,000 women every year since the Mirena IUD has come out on the birth control market. Are you one of these women who are searching for the link between your hair loss and birth control?
I have been in your shoes, and I am still suffering the repercussions of the Mirena IUD. The actual truth is that the synthetic hormone used in the Mirena IUD wreaks its havoc on your body's natural hormones and, therefore, your own natural endocrine system.
Because of this synthetic hormone, you may either experience hair loss while the IUD is in place or after it is removed. Just look up "telogen efluvium" and its potential causes, and you will see that an abrupt change in hormones can lead to sudden hair loss in females.
Now that we know what's causing it, how do we stop shedding too much hair? How do we grow back what we've lost? Here are some personally proven ways that will help stop your hair loss and promote regrowth.
First Tip: Get Off the Mirena IUD!
The first thing to do if you are experiencing hair loss while on the Mirena IUD is to get it removed! While you will probably need some other form of birth control to replace it, just know that there are other options out there that are more natural and won't displace your body's own natural hormones in order to prevent you from getting pregnant. Do your research and choose a form of birth control that does not have levonorgestrel in it.
If, in fact, you have already had your IUD removed and are now losing your hair, obviously there's not much you can do as far as having the synthetic hormones leave your body. You'll have to wait until your body's own hormonal levels have balanced out and the synthetic hormones have been filtered from your system naturally. It will take time, but in the meantime, there are some things you can do to prevent further hair loss and promote hair growth.
Second Tip: Be Gentle to Your Hair
My first action to prevent further hair loss was to stop or slow down, doing whatever seemed to trigger further hair loss. In my case, whenever I dyed or washed my hair, it seemed to fall out even faster. So here's what I did:
- Stop coloring or treating your hair with chemicals.
- Do not wash your hair as often. For me, I cut it down to once every three days (you can always put a hat on one of the days or throw your hair up in a ponytail to prevent it from appearing oily).
- Switch shampoos to a natural shampoo low in chemicals (most commercial shampoos have paragons and sulfates—things you want to avoid). Or make your own homemade natural shampoo from oils, coconut milk, etc.
- Do not brush your hair as often. This sounds weird, but many of us tend to over brush our hair on a daily basis, causing further unnecessary shedding.
- Do not use any ponytail holders that are prone to pulling out your hair. Also, do not put in a ponytail holder so tightly that it will pull out any hair.
- Do not use a hairdryer, a curling iron, hot curlers, or a flat iron on your hair—or, if you have to, use it as little as possible. The extra heat can cause further damage to your still-healthy locks.
While this may seem like a huge change to some women who are used to over-treating and over-doing their hair, once you realize you are losing hair, you might change your mind and approach hair care in a different light! I know I did!
Third Tip: Watch Your Nutrition and Drink Water
So now that you know what actions to take in order to prevent further hair loss, what can you do to promote hair regrowth?
Here are some of the things that I changed with my daily routine that is proving to aid in hair regrowth.
- Take a prenatal vitamin every day (the B vitamins and folic acid in the vitamins are proven to help with hair growth).
- Drink aloe vera juice. You can blend it into a smoothie or mix it with orange juice in the mornings. The enzymes in aloe vera juice have been used to promote hair growth for years!
- Drink lots of water. Take half of the number of pounds you weigh and drink that many ounces of water each day. (This means if you weigh 140 pounds, you should be drinking 70 fluid ounces of water every day. The reason behind this is that your body needs water in order to hydrate itself and to promote circulation to your scalp and elsewhere.)
- Eat leafy greens and other foods high in folic acid.
Other Ways to Prevent Hair Loss and Promote Growth
So once you've realized you have to change the way you care for your hair and your diet, what other ways can be used to promote further hair growth?
Here are some other changes I've made to my life and daily routines.
- Stop stressing so much over the little things. Stress only causes further hair loss, and we want to keep what hair we have, right?
- Exercise is important. And I can admit that I don't always follow this rule, but in order to have a healthy head of hair, the rest of our body has to be healthy too!
- Evaluate how much of your self-esteem is wrapped up in your hair. I realized how much of my ego was locked into my hair once I started losing it after I had the doctor remove the Mirena IUD. This caused me to re-evaluate how I felt about myself and really determine other areas of my life that build my self-confidence.
- Do something positive to outweigh the negative thoughts about your hair. When I first started losing my hair and noticed balding spots, my self-esteem was very challenged, and I felt extremely depressed. But then I realized that there are way worse things to be going through in life than a few thin patches of hair! It made me appreciate what I do have in my life on a higher level. And so now I am making something positive out of the experience by writing about it and helping others who might be experiencing the same thing.
I wish you all a wonderful life and a full head of healthy hair.
This content is accurate and true to the best of the author's knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
Questions & Answers
Question: I would rather keep the IUD coil in as no other side effects bother me. What should I do?
Answer: Switch to the ParaGard. It has the same effect but doesn't have hormones, so it won't make you lose your hair.
© 2013 Kitty Fields
Caitlin Gimpl on July 31, 2018:
I can't tell you all how happy I am that I found this post.
I had the Mirena put in four years ago after my second child. I didn't have any symptoms at first, but about two years ago my hair started breaking off around the crown. I was also shedding more hair than I typically did. I process and straighten my hair, so I really attributed it to over-processing. I stopped all straightening, etc. but the hair loss didn't stop. I went to a new hairdresser and she was questioning why overprocessing only affected the hair aroudn teh crown. Then the other symptoms started-- thirty pounds of weight gain in a year (with no change in my diet); chronic fatigue, muscle pain and weakness; depression and most recently dizzy spells. My normally active lifestyle has been seriously compromised for the past year and a half. I have been to more doctors, and through even more blood tests. My hormone levels are completely out of whack and although my naturopath claims adrenal insufficiency, my endocronologist says it is not that severe. Either way what is not clear WHY this is happening and the only thing I can think to attribute it to now is my Mirena. Unfortunately I've learned to power through the fatigue and pain, but the hair issue really upsets me. I am calling to schedule to have the Mirena moved today!!
Dr Alan J Bauman MD from Boca Raton on July 18, 2018:
I have had many concerned Mirena IUD users contact my hair restoration practice so I wanted to offer some advice to your readers. We believe that the Mirena IUD hair loss, hair shedding and hair thinning is due to the hormone shifts. This can occur when you start or stop ANY hormone-based birth control. It is typically worse in patients who have a risk of female hair loss genetically or due to other reasons. The good news is that we have seen very good success in treating these IUD hair loss patients with non-invasive at-home therapies. Prescription topical medications (like non-greasy Formula 82m Compounded Minoxidil+Tretinoin) or non-drug laser therapy (like CapillusRX 315 or LaserCap 224). Some patients may need more powerful intervention like Platelet-Rich Plasma (PRP+ACell/BioD) or even SmartGraft FUE hair transplantation if the density is depleted.
All types of hair loss and hair thinning, hairline receding can be concerning, depressing and anxiety causing, so first-off, DON'T PANIC! Do your research and get advice from an expert in hair loss. Help is available from doctors who specialize in female hair loss. It takes time to know if a treatment is working and it takes routine measurements with HairCheck to monitor what is going on. Get a baseline HairCheck measurement from a HairCoach or ABHRS-certified hair doctor in your area. Sincerely, Dr. Alan J. Bauman MD, ABHRS - Bauman Medical
Kitty Fields (author) from Summerland on May 03, 2018:
Justine x - I used paragard IUD after I had mirena removed. I had no problems with regular periods, no hair loss, no hormonal side effects because paragard doesn't pump hormones into your system. I'm not a doctor, but I had success with the paragard. Hope this helps.
Justine x on May 02, 2018:
I made an account just to comment... i had 3 kids before my 22 birthday. so instead of having my tubes tied i wanted to get the mirena... i knew i was young and the though of no more kids broke my heart. I had issues with the pills, nuvaring and patch.. thats were the 3 kids came from.. so know my journey on mirena.. i got it inplanted on the check up after my 3rd child in 2013. 2 weeks after i got it implanted i had a reverse effect on my period. I had a period for 3weeks every month and 1week period free. For a whole year. Then suddenly i stopped.. so i finally thought. Hey mayb this is worth it now. But 6months later... i had major back pains, gained over 50lbs, about 2/3 hairloss, cysts, migraines, occasional numbness on half my body. So i just made all the connections.. i hope i dont lose anymore hair after the removal.. i will be calling in the morning for an appt. And now i have to do research on a new contraceptive because i still dont want kids yet.. maybe in the future. I juat want to help get my kids the things they deseve now. Please let me know of any other birth controls that you guys recommend. Im looking for one that i dont need to use condoms with.. i am in a monogamous marriage and trust my husband.. so i need something that would work for both of us.. thanks and hope this helps..
