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Get Your Pre-Employment Medical in the Brendale or Lawnton Area
Gympie Road Medical Centre is a state of art multidisciplinary practice located in Lawnton, north side of Brisbane. We are proud to be one of the leading providers of high quality pre-employment medical assessments; work place injury management as well as work cover services. We service residents in Brendale, Lawnton, Petrie and Strathpine.
Pre-employment medical assessments are used to screen individuals for risk factors that may limit their ability to perform a job effectively and safely.
We understand that every medical is different, depending on the role employees are applying for. As a minimum, employees will be required to fill out a health assessment questionnaire and undergo a medical examination by one of our qualified healthcare professionals.
To accommodate all requirements your exam might include anything from straightforward medical checks (such as eye tests and blood pressure) through to more complex fitness testing, hearing test and lung function tests. One thing you can be certain of, you will need to complete a written questionnaire as part of every pre-employment medical.
Our medical practitioners at Gympie Road Medical Centre will review the results of the questionnaire and initial tests results prior to assessing the candidate themselves. Our specially trained doctors will assess and consolidate all relevant aspects of the candidate's medical history and physical condition to make a recommendation in relation to the candidate's ability to perform the proposed role. This report then will be released to the employers.
If you're in the Brendale, Lawnton, Petrie or Strathpine areas book a pre-employment medical with Gympie Road Medical Centre today.
Step 1 – Written questionnaire:
Prior to your medical assessment, you need to complete a written questionnaire. In most cases, the questionnaire will ask very broad questions to gather as much information as possible. You will need to declare all your medical concerns, regarding physical or mental health. Also, be prepared to answer questions about your medical history as well as your current health and lifestyle.
Normally you will need to fill out the form yourself, but occasionally the medical examiner will complete the questionnaire while interviewing you.
Step 2- Medical assessment:
When candidates arrive for their pre-employment medical, our receptionist will ask them to show photo ID and complete some additional forms.
Please bring your ID (Such as Medicare card, driving license, passport etc.) on the day of assessment.
Depending on your proposed role, your medical examination process will be comprehensive from measurement of your blood pressure to your vision, abdomen, chest, heart, spine and limbs. You will also have your urine checked for drugs, sugar and blood. Please be aware that you may be required to strip to your underclothes, so please wear appropriate underwear.
If your job involves demanding physical activities, you might be required to undertake a work fitness assessment (also known as a functional capacity assessment or musculoskeletal assessment), so appropriate loose-fitting clothing and closed in shoes (preferably runners) should be worn.
Types of our Pre-Employment Medical:
PE1 – Basic Pre-Employment Medical:
- Blood Pressure & Pulse
- Vision Acuity & Colour Test (Ishihara test)
- Height & Weight
- Body Mass Index
- Urine Analysis
PE2 – PE1 Pre-Employment Medical plus Audiometry (hearing) test
PE3 – PE2 Pre-Employment Medical plus Spirometry (lung function) test
Additional Tests to Combine with Pre-Employment Examinations
- Urine Drug Screen (only)
- Alcohol Breath Test (only)
- Urine Drug Screen and Alcohol Breath Test
- Chain of Custody Test (for non-negative urine drug results)
- Functional/Fitness Assessments
Functional/Fitness Assessments
Our allied health professionals perform functional and fitness assessments as an adjunct to the pre-employment medical process if required. These assessments are designed to cover flexibility and strength, task matched to the job description. The assessment will provide a better indication of the candidate's physical capacity, allowing employers to appropriately match a job to the applicant's functional capacity.
We strongly recommend the benefits of conducting this assessment on candidates applying for positions with an increased risk of injury, high injury rates or unusual physical demand that might result in injury, for example ceiling-fixers, baggage handlers, and tunnellers.
During an assessment, our allied health professionals check manual handling techniques and provide education to correct and reinforce safe manual handling practices. If there are specific physical tasks required for the position, our allied health professional will design a test to mimic and assess the candidate's ability to undertake that specific function for example, a baggage handling test replicating work carried out in a plane's hold.
Moreover, we are able to tailor our services to employer's requirements (also known as Stand Alone Medical Examinations). In such cases, our team at Gympie Road Medical Centre will develop a medical assessment after consultation with employers to make sure it is meeting industry specific requirements and individual business needs.
Additional Services
These tests occasionally requested by our doctors if clinically indicated.
- X-Ray
- Electrocardiogram (ECG)
- Pathology (blood) tests
- Vaccinations
- Audiometry (hearing) Test
- Spirometry (lung function) Test
Step 3 – Report and recommendation:
Following the assessment, our medical practitioners will provide a report that includes a recommendation on the candidate's medical suitability for the specific role and the risk of aggravating a pre-existing condition or developing a new condition. This enables the employers to appropriately determine their course of action. We ensure you receive the report within 24- 48 hours depends of the complexity of the situation.
Book an appointment for your pre-employment medical today
Choose Gympie Road Medical Centre for your pre-employment medical. Book an appointment with us today by calling (07) 3338 8828. We are available for patients around the Moreton Bay region including Lawnton, Petrie, Strathpine, Brendale, Bald Hills and Warner.


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Home/Contact | News | Committee | Survivors | Prisoners | Photos | Links | Order Book
For Immediate Release April 20, 1993
The Federal Bureau of Investigation then made every reasonable effort to bring this perilous situation to an end without bloodshed and further loss of life. The Bureau's efforts were ultimately unavailing because the individual with whom they were dealing, David Koresh, was dangerous, irrational, and probably insane.
This weekend I was briefed by Attorney General Reno on an operation prepared by the FBI, designed to increase pressure on Koresh and persuade those in the compound to surrender peacefully. The plan included a decision to withhold the use of ammunition, even in the face of fire, and instead to use tear gas that would not cause permanent harm to health, but would, it was hoped, force the people in the compound to come outside and to surrender.
Again, I want to say as I did yesterday, I am very sorry for the
loss of life which occurred at the beginning and at the end of this
tragedy in Waco. I hope very much that others who will be tempted
to join cults and to become involved with people like David Koresh
will be deterred by the horrible scenes they have seen over the last
seven weeks. And I hope very much that the difficult situations
which federal agents confronted there and which they will be doubtless
required to confront in other contexts in the future will be somewhat
better handled and better understood because of what
has been learned now.
I was further told that under no circumstances would our people fire any shots at them even if fired upon. They were going to shoot the tear gas from armored vehicles which would protect them and there would be no exchange of fire.
And so I asked if the military had been consulted. The Attorney General said that they had, and that they were in basic agreement that there was only one minor tactical difference of opinion between the FBI and the military -- something that both sides thought was not of overwhelming significance.
I will say this, however. I was, frankly, surprised would be a mild word, to say that anyone that would suggest that the Attorney General should resign because some religious fanatics murdered themselves. (Applause.)
They have evidence that those children are still being abused and that they're in increasingly unsafe conditions, and that they don't think it will get any easier with time -- with the passage of time. I have to take their word for that.
This is the same FBI that found the people that bombed the World Trade Center in lickety-split, record time. We want an inquiry to analyze the steps along the way. Is there something else we should have known? Is there some other question they should have asked?
There is, unfortunately, a rise in this sort of fanaticism all across the world. And we may have to confront it again. And I want to know whether there is anything we can do, particularly when there are children involved. But I do think it is important to recognize that the wrong-doers in this case were the people who killed others and then killed themselves.
THE PRESIDENT: They were not just practicing their religion, they were -- the Treasury Department believed that they had violated federal laws, any number of them.
Q What federal laws --
No Answer
Clinton Says Law Enforcement Errors Don't Compare
to Waco "Depravity"
By Marcy Gordon
Associated Press Writer
July 20, 1995
WASHINGTON (AP) - As House Republicans expressed
concern about the use of military force during the Waco siege, President
Clinton today angrily rejected any suggestion that law enforcement mistakes
were comparable to the "depravity" of cult leaders.
As the Waco hearings entered their second day focusing on the military's role, Clinton told a group of law enforcement officials, "It is irresponsible for people in elected positions to suggest that the police are some sort of armed bureaucracy acting on private grudges and hidden agendas."
"That is wrong. It's inaccurate and people who suggest that ought to be ashamed," he said.
Clinton spoke as Republicans running the hearings voiced concern about the military's role.
"More than any other, the image of Bradley fighting vehicles and M1 tanks set against the burning Mount Carmel compound calls into question the role of the military at Waco," said Rep. Steve Buyer, R-Ind.
"Since before the founding of our nation," he said, "Americans have had deeply rooted concerns about the separation of the military from civilian affairs."
Clinton, speaking across town at a monthly meeting of law enforcement officials, acknowledged that the government made mistakes in Waco and said "changes were made, people were dismissed."
"We need to be accountable, we need to get all the facts out, if we make a mistake we need to correct it," Clinton said. "But we must not make war against police and we must not confuse making mistakes ... with the awful things that happened in that compound at Waco."
He said the hearings were "a sad and painful reminder of the depravity that took place inside that compound."
A former FBI expert who appeared before the panel today underscored the high risk of the so-called "dynamic entry" attempted in the raid by the Bureau of Alcohol, Tobacco and Firearms.
There was "the exposure of the approaching raid teams. ... They couldn't turn their vehicles around as they approached the compound," said Donald A. Bassett, a former FBI crisis management specialist. The Defense Department was allowed to help prepare ATF for the raid because ATF officials said they had evidence that the Branch Davidians were operating an illegal methamphetamine lab.
No trace of an illegal drug lab was found after the fire, leading some opponents to suggest that ATF concocted the rumor to get the military assistance.
A Democrat on the panel, Rep. Sheila Jackson Lee of Texas, said today that the use of the so-called "drug nexus" as a basis for military help was inadequate. "That nexus fell short. Let us acknowledge that," she said.
For evidence of Clinton's obstruction of justice on Waco, click here.
For photos of 1998 Impeach Clinton rallies, click

