text:
pb783 (North) v VigaBrand (South)
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Location: Coming out of the attic-- I've finally beaten Athena
This is the situation after my attack on Nashville.
So, what is that unit with two inside the city? The largest unit is a signal corp. What happens next is so typical of the real Union efforts in 1861 as to be comical. The generals outside Nashville decided they were to tired to assault the signal unit inside. A few days later Gen'l Johnston ("the good one") kicked my units back north of the Cumberland.
Late January 1862
I suppose my orders in Nashville should have instructed some of my units to enter the town at the end of combat! As a result, a single service unit, communications, held the town in the face of my two divisions.
On the next turn General Daniel Miles thought his men were too tired to assault this single unit. And a few days later General Albert S Johnson shows up with the Army of the Tennessee, fresh from fishing the Mississippi at Columbus, Ky., to demand what for of Miles.
Uggh!
Now the race is on to get to Gallatin, because of course, my two divisions fled to Clarksville, not Gallatin!
Lot's of money, no men. But I may be able to afford a $3K/ company draft in June if this continues. Lot's of rebuilding going on behind the lines.
And, the move of Johnston to Nashville opens Grant to possibly moving to Columbus, Ky. However, the underlying division is still pretty tired.
On the Mississippi, I beat up the Southern naval forces around Memphis. I've pulled more artillery up, his units are tired, this is not going to end well for him.
In East/Central Tennessee I'm making some small moves on Huntsville (so close to the vital city of Knoxville) and Livingstone.
Missouri, Kentucky, Nebraska and West Virginia will see the usual work to increase the Military Control starting shortly. I should have complete military control of Nebraska and Kansas to the line of forts by mid-summer. I should have good military lines in Missouri to Springfield by then too. I've developed a back woods means for supply to reach Madison, Ark.
I'll push the military control of some West Virginia regions so that I can, if I have the manpower, attack the east-west railroad from Knoxville to Richmond.
Also on the East, I'm gathering units anticipating there may be an opportunity to attack Manassas. I have three divisions and four leaders in the area. I'm guessing the units will need to be commanded by Little Mac for me to successfully gather the forces.
Facing them is the raging Cajun, Beauregard with a decent division, Huger and some tasty guns I'd like to own for myself.
I can probably get 2:1, but I'd prefer 3:1.
This may take some time, the units are ready, but I need several commanders to line-up at the same time, again, probably including Little Mac.
I'd also like to drop a trip wire unit into Loudon and Aquia in case there was an attempt to jump at the District, which would be relatively undefended.
It is the next turn, I've ordered five divisions in the East to attack Harper's Ferry, on the way, three of the divisions will pass through Loudon, Va., attacking Stonewall Jackson.
Further East, on the peninsula, it appears Rappahanock is empty, I've ordered Butler to take it. It will act as a distraction to the action near Harper's Ferry, if nothing else.
Middle Tennessee, is quiet. I'm gathering units for crossing the Cumberland and then attacking Forts Henry & Donelson from the east. I'm also gathering forces for an attack on Little Rock.
Hopefully, releasing the units from Kentucky will allow Grant to run free too.
Further west, the attach in Kansas has started. It will take a turn or two for it to develop, but it should be successful when it starts. There's a core of a division out there. A few units are on the hunt for Knoxville, but that will take a few turns to develop.
Late February 1862
It is late February 1862. The Union ordered two high risk attacks. The first was ordering 'The Beast' Gen. Butler to take Tappahannock. We've succeeded and there are no reports of any opposition. The Irish Legion led the charge up the peninsula.
You can see some of my underused generals working the rear of the Confederate lines here. While they don't report anything in Richmond and Fredericksburg I have other sources that tell me there are strong units in both cities.
This had to be a shock. Five Union divisions, four of them 'Legions', have routed Stonewall Jackson in Loudon, Va. and taken the Harper's Ferry from the South in a single movement.
The President himself is impressed and I understand he is looking at making some of the units Guard status.
Here is the report for the Day 12 attack on Harper's Ferry. On the Union Side there are three divisions, two of them Legions.
Here is my intelligence on Little Rock
There is no artillery, there may be some cavalry or light infantry. Two units, both seem to be outside the town. The raw total is 109 - 20%, or about 87.
Against them I can assault with 111, raw. Some of that is artillery. Plus I have 30 naval bombardment points.
One of the three brigs will need to patrol the upper Arkansas to discourage the use of riverine transport from Ft. Smith to reinforce Little Rock.
My supply unit, if I send it, will need to travel across the state from Madison. Even starting the unit moving prior to the attack, it will take two or three turns to reach Little Rock.
And reinforcements will need to trickle in. I can send three additional elements on the second turn, probably nearly doubling my attack force.
The snow and the amphibious assault are major drags on my combat. I don't want to get into a drawn-out combat for LR. I'll get my units ready and move the first turn the weather turns. In addition, I won't assault. I'll attack and direct the units into the town. Follow-up units can help police the situation if I can force a retreat. Yikes. Small but could be decisive for the Western theater.
Plan Two: Okay, we'll gather the forces for this, and wait for spring. I'll use the riverine transport to move the follow-on units to Perry, Ark., upriver from Little Rock. That will include a supply unit and some other units as well. An initial amphibious force will attempt to land in LR and move into the depot. But the main force will follow. Simpler and more in keeping with the spirit of the game I think.
Northern Newspapers are demanding another attack, this time to within two regions of Richmond. Is the Butler force in Tappanhannock already fulfilling the demand?
No. Tappahannock is specifically excluded from the list of regions that fulfill the requirement.
I'm thinking I'll need parts of two divisions. I'll put them in James City or the other region near Williamsburg and adjacent to Richmond.
Lincoln became nervous that Little Mac had stripped Washington to supply his Peninsula Campaign.
In history, Little Mac had double counted some units, sent others to the Shenandoah, and done other bookkeeping tricks. All this, and the failed Peninsula campaign may have led to his dismissal later.
However, I'll need to keep what amounts to two divisions adjacent to or in Washington for a few months. I have more than three divisions fulfilling the requirements.
The South could use this as a reason to attack Washington, or Harper's Ferry.
I'll be resetting the Washington defense this turn.
McCulloch and some light units have taken Arkansas Post from me. I don't feel threatened as there is about a division on the way. They should be able to clear the way for an attack by me on Little Rock prior to the June build.
This is a screen clip of the movie function. VigaBrand has formed a mixed unit of irregulars, including natives, Texas Rangers and others, in SouthWest Missouri. The units can't really take a town, but they can take a depot and destroy it. They can also rip up railroads. The most obvious target here is Lexington, MO. I'll estimate the strength of the unit at about 120-150 points. I'll strengthen Lexington with additional units, including some artillery and some cavalry. That should safeguard the city.
Push for Northern Offensive
Central Tennessee
No screen clips yet. Action is dying down across the map.
In the East Butler is likely to head an effort to forestall the 10NM loss by moving two divisions to one of the counties between the Union frontlines and either Spotsylvania or Richmond. I'm putting the units and the leaders together now. And I'm debating between Charles City, New Kent, both bordering on the James River and with good communications back to Willamsburg, but also fronting on Richmond. The two other choices are Hanover, a clear hex that shares the Pamunkey River with Richmond and a clear side with Spotsylvania, and 'Bowling Green', a county up on the Rappahannock that shares good communications with Tappahannock.
I'll need to make a decision in one turn. Time to gather intelligence.
Further West I'm about to take Huntsville, Tenn. This mountain hideaway is tucked between two impassible counties and very close to Knoxville and its railroad. A strong force here can threaten Knoxville and protect Kentucky from partisans.
General Price is still in Paducah. Indeed, I have done nothing about the issue since he boldly captured it and two regiments late last year.
His move spoiled what would have been a one turn take-over of the Blue Grass State by the Union.
Grant saw Johnston in Columbus and wisely decided to regroup on Island 10.
Now, however, with the Cumberland secured by fortifications, Grant, possibly in charge of the Army of the Tennessee, will be threatening Price.
Johnston, in Nashville, will be faced with a choice of whether to defend Nashville, Paducah or Memphis. I'm betting he decides to give up Paducah.
Lyons campaign to threaten Memphis has stalled. There is simply no troops capable of defending the West Bank of the Mississippi AND crossing the river to take Memphis.
Benjamin McCullough has taken a small force, about 360 points, and pushed out my militia in Arkansas Post. I have no idea where the unit has disappeared to. There was no battle. I guess it evaporated in the swamp.
That's nice, as I have brigs that slipped past Memphis and can now cut McCullough off from moving to save Little Rock.
The McCullough forces will also make it more interesting to attack LR. I had intended to bring about 300 points to bear on the city. But now they will need to march around McCullough to the Arkansas, with supplies, to reach LR.
In other words, there will be lots of warning of what I'm going to do.
I have a division sitting in Springfield, MO. Perhaps it can threaten Fayetteville and draw McCullough there first?
Any long distance moves like I'm considering will break the cohesion of my units. They can do it, but they'll need supplies and overwhelming force.
And they need to act fast.
The South will receive a major boost with the first partial mobilization in the game starting in about two turns.
I have been concerned with the implications of this for most of the year.
As a result, I've saved about $500K, so far, towards increasing the mid-year draft bonus to $3k/ company.
That would give me an additional 80 regiments of conscripts to use until I can meet the CSA mobilizations myself later this year. (House Rule)
So, what do I expect?
Most of the important moves will be made in the West. There are too many rules tying my hands at the moment in the East (Washington garrison and the attack on Richmond being the most important of these).
I cannot risk losing 10 NM, bringing me down to 70 NM.
In the West, I'm going to take Paducah probably within four turns.
With the river under my control again, I can match rail movements by the South.
I'll make a decision on whether to take Memphis, Little Rock or Nashville.
Ideally I'll take two of the three cities by July 1.
I've been planning the LR move for months. The issue has been units. They don't exist and are slow to get into position.
McCullough cannot cross the White River without support.
If he brings up ironclads I'll move up artillery to trap them-- I have a lot of artillery ready in this area.
If he withdraws I'll try to continue to move naval units into position to prevent him crossing the Arkansas River.
I'll also gather intelligence for an attack on Fayetteville. If it looks promising, I'll move. But without LR, Fayetteville is dangling fruit for the irregular units in the West.
April 1862; Intelligence and War
This AAR will bring the reader up to the very point in time that the game is at right now. If you've read the AAR you'll know VigaBrand objected to a gamey exploit. Although he actually objected to what I've done with the AAR, saying it wasn't necessary, I have published all the AAR's up to the current game turn.
I felt that would allow VigaBrand to see into my strategy and balance what I'd gained from putting leaders behind his lines.
The real life date is May 10, 2013, with the game operating at the date of April 1, 1862.
In the last days of March 1862 Confederate military police capture a group of slaves in the area of James City, Virginia.
The slaves have information leading the Confederate government to believe there is a vast Union spy ring operating just behind Confederate lines.
