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Why We Ended Legacy Admissions at Johns Hopkins
Eliminating an unfair tradition made our university more accessible to all talented students.
Ronald J. Daniels
President of Johns Hopkins University
When I served as the dean of the Faculty of Law at the University of Toronto—Canada's most selective law school—I would be asked every so often by one of our alumni what preference their children would enjoy when applying. The answer I gave was always the same: none whatsoever. When I became president of Johns Hopkins University 10 years ago, I found that one in eight newly admitted students benefited from preferences given to relatives of alumni. Today, it's important that I'm able to give the same answer to Hopkins alumni that I once gave in Toronto.
Legacy preferences—the admissions advantage given to family of alumni—are generally alien to Canadian (and, indeed, European) universities. And I never became reconciled to the prevalence of this form of hereditary privilege in American higher education, particularly given this country's deeply ingrained commitment to the ideals of merit and equal opportunity.
In the intensely competitive process of admission to America's selective universities, the advantage afforded legacy students is no small matter. One study that looked at admissions to elite colleges in 1997 estimated that legacy status afforded applicants an admissions boost equivalent to an added 160 points on the SAT. Another study, which looked at admissions to 30 highly selective institutions in 2007, concluded that legacy applicants were more than three times as likely to be admitted as their non-legacy peers. Because legacy students at these schools are more likely to be wealthy and white than non-legacy students, the very existence of legacy preferences limits access for high-achieving low- and middle-income students, and also for African American, Latino, and Native American students.
Read: The real reasons legacy preferences exist
Over the past two centuries, higher education has served as America's most potent engine of social mobility. The creation of public university systems and community colleges, visionary legislation such as the GI Bill and the Higher Education Act, and universities' own investment in financial aid have given students from all socioeconomic backgrounds greater access to higher education and the opportunities it confers. Today, according to the economist Raj Chetty and his colleagues, a child without a college degree from a family in the lowest income quintile has only a 5 percent chance of moving to the highest quintile. But if that child graduates from one of America's most selective universities, the odds of making that leap rise to 60 percent.
Liberal-democratic societies make a compact with their citizens that anyone with enough grit and talent can move beyond the confines of the class into which they were born and live a better life than their parents. As we well know, Americans are increasingly cynical about that promise, believing that democratic institutions are stacked against them. As American higher education has become more stratified, with the wealthiest students concentrated at the most selective institutions, the unabashed commitment to legacy preferences cannot help but lend credence to that belief.
It doesn't have to be this way. Extraordinary institutions such as MIT and Cal Tech have never entertained legacy preferences, and the University of California system did away with them in the 1990s. In 2014, Johns Hopkins joined their ranks. We made this change with little fanfare, so we could watch its impact and ensure that our approach was sustainable.
Admittedly, the decision to do away with legacy preferences was not easy. Defenders often argue that legacy preferences are a powerful tool to strengthen multigenerational bonds within a university community. Institutions like Hopkins rely on a robust network of dedicated alumni for counsel, outreach, and support. We take sincere pride in the fact that so many of our graduates feel such a strong connection to their alma mater that, years later, they urge their own children to apply. All our applications are subject to a holistic assessment, and many of these young people are exceptional applicants.
But maintaining the long-standing tradition of affording such students a routine admissions advantage based solely on their parentage had come at a high cost. It was impairing our ability to educate qualified and promising students from all backgrounds and to help launch them up the social ladder.
Read: Elite-college admissions were built to protect privilege
The year I arrived, Hopkins had more legacy students in its freshman class (12.5 percent) than students who were eligible for Pell Grants (9 percent). Now those numbers are reversed—3.5 percent of students in this year's freshman class have a legacy connection to the university, and 19.1 percent are Pell-eligible—and we expect that the number of Pell-eligible students will continue to rise in the coming years.
Ending legacy preferences is but one piece of our university's work to make a Johns Hopkins education accessible to all talented students, to mitigate the burdens of debt, and to ensure that students receive the supports and services that will help them thrive. These efforts are not a panacea for the structural inequities that plague our society. But they are necessary if American universities are truly to fulfill their democratic promise to be ladders of mobility for all.


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Current Recipient
Prize History
The HudsonAlpha Life Sciences Prize recognizes scientists who have made innovative contributions to life sciences research with the potential for positive impact on human health and social well-being. The HudsonAlpha faculty select awardees with outstanding achievements in scientific discovery, genomic medicine, economic development and public science education. Award recipients reflect HudsonAlpha's core values of cooperation, collaboration and the ability to integrate ideas across different areas of thought and expertise.
2019 Life Sciences Prize Recipient
Susan R. Wessler, PhD
Neil and Rochelle Campbell Presidential Chair for Innovations in Science Education University of California, Riverside
Home Secretary, US National Academy of Sciences
The Wessler laboratory studies transposable elements (TEs) with a special focus on their identification in newly sequenced genomes and their contributions to gene and genome evolution. Her laboratory has pioneered the use of computational analysis to determine the TE landscape of many plant genomes, including maize, rice, B. oleracea, arabidopsis, Lotus japonicus, poplar, amborella, mimulus, and citrus. Furthermore, they have tested the activity of numerous in silico TEs by developing transposition assays in yeast and arabidopsis. Her laboratory is best known for the discovery of miniature inverted repeat transposable elements (MITEs), which are the predominant TE associated with plant genes, and are abundant in the genomes of many animal species.
Life Sciences Prize ∙ Public Lecture
Location/Date: Paul Propst Center from 3pm to 4pm (October 14th, 2019)
Wessler will give a public talk on October 14, 2019 at the Paul Propst Center from 3pm to 4pm. The talk will focus on the legacy of Barbara McClintock's work. McClintock discovered in the 1940's that the movement of TEs could explain why individual kernels of maize look different. More than 40 years later, McClintock was awarded the Nobel Prize for that work. Wessler's talk explores why it took so long for the work to be recognized and why TEs are now seen as key contributors to the evolution of complex life.
Register to Attend Public Talk
History of the Life Sciences Prize
The annual Life Sciences Prize was instituted in 2008 by HudsonAlpha co-founder, Lonnie McMillian, and recognizes an academic scientist who has made outstanding and ongoing contributions that emphasize imagination, innovation, and the potential for impact on society and/or human health. For the first several years, the prize highlighted Alabama scientists, with the nomination and selection of prize candidates carried out by Institute leadership together with the Scientific Advisory Board. A decade later, the award includes scientists around the world, emphasizing achievements that exemplify HudsonAlpha's key missions.
Charles Rotimi, PhD
Honored for his genomics research in health disparities.
Bruce Alberts, PhD
Honored for his extraordinary contributions to, and advocacy for, science and science education.
Mary-Claire King, PhD
Honored for her foundational work on genetic susceptibility to breast and ovarian cancer.
Jay Shendure, PhD
Honored for his innovative work in the development and application of genomic technology to human biology and disease.
Tim Townes, PhD
Honored for his longstanding research on understanding and treating sickle cell and related blood disorders.
Casey Weaver, MD
Honored for his work on immune protection and immune disease.
Guy Caldwell, PhD, and Kim Caldwell, PhD
Honored for their work on the pathophysiology of neurodegenerative disease.
The HudsonAlpha Institute for Biotechnology presents the Life Sciences Prize recipient with a glass sculpture crafted by Cal Breed, a local artist with Orbix Hot Glass.
The sculpture links us to beginnings. Fittingly so, the egg design of the HudsonAlpha Life Science Prize reflects the refined sculpture's form and each piece has distilled colors and detailed shapes that are unique to each scientific prize winner.

redpajama_set_name: RedPajamaCommonCrawl


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module FormtasticBootstrap
  module Actions
    module Base

