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One night for dinner I felt like having a few different appetizers instead of an entire meal. I had some mushrooms, pecorino cheese, and breadcrumbs so decided to throw together some stuffed mushrooms.
They were very simple, quick to make, and tasted really good! I had already popped a few in my mouth right out of the oven before I even sat down. I enjoyed these mushrooms with some double tomatoe brushetta on toasted sourdough bread and a salad.
For the breadcrumbs: you can make them fresh, or get store-bought seasoned breadcrumbs. Most breadcrumb brands contain some byproduct of meat. The only vegetarian brand I've come across from Ralphs is Cento Bread Crumbs (Italian Style). To make Italian style breadcrumbs at home, simply combine Planko Breadcrumbs, Italian seasoning, garlic powder, onion powder, and salt to taste.
Yields makes 28 stuffed mushrooms
- 1/2 cup Italian Style Dried Breadcrumbs
- 1/2 cup grated Pecorino Romano Cheese
- 2 cloves garlic, minced
- 2 tbsp parsley, chopped
- 2 tbsp mint, chopped
- 1/3 cup olive oil
- 28 large white mushrooms, washed
- salt/pepper
- Turn the oven on to 400 degrees for baking.
- De-stem the mushrooms and spoon out the cavities for stuffing. Set aside.
- Stir the bread crumbs, pecorino romano cheese, garlic, parsley, mint, and 2 tbsp olive oil. Add salt and pepper to taste.
- Drizzle a heavy large baking sheet w/ 1 tbsp olive oil to coat.
- Spoon the filling into each of the mushroom cavities and arrange them on the baking sheet.
- Drizzle the remaining oil over the filling in each mushroom.
- Bake the mushrooms until they are tender and the filling is heated and golden on top (~20min).


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Mozart Mass for TTBB Chorus
I'm searching desperately for a TTBB men's choral arrangement of one of Mozart's Masses. Preferably a Missa Brevis.
We use cookies on this site to enhance your user experience
By clicking any link on this page you are giving your consent for us to set cookies.
I'm searching desperately for a TTBB men's choral arrangement of one of Mozart's Masses. Preferably a Missa Brevis.
Looking forward to more scores and your help to volunteer to comment is greatly appreciated.
Took a Few days for us to write.
Hi guys, this is kind of my first real attempt at making a cover. I don't really know what to do with this thing. I want to improve it but I don't really know how. Anyone? Link is here:
Feedback is appreciated for later projects. Thanks!
I just finished working on this piece today, "Romance"; any feedback is appreciated!
Also, does anyone know how to create those brackets that connect two notes from the bass/treble clef? I wanted to make some where I wanted the LH to catch a few notes in the treble clef, but I can't find what I'm looking for.
I don't really care, but if you guys want to, sure. Just say whether you want to or not, if I can get five 'wants' with no 'no wants' it'll start. Also, if it happens, the competition will start on a different discussion. (The rules will be there too.) *If the group gets 200 discussions before all of the 'yeses' and 'no's, the competition will not start and this advertisement will be deleted.
I've never touched a violin, viola or a cello, let alone played one. However, there are some emotions that can only be conveyed through their sound. That's why I made this piece.
It is a tribute to my deceased grandfather and was made on the same day of his death. Hope you enjoy it.
hello this group is for all composers of all instruments and anything is welcome here but just a few rules:
1. keep you comments clean no swearing
2. don't bully, if you see a score you don't like please don't leave negative comments.
3.have fun
(if you think of any other rules i should add tell me :)
Flutes r da best
Have any questions about this group? Ask me in this discussion or by private email and I'll answer them.
i've been meaning to ask this for a while, but what is patrick doing in the group icon?
Check it out:
Post anything other here as long as it follows the rules. Have fun composing!
like best friends brother, make it shine or shut up and dance
Ive updated my account (hope u like it)
i will be changing my profile picture evry week if i feel like it.

subset: commoncrawl


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Social Media Specialist
Toronto / June 13, 2019
At Proof, your passion for social media, ability to ask better questions and desire to make a positive impact on our client's business – by meeting their customer needs – earns you a seat at the table. You bring fresh ideas to how we deliver content, a deep knowledge of social media platforms and best practices, and provide strategic recommendations based on audience data and insights. The Social Media Specialist works closely with our strategy, creative, influencer and paid media teams to create and deliver social media campaigns across brands spanning consumer lifestyle, health, technology, financial services, government relations, and more.
The ideal candidate loves a team environment, is creative, nimble and must have strong organizational and communication skills.
- Your role will be to guide and deliver compelling social media content that meets client and audience objectives, including experience in building content calendars and one-off campaigns.
- You're part content developer, part planner and like to get your hands on data. You want to experiment with new formats and platforms and navigate the ever-changing social media landscape.
- Each day you will collaborate with our strategy, creative, influencer, paid media and account teams to identify social media content opportunities that adhere to best practices and deliver against the digital customer journey.
- When working with clients, you develop an understanding of their business and the competitive environment to add value in planning and execution.
- In research and planning, you demonstrate how audiences integrate social media into their lives, and the cultural trends and social behaviours that motivate them to action.
- We expect that you stay up-to-date on social media trends, best practices, and emerging content, partner and platform opportunities that can make our work better.
- Regular status updates with partner representatives (Facebook, LinkedIn, Twitter, etc.)
- Part of this role will be to provide ongoing counsel to community managers across the agency, by providing best practices on process and platform tools.
- Since you will bring expertise in social media to the agency, we expect you to educate teams through presentations, communicating points-of-view, and ongoing collaboration.
- Table-stakes:
- Support teams on the delivery of tasks and projects and are accountable for high-quality project delivery to agreed-upon deadlines and budgets.
- Actively contributes to regular client status meetings and manage/maintain up-to-date client reports.
- Live by the Golden Rule: "Treat others as you would like them to treat you."
Skills & Experience
- Unrelenting curiosity.
- 3-5 years of relevant experience working within a similar role.
- Provide clients, and colleagues, with a high standard of service.
- The person in this role has a track record of experimenting with content formats, platforms and tools to bring new thinking and approaches to his/her organization and/or clients
- Deep experience in social media platforms and content best practices (for instance: Facebook, Instagram, Twitter, LinkedIn, Pinterest, and SnapChat).
- Desire to learn about emerging platforms opportunities (i.e. Facebook Brand Collabs Manager, Mobile Studio, Twitter promote mode, etc.).
- Ability to own our clients' brand voice on social media, through content, posts and community management.
- Demonstrated experience managing social media content, programs and campaigns, including calendar planning, content development and management and reporting.
- Understanding of digital marketing and ecosystem planning, including paid, earned and owned media channels.
- Motivated, enthusiastic and highly responsive team player with a passion for marketing and all things social.
- Familiar with standard client service practices – status reports, agency team briefs, SOWs – and ability to support internal and external clients expeditiously.
- Exceptional communication skills – oral and written.
- Strong proficiency in Microsoft software (Word, Excel, PowerPoint).
- Razor-sharp focus, attention to detail and time management skills.
- Detail oriented and able to manage multiple projects and clients simultaneously.
- Excellent people management skills.
- You continuously demonstrate Proof's core values: entrepreneurial & creative; respectful; driven and responsive; collaborative & fun.
- Bonus!
- Community management experience
- Experience working with influencers and influencer content
- Familiarity with paid social distribution
- Proficient in Photoshop and Illustrator
The salary for this position will commensurate with your experience. Proof provides excellent benefits including medical and dental, subsidized continuing education, milestone trips and more.
We thank all applicants for their interest in this position; however, only those candidates selected for an interview will be contacted.


