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Surgery, Radiation, or Active Surveillance? Findings From the ProtecT Trial for Prostate Cancer
By Neha Vapiwala, MD
Article Highlights
- The ProtecT trial provided the first level 1 evidence comparing the relative long-term impacts of surgery, radiation, and active surveillance on outcomes and quality of life (QOL) of patients with localized prostate cancer.
- There was no difference in metastasis-free or overall survival between the radical prostatectomy and external-beam radiotherapy groups, and a "winner" cannot be declared. However, the nature, duration, and QOL impact of the side effects were different between the arms and warrant discussion.
- Although the results are not practice-changing, these data assist more informed decision-making by all stakeholders. The results also reinforce the now-established role of active surveillance as the third form of treatment for localized prostate cancer.
To say that publication of the ProtecT trial results1,2 was highly anticipated is an understatement. Various stakeholders in the prostate cancer community have patiently awaited answers to the perennial question of whether surgery or radiation is "better"—and the more topical question of whether either of these is better than active surveillance—in patients with clinically localized prostate cancer.
As the first, and likely only, level 1 evidence comparing the relative long-term impact of surgery, radiation, and active surveillance on outcomes and quality of life (QOL) of patients with prostate cancer, the successful conduct of this trial is a feat in and of itself. More than 1,600 men with localized prostate cancer, derived from a larger group of more than 2,600 men diagnosed with localized prostate cancer, were randomly assigned to active surveillance (545 patients), radical prostatectomy (553 patients), or external-beam radiotherapy (RT; 545 patients). The primary outcome was prostate cancer–specific mortality; secondary outcomes included the rates of disease progression, metastases, and all-cause deaths.
With a median follow-up of 10 years, there was no statistically significant difference in either prostate cancer–specific mortality or overall mortality among the three groups. Notably, the rates of death from prostate cancer were low in all three groups1—which I will discuss in greater detail later. In terms of the patient-reported outcomes, the authors reported on multiple domains, including urinary and sexual function and general health- and cancer-related QOL. Sexual function declined in all three groups, but there was less of a deterioration in the active surveillance group. Radical prostatectomy was associated with the greatest and most persistently negative impact on sexual and urinary function, whereas patients in the RT arm reported worse bowel function and urinary voiding at 6 months, with some or near-complete recovery, respectively. Interestingly, levels of anxiety, depression, and QOL were not significantly different among the groups.2
Praise for this study as a Herculean undertaking with meticulous long-term follow-up is well deserved, but we should consider some important caveats and criticisms. The original study design was based on an assumed 10-year prostate cancer–specific mortality of 15%, and later 10%. But with only 17 deaths from prostate cancer, the study was arguably underpowered to evaluate the primary outcome.3
Active Surveillance Considerations
The data above essentially corroborate the current practice of offering active surveillance to patients with low-risk prostate cancer, which represented the majority of patients in this population. These results support long-term safety and tolerability of active surveillance in appropriately counseled patients with localized prostate cancer when cause-specific death is the primary endpoint of interest, rather than biochemical or disease progression. But, as with any high-profile study that generates attention in both the trade and lay press, providers and patients must consider the nuances when interpreting and applying the results to formulate optimal personalized disease-management decisions.
For example, some news headlines have warned that patients randomly assigned to the active surveillance group were "more than twice as likely" to develop cancer progression and spread compared with the patients assigned to undergo immediate treatment.4 Although disease progression and metastasis development were statistically significantly worse (p < 0.001 and p = 0.004, respectively) in the active surveillance arm compared with either treatment arm, they remarkably did not result in greater cause-specific mortality. Another 5 years of follow-up may reveal this as a downside or, alternatively, demonstrate that such differences are ultimately negated by survival-enhancing agents and competing causes of death.
For now, it is certainly important to inform the appropriately selected active surveillance candidate about this relative risk compared with their counterpart who elects to have immediate prostate cancer treatment. Having said this, it is the absolute risk of a given negative outcome that fundamentally provides necessary and meaningful context to understand relative risks.
It is challenging but critical to provide patients with a clinical perspective on the statistics so that they can determine their personal priorities and exercise their prerogative accordingly. When the absolute risk of prostate cancer disease progression is exquisitely low with treatment—as in this case at about 3%—a doubling to 6% without treatment may be quite acceptable to some patients for deferring the treatment-related morbidity described above, recognizing that neither radical prostatectomy nor RT are guaranteed cures, even in early-stage, organ-confined disease.
Conversely, for other patients, any intervention to minimize the risk may be preferable to no intervention; 15- and 20-year data may be more relevant to properly weigh the ramifications of an active surveillance decision made at age 50 on disease-free survival. The logistical and financial costs should also be factored, along with psychosocial stressors on loved ones—none of which are captured here, but they are factors that will matter to some individuals. Unfortunately, the published reports do not provide details regarding the Gleason score or other pathologic characteristics of the patients whose disease progressed, which would be useful when counseling individual patients.
Two other aspects must be considered when adapting the ProtecT trial's active surveillance data to today's clinic. First is the very real-world crossover rate: approximately one-third of patients in the active surveillance arm elected to undergo treatment secondary to anxiety and suspicion, and an additional one-fifth pursued treatment for disease progression, leaving 44% of the original group successfully on active surveillance for 10 years. Second, modern-day active surveillance protocols in the United States are more stringent in terms of prostate-specific antigen and biopsy requirements than the protocols used in the ProtecT trial, and emerging molecular and imaging advances were, of course, not available.5 As with any clinical trial, the benefits of long-term follow-up are inherently tempered by the inability of the original protocol to account for every advance during the course of its conduct.
Immediate Treatment Considerations
The statement above also understandably applies to the two treatment arms, primarily with respect to the relatively high rates of patient-reported toxicities. Taking the positive resection margin rate as a surrogate for quality, modern-day series report an average of 15% (markedly lower in high-volume, high-quality settings) and raise some concern regarding the 24% reported in the surgical arm of the study. Urologic surgeons also nowadays commonly perform robotic-assisted radical prostatectomy, whereas nearly all patients in this study underwent the more traditional open retropubic nerve-sparing radical prostatectomy. Similarly, some radiation oncologists would argue that 3D conformal RT and the use of 3 months to 6 months of androgen deprivation therapy (not medically indicated in this group6) are contributors to greater toxicity that would not be used in the United States for these patients today. In the case of radiation technique, the use of intensity-modulated radiation has been associated with both reduced recurrence rates and toxicity, albeit not with overall survival differences.7
As mentioned earlier, the ProtecT study population is enriched with patients who would be prime active surveillance candidates by today's standards (median prostate-specific antigen 4.6 ng/mL and more than three-quarters with clinical stage T1c and Gleason score 6 disease). To determine clinically meaningful differences between surgery and RT, one ideally needs a population prone to more disease-related events (i.e., intermediate- and high-risk localized prostate cancer), which, unfortunately, comprises a relatively small proportion of the trial. As far as what we can glean from this dataset, there is no difference in terms of metastasis-free survival or overall survival between the two treatment groups, and a "winner" cannot be declared.
To many radiation oncologists accustomed to hearing that surgery is the gold standard for prostate cancer treatment, the equal footing—as of now, anyway—is a small victory in itself. The nature, duration, and QOL impact of the side effects, however, are quite different between radical prostatectomy and RT, and they warrant healthy and honest discussion. Additional follow-up will reveal whether everything equals out in the end, as it did in the Prostate Cancer Outcomes Study,8 and if differences in provider-reported grade 3 to 4 late toxicities and secondary malignancy rates emerge. Ultimately, both reports from the ProtecT trial humbly remind us of the therapeutic limitations of immediate treatment and of the potential for treatment to do harm in a population that is unlikely to die of their disease.
The ProtecT investigators should be commended for providing us with what no one else could or likely ever will. Although the results are not practice-changing and the roles of radical prostatectomy and RT remain vital in the overall management of prostate cancer, including for some men with early-stage disease, these data assist more informed decision-making by all stakeholders. The results also reinforce the now-established role of active surveillance as the third—and for many, perhaps, the preferred—form of treatment for men with localized prostate cancer.
About the Author: Dr. Vapiwala is an associate professor of radiation oncology and vice chair of education in the Department of Radiation Oncology at the Hospital of the University of Pennsylvania.


