text:
Zola Tours Les Halles at Dawn
by Zack Anderson, April 25, 2019 2 Comments
A bright glow at the far end of the rue Rambuteau announced that day was dawning. The sonorous voice of the market was increasing in volume, and every now and then the ringing of a bell in some distant pavilion mingled with the swelling clamor.
Claude and Florent entered one of the covered alleys between the fish and poultry pavilions. Florent raised his eyes and looked at the lofty vault overhead, the interior timbers of which shone out from amid the black lacework of the iron supports. As he turned into the great central avenue, he was vaguely dreaming of some strange town, with its various districts, its suburbs, its neighboring villages, its promenades and streets, its squares and crossroads, all suddenly placed under the shelter of a roof some rainy day by the whim of some gigantic power. The deep gloom that brooded in the hollows of the roof seemed to multiply the forest of pillars, and infinitely increased the apparent number of delicate ribs and bands and carved cornices and transparent shutters. Over it all, too, even down within the deepest depths of gloomy shade there seemed to be budding out a teeming growth of flowers and vegetation of luxuriant metalwork, with climbing clustering twigs and branches that twined and knotted themselves and spread over all an airy network that resembled the interlaced foliage of some ancient forest. Several portions of the market still slumbered behind their closed gates. The little trellised stalls of the butter and poultry pavilions stood out conspicuously in the midst of the solitude, and their alleys remained deserted in the glimmering gaslight. The fish market had just been opened, and women were flitting to and fro among the rows of white marble slabs that were as yet littered over with hampers and cloths. In the pavilions devoted to the sale of vegetables and fruit and flowers, the noise and bustle were gradually increasing. The whole place was now waking up by degrees, from the popular quarter where the cabbages had been piled up since four o'clock in the morning to the lazy and rich district that only began to display its pullets and pheasants as the hands of the clock pointed to eight.
The great covered alleys were now beginning to teem with life. All along the causeway, on both sides of the road, the market gardeners and other smaller growers from the environs of Paris were still crowding, displaying in hampers the harvest they had gathered on the previous evening—bundles of vegetables and clusters of fruit. Vehicles of one sort and another passed under the arches into the midst of this ever-circulating throng, the drivers slackening the noisy jogging of their horses as they made their way through the crowd. Florent, in order to force a passage, was obliged to press up against some dingy sacks that looked like coal sacks, of such enormous weight as to make the axletrees bend beneath them. They were quite damp and exhaled the fresh odor of seaweed. Through a rent in the end of one of them, a black stream of big mussels was trickling out. The two companions were now obliged to stop after almost every step. The fish was arriving, and wagon succeeded wagon, ladened with the tall wooden cages filled with hampers that were brought by train from the seacoast. To get out of the way of the wagons of fish that ever pressed more and more closely upon them, the two men now rushed among the wheels of the wagons that were coming loaded with butter and eggs and cheese, huge yellow vehicles bearing colored lanterns and drawn by four horses. Strong-limbed men carried off the cases of eggs and the hampers of cheese and butter, bearing them away to the salesroom, where clerks in caps were scribbling in ledgers in the gaslight.
Claude was quite delighted with all this tumult and uproar, and he lost himself in admiration at some effect of light, or at some group of blouses, or the unloading of a cart. At last they extricated themselves from the crowd. As they continued to make their way along the main artery, they presently found themselves in the midst of an exquisite perfume that seemed to be following them. They were in the middle of the cut-flower market. All over the square, to the right and left, women were seated in front of great rectangular baskets filled with bunches of roses, violets, dahlias, and marguerites. The bunches had a dark, gloomy look, something like splotches of blood, lit up softly here and there with silvery grays of the tenderest tones. A lit candle was standing near one of the baskets, making up a rich oasis of color in the midst of the general grayness, and lighting up with its rays the bright variegations of the marguerites, the bloodred crimson of the dahlias, the purple hues of the violets, and the glowing tints of the roses. After escaping from the strong, sharp odors of the fish market, and the pestilential scents of the butter and cheese, it would have been impossible to imagine anything more grateful or more suggestive of the sweetness of the springtime than this soft, gentle breath of perfume wafted over the roadway.
Claude and Florent turned around again and made their way very leisurely back through the flowers, stopping and lingering here and there. They stood and watched with some curiosity the women who were selling bunches of fern and bundles of vine leaves, very neatly tied up in packets of five and twenty. Then they turned down a covered and almost deserted alley, where their footsteps echoed as though they had been walking along the nave of a church. Here they saw a very small donkey harnessed to a cart about the size of a wheelbarrow. The little animal was probably feeling bored, and when it caught sight of the two companions, it broke out into such a sonorous and prolonged bray that the vast roof of the market fairly trembled with it. Then the horses began to neigh in reply and paw the ground, and presently there was a perfect uproar in the distance, which gradually swelled and then rolled along and died away.
In front of them, in the rue Berger, the gas lamps enabled the two wanderers to distinguish in the empty but open stalls piles of hampers and fruit heaped up within the three dirty walls that were covered all over with addition sums scribbled in pencil. While they were standing there, they noticed a well-dressed lady huddling herself up with an air of happy lassitude in the corner of a cab that had got into the midst of the general block and was cautiously making its way onward.
"It is Cinderella coming back without her slippers," said Claude with a smile.
They were chatting together now, as they returned back to the markets. Claude whistled as he strolled along with his hands in his pockets and expatiated on his love for this teeming luxuriance of food that breaks out every morning in the very center of Paris. He prowled about the squares night after night, dreaming of colossal sketches of still life and extraordinary pictures. He had even commenced to paint one, and he had got his friend Marjolin and that jade Cadine to pose for him, but these confounded vegetables and fruit and fish and meat were too much for him! It was vain for him to attempt them! Florent listened to the artist's flow of enthusiastic talk with a void and hunger-aching stomach. It did not appear to enter into Claude's mind that all these things were intended to be eaten. Their charm for him lay in their color. Suddenly he ceased speaking and tightened, with a gesture that was habitual to him, the long red belt that he wore under his green-stained cloak.
Presently he commenced to talk again.
"Then, too, I breakfast here, through my eyes, at any rate, and that is better than getting nothing at all. Sometimes when I have forgotten to dine on the previous day, I give myself a perfect indigestion here in the morning by watching the carts arrive loaded with all sorts of good things. On such mornings as these, I love my vegetables more than ever. What irritates me and exasperates me, and what is really a crying sin, is that these miserable townspeople eat them all up!"
Then he went on to tell Florent of a magnificent supper to which a friend had treated him at Baratte's on some festal day. They had had oysters, fish, and game. But Baratte's had been done away with, and all the riotous life of the old market was dead and buried now. They had got these huge central markets in its place, this colossus of ironwork, this new and wonderful town. It was to no purpose that foolish folks had protested. It was the embodiment of the spirit of the times. Florent could not make out whether he was condemning the picturesque old neighborhood or Baratte's good cheer. ¥¥
– Emile Zola. From The Belly of Paris. After twice failing the baccalauréat exam, Zola spent his early twenties unemployed before managing to establish himself as a journalist. This third novel in his twenty-volume Les Rougon-Macquart cycle takes place around the central market known as Les Halles in nineteenth-century Paris. Zola died of carbon monoxide poisoning due to a blocked chimney in 1902; a sweeper later claimed the blockage was retribution for Zola's 1898 public defense of Jewish artillery captain Alfred Dreyfus, who had been falsely accused of treason.
2 Responses to "Zola Tours Les Halles at Dawn"
Bruce McEwen April 25, 2019 at 12:47 pm
Just finished a luncheon of pickled sardines and gorgonzola cheese with Ritz crackers, while reading this at the picnic table, and it occurred to me to ask, "was this esteemed author a paragon of virtue, or the epitome of cheeses, the gorgonzola?
Zack Anderson April 25, 2019 at 3:16 pm
The rumor is that Emile Z. could trace his lineage back to the legendary King of the Akkadians, Sargonzola.
Leave a Reply to Bruce McEwen Cancel Reply
MCT: Saturday, January 18, 2020


