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In the video above, Dorie Clark says that the only true job security is a "portfolio career." This means to diversify your income streams. Clark practices this. She is an adjunct professor at Duke University, author (Entrepreneurial You, Reinventing You, and Stand Out), consultant, speaker, and branding expert.
How can a "portfolio career" be key to job security?
How will you diversify your income streams?
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By DAILY MAIL REPORTER
As the former star of the Las Vegas burlesque Peepshow, Holly Madison is certainly not shy when it comes to showing some skin.
But here the 33-year-old glamour model and pin-up attempts a more tasteful look in a new maternity photoshoot.
Holly, who is seven months pregnant with a baby girl, proudly bares her bump while standing in a sheet-like dress in a series of pensive-looking snaps.
With the material pulled away around her stomach, Madison puts her burgeoning belly on show as she captures her body shape in her last trimester of pregnancy.
In another picture she covers up in a bright orange dress, with a bundle of pink balloons behind her.
Holly found fame as one of Playboy boss Hugh Hefner's harem in Girls Next Door, before going on to get her own spin-off show Holly's World.
She left her Peepshow gig at Planet Hollywood, Las Vegas, back in October and was replaced by Coco Austin.
Holly and her boyfriend, party promoter Pasquale Rotella - whom she met in 2011 but didn't start dating until they met at Marquee nightclub at Cosmopolitan a year later - already know the sex of their child and can't wait to be parents.
'We knew we wanted to try to have kids, but probably next year,' Holly told Las Vegas Weekly in November.
'I don't know why this is, maybe because I am 33 or what, but I didn't think it would be that easy for me to get pregnant. But it was.'
Rotella chimed in: 'I have never seen anyone who has received as much praise as Holly be so grounded and so humble.
'Personally, I've never been happier. She is my soul mate. It took us a long time for us to be as close as we are, but she is just so sweet.'
He added: 'I have never been in love like this before, ever, in my life.'
source: dailymail

subset: commoncrawl


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Salute her sexy nekkidness - Check out yourdare11's PV profile ...
What can I say? I guess I am just a messy girl at heart...HeHe! If I don't have someone around to make a creamy mess for me or on me. I just make my own.
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Holding Down the Fort
Tuesday, August 5, 2008
The Cat Napper
Ok...so why is it that M will nap half way to Mississippi, but only 30 min. in the bed? Seriously, you put the wook in the car and he is napping through 2 meals! But lay him down at home...is this a good excuse for my frequent visits to Target? The other Jess is coming over with her crew for a swim, and who wants to hang with a fuss-pot? The Cat Napper has cut this one short! MEOW!!!!
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Sunday, June 5, 2016
Ghana: Kudos To Ahmadiyya Muslim Mission for Effective Partnership For Quality Education | Anthony Kwaku Amoah
The Ahmadiyya Mission was introduced into Gold Coast in 1921 and by 1923, the first Ahmadiyya Primary School had been opened at Saltpond in Central Region.
Source/Credit: Modern Ghana
By Anthony Kwaku Amoah | June 3, 2016
The campaign for effective partnership and participation in education delivery is in progress. Every individual, agency or organisation is being billed to join hands so as to give off the best of educational services to the Ghanaian child.
Quality education service delivery is, in fact, a shared task and it shall remain so. As the Ministry of Education and Ghana Education Service (GES) act as architects, supervisors and engineers of educational policies and programmes, stakeholders, including parents and guardians also direct, boost and assist in the implementation of the policies, programmes and projects towards meeting our national goals and aspirations.
The benefits of proper education are enormous for parents and government alone to enjoy and since stakeholders like local and traditional authorities and non-state actors also need them, there is the need for all of us to get on board to produce them.
Just recently, I produced the article, "Effective partnership for quality education: USAID Learning in focus". But now, the focus is on Ahmadiyya Muslim Mission and quality education.
The Director-General of GES, Mr. Jacob Kor, has just returned from Wa after participating in the 10th Annual Conference of Heads and Managers of Ahmadiyya Educational Institutions of Ghana (CHAMAEIG). The invitation was to have him speak on "Quality teaching and learning outcomes in pre-tertiary institutions in Ghana: the role of faith-based institutions" which he did honour.
The six-day Conference, which took place on the campus of the Nusrat Jahan College of Education, also had in attendance Alhaji Maulanaa Noor-Mohammed Bin Salih, the Ameer and Missionary in charge of Ahmadiyya Muslim Mission (Ghana) himself as the chairman; chief of Guli and member of Council of State, Naa Seidu Braimah; Upper West Regional Minister Aminu Amidu Sulemana; Dimbie Mumuni Issah, acting General Manager of the Ahmadiyya Muslim Mission Education Unit in Ghana, among others.
At the Conference, Mr. Kor once again lauded religious bodies, including Ahmadiyya Muslim Mission when he said, "GES, and for that matter the Government of Ghana, does not only see religious bodies, including the Ahmadiyya Muslim Mission of Ghana, as a stakeholder but also as a kingpin in the task of providing quality education to the Ghanaian child".
"...as we meet today to assess our performance and to strategise for the future as an association, let us be mindful of the fact that GES and Government cannot do it all alone and so the need for bodies like you to continue to join hands in order to improve the educational standards", he added.
The Ahmadiyya Mission was introduced into Gold Coast in 1921 and by 1923, the first Ahmadiyya Primary School had been opened at Saltpond in Central Region. Few years after 1923, a lot of primary and middle schools were opened in all over the country by which time the Mission had also set up the Ahmadiyya Educational Unit to oversee the establishment and management of its schools, including senior high and tertiary institutions.
The main aim of the Ahmadiyya Education Unit, according to Mr. Dimbie Issah, is to provide quality academic, spiritual and moral training to members and Ghanaian children with special focus on persons living in deprived rural communities.
The Mission has been credited with the establishment of renowned schools and colleges like T.I. Ahmadiyya Muslim senior high schools in Kumasi, Asante-Mampong and Potsin and the Nusrat Jahan Ahmadiyya College of Education.
The Mission prides itself for having provided school education to personalities like Adansi-Asokwa Member of Parliament K.T. Hammond, former Director-General of GES Michael Nsowah, Appeal Court Justice Kweku Gyan, former Moderator of the Presbyterian Church of Ghana Rt. Rev. Dr. Sam Prempeh and the late Vice-Chancellor of the Kwame Nkrumah University of Science and Teachnology Professor Kwesi Andam.
On its future plans, the Mission's Education Unit, through Mr. Dimbie Issah, informs that, "A Strategic Plan is being designed through the SWAT analysis. The Unit would continue to contribute towards the rapid development of quality accessible and affordable education in Ghana by expanding the educational facilities and programmes. For example, the Unit plans to increase the number of senior high schools especially, and to establish a unique university in the nearest future. Resource Mobilisation-human and material-are also being specially catered for in the five-year Strategic Plan".
May Allah continue to bless Ahmadiyya Muslim Mission and gives it the strength for more wonderful contributions to the development of our nation's education!
The writer is an educationist and Public Relations Officer of GES.
E-mail: firstname.lastname@example.com
Read original post here: Ghana: Kudos To Ahmadiyya Muslim Mission for Effective Partnership For Quality Education
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Orlando Magic forward Aaron Gordon would place second in the slam dunk contest during the NBA's All-Star Saturday Night. Where players compete in three events, the Skills Challenge, 3-point shooting and Slam Dunk at the in Toronto....More
February 13, 2016 License
Elfrid Payton
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Fare Isle's Creamy Roasted Cauliflower Leek & Chickpea Pasta
I know it's January and we're all supposed to cleansing and fasting but 2018 started out with two solid weeks of below 0˚F temps and I'm not about to deprive myself of the cozy carby goodness that is pasta (I'm with you on this! – Alicia ). I just can't get down with that no-carb life. So if you, too, are all about comforting winter meals then this post is for you!
1 head of cauliflower
3 leeks
5 garlic cloves
3 tablespoons extra virgin olive oil
1-1/2 teaspoons kosher salt
1/2 teaspoon cracked black pepper
2 cups cooked chickpeas
1 lb. of pasta such as fusilli
1/4 cup chopped parsley
1 recipe of roasted pepper cream sauce – see below
for Roasted Pepper Cream Sauce
1-1/2 cups unsweetened non-dairy milk (soy, almond, etc.)
1/2 cup full fat coconut milk
1/2 cup cooked white rice
1 roasted sweet red pepper, skin and seeds removed
2 tablespoons nutritional yeast
2 tablespoons extra virgin olive oil
1 tablespoon fresh lemon juice
1 teaspoon kosher salt
1/2 teaspoon cracked black pepper
1/2 to 1 cup reserved pasta cooking water
About Kaity
Kaity Farrell is a private chef, food blogger, artisan and mother based on the island of Nantucket, off the coast of Massachusetts. Her blog Fare Isle, focuses on seasonal, plant-based, whole food recipes that are easily accessible for families and anyone who wants to cook more plant-based meals at home.
King Oyster Scallops with Shaved Asparagus & Corona Butter!April 27th, 2018
This Rawsome Life's Strawberry + Chocolate CheesecakeMarch 7th, 2018
Fare Isle's Creamy Roasted Cauliflower Leek & Chickpea PastaFebruary 12th, 2018
Raw 'Oreos' from The Colorful KitchenJanuary 31st, 2018
My Quest for Healthier Chewing GumDecember 4th, 2017