The Confederate government executes the slaves, then taking 500 Union prisoners of war to a hill, they call for a truce. On a dreary May morning Little Mac meets Gen'l Lee on neutral ground near Manassas. The prisoners will be executed if the General McClellan does not recall all Union spies operating inside the Confederacy Lee declares.
McClellan laughs.
"We'll just execute 1,000 Confederate POWs... " his voice trails off as his spy glass looks at the Union prisoners. The group includes ten Union generals captured in the last few days in a round-up of Union spies. The Union spy ring has been busted wide open. Along with the generals are their staffs. The cream of the Union army could be dead inside the next few minutes.
His voice shaking, McClellan agrees to the terms. The officers will be returned to Union lines over the next month.
Union efforts grind to a halt and McClellan is widely critisized in the press. Returning to Washington, he calls a friendly reporter.
Meanwhile, in the White House, President Lincoln worries about rumors that McClellan is demanding to be made 'dictator' of the Union. He fingers papers he has been working on. The catastrophe of intelligence will make the President reconsider a plan to free slaves in rebel territories, a plan he will not return to for months. What will the public think? What will the British and the French think?
In Richmond Confederate intelligence officers are ruthless with their prisoners. They break them quickly, learning of Union plans to invade Texas, New Orleans and Florida. A plan to take Little Rock causes them to redeploy units in Arkansas to protect the vital depot.
The Union plans are in disarray.
THE FIRST YEAR OF WAR
1861 saw the Union take all of Missouri, except a small port on the Mississippi called New Madrid. Attacks were made on Fayetteville. Kentucky was taken in a single turn, though Gen'l Price was able to push Gen'l Grant back into Island 10 and retake Paducah. In the East Gen'l Butler moved up the Virginia Peninsula, taking Hampton Roads, Williamsburg and Tappahannock.
A brilliant attack under Gen'l McDowell had sent Gen'l Jackson running for Manassas and recaptured Harper's Ferry from the Rebs.
The Union had had brushes with disaster too.
Gen'l Hamilton had to retreat from the Shenandoah Valley in a blizzard, nearly losing his entire command. At sea, poor planning had let the US Naval blockade run down, resulting in threats to the entire Eastern Seaboard.
Yet, the Union had endured the first year of war, correcting problems it encountered. It believed it was ready to take the war to the enemy in a more forceful manner.
In Washington, Gen'l McClellan and President Lincoln met at the White House with the War Cabinet. McClellan sneared at Lincoln. Clearly the Gen'l detested this tall, lanky rube.
"My armies will be in Richmond by July, sir," Little Mac told the Commander in Chief.
Through the door burst Gen'l James Veatch.
Veatch had been one of the leaders seized by rebels in their round-up of Union spies.
"No! General!" Veatch cried.
His body was bruised. Bones had been reset, and the battered dark eyes showed unnatural aging. McClellan, who had not seen his friend since sending him south of the lines at Alexandria several months ago nearly fell over seeing the sorry state of his friend. Veatch had clearly been tortured.
"The Rebs! They are much more powerful than we thought!"
A dark mood gathered as the cabinet listened to Veatch's story. It was going to be a long and violent summer. Alone, in a corner, Gen'l McClellan contemplates an exclusive he gave to a New York Herald reporter. McClellan predicted Union troops would be parading through Richmond by July 4th. Surely the Herald wouldn't demand a Northern Offensive?
EAST- Rebel units outnumber Union forces.
Richmond is garrisoned by a force of at least one corps sized unit with artillery.
A corps, with artillery, is well entrenched at Spotsylvania.
Gen'l Lee, with what appears to be five division-sized units has crossed the Rappahannock into Aquia.
Gen'l Longstreet with about two or three divisions is well entrenched at Manassas.
Gen'l Holmes occupies Winchester with more than one division, possibly two divisions.
A strong brigade is holding Strasburg
TENNESSEE- Union / South in Parity
Two divisions under Johnston are holding Nashville.
Up to another division is East of the Tennessee River
About four divisions are well entrenched at Memphis
Another division under Gen'l Price is at Paducah. It is surrounded by a Union army but the South has intact lines to both Memphis and Nashville, so the threat is weaker than it appears.
ELSEWHERE-
This is more of an educated guess: The South has thrown everything upfront. There is no depth to their defense. If we can gather enough units after the coming storm, things will move quickly.
Lee Takes Command
Gen. Monkey-Bear
Location: The San Francisco Bay Area
My gosh, I leave the forums for one day and suddenly your AAR is two full pages! I'll need some time to catch up and comment, but I think this AAR should win a "fastest written" award.
Butler Takes Northern Offensive Seriously!
GMB:
What do we win for 'fastest written?' If it is Scotch, I'm all in.
I think VigaBrand prefers German beer!
VigaBrand
Rose Greenhowe and his daughter give the information about your plans. You can not kill this women, so there will be prisoners but alive. Beware of women they are very usefull in intelligence.
VigaBrand wrote: Rose Greenhowe and his daughter give the information about your plans. You can not kill this women, so there will be prisoners but alive. Beware of women they are very usefull in intelligence.
I shall assign Gen'l Butler to get to the bottom of this female spy ring. His knowledge to the wiles of women is well known!
Sheik Yerbuti
This might win an award as the most amusing AAR.
"General McClellan, hiding in an undisclosed location, announced 'I am in charge.'"
As for using your generals as spies I would never do that because the AI needs all the help it can get and then some.
Playing against a human that ought not to be allowed, but if both players are fine with it, well it's your game!
But, think exactly how absurd it would be: Union generals hanging around the Richmond courthouse? Think someone might notice? "Hey, y'all notice that guy wearing a Union general's uniform over there watching our troop trains through a pair of binoculars?"
Yes, some of those newspaper articles are so gleefully immature with humor, that's the style we wrote in for high school newspaper to make our friends laugh Though I would stay away from slave/race humor if I were you. Just a warning
Gen. Monkey-Bear wrote: Yes, some of those newspaper articles are so gleefully immature with humor, that's the style we wrote in for high school newspaper to make our friends laugh Though I would stay away from slave/race humor if I were you. Just a warning
Good point. Thank you.
I've already offended some folks here. Though they haven't written, I apologize. The posts were not meant to offend or to indicate a current racism. The articles were meant to reflect what was happening at the time. It was not pretty.
I had poor judgement in writing it that way without a disclaimer.
I'll clean these up moving forward to reflect a more pure view of the military situation.
We now moving into August, 1862.
I haven't written much as the past few turns have not been memorable for any new military issue.
The images, however, indicate the size of the Union disaster.
Gen'l Butler's entire command of 40 elements (two divisions plus), plus what amounted to an additional division of forces located in the cities of the Peninsula, were hunted down and exterminated. If this had actually happened I'm not certain the North would have been able to maintain the war.
Losses to the CSA were probably less than 5,000.
There were only two forces that could have effected the fighting. They tried, but were ineffective.
The navy did not engage CSA forces with shore bombardment. After an initial attempt to perform rescue, the navy withdrew to a safe distance and is being strengthened for an expected Southern naval push. If you've followed the AAR you'll realize that the Merrimack never came out. It finally did come out in August, but we are not yet there.
Further north, McClellan had a number of divisions around the capital. Following an attack on Harper's Ferry by Southern units, I ordered three divisions to attack Strasburg from Washington. Their path would take them through HF.
The HF attack hurt the Southern corp in HF. It had not expected to be attacked, was set to attack itself, and was taken by surprise by the sudden appearance of three Union divisions. Nevertheless it acquitted itself well, scoring an NM, a win and losses of about 6K on the Union side to about 4K on the Confederate side.
The three Union divisions then rolled through Winchester brushing aside a Southern defender. Finally, they arrived, about 12 days after leaving Washington, in Strasburg. Despite two battles, the units were in excellent cohesion. They took control of the depot, causing the two brigades to rout.
The next turn saw the Union units returning to Washington. Several brigades were assigned the task of destroying the depot, others were assigned to hold Winchester.
On the way through HF to Washington, they encountered the CSA corps for the second time. One division was assigned to cover the remaining force with an attack. Units inside HF assisted, sending the corp running to Manassas.
As a result of this attack the Union destroyed the Strasburg depot and moved its Washington defensive line to the Shenandoah River. Gen'l Lee did not flinch from eliminating the Union units in the Peninsula, however.
In the west, Gen'l Grant took control of Memphis. There is a strong Southern army with two corps located at Corinth. The South appears to have largely abandoned Western Tennessee, though the Union has not moved in to the area yet.
A weak Northern unit advanced to Knoxville. Northern leadership couldn't believe their good fortune and hurried an elite division to back the advance. As of August, it appears as though the North is digging in at Knoxville.
On the Mississippi, a strong Northern naval push has hit the Southern riverine fleet in a series of battles pushing it toward Vicksburg. Due to earlier successful attacks in Memphis and Nashville, there appear to be no CSA river units north of Yahzoo at present.
In the far west Gen'l Watie takes Ft. Smith, then withdraws, apparently due to supply issues. Then he returns and takes it again, only to withdraw again as supply issues loom.
The South has used its first partial mobilization.
While Southern Foreign Intervention seems implausible (it is at a high of -3), there is the smell of an automatic win in the air. CSA morale is now 135. It has been as high, this summer, as 140. US morale is at 72. It has been as low as 67.
The lopsided loss of Butler to Lee led to a huge POW population in the South. We just had an exchange and I received 99K to just 16K for the South.
For new players, these forces are returned to my conscript total, an increase of 100 conscript points. VigaBrand pointed out that this was a real deal for me, and I agree. From a strategy view, VB should have refused to release these points. I owe him one down the road.
One of the give backs I'm considering offering is a delayed Emancipation Proclamation.
We're celebrating the 150th anniversary of this great event in the US. As you may know, freedom wasn't a sudden event. It was rolled out as a military necessity. (That was part of the reason I'd discussed the role of slave contrabands in the Peninsula campaign).
Gen'l Butler, and other military leaders were sometimes driven by military necessity, sometimes by a belief in abolitionism, to refuse the demands of slave owners for a return of their property. The first moves towards freedom was the First Contraband Act. If the slaves were property and the property was being used for a military purpose against the government, then the property could be seized by the government without compensation.
From there, the government could 'free' the property.
Anyway... in the game, the effect is to raise Northern National Morale, among other effects (lowering Border State loyalty for example). I had hoped to pocket this decision. Fight the war without the EP. However, the sinking NM of the North has me worried. I hope, at least, that I can hold off on the decision, as President Abraham Lincoln did, till there is a significant Northern military victory.
I'm hoping it isn't as costly a victory as Antietam.
Thanks for the apology, pb783. I think most of us here on the forums are forgiving, after all, I'm sure we all say things we don't mean. Personally I find your writing very entertaining though it's best to be cautious about these things.
Defeat is all relative
How did it come to this? How did it happen so quickly? Stay tuned readers as this AAR entertains an alternative series of battles. To our American neighbors: Happy Decoration Day! (To our Canadian friends: WINTERHAWKS!)
Eastern Situation Late August 1861
The attachment shows the Eastern situation. As I recall, the turn was about a month following the dispatch of Gen'l Butler's entire force in the Peninsula.
This was a loss of four Union divisions, all the Union holdings down to Ft Monroe and also two naval shore batteries. So the date here seems to be late August. Confederate forces have, for the first time, taken Loudon, Virg. My intel here is terrible. It is very unclear what is in Loudon.