text:
By lars.ON Apr 29, 2011, 3:21pm PDT
Share All sharing options for: The Future is Bright
I read this article by KSL's Greg Wrubell about a week ago. In it, Greg takes us back to some thoughts that he shared back in 2008 about a certain timeline that transpired from Dec 04 to Apr 05. During that time, Bronco Mendenhall was promoted to head football coach, Tom Holmoe was appointed as the new Athletic Director at BYU, and Dave Rose was promoted to head basketball coach. Greg correctly points the effects those moves have had in the past 6+ years.
Mendenhall and Rose have added to their many accomplishments, with the football team playing in a bowl games in all six seasons of Mendenhall's tenure, and the basketball team having played in a school-record five consecutive NCAA Tournaments.
Mendenhall (73%) and Rose (78%) are among the most successful coaches of their era; only BYU and Ohio State can claim that their football and basketball coaches are both ranked in the current top ten in career active coaching win percentage.
BYU leaves the MWC as the dominant historical leader in conference championships across all sports, and as the league leader in football and basketball, with both programs holding the league record for conference championships and conference wins. The BYU Basketball team also holds the conference record for overall wins since the MWC was formed.
BYU has been dominant during this "new golden era" but I believe, even coming off a less-than-stellar football season and losing one of the top 5 greatest BYU athletes ever (Jimmer Fredette), there is much hope to be had for the future of BYU Sports. I think having Bronco & Rose are the keys, but BYUtv's advancement & relationship with ESPN is equally fundamental.
After an energy-filled and very exciting spring practice, Coach Mendenhall looks to bring the most depth he has ever had to the field this fall. At almost every position their is a starter with experience & talent and an equally talented backup waiting in the wings. most importantly, their is a designated quarterback at the starting spot in Jake Heaps. Under the tutelage of Brandon Doman, Jake has grown & matured into this roll. Bronco leads a defensive unit that is full of speed and toughness. Most impressive is the linebacking core with names like Pendelton, Ogletree, and Van Noy to name a few. Look for Uona Kaveinga, a USC transfer, to make an immediate impact. Not only is next season packed, but their are countless players in the pipeline for future years. Recruiting at BYU is unique because of the mission aspect. BYU might sign a guy that won't play in the program for 3 years. It can create headaches and difficulties but it also allows the coaching staff to stack players for future years. Ton Holmoe is a genius/mastermind/magician for what he has been able to negotiate for BYU Football in the 9 months since Independence day (Granted with ESPN's help). The game with Texas was already scheduled but he was able to go out and get Ole Miss, Oregon St moved to later in the season, TCU (again later in the season) & an underrated UCF team. The 2-year agreement with the WAC was necessary to fill the gaps. There are also 8 & 10 year deals with Notre Dame and Hawaii.
I am a self-proclaimed basketball guy. I will take basketball over any other sport, any day of the week. This past season was the greatest ride BYU has seen since Daniel Ray Ainge played in the Marriott Center. Jimmer took the nation by storm, and racked up every meaningful POY the award. The AP POY, the Adolf Rupp Trophy, the Oscar Robinson award, the Naismith award and the John Wooden award. He garnered unheard of attention for a BYU player is this day & age of twitter, blogs (hey O!) and podcasts. But now the Jimmer show moves on to the NBA. So what is there to look forward to? Plenty. By all indications Brandon Davies will be back to anchor the low post next season. Noah Hartsock & Charles Abouo will be the senior leadership that Dave Rose depends on so much. The excitement for me is to see how Matt Carlino and Damarcus Harrison start their career's at BYU. We are coming off the biggest increase in attendance in the nation this past season. I hope we can continue that trend going forward into the West Coast Conference. I like that conference because it is dominated by basketball. Gonzaga has a national profile and St Mary's has been on the rise for a few years. My hope is that the other schools in the conference will seize this opportunity with an increased conference profile to reinvest in their programs. From day one we will be competing for a conference title. I don't think we can expect the kind of season from last year, be we will compete and succeed. Dave Rose has been a great recruiter and he showed his leadership and integrity through the Davies Honor Code saga. Those are traits parents will feel comfortable allowing their sons to be a part of. And with his new 5-year contract, its something we can look forward to seeing for years to come.
BYUTV & ESPN PARTNERSHIP
Anyone who watched the old BYUtv knows the quality was not high up there. As the LDS Church has embraced technology and invested in it, the capacities of BYUtv have grown. BYU also built a new state-of-the-art broadcast facility and a new HD broadcast truck. The Marriott Center and Lavell Edwards Stadium have been hardwired for HD. Comcast has already picked up BYUtv HD for Utah, with hope for more carriers in the future. BYUtv has focused on rebranding itself in two lights. Their motto is 'See the good in the world' and they focus on family-friendly content to support that. They other is 'The home of BYU sports.' The new True Blue francise hosted by Dave McCann has brought new access to BYU sports and allows fans to follow even more in depth. ESPN will have the right to all home BYU Football & Basketball games, with those not airing on an ESPN network to be aired on BYUtv. Also, BYUtv will hold ALL rebroadcasting rights. It certainly is nice to have the worldwide leader in sports in your corner, and it has already shown in the football scheduling. ESPN also holds the rights to WCC basketball, so we will likely see many of the road games on ESPN channels. Through this increased and unique exposure BYU coaches will have added benefits to pitch to potential recruits.
The future is bright for BYU sports. The right coaches are in place. The right TV deals are in place. It is time for BYU to show off just how unique it is. I look forward to cheering them on with the rest of you.

redpajama_set_name: RedPajamaCommonCrawl


I know it is a little last-minute, but I still wanted to get this post out before the big holiday because Thanksgiving is a very important day here in the United States. We want to share with you some of our favorite Thanksgiving books for kids, activities and crafts this year.
I am going to show you the ones we read the most this year and then I will share some additional titles, in case you were looking for something in particular. Remember that once Thanksgiving is over, you can come back to this post and shop for the books at a discounted price! Win-win! You will then be prepared for next year!
Here is our Homeschool Fall Pinterest Board.
Feel free to visit, follow and share with your friends!
Follow The Natural Homeschool's board Homeschool Fall Activities on Pinterest.


This bot will try to help you always be aware of the latest HARDWARESWAP posts.
You can subscribe on a specific FLAIR to receive a new posts from the HARDWARESWAP category.
Be the first to post a review for Reddit HardwareSwap Bot.


This programme will guide your staff in creating and maintaining Human Resources "best practice" within your organisation. Facilitators will work with your staff to make sure that employment contracts and HR manuals meet your organisation's needs, whilst attracting, retaining, engaging and motivating employees. In today's increasingly competitive employment environment, training your staff to attract and retain high performers, and managing your employee relations and communications are increasingly vital aspects of your overall HR strategy.
This five-day in-company course will inform and educate your HR staff on the key areas of HR policies and procedures so that you adopt best-practice to compete more effectively in the war to attract talent. They will learn how to improve employee engagement whilst fostering an environment of trust and fairness for both parties in the employer-employee relationship.
Upon successful completion of this course, candidates will receive a CHRM™ Human Resources Manager Certificate.
Fill out your details to find out more about Certified Human Resource Manager (In-House).


A geothermal system is an area of heated rock fed by a single upflow from deep within the earth.
Click on the geothermal system names on the map below to find out more about the main geothermal fields in the Waikato region.
Click on the white dots to find out about some of our smaller geothermal systems.
Or use the text navigation below.


The Master of Architecture Programme is a professional degree equivalent to the professional qualification of the Board of Architects Malaysia Part II. It is a continuation of the Board Architects Malaysia Part I, which is addressed in the Bachelor of Science in Architecture programme in UTM. The programme is a taught course Masters Programme and as such there is a structured curriculum with an emphasis on more research-based architectural design studio projects. This focus enables a more intellectual and theoretical basis in the architectural projects addressed within the programme at the same time contribute to the development of architecture within the National framework, that emphasises on the sustainable development. The focus on research-based is an addition to the technical, scientific and technological considerations that are already embedded in the courses. The Master of Architecture program is recognised by the Board of Architects Malaysia (LAM), Malaysian Institute of Architects (PAM) and the Public Services Department (JPA). The architecture programme in UTM is the first in country acknowledged by PAM and LAM. The preceding 3 years Bachelor of Science in Architecture is accredited for LAM Part I, and this 2 year Master of Architecture is accredited for Part II.
UTM degree holders in Master of Architecture with 2 years relevant working experience are eligible to sit for the LAM Part III examination in order to be registered as a professional architect.
PEO1 To produce graduates who are knowledgeable and competent whilst fulfilling the professional qualification of Board of Architect Malaysia Part II.
PEO2 To produce graduates who are in possession of scholastic characteristics in the aspects of research and are able to solve problems analytically, critically and creatively based on sound scientific approaches and ideas.
PEO3 To produce graduates who are ethical, professional, responsible and acutely aware of the values of humanistic and sustainability.
PEO4 To produce graduates who are communicative and effectively contribute in working teams as well as competitive in the local and global markets.
PO1 Able to analyse and interpret knowledge in the areas of humanities, history and culture, environment and technology, professional practice and by-laws, in relation to architecture and the building industry.
PO2 Able to accomplish designs that are coherent and based on critical thinking and supported by integrated research in culture, behaviour, environment, technology, use of materials and practice.
PO3 Able to solve problems and provide new solutions backed by research and critical thinking on various constraints of issues and problems; technology and nature; contextual and contemporary rationale; by the integration of knowledge in design, communication, technology, environments, culture and practice.
PO4 Able to communicate confidently and able to justify design solutions with the use of appropriate communication media to convince stake-holders and target groups.
PO5 Able to organise and exhibit cooperative and collaborative professional team spirit in the execution of projects that involve group work.
PO6 Able to organise and acquire new concepts and up to date knowledge relevant to architectural design, practice and research.
PO7 Able to carry out the responsibility professionally and ethically as one entrusted with the care of the environment and the community.
PO8 Able to manifest the ability to initiate, lead, motivate and coordinate the team in the search for knowledge, production of architectural design and attainment of goals.
PO9 Able to exhibit entrepreneurial knowledge and abilities in the exploration of the architectural industry and related creative industries.
To be eligible to graduate from this programme, students must complete a total of 72 credit hours, accumulated from courses that are set according to the classification scheme shown, with a minimum CGPA of 3.0 and have completed all the relevant courses within the time allowed.


Every building or place used for the purpose of unlawfully selling, serving or giving away any spirituous, vinous, malt or other alcoholic liquor, and every building or place in or upon which such liquors are unlawfully sold, served or given away, is a nuisance which shall be enjoined, abated and prevented, whether it is a public or private nuisance.
Whenever there is reason to believe that a nuisance as defined in this article is kept, maintained or exists in any county, the district attorney, in the name of the people of the State of California, shall, or the city attorney of an incorporated city, or any citizen of the state resident within the county, in his or her own name may, maintain an action in equity to abate and prevent the nuisance and to perpetually enjoin the person or persons conducting or maintaining it, and the owner, lessee or agent of the building, or place, in or upon which the nuisance exists, from directly or indirectly maintaining or permitting it.
The complaint in the action shall be verified unless filed by the district attorney.
Whenever the existence of a nuisance is shown in an action brought under this article to the satisfaction of the court or judge thereof, either by verified complaint or affidavit, and the court or judge is satisfied that the owner of the property has received written notice of the existence of the nuisance, signed by the complainant or the district attorney at least two weeks prior to the filing of the complaint, the court or judge shall allow a temporary writ of injunction to abate and prevent the continuance or recurrence of the nuisance. On granting such writ the court or judge shall require an undertaking on the part of the applicant to the effect that the applicant will pay to the party enjoined such damages, not exceeding an amount to be specified, as the opposing party may sustain by reason of the injunction, if the court finally decides that the applicant was not entitled to the injunction.
Actions brought under this article shall have precedence over all other actions, excepting criminal proceedings, election contests and hearings on injunctions. If a complaint is filed under this article by a citizen, it shall not be dismissed by the plaintiff or for want of prosecution except upon a sworn statement made by the complainant and his attorney, setting forth the reasons why the action should be dismissed, and the dismissal ordered by the court. In case of failure to prosecute any such action with reasonable diligence, or at the request of the plaintiff, the court, in its discretion, may substitute any other citizen consenting thereto for the plaintiff. If the action is brought by a citizen and the court finds there was no reasonable ground or cause therefor, the costs shall be taxed against such citizen.
If the existence of a nuisance is established in an action as provided in this article, an order of abatement shall be entered as part of the judgment in the case, and plaintiff's costs in such action are a lien upon the building and place, enforceable and collectible by execution issued by order of the court.
Any violation or disobedience of an injunction or order expressly provided for in this article is punishable as a contempt of court by a fine of not less than two hundred dollars ($200) nor more than one thousand dollars ($1,000), or by imprisonment in the county jail for not less than one nor more than six months, or by both.
Whenever the owner of a building or place upon which an act or acts constituting a contempt as defined in this article has been committed is guilty of a contempt of court, and is fined therefor in any proceedings under this article, the fine is a lien upon such building and place to the extent of the interest of such person therein, enforceable and collectible by execution issued by order of the court.
"Person," as used in this article, means individuals, corporations, associations, partnerships, limited liability companies, trustees, lessees, agents and assignees.


