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Urology – Professional Education
Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center are committed to establishing and maintaining high-quality Graduate Medical Education training programs.
Contact us
To learn more about educational programs in Urology, call
Our institution provides the diverse patient population, dedicated faculty, excellent clinical and basic science departments, and nationally recognized research programs required to create an environment optimal for learning and for the development of future leaders in the art and science of medicine.
Learn more about the Urology fellowship program listed below.
Residencies and Fellowships
Find more information about all of our residency and fellowship programs.
Urology Residency
Our urology residency training program is intended to develop a superb urologist who has as his or her primary concern the health and well being of the patient. The program fosters lifelong learning skills, an appreciation for research, and the ability to critically evaluate future medical and surgical therapies to enable the physician to incorporate valuable newly developed treatments into his or her practice.
Surgery Clerkships
The Department of Surgery offers both third-year clerkships as well as fourth-year electives and acting internships. Elective information can be found at the bottom of this page.


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Spun Poly is an excellent tablecloth fabric that has the look and feel of cotton and very soft. Heavyweight fabric and durable. Popular with upscale hotels, resorts and fine dining restaurants. Spun Polyester looks and feels like cotton. In fact, it's amazing how Polyester can feel so much like Cotton. However, it's machine washable, tumble dryer safe, does not shrink and performs like high-end Polyester should.

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By Don Lee
By Don Lee
Tribune Washington Bureau
WASHINGTON — Despite dark clouds in the global and U.S. economies, American consumers are feeling more upbeat than they have at any time since the fall of 2007.
That is according to an unexpectedly strong reading of consumer sentiment from the University of Michigan and Thomson Reuters, released Friday. The report suggests that the holiday shopping season could turn out stronger than forecast.
The index jumped to 83.1 in October — nearly a five-point gain from the previous month and the highest since September 2007.
Measures of both components of the index — people's assessment of their current financial conditions and future expectations — went up over the month. Sentiment improved for families making more than $75,000, as well as those making less.
Most analysts had forecast a slight drop in consumer confidence this month, given persistent sluggish growth at home and increasing worries about a global slowdown. Hiring continues to be slow, gas prices remain high, and businesses and many others are concerned about looming tax increases and fiscal spending cuts set to take effect in January.
But consumers seem to be wearing these troubles like a light sweater. The Michigan survey is the third economic report in a week to show a post-recession best.
Last Friday, the Labor Department reported that the unemployment rate fell to a 3½-year low of 7.8 percent in September, and on Thursday officials said new jobless claims last week fell to their lowest level since February 2008.
Although many are skeptical about the big drops in jobless rate and weekly claims, the latest consumer-confidence measure may reflect a pick-up in job growth from spring, more signs of a recovering housing market, and somewhat calmer headlines coming out of the eurozone. Plus, the Federal Reserve last month launched a new round of monetary stimulus and pledged to fight high joblessness with everything it has.
"On the whole, this is a very encouraging report, especially given that the gains were spread out across components of the index, income groups and geographies," economists at Barclays Bank wrote after the consumer survey's release. "We expect that consumer sentiment will continue to move higher as the labor market recovery picks up and income trends improve."


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WHITE HOUSE RECAP: February 18-24, 2012
The Obama White House has had a great week — featuring BB King, the Boeing Dreamliner, a speech about American energy, a payroll tax cut extension, and special musical guest Keb Mo.
West Wing Week: 2/24/12 or West Wing Week 100!
Source: WH, 2-24-12
It's hard to believe that when West Wing Week was born, "Don't Ask Don't Tell" was still around, American troops were still fighting in Iraq, the American auto industry was on the brink of collapse, and nobody knew that President Obama could sing — what a difference 694 days makes. We've got a great week for you — featuring BB King, the Boeing Dreamliner, a speech about American energy, a payroll tax cut extension, and special musical guest Keb Mo.
Weekly Wrap Up: "Sweet Home Chicago"
Source: WH, 2-24-12
Your Voice, Your $40: On Wednesday, the President signed the Middle Class Tax Relief and Job Creation Act of 2012, which extends the payroll tax cut and emergency jobless benefits through the end of the year. He credits the Americans who added their voices to the debate by letting their representatives know what $40 means to them—"This got done because of you…You made it clear that you wanted to see some common sense in Washington."
President Obama, In Performance: Some huge names in music—Mick Jagger and B.B. King, among others—joined the President and the First Lady for a night of blues on Tuesday as part of the PBS "In Performance at the White House" series. By now, we're no strangers to the President's impressive pipes, and he certainly held his own against the music legends as he sang a few lines of "Sweet Home Chicago."
New Museum on the Block: Tourists and locals alike appreciate Washington, D.C.'s museums. In 2015, a new one will open its doors—the Smithsonian National Museum of African American History and Culture. The President, who was accompanied by the First Lady at the future museum's ground breaking on Wednesday morning, remarked that, "This museum should inspire us…It should stand as proof that the most important things rarely come quickly or easily. It should remind us that although we have yet to reach the mountaintop, we cannot stop climbing."
CC2C: Dr. Jill Biden and Labor Secretary Hilda Solis hit the road this week for their three-day "Community College to Career" bus tour to highlight the integral role community colleges play in developing a flexible, highly-skilled 21st century workforce.
Welcome to Miami: President Obama visited the Sunshine State on Thursday and stopped at the University of Miami to check out their Industrial Assessment Center (IAC)—a smart and important piece of the administration's "all-of-the-above" approach to domestic energy sources. He also spoke to the Hurricanes about securing a future for America built on home-grown energy, and his blueprint to help us get there.


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A photo gallery featuring images created by photojournalism students in Penn State's College of Communications throughout the 2014 spring semester.
Com-Photojournalism_students -spring14-1011
Members of Natya, an Indian classical dance team, on stage at Schwab Auditorium. The group performed in Penn State's Best Dance Crew competition. Photo by Kristina Slacum
Com-Photojournalism_students -spring14-1012
Logan Bryan,age 4, the son of a THON Four Diamonds cancer survivor, danced on stage with the Nittany Lion during the final hours of THON 2014 at Penn State's Bryce Jordan Center. Photo by Britany Nelson.
Com-Photojournalism_students -spring14-1013
Jenny Litz, left, and Bob Livsey helped to push a car out of the snow on West Calder Way in downtown State College on Wednesday February 5, 2014. A winter storm warning was advised, predicting 5 to 10 inches of snow and ice accumulation. Photo by Hannah Bressi
Com-Photojournalism_students -spring14-1014
Cassidy Comly cleaned a bathroom in the Business Building on Penn State's University Park campus on the evening of March 5, 2014. Comly, a freshman studying engineering, works at Penn State to help pay for her education. Photo by Matt Nestor.
Com-Photojournalism_students -spring14-1020
Alissa Gothberg read some class material while surfing the web for chapter questions and analysis in her residence hall room on May 6, 2014. Photo by Alexandra Halley.
Com-Photojournalism_students -spring14-1015
Max Rohn practiced his discus throw at the Multi-Sports Complex track at on Penn State's University Park campus on April 24, 2014. Rohn competed with the USA Paralympic Track and Field National Team in 2013 for shot put and has been working to improve his discus and javelin throws. He lost his right leg serving with the US Navy in Iraq in 2009. Photo by Ashley Cummings.
Com-Photojournalism_students -spring14-1018
Emma Lindsay Johnson, age 10, a THON child from Hershey, PA, had a group hug with members of the Whiplash Dance Team after their performance at THON on Friday, Februrary 21, 2014. The Whiplash Dance Team also identified themselves as Emma's Army throughout the three-day event at Penn State's Bryce Jordan Center. Photo by Shurong Liu.
Com-Photojournalism_students -spring14-1016
Penn State's Katie Muller, right, battled for the ball against Harvard's Rachael Foo in their rugby match at Penn State on April 4, 2014. Penn State defeated Harvard 50-12. Photo by Allie Coleman.
Com-Photojournalism_students -spring14-1017
The Palmer Museum of Art on Penn State's University Park campus is a free-admission arts resource for the University and surrounding communities in Central Pennsylvania. Photo by Ana Zelada.
Com-Photojournalism_students -spring14-1019
Penn State head coach James Franklin talked to quarterback Christian Hackenberg on the sideline during the Blue-White game at Beaver Stadium on April 12, 2014. Photo by Kelsie Netzer.