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Our Bakery
Pie Baking Instructions:
******** All pies Cook from frozen*********
Remove plastic before cooking
Apple, Blueberry, & Pumpkin 6": Cook for 25-30 minutes at 350 degrees
Apple & blueberry 10" : Cook for 10 minutes at 400 degrees then cut back to 350 degrees for the remaining 30-40 minutes (depending on oven temp variables)
Pumpkin 10" bake 350 degrees for 30-40 minutes
****you may add an egg wash or use cream on surface of pie dough before baking*****
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all of our pies are made here on the farm from scratch! even our pie dough
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Learning Objectives
Become resilient by learning to:
- Understand yourself
- Better understand your current situation
- Learn a set of skills to build resiliency or your "bounce-back-ability"
Feeling Overwhelmed?
If you are feeling overwhelmed, you are not alone. In fact, it's pretty normal to experience multiple hassles and obstacles to varying extents throughout your graduate school experience:
- Too much work?
- Not enough sleep?
- Feeling stressed out?
- Calling the lab "home"?
The good news is that there are ways to manage the challenges you experience.
Goal of the Problem-Solving Method: Build Resilience
During difficult times it's easy to lose sight of your passions and goals. The CareerWISE Problem-Solving Model can help you stay focused and motivated, in spite of personal and professional challenges that may make you feel like you have gotten off track.
Career Goals & Motivation is a module intended to help you learn how your beliefs and goals are related to how you act and what you achieve.
Being resilient means that no matter what life throws at you, you will be able to manage it. Resilience helps you turn challenges into opportunities. Through the CareerWISE four-step Problem Solving Method, you will find personalized learning materials that will build your resilience by helping you to:
- Understand yourself
- Better understand your current situation
- Learn a set of skills to build resiliency or your "bounce-back-ability"
Resilience is a module intended to help you bounce back when you are confronted with a challenging situation—professionally and personally.
Managing the Culture of American Universities
The CareerWISE materials can also serve as a cultural guide to manage common problems in American universities. There are many different cultures represented in graduate programs throughout the country. As students come from all different parts of the U.S., as well as from around the world, and bring a wealth of knowledge and diversity to universities everywhere. The skills and concepts presented are intended to address issues that are often found in science and engineering departments in the U.S. It's important for students to feel that they can retain their culture and be successful in graduate school, even if the disciplinary "culture" is different from their own.
International Students is a module intended to help you learn how to manage the stressors that often accompany the issues that international students experience.
Things to Keep in Mind
The CareerWISE Problem-Solving Method is not a linear process. Rather, it's a cyclical one that involves trying out similar tactics for different problems or regrouping when a strategy doesn't work out as planned.
You have the awareness and ability to use these resilience skills to manage your current concern and those that may come up in the future. They just take practice and determination— things you already do very well as a graduate student. Commit to yourself and your goals as you would an important project or grant in the lab.
The resources presented on this website can be used for many more circumstances beyond the situations presented here. You can always return to the CareerWISE site for supportive resources and for a refresher on the topics that are important to you.
The CareerWISE Problem Solving Method
As emerging scientists and engineers, you are accustomed to grappling with technical, research, and design problems in a considerate and scientific way. The CareerWISE Problem Solving Method builds on the scientific processes that you know well but applies them to problems, like personal and professional challenges, that are different from the ones you typically address in your projects and experiments.
The CareerWISE Problem-Solving Method guides you through four steps:
Step 2: SPECIFY THE OUTCOME YOU WANT
Working through these four steps will take you to dozens and dozens of skill-building units, personal testimonials, interactive learning opportunities, and self-tests. These materials are intended to help you feel more confident about your ability to handle both everyday and tough problems as well as develop strategies to be successful, both personally and professionally. Following the Problem-Solving modules step-by-step is the best way to take advantage of all the resources on this site. We recommend this path if you are new to the site.
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The importance of sharing stories of sexual harassment with others and realizing that you are not alone.
Getting Married During Graduate School
The decision to get married in graduate school.
Critical Mass
Captures the annoyance of male colleagues making sexist assumptions and the challenges with conference travel as a female graduate student.
An Example of How to Negotiate (Part 2)
Strategies for negotiating as a faculty member.
Sexual Harassment: It's Not Just You
The importance of sharing stories of sexual harassment with others to gain support.
It's the Little Things that Annoy You (Part 1)
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How to be upfront, direct, and assertive when confronting instances of sexual harassment.
We want to hear from you. Did this page remind you of any experiences you've had? Did you realize something new? Please take a moment to tell us about it—and we'll keep it confidential.
An Arizona State University project, supported by the National Science Foundation under grants 0634519 and 0910384
Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views
of the National Science Foundation. © 2016 CareerWISE. All rights reserved. Privacy | Legal


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Fat: It's the stuff that gives ice cream its creaminess, pizza its dreaminess, and Nicki Minaj her twerkiness. In the right places and in the right amounts, fat is the stuff that makes life worth living.
But when your curves start crashing over the bulwark of your beltline, it's time to start thinking seriously about reducing body fat. Not losing weight per se, but burning off the soft, jiggly stuff and replacing it with firm, lean muscle. Too much fat isn't just an aesthetic issue, it's a health issue: belly fat in particular is linked to everything from heart disease and diabetes to liver failure, depression and dementia.
So to help you be less large and more in charge, we surveyed some of the most sought-after fitness, nutrition and health experts in America to find out what's happening on the cutting edge of weight loss.


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I had the pleasure to design the first catalogue of LoveArabic Initiative. It was challenging for me to work with so many details, but, Waleed (co-founder of LoveArabic) was really helpful about organizing the needed details. Here we go: I had… Continue Reading →
NETnadive is a platform that connects between students at campus with local volunteering opportunities that give students rewards for their social involvement. This project was design as a final project for the Business Administration Seminar Course at the Hebrew University…. Continue Reading →
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Of course, you've had sex before. But have you done it pregnancy-style?
Though the basic rules apply when you're expecting, you'll find that sex at 23 weeks pregnant and beyond requires a few adjustments, a little finessing, and a lot of flexibility -- literally. Choose positions with her comfort in mind. A top pregnancy favorite is her on top, because this position gives her the most control over depth and speed of penetration. Another is spooning (she faces away on her side). And when her belly starts getting between you, get around it creatively: Try it from behind with her on her knees or sitting on your lap while you lie down. Remember, if intercourse isn't comfortable, find alternate paths to pleasure that you both can enjoy -- masturbation, oral sex, or two-way massage.See more tips for Dad during pregnancy.


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|I'm ready for another season!
#2 With one convention aside (before I started representing Total Language Plus), conventions have always been a combination of work, shopping and encouragement for me (probably in that order.) ~ Now it tends to be work, seeing and connecting with friends we've made and encouraging just about every mom I come into contact with that they can make it!
|My hard working daughter, Ariel!
|My other hardworking daughter, Lexie.
#3 It used to be a big deal to get everything and everyone ready to go. ~ We've been doing this so long now it's like second nature. That, plus the fact that debate tournaments make working conventions seem like a piece of cake, puts it into a different perspective.
#4 The kids used to love going to hotels, always had to make sure it had a pool! ~ Now, they are so used to hotels and eating out (which used to be a huge treat) we never go to the pool (if the hotel has one) and sometimes we'll find a grocery store to buy food because we are tired of eating out.
So what hasn't changed?
*I'm so blessed to have a business where my family travels with me. We have so many memories, in so many cities over the years.
*I'm so blessed to have connected (and connected my kids with) so many great people, customers and other vendors over the years. It is an amazing community to be a part of.
*I am blessed to have the best customers in the world! Homeschool families are kind, loving, caring, enthusiastic, honest customers that I have so loved.
So whether you've never attended a homeschool convention, or your on your 200th I encourage you to love every minute of it, it's a special place to be!