text:
All Research > Satellite based flood mapping to build resilience – Jeff Ho (Geo4Dev 2018)
Satellite based flood mapping to build resilience – Jeff Ho (Geo4Dev 2018)
Dr. Jeff Ho is the Senior Remote Sensing Scientist at Cloud to Street, where he leads the development of new algorithms for global flood detection and manages the development of new products for disaster risk response. Cloud to Street leverages satellite earth observation data for mapping flood exposure, risk and vulnerability in the developing world, and its remote sensing platform dynamically maps local flood vulnerability globally. Jeff received his PhD and MS in Civil and Environmental Engineering from Stanford University, where his research on satellite remote sensing of water quality and water access monitoring in resource-constrained settings has been described in numerous academic publications and featured in the New York Times, Forbes, and PBS News Hour. He is a former Natural Sciences and Engineering Research Council of Canada Doctoral scholar and a former Rising Environmental Leaders Fellow at the Woods Institute for the Environment.
Dr. Jeff Ho's talk is titled: Satellite based flood mapping to build resilience: applications from the Eastern Nile Basin to the Republic of Congo. Flood events affect more people globally than any other type of environmental hazard and are expected to increase in severity and frequency due to climate and demographic change. However, many current approaches to evaluate flood exposure and manage emergency response are not leveraging satellite remote sensing to improve accessibility and speed of flood risk information in the places that need it the most. This talk will describe how Cloud to Street uses satellite data to fill critical gaps in disaster decision-making in the developing world. Examples from South America and Africa will demonstrate how geospatial data from satellite imagery are bridging the flood risk information gap in low- and middle-income countries.
The 2nd Annual Symposium on Geospatial Analysis for International Development (Geo4Dev) focused on geospatial research that addresses climate- and conflict-driven migration and humanitarian response. This includes observation and modeling of migration and human settlement patterns (in response to climate or conflict stressors), as well as the design and evaluation of interventions for humanitarian crises, mass migration, and community resilience.
Geo4Dev is a yearly event focused on the use of novel geospatial data and analytic techniques to address issues of poverty, sustainable development, urbanization, climate change, and economic growth in developing countries and beyond. This includes a particular emphasis on the use of emerging geo-tagged big data, including satellite, social media, and CDR datasets.
Affiliate Eric Brewer Discusses AI Impacts on Work & Retirement | Forbes


text:
You are here: Home > News October 2001
News October 2001
By Robbie Wood on October 31, 2001 in News
LPS 14th at Northern 6 stage Road Relay
This years northern 6 stage was held in Sunderland and just 6 runners made the long trip north along the A1 to represent the club. Once again illness, injury and apathy ruled the day with many preferring to stay at home to watch the England match. The 4 mile course at Silksworth was reasonably fast, but with a punishing climb into the finish and a severe headwind on the second half of the course, it was far from easy. Nathan Vengdasalem (20.11) had an excellent leg to bring the team home in 14th place. This was all the more impressive as Nathan had to contend with stomach cramps throughout the second lap. Alan Woods (20.54) pulled the team into a top 10 position on the second leg with an excellent run despite the wind on the course picking up considerably. Bernie Murphy (21.52) continued in his rich vein of form by running even faster than Woodsie to bring the team into 8th. These three excellent performances virtually guaranteed our qualification for the National event in 3 weeks. Nevertheless the remaining runners still had a job to do and each played their part. Sammy Rashid (21.42) showed what a valuable member of the team he is by maintaining the clubs top 10 placing despite running much of his leg with his shoelaces undone ! Mark Bleasdale (22.47) performed solidly as usual and the anchor leg was left to Jim Eden (22.17) who bought the team home in 14th place qualifying comfortably for the National. Credit goes to those athletes who turned out to run and special thanks to Robbie Wood and Charlie Gains for making the trip to support the runners.It remains to be seen how the team at Sutton Coldfield will take shape but each of the runners at Sunderland made a strong case for inclusion. Nevertheless, it would be nice to have a few athletes on the sidelines ready to step in the event of illness or injury. Hopefully Tom Snape and Jon Rice can shake off injury and stake a claim for a places
Report Jim Eden.
Kiera fastest as U/17 come home 6th
LPS sent team up to Carlisle for the NoEAA young athlete relays. Best performance was from our under 17 ladies who cme home 6th with Kiera Vogel running the fastest leg for them. Our under 13 girls also had a good performance with a solid 10th place. The under 15 boys came 12th. The under 17 men came 7th with Michael Rimmer being 10th joint fastest in the age group.
Graham Cairns 3rd at Sandstone Trail
Running only his 3rd competitive race of the year Graham Cairns showed he still has his old touch as he finished 3rd in the short(9 miles) race, at the 25 running of this popular event. Graham who is only one day away from his 45th birthday was first O/40. Not to be outdone Gill Darby also picked up the ladies O/40 prizes. Robbie Wood manged to come 10 and Richie Webster not running quite as quickly as last year was 28th.
3 in first 6 LPS take team title at City of Liverpool 10k
In a record field LPS picked up the team event with 3 in the first six to see off a strong challenge from Liverpool Harriers. Lead home once again by Nathan Vengdasalem in second place backed up by in form Bernie Murphy 4th & John Kilbane in 6th place. Joey Parkinson just missed out on the counters finishing 13th. Mark Bleasdale just held off Graham Cairns in 25 & 26 place and with Jeff Mason in 29th spot made this a good day for LPS. Interesting to see that a M McLoughlin!!! finished in 42.
Courtney wins Reebok , LPS take all the male team races in Mid Lancs & L&D at Sefton Park
Courtney Birch returned to Sefton Park to win the junior ladies event in the opening Reebok fixture of the season. In a combined senior and junior event Courtney was 7th overall and 1st junior. Backing Courtney was Cheryl Lucas 70th and Gill Darby 79th. LPS male athletes made the best of the mild weather, on a course which cut up as the afternoon went on.
Team titles in all the male section of the Mid Lancs plus wins in all but one of the L&D The under 17 men won the overall team race with 3 in 21. Ben Jones (non-scorer) lead them home in 14th followed by Alan Stewart in16th and Chris Watson in 21 leaving UK age record holder Michael Rimmer to close in the team in 27th.
Under 17 Ladies Laura Davenport 41st & Amy Potter 54th ran well in the mud in the under 17 ladies race. Under 15 Girls a full team in the under 15 girls saw Nicki Bear lead us home in 14th backed up by Erin Halsall 28th, Anna Caunce 55th and Mega Singleton 79 Under 13 Girls Jane Walmsley 42nd. Rachel Roberts 51st and Helen Quirk all ran well in the girls event
A Good day for LPS.
Disappointment at National six stage
As always Sutton Park, that oasis of green parkland in the midst of the urban jungle known as Birmingham was the location for the National 6 stage road relays. Birmingham, the city that gave us cultural icons such as ELO, Black Sabbath, Jasper Carrott and the Balti curry, once again played host to the nation's top athletes.
The course over 5,847 undulating metres is a tough one but in stark contrast to the previous years gales and heavy rain, this year turned out pleasant – chilly with sunshine and a reasonable headwind. First off for LPS was leg one specialist Nathan Vengdasalem (18.10) who gave 100% as always in a very strong field. Nathan brought the team home in a very respectable 25th position and handed over to Bernie Murphy (18.47). Bernie, enjoying his best form for some time ran well to keep the team in the top 30 places. Afterwards Bernie said that he had felt rough all the way and, though disappointed by his run, Bernie will be encouraged to note that last year he took more than 20 minutes on this course! Next up for LPS was hometown boy Sammy Rashid (19.10) now a key member of the 6-stage team and one of a swiftly diminishing group of Birmingham City FC season ticket holders. Sammy, who always seems to run well in the relays, brought the team home in 34th position. What was particularly impressive about this was that Sammy was still shaking after a harrowing train trip through Birmingham surrounded by Aston Villa supporters. Club captain Jim Eden (19.58) was on fourth leg. Jim, whose training had been restricted since the Northern event with shin soreness and was therefore in even worse shape than usual, ran as hard as he could but could not prevent 4 runners coming past in the later stages of his leg. He handed over Mark Bleasdale who ran his usual steady reliable leg and handed over to our anchorman in 38th position. Cometh the hour, cometh the man. Once again it was Robbie Wood (22.54) who had helped the club out of a tight spot at the 12 stage in April who answered Jim's extremely late plea to run. Robbie showed a loyalty to the club that would put many of our other athletes to shame and brought the team home in 49th position.
This race marks the end of a 6-stage season, which the club will want to forget. How is it possible that a club with our membership struggled every time to find just 6 available athletes? Thank heaven for the handful of runners who gave their time each race, as, without them, LPS would have not entered a team in any of the 6 stage races this year. One or two runners were injured all autumn and this could not be helped but where were the others? All of us enjoy relaxing at weekends and any one of the athletes who did turn out for the club could have found something they would have preferred to do on a Saturday afternoon. But being in a club surely implies some level of commitment to that club and at the moment the number of runners demonstrating that commitment can be counted on one hand. If things don't change we will not have a team for the 12 stage relays.
Finally thanks are due to Bernie, Nathan, Sammy, Jim, Luke, Mark, and Alan and, last but definitely not least, Robbie for their efforts this autumn.
Report Jim Eden
Girls turn out at Young Athletes relays
LPS turned teams out in all three age groups of the girls events at Sutton Park. Under 13 girls came 31st Under 15s came 23rd with Niki Bear 9th fastest overall. Under 17s came 21st Full report to follow I hope.
Bear, Birch, Bleasdale, Boardman, Cairns, Caunce, Darby, Davenport, Eden, Gains, Halsall, Jones, Kilbane, Lucas, Mason, McLoughlin, Murphy, Parkinson, Potter, Quirk, Rashid, Rice, Rimmer, Roberts, Singleton, Snape, Stewart, Vengdaslerm, Vogel, Walmsley, Watson, Webster, Wood, Woods
← News September 2001
News November 2001 →