      # Bootstrap doesn't have wrappers.
      def wrapper(&block)
        # TODO Detect if user passed wrapper_html_options and issue
        #      a warning that they're ignored. (See the original in
        #      Formtastic.)
        template.capture(&block)
      end

      def default_button_html
        {
          :accesskey => accesskey,
          :class => "btn"
         }
      end

    end
  end
end

redpajama_set_name: RedPajamaGithub


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Home Press Releases Carpenter Brut Announces Return To North America in Summer 2022
Carpenter Brut Announces Return To North America in Summer 2022
French synthwave icon Carpenter Brut is returning to North America this summer with a series of 13 tour dates just announced for the U.S. and Canada, kicking off August 18 in Los Angeles and running through September 3 in Silver Spring, Maryland.
Tickets go on sale beginning Friday March 4 at 10 AM local time in each market here.
The upcoming tour is in support of Carpenter Brut's brand-new album Leather Terror, out April 1 via Universal. The first single – the colossal synthrock anthem "Imaginary Fire" – is out now. It features vocalist Greg Puciato (The Dillinger Escape Plan, Killer Be Killed, The Black Queen) with an accompanying music video directed by Dehn Sora that captures an eerily beautiful apocalypse during a psychedelic trip.
Leather Terror is the second in Carpenter Brut's Leather album trilogy, the next chapter following his widely acclaimed 2018 album Leather Teeth. That album was included in numerous Best Album lists across the spectrum of rock, alternative and electronic music that year. Kerrang championed the mysterious French artist as one of the "Best Live Bands On Earth" while Carpenter Brut was also honored as a performer at the Metal Hammer awards.
The albums form the soundtrack of an imagined movie from 1987. The previous record introduced the story of Bret Halford, an introverted science student. He liked a girl who didn't like him and much preferred the team's star quarterback.
Bret got mad and tried to create a concoction that would allow him to control them all, but ends up disfigured and decides instead to become a rock star. This is how he will seduce the girl, and all other girls: By becoming Leather Teeth, singer of Leather Patrol.
Now, Leather Terror finds Bret Halford as a true rock star and a ruthless avenger. Leather Teeth inflicts vengeance on those who stand between him and what he desires. While the album Leather Teeth was in parts a celebratory take on '80s glam rock, in his new opus, Carpenter Brut – across the space of twelve tracks – gets more malevolent, documenting the rise of his protagonist as a serial killer who wants to take revenge on all those who mistreated him when he was younger.
Regarding the album, Carpenter Brut says, "After spending much of 2018 touring, I had decided to take a long break to compose the new album of the trilogy. The pandemic confirmed that my choice to stay home was the right one. I ended up taking over a year and a half to compose this album. I made a lot of decisions with the time I had that I wouldn't have had time to make if the pandemic hadn't happened. I wanted to make the whole thing as massive as possible. There is no guitar on this album. I did everything with synths. Even though I didn't know exactly how I wanted the album to sound at first, I knew I wanted it to be massive and violent."
Massive and violent, yes. But inviting – so much so, that Leather Terror features a significant number of guests.
In addition to the aforementioned Greg Puciato on new single "Imaginary Fire," Alex Westaway of Gunship gives voices on the pummelling synth pop of "The Widow Maker" ("a rather particular hybrid timbre"), and Ben Koller of Converge and Jonka of Tribulation appear on the sinister title track, which closes the story. The Norwegian band Ulver and Kathrine Shepard from the band Sylvaine are also on board as well as Persha – a Parisian singer – who directly contacted Carpenter Brut to initiate a collaboration.
Leather Terror reflects both a serial killer, and an artist, in their prime: Bold and daring while full of shock and awe, creating a true spectacle out of great darkness with a flamboyant disregard for rules.
LEATHER TERROR TRACK LISTING
1. Opening Title
2. Straight Outta Hell
3. The Widow Maker
4. Imaginary Fire
5. … Good Night, Goodbye
6. Day Stalker
7. Night Prowler
8. Lipstick Masquerade
9. Color Me Blood
10. Stabat Mater
11. Paradisi Gloria
12. Leather Terror
Presales for Leather Terror are available here.
CARPENTER BRUT NORTH AMERICAN LEATHER TERROR TOUR:
18 Los Angeles, CA @ Fonda
19 Las Vegas, NV @ Psycho Vegas Festival
20 San Francisco, CA @ UC Theater
22 Portland, OR @ Wonder Ballroom
23 Seattle, WA @ Showbox
26 Minneapolis, MN @ Varsity
27 Chicago, IL @ Metro
28 Pontiac, MI @ Crofoot Ballroom
30 Toronto, ON @ Danforth Music Hall
31 Montreal, QC @ MTelus
01 Boston, MA @ Royale
02 New York, NY @ Brooklyn Steel
03 Silver Spring, MD @ Fillmore
About Carpenter Brut
Carpenter Brut draws its influences from '80s TV shows and B-movies loaded with synthesizers. The mysterious and discreet man evokes an encounter between Justice beats and the universe of John Carpenter. The French act pays tribute to the post-hippie/pre-AIDS culture that then set the basis of electro and metal to give us a unique, violent and crazy '80s revival sound. Over the last decade he built a successful career, as a major act from the darksynth scene.
He has toured the world with acts like Ghost and Ministry and performed at well-known festivals such as Coachella & SXSW, and has accumulated 366 million streams of his music worldwide.
Follow Carpenter Brut:
Website | Facebook | Twitter | Instagram | Youtube | Bandcamp
Carpenter Brut 2022
Carpenter Brut Live
Carpenter Brut North American Tour
Carpenter Brut Tour
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Tora! Tora! Tora! Reviews
Semi-documentary account of the buildup to the Japanese attack on Pearl Harbor in 1941. Won an Oscar for visual effects.
The Japanese sneak attack that plunged the US into WW II is lavishly and fairly accurately, if not enthrallingly, brought to the screen in this Japanese-US coproduction. The strategies of the Japanese high command as they prepare to further their expansionist aims by destroying the main American naval base in the Pacific are contrasted with the normal peacetime business of US government officials and military brass, only a few of whom are suspicious that the Japanese aren't sincere in their desire to negotiate. The film climaxes with the Pearl Harbor attack itself, re-created on the actual locations with the kind of detail that only millions of Hollywood dollars can buy. The first half of this movie, as the Japanese plot and Americans scratch their heads in apprehension, is static, boring, and 79 minutes long, the duration of many better movies. This is followed by 65 more minutes that largely comprise the actual attack--which, once it finally comes, is spectacular, involving dozens of planes refurbished to look like Japanese fighters, dive bombers, and torpedo planes. But despite all the grand spectacle, even the attack, as unimaginatively staged by Richard Fleischer, begins to bore after a while. How many times can one see planes swoop down and drop bombs on ships without it getting tedious? The film was the result of years of negotiation between Japanese and American investors. In the end, two different films were made; a Japanese film showing the Japanese side, and an American film doing the same for the US point of view. The two films were then edited together in two different versions, one for each nation. Initially, 20th Century Fox hired the great Japanese director Akira Kurosawa (THE SEVEN SAMURAI) to direct the Japanese sequences, telling him that Englishman David Lean (LAWRENCE OF ARABIA) was to direct the American sequences. As it turned out, Lean was never involved with the film and Kurosawa shot only for a few weeks, chafing under the tight controls imposed on him by the studio. The unhappy Kurosawa purposely got himself fired from the picture, and was replaced by Toshio Masuda and Kinji Fukasaku, two unremarkable directors of Japanese genre pictures equal in stature to Hollywood hack Fleischer. It all ended up costing over $25 million and failed miserably at the box office in the US, but was a great success in Japan, although it still took several years before the studio made back its money (partly through the sale of the battle footage, which appears in MIDWAY [1976] and MACARTHUR [1977]). The film won an Oscar for Best Special Effects and received nominations for Best Cinematography, Best Art Direction/Set Decoration, Best Sound and Best Film Editing.


Comfortable motel accommodation in Tokoroa.
The Amisfield Motel complex sits on approximately 2 acres of land offering pet-friendly Tokoroa accommodation. All units are facing north to capture the late morning and early evening sun which streams into the units making them warm and cosy. All booking confirmations are either emailed or texted to the person who has made the enquiry.
Checking In Time is between 2pm - 7pm week days and 2pm - 6pm weekend. If arriving later than specified time, please let us know and we will arrange for Unit Key to be left for you to pick up. Check Out Time is 10am.
All units have broadband internet access at a daily rate for laptops or PC's only. All units have flatscreen TV's and a DVD player and hair dryer are available on request. All continental breakfast is delivered to your units at night. Cooked breakfast is available on request and delivered to your unit at the time specified by you.
$100- $113 (single), $103 - $113 (double). Extra Adults $21, children $10. Unit rates may apply. Longer stay rates are available on request. All major credit cards excepted (NOT INCLUDING AMEX) plus Bartercard.


