You are responsible for the success of your clinic so you are constantly thinking about how to attract new patients.
In today's digital economy, cutting through the noise of Social Media and Google can be challenging.
doing seperate pieces is time consuming and inefficient.
You are a clinician, you should focus on what you do best and that's seeing patients.
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Home Caufield & Shook Collection Flood relief station at Louisville Hotel, Louisville, Kentucky, 1937.
Flood relief station at Louisville Hotel, Louisville, Kentucky, 1937.
Title Flood relief station at Louisville Hotel, Louisville, Kentucky, 1937.
Description Address: 612 W. Main Street, Louisville, Kentucky. People displaced by the 1937 Flood were able to use phones at the Louisville Hotel. Some sit filling out missing persons reports or other forms as they warm their feet on heaters.
Source 8 x 10 in. b&w safety negative. Item no. ULPA CS 149593 in the Caufield & Shook Collection, University of Louisville Photographic Archives.
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PSY 635 WEEK 4 DISCUSSION Week 4 – Discussion Recommend a Qualitative Design Prior to beginning work on this discussion, read Chapters 2, 3, 4, and 5 from the Frost (2011) e-book. For this discussion you will take on the role of a clinical psychologist treating clients for depression. You are interested in doing research on effective treatments for a chronic form of depression called dysthymia. In the DSM-5, it is referred to as persistent depressive disorder. TheDSM-5 is listed in your recommended resources, and details regarding the disorder can be found in section 300.4(F34.1). In your review of the current materials, you find that most of the previous research on this disorder has been done using quantitative methods. Identify an aspect of this topic you feel should be studied using qualitative methods. Apply the scientific method to this research issue and develop a specific research question. Compare the characteristics and appropriate uses of various qualitative research designs and choose an appropriate qualitative design for this research question. Create a feasible research design that includes plans for the sample selection, data collection, and data analysis. Apply ethical principles to your design by explaining how this type of qualitative design may affect the participants in your study and how you will deal with sociocultural issues. Guided Response: Review several of your colleagues' posts and respond to at least two of your peers by 11:59 p.m. on Day 7 of the week. You are encouraged to post your required replies earlier in the week to promote more meaningful interactive discourse in this discussion. Comment on the suitability of your peer's proposed research question(s) and research design. Has your colleague chosen the most appropriate qualitative design to answer the question(s) posed? Why, or why not? What other design option(s), besides the one you selected for your own post, would you recommend to study the proposed research question? Review the ethical issues your colleague raised in his or her post and suggest other issues that should be considered when conducting this research. Continue to monitor the discussion forum until 5:00 p.m. Mountain Standard Time (MST) on Day 7 of the week and respond to anyone who replies to your initial post. Carefully review the Discussion Forum Grading Rubric for the criteria that will be used to evaluate this Discussion Thread.


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Human Rights Watch Submission on Bosnia and Herzegovina, Serbia and Kosovo to the European Commission Progress Report Consultation
Bosnia and Herzegovina Ethnic and Religious Discrimination in the Political System The majority of Human Rights Watch's concerns with respect to Bosnia and Herzegovina (BiH) are summarized in the 2015 World Report chapter on…
UN Human Rights Council: Item 10 General Debate
Human Rights Abuses in Libya and Sudan
Libya Human rights conditions in Libya regressed sharply in 2014. Since May 2014, parties to the armed conflicts have directly attacked and abducted civilians and looted, burned and otherwise destroyed civilian infrastructure. Hundreds of…
ICC: Libya's Bids to Try Gaddafi, Sanussi
(Brussels) – The ICC is considering challenges to the court's jurisdiction to try ICC suspects Saif al-Islam Gaddafi, the son of Libya's former ruler Muammar Gaddafi, and Abdullah Sanussi, the Gaddafi-era intelligence chief. Libya says it is…
Statement at the Human Rights Council on the International Commission of Inquiry on Libya
Oral statement under Item 4 - Interactive Dialogue with the International Commission of Inquiry on Libya
Human Rights Watch welcomes the report of the International Commission of Inquiry on Libya, which rightly highlighted a wide range of past and ongoing human rights violations. We support the Commission's conclusions that "international crimes,…
Libya: Q&A on the ICC and Saif al-Islam Gaddafi
The International Criminal Court (ICC) judges granted arrest warrants on June 27, 2011, for Muammar Gaddafi, his son Saif al-Islam, and former intelligence chief Abdullah Sanussi in an investigation authorized by United Nations Security Council Resolution…
Oral Statement by HRW on Libya
The Libya Commission of Inquiry has enormous amounts of work. The list of human rights violations committed during the six-month conflict – which has yet to end – is long, and the abuses involved intense. As the forces of Muammar Gaddafi retreated from…
Libya: Q&A on the Arrest and Surrender of the Three International Criminal Court Suspects
What is the source of the International Criminal Court's jurisdiction in Libya? Has the court issued any arrest warrants related to the ICC prosecutor's current investigation? How did the judges make the determination to issue arrest warrants…
Libya: Q & A on the Arrest Warrants for Gaddafi, Cohorts
The International Criminal Court (ICC), by issuing an arrest warrant for Muammar Gaddafi, signaled that the law can reach even those long thought to be immune to accountability. The ICC judges granted warrants on June 27, 2011, for Gaddafi, the Libyan…
Oral Statement - U.N. Follow Up Libya Special Session
Delivered on June 9, 2011 by Human Rights Watch Human Rights Watch welcomes the report of the Libya Commission of Inquiry, which has rightly highlighted serious violations of human rights and international humanitarian law. We believe the Commission…
ICTY: Q&A on the Case against Ratko Mladic
1. Who is Ratko Mladic? 2. What is Mladic accused of? 3. Why is the Mladic case significant? 4. Why did his arrest take so long? And why did it happen now? 5. What happens following Mladic's transfer to the Yugoslav Tribunal in The Hague? 6. Is…
ICC: Prosecutor to Open an Investigation in Libya
Q&A on Libya and the International Criminal Court
On March 3, 2011, the prosecutor of the International Criminal Court (ICC) announced he would open an investigation into the situation in Libya. This follows the referral on February 26, 2011 by the United Nations (UN) Security Council-by a vote of 15-0-…
Q&A: The International Criminal Tribunal for the former Yugoslavia Trial of Radovan Karadzic
Who is Radovan Karadzic? What are the charges against him? It's been more than 14 years since his initial indictment. Why is his trial important? Why hasn't Karadzic's co-accused, Ratko Mladic, been arrested? Doesn't Karadzic claim that he was…
Seven Initiatives Congress Should Take on International Justice
1. Insist on justice as a key element of strategies to address situations where widespread atrocities are being committed, such as in Darfur. 2. Adopt a zero tolerance attitude on impunity for mass atrocities committed in Darfur and press the…
Eight Initiatives the Obama Administration Should Take on International Justice
1. Convey a firm commitment to ensure justice for serious crimes. 2. Send an unequivocal message to the Sudanese leadership that the Obama administration will not use justice as a bargaining chip in any negotiations with Khartoum. 3. Initiate…
Human Rights Watch Memorandum on the Western Balkans
Prepared for EU Foreign Ministers' informal meeting
Human Rights Watch welcomes the opportunity to highlight a number of pressing concerns pertaining to the Western Balkans in advance of the informal Gymnich meeting of EU foreign ministers in Salzburg on March 10-11, during which relations with the…
Q & A: Serbian President Slobodan Milosevic's Trial
1. Where do the proceedings in the Milosevic trial stand? Former Serbian President Slobodan Milosevic was indicted under three separate indictments for crimes committed in Kosovo, Croatia, and Bosnia and Herzegovina. The trial started on…
Human Rights Watch Comments on the Council of Europe List of Post-Accession Commitments for Yugoslavia
On July 2, 2002, president of the Council of Europe Parliamentary Assembly Peter Schieder handed to the Chamber of Citizens of the Federal Republic of Yugoslavia (FR Yugoslavia) a list of commitments that the country must be "determined to honour"…
Memorandum On Charges Against Indictees Currently Living in Serbia
At least nine individuals indicted by the International Criminal Tribunal for the former Yugoslavia (ICTY), are currently believed to be residing in the Federal Republic of Yugoslavia (FRY). The authorities in Belgrade have refused to arrest any of these…
Recommendations on the OSCE Kosovo Verification Mission
Pre-deployment Benchmarks The Mandate of the Verification Mission Conclusion In light of the Federal Republic of Yugoslavia's (FRY) poor record of cooperation with the international community, Human Rights Watch is concerned that the OSCE Kosovo…
Human Rights Watch Statement to the Contact Group
The international community has repeatedly vowed to prevent "another Bosnia" from happening in Kosovo. Yet indiscriminate shelling, summary executions, and the razing of villages that marked the war in Bosnia are now taking place in Kosovo on a daily…