subset: commoncrawl


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Teen Spirit Nirvana Poster 61cm x 91.5cm (24" x 36")
Product Description
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Stewart and Sentinel. Peaks 94 and 95. Sentinel Wilderness Unit
Entry posted by Neil ·
740 views
The Sentinel Wilderness Unit houses 5 Hundred Highest Peaks. Pitchoff is the only trailed peak and I did it on my first day for peak number 3. This map shows the Unit quite clearly.
We started the hike of Stewart a bit late due to human (ie. me) error in setting the alram clock. However, the extra hour's sleep after a 12h30m hike in the Santanoni Range was salutary. At low elevation the going was quite easy through hardwood forests. Just when we crossed onto state land we saw a hunting blind. The owner had sawed off about 100 trees in the immediate vicinity, I imagine to create shooting lanes and encourage the growth of browse. We followed a compass bearing and came upon an old logging road that appeared well-maintained. The road followed a drainage and followed our compass bearing exactly. Then it stopped suddenly and we bushwhacked to the summit of Stewart through mostly open woods. Near the end it became very steep and David did a fantastic job of showing Jean and I how it's done. We wandered a bit on the summit looking for the letter S carved into a tree and then I looked up and saw I was standing right next to it.
Our next goal was a col 500 vertical feet below down across moderate slopes with the occasional steep drop. It did not go as easily as the appearance of the terrain suggested it should have. This was due to a very hard crust of ice under ball-bearing snow. We took turns going sprawling. Getting a grip (pun intended) was difficult. One of us swore copiously and with great acoustic volume. I began to re-consider my route plan to Sentinel, which involved a mile of steep side-hilling under the Sentinel's NW ridge.
I have drawn my originally intended route on this map.
I had done this side-hilling in the opposite direction in summer and I remembered it as being very steep. Just as we began to round the ridge I conferred with Jean and we decided to go up onto the crest of the ridge and take our chances with it. On the map it looks like a good route but in reality I knew it could be very bad. Up on the crest we were exposed to very cold and insistent winds. Throughout most of the distance the woods were fairly open but the tight areas were brutal. We were very cold and wet and the wind was cruel. In spite of having dry changes of clothing we didn't stop to change because doing so would have meant exposing ourselves to the cold winds. So, we kept pressing on. If one was in the lead he managed to keep ahead of feeling hypothermic but in 2nd position it was colder. We had to stop often to verify our navigation and make route choices (the ridge is not an obvious knife-edge) and ensure we were taking the best lines. At these times we immediately began shivering hard, too hard, but we preferred pushing on at the edge to changing clothes.
I kept a sharp eye on myself and my mental faculties and asked Jean how he was doing regularly. David, whenever I checked him was his usual self. Topo looked quite green. We were aiming for a mini-col to the immediate NW of Sentinel. Near the col the woods opened right up and being in the lead, I charged through at high speed. But, when I stopped and verified my compass I saw I had unwittingly veered about 150 degrees off-course in less than 5 minutes! I believe it when I read that there is no such thing as a "sense of direction". We had no choice but to turn towards the thick woods and tangled blowdown and expose ourselves to those bitter winds. And the wind was very strong now funneling through the col. The final couple hundred yards required a lot of intense focus, patience and extremely hard work through hallmark ADK cripplebrush. David asked me if this was in my top ten of difficult hikes. I didn't respond but had long since considered it to be the toughest hike I have ever done.
We finally made the summit and saw the sign but did not break stride. The woods opened right up and the wind was at our backs. We made 500 meters fairly quickly but I made a wrong turn (I was paranoid of "falling" off the ridge) and we descended something wicked steep and David nearly bought the farm. I called out, "don't go down there as he was lying on his back, sliding feet downhill towards a 10 foot vertical drop and yelling to me, "I'm trying REAL hard not too".
Straight ahead I knew we would run into cliffs and so I led us downhill to the south and then I decided to curl northward under the cliffs and set us up to descend towards the ridge that leads to the Cobble. Well, I curled too early and we ended up descending the valley to the immediate north of the Cobble ridge. This turned out for the best (once the guys got me to accept it) and we had about 2 miles of easy trudging through wide open hardwoods sloping gently downhill to Bartlett Road. When we paused to put our headlamps on I finally changed into a dry base layer shirt, put on my puffy jacket, a dry shell, new mitts and shell mitts and one more hat. It felt incredibly good and I mentally castigated myself for not having done so 2 hours earlier.
David's presence of mind and 2 bars of cell signal resulted in Tmax picking us up on Bartlett Road and delivering us to our vehicles. While waiting for her I privately mused that I had 5 peaks still to do.
Me two days later on the summit of Wilmington (96). Very mellow hike following Luc Labarre's broken trail!


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Careers at The Dedica Anthology
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There are currently four hotels within The Dedica Anthology, each individually named to reinforce its unique personality and sense of place. They are: Palazzo Naiadi in Rome; Grand Hotel dei Dogi in Venice; New York Palace in Budapest; and Carlo IV in Prague. Palazzo Gaddi Firenze and Hotel Plaza Nice will come under the aegis of the brand in 2020.
Underpinned by values of authenticity, curiosity and open-mindedness, The Dedica Anthology brand is a vibrant part of a city, an upbeat blend of details and rituals and a charming storyteller, powered by people with a mastery of hospitality and a human touch.
If you would like to build your career by becoming part of an exceptional team committed to delivering our brand of curated, contemporary hôtellerie, please explore our current employment opportunities or click on the link to submit your CV for general consideration.
The Dedica Anthology is an equal opportunity employer committed to hiring a diverse workforce and sustaining an inclusive culture. The Dedica Anthology does not discriminate on the basis of disability, religion, race, sexual orientation or gender identity.