This, the largest PV installation in Australia would be a piker next to the scheme David Densford is proposing. Imagine a string of solar panels stretching from Jacksonville, Florida to Los Angeles, California.
An Energy Plan Just Crazy Enough To Work?
OpEd: When Texans think big, they really think BIG!
The Bush National Energy Plan wants to build hundreds of new nuclear power plants in the US, but there is already a perfect thermonuclear power plant a safe 93 million miles away. God's nuclear reactor showers our 3rd rock with enough power every single day to run our 3rd rock for a year. God's nuclear power plant has enough fuel to be self-sustaining for at least a couple more thousand years. Moreover, it does not pollute this planet. So here is my plan to address the myriad challenges confronting America in the near future.
Prove that the energy companies are overcharging and make them pay multi-million dollar fines that will directly fund the installation of solar powered picnic table shades, RV parking spaces, and marinas at all the National and State Parks. Encourage the National and State Park concessionaires to rent electric vehicles as part of a "Park and Ride" program to reduce the destruction of our natural resources. Patrons of the parks will be able to recharge their electric golf carts and bicycles at every campsite. The picnic table shades, RV covers, and houseboat slips will have built in LED lighting that will be battery powered at night. This will reduce the need to pack in flammable fuel, throwaway batteries, and chop down more trees to build a campfire for night vision. First we have to legalize electric bikes that do not exceed 20 mph and Neighborhood Electric Vehicles that do not exceed 40 mph.
The profitable business of renting electric vehicles to campers will then develop a new industry and will reduce the research and development cost of new and better technology. Through mass purchases of photovoltaic power generation equipment, the cost of producing PV systems will drop. This will end up making PV applications more profitable for future communities that desire to become less dependent upon the failure prone "Grid".
Based upon the success of the PV campgrounds, build solar farms with 60'x100' arrays along Interstate 10 and the southern railroad tracks from Jacksonville, Florida to Los Angeles, California. That is 10 states with connections to most major southern cities, entertainment areas, and ports. If we use the solar farms to augment the existing "Electrical Power Distribution Grid" then we can reduce the need to build new power production facilities at the taxpayer and consumer levels. If we use the land along the tracks to bury new superconducting cable, we can avoid having to rewire the country. This will support NAFTA in the long run. San Antonio and Del Rio are Amtrak stops. They are on both I-10 (east-west) and I-35 (north-south).
Offer the 60'x100' lots under the solar arrays to manufactured housing community operators and charge rent for the spaces. Design these solar powered communities exclusively for the retired. Not only will the retired homeowners no longer have utility bills as large as their retirement checks, they will also help fund, in the form of shaded living space rental, the generation of 4 times more electricity than they can consume. A 60'x100' PV array can generate 36 kW. A single 100 home community can generate 3.6 MW. The average single family home in the sun uses 4 kW a day. These homes are sitting in the shade now and use geothermal radiant heating and cooling systems. The community residents can drive electric vehicles recharged by the PV system over their home.
Geriatric specific healthcare can make house calls to the residents of these communities. Current Technology, highly advanced sonogram equipment that is very portable can be carried into a home like a briefcase, and makes most x-ray equipment obsolete . The need for large hospital systems is reduced to a few vans that make the daily visits to the residents as necessary or transport the needy to the hospital. There is a whole Association of doctors and nurses that specialize in home health care. As the retirees become less independent they can be moved to better facilities as required. The sale of their homes to new retirees will help fund their future healthcare needs.
No new schools need to be built for these communities. In fact, if the retired desire to continue their education they can drive to a nearby college or do it online. The life experiences and knowledge the residents have be collectively gathered into a usable database that will help future generations make better decisions. The retired could be very active in writing real history.
Now the retirees have a place to go other than staying in the hustle and bustle of "the big cities". Future retirees may desire to help slow urban sprawl by moving out of the homes they raised their families in and allow the next generation to move in. By slowing urban sprawl and passing family housing to the next generation, developers will be expected to take more time and build better communities that will last longer than one warranty period.
Tell this to the insurance companies.
School Districts can charge fewer taxes because the staff and equipment requirements will be reduced by not having to build new schools. The educators can concentrate on quality, not quantity!
Our elders can enjoy a better quality of life with more freedom to move about. Because they planned to move out, they made better investments for their future at a younger age. They will shop around to work for companies that have great 401K plans and stock options. They made room for younger employees to be promoted sooner by being able to retire at a younger age financially. In addition, the retirees can elect to remain available for business suggestions. Remember also that those that move into solar-powered communities have no utility bills.
Use this concept of solar farms along railroad tracks to design high-speed electric rail service that can accommodate both freight and passenger service. By developing rail yards centered on standardized sea-land shipping containers, we can create a new land bridge that reduces our need for a Panama Canal. We already have the one rail line along the southern United States with access to the major ports and Interstate highways. It would be very profitable to build the solar powered retirement communities near the 35 AMTRAK stops along its route. The required power distribution is combined with the labor pool. It just makes sense.
As the high-speed electric rail lines are branched from south to north, additional communities can be built to support the electrical and manpower requirements. A new rail line should be developed that carries freight and passengers from Seattle, WA to Chicago, IL to Norfolk, VA to New York City. A strategic land bridge would be created and housing will be made economical in that region without a need for a lot of infrastructure.
Studies have been done already to prove that rail is just as economical as ships. In fact, rail from Seattle to New York as opposed to ship transport, can shave almost a week off shipping time. High-speed electric rail will shave even more time off this cost.
Get the military involved financially and strategically. They desperately need land bridges and housing just as bad as the civilians do. There are many military bases that have been closed and the land is unused. Design PV military retirement communities that can provide emergency power to the grid and national defense experience to the overall decision making process. High speed rail incorporating standardized shipping containers will vastly improve the military's ability to respond to any threat. The military has cargo helicopters and cargo fixed wing planes that are able to carry these containers. They have rail-based anti-aircraft and missile defense systems that are designed to operate on rail systems. The railways are easier, quicker, and cheaper to repair than runways and highways in times of war.
Within all this, the rail industry will have to design a new locomotive. Most locomotive engines are diesel-electrics. The large diesel engine turns a large generator that powers a large electric motor. In order to use all the power given to the tracks from the PV arrays there will have to be some kind of way for the locomotive to collect and store electricity while on the go. The solution may be not unlike the old coal cars towed behind the engine. The first car will be the electric engine/generator. The second and subsequent cars will be the energy storage cars. The energy storage can be Ovonic's nickel metal hydride based fuel cells complete with water tanks and electrolysis. There could be starved electrolyte lead-acid batteries or ultra-capacitors. There is no reason that all technologies can not be incorporated. There are a great deal of studies and technological papers written on this very subject.
So, there you have it, A simple solution to a myriad of problems. The Social Security Administration, Medicare and Medicaid, The Department of Energy, The Department of Housing and Urban Development, The Department of Education, The Department of Transportation, The Department of Defense, and the Department of the Interior all have something that they can collectively throw money at. Get FEMA and the Native Americans involved and there will be nothing financially that can stop this train. Get the Security and Exchange Commission involved in the 401K possibilities and the banking industry may just fall in love with the concept.
Every single application of this concept may cost a few billion dollars to implement. However, it will save trillions of federal tax dollars within a decade.
This type of policy will inspire whole generations of worker bees to plan for a new type of hive. The retirees can still work at farming and grow crops that can be sold to make biodiesel or ethanol. There could even be community owned and operated alternative fuel "gas stations" selling hydrogen and biofuels along the nearby roads. Selling biofuel products that are grown locally. Most kids hate to live on the farm after they are old enough to date anyway. Allow the retired to practice living off the land instead of rusting up at home.
There really are some very well made single, double, and triple wide mobile homes that will fit perfectly under a 60'x100' PV array. This type of community can replace a community that is blown, washed, or shaken away by Mother Nature in a matter of weeks.
It will all begin the day the federal government says to the oil, gas, coal, and electric industries…"alright, that is enough!" "We are going to take some of your greed to finance the means of becoming less dependent upon you." When we do, think of how much quieter our National and State Parks will become. It may even be possible for the energy companies to volunteer to begin funding such a concept. What a media coup it would be for the first company (such as Texaco who owns part of Uni-Solar) to do so. Free advertising would be available on all the national television stations and in all the papers.
David is a Texas National Guard Chinook flight engineer instructor. His father took George W. Bush's photograph while the President was a pilot at Ellington AFB. He writes that his grandfather, "had the task of preventing the Nazis from getting nuclear material out of South and Central America during W.W.II."