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Constellation Energy Group and Exelon Corp. are expected to close their $7.9 billion merger Monday, after the deal cleared its final regulatory hurdle Friday.
The approval by the Federal Energy Regulatory Commission ends an almost yearlong effort to combine the companies — creating the largest non-utility energy provider in the United States. The deal also means that Baltimore will lose its last Fortune 500 company; the new company will be headquartered in Chicago but will maintain a large footprint here, including a new building in Harbor Point.
Separately on Friday, Constellation agreed to pay $245 million to settle FERC's allegations that the company manipulated the New York wholesale energy market through its trades from September 2007 to December 2008. The FERC's claims were revealed for the first time Friday.
While the company said it disagreed with the FERC's investigation and admits no wrongdoing, Constellation Chairman and CEO Mayo A. Shattuck III said in a statement that "we believe it is in the interest of all parties to settle this case and avoid expensive, protracted litigation."
Once the merger closes, each of Constellation's Baltimore Gas and Electric residential customers can expect to receive a one-time $100 rate credit within 90 days. The rate relief was among dozens of conditions that the two energy companies have agreed to provide as part of a settlement with state regulators and Gov. Martin O'Malley.
"We are pleased to now be able to proceed with this transaction and unite our two companies," said Shattuck, who will become the combined company's executive chairman.
The Maryland Office of People's Counsel, the state's consumer advocate, and its counterpart in Pennsylvania had raised concerns that the combined company would hold too much market power in the PJM Mid-Atlantic electricity grid, potentially pushing wholesale electricity prices higher.
But in its 48-page order, FERC said it found that the merger "will not harm competition in the relevant geographic markets" in part because the companies had agreed to several conditions to alleviate those concerns. The conditions include selling three Maryland plants that employ 300 workers in Baltimore and Anne Arundel counties.
The coal-fired plants — Brandon Shores and H.A. Wagner in Anne Arundel County, and C.P. Crane in Baltimore County — generate 2,648 megawatts of power.
"[W]e conditionally authorize the Proposed Transaction as consistent with the public interest," Nathaniel J. Davis Sr., the agency's deputy secretary, wrote in the order.
The Maryland Public Service Commission, seen as the toughest regulatory obstacle to overcome, approved Constellation's sale in mid-February. Constellation and Exelon agreed to several dozen conditions that largely mirrored concessions the companies had previously promised, most recently under a $1 billion settlement with O'Malley.
Besides the $100 rate credit, the companies agreed to provide more investments in green energy, financial aid for low-income ratepayers and additional financial protections for BGE.
Come Monday, Shattuck will finally realize the sale of the company that he has led since 2001. Two previous plans to sell the company had collapsed.
Three years ago, Constellation faced an uncertain future as a credit crunch amid the financial crisis pushed the company to the brink of bankruptcy. The company's commodities trading operation, which required a lot of cash collateral, was the source of its credit troubles.
The FERC allegations about market manipulation related to some Constellation transactions in New York are different from the liquidity issues that the business faced in 2008.
Under the FERC settlement, the company agreed to pay a $135 million civil penalty and another $110 million, which will be distributed in two ways.
Constellation will provide $1 million to each of the six U.S. regional grid operators, while the remaining money will be directed to a fund overseen by a FERC administrative law judge. The fund is designed to benefit consumers in the six grid markets, and state agencies can request the money on behalf of the consumers.
In an email Friday to employees, which was obtained by The Baltimore Sun, Shattuck said it was in the company's best interest to settle FERC's allegations to move ahead with the merger. He added that the company "would have preferred the opportunity to argue our case with full transparency."
"I want to strongly reinforce that in our view we violated no FERC or [New York's wholesale market] rules," Shattuck wrote. "We engaged in lawful hedging and risk-management activities."
After the deal closes, Constellation and the 195-year-old BGE will become part of Exelon. Executives of the two companies believe the combined company, called Exelon, will be better able to weather the increasingly competitive and capital-intensive energy market.
Still, the merger is expected to lead to the elimination of about 630 positions across both companies, with job reductions felt most in Baltimore. Exelon has committed to building a new skyscraper in downtown Baltimore, and picked Harbor Point as the site.
Constellation's name will not go away entirely. The brand will remain for the companies' retail and marketing business, which will be based in Baltimore.
The FERC merger order can be read here.
Sun reporter Steve Kilar contributed to this article.


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If Aliens come here there shall be future shock for great many.
Marvel Comics will simply have to be airbrushed away. Out with kryptonite and batman's cape. Both shall be replaced by something more life-like, I mean Alien-size to fit three microns width of alien forms.
Those who swore by Star Wars and genuflected before some sci-fi mumbo-jumbo will simply dig a hole and be nomads of the Middle Kingdom.
Scientology will prove to be the Emperor's New Clothes. Some Alien street Arab will point to the ridiculous travesty of Religion and laugh their heads off. Is it Mission Impossible Mr. Cruise?
Those paranormalists will levitate while their brains that they left behind will go around asking if their brains can be set right.
Harry Potter will learn that he simply cannot escape the Hall of Incoherence in which he is trapped between bad prose and infantile fantasies.
These are some of the future shocks we are going to live with. Aliens will show themselves. Whether we take them for what they are depends on this question: Have we learned to separate the real from fantasy? If we have not set our upper case in order we will see Aliens and look to the sky while ther are down at our feet.
Think of all the conspiracy theories we have; do they speak well as to our judgment or our intellect? We have learned to progress while undermining progressively the learning. We have covered up our tracks in such a fashion we all have become too clever for our own good. We merely lived not with human beings with real problems. We escaped instead in virtual reality. Perhaps the invasion of Aliens ,-not in a negetive sense but in moral terms, may drive us to give learning its right value. Not the instant gratification but acquisition of maturity by willing to pay the price for becoming real human beings.
Tailspin:What value is to bend spoons? Aliens may teach Uri geller (if his gift is genuine) a few tricks to make some real contribution to science. For instance relation between mind and matter and not limit it to some spoons and forks.
LONDON (AP) – British astrophysicist Stephen Hawking says aliens are out there, but it could be too dangerous for humans to interact with extraterrestrial life.
The 68-year-old scientist says a visit by extraterrestrials to Earth would be like Christopher Columbus arriving in the Americas, "which didn't turn out very well for the Native Americans."
He speculates most extraterrestrial life will be similar to microbes, or small animals – but adds advanced lifeforms may be "nomads, looking to conquer and colonize."(Ack:The Chicago Tribune-AP Press)