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Latest tickets bought
- Split to Dubrovnik1 min ago
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- Sarpsborg to Malmö1 min ago
- Malmö to Sarpsborg1 min ago
Getbybus guides
Latest blog posts
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Old and uncomfortable bus There was wifi Old busby AnonymousSee more
Croatia bus-Globtour-Salinea-Jadran ekspres
Bus was extremely crowded. We were stuck in the back seat with the seats in front of us reclined, so very cr...by ShaunSee more
Promet Makarska d.o.o.
The two journeys we had were completely different than in terms of experience with the company. Value for money ...by AnonymousSee more


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Complex Needs Team Manager
- Recruiter
- One Trust
- Location
- London (South), London (Greater)
- Salary
- £38,240 - £41,290
- Posted
- 15 Aug 2019
- Closes
- 30 Aug 2019
- Ref
- Complex Needs Mgr
- Function
- Management
- Sector
- Disability, Social Care & Welfare
- Hours
- Full Time
- Contract Type
- Permanent
One Trust's vision is to lead the way in creating, "A world where people with profound and multiple learning disability (PMLD) and their family carers are valued, can realise their potential and live their lives the way they choose". We do this through providing leading edge services, opportunities, therapies and respite, currently in South West London. We offer safe, proactive and flexible services that provide opportunities for adults with learning disability allowing them to live fulfilling lives. One Trust was incorporated in 2015, and following a successful start-up phase, is now looking to recruit talented individuals to deliver on a 3-5 year strategy focused on growth. One Trust has ambitions to reach as many people as possible. There is a shortage of first class (PMLD) provision across South London and One Trust is dedicated to filling that void. One Trust is now looking to skilled and experienced people who can make that happen.
Complex Needs Team Manager
£38,240 - £41,290
Wandsworth/South London
Reporting directly to the Chief Operating Officer and CEO - This is a full-time, role where you will provide direct and hands on, day to day leadership to a team consisting of team leaders and support workers - whilst supporting adults with profound and multiple learning disabilities, along with physical disabilities, sensory impairment, complex care needs and behaviours which may prove extremely challenging. You'll lead your team to deliver an innovative service that ensures everyone you support is safe, happy, healthy and full of plans to learn and develop. Day to day, you'll be doing anything from managing rotas, to performing risk assessments. The role will include management of the services you cover, ensuring the individuals we support receive a personalised service which meets and continually responds to their changing needs, whilst also working to maintain quality and compliance.
You will have…
- Managerial experience of leading a team within a Learning Disabilities and complex needs setting.
- The ability to work as part of a team; lead by example, manage performance effectively and use own initiative.
- Experience of working to Care Inspectorate relevant legislation and professional regulations
- Experience undertaking investigations and/or the ability to manage complaints appropriately and in a confidential manner
- Commitment to give service users the respect, choice and the future they deserve.
- Desirable: Degree standard qualifications in Leadership & Management / Health & Social Care.
See 'Supporting Documents' below for full job description.
The head office of One Trust is 21 Church Lane, Tooting, London, SW17 9PW, however there is scope for the successful applicant to base themselves at our other service sites.
Please read the Job Description and Person Specification and then forward the following to email@example.com .
- Your CV.
- A supporting statement setting out your motivations for applying and how your experience to date covers, strategic planning, communications, quality control and operational management.
- Included in the supporting statement, describe how you meet the person specification.
If you would like to find out more about One Trust then you can visit our website, www.onetrust.co.uk.
Please contact our CEO, firstname.lastname@example.com or if you want to discuss the role 07538667901.
Closing date: 30 August 2019
Panel interviews at One Trust's Head Office: Week commencing 16th September 2019.


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A student let property ideal for Christchurch University. Arranged as accredited, student accommodation occupied and let for the next academic year.
A three bedroom family home ideally situated for all local amenities including; schools, railway station and town centre.
The perfect home for you and your family. This 3 bedroom semi detached house has been extremely well maintained by the current owners and is ready for you to move straight into. Not only does ...
Descriptions of the property are subjective and are used in good faith as an opinion and NOT as a statement of fact. Please make further specific enquires to ensure that our descriptions are likely to match any expectations you may have of the property. We have not tested any services, systems or appliances at this property. We strongly recommend that all the information we provide be verified by you on inspection, and by your Surveyor and Conveyancer.


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Too often, it is when women show up for prenatal exams that they discover they are HIV positive, or sick with full-blown AIDS. Even more common, the women are black or Hispanic, and in long-term relationships they believed were monogamous.
Their risk factor for contracting the virus that causes AIDS? Being an adult and being a woman of color.
Last year in North Carolina, 80 percent of HIV cases diagnosed in women were among blacks, Hispanics and Native Americans. While men, particularly African-American men, still account for the largest number of HIV/AIDS cases, an often hidden epidemic is taking place among women.
"We are losing the war against AIDS," said Dr. Steve Cline, deputy state health director. "We're losing it not just as a nation, but also losing it as a region. The South is disproportionately hit."
Cline addressed advocates, care providers and HIV patients Tuesday to help launch a Web page designed to reach Southern women infected with HIV/AIDS. It features video testimony of 30 women, including several from the Triangle, who have been diagnosed with HIV or are working to combat the disease. (more…)


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Professional Experience
Jackie's practice includes a variety of business matters. She assists clients with forming and operating businesses, including employee hiring, termination, and non-competition agreements, and federal and state wage and hour best practices. Jackie helps individuals and businesses efficiently navigate and negotiate business transactions such as the purchase and sale of businesses and assets, and by analyzing and drafting contracts, leases, and licenses. Jackie also represents clients in real estate transactions, including title work and financing.
Publications & Presentations
"Real Property Law Update." Speaker and co-author. Minnesota Society of Professional Surveyors 2013, 2014, 2015
"A Torrens Law Primer." Co-author. Minnesota Society of Professional Surveyors, 2015
"How Roads and Rights of Way Are Created and Terminated, and How the Differing Methods Impact Your Clients." Co-author. Real Estate Institute, Minnesota State Bar Association, 2014
"Getting There: 7 Ways to Establish Access to Real Property." Co-author. Real Estate Institute, Minnesota State Bar Association (MSBA), 2012
"The Changing Contours of Torrens Law." Co-author. Real Estate Institute, MSBA, 2011
- J.D., cum laude, University of St. Thomas School of Law
- B.A., summa cum laude, University of St. Thomas
- Washington State Bar
- Minnesota State Bar
- U.S. District Court for the District of Minnesota
Professional and Community Involvement
- Mother Attorneys Mentoring Association of Seattle
- King County Bar Association
- Latino Bar Association of Washington
News & Events
Kim Stephens and Chase Alvord Named 2020 Best Lawyers in America©Read more
$9.8 million Settlement Agreement Preliminarily Approved in Eddie Bauer Data Breach Class ActionRead more
Four TBS Attorneys Recognized as 2019 Washington Super Lawyers®/Rising StarRead more
Proposed Settlement Reached in Premera Data Breach LawsuitRead more
Chris Brain Argues Before 9th Circuit Court of Appeals for Swinomish TribeRead more
Kim Stephens to Discuss Settlement Strategies at 15th Annual Class Action ConferenceRead more
WSU Settlement of $5.26 Million Preliminarily ApprovedRead more
Cedar Shake and Shingle Price Fixing Class Action FiledRead more
Janissa - I would never talk to any lawyer about anything until I talk to you first. You are just simply AMAZING and not only did you go completely above and beyond to ensure my daughter's trust was safe and secure, but every time I thought I couldn't go on, you constantly assured me that everything would be all right.Sophia Cosola Contact Us
Kevin is a great fit for the issue he helped with and continues to help with. We have followed him from another firm to TBS and have worked with him for 10 years now...I appreciate Kevin and what he continues to do to assist us.Leif Langlois Contact Us
Chase...thank you for your professional assistance in the resolution of the recent lawsuit against me. I could not have obtained such a favorable outcome without your assistance even though I am a lawyer myself and have handled similar matters during my over 40 year legal career.
You have saved me tens of thousands of dollars over what I could have obtained had I tried to handle the matter myself. With hundreds of thousands of dollars at stake you were worth every penny of your most reasonable fee. Beyond that was the peace of mind for both me and my wife during the process, and you can't put a price tag on that. Your knowledge and expertise were much appreciated.Stanley R. Byrd Contact Us


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The Bedford Village Inn: Hot Deals Detail
Luxe Spa Package
*Overnight stay *Bottle of BVI's Signature Red Wine & Chocolates in room upon arrival *$100 Spa Credit (Reservations Required, Availability is not Guaranteed) Promotional Package eligible for new reservations only. Taxes and Gratuities are not included in promotional rate. Rates & Availability are subject to change without notice. Luxe reservations are required, availability cannot be guaranteed. If reservations are not available, package may be removed and rates will return to the non-package, Best Available Rate at the time of revision. Any unused services or inclusions will be forfeited. A non-refundable deposit is required to secure reservation. Other restrictions may apply, please contact our Reservations department for more information.
Call (800) 678-8946 to book today!


