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2017| April-June | Volume 54 | Issue 2
Online since February 21, 2018
GENERAL ONCOLOGY
Knowledge, attitude, and practice toward cervical cancer among women attending Obstetrics and Gynecology Department: A cross-sectional, hospital-based survey in South India
G Narayana, M Jyothi Suchitra, G Sunanda, J Dasaratha Ramaiah, B Pradeep Kumar, KV Veerabhadrappa
April-June 2017, 54(2):481-487
DOI:10.4103/ijc.IJC_251_17 PMID:29469083
INTRODUCTION: Cervical cancer-related deaths among women in India are often due to late diagnosis of disease. Knowledge about disease and early screening is the most effective measure for cervical cancer prevention. Lack of awareness, negative attitude, and poor practice about cervical cancer and screening are the major causes to increase the incidence of disease. AIM: The study is designed to assess knowledge, attitude, and practice (KAP) toward cervical cancer, screening, and prevention. SETTINGS AND DESIGN: A cross-sectional, hospital-based survey was conducted in women attending Obstetrics and Gynecology Department of a secondary care referral hospital. MATERIALS AND METHODS: A total of 403 subjects were enrolled and subjected for interview using prevalidated KAP questionnaire on cervical cancer. STATISTICAL ANALYSIS: Descriptive statistics were used to represent the sociodemographic characteristics and KAP levels. Association of sociodemographic variables with KAP levels is determined using Chi-square test. RESULTS AND DISCUSSION: Most of (301; 74.6%) the respondents had heard about cervical cancer and majority of them are heard from media (168; 41.6%) and friends (83; 20.5%). Most women knew symptoms (259; 64.2%), risk factors (253; 62.7%), screening methods (310; 76.9%), and preventive measures (249; 61.7%) for cervical cancer. More than half of the women (252; 62.5%) having positive attitude toward screening. More than three-fourth of women (349; 86.6%) are not having practice toward cervical cancer screening. Sociodemographic characteristics are strongly associated with KAP levels. CONCLUSION: Although women are having good knowledge, positive attitude toward cervical cancer screening and prevention still there is a gap to transform it into practice. There is a need for more educational programs to connect identified knowledge slits and uplift of regular practice of cervical cancer screening.
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Clinico-pathological profile of colorectal cancer in first two decades of life: A retrospective analysis from tertiary health center
D Sharma, G Singh
AIM: This retrospective observational study was done to analyze age, gender, site of primary tumor and histological characterstics in patients of colorectal carcinoma in the first two decades of life. MATERIAL AND METHOD: A total of 373 patients of colorectal patients were registered in the Department of Radiation Oncology from January 2010 to December 2015. Patients who were <20 years of age were analyzed for clinicopathological characteristic. RESULTS: In our study, a total of 29 out of 373 patients (7.75%) were ≤20 years. Male to female distribution was 2.2:1. Younger age group presented with advanced Stage III and IV 58.62% and 10.34% patients, respectively. Only 9 (30.5%) patients were of Stage I and II. The most common involved site was rectum in 21 (72.41%) patients, followed by rectosigmoid involvement in 5 (17.24%). CONCLUSIONS: Colorectal carcinoma in young adults is usually locally advanced or metastatic. Therefore, the diagnosis of CRC should be done at early and curable stage. Bleeding per rectum in a younger age group should not be ignored but must be properly evaluated.
Neoadjuvant chemotherapy for unresectable oral cancers: Optimizing outcomes?
T Puri
HEMATOLYMPHOID
Long-term outcome of diffuse large B-cell lymphoma: Impact of biosimilar rituximab and radiation
P Ganesan, TG Sagar, K Kannan, V Radhakrishnan, S Rajaraman, A John, S Sundersingh, V Mahajan, TS Ganesan
INTRODUCTION: Rituximab (R)-CHOP improves survival over CHOP in diffuse large B-cell lymphoma (DLBCL). The availability of biosimilar rituximab in India has increased access of this drug. We report on the impact of treatment on outcomes with special emphasis on the impact of biosimilar rituximab and radiation. METHODS: Outcomes of adults (age 15–60 years) treated with CHOP+/- Rituximab radiation were analyzed retrospectively to look at baseline features, treatment, and event-free and overall survival (EFS and OS). RESULTS: In the period 2000–2013, 444 patients (median age 47 years: 15–60; males: 288 [65%]; Stage III/IV: 224 [50%]; age-adjusted international prognostic index [aaIPI] Score 2 or 3 in 50%) received either CHOP (n = 325 [73%]) or RCHOP (n = 119 [27%]) therapy. Biosimilar rituximab and the original were used in 95 (80%) and 24 (20%) patients, respectively. Radiation was given in 134 (30%) patients (Stages I and II, 100/220 [45%] and Stages III and IV, 34/224 [15%]). After a median follow-up of 46 (0.2–126) months, the 5-year EFS and OS were 59% and 68%, respectively. The factors predicting inferior EFS and OS were age >40 years, performance status 2–4, Stage III/IV, hemoglobin <12 g/dL, the aaIPI Score 2 or 3, and nonuse of rituximab and radiation. Radiation used in early stage disease benefitted all subgroups regardless of bulky disease, use of rituximab, or the number of cycles of chemotherapy. Addition of rituximab improved survival across all categories of aaIPI. CONCLUSION: Availability of biosimilar rituximab has increased access and survival of patients with DLBCL in India. Radiotherapy improved outcomes in early stages.