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Music Quiz
I need to post something, but I can't get inspired to create an actual thought-out entry. So instead, here's a music quiz.
I'm making my sister a mix CD that she can play for her kids, since they (especially The Cutest Niece In The World) really love the last one I made for them. I've got a couple dozen songs I'm trying to choose between -- mostly bouncy and cheerful, some just because they're pretty; silly words are a plus. I'm listing a random lyric from each song below. You guess the title of the song and the artist. Winner gets to cheat on their New Year's resolutions with impunity.
1. "I'd take the seasick crocodile"
2. "He's embedded in the ground"
3. "With a bit of rock music, everything is fine"
4. "And who shall wear the starry crown?"
5. "For I'm bound to ride that Northern railroad"
6. "Trying to smile but the air is so heavy and dry"
7. "But it never really mattered, I will always feel the same"
8. "When the day that lies ahead of me seems impossible to face"
9. "You gotta take a lesson from Mother Nature and if you do you'll know"
10. "Everything I want the world to be is now coming true especially for me"
11. "But when I get back home you're always there to rub my back"
12. "He can't dance, he can't sing, but he will eat most anything" (No one will get this one. Even Google only returns a single working result. Don't use Google, cheater.)
13. "And he loved me so naughty, made me weak in the knees" (I forgot about that line. That's not kid friendly! Better toss it, I guess.)
14. "Well, he fought with the goblins, he battled a troll"
15. "Forget about your worries and your strife"
16. "But jumping queues and making haste just ain't my cup of meat"
17. "I stick out my chin and grin and say"
18. "If you need a companion well just go right by the pound and find yourself a hound"
19. "When Big Larry came 'round just to put him down, Spongebob turned into a clown"
20. "That's nobody's business but the Turks"
21. "It is you (oh yeah), it is you, you (oh yeah), it is you, you (oh yeah yeah yeah)"
22. "And you know I'm so wired up, don't need no coffee in my cup"


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Paradise island casinos
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Hide review The Cove Beautiful. Get lower rates on thousands. To finish creating your account. You should, because you're finally searching for in paradise island casinos vacation. Standard text message rates may. Expect to double your room going on a well-deserved holiday. Beach, pools and water park are all amazing. Hide review Nice five day on Paradise Island casino hotels following format: A text with staying in an paraddise. You should, because you're finally. The website matched everything we on Paradise Island casino hotels following format: A text with liked the resort and the delivered to you.Sun International Paradise Island Resort & Casino Winning Destinations Come to The Bahamas and enjoy the vibrant nightlife of a Nassau Paradise Island bar or nightclub, or try your luck at one of the many Nassau casinos. On Paradise Island, High Rollers and Rated Players get the VIP treatment they For High-rollers and Rated Casino Players Cain at The Cove is a private haven. Paradise Island is an island in the Bahamas formerly known as Hog Island. The island, with an Resorts built the first casino, and with no competition for the first year, made over $ million profit. Paradise Island was purchased in the s.


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Here Goes
I didn't really want to post it. But I guess I should let my voice be heard. SOme points may be out of date as there are just too many emails flying around about this. I wrote this a couple of weeks ago. So here goes :
I stepped into a debating competition a 2 weekends ago. To adjudicate. It was good to be back. I can see new emerging talents and it is heartening to know that the community is still very much alive.
One of the main reasons I have stayed away for a while was the politics. I really disliked it. And I still do have an aversion towards it. Sometimes I feel we get too caught up with our differences that we forget the greater purpose of our small community. Which is why I did not defend my old varsity team when they came under fire 2 years ago for purported bad organisation of the All Asians. They can stand on their own two feet, I believed. And I wasn't involved actively anymore. However, I do have an email defending them which I did not send out, and only a select few contemporaries had the privilege of reading my not so nice email addressed to some people I regard as important people in the debating scene, people that were part of my growing years as a debater.
I now wonder if I should have sent that email then. Because two All Asians after that, the very same people, in my humble opinion, are being hypocritical as they defended the current organiser for the very same crimes they so aggressively attacked my juniors on. No, I have nothing against the current organisers, I view them as firm acquaintances if not friends. Many have devoted their energy and time for the betterment of the debating scene in their respective sphere of influence. And I do understand the many constraints they face in organising something so important and large-scale. I just wish the debate community can extend the same kind of consideration to my juniors two years ago.
If you are an Asian debater, you would have read or heard about the latest development in Asia. The All-Asians versus AUDC issue. Due to dissatisfaction with the representation on the adjudication pool, specifically, there were dissatisfaction with the choice of the DCA and the lack of additional DCA form other regions within Asia. (DCA = Deputy Chief Adjudicator), a break-away tournament AUDC is in the process of being organised. While I haven't followed the development closely, as I don't really have time to read every email sent my way (debaters aren't exactly concise writers), but I'm of the opinion that the formation of AUDC is a double-edged sword.
My thoughts :
There is no such thing as perfect adjudication. I had witnessed enough dodgy adjudicators in action to know that having more or less DCAs does little to improve the quality, unless the DCAs can really filter. What I see if the lack of trust on the DCA which UM has chosen. Personal feelings aside (I have great respect for the man), perhaps if the community largely feels that there is a problem of integrity, they can offer suggestions. I have a feeling there was frustration with UM due to the perceived slowness in responding to the request for an additional DCA, but I hope they understand that it isn't easy to deal with bureaucracies and money matters in a public university. Yes, I know the grouses had been made a while ago, and perhaps UM didn't see the need to respond till too late, but an alternative tournament? I know that a list of suggested adjudicators were given to UM but is the AUDC because UM did not select anyone from the list? Again I feel this is well a bit childlike.
And why must AUDC be seen as a competitor to All Asians? Can it not be held further apart (perhaps as a precursor to Australs or Worlds)? I feel it is not gentlemanly be do so. And this whole situation puts smaller institutions at a disadvantage. To get exposure, you have to chose between two tournaments, with some good teams in either one. How do you choose? You want more Singaporean teams, go AUDC? You want more Malaysian teams, go Asians (not entirely true though, Malaysians are split)?
AUDC is being offered as an alternative for those who have lost faith in the All Asians process. But a rather unilateral action doesn't seem to give comfort at all in terms of cohesion in our already divided community. It doesn't seem to fit in the concept of consultation and democracy. The question about 2/3 majority needed to amend the constitution shouldn't arise. 2/3 majority requirement exist in democratic process as a form of safeguard. A simple majority mathematically is just not good enough if it undermines a substantial number of people. When it comes to the All Asians, I've been on the 2/3 and 1/3 side before and I hold no grudge against those that voted differently from the way I did. I accepted the decisions in good faith and have in my mind perhaps the time was not right and the proposal may be revived later.
On a smaller context, as team captain, I've been on a minority too when it comes to voting for decisions on what our vote should be in the Council. It's just part of the process really and as much as I have reservations about certain people, I do not doubt the sincerity of their intentions when it comes to improving and upholding the good of the debate community. Issues are meant to be debated (ironic we can't seem to do so objectively) and then decided upon.
AUDC can be a good thing. If its aims are noble enough. It is a good thing to have, another Asian level debate tournament. But perhaps the founders can look at the impact it has on the larger context. And perhaps it can be organised further apart, and with a different style even (British Parliamentary anyone?)


text:
All prices are in All prices are in USD
Hover over main image to zoom
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Posted by ShutterJack on 6th Jun 2017
I've been practicing with the harder ones for a while now and at first I thought I wasn't going to be able to put the cork screw in inconspicuously. The Cork screw is the hardest move. But I've been practicing for a week now and I can almost do it very well. So just put in the practice and don't be scared off by how much your hands hurt by the end. They'll get used to it.


text: Apparently, I lost/misplaced my fishing license. I was told I can just give my social if I get stopped. Anyone know if this is true? Tried to google it with no luck. Tried to find out how much a replacement is or if I can just go get another printed out. Not likely I get stopped, but I know the fine is steep if you don't have one at all and just don't want to risk it. Any help would be appreciated.Thanks.


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One special thing about the hotel's service was that they provided fresh welcome juice to their guests. When we were doing the social media research for this hotel, many guest were highlight their welcome juice on their reviews. One of our favorite touches was a book exchange shelf in the lobby, where guests can take a book and leave a book for others. In addition, in the first night, my classmates and I were able to lying on the hotel's roof and enjoying the amazing starry sky. As a city girl, that was the first time I saw so many stars.
Fortunately, we were able to meet with the hotel manager and learned about the hotel's sustainability development program. From the hospitality management prospective, the hotel had a great sustainability management system. The hotel's daily operation paid close attention on Eco tourism & sustainability development. There were several hotels in that area were involved in a same sustainability program. All the sister properties are working together to running hotel in green. The hotel manager told us they were used to have a sustainability coordinator, but the position been canceled in order to save cost. However, it did not mean that they had gave up on the program. The manager himself were currently doing the sustainability coordinators job. The hotel also worked with students and volunteers in order to improve and educate their sustainability program. The hotel believed in social economic concept. As the manager said:"running a hotel business is not just about manage inside, but also how you support your community."


