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Ventricular Assist Device (VAD): A Recommended Approach to the Treatment of Intractable Cardiogenic Shock
June 18, 2013 by larryhbern
Writer: Larry H Bernstein, MD, FCAP
Curator: Aviva Lev-Ari, PhD, RN
A ventricular assist device (VAD) is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. VADs are used in people who have weakened hearts or heart failure. Although VADs can be placed in the left, right or both ventricles of your heart, they are most frequently used in the left ventricle. When placed in the left ventricle they are called left ventricular assist devices (LVADs).
You may have a VAD implanted while you wait for a heart transplant or for your heart to become strong enough to effectively pump blood on its own. Your doctor may also recommend having a VAD implanted as a long-term treatment if you have heart failure and you're not a good candidate for a heart transplant.
The procedure to implant a VAD requires open-heart surgery and has serious risks. However, a VAD can be lifesaving if you have severe heart failure.
http://www.mayoclinic.com/health/lvad/MY01077
This is an assessment of the development and progression of cardiogenic shock and review of the use of ventricular assist devices in that setting. It is another piece of the chapter on cardiothoracic surgical management at Columbia University Medical Center, New York, NY.
Heart Lung. 2012 Sep-Oct;41(5):500-4. http://dx.doi.org/10.1016/j.hrtlng.2012.03.007.___Epub 2012 May 16.
A stepwise progression in the treatment of cardiogenic shock.
Pollack A, Uriel N, George I, Kodali S, Takayama H, Naka Y, Jorde U.
Department of Medicine, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.
Cardiogenic shock remains a deadly complication of acute myocardial infarction (MI). Early revascularization, inotropic support, and intraaortic balloon counterpulsation are the mainstays of treatment, but these are not always sufficient. New mechanical approaches, both percutaneous and surgical, are available in this high-risk population. We present a case of a young woman with a massive anterior wall MI and subsequent cardiogenic shock who was treated with advanced mechanical circulatory support. This case serves as an illustration of the stepwise escalation of mechanical support that can be applied in a patient with an acute MI complicated by refractory cardiogenic shock. We also review the literature with regard to the use of percutaneous left ventricular assist devices in the setting of cardiogenic shock.
Care of the Critically Ill: A Stepwise Progression in the Treatment of Cardiogenic Shock.
Pollack A, Uriel N, George I, Kodali S, Takayama H, Naka Y, Jorde U
J Heart & Lung 2012; 41:500-504.
http://dx.doi.org/10.1016/j.hrtlng.2012.03.007
A 21-year-old woman with a history of migraine headaches was admitted to the hospital with nonradiating substernal chest pain onset that morning. When she presented to another hospital she had a normal electrocardiogram (EKG) and was discharged. When the patient's chest discomfort became crushing she presented again to the same hospital where her EKG revealed ST-segment elevations in an anterolateral distribution. Her peak (hs) troponin was 229 ng/mL and peak creatinine kinase was 6900 U/L. This was an elevation of CK far out of proportion to the troponin increase (suggestive of decreased peripheral circulation with massive release of CK from muscle). There was no family history of early myocardial infarction (MI), sudden cardiac death, clotting disorders, or hypercholesterolemia. She had been taking amitriptyline for migraines and oral contraceptives for 3 years. The patient developed significant hypotension, after she was given metoprolol and morphine, for which dobutamine and dopamine were administered. Medication was switched to norepinephrine because of excessive tachycardia. Cardiac catheterization was performed emergently approximately 12 hours after the onset of the patient's chest pain.
Thrombectomy of an angiographically identified clot in the proximal portion of the left anterior descending artery was performed, followed by placement of a bare metal stent with no residual occlusion. An intraaortic balloon bump (IABP) was placed. The initial transthoracic echocardiogram revealed an ejection fraction of 25% and global hypokinesis with regional wall motion abnormalities, worst in the anterior, apical, and lateral walls. She was intubated and required significant hemodynamic support with norepinephrine. Her antiplatelet regimen consisted of oral aspirin, clopidogrel, and intravenous eptifibatide. The patient was transferred to the New York Presbyterian Hospital/Columbia University Medical Center approximately 12 hours after revascularization.
Transfer to NY Presbyteran Columbia Hospital
On arrival, the patient was intubated and sedated. Her blood pressure was 80/51mmHg, pulse rate was 140 beats/min, and oral temperature was 101F. On examination, she was tachycardic with warm extremities. The jugular veins were not distended. Her lactate was 7.0 mmol/L. (If she was so severely hypotensive with lactic acidemia, possibly from impaired liver and/or muscle circulation with aerobic glycolysis, then why was the temperature 101 deg F?) The patient was not tested for procalcitonin (Brahms, BioMerieux), but sepsis is now considered bacterial or abacterial. Whether there was release of bacterial endotoxin secondary to poor decreased circulation in the superior mesenteric artery is not known, which complicates the situation more. In a study of acute phase changes in liver proteins by Bernstein and associates [Transthyretin as a marker to predict outcome in critically ill patients. Devakonda A, George L, Raoof S, Esan A, Saleh A, Bernstein LH. Clin Biochem 2008; 41(14-15):1126-1130. ICID: 939927], and another on procalcitonin and sepsis [The role of procalcitonin in the diagnosis of sepsis and patient assignment to medical intensive care. Bernstein LH, Devakonda A, Engelman E, Pancer G, Ferrar J, Rucinski J, Raoof S, George L, Melniker L. J Clin Ligand Assay] there was a notable case of negative bacterial culture in a patient with highly elevated procalcitonin, considered a reliable early indicator of sepsis.
Procalcitonin (PCT) is a sensitive and specific inflammation marker, which can be used to detect both inflammatory infections and noninflammatory complications in postsurgical monitoring of patients after cardiac surgery using extracorporeal circulation. The optimum cut-off value for PCT levels, as a predictor of postoperative complications, appears to be 1.2 ng/mL with a sensitivity of 80% and a specificity of 90%. PCT may be used to monitor response to therapy because blood concentrations increase in an inflammatory disease relapse. Importance of procalcitonin in post-cardiosurgical patients. Topolcan O, Bartunek L, Holubec Jr L, Polivkova V, eta al. Journal of Clinical Ligand Assay 2008; 31(1-4): 57-60.]This might be expected to be associated with a CRP increase over 50-70 mg/ml. In addition, the hemogram would have been of some interest, perhaps raising the question of whether the cardiovascular impairment triggered other events [Validation and Calibration of the Relationship between Granulocyte Maturation and the Septic State. Bernstein LH and Rucinski J. Clin Chem Lab Med 2011; 49. Walter de Gruyter . http://dx.doi.org/10.1515cclm.2011.688. Converting Hematology Based Data into an Inferential Interpretation. Bernstein LH, David G, Rucinski J and Coifman RR. In Hematology – Science and Practice, 2012. Chapter 22, pp 541-552. InTech Open Access Publ. Croatia].
A chest radiograph showed pulmonary edema. Her EKG revealed sinus tachycardia at 121 beats/min with ST-segment elevation of 3 mm in leads V1 to V4 and poor R-wave progression throughout the precordial leads with pathologic Q waves in V1 to V6, I, and aVL. Eptifibatide (Integrilin, Merck & Co., Inc., Whitehouse Station, NJ) was stopped, and norepinephrine was continued at 20 mg/min. Dobutamine 2.5 mg/min and broad-spectrum antibiotics were administered. During the next 4 hours, the patient's mean arterial pressure fluctuated between 60 and 70 mm Hg with a heart rate between 120 and 140 beats/min on 20 mg/min of norepinephrine, 2.5 mg/min of dobutamine, and the IABP. Rapid escalation of mechanical support with a left ventricular assist device (LVAD) was deemed necessary. Right-sided heart catheterization after placement of an Impella 2.5 assist device (ABIOMED, Inc.) revealed a cardiac output of 3.3 L/min and a cardiac index (CI) of 2.1 L/min/m2, despite addition of 3 ug/min and 4 U/h of vassopressin.
On the second day after transfer she was severely hyponatremic, but her plasma sodium stabilized at 131 to 138 mmol/L after discontinuing the vasopressin. She also developed significant bleeding at the site of the Impella and hemolysis requiring several blood transfusions. Her hemoglobin on transfer was 10.4 g/dL, which trended down to 7.8 g/dL after Impella placement. The patient's lactate dehydrogenase was 1980 U/L (probably reflecting poor liver perfusion), and total bilirubin was 2.6 mg/dL on day 2 of her hospitalization compared with 1.1 mg/dL on transfer.
After the Impella device was removed on day 3 because of persistent bleeding, the patient's hemoglobin, bilirubin, and platelet count stabilized, but while the patient was able to maintain end-organ perfusion initially as manifested by a normal creatinine, as the day progressed, the patient's systemic blood pressure trended downward and urine output decreased, and she could not tolerate discontinuation of the vasoactive agents being administered. Pulmonary hypertension developed with a rate-dependent cardiac output as manifested by persistent tachycardia, and had an ejection fraction of 20% with severe hypokinesis of all segments except the basal inferior and inferolateral walls. As a consequence of the enduring cardiogenic shock and the low likelihood for recovery of left ventricular function, it was evident the patient required long-term mechanical support. A continuous flow LVAD (HeartMate II; Thoratec Corporation) was implanted as a rescue therapy, and the patient was emergently listed for transplantation.