HEAD AND NECK/MEDICAL ONCOLOGY
Carboplatin-based concurrent chemoradiation therapy in locally advanced head and neck cancer patients who are unfit for cisplatin therapy
V Noronha, V Sharma, A Joshi, VM Patil, SG Laskar, K Prabhash
BACKGROUND: Cisplatin-based chemoradiation (CTRT) is the standard of care in locally advanced head and neck cancers. Limited treatment options are available in patients unfit for cisplatin. AIMS: This audit was carried out to study the toxicities, tolerance, and outcomes of carboplatin-based CTRT in patients who are not eligible for cisplatin. MATERIALS AND METHODS: A total of 63 locally advanced head and neck cancer patients treated between January 2011 and October 2015 were administered carboplatin-based CTRT. The dose of carboplatin was equivalent to area under the curve equivalent to 2 administered once a week for a maximum of 7 cycles. Toxicity was coded as per the CTCAE version 4.03. SPSS software version 16 was used for statistical analysis. STATISTICAL ANALYSIS: Descriptive statistics was performed. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan–Meier survival analysis. Cox proportional hazard model was used for identifying factors affecting PFS and OS. RESULTS: The reasons for patients being unfit for cisplatin were low serum creatinine clearance in 41 (65.07%), sensorineural hearing loss in 18 (28.57%), uncontrolled medical comorbidities in 3 (4.76%), and old age in 1 patient (1.6%). 53 patients (84.1%) completed planned radiotherapy. The median number of chemotherapy cycles administered was 6. Grade 3–4 toxicities were seen in 32 patients (50.8%). The median OS and PFS were 28 months (95% confidence interval [CI]: 20.9–34.6 months) and 17 months (95% CI: 08.2–25.7 months), respectively. Age was the only factor significantly affecting OS and PFS. CONCLUSION: Carboplatin-based CTRT is well tolerated in patients unfit for cisplatin and seems to have superior outcomes than those reported in radical radiotherapy studies.
Statins and risk of cancer: A meta-analysis of randomized, double-blind, placebo-controlled trials
MK Kim, SK Myung, BT Tran, B Park
PURPOSE: Several meta-analyses of randomized controlled trials (RCTs) reported no association between the use of statins and the risk of cancer. However, they included open-label RCTs, which did not use placebo as a control group. This study aimed to evaluate the effect of statins on cancer risk using a meta-analysis of randomized, double-blind, placebo-controlled trials (RDBPCTs). METHODS: We searched PubMed, EMBASE, and the Cochrane Library in March 2016. Two individual authors reviewed and selected RDBPCTs based on selection criteria. RESULTS: Out of 676 retrieved articles, a total of 21 RDBPCTs with 65,196 participants (32,618 in the statin group and 32,578 in the placebo group) were included in the meta-analysis. Overall, we found that there was no significant association between the use of statins and the risk of cancer (relative risk 0.97, 95% confidence interval 0.92–1.02, I2 = 0.0%) in a fixed-effect meta-analysis. In addition, in the subgroup meta-analyses, no beneficial effect of statins was observed when analyzed by statin type, country, follow-up period, methodological quality, underlying diseases/population, and type of cancer. CONCLUSIONS: The current meta-analysis of RDBPCTs found that there was no association between the use of statins and the risk of cancer.
Role change as breadwinner in cancer caregiving
C Sivakumar
INTRODUCTION: Indian families are known for adopting the role of caregiver naturally when someone in the family falls ill to cancer. Although there were strong family structure and system existed here, now the changing family pattern and structure are challenging the role of cancer caregiving as well. OBJECTIVE: This study analyses the life situation of caregivers of cancer survivors during the course of treatment and attempts to explore the areas of interventions for caregivers themselves. METHODS: A descriptive research design was adopted for the study. A sample of 40 respondents was chosen for the study through purposive sampling technique. RESULTS: Majority of the caregivers were females (75%) and fell into the age group of 35 to 45 years (65%). The education among the caregivers was varying between illiteracy to postgraduation. Majority of 95% of them adapted the dual role voluntarily and 85% of them felt that they were finding it very difficult to cope with the dual responsibility. About 60% of them felt that they would fail in their roles and were not satisfied with their performances dually. CONCLUSION: Adaptation to a dual role involves time factor and as part of care to the caregiver, a guided interaction and orientation towards managing these roles would help them better ways to adapt. Given the scarcity of support system on Indian settings, the caregivers who do dual role have huge responsibility and challenges to deliver quality caregiving and fulfill their other roles as well. It is the duty of the complete health care system to seriously take this into consideration and to act on it.
SOFT TISSUE SARCOMA/PATHOLOGY
Histopathologic review of 400 biopsies and resection specimens of trunk and extremity-based soft tissue tumors
R Badanale, B Rekhi, NA Jambhekar, A Gulia, J Bajpai, S Laskar, N Khanna, G Chinnaswamy, A Puri
AIMS: To review various pathologic parameters in diagnosed cases of trunk and extremity-based soft tissue tumors (STTs), in order to identify concordance rate between initial biopsy and resection specimen and discrepancies between initial and review diagnosis, by a specialist pathologist. MATERIALS AND METHODS: Over a 2-year-period, 400 retrospectively diagnosed STTs (553 specimens) including referral and "in-house" cases were studied. The reviewing specialist pathologist was blinded to the initial diagnoses. Discordances including discrepancies and deficiencies were defined as major and minor. Major discrepancies included those that could lead to significant treatment changes. True discrepancies were those related to sampling issues between the biopsies and resection specimens. Deficiencies relating to tumor subtyping, sarcoma grading, documentation of tumor size, and marginal status (in resections) were subdivided as major and minor. RESULTS: Most cases (328, 82%) were sarcomas (most common, synovial sarcoma; most common Stage, III), followed by benign tumors (36, 9%) (most common, schwannoma) and intermediate malignancies (32, 8%) (most common, fibromatosis). Within STTs, liposarcomas, neural tumors, and undifferentiated pleomorphic sarcomas were relatively more frequently associated with discrepancies. Percentage of cases with major discordances between the referral reports (100 cases) and review diagnosis was 60%. Percentage of cases with major discordances between the specialist and other oncopathologists was 11%. True discrepancies were observed in 20 (5%) cases. The association of type of specimen with the rate of discordance was not significant (P = 0.114). CONCLUSIONS: Diagnoses of STTs are fraught with errors mostly from general pathologists, followed by nonspecialist oncopathologists. These findings reinforce the need for reporting of STTs, especially sarcomas, by specialist pathologists.