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Home >> AZ >> Furniture And Upholstery Cleaning >> Parque Vista Estates >> Furniture Cleaning Services
Furniture brings the family together. Without it, your family won't have a place to stay together making your house a home.
It's almost automatic that grime and bacteria will accumulate making furniture look nasty needing professional cleaners.
It could be just a small spot on a cushioned office chair, or someone spilled coffee on the sleeper sofa. Or maybe you just got a great second-hand sofa that fits perfectly in your house but want to have it professionally restored to make it last longer. We can help with all of the above and more.
With about 2 decades of expertise in furniture cleaning we've handled almost all kinds of furniture and fabric that exists.
We make sure our cleaning technicians are highly trained and only use the highest quality equipment and best industry cleaning practices. With years of mastery in cleaning furniture. They are the experts you want working on your furniture.
The equipment we use is specific just for furniture to ensure safety while we are deep cleaning. You don't have to worry about mix-ups as we're good at what we do. And you'll be satisfied with the results. Should you feel otherwise, please do give us a call and we'll happily go back to repeat the job, however, just know we haven't had complaints like that for over 10 years. So you're in safe hands!
Regardless of the type of furniture, we will deal with all of your cleaning needs. Once we are done you'll see your upholstery will be gleaming just like it was bought yesterday.
Looking to book in your cleaning right now? Call us on (602) 833-0466


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tag:blogger.com,1999:blog-1598877299622973005.post9158834685990531815..comments2018-05-27T23:19:16.105-04:00Comments on Chalgyr's Game Room: The Walking Dead: Season One - PS3 ReviewChalgyrhttp://firstname.lastname@example.com:blogger.com,1999:blog-1598877299622973005.post-15735323031637100242014-03-01T12:33:18.646-05:002014-03-01T12:33:18.646-05:00I'm not a big zombie person myself - I have on...I'm not a big zombie person myself - I have only seen a handful of the television episodes (though my wife loves the show). I would say, similar to my other comment, it's more akin to 'episode' like format leading to an end story thta wraps up the content, but leaves the door open to more (seasons)Chalgyrhttp://firstname.lastname@example.com:blogger.com,1999:blog-1598877299622973005.post-18981543798966610872014-03-01T12:32:16.032-05:002014-03-01T12:32:16.032-05:00Yeah. It's basically episodic format - both in...Yeah. It's basically episodic format - both in the parts of the 'season' and then the seasons themselves.Chalgyrhttp://email@example.com:blogger.com,1999:blog-1598877299622973005.post-9874783544817689832014-03-01T12:31:46.752-05:002014-03-01T12:31:46.752-05:00Haha - fair enough. it's fun, very story drive...Haha - fair enough. it's fun, very story driven and not as heavy on the ol' reflexes. Season 2 picks up w/ a main character from season 1 (trying not to spoil anything) some time later. Basically they're treating it LIKE a tv show - stories that are self contained to a season - but that do seem to interplay with one naother.

Thanks for dropping by!Chalgyrhttp://email@example.com:blogger.com,1999:blog-1598877299622973005.post-9057289550628519802014-02-28T19:46:49.101-05:002014-02-28T19:46:49.101-05:00Okay, but it still has 'season one' in its...Okay, but it still has 'season one' in its name which is not something typically done with video games, and since it IS a video game and therefore almost certainly features moving graphics, it would be more akin to an interactive TV show (or film) than comic, surely? Hmm, anyway, sounds quite good... for a zombie game :PRetroKingSimonhttp://firstname.lastname@example.com:blogger.com,1999:blog-1598877299622973005.post-40500595540066369862014-02-28T18:23:48.733-05:002014-02-28T18:23:48.733-05:00The game is based on the comic not the showThe game is based on the comic not the showJimhttp://firstname.lastname@example.com:blogger.com,1999:blog-1598877299622973005.post-9312168448455369532014-02-28T08:53:15.543-05:002014-02-28T08:53:15.543-05:00I have very little interest in this owing to my co...I have very little interest in this owing to my complete indifference to boring zombie-related nonsense but I'm intrigued as to how a game can have 'seasons'. Are they trying to make it an interactive TV show?RetroKingSimonhttp://email@example.com


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Open House: Introducing F.A.S.T (FREE Algorithm Study Team)
Open House to Introduce all F.A.S.T groups (SE, JS, DS, and SQL)
Today's high-tech companies demand their software engineers to be very good at problem-solving and algorithms. They put algorithm as one of the most critical hiring criteria. As such, job seekers, fresh or experienced, devote themselves to study and practice of advanced algorithms. USTSV believes learning and practicing advanced algorithm should be a right for each and every software engineer, fresh and experienced. Furthermore through working collaboratively we all can advance our algorithm skill without paying a high price.
USTSV is proud to offer FREE Algorithm Study Teams (F.A.S.T). This is NOT a free trial, but completely free from the beginning to the end.
F.A.S.T is a FREE collaborative study group where interested job seekers practice and solve advanced algorithms together under the guidance of experienced USTSV professors. A typical example is to solve most of the LEETCODE algorithms at F.A.S.T. The goal of F.A.S.T is to improve a job seeker's problem-solving and algorithm skill, and for them to succeed in most challenging coding tests and job interviews at companies like FAANG.
- SE - Software engineering for advanced algorithms (such as medium and hard problems at leetcode.com). Programming languages include C/C++, Java, JavaScript and Python.
- JS - Full Stack JavaScript for medium algorithms. Programming language is JavaScript.
- DS - Data science for basic algorithms (such as easy and medium problems at leetcode.com), analytics, statistics, visualization. Programming language is Python.
- SQL - Database in Data Science for SQL queries in leetcode.com. Programming language is SQL.
- 2 or 3 sessions per week, 2 to 5 hours per session
- It lasts about two months.
- New teams are formed as soon as enough job seekers sign up here.
Minimal Requirements
This is not an entry-level training class. Instead, it requires participates to have a computer-related degree, knowledge of software development, and at least one programming language. If you do not meet the minimal requirements, please do not register and attend this open house.
The faculty for F.A.S.T are all veteran professors and industry experts. They not only guide participates on advanced algorithms, but also become a mentor to job search. Their insight knowledge and career accomplishments in the software industry will be a big help to the participates.
Open House to Introduce F.A.S.T
We will introduce F.A.S.T Program and answer all of your questions. Onsite signup to F.A.S.T is available. Please bring all your questions and sign up actual sessions.
Current Sessions:
USTSV Office:


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Listings in Appraisals, Buy & Sell, Cents, Certified World Coins, Appraisals and U.S. Medals & Tokens
Colorado Stamps & Coins
Business Contact: Shayne Clinard
in Web e-Commerce, Obsolete Notes, National Bank Notes, Military Payment Certificates, Large Type Notes, Key Date Coins, Foreign Currency, Exonumia, Errors, Early Amer. Coppers, Confederate Notes, China, Certified Paper Money, Appraisals, Buy & Sell
3260 E Woodmen Rd
Ste 100
Colorado Springs, Colorado 80920
United States
Infinity Coins
Business Contact: Kevin Josephson
in U.S. Coins, Silver Coins, Silver Bullion, Platinum Bullion, Paper Money, Numismatic Literature, Medals & Tokens, Loans, Grading Companies, Gold Coins, Gold Bullion, Exonumia, Collector Supplies, Appraisals, Buy & Sell
Infinity Coins is a small town coin shop with a big reach. With all of our experience in the coin industry, we have developed many trade relationships that allow us to be extremely competitive in the world of coins and bullion.
545 Shoup Ave
Ste 108A
Idaho Falls, Idaho 83402-3575
United States
(208) 201-5007
Fax: (208) 881-5174
Gilbert Coin & Collectible Exchange
Business Contact: Steve Twitty
in World Coins, U.S. Coins, Silver Coins, Silver Bullion, Paper Money, Obsolete Notes, Grading Companies, Gold Coins, Gold Bullion, Confederate Notes, Colonial Currency, Brick & Mortar, Appraisals, Buy & Sell, Appraisals
If you're searching for collectible US coins, gold, silver, bullion, or paper money please stop in and see us. We also offer a selection of coin and paper money supplies for the collector.
4079-H Augusta Hwy
Gilbert, South Carolina 29054
United States
GreatCollections Coin Auctions
Business Contact: Ian Russell
in World Coins, U.S. Coins, Type Coins, Silver Coins, Russia, Paper Money, Key Date Coins, Gold, Collector Services, China, Appraisals, Buy & Sell
GreatCollections offers thousands of PCGS and NGC certified coins and PCGS and PMG certified currency each week in auction. All coins and currency have been professionally listed and imaged by GreatCollections professional staff.
17500 Red Hill Ave
Ste 160
Irvine, California 92614
United States
(800) 442-6467
Fax: (949) 679-4178
Integrity Coin Store
Business Contact: Richard Schornak
in Type Coins, Quarters, Paper Money, Key Date Coins, Half Dollars, Gold Coins, Dollars, Dimes, Commemoratives, Cents, Bullion, Appraisals, Buy & Sell, 5 Cents, 3 Cents
We maintain a large selection of collectible coins and currency. Certified and Raw, We utilize ANA grading standards on all coins that we sell. Friendly local services with many positive reviews. We provide a local web page along with a e-store.
372 Wythe Creek Rd
Ste E
Poquoson, Virginia 23693
United States
Business Contact: Steve Zeller
in Web e-Commerce, Silver Certificates, Paper Money, Obsolete Notes, National Bank Notes, Legal Tender Notes, Large Type Notes, Gold Notes, Fractional Currency, Federal Reserve Notes, Confederate Notes, Colonial Currency, Certified Paper Money, Appraisals, Buy & Sell
Rare U.S. Currency FOR SALE
PO Box 15084
Reading, Pennsylvania 19612
United States
Stack's Bowers Galleries
Business Contact: Christine Karstedt
in World Coins, U.S. Coins, Silver Coins, Paper Money, Key Date Coins, Grading Companies, Gold Coins, Errors, Bullion, Brick & Mortar, Auction Services, Appraisals, Buy & Sell, Ancient Coins
Stack's Bowers Galleries conducts live, Internet and specialized auctions of rare U.S. and world coins and currency and ancient coins, as well as direct sales through retail and wholesale channels.
123 West 57th St
Ste 100
New York, New York 10019
United States
Mid-American Rare Coin Gallery
Business Contact: Jeff Garrett
in World Coins, U.S. Medals & Tokens, U.S. Coins, Retail Sales, Paper Money, Mints, Collector Services, Bullion, Auction Services, Appraisals, Buy & Sell, Ancient Coins
We buy and sell all United States coinage and paper money. We have handled nearly every coin listed in the Guide Book of United States Coins. We consider "knowledge" to be the key to our success. Based in Lexington, Kentucky.
1707 Nicholasville Rd
Second Floor
Lexington, Kentucky 40503-1424
United States
Gary Adkins Associates, Inc.
Business Contact: Gary Adkins
in World Medals & Tokens, World Coins, U.S. Medals & Tokens, U.S. Coins, Retail Sales, Paper Money, Numismatic Literature, Medals & Tokens, Exonumia, Errors, Early Amer. Coppers, Bullion, Auction Services, Appraisals, Buy & Sell
Gary Adkins is a rare coin and currency expert as well as a gold, silver, platinum specialist. Located in Minneapolis, Minnesota. Buying and selling. Collections and estate appraisal, liquidation and auction services. Minneapolis, MN.
5151 Edina Industrial Blvd
Ste 200
Minneapolis, Minnesota 55439-3028
United States
(952) 746-0860
Fax: (952) 835-2266
RSR Numismatics and Collectibles, LLC
Business Contact: Robert Riemer
in World Coins, U.S. Coins, Proof/Mint Sets, Paper Money, Medals & Tokens, Gold Coins, Fractional Currency, Exonumia, Errors, Confederate Notes, Commemoratives, Bullion, Appraisals, Buy & Sell, Ancient Coins
RSR Collectibles and Numismatics LLC (also known as RSR Coins) has been in the coin business, buying and selling coins for over 40 - years. We were among the early dealers in the certified coin market, selling ANACS coins in the late 1970's.
1881 Black Rock Turnpike
Fairfield, Connecticut 06825
United States
(203) 359-2646
Fax: (203) 256-0075


