text:
- Review
- Open Access
Peritoneal carcinomatosis: patients selection, perioperative complications and quality of life related to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
- Gabriel Glockzin1,
- Hans J Schlitt1 and
- Pompiliu Piso1Email author
© Glockzin et al; licensee BioMed Central Ltd. 2009
- Received: 09 October 2008
- Accepted: 08 January 2009
- Published: 08 January 2009
Peritoneal tumor dissemination arising from colorectal cancer, appendiceal cancer, gastric cancer, gynecologic malignancies or peritoneal mesothelioma is a common sign of advanced tumor stage or disease recurrence and mostly associated with poor prognosis.
Methods and results
In the present review article preoperative workup, surgical technique, postoperative morbidity and mortality rates, oncological outcome and quality of life after CRS and HIPEC are reported regarding the different tumor entities.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) provide a promising combined treatment strategy for selected patients with peritoneal carcinomatosis that can improve patient survival and quality of life. The extent of intraperitoneal tumor dissemination and the completeness of cytoreduction are the leading predictors of postoperative patient outcome. Thus, consistent preoperative diagnostics and patient selection are crucial to obtain a complete macroscopic cytoreduction (CCR-0/1).
- Gastric Cancer
- Peritoneal Carcinomatosis
- Cytoreductive Surgery
- Peritoneal Cancer Index
- Cytostatic Agent
Peritoneal carcinomatosis is a common sign of advanced tumor stage, disease progression or recurrence in numerous tumor entities of gastrointestinal or gynecological origin. Moreover, there are primary peritoneal malignancies such as malignant peritoneal mesothelioma or primary peritoneal carcinoma. In general, the diagnosis of peritoneal tumor manifestation is associated with poor prognosis. In the European multicenter EVOCAPE I study the median survival rates were 5.2 months for advanced colorectal cancer (CRC, n = 118) and 3.1 months for advanced gastric cancer (GC, n = 125), respectively[1]. The median survival rate in patients with stage IV ovarian cancer (OC) range from 12 to 23 months [2–4]. For diffuse malignant peritoneal mesothelioma (DMPM) median survival rates of less than one year are reported in most existing studies [5–7]. However, in a Phase II trial with systemic application of permetrexed and gemcitabine the median survival rate was 26.8 months in patients with malignant peritoneal mesothelioma [8]. The treatment of choice for patients with peritoneal surface malignancies is palliative systemic chemotherapy. In the past, surgery was performed in palliative intention for prevention or therapy of tumor-related complications such as gastrointestinal obstruction, bleeding or tumor perforation [9]. Solely, in ovarian cancer cytoreductive surgery was already established as an inherent part of the standard treatment regimen [10]. In the early 1990's Sugarbaker et al. introduced cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) as a new innovative therapeutic option for selected patients with peritoneal carcinomatosis [11, 12]. Over the years peritoneal carcinomatosis treatment centers were established in the United States, Europe and Japan. Feasibility, efficacy and safety of CRS and HIPEC have been proved in numerous clinical trials. In the present review article patient selection, treatment strategy, mortality and morbidity rates and oncological outcome is reported regarding the different tumor entities.
Cytoreductive surgery
Hyperthermic intraperitoneal chemotherapy
In case of complete macroscopic cytoreduction (CCR-0/1) CRS is followed by hyperthermic intraperitoneal chemotherapy (HIPEC). The theoretical advantage of the intraperitoneal distribution of cytostatics is a high local concentration of the used agents and reduced systemic toxicity. In vitro studies could show that hyperthermia may potentiate the cytostatic effects. For example an improved tissue penetration could be shown for cisplatin. Moreover, hyperthermia leads to direct cytotoxic effects such as protein denaturation, induction of apoptosis and inhibition of angiogenesis [15].
Selected studies with CRS and HIPEC in patients with peritoneal carcinomatosis of different origin.
Author, year
Tumor entity
Cytostatic agent(s)
Median survival
Overall survival
28 (3-y)
45 (5-y)
Glehen, 2004[33]
39 (3-y)
47 (3-y)
Shen, 2004[34]
25 (3-y)
44 (3-y)
Glehen, 2004[29]
8 (5-y)
29 (5-y)
Hall, 2004[45]
21 (5-y)
Yonemura, 2005[30]
7 (5-y)
27 (5-y)
Feldmann, 2003[35]
59 (5-y)
Deraco, 2006[36]
57 (5-y)
Yan, 2007[27]
49 (5-y)
Piso, 2004[37]
15 (5-y)
44 (5-y)
Cotte, 2007[38]
Di Giorgio, 2008[26]
17 (5-y)
26 (5-y)
Preoperative diagnostics and patient selection
Preoperative diagnostic workup.
Essential preoperative diagnostics
Clinical investigation
Laboratory testing incl. tumor markers
Computed tomography (CT) of the chest, abdomen and pelvis with oral, rectal and intravenous contrast
Tumor-specific essential diagnostics
CRC: complete colonoscopy
GC: gastroscopy
Useful additional diagnostics (case-dependent)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)/PET-CT
Diagnostic laparoscopy
Morbidity and mortality
In the literature morbidity and mortality rates after CRS and HIPEC range from 25% to 41% and from 0% to 8%, respectively (Table 1) [25–38]. Morbidity can be divided in surgery-related and chemotherapy-related complications. Common surgery-related complications are for example postoperative ileus, anastomotic leakage, wound infection, bleeding, thrombosis and lung embolism. The different cytostatic agents used for HIPEC can lead to leucopenia, anemia, thrombopenia, heart, liver or renal toxicity and other side effects.
In a prospective study of 70 patients with DMPM Yan et al. found primary colonic anastomosis, more than four peritonectomy procedures (total anterior parietal peritonectomy, greater omentectomy/splenectomy, subphrenic peritonectomy, pelvic peritonectomy, lesser omentectomy/cholecystectomy) and operating time greater than 7 hours to be associated with grade IV morbidity [27]. The grade III and IV morbidity rate were 27% and 14%, respectively. The perioperative mortality rate was 3%. Hansson et al. analyzed 123 patients treated with CRS and HIPEC for peritoneal carcinomatosis [39]. The grade III/IV morbidity rate and the treatment-related mortality rate were 41% and 4%, respectively. Bowel morbidity was associated with electroevaporation or excision of tumor nodes on the small bowel surface. In conclusion, morbitity rates after CRS and HIPEC are relatively high but comparable to other major gastrointestinal surgery. However, in the existing studies the assessment of morbidity is not standardized and therefore often not comparable. Thus, following the consensus statement from Milan in further studies the classification system CTCAE version 3.0 should be used. Morbidity is classified in minor complications (grade 0 to 2) and major complications (grade 3 to 5). Moreover, the classification system includes 28 categories leading to an efficient assessment of morbidity [40].
Survival rates
Several studies have shown that CRS and HIPEC as an integrative part of an interdisciplinary cancer treatment concept may improve survival of patients with peritoneal dissemination of different tumor entities such as colorectal cancer (CRC), gastric cancer (GC), ovarian cancer (OC) and diffuse malignant peritoneal mesothelioma (DMPM) (Table 1).
There are two prospective randomized controlled trials (RCT), one non-randomized comparative study and numerous observational studies regarding clinical and oncologiocal outcome of patients with peritoneal carcinomatosis arising from CRC. Verwaal et al. reported a disease-specific survival of 22.2 months after additional CRS and HIPEC vs. 12.6 months after standard systemic treatment with 5-FU and leucovorin [25, 41]. In patients with complete macroscopic cytoreduction (CCR-0/1) median survival was 48 months and 5-year survival rate was 45%, respectively. The second RCT was closed after inclusion of only 35 patients during a 4 year accrual period. The 2-year survival rates were 60% in both arms [42]. In the comparative study published by Mahteme et al. the median survival in the HIPEC group was 32 months vs. 14 months in the control group. 5-year survival rates were 28% and 5% respectively [43]. In the observational studies the overall median survival ranged from 15 to 32 months and from 28 to 60 months after complete macroscopic cytoreduction (CCR0-1), respectively [9].
The prognosis of patients with peritoneal tumor dissemination from GC is poor but could be significantly improved by CRS and HIPEC in selected patients. Six observational studies including between 17 and 154 patients showed median survival rates ranging from 10 to 19 months [28–31, 44, 45]. The 5-year survival rates after complete macroscopic cytoreduction (CCR-0/1) were 21%, 27%, 29%, 31% and 32%, respectively. Yonemura et al. could show in a multivariate analysis that the completeness of cytoreduction is a highly significant factor for the prediction of patient survival. Moreover, low PCI as well as P1/P2 using the Japanese classification or stage I/II using the Lyon classification indicating limited extent of peritoneal tumor dissemination were associated with better prognosis [46].
Cytoreductive surgery has already been shown to improve survival of patients with stage III and IV ovarian cancer previous to introduction of the combined treatment concept with CRS and HIPEC [10]. Nevertheless, further improvement of long-term survival is reported for CRS and HIPEC in selected patients. In several studies the median survival rates range from 28 to 46 months and 5-year survival rates from 15 to 50% [26].