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World Exclusive: The Zeno Clash Review
We've been playing Zeno Clash. Developers Ace Team were kind enough to suggest that we should furnish you with the world's first review of their insane beat 'em up. Our razor-sharp analysis of defeating elephantmen and bludgeoning lunatics follows.
Jim: Right, our subject today is the esoteric fist 'em up, Zeno Clash, by Chilean types, Ace Team.
Alec: I liked the bit where I repeatedly punched a bird-man in the face.
Jim: Bird-men are scum.
Kieron: Shall I do a brief fact-o-list of the game so we have the FACTS on the table?
Jim: Yes, facts, because facts are super-true.
John: I once heard that a fact can be so true it can slice a lie in half.
Kieron: Right – Zeno Clash is a linear first-person fighting (with bits of shooting) game built in the Source Engine. There's no multiplayer, bar a challenge mode where you can compete to beat friend's scores in set battles. It's ACE team's first game. They live in Chile. And that is all for the facts. SUBJECTIVITY ENGINES GO!
Jim: I believe it's only available on Steam, at least initially? That might be a fact?
Kieron: No, it's not. It's on Direct To Drive.
Jim: Ok then, no fact there.
Kieron: Oh – for the record, how much has everyone actually played of the thing? I've finished it and played some of the challenges.
Jim: I finished it and I've not played any challenges.
Alec: I am on the very last fight, but became annoyed by it and haven't yet completed it. I've also done a few of the challenges.
John: I've finished it ten minutes ago, so no challenges.
Jim: So it's a game of melee, and of shooting. But it's not much like any FPS I can think of. Can anyone think of any good comparisons or references to help give this game of context?
Alec: It reminded me a little of Riddick, but only a little.
Jim: Oh yes, Riddick is the closest in terms of sheer fist-action.
John: Hmmm, imagine if Condemned were set in the world of Mirrormask, and not shit.
Alec: Aesthetically, it's Outcast meets a slew of crazy late-90s French adventure games.
Kieron: I think it's actually a lot like a trad linear fighting game ala Double Dragon, as in, you move from fight to fight and it makes no pretense of being a "world".
Jim: Yes, it did feel rather like the FPS rejig of a classic scrolling beat 'em up.
Alec: It cheerfully repeats its enemies in the same way. That curious thing of fighting games: "oh, it's that guy again."
Kieron: Yeah – in a "You've had this guy – now fight this guy with a little friend" way.
Jim: Even down to food lying about to heal you up.
Kieron: But fruit instead of chicken. So healthier.
Alec: Mmmm. Chicken.
Jim: Yes, and it does feel healthy, as a game.
John: Going back a step: I don't think that's fair to the aesthetics, Alec. Those French adventures were lazy in their surrealism, just doodles for the hell of it. This feels like Bosch meets Dave McKean.
Jim: Quite so. It's really unusual to look at. The visuals are something of a reward, I felt.
Alec: Yes, the main driving force for me was to see what new madness they'd show me. And agreed, it's far more visually imaginative than those old adventure games – I was just scrabbling for some sort of context.
Jim: Anyone not actually like it?
John: Only a dangerous idiot wouldn't enjoy it.
Kieron: No, adored it. Reminded me of French graphic novels too.
Jim: If one part of it disappointed me, it was that it didn't escalate the craziness at the end – that final arena was *boring*.
John: And familiar.
Alec: Yeah, after the boat ride it pretty much just repeated earlier stuff.
Jim: Where as the beach whale-monster, or the giant elephant-giraffe things were incredible.
Alec: It does suffer a little from the Halo backtrack/repeat effect.
Kieron: Actually, about the graphical style – it's worth noting that Alejandro Jodorowsky is actually Chilean. It feels a lot like a Jodorowsky joint. Even the plot.
Jim: Is he? I thought he was Spanish
Kieron: No, Chilean.
Alec: (The readers will have no idea what we're talking about now. Giant elephant-giraffes, readers! With sheds hanging from their necks!)
Jim: Yeah, those should give you a gist of the kind of world it is, it's probably one of the maddest I've seen since Sacrifice.
Kieron: For the uninitated – Jodorowsky's a writer/director chap best known either for his weirdo westerns (El Topo, etc) or his comics (Metabarons) or just being gloriously mental. Anyway, yeah – someone paraphrase the plot.
Jim: Hmm, well, the raw story Zeno Clash tells is actually fairly unexciting. It's journey of discovery thing. A young male protagonist fleeing after killing his monstrous "Father-Mother"
John: And having learned a terrible secret. Trying to return home, he's outcast by his siblings. He had joined a clan called the Corwids of the Free, a group "not slaves to reality or common sense." But their insanity makes them his enemies too. So he's trying to escape, along with a friend, to find new hope.
Kieron: It's the mentalness of the details which elevates the stories – the woods full of monomaniacal psychopaths, for example. They were amazing.
Jim: His friend seems like the biggest mystery of the game, to me. The actual key plot "mystery" was obvious fairly early on, but his companion remains unexplained.
Kieron: She's an odd un, isn't she?
Alec: She's just a friend/lover, with antlers on her 'ead.
Jim: That old cliché.
Kieron: She's Alyx with an enormous furry hat.
John: I figured that was splendid hair.
Alec: She's curiously uninvolved – always disappears off to a safe ledge as you face-punch people.
Jim: Going back to what Kieron was saying about the Corwids: the entire game felt a bit like an excuse for the incredible character designs. Your companion is part of that, but just a tiny part: almost everything you meet is an awesome concept.
Alec: Yes. The Corwids are really there so that you can tour through a bunch of mad ideas, though they're affectingly tragic too. There's that bit where the narration tells you about one who basically curled up and died. And then later you actually pass her body – it's weirdly distressing to do so.
Kieron: There' s a real poetry to them.
John: Does this remind people of films like The Labyrinth and MirrorMask? A series of extraordinary visuals, loosely sewn together as a story.
Kieron: Yeah, a little – but really, much more the French stuff which you haven't read.
John: Actually, it reminds me more of a Serbian thing that you've never even heard of.
Jim: No, it's like Chinese stuff from a future only I can see.
Kieron: CHINA!
Alec: I definitely got a vague Metabarons vibe off it.
Jim: It does have a real whiff of esoterism to it, and I wonder if that will put people off.
Kieron: Maybe. But I dunno – to choose an example of its ideas, one of the Corwids who believes it's most important to be invisible. To do so, he tears out everyone else's eyes. I think that stuff captures the imagination.
John: Anyway, shall we talk about the game itself? I had thought, having played the few preview levels before, that it was just going to be a series of arena fights. So I was really delighted by the magic torch sequences.
Jim: Yes, it just about manages to be varied enough
Alec: If it had just been fight to fight to fight it would have failed, but it's impressively diverse, with the exception of the last three-ish levels.
Jim: how does everyone feel about that base-line action: the melee combat? I was surprised by how good it felt.
John: I was really worried it wouldn't work. I was convinced it would become a jumble. But it's just stunning. I never got a good hang of the blocking, but I wonder if that's because I never get the hang of blocking in games.
Alec: The only thing I thought was that some of the modeling is off – some beasts' punch-range doesn't seem to match the visible length of their arms, or their distance from you.
Jim: Boss battles in an FPS are usually achingly rubbish, but with perhaps the exception of the very end, the "character battles" in Zeno Clash are really something, especially the parachuting squirrel-bomb sequences.
Kieron: My main problem was the lock on system – where you lock onto an enemy and can circle them – was on the same key you use to pick up stuff. So trying to make a grab at an object near a baddie was literally impossible. And allow me to repeat what Jim just said: "Parachuting Squirrel Bomb sequences."
Jim: In terms of feeling manageable, and visceral, the melee is about as good as anything other than Riddick.
Alec: The other thing that annoyed in the melee was if you knocked someone down they were automatically de-targeted, and if you had a gun at the time, that would auto-pop up, which totally alters the fighting style.
Jim: Yes, that was what was interesting about it how it mixed in the ranged combat: it allowed you to put away your weapon and fight, or to have it knocked from your hands when an enemy got close. You could try to play a shooter at times, but it wouldn't work. Or, at least, it would only work so far.
Alec: I was actively trying to get my weapon knocked out my hands at times, just so it wouldn't pop up whenever I knocked a guy down.
Jim: I didn't notice that, but then I generally had the weapon knocked away from me.
Kieron: The problem with that is how long some moves take – like, say, reloading. How slow you move when you reload is… grating.
John: On a number of occasions, in the middle of a battle, it would take control away from you and show a cutscene in which you were losing. And I bloody wasn't! It did this twice when you've actually beaten the enemy, cutting to your being held to the ground and only winning by an action in the cutscene. I WON THAT!
John: So what were the other problems, Kieron?
Kieron: Doesn't end, for a start.
John: It sure seemed like it ended.
Kieron: Explain Golem. What did Golem do? Who was the enormous dude? All the spoiler stuff we can't really talk about in this verdict?
Jim: The end was unsatisfactory. I think it needed a bigger reveal to be any good – I'd already guessed the secret.
Kieron: I didn't. I wasn't trying, admittedly. I thought it was a pretty funny secret.
John: I was perfectly happy with it. I didn't guess the secret, which I guess helps.
Alec: I shrugged the story off as cheerfully inchoherent bunkum – just a backbone to show us mad stuff.
Kieron: But fuck you, y'know? I paid for a story. You didn't say it would be a Halo 2.
John: I paid for fistifights. Well, none of us paid a thing because we're too important.
Kieron: Well, obviously.
John: Regarding linearity, I think that's great. Double Dragon was linear. Hell, the Half-Life games are linear. It's an ideal way to give us this sort of game.
Jim: Kieron, you're not satisfied with just the ideas and the fights? I think that would be enough for most people?
Kieron: Oh, I like the game a lot. But I think for developers to end their first game with so many things open is an act of incredible arrogance.
John: It felt more dreamlike for me. Aimless start and aimless end, with a couple of threads through the middle.
Jim: It is quite dreamlike in that way, but then the narrative of dreams tend to not be much good. It's an incredibly visual game, and not in an "oh we're showing off with technology" way. It was more about their abilities as animators and artists. And even the voice acting is okay.
Kieron: Which is all the more amazing when it appears to have been done by the team.
John: There's so many needless mistakes.
Jim: I think you're exaggerating that, John. Look at it in the context of almost every other foreign game. The dialogue is fine.
John: I'm not exaggerating that there were many needless mistakes.
Jim: Oh come on, the voice acting in Men Of War makes Zeno Clash seem like an Oscar winner.
John: The subtitles were littered with typos, and many statements weren't correct.
Jim: I didn't have any subtitles, mistakes in the subtitles would emphasize it enormously.
Kieron: I dunno. It felt okay, in a translated foreign film way.
Alec: When the world it depicts is so strange and alien, it's easier to forgive grammar messiness. They almost add to the strangeness, in the way they did with Russian in Stalker SHOC.
John: I think that's nonsense.
Kieron: I didn't notice a single typo.
Jim: And in the game? Aaaanyway, does anyone have anything they've not yet vented?
Kieron: We haven't even hit the major problems, you know? As in, it's 4 hours long.
Jim: How much is it going to cost at release? Because for £7 on pre-order, that seems okay.
Kieron: When its released, its 15 quid.
Alec: I genuinely think it would have outstayed its welcome if it got much longer, some of the multi-enemy fights were getting pretty frustrating as they were – if it had been longer, it would probably have involved more escalation and thus become miserably hard.
Jim: I think it could have been longer, if they'd had more visual awesomeness to throw at us. Towards the end it was losing that edge, for me.
Alec: It's best they quit while they were still ahead.
Kieron: Which actually seems reasonable for me – you're right, that they'd have to have added more art assets and general mentalness to justify extending the game. As a budget game, it sits right. I think the actual challenges show the game's combat system up for the best actually – stuff like enemies fighting each other becomes much more important.
Jim: Do the challenge mode things have any life to them? I mean, I can't see myself replaying the story any time soon
Alec: If you're into competing with your mates for leaderboard places, maybe.
John: I want to say about the melee: The visceral nature of the combat is just astonishing. The force and heft makes you reel, and the sense of contact is incredible.
Kieron: Totally. KICK! PUNCH!
Alec: It's incredibly brutal in its feedback loop. I really felt bad about kicking guys when they're down.
Kieron: Yeah. I mean, I didn't feel bad. I felt ruthless. For me, the height of the game is stuff like stunning an enemy, grabbing him, kneeing him in the face three times – no more – and then throwing him to my left, where I know another enemy is, knocking them both over.
Jim: Compared to Mechants Of Brooklyn – a very similar project in size and attitude – this is a true feat of design and production.
John: We've been quite picky about bits and pieces, but I think that's testament to the fantastic standard overall. It in no way feels like the first game from an indie developer.
Alec: Yes, we're not criticising its fundamentals. It's an FPS fisticuffs game that looks and feels incredible.
John: My concluding remarks would be: Amazingly brutal, properly good melee combat, in the most beautiful lunatic world.
Jim: Enough! VERDICT!
John: BUY!
Alec: The Meerian thumb is aloft.
Jim: BUY!
Kieron: Yeah, thumbs up. If you're interested, I suggest you pre-order now. It's ten dollars on Direct2Drive right now, a 50% off offer which ends on Sunday night. On Steam it's only 25% off, but that's up to launch, I believe.
Our verdict: SALE!
Jim: Hooray, good work, Ace Team. The name proves befitting.
Kieron: I've always wanted to punch an elephant.
John: RPS instructs you to buy this immediately.