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A Look Inside the Growing Trouble of Opioid Addiction in the
The usa is currently down the middle of a crisis with regards to opioid addiction. Nora N. Volkow, composing for the National Institute on Drug Abuse , carries indicated the fact that as of the entire year 2012, there have been a total of approximately 2 . one particular million Vacationers were insulting prescription opioids, and that an alternative 467, 500 were hooked on heroin. These kinds of numbers will be startling, and indicate that opioid obsession should be spray-treated as a problem affecting the healthiness of many people in the nation.
That include opioids represents a range of drugs that talk about a common chemical substance origin and exhibit general properties. These drugs comprise opium, morphine, oxycontin, and heroin. The abuse have proven to be drugs just brings into play approximately twenty five, 000 American deaths a year. These medications are lingering when mistreated and overdose deaths from them outnumber community drugs, which includes heroin. Heroin itself triggers more overdoses than some other class in street illegal drug in the leisure drug growing culture of United states of america. In 2014 there were above 10, 1000 heroin overdose deaths, plus much more than hai th?p k?, 000 fatalities from doctor paperwork opioids in america, according to drugabuse. gov.
Deaths by opioids and related pain killers (1999 supports 2015)Source: CDC Opioid use in America is ChiefEssays.Net mostly a potentially dangerous concern. Opioids and related analgesics had been the grassroots cause of your demise for approximately 13 people from every 100, 1000 in 2015.
Historical past of opioids
Opioids can be a class of drugs that are prescribed by doctors primarily for the purpose of pain relief. Your side effect a feeling of euphoria is what tends to end in opioids appearing abused. Opioids have a very huge history. The reason for opium comes from the poppy plant, which had been known to people of traditional civilizations. Purdue Pharma, within an article produced by The Atlantic , has required that the initial reference to opium cultivation are situated as far back as the year 3400 BC, in Mesopotamia.
The opium poppySource: Wiki Opium and opioids are produced from a types of poppy identified as Papaver somniferum pictured down below.
Purdue Pharma has developed a helpful time line regarding the great opioids all over human world. Given that this was created with a pharmaceutical organization, there is fact to suspect bias; however , it would seem that basic basic facts of the time series are in fact objectively accurate, whether not the value and signifying ascribed with each fact.
The history from opium and opioidsSource: ?KA Since its farming in 3400 B. City., opium has got captured benefit and fascination of humankind. The schedule below is the word for the appear to have been of opium into the pain-relieving controlled drug it is at this time. Year Production 3400 BC Cultivation in opium during Mesopotamia vitamins. 400 BC The great Ancient greek physician Hippocrates recognizes the medicinal benefits of opium 1100s-1400s As a consequence of the Catholic Inquisition, opium is condemned in the West, as seen as a system of the East and thus satan 1527 The Swiss-German alchemist Paracelsus invents laudanum, that is found being very impact at lowering pain 1806 German researchers Sertü ner isolates some drug from opium; people like it morphine, after Morpheus the the almighty of dreams 1800s Morphine regularly used by pain treatment and especially surgical treatments 1909 American Congress ?uvre opium with respect to smoking: quick the War on Drugs 1916 German researchers synthesize oxycodone 1924 Heroin made operating illegally for all needs within the North american 1950 Oxycodone approved with regards to medical usage by the Food and Drug Administration (FDA) 1960s-1970s Addiction to opioids in America ages, as does government crackdown around the use of opioids 1980s "Opiophobia: " medical doctors become unlikely to assign opioids to patients 1990s Landscape is altered: greater tact to the concern of problems leads to dramatic rises found in prescription in opioids 2000s Opioid desire grows 2010 to present A couple technical sure being taken up make opioids more difficult to abuse
Different motivators
Opioids have a long history of use simply by human beings, beginning with the fostering of opium from the poppy plant above five millennia ago. The moment Chinese migrants began reducing in San Francisco during the Wisconsin gold buzz, they helped bring opium with them.
Opium dens were common taniere for the Chinese staff, who were frequently overworked, and essentially medicated like slaves. Americans buying a thrill, or maybe an escape as well began to recurrent these opium dens, simply kick-starting opium abuse in the nation. Opium play rooms were the foundation behind the first ever anti-drug law elapsed in America, the 1875 code banning opium dens.
Opium living area in Truly lodging home (San Francisco, CA)Source: Wiki Chinese foreign nationals smoke in the opium den nya in S . fransisco in this early 1900s take pictures. When Vacationers began to frequent these play rooms, the earliest anti-drug legal requirements banning opium abuse is passed found in 1875.
Over time, with greater standard acceptance in opioids, many people began to be approved for the treating of pain inside United States. As well, this typical acceptance greatly increased the rates for the nonmedical modern trend mistreatment of opioids by Us americans.
On one hand, equally pharmaceutical firms and medical doctors may have vested motivations in revitalizing public perceptions regarding opioids. Usually, all these interests are motivated by just profit. On the flip side, ordinary people typically find themselves realized in the throes of cravings. These people uncover pleasure, and the above-mentioned euphoria from the narcotic effects of opioids, and thus knowledge drawn to destroying them.
Aspects significantly troubled by opioid fixation
The opioid abuse situation within the The us is not demographically distributed within an even technique. Rather, there are clearly most communities inside the nation which have been affected by it in a significantly more significant technique than other social networks. In general, it appears that inculto areas have been hit very much harder than urban areas through opioid damage epidemic.
Katherine M. Keyes et jordlag., in an content page published inside the American Newspaper of Submitted Health back in 2014, have got indicated all of the following:
inches Even though all claims have demonstrated an increase in nonmedical directions opioid morbidity and death during the past 10 years, death and injury by non-medical prescription medication opioid neglect are located in conditions with considerable rural multitude, such as Kentucky, West Virginia, Alaska, and Oklahoma. "
So , while the problem is a national one, it is clearly extra concentrated in certain regions as opposed to it is found in others.
A good broader narcotic issue
The numbers mean that the taller concentration from opioid amuse in non-urban areas could possibly be related to a fabulous broader design of more predominant drug abuse found in those pueblerino areas. Get hold of, it would seem that rural rige are less vulnerable to seek treatment for drug abuse on their own project than city folk.
One example, in a review of substance abuse clinics, the Substance Abuse and Mental Physical health Services Current administration (SAMHSA) includes indicated that 51. 6 percent of rural masse were seen by the lawbreaker justice system, compared with merely 28. 4 percent from urban foule.
Unconscious drug commercial grade admissions (rural vs . urban)Source: SAMHS Info from the Drug abuse and Subconscious Health Expertise suggests that substance abuse is more concentrated in villano areas when compared to urban areas, with rural users less likely to seek treatment under your own accord.
This kind of points toward a abgefahren cultural main difference regarding drug abuse that may underlie the imbalance in opioid abuse premiums. However , it can possibly be necessary to seek your deeper good reason that this significant difference exists anyway.
The situation of give up hope
It is a overall principle that men and women may turn to drug abuse, including opioid amuse, when they are perception depressed as well as hopeless of the lives. With this in mind, it is worth turning focus on recent stats regarding financial significance and voter selection in the 2016 American presidential election.
According to Anthony Tankersley of a Washington Post , Hillary Clinton won about five-hundred counties inside the nation the fact that generate sixty four percent in economic activity within the us; whereas Jesse Trump won about 2, 600 areas that create the various other 36 percent of the monetary activity while using nation. Subsequent charts are going to graphically display the significant disparities inherent in these figures.
U. S. counties vs . economical activitySource: WP People are additional inclined to abuse medications when they usually do not feel their particular voice is definitely heard. In accordance with the Washington Put up , most marketers make no America's areas – the vast majority of which are in rural spaces – get only 1/3rd of one's nation's economical activity. This is exactly illustrated inside the charts listed below.
These charts reveal that more when compared to four-fifths of one's counties on the nation create just a little a lot more than one-third of one's economic process of the nation. Also, these counties would seem that should be concentrated from the heartland on the nation, inside large inculto areas that heavily went for Trump inside recent usa president election.
This is tightly related to the present discourse on opioid abuse, because doing so indicates that your American market has more or less left non-urban people and communities after. This can allow it to become difficult designed for such people to dream about a life or feel a really sense in self-efficacy. It feels right they would get left with little more than anger, hopelessness, animosity, and panic attacks. These unconscious conditions they may be left with, are actually conditions that generally get people toward drug abuse.
An increase in heroin use
Many Americans in modern times whom become heroin addicts had their primary introduction to opioids through a pharmaceutical drug. The National Societe on Drug Abuse has available a report of pooled country specific data regarding heroin buffs, that in the year 2010, in regard to 67 percent of heroin addicts experienced first chosen prescription opioids before moving over over to heroin.
Heroin addicts' introductions to opioids (2010)Source: NIH According to The Country Institute upon Drug Abuse , most heroin addicts 2010 were introduced to opioids because of prescription drugs.
This means that a substantial amount Americans start by abusing directions opioids, and end up turning over to heroin for whatever reason.
Heroin, a cheaper alternative to popular other prescriptions
One of the main reasons for this switch via prescription opioids (such due to oxycontin) to heroin is always that heroin is much cheaper than pharmaceutical remedies. Dr . Sanjay Gupta of CNN carries written below regarding the following matter:
inches Heroin is usually less costly than prescription medications. Opiate problems medications price the uninsured about $1 per mg; so an important 60-milligram herbal remedy will cost $60. You can receive the equivalent amount of money of heroin for about one-tenth the price. "
Market trends itself purely drives opioid users to heroin. With everything else as equal rather than price, any individual would naturally go for the more affordable of two similar products and solutions in any offered area.
Associated with heroin
This kind of emphasizes the that the change from recommended opioids to heroin is without question popular, simply because heroin should in fact deliver effects which might be similar to the prescription drugs. Both heroin and prescribed opioids are ultimately derived from the opium for this poppy manufacturing facility. Dr . Stephen E. Lankenau of Drexel University stated to the Houston Times many opioid addicts tend to convert from heroin to oxycontin (and various other prescription drugs) and back again, depending on precisely what is available and what they have enough money at any given time.
Intake of heroin
It is also worthy of noting which the switch to heroin among opioid users is sometimes catalyzed through fact that pharmaceutic companies include begun making it feel like more difficult to get high on prescription opioids.
For example , The Food and Drug Governing administration (FDA) features indicated there exists certain equipment being already a part of pills that make abusing these folks more difficult. For example a measurement that allows the harmful chemicals to release eventually only when they are simply swallowed. Which indicate that if opioid addicts needed to get increased, they would sometimes need to get extra creative regarding how they take from the pharmaceutical pills, or they'd need to change over to unregulated heroin.
Injecting heroinSource: Wiki With prescription products becoming harder to maltreatment, some opioid addicts try out heroin to get elevated. The heroin user inside the photograph underneath has the medicine injected right into a vein found in her give.
Routines of personal pill use
The information cited over from the Countrywide Institute for Drug Abuse and other sources intently indicate that current generation of heroin users are turned on into the drug throughout the previous use of prescription prescription drugs. These kind of latter prescription drugs are prescribed by doctors to provide rest from some type of physical pain. These prescriptions are largely momentary, and are can be used within a certain time period that matches with the person's pain.
Each doctor determines there is no much longer a need for the prescribed opioid, or cure is finished, they will quit prescribing these individuals. The problem starts when the patient still demands the 'high the pills granted, but do not has usage of them. It can be in this point that many recent users of heroin and various other opioids in the beginning get hooked on the prescribed drugs, and may also pursue other option means to get them.
Evidence on this subject strongly holds this notion. Among non-medical users from opioids, a fabulous prescription from a single or more medical practitioners is one of the more prevalent paths of discover that were reported, second only to being supplied the pharmaceutical for free by friends or relatives. As well as for consistent, all the time users in opioids, a fabulous prescription out of a physician is regarded as the leading direct of gain access to and supply.
That data was reported by the Centers to get Disease Control and Cures on the basis of explore published inside Journal of your American Therapeutic Association .
How non-medical opioid users looked at prescription opioidsSource: CDC A large number of nonmedical end users obtained opioids via a close friend or relative as displayed in the chart below.
If an opioid user gets his drug(s) from family and friends either for funds or at no cost, it is likely explained friend/relative boasts a prescription with a doctor relating to the pill. It's in cases like this that the friend/relative either specifically needs the medication , and has now chosen to deal with a price reduction to others, or perhaps decided to that. While the second-hand of prescription medication is obviously operating illegally, so is normally giving it at a distance for free.
Group data of drug end users
Two specific populations which might be especially struggling with the current opioid abuse problem are adolescents (ages doze to 17) and women. As per the American The population of Habit Medicine, difficult 467, 1000 adolescent nonmedical users in opioids in the year 2014. This kind of organization features written down the page regarding opioids and women:
" Women are more inclined to have serious pain, get prescribed herpes virus pain relievers, get higher estimation, and employed for longer routines than males. Women can become dependent on medicine pain relievers more quickly than guys. very well
Relating to race, it appears that the opioid addiction disease is actually impinging upon Whites additional significantly than it is small section populations just like Blacks or perhaps Hispanics. This can be a relatively anomalous trend when it comes to drug abuse. Steven Ross Ruthers, writing suitable for Modern Medicine and health , does have indicated this may by reason of racial opinion in the medicine of opioids: physicians will be in general more reluctant to prescribe opioids to small section patients, considering that they tend to consider that fraction patients could possibly be more at risk of addiction and/or selling the medication along the black market.
Reasons for popularity (compared to alcohol)
Opioids, of course , are certainly not the only training of drugs that will be abused by way of Americans. For example , the Country wide Institute upon Alcohol Abuse and Alcoholism comes armed with indicated that in the year 2014, a total around 17 million dollars Americans experienced alcohol work with disorder (more commonly known as alcoholism). This is in excess of the number of People in the us abusing opioids by a factor of about eight. 5 indicating, there are almost eight. 5 times the amount of alcoholics in America as there are opioid addicts. Not to mention, alcohol can be described as perfectly legal drug.
Alcoholism or opioid cravings in America (2014) While opioid addiction is definitely a growing apprehension in the United States, info from the Country wide Institute with Alcohol Abuse and Alcoholism shows far more People in america suffer from alcohol addiction.
What these volumes indicate is undoubtedly although opioid abuse is definitely an a serious issue, it is also very important to maintain a feeling of scale or perhaps proportion about the issue. It is not necessarily as though the only drug abuse problem working on the United States.
The appeal of opioids
It is having said that true that opioids in particular have a extra appeal for that good number of people. The obvious reason for this could only be traced time for the drug's euphoric results. After all, the name inch laudanum " is derived from a good root Latin verb actually "to honor; " upkeep morphine is discovered, it was named after Morpheus, the ancient Greek god in dreams. The sole conclusion which can be drawn, usually at least from the short run, the consequences of opioids are quite pleasurable to find human beings.
Morpheus, smart of dreamsSource: GMGM The appeal of opioids lies in all their ability to build a feeling of relish in the buyer. When morphine – an opioid analgesic – was first discovered, it turned out named after Morpheus, the Artistic god of dreams.
Essentially, opioids and especially heroin produce a huge endorphin and dopamine push that struck the brain fast, and they also obstruct off any kind of signals of pain coming from being signed up by the grey matter. It is that mix of enormously enhanced achievement and greatly reduced pain that leads people to find opioids and keeps all of them coming back for much more of the medication.
In cases where opioids are actually a country problem, well then this very likely due to the market place being bombarded with these people. It is not that a lot of people basically suddenly realized that they want to find themselves rush in opioids. Instead of, the issue is the fact that opioids are actually far more easily obtainable, and people already have much greater opportunity for getting switched on to them all. This will be further elaborated on a small later outlined in this article.
Responses towards the problem
At the present time, it would seem that federal government is simply at the upfront phases in developing a concerted response to the challenge of the opioid abuse disease. According to Nora D. Volkow of the Nationwide Institute at Drug Abuse , one of the main attempts in this area offers consisted of thriving new pain alleviation medications (also known as analgesics) that will offer the desired outcome but have fewer potential for making opioid habit.
The phrase "analgesic" can be an umbrella term for any drug that generates the effect in pain relief. All these drugs get the job done by keeping pain receptors within the brain. Historically, opioids have been typically the most popular and effective form of pain killer. In process, though, it should possible to create other meds that have a similar pain relief results as opioids but a smaller amount addictive possibility.
Underneath public and governmental force, pharmaceutical companies have also initiated manufacturing medicine that have been labeled as abuse-deterrent by your Food and Drug Administration . This is how the agency is the word for these new items:
" Formulations with abuse-deterrent real estate target the known or maybe expected ways of mistreatment, such as killer in order to snort or dissipating in order to utilize, for the precise opioid tablet substance. "
The thought here is that whenever the prescriptions are manipulated in a way that can lend the crooks to abuse, they will deactivate the kind of active chemical substances so that joue is no longer likely.
Response to opioid abuse for the local level
At the localized level, the leading priorities on the subject of opioid exploitation would seem to get:
- Doing the job toward large public education the risks built in in the entry to opioids and the high possibility of addiction.
- Develop awareness between both health issues and law enforcement professionals regarding the ways in which 60 affecting town.
These details emerge in numerous brief press releases found on the Net regarding reactions to the opioid abuse pandemic across several individual states of the union, including Maryland, Massachusetts, and Nebraska. As a rule, it can be suggested that in your responses towards the opioid use epidemic, in the both the government and the fine levels, are only at the early stages of communication. It is only lately that the size of the issue and the requirement a determined policy response has become apparent to all.
Treatment pursuits
There are some main treatment initiatives which have emerged in reply to the opioid abuse crisis within the Us. These are: the opioid overdose prevention toolkit, Good Samaritan laws, plus the drug Naloxone. It is truly worth discussing every one of these in turn.
Overdose prevention tool set
The tool set is essentially some packet data distributed by groups regarding what various stakeholders should do in a case where an instance in opioid overdose occurs in their presence. The Substance Abuse and Mental Overall health Services Direction (SAMHSA), for instance , has furnished one such tool set. Here is a screenshot of it has the table of contents:
Table from contents to obtain the SAMHSA opioid overdose toolkitSource: SAMHS Toolkits just like the one below summarise what to do whereas witnessing an opioid overdose. The bedside of valuables of The Substance Abuse and Mental Well being Services Delivery Opioid Overdose Toolkit is usually captured in the image underneath.
The diversity of stakeholders have the information inside the toolkit is without question characteristic on this form of treatment initiative.
Great Samaritan legal guidelines
In general, a good quality Samaritan legislations is a legal provision that grants defenses to a one that calls support for someone else in danger, in the event that calling for help would make that person trusted of a wrongdoing or breach in some way. For example , if the right conditions are met, then simply someone who cell phone calls 911 because his friend is being affected by a heroin overdose may well be granted defense against legal charges to possessing heroin himself.