A comprehensive heart failure regimen was introduced, and the patient was discharged with warfarin 25 days after her transfer. A comprehensive hypercoagulability workup performed while the patient was receiving anticoagulation with negative results. Aside from oral contraceptive use, no other obvious risk factor for an acute arterial thrombosis could be identified, which is not surprising given that up to 40% of all thrombotic events occur in patients without a recognizable risk factor. Early revascularization, inotropic support, and intraaortic balloon counterpulsation are the mainstays of treatment, but these are not always sufficient. New mechanical approaches, both percutaneous and surgical, are available in this high-risk population. This case serves as an illustration of the stepwise escalation of mechanical support that can be applied in a patient with an acute MI complicated by refractory cardiogenic shock. We also review the literature with regard to the use of percutaneous left ventricular assist devices in the setting of cardiogenic shock.
The authors recommend the following protocol for patients with cardiogenic shock superimposed on acute MI. Treatment of cardiogenic shock. PCI, percutaneous coronary intervention; IABP, intraaortic balloon pump; VAD, ventricular assist device; VA-ECMO, venoarterial extracorporeal membrane oxygenation; OHT, orthotopic heart transplantation; pVAD, percutaneous ventricular assist device. It is important to note that it includes immediate revascularization in conjunction with IABP placement. In patients with refractory cardiogenic shock who are unable to be weaned from the IABP, mechanical circulatory support using a percutaneous or surgical device is the next essential measure to be taken. The type of mechanical support to be used depends on many factors, including the reversibility of the shock state, chances of ventricular recovery, and risk of bleeding. Mechanical circulatory support with left ventricular assists devices can improve cardiac performance and reduce myocardial ischemic injury. Principle mechanisms include unloading of the left ventricle, thereby decreasing myocardial oxygen demand and improvement of systemic hypotension, thus increasing coronary perfusion.
Although there were complications related to the use of the device, its deployment resulted in the improvement of the patient's surgical candidacy by virtue of maintaining her end-organ function. After the removal of the Impella device, we thought the left ventricle in this patient would not recover, and for this reason, we chose a definitive surgical procedure as opposed to alternative temporary support device. Clinical studies focusing on the use of VA-ECMO in refractory cardiogenic shock after an acute MI are limited. Observational and retrospective series have thus far demonstrated a high mortality rate in these patients. However, a recent retrospective study of 33 patients who received ECMO support for advanced refractory cardiogenic shock after an acute MI demonstrated a mortality rate of 46% and 52% at 30 days and 1 year, respectively. In addition to mny complications with VA-ECMO, the procedure also can lead to increased afterload from the retrograde flow of peripheral cannulation., which may to lead to increased left ventricular pressure and wall stress, thereby compromising myocardial recovery and worsening pulmonary edema, both of which were major concerns
in this patient.
This case demonstrates that a sequential approach using percutaneous mechanical support as a bridge to surgical mechanical support is feasible in this high-risk population (Figure ). Advantages of percutaneous mechanical support include its rapid and straightforward placement. Disadvantages include its limited cardiac output and bleeding. Future technology should focus on a device that is capable of providing significant cardiac output and that can be easily placed, like the Impella. Such a device could alter the natural history of intractable cardiogenic shock.
University of Miami Hospital sends team to Panama to save NCIS agent's life (miamiherald.com)
The SOAP-II trial: First-line vasopressor for shock management [Classics Series] (2minutemedicine.com)
Abiomed (ABMD) Impella Approved for Reimbursement in the Netherlands (streetinsider.com)
Thoratec Announces Presentations At Upcoming Investor Conferences (sys-con.com)
Abiomed gets reimbursement for Impella heart pump (bizjournals.com)
Other related articles published on this Open Access Online Scientific Journal include the following:
Implantable Synchronized Cardiac Assist Device Designed for Heart Remodeling: Abiomed's Symphony
Aviva Lev-Ari, PhD, RN, 7/11/2012
https://pharmaceuticalintelligence.com/2012/07/11/implantable-synchronized-cardiac-assist-device-designed-for-heart-remodeling-abiomeds-symphony/
Biomaterials Technology: Models of Tissue Engineering for Reperfusion and Implantable Devices for Revascularization
Larry H Bernstein, MD, FCAP and Aviva Lev-Ari, PhD, RN
https://pharmaceuticalintelligence.com/5_04_2013/bernstein_lev-ari/Bioengineering_of_Vascular_and_Tissue_Models
Foreseen changes in Guideline of Treatment of Cardiogenic Shock with Intra-aortic Balloon counterPulsation (IABP)
https://pharmaceuticalintelligence.com/2012/08/27/foreseen-changes-in-guideline-of-treatment-of-cardiogenic-shock-with-intra-aortic-balloon-counterpulsation-iabp/
Evidence for Overturning the Guidelines in Cardiogenic Shock
Aviva Lev-Ari, PhD, RN, 9/3/2013
https://pharmaceuticalintelligence.com/2012/09/03/evidence-for-overturning-the-guidelines-in-cardiogenic-shock/
Clinical Indications for Use of Inhaled Nitric Oxide (iNO) in the Adult Patient Market: Clinical Outcomes after Use, Therapy Demand and Cost of Care
https://pharmaceuticalintelligence.com/2013/06/03/clinical-indications-for-use-of-inhaled-nitric-oxide-ino-in-the-adult-patient-market-clinical-outcomes-after-use-therapy-demand-and-cost-of-care/
Reduction in Inappropriate Therapy and Mortality through ICD Programming
Aviral Vatsa PhD MBBS, 1/4/2013
https://pharmaceuticalintelligence.com/2013/01/04/reduction-in-inappropriate-therapy-and-mortality-through-icd-programming/
English: Ventricular assist device (Photo credit: Wikipedia)
English: Simulation of a wave pump human ventricular assist device (Photo credit: Wikipedia)
myocardial infarction – Myokardinfarkt – scheme (Photo credit: Wikipedia)
English: Graphic presentation of an LVAD, left ventricular assist device. (Photo credit: Wikipedia)
Posted in Cardiac & Vascular Repair Tools Subsegment, Cardiac and Cardiovascular Surgical Procedures, Cardiovascular Pharmacogenomics, Chemical Biology and its relations to Metabolic Disease, Coagulation Therapy and Internal Bleeding, Electrophysiology, Medical Devices R&D and Inventions, Medical Devices R&D Investment, Origins of Cardiovascular Disease, Pharmacotherapy of Cardiovascular Disease, Technology Transfer: Biotech and Pharmaceutical | Tagged Cardiogenic Shock, Cardiovascular Disorders, Columbia University Medical Center, Conditions and Diseases, Electrocardiography, Heart disease, myocardial infarction, Thoratec, United States, Ventricular assist device | 8 Comments
on June 30, 2013 at 10:03 AM | Reply Heart transplantation research in the next decade–a goal to achieving evidence-based outcomes | Pharmaceutical Intelligence
[…] Device (VAD): A Recommended Approach to the Treatment of Intractable Cardiogenic Shock (larryhbern) https://pharmaceuticalintelligence.com/2013/06/18/a-recommended-approach-to-the-treatmnt-of-intractab… Trans-apical Transcatheter Aortic Valve Replacement in a Patient with Severe and Complex Left Main […]
on June 30, 2013 at 10:50 AM | Reply Advanced heart failure | Pharmaceutical Intelligence
on June 30, 2013 at 11:40 AM | Reply Vasoplegia in orthotopic heart transplants | Pharmaceutical Intelligence
on July 8, 2013 at 8:33 PM | Reply Becoming a Cardiothoracic Surgeon: An Emerging Profile in the Surgery Theater and through Scientific Publications | Pharmaceutical Intelligence
[…] 4.1.6 Ventricular Assist Device (VAD): Recommended Approach to the Treatment of Intractable Cardiogentic… […]
on July 17, 2013 at 12:18 PM | Reply Treatment Options for Left Ventricular Failure – Temporary Circulatory Support: Intra-aortic balloon pump (IABP) – Impella Recover LD/LP 5.0 and 2.5, Pump Catheters (Non-surgical) vs Bridge Therapy: Percutaneous Left Ventricular Assist Devices
[…] A recommended approach to the treatmnt of intractable cardiogenic shock (pharmaceuticalintelligence.com) […]
on April 17, 2014 at 9:53 AM | Reply MedTech & Medical Devices for Cardiovascular Repair – Curation by Aviva Lev-Ari, PhD, RN | Pharmaceutical Intelligence
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2012pharmaceutical
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David Orchard-Webb, PhD
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Demet Sag, Ph.D., CRA, GCP
Dror Nir
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Gail S Thornton
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Ed Kislauskis
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marzankhan
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pkandala
Rosalind Codrington, PhD
ritusaxena
Rick Mandahl
sjwilliamspa
stuartlpbi
Dr. Sudipta Saha
tildabarliya
zraviv06


