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The Proteus Project: Writing Stories for Children by Alexi Sargeant
Thanks to support from The Sheen Center, Turn to Flesh Productions was able to introduce a new part of the play development process: The Proteus Project. A step between Monthly MUSE - a place to workshop individual scenes - and our Annual Staged Reading Series, The Proteus Project gives our playwrights the chance to hear their project in full at a music stand reading for a small, private audience.
Thus far, the Proteus Project readings have all gone on to further, exciting development. TTF playwright, Duncan Pflaster's Cockeye(D), an updated take on The Bacchae in the light of Kevin Spacey and #MeToo, has played at TOSOS, Chris Rivera's Our Own Odyssey, a look at a gay Latinex youth's journey to find home, won awards at FUERZAFest, while Artistic Director Emily C. A. Snyder's The Merry Widows of Windsor, a feminist sequel to Shakespeare's Merry Wives, will receive a fully staged reading at The Sheen Center in on Sunday, June 24th.
Up next for the Proteus Project is TTF playwright and member of Monthly MUSE open workshop, Natalie Sack's Invasive Species.
Thus far, the Proteus Project readings have all gone on to further, exciting development. TTF playwright, Duncan Pflaster's Cockeye(D), an updated take on The Bacchae in the light of Kevin Spacey and #MeToo, has played at TOSOS, Chris Rivera's Our Own Odyssey, a look at a gay Latinex youth's journey to find home, won awards at FUERZAFest, while Artistic Director Emily C. A. Snyder's The Merry Widows of Windsor, a feminist sequel to Shakespeare's Merry Wives, will receive a fully staged reading at The Sheen Center in on Sunday, June 24th.
Up next for the Proteus Project is TTF playwright and member of Monthly MUSE open workshop, Natalie Sack's Invasive Species.
And today we bring you an exciting interview with TTF board member, Alexi Sargeant, whose Proteus Project: Writing Stories For Children, Or How To Give Birth To Gods goes up Thursday, May 24 at the Sheen Center. Alexi took the time to answer a few questions about the play, their experience as part of our Proteus Project this year, and a few questions straight from our Turn to Flesh Community. (Questions from our community denoted with an *)
I wrote this play in a class at Yale taught by Sarah Ruhl. The focus of the class was "Ovidian Drama," that is, stories driven less by Aristotelian plot structure than by dreamlike metamorphoses. We read plays like Shakespeare's Winter's Tale and Elizabeth Egloff's The Swan and debated to what extent they were Ovidian. Then Sarah gave us a list of ingredients with which to write a play: A nonhuman character, a song, a magical object, and an unexpected transformation. I threw in some of my own pet obsessions about fantasy fandom and childbearing, and the result was Writing Stories for Children.
Not an existing classical pantheon. I wanted to create my own set of deities. I thought about what forces would be most interesting to personify, and a little about which would have the most interesting conflicts in a modern setting. That's how we got gods of tradition, progress, and regret. Three other gods are very classic tropes. The Lady is Death herself, Tarth is a war god, and Sonus a goddess of song (with a flavor of overflowing natural fecundity). But I twisted those tropes a bit. Tarth, for instance, has expanded his patronage to include the non-military war of economic competition. Sonus is in a strange half-awake state and speaks in gnomic snatches. Her relationship with Kestrel, god of progress, who put her into this sleep as part of project of perfecting her, echoes the way technological progress relates to nature itself and even human nature.
Asking the heavy questions! There's no getting around that death is scary. As a Christian, I have a hope that transcends death. But it still shapes my life, often through tragic losses. In the play, death is The Lady, and she is portrayed fairly sympathetically. She's someone bound by her nature to take people from this world, but approaches this without malice. She has a compassionate interest in the living and kicks off the plot of the play by seeking out the quintessentially living experience of motherhood. I think it's fairly healthy to be able to view death this way. We have to be able to see death as both an enemy (thanks to Christ, a defeated enemy) but also as a natural part of living in a fallen world. That way we can, God willing, embrace and transcend death rather than deny it.
I have read it, and your question prompted me to read it again. What a lovely essay. Lewis, as always, puts things so well. His argument that the best literature for children is that which the author himself or herself enjoys is very sound.
This essay was not at the front of my mind when I was writing my play, but it could well have subconsciously influenced me. There is a bit where Lewis touches on the concept of longing for another world that he elsewhere calls Joy:
[The child reading fairy stories] does not despise real woods because he has read of enchanted woods: the reading makes all real woods a little enchanted. This is a special kind of longing.
You're Catholic, but you're writing about a polytheistic world. How does this milieu help you to explore your worldview?
The gods in this play are, explicitly, created beings, thought up by a fantasy author named Glenn Braddock before somehow working their way into our world. Their eternity and omniscience are highly conditional. This makes them quite different from the God I believe in. But it does help me think about what kinds of stories we tell about ourselves, and what things we make the gods of those stories. I picked gods like a god of progress and a goddess of regret because I think it's not unusual for people to set those concepts up as idols in their lives, or for societies to worship them on a larger scale.
Many colleges end up terribly mistreating students who try to get mental healthcare. My own school, Yale, was no exception. Christine's experience in my play reflects some of my anger at such injustices. It's a crying shame that schools treat this entirely in terms of liability, hurrying to kick students off campus when those students are going through a rough time. Universities should do more to prioritize students' wellbeing, instead of treating students like ticking time-bombs that need to be shipped away from school fast.
My play has some extremely technically-challenging stage directions, including calling for a wolf made of light. I wondered if folks would be scared away from the prospect of a full production because of those directions. But every time people read the play, they're pretty excited by the stage directions and immediately start brainstorming how you could actually pull them off without breaking the bank. So perhaps I will get to see a fully-staged Writing Stories for Children someday, wolf made of light and all!
Ask me again after the reading! I'm excited to learn what the audience likes in this play, and hear any question they have about the story, characters, and world.
Join us this Thursday at 8:30 for a free reading of the play at the Sheen Center! I'm extremely pleased with the cast of actors reading the show, including Turn to Flesh favorites like Abby Wilde, Isabel Kruse, Amanda Roberts, Andrew Barrett, and Stephen Lyons, as well as folks I know from Yale like Iason Togias and Rachel Goldstein. Plus, my lovely wife Leah is reading those maybe-impossible-but-
certainly-evocative stage directions. I look forward to getting to share the play with an audience there. Come one, come all!

