title: Mazda Wankel engine

text: The Renesis has also been adapted for a dual-fuel use, allowing it to run on petrol or hydrogen in cars like the Mazda Premacy Hydrogen RE Hybrid and Mazda RX-8 Hydrogen RE.


title: Mazda Wankel engine

text: All the Mazda rotary engines have been praised because of their light weight. The unmodified 13B-MSP Renesis Engine has a weight of , including all standard attachments (except the airbox, alternator, starter motor, cover, etc.), but without engine fluids (such as coolant, oil, etc.), known to make .


title: Mazda Wankel engine

text: Also known as the Renesis II, made its first and only appearance in the Mazda Taiki concept car at the 2007 Tokyo Auto Show, but has not been seen since. It features up to , a lengthened stroke, reduced width rotor housing, direct injection, and aluminum side housings.


title: Mazda Wankel engine

text: Mazda was fully committed to the Wankel engine just as the energy crisis of the 1970s struck. The company had all but eliminated piston engines from its products in 1974, a decision that nearly led to the company's collapse. A switch to a three-prong approach (piston-gasoline, piston-Diesel, and Wankel) for the 1980s relegated the Wankel to sports car use (in the RX-7 and Cosmo), severely limiting production volume. But the company had continued production continually since the mid-1960s, and was the only maker of Wankel-powered cars when the RX-8 was discontinued from production in June 2012 with 2000 RX-8 Spirit R models being made for the JDM (RHD) market.


title: Mazda Wankel engine

text: Though not reflected in the graph at right, the RX-8 was a higher-volume car than its predecessors. Sales of the RX-8 peaked in 2004 at 23,690, but continued to decline through 2011, when fewer than 1000 were produced.


title: Mazda Wankel engine

text: On 16 November 2011, Mazda CEO Takashi Yamanouchi announced that the company is still committed to producing the rotary engine, saying, "So long as I remain involved with this company... there will be a rotary engine offering or multiple offerings in the lineup."


title: Mazda Wankel engine

text: Currently, the engine is produced for SCCA Formula Mazda, and its professional Indy Racing League LLC dba INDYCAR sanctioned Pro Mazda Championship.


title: Mazda Wankel engine

text: Mazda last built a production street car powered by a rotary engine in 2012, the RX-8, but had to abandon it largely to poor fuel efficiency and emissions. It has continued to work on the technology, however, as it is one of the company's signature features. Mazda officials have previously suggested that if they can get it to perform as well as a reciprocating engine they will bring it back, to power a conventional sports car.


title: Mazda Wankel engine

text: On 17 November 2016 Senior managing executive officer of Mazda research and development Kiyoshi Fujiwara told journalists at the Los Angeles motor show that the company is currently developing its first EV in 2019, and it's likely to incorporate a rotary engine, but that the details were still "a big secret." He did say, however, that the car is likely to use a new-generation rotary engine as a range extender, similar in concept to a BMW i3. In 2013, Mazda had displayed a Mazda2 RE prototype car, using a similar rotary range extender EV system.


title: Mazda Wankel engine

text: On 27 October 2017 Senior managing executive officer and R&D Chief Kiyoshi Fujiwara told journalists that they were still working on a rotary engine for a sports car, that will potentially in some markets be with hybrid drivetrains, but both will have distinct powertrains from Mazda's first EV, which will be released in 2019/20. "...some cities will ban combustion, therefore we need some additional portion of electrification because the driver can’t use this rotary sports car. Some of the regions we don’t need this small electrification, therefore we can utilise pure rotary engines."


title: Mazda Wankel engine

text: In 2021, Mazda announced that the upcoming plug-in hybrid variant of the MX-30 will feature a new rotary engine that acts as a range extender to recharge the batteries, but not to power the wheels.


title: Puppet state

text: A puppet state, puppet régime, puppet government or dummy government, is a state that is "de jure" independent but "de facto" completely dependent upon an outside power and subject to its orders. Puppet states have nominal sovereignty, but a foreign power effectively exercises control through means such as financial interests, economic, or military support. By leaving a local government in existence the outside Powers evade all responsibility, while at the same time successfully paralyzing the Government they tolerate.


title: Puppet state

text: Puppet states are distinguished from allies, which choose their actions on their own or in accordance with treaties they voluntarily entered. Puppet states are forced into providing legal endorsement for actions already taken by a foreign power.


title: Puppet state

text: A puppet state preserves the external paraphernalia of independence (such as a name, flag, anthem, constitution, law codes, motto and government), but in reality it is an organ of another state which creates,


title: Puppet state

text: sponsors or otherwise controls the government of the puppet state (the "puppet government"). International law does not recognize occupied puppet states as legitimate.


title: Puppet state

text: The term is a metaphor which compares a state or government to a puppet controlled by a puppeteer using strings. The first recorded use of the term "puppet government" is from 1884, in reference to the Khedivate of Egypt.


title: Puppet state

text: In the Middle Ages vassal states existed which were based on delegation of rule of a country from a King to noble men of lower rank. Since the Peace of Westphalia of 1648 the concept of a nation came into existence where sovereignty was connected more to the people who inhabited the land than to the nobility who owned the land.


title: Puppet state

text: A similar concept mainly associated with pre-19th century political history is suzerainty, the control of the external affairs of one state by another.


title: Puppet state

text: The Batavian Republic was established in the Netherlands under French revolutionary protection. In Eastern Europe, France established a Polish client state of the Duchy of Warsaw.


title: Puppet state

text: In Italy, republics were created in the late 18th and early 19th centuries with the assistance and encouragement of Napoleonic France (see also French client republics).


title: Puppet state

text: During 1836 U.S. citizens allowed to live in the Mexican state of Texas revolted against the Mexican government to establish a U.S.-backed Republic of Texas, a country that existed less than 10 years (from 14 May 1836, to 29 December 1845) before it was annexed to the United States of America.


title: Puppet state

text: However, in August 1837, Memucan Hunt, Jr., the Texan minister to the United States, submitted the first official annexation proposal to the Van Buren administration (the first American-led attempts to take over Mexican Texas by filibustering date back to 1819 and by separatist settlers since 1826).


title: Puppet state

text: In 1810 U.S. citizens living in Spanish territory declared the area from the Mississippi River to the present state of Florida to be an independent nation. Known as the Republic of West Florida, it only lasted for 10 weeks. Not desiring to cross American interests, the republic's government encouraged annexation by the U.S., which soon occurred.


title: Puppet state

text: During Japan's imperial period, and particularly during the Pacific War (parts of which are considered the Pacific theatre of World War II), the Imperial Japanese regime established a number of dependent states.


title: Puppet state

text: Several European governments under the domination of Germany and Italy during World War II have been described as "puppet régimes". The formal means of control in occupied Europe varied greatly. These states fall into several categories.


title: Puppet state

text: The Axis demand for oil and the concern of the Allies that Germany would look to the oil-rich Middle East for a solution, caused the invasion of Iraq by the United Kingdom and the invasion of Iran by the United Kingdom and the Soviet Union. Pro-Axis governments in both Iraq and Iran were removed and replaced with Allied-dominated governments.


title: Puppet state

text: As Soviet forces prevailed over the German Army on the Eastern Front during the Second World War, the Soviet Union supported the creation of communist governments throughout Eastern Europe. Specifically, the People's Republics in Poland, Romania, Czechoslovakia, Bulgaria, Hungary, and Albania were dominated by the Soviet Union. While all of these People's Republics did not "officially" take power until after World War II ended, they all have roots in pro-Communist war-time governments.


title: Puppet state

text: In some cases, the process of decolonization has been managed by the decolonizing power to create a neo-colony, that is a nominally independent state whose economy and politics permits continued foreign domination. Neo-colonies are not normally considered puppet states.


title: Puppet state

text: The Netherlands formed several puppet states in the former Dutch East Indies as part of the effort to quell the Indonesian National Revolutionː


title: Puppet state

text: Following Belgian Congo's independence as the Congo-Leopoldville in 1960, Belgian interests supported the short-lived breakaway state of Katanga (1960–1963).


title: Puppet state

text: Indonesia established a Provisional Government of East Timor following its invasion of East Timor in December 1975.


title: Puppet state

text: During the 1970s and 1980s, four ethnic bantustans, called "homelands" by the government of the time (some of which were extremely fragmented), were carved out of South Africa and given nominal sovereignty. Mostly Xhosa people resided in the Ciskei and Transkei, Tswana people in Bophuthatswana and Venda people in the Venda Republic.


title: Puppet state

text: The principal purpose of these states was to remove the Xhosa, Tswana and Venda peoples from South African citizenship (and so to provide grounds for denying them democratic rights). All four bantustans were reincorporated into a democratic South Africa on 27 April 1994.


title: Puppet state

text: The South African authorities established 10 bantustans in South West Africa (present-day Namibia), then illegally occupied by South Africa, in the late 1960s and early 1970s in accordance with the Odendaal Commission, three of which were granted self-rule. These bantustans were replaced with separate ethnicity based governments in 1980.


title: Puppet state

text: The United States had many puppet states including the Islamic Republic of Afghanistan as well as the Iraqi Interim Government which both were military occupied by the United States. The US also military occupied parts of Latin America during the Banana Wars and installed puppet regimes in Cuba, the Dominican Republic, Haiti, and Mexico.


title: Puppet state

text: The Republic of Kuwait was a short-lived pro-Iraqi state in the Persian Gulf that only existed three weeks before it was annexed by Iraq in 1990.


title: Puppet state

text: The Republic of Serbian Krajina was a self proclaimed and by Serbian forces ethnic cleansed territory during the Croatian War (1991–95). It was not recognized internationally. That regime was completely dependent to the Serbian regime of Slobodan Milošević.


title: Hyponatremia

text: Hyponatremia or hyponatraemia is a low concentration of sodium in the blood. It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. Symptoms can be absent, mild or severe. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. Severe symptoms include confusion, seizures, and coma; death can ensue.


title: Hyponatremia

text: The causes of hyponatremia are typically classified by a person's body fluid status into low volume, normal volume, or high volume. Low volume hyponatremia can occur from diarrhea, vomiting, diuretics, and sweating. Normal volume hyponatremia is divided into cases with dilute urine and concentrated urine. Cases in which the urine is dilute include adrenal insufficiency, hypothyroidism, and drinking too much water or too much beer. Cases in which the urine is concentrated include syndrome of inappropriate antidiuretic hormone secretion (SIADH). High volume hyponatremia can occur from heart failure, liver failure, and kidney failure. Conditions that can lead to falsely low sodium measurements include high blood protein levels such as in multiple myeloma, high blood fat levels, and high blood sugar.


title: Hyponatremia

text: Treatment is based on the underlying cause. Correcting hyponatremia too quickly can lead to complications. Rapid partial correction with 3% normal saline is only recommended in those with significant symptoms and occasionally those in whom the condition was of rapid onset. Low volume hyponatremia is typically treated with intravenous normal saline. SIADH is typically treated by correcting the underlying cause and with fluid restriction while high volume hyponatremia is typically treated with both fluid restriction and a diet low in salt. Correction should generally be gradual in those in whom the low levels have been present for more than two days.