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Support Acadia Center
Archive: Jul 2017
Viewpoints: How clean energy can help save Connecticut's budget
As the state's budget battle continues, debate over cutting costs and raising revenue has not focused on a promising strategy – ramping up clean energy efforts to grow our way out of the budget problem. Deploying solar and increasing building energy efficiency cuts air pollution, reduces energy costs, creates jobs, and stimulates the state's economy – all while putting more tax revenue in state coffers. We can help plug the budget gap by strengthening our clean energy economy. The two work together. What we absolutely should not do is raid clean energy funds. An essential part of Connecticut's clean energy
EnergyVision 2030 for Massachusetts
Massachusetts has a strong record addressing climate-changing pollution. In the early 2000s, Massachusetts was a founding partner in the Regional Greenhouse Gas Initiative (RGGI), a multi-state, bipartisan cooperative that has contributed to a 50% drop in power plant emissions. Passage of the Green Communities Act in 2008 led to nation-leading energy efficiency policies that reduce energy waste and save consumers billions of dollars. Last year, the Baker Administration and Legislature collaborated on landmark legislation to launch the U.S. offshore wind industry, enable further growth of onshore wind and solar power, import Canadian hydroelectricity, and place the Commonwealth at the forefront
Massachusetts must fill void left by U.S. withdrawal from Paris Agreement (Guest viewpoint)
Category: News & Blog, News
Op-ed by Daniel Sosland and Peter Rothstein in Mass Live. Since President Trump announced his decision to withdraw from the Paris climate accord, business leaders, environmental organizations and public officials across the nation have expressed concern for the impact on our climate and economy. The momentum we've achieved in building our nation's renewable and clean energy sector must now be picked up by forward-looking states, cities and businesses around the country. Massachusetts is in a unique position to be a leader in this effort. Massachusetts has a long history of using policy to bolster renewable and advanced clean energy deployment and innovation.
How Can We Replace Traditional Infrastructure with Clean Energy?
In March, Acadia Center released an analysis demonstrating that outdated financial incentives are driving expenditures on expensive and unnecessary utility infrastructure and inhibiting clean energy in the Northeast. The report, Incentives for Change: Why Utilities Continue to Build and How Regulators Can Motivate Them to Modernize, shows that under current rules, utilities can earn more money on infrastructure expenditures like natural gas pipelines and electric transmission lines than on cleaner, local energy resources like energy efficiency, rooftop solar, and highly efficient electric heat pumps. The key takeaway from the analysis is that without changes to the way they are regulated
New State Home Heating Oil Fees Proposed
Claire Coleman, an attorney with the Connecticut Fund for the Environment, said the draft strategy plan involves "some significant missed opportunities, and … doesn't get Connecticut where we need to be in terms of greenhouse gas reductions." The Acadia Center's Kerry Schlichting also said her organization "have some doubts" about the plan's ability "to make real progress on carbon reductions." Read the full article from the Hartford Courant here.
California Shows How States Can Lead on Climate Change
Attention now turns to the Northeast, where nine states, including New York, Connecticut and Massachusetts, are part of what is known as the Regional Greenhouse Gas Initiative, which, like California's effort, is a market-based cap-and-trade program that goes beyond state boundaries. So far, R.G.G.I., as it is known for short, has helped reduce emissions from power plants in the region by 40 percent between 2008 and 2016, according to the Acadia Center, a research and public interest group. States are now negotiating the future of the program beyond 2020. Read the full editorial from The New York Times here.
Northeast States Talk Big On Climate. This Is Their First Serious Test.
"What we gain in return for that marginal additional cost is that we avoid 99 million [short] tons of CO2 emissions" from 2017 to 2031, Jordan Stutt, a policy analyst at the Boston-based Acadia Center, told HuffPost. "That's more than a full year's worth of emissions for this region. If the states are serious about acting on climate, they can't ignore those kinds of emissions reductions at that low a cost." Read the full article from the Huffington Post here.
Healey calls for Eversource rate cut
A group of local officials and environmental groups have also raised concerns about Eversource's proposal, which they say would reduce the compensation paid to cities and towns for solar projects by about 40 percent. "The Eversource proposal that impacts these municipal solar projects is part of broader rate proposals to reduce customer control over bills and lower incentives for local clean energy," Acadia Center staff attorney Mark LeBel said in a statement. "Eversource's proposals would set back efforts to promote energy efficiency, electric vehicles, storage, and efficient electric heating too. The DPU should be looking for economically sensible ways to
Greens fear momentum loss in 9-state climate pact
Peter Shattuck, director of the Acadia Center's Clean Energy Initiative, said the decision has become increasingly important in the wake of President Trump's announcement of the United States leaving the Paris Agreement. An Acadia Center study found that emissions in the RGGI region fell by 37 percent after 2008, the year the program was instituted, while electricity prices fell by more than 3 percent. "I think they need to follow through on the commitments they've made on climate change," Shattuck said. "This is now an issue of global importance." Read the full article from E&E News here (article may not
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Vascular Complications after Facial Filler Injection
A Literature Review and Meta-analysis
by GIUSEPPE SITO, MD, PhD; VERONICA MANZONI, MD; and RAFFAELLA SOMMARIVA, MD
Prof. Sito is with the Prof. Professor Giuseppe Sito Clinic in Turin, Italy. Dr. Manzoni is with the Istituto Auxologico Italiano in Milan, Italy. Dr. Sommariva is a specialist in plastic surgery practicing in Acqui Terme, Italy and Genoa, Italy.
NJ Clin Aesthet Dermatol. 2019;12(6):E65–E72
Vascular occlusion during the injection of facial fillers is uncommon, but can result in serious adverse events, including necrosis, blindness, and stroke.
We explored factors that influence the frequency and severity of vascular complications during filler injections.
This was a meta-analysis that included case reports and case series published during the years 2004 to 2016 describing patients who experienced any type of vascular complication after an aesthetic procedure. In addition to the descriptive analysis of the variables retrieved, a logistic regression for predicting the outcome of the vascular event was performed.
The analysis included 93 cases described in 30 articles. Blindness was the main consequence of the vascular complications (n=57; 61%). The reported outcome was partial or total recovery in 24 cases (28%) and no improvement in 61 cases (72%). Hyaluronic acid (HA) and autologous fat were the two fillers most frequently involved in vascular occlusions, with autologous fat showing a stronger trend toward no improvement than HA. Involvement of the ophthalmic and retinal arteries was most frequently associated with no improvement.
Injury to ophthalmic and retinal arteries during the injection of facial fillers can result in irreversible serious adverse events. Physicians performing facial filler injections should have a proficient knowledge of anatomy.
Nonsurgical cosmetic procedures are a growing trend worldwide. Included among these minimally invasive techniques are botulinum toxin and soft-tissue augmentation with fillers, which are used to restore tissue loss and correct aging-related rhytides and folds. In 2011, dermal fillers were used in nearly 1.6 million aesthetic procedures, increasing to 2.3 million in 2013 and 5.5 million in 2014.1–3
Hyaluronic acid (HA) fillers are the most commonly used injectable fillers, followed by autologous fat. According to the American Society for Aesthetic Plastic Surgery, nearly 900,000 soft- tissue augmentation procedures were performed with HA in 2004.4,5 Other commonly used filler materials include bovine and human collagen (active for 1–3 months before degradation); poly-L-lactic acid, which stimulates endogenous collagen production for up to 15 months; and calcium hydroxylapatite, which offers up to 2 years of activity.3 These fillers can all be used for volume replacement and enhancement, such as cheek and chin augmentation, tear trough valley correction, nose reshaping (rhinoplasty), midface volumization, and lip enhancement.1,5–7 Although these procedures are generally considered safe, some local adverse events, aside from the relatively common site-injection reactions (e.g., swelling, tenderness, pain, bruising), have been observed.8–10 These include edema, erythema, scarring, granuloma formation, hyper- and hypopigmentation, infection, abscess formation, herpetic outbreaks, nodular masses, and paresthesia (if a nerve has been pinched during the procedure). While these adverse reactions are usually transient, the common use of three- dimensional facial volume restoration techniques, where the filler material can be injected at any depth, has brought about infrequent but serious and often irreversible vascular complications caused by symptomatic arterial occlusion.6,11–13 These vascular complications can result in persistent skin necrosis, ophthalmoplegia, permanent unilateral or bilateral vision loss, and stroke.11–13 Ocular and cerebral embolism occurs when the injected material travels from the distal to proximal retinal and ophthalmic arteries, causing sudden, excruciating pain, persistent blindness, and further tissue necrosis.11–13 In addition to fillers accessing the vessel lumen, vascular occlusion can occur by external compression of the stiff gel bolus deposited in direct contact with the vessel wall.14–16
Based on the available literature, some authors have suggested that the injection technique, site, and substance can have significant influence on the level of risk for an adverse vascular event.2,5,7,11,12,17 However, most of these reviews were not systematic, and the potential influence of other variables on the incidence of adverse events has not been addressed. Therefore, we reviewed the literature regarding vascular complications and performed a meta-analysis of the variables that potentially affect the frequency and severity of adverse events.
Literature search and article selection.
This meta-analysis included data from case reports and case series of patients experiencing any type of vascular complication after an aesthetic procedure published during the years 2004 to 2016. The main source for article retrieval was the PubMed. Additional sources included Google Scholar, where the search was restricted to the article title, and a case series by Park et al,18 which provided details from 19 cases previously published as case reports. The database search, performed on December 2016, combined the term filler with the following terms: injection (or injected), blindness, visual loss, ophthalmoplegia, artery occlusion, embolism, ischemia (or ischemic), necrosis, and complication. Only full-text articles written in English were considered for eligibility. To be included in the analysis, cases had to report a vascular event occurring after an aesthetic procedure on the human face.
Data extraction and management.
Data for the meta-analysis were extracted
from each case and transferred to a predefined form containing the following variables: case reference, age, sex, injected product, aesthetic procedure, needle diameter, injected volume, person who injected the product, injection site, blood vessel affected, main consequence(s) of the vascular event, concomitant symptoms, time to symptom onset, intervention performed to treat the vascular complication, and outcome. Additionally, diagnostic tests performed to confirm the occurrence of vascular complications were recorded to address the quality of the articles included in our review. The main consequences of a vascular complication were blindness, visual loss, necrosis, and other. Blindness was only considered when explicitly stated in the text, whereas visual loss included a reduction in visual acuity, the perception of light only, and the perception of hand movement only. Time-to-onset values were grouped into three categories: less than one hour postprocedure, 1 to 24 hours postprocedure, and more than 24 hours postprocedure. The final outcome was categorized as no change, partial recovery, or full recovery based on the progress of the main consequence of the vascular complication.
Statistical analysis.
Categorical variables were described as frequency and percentage, whereas quantitative variables were described as means and standard deviations (SDs). To assess the factors possibly influencing the outcome of vascular complications, the percentages of cases with no improvement and those showing partial or full recovery were compared using the chi- squared test. For variables showing statistically significant differences, a post-hoc analysis was performed by computing the chi-squared values of the adjusted residuals and applying the Bonferroni correction, as described by Beasley et al.19 A prediction model (multivariate analysis) for the vascular event outcomes was built using logistic regression. The multivariate analysis included all variables regarding events occurring prior to any vascular complication, which showed significant differences when comparing patients without improvement and those with partial or total recovery. The significant threshold was set at α=0.05 and all analyses were performed using the Statistical Package for the Social Sciences version 22.0 for Windows software program (IBM Corp., Armonk, New York).
Study selection.
The initial search (including articles retrieved from additional sources) yielded 143 articles, published during the years 2004 to 2016, on vascular events potentially associated with the use of injected fillers (Figure 1). After removing duplicates and excluding non-English articles and those without full-text availability, 86 were considered eligible. Of these, 56 either reported results at injection sites other than the face or did not report any vascular complication, and thus were discarded. The final selection included 30 full-text articles reporting 93 cases: 22 case reports (i.e., articles containing a full description of one or more cases),2,8,13,20–39 seven case series (i.e., articles containing a tabulated description of various cases with vascular complications),18,40–44 and one observational trial (i.e., an article retrieving data from a cohort of patients, including at least one patient experiencing a vascular complication).45 Most cases (n=62; 66.7%) were reported in Korea, while 14 (15.1%) were reported in China, 10 (10.8%) were reported in the United States, three (3.2%) were reported in Germany, three (3.2%) were reported in Taiwan, and one (1.1%) was reported in Japan.
All cases had information regarding the injection site and main consequences of vascular complications. Other key variables, such as injected substance, outcome, and affected blood vessel were reported in 92 (98.9%), 85 (91.4%), and 82 (88.2%) cases, respectively. In 80 cases (86.0%), the vascular complication and identity of the affected blood vessel were confirmed by at least one of the following imaging techniques: optical coherence tomography, magnetic resonance imaging, ultrasonography, or fundoscopy. In six cases, the affected vessel was deduced from the signs (e.g., necrosis affecting a skin area clearly irrigated by the facial artery) or the treatment outcome (e.g., prostaglandins injected into a vein, leading to the improvement of signs and symptoms). Conversely, in four cases, the physician failed to identify the affected vessel despite performing imaging diagnostic tests. Needle diameter, injected volume, and the professional who performed the injection were only reported in 11, 17, and 13 cases, respectively; due to their low representation in the study sample, these variables were excluded from analysis.
Case characteristics.
Table 1 summarizes the main characteristics of the cases described in the selected articles. In most cases (n=57; 61.3%), blindness was the main consequence of vascular complication. In five cases (5.4%), the patients experienced blindness and skin necrosis simultaneously. Whereas blindness was typically assumed to be a consequence of a vascular embolization of the filler material, necrosis was sometimes attributed to compression (Figure 2).2,39,45 However, none of these cases reported evidence regarding the etiology of skin necrosis, and compression was suggested based on the time-to-onset or necrosis progression. Nine patients (9.7%) experienced neither necrosis nor visual loss or blindness despite a diagnosis of vascular occlusion. Eight patients (8.6%) reported mild consequences (e.g., pain, erythema), all of which resolved completely. One patient that was injected with autologous fat in the glabella experienced occlusion of the retinal artery with concomitant brain infarction, which resulted in hemiplegia and death.43
Theoretically, multiple blood vessels and nerves can be reached by the needle during filler injection (Figure 3). However, the paths of facial, nasal, temporal, and ophthalmic arteries define anatomical areas with increased risk of injury during filler injection (Figure 4). In the case of the ophthalmic artery, the increased risk included occlusion of one of its most important branches: the retinal artery. In our analysis, the ophthalmic retinal arteries accounted for 79.3 percent of the cases in which the affected blood vessel was reported. In addition to the nasociliary artery, other blood vessels affected by the aesthetic procedure were the choroid vessels, the internal carotid artery, the middle cerebral artery, and the facial vein and artery. The occlusion of the ophthalmic artery was mostly due to injections in the nose (n=18, 42.9% of all cases affecting the ophthalmic artery). Conversely, the occlusion of the retinal artery was mostly due to injections in the glabella (n=18, 55% of all cases affecting the retinal artery).