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chapter two: styx
Styx considers knocking over the marble sculpture in The Grandfather's entryway. The snow white wings and cold empty eyes are supposed to be reminiscent of an angel, she muses. But the teeth—bared in what may have been a smile, if the sculptor was blind or missing lips—appeared demonic and hellish.
Styx contemplates knocking the sculpture over for a full three minutes while The Grandfather keeps her waiting. Not because she's particularly destructive—she isn't. She just wonders what kind of sound it will make.
She can count on one hand the number of times she has stood in The Grandfather's foyer—or stood in his presence at all, really.
The first on her fifth birthday, the day before kindergarten. He visited Mom and Pops' "home," and Styx was forced to wear a dress meant for church (according to Blue) which was weird because Mom and Pops told her Santa and Jesus were friends and she stopped believing in Santa the year before. But Styx stood in the living room in her shiny shoes and scratchy dress while The Grandfather looked down his nose at her and even at five she knew that he was someone she should be afraid of.
She couldn't tear her eyes away from his. Staring into them was like staring into fire and she couldn't tear her eyes away. He returned her unblinking stare for some time before stating, memorably,
"I am sad to remark her resemblance to The Dead Mother."
Styx didn't know Mom wasn't hers, until that moment.
The second time she saw him was through a window. Styx and her best friend Blue were on a field trip with the rest of the sixth grade. Styx stared into the tiger cage remembering eyes that looked similar to the tigers and then he was there, standing on the other side of the exhibit, directly across from her as if summoned. He didn't speak a word, he simply stared. He gave her a brief nod through the prism's of glass before turning and walking away.
The third time was when she started high school. Mom and Pops tried to create false excitement—well, Mom did, Pops just frowned and grunted—both monotonously reciting to her that this was "a great opportunity" and that she should "thank The Grandfather for his generosity." As she sat across from him in the limo staring into those glittering eyes once more she could only think of one question to ask:
"How many people have you killed." He seemed surprised by her question and she wondered if he considered kicking her out.
"What makes you believe that I have killed people? Did Mom or Pops tell you this?"
"They didn't have to. You just look like you've killed someone." He chuckled, and she felt as if she were doused in ice and flame simultaneously.
"Dear Styx. Never do yourself what you can pay another man to do for you. After a while. . .the man will do it for you for free." Styx doubted this. She contemplates pointing out to him that no one would accept killing enough to do it for free, but she nodded anyway, satisfied by his relative honesty.
The fourth time was six months ago. The Grandfather invited Styx to his home for dinner—just him and Styx. The awkward tension was made more awkward with Styx's question:
"Where is my father." The Grandfather stared at Styx coldly before responding.
"Deceased, I suppose."
"And my mother?"
"Deceased, assuredly."
"How do you know?"
"I could not say."
"Did you kill my father? And my mother?"
"Hardly." Brief pause. Styx assesses him cooly before continuing.
"Are we related?"
"Fundamentally. I suppose."
"Is that why you have me over? Because we're related? Or because you love me."
"Styx. As your only living relative, let me give you a piece of advice. Love is irrelevant. And useless. If you must love, love animals. Plants. Never people. Animals die, you bury them. Plants wilt, you throw them away. But people. People die and you die with them. I have you over because we share, at our core, that which is essential. I am interested in you. A passing interest, I must confess. But it is an interest. I hope that is enough."
Styx stalled briefly.
"If I cared, it might be. But I don't." The Grandfather laughed then, laughed so hard that tears streamed down his cheeks.
"Indeed? I do believe we are relatives, dear Styx."
This is the fifth. The Grandfather invited her—sent her a real invitation—to a black tie dinner. She isn't sure why but she stands in the foyer listening to muted music beyond the french doors with a large man in black staring suspiciously at her. She can't bring herself to care about him—Mom's doing, not The Grandfather's. Styx feels the tug at her heart, the strange homesickness she feels when she's in a place for too long. The feeling of missing Mom and Pops, the want to be missed.
She turns away from the sculpture at the exact moment that the man beckons her to the doors. Styx takes a huge breath into her lungs, pauses for a second, and walks inside, head held high.
She is not, however, entering the party. Behind the french doors she is ushered into The Grandfather's office. Large, plush, with muted red carpet and rugs and large paintings hung from the walls, the office is rivaled in intimidating intensity only by The Grandfather, who sits comfortably behind the large oak desk, his feet propped lazily on the top.
"Dear Styx. Welcome. Have a seat. Cigar?" He beckons to a guard, as large and as forgettable as all the others, who offers Styx the case. She holds up her hand in protest casually, her eyes never leaving The Grandfather.
"No, thank you. I appreciate your inviting me over. Can I go home now?" The Grandfather offers her another laugh, the smile not quite meeting his eyes.
Styx wonders if this smile belongs to her father as well. Belonged to her father.
"In a bit, Styx. I will not keep you long, I promise. I have a business opportunity that I would like to offer you." Styx raises a suspicious eyebrow. Mom and Pops have only ever been honest. She knows what type of business The Grandfather conducts. Her interest is more than passing, but the prospect of working for or with The Grandfather turns her stomach.
"I'm not interested," Styx lies bluntly, rising from her seat.
"Sit down, Styx," The Grandfather commands. Styx flinches, but regains her seat, perching apprehensively on the edge.
"Please," The Grandfather corrects himself. Styx sighs but relents, relaxing back into the cushions.
"Now, I want to explain my—" His phone rings before he continues. He answers, responding in three words: Yes. No. Now. "I apologize dear Styx. I will be a few moments, please make yourself at home." He excuses himself hurriedly before leaving the room, closing the door sharply behind him.
Styx waits silently, absently gazing around the office, her eyes skipping over the photo twice before she realizes the familiarity.
This must be her father. The nose. The eyes. They are hers. He stands next to The Grandfather, the space between them indicating the chasm of their relationship. Styx estimates he must be about 18 or 19 in the photograph. She wonders if he knew her mother then. She wonders if he loved her. If she loved him. She places the photo down awkwardly, feeling ashamed for caring.
Mom would be ashamed if she knew.
As she turns from the shelf an envelope catches her eye. She isn't sure why. She will never be certain. Perhaps it is the awkward placement, jutting out crisply from volumes of judicial lore. The color is striking against the darkened leather that characterizes the rest of the room. The envelope is thick in her hands and she glances at the door, listening intently. She hears music from the room beyond, but no tell-tale footsteps indicating The Grandfather's return. Sitting down at his desk she pours the contents from inside.
Two things are immediately apparent.
Styx needs to run. And she needs to run now.
Pops' voice is in her head. Down. It doesn't matter how you get there, just get there. Remember balance and awareness. Jump.
Styx tucks the envelope beneath her dress before standing on the window sill, prying it open. A large burst of wind pours through, and the distance to the street at the bottom appears surprisingly short. Still she does not hear the turning of the knob, nor does she hear The Grandfather's shouts from the door. She simply climbs up to the window, looks down at the street below, and she leaps without demurring.
Well shit. If I ever run across that sonofabitch I'll yank out his intestines. Me and the kid should be out there flying by night, staying under the radar. We only have days to catch the Ferry. I can see the bike out of the grime from the window. Dead. Not "needs a break" dead, but "we'd be better off riding a mule" dead. I paid $1,000 dollars for scrap metal dead.
I'm going to repay the favor to that sonofabitch dead.
"So," I begin talking to her in large part to keep my mind off of our hopeless predicament. "What kind of name is Styx?" She doesn't answer for so long that I begin to wonder if she heard me. As I contemplate asking her again just to have something to do she turns to me, a small smile in her eyes.
"The kind I was born with. What kind of name is Townie?"
"The kind of name that I was given. You weren't born with Styx."
"I guess I may as well have been. It's the only thing my mom gave me. She died right after I was born."
"I'm sorry," I offer, feeling artificial, my platitude empty. It's empty because I don't feel sorry. The kid is smart, though, and she frowns at me.
"Don't be. You didn't know her. Neither did I." We sit in silence for a few moments and I watch her carefully. She keeps peering into the bag, which I know isn't filled with dolls, but she ain't my kid so I'm not responsible for what she carries. She's still doing the leg jerking thing, but now I don't think it's because she's afraid. She don't express fear in her eyes the way The Girl might. In fact, she seems impatient. Like she's ready to move and she don't care too much where she goes. I definitely think she's a runner. Which is good, because we're going to have a hell of a time getting out of here.
The bar is about 100 miles west of where I first picked her up. We're both covered in dust and dirt but we're the cleanest things in this place. We're huddled in a corner at the back of the bar, her face obscured by shadow. From here I can see everyone who comes and goes without them seeing me until they get close. I don't think he'll find us here because he can't be sure which way she ran, but then again, The Grandfather seems to have eyes everywhere. I think the kid knows this. That's why she keeps looking around, like she's waiting for something. Someone.
Okay. What would a parent do?
Well, Mama would have thrown back a few and Daddy would have thrown a few punches in response.
What would a real parent do? Ask about hobbies? Favorite food?
Fuck it, I'm not parenting material.
"So Mom and Pops raised you?" I prod. In part because I'm still fuming about the dead bike, but also because I want to know what kind of risk I'm taking carrying her to the Ferryman.
I would like to think that I'm the type of person that will help out someone in need. A little girl like Styx, I'd like to think I'll see her on the side of the road looking for a ride and I'd help her. That I would know that she's a kid just caught up in the wrong-place-wrong-time scenario and I'd say "I'll help you with no thought to what it might cost me."
But I'm not and she's not. No, Styx ain't in need. Well she is, but she ain't innocent. Can't be.
Before I worked for The Grandfather I did odd jobs here or there. Fixed what needed fixing. Broke what needed to break.
Buried the bodies that needed to buried.
But The Grandfather is a different breed. I didn't have to search for him—he found me. He sent me out for a year to watch someone. Some "friend" that his nephew or son knew.
An entire year spent watching.
The Grandfather doesn't like His Family to get our hands dirty. Says he wants us to know as little as possible.
I don't even know the "friend's" name. Never found out.
I just knew her comings and goings, the. . .intimate details. . .of her relationship with the son. Or nephew.
The Grandfather never even told me it was time. He didn't come out and say it. He just gave me a letter that had a date, time, and code.
The man was late. Extremely late. I started to wonder if The Grandfather hadn't set me up when the man finally showed up, small package in hand. I tore it open without even bothering to read it. Walked into her room without question. She was sleeping with the baby in her arms. I looked at the baby and then I couldn't stop looking. By the time I could tear my eyes away it was almost too late. I hadn't hit my growth spurt yet so I could barely reach the bag. But I did. I injected it and left the room. I imagined that I heard "code blue in l&d," but it could've just been my imagination. I was only, what, thirteen. Still a kid, really. I tried to pretend that whatever he gave me to give her was just to put her to sleep. Not permanently. I don't know why I cared. I didn't care before. I haven't cared since. But I pretended all the same.
I never saw the "friend" again, though. In a way I'm glad I didn't catch her name.
No one questioned me being at the hospital, now that I think about it. No one even blinked. In fact, they all looked through me. As if looking at me would get them killed.
The Grandfather has a reach and it is far.
So why am I helping Styx? The Grandfather is after her, that much I know.
Mom doesn't say much, and Pops says even less. The conversation went like this:
Mom: Townie. I'm calling in a favor
Townie: I don't do favors
Mom: Fine, I need you to get someone to the Ferryman
Townie: He's hard to catch these days. It's gonna cost you.
Mom: It always does. She needs. . .she needs to be protected.
Townie: From?
Mom: The Grandfather
Townie: Are you insane? Mom, have you lost your goddamned mind? Why would go against my bread and butter
Mom: Townie, please. I can pay you.
Townie: . . .How much?
Mom: How much does it cost to find the Ferryman these days?
Townie: One.
Mom: One hundred?
Townie: One million
Mom: Half
Townie: Sold. But if we get caught up I'm ditching the kid.
Mom: I would expect nothing less
After I started thinking. One, I definitely got the short end of the stick. Mom and Pops ain't together together, but I know they can at least pool their resources. I'm over here eating eggs and grits and shit and they're living in that mansion on the coast. Plain sight. We all live in plain sight, to be truthful. That was one of The Grandfather's requirements. We know of each other. He knows us.
But anyway, I started wondering if it's worth it. To take the girl underground. The Grandfather will know. But I need the money. This isn't some vigilante mission. I don't know why he wants her and I don't want to know. I know I need the money. And I can talk Mom up to a million.
I'm still on the market, besides. Mom knows I'm a businessman before anything else. If The Grandfather finds us before we get to the Ferryman and he's in a gambling mood, I'll play. I ain't got morals to sell, and my soul is long gone besides.
Yeah. I'll definitely play.
Even if she does remind me of The Girl.
I bet Townie's laid up somewhere fuming. I wouldn't have sold it to him but the boy doesn't have the sense God gave a billy goat.
Lucky for me I don't have good sense either, but I can make a quick buck.
And shit. Townie knows good and damned well he won't find a decent ride for a thousand dollars! Easiest thousand I've made in a while. If I had any kind of heart I'd feel bad. But no kind of honor amongst thieves and all.
I make good money from The Grandfather. I should—I've worked for him for damn near 25 years. And I don't have a pension plan.
The Family isn't loyal, so that's not why we stay. Not me and Olive, anyway. We stay because the money's good, the rent's cheap, and yes, I admit there's a thrill to the kill.
Townie's problem is he thinks too damned much. Always trying to find that fucking girl. That—his being loose minded—makes him soft. Weak. The Grandfather has to know that, so I don't know why he keeps him around.
Maybe the pretty-boy attitude and the lack of brain cells makes him harder to follow. He's not as good as I am but he's still alive, so that must mean something.
Mom and Pops are the same as Townie. Too liberal with their affection. I don't know what the fuck is going on with that girl they're raising, but that side of the family is fucked up. No one in The Family speaks of it, but we're pretty sure Styx is related to The Grandfather—really related, not this family of killers shit we have going.
Olive was pretty torn up about Styx going to Mom and Pops and not us. They aren't even fucking let alone nuptualed, so I don't know what kind of shit's going on over there.
Now Pops. . .Pops is crazy. I've worked with him one time, and I'll never do it again. A few years back Hyde sent Pops and myself down into Columbia. Never been before, never want to go again.
Incognito. Hyde clearly said be incognito.
I remember yelling that at Pops, too, the coppery taste of blood still in my mouth. I could barely see through the heavy smoke. I turned to Pops, or the direction that I thought he was in, and and shouted, "The fuck?! You could've killed me, too!" That crazy motherfucker didn't even have the decency to look sad when he stepped through the smoke to stand in front of me. He just turned his eyes at me, stared into my soul, and looked away.
We were there for one man, some diplomat that was loose with his constituents change. We had one mark.
The final count was 16. I work for the money and the money alone and I'm the first to admit I don't care about their families, where they've come from, where they're going. But Pops—he really doesn't care. He doesn't care who gets caught in the crossfire as long as he hits his mark. I don't even know if the blood I tasted was mine.
Yeah. Never again.
I think about him when The Grandfather calls. Usually he has Hyde contact me and Olive, so when I hear his voice I perk up. I stand by the window in the dining room, listening to his instructions while watching movement across the street.
In the 25 years that I've worked for him The Grandfather has never surprised me with a mark. So when he gives me the name—the names—I ask him to repeat them. Not because I didn't hear—I can hear better than most.
I just need to hear them again. I guess I need to make sure he's sure.
Guess I'll be seeing Pops again after all.
I had a house collapse on me once. Before I entered my tenure with The Grandfather I worked with a different type of family in London. We were tracking a small group of anarchists—amateurs, really, but without a core ideal between the lot of them. At any rate Prick (his name was Pritchard, but Prick was far more suitable) wanted to embed with the group.
He sent me in first, of course, saying I was sweet. Trusting. The rebels, they would trust me.
One week, and we'll pull you out, he promised. Two, tops.
It took me six hours. It wasn't difficult to become acquainted with the young members of the group—a few shots all around and they invited me in.
They were based outside of London, in an older, Edwardian home tucked away safely in Marlow. I remember walking briskly up the long cobbled drive wishing I had been given more protection than my wits.
By the time I entered they were in the middle of a card game—spades, I think. My heart beat so hard and fast I was certain it would give me away. I didn't ask about their mission or their goals—I didn't have to. The youngest there was no more than 14. He could have been my kid brother. They were all children, really.
He didn't talk. I never heard him speak. He hummed—dodo l'enfant do. His humming was sweet and innocent; they played cards through it, but not impervious to the sound his humming made. It was calming. Peaceful. He met my eyes curiously throughout the games, but his humming was soothing and I couldn't interrupt.
I would have perhaps asked about their families later, but I heard the noise first. A small buzzing sound—not at all like the beeping from the films. No the buzzing was loud and the smell was hot and I looked up for just a moment, making eye contact with Prick, staring down into a window. His eyes were like death, and he nodded just once at me before turning away. The explosion came instantaneously.
The feeling of being engulfed in flame is so intense as to be overwhelming—my mind could not comprehend. The smoke from the bomb—homemade, I later discovered, supposedly detonated by the rebels by mistake—was black and billowing, stretching up into the sky far beyond what my eyes could see. The roof was gone. I tried to move, but my left leg was warm and sticky with blood, a heavy body resting on it. The body was still warm but the eyes—which peered into me—had gone cold. The one who looked like my brother.
With shaking hands I reached down to close his eyes before straining to roll him off of me. His body in death was heavy. I couldn't stop the shame from bubbling in my stomach, shame that overflowed in the form of angry, hot tears. As I groaned with effort the house groaned with me. Through the smoke and coughing I ascertained that the entire roof was not, in fact, destroyed, and the three stories that I could see above seemed to be sagging.
My own breath was my undoing.
I inhaled sharply, taking in the heavy floors about to give way. I exhaled and the roof caved in, the building around me crumbling loudly.
The boy's body saved me. Hours later, when I was dragged from the rubble, I still held him close to me. Oddly bruised and mangled, his eyes were once again open. I did not bother to close them again.
My own eyes locked on the face above me, the arms that gripped me cruelly tight. It was not, as I had imagined, the face of a rescuer.
No, it was Pritchard. His eyes—I had longed for those eyes—had become dark. Pure hatred seemed to glow in them. . .a hatred reserved for me.
His mouth was moving and I'm certain words were coming out, but the bedlam of the explosion had rendered my ears useless.
My eyes were still trained on him as he lifted the gun, held it directly above me before lowering it to my knees.
Pritchard never was a good shot, but the bullet lodged below my knee and I imagined my scream pierced through the night. The pain shattered my senses.
"Why?" I knew I wailed, but of course I could discern no answer.
Instead he pointed the gun at my eye, backing away carefully. Perhaps he changed his mind.
He didn't want my blood on the uniform. He smiled—no, sneered—down at me, and I watched his mouth move.
Beg, he mouthed. Beg me to spare you.
I couldn't believe I loved him. How did I love him? I wanted to beg for my life. Beg for something from him. Something like, "Fine. Don't love me. But don't leave me here. Please don't kill me." But I couldn't. My mouth didn't move. My refusal made him angry, and the pools of black grew ever larger.
As the bullet exploded from the barrel I was aware only of the burning pain in my throat, the albatross of Pritchard slowing and stopping my heart.
The smoke that surrounds me now is a different type, and I have learned to see through it. On my sooty, gray-gloved hands and sore knees I crawl around the floor, peering through the lifting smoke. In the distance I hear sirens.
Only seven minutes separate us from the complete, timed destruction of the house.
I am not a cook, which The Grandfather should well know. He must have known, because he is nowhere and I am almost certain the blast did not take him. It may have rendered him partially deaf, but the brunt of the blast came from the kitchen. The Grandfather likely walked away with smoke inhalation, slight bruising, and a killer's thirst. But Pops. . .
My knees throb painfully but I keep crawling, determined (or perhaps desparate) to find him in the rubble. At last I do, and my heart catches in my throat.
His eyes are closed tightly and his nostrils are flared in unmasked pain. Blood trickles steadily from his nose, complemented by an angry gash on his forehead. Peeling off my gloves I press my finger to his neck.
His pulse is light and faint, but his heart still beats.
I breathe a heavy sigh of relief, breath I didn't know I was holding. Lightly I trace his brow, calculating the distance of the ambulance. Three minutes. Pressing a chaste kiss to Pops mouth I rise steadily, heading for the kitchen. A small fire still simmers in the corner, and the stove emits a loud crack every few seconds. Ignoring both I reach underneath the smoldering sink, pulling the lever. The top of the kitchen island—still standing—rises gently. The top drifts away to reveal several drawers. From the first I pull a small case, heavy with the clothing I'll need for travel. From the second I grab another case, larger and heavier than the first. I hesitate for a moment before pulling open the third drawer. The only drawer that I shouldn't have.
The photo of Styx is my favorite. I shouldn't have a favorite. It is normal and a part of our story to have photos of us pretending happiness with our "daughter" in the event we had guests or visitors.
Our happiness was never pretend, though.
I wonder if The Grandfather knows that. Has always known.
This photo—I was caught off guard. The photographer—I have never known who exactly took the photo—snapped the picture just as I was looking down at Styx and she was looking away. The love for her that I didn't know I carried until this photo was delivered is written plainly on my face. It is undeniable. It is in the pride of my eyes, the genuine light in my smile. Styx's eyes are closed in an eternal giggle, her dimples deep and her curly hair hanging over her forehead. My hand is suspended just above her head in the photo, my futile attempts to brush it from her eyes captured forever.
I contemplate leaving the photo behind. Whomever sent me the photo all those years ago must have known that this day would come. Must have felt that I would stand at this crossroads—do I find Styx and cede her to The Grandfather? Or do I find Styx and deliver her to safety? Or (perhaps more like what I should be) should I just run? Run away and keep running?
Gripping the photo tightly I press the lock code, backing away as the island readjusts. Rushing back into the living room I can see the lights of the firetrucks down the block. Kneeling next to Pops I lean close to his ear whispering,
"I'm sorry."
As I leap over the fence separating our yard from the neighbors I do feel guilt. I hope he survives. I want him to. When I place enough distance between myself and the house I stop, panting for breath.
Pain. Pain in my leg. Looking down I realize that a shard of glass juts out painfully from my calf. Gritting my teeth together I pull it out, gasping with the shock of removal.
My chest aches and briefly I contemplate the glass shot into there, too. Looking down at my dress, ruined by smoke and ash, I espy no glass. My pain is internal. As unnatural as it was before, but ever deeper.
The house. Our home. Our makeshift family. The photo. A brilliant wave of turmoil threatens to overtake me. I breathe steadily, walking stealthily to the car hidden in the shadows of the abandoned house four blocks from ours. In the distance I can see the smoke billowing into the sky.
Squaring my shoulders I make my decision. Starting the engine the car purrs down the street and into the night, the black within and without taking me again.
The others think I killed my family. My real family, I mean. They don't agree on the details, but there's always a kid sister. The story surrounding them varies depending on who's telling it.
"He murdered them. Every one. The Grandfather sent in van Cleef but Townie'd already done the job. van Cleef felt so bad he kept him. Thought The Grandfather could use him."
"The sister was orphaned by their parents when he was twelve and she was just a baby. He ran off with her and raised her himself. After she died—fiery crash, I'm told—he went crazy. I don't know how he met The Grandfather. But The Grandfather took pity on him and brought him in."
"The parents were burnt up in a fire. So bad the dental work couldn't even identify them. Somehow Townie and the girl—a twin sister, I think—survived. They were both adopted by The Grandfather. Don't know where the girl is now."
"Stop it. Townie was a nice boy. He got into a bit of trouble—got a girl pregnant, I think. He sends money."
In the darkened corner of the booth Styx stares at me, waiting for a response. Shrugging I pause as I squint at the door.
"There's a girl," I begin, my eyes still focused on the door. "My sister. I call her Georgia. Called her Georgia, I mean." The kid's eyes widen for a moment, fleeting sympathy on her face. There but then it's gone. Damn. Mom and Pops have conditioned her but good, because now she stares into me, emotionless and impassive as stone.
"She was murdered. Our parents were killed first. We were told it was a crash. It wasn't until after—after Georgia was murdered—that I found out. Somebody—I don't know who—someone killed them. And her. That's why I'm in The Family." This time the sympathy in the kid's face is unmistakable.
The kid was raised by a pair of assassins. Good ones, too. If you ain't dead after this long you got to be. At her heart I'm sure she has it in her. But right now, listening to my story, she's just a kid.
I wish I could offer her some advice. Run, kid. Run away as fast as you can. Run away from me, Mom, Pops.
Especially The Grandfather.
I wish I could give her the advice that I should've given Georgia. Go out and live. Don't cry for them. Fuck them. They would never cry for you.
It's just us, Georgia. We need to take care of each other.
I need to take care of you.
I wish I could offer that to the kid, but like I said, I ain't parenting material. And she's a job. If I don't deliver her like Mom said. . .I won't get what's mine.
And I won't see my 31st birthday.
Like I said. Mom and Pops are good at what they do.
My thoughts are turned to Georgia so I don't notice the man until he's upon us, already at the table. Her back is to him, but his eyes are trained on her.
As if he knows her.
As if he's looking for her.
He is unfamiliar. The Grandfather must be getting desperate. It an't not like him to hire shady bastards that have no hope of escape.
"Couldn't help notice you're in need of a ride," he drawls out, still staring down at Styx. Over his shoulder I'm aware of the hush—every eye in the bar is trained on us.
Shit. They're here for a show.
Styx's eyes meet mine, and I expect her to be afraid. I expect to need to reassure her, to offer her a wink, let her know I'll protect her.
I'm wholly unprepared for the glint in Styx's eye. Her eyes are bright, brighter than I've seen them. She looks happy. Does she know this guy?
"Whatever you're selling, we're not buying," Styx throws over her shoulder, that smirk back onto her face. The man snarls down at her, reaching out his hand lightly grasping her hair.
Styx stiffens under his touch, her eyes narrowing, the glistening light simmering into a fire. "Please don't touch me again, mister. I need to ask you to leave me and my friend alone." Her voice betrays nothing. Cool confidence. It renders me speechless.
The man chuckles, letting his hand fall.
"C'mon, Ms. Styx. I'm your friend. Just let me take you on home." Styx's nostrils flare, and for the first time I am afraid.
Don't do anything stupid, I want to whisper. The man is standing behind the kid; if I pull the trigger now I may hit her in the abdomen. Somehow I'm sure this would be frowned upon by Mom and Pops.
"You're a stranger. Mom said never talk to strangers." Strangers leaves the kid's mouth in a small whisper, and the man chuckles again, reaching out before tugging a curl.
She is her parents' child. She spins around with shocking speed, catching the man's hand and bending his finger back. The snap is sickening, and his face is drained of blood. Before he can react Styx punches him in the throat, pressing the back of his head until his forehead collides with the table.
All of this happens before I've cocked my pistol.
At least fifteen guns and rifles are pointed at us when I raise my hands above my head. Styx, however, is not prepared to give in.
"I've got your man," she yells unnecessarily. I peer around her back, surprised to see the dagger that she has at his throat. His face is covered in blood, but I can't tell if the shock is from the blade or the fact that his ass was kicked by a 120 pound teenager.
"Let 'em go, little girl. Let 'em go and we'll let you take your friend here and get out."
"I have a better idea. You get out in thirty seconds, and I won't blow the place up." Various pairs of eyes meet. Styx presses the blade harder into the man's neck, reaching into the bag beside her.
"Hey," the man yells at her, but she ignores him.
She pulls out. . .
A fucking grenade.
"What the fuck!" I exclaim loudly. "Styx!"
"Shut up, Townie," Styx yells, throwing a smirk over her shoulder. Her and those fucking smirks.
This isn't how I imagined I'd die. Killed by some obnoxious teen.
"You're playing with fire, little girl."
"I'd listen to her if I were you," I yell, deciding to join the discussion.
"You have fifteen seconds," Styx offers calmly.
Shit. I don't know Styx well, but she's a teen, and they're nothing if not impulsive.
There is no way we'll get out of here alive. No one is moving. They don't think she has it in her. They're trying to decide whose going to shoot first. Which one of us they're going to shoot first. Do I let them shoot her and run, or do we shoot first?
My decision is made before I pull the trigger. The man who yelled collapses, the bullet lodged above his left eye. The next hits the man in Styx's hand; blood splatters over her face and she drops the knife, shocked. I press the gun to the back of her head.
"Sorry, Styx," I begin, but the sentence hangs in the air, unfinished. The blinding pain of a dislocated shoulder causes me to drop the gun.
As I fade to black, chaos surrounding us, I hear a cold, "Sorry Townie," and then I am nothing.