Impact of pictorial warning labels on tobacco products among patients attending outpatient department of a dental college in Bangalore city: A cross-sectional study
N Vanishree, RR Narayan, N Naveen, D Bullapa, D Vignesh, NM P Raveendran
AIM: The aim of this study is to assess the knowledge, attitude, and impact of pictorial warnings present on tobacco packets among patients attending outpatient department of a dental college of Bangalore city. MATERIALS AND METHODS: A cross-sectional study was conducted among 419 patients through convenience sampling, using a structured close-ended questionnaire containing 35 questions. The participants were approached and invited to participate voluntarily. The data obtained were analyzed using descriptive statistics, Chi-square test and ANOVA. RESULTS: Mean age of the participants was 28.1 ± 7.06 years. Out of total 419 participants, 62.8% were tobacco users. About 40.6% of the participants had average knowledge and only 22.9% had positive attitude regarding the pictorial warnings. Nearly 77.9% of tobacco users had previously attempted decreased frequency of tobacco use and 63.7% had tried quitting the habit. The difference was statistically significant (P < 0.05 Chi-square test and ANOVA). CONCLUSION: The present study revealed that most of study participants have noticed the warnings on tobacco products, and most of them believe that they could understand warning labels. This study also showed that most of study participants believed that pictorial health warnings create awareness about probable health hazards of tobacco use and that these pictorial presentations on tobacco packs positively assist in reducing or quitting tobacco smoking.
HEAD AND NECK/QOL/RADIOTHERAPY
Quality of life outcome measures using University of Washington questionnaire version 4 in early T1/T2 anterior tongue cancers with and without radiotherapy: A cross-sectional study
P Sakthivel, DV K Irugu, CA Singh, H Verma, R Yogal, B Jat, A Chadran, K Sikka, A Thakar, SC Sharma
CONTEXT: To evaluate the quality of life (QOL) outcome measures in disease-free survivors of pathological T1/T2 tongue cancers and to compare QOL in patients treated with only surgery and with adjuvant treatment. SETTINGS AND DESIGN: Cross-sectional survey. PATIENTS AND METHODS: All pathological T1/T2 anterior tongue cancer cases with follow-up from January 2011 till December 2015, who had locoregionally controlled disease with a minimum disease-free survival period of 1 year, were included in the study. RESULTS: A total of 36 patients, 28 are males and 8 are females with an age range of 24–66 years (median age of 43) were enrolled in the study. The patients were divided into two groups with (n = 26) and without adjuvant postoperative radiotherapy (RT) (n = 10) and the University of Washington-QOL questionnaire version 4 for physical and social domains, global questions and three important domains were analyzed. On the physical and social domain scores, the surgery-alone group outscored the combined modality group on all scales and the differences were statistically significant for specific physical domains such as saliva (0.0001), taste (P = 0.0001), chewing (P = 0.0004), swallowing (P = 0.0026), and social domains such as mood (0.0001), pain (P = 0.0001), and shoulder function (P = 0.0061). The overall global QOL scores were also better for the surgical group compared with group which received adjuvant RT but was not statistically significant. All patients chose saliva as their top priority domain in the group which received radiation, and 60% chose "swallowing ability" as the preferred top priority domain in the only surgical group. CONCLUSIONS: Although locoregional control and disease-free survival are the major treatment-related endpoints for cancer management, QOL outcome measures have to assess to determine the impact of a treatment modality on patients well-being and for better rehabilitation of cancer-free patients.
FROM THE NEW EDITORS
From the new editors.....
LUNG/MEDICAL ONCOLOGY
ROS1 rearranged nonsmall cell lung cancer and crizotinib: An Indian experience
V Noronha, MV Chandrakanth, AP Joshi, V Patil, A Chougule, A Mahajan, AK Janu, R Chanana, K Prabhash
ROS1 rearrangement acts as a driver mutation in 1-2% of NSCLC. Crizotinib is approved in this situation both in treatment naïve and pre-treated patients. Here we report our experience with crizotinib in patients with advanced NSCLC harbouring ROS1 rearrangement. Eleven patients were included in our study. More than half of our patients had associated comorbidities and one fourth of them had a compromised performance status. Out of 11 patients, 5 of them were exposed to crizotinib .The response rates among crizotinib treated patients was 80%. With a median follow up of 9 months, median PFS and OS were 5.4 months and 8.5 months respectively for the entire population. Analyzing the outcomes separately , median PFS and OS was not reached for those who received crizotinib compared to median PFS of 2.5 months and median OS of 4.2 months in those who were not exposed to crizotinib. The difference was statistically significant. Estimated 1 year OS was 80% for those who received crizotinib compared to 18% for who did not receive crizotinib. In conclusion, crizotinib is effective with acceptable side effect profile in patients with ROS1 rearranged NSCLC in our population.
ESOPHAGUS/SURGERY/MEDICAL ONCOLOGY
Perioperative complications of esophagectomy: Postneoadjuvant treatment versus primary surgery – Our experience and review of literature
AS Patil, NV Gulavani, NP Dharmadhikari, KC Polavarapu, SS Sharma, RC Mistry
AIMS: To compare perioperative complications in esophagectomy after neoadjuvant therapy v/s primary surgery. SETTINGS AND DESIGN: Retrospective analysis of perioperative complications in a prospectively maintained data base of patients who underwent esophagectomy as Primary surgery or after neoadjuvant therapy was done. METHODS AND MATERIAL: 238 cases of esophagectomies performed for esophageal carcinoma were analysed and compared, out of which 125(52.5%) were given neoadjuvant therapy followed by surgery and 113(47.5%) underwent primary surgery. Surgical procedure was standard for both the groups. All the cases were analysed for perioperative complications. STATISTICAL ANALYSIS USED: Data was analysed using Open Epi soft ware. Association between the two study group was assessed with Chi square test. RESULTS: On comparison, both the groups were comparable in demographic profile and type of surgery performed. However, tumour stage was higher for cases who received neoadjuvant therapy as expected. On analysis there was no significant difference in overall morbidity and 30 days mortality. CONCLUSIONS: Neoadjuvant Chemo/chemoradiotherapy is a feasible option in esophageal carcinoma without increase in incidence of peri operative morbidity or mortality.