DMPM is a rare disease with relatively low incidence. Thus, in the systemic review published by Yan et al. survival data of only seven studies including 12 to 100 patients are reported [47]. In these studies median survival ranges between 34 and 92 months and the 5-year survival rates between 33% and 59%, respectively. All studies showed a significant improvement of survival compared to historical controls. Nevertheless, a prospective randomized controlled trial comparing the best available therapy – especially after introduction of permetrexed for the systemic treatment of DMPM – with or without CRS and HIPEC is still not available.
Quality of life after CRS and HIPEC
Despite relatively high morbidity rates and consecutive initial impairment of quality of life (QoL) several studies could show an improvement of QoL after CRS and HIPEC in long-term survivors [48–52]. McQuellon et al. reported an initial decrease of physical, functional and well-being scores with an increase relative to baseline levels during follow-up at 3, 6 and 12 months. One year after surgery 74% of the patients resumed > 50% of their normal activities [49]. In another publication McQuellon et al. concluded that acceptable QoL, return of functional status and reduced pain can be attained 3 to 6 months after CRS and HIPEC. However, a significant number of patients show depressive symptoms at the time of surgery (32%) as well as one year after surgery (24%) [52]. Schmidt et al. evaluated QoL after CRS and HIPEC in 67 patients with peritoneal carcinomatosis using the EORTC QLQ-C30 questionnaire. The mean score for global health status of long-term survivors was significantly decreased compared to the control population (62.6 vs. 73.3) showing particularly an impairment of role and social functioning [48]. Tuttle et al. showed a return of QoL measurements to baseline 4 months after surgery in a prospective analysis of 35 patients. Eight and twelve months after CRS and HIPEC QoL was significantly improved [51]. In conclusion, the existing studies show that CRS and HIPEC can be performed with acceptable postoperative QoL and even may improve QoL in a selected part of long-term survivors.
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy provide a promising therapeutic option for highly selected patients with peritoneal carcinomatosis arising from different malignancies such as colorectal cancer, gastric cancer, ovarian cancer or peritoneal mesothelioma. Numerous studies with different levels of evidence have shown that the integration of CRS and HIPEC in an interdisciplinary treatment concept may improve the oncological outcome compared to sole palliative systemic chemotherapy. The completeness of cytoreduction plays a pivotal role for long-term survival. Thus, consequent preoperative diagnostic workup and patient selection is essential. The existing studies also show that the combined treatment concept can be performed with low mortality and acceptable morbidity in specialized centers. The rate of complications is influenced by the extent of surgery and the cytostatic agent used for intraperitoneal application and its concentration. The quality of life is initially impaired by surgery and postoperative complications. Nevertheless, the functional status returns to baseline in most patients during the first 4 moths after surgery. In selected patients QoL may even be improved one year or later after surgery.
However, for most tumor entities prospective randomized controlled trials comparing best available therapy using new therapeutic agents and combined systemic chemotherapy with and without CRS and HIPEC are still not available. Such studies may provide higher levels of evidence in the future and help to determine the significance of CRS and HIPEC as an integrative part of an interdisciplinary cancer treatment strategy in selected patients with peritoneal carcinomatosis.
Authors' Affiliations
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text:
This is a build your own review! If you haven't read the book yet and want to, I'd recommend reading only the quick overview below. If you've done the reading, are in a hurry or simply aren't into critiques, go straight for the Snippets section. Want a closer look? Head down to the specifics. If you're all in, no turning back, read the in-depth analysis at the bottom.
A Quick Overview
Want to appear knowledgeable about the newest romance novels? Need to pull out some quick party conversation, but don't have the time to read the full novel? Be ready for your next girl's night out!
Series: Maiden Lane, Book 3
Genre: Historical Romance (1738)
Trope: The Pirate and His Lady (Widow)
Setting: The Palace of Mickey O'Connor, Streets of St. Giles, the Home for Unfortunate Infants and Foundling Children, Windward House, and Newgate Prison. Did you get whiplash from how quickly we jumped around during our journey?
Unique: Fionnula (an Irish name) Imagine it in Brogue, fairly rolls off the tongue.
Sequel Bait: Hoyt introduces so many characters which makes identifying sequel bait difficult, except that I think most characters will get their day in the sun. She's a trickster that Hoyt, but Winter Makepeace and Isabell Beckinhall are definitely meant for the next novel in the Maiden Lane series, and closely following should be Lady Penelope and Artemis, since they are featured heavily in Scandalous Desires. The cousins have an interesting dynamic, and I'm excited to see it explored further.
Sex Scene Rating: Food porn mixed with masturbation fantasies by both parties. Also, can Stockholm syndrome work both ways? Because if it can, then it does in this book.
Sex Scene Grade: B+ for delving into forbidden territories! Our hero pleasures himself while he thinks about performing cunnilingus on our heroine (*eyebrow raise*) while our heroine watches through a slit in the door. (*whew*) Then Silence alludes to the fact that she has touched herself while thinking about Michael mastering his own body to the thought of her. (Feel that trickle of sweat? Is this room hot to you?)
Social Issues Tackled: Racism against the Irish immigrants, of which Mickey's mother is one. Violence against women perpetrated by randos in St. Giles and the Vicar of St. Giles. Animal Cruelty with respect to bull baiting, which is exactly what it sounds. Hoyt gets an A+ for tackling all of these social issues. She definitely understands the historical implications of the period.
Guiding Narrative: The story of Clever John guides this novel, and I'd like to note that he isn't super clever until the end of his story when he FINALLY decides that what matters is to him is Tamara, and not the riches, kingdom, or army with which she provided him.
Favorite: Didactic pairings appeal to me. We get the pirate King of the slums and the savior mother extraordinaire – the man who refuses to love and the woman who forces him to.
Hooked By: "Wolves, as Silence Hollingbrook well knew, are savage beasts, little given to pity or honor. If one must face a wolf cleverly disguised in human form, it did no good to show fear. Rather, one must throw one's shoulders back, lift one's chin, and stare the damned beast down."
Let's get a bit more particular about some of the snippets listed above. Shall we?
Some things I love about this book: Mary Darling is delivered to Silence's doorstep via stork. (As all babies should be delivered.) Mickey O'Connor's throne room is described as "corrupt." I just love that idea that a man's influence is so corrosive that it could corrupt a room. Animal issues in the form of Lad, a dog used for bull baiting before Harry rescued him. (Peta would have a field day in 1700s.) And let's not forget Gin.
Enter Gin. She is a comely lass of ten and eight who rotates her hips making men swoon with the sight of her wares – but really, gin was a problem during this time period, which is another point that Hoyt brought up in the novel. She gets to experience both sides of the gin debate (admittedly to a lesser extent) again through her characters just as she did in the second book of the series, Notorious Pleasures. Mick understands more than any other that the old women who are being picked up aren't the problem with St. Giles, and his opinion has merit.
Poverty is discussed in the form of Mickey O'Connor and to a lesser extent Silence Hollingbrook. Rampant prostitution, by women and children of both sexes, is seen on the streets, Mick even sleeps with numerous prostitutes at the very beginning of the book. Begging as an honorable profession is seen, and that's the idea that truly caught me, because our society faces the same problem that 1738 London did. Too many people, not enough jobs. In America, we have service industry jobs for which the employees aren't paid enough and don't receive benefits. Yes I'm looking at you, McDonalds! Your arches be damned! Hoyt brings up the idea of labor inequality and discusses that the many immigrants, like the Irish and even other native Londoners, want to work but don't but can't find employment. The public deteriorates in a state of languish. Robbery, rape, gin over consumption, and general violence are all symptoms of the larger economic problem, one that can still be seen in our society. (Think Detroit. Think about towns that die when jobs leave and good jobs can't be found, but it is the service industry that should be forced to pay a decent wage… and I think I should stop right there and move on.)
Serving broken dreams since 1940.