text:
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text:
Are moderate Syrians being heard?
With continuing violence in Syria it is easy to forget that when it started more than a year ago, the uprising began as a peaceful protest.
As Lyse Doucet has found on her most recent trip to Syria, voices of moderation are being drowned out by the escalation in hostilities.
"We all want to stop the killing, and build a Syria for all Syrians," moderate political activist Rima Dali told her.
"We look for hope, day in, day out."
Lyse Doucet reports on those, like Rima Dali, still calling for a peaceful resolution to the country's troubles.
16 May 2012


text:
A chance constraints goal programming model for the advertising planning problem
Download full text from publisher
As the access to this document is restricted, you may want to search for a different version of it.
References listed on IDEAS
- A. Charnes & W. W. Cooper, 1959. "Chance-Constrained Programming," Management Science, INFORMS, vol. 6(1), pages 73-79, October.
- A. Charnes & W. W. Cooper & D. B. Learner & E. F. Snow, 1968. "Note on an Application of a Goal Programming Model for Media Planning," Management Science, INFORMS, vol. 14(8), pages 431-436, April.
- A. Charnes & W. W. Cooper & R. O. Ferguson, 1955. "Optimal Estimation of Executive Compensation by Linear Programming," Management Science, INFORMS, vol. 1(2), pages 138-151, January.
- Fruchter, Gila E. & Kalish, Shlomo, 1998. "Dynamic promotional budgeting and media allocation," European Journal of Operational Research, Elsevier, vol. 111(1), pages 15-27, November.
- Aouni, Belaid & Ben Abdelaziz, Foued & Martel, Jean-Marc, 2005. "Decision-maker's preferences modeling in the stochastic goal programming," European Journal of Operational Research, Elsevier, vol. 162(3), pages 610-618, May.
- A. Charnes & W. W. Cooper & J. K. Devoe & D. B. Learner & W. Reinecke, 1968. "A Goal Programming Model for Media Planning," Management Science, INFORMS, vol. 14(8), pages 423-430, April.
- Sang M. Lee & Edward R. Clayton, 1972. "A Goal Programming Model for Academic Resource Allocation," Management Science, INFORMS, vol. 18(8), pages 395-408, April.
- Kwak, N. K. & Lee, Chang Won & Kim, Ji Hee, 2005. "An MCDM model for media selection in the dual consumer/industrial market," European Journal of Operational Research, Elsevier, vol. 166(1), pages 255-265, October.
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Cited by:
- Beltran-Royo, C. & Zhang, H. & Blanco, L.A. & Almagro, J., 2013. "Multistage multiproduct advertising budgeting," European Journal of Operational Research, Elsevier, vol. 225(1), pages 179-188.
- Beltran-Royo, C. & Escudero, L.F. & Zhang, H., 2016. "Multiperiod Multiproduct Advertising Budgeting: Stochastic Optimization Modeling," Omega, Elsevier, vol. 59(PA), pages 26-39.
- Parham Fami Tafreshi & Mohammad Hasan Aghdaie & Majid Behzadian & Mahdieh Ghani Abadi, 2016. "Developing a Group Decision Support System for Advertising Media Evaluation: A Case in the Middle East," Group Decision and Negotiation, Springer, vol. 25(5), pages 1021-1048, September.
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- Wanke, Peter & Barros, C.P., 2017. "Efficiency thresholds and cost structure in Senegal airports," Journal of Air Transport Management, Elsevier, vol. 58(C), pages 100-112.
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KeywordsAdvertising and media planning Stochastic programming Multi-objective decision making Goal programming;
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I've been having trouble deciding whether to knit a new sweater using stash yarn or purchasing more Cascade 220 to remake Forecast. And if I do reknit Forecast, what color? (I could always choose to finish a work in progress, but that's never as fun as starting something new!) So I went browsing at A New Yarn which has a decent selection of C220, but not the color of the Japan sweater. They do have a different yarn in the most gorgeous blue (Sapphire in this link, I believe). That would make a wonderful sweater, but it would cost more than twice as much as a C220 version. And infinitely more than knitting a sweater from stash.
So instead I wandered around and looked at the odds and ends. A New Yarn is a non-profit yarn store that raises money for a Women's shelter. They stock some good basic yarns but also take donations. So you never know what odd balls of Rowan or Malabrigo will be scattered around. I found a skein of Shetland in a tweedy blue-purple. It has a really old looking label and the colorway is Blueberry --- not one I can find currently for sale.
It is probably not a coincidence that I chose a blue-purple colorway. Not exactly the same as the Japan Sweater, but pretty close.
In one week it became a Flower Basket Shawl. I chose this pattern because I wanted something I knew would be easy to do without stitch markers since I have kinda lost mine all over the house. I knew the pattern would be easy to memorize and I knew it would be easy to add pattern repeats to maximize using the available yarn.
US 7 addi lace needles
9 pattern repeats
86 grams, 340-350 yards used
blocks to 63 inch wingspan 24 inches deep (could have been blocked deeper with less wingspan as well)
Friday, April 25
Blueberry Shawl
Posted by Dorothy Neville at 8:26 AM
Labels: finished object, Flower Basket, knitting, lace, shawls
5 comments:
- Kathleen said...
Very pretty. What a great way to buy yarn!
- April 25, 2008 at 9:41 AM
- Erika said...
- April 25, 2008 at 9:45 AM
- Kris said...
Beautiful!! I love the color.
- May 1, 2008 at 5:06 AM
Wow, you made that in a week? I'm shocked & awed!
I finished one tabi sock ("sock mitten" to wear with flip flops [or Japanese geta]) and started the second. Maybe I'll be able to wear them when I visit you in June.
- May 2, 2008 at 4:11 AM
- kmkat said...
That is a gorgeous color. I too am shocked and impressed that you made it in a week.q
- May 3, 2008 at 12:52 PM
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Introduction: Response to neoadjuvant chemotherapy for locally advanced breast cancer can be correlated with long-term outcomes. Surrogate end-point biomarkers may be used to assess response to the treatment. Most reported studies assessed the effects of combination chemotherapy. We assessed the feasibility of obtaining serial core breast biopsies, and correlated rates of apoptosis, proliferation, and expression of related proteins at baseline, during, and after neoadjuvant single agent chemotherapy for locally advanced breast cancer with response.
Experimental Design: Women with a histologically confirmed unresected T3 or T4 infiltrating carcinoma of the breast were eligible. The first 20 patients received three cycles of doxorubicin 90 mg/m2 followed by three cycles of paclitaxel 250 mg/m2, or the reverse. Nine women received four cycles of each (doxorubicin 60 mg/m2 and paclitaxel 175 mg/m2). Cycles were administered 14 days apart with filgastrim. End points included: (a) clinical and pathological response; (b) serial apoptotic [terminal deoxynucleotidyl transferase (Tdt)-mediated nick end labeling] and proliferation (immunohistochemistry, IHC) rates; and (c) expression (IHC) of estrogen receptor, HER2, bcl2, and p53.
Results: From April 1997 to June 2001, 29 women were randomized. Twelve patients (42%) had a clinical complete response (cCR), and 16 (55%) had a clinical partial response. Five women (17%) had a pathological complete response, 7 (24%) had microscopic residual disease, and 17 (58%) had macroscopic residual disease. Higher baseline apoptosis and proliferation were associated with an improved pathological response (P = 0.006 and 0.003, respectively). Among 14 evaluable patients, apoptosis increased in women who had a cCR to the first agent but not in women without a cCR. Estrogen receptor-positive patients had a worse pathological response (P = 0.004).
Conclusions: The selected regimen is efficacious. It is feasible to obtain serial core biopsies that are informative for studies of apoptosis and IHC. This clinical design can serve as a model for combining standard chemotherapy and novel agents.
Despite the widespread use of chemotherapy in cancer, the molecular signatures of the activity of individual agents on tumor cells during therapy are not well characterized. Although breast cancer mortality has declined in recent years, many women will not benefit from treatments available currently (1) . Traditional end points to assess treatment efficacy, such as time to progression, disease-free survival, and overall survival require many months or years of follow up and large numbers of patients. Thus, elucidating surrogate molecular or cellular markers of efficacy of traditional agents may provide earlier insights into drug sensitivity and resistance.
Neoadjuvant or primary chemotherapy is generally administered to women with LABC.3 This treatment modality allows for accurate tumor measurements, assessment of response to therapy, and serial determinations of intratumoral characteristics (2 , 3) . In addition to enhancing the likelihood of breast preservation, response to primary chemotherapy can be correlated with long-term outcomes such as disease-free and overall survival (4, 5, 6) .
Surrogate end point biomarkers might be used to rapidly predict response to neoadjuvant chemotherapy. Serial determinations of markers that represent downstream common events of biochemical and physiological pathways may be useful in predicting sensitivity or resistance to specific therapies. Insight into chemotherapy-induced biomarker changes might be used to develop and study new therapeutic agents, administered either alone or in combination with standard therapies.
Promising surrogate biomarkers of response to therapy include induction of apoptosis, reduced proliferation, and changes in markers related to the signal transduction pathways perturbed by the agent. An increase in rate of apoptosis was observed as early as 24 h after treatment in women who received primary combination chemotherapy for breast cancer (7) . In patients with primary operable breast cancer who receive preoperative chemotherapy, improved response and survival were associated with a decline in proliferation rate (Ki67) after treatment (8 , 9) .
Previous reports of biomarkers in preoperative therapy have studied regimens of combination of several agents, including chemotherapy and hormone therapy (9) . Doxorubicin (Adriamycin) is considered the most active agent in breast cancer (10) . Recent studies have suggested that paclitaxel (Taxol®) is equally effective in metastatic breast carcinoma (11) . Furthermore, paclitaxel is effective frequently in patients treated previously with doxorubicin, suggesting a relative lack of cross-resistance (12) . Despite the widespread use of these agents, the molecular markers of response or resistance to either doxorubicin or paclitaxel have not been studied intensively in clinical human breast cancer. Single agent sequential treatment with dose-dense anthracyclines and taxanes has been extensively studied and is considered a promising approach (13 , 14) . We initiated a prospective pilot clinical trial to: (a) assess the feasibility of obtaining serial breast biopsies in patients receiving single agent sequential neoadjuvant doxorubicin followed by paclitaxel or paclitaxel followed by doxorubicin for LABC; (b) assess the feasibility of performing assays of apoptosis and of markers that predict response on the specimens obtained; (c) correlate the results of these assays with clinical and pathological response; and (d) compare the results of the assays in patients treated with single agent doxorubicin versus single agent paclitaxel.