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Adenocarcinoma Originating From a Completely Isolated Duplication Cyst of the Mesentery in an Adult
Article information
Alimentary tract duplications are uncommon congenital abnormalities that usually have an anatomical connection with some part of the gastrointestinal tract and have a common blood supply with the adjacent segment of intestine. A completely isolated duplication cyst (CIDC) is a very rare type of gastrointestinal duplication that does not communicate with the normal bowel segment and possesses its own exclusive blood supply. Only 5 CIDC cases in adults have been reported in the English medical literature. Additionally, only 1 case of mucinous cystadenoma from an infected CIDC of the ileum has been reported. This report describes a 52-year-old male patient with a peritoneal CIDC, which upon curative excision was found to have given rise to an adenocarcinoma. The latter was lined internally with malignant glandular cells and contained a smooth muscular outer layer as determined by microscopic examination of the tissue. We believe that this is the first reported case of an adenocarcinoma originating from a CIDC in an adult.
Duplication cysts are rare congenital abnormalities that are usually diagnosed in childhood, and the occurrence of such cysts is rare in adulthood.1,2 The cysts can occur anywhere from the mouth to the anus. Duplication cysts have been described as congenital malformations that involve the mesenteric side of the gastrointestinal tract and share a common wall or blood supply with the involved bowel.3
Most cases are diagnosed during early childhood because duplication cysts tend to accompany symptoms such as abdominal pain or palpable masses in this age group. In contrast, these cysts are diagnosed incidentally as asymptomatic disease during adulthood. There are several associated complications, including bleeding, fistula formation, and inflammatory masses.4,5 Furthermore, malignant transformation can occur, although this is rare.6,7 These complications might be caused by heterotropic mucosa of a gastric or pancreatic origin, which is a common finding in histological examinations of duplication cysts.8
Generally, duplication cysts are firmly attached to the digestive tract and are most frequently found around the ileocecal region. Thus, it is essential to remove the bowel segment containing the duplication cyst when surgical intervention is necessary.9 Completely isolated duplication cysts (CIDCs) comprise an extremely rare type of gastrointestinal duplications, which possess their own blood supply and do not communicate with the normal bowel segment.10,11
Only 5 CIDCs in adults were reported in the English medical literature,10,11,12,13,14 and only 1 case of a mucinous cystadenoma that originated in an infected ileal CIDC has been reported, in 2012.10 However, to date, there are no reports of adenocarcinoma arising from a CIDC. We present the first case of an adenocarcinoma originating from a CIDC in an adult who underwent a curative mass excision, along with a literature review.
A 52-year-old male patient with abdominal pain was admitted to the Wonju Severance Christian Hospital. His medical history was unremarkable, except for pulmonary tuberculosis, which had been cured with medication 6 months earlier. An intraperitoneal mass was noted on abdominopelvic CT conducted by an external facility (Fig. 1A).
The patient had mild abdominal pain in the middle of his abdomen that was not associated with food intake or positional change. Upon system review, there were no specific findings such as weight loss. Findings of the physical examination were unremarkable and did not reveal a palpable mass or abdominal tenderness. Laboratory analysis revealed a CEA level of 29.3 ng/mL (standard value: <5 ng/mL), and a markedly increased level of CA 19-9 of up to 4881 U/mL (standard value: <5 U/mL). Other laboratory results were within normal ranges.
Chest CT revealed improved pulmonary tuberculosis and an approximately 4.3-cm-sized cystic mass in the sub-gastric area; the internal contents of the mass showed an enhanced density greater than that of the surrounding fluid. The mass contained a partially calcified region and was not attached to an adjacent organ such as the stomach or small intestine.
The endoscopy finding from an external facility indicated only chronic superficial gastritis. There was no visible mass or mass effect lesion. Endoscopic ultrasound (EUS) was available for further evaluation of the mass because it was located near the lower border of the stomach. On EUS, the mass was found to be in the extra-gastric area and presented as a cystic feature with an internally mixed echoic pattern, and the cystic mass wall had both an inner smooth hyperechoic mucosal layer (Fig. 1B, arrow a) and an outer hypoechoic muscular layer (Fig. 1B, arrow b).
On the basis of these findings, we diagnosed this case as a malignant gastrointestinal tumor or malignant lymph node and performed surgery. The entire cyst was excised without disturbing the normal bowel or mesenteric anatomy. The mass featured a well-encapsulated oval shape (Fig. 2A). During surgery, we found that the mass was located in the peritoneum, was not attached to the small bowel or stomach, and had a separate feeding vessel. Upon a gross sectional inspection, the mass was a 4×3×3-cm unilocular cyst filled with dark brown necrotic material that appeared to comprise hemorrhagic contents. The cyst wall was evenly thin with focally located, ill-defined yellowish-brown mural nodules (Fig. 2B). Upon microscopic examination, the cyst wall was found to be composed of an inner columnar epithelial lining, 2 smooth muscle layers, and serosa, thus mimicking the intestine. However, the epithelial lining of the entire cyst consisted of gland-forming neoplastic columnar epithelium, which was characterized by a loss of nuclear polarity, a high nuclear/cytoplasmic ratio, and hyperchromasia, without spared non-neoplastic epithelium (Fig. 3A). Focal areas of invasion into the smooth muscle were observed, and the cyst wall contained multifocal cholesterol granulomas that matched the yellowish nodules observed during the gross examination (Fig. 3B). The immunohistochemical stains were positive for cytokeratin 20 and negative for cytokeratin 7 in the neoplastic epithelial lining of the cyst (Fig. 3C, D). These findings were consistent with an adenocarcinoma that had arisen from the intestinal duplication cyst.
There were no metastases or local cancer invasion, according to 18F-fluorodeoxyglucose PET-CT. No postoperative complications occurred, the patient remains well, and the tumor marker levels had decreased to within normal ranges at follow-up.
Duplication cysts in the alimentary tract are rare developmental anomalies that involve the mesenteric side of the associated alimentary tract and share a common blood supply with the native bowel.2 These cysts can occur anywhere along the alimentary tract from the mouth to the anus, although the ileum is the most frequently involved region (35%) followed by the esophagus (19%), jejunum (10%), stomach (9%), and colon (7%).15 CIDC is an extremely rare variant form of gastrointestinal duplication that has its own blood supply and does not communicate with the normal bowel segment.
To our knowledge, only 5 CIDC cases have been found in adults among 8 reported cases to date.10,11,12,13,14 Only 1 case of a malignant transformation from CIDC (mucinous cystadenoma) in an adult has been reported.10 In the present case, during abdominal surgery, we diagnosed an adenocarcinoma that originated from a CIDC in a 52-year-old male with nonspecific abdominal pain. To our knowledge, this is the first report of such a case.
Several theories were proposed to account for the development of enteric duplications, including recanalization after the solid epithelial stage of embryonic bowel development, persistent embryologic diverticula, and the intrauterine vascular accident theory.15,16,17 Bremer's "aberrant vacuolization" theory suggests that epithelial proliferation occurs during embryonic intestine development and occludes the bowel lumen in the 6-week embryo ("solid stage"); thereafter, a vacuolization of the entire alimentary tract occurs, thus transforming the digestive system into a tube with a single lumen. Throughout the process of vacuole coalescence, an error might occur ("aberrant vacuolization"), resulting in the formation of 2 (or more) parallel channels that may or may not communicate with each other.8 However, no single theory adequately explains all known duplications.8
Malignant changes of in communicating type duplication cysts were most frequently observed in the small bowel, followed by the colon, rectum, and stomach.17,18 Such changes can originate from the underlying mucosa and develop into adenocarcinoma in almost all cases. However, in our case, there was no remaining normal mucosa, only heterotrophic mucosa. Once a malignant change occurs, the prognosis is generally poor because of the high metastasis rate and rare presentation of symptoms in adults. Therefore, early diagnosis and management are essential for duplication cysts.
Diagnoses of duplication cysts are generally made by abdominal CT, MRI, and ultrasonography.19,20 Duplication cysts manifest as smooth, rounded, fluid-filled cysts or tubular structures with thin, slightly enhancing walls on CT scans. ultrasonography and MRI might indicate a duplication via the identification of a 3-layered image that represents the walled layer of the duplication cyst. Additionally, if a CIDC is located in an available area, EUS might be helpful because it can allow a detailed identification of the internal contents of cysts and discriminate the cyst wall layers. The pathologic characteristics of duplication cysts include spherical or tubular structures that are firmly attached to at least 1 point in the alimentary tract, possess well-developed smooth muscle layers, and have an epithelial lining that resembles some part of the alimentary tract.
In conclusion, we report herein a rare case of adenocarcinoma that originated from a CIDC in an adult. This case suggests that the various duplication cyst forms and the associated possibilities of malignant transformation should be considered for the early detection and treatment of uncommon duplication cysts.
Financial support: None.
Conflict of interest: None.


