document_title: Panama Canal Zone

question_text: who was president when the united states acquired the right to build a canal across panama

text: Panama Canal Zone

text: History[edit]

text: Proposals for a canal[edit]

text: Proposals for a canal across the Isthmus of Panama date back to 1529, soon after the Spanish conquest. Álvaro de Saavedra Cerón, a lieutenant of conquistador Vasco Núñez de Balboa, suggested four possible routes, one of which closely tracks the present-day canal. Saavedra believed that such a canal would make it easier for European vessels to reach Asia. Although King Charles I was enthusiastic and ordered preliminary works started, his officials in Panama soon realized that such an undertaking was beyond the capabilities of 16th-century technology. One official wrote to Charles, "I pledge to Your Majesty that there is not a prince in the world with the power to accomplish this".[3] The Spanish instead built a road across the isthmus. The road came to be crucial to Spain's economy, as treasure obtained along the Pacific coast of South America was offloaded at Panama City and hauled through the jungle to the Atlantic port of Nombre de Dios, close to present day Colón.[4] Although additional canal building proposals were made throughout the 16th and 17th centuries, they came to naught.[3]

text: The late 18th and early 19th centuries saw a number of canals built. The success of the Erie Canal in the United States and the collapse of the Spanish Empire in Latin America led to a surge of American interest in building an interoceanic canal. Beginning in 1826, US officials began negotiations with New Granada (present-day Colombia and Panama), hoping to gain a concession for the building of a canal. Jealous of their newly obtained independence and fearing that they would be dominated by an American presence, New Granadan officials declined American offers. The new nation was politically unstable, and Panama rebelled several times during the 19th century.[5]

text: In 1836, U.S. statesman Charles Biddle reached an agreement with the New Granadan government to replace the old road with an improved one or a railroad, running from Panama City on the Pacific coast to the Chagres River, where a steamship service would allow passengers and freight to continue to Colón. His agreement was repudiated by the Jackson administration, which wanted rights to build a canal. In 1841, with Panama in rebellion again, British interests secured a right of way over the isthmus from the insurgent regime and occupied Nicaraguan ports that might have served as the Atlantic terminus of a canal.[6][7] In 1846, the new US envoy to Bogotá, Benjamin Bidlack, was surprised when, soon after his arrival, the New Granadans proposed that the United States be the guarantor of the neutrality of the isthmus. The resulting Mallarino–Bidlack Treaty allowed the United States to intervene militarily to ensure that the interoceanic road (and when it was built, the Panama Railroad as well) would not be disrupted. New Granada hoped that other nations would sign similar treaties, but the one with the United States, which was ratified by the US Senate in June 1848 after considerable lobbying by New Granada, was the only one.[8]

text: The treaty led the U.S. government to contract for steamship service to Panama from ports on both coasts. When the California Gold Rush began in 1848, traffic through Panama greatly increased, and New Granada agreed to allow the Panama Railroad to be constructed by American interests. This first "transcontinental railroad" opened in 1850.[9] There were riots in Panama City in 1856; several Americans were killed. US warships landed Marines, who occupied the railroad station and kept the railroad service from being interrupted by the unrest. The United States demanded compensation from New Granada, including a zone 20 miles (32 km) wide, to be governed by US officials and in which the United States might build any "railway or passageway" it desired. The demand was dropped in the face of resistance by New Granadan officials, who accused the United States of seeking a colony.[10]

text: Through the remainder of the 19th century, the United States landed troops several times to preserve the railway connection. At the same time, it pursued a canal treaty with Colombia (as New Granada was renamed). One treaty, signed in 1868, was rejected by the Colombian Senate, which hoped for better terms from the incoming Grant administration. Under this treaty, the canal would have been in the middle of a 20-mile zone, under American management but Colombian sovereignty, and the canal would revert to Colombia in 99 years. The Grant administration did little to pursue a treaty, and in 1878, the concession to build the canal fell to a French firm. The French efforts eventually failed, but with Panama apparently unavailable, the United States considered possible canal sites in Mexico and Nicaragua.[11]

text: The Spanish–American War of 1898 added new life to the canal debate. During the war, American warships in the Atlantic seeking to reach battle zones in the Pacific had been forced to round Cape Horn. Influential naval pundits, such as Captain Alfred Thayer Mahan, urged the construction of a Central American canal. In 1902, with the French efforts moribund, US President Theodore Roosevelt backed the Panama route, and Congress passed legislation authorizing him to purchase the French assets[12] on the condition that an agreement was reached with Colombia.[13] In March 1902, Colombia set its terms for such a treaty: Colombia was to be sovereign over the canal, which would be policed by Colombians paid for by the United States. The host nation would receive a larger percentage of the tolls than provided for in earlier draft treaties. The draft terms were quickly rejected by American officials. Roosevelt was in a hurry to secure the treaty; the Colombians, to whom the French property would revert in 1904, were not. Negotiations dragged on into 1903, during which time there was unrest in Panama City and Colón; the United States sent in Marines to guard the trains. Nevertheless, in early 1903, the United States and Colombia signed a treaty which, despite Colombia's previous objections, gave the United States a 6 miles (9.7 km) wide zone in which it could deploy troops with Colombian consent. On August 12, 1903, the Colombian Senate voted down the treaty 24–0.[14]

text: Roosevelt was angered by the Colombians' actions, especially when the Colombian Senate made a counteroffer that was more financially advantageous to Colombia. A Frenchman who had worked on his nation's canal efforts, Philippe Bunau-Varilla, represented Panamanian insurgents; he met with Roosevelt and with Secretary of State John Hay, who saw to it that his principals received covert support. When the revolution came in November 1903, the United States intervened to protect the rebels, who succeeded in taking over the province, declaring it independent as the Republic of Panama. Bunau-Varilla was initially the Panamanian representative in the United States, though he was about to be displaced by actual Panamanians, and hastily negotiated a treaty, giving the United States a zone 20 miles (32 km) wide and full authority to pass laws to govern that zone. The Panama Canal Zone (Canal Zone, or Zone) excluded Panama City and Colón, but included four offshore islands, and permitted the United States to add to the zone any additional lands needed to carry on canal operations. The Panamanians were minded to disavow the treaty, but Bunau-Varilla told the new government that if Panama did not agree, the United States would withdraw its protection and make the best terms it could with Colombia. The Panamanians agreed, even adding a provision to the new constitution, at US request, allowing the larger nation to intervene to preserve public order.[15]

text: Construction (1903–1914)[edit]

text: The treaty was approved by the provisional Panamanian government on December 2, 1903, and by the US Senate on February 23, 1904. Under the treaty, Panama received US$10 million, much of which the United States required to be invested in that country, plus annual payments of US$250,000; with those payments made, as well as for the purchase of the French company assets, the Canal Zone was formally turned over by Panama on May 4, 1904, when American officials reopened the Panama City offices of the canal company and raised the American flag.[16] This marked the beginning point for U.S. excavation and construction which concluded in August 1914 with the opening of the canal to commercial traffic.

text: Governance of the Canal Zone[edit]

text: By order of President Theodore Roosevelt under the Panama Canal Acts of 1902 and 1904 the Secretary of War was made supervisor of canal construction and the second Isthmian Canal Commission made the governing body for the Canal Zone.[17] Under the Panama Canal Act of May 24, 1912 President Woodrow Wilson issued Executive Order 1885, January 27, 1914, effective April 1, 1914 abolishing the previous governance placing it under the direction of the Secretary of War with the entity designated as The Panama Canal.[17][18] The Governor of the Panama Canal was charged with "completion, maintenance, operation, government and sanitation of the Panama Canal and its adjuncts and the government of the Canal Zone" in the Executive order.[18] A number of departments were specified in the order with others to be established as needed by the Governor of the Panama Canal with approval of the President and under the supervision of the Secretary of War.[18] Defense of the canal was the responsibility of the Secretary of War who retained control of troops with provisions for Presidential appointment of an Army officer in wartime who would have "exclusive authority over the operation of the Panama Canal and the Government of the Canal Zone."[18] The Executive Order noted in closing "that the supervision of the operations of the Panama Canal under the permanent organization should be under the Secretary of War" thus establishing the essentially military arrangement and atmosphere for the canal and Canal Zone.[18]

text: Effective July 1, 1951, under an act of Congress September 26, 1950 (64 Stat. 1038), governance of the Canal Zone was through the Canal Zone Government with the canal operated by the Panama Canal Company until 1979 when the Panama Canal Commission took over its governance.[19][20] The entire structure was under the control of the United States government with the Secretary of the Army appointing the Panama Canal Company board of directors and the Canal Zone Government was entirely financed by the company.[21] The office of Governor of the Panama Canal Zone was not usually a stepping stone to higher political office but a position given to a US Army active duty general officers of the United States Army Corps of Engineers.[22] The Governor was also President of the Panama Canal Company. The Canal Zone had its own police force (the Canal Zone Police), courts, and judges (the United States District Court for the Canal Zone).

text: Everyone worked for the company or the government in one form or another. Residents did not own their homes; instead, they rented houses assigned primarily based on seniority in the zone. When an employee moved away, the house would be listed and employees could apply for it. The utility companies were also managed by the company. There were no independent stores; goods were brought in and sold at stores run by the company, such as a commissary, housewares, and so forth.

