title: Dartmouth College

text: In addition to its 19 graduate programs in the arts and sciences, Dartmouth is home to three separate graduate schools. The Geisel School of Medicine is located in a complex on the north side of campus and includes laboratories, classrooms, offices, and a biomedical library. The Dartmouth–Hitchcock Medical Center, located several miles to the south in Lebanon, New Hampshire, contains a 396-bed teaching hospital for the Medical School. The Thayer School of Engineering and the Tuck School of Business are both located at the end of Tuck Mall, west of the center of campus and near the Connecticut River. The Thayer School comprises two buildings; Tuck has seven academic and administrative buildings, as well as several common areas. The two graduate schools share a library, the Feldberg Business & Engineering Library. In December 2018, Dartmouth began a major expansion of the west end of campus by breaking ground on the $200 million Center for Engineering and Computer Science. The Center will house the Computer Science department and Magnuson Center for Entrepreneurship. In October 2019, construction began on the Irving Institute of Energy and Society. Both were completed by Spring 2022, and the Center for Engineering and Computer Science was renamed the Class of 1982 Engineering and Computer Science Center.


title: Dartmouth College

text: Dartmouth's libraries are all part of the collective Dartmouth College Library, which comprises 2.48 million volumes and 6 million total resources, including videos, maps, sound recordings, and photographs. Its specialized libraries include the Biomedical Libraries, Evans Map Room, Feldberg Business & Engineering Library, Jones Media Center, Rauner Special Collections Library, and Sherman Art Library. Baker-Berry Library is the main library at Dartmouth, consisting of a merger of the Baker Memorial Library (opened 1928) and the Berry Library (completed 2002). Located on the northern side of the Green, Baker's tower is an iconic symbol of the College.


title: Dartmouth College

text: Dartmouth's original sports field was the Green, where students played cricket and old division football during the 19th century. Today, two of Dartmouth's athletic facilities are located in the southeast corner of campus. The center of athletic life is the Alumni Gymnasium, which includes the Karl Michael Competition Pool and the Spaulding Pool, a fitness center, a weight room, and a 1/13th-mile (123 m) indoor track. Attached to Alumni Gymnasium is the Berry Sports Center, which contains basketball and volleyball courts (Leede Arena), as well as the Kresge Fitness Center. Behind the Alumni Gymnasium is Memorial Field, a 15,600-seat stadium overlooking Dartmouth's football field and track. The nearby Thompson Arena, designed by Italian engineer Pier Luigi Nervi and constructed in 1975, houses Dartmouth's ice rink. Also visible from Memorial Field is the Nathaniel Leverone Fieldhouse, home to the indoor track. The new softball field, Dartmouth Softball Park, was constructed in 2012, sharing parking facilities with Thompson arena and replacing Sachem Field, located over a mile from campus, as the primary softball facility.


title: Dartmouth College

text: Dartmouth's other athletic facilities in Hanover include the Friends of Dartmouth Rowing Boathouse and the old rowing house storage facility (both located along the Connecticut River), the Hanover Country Club, Dartmouth's oldest remaining athletic facility (established in 1899), and the Corey Ford Rugby Clubhouse. The college also maintains the Dartmouth Skiway, a skiing facility located over two mountains near the Hanover campus in Lyme Center, New Hampshire, that serves as the winter practice grounds for the Dartmouth ski team, which is a perennial contender for the NCAA Division I championship.


title: Dartmouth College

text: Dartmouth's close association and involvement in the development of the downhill skiing industry is featured in the 2010 book "Passion for Skiing" as well as the 2013 documentary based on the book "Passion for Snow".


title: Dartmouth College

text: Beginning in the fall term of 2016, Dartmouth placed all undergraduate students in one of six House communities, similar to residential colleges, including Allen House, East Wheelock House, North Park House, School House, South House, and West House, alongside independent Living Learning Communities. Dartmouth used to have nine residential communities located throughout campus, instead of ungrouped dormitories or residential colleges. The dormitories varied in design from modern to traditional Georgian styles, and room arrangements range from singles to quads and apartment suites. Since 2006, the college has guaranteed housing for students during their freshman and sophomore years. More than 3,000 students elect to live in housing provided by college.


title: Dartmouth College

text: Campus meals are served by Dartmouth Dining Services, which operates 11 dining establishments around campus. The Class of 1953 Commons, commonly referred to as "Foco", is the all-you-can-eat dining hall, located at the center of campus. Dartmouth also operates à la carte cafes around campus (Collis Café, Courtyard Café, Novack Café, The Fern Coffee & Tea Bar, Ramekin, and Café@Baker), a convenience store (Collis Market), and 3 snack bars located in the Allen House Commons (also called the “Cube”), McLaughlin Cluster, and East Wheelock Cluster.


title: Dartmouth College

text: The Collis Center is the center of student life and programming, serving as what would be generically termed the "student union" or "campus center". It contains a café, study space, common areas, and a number of administrative departments, including the Academic Skills Center. Robinson Hall, next door to both the Collis Center and the Class of 1953 Commons, contains the offices of a number of student organizations, including the Dartmouth Outing Club and "The Dartmouth" daily newspaper.


title: Dartmouth College

text: In 2006, "The Princeton Review" ranked Dartmouth third in its "Quality of Life" category, and sixth for having the "Happiest Students". Athletics and participation in the Greek system are the most popular campus activities. In all, Dartmouth offers more than 350 organizations, teams, and sports. The school is also home to a variety of longstanding traditions and celebrations and has a loyal alumni network; Dartmouth ranked #2 in "The Princeton Review" in 2006 for Best Alumni Network.


title: Dartmouth College

text: Under Hanlon's leadership, Dartmouth launched a comprehensive set of initiatives designed to combat high-risk behaviors and build a more diverse, inclusive, and equitable environment for students, faculty, and staff. Among them were Moving Dartmouth Forward (2015), Inclusive Excellence (2016) and, most recently, the Campus Climate and Culture Initiative (2019), which is aimed specifically at creating a learning environment free from sexual harassment and the abuse of power.


title: Dartmouth College

text: In 2014, Dartmouth College was the third highest in the nation in "total of reports of rape" on their main campus, with 42 reports of rape. The "Washington Post" attributed the high number of rape reports to the fact that a growing number of sexual assault victims feel comfortable enough to report sexual assaults that would have gone unreported in previous years. In 2015, the Huffington Post reported that Dartmouth had the highest rate of bystander intervention of any college surveyed, with 57.7% of Dartmouth students reporting that they would take some sort of action if they saw someone acting in a "sexually violent or harassing manner," compared to 45.5% of students nationally.


title: Dartmouth College

text: Dartmouth fraternities have an extensive history of hazing and alcohol abuse, leading to police raids and accusations of sexual harassment.


title: Dartmouth College

text: Dartmouth's more than 200 student organizations and clubs cover a wide range of interests. In 2007, the college hosted eight academic groups, 17 cultural groups, two honor societies, 30 "issue-oriented" groups, 25 performing groups, 12 pre-professional groups, 20 publications, and 11 recreational groups. Notable student groups include the nation's largest and oldest collegiate outdoors club, the Dartmouth Outing Club, which includes the nationally recognized Big Green Bus; the campus's oldest a cappella group, The Dartmouth Aires; the controversial independent newspaper "The Dartmouth Review"; and "The Dartmouth", arguably the nation's oldest university newspaper. "The Dartmouth" describes itself as "America's Oldest College Newspaper, Founded 1799".


title: Dartmouth College

text: Partially because of Dartmouth's rural, isolated location, the Greek system dating from the 1840s is one of the most popular social outlets for students. Dartmouth is home to 32 recognized Greek houses: 17 fraternities, 12 sororities, and three coeducational organizations. In 2007, roughly 70% of eligible students belonged to a Greek organization; since 1987, students have not been permitted to join Greek organizations until their sophomore year. Dartmouth College was among the first institutions of higher education to desegregate fraternity houses, doing so in the 1950s, and was involved in the movement to create coeducational Greek houses in the 1970s. In the early first decade of the 21st century, campus-wide debate focused on a Board of Trustees recommendation that Greek organizations become "substantially coeducational"; this attempt to change the Greek system eventually failed.


title: Dartmouth College

text: Dartmouth also has a number of secret societies, which are student- and alumni-led organizations often focused on preserving the history of the college and initiating service projects. Most prominent among them is the Sphinx society, housed in a prominent Egyptian tomb-like building near the center of campus. The Sphinx has been the subject of numerous rumors as to its facilities, practices, and membership.


title: Dartmouth College

text: The college has an additional classification of social/residential organizations known as undergraduate societies.


title: Dartmouth College

text: Approximately 20% of students participate in a varsity sport, and nearly 80% participate in some form of club, varsity, intramural, or other athletics. In 2021, Dartmouth College fielded 33 intercollegiate varsity teams: 15 for men, 17 for women, and coeducational sailing and equestrian programs. Dartmouth's athletic teams compete in the NCAA Division I eight-member Ivy League conference; some teams also participate in the Eastern College Athletic Conference (ECAC). As is mandatory for the members of the Ivy League, Dartmouth College does not offer athletic scholarships. In addition to the traditional American team sports (football, basketball, baseball, and ice hockey), Dartmouth competes at the varsity level in many other sports including track and field, softball, squash, sailing, tennis, rowing, soccer, skiing, and lacrosse.


title: Dartmouth College

text: The college also offers 26 club and intramural sports such as fencing, rugby, water polo, figure skating, boxing, volleyball, ultimate frisbee, and cricket, leading to a 75% participation rate in athletics among the undergraduate student body. The Dartmouth Fencing Team, despite being entirely self-coached, won the USACFC club national championship in 2014. The Dartmouth Men's Rugby Team, founded in 1951, has been ranked among the best collegiate teams in that sport, winning for example the Ivy Rugby Conference every year between 2008 and 2020. The figure skating team won the national championship five straight times from 2004 through 2008. In addition to the academic requirements for graduation, Dartmouth requires every undergraduate to complete a swim and three terms of physical education.


title: Dartmouth College

text: The charter of Dartmouth College, granted to Wheelock in 1769, proclaims that the institution was created "for the education and instruction of Youth of the Indian Tribes in this Land in reading, writing and all parts of Learning ... as well as in all liberal Arts and Sciences; and also of English Youth and any others". However, Wheelock primarily intended the college to educate white youth, and the few Native students that attended Dartmouth experienced much difficulty in an institution ostensibly dedicated to their education. The funds for the Charity School for Native Americans that preceded Dartmouth College were raised primarily by the efforts of a Mohegan named Samson Occom, and at least some of those funds were used to help found the college.