subset: commoncrawl


text:
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Oral cancer
|Oral cancer
|Other names
|Cancer of the lip, oral cavity and pharynx, mouth cancer, cancer or the lips, oral cavity and pharynx[1]
|Oral cancer on the side of the tongue, a common site along with the floor of the mouth
|Oncology, ENT surgery, oral and maxillofacial surgery
|Persistent rough white or red patch in the mouth lasting longer than 2 weeks, ulceration, lumps/bumps in the neck, pain, loose teeth, difficulty swallowing
|Risk factors
|Smoking, alcohol, HPV infection, sun exposure (lower lip)
|Diagnostic method
|Tissue biopsy, CT scan, MRI
|Differential diagnosis
|Non-squamous cell carcinoma oral cancer, salivary gland tumors, benign mucosal disease
|Frequent screening at the dentist, HPV vaccination, limit alcohol <2 drinks per day, avoid tobacco, HPV vaccination
|Surgery, radiation, chemotherapy
|Five-year survival 63%, highly dependent on site of tumor and spread
|11.3 per 100,000 (US)
|2.5 per 100,000 (US); 146,000 (2015)[2]
Oral cancer, also known as mouth cancer , is cancer of the lining of the lips, mouth, or upper throat.[3] In the mouth, it most commonly starts as a painless white patch, that thickens, develops red patches, an ulcer, and continues to grow. When on the lips, it commonly looks like a persistent crusting ulcer that does not heal, and slowly grows.[4] Other symptoms may include difficult or painful swallowing, new lumps or bumps in the neck, a swelling in the mouth, or a feeling of numbness in the mouth or lips.[5]
Risk factors include tobacco and alcohol use.[6][7] With both tobacco and drinking alcohol the risk of oral cancer is 15 times greater.[8] Other risk factors include HPV infection,[9] chewing paan,[10] and sun exposure on the lower lip.[11] Oral cancer is a subgroup of head and neck cancers.[3] Diagnosis is made by biopsy of the concerning area, followed by investigation with CT scan, MRI, PET, and examination to determine if it has spread to distant parts of the body.
Oral cancer can be prevented by avoiding tobacco products, limiting alcohol use, sun protection on the lower lip, HPV vaccination, and avoidance of paan. Treatments used for oral cancer can include a combination of surgery (to remove the tumor and regional lymph nodes), radiation therapy, chemotherapy or targeted therapy. The types of treatments will depend on the size, locations, and spread of the cancer taken into consideration with the general health of the patient.[4]
Between 1999 and 2015 in the United States rate of oral cancer increased 6% (from 10.9 to 11.6 per 100,000). Even though smoking cessation campaigns have decreased the rate of tobacco induced tumors, the rate of HPV related cancers has offset the gains. Deaths from oral cancer during this time deceased 7% (from 2.7 to 2.5 per 100,000).[12] Oral cancer has an overall survival rate of 63%[13] but varies widely depending on when treatment is started. If treated early in the disease, oral cancer has an 84% 5-year survival rate, compared to 65% if it has spread to the lymph nodes in the neck, and 39% if it has spread to distant parts of the body.[14] Survival rates also are highly dependent on the location of the disease in the mouth.[15]
- 1 Signs and symptoms
- 2 Causes
- 3 Pathophysiology
- 4 Diagnosis
- 5 Management
- 6 Prognosis
- 7 Epidemiology
- 8 References
- 9 External links
Signs and symptoms[edit]
The signs and symptoms of oral cancer depend on the location of the tumor. The classic warning sign is a persistent rough patch with ulceration and a raised border that is minimally painful. On the lip, the ulcer is more commonly crusting and dry, and in the pharynx it is more commonly a mass. It can also be associated with a white patch, loose teeth, bleeding gums, persistent ear ache, a feeling of numbness in the lip and chin or swelling.[16] In the case of pharyngeal cancer there can also be difficulty or painful swallowing, and an altered voice.[17] Typically the lesions have very little pain until they become larger and then are associated with a burning sensation.[18] As the lesion spreads to the lymph nodes of the neck, a painless hard mass will develop, and if it spreads elsewhere in the body general aches can develop most often due to bone metastasis.[18]
Oral squamous cell carcinoma is a disease of environmental factors, the greatest of which is tobacco. Like all environmental factors, the rate at which cancer will develops is dependent on the dose, frequency and method of application of the carcinogen (the substance that is causing the cancer).[19] Aside from cigarette smoking, other carcinogens for oral cancer include alcohol, viruses (particularly HPV 16 and 18), radiation, and UV light.[4]
Tobacco is known to be a multi-organ carcinogen, that has a synergistic interaction with alcohol to cause cancers of the mouth and pharynx by directly damaging cellular DNA.[19] Tobacco is estimated to increase the risk of oral cancer by 3.4[19]-6.8[6] and is responsible for approximately 40% of all oral cancers.[20]
Some studies in Australia, Brazil and Germany pointed to alcohol-containing mouthwashes as also being potential causes. The claim was that constant exposure to these alcohol-containing rinses, even in the absence of smoking and drinking, leads to significant increases in the development of oral cancer. However, studies conducted in 1985,[21] 1995,[22] and 2003[23] summarize that alcohol-containing mouth rinses are not associated with oral cancer. In a March 2009 brief, the American Dental Association said "the available evidence does not support a connection between oral cancer and alcohol-containing mouthrinse".[24] A 2008 study suggests that acetaldehyde (a breakdown product of alcohol) is implicated in oral cancer,[25][26] but this study specifically focused on abusers of alcohol and made no reference to mouthwash. Any connection between oral cancer and mouthwash is tenuous without further investigation.
Human papillomavirus[edit]
Infection with human papillomavirus (HPV), particularly type 16 (there are over 180 types), is a known risk factor and independent causative factor for oral cancer.[27] A fast-growing segment of those diagnosed does not present with the historic stereotypical demographics. Historically that has been people over 50, blacks over whites 2 to 1, males over females 3 to 1, and 75% of the time people who have used tobacco products or are heavy users of alcohol. This new and rapidly growing sub population between 30 and 50 years old,[28] is predominantly nonsmoking, white, and males slightly outnumber females. Recent research from multiple peer-reviewed journal articles indicates that HPV16 is the primary risk factor in this new population of oral cancer victims. HPV16 (along with HPV18) is the same virus responsible for the vast majority of all cervical cancers and is the most common sexually transmitted infection in the US. Oral cancer in this group tends to favor the tonsil and tonsillar pillars, base of the tongue, and the oropharynx. Recent data suggest that individuals that come to the disease from this particular cause have a significant survival advantage,[29] as the disease responds better to radiation treatments than tobacco caused disease.