title: Hyponatremia

text: Hyponatremia is the most common type of electrolyte imbalance, and is often found in older adults. It occurs in about 20% of those admitted to hospital and 10% of people during or after an endurance sporting event. Among those in hospital, hyponatremia is associated with an increased risk of death. The economic costs of hyponatremia are estimated at $2.6 billion per annum in the United States.


title: Hyponatremia

text: Signs and symptoms of hyponatremia include nausea and vomiting, headache, short-term memory loss, confusion, lethargy, fatigue, loss of appetite, irritability, muscle weakness, spasms or cramps, seizures, and decreased consciousness or coma. Lower levels of plasma sodium are associated with more severe symptoms. However, mild hyponatremia (plasma sodium levels at 131–135 mmol/L) may be associated with complications and subtle symptoms (for example, increased falls, altered posture and gait, reduced attention, impaired cognition, and possibly higher rates of death).


title: Hyponatremia

text: Neurological symptoms typically occur with very low levels of plasma sodium (usually <115 mmol/L). When sodium levels in the blood become very low, water enters the brain cells and causes them to swell (cerebral edema). This results in increased pressure in the skull and causes "hyponatremic encephalopathy". As pressure increases in the skull, herniation of the brain can occur, which is a squeezing of the brain across the internal structures of the skull. This can lead to headache, nausea, vomiting, confusion, seizures, brain stem compression and respiratory arrest, and non-cardiogenic accumulation of fluid in the lungs. This is usually fatal if not immediately treated.


title: Hyponatremia

text: Symptom severity depends on how fast and how severe the drop in blood sodium level is. A gradual drop, even to very low levels, may be tolerated well if it occurs over several days or weeks, because of neuronal adaptation. The presence of underlying neurological disease such as a seizure disorder or non-neurological metabolic abnormalities, also affects the severity of neurologic symptoms.


title: Hyponatremia

text: Chronic hyponatremia can lead to such complications as neurological impairments. These neurological impairments most often affect gait (walking) and attention, and can lead to increased reaction time and falls. Hyponatremia, by interfering with bone metabolism, has been linked with a doubled risk of osteoporosis and an increased risk of bone fracture.


title: Hyponatremia

text: The specific causes of hyponatremia are generally divided into those with low tonicity (lower than normal concentration of solutes), without low tonicity, and falsely low sodiums. Those with low tonicity are then grouped by whether the person has high fluid volume, normal fluid volume, or low fluid volume. Too little sodium in the diet alone is very rarely the cause of hyponatremia.


title: Hyponatremia

text: Both sodium and water content increase: Increase in sodium content leads to hypervolemia and water content to hyponatremia.


title: Hyponatremia

text: Hypovolemia (extracellular volume loss) is due to total body sodium loss. Hyponatremia is caused by a relatively smaller loss in total body water.


title: Hyponatremia

text: Antipsychotics have been reported to cause hyponatremia in a review of medical articles from 1946 to 2016.


title: Hyponatremia

text: Available evidence suggests that all classes of psychotropics, i.e., antidepressants, antipsychotics, mood stabilizers, and sedative/hypnotics can lead to hyponatremia. Age is a significant factor for drug induced hyponatremia.


title: Hyponatremia

text: Miscellaneous causes that are not included under the above classification scheme include the following:


title: Hyponatremia

text: The causes of and treatments for hyponatremia can only be understood by having a grasp of the size of the body fluid compartments and subcompartments and their regulation; how under normal circumstances the body is able to maintain the sodium concentration within a narrow range (homeostasis of body fluid osmolality); conditions can cause that feedback system to malfunction (pathophysiology); and the consequences of the malfunction of that system on the size and solute concentration of the fluid compartments.


title: Hyponatremia

text: There is a hypothalamic-kidney feedback system which normally maintains the concentration of the serum sodium within a narrow range. This system operates as follows: in some of the cells of the hypothalamus, there are osmoreceptors which respond to an elevated serum sodium in body fluids by signalling the posterior pituitary gland to secrete antidiuretic hormone (ADH) (vasopressin). ADH then enters the bloodstream and signals the kidney to bring back sufficient solute-free water from the fluid in the kidney tubules to dilute the serum sodium back to normal, and this turns off the osmoreceptors in the hypothalamus. Also, thirst is stimulated. Normally, when mild hyponatremia begins to occur, that is, the serum sodium begins to fall below 135 mEq/L, there is no secretion of ADH, and the kidney stops returning water to the body from the kidney tubule. Also, no thirst is experienced. These two act in concert to raise the serum sodium to the normal range.


title: Hyponatremia

text: Hyponatremia occurs 1) when the hypothalamic-kidney feedback loop is overwhelmed by increased fluid intake, 2) the feedback loop malfunctions such that ADH is always "turned on", 3) the receptors in the kidney are always "open" regardless of there being no signal from ADH to be open; or 4) there is an increased ADH even though there is no normal stimulus (elevated serum sodium) for ADH to be increased.


title: Hyponatremia

text: Hyponatremia occurs in one of two ways: either the osmoreceptor-aquaporin feedback loop is "overwhelmed", or it is "interrupted". If it is interrupted, it is either "related" or "not related" to ADH. If the feedback system is overwhelmed, this is water intoxication with maximally dilute urine and is caused by 1) pathological water drinking (psychogenic polydipsia), 2) beer potomania, 3) overzealous intravenous solute free water infusion, or 4) infantile water intoxication. "Impairment of urine diluting ability related to ADH" occurs in nine situations: 1) arterial volume depletion 2) hemodynamically mediated, 3) congestive heart failure, 4) cirrhosis, 5) nephrosis, 6) spinal cord disease, 7) Addison's disease, 8) cerebral salt wasting, and 9) syndrome of inappropriate antidiuretic hormone secretion (SIADH).


title: Hyponatremia

text: If the feed-back system is normal, but an "impairment of urine diluting ability unrelated to ADH" occurs, this is 1) oliguric kidney failure, 2) tubular interstitial kidney disease, 3) diuretics, or 4) nephrogenic syndrome of antidiuresis.


title: Hyponatremia

text: Sodium is the primary positively charged ion outside of the cell and cannot cross from the interstitial space into the cell. This is because charged sodium ions attract around them up to 25 water molecules, thereby creating a large polar structure too large to pass through the cell membrane: "channels" or "pumps" are required.


title: Hyponatremia

text: Cell swelling also produces activation of volume-regulated anion channels which is related to the release of taurine and glutamate from astrocytes.


title: Hyponatremia

text: The history, physical exam, and laboratory testing are required to determine the underlying cause of hyponatremia. A blood test demonstrating a serum sodium less than 135 mmol/L is diagnostic for hyponatremia. The history and physical exam are necessary to help determine if the person is hypovolemic, euvolemic, or hypervolemic, which has important implications in determining the underlying cause. An assessment is also made to determine if the person is experiencing symptoms from their hyponatremia. These include assessments of alertness, concentration, and orientation.


title: Hyponatremia

text: False hyponatremia, also known as spurious, pseudo, hypertonic, or artifactual hyponatremia is when the lab tests read low sodium levels but there is no hypotonicity. In hypertonic hyponatremia, resorption of water by molecules such as glucose (hyperglycemia or diabetes) or mannitol (hypertonic infusion) occurs. In isotonic hyponatremia a measurement error due to high blood triglyceride level (most common) or paraproteinemia occurs. It occurs when using techniques that measure the amount of sodium in a specified volume of serum/plasma, or that dilute the sample before analysis.


title: Hyponatremia

text: True hyponatremia, also known as hypotonic hyponatremia, is the most common type. It is often simply referred to as "hyponatremia." Hypotonic hyponatremia is categorized in 3 ways based on the person's blood volume status. Each category represents a different underlying reason for the increase in ADH that led to the water retention and thence hyponatremia:


title: Hyponatremia

text: Chronic hyponatremia is when sodium levels drop gradually over several days or weeks and symptoms and complications are typically moderate. Chronic hyponatremia is often called asymptomatic hyponatremia in clinical settings because it is thought to have no symptoms; however, emerging data suggests that "asymptomatic" hyponatremia is not actually asymptomatic.


title: Hyponatremia

text: Acute hyponatremia is when sodium levels drop rapidly, resulting in potentially dangerous effects, such as rapid brain swelling, which can result in coma and death.


title: Hyponatremia

text: The treatment of hyponatremia depends on the underlying cause. How quickly treatment is required depends on a person's symptoms. Fluids are typically the cornerstone of initial management. In those with severe disease an increase in sodium of about 5 mmol/L over one to four hours is recommended. A rapid rise in serum sodium is anticipated in certain groups when the cause of the hyponatremia is addressed thus warranting closer monitoring in order to avoid overly rapid correction of the blood sodium concentration. These groups include persons who have hypovolemic hyponatremia and receive intravenous fluids (thus correcting their hypovolemia), persons with adrenal insufficiency who receive hydrocortisone, persons in whom a medication causing increased ADH release has been stopped, and persons who have hyponatremia due to decreased salt and/or solute intake in their diet who are treated with a higher solute diet. If large volumes of dilute urine are seen, this can be a warning sign that overcorrection is imminent in these individuals.


title: Hyponatremia

text: In persons with hyponatremia due to low blood volume (hypovolemia) from diuretics with simultaneous low blood potassium levels, correction of the low potassium level can assist with correction of hyponatremia.


title: Hyponatremia

text: American and European guidelines come to different conclusions regarding the use of medications. In the United States they are recommended in those with SIADH, cirrhosis, or heart failure who fail limiting fluid intake. In Europe they are not generally recommended.


title: Hyponatremia

text: There is tentative evidence that vasopressin receptor antagonists (vaptans), such as conivaptan, may be slightly more effective than fluid restriction in those with high volume or normal volume hyponatremia. They should not be used in people with low volume. They may also be used in people with chronic hyponatremia due to SIADH that is insufficiently responsive to fluid restriction and/or sodium tablets.


title: Hyponatremia

text: Demeclocycline, while sometimes used for SIADH, has significant side effects including potential kidney problems and sun sensitivity. In many people it has no benefit while in others it can result in overcorrection and high blood sodium levels.


title: Hyponatremia

text: Daily use of urea by mouth, while not commonly used due to the taste, has tentative evidence in SIADH. However, it is not available in many areas of the world.


title: Hyponatremia

text: Raising the serum sodium concentration too rapidly may cause osmotic demyelination syndrome. Rapid correction of sodium levels can also lead to central pontine myelinolysis (CPM). It is recommended not to raise the serum sodium by more than 10 mEq/L/day.