text: In 1952 the Panama Canal Company was required to go on a break-even basis in an announcement made in the form of the President's budget submission to the United States Congress.[23] Though company officials had been involved in previewing the requirement, there was no disclosure in advance, even though the Bureau of the Budget directed that the new régime become effective on March 1.[23] The company organization was realigned into three main divisions; Canal Activity and Commercial Activity with the Service Activity providing services to both operating activities at rates sufficient to recover costs.[24] Rate adjustments in housing and other employee services would be required and a form of valuation, compared to a property tax, would be used to determine each division's contribution to the Canal Zone Government.[25]

text: Tensions and the end of the Canal Zone[edit]

text: In 1903, the United States, having failed to obtain from Colombia the right to build a canal across the Isthmus of Panama, which was part of that country, sent warships in support of Panamanian independence from Colombia. This being achieved, the new nation of Panama ceded to the Americans the rights they wanted in the Hay–Bunau-Varilla Treaty. Over time, though, the existence of the Canal Zone, a political exclave of the United States that cut Panama geographically in half and had its own courts, police, and civil government, became a cause of conflict between the two countries. Demonstrations occurred at the opening of the Thatcher Ferry Bridge, now known as the Bridge of the Americas, in 1962 and serious rioting occurred in January 1964. This led to the United States easing its controls in the Zone. For example, Panamanian flags were allowed to be flown alongside American ones. After extensive negotiations, the Canal Zone ceased to exist on October 1, 1979, in compliance with provisions of the Torrijos-Carter Treaties.

text: Lifestyle of residents[edit]

text: "Gold" roll and "silver" roll[edit]

text: During its construction and into the 1940s, the labor force in the Canal Zone (which was almost entirely publicly employed) was divided into a "gold" roll (short for payroll) classification, and a "silver" roll classification. The origins of this system are unclear, but it was the practice on the 19th-century Panama Railroad to pay Americans in US gold and local workers in silver coin.[26] Although some Canal Zone officials compared the gold roll to military officers and the silver roll to enlisted men, the characteristic that determined on which roll an employee was placed was race. With very few exceptions, American and Northern European whites were placed on the gold roll, and blacks and southern European whites on the silver roll. American blacks were generally not hired; black employees were from the Caribbean, often from Barbados and Jamaica. American whites seeking work as laborers, which were almost entirely silver roll positions, were discouraged from applying.[27] In the early days of the system, bosses could promote exceptional workers from silver to gold, but this practice soon ceased as race came to be the determining factor.[28] As a result of the initial policy, there were several hundred skilled blacks and southern Europeans on the gold roll.[29] In November 1906, Chief Engineer John Stevens ordered that most blacks on the gold roll be placed on the silver roll instead (a few remained in such roles as teachers and postmasters); the following month, the Canal Commission reported that the 3,700 gold roll employees were "almost all white Americans" and the 13,000 silver roll workers were "mostly aliens".[27] On February 8, 1908, President Roosevelt ordered that no further non-Americans be placed on the gold roll. After Panamanians objected, the gold roll was reopened to them in December 1908; however, efforts to remove blacks and non-Americans from the gold roll continued.[30]

text: Until 1918, when all employees began to be paid in US dollars, gold roll employees were paid in gold, in American currency, while their silver roll counterparts were paid in silver coin, initially Colombian pesos. Through the years of canal construction, silver roll workers were paid with coins from various nations; in several years, coin was imported from the United States because of local shortages. Even after 1918, both the designations and the disparity in privileges lingered.[29]

text: "Diasporization" in the Panama Canal Zone[edit]

text: Until the end of World War II in 1945, the Panama Canal Zone operated under a Jim Crow society, where the category of "gold" represented white, U.S. workers and the title "silver" represented the non-white, non-U.S. workers on the Zone. After the strike of 1920, the Afro diasporic workers were banned from unionizing by the U.S. Canal officials. As a result, the Panama Canal West Indian Employees Association (PCWIEA) was created in 1924 to fill this vacuum of representation.[31] The PCWIEA did not garner much support on the Canal Zone because of its restrictive membership policies and the haunting of the 1920 strike and its damaging consequences. However, in 1946, the PCWIEA summoned the Congress of Industrial Organizations (CIO) for representation and the establishment of a local union. In July of that year, the West Indian and Panamanian workers received a charter for Local 713 of the United Public Workers of America (UPWA)-CIO.[32][33] Together, with the assistance of U.S. representatives for the Local, these Afro-diasporic workers came together to secure material benefits in their livelihoods. They organized together in order to pose a serious threat to the Jim Crow system which resulted, however, only in minimal gains. The imperial system of the U.S. and its segregationist policies persisted as it related to housing and schooling.[34] In the end, ties to communism destroyed the UPWA and as a result Local 713 collapsed.[35] Nevertheless, it is important to see this as a moment of what Frank Gurridy describes as diasporization, “diaspora in action, or the ways Afro-diasporic linkages were made in practice”.[36] In the case of the Panama Canal Zone, these linkages were made not only by the West Indian and Panamanian communities, but also between the Afro descended workers on the Zone and African Americans, on the mainland of the U.S., through the transnational struggle to dismantle the system of Jim Crow.

text: Community[edit]

text: Housing and goods[edit]

text: Canal Zone housing was constructed in the early days of construction, as part of Stevens' plans. Housing constructed for couples and families consisted of structures containing four two-story apartments. The units had corrugated-iron roofs, and were uniformly painted gray with white trim. Constructed of pine clapboard, they had long windows and high ceilings, allowing for air movement. Better-paid employees were entitled to more square feet of housing, the unit in which allowances were expressed. Initially, employees received one square foot per dollar of monthly salary. Stevens from the first encouraged gold roll employees to send for their wives and children; to encourage them to do so, wives were granted a housing allowance equal to their husband's, even if they were not employees. Bachelors mostly resided in hotel-like structures. The structures all had screened verandas and up-to-date plumbing. The government furnished power, water, coal for cooking, ice for iceboxes, lawn care, groundskeeping, garbage disposal, and, for bachelors only, maid service.[37]

text: In the first days of the Canal Zone, the ICC provided no food, and workers had to fend for themselves, obtaining poor-quality food at inflated prices from Panamanian merchants. When Stevens arrived in 1905, he ordered food to be provided at cost, leading to the establishment of the Canal Zone Commissary. The functions of the Commissary quickly grew, generally against the will of the Panamanian government, which saw more and more goods and services provided in the Zone rather than in Panama. Merchants could not compete with the commissary's prices or quality; for example, it boasted that the meat it sold had been refrigerated every moment from the Chicago slaughterhouse to the moment it was passed to the consumer. By 1913, it consisted of 22 general stores, 7 cigar stores, 22 hostels, 2 hotels, and a mail-order division. It served high-quality meals at small expense to workers and more expensive meals to upper-echelon canal employees and others able to afford it.[38]

text: The commissary was a source of friction between the Canal Zone and Panama for several other reasons. The commissary dominated sales of supplies to passing ships.[39] The commissary was off limits to individuals who were not in the U.S. Military, employees of the Panama Canal Company, the Canal Zone Government and/or their dependents. This restriction was requested by Panama for the benefit of Panamanian storekeepers, who feared the loss of trade. Panama had laws restricting imports from the Canal Zone. Goods from the commissary would sometimes show up in Panamanian stores and in vendor displays, where Comisariato goods were deemed of high quality.[40] Additionally, there were separate commissaries on the U.S. military installations that were available only to the U.S. Military personnel and their dependents. Employees and dependents of the Panama Canal Company/Government were not allowed to utilize the commissaries, exchanges, packages stores, theaters, gas stations, and other facilities on the U.S. Military installations.

text: Citizenship[edit]

text: Although the Panama Canal Zone was legally a leased territory of the United States[41] until the implementation of the Torrijos-Carter Treaties in 1979, questions arose almost from its inception as to whether it was considered part of the United States for constitutional purposes, or, in the phrase of the day, whether the Constitution followed the flag. In 1901 the US Supreme Court had ruled in Downes v. Bidwell that unincorporated territories are not the United States.[42] On July 28, 1904, Controller of the Treasury Robert Tracewell stated, "While the general spirit and purpose of the Constitution is applicable to the zone, that domain is not a part of the United States within the full meaning of the Constitution and laws of the country."[43] Accordingly, the Supreme Court held in 1905 in Rasmussen v. United States that the full Constitution only applies for incorporated territories of the United States.[44]

text: The treaty with Panama made no mention of the nationality status of the native inhabitants of the Zone. Pursuant to the principles of international law, they became non-citizen U.S. nationals unless they elected to retain their previous nationality. Children of non-citizen U.S. nationals generally acquired the status of their parents. However, for most nationality purposes, the Canal Zone was considered to be foreign territory and the status persons acquired at birth was governed by the Naturalization Act of 1795, which granted them statutory US citizenship at birth but only if their fathers were, at the time of the child's birth, U.S. citizens who had previously resided in the United States. In 1934 the law was amended to allow for citizenship to be acquired at birth through either parent if the parent was a U.S. citizen who had previously resided in the United States. In 1937 the law was further amended to provide for US citizenship to persons born in the Canal Zone (since 1904) to a U.S. citizen parent without that parent needing to have been previously resident in the United States.[41] The law is now codified under title 8, section 1403.[45] It not only grants statutory and declaratory born citizenship to those born in the Canal Zone after February 26, 1904, of at least one US citizen parent, but also does so retroactively for all children born of at least one US citizen in the Canal Zone before the law's enactment.[46] This rule was later rendered moot when the rules were changed to state that (almost all) children born to U.S. citizens anywhere in the world were considered U.S citizens.[47]

text: In 2008, during a minor controversy over whether Canal Zone–born John McCain, born in the Zone in 1936, was legally eligible for the presidency, the US Senate passed a non-binding resolution that McCain was a "natural born Citizen" of the United States.[48]

text: Notable people[edit]

text: Notable people born in the Panama Canal Zone include

text:
Earl Bell,[49]
Rod Carew
Kenneth Bancroft Clark
Thomas H. Jordan
John McCain, the Republican 2008 presidential candidate and US Senator from Arizona.
Edward A. Murphy, Jr.
Richard Prince
Sage Steele

text: Culture[edit]

text: Documentary filmmaker Theo Uittenbogaard made a film about the Panama Canal zone, entitled 'The Treaty', which was released and aired on the Dutch national TV-channel VPRO in the series 'Machiavelli' in 1976.