Betel nut[edit]
Chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer even in the absence of tobacco. It increases the rate of oral cancer 2.1 times, through a variety of genetic and related effects through local irritation of the mucous membrane cells, particularly from the areca nut and slaked lime.[19] In India where such practices are common, oral cancer represents up to 40% of all cancers, compared to just 4% in the UK.
Stem cell transplantation[edit]
Patients after hematopoietic stem cell transplantation (HSCT) are at a higher risk for oral squamous cell carcinoma. Post-HSCT oral cancer may have more aggressive behavior with poorer prognosis, when compared to oral cancer in non-HSCT patients.[30] This effect is supposed to be owing to the continuous lifelong immune suppression and chronic oral graft-versus-host disease.[30]
Premalignant lesions[edit]
A premalignant (or precancerous) lesion is defined as "a benign, morphologically altered tissue that has a greater than normal risk of malignant transformation." There are several different types of premalignant lesion that occur in the mouth. Some oral cancers begin as white patches (leukoplakia), red patches (erythroplakia) or mixed red and white patches (erythroleukoplakia or "speckled leukoplakia"). Other common premalignant lesions include oral submucous fibrosis and actinic cheilitis.[31] In the Indian subcontinent oral submucous fibrosis is very common due to betel nut chewing. This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth becomes progressively limited, and later on even normal eating becomes difficult. It occurs almost exclusively in India and Indian communities living abroad.
Oral squamous cell carcinoma is the end product of an unregulated proliferation of mucous basal cells. A single precursor cell is transformed into a clone consisting of many daughter cells with an accumulation of altered genes called oncogenes. What characterizes a malignant tumor over a benign one is its ability to metastasize. This ability is independent of the size or grade of the tumor (often seemingly slow growing cancers like the adenoid cystic carcinoma can metastasis widely). It is not just rapid growth that characterizes a cancer, but their ability to secrete enzymes, angiogeneic factors, invasion factors, growth factors and many other factors that allow it to spread.[4]
Early diagnosis of oral cancer patients would decrease mortality and help to improve treatment. Oral surgeons and dentists can diagnose these patients in the early stages. Health providers, dentists, and oral surgeons shall have high knowledge and awareness that would help them to provide better diagnosis for oral cancer patients. An examination of the mouth by the health care provider, dentist, oral surgeons shows a visible and/or palpable (can be felt) lesion of the lip, tongue, or other mouth area. The lateral/ventral sides of the tongue are the most common sites for intraoral SCC. As the tumor enlarges, it may become an ulcer and bleed. Speech/talking difficulties, chewing problems, or swallowing difficulties may develop. A feeding tube is often necessary to maintain adequate nutrition. This can sometimes become permanent as eating difficulties can include the inability to swallow even a sip of water. The doctor can order some special investigations which may include a chest x-ray, CT or MRI scans, and tissue biopsy.
While a dentist, physician or other health professional may suspect a particular lesion is malignant, there is no way to tell by looking alone - since benign and malignant lesions may look identical to the eye. A non-invasive brush biopsy (BrushTest) can be performed to rule out the presence of dysplasia (pre-cancer) and cancer on areas of the mouth that exhibit an unexplained color variation or lesion. The only definitive method for determining if cancerous or precancerous cells are present is through biopsy and microscopic evaluation of the cells in the removed sample. A tissue biopsy, whether of the tongue or other oral tissues and microscopic examination of the lesion confirm the diagnosis of oral cancer or precancer.
The US Preventive Services Task Force (USPSTF) in 2013 stated evidence was insufficient to determine the balance of benefits and harms of screening for oral cancer in adults without symptoms by primary care providers.[32] The American Academy of Family Physicians comes to similar conclusions while the American Cancer Society recommends that adults over 20 years who have periodic health examinations should have the oral cavity examined for cancer.[32] The American Dental Association recommends that providers remain alert for signs of cancer during routine examinations.[32]
There are a variety of screening devices, however, there is no evidence that routine use of these devices in general dental practice is helpful.[33] However, there are compelling reasons to be concerned about the risk of harm this device may cause if routinely used in general practice. Such harms include false positives, unnecessary surgical biopsies and a financial burden.
Oral cancer is a subgroup of head and neck cancers which includes those of the oropharynx, larynx, nasal cavity and paranasal sinuses, salivary glands, and thyroid gland. Oral melanoma, while part of head and neck cancers is considered separately.[3] Other cancers can occur in the mouth (such as bone cancer, lymphoma, or metastatic cancers from distant sites) but are also considered separately from oral cancers.[3]
Oral cancer staging is an assessment of the degree of spread of the cancer from its original source.[34] It is one of the factors affecting both the prognosis and the potential treatment of oral cancer.[34]
The evaluation of squamous cell carcinoma of the mouth and pharynx staging uses the TNM classification (tumor, node, metastasis). This is based on the size of the primary tumor, lymph node involvement, and distant metastasis.[35]
TMN evaluation allows the patient to be classified into a prognostic staging group;[35]
|When T is...
|And N is...
|And M is...
|Then the stage group is...