From my notes:
Hmmm, the movie shows there are a minimum of two corps in Loudon. There's a lot of movement here.
Washington is well protected, as is Harper's Ferry.
The intel here is terrible. I can't see what the hell is in there.
I've moved McClellan to Frederick City to join Dix. I've also placed all the units on a higher level of ROE in this region.
If the attack happens, I'm hoping Little Mac gets called in first, then he calls in support from the three surrounding divisions.
I have a division dug in in each of the counties here. HF has a larger division. Each division is listed as a corps (with one division). And, aside from that there is a separate militia dug in in each of the counties (so if the division moves, the militia will maintain the level of entrenchment).
Behind this there are militia dug in all the way to Harrisburg.
The Union will be able to do a partial mobilization next turn, giving it 550 points (22). I'll be unable to use all that without printing money (5).
I also have the Emancipation Proclamation. The EP gives the Union a big boost in NM (82) and VP (1120), plus reduces the Foreign Intervention (-1).
Why not do it? Game balance, border states become less loyal [Missouri- 8%; Kentucky- 42%; West Virginia 75%; Maryland- 62%; Delaware 91%]
So, at this point, I hadn't realized the full extent of the loss of Butler's units nor the danger to Washington.
Here is a summary (from the Union intel screen) of the opposing forces. Note that I have two estimates of the spearhead force. When I reopened the file I received a different accounting of what was in the region of Loudon.
Early October 1862
Here is the screen shot from early October. Longstreet has penetrated to the border of Pennsylvania (Westminster, MD). Lee is right behind him.
Late October- I say STOP!
You can see the CSA is actually moving back across the Potomac!
At this point VigaBrand and I exchanged a series of emails:
as I woke this morning I realized you had your armies setup in a way that should have allowed you to conquer Washington.
If you didn't do what I think you should have, let's pause for a moment. [Checking the file]
No. You didn't do the attack that probably would have won the game. It may have failed, but the Southern effort is about taking your shots and rolling the die. I think if we test it we'll find it would have succeeded.
Dominic:
I didn't attack Washington because I don't know why I should have succes with that attack.
I retreat behind the river. How was that setup good for a tactical attack at washington? Il will save this backup file, so after the game we can switch side at this point and you show me what you mean.
I'd like to roll back one turn and tweak the defense (maybe).
Yes, this is for the turn that just ended (I think it is late October)
For your attack, I suggest that
Lee hits Washington first with either a standard or an aggressive attack.
Jackson (I'm not looking at the game, so this is from memory) follow the Lee attack directly with either a standard or an aggressive attack, but also be instructed to enter the city.
I'll send a slightly changed .ord file to you. I'm going to instruct the defense to include a static unit (it won't be able to retreat). That should keep my units in the region without the need for a stand and fight order. I think that would make the defense a bit harder to shatter. I'm not sure. It is using the system to exploit a rules bug.
Also, I want to see what happened to the Northern Navy. The navy was ordered all-in to Hampton Roads. Where are they? Delayed orders shouldn't have hit so many units.
If this works as I expect, you'd have taken Washington this turn. This is similar to the attack I used to take Strasburg earlier in 1862. It should work because Jackson will find weakened units outside Washington and will brush them aside to get inside. My changes to the navy and the outside units might be able to save the day for the North.
you are right. I can beat you, if I made a all-in attack on washington. I estimate more troops and so I decide not to attack you. It was a heavy battle with many casulaties for my side and I didn't take the risk, but it should be work.
Problem by this ideas are, you know your side exactly and I didn't know it. I don't see reserves from you coming by train and than help the fight or teh actual number of forces. So if I attack and there are more forces (I believe you are stronger there) than I suffer heavy losses without gaining somethink. So I didn't attack. And I overestimate the fortress. I was thinking, that I can not storm the fortress in one turn.
I send you the replay and trn. file, so you can look on my lost chance to win and we can continue our interesting game. Maybe you should send some reinforcments from Tennessee to washington or so.
Why didn't you defend your capital?
Your last question is really the key question: Why didn't I protect Washington?
In my defense, I thought I had adequate protection until about two turns ago. I hadn't realized, due to my own intel failure, how large Lee's forces were.
In part this is due to my having never played a PBEM prior to this.
What was in the area? Three divisions (including the District Home Guard of artillery that is static), another division in Anne Arundel, another two divisions in the area of Harper's Ferry with two additional divisions inside HF.
In the west 2 1/2 divisions in the area of Bowling Green, another at Knoxville, another two threatening Chattanooga, 1 1/2 in Western Kentucky and 3 1/2 in the area of Memphis.
Another 1 1/2 divisions in Missouri.
East 8 divisions plus two - three static forces of division size
Mississippi 9 1/2 divisions
TransWest 1 1/2 divisions
In my opinion, the heavy losses would have been worth the victory. In this case you would have taken the capital. Now, I'll be moving the government in advance of the attack that I expect you'll be executing. You'll need to weigh that as you consider what to do next.
In addition, I think the form of the attack was probably important. That form, if you followed my idea, was for Lee to weaken the forces, then the second corps in Maryland to enter with instructions to enter the city. I expect MTSG had the effect of calling in units from Alexandria for your side and from Anne Arundel for my side. If you used a different form, I'd like to hear about it.
I'll need to examine the file. But you actually saw the battle take place. Was it close? (I'm at work again and can't play till tonight).
Now, what do you think I've misunderstood? I need some constructive critique here. I am surprised, like you, in the way the Union defense didn't hold. I also think that if you wait you'll see a serious amount of firepower pouring into the area that could tip the balance in a close battle.
There are two factors that I think should be considered.
McClellan is a weak commander giving a terrible multiplier to forces under his command
My army suffered the loss of about 4 divisions under Lee's attack on Butler.
it was to easy to crossing the river.
You have to much in Harpers Ferry. Harpers Ferry has no depot (because you blow them), it is a hill countryside, so it will be okay, to have two divisions in it. Maybe less of them.
After the defeat on the peninsula, you maybe have to move some forces to the washington area from other theaters.
The 4 divisions from the peninsula are very hard to compensate and this falls in the phase where I can partial mobilise. So at my strongest point, you are weak in the main important area.
The divisions defending the Potomac were at maximum entrenchment, but only had four artillery with each. I was working on increasing the artillery with each unit.
But I was surprised they didn't contest the river crossings, choosing instead to withdraw. That did work to delay you, as you kept hitting the entrenchments in each region. I don't know if you ordered the units to ride through to a further county or not, but I suspect you ordered the army to attack one county at a time. I'd like to think the entrenchments act to slow an army compared to no entrenchments. But the system actually doesn't seem to force attacking units to deal with entrenchments in this way.
So, the entrenchments, which I spent a lot of time, but not a lot of manpower, on developing were not useful.
In total I believe I had up to 12 militias working on entrenchments from the river back through all of Maryland (and now parts of Pennsylvania.)
The divisions, once they withdrew, generally were folding into the Washington defense, making the capital that much tougher. So their job, if I may describe it as such, was to trip you, then move to the District. They each did that.
The three divisions that were on the Western flank of Lee's advance, in HF and Winchester, were tasked with attacking Manassas. Instead they ran into a force coming from somewhere in the rear to take Winchester. The result was that Manassas wasn't attacked (I have no idea how the loss of this supply would have impacted you.)
I really am not concerned with the loss of Winchester.
Obviously you are correct that I was too optimistic after the Lee Peninsula victories. Units should have been stripped from the West to aid the defense of the capital.
Those Western units would have been arriving at about this time.
I think with rail transport your troops from the west need maybe two turns to arrive in Washington area, that was the reason why I attack at the beginning the railway depot in Westvirginia. I want to cut this railway connection. Lee and Jackson need two turns too, to come from peninsula to washington area, so I overestimate your forces and with the winchester attack, you are lucky. If you strike at manassas in our real game, you will run into a reserve corps with nearly all my other corps around them and helping that corps. So you will suffer heavy losses by this assault.
That's true about the attack on Manassas. I had hoped the troops in Alexandria would have been involved in the attack on Washington though. But good point. I hadn't considered the MTSG element there.
So, we have a game in which the opponent (me) detected the move necessary to win. At least a 1/2 point to VigaBrand for creating this situation.
What is your thoughts readers? I think we'll continue the game, perhaps rolling back a turn or two to allow the Union to regroup a bit better from the Butler losses as it is obvious that Washington will be lost.
How would you regroup the game so that the South continues its roll in the East, although it missed it's best chance to end the war.
Time to Fly!
If your morale is as low as you say it is (67), you cannot issue emancipation proclamation. It has to be over 80.
That's a very interesting situation you have here. Of course as your audience member I want the game to continue so I can read the AAR, but in reality I think I would have just continued the game as is (before you pointed the better move to your opponent). Both sides made blunders in real life, and perhaps the failure to attack on Washington could be seen simply as General Lee losing his nerve at a critical time. Of course I think your decision to rewind a few turns was also good
Gen. Monkey-Bear wrote: That's a very interesting situation you have here. Of course as your audience member I want the game to continue so I can read the AAR, but in reality I think I would have just continued the game as is (before you pointed the better move to your opponent). Both sides made blunders in real life, and perhaps the failure to attack on Washington could be seen simply as General Lee losing his nerve at a critical time. Of course I think your decision to rewind a few turns was also good
That's exactly what we're going to do. So, stick around for more fun and games as the action moves West.
Ace wrote: If your morale is as low as you say it is (67), you cannot issue emancipation proclamation. It has to be over 80.
I guess I didn't know that. I did issue the EP after consulting with VigaBrand. I felt it was a critical point for the Northern player and I wanted more breathing room, so, for what I'm sure are some pretty terrible reason...
Morale has stood up pretty well. After a loss of 6 points this turn due to a loss in the West it is holding at 73 NM.
The game has continued from the point at which the Union player (that would be me) spotted a near certain win for the South (VigaBrand). The turn is now moving into February 1863.
Would it surprise you to learn that Lee has taken about four corps and moved into Central Tennessee?
Would it surprise you to learn that the North has units in the mountains north of Atlanta?
Would it surprise you to learn that the North has taken Nashville, Forts Henry & Donelson and threatened Chattanooga several times?
Would it surprise you to learn that nearly the entire Southern Riverine fleet is bottled up at Little Rock?
Would it surprise you to learn that despite all this Union morale has sunk as low as 39? That Union casualties are nearly double Southern casualties (70K v ~169K)?
Yeah, it has been an interesting year. And I only picked out the high points of the Union for you. Strap yourself in for the next installment as you watch the Union p_ss away its strength.
(Coming soon to this AAR, provided the Chicago Blackhawks cooperate against the Boston Bruins. Let's go Hawks!)
Return to "American Civil War AARs"