It was at one of Susan's charming shows that I first spotted Steven playing in her band and exchanged cards. He's been in all my shows since. I introduced him to my outstanding Musical Director Daryl and they have worked together many times since. I know that Susan & Daryl shared my thrill at hearing Steven's brilliant work. If you get a chance to do so, don't let it slip by. You'll thank me the next day. I'm sure happy that I was there!


text:
Il Club Deportivo Mandiyú, o semplicemente Deportivo Mandiyú, è una società calcistica argentina con sede nella città di Corrientes, nell'omonima provincia dell'Argentina nord-orientale. Milita nel Torneo Argentino A, divisione regionale della terza serie argentina.

Il termine Mandiyú vuol dire "cotone" nella lingua guaraní.

Storia
Il club venne fondato a Corrientes il 14 dicembre 1952 da un gruppo di lavoratori tessili della locale azienda Tipoiti. Il nome originale era Club Deportivo Tipoiti, per poi assumere l'attuale denominazione poiché l'AFA non accettava nomi ispirati a compagnie commerciali.

Il periodo di maggior successo del club fu tra il 1988 e il 1995, allorché disputarono 7 stagioni consecutive nella massima serie argentina. I migliori risultati furono il terzo posto nel Clausura 1991 e il sesto posto nell'Apertura 1991.

Per un breve periodo, nel 1995, la squadra fu allenata da Diego Armando Maradona.

Statistiche in Primera División
1988/89: 14°
1989/90: 10°
1990 Apertura: 17°
1991 Clausura: 3°
1991 Apertura: 6°
1992 Clausura: 18°
1992 Apertura: 13°
1993 Clausura: 12°
1993 Apertura: 13°
1994 Clausura: 20°
1994 Apertura: 19°
1995 Clausura: 18° - Retrocesso

Palmarès

Competizioni nazionali
Primera B Nacional: 1
1988

Altri piazzamenti

Terzo posto: Clausura 1991

Collegamenti esterni

Deportivo Mandiyu
Sport a Corrientes

redpajama_set_name: RedPajamaWikipedia


Minors must be accompanied by the parent or legal guardian who accompanied them at the consultation.
Do not drink any alcoholic beverages the night before your appointment.
A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home. The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
If you have painted fingernails, remove polish, as well as the acrylic nail (if present) from at least one (1) finger prior to surgery.
If you take routine oral medications, please check with Dr. Michajlenko prior to your surgical date for instructions. If pre-operative medication(s) are prescribed, take the medication(s) with the smallest amount of water possible, one (1) hour prior to your appointment. Under no circumstance should this volume of water exceed two (2) ounces (1/4 cup).


The magazine represents a collection of 34 pieces by aspiring artists, students and professionals in the country. Fifty percent (50%) of the paintings were done by children and 50% by adults. Seventy-six percent (76%) of the artists appear to be Indians and 24% seem to be non-Indians, based on an analysis of their surnames. Fifty-three percent (53%) bear Hindi surnames, 24% carry English/Other surnames, and 23% of them have Arabic last names.
The collection of paintings in magazine format can mirror a display of visual art images in a public gallery exhibition. However, a magazine carries the advantage of allowing one to view the images at one's own private place, time and convenience. Indeed, it brings the conventional city art gallery – frequented by the elite in society – to the private living room of the common folk. Like a photographic album, a magazine can be kept as a collector's item for future reference, study, review and enjoyment. This magazine has the added value of including an art critique of each painting, which makes it relevant to any discourse on contemporary culture and ethnic identity. The "reading" of each painting highlights the visual creativity of our local artists and the appreciation of Hindu/Indian aesthetics in the Caribbean.
This entry was posted in Divali Magazine on November 23, 2009 by Kumar Mahabir.


text:
'''
    This module applies Rules to the document in iterative generations.
    There are two modes in which this can be done
        * Edge replacement
        * Node replacement

    Both generate the same document that describes the structure according
    to the Rules used.

    Node generation may be easier to use in the renderer to keep track of
    which generation produced a given piece of the structure. This can be
    then used to vary the thickness of branches between generations.
'''
import logging

from rules import *

class EdgeGenerate(object):
    logger = logging.getLogger('EdgeGenerate')

    def _applyRules(self, rules, doc, generation):
        newDoc = ''
        idx = 0
        while idx < len(doc):
            ruleMatched = False
            for rule in rules:
                consumed, ruleDoc = rule.apply(doc[idx:])
                if consumed:
                    idx += consumed
                    ruleMatched = True
                    newDoc += ruleDoc
            if not ruleMatched:
                newDoc += doc[idx]
                idx += 1
        return newDoc

    def __call__(self, program, generations):
        doc = program.initiator
        self.logger.debug('generation %s: %s' % (0, doc))
        for n in range(generations):
            doc = self._applyRules(program.rules, doc, n)
            self.logger.debug('generation %s: %s' %(n+1, doc))
        self.logger.debug('doc: %s' %doc)
        return doc

Node = namedtuple('Node', 'data generation')

class NodeGenerate(object):
    logger = logging.getLogger('NodeGenerate')

    def _applyRules(self, rules, node):
        newData = []
        idx = 0
        self.logger.debug('apply rule: %s' %node.data)
        while idx < len(node.data):
            if type(node.data[idx]) == Node:
                subNode = node.data[idx]
                newData.append(self._applyRules(rules, subNode))
                idx += 1
            else:
                ruleMatched = False
                for rule in rules:
                    consumed, ruleDoc = rule.apply(node.data[idx])
                    if consumed:
                        idx += consumed
                        ruleMatched = True
                        newData.append(Node(ruleDoc, node.generation+1))
                if not ruleMatched:
                    newData.append(node.data[idx])
                    idx += 1
        return Node(newData, node.generation)

    def __call__(self, program, generations):
        root = Node(list(program.initiator), 1)

        for n in range(generations):
            self.logger.info('generation %s' %n)
            root = self._applyRules(program.rules, root)
        return Node(list(program.initiator) + [root], 1)