title: Hyponatremia

text: Hyponatremia is the most commonly seen water–electrolyte imbalance. The disorder is more frequent in females, the elderly, and in people who are hospitalized. The number of cases of hyponatremia depends largely on the population. In hospital it affects about 15–20% of people; however, only 3–5% of people who are hospitalized have a sodium level less than 130 mmol/L. Hyponatremia has been reported in up to 30% of the elderly in nursing homes and is also present in approximately 30% of people who are depressed on selective serotonin reuptake inhibitors.


title: Hyponatremia

text: People who have hyponatremia who require hospitalisation have a longer length of stay (with associated increased costs) and also have a higher likelihood of requiring readmission. This is particularly the case in men and in the elderly.


title: Super Bowl XXXII

text: Super Bowl XXXII was an American football game played between the National Football Conference (NFC) champion Green Bay Packers (who were defending their Super Bowl XXXI championship) and the American Football Conference (AFC) champion Denver Broncos to decide the National Football League (NFL) champion for the 1997 season. The Broncos defeated the Packers by the score of 31–24. The game was played on January 25, 1998, at Qualcomm Stadium in San Diego, California, the second time that the Super Bowl was held in that city. Super Bowl XXXII also made Qualcomm Stadium the only stadium in history to host both the Super Bowl and the World Series in the same year.


title: Super Bowl XXXII

text: This was Denver's first league championship after suffering four previous Super Bowl losses, and snapped a 13-game losing streak for AFC teams in the Super Bowl (the last win being the Los Angeles Raiders' win in Super Bowl XVIII after the 1983 season). The Broncos, who entered the game after posting a 12–4 regular-season record in 1997, became just the second wild card team to win a Super Bowl and the first since the Raiders in Super Bowl XV. The Packers, who entered the game as the defending Super Bowl XXXI champions after posting a 13–3 regular-season record, were the first team favored to win by double digits to lose a Super Bowl since the Minnesota Vikings in Super Bowl IV.


title: Super Bowl XXXII

text: The game was close throughout much of the contest. The Broncos converted two turnovers to take a 17–7 lead in the second quarter before the Packers cut the score to 17–14 at halftime. Green Bay kept pace with Denver in the second half, before tying the game with 13:31 remaining. Both defenses stiffened until Broncos running back Terrell Davis scored the go-ahead touchdown with 1:45 left. Despite suffering a migraine headache that caused him to miss most of the second quarter, Davis (who is coincidentally a San Diego native) was named Super Bowl MVP. He ran for 157 yards, caught two passes for 8 yards, and scored a Super Bowl record three rushing touchdowns.


title: Super Bowl XXXII

text: NFL owners awarded Super Bowl XXXII to San Diego during their October 26, 1993 meeting in Chicago. This was the second time San Diego hosted the game; the city previously hosted Super Bowl XXII ten years earlier on January 31, 1988. The Broncos played in both San Diego Super Bowls and became the first franchise to play two different Super Bowls in the same stadium twice; they had already played twice at the Louisiana Superdome, in Super Bowls XII and XXIV.


title: Super Bowl XXXII

text: The Packers entered the 1997 season coming off of their win in Super Bowl XXXI. They then repeated as NFC Central division champions, earning a 13–3 regular-season record. Green Bay's offense ranked 2nd in the league in points scored and 4th in yards gained, while their defense respectively ranked 5th and 7th in those two categories.


title: Super Bowl XXXII

text: Quarterback Brett Favre had another Pro Bowl season and became the first player ever to win the NFL MVP award three times, winning it for the third consecutive year (Favre was named co-MVP in 1997 with Detroit Lions running back Barry Sanders). Favre led the league with 35 passing touchdowns and completed 304 out of 513 attempts for 3,867 yards, with 16 interceptions, while ranking second on the team in rushing with 187 yards and a touchdown. Wide receiver Antonio Freeman led the team in receptions with 81 catches for 1,243 yards and 12 touchdowns. Wide receiver Robert Brooks was also a major deep threat, catching 60 passes for 1,010 yards and 7 touchdowns. Pro Bowl tight end Mark Chmura recorded 38 receptions for 417 yards and 6 touchdowns. Pro Bowl running back Dorsey Levens led the team in rushing with 1,435 yards and 7 touchdowns, while also catching 53 passes for 373 yards and 5 touchdowns. Fullback William Henderson rushed for 113 yards and caught 41 passes for 367 yards and a touchdown. On special teams, receiver Bill Schroeder led the team with 33 punt returns for 342 yards, while also gaining 562 yards on 24 kickoff returns.


title: Super Bowl XXXII

text: On the Packers' defense, the line was led by veteran Pro Bowl selection Reggie White, who led the team with 11 sacks. Behind him, Santana Dotson recorded 37 tackles and 5.5 sacks. In the secondary, Pro Bowl defensive back LeRoy Butler led the team with 5 interceptions, while also adding 70 tackles. Safety Eugene Robinson led the team with 74 tackles while also recording 2.5 sacks, 2 fumble recoveries, and 1 interception. Cornerback Mike Prior recorded 4 interceptions, while rookie Darren Sharper recorded 2 of them, both of which he returned for touchdowns.


title: Super Bowl XXXII

text: The Broncos entered Super Bowl XXXII after suffering four Super Bowl losses: Super Bowls XII, XXI, XXII, and XXIV from 1978, 1987, 1988, and 1990, respectively. In all of those losses, the Broncos never had the ability to rush well enough or score enough points to be competitive. Denver had been defeated by a large margin in each one, losing all four by a combined scoring margin of 163–50.


title: Super Bowl XXXII

text: The previous three Super Bowl losses were under starting quarterback John Elway, whose ad-libbing skills enabled the Broncos to advance to the league's championship game in a span of three out of four seasons. Elway also led his team to the 1991 AFC Championship Game, but they lost in a defensive struggle to the Buffalo Bills, 10–7.


title: Super Bowl XXXII

text: The team's fortunes changed when Mike Shanahan became head coach of the Broncos in 1995. Shanahan was previously Denver's offensive coordinator during those Super Bowl losses, but was fired in 1991 after a power struggle between him and then-head coach Dan Reeves over the offensive personnel. Shanahan then served as the offensive coordinator for the San Francisco 49ers from 1992 to 1994, including the 49ers' Super Bowl XXIX win. Under Shanahan, the San Francisco offense ranked first in the league in total yards gained for all three of his seasons there.


title: Super Bowl XXXII

text: When Shanahan returned to the Broncos in 1995, he selected running back Terrell Davis in the 6th round of the NFL draft. Davis became the cornerstone of Denver's rebuilt running game, leading the team with 1,117 rushing yards in just his rookie year. The Broncos finished the 1995 regular season with just an 8–8 record. By 1996, the Broncos had the league's best offense, gaining 5,791 total yards, and recorded the AFC's best regular-season record at 13–3, but they were upset by the second-year Jacksonville Jaguars, 30–27 in the playoffs.


title: Super Bowl XXXII

text: During the 1997 regular season, the Broncos once again had the league's best offense with 5,872 total yards and led the league in total points scored with 472. Although they recorded a 12–4 regular-season record, they finished in second place behind the 13–3 Kansas City Chiefs in the AFC West.


title: Super Bowl XXXII

text: Davis, a Pro Bowl selection, remained the team's leading rusher, recording 1,750 yards and 15 touchdowns, while also catching 42 passes for 287 yards. At 37 years old, Elway still posted a Pro Bowl season with 280 out of 502 completions for 3,635 yards, 27 touchdowns, and only 11 interceptions. He also rushed for 215 yards and another touchdown. Pro Bowl tight end Shannon Sharpe led the team with 72 receptions for 1,107 yards. Wide receiver Rod Smith, who was not drafted by any NFL team and recorded only 22 receptions for 389 yards and 3 touchdowns in his two previous seasons, had a breakout year with 70 receptions for 1,180 yards and 12 touchdowns. Wide receiver Ed McCaffrey, who played in Shanahan's 1994 49ers offense, recorded 45 receptions for 590 yards and 8 touchdowns. Denver's offensive line was led by seven-time Pro Bowl left tackle Gary Zimmerman and Pro Bowl center Tom Nalen.


title: Super Bowl XXXII

text: On defense, the major acquisition to the team prior to the season was former Chiefs defensive lineman Neil Smith. Smith had a Pro Bowl season for the 6th time in his career with 28 tackles and 8.5 sacks. Defensive end Alfred Williams recorded 36 tackles, 8.5 sacks, and a fumble recovery. The linebacking corps was led by veteran Bill Romanowski, who had 55 tackles and 2 sacks, and John Mobley, who led the team with 97 tackles while also recording 4 sacks, a fumble recovery, and an interception.


title: Super Bowl XXXII

text: The secondary was led by veteran defensive backs Tyrone Braxton, who led the team with 4 interceptions for 113 yards and 1 touchdown, and Steve Atwater, who had 53 tackles, 1 sack, 2 fumble recoveries, and 2 interceptions for 42 yards and 1 touchdown. Defensive back Darrien Gordon recorded 50 tackles, 2 sacks, 4 fumble recoveries, 4 interceptions, 64 return yards, and 1 touchdown. He also returned 40 punts for 543 yards and 3 touchdowns.


title: Super Bowl XXXII

text: The Broncos entered the playoffs as a wild-card team and defeated the Jacksonville Jaguars, 42–17, the Kansas City Chiefs, 14–10, and the Pittsburgh Steelers, 24–21, making Denver the fifth wild-card team to make it to the Super Bowl. Meanwhile, the Packers were victorious against the Tampa Bay Buccaneers, 21–7, and the San Francisco 49ers, 23–10.


title: Super Bowl XXXII

text: The Packers came into the game as 11-point favorites, having compiled a 13–3 record regular-season record compared to the Broncos' 12–4 and coming in as defending Super Bowl champions after winning Super Bowl XXXI 35–21 over the New England Patriots. Furthermore, the Packers had easily crushed their two playoff opponents, while the Broncos had barely edged out their final two postseason victories by a margin of one score.


title: Super Bowl XXXII

text: As the designated home team in the annual rotation between AFC and NFC teams, the Broncos chose to wear their newly unveiled home navy uniforms with white pants. The uniforms replaced the "Orange Crush" uniforms they previously wore in three of their four Super Bowl losses. The Packers wore their customary road white uniforms with gold pants. Both teams wore the Super Bowl XXXII logo on the left breast of their jersey. The Super Bowl logo was previously worn in Super Bowl XXV to commemorate the game's silver anniversary. All future Super Bowls contestants would wear the game's logo on their jerseys.


title: Super Bowl XXXII

text: The game was televised in the United States by NBC, with play-by-play announcer Dick Enberg (calling his eighth and final Super Bowl), color commentators Phil Simms and Paul Maguire, and sideline reporter Jim Gray. Greg Gumbel hosted all the events, and was joined by co-host Ahmad Rashad and commentators Cris Collinsworth, Sam Wyche, and Joe Gibbs. This was Gumbel's final assignment for NBC as he returned to CBS for the 1998 season. Following the game, NBC aired a special one-hour episode of "3rd Rock from the Sun", which opened live at the game site with Gumbel playing himself before he was "attacked" by show star John Lithgow (except for the NBC affiliate in Denver, which broadcast 30 minutes of post-game reactions and interviews before screening the programme). During the game, NBC (partnering with Silicon Graphics Inc.) included real-time 3D computer graphics on SGI's Onyx2 computers to display a model of Qualcomm Stadium and simulating real-time animation of things such as receiver patterns and yards after the catch; along with a second model known as "Football Guy" which allowed viewers to see defensive players from the quarterback's vantage point, with those replays handled by Randy Cross.