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Thanksgiving turkeys can be red meat to a growling critic. And Frank N. Nugent growled. He reviewed movies for The Times before 20th Century-Fox employed him as a script doctor, the theory being, according to his obituary in The Times, "If you can't fire 'em, hire 'em."
Turkeys were clearly on Nugent's mind in late November 1937, when he wrote an essay under the headline "Pity the Pilgrim Fathers."
"Amazing, when you think of it, that the Pilgrims could be thankful even without a neighborhood movie house around the stockade corner," he wrote, adding: "And yet, in their simple way, they had reason to rejoice. They had no double bills before them; no five-minute trailers (like as not shoved into the middle of the newsreel) to herald the greatest picture of the year and reveal so much of its story in the process that you would not want to see it even if it was. ... There were many things the Pilgrims might have been thankful to be without. Possibly they might have carved another turkey if they had known what they were missing."
He wasn't all cranberry tartness: "In the long view — and a year is a decade in so rapidly developing an art industry — Hollywood is steadily on the ascent, growing more mature, more skillful, ever more generous. Although its place in our national scheme is accepted, let us not accept it too casually. This is the Thanksgiving season, and Hollywood must take its bow, for, with all its faults, it has probably given you — the personal you — more hours of entertainment than any other public amusement source this year."
But not so fast. "Having thus squared the departmental debt of honor, we roll up our sleeves, whet the cleaver and turn to the week's offerings." He proceeded to carve up a forgotten epic called "52nd Street," then was kinder to an equally forgotten "Ebb Tide," but his comments on the industry are of note for their documentation of technological advances:
"On the chromatic side, it finds Technicolor continuing its slow improvement. Sky and water seem to have been conquered, are not the blinding blues they used to be; the greens are clear, not smudged with brown. But faces still have the texture of waxed fruit, and sunsets, although temptingly beautiful, must not be overindulged."
If advances in color were the talk of movies in 1937, a decade earlier it was talk itself.
Paramount released its first full-length "talkie" in 1928, a melodrama starring William Powell. The critic Mordaunt Hall, in his review in The Times, wrote that "the audible screen adaptation of the play 'Interference' is in many respects so remarkable that it may change the opinion of countless skeptics concerning talking photoplays."
Hall continued to extol the amazing improvements to this rapidly evolving technology since the "The Jazz Singer" had ushered in the talkies era the previous year:
"As the picture with excellent diction was unfurled, it became quite clear that the Paramount officials had learned something by the mistakes of others. There were no muffled sentences and no disturbing explosive utterances. This spoken picture continued its melodramatic route on an even keel, with good expression and without the tinny timbre so often heard in its forerunners. The ringing of a telephone bell was natural, and so was the knock on a door. One even heard a pen scratching its way over the paper as Evelyn Brent wrote a missive with her left hand. Yet the auxiliary sounds were not overdone, and those that were heard were not obtrusive, merely interesting."
One of the sound problems that plagued the early talkies was a persistent lisp in the voices of the actors. Much less so in "Interference," Hall noted:
"And here it might be said that only in a few cases is the lisp perceptible. When the Scotland Yard Inspector is searching for a stopper of the bottle containing the poison, it rather sounded like 'thopper' each time he said it. Yet when Mr. Powell produced the stopper and called attention to it, the word did not seem to have even a tinge of a lisp."