text:
https://vardmarine.com/wp-content/uploads/2018/11/banner-about.jpg https://vardmarine.com/wp-content/uploads/2018/11/banner-about-mobile.jpg
Vard MarineAboutMaritime Tales
Maritime Tales: A Company History Series | Episode 12
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)Jones Act Oil/Chemical Tanker "American Phoenix"In 2005, American Heavy Lift (AHL) awarded Aker Yards... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)ACV "LARUS" in FinlandLAMP-H design proposalIt was 1991, and after completing the two U.S.... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)In the late 1990s, the company (at the time Kvaerner Masa Marine Inc.) worked... Read More
Maritime Tales: A Company History Series | Episode 9
Original "Fremantle" classBDSA/KMM RPB DesignWords by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)We had been actively trying to expand our OPV vessel... Read More
Platform Supply Vessel - Pionero VARD 2 270 class for SeacorWords by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)In 2002, Bender Shipbuilding... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020) In the spring of 2002, the company was awarded a contract by Exxon... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020) The High Speed Monohull (HSM) Focused Technology Development Project was one of the... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)In 2001, we partnered with Marinette Marine to develop a new concept for the... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)In 1995, the company was awarded a contract by the Advanced Research Projects Agency... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)In 1990, soon after joining Wartsila Marine, I was assigned the position as project... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020) One of the decisions that had the greatest impact through the life of... Read More
Words by Dave McMillan, former CEO of Vard Marine Inc. (1989-2020)I started with Wartsila Marine Inc. (now Vard Marine Inc.) in September 1989 as... Read More