|Any T
|Any N
|Any T
|Any N
Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery is likely to result in a functionally satisfactory result. Radiation therapy with or without chemotherapy is often used in conjunction with surgery, or as the definitive radical treatment, especially if the tumour is inoperable. Surgeries for oral cancers include:
- Maxillectomy (can be done with or without orbital exenteration)
- Mandibulectomy (removal of the mandible or lower jaw or part of it)
- Glossectomy (tongue removal, can be total, hemi or partial). When glossectomy is performed for smaller tumors (< 4 cm), the adequacy of resection (margin status) is best assessed from the resected specimen itself. The status of the margin (positive/tumor cut through versus negative/clear margin) obtained from the glossectomy specimen appears to be of prognostic value, while the status of the margin sampled from the post-glossectomy defect is not. The method of margin sampling appears to correlate with local recurrence: preference for tumor bed/defect margins may be associated with worse local control.[36][37]
- Radical neck dissection
- Mohs surgery or CCPDMA
- Combinational, e.g. glossectomy and laryngectomy done together
- Feeding tube to sustain nutrition
Owing to the vital nature of the structures in the head and neck area, surgery for larger cancers is technically demanding. Reconstructive surgery may be required to give an acceptable cosmetic and functional result. Bone grafts and surgical flaps such as the radial forearm flap are used to help rebuild the structures removed during excision of the cancer. An oral prosthesis may also be required. Most oral cancer patients depend on a feeding tube for their hydration and nutrition. Some will also get a port for the chemo to be delivered. Many oral cancer patients are disfigured and suffer from many long term after effects. The after effects often include fatigue, speech problems, trouble maintaining weight, thyroid issues, swallowing difficulties, inability to swallow, memory loss, weakness, dizziness, high frequency hearing loss and sinus damage.
Survival rates for oral cancer depend on the precise site and the stage of the cancer at diagnosis. Overall, 2011 data from the SEER database shows that survival is around 57% at five years when all stages of initial diagnosis, all genders, all ethnicities, all age groups, and all treatment modalities are considered. Survival rates for stage 1 cancers are approximately 90%, hence the emphasis on early detection to increase survival outcome for patients. Similar survival rates are reported from other countries such as Germany.[38]
Following treatment, rehabilitation may be necessary to improve movement, chewing, swallowing, and speech. Speech and language pathologists may be involved at this stage.
Chemotherapy is useful in oral cancers when used in combination with other treatment modalities such as radiation therapy. It is not used alone as a monotherapy. When a cure is unlikely, it can also be used to extend life and can be considered palliative but not curative care. Biological agents such as Cetuximab have recently been shown to be effective in the treatment of squamous cell head and neck cancers, and are likely to have an increasing role in the future management of this condition when used in conjunction with other established treatment modalities. Likewise, molecularly targeted therapies and immunotherapies maybe be effective for the treatment of oral and oropharyngeal cancers.[39] Adding epidermal growth factor receptor monoclonal antibody (EGFR mAb) to standard treatment may increase survival, keeping the cancer limited to that area of the body and may decrease reappearance of the cancer.[39]
Treatment of oral cancer will usually be by a multidisciplinary team, with treatment professionals from the realms of radiation, surgery, chemotherapy, nutrition, dentistry, and even psychology all possibly involved with diagnosis, treatment, rehabilitation, and patient care.
- Postoperative disfigurement of the face, head and neck
- Complications of radiation therapy, including dry mouth and difficulty swallowing
- Other metastasis (spread) of the cancer
- Significant weight loss
Prognosis depends on stage and overall health. Grading of the invasive front of the tumor is a very important prognostic parameter.[40]
In 2013 oral cancer resulted in 135,000 deaths, up from 84,000 deaths in 1990.[41] Oral cancer occurs more often in people from the lower end of the socioeconomic scale.[42] In the US oral cancer accounts for about 8 percent of all malignant growths. Men are affected twice as often as women, particularly men older than 40/60.
Europe places second highest after Southeast Asia among all continents for age-standardised rate (ASR) specific to oral and oropharyngeal cancer. It is estimated that there were 61,400 cases of oral and lip cancer within Europe in 2012. Hungary recorded the highest number of mortality and morbidity due to oral and pharyngeal cancer among all European countries while Cyprus reported the lowest numbers [43]
United Kingdom[edit]
British Cancer Research found 2,386 deaths due to oral cancer in 2014; other studies show this is particularly within the elder population category; only 6% of people affected by oral cancer are under 45.[44] The UK is 16th-lowest for males and 11th-highest for females for oral cancer incidence among Europe. Additionally, there is a regional variability within the UK, with Scotland and northern England having higher rates than southern England. The same analysis applies to lifetime risk of developing oral cancer, as in Scotland it is 1.84% in males and 0.74% in females, higher than the rest of the UK, being 1.06% and 0.48%, respectively.
Oral cancer is the sixteenth most common cancer in the UK (around 6,800 people were diagnosed with oral cancer in the UK in 2011), and it is the nineteenth most common cause of cancer death (around 2,100 people died from the disease in 2012).[44]
Northern Europe[edit]
The highest incidence of oral and pharyngeal cancer was recorded in Denmark, with age-standardised rates per 100,000 of 13.0, followed by Lithuania (9.9) and the United Kingdom (9.8).[43] Lithuania reported the highest incidence in men while Denmark reported the highest in women. The highest rates for mortality in 2012 were reported in Lithuania (7.5), Estonia (6.0) and Latvia (5.4).[43] The high incidence rate of oral and pharyngeal cancer in Denmark could be attributed to their higher alcohol intake than citizens of other Scandinavian countries and low intake of fruits and vegetables in general.
Eastern Europe[edit]
Hungary (23.3), Slovakia (16.4) and Romania (15.5) reported the highest incidences of oral and pharyngeal cancer.[43] Hungary also recorded the highest incidence in both genders as well as the highest mortality rates in Europe.[43] It is ranked third globally for cancer mortality rates.[45] Cigarette smoking, excessive alcohol consumption, inequalities in the care received by cancer patients and gender-specific systemic risk factors have been determined as the leading causes for the high morbidity and mortality rates in Hungary.[46][47][48][49]
Southern Europe[edit]
The incidence rates of oral cancer in western Europe found France, Germany and Belgium to be highest. The ASRs (per 100,000) were 15.0, 14.6 and 14.1, respectively. When filtered by gender category, the same countries rank top 3 for male, however, in different order of Belgium (21.9), Germany (23.1), France (23.1). France, Belgium and Netherlands ranks highest for females, with ASRs 7.6, 7.0, 7.0, respectively.[43]
Western Europe[edit]
Incidence of oral and oropharyngeal cancers were recorded, finding Portugal, Croatia and Serbia to have highest rates (ASR per 100,000). These values are 15.4, 12 and 11.7, respectively.