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Wallace Stevens's Connecticut Home is on the Market
June 27, 2014
The Hartford, CT, home of modernist poet (and insurance executive) Wallace Stevens, winner of the National Book Award and the Pulitzer Prize, is now on the market with an asking price of $489,900. The home is currently owned by Christ Church Cathedral in Hartford. Since the property was listed on the market (June 22nd, a "Sunday Morning" of course), there've been numerous showings, with surely more to come. The Hartford Courant newspaper described the 3,900-square-foot home with six bedrooms as "a bit of a fixer-upper, with updates needed in the kitchen and bathrooms. None of the furniture that remains is vintage Stevens, but a biography of his life has been casually placed on an enclosed cast-iron radiator in a first-floor sitting room." The Courant claims the neighborhood is "one of the city's most exclusive."
Stevens, who died in 1955, purchased the home in 1932. Though he widely received praise in the '30s, he did not draw celebrity attention in his neighborhood, through which he walked from his house every day to his job at the Hartford Accident and Indemnity Co. (now known as The Hartford).
For more than thirteen ways of looking at the Stevens home, hop over to The Hartford Courant. And stop by the Poetry Foundation for some of his most beloved poems. Actor Bill Murray read a few of his poems (including "A Rabbit as King of the Ghosts") at a Poets House event in Brooklyn.
Ewan McGregor to Star in Film Version of American Pastoral by Philip Roth
June 27, 2014
AWP's Dossier Service Coming to an End
July 2, 2014