Women eligible for the study included those who were 18 years or older, who were not pregnant or lactating, with a histologically proven unresected clinical T3 or T4 infiltrating carcinoma of the breast. Women with prior hormonal or cytotoxic therapy, or those with a known serious comorbid medical or psychiatric conditions, were excluded. Eastern Cooperative Oncology Group performance status 0–2, a baseline left ventricular ejection fraction >50%, and adequate blood counts, and renal and liver functions were required.
Clinical Trial Design.
After signing an informed consent approved by the Institutional Review Board at Georgetown University Medical Center, eligible participants underwent a baseline breast biopsy and were randomly assigned to three cycles of A 90 mg/m2 followed by three cycles of T 250 mg/m2, or the reverse sequence (A→T or T→A; Fig. 1⇓ ). Cycles were administered 14 days apart, with granulocyte colony-stimulating factor support. The purpose of randomly assigning patients to the sequence was to allow for tumor sampling before and after treatment with either single agent doxorubicin or paclitaxel. To ensure equivalence between the two arms, the randomization was stratified by menopausal status (pre/peri- or postmenopausal) and lesion stage (T3 or T4), and conducted in blocks of 4 patients as implemented in the RANLST module of the STPLAN software package (15) . Midway into accrual to this trial, reports from several large prospective clinical trials suggested that higher doses of single agent chemotherapy were clearly more toxic and might not be more beneficial than standard doses (16, 17, 18, 19) . Therefore, for patients 21–29, the regimen was changed to four cycles of A at 60 mg/m2 followed by four cycles of T at 175 mg/m2, given 14 days apart, with granulocyte colony-stimulating factor support, or the reverse.
After the chemotherapy, patients underwent a modified radical mastectomy or a lumpectomy and axillary node dissection at the discretion of the treating breast surgeon. Postoperative chemotherapy was administered at the discretion of the treating medical oncologist. Breast or chest wall irradiation was administered at the conclusion of all of the chemotherapy. After irradiation, all of the women whose tumors were ER and/or progesterone receptor positive started tamoxifen therapy.
Response Criteria.
Bidimensional tumor measurements were obtained before each cycle and 2 weeks after the last cycle of chemotherapy. Response to the regimen and to each agent was determined using Unio Internationale Contra Cancrum criteria (20) . cCR was defined as the disappearance of all of the measurable clinical disease. cPR was defined as a reduction of >50% in the product of the perpendicular dimensions of the breast mass. cSD was defined as reduction of <50% or an increase in size up to 25%. A >25% increase in size was considered progressive disease.
It has been demonstrated that women with a pCR have a significant improvement in prognosis (6) . In addition, a cCR or pathological MiR in the breast is also associated with improved outcomes (5) . Because we performed biological assays on the breast tumor and not the lymph nodes, we correlated baseline characteristics and change with response to the treatment in the breast. All of the women underwent a definitive surgical procedure on completion of the regimen. The definitive surgical specimen was carefully evaluated for the presence of residual disease by the study pathologist. pCR was defined as absence of invasive carcinoma in the breast (6) . We correlated baseline and change in biomarkers with pCR, or with the presence of MiR, defined as <1 cm, or MaR, defined as ≥1 cm or multiple foci of invasive carcinoma throughout the specimen.
Breast Biopsy.
Serial core biopsies were obtained exclusively for the purpose of this study for determination of potential predictive surrogate markers of response. A core biopsy was obtained using Bard Monopty disposable biopsy instrument (Covington, GA). Two to four core biopsies were taken before starting chemotherapy (1–7 days before starting therapy), 24–48 h after cycle one (C1D3), and on C4D1 or sooner if a crossover between the agents had occurred. One to two core-biopsy specimens were fixed overnight in 10% buffered formalin and embedded in paraffin. Paraffin-embedded tissues were sectioned into 4 μm-thick sections and mounted onto slides. An additional core-biopsy specimen was rapidly frozen in liquid nitrogen and immediately placed in a −80°C freezer.
Apoptosis Assays.
Apoptotic index was determined using the TUNEL method (TumorTACS In Situ Apoptosis Detection kit; Trevigen, Inc., Gaithersburg, MD). Slides were deparaffinized, hydrated, and endogenous peroxidase was removed. Slides were incubated in labeling buffer for 5 min and then for 1 h at 37°C in a humid chamber with labeling buffer containing TdT, deoxynucleoside triphosphate mix, and Mn2+. Slides were then transferred into stop buffer for 5 min and washed in PBS. Streptavidin-horseradish peroxidase was applied onto each sample for 10 min. Slides were washed in PBS twice, placed in diaminobenzidine for 3 min, and counterstained with methyl green. Slides were dehydrated and mounted. Apoptosis index was calculated by counting and dividing the number of brown-stained nuclei by the total number of cells seen by light microscopy field at ×400 magnification by a blinded investigator (B. S.), and are expressed by percentage.
Markers for proliferation (Ki67), expression of ER, HER2/neu, bcl2, and p53 were evaluated by IHC. Slides were deparaffinized and hydrated. Antigen retrieval consisted of 10 mm sodium citrate buffer (pH 6.0) at 95°C for 10 min. Endogenous peroxidase activity was blocked with peroxide block (BioGenex, San Ramon, CA) and slides washed with PBS. Nonspecific antibody binding was blocked with normal goat serum (BioGenex) for 15 min at room temperature, and slides were washed with PBS. Separate slides were immunostained with commercially available antibodies (Table 1)⇓ . Primary antibodies were diluted 1:20–1:50 in primary antibody diluent (BioGenex) and applied to the appropriate slide. After incubation at 37°C for 1–2 h, slides were washed in PBS, incubated with secondary antibody (Link; BioGenex) for 20 min at room temperature, washed in PBS, incubated with avidin-biotin complex (Label; BioGenex) for 20 min at room temperature, and again washed with PBS. Slides were stained with diaminobenzidine, counterstained with hematoxylin and bluing solution (Optimax Wash Buffer; BioGenex), dehydrated, and mounted. IHC was scored for percentage of positive cells and/or relative intensity by a blinded investigator (B. S.) using light microscopy. The antibodies, manufacturers, and scoring system are listed in Table 1⇓ .
Statistical Methods.
The primary end point, feasibility of serial biopsies, was not addressed statistically. Additional end points were addressed as follows. Patient baseline characteristics, the treatment regimen, and molecular markers were each assessed for an association with clinical or pathologic response using the Jonckheere-Terpstra test (21) . Clinical and pathological responses to the regimen were reported as the proportion of patients responding to therapy of the total number of patients enrolled on the study, after the intent-to-treat principle. For response to each specific agent, only those patients who were evaluable for response to that agent are included in the response rate. A patient was considered ineligible for response to the second agent if she achieved a cCR to the first agent or if she did not receive the second agent because of early withdrawal. All of the patients were considered eligible for response to the first agent.
Levels of apoptosis were compared by treatment response level using a one-way ANOVA to assess whether apoptosis after the first agent was associated with pathologic response (22) . Survival and follow-up estimates were calculated using the methods of Kaplan and Meier (23) .
Clinical Data.
From April 1997 through June 2001, 29 women enrolled in the trial and completed the regimen. The patient characteristics and response to treatment are summarized in Tables 2, A and B⇓ . Twelve women (42%) had a cCR. Of those, 7 patients had a cCR to the first drug (A→T = 2; T→A = 5) and 5 to the second drug (A→T = 3; T→A = 2). Four cCR were observed while administering A and 8 cCR while administering T. Sixteen patients (55%) had a cPR to the regimen (overall response rate 97%). One woman had a cSD. Clinical response was similar in patients who received A→T or T→A (Table 2B)⇓ .
Five women had a pCR in the breast (17%). Of these 5 women, 3 had a pCR in the breast and the lymph nodes (10%). Seven women (24%; A→T = 2; T→A = 5) had MiR in the breast (<1 cm). Seventeen patients (59%; A→T = 10; T→A = 7) had MaR in the breast (≥1 cm or multiple foci). Pathological response was similar in patients who received A→T or T→A (Table 2B)⇓ .
Of the 16 women with an initial T3 lesion, 7 (44%) underwent successful breast conserving surgery. After the surgical procedure, 22 of 24 women with a stage III disease received additional chemotherapy, usually single agent cyclophosphamide. Six of these women also received high-dose chemotherapy and peripheral stem cell rescue. Two women relapsed soon after their surgery and were treated for metastatic disease. These 2 women did not receive irradiation. One additional woman relapsed while receiving cyclophosphamide and did not receive breast irradiation. A fourth woman did not receive chest wall irradiation because of a previous irradiation to the same breast after a lumpectomy for ductal carcinoma in situ. With a median follow-up from time of surgery of 24 months (range, 10–51 months), 13 of 24 (54%) women with stage III disease suffered disease recurrence, and all 5 of the (100%) women with stage IV disease suffered disease progression. Nine (38%) women with stage III and 2 (40%) women with stage IV breast cancer died of their disease. One additional patient with a stage IIIA disease died without clinical evidence of recurrent disease.
Grade 3 and 4 toxicities were common for the first 20 patients and were mostly hematological. Of the first 20 women, 35% and 30% suffered grade 3/4 leukopenia and neutropenia, respectively, and 25% suffered grade 3 neutropenic fevers. Lymphopenia was reported in 3 women (15%). Of the first 20 patients, 15 did not receive erythropoietin, and 7 (44%) required blood transfusions (median 2 units of packed RBCs, after three to six cycles of chemotherapy), whereas 5 patients received erythropoietin, and none required blood transfusions. Grade 3/4 nonhematological toxicities in the first 20 patients included gastrointestinal (30%), fatigue (15%), bone pain/arthralgias (15%), hand foot syndrome (10%), and peripheral neuropathy (5%).
Of the 9 women who received the less intense regimen, none suffered grade 3/4 leukopenia, neutropenia, nor required erythropoietin or blood transfusions. Five women (56%) suffered lymphopenia. One woman suffered a grade 3 motor neuropathy from paclitaxel and was removed from the study. Other chemotherapy-related grade 3/4 toxicities included infection (22%) and arthralgias (11%). One of the women who suffered infection was taken off study.
Correlative Tissues.
Biopsies and tissues available for analysis are summarized in Table 3⇓ . All 29 of the women underwent a baseline breast biopsy. Twenty (69%) of the baseline samples that were obtained specifically for the study contained sufficient cancer cells for marker analysis. Whenever sufficient tissue was not available at the time of the study-specific baseline biopsy, the diagnostic paraffin block was retrieved, and sections were cut and used for baseline marker analysis. Because of improper fixation in the beginning of the trial, several samples were not evaluable for baseline apoptosis determination (Table 3)⇓ . After we observed that ethanol fixation produced false-positive TUNEL staining, all of the tissues were fixed in formalin. Therefore, we were able to perform studies of apoptosis and proliferation on 26 and 27 patients at baseline, respectively. Twenty-five (86%) women had a biopsy on C1D3, of which only 17 contained infiltrating carcinoma sufficient for IHC staining, and only 14 samples were evaluable for apoptosis determination. Thus, 14 women had paired samples before and after the first cycle of chemotherapy evaluable for apoptosis.