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A&M Resort is located in the city of Hawassa.
United Africa Group Hotel Hawassa is located in Hawassa and features a Restaurant and Bar. The Hotel offers stable electricity, free WiFi internet access and on-site parking.
In our shop we have all stationary items, laminating machines, binding machines, original toner and all computer accessories.


DO NOT turn off ATT!
need to be ON at all times to prevent receiver overload. Turning on the NB is only useful if you enjoy intermodulation distortion. This receiver is good for HF monitoring with some reception on VHF/UHF bands as well.


Driving and dementia: Efficient approach to driving safety concerns in family practice.
OBJECTIVE: To provide primary care physicians with an approach to driving safety concerns when older persons present with memory difficulties. SOURCES OF INFORMATION: The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Primary Care Collaborative Memory Clinic. MAIN MESSAGE: One of the most challenging aspects of dementia care is the assessment of driving safety. Drivers with dementia are at higher risk of motor vehicle collisions, yet many drivers with mild dementia might be safely able to continue driving for several years. Because safe driving is dependent on multiple cognitive and functional skills, clinicians should carefully consider many factors when determining if cognitive concerns affect driving safety. Specific findings on corroborated history and office-based cognitive testing might aid in the physician's decisions to refer for comprehensive on-road driving evaluation and whether to notify transportation authorities in accordance with provincial reporting requirements. Sensitive communication and a person-centred approach are essential. CONCLUSION: Primary care physicians must consider many factors when determining if cognitive concerns might affect driving safety in older drivers.


Jessica and I are definitely on the same organizing wavelength, because we both used the very same concept to get our drawers into tip top shape! It is such an incredible feeling when you see ideas that are working well for you, adapted by another with the same happily ever after. And that is definitely the case here.
Being organized at work is just as important as being organized at home. It's hard for me to show you the difference because I work from home... but I do know first hand due to my 8+ years of office experience.
That's why I am uber excited to share this Reader Space today. Because it takes place in the workplace. A place I haven't yet featured here on the blog!
But the really cool thing, is that the concept and the idea of today's post, can also be implemented in the home! Love that!
As a daily follower of your blog, I like to apply your tips to my home, but also to my classroom. I am an elementary art teacher. I have a blog for art teachers called "The ART of Education." A large portion of my blogging involves classroom organization. I wanted to share with you a post I did about organizing my desk drawer. I think many people think about organizing their homes, but their work life is not that organized, or the other way around! I am especially liking your "Organize in 15 Minutes" posts, which I recently commented on. Thanks for everything!
At the beginning of the week, I shared with you a deep dark space in my life. My top desk drawer. It was such a mess. I swallowed my pride and took a few photos, challenging you to organize your own drawer with me this week, in my "Tackle it Together" series. Check out that post here. I'd love to hear how you all did!
And that is just to name a few! All of these things I did not use on a regular basis…. My goal for the drawer was to only put things in here I use and can grab easily EVERY DAY!
Here is what I did. I started by dumping out everything on Monday. I cleared the drawer into a tub. I like to start organizing projects with a fresh clean slate. I only added back in my favorite pens.
As the week went on, I would only pull things from the bucket that I needed, telling me it was an item I needed on a weekly or daily basis. I would gradually add things as the week went on. It turns out I didn't need very much of what I had pulled out. My only putting a few things back, I really simplified my life!
So, what did I choose to keep in my top drawer? The following are the items I grab every day.
Pencils – MY pencils, to keep save from the grubby hands of little kids. I hate using their pencils. I am constantly washing my hands! These are in my safe zone!
White index cards – One of the office supplies that makes me giddy. I write all of my TO DO lists on these cards. Note, three different sizes, depending on how much I have to do!
Highlighters – Another love affair. I highlight things all the time!
Staple Removers – for those pesky bulletin board take downs!
And then, I got a little drawer organizer, which is really just a serving tray I picked up for a dollar. In this, I have my highlighters, my professional cards to hand out, and also my recess whistle and key for the kiln room. Both things I do not want to lose! Since this project was completed, it has definitely made my life easier and the system is working, which is a good sign!
So, there you have it. Lets see a side by side for effect.
What do you guys think!? Pretty awesome way to organize right? I showed you here, how I used the same system to get my kitchen drawers in tip top shape, so now you have multiple visuals of the benefits of hopping through the same process.
1. Empty contents from drawer or other space, into a large bin. This gives you a blank slate.
2. Dedicate a realistic period of time, one to two weeks is typically best. Only place items back into your zone, that you have removed from the bin to use.
3. Assess. At the end of your dedicated time frame, you can analyze what's left in the bin that didn't get touched. Think about the whys? Does it belong in a better place to be more functional to you? Is it just taking up valuable real estate in your home/zone? Can someone else put better use to the object?
4. Toss/Sell/Donate. Determine your best method to say goodbye to the remainder of the bin contents.
5. Dance. Yep, like no one is watching. Be proud of your newly organized zone! It will function SO much better with less items weighing it down!
Thank you SO much to Jessica for giving us a glimpse into her work life, and showing us the importance of looking at all aspects of our lives when it comes to organization!
P.S. Have an awesome story to share? How about some organizing tips and tricks? Maybe a project completed from an inspiration found? Please send your story and photos to iheartorganizing@gmail.com and I would heart to feature them right here, on the blog!! Oh, and no worries my friends, we will NEVER judge "before" pictures because that just wouldn't be nice! Only love goes on at this blog!
Great organization. Inspires me to crack open my desk at work! [lol].
I loved this post...I am in the process of organizing my "teacher corner" in my classroom too. And yes, I took pictures along the way! :-) I'll be sending them in as soon as I am done!
I must admit- Every since doing this project I have kept it just this way, and it has made my life so much easier!... The next thing I plan to tackle is under the sink in my art room. Now THAT will be interesting! Thanks, Jen for all of your inspiration, too. Whether we are at home or at work, being organized makes our lives easier.
My girlfriend did this with her BIG drawer in her kitchen that holds the utensils. She dumped EVERYTHING into a box and for a week only put back in what she used. Just like this post! GREAT idea, would work for clothes, bathrooms etc., etc!!!!
Thank you for sharing that blog! It inspired me to come to work today and do the same. I wish I would have done and B&A. It was terrible! I didn't use things over a week but instead took out office supplies, business cards and other things I knew I hadn't used and never would. I can't wait to tackle the rest of them before I leave work for Xmas break.