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Verse (Click for Chapter)
New International Version
The cords of death entangled me; the torrents of destruction overwhelmed me.
New Living Translation
The ropes of death entangled me; floods of destruction swept over me.
English Standard Version
The cords of death encompassed me; the torrents of destruction assailed me;
Berean Study Bible
The cords of death encompassed me; the torrents of chaos overwhelmed me.
New American Standard Bible
The cords of death encompassed me, And the torrents of ungodliness terrified me.
King James Bible
The sorrows of death compassed me, and the floods of ungodly men made me afraid.
Christian Standard Bible
The ropes of death were wrapped around me; the torrents of destruction terrified me.
Contemporary English Version
Death had wrapped its ropes around me, and I was almost swallowed by its flooding waters.
Good News Translation
The danger of death was all around me; the waves of destruction rolled over me.
Holman Christian Standard Bible
The ropes of death were wrapped around me; the torrents of destruction terrified me.
International Standard Version
The cords of death entangled me; the rivers of Belial made me afraid.
NET Bible
The waves of death engulfed me, the currents of chaos overwhelmed me.
New Heart English Bible
The cords of death surrounded me. The floods of ungodliness made me afraid.
Aramaic Bible in Plain English
Because the destructions of death surrounded me and the torrents of evil ones troubled me.
GOD'S WORD® Translation
The ropes of death had become tangled around me. The torrents of destruction had overwhelmed me.
JPS Tanakh 1917
The cords of Death compassed me, And the floods of Belial assailed me.
New American Standard 1977
The cords of death encompassed me, And the torrents of ungodliness terrified me.
Jubilee Bible 2000
The pain of death compassed me, and the rivers of Belial made me afraid.
King James 2000 Bible
The sorrows of death surrounded me, and the floods of ungodly men made me afraid.
American King James Version
The sorrows of death compassed me, and the floods of ungodly men made me afraid.
American Standard Version
The cords of death compassed me, And the floods of ungodliness made me afraid.
Douay-Rheims Bible
The sorrows of death surrounded me: and the torrents of iniquity troubled me.
Darby Bible Translation
The bands of death encompassed me, and torrents of Belial made me afraid.
English Revised Version
The cords of death compassed me, and the floods of ungodliness made me afraid.
Webster's Bible Translation
The sorrows of death compassed me, and the floods of ungodly men made me afraid.
World English Bible
The cords of death surrounded me. The floods of ungodliness made me afraid.
Young's Literal Translation
Compassed me have cords of death, And streams of the worthless make me afraid.
Study BibleThe LORD is My Rock
…3I will call upon the LORD, who is worthy to be praised; so shall I be saved from my enemies. 4The ropes of death entangled me; the torrents of chaos overwhelmed me. 5The cords of Sheol entangled me; the snares of death confronted me.…
Cross References
Luke 21:20
But when you see Jerusalem surrounded by armies, you will know that her desolation is near.
Psalm 55:4
My heart murmurs within me, and the terrors of death assail me.
Psalm 69:2
I have sunk into the miry depths, where there is no footing; I have drifted into deep waters, where the flood engulfs me.
Psalm 116:3
The ropes of death entangled me, and the anguish of Sheol overcame me; I was confronted by trouble and sorrow.
Psalm 124:3
when their anger flared against us, then they would have swallowed us alive,
Psalm 124:4
then the floods would have engulfed us, the torrent would have overwhelmed us,
Isaiah 17:12
Alas, the tumult of many peoples--they rage like the roaring seas; the uproar of the nations--they rumble like the crashing of mighty waters.
Jeremiah 51:55
For the LORD will destroy Babylon; He will silence her mighty voice. The waves will roar like great waters; the tumult of their voice will resound.
Jonah 2:2
saying: "In my distress I called to the LORD and He answered me. From the belly of Sheol I called for help, and You heard my voice.
Treasury of Scripture
The sorrows of death compassed me, and the floods of ungodly men made me afraid.
Psalm 116:3 The sorrows of death compassed me, and the pains of hell got hold …
2 Samuel 22:5,6 When the waves of death compassed me, the floods of ungodly men made …
Isaiah 13:8 And they shall be afraid: pangs and sorrows shall take hold of them; …
Isaiah 53:3,4 He is despised and rejected of men; a man of sorrows, and acquainted …
Matthew 26:38,39 Then said he to them, My soul is exceeding sorrowful, even to death: …
Mark 14:33,34 And he takes with him Peter and James and John, and began to be sore …
2 Corinthians 1:9 But we had the sentence of death in ourselves, that we should not …
Psalm 22:12,13,16 Many bulls have compassed me: strong bulls of Bashan have beset me round…
Jonah 2:2-7 And said, I cried by reason of my affliction to the LORD, and he …
Matthew 26:47,55 And while he yet spoke, see, Judas, one of the twelve, came, and …
Matthew 27:24,25,39-44 When Pilate saw that he could prevail nothing, but that rather a …
Acts 21:30 And all the city was moved, and the people ran together: and they …
ungodly men [Heb.] belial
The sorrows of death.--The Hebrew word may mean either birth pangs (LXX. and Acts 2:24, where see Note, New Testament Commentary), or cords. The figure of the hunter in the next verse, "the snares of death," determines its meaning there to be cords (see margin). It is best, therefore, to keep the same rendering here: but there can be little doubt that the version in Samuel, breakers, or waves, is the true one, from the parallelism--
"Waves of death compassed me,
And billows of Belial terrified me."
For Belial, see Deuteronomy 13:13. Here the parallelism fixes its meaning, "ruin." For the ideas of peril and destruction, connected by the Hebrews with waves and floods, comp. Psalm 18:16, also Psalm 32:6; Psalm 42:7; Psalm 69:1. Doubtless the tradition of the Flood and of the Red Sea helped to strengthen the apprehensions natural in a country where the river annually overflowed its banks. and where a dry ravine might at any moment become a dangerous flood. The hatred of the sea arose from quite another cause--viz., the dread of it as a highway for invasion.Verse 4. - The sorrows of death compassed me. Here begins the narrative of David's sufferings in the past. "'The sorrows' - or rather, 'the cords' - of death," he says, "encompassed me," or "coiled around me" (Kay). Death is represented as a hunter, who goes out with nets and cords, encompassing his victims and driving them into the toils. David's recollection is probably of the time when he was "hunted upon the mountains" by Saul (1 Samuel 26:20), and expected continually to be caught and put to death (1 Samuel 19:1; 1 Samuel 23:15; 1 Samuel 27:1). And the floods of ungodlymen made me afraid; literally, the torrents of Belial, or of ungodliness. The LXX. have χείμαῥῤοι, ἀνομίας. Streams of ungodly men, the myrmidons of Saul, cut him off from escape. Psalm 18:5, as they respect David, show the snares that were laid for his life, the danger of death he was in, and the anxiety of mind he was possessed of on account of it; and as they refer to Christ, include all the sorrows of his life to the time of his death, who was a man of sorrows and acquainted with grief personally, and bore and carried the sorrows and griefs of all his people; and may chiefly intend his sorrows in the garden, arising from a view of the sins of his people, which he was about to bear upon the cross; and from an apprehension of the wrath of God, and curse of the law, which he was going to sustain for them, when his soul was encompassed about with sorrow, even unto death, Matthew 26:38; when his sorrow was so great, and lay so heavy upon him, that it almost pressed him down to death, he could scarce live under it; and may also take in the very pains and agonies of death; he dying the death of the cross, which was a very painful and excruciating one; see Psalm 22:14; The Hebrew word for "sorrows" signifies the pains and birth throes of a woman in travail; and is here fitly used of the sufferings and death of Christ; through which he brought forth much fruit, or many sons to glory. The Targum is,
"distress has encompassed me, as a woman that sits upon the stool, and has no strength to bring forth, and is in danger of dying.''
In 2 Samuel 22:5, it is "the waves" or "breakers of death compassed me"; and the word there used is rendered in Hosea 13:13; "the breaking forth of children"; moreover the same word signifies "cords" (r), as well as pains and sorrows; and the allusion may be to malefactors being bound with cords when led to execution, and put to death; and may here signify the power of death, under which the Messiah was held for a while, but was loosed from it at his resurrection; to which sense of the word, and to the words here, the Apostle Peter manifestly refers, Acts 2:24;
and the floods of ungodly men made me afraid; meaning either the multitude of them, as Herod, Pontius Pilate, the Roman soldiers, and people of the Jews, who all gathered together against him; so the Targum renders it, "a company of wicked men"; or the variety of sufferings he endured by them; as spitting upon, buffering, scourging, &c. The word rendered "ungodly men is Belial"; and signifies vain, worthless, and unprofitable men; men of no figure or account; or lawless ones, such as have cast off the yoke of the law, are not subject to it; persons very wicked and profligate. The word in the New Testament seems to be used for Satan, 2 Corinthians 6:15; where it is so rendered in the Syriac version, and he may be designed here; and by the floods of Belial may be meant, not so much the temptations of Satan in the wilderness, as his violent and impetuous attacks upon Christ in the garden, when being in an agony or conflict with him, his sweat was, as it were, great drops of blood, Luke 22:44. The Septuagint render the word, "the torrents of iniquity troubled me"; which was true of Christ, when all the sins of his people came flowing in upon him, like mighty torrents, from all quarters; when God laid on him the iniquity of them all, and he was made sin for them; and in a view of all this "he began to be sore amazed", Mark 14:33; compare with this Psalm 69:1. Arama interprets Belial of the evil imagination in David, who had a war in himself.
(r) "funes mortis", Musculus, Montanus, Vatablus, Gejerus, Michaelis; so Ainsworth, Hammond.
5 The sorrows of hell compassed me about: the snares of death prevented me.
6 In my distress I called upon the Lord, and cried unto my God he heard my voice out of his temple, and my cry came before him, even into his ears.
7 Then the earth shook and trembled; the foundations also of the hills moved and were shaken, because he was wroth.
8 There went up a smoke out of his nostrils, and fire out of his mouth devoured: coals were kindled by it.
9 He bowed the heavens also, and came down and darkness was under his feet.
10 And he rode upon a cherub, and did fly yea, he did fly upon the wings of the wind.
11 He made darkness his secret place; his pavilion round about him were dark waters and thick clouds of the skies.
12 At the brightness that was before him his thick clouds passed, hail stones and coals of fire.
13 The Lord also thundered in the heavens, and the Highest gave his voice; hail stones and coals of fire.
14 Yea, he sent out his arrows, and scattered them; and he shot out lightnings, and discomfited them.
15 Then the channels of waters were seen, and the foundations of the world were discovered at thy rebuke, O Lord, at the blast of the breath of thy nostrils.
16 He sent from above, he took me, he drew me out of many waters.
17 He delivered me from my strong enemy, and from them which hated me: for they were too strong for me.
floods—denotes "multitude."
Jump to PreviousAfraid Assailed Bands Belial Compassed Cords Death Destruction Encompassed Entangled Evil Fear Floods Overwhelmed Perdition Round Seas Sorrows Streams Surrounded Terrified Torrents Ungodliness Ungodly Worthless
Jump to NextAfraid Assailed Bands Belial Compassed Cords Death Destruction Encompassed Entangled Evil Fear Floods Overwhelmed Perdition Round Seas Sorrows Streams Surrounded Terrified Torrents Ungodliness Ungodly Worthless
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Alphabetical: And cords death destruction encompassed entangled me of overwhelmed terrified The torrents ungodliness
OT Poetry: Psalm 18:4 The cords of death surrounded me (Psalm Ps Psa.) Christian Bible Study Resources, Dictionary, Concordance and Search Tools


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Get a snapshot of upcoming events: spring Esri Canada User Conferences, Insights for ArcGIS webinar, ArcGIS 3: Performing Analysis course and much more.
Insights for ArcGIS: Understanding Spatial and Tabular Data
March 9, 1 – 2 pm (ET)
Insights for ArcGIS revolutionizes the way GIS and non-GIS users analyze data with maps. In this webinar, we'll show how, with a simple drag-and-drop technique, you can gain useful insights into your data. You will also learn how data is accessed through cards to create maps, charts, graphics and tables that are all interconnected and can be easily synchronized. Finally, we'll show you how to leverage powerful point in polygon aggregation analysis and filtering data for a targeted community.
ArcGIS for Developers: Choosing the Right Approach
April 20, 1 – 2 pm (ET)
Cost-effectively delivering the best experience and functionality for the audience of their app is an important goal for GIS developers and their managers. This webinar will help developers and managers level up their knowledge of the ArcGIS SDKs and APIs. We'll compare native versus web strategies, look at what ArcGIS capabilities are offered, identify which SDKs offer cross-platform development and provide some clarity on licensing scenarios.
Esri Canada User Conferences
London User Conference
London, ON
April 4 – Four Points by Sheraton
Thunder Bay User Conference
Thunder Bay, ON
April 12 – Valhalla Inn
Québec City User Conference
Québec City, QC
April 19 – Centre des congrès de Québec
Winnipeg User Conference
Winnipeg, MB
April 25 – Fort Garry Winnipeg
Victoria User Conference
Victoria, BC
May 10 – Victoria Conference Centre
Calgary User Conference
Calgary, AB
May 17 – BMO Centre
Kelowna User Conference
Kelowna, BC
June 6 – Coast Capri
As some of Canada's most important annual events for the GIS community, Esri Canada User Conferences provide you an opportunity to discover exciting new developments about Esri's GIS solutions and network with your peers. Check out photos from the 2016 Esri Canada UCs and access the proceedings.
Conferences & Tradeshows
The National Surveyors' Conference
Ottawa, ON
March 1-2 – Shaw Centre
Esri Partner Conference
Palm Springs, CA
March 4-6 – Palm Springs Convention Center
Prospectors & Developers Association of Canada (PDAC) 2017
Toronto, ON
March 5-8 – Metro Toronto Convention Centre
GIS CAMA Technologies Conference
Chattanooga, TN
March 6-8 – Chattanooga Convention Centre
Esri Developer Summit
Palm Springs, CA
March 7-10 – Palm Springs Convention Center
Esri User Conference
San Diego, CA
July 10-14 – San Diego Convention Centre
ArcGIS 3: Performing Analysis
This course teaches a standard workflow that you can apply to any spatial analysis project. Working with a variety of ArcGIS tools and data, you will perform different types of analyses to efficiently create reliable results that support informed decision-making. This course is taught using ArcGIS Desktop Advanced, and some course exercises use tools provided in the ArcGIS Spatial Analyst extension.
ArcGIS 4: Sharing Content on the Web
This course prepares you to share geographic content, so it is accessible to everyone who needs it, when they need it and however they want to access it. You will learn ArcGIS best practices to publish your organization's authoritative GIS data, maps and tools as services that can be discovered on your organization's public or private ArcGIS portal, easily accessed from desktop and online applications and featured in web and mobile apps.
Deploying Portal for ArcGIS
Learn best practices to deploy Portal for ArcGIS to meet your organization's need for private, secure geospatial content sharing. This course introduces the architectural and security models that support Web GIS workflows. You will learn how to configure Portal for ArcGIS and its supporting GIS service and data-hosting components to enable a complete Web GIS in your infrastructure.
About the Author
Anneliese Sanghara is a Marketing Communications Coordinator with Esri Canada. As part of this role, she reviews and develops content for the company's various marketing channels and provides support for several communications programs. Along with her Honours Bachelor of Arts from the University of Toronto, Anneliese attained a Master of Professional Communication from Ryerson University. Her many teachers and mentors sparked her passion for strategy, writing and design. In her spare time, Anneliese enjoys exploring the city, honing her culinary skills and volunteering.More Content by Anneliese Sanghara