United States[edit]
In 2011, close to 37,000 Americans are projected to be diagnosed with oral or pharyngeal cancer. 66% of the time, these will be found as late stage three and four disease. It will cause over 8,000 deaths. Of those newly diagnosed, only slightly more than half will be alive in five years. Similar survival estimates are reported from other countries. For example, five-year relative survival for oral cavity cancer in Germany is about 55%.[38]
Oral cancers overall risk higher in black males opposed to white males, however specific oral cancers-such as of the lip, have a higher risk in white males opposed to black males. Overall, rates of oral cancer between gender groups (male and female) seem to be decreasing, according to data from 3 studies [50]
Of all the cancers, oral cancer attributes to 3% in males, opposed to 2% in women. New cases of oral cancer in US as of 2013, approximated almost 66,000 with almost 14000 attributed from tongue cancer, and nearly 12000 from the mouth, and the remainder from the oral cavity and pharynx. In the previous year, 1.6% of lip and oral cavity cancers were diagnosed, where the age-standardised incidence rate (ASIR) across all geographic regions of United States of America estimates at 5.2 per 100,000 population.[51] It is the 11th most common cancer in USA among males while in Canada and Mexico it is the 12th and 13th most common cancer respectively. The ASIR for lip and oral cavity cancer among men in Canada and Mexico is 4.2 and 3.1 respectively.[51]
South America[edit]
The ASIR across all geographic regions of South America as of 2012 sits at 3.8 per 100,000 population where approximately 6,046 deaths have occurred due to lip and oral cavity cancer, where the age-standardised mortality rate remains at 1.4.[52]
In Brazil, however, lip and oral cavity cancer is the 7th most common cancer, with an estimated 6,930 new cases diagnosed in the year 2012. This number is rising and has an overall higher ASIR at 7.2 per 100,000 population whereby an approx 3000 deaths have occurred [52]
Rates are increasing across both males and females. As of 2017, almost 50000 new cases of oropharyngeal cancers will be diagnosed, with incidence rates being more than twice as high in men than women.[52]
Oral cancer is one of the most common types of cancer in Asia due to its association with smoking (tobacco, bidi), betel quid and alcohol consumption. Regionally incidence varies with highest rates in South Asia, particularly India, Bangladesh, Sri Lanka, Pakistan and Afghanistan.[53] In South East Asia and Arab countries, although the prevalence is not as high, estimated incidences of oral cancer ranged from 1.6 to 8.6/ 100,000 and 1.8 to 2.13/ 100,000 respectively.[54] [55] According to GLOBOCAN 2012, the estimated age-standardised rates of cancer incidence and mortality was higher in males than females. However, in some area, specifically South East Asia, similar rates were recorded for both genders.[54] The average age of those diagnosed with oral sarcoma cell carcinoma is approximately 51-55.[53] In 2012, there were 97,400 deaths recorded due to oral cancer [56]
Oral cancer is the third most common form of cancer in India with over 77 000 new cases diagnosed in 2012 (2.3:1 male to female ratio)[57] Studies estimate over five deaths per hour.[58] One of the reasons behind such high incidence might be popularity of betel and areca nuts, which are considered to be risk factors for development of oral cavity cancers.[59]
There is limited data for the prevalence of oral cancer in Africa. The following rates describe the number of new cases (for incidence rates) or deaths (for mortality rates) per 100 000 individuals per year.[56]
The incidence rate of oral cancer is 2.6 for both sexes. The rate is higher in males at 3.3 and lower in females at 2.0.[56]
The mortality rate is lower than the incidence rate at 1.6 for both sexes. The rate is again higher for males at 2.1 and lower for females at 1.3.[56]
The following rates describe the number of new cases or deaths per 100 000 individuals per year. The incidence rate of oral cancer is 6.3 for both sexes; this is higher in males at 6.8-8.8 and lower in females at 3.7-3.9.[60] The mortality rate is significantly lower than the incidence rate at 1.0 for both sexes. The rate is higher in males at 1.4 and lower in females at 0.6.[61] Table 1 provides age-standardised incidence and mortality rates for oral cancer based on the location in the mouth. The location 'other mouth' refers to the buccal mucosa, the vestibule and other unspecified parts of the mouth. The data suggests lip cancer has the highest incidence rate while gingival cancer has the lowest rate overall. In terms of mortality rates, oropharyngeal cancer has the highest rate in males and tongue cancer has the highest rate in females. Lip, palatal and gingival cancer have the lowest mortality rates overall.[61]
|Incidence per 100 000 individuals per year
|Mortality per 100 000 individuals per year
|Both sexes
|Both sexes
|Floor of mouth
|Other Mouth
|Major salivary glands
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- ^ a b Elad S, Zadik Y, Zeevi I, Miyazaki A, de Figueiredo MA, Or R (December 2010). "Oral cancer in patients after hematopoietic stem-cell transplantation: long-term follow-up suggests an increased risk for recurrence". Transplantation. 90 (11): 1243–4. doi:10.1097/TP.0b013e3181f9caaa. PMID 21119507.
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- ^ a b Listl S, Jansen L, Stenzinger A, Freier K, Emrich K, Holleczek B, Katalinic A, Gondos A, Brenner H (2013). Scheurer M (ed.). "Survival of patients with oral cavity cancer in Germany". PloS One. 8 (1): e53415. Bibcode:2013PLoSO...853415L. doi:10.1371/journal.pone.0053415. PMC 3548847. PMID 23349710.
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- ^ Social inequalities in oral health: from evidence to action (PDF). 2015. p. 9. ISBN 9780952737766.
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- ^ Varshitha A (2015). "Prevalence of Oral Cancer in India". Journal of Pharmaceutical Sciences and Research (10): e845–48. Text " volume 7 " ignored (help)
- ^ Chapman, Christopher H.; Garsa, Adam (2017-10-13), "Cancer of the Lip and Oral Cavity", Handbook of Evidence-Based Radiation Oncology, Springer International Publishing, pp. 193–207, doi:10.1007/978-3-319-62642-0_8, ISBN 9783319626413
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External links[edit]
|External resources
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text:
Missile Silo Charlie
Missile Silo Charlie
Missile Silo Charlie is a location in Fallout 76.
Background[edit | edit source]
Main article: R & G Processing Services
Missile Silo Bravo is one of three prewar silos that housed and manufactured intercontinental ballistic missiles, or I.C.B.M's, in Appalachia that were operated by the Commonwealth Defense Administration Ballistic Defense Division. Located between the The Ash Heap and the Savage Divide within the grounds of R & G Processing Services, it was a last-ditch effort in the event of a foreign invasion or attack on America.