Two strong associations were pulled from me based upon that first line: The Call of the Wild by Jack London and the corresponding episode "Beauty and the Beasts" in Buffy the Vampire Slayer. Mickey is the wolf of St. Giles, and has been so since he was thirteen years of age when his father tried to make him prostitute himself. He attacked his dear old dad with acid, scaring the side of his face, and then roamed the streets that he would later come to own, begging and stealing, until he worked his way up through the ranks of its criminals. Needless to say, people give him a wide berth. They feel what my association does, which is that Michael gave into the call of the wild, just as Buck did in London's novel, and the civilized veneer that society cultivates falls away. – This association brought to you by Buffy the Vampire Slayer.
"From the depths of the forest, the call still sounded."
The instinctual violence that Mick and his pack show tells us that their mentality is fostered by their breeding (Mick's father was a violent man) and their upbringing in a city that preys upon those who are weak.
In an earlier review I proposed the idea that Michael was the Ghost of St. Giles. I was wrong. I'll admit. Was I crazy for thinking so? Perhaps. But I still think it could've been a great storyline! A superman story. Clark Kent is Michael O'Connor and the Ghost of St. Giles is Superman, aka, who Michael really is. Eh? Eh?
The Ghost of St. Giles is revealed at the end of the book, and I won't spoil it. No, I won't say a thing, as long as you skip past the end of this paragraph without reading on, because I'm about to say who the ghost is! Winter? Really? Well, I suppose it makes total sense if you look at his personality. He's Mr. self-sacrifice guy, that's true, but can I just say one thing?
Where does this guy find the time?! He runs the Home for Unfortunate Infants and Foundling Children, gives lessons to the male children, helps take care of all the kids, goes to meetings with prospective patrons, tracks down wayward children… and sisters, in addition to planning lessons and answers letters, then he somehow finds time to roam the streets and prevent crimes. OH! Also, he just happens to show up right when he's needed… So, it's he who's supposed to remind me of Superman! Come down from Krypton to save us all from the crime in St. Giles!
Could he pull off a Harlequin Motley? Yeah, those muscles could pull off a garbage bag.
An In-Depth Analysis
Hoyt did well when she chose to utilize the St. Giles dialect throughout the novel. The changes are simple (and listed below), but they do much to give the proper atmosphere of the slums to the characters. Hoyt has used this dialect in past books with minor characters but never with a main character, and boy did this book call for it. It wouldn't make sense for Mickey to speak proper English, and I'm glad that she forsook the debate over whether or not to use a dialect throughout a novel (because it can be difficult to read) and made the right decision. Examples:
Me: me and my
Wi': dropping the th
Thoughts in clear speech
O': dropping the f
Yer: you are/your
Barrin': drops g
Afore: before
If 'n: ?
D'ye: do ye
M'self: exclude y
Mightn't: might not
Et: ate
A'glowin': glowing
I want to talk in depth about that first sentence and the thoroughfare that the book follows based upon Michael Connor's comparison to a wolf. That first sentence threw a hook into me. I love it when a writer (like Hoyt) does that. Silence's thought has a tonal implication of unrepentant fearlessness that tells the reader her story will be about struggle, danger, and how to meet them head on. The nature of the sentence and perhaps of Michael and Silence's love story reminds me of a poem by Margaret Atwood "You Fit Into Me."
Now you can feel superior to the masses. You've read a poem today!
My associations aside, comparing Michael O'Connor to a wolf is apt, owing to the type of prey he stalks, his offspring, the hierarchy of his crew, and food habits. For although he hunts larger prey than himself, aka the Vicar of St. Giles and his father (wow at the paternal issues and psychological consequences of that), he also toys with ship captains from which he routinely requires tribute.
Next, there is Mary Darling. In a pack, the dominant male and his mate are the only ones to breed, and undoubtedly, this lovely toddler is Mickey and Silence's offspring and the only child who matters in this storyline. Yes, we should point out that she is not Silence's biological child, but the woman who takes care of you when you're sick, soothes you before you go to sleep, and protects you from any threat is absolutely your mother. Biology isn't everything. Also, the submissive wolves help care for the leader's children, and we see that Finnoula, Bert, Harry, and the pack pirates tend to Mary Darling throughout the story.
The hierarchy of his crew is like that of a wolf pack, with Mickey as the dominant male who gives orders and leads his men into battle and Silence as his mate who has her share of their devotion. She holds favor with the men, (namely Bert and Harry who guard her and Mary Darling), Finnoula (her ladysmaid), the cook (who allows the dog to be given a bath in the kitchen. Let your imagination go there!), and various other foot soldiers (who seem ever present in the home). Within days, everyone comes to love Silence with a startling ferocity that owes to her purity, love, and refreshing outlook, which makes her the antithesis of Michael O'Connor. To show how far the staff will go for their new lady, when Mickey orders that Silence be denied food until she agrees to eat in the dining hall, her new friends sneak her food in a heartwarming display of their devotion to her.
While we're on the subject of food, let's talk eating habits. At Casa De O'Connor, everyone eats together (period). Meals filled with sweetmeats, oysters, avocados, delectable and foreign food. Mickey insists that his entire crew eat together and that Silence eat by his side. In this way, they are reminiscent of a wolf pack who when they take down large game consume the meat with no respect to moderation. Elaborate feasts bring the pack closer together, and Mickey explains that the men expect these sumptuous meals as part of their pay. Buyers Beware to enjoy the food porn that this book contains. Having a man feed your secret need for treats is quite a delectable experience. However, the idea that truly drives the feasts relates to Mickey's upbringing.
Hunger. Oy! What would you do to avoid the emptiness, the clenching, the acid? Hunger is a demon that plagued Michael in childhood, as it is for much of our world today. He exorcises that fear by eating, and we associate the need to eat with Michael from the moment we meet him, because Hoyt is careful to introduce Michael in Book 1 of the Maiden Lane series, Wicked Intentions, while he's eating sweetmeats. Then in Book 3 Scandalous Desires, we see him again introduced while eating sweetmeats served to him on a platter in the first scene of this novel.
Food and the lack thereof were his mother's and his plight. "When there was naught in the cupboard, me mam would take me down to the street corner. She'd lay a handkerchief on the ground at our feet and we'd sing for pennies. It might take minutes or hours or all day afore we had enough to buy our supper". When you grow up without enough to eat, you'll never feel comfortable about food, and that idea is brought home by his life experiences.
Here's where we get to the mommy issues, because really this guy's got heaps and they're the reason he falls in love with Silence. Her self-sacrificing nature, which we see in all the Makepeace's, is why he initially takes her good name from her, but also why he begins to fall for her. Silence is an excellent mother who loves her child (and his too) to distraction. That coupled with the fact that she would do anything to protect her draws Mickey to Silence. (So Electra Complex anyone?) (And no, that doesn't mean he wants to make love to his mother.) He finds Silence intriguing because she's the antithesis of his mother in that she has a strong mothering instinct.
Let's flip the script. Silence begins to fall in love with Michael when he opens up to Mary and sings her to sleep with a lovely ballad.
"My father and my mother
In yonder room do lay
They are embracing one another
And so may you and I
So take me in your arms, my love
And blow the candle out."
(Oh, did I not mention yet that his voice sounds like angels singing mixed with liquid sex? Well now you know.) If you're not a baby person then perhaps you don't get this, but watching a man sing or care for a child is incredibly sexy. I mean, a man who plays with children and feels comfortable around them is invaluable.
So cheers! He loves her and she loves him. The only demon she fights against is convention. She shouldn't love him or feel the level of sexual desire for him, but Silence is facing normal personal demons here, and she overcomes them readily. Yet, why can't they be together?
#Pirating! (Say it in Jerry's voice… I'll wait-)
There's the rub. So let's talk about why Michael he won't give up his swashbuckling ways. (Until the end of the book that is, which Smart Bitches Trashy Books and I have a problem with, but ho-hum.) A pirate's life for Michael O'Connor is the plan, and he plans to do it until he dies. Though Silence tries to understand where he's coming from because Mickey is reticent to leave the lifestyle even as the army closes in on him, she can only try to understand that it's not pirating that he'll miss but the security that pirating provides, even at the high price of his freedom and life. He even has a backup plan, Windward House, but he's afraid it won't be enough, and he's pledged to never go hungry again.
Pretty much Mickey O'Connor's motto for life.