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This post is especially for my young readers. To grow up into the leader you want to be, you need to remember the two S's of character – Selflessness and Sacrifice. Before going into more about this, there are many levels of progression into leadership:
1) Competence: You need to be able to do a task competently. This is where all you skills come into play and all the learning matters.
2) Teaching: Ideally anyone can be trained to do a task competently. With proper education and training, this is possible. However, leaders tend to be great teachers. Teach a man to fish and he will have dinner for life – as the saying goes.
3) Enablement: The next step in leadership is enablement. You want to be an enabler – make possible others to do the tasks. Give them the right tools and environment. Give them a few teachers.
4) Motivating: After enabling, you need to be good at motivating others to do what they need to do. It isn't enough to enable someone and let them be de-motivated. I think this is where President Obama is shines. In his inaugural speech, he said 'Remember, you are remembered by what you build, but not by what you destroyed' – a clear message to the terrorists.
5) The last rung is leading by example. Do all the above with the two S's – Selflessness and Sacrifice. It is because of the two Ss that America is what it is today. Many founding fathers gave away vast amounts of lands to the Government and their wealth to others. You have to recognize and understand what the two Ss are in a situation and these need to come from unconditionally. Read about William Penn, the founder of the state of Pennsylvania.


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Surgeons: how would you like every move of the surgeries you perform recorded with a "black box" type device? Such a device would make a record of every movement during a surgery, and potentially, provide real-time feedback to identify mistakes. Not … Continue reading
Tag Archives: medical malpractice
No Sweeping Under the RugPosted in Health Care Law, Litigation Tips, Medical Malpractice, Risk Management, Tort Reform
It happed in California several weeks ago. After 2 ½ days of jury deliberation, the jury awarded a $4 million verdict against a hospital for allegedly covering up the cause of the post-operative death of a patient. The jury did … Continue reading
Florida throws out caps in med mal casesPosted in Health Care Law, Litigation Tips, Medical Malpractice, Nebraska Hospital-Medical Liability Act, Tort Reform
It's time for my somewhat regular update regarding the latest state to address the constitutionality of caps on damages in medical malpractice lawsuits. Previously, I have discussed Kansas and Missouri and their judicial treatment of such caps. In its recent … Continue reading
Expanding Physician-Patient ConfidentialityPosted in HIPAA, Litigation Tips, Medical Malpractice, Risk Management
On December 20, 2012, the Florida Supreme Court expanded the already far reaching scope of doctor-patient confidentiality. In the case of Hasan v. Garvar, 2012 WL 6619334 (Fla.), a patient sued a dentist (referred to as Dentist #1 for purposes of … Continue reading
Kansas: 1 Missouri: 0. The score on the constitutionality of non-economic damage capsPosted in Litigation Tips, Medical Malpractice, Tort Reform
Kansas recently became the eighteenth state to hold that statutory caps on non-economic damages are constitutional. The court in Miller v. Johnson, No. 99,818 (Kan. Oct. 5, 2012) held that a Kansas statute did not violate the plaintiff's right to a … Continue reading
Issues with high-low agreements in the medical malpractice contextPosted in Litigation Tips, Medical Malpractice, Risk Management
Should a high-low agreement waive the right to appeal? Waiving the right to appeal, and the finality that this brings, is a potential benefit. However, giving up the right to challenge any error or impropriety in the proceedings has its … Continue reading
The Failure to Pass Board Examinations as Evidence in a Medical Malpractice TrialPosted in Litigation Tips, Medical Malpractice
So, you didn't pass your medical boards? Or you didn't pass your medical boards on your first try? Worried how it might affect your career as a physician? Well, you can rest easy when it comes to malpractice suits. Generally, … Continue reading
Falling on Your Scalpel: Admitting Fault in Medical MalpracticePosted in Litigation Tips, Medical Malpractice, Risk Management
In a previous post, I discussed the potential use of an apology to head off medical malpractice litigation. In this post, I will discuss situations where a complete admission of fault may help bring about a more favorable outcome in … Continue reading
What is Malpractice?Posted in Litigation Tips, Medical Malpractice
What constitutes "malpractice?" If a patient slips and falls while at the doctor's office, does that implicate professional negligence? Generally speaking, malpractice is defined as treatment by a doctor in a manner contrary to accepted standards of care which results in … Continue reading


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The plan:
* This is planned to be a fun ride enjoying the beautiful ocean and coastline we are blessed with. We are staying a minimum of 1/4 mile offshore, as is required by the city of Malibu. If you are worried about running out of gas with a Super Charged PWC, it is suggested you don't go WOT! I have done this many times on my 2012 Seadoo RXP-X take it easy just in case we go farther than Malibu.
**Bring $10 cash for launch fee!**
13477 Fiji Way
Marina del Rey, CA 90292
310 305-9546
* Following the coast hugging ride plan above here are the miles calculated old-school, off of a paper map from MDR breakwater:
- To Malibu Pier 14.5 total miles (29 miles round trip).
- To the Paradise Cove Pier 21 total miles (42 miles round trip).
- To Point Dume 23 total miles (46 miles round trip).
- To Zuma Beach, 25 total miles (50 miles round trip)
* Look at the above mileage and plan for how far you want to go, knowing the fuel capacity of your PWCs. Or bring extra gas!
* Skis in the water 8:30 AM
* Leave at 9:00 AM, head to Malibu
* Forecast High of 72 degrees F, partly cloudy at launch, Wind: WSW at 8 mph,
* Head back to Marina Del Rey to fuel up if lunch is in Redondo Beach
* Lunch = TBD.
During the ride general items:
* All riders must meet before hand to discuss the ride plan and to take a club photo.
* Periodic stops planned for Santa Monica Pier, Topanga, Malibu Pier. At this point we will decide for a go, no-go for further points.
* We always watch out for each other which means we look behind us occasionally. No one is ever left behind.
* People who do want to go WOT or those in race training, you can form a separate group
* People with Marine Radios, we will establish a channel and test before we hit the water


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Transportation Fee Update:
If you have not yet payed the transportation fee, please write a check made out to Esperanza High School for $145.00 and place it in the everything box. (Please include the student's name with the check.) These fees are due to the school no later than Sept 20th so please place your checks in the everything box by September 19th so Mr. Davis can get them to the school office before the deadline.
From Principal Kenneth Fox regarding transportation fees
Dear Parent:
As you are aware, the Placentia-Yorba Linda Unified School District has established transportation fees for those students who use the bus to travel to and from extra-curricular activities. The transportation fee is necessary to continue with our existing programs.
There has been much discussion about what the fees are to be and the following explains how they are established. There are two known transportation costs, cost for the bus itself and cost for the driver. These costs may vary between sports, based upon the distance traveled, frequency of events and the number of hours a bus remains at an activity. An example of this is the band participating at a field show in Palm Springs in which the bus departs at 7:00 a.m. and returns at 10:00 p.m. vs. the football team traveling to Los Alamitos at 6:00 p.m. and returning at 10:00 p.m. Another example of varying costs is the number of events which require transportation. For example, baseball plays three rounds in our league and travels much more than cross country which participates in a single round.
The individual fee for a sport or activity was determined by taking the cost of transportation for a given activity and dividing that cost among the number of participants in the activity. This gave us the cost per student to pay for transportation. Please note that we have small teams travel together whenever possible, in the hope of filling each bus to near capacity, which helps minimize transportation costs.
The decision to ride the bus or find another source of transportation belongs to each family. The parents have the option of providing transportation for their son or daughter to each away event if they so choose. If this option is used, the student will not be allowed to travel by bus with the team or group. I would encourage you to use the bus as it is the safest possible means of transportation for students, while helping to build group camaraderie. If you choose alternate ways of transporting your student, please return the DMV/Risk Management School Driver form.
Finally, before any student is cleared to participate in the band, choir, pepsters or athletics, they must pay the transportation fee or have a waiver form completed by a parent indicating they will transport their child to all away events. Waiver forms are located in the finance office or athletic office.
Please make checks payable to Esperanza High School and turn in to the Athletic Office room 759 with the Esperanza student ID card to Midge Martinez. Please do not turn payment into booster club. Due date for transportation fees are – September 20th for the fall season; November 15 th for winter sports and March 13, 2011 for spring sports.
If your have any questions about transportation fees, please feel free to call and I will discuss them with you.
Kenneth C. Fox
Kenneth C. Fox, Ed.D.
Band Fees: $145
Complete word document attached.