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SXSW 2012 is over. Head to the SXSW 2014 Schedule!
or signup / login to see what your friends are attending and create your schedule!
NEW FEATURE → Login and connect your Eventbrite account to auto-track your Party RSVPs!
Come see Jesse Dayton for OPA's 3rd Annual Radio Thon during SXSW with Big Kev and Rick Star.
No badge or wristband required.


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More than 1,000 BDN readers recently cast their votes online for women with Maine roots who should grace the $10 bill. They clearly prefer former Skowhegan legislator Margaret Chase Smith.
Sixty-two percent of readers chose Smith, the first woman to serve in both chambers of Congress. The distant runner-up was former Labor Secretary Frances Perkins, with 11 percent, followed by author and abolitionist Harriet Beecher Stowe, with 9 percent of a total of 1,002 votes.
The U.S. Treasury last week announced it would finally add a woman to the face of the bill in 2020 — though she would have to share space with first Treasury Secretary — and long-time 10-spot occupier — Alexander Hamilton. Current Treasury honcho Jacob Lew said it would consider public input in its final decision.
So who should be on the new $10 bill? Let's look at our poll winner.
Smith, born just before the turn of the 20th century, took over her husband Clyde's congressional seat in 1940 when he fell ill, winning a special election by a huge margin. She won every subsequent regular election until 1948, when she was elected — again, by a huge margin — to the U.S. Senate.
For 32 years, in fact, the Republican won every election, except for her failed presidential run in 1964, where she became the first woman added to a nomination for president by a major party.
She knew she wouldn't win. But that didn't stop her.
"I have few illusions and no money, but I'm staying for the finish," she said. "When people keep telling you, you can't do a thing, you kind of like to try."
Smith was known for being fearless — with a fierce independence characteristic of Mainers.
But it was a speech she gave in 1950 for which she is perhaps most widely remembered.
In that speech, "Declaration of Conscience," Smith became the the first U.S. senator to stand up against Joseph McCarthy, the then-junior senator from Wisconsin, whose communist witch hunt dug the nation into a dark period of fear, distrust and paranoia.
"Today our country is being psychologically divided by the confusion and the suspicions that are bred in the United States Senate to spread like cancerous tentacles of 'know nothing, suspect everything' attitudes," she said on the Senate floor on June 1, 1950.
"As a United States Senator, I am not proud of the way in which the Senate has been made a publicity platform for irresponsible sensationalism. I am not proud of the reckless abandon in which unproved charges have been hurled from this side of the aisle. I am not proud of the obviously staged, undignified countercharges that have been attempted in retaliation from the other side of the aisle.
"I don't like the way the Senate has been made a rendezvous for vilification, for selfish political gain at the sacrifice of individual reputations and national unity. I am not proud of the way we smear outsiders from the Floor of the Senate and hide behind the cloak of congressional immunity and still place ourselves beyond criticism on the Floor of the Senate."
Her stand did little to slow McCarthy's fear mongering, and it made her a target of his wrath. But it was notable at a time when many others were too terrified to speak against him.