subset: commoncrawl


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Every company needs to pin down "why we do what we do" and managing innovation better than your competitors is key of a business to survive and thrive in today's economy.
Patent search and examination constitutes the bulk of patent prosecution prior to a grant or refusal of a patent application. At the IP Office of Singapore (IPOS) International, we are committed to provide high quality patent search and examination as well as innovative patent strategies that will impact change towards patent portfolio management. We hope our focus in Quality, Connectivity and Speed will contribute the best commercial value to your patent portfolio.


text: Bedrock Tyre Successfully participated in Cycle Trade Fair held at Moti Mahal Lucknow from 26 Sep to 27Sep 2015. Bedrock Tyre stall was the center of attraction during the fair. We have launched the our Nylon premium series Tyre over there. We got the tremendous response from all the dealers and visitors.


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German Agency Plans Misconduct Database
BERLIN—Worried that high-profile media coverage of misconduct cases has tarnished the reputation of the country's scientists, the German research funding agency DFG is beefing up its response to fraud allegations. Last week, it announced plans to recruit two new groups of experts. One will advise DFG on legal issues surrounding misconduct investigations and the other will examine how to better protect whistleblowers. The agency also intends to establish a database of closed cases to better measure the scale of the problem and identify recurring patterns.
In recent years, Germany's strong data- and employee-protection laws have impeded several panels investigating misconduct allegations. For example, a committee investigating a clinical study in Göttingen had to get permission from all the patients involved before it could access the study's raw data (Science, 22 November 2002, p. 1531). An expert panel could advise investigators in such cases, says a DFG spokesperson.
The moves drew praise from Peter Hans Hofschneider of the Max Planck Institute for Biochemistry in Martinsried, who has helped several whistleblowers make their charges public. DFG is "finally giving serious attention to the problem," he says.
More Cuts Expected at NATO
NATO's already slimmed-down science division is facing the prospect of further, crippling cuts. The $24 million Science Programme could see its 2004 budget slashed by up to 25%, Science has learned.
The program supports research grants, fellowships, and workshops linking scientists from NATO's 19 member countries with those elsewhere. It has won praise for working in flash points such as Central Asia, including mapping contamination at the Soviet Union's atom bomb test site (Science, 23 May, p. 1220). Even so, sources say that member states are intent on trimming NATO's civilian spending and that the science program could lose as much as $6 million. That could doom its fellowship program. Some savings may come from the research program's newly narrowed focus on antiterrorism and other security threats.
Stem Cell Groups Fret Over Patent Amendment
As Science went to press, advocates of stem cell research were working furiously to head off a congressional provision that they said could strangle research on human embryonic stem cells.
A coalition of biotech and patient-advocacy groups was alarmed last July when the House inserted language into a 2004 spending bill banning patents on "a human organism." The U.S. Patent and Trademark Office already denies patents on a human being but has never clarified how that is defined. Advocates worried that the language would rule out obtaining patents on human stem cell lines, which are derived from embryos. Last week, Sam Brownback (R-KS) circulated language excluding stem cell lines from the House-Senate report on the Commerce-Justice-State appropriations bill. But Carl Feldbaum, president of the Biotechnology Industry Organization in Washington, D.C., says "it's not much of an improvement," adding that "it's a backdoor attempt" to make patent policy. Congress hopes to complete work on all 2004 spending bills by next week.
Funding System Needs Fix, Says Royal Society
LONDON—The Royal Society (RS) this week added its voice to a chorus clamoring for changes in the way U.K. university research is funded.
Currently, scientists compete for project funding from research councils and universities vie for indirect costs and infrastructure support—including computers, libraries, and staff—in an elaborate government-run Research Assessment Exercise. This dual-support system, established after World War II, was designed to allow academic scientists to compete for grants on a relatively equal footing regardless of their location. As Britain's higher education system has expanded, however, the two evaluation streams have grown ever more costly and bureaucratic.
Although RS President Robert May has called for a "radical shakeup," he would not speculate about what might work better. Instead, he urged the government to conduct a "fundamental review" of the dual-support system.


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Best Wp Hostings For Bloggers & Website Owners
Best wp Hostings :
How to Choose the Best Web Host for You
Choosing a web hosting company is not a easy task. There are hundreds upon hundreds of options, many of which look like they're exactly the same. The reality is, there's no one best web host. Different companies will offer different things that will appeal to different people. Someone wanting to host a simple blog website will need a different host than someone who is wanting to host a business website selling things online.
There is, however, a right web host for every type of website. In order to pick the best web host for your website you'll need to assess what you need to succeed. Here are a few things to take into account when looking for a web hosting company.
DISCLAIMER: As an affiliate of the web hosting companies I review, I do receive commissions for any referral I send to that company. These payments do not influence my rankings, nor do I accept any higher commission rate from any company on my website.


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5 Best Legal DramasChristine Orlando at . Comments
From dramatic to sexy, funny to stylish, it's time to check out the very best legal shows currently on TV.
1. Suits - USA (Most Buzz Worthy Legal Drama)
2. The Good Wife - CBS (Best Legal Drama)
3. How to Get Away with Murder - ABC (Best Law School)
4. Franklin & Bash - TNT (Funniest Legal Show)
5. Reckless - CBS (Sexiest Legal Show)
Wait! There's more! Just click "Next" below:Next
- Shows:
- Suits, The Good Wife, How to Get Away with Murder, Franklin & Bash, Reckless
- Related Photos:
- Suits Slideshows, Good Wife Slideshows, How to Get Away with Murder Slideshows, Franklin & Bash Slideshows, Reckless Slideshows
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The Monotype Font Curator
The lovely people at Monotype launched a new tool which presents fonts in a totally new way. Part of this is personally curated type lists by curators such as Abott Miller (Pentagram), Andy Payne (Interbrand), Monotype designers like Dan Rhatigan, ADC Young Guns... and little old me.
Of course always one to make a mountain out of a molehill (a good mountain, of course), my list was on places and their connections to typefaces. Along with writing and research I made a series of wallpapers for type lovers. Hope you enjoy this as much as I enjoyed working on it.
New York
Hardly any surprises here, Helvetica is rolling in as the type-face of New York. Proving–like the aforementioned Gill Sans–that transport makes a big impact on the face of a city. Four letters of American Typewriter are also very familiar as being quite New York to the world, due to Milton Glaser's I heart NYC mark. However it's Massimo Vignelli's choice of Helvetica that New Yorkers know the ins and outs of.
The word Helvetica originates from a derivative of the Swiss goddess, Helvetia. Helvetia is the national personification of the Swiss Confederacy, whose American counterpoint is the Statue of Liberty.
Gill Sans
I think I can confidently say that if you ask a designer Family Fortune style what imagery represents London and the UK to them, our survey says top answer would be the iconic London Underground Map, perhaps somewhere in the list would be Penguin Books, and maybe even the BBC would get a few votes. What these three have in common goes back to their type.
The widely used Gill Sans was designed by the English type designer Eric Gill and issued by Monotype in 1928 to 1930. Believe it or not, Eric Gill's lettering teacher was Edward Johnston, the fella who designed the lettering for the London Transport and Underground Signage. Hence my reasoning for picking Gill Sans, a typeface that no matter how much I squint my eyes at it, it speaks to me in a London accent, and core blimey, it's scrumptious.
Having lived in Amsterdam and working as a designer, I possibly could be a teeny tiny bit biased on selecting Avenir as the typeface for this one. However even the average tourist and my Mom comes away from a visit to Amsterdam with a distinct image in their mind of what font looks like in the city, despite not knowing about type.
Avenir–designed by the prolific Adrian Frutiger–is the typeface for the city's identity, developed by EDEN (now Edenspiekermann). OK I'll admit, I did make some Amsterdam posters in my time there. But through it's bold use from everything down to signage, amsterdam.nl and the giant I amsterdam sign, it's hard to ignore. Avenir is more stylish than your average sans-serif, and not completely round, or sensible.
The Moon
If you believe, they put a man on the moon, then you should believe that the first typeface to make it to the moon was Futura. Futura has been so often used it's hard to say one place owns it, so hard in fact that I felt it needed to go to space. In 1969 the Apollo 11 astronauts left a commemorative plaque on the moon set in Futura (Futura Medium, to be exact).
32 years later Futura would again be associated with space as famously used for the 2001: A Space Odyssey film titles and credits. Futura was not the first geometric sans-serif typeface ever created, but it came in close as the second. Derived completely from geometric near perfect forms, Futura sits legibly, cleanly and stylishly. That's one small step for Paul Renner, one giant leap for type design.
ITC Clearface
The charming Apartamento magazine was started in Barcelona in a tiny room in one of the founder's homes. An interiors magazine like no other, the spaces featured in Apartamento are lived in, small, full of thoughtful possessions and mostly by creative types. ITC Clearface is used as the bold headline typeface throughout the magazine.
I'll admit, it's not a Spanish typeface or one that used throughout the city of Barcelona. But since the first publishing of Apartamento in April of 2008 the typeface is gradually becoming representative of a certain Spanish special-something.
Gap in the market perhaps, but If there were to ever be a period TV show about typography, the story of the Didot dynasty sounds like it has a lotta weight to it (apologies for the pun). Firmin Didot was born into a French typefounding family that had a huge presence in the industry for two whole centuries. His family even owned their own printing firm, the House of Didot.
If having that lineage wasn't a big enough story in itself, Firmin Didot would go on to create the first modern Roman typeface in 1784, and he has left his Parisian mark in the world today as the namesake of the infamous typeface Didot, which truly captures Modern style.
If you're looking for a utilitarian, legible and precise typeface that communicates the feeling of Germany, then DIN 1451 could be exactly what you're looking for. There was no willy-nilly-ing around, in Din 1451 was developed by DIN (Deutsches Institut fur Normung or The German Institute for Standardisation in English) as a sans-serif typeface used for railways, administration and traffic purposes.
Nowadays you might recognise Din in the New York City Ballet identity, or the opening titles of Dexter, or even on a plane in the JetBlue logo. Aber das ist gut, ja?