text: Documentary filmmaker Frederick Wiseman made a film about the Panama Canal Zone, entitled Canal Zone, which was released and aired on PBS in 1977.

text: Religion[edit]

text: No official statistics were ever collected. Stationing around the Canal were primarily Americans, who were mostly either Protestant, Catholic, or Jewish.

text: Townships and military installations[edit]

text: The Canal Zone was generally divided into two sections, the Pacific side and the Atlantic side, separated by Gatun Lake.

text: A partial list of Canal Zone townships and military installations:

text: Pacific side[edit]

text: Townships[edit]

text:
Ancón – built on the lower slopes of Ancon Hill, adjacent to Panama City. Also home to Gorgas Hospital.
Balboa – the Zone's administrative capital, as well as location of the harbor and main Pacific-side high school.
Balboa Heights
Cardenas – as the Canal Zone was gradually handed over to Panamanian control, Cardenas was one of the last Zonian holdouts.
Cocoli
Corozal
Curundú – on a military base, but housed civilian military workers, also home to the Junior High School for the Pacific Side
Curundu Heights
Diablo
Diablo Heights
Gamboa – headquarters of dredging division, located on Gatun Lake. Many new arrivals to the Canal Zone were assigned here.
La Boca – home of the Panama Canal College.
Los Rios
Paraíso
Pedro Miguel
Red Tank – abandoned and allowed to be overgrown around 1950.
Rosseau – built as a naval hospital during World War II, housed FAA personnel until Cardenas was built. Torn down after about 20 years.

text: Military installations[edit]

text:
Fort Amador – on the coast, partly built on land extended into the sea using excavation materials from the canal construction
Fort Clayton – on the east side of the canal, it was the headquarters of the 193rd Infantry and the Southern Command Network (SCN), an American Forces Radio and Television Service (AFRTS) outlet.
Corozal Army Post – close to, but separate from, the civilian township.
Fort Kobbe
Rodman Naval Station (which includes the Marine Barracks)
Albrook Air Force Base
Howard Air Force Base
Quarry Heights – headquarters of the United States Southern Command.

text: Atlantic side[edit]

text: Townships[edit]

text:
Brazos Heights: privately owned housing (by United Brands and other, mostly shipping companies) where employees and owners of shipping agencies, lawyers, and the head of the YMCA lived.
Coco Solo – main hospital and site of the only Atlantic-side high school, Cristobal High School.
Cristóbal – main harbor and port.
Gatún
Margarita
Mount Hope – site of the only Atlantic-side cemetery and drydock.
Rainbow City

text: Military installations[edit]

text:
Fort Gulick – home to the School of the Americas.
Galeta Island
Fort Randolph – located on Margarita Island in Manzanillo Bay.
Fort De Lesseps – located in Colón.
Fort Davis
France Field
Fort Sherman – home to Jungle Operations Training Center.

text: Panama Canal Treaty implementation[edit]

text: On 1 October 1979, the day the Panama Canal Treaty of 1977 took effect, most of the land within the former Canal Zone transferred to Panama. However, the treaty set aside many Canal Zone areas and facilities for transfer during the following 20 years. The treaty specifically categorized areas and facilities by name as “Military Areas of Coordination”, "Defense Sites" and "Areas Subject to Separate Bilateral Agreement". These were to be transferred by the U.S. to Panama during certain time windows or simply by the end of the 243-month treaty period. On 1 October 1979, among the many such parcels so designated in the treaty, 35 emerged as enclaves (surrounded entirely by land solely under Panamanian jurisdiction). In later years as other areas were turned over to Panama, nine more enclaves emerged.

text: At least 13 other parcels each were enclosed partly by land under the absolute jurisdiction of Panama and partly by an “Area of Civil Coordination" (housing), which under the treaty was subject to elements of both U.S. and Panamanian public law. In addition, the 1977 treaty designated numerous areas and individual facilities as “Canal Operating Areas” for joint U.S.-Panama ongoing operations by a commission. On the effective date of the treaty, many of these, including Madden Dam, became newly surrounded by the territory of Panama. Just after noon local time on 31 December 1999, all former Canal Zone parcels of all types had come under the exclusive jurisdiction of Panama.[50][51][52][53][54][55]

text: The 44 enclaves of U.S. territory that existed under the treaty are shown in the table below.

text:
Enclave name
Type (military/civil)*
Function
Date created
Date transferred

PAD (former Panama Air Depot) Area Bldg. 1019 (Defense Mapping Agency)
military
logistics
1 October 1979
1 October 1980

PAD Area Bldg. 1007 (Inter-American Geodetic Survey Headquarters)
military
logistics
1 October 1979
1 October 1980

PAD Area Bldg. 1022 (warehouse)
military
logistics
1 October 1979
1 October 1980

PAD Area Bldg. 490 (U.S. Army Meddac Warehouse)
military
logistics
1 October 1979
1 October 1981

PAD Area Bldg. 1010 (U.S. Army Meddac Warehouse)
military
logistics
1 October 1979
1 October 1981

PAD Area Bldg. 1008 (AAFES Warehouse)
military
logistics
1 October 1979
1 October 1982

PAD Area Bldg. 1009 (AAFES Warehouse)
military
logistics
1 October 1979
1 October 1982

Curundu Antenna Farm
military
communications
1 October 1979
1 October 1982

Curundu Heights
military
housing
1 October 1979
1 October 1982

France Field housing (15 units) on McEwen St.
military
housing
1 October 1979
1 October 1984

Navy Salvage Storage Area (Balboa)
military
logistics
1 October 1979
1 October 1984

Coco Solo Hospital
civil
medical
1 October 1979
31 May 1993

Ft. Amador Service Club Bldg. 107
military
base
1 October 1979
1 October 1996

Ft. Amador Bldg. 105 complex
military
base
1 October 1979
1 October 1996

FAA Long Range Radar, Semaphore Hill (coordinates 485035)
civil
aviation
1 October 1979
13 December 1996

Ancon Hill: Bldg. 140 (coordinates 595904)
military
logistics
1 October 1979
8 January 1998

Ancon Hill: Bldg. 159 - Quarry Heights Motor Pool
military
logistics
1 October 1979
8 January 1998

Ancon Hill FAA microwave link repeater station, Bldg. 148 (coordinates 594906)
civil
aviation
1 October 1979
16 January 1998

Ancon Hill FAA VHF/UHF communications station (coordinates 595902)
civil
aviation
1 October 1979
16 January 1998

Piña Range (part)
military
training
1 October 1979
30 June 1999

Balboa High School Shop Bldg.
civil
school
1 October 1979
31 August 1999

Balboa High School Activities Bldg.
civil
school
1 October 1979
31 August 1999

Cerro Gordo communications site
military
communications
1 October 1979
31 August 1999

Howard AFB/Ft. Kobbe Complex
military
base
1 October 1979
1 November 1999

Military Traffic Management Command, Bldg 1501, Balboa/Pier 18
military
logistics
1 October 1979
22 December 1999

Army Nuclear, Biological and Chemical Chambers (in current Parque Natural Metropolitano)
military
research
1 October 1979
31 December 1999

Federal Aviation Administration Bldg. 611
civil
aviation
1 October 1979
31 December 1999

FAA radar station, Isla Perico
civil
aviation
1 October 1979
31 December 1999

Stratcom Transmitter Station Bldg. 430 (in Corozal Antenna Field)
military
communications
1 October 1979
31 December 1999

Stratcom Transmitter Station Bldg. 433 (in Corozal Antenna Field)
military
communications
1 October 1979
31 December 1999

Stratcom Transmitter Station Bldg. 435 (in Corozal Antenna Field)
military
communications
1 October 1979
31 December 1999

Army Transport Shipping Facility (Balboa)
military
logistics
1 October 1979
31 December 1999

Navy Communications Electric Repair Facility (Balboa)
military
communications
1 October 1979
31 December 1999

U.S. Air Force Communications Group storage/training facility, Bldg 875
military
logistics
1 October 1979
31 December 1999

Inter-American Air Force Academy Jet Engine Test Cell, Bldg. 1901
military
research
1 October 1979
31 December 1999

Bachelor Officers’ Housing (larger parcel) – Curundu Heights
military
housing
2 October 1982
Nov-Dec 1992

Bachelor Officers’ Housing (smaller parcel) – Curundu Heights
military
housing
2 October 1982
Nov-Dec 1992

Curundu Laundry facility
military
housing
2 October 1982
15 November 1999

Ft. Gulick Elementary School
civil
school
2 October 1984
1 September 1995

Ft. Gulick Ammunition Storage Facility
military
logistics
2 October 1984
1 September 1995

Cristobal Junior-Senior High School
civil
school
1990
1 September 1995

Chiva Chiva Antenna Farm (Foreign Broadcast Information Service)
military
communications
1993
6 January 1998

Curundu Middle School
civil
school
1 August 1997
15 September 1999

Piña Range (remainder)
military
training
30 June 1999
1 July 1999

text: Postage stamps[edit]

text: The Panama Canal Zone issued its own postage stamps from 1904 until October 25, 1978. After a transition period, Panama administered the stamps.

text: The two-letter state abbreviation for mail sent to the Zone was CZ.

text: Amateur radio[edit]

text: Amateur radio licenses were issued by the United States Federal Communications Commission and carried the prefix KZ5, the initial 'K' indicating a station under American jurisdiction. The American Radio Relay League had a Canal Zone section, and the Canal Zone was considered an entity for purposes of the DX Century Club. Contacts with Canal Zone stations from before repatriation may still be counted for DXCC credit separate from Panama.