Yes, cupcakes are a part of my life. It's not something I like to admit. It seems when everyone finds out I am a pastry chef, one of the first comments is, "Oh, so you make cupcakes?." An innocent question, but one that I find irritating. I would never call myself a chef if all I did was make cupcakes. That all encompassing title means that you should know and be able to execute so much more. As a pastry chef in charge of a restaurant menu, cafe menu, and catering, I need to know ice creams, breads, cakes, and pastries in all its forms and intricacies. This on top of management, basic food knowledge, setting a good example, and working in a kitchen setting. I love a good cupcake, but I would never want anyone to think that all I do is bake cupcakes all day. Yet, a good cupcake hits the spot, and a perfectly executed cake and frosting ratio says more about a pastry chef than a resume ever could. Pictured are red velvet cupcakes, white chocolate and cream cheese frosting, topped with meringue and hollyhocks.


Classic Services of Louisville has been cleaning hardwood floors since 1999. Our staff of experienced hardwood floor cleaners uses high speed rotary brushes and premium hardwood floor cleaning products for a quality wood floor cleaning result.
Hardwood floors need to be maintained on a regular basis with periodic deep cleaning and conditioning. Classic Services of Louisville recommends deep cleaning your wood floor several times a year for maximum durability. Invest in your home by calling (502) 353-5193 to schedule your wood floor cleaning.
Classic Services of Louisville brings out the best shine in your hardwood floor.
Classic Services of Louisville pays extra attention to high traffic areas, like entryways. We remove scuff marks and restore worn out areas, so the high traffic areas blend seamlessly with the rest of your floor.
Call (502) 353-5193 to speak with one of our hardwood floor specialists.
We using non-toxic cleaning solutions that are safe for your family and pets. All Classic Services of Louisville cleaning products have fresh, pleasant scents.
Bring out your hardwood floor's natural warmth with a professional deep clean, guaranteed to make your floor look it's best. Classic Services of Louisville has more than 20 years of experience cleaning all types of hardwood floors. Call (502) 353-5193 today to schedule a deep clean for your hardwood floor.


The MADDLAIN project aims to analyse the behaviour and needs of different audiences with regard to digital access to the collections offered by the CegeSoma, the Royal Library of Belgium and the State Archives of Belgium.
A study concerning general access to digital information.
A study regarding the use of e-learning by university students who are studying humanities subjects.
A study focusing on the use of Virtual Research Environments by researchers in the humanities.
Structured data obtained from databases and websites belonging to the institutions.
Unstructured or semi-structured data collected by means of questionnaires and interviews.


BABY DOLLS LOVE ¡NUEVOS! BODIES ¡NUEVOS! BATA Y CHEMISE BIKINIS Y TANGAS BUSTIERS Y CORSES CINTURA DE AVISPA ¡NUEVO! COORDINADOS DANCE Y MINIS DISFRACES ¡NUEVOS! DISFRACES TALLA EXTRA GUANTES LADY IN RED LIGUEROS LIGUEROS Y MAS MEDIAS NOVIAS ¡NUEVOS! PANTYMEDIAS PANTYLIGUEROS PARA EL PEQUEÑOS DETALLES ¡NUEVOS! $399 O MENOS BABY DOLLS MENOS DE $499.- ¡SUPER OFERTA!!! TALLAS EXTRA ¡NUEVOS! TEDDIES ¡NUEVOS! ¡MÁS NUEVOS!!
ShopFactory shopping cart software powers LUNAROSA Lencería de Alto Nivel. All-in one eCommerce software and shopping cart.