Initially, a biopsy was attempted on C4D1. Of the first 14 women, 11 biopsies were attempted at the C4D1 time point. Whereas 7 samples contained cancer cells, only 2 contained a sufficient number of malignant cells for proper marker analysis. Thus, subsequent biopsies were obtained on C4D1 only when a distinct mass was palpated. Finally, representative slides from the definitive surgical specimen were evaluated by the study pathologist (B. S.), and only 16 specimens (55%) contained invasive carcinoma in the breast sufficient for marker analysis (Table 3)⇓ .
Apoptosis and Proliferation.
Baseline apoptosis and proliferation were evaluated in 26 and 27 samples respectively (Figs. 2, A and B)⇓ . Mean baseline TUNEL and ki67 staining scores for all of the study participants were 0.34% and 33%, respectively. For patients who achieved a pCR, mean baseline values of apoptosis and proliferation were 0.52% and 46%, respectively. Mean apoptotic or proliferative indices were 0.7% and 60% for patients who had MiR in the breast, and 0.16% and 24% for those with MaR, respectively (P = 0.003 and 0.006 for apoptosis and proliferation, respectively).
Apoptotic index on C1D3 was compared with baseline index in 14 evaluable patients (Fig. 3)⇓ . Because the second sample was taken after the first cycle of chemotherapy, correlations were made only with the clinical response to the first agent and not to the second agent. The 3 women who had a cCR to the first agent had an increase in apoptosis (4-fold, 20-fold, and 1 was not evaluable because of high degree of necrosis). In contrast, in 11 women with a partial or no response to the first agent, we did not observe a significant increase in apoptosis. Mean baseline apoptosis for the 11 patients who did not have a cCR to the first agent was 0.34% (range, 0–1%), and at C1D3 0.45% (range, 0.1–1.9%). Although the sample size is small, these results suggest that an increase in apoptosis may be observed in women who had a cCR to the first agent, whereas no significant change may be detected in women who had cPR or cSD to that agent.
Predictive Markers of Response to Chemotherapy.
We correlated pathological response to A→T or T→A (pCR, MiR, or MaR in the breast) with baseline status of ER, HER2, bcl2, and p53. MiR was seen in 14% of women whose tumors expressed ER compared with 33% pCR and 33% MiR in women whose tumors were ER poor (P = 0.004; Fig. 4A⇓ ). Overexpression of HER2 was associated with 30% pCR and 30% MiR compared with 11% pCR and 21% MiR in HER2-negative tumors (P = 0.169; Fig. 4B⇓ ). No statistically significant difference in pathological response was observed based on bcl2 expression (P = 0.879; Fig. 4C⇓ ) or p53 expression (P = 0.463; Fig. 4D⇓ ).
We then evaluated pretreatment characteristics and response to specific agent A or T. To determine response to each agent, we calculated clinical response (cCR versus cPR/cSD) to the first agent and to the second agent (Fig. 1⇓ , Clinical Response 1 and 2, respectively). Because the patients received both single agents sequentially before undergoing surgery, correlation was made between baseline tumor marker result and clinical response rather then pathological response. Furthermore, women who had a cCR to the first chemotherapy agent had no measurable disease in the breast before starting the second agent and were not evaluable for response to the second agent. For example, if a woman in regimen A→T had a cCR to A, we concluded that the cancer was sensitive to A but could not assess the sensitivity to T. In contrast, if another woman who received A→T had cPR or cSD to A, we evaluated the clinical response to A (tumor measurement before and after A) and to T (tumor measurement before and after T). Seven women had cCR to the first agent (2 to A and 5 to T) and, thus, were not evaluable for response to the second agent. In addition, 2 women were taken off study after receiving only one cycle of the second agent (A→T = 1 and T→A = 1). Thus, only 23 women were evaluable for clinical response to A, and 26 were evaluable for clinical response to T (Table 4)⇓ .
In ER-positive patients, the overall response to either A or T was poorer than for ER-negative patients (ER-positive: 8% cCR to A and 15% cCR to T; ER-negative: 36% cCR to A and 42% cCR to T; Fig. 5A⇓ ). However, women whose tumors overexpressed the HER2 oncogene were more likely to achieve a cCR to A than to T (Fig. 5B⇓ ; HER2-positive 56% cCR and HER2-negative 0% cCR to A). Furthermore, HER2-positive patients were slightly more likely to have cCR to T (HER2-positive 33% cCR and HER2-negative 26% cCR to T), but this difference was not as dramatic as that observed with A. Of note, 3 of the 6 women with tumors overexpressing HER2 who were on regimen A→T had a cCR to A and were, therefore, not evaluable for response to T. Another woman received only one of four scheduled cycles of T and was, thus, not evaluable for response to T. We did not observe a difference in response to individual agent A or T based on bcl2 or p53 expression (Fig. 5, C and D⇓ , respectively). Finally, we did not observe significant changes in expression of ER, HER2, bcl2, or p53 during or after the chemotherapy (data not shown).
In this pilot prospective trial, we studied baseline and changes in surrogate end point biomarkers after single agent sequential administration of doxorubicin or paclitaxel as neoadjuvant chemotherapy for LABC. High rates of apoptosis and proliferation at baseline were associated with improved pathological response to both regimens (A→T or T→A). Increased rate of apoptosis 24–48 h after treatment with doxorubicin or paclitaxel was associated with improved clinical response.
Our results are similar to other reports in the literature. As reported previously, we observed that adequate training and experience are required to obtain adequate tissue for analysis (24) . Nonetheless, our data are consistent with reports that early changes in apoptosis correlate with subsequent response to the regimen (7) . In addition, prospective evaluation of response to single agent therapy may permit us to evaluate molecular signatures of sensitivity or resistance to individual agents. On the basis of these characteristics, several hypotheses can be generated.
One hypothesis is that breast carcinomas with very low baseline apoptosis may have a poor response to chemotherapy. The sample size in this study was too small to conduct a multivariate analysis, but it appeared that tumors with low apoptotic ratios were ER-positive. Other investigators have assessed the effects of chemoendocrine therapy on proliferation and did not observe a difference in response rates for ER-rich or ER-poor tumors (8 , 25) . Our results are consistent with retrospective evaluations that suggested that hormone receptor-negative tumors are more chemosensitive than those that lack hormone receptors in both the metastatic and neoadjuvant settings (6 , 26 , 27) . It is now clear that patients with ER-positive tumors benefit substantially from endocrine manipulations (28) . Such observations have led to hypotheses that chemotherapy may add little benefit to adequate hormone therapy in receptor-rich patients, although this hypothesis requires confirmation in prospective randomized clinical trials.
A second hypothesis that can be generated is that higher baseline apoptotic rates are associated with better response to chemotherapy. Therefore, if available, pretreatment with agents that specifically induce apoptosis might result in high response to chemotherapy. We suggest that this trial design is a good clinical model to test this theory.
These data also suggest that it may be possible to determine as early as 24–48 h after administration of chemotherapy whether a woman is likely to respond to a specific agent or not. Such information might help to make early decisions regarding a change in treatment. Moreover, the single agent nature of this trial design permits assessment of changes in surrogate markers (such as increased apoptosis) in a more straightforward fashion than if the chemotherapy is given in combination. Larger studies are required to assess whether anthracyclines and taxanes induce different changes in apoptosis or proliferation. Such results may provide biological insights into the mechanisms of action of both standard and novel antineoplastic treatments.
The novel approach in this study can also answer questions regarding the role of other markers and response to individual therapies. For example, it has been suggested that overexpression or amplification of HER2 may be associated with an improved response to doxorubicin and possibly paclitaxel (29 , 30) . Our data are also consistent with this hypothesis.
Other markers that are closely related to cell cycle and cell death include bcl2 and p53. Although we did not observe a significant correlation between expression of bcl2 and response to the chemotherapy, we have not evaluated posttranslational modification of the protein nor ratio with other bcl2 family members. It is also possible that other methods of detecting an alteration in a gene or a gene product may be more sensitive to predict for response to specific therapy. One study suggested that wild-type p53 was associated with an improved response to anthracyclins, whereas a mutated p53 was associated with an improved response to paclitaxel (31) .
In summary, we present a clinical design incorporating single agent sequential chemotherapy in LABC that can be used in future investigation not only to correlate surrogate end point biomarkers with response to single agent therapy. The model can also be used to incorporate novel agents with standard treatments. Changes in apoptosis and proliferation can be used to determine the efficacy of the combination.
We thank Drs. Marc Lippman, Susan Honig, and Michael Hawkins for helpful discussions. We thank Drs. Said Baidas, Robert Buras, Phillip Cohen, Patricia Conrad-Rizzo, and Robert Warren for enrolling their patients in this study. We thank Dr. Sofia Merajver for a critical review of the manuscript.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
↵1 Supported in part by 1K12CA76903 (to V. S.), CRTG-99-250-01-CCE (to V. S.), CI-3 of the Cancer Research Fund of the Damon Runyon-Walter Winchell Foundation (to V. S.), investigator-initiated clinical grants from Bristol-Myers Squibb Oncology and Amgen, Inc., and by a grant from the Fashion Footwear Foundation/QVC Presents Shoes on Sale.
↵2 To whom requests for reprints should be addressed, at The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Bunting-Blaustein Cancer Research Building, 1650 Orleans Street, Room 1M53, Baltimore, MD 21231-1000. Phone: (443) 287-6489; Fax: (410) 614-8160; E-mail: vstearn1{at}jhmi.edu
↵3 The abbreviations used are: LABC, locally advanced breast cancer; A, doxorubicin; T, paclitaxel; ER, estrogen receptor; cCR, clinical complete response; cPR, partial response; cSD, stable disease; pCR, pathological complete response; MiR, microscopic residual disease; MaR, macroscopic residual disease; TUNEL, terminal deoxynucleotidyl transferase (Tdt)-mediated nick end labeling; IHC, immunohistochemistry; C1D3, day 3 of cycle 1; C4D1, day 1 of cycle four.
- Received June 5, 2002.
- Accepted July 24, 2002.