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The Loma Prieta Earthquake Was 22 Years Ago, Today
by April Siese | October 17, 2011 10:45 am	| in News | 0
The World Series Quake or Loma Prieta as it's formally called, occurred 22 years ago today.
The 1989 Loma Prieta earthquake occurred at 5:04 PM on October 17, 1989. The epicenter for the magnitude 6.9 quake was located near Loma Prieta peak in the Santa Cruz Mountains, about 60 miles south of SF.
Those present say shaking from the quake lasted between 10-15 seconds. It interrupted the first game of the World Series (participants: The SF Giants and the Oakland A's), killed 57 people and injured almost 4,000. It also caused the collapse of a section of the Bay Bridge and the Nimitz Freeway, and an overall estimated $6 billion in damages.
As ABC7 reports, to mark that occasion a symposium on recovering from natural disasters is being held at SF's City Hall today.
According to Bay City News, the discussion was part of a commemorative conference to remember community actions that helped the city recover after the quake and urging similar cooperative efforts in future disasters.
"We promised those we lost and their families that we would be better prepared, so since Loma Prieta, we've made great strides … we've built the city better," California Emergency Management Agency Acting Secretary Mike Dayton said today.
Dayton said the agency is working to send the message to San Francisco residents that preparedness is key for future earthquakes and other emergencies.
Federal Emergency Management Agency Deputy Administrator Rich Serino echoed Dayton's words, highlighting the critical role of "neighbors helping neighbors" in increasing survival rates during emergencies.
"The most important part of the team is survivors and the public at large," he said. "They have to be involved in taking care of themselves and taking care of their communities."
Serino and San Francisco Department of Public Health Director Barbara Garcia said it's also crucial that members of the public, government and private businesses–from large supermarkets to small local restaurants — work together to help cities recover from catastrophes.
Police and firefighters are also set to commemorate the quake at an open house event beginning at 3 p.m. today at the San Francisco Fire Department Museum.
A large earthquake drill will also be held in SF this Thursday, as residents, employees and businesses will take part in the Great California Shake Out.