title: Super Bowl XXXII

text: This broadcast was the last for NBC as the AFC network after 33 years (CBS has held the AFC broadcast rights ever since), their last NFL broadcast overall until 2006, when they signed on to televise "Sunday Night Football", and their last Super Bowl broadcast until 2009 (Super Bowl XLIII). This was also the last time Channel 4 in the United Kingdom showed the Super Bowl – and their last NFL coverage until 2010 – after they had been showing the event since 1983 (Super Bowl XVII). Only Sky Sports showed it live until Channel 5 joined them in 2003 (Super Bowl XXXVII). It also marked the last Super Bowl until 2007 for CTV in Canada after airing the NFL and the event since Super Bowl XVI; from 1999 to 2006 the Super Bowl aired on the Global Television Network. CTV had aired NFL football since 1970 and the Super Bowl since 1982 (Super Bowl XVI). It was also the final NFL game for GMA Network in the Philippines until the 2006 season; GMA had aired NFL football since 1986 and the Super Bowl since Super Bowl XXI in 1987. The Super Bowl was broadcast on ABC 5, also from 1999 until 2006. It was also the final Super Bowl in which the Televisa family of networks aired on its own in Mexico, also until 2007, being broadcast on Canal 5; Televisa had aired NFL football since 1970 and the Super Bowl since 1988 (at the time, the only other Super Bowl in San Diego). Azteca 13 likewise exclusively aired the Super Bowl from 1999 until 2006, including Super Bowl XXXVII which was the next Super Bowl to be played at Qualcomm Stadium.


title: Super Bowl XXXII

text: The pregame show, narrated by actor and comedian Phil Hartman (who was murdered four months and three days later), celebrated the music and history of California. It featured performances by The 5th Dimension, Lee Greenwood, and The Beach Boys. Singer Jewel later sang the U.S. national anthem.


title: Super Bowl XXXII

text: To honor the 10th anniversary of the Washington Redskins' win in Super Bowl XXII, the only other previous Super Bowl played in San Diego, the game's MVP, Doug Williams, and former head coach Joe Gibbs participated during the coin toss ceremony. They were joined by the recently retired, longtime college football head coach Eddie Robinson, who ran the Grambling State University Tigers football team from 1942 until 1997.


title: Super Bowl XXXII

text: The halftime show was titled "A Tribute to Motown's 40th Anniversary" and featured Boyz II Men, Smokey Robinson, Queen Latifah, Martha Reeves and The Temptations.


title: Super Bowl XXXII

text: Packers wide receiver Antonio Freeman returned the opening kickoff 19 yards to the Green Bay 24-yard line. On the third play of the drive, quarterback Brett Favre kept the offense on the field by completing a 13-yard pass to Freeman on 3rd down and 9. Then running back Dorsey Levens rushed the ball on three consecutive plays, gaining 27 yards to advance to the Denver 35-yard line. Favre finished the drive with two completions to Freeman: the first one for 13 yards, and the second one a 22-yard touchdown pass to give the Packers a 7–0 lead (the Packers were the third team to take the opening kickoff down the field and score a touchdown on that drive; the other two were the Miami Dolphins in Super Bowl VIII and the San Francisco 49ers in Super Bowl XXIX).


title: Super Bowl XXXII

text: The Broncos responded with a touchdown of their own. Denver running back Vaughn Hebron returned the ensuing kickoff 32 yards to their own 42-yard line. Denver then drove to the Green Bay 46-yard line. On third down, a holding penalty on Packers defensive back Doug Evans nullified quarterback John Elway's incompletion and gave the Broncos a first down. On the next play, running back Terrell Davis ran the ball 27 yards to the 14-yard line. Then after a 2-yard run by Davis, Elway scrambled 10 yards to gain a first down at the 2-yard line. Two plays later, Davis capped off the 10-play, 58-yard drive with a 1-yard touchdown run to tie the game (this is to date the only Super Bowl in which both teams scored TDs on their opening drives).


title: Super Bowl XXXII

text: On the second play of the Packers' next possession, Denver defensive back Tyrone Braxton intercepted a pass from Favre at Green Bay's 45-yard line.


title: Super Bowl XXXII

text: Aided by five runs by Davis for 29 yards, Denver marched 45 yards to score on Elway's 1-yard touchdown run on the first play of the 2nd quarter, taking a 14–7 lead. Elway's touchdown play involved a fake handoff to Davis, who was previously taken out of the game during the drive because the onset of a migraine headache after being inadvertently tripped by LeRoy Butler had severely impaired his vision. But head coach Mike Shanahan decided to send him into the game for the 3rd-down play, believing that the Packers would not be fooled by a fake handoff without Davis on the field. Davis later said his vision was so impaired that he was afraid Elway would call an audible at the line and try to hand him the ball. Despite his blurred vision, Davis perfectly executed the play, drawing the Green Bay defense into the middle of the line as Elway rushed to the right and into the end zone completely untouched. By the second half, Davis had taken migraine medication, and his vision had returned to normal, allowing him to play the rest of the game.


title: Super Bowl XXXII

text: On the Packers' ensuing possession, Broncos safety Steve Atwater forced a fumble while sacking Favre, and defensive end Neil Smith recovered the ball on the Packers 33-yard line. Although the Broncos were unable to get a first down, kicker Jason Elam made a 51-yard field goal, the second-longest in Super Bowl history, to increase Denver's lead to 17–7. Both teams went three-and-out on their next possessions, and Denver punter Tom Rouen's 47-yard kick planted Green Bay at their own 5-yard line with 7:38 left in the quarter. But Green Bay stormed down the field on their ensuing drive, marching 95 yards in 17 plays and scoring with Favre's 6-yard touchdown pass to tight end Mark Chmura with just 12 seconds left in the half. Thus at halftime, the Broncos held a slim 17–14 lead.


title: Super Bowl XXXII

text: Green Bay kicked to Denver to start the second half. On the first play after the kickoff, Packer defensive back Tyrone Williams forced and recovered a fumble from Davis. Green Bay took possession with good field position at the Broncos' 26-yard line to begin the second half. But Denver's defense forced a three-and-out. However, on the ensuing field goal attempt, Denver's special teams were called for an offsides penalty, giving the Packers a second 1st and 10 at the Broncos' 15-yard line. But the Broncos defense forced a second three-and-out in back-to-back possessions, stalling the Packers' drive at the 9-yard line and forcing them to settle for a 27-yard Ryan Longwell field goal, tying the game at 17–17.


title: Super Bowl XXXII

text: Green Bay kicked off once again and Denver's offense stalled once more, resulting in a punt, giving the Packers possession with good field position again, this time near their 40-yard line. But Denver's defense forced another three-and-out for the third straight time. However, again on the ensuing punt, the Broncos' special teams were called for an offsides penalty, giving Green Bay a fresh set of downs near midfield. Denver's defense then forced another punt with a fourth three-and-out in a row.


title: Super Bowl XXXII

text: Green Bay punter Craig Hentrich's 51-yard kick pinned the Broncos back at their own 8-yard line. But the Packers' defense could not stop Denver as they marched on a 13-play, 92-yard drive to regain the lead. Aided by a 36-yard reception by receiver Ed McCaffrey, the Broncos advanced to the Green Bay 12-yard line. On 3rd and 6 from the 12-yard line, Elway scrambled for an 8-yard run and dove for the first down, a play in which he was hit so hard by Packers defenders Butler and Mike Prior that he spun sideways in mid-air. This run was later referred to as "The Helicopter," and what many consider as Elway's career-defining moment and the defining moment of Super Bowl XXXII. Two plays later, Davis scored on another 1-yard touchdown run, giving the Broncos the lead, 24–17.


title: Super Bowl XXXII

text: On the ensuing kickoff, Denver's special teams player Detron Smith ran full speed into the wedge of the Green Bay blockers, forcing Freeman outside, to his left. Freeman was hit as he held the ball exposed while running sideways and fumbled, then Denver defensive back Tim McKyer recovered the ball at the Packers' 22-yard line. The Broncos immediately tried to capitalize on the turnover by trying a quick-strike touchdown pass, intended for Rod Smith as he ran a post pattern following a fake handoff and a roll out by Elway, but Packers safety Eugene Robinson intercepted Elway's pass in the end zone and returned it to the 15-yard line.


title: Super Bowl XXXII

text: After the interception, the Packers marched 85 yards on four straight pass completions, three of them receptions by Freeman, to tie the game once again 1:28 into the 4th quarter with Freeman's 13-yard touchdown catch. On the scoring play, Freeman and Robert Brooks ran a "criss-cross" pattern, with Freeman on the inside running towards the sidelines. Denver defensive back Darrien Gordon hesitated as to which receiver to cover, and Favre hit Freeman for the score, tying the game at 24–24.


title: Super Bowl XXXII

text: After the ensuing kick-off, the Packers forced Denver's offense to punt. With a short punt of only 33 yards, the Packers took possession with good field position, having 1st-and-10 at their own 48-yard line. The Packers drove to Denver's 39-yard line. On 3rd and 8, Favre dropped back to pass and Denver's defense blitzed, leaving Packers receiver Robert Brooks to face one-on-one coverage deep. Favre attempted the pass to a seemingly wide-open Brooks at Denver's 16-yard line, but Broncos safety Steve Atwater closed in and knocked the pass away at the last second, leaving the Packers just outside of field-goal range and forcing another punt. The Packers' defense was able to stop Denver's offense on the ensuing possession again, giving Green Bay 1st-and-10 at their own 10-yard line with 5:25 remaining in the game and a chance at a game winning drive with Favre, the 3-time league MVP, at the helm. With the game in the balance, the Broncos defense forced a fifth critical three-and-out in the second half.


title: Super Bowl XXXII

text: Packers kicker Hentrich then punted the ball 39 yards to the Packers' 49-yard line, giving Denver a chance to end the game on a potentially game-winning drive with only 3:27 left in the game. On the first play of the ensuing drive, Packers linebacker Darius Holland committed a 15-yard face-mask penalty while tackling Davis on a 2-yard run, moving the ball to the 32-yard line. Two plays later, Elway completed a 23-yard pass to fullback Howard Griffith, aided by a powerful block by Ed McCaffrey. A holding penalty pushed the Broncos back to the 18-yard line, but then Davis rushed 17 yards to the 1-yard line, and the Broncos called a time-out. This left the Broncos facing 2nd and goal with 1:47 left on the clock. Green Bay had two time-outs remaining.