GERM CELL TUMOURS
Retrospective analysis of patients with relapsed or refractory testicular nonseminous germ cell tumors treated with autologous stem cell transplantation
F Yilmaz, N Soyer, R Uslu, AP Erdogan, B Karaca, G Saydam, F Sahin, F Vural
BACKGROUND AND AIM: About 20-25% of the testicular germ cell tumors (TGCT) are relapsed or refractory after first line therapy and optimal treatment for this group is poorly defined. We aimed to analyze the efficacy and safety of autologous stem cell transplantation (ASCT) in this patient group.Material and METHODS: 19 patients with 28 ASCT were retrospectively analyzed. All the patients were treated with BEP (Bleomycin, etoposide, cisplatin) as first line therapy and TIP(paclitexalifosfamide, cisplatin) was given as salvage chemotherapy. Stem cell collection was performed with TIP and granulocyte stimulating factor. ASCT was performed with carboplatin(700mg/m2) and etoposite(750mg /m 2). The results were provided as median(min-max). P<0.05 was accepted as statistical significant level. RESULTS: After ASCT, complete(CR) and partial remission (PR) rates were 47.3% and 31 .5% respectively. The median overall survival(OS) and progression free survival (PFS) were 18(0-37.4 months) and 7(0-15months) months respectively. Estimated 2-year OS was 47.4% and PFS was 35.3%. Grade 3/4 toxicities including diarrhea, mucositis, and toxic hepatitis were observed in 5 patients. Only one patient died due to complication of transplantation. CONCLUSION: Although the number of the patients in this study is limited, ASCT seems to be a safe and effective treatment modality in relapsed refractory non-seminomatousTGCT with an acceptable OS, PFS and mortality rates.
HEAD AND NECK/IMAGING
Paralingual and sublingual space invasion in magnetic resonance imaging of squamous cell carcinoma of anterior two-thirds of tongue: Is there a prognostic significance? A prospective evaluation
SC Jayasankaran, PG Chelakkot, K Thankappan, S Iyer, S Moorthy
BACKGROUND: Magnetic resonance imaging (MRI) in tumors of anterior two-thirds of tongue has a significant role in assessing different tumor parameters, and in prognosticating. AIM: This prospective study conducted in a tertiary cancer care center, focused on patients with squamous cell carcinoma of anterior two-thirds of tongue. The significance of invasion of paralingual and sublingual spaces in relation to the pathological grade of these tumors, and its predictive value in pathological nodal involvement were analyzed. MATERIALS AND METHODS: All consecutive patients with the required inclusion criteria were accrued. Imaging was done with 3 Tesla MRI and invasion of sublingual and paralingual spaces were accurately assessed. Data elucidated were tabulated and analysed using IBM SPSS version 20.0. Chi-square test, nonparametric correlation using Spearman's Rho correlation, and two-independent sample test using Mann–Whitney's U-test were used to arrive at correlations between the imaging and histopathological parameters. RESULTS: Sixty-three patients were analyzed. Mean age was 52.3 ± 11.45 years. 74.6% were males. MRI showed sublingual space invasion in 47.6%. 18/28 with and 11/33 without invasion had node positivity. Paralingual space involvement was observed in 31.7% of patients. Thirteen of these and 16/43 with no involvement had positive cervical nodes. No statistically significant correlation was observed. CONCLUSION: This prospective study did not establish any statistically sound correlation, and robust data are lacking to support newer parameters such as sublingual space and paralingual space as probable predictors of cervical nodal involvement, and for prognostication.
Barriers affecting adherence to radiation treatment and strategies to overcome those barriers
R Rangarajan, K Jayaraman
BACKGROUND: The WHO defines adherence as the extent to which a patient's behavior coincides with recommendations from a health-care provider. Nonadherence to cancer treatment has a major impact on the therapeutic outcome. AIM OF THE STUDY: To assess the prevalence of nonadherence to radiation regimen and to analyze the factors that affect adherence to cancer treatment. MATERIALS AND METHODS: Patients receiving radiation treatment in our hospital were screened for adherence to appointment keeping and to the prescribed radiation regimen and patients who had unplanned treatment breaks during treatment were interviewed. Between January and July 2013, we identified 61 patients who had unplanned breaks during treatment. We analyzed the social, emotional, educational, economic, and therapeutic barriers that led to nonadherence. RESULTS: Of the 61 patients who had unplanned breaks during treatment, 54% were males and 46% were females. Fifty-seven percent of patients had head and neck cancers and 25% had gynecological cancers. Seventy-one percent of patients were planned for concurrent chemoradiation. The number of days of unplanned treatment breaks ranged from 3 to 27 days. Social and therapeutic barriers were found to be the most common factor that led to nonadherence in these patients. CONCLUSION: Identification of barriers that lead to nonadherence, designing strategies to overcome such barriers and effective communication becomes imperative to ensure uninterrupted treatment. Based on the above analysis, we have designed several strategies to improve adherence to treatment among our patients.