document_title: Blood transfusion

question_text: what is the most common transfused component of blood

question_tokens: what is the most common transfused component of blood

root

text: Blood transfusion

text: Medical uses[edit]

text: Historically, red blood cell transfusion was considered when the hemoglobin level fell below 100 g/L or hematocrit falls below 30%.[1][2] Because each unit of blood given carries risks, a trigger level lower than that at 70 to 80 g/L is now usually used as it has been shown to have better patient outcomes.[3][4] The administration of a single unit of blood is the standard for hospitalized people who are not bleeding, with this treatment then followed with re-assessment and consideration of symptoms and hemoglobin concentration.[3] Patients with poor oxygen saturation may need more blood.[3] The advisory caution to use blood transfusion only with more severe anemia is in part due to evidence that outcomes are worsened if larger amounts are given.[5] One may consider transfusion for people with symptoms of cardiovascular disease such as chest pain or shortness of breath.[2] In cases where patients have low levels of hemoglobin but are cardiovascularly stable, parenteral iron is a preferred option based on both efficacy and safety.[6] Other blood products are given where appropriate, such as clotting deficiencies.

tag: p

text: Procedure[edit]

text: Before a blood transfusion is given, there are many steps taken to ensure quality of the blood products, compatibility, and safety to the recipient. In 2012, a national blood policy was in place in 70% of countries and 62% of countries had specific legislation that covers the safety and quality of blood transfusion.[7]

text: Blood donation[edit]

text: Blood transfusions typically use sources of blood: one's own (autologous transfusion), or someone else's (allogeneic or homologous transfusion). The latter is much more common than the former. Using another's blood must first start with donation of blood. Blood is most commonly donated as whole blood intravenously and collecting it with an anticoagulant. In developed countries, donations are usually anonymous to the recipient, but products in a blood bank are always individually traceable through the whole cycle of donation, testing, separation into components, storage, and administration to the recipient. This enables management and investigation of any suspected transfusion related disease transmission or transfusion reaction. In developing countries the donor is sometimes specifically recruited by or for the recipient, typically a family member, and the donation occurs immediately before the transfusion.

text: Processing and testing[edit]

text: Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. Collected blood is then separated into blood components by centrifugation: red blood cells, plasma, platelets, albumin protein, clotting factor concentrates, cryoprecipitate, fibrinogen concentrate, and immunoglobulins (antibodies). Red cells, plasma and platelets can also be donated individually via a more complex process called apheresis.

text:
The World Health Organization (WHO) recommends that all donated blood be tested for transfusion transmissible infections. These include HIV, Hepatitis B, Hepatitis C, Treponema pallidum (syphilis) and, where relevant, other infections that pose a risk to the safety of the blood supply, such as Trypanosoma cruzi (Chagas disease) and Plasmodium species (malaria).[8] According to the WHO, 25 countries are not able to screen all donated blood for one or more of: HIV; Hepatitis B; Hepatitis C; or syphilis.[9] One of the main reasons for this is because testing kits are not always available.[9] However the prevalence of transfusion-transmitted infections is much higher in low income countries compared to middle and high income countries.[9]
All donated blood should also be tested for the ABO blood group system and Rh blood group system to ensure that the patient is receiving compatible blood.[10]
In addition, in some countries platelet products are also tested for bacterial infections due to its higher inclination for contamination due to storage at room temperature.[11][12] Presence of Cytomegalovirus (CMV) may also be tested because of the risk to certain immunocompromised recipients if given, such as those with organ transplant or HIV. However, not all blood is tested for CMV because only a certain amount of CMV-negative blood needs to be available to supply patient needs. Other than positivity for CMV, any products tested positive for infections are not used.[13]
Leukocyte reduction is the removal of white blood cells by filtration. Leukoreduced blood products are less likely to cause HLA alloimmunization (development of antibodies against specific blood types), febrile non-hemolytic transfusion reaction, cytomegalovirus infection, and platelet-transfusion refractoriness.[14]
Pathogen Reduction treatment that involves, for example, the addition of riboflavin with subsequent exposure to UV light has been shown to be effective in inactivating pathogens (viruses, bacteria, parasites and white blood cells) in blood products.[15][16][17] By inactivating white blood cells in donated blood products, riboflavin and UV light treatment can also replace gamma-irradiation as a method to prevent graft-versus-host disease (TA-GvHD).[18][19][20]

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text: Compatibility testing[edit]

text: Before a recipient receives a transfusion, compatibility testing between donor and recipient blood must be done. The first step before a transfusion is given is to type and screen the recipient's blood. Typing of recipient's blood determines the ABO and Rh status. The sample is then screened for any alloantibodies that may react with donor blood.[21] It takes about 45 minutes to complete (depending on the method used). The blood bank scientist also checks for special requirements of the patient (e.g. need for washed, irradiated or CMV negative blood) and the history of the patient to see if they have previously identified antibodies and any other serological anomalies.

text: A positive screen warrants an antibody panel/investigation to determine if it is clinically significant. An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been phenotyped for antigens that correspond to commonly encountered and clinically significant alloantibodies. Donor cells may have homozygous (e.g. K+k−), heterozygous (K+k+) expression or no expression of various antigens (K−k−). The phenotypes of all the donor cells being tested are shown in a chart. The patient's serum is tested against the various donor cells. Based on the reactions of the patient's serum against the donor cells, a pattern will emerge to confirm the presence of one or more antibodies. Not all antibodies are clinically significant (i.e. cause transfusion reactions, HDN, etc.). Once the patient has developed a clinically significant antibody it is vital that the patient receive antigen-negative red blood cells to prevent future transfusion reactions. A direct antiglobulin test (Coombs test) is also performed as part of the antibody investigation.[22]

text: If there is no antibody present, an immediate spin crossmatch or computer assisted crossmatch is performed where the recipient serum and donor rbc are incubated. In the immediate spin method, two drops of patient serum are tested against a drop of 3–5% suspension of donor cells in a test tube and spun in a serofuge. Agglutination or hemolysis (i.e., positive Coombs test) in the test tube is a positive reaction and the unit should not be transfused.

text: If an antibody is suspected, potential donor units must first be screened for the corresponding antigen by phenotyping them. Antigen negative units are then tested against the patient plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read.

text: In urgent cases where crossmatching cannot be completed, and the risk of dropping hemoglobin outweighs the risk of transfusing uncrossmatched blood, O-negative blood is used, followed by crossmatch as soon as possible. O-negative is also used for children and women of childbearing age. It is preferable for the laboratory to obtain a pre-transfusion sample in these cases so a type and screen can be performed to determine the actual blood group of the patient and to check for alloantibodies.

text: Compatibility of ABO and Rh system[edit]

text: This chart shows possible matches in blood transfusion between donor and receiver using ABO and Rh system.

text:
Donor

O-
O+
B-
B+
A-
A+
AB-
AB+

Recipient
AB+

AB-

A+

A-

B+

B-

O+

O-

tag: table

text: Adverse effects[edit]

text: In the same way that the safety of pharmaceutical products is overseen by pharmacovigilance, the safety of blood and blood products is overseen by haemovigilance. This is defined by the World Health Organization (WHO) as a system "...to identify and prevent occurrence or recurrence of transfusion related unwanted events, to increase the safety, efficacy and efficiency of blood transfusion, covering all activities of the transfusion chain from donor to recipient." The system should include monitoring, identification, reporting, investigation and analysis of adverse events near-misses and reactions related to transfusion and manufacturing.[23] In the UK this data is collected by an independent organisation called SHOT (Serious Hazards Of Transfusion).[24]

text: Transfusions of blood products are associated with several complications, many of which can be grouped as immunological or infectious. There is controversy on potential quality degradation during storage.[25]

text: Immunologic reaction[edit]

text:
Acute hemolytic reactions are defined according to Serious Hazards of Transfusion (SHOT) as "fever and other symptoms/signs of haemolysis within 24 hours of transfusion; confirmed by one or more of the following: a fall of Hb, rise in lactate dehydrogenase (LDH), positive direct antiglobulin test (DAT), positive crossmatch" [26] This is due to destruction of donor red blood cells by preformed recipient antibodies. Most often this occurs due to clerical errors or improper ABO blood typing and crossmatching resulting in a mismatch in ABO blood type between the donor and the recipient. Symptoms include fever, chills, chest pain, back pain,[27] hemorrhage, increased heart rate, shortness of breath, and rapid drop in blood pressure. When suspected, transfusion should be stopped immediately, and blood sent for tests to evaluate for presence of hemolysis. Treatment is supportive. Kidney injury may occur due to the effects of the hemolytic reaction (pigment nephropathy).[28] The severity of the transfusion reaction is depended upon amount of donor's antigen transfused, nature of the donor's antigens, the nature and the amount of recipient antibodies.[27]
Delayed hemolytic reactions occur more than 24 hours until 14 days after a transfusion. This is due to low amount of antibodies available during the start of the transfusion. Therefore, acute haemolytic reaction does not manifests until after 24 hours when enough amount of antibodies are available to cause a reaction. The red blood cells are removed by macrophages from the blood circulation into liver and spleen to be destroyed, which leads to extravascular haemolysis. This process usually mediated by anti-Rh and anti-Kidd antibodies. However, this type of transfusion reaction is less severe when compared to acute haemolytic transfusion reaction[27]
Febrile nonhemolytic reactions are the most common type of blood transfusion reaction and occur due to the release of inflammatory chemical signals released by white blood cells in stored donor blood[14] or attack on donor's white blood cells by recipient's antibodies.[27] This type of reaction occurs in about 7% of transfusions. Fever is generally short lived and is treated with antipyretics, and transfusions may be finished as long as an acute hemolytic reaction is excluded. This is a reason for the now-widespread use of leukoreduction – the filtration of donor white cells from red cell product units.[14]
Allergic reactions is caused by IgE anti-allergen antibodies. When antibodies are bound to its antigens, histamine is released from mast cells and basophils. Either IgE antibodies from the donor's or recipient's side can cause the allergic reaction. It is more common in patients who has allergic conditions such as hay fever. Patient may feel itchy or having hives but the symptoms are usually mild and can be controlled by stopping the transfusion and giving antihistamines.[27]
Anaphylactic reactions is a rare by life-threatening allergic condition caused by IgA anti-plasma protein antibodies. For patient who has selective immunoglobulin A deficiency, the reaction is presumed to be caused by IgA antibodies in the donor's plasma. The patient may presented with symptoms of fever, wheezing, coughing, shortness of breath, and circulatory shock. Urgent treatment with epinephrine is needed.[27]
Post-transfusion purpura is a complication that occurs after transfusion of platelets and is associated with the presence of antibodies in the patient's blood directed against both the donor's and recipient's platelets HPA (human platelet antigen). Recipients who lack this protein develop sensitization to this protein from prior transfusions or previous pregnancies, can develop thrombocytopenia, bleeding into the skin, and causes purplish discolouration of skin which is known as purpura. Intravenous immunoglobulin is the treatment of choice to neutralise such antibodies.[27][29]
Transfusion-associated acute lung injury (TRALI) is a syndrome that is similar to Acute respiratory distress syndrome (ARDS), which develops within 6 hours during a plasma-product containing blood products transfusion. Fever, hypotension, shortness of breath, and tachycardia often occurs in this type of reaction. It occurs in 15% of the transfused patient with mortality rate of 5 to 10%. Recipient risk factors includes: end-stage liver disease, sepsis, haematological malignancies, sepsis, and ventilated patients. Human Neutrophil Antigen (HNA) has been associated with this type of transfusion reaction. Donor's antibodies would interact with recipient's neutrophils and monocytes, releasing inflammatory cytokines and causes pulmonary capillary leakage. The treatment is supportive.[30]
Transfusion-associated graft versus host disease frequently occurs in immunodeficient patients where recipient's body failed to eliminate donor's T cells. Instead, donor's T cells attack the recipient's cells. It occurs one week after transfusion.[27] Fever, rash, diarrhoea are often associated with this type of transfusion reaction. Mortality rate is high, with 89.7% of the patients died after 24 days. Immunosuppressive treatment is the most common way of treatment.[31] Irradiation and leukoreduction of blood products is necessary for high risk patients for prevent T cells from attacking recipient cells.[27]