title: Super Bowl XXXII

text: Packers coach Mike Holmgren told his team to let the Broncos score to maximize the time the Packers would have on the clock for a potential game-tying drive. He admitted later that he had thought that it was 1st and goal rather than 2nd and goal, a crucial distinction in clock-management decision-making on the play. Davis then scored his third rushing touchdown on 2nd and goal, leaving 1:45 on the clock. The Broncos now had a one-touchdown lead, with the score 31–24.


title: Super Bowl XXXII

text: The Packers attempted one final drive to try to tie the game before the end of regulation and send the contest into overtime. Shanahan famously instructed his defensive coordinators to keep playing the same blitzing defense they'd done throughout the game as Green Bay attempted to drive downfield in the final two minutes, rather than playing prevent defense. Freeman returned the Broncos' kickoff 22 yards to the 30-yard line. On the very first play of the drive, the Packers advanced to the Broncos' 48-yard line with a 22-yard screen pass to Levens, leaving them in Broncos Territory with 1:30 still remaining in the game and two time-outs. But following the first pass, rather than use one of their time-outs, the Packers hurried to the line of scrimmage and ran a second consecutive screen pass to Levens. The pass was complete, but Levens was stopped for no gain. The play cost the Packers 19 seconds, leaving 1:11 on the game clock and also forcing the Packers to take one of their two time-outs.


title: Super Bowl XXXII

text: On the next play Favre completed another pass to Levens. Levens picked up 13 yards and was able to run out of bounds, stopping the clock with 1:04 left in the game. The Packers had 1st-and-10 at the Broncos' 35-yard line with one time-out remaining. The Broncos defense would stop the Packers on the next four downs. On the first-down play, Favre completed a 4-yard pass to Levens, but he was stopped in-bounds. The Packers hurried to the line but 20 seconds ran off before Favre could attempt a second pass. On second down, Favre attempted a pass downfield that hit receiver Antonio Freeman in both hands and the chest at the Broncos' 15, but Freeman could not handle the ball. The incomplete pass stopped the clock, but left the Packers with 3rd-and-6 and now only :37 seconds remaining. On 3rd down, Favre intended the pass for receiver Robert Brooks, covered by Denver's Randy Hilliard, but both were hit by Atwater, and the pass was incomplete. All three players were knocked out of the game. Because of NFL rules regarding injuries to players in the final two minutes of a game, both teams were charged a time-out since players on both teams were injured and needed to be tended to. This left the Packers facing 4th and 6 with the ball at the Broncos' 31-yard line, with no time-outs and the clock stopped at :32 seconds remaining. On 4th down, Denver linebacker John Mobley broke up a pass intended for Chmura, enabling the Broncos to take the ball back and run out the clock for the victory.


title: Super Bowl XXXII

text: During the post-game victory celebration, Broncos owner Pat Bowlen held the Vince Lombardi Trophy in the air and said, "This one's for John," referring to the fact that Elway's long quest for a Super Bowl victory was finally complete. Eighteen years later, Elway, now general manager for the team, would salute an Alzheimer's-stricken Bowlen in the same fashion after the Broncos won Super Bowl 50.


title: Super Bowl XXXII

text: A remarkable fact about Denver's offensive performance was that, except for two penalties and Elway's kneel-downs to end each half, the Broncos did not lose yardage on any play from scrimmage. Green Bay's Reggie White, Gilbert Brown, LeRoy Butler and others were unable to register a sack against the Broncos' front line. Elway completed 12 out of 22 passes for 123 yards, with 1 interception. He became the sixth player to score touchdowns in three different Super Bowls, joining Lynn Swann, Franco Harris, Thurman Thomas, Jerry Rice, and Emmitt Smith. He was also the Broncos' second-leading rusher behind Davis, with 17 yards and a touchdown on 5 carries. Terrell Davis became the only player to rush for three touchdowns in a Super Bowl, and the only non-San Francisco 49er to score three touchdowns in a Super Bowl; Roger Craig, Jerry Rice, and Ricky Watters were the only other players to do so. Rice had 3 touchdown catches in two different Super Bowls. This feat has only been accomplished one time since Davis, by James White in Super Bowl LI. Davis's three touchdowns in this Super Bowl gave him a total of 48 points (8 touchdowns) during the postseason, an NFL record.


title: Super Bowl XXXII

text: Denver's defense limited Green Bay to only 10 points in the second half, despite Green Bay having nine possessions in the second half. The Packers' first four possessions of the second half were all 3-and-out's. Their fifth possession of the second half resulted in a lost fumble by their kick return team, the sixth possession resulted in an 85-yard drive and a touchdown, the seventh ended in four plays and a punt, the eighth resulted in another 3-and-out, and the ninth and final possession ended on a fourth down stop.


title: Super Bowl XXXII

text: Levens was Green Bay's leading rusher with 90 rushing yards, and was their second-leading receiver with 56 yards on 6 receptions. Both Freeman and Favre had outstanding performances for the second Super Bowl game in a row. Favre completed 25 out of 42 passes for 256 yards and 3 touchdowns, with 1 interception. Freeman caught 9 passes for 126 yards and 2 touchdowns, and also gained another 104 yards on 6 kickoff returns, giving him 230 total yards, the third highest total in Super Bowl history. Freeman also tied himself for second all-time in touchdown catches in Super Bowls with three, joining Lynn Swann, John Stallworth, and Cliff Branch, trailing only Rice's eight. He also became just the third player to have at least 100 yards receiving in back-to-back Super Bowls, joining Rice and Stallworth.


title: Super Bowl XXXII

text: Denver was the first team with a previous 0–2 Super Bowl record to win (their record had been 0–4). The Broncos' victory snapped the NFC's 13-game winning streak in the Super Bowl. The Broncos were the first AFC team to win the NFL championship since the Los Angeles Raiders defeated the Washington Redskins in Super Bowl XVIII. Denver also became the first team to score on four 1-yard touchdown runs in a Super Bowl. The Packers became the third defending Super Bowl champion to lose the Super Bowl, joining the Dallas Cowboys (1977–78: won Super Bowl XII, lost Super Bowl XIII) and the Washington Redskins (1982–83: won Super Bowl XVII, lost Super Bowl XVIII), and would be later joined by the Seattle Seahawks (2013–14: won Super Bowl XLVIII, lost Super Bowl XLIX), the New England Patriots (2016–17: won Super Bowl LI, lost Super Bowl LII) and the Kansas City Chiefs (2019-20: won Super Bowl LIV, lost Super Bowl LV).


title: Super Bowl XXXII

text: One new record was set and several were tied in Super Bowl XXXII, according to the official NFL.com boxscore, the 2016 NFL Record & Fact Book and the ProFootball reference.com game summary.


title: Super Bowl XXXII

text: John Robison was originally assigned as the field judge, but was pulled by Vice President of Officiating Jerry Seeman after he missed a call in the Vikings-Giants wild card game. Don Dorkowski, the field judge for the NFC championship game, was named as Robison's replacment.


title: Fire Punch

text: "Fire Punch" takes place on an Earth that has become frozen over and barren, purportedly at the hands of a being known as the Ice Witch. The witch is among a few who possess special abilities known as "blessings". The protagonist Agni is a boy who has the blessing of regeneration, along with his sister Luna. They help the few elders in the village subsist on the meat of Agni's severed arms. One day, their village is visited by a blessed named Doma who offers to take Agni to his city of Behemdorg. Doma, disgusted at their practice of cannibalism, immolates the inhabitants with his inextinguishable flames. Luna, whose regeneration is slower, also succumbs, but not before imploring Agni to "live".


title: Fire Punch

text: Constantly on fire, Agni's body breaks down and regenerates, leaving him in anguish. Over eight years, he is able to control his body again, vowing to get revenge on Doma. Agni comes across a convoy of slaves to Behemdorg and kills the soldiers. A boy named Sun, who thinks Agni is a god, follows him. Later, more soldiers find Agni, and one of them, Judah, a blessed resembling Luna, beheads him. They take him to Behemdorg, and Sun is tied up and made to generate electricity for the city. A repentant Doma asks Agni for forgiveness, but does not allow Agni to kill him.


title: Fire Punch

text: Judah decides to try to kill the seemingly immortal Agni by throwing his severed head into the ocean, taking a train there. Also on the train is Togata, a regenerative blessed and twisted cinephile who has taken an interest in Agni, aiming to make him the subject of a film as director. Togata kills all the Behemdorg soldiers on the train, saving a girl named Neneto from being raped and making her camerawoman. Agni agrees to let Togata film his revenge on Doma in exchange for training.


title: Fire Punch

text: At Behemdorg, Agni decides to free the slaves. While fighting Behemdorg's blessed, Agni's flames burn the city down, killing the residents. Agni defeats the blessed and the slaves are transported by an ally. Judah, no longer needing to maintain a facade of divine revelation, sets herself on fire using Agni's flames, but is stopped when the Ice Witch beheads her.


title: Fire Punch

text: "Fire Punch", written and illustrated by Tatsuki Fujimoto, was published on Shueisha's "Shōnen Jump+" website from April 18, 2016, to January 1, 2018. Shueisha collected its chapters in eight "tankōbon" volumes, released from July 4, 2016, to February 2, 2018.


title: Fire Punch

text: In North America, Viz Media announced that they licensed the manga for English release in January 2018. The eight volumes were published under the VIZ Signature Imprint from January 16, 2018, to October 15, 2019.


title: Fire Punch

text: In 2017, "Fire Punch" was nominated for the 10th Manga Taishō. The series ranked #15 on the "Nationwide Bookstore Employees' Recommended Comics of 2017" poll by Honya Club online bookstore. The 2017 edition of Takarajimasha's "Kono Manga ga Sugoi!" guidebook listed the series at #3 on its list of manga for male readers.


title: La Bamba (film)

text: La Bamba is a 1987 American biographical drama film written and directed by Luis Valdez. The film follows the life and short-lived musical career of Mexican-American Chicano rock and roll star Ritchie Valens. The film stars Lou Diamond Phillips as Valens, Esai Morales, Rosanna DeSoto, Elizabeth Peña, Danielle von Zerneck and Joe Pantoliano. The film also covers the effect that Valens' career had on the lives of his half-brother Bob Morales, his girlfriend Donna Ludwig, and the rest of his family. The film is titled after a Mexican folk song of the same name, which Valens would later transform the song by turning it into a rock and roll rendition in 1958. In 2017, "La Bamba" was included in the annual selection of 25 motion pictures added to the National Film Registry of the US Library of Congress being deemed "culturally, historically, or aesthetically significant" and recommended for preservation.


title: La Bamba (film)

text: During the Summer of 1957 in Northern California, Richard "Richie" Steven Valenzuela is a 16-year old Mexican-American boy who lives with his mother, Concepcion “Connie” Valenzuela and his younger brothers and sisters. His family is poor, and he works as a farmworker after school. He loves music, especially rock and roll, and dreams of becoming a famous musician. Richie suffers from aviophobia due to recurring nightmares about the mid-air collision that occurred directly over his school, in which his best friend was crushed to death by the fallen aircraft, an event he did not witness due to attending his grandfather's funeral. One day, Richie's troubled older half-brother Bob Morales arrives after being released from jail, surprising him and his mother. They all decide to leave the farm and move to a house in Southern California, along with Bob's girlfriend, Rosie.