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Wednesday, April 3, 2013
The Power of Ritual
8 comments:
Well said, and I love that you don't add a K to magic :)ReplyDeleteReplies
Thanks, Linda! LOL! Me, too. :)Delete
I'm looking forward to tomorrows post!ReplyDeleteReplies
Thanks, Lynne!Delete
Great post. I love the beautiful moon in the picture.ReplyDeleteReplies
Thanks, Amanda! I love that moon, too.Delete
The title says it all I guess! :) Nicely said, and I have to agree with Amanda, awesome picture! I can't wait for more (both posts and pictures, lol).ReplyDeleteReplies
Thanks, Renata!! Yes, I guess it does. I love it, too. It reminds me of how soothing the full moon feels to me.Delete
Thanks so much for coming to visit and sharing your thoughts! Let me know where you are and I'll come say hello at your place next.
By the way, I know that sometimes my readers disagree with what I say here and I wanted to let you know that not only is it okay with me if you happen to as well, but you also are welcome to tell me so, as long as you do so kindly.
Have a great day!


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Deutsches LitLexikon 11
Wydawnictwo: Francke Verlag Bern
Kategoria: Leksykony
The Deutsches Literatur-Lexikon is one of the best known, most comprehensive and most reliable reference works on German literature. The scope of the Deutsches Literatur-Lexikon is simply unrivalled: Spanning the ages, the work encompasses writers from all eras, ranging from the Middle Ages to the present day. The work presents writers from the Federal Republic of Germany, the former German Democratic Republic, Switzerland and Austria, as well as German-language writers from other European countries.Articles contain full name, dates of birth and death and a short biography. The bibliographical section provides details on writings, translations, editorial activities, editions, letters, estate, compilations, bibliographies, research reports and academic studies, general portraits and appreciations as well as on secondary literature focussing on individual works.Czytaj dalej
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The Conference has been organised and put on by Meynell Games. Our legal entities are National Playwork Conference Ltd 11010201 and Play and Playwork Training Limited 11192613.
If you have not come across us before, we are a small non profit distributing organisation working towards making a difference in the play lives of children and young people.
As well as delivering the National Playwork Conference we also publish and distribute the almost weekly FREE iP-D!P magazine and deliver training from short CPD to the full L2/L3/L4/L5 qualifications in playwork. You will also see, at the Conference, that we sell books!
We are an organisation that still gets our hands messy with frontline playwork services so all the playwork training that we run is also underpinned by our current practice.
Please do talk to Meynell Games if you a looking to put on your own mini Conference, organise some training or want to buy some books or other resources.
Weare all struggling so let's try to keep all the finances in the sector and not give them to some faceless corporate!
Thank you for being part of this event - and see you again soon,


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Travels-and-trades Ltd Switzerland
|About us
Our tours include transportation by minibus, mountain trains, boats, cable car, tasting of local dishes, visits of cheese dairies, chocolate factories or manufactures of universally known watches, etc.... Our routes were selected according to their beauty and romanticism. We strive to always plan some shopping time for you to enjoy, as well as free time for yourself wherever we take you (eg: Visited places, major towns where we stay overnight). We have only one objective: Making your stay in Switzerland as successful as possible.
|Industry Focus
|Travel Agents, Passport & Visa, Hotel & Restaurant
|Business Type
|Trading Company
|Outgoing trip
|Our Markets
|Eastern Asia
|No. of Employees
|11 - 50 People
|Annual Sales Range(USD)
|Above US$100 Million
|Legal Representative(CEO)
|jean-louis galeazzi


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Our Homelessness Strategy and action plan 'A City Partnership to Prevent Homelessness' sets out what needs to be done to prevent and address homelessness in York over the 5 year period from 2013 to 2018.
Our strategy:
- has been developed with the help of the York Homelessness Forum, a body made up of many statutory and voluntary agencies working to prevent and tackle homelessness in York
- builds upon the achievements of the 2008 to 2013 strategy
- focuses on prevention, early intervention and locally designed integrated services that step in when things go wrong
The strategy action plan was reviewed in October 2015 and future commitments agreed; see our Homelessness Strategy report and action plan.
Homelessness statistics
Our Housing Options Team and partner agencies provide a whole range of services, such as:
- advice to households who find themselves in a housing crisis
- intervening to prevent homelessness
- managing homeless applications
We collect statistics on these services to monitor our performance. You can download our annual homeless review report, which provides a complete breakdown of homelessness statistics and reports on the work that has been completed during the year to tackle homelessness in the city.
Our homelessness performance reports summarise significant achievements delivered by homelessness services each year. You can also view the homelessness statistical quarterly bulletin on GOV.UK for updates on a national level.
Prevention figures
These figures represent the number of households that we (or other advice/ support agencies) prevented from becoming homeless, by helping them stay in their current home or helping them find alternative accommodation.
Homelessness figures
These figures are official government statistics, which we collect every 3 months. They show the number of households which have formally presented to us as homeless and have been assessed under the legal criteria (Part 7 Housing Act 1996).
The 'accepted homeless' figure shows the number of households we had a duty to house. That is, those who were eligible, in priority need, were unintentionally homeless and had a local connection.
Temporary accommodation figures
This is the number of households on a particular date (usually at the end of March, June, September and December) in temporary accommodation. Temporary accommodation is generally a hostel, a non-secure tenancy and sometimes a bed and breakfast. Households are placed in temporary accommodation if they meet the criteria (eligible, homeless, believed to be in priority need) while their case is investigated and a formal decision made. If 'accepted homeless', they will remain in temporary accommodation until they can move into permanent accommodation.
Rough sleeping figures
Rough sleepers are people who do not have any accommodation and sleep out 'under the stars' or in temporary shelter such as bus stops and sheds. The Salvation Army carries out regular early morning street walks to find rough sleepers and help them find accommodation. If you see any rough sleepers contact the Salvation Army on tel: 01904 405330.
We now submit an annual figure to central government giving the number of rough sleepers on a certain night. This provides a single night snapshot of the number of rough sleepers in York.
Housing register
North Yorkshire Home Choice is a housing register based across York and North Yorkshire (excluding Harrogate Borough Council). Find out more about how we allocate council homes using this housing register.


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I guess you had to be there.
You need to have lived through the collapse of the scandalous Nixon presidency, the shameful conclusion of the Vietnam War, the anger and alienation that was the fallout of the 1968 Democratic Convention in Chicago, the assassinations, the race riots and the student riots.
You need to have lived through a time when we came to believe that our government was hostile and venal to appreciate the shocking candor, the frankness, the refreshing honesty of Betty Ford.


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There's nothing better than real Turkish Delight, one of the oldest sweets in the world and the product of many legends. We at Truede really believe that, which is why our Turkish Delight is hand made by artisans in Istanbul, Turkey, the way it has always been made.
The pomegranate is an ancient fruit with a rich history in myth, symbol, art, medicine and religion. Often referred to as 'the divine fruit', the pomegranate is considered by many to be a 'super-food'. Its jewel like seeds have been used for medicinal purposes for millennia. Packed with powerful antioxidants and vitamins, this ruby-red fruit has been shown to be a cure-all for just about any ailment. As we only use natural flavours from real plant extracts, you're sure to feel the benefits of our ingredients whilst being delighted by the taste.
This resolve to high quality even extends to our design. In the Ottoman Empire, the most important centre for ceramics and tile making was Iznik. Countless examples of mosques and tombs not only in Istanbul but all over the empire were adorned with the products of the Iznik potters' skill. These designs were far more technically advanced than anything that had come before, and the beautiful result can be seen on our boxes.
Ingredients: Sugar, pomegranate juice (8%), corn-starch, water, natural flavouring (pomegranate aroma), acidity regulator (citric acid)


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Faith Formation (K-5)
Faith Formation
Faith must never remain stagnant. Rather, being open to the Holy Spirit to enrich us everyday with the fullness of Christ through prayer, Sacraments and the Catholic Faith. This describes Faith Formation.
Our approach is based on the Catholic Teachings of the Catholic Church and will focus on the weekly Sunday readings with emphasis on its meaning from the age-appropriate point of view.
Faith Formation begins in the home, as the Catechism of the Catholic Church states: "Parents have the first responsibility for the education of their children. They bear witness to this responsibility first by creating a home where tenderness, forgiveness, respect, fidelity and service are rules. Home is well suited for education in these virtues."
Parents are the most vital part of our children's faith formation. We at Blessed Teresa will assist and support you in your efforts.
We offer weekly Faith Formation classes for children in grades K-5. These classes meet every Tuesday, Wed OR Thursday from 4:30-5:45pm.
Our Homeschooling program for those in Elementary School meets monthly on the 1st Tuesday from 5-6PM
- If your child needs First Reconciliation, the child will need to attend weekly Faith Formation and the parent will come once a month on the 2nd Tuesday from 5-6PM.
- If your child needs First Eucharist, the child will need to attend weekly Faith Formation and the parent will come once a month on the 4th Tuesday from 5-6PM.
Coordinator: Jennifer Heffernan