redpajama_set_name: RedPajamaGithub


text:
Treatment & Management of Prostate Cancer
Cancer Connect - Treatment & Management of Prostate Cancer
Prostate Cancer Overviews
Medically reviewed by Dr. C.H. Weaver M.D. 1/2021
The choice of prostate cancer treatment is influenced by a patient's age, concurrent health problems, life expectancy, the genomic profile and characteristics of the individual's cancer, the patient's goals of treatment, and the bias of the treating physician.
Several different doctors may be involved with the diagnosis and management of prostate cancer including a urologist, radiation oncologist and a medical oncologist. Urologists are surgeons who specialize in treatment of disorders of the male genital tract, including prostate cancer. Radiation oncologists use various forms of radiation to treat prostate cancer and medical oncologists are often involved when systemic chemotherapy or precision cancer medicines are required.
Treatment options include hormone therapy, surgery, radiation, newer precision cancer medicines, combinations of therapy and "watchful waiting." It is important to obtain as much information as possible about the results of each treatment and obtain more than one opinion, especially when deciding on surgery versus radiation therapy.
Local Treatment of Prostate Cancer
Surgery is used to diagnose, stage, and treat prostate cancer and performed by a urologist. Surgical removal of the prostate is considered a local treatment and is very effective treatment if the cancer has not spread beyond the prostate. (1-4)
Radiation Therapy - During radiation therapy, high-energy X-rays are used to kill prostate cancer cells. In early-stage prostate cancer, radiation can be used instead of surgery, or it may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages of prostate cancer, it may be given to relieve pain or other problems. (5-10)
Hormone Therapy - Testosterone is a male hormone produced mainly by the testicles. Many organs in the body are composed of cells that respond to or are regulated by exposure to testosterone. Cells in the prostate have testosterone receptors and when exposed to testosterone, are stimulated to grow. When cells that have testosterone receptors become cancerous, the growth of these cancer cells can be increased by exposure to testosterone. The basis of hormone therapy as a treatment for prostate cancer is to block or prevent the cancer cells from being exposed to testosterone. This can be done using medications or surgical castration by removal of the testicles. (3,4,11,12)
Active Surveillance & Watchful Waiting
Some physicians and patients choose a strategy of delaying any treatment of prostate cancer until symptoms from the cancer appear. Because treatment with radiation or surgery may be associated with side effects, in addition to inconvenience, electing not to receive immediate treatment may be appropriate for selected patients especially those with other health concerns or a shorter life expectancy. Watchful waiting is based on the premise that some patients will not benefit from definitive treatment of the primary prostate cancer. The decision is to forgo definitive treatment and to instead provide treatment to relieve symptoms of local or metastatic progression if and when it occurs.
In contrast to watchful waiting, a program of active surveillance is based on the premise that some, but not all, patients may benefit from treatment of their primary prostate cancer. A program of active surveillance is designed to provide definitive treatment for men with localized cancers that are likely to progress and to reduce the risk of treatment-related complications for men with cancers that are not likely to progress. Clinical studies suggest that individuals with lower risk cancers could be candidates for this treatment strategy because they have a low risk for clinical progression of their cancer within the first 10 to 15 years after the diagnosis. Thus, this treatment strategy may be best suited for men with a shorter life expectancy. Genomic testing may help determine whether active surveillance or watchful waiting is a good treatment option.
Role of Surgery in Prostate Cancer
A surgeon who specializes in treatment of disorders of the male genital tract, including prostate cancer, is known as a urologist. A urologist plays an important role in the diagnosis and treatment of prostate cancer. Nearly all patients with prostate cancer will have some kind of surgery. Surgery may be used to perform a biopsy in order to obtain tissue for determining an accurate diagnosis, provide local treatment of the cancer, and obtain other information to help determine whether additional treatment is necessary. Surgical techniques continue to improve, and surgeries are now less invasive and typically performed on an outpatient basis.
Prostate Biopsy - If laboratory tests or physical examination results suggest that prostate cancer may be present, you will need to have a prostate biopsy. A biopsy is the only way to know for sure whether an individual has cancer. During a biopsy, a needle is used to remove several small pieces of prostate tissue through the rectum. These pieces of prostate tissue are examined under the microscope to determine whether cancer cells are present. If cancer cells are present, an assessment of how aggressive or abnormal the cancer appears is performed. Patients should discuss the role of NGS testing on their biopsy and consider a liquid biopsy as well. Understanding Your Pathology Report
Radical Prostatectomy and Lymph Node Dissection - Surgery is a common treatment of stage I, II, and sometimes stage III cancer of the prostate. The operation used to remove the prostate cancer is called a radical prostatectomy and performance of a "nerve sparing" prostatectomy is preferred in order to not damage the nerves that control the bladder and erections. A surgeon can perform a radical prostatectomy using different techniques including the following. Make sure you discuss the advantages and disadvantages of each technique, as well as your preferences, to determine which approach is best for you. (1-5)
Open Radical Prostatectomy
Radical prostatectomy can be performed through a low abdominal incision (retropubic) or through the perineum, the area between the scrotum and the anus (perineal prostatectomy). During a radical prostatectomy, the entire prostate gland with the cancer and a rim of normal tissue around it is removed. With a radical prostatectomy, a portion of the urethra, or tube that empties the bladder through the penis, is removed and the cut ends are re-attached. To help with the healing of the urethra, the patient will go home with a catheter into the bladder for a couple of weeks. Before a prostatectomy is performed, the urologist may perform surgery to take out lymph nodes to see if they contain cancer. This is called a pelvic lymph node dissection. If the lymph nodes contain cancer, usually the urologist will not proceed with a radical prostatectomy. Another form of treatment, usually hormone therapy and/or radiation therapy, is generally recommended. A pelvic lymph node dissection is most useful when it prevents an unnecessary prostatectomy from being performed. It is typically recommended for patients with clinical stage III cancer or those with higher risk stage I or II cancer who are considering surgical treatment.
Several recent studies suggest that minimally-invasive radical prostatectomy (MIRP) may be produce better outcomes than traditional open surgery—resulting in fewer post-surgical complications, fewer blood transfusions, and shorter hospital stays. Men with prostate cancer should speak with their physician to safely evaluate the risks and benefits of the different surgical procedures.
Robotic-assisted Radical Prostatectomy (daVinci) - During Robot-assisted surgery the surgeon sits at a console near the operating table and performs the surgery by controlling robotic arms that hold the surgical instruments and a camera. Several small incisions are made in the lower abdomen. The instruments and camera are inserted into the patient's body through these small incisions. The magnified, three-dimensional view provided by the camera, in combination with very small surgical instruments and highly maneuverable robotic arms, allow trained surgeons to work with precision. The ability to operate with increased precision can provide important benefits in urologic surgery. Organs such as the prostate are in a tightly confined area, and are close to nerves that affect urinary and sexual function. Avoiding damage to neighboring organs and structures is an important goal of surgery. (2-4)
Cryosurgery is a technique that kills cancer cells by freezing them with sub-zero temperatures. During this procedure, hollow steel probes, guided by ultrasound, are placed inside and surrounding the cancer. Liquid nitrogen is then circulated through the probes, freezing the cancer cells and creating a ball of ice that surrounds the cancer. Once an adequate ice ball is formed, heated nitrogen is circulated through the probes. This process is then repeated. A heated probe is placed near the urethra throughout the freezing process so that the urethra is protected during the entire procedure. It is believed that cryosurgery creates cancer-killing effects through three distinct processes. First, ice crystals formed within cells are known to be lethal to nearly all cells. Second, when the ice forms around the cell, it draws water out of the cell, which collapses many of the walls or membranes within the cell. Third, when the ice surrounding the cells melts through the heating process, the water rushes back into the shrunken cell and causes it to burst.
This procedure has some compelling advantages, such as out-patient treatment, less pain, less blood loss, and faster recovery times. Since healthy tissue is preserved in the cancer-involved organ, the procedure can be repeated if the cancer returns.
The most serious complication associated with cryosurgery is when the rectal tissue is mistakenly frozen along with the prostate cancer. This complication has been reported in less than 1% of patients in several large studies. However, it is more likely to occur with a less experienced surgeon. The repair of this complication may require a temporary colostomy and additional surgery to close the hole between the rectum and the urethra. In one clinical trial, approximately 50% of the patients who had undergone cryosurgery were still impotent one year following surgery. The patients who may be the most appropriate candidates include older men over 70 years of age; patients who might have medical problems that would increase their risks of undergoing major surgery; or patients who have failed radiation therapy and have no other options. (5)
Orchiectomy
Prostate cancer cells need male hormones (especially testosterone) in order to grow. Bilateral orchiectomy (castration) is an operation to remove the testicles which produce the testerone. By removing the testicles, the main source of male hormones is removed and hormone levels decrease. Orchiectomy is a common treatment for patients with metastatic (stage IV) prostate cancer who will likely require hormone therapy for life. Patients may experience a benefit in symptoms in a matter of days following surgery. Orchiectomy can cause side effects such as loss of sexual desire, impotence, hot flashes, and weight gain. The operation itself is relatively safe and not associated with severe complications. Because it is a one-time procedure, orchiectomy is a convenient and the less costly method of hormone therapy. (4)
Transurethral Resection of the Prostate (TURP)
Transurethral resection of the prostate (TURP) is a type of prostate surgery done to relieve moderate to severe urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). In this procedure, the cancer is cut out of the prostate gland using a small tool that can be inserted into the prostate through the urethra. During TURP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The urethra is surrounded by the prostate. Using the resectoscope, your doctor trims away excess prostate tissue that's blocking urine flow and increases the size of the channel that allows you to empty your bladder. The following section may answer additional questions that you have about undergoing surgery.
Frequently Asked Questions About Surgery
Radiation therapy, or radiotherapy, is a common way to treat early stage prostate cancer. Doctors who specialize in treating cancers with radiation are known as radiation oncologists. In radiation therapy, high-energy X-rays are used to kill cancer cells. In early-stage prostate cancer, radiation can be used instead of surgery, or it may be used after surgery to destroy any cancer cells that may remain in the area. In advanced stages of prostate cancer, it may be given to relieve pain or other problems.
Radiation therapy for early stage prostate cancer can be given in a variety of ways. The two most common ways are external beam radiation therapy and brachytherapy. External beam radiation therapy (EBRT) involves the delivery of radiation via a machine that aims X-rays at the body. During brachytherapy or interstitial implantation, a physician places small pellets or seeds of radioactive material directly into the prostate gland.
External Beam Radiation Therapy
Proton Beam Therapy
Interstitial Brachytherapy
Is Radiation Necessary after Prostatectomy?
Side Effects From Radiation
EBRT or Brachytherapy?
Treatment of Bone Metastases
External beam radiation therapy (EBRT) for prostate cancer is given on an outpatient basis. Historically radiation was administered five days a week, for approximately six to eight weeks, however treatment schedules have been decreased using more intensive radiation dosing resulting in many patients only requiring 5-6 days of intensive radiation.
EBRT begins with a planning session, or simulation, where marks are placed on the body and measurements are taken in order to line up the radiation beam in the correct position for each treatment. Patients lie on a table and are treated with radiation from multiple directions to the pelvis. The actual area of the pelvis receiving radiation treatment may be large or small, depending on the features of the cancer. Radiation can be delivered specifically to the prostate gland (prostate-only radiation) or encompass the surrounding pelvic lymph nodes in addition to the prostate gland (whole-pelvic radiation). Patients who are receiving treatment to a larger area of the pelvis may undergo another planning session to focus the radiation to the prostate gland, where cancer cells are greatest.
As the technology for delivering radiation therapy has evolved, important advances have been made in the ability of physicians to precisely target the area of the cancer with higher doses of radiation while sparing normal tissue to the extent possible. EBRT can be delivered more precisely in greater doses using a variety of newer techniques.[1]
Three-Dimensional Conformal Radiation Therapy (3D-CRT): 3D-CRT uses computers to precisely map the location of your prostate. Radiation beams are then shaped and aimed at the prostate from several directions, which makes it less likely to damage normal tissues.[1]
Intensity Modulated Radiation Therapy (IMRT): IMRT is an advanced form of 3D-CRT that allows doctors to customize the radiation dose by modulating, or varying, the amount of radiation given to different parts of the body being treated. The radiation intensity is adjusted with the use of computer-controlled, moveable "leaves" that either block or allow the passage of radiation from the many beams that are aimed at the treatment area. The leaves are carefully adjusted according to the shape, size, and location of the tumor. As a result, more radiation can be delivered to the tumor cells while less is directed at the normal cells that are nearby.[2]
Image-guided radiation therapy (IGRT): may be used in combination with other approaches such as IMRT. IGRT involves imaging during the course of radiation treatment, and is able to account for changes in the patient's body or position that may shift the exact location of the cancer. The location of the prostate, for example, may vary somewhat depending on the contents of the bladder or rectum.
Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Protons are positive parts of atoms. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beams can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues.
Proton beams can be aimed with similar techniques to 3D-CRT and IMRT. Although early results are promising, so far studies have not shown that proton beam therapy is significantly better in the long-run than other types of EBRT. Thus far some but not all studies suggest that PBT may have fewer short term side effects however PBT is substantially more costly than IMRT and does not appear to produce a difference in toxicity 12 months after treatment. (2,3)
Internal radiation is known by a number of names: "interstitial brachytherapy," "seeds," or "implantation." These terms refer to treatment where radioactive material is placed directly into the prostate gland. For prostate cancer, the most common method of interstitial brachytherapy is permanent implantation of radioactive seeds into the prostate gland through the perineum. The perineum is the area of skin between the scrotum and the anus. The implantation procedure is performed in the operating room while the patient is asleep or numb from the waist down. An imaging device known as an ultrasound is inserted into the rectum to visualize and guide placement of the seeds with needles into the prostate. After the procedure, the patient will temporarily contain a small amount of radiation from the seeds. Although this amount is not generally dangerous to most other people, some doctors may advise patients to avoid close contact with young children or pregnant women for several weeks.
Because implant radiation focuses the radiation closely around the prostate, this form of radiation works best in patients with early-stage prostate cancer. If the prostate-specific antigen (PSA) level or Gleason score is high, another form of treatment may provide improved results. Also, seed implantation does not work as well in patients who have had prior transurethral resection of the prostate (TURP), prior prostate infections, or in patients with large size prostate glands. There are 2 types of prostate brachytherapy. Both are done in an operating room and require some type of anesthesia. (6)
Permanent (low dose rate, or LDR) Brachytherapy: In this approach, pellets (seeds) of radioactive material (such as iodine-125 or palladium-103) are placed inside thin needles, which are inserted through the skin in the area between the scrotum and anus and into the prostate. The pellets are left in place as the needles are removed and give off low doses of radiation for weeks or months. Radiation from the seeds travels a very short distance, so the seeds can put out a very large amount of radiation to a very small area. This lowers the amount of damage done to the healthy tissues that are close to the prostate.
Usually, anywhere from 40 to 100 seeds are placed. Because they are so small, the seeds cause little discomfort, and they are simply left in place after their radioactive material is used up. This type of radiation therapy requires spinal anesthesia (where the lower half of your body is numbed) or general anesthesia (where you are asleep) and may require an overnight stay in the hospital.
Temporary (high dose rate, or HDR) Brachytherapy: This is a newer technique. Hollow needles are placed through the skin between the scrotum and anus and into the prostate. Soft nylon tubes (catheters) are placed in these needles. The needles are then removed but the catheters stay in place. Radioactive iridium-192 or cesium-137 is then placed in the catheters, usually for 5 to 15 minutes. Generally, about 3 brief treatments are given, and the radioactive substance is removed each time. The treatments are usually given over 2 days. After the last treatment the catheters are removed. For about a week after treatment, you may have some pain or swelling in the area between your scrotum and rectum, and your urine may be reddish-brown.
These treatments are usually combined with EBRT given at a lower dose than if used by itself. The total dose of radiation is computed so that it is high enough to kill all the cancer cells. The potential advantage of this approach is that most of the radiation is concentrated in the prostate gland itself. (6-8)
Possible Risks of Brachytherapy: If you receive permanent brachytherapy seeds, they will give off small amounts of radiation for several weeks. Even though the radiation doesn't travel far, your doctor may advise you to stay away from pregnant women and small children during this time. You may be asked to take other precautions as well, such as wearing a condom during sex.
There is also a small risk that some of the seeds may move (migrate). You may be asked to strain your urine for the first week or so to catch any seeds that might come out. Be sure to carefully follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this doesn't seem to cause any ill effects and happens very rarely. (19)
Radiation After Prostatectomy
A significant number of patients will still require postoperative radiation following radical prostatectomy because they are at an increased risk of cancer recurrence. Clinical studies have demonstrated that adjuvant radiation following radical prostatectomy may prolong the time until PSA recurrence, delay the use of hormonal therapy, and improve overall survival for certain patients.
Adjuvant radiation therapy is typically offered to high-risk patients following surgical prostatectomy. This includes individuals defined as high-risk and those found to have cancer involving the margins of the surgical specimen, seminal vesicle invasion, positive surgical margins, or extra prostatic extension following prostatectomy and individuals where the PSA remains persistently elevated.
The ideal time to deliver radiation therapy following radical prostatectomy is the subject of some debate. Radiation can be administered immediately after prostatectomy to high-risk individuals or in some cases delayed until there is evidence of PSA recurrence. The understanding of how best to use radiation following prostatectomy continues to evolve and patients should discuss the role and timing of radiation with their treating physician.(19)
Although patients do not feel anything while receiving a radiation treatment, the effects of radiation gradually build up over time. Many patients experience fatigue as treatment continues. Side effects increase with patient age and may be more or less common with EBRT or Brachytherapy. In general the occurrence of side effects continues to decrease as a result of more targeted radiation to the prostate. Its best to discuss the risk of various side effects with your treating physician as they can very significantly based on the institution and method of radiation delivery. Radiation may cause bowel and bladder dysfunction and impotence. (19,20)