text:
Date book
7:45 p.m. A few dates to watch as the Bengals close in on the draft and the ensuing on-field workouts: **
March 22-25:** NFL annual league
league meetings in Dana Point, Calif., where the Bengals' 13-13 tie against the Eagles back in November is going to be rehashed and regurgitated as overtime no doubt gets hotly debated. With The Chicago Sun-Times reporting that the Bengals are actively shopping left tackle Levi Jones, this could be a week it gets done. The gamble for a team would be if the draft doesn't break the right way for the Bengals and they decide not to cut him. **
March 23:** During the Monday afternoon session of the meetings, the NFL usually releases the compensatory draft picks.
With the Bengals having a net loss of five players in 2008 unrestricted free agency (Justin Smith, Madieu Williams, Landon Johnson, Bryan Robinson and Alex Stepanovich) on top of signing Antwan Odom, the Bengals could get as many as the maximum of four.
Best-case scenario? A third-rounder, sixth-rounder and two seventh-rounders. Worst case? A fourth and a seventh.
It all depends on a byzantine formula that takes into consideration playing time, pay and postseason awards. Because Smith signed such a big deal, all indications are the Bengals will get a third-rounder for him. It would be a bit fitting they would get a compensatory for Johnson even if it is just a sixth. The Bengals took him with the extra third-rounder (No. 96 in 2004) they got for losing Takeo Spikes in 2003. **
March 30:The first day of offseason workouts at Paul Brown Stadium. Anybody who has been asked (including Chad Ocho Cinco) has said he is going to show. The Ocho hasn't been available for comment since T.J. Houshmandzadeh signed with Seattle and the Bengals signed Laveranues Coles, but before that he said he was a go. Middle linebacker Dhani Jones, who has been tackling the globe for the Travel Channel, has said he'll be there but maybe not right away.
April 6:Give or take a few days, this is about the time the Bengals start bringing in college prospects to visit at Paul Brown Stadium. They are allowed 30 visits, but all of them won't be auditioning for the No. 6 pick. Some are players that weren't invited to the scouting combine and the Bengals need to take their physicals. Others could be possible free agents if they're not drafted and the team can start the recruiting pitch a few weeks early.
April 14:First guess on when the NFL schedule is released. It was released on Tuesday, April 15 last year and the 14th is the second Tuesday in April this trip. One thing we do know is it starts with an easier sked off the previous season. This year the Bengals have the 11th easiest schedule in the league with foes going a combined .467 last season. Last year they had the sixth hardest at .547.
April 25, roughly 5:50 p.m.:When the Bengals should be making their first pick now that the start of the draft has moved to 4 p.m.
April 26:When the Bengals could have as many as nine picks in the last five rounds of the draft if they max out the compensatories.
May 1 (tentative):Debut of the No. 6 pick on the field in the rookie minicamp, which in the past couple of years has started the Friday after the draft.
May 12 or May 19:** Another Carson Comeback in the first practice of the voluntaries. There's not nearly the angst surrounding the comeback from his elbow injury as there was about his knee three years ago. Probably because he was gunning the ball the last couple of weeks of last season.


All About South Carolina Wildflowers p107?
Great Smoky Mountains Wildflowers p092?
Wildflowers of the Carolina Lowcountry p149?
Wild Flowers of NC, 1st edition p152?
Wild Flowers of NC, 2nd edition p202?
Wildflowers of the Southern Mountains p127?
Leaves alternate and numerous, per Forest Plants of the Southeast and Their Wildlife Uses.
Plant is rough-hairy throughout, per Guide to the Wildflowers of SC.
Leaves abundant, linear to elliptic, obovate, oblanceolate or hastate, per Wildflowers of the Eastern United States.
Follicles erect, 8-15 cm long and 1-1.5 cm broad, per Vascular Flora of the Carolinas.
At first glance, early instar Milkweed Bug nymphs look like red aphids, per Milkweeds, Monarchs and More by Rea, Oberhauser, and Quinn.
Markings on Large Milkweed Bug (Oncopeltus fasciatus) form a black band, per Milkweeds, Monarchs and More by Rea, Oberhauser, and Quinn.
Erect boat-shaped pod splits on one side to release many plume-tufted seeds, per Forest Plants of the Southeast and Their Wildlife Uses.
Seeds with feathery parachute-like structures float on the slightest breeze, per Wildflowers & Plant Communities of the Southern Appalachian Mountains and Piedmont.
Milkweed Bug nymphs eat Milkweed plant matter, seeds and nectar, per Milkweeds, Monarchs and More by Rea, Oberhauser, and Quinn.
Milkweed Bug nymphs congregating on a Milkweed pod.
Seed pods are 4-5" long and look like elongated footballs held upright, per All About South Carolina Wildflowers.


Jules A. Case of Trenton was honored last Tuesday night by the Dade County Lions Club as "Citizen of the Month." Tribute was paid the business, church and civic leader during a dinner meeting of the club at Wright's Restaurant.
"It is my pleasure and privilege tonight to show respect and to honor one of our own.
"Jules A.Case was born on Christmas Day, 1902, in Trenton, one block from his present home. He Attended school through the ninth grade in the old Masonic building, and attended Chattanooga High School from 1917 to 1920. Then he decided he was ready for the world.
"He started working in 1920 for George K. Brown Co., Chattanooga, stayed until 1926 and had worked up to plant superintendent . The Brown Co. had operated the old 'Palace Cream Parlor' which during the 'wild '20's was a favorite meeting place for the younger sect.
"His next stop was at Swift Gold Co. also in Chattanooga over 10 years, and he worked from shipping clerk to assistant manager. He stayed in Nashville for eight years as branch manager, then transferred to Savannah as manager there for about two years.
."Then he went into business for himself in Statesboro, Ga., for about a year, operating a meat packing company there. Then he moved back to Trenton in 1946.
"While in Nashville, he was a member of the Kiwanis Club and Chamber of Commerce, also belonging to the Kiwanis Club in Savannah.
"Mr. Case has a daughter, Mrs. Robert Ingle of Chattanooga, and she has a boy and girl in college and a younger son attending Baylor School. Mr. Case and Thelma, his wife, have two boys, John, who is married, the father of a 3-year-old son, lives on Sand Mountain, works for the telephone company, and Bruce, the younger son, who lives in knoxville and is still single. I'm sure most of you know both Bruce and John.
"I have known Mr. Case during the part of his life since he moved back to Trenton in 1946, and am sure some of you have known him as long as I have. He has been a faithful member of the Methodist Church since he moved back here, and still serves on the administrative board. He was Church treasurer for many years and never seemed to have any trouble getting what money the church needed. I am glad to be able to say that he is still a regular attendant every Sunday.
"Mr. Case has served on the Tax Board for Dade County, and for several years was a councilman for the City of Trenton. He has been a member of the Lions Club since moving back until a few years ago when he resigned. He served as president one year. During the years, he worked on all kinds of projects for the Lions Club, and was a member you could always count on.
"He served as president of the Dade County Forestry Club, the first year it was organized. He was on the Board of Directors of the Bank of Dade from the beginning in 1956 until January of this year. He was Chairman of the Board during the last year, resigning in January of this year. He served several years on the Dade Development Board and played a big part in getting Lee Corporation to move here.
"Along with Bill Tatum, Mr. Case developed the Trenton Telephone Co. from a small operation of about 125 phones to about 4,000 at the present time. Along with the late Maddox Hale and myself, Mr. Case helped develop the Mountain View Subdivision and also the Stevenson property south of Trenton. He was also instrumental in getting a doctor here about 20 years ago, when we were in worse shape in that way than we are now.
"Now that the years have come along and he is in semi-retirement, I am sure he will devote much time to two things that he enjoys much, golf and traveling.