Kitty Fields (author) from Summerland on April 30, 2018:
Las2121 - After I had the mirena removed, it took about a year for me to see substantial growth. I stopped dying my hair, let it air-dry more and stopped using product in it just to help the growth along. Yes, my period stopped completely on mirena...the mirena isn't just an IUD it also pumps hormones into your reproductive system. Which is unnecessary in terms of IUD birth control. After I had mirena removed, I had the paragard inserted and had zero problems with it. It is just a copper IUD with no hormones, so you'll still get your period and you won't lose any hair!
Las2121 on April 29, 2018:
Hello. So glad to find this post. I have been experiencing hair loss for months now and have seen every doctor under the sun and of course they all chalk it up to stress but i have been stressed for years since i am in Law School and never had a problem til now. I was curious how long after getting your IUD places that you noticed your hair falling out and also if you noticed any other symptoms like oily skin, loss of menstrual cycle completely, back pain, ect.... I have had all of the above and i have told my obgyn and she didn't have concern about it. I should have had it taken out a while ago, but instead opted to go on BC and the Mirena per her advice. It has only gotten worse since starting the pill. I am planning on having Mirena removed immediately. Second question about how long until you noticed your hair growing back after having it removed? It's been completely devastating having this happen and very distracting in terms of trying to focus on school so i would greatly appreciate any response and/or updated advice if you have any. Thank you for your post!
Nikolblerone on February 19, 2018:
I had massive hair loss while I was on Mirena. My hair used to be thick and full and I probably lost over half of it. Always came out in handfuls in the shower, on my brush...hair was everywhere. Even clogged up my vacuum. I had the Mirena for a total of three months, the hair loss started around week two and I never stopped bleeding and was having severe, sharp cramps. I'm a nurse, so I did my research on Mirena removal and did it myself. Cramps were immediately gone, bleeding stopped shortly thereafter. Unfortunately, here it is - two and a half years later and my hair never completely recovered. I still have hair loss, although not as severe as when I had the Mirena. Went to my obgyn and she determined I have PCOS and testinsterone induced hair loss (wonder if the Mirena caused the PCOS?). Went on 50mg spironolactone and BCP. Hair loss slowed, but never stopped. I have recently decided to go off both. It is what it is.
Strezdoutmommy on May 22, 2017:
I signed up just to comment on this! I just had my mirena removed about 2 weeks ago because it has been 5 years. Ive been suffering with hair loss the whole time and never connected the two! I'm furious that this is obviously a serious side effect that the drug companies and doctors blow off. I used to have pretty thick curly hair. Now all I can do is pull it back, and I have to be careful how I do so to avoid bare spots. My "bun" or pony tail is so pathetic. I've considered chopping it all off, but I worked so hard to grow it out! After reading your article, I have hope that I may regrow some of what I've lost, but at my age, I'm sure it won't be like it was. (On the menopause train). Thank you for your article. Prenatal vtmns have just made my grocery list!
Kitty Fields (author) from Summerland on January 27, 2017:
Kylie42 - I heard the same thing from people about my hair, but the truth of the matter is, as women we know when our hair is different. And even if other people don't notice it, we do. I would suggest having the Mirena removed, definitely, and yes paragard IUD is a better option. After I had mirena removed, I had the copper IUD placed and had no issues with it. And I've always been a heavy bleeder, myself. The great thing about the copper IUD is that it has NO fake hormones and it lasts for up to 10 years. And from my experience, it has way less side effects than Mirena. Good Luck, Kylie.
Kylie42 on January 26, 2017:
I think I have lost 1/3 of my hair. I plan to get mirena taken out soon, but I need a replacement BC. I am trying to decide between copper IUD and Nuvo ring. Which one would you recommend?
I have ruled pills and injections and the patch. I have a history of VERY heavy and long periods, so the copper one I heard can make that worse, but I'd love the extra effectiveness and convenience of an IUD.
I think my OBGYN thinks I am crazy for thinking that the Mirena is causing hair loss. She says "it's probably just stress" despite noticing the hair loss within 3 months of Mirena. She will say "your hair looks fine" --which it does, I was born with a lot of hair, so when I lost a third it wasn't tragic. Anyway, thank you for this wonderful article and I'd appreciate a little advice. :)
Kitty Fields (author) from Summerland on December 02, 2016:
Angela - Sorry you are experiencing this. It will grow back...it just takes time.
Angela Ficca on November 28, 2016:
I have very thick hair and have always "shed" a lot. About a month after having Marena I started losing hair in large clumps. I have curly hair so I don't brush it. I just run my fingers through it in the shower. So I just assumed I was losing the hair that would normally come out in a brush. But it was A LOT - clumps and clumps. The only thing I had changed about my daily habits or life was the Marena, so I googled it and was shocked to see that I wasn't alone. Last night I removed my IUD by myself (I am not a doc but it was easier than removing a tampon). Now I am waiting for this hormone to leave my body and I'm paranoid about losing more hair. I am going to stock up on herbals and natural solutions for regrowth. I'm really sad about it. My pony tail feels like 1/2 it's thickness :(
Kitty Fields (author) from Summerland on November 29, 2014:
I had had the Mirena for almost 5 years when I started experiencing hair loss and abnormal pap smears.
Jessica Ballard on November 27, 2014:
How long have you all had Mirena? I have had mine almost 5 yrs and just started having hair loss. Wonder if this is Mirena or something else?
Kitty Fields (author) from Summerland on November 06, 2014:
Thanks for letting me know. It happens all too often, unfortunately.
Lionrhod from Orlando, FL on November 02, 2014:
Please remove this after you read. I believe your content has been stolen here: http://bestspace4you DOT blogspot DOT com/2014/10/hair-loss-from-mirena-iud-ways-to.html
Not PreMeno!!! on April 04, 2014:
I was diagnosed as being pre-menopausal at age 38. Not unheard of, but not exactly common. The problem? I have all of the symptoms but none of my blood levels support the diagnosis. So I start doing research and discover that the hair loss, back pain, hot flashes, night sweats, painful breasts, mood swings, uncontrollable crying and more are probably all related to the Mirena.
I'm on year 7, that's right, I'm on my second one, and had none of these problems with the first. I wonder if they changed the ingredients or if the whole thing was a bad idea to begin with. Strangely, it's my hair loss that's upset me the most. I'm having the IUD removed in a week, I can't wait. Thank you for the sound advice. I have bald patches all over my head and short enough hair that it really shows.
gloria on April 02, 2014:
I don't like iud. I had it put in before i ever had kids and it hurt more then it did when i had my kids. I don't recommend anyone getting it. I didn't keep it in long. I had so many issues after getting it then once it was takin out i went back to normal in no time
Kitty Fields (author) from Summerland on March 30, 2014:
Arykah - I don't think it's supposed to hurt to re-grow hair. I know that sometimes your scalp will get itchy losing it but not re-growing it. All the best of luck to you!
Arykah on March 29, 2014:
Thank you for writing this! So great to know its not just in our heads, even when our doctors won't admit to anything...which is so strange! I had my mirena taken out 4 months ago, and it took over a month for the hair loss to stop. But I continue to have such a painful scalp that just won't get any better. I can only assume its still from the hormones in the mirena, but I have no idea how to make it get any better, and the dermatologist is at a loss, too...even doing a biopsy next week. !!! Is it possible it hurts this badly just to re-grow your hair?
Jeannie Marie from Baltimore, MD on December 20, 2013:
This is such useful advice. I had hair loss issues when I was getting the Lupron Depot shots. I was also told to take prenatal vitamins. That was about 7 years ago and my hair is totally normal now. I remember it was so scary waking up to hair on my pillow each morning. I am glad to hear your hair is growing back now. :-)
Kitty Fields (author) from Summerland on December 06, 2013:
Hi, Mp. Unfortunately I know all too well the pain you're going through. I can tell you that my hair is growing back now. I have visible baby hairs where I had lost my hair and my hair is looking thicker than it had 5 months ago. Give it time after having it removed, and it will grow back if indeed it is the Mirena causing the issue. All the best to you.