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From: MI, United States
Genre: Alternative/Alt. Rock, Experimental, Psychedelic
Alien Inquisition is an experimental, psychedelic rock duo from Detroit. They take an unconventional approach to song writing, using atypical song structures and darkly poetic lyrics to produce a driving and enticing sound. Alien Inquisition successfully and creatively tackle psychedelic and experimental rock in a way that continually leaves listeners wondering how a two-piece band can create such a huge and rich sound.
In 2009, Alien Inquisition's debut video for the song "'Cause I F___ing Will" prem…


text: I've always prioritised seeing new and exotic places over exploring those close to home, but this year I've decided to dedicate time to the adventures right in my own backyard. As I seek out unique experiences, discover beautiful beaches, enjoy scenic walks, and play tourist here in Sydney, I also want to create a comprehensive guide to this incredible region that will inspire people to come explore. Whether rediscovering old favourites with a camera in hand or stumbling upon new gems, I'll document it all here.


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Many Homeowners Associations plan fall festivals. Some celebrate the end of the harvest, while others use a fall festival to provide a safe alternative to traditional Halloween trick-or-treating. Whatever the reason for thecommunity activity, with a little bit of planning the festival can be a lot of fun for all home owners.
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Decide who is eligible to participate. For a project like this, the more community involvement you have, the more likely that the event is fun and successful.
- 2
Set a location and time. Advertise it on the street corners. Schools regularly host fall festivals, as do churches. In larger communities, the neighborhood holds the fall festival in one of its parks or grassy areas. Whatever location you choose, secure a backup location in case of bad weather.
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Check out any insurance coverage you might need. Also, apply for any legal permits.
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Enlist volunteers. This is sometimes the trickiest part of the equation. Recruit dependable people for key positions so you don't have to scramble to do their job at the last minute.
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Arrange for food kiosks. You might have apple pie stands, pumpkin bread stands and chili booths. Or, you might just decide to have a potluck-type meal where everyone brings a covered dish or two. Rent a cotton candy or hot dog machine.
- 6
Decorate your fall festival site. It can be as simple as setting out some pumpkins or more elaborate. A decoration committee is well advised for this chore.
- 7
Set up games. Carnival-type games, such as cake walks and fish ponds. Rent a bounce house…these are great for children. Going along with the fall theme, pumpkin carving competitions are fun as well.
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Enjoy! But alas, make sure there is a clean-up committee designated to tidy up after all of the fun!


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- LeBron James is leading the Cavaliers in almost every conceivable statistic through the 2018 NBA Playoffs so far.
- "Saturday Night Live" played on this notion, with host Donald Glover and other members of the cast mocking the relatively simple tasks of "The Other Cavaliers" in a sketch released over the weekend.
- The night the sketch was released, James hit yet another game-winning buzzer beater for Cleveland, showing it wasn't all that far off from the truth.
LeBron James is used to carrying the Cleveland Cavaliers.
Thus far in the playoffs, James is leading his team in points, assists, steals, blocks, and minutes played. Kevin Love is the only teammate that leads him in a statistical category, getting 10.5 rebounds a game — James sits at 9.5 per game.
On "Saturday Night Live," host Donald Glover and the show's cast had a bit of fun with this one-sided basketball relationship, creating a promo video featuring "The Other Cavaliers" in which they describe their respective roles as teammates of LeBron.
While the sketch was cut for time from the episode on Saturday, it was later released online, and you can watch it below.
"Whatever LeBron needs, we'll get it done," the players say with confidence before adding, "as long as what he needs isn't basketball."
"I hold LeBron's third and fourth cell phones," said one of his spoofed teammates. "I run the pick-and-roll," added another. "That's when I pick up LeBron's laundry and roll it on over to his house."
"Our point guard is a Roomba," says another, as the teammates devolve into more absurdity.


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There is an old Mexican proverb that states, "They tried to bury us. They didn't know we were seeds."
This proverb resonates with Call Center Plus. Why? We began as a home-based business in a bedroom loft by a single mom with zero business experience as a means of supporting her children while still being home with them. The odds of succeeding suggest that any one of those factors would be cause for failure. Add them all together and failure within the first two years would be almost certain. However the odds of success never went up against someone with as much faith, determination, and imagination as Ilene.
Before long at all the business outgrew the loft. In order to still be home with her children and to keep overhead low, Ilene converted part of her garage into office space. With shear grit, determination, faith, and prayer, she used her innate abilities to grow and nurture the business. A call center requires the use of sophisticated equipment, so out of necessity to keep things running smoothly, she also learned everything she could about computer hardware, software, and servers. She became a topnotch IT specialist as she learned to build, troubleshoot, repair, and program computers. Now, as a result of her business savvy, here we are 22 years later, moving into a brand new office building!
We may be changing locations but one thing will never change. We will always maintain a high level of commitment to our customers. We will continue to think outside the box so we can help you handle your unique call center needs. We will still answer the phone, still send a page or text or fax or email, still take orders, still take care of your customers like they were our very own. We will take care of you, 24/7/365.
The bigger call centers could not buy us out or squeeze us out. The odds of failure in the business world could not bury or destroy us. We were seeds that have blossomed and flourished. Not only did we hold our own, we moved ahead!
Mention Telephone Answering Service or Call Center Services for a Free Setup


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By Tim Colen
Executive Director, San Francisco Housing Action Coalition
The members of the Alice B. Toklas Club deserve enormous credit for their leadership in opposing Prop B. The City is lucky to have groups like yours that respond with common sense to silly political games.
In spite of its deceptive language, Prop B represents a dangerous vision of what San Francisco should do with its derelict industrial lands along our eastern waterfront.
Despite its bland appearance, Prop B is a crazy political scheme that would severely harm the value of an enormous swath of our public property. The San Francisco Port has conducted an analysis of its fiscal effects that should frighten any voter. They conclude that $8.46 Billion projected for the Port Harbor Fund could be "delayed, reduced or lost" as a result of Prop B.
Other US cities repurpose their old industrial land in ways that respond to a vision for the future, one that maximizes public benefits. They do not downzone their derelict public land. Prop B makes no sense as a modern urban planning tool – it only makes sense for continuing insider political games.
The City is enduring a brutal housing affordability crisis that cannot be solved unless we find the will to increase housing production. This vacant, unused waterfront land could deliver many thousands of new middle-income homes.
Do not be deceived by slogans that promise "citizen participation," yet are designed to prevent us from responding to the challenges we actually face.
Vote No on Prop B!


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Find the right golf shoe for your game.
FJ Ambassador Louis Oosthuizen (FJ ICON & SciFlex) began The 2012 Race to Dubai in style as he successfully defended his Africa Open title at East London Golf Club.
The South African won on home soil for the second year running with a closing 67 to hold off the challenge of compatriot and fellow FJ loyalist Tjaart Van der Walt. The former Open Champion held firm on the back nine as his playing partners struggled for birdies, Oosthuizen running out a two shot winner on 27 under par.
Oosthuizen was by far the most aggressive player in the final group, and asked about his decision to try and drive the greens on the shorter par fours said: "On six, I go for that green every time, so to me it was a good driver today with the wind into me."
A huge drive at the 11th set up Oosthuizen for a two-putt birdie on the 11th, and a 30 foot birdie at the penultimate hole all but sealed a victory that was confirmed when he got up-and-down from the back of the 18th green for par.
Oosthuizen scooped the prizes of €158,500 which provisionally places him top of the Race to Dubai standings.


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Zits can occur just about anywhere on the body although, the face is probably the most embarrassing. Regardless of its location, it is necessary to treat the problem in order to solve it. You can treat your acne the right way with the help of this informative article.
Try using tea tree oil on acne prone spots for clearer skin. Tea tree oil doesn't dry out skin and if you find it works for you, it can reduce overall oil buildup in your pores just as effectively as chemical zits treatments.
Make sure you keep your pillowcases clean. Think this through! Realize that this is what you are rolling on night in and night out. You should clean your linens and your pillowcases all of the time and change the one you are sleeping on every single night.
Tooth whitening products can cause breakouts around your mouth, so you should consider halting your use of them. If you experience zits breakouts in the mouth area, think about any treatments that are being used on your teeth. These products contain harsh chemicals that can irritate your skin and bring on a breakout. The skin that is close to your mouth is extremely sensitive, and can be irritated easily.
Stay away from situations that will stress you out. Feeling stress will not cause pimples, will make your zits even worse.
Caffeine is notorious for causing acne, so it is important to moderate your intake of coffee, teas and sodas. By reducing your caffeine intake, you may be able to limit breakouts.
Frequently changing your linens can have a remarkably beneficial effect for your pimples problems. When you sleep these oils transfer to your sheets and pillow cases. Then they can make their way back to your skin. Wash your bed sheets regularly to break this cycle.
Skin care treatments containing salicylic acid are very effective in treating acne. This ingredient, along with a few beta hydroxyl acids, is crucial in helping the skin get rid of dead cells.
Stress may be what is causing you to breakout with acne. Take the time to relax and unwind during the day. If you take part in an activity that you enjoy, you will reduce your stress levels and have balanced hormones, these are the causes of zits breakouts. Do not smoke or drink caffeine if you suffer from pimples.
Avoid the temptation of picking at your pimples, as this can cause it to worsen due to the dirt and oil that can be found on your hands. The dirt gets trapped in pores and inflammation ensues.
Do you think that your blemishes will never leave? Hay fever, mites, and other allergens can attribute to skin problems. Lastly, avoid getting over-stressed. Stress hormones can create irritation.
When purchasing make-up, try to steer clear of the oil-based varieties. Makeup that is oil-based can clog your pores. Water soluble make-up is better for the skin than oil-based products. Read the label to determine what is in your makeup. You could face a breakout when using these products that contain synthetics.
Pimples occurs all over the body, not just on the face. Keep the helpful hints here in mind and you can start clearing up your acne with proper treatments and possibly topical creams. By continuing to use proper treatment, your pimples will soon be gone.