Points of interest[edit | edit source]
Notable Loot[edit | edit source]
- Holotapes and Notes
- Overseer's Log - Site Charlie: Located in the above-ground Overseer's Cache box in the elevator building.
Notable loot[edit | edit source]
- Dynamic spawns
- Any ranged ammo
- Junk: Military ammo bag, military grade duct tape, dog tags, ballistic fiber scrap, military-grade circuit board
Appearances[edit | edit source]
Missile Silo Charlie appears in Fallout 76.


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- Arrest Number: 71035
- First Name: KAELA
- Last Name: BALLENGER
- Middle Name: LEAH
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- Current Age: 23
- Booking Date: 11/30/2018 10:53:00 AM
- Height: 5' 1"
- Weight: 150 lbs
- Hair Color: BROWN
- Eye Color: HAZEL
- Race: WHITE
- Sex: F
- Arresting Agency: HANCOCK COUNTY SHERIFF
- Arrest Date: 11/30/2018
- City: Greenfield
- State: Indiana
booking information
KAELA BALLENGER was booked on 11/30/2018 10:53:00 AM. BALLENGER was arrested by HANCOCK COUNTY SHERIFF in Greenfield, Indiana. BALLENGER was 23 years old at the time of the arrest.
KAELA BALLENGER may not have been convicted of the charges or crimes listed and are presumed innocent until proven guilty. Please contact the HANCOCK COUNTY SHERIFF for more information regarding arrest records.
We are not affiliated with the HANCOCK COUNTY SHERIFF and we cannot make any claims as to the validity of the records provided by them.


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Uses language study and linguistic theory to set the rationale for feminist text analysis. The book examines sexism, political correctness, reader positioning. : Feminist Stylistics (Interface) (): Sara Mills: Books. Feminist Stylistics by Sara Mills, London: Routledge, pp. x & ISBN 0 Show all authors. Katie Wales · Katie Wales. University of Leeds.
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ACT Brumbies sign Rugby World Cup star
Argentina scrum-half Tomas Cubelli has joined Super Rugby side Brumbies on a two-year deal from Pampas.
The 26-year-old has made 45 appearances for the Pumas and was a member of the squad that reached the Rugby World Cup semi-finals.
Cubelli's deal with the Australian franchise will not prevent him from representing Argentina.
"We've seen through his performances in The Rugby Championship and the great form he showed at the Rugby World Cup, particularly against the All Blacks, Tomas has the necessary skills and knowledge of the game to successfully fit into our structure, and be a game-breaker in Super Rugby," head coach Stephen Larkham told Brumbies' official website.
Brumbies chief executive officer, Michael Jones, added: "The Argentine Rugby Union have been fantastic throughout the entire period.
"Obviously Tomas is a very valuable property for them but they have taken a very mature and strategic view that, as one of their key players for the future, he would really benefit from being part of the renowned Brumbies program and playing alongside so many Wallabies and under Wallaby attack coach Stephen Larkham."


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It seems quite a while ago I took the leap into full time self employment. The first 8 months were fabulous (although cushioned by savings).
So what have I learnt so far?
1) Always be yourself – all of my current clients have come from word of mouth. Either via other clients or recommendations from twitter or friends. It has helped that I haven't gone for a corporate or overly salesy approach to business but one where I feel natural.
2) Accounting – I go through my accounts on a regular basis and save all invoices and my accounting spreadsheet. Saving back 30% for tax and national insurance before I take a wage. I am super cautious about getting that bit right.
3) No matter what you do you need passion – I love what I do and the fact that it came from something I loved doing already is a huge bonus. When it doesn't feel like work and you get a really good result it's like your child doing something super dooper.
4) Regardless of you loving your job time management is a requirement if you don't want to get overly distracted. My line of work means being social. My family need me to be there for them. Getting the balance right is hard work and requires 3 diaries in our house but that is what works for us.
5) Know your worth – one friend said to me 'If you are happy with what you are earning then that is what is right for you'. For my business self worth vs competitor rates is a very difficult compromise. I have a niche market that can't necessarily afford the rates of my competitors. However you cannot afford to undersell yourself and be pushed from the market and being that ebay cheapie equivalent.
Have you taken the leap to run your own business? What tips would you add?


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Felisi x Officina Slowear:
The Essence Of Made In Italy
From the encounter of two brands that have made artisan quality and the art of making their trademark comes a limited-edition capsule collection of man's bags with a unique, authentically Italian character
rtisan quality, the right amount of time devoted to things, the culture and the research work that make an object's design special and fascinating: all these elements contribute to defining what true luxury is today. A luxury that stays out of the spotlight and yet glows in the eyes of those who can see it, and which is born out of a story made of people and know-how.
Felisi, the Italian brand that conquered the world from a small artisan leather workshop, has quite a story to tell: every single bag they make from original designs and superb materials is conceived as unique and made to last.
Quite the same goes for Officina Slowear, the brand of exquisitely made-in-Italy artisan accessories created by SLOWEAR Venezia.
From the encounter of these two stories comes the brand new Felisi x Officina Slowear capsule collection, featuring three limited-edition man's bags that revisit as many classic designs by Felisi with an exclusive print specially devised by Officina Slowear's creative department.


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How Long Should I Exercise?
Over the last decade, the recommendations of exercise have been boosted to 60-minutes, up from 30 minutes. The origin of the new workout advisements is based on the emerging food intakes of Americans. Since the United States populations are increasing their consumption habits, daily exercise suggestions represent the amount of activity required to count calories.
As a result, there is significant controversy regarding how long one should work-out. The answer can be determined based upon your age, gender, current weight, eating habits, and health goals.
Even for the individuals who are not trying to lose weight, the incentives to get physically active are related to the future of their well-being Nonetheless, the benefit of staying fit may curtail your biological clock from fast forwarding.
Here are the chronic diseases that may be reduced or prevented through regular exercise:
- Hypertension – High blood pressure
- Diabetes
- Specific types of cancers, (For example, breast cancer, and cancer colon)
- Stroke
- Heart disease and cardiovascular problems
In the realm of physical well-being a workout regimen will enable the following enhancements:
- Build and maintain healthy muscles, bone mass, joints.