title: La Bamba (film)

text: Three months later, Richie attends San Fernando High School where he falls in love with fellow student Donna Ludwig, and joins his friend Chino's band, The Silhouettes. Bob becomes an alcoholic and starts to abuse Rosie, shouting at her and raping her. When he learns that Rosie is pregnant, he refuses to take responsibility. Richie invites Donna to a garage party where he and the Silhouettes are performing. At the party, Richie performs on his guitar, but he doesn't get his turn to sing and Donna does not attend.


title: La Bamba (film)

text: Richie decides to host another party and becomes The Silhouettes’ new leader after they vote out their original leader. However, a drunken Bob crashes the party and starts a brawl among the attendees. The next day, Bob Keane, the owner and president of Del-Fi Records in Hollywood, auditions Richie after seeing him perform at the party and signs him to his label; Keane becomes his record producer and manager. Richie and Donna become a couple, despite Donna's father disapproving of his daughter dating a Hispanic boy, and Richie starts recording songs like "We Belong Together" and "Come On, Let's Go" at Gold Star Studios. Keane gives Richie his professional name of "Ritchie Valens", which Richie dislikes at first, but eventually accepts it. Ritchie starts releasing his songs on the radio and becomes an overnight sensation.


title: La Bamba (film)

text: Despite his increasing fame, Ritchie's relationship with Donna suffers with her father refusing to let Ritchie see her. He then gets the inspiration to write the song "Donna", as a tribute to her. One night, Bob meets up with Ritchie, and they go to Tijuana, Mexico. At a brothel, Ritchie sees a band performing the Mexican folk song "La Bamba". He awakens the next day in a small village and is given a talisman by an old man called El Curandero to protect him from his fear of flying. Ritchie and Bob return home to discover that Rosie gave birth to a girl in their absence. Ritchie soon decides to make a rock and roll rendition of "La Bamba" as a single to go along with "Donna" and convinces Keane to release it.


title: La Bamba (film)

text: At first, Ritchie avoids flying to his concerts and appearances, but eventually conquers his fear when invited to perform his song "Donna" on "American Bandstand" in Philadelphia. Keane helps him by giving him a little vodka to calm his nerves during the flight. Bob soon becomes jealous of Ritchie's success and drinks excessively while screaming and shouting at his family, wanting to see his daughter. Ritchie buys his family a brand new house and goes to New York City to perform at Alan Freed's 1st Anniversary Rock 'n' Roll Show at the Brooklyn Paramount Theater, meeting Eddie Cochran and Jackie Wilson backstage. He then goes onstage to perform "La Bamba" to the crowd's adoration. Arriving home for Christmas, he is given a welcoming party by his family and friends, but Bob is resentful and later starts a fight with Ritchie, breaking his talisman in the process. Ritchie promises Donna that he will always love her and hopes that one day they will get married.


title: La Bamba (film)

text: Ritchie later joins the Winter Dance Party tour with Buddy Holly (Marshall Crenshaw) and The Big Bopper after "La Bamba" and "Donna" reach the top of the "Billboard" charts. While performing in Clear Lake, Iowa, at the Surf Ballroom, the tour bus' heating system breaks down, so Holly charters an airplane to fly to their next stop in Moorhead, Minnesota. Valens, Holly, and the Big Bopper take off in the airplane during a snowstorm on February 2, 1959. Before the flight, Ritchie makes a call to his brother, wherein they resolve their differences. He invites Bob to fly out to Chicago to join the tour for family support, which Bob accepts.


title: La Bamba (film)

text: The next day, as Bob is fixing his mother's car, he hears on the radio that his brother's airplane crashed, killing everyone on board. Bob darts out of his driveway in an attempt to get to his mother before she hears the news, but is too late. The news hits the Valenzuela family, Bob Keane, and Donna very hard. After Ritchie's funeral procession at the San Fernando Mission Cemetery, Bob walks across a bridge and screams out Ritchie's name, remembering all the good times they had together.


title: La Bamba (film)

text: Also featured are several members of the Valenzuela family and director Luis Valdez's family, including:


title: La Bamba (film)

text: Brian Setzer has a cameo as Eddie Cochran performing "Summertime Blues" onstage, while Howard Huntsberry plays Jackie Wilson singing "Lonely Teardrops" onstage. Marshall Crenshaw plays Buddy Holly performing "Crying, Waiting, Hoping" at the final concert in Clear Lake, Iowa.


title: La Bamba (film)

text: All of Ritchie Valens' songs were performed by Los Lobos, whom the Valenzuela family personally requested be involved in the film. The band has a cameo in the film performing in the brothel ballroom in Tijuana.


title: La Bamba (film)

text: The film opened in wide release in the United States on July 24, 1987. In the Philippines, it premiered on September 10, 1987. In Australia it opened on September 17, 1987.


title: La Bamba (film)

text: In its opening weekend, the film grossed a total of $5,698,884. "La Bamba" eventually grossed $52,678,820 in the United States in 12 weeks.


title: La Bamba (film)

text: Roger Ebert liked the film and the screenplay, writing, "This is a good small movie, sweet and sentimental, about a kid who never really got a chance to show his stuff. The best things in it are the most unexpected things: the portraits of everyday life, of a loving mother, of a brother who loves and resents him, of a kid growing up and tasting fame and leaving everyone standing around at his funeral shocked that his life ended just as it seemed to be beginning." Writing for "The New York Times", Janet Maslin said she was impressed with Lou Diamond Phillips' performance, and wrote, "A film like this is quite naturally a showcase for its star, and as Valens, Lou Diamond Phillips has a sweetness and sincerity that in no way diminish the toughness of his onstage persona. The role is blandly written, but Mr. Phillips gives Valens backbone."


title: Jensen Huang

text: Jen-Hsun "Jensen" Huang (; born February 17, 1963) is a Taiwanese American billionaire business magnate, electrical engineer, and the co-founder, current president and CEO of Nvidia Corporation.


title: Jensen Huang

text: Huang was born in Tainan, Taiwan. His family emigrated to the United States when he was 9 years old, first living in Oneida, Kentucky, and settling in Oregon, where he graduated from Aloha High School just outside Portland.


title: Jensen Huang

text: Huang received his undergraduate degree in electrical engineering from Oregon State University in 1984, and his master's degree in electrical engineering from Stanford University in 1992.


title: Jensen Huang

text: After college he was a director at LSI Logic and a microprocessor designer at Advanced Micro Devices, Inc. (AMD). On his 30th birthday in 1993, Huang co-founded Nvidia and is the CEO and president.


title: Jensen Huang

text: In 2022 Huang donated $50 million to his alma mater, Oregon State University, as a portion of a $200 million donation towards the creation of super computing institute on campus.


title: Jensen Huang

text: Huang gave his other alma mater Stanford University US$30 million to build the Jen-Hsun Huang School of Engineering Center. The building is the second of four that make up Stanford's Science and Engineering Quad. It was designed by Bora Architects of Portland, Oregon and completed in 2010. Huang gave his alma mater Oneida Baptist Institute $2 million to build Huang Hall, a new girls' dormitory and classroom building. It was designed by CMW Architects of Lexington, Kentucky.


title: Jensen Huang

text: In 2007, Huang was the recipient of the Silicon Valley Education Foundation's Pioneer Business Leader Award for his work in both the corporate and philanthropic worlds.


title: Jensen Huang

text: In 1999, Jensen Huang was named Entrepreneur of the Year in High Technology by Ernst & Young. In 2003, Huang received the Dr. Morris Chang Exemplary Leadership Award, which recognizes a leader who has made exceptional contributions to driving the development, innovation, growth, and long-term opportunities of the fabless semiconductor industry, from the Fabless Semiconductor Association. He was also a National Finalist for the EY Entrepreneur of the Year Award in 2003 and was an Award Recipient for the Northern California region in 1999.


title: Jensen Huang

text: Additionally, Huang is a recipient of the Daniel J. Epstein Engineering Management Award from the University of Southern California and was named an Alumni Fellow by Oregon State University. Huang was awarded an honorary doctorate from Oregon State University at the June 13, 2009, commencement ceremony.


title: Jensen Huang

text: In 2018, Huang was listed in the inaugural "Edge 50", naming the world's top 50 influencers in edge computing. In October 2019, Harvard Business Review named Jensen Huang best-performing CEO in the world. In November 2020, Jensen Huang was named "Supplier CEO of the year" by Eurostars AutomotiveNewsEurope. Huang was awarded an honorary doctorate from National Taiwan University at the school anniversary in November, 2020. In August 2021, the Semiconductor Industry Association (SIA) announced that Jensen Huang is the 2021 recipient of the industry’s highest honor, the Robert N. Noyce Award. In September 2021, he was included in the "Time" 100, "Time"s annual list of the 100 most influential people in the world.


title: Jensen Huang

text: While at Oregon State, Huang met his future wife, Lori, his engineering lab partner at the time. Huang has two children.


title: Adam Arkin

text: Adam Arkin (born August 19, 1956) is an American actor and director. He is known for playing the role of Aaron Shutt on "Chicago Hope". He has been nominated for numerous awards, including a Tony (Best Actor, 1991, "I Hate Hamlet") as well as three primetime Emmys, four SAG Awards (Ensemble, "Chicago Hope"), and a DGA Award ("My Louisiana Sky"). In 2002, Arkin won a Daytime Emmy for Outstanding Directing in a Children's Special for "My Louisiana Sky". He is also one of the three actors to portray Dale "The Whale" Biederbeck on "Monk". Between 2007 and 2009, he starred in "Life". Beginning in 1990, he had a guest role on "Northern Exposure" playing the angry, paranoid Adam, for which he received an Emmy nomination. In 2009, he portrayed villain Ethan Zobelle, a white separatist gang leader, in "Sons of Anarchy" and as Principal Ed Gibb in "8 Simple Rules" (2003–2005). His father Alan Arkin and brother Matthew are also actors.


title: Adam Arkin

text: Arkin was born in Brooklyn, New York City, to actor, director and writer Alan Arkin and his first wife Jeremy Yaffe. Arkin joined his parents singing in the children's music group the Baby Sitters, along with Lee Hays and Doris Willens. He graduated from Horace Greeley High School in Chappaqua, New York. Arkin is Jewish.