Interstitial Brachytherapy or External Beam Radiation?
The decision to undergo radical prostatectomy, EBRT or radiation seed implantation is difficult. This is because these treatment strategies continue to evolve and improve making it difficult to directly compare them in well-designed clinical studies. The choice of radiation versus prostatectomy is often based on weighing the possible complications of treatment and the relative inconvenience of the treatments. It is important to be seen by more than one physician to determine the likely treatment outcome associated with the various options available in your community.[4] Questions you may wish to ask your physicians include:
Votrient® (pazopanib)
Halaven® (eribulin Mesylate) Yondelis® (trabectedin)
What are the chances of this treatment curing the cancer?
What is the risk of impotence and incontinence?
What are the other possible complications from this treatment?
Radiation Therapy: Standard radiation therapy utilizes either external beam radiation (EBRT) consisting of daily treatments on an outpatient basis for approximately 6 to 8 weeks or interstitial brachytherapy, which involves permanent placement of radioactive seeds directly into the prostate gland. Because radiation implants focus the radiation closely around the prostate, this form of radiation works best in patients with stage I prostate cancer or low or intermediate risk stage II prostate cancer. For high-risk patients another form of treatment may be better suited for the patient. In addition, patients with a large prostate gland, prior history of prostate infections or recent transurethral resection of the prostate (TURP) may not be able to undergo the implantation procedure for brachytherapy. Patients should discuss the pros and cons of each with their treating physician. (19,20)
Hormonal Therapy - Androgen Deprivation Therapy
Hormone therapy, also known as androgen-deprivation therapy or (ADT), is designed to stop testosterone from being released or to prevent it from acting on the prostate cells and prevent the growth of cancer. Hormone therapy is primarily cytostatic; it prevents cancer cells from growing. It is not cytotoxic, like chemotherapy, which kills cancer cells. Hormone therapy may work for many years but eventually prostate cancer becomes resistant. When prostate cancer cells grow independent of or become insensitive to hormone therapy the cancer is referred to as hormone or castration resistant and is referred to as castration resistant prostate cancer (CRPC).
Hormone therapy may be used before, during, or after local treatment and is a mainstay of the treatment of advanced prostate cancer. The type and timing of hormone therapy is an individual decision and one that should be discussed with your doctor. Surgical orchiectomy or medical androgen deprivation therapy are two methods of delivering hormone therapy for early stage disease.
Surgical Orchiectomy - bilateral orchiectomy (castration) is a surgical operation to remove the the testicles - the main source of testosterone. Orchiectomy is a common treatment for patients with metastatic (stage IV) prostate cancer who will likely require hormone therapy for life. Patients may experience a benefit in symptoms in a matter of days following surgery.
Orchiectomy can cause side effects such as loss of sexual desire, impotence, hot flashes, and weight gain. The operation itself is relatively safe and not associated with severe complications. Orchiectomy is a convenient and less costly method of hormone therapy; however, it is irreversible.
Medical Androgen Deprivation Therapy - utilizes medicines that produce the same effect as an orchiectomy. This is referred to as Androgen Deprivation Therapy (ADT). ADT slows or stops prostate cancer growth by reducing the exposure of the prostate to testosterone. Medicines that reduce male hormone levels are called LHRH analogues and anti-androgens. Female hormones such as estrogens can also reduce male hormone levels, but can also cause serious side effects and are therefore rarely used.
LHRH Analogues - drugs that act like luteinizing hormone releasing hormone (LHRH) are known as LHRH analogues (Note that LHRH is sometimes called gonadotropin-releasing hormone (GnRH). These drugs turn off the signal for testosterone production by the testicles. By turning off the signal, hormone levels are reduced and cancer cells are not exposed to male hormones. LHRH analogues are typically given as a small injection under the skin of the abdomen every month or every three months. Lupron (leuprolide) is the most widely used but the FDA approved Orgovyx in 2021 as the first oral therapy and its availability reduces the need for in person clinic visits which is especially beneficial in helping patients with cancer stay home and avoid exposure during the coronavirus pandemic.
These drugs work just as effectively against prostate cancer as bilateral orchiectomy.
LHRH Antagonists - a class of medications can block LHRH from stimulating testosterone production without causing an initial testosterone surge. This class includes degarelix, which is given monthly to men as an alternative to orchiectomy or LHRH agonists. (22)
LHRH analogues can cause side effects such as loss of sexual desire, impotence, hot flashes and the development of osteoporosis, which increases the risk of bone fractures. Because these drugs require an injection every 1 or 3 months, LHRH analogues may not be as convenient as an orchiectomy. Unlike orchiectomy however, these drugs can be discontinued, and male hormone levels gradually return to normal.
LHRH analogues may be used to treat patients with any stage of prostate cancer. When first taken, these drugs may increase prostate cancer growth and make a patient's symptoms worse. This temporary problem is called "tumor flare." Gradually, these drugs cause hormone deprivation, shrinkage of prostate cancer, and improvement in symptoms. Tumor flare can be prevented by administering an anti-androgen medication before the LHRH analogue.
Leuprolide (Lupron, Eligard)
Orgovyx (relugolix)
Goserelin (Zoladex)
Triptorelin (Trelstar)
Histrelin (Vantas)
Degarelix (Firmagon)
Anti-androgens: Not all male hormones are made by the testicles. A small amount of male hormone is made by the adrenal glands, and may not be affected by bilateral orchiectomy or LHRH analogues. An anti-androgen is a medication that can block the effect of the remaining male hormone on prostate cancer cells. Anti-androgens are pills often given to patients in addition to orchiectomy or LHRH agonists. This combination of treatment is known as total or combined androgen blockade (CAB).
Anti-androgens can cause side effects such as loss of sexual desire, diarrhea, enlargement of the breasts and occasional impotence. When used alone, these drugs appear to cause impotence much less often than other forms of hormone therapy. On rare occasion, these drugs can cause liver abnormalities, and blood tests can help detect these problems before serious side effects occur. These drugs can also be discontinued, and male hormone levels gradually return to normal. Anti-androgens are given as oral medications. They are usually prescribed along with an LHRH agonist or before taking an LHRH agonist to decrease risks associated with the hormone flare that can be caused by an LHRH agonist.
Casodex (bicalutamide)
Eulexin (Flutamide)
Nilandron (nilutamide)
Combined Androgen Blockage - several clinical studies have directly compared CAB with a single form of hormone therapy (LHRH analogue or orchiectomy) for patients with metastatic prostate cancer. Two large studies conducted in the U.S. and Europe have shown improvement in disease control and survival with CAB. Most doctors feel CAB controls disease and improves survival better than either an LHRH analogue or orchiectomy alone. (4)
Continuous vs. Intermittent Therapy - some doctors believe that using medical hormone therapy intermittently can decrease the cost and reduce the side effects of treatment. When treatment is withheld for a period of time, sexual function and quality of life may improve. This was recently confirmed in a group of asymptomatic men with rising PSA levels after prostate cancer treatment. Men who received intermittent therapy appeared to have better quality of life, especially in terms of physical function, fatigue, urinary problems, hot flashes, libido, and erectile function and there was no difference in overall survival. (24)
Newer hormonal medications that inhibit the synthesis of androgen Zytiga (abiraterone) and block androgen receptor signaling Xtandi (enzalutamide) are now FDA-approved for the treatment of advanced prostate cancer.
Zytiga® (abiraterone) - is an oral targeted agent that blocks the production of androgens not only by the testes, but also by the adrenal glands and the tumor itself. Zytiga when administered with prednisone has been shown to improve quality of live and delay patient-reported pain progression in HRPC patients. Although this medication is generally well-tolerated, side effects may include fatigue, high blood pressure, and electrolyte or liver abnormalities and patients need to be monitored regularly. (25)
Xtandi® (exnzalutamide)- targets multiple steps in the androgen-receptor–signaling pathway, interfering with molecular pathways that help the prostate cancer grow. What's more, the drug does Xtandi has been shown to improve survival, reduce the risk of cancer progression, and delay the need for additional chemotherapy in men with HRPC. (26,27)
Erleada™ (apalutamide) is an androgen receptor inhibitor that works by binding directly to the ligand-binding domain of the AR. Erleada™ inhibits AR nuclear translocation, inhibits DNA binding, and impedes AR-mediated transcription.
When to Start Hormonal Therapy
There is general agreement that men with advanced prostate cancer experiencing symptoms should begin treatment immediately. There has been some disagreement, however, regarding the best time to start hormonal therapy in asymptomatic patients. Studies also suggest that men treated with immediate hormonal therapy lived longer without cancer progression and were less likely to develop significant complications from cancer compared to deferring hormone therapy until they developed symptoms.
Side Effects of Androgen Deprivation Therapy
Treatment of Advanced Prostate Cancer
More advanced cancers cannot be treated with surgery or radiation because the cancer cells have already spread away from the prostate gland. Systemic therapies commonly used in the treatment of prostate cancer include the following and doctors work to determine the best sequence of treatment in order to delay cancer progression and prolong survival. Systemic therapy is any treatment directed at destroying cancer cells throughout the body and typically consists of additional ADT or a precision cancer medicine followed by immunotherapy, chemotherapy and or bone directed treatment in individuals with advanced prostate cancer no longer responding to ADT.
Zytiga® (zbiraterone)
Xtandi® (Enzalutamide)
Precision Cancer Medicines
Lynparza (olaparib)
Provenge® (sipuleucel-T)
Keytruda (pembroluzimab)
Taxotere (docetaxel)
Jevtana® (Cabazitaxel)
Novantrone (mitoxantrone)
Estramustine
Treatment of Bone Complications
Denosumab (Xgeva™)
Xofigo (Radium Ra 223 dichloride)
Precision Cancer Medicines - Cancer cells may differ from one another based on what genes have mutations. Precision cancer medicine requires molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer's genome to identify specific genetic abnormalities that can be targeted. Once a genetic abnormality is identified, a specific targeted therapy that attacks a specific mutation or other prostate cancer-related change in the DNA programming of the cancer cells can be selected for treatment. This "genomic testing" is performed on a biopsy sample of the cancer and increasingly in the blood using a "liquid biopsy" In 2020 Lynparza was the first precision cancer medicine approved for the treatment of men with prostate cancer and BRCA1 and BRCA2 gene mutations which are critical for DNA damage repair (DDR) and present in ~ 5-10% of prostate cancer patients. All men with prostate cancer should undergo genomic testing to determine if they have cancer causing mutations treatable with a precision cancer medicine. (18) All patients with prostate cancer should undergo genomic biomarker testing for BRCA, and other potential targets. Learn more here...
Immunotherapy - is a type of treatment that uses the body's immune system to facilitate the killing of cancer cells. Types of immunotherapy therapy include interferon, interleukin, monoclonal antibodies, colony stimulating factors (cytokines), and vaccines. Sipuleucel-T (Provenge®) is an immunotherapy that prompts the body's immune system to respond against the cancer, and was recently approved by the FDA. (16,17)
Chemotherapy - The chemotherapy drug Taxotere® (docetaxel) was demonstrated to improve survival of men with metastatic prostate cancer in 2004 and has remained the mainstay of chemotherapy often utilized in combination with other chemotherapy drugs. In a study conducted by researchers at the Dana-Farber Cancer Institute, Taxotere administered with ADT to metastatic prostate cancer patients was found to extend overall survival by more than 13 months. Men in the ADT/Taxotere arm had a median overall survival of 57.6 months; those in the ADT-only arm had a median overall survival of 44 months.
Immunotherapy: Precision immunotherapy treatment of cancer has also progressed considerably over the past few decades and has now become a standard treatment. The immune system is a network of cells, tissues, and biologic substances that defend the body against viruses, bacteria, and cancer. The immune system recognizes cancer cells as foreign and can eliminate them or keep them in check up to a point. Cancer cells are very good at finding ways to avoid immune destruction, however, so the goal of immunotherapy is to help the immune system eliminate cancer cells by either activating the immune system directly or inhibiting the mechanisms of suppression of the cancer.
Sipuleucel-T( Provenge®) - is an immunotherapy that prompts the body's immune system to respond against the cancer. A Phase III clinical trial that contributed to the FDA approval of sipuleucel-T was a study known as IMPACT (Immunotherapy for Prostate AdenoCarcinoma Treatment) which demonstrated an improvement in overall survival for men treated with sipuleucel-T. The main side effects reported were chills, fever, and headache.[4]
Patients with advanced prostate cancer can have cancer cells that have spread to their bones, called bone metastases. Bone metastases commonly cause pain, increase the risk of fractures, and can lead to a life-threatening condition characterized by an increased amount of calcium in the blood called hypercalcemia. Treatments for bone complications may include drug therapy or radiation therapy.
Xgeva™ (denosumab) - targets a protein known as the RANK ligand. This protein regulates the activity of osteoclasts (cells that break down bone). Studies have suggested that Denosumab may be more effective than Zoledronic acid at delaying bone complications in prostate cancer patients with bone metastases. Denosumab is associated with side effects including hypocalcemia (low levels of calcium in the blood) and osteonecrosis of the jaw (death of bone in the jaw) (28)
Xofigo® (radium Ra 223 dichloride) - is a targeted radiopharmaceutical agent that binds with minerals in the bone to deliver radiation directly to bone tumors, thereby limiting the damage to the surrounding normal tissues. The U.S. Food and Drug Administration (FDA) approved the drug in May 2013 after a trial known as Alpharadin in Symptomatic Prostate Cancer Patients (ALSYMPCA) was stopped early after an interim analysis showed that treatment with significantly improved survival. (29)
Zoledronic acid (Zometa®) is a bisphosphonate drug and this class of drugs can effectively prevent loss of bone that occurs from cancer that has spread to the bones thereby reducing the risk of fractures, and decreasing pain. Bisphosphonate drugs work by inhibiting bone resorption, or breakdown. Zoledronic acid may be used to reduce the risk of complications from bone metastases or to treat cancer-related hypercalcemia.
Bill-Axelson A, Holmberg L, Garmo H, et al. Radical prostatectomy or watchful waiting in early prostate cancer. New England Journal of Medicine. 2014; 370:932-942.
Kowalczyk KJ, Levy JM, Caplan CF, et al. Temporal national trends of minimally invasive and retropubic radical prostatectomy outcomes from 2003 to 2007: Results from the 100% Medicare Sample. European Urology. 2012; 61: 803-809.
Lowrance WT, Elkin EB, Jacks LM, et al. Comparative effectiveness of prostate cancer surgical treatments: A population based analysis of postoperative outcomes. Journal of Urology. 2010 Apr;183(4):1366-72
Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline (2017)
Prepelica K, Okeke Z, Murphy A, et al. Cryosurgical ablation of the prostate: High-risk patient outcomes. Cancer. 2005; 103: 1625-1630.
Zietman AL, Bae K, Slater J, et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: Long-term results from Proton Radiation Oncology Group/American College of Radiology 95-09. Journal of Clinical Oncology. 2010; 28: 1106-1111.
Yu JB, Soulos PR, Herrin J, et al. Proton versus intensity-modulated radiotherapy for prostate cancer: Patterns of care and early toxicity. Journal of the National Cancer Institute. Published early online December 14, 2012. doi: 10.1093/jnci/djs463
Talcott JA, Rossi C, Shipley WU et al. Patient-reported long-term outcomes after conventional and high-dose combined proton and photon radiation for early prostate cancer. JAMA. 2010;303:1046-1053.
Stereotactic Body Radiotherapy for High-Risk Localized CARcinoma of the Prostate (SHARP) Consortium: Analysis of 344 Prospectively Treated Patients
Long-term Outcomes of Stereotactic Body Radiotherapy for Low-Risk and Intermediate-Risk Prostate Cancer
Sylvester, J. E., Blasko, J. C., Grimm, P. D., Meier, R. and Malmgren, J. A.: Ten-year biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: the Seattle experience. Int J Radiat Oncol Biol Phys, 57: 944, 2003
D'Amico, A. V., Manola, J., Loffredo, M., Renshaw, A. A., DelaCroce, A. and Kantoff, P. W.: 6-Month androgen suppression plus radiation therapy vs radiation therapy alone for patients with clinically localized prostate cancer: a randomized controlled trial. JAMA, 292: 821, 2004
Tannock I, de Wit R, Berry W, et al.Docetaxel plus Prednisone or Mitoxantrone plus Prednisone for Advanced Prostate Cancer. New England Journal of Medicine. 2004; 351:1502-1512.
Petrylak D, Tangen C, Hussain M, et al. Docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer. New England Journal of Medicine. 2004; 351:1513-1520.
de Bono JS, Oudard S, Ozguroglu M et al: Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomized open-label trial. Lancet 2010; 376: 1147.
Kantoff PW, Higano CS, Shore ND, et al. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. New England Journal of Medicine. 2010;363:411-422.
Kantoff P, Higano CS, Berger ER, et al. Updated survival results of the IMPACT trial of sipuleucel-T for metastatic castration-resistant prostate cancer (CRPC). Presented at the 2010 Genitourinary Cancers Symposium in San Francisco. March 5-7, 2010.
Chung JH, et al.JCO Precis Oncol.2019;doi:10.1200/PO.18.00283
Wiegel T, Bottke K, Steiner U et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. Journal of Clinical Oncology. 2009;27:2924-30.
Nam RK, Cheung P, Herschorn S, et al: Incidence of complications other than urinary incontinence or erectile dysfunction after radical prostatectomy or radiotherapy for prostate cancer: a population-based cohort study.The Lancet Oncology. 2014; 15(2): 223-231.
Rudnick MJ, Koyama T, Fan KH, et al. Long-term functional outcomes after treatment for localized prostate cancer. New England Journal of Medicine. 2013; 368:436-445.
Klotz L, Boccon-Gibod L, Shore ND et al. The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-label, parallel-group phase III study in patients with prostate cancer. BJU Int. 2008;102:1531-8.
Keating NL, O'Malley AJ, Freedland SJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy: observational study of veterans with prostate cancer. Journal of the National Cancer Institute. 2010;102:39-46.
Cook JM, O'Callaghan CJ, Duncan G, et al. Intermittent androgen suppression for rising PSA level after radiotherapy. New England Journal of Medicine. 2012; 367: 895-903.
Basch E, Autio K, Ryan CJ, et al: Abiraterone acetate plus prednisone versus prednisone alone in chemotherapy-naive men with metastatic castration-resistant prostate cancer: patient-reported outcome results of a randomised phase 3 trial. The Lancet Oncology. 2013; 14(12):1193-1199.
Beer TM, Armstrong AJ, Sternberg CN, et al: Enzalutamide in men with chemotherapy-naive metastatic prostate cancer (mCRPC): Results of phase III PREVAIL study. Presented at the 2014 Genitourinary Cancers Symposium. Journal of Clinical Oncology. 2014; 32 (supplement 4; abstract LBA1).
Scher HI, Fizazi K, Saad F et al: Increased survival with enzalutamide in prostate cancer after chemotherapy. N Eng J Med 2012; 367: 1187.
Smith MR, Saad F, Coleman R et al. Denosumab and bone-metastasis-free survival in men with castration-resistant prostate cancer: results of a phase 3, randomised, placebo-controlled trial. Lancet. Early online publication November 16, 2011.
Michalski J, Sartor O, Parker C, et al. Radium-223 dichloride (Ra-223) impact on skeletal-related events, external-beam radiotherapy (EBRT), and pain in patients with castration-resistant prostate cancer (CRPC) with bone metastases: Updated results from the phase III ALSYMPCA trial. Proceedings of the 55th Annual Meeting of the American Society of Radiation Oncology. International Journal of Radiation Oncology Biology Physics. 2013; 87(2): S108-S109. Abstract 265.
Treatment of Stage II Prostate Cancer
Cancer Connect - Treatment of Stage II Prostate Cancer
Treatment of Stage IV (D) Prostate Cancer
Cancer Connect - Treatment of Stage IV (D) Prostate Cancer
Treatment of Stage III (C) Prostate Cancer
Cancer Connect - Treatment of Stage III (C) Prostate Cancer
Treatment for Recurrent Prostate Cancer
Cancer Connect - Treatment for Recurring Prostate Cancer
Treatment of Stage I Prostate Cancer
Erectile Dysfunction After Prostate Cancer Treatment-What You Need to Know!
Understand how prostate cancer treatment affects erectile function and what can be done about it.
Prostate Cancer Treatment
Erleada Treatment for Prostate Cancer
Erleada prolongs survival in non-metastatic Castration-resistant Prostate Cancer and for those with metastatic disease.
Understanding Side Effects of Androgen Deprivation Therapy
Osteoporosis and Obesity in Men with Prostate Cancer Treated with Androgen Deprivation Therapy
Overview of Prostate Cancer
The PSA, ultrasound, biopsy, CT, MRI, and Oncotype are all used for diagnosing prostate cancer and determining treatment