redpajama_set_name: RedPajamaCommonCrawl


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Sport is of central importance at John Lyon. We believe competitive team games and individual sporting disciplines play an essential role in developing healthy, well-rounded pupils.
From September 2020 all pupils in Years 7, 8 & 9 will be transported from School to Sudbury Fields playing pitches.
The School has a number of key sports, notably Hockey, Football, Cricket, Athletics and Badminton. Increasingly, disciplines such as Water Polo and Basketball are growing in popularity with our pupils. And the list doesn't stop there. Through timetabled games lessons and our strong Extra-Curricular Programme, we are also able to offer Swimming, Archery, Golf, Cross Country, Gymnastics, Karate, Squash and Table Tennis to pupils.
John Lyon can boast excellent sporting facilities. On the main School site there is a large sports hall, fitness suite, 25m swimming pool and an outdoor practice pitch/court. At the nearby 25-acre Sudbury Fields, we have ten Football pitches, as well as three Cricket squares, an artificial wicket, a large pavilion with hospitality facilities and an Archery range. The School has both indoor and outdoor Cricket nets. John Lyon also has extensive access to sporting facilities at Harrow School, including a new Athletics track, a nine-hole Golf course and Tennis, Squash and Badminton courts.
Teaching staff in our Sports Department strive for excellence, often identifying talent early through house competitions and regular fixtures against other schools at all ages. Many pupils go on to represent John Lyon at county, regional and national level. They also work hard to ensure that all pupils – including those who may not think they are natural sportsmen – have opportunities to fulfil their potential.
The School offers competitive entrance scholarships in Sport at 11, 13 and 16.
MISOCS