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A Closer Look At Beaming The Columns In The Charcot Diabetic Foot
In the unstable Charcot foot, the concept of beaming may help patients with diabetes attain stability and greater weightbearing. These authors discuss the pathway of Charcot neuroarthropathy and offer essential surgical pearls. Charcot neuroarthropathy is a disease that arises secondarily in patients with diabetes mellitus and peripheral neuropathy although there are cases of Charcot in which patients may or may not have diabetes or neuropathy.1 Due to fast food diets and eating-on-the-go lifestyles, diabetes has become an epidemic across the globe.2 Charcot neuroarthropathy results in structural deformities and most commonly occurs in the foot and ankle. Bony deformities of the foot can result in the development of ulcerations in areas of high pressure. Diabetic foot ulcers are a frequent cause of foot amputations.2 Charcot neuroarthropathy disease is characterized by increased local bone resorption by osteoclasts in small weightbearing joints, particularly in the foot. Osteoclasts are among the three main cells present in bone and they resorb bone tissue.3 The elevated bone resorptive process that occurs in Charcot neuroarthropathy is a product of more than just one cellular pathway. The receptor activator of nuclear factor-kB ligand (RANKL) is an integral component in the regulation of osteoclast differentiation and activation. The RANKL activates the osteoclast membrane protein known as RANK.4 Advanced glycation end products (AGEs) regulate RANKL activation. The AGEs modify type 1 collagen and these end products are a normal result of aging but can form prematurely.5 The receptor for advanced glycation end products (RAGE) expresses continually and increases RANKL activation. The soluble receptor for AGE (sRAGE) down-regulates RANKL activation.6
Current Insights On Pathways For Charcot NeuroarthropathyResearchers have yet to determine the cellular process primarily responsible for Charcot neuroarthropathy but there are multiple pathways to consider. Receptor activator of nuclear factor-kB ligand induces the activation and differentiation of osteoclasts by binding to the osteoclasts' RANK.7 Both RANK and RANKL are expressed constitutively. The RANKL overproduction is a characteristic of Charcot but it is not limited to Charcot. It also occurs in many bone diseases such as psoriatic arthritis, rheumatoid arthritis and osteoporosis.1 In a study involving three patient groups, Mabilleau and colleagues compared monocyte formation into osteoclasts and osteoclastic activity in vitro with and without the addition of RANKL.8 The groups included patients with diabetic Charcot neuroarthropathy, healthy patients and patients with diabetes. Without the addition of RANKL, researchers noted a significant increase in osteoclast formation in the Charcot group in comparison with the healthy and control groups. There was also increased osteoclastic activity in the Charcot group in comparison with the others. With the presence of RANKL, the study authors noted an increase in osteoclastic activity in all three of the groups.8 However, osteoclastic activity was considerably more aggressive in the Charcot neuroarthropathy group and was four times greater than the osteoclastic activity in the healthy group. Osteoclasts in patients with Charcot neuroarthropathy differentiate to become highly active.5 The formation of AGEs is a common consequence of aging. Increased AGE production occurs in patients with prolonged elevated blood glucose levels, frequently termed hyperglycemia. Advanced glycation end products modify N-carboxymethyl lysine of type I collagen (CML collagen).9 The post-translational modification of the CML collagen occurs by non-enzymatic glycosylation, termed glycation. This primarily occurs in tissues with a slow turnover rate, exposing collagen proteins to the extracellular environment where non-enzymatic glycosylation takes place.5 Advanced glycation end products crosslink within and around collagen fibers, and compromise their functionality.10 Type 1 collagen's main function is to resist tension and accounts for the for rigidity in bone. Its primary locations are skin, tendon, bone and dentin.6 Collagen crosslinking within bone is known to affect bone stiffness and Young's modulus independent of the bones' mineralization and microarchitecture. This leads to weakening of bone strength without evidence of demineralization.11 Advanced glycation end product accumulation recruits the increased formation of the pattern recognition receptor for AGE, known as RAGE, which expresses constitutively and causes increased downstream activation of RANKL when bound. According to Macaione and colleagues, increased RANKL activation causes osteoclastogenesis.12 The soluble receptor (sRAGE) competes with RAGE to bind RANKL. The sRAGE also inhibits RAGE by binding to RAGE.13 Witzke and colleagues assessed the loss of RAGE defense as a cause of Charcot neuroarthropathy by focusing on three groups of patients.6 The three groups included healthy control patients, patients with type 2 diabetes and patients with diabetic Charcot neuroarthropathy. Researchers recorded circulating levels of sRAGE and bone stiffness for each group. The study authors noted an 86 percent decrease in sRAGE values for patients with Charcot neuroarthropathy in comparison to the healthy control population. Bone stiffness was markedly reduced in the Charcot group. The study authors concluded that RAGE did in fact increase RANKL activation and RANKL is responsible for increased osteoclastic activity. Additionally, a reduction in bone stiffness with a concomitant increase in bone density may suggest a pathologic proliferation of cross-linked collagen. Another potentially deleterious effect of reduction in circulating sRAGE is AGE-induced osteoblast apoptosis, which has been implicated in alterations to bone repair in the face of elevated osteocalcin.13 This may explain why Charcot fusion sites remain weak even after consolidation. For the foot and ankle surgeon, the most important part of these biochemical studies is the finding that bone stiffness was markedly reduced in patients with Charcot neuroarthropathy.6 These findings correlate directly with studies that demonstrate decreased Young's modulus of elasticity and tensile strength in the Achilles tendon in patients with Charcot neuroarthropathy.14 Carboxymethyl lysine of type I collagen is a major constituent of bone, tendon and the ligaments that holds bones together. There is a combination of biochemical evidence and laboratory testing evidence that shows that AGE radically alters bone and tendon.14 The best clinical treatment solution for this process would be a reversal of AGEs or a replacement of sRAGE, but these options are not feasible at this time.
Why Beaming May Be Effective In CharcotThe alternative for surgeons is to design methods of reconstruction that deal directly with the decrease in tissue strength. This demands an approach different from traditional fixation with plates and/or screws that count on a normal healthy arthrodesis to be the arbiter of load bearing. In fact with Charcot neuroarthropathy, even if arthrodesis occurs, there is compelling evidence to believe that the healed bones are abnormal and at risk of re-fracture.15 The concept of beaming is such a solution. In the field of engineering, beams accept loads of tension and compression. These are exactly the same types of loads that the foot experiences during weightbearing and propulsion. In the case of Charcot neuroarthropathy, beaming provides the appropriate load sharing for pathologic bone and ligament.15 Medial and lateral column beaming can clinically increase the stability of the hindfoot and arthrodesis of the Lisfranc joint in patients with Charcot neuroarthropathy. When the foot receives the axial load of weightbearing, there is maximum load at the level of the subtalar joint with the creation of bending moments posteriorly toward the calcaneus and distally toward the first metatarsal head. The dorsal surface of the foot is under compression and the plantar surface of the foot bones are under tension. Surgeons currently perform beaming by using large diameter cannulated screws. From a surgical perspective, there are two columns to beam for Charcot. There is the medial column to include the first metatarsal, medial cuneiform, navicular and talus. There is also the lateral column to include the bases of the fourth and fifth metatarsals, the cuboid and calcaneus. From a reconstructive perspective, the two columns act independently.16 Beaming the medial column, however, will improve the function of the lateral column but the reverse is not true. A beamed lateral column is not capable of providing a stable and propulsive medial column. In many instances, we see a unique biomechanical combination of events with Charcot neuroarthropathy. We see a collapsed medial longitudinal arch and a simultaneous ulcer laterally beneath the cuboid and a varus heel. This represents the reactive forces of weightbearing on a foot with a contracted and inelastic Achilles tendon and weakened midfoot ligaments that fail. The bases of the lesser metatarsals dislocate and sit dorsal to the cuboid, pushing the cuboid through the plantar surface of the foot. The peroneus longus and brevis tendons lose their functional pull with the cuboid altering the tendon balance. An unopposed tibialis posterior pulls the hindfoot into varus, instigating medial column collapses and an inability of the first metatarsal to bear weight, creating a rocker bottom.14 Beaming as a basic construct for reconstruction of both columns represents a surgical solution to a metabolic disease.
A Guide To The Art Of BeamingIn a severe Charcot midfoot collapse, beaming of the columns can act as a simple solution to a complex anatomic dilemma with fracture and/or dislocation at multiple joints. Simply stated, a beam down the medial column can align the first metatarsal, medial cuneiform, navicular and talus in a rectus alignment swiftly and surely as in the radiograph image below. Since the screw is cannulated, one can use a Steinmann pin to directly align all fractures and dislocations. It is the senior author's experience that it is sometimes easier to remove some of the most dislocated/fractured bones, allowing one to manipulate the foot more easily into a rectus alignment with a Steinmann pin, replacing the dislocated bones just prior to beam placement. Similarly on the lateral column, removal of a plantar dislocated cuboid from its non-anatomic location, debriding the cuboid on the back table and replacing it in an anatomically correct position can serve to eliminate the causation of the plantar ulcer and restore peroneal tendon function. The beams need to cross multiple joints beyond the joints that were fractured or dislocated.17 This is because the underlying disease is present in all of the joints and can be progressive if load sharing does not happen. Furthermore, in many instances of Charcot, segments of the midfoot bones are virtually destroyed. Currently, we are investigating substitutes for those bones but until those become available, we frequently simply beam across the void, packing it with bone chips, platelet rich plasma and stem cells. It is understood that the beams will support the load, share the load with the remaining diseased bones and produce a framework for stability and weightbearing. The question arises as to whether one should lock the medial and lateral columns with fusion of the subtalar joint or with a subtalar implant. The subtalar implant is the senior author's preference because it limits any subtalar motion that is abnormal without completely eliminating inversion and eversion. Accordingly, there can be some mobile adaptation of the foot to the supporting surface on which it ambulates and, at the same time, the two columns can now serve to support each other. It has been the senior author's experience that of the two columns, the medial column is vastly more important in Charcot reconstruction. If one removes the medial column beam due to infection or other complications, the loss of the Charcot correction will be inevitable unless the patient has had arthrodesis. Similarly, a broken medial column beam will result in a significant loss of correction. The lateral column beam only serves to prohibit plantar dislocation of the cuboid. If the lateral column is completely stable prior to surgery, the lateral column beam is not really necessary. It is important to recognize that the purpose of beams is not to compress the fusion sites but only to act as support structures for the diseased ligaments and bones of the foot. Grant and coworkers clearly showed evidence that a frame with tension and compression and parallel fixation produced superior compression than other methods of fixation.14
Further Pointers On The Beaming TechniqueThe fluoroscope is requisite for the correct placement of beams. One can place the guide pin via a plantar approach to the first metatarsal by dorsiflexing the toe or a dorsal approach by plantarflexing the toe. One should center the tip of the pin in the metatarsal head. Drive the pin through the long shaft of the metatarsal until it exits its base centrally as one can see in the photo on the right. Similarly, the guide pin should traverse the center of the medial cuneiform, the body of the navicular and the head and neck of the talus. This may take some practice. Generally speaking, a 115 mm cannulated screw is necessary for the medial column. It should be made out of stainless steel, not titanium, because stainless steel has a 240,000 PSI versus only 180,000 PSI for titanium. Use the largest diameter screw you can find. The heads of commercial hip screws have a tendency to be very hard on the metatarsal head so carefully countersink the screw head — whether you drill or not — to protect it from splintering and collapsing. At this time, if one decides to place a lateral column beam, advance the guide pin. Typically, it is necessary to enter the foot just proximal to the sulcus between the third and fourth toes, and transverse the soft tissues of the forefoot with the guide pin. The guide pin should be virtually horizontal as it enters between the bases of the third and fourth metatarsals. Elevate the cuboid into its anatomically correct position as the guide pin passes through the cuboid into the body of the talus. Place the medial column beam under direct fluoroscopic guidance. The threads of the screw at the tip are the weakest point of the screw and they are at the area of the highest bending moment. The screw threads should be as far away from the talonacivular joint as possible, buried as deep as possible in the talus. The lateral column screw should have its head interdigitating between the bases of the fourth and fifth metatarsals, and not compress through the bases. This is perhaps the best evidence that the purpose of beaming isn't to compress segments for arthrodesis, it is to load share. If beaming a subtalar implant or fusion of the subtalar joint appropriate for the reconstruction, do this prior to the placement of the medial and lateral beams. Since the senior author first began using beaming procedures in 1994, the demographics of the population have significantly changed with regard to obesity. This epidemic directly correlates with the increase in diabetes and patients with Charcot neuroarthropathy. Currently manufactured orthopedic screws may provide a reasonable 2x safety factor for bending moments through the hindfoot in patients weighing 150 lbs. This is not the case for patients who exceed 300 and sometimes 400 lbs. In this population group, beam failure directly associated with the design of the current commercially available large diameter cannulated screws is a clinical concern as one can see in the radiographic images above at left. We see it as a challenge to solve this problem.
In ConclusionPatients with diabetes and peripheral neuropathy are predisposed to have Charcot neuroarthropathy. Damaged nerve conduction pathways from altered glucose tolerance can be a viable source for inducing Charcot neuroarthropathy due to a lack of balance and proprioception resulting in damaged bone, which stimulates osteoclastic activity.2 As surgeons, our challenge is to find solutions that address the pathologies at hand. Beaming is uniquely appropriate for Charcot neuroarthropathy in that it directly addresses issues of increased bone density, decreased bone stiffness and ligament failure with a time proven basic engineering solution. Refinement of this concept is necessary as the population of our patients with this disease become more obese. Dr. Grant is a Fellow of the American College of Foot and Ankle Surgeons, and is board-certified by the American Board of Podiatric Surgery. He is an instructor in the Department of Surgery at Eastern Virginia Medical School and is in private practice in Virginia Beach, Va. Mr. Barbato is a graduate of James Madison University and a current applicant to colleges of podiatric medicine. Mrs. Grant-McDonald is a fourth-year podiatric medical student at Des Moines University. References 1. Larson S, Burns P. The pathogenesis of Charcot neuroarthropathy: current concepts. Diabetic Foot & Ankle. 2012; epub Jan. 10. 2. Sohn M, Stuck R, Pinzur M, Lee T, Budiman-Mak E. Lower-extremity amputation risk after Charcot arthropathy and diabetic foot ulcer. Diabetes Care. 2009; 33(1):98-100. 3. Christensen T, Bulow J, Simonsen L, Holstein E, Svendsen O. Bone mineral density in diabetes mellitus patients with and without a Charcot foot. Clin Physiol Functional Imaging. 2009; 30(2):130-134. 4. McCarthy A, Etcheverry S, Bruzzone L, Lettieri G, Barrio D, Cortizo A. Non-enzymatic glycosylation of a type I collagen matrix: effects on osteoblastic development and oxidative stress. BMC Central Cell Biology. 2001; 2(16) epub Aug. 2. 5. Vashishth D. Advanced glycation end-products and bone fractures. International Bone & Mineral Society. 2009; 6(8):268-278. 6. Witzke KA, Vinik AI, Grant LM, Grant WP, Parson HK, Pittenger GL, Burcus N. Loss of RAGE defense: A cause of Charcot neuroarthropathy? Diabetes Care. 2011; 34(7):1617-1621. 7. Jeffcoate W. Vascular calcification and osteolysis in diabetic neuropathy- is RANKL the missing link? Diabetologia. 2003; 47(9):1488-1492. 8. Mabilleau G, Petrova N, Edmonds M, Sabokbar A. Increased osteoclastic activity in acute Charcot's osteoarthropathy: the role of receptor activator of nuclear factor-kappaB ligand. Diabetologia. 2008; 51(6):1035-1040. 9. Alikhani M, Alikhani Z, Boyd C, Maclellan C, Raptis M, Liu R, Graves D. Advanced glycation endproducts stimulate osteoblast apoptosis via the MAP kinase and cytosolic apoptotic pathways. Bone. 2007; 40(2):345-353. 10. Alikhani Z, Alikhani M, Boyd C, Kiyoko N, Trackman P, Gravest D. Advanced glycation end products enhance expression of pro-apoptotic genes and stimulate fibroblast apoptosis through cytoplasmic and mitochondrial pathwayss. J Bio Chem. 2004; 280(13):12087-12095. 11. Saito M, Marumo K. Collagen cross-links as a determinant of bone quality: a possible explanation for bone fragility in aging, osteoporosis and diabetes mellitus. Osteoporosis Int. 2010; 21(2):195-214. 12. Macaione V, Aguennouz M, Rodolico C, Mazzeo A, Patti A, Cannistraci E, Vita G. RAGE-NF-kB pathway activation in response to oxidative stress in facioscapulohumeral muscular dystrophy. Acta Neurologica Scandinavica. 2005; 115(2):115-120. 13. Lindsey J, Cippollone F, Adullah S, Mcguire D. Receptor for advanced glycation end-products (RAGE) and soluble RAGE (sRAGE): cardiovascular implications. Diabetes Vasc Dis Res. 2009; 6(1):7-14. 14. Grant W, Rubin L, Pupp G, Vito G, Jacobus D, Jerlin E, Tam H. Mechanical testing of seven fixation methods for generation of compression across a midtarsal osteotomy: a comparison of internal and external fixation devices. J Foot Ankle Surg. 2007; 46(5):325-335. 15. Grant W, Foreman E, Wilson A, Jacobus D, Kukla R. Evaluation of Young's Modulus in Achilles tendons with diabetic neuroarthropathy. J Am Podiatr Med Assoc. 2005; 95(3):42-246. 16. Grant W, Lavin S, Sabo R. Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis. J Foot Ankle Surg. 2011; 50(2):182-189. 17. Sammarco J. Superconstructs in the treatment of Charcot foot deformity: plantar plating, locked plating, and axial screw fixation. Foot Ankle Clin N Am. 2009; 14(3):393-407. For further reading, see "Limb Salvage And The Charcot Foot: What The Evidence Shows" in the March 2011 issue of Podiatry Today, "Can Scaling Theory Aid In Charcot Foot Reconstruction In Obese Patients?" in the March 2013 issue or the DPM Blog "Can 'Beam' Surgery Have An Impact For The Collapsed Charcot Foot?" at http://tinyurl.com/pa4ah9y . To enhance your online experience, check out Podiatry Today on your iPad or Android tablet.