title: Dartmouth College

text: The college graduated only 19 Native Americans during its first 200 years. In 1970, the college established Native American academic and social programs as part of a "new dedication to increasing Native American enrollment". Since then, Dartmouth has graduated over 700 Native American students from over 200 different tribes, more than the other seven Ivy League universities combined.


title: Dartmouth College

text: Dartmouth is well known for its fierce school spirit and many traditions. The college functions on a quarter system, and one weekend each term is set aside as a traditional celebratory event, known on campus as "big weekends" or "party weekends". In the fall term, Homecoming (officially called Dartmouth Night) is marked by a bonfire on the Green constructed by the freshman class. Winter term is celebrated by Winter Carnival, a tradition started in 1911 by the Dartmouth Outing Club to promote winter sports. This tradition is the oldest in the United States, and subsequently went on to catch on at other New England colleges. In the spring, Green Key is a weekend mostly devoted to campus parties and celebration.


title: Dartmouth College

text: The summer term was formerly marked by Tubestock, an unofficial tradition in which the students used wooden rafts and inner tubes to float on the Connecticut River. Begun in 1986, Tubestock was ended in 2006 by town ordinance. The Class of 2008, during their summer term on campus in 2006, replaced the defunct Tubestock with Fieldstock. This new celebration includes a barbecue, live music, and the revival of the 1970s and 1980s tradition of racing homemade chariots around the Green. Unlike Tubestock, Fieldstock is funded and supported by the College.


title: Dartmouth College

text: Another longstanding tradition is four-day, student-run First-Year Trips for incoming freshmen, begun in 1935. Each trip concludes at the Moosilauke Ravine Lodge. In 2011, over 96% of freshmen elected to participate.


title: Dartmouth College

text: Dartmouth's motto, chosen by Eleazar Wheelock, is "Vox clamantis in deserto". The Latin motto is literally translated as "The voice of one crying in the wilderness", but is more often rendered as "A voice crying out in the wilderness". The phrase appears five times in the Bible and is a reference to the college's location on what was once the frontier of European settlement. Richard Hovey's "Men of Dartmouth" was elected as the best of Dartmouth's songs in 1896, and became the school's official song in 1926. The song was retitled to "Alma Mater" in the 1980s when its lyrics were changed to refer to women as well as men.


title: Dartmouth College

text: Dartmouth's 1769 royal charter required the creation of a seal for use on official documents and diplomas. The college's founder, Eleazar Wheelock, designed a seal for his college bearing a striking resemblance to the seal of the Society for the Propagation of the Gospel, a missionary society founded in London in 1701, in order to maintain the illusion that his college was more for mission work than for higher education. Engraved by a Boston silversmith, the seal was ready by commencement of 1773. The trustees officially accepted the seal on August 25, 1773, describing it as:


title: Dartmouth College

text: On October 28, 1926, the trustees affirmed the charter's reservation of the seal for official corporate documents alone. The College Publications Committee commissioned noted typographer William Addison Dwiggins to create a line drawing version of the seal in 1940 that saw widespread use. Dwiggins' design was modified during 1957 to change the date from "1770" to "1769", to accord with the date of the college charter. The trustees commissioned a new set of dies with a date of "1769" to replace the old dies, now badly worn after almost two hundred years of use. The 1957 design continues to be used under trademark number 2305032.


title: Dartmouth College

text: On October 28, 1926, the trustees approved a "Dartmouth College Shield" for general use. Artist and engraver W. Parke Johnson designed this emblem on the basis of the shield that is depicted at the center of the original seal. This design does not survive. On June 9, 1944, the trustees approved another coat of arms based on the shield part of the seal, this one by Canadian artist and designer Thoreau MacDonald. That design was used widely and, like Dwiggins' seal, had its date changed from "1770" to "1769" around 1958. That version continues to be used under trademark registration number 3112676 and others.


title: Dartmouth College

text: College designer John Scotford made a stylized version of the shield during the 1960s, but it did not see the success of MacDonald's design. The shield appears to have been used as the basis of the shield of the Geisel School of Medicine, and it has been reproduced in sizes as small as 20 micrometers across. The design has appeared on Rudolph Ruzicka's Bicentennial Medal (Philadelphia Mint, 1969) and elsewhere.


title: Dartmouth College

text: Dartmouth has never had an official mascot. The nickname "The Big Green", originating in the 1860s, is based on students' adoption of a shade of forest green ("Dartmouth Green") as the school's official color in 1866. Beginning in the 1920s, the Dartmouth College athletic teams were known by their unofficial nickname "the Indians", a moniker that probably originated among sports journalists. This unofficial mascot and team name was used until the early 1970s, when its use came under criticism. In 1974, the Trustees declared the "use of the [Indian] symbol in any form to be inconsistent with present institutional and academic objectives of the College in advancing Native American education". Some alumni and students, as well as the conservative student newspaper, "The Dartmouth Review", have sought to return the Indian symbol to prominence, but never succeeded in doing so.


title: Dartmouth College

text: Various student initiatives have been undertaken to adopt a mascot, but none has become "official". One proposal devised by the college humor magazine the "Dartmouth Jack-O-Lantern" was Keggy the Keg, an anthropomorphic beer keg who makes occasional appearances at college sporting events. Despite student enthusiasm for Keggy, the mascot has received approval from only the student government. In November 2006, student government attempted to revive the "Dartmoose" as a potential replacement amid renewed controversy surrounding the former unofficial Indian mascot.


title: Dartmouth College

text: Dartmouth's alumni are known for their devotion to the college. Most start by giving to the Senior Class Gift. According to a 2008 article in "The Wall Street Journal" based on data from payscale.com, Dartmouth graduates also earn higher median salaries at least 10 years after graduation than alumni of any other American university surveyed.


title: Dartmouth College

text: By 2008, Dartmouth had graduated 238 classes of students, and had over 60,000 living alumni in a variety of fields. Finance, consulting, and technology have consistently been the most popular industries to enter for students. Top employers of new graduates include Goldman Sachs, Morgan Stanley, McKinsey & Company, Bain & Company, Amazon, Microsoft, Google, and Teach for America. The most common graduate and professional schools for Dartmouth undergraduates include other members of the Ivy Plus, Icahn School of Medicine, NYU, Oxford, and Cambridge.


title: Dartmouth College

text: Nelson A. Rockefeller, 41st Vice President of the United States and 49th Governor of New York, graduated cum laude from Dartmouth with a degree in economics in 1930. Over 164 Dartmouth graduates have served in the United States Senate and United States House of Representatives, such as Massachusetts statesman Daniel Webster. Cabinet members of American presidents include Attorney General Amos T. Akerman, Secretary of Defense James V. Forrestal, Secretary of Labor Robert Reich, Secretary of the Treasury Henry Paulson, and Secretary of the Treasury Timothy Geithner. C. Everett Koop was the Surgeon General of the United States under President Ronald Reagan. Two Dartmouth alumni have served as justices on the Supreme Court of the United States: Salmon P. Chase and Levi Woodbury. Eugene Norman Veasey (class of 1954) served as the Chief Justice of Delaware. The 46th Governor of Pennsylvania, Tom Wolf; the 42nd Governor of Illinois, businessman Bruce Rauner; and the 31st governor and current senator from North Dakota, John Hoeven (R), are also Dartmouth alumni. Ernesto de la Guardia, class of 1925, was president of the Republic of Panama.


title: Dartmouth College

text: In literature and journalism, Dartmouth has produced 13 Pulitzer Prize winners: Thomas M. Burton, Richard Eberhart, Dan Fagin, Paul Gigot, Frank Gilroy, Jake Hooker, Nigel Jaquiss, Joseph Rago, Martin J. Sherwin, David K. Shipler, David Shribman, Justin Harvey Smith and Robert Frost. Frost, who received four Pulitzer Prizes for Poetry in his lifetime, attended but did not graduate from Dartmouth; he is, however, the only person to have received two honorary degrees from Dartmouth.


title: Dartmouth College

text: Other authors and media personalities include CNN Chief White House correspondent and Anchor Jake Tapper, novelist and founding editor of "The Believer" Heidi Julavits, "Dean of rock critics" Robert Christgau, National Book Award winners Louise Erdrich and Phil Klay, novelist/screenwriter Budd Schulberg, political commentator Dinesh D'Souza, radio talk show host Laura Ingraham, commentator Mort Kondracke, and journalist James Panero. Norman Maclean, professor at the University of Chicago and author of "A River Runs Through It and Other Stories", graduated from Dartmouth in 1924. Theodor Geisel, better known as children's author Dr. Seuss, was a member of the class of 1925.


title: Dartmouth College

text: In the area of religion and theology, Dartmouth alumni include priests and ministers Ebenezer Porter, Jonathan Clarkson Gibbs, Caleb Sprague Henry, Arthur Whipple Jenks, Solomon Spalding, and Joseph Tracy; and rabbis Marshall Meyer, Arnold Resnicoff, and David E. Stern. Hyrum Smith, brother of Mormon Prophet Joseph Smith, attended the college in his teens. He was Patriarch of the LDS Church.


title: Dartmouth College

text: Dartmouth alumni in academia include Stuart Kauffman and Jeffrey Weeks, both recipients of MacArthur Fellowships (commonly called "genius grants"). Dartmouth has also graduated three Nobel Prize winners with four separate prizes: Owen Chamberlain (Physics, 1959), K. Barry Sharpless (Chemistry, 2001 and 2022), and George Davis Snell (Physiology or Medicine, 1980). Educators include founder and first president of Bates College Oren Burbank Cheney (1839); the current chancellor of the University of California, San Diego, Marye Anne Fox (PhD. in Chemistry, 1974); founding president of Vassar College Milo Parker Jewett; founder and first president of Kenyon College Philander Chase; first professor of Wabash College Caleb Mills; president of Union College Charles Augustus Aiken. Nine of Dartmouth's 17 presidents were alumni of the college.


title: Dartmouth College

text: Dartmouth alumni serving as CEOs or company presidents and executives include Charles Alfred Pillsbury, founder of the Pillsbury Company and patriarch of the Pillsbury family, Sandy Alderson (San Diego Padres), John Donahoe (eBay), Louis V. Gerstner, Jr. (IBM), Charles E. Haldeman (Putnam Investments), Donald J. Hall Sr. (Hallmark Cards), Douglas Hodge (CEO of PIMCO accused of fraud), Jeffrey R. Immelt (General Electric), Gail Koziara Boudreaux (United Health Care), Grant Tinker (NBC), and Brian Goldner (Hasbro).