Mp on December 05, 2013:
Did your hair ever get better?! Grow back or just stopped shedding? I have the mirena and am removing it tommorow .., have also experienced hair loss since I got it but others convinced me it was all in my head well forward about 1 year and a half later my hair is so thin thAt you can see my scalp and I've been to dermatologist wad told i have androgenic alopecia! And she also told me mirena is not good because it doesn't help with hair loss . I'm also almost 90% sure the mirena caused it because I experienced my hair loss all in one year ... Androgenic Alopecia is something thAt happens over long period of time ... I feel so emotionally unstable and sad because of this ... Just hoping my hair won't get worse after I remove it and praying for a miracle.
Kitty Fields (author) from Summerland on August 01, 2013:
ChristinS - Oh my gosh, yes! I agree. Thank you so much. Blessings.
Christin Sander from Midwest on August 01, 2013:
Another great hub on this topic. One thing I would recommend is to get your B vitamins in a sublingual form as they will absorb better than the types in hard tablets. Liquid B's help immensely as does a healthy anti-oxidant rich diet. So glad I got rid of Mirena - not only for hair loss but due to huge, painful cysts it caused too.


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If you haven't heard Gary Stager speak about computing in school, you are truly missing out. He is cutting to the ideas he feels are pedestrian, but in such a way that you end up feeling that way too. For example, the other day I discussed the idea of the term 21st Century skills. Stager characterized them this way:
This talk of 21st Century Skills is redundant; These are the things that rich people have wanted for their children since the 18th Century.
and he's completely correct. We could go back further and ask the Greek's if they valued communication, collaboration, and critical thinking and our answer would be a resounding yes. Our discussions of these skills, regardless of their origin, are here, and Stager addressed them in the form of what we should be doing with computers. Interestingly, he feels that going "online" is the most boring thing you can do with a student. Rather, he says, we need to engage students in meaningful activities that involve the use of the laptops in ways that the students didn't think possible.
Here are few more soundbites:
Regarding the funding of school technology programs:
Making educational decisions based on price is educationally and morally wrong. The best thing that could happen would be for schools to get out of the business of technology. I'd like to see states give tax breaks for parents to buy their kids laptops.
Regarding the use of certain terms in education:
When we use words like pilot, program, initiative we guarantee a high chance of failure.
Regarding students and video games:
The person who learns the most from video game software is the one who made it.
Regarding the use of video to help students explain their work:
Video is an incredibly powerful medium for telling learning stories. It helps make invisible thinking visible
Regarding the phrase "It's not about the technology:"
I say it is about the technology. We have to look at the technology and decide what about it that does matter and then act upon that.
What I enjoy about how Gary challenges my thinking is that he leaves no sacred cow un-tipped. I have said the phrase "it's not about the technology," countless times, and usually in a mode to pacify angry teachers who feel overwhelmed by what we are doing. It's going to take me some time reflect on what the means now. I've been pushed a little here.
For more information on Gary Stager's Constructing Modern Knowledge Institute in July, follow this link.


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Kylie Jenner May Have Foreshadowed Her Own Pregnancy In This Old Video
Kylie Jenner is loving her new mom life, but before she brought little Stormi into the world, she low-key foreshadowed her pregnancy in a video shot only months before she got pregnant with little Stormi. This video of Kylie Jenner celebrating not being pregnant at 19 is so funny because, LOL, girl, just give it a few months. Jenner gave birth to Stormi six months after her 20th birthday, so while she wasn't 19 when Stormi arrived and she officially started mom life, she got pregnant when she was 19. So it turns out homegirl spoke too soon.
The video in question was one Jenner posted to YouTube and her app on Oct. 20, 2016, called "KYLIE UP CLOSE: Kylie Rumors True or False." The title of the video is self-explanatory, but just for good measure, let's talk about what went down in the video. Jenner and her friend, Anastasia Karanikolaou (aka Stassie), talk about all of the rumors surrounding Jenner's life and reveal whether they're true or false. (Spoiler alert: most of them are false.)
Some of the questions Jenner addressed were, "Did you get cheek and jaw reconstructive surgery?" "Did you sleep with Scott Disick?" "Did you get a nose job?" "Do you compete with Kendall?" "Did you get butt implants?" and "Are Kylie Cosmetics and Colourpop the same company?" But the one question/answer we're focusing on here (other than if she had sex with Scott Disick, which she denied with complete disgust, thank sweet baby Jesus) is "Are you pregnant?" The question was in present tense, so if she was pregnant at the time of the video (October 2016), the baby would've most likely been Tyga's, since they were still together at the time. "I'm not pregnant. Never was," Jenner responded. She gave Stassie a high five and said, "We did it. 19 years old and we're still not pregnant."
Oh, Kylie. Just you wait.
Just about seven months after this video was posted, Jenner was pregnant with Stormi. According to, well... math, Stormi being born on Feb. 1, 2018, means Jenner must've gotten pregnant around April or May 2017 — just a few months before she turned 20 years old. So Jenner can say she avoided teen pregnancy up until about three to four months before ending her teen years. This video is hilarious in hindsight.
People on Instagram couldn't stop laughing at the irony of the video posted by @KardashianClips. They commented things like, "Soon you were" and "Kylie: 19 years old and still not pregnant, life: hold my beer." Ohhh, Kylie. You had no idea how much life was about to change when you made this video. You were but a wee, smol bean who had no idea that she actually had psychic powers.
Despite the surprise of Stormi coming along, Jenner told Vogue Australia that she's happier than ever and having Stormi has taught her more about self-love.
She said, "I actually feel like I love myself more after I had Stormi. And I'm trying to be… I mean, I'm already a positive person, but just having fun, being positive."
So, while Jenner might not have expected to get pregnant when she did (and while she low-key predicted it happening without even knowing it), Jenner is living her best life as a new mom.


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Each of the countries where Adventures has started a base is unique, so our plan for bringing Jesus into that local context must be tailored to it. "The bases give us a chance to come alongside God's movement and play a role in helping the local body expand their reach," says Adventures' President, Bob Mudd. "Working in partnership with local leaders has given us the opportunity to make a lasting impact."
We define generational discipleship as when an elder listens and speaks life into someone who wants to pursue a similar path as them. Discipleship is the process of pointing people to Jesus and reliance on the Holy Spirit; it is woven within every aspect of a Kingdom lifestyle and is vital for both the upcoming generations and the older generations of the Church.
Gary Black, a discipler at G42 Leadership Academy and the World Race, sat with us to discuss generational discipleship, one of his favorite topics.
What does it take for a person to feel loved? Do our words "I love you" and "You are loved" hold enough influence to actually convince a person of their lovability?
When we look at scripture (1 John 4:7-8, Luke 6:35, 1 Corinthians 13:13) we find that love is our greatest tool to build the Kingdom of God. Within the beautifully unique Body of Christ there are countless ways for people to give and receive love.
In today's society, we often compare our value to that of those in power or celebrity. We see the perceived perfection of lives around us and so easily discount our own worth. We are warned of this is, consider Romans 12:2 – "Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect."
As humans we ask if we are enough.
Are we good enough? Are we smart enough? Do we have enough?
If you or someone you know is interested in a World Race program, then you likely want to hear about the World Race from people who have actually experienced this journey.
Here are testimonials from few of our World Race alumni about their time with one of our programs!
Since 1989, Adventures in Missions has mobilized over 115,000 people on mission trips around the world. Through various short and long-term programs, we have dedicated our lives to helping people from all walks of life discover the world, who Jesus is, and what Jesus has called them to: to make disciples of all nations (Matthew 28) and be His witness to the ends of the earth (Acts 1).
This video offers great insight into the heart of the World Race. Seth Powell is our Risk Management Coordinator for all our World Race trips, and here he sheds some light on some of the greatest concerns we hear from people interested in our programs.


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The New York Times published a lengthy piece recently stating President Trump drinks up to a dozen Diet Cokes a day. The information apparently came, in part, from a book written by former Trump campaign aides Corey Lewandowski and David Bossie entitled "Let Trump Be Trump: The Inside Story of His Rise to the Presidency."
Today the most busted name in news, CNN, devoted an entire segment with Brooke Baldwin and Dr. Samantha Nazareth, a board certified gastroenterologist, to discuss the president's consumption of the fizzy beverage.