redpajama_set_name: RedPajamaCommonCrawl


text:
'''tests for score schema'''
import pytest
from marshmallow import ValidationError
from tenable.ad.score.schema import ScoreSchema

schema = ScoreSchema()

@pytest.fixture
def score_schema_directory_id_list():
    return {
        'profileId': '1',
        'directoryIds': [3, 4]
    }

def test_score_schema_directory_id_list(score_schema_directory_id_list):
    test_response = [{
        'directoryId': 3,
        'score': 100
    }, {
        'directoryId': 4,
        'score': None
    }]

    req = schema.load(score_schema_directory_id_list)
    assert test_response[0]['directoryId'] in req['directory_ids']
    assert test_response[0]['score'] == 100
    assert test_response[1]['score'] is None
    with pytest.raises(ValidationError):
        score_schema_directory_id_list['new_val'] = 'something'
        schema.load(score_schema_directory_id_list)

@pytest.fixture
def score_schema_directory_id_single():
    return {
        'directoryIds': '3',
        'checkerIds': '1',
        'reasonIds': '1'
    }

def test_score_schema_directory_id_single(score_schema_directory_id_single):
    test_response = [{
        'directoryId': 3,
        'score': None
    }]
    assert isinstance(test_response, list)
    req = schema.dump(schema.load(score_schema_directory_id_single))
    assert str(test_response[0]['directoryId']) == req['directoryIds']
    assert test_response[0]['score'] is None
    with pytest.raises(ValidationError):
        score_schema_directory_id_single['new_val'] = 'something'
        schema.load(score_schema_directory_id_single)

def test_score_schema_validation_error(score_schema_directory_id_single):
    '''
    test to raise the exception when directory_ids doesn't match with
    expected type
       '''
    with pytest.raises(ValidationError):
        score_schema_directory_id_single['directoryIds'] = True
        schema.load(score_schema_directory_id_single)

redpajama_set_name: RedPajamaGithub


The Ukrainian sappers reported on mine clearing on August 16th.
The Ukrainian State Emergency Service reported that rescuers worked on the territory of Donetsk region near Mariupol, Bakhmut, Volnovakha, Yasinovataya and Sloviansk. They could examine 6,54 hectares of dangerous territories per day.
As a result 72 explosive objects were revealed and successfully neutralized. In total: 31 missiles, 19 hand-grenades and 5 mines, 17 explosive objects of unspecified origin. All dangerous items were destroyed.
We should note that, despite efforts of the Ukrainian State Emergency Service on detection and neutralization of mines and ammunition in Donbass there is still a huge number of dangerous items. Not only experts, but also news demonstrates to cases of blasting civilians. So in the village near Bakhmut city the driver of the tractor (age 62) got explosive trauma. He worked in the field when the car ran into a mine. The equipment was destroyed and the driver was hospitalized to local hospital.
Other incident happened in the uncontrollable territory near Seversky Donets river. The man (age 60)went to the river, most likely for fishing and there was a trip wire. With a fragmental injury of the right hand and the right part of a trunk he was taken to hospital No. 8 in Luhansk.
Both cases happened in places theoretically free of mines or trip wires. Therefore they visually show the real of mine threat for civilians of Donbass.
We should remind that since August 14thsappers from the international organization HALO Trust have joined mine clearing activities. They have got official permission to inspection and mine clearing of territories from Ministry of Defence of Ukraine. Their activity is financed by sponsors from Great Britain and the USA.


text:
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LOS ANGELES PHILHARMONIC OFFERS FOOD-LOVERS A TASTE OF THE BOWL – LITERALLY!
The Hollywood Bowl and picnics are as intertwined as baseball and hot dogs. Now, the world-renowned venue that has brought Music Under the Stars to fans for more than 80 years, is giving people across the nation a taste of the glamour and laid-back luxury of the Bowl with The Hollywood Bowl Cookbook: Picnics Under the Stars. Even better than its recipes, proceeds from the cookbook benefit the Los Angeles Philharmonic Association's Music Matters, a fund for children's music education.
Compiled by the Los Angeles Philharmonic Affiliates, The Hollywood Bowl Cookbook is filled with more than 150 recipes in eight different picnic-friendly categories: Appetizers; Soups, Breads, and Sandwiches; Side Salads; Entree Salads; Entrees; Side Dishes and Quiches; Desserts; …and More. "And More" includes specially submitted recipes from Los Angeles Philharmonic Music Director, Esa-Pekka Salonen and Hollywood Bowl Orchestra Principal Conductor John Mauceri, as well as music legend, Peggy Lee, to name a few.
The Hollywood Bowl Cookbook does more than offer its readers recipes, however. Bowl cookbook owners also take away a historically relevant keepsake with pages of fascinating bits of Hollywood Bowl history, including photos from the venue's past (hardback cover) and copies of original Hollywood Bowl program covers (chapter dividers).
The Hollywood Bowl Cookbook: Picnic Under the Stars is $19.95 and will be available after May 15, 2002 at the Hollywood Bowl Store, and online at laphil.com and hollywoodbowl.com. Advance orders (online only until May 15, 2002) are being accepted for a reduced price of $17.95. Proceeds from The Hollywood Bowl Cookbook will be used for Music Matters and the other community-based music education projects the Los Angeles Philharmonic and its Affiliates support.
The LOS ANGELES PHILHARMONIC AFFILIATES group is comprised of approximately 1,000 volunteers in 14 independent committees throughout Southern California. It constitutes one of the largest and most active major symphony orchestra support groups in the country. The Affiliates' purpose is to support the Los Angeles Philharmonic in all its activities through the promotion of volunteerism, fundraising, ticket sales, and youth music education programs.
Elizabeth Hinckley, 323/850-2047; Melanie Gravdal, 323/850-2021
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Stories for December 2008
Tuesday, December 30th 2008 - 20:00 UTC
Petrol price reached three-year low in United Kingdom
The price of petrol has reached a three-year low in the United Kingdom, according to the Automobile Association and reported in the London press. The average cost of petrol at the beginning of this week was 87.79p a litre compared with 88.27p at the end of December 2005.
Brazil openly admits trade surplus benefits from Mercosur
The lack of mechanisms to correct asymmetries and finance infrastructure projects are the biggest hurdles for Mercosur and Latinamerican integration, according to the Brazilian presidency main foreign policy advisor Marco Aurelio Garcia.
Paraguay GDP grows 5.8% in 2008; record per capita income
The Paraguayan GDP expanded 5.8% in 2008 with a good performance in almost all sectors and a record per capita income, according to preliminary figures from the Central Bank released this week.
Monday, December 29th 2008 - 20:00 UTC
Foreign tourists' arrivals in Spain fall 11.6% in Nov.
Arrivals of foreign tourists to Spain, the world's second biggest tourist destination, plummeted in November as top customers Britons and Germans stayed at home during the global economic slowdown.
EU Court rules airlines must compensate for technical problems
Airlines must pay compensation to passengers whose flights are cancelled because of technical problems with the plane, European judges ruled this week.
The only exception, said the European Court of Justice, is if the technical problems are caused by "extraordinary" events outside the normal activities of the airline - such as terrorism or sabotage or a hidden manufacturing fault which suddenly comes to light.
Coal mining venture threatens Chilean Patagonia Island
A coal mining venture being considered for Chile's Region X Isla Guafo, off the southwest coast of Chiloé, is raising alarm bells among area scientists, indigenous groups and local fishermen who fear the endeavour could cause irreparable harm to the uninhabited island's diverse and abundant wildlife.
Warning of fake Colgate toothpaste in UK main chain stores
Thousands of tubes of fake Colgate toothpaste have been recalled by Britain's main chain stores Sainsbury's and Boots. Both stores have contacted customers directly and put up notices in shops concerning the counterfeit product sold between 28 November and 5 December.
Damien Hirst Mexico vacation with SAS bodyguards
Damien Hirst, the British artist with a personal fortune estimated in excess of 300 million US dollars has hired four personal bodyguards who are all former members of the SAS, British special forces.
Copper keeps sliding, reaches a four year low at 1.27 USD lb
The price of copper, Chile's biggest export, may not rebound past 2 US dollars per pound after the international credit crisis hammered speculators, according to Santiago Gonzalez, Chile's Mining minister. Copper reached last week a four year low.
Origin of Species controversy on Darwin's bicentennial
As the scientific world prepares to mark Charles Darwin's bicentenary, the author of On the Origin of Species is facing accusations of plagiarism and unjustly claiming credit as the father of evolutionary theory.