During the past year and a half, I've enjoyed a great working relationship with the people at Gillette.
I have become a fan of the Gillette Fusion ProGlide Razor and have shared a few with friends and even my dad, who last time I saw him, was still using the one I gave him. The ProGlide is the only razor I ever plan to use again. Seriously. I've not cut my face in more than a year and that was a daily occurrence when I was using those cheap-ole Bic Razors. No more of that.
In the past few months, they've also been generous and asked me to try two other products of theirs–the Odor Shield Anti-Perspirant & Deodorant and the Odor Shield Body Wash.
I have no problem with either product and have given them both a chance. I've long been one to use Sure roll on so switching to something else was a huge loyalty issue. I also have skin sensitivities so that was another issue to consider. I have used Old Spice in the past and that's caused incredible rashes, etc. so I was leery of trying something else than what I already knew worked.
To be honest, I had some of the same issues with the Odor Shield Anti-Perspirant & Deodorantt, but not enough to tell anyone not to use it. It did what it was supposed to. It kept me dry.
Okay, first of all, I do historically fast showers. Soap?!! I am a guy, you know. I use the body wash during some showers but I don't use it every time. Ironically, I'm not real crazy about the smell of it.
But like the fokes at Gillette reminded me, no one likes stressful moments – especially those guys who are heavy sweaters. Personally, I'd rather be freezing cold than hot. And I tend to have those Broadcast News sweating spells when I get too hot or too stressed. It's very uncomfortable. So is not having shaved for a day or so and getting hot.
In literature Gillette sent me to consider while using their products, they also reminded me about some tips provided by Dr. Avery Gilbert.
· Stock up on greens at your grocery – A diet with a based on greens (parsley, cilantro, celery, mint) can act as an internal deodorizer while strong-smelling foods (garlic, curry or onions) seep through pores, creating a more unpleasant odor.
· Opt for antibacterial – Although fragrant soaps and sweeter smelling gels might seem like a good way to get rid of your body odor, many only mask the odor causing bacteria. Using an antibacterial soap regularly or pre-moistened wipes during a workout can reduce the amount of bacteria causing body odor.
· Arm yourself with the right products – Bacteria has a hard time breeding in dry areas; be sure to immediately apply underarm antiperspirant to clean, dry armpits. It helps to eliminate odor and releases a fresh scent in its place.
· Dress Appropriately – Be mindful of the materials you wear when working out. Nylon and polyester can impede airflow and prevent sweat from evaporating. When that sweat doesn't evaporate, it feeds germs and bacteria that cause odor. Look for natural materials that breathe, such as cotton.
Uh, I'm not going there, or any lower, either….
Give these products from Gillette a try. The Fushion Pro-Glide Razor is the world's best. The deodorant and body wash are good products, too, and worthy of your consideration.


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Tesla opens first European factory in Germany
Tesla has opened its delayed electric vehicle gigafactory in Berlin, Germany, with plans to create 12,000 new jobs.
Cara Lyttle
US-based Tesla, the electric vehicle (EV) and clean energy company, has opened its first European factory in Grünheide, near Berlin, Germany. The company has already hired 3,000 employees for the new factory with a further 9,000 positions still to be filled. At full capacity, the plant will produce 500,000 cars annually, with initial plans to produce 1,000 vehicles per week at the six-week mark, increasing to 5,000 per week by the end of 2022.
Why tech innovators and start-ups thrive in Brabant
Brabant is one of the most innovative regions in Europe, where high-tech industries meet advanced manufacturing and technological innovations happen frequently. Collaborations between businesses, government and academia create an environment where innovation thrives. Projects include everything from battery storage, emission-free cars and electric flights to robotics and AI, and the future of processing chips. Home to 2.5 million people and best-in-class physical and telecoms infrastructure, Brabant has become one of the world's most competitive economies. This whitepaper provides a detailed analysis of what makes a globally competitive economy, from bright talent to robust value chains. It presents an insight into Brabant's high-tech systems and materials sector, and the spirit of collaboration driving world-class innovation. Download to learn about the business-friendly environment, industrial and knowledge networks and geographical advantages that make Brabant the ideal destination for ambitious innovators and start-ups.
By Brabant
By clicking the Download Free Whitepaper button, you accept the terms and conditions and acknowledge that your data will be used as described in the Brabant privacy policy
Tesla has been struggling to keep up with global demand for EVs and previously had to ship stock from China for customers based in Europe. In November 2019, when CEO Elon Musk announced his plans to open an EV plant in Germany, he acknowledged the talent available, explaining: "Everyone knows that German engineering is outstanding, for sure. That is part of the reason why we are locating our 'Gigafactory Europe' in Germany. We are also going to create an engineering and design centre in Berlin, because Berlin has some of the best art in the world."
The company had originally intended to commence production at the plant in mid-2021; however, due to a host of complications including Covid-19 and supply chain issues, it had to postpone the opening.
Cara Lyttle is a senior investment consultant at Investment Monitor with experience tracking and analysing cross-border investment. She joined from the Financial Times where she was production manager of fDi Markets for the fDi Intelligence division. During her seven years at the Financial Times she also worked as a senior investment analyst and researcher focusing on western Europe, Africa and the Middle East.
Employee Benefits in Germany, 2022 Update - Key Regulations, Statutory Public and Private Benefits, and Industry Analysis
Enterprise Tech Ecosystem Series: Deutsche Bank
Germany Retail Banking Country Report
Germany Retail Banking - Competitor Benchmarking, 2021-2025
Employee Benefits in Germany 2020
Tesla S.r.l.
CBI urges government to continue energy cost support to protect UK economy from recession
MassiveMusic opens new office in Dubai
IDEA study: Half of democratic governments worldwide are in decline
Temasek to open third European office in Paris


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Lick Run is a  long 1st order tributary to Sewickley Creek in Westmoreland County, Pennsylvania.

Variant names
According to the Geographic Names Information System, it has also been known historically as:
Hull Run

Course
Lick Run rise at Mendon, Pennsylvania, and then flows north to join Sewickley Creek at Yukon.

Watershed
Lick Run drains  of area, receives about 40.5 in/year of precipitation, has a wetness index of 342.83, and is about 70% forested.

References

Tributaries of the Ohio River
Rivers of Pennsylvania
Rivers of Westmoreland County, Pennsylvania
Allegheny Plateau

redpajama_set_name: RedPajamaWikipedia


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Gavin Newsom Issues Warning to Democrats Heading Into Midterms
California Democratic Governor Gavin Newsom warned fellow Democrats that a "red wave" is coming on Tuesday due to the party not doing enough to compete with Republicans on "messaging."
California Gov. Gavin Newsom is campaigning for embattled Democrats in an effort to bail out a party he says is being "destroyed on messaging." He spoke exclusively with @MajorCBS addressing questions about whether his political ambitions extend beyond the Golden State. pic.twitter.com/CzVdOhz7kX
— CBS Evening News (@CBSEveningNews) November 1, 2022
When asked whether or not a red wave is coming, Newsom said, "Yeah. Of course, it does. And again, I'm not paid to say that, I'm paid to say, you know, [indistinguishable] — I get it. Look, I mean, I could be the cheerleader. I'm also a pragmatist. You feel it."
Newsom also added Democrats are "getting crushed on narrative."
He also stands by his claim of having "no interest" in running for president. When asked if he would "never" run he said "yeah."
Newsom will spend days leading up to midterms campaigning for Democrats in his home state of California.
Creepy Dad Supports 23-Year-Old Daughter Showing Boobs
A 23-year-old social media influencer and TikToker with millions of followers showcases her supporting father during her videos.
As Steve Crowder stated in the video below, this is what happened when parents try to become friends. It's important for parents to be parents, not friends. Or else we ended up with brutally awkward situations like this.
'There's Something Wrong With This Guy': Megyn Kelly Points Out 'Weird' Viral Video of Biden
Megyn Kelly, formerly of Fox News, pointed out "there's something wrong" with President Joe Biden after a video clip of him went viral of him putting his hands on the shoulders of a young girl and giving her dating advice.
During an episode of "The Megyn Kelly Show," which appears on Sirius XM, Kelly was speaking with her guests entrepreneur/ founding COO of PayPal David Sacks and founder/CEO of The Production Board David Friedberg. Kelly mentioned the "weird" manner in which he touched a female during his visit to a college in Irvine, California.
McDonald's Set to Sell Delicious Donuts From Iconic Food Chain
Two iconic restaurant chains will be combining their powers when some McDonald's locations begin to sell donuts from Krispy Kreme. The donuts will be tested at certain locations.
Starting October 26 McDonald's will offer glazed, chocolate with sprinkles and raspberry-filled donuts from Krispy Kreme. They will be offered at nine locations in the Louisville, Kentucky are, per a press release from both companies.
Jill Biden Makes Insane Request to Attendees of $1,000 Dinner: 'Dig a Little Deeper'
With midterms coming soon, both parties are looking to do whatever they can to gain an edge. Count First Lady Jill Biden among those willing to do absolutely anything.
Somehow Jill Biden is one of the most popular figures in the Democratic Party. The New York Times described her as one of President Joe Biden's "most popular" surrogates. Invitations to her to attend events are piling up.
Legendary Rock Band Lynyrd Skynyrd Surprises Fans on Stage With Special Guest Republican
Legendary rock band Lynyrd Skynyrd is still on tour. The band hails from Jacksonville. Florida Governor Ron DeSantis also hails from Jacksonville.
During a recent concert, the band brought Governor DeSantis out on the stage and the crowd went absolutely nuts.
Rep. Chip Roy Calls for Biden, Mayorkas Impeachment Over Border Crisis
Twitter Employee in Charge of Fact-Checking Trump Once Said 'Actual Nazis' in White House
Arizona Gubernatorial Candidate Kari Lake Shuts Down Reporters
Biden Tries to Court Latino Voters by Playing 'Despacito' on His Phone (VIDEO)