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When traversing a structure that has a coderef containing a closure, I encountered the error: not ok 6 - No memory cycles were found! # Failed test 'No memory cycles were found!' # at /home/ether/t/Foo/bar.t line 50. # Cycle #1 # MyApp::Foo::Bar A->{_baz} => MyApp::Blah::Bar B # MyApp::Blah::Bar B->{table} => &C # Unknown! This should never happen! # $D => MyApp::Foo::Bar A This is because the 'CODE' type of reference is not checked for in weakened_memory_cycle_ok(), whereas it is checked in memory_cycle_ok().


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Products and solutions, 2006-04-20, 11:01 AM
A strong link - 40 years in the professional league
Bright, transparent, appealing and modern - this is the impression the ARD "Sportschau" sports program gives in its new studio environment. Nothing distracts from the presenter, the words and pictures or the interviewee.
Professionals naturally prefer to work with other professionals - there are no failures, no fouls and no tricks. The material AcrylArte ultimately proved the most suitable for the very precise specifications and wishes of a discerning customer such as German TV station ARD for the renovation of the studio used for its "Sportschau" sports program. Together with its partner ThyssenKrupp Schulte, Franz Kunststofftechnik ensured that the high-tech product was supplied and processed professionally.
AcrylArte is a high-quality cast acrylic. It refracts light from its polished edges in a fascinating way and is characterized by largely stress-free flat surfaces. It is virtually perfect for the purposes of the ARD studio set and, for the experienced plastics engineers at Franz, tailor-made for the demanding processing task.
ARD is correspondingly pleased with the results. Presenters and studio technicians alike have hailed the realization of the creative idea as a success and Sportschau fans are delighted that the program has been given a completely new look.
Ekkehard Franz Kunststofftechnik, located in Wassenberg near Aachen, has been in the professional league of plastics processors for over 40 years. Their motto: "We get plastics into shape". Franz works predominantly in mechanical engineering and trade fair construction, the pharmaceutical and chemical industries, medical equipment as well as advertising and display technology.
The company, now in its second generation and managed by Hendrik Franz, has placed its trust in ThyssenKrupp Schulte Kunststoffe in Aachen for 40 years. They value the incredibly wide range of quality plastics and rapid availability through the ThyssenKrupp Schulte Logistics Center in nearby Düsseldorf.


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To inspire those who are feminine and crossdress. Share your pictures/suggestion/comments at email@example.com Disclaimer: the information on this website is published in good faith and for general information purpose only.This site does not make any warranties about the completeness, reliability and accuracy of this information. Any action you take upon the information you find on this website is strictly at your own risk.
Tuesday, October 26, 2010
Working Miss
What a lovely photo of Miss Karen in this pretty outfit. I like the floral print in the creamy white on her; it totally compliments her skin tone. Perfect light beige sandals and a great smile make this look complete.
Posted by Mistress Kika at 6:41 AM
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Sincordia provide web design, development, hosting and digital marketing services across the whole of the UK. They are based in Romford, London and Leamington Spa, Warwickshire and have been established for over 10 years providing web solutions to many different businesses and individuals.
Sincordia's Challenge
The company approached us to recruit an IT apprentice and the process to fulfil this requirement was underway. As well as starting the process we also discussed with the company whether they had other recruitment needs. The company advised us that they were looking for a Junior Web Designer and asked us if we had a means to advertise the post. The college's existing students could be a source of interest.
How we helped
The company was asked to forward the job specification for the role and we promoted the role to our IT students completing client-led web design project programmes; specific to the technologies identified in the job specification.
The college's programme leader for HND computing programmes was quick to respond and made contact with Sincordia, providing the name of a student who had been achieving good results and was keen to take up the opportunity.
The student was encouraged to make direct contact with the company and send his CV. Things moved quickly and the student was invited in for an interview.
Sincordia were very impressed with the student and felt he would fit in well with the company. A second, technical session interview was arranged.
Following the second interview the company offered the student the position of junior web designer. The student accepted the offer and will start work once he has completed his studies.
With the experience knowledge and support gained within the company, he is expected to progress to the next level as a web developer and become a very valuable member of their team.
"I would like to thank the college for the help and support it provided during our recruitment process and we will be recommending and using its services again in the future."
Darran Hunt, Managing Director, Sincordia Ltd