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Shelagh Fogarty 1pm - 4pm
Clive Bull
Shelagh Fogarty is Leading Britain's Conversation.
Listen Shelagh Fogarty
Alistair Carmichael Thinks It Is 'Credible' That Jo Swinson Could Become PM
The Chief Whip of the Liberal Democrats says the party are not "predicting anything" but that they are "looking seriously" at the idea of Jo Swinson at 10 Downing Street.
He said: "We are having to look seriously at what our position would be in that eventuality."
Carmichael told LBC presenter Clive Bull: "In the event of there being a Liberal Democrat majority, then we would revoke Article 50."
Alistair Carmichael says it's credible that Jo Swinson could be PM. Picture: pa
If there was not a majority, he explained that a People's Vote would be a possibility.
He also teased that he cannot name any further defections to the party but that Clive shouldn't leave his phone off for "too long."
Best of LBC
See more Best of LBC
Nick Ferrari's must-watch interview with Lib Dem peer who compared Brexit to 1930s Germany
LBC's Top 10 of the decade: 1. Diane Abbott's agonising interview
LBC's Top 10 of the decade: 2. James O'Brien v Nigel Farage
Download LBC Podcasts
How to Listen to LBC: FM, Digital Radio, TV, Online, Mobile
Data watchdog slammed for lack of action against Google on UK's 'largest ever data breach'


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The Mt. Rushmore of Law & Order Characters
I love ranking things (I have an entire site dedicated to it), but the Rushmore model is so intuitive to grasp. Four names only, so there are no sentimental choices. There aren't enough spots to pay homage: you need titans, and titans only.
To explain (for my international and North Carolina readers): in South Dakota, there is a giant freaking rock called Mt. Rushmore. In case you have already forgotten the picture at the beginning, here is another look:
You will perhaps notice there are "faces" carved into the rock. Those faces are of America's greatest presidents: George Washington, Thomas Jefferson, Teddy Roosevelt, Abraham Lincoln.
(Why Teddy Roosevelt and not James "the Incredible" Polk? That's a long story, which we'll get into another time, but for now, let's say this: only one president has ever had a bear named after him. That's right. The Teddy Bear comes from Roosevelt. And no, I don't consider Tummi Gummi to have been named after Taft.)
Anyway: when you have a "Mt. Rushmore" debate, what you're asking is, "If they were to carve the Mt. Rushmore of _________, who should be on it?"
Simple, right? Four names. Four faces. That's it.
Over New Year's my brother and Carlos visited me, and we spent approximately 485 hours arguing every Mt. Rushmore you could think of. Some day I may share those, but this morning I felt moved to act when R.K. Milholland (my favorite web cartoonist ) Started Twittering about how Law And Order has returned to its former glory days. This may or may not be true, but it caused me to reply as to who the best ADA was, which caused Milholland to write me back. (This is how Twitter works. You can actually write big-shots like a universe-famous web-cartoonist, and sometimes they write back.)
Bottom Line: My brain shifted into "If they made the Mt. Rushmore of Law Order...." and I knew I had something. A quick inventory of the more than 25 principle characters of Law & Order reveals 3 absolute locks, which leaves 5 or 6 possible choices for the fourth slot. Below are my picks, along with a brief explanation of why some didn't make it.
THOSE WE DON'T TAKE FOR GRANITE (Get it: granite/granted? Fine: don't laugh.)
Detective Mike Logan (Chris Noth) - The backbone of the show for so many years. Didn't make it because his C.I. work sullied Logan's legacy, Noth's association with SATC, and I never liked that plaid tie.
Lt. Anita Van Buren (S. Epatha Merkerson) - I've seen Merkerson in other things, and the girl can act, but she rarely gets the chance to say more than one or two lines, and they are usually boring.
DetectiveEd Green (Jesse L. Martin) - Even if we were going to overlook his participation in RENT, Martin never got enough to do as Green. I suspect Ed Green could have anchored the show, though.
Assistant District Attorney Claire Kincaid (Jill Hennessy) - Loved the never-acknowledged romance between Claire and Jack; cannot forgive her for waiting until Crossing Jordan to grow hair out and become Smoking hot.
A.D.A. Paul Robinette (Richard Brooks) - LOVE this character, one of the best things about old episodes. Just not on long enough.
Executive A.D.A. Ben Stone (Michael Moriarty) - It absolutely breaks my heart to leave Ben Stone off the L&O Rushmore. I loved his determination and doggedness but cluelessness about office politics. Exactly what you'd want in a D.A. Stone was there in the ground-breaking days, when they lost as much as they won, and tackled tough issues honestly without the need for the "Don't miss the last five minutes!!!!! twist-gimmick that became such a staple of this decade. (Not that I'm bitter.) On a personal note, I think Moriarty is one of the most underrated actors of all time. Were it not for the fact that he is quite possibly insane, I think he would be considered a lion of TV history. I have been working on a TV show idea for years with the understanding that no matter what, Moriarty is the only person I'd ever want to play the main character.
Special Shout Out - Dr. Emil Skoda (J.K. Simmons) - He wasn't on the show enough to be considered, but I cannot think of another psychiatrist I have enjoyed seeing more on television. What a refreshing changed to have a no-B.S. shrink.
[SIDE NOTE: I know that not everyone will have the same four characters I do. That's okay; you can't have all thought it through and have as good a judgment. But can we all, right here, right now, have a bond? Can we all agree that Serena Southerlyn was far-and-away the worst character ever? Thank you.]
THE MOUNT RUSHMORE OF LAW & ORDER
Detective Lennie Briscoe (Jerry Orbach) - As no-brainer as it gets. Lennie had toughness, charm, class (but not too much) and a world-weary attitude we all loved. Plus, he single-handedly revived the funny-line to end the opening. Nobody ever did it better. Admit it: if Lennie Briscoe told you something, you'd believe him. (And he was freakin' Lumiere!)
District Attorney Adam Schiff (Steven Hill) - My favorite character in all of Law & Order. I haven't enjoyed a cynical curmudgeon this much since Statler and Waldorf. Schiff had the comic timing of a god, and he never over-played his part. He rarely got much red meat (except for the incredible episode where his wife was on life-support), but he always added gravitas, humor, and heart to any scene he was in. Absolutely love him.
Executive District Attorney Jack McCoy (Sam Watterson) - I will freely admit that my questionably heterosexual love affair with Ben Stone made me discount McCoy for a few seasons, but he eventually won me over by carving out a unique character. It says a lot about a character that we could follow for so many seasons and yet not always root for! Jack was like that: you trusted him one moment, was appalled the next. He always seemed to go right to the edge, and maybe even peeked over, but usually, his conscience would real him in. This new role for him (as D.A.) has brought even more depth to the character. We're not on our 14th season of Jack McCoy and still going strong.
A.D.A. Jamie Ross (Carey Lowell) - This fourth spot on the Mt. Rushmore of Law & Order was a tough call, but I made it and I expect you to fall in line. Jamie was toŭgh as nails without coming off strident (cough cough Abbie Carmichael cough cough), and was sensitive without appearing maudlin. She was sexy as hell without ever flaunting it, and she related so well to anyone. Close your eyes and think of every A.D.A. right now. Did any of them get along better with the cops than Jamie? And also get along with the bosses? No, they didn't. While I love the energy of the early years, it was in the Jamie Ross era that Law & Order had its best run. Maybe that was partially the writing, but I think a fair amount of praise should go to a character that pulled things together without even trying.
It's official. I now have it in my blood, so expect to see more Mt. Rushmore columns. If you have an idea for one please email me. And if for some reason you think I have overlooked anyone in the Law & Order universe (maybe you have a thing for Russian hats), by all means, leave a comment and explain why I'm wrong. If you convince me I'll write a separate column trumpeting your Awesomeness.
From the Mountaintop,
(106 days B.H.E.)
[If you would like to see more lists Hyperion created check out RANK EVERYTHING]
Remember when it seemed to matter so much? sniff sniff
Koz said...
Never seen it, not joking.
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Students grab manufacturing knowledge with pneumatic mechanical arms!
Give students a glimpse into a real-world manufacturing career by teaching them about the mechanical, electrical, and computer systems used in robotic arms – one of the most common types of robots in the industry. Students will build 6 mechanical arms, grabbers, and exoskeletons found on robotic machines, perform experiments using pneumatic force to operate them, and observe their results like real mechanical engineers! Kit includes 204 pieces and a full-color, 36-page manual. See complete contents list below. Grades 2 and up.
5-Hole Cross Rod, 1 ea.