In 12 cases (12.9%), vascular occlusion progressed to brain infarction, identified by magnetic resonance imaging. Two of these were associated with ophthalmic artery occlusion, whereas eight were associated with retinal artery occlusion. With the exception of two cases—one leading to the patient's death and another resulting in neurological sequelae—blindness was the main consequence for all patients affected by brain infarction.
Full recovery was reported in seven cases (8.2%): one case of blindness, one of visual loss, and five cases of vascular occlusion with minor consequences. Temporary blindness was caused by an HA injection in the eyebrow. The patient reported foggy and hazy vision immediately after the filler injection; 10 days later, the filler was successfully removed by irrigation and aspiration after creating a temporal limbal incision in the affected eye. Eight days after removal, visual acuity was restored.27
Hyaluronidase was used only in 10 of 40 cases in which HA was the cause of vascular occlusion. The time between symptom onset and hyaluronidase injection exceeded three hours in all cases. The dose of hyaluronidase injected, reported only in five cases, ranged from 1,000 to 9,000 units. In five of these cases, blindness was the main consequence of the vascular event; only one patient experienced partial recovery,25 whereas the rest remained blind despite attempts to remove the HA obstruction by injecting hyaluronidase.
Factors influencing outcome.
To explore possible baseline factors influencing the outcome, cases with either visual loss or blindness as the main consequence were grouped into two categories based on the outcome: total or partial recovery and no improvement (Table 2). A chi-squared test revealed significant differences in the injected substance, the affected blood vessel, and the time to symptom onset. The post-hoc analysis of the injected substance showed that both HA and autologous fat were significantly associated with no improvement (p=0.003 and p<0.001 for the chi-squared adjusted residuals of HA and autologous fat, respectively; the significance threshold after Bonferroni correction was set at α=0.005). Regarding the affected vessel, only the ophthalmic artery was significantly associated with no improvement (p=0.001 for the chi-squared adjusted residuals; the significant threshold after the Bonferroni correction was set at α=0.006).
A post-hoc analysis of time-to-onset did not reveal significant differences in any of the three categories.
The injected substance, the affected blood vessel, and the time to symptoms onset were included in a logistic regression analysis.
The resulting model explained 22 percent of the outcome's variance, categorized as "no improvement"and"total or partial recovery" (R2=0.219; p=0.027). However, only the affected blood vessel significantly contributed to the overall model (Table 3).
In this systematic review and meta-analysis of patients with vascular complications occurring after aesthetic procedures, we found that unilateral blindness was the most frequent vascular adverse event associated with cosmetic fillers for facial tissue augmentation. Of these, autologous fat tended to cause more cases of permanent vascular damage. Among all blood vessels affected, the ophthalmic artery was significantly associated with irreversible blindness.
The risk of vascular complications associated with facial aesthetic procedures has been addressed previously in case reports, case series, and literature reviews. In an attempt to further understand the factors influencing the risks and outcomes of vascular complications, we extracted data from individual cases to provide a quantitative approach. Moreover, considering that the number of products available for soft- tissue augmentation has been progressively and continuously increasing for the last 10 years, our review aimed to present an updated picture of vascular complications associated with these fillers. All analyses based on case reports are constrained by the amount and accuracy of the information published. Eighty-six percent of cases reported using imaging diagnostic techniques to verify the diagnosis of vascular occlusion, and most of them provided details regarding key variables such as the injected substance, the blood vessel affected, the outcome of the vascular complication, and the time to symptom onset.
In terms of clinical correlation, one of the most relevant variables was the filler injected. In our study selection, the absolute number of cases with vascular complications after the use of HA and autologous fat was similar. However, considering that HA is, by far, the most used filler in the world for aesthetic procedures,4,5 this observation suggests that autologous fat is more often associated with vascular complications than HA. Regarding the recovery rate of vascular complications, both HA and autologous fat were significantly associated with a lower frequency of improvement, but the latter showed a stronger trend towards more severe outcomes. This result is consistent with that of previous reviews, which concluded that autologous fat is the filler material that most frequently causes permanent blindness.12,17,46 In a previous review by Beleznay et al,12 autologous fat was responsible for 47.9 percent of cases of unilateral permanent blindness, followed by HA (23.5%), collagen (8.2%), poly-L-lactic acid (3.1%), and calcium hydroxylapatite (2%).The increased risk of major vascular complications associated with autologous fat injections could be explained by its large particle size, enabling it to occlude relatively large vessels, such as the ophthalmic artery.12,17
Regarding safety, one of the advantages of HA is the availability of an effective rescue procedure (i.e., hyaluronidase injection into or around the occluded blood vessel).45,47,48 This is one of the reasons why HA has been claimed as the safest substance indicated for tissue augmentation.48,49 However, in our review, the number of cases in which hyaluronidase was administered accounted for only a quarter of all cases in which HA was used (10 vs. 40). Furthermore, although the reduced number of cases limited our statistical analysis, it is worth mentioning that only half of these cases resulted in the total recovery of the main outcome related to vascular occlusion. The low recovery rate despite the use of hyaluronidase could be partially explained by the excessive time gap between symptoms onset and hyaluronidase injection, ranging from 3 to 24 hours, with five over seven cases exceeding the four-hour threshold, below which significant differences are seen.45 These observations suggest that the safer profile of HA compared with autologous fat might be better explained by the properties of the filler material rather than the availability of a rescue procedure. Due to the different physical properties of each substance, the injector's ability to inject the filler using the right pressure might become an overriding factor influencing the risk of vascular complications.12,50 Rapid injections not only result in greater amounts of filler but also limit the capacity of the injector to identify and amend any vascular occlusion. Furthermore, various authors have proposed that, when exerting too much pressure on the plunger, even during the injection of small amounts of filler, arterial pressure can easily be overcome, with the filler reaching deeper arteries.6,12 Of course, injection pressure and rate cannot be monitored unless the professional performing the injection uses a motorized injector to deliver the filler; hence, this information could not be included in our analysis. Motorized injectors have been proposed as a means to reduce injection risks, as they provide a comfortable flow rate and allow physicians to keep their attention on the patient.50,51
Considering that shorter onset times are more likely to prompt early interventions, we expected time to symptom onset to influence the outcome. However, no significant differences were found between the times before and after one hour.
The importance of the time gap between the vascular complication and the intervention was investigated in animal models by Kim et al38 and Cavallini et al,47 who found that rescue procedures performed less than four hours after a filler injection significantly reduced the area of necrotic ear skin. However, these studies were based on hyaluronidase injections as rescue procedures, which were barely used in our case collection. Notwithstanding the lack of correlation with other studies, two important drawbacks limited our analysis of the potential influence of the time- to-onset on symptom recovery. First, our dataset did not include time frames more accurate than a 24-hour interval. Second, most of these cases were reported by ophthalmologists with patients showing sudden blindness concurrent with filler injections; therefore, the time from the aesthetic intervention to the onset of vision loss or blindness was assessed retrospectively.
Our results also showed that the affected blood vessel significantly influenced the outcome of the vascular complication. Based on the statistical analysis, ophthalmic artery occlusion was more frequently associated with no improvement than that of other blood vessels, particularly the nasociliary artery. However, individual case examinations revealed that the most dangerous adverse events (i.e., cerebral infarctions) occurred as an ultimate consequence of retinal artery occlusion. Since the retinal artery is a final branch of the ophthalmic artery, it could be assumed that an occlusion of the retinal artery is not likely to have consequences at more central areas. However, as previously discussed, when the tip of the needle penetrates the artery and pressure is applied to the plunger, the filler can reverse the flow in it, moving as a column proximal to the origin of the retinal artery. If the injector exerts more pressure on the plunger for a longer time, the column can reach the origin of the ophthalmic artery, and part of the filler embolus can access the internal carotid artery and subsequently reach cerebral circulation (Figure 2).6,12 The use of motorized devices, which enable accurate pressure control, has been proposed to minimize this risk.50,51 We found no differences in the outcome when the occlusion occurred in other blood vessels, particularly the nasociliary and facial arteries. Although this observation is consistent with the larger diameter of these vessels, due to the limited number of cases in which there was occlusion in blood vessels other than the ophthalmic and retinal arteries, no firm conclusions could be reached.
Finally, we addressed the influence of the injection site on the outcome of the vascular event. Previous studies reported the glabella and the forehead as areas more frequently associated with blindness and visual loss than the nose.5,7,11 However, in our analysis, injections in the nose accounted for nearly half of the cases of vascular complications and had a similar frequency to that of injections in the glabella. These observations indicated that the nose might not be a safer injection site than the glabella. Lazzeri et al11 suggested that the dorsal nasal artery (i.e., the second terminal branch of the ophthalmic artery) might be responsible for the transmission of emboli following injections in either the glabella or the area proximal to the nasal root. Other injection sites did not yield significant results upon comparing the outcomes of the vascular procedures. However, it is worth mentioning that our analysis was compromised by the fact that a single patient could be injected at various sites, which precludes the identification of the precise injection responsible for the vascular complication.
Limitations.
The fact that our meta-analysis was based mostly on case reports implies some limitations that should not be dismissed. Case reports do not always provide all details of the procedures performed. This was particularly notable for some variables identified as risk factors for vascular complications, such as injection technique, injected volume, pressure applied, and needle diameter, which were omitted in most cases. Some of these factors were investigated by Glogau et al,5 who concluded that low injection pressures (i.e., flow rates of less than 0.3mL/minute) and small volume injections (i.e., less than 0.5mL) might prevent retrograde embolization of the filler; the authors also recommended avoiding the fan-like technique, which was identified as the main cause of iatrogenic vascular occlusion. Other variables that could not be analyzed because of data omission, despite their potential interest, include the specialty of the person performing the injection, the characteristics of the device (e.g., needle, cannula), and the concentration of hyaluronidase used in the rescue procedure. In addition to a few poor-quality case reports, some of the cases analyzed were not reported by the physician injecting the filler but rather by the ophthalmologist who treated the complication, thus omitting details of the initial aesthetic procedure. The variables most affected by this lack of data were time-to-onset, initial rescue treatment, and concomitant symptoms, which, in most cases, were retrospectively reported by the physician treating the complication. Another potential source of inaccuracy was the ad-hoc data transformation. The heterogeneity in the way the various case reports reported the data prevented the use of pure, raw data for the analysis, which would have been a factor adding simplicity and clarity to our conclusion.
In addition to presenting an updated and quantitative perspective of vascular complications associated with filler injections, the results obtained in our analysis might serve to support a few recommendations to help clinicians who perform filler augmentation procedures avoid vascular adverse events or minimize their consequences. Table 4 provides a list of key recommendations for preventing and minimizing vascular adverse events when performing filler injections. However, as mentioned before, our analysis has important limitations associated with the accuracy and diversity of data presentation in the source articles. Hence, the recommendations we present in Table 4 should not be interpreted as being strictly supported by the results of our meta-analysis; our recommendations are also based on our own insights gained from our extensive experience as plastic surgeons.
This meta-analysis provides an up-to-date overview of vascular complications associated with the injection of facial fillers. Our results support the hypothesis that autologous fat is more likely to cause serious vascular events than HA, irrespective of the use of hyaluronidase to treat the vascular occlusion. In light of the information published in the literature, it seems that accidental injection in the terminal branches of the facial artery, particularly the retinal artery, almost invariably leads to unilateral, and occasionally bilateral, blindness. The incidental occlusion of the retinal artery most frequently occurs when treating the nose, but this artery can also be reached from the glabella. Thus, to prevent vascular adverse effects, it is essential that the physician performing the filler injections has a proficient knowledge of anatomy.
The authors gratefully acknowledge the time and effort of Dr. Patrice Delobel, Dr. Kévin Legent, and Dr. Luana Consolini, who provided scientific advice and helped with laying the groundwork of this research. The authors also thank the i2e3 Biomedical Research Institute team for providing statistical and medical writing assistance.
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39. Tracy L, Ridgway J, Nelson JS, et al. Calcium hydroxylapatite associated soft tissue necrosis: a case report and treatment guideline. J Plast Reconstr Aesthetic Surg. 2014;67(4):564–568.
40. Park SW, Woo SJ, Park KH, et al. Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections. Am J Ophthalmol. 2012;154(4):653–662.
41. Park TH, Seo SW, Kim JK, Chang CH. Clinical experience with Hyaluronic acid-filler complications. J Plast Reconstr Aesthetic Surg. 2011;64(7):892–897.
42. Kim YK, Jung C, Woo SJ, Park KH. Cerebral angiographic findings of cosmetic facial filler-related ophthalmic and retinal artery occlusion. J Korean Med Sci. 2015;30(12):1847–1855.
43. Hong JH, Ahn SJ, Woo SJ, et al. Central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections. J Neurol Sci. 2014;346(1–2):310–314.
44. Lee SK, Kim SM, Cho SH, et al. Adverse reactions to injectable soft tissue fillers: memorable cases and their clinicopathological overview. J Cosmet Laser Ther. 2015;17(2):102–108.
45. Kim DW, Yoon ES, Ji YH, et al. Vascular complications of hyaluronic acid fillers and the role of hyaluronidase in management. J Plast Reconstr Aesthetic Surg. 2011;64(12):1590–1595.
46. Rzany B, DeLorenzi C. Understanding, avoiding, and managing severe filler complications. Plast Reconstr Surg. 2015;136(5S):196S–203S.
47. Cavallini M, Gazzola R, Metalla M, Vaienti L. The role of hyaluronidase in the treatment of complications from hyaluronic acid dermal fillers. Aesthet Surg J. 2013;33(8):1167–1174.
48. BuhrenBA,SchrumpfH,HoffNP,etal.Hyaluronidase: from clinical applications to molecular and cellular mechanisms. Eur J Med Res. 2016;21(1):5.
49. Vartanian AJ, Frankel AS, Rubin MG. Injected hyaluronidase reduces restylane-mediated cutaneous augmentation. Arch Facial Plast Surg. 2005;7(4): 231–237.
50. Carey W, Weinkle S. Retraction of the plunger on a syringe of hyaluronic acid before injection: are we safe?. Dermatologic Surg. 2015;41(c):S340–S346.
51. Cassuto D, Papagni M. Anteis injection system: positive results of a preliminary clinical evaluation. Updat Plast Surg. 2010;3:5–8.