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Does Video Length Matter?
May 7, 2012
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Ben Ruedlinger
The above graph (let's call it Exhibit A, because it's fun to feel like a detective) is the most consolidated display of the data, with one data point for each video length range, on the x-axis, with the average % viewed for videos of that length on the y-axis. Basically, it's representative of the video engagement number within Wistia (so you could compare your number with the number for that length on this graph to see how well you're doing compared to the average!). This graph tells us that shorter videos are better for getting people to watch the whole thing. After all, most business video is created to serve up a pre-packaged message, so the longer the video, the less people will watch. It's also noticeable that after a certain point the engagement average flattens out — so there's not a major difference in engagement for a 4-minute versus a 10-minute video.
On to Exhibit B, where the x-axis represents the percentage of a video viewed (think of each line as the average engagement graph for a video of that length range in Wistia, one of the bars of Exhibit A over time, with each line representing the average video for that bin, with the lengths normalized), and the y-axis represents audience engagement. In this case, you could compare the engagement graph line of your own video to the appropriate line of this graph to compare yourself to the average.
A possible takeaway from this graph would be to organize the content of your videos journalistically, placing the most important, essential information first, then following with supporting details. For longer videos, notice that the dropoff at the beginning is extremely steep; it seems that most viewers decide quickly whether or not to watch, and once that decision is made, they tend to stick around until the end of the video, when they detect that the video is wrapping up and another drop off occurs. For this reason, if you're using a [post-roll call-to-action][3], you might want to consider a harder stop to your video, rather than a meandering wrap-up — this will ensure that more viewers stick around to see your CTA.
Exhibit C takes things one step deeper: this is the raw data that went into creating the above graphs. Each frame in this animated graph represents one of the time ranges from the above graph. Each of the faded lines is the engagement graph for an actual video, while the average line for that video length is in orange. Again, the x-axis represents percent viewed and the y-axis represents audience engagement.
The interesting thing to notice here is the wide variation even for videos of the same length. The variation tends to be more wide at the beginning, tightening toward the end (again hinting that people decide whether or not to watch pretty quickly). There are definitely outliers, but all in all, longer videos see a tighter overall distribution, where it's safe to say that if you're doing 30% versus 25% engagement on average, for example, you're doing pretty well.
The main takeaways from our first "Does Length Matter?" post still hold true: overall, shorter videos are more engaging than longer videos. You should strive to make your content as concise as possible to achieve the highest engagement. If your message is more complex, feel free to give it the time it deserves, but understand that a major chunk your audience won't make it to the end of the video and consider front-loading your video with the most important information at the beginning.