Join us in a pick-up game of soccer. We play at least once a week and everyone is welcome. You can be good or bad, male or female, old or young. Our goal is to enjoy each other and to enjoy God through the gift of this beautiful game.


Haines is a community just 15 miles south of Skagway. Within arm's reach is a coastal rain forest, glacial carved peaks, and a pristine marine environment. This is one of several companies that we found personable, knowledgeable, and anxious to introduce you to the assets of this area.
Your tour begins with a high-speed Fast Ferry ride along the steep-walled fjords connecting Skagway to Haines. Once in Haines, your round trip hike offers you tremendous views of the Chilkoot and Taiya Inlets with the Coastal Range as your backdrop. Your guide will choose hiking distance and pace based upon the group's fitness and ability levels.
Learn about the ecology of the temperate rain forest and the cultural uses of plants as you stroll beneath towering centuries-old trees. Tour highlights include a picnic lunch on a black pebble beach (well known for marine mammal viewing), traversing wildflower meadows, and exploring tidal pools. Water fowl, shorebirds, forest dwelling birds, and other species are commonly seen in this area.
Your hike concludes with an interpretive drive through Historic Fort Seward.
6.15 hrs - The departure time will be determined by ShoreTrips. Times vary due to ferry schedule.
• Wear layered clothing with a waterproof shell, and good hiking shoes or boots with traction soles.
• The price of the tour includes round trip transfer by Fast Ferry, lunch (chicken Caesar wrap, whole grain chips, fresh fruit, a cookie, and bottled water or juice pack), and use of a belt pack and walking stick, if needed.
• There is a minimum of 4 people required for this tour.
• Participants must be at least 7 years old, in good health, and able to easily walk over uneven terrain. All hikers must be able to easily walk over uneven ground for 4 miles and be on their feet for 3 to 4 hours.


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Ohio State Scientists Uncover New COVID-19 Variant In Columbus
By: Nick Evans | WOSU
Posted on: Wednesday, January 13, 2021
COLUMBUS, Ohio (WOSU) — Ohio State Wexner Medical Center doctors have identified new strains of COVID-19 in Ohio, one with a mutation identical to the virus spreading rapidly through the United Kingdom.
A pharmacist labels syringes in a clean room where doses of COVID-19 vaccines will be handled, Wednesday, Dec. 9, 2020, at Mount Sinai Queens hospital in New York. [AP Photo | Mark Lennihan]
The virus mutation that mirrors the U.K. variant has been found in just one person in Columbus, but researchers believe it developed independently from a virus already present in the United States. In addition, the team says they've found a different variant with a handful of mutations that has become the dominant virus in the Columbus area since late December.
Peter Mohler, who co-authored the study and serves as Ohio State's chief scientific officer, warns against over-reaction. In a press release, he said scientists are still working to "understand the impact of mutations on transmission of the virus, the prevalence of the strain in the population and whether it has a more significant impact on human health."
Mohler also says there is no indication either strain is resistant to current vaccines. He explains the the mutations change a handful of amino acids in a virus protein made up of 1,300. But the vaccine is built to interact with the entire thing.
"Think of it almost like Velcro, right?" Mohler says. "So if you had a whole bunch of different pieces of Velcro and it's sticking together, if you take one or two of those off, certainly it's going to weaken the Velcro, but the Velcro is still likely going to work."
Researchers say the discovery of the new variant in Columbus underscores how commonly viruses mutate and suggests similar changes could be happening independently around the world.
Ohio State has been sequencing virus samples since March of 2020 to track changes over time. Dr. Dan Jones, vice chair of molecular pathology, says it's natural for viruses to mutate.
"The thing that's concerning us a little bit is that over the course of the last three weeks, we are finding the virus with the three additional mutations more commonly in patient samples, and that suggests it may be able to spread or be more transmissible," Jones says.
ColumbusCoronavirusCOVID-19Ohio
DeWine's Conflicting COVID Results Bring Attention To Tests In Ohio Athens County Confirms 22 New COVID-19 Cases For January 10 Athens County Confirms 45 New COVID-19 Cases For January 8 Republican Lawmaker Pushes Bill To Cancel COVID State of Emergency