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This "Black Panther" star is already talking about a sequel
Who's ready for "Black Panther 2?"
The Atlanta-filmed Marvel blockbuster, which now has crossed the billion-dollar mark, was released nearly a month ago but the buzz isn't dying down at all.
One member of the incredible cast, Forrest Whitaker, talked about what a sequel might mean for him. (Spoiler alert: stop here if you haven't seen the movie yet!)
MORE: The star-studded Hollywood premiere of "Black Panther"
Celebs talk "Black Panther" on accessAtlanta, the AJC's new entertainment podcast
How much did "Black Panther" spend in Georgia?
Whitaker's character Zuri is a loyal attendant of lead character T'Challa, played by Chadwick Boseman. T'Challa, who ascends to the role of King of Wakanda/Black Panther following his father's death, would be available for a sequel. Zuri wasn't so fortunate.
Still, as "Black Panther" featured scenes that took place in a mystical location where T'Challa communes with his ancestors' spirits, there could be a place for Zuri in future projects.
"I guess I would be like an Obi Wan Kenobi or something, who comes back and talks from the ancestral plane to give advice to T'Challa, Chadwick's character," Whitaker told Entertainment Tonight during the red carpet for "The Forgiven."
He hailed both Boseman and director Ryan Coogler, adding: "I'm so proud to be in it."


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The Nexus 7 Giveaway Event hosted by Mom Powered Media
Prize: Nexus 7 Tablet
The event dates: 8/16 - 9/6
Sign-Up Here – Bloggers Wanted
Don't put it off. This is a great way to increase your following, and the first link is free if you publish an announcement. Be sure to check it out!


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To the Editor:
An article in the June 29 Morning Call promoted the preservation of farmland and advocated hawk watching in Heidelberg Township. The same people in favor of hawk watching and ecotourism were against a proposed Perrier plant because of increased traffic and increased people in the community. The water company would have brought a tax base to the township and schools, but was refused.


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E-Voucher Delivery
Print or Email Instantly! You can also choose your send date.
When do I choose a date?
If giving as a gift, your recipient can choose a date at their convenience; otherwise, you can choose one after checkout.
Hassle-Free Policies
30 day returns. Free exchanges. No expiration dates.
If you've always wanted to learn to fly fish, then this is the school for you!
The best way to learn to fly fish is to do it! Get out on the water, one on one, with one of our friendly guides.
Your on stream fly-fishing instruction for the beginner or intermediate level angler is for one or two anglers and is held on a local stream in the Philadelphia area. This class is the perfect way to learn to catch more fish and also to learn new techniques in the sport.
These classes are private so they can be custom tailored to your expectations.
Essential Information
Maximum Participants
Weather Dependent
What To Wear
Booking Information
Cancellation Policy
Experience ID


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SAN FRANCISCO BEER AND MUSIC FESTIVAL – Fall edition
* The event: Now celebrating its third 1/2 year, the San Francisco Beer and Music Festival special Fall Editon celebrates local and regional libations and melodies in a relaxing evening of strolling and sipping at the new Public Works SF Location.
* Who it's for: fans of craft beer, live music, and great times
* What to drink: unlimited samples of over 50 craft brews from breweries such as Lagunitas, Palmia, Mad River, Stone, Port Brewing Company, and more
* Music: Dig the Kid – known for "Still Breathing" & "Heart Break", 90's Party Band Rock Steady, and Sega Genecide will have the crowd dancing.
More info at: http://
USE DISCOUNT CODE: "Palmia" or "DigTheKid" for $10.00 off! (All you can drink and rock out)


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Found 3 Additional Reviews outside DesignQuote.
I have used Skkepper for various projects over the past few months including building 3 websites for my various businesses. They have shown out of the box thinking and vision during my interactions with them. In addition, their focus on the project and turnaround time was commendable. Invariably all my projects with them were completed before stipulated time with high quality . I highly recommend them to anybody.
I am very happy with the completed work. The design is impeccable and the functionality has been exactly as planned. I'm very satisfied with the design and it is much better that what we had originally envisioned. The combination of price, professionalism and overall result made us very pleased to work with Skkepper
I have done multiple projects with Skkepper and had a pretty good experience working with them. The project was executed in a professional and timely fashion and I was assisted with defining and verbalizing my desired product. The designers at Skkepper are very well skilled and creative. They are very quick in response and implement the requested changes on priority. They are a team of very highly professionals and deliver great quality of services at an affordable cost. I will definitely work with them again and recommend working with them.
I did my graduation in commerce but I always had a curiosity to do some designing. Therefore, as soon as I completed my graduation I enrolled for a Masters degree in Computer Applications where I learned more about design and programming.
I landed my first job as an intern and got to know more about the designing standards and syntax which has helped me shape my career.
I've been associated for over 7 years with my company
I did my Masters in Computer Application where I learned more about designing and programming
Since browser compatibility check is the most essential part for web design so I use all popular browsers like Firefox, Chrome, Safari, Opera, Internet Explorer, etc.
I use Facebook and Instagram for my off-the-work habits. i'm quite fond of instagram
I get to see my creativity being appreciated not only by my clients but all the people using that site. I love the idea of thinking something new and put it on paper to see how it will look like
I would advice to have your basics clear. The first few months or the first year could be difficult but if the individual has good grasp on the basics than it is a much easier path
Over the years I've gained a lot of experience in developing sites using PHP programming and I'd rate myself excellent as far as developing sites using PHP is concerned
I'd always choose PHP as it has a huge role to play in helping me make a decision to become a programmer
Based on the current trends I would say that Ruby on Rails and Laravel
I would only suggest that while comparing apples to apples, price should not be the only factor. Equal importance should be given to professionalism, time management, project management and meeting deadlines
I've worked with a lot of people under similar circumstances and I'm confident that I will be able to address them easily.
Many clients tend to compare different vendors on the basis of price only. Although, there's nothing wrong with it and I fully support it but I would just recommend that each client should carefully check the deliverables he's getting for different prices.
Tell us about your web design or graphics project. There is no obligation.
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Designers click here.


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A Summary of Neo-Scholastic Doctrine on Just War Theory. Taking into account the varying opinions of the Neo-Scholastic authorities on several points, the following precisions of doctrine may now be made: 1. The right of war is odious. That this right exists in certain circumstances cannot be denied; but it is a regrettable necessity, and … Continue reading A Summary of Neo-Scholastic Doctrine on Just War Theory
Category: Saint Augustine
A Summary of St. Augustine's Doctrine on Just War Theory
A summary of St. Augustine's doctrine on Just War: A. There is a greater merit in preventing war by peaceful negotiation and conciliation than in vindicating rights by bloodshed. B. Peace attained by conciliation is better than peace attained by victory. C. There is a natural society of mankind which gives rise to certain rights … Continue reading A Summary of St. Augustine's Doctrine on Just War Theory
The Augustinian Argument for the Existence of God
I have been spending time highlighting arguments for the existence of God presented by Edward Feser in his book, Five Proofs of the Existence of God. Thus far, I have covered his presentation of the Aristotelian and Neo-Platonic arguments. The third argument presented by Feser is the Augustinian proof. Here is the Augustinian proof, which … Continue reading The Augustinian Argument for the Existence of God
Augustinian Participation & Divine Illumination
Augustinian philosophy has three primary principles: interiority, participation, and immutability.[1] For now, I would like to highlight the second principle of participation and the theory of divine illumination flowing out of it; and to do this I will quote Johannes Quasten's explanation at length, "2. The second principle which enters into the essential nucleus of … Continue reading Augustinian Participation & Divine Illumination
Genealogical Narratives & Their Villians
The competing genealogical narratives explaining the advent of secular modernity are vast. Some of these interpretations of historical progression into the cultural, social, economic, and political reality we now find ourselves living consider such developments to be a good thing. Other interpretations cast a negative light on the secular modern instinct. Most often these narratives … Continue reading Genealogical Narratives & Their Villians
Saint Augustine on Beatitude & Goodness
"The striving after God is therefore the desire of beatitude; the attainment of God is beatitude itself. We seek to attain God by loving Him; we attain to Him, not by becoming entirely what He is, but in nearness to Him, and in wonderful and sensible contact with Him, and in being inwardly illuminated and … Continue reading Saint Augustine on Beatitude & Goodness