- Decrease the symptom of stress, depression, and anxiety
- Minimize accidental falls — which may incur a bone fracture in aging adults
- Develop good posture
- Build confidence
- Improve psychological well-being
- Mitigate arthritis pain
- Extend life expectancy and good health
Depending on the source, medical practitioner or personal trainer, between 30 minutes to 1 hour of exercise will be recommended. However, with a reduction in food intake, only 30-minutes (6 out of 7 days weekly) will be necessary for you to reap the health incentives of physical activity. Essentially, well-being is ensured when there is a balance of exercise and nutritional eating habits.


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1.Scope of work:
Scope of work leveraged by Raben events will cover the following:
- Promotional, publicity and marketing – via various methods and strategies that include running tele-faxing VIP invitation , press releases, Media advertising and so on.
- Development of theme and concept, flow of events, system and logistics coordination
2. Workflow Process:
Each of our event is carried out not without due and extensive planning strategies. This ensures all key aspects for successful event coordination are covered. Our events follow the strict guideline and the following signature processes:
- Design, Plan and Execution under One Roof:
From the design, plan, execution and closure of a project, we ensure the smooth running of all aspects in the implementation. All critical areas such Guest Invitation and Management, speakers & Talent Acquisitions, VIP Protocols, PR and Media Relation, corporate Sponsorships, Risk Evaluation & management and Logistics & Saftely will be given the utmost care and attention.
- Backdrop and Stage Creation:
To create a long lasting impression to our audience, the need for a attractive yet meaningful and targeted stage presentation is inevitable. Our productions and design teams work hard to provide you the very much needed customized backdrops and stage sets tailored accordingly towards the theme of our event projects.
- Presentation Tools:
Leave the engineering and technical parts to us. Just tell us what you want to do and we will assemble the latest state-of-the-art technological tools and equipment for your use. We even create Power Point Presentation Materials, Promotional Videos, Speech and Script Writing and other tools as required by you.
- News Release and Promotion Drives:
Off course, No one knows the existence of a major, upcoming event unless it is properly promoted to the right channel and audience. We help to create a buzz and presence with fast and efficient marketing drive that includes Press Release & Conferences, Cold Calling, Leaflet Distribution, Faxing Service and Online Promotion. We initiates press releases and ensure your upcoming event is captured by your targeted audience. We create a buzz using multi-faceted approach to ensure maximum exposure and benefit.
- Closure and Post mortem report:
Our credibility is built through our strong and consistent communication with the client throughout the projects. Just because an event ends, it does not signal the end of relationship. We are able assist our client to discuss and provide feedback about the overall running of the project from the planning stage until the last guest leaves. By doing so, both parties can learn to continuously improve the next event and make it an even bigger success.


text: Key Largo and South Florida Events Event(s) for Thursday, December 06, 2018 Date Event Category 12/5/2018 Light Up Key Largo Business Contest Annual Events 12/6/2018 MarrVelous Pet Rescues Yappy Hour Community Events 12/6/2018 It's A Wonderful Life: A Live Radio Play Community Events The indicates on-line registration is available for this event. Enter your email address and "check" the box for each event that interests you. You will automatically receive an email reminder before the event! Your Email Address Remind me 1 2 3 4 5 day(s) prior to the event date.


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Receive the latest housing news from VHFA by email.
Vermont Housing Finance Agency (VHFA) has issued a Request for Proposals to provide underwriter services for VHFA's bond issuance.
The details of the RFP can be found on our website. The deadline to submit a proposal is Friday, January 4, 2019.
Proposals and questions should be directed to firstname.lastname@example.com. We will be posting your questions related to the RFP, and our answers, on the RFP page.
Vermont Housing Finance Agency (VHFA) has issued a Request for Proposals to provide trustee services for VHFA's bond issues.
The details of the RFP can be found on our website. The deadline to submit a proposal is Tuesday, December 11, 2018.
The Vermont State Treasurer's Office is now accepting local investment financing proposals in the areas of weatherization and housing improvement. Agencies, authorities, non-profits, municipalities, and housing organizations are eligible to apply.
FFY2018 HUD Continuum of Care Program * Notice of Funding AvailabilityREQUEST FOR PROPOSALS
As the Collaborative Applicant for the Chittenden County Homeless Alliance Continuum of Care, the Community & Economic Development Office (CEDO) is accepting proposals for new, renewed, expanded or bonus projects as outlined below with Continuum of Care Homeless Assistance funding from the U.S. Department of Housing and Urban Development (HUD).
Vermont Coalition to End Homelessness (VT-500 Balance of State Continuum of Care)
FFY2018 HUD Continuum of Care Program - Notice of Funding Availability
The Vermont Balance of State Continuum of Care (VT BoS CoC) is accepting proposal applications for projects to be funded by the U.S. Department of Housing & Urban Development (HUD) as part of the FFY2018 CoC Program Notice of Funding Availability.
VHFA invited bids from investors Friday for the "Housing for All" initiative passed by Vermont lawmakers earlier this year. The proceeds from this financing will be used to create and rehabilitate an estimated 650 rental and owned homes across the state.
The Citizens' Institute on Rural Design (CIRD) has issued a request for proposals to rural communities interested in applying for funding to host a community design workshop in 2016 or 2017.
VHFA is looking for a firm (or combination of firms) to perform one or a combination of financial advisory services. We've published a request for proposal (RFP) document at www.vhfa.org to help us in our search.
The contract will likely begin in October 2014. Deadline for replies is September 10, 2014.
VHFA has selected The Reznick Group of Baltimore, Md., for the purpose of auditing its financial statements.
The company received the job as a result of our RFP process in March.
VHFA is soliciting proposals from independent, nationally- or regionally-recognized public accounting firms for the purpose of auditing its financial statements beginning with the fiscal year ending June 30, 2011.
All details are available online.


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White Beaded Collar Choker
White beaded collar choker. 1.5cm deep with nine graduated drops. Longest drop is 7cm. Max length is 35cm including extension chain.
Ref: N102
Choker with gold wire crystal and pearl
Choker with gold wire crystal and pearl.