text: Infection[edit]

text: The use of greater amount of red blood cells is associated with a high risk of infections. In those who were given red blood only with significant anemia infection rates were 12% while in those who were given red blood at milder levels of anemia infection rates were 17%.[32] [clarification needed]

text: On rare occasions, blood products are contaminated with bacteria. This can result in a life-threatening infection known as transfusion-transmitted bacterial infection. The risk of severe bacterial infection is estimated, as of 2002, at about 1 in 50,000 platelet transfusions, and 1 in 500,000 red blood cell transfusions.[33] Blood product contamination, while rare, is still more common than actual infection. The reason platelets are more often contaminated than other blood products is that they are stored at room temperature for short periods of time. Contamination is also more common with longer duration of storage, especially if that means more than 5 days. Sources of contaminants include the donor's blood, donor's skin, phlebotomist's skin, and containers. Contaminating organisms vary greatly, and include skin flora, gut flora, and environmental organisms. There are many strategies in place at blood donation centers and laboratories to reduce the risk of contamination. A definite diagnosis of transfusion-transmitted bacterial infection includes the identification of a positive culture in the recipient (without an alternative diagnosis) as well as the identification of the same organism in the donor blood.

text: Since the advent of HIV testing of donor blood in the mid/later 1980s, ex. 1985's ELISA, the transmission of HIV during transfusion has dropped dramatically. Prior testing of donor blood only included testing for antibodies to HIV. However, due to latent infection (the "window period" in which an individual is infectious, but has not had time to develop antibodies) many cases of HIV seropositive blood were missed. The development of a nucleic acid test for the HIV-1 RNA has dramatically lowered the rate of donor blood seropositivity to about 1 in 3 million units. As transmittance of HIV does not necessarily mean HIV infection, the latter could still occur at an even lower rate.

text: The transmission of hepatitis C via transfusion currently stands at a rate of about 1 in 2 million units. As with HIV, this low rate has been attributed to the ability to screen for both antibodies as well as viral RNA nucleic acid testing in donor blood.

text: Other rare transmissible infections include hepatitis B, syphilis, Chagas disease, cytomegalovirus infections (in immunocompromised recipients), HTLV, and Babesia.

text: Inefficacy[edit]

text: Transfusion inefficacy or insufficient efficacy of a given unit(s) of blood product, while not itself a "complication" per se, can nonetheless indirectly lead to complications – in addition to causing a transfusion to fully or partly fail to achieve its clinical purpose. This can be especially significant for certain patient groups such as critical-care or neonatals.

text: For red blood cells (RBC), by far the most commonly transfused product, poor transfusion efficacy can result from units damaged by the so-called storage lesion – a range of biochemical and biomechanical changes that occur during storage. With red cells, this can decrease viability and ability for tissue oxygenation.[34] Although some of the biochemical changes are reversible after the blood is transfused,[35] the biomechanical changes are less so,[36] and rejuvenation products are not yet able to adequately reverse this phenomenon.[37] There has been controversy about whether a given product unit's age is a factor in transfusion efficacy, specifically about whether "older" blood directly or indirectly increases risks of complications.[38][39] Studies have not been consistent on answering this question,[40] with some showing that older blood is indeed less effective but with others showing no such difference; these developments are being closely followed by hospital blood bankers – who are the physicians, typically pathologists, who collect and manage inventories of transfusable blood units.

text: Certain regulatory measures are in place to minimize RBC storage lesion – including a maximum shelf life (currently 42 days), a maximum auto-hemolysis threshold (currently 1% in the US, 0.8% in Europe), and a minimum level of post-transfusion RBC survival in vivo (currently 75% after 24 hours).[41] However, all of these criteria are applied in a universal manner that does not account for differences among units of product.[42] For example, testing for the post-transfusion RBC survival in vivo is done on a sample of healthy volunteers, and then compliance is presumed for all RBC units based on universal (GMP) processing standards (of course, RBC survival by itself does not guarantee efficacy, but it is a necessary prerequisite for cell function, and hence serves as a regulatory proxy). Opinions vary as to the "best" way to determine transfusion efficacy in a patient in vivo.[43] In general, there are not yet any in vitro tests to assess quality or predict efficacy for specific units of RBC blood product prior to their transfusion, though there is exploration of potentially relevant tests based on RBC membrane properties such as erythrocyte deformability[44] and erythrocyte fragility (mechanical).[45]

text: Physicians have adopted a so-called "restrictive protocol" – whereby transfusion is held to a minimum – due in part to the noted uncertainties surrounding storage lesion, in addition to the very high direct and indirect costs of transfusions.[46][47][48] Of course, restrictive protocol is not an option with some especially vulnerable patients who may require the best possible efforts to rapidly restore tissue oxygenation.

text: Although transfusions of platelets are far less numerous (relative to RBC), platelet storage lesion and resulting efficacy loss is also a concern.[49]

text: Other[edit]

text:
A known relationship between intra-operative blood transfusion and cancer recurrence has been established in colorectal cancer.[50] In lung cancer intra-operative blood transfusion has been associated with earlier recurrence of cancer, worse survival rates and poorer outcomes after lung resection.[51][52] Also studies shown to us, failure of the immune system caused by blood transfusion can be categorized as one of the main factors leading to more than 10 different cancer types that are fully associated with blood transfusion and the innate and adaptive immune system.[53] Allogeneic blood transfusion, through five major mechanisms including the lymphocyte-T set, myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages (TAMs), natural killer cells (NKCs), and dendritic cells (DCs) can help the recipient’s defense mechanisms. On the other hand, the role for each of the listed items includes activation of the antitumor CD8+ cytotoxic T lymphocytes (CD8+/CTL), temporal inactivation of Tregs, inactivation of the STAT3 signaling pathway, the use of bacteria to enhance the antitumor immune response and cellular Immunotherapy.[54]
Transfusion-associated volume overload is a common complication simply due to the fact that blood products have a certain amount of volume. This is especially the case in recipients with underlying cardiac or kidney disease. Red cell transfusions can lead to volume overload when they must be repeated due to insufficient efficacy (see above). Plasma transfusion is especially prone to causing volume overload due to its hypertonicity.
Hypothermia can occur with transfusions with large quantities of blood products which normally are stored at cold temperatures. Core body temperature can go down as low as 32 °C and can produce physiologic disturbances. Prevention should be done with warming the blood to ambient temperature prior to transfusions.
Transfusions with large amounts of red blood cells, whether due to severe hemorrhaging and/or transfusion inefficacy (see above), can lead to an inclination for bleeding. The mechanism is thought to be due to disseminated intravascular coagulation, along with dilution of recipient platelets and coagulation factors. Close monitoring and transfusions with platelets and plasma is indicated when necessary.
Metabolic alkalosis can occur with massive blood transfusions due to the breakdown of citrate stored in blood into bicarbonate.
Hypocalcemia can also occur with massive blood transfusions due to the complex of citrate with serum calcium.
Blood doping is often used by athletes, drug addicts or military personnel for reasons such as to increase physical stamina, to fake a drug detection test or simply to remain active and alert during the duty-times respectively. However a lack of knowledge and insufficient experience can turn a blood transfusion into a sudden death. For example, when individuals run the frozen blood sample directly in their veins this cold blood rapidly reaches the heart, where it disturbs the heart's original pace leading to cardiac arrest and sudden death.