Watch how Baldwin tries to "lead" her guest to stick with the narrative that drinking Diet Coke harms the body and can lead to dementia. Bare in mind this was what CNN chose to cover instead of an attempted suicide bombing in New York City this morning. It can't possibly get any more ridiculous. Oh wait, yes it can. It's CNN!
🥤 🥤 🥤 🥤🥤 🥤 🥤 🥤🥤 🥤 🥤 🥤— CNN (@CNN) December 11, 2017
President Trump reportedly drinks 12 Diet Coke's each day. What exactly does that do to his body? https://t.co/KT0BRbADtg https://t.co/iYRNRa45zo
No denial of 12 diet cokes a day https://t.co/oAOIk1Fi7y— Manu Raju (@mkraju) December 11, 2017
Can't fool Manu. He's on top of the story of the day. Let's ck Pelosi's trash can...I'll bet it's not empties of diet coke....😉😉😉— MauiGirl (@MauiGir65636677) December 12, 2017


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Magnesium Body Scrub Relax
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The Saint Charles Magnesiumspray is made from 100% natural Zechstein magnesium. Direct application to the skin is the most effective way of delivering magnesium to the body. The intake of magnesium is especially recommended for athletes or those undergoing stress or strain.
Saint Charles Magnesiumöl can be applied to the whole body. For athletes and physical ailments, it is preferential to massage the oil directly onto those particularly stressed parts of the body (avoiding contact with eyes or wounds).
About Zechstein magnesium
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Zechstein magnesium oil is pumped from about 1,800 meters below the surface and continually undergoes rigorous quality controls. Due to its exceptional purity and without the use of additives, this ready-for-use solution is used extensively in health and wellness areas.


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Rochester Welcomes Marijuana Grow Center
Sanctuary Alternative Treatment Center plans run its cannabis dispensary in Plymouth, and its cultivation center – where plants are grown and processed -- in Rochester. The cultivation center already complies with Rochester's zoning ordinances, and does not need any further approval. Nevertheless, the Department of Health and Human Services held a public hearing there on Tuesday.
Sanctuary CFO Josh Weaver began the evening in a defensive stance, promising the site will be secure and inconspicuous.
That's likely because a similar hearing in Plymouth lasted more than two hours, with much scrutiny from residents.
But in Rochester, only four people rose to speak. All were pleased to welcome Sanctuary to Rochester. Brian Marshall spoke last.
"I want to thank you for bringing your business here and helping Rochester to revitalize," he said. "How many long term jobs do you see?"
The answer: at least 10.
If everything goes according to plan, the 15,000 square foot cultivation center will open up at Spaulding Industrial Complex in less than a year.


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Journal of Cancer Therapy
Vol.09 No.10(2018), Article ID:88135,11 pages
Significance of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Portal Vein System of Pancreatic Cancer Patients
Shuiqing Zhuo*, Sihui Zeng*, Jingping Yu, Lizhi Liu#
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Imaging Sciences of Sun Yat-sen University Cancer Center, Guangzhou, China
Copyright © 2018 by authors and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
Received: October 9, 2018; Accepted: October 26, 2018; Published: October 29, 2018
Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Materials and methods: 47 patients with clinically suspected pancreatic cancer (all confirmed by pathology) were collected. Routine plain scan was performed with Siemens Force dual-source dual-energy CT followed by 3 scans respectively carried out in arterial phase, portal phase and delayed phase. Traditional virtual monoenergetic reconstructions (Mono_E) and new generation of virtual monoenergetic reconstructions (Mono+) were respectively performed on portal vein images to obtain virtual single energy images including Mono_ E70 keV, Mono_E 55 keV and Mono+ 70 keV and Mono+ 55 keV. The signal-to-noise ratio (SNR) and noise of portal vein, normal pancreatic tissues and pancreatic lesions of 100 kV, Mono_E and Mono+ images were compared. In addition, the contrast noise ratio of portal vein and lesions as well as pancreatic tissues and lesions (CNR PV, CNRtumor) were also compared. At the same time, two imaging physicians with rich clinical experiences read the films and scored the images of each group by using the 5-point scoring method. Results: Mono+ 55 keV images including SNRpv, SNRpanc, SNRtumor, Noise, CNRpv, CNRtumor were statistically different from 100 KV images and Mono_E images (P < 0.05). As for the subjective score, Mono+ 55 keV image score also had the highest score, which had statistical significance (P < 0.05). The results showed that Mono+ 55 keV images had the best quality. Conclusion: The new generation of virtual Mono+ post-treatment can reduce image noise. Low energy Mono+ images can improve the contrast between pancreatic cancer lesions and portal of pancreatic cancer patients.
Dual-Source, Virtual Monoenergetic Reconstructions, Computed Tomography, Pancreatic Tumors, Portal Vein System, CT Angiography, Image Quality
1. Introduction
Pancreatic cancer is a fatal malignant tumor, rarely found in the early stage. It is called "the king of cancer" because of its low resection rate, easy recurrence and strong invasiveness [1] . For patients diagnosed with pancreatic cancer, radical resection is the only effective way to achieve long-term survival. The preoperative localization diagnosis and resectability evaluation of pancreatic tumors is one of the hot spots and difficulties in abdominal surgery. Imaging plays an important role in the diagnosis, staging and prognosis of pancreatic cancer. The pancreas is closely related to peripheral blood vessels such as abdominal aorta, portal vein, inferior vena cava, superior mesenteric artery and vein, and splenic artery and vein. In preoperative evaluation of pancreatic cancer, it is very important to clarify the relationship between tumor and peripheral blood vessels as well as the scope and extent of invasion to blood vessels. The purpose of this study is to explore the advantages of the new generation of virtual single-energy post-treatment technology (Mono+) of dual-source dual-energy CT compared with 100 KV mixed-energy images and traditional virtual single-energy post-treatment technology (Mono_E) and its significance in improving the imaging quality of portal vein system of pancreatic cancer patients.
2 .Materials and Methods
2.1. General Data
47 patients with pancreatic cancer from June 2017 to April 2018 were retrospectively collected, including 32 males and 15 females, aged from 33 years old to 79 years old, with an average age of 58.19 ± 10.36 years and an average weight of 59.02 ± 7.89 kg. Case inclusion criteria: 1) All the patients with pancreatic cancer confirmed by pathological results; 2) All the patients were initially diagnosed; 3) the patients were conscious and able to cooperate with the examination. 4) There was no statistical difference in weight. Exclusion criteria: 1) The patients have hepatic and renal insufficiency; 2) The patients have contraindication of iodinated contrast agent; 3) The patients have serious cardiac dysfunction and other diseases. This study was approved by the local ethics committee.
2.2. Inspection Methods
All study examinations were performed on the same third-generation dual-source CT scanner (SOMATOM Force, Siemens Healthcare, Forchheim, Germany); the U.S. MEDRAD Stellant CT special high pressure syringe was used. The contrast agent was 350 mg/ml nonionic iodine-containing contrast agent. The dosage was 1.5 ml/kg body weight and the bolus injection rate was 4 ml/s. 20 ml saline was injected at the same speed to test the patency of blood vessels before bolus injection of contrast agent, and 20 ml saline was injected for washing after bolus injection of contrast agent. All patients underwent routine plain scan, arterial scan, portal scan and delayed scan. In the arterial phase, the contrast bolus intelligent tracking technique was used. The tracking point was set at 2 cm below the diaphragm of abdominal aorta. The ROI area was about 1 mm2 and the trigger threshold was 100 Hu. The arterial phase scan was started 7 seconds after the enhancement of the region of interest reached the threshold. The scanning range was from the diaphragmatic roof to the bifurcation of the abdominal aorta, and the scanning time is about 3 seconds. The portal phase scan was triggered 20 seconds after the arterial phase was completed, and the delayed phase trigger scan was 3 minutes after the contrast agent injection. During the portal vein phase, double-energy scan was used. The A and B bulb tube were started. The scan parameters: care dose 4d tube voltage and tube current intelligent modulation technology was used. CARE Dose4D tube voltage and current intelligent control technology was adopted. The reference tube voltage/tube current of the A and B bulb tube were: 100 kV/ref250 mAs, Sn150 KV/ref125 mAs. The bulb tube rotation speed was 0.5 second, and pitch was 1; collimation: 2 × 192 × 0.6 mm; thickness slice: 1 mm.