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Hang Zhou Heaven On Earth Day Bus Tour
Travel to Hangzhou, a city rich in history and spectacular scenery on this day trip from Shanghai. Cruise on Hangzhou's famous West Lake and take in the stunning views that have inspired poets and artists for centuries. Also visit the Six Harmonies Pagoda, a magnificent example of ancient Chinese architecture.
Pick-up and drop-off service for Shanghai downtown hotels.
Local English-speaking tour guide for transfer and sightseeing program as indicated for seat-in-coach tour.
Entrance fees to scenic spots as indicated in the itinerary.
Meals: Lunch.
Parking fee & toll fee wherever applicable.
Personal expenses such as drinks, optional activities, etc.; Gratuities to the tour guide & driver.
Available: Daily; Pick up around 7:30-8:30am.
Approximately 9 hours.
Our tour guide will pick you up at your Shanghai downtown hotel lobby around 7:30-8:30am.
A 2.5 hours high way drive will take you to the city of Hang Zhou. It is a city rich with history and culture, spanning back over 2000 years. It made a name for itself in the sixth century, when the Grand Canal opened up and linked the area to other centers of trade. The Song dynasty helped to make Hang Zhou famous when the imperial family moved there in the 12th Century. With its inviting views and outstanding scenery, the area soon became popular with numerous artists, poets and painters seeking inspiration in this little bit of "paradise".
You will first cruise across the West Lake to view unforgettable sceneries such as the Three Pools Mirroring the Moon, the Bai and Su causeways, and Solitary Hill. The boat ride starts at the Fish & Flower harbor and ends up by the Shangri-la Hotel or reverse.
Then you will have a traditional Chinese lunch at a local restaurant.
After lunch, you will also visit Guo's Villa that is the best existing traditional private garden in Hang Zhou.
Dragon Well (Longjing) tea is that famous throughout China, so you will be guided to the China Tea Museum and the Meijiawu Tea Plantation, to discover the history of Chinese tea and the tea ceremony.
Before turning back to Shanghai, stop at the Qiantang River and overlook the Six Harmonies Pagoda.
Tour requires a minimum of 2 people to operate.
Complete information, including local telephone numbers at your destination, will be included on your Confirmation Voucher.