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Secretary of State Hillary Clinton waves alongside Myanmar Deputy Foreign Minister Myo Myint (L) upon her arrival at Naypyitaw November 30, 2011. (REUTERS/Saul Loeb/Pool)
After the invasion of Iraq, Defense Secretary Donald Rumsfeld infamously said that "democracy is messy." Secretary of State Hillary Clinton may well be thinking along similar lines as she visits Burma this week.
Clinton's historic trip—the first to Burma by a US secretary of state since 1955—signals a significant but complicated détente between the two countries. The opening was made possible by a series of reforms initiated by Burma's quasi-military USDP government following its victory in the November 2010 elections. These include the release of more than 300 political prisoners, the cancellation of a controversial hydroelectric dam project in northern Burma, limited improvements in freedom of expression and assembly, and the legalization of labor unions. They are among the biggest changes made by the regime since the military seized power in a coup in 1962.
Clearly, the Burmese government has realized that in order to strengthen its position economically and politically, it has to secure investment and technical assistance from foreign governments along with credit from the World Bank and International Monetary Fund. But progress will be possible only if Burma loses its pariah status, re-engages with the international community and weans itself away from what it views as an over-reliance on China. The United States, meanwhile, is eager to encourage a transition to democracy in Burma as it seeks to counter China's growing influence in the region.
Even though recent steps toward democratization in Burma are tentative, they have already yielded tangible improvements. Aung San Suu Kyi—the Nobel Peace Prize laureate and leader of the main opposition party, the National League for Democracy (NLD)—was quick to acknowledge the significance of the overtures. Realizing that progress could come only through negotiations with the regime, she pledged that she was willing to work with the government, even though it is dominated by a military that had placed her under house arrest for most of the past two decades. The NLD's decision to apply to re-register as a political party in November stemmed from the belief by Suu Kyi and senior party members that the government is serious about reforms and democratization. This step means that the NLD leader will more than likely stand in by-elections scheduled for next spring.
Clinton's foray is similarly tentative, a cautious testing of the waters before Washington decides whether to re-engage further with the southeast Asian country and thereby provide greater legitimacy to its government. She is scheduled to hold talks with former military man and current President Thein Sein as well as Suu Kyi, and she is likely to encourage the Burmese government to continue making space for political opponents.
There is no doubt that relations between the United States and Burma have come a long way in a short period of time. The Burmese exile began in 1988: after the regime brutally cracked down on unarmed pro-democracy protesters that year, Washington cut off foreign aid, downgraded its diplomatic presence and gradually imposed a raft of sanctions that are still in place. Since 2009, however, the United States—mindful of China's growing economic, military and political presence in Burma—has shifted its hardline stance. The Obama administration realized early that the United States had failed to secure the progress on democracy and human rights it sought in Burma, and had lost what little influence it had in the region, as the regime simply looked to India, North Korea, Russia, Thailand and China for assistance. Clinton's trip is the culmination of a series of visits over the past eighteen months by other senior US officials, including US Special Representative to Burma Derek Mitchell. During this span of time, the administration has come to understand that a mix of engagement and pressure may be an effective way to push for its three main aims in Burma: strengthening democracy, ending the appalling litany of human rights abuses perpetrated by the military and countering Beijing's influence in the region.
While Clinton will rightly applaud Thein Sein's government for its apparently genuine commitment to implementing the recent reforms, she should not lose sight of the fact that the majority of changes have so far benefited only Burma's political and economic elites, who live in its cities and towns. The majority of Burma's 50.5 million people (among the poorest in the region) live in rural areas and rely on farming, and have yet to see the dividends of any of these reforms. Sein's government prefers to use the roughly 2,000 remaining political prisoners as a bargaining tool with other governments and rights groups, and it continues to provide military and political officials accused of committing human rights abuses with immunity from prosecution. It remains to be seen whether the regime will revert to tightening the screws (re-imprisoning political opponents or cracking down on demonstrators who exercise their newly gained freedoms), as it has done in the past.
Clinton should also be wary of focusing too narrowly on the political relationship between the government and the NLD. In this binary narrative the crucial relationship between the regime and the ethnic communities—including the Kachin, Karen, Shan, Mon and Chin, which along with other ethnic groups make up around one-third of the population—is neglected.
Overlooking the systematic state repression of these ethnic groups would be costly. Prospects for peace and stability in Burma have been hampered by civil wars between ethnic insurgent groups and the military since the 1940s. The issue of ethnic conflict is an integral part of any substantive debate on Burma, as President Obama acknowledged last month when he said a peaceful resolution to conflict in ethnic areas was vital.
Though the Burmese government has initiated piecemeal cease-fires with many armed ethnic groups, these truces remain strained and brittle. In the northeastern Kachin State, a cease-fire collapse in the wake of last year's polls has led to a new round of war between the army and the Kachin Independence Army. Reports from rights workers and analysts in Burma as recently as last week speak of growing violence in Kachin State, with an estimated 30,000 men, women and children being forced to flee their homes to escape the fighting. New research released on November 28 by the charity Partners Relief and Development points to the military's systematic use of rape, torture and murder in its Kachin campaign. Once again, the military stands accused of war crimes as it continues to flex its muscle in the restive border regions.
Without genuine and inclusive negotiations between the regime, the NLD and all of Burma's ethnic communities, the conflicts will continue, and durable peace, stability and democratization will remain elusive. Though both Suu Kyi and Sein have spoken of their commitment to an "inclusive" peace, these words have yet to translate into any concrete policy change by the military.
If ethnic tensions are allowed to fester, the country's long-suffering people will likely see a continuation of the status quo in which two Burmas co-exist: one where areas under government control enjoy limited reforms and an opening of political space, and another where regions under military rule (including most areas populated by ethnic groups) suffer an escalation of violence and repression.
Clinton must address this enormous challenge. If Burma's military and government are serious about a political transition, they have to negotiate with all ethnic groups and tackle the underlying political and economic problems that have fueled the ongoing wars. Doing so will provide the state with the international legitimacy it craves and may help make the regime feel more secure in pursuing its reform agenda. It is this desire for acceptance that the United States must use as leverage to initiate further change. But if Clinton's foray is perceived by the military as a tacit nod by the West that the regime's brutal policies will be overlooked, then accusations that the visit is premature will be harder to fend off.
There are no easy answers to the Burma question. Have prospects for democracy improved in the country in the past twelve months? Some analysts say yes. Has the situation deteriorated? Other experts say yes. Both camps are right.
Ultimately, it is up to the people of Burma to decide what needs to change and how. While many Burmese will welcome Clinton's visit, the promise it represents for economic, political and social improvements remains fragile. Hardliners inside and outside the regime could attempt to derail the gains that have been made. The current climate of engagement should be fostered, but the true measure of progress will come long after the fanfare over Clinton's visit has faded.


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African Oceans Luxury Accommodation in Mossel Bay
7 Bob Bouwer Crescent, Bayview, Mossel Bay, South Africa
GPS : 34.08 ° South, 22.06 ° East
Tel : +27 (044) 695 1846
Fax : +27 (086) 608 0973
This breath taking suite offers both ocean and mountain views. Stylishly decorated in shades of white, silver and grey.
Enjoy a sunset drink or picnic basket ordered from kitchen, on the private patio equipped with patio furniture and deck chairs.
Spoil yourself in the spa bath in the spacious and full modern bathroom, complete with a selection of our personalized luxury amenities.
Suite features:
This superior double room is on the beach front. It consists of a magnificent view over the ocean from the sliding door/window.
Decorated in lovely colours of champagne beige with a hint of olive green. Attention to detail, luxury and elegance!
Spoil yourself in a Victorian bath complete with our personalized luxury amenities. Also consist of spacious shower.
Enjoy a glass of wine from the mini-bar or wine menu, laugh in good company, with the moon pouring soft over the ocean.
This is a magnificent opulence at its all-time best.
Suite features:
This suite has a unique natural beauty of its own. This spacious unit, with the natural colours of soft green and gold, together with its own exclusive décor, creates a sense of absolute calm and romance. There are wide windows, with a view over the ocean, and it has its own very private garden: Yes, indeed, a thing of beauty is certainly a joy forever…!
Enjoy the evening beauty with a cocktail right on the dunes, close to the beach.
Suite features:
Suite 1 is our luxury duplex unit for two persons, with a B&B or self-catering option. Enjoy the privacy of your own garden entrance right on the beachfront. Each room is individually decorated in style and is fitted out with refined comforts.
The private balcony overlooks the endless beach and majestic Outeniqua mountains.
Room rate includes:
This suite has a private entrance and is stylishly decorated in shades of beige, brown and autumn softness.
There is a private built-in BBQ on the deck which partly overlooks the ocean. There is no sea view from the bedroom. It boasts a fully modern en-suite bathroom with luxurious amenities and decorations. This unit sings a chorus to anyone's immaculate taste.
Suite features:


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Turning Points
in Wisconsin History
Early Days in the Chippewa Valley.
Early Days in the Chippewa Valley.
This autobiographical narrative relates a young lawyer's search for the best palce in the Upper Midwest to settle in the late 1850s. The author first came to Wisconsin from Oxford, in Chenango County, New York, in 1856. His account provides vivid descriptions of Reed's Landing, Pepin, Eau Claire, Menomonie, and Chippewa Falls.
|Related Topics:
Mining, Logging, and Agriculture
Logging and Forest Products
|Bundy, Charles Smith, 1831-1928.
|Pub Data:
|Menomonie, Wis., Flint-Douglas ptg. co., 1916.
|Bundy, Charles Smith. Early Days in the Chippewa Valley (Menomonie, Wis., Flint-Douglas Ptg. Co., 1916);
Online facsimile at:
+@od1(Early+days+in+the+Chippewa+Valley+)); Visited on: 6/26/2019