2.3. Image Reconstructions
The three groups of images, group A, B, and M obtained during portal phase through dual-energy scan respectively represent 100 KV images, Sn150 kV images, and linear fusion images of the previous two. Workstations that transmit image A and B implement post-treatment by using the "dual energy" function module in Syngo.vi software. Two groups of images, group A and group B, were selected for nonlinear fusion by Mono_E and Mono+ to obtain four groups of simulated single energy images including Mono_E 70 keV, Mono E55 keV, Mono+ 70 keV and Mono+ 55 keV respectively. The "blood vessel" function module in Syngo.via VB20 software was used to perform three-dimensional reconstruction on the above four groups of simulated single energy images and 100 KV images to obtain volume rendering (VRT) images and maximum intensity projection (MIP) images.
2.4. Image Analysis and Measurement
Subjective evaluation: Syngo.via VB20 software was used for film reading in Simens workstation, and two senior imaging diagnostic physicians used double-blind method to carry out subjective evaluation on the cross-sectional images, VRT and MIP images of the above five groups of images respectively. In case of different opinions, consensus would be reached through joint review and negotiation. The window width was 400 Hu and the window level was 40 Hu. The evaluation contents included main portal vein, portal vein and its branches, pancreatic tissue and tumor tissue. Image quality evaluation criteria included: image noise, resolution, contrast, definition, artifact, focus contour and tissue edge display. 5-point evaluation was adopted: 1 point: the image quality is very poor and cannot be used for evaluation at all (the image noise is very high; the artifact is extremely significant; the spatial or contrast resolution is completely distorted, and the edge definition is very poor); 2 points: the image quality is poor, and can basically be used for evaluation (image noise is high; the artifact is obvious; spatial or contrast resolution is distorted, and edge definition is poor); 3 points: the image quality is general and can be tolerated, but is affected by appropriate amount of noise, artifacts and image distortion; 4 points: the image quality is good. The noise, artifact and image distortion does not affect the clinical diagnosis; 5 points: the image quality is very good. There is low noise, good contrast, no artifact and no image distortion, which completely meets the clinical diagnostic requirements.
Objective evaluation: Syngo.via VB20 software "MM Basic Comparison" was used to read the function module. At the same time, the above four groups of simulated unipolar images and 100 KV images were opened to measure the background noise of the images and the CT values and standard deviation of portal vein, normal pancreatic tissue, and tumor tissue. Measurement position: five groups of images were selected at the same level. ROI was placed in the air in front of the images, in the center of the portal vein, in the normal pancreatic tissue and in the tumor parenchyma. ROI was about 1 mm3. Each part was measured 3 times and the average value was taken of the 3 times of measurement (Figure 1). The signal-to-noise ratio (SNR) of the portal vein, normal pancreas and tumor, and the contrast noise ratio of portal vein and tumor were calculated. The calculation formula was: SNR = ROI/SD, CNRpv = (ROIpv − ROIpanc)/SDair, CNRtumor = (ROIpanc − ROItumor)/SDair [2] .
2.5. Statistical Analysis
The measurement data of each group were expressed by mean ± standard deviation. SPSS20 software was used for statistical processing. The measurement data, calculated values and subjective scores were tested for normality and homogeneity of variance. If the conditions were met, the paired t test was used. If the conditions were not met, the nonparametric Wilcoxon sign rank sum test was used. P ≤ 0.05 indicated that the difference was statistically significant. The consistency of the image scores of the two radiologists was analyzed by weighted Kappa. Kappa > 0.75 indicated good consistency; 40 ≤ Kappa ≤ 0.75 indicated relatively good consistency; Kappa < 0.40 indicated poor consistency [3] .
Figure 1. The ROI was placed in portal vein, normal pancreatic tissue, tumor tissue and air to measure CT value and standard deviation.
3. Results
All 47 subjects successfully completed multi-phase enhanced CT scan of the upper abdomen without any contrast agent allergy, and all of them were able to cooperate well with the examination. All the cases were confirmed by pathology as pancreatic cancer, including 25 cases of pancreatic head uncinate process cancer and 22 cases of pancreatic body and tail cancer. The signal-to-noise ratio (SNR) of portal vein, normal pancreas and tumor, the contrast noise ratio measurement data and statistical results of portal vein and tumor of the five groups of images were shown in Table 1, and the subjective scoring results of image quality were shown in Table 2.
3.1. Analysis of Statistical Results
Regarding to comparison of new generation of virtual monoenergetic reconstructions (Mono+) images with traditional virtual monoenergetic reconstructions (Mono_E) images and 100 KV images, portal vein signal-to-noise ratio (SNR PV): the comparison among Mono+ 70 keV, Mono+ 55 keV, Mono_E 70 ke and 100 KV images had no statistical difference (P > 0.05). Mono_E 55 keV images had the lowest signal-to-noise ratio (P < 0.05); pancreatic signal-to-noise ratio (SNRpanc): according to the comparison among Mono+ 70 keV, Mono+ 55 keV, Mono_E 70 keV and 100 KV images, Mono+ 55 keV images had the highest signal-to-noise ratio, but there was no statistical difference (P > 0.05); Mono_E 55 keV image had the lowest signal-to-noise ratio (P < 0.05); tumor signal-to-noise ratio (SNR tumor): according to the comparison among Mono+ 70 keV, Mono+ 55 keV, Mono_E 70 keV and 100 KV images, Mono+ 55 keV images had the highest signal-to-noise ratio, but there was no statistical difference (P > 0.05); Mono_E 55 keV images had the lowest signal-to-noise ratio (P < 0.05); noise: there were statistical differences among the five groups (P < 0.05), among which Mono+ 70 keV images and Mono+ 55 keV images had the lowest noise and Mono_E 55 keV images had the highest noise; portal vein contrast noise ratio (CNR PV) and tumor contrast noise ratio (CNR tumor): Mono+ 55 keV images had the highest contrast noise ratio which was significantly different from that of the first 4 groups of images (P < 0.05).
Table 1. 5 Statistical results of measurement data of five image groups (x ± s).
Table 2. Subjective evaluation results of quality of five image groups (x ± s).
3.2. Analysis of Subjective Evaluation
The subjective evaluation results of 5 groups of images showed that: Mono+ 70 keV, Mono_E 70 keV and 100 KV images had no significant difference in portal vein, tumor contour and overall image quality (P > 0.05); Mono_E 55 keV images had the lowest subjective score which was significantly different from that of other 4 groups (P < 0.05); Mono+ 55 keV images had the highest subjective score which was significantly different from that of other 4 groups (P < 0.05).
4. Discussion
With the wide application of dual-energy CT and continuous technological innovation, different post-treatments and analysis algorithms have been continuously developed. Virtual single energy spectrum is one of the important post-treatment applications of dual-energy CT. It is generated by virtually calculating the CT values of substances under each single energy through dual-energy CT scan [4] . At present, the new generation of dual-source dual-energy CT can calculate single-energy images of any energy level ranging from 40 keV to 190 keV. Because substances with high atomic number such as iodine contrast agent have strong ability to absorb low energy X-ray photons, tissues such as blood vessels and lesions enhanced by contrast agent have better contrast than those under ordinary single energy CT scanning in low energy single energy spectrum images, and can thus be used to optimize the display of lesions. However, the lower the energy is, the lower the penetration ability of X-ray photons and the higher the noise is, which causes lower signal-to-noise ratio of the images and even affects the diagnosis. Therefore, the traditional virtual single energy spectrum image post-treatment technology (Mono_E) has not overcome the noise of low energy single energy image, which affects its wider application. For example, LV et al. [5] argues that 70 keV single energy images are the best for small display of hepatocellular carcinoma, while lower single energy images affect diagnosis due to too high noise. In recent years, the report on small pancreatic cancer with equal enhancement has attracted the attention of clinicians [6] , because when small pancreatic cancer with equal enhancement is enhanced, it is difficult to detect it. However, this type of pancreatic cancer is often early in the focus and the prognosis can be significantly improved after surgery [7] . This is precisely the short board of traditional single energy CT images.