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Milo Yiannopoulos' event at UC Irvine last evening was oversubscribed, leading to "over 1,000" people being turned away, according to the Breitbart Tech editor.
Over 1,000 people turned away tonight. So sorry I wasn't allowed to say hi. The hundreds (!) of police did an amazing job. Thank you!
— Milo Yiannopoulos ✘ (@Nero) June 3, 2016
However, plenty of Milo fans nonetheless gathered outside the venue, where they engaged in chanting competitions with left-wing protesters.
Protestors at UCI outside while
Milo Yiannopoulos speaks inside to a packed house. pic.twitter.com/TbHu6HcmDE
— Stacey butler (@StaceyCBS) June 3, 2016
Milo fans chanted "get a job" and "USA! USA!" at the protesters, who in turn shouted "shame on you!" at attendees as they exited the Milo speaking event.
Outside @Nero event @UCIrvine @bakedalaska pic.twitter.com/iRKi3OHR95
— Joe Biggs (@Rambobiggs) June 3, 2016
Protests as people leave #ucirvine #milo pic.twitter.com/b0DSAMGImz
— Alexandra Mateo (@ancmateo) June 3, 2016
One particularly agitated protester had to be physically held back by classmates.
At the Milo event at UC Irvine pic.twitter.com/GR2gmpxc5w
— ♿ Robert McDougal (@mcdougalbugle) June 3, 2016
At some point, protesters became preoccupied with the Israeli-Palestinian conflict, chanting "Long live the Intifada!" and "free Palestine!" Their opponents, separated from the protesters by lines of heavily armed policemen, responded by waving an Israeli flag.
#milo #ucirvine pic.twitter.com/bcb7H7HuUl
— Alexandra Mateo (@ancmateo) June 3, 2016
Protestors gather at UCI where the controversial
Milo Yiannopoulos will speak pic.twitter.com/1quHYIrMyG
— Stacey butler (@StaceyCBS) June 3, 2016
Milo's full talk at UC Irvine can be watched below:
You can follow Allum Bokhari on Twitter, add him on Facebook. Email tips and suggestions to email@example.com


text: Regardless of their circumstances, at times parents find raising children challenging. There are a range of different parenting support services that may be able to help you and your family. Page Content Maternal and Child Health Line The MCH Line - 13 22 29 - is available every day of the year for Victorian families with children from birth to school age. Playgroups Playgroups and parent groups give you an opportunity to develop friendships and share experiences with other parents in your local area.


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I've been quite the hermit. I didn't leave the house much since late October last year… and only recently did I feel comfortable enough to leave the house to go shopping with the baby. Of course I'd go out once in a while, but no more than once a week. I mean, I'm used to going out every day. LOL! I have been reading about new offerings and I've been curious about the Rouge Dior Baume. I heard that it replaces Serum de Rouge but I'm not 100% sure. Is this true? Man, I really liked those Serum de Rouge. They were really good. Anyway, I decided to give this Rouge Dior Baume (RM102) a try, and I picked the shade 760 Garden Party.
Garden Party is a sheer natural rosy red on me. It makes my lips look a little redder, a little darker, but still natural. The packaging reminds me of Chanel Coco Shines but this Dior one, in my opinion, is a little more pigmented and less slippery. Compared to the Serum de Rouge, this feels the same. The only difference is that Garden Party is sheerer. I tried on a few other shades as well, and I think they all run sheer. The Serum de Rouge however, was much more pigmented. The Rouge Baume feels like a light lip balm. It is not as thick as the Dior Addict Lip Glow and when layered, it doesn't feel heavy either. The balmy texture is very forgiving on the lips, and I find that it conditions and moisturizes my lips as well. It doesn't wear very long though – probably 3 hours at best and it definitely needs reapplying after a meal.
The Rouge Dior Baume is unscented. I can however smell something after taking in a very deep breath with my nose literally a millimeter away from the lipstick. To me, it means unscented. The "CD" on the bullet doesn't last 2 applications, in case you're curious. Here is how it looks on me, with clean skin and bright eyes. The bullet of the lipstick looks much deeper doesn't it? Here, you see a wash of colour but I applied 2 layers of Garden Party on my lips.
With the prices of beauty products going up, I don't know how much more people are willing to pay for a lipstick. If you want to ask me if there's anything better or the same in a lower price range, well, my answer is, I don't know. I bought this because Dior is a brand I'm comfortable with, and this is something I've been wanting to try. I also know some people have the worst experience with this brand, so really, to each her own. I can't tell you to run and go get this because it's not out of this world and it's not unique. However, I'm pretty happy with this, and have been wearing it regularly.
xoxo Lily


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Subprime Mortgage, Mortgage Loans for Less Than Perfect Credit
Do you have less than perfect credit? If you have credit problems, or bad credit, we can help.
A subprime loan is perfect for you if you have had problems financing a home loan due to your bad credit history.
Interest rates are lower than they have been in nearly 40 years, but this can not last forever. Even though
subprime loans
may have slightly higher rates, now is the time to buy! Don't throw your money away by paying rent. Getting a mortgage is one good way of getting your credit history back on track. Don't let your credit past ruin your future. Stop wasting time, find out what you qualify for today by getting a free quote now.
Get a Free, Subprime Mortgage Loan Quote Now!
Q. How do I get a free quote?
A. Just fill out our 2 minute "
Mortgage Quotes
" form and get matched with up to 10 lenders who can provide you a free quote based on your specific needs.
Q. How soon will I be contacted by a lender or broker?
A. As soon as you select and submit the lenders or brokers whom you want a quote from, you should instantly get a confirmation email with a list of these lenders' contact information. You can immediately follow up on your request for a quote or wait for them to respond. The lenders and brokers work differently but you should expect a response from them via email or phone within 24 hours.
Q. What do I do once I get a quote?
A. Depending on the quantity of lenders or brokers you chose to get a quote from, you should compare from these quotes and choose which loans have the best terms and rates that will maximize your savings. Let the lenders compete! Follow up with the lender or broker that has the best loan offer.
Mortgage quotes and services provided to you FREE and at NO OBLIGATION.
Exclusive access to our network of over 10,000 lenders and brokers nationwide.
Get a better rate, lower monthly payments, save money, get cash in your wallet.
Select from instant result matches with up to 10 competing lenders.
Private and secure networks to ensure confidentiality.
More about:
Home Equity
New Home Purchase
Less Than Perfect Credit
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is the 100% advertiser supported loan search engine. We are not a lender or broker. When you choose to inquire with a lender or broker who advertises on Loan Links, your information remains between you and that lender(s). Advertisers are solely responsible for keeping their information current.
LoanLinks.com is an
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Mortgage Quotes From Lenders Near You:
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Loan Links - home equity loans, mortgage quotes, home loans, mortgage rates, refinancing loan.
Subprime mortgage and loan quotes for less than perfect credit
from competing lenders available at no cost.


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- Home
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- About
1Windows Developer is an independent website and is not affiliated with, nor has it been authorized, sponsored, or otherwise approved by Microsoft Corporation.
2Microsoft, Silverlight, .NET, Windows Phone and Windows are either registered trademarks or trademarks of Microsoft Corporation in the United States and/or other countries.
3All the information on this website is published in good faith and for general information purpose only. No warranties are given about the completeness, reliability and accuracy of this information. Any action you take upon the information in this website is strictly at your own risk and we will not be liable for any losses and damages in connection with the use of this website.
Kevin Harris (Homer, IL) © June 2013


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- Microblogging on our Facebook page too. Stop by and visit there.
To subscribe by email or in a feed reader click click here.
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Tag Archives: yuk
Yuk and Yay
YUK! I had to go to the VET. I do not like it there. YAY he said I should get more stinky goodness! Maybe Dr. Z. isn't all that bad for a torturer vet.
Posted in My Pet Cats, The Hotties Cats Tagged Miss Mini, vet, yay, yuk 16 Comments


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Forensic accounting – You can rely on our expertise
The adjective forensic comes from the Latin word forensis, meaning "in open court" or "public". Forensic accounting usually relates to finding evidence to solve a crime, or related to the courts or legal system. It could also apply if you are seeking a forensic advantage, especially if there is a legal dispute.
We use our experience as forensic accountants to help investigate financial misrepresentations and even fraudulent activity.
Furthermore any forensic accounting work we carry out enables our clients, and their lawyers, insurance companies and other institutions, to resolve disputes.
At Wellden Turnbull we feel it is important to be able communicate financial information clearly. A number of our staff are trained to look beyond the numbers, and deal with the business realities of situation. That's where our experience as forensic accountants comes in.
As forensic accountants we will analyse, interpret and then summarise complex financial and business related issues clearly. Our experience and expertise in this area is second to none.
Some forensic accounting areas that we will assist you with:
- Investigating and analysing financial evidence.
- Matters relating to HMRC and tax investigations
- Assistance in professional negligence claims.
- Assisting in the analysis and presentation of financial evidence.
- Communicating our findings in the form of exhibits and reports.
- Assisting in legal proceedings, including testifying in court as an expert witness.
- We can also assist with matrimonial disputes, providing forensic analysis where required.
So whatever the circumstances we will provide superb forensic accounting and auditing expertise. We will ensure that you have the best possible forensic support. As with the other areas of assistance we provide such as Business, Personal and International Services we maintain the highest possible professional standards, as our clients will testify. For more information on forensic accounting, take a look at out FAQs.
Why not contact us on firstname.lastname@example.com, or better still call us on 01932 868 444, for your complimentary 'no obligation' meeting with one of our Partners. With offices in London and Surrey, we assist businesses across the south east.