title: Dartmouth College

text: In film, entertainment, and television, Dartmouth is represented by David Benioff, co-creator, showrunner, and writer of Game of Thrones; Shonda Rhimes, creator of "Grey's Anatomy, Private Practice" and "Scandal"; Budd Schulberg, Academy Award-winning screenwriter of "On the Waterfront"; Michael Phillips, who won the Academy Award for best picture as co-producer of "The Sting"; Rachel Dratch, a former cast member of "Saturday Night Live"; Chris Meledandri, executive producer of "Ice Age", "Horton Hears a Who!", and "Despicable Me"; writer and director duo Phil Lord and Chris Miller; and the title character of "Mister Rogers' Neighborhood", Fred Rogers. Other notable film and television figures include Sarah Wayne Callies ("Prison Break"), Emmy Award winner Michael Moriarty, Andrew Shue of "Melrose Place", Aisha Tyler of "Friends" and "24", ESPN and Tennis Channel broadcaster Brett Haber, Connie Britton of "Spin City" and "Friday Night Lights", Mindy Kaling of "The Office" and "The Mindy Project", David Harbour of "Stranger Things", and Michelle Khare of HBO Max's "Karma".


title: Dartmouth College

text: A number of Dartmouth alumni have found success in professional sports. In baseball, Dartmouth alumni include All-Star and three-time Gold Glove winner and manager Brad Ausmus, All-Star reliever Mike Remlinger, and pitcher Kyle Hendricks. Professional football players include Miami Dolphins quarterback Jay Fiedler, linebacker Reggie Williams, three-time Pro Bowler Nick Lowery, quarterback Jeff Kemp, and Tennessee Titans tight end Casey Cramer, plus Miami Dolphins defensive coordinator Matt Burke. Dartmouth has also produced a number of Olympic competitors. Adam Nelson won the silver medal in the shot put in the 2000 Sydney Olympics and the gold medal at the 2004 Athens Olympics to go along with his gold medal in the 2005 World Championships in Athletics in Helsinki. Kristin King and Sarah Parsons were members of the United States' 2006 bronze medal-winning ice hockey team. Cherie Piper, Gillian Apps, and Katie Weatherston were among Canada's ice hockey gold medalists in 2006. Lawrence Whitney won bronze at the 1912 Summer Olympics in men's shot put.


title: Dartmouth College

text: Dick Durrance and Tim Caldwell competed for the United States in skiing in the 1936 and 1976 Winter Olympics, respectively. Arthur Shaw, Earl Thomson, Edwin Myers, Marc Wright, Adam Nelson, Gerry Ashworth, and Vilhjálmur Einarsson have all won medals in track and field events. Former heavyweight rower Dominic Seiterle is a member of the Canadian national rowing team and won a gold medal at the 2008 Summer Olympics in the men's 8+ event.


title: Dartmouth College

text: Dartmouth College has appeared in or been referenced by a number of popular media. Some of the most prominent include:


title: Prefectures of Japan

text: Japan is divided into 47 prefectures (, "todōfuken", ), which rank immediately below the national government and form the country's first level of jurisdiction and administrative division. They include 43 prefectures proper (, "ken"), two urban prefectures (, "fu": Osaka and Kyoto), one "circuit" or "territory" (, "dō": Hokkai-dō) and one metropolis (, "to": Tokyo).


title: Prefectures of Japan

text: In 1868, the Meiji "Fuhanken sanchisei" administration created the first prefectures (urban "fu" and rural "ken") to replace the urban and rural administrators ("bugyō", "daikan", etc.) in the parts of the country previously controlled directly by the shogunate and a few territories of rebels/shogunate loyalists who had not submitted to the new government such as Aizu/Wakamatsu. In 1871, all remaining feudal domains "(han)" were also transformed into prefectures, so that prefectures subdivided the whole country. In several waves of territorial consolidation, today's 47 prefectures were formed by the turn of the century. In many instances, these are contiguous with the ancient ritsuryō provinces of Japan.


title: Prefectures of Japan

text: Each prefecture's chief executive is a directly elected . Ordinances and budgets are enacted by a unicameral whose members are elected for four-year terms.


title: Prefectures of Japan

text: Under a set of 1888–1890 laws on local government until the 1920s, each prefecture (then only 3 "-fu" and 42 "-ken"; "Hokkai-dō" and "Okinawa-ken" were subject to different laws until the 20th century) was subdivided into and and each district into and . Hokkaidō has 14 subprefectures that act as and of the prefecture. Some other prefectures also have branch offices that carry out prefectural administrative functions outside the capital. Tokyo, the capital of Japan, is a merged city-prefecture; a metropolis, it has features of both cities and prefectures.


title: Prefectures of Japan

text: The West's use of "prefecture" to label these Japanese regions stems from 16th-century Portuguese explorers' and traders' use of "prefeitura" to describe the fiefdoms they encountered there. Its original sense in Portuguese, however, was closer to "municipality" than "province". Today, in turn, Japan uses its word "ken" (), meaning "prefecture", to identify Portuguese districts while in Brazil the word "Prefeitura" is used to refer to a city hall.


title: Prefectures of Japan

text: Those fiefs were headed by a local warlord or family. Though the fiefs have long since been dismantled, merged, and reorganized multiple times, and been granted legislative governance and oversight, the rough translation stuck.


title: Prefectures of Japan

text: The Meiji government established the current system in July 1871 with the abolition of the han system and establishment of the . Although there were initially over 300 prefectures, many of them being former han territories, this number was reduced to 72 in the latter part of 1871, and 47 in 1888. The Local Autonomy Law of 1947 gave more political power to prefectures, and installed prefectural governors and parliaments.


title: Prefectures of Japan

text: In 2003, Prime Minister Junichiro Koizumi proposed that the government consolidate the current prefectures into about 10 regional states (so-called "dōshūsei"). The plan called for each region to have greater autonomy than existing prefectures. This process would reduce the number of subprefecture administrative regions and cut administrative costs. The Japanese government also considered a plan to merge several groups of prefectures, creating a subnational administrative division system consisting of between nine and 13 states, and giving these states more local autonomy than the prefectures currently enjoy. As of August 2012, this plan was abandoned.


title: Prefectures of Japan

text: Japan is a unitary state. The central government delegates many functions (such as education and the police force) to the prefectures and municipalities, but retains the overall right to control them. Although local government expenditure accounts for 70 percent of overall government expenditure, the central government controls local budgets, tax rates, and borrowing.


title: Prefectures of Japan

text: Prefectural government functions include the organization of the prefectural police force, the supervision of schools and the maintenance of prefectural schools (mainly high schools), prefectural hospitals, prefectural roads, the supervision of prefectural waterways and regional urban planning. Their responsibilities include tasks delegated to them by the national government such as maintaining most ordinary national roads (except in designated major cities), and prefectures coordinate and support their municipalities in their functions. De facto, prefectures as well as municipalities have often been less autonomous than the formal extent of the local autonomy law suggests, because


title: Prefectures of Japan

text: Historically, during the Edo period, the Tokugawa shogunate established around the nine largest cities in Japan, and 302 elsewhere. When the Meiji government began to create the prefectural system in 1868, the nine bugyō-ruled zones became , while the township-ruled zones and the rest of the bugyo-ruled zones became . Later, in 1871, the government designated Tokyo, Osaka, and Kyoto as "fu", and relegated the other "fu" to the status of "ken." During World War II, in 1943, Tokyo became a "to," a new type of pseudo-prefecture.


title: Prefectures of Japan

text: Despite the differences in terminology, there is little functional difference between the four types of local governments. The subnational governments are sometimes collectively referred to as in Japanese, which is a combination of the four terms.


title: Prefectures of Japan

text: Tokyo is referred to as , which is often translated as "metropolis". The Japanese government translates as "Tokyo Metropolis" in almost all cases, and the government is officially called the "Tokyo Metropolitan Government".


title: Prefectures of Japan

text: Following the capitulation of shogunate Edo in 1868, "Tōkyō-fu" (an urban prefecture like Kyoto and Osaka) was set up and encompassed the former city area of Edo under the Fuhanken sanchisei. After the abolition of the han system in the first wave of prefectural mergers in 1871/72, several surrounding areas (parts of Urawa, Kosuge, Shinagawa and Hikone prefectures) were merged into Tokyo, and under the system of (numbered) "large districts and small districts" "(daiku-shōku)", it was subdivided into eleven large districts further subdivided into 103 small districts, six of the large districts (97 small districts) covered the former city area of Edo. When the ancient ritsuryō districts were reactivated as administrative units in 1878, Tokyo was subdivided into 15 [urban] districts "(-ku)" and initially six [rural] districts ("-gun"; nine after the Tama transfer from Kanagawa in 1893, eight after the merger of East Tama and South Toshima into Toyotama in 1896). Both urban and rural districts, like everywhere in the country, were further subdivided into urban units/towns/neighbourhoods "(-chō/-machi)" and rural units/villages "(-mura/-son)". The yet unincorporated communities on the Izu (previously part of Shizuoka) and Ogasawara (previously directly Home Ministry-administrated) island groups became also part of Tokyo in the 19th century. When the modern municipalities – [district-independent] cities and [rural] districts containing towns and villages – were introduced under the Yamagata-Mosse laws on local government and the simultaneous Great Meiji merger was performed in 1889, the 15 "-ku" became wards of Tokyo City, initially Tokyo's only independent city "(-shi)", the six rural districts of Tokyo were consolidated in 85 towns and villages. In 1893, the three Tama districts and their 91 towns and villages became part of Tokyo. As Tokyo city's suburbs grew rapidly in the early 20th century, many towns and villages in Tokyo were merged or promoted over the years. In 1932, five complete districts with their 82 towns and villages were merged into Tokyo City and organised in 20 new wards. Also, by 1940, there were two more cities in Tokyo: Hachiōji City and Tachikawa City.


title: Prefectures of Japan

text: In 1943, Tokyo City was abolished, "Tōkyō-fu" became "Tōkyō-to", and Tokyo-shi's 35 wards remained Tokyo-to's 35 wards, but submunicipal authorities of Tokyo-shi's wards which previously fell directly under the municipality, with the municipality now abolished, fell directly under prefectural or now "Metropolitan" authority. All other cities, towns and villages in Tokyo-fu stayed cities, towns and villages in Tokyo-to. The reorganisation's aim was to consolidate the administration of the area around the capital by eliminating the extra level of authority in Tokyo. Also, the governor was no longer called "chiji", but "chōkan" (~"head/chief [usually: of a central government agency]") as in Hokkaidō). The central government wanted to have greater control over all local governments due to Japan's deteriorating position in World War II – for example, all mayors in the country became appointive as in the Meiji era – and over Tokyo in particular, due to the possibility of emergency in the metropolis.


title: Prefectures of Japan

text: After the war, Japan was forced to decentralise Tokyo again, following the general terms of democratisation outlined in the Potsdam Declaration. Many of Tokyo's special governmental characteristics disappeared during this time, and the wards took on an increasingly municipal status in the decades following the surrender. Administratively, today's special wards are almost indistinguishable from other municipalities.