Mono+, the new generation of virtual monoenergetic reconstructions of dual-source dual-energy CT, overcomes the shortcomings of traditional virtual monoenergetic reconstructions technology Mono_E and highlights its advantages in noise reduction. In recent years, the clinical application of this new technique in abdomen has also been continuously reported [2] [8] [9] . It is believed that this technique can improve the image contrast, reduce noise, improve the image quality, and improve the detection rate of small pancreatic cancer. Thus, it is a very promising technique. Davide Bellini and other scholars found that Mono+ can overcome the significant noise of conventional mono images and thus improve the image quality when the energy value is lower than 70 keV through dual-source dual-energy CT examination of a group of pancreatic tumor patients. Objective image quality evaluation shows that the best contrast noise ratio can be obtained at Mono+ 40 keV energy level, while subjective image quality evaluation thinks that the best image quality can be obtained at Mono+ 55 keV energy level [10] . Similarly, Claudia Freillese and other scholars have also found that the best image quality can be achieved at Mono+ 55 keV energy level [2] in their research on the image quality of pancreatic cancer lesions and normal pancreatic tissues.
The purpose of this study is to explore the advantages of Mono+, the new generation of virtual monoenergetic reconstructions technology, in improving the imaging quality of portal vein system of pancreatic cancer patients. The comparison among Mono+ 70 keV, Mono_E 70 keV and 100 KV images (Figure 2) showed that there was no statistical difference in signal-to-noise ratio, but Mono+ 70 keV images still had lower noise; when keV value dropped to 55 keV, noise of Mono_E 50 keV images had increased significantly and the signal-to-noise ratio decreased significantly. Although this group of images improved the contrast between portal vein and pancreatic tissue, portal vein and tumor tissue, the noise was too high, which affected the image quality; noise of Mono+ 55 keV images was not significantly different from that of Mono+ 70 keV images and was slightly lower than that of 100 kV images. However the contrast between portal vein and pancreatic tissue, portal vein and tumor tissue in Mono+ 55 keV images was significantly increased, and CNRpv and CNR tumor were obviously improved. In this study, five groups of images were reconstructed by volume rendering technique (VRT) (Figure 3), minimum density projection technique (MIP) (Figure 4) and curved surface reconstruction technique (CPR) (Figure 5) respectively in a three-dimensional manner. Subjective observation results showed that Mono+ 70 keV, Mono_E 70 keV and 100 KV images had little difference in image quality; Mono_E 55 keV images had the worst image quality due to the influence of noise. The edge of the image was rough, which was not conducive to showing the relationship between blood vessels and small tumors. However, Mono+ 55 keV images had better contrast and sharper edge of blood vessels; CPR images showed that the relationship between tumor and blood vessels and the boundary between tumor and pancreatic tissue were more clear.
(a) (b) (c) (d) (e)
Figure 2. The images of (a)-(e) Cross-sectional images of 100 keV, Mono_E 70 keV, Mono+ 70 keV, Mono_E 55 keV and Mono+ 55 keV showed that the signal-to-noise ratio of Mono+ 70 keV and Mono_E 55 keV were significantly higher than that of the 100-kv image. However, the Mono_E 70 keV image had no reducing noise effect compared with 100 kV image, and the Mono_E 55 keV image noise was significantly increased, and the signal-to-noise ratio was reduced, which affected the diagnosis.
(a) (b) (c) (d) (e)
Figure 3. The images of (a)-(e) were 100 keV, Mono_E 70 keV, Mono+ 70 keV, Mono_E 55 keV and Mono+ 55 keV VRT images respectively, showing that the portal vein system of Mono+ 55 keV was more clear and delicate, while the blood vessels of Mnon_E55 keV images were rough.
(a) (b) (c) (d) (e)
Figure 4. The images of (a)-(e) were respectively 100 keV, Mono_E 70 keV, Mono+ 70 keV, Mono_E 55 keV and Mono+ 55 keV MIP images, showing that the portal venous system of Mono+ 55 keV images had better contrast and were more clear and delicate than other images, while the Mnon_E55 keV images had large granules and rough blood vessels.
(a) (b) (c) (d) (e)
Figure 5. The images of (a)-(e) were respectively 100 keV, Mono_E 70 keV, Mono+ 70 keV, Mono_E 55 keV and Mono+ 55 keV CPR images, showing the relationship between portal vein and tumor. Mono+ 55 keV images showed stronger contrast between portal vein and tumor tissue and clearer edge relationship.
To sum up, Mono+ technology, the new generation of virtual monoenergetic reconstructions technology of dual source dual-energy CT, can significantly reduce image noise and improve image quality in pancreatic cancer portal vein system imaging. Choosing appropriate low keV virtual single energy image can obviously improve the contrast between tumor, blood vessel and pancreatic tissue. This can improve the detection rate of small pancreatic cancer and has important clinical significance for preoperative evaluation and treatment of pancreatic cancer.
Of course, this study also has some limitations, such as: too few cases may lack universality; at present, the new generation of dual-source dual-energy CT can calculate single-energy images of any energy level ranging from 40 keV to 190 keV. In this study, only the virtual monoenergetic reconstructions images of 55 keV and 70 keV were compared, but the images of other more energy levels were not studied. For the detection of small lesions of the pancreas, there may be more appropriate level virtual monoenergetic reconstructions image, which needs further study.
Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.
Cite this paper
Zhuo, S.Q., Zeng, S.H., Yu, J.P. and Liu, L.Z. (2018) Significance of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Portal Vein System of Pancreatic Cancer Patients. Journal of Cancer Therapy, 9, 827-837. https://doi.org/10.4236/jct.2018.910068
- 1. Mertz, H.R., Sechopoulos, P., Delbeke, D., et al. (2000) EUS, PET, and CT Scanning for Evaluation of Pancreatic Adenocarcinoma. Gastrointestinal Endoscopy, 52, 367-371. https://doi.org/10.1067/mge.2000.107727
- 2. Frellesena, C., Fesslera, F., Andrew, D., et al. (2015) Dual-Energy CT of the Pancreas: Improved Carcinoma-to-Pancreas Contrast with a Noise-Optimized Monoenergetic Reconstruction Algorithm. European Journal of Radiology, 84, 2052-2058. https://doi.org/10.1016/j.ejrad.2015.07.020
- 3. Li, Q., Wang, Y.T., Yu, M.M., et al. (2017) Effect of Radiation Dose of Dual-Source Computed Tomography Dual Energy Single—Phase Enhanced Scan in Patients with Esophageal Cancer: A Perspective Study. Chinese Journal of Digestive Surgery, 16, 527-532.
- 4. Lu, G.M. and Zhang, L.J. (2016) Guide to Clinical Application of Dual-Energy CT. People's Health Publishing House, No. 1, 6-8.
- 5. Lv, P., Lin, X., Chen, K., et al. (2012) Spaectral CT in Patients with Small HCC: Investigation of Image Quality and Diagnostic Accuracy. European Radiology, 22, 2117-2124.
- 6. Prokesch, R.W., Chow, L.C., Beaulieu, C.F., et al. (2002) Isoattenuating Pancreatic Adenocarcinoma at Multi-Detector Row CT: Secondary Signs. Radiology, 224, 764-768. https://doi.org/10.1148/radiol.2243011284
- 7. Kim, J.H., Park, S.H., Yu, E.S., et al. (2010) Visually Iosattenuating Pancreatic Adenocarcinoma at Dynamic-Enhanced CT: Frequency, Clincal and Pathologic Characteristics, and Diagnosis at Imaging Examinations. Radiology, 257, 87-96. https://doi.org/10.1148/radiol.10100015
- 8. Schabel, C., Bongers, M., Sedlmair, M., et al. (2014) Assessment of the Hepatic Veins in Poor Contrast Conditions using Dual Energy CT: Evaluation of a Novel Monoenergetic Extrapolation Software Algorithm. Fortschr Rontgenstr, 186, 591-597.
- 9. Andrew, D., Hardie, M.D., Melissa, M., et al. (2015) Application of an Advanced Image-Based Virtual Monoenergetic Reconstruction of Dual Source Dual-Energy CT Data at Low keV Increases Image Quality for Routine Pancreas Imaging. Journal of Computer Assisted Tomography, 39, 716-720. https://doi.org/10.1097/RCT.0000000000000276
- 10. Bellini, D., Gupta, S., Ramirez-Giraldo, J.C., Marin, D., et al. (2017) Use of a Noise Optimized Monoenergetic Algorithm for Patient-Size Independent Selection of an Optimal Energy Level During Dual-Energy CT of the Pancreas. Journal of Computer Assisted Tomography, 41, 39-47.
*Sihui Zeng and Shuiqing Zhuo contributed equally to this work.


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How many at-risk students in Lafayette charter schools?