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307P - Risk factors of trastuzumab induced cardiotoxicity in HER2-positive early breast cancer
|29 September 2014
|Poster Display session
| Anti-Cancer Agents & Biologic Therapy
Breast Cancer, Early Stage
Complications of Treatment
|Mehmet Sendur
|Annals of Oncology (2014) 25 (suppl_4): iv85-iv109. 10.1093/annonc/mdu327
M.A. Sendur1, S. Aksoy2, H. Yorgun3, N. Ozdemir1, F.M. Yilmaz4, O. Yazici5, C. Zungun4, K. Aytemir3, N. Zengin1, M.K. Altundag2
Trastuzumab induced cardiotoxicity (TIC) was defined as the most serious side effect of trastuzumab. In this study, we aimed to define risk factors of adjuvant 9-weeks and 52-weeks trastuzumab therapies of HER2-positive breast cancer.
Patients who completed 9 or 52-weeks adjuvant trastuzumab in HER2 positive breast cancer were included to the study. A total of 164 patients were included to this study; 108 and 56 patients were treated with 9-weeks and 52-weeks trastuzumab, respectively. The demographic characteristics and echocardiographic measurements of all patients enrolled in the study were recorded. Echocardiographic measurements were made at baseline and every 3 cycles during trastuzumab.
The median follow-up of our study was 32 (10-95) months. Symptomatic heart failure was not observed during trastuzumab treatment in both 9-weeks and 52-weeks trastuzumab groups. Asymptomatic LVEF decline was observed in 19 (11.5%) during trastuzumab treatment. In 7 patients of 52-weeks trastuzumab treatment group, mean LVEF values were decreased below 50% and all of them were treated with heart failure medications. In 52-weeks treatment group 5 patients failed to complete 52-weeks trastuzumab. The mean trastuzumab dose was 49.7 week in 52-weeks arms. According to the risk factor analyses, no association was found between TIC and hypertension (P = 0.54), hyperlipidemia (P = 0.69), diabetes (P = 0.59), obesity (P = 0.79), total anthracycline dose (P = 0.68) and family history of coronary artery disease (P = 0.68). Despite the risk of TIC was increased with advanced age (>50 year) (P = 0.08) and with combination taxane and anthracycline regimens (P = 0.07), this risk was not significant. But the risk of TIC was increase with the longer duration (1.9% and 30.3% in 9-weeks and 52-weeks trastuzumab treatment groups, respectively; P < 0.001).
In our study, no risk factor association was found between hypertension, hyperlipidemia, diabetes, obesity and total anthracycline dose and the risk TIC. But the risk of TIC was increased non-significantly with advanced age (≥ 50 year) and with combination taxane and anthracycline regimens. The main risk factor of TIC was longer duration usage of trastuzumab in our study like trials of longer duration usage of trastuzumab in HERA and PHARE trials.
All authors have declared no conflicts of interest.


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Beds: 14 | Baths: 14 | Sleeps: 28 Swimming Pool: Yes | Distance to Beach: 5 km
Situated in the heart of Bangsaray, we have this unique 14-bedroom villa mini-resort, which offers options for up to 42 guests (32 guests are included in the rate and for another 10 guests will be an additional 500 Bath charge per guest and night) with a large swimming pool, clubhouse with restaurant and kid's play areas. The resort can only be booked as a whole, but offers an amazing option for large groups.
Todays Price
(per Night)


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If you have access to the internet then you also have access to a whole host of ways to earn money online. This handy tool can be your path to a whole lot of cash and we're here to tell you how.
Buy and Sell
There's a great market out there for buying and selling items, you just have to be able to pick out the best ones. EBay auctions and sales are excellent ways to pick up items cheaply and then resell them at a better price.
If you're a crafty sort of person then you can even add value to the items that you buy. Fixing up old items or upcycling them can allow you to put your own unique twist on them. Just a little paint or fabric can really transform a piece and make it worth so much more. Keep your eyes peeled for anyone throwing away old items that you could work your magic on.
Write a Blog
Writing your own blog can be a viable way to earn some advertising bucks. There are a couple of avenues that you can go down; selling advertising space or accepting sponsored posts. Both are pretty easy to set up and maintain, though finding sponsors can require a bit more interaction.
The most important thing to bear in mind while attempting to make money off your blog is that it should be good. If it doesn't have value or just copies the ideas of another site then you won't be able to attract as many visitors or sponsors.
Take time when setting up your blog to pick a niche that you can feasibly write about regularly. Popular blogs include ones on fitness, general lifestyle, nutrition, parenting and gaming.
Play Free Bingo Games
Certain bingo sites offer free bingo games that you can play to win real money. There are games out there that can allow you to win real money without spending any of your own cash. Look for games that specify that you can win real money, as some will only pay out bonus funds instead… Rocket Bingo is one such example of a brand that pays out in real cash on most of its free games.
Even if you choose to spend a bit of money with a site, you can make some good returns. Of course, it's all down to luck on whether you win that jackpot or not, so you'll just need to keep those fingers crossed.
Offer up your Knowledge
If there's a topic that you know a lot about then the chances are that there's someone out there who wants to learn about it too. Providing tutoring or consulting on a project can make you a lot of money, if you know your stuff. There are lots of job boards for those looking for freelance work in a variety of industries.
Be sure to do some research into the going rate of what you're offering, as you don't want to be selling your skills too cheaply or price yourself out of the market. No matter what you're good at, you will most likely find someone seeking those services. Translation work, project planning and tutoring are great ways to make the most of your skills.
Provide your Opinion
Companies will often pay good money for you to give your opinion. Paid surveys and polls are quite common, there are even sites that you can use to find the best ones. The sums that you get from these can be on the smaller side, but if you spend enough time completing them then you can earn a decent amount.
There are also other incentives on offer from some sites, like products to test or freebies. These can be nice added bonuses on top of your income, so be sure to watch out for products that you like the look of. It's a good idea to set up an email address solely for the purpose of survey based communication, as your inbox can very quickly be flooded by these companies.
These are just some of the options that you have available to you if you want to make money online. The most important part is to find one of these methods that appeals to you.


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Order Hotline
1300 304 607
Disk recorder that captures uncompressed 10 bit SDI or HDMI video onto Solid State Disks (SSDs). HyperDeck 2.5 Software Update public beta is available to download free of charge now!
Introducing the world's most exciting portable broadcast deck that fits in your hand. Get the highest quality compressed and uncompressed video! Dramatically improve the quality of professional or consumer cameras! HyperDeck Shuttle records and plays back uncompressed QuickTime, and Apple ProRes 422 (HQ) or Avid DNxHD MXF files to common low cost SSDs so you can edit direct from the recorded files!
Go Anywhere, Record Everywhere!
With a compact and incredibly sturdy design, HyperDeck Shuttle is machined out of a solid block of aircraft grade aluminum! That means you get a design with the strength to go anywhere! Take your HyperDeck Shuttle into the field, on set, to live events, or even on your extreme sport shoots. With an internal battery, just recharge and go! The possibilities are virtually endless! There's no need to haul around a computer because the lightweight HyperDeck Shuttle does it all, yet fits easily in your backpack! You can even add HyperDeck Shuttle to your tripod along with your camera!
Solid State Disk (SSD) TechnologySimply plug a 2.5" solid state disk into HyperDeck Shuttle and you get video recording with blazing fast speed, low power consumption and totally silent operation. Now you can eliminate complicated and expensive disk arrays. A single SSD can record either compressed or uncompressed video effortlessly! Removable media like CF and SxS cards simply cannot match that kind of performance and require slow file copying to use. With no moving parts, SSDs are extremely robust and you can edit direct from the disk. Only SSDs can easily handle shocks and vibrations that would destroy conventional hard drives or videotapes.
Unparalleled File Compatibility
HyperDeck Shuttle captures the world's most popular video files in native uncompressed 10-bit QuickTime and compressed Apple ProRes 422 (HQ) or Avid DNxHD MXF files. Recording straight to ProRes or DNxHD is perfect for working with the full Avid Media Composer family of software including NewsCutter and Symphony. There is no need to reformat or transcode your files, so you get the most efficient Avid workflow. DNxHD files can easily be graded natively with DaVinci Resolve using full AAF roundtrip with Media Composer. HyperDeck Shuttle also records direct to mathematically perfect quality uncompressed 10-bit QuickTime files that can be used with all popular video software like Final Cut Pro, Premiere Pro, After Effects, DaVinci Resolve and more
|SDI Video Input:
|1 x 10-bit SD/HD switchable via DIN 1.0/2.3 connector.
|SDI Video Output:
|1 x 10-bit SD/HD switchable via DIN 1.0/2.3 connector.
|HDMI Video Input:
|1 x HDMI type A connector
|HDMI Video Output:
|1 x HDMI type A connector
|SDI Audio Input:
|16 channels embedded in SD and HD in QuickTime files.
2 channels in Avid DNxHD MXF files.
|SDI Audio Output:
|16 channels embedded in SD and HD in QuickTime files.
2 channels in Avid DNxHD MXF files.
|HDMI Audio Input:
|8 channels embedded in SD and HD in QuickTime files.
2 channels in Avid DNxHD MXF files.
|HDMI Audio Output:
|2 channels embedded in SD and HD
|SSD Interface:
|1 x 2.5' SATA 3Gb/s
|SD Format Support:
|625/25 PAL and 525/29.97 NTSC. 480p60 and 576p50 via HDMI only.
|HD Format Support:
|720p50, 720p59.94, 720p60, 1080i50, 1080i59.94, 1080i60, 1080PsF23.98, 1080PsF24, 1080PsF25, 1080PsF29.97, 1080PsF30, 1080p23.98, 1080p24, 1080p25, 1080p29.97, 1080p30.
|4K Playback Format Support:
|SDI Compliance:
|Audio Sampling:
|Television standard sample rate of 48 kHz and 24 bit
|Video Sampling:
|Codec Support:
|Uncompressed QuickTime, Apple ProRes 422 (HQ) QuickTime, Avid DNxHD QuickTime, Avid DNxHD MXF


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Legal Status
Document Details
Published Document
Take notice that on August 1, 2003, El Paso Natural Gas Company (El Paso) tendered for filing to become part of its FERC Gas Tariff, First Revised Volume No. 1A, the tariff sheets listed in Appendices A, B and C to the filing.
El Paso states that the tariff sheets are being filed to implement the capacity allocation changes in compliance with the Commission's July 9, 2003 orders in this proceeding. The tariff sheets are proposed to become effective November 1, 2002 and September 1, 2003.
Any person desiring to protest said filing should file a protest with the Federal Energy Regulatory Commission, 888 First Street, NE., Washington, DC 20426, in accordance with § 385.211 of the Commission's Rules and Regulations. All such protests must be filed in accordance with § 154.210 of the Commission's Regulations. Protests will be considered by the Commission in determining the appropriate action to be taken, but will not serve to make protestants parties to the proceedings. This filing is available for review at the Commission in the Public Reference Room or may be viewed on the Commission's Web site at http://www.ferc.gov using the "FERRIS" link. Enter the docket number excluding the last three digits in the docket number field to access the document. For assistance, please contact FERC Online Support at email@example.com or toll-free at (866) 208-3676, or TTY, contact (202) 502-8659. The Commission strongly encourages electronic filings. See 18 CFR 385.2001(a)(1)(iii) and the instructions on the Commission's Web site under the "e-Filing" link.
Protest Date: August 13, 2003.Start Signature
Linda Mitry,
Acting Secretary.
[FR Doc. 03-20602 Filed 8-12-03; 8:45 am]