Pieter Paul Pothoven (1981) is a multimedia artist who engages with historical sites, artifacts and resources in order to mediate new relationships with the past, often based on the potential use value of these locations and objects in the present. He received his BFA at the Gerrit Rietveld Academie in Amsterdam and his MFA at Parsons The New School for Design, New York. He was a fellow at the Fine Arts Work Center, Provincetown (US) and a resident at the Instituto Sacatar in Salvador, Brazil. In 2014 and 2015 he was a participant at the Jan van Eyck Academie in Maastricht.
Recent exhibitions with Pieter Paul Pothoven include Territorial Drift at Garage Rotterdam, Listen to the stones, think like a mountain at Tatjana Pieters, Ghent, Lapis Lazuli from Serr-I-Sang at PuntWG, Amsterdam, 11:59 at Hudson D. Walker Gallery, Provincetown and The Intelligence of Things at The Kitchen, New York. His writings have been published by De Internet Gids, Volume and by the International Center of Photography in collaboration with CCS Bard. Work by Pothoven is held in private and public collections, including the Fries Museum, Leeuwarden, Akzo Nobel Art Foundation, Amsterdam and the Van Lanschot Art Collection, The Hague.


And so they carried on, affirming and supporting him. I wanted to hug them. But then thought – I had been expecting them to come out with stereotypical comments. In fact I was the one who was guilty of stereotyping, because they looked a bit scary and spoke in very broad scouse accents with the odd 'F' word thrown in.
I am the one who goes on and on about justice and, albeit briefly, had unfairly passed judgment on someone else!
That's the thing about injustice. It affects real people. Behind every person who is threatened with homelessness or is a victim of catastrophic injuries, or who is having to face the humiliation of a food bank, is a real story. Injustice happens when they are depersonalised. When they become a 'problem' on the one hand or a 'cause' on the other. We can all be guilty of being too concerned about being 'right' than about being fair.
So here is belated thanks to those guys on the train.
A timely lesson in the real world.
Head of NHS Resolution says claimant's refuse to mediate!!
It was really no great surprise when the head of NHS Resolution yesterday blamed Claimant lawyers for the small number of claims which have been successfully mediated since the NHS Litigation Authority changed its name in April 2017.
And to give credit where it is due the name has in fact changed. I recently discussed the announcement with a group of claimant lawyers who were unanimously of the view the nothing much else had changed.
Yesterday's assertion was made to the House of Commons Public Accounts Committee by Helen Vernon. She told the committee that few cases had been referred to mediation and shamelessly attributed this to the reluctance of Claimant lawyers to engage in the process.
I have litigated hundreds of medical negligence cases and have never refused mediation. Neither do I know any other lawyers who have refused. What Ms Vernon overlooked is that the courts have introduced a huge incentive on parties to resolve claims in this way. There is a power to impose costs sanctions on any party who unreasonably refuses an offer to mediate. Most experienced lawyers include a paragraph in their initial letter of claim offering to refer the case to mediation. This is routinely refused or even ignored. The reason that the NHS give for such refusal is that the matter is disputed – even though the vast majority end up being settled.
The last Clinical Negligence case that I dealt with at my last firm was listed for trial in February 2017. We had made an early offer to settle and in 2016 proposed a Joint Settlement Meeting which is designed to resolve disputes without trial. There was no response until less than 2 weeks before trial when the case settled on terms that would have been accepted 2 years earlier. The costs were through the roof by then.
If claimant representatives had been there they would certainly have pointed out what a ludicrous statement Ms Vernon made. Claimant lawyers are under a professional duty to achieve the best result for their client. This would never included a refusal to discuss resolution.
Costs in clinical negligence cases are a burden on the tax payer. Resolution of claims should be a priority.
It takes two to mediate! It is unhelpful for a manager of NHS Resolution to blame one set of lawyers for this. Especially or possibly because those lawyers were not there to set the record straight.
On Tuesday last week, I was proud to be part of the 6th Liverpool Legal Walk. About 150 of us from Law Firms, big and small, walked 5k around the centre of Liverpool. I have to say, it was a very pleasant walk around the city. It really has been transformed beyond recognition over the last few years. And the rain kept off!
The highlight of the event was however to see the efforts of the walkers to raise much needed funds for legal charities.
The effect of this is that thousands of ordinary people have been left with legal rights that they cannot enforce.
'Courts exist in order to ensure that the laws made by Parliament, and the common law created by the courts themselves, are applied and enforced. That role includes ensuring that the executive branch of government carries out its functions in accordance with the law.
It is also a point I have made on this blog over and over again!
I have been involved in this walk since the start. It is fair to say that there was some hesitation at first. Why should the legal profession be raising funds for legal advice which should be properly funded by the government? That was, and still is, a fair question. But in the meantime, peoples' fundamental rights are at risk. There is now no alternative to doing all we can, whilst at the same time campaigning for change. Liverpool Law Society have supported the event from the start and John Ballam is the latest President to walk for justice. We were also well supported by the Women Lawyers Division.
We were very pleased to welcome the Lord Mayor of Liverpool, Cllr Malcolm Kennedy. At the end of the walk, as we enjoyed a well-deserved drink, he commented that lawyers do not always get a good press! He went on to thank all of those who had given up their time to help secure justice for those in greatest need in Liverpool and across the North West. It is often overlooked that the drive to fight for justice is what led many to become lawyers in the first place. Another well known face was actor, Michael Starke - known to us all as Sinbad from Brookside!
So thank you to all of our walkers. We will be back again next year – and we will continue until we are no longer needed.
I fear I may be on my zimmer by then!
I presented a training course last week, for Liverpool Law Society on Professional Negligence in Personal Injury Claims. These claims have become more common over the last few years. This is partly because of the pressure on firms to delegate work to junior case workers because of limited recoverable costs. It is also because some firms have actively advertised for work. We discussed the things that can go wrong including missing limitation and court deadlines which are often the cause of sleepless nights for PI Lawyers.
The most interesting discussion concerned 'under settlements', those cases where the client is unhappy with the outcome of the case and wants more compensation. Some of these are fairly straightforward. I acted for a client last year, whose case had settled for £2.5k. We were now 4 yeurs post accident and he still had problems with his knee. His original solicitors had obtained a report from a GP expert who had given him an optimistic prognosis for a soft tissue injury. But he had also said that he would need to be seen by an orthopaedic surgeon if he had ongoing symptoms. This had not been done and the case had settled. The client had not recovered. Further evidence revealed a significant ligament injury and the claim against the solicitors settled for about £24k. That was a clear error by the junior case worker who had processed the claim. The advice from the expert had simply been missed.
Under settlement claims are not always that straightforward. The idea of claimants effectively bringing a secondary claim for an uplift is controversial. There are concerns about the growth of a secondary market for these cases, especially when backed up by adverts promising more money.
All of this was considered by the Court of Appeal, including Jackson LJ, in the recent case of Thomas v Hugh James Ford Simey Solicitors  EWCA Civ 1303. The original case concerned a claim under the old Coal Miners VWF Scheme. This was a procedure for processing high volumes of cases on the basis of processed work and relatively low fixed fees. So it has many of the features of those cases brought under the PI protocol or fixed fees. In 2001, his solicitors secured an offer of £10,373 for pain and suffering. They wrote to him to say that he might be able to claim further damages if he was no longer able to do – 'things such as gardening, DIY, home decoration, window cleaning, car maintenance, and car washing.' The letter went on to say – 'The amount of compensation payable in such cases can be significant.' No figure was mentioned.
So what will be expected of solicitors as we move into a world where most straightforward PI claims will be – 'high volume, low value personal injury cases for fixed costs'?
Will the bar be lowered? Where will the line be drawn?
'The civil justice system exists to enable injured parties to recover compensation for genuine wrongs. It does not exist to service artificial claims stirred up by advertisements.' (my emphasis).
So the solicitor has to ensure that the basis issues are explained and understood. But beyond that it is going to be a challenge. It isn't enough to show that there was an under settlement if the lawyer did what was expected.
And any solicitors who are considering advertising for, or buying in these cases, can expect a hostile reception from the courts.