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Brand New Home that is ready to move in! This gorgeous Dornoch floorplan! Beautiful kitchen with very open layout to the spacious great room with a gas fireplace. Luxurious Owner Suite with two walk-in closets, each of the other Large bedrooms on second floor have their own en-suite bathroom.
Courtesy of Hamlet Homes
Electricity Connected, Natural Gas Connected
Dishwasher, Gas Range, Microwave, Oven
Landscaped - Fully, Patio(s), Porch
Gradual Slope, PUD - Planned Unit Development
The information provided is for consumers' personal, non-commercial use and may not be used for any purpose other than to identify prospective properties consumers may be interested in purchasing. All properties are subject to prior sale or withdrawal. All information provided is deemed reliable but is not guaranteed accurate, and should be independently verified.
The multiple listing information is provided by Park City Board of Realtors® from a copyrighted compilation of listings. The compilation of listings and each individual listing are © 2019 Park City Board of Realtors®, All Rights Reserved. Access to the multiple listing information through this website is made available by Summit Sotheby's International Realty as a member of the Park City Board of Realtors® multiple listing service. No other entity, including a brokerage firm or any franchisor, may be listed in place of the specific Listing Broker on the foregoing notice. Terms of Use
Listing information last updated on September 19th, 2019 at 6:43pm CDT.