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For Cartoonists Who Cover Obama: Four More Ears
By Alison MacAdam
Scott Stantis calls himself a conservative, and his cartoons frequently criticize President Obama. But for the inauguration in 2009, he simply chose to mark the moment as historic.
Four years ago, when the nation's first African-American president was inaugurated, even conservative editorial cartoonists marked the moment with reverence.
As Scott Stantis, now of the Chicago Tribune, tells All Things Considered host Audie Cornish: "There are times in our history where we can just take half a step back from our partisanship and revel in the history and wonder of something."
/ Courtesy of Matt Wuerker/Politico
Matt Wuerker borrowed the concept of "œstanding on the shoulders of giants" in his cartoon for the inauguration in 2009.
Stantis' left-leaning peer, Matt Wuerker of Politico, concurs. "It was a very epic moment. I think that everybody was really suddenly embracing this moment of idealism."
But, says Wuerker: "Four years later, so much of that is gone."
President Obama would not be the first president to suffer a diminishment of his cartoon image over eight years in office. Jimmy Carter, says Stantis, "was diminished to about — he was standing about 3 1/2 feet tall. You had Bill Clinton, who just became this big, doughy, sensualist character." George W. Bush, he adds, "devolved into a demonic Keebler elf."
So what's happened to Obama's image?
Cartoonists were careful at first in their depictions of the president, fearful of racial sensitivities, Wuerker explains. But "Obama is now just another goofy guy that we get to have fun with and play with his big smile and make his ears bigger."
So what to do for Obama's second inaugural?
"I'm still flummoxed," says Wuerker, who won the 2012 Pulitzer Prize for his work. "What was extraordinary four years ago is ordinary."
This weekend and Monday, when the president is inaugurated again, editorial cartoonists will be sketching and scribbling, trying to decide what story to tell and what symbolism to use, as a president besieged by critics on both sides begins his second four years in the White House.
/ Courtesy of Scott Stantis
Scott Stantis says the issues the president faces haven't changed, so he plans to continue critiquing government spending in his cartoons.
Alison MacAdam
See stories by Alison MacAdam


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Dr. Peter Attia: Raising Questions on What Constitutes a Healthy Diet
Shares his own personal weight loss journey coupled with his medical background
Site Staff February 6, 2014 Health & Wellness 0 Comments
Peter Attia is not out to convert you.
He would much rather have you leave one of his speaking engagements questioning your own knowledge base on nutrition, exercise or pharmacology.
"It's always really this idea of using my passion to basically create a seed of doubt because I think that's healthy," says Dr. Attia. "I think that's how we evolved."
Dr. Attia will speak Feb. 11 on "Relationship Between Nutrition, Obesity and Diabetes" as part of the Wellness Matters Speakers Series at the Annenberg Center for Health Sciences at Eisenhower Medical Center in Rancho Mirage.
His information is as much attributed to his medical education as it is to his own personal journey. Five years ago, he weighed 200 pounds despite following what he thought was the correct prescription to being healthy – he exercised more than the normal person and didn't eat junk food.
However, he was still overweight and putting himself at risk for a family history of heart disease. So he radically changed his diet, going to a low carbohydrate that allowed him to lose weight and body fat at the same time.
While that's a simplification of his weight loss, Dr. Attia says we're not equally equipped to answer the question of what works for each of us (see his website for more details).
"If today someone says, 'Boy, it's really hard for me to change my diet,' I would argue that a big part of it is they don't actually know what they should be eating," he says. "Everyday they're being told something different, and so that to me is the actual problem."
Dr. Attia recently shared more with Palm Springs Life.
Do you have your own personal definition of what's considered a healthy diet?
I obviously eat according to what I believe is the healthiest thing I can eat. Again, I think it's irrelevant to the broader question.
When we talk about healthy eating, is there a way to communicate that in a way that people will find appealing and not think they're being punished?
"I think it's a little soon to really say that. To be honest with you, if you ask me personally what my objective is, my objective is to figure out what the right answer is before telling people what to eat. I'm certainly happy to tell people what I eat and explain the literature as it exists today which makes a pretty strong case for saying that the way we ought to eat is not the way we do eat.
But I really savor a prospective approach as opposed to a retrospective approach so rather than getting people all anxious over changing their eating behaviors today, I'd rather get people to at least accept the fact that we probably ought to reassess exactly what constitutes a healthy diet so that people can then at least make the choice freely."
Is there a tendency or a convention to want to continue to look at diabetes the way we have been or does there seem to be a growing acceptance that … of looking at maybe a little bit different the way you have?
"One of the greatest lessons I learned in my Surgical Oncology training was that we never ever, ever use the language that the patient failed the treatment. You never use that language because it was so inherent within our culture to understand that the therapy failed Mr. Smith.
Mr. Smith didn't fail anything, and yet in diabetes and obesity for that matter we don't use that language at all. We talk about patients failing. I guess my point is that I think that can only go on so long. At some point, if you're an honest person, which I think most people are, you have to look yourself in the mirror and say, 'Wait a minute, maybe this isn't the failure of the patient, maybe it's the failure of the treatment?' I think we're actually at that turning point right now."
What, at this point needs to be done or maybe is currently being done to improve the scientific rigor in Nutrition and Obesity Research? Is enough being done?
The first thing that has to be done when any scientific discipline undergoes a revolution is there has to be an acceptance of an alternative hypothesis. To this there is not. Doing more science through the lens of a conventionalism framework, it's only likely to enhance one's belief in the conventional wisdom whether or not it's correct. At the risk of again sounding a little preachy, I guess, the most important first step is the acceptance that there may be alternative hypotheses for things that we believe are iron clad and certainty, and that we need to go about it testing those alternative hypotheses rigorously, transparently, and with the best tools that science brings to it.
Can you give me an example of a hypothesis that needs to be tested?
"Sure. The current accepted wisdom for why people get fat is that they eat too much or don't exercise enough. By that logic treating obesity requires restricting calories and or increasing energy expenditure. That is conventional wisdom and it seems logical, and it's been preached for 40 years and yet during that period of time we've seen a monotonic rise in the incidence and problems of obesity and a long with it Type 2 Diabetes. So, it's sort of intellectually appealing as the hypothesis might be worth asking if there's another hypothesis that could explain this."
Healthy Priorities
Plan for the Care You Want


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author: Oliver Bleeck
Thomas, Ross writing as "Oliver Bleeck."
THE HIGHBINDERS.
New York: William Morrow and Company, Inc., 1973. Octavo, cloth backed boards. First edition. A Philip St. Ives novel. "[The Bleeck titles]...are distinguished for their crisp dialogue, unusual backgrounds, and understated sense of irony." Pronzini and Muller: 1001 Midnights, pp. 65. Hubin, p. 79.
Item Details for THE HIGHBINDERS
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New York: William Morrow and Company, Inc., 1976. Octavo, cloth backed boards. First edition. A Philip St. Ives novel. Hubin, p. 79.
Item Details for NO QUESTIONS ASKED
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THE PROCANE CHRONICLE.
New York: William Morrow and Company, Inc., 1972. Octavo, cloth backed boards. First edition. A Philip St. Ives novel, in which he is hired by Albert Procane, a thief, to arrange the return of his stolen journals. "[The Bleeck titles]...are distinguished for their crisp dialogue, unusual backgrounds, and understated sense of irony." Pronzini and Muller: 1001 Midnights, pp. 65. Hubin, p. 79.
Item Details for THE PROCANE CHRONICLE
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Thomas, Ross, writing as "Oliver Bleeck."
New York: William Morrow and Company, Inc., 1976. Octavo, cloth backed boards. First edition. "What happens when a cautious-to-the-point-of-cowardice go-between gets emotional about a bunch of starving kids. Phil St. Ives is hired by a Washington musem to recover the invaluable ""shield of Komporeen,"" which is a poetical hot potato." - Kirkus Reviews, 24 September, 1969. Hubin, p. 79.