SSC CGL examination has commenced from 27th August 2016 and will continue till 11th September, 2016. The tier 1 examination is followed by tier 2 and then tier 3. This is one of the most popular examinations in India because of the scale of recruitment and the opportunity of getting a good job under Government of India. One of the posts for which recruitment is done through SSC CGL is accountant or junior accountant in CAG, CGDA and CGA.


Rebecca Williams, Naomi Tadevossian, Alasdair Stewart, Martina Bussi, Daniel Connor, Chris Knight and Junior Cunningham in Scattered.
For almost 30 years, Kevin Finnan has been making bold, highly physical dance theatre for Motionhouse, the company he formed, with Louise Richards, in 1988. No-one makes work even vaguely similar to Finnan's exciting, absorbing blend of dance theatre, circus and technology. Often produced on a grand scale, it is suited to a repertoire that includes spectacular outside events, such as a show for dancers and JCBs; and another featuring the facsimile of a full-size ocean liner. These expansive skills led to Finnan's appointment as choreographer for the 2012 Paralympic Opening Ceremony.
Motionhouse visits to London are sporadic. After an absence of four years, the company showed Broken (2013), at the Peacock Theatre, in 2016, and I hope that this relatively quick return visit indicates a greater regularity of London seasons for one of the most under-rated of British companies. We often marvel at circus-based dance brought from as far afield as Canada and Australia; but we have a remarkable company making dance-based circus right here, in Leamington Spa!
Rebecca Williams, Naomi Tadevossian, Alasdair Stewart, Martina Bussi, Daniel Connor and Junior Cunningham in Scattered.
Broken is the second part of Finnan's Earth trilogy, which began with Scattered, in 2009; so, in that sense – in 16/17- the two shows arrived in London in their reverse order. By the way, the third part of the trilogy, Charge, is due to premiere at the Warwick Arts Centre, in October 2017. Given the complexity of Motionhouse works, it is no surprise that each piece takes four years to make.
Charge will take its inspiration from energy; Broken examined the human relationship with the Earth; and Scattered is all about our relationship with water. Its main feature is a vertiginous, sloping wall, which initially provides the optical illusion of being a sheer drop; a trick of the eye, shockingly exposed – early into the work – when one of the dancers leaps from the five-metre-high edifice. There is an audible collective, sharp intake of breath, but the dancer's airborne fall is quickly arrested by an unseen slope in the wall. It is, in fact, one great big slide; ingeniously designed by Motionhouse's long-term collaborator, Simon Dormon.
Rebecca Williams and Alasdair Stewart in Scattered.
For the next 70 minutes' the wall is the centrepiece of the work. It provides a projection screen for the digital imagery, designed by the filmmakers from Logela Multimedia. The (magnificent) seven dancers frequently run up the wall, especially effective when "stepping up" on the motion graphics of an escalator; they dig their hands into the cracks of a dried-out water basin; they freeze in an arctic wasteland; or throw themselves headlong into a perfectly synchronised graphical splash.
They run along the parapet at the top of the wall and jump and slide down with all the enthusiasm of three-year olds in the local playground. It is all, of course, connected to water: in our imaginations, they are riding over a waterfall; diving into the ocean; sliding with an avalanche. As if the slope itself isn't enough fun, it is supplemented with clever aerial work to provide an extra dimension with both the stage and the wall providing performance platforms at a right-angle to one another. Another optical illusion.
While the synchrony of motion graphics and live action is impressive, an even greater impact comes from the powerful dynamism of the dancers. It is no accident that the jolting impression of the first dancer to leap from the wall's summit is pre-empted by a magnificent, appropriately liquid, dance solo by Chris Knight.
Weaker choreography might easily be overshadowed by the monumental capacity of the set and motion graphics, but Finnan's work is equally imposing; seamlessly transitioning from punishing floor-based movement to dizzying spins and sudden, tightly-controlled balances. It is high-energy, non-stop action with lifts, spins and dives into those perfectly synched splashes on the screen. This is a hugely talented, athletic and acrobatic septet of dancers, only one of whom (Junior Cunningham) is a survivor from the original 2009 cast.
The work benefits from an eclectic score, designed by Finnan, together with Sophy Smith who composed the original music with Tim Dickinson. It has a round-the-world feel with memorable influences from Europe, India, the middle east and Africa; but it is all hummable, danceable music, providing an effective aural envelope for a full house of magical interactive creative contributions, which gel together to provide arresting entertainment.
Unfortunately, Scattered is nearing the end of its evangelical journey, articulating the preciousness of water to the earth, as Motionhouse's longest running show, to date. These Peacock showings bring to an end the show's fifth UK tour and it has also visited the USA, twice, plus regular trips to mainland Europe, China, Macau, Hong Kong and Japan. No wonder we haven't seen much of them in London! I'm eagerly awaiting the next highly-charged instalment, coming in October. It might even tempt me to Warwick!