text: Frequency of use[edit]

text: Globally around 85 million units of red blood cells are transfused in a given year.[2]

text: In the United States, blood transfusions were performed nearly 3 million times during hospitalizations in 2011, making it the most common procedure performed. The rate of hospitalizations with a blood transfusion nearly doubled from 1997, from a rate of 40 stays to 95 stays per 10,000 population. It was the most common procedure performed for patients 45 years of age and older in 2011, and among the top five most common for patients between the ages of 1 and 44 years.[55]

text: According to the New York Times: "Changes in medicine have eliminated the need for millions of blood transfusions, which is good news for patients getting procedures like coronary bypasses and other procedures that once required a lot of blood." And, "Blood bank revenue is falling, and the decline may reach $1.5 billion a year this year [2014] from a high of $5 billion in 2008." Job losses will reach as high as 12,000 within the next three to five years, roughly a quarter of the total in the industry, according to the Red Cross.[56]

text: History[edit]

text: Beginning with William Harvey's experiments on the circulation of blood, research into blood transfusion began in the 17th century, with successful experiments in transfusion between animals. However, successive attempts by physicians to transfuse animal blood into humans gave variable, often fatal, results.

text: Pope Innocent VIII is sometimes said to have been given "the world's first blood transfusion" by his Jewish physician Giacomo di San Genesio, who had him drink (by mouth) the blood of three 10-year-old boys. The boys subsequently died. The evidence for this story, however, is unreliable and may have been motivated by anti-semitism.[57]

text: Early attempts[edit]

text: Animal blood[edit]

text: Working at the Royal Society in the 1660s, the physician Richard Lower began examining the effects of changes in blood volume on circulatory function and developed methods for cross-circulatory study in animals, obviating clotting by closed arteriovenous connections. The new instruments he was able to devise enabled him to perform the first reliably documented successful transfusion of blood in front of his distinguished colleagues from the Royal Society.

text: According to Lower's account, "...towards the end of February 1665 [I] selected one dog of medium size, opened its jugular vein, and drew off blood, until … its strength was nearly gone. Then, to make up for the great loss of this dog by the blood of a second, I introduced blood from the cervical artery of a fairly large mastiff, which had been fastened alongside the first, until this latter animal showed … it was overfilled … by the inflowing blood." After he "sewed up the jugular veins," the animal recovered "with no sign of discomfort or of displeasure."

text: Lower had performed the first blood transfusion between animals. He was then "requested by the Honorable [Robert] Boyle … to acquaint the Royal Society with the procedure for the whole experiment," which he did in December 1665 in the Society's Philosophical Transactions. [58]

text: The first blood transfusion from animal to human was administered by Dr. Jean-Baptiste Denys, eminent physician to King Louis XIV of France, on June 15, 1667.[59] He transfused the blood of a sheep into a 15-year-old boy, who survived the transfusion.[60] Denys performed another transfusion into a labourer, who also survived. Both instances were likely due to the small amount of blood that was actually transfused into these people. This allowed them to withstand the allergic reaction.

text: Denys' third patient to undergo a blood transfusion was Swedish Baron Gustaf Bonde. He received two transfusions. After the second transfusion Bonde died.[61] In the winter of 1667, Denys performed several transfusions on Antoine Mauroy with calf's blood. On the third account Mauroy died.[62]

text: Six months later in London, Lower performed the first human transfusion of animal blood in Britain, where he "superintended the introduction in [a patient's] arm at various times of some ounces of sheep's blood at a meeting of the Royal Society, and without any inconvenience to him." The recipient was Arthur Coga, "the subject of a harmless form of insanity." Sheep's blood was used because of speculation about the value of blood exchange between species; it had been suggested that blood from a gentle lamb might quiet the tempestuous spirit of an agitated person and that the shy might be made outgoing by blood from more sociable creatures. Coga received 20 shillings (equivalent to £158 in 2016) to participate in the experiment.[63]

text: Lower went on to pioneer new devices for the precise control of blood flow and the transfusion of blood; his designs were substantially the same as modern syringes and catheters.[58] Shortly after, Lower moved to London, where his growing practice soon led him to abandon research.[64]

text: These early experiments with animal blood provoked a heated controversy in Britain and France.[61] Finally, in 1668, the Royal Society and the French government both banned the procedure. The Vatican condemned these experiments in 1670. Blood transfusions fell into obscurity for the next 150 years.

text: Human blood[edit]

text: The science of blood transfusion dates to the first decade of the 20th century, with the discovery of distinct blood types leading to the practice of mixing some blood from the donor and the receiver before the transfusion (an early form of cross-matching).

text: In the early 19th century, British obstetrician Dr. James Blundell made efforts to treat hemorrhage by transfusion of human blood using a syringe. In 1818 following experiments with animals, he performed the first successful transfusion of human blood to treat postpartum hemorrhage. Blundell used the patient's husband as a donor, and extracted four ounces of blood from his arm to transfuse into his wife. During the years 1825 and 1830, Blundell performed 10 transfusions, five of which were beneficial, and published his results. He also invented a number of instruments for the transfusion of blood.[65] He made a substantial amount of money from this endeavour, roughly $2 million ($50 million real dollars).[66]

text: In 1840, at St George's Hospital Medical School in London, Samuel Armstrong Lane, aided by Dr. Blundell, performed the first successful whole blood transfusion to treat haemophilia.

text: However, early transfusions were risky and many resulted in the death of the patient. By the late 19th century, blood transfusion was regarded as a risky and dubious procedure, and was largely shunned by the medical establishment.

text: Work to emulate James Blundell continued in Edinburgh. In 1845 the Edinburgh Journal described the successful transfusion of blood to a woman with severe uterine bleeding. Subsequent transfusions were successful with patients of Professor James Young Simpson after whom the Simpson Memorial Hospital in Edinburgh was named.[67]

text: The largest series of early successful transfusions took place at the Edinburgh Royal Infirmary between 1885 and 1892. Edinburgh later became the home of the first blood donation and blood transfusion services.[67]

text: Modern era[edit]

text: It was not until 1901, when the Austrian Karl Landsteiner discovered three human blood groups (O, A, and B), that blood transfusion was put onto a scientific basis and became safer.

text: Landsteiner discovered that adverse effects arise from mixing blood from two incompatible individuals. He found that when incompatible types are mixed, an immune response is triggered and the red blood cells clump. The immunological reaction occurs when the receiver of a blood transfusion has antibodies against the donor blood cells. The destruction of red blood cells releases free hemoglobin into the bloodstream, which can have fatal consequences. Landsteiner's work made it possible to determine blood group and allowed a way for blood transfusions to be carried out much more safely. For this discovery he was awarded the Nobel Prize in Physiology and Medicine in 1930, and many other blood groups have been discovered since.

text: George Washington Crile is credited with performing the first surgery using a direct blood transfusion in 1906 at St. Alexis Hospital in Cleveland while a professor of surgery at Case Western Reserve University.[when?][68]

text: Jan Janský also discovered the human blood groups in 1907 which he classified blood into four groups I, II, III, IV. Titled in Czech "Hematologická studie u psychotiků". His nomenclature is still used in Russia and states of the former USSR, in which blood types O, A, B, and AB are respectively designated I, II, III, and IV.

text: Dr. William Lorenzo Moss's (1876–1957) Moss-blood typing technique of 1910 was widely used until World War II.[69][70]

text: William Stewart Halsted, M.D. (September 23, 1852 – September 7, 1922) was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several new operations, including the radical mastectomy for breast cancer. Halsted returned to New York in 1880 and for the next six years led an extraordinarily vigorous and energetic life. He operated at multiple hospitals, including Roosevelt Hospital, the College of Physicians and Surgeons, Charity Hospital, Emigrant Hospital, Bellevue Hospital and Chambers Street Hospital. He was an extremely popular, inspiring and charismatic teacher. In 1882 he performed one of the first gallbladder operations in the United States (a cholecystotomy performed on his mother on the kitchen table at 2 am). Halsted also performed one of the first blood transfusions in the United States. He had been called to see his sister after she had given birth. He found her moribund from blood loss, and in a bold move withdrew his own blood, transfused his blood into his sister, and then operated on her to save her life.

text: Blood banks in WWI[edit]

text: While the first transfusions had to be made directly from donor to receiver before coagulation, it was discovered that by adding anticoagulant and refrigerating the blood it was possible to store it for some days, thus opening the way for the development of blood banks. John Braxton Hicks was the first to experiment with chemical methods to prevent the coagulation of blood at St Mary's Hospital, London in the late 19th century. His attempts, using phosphate of soda, however, were unsuccessful.

text: The first non-direct transfusion was performed on March 27, 1914 by the Belgian doctor Albert Hustin, though this was a diluted solution of blood. The Argentine doctor Luis Agote used a much less diluted solution in November of the same year. Both used sodium citrate as an anticoagulant.[71]

text: The First World War acted as a catalyst for the rapid development of blood banks and transfusion techniques. Canadian doctor and Lieutenant Lawrence Bruce Robertson was instrumental in persuading the Royal Army Medical Corps to adopt the use of blood transfusion at the Casualty Clearing Stations for the wounded. In October 1915, Robertson performed his first wartime transfusion with a syringe to a patient suffering from multiple shrapnel wounds. He followed this up with four subsequent transfusions in the following months and his success was reported to Sir Walter Morley Fletcher, director of the Medical Research Committee.[72]

text: Robertson published his findings in the British Medical Journal in 1916 and, with the help of a few like minded individuals (including the eminent physician Edward William Archibald who introduced the citrate anticoagulant method), was able to persuade the British authorities of the merits of blood transfusion. Robertson went on to establish the first blood transfusion apparatus at a Casualty Clearing Station on the Western Front in the spring of 1917.[72] [73]

text: Oswald Hope Robertson, a medical researcher and U.S. Army officer was attached to the RAMC in 1917, where he was instrumental in establishing the first blood banks, in preparation for the anticipated Third Battle of Ypres.[74] He used sodium citrate as the anticoagulant and the blood was extracted from punctures in the vein and was stored in bottles at British and American Casualty Clearing Stations along the Front. He also experimented with preserving separated red blood cells in iced bottles.[73] Geoffrey Keynes, a British surgeon, developed a portable machine that could store blood to enable transfusions to be carried out more easily.