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Gibraltar Private Bank & Trust is under federal investigation for possible violations of the Bank Secrecy Act and related anti-money laundering requirements.
"The Bank cannot at this time predict the results of such investigations, whether penalties or fines will be sought, and, if so, the amounts of any proposed penalties or fines," the bank wrote in an annual report to its shareholders released March 19.
The U.S. Attorney's Office and the Department of Justice's Asset Forfeiture and Money Laundering Section are handling the investigation, according to the report. Sarah Schall, a spokeswoman for the U.S. Attorney's Office, said she could not confirm or deny the existence of an investigation into Gibraltar.
The South Florida Business Journal first reported the news.
Previously, Gibraltar paid $65 million in a settlement to victims of Ponzi schemer Scott Rothstein, who used Gibraltar and TD Bank to hold trust accounts for his clients.
It was unclear when the violations at the center of the new investigation occurred. Gibraltar brought in a new management team in 2012, including CEO Adolfo Henriques, a well-respected local banker.
Henriques and Gibraltar — which largely deals with private wealth management for the rich— did not respond to requests for comment.
Banks in South Florida are often the target of regulatory actions over money laundering, said Ken Thomas, a local banking consultant. That's in part because of Miami's connection to foreign wealth and because of its historical, Cocaine Cowboy-era ties to the drug trade.


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The "flu" is such a common expression to describe wintertime illnesses that Americans sometimes underestimate the power of the disease. Even in a mild year for flu, it kills about 12,000 people, according to the Centers for Disease Control and Prevention. And in a bad year, that number has soared has high as 56,000 — not including the infamous pandemic of 1918, which infected 28 percent of the U.S. population and killed between 500,000 and 675,000 people.
This year the CDC rates the seasonal virus as "moderately severe." It is too early to calculate mortality statistics because this year's strain still is spreading, but the CDC said the flu is responsible for about 6 percent of all cases for which Americans have sought health treatment this winter. In a typical year, the flu is responsible for about 2 percent of treated cases.
And mortality is known to be up in some areas. San Diego, for example, anticipates a record number of flu-related deaths.
Testing so far this year has shown the predominant strain to be the most difficult of the seasonal flu strains to address by seasonal vaccine. Known as H3N2, the strain first was identified in Hong Kong in 1968, during which it killed more than 1 million people worldwide.
Each year researchers devise a vaccine to address the strain that they expect to develop. The vaccine always includes a component to fight H3N2, but this year that component appears to be about 30 percent effective against the circulating strain. The same vaccine was used in Australia during its just-completed flu season, where it was found to be only about 10 percent effective.
Meanwhile, researchers at multiple institutions have made significant progress toward a universal flu vaccine that could eliminate the need to formulate a new vaccine each year. It would focus on common genetic traits of the four major seasonal strains.
The National Institutes of Health says developing a universal vaccine is a high priority, but funding for the project is just $32 million a year. The Biomedical Advanced Research and Development Authority spends another $43 million. That compares with about $1 billion spent each year on developing an HIV vaccine and billions more for research on vaccines for the Ebola and Zika viruses.
Congress should fully fund the effort to find a universal influenza vaccine.


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I applied last week for an AMEX Zync and was approved with a $500 CL if I enrolled in auto-pay (which I did). I received the card in the mail today along with all of my paperwork, but I don't see a credit score of any kind listed on any of the paperwork. I've heard that AMEX pulls EX, so I was really curious to see what my actual EX score was.
What gives?
Generally they only give you the score when they deny you. They have to put it in the denial letter. I geuss you can call them and see if the CSR can pull it up with your record but make sure they dont do another pull thinnking thats what you want.
The new act only requires card companies to provide score if you're denied. If you're approved, they may give it to you or they may not, it varies.
Really? I thought that CCCs also had to give you your credit score if you were approved, but did not receive the optimum benefits (lower CL, higher APR, etc.).
Mandazoid wrote:
Really? I thought that CCCs also had to give you your credit score if you were approved, but did not receive the optimum benefits (lower CL, higher APR, etc.).
If you don't get the most favorable term, they are required to tell you about the negative items on your report, not necessarily the score. Please correct me if I'm wrong.
Hmm...interesting. Thanks, csol! I'll have to give them a call and see if they'll tell me.
That may be the case, silver. I'm not sure!
I also received no score with my BCP...
I got approved for the BCE, and 2 days before I got the card, I got a letter that gave my FICO score in it. It stated I had a 748... but I also got the highest APR so I guess that's why they included the score.
My AMEX Clear letter gave me my EX and my apr is 19.94%. I don't know what the APR range is though.


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Physics AB ( 9 CFU )
Prof. Andrea Baraldi
Tel. 0521-905234 - E-mail: firstname.lastname@example.com
The objective of the course is the basic knowledge and understanding of the fundamental laws of classical mechanics, thermodynamics, and electrostatics. Students will also learn how to solve simple problems.
Physical quantities. Basic quantities, dimensional analysis, error analysis and significant figures.
. Vector and scalar quantities. Vector: products, addition, and derivatives. Superposition principle.
Particle kinematics
. Position, displacement, velocity, and acceleration. Radial and tangential acceleration. Motion in one dimension (constant velocity, constant acceleration, simple harmonic). Motion in two dimensions (projectile, circular). Reference frames.
Particle dynamics
. Newtons laws of motion. Forces: gravity, normal, friction, and linear restoring; circular motion and Newtons laws; inertial and noninertial reference frames.
Work and energy
. Work done by a force, power: constant and varying forces Conservative forces and potential energy. Kinetic energy and work-kinetic energy theorem; principle of conservation of mechanical energy.
. Impulse and momentum; system of particles. Conservation of linear momentum; center of mass and its motion; collisions.
Particle rotational dynamics
. Torque, angular momentum, Newtons second law. Kinetic energy of a particle in rotational motion. Generalization to a many-particle system.
Rigid object dynamics
. Translational and rotational motion, and center of mass. Rotational motion about a fixed axis. Moment of inertia and parallel-axis theorem. Rotational kinetic energy and work; pure rolling. Conservation of angular momentum
Static equilibrium
. The rigid object in equilibrium.
Newtons law of universal gravitation
. Gravitational force and gravitational field. Gravitational potential energy. Keplers laws.
Fluid mechanics
. Pressure and density; variation of pressure with depth, Archimedess principle. Bernoullis equation.
. Fundamental quantities of thermal physics. Temperature and thermometers. Gas laws. Thermodynamical work, heat, specific heat, latent heat. The principles of thermodynamics. Carnot cycle. Thermal engines and efficiency. Entropy.
. The electrical charge. Coulombs law and electric field. Gauss theorem and its applications. Electric potential energy and electric potential. Conductors in electrostatic equilibrium, the electrostatic shield.
. Energy stored in a capacitor. Equivalent capacitor of a network of circuit elements: series and parallel combinations. Polarization of matter and dielectrics: the dielectric constant.
Electric stationary currents
. The Ohms law. Equivalent resistance of a network of circuit elements: series and parallel combinations. Kirckoffs laws. RC circuits.
Attività d'esercitazione
Exercise sessions will be held during the course.
Modalità d'esame
It is required to pass both a written and an oral examination.
The course is calculus based.
The courses of Mathematical Analysis AB and Geometry should be previously attended.
Testi consigliati
D. Halliday, R. Resnick, K.S. Krane, Fondamenti di fisica sesta edizione vol 1 e 2 (CEA)
W.E. Gettys, F.J. Keller, M.J. Skove, Fisica classica e moderna vol. 1 e 2 (casa editrice McGraw-Hill)
P. Mazzoldi, M. Nigro, C. Voci, Elementi di Fisica in più volumi (EdiSES)
Testi d'approfondimento
Serway-Beichner Fisica per Scienze ed Ingegneria Vol 1-2 Ed. EdiSES
Halliday-Resnick-Krane Fisica 1 e 2 Ed. CEA
P.Mazzoldi, M.Nigro, C.Voci Fisica vol. I e II . Ed. EdiSES


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Holfeld will unveil an extended range of soft fruit punnets at Fruit Logistica
Posted by RobertByrne on January 6, 2017
Holfeld will unveil an extended range of soft fruit punnets at Fruit Logistica, Berlin in February
Holfeld Plastics, part of Waddington Europe says it is the growing force in soft fruit packaging rivalling the best in the industry and will be inviting visitors on their stand A-06 Hall 8.2 at Fruit Logistica to take a fresh look at an exciting new and extended packaging range.
The manufacturer has extended its soft fruit punnet range to rival the very best the soft fruit packaging industry can offer.
Following investment in Holfeld's capabilities three exciting new soft fruit punnet ranges have been added to the existing portfolio – the M81, HP30 and HP80 all available in varying depths.
Addressing customer demand for promotional family-sized packs the company has developed a new deep punnet HP80 range available in depths 56, 70 and a generous 85mm depths. In line with market demand the range is also available for top sealing as well as auto de-nesting and are laterally vented to reduce condensation and improve airflow even when the punnets are stacked.
In addition the manufacturer has created the new M81 range in depths 85,70, 60, 50, 40 and 30mm and the HP30 range in depths 34, 60 and 75mm. Both ranges are suitable for top sealing and auto de-nesting.
There is also the HP62 range – two depths are available 40 & 58mm -these have all the features and benefits to be found with the other ranges.
As well as the complete new ranges Holfeld has introduced incremental profiles such as the HP37 Divide to accommodate two soft fruit varieties with or without pads.
Holfeld has, in recent years carried off a number of awards for its low carbon lightweight materials. rPETeCO was recently launched, a multi-market universal and innovative material for brand owners, growers, distributors and retailers looking to add value in their packaging and to enhance their environmental credentials. The material has a non-plastic appearance is irresistibly tactile with a unique textured finish and blended with up to 90% post-consumer recyclate.
In 2016 and for the 2nd consecutive year Holfeld Plastics won a Worldstar Award for food contact materials, this time with H-PET Hydrozorb. H-PET is a material that reduces surface tension in pre-packed produce such as mushrooms and soft fruit considerably extending shelf life.
For more details on the enhanced ranges and products visit the new, easy-to-navigate on line product catalogue at www.holfeldplastics.com / email email@example.com or telephone +353 (0) 402 41234