Acadiana Renaissance Charter Academy is expanding its marketing efforts amid questions about whether it is meeting state-mandated targets for enrolling a certain number of at-risk students.
Meanwhile, the Louisiana Department of Education declined to answer specific questions about the matter, or whether it is considering taking any action against the school.
According to the department's Bulletin 126, new charter schools must have an at-risk student population percentage equal to the percentage of students eligible for free and reduced lunch in the school's district, or the average of districts from which the charter school's students live.
Those percentages are based on Oct. 1 enrollment counts. State data shows the October 2014 enrollment for Acadiana Renaissance was 675 students. Of those, 30.37 percent were classified as economically disadvantaged. The state average for economically disadvantaged students is 67.54 percent.
As a Type 2 charter school authorized by the state, Acadiana Renaissance can enroll a student from anywhere in Louisiana. Gifford Briggs, secretary of the Lafayette Charter Foundation, said the school has students from several Acadiana parishes, including Lafayette, Iberia, Vermilion and St. Martin.
Barry Landry, a spokesman for the state education department, confirmed that economically disadvantaged students are considered at-risk.
But beyond that, Landry declined to answer a series of specific questions from The Daily Advertiser about Acadiana Renaissance. The questions included whether Acadiana Renaissance is fulfilling the at-risk population requirement, what penalties the school could face or if the state has taken any action against the school regarding the matter.
"Charter schools are continuously improving how they serve students," Landry wrote in an email. "Statewide, 78.3 percent of students enrolled in charter schools are Economically Disadvantaged, compared to 67.5 percent in the state as a whole. Additionally, African-American students make up 73.3 percent of charter school enrollments, compared to 44.3 percent in the state."
The Daily Advertiser reiterated its request for answers to specific questions about Acadiana Renaissance, but received the same email response from the state.
"The Department will follow the intervention process as outlined in the Charter School Performance Compact and Bulletin 126 to address issues of noncompliance once we have final at-risk data on all charter schools for the 2014-2015 school year," Landry continued.
Briggs said charter school officials have not yet looked at individual data to see whether Acadiana Renaissance is serving enough at-risk students.
"We know that we want to do everything we can to ensure that we meet all of our obligations to the state," Briggs said. "For our first year, we accepted every applicant at Acadiana Renaissance until it was full. For the upcoming school year, during the enrollment period for Acadiana, in any grade with a spot available, if an at-risk student applied, they received an offer letter to attend the school."
Briggs said there have been no formal talks between the state and the Lafayette Charter Foundation about the at-risk student population at the school.
"In some preliminary conversations, we are obviously aware of making some adjustments to be able to broaden our base," he said. "We are going to make every effort to have every option available for students."
The Lafayette Charter Foundation and Charter Schools USA also operate Lafayette Renaissance Charter Academy. As of October, Lafayette Renaissance had 534 students enrolled, with 72.28 percent classified as economically disadvantaged.
Briggs said that during this past spring's enrollment period, the foundation reworked its marketing strategy to advertise both schools across Lafayette Parish and other parts of Acadiana, rather than target specific zones. Brochures were distributed throughout the parish, and the school websites were reconstructed to feature both schools, he added.
"We're very fortunate in Lafayette and Acadiana that we have two incredible schools that provide a wonderful learning opportunity for students," he said. "In a lot of cases, students apply for both schools."
Colleen Reynolds, a spokeswoman for Charter Schools USA, said that to the best of her knowledge, Louisiana is the only state where the company has schools that has an at-risk student population requirement. The company also operates schools in Florida, Georgia, Illinois, Indiana, Michigan and North Carolina.
Willow Charter Academy, which is operated by National Heritage Academies, had 483 students as of October, with 87.58 percent of students considered economically disadvantaged, according to the state.


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Rabbit Hole (2010)
Directed by John Cameron Mitchell / Dianne Wiest / Giancarlo Esposito / Jon Tenney / Nicole Kidman / Sandra Oh / Aaron Eckhart / Tammy Blanchard / Miles Teller
Genres - Drama | Sub-Genres - Psychological Drama | Release Date - Dec 17, 2010 (USA - Limited), Dec 25, 2010 (USA - Expanding) | Run Time - 92 min. | Countries - United States | MPAA Rating - PG13
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Synopsis by Jason Buchanan
Adapted for the screen by David Lindsay-Abaire from his own Pulitzer Prize-winning play, director John Cameron Mitchell's Rabbit Hole stars Oscar winner Nicole Kidman and Golden Globe-nominated Aaron Eckhart as a married couple who find their relationship on life support following the devastating loss of their young child. The further their relationship deteriorates, the harder the grieving parents fight to keep it alive.
grief, husband-and-wife, marital-problems


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Felt Sense
'Felt sense is the raw, direct experiencing of the body's feeling of a situation or memory before being clarified with words.'[1]
Eugene T. Gendlin first described this term in his book 'Focusing'.[2]
Felt sense and the focusing model is great bridge between mind and emotions and body.
Focusing: A Tool for Changing Times[3]
Focusing; the technique is uniquely suited for our changing times where most of us are having to invent, discover, and create the next steps of our lives without a light, a map, or a relevant tradition. We are trying to keep apace with rapidly changing technology, trying to understand our selves and our relationships, seeking ways to be well, looking for meaning in our work, and finding a new center of gravity within ourselves. Focusing is at once richly complex and surprisingly simple. It is mental and kinesthetic, mysterious in its capacity to summon buried wisdom, holistic in its respect for the 'felt sense' of a problem. An effective method in itself, it is valuable in conjunction with a variety of psychotherapies, somatic based therapies, and tools such as meditation. Focusing unblocks the creative processes, helps to define problems and enhances resources. In short, focusing works with any form of 'stuckness'.
The discovery of focusing
In the early 1970s, Professor Gene Gendlin of the University of Chicago began research into the question 'Why is psychotherapy helpful for some people, but not for others?' After studying hundreds of therapy sessions, Gendlin and his research team concluded that they could predict the success of treatment based on the clients that were able to have body awareness; for which he coined the term 'felt sense'. This approach has become useful in the treatment and resolution of trauma and has been adapted in this healing field with innovators such as the work of Babette Rothschild and Peter Levine. Focusing technique has also been adapted by many authors and therapists working in the field of psychophysiology.
What is focusing?
Focusing is a body-oriented process of self-awareness. It is as simple as noticing how you feel and then having a conversation with your feelings in which 'you' do most of the listening. Focusing is a natural skill that was discovered not invented. It was discovered by looking at what people are doing when they are changing successfully. Focusing ability is the birthright of every person: we are born with the ability to know how we feel from moment to moment. But for some of us the experiences of hurt and alienation from our cultures have caused us to lose trust in our bodies and feelings. We need our bodies and feelings to re-learn focusing.


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Project Description
Based in New York since 1967, Mediflex is a multi-generational, family-owned manufacturer of innovative surgical devices. Keir Surgical has been the exclusive distributor of Mediflex since the late 2000's. Mediflex is best known for their high quality laparoscopic products and table mounted retractor systems. This includes the StrongArm™ & FlexArm™ holding/positioning devices and the Cutting Edge™ Disposable Scissor Tip which improve OR efficiency.


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If someone were to ask who at your startup owns growth and the customer experience, which people or teams would raise their hands? Or perhaps a better question is who wouldn't raise their hand? In the early days growth and a positive customer experience are everyone's responsibility. But as companies grow and employees continue to specialize, it makes sense to form teams to own certain responsibilities. The downside of specialization is siloed teams that have misaligned or even conflicting goals. Customer Success and Growth teams have sprung out for companies to offer a more compelling customer experience while driving new and existing customer growth. Both companies and customers benefit from Growth leveraging the knowledge Customer Success teams gain from collaborating with customers. The majority of the experiments and optimizations Growth teams tinker with fall under the umbrella of the Customer Acquisition (sometimes called Growth Marketing) funnel. We'll use this funnel to take a closer look at how Customer Success can boost the work Growth teams do.
Growth Marketing Funnel
Reach potential new customers through distribution and acquisition marketing channels and capture interested people as new leads
Insights from Customer Success: Target people and companies that align with company's ideal customer profile to increase the likelihood that the leads Growth acquires are more likely to result in successful long term customers.
Benefits to customer: Pursuing potential customers who are more likely to find value in your product reduces the burden of researching your solution for customers who aren't a good fit.