text: Expansion[edit]

text: The world's first blood donor service was established in 1921 by the secretary of the British Red Cross, Percy Oliver. In that year, Oliver was contacted by King's College Hospital, where they were in urgent need of a blood donor. [75] After providing a donor, Oliver set about organizing a system for the voluntary registration of blood donors at clinics around London, with Sir Geoffrey Keynes appointed as a medical adviser. Volunteers were subjected to a series of physical tests to establish their blood group. The London Blood Transfusion Service was free of charge and expanded rapidly in its first few years of operation. By 1925, it was providing services for almost 500 patients and it was incorporated into the structure of the British Red Cross in 1926. Similar systems were established in other cities including Sheffield, Manchester and Norwich, and the service's work began to attract international attention. Similar services were established in France, Germany, Austria, Belgium, Australia and Japan.[76]

text: An academic institution devoted to the science of blood transfusion was founded by Alexander Bogdanov in Moscow in 1925. Bogdanov was motivated, at least in part, by a search for eternal youth, and remarked with satisfaction on the improvement of his eyesight, suspension of balding, and other positive symptoms after receiving 11 transfusions of whole blood. Bogdanov died in 1928 as a result of one of his experiments, when the blood of a student suffering from malaria and tuberculosis was given to him in a transfusion.[77] Following Bogdanov's lead, Vladimir Shamov and Sergei Yudin in the USSR pioneered the transfusion of cadaveric blood from recently deceased donors. Yudin performed such a transfusion successfully for the first time on March 23, 1930 and reported his first seven clinical transfusions with cadaveric blood at the Fourth Congress of Ukrainian Surgeons at Kharkiv in September. However, this method was never used widely, even in Russia.

text: One of the earliest blood banks was established by Frederic Durán-Jordà during the Spanish Civil War in 1936. Duran joined the Transfusion Service at the Barcelona Hospital at the start of the conflict, but the hospital was soon overwhelmed by the demand for blood and the paucity of available donors. With support from the Department of Health of the Spanish Republican Army, Duran established a blood bank for the use of wounded soldiers and civilians. The 300–400 mL of extracted blood was mixed with 10% citrate solution in a modified Duran Erlenmeyer flask. The blood was stored in a sterile glass enclosed under pressure at 2 °C. During 30 months of work, the Transfusion Service of Barcelona registered almost 30,000 donors, and processed 9,000 liters of blood. [78]

text: In 1937 Bernard Fantus, director of therapeutics at the Cook County Hospital in Chicago, established the first hospital blood bank in the United States. In creating a hospital laboratory that preserved, refrigerated and stored donor blood, Fantus originated the term "blood bank". Within a few years, hospital and community blood banks were established across the United States.[79]

text: Frederic Durán-Jordà fled to Britain in 1938, and worked with Dr Janet Vaughan at the Royal Postgraduate Medical School at Hammersmith Hospital to create a system of national blood banks in London.[80] With the outbreak of war looking imminent in 1938, the War Office created the Army Blood Supply Depot (ABSD) in Bristol headed by Lionel Whitby and in control of four large blood depots around the country. British policy through the war was to supply military personnel with blood from centralized depots, in contrast to the approach taken by the Americans and Germans where troops at the front were bled to provide required blood. The British method proved to be more successful at adequately meeting all requirements and over 700,000 donors were bled over the course of the war. This system evolved into the National Blood Transfusion Service established in 1946, the first national service to be implemented. [81]

text: Medical advances[edit]

text: A blood collection program was initiated in the US in 1940 and Edwin Cohn pioneered the process of blood fractionation. He worked out the techniques for isolating the serum albumin fraction of blood plasma, which is essential for maintaining the osmotic pressure in the blood vessels, preventing their collapse.

text: The use of blood plasma as a substitute for whole blood and for transfusion purposes was proposed as early as 1918, in the correspondence columns of the British Medical Journal, by Gordon R. Ward. At the onset of World War II, liquid plasma was used in Britain. A large project, known as 'Blood for Britain' began in August 1940 to collect blood in New York City hospitals for the export of plasma to Britain. A dried plasma package was developed, which reduced breakage and made the transportation, packaging, and storage much simpler.[82]

text: The resulting dried plasma package came in two tin cans containing 400 mL bottles. One bottle contained enough distilled water to reconstitute the dried plasma contained within the other bottle. In about three minutes, the plasma would be ready to use and could stay fresh for around four hours.[83] Dr. Charles R. Drew was appointed medical supervisor, and he was able to transform the test tube methods into the first successful technique for mass production.

text: Another important breakthrough came in 1939–40 when Karl Landsteiner, Alex Wiener, Philip Levine, and R.E. Stetson discovered the Rhesus blood group system, which was found to be the cause of the majority of transfusion reactions up to that time. Three years later, the introduction by J.F. Loutit and Patrick L. Mollison of acid–citrate–dextrose (ACD) solution, which reduced the volume of anticoagulant, permitted transfusions of greater volumes of blood and allowed longer term storage.

text: Carl Walter and W.P. Murphy Jr. introduced the plastic bag for blood collection in 1950. Replacing breakable glass bottles with durable plastic bags made from PVC allowed for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of whole blood.

text: In the field of cancer surgery replacement of massive blood loss became a major problem. The cardiac arrest rate was high. In 1963, C. Paul Boyan and William S. Howland discovered that the temperature of the blood and the rate of infusion greatly affected survival rates, and introduced blood warming to surgery.[84][85]

text: Further extending the shelf life of stored blood was an anticoagulant preservative, CPDA-1, introduced in 1979, which increased the blood supply and facilitated resource-sharing among blood banks.

text: As of 2006, there were about 15 million units of blood products transfused per year in the United States.[86] By 2013, the number had declined to about 11 million units, due to the shift towards laparoscopic surgery and other surgical advances and studies that have shown that many transfusions were unnecessary. For example, the standard of care reduced that amount of blood transfused from 750 to 200 ml.[87]

text: Special populations[edit]

text: Neonate[edit]

text: To ensure the safety of blood transfusion to pediatric patients, hospitals are taking additional precaution to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for Cytomegalovirus. Most guidelines recommend the provision of CMV-negative blood components and not simply leukoreduced components for newborns or low birthweight infants in whom the immune system is not fully developed.[88] These specific requirements place additional restrictions on blood donors who can donate for neonatal use. vnv Neonatal transfusions typically fall into one of two categories:

text:
"Top-up" transfusions, to replace losses due to investigational losses and correction of anemia.
Exchange (or partial exchange) transfusions are done for removal of bilirubin, removal of antibodies and replacement of red cells (e.g., for anemia secondary to thalassemias and other hemoglobinopathies).[89]

text: Massive trauma[edit]

text: A massive transfusion protocol is used for massive trauma resuscitation, when more than ten units of blood are needed. Packed red blood cells, fresh frozen plasma, and platelets are administered in lieu of crystalloids or whole blood.[90] Typically higher ratios of fresh frozen plasma and platelets are given relative to packed red blood cells.[90]

text: Unknown blood type[edit]

text: Because blood type O negative is compatible with anyone, it is often overused and in short supply.[91] According to the American Association of Blood Banks, the use of this blood should be restricted to persons with O negative blood, as nothing else is compatible with them, and women who might be pregnant and for whom it would be impossible to do blood group testing before giving them emergency treatment.[91] Whenever possible, the AABB recommends that O negative blood be conserved by using blood type testing to identify a less scarce alternative.[91]

text: Religious objections[edit]

text: Jehovah's Witnesses object to blood transfusions due to their belief that blood is sacred.[92]

text: Research into alternatives[edit]

text: Although there are clinical situations where transfusion with red blood cells is the only clinically appropriate option, clinicians look at whether alternatives as feasible. This can be due to several reasons, such as patient safety, economic burden or scarcity of blood. Guidelines recommend blood transfusions should be reserved for patients with or at risk of cardiovascular instability due to the degree of their anaemia.[93][94] In these cases parenteral iron is recommended.

text: Thus far, there are no available oxygen-carrying blood substitutes, which is the typical objective of a blood (RBC) transfusion; however, there are widely available non-blood volume expanders for cases where only volume restoration is required. These are helping doctors and surgeons avoid the risks of disease transmission and immune suppression, address the chronic blood donor shortage, and address the concerns of Jehovah's Witnesses and others who have religious objections to receiving transfused blood.

text: A number of blood substitutes have been explored (and still are), but thus far they all suffer from many challenges. Most attempts to find a suitable alternative to blood thus far have concentrated on cell-free hemoglobin solutions. Blood substitutes could make transfusions more readily available in emergency medicine and in pre-hospital EMS care. If successful, such a blood substitute could save many lives, particularly in trauma where massive blood loss results. Hemopure, a hemoglobin-based therapy, is approved for use in South Africa.

text: Other uses[edit]

text: Minor blood transfusions are used by a minority of nyaope drug addicts in South Africa to economically share the high the drug induces in a practice colloquially known as Bluetoothing, named after the wireless technology of the same name.[95]

text: Veterinary use[edit]

text: Veterinarians also administer transfusions to other animals. Various species require different levels of testing to ensure a compatible match. For example, cats have 3 known blood types, cattle have 11, dogs have 12, pigs 16 and horses have 34. However, in many species (especially horses and dogs), cross matching is not required before the first transfusion, as antibodies against non-self cell surface antigens are not expressed constitutively – i.e. the animal has to be sensitized before it will mount an immune response against the transfused blood.

text: The rare and experimental practice of inter-species blood transfusions is a form of xenograft.


document_title: Diary of a Wimpy Kid: The Long Haul (film)

question_text: where was diary of a wimpy kid long haul filmed

text: Plot[edit]

text: One year after the previous film, while at the Corny's family restaurant, the Heffley family plans to attend Meemaw's 90th birthday. However, after Greg rescues his younger brother Manny, who got stuck inside a tube in the play area, Greg ends up in a ball pit with a diaper stuck on his hand. He subsequently becomes infamous after the people around him record him and post the footage on the internet, leading Greg to be dubbed as "Diaper Hands".