Informant: Enrique is a 19-year-old boy, born and raised in Manila, Philippines who now attends college in California. South Ridge (the school in his story) is a Catholic all-boys school in Manila which he attended from kindergarten through until 7th grade.
Informant: So when I went to South Ridge, [all boys school in Manila, Philippines] there was a super scary bathroom on the top floor of the school. No one ever used this bathroom because there was a rumor that someone had died inside the bathroom years ago. On special occasions, our classes would have sleep overs at school and during one of these sleep overs, one of the older batches went up to that bathroom in the middle of the night. The rumor goes that if you say Bloody Mary in front of the mirror in that bathroom four times, Bloody Mary actually shows up. So when one of the guys that decided to go into that bathroom did the ritual, she actually appeared and when he left the bathroom, he was covered in cuts and scratches.
Interviewer: Do you know what Bloody Mary has to do with the guy that had died in the bathroom?
Informant: She was apparently the one who killed him.
Thoughts about the piece: It is extremely interesting that the Bloody Mary ritual would occur at a local all-boys school in the Philippines. Especially considering the context that we discussed it in during class wherein we saw that the ritual is most popular among pre-pubescent girls usually in Western countries. We took this to be part of girls growing up as womanhood is bloody, thus, girls are basically looking into their future (by spinning and looking into the mirror) and trying to understand it by performing the ritual. I too attended school in the Philippines however it was an international school with many American and European students- here too I noticed that only girls would take part in the Bloody Mary ritual. Thus, it is intriguing that this would be such a big sensation (seeing as how no one wanted to use the bathroom because they all know what had happened there) at a local, Catholic all-boys school.
Something else that it interesting about this version of the story is that Bloody Mary actually physically harms the people that perform the ritual whereas usually, you are said to simply see an image of her in the mirror.
JH is a senior at an all-boys Catholic high school in La Canada Flintridge, CA. He lives in Pasadena, CA.
A lot of high schools that have the resources put on these "retreats" for their students, especially at the end of senior year, or the end of their high school career. It helps usher these students through the liminal period, or help them slow down and understand the importance of the transition they're in the midst of, and by emphasizing parental involvement JH's school highlights the community aspect, where families would play a big role in celebrating the child's transition to adulthood. This is actually the first kind of retreat I'd heard of that gave parents such a role – usually it revolves more around the school's influence and presence in the students' lives.
My informant graduated in 2011 from Notre Dame Academy Girl's High School in West Los Angeles, California. She currently attends UCLA in Westwood, California. Notre Dame Academy, often called NDA, is a Catholic, all girls school with many traditions the students participate in annually. My informant told me about the one she considers most exciting and memorable: NDA Day.
My informant enjoyed this spirit day quite a bit and cites it as one of the things she misses about high school. Spirit days are a common occurrence in many high schools, but every school does it differently.