title: Prefectures of Japan

text: The postwar reforms also changed the map of Tokyo significantly: In 1947, the 35 wards were reorganised into the 23 special wards, because many of its citizens had either died during the war, left the city, or been drafted and did not return. In the occupation reforms, special wards, each with their own elected assemblies ("kugikai") and mayors ("kuchō"), were intended to be equal to other municipalities even if some restrictions still applied. (For example, there was during the occupation a dedicated municipal police agency for the 23 special wards/former Tokyo City, yet the special wards public safety commission was not named by the special ward governments, but by the government of the whole "Metropolis". In 1954, independent municipal police forces were abolished generally in the whole country, and the prefectural/"Metropolitan" police of Tokyo is again responsible for the whole prefecture/"Metropolis" and like all prefectural police forces controlled by the prefectural/"Metropolitan" public safety commission whose members are appointed by the prefectural/"Metropolitan" governor and assembly.) But, as part of the "reverse course" of the 1950s some of these new rights were removed, the most obvious measure being the denial of directly elected mayors. Some of these restrictions were removed again over the decades. But it was not until the year 2000 that the special wards were fully recognised as municipal-level entities.


title: Prefectures of Japan

text: Independently from these steps, as Tokyo's urban growth again took up pace during the postwar economic miracle and most of the main island part of Tokyo "Metropolis" became increasingly core part of the Tokyo metropolitan area, many of the other municipalities in Tokyo have transferred some of their authority to the Metropolitan government. For example, the Tokyo Fire Department which was only responsible for the 23 special wards until 1960 has until today taken over the municipal fire departments in almost all of Tokyo. A joint governmental structure for the whole Tokyo metropolitan area (and not only the western suburbs of the special wards which are part of the Tokyo prefecture/Metropolis") as advocated by some politicians such as former Kanagawa governor Shigefumi Matsuzawa has not been established (see also Dōshūsei). Existing cross-prefectural fora of cooperation between local governments in the Tokyo metropolitan area are the Kantō regional governors' association "(Kantō chihō chijikai)" and the "Shutoken summit" (formally "conference of chief executives of nine prefectures and cities", "9 to-ken-shi shunō kaigi"). But, these are not themselves local public entities under the local autonomy law and national or local government functions cannot be directly transferred to them, unlike the "Union of Kansai governments" "(Kansai kōiki-rengō)" which has been established by several prefectural governments in the Kansai region.


title: Prefectures of Japan

text: There are some differences in terminology between Tokyo and other prefectures: police and fire departments are called instead of , for instance. But the only functional difference between Tōkyō-to and other prefectures is that Tokyo administers wards as well as cities. Today, since the special wards have almost the same degree of independence as Japanese cities, the difference in administration between Tokyo and other prefectures is fairly minor.


title: Prefectures of Japan

text: In Osaka, several prominent politicians led by Tōru Hashimoto, then mayor of Osaka City and former governor of Osaka Prefecture, proposed an Osaka Metropolis plan, under which Osaka City, and possibly other neighboring cities, would be replaced by special wards similar to Tokyo's. The plan was narrowly defeated in a 2015 referendum, and again in 2020.


title: Prefectures of Japan

text: Hokkaidō is referred to as a or circuit. This term was originally used to refer to Japanese regions consisting of several provinces (e.g. the Tōkaidō east-coast region, and Saikaido west-coast region). This was also a historical usage of the character in China. (In Korea, this historical usage is still used today and was kept during the period of Japanese rule.)


title: Prefectures of Japan

text: , the only remaining "dō" today, was not one of the original seven "dō" (it was known as Ezo in the pre-modern era). Its current name is believed to originate from Matsuura Takeshiro, an early Japanese explorer of the island. Since Hokkaidō did not fit into the existing "dō" classifications, a new "dō" was created to cover it.


title: Prefectures of Japan

text: The Meiji government originally classified Hokkaidō as a , and later divided the island into three prefectures (Sapporo, Hakodate, and Nemuro). These were consolidated into a single in 1886, at prefectural level but organized more along the lines of a territory. In 1947, the department was dissolved, and Hokkaidō became a full-fledged prefecture. The "-ken" suffix was never added to its name, so the "-dō" suffix came to be understood to mean "prefecture".


title: Prefectures of Japan

text: When Hokkaidō was incorporated, transportation on the island was still underdeveloped, so the prefecture was split into several that could fulfill administrative duties of the prefectural government and keep tight control over the developing island. These subprefectures still exist today, although they have much less power than they possessed before and during World War II. They now exist primarily to handle paperwork and other bureaucratic functions.


title: Prefectures of Japan

text: "Hokkaidō Prefecture" is, technically speaking, a redundant term because "dō" itself indicates a prefecture, although it is occasionally used to differentiate the government from the island itself. The prefecture's government calls itself the "Hokkaidō Government" rather than the "Hokkaidō Prefectural Government".


title: Prefectures of Japan

text: Osaka and Kyoto Prefectures are referred to as . The Classical Chinese character from which this is derived implies a core urban zone of national importance. Before World War II, different laws applied to "fu" and "ken," but this distinction was abolished after the war, and the two types of prefecture are now functionally the same.


title: Prefectures of Japan

text: 43 of the 47 prefectures are referred to as . The Classical Chinese character from which this is derived carries a rural or provincial connotation, and an analogous character is used to refer to the counties of China, counties of Taiwan and districts of Vietnam.


title: Prefectures of Japan

text: The prefectures are also often grouped into eight regions ("Chihō"). Those regions are not formally specified, they do not have elected officials, nor are they corporate bodies. But the practice of ordering prefectures based on their geographic region is traditional. This ordering is mirrored in Japan's International Organization for Standardization (ISO) coding. From north to south (numbering in order), the prefectures of Japan and their commonly associated regions are:


title: Prefectures of Japan

text: Here are some territories that were lost after World War II. This does not include all the territories of the Empire of Japan such as Manchukuo.


title: Pulmonary embolism

text: Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood. Symptoms of a blood clot in the leg may also be present, such as a red, warm, swollen, and painful leg. Signs of a PE include low blood oxygen levels, rapid breathing, rapid heart rate, and sometimes a mild fever. Severe cases can lead to passing out, abnormally low blood pressure, obstructive shock, and sudden death.


title: Pulmonary embolism

text: PE usually results from a blood clot in the leg that travels to the lung. The risk of blood clots is increased by advanced age, cancer, prolonged bed rest and immobilization, smoking, stroke, long-haul travel over 4 hours, certain genetic conditions, estrogen-based medication, pregnancy, obesity, trauma or bone fracture, and after some types of surgery. A small proportion of cases are due to the embolization of air, fat, or amniotic fluid. Diagnosis is based on signs and symptoms in combination with test results. If the risk is low, a blood test known as a D-dimer may rule out the condition. Otherwise, a CT pulmonary angiography, lung ventilation/perfusion scan, or ultrasound of the legs may confirm the diagnosis. Together, deep vein thrombosis and PE are known as venous thromboembolism (VTE).


title: Pulmonary embolism

text: Efforts to prevent PE include beginning to move as soon as possible after surgery, lower leg exercises during periods of sitting, and the use of blood thinners after some types of surgery. Treatment is with anticoagulants such as heparin, warfarin or one of the direct-acting oral anticoagulants (DOACs). These are recommended for at least three months. Severe cases may require thrombolysis using medication such as tissue plasminogen activator (tPA) given intravenously or through a catheter, and some may require surgery (a pulmonary thrombectomy). If blood thinners are not appropriate, a temporary vena cava filter may be used.


title: Pulmonary embolism

text: Pulmonary emboli affect about 430,000 people each year in Europe. In the United States, between 300,000 and 600,000 cases occur each year, which contribute to at least 40,000 deaths. Rates are similar in males and females. They become more common as people get older.


title: Pulmonary embolism

text: Symptoms of pulmonary embolism are typically sudden in onset and may include one or many of the following: dyspnea (shortness of breath), tachypnea (rapid breathing), chest pain of a "pleuritic" nature (worsened by breathing), cough and hemoptysis (coughing up blood). More severe cases can include signs such as cyanosis (blue discoloration, usually of the lips and fingers), collapse, and circulatory instability because of decreased blood flow through the lungs and into the left side of the heart. About 15% of all cases of sudden death are attributable to PE. While PE may present with syncope, less than 1% of syncope cases are due to PE.


title: Pulmonary embolism

text: On physical examination, the lungs are usually normal. Occasionally, a pleural friction rub may be audible over the affected area of the lung (mostly in PE with infarct). A pleural effusion is sometimes present that is exudative, detectable by decreased percussion note, audible breath sounds, and vocal resonance. Strain on the right ventricle may be detected as a left parasternal heave, a loud pulmonary component of the second heart sound, and/or raised jugular venous pressure. A low-grade fever may be present, particularly if there is associated pulmonary hemorrhage or infarction.


title: Pulmonary embolism

text: As smaller pulmonary emboli tend to lodge in more peripheral areas without collateral circulation, they are more likely to cause lung infarction and small effusions (both of which are painful), but not hypoxia, dyspnea, or hemodynamic instability such as tachycardia. Larger PEs, which tend to lodge centrally, typically cause dyspnea, hypoxia, low blood pressure, fast heart rate and fainting, but are often painless because there is no lung infarction due to collateral circulation. The classic presentation for PE with pleuritic pain, dyspnea, and tachycardia is likely caused by a large fragmented embolism causing both large and small PEs. Thus, small PEs are often missed because they cause pleuritic pain alone without any other findings and large PEs are often missed because they are painless and mimic other conditions often causing ECG changes and small rises in troponin and brain natriuretic peptide levels.


title: Pulmonary embolism

text: PEs are sometimes described as massive, submassive, and nonmassive depending on the clinical signs and symptoms. Although the exact definitions of these are unclear, an accepted definition of massive PE is one in which there is hemodynamic instability. This is a cause of obstructive shock, which presents as sustained low blood pressure, slowed heart rate, or pulselessness.


title: Pulmonary embolism

text: About 90% of emboli are from proximal leg deep vein thrombosis (DVTs) or pelvic vein thromboses. The rare venous thoracic outlet syndrome can also be a cause of DVTs, especially in young men without significant risk factors. DVTs are at risk for dislodging and migrating to the lung circulation. The conditions are generally regarded as a continuum termed "venous thromboembolism" (VTE).


title: Pulmonary embolism

text: VTE is much more common in immunocompromised individuals as well as individuals with comorbidities including:


title: Pulmonary embolism

text: The development of thrombosis is classically due to a group of causes named Virchow's triad (alterations in blood flow, factors in the vessel wall, and factors affecting the properties of the blood). Often, more than one risk factor is present.


title: Pulmonary embolism

text: Although most pulmonary embolisms are the result of proximal leg deep vein thrombosis (DVTs), there are still many other risk factors that can also result in a pulmonary embolism.


title: Pulmonary embolism

text: After a first PE, the search for secondary causes is usually brief. Only when a second PE occurs, and especially when this happens while still under anticoagulant therapy, a further search for underlying conditions is undertaken. This will include testing ("thrombophilia screen") for Factor V Leiden mutation, antiphospholipid antibodies, protein C and S and antithrombin levels, and later prothrombin mutation, MTHFR mutation, Factor VIII concentration and rarer inherited coagulation abnormalities.


title: Pulmonary embolism

text: To diagnose a pulmonary embolism, a review of clinical criteria to determine the need for testing is recommended. In those who have low risk, age less than 50, heart rate less than 100 beats per minute, oxygen level more than 94% on room air, and no leg swelling, coughing up of blood, surgery or trauma in the last four weeks, previous blood clots, or estrogen use, further testing is not typically needed.


title: Pulmonary embolism

text: In situations with more high risk individuals, further testing is needed. A CT pulmonary angiogram (CTPA) is the preferred method for diagnosis of a pulmonary embolism due to its easy administration and accuracy. Although a CTPA is preferred, there are also other tests that can be done. For example, a proximal lower limb compression ultrasound (CUS) can be used. This is a test which is primarily used as a confirmatory test, meaning it confirms a previous analysis showing the presence or suspected presence of a pulmonary embolism. According to a cross-sectional study, CUS tests have a sensitivity of 41% and specificity of 96%.


title: Pulmonary embolism

text: If there are concerns this is followed by testing to determine a likelihood of being able to confirm a diagnosis by imaging, followed by imaging if other tests have shown that there is a likelihood of a PE diagnosis.


title: Pulmonary embolism

text: The diagnosis of PE is based primarily on validated clinical criteria combined with selective testing because the typical clinical presentation (shortness of breath, chest pain) cannot be definitively differentiated from other causes of chest pain and shortness of breath. The decision to perform medical imaging is based on clinical reasoning, that is, the medical history, symptoms, and findings on physical examination, followed by an assessment of clinical probability.


title: Pulmonary embolism

text: The most commonly used method to predict clinical probability, the Wells score, is a clinical prediction rule, whose use is complicated by multiple versions being available. In 1995, Philip Steven Wells, initially developed a prediction rule (based on a literature search) to predict the likelihood of DVT, based on clinical criteria. A new prediction score for PE was created in 1998 This prediction rule was revised by Wells "et al." in 2000. In the 2000 publication, Wells proposed two different scoring systems using cutoffs of 2 or 4 with the same prediction rule, and also included D-dimer testing in the rule-out of PE in low probability patients. In 2001, Wells published results using the more conservative cutoff of 2 to create three categories. An additional version, the "modified extended version", using the more recent cutoff of 2 but including findings from Wells's initial studies were proposed. Most recently, a further study reverted to Wells's earlier use of a cutoff of 4 points to create only two categories.


title: Pulmonary embolism

text: There are additional prediction rules for PE, such as the Geneva rule. More importantly, the use of "any" rule is associated with reduction in recurrent thromboembolism.


title: Pulmonary embolism

text: Recommendations for a diagnostic algorithm were published by the PIOPED investigators; however, these recommendations do not reflect research using 64 slice MDCT. These investigators recommended:


title: Pulmonary embolism

text: The pulmonary embolism rule-out criteria (PERC) helps assess people in whom pulmonary embolism is suspected, but unlikely. Unlike the Wells score and Geneva score, which are clinical prediction rules intended to risk stratify people with suspected PE, the PERC rule is designed to rule out the risk of PE in people when the physician has already stratified them into a low-risk category.


title: Pulmonary embolism

text: People in this low risk category without any of these criteria may undergo no further testing for PE: low oxygen saturations – Sa <95%, unilateral leg swelling, coughing up blood, prior DVT or PE, recent surgery or trauma, age >50, hormone use, fast heart rate. The rationale behind this decision is that further testing (specifically CT angiogram of the chest) may cause more harm (from radiation exposure and contrast dye) than the risk of PE. The PERC rule has a sensitivity of 97.4% and specificity of 21.9% with a false negative rate of 1.0% (16/1666).


title: Pulmonary embolism

text: In people with a low or moderate suspicion of PE, a normal D-dimer level (shown in a blood test) is enough to exclude the possibility of thrombotic PE, with a three-month risk of thromboembolic events being 0.14%. D-dimer is highly sensitive but not specific (specificity around 50%). In other words, a positive D-dimer is not synonymous with PE, but a negative D-dimer is, with a good degree of certainty, an indication of absence of a PE. A low pretest probability is also valuable in ruling out PE. The typical cut off is 500 μg/L, although this varies based on the assay. However, in those over the age of 50, changing the cut-off value to the person's age multiplied by 10 μg/L (accounting for assay which has been used) is recommended as it decreases the number of falsely positive tests without missing any additional cases of PE.


title: Pulmonary embolism

text: When a PE is being suspected, several blood tests are done in order to exclude important secondary causes of PE. This includes a full blood count, clotting status (PT, aPTT, TT), and some screening tests (erythrocyte sedimentation rate, kidney function, liver enzymes, electrolytes). If one of these is abnormal, further investigations might be warranted to the issue.


title: Pulmonary embolism

text: In typical people who are not known to be at high risk of PE, imaging is helpful to confirm or exclude a diagnosis of PE after simpler first-line tests are used. Medical societies recommend tests such as the D-dimer to first provide supporting evidence for the need for imaging, and imaging would be done if other tests confirmed a moderate or high probability of finding evidence to support a diagnosis of PE.


title: Pulmonary embolism

text: CT pulmonary angiography (CTPA) is a pulmonary angiogram obtained using computed tomography (CT) with radiocontrast rather than right heart catheterization. Its advantages are that it is accurate, it is non-invasive, it is more often available, and it may identifying other lung disorders in case there is no pulmonary embolism. The accuracy and non-invasive nature of CTPA also make it advantageous for people who are pregnant.


title: Pulmonary embolism

text: Assessing the accuracy of CT pulmonary angiography is hindered by the rapid changes in the number of rows of detectors available in multidetector CT (MDCT) machines. According to a cohort study, single-slice spiral CT may help diagnose detection among people with suspected pulmonary embolism. In this study, the sensitivity was 69% and specificity was 84%. In this study which had a prevalence of detection was 32%, the positive predictive value of 67.0% and negative predictive value of 85.2%. However, this study's results may be biased due to possible incorporation bias, since the CT scan was the final diagnostic tool in people with pulmonary embolism. The authors noted that a negative single slice CT scan is insufficient to rule out pulmonary embolism on its own. A separate study with a mixture of 4 slice and 16 slice scanners reported a sensitivity of 83% and a specificity of 96%, which means that it is a good test for ruling out a pulmonary embolism if it is not seen on imaging and that it is very good at confirming a pulmonary embolism is present if it is seen. This study noted that additional testing is necessary when the clinical probability is inconsistent with the imaging results. CTPA is non-inferior to VQ scanning, and identifies more emboli (without necessarily improving the outcome) compared to VQ scanning.


title: Pulmonary embolism

text: A ventilation/perfusion scan (or V/Q scan or lung scintigraphy) shows that some areas of the lung are being ventilated but not perfused with blood (due to obstruction by a clot). This type of examination is as accurate as multislice CT, but is less used, due to the greater availability of CT technology. It is particularly useful in people who have an allergy to iodinated contrast, impaired kidney function, or are pregnant (due to its lower radiation exposure as compared to CT). The test can be performed with planar two-dimensional imaging, or single photon emission computed tomography (SPECT) which enables three-dimensional imaging. Hybrid devices combining SPECT and CT (SPECT/CT) further enable anatomic characterization of any abnormality.


title: Pulmonary embolism

text: Historically, the gold standard for diagnosis was pulmonary angiography by fluoroscopy, but this has fallen into disuse with the increased availability of non-invasive techniques that offer similar diagnostic accuracy.


title: Pulmonary embolism

text: The primary use of the ECG is to rule out other causes of chest pain. An electrocardiogram (ECG) is routinely done on people with chest pain to quickly diagnose myocardial infarctions (heart attacks), an important differential diagnosis in an individual with chest pain. While certain ECG changes may occur with PE, none are specific enough to confirm or sensitive enough to rule out the diagnosis. An ECG may show signs of right heart strain or acute cor pulmonale in cases of large PEs – the classic signs are a large S wave in lead I, a large Q wave in lead III, and an inverted T wave in lead III (S1Q3T3), which occurs in 12–50% of people with the diagnosis, yet also occurs in 12% without the diagnosis.


title: Pulmonary embolism

text: This is occasionally present (occurring in up to 20% of people), but may also occur in other acute lung conditions, and, therefore, has limited diagnostic value. The most commonly seen signs in the ECG are sinus tachycardia, right axis deviation, and right bundle branch block. Sinus tachycardia, however, is still only found in 8–69% of people with PE.


title: Pulmonary embolism

text: ECG findings associated with pulmonary emboli may suggest worse prognosis since the six findings identified with RV strain on ECG (heart rate > 100 beats per minute, S1Q3T3, inverted T waves in leads V1-V4, ST elevation in aVR, complete right bundle branch block, and atrial fibrillation) are associated with increased risk of circulatory shock and death.


title: Pulmonary embolism

text: Cases with inverted T in leads V are suspected with PE or inferior myocardial infarction. PE cases show inverted T waves in leads II and aV, but inferior myocardial infarction cases do not show inverted T waves in II and aV.


title: Pulmonary embolism

text: In massive and submassive PE, dysfunction of the right side of the heart may be seen on echocardiography, an indication that the pulmonary artery is severely obstructed and the right ventricle, a low-pressure pump, is unable to match the pressure. Some studies (see below) suggest that this finding may be an indication for thrombolysis. Not every person with a (suspected) pulmonary embolism requires an echocardiogram, but elevations in cardiac troponins or brain natriuretic peptide may indicate heart strain and warrant an echocardiogram, and be important in prognosis.


title: Pulmonary embolism

text: The specific appearance of the right ventricle on echocardiography is referred to as the "McConnell's sign". This is the finding of akinesia of the mid-free wall but a normal motion of the apex. This phenomenon has a 77% sensitivity and a 94% specificity for the diagnosis of acute pulmonary embolism in the setting of right ventricular dysfunction.


title: Pulmonary embolism

text: Pulmonary embolism may be preventable in those with risk factors. People admitted to hospital may receive preventative medication, including unfractionated heparin, low molecular weight heparin (LMWH), or fondaparinux, and anti-thrombosis stockings to reduce the risk of a DVT in the leg that could dislodge and migrate to the lungs.


title: Pulmonary embolism

text: Following the completion of anticoagulation in those with prior PE, long-term aspirin is useful to prevent recurrence.


title: Pulmonary embolism

text: Anticoagulant therapy is the mainstay of treatment. Acutely, supportive treatments, such as oxygen or analgesia, may be required. People are often admitted to hospital in the early stages of treatment, and tend to remain under inpatient care until the INR has reached therapeutic levels (if warfarin is used). Increasingly, however, low-risk cases are managed at home in a fashion already common in the treatment of DVT. Evidence to support one approach versus the other is weak.


title: Pulmonary embolism

text: Anticoagulant therapy is the mainstay of treatment. For many years, vitamin K antagonists (warfarin or less commonly acenocoumarol or phenprocoumon) have been the cornerstone. As vitamin K antagonists do not act immediately, initial treatment is with rapidly acting injectable anticoagulants: unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fondaparinux, while oral vitamin K antagonists are initiated and titrated (usually as part of inpatient hospital care) to the international normalized ratio, a test that determines the dose. In terms of injectable treatments, LMWH may reduce bleeding among people with pulmonary embolism as compared to UFH. According to the same review, LMWH reduced the incidence of recurrent thrombotic complications and reduced thrombus size when compared to heparin. There was no difference in overall mortality between participants treated with LMWH and those treated with unfractionated heparin. Vitamin K antagonists require frequent dose adjustment and monitoring of the international normalized ratio (INR). In PE, INRs between 2.0 and 3.0 are generally considered ideal. If another episode of PE occurs under warfarin treatment, the INR window may be increased to e.g. 2.5–3.5 (unless there are contraindications) or anticoagulation may be changed to a different anticoagulant e.g. LMWH.


title: Pulmonary embolism

text: In recent years, many anticoagulants have been introduced that offer similar to warfarin but without a need for titration to the INR. Known as the directly acting oral anticoagulants, these treatments are now preferred over vitamin K antagonists by American professional guidelines. Two of these (rivaroxaban and apixaban) do not require initial heparin or fondaparinux treatment, whereas dabigatran and edoxaban do. A Cochrane review found that there is no evidence of a difference between oral DTIs (dabigatran, rivaroxaban, edoxaban, apixaban) and standard anticoagulation in the prevention of recurrent pulmonary embolism.


title: Pulmonary embolism

text: In people with cancer who develop pulmonary embolism, therapy with a course of LMWH is favored over warfarin or other oral anticoagulants. Similarly, pregnant women are treated with low molecular weight heparin until after delivery to avoid the known teratogenic effects of warfarin, especially in the early stages of pregnancy, but it can be used while breastfeeding.


title: Pulmonary embolism

text: Anticoagulation therapy is usually continued for 3–6 months, or "lifelong" if there have been previous DVTs or PEs, or none of the usual transient risk factors is present. In those without a known cause that can be reversed 2 years of treatment may be better than 6 months. For those with small PEs (known as subsegmental PEs) the effects of anticoagulation is unknown as it has not been properly studied as of 2020.


title: Pulmonary embolism

text: Massive PE causing hemodynamic instability (shock and/or low blood pressure, defined as a systolic blood pressure <90 mmHg or a pressure drop of 40 mmHg for >15 min if not caused by new-onset arrhythmia, hypovolemia or sepsis) is an indication for thrombolysis, the enzymatic destruction of the clot with medication. In this situation, it is the best available treatment in those without contraindications and is supported by clinical guidelines. It is also recommended in those in cardiac arrest with a known PE. Catheter-directed thrombolysis (CDT) is a new technique found to be relatively safe and effective for massive PEs. This involves accessing the venous system by placing a catheter into a vein in the groin and guiding it through the veins by using fluoroscopic imaging until it is located next to the PE in the lung circulation. Medication that breaks up blood clots is released through the catheter so that its highest concentration is directly next to the pulmonary embolus. CDT is performed by interventional radiologists or vascular surgeons, and in medical centers that offer CDT, it may be offered as a first-line treatment. Catheter-based ultrasound-assisted thrombolysis is being investigated.


title: Pulmonary embolism

text: The use of thrombolysis in non-massive PEs is still debated. Some have found that the treatment decreases the risk of death and increases the risk of bleeding including intracranial hemorrhage. Others have found no decrease in the risk of death.


title: Pulmonary embolism

text: There are two situations when an inferior vena cava filter is considered advantageous, and those are if anticoagulant therapy is contraindicated (e.g. shortly after a major operation), or a person has a pulmonary embolus in spite of being anticoagulated. In these instances, it may be implanted to prevent new or existing DVTs from entering the pulmonary artery and combining with an existing blockage. In spite of the device's theoretical advantage of preventing pulmonary emboli, there is a lack of evidence supporting its effectiveness.


title: Pulmonary embolism

text: Inferior vena cava filters should be removed as soon as it becomes safe to start using anticoagulation. Although modern filters are meant to be retrievable, complications may prevent some from being removed. The long-term safety profile of permanently leaving a filter inside the body is not known.


title: Pulmonary embolism

text: Surgical management of acute pulmonary embolism (pulmonary thrombectomy) is uncommon and has largely been abandoned because of poor long-term outcomes. However, recently, it has gone through a resurgence with the revision of the surgical technique and is thought to benefit certain people. Chronic pulmonary embolism leading to pulmonary hypertension (known as "chronic thromboembolic hypertension") is treated with a surgical procedure known as a pulmonary thromboendarterectomy.


title: Pulmonary embolism

text: There are roughly 10 million cases of pulmonary embolisms per year. In the United States, pulmonary embolisms are the primary cause of at least 10,000 to 12,000 deaths per year and a contributing cause in at least 30,000 to 40,000 deaths per year. True incidence involving pulmonary embolisms is unknown because they often go undiagnosed or unnoticed until autopsy. From 1993 to 2012, there have been an increased number of admissions in hospitals due to pulmonary embolisms, jumping from 23 cases per 100,000 people to 65 cases per 100,000 people. Despite this increase, there has been a decrease in mortality during that same time period due to medical advances that have occurred.


title: Pulmonary embolism

text: Venous thromboembolism (VTE), a common risk factor, is present at much higher rates in those over the age of 70 (three times higher compared to those aged 45 to 69). This is likely due to there being a generally lower level of activity among the elderly, resulting in higher rates of immobility and obesity. VTE has a large, and continuously rising, case fatality rate. This rate is roughly 10% after 30 days, 15% after three months and up to 20% after one year. Pulmonary embolisms alone (when resulting in hospitalizations) have a case fatality rate of about 5% to 10% so VTE can play a large factor in the severity of the embolisms.


title: Pulmonary embolism

text: When looking at all cases, the rate of fatal pulmonary emboli has declined from 6% to 2% over the last 25 years in the United States. In Europe, an average of approximately 40,000 deaths per year with pulmonary embolism as the primary cause were reported between 2013 and 2015, a conservative estimate because of potential underdiagnosis.


title: Pulmonary embolism

text: There are several markers used for risk stratification and these are also independent predictors of adverse outcomes. These include hypotension, cardiogenic shock, syncope, evidence of right heart dysfunction, and elevated cardiac enzymes. Some ECG changes including S1Q3T3 also correlate with a worse short-term prognosis. There have been other patient-related factors such as COPD and chronic heart failure thought to also play a role in prognosis.


title: Pulmonary embolism

text: Prognosis depends on the amount of lung that is affected and on the co-existence of other medical conditions; chronic embolisation to the lung can lead to pulmonary hypertension. After a massive PE, the embolus must be resolved somehow if the patient is to survive. In thrombotic PE, the blood clot may be broken down by fibrinolysis, or it may be organized and recanalized so that a new channel forms through the clot. Blood flow is restored most rapidly in the first day or two after a PE. Improvement slows thereafter and some deficits may be permanent. There is controversy over whether small subsegmental PEs need treatment at all and some evidence exists that patients with subsegmental PEs may do well without treatment.


title: Pulmonary embolism

text: Mortality from untreated PEs was said to be 26%. This figure comes from a trial published in 1960 by Barrit and Jordan, which compared anticoagulation against placebo for the management of PE. Barritt and Jordan performed their study in the Bristol Royal Infirmary in 1957. This study is the only placebo-controlled trial ever to examine the place of anticoagulants in the treatment of PE, the results of which were so convincing that the trial has never been repeated as to do so would be considered unethical. That said, the reported mortality rate of 26% in the placebo group is probably an overstatement, given that the technology of the day may have detected only severe PEs.


title: Pulmonary embolism

text: The PESI and sPESI (= simplified Pulmonary Embolism Severity Index) scoring tools can estimate mortality of patients. The Geneva prediction rules and Wells criteria are used to calculate a pre-test probability of patients to predict who has a pulmonary embolism. These scores are tools to be used with clinical judgment in deciding diagnostic testing and types of therapy. The PESI algorithm comprises 11 routinely available clinical variables. It puts the subjects into one of five classes (I–V), with 30-day mortality ranging from 1.1% to 24.5%. Those in classes I and II are low-risk and those in classes III–V are high-risk.


title: Tom Welling

text: Thomas "Tom" John Patrick Welling (born April 26, 1977) is an American actor, director, producer, and model best known for his role as Clark Kent in The WB/The CW superhero drama "Smallville" (2001–2011). He also co-starred in the third season of Fox fantasy comedy-drama "Lucifer" as Lt. Marcus Pierce/Cain (2017–2018).


title: Tom Welling

text: A high school athlete, Welling initially worked in construction and, in 1998, he successfully modeled men's clothing for several popular brands. In 2000, he made a successful transition to television. He has been nominated and received several awards for his role as Clark Kent. In 2001, he had a recurring role as Rob "Karate Rob" Meltzer in the second season of the CBS legal drama "Judging Amy". His films include "Cheaper by the Dozen" (2003), "Cheaper by the Dozen 2" (2005), "The Fog" (2005), "Draft Day" (2014) and "The Choice" (2016). He has been cast as Samuel Campbell in the TV series "The Winchesters". He has also been involved behind the camera as an executive producer and a director.


title: Tom Welling

text: Welling was born in Putnam Valley, New York. His family moved frequently, making stops in Wisconsin, Delaware, and Michigan. Welling attended Okemos High School in Okemos, Michigan, where he started acting in plays, but then switched to sports. Welling played baseball and soccer, but his favorite sport is basketball. Welling is one of four children, with two older sisters, Rebecca and Jamie, and a younger brother, Mark Welling, who is also an actor.


title: Tom Welling

text: Originally a construction worker, Welling was discovered in 1998 at a party in Nantucket by casting director Jennifer Starr who was there finding fresh faces for a Tommy Hilfiger campaign and suggested he try modeling. Welling modeled for Louisa Modeling Agency until 2000, when he relocated to Los Angeles. There he modeled for Tommy Hilfiger, Abercrombie & Fitch, and Calvin Klein while pursuing an acting career. In 2000, Welling appeared in Angela Via's music video "Picture Perfect" where he played Vía's love interest. Welling has said that he did not like modeling and that he was not good at it because it was all on the outside or from an external point of view. He pursued acting because he wanted to express a range of emotions, but Welling still models occasionally and appeared in the May 2008 issue of "Vogue", the so-called "Superhero Issue". In his first major acting role, Welling played karate teacher Rob "Karate Rob" Meltzer, a younger love interest of Amy Gray (Amy Brenneman) in the second season of the CBS legal drama "Judging Amy", which aired in 2001. Welling was originally signed for three episodes, but after receiving good feedback, the producers kept him for three more. Welling also had a small role in the pilot episode of the UPN science fiction sitcom "Special Unit 2", and he appeared in the pilot episode of the short-lived Fox sitcom "Undeclared".


title: Tom Welling

text: Welling was cast in the WB superhero drama "Smallville" after a nationwide search for an actor to play Clark Kent. In an interview with a teen magazine, Welling spoke about the day he auditioned for the role: "I was on my way back from the Warner Bros. studio, and I stopped in a gas station to call my manager and tell him how it went. I called and got him on the phone and he said, 'Can you hold on a second?' Next thing I know, there are literally seven people on the other line and almost in unison they say, 'Tom, you got it!'" The pilot aired in October 2001 and became the highest-rated debut for The WB, with 8.4 million viewers. Welling told "TV Guide" that he turned down the lead role twice, but after reading the script, decided to take the job. Like Christopher Reeve, he was not a "Superman" fan before being cast as Clark Kent. In fact, he said, he continued to not read "Superman" comics: "I made a conscious decision to stay away from that material. We're doing something different at a time before all that, I don't want that to affect what I'm doing, even subconsciously." He did get the chance to meet two previous "Superman" actors: Christopher Reeve, who appeared in season 2: episode 17 titled "Rosetta", and Dean Cain, who appeared in season 7: episode 4 titled "Cure".


title: Tom Welling

text: Welling was named one of "People" magazine's "Breakthrough Stars of 2001", and also won the Teen Choice Award as "Choice Breakout Star (Male)" in 2002 for his role as Clark Kent. Following the third season, Welling was interviewed by "Smallville Magazine" and said that if he could play one character on the show that was not Clark Kent, it would be Lex Luthor; "Lex Luthor! I wouldn't mind having my head shaved—as an actor, [it is the ultimate,] getting to play the complete opposite of your character."


title: Tom Welling

text: In 2003, Welling said he met with director Brett Ratner about potentially playing Clark Kent/Superman in the superhero film "Superman Returns" (2006), but scheduling conflicted with "Smallville". Comic book artist Alex Ross even did two sketches of Welling as the "Man of Steel" to see what the actor would look like in the famous costume. In August 2009, Welling won another Teen Choice Award as "Choice TV Actor (Action Adventure)" for "Smallville".


title: Tom Welling

text: In 2019, Welling reprised his role as Clark Kent in the "Batwoman" episode of the CW Arrowverse crossover event "Crisis on Infinite Earths", along with his "Smallville" co-star Erica Durance as Lois Lane. Welling's reprisal concluded his incarnation's story where it showed Clark gave up his powers, retired as an average farmer, and has at least two daughters with Lois.


title: Tom Welling

text: On July 13, 2022, Welling and fellow "Smallville" actor Michael Rosenbaum launched the podcast "Talkville," where the two co-stars comment on every episode of "Smallville".


title: Tom Welling

text: In 2017, Welling was cast to co-star in the third season of the Fox fantasy comedy-drama "Lucifer". He played Marcus Pierce, a police lieutenant at the precinct and the main antagonist of the season who is the immortal Cain.


title: Tom Welling

text: In December 2003, Welling made his feature film debut as Charlie Baker, the oldest son and second-oldest in the Baker family which had 12 children, in the family comedy "Cheaper by the Dozen" with Steve Martin and Bonnie Hunt, which is a remake of the 1950 movie starring Clifton Webb and Myrna Loy, based on the 1948 book about the family of Frank and Lillian Gilbreth and written by two of their children. Welling talked about why he was interested in the project in an interview with Paul Fischer: "The top three reasons I decided to do this film were, one, Steve Martin, two, Steve Martin and three, Steve Martin. That was the number one draw for me. Then, after reading the script, I really liked this character, Charlie. I liked what he went through, what he had to go through, and I felt I understood where he was coming from. And I just wanted to be a part of it." Welling had always been a fan of Martin's and said that he "absolutely loved" working with him.


title: Tom Welling

text: In 2005, Welling co-starred in the horror film "The Fog", a remake of John Carpenter's 1980 film of the same name, as Nick Castle (a character originally played by Tom Atkins). At the same time "The Fog" was in production, Welling was still working on the last few episodes of the fourth season of "Smallville". The same year, he reprised his role as Charlie Baker in "Cheaper by the Dozen 2".


title: Tom Welling

text: In 2013, Welling was among the all-star cast of the historical drama "Parkland", based on the book "Reclaiming History: The Assassination of President John F. Kennedy" by author Vincent Bugliosi. The story centers on the chaotic events that occurred at Parkland Hospital in Dallas, Texas on the day President John F. Kennedy was assassinated on November 22, 1963. In 2014, Welling co-starred in Ivan Reitman's sports drama "Draft Day". He played a veteran quarterback whose career is at a crossroads.


title: Tom Welling

text: For "Smallville"s ninth season, Welling served as a co-executive producer. He returned as Clark Kent for the show's tenth and final season in Fall 2010 and became a full executive producer, as credited in a May 20, 2010 press release by the CW.


title: Tom Welling

text: Welling served as an executive producer of the CW comedy-drama "Hellcats" based on journalist Kate Torgovnick's book "Cheer: Inside the Secret World of College Cheerleaders". The series first aired on The CW beginning in the fall of 2010, and was canceled on May 17, 2011. According to Welling, the reason of cancellation was because of the change of CW president of entertainment from Dawn Ostroff to Mark Pedowitz.


title: Tom Welling

text: Welling made his directorial debut in 2006 with the "Smallville" episode "Fragile" (5.18). He also directed "Hydro" (6.10); the show's 150th episode, "Apocalypse" (7.18); "Injustice" (8.21); the second part ("Legends") of the two-hour episode "Absolute Justice" (9.11); and two episodes of "Smallville"'s final season, "Patriot" (10.09) and "Booster" (10.18).


title: Tom Welling

text: On July 5, 2002, Welling married model Jamie White on Martha's Vineyard with Welling's friends and then-"Smallville" co-stars Kristin Kreuk and Michael Rosenbaum in attendance. Welling and White resided in Vancouver, British Columbia, but returned to Los Angeles in March 2011. On October 17, 2013, White filed for divorce from Welling. The divorce was finalized in November 2015.


title: Tom Welling

text: In 2014, Welling began dating equestrian and Saddle Club founder Jessica Rose Lee. In April 2018, they announced their engagement. The couple has two sons, born in January 2019 and June 2021. Welling and Lee married on November 30, 2019, at Sunstone Vineyards & Winery in San Ynez, California.


title: Tom Welling

text: Welling plays golf in his spare time. Welling has said in "YM" that he dislikes interviews. He said "I don't want to be a celebrity for the sake of being a celebrity. I want to work and then go home and live in private." Welling has also said he disliked modeling because it was not fulfilling and was not an expressive job.


title: Tom Welling

text: The following is a List of awards and nominations received by Tom Welling throughout his acting career.


title: Mare Winningham

text: Mary "Mare" Megan Winningham (; born May 16, 1959) is an American actress and singer-songwriter. She is the recipient of two Primetime Emmy Awards and has been nominated for an Academy Award, two Golden Globe Awards and two Tony Awards.


title: Mare Winningham

text: An eight-time Emmy Award nominee, she won Outstanding Supporting Actress in a Miniseries or Movie for "Amber Waves" in 1980 and "George Wallace" in 1998. She was also nominated for the Academy Award for Best Supporting Actress for the 1995 film "Georgia".


title: Mare Winningham

text: Winningham's other film and TV roles include "St. Elmo's Fire" (1985), "Miracle Mile" (1988), "Turner & Hooch" (1989), "The War" (1994), "Dandelion" (2004), "Swing Vote" (2008), "Brothers" (2009), "Mildred Pierce" (2011), "Hatfields & McCoys" (2012) and appeared in "American Horror Story" for four seasons: "" (2013), "" (2014), "" (2015–16) and "" (2017). She made her New York stage debut in the 2007 Off-Broadway musical "10 Million Miles", for which she received a Drama Desk Award nomination. She made her Broadway debut in the 2013 revival of "Picnic". In 2014, she was nominated for the Tony Award for Best Featured Actress in a Play for the original Broadway production of "Casa Valentina". She was cast as Cherry Lockhart for Seasons 1–2 and 4 as Cole's mother in the TV series "The Affair".


title: Mare Winningham

text: Winningham was born in Phoenix, Arizona, and raised in Northridge, California. She is the daughter of Marilyn Jean (née Maloney) and Sam Neal Winningham. She has three brothers and one sister. Her father was football coach, athletic director and later the chairman of the Department of Physical Education at California State University, Northridge (CSUN), and her mother was an English teacher and college counselor at Monroe High School and Grant High School. She credits her first interest in acting to seeing an interview with Kym Karath (who played Gretl in "The Sound of Music") on Art Linkletter's television show "House Party" when she was five or six years old.


title: Mare Winningham

text: Winningham attended Andasol Avenue Elementary School, where her favorite activities included drama and playing the guitar and drums. She took the extended drama option at Patrick Henry Junior High School and continued to study over her summer vacations at CSUN's Teenage Drama Workshop. It was at this time that she adopted the nickname "Mare". Her mother arranged for her to go to Chatsworth High School. In grade 12, Winningham starred in a production of "The Sound of Music", playing the part of Maria, opposite classmate Kevin Spacey as Captain Von Trapp. Her high school boyfriend was Val Kilmer. She graduated co-valedictorian (with Spacey) of her high school class in 1977.


title: Mare Winningham

text: Winningham began her career as a singer-songwriter. In 1976 and 1977, she got her break singing The Beatles song "Here, There and Everywhere" on "The Gong Show". Although Winningham received no record contracts as result of the appearance, she was signed to an acting contract by Hollywood agent Meyer Mishkin, and received her Screen Actor's Guild card for doing three lines in an episode of "James at 15". That year she was offered a role on "Young Pioneers" and "Young Pioneers Christmas", pilots for the short-lived 1978 drama "The Young Pioneers". Though the series ended with just three episodes being broadcast, a number of television projects followed, including parts on "Police Woman" in 1978 and "Starsky and Hutch" in 1979. Later that same year, she played the role of teenage outcast Jenny Flowers in the made-for-TV film "The Death of Ocean View Park".


title: Mare Winningham

text: In 1980, Winningham starred in "Off the Minnesota Strip" playing a young prostitute. She then won an Emmy Award for "Best Supporting Actress in a Miniseries or a Movie" for her role in the critically acclaimed "Amber Waves", a television film about a rough farmer (Dennis Weaver) who finds he is dying of cancer. In that year, she also broke into feature films with "One Trick Pony", starring Paul Simon. In 1983, Winningham was nominated for a Canadian Genie Award for her work in the futuristic 1981 drama "Threshold", and appeared in the 1983 epic miniseries "The Thorn Birds", in which she played Justine O'Neill. In 1984, she starred as Helen Keller in "Helen Keller: The Miracle Continues".


title: Mare Winningham

text: Winningham achieved greater fame co-starring in "St. Elmo's Fire" (1985), alongside the other original "brat pack" alumni. Despite the film's success, she failed to cash in on her teen idol status, and returned to television in the Hallmark Hall of Fame movie, "Love Is Never Silent", for which she received an Emmy nomination. Another well-known and well-received performance was as a homeless young mother in the television movie "God Bless the Child". Winningham finished the 1980s with two Hollywood films: the nuclear disaster drama, "Miracle Mile" (1988), for which she received an Independent Spirit Award nomination in 1989, and the Tom Hanks vehicle "Turner & Hooch" in 1989. In 1988, Winningham also starred in the Los Angeles stage production of "Hurlyburly" with Sean Penn and Danny Aiello.


title: Mare Winningham

text: In the early 1990s, she returned to film for 1994's all-star "Wyatt Earp" and the family drama "The War", both starring Kevin Costner. 1995 brought "Georgia", a thoughtful character study of two sisters (Winningham and Jennifer Jason Leigh), which earned Winningham Screen Actors Guild and Academy Award nominations. Two years later, she starred opposite Gary Sinise in "George Wallace", for which she garnered her Golden Globe Award nomination and won an Emmy Award.


title: Mare Winningham

text: She made acclaimed appearances on the series "ER" and "", as well as appearances in the 2001 television project "Sally Hemings" opposite Sam Neill and the short-lived David E. Kelley series "The Brotherhood of Poland, New Hampshire". Also in 2001, she appeared in the made-for-TV movie "Snap Decision" with Felicity Huffman. She also appeared in the independent film "Dandelion", which was a staple of film festivals worldwide between 2003 and 2004 and had a limited American release in October 2005.


title: Mare Winningham

text: In 2006, she landed the role of Susan Grey on the ABC drama "Grey's Anatomy" where she played the stepmother of one of the main characters, Dr. Meredith Grey. Her character was killed off in May 2007. In 2006, Winningham voiced the audio version of Stephen King's "Lisey's Story". In 2007, she voiced Alice Hoffman's "Skylight Confessions". In 2010, Winningham starred in an episode of "Cold Case" as main character Lilly Rush's stepmother, Celeste Cooper. In 2011 she appeared in the fourth episode of "" as character Ellis Hartley Monroe. She also starred in miniseries "Mildred Pierce" and "Hatfields & McCoys" and garnered another two Emmy nominations. In 2012, she appeared Off-Broadway as Beth, the mother in an intellectual, though dysfunctional, British family, in the award-winning comic-drama "Tribes" by Nina Raine. In 2021 she appeared in "Dopesick" on Hulu with Michael Keaton.


title: Mare Winningham

text: In 2022, she was nominated for a second Tony for her leading performance in "Girl from the North Country".


title: Mare Winningham

text: Winningham has alternated her film career with a music career, and has used some of her films as a way to showcase her singing. She can be heard singing a few bars of "Me and Bobby McGee" in "One Trick Pony". In 1981, she played a teenage runaway with an aspiration to become a singer in the TV film "Freedom", and sang six songs in the film, all written by Janis Ian. She appeared as a club singer in the film "Teresa's Tattoo", and sang three songs in the film "Georgia".


title: Mare Winningham

text: Winningham has recorded four albums: "What Might Be" (1992) on the Bay Cities label, "Lonesomers" (1997) produced by Carla Olson on the Razor and Tie label, and "Refuge Rock Sublime" (2007) on the Craig & Co. label. "Lonesomers" is a folksy album dealing with relationship issues. The country/bluegrass/Jewish/folk songs on "Refuge Rock Sublime" deal mostly with her recent conversion to Judaism, and include the tracks, "What Would David Do," "A Convert Jig" and the Israeli national anthem "Hatikva". Winningham released her fourth album "What's Left Behind" independently on digital outlets in March 2014.


title: Mare Winningham

text: Winningham has been married four times and divorced three. In the early 1980s, she was briefly married to actor A Martinez. They both starred in the miniseries "The Young Pioneers". After their divorce, she married television technical advisor William Mapel, with whom she had five children. The marriage ended in 1994. Winningham later married and divorced artist Jason Trucco. At the end of 2021, she and long-time friend and fellow actor Anthony Edwards eloped. The two have known each other for 35 years.


title: Mare Winningham

text: Winningham was raised a Roman Catholic. She converted to Judaism in her early 40s, as a personal choice; she is a practicing Jew.


title: Fruit

text: In botany, a fruit is the seed-bearing structure in flowering plants that is formed from the ovary after flowering.


title: Fruit

text: Fruits are the means by which flowering plants (also known as angiosperms) disseminate their seeds. Edible fruits in particular have long propagated using the movements of humans and animals in a symbiotic relationship that is the means for seed dispersal for the one group and nutrition for the other; in fact, humans and many animals have become dependent on fruits as a source of food. Consequently, fruits account for a substantial fraction of the world's agricultural output, and some (such as the apple and the pomegranate) have acquired extensive cultural and symbolic meanings.


title: Fruit

text: In common language usage, "fruit" normally means the seed-associated fleshy structures (or produce) of plants that typically are sweet or sour and edible in the raw state, such as apples, bananas, grapes, lemons, oranges, and strawberries. In botanical usage, the term "fruit" also includes many structures that are not commonly called "fruits" in everyday language, such as nuts, bean pods, corn kernels, tomatoes, and wheat grains.


title: Fruit

text: Many common language terms used for fruit and seeds differ from botanical classifications. For example, in botany, a "fruit" is a ripened ovary or carpel that contains seeds; e.g., an apple, pomegranate, tomato or a pumpkin. A "nut" is a type of fruit (and not a seed), and a "seed" is a ripened ovule.


title: Fruit

text: In culinary language, a "fruit" is the sweet- or not sweet- (even sour-) tasting produce of a specific plant (e.g., a peach, pear or lemon); "nuts" are hard, oily, non-sweet plant produce in shells (hazelnut, acorn). "Vegetables", so called, typically are savory or non-sweet produce (zucchini, lettuce, broccoli, and tomato); but some may be sweet-tasting (sweet potato).


title: Fruit

text: Examples of botanically classified fruit that typically are called vegetables include: cucumber, pumpkin, and squash (all are cucurbits); beans, peanuts, and peas (all legumes); corn, eggplant, bell pepper (or sweet pepper), and tomato (see image). The spices chili pepper and allspice are fruits, botanically speaking. In contrast, rhubarb is often called a fruit when used in making pies, but the edible produce of rhubarb is actually the leaf stalk or petiole of the plant. Edible gymnosperm seeds are often given fruit names, e.g., ginkgo nuts and pine nuts.


title: Fruit

text: Botanically, a cereal grain, such as corn, rice, or wheat is a kind of fruit (termed a caryopsis). However, the fruit wall is thin and fused to the seed coat, so almost all the edible grain-fruit is actually a seed.


title: Fruit

text: The outer layer, often edible, of most fruits is called the "pericarp". Typically formed from the ovary, it surrounds the seeds; in some species, however, other structural tissues contribute to or form the edible portion. The pericarp may be described in three layers from outer to inner, i.e., the "epicarp", "mesocarp" and "endocarp".


title: Fruit

text: A fruit results from the fertilizing and maturing of one or more flowers. The gynoecium, which contains the "stigma-style-ovary" system, is centered in the flower-head, and it forms all or part of the fruit —(see graphic: 'the parts of a flower'). Inside the ovary(ies) are one or more ovules. Here begins a complex sequence called "double fertilization": a female gametophyte produces an egg cell for the purpose of fertilization. (A female gametophyte is called a megagametophyte, and also called the embryo sac.) After double fertilization, the ovules will become seeds.


title: Fruit

text: Ovules are fertilized in a process that starts with pollination, which is the movement of pollen from the stamens to the stigma-style-ovary system within the flower-head, (see graphic). After pollination, a pollen tube grows from the (deposited) pollen through the stigma down the style into the ovary to the ovule. Two sperm are transferred from the pollen to a megagametophyte. Within the megagametophyte one sperm unites with the egg, forming a zygote, while the second sperm enters the central cell forming the endosperm mother cell, which completes the double fertilization process. Later the zygote will give rise to the embryo of the seed, and the endosperm mother cell will give rise to endosperm, a nutritive tissue used by the embryo.


title: Fruit

text: As the ovules develop into seeds, the ovary begins to ripen and the ovary wall, the "pericarp", may become fleshy (as in berries or drupes), or it may form a hard outer covering (as in nuts). In some multiseeded fruits, the extent to which a fleshy structure develops is proportional to the number of fertilized ovules. The pericarp typically is differentiated into two or three distinct layers; these are called the "exocarp" (outer layer, also called epicarp), "mesocarp" (middle layer), and "endocarp" (inner layer) —(see image of apple-section).


title: Fruit

text: In some fruits the sepals, petals, stamens and/or the style of the flower fall away as the fleshy fruit ripens. However, for simple fruits derived from an "inferior ovary" —i.e., one that lies "below" the attachment of other floral parts, (see graphic re 'insertion point')— there are parts (including petals, sepals, and stamens) that fuse with the ovary and ripen with it. For such a case, when floral parts other than the ovary form a significant part of the fruit that develops, it is called an accessory fruit. Examples of accessory fruits include apple, rose hip, strawberry, pineapple; see below, and "Table of fleshy fruit examples".