title: Adam Arkin

text: Arkin guest-starred in the award-winning television show "Happy Days" in episode 35, season 2 in 1975. Also in 1975, he made a guest appearance on "Barney Miller" (episode: "Grand Hotel"). His first starring role in television was as Lenny Markowitz, the central character in the 1977 series "Busting Loose". He since has appeared in various television series such as "A Year in the Life" (1988), "The Twilight Zone" (1986), "Northern Exposure" (CBS, 1990–1995), where he played the mercurial barefooted chef Adam, and "Chicago Hope" (CBS, 1994–2000). He appeared in two "Law & Order" episodes, "Self Defense" (season three, 1992) as jewelry store owner George Costas and "Red Ball" (season 16, 2005) as a district attorney named Charles Graham. He also appeared in "Picket Fences" (season two, episode 13). Other television appearances include "The West Wing" (1999) (as trauma specialist and psychiatrist Dr. Stanley Keyworth), "Frasier", as an obsessive fan of Frasier, for which he was nominated for a Primetime Emmy Award for Outstanding Guest Actor in a Comedy Series, "Boston Legal", "Baby Bob", "Monk" and "8 Simple Rules for Dating My Teenage Daughter" (2002). In 2007, he starred in the NBC drama "Life" in the role of Ted Earley. He played a white separatist leader named Ethan Zobelle during the second season of the series "Sons of Anarchy". In 2011, he appeared in "The Closer" episode "To Serve with Love" (season seven). He also portrayed mob boss Theo Tonin on "Justified" in 2011 and an FBI agent in "The Chicago Code".


title: Adam Arkin

text: Arkin's film appearances include "Hitch" (2005) and "" (1998). He has performed in Broadway, off-Broadway, and regional theatre productions, including both the South Coast Repertory world premiere and Broadway production of "Brooklyn Boy" by playwright Donald Margulies. In addition, he is known for his directing work, having done episodes of "Grey's Anatomy", "Boston Legal", "The Riches", "Dirt", "Ally McBeal", "Sons of Anarchy", "The Blacklist", "Justified", and "Masters of Sex". He won an Emmy for directing the Showtime television film "My Louisiana Sky". In April 2008, Arkin guest-starred in the web series "Gorgeous Tiny Chicken Machine Show". He played the part of a divorce lawyer in the film "A Serious Man" (2009), directed by Ethan and Joel Coen.


title: Adam Arkin

text: Arkin also played a minor role in the radio drama of "Star Wars" as the voice of Fixer. For PBS, he voiced Meriwether Lewis in Ken Burns' "" (1997). He also provided character voice work for the Emmy-winning series "".


title: Adam Arkin

text: He has directed three episodes of the 2013 Cold War television drama "The Americans", is co-executive producer of the television series "Get Shorty", directed the final episode of the second season (2014) of "Masters of Sex", and directed the final two episodes of the critically acclaimed second season (2015) of "Fargo", in which he also had a minor role.


title: Adam Arkin

text: He has a daughter Molly with his first wife Linda. He was married to Phyllis Anne Lyons from 1999 to 2013, and they had one son together. Phyllis filed for divorce in August 2013. He married Michelle Dunker in 2017.


title: Domperidone

text: Domperidone, sold under the brand name Motilium among others, is a dopamine antagonist medication which is used to treat nausea and vomiting and certain gastrointestinal problems like gastroparesis (delayed gastric emptying). It raises the level of prolactin in the human body and is used to induce and promote breast milk production. It may be taken by mouth or rectally.


title: Domperidone

text: Side effects of domperidone include headache, dry mouth, abdominal cramps, diarrhea, and elevated prolactin levels. Secondary to increased prolactin levels, breast changes, milk outflow, menstrual irregularities, and hypogonadism can occur. Domperidone may also cause QT prolongation and has rarely been associated with serious cardiac complications such as sudden cardiac death. However, the risks are small and occur more with high doses. Domperidone acts as a peripherally selective antagonist of the dopamine D and D receptors. Due to its low entry into the brain, the side effects of domperidone are different from those of other dopamine receptor antagonists like metoclopramide and it produces little in the way of central nervous system adverse effects. However, domperidone can nonetheless increase prolactin levels as the pituitary gland is outside of the blood–brain barrier.


title: Domperidone

text: Domperidone was discovered in 1974 and was introduced for medical use in 1979. It was developed by Janssen Pharmaceutica. Domperidone is available over-the-counter in many countries, for instance in Europe and elsewhere throughout the world. It is not approved for use in the United States. However, it is available in the United States for people with severe and treatment-refractory gastrointestinal motility problems under an expanded access individual-patient investigational new drug application. An analogue of domperidone called deudomperidone is also currently under development for potential use in the United States and other countries.


title: Domperidone

text: There is some evidence that domperidone has antiemetic activity. It is recommended by the Canadian Headache Society for treatment of nausea associated with acute migraine.


title: Domperidone

text: Gastroparesis is a medical condition characterised by delayed emptying of the stomach when there is no mechanical gastric outlet obstruction. Its cause is most commonly idiopathic, a diabetic complication or a result of abdominal surgery. The condition causes nausea, vomiting, fullness after eating, early satiety (feeling full before the meal is finished), abdominal pain and bloating. Domperidone can be used to increase the transit of food through the stomach by increasing gastrointestinal peristalsis and hence to treat gastroparesis. It may be useful in idiopathic and diabetic gastroparesis. However, increased rate of gastric emptying induced by drugs like domperidone does not always correlate well with relief of symptoms.


title: Domperidone

text: The hormone prolactin stimulates lactation. Dopamine, released by the hypothalamus, stops the release of prolactin from the pituitary gland. Domperidone, by acting as an anti-dopaminergic agent, results in increased prolactin secretion, and thus promotes lactation as a galactogogue). Domperidone moderately increases the volume of expressed breast milk in mothers of preterm babies where breast milk expression is inadequate, and appears to be safe for short-term use for this purpose. In the United States, domperidone is not approved for this use.


title: Domperidone

text: A study called the "EMPOWER" trial was designed to assess the effectiveness and safety of domperidone in assisting mothers of preterm babies to supply breast milk for their infants. The study randomized 90 mothers of preterm babies to receive either domperidone 10 mg orally three times daily for 28 days (Group A) or placebo 10 mg orally three times daily for 14 days followed by domperidone 10 mg orally three times daily for 14 days (Group B). Mean milk volumes at the beginning of the intervention were similar between the 2 groups. After the first 14 days, 78% of mothers receiving domperidone (Group A) achieved a 50% increase in milk volume, while 58% of mothers receiving placebo (Group B) achieved a 50% increase in milk volume.


title: Domperidone

text: To induce lactation, domperidone is used at a dosage of 10 to 20 mg 3 or 4 times per day by mouth. Effects may be seen within 24 hours or may not be seen for 3 or 4 days. The maximum effect occurs after 2 or 3 weeks of treatment, and the treatment period generally lasts for 3 to 8 weeks. A 2012 review shows that no studies support prophylactic use of galactagogue medications, including domperidone, at any stage of pregnancy.


title: Domperidone

text: Parkinson's disease is a degenerative neurological condition where a decrease in dopamine in the brain leads to rigidity (stiffness of movement), tremor and other symptoms and signs. Poor gastrointestinal function, nausea and vomiting is a major problem for people with Parkinson's disease because most medications used to treat Parkinson's disease are given by mouth. These medications, such as levodopa, can cause nausea as a side effect. Furthermore, anti-nausea drugs, such as metoclopramide, which do cross the blood–brain barrier, may worsen the extrapyramidal symptoms of Parkinson's disease. Domperidone can be used to relieve nausea and gastrointestinal symptoms in Parkinson's disease; it blocks peripheral D receptors but minimally crosses the blood–brain barrier in normal doses, so has no effect on the extrapyramidal symptoms of the disease.


title: Domperidone

text: Domperidone may be used in functional dyspepsia in both adults and children. It has also been found effective in the treatment of reflux in children. However some specialists consider its risks prohibitory of the treatment of infantile reflux.


title: Domperidone

text: Domperidone is available for use by oral administration in the form of tablets, orally disintegrating tablets, and suspension, and by rectal administration in the form of suppositories. The oral tablets are available in the strength of 10 mg. Domperidone has been studied for use by intramuscular injection and an intravenous formulation was previously available, but the medication is now only available in forms for oral and rectal administration.


title: Domperidone

text: Side effects associated with domperidone include dry mouth, abdominal cramps, diarrhea, nausea, rash, itching, hives, and hyperprolactinemia (the symptoms of which may include breast enlargement, galactorrhea, breast pain/tenderness, gynecomastia, hypogonadism, and menstrual irregularities).


title: Domperidone

text: Due to blockade of D receptors in the central nervous system, D receptor antagonists like metoclopramide and antipsychotics can also produce a variety of additional side effects including drowsiness, akathisia, restlessness, insomnia, lassitude, fatigue, extrapyramidal symptoms, dystonia, Parkinsonian symptoms, tardive dyskinesia, and depression. However, this is not the case with domperidone, because, unlike other D receptor antagonists, it minimally crosses the blood–brain barrier, and for this reason, is rarely associated with such side effects. However, domperidone theoretically might be able to produce some blockade of central D receptors at higher doses, in turn producing side effects similar to those of centrally permeable D receptor antagonists like antipsychotics.


title: Domperidone

text: Due to D receptor blockade, domperidone causes hyperprolactinemia. Hyperprolactinemia can suppress the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, in turn suppressing the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and resulting in hypogonadism and low levels of the sex hormones estradiol and testosterone. Accordingly, 10 to 15% of females have been reported to experience mammoplasia (breast enlargement), mastodynia (breast pain/tenderness), galactorrhea (inappropriate or excessive milk production/secretion), and amenorrhea (cessation of menstrual cycles) with domperidone therapy. Males may experience low libido, erectile dysfunction, and impaired spermatogenesis, as well as galactorrhea and gynecomastia. D receptor antagonists like antipsychotics and domperidone may also increase the risk of prolactinomas, but more research is needed to confirm this.


title: Domperidone

text: Domperidone use is associated with an increased risk of sudden cardiac death (by 70%) most likely through its prolonging effect of the cardiac QT interval and ventricular arrhythmias. The cause is thought to be blockade of hERG voltage-gated potassium channels. The risks are dose-dependent, and appear to be greatest with high/very high doses via intravenous administration and in the elderly, as well as with drugs that interact with domperidone and increase its circulating concentrations (namely CYP3A4 inhibitors). Conflicting reports exist, however. In neonates and infants, QT prolongation is controversial and uncertain.


title: Domperidone

text: UK drug regulatory authorities (MHRA) have issued the following restriction on domperidone in 2014 due to increased risk of adverse cardiac effects:


title: Domperidone

text: In Britain a legal case involved the death of two children of a mother whose three children had all had hypernatraemia. She was charged with poisoning the children with salt. One of the children, who was born at 28 weeks gestation with respiratory complications and had a fundoplication for gastroesophageal reflux and failure to thrive was prescribed domperidone. An advocate for the mother suggested the child may have had neuroleptic malignant syndrome as a side effect of domperidone due to the drug crossing the child's immature blood–brain barrier.