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Alexander: Senate Dems block bill that would have aided economy
WASHINGTON, D.C., Oct. 8 — Setting what U.S. Sen. Alexander (R-Tenn.) called a "dangerous precedent" for the Senate, Senate Democrats on Oct. 8 blocked debate on the bipartisan Energy and Water Development Appropriations Bill.
On the floor Thursday he said, "You don't start the process at the beginning and not even let the whole Senate go through the process. This is a very bad precedent and it really insults the Senate. … That's not the way we are supposed to do our jobs. We are sent here to work on behalf of the people. I would say to my friends on the other side, if you want to have a say about nuclear waste, about national defense, about national laboratories, about flood control, about waterways, about locks, about dams, then vote 'yes,' because that will give each of you a say, and you will be doing your job."
He continued, "To vote 'no' sets a dangerous precedent for the Senate that says we are not interested in doing what taxpayers elected us to do."
Senate Democrats' filibuster prevented the Senate from beginning debate on the bill, which Alexander said effectively blocked 70 senators who aren't on the 30-member appropriations committee from having any say on federal spending.
The bill is among the most bipartisan of the 12 funding bills. It was approved by the Energy and Water Development subcommittee, which Alexander leads, and reported out of the full Appropriations Committee with a 26-4 vote.
Funding in the bill totals $35.4 billion, which is $1.2 billion above the FY2015 enacted level and $668 million below President Obama's budget request.
Affected funding
The bill provides funding for the following programs and projects:
- The Army Corps of Engineers's restart on construction of Chickamauga Lock in fiscal year 2016. Funding of $29 million would be available because of the lock's high position on the priority list of essential American waterways to be rebuilt.
- The Department of Energy's Office of Science, which supports basic energy research and is the nation's largest supporter of research in the physical sciences.It is funded at $5.144 billion, a record high.
- Advanced computing, which supports the new Summit supercomputer at Oak Ridge National Laboratory. It is funded at $620.9 million within the Office of Science. A total of $1.24 billion is provided for advanced computing, including both the Office of Science and the National Nuclear Security Administration.
- Exascale computing, which Alexander said is essential to national security and competitiveness in science and technology. It is funded at $222 million.
- The Advanced Research Projects Agency – Energy (ARPA-E), which the America COMPETES Act created to invest in high-impact energy technologies. It is funded at $291 million.
- Consolidated storage of nuclear waste. The legislation authorizes and funds a pilot program and also includes language that allows the Department of Energy to store nuclear waste at private facilities, such as those proposed in Texas and New Mexico.
- Nuclear infrastructure at Oak Ridge National Laboratory, including hot cells and isotope production facilities. Many of the isotopes produced at Oak Ridge National Laboratory are not available anywhere else in the world, and are necessary to support medical treatments, oil and gas exploration, and deep-space satellites, among other priorities.
- The Uranium Processing Facility at the Y-12 National Security Complex. (It is funded at $430 million, which will continue to keep this project on time and on budget.
- Continued development of Small Modular Reactors, which Alexander said will give utilities and the military the ability to generate clean energy in new ways. The bill provides $62.5 million in funding.
- A new mercury treatment facility in Oak Ridge, as well as cleanup of nuclear facilities that are no longer in service.
Funding cuts
The bill also cuts funding for several wasteful programs at the Depart-ment of Energy, including eliminating $150 million for the International Thermonuclear Experi-mental Reactor in France, as well as reducing funding for wind programs by more than $100 million compared to President Obama's budget request.
U.S. Sen. Lamar Alexander (R-Tenn.) may be reached via his website's contact page at alexander.senate.gov/public/index.cfm/email.


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Sarasota, Florida (PRWEB) August 15, 2012
ChurchPlaza, a major provider of church chairs, sanctuary chairs, church seating and other quality church products to the more than 375,000 churches making up the American church markets and more than 20 foreign countries, today announced plans to resume publishing the popular monthly online news letter "THE CHURCH DECISION MAKER" in conjunction with Christianity Today Publications, the nations leading publisher of magazines for the Christian market.
Featuring relevant articles from Christianity Today's family of magazines and editorial comment dealing with issues important to American churches, the newsletter was originally published between 2007 and 2010. Monthly readership grew to more than 20,000 individual church leaders.
Resumption of the popular newsletter resulted from popular requests from former newsletter recipients. Dr. Thomas McElheny, Founder and CEO of ChurchPlaza commented "we are honored and excited that church leaders throughout American found value in our online publication and our hope is we can continue this tradition of service to America's church leaders.
ChurchPlaza is a 26 year old provider of quality church chairs, sanctuary chairs, church seating and other products to churches throughout the United States and many foreign countries. Over the years, ChurchPlaza has received endorsements from 45 national denominations, ministries and/or their publishing houses and is the only church seating provider so honored. ChurchPlaza maintains administrative and sales offices in Sarasota, Florida in addition to warehousing and manufacturing facilities in three other locations.
3231 Gulf Gate Dr # 204
Sarasota, FL 34231


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My life has been one continuous learning experience. Back to back to back... one right after another. Maybe you can learn from my experiences and mistakes. Or not..
Tuesday, June 11, 2013
Overheard in the foodcourt at the mall
Posted by KrippledWarrior at 11:50 AM
3 comments:
- NanaDiana said...
LOL-Not much ground left to cover there,is there? xo Diana
- June 11, 2013 at 3:34 PM
- Karen said...
Well, KW, truth be told.. that same conversation could be had although we would change the specifics.. about every single administration depending on how you want to spin it.
Yes I know, I am NOT your favorite customer today :-)
I'm pretty much disgusted with the whole political scene, the mess we have here is not just about one man, couldn't have been made by just one administration.
Hope all is well with you and yours -
- June 11, 2013 at 3:48 PM
- Indi said...
KW ~ never trust a politician
- July 6, 2013 at 6:35 AM
Subscribe to: Post Comments (Atom)


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Patient organisation and charity partners supporting development of the app include:
. Heart and Stroke Foundation of Canada
. Diabetes Canada
. YMCA of Canada.
The Carrot Rewards app is designed to deliver incentives in a way that builds people's motivation to engage in healthy behaviors – so that they continue to engage in the behavior over the long-term.
The app addresses key lifestyle issues, including:
. healthy eating
. physical activity
. positive mental health
. immunization
. alcohol moderation
. tobacco cessation.
Carrot Rewards users can:
. Use the app to build knowledge and skills around how to incorporate healthy habits into their lifestyle
. Completing surveys, quizzes and learning activities about how to lead healthier lives
. Be rewarded for their actions with loyalty points from their preferred participating loyalty partner.
. Convert their points into rewards including contributions to flights, hotels, movies, and fuel.
Available for:
. Iphone and ipad (IoS 9 or higher)
. Apple watch
. Android phones and tablets (Jellybean 4.3 or higher)
Following pilots and evaluation, the intention is to roll the app out across Canada, and expand its functionality.
Tags: Health, Wellness & Care in the Community (HWCC) · Medical
PatientView provides this website for use as information, or for educational purposes. We do not warrant that the information we provide on the website will meet your health or medical requirements. Contact a health professional if you are concerned about your health. Nor can we guarantee that the information we provide on the website will always be up to date or accurate. PatientView is providing details of apps recommended by patient groups, an act which does not imply PatientView's endorsement of any app. PatientView is not responsible for third-party content. Read more for copyright considerations


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About Dryrun
Dryrun helps bookkeepers, accounting professionals and businesses optimize cash flow with Xero data in Dryrun by quickly and flexibly modeling and comparing future scenarios. Cash flow planning identifies issues that may affect business in the upcoming weeks and months.
Visualizing different futures means decisions become a snap; it's easy to communicate cash plans to clients.
Create cash flow forecasts with Xero data by customizing any data to match your vision of future possibilities and graph different scenarios to compare 'what-ifs'.
Use Xero data in Dryrun to create easy cash flow forecasts for business. These forecasts are your map to look ahead and identify possible risks and opportunities that could affect your clients' business.
Integrate sales data for future revenue planning; flexibly compare scenarios to map out growth opportunities while avoiding risks.
Explore all Features of Dryrun
Dryrun + Xero
Dryrun integrates with Xero and imports expense invoices, income invoices, and bank balance info into various scenarios so that Xero users can start managing and forecasting cash flow quickly and visually in order to direct operations strategy. Accountants and bookkeepers can communicate cash plans to clients and offer cash flow strategy easily using the most flexible cash flow forecasting app on the market.
Getting started
From within a new or existing Forecast, customers can click the Scenario title, then the Xero badge to customise import settings. Optimize business cash flow with Xero data in Dryrun.
Support & Contact
SupportContact Support
WebsiteXero and Dryrun
SetupSetup walkthrough
Sign upSign up walkthrough
IntegrationIntegration walkthrough
InstragramContact on Instragram
Integration details
Global, New Zealand, Australia, United States, United Kingdom
SupportContact Support
WebsiteXero and Dryrun
SetupSetup walkthrough
Sign upSign up walkthrough
IntegrationIntegration walkthrough
InstragramContact on Instragram
Global, New Zealand, Australia, United States, United Kingdom