text: Later, at the Heffley residence, Greg learns that Player Expo is taking place not very far from Meemaw's house in Indianapolis. Greg's gaming star, Mac Digby, will be attending, and Greg hopes to meet him and get in one of his videos so he will gain popularity. He acknowledges that he will have to somehow sneak off from the road trip and attend the Expo without his parents' knowledge, however. The Heffley family hits the road, where Greg, Rodrick, Frank, and Manny's devices are immediately confiscated by Susan, who wants the road trip to be absolutely technology-free.

text: After arriving at a motel, Greg discreetly gets into the car and takes his phone out of the bag Susan had put it in and plans to use it. Later, when Greg and Rodrick are relaxing in the hot tub, Rodrick hears a notification from Greg's phone and discovers his plans to go to Player Expo. Greg discourages Rodrick from telling Susan, saying that they had a rock band video game tournament there that Rodrick could participate in. Liking the idea, Rodrick opts to go with Greg to the Expo.

text: Going to sleep, Greg is annoyed by a loud bang noise created by the Beardo siblings, who playfully crash a trolley into a wall, and storms out of the room. He confronts them but Brandi, the eldest sibling, rolls the trolley — which is meant for Greg — into their car, leaving a huge scratch. Just as Mr. Beardo comes out of his motel room, Brandi blames Greg responsible and Mr. Beardo goes after him but he manages to outrun him. Greg returns to his room, but the next morning, he actually slept next to Mr. Beardo, who chases him again, but he manages to escape from the motel with his family.

text: The Heffleys attend a county fair where Manny wins a pig, but Mr. Beardo and his family notices Greg and begins chasing after him but manages to outrun again. Back at the road, the Heffleys, unable to take care of the pig, drop it off at the petting zoo, much to Manny's dismay, but not before Greg reroutes the GPS to the Player Expo convention. Checking at the hotel room, Greg and Rodrick sneak out to go to Player Expo using the excuse that they are going to get a present for Meemaw. However, after Frank and Susan see their children on live TV, they go to get the boys themselves.

text: Greg finally sees Mac Digby participating in a video game competition. Desperate to be in one of his videos, Greg instructs Rodrick to record him going up on stage with Mac so his popularity will boost. But the attempt fails when Susan storms into the stage and inadvertently reveals that he is Diaper Hands to the public, causing them to chant at him. Susan opens up to Greg and says that all she wanted was a nice road trip that would bring the family closer together, and she accuses Greg of not caring. Greg snaps back at Susan, saying that she doesn't care about what he wants, which is why he had to sneak out to the Expo in the first place. Hurt by her son's words, Susan hands her phone to Greg because she doesn't care anymore.

text: On the road again, the tarp on the boat — hitched to the car — carrying the majority of their belongings flies off all across the road. The Heffleys recover their belongings but the Beardo's van pulls up and begins stealing suitcases and clothes. This causes Susan to be very upset that the trip became a disaster. Greg saw his family hit rock bottom. He encourages them to continue the trip. They found the Beardos. They get into the motel room, where the Beardos occupied, and successfully retrieve their belongings, but not before Greg and Mr. Beardo have a short but intense battle in the motel shower, which ends with Mr. Beardo slipping in the tub.

text: After encountering some obstacles, the Heffleys celebrate happily at Meemaw's and get their car fixed, but the radiator breaks due to the AC not being cranked up all the way. A Spanish-speaking man, Mr. Luis, who works for a towing company pulls over to assist them, but none of the Heffleys can understand him, except Manny, who speaks in fluent Spanish (thanks to the Spanish tutorial CD Susan put in during the road trip) to the man and explains their current situation.

text: Luis then tows their car and Manny gives him instructions to the petting zoo where his pig is, and the two reunite. At the end, Greg explains that although the road trip wasn't perfect, he still wouldn't change a thing. He says that Manny was allowed to keep his pig as a pet, Rodrick was able to get a new van, and Dad was able to explain having time off from work to bond with family. Greg expresses excitement for where they'll be going next year, but Susan steps in to say they will be flying.

text: In a mid-credits scene, two girls take selfies with Greg, who they recognize as Diaper Hands.

text: Cast[edit]

text:
Jason Drucker as Gregory "Greg" Heffley
Alicia Silverstone as Susan Heffley, Greg's mother
Tom Everett Scott as Frank Heffley, Greg's father
Charlie Wright as Rodrick Heffley, Greg's older brother
Owen Asztalos as Rowley Jefferson, Greg's best friend
Wyatt and Dylan Walters as Manny Heffley, Greg's little brother[6]
Joshua Hoover as Mac Digby, a popular internet gamer who Greg idolizes
Chris Coppola as Mr. Beardo, the main antagonist of the film
Kimberli Lincoln as Mrs. Beardo, Mr. Beardo's wife
Mira Silverman as Brandi Beardo, Mr. Beardo's rude and spoiled daughter who blames Greg for damaging their car
Mimi Gould as Meemaw, Susan's grandmother and Greg's great-grandmother

text: Production[edit]

text: Development[edit]

text: In 2012, the series' third entry, Diary of a Wimpy Kid: Dog Days was described as the last live action film in the franchise.[7][8] In August 2012, while doing press for the film, author Jeff Kinney and actors Zachary Gordon and Robert Capron each indicated that there were no plans for a fourth movie, but did not dismiss the possibility entirely.[7][8][9]

text: Kinney replied to inquiries regarding the possibility of another sequel, stating, "At present, we don’t have a fourth film in development, but you never know!"[9] When describing the likelihood of starring in another film in the series, Gordon explained, "Dog Days most likely will be the last movie. The main problem is [the cast] is getting older. You can't stop it. There's no way to temporarily stop us from changing and growing up. You know, that's the problem because the characters are supposed to be timeless."[7]

text: In March 2013, Gordon stated in a Spreecast live stream that there would not be a fourth live action film. Previously, Kinney had indicated that instead of making a live action film of the third novel, Diary of a Wimpy Kid: The Last Straw, instead he would like to see Diary of a Wimpy Kid: Cabin Fever adapted into an animated film, stating in an interview, "I hope that it gets made into an animated movie. but I'd really like to see it turn into an animated television special."

text: Pre-production[edit]

text: On July 29, 2016, it was announced that a fourth live action Diary of a Wimpy Kid film was in production, and will have a completely different cast, as many of the members from the original cast were too old and have outgrown from their roles.[citation needed] Jason Drucker and Owen Asztalos portray Greg and Rowley, with David Bowers returning as the director. Alicia Silverstone and Tom Everett Scott portray Greg's parents, Susan and Frank, and Charlie Wright portrays Greg's older brother Rodrick.[4]

text: Filming[edit]

text: Filming of The Long Haul began on September 20, 2016, in Atlanta, and concluded on November 18, 2016.

text: Cultural references[edit]

text: The film somewhat acts as a parody film, referencing two films directed by Alfred Hitchcock. The film in one scene parodies the film The Birds, where the Heffley family getting mauled by seagulls. The film also parodies the film Psycho in the third act, where Greg Heffley is caught by Mr. Beardo in the shower, which Greg is stuck in, which Mr. Beardo nearly catches him, and wet mud goes down the drain. Additionally, Diary of a Wimpy Kid: The Long Haul also referenced a scene of the film Are We There Yet?. When Greg Heffley was in the ball pit in the start of the film, the film referenced a scene in Jingle All the Way.

text: Release[edit]

text: The film was released on May 17, 2017, in the Philippines, May 19, 2017, in the United States, and May 20, 2017, in the United Kingdom.[5]

text: Trailer reactions[edit]

text: On February 23, 2017, a theatrical poster and teaser trailer were released, and the following month, the official trailer was released. Both trailers received negative feedback from fans for its recasting of the main characters, most notably Charlie Wright as Rodrick. To further express their outrage, the fans took to social media and started the hashtag "#NotMyRodrick" (a parody of the "#NotMyPresident" trend that followed the election of U.S. president Donald Trump), which has spawned countless online memes. Other hashtags included "#NotMyHeffleys" and "#NotMyRowley".[10]

text: Both trailers received significant backlash from audiences, and the official trailer received over 46 thousand dislikes, compared to only 9 thousand likes.[11]

text: Box office[edit]

text: As of August 12, 2017[update], Diary of a Wimpy Kid: The Long Haul had grossed $20.7 million in the United States and Canada and $19.3 million in other countries for a worldwide total of $40,077,469 million, against a production budget of $22 million thus making the film the lowest grossing film of the Diary of a Wimpy Kid series.[3]

text: In North America, the film was released alongside Everything, Everything and Alien: Covenant, and was initially projected to gross around $12 million from 3,129 theaters during its opening weekend.[4] However, after grossing $2 million on its first day, projections were lowered to $7 million. It ended up finishing with $7.1 million, placing 6th at the box office and marking the lowest opening of the franchise.[12] When the film was released in the United Kingdom, it opened on #2, behind Pirates of The Caribbean: Salazars Revenge with £1,444,092.[13]

text: Critical response[edit]

text: On Rotten Tomatoes, the film has an approval rating of 20% based on 66 reviews and an average rating of 4.2/10. The site's critical consensus reads, "With an all-new cast but the same juvenile humor, Diary of a Wimpy Kid: The Long Haul finds the franchise still stuck in arrested – and largely unfunny – development."[14] On Metacritic, the film has a score of 39 out of 100 based on 16 critics, indicating "generally unfavorable reviews".[15] Audiences polled by CinemaScore gave the film an average grade of "B" on an A+ to F scale.[16]

text: Home media[edit]

text: Diary of a Wimpy Kid: The Long Haul was released on Digital HD from Amazon Video and iTunes on August 1, 2017, and on Blu-ray and DVD on August 8, 2017 by 20th Century Fox Home Entertainment.[17][18]