Benefits to company: With SaaS companies spending a median of $1.13 to acquire each new dollar of new customer Annual Contract Value, targeting companies that fit your company's ideal customer profile can greatly lower your Customer Acquisition Cost (source).
Motivate these new leads to sign-up for your product and become paid customers
Insights from Customer Success: Compelling case studies and testimonials that resonate with leads can increase sign-ups. Leads are more likely to buy into your company's vision (instead of just a list of features), which can be helpful when implementation roadblocks arise during the Retention stage.
Benefits to customer: No one likes signing up for a product only to find out that it doesn't solve the problem you "hired" it to do. Testimonials and case studies allow customers to see for themselves what they can expect to accomplish with your solution.
Benefits to company: Streamlining your targeting and messaging of potential new customers during the Acquisition and Activation stages decreases your Customer Acquisition Cost while increasing your Customer Lifetime Value. This means that you will be able to sign-up new customers for less money, and that these customers will bring in more revenue by sticking around for longer.
Onboard these new customers to expose the value of your product and create long term user engagement
Insights from Customer Success: Getting users to sign-up is just the beginning! For companies that have both a self-serve and sales owned sign-up process, Customer Success and Growth need to work together closely to create a consistent customer experience. Growth teams often drop in to optimize sign-up and implementation workflows that impact the work of Customer Success. The two teams should collaborate on identifying key actions that increase the likelihood of a customer being successful, and to use this data to create engagement campaigns that blend automation and a human touch.
Benefits to customer: Post sign-up customers are full of optimism and hope, and it's your job to reduce their time to first value and keep them from falling into the "trough of disillusionment" (source). Properly onboarded and engaged users are able to use your product to solve their problems and receive maximum value.
Benefits to company: A great onboarding workflow has compounding benefits- retaining 15% more users from Week 0 to Week 1 has a cascading effect that will lead to a 2.6x increase from just a 15% improvement in retention (this article dives into more of the details of how optimizing onboarding can affect revenue).
Connect revenue to the value customers receive from your product through expansion, cross-sells, and upsells
Insights from Customer Success: Ideally your company should capture additional revenue as customers receive incremental value from your product and services. Customer Success teams directly impact this process by assisting customers in achieving the goals they have for your product, which makes them an integral part of a company's growth engine. This growth can come in the form of expansion revenue (ie. a customer pays for more storage space as they add more files to your cloud storage product), cross-sells (ie. buying additional products or features that connect to your platform), and upsells (ie. purchasing additional seats for another internal team). Growth and Customer Success teams need to work closely together to ensure there is a pricing model that makes sense for your company and your customers. Additionally, Growth needs to support Customer Success' efforts to bring in additional revenue, whether that's through targeted in-app messages encouraging a customer to purchase more seats, or through import tools that make it easy for customers to expand their use case.
Benefits to customer: Customers will be pleased to hear from your team if you can offer additional products and services that allow them to solve additional problems.
Benefits to company: According to a Totango study, 70%–90% of a customer's lifetime value is generated via renewals, cross-sells, and upsells (source).
Leverage the success of your current customers to drive growth through referrals
Insights from Customer Success: Customer loyalty and advocacy are cultivated by a Customer Success team that is focused on delivering value. Because Customer Success works closely with customers, they are able to identify which customers are most likely to act as references or collaborate on producing case studies.
Benefits to customer: Case studies and press releases can provide coverage and exposure that is mutually beneficial to you and your customers.
Benefits to company: 84% of B2B decision makers start the buying process with a referral (source).
Ways Customer Success and Growth should work together
Great cross-team collaboration requires established goals and access to shared knowledge and tools.
Shared goals
In order to effectively work together teams need to establish shared goals and priorities. For Customer Success and Growth the overarching goal should be acquire and retain customers that see long term value in your company's products. To this end, Growth and Customer Success teams focus on encouraging users towards behavior that they know drive long term successful customers. Both teams intimately know what their product's value proposition is and what actions lead users towards seeing value. Growth seeks to acquire new customers who mirror existing customers Customer Success know are receiving value from your product, or fit the profile of new customer segments the company wants to target. Growth runs growth experiments that often affect current customers and as a result should work closely with Customer Success to ensure the customer experience is never being sacrificed in favor of short term growth hacks.
Shared knowledge and tools
Customer Success and Growth teams work cross-functionally with Marketing, Sales, and Product to bridge communication gaps between potentially siloed teams. As a result of all this cross-team collaboration, both teams have a great deal of tribal knowledge they can share with each other. As mentioned before, Customer Success is in a unique position to act as the voice of the customer in key internal discussions that will shape the customer experience of current or future customers. Growth teams are often focused on making data-driven decisions and have access to tools that allow them to leverage data to impact the Growth Marketing funnel at scale. Customer Success can benefit from having access to these analytics and marketing tools to uncover insights that will allow for cohesive and scalable messaging at each stage of the Growth Marketing funnel.
Examples of Customer Success and Growth collaborating:
- Growth manages an automated new user onboarding campaign in Marketo. Customer Success should be able to dig into the performance if this campaign to see how each message performed for different customer personas and reach out to users who did not complete all onboarding stages for additional training and feedback.
- Customer Success wants to automatically trigger an Intercom in-app message to customers who have reached their seat limit. In this message the CSM on the account suggests the user use the Calendly link provided to schedule a time to chat about potentially expanding their account. Growth should be able to analyze the performance of this campaign. If personal outreach is shown to increase account expansions it might be a good idea to A/B test introducing personal touch points from Sales or Customer Success into different stages of the Growth Marketing funnel.
Customer Success and Growth teams share the goal of creating a compelling customer experience that drives top-line growth. Customer Success teams need to have an open channel of communication with Growth in order to share their knowledge gained from working with new and existing customers. This feedback loop multiplies the impact of Growth experiments and optimizations to the Growth Marketing funnel. When Growth teams take the time to incorporate the insights the Customer Success team have gained from working with customers, both companies and customers benefit.
Originally posted on the Calendly blog.


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Local News
Campbellsport Dollar General Bomb Threat
Police responded to the Dollar General store in Campbellsport Tuesday for the report of a bomb threat. The store called dispatch, saying they had taken a call from a person with a disguised voice saying there was a bomb and to not call police. Area schools were put on lockdown, and a daycare next to the store was evacuated. The building was searched and nothing was found. The Fond du Lac County Sheriff's Office is continuing an investigation into the case. Dollar General stores in Waupaca and West Bend also received threatening phone calls Tuesday morning.


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EDF Energy and EDF Energies Nouvelles have sold a majority stake in their Fallago Rig onshore wind farm – which was officially opened last year by Scottish Energy Minister Fergus Ewing – to a City-based pension fund.
The 48 turbine, 144 MW wind farm – located on the Roxburghe Estate in the Scottish Borders near Westruther – was built by EDF Energy Renewables, which is a 50:50 Joint Venture between EDF Energy and EDF Energies Nouvelles.
The sale to Hermes GPE (manager of the Hermes GPE Infrastructure Fund and the discretionary infrastructure managed account programme for the BT Pension Scheme) will release equity from the project for EDF Energy Renewables to invest in the development of other renewable projects in the UK.
Hermes GPE, part of Hermes Fund Managers Limited, is a leading UK-based infrastructure fund manager that manages approximately £2.6bn on behalf of the BT Pension Scheme and other UK investors.
EDF Energy and EDF Energies Nouvelles will continue to own equity in the wind farm and EDF Energy Renewables will continue to manage the site on behalf of the new owners by providing operations, maintenance services and asset management. EDF Energy will continue to purchase electricity generated by the wind farm.
A fund set up for the benefit of the local community and visitors to the area remains unchanged. It will receive £240,000 each year from the Fallago Rig Wind Farm and the Roxburghe Estate for the life of the project. This is managed by the Tweed Forum.
Christian Egal, Chief Executive, EDF Energy Renewables said: "We're pleased to have entered this agreement with Hermes GPE which will help us to free up capital which we will use to invest in other UK renewables projects.
"We have ambitious plans for the future to support the UK in reaching its renewable energy targets. This sale is consistent with that ambition and our ability to deliver new projects."
In addition to 500MW of onshore and offshore projects already in service, EDF Energy Renewables has over 1000MW of onshore renewables projects in development together with a 1100MW offshore wind farm project currently under development, Navitus Bay, a 50-50 Joint Venture between Eneco Wind UK Ltd and EDF Energy