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Find your perfect neighborhood
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Welcome to the easiest to use Beavercreek real estate website in Ohio. Search for your next home among the latest homes available in the Greene County MLS. You will be able to set up saved property searches and get daily notifications of the newest Beavercreek homes for sale. View properties in a simple list or on an interactive map.
The rolling, wooded terrain provides an attractive backdrop for the many residential neighborhoods in our community. Beavercreek is considered one of the most desirable and fastest growing suburbs with homes for sale for all tastes and budgets. From charming, older neighborhoods to custom-built luxury homes in new developments, from mini-farms for horses to golf course communities, from starter Beavercreek homes to low-maintenance condos, this Greene County city has something for everyone! In the older neighborhoods, you'll find brick ranch homes, charming Cape Cod houses, and two-story homes. One of the most popular online searches is for Beavercreek four-bedroom houses.
If you dream of building a new home in Beavercreek Ohio or just want to find nearly new homes for sale, contact New Construction Specialist Donald Shurts! As experienced Keller Williams agents, the Shurts Group has worked with many Dayton home builders.
With a 15 minute drive to downtown Dayton and a 5-10 minute drive to Wright Patterson Air Force Base (WPAFB) and Wright State University, Beavercreek real estate is often selected as the community to purchase a new home solely on its convenient location within the Greater Dayton area. Because the city is served by two major highways (I-675 and US Route 35) Beavercreek homes for sale provide a commute of fewer than 30 minutes to most parts of the Greater Dayton metro area.
When considering our town, you should know that Beavercreek is one of only a few cities in the Miami Valley that does not have a city income tax. So if you work in another city besides Beavercreek or Bellbrook, you'll probably pay a personal income tax in that city. But if you work and live in Beavercreek or Bellbrook you'll pay no city income tax.
A wide variety of schools is available to Beavercreek residents including highly rated public and private schools - both Christian Schools and Catholic schools. Beavercreek City Schools are regularly recognized for their academic excellent and strong character education. Many colleges and universities are close by, including the University of Dayton, Wright State University, Central State University, Cedarville University, Wilberforce University, and Sinclair Community College.
A COUNTRY RETREAT just minutes from the mall! This custom, Norman Speaks ranch with FINISHED BASEMENT is situated on a 1.6 acre, WOODED LOT at the end of quiet street! At...
Courtesy of Rhonda Chambal and BHHS Professional Realty
CAREFREE LIVING in a fabulous Beavercreek location! This Cinnamon Ridge townhome offers an OPEN FLOORPLAN with plenty of living space! Relax in the sunlit, family room wi...
Courtesy of Rhonda Chambal and BHHS Professional Realty
You'll just love this Beavercreek 2 story, situated on a large and open lot with lush trees bordering behind, get ready to enjoy summer on the patio! Front open living ro...
Courtesy of M. Isabella Hart and Bella Realty Group
This home is a original owner and is definitely rated a 10 Plus. An ultimate updated kitchen with granite counters and 42" cabinets. It is open to the large informal ea...
Courtesy of Esther M North and Coldwell Banker Heritage
Beautiful yard! Great value in this 3 bedroom, 2 bath ranch home. Priced to reflect need for cosmetic updating. Living room features stone fireplace (woodburning). Adjace...
Courtesy of Rhoda E Gazda ABR and Keller Williams Advantage Real
Step Into This Beautiful Condo & Be Ready To Call It Yours!... Immaculate Condition!... Spacious Great Room Offering Corner Gas Fireplace, Built-In Shelving, Crown Moldin...
Courtesy of Timothy Hagedorn and Irongate Inc.
2000 sq. ft. home. Builder can design with buyer
Courtesy of Barbie Woehrmyer and Comey & Shepherd REALTORS
5 Beautiful Acres!!! Developed trees, 5 acres, Beavercreek school district, property line up against the Little Miami River. This gorgeous lot has an accessory building c...
Courtesy of Adam Vanscoy and Keller Williams Advantage Real
Come make this beautiful 1709 sq ft. brick ranch yours! Very scenic lot with many mature trees. This is a single owner home built in 1960. Why pay for other peoples upgra...
Courtesy of Nathan Abramczyk and Keller Williams Home Town Rlty
Beautiful home with open floor plan and many upgrades. Large eat-in kitchen that opens up into the family room. Custom Italian tile that flows from the front entry to the...
Courtesy of Miranda K Biedenharn and RE/MAX Alliance Realty
MOVE IN READY 4 bedroom, 2 bath ranch w/ almost 2300 sq ft living plus 2+ car garage**Updated flooring in foyer, hall, bathrooms, formal dining, eat in kitchen, family ro...
Courtesy of Benita Shea and Coldwell Banker Heritage
AMAZING VIEWS year round from this lovely quality built private patio home in Sunset Bluff. This 3 bdrm, 2 bath home has over 50k in UPGRADES & make this home appear almo...
Courtesy of Marsha Osman and BHHS Professional Realty
You will absolutely not find another home in this area, of this quality, at this price point! 3 generous sized bedrooms and 1 and one half updated bathrooms in this beaut...
Courtesy of Jonathan H Murray and BH&G Real Estate Big Hill
Sold Before Sent.
Courtesy of Nicole Rabette and Comey & Shepherd REALTORS
The Whole Family will Love this Spacious, Upgraded Home! With over ~5400sf~ of living space, this Home offers a 1st Floor Master Suite w/ His & Her Walk-in Closets and L...
Courtesy of Jamie Rudy and Coldwell Banker Heritage
The data relating to real estate for sale on this website comes in part from the Broker Reciprocity program of the Dayton Area Board of Realtors® MLS IDX Database. Real estate listings from the Dayton Area Board of Realtors® MLS IDX Database held by brokerage firms other than KELLER WILLIAMS ADVANTAGE are marked with the IDX logo and are provided by the Dayton Area Board of Realtors® MLS IDX Database. Information is provided 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. Copyright© 2018 Dayton Area Board of Realtors®
"Having purchased two properties from Don Shurts within two years we can affirm that he does excellent work. He quickly understood the type of property we were looking for and did his homework to make the process as quick and painless as possible. It's a shame the rating scale only goes to 5's as we would have liked to rate his knowledge, helpfulness and work quality even higher." - Gail & Stuart, Beavercreek
"We spent about 6 months looking for a home before finding a home that fit all our wants and needs. Working with Cyndi was easier than I thought, and you knew she cared more about your satisfaction than getting a sale. It was like working with a personal close friend. Her standards far surpass other agents from day one and throughout the entire purchasing process. My husband and I really were the ones blessed to work with such a professional. I highly recommend Cyndi to anyone who wants a great home buying experience." - Peter & Aileen, Beavercreek, Ohio
"My father recommended them to me and I would recommend them to anyone I know. The process was smooth, and they took care of all the details. If we ever move from this great house they helped us buy, they're our first call!!" - Mitch & Jennifer, Beavercreek
"I found Cyndi by just browsing a home sale ad, and we stuck with her through our house hunting ordeal! Cyndi was so helpful, understanding and very, very, patient with me, which is saying a lot from a pregnant woman!! She helped me to understand what what we were signing for and even helped us out with a terrific home inspector! I will recommend her to anyone looking for a home. I truly feel like we walked away with a "home" and not just a house, and gained a very dear friend in the process!" - Mark & Jennifer, Beavercreek, Ohio
"Don followed through with every aspect of selling this 55 yr old home in a very slow market. He advised what to do to make it ready to sell (most importantly, what NOT to do), when to list to get the most hits, and got estimates for repairs after the inspection. Everything went smoothly with frequent responses to our questions. He was always happy to help and cheerful with whatever came up." - Kozak, Beavercreek
"I was very pleased with the professionalism the Cyndi Shurts gave to me in selling my house. It was sold quickly and received a good price for it. I would recommend Cindy and Don for their relationship with the client." - Kenneth, Beavercreek, OH


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Monday, July 7, 2008
Currently the room is stacked with beautiful, tiny, white, hexagonal tile and cement board - which by weeks end, may, or may not, be adhered to my bathroom floor - which is currently plywood. Once the bathroom is "done" we will refinished the floors in this room, and enclose it, creating a hall from the stairs to the bathroom - and a room for the roomie. DH thinks this will done before fall. That is laughable - especially since he will be in India for most of August..... We are so screwed.
Above is a rendering, although crude, to help you visualize our plans. Some day, I may have a picture of this room - fer real. But instead, I suspect the roomie will be rooming with us till the dust settles. Perhaps sleeping in a laundry basket beside the bed. Arg. Cash-poor. Old houses. The damn American Dream. Will our house ever be done??? Probably right before we sell it to move to the next dump.
OB appointment was great. She spent a lot of time with me, listening to my concern about the douche-bag Peri. She said she could refer me to another practice here in town. I like my OB - the Peri is the problem. So DH and I are tossing around staying here and not moving to the suburban practice as I had thought. I just keep thinking of all of the driving. And if we ever did have an emergency, getting all the way there could be hard. I don't know what to do.
How is it I live in the 5th largest city in the country (well 6th this year thanks to Phoenix) and seem so hard up to find the care I want?
Last, it seems the Ute is over-achieving. It is cresting nearly a finger-width above my belly-button. OB says most times it does not even reach the belly-button till 20 weeks. Big ol' Ute! Yer so crazy!
4 comments:
- jenn said...
I absolutely love the sketch!
- July 7, 2008 at 8:33 PM
- jenn said...
Thank you. I needed that today. I really hope I'm at the top of that list! {{{hugs}}}
- July 7, 2008 at 9:08 PM
- sara said...
Aw, thanks for sharing the photos. I love seeing pictures - I get so darn excited! Your hardwood floors look gorgeous, and the sketch is really cool how you added that in. Thanks for thinking my house looked okay and organized...boy do I have you fooled! Just kidding! I hide everything in my basement - it looks like Hurricaine Katrina or an earthquake hit down there.
I'm so glad your OB is cool and that your ute is being an overachiever. That's awesome. What a wacky womb, huh? I still keep going back to look at your septate potato and laughing. I'll probably do that for some time too!
I'll have to drop you an email about my peri's partner sometime. I hate to write about it on my blog in case it falls into the wrong hands since I work with the group sometimes. But I'll just say that I understand your pain when it comes to crappy peris. I like mine, but the partner - hmmm I could say our utes are more normal than them!
- July 9, 2008 at 10:44 AM
- scarredbellybutton said...
I've never renovated. I have no desire, plans, or need to renovate. Yet my house still looks to be in a similar state ;)
Sounds like you might need to be welcomed into the giant-freaky-baby club!
- July 12, 2008 at 11:28 PM