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The Urogenital Tract: Surgical Overview
7 The Urogenital Tract: Surgical Overview
S. Chandrasekara, G. H. Muir
The current chapter predominantly outlines the role of ultrasound, as well as other imaging modalities, in different urological clinical settings, emphasizing the uro-logical surgeon's perception of the status of imaging in diagnosis and management.
Urinary tract infections (UTIs) are a common urological problem, with the importance lying in the identification of those at risk of developing severe sequelae whilst avoiding investigation in patients with uncomplicated infections. Therefore it is useful to broadly divide UTIs into "uncomplicated" and "complicated," which dictates the extent of evaluation and the duration of treatment and also acts as an indicator of potential treatment failure (Table 7.1). UTIs are classified according to the dominant clinical symptom: Urethritis, cystitis, prostatitis, or pyelonephritis.1 Clinical signs alone will not differentiate the site of the infection into an upper or lower urinary tract infection.2 A UTI in a male patient is regarded as complicated, as in the young and the elderly male it is often associated with structural or outflow-related abnormalities. A UTI in a male patient between age 15 and 50 is uncommon.1
Uncomplicated Urinary Tract Infection
In females an uncomplicated UTI may be cystitis, urethritis, or pyelonephritis, with cystitis the most common. The UTI may be entirely asymptomatic or associated with symptoms of urgency, hesitancy, and pain. Common bacterial pathogens include E. coli (70–95%), Staphylococcus saprophyticus, Proteus, and Klebsiella. The probability of a UTI in a female patient is high, namely 20–35% between age 20 and 40, 10–20% of which may acquire recurrent uncomplicated infections.1 Those patients with pyelonephritis in addition to cystitis have classical symptoms of fever, loin pain, and renal angle tenderness, but the absence of upper tract symptoms does not exclude pyelonephritis.
Table 7.1 Factors that suggest a complicated urinary tract infection
• Male gender
• Elderly
• Pregnancy
• Recent urinary tract infection
• Nosocomial infection
• Indwelling urinary catheter
• Recent antibiotic therapy
• Symptoms for more than seven days
• Functional or anatomical anomaly of the urinary tract
• Diabetes mellitus
• Immunosuppression
Complicated Urinary Tract Infection
Investigation beyond a posttreatment urine analysis is unnecessary for uncomplicated UTI. With acute, un-complicated pyelonephritis, a white cell count, C-reactive protein, and blood cultures for bacteriology are necessary. An abdominal radiograph and ultrasound should be performed in both uncomplicated and complicated UTI. The plain radiograph may identify radio-opaque calculi or in rare instances demonstrate gas in the renal parenchyma, which is indicative of emphysematous pyelonephritis, or obliteration of the psoas muscle outline, a nonspecific sign of a perirenal abscess formation. An ultrasound examination is useful in excluding the presence of an abscess or pelvicalyceal obstruction. However, in some patients the upper urinary tract may be dilated in the absence of obstruction, attributed to "bacterial virulence factors."
Routine use of an intravenous urography (IVU) in uncomplicated UTI is not recommended as over 75% of patients will have a normal study.3 However, if there is no clinical improvement within 72 hours of antibiotic therapy, further imaging is indicated. Computed tomography (CT) is the best option in such situations, as it offers greater anatomical detail of the renal parenchyma and the perirenal areas.
Emphysematous pyelonephritis is a rare, acute narcotizing condition caused by any "gas-forming" organism.4 Diabetes mellitus, immunosuppression, urolithiasis, and renal tract obstruction are common predis-posing conditions. These patients are often severely ill and may fail to respond to antibiotic therapy. Ultra-sound and CT imaging are the most useful methods of assessment, with CT imaging offering accurate anatomical detail, including areas of gas formation. Any perinephric infected fluid collection may be percutaneously drained under ultrasound guidance. There is a reported mortality rate of 50–60% in emphysematous pyelonephritis, with nephrectomy the only viable option for cure.4
Fig. 7.1 Investigation of a child with a urinary tract infection (UTI) (VCUG = voiding cystourethrography; 99mTc-DMSA = 99mTcdimercaptosuccinic acid)
Urinary Tract Infection in Children
UTIs are the commonest bacterial infection in children. Clinical presentation in the pediatric age group may be variable and would include failure to thrive, episodes of fever, vomiting, and dehydration.1 Investigations are usually undertaken following the first episode of infection in male patients and following the second episode in female patients. The main objective of evaluating these patients is to exclude an underlying structural or functional anomaly that may be corrected. A diagnostic algorithm for the management of UTIs has been formulated by the European Association of Urology (Fig. 7.1).1
Ultrasound is the preferred imaging modality in the pediatric age group; there is the benefit of absence of ionizing radiation and adverse effects related to the use of iodinated contrast media. Ultrasound has been shown to be as accurate as IVU in detecting significant renal anomalies.5,6
In neonates and in children between age two and 18 years with a UTI, approximately 30% will have vesicoureteric reflux (VUR).5 Male patients with VUR are likely to be diagnosed in infancy, whereas in female patients the diagnosis is delayed until between age two and eight years. Although VUR will resolve spontaneously in the majority of patients, UTI associated with reflux facilitates ascending infection, resulting in possible renal parenchyma cortical damage and resultant scarring. The recommended investigation for VUR in children less than age one year is a voiding cystourethrography using low-dose fluoroscopy. Indirect cystography, using either99mTc-mercaptoacetyltriglycine (99mTc-MAG3) or99mTc-diethylenetriamine pentaacetic acid (99mTc-DTPA) renography with reflux studies is a suitable option for older children.1 Reflux may also be assessed using microbubble ultrasound contrast media, avoiding the use of ionizing radiation.7 A99mTc-dimercaptosuccinic acid (99mTc-DMSA) radioisotope scan is performed to identify renal scarring in those patients with VUR, as ultrasound is not as sensitive in the detection of renal parenchyma abnormalities.1 The presence of renal scarring due to VUR is a relative indication for corrective surgery. This may, however, not necessarily prevent recurrence of lower UTIs. The role of IVU is limited to those who require greater anatomical detail of the upper renal tract.
Summary points:
• Divided into "uncomplicated" and "complicated" which dictates extent of evaluation and duration of treatment
• Classified into urethritis, cystitis, prostatitis, or pyelonephritis
• UTI in a male patient is regarded as complicated
• Probability of a UTI in a female patient is high
Urinary Calculus Disease
The average life-time risk of renal calculus disease is 5–10%.8 Ureteric colic is a frequent cause of emergency urological referral, with the patient presenting with characteristic radiating loin pain, vomiting, a low-grade fever, and microscopic hematuria. The differential diagnosis is wide and includes biliary colic (on the right), peptic ulcer disease, pancreatitis, and abdominal aortic aneurysm. Urinary calculi are the commonest cause of renal colic, although sloughed renal papillae, a blood clot, and fungal debris are occasionally implicated. Investigations for renal colic that follow clinical diagnosis include analysis of urine (for red cells, leukocytes, nitrites, pH and cystene), urine culture, serum creatinine, calcium, albumin, urate, and a white cell count.9 Appropriate imaging will immediately confirm the diagnosis and help to decide on management. The choice of imaging includes a plain abdominal radiograph combined with an ultrasound examination, IVU, or an unenhanced CT examination.
CT is likely to be the best single imaging investigation for ureteric calculi, as both radiolucent and radio-opaque calculi are visualized. However, in a number of countries, including the United Kingdom, the investigation of choice in renal colic remains an IVU, a situation that is likely to change to CT imaging in the future. IVU offers accurate assessment of the calculus size, site, and the degree of renal obstruction. The absence of hydro-nephrosis on ultrasound does not reliably rule out renal obstruction. Over 80% of calculi < 4 mm in diameter will pass spontaneously, but this is less likely with larger calculi.10 Patients with persistent pain, UTI, risk of pyonephrosis, renal failure, single kidney, or bilateral obstruction need urgent decompression irrespective of calculi size.
Nonobstructing calculi in the kidney may be detected incidentally, or be imaged as a consequence of investigations for pain, UTI, or hematuria. Ultrasound and CT imaging may be useful in the evaluation of radio-lucent calculi.99mTc-DMSA scintigraphy is an optional investigation used to assess the differential renal function, especially in the presence of a large "stag-horn" calculus. A complete set of investigations for calculus disease, which comprises serum creatinine, uric acid, calcium, phosphate, and a 24-hour urine assessment, is recommended for patients at high risk of forming further calculi (indicated by a positive family history or previous episodes of calculus disease). Treatment options for renal calculi include extracorporal shock-wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and endoscopic surgery; open surgery is now almost never necessary for calculus disease.9
Bladder calculi may be formed de novo in the bladder or migrate from the upper urinary tract. Bladder calculi are now rare, with primary bladder calculi occurring most often as a consequence of structural bladder abnormalities such as diverticula or voiding dys-function.9 Patients usually present with lower urinary tract symptoms (LUTS), suprapubic pain, or associated complications such as UTI, hematuria, or urinary retention. A plain abdominal radiograph often reveals the bladder calculi; an ultrasound is helpful in assessing any underlying abnormality such as residual urine and diverticula. Male patients should also have urine flow rate measured, as bladder outflow obstruction is a common cause of bladder calculi formation. Management includes removal of the calculi (usually by cystoscopy) and treating the underlying cause.
• Ureteric colic is a frequent cause of emergency urological referral
• CT is the best single imaging investigation for ureteric calculi
• Persistent pain, pyonephrosis, renal failure, single kidney or bilateral renal obstruction needs urgent decompression
• Bladder calculi are rare, occurring as a consequence of structural bladder abnormalities
Upper Urinary Tract Obstruction (Hydronephrosis)
Upper urinary tract obstruction may result from a variety of causes (Table 7.2). The presentation and natural history may vary according to the degree of obstruction. Acute upper urinary tract obstruction is often due to calculi with sloughed papillae, blood clots, renal pelvis debris, and retroperitoneal abnormalities also implicated. Chronic upper urinary tract obstruction may be further divided into equivocal (doubtful) or unequivocal. Those with equivocal obstruction may have IVU and/or ultrasound appearance of hydronephrosis or clinical symptoms such as diuresis-induced loin pain, but fail to demonstrate evidence of obstruction on99-mTc-MAG3 renography.11 The main clinical concern with both acute and chronic upper urinary tract obstruction is the risk of any resulting renal injury causing loss of renal function.
In children pelviureteric junction (PUJ) obstruction is the commonest cause of upper tract obstruction.11 Congenital PUJ obstruction may be visualized on ultrasound as early as the second trimester of pregnancy with antenatal imaging. Not all of the PUJ obstructions present on the antenatal ultrasound examination will persist after birth.11 A follow-up ultrasound examination will identify those with a persisting PUJ obstruction and allow institution of the correct management. Older children with upper urinary tract obstruction may present incidentally with pain, infection, a palpable renal mass, renal impairment, hematuria, and hypertension.11 Dhillon et al. have demonstrated the risk of surgical correction according to the degree of hydronephrosis measured as the anteroposterior diameter of the renal pelvis (Table 7.3).11,12 The indications for surgical correction may be further refined when combined with differential renal function ascertained with99mTc-MAG3 renography.11 In neonates, 99mTc-MAG3 renography may be inaccurate due to renal immaturity, with99mTc-MAG3 renography best performed at age six weeks.11 IVU in this setting may not add any further information and is therefore not routinely recommended.
Table 7.2 Causes of hydronephrosis
•Pelviureteric junction (PUJ) obstruction
• Congenital megaureter
• Ureterocele
• Vesicoureteric junction (VUJ) obstruction
• Ureteric stricture
• Ureteric tumor
• Tuberculosis
• Bilhaziasis
• Ureteric duplication
• Retroperitoneal pathology
– Retrocaval ureter
– Abdominal aortic aneurysm
– Retroperitoneal fibrosis
• Bowel/other malignancy extending into the retroperitoneum
Table 7.3 Correlation between anteroposterior diameter of the renal pelvis and the requirement for pyeloplasty
Anteroposterior diameter of therenal pelvis (mm)
Risk of requirement for pyeloplasty (%)
Surgical correction is recommended when the divided renal function is < 40% and the anterior–posterior diameter of the PUJ is > 30 mm on the affected side.11 An Anderson–Hynes pyeloplasty is the standard surgical procedure for PUJ obstruction. When there remains uncertainty, for example when the divided renal function is > 40% and the anterior–posterior diameter of the PUJ is < 30 mm, a conservative approach is usually adopted; the majority of these patients improve or remain stable.
The management of a poorly or nonfunctioning kidney (divided renal function < 15%) is more controversial; recommendations vary from an initial nephrostomy to monitor any functional improvement to immediate nephrectomy.11 A clinical decision must be based on serial functional assessment with 99mTcMAG3 renography. When bilateral PUJ obstruction is present, it is important to exclude voiding dysfunction as a cause. Radioisotope scans are unreliable in patients with bilateral PUJ obstruction.
In adults, unilateral hydronephrosis may be a result of an undetected, congenital PUJ obstruction. However, it is important to exclude other acquired causes, as 5% of transitional cell carcinomas (TCCs) occur in the upper urinary tract and may present as urinary tract obstruction. IVU is performed more frequently in adults than in children with upper urinary tract obstruction along with other investigations such as urine cytology, retrograde pyelography, and CT or magnetic resonance (MR) imaging of the retroperitoneum.
Bilateral upper urinary tract obstruction in the elderly male patient occurs most frequently due to high-pressure chronic retention as a result of bladder out-flow obstruction. Locally advanced bladder, prostate, or gynecological tumors will occasionally cause bilateral ureteric invasion, resulting in upper urinary tract obstruction with the patients usually presenting with acute renal failure. Percutaneous nephrostomy insertion under radiological guidance is the initial management, although it is best practice to insert either a double-J stent or a metallic stent across the obstruction as soon as possible.
• Due to calculi, sloughed papillae, blood clots, renal pelvis debris, and retro-peritoneal abnormalities
• Acute and chronic upper urinary tract obstruction may result in loss of renal function
• Percutaneous nephrostomy insertion is possible, although it is best practice to insert a double-J stent across the obstruction as first line management
• In children PUJ obstruction is common
The presentation of hematuria may vary from microscopic hematuria detected on urine analysis, visible blood in the urine, to blood clots causing urinary retention. The importance of careful assessment in these patients cannot be underestimated; underlying urinary tract pathology occurs frequently. Urinary tract malignancy is found four times more often in patients with macroscopic than those with microscopic hematuria; studies have suggested a 5% and 22% incidence of bladder carcinoma with microscopic and macroscopic hematuria, respectively.13–15
There are a number of causes for hematuria which include both medical and surgical diseases. Glomerulonephritis, UTIs, and childhood tumors are the main differential diagnoses in the pediatric age group. Uri-nary stones, trauma, atypical glomerulonephritis, UTI, and IgA nephropathy should be considered in young adults, whereas over age 40 urinary tract malignancy is the main concern. Complications of benign prostatic hypertrophy, such as UTI and bladder calculi, are also a common cause in older men.
Clinical assessment of patients with any form of hematuria includes a focused history and examination, urine testing, cystoscopy, and urinary tract imaging (Fig. 7.2). There remains some dispute as to the benefits of investigating microscopic hematuria in younger patients to the same extent as macroscopic hematuria in all age groups; the risk of cancer in young patients with microscopic hematuria is low.14,16 However, a study has suggested significant disease in 18.5% of patients with microscopic hematuria, which implies that a thorough evaluation is always indicated.14
Fig. 7.2 Investigation of hematuria
(MSU = midstream urine; FBC = full blood count; ESR = erythrocyte sedimentation rate; PSA = prostate-specific antigen; KUB= kidneys, ureter, bladder)
From the clinician's point of view, the most appropriate technique for imaging the upper renal tracts remains debatable. Ultrasound is the favored option as it is as accurate as an IVU for hydronephrosis and superior at imaging bladder tumors.1,16 When further imaging is indicated, CT has the advantage of tumor staging and detecting nonurological causes of hematuria.13 The most reliable method of assessing the lower urinary tract is cystoscopy.17 If a bladder tumor is demonstrated on cystoscopy, a transurethral resection (TUR) of the tumor for histological confirmation and staging may be performed. The presence of hydronephrosis, secondary to a tumor at the ureteric orifice, is frequently a sign of muscle-invasive disease.17 Over 90% of bladder tumors are TCCs, of which over 70% are superficial in nature.17 The risk of recurrence varies from 50–70% according to tumor grade.17,18 Superficial TCC may progress to invasive disease; carcinoma in situ and poorly differentiated (Grade 3) tumors pose by far the highest risk. Intravesical therapy, with either mitomycin C or epirubicin, may reduce the frequency of recurrent disease, whereas intravesical bacille Calmette–Guérin (BCG) reduces the overall recurrence rate, as well as the risk of tumor progression.19 Patients are monitored with regular cystoscopy to detect and treat any tumor recurrence. When muscle-invasive disease is present, staging with CT or MR imaging is performed. A radio-nucleotide bone scan should be requested with advanced disease. Treatment options for invasive bladder carcinoma include radical cystectomy or radiotherapy, with platinum-based chemotherapy being used in advanced disease.
• Causes for hematuria include both medical and surgical diseases
• Urinary tract malignancy is 4x more common in macroscopic than in microscopic hematuria
• There is dispute as to the benefits of investigating microscopic hematuria in younger patients
• Assessment of any form of hematuria includes a focused history and examination, urine testing, cystoscopy, and urinary tract imaging
Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia
Lower urinary tract symptoms (LUTS), affecting up to 30% of males over age 65, are a heterogeneous group of symptoms related to the bladder and bladder outflow, further divided into storage (filling) or voiding (obstructive) symptoms (Table 7.4). There are numerous causes for LUTS (Table 7.5), of which benign prostatic hyperplasia (BPH) is the commonest. The aim of assessing patients with BPH/LUTS is to establish the diagnosis, identify the cause, and manage treatment appropriately (Fig. 7.3). Patients with troublesome symptoms have a substantial improvement in quality of life following successful treatment.
Diseases of the Bladder and Prostate
Ultrasound of the Pediatric Urogenital Tract
Non-Ultrasound Imaging of the Urogenital Tract
Oncological Management of Tumors of the Urogenital Tract
Parenchymal Diseases of the Kidney
Diseases of the Testis and Epididymis
Focal Lesions of the Kidney
Tags: Ultrasound of the Urogenital System
Jan 14, 2016 | Posted by admin in GENITOURINARY IMAGING | Comments Off on The Urogenital Tract: Surgical Overview


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The Hot Chocolate Run is a community celebration of Safe Passage, the Hampshire County organization addressing domestic violence.
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