The unfolding events in Libya have had major consequences upon the population. It has been estimated that currently 3 million people have been affected by the conflict, including 218,000 internally displaced persons (IDPs) and 860, 900 people (192,000 Libyans) forced across the border. In May, Italian maritime authorities were conducted a rescue mission for 500 Libyan refugees whose boat had hit rocks just off the coast. The vast majority of Libyan refugees have sought asylum in Europe and Italy in particular, which already received thousands of Tunisian refugees earlier this year. However, as the situation in Tunisia stabilises, the Tunisian government has established refugee camps for Libyan refugees (mostly in Choucha), although many Libyan refugees are opting to return home due to poor conditions.
The government's deadly crackdown on Syrian protestors has induced major refugee flows. Neighbouring states, Lebanon and Turkey have received the majority of refugees fleeing the violence. Turkey has received an estimated 12,000 refugees throughout the conflict. Although Turkey is hosting these refugees in border camps, Turkey is only party to the original 1951 Refugee Convention and thus, only recognises asylum seekers displaced prior to this period. The prospects for resettlement for this refugee population are bleak. In the case of Lebanon, they have received around 5,000 refugees. The Syrian population are not the only group affected; given that Syria was the third top refugee hosting country with around 1 million refugees residing in camps, parts of the existing refugee population have been forced out of the country. Around 5,000 Palestinian refugees have been forced to flee Latakia which has hosted around 10,000.
Following a referendum held earlier in the year, South Sudan formally declared independence from Sudan on the 9th July effectively enforcing the Comprehensive Peace Agreement formulated in 2005. However, the birth of South Sudan has not halted the violence and has not stemmed the flow of refugees. The UNHCR estimated that, thus far, 31,256 have been displaced into neighbouring countries. The complexity of the agreement also places current refugees and IDPs in a precarious situation. There are currently 1 million Southerners residing in the North that are required to either move to South Sudan, which is now a recognised international border or retain their citizenship in the North. Even more ambiguous is the proposition that those wishing to remain in the North may not be offered automatic citizenship. They may have to lodge a claim for asylum citing the threat of persecution in the South; there is a major risk that this population will become stateless.
 ABC News. 3 March 2011. 'Libyan crisis could spell 'disaster' for Italy'.
 Muscati, S and Kwiram, S. 23 june 2011. 'Libya's Forgotten Civilians.' Huffington Post. Cited by Human Rights Watch.
 International Crisis Group. 1 July 2011. Syria.
 The 1951 Refugee Convention was originally formulated in response to the displacement caused by Nazi Germany and thus, only responded to the needs of those displaced prior to this period. The Convention was expanded upon with the 1967 Protocol that removed geographical stipulations. Turkey is not party to the subsequent Protocol. See: United Nations High Commissioner for Refugees. 2008. State Parties to the 1951 Convention relating to the Status of Refugees and the 1967 Protocol.
 United Nations High Commissioner for Refugees. June 2011. 'Refugee- news'.
 Arbour, L. 8 July 2011. 'New Country, Old Problems'. International Herald Tribunal.
 United Nations High Commissioner for Refugees. 31 May 2011. 'Sudan's Abyei region could see further displacement warns UNHCR'.


text:
Horatio Bisbee Jr.
Horatio Bisbee, Jr.
from Florida's 2nd district
Jesse J. Finley
Charles Dougherty
Noble A. Hull
March 4, 1877 – February 20, 1879
11th Florida Attorney General
Harrison Reed
J. B. C. Drew
J. P. C. Emmons
United States Attorney for the Northern District of Florida
Appointed by
Ulysses S. Grant
(1839-05-05)May 5, 1839
Canton, Maine
March 27, 1916(1916-03-27) (aged 76)
Dixfield, Maine
Charlotte Randolph
Tufts College
United States of America
5th Regiment Massachusetts Volunteer Militia
9th Maine Volunteer Infantry Regiment
American Civil War
Horatio Bisbee Jr. (May 1, 1839 – March 27, 1916) was an American attorney and politician who served as a U.S. Representative from Florida.[1]
1 Early life and education
2.1 U.S. House of Representatives
4 Death and burial
5 Electoral history
6 Notes
Bisbee was born on May 1, 1839 in Canton, Maine. Bisbee began attending Tufts College in Massachusetts, but halted his studies in 1861 when the American Civil War broke out.[2]
Bisbee enlisted in the Union Army with the 5th Massachusetts Militia as a private until July 1861, when he was appointed as a captain in the 9th Maine Infantry. He eventually rose to the ranks of lieutenant colonel and later colonel.[3] Bisbee retired from the army in March 1863 and returned to Tufts College, graduating later that year.[2]
Bisbee moved to Chicago, Illinois in late 1863 and was admitted into the Illinois Bar in 1864. After the end of the war in 1865, Bisbee moved to Jacksonville, Florida and established his law practice there. In 1869, President Ulysses S. Grant appointed Bisbee as the U.S. Attorney for the Northern District of Florida.[2] In this position, Bisbee, a Republican, made acquaintance with several high-profile Floridians, including Governor Harrison Reed and lawyer Joseph E. Lee, who was one of the most prominent black Republicans in Florida at the time.[4][5]
In 1872, Bisbee was temporarily appointed as the eleventh Florida Attorney General by Reed. He stepped down when lawyer J. P. C. Emmons was chosen to permanently fill the position. During his appointment, he was still serving as a U.S. Attorney. He resigned as U.S. Attorney in 1873.[6]
In 1876, Bisbee was elected to the U.S. House of Representatives, representing Florida's recently created 2nd congressional district. Bisbee defeated Democratic incumbent Jesse J. Finley by just three votes. Finley successfully contested the election and was seated on February 20, 1879, less than a month before the term expired.[2]
As Finley was not seated until after the election of 1878, Bisbee was technically still the incumbent leading into that election. Bisbee was defeated by Democratic Lieutenant Governor Noble A. Hull by just 22 votes. Bisbee successfully contested the election, taking the seat on January 22, 1881, a month and a half before the term expired.[7]
During the 1880 elections, Hull, the technical incumbent going into the election, did not seek reelection. Bisbee and Finley again ran as the Republican and Democratic nominees. Finley won, but the election was contested by Bisbee. On June 1, 1882, Bisbee was declared the winner, meaning he would be the incumbent entering the 1882 election.[8]
In the 1882 election, Bisbee won a decisive and undisputed victory over Finley. Bisbee ran for reelection in 1884, losing to Charles Dougherty, the former Speaker of the Florida House of Representatives.[2]
After this loss, Bisbee retired from politics, returning to private practice.[6]
At some point after his retirement, Bisbee married Charlotte Randolph. They had a daughter, Florence, in 1885.[9]
Bisbee and his wife returned to Maine leaving their daughter in Jacksonville with her husband and his family.[10]
Death and burial
Bisbee died in Dixfield, Maine on March 27, 1916. He is buried with his wife, who died twelve years later, in Dixfield's Greenwood Cemetery.[2]
1884 United States House of Representatives election in Florida
Florida 2nd district[11]
Democratic Charles Dougherty 17,248 51.77% +2.27%
Republican Horatio Bisbee, Jr (inc.) 15,857 47.59% -2.91%
Independent Republican Josiah T. Walls 256 0.65% N/A
1,391 4.18% +3.18%
Republican Horatio Bisbee, Jr. (inc.) 13,069 50.50% +2.80%
Democratic Jesse J. Finley 12,813 49.50% -2.80%
256 1.00% -3.54%
Florida 2nd district[a][13]
Democratic Jesse J. Finley 13,105 52.30% +2.27%
Republican Horatio Bisbee, Jr. (inc.) 11,953 47.70% -2.27%
Florida 2nd district[b][14]
Democratic Noble A. Hull 9,640 50.03% +0.04%
Republican Horatio Bisbee, Jr. (inc.) 9,628 49.97% -0.04%
12 0.06% N/A
Florida 2nd district[c][15]
Republican Horatio Bisbee, Jr. 11,574 50.01% -1.12%
Democratic Jesse J. Finley (inc.) 11,571 49.99% +1.12%
3 0.02% -2.24%
^ Bisbee contested Finley's election and was seated in his place on June 1, 1882
^ Bisbee contested the election and was seated on January 22, 1881
^ Finley contested Bisbee's election and was seated in his place on February 20, 1879
^ "BISBEE, Horatio, Jr. | US House of Representatives: History, Art & Archives". history.house.gov. Retrieved March 31, 2019.
^ a b c d e f "BISBEE, Horatio, Jr. - Biographical Information". bioguide.congress.gov. Retrieved March 31, 2019.
^ "Civil War Index - 9th Maine Infantry". civilwarindex.com. Retrieved March 31, 2019.
^ "The Florida historical quarterly | ucf.digital.flvc.org". ucf.digital.flvc.org. Retrieved March 31, 2019.
^ Florida, State Library and Archives of. "Letter to Joseph E. Lee Concerning the Florida Gubernatorial Election of 1916". Florida Memory. Retrieved March 31, 2019.
^ a b "Horatio Bisbee, Jr". Find a Grave. Retrieved March 31, 2019.
^ United States Congressional Serial Set. U.S. Government Printing Office. 1879.
^ Political Pamphlets, 1876-1888. 1882.
^ "Charlotte "Lottie" Randolph Bisbee". Find a Grave. Retrieved March 31, 2019.
^ "Florence B. Rogers". Find a Grave. Retrieved March 31, 2019.
^ "1884 FL - District 02". Our Campaigns. Retrieved April 15, 2019.
from Florida's 2nd congressional district
March 4, 1877 – February 20, 1879 Succeeded by
January 22, 1881 – March 3, 1881 Succeeded by
June 1, 1882 – March 3, 1885 Succeeded by
Legal offices
Florida Attorney General
Florida Attorneys General
Papy
Galbraith
Meek
Conant
Emmons
Raney
Trammell
Swearingen
Faircloth
Shevin
This page was last edited on 7 July 2022, at 02:12