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About us
We are friendly, dynamic and hard-working
We are researchers, methodologists and trainers, with expertise in a range of qualitative, quantitative and mixed methods approaches to analysis and experience of working in a variety of academic, applied, government and commercial settings.
We have several decades experience conducting research and training others and our ethos is to provide impartial advice and always tailor our services to your needs.
Qualitative Data Analysis Services (QDAS) was founded in 2002 by Ann Lewins and Christina Silver.
We began working together from 1998 at the CAQDAS Networking Project (CNP) at the University of Surrey. The CNP provides platforms for debate about the issues arising from the use of CAQDAS packages, undertakes research into their use, and offers advice, training and ongoing support in their use.
These technologies offer powerful tools for undertaking qualitative and mixed methods research, enabling the systematic management, analysis, interpretation and sharing of data and understanding. They are widely used across academic, government, non-for-profit and commercial sectors.
We founded QDAS to provide users with tailored training, coaching and project consultancy in their chosen CAQDAS package, whatever the type of project. In 2007 we published the first edition of our book Using Software in Qualitative Research: A Step-by-Step Guide, which was updated and extended in the second edition, published in 2014.
Since then, awareness and use of qualitative analysis software has grown year on year, and our work has increasingly diversified, and now includes data analysis services as well as training, coaching, and project consultancy. In this time, we have worked with a whole range of universities, businesses, charities and government organisations (both large and small) across Europe and America, helping them to get the most out of their chosen software for their specific needs.
We have been lucky enough to have been joined by a number of experienced associates who share our vision and passion for realising the full potential and value of what can be achieved in the field of qualitative and mixed methods research.
Thank you for a fantastic session. It is one of the best software training sessions I have had the pleasure of attending. It was a lovely interplay of method with technique while keeping the focus and making progress with the software.Robert Galavan, Professor of Strategic Management
School of Business, National University of Ireland Maynooth


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Cecile ZwiebachAssociate
Cecile Zwiebach is a member of the firm's Corporate group and is resident in our New York office. Her practice focuses on Latin American cross-border transactions and on technology transactions. She advises financial institutions, private equity firms and companies in strategic mergers and acquisitions. She also advises a wide range of clients in connection with IT infrastructure matters, including the negotiation of information technology services agreements and global ticket inventory distribution arrangements as well as data collaborations and various projects relating to proprietary rights to data, data privacy and data security.
Prior to joining Covington, Ms. Zwiebach was associated with another leading law firm in New York City.


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Regular Habits That Damage The Liver
Sometimes, we make small errors without knowing it or we have lifestyle habits that are not good for our bodies.
The liver is one of the most important and delicate organs in our body, it filters toxins, produces bile, transforms carbohydrates, proteins, minerals, and vitamins.
The functions that the liver performs are essential for health, which is why sometimes a small mistake can cause consequences that you will notice immediately e.g. small inflammation.
Everything we eat must be processed by the liver before it can be distributed throughout the body, the liver has wide range of functions and it plays a vital role in numerous physiological processes including metabolic function and blood detoxification.
As a result, the health of our body is directly related to the liver functioning at its peak, although the liver can replace damaged cells, if enough cells are lost, the liver may not be able to function properly.
There are several common bad habits that are part of our daily routine which may increase the risk of liver damage without us even realizing it, as the damage can be gradual and initially without obvious symptoms. But over time these bad habits can severely harm the liver, this is very dangerous, as the body cannot function properly without a properly working liver.
Alcohol: Consumption of alcohol in heavy amounts can cause damage to the liver, the excessive amount of alcohol reduces the liver's ability to remove toxins from the body. Heavy alcohol consumption is the most common cause of liver damage. This is because the liver gets diverted from its other functions and focuses mainly on converting alcohol to a less toxic form, and this causes fatty liver disease and inflammation.
Smoking: There are numerous side-effects of smoking and liver damage is one of them, the effect of cigarette smoke impacts the organ indirectly. The toxic chemicals present in cigarette smoke gradually reach the liver and cause oxidative stress, producing free radicals that damage liver cells. This oxidative stress also causes fibrosis, a process in which the liver develops excess tissue, similar to scar tissue, during its attempt to repair itself, and this can greatly affect the liver. Also these toxic chemicals reduces the liver function over time so it becomes less effective in performing its main role – removing toxins from the body.
Sleeplessness: Surprisingly, sleep deprivation can have some serious-effects on your liver's condition. It was found in a study that sleeplessness can cause oxidative stress to the liver. Lack of sleep will ruin your elimination process and damage your liver.
Processed food: Eating high amount of processed foods can be harmful for the liver. Processed foods are often loaded with preservatives, additives and artificial sweeteners.
Overuse of drugs: As the liver's role is to break down substances taken by mouth, including medications, herbs and supplements, consuming too much of certain medications can gradually harm the liver. The damage can range from mild to a complete liver failure. This is true not just for conventional medicines, but also for supplements and herbs as they, too, can be harmful to the liver in excess amounts.


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"I am looking out my living room window and see a beautifully sunny and clear blue sky. Such a sight has been so rare in the last number of months that it almost takes my breath away. How can it be so blue? Where does that blue come from? Why blue and not another colour like pink or yellow? And I'm not looking for a scientific explanation here – only the affirmation that this world I am living in, is wondrous and full of miracles. For those who have eyes to see and…Continue
Added by Kita Szpak on April 25, 2015 at 7:25am — No Comments
"Here's a blast from the past: how many of you remember Maharishi Mahesh Yogi? I must confess in my naive know-it-all youth, I dismissed him and his transcendental meditation "fad". Who would have thought that quantum physics would so closely correlate the state of coherence and lack of stress in systems including ours as a state of bliss – happiness - just as Maharishi described it to his followers way back when. How little I knew…and I still have a long way to…Continue
Added by Kita Szpak on April 17, 2015 at 11:55am — No Comments
"People are talking to us and at us all the time. Wisely, we shut out some of this conversation so as not to be overwhelmed by other people's opinions, perspectives, comments, criticism – even if they mean well. Be careful though not to shut out all the sounds that surround you. Perhaps it is the wind or the birds or the river or the train along the railway tracks or even the old man mumbling who are talking to you. Be open to this kind of listening. You may…Continue
Added by Kita Szpak on April 11, 2015 at 1:46pm — No Comments
"We avoid speaking of death because it is unpleasant yet unavoidable. In this season of new beginnings and rebirth, something has to give in order for you to create space for something new. Is there a habit, ritual, job, relationship, that needs closure for your rebirth to occur? It takes courage and resolve for sure. There will be steps backwards before the new can completely enter. I know this and so do you. We've been through it before and we will go through it…Continue
Added by Kita Szpak on April 4, 2015 at 1:41pm — No Comments
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Vinyl Hemispheres
Vinyl Hemispheres...are great for displays!
Mylar Fringe/Curtains
mylar fringe! are you building a float anytime soon?...if not, well..it's also great for a backdrop for parties! Use it around a banquet table or all tables at an event.
Security Mirrors
Acrylic Hemisphere 6" to 72" in diameter--different wall thickness & colors available
Acrylic hemispheres have such diverse uses. You can use it as a salad bowl. You can flip it over and use it to encase and protect a treasured item. You can mount it on the wall for a conversational picture frame or make a really neat terrarium...How 70's!...cool, right?
We have sold hemispheres for years to the retail industry for product displays, photographers , movie and commercial sets, artists, students, research labs and the adult industry used by exotic dancers (larger sizes).
The hemispheres are made of clear, sturdy acrylic. The depth is half the diameter (i.e. 12" diameter = 6" deep). They have a 1" flange around that you can drill into (with a plexi drill bit).
They can be made in various sizes as well as different thickness (1/8" up to 1/2") and in colors.
1/8" & 1/4" are standard
SPECIAL ORDERS UP TO 72" IN DIAMETER--CALL FOR DETAILS 212-226-2010 OR Email :
Textured Vinyl Sheets (Size:36" X 22" X .030'')
Our Price:
These textured vinyl sheets come in 3 great colors; green, red and purple. They are 36" X 22" X .030'' in size and have raised lines on one side (like striations) and is shiny on the other.
Frosted Vinyl Sheets
Our Price:
These frosted vinyl sheets come in 3 great colors; tangerine, lime and burgundy. They are 45" X 25" X .022'' in size and are frosted on one side and shiny on the other. There are many uses for vinyl sheeting. You can cut shapes out or create a stencil that you can paint over and over and not worry that you wouln't be able to reuse it like cardboard. They make great book covers that wouln't fall apart like construction paper or newspaper will. I have seen customers make boxes and trays using a little glue and ingenuity.
Unlike a lot of craft materials, vinyl will not be affected by water, paint, or most chemicals. It's easy to work with and can be cut with either a razor knife or a good pair of sheers.
Acrylic Diamonds (Small Size) 57 count
Our Price:
Acrylic diamonds used for party decoration, corporate functions, weddings or sweet sixteens. Each diamond is perfect for dressing up a party table either by using them with the centerpiece or just sprinkling them across the table. Remember "It's all about the BLING"
Acrylic Diamonds (Large Size) 20 Count
Our Price:
Acrylic diamonds used for party decoration, corporate functions, weddings or sweet sixteens. Each diamond is perfect for dressing up a party table either by using them with the centerpiece or just sprinkling them across the table. Remember "It's all about the BLING"
Iridescent Ice Shards
Our Price:
Ice shards are used to dress up a party or event table by filling the center pieces, drizzling them across the table or making a display of a drink where the ice never melts. With there iridescent colors they really give a pop to what ever they reflect on to.
Wonder Film Display and Gift Wrapping Material-Very Cool!
List Price: $199.95
Our Price:
You save $100.00!
Great for gift wrapping
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