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Key Details
Property Type: Single Family Home
Lot Size: 5,227 Sqft
Year Built: 2019
Purchase Type: For Sale
Listing Status: Under Contract
MLS Listing ID: 3471785
HOA Fees: $600/ann
Price per Sqft: $151
Financing: Cash,Conventional,VA
Style: Charleston
Subdivision: Cameron Creek
Full Baths: 2
Half Baths: 1
Special Sale: None
Property Description
This home greets you w/ a beautiful stacked stone exterior and a nice rocking chair front porch. 3 bedrooms, 2/1 baths and there's a study on the main floor. Large open kitchen with tons of cabinets, granite counters and a walk-in pantry. Owners suite is upstairs with secondary bedrooms and features a deluxe bath w/ a drop in tub. This home is energy star qualified.
State: SC
County: York
Bathroom(s),Breakfast,Family Room,Foyer,Kitchen,Pantry,Study: Main Level
Bathroom(s),Bedroom(s),Laundry,Master Bedroom: Upper Level
Interior Features: Attic Stairs Pulldown,Cable Available,Kitchen Island,Open Floorplan,Pantry,Split BR Plan,Walk-In Closet(s)
Laundry: Upper,Laundry Room
Hot Water: Electric
Heating: Central Air,g-Energy Star HVAC,Gas Hot Air/Furnace,Multizone A/C,MultiZone Heat
Flooring: Carpet,Prefinished Wood,Tile
Fireplaces Type: Great Room
Equipment: Cable Prewire,CO Detector,g-Energy Star® Dishwasher,Disposal,Gas Range/Electric Oven,Ice Maker Connection,Microwave,Natural Gas
Exterior Feature: Fiber Cement,Stone
Garage: Garage - 2 Car
Community Features: Playground,Pool,Other
Story: 2
Foundation: Slab
Sewer: City Sewer
Water: City Water
Elementary Schools: Gold Hill
Middle Schools: Gold Hill
High Schools: Fort Mill
School District: York School District 4
Listing Provided By Alan Beulah of M/I Homes
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Express Yourself Daily/
Chapter 3.1 of 'How To Get Your Sh!t Together' - Out Now eBook, Paperback & Audible
Prefer audio to text? Listen to this chapter instead
Express Yourself Daily
"I write because I don't know what I think until I read what I say."
– Flannery O'Conner
Artistic expression is amazingly therapeutic way to work through past trauma.
Readers of my first book 'Under The Influence - Reclaiming My Childhood,' will know that I have faced a degree of trauma during my childhood and early adolescence. My father was an addict, paranoid schizophrenic, chronic hoarder and drug dealer. While he never harmed me directly, the clientele that he allowed into his house were a different story. I am still not entirely certain of exactly what happened, but I know that I have many partial memories of sexual abuse, emotional neglect, and exposure to a dangerous world that was well beyond my years.
While life at my mother's house was far safer, I didn't feel that I had the emotional support needed to help deal with both the normal adolescent changes as well as the above mentioned mental afflictions. Eventually, at age 15, I moved out of home to live with my then girlfriend who was also facing issues with her home life.
Looking back over my past, it feels like I was in survival mode for a lot of the time, first through life at my father's house and then handling life away from home. I have felt hamstrung by my past. Tied to my trauma and limited by neglect, I struggled to move on and start living life on my own terms.
I have tried many different psychological interventions, including medications, but they were ineffective as a long term solution. These treatments kept me from suicide, but didn't really bring me any lasting relief.
It wasn't until I tried writing that I saw major improvements as a direct result of treatment.
Unlike talking therapy, I found that I could express myself far more freely onto a blank page. When I sat down to write, I didn't have to worry about what the page thought of me. It can't judge. I could ramble, reiterate and back track without concern for transmitting understanding to someone else.
Writing became a form of pure expression that I had never experienced before, providing an emotional release like no other.
I started with simple free writing. This involved just writing down whatever came to mind onto the page. No time limits, no narrative, no thought for grammar or story. I just wrote my thoughts. I don't keep much of this stuff, usually I burnt, flushed or threw out most of this kind of writing, often without even reading over it. The healing comes from the writing itself.
From there I moved onto writing poetry. If you had have told the teenager version of myself that I would not only be writing but also recommending the writing of poetry to other people, I would have laughed. School corrupted me into believing that poetry is something best left to those with an innate artistic streak or those born 100's of years ago in a forgotten, distant empire. This is simply not the case. Poetry is great because it combines self-expression with the skillful choice of word and rhythm. Don't get me wrong, I am by no means a great poet, but the act of creating poetry from the heart has been tremendously beneficial in the healing process.
Can't Quite Express
There are things that I want to say, but just can't quite express
Ruminations and meditations that I'm too afraid to address,
Like the veil over my eyes that keeps me hidden from the stress
To the dark wishes that I'm fighting to suppress.
Like the fear and anxiety that I will constantly transgress
To the past expressions that I am never going to confess,
Like how everything I do causes me nothing but duress
To the unwavering ache and torment that's causing me to regress.
I must profess, I desire to express my stress, confess to address this abscess. To obsess on happiness, to aim for excess and to stop living like a fucked-up mess.
Yes, I want to make progress but there are just some things that I can't quite express.
Following poetry, I got into writing about the specific events that occurred in my past as a way to get a deeper understanding. Not only what happened to me when I was younger, but also as a way to begin the process of moving on from it.
Through this process I was able to look at the more traumatic events from my past in a safe and detached manner, allowing me to get a more adult understanding of the events that occurred, and through the continued help of my psychologist, I am slowly working through it.
This process was not without its own problems, as through the process of writing, new and more troubling memories have come to the surface, the contents of which I now have no real way of verifying. However on the whole, the process is tremendously therapeutic.
The more I write, the less my past impacts me.
Eventually I showed these writings to some friends of mine who convinced me to share it with the world as a way to help other people dealing with similar circumstances in their life. Ultimately this became 'Under The Influence - Reclaiming My Childhood'. I continue to write daily, although now in addition to poetry or personal narratives, I am now moving into writing fiction.
Self-expression through art is one of the best forms of emotional release.
Although I would strongly recommend everyone attempt writing therapy in the form that I describe in the TAKE ACTION below, creative expression is where the real benefits lie. I am not much of a drawer, sculptor, musician, singer, photographer or dancer, however I have spoken to many people who have found similar benefits to what I have from writing from their chosen art form.
I have also found similar benefits from the 'art' component of martial arts, only to a much smaller degree than writing. Try writing, and if that doesn't click with you, try some other form of artistic expression. This may mean taking classes or looking at online instructional to develop some of the basics needed, but it will be well worth it.
When you find a form of expression that you connect with, express yourself each day.
Take some time to let go of the accumulated daily stress and reoccurring memories from your past. You don't need to share your creation with anyone unless you want to. This is purely for yourself.
Spend the next five minutes free writing. Write down whatever thoughts come to mind. Don't think about what you are writing, don't edit the words, grammar or spelling, and don't think of the final product. Just write.
It is the process of writing that is important here, not the product that you end up writing. You don't even have to look over what you have written to get the benefits.
Initially this may be a difficult process as you could potentially feel self-conscious. This is to be expected and will pass with time and practice. Just keep writing. If you have to, you can start by writing that you feel awkward about doing the exercise. Given enough time, it will start to flow.
The time limit of five minutes is by no means a maximum time. If you find yourself wanting to keep going, please do so. Write until it is all out of your system.
I have also found benefits from writing a daily journal. Unlike the free writing exercise described above, journaling is a more structured affair. I found that noting down what happened each day and how I felt about it allowed me to detach from the day's events and to see them from a clearer perspective.
I have added to this process by also tracking my mood through a subjective number based ranking system. For example noting down out of 10 (10 being high, 0 being low), my levels of happiness, anxiety and energy. This process gave me enough valuable data to prove to myself that I am 'not always depressed'.
As you may well know, when you are suffering from a mental affliction it can be easy to believe that you have always felt that way. A simple check over the journal revealed to me the fact that my moods don't stay the same. I could observe that in my past, times of ongoing depression always relented into times of no depression and then into times of ongoing happiness.
What's more, it enabled me to look back and see if there are any trends, people or events that directly lead to bouts of depression. This information enables me to better 'Guard My Mental State' (chapter 2.1).
Take five minutes to note down the events of your day as well as how you are feeling out of 10 (10 being high, 0 being low), in terms of happiness, anxiety and energy levels, as well as anything else that you would like to keep track of.
Continue the conversation
What is your favorite form of self-expression and why?
Tweet @zacpphillips #expression, with your thoughts.
Frequently Asked Questions
Q) Why do I have to express myself daily
A) Developing positive habits like daily expression will help your mental state to trend upwards. Alternatively, you could use it as a tool for when you are suffering from a particularly strong mental affliction.
Q) Should I hand write or type my writing? Does it matter?
A) I prefer hand written because it is quite portable and very easy to begin. There is no worry about batteries, saving documents or technical difficulties. That being said, writing is about expression. Write, type, or even dictate your voice, it really doesn't matter, provided you are expressing yourself!
Q) I am struggling to express myself honestly, I find myself holding back.
A) Give it time. At first it may feel forced and unnatural. For me, I felt quite self-conscious in the beginning, but once I got going these blocks steadily broke down. Over time you will be more and more able to express yourself and will be significantly less judgmental. Keep going!
Big Magic, Elizabeth Gilbert
Find a way to express yourself freely and then do it every day. This process will release the stress accumulated throughout the day as well as help you to move on from past traumas.
'Express Yourself Daily', is chapter 3.1 of 'How To Get Your Sh!t Together' - Out Now eBook, Paperback & Audible - Sign up to my email list to get every chapter sent directly to your inbox the moment they are released.