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Will Power, or Reducing (Fat) Shakespeare
Posted on October 1, 2019 by Elena Levy-Navarro
Shakespeare Funerary Monument. Trinity Church, Stratford. Cropped from Sicinius [CC BY-SA 4.0] via Wikimedia Commons
Consider the photograph here of the half-length statue of Shakespeare on his funerary memorial in Trinity Church, Stratford, with the image of Shakespeare in popular culture, and especially Shakespeare as a young artist and lover in the 1998 blockbuster Shakespeare in Love. Consider how unrecognizable the Shakespeare in the monument is, as Shakespeare, because Shakespeare is assumed to be youthful and thin. Nineteenth-century responses to the monument help us trace the development of a particularly toxic modern understanding of the fat and thin body, in which the fat body is seen as slow, slow-witted, and eventually prematurely aged, and the thin body is seen as vibrant, quick-witted, and young. As Shakespeare cannot be imagined as "fat,", so too a fat person today must labor under the pervasive reading of her body as a sign of her slow-wit and de-formed character.
Only two "portraits" can be said to have any claim to represent Shakespeare – the Droeshout etching on the title page of the First Folio and the half-length statue on his memorial in Trinity Church, Straftord. Erected in 1616, the funerary monument was commissioned by his son-in-law and fashioned by Dutch tomb-maker, Gerard Janssen. Recent scholars accept the sculpture as authoritative, even as they acknowledge that its purpose is not to give an accurate representation of Shakespeare as he was in life but to commemorate the dead. However, in the nineteenth century, this sculpture began to trouble Shakespeareans as it began to be read through the emerging negative understanding of fat. Because associations of the fat body came to be seen as inimical to the poetic genius and sensitivity of a Shakespeare, Shakespeareans began to develop techniques to rescue "Shakespeare" from any charge that he was fat.
In what follows, I offer a few snapshots of nineteenth-century responses to the funerary monument half-length sculpture. (Elsewhere, I have told a very similar story concerning Shakespeare's tragic hero Hamlet. In the last decades of the nineteenth century, a fat Hamlet is identified and diagnosed, but just as quickly, he is reduced to a thin figure seen as more felicitous and proper for a tragic hero.)
Snapshot One – Retiring Fat Shakespeare
Our first snapshot is James Boaden's 1824 An Inquiry into the Authenticity of Various Pictures and Prints, which from the Decease of the Poet to our Own have been offered to the public as portraits, the first published commentary I have found that troubles over the fatness of the monument. Boaden assumes that the "great and admirable poet" must have a body that is thin – or at least, not fat (3). He understands the monument, then, as offering an "authentic" portrait of Shakespeare, but not the Shakespeare associated with his poetic output. In fact, introducing an understanding of the fat body recognizable today, the monument is seen as offering a "fat Shakespeare" relegated to old(er) age and retirement. The youthful Shakespeare is "thin and sharp," but in "retirement he had gotten in to flesh" (32). The fat Shakespeare offers a cheerful expression, where fat is associated with too much "conviviality"; but it is also seen as a condition that is distanced from his productive years (32). Boaden begins to conceptualize the fat and thin (Shakespearean) body in terms of a before and after, where the fat body is seen as the body that weighs down the true self. Thus, he introduces a technique of reading the monument, as authentic and yet not as representative of Shakespeare, the genius.
Snapshot Two – Reducing Shakespeare
Under such a technique, the monument must be reduced for the true Shakespeare to appear. Just 22 years later, James Friswell in Life Portraits of Shakespeare (1864) further develops this method of reading by which the fatness of the monument is reduced and the true Shakespeare uncovered. He is even more horrified by the monument insofar as it is "round," and he begins to rescue Shakespeare from any association with fat (even in his retirement) by suggesting that the sculpture was the work of a crude artist:
"The skull of the figure, rudely cut, and heavy, without any feeling, is a mere block; a phrenologist would be puzzled at its smoothness and roundness. It has no individuality or power in it than a boy's marble. The cheeks are fat and sensual, the neck just rounded out of stone. . ." (11).
Importantly, the 1849 "discovery" of the Shakespeare death-mask in Kesselstadt, Germany, provided a means by which to understand the monument as having wrongly de-formed Shakespeare's thin, elegant lines. The mask served the purpose of becoming Shakepeare's "before" – his true form, which was only crudely captured by the funerary monument. Friswell contrasted the gaunt face of the original to the fat one of the tomb-makers's rendition.
"The cast differs very widely from the bust said to have been cut from it. The nose is utterly unlike; in the cast it is a fine, thin, aquiline nose. . . . The face is a sharp oval, that of the bust is a blunt one; the chin is narrow and pointed, that of the bust rounded and rather square, and full of force; the cheeks are thin and drawn in, those of the bust full, fat, and almost coarse." (18)
Friswell offers the same technique of reading of a "before" and "after" by which the reader comes to see that Shakespeare is not, in fact, fat. He states that "the features alter extremely after death in most persons; and although Shakespeare is said to have died after a very short illness, he may have lost much flesh. The 'tombe-maker,' wishing to exhibit him ad vivum, would alter this" (26). The reader learns to read beneath the de-formity of the fat to the true thin Shakespeare much as the dieter is encouraged to see her true self as the thin self she once was.
Snapshot Three – Universalizing Thin Shakespeare
Now, to snapshot three – John S. Hart's "The Shakespeare Death Mask," published just ten years after Friswell's Life Paintings. Hart drew on phrenology to analyze the death mask and other portraits in order to reduce Shakespeare to his essential character. He read the size and shape of the forehead and cheeks as almost inversely proportionate. Insofar as the one was large, the other was small in comparison. Such a reading led Hart to dismissing the monument as inappropriately representing the cheeks as fat, thereby wrongly representing Shakespeare as having an "earthbound" character, "not overburdened with sense or intellect" (313).
According to Hart's reading, the sculptor de-formed the face by introducing fat to it. Further developing the story from Friswell, Hart writes,
"Gerhard Johnson [the sculptor] in undertaking to supply the supposed falling off of the flesh, simply over-did the matter, and gave us a rollicking, jolly Englishman, instead of the thoughtful author of 'Hamlet'" (309).
By adding the fat to the face, Hart sees Johnson identifying with a particular common English identity. In order to find the true Shakespeare, the reader must learn to reduce the form of the face (and increase the size of the forehead: "Underlying this superabundant fullness of flesh, however, the eye can easily trace all the essential lines of grace and thought to be seen in the mask" (309).
Fat studies help us consider the emergence of a modern toxic understanding of the (fat) body. It also helps us see how the privileging of the thin body requires first the pathologization of the fat body and finally its erasure. Is it possible to imagine a fat Shakespeare? To ask this question is to ask fat studies to do more than objectively define the problem, but also to offer various forms of intervention. To do that, we need more than a snapshot, more than a monument: we need to represent the fat body in all its complex relational forms.
This entry was posted in Body Politics and tagged fatness, fatphobia, nineteenth century, Shakespeare. Bookmark the permalink.
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Elena Levy-Navarro
levye@uww.edu
Elena Levy-Navarro, Professor of English at University of Wisconsin—Whitewater, is author of The Culture of Obesity in Early and Late Modernity: Shakespeare, Jonson, Middleton, and Skelton (Palgrave Macmillan, 2008) and editor of the essay collection Historicizing Fat in Anglo-American Culture (Ohio State University Press, 2010). Her current work in progress explores how nineteenth-century conceptions of fat and thin bodies influence their understanding of the early modern period.
» More articles by Elena Levy-Navarro