CNS/RADIOTHERAPY
Reirradiation for recurrent primary central nervous system tumors: Eight-year audit from a tertiary cancer care center in South India
D Menon, PG Chelakkot
BACKGROUND: Radiation therapy is a major treatment option in the management of primary central nervous system (CNS) tumors, though recurrences after primary treatment, especially in high-grade glial tumors, is a challenge for treating physician. Advances in the field of radiation have made reirradiation a feasible option in recurrent CNS tumors. MATERIALS AND METHODS: Details of patients with primary CNS lesions who presented between 2009 and 2016, with recurrent CNS lesions, and who were treated with reirradiation were retrieved from electronic medical records, as a departmental audit, and the outcome was analyzed. RESULTS: A total of 33 patients received reirradiation. Median follow-up was 112.7 months. Median age at presentation was 36 years. On completing initial treatment, 42.4% had no residual disease. Median time to symptomatic recurrence was 51.33 months. For reirradiation, stereotactic radiotherapy was used in 27.3%, stereotactic radiosurgery in 12.1%, and intensity-modulated radiation therapy in 36.4%. Mean cumulative 2 Gy equivalent dose (EQD2) was 111.00 ± 15.287 Gy. At the last follow-up, 57.6% of patients were alive, and 27.3% had succumbed to the disease. Median OS was 187.67 months. Three-year survival after reirradiation was 74.1%. CONCLUSION: Our study is probably one of the first from the Indian subcontinent analyzing a series of reirradiation in primary CNS tumors. Our survival subsequent to reirradiation is comparable to that in available literature; which are also mostly retrospective. Our analysis also substantiates that younger patients, longer intervals between the two sets of radiation and biologically effective dose <100 Gy and EQD2Cumulativeof <100 Gy are factors that favorably improve the survival after reirradiation as has been shown in literature.
Microsatellite Instability in Chronic Myeloid Leukemia using D17S261 and D3S643 markers: A Pilot Study in Gujarat Population
TN Patel, M Chakraborty, P Bhattacharya
CONTEXT: Tumor progresses through a series of genetic alterations that involve proto-oncogenes and tumor suppressor genes – the gatekeeper, caretakers, and landscaper genes. Microsatellites are short tandem repeat sequences, present over the span of human genome and are known to be variable at multiple loci due to errors in DNA Mismatch Repair machinery. AIM: The present study was aimed to evaluate the association between Microsatellite Instability (MSI) and evolution of Chronic Myeloid Leukemia (CML) – genetically a rare event but profound in this pilot study. SETTINGS AND DESIGNS: We explore the possibility of MSI in primary CML patients confirmed by t(9;22) using capillary electrophoresis. Fifteen CML patients and healthy individual samples, respectively, were used to study the markers D17S261 and D3S643. MATERIALS AND METHODS: The DNA was amplified using tagged and nontagged primers and further subjected to bioanalysis and fragment analysis. RESULTS: While the results from bioanalyzer fluctuated, fragment analysis indicated the presence of microsatellite variability in 80% of the patients' samples as compared to no MSI in normal individuals for both the markers. CONCLUSION: These findings suggest that MSI is a genetic event that may have a role in CML progression or evolution. Further studies are warranted to understand the plausible underlying causes.
MALE GENITOURINARY SYSTEM/SURGERY
Utilization of pelvic lymph node dissection in patients undergoing robot-assisted radical prostatectomy in India versus the United States – A Vattikuti Collective Quality Initiative database analysis
F Abdollah, S Arora, T Jindal, P Gild, A Sood, TB Yuvaraja, RK Ahlawat, NP Gupta, M Bhandari, M Menon
BACKGROUND: The utilization and extent of pelvic lymph node dissection (PLND) varies depending on the disease and practice patterns. AIMS: This study compares practice patterns in utilization of PLND between Indian and United States (US) practices. SETTINGS AND DESIGN: We focused on 415 patients (204 India; 211 US) prostate cancer patients treated with robot-assisted radical prostatectomy, between 2015 and 2016, within the Vattikuti Collective Quality Initiative database. SUBJECTS AND METHODS: Utilization of PLND and number of nodes removed were evaluated for the entire cohort, and after stratifying for Country of treatment and D'Amico risk groups. Logistic regression tested the relationship between PLND and country of treatment, after adjusting for disease risk. RESULTS: Indian patients had a higher risk distribution (D'Amico high-risk 53.4% in India vs. 27% in the US; P< 0.001) compared to their US counterparts. Overall, 193/204 (94.6%) Indian patients underwent PLND versus 181/211 (85.8%) US patients (P = 0.003). When stratified based on disease risk, PLND was performed more frequently in Indian patients with low-risk disease (81.0% vs. 41.4%,P= 0.008), but not in those with intermediate and high-risk disease. On multivariable analysis, Indian patients had a 2.57-fold higher probability of undergoing PLND than their US counterparts (P = 0.02). The analysis of the number of lymph nodes removed showed similar trends. CONCLUSIONS: Indian patients are more likely to undergo PLND than US patients. This is, especially true for patients with low-risk disease, who are unlikely to benefit from this procedure. Efforts should focus on optimizing the utilization of PLND, and deliver it only when there is clinical indication.
Novel use of bioelectric impedence technique to detect alterations in body composition in advanced small cell lung cancer
A Mohan, R Poulose, A Ansari, K Madan, V Hadda, GC Khilnani, R Guleria
BACKGROUND: Malnutrition is frequent in lung cancer and is measured using various tools, including the novel bioelectric impedance technique for measuring body composition. However, the validation of this technique for assessing body composition in advanced small cell lung cancer (SCLC) is untested. METHODS: Forty-one treatment naïve patients (all males) and an equal number of age- and sex-matched controls were evaluated by anthropometric measurements of skinfold thicknesses and body composition parameters such as body fat%, fat mass, fat-free mass (FFM), and total body water (TBW). RESULTS: The mean (SD) age of the patient group was 55.7 (7.5) years, median pack-years was 20 (range, 0-80), and mean (SD) duration of symptoms was 152.6 (153.7) days. Median Karnofsky Performance Scale was 70 (range, 50–90). Majority of our patients (68.3%) were Stage IV followed by Stage III (31.7%). The percentage of patients with low, normal, and high body mass index (BMI) was 31.7%, 61%, and 7.3%, respectively. All components of body composition, i.e., body fat%, FFM, and TBW were significantly lower in patients compared to controls. However, the body composition in patients and controls with normal BMI was similar. The phenomenon of sarcopenia as a cause of cancer cachexia may explain these findings, whereas the combination of loss of body fat and lean body mass may lead to weight loss and reduced BMI. CONCLUSION: Our results indicate that body composition is markedly altered in Indian patients with advanced SCLC. The impact of these parameters on clinically relevant outcomes needs further evaluation.