text:
Facebook Launches Cross-Account Reporting and Custom Ad Metrics
Facebook has this week added some new performance measurement options in Ad Manager, including cross-account reporting and custom metrics.
First off, on cross-account reporting - now, when you're managing multiple Facebook ad accounts, you'll be able to get a clearer, overall view of ad performance, all within the Ad Manager dashboard, as opposed to having to extract the data for each account yourself.
As per Facebook:
"With cross-account reporting, you'll be able to see metrics - such as reach, impressions, and conversions - across multiple ad accounts. This reporting surface serves as a one-stop shop for a clear, concise report on your business' performance and will allow you to save time that was previously spent manually building reports."
As you can see in the screenshot above, the option makes it easier to measure and compare specific performance metrics across each of the accounts you manage, giving you more context for your decisions, and streamlining your ad management process.
In addition, the new listings will also display de-duplicated reach, a data option which is not available when you download the same reports manually.
Facebook's also rolling out a new custom metrics option, which will enable advertisers to build the metric formulas of most relevance to their goals, then save them for ongoing tracking.
The features are more aligned to dedicated Facebook ad management organizations, and those conducting broader scale ad initiatives, but the custom metrics tools, in particular, could provide additional assistance for all Facebook advertisers who are looking to get more specific insights into their ad performance.
You can read more about the new Facebook ad metric additions here.


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The outcomes for small bowel adenocarcinomas have been shown to be worse than for colorectal cancer.
The recommended frontline therapy is either CAPOX or FOLFOX.
Pathways such as VEGF, EGFR, and MSI are highly expressed in small bowel adenocarcinomas.
Standard treatment for metastatic disease has not been well established.
Dysregulation of the Wnt/b-catenin pathway, TGFb signaling, and cell-cycle regulation is involved in the pathogenesis of these tumors, as suggested by the abnormal nuclear accumulation of catenin observed in 40% to 50% of cases.19 All of these molecular characteristics suggested that small bowel adenocarcinoma is a distinct disease.
A few cases have reported responses to anti-EGFR therapy in patients with KRAS wild-type tumors. The observed overexpression of VEGF-A, EGFR, and MSI suggests that therapies targeting these signaling pathways might display antitumor activity; at this moment there are prospective studies using anti-EGFR (e.g., panitumumab [NCT01202409], bevacizumab [NCT01208103], and pembrolizumab [NCT02949219]).
Small bowel adenocarcinomas are rare malignancies. Although they are morphologically similar to colorectal cancer adenocarcinomas, they are a different disease with distinct clinical, pathologic, and molecular characteristics to gastric and colorectal cancers. Despite being more molecularly similar to colon cancer than stomach cancer, its behavior has worse prognosis, perhaps by being influenced by other factors such as the microbiota or tumor microenvironment.
Standard treatment for metastatic disease has not been well established; however, combinations of 5-fluorouracil and oxaliplatin appear to be the most effective. Knowledge about the molecular profile of small-intestine cancers offers a great opportunity for the use of new therapies in randomized studies—and worldwide, multicenter research efforts are required because of the regional and racial differences and rarity of this cancer.
About the Author: Dr. Montenegro is with the Instituto Nacional de Enfermedades Neoplásicas.
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