The transfer window is closed but managers are working hard on their plans for the summer so we'll bring you all the latest gossip from around the globe. Today, Man Utd are ready to bid for Ryan Sessegnon….
Manchester United are ready to steal a march on Liverpool and Tottenham by launching a £40m bid to sign Fulham starlet Ryan Sessegnon this summer, according to the Sun via TeamTalk.
Sessegnon has been with Fulham since joining the club as a youngster and he progressed through the youth ranks to emerge as one of the most exciting young talents in European football.
The 17-year-old broke through as a left-back last year but has been playing further forward this season which has led to him providing 14 goals and 5 assists in 38 league games so far this campaign.
That stunning form has caught the attention of clubs in the Premier League with TeamTalk claiming that Liverpool, Spurs and Man Utd are all battling it out over his signature this summer.
Mauricio Pochettino could be eyeing Sessegnon as a replacement for Danny Rose while Jurgen Klopp is also being tipped to strengthen his options with Alberto Moreno's future in doubt.
However, it looks like United are ready to steal a march on their rivals as TeamTalk are citing a report from the Sun that claims Jose Mourinho is planning to test Fulham's resolve with a formal £40m offer.
Mourinho is expected to be in the market for a new left-back as Luke Shaw is set to leave following a bust-up with the United supremo and Sessegnon is being lined-up as a replacement.
The report says Shaw will be allowed to leave Old Trafford at the end of the season and Mourinho wants Sessegnon to spend a year learning from the likes of Ashley Young before taking over the first team shirt in 2019.
We'll have to wait and see how things develop over the coming months but Sessegnon is a huge talent so I think he would be an excellent signing if United manage to beat the likes of Liverpool and Spurs to his signature.


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I don't think I need to tell you, but Daniel Craig is an awesome example of having a good amount of size & definition. It seems like Craig really made a name for himself and his physique with his appearance as 007 in Casino Royale. Since that movie came out in 2006, and now with the release of Skyfall, everyone wants to know what Daniel Craig's workout looked like and how he built his James Bond body.
Not surprisingly, Craig's workout is pretty well put together and obviously effective.
"I gave up smoking and exercised 5 times a week. At weekends I ate and drank what I liked. The work out lasted only 45 minutes but we didn't stop. Circuits, lifting, working weights and lots of pull ups … I told my personal trainer, Simon Waterson, I've got to look like I could kill someone when I take my shirt off" – Said Craig.
Usually, when examining a celebrity's workout this is the part where I would advise you not to follow James Bond's workout routine and I'd tell you that there are much better ways of working out, but this one is actually pretty darn good.
Craig's workout began every week with a full body circuit routine routine. Circuits seem to come and go as far as popularity, but if done correctly they can be an awesome way to not just build muscle and shed fat but to also actually get in shape.
After hitting the circuit routine on Monday, the rest of the week was focused on building solid muscle until Friday where he repeated the circuit.
Then he took the weekend to do light cardio and recover from the week's grueling workouts.
Since this is a circuit, doing all of the exercises consecutively is considered 1 set. Do 15 reps for each exercise with as little rest between exercises as you can do.
After you've done 1 set rest for 3-4 minutes and repeat. Do a total of 3 sets.
Daniel Craig was able to quickly pack on some solid muscle mass for his role in Casino Royale and then take it to the next level in Skyfall mainly because he had an awesome trainer, solid diet and he was already in good shape before he even started working out for the role.
Similar to how Brad Pitt prepared for his roles in both Fight Club and in Troy, Craig added muscle to an already lean body — a (now mainstream) method of looking sharp during the "bulking" process.
The idea behind this is that your skin is used to a lean and smaller version of you. When you build muscle (whether using the this workout or not) your skin is tight because you've been smaller for a long time.
So if you are small or even downright skinny, your main priority should be to pack on dense muscle mass.
If you have a bit of fat to lose don't worry about looking too small if you diet down.
Once you are at a lower body fat percentage you will actually look a bit bigger. Having an increased amount of muscle definition works wonders and this is the perfect platform to build muscle on.
The diet that almost all of my fitness colleges and I use to shed fat is Eat Stop Eat. But the main goal is to simply find a diet that you can follow and still live a normal life without counting every calorie or needing to prepare 6 meals a day in advance.
A good approach adding muscle can be found in the Visual Impact Muscle Building workout routine. If you're already lean then I recommend you just staying on phase 1 and/or 2 until you've built all the muscle mass you want.
If you need to shed a few pounds of fat, do what I did and skip straight to phase 3 to get lean and toned and then move to phase 1 where you can build more muscle.
The author, Rusty Moore, goes into greater detail and some advanced methods on his website. To learn more about this workout program you can visit the official website here, or you can heckout my before and after photos to see what kind of results I was able to get from it.
Vesper Lynd: If the only thing left of you was your smile and your little finger, you'd still be more of a man than anyone I've ever known.
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How may reps should a person do for each station in the circut? Also, are there any alternatives to clean and press for someone who feels like he never has proper form? Finally, what kind of weight should a person be using? Should I be looking to hit failure towards the end or should I always have a few left in the tank? Thanks.
clean and press with dumbbells. Hope this was helpful.
I'm curious as to why he didn't do any flat bench chest workouts and all of them were inclined? I thought flat bench is the most beneficial for strength gains? Is it because working your upper chest makes ur chest look bigger?
Great article. A couple of questions.
1. How do you determine the weight to use?
2. How often do you increase the weight (weekly,etc) and usually by what percentage?
Thanks and looking forward to starting the routine!
1. For the first set try to hit around 70% of your 1 rep max, the second set 80% and anything left you've got on the last set. It's okay if you can't complete the last set.
2. Increase weight every 2-4 weeks by 5-10% depending on progress and needs. If you need to build more size increase the weight while decreasing the reps, if you are going to be cutting, change weight every 4 weeks while concentrating on negative or some other cutting method.
Thanks Aaron. Sorry for the delay in responding. I appreciate the info.
For what it is worth, I'm started into weight training after doing triathlon for about 4 years. Unfortunately, I developed some really bad arthritis and had to quite any type of activity for a number of years. However, after two months of working out, I have noticed a drop in fat…and an increase in muscle.
I am about to wrap up a workout routine and will hit yours beginning the second week in April. Really looking forward to it.
Again, many thanks and blessings to you.
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It's only meant to be done for 2-3 months out of the year but it works amazingly well!
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