Summer school in oncology - setting a benchmark in inspiring the future oncologists - a surgical postgraduate's perspective
KN Rao, MV Jagade
NOTICE OF RETRACTION
Retraction: Histopathological analysis of meningioma and its variants: A study of fifty cases
Autobiography of a bosom
RF Chinoy


In 1997 Sandy Chilewich, Chilewich textile designer based in New York. In her studio she impresses the world of design by his interest in color and experimentation using different textile fibers to create his signature. His creations are full of style and sophistication, modern, practical and durable. In his collection of one table, Chilewich has over 100 color combinations and weaving.?


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What is the high ground in cyberspace?
I can't even possibly get into how crazy hilarious most of the proposed cyber norms are. Usually the response is "What does the technical community know? and then a few years later, "Hmm. That didn't work." even though it was entirely predictable.
High Ground (C.F. Thomas Dullien)
High ground in cyber is high traffic sites! Facebook and Google are "unsinkable aircraft carriers" in that sense, but any site which has a huge traffic share is high ground, most of them have very low security, and there's lots of mountain ranges we don't acknowledge the existence of.
This screencap from Matt Tait's 2018 INFILTRATE keynote talks about update providers as strategic risks...
RedTube and other major porn sites have a wider reach than the New York Times ever will. Gaming sites are equally high ground. Dating sites are clearly high ground. There's what you think people do on the Internet versus what they really do, almost everywhere you look, which is why good strategists are holding themselves to the hard data they get from historical operations, and not just making up fanciful cyber norms in Tallinn.
I think it's counter-intuitive to grasp that almost everything your computer does when it reaches out is "get more code to execute". Software Updates are the obvious one, but a web page is also just code executing. PDFs are code executing. Word documents are code executing. New TF2 maps are code executing. NVidia's driver download page is exceptionally high ground.
In other words, there's nothing your computer does that is not "updates" when it comes to understanding your strategic risk.
We covered team compositions as applied to cyber operations quite heavily in our talk at T2 in Finland. To quickly summarize: Dive Tanks are going to be implants that are more "RAT"-like. These typically are entirely in userspace, and operate in the grey zones and chaotic areas of your operating system. Main tanks tend to be kernelspace or below. Obviously your implant strategy changes everything about what else you incorporate into your operations.
Win Condition
In Overwatch, one win condition is "we have a ranged DPS on the high ground, unopposed". Knowing the win conditions is important because it keeps you from wasting time and "feeding" your opponents when the battle is already lost. In cyber operations, feeding your opponents is quite simply using new exploits and implants when your current ones have already been caught. This is why a good team will immediately remove all their implants and cease operations once they even get a hint that they were discovered.
Unlike in Overwatch, the win condition in cyber is usually who is more covert than the other person. You don't have to remove your opponent from the field, you just have to make it irrelevant they are there.
Keeping your strategy as simple as possible allows for a high tempo of operations with a predictable and scalable results. Create a proper toolkit composition, execute the right tactical positioning based on your composition, and understand your win condition, and you will end up a grandmaster. :)
When our countermeasures have limits
Countermeasures are flashy. But do they work?
So the FBI took over the domain VPNFilter was using for C2. VPNFilter also used a number of Photobucket accounts for C2, which we can assume have been disabled by Photobucket.
Hmm. Why did they do so many? Do we assume that every deployed region would have the same exact list?
Here's my question: How would you build something like this that was take-down resistant? Sinan's old paper from 2008 on PINK has some of the answers. But just knowing that seizing a domain is useless should change our mindset...
As a quick note: that last sentence of the FBI affidavit is gibberish.
From what I can tell from public information, the VPNFilter implants did not have a simple public-key related access method. But they may have a secret implant they installed only in select locations which does have one. Cisco and the FBI both are citing passive collection and a few implants from VirusTotal and from one nice woman in PA. We do know the attackers have a dedicated C2 for Ukrainian targets.
My point is this: Our current quiver of responses can't remove botnets from IoT devices. The only reasonable next move is to do a larger survey of attacker implants - ideally to all of them, using the same methods the attackers did (we have to hope they didn't patch each box). This requires a policy framework that allows for DHS to go on the offense without user permission, and worldwide.
Posted by Dave Aitel at 10:42 AM No comments:
Exploits as Fundamental Metrics for Cyber Power
If you're measuring cyber power, you can measure it in a number of different ways:
Exploitation (this article!)
Implantation (our previous article)
Exfiltration and Analysis (the Satellite technique used by Turla)
Integration into other capabilities (HUMINT, for example)
Achieved Effect (so much of IL wants to look here, but it is very hard)
In a previous article on this site we built a framework around software implants as a metric for measuring sophistication in capability. (Also see this Ben Buchanan piece for Belfer.)
Since there are no parades through downtown DC of cyber combat platforms, or even announcements in Janes, non-practitioners have thus tried to tag any effort which includes "0days" as sophisticated, and in the case of export control - too sophisticated to allow to be traded in without controls. The way this typically appears is by the concept of "Bypassing Authorization" being some sort of red line.
But from a strategic standpoint we have for years tried to look at the development and expenditure of 0day as a declaration of capabilities befitting a State-level opponent. This is of course a mistake, but one part of that mistake is of thinking of all 0days as equal from an information-carrying perspective as regards capabilities.
So what then, do practitioners look for when gauging 0day for nation-state-level sophistication, if not simply the use of any 0day?