title: Domperidone

text: In healthy volunteers, the CYP3A4 inhibitor ketoconazole increased the C and AUC concentrations of domperidone by 3- to 10-fold. This was accompanied by a QT interval prolongation of about 10–20 milliseconds when domperidone 10 mg four times daily and ketoconazole 200 mg twice daily were administered, whereas domperidone by itself at the dosage assessed produced no such effect. As such, domperidone with ketoconazole or other CYP3A4 inhibitors is a potentially dangerous combination.


title: Domperidone

text: Domperidone is a peripherally selective dopamine D and D receptor antagonist. It has no clinically significant interaction with the D receptor, unlike metoclopramide. The medication provides relief from nausea by blocking D receptors in the chemoreceptor trigger zone and from gastrointestinal symptoms by blocking D receptors in the gut. It blocks D receptors in the lactotrophs of the anterior pituitary gland increasing release of prolactin which in turn increases lactation. Domperidone may be more useful in some patients and cause harm in others by way of the genetics of the person, such as polymorphisms in the drug transporter gene "ABCB1" (which encodes P-glycoprotein), the voltage-gated potassium channel "KCNH2" gene (hERG/K11.1), and the α-adrenergic receptor "ADRA1D" gene.


title: Domperidone

text: A single 20 mg oral dose of domperidone has been found to increase mean serum prolactin levels (measured 90 minutes post-administration) in non-lactating women from 8.1 ng/mL to 110.9 ng/mL (a 13.7-fold increase). This was similar to the increase in prolactin levels produced by a single 20 mg oral dose of metoclopramide (7.4 ng/mL to 124.1 ng/mL; 16.7-fold increase). After two weeks of repeated administration (30 mg/day in both cases), the increase in prolactin levels produced by domperidone was reduced (53.2 ng/mL; 6.6-fold above baseline), but the increase in prolactin levels produced by metoclopramide, conversely, was heightened (179.6 ng/mL; 24.3-fold above baseline). This indicates that acute and continuous administration of both domperidone and metoclopramide is effective in increasing prolactin levels, but that there are different effects on the secretion of prolactin with repeated use. The mechanism of the difference is unknown. The increase in prolactin levels observed with the two drugs was much greater in women than in men. This appears to be due to the higher estrogen levels in women, as estrogen stimulates prolactin secretion from the pituitary gland.


title: Domperidone

text: For comparison, normal prolactin levels in women are less than 20 ng/mL, prolactin levels peak at 100 to 300 ng/mL at parturition in pregnant women, and in lactating women, prolactin levels have been found to be 90 ng/mL at 10 days postpartum and 44 ng/mL at 180 days postpartum.


title: Domperidone

text: The absolute bioavailability of domperidone is low (13–17% or approximately 15%). This is due to extensive first-pass metabolism in the intestines and liver. Conversely, its bioavailability is high via intramuscular injection (90%). The onset of action of domperidone taken orally is about 30 to 60 minutes. Peak levels of domperidone following an oral dose occur after about 60 minutes. Domperidone exposure increases proportionally with doses in the 10 to 20 mg dose range. There is a 2- to 3-fold accumulation in levels of domperidone with frequent repeated oral administration of domperidone (four times per day (every 5 hours) for 4 days). The oral bioavailability of domperidone is somewhat increased and time to peak slightly increased when it is taken with food and bioavailability is decreased by prior concomitant administration of cimetidine and sodium bicarbonate.


title: Domperidone

text: The plasma protein binding of domperidone is 91 to 93%. The tissue distribution of domperidone based on animal studies is wide, but concentrations are low in the brain. The drug is a substrate for the P-glycoprotein (ABCB1) transporter, and animal studies suggest that this is the reason for the low central nervous system penetration of domperidone. Small amounts of domperidone cross the placenta in animals.


title: Domperidone

text: Domperidone is extensively metabolized in the liver and intestines with oral administration. This occurs via hydroxylation and N-dealkylation. Domperidone is almost exclusively metabolized by CYP3A4/5, though minor contributions by CYP1A2, CYP2D6, and CYP2C8 have been reported. CYP3A4 is the major enzyme involved in the N-dealkylation of domperidone, while CYP3A4, CYP1A2, and CYP2E1 are involved in its aromatic hydroxylation. All of the metabolites of domperidone are inactive as D receptor ligands. Overall and peak levels of domperidone are increased by about 2.9- and 1.5-fold in moderate hepatic impairment, respectively.


title: Domperidone

text: Domperidone is eliminated 31% in urine and 66% in feces. The proportion of domperidone excreted unchanged is small (10% in feces and 1% in urine). The elimination half-life of domperidone is about 7 to 9 hours in healthy individuals. However, the elimination half-life of domperidone can be prolonged to 20 hours in people with several renal dysfunction.


title: Domperidone

text: Domperidone is a benzimidazole derivative and is structurally related to butyrophenone neuroleptics like haloperidol.


title: Domperidone

text: Domperidone was synthesized at Janssen Pharmaceutica in 1974 following their research on antipsychotic drugs. Janssen pharmacologists discovered that some of antipsychotic drugs had a significant effect on dopamine receptors in the central chemoreceptor trigger zone that regulated vomiting, and started searching for a dopamine antagonist that would not pass the blood–brain barrier, thereby being free of the extrapyramidal side effects that were associated with drugs of this type. This led to the discovery of domperidone as a strong antiemetic with minimal central effects. Domperidone was patented in the United States in 1978, with the patent filed in 1976. In 1979, domperidone was first marketed, under the brand name Motilium, in Switzerland and West Germany. Domperidone was subsequently introduced in the forms of orally disintegrating tablets (based on Zydis technology) in 1999. Janssen Pharmaceutical has brought domperidone before the United States Federal Drug Administration (FDA) several times, including in the 1990s, but it has not been approved.


title: Domperidone

text: In April 2014, the Co-ordination Group for Mutual Recognition and Decentralised Procedures – Human (CMDh) published official press-release suggesting to restrict the use of domperidone-containing medicines. It also approved earlier published suggestions by Pharmacovigilance Risk Assessment Committee (PRAC) to use domperidone only for treating nausea and vomiting and reduce maximum daily dosage to 10 mg.


title: Domperidone

text: It was reported in 2007 that domperidone is available in 58 countries, including Canada, but the uses or "indications" of domperidone vary between nations. In Italy it is used in the treatment of gastroesophageal reflux disease and in Canada, the drug is indicated in upper gastrointestinal motility disorders and to prevent gastrointestinal symptoms associated with the use of dopamine agonist antiparkinsonian agents. In the United Kingdom, domperidone is only indicated for the treatment of nausea and vomiting and the treatment duration is usually limited to 1 week.


title: Domperidone

text: In the United States, domperidone is not currently a legally marketed human drug and it is not approved for sale in the United States. On 7 June 2004, FDA issued a public warning that distributing any domperidone-containing products is illegal.


title: Domperidone

text: It is available over-the-counter to treat gastroesophageal reflux and functional dyspepsia in many countries, such as Ireland, the Netherlands, Italy, South Africa, Mexico, India, Chile, and China.


title: Domperidone

text: Domperidone is not generally approved for use in the United States. There is an exception for use in people with treatment-refractory gastrointestinal symptoms under an FDA Investigational New Drug application.


title: Little Women (1994 film)

text: Little Women is a 1994 American coming-of-age historical drama film directed by Gillian Armstrong. The screenplay by Robin Swicord is based on Louisa May Alcott's 1868-69 two-volume novel of the same title, the fifth feature film adaptation of the classic story. After a limited release on December 25, 1994, the film was released nationwide four days later by Columbia Pictures.


title: Little Women (1994 film)

text: The film received three Academy Award nominations for Best Actress (Ryder), Best Costume Design, and Best Original Score. It was followed by a loose sequel, "Little Men", without Ryder's involvement.


title: Little Women (1994 film)

text: The March sisters: responsible Meg, Jo, tender Beth, and romantic Amy, are growing up in Concord, MA during and after the American Civil War. Their father is fighting in the war and, with their strong-willed mother, Marmee (pronounced "Mahmee") they struggle with major and minor problems in 19th century New England. The girls revel in performing Jo's romantic plays in their attic theater.


title: Little Women (1994 film)

text: Next door neighbor, wealthy Mr. Laurence's grandson Theodore ("Laurie") moves in, becoming a close friend of the Marches, particularly Jo. Mr. Laurence mentors Beth, whose exquisite piano-playing reminds him of his deceased daughter, and Meg falls in love with Laurie's tutor John Brooke.


title: Little Women (1994 film)

text: When Mr. March is wounded, Jo sells her hair so Marmee can go by train to nurse him back to health. While she is away, Beth continues visiting a struggling immigrant family, providing food and firewood. She contracts scarlet fever from them. Awaiting Marmee's return, Meg and Jo, who both previously survived scarlet fever, send Amy away to live safely with their Aunt March. Amy laments to Laurie that she may die without ever being kissed. He promises to kiss her before she dies if she becomes ill.


title: Little Women (1994 film)

text: Prior to Beth's illness, Jo had been Aunt March's companion for several years, and although she didn't enjoy it, she hoped she would take her to Europe. Beth gets worse, so Marmee returns home, nursing her to recovery in time for Christmas, but the illness has severely weakened her. Mr. Laurence gives his daughter's piano to Beth, Meg accepts John Brooke's proposal and Mr. March surprises them, returning home from the war.


title: Little Women (1994 film)

text: Four years pass; Meg (now 20) and John marry, and Beth's health is worsening. Graduating from college, Laurie proposes to Jo (now 19) and asks her to go to London with him but, seeing him more as a brother than a lover, she refuses. Jo is disappointed when Aunt March decides to take 17-year-old Amy with her to Europe instead of her. She has been Aunt March's companion and wishes to further her artistic training in Europe. Crushed, Jo departs for New York City to pursue writing and experience life. There she meets Friedrich Bhaer, a German professor who challenges and stimulates her intellectually, introducing her to opera and philosophy, and encouraging her to write better stories than the lurid Victorian melodramas she has penned so far.


title: Little Women (1994 film)

text: In Europe, Amy is reunited with Laurie. Disappointed to find he has become dissolute and irresponsible; she scolds him for pursuing her merely to become part of the March family. In return, he bitterly rebukes her for courting one of his wealthy college friends to marry into money. He asks Amy to wait for him in a letter while he works in London for his grandfather and makes himself worthy.


title: Little Women (1994 film)

text: Jo is called home for eighteen-year-old Beth, who finally dies of the after-effects of scarlet fever (presumably rheumatic heart disease) that plagued her for the past four years. A saddened Jo retreats to the comfort of the attic, writing her life story. Upon completion, she sends it to Professor Bhaer. Meanwhile, Meg has fraternal twins Demi and Daisy.


title: Little Women (1994 film)

text: A letter from Amy tells them Aunt March is too ill to travel, so Amy must remain in Europe with her. In London, Laurie receives a letter from Jo about Beth's death, saying Amy is in Vevey, unable to come home. He immediately goes to be at Amy's side. They finally return to the March home as spouses, to Jo's surprise and eventual delight.