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The Twelve Tribes of Hattie by Ayana Mathis (Vintage; 320 pages; $15.95).
One of my favorite novels from 2012 is now available in paperback. Trust me–you'll love it.
Reading Ayana Mathis' epic debut The Twelve Tribes of Hattie, I could not help but think of the poem "A Dream Deferred" by Harlem Renaissance poet Langston Hughes (1902-1967).
What happens to a dream deferred?
Does it dry up
like a raisin in the sun?
Or fester like a sore—
and then run?
Does it stink like rotting meat?
Or crust and sugar over—
like a syrupy sweet?
Maybe it just sags
like a heavy load.
Or does it explode?[1]
Hattie, Mathis' central character, and her family left their home in Georgia as part of the African-American exodus to the North during the Great Migration. Six million blacks moved out of the rural South to the Northeast, Midwest, and West from around 1910 to 1970.
When their exodus began, slavery had long been abolished. Yet, African-Americans were still very much bound. Segregation, discrimination, and physical violence prompted blacks to hope for better lives in urban centers like Chicago and New York City. Some may have had families in those cities; others set out with uncertainty, knowing no one but desperate for better lives. The dreams of many were fulfilled as they found jobs and discovered new avenues open to them. The dreams of others, as Hughes lyrically laments, were deferred.
Hattie belongs in the latter category. In 1925, she and her husband, August, live in Philadelphia, where they rent a house and where August works long hours. Hattie gives birth to twins, Philadelphia and Jubliee, appellations "that weren't already chiseled on a headstone in the family plots in Georgia…names of promise and of hope, reaching forward names, not looking back ones."
The names she chooses for her children are significant. Philadelphia represents their new home, the city of Philadelphia. Hattie has high hopes for her family's future in this great city. The name then carries with it all of Hattie's optimisms and dreams. The name Jubilee evokes echoes of the African-American Juneteenth celebrations that marked the end of slavery (the first celebration occurred June 19, 1865). In the North, Hattie's children are free and do not have to worry about seeing August beaten, as Hattie once saw happen to her own father. In Philadelphia, Hattie is certain that her twins will have opportunities she did not have growing up in Georgia.
When the twins become ill with pneumonia at seven months old, Hattie's world is shaken. She tries to lessen their cough with eucalyptus, but the plant is difficult to find in Philadelphia. When Hattie finds the plant, she has to buy it. This feels so wrong to her. Back home in Georgia, a eucalyptus tree is located directly "across from Hattie's house." Such a stark realization leaves her bitter–especially when she cannot save them.
What happens to a dream deferred? For Hattie, losing the twins is earth-shattering. She feels as if a part of her dies with Philadelphia and Jubilee. Hattie and August go on to have other children, but Hattie is never the same after the tragedy.
For her other offspring to survive in this world, Hattie must harden herself so she can harden them. If they are to survive, then Hattie must be a survivor. She will hold them at arm's length if it means they will reach adulthood. She will close herself off from them if it means they will grow up.
Mathis then switches gears and focuses on what happens to Hattie's eleven children and one grand-child, her twelve tribes. When we meet each of Hattie's progeny in wholly intimate chapters, they are all on the cusp of something: grappling with identity, homophobia, abuse, jealousy, and sickness. Mathis also illustrates through these chapters how Hattie's children see her as a cold, bitter, and sometimes hateful woman. The structure of the chapters also allows us to see how things change as the years pass. Although Hattie and August grow apart, she still stays with him, even after she has a baby by another man and runs away. She feels bound to August and stays by his side through affairs and economic hardships.
The Twelve Tribes of Hattie cuts to the quick. Mathis employs incisive, gritty dialogue that lodges itself deep in the hearts and guts of readers. She can be elegantly precise yet equally coarse and raw when necessary, showing an amazing range of talent.
For me, Mathis' other characters pale next to Hattie. The author provides fascinating windows into Hattie's psyche through her twelve tribes. We know what they do not. We know why she is cold, bitter, and sometimes hateful.
Mathis is by no means using Hattie to represent all African-American women who left the South to make new lives in the North. Instead, Mathis is re-presenting one possible story through the character of Hattie. Mathis wants to show the gritty underbelly of a family who took part in the Great Migration with all the sufferings and ordeals such an epic journey would entail.
Hattie's dream of a new life did not go the way she had hoped it would. Hattie's was a dream deferred that festered, crusted over, and dried up. Surely, Hattie would say her heart rotted and stank. Perhaps she exploded from the pain. Hattie had to survive so her children would. What a heavy load she carried. What a stunning literary achievement from Mathis as she chronicles one woman's trials and tribulations. The Twelve Tribes of Hattie resonates with meaning and with beauty.
[1] Langston Hughes, "Harlem" from Collected Poems. Copyright © 1994 by The Estate of Langston Hughes.