Ref: N267-1
AB Crystal choker on looped silver wire
AB Crystal choker on looped silver wire. Choker approx. 32cm including extension chain. Made in Italy. Matches bracelet B176-15
Ref: N267-15
Choker with hooped gold wire
Choker with hooped gold wire entwined with crystal bugle beading and individual small and large ab crystals 32cm long with 4.5 cm extension chain.
Ref: N267-151
White Pearl Bead Necklace
White pearl bead necklace on silver chain (Beading goes all the way around the neck to the fastening) Necklace is 38cm long including extension chain.
Ref: N28P
White Glass Pearl Choker Necklace
White glass pearls designed for us in a stunning choker shape.
Note: An extension chain cannot be added to this necklace.
Approx 35cm in length.
Ref: N3770


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"…feels like the best thing in the world."
Things You Might Need
- Gear VR
- Controller
- Headphones or Earphones
Eve Gunjack
Software Name: Eve Gunjack
Age Rating: Family Friendly
System: Gear VR
Type: Arcade
Size: 183.41M
Ads: No
Controller Use: Not Required, But Suggested
Review: Gunjack is a visually stunning virtual reality arcade shooter set in the sprawling EVE science fiction universe. Jump into your heavy weapons turret, power up your guns, and defend your mining platform from deadly waves of enemy ships determined to blast you and your crew into oblivion. With its intuitive controls and intense, immersive action, Gunjack is the ultimate pick- up-and-play VR experience.
The strange thing about this game is just how realistic it all feels! Not that I am saying any of us in the VR shop office know what being inside a giant space turret feels like, but it just feels and looks so real! Sure, it suggests using the headset, but playing this game with a controller feels like the best thing in the world. You will soon believe you are in space and you life does depend on just how well you can shoot. OK, so this is one of the most expensive apps on the Gear VR store, but yet we reckon it is worth every single penny.


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Mr. Miami High
By Amanda Echevarria, News Editor
March 15, 2019
Filed under Briefs, Club briefs, School briefs
On Wednesday, March 13, 2019, over 70 students gathered in the theatre at 3:30 to watch as Honoria hosted their annual Mr. Miami High contest, which is essentially an all-male pageant hosted for fun and judged by teachers. This year's 6 individuals representing their clubs competed for the coveted title o...
SGA- PB&J Service
March 13, 2019
Filed under Briefs, Club briefs, School briefs
On Tuesday March 12th SGA hosted their bi-annual PB&J Service afterschool to benefit Camillus House, a non-profit organization that provides humanitarian services to Miami's homeless population. SGA's PB&J Service invites all students and faculty to make sandwiches that are...
Christian Moreno
By Amanda Echevarria, News Editor
March 12, 2019
Filed under Briefs, School briefs
On January 10th, 2019 as, Senior Christian Moreno sat in his Health Science class, he was surprised with news of a lifetime. While Christian believed that his U.S. Navy Counselor was walking in to tell him he was being kicked out of the Navy, it was quite the opposite. Chief Curtis Bembo...
Principal- Mr. Valdes
By Amanda Echevarria, News Editor
March 12, 2019
Filed under Briefs, School briefs
Principal Mr. Valdes reports that the first ever Top 100 Freshmen dinner held in February was successful in informing those top achieving students and their parents about the advanced academic offerings at Miami High. He would also like to commend the girls' basketball team for their hard work and...
Class of 2019
By Amanda Echevarria, News Editor
March 12, 2019
Filed under Briefs, Club briefs, School briefs
Senior Class Secretary Briana Arroliga reports that Senior Week was a great success, and on behalf of all Class of 2019 officers, she would like to extend her gratitude to all who participated. If any Seniors have yet to sell at least three cakes or candies, please make sure to stop by activities to...
Class of 2020
March 11, 2019
Filed under Briefs, Club briefs, School briefs
Class of 2020 sponsor Ms. Armas wants to congratulate all juniors who received their rings on January 24th, an amazing evening spent with family and friends. She also wants juniors to be on the lookout for new Class of 2020 t-shirts and for a new fundraising opportunity. If you want to find out the la...
Food Trucks Visit Miami High
March 5, 2019
Filed under Briefs, News, School briefs
On March 5th, Miami High students got the opportunity to experience a more laid-back lunch, giving us carnival vibes. A big blue Miami Dade Department of Food and Nutrition food truck, which can feed up to 900 kids, was stationed next to Building 2 in the student parking lot for both first and second...
Skills USA
March 1, 2019
Filed under Briefs, Club briefs, News, School briefs
Cosmetology instructor Ms. Northcut would like to congratulate the students for their hard work at Skills USA Region 5 competition. The gold winner in Esthetics was Ailen Milanes, who has advanced to the State competition in Pensacola, FL. Silver winners were Jessica Torres in Esthetics and Yesenia Nerey...
February 28, 2019
Filed under Briefs, Club briefs, School briefs
Theatre teacher Ms. Cote wants to recognize the advanced theatre students who showcased their teamwork at the One Act competition for Theatre back in November. Emma Alonso, Andrea Burgos, Secret Chaparro, Shantel Chavarria, Mayra Chavez, Melany Goycochea, Nayely Infante, Gisele Joseph, Ashley Martinez,...
Water Polo
February 27, 2019
Filed under Briefs, Club briefs, News, School briefs, Sports Briefs, Sports Stories
The season of the water polo team began on February 14. The first game was a 0-14 loss for the girls and a 4-20 defeat for the boys against Miami Beach High School. On 02/19 the guys and girls both won against Hialeah Miami Lakes. The game against MAST 02/21 got rescheduled because of weather. On 02/25...
February 27, 2019
Filed under Briefs, Club briefs, News, School briefs
HOSA members have worked hard all year and it showed in this year's District competition on January 25th at Robert Morgan Educational Center. The Home Health Aide category was swept from 1st through 4th place by Edith Stubbs, Nicole Colombo, Victoria Mendez, and Liaison Gonzalez. In the Medical Assista...
By Juliana Jaramillo, Staff Writer
February 27, 2019
Filed under News, School briefs, Sports Briefs
Stingarees in the FBLA club made their mark at this year's district competition at MDC's Kendall Campus on January 25th. A total of 8 students across 4 categories qualified for the state competition in March which will occur in Orlando: for Spreadsheet Applications, Harold Hernandez in 1st place, ...