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POP ART: Episode 67, Hell House, LLC/Man Bites Dog
Howard Casner • January 5, 2022
"Usually, I start the month with a postman". It ain't easy being a new filmmaker these days. First there's the money. Then you have to assemble a crew. Of course, you need actors. And if all that's not difficult enough, then you have demons trying to kill you or a serial killer who gets you involved in his gleeful crime spree. What's an artist to do? Sounds like it's time for Episode 67 of Pop Art, the podcast where my guest chooses a movie from popular culture, and I'll select a film from the more art/classic/indie side of cinema with a connection to it. For this episode, I am happy to welcome as my guest for the Pop Art Halloween special, teacher by day, horror aficionado by night and someone who makes a career of being on other people's podcasts as well as being a podcaster herself, Lisa Leaheey, who has chosen as her selection the horror found footage film Hell House LLC, while I have chosen the Belgian dark comedy found footage film, Man Bites Dog, both films about documentarians who discover that their subject matter is a little more than they bargained for.
And in this episode, we answer such questions as: What is found footage film and how has the meaning changed? Why should first time filmmakers watch Man Bites Dog? Clowns, why is it always clowns? What is one of the faults often found in found footage films, especially in Man Bites Dog? What are the literary precedents of found footage films? What does the phrase Man Bites Dog mean? What is the first found footage film? Where was Man Bites Dog banned? 2C or not 2C? What rating did Man Bites Dog get and how did it end up in Blockbusters? What really happened in the basement?
CONTENT: Feature Length, Genre, Interview, Plot, Review