text:
Happy Christmas and a Very CONTENT Vacations to any or all!!! Seeing that it is usually pretty difficult to send out our visitors a gift… all of us produced you almost all an attractive Free of charge Savings 2017 Flower Work schedule which i believe you will be all likely to love! Very flowers will certainly greet the printable publication as regular monthly homework calendars. librarians to out to customers. family members who wish to appreciate wonderful literature is to do basic designed actions in the home. The collection contains doze calendars (September 2016- Aug 2017) and doze assets linens. Psssssttt… you can discover a totally free savings 2016 work schedule right here and a free of charge savings 2017 diary in this article Persons might arrive in and begin asking intended for all of them in August 2017 Calendar Printable With Holidays, and they will keep asking for week pursuing week pursuing week till they received their totally free calendar.
Perhaps you should get a ramp up before 2017 arrives? Begin the fresh year aside with Michelle does the sexiest calendars and she has capable to offer this kind of kind of printable package that's Filled with everything you need to get structured for the entire year coming forward. Get the existence in order with the Free Good holidays and birthdays, simply so because I am actually speedy skimming that web page I could observe essential things. Following all those webpages we all start the weeks : a left-and-right propagate from the month to month appointments, after that every This comes with a work schedule design template and everything the items required (months, times of the week, years, seasons, days and nights, and holidays) to put together an adorable and vibrant date to enjoy most school 12 months! Calendar continues to be updated to get the August 2017 Calendar Printable With Holidays Also.
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text:
by Wanda Jessome
(St Catharines, Ontario, Canada)
I was just crossing Ontario Street to take up my post as a crossing guard in St. Catharines, Ontario, when a Bald Eagle gracefully soared overhead.
Join in and write your own page! It's easy to do. How? Simply click here to return to Eagles.


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Hayden Panettiere has expressed her hope that convicted murderer Amanda Knox will eventually be able to live a normal life.
Knox is currently serving a 26-year prison sentence in a Perugia, Italy prison for her alleged role in the murder of college student Meredith Kercher.
Panettiere, who portrayed Knox in a Lifetime telemovie, told the Los Angeles Times: "[The network] was like, 'Don't say whether you think she is guilty or innocent'. But I couldn't even tell you, because I haven't decided.
"The approach I had to take was that even if she was guilty, she had convinced herself she was innocent. I had her voice recordings on my iPod and I'd listen to her intonations as close as I could. I wasn't sleeping during production because I was nervous."
The actress added: "I've lived a very different life than her. She went to normal school and worked at a coffee shop and was just going over to Europe, and I grew up acting.
"We're both young girls. And I care about her. To a certain degree, guilty or innocent, I want to see her get out and be able to live the rest of her life. She's someone that I root for."
Panettiere recently suggested that she felt "pressure" to accurately depict the details of the Kercher murder in the TV movie Amanda Knox: Murder On Trial in Italy.


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i looked around at all of the different options of digital photo books and i fell in love with artifact uprising as soon as i clicked on their main page.
the site is so clean and so inviting. it took me about 45 minutes to upload and send my book to print (and nope...not being compensated with product for this review...just my honest to goodness opinions). i chose the 8.5x8.5 inch softcover book and i went with a very simple approach. pictures and words. pictures and words.
i did a daily recap of each day and then followed that with my daily pictures. using ali edwards daily sheets was a true lifesaver. i left one page blank at the end of each day to go back and write notes and thoughts. (but...knowing me and my OCD tendencies...it is highly unlikely that a pen, or even my children, will ever touch this book)
i put together a little video to show you a quick look at the book. i felt like still photos didn't do it justice...you just have to look at to pretty music! and just so you know...this is my very first video. please don't judge me. i'm apparently video-challenged.
here are a few photos of some of my favorite pages....


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Certain debilitating attacks reduce one's combat effectiveness instead of one's hit points. Examples include a stun grenade, a forced march, a paralyzing venom, or long-term exposure to extreme temperatures. Multiple conditions have cumulative effects and can quickly drive a creature from it's normal state to unconsciousness or disable an otherwise functional device or vehicle.
Physically debilitating attacks are usually made against the target's Fortitude defense, while mentally debilitating attacks target one's Will defense. Either type of attack pushes the target along the same track.
The Condition Track
A creature, object, or vehicle not affected by any debilitating conditions is assumed to be in a "normal state", which represents one end of the condition track. Each debilitating effect to which it succumbs moves it one or more steps along the condition track. A creature pushed to the last step of the condition track falls unconscious. An object or vehicle pushed to the last step on the condition track is disabled until repaired using the Technology skill.
When a device is pushed down the condition track, apply the indicated penalty on skill checks to any skill check made using the device.
When a vehicle is pushed down the condition rack, all the vehicle's occupants suffer the same penalties as the vehicle itself until the vehicle is disabled. Penalties imposed by multiple condition tracks are cumulative; in other words, a vehicle's occupants suffer the effects of their own personal condition tracks in addition to the effects of the vehicle's condition track.
|Normal State (No Penalties)
|-1 step +1 step
|-1 penalty to all defenses;
-1 penalty on attack rolls, ability checks, and skill checks
|-1 step +1 step
|-2 penalty to all defenses;
-2 penalty on attack rolls, ability checks, and skill checks
|-1 step +1 step
|-5 penalty to all defenses;
-5 penalty on attack rolls, ability checks, and skill checks
|-1 step +1 step
|-10 penalty to all defenses;
-10 penalty on attack rolls, ability checks, and skill checks
|-1 step +1 step
|Helpless (unconscious or disabled)
Removing Conditions
You can improve your condition by spending three swift actions to use the recover action, moving +1 step along the condition track. You can spend all three swift actions in a single round or spread them out across consecutive rounds. Certian situations may prevent you from spending swift actions to move toward a normal state on the condition track.
Resting for eight consecutive, uninterrupted hours usually removes all debilitating conditions affecting a creature and returns it to its normal state. Some causes of debilitation such as poison and hunger, may prevent a creature from improving its condition or returning to its normal state until the cause of the debilitation is treated.
Persistent Conditions
Some hazards and attacks (such as poison and disease) result in a persistent condition that cannot be removed except in certain circumstances. Any time a condition is persistent, you cannot use the recover action to move steps up the condition track, and you do not regain any hit points from natural healing. However, once a persistent condition is removed by satisfying the requirements stated in its description, you can move up the condition track and heal normally.
Persistent conditions do not prevent you from moving up the condition track by means other than the recover action or resting for 8 hours. For example, an unconscious creature that fails its first Constitution check has a persistent condition from its injuries, but it still moves +1 step on the condition track when it makes a successful Constitution check to regain consciousness.
Multiple Persistent Conditions: Sometimes you are affected by more than one persistent condition. In this case, you must satisfy the requirements for removing all of these persistent conditions before you can move up the condition track.


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Welcome to the Directory of Ebook Conversion Services, the only listing of its kind on the internet.
The Ebook Conversion Services Directory is the place to find someone to convert your books into ebook formats. For books in Microsoft Word, Adobe InDesign, PDF or other formats, you'll find people who can convert one book or many books at a time. Conversions are provided into ePub, Mobi, and many other formats for use in every eBook reader available today. When you need to get your products onto the shelves of the Kindle Store, Apple's iBookstore, or BarnesandNoble.com, you'll need one of these ebook conversion services.
This directory is provided as a service to help you find someone to convert your existing books into ebook formats. Each person or company listed has provided their own contact, pricing and detail information. They range from individuals to large prepress houses, and do business in several countries.
Listing here does not imply an endorsement of any kind for the companies listed, and their services have not been sampled or tested in any way. There is no fee to use this directory, and there is no fee required to be listed here.
Part of the information-gathering was an optional request for a quote on a typical book that had been prepared for print-on-demand printing. This sample book, "Speeches of Obama," is taken from public-domain text on the whitehouse.gov website. You can download a copy of this book to better understand the prices quoted by those companies that agreed to participate.
Listings were solicited from posts on Twitter, LinkedIn and other networks. We welcome your submission. If you would like to be listed here, please see the Submissions page.
Click here for more information about ebook formats.


text:
Parfitt, R (2014) Scary monsters. In: Heroes and monsters: extraordinary tales of learning and teaching in the Arts and Humanities, 2-4 June 2014, Salford Quays, Manchester, UK.
|Item Type:
|Conference or Workshop Item (Paper)
|L Education > L Education (General)
L Education > LB Theory and practice of education > LB2300 Higher Education
|College of Liberal Arts
|Date Deposited:
|18 Aug 2014 19:45
|Last Modified:
|29 Apr 2016 14:06
|Request a change to this item or report an issue
|Update item (repository staff only)