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Legal and Ethical Considerations in TeleMental Health
Barb Wilson, Ph.D. LPC, CPCS, LMHC, NCC, BC-TMH
TeleMental Health (TMH) is a quickly growing option for Mental Health services. The TMH format removes some barriers that might otherwise prevent clients from accessing counseling resources. This webinar gives professionals an introductory view at the legal and ethical considerations related to TeleMental Health. Participants will gain knowledge, learn related vocabulary, and identify resources for additional training.
Register for LEGAL & ETHICAL CONSIDERATIONS
Best Practices in Telemental Health
Raymond Barrett, LMHC, BC-TMH
Ray is the owner of the Telehealth Certification Institute, LLC. He has provided telemental health counseling services extensively in private practice, for facilities, and for an EAP program. He has developed several courses on telemental health and ensures his courses are kept updated. Trainees find Ray to be very approachable, available, and knowledgeable. He has presented on telebehavioral health at several conferences and has assisted many private practices to begin and enhance their telehealth programs through his private consultations.
This webinar will provide you a broad overview of the following aspects of telemental health (TMH):
The need for TMH
How to choose technology
Emergency management planning
The setup of the environment
Preparation of the client
The most common mistakes
How to obtain further training
The challenge of adhering to practicing within one's boundaries of competence:
You can only assess your competency in telemental health if you know the list of competencies to assess. This webinar is not intended to cover all of the competencies of telemental health, but to inform you of how to assess your competency and to provide you a broad overview of the competencies of TMH.
The Telehealth Certification Institute, LLC ( https://telementalhealthtraining.com) is an approved training provider for the Board Certified TeleMental Health Provider (BC-TMH) credential. The BC-TMH credential is provided by a highly respected national organization, the Center for Credentialing and Education (CCE), an affiliate of the National Board for Certified Counselors (NBCC). The BC-TMH credential is based on established credentialing standards and has been rigorously reviewed by many telemental health experts across most behavioral health professions.
Register for TELEMENTAL HEALTH
Transformative Online Supervision
Theresa Kascsak, PhD, LPCS, NCC, RPT-S, LSC(NC)
Nicole M. Arcuri Sanders, PhD, ACS, LPC, NCC, BC-TMH,
The presenters will actively demonstrate their transformative and creative approaches to supervision in the online environment utilizing both the Discrimination Model (Bernard & Goodyear, 2014) and a psychodynamic approach (Bomba, 2011). In online supervision, there is an increased need to provide formative feedback that matches the needs of a diverse cadre of supervisees. Developing practices for gauging interpersonal development and skill acquisition are imperative to ensure supervision outcomes (Cicco, 2013) and facilitate counselor identify development.
Register for TRANSFORMATIVE ONLINE SUPERVISION
Theoretically Driven Clinical Supervision: Adlerian Style
Dale V. Wayman, PhD, LCAC, LMHC, ACS
This seminar provides a concrete plan on how to supervise competently and carefully, understanding that good supervision provides growth not only for the supervisee but also growth for the supervisee's caseload. Practical research is also provided that helps the supervisor measure the effectiveness of supervision.
Theoretically Driven Clinical Supervision: Adlerian Style
Beyond Breathing and Yoga: Mindfulness theory into practice
Helena Stevens, PhD, LPC, LSC, PPS
Mindfulness is a hot buzz word these days both within counseling and outside of counseling. Mindfulness is often understood to be a breathing technique, yoga position, or simply a way to think. However, it is much more than a technique and is a theoretical approach that can be highly effective for treatment outcomes across all spectrums of problems and disorders. From understanding problem formation to approaching problem solution, this presentation will provide content and tools on how to practice with a mindfulness lens and approach.
Beyond Breathing and Yoga: Mindfulness theory into practice
Is THAT really necessary?
Ray Watson, PhD, LMHC
A pragmatic look at driving forces behind all behavior, particularly that which seem to make "little or no sense" in the appearance of counter-productive results for client:
- Understand the utilitarian nature of behavior
- Gain pragmatic insights to Relational & Circumstantial Dynamics affecting Behavioral Responses
- Gain a clinical view of the "necessity" of some behaviors as distinguished from justification or excuse making
- Improve treatment considerations to extinguish unwanted behavior by virtue of making those patterns of behavior "unnecessary"
Presenter: Dr Ray Watson, Core Faculty at Capella University, has over 40,000 hours of clinical experience treating a wide range of behavioral conditions as well as mood disorders. He is the published author "Putting Power in Your Perceptions", the former producer and host of the "Off the Couch with Dr Ray" syndicated radio shown over 350 stations across that US and has over 1,000 professional presentations to his credit. In addition to his teaching activities, he currently provides AeroMedical consulting to major airlines for policy and regulatory considerations for pilot health, as well as direct remote counseling services for professional pilots.
Is THAT really necessary?
Twelve-Step Recovery: An Overview
Eric L. Davis, PhD, LCSW, LCAC, ICAADC, MAC, ICOGS
This webinar provides an overview of twelve-step recovery and why it can be an excellent resource for clients in treatment. Dr. Davis will discuss several elements and philosophies of twelve-step recovery including the disease model, powerlessness, step work, sponsorship, honesty, higher power, open-mindedness, and willingness.
Register 12-Step Recovery
Lost Boys: Trends in Identity Confusion and How to Support
Heather Lindstrom, MS, LPC
Social Counselor, Uplift Education
Understand the areas of identity confusion in young men and boys
Examine the effects of gender identity issues
Discuss methods to support identity development to promote overall achievement
Register for LOST BOYS
The Pieces of My Life
Suzette V. Sorrells, MS Ed, QBHP, NCE, IN ANSA 2.4
Holistic therapy encompasses the whole person as a system incorporating an integrated approach for mental health treatment. Compatible therapies for holistic therapy are CBT, Existential, Art and Music therapies, Humanistic and Behavioral and successfully supports children / adolescents, addictions / SUD, mental health and diverse populations. This presentation will include an original concept of holistic therapy, blank puzzles the client uses to describe aspects and characteristics and traits of his/her life.
Register for THE PIECES OF MY LIFE
Professional Development Groups: Using Adlerian theory to promote professionalism and wellness among counseling professionals and students
Dale V Wayman, PhD, LCAC, LMHC, ACS
Adlerian theory has much to offer in the delivery of professional development groups. The theory, process and structure of Adlerian theory demonstrates its usefulness in the education, training in wellness, and supervision of counseling professionals and students.
Register for PROFESSIONAL DEVELOPMENT GROUPS
"Indiana Counseling Association has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 2015. Programs that do not qualify for NBCC credit are clearly identified. Indiana Counseling Association is solely responsible for all aspects of the programs."


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You read the title right – rock paper scissors is big time.
Sponsored by Bud Light, and being held at the Mandalay Bay Hotel & Casino in Las Vegas, the weekend long event ends with a champion being crowned on Sunday, June 22.
Check this; the champ will receive a $50,000 prize and a ticket to compete in Beijing, China during the Summer Olympics. No there is no actual event in the Olympics, but instead the US winner will compete in the inaugural international Rock Paper Scissors Federation Championship, where they will compete against the champions from Canada, Guam, Hong Kong, Ireland and Malaysia.
Check out their website here.


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Ellie Bryant
As a girl, I loved to write and illustrate stories and poems, and spent hours immersed in the worlds of my favorite authors. When I was in high school, I told my parents that I wanted to be a writer. My mother tried to be tactful, suggesting that writing fiction was a nice hobby, but my talents would be better suited to a career in communications. My dad was a bit more blunt: "A writer? You'll starve!" Thanks, Dad.
So twenty (plus or minus) years went by. I spent tens of thousands on an advanced degree I never used, choosing instead to stay home and raise two sons. Since it became clear that no one was going to pay me to sit on my couch and binge-read in my pajamas, I decided to put down on paper some of the characters who were walking around in my head. I'm so glad that I did, because now I get to share their lives with others. It is—at the risk of sounding like a cliché—a dream come true.
I live with my husband and sons in rural Maryland. My husband is still the love of my life and my best friend. He gives me support, inspiration, and (most importantly) Hershey bars.
I'd love to hear from you! Write to me at firstname.lastname@example.com, or find me on Facebook at www.facebook.com/ellie.bryant.5243


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Categories: Taskforce
By Marian Haus, PMP
We've all heard about those projects in crises—the ones that required a quick and firm intervention with the help of a taskforce to bring it back on track.
No project manager wants to be in such a difficult situation, especially not with her or his own project.
But how do we, as the hero of the day, handle being tasked with saving a troubled project?
First let us examine what a project taskforce is and what it is good for.
A project taskforce is a mandate allotted by the project sponsors or the upper management of the project organization to a senior project manager or a senior leader. The goal is to find the best option for resolving a particular problem in a very short timeframe.
A taskforce is a management mechanism that should be only used in exceptional situations. It generally requires disrupting other project activities and deploying the best people to solve a particular problem under possibly highly stressful and energy-depleting conditions.
So how do we handle this? Here are some tips on what an effective taskforce needs:
- One experienced lead: It can either be a senior project manager or a leader experienced with crisis situations. I put the emphasis on one, since single leadership is the key to getting the job done! The last thing you'd want in a taskforce is having two or more leads debating how to drive the taskforce. One person has to call the shots.
- An elite team: The taskforce lead will need to quickly assemble an expert team, formed with the best people who have the required field expertise to quickly understand and resolve the problem. The smaller the team, the easier it is for the taskforce lead to motivate and steer the team to finding the right solution.
- A sharp focus: The particular problem the taskforce is working on has to be clearly articulated and known to the entire taskforce team. The objectives the team will be working on also have to be clear to everyone involved. Secondly, several other project issues may come up along the way. But to be effective, the taskforce must remain focused on the main problem.
- A short timeframe: Given the urgency, plus the high level of the deployed team's energy, a taskforce is only effective if conducted in a short timeframe (matter of hours or a few days). If efforts go on for longer, it's likely not a taskforce, since the energy and effectiveness dissipate over time.
- The appropriate logistics: Due to the intensity and possibly a stressful situation, taskforces require an isolated project space—or war room. That entails a space that provides appropriate office materials (whiteboard, note cards, etc.) to facilitate brainstorming and for capturing the results (notes, action items, assumptions, decisions, solutions, etc.) of the taskforce.
- Options for a solution: The taskforce's outcome should include one or more options that lead to a resolution, with a recommendation for the best option. This option, even if it is technically the best the expert team can recommend, might not satisfy the risk appetite of the person or organization that has mandated the taskforce. Therefore, every option should also provide the related pros and cons.
- Qualified assumptions: Beware of unqualified assumptions. If the identified options are building up on assumptions that are not fully validated, highlight the risks or need for confirmation before making a final decision.
- Plain outcome communication: To terminate the taskforce, its lead and the expert team will have to reduce the complexity and sum up the outcome of the conducted work (options with pros and cons, along with assumptions and their risks or opportunities). Ultimately the taskforce lead will communicate the outcome, confirm the decided solution and conclude the mandate of the taskforce.
If set up and executed properly, a taskforce can be an effective tool to resolving crisis situations in projects.
Have you ever worked on a project taskforce? What tips would you share?