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NEW YORK (AP) — GLAAD has named the film "Cloud Atlas," AMC's reality show "Small Town Security," and the New Yorker magazine among its nominees for the 24th Annual GLAAD Media Awards.
The Gay & Lesbian Alliance Against Defamation announced on Wednesday 120 nominees in English-language categories and 33 nominees in Spanish-language categories.
Other nominees include the NBC shows "Smash" and "The New Normal," Frank Ocean for his "Channel Orange" album, the magazine People en Espanol, and Oprah Winfrey's interview with Neil Patrick Harris and partner David Burtka.
The awards are meant to recognize and honor media for outstanding images of the gay and lesbian community. The winners will be announced March 16 in New York and at ceremonies in April and May in Los Angeles and San Francisco.
(Photo: AP)


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Atelier DVD - Level 5 (ages 8-13)
Designed for ages 8-13, Level 5 is a full year of visual art instruction . Students will build and develop a foundation of skills by learning and working through the essential elements and principles of art including: line, color, space, shape, form, texture, pattern, balance and emphasis. Level 5 also includes art-history, media exploration, creative self-expression, cultural appreciation, right-brain drawing techniques, and much more.
Level 5 is available in one of two options: Option 1, the Basic Program, includes the instructional DVD's and Parent's Manual. Option 2, the Enriched Program, includes the DVD's and Parents Manual plus a 3-year subscription to the Level 5 Online Art Image Program (OAIP).The Level 5 Online Art Image Program (OAIP) offers 10 Great Masters Art Images, along with discussion guides, that are used to enrich the lessons and to help students connect the art elements, techniques and skills that they are using to those used by the great masters.


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The International Trade Council provides a range of e-Government services designed to increase efficiency, accountability / transparency and facilitate public sector reforms among developing countries.
Some of the areas in governmental operations which may be improved by the application of suitable ICT tools:
- e-Government: Applying to inter-organisational relationships, including policy coordination, policy implementation and public service delivery.
- e-Administration: Applying to intra-organisational relationships, including policy development, organisational activities and knowledge management.
- e-Governance: Applying to interaction between citizens, government organisations, public and elected officials, and includes democratic processes, open government and transparent decision-making.
The Council aims to demystify concepts behind e-Government, e-Administration and e-Governance and strengthen the understanding of all those involved in planning and execution of these projects.
Planning Services
The Council works collaboratively with governments to involve all stakeholders including government executives, parliamentarians, public institutions, and non-government organisations and members of the public to guide them through various phases in their initiatives.
The Council works to address all possible aspects in initiating, implementing and sustaining programmes; from providing initial education services, defining basic concepts, reviewing regulatory frameworks and developing the action plan for the implementation of the appropriate technologies, infrastructure and supporting capabilities.
ICT & Governance
The emergence of the digital economy has affected both the role and functions of public institutions. While undertaking traditional functions such as defence, law and order, justice, taxation, legislation, regulation, education, health care and social equity, the governments are now required to take new roles of harnessing the power of information technology and leading change. There has been a transformation of the role of the government from a buyer or producer of ICT services to that of a facilitator and a leader.
To compete successfully in a network-based global economy, governments need to be both leaders and facilitators. The leadership and facilitation roles comprise the following elements:
- Developing national e-strategy, making ICT adoption and network readiness a national priority, bridging "digital divide" and championing an e-readiness framework;
- Undertaking innovative projects that make a difference to lead by example, adopting best practices and pushing for their adoption by others and developing public-private-people partnerships;
- Implementing Right to Information (RTI) and committing to transparency in governmental operations;
- Reforming government processes covering areas such as revenues, expenditures, procurement, service delivery, customer grievances etc.,
- Tracking, storing and managing information, promoting production of national content online and through electronic media;
- According high priority to protection of individual rights, intellectual property, privacy, security, consumer protection etc. and mobilizing the civil society;
Implementation of appropriate and efficient initiatives can lead to demystification of complicated government processes and empowerment of citizens. It can lead to enhanced government performance and generate a multiplier effect on economic progress. ICT has enabled citizens to demand information and better services from governments. With increased citizen awareness, governments today are under increasing pressure to deliver a range of services – from ration cards, motor driving licenses and land records to health, education and civic services – in a manner that is timely, efficient, economical, equitable and transparent.


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2012 Ford F-150 Lariat
- Dearborn Ford located in Kamloops, BC has been in business for over 75 years. We are a trusted name and sell New and Pre-owned cars and trucks throughout the Thompson-Okanagan region, even as far as Alberta and Saskatchewan. If your looking for a new or used car or truck, look no further for the best price, best financing payments & great trade in values, based on current market. If you don't find the vehicle you want on our website, or lot, let us do the work for you, saving you time and money. _____________________________________ Give us a call or send us an email. Our experienced Sales staff are knowledgeable, friendly and work hard to get you the best deal.


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A vast section of the App Store is dedicated to personal health: apps for malignant mole detection, for the monitoring of body weight fit, etc.; each fitting snugly alongside hundreds of their brethren. And in that group is the first aid group which includes demonstrations, videos, and how-to's. Only one of that number, however, lets you administer CPR to your iDevice. PocketCPR either coaches or recuses your CPR efforts by detecting your methods with the inbuilt-accelerometer and some lovely programming.
If you get strange looks while pile-driving your iPhone, say that you are practicing medicine: when an emergency calls, you alone may be fit enough to lend a helping hand. NOTE: PocketCPR hasn't been ratified by the U.S. FDA.
Bio-Detek Inc., PocketCPR, 9.99$, 1.7 MB
App Description and screenshots after the gap.