Here is my personal list:
Scalable CONOPS
Toolchain Integration
Cohesive OPSEC
Historical Effort and Timescales
Without going into each one of those in detail, I want to highlight some features that you'll see in State-level exploits. Notably, there is no red line on the "sophistication" of an exploit technique that differentiates "State" from "amateur". On the contrary, when you have enough bugs, you pick the ones that are easiest to exploit and fit best into your current CONOPS. Bugs with the complexity level of strawberry pudding recipes tend to be unreliable in the wild, even if they are perfectly good in the lab environment.
A notable exception is remote heap overflows, which for a long time were absent from public discourse. These tend to be convoluted by nature. And it's these that also typically demonstrate the hallmarks of a professional exploit that has had the time to mature properly. In particular, continuation of execution problems are solved, the exploit will back off if it detects instability in the target, the exploit will use same-path-stagers, you'll see PPS detection and avoidance, and the exploit will be isolated properly on its own infrastructure and tookit. What you're looking for is the parts of an exploit that required a significant testing effort beyond that which a commercial entity would invest in.
One particular hallmark is of course the targeting not of the newest and greatest targets, but of the older and more esoteric versions. A modern exploit that also targets SCO UnixWare, or Windows 2000, is a key tell of a sophisticated effort with a long historical tail.
There is a vast uneducated public perception that use of any 0day at all in an operation, or 4 or 5 at once, indicates a "state effort". However, the boundaries around state and military use of exploits are more often in the impressions of the toolkits they fit into than in the exploits themselves. While exploits, being the least visible parts of any operation, are sometimes the hardest to build metrics around, it's worth knowing that the very fact that 0days exist as part of a toolchain is not the needed metric for strategic analysis, nor the one practitioners in the field use.
What is an "Observable Characteristic" in Software Export Control?
Note: This is a living document partially written for those new to export controls - if you think I misunderstood something let me know and I'll address it within!
I want to highlight this Twitter thread here which goes over the 4D4 ("Intrusion Software") in a bit of detail. I feel like many people who are proponents of 4D4 complain that the rest of us, who have concerns, don't properly understand export control frameworks. I would posit there IS NO UNDERSTANDING OF EXPORT CONTROL FRAMEWORKS BY DESIGN :). But to be more specific about the concerns the following bite size bit is the most important part:
Being able to look, objectively, at a piece of hardware and say "This is a stealth coating because it has the following manufacturing characteristics" is a different category than being able to look at a piece of software and saying "This bypasses ASLR and DEP". Deep down, while radio frequencies are in general going to be a universal thing, and performance can be measured, the export control language applied to software exists in a huge fog! What does it mean to "bypass a mitigation"?
The Issues of End Use Controls
What this results in is END USE controls. In other words, instead of saying "We want to ban antennas that can emit the following level of power" we are writing controls that say "We want to ban software that CAN BE USED for the following thing". This means instead of looking at the software to control it, you end up looking at the marketing, so the controls are littered with marketing language ("Carrier Grade Speed!") and do not have functions, characteristics, or performance levels of any kind.
Sometimes you see long lists of functionalities in software controls, as if this is going to be a definitive characteristic if you add enough of them. For example, 5a1j ("Surveillance software") is essentially:
Collects network information
parses it and stores the metadata about it (aka, FTP usernames and such) into a DB
Indexes that information (why else would you have this in a DB?)
Can visualize and graph relations between users (based on the information you indexed)
Can search the DB using "selectors" ("again, why else is it in a DB?")
This is what modern breach detection software is - a product category that did not really exist when 5a1j was formulated. But each of the pieces DID exist and given a market opportunity, they got put together as you would expect. In other words - long lists of functions are not enough to make a good control (especially when all the functions you are describing are commoditized in the ELK Docker image).
Performance levels are the big differentiation typically. The general rule is that if you cannot define a performance level, you are writing a terrible regulation because it will apply broadly to a huge population you don't care about and have massive side effects, but the international community has typically just ignored this for software controls (because it is hard). Part of the difficulty here is that performance levels in the cyber domain tend to go up a lot faster than in most manufacturing areas. The other issue is that for the controls people seem to want, there are no clear metrics on performance. For example, with 5a1j there is nothing that differentiates the speeds/processing/storage that Goldman Sachs (or even a small university) would use versus a country backbone ISP.
Another thing to watch out for is the contrast between controls on "Software" and the controls on "Technology". Usually these controls go hand in hand. They'll say "We control this antenna, but also we control technology for making those antennas so you can't just sell a Powerpoint on how to make them to China either". In software, this gets a lot more difficult. Adding an exception to a technology control does not fix the software control...
What we are learning is that software export controls work best when tied to an industry Standard. This does not describe the current cyber tools regulations (4d4 or 5a1j), however. We do know that end use-based controls are not good even with very large exceptions carved into them for reasons which might require another whole paper, but which seem obvious in retrospect when looking at the regulations as "laws" which need to be applied on an objective basis.
I got flack last Sunday for Tweeting that export controls "ban" an item, which they clearly do not. However, the effect of export controls is similar - largely a slower, more painful, and silent death rather than a strict ban. I.E. export controls are less a bullet to the head and more a chronic but fatal disease for your domestic industry. This is partially because licensing has an extremely high opportunity cost on US businesses which raises the expense of doing business up and down the supply chain.
There's a common misconception among export control proponents that when used loosely (aka, automatic licensing with only reporting requirements), export control is "cost free" for businesses. Nothing could be further from the truth. Even very small companies (aka startups) are now international companies, and having to understand their risks from export control regimes can be prohibitively expensive with such broadly (and poorly) designed controls as 4d4 or 5a1j.
More strategically, no proponent of strict export control regimes wants to look at their cost and efficacy. Do they even work? Do they work at a reasonable cost? For how long do they work? Do we have a realistic mechanism for removal of controls once they become ineffective? These are all questions we should answer before we implement controls. The long term impacts are recorded at policy meetings in sarcastic anecdotes - "We don't even build <controlled system> in the US anymore, we just buy it from China - that export control did its job!"