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Power Comicon is sponsored by Power Comic Shop in Conway, South Carolina.
We are conveniently located in Conway on Highway 501 East, next to Coastal Carolina University.
Power Comics is your one-stop shop for new comics, back issues, graphic novels, art, collectibles, toys, and more!
We carry items from Sideshow, Diamond, Funko, and Neca. We are licensed CGC and CBCS dealers; As well as a Sideshow Collectibles representative.


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While working as a young woman in a male-dominated industry has its challenges, Kaitlin Elliot is working hard to prove the disbelievers wrong.
After completing her hairdressing apprenticeship and working in the industry for 10 years, Heather McMurtrie opened her own salon.
Find out what it takes to work as a commercial pilot in Australia.
Skills Boost is an initiative providing a second training subsidy for eligible individuals to update their skills to go further in their career.
TAFE Queensland is playing a critical role in the state's prosperity, creating jobs and enhancing social wellbeing.
For students with a census after 29 January 2020, the gap fee has either been reduced or removed for more than 30 courses at TAFE Queensland.


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Exactly at the moment when Fleet Street has grown most familiar (that is, most bewildering and bright), my eye catches a poster of vivid violet, on which I see written in large black letters these remarkable words: "Should Shop Assistants Marry?"
When I saw those words everything might just as well have turned upside down. The men in Fleet Street might have been walking about on their hands. The cross of St. Paul's might have been hanging in the air upside down. For I realise that I have really come into a topsy-turvy country; I have come into the country where men do definitely believe that the waving of the trees makes the wind. That is to say, they believe that the material circumstances, however black and twisted, are more important than the spiritual realities, however powerful and pure. "Should Shop Assistants Marry?" I am puzzled to think what some periods and schools of human history would have made of such a question. The ascetics of the East or of some periods of the early Church would have thought that the question meant, "Are not shop assistants too saintly, too much of another world, even to feel the emotions of the sexes?" But I suppose that is not what the purple poster means. In some pagan cities it might have meant, "Shall slaves so vile as shop assistants even be allowed to propagate their abject race?" But I suppose that is not what the purple poster meant. We must face, I fear, the full insanity of what it does mean. It does really mean that a section of the human race is asking whether the primary relations of the two human sexes are particularly good for modern shops. The human race is asking whether Adam and Eve are entirely suitable for Marshall and Snelgrove. If this is not topsy-turvy I cannot imagine what would be. We ask whether the universal institution will improve our (please God) temporary institution. Yet I have known many such questions. For instance, I have known a man ask seriously, "Does Democracy help the Empire?" Which is like saying, "Is art favourable to frescoes?"
I say that there are many such questions asked. But if the world ever runs short of them, I can suggest a large number of questions of precisely the same kind, based on precisely the same principle.
"Do Feet Improve Boots?"—"Is Bread Better when Eaten?"—"Should Hats have Heads in them?"—"Do People Spoil a Town?"—"Do Walls Ruin Wall-papers?"—"Should Neckties enclose Necks?"—"Do Hands Hurt Walking-sticks?"—"Does Burning Destroy Firewood?"—"Is Cleanliness Good for Soap?"—"Can Cricket Really Improve Cricket-bats?"—"Shall We Take Brides with our Wedding Rings?" and a hundred others.
Not one of these questions differs at all in intellectual purport or in intellectual value from the question which I have quoted from the purple poster, or from any of the typical questions asked by half of the earnest economists of our times. All the questions they ask are of this character; they are all tinged with this same initial absurdity. They do not ask if the means is suited to the end; they all ask (with profound and penetrating scepticism) if the end is suited to the means. They do not ask whether the tail suits the dog. They all ask whether a dog is (by the highest artistic canons) the most ornamental appendage that can be put at the end of a tail. In short, instead of asking whether our modern arrangements, our streets, trades, bargains, laws, and concrete institutions are suited to the primal and permanent idea of a healthy human life, they never admit that healthy human life into the discussion at all, except suddenly and accidentally at odd moments; and then they only ask whether that healthy human life is suited to our streets and trades. Perfection may be attainable or unattainable as an end. It may or may not be possible to talk of imperfection as a means to perfection. But surely it passes toleration to talk of perfection as a means to imperfection. The New Jerusalem may be a reality. It may be a dream. But surely it is too outrageous to say that the New Jerusalem is a reality on the road to Birmingham.
— Tremendous Trifles (1909).


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Those who want you to doubt that anarchy (self-ownership and individual responsibility) is the best, most moral, and ethical way to live among others are asking you to accept that theft, aggression, superstition, and slavery are perhaps better.
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Tuesday, January 08, 2013
Keep playing an unfair game
"That's not fair!"
Every time I hear those words I smile because I am reminded of Scott Adams' assertion that "fairness" isn't a feature of reality, but a concept invented so that stupid people could feel like they are participating in conversations.
Maybe that's true; maybe it isn't completely true.
However, "fair" does figure into playing games with agreed-upon rules. When someone doesn't play by those rules you feel it isn't fair. You can whine about it, you can keep trying to adapt to the "new" rules, you can "cheat" in your own way and hope to somehow win, or you can walk away.
Some people seem to think of The State as a kind of game. They realize that the rules seem to only be applied in one direction- against individuals who are not a part of the government gang- but they still believe they should keep playing and try to win. Or at least not lose.
What I don't get is that so many of those people think whining about the unfairness will change anything. As long as you keep playing, what incentive is there for any change? You'll keep playing, keep losing, and The State will keep teasing you with the promise of winning a little bit... someday.
When playing against someone who keeps changing the rules to benefit themselves, you are an idiot to not walk away.
Withdraw consent.
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A newly published study reveals that the female hormone estrogen has a significant effect on the persistent HIV reservoir. It suggests that women may respond differently than men to some curative interventions that are currently under investigation or, perhaps, that an effective cure for women could differ from a cure for men.
The reservoir of HIV that is impervious to antiretroviral therapy remains the principal barrier to a cure. Following a cohort of 26 men and 26 women, the researchers, led by Dr. Jonathan Karn of Case Western Reserve University, found that women have a smaller "inducible" reservoir than men. In other words, while the total size of the reservoir appears to be the same for both sexes, women have a smaller amount of reservoir virus that can be coaxed out of hiding by so-called latency-reversing agents (LRAs).
The finding has several important implications. First, one of the main cure strategies being pursued by researchers is "shock and kill" (or "kick and kill"). The intent is to shock HIV out of the reservoir so that it can be killed by the immune system or some other killing agent. Given their smaller inducible reservoir, would such a strategy be less effective in women?
Second, since reactivation of the reservoir is inhibited by estrogen, the researchers suggest that "studies of the impact of hormonal contraception on reservoir establishment and its long-term maintenance should be undertaken."
And, given the small size and exploratory nature of cure-focused clinical studies to date, the inclusion of women in small clinical trials may lead to skewed results if hormone exposure is not considered.
The study concludes that further investigations into sex differences in latency reversal and HIV persistence "are mandatory to extend the benefits of the HIV cure effort to all men and women impacted by the global epidemic."
Published in the Proceedings of the National Academy of Sciences, these findings are the most recent outgrowth of a multi-year amfAR investigation into sex differences in HIV. "We've long known that women and men differ in immune system function and response to antiretroviral therapy, but few researchers have followed up on these leads in cure research," said amfAR Vice President and Director of Research Dr. Rowena Johnston, a co-author of the study. "It is imperative that we develop a cure that works for everyone."
In 2012 Dr. Johnston was invited to give a talk on sex differences in HIV cure research at a conference. She soon realized, however, that there were very little available data on the topic. So she teamed up with Dr. Mary Heitzeg of the University of Michigan to undertake a systematic review of more than 150 published HIV cure research studies.
"It is imperative that we develop a cure that works for everyone." -- Dr. Rowena Johnston
The study, published in 2015, found that while there was a strong possibility that the efficacy of a potential cure could vary by demographic variables, only 8% of the studies reported conducting efficacy analyses by sex. They concluded that, "More data are needed to determine associations between demographic characteristics and safety/efficacy of curative interventions."
Responding to this need, in 2016 amfAR awarded a grant to two teams of researchers led by Dr. Karn and Dr. Eileen Scully of Massachusetts General Hospital to explore how sex-based differences might affect the HIV reservoir and, by extension, a potential cure. The researchers were tasked with comparing the key differences in latent virus in men and women, and exploring the immune profile, activation levels and distribution of latent viral reservoirs in men versus women.
Their first set of findings, detailed in the PNAS paper, lay the groundwork for a preliminary trial to evaluate the effectiveness of the drug tamoxifen combined with the latency-reversing agent vorinostat in reactivating latent HIV in women. Supported by the National Institutes of Health's AIDS Clinical Trials Group, the study is expected to conclude in September 2019.
[Note from TheBodyPRO: This article was originally published by amfAR on Aug. 8, 2018. We have cross-posted it with their permission.]