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Two engine configurations are available, one offering 90 horsepower, the other 115 hp. In both cases, the torque is 16.9 Nm. Moreover, the transmission is six-speed manual.
It is worth noting that in its less powerful configuration, the new engine allows the consumption of Adam is of 23.25 km / l. Regarding CO2 emissions are 99 g / km.


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back to main news hub
Mayor calls on Government to help Greater Manchester 'build back greener'
Mayor calls on ministers to support extra funding for cleaner vehicles
Money would also help to support small businesses, sole traders and taxi drivers
Funding commitment needed to keep air quality gains and support green recovery
Greater Manchester is calling on Government to support its plans to 'build back better' and help to tackle air pollution as the city-region sets out ambitions for a green economic recovery.
The coronavirus pandemic has seen air pollution levels drop by 30%1 and road traffic volumes fall by as much as 52%2 across Greater Manchester as a result of the lockdown – and at the same time cycling journeys have increased by 42%3.
To build on this, and give businesses across the city-region the support they need to prepare for the introduction of a Greater Manchester-wide Clean Air Zone as directed by Government, the Mayor is calling on ministers to financially support the city-region's plans to rebuild the economy in an environmentally sustainable way.
The financial package would enable Greater Manchester businesses and transport operators to make the shift to cleaner vans, lorries, buses taxis and private hire vehicles.
Andy Burnham, Mayor of Greater Manchester, said: "Our focus has rightly been on reducing as best we can the terrible impacts of coronavirus on our people and our businesses.
"But it's also right that we now look to the future and how we can make sure that, as we recover, we build back better, but at the same time build back greener.
"We've seen tremendous shifts in travel patterns over the last few months, with reduced air pollution levels, more people than ever before cycling and walking, and a significant switch to working from home, and we need to keep these benefits.
"We can't go back to how we were – no one wants to see the levels of air pollution and congestion we were experiencing. We must seize the opportunities offered by this difficult situation to support our businesses through recovery and into a greener future.
"To achieve that we need dedicated funding from Government to support our businesses as they move to cleaner vehicles, and long-term funding to support the roll out of more cycling and walking measures and to make sure our public transport network is capable of supporting our economy in a much more environmentally friendly way."
The ask of ministers is made up of:
£98m for a Clean Commercial Vehicle Fund for vans, HGVs, coaches and minibuses (increased from £59m).
£16m for a Clean Bus Fund to support retrofit of the existing bus fleet. (Greater Manchester is also working with Government on additional funding for the replacement of vehicles that can't be retrofitted with new, cleaner vehicles.)
A £28m Clean Taxi Fund for taxi and private hire drivers and operators to switch to cleaner vehicles.
A new £10m hardship fund – dedicated to small businesses and sole traders who could face additional financial concerns to help them switch to compliant vehicles.
Funding for 350 new electric vehicle charging points, doubling the size of the existing Greater Manchester publicly owned charging network, and for up to 600 electric buses by the mid-2020s. (This investment would come from sources other than Government Clean Air Plan core funding.)
Greater Manchester local authorities are already progressing bold active travel plans after emergency funding was made available as part of coronavirus recovery, with their 'Safe Streets Save Lives' initiative. This has seen the creation of a new-look space for pedestrians and cyclists in Manchester city centre with the temporary closure of part of Deansgate to motor vehicles.
Plans for a Greater Manchester-wide bike hire scheme are also progressing, with the intention of offering residents a cost-effective, attractive and easy way to make short journeys.
Leaders continue to press Government for additional emergency funding to support Metrolink beyond 8 June, when the initial funding ends, and for a multi-year settlement for the Greater Manchester bus network.
Councillor Andrew Western, Greater Manchester Green City-region Lead, added: "Our recovery must be green and sustainable, and that means a shift away from transport powered by fossil fuels.
"Transport and goods deliveries are at the backbone of our economy, so that's why we're making this ask of Government to help us support local businesses and transport operators as they make the move to a greener, more sustainable future.
"Government has provided some initial funding but we need certainty on the full funding package as soon as possible so we can give Greater Manchester businesses, many of whom we know are struggling due to the coronavirus lockdown, the information they need to play a full role in a Clean Air Plan public consultation and further development of the proposals.
"In particular, I'd like to highlight the taxi and private hire trade, which has experienced some of the worst effects. Work is under way to look at the funding needed to support them on the road to a zero-emission future, and we continue to work closely with the trade on proposals for minimum licensing standards across Greater Manchester, to make sure they are suitable and achievable."
Greater Manchester local authorities intend to consult on proposed taxi and private hire minimum licensing standards alongside the Greater Manchester Clean Air Plan consultation, including a roadmap to when taxi and private hire fleets should be zero-emission capable.
Greater Manchester last month announced that plans to hold a statutory public consultation on the Clean Air Plan had been postponed due to the coronavirus pandemic. The consultation will be held as soon as is feasible.
A report on the consultation will be brought to Greater Manchester leaders when there is a clear timeframe for exiting lockdown and moving to the next phase of the coronavirus response. The delay to the consultation also means that the introduction of the Clean Air Zone has been moved back to 2022.
Analysis up to 30 April by environmental consultancy AQ Consultants for the Air Quality Expert Group (an expert committee to Defra) suggests that the average levels of nitrogen dioxide and nitrogen oxides air pollution at 122 roadside sites across the UK reduced by 30% compared to pre-lockdown levels. This includes an estimated 25-30% reduction (taking into account variables such as weather) at the air quality monitoring stations at Piccadilly Gardens and Oxford Road in Manchester city centre.
Transport for Greater Manchester (TfGM) highways data during lockdown shows that 16.6m journeys were made during the week commending 4 May, 52% lower than a typical week prior to the lockdown (34.8m journeys).
Cycling data from several sources, including TfGM's network of automatic cycle counters, the cycle totem on Oxford Road, combined automatic traffic counters and data from camera-based sensors, suggests that the number of journeys by bike during the week commencing 4 May was 42% higher than a similar week pre-lockdown.


Sophisticated penthouse of 135 m2 is located in one of the most beautiful buildings of the skyline of Barcelona.
The distribution is structured in living room and kitchen, partially integrated by sliding doors, and bathroom. The exterior beauty is part of this great social space, thanks to the glazing system that gives access to a terrace of 30 m2. This unique outdoor space has been designed in a "L" shape to make the most of the unbeatable location. The views are panoramic, where the Mediterranean Sea merges into the perfect Barcelona.
The night area is composed of the master bedroom suite, a double bedroom and a bathroom.
The finishes are modern and the equipment is high-end and exquisite taste. The property is in perfect condition, since it has been renovated in 2017.
The estate has modern style, where discretion and elegance are the keys. It has a concierge service and 24-hour security. The property has two underground parking spaces in the same building and a storage space.
Sophisticated penthouse with the surface of 138 m2. Its distribution is composed of a living-dining room and a kitchen partially integrated by the sliding doors and a guest toilet. The exterior beauty forms the part of this great social space, thanks to the glazing system.
The terrace has a surface of 30 m2, designed in form of "L" to take advantage of its unbeatable location. Its views are simply wonderful: panoramic where the Mediterranean Sea merges to the singular Barcelona.
The night area consists of a master suit bedroom, one double bedroom and a full bathroom.
High quality modern finishes and equipment. The property is in a perfect state of preservation, as it has been reformed in 2015.
The building has a modern style, where discretion and elegance are the keys. It has a concierge service and 24 hours surveillance. The property dispose of the two underground parking spaces in the same building and a storage room.


Make sure you're geared up for the next Wichita State Shockers game day! This Classic Wordmark tee is a great way to top off your favorite look while cheering on the team!
Mens_Yellow_Wichita_State_Shockers_Classic_Wordmark_Tri-Blend_T-Shirt http://images.fanatics.com/lf http://dmimages.ff.p10/chains/2213668.txt false We are unable to customize this item with the text you have entered. Please try a different entry again. Your current entry cannot be processed due to guidelines for past and present player names. Please create a new entry.


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INGREDIENTS: Milk Chocolate (Sugar, Whole Milk, Cocoa Butter, Chocolate Liquor, Soy Lecithin (an emulsifier), and Vanillin (an artificial flavoring)), Roasted Salted Pecans (Pecans, Salt, Peanut and Vegetable Oil (Soybean)), Confectioners Glaze.
ALLERGEN INFORMATION: Contains Tree Nuts, Soy,Milk. Manufactured in a Facility that ProcessesPeanuts, Tree Nuts, Wheat, Soy, Milk Products.


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