The computer is one of the most brilliant gifts of science. This device was originally developed by Charles Babbage. Most countries have developed fast due to computerization. Writing a program is essential for a computer. Speed, accuracy, reliability, and integrity are the main characteristics of a computer.
Many of the routine activities today at home and in business are done by computers. The computer has proved a friend and servant of science, technology and industry. Most offices, shops, factories and industries use computers. The Internet is a storehouse of information. The computer is a boon to all. Telecommunication and satellite imageries are computer based. Computers have made the world a global village today.
The computer is one of the most brilliant gifts of science. It is an electronic device for storing and analyzing information fed into it, for calculating, or for controlling machinery automatically. Charles Babbage developed this device first in 1812 followed by George Boole in 1854, Howard and Aitten in 1937, Dr. John Nouchly and J. P. Eckert in 1946. These computers were named the first generation equipment. Today, wit the 'Artificial Intelligence' technology, we are using fifth generation computers. Each new generation of computers has been smaller, lighter, speedier and more powerful than the earlier ones. Now note-book sized computers like laptop are fairly common. Computers have been dominating technology since 1970s, and has now entered almost all walks of life.
Writing a program is essential for running a computer. This job is done by a software engineer. A computer program is a complete list of instructions which the computer accepts in order to solve a problem. There are many different languages that can be used to programme a computer. BASIC, COBOL, FOR TRAN, C, C++, JAVA and Visual Basic are some of them.
Speed, accuracy, reliability and integrity are some of the characteristics of a computer. It can execute over a million.


text:
Attorney General Delaney may refer to:

John Delaney (lawyer) (born 1964), Attorney General of the Bahamas
Michael Delaney (lawyer) (born 1969), Attorney General of New Hampshire