Sadly, this means that export controls are almost certainly having the exact opposite effect from what is desired. This could probably be addressed by having a quite strict "Foreign availability" rule when designing new regulations. After all, what is the point of putting restrictions on our exports when the same or similar technology is available from non WA members? Any real stress on these issues is mysteriously missing from discussions around the cyber-tools regulations. :)
Unilateralism
The goal of the Wassenaar Arrangement and other similar agreements is of course to avoid the problem of unilateral controls, which are an obvious problem. What they don't want to hear is that the implementation differences between countries are large enough that the controls are unilateral anyway. To have truly non-unilateral controls you need one body making licensing decisions - and by design WA does not work like that.
The gaps in implementation are large enough that entire concepts appear in one country that don't exist in others - most prominently, the "Deemed Export" ruleset, which says that if I sell an Iranian an iPhone in Miami, that is the same as exporting it to Iran and I need to get a license.
Goals, both Stated and Unstated
The stated goal of export controls is avoiding technology transfer for national security purposes! (Note that "human rights issues" are not a stated goal for the WA).
The unstated goals are more complex. For example, we get a lot of intelligence value out of the quarterly reports from software companies for all of their international customers. There's probably also limited intel value in the licensing documents themselves ("Please have your Chinese customer fill out a form - in English - stating what they are using your product for!") Obviously the US likes having a database somewhere of every foreign engineer who has accessed a lithography plant, I guess. Because this stuff is unstated, it's hard to argue against in terms of ROI but I would say that for most of this you can get a ton better value by having a private conversation with the companies involved, which is a good first step towards building the kinds of relationships we always claim we want between the USG and industry. As stated previously, the costs imposed by even a "reporting only" licensing scheme are enormous.
When I talk to Immunity customers (large financials) about 5a1j, they assume that the reason the USG wants reporting on all breach detection systems sold overseas is so they can better hack them. It's hard to argue with that. This is a high reputational cost that the USG pays among industry for intelligence that is probably of little real value.
The other unstated goal is leverage. Needless to say with a complicated enough export control regime, nearly every company will eventually be in violation. Likewise, blanket export licenses can massively reduce your opportunity cost, and many countries are happy to issue them in various special cases. Again, I think from a government's perspective it is better long term to develop fruitful bilateral relationships.
A lot of these issues are especially true with "end use"-centric controls - which rely on information that the SELLER or BUILDER of the technology has no way to know ahead of time.
And the last-but-not-least unstated goal is to control the sale of 0day. Governments are mostly aligned in their desire to do this, although few of them understand what that means, what the side effects would be, or how this would really play out. But parts of the rest of their strategy (VEP) only really work when these controls go into place, so they have a strong drive to write the controls and see how things work later. It is this particular unstated but easily visible goal that I think is the largest threat towards the security industry currently.
I tried in this document to start painting the landscape as to where cyber tool export controls can go wrong. Part of my goal joining ISTAC was to stop making the mistakes we made with 5a1j and 4d4 by putting things into a bit of a more coherent policy framework. Hopefully this document will be useful to other technical and policy groups as together we find a way to navigate this tricky policy area.
Resources/notes:
To be fair, we've known a lot of these issues for a very long time, and we simply have not fixed them:
From this very good, very old book.
How to find good Cyber Security Policy Writing
There are some simple rules to follow to see if a policy piece in this space will be extra painful to read:
Does it use "unpack" and not in the context of talking about compression algorithms?
Does it liberally quote a thousand other articles, but without any real understanding of their context?
Does it have obvious misstatements about technical facts?
Does the author have no experience in Intel or industry?
Does it lean heavily on "data" which could be reasonably considered purely subjective or of shoddy quality?
The "Cyber Strategy" book reviewed on this blog is a good example of this. But the opposite is also true! Lately you have spooks coming out from the shadows to write policy pieces, and the heads of various companies have spent time to do so as well. There are policy teams (both in the US and elsewhere) that have spent time to learn the technology!
You can see the examples of some of this work here, on the Cyber Defense Review. I haven't even read it yet, but I know a journal that has an article from Bryson Bort or Shawn Henry is going to have worthwhile perspectives.
For what it's worth pure legal writing can also have interesting tidbits, like this piece from Mike Schmitt - a leading proponent of International Law's role in this space. Usually the value in a pure policy or legal piece occurs when they acknowledge the current issues of the system instead of optimistically whitewashing past efforts.
Mike got pushback (largely from the US) when he and others proposed a "violation of sovereignty" standard. This is because it doesn't work in operational practice. But he still likes the idea because it makes LEGAL decisions quite clear. :)
Book Review: Cyber Strategy by Valeriano, Jensen, Maness
I give this book 0 stars out of 5. To be fair, I give the entire genre of books like this 0 stars of out 5. This is the worst kind of cyber policy writing. They've concocted some sort of database of information, culled mostly from news reports from what I can tell. Then they do some basic statistical analysis on it and somehow flesh that out into an entire book by pulling random quotes from other terrible parts of the cyber policy pantheon.
For example, here they both misspell "Regin" and then attribute it to the United States (for no reason).
In general the editing of the book itself was spotty - but this is something that concerns me more about the original dataset, which appears to attribute various efforts to various countries in ways I'm 90% sure are not the correct ones. If your data is wrong, then eventually your conclusions are essentially random, and your policy proscriptions are base opinion.
For example, the above simplistic argument against the use of exploits during cyber operations is one that you often see in policy-world but which nobody who has ever been involved in an operation takes seriously. Also, "Tomahawk" is a proper freakin' noun! I don't think anyone but me has even read this book, to be honest.
But to reiterate: IT IS HUGELY RARE TO SEE AN ADVERSARY USE YOUR ATTACKS AGAