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zmairinarurik · 4 years

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JENNA LOUISE COLEMAN, THIRTY, IRINA RURIK. ❝ ⤚⟶ EUROPE, 1458. thanks is given by the GRAND DUCHESS, IRINA RURIK, from RUSSIA. they are at best DEDICATED, and at their worst ENVIOUS. whilst abroad, their ambition is to BE INDISPENSABLE TO HER BROTHERS & FAMILY AND TO MAKE RUSSIA STRONGER. SHE seem/s to remind everyone of JENNA LOUISE COLEMAN & AN ARROW RIPPING THROUGH THE COLD WINTER BREEZE, STRING OF PEARLS, SOFT HUMMING OF LULLABY . ❞

FULL NAME : Maria Irina Zinovia Rurik TITLES : ( FROM BIRTH UNTIL PRESENT )

Grand duchess of Russia (by birth) Princess of Sweden, Dowager duchess of Värmland (by marriage)

BIRTHPLACE : Russian Kremlin, Moscow AGE : 30 years old LANGUAGES : Russian, Swedish, French, Latin, Spanish, English DYNASTY / HOUSE:

Rurik (by birth) Valdemarsson (by marriage)

MOTHER & FATHER : Dmitri Rurik & Vasilia Palaiologina SPOUSE : ( IF ANY ) Prince Magnus of Sweden, duke of Värmland ISSUE :

Sveinn Kristoff Magnusson ( 6 years old ) Astrid ekaterina Magnusdottir ( 4 years old ) Kjell Olaf Nikolai Magnusson ( 3 year old )

SIBLINGS :

Ivan, Tsar of Russia Konstantin, Crown prince of Russia Nikita, Grand duke of Russia Katrinka katherine, Grand duchess of Russia, Princess of Wales Youngest Grand duchess of Russia

OTHER : ( NIECES / NEPHEWS, BETROTHALS, ETC )

Vasilia, ( niece ) daughter of Ivan & Adalsinda Mary, ( niece ) daughter of Katrinka/Katherine & Harry of Wales Eudoxia, Crown princess of Russia ( in-law ) Adalisnda d’Anjou, Tsarina of Russia ( in-law ) Harry Plantagenet, Prince of Wales ( in-law )

ZODIAC : Gemina ( May 19, 1428 ) RELIGIOUS AFFILIATION :

Orthodox ( my birth ) Roman Catholic ( after marriage )

ORIENTATION : Heterosexual with very slight biromantic tendencies but she loves dick too much im sorry VICES : envious, impatient, scheming, cynical, mistrusting VIRTUES : dedicated, loyal, eloquent, independent FACECLAIM : Jenna Louise Coleman HEIGHT : 5′2″ ft / 157 cm RECOGNISABLE FEATURES : dark brown hair, high nose, big round brown eyes. REPUTATION :

she is not a force to be reckoned with. in russia, she is known for her assertiveness and sharp wit. She often makes appearances in her brothers councils and serves as an advisor. She has eyes and ears all over russian court and is known to be a spitting image of her mother, always by her side. Irina will do whatever it takes ensure the safety of her brother’s rule.

WANTED CONNECTIONS :

spies in english court - shes sus about it over there and wants to ensure her sister’s position

lovers - she’s basically a free woman now. irina knows she has done her duties to her family and to her husband so she’s chilling and living her best life

enemies - those who oppose russia

friends - shes doesnt have very many lol but id like for her to have some in lisbon

coughs husband number 2 maybe?

⇢TIMELINE

1428 - birth of the 3rd rurik child, Ma. Irina Zinovia Rurik, Grand duchess of Russia 1450 - Marriage to Prince Magnus of Sweden 1452 - Birth of eldest son Sveinn 1454 - Birth of daughter Astrid 1455 - Birth of Kjell 1456 - Death of Prince Magnus of Sweden & return to Russian court 1458 - Lisbon Summit

What current conflicts does your character face?

As a young girl, Irina didn’t understand why her brothers were always put first other than the fact that they were older. She was just as smart, just as strong, and just as intuitive as they were. They were siblings were they not? Then why does she often get told to sit down and watch or embroider some flowers? How was this fair? These were beneath her, the grand duchess wailed, refusing to be treated as such and would not stop her cries until she got what she wanted which was to have the same education as her brothers. She truly was her mother’s daughter people whispered seeing how ambitious and assertive the grand duchess was. Her chin was always held high and knew exactly what she wanted which people saw as intimidating. Irina felt like she needed to put this façade up to be taken seriously even with in her family. It becomes a conflict because at one point it gets tiring. It’s exhausting to put such a cold and hard front but she knows she has to in order for her to survive her in brother’s court— or anywhere for that matter. She had to be strong in Swedish court, establish that she is more than just the youngest prince’s wife. Now that he has passed, Irina continues to fight for her place but now back in Russian court, proving herself to be important but because she’s female and a woman, it makes it a little a harder. She has dreams for herself and for her beloved Russia, which her family has helped build and fortify. Sometimes she wonders is it all worth it? This is what she asks herself continuously.

What are some potential plotlines you are interested in pursuing?

It was always about family for Irina. The things she does, the things she wants to achieve is all for the Rurik family name. Despite her pride, she knew that a marriage outside of Russia was her destiny to which she gracefully accepted to keep Russia’s neighbor, Sweden, as an ally. It pained her greatly to be away from her family but she did it with no complains. Now a widow, she knows that her place is to be a mother to her children and guardian to her eldest son who will inherit his father’s lands however there is still that itch, a desire to more than that, a desire for power. Which was only soothed when her mother called her back to Russian court shortly after his death. She aides her brothers as a councilor, representative, and as a mediator— heavens know what they’ll do to each other. The grand duchess knows that the tsarina is still getting to know the Russian court and by the order of her mother, she helps the French woman assimilate into Russian customs despite of her not so subtle ways. She helps the queen mother oversee and run the court and household. Now in Lisbon, her one goal is to see her youngest sister married. Irina wants to help oversee her betrothal and make sure it’s as powerful as hers to both make Russia stronger but to toughen up her sister as well. In short, Irina finds ways to become indispensible to her brothers, make them see that they need her. She cannot be their equal; She can never be tsarina, no, but she vows to see to it that a Rurik will always be on the Russian throne no matter what.

three bullet-points.

Nobody needed to tell Irina that the Russian court was initially mildly disappointed that the 3rd Rurik child was female. She could see it in their eyes that they had hoped she was a boy. The grand duchess was just as disappointed as they were too. Why must she have to wail and fight for her right to be as educated and skilled as her older brothers? It was not becoming of a grand duchess to learn such masculine activities such riding and archery, they said. But Irina simply did not take no for an answer. She learned these skills, along with languages, politics, and literature, wanting only to be taught the same things as her brothers. Why was she not allowed to have the same education? She was never going to be tsarina anyway, a young Irina argued. Although her brothers were still prioritized, she made sure she excelled to prove to everyone that she was just as capable as them. Deep down the eldest grand duchess envied her brothers; she envied how everything was much easier for them whilst she had to throw a tantrum before being heard.

Assertive and astute, these were attributes she learned from her mother that, to this day, has been engraved into her psyche. Her pride is her strength but it can easily be turned into hubris, which will one day either be the cause of her success or her ruination. If she wants something, she must fight for it. That’s what she has been doing all her life, fighting for what she thinks she deserves. This, in turn, has somehow made her as cold as the snow that falls on Russia, her personality forming around the ideology of being a fighter. She hides the fact that she grows tired of it and wishes things were different. It was a heavy burden to bear and there was no one to blame for it but herself.

Prince Magnus of Sweden, duke of värmland was the youngest brother of the-then King of Sweden. His marriage to Irina kept the Swedish at bay from invading Russia’s territories. The grand duchess wouldn’t say she was exactly thrilled with the match but she didn’t oppose it either. It was commanded and she simply had to comply; she didn’t have much of a choice anyway. She was prepared for her new life away from Russia and performed her duties as a wife, bearing the prince 3 children namely: Sveinn, Astrid, and Kjell. However, the prince died in battle shortly after the birth of their 3rd child. They were only married for 6 years. His death devastated Irina greatly. Though since she bore him children, they get to keep their father’s lands. The 1st year she spent in Sweden after her husband’s passing was very difficult. When her mother called her back to Russia, she hesitated at first but later came home, bringing her children with her. She found strength being in her homeland, and oddly enough, renewed vigour and a newfound purpose.

#crhs.intro #♔‘ﾟ‣ { headcanons } — sad birds still sing #AYE AYE I FINALLY FINISHED OMG #krp #krp ad #skeleton krp #lsrpg #krpg

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sebastian--vandekamp · 3 years

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hey, I just saw sebastian van de kamp walking down the streets of clarendon hills. you can catch him around town being a business graduate. I hear he’s known to be ambitious & reliable but discontented & serious. click the read more below to find out more.

BASIC

NAME: sebastian parker van de kamp NICKNAMES: ash AGE: 26 BIRTHDAY: january 3rd SPECIES: human GENDER: cis male PRONOUNS: he/him

FAMILY

MOTHER: sarah van de kamp ( neé coleman ) ( 60 ) FATHER: paul van de kamp ( 63 ) eric hale ( 43 ) PARENTS: married SIBLINGS: cameron van de kamp ( 29 )

PHYSICAL ATTRIBUTES

FACE CLAIM: tom felton RACE/ETHNICITY: caucasian NATIONALITY: american HEIGHT: 5 ft 9 / 175 cm WEIGHT: 153 pounds / 70 kg BUILD: slim HAIR: short FACIAL HAIR: n/a HAIR COLOR: dark blond EYE COLOR: blue SKIN COLOR: white DOMINANT HAND: right ANOMALIES: n/a ACCENT: american / chicago PHYSICAL DISABILITIES: n/a LEARNING DISABILITIES: n/a ALLERGIES: n/a DISORDERS: n/a FACTS: loves hard, has been interested in experimenting with guys before but never has, full of persistency where he lacks talent, pours his all into a relationship and so far has only come up empty, had a four year relationship that turned out to be very one-sided, values quality time with family and friends and loves to have game nights, looks forward to big gatherings such as birthdays weddings etc, moved to nyc after high school and graduated from columbia at 24, takes a while for him to truly open up to and trust people, prefers just doing things over spending too much time mulling over it which is why many of his endeavours haven’t worked out so far, cares about status and materialism, takes criticsm to heart but holds a grudge if you doubt his drive, good at networking, feels more strongly than he shows it, hates letting people down, likes dressing well and well-dressed people, loves cars, doesn’t like being teased even if it’s good-natured, gets really competitive with games, feels very aggravated when he feels like he’s not doing something useful with his time, is pretty open to newness in the bedroom, has a very dry sense of humour & values traditions

LIFESTYLE

BORN: wilmette, illinois, usa RAISED: wilmette, illinois, usa VEHICLE: oldtimer chevrolet at home PHONE: iphone x LAPTOP/COMPUTER: macbook PETS: n/a

HIGH SCHOOL EDUCATION: wilmette junior high school MIDDLE SCHOOL EDUCATION: highcrest middle school

POLITICAL AFFILIATION: center-left RELIGION: n/a MISDEMEANORS: n/a DRUGS: weed ( rarely ), cocaine ( tried ), ritalin ( tried ) SMOKES: no ALCOHOL: socially DIET: standard

ROMANTIC ORIENTATION: heteroromantic SEXUAL ORIENTATION: heterosexual AVAILABILITY: single

LANGUAGES: english

PHOBIAS: n/a HOBBIES: skiing, playing guitar, eating out & travelling TRAITS: + tenacious, classy & thoughtful, - pessimistic, moody & restless SOCIAL MEDIA: instagram & linkedin

FAVOURITE

SPORTS TEAM: new york red bulls SPORTS: tennis, soccer & swimming GAME: puzzles, risk MUSIC: dance/electronic & dj SINGER: kerala dust SHOWS: how to get away with murder & suits MOVIES: men in black, star wars, back to the future & there will be blood FOOD: spaghetti meatballs BEVERAGE: water COLOR: green

CHARACTER

WESTERN ZODIAC: capricorn CHARACTER ALIGNMENT: lawful neutral GOALS/DESIRES: be successful and achieve what he’s working for

#about

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dwindledglow · 4 years

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001. MEET INDIGO

FULL NAME: indigo blu bertrand. PREFERRED NAME: indigo. NICKNAME/S: indi. DATE OF BIRTH: august 12th, 1993. GENDER & PRONOUNS: cis female & she/her. ORIENTATION: bicurious. RELIGION: agnostic. RELATIONSHIP STATUS: engaged to william coleman. OCCUPATION: fashion journalist, fashion director and entrepreneur. RESIDENCE: boston, massachusetts.

002. CHECK INDIGO’S BACKGROUND

HOMETOWN: marseille, france. NATIONALITY: french and american. she obtained dual citizenship following eight years of living in the united states. ETHNIC BACKGROUND: filipino, irish, spanish and french. LINGUISTICS: french which is her native language, english in a fluent level and she can lead a conversation in spanish and italian. EDUCATION: she, primarily, attended central saint martins in order to get her BA in fashion communication: fashion journalism and, afterwards, she attended parsons school of design where she got her MA in fashion studies. CRIMINAL RECORD: clean. BIRTH ORDER: second. FATHER: pierre anton bertrand, born on march 16th, 1964 in provence, france, currently residing in between marseille and paris. he is the CEO and owner of the bertrand group. MOTHER: ophelia amelie bertrand, née deneuve, born on july 28th, 1963 in bordeaux, france, currently residing in between marseille and paris. she’s a retired teacher at ifm, central saint martins and parsons school of design, and a high-profile fashion stylist who, nowadays, only does selective work for some of her dearest clients. SISTER/S: brielle clémence bertrand, born on january 14th, 1991 in marseille, france, currently residing in tokyo, japan and working as the CBDO of the bertrand group. BROTHER/S: jean-claude bertrand, born on september 2nd, 1999 in paris, france, currently residing in boston, massachusetts where he studies economics at harvard university and competes in the ncaa basketball league as a part of the harvard crimsons. christian guillaume bertrand, born on may 30th, 2001 in paris, france, currently residing in paris, france and working as a model and song-writer. SIGNIFICANT OTHER: william coleman. CHILDREN: rey alexander coleman, born on october 2nd, 2019 in boston, massachusetts. OTHER RELEVANT FAMILY: lawrence rhodes, brielle’s husband thus brother-in-law. EX/ES: luca debuchy and jaylen aldridge. PETS: roux, a hotot bunny, blanc, a pomeranian and rogue, a german shepherd.

003. GET UP CLOSE & PERSONAL

HEIGHT: 5′8″ or 177 cm. WEIGHT: between 121 lbs or 55 kg and 130 lbs or 59 kg. BODY BUILD: she has a banana ( otherwise known as rectangle ) shaped body which, all in all, means she has a rather slim figure or, what would be deemed by some as, the classic supermodel-like look. naturally, it’s easy for her to maintain her desired weight and her flat stomach. indigo has slim shoulders and hips, and thanks to her workout routine, she has toned legs and a more toned bum. she has a small bust — she’s a 32B — and despite being considered petite, she still has some adequate curves. EYE COLOR: her eyes are a dark shade of brown, at first glance. if you pay close attention, you’ll notice how while her right eye is brown, her left eye is black. this becomes more prominent when sun or light are directly lighting up her eyes. EYESIGHT: due to her job and how long she spends on a laptop, as well as reading different articles and books, indigo has eye fatigue and, often, gets blurry vision. in those cases, she wears glasses to help her and so she doesn’t get a headache of any sorts. on the regular, however, she doesn’t wear glasses or contacts. HAIR COLOR & STYLE: naturally, her hair is a dark shade of brown, almost black. currently, it’s dyed in a chocolate brown shade. within indigo’s line of work, appearance is easily one of the most important things and what people base their first impression of you on. alongside her fashion choices, posture and makeup, her hair happens to be a pivotal thing for the girl. in its natural state, indigo’s hair is wavy and, often, that’s how she prefers to wear it — of course, most times she uses the right products and equipment to give it some help and loosen the waves. if she’s looking for a casual, distressed look, she enjoys going for the beach waves or throw her long locks in a messy bun, but for events or other important occasions, indigo tends to go for a sleek high ponytail or sleek straight hair. DOMINANT HAND: left. NOTABLE PHYSICAL TRAITS: the most notable and distinguishable of her physical traits is the color of her eyes — while her left eye is black, her right one is a lighter, coppery-brown shade. her model-like body and, often referred as, towering height are two other things that stand out, along with her long, toned legs. additionally, her long, silky hair that is always kept in perfect condition is another one of her notable physical traits. SCARS AND MARKS: there’s a small scar above her belly button due to a surgery she was submitted to when she was born but, other than that, she doesn’t have any other noticeable scars. scattered through her body, indigo has some freckles. she has a birthmark on her right foot and another one on the small of her back. TATTOOS: on the inside of her left wrist, she has a small camera — reference. in small, cursive font placed inside her right arm, indigo has the lyrics satisfaction feels like a distant memory. on the side of her left ankle, she has a feather tattoo — reference. along her left hip, she has the lyrics kissing to cut through the gloom in small, handwritten font. indigo has a hanger tattoo — reference — on the side of her left arm, nearing her wrist and she has a small world map inside her right wrist — reference — and a eiffel tower tattoo right next to it — reference. a little above the junction of her lower and upper left arm, she has the quote be yourself first in cursive font — reference — and on the side of her right ankle, she has three small birds — reference. she has cote d’azure tattooed in small font, on the left side of her rib cage. she has a matching tattoo with alana, a flame on her right hip — reference. on her ribcage, below her left boob, she has the lyrics pour dire la vérité, je te veux just toi — dvsn’s the line’s lyrics, meaning to tell the truth, i only want you — a subtle tattoo she has gotten for will. beside it, she has an eleven — reference — tattooed in cursive font, her boyfriend’s shirt number. PIERCINGS: she has her regular lobes pierced and two tragus piercings on her left ear. VOICECLAIM: shay mitchell. ACCENT & INTENSITY: when she says certain words, you can hear her subtle marseille accent underlying what is, otherwise, a new york accent. likewise, if she’s angry or if she has returned home after spending some time in france, her marseille accent becomes more prominent. in general, however, her french accent isn’t particularly strong anymore and, more often than not, the new york one overpowers it. ALLERGIES: cats and hayfever PHOBIAS & FEARS: snakes, being forgotten and trypophobia. MENTAL & PHYSICAL ILLNESSES: she has rhinitis. ALCOHOL USE: she drinks on social situations and she doesn’t say no to a glass of rosé after a long, stressful day of work. SMOKING: no. NARCOTICS USE: she used to experiment / do hard drugs during university but she quit that. she smokes weed on the rare. INDULGENT FOOD: yes, food is definitely one of her comforts and every so often, she indulges in it. SPLURGE SPENDING: yes, on occasion. GAMBLING: no, never.

004. DIG DEEPER

CAN THEY DRIVE? yes, she can drive. CAN THEY COOK & BAKE? yes and yes. CAN THEY CHANGE A FLAT TIRE? she can but she’d rather not have to do it. CAN THEY TIE A TIE? yes. CAN THEY SWIM? yes. CAN THEY RIDE A BICYCLE? yes. CAN THEY JUMP START A CAR? no. CAN THEY BRAID HAIR? yes. CAN THEY PICK A LOCK? no. EXTROVERTED OR INTROVERTED? extroverted. DISORGANIZED OR ORGANIZED? organized, without being overly so. CLOSE OR OPEN MINDED? open minded. CALM OR ANXIOUS? calm. PATIENT OR IMPATIENT? patient. OUTSPOKEN OR RESERVED? in-between. LEADER OR FOLLOWER? in-between. OPTIMISTIC OR PESSIMISTIC? optimistic. TRADITIONAL OR MODERN? modern. HARD-WORKING OR LAZY? hard-working. CULTURED OR UNCULTURED? cultured. LOYAL OR DISLOYAL? loyal. FAITHFUL OR UNFAITHFUL? faithful. NIGHT OWL OR EARLY BIRD? a balance of both. HEAVY OR LIGHT SLEEPER? she’s a heavy sleeper. COFFEE OR TEA? coffee. DAY OR NIGHT? day. TAKING BATHS OR SHOWERS? baths. COCA COLA OR PEPSI? coca-cola. CATS OR DOGS? dogs. NETFLIX OR CINEMA? netflix. SHOWS OR MOVIES? shows. LAPTOP OR GAMING CONSOLE? laptop. HEALTHY OR JUNK FOOD? healthy food. ICE CREAM OR FROZEN YOGURT? ice cream. PIZZA OR HAMBURGER? pizza. LOLLIPOPS OR GUMMY WORMS? gummy worms. BEACH OR POOL? beach. SNOWBALLS FIGHTING OR ICESKATING? snowballs fighting. LITERATURE OR SCIENCE? literature. HISTORY OR ART? art. CHOCOLATE BARS OR COTTON CANDY? chocolate bars. XBOX OR PLAYSTATION? playstation. FACE-TO-FACE OR PHONE INTERACTIONS? face-to-face interactions. DRAMA OR SCI-FI? drama. HORROR OR COMEDY? comedy.

005. INDIGO’S FAVORITES

FAVORITE ACTIVITY: writing. FAVORITE ANIMAL: dolphin. FAVORITE BOOK: milk and honey by rupi kaur. FAVORITE COLOR/S: dusty rose, soft grey and burgundy. FAVORITE CUISINE: mediterranean cuisine. FAVORITE DISH/ES: bouillabaisse, any kind of pizza but especially italian pizza cappricciosa and pizza calzone, rollatini and shakshuka eggs. FAVORITE DRINK/S: salted caramel mocha frappuccino and minted lemonade, the black rose cocktail, rosé wine and don pérignon. FAVORITE FLOWER/S: black orchids. FAVORITE GEM: sapphire. FAVORITE MOVIE: coco avant chanel by anne fontaine. FAVORITE SONG: time by sevdaliza. FAVORITE SCENT/S: açai, cakes baking in the oven, cinnamon and wine. FAVORITE SHOW/S: grey’s anatomy, american crime story, the resident and the good doctor FAVORITE SPORT/S & TEAM THEY SUPPORT: basketball, she’s a cleveland cavaliers fan but she always roots for whatever team william is playing for, and soccer, she supports olympique de marseille. FAVORITE SEASON OF THE YEAR: summer. VACATION DESTINATION: anywhere in southeast asia, particularly in indonesia and harbor islands, bahamas.

#── ✰. ┊ indigo : — HEADCANON. ❜

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colemanpolandinterviews · 3 years

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„Jest tak wiele rzeczy, które chcę zrobić": Świat według Zendayi.

via. www.vogue.co.uk

Dla pokolenia Z jest najważniejszą influencerką. Dla tych, którzy ją znają jest - w wieku zaledwie 25 lat - starą duszą. Aktorka Zendaya rozmawia z Marisą Meltzer o tym, czego nauczyła ją trwająca już ponad dekadę kariera i dlaczego tak wiele jeszcze przed nią.

Jest pora lunchu w nieskazitelnie słoneczny dzień w LA, a Zendaya i ja siedzimy w narożnej budce na zapleczu hotelu w West Hollywood rozmawiając o jej skłonnościach do pracoholizmu. "Nienawidzę wolnego czasu" - mówi, marszcząc lekko nos. "Po prostu nie wiem, co robię, kiedy nie pracuję. Myślę wtedy: "nie wiem co to [i tu aktorka macha rękami po swoim ciele] jest."

W przeciwieństwie do większości dwudziestokilkulatków, Zendaya (jej nazwisko brzmi Coleman, ale tak jak w przypadku Rihanny czy Adele, komu to potrzebne?) ma już za sobą długą i zróżnicowaną karierę. Weteranka dwóch różnych seriali Disneya pracuje "od dziewiątego do piątego roku życia". Jej działalność pozaszkolna obejmuje udział w Tańcu z gwiazdami (zajęła drugie miejsce w wieku 16 lat) i współtworzenie kapsułowej kolekcji dla Tommy'ego Hilfigera (jest również twarzą Lancôme, Bulgari i Valentino). Na jej podobieństwo powstała Barbie i spotkała się ze wszystkimi swoimi bohaterkami: Beyoncé ("tak bardzo wspierająca"), Oprah Winfrey, Michelle Obama. Z ponad 104 milionami obserwujących na Instagramie następnym celem jest prawdopodobnie dominacja nad światem.

Weźmy pod uwagę jesień, którą zaplanowała i która pozwoli jej zawładnąć dużymi i małymi ekranami. W grudniu ponownie wcieli się w rolę MJ w filmie Marvel's Spider-Man: No Way Home (co może o nim powiedzieć? "Nic!"), ale nie wcześniej niż w październiku wystąpi u boku Timothée Chalameta w bardzo oczekiwanym remake'u legendarnej powieści sci-fi Dune z 1965 roku. Następnie pojawi się drugi sezon serialu Sama Levinsona Euphoria, w którym Zendaya zagra uzależnioną od narkotyków nastolatkę Rue. Rola ta sprawiła, że w zeszłym roku została najmłodszą kobietą, która zdobyła nagrodę dla najlepszej aktorki pierwszoplanowej w serialu dramatycznym podczas rozdania nagród Emmy.

Spotykamy się podczas wyczerpującego tygodnia nocnych sesji zdjęciowych do tego ostatniego. Jeśli nie jest natychmiast rozpoznawalna (to te urzekające oczy i lekko wykrzywione usta, które ją zdradzają), można by pomyśleć, że mierząca 180 cm Zendaya będzie nie do przeoczenia, ale ona wślizguje się na zaplecze tak cicho, że potrzeba chwili, by zauważyć, że pojawiła się przy stoliku. Ma na sobie białą koszulkę bez stanika, jak wszystkie fajne młode kobiety w dzisiejszych czasach, spodnie Tommy Hilfiger, Converse Chuck Taylors i pozornie nie ma makijażu. Połowa jej długich włosów jest zaczesana na twarz, reszta opada w miękkie loki sięgające połowy pleców. Jej telefon zapala się, gdy dzwoni Levinson, a kiedy po niego sięga zauważam pierścionek z żółtym diamentem (co najmniej pięć karatów, może sześć) od Bulgari. "To mój wydatek, mój prezent dla siebie", uśmiecha się. "Dostaję małą zniżkę pracowniczą," śmieje się nieśmiało. "Czuję, że to będzie pamiątka, że pewnego dnia będę mogła dać go moim wnukom".

Wnuki? Jeśli wydaje się to przedwczesne w przypadku kobiety, która, gdy się spotykamy ma wciąż 24 lata, to jest to w porządku wobec kogoś kto jest "nazywany 'babcią' bardzo często". Jak wielu dziecięcych aktorów Zendaya jest kimś, kto wydaje się jednocześnie młody i stary, zmęczony światem i trochę... nie naiwny, ale otwarty i podekscytowany, by nauczyć się wszystkiego, co może o życiu, które w dużej mierze widziała z perspektywy planów filmowych i wystąpień reklamowych. 16-letni syn przyjaciela powiedział mi, że kiedy oglądał ją grającą nastoletniego szpiega w serialu Disneya KC Undercover uderzyła go jako stara dusza. Ona śmieje się i przytakuje. "Mówiono mi to wiele, wiele, wiele razy".

via. www.vogue.co.uk

W tym roku można odnieść wrażenie, że kariera Zendayi dorównuje tej reputacji. Jej ostatni film, Malcolm & Marie nakręcony w czarno-białej tonacji z udziałem Johna Davida Washingtona, który ukazał się na początku 2021 roku, sprawiał wrażenie, jakby był momentem jej dojrzewania; jej przejściem od gwiazdki do gwiazdy. Wymyślony i nakręcony w całości w zamknięciu, był także pierwszym filmowym sukcesem Zendayi jako producentki, która zadbała o to, by część dochodów z filmu trafiła do organizacji charytatywnej Feeding America.

Jeśli "Malcolm & Marie" świadczył o jej ambicjach, to "Diuna" w reżyserii Denisa Villeneuve'a pokazuje jej determinację, by wziąć karierę w swoje ręce. Film opowiada o Atrydach, rodzinie międzyplanetarnych arystokratów, którzy niedawno przejęli zarząd nad pustynną planetą Arrakis, gdzie wydobywa się przyprawę, najcenniejszą substancję we wszechświecie. Zendaya postawiła sobie za cel zagranie Chani, tajemniczej postaci, z którą Paul Atryda (Chalamet), potomek rodu ciągle ma wizje i która wydaje się w jakiś sposób związana z jego przyszłością.

"Zanim jeszcze patrzyli na ludzi, usłyszałam o tym", wspomina Zendaya. "I byłam jak, 'Naprawdę chcę się dostać do pokoju'. Oni nie patrzyli w moim kierunku. A ja byłam jak, 'Hej, jestem tutaj!'". Zendaya była chętna do pracy z Villeneuve - "Nie sądzę, że robi złe filmy" - i nigdy wcześniej nie spotkała Chalameta, ale jak wszyscy inni uważała, że jest wyjątkowy. Wydawało jej się, że to zespół marzeń.

Villeneuve'a nie trzeba było długo przekonywać. "Pamiętam, że po raz pierwszy spotkałem Chani, kiedy Zendaya sprawiła, że uwierzyłem, że wychowała się na obcej planecie, na głębokiej pustyni, w najbardziej surowym środowisku" - opowiada o przesłuchaniu. "Wszyscy wiemy, że Zendaya jest genialną aktorką, ale szczególnie zadziwiła mnie wysoka precyzja jej umiejętności aktorskich, inteligencja, pełna wdzięku cierpliwość i wielka hojność. To jedna z najbardziej profesjonalnych artystek, z jakimi kiedykolwiek pracowałem."

Zendaya czuła, że Chalamet w szczególności docenił jej obecność. "Byłam jedyną inną osobą bliższą jego wiekowi w obsadzie. Więc on powiedział, 'Zajebiście, ktoś kto rozumie moje żarty!'". Urządzali imprezy taneczne w jej przyczepie. "Po prostu zwijał się ze swoim małym boomboxem", śmieje się, i puszczał "taneczne piosenki z lat 2000, jak Soulja Boy".

"Weszliśmy w miły, piękny rytm, w którym byliśmy w stanie skupić się na scenach, ale mieliśmy też dużo zabawy", mówi Chalamet opisując Zendayę jako "totalną ikonę" i "wspaniałą przyjaciółkę". Piszą SMS-y i widzą się, gdy ona jest w Nowym Jorku, a on w Los Angeles. "On jest oczywiście bardzo utalentowanym aktorem, ale i po prostu wspaniałą osobą i dobrym przyjacielem, którego można mieć", mówi. "Zwłaszcza w tej branży, miło jest mieć innych ludzi, którzy też przez to przechodzą i z którymi możesz porozmawiać".

Zendaya nie jest kimś, kto nosi świat zbyt lekko. Czy ona ma terapeutę, pytam? "Tak, oczywiście, że chodzę na terapię", mówi. "To znaczy, jeśli ktoś jest w stanie posiąść środki finansowe, aby pójść na terapię, polecam to zrobić. Myślę, że to piękna rzecz. Wiesz, nie ma nic złego w pracy nad sobą i radzeniu sobie z tymi rzeczami z kimś, kto może ci pomóc, z kimś, kto może z tobą porozmawiać, kto nie jest twoją mamą czy kimkolwiek innym. Kto nie ma żadnych uprzedzeń". Pandemia przyniosła ze sobą jej "pierwszy rodzaj smaku smutku, kiedy budzisz się i czujesz się źle przez cały dzień, jak: co się do kur** dzieje? Czym jest ta ciemna chmura, która się nade mną unosi i nie wiem, jak się jej pozbyć, wiesz?"

Można dostrzec, że niektóre z tych depresyjnych momentów przeniosła na rolę często odrętwiałej Rue w Euphorii, spektaklu poruszającym takie tematy jak uzależnienie, seks i przemoc. Ale, jak sama podkreśla jest również "najbardziej trzeźwą osobą, jaką można poprosić o zagranie tej roli. Mogę to zrozumieć tylko do pewnego stopnia, a potem muszę się oprzeć na Samie. On był uzależniony przez wiele lat jako nastolatek. A od 19 roku życia jest czysty. To jest rzecz, która daje mi nadzieję. Kiedy mamy całe to naprawdę mroczne gówno - szczególnie w tym sezonie łamie mi serce Rue - pojawia się promyk nadziei, bo wiem, że ona jest wersją Sama." Wzruszający jest sposób, w jaki mówi z takimi emocjami zarówno o przeszłości Levinsona, jak i o fikcyjnej Rue, która jest po części Zendayą, po części Levinsonem i po części w sumie swoją własną osobą.

"To taki brutalny sezon," mówi Levinson, "a to, co najbardziej kocham w Z, to fakt, że jest w stanie wejść w te mroczne miejsca, a potem, gdy tylko powiem cięcie, siedzi za monitorem, je Cheesecake Factory i żartuje." Dalej mówi: "Jest też rodziną. Cały dzień gadamy jak najęci. Rozmawiamy o serialu, bohaterach, życiu, filmach, polityce. Jest jedną z najbardziej przyziemnych istot ludzkich, jakie znam".

Wygląda na to, że najważniejsze relacje Zendayi balansują na granicy biznesu i przyjemności. ("Lubię być na planie," wzrusza ramionami, "to moje życie towarzyskie."). Była pierwszą poważną klientką swojego stylisty i bliskiego przyjaciela Law Roach, którego poznała w wieku 14 lat, kiedy Roach był właścicielem sklepu vintage w Chicago. Od razu przypadli sobie do gustu, a on zabrał ją na zakupy w poszukiwaniu stroju na premierę. Teraz porozumiewają się w skrócie wysyłając sobie zrzuty ekranu z inspiracjami - Zendaya przewija swój telefon pokazując mi odniesienia do jej sesji do Vogue'a, takie jak Cindy Crawford i inne supermodelki w mocnych pozach. Rozpoczęli również pracę nad budowaniem jej archiwum ubrań od projektantów. "Chcę ponownie wykorzystać moje ubrania. Chcę być w stanie założyć tę sukienkę ponownie, gdy będę miała 40 lat i powiedzieć, 'Ta stara rzecz?'. Naprawdę znalazłam dobre kawałki vintage, w które chcę zainwestować swoje pieniądze."

Głównie jednak ma trudny czas wydawania na siebie. "Moja mama jest oszczędna, więc staram się o tym pamiętać. Potem mój tata mówi: 'Wiesz, nie możesz tego wydać, kiedy będziesz martwa', tego typu rzeczy. Ja jestem gdzieś pomiędzy". W wieku 23 lat wybrała się na swoje pierwsze wakacje do Grecji i powiedziała swojemu asystentowi Darnellowi Applingowi (poznali się, gdy był jej stand-inem w KC Undercover i pozostają niesamowicie blisko mieszkając razem w jej domu w San Fernando Valley), żeby wziął jej kartę, zapłacił za wszystko i nie mówił jej ile, żeby się nie stresowała.

Jest to coś, o czym rozmawia ze swoim terapeutą. "Nadzieją jest kariera, która pozwoli ci finansowo robić rzeczy, które chcesz robić, ponieważ lubisz tę pracę i nie musisz się martwić o inne rzeczy" - mówi. Nie jest jeszcze pewna, czy to osiągnęła, zdradzając, że za jej dążeniem stoi ciężar obowiązków. "Ale zawsze myślę, 'Zawsze będę musiała pracować'. Bo jeśli nie będę pracować, to jutro wszystko może przepaść".

via. www.vogue.co.uk

Zendaya dorastała w Oakland, w rejonie Zatoki San Francisco w północnej Kalifornii. To miasto, które nigdy nie straciło swojego radykalnego charakteru (było domem dla Czarnych Panter), choć w ostatnich latach wkradły się tam pieniądze świata techniki. Zendaya ma białą matkę, Claire Stoermer i czarnego ojca, Kazembe Ajamu Coleman, oboje są nauczycielami, którzy obecnie są rozwiedzeni. "Moi rodzice bardzo ciężko pracowali, aby zapewnić mi wszystko, czego mogłam pragnąć jako dziecko", mówi. W czasie wakacji jej matka pracowała na festiwalu szekspirowskim. "Wychowałam się w teatrze. Byłam małym dzieckiem oglądającym Richarda III".

W tym sensie była klasyczną przedwcześnie dojrzałą jedynaczką otoczoną przez dorosłych. W rzeczywistości ma pięcioro przyrodniego rodzeństwa - trzy siostry i dwóch braci - choć są oni znacznie starsi. Mimo to są ze sobą zżyci - jej siostra pracuje dla niej, a bracia nie mieszkają daleko - i mają dzieci w wieku zbliżonym do wieku Zendayi. Dla nich jest ona ciocią Dayą. "Lubię myśleć, że jestem fajną ciocią, miałam tę całą sytuację na drugi dzień, gdzie moja mała siostrzenica miała przyjaciół nad. A ja na to, 'Chcesz się pobawić? Potrzebujesz podwózki?" - mówi w zbyt chętny sposób. "Moja siostrzenica, która jest dwa lata starsza ode mnie miała na sobie przedziałek na bok i skinny jeans, a ja na to, 'Uh oh, nie słyszałaś? Skinny jeans są wymarłe. Wypadasz kochanie, wypadasz."

Jej rodzina pomaga jej się uziemić i chroni ją również w jej bardzo prywatnym, aczkolwiek mocno przeanalizowanym życiu miłosnym. Zendaya grała u boku prawie wszystkich chłopaków z internetu: Chalamet w Dune; Jacob Elordi w Euphoria; John David Washington w Malcolm & Marie; Zac Efron w The Greatest Showman. "Tak, widziałam te tweety" - śmieje się. Ale umawianie się z nią na randki w realu to, jak sama twierdzi nie lada wyzwanie. Lista aprobat jest długa - "mój tata, moi bracia, to cała sprawa. Powodzenia dla tego, kto chciałby się tego podjąć" - kpi. Być może jej partner z filmu Spider-Man, Tom Holland, o którym od dawna krążą plotki, że jest jej chłopakiem, sprosta temu zadaniu? W końcu następnego dnia pojawiają się zdjęcia, na których para całuje się w samochodzie po naszym lunchu.

Kto może ją winić za to, że w połowie dwudziestego roku życia nie chce publicznie mówić o czymś tak intymnym i potencjalnie dramatycznym jak życie miłosne? To jest ktoś, kto odmówił swojego pierwszego pocałunku na ekranie jako nastoletnia gwiazda Disneya. "Pamiętam, że byłam w Shake It Up i byłam jak, 'Nie zrobię tego. Zamierzam pocałować go w policzek, ponieważ się jeszcze nie całowałam, więc nie chcę, żeby ten pocałunek był w kamerze'", wspomina. W każdym razie, gdy nie zamyka klubów w Hollywood, jest domatorką, która spędza czas na oglądaniu filmów i słuchaniu podcastów o prawdziwym kryminale. Podczas zamknięcia zaczęła malować - jej współscenarzystka z Euphorii, Hunter Schafer kupiła jej kilka farb olejnych. "Jeśli za pierwszym razem nie jest to pierdolony Picasso, to się denerwuję" - mówi o opanowaniu tej rozrywki. Dla tych, którzy są astrologicznie nastawieni: tak, jest perfekcjonistyczną Panną.

Ale dla wszystkich jej skłonności do perfekcjonizmu, Zendaya nie jest zainteresowana linią czasu. "Nigdy nie byłam jak, 'Chcę to zrobić w tym czasie, a następnie od tego wieku chcę zrobić to'. Pewnego dnia będę miała rodzinę, ale staram się nie nakładać na tego presji, to się stanie, jeśli tak ma się stać." Prawdziwy feminizm, mówi, musi być intersekcjonalny i obejmować "kobiety, które wyglądają jak ty, kobiety, które nie wyglądają jak ty, kobiety, których doświadczenia są inne niż twoje. Oznacza to czarne kobiety, oznacza to kobiety trans, oznacza to wszystkie kobiety."

Czy myśli o tym, co mogłaby powiedzieć swoim przyszłym dzieciom o tym, jak to jest być czarnym w Ameryce w tym momencie? Wzdycha. "To znaczy, to jest wielkie pytanie. Nie wiem - nie wiem, co im powiem. Mam nadzieję, że będą w stanie spojrzeć na to, co zrobiłam i na mój dorobek i to dostrzec." Sztuka, jej zdaniem jest "ogromnym katalizatorem zmian. Jeśli kiedykolwiek zostanę filmowcem, wiem, że głównymi bohaterkami moich filmów zawsze będą czarne kobiety." I to z pewnością znajduje się na jej liście. Na planie lubi siedzieć blisko monitorów i zadawać pytania dotyczące storyboardowania ujęć. "Muszę się pospieszyć i dowiedzieć się, jak, kurwa, zostać reżyserem, człowieku. Staram się, uczę się każdego dnia, naprawdę. Jest tak wiele rzeczy, które chcę zrobić." Levinson przewiduje, że będzie ona "zdumiewającym filmowcem".

Zanim za bardzo się rozpędzi, ma jeszcze jesień do przejścia. Kończymy zanim wróci na kolejną długą noc filmowania. Na horyzoncie są jeszcze dwie trasy prasowe dla Dune i Spider-Mana, a także jej 25 urodziny na początku września. W tym roku nie będzie imprezy - będzie pracować w Wenecji. "Nie jest to zły sposób na spędzenie urodzin," uśmiecha się.

/Karolina ♡ Twitter: @InfoZendaya Źródło: www.vogue.co.uk

#zendaya #british vogue #dune movie #euphoria #no way home #spider man

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bomberlandia · 3 years

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26 Reasons to love the Bombers right now

The 11-point loss to the Demons was another gallant performance against a more experienced team. It has sparked discussion around how the Bombers “aren’t quite ready” to mix it with the contenders. And that’s true. Remember: the Bombers were predicted to finish 12th or lower this year. They have surpassed expectations and it looks like their development and connection has been fast-tracked with a collective buy in to the Rutten ethos.

Even though the Bombers are slightly off competing at the pointy end of the year, there’s been so much to like about their season. Here’s 26 things I love about the Bombers right now.

1. Cale Hooker: Before this year, Cale Hooker worked his way back from injury and was a permanent defender. At 31, he looked tired toward the end of last season. Fast forward 12 months and he’s kicked 30 goals - the most out of any Bombers player - and sits 8th in the Coleman Medal race. I love his work in the forward ruck contests where he hacks the ball forward at any cost. It’s produced some great results. He’s true fighter.

2. Consistent Form On The Road: Bombers have gone 2-5 from 7 outings on the road. Apart from the Power loss (54) and Lions (57), the other losses have been tight affairs: Swans by 3, Giants by 2 and Tigers by 39 after the Bombers had led in the early stages of the final quarter. It’s not a perfect record but since round five Essendon have been consistently better. They’ve travelled for half of the season so far with the fifth youngest team and can show they can compete.

3. Dyson Heppell is Back: After only playing 3 games in 2020, many said the Bombers captain was too slow for the midfield and there were question marks over what his role might look like and if he could ever recover back to full health. Heppell answered those questions by playing some inspired football. If you look at the AFL rankings, he’s 45th for disposals, 10th for marks, 17th for intercepts with 90 in total; Steven May has 85. He’s bringing other players like Hind and Laverede into contests and his calm influence is having a big impact. This is the year Bombers fans hoped would happen for Heppell. He’s back.

4. Sam Draper’s Aggression: He has only played 12 games and yet plays the game with such an energy and ferociousness it’s hard not to get excited about what he could look like three years from now. I’m enjoying the little things about Draper’s game: the intelligent knock-ons, the scrappy kicks from congestion, the high-flying contested intercept marks on the wing. Once he figures out his true potential and can start hurting teams at both ends his value will go through the roof.

5. Brownlow Medal Fancies: Darcy Parish and Zach Merrett are having years to remember. The predictor has Parish at 18 votes at 9-1 and Merrett at 13 votes for 26-1. Parish has a real chance of winning Charlie.

6. Darcy Parish’s Year of Growth: Speaking of Parish, he’s the no.1 player in the AFL for centre clearances with 56. His breakout year has resulted in large improvements across the board but his best work has been generating touches at the bounce which has kept Essendon in games much longer. He’s also the best Bomber in the AFL for: goal assists (2nd), contested ball (9th), score involvements (6th) and metres gained (20th).

7. Jayden Laverde: He’s played every game this year (14) which is the most he’s played in a single year - his previous best was 10 in 2019. The transition to the backline has made him a vital cog in defence now. He’s ranked 54th in the AFL for marks; the second best Bombers player. And he’s ranked 30th for interceptions (81) behind Heppell, Hind, Ridley. Since making the shift to defence he’s doubled his production: 114 disposals in 2019 to 201 touches in 2021; his marking numbers have gone from 43 in 2016 to 84 this year; and he’s had 41 rebounds this year ( 7 was his previous best in 2015). It’s taken the 60-gamer almost seven years to find a perfectly fitting role and now he looks at home.

8. Great Depth: The injuries haven’t been good but when you think of who has to come back into the team you start to imagine what a full Essendon lineup might look like. Missing: McGrath, Shiel, Caldwell, Snelling, Hurley, Francis. And then think of some of the players that got games last year but are working away in the VFL right now, like Cutler, Gleeson, BZT, Phillips, Cahill, Zaharakis. And then development players are there too: Reid, Bryan, Durham, Hird, Brand, McBride.

9. Anthony McDonald-Tipungwuti: He’s arguably the safest set shot in the AFL. In the last three years he’s kicked 80.32; this year 29.12. His goal accuracy of 67.8 percent and his 2.1 goal-average puts him in the elite category.

10. Ranked second in the AFL for goals scored: The Bombers have an average winning margin of 34.5 (5th best in the AFL). They are also ranked third for points scored behind the Bulldogs, Lions and are better than the Demons (4th), Eagles (5th), Power (6th).

11. Closing the Gap: The Bombers average losing margin is 22.9. That has dropped. In 2019 it was at 35.6 and in 2020 it was 30.7. This means we’re seeing the Bombers be more competitive. This year the Demons have an average losing margin of 9 points. Geelong has been the benchmark in recent years with 18, 15 and 12 point average losing margins since 2018.

12. Jordan Ridley: The 22-year-old has only played 39 games and already owns a best and fairest award. His play-making, intercepts (ranked 27th in the AFL), and efficiency has made him Essendon’s no.1 defender now. This year he’s ranked 7th in the AFL for rebounds (90), the best of the Bombers. He just does a lot of things right - from body positioning, reading the play, and decision-making - which has been so good to watch.

13. Nick Hind is Better than Saad: This has been a talking point all year. It’s time to lay it all out. Out of 11 categories, Hind is more dominant in eight of them. Here they are:

Tackles +5

Inside 50s +5

Goal assists +4

Contested Ball +17

Uncontested +57

Efficiency +1 %

Score Involvements +6

Saad is +1 for rebounds, +23 for bounces, and +18 for metres gained (on average). But Hind looks to be a much more complete player with room to grow. Both players are the same age - 26 - but Hind has only played 35 games; Saad has 123 games behind him. It’s been an impressive year by Hind at his new club and I think what he’s done is even more remarkable considering it’s only his third year in the AFL system.

14. The Bombers’ Form Looks Real: Watching them play they have more purpose, more system in their game. They’re no longer the indecisive team that gets strangled under pressure. It’s all about executing and when they do it, it works. They still have gaps. They still turn the ball over. But they’re finally playing a brand of football that is more even and fluid than 12 months ago. Had a few more results fallen their way they could have been a top six team this year.

15. Highest score this year is 143: That score was against St.Kilda in April and is ranked second highest in the AFL behind the more advanced Bulldogs’ 167. It’s better than the Cats’ 136 and Tigers’ 134. They also scored 141 against the rebuilding Roos.

16. Last Quarters Won: The ability to finish off games has been one of the Bombers’ strengths. They’ve won 9 last quarters out of 14 which is the best in the AFL. They share that with the Bulldogs, Lions, Crows. The Bombers have also won 8-of-14 first quarters (ranked sixth best), but need to improve on second and third quarters: they’ve won 9 out of 28 collectively (five and four respectively).

17. Ben Rutten: I think the best trait Rutten has is his communication. Whatever is happening behind closed doors is working because the players have responded on the field. They have responded by signing contracts. They have responded by saying the culture is tight. There’s been player improvement from last year’s fringe guys - Redman, Laverde, Stewart, Snelling, Ham. The Hooker move worked. The game plan is something to finally get behind. He’s surprised a lot of people but also confirmed he’s the man for the job: to take Essendon to their next flag.

18. Rising Stars: Nik Cox and Harrison Jones both got nominations. It was Cox who started the year consistently with great endurance and skills on both sides of the feet. Now we’re seeing Jones’ contested marking come to the surface and his work rate: running 14-15 kilometres per game. Jones has 18 goals and 52 marks. Cox has 8 goals, 59 marks. There’s no ceiling for either player. Their evolution will be exciting to watch.

19. Merrett’s 2021 is the Best Merrett Yet: He’s had a very consistent career but if he keeps going at the pace he’s at now, he’ll return his best year of production. He needs 219 disposals in nine games to eclipse 659 in a year which is his previous best. He’s ranked 4th in the AFL for disposals per game (31.50), 20th for tackles (69), and he’s had 95 score involvements (second behind Parish at Essendon). Six more years of the Merrett way.

20. Tackle Count: Bombers are ranked 4th for tackles in the AFL with 61.4 per game. To compare: In 2020 the Bombers were ranked 11th averaging 49.5 per game. This has been a big part of the elevation in intensity and pressure. When it’s all humming, man, it looks good.

21. Jake Stringer’s Trajectory: Stringer’s range has no ceiling. Whether he’s a midfield bull, clearance king, goal-scorer, game-changer, x-factor, and more recently “Dusty-like”. He’s surging. Forget the fat-shaming of 2020, he’s taking his game to new levels. With a bit of luck he stays healthy and stays consistent.

22. Debutants: The trio of Reid, Waterman and Perkins have shown flashes of their potential. Reid has only played the one game but his 202-cm frame will make him one of Essendon’s key defenders of the future. Perkins has had 57 score involvements and 110 uncontested touches. His poise with the ball is ahead of his time. And Waterman has kicked nine goals in seven games and looks like a good fit in the forward line. He brings tenacity and a raking, deadly, left-foot. His AFL journey still gives me goosebumps.

23. That Eagles 16-point Win: It was dubbed a “coming of age” win for the fact the Bombers beat the Eagles - a finals team - in Perth with a young team. They were down by 29 and kicked 7.8 to 2.5 in the second half. Once they start beating contending teams, they’ll look back at this game and say that’s when it all started to sink in that their best was better than the best.

24. The Critics Have Turned: Remember this headline? “Essendon star Zach Merrett a casualty of leadership mess”. The Bombers’ 2020 season was called a “death spiral” and “Tipungwuti is a marvellous player in hopeless surrounds”. What about this one: “Saad decisions spells disaster for Essendon.” Those doomsday headlines have now been replaced with “fiesty” Bombers, “Rising” and “Brave”.

25. Will Snelling: He’s recovering from a thumb injury but has taken a leap this year with his pressure role. He’s kicked 10 goals, has 18 tackles inside 50 (second best at Essendon), 9 goal assists and 52 tackles. He’s played 33 games since 2016 when his career looked uncertain and now he’s an important cog for Essendon.

26. Peter Wright: He’s had to pinch-hit in the ruck while Draper was injured and collected 139 hitouts - the most at Essendon. He’s been a solid contested mark option with 18 and has 15 marks inside 50. His 11 goals puts him behind Hooker, Walla, Stringer and Jones and makes him a very versatile tall that will continue to develop.

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cmcolemanhome · 3 years

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Just A Little Laundry || Laundry Motivation // Do Laundry with me

#laundry #do laundry with me #laundry buddy #cm coleman home

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upsidedown-souffle · 6 years

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Get to know me tag

Rules: answer 30 questions then take 20 blogs you would like to know better

I was suddenly tagged by @impossiblemoriartysgirl and I’ve never done this stuff before, so why not? :)

Nickname: I’m boring and don’t have one

Gender: Female

Star Sign: Libra

Height: I honestly don’t remember... around 164 cm (it means 5′3)

Time: Erm...

Birthday: Somewhere in October

Favourite Band(s): I don’t really have one, because I just listen everything. Let’s say... Radiohead, Coldplay and Guns N’Roses

Favourite Solo Artist(s): Again, I don’t listen someone in particular. James Blunt is nice (I like his voice) and I enjoy listen Tim Minchin’s songs

Song Stuck In My Head: Oft gefragt by Annenmaykantereit

Last Movie Watched: The Death of Stalin and it was great

Last Show Watched: Dark and it was also really great! I strongly recomend to check it out if you didn’t already

When Did I Create My Blog: It’s too hard for me to keep track, so I had to look it up: August 2016. Time flies fast

What Do I Post: Photoshop manipulations. Sometimes I reblog posts about whouffaldi or Jenna Coleman. That’s all for now, I guess

Last Thing I Googled: Hm. Jheronimus Bosch. I needed to find one of his paintings

Do You Have Other Blogs: Yeah, actually, this is not my main blog. But I don’t really use the other one

Do You Get Asks: I wish. If anyone wants to ask me something, go ahead :)

Why Did You Choose Your Url: Because I’m rubbish at this and my friend once gave me an idea to combine souffle with the first word I have in mind

Following: 38

Followers: 237 (and it’s actually a lot, so thank you all!)

Favourite Colour: Blue

Average Hours Of Sleep: Sleep? What an interesting concept! I should try it one day

Lucky Number: Don’t have one

Instruments: Guitar/Ukulele

What Am I Wearing: Just some boring home clothes

How Many Blankets I Sleep With: I have one and it’s enough for me

Dream Job: It’s strange, but I don’t have anything in mind right now. Something that has to do with visuals maybe (or just go back in time and serve coffee for Peter and Jenna, so I could see what’s going on DW set by myself)

Dream Trip: New Orlean and some places in Great Britain

Favourite food: Lasagna

Nationality: Russian

Favourite Song Now: Another music question... Why so many? Ok, let’s say Creep by Radiohead

Wow, it was long! Thanks for tagging and I have no idea who to tag myself so... Anyone who’s interested is invited to join!

#get to know me tag #about me

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annieboltonworld · 4 years

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Juniper Publishers- Open Access Journal of Environmental Sciences & Natural Resources

Mesopredator Release Theory: Comparing Mesocarnivore Abundance and Prey Choices in an Urban Landscape and Impacts on Prey Populations

Authored by Melissa L Karlin

Abstract

According to the mesocarnivore release theory, when apex carnivores from the landscape the populations of mid- to small-sized carnivores explode and many prey species decline. Apex predators are replaced by smaller mesocarnivores, such as domestic cats (Feliscatus), which should consume smaller prey such as birds, arthropods, and rodents, while larger mesocarnivores, such as Coyotes (Canislatrans), should prey on small mammals such as rodents and rabbits. The purpose of this research was to determine the abundance of mesocarnivores in two urban landscapes, and by determining their prey choices, estimate their impacts on small mammal and bird population abundance in their landscape.

Birds and arthropods were found in highest abundance (42.86%) in cat and Gray fox (Urocyon cinereoargenteus) samples, while Eastern cottontail (Sylvilagus floridanus) was found in highest abundance (41.18%) in Coyote and Bobcat (Lynx rufus) samples. There was a significant difference in prey consumed between these two groups, as expected based on the mesopredator release theory. However, small mammal and bird abundance and diversity indices were similar when comparing the site with the Coyote as the apex predator with the site with cats as the apex predator, suggesting no significant impacts on these prey. Based on the results of primarily the scat analysis in this study, the mesopredator release theory was supported by these results and the difference between the groups was significant, although sample sizes were small.

Keywords: Coyote; Mesocarnivore; Mesopredator release; Small mammal

Abreviations: GCSNA: Government Canyon State Natural Area; StMU: St. Mary's University

Introduction

A 2013 study by the Smithsonian Conservation Biology Institute estimated that un-owned and owned free-ranging domestic cats (Feliscatus) kill between 1.4 and 3.7 billion birds and between 6.9 and 20.7 billion small mammals each year in the contiguous United States (U.S.) alone Loss et al. [1]. If these estimates are correct, this represents the largest source of human-related mortality of U.S. birds and mammals. The same study noted that it is the un-owned cats (farm and barn cats, strays, colony cats, and feral cats) that cause about 69% of the bird deaths and 89% of the mammal deaths. In situations where humans are providing an artificial food source to these cats, a process known as hyper predation may occur, in which a prey species can indirectly affect another prey species, by causing an increase in abundance of a shared predator Baker et al. [2]. In this scenario, the humans are acting as a prey species by providing a food source to cats, allowing the abundance of the cat population (the predator) to surpass the carrying capacity of the environment Baker et al. [2]. This causes an increase in predation of the other prey type (i.e., birds or small mammals) due to the inflated predator population size. Predation rates by individual cats may be lower when cats are provided an artificial food source, but the collective number of birds and small mammals killed in these scenarios are elevated because the number of predators present is above the carrying capacity of the area, up to densities 100 times or more high than native carnivore densities Coleman [3].

Large native carnivores such as Gray wolves (Canis lupus)or Mountain lions (Puma concolor) once served as apex predators in many ecosystems prior to urban settlement and habitat fragmentation Crooks & Soule [4]. These apex predators controlled population sizes of the mid-sized carnivores such as Coyotes (Canislatrans) through, in the case of wolves, territorial exclusion and aggressive interactions Smith et al. [5]. An indirect effect of this top-down control was that smaller prey items targeted by Coyotes or other mid- to small-sized carnivores were not heavily predated upon. When these apex carnivores disappeared across the U.S. due to predator control and urban settlement, the populations of mid- to small-sized carnivores exploded and many prey species declined, a phenomenon known as mesocarnivore release Crooks & Soule [4]. In many areas of the U.S., the Coyote has now risen to the role of apex predator, although it is a mid-sized carnivore, because the former apex predators have been extirpated Prugh et al. [6]. Cats can also function as mesocarnivores in continental ecosystems or even apex predators in island ecosystems Prugh et al. [6]. This apex role for cats is particularly true in heavily urban areas where Coyotes cannot exist, but free-ranging cats, un-owned by anyone in particular, are maintained by an urban human population.

In areas where Coyotes serve as the apex predator, they can suppress the population abundance of smaller carnivores such as Striped skunks (Mephitis mephitis), Raccoon (Procyon lotor), Gray fox (Urocyoncinereoargenteus) and cats Crooks & Soule [4]. One study documented an increase in scrub bird diversity in areas where Coyotes were present and these smaller carnivores were absent (due to being predated by the Coyote), and a corresponding decrease in bird diversity in areas where these smaller carnivores were present but Coyotes were absent Crooks & Soule [4]. Based on this example, ecosystems with coyotes present as the apex predator may have higher bird and small mammal's population diversity and possibly abundance, when compared to systems where the Coyote is absent and smaller carnivores abound. In light of the recent studies on the impact of free-ranging cats on prey such as birds and small mammals, ecosystems that have free-ranging cats as the apex predator may have extremely low levels of these prey when compared to ecosystems with Coyotes present.

Coyotes, Bobcats (Lynx rufus), and Gray fox are sympatric in many areas of the U.S. Whitaker & Hamilton [7], and can all be considered generalists in terms of habitat use; in terms of diet, Bobcats are mainly carnivorous while Coyotes and Gray fox are omnivorous Litvaitis & Harrison [8]. All three, however, prey on mammals Litvaitis & Harrison, Harrison [8,9]. A combination of competition for resources and intraguild predation among these three species may be present where they coexist Fedriani et al. [10]; a study in California documented Coyote dominance over Bobcats and Grayfoxes, with multiple Gray fox and Bobcat deaths attributed to Coyotes Fedriani et al. [10]. Diets of feral cats have been studied extensively on islands, where their impact on native fauna may be significant. They prey on arthropods, reptiles, birds, and lagomorphs Paltridge et al. [11-13]. On San Clemente Island, CA, Island fox (Urocyonlittoralis) and feral cats consumed similar proportions of birds, but feral cats consumed rodents and lizards at a higher frequency than Island foxes, which consumed more arthropods and plants Phillips et al. [13].

The purpose of this research was to determine the abundance of mesocarnivores in two urban landscapes, and by determining their prey choices and measuring prey abundance and indices, estimate their impacts on small mammal and bird populations in their lands cape in light of the mesopredator release theory. The objectives of this project were to quantify abundance of mesocarnivores, birds and small mammals at both sites and determine prey choice by mesocarnivores using scat analysis.

Study Sites

St. Mary's University

St. Mary's University (StMU) is located on the west side of San Antonio, Texas in a mixed residential/commercial urban and covers approximately 0.55 km2 (Figure 1). The campus is home to about 3,800 students and is in a heavily urban area. The majority of the land use on the campus is urban, impervious surfaces, with little green space. All areas of the campus are maintained by grounds keeping and no natural areas exist.

Government Canyon State Natural Area

Government Canyon State Natural area (GCSNA) is an approximately 47.04 km2 state natural area within the Balcones Canyonlands sub-region of the Edwards Plateau Ecoregion (Texas Parks & Wildlife 2005) and is located approximately 37 km north west of San Antonio, TX (Figure 1). Dominant vegetation includes Ashe juniper (Juniperus ashei) and a mixed deciduous component of Texas oak (Quercus buckleyi), Live oak (Quercus fusiformis), Cedar elm (Ulmuscrassifolia), Texas ash (Fraxinustexensis), and Escarpment black cherry (Prunus serotina) Watson The natural area has canyon lands and grasslands, is home to the endangered Golden-cheeked warbler (Dendroicachrysoparia) and has over 64 km of hiking trails, as well as a visitor center and campgrounds.

While GCSNA represents a large natural area, the location of this study within GCSNA was in the southernmost section of the natural area, and was the most heavily disturbed by neighboring urban development (Figure 2). The entry road to the park and offices passes through the study site, and the closest residential home was between 25 m and 1 km from the study area. This section of the natural area was selected for this study as it represented the region where impacts from edge effects and residential pets would likely be the greatest.

Materials and Methods

Small mammal surveys

All surveys, field work, and data collection were conducted from June - July 2014. At both sites, 20 Sherman Live Traps (7.62 cmby7.62 cm by 22.86 cm) and 10 track stations, spaced 10 m apart in an alternating pattern, were used to measure small mammal population diversity and abundance. At StMU, these 30 stations were laid in a straight line transect for four nights Kays , DeWan [14], and then moved 50 m to a new line, for a total of five transects and 600 total trap nights (number of traps multiplied by number of nights) O’Brien et al. [15] (Figure 2). At GCSNA, these 30 stations were laid in a straight line transect as well, and moved 50 m to a new line after four nights, for three transects and a total of 360 trap nights. The original location at GCSNA yielded no small mammal captures after 12 trap nights, and a severe Solenopsis invicta Buren (red imported fire ant) presence in the area. The trap line was moved to the grassy area in the southern section of the natural area, and the original trapping methodology was continued for an additional two transect lines and 240 trap nights (Figure 3). All traps were checked daily before 1000 h, and were reset each evening after 1800 h to avoid the day time heat. If an animal was captured, it was marked with a nonpermanent livestock marker paint pen, so that it would not be counted if captured again.

Small mammal track stations consisted of 60.96 cm plastic gutters inverted over an aluminum metal strip which had an approximately15.2 cmby12.7 cm area sprayed with a combination of 4 to 5 tablespoons of carpenters chalk and 473 ml of 98% isopropyl alcohol, followed by 15.2 cm by 12.7 cm sheet of contact paper, on each end, with a 2.54 cm wide bait station in the center Neal [16]. Traps were baited with peanut butter and track stations with peanut butter and bird seed. Contact paper strips recorded footprints from each track stations for later identification to the genus level. In addition, the small mammal abundance data collected at four camera stations (Figure 3) in GCSNA during a previous study (September-December 2013) were used to supplement small mammal abundance data on larger wildlife, such as Eastern cottontail (Sylvilagus floridanus). The cameras used during this previous study were the DLC Covert Extreme Black 60 (Covert Scouting Cameras, Lewisburg, KY). This camera was a black infrared camera with a 40 ft detection range; 12 megapixel (MP) picture resolution; a 1.2 second trigger speed; a variable trigger interval of 1 s - 60 min; takes pictures or video; includes 60 infrared black LED’s; and includes a date, time, temperature, and moon phase stamp on every picture. The infrared technology detects motion, and an animal must move into the detection zone in order to activate the camera Kelly & Holub. For the trail camera data, photos were analyzed to determine species type, and total number of individual species was calculated based on trap events Kelly & Holub, which consisted of a record of an animal within a 30 min period. If the same species was recorded within 30 min, it was assumed to be the same individual and was not counted. This research was authorized by the St. Mary’s University Institutional Animal Care and Use Committee, Approval No. STMU-2014-7.

Bird surveys

Bird abundance and diversity was measured for both sites during three bird surveys, covering three transects at each site. The surveys followed guidelines established by the Expedition Field Techniques from Bird Life International Bibby et al. [17]. Birds were surveyed from transects at each site, as illustrated in (Figures 2 & 3). The observer stopped for 3 min at every 100 m distance mark along the transects, and recorded the abundance and species of birds visible from the transect line. Transect locations were selected based on building configuration at StMU and to cover both areas surveyed for small mammals at GCSNA. Total transect length at StMU was 1.5 km and 2.75 km at GCSNA. All surveys were conducted between 0700-0900 h, when wind speeds were less than 12 mph, and when there was no precipitation [18].

Mesocarnivore surveys

Five predator scent stations were established at each study site (Figures 2 &3), which consisted of a fatty-acid impregnated predator scent disk (USDA APHIS) placed in a mesh stocking and hung from a branch, placed over a track pad Kays & DeWan [14]. For this study, 50 cm by 75 cm sheets of aluminum flashing painted with a combination of 4 by 5 tablespoons of carpenters chalk and 473 ml of 98% isopropyl alcohol were used as the track substrate, and contact paper placed in the center of the flashing was used as the track pad (Neal 2007). Animals were identified based on the track records using an animal tracks identification guide Murie et al. [19]. A DLC Covert Extreme Black 60 (Covert Scouting Cameras, Lewisburg, KY) trail camera was also placed at each scent station to record predators). (Figures 2 &3) Predator abundance data collected at four camera stations (Figure 3) in GCSNA during a previous study (September- December 2013) was also included to supplement the survey of predator abundance.

Scat Analysis

Scat was opportunistically at both study sites to determine the diets of carnivores in the study areas. Scat samples were collected along trapping transects lines and was identified to the species level when collected. Samples were stored in a freezer until they could be analyzed. For analysis, the samples were thawed, dried in an oven at 200°F for 24 hr, and placed in a mesh stocking and rinsed in running water to separate the items, similar to methods followed by Phillips et al. [13]. Scat contents were categorized into prey groups (rodent, rabbit, bird, arthropod, and fruit/seed), non-preyitems (e.g., twigs, rocks, vegetation), and an unknown category, similar to Phillips et al. [13]. Prey items were identified to the most detailed taxonomic level possible.

Data analysis

Species richness (S), Shannon diversity index (H), and the Shannon's Equitability index (EH) (Molles [19]) were calculated for birds, small mammals and mesocarnivores, using survey data, trap event data from trail cameras and trapping data from small mammal traps and track pads. S was a measure of the number of different species present; H was a measure of species abundance and diversity; and EH was a measure of evenness among the species present. Based on the scat analysis, the Pianka Index was calculated to determine dietary overlap between the mesocarnivore species Pianka [20,21]. The Pianka Index ranges from 0 (no dietary overlap) to 1 (complete dietary overlap).A Chi-Square analysis (α = 0.05) was conducted to determine if abundance of prey types consumed by mesocarnivores differed between species.

Results

No small mammals were captured in the traps or recorded on the track pads at StMU. At GCSNA, only two small mammals were captured in the traps, both White-footed mice (Peromyscusleucopus). No small mammals were documented on trail cameras at StMU, but Eastern cottontail was documented by a trail camera in the GCSNA study area. At StMU, mesocarnivores documented by trail cameras included striped skunk, cat, domestic dog (Canis lupus familiaris), and Virginia opossum(Didelphis virginiana); at GCSNA, coyote, bobcats, gray fox, Feral pig (Susscrofa), striped skunk, and raccoons were documentedon trail cameras in the September - December 2013 data collection period and the current June - July 2014 period (Table 1). No domesticcats were recorded at GCSNA. The track pads for mesocarnivores were discontinued after two trapping sessions because the trail cameras documented all required data.

Cats dominated the mesocarnivores at StMU (75% of trap events) and coyotes dominated the mesocarnivore population at GCSNA (43%). Total species richness (S) for small mammals was low at both sites, although the small mammals documented at GCSNA were similarly represented, as indicated by the EH value (Table 2). H values for small mammals and mesocarnivores were similarly low for both sites, considering the potential range of 1- ln S. Bird species richness and H, however, were high at both sites and showed a similar distribution between the sites (Table 2). The abundance of each particular bird species, and the rarity of the species, however, varied considerably between the study areas (Figure 4).

Although small mammals were not captured at StMU and were captured in limited abundance at GCSNA, the scat analysis revealed the most common prey items of these groups. Because of their similar prey choices based on trophic level, cat and gray fox scat samples were combined for analysis. A total of 11 cat, one gray fox, four bobcat, and six coyote scat samples were collected. Birds and arthropods were found in 75% of cat/Gray fox samples, and Eastern cottontail rabbit was found in 70% of the Coyote/Bob cat samples. By total prey items, birds and arthropods were the most abundant items (42.86% each) in cat/Gray fox scat, and Eastern cottontail rabbit was the most abundant (41.18%) in Coyote/Bobcat scat (Table 3). There was a significant difference in the number and type of prey consumed between the two groups (χ2 = 13.44, df = 4, p < 0.05), although n values were low. Vegetation (mostly grass) was found in 90% of the cat/Gray fox scat and in 36% of the Coyote/Bobcat samples. The Pianka Index of dietary overlap, however, was low for all mesocarnivore comparisons (Table 4).

Discussion

There were no correlations between predator abundance and small mammal abundance at either site, due to the lack of data from the small mammal trapping. This may have been due to the time of year: the summer heat and the abundance of other food sources; or the prevalence of Fire ants at both study sites which were attracted to the bait. However, a small mammal trapping study conducted at GCSNA from 1999-2008 revealed a steady decline in small mammal numbers, from a high of 45 individuals during a two night trapping period, to 0 individuals (D. Ribble, Trinity University, San Antonio, TX, 2014 unpubl. data). This suggests that actual small mammal abundance at GCSNA may be very low. At StMU, rodent traps are also placed near many of the buildings to keep the population low, which may explain the lack of small mammals recorded at StMU. Bird surveys revealed similar numbers and diversity of species at both sites, although GCSNA had species such as the Painted Bunting (Passerina ciris) and Northern Bobwhite (Colinus virginianus) that preferred more natural, grassy habitats, while StMU had an abundance of typical urban species such as House Sparrows (Passer domesticus), White-winged Doves (Zenaida asiatica), and Northern Mockingbirds (Mimuspolyglottos).

Mesocarnivore numbers based on trap events at GCSNA may be inflated since they are based only on a 30 min threshold, whereas at StMU, the cats had identifying features (e.g., color patterns) so in addition to the 30 min threshold, the trap events could be filtered by these features. Based on this abundance data, cats were the dominate mesocarnivore at StMU and Coyotes were the dominate mesocarnivore at GCSNA. The low Shannon indices for both sites reflected that there were a few, very abundant, species at both sites, such as the cat and Coyote, and overall diversity and species richness were low. Given the heavily urban setting of StMU, a wide array of mesocarnivores was not expected and these low indices reflect the nature of the urban environment; the low indices at GCSNA support the premise that this region of the natural area may be disturbed by the neighboring urban areas. Based on the high abundance of Coyotes (Table 1), this mesocarnivore may also be dominating the landscape at GCSNA and restricting the presence of other species. This may explain why no cats or domestic dogs, and very few small mesocarnivore species such as Striped skunks, were documented at GCSNA. The scat analysis became the focus of this study after a disappointing small mammal trapping season, and while sample sizes for this analysis were low, the clear separation between bird abundance in the cat/Gray fox samples and Eastern cottontail abundance in Coyote/Bobcat samples was in line with other published reports of prey choices for all the mesocarnivores. It does not appear, however, based on the indices calculated, that the site with cats as the apex predator has less of an abundance of small mammal or bird species than the site with Coyotes as the apex predator. This is contrary to many other studies which document higher bird and small mammal population diversity and abundance in systems where the Coyote is present Crooks & Soule, Prugh et al. [3,6].

Plant material was found in a high number of cat/Gray fox samples, which has been reported in low numbers from other cat studies Phillips et al. [13]. The Pianka index of dietary overlap revealed expected low numbers when comparing cat to both Coyotes (0.28) and Bobcats (0.22), but also a low overlap when compared to the Gray fox (0.29). This, however, is due to the fact that only one Gray fox scat sample was obtained. The highest dietary overlap, as expected, was between Coyotes and Bobcats (0.44), which was also lower than may have been expected and may also be attributed to low sample sizes.

According to the mesocarnivore release theory, the smaller mesocarnivores such as cats and Gray fox should consume smaller prey such as birds, arthropods, and rodents, while the larger mesocarnivores, such as the Coyotes and Bobcats, should prey on small mammals such as rodents and rabbits. Based on the results of primarily the scat analysis in this study, this theory was supported by these results and the difference between the groups was significant, although sample sizes were small. However, there did not appear to be a significant difference in bird and small mammal abundance between the sites, even though cats appeared to prey preferentially on birds in this study. Additional scat samples from both sites and a longer study duration, however, may yield more insight on the impacts of cats in the StMU urban landscape.

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shortsovereign-blog · 6 years

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Is that JENNA COLEMAN walking the streets of Sparkwood ?? No, it’s just VICTORIA KENSINGTON !! Before coming here, she once lived on the pages of THE YOUNG VICTORIA. Though now they currently spend time as a CONGRESSWOMAN. If you ask the townsfolk about what they are like, you will hear that they are STRONG-WILLED but also GUARDED. Let’s see how their story unravels this time.

Victoria came from an extremely wealthy family who had many people who wanted to rid of them so from a young age she was not able to live a normal life

She was not able to go to school with kids her age and was kept indoors most of the time, becoming extremely sheltered

She was home-schooled from the age of five and took many different other private lessons such as dance, piano, and etiquette

She was never truly close to her mother (her only living parent) due to the fact she had no interest in who her mother chose to associate herself with

She hates being treated like a child even though she is rather young

She became the youngest woman in history to be elected to Congress as a representative for the state of Virginia, being 25 years of age

Her interest in politics began with her uncle William who always said she had a brilliant mind and was destined to change the world

She’s very small being only 153 cm tall and she hates that everyone always looks down at her while speaking so she usually will wear high heels to make herself feel better

She’s extremely progressive in her political ideals

Super intersectional feminist Victoria to the rescue of the world

Had a huge yet unrequited crush on her political advisor/campaign manager, William Lamb (Melbourne)

Hi there! My name's Laiken and I love period dramas (mainly regency, post-Edwardian, or Tudor era) way too much for my own good. I'm a history major with a minor in British literature so I'll probably be bringing in a lot of characters from historical fiction in the near future. If you’re interested in plotting with Victoria, hit me up.

#pofl: talk #let me know if i have to tag this somewhere else

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kristinsimmons · 5 years

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How are hospitals supposed to reduce readmissions? Part III

By KIP SULLIVAN, JD

The Medicare Payment Advisory Commission (MedPAC) and other proponents of the Hospital Readmissions Reduction Program (HRRP) justified their support for the HRRP with the claim that research had already demonstrated how hospitals could reduce readmissions for all Medicare fee-for-service patients, not just for groups of carefully selected patients. In this three-part series, I am reviewing the evidence for that claim.

We saw in Part I and Part II that the research MedPAC cited in its 2007 report to Congress (the report Congress relied on in authorizing the HRRP) contained no studies supporting that claim. We saw that the few studies MedPAC relied on that claimed to examine a successful intervention studied interventions administered to carefully selected patient populations. These populations were severely limited by two methods: The patients had to be discharged with one of a handful of diagnoses (heart failure, for example); and the patients had to have characteristics that raised the probability the intervention would work (for example, patients had to agree to a home visit, not be admitted from a nursing home, and be able to consent to the intervention).

In this final installment, I review the research cited by the Yale New Haven Health Services Corporation (hereafter the “Yale group”) in their 2011 report to CMS in which they recommended that CMS apply readmission penalties to all Medicare patients regardless of diagnosis and regardless of the patient’s interest in or ability to respond to the intervention. MedPAC at least limited its recommendation (a) to patients discharged with one of seven conditions/procedures and (b) to patients readmitted with diagnoses “related to” the index admission. The Yale group threw even those modest restrictions out the window.

The Yale group recommended what they called a “hospital-wide (all-condition) readmission measure.” Under this measure, penalties would apply to all patients regardless of the condition for which they were admitted and regardless of whether the readmission was related to the index admission (with the exception of planned admissions). “Any readmission is eligible to be counted as an outcome except those that are considered planned,” they stated. (p. 10) [1] The National Quality Forum (NQF) adopted the Yale group’s recommendation almost verbatim shortly after the Yale group presented their recommendation to CMS.

In their 2007 report, MedPAC offered these examples of related and unrelated readmissions: “Admission for angina following discharge for PTCA [angioplasty]” would be an example of a related readmission, whereas “[a]dmission for appendectomy following discharge for pneumonia” would not. (p. 109) Congress also endorsed the “related” requirement (see Section 3025 of the Affordable Care Act, the section that authorized CMS to establish the HRRP). But the Yale group dispensed with the “related” requirement with an astonishing excuse: They said they just couldn’t find a way to measure “relatedness.” “[T]here is no reliable way to determine whether a readmission is related to the previous hospitalization …,” they declared. (p. 17) Rather than conclude their “hospital-wide” readmission measure was a bad idea, they plowed ahead on the basis of this rationalization: “Our guiding principle for defining the eligible population was that the measure should capture as many unplanned readmissions as possible across a maximum number of acute care hospitals.” (p. 17) Thus, to take one of MedPAC’s examples of an unrelated admission, the Yale group decided hospitals should be punished for an admission for an appendectomy within 30 days after discharge for pneumonia. [2]

Having declared that the relatedness criterion was out the window, the Yale group went on to report that the algorithm they recommended “captures 95 percent of eligible Medicare admissions and 88 percent of readmissions following those admissions….” (p. 32)

Thus, the Yale group set for themselves a much tougher challenge than even that which the MedPAC commissioners set for themselves in their 2007 report to Congress. Whereas MedPAC “only” had to cite research demonstrating methods of reducing readmissions for all patients (that is, populations without severe exclusions such as “must live near the hospital”) with one of only seven discharge diagnoses/procedures, the Yale group had to cite research demonstrating methods of reducing readmissions for all patients (regardless of whether they lived near the hospital etc.) and regardless of their diagnosis at discharge.

You will not be surprised when I tell you the Yale group didn’t come remotely close to meeting their burden of proof. They did not cite a single study showing hospitals how to reduce readmissions as the Yale group defined “readmission.”

Research supported using a scalpel, not a chain saw The Yale group claimed that numerous “randomized controlled trials” justified their extravagant recommendation to CMS. They cited the 16 studies listed in the table below. (p. 8) [3] I have divided those studies into those that did not examine an intervention and those that did. I have divided the latter group into those that found that the intervention reduced readmissions and those that did not. As I did in Part II, I have written “heart failure” in red to call your attention to how much of the research focused on that disease.

Studies cited by the Yale group’s 2011 report to CMS*

Studies that did not examine an intervention (3)

Krumholz et al., 2002: Reported a correlation between readmissions of heart failure patients and number of vaguely defined “strategies” (such as “partnering with physicians”).

Conley et al., 2003: “One-year risk of readmission for patients treated with SGAs [second-generation antipsychotics] were at least comparable to the one-year risk for patients receiving fluphenazine decanoate and lower than the risk for patients treated with haloperidol decanoate.”

Weiss et al., 2010: Correlation between nurse assessments of “discharge readiness” with patient assessment is low.

Studies that examined an intervention that did not reduce readmissions (4)

van Walraven et al., 2002: Found a non-significant odds ratio of .74 for readmission of all types of patients if patients’ family doctors received discharge summary.

Garasen et al., 2007: Differences in readmissions at 60 days for patients admitted for “an acute illness or an acute exacerbation of a known chronic disease” not statistically significant.

Mistiaen et al., 2007: Meta-analysis of 11 “systematic reviews.” “Based on above two reviews, it appears that readmissions in heart failure patients can be reduced by some kind of intervention.” “Our conclusions on the basis of these fifteen reviews, is that there is only limited evidence for the positive impact of discharge interventions.”

Koehler et al., 2009: This was a literature review of randomized trials conducted since 1990 on “adult patients admitted to the hospital for a medical or surgical cause.” “In general, these assessments should be regarded as hypothesis-generating and the inferences made based on subgroup analyses must be viewed as tentative…. [T]here was evidence of publication bias.”

Studies that examined an intervention that reduced readmissions (9)

Naylor et al., 1994; Naylor et al., 1999: The 1999 study examined patients admitted with one of five diagnoses (including heart failure) or for one of four procedures. “By 24 weeks after the index hospital discharge, 37 percent of the control group had been re-hospitalized compared with 20 percent of the intervention group.”

Stauffer et al., 2011: This was a study of the “transitional care program” studied by Naylor et al. (see above) but limited to heart failure patients.

Coleman et al., 2004: Examined the “Care Transitions Intervention.” Subjects were “Community‐dwelling adults aged 65 and older admitted to the study hospital with one of nine selected conditions,” including heart failure. “The adjusted odds ratio comparing rehospitalization of intervention subjects with that of controls was 0.52 … at 90 days.”

Voss et al., 2011: Authors studied Coleman et al.’s Care Transitions Intervention. “30-day readmissions were fewer for participants who received coaching….”

Phillips et al., 2004: Meta-analysis of 18 RCTs. “Comprehensive discharge planning plus post-discharge support significantly reduced readmission rates for older people with CHF [heart failure].”

Jovicic et al., 2006: This meta-analysis of six studies concluded, “Self-management programs targeted for patients with heart failure decrease overall hospital readmissions and readmissions for heart failure.” Three of these studies showed no reduction in readmission rates. All three of those that did (Cline, Koeling and Krumholz) used significant exclusion criteria.

Courtney et al., 2009: This was a study of emergency visits to hospitals and primary care doctors, not hospital readmissions only, among patients who were admitted for an “acute” condition, “aged 65 and older and with at least one risk factor for readmission (multiple comorbidities, impaired functionality, aged ≥75, recent multiple admissions, poor social support, history of depression).“ The intervention group required significantly fewer emergency hospital readmissions … and emergency GP visits….”

Jack et al., 2009: Patient participation was severely limited (see discussion in Part I). Change in readmissions was not significant, but change in readmissions plus ER visits was.

*All quotations are from the cited articles. Complete citations are available at pp. 34-35 of the Yale group’s 2011 report to Congress, endnotes 20-35.

We see that only nine of the 16 studies reported that the intervention reduced readmissions. Of those nine, not one studied patient samples that met the “hospital-wide” inclusion criteria the Yale group endorsed – no restrictions on patients’ ability to give consent, speak English, etc., and no restrictions on the type of diagnosis at discharge. Of the patient populations examined in these 16 studies, the populations studied by Jack et al. and Voss et al. were subject to the least restrictions, but even their patient populations were very restricted compared with the “hospital-wide” standard endorsed by the Yale group. The Jack and Voss studies examined patient populations unrestricted by diagnosis, but both studies utilized draconian inclusion criteria that limited patients to those who were more likely to benefit from the intervention. I discussed the severe inclusion criteria utilized by Jack et al. in Part I (patients had to have a phone and could not be included if they had been living in a nursing home, for example). I comment here on the Voss study.

Like Jack et al., Voss et al. chose a patient sample relatively unrestricted by diagnosis (they examined “all general medicine FFS Medicare beneficiaries, regardless of diagnosis”), but they severely restricted this population with other criteria designed to maximize the probability that patients would understand and respond to coaching. They excluded patients who were discharged to or admitted from a nursing home, discharged to a hospice, had “limited English proficiency or inadequate cognitive function unless a caregiver agreed to receive the intervention as a proxy,” who refused to consent to coaching and a home visit, and those who for some reason were unable to “complete the home visit” (even though they consented to it). As the authors put it, their “final intervention group represents 13.6 percent of the eligible approached population….” Inclusion criteria that excludes 86 percent of the admitted population may accurately be described as draconian.

Voss et al. reported that the intervention they examined (the “Care Transitions Intervention” [CTI] developed by Coleman et al.) was successful – it produced a 36-percent reduction in readmissions. But they made a statement one rarely encounters in the research on readmissions: They emphasized that they applied the CTI to a carefully selected group of patients, and they warned that the CTI probably would not have reduced readmissions if it had been applied it to the entire population of admitted patients. “Because the CTI depends on activating individuals to advocate for their own health, it is less likely to benefit those who are not or cannot currently be activated to a certain level of readiness to act,” they noted, “and identifying such individuals is an important consideration for resource allocation….” But under the HRRP, hospitals do not have the option “of identifying such individuals” and administering the intervention to just those patients. Under the HRRP, hospitals are subject to punishment for all unplanned admissions that occur within 30 days after discharge.

The Yale group failed to offer a warning like the one Voss et al. offered. There is no excuse for that omission. It is obvious what the Yale group’s motivation was: They decided on their own say-so that the HRRP should apply to 95 percent of all admissions rather than select groups of patients, and achieving that goal would not be possible if hospitals were given the option to decide for themselves which patients should receive the intervention services.

To sum up: The Yale group endorsed the equivalent of a chainsaw when the research supported the equivalent of a scalpel.

The free-lunch syndrome

The inexplicable failure of MedPAC and the Yale group to warn their readers that the research they cited did not support their recommendation was compounded by their utter indifference to the cost of the interventions they claimed research had already proven. MedPAC at least acknowledged the issue in their 2007 report to Congress; they said the cost of interventions was “beyond the scope” of their report. [4] The Yale group didn’t even acknowledge the issue. Apparently, the commission and the Yale group thought all those allegedly proven interventions either cost nothing, or hospitals have figured out how to create money out of thin air.

Even if it were true that proven methods of reducing readmissions are available to hospitals, that fact alone would not support a recommendation that hospitals be punished for “excess readmissions.” We would need to know as well how much it would cost hospitals to deploy the allegedly proven methods, and whether those costs were more than the savings hospitals would reap from using those methods. What little research existed on this issue in 2007 (when MedPAC made their report) and 2011 (when the Yale group made theirs) was inconclusive, and that is still the case today. In a 2017 literature review of 44 studies on this issue, Nuckols et al. concluded, “[I]t remains unclear whether effective interventions tend to produce net savings or losses to the health system.” [5]

To illustrate how murky this research is, let me compare two studies of the same intervention cited by the Yale group – the care transition program described by Naylor et al. in their 1999 article and the same program studied by Stauffer et al. in their 2011 article. Naylor et al. and Stauffer et al. both applied the intervention to small pools of carefully selected patients (small compared with the virtually unrestricted populations recommended by the Yale group). But they limited their patient pools in different ways. Naylor et al. restricted their patients both by diagnosis/procedure (they had to have been discharged with one of nine diagnoses/conditions) and by susceptibility to coaching (they had to live near one of two University of Pennsylvania hospitals and have a phone, for example). Stauffer et al. applied the same intervention to just HF patients, but they made no attempt to limit participating patients to those susceptible to coaching. (Stauffer et al. explicitly designed their patient sample to match the expected population that would be covered by the HRRP. It was the only study cited by the Yale group that did that.)

But the financial outcomes of these two studies were starkly different. Naylor et al. reported impressive net savings – about $3,000 per patient over 24 weeks – whereas Stauffer et al. reported no net savings. As Stauffer et al. put it, “[T]he intervention did not save money from the hospital perspective.”

The readmission-penalty experiment has gone on long enough

The research cited by MedPAC and the Yale group was sufficient to support a recommendation that Congress and private payers pay hospitals for several of the interventions described in that research, notably Coleman et al.’s CTI and Naylor et al.’s transitional care program. The research definitely did not indicate that hospitals could reduce all-cause, hospital-wide readmissions (the Yale group’s assumption) nor even “related” readmissions of patients with one of seven diagnoses/procedures (MedPAC’s assumption) even if they spent great wads of money. Moreover, the research did not indicate that hospitals could achieve net savings even if they applied their intervention only to select patient groups, never mind that all patients.

Given this state of knowledge about readmissions, the assumption made by MedPAC, the Yale group, NQF, and their many cheerleaders that punishing hospitals for “excess readmissions” was the solution was inexcusable. The creation of the HRRP and penalty programs like it on the basis of this reckless assumption has placed hospitals, especially safety-net hospitals, in a lose-lose situation. If they make no attempt to reduce readmissions, they are very likely to be punished. If they do take a stab at reducing readmissions based on the murky research available to them, they run a high risk of spending more money on interventions than they will save in the form of reduced penalties.

It is human nature to respond to inescapable lose-lose situations like this by gaming – at least some of the time. Evidence that has accumulated since the HRRP began in 2012 suggests hospitals are gaming the HRRP in several ways, including making greater use of observation stays and emergency rooms, and possibly by upcoding and documenting more often that a patient left against medical advice. Some of these gaming strategies may be harming some patients.

Should we wait for that happy day when research proves conclusively that readmission-penalty programs are harming patients before pulling the plug on them? My answer is definitely not. The HRRP and private-sector programs like it should have been treated the way we treat new, unproven drugs. The burden lies on those who propose to expose the populace to new drugs to demonstrate that they are safe and effective before they are placed on the market. We should apply the same standard to new, unproven health policy schemes. The HRRP and private-sector programs like it should be terminated immediately.

[1] The Yale group also exempted admissions that end in patients leaving against medical advice and in discharges with “conditions with very high post-discharge mortality” (primarily cancer).

[2] The Yale group took a similarly cavalier attitude toward risk adjustment of readmission rates. They refused to recommend adding morbidity data from Medicare’s Part B files to the diagnoses listed by hospitals (which would have substantially improved the accuracy of risk adjustment) on the ground that it would be “technically cumbersome.” (p. 20)

[3] Here is an excerpt from the Yale group’s report to CMS in which they claimed research supported their “hospital-wide all-condition readmission measure.” “Furthermore, randomized controlled trials have shown that improvement in the following areas can directly reduce readmission rates: quality of care during the initial admission; improvement in communication with patients, their caregivers and their clinicians; patient education; pre-discharge assessment; and coordination of care after discharge. [Sixteen studies cited.] Evidence that hospitals have been able to reduce readmission rates through these quality-of-care initiatives illustrates the degree to which hospital practices can affect readmission rates. Successful randomized trials have reduced 30-day readmission rates by 20-40%….Given that studies have shown readmissions within 30-days to be related to quality of care, and that interventions have been able to reduce 30-day readmission rates, it is reasonable to consider an all-condition 30-day readmission rate as a quality measure.” (p. 8) The Yale group developed the “hospital-wide readmission measure” in consultation with the National Quality Forum (NQF). The NQF’s explanation of this “quality measure,” published just a few months after the Yale group sent their recommendation to CMS, incorporates much of the Yale group’s report verbatim. It also cites MedPAC’s 2007 report to Congress as well as most of the studies the Yale group cited.

[4] Here is how MedPAC dodged the question of where hospitals were supposed to find the resources to hire extra staff to carry out the interventions MedPAC claimed research had already documented: “A related issue that is beyond the scope of this chapter is the lack of funding for care management services…. Perhaps once experience is gained in how much hospitals can improve and what resources are needed to achieve improvement, policymakers can consider the need for any explicit financing for care management services as a complement to a change in readmission payment policy.” (p. 115, Chapter 5, MedPAC’s 2007 report to Congress)

[5] I have not read most of the 44 studies Nuckols et al. reviewed, but based on my reading of the readmissions literature, including the studies I discussed in this series, I’m confident that none of those 44 studies analyzed interventions applied to “readmissions” as the HRRP defines them, much less as the Yale group defines them. I’m confident all 44 studies analyzed interventions applied to carefully defined groups of patients. If my assumption is accurate, that would mean that those studies Nuckols et al. reviewed that did report net savings overestimated net savings, and those that reported net losses underestimated those losses.

Kip Sullivan is a member of the advisory board of Health Care for All Minnesota, and a member of the Minnesota chapter of Physicians for a National Health Program

How are hospitals supposed to reduce readmissions? Part III published first on https://wittooth.tumblr.com/

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How are hospitals supposed to reduce readmissions? Part II

By KIP SULLIVAN, JD

The notion that hospitals can reduce readmissions, and that punishing them for “excess” readmissions will get them to do that, became conventional wisdom during the 2000s on the basis of very little evidence. The Medicare Payment Advisory Commission (MedPAC) urged Congress to enact the Hospital Readmissions Reduction Program (HRRP) beginning in 2007, and in 2010 Congress did so. State Medicaid programs and private insurers quickly adopted similar programs.

The rapid adoption of readmission-penalty programs without evidence confirming they can work has created widespread concern that these programs are inducing hospitals to increase utilization of emergency rooms and observation units to reduce readmissions within 30 days of discharge (the measure adopted by the Centers for Medicare and Medicaid Services [CMS] in its final rule on the HRRP), and this in turn may be harming sicker patients. Determining whether hospitals are gaming the HRRP and other readmission-penalty schemes by diverting patients to ERs and observation units (and perhaps by other means) should be a high priority for policy-makers. [1]

In Part I of this series I proposed to address the question of whether hospitals are gaming the HRRP by asking (a) does research exist describing methods by which hospitals can reduce readmissions under the HRRP and, in the event the answer is yes, (b) does that research demonstrate that those methods cost no more than hospitals save. If the answer to the first question is no, that would lend credence to the argument that the HRRP and other readmission-penalty schemes are contributing to rising rates of emergency visits and observation stays. If the answer to second question is also no, that would lend even more credence to the argument that hospitals are gaming the HRRP.

In Part I, I noted that proponents of readmission penalties, including MedPAC and the Yale New Haven Health Services Corporation (hereafter the “Yale group”), have claimed or implied that hospitals have no excuse for not reducing readmission rates because research has already revealed numerous methods of reducing readmissions without gaming. I also noted many experts disagree, and quoted a 2019 statement by the Agency for Healthcare Quality that “there is no consensus” on what it is hospitals are supposed to do to reduce readmissions.

In this article, I review the research MedPAC cited in its June 2007 report to Congress, the report that the authors of the Affordable Care Act (ACA) cited in Section 3025 (the section that instructed CMS to establish the HRRP). In Part III of this series I will review the studies cited by the Yale group in their 2011 report to CMS recommending the algorithm by which CMS calculates “excess” readmissions under the HRRP. We will see that the research these two groups relied upon did not justify support for the HRRP, and did not describe interventions hospitals could use to reduce readmissions as the HRRP defines “readmission.” The few studies cited by these groups that did describe an intervention that could reduce readmissions:

were based on carefully selected patient samples that were much narrower than the broadly defined patient population covered by the HRRP;

focused on diseases of the heart, primarily heart failure (HF), and shed little or no light on how hospitals were supposed to reduce readmissions of patients diagnosed with pneumonia or COPD, or patients who had knee or hip replacements, all of whom are now covered by the HRRP;

offered limited evidence that some interventions could pay for themselves if hospitals were allowed to select the patients to whom the intervention would apply, but no evidence that any intervention could do that when applied to the broad pool of patients defined by the HRRP.

MedPAC’s faith-based diagnosis

Congress authorized CMS (via Section 3025 of the ACA) to punish readmissions of patients with one of five diagnoses, or who received two procedures, mentioned by MedPAC in their June 2007 report to Congress. Those conditions/procedures were: HF, chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI), pneumonia, coronary artery bypass graft (CABG) surgery, percutaneous transluminal coronary angioplasty (PTCA), and “other vascular.” [2]

Obviously, MedPAC’s June 2007 report played a critical role in convincing Senator Max Baucus and other authors of the ACA the HRRP would work. But that report was extremely misleading (1) because its diagnosis of the “excess readmission” problem was wrong, and (2) because its solution was based on a few studies that did not support the proposed solution, i.e., the HRRP.

In that 2007 report, and in subsequent reports, MedPAC took the position that research exists showing hospitals how to reduce readmissions, but hospitals refuse to deploy these proven methods because hospitals are paid fee-for-service, and because consolidation of the industry into chains of hospitals, nursing homes, and clinics has not progressed far enough. Here is how MedPAC explained the failure of hospitals to implement the numerous (allegedly proven) methods of reducing readmissions in their 2007 report to Congress: “Research shows that specific hospital-based initiatives … can avert many readmissions…. Policy changes could encourage more hospitals to adopt successful strategies…. [H]ospitals and other providers have not broadly invested in their role in managing the [post-discharge] transition. Two related factors account for this. First, providers often operate independently of one another (in ‘silos’)…. A second related factor is Medicare’s (and other insurers’) fee-for-service payment policy.” (p. 115)

MedPAC cited not a single study in support of this diagnosis. The reason was, of course, that there was no research to cite.

MedPAC’s off-label solution

Having offered its evidence-free diagnosis, MedPAC went on to offer a solution based on research that did not support their prescribed solution. If you go to MedPAC’s website and open up Chapter 5 of their 2007 report, you will come upon a section with the encouraging (and very misleading) title, “How can hospitals reduce readmissions?” (pp 111-114) In this section, MedPAC asserted hospitals can reduce readmissions four ways: “Provide better, safer care during the inpatient stay”; “Attend to patient’s medication needs at discharge”; “Improve communication with patients before and after discharge”; and “Improve communication with other providers.” The commission cited 17 studies in support of these statements.

The table below offers brief descriptions of the 17 studies. I have grouped them into two categories: Those that did not study an intervention, and those that did. To call your attention to how many of the studies in the latter group examined heart failure, I have put “heart failure” in red.

Studies cited by MedPAC in their June 2007 report to Congress, pp. 111-114*

Studies that did not examine an intervention (10)

Bernard and Encinosa, 2004: “likelihood of readmission doubled (from 14 percent to 28 percent) with an adverse patient safety event during the initial hospitalization.”

Pennsylvania Health Care Cost Containment Council, 2006: “rates of readmission after CABG with hospital-acquired infections are more than double those of uninfected CABG patients.”

Pennsylvania Health Care Cost Containment Council, 2005: “blood clots are among the top three reasons for readmission” of knee and hip replacement patients.

Hannen et al., 2003: “early extubation or use of beta blockers and aspirin on discharge for CABG patients could … contribute to lower readmission rates.”

Forster et al., 2003: “19 percent of all patients discharged from the hospital experienced an associated adverse event within three weeks; 66 percent of them were adverse drug events.”

Coleman et al., 2005: “elderly patients who had medication discrepancies at discharge were more than twice as likely to be rehospitalized within 30 days.”

Kripalani et al., 2007: Discharge summaries are often incomplete and often don’t get to outpatient doctors.

HMO Group, 2004: Lahey Clinic in MA holds quarterly meetings with “SNF physicians” to reduce readmissions. No data on what happens at these meetings or what impact they have on readmissions.

Kind et al., 2007: “Stroke patients … readmitted after suffering a stroke were much more likely than other patients to be dehydrated and have electrolyte imbalances.”

Trisolini et al., 2006: The participants in the Physician Group Practice (PGP) Demonstration “have put in place better systems to reduce readmissions.” (Note: The final evaluation of the PGP published in 2012 reported the ten PGPs failed to reduce readmissions.)

Studies that examined an intervention (7)

Lappe et al., 2004: Medication protocol for patients with heart failure, coronary artery disease, AMI or atrial fibrillation “significantly improved mortality rates after discharge and 30-day readmission rates, particularly for patients with HF.”

Naylor et al., 1999: Two Philadelphia hospitals “were able to … reduce readmissions by 45 percent over the 24 weeks of the study by having nurses repeatedly meet with patients at high risk for poor outcomes after discharge, both during hospitalization and at home after discharge.” Patients were diagnosed with heart failure, and seven other diagnoses.

Coleman et al., 2006: “Transition coaches” lowered readmissions at 30, 60 and 90 days for patients with one of 11 chronic disease diagnoses (including heart failure, and coronary artery disease, but not pneumonia).

Institute for Healthcare Improvement, 2004a: Phone calls to heart failure, patients reduced readmissions, but no description of study available.

Institute for Healthcare Improvement, 2004b: Phone calls to heart failure, patients reduced readmissions, but no description of study available.

Berenson, 2006: Describes interventions used for heart failure, patients by Billings Clinic (MT) and Park Nicollet Clinic (MN), but makes no mention of their effect on readmissions.

VanSuch et al., 2006: Heart failure, patients were less likely to be readmitted if they received complete discharge instructions. Readmission reduction was not significant after adjustment for patient characteristics and distance from the hospital.

* The descriptions of all studies are based on MedPAC’s June 2007 Report to Congress, Chapter 5. All quoted statements are from MedPAC’s report. The descriptions of the last four studies are also based on my reading of those studies. Complete references for the articles cited here may be found at p. 120 of Chapter 5 in the 2007 report.

Three features of this table are notable. First, of the 17 studies, ten did not examine an intervention.

Second, of the remaining seven studies that did report on an intervention, all but one focused on cardiovascular patients (primarily HF patients). Third and most significant, only three of those seven studies – those by Lappe et al., Naylor et al., and Coleman et al. (2006) – described a successful intervention as well as the methodology used to evaluate the intervention. [3]

It gets worse. Two of those three studies – the Coleman (2006) and Naylor studies – restricted their samples so severely they bore little resemblance to the populations that MedPAC recommended should be exposed to readmission penalties, and which the HRRP later covered. As I noted in Part I, the population to which the HRRP applies is largely unrestricted; there are no requirements, for example, that patients give consent, live near the hospital, be able to understand their case manager, have a caregiver at home, take x number of drugs per day, etc. in order to be exposed to the HRRP.

I discussed the 2006 study by Coleman et al. in Part I. We saw that the authors restricted their patient sample so severely (with exclusion criteria such as patients had to consent, live near the hospital, have a phone, not be demented, etc.) that they wound up excluding 60 percent of the patients they screened. Hospitals laboring under the threat of HRRP penalties do not have the luxury of excluding 60 percent of, say, their pneumonia patients, and reporting on the readmission rate of only the remaining 40 percent.

Naylor et al. restricted their participants just as rigorously. First, patients had to have been admitted through one of two hospitals owned by the University of Pennsylvania. Here is how Naylor et al. described their exclusion criteria for patients admitted to those two hospitals: “Eligible patients had to speak English, be alert and oriented when admitted, be able to be contacted by telephone after discharge, and reside in the geographic service area. Patients also had to meet at least one of the following criteria….: age 80 years or older; inadequate support system; multiple, active, chronic health problems; history of depression; moderate-to-severe functional impairment; multiple hospitalizations during prior six months; hospitalization in the past 30 days; fair or poor self-rating of health; or history of nonadherence to the therapeutic regimen.” The patient sample was further restricted by the requirement that patients consent to the study. A whopping 61 percent refused to consent. [4]

Turning now to Lappe et al. – the third of the three studies listed in the table above that actually reported a successful intervention: That study examined a patient sample that was relatively unrestricted compared with the subjects in the Coleman and Naylor studies, but was still quite restricted compared with the population swept up by the HRRP. Lappe et al. did not count readmissions to hospitals outside of the ten Intermountain Healthcare System hospitals that participated in the study (all hospital readmissions count under the HRRP); and they did not count readmissions unrelated to one of the four heart-related diagnoses that were the focus of the study — HF, AMI, coronary artery disease, and atrial fibrillation (under the HRRP, with the exception of planned admissions, all admissions within 30 days of discharge count, regardless of whether they relate to the diagnosis of the index admission).

To sum up, of the 17 studies MedPAC cited in the course of explaining how hospitals “can reduce readmissions,” only seven described an intervention; of those seven, only three reported that the intervention reduced readmissions; and of those three, only one (Lappe et al.) studied a population somewhat similar to the broadly defined population covered by the HRRP, and that one was limited to diseases of the heart. [5]

Having made their evidence-free diagnosis of the “excess readmission” problem, and having completed their discussion of these 17 studies, MedPAC then recommended that Congress consider punishing “hospitals with high risk-adjusted rates of readmission,” and that Congress start such a program with a “subset [that] would include conditions for which some hospitals have successfully reduced readmissions.” (p. 115) MedPAC alleged that these conditions include HF, four other cardiac conditions or procedures, COPD, and pneumonia. MedPAC, to its credit, did recommend that punishable readmissions should consist of only those “related” to the index admission. But MedPAC, to its discredit, did not warn Congress about the aggressive exclusion criteria used by the three studies that demonstrated successful interventions, nor in any other way convey to Congress that the research they cited provided no basis for their recommended solution. Instead, MedPAC recommended that all patients be included in the pool regardless of their ability to give consent, how far away they lived from the hospital, etc.

Egregious off-label prescribing

The MedPAC commissioners and staff were by no means the only people flogging the readmission-penalty notion in the 2000s. But they were among the most influential. Their support for a readmission-penalty program imposed upon broadly defined swaths of Medicare enrollees was instrumental in persuading Congress to authorize the HRRP, and the authorization of the HRRP by Congress in turn encouraged copycat behavior by the insurance industry. MedPAC has an obligation to all of us – taxpayers, other policy-makers, doctors, hospital executives, and above all patients – to base their recommendations to Congress on rigorous evidence, not hunches and groupthink.

But MedPAC did not do that. The studies cited by MedPAC, listed in the table above, did not warrant endorsement of the HRRP. Nor did those studies warrant the assumption made by MedPAC and others that numerous methods of reducing readmissions (as MedPAC and the HRRP defined them) had already been proven, and all hospitals had to do was pull them off the shelf and implement them. Hospital executives who read every one of the 17 studies listed in the table would not have found a single intervention that could reduce readmissions (as MedPAC and the HRRP defined “readmissions”) for even one of the seven broadly defined categories of patients recommended by MedPAC, never mind all seven of them. Of the 17 studies, only the one by Lappe et al. studied a patient sample somewhat resembling the population exposed to the HRRP, and that study was limited to HF and three other heart conditions.

In Part I of this three-part series, I compared MedPAC’s behavior to “off-label prescribing” – the prescribing of a drug for a purpose that has not been approved by the FDA because there is little or no evidence for using that drug for the proposed purpose. MedPAC’s endorsement of the HRRP on the basis of the research listed in the table above was egregiously “off label” in two respects: The patients tested in those studies were very different from the patients exposed to the HRRP; and those studies focused on HF even though MedPAC urged Congress to impose the HRRP on non-HF patients. Recommending a readmission penalty for pneumonia or COPD patients on the basis of research conducted on carefully selected patients who don’t have pneumonia or COPD is neither rational nor ethical.

[1] Determining whether gaming has been induced by readmission-penalty programs is far more difficult today than it would have been if the readmission-penalty notion had been subjected to rigorous research before it was inflicted on the populace. Because research like that is a public good, and because it’s expensive to run controlled experiments, we can’t expect the private sector to pay for it. The research should have been done by CMS before Congress authorized CMS to establish the HRRP. A well-designed trial would have shown, among other things, whether the HRRP induced gaming (just as the Physician Group Practice Demonstration revealed that the experimental groups gamed that demo by upcoding at twice the rate of the control groups). But the research was not done, and now we’re trying to fix the plane while it’s in flight.

[2] In 2012, CMS selected a list of conditions and procedures for the HRRP that was slightly different from that recommended by MedPAC in their 2007 report. When the HRRP program began on October 1, 2012, three conditions were targeted – HF, AMI, and pneumonia. On October 1, 2014, hip and knee replacement and COPD were added. On October 1, 2016, CABG was added. To sum up, to MedPAC’s list CMS added hip and knee replacement, and deleted PTCA or “other vascular.”

[3] As the table in the text indicates, MedPAC listed two studies by the Institute for Health Improvement (IHI), one labeled 2004a and the other 2004b. In both cases, MedPAC provided only the title of the study and the IHI’s web address. Plugging the title of the 2004a study into IHI’s search engine produced a short “improvement story” that reads like a press release. It contains no information about how the study, if one was done, was conducted. Plugging the title of the 2004b study into IHI’s search engine produced no matches.

[4] Naylor et al. reported screening 1,296 patients. Of these, only 28 percent were enrolled in the study. Naylor et al.’s explanation for the attrition is confusing. They report that 376 of the 1,296 patients were “discharged before screening” (which left 920), which is inconsistent with the statement that all 1,296 were screened. Of the remaining 920, 61 percent (557) refused to give their consent.

[5] MedPAC also discussed the readmission-penalty notion in their June 2008 report to Congress (this was in addition to their chapter on readmissions in their June 2007 report). In a chapter on “bundling payments” in the 2008 report, MedPAC formally recommended Congress adopt a program like the HRRP. But with the exception of an article about Geisinger’s program to improve the quality of care of CABG patients, and an article about the Catholic Health Partnership’s effort to reduce readmissions of HF patients, MedPAC cited no research on specific interventions to reduce readmissions beyond what they had cited in their 2007 report. The article about the Geisinger program did not report a statistically significant drop in CABG readmission rates. The article about the Catholic hospitals reported enormous reductions in readmission rates for HF patients, but the author provided no methodology for the study.

Kip Sullivan is a member of the Health Care for All MN advisory board, and of MN Physicians for a National Health Program.

How are hospitals supposed to reduce readmissions? Part II published first on https://venabeahan.tumblr.com

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