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Get the information you might need on any phone number
So you've heard that reverse phone lookup is kind of a big deal, and you're not sure which service to choose. Our reverse phone service is fast and effecting extracting every single bit of available data for a given phone number that brings the ultimate customer experience.
We can deliver information for the following phone types:
It is huge. Contains USA and Canada.
|Area code & Prefix
|City & State
|(667) 211
|Baltimore, MD
|Cellco Partnership Dba Ve...
|(667) 234
|Bel Air, MD
|(667) 555
|Baltimore, MD
|(667) 611
|Baltimore, MD
|(667) 667
|Baltimore, MD


text: I'm trying to add newer Apple mail messages to specific EA folders. When I fn-F1 the mail message is imported but an additional folder is created, thus Folder-1, instead of sending the mail message to the same folder in EA as the older messages. How would I move a newer message in Apple Mail (OS X 10.7) into the existing folder with the same name in EagleFiler?


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4 PHD faculty
16 faculty
Ranked 9th as per NIRF among all Indian Universities | 325+ courses across 30+ diverse disciplines.
A university with more than 47500 alumni with overall 80% placement. More than 350 companies have visited the campus for recruitment procedure. The highest package has reached up to INR 65 LPA.
NAAC A grade accredited University | Among Top University by NIRF | 100% Merit Based Scholarship
Ranked Number 1 Private University in North India by Assocham | 60 Acre Campus | Apply Online for 100+ Programs in 2020 Batch
31 LPA Highest Package Offered | Global Exposure for students | Top private University in Punjab


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Hi guys,
Currently in a debate on Facebook with a creationist friend... as per usual haha.
The latest reply is this:
even if the mutations were slow and slight, they never consisted of NEW genetic information being introduced or forming itself out of nowhere, only mutation of whatever was there already.
I mean for the whole grand/mega-coplex of evolution concept built up nowadays, there sould be at least a few tiny minuscule examples in the billions of living organism today where we can see this slight process at work,
there is like.... not even ONE such example??
that kindda settles it for me.
Now I've heard this argument plenty of times, but I'm not confident in giving an answer as I don't feel I have enough knowledge on this specific point. So... will someone enlighten me? Thanks :)
Views: 669
This irks me. People who have just enough knowledge to be annoying with these questions that would be answered in 9th grade biology class.
Unfortunately, the ID crowd will interpret that line as just another appeal to an arbitrary authority. They don't understand what science is, so explaining that scientists have reached a consensus sounds to them just like millions of ignorant Xtians have reached a consensus.
Yes but trying to reason with a lunatic is lunacy. So I will say that and walk away.
A mutation IS new genetic information. Genes are not single, discreet units. They are made up of a sequence of amino acids. If any of those acids are out of order, or swapped with another, that makes an entirely new gene, which might kill the creature, might be irrelevant, like hair color, or might give it an edge in reproducing, thus propagating the new sequence on to future generations.
Also, we now know that genes can be swapped from one organism to another. When you get a virus, it injects it's dna into your cells to reproduce more viruses. Some of that dna can combine with yours, thus altering your genetic code. What that gene does in a virus could be quite different from what it does in your body.
People get hung up on this deal about new information. The truth is, new information isn't really needed. Look into fruit fly research. They can get rid of wing, change colors, and multiple other things simply by turning genes on or off. A lot of information is already there. It is simply recessive or turned off. Whales have hips and manatees have three toe nails on there from flippers. Why hips or toe nails on sea creatures that have no back legs or toes? They once walked on land obviously. Enough changes will make DNA non compatible over time with the original because of genetic changes. People that deny this either are to....dim or they are lying to themselves. You can't change there mind because they will deny the truth, even when it's in there face. Ask him about the whale and manatee. I bet they say " it's god design."
If I understand correctly they are talking about not evolution of current or even past organisms but the arising of new life or radically new types of life in living creatures. If this is the case then just respond that A) evolution has nothing to do with the origins of life and doesn't even address that and B) even if it did then the reason new life has not come about like the life we see evoked around us now is because the conditions that allowed for the origins of life are no longer present on the earth.
The inherent problem in this specific argument is the notion of 'new information.' As has been pointed out, information in this instance is coming from arguments by Dembski, and ultimately it (in my view) steers the conversation towards the inevitable goal of information = design. Other problems arise that anything you get that answers the question being posed, is that they will either not understand, or ignore what you present. You could talk about polyploidy, which doubles (or triples, etc) the genetic information, which just by itself can lead to speciation (which is what many creationists call 'macroevolution'). You can see that in many plants, like dandelions. However this won't satisfy the question as its a doubling (or more) of the information that is already there, and would be dismissed as not introducing 'new' genetic information. Dave G's suggestion of bacteria digesting nylon is an excellent example, but more than likely it will be ignored as well (having had this same conversation myself with a creationist).
Trisomy is an example of genetic information being expanded. When one has 3 of a particular chromosome rather tan 2, they have a 50% increase of information at that juncture. Trisomy is not always deleterious, and therefore can be passed along. Look up XYY syndrome, argument from ignorance refuted, irrefutably.


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June 25, 2012
'THE WINNER' is Anthony Lombardi Principal, PS 49 located at 79-15 Penelope Avenue, Middle Village,NY 11379
A man who had vision when he came to this school, made it his priority, collaborated with the teachers, made some changes, and the end result speaks for itself. Mr. Lomabardi had to overcome oppositions and dealt with it. He had to undergo internal investigations and the results were in his favor. His success, is attributed to hard work, team effort from the teachers to visualize his combining academics with music. Now currently this School P.S. 49 has 5 additional hours per week for the students to learn more, and in turn giving the teachers more work and hours of pay. A fabulous achievement, and one that has made students, their parents and teachers very happy. Now lastly, with so much positive happenings in this School, it is no wonder why the ratings have shot up with the Board of Education, and within the Community as well. Now our Community has another top rated School, in Middle Village,NY 11379, P.S.49.
Final Note: This Principal, Anthony Lomabrdi of P.S. 49 indirectly has achieved another milestone. That is making the Community of Middle Village, more desirable and stronger, due to his turning this Public School completely around for the better.
For this I wish to personally say, Thank You! The sentiments from the parents students, and teachers are the same. The Board of Education, and the Mayors' office should be Proud of you!
You are A 'Winner', and you have made a Big difference in Middle Village, New York!


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TIME is something we all have an equal amount of.
Someone says they are just killing time.
Or, they say they are just hanging out buying some time.
Killing time? Buying time? Yuck!
How about teach on time management?
You cannot manage time!
Time goes on. You do not need to manage it. It does not need our help.
We get 24-hours. You get it, we get it, all get 24-hours.
So you do not manage time. What you do is manage yourself!
The best use of time is not managing use of time, it is managing me.
So that I take the time I have and I do the things I need to do.
If I do that correct, then time becomes my friend.
If I do it incorrect, then times becomes just something I bear with. Something I kick around until the next important event.
Here is a challenge:
Log your time this week.
Not minutes and not the whole day.
But maybe the most important part of your day, and write down what you did each hour.
Then, ask yourself a simple question.
Did I maximize my time?
Did I use it correct?
Did I manage myself well?
Or, did I just let hours slide by?
The choice is yours. Do the assignment and see how you do.
How can we best help you today?
PTC Hoopla is a simple easy traffic and commissions builder.
Instructions: Join and use each to promote Your Hoopla.
- The point is to get signups and earn referral rewards.
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That Brink video the other day was nice, but there wasn't much shooting. Not very helpful for a game where you're meant to be shooting things. So here's two more. Shooting included.
These are from the same demo we saw at E3. Back in June. Was kind of hoping to see something else by December, but hey, this'll have to do.
Xbox 360 Games - E3 2010 - Brink


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Item #: GB20700
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|A tangled web of guilt, remorse, humor and thwarted sexuality is unravelled against the background of the English countryside in this complex story of an Oxford love triangle. An inside view of English repression at the university level adapted for the screen by Pinter from the novel by Nicholas Mosley. Long-winded but occasionally engrossing character study with interesting performances.
|Directed by:
|Joseph Losey
|Lippert Productions.
|Dirk Bogarde, Michael York, Stanley Baker, Jacqueline Sassard, Delphine Seyrig, Alexander Knox, Vivien Merchant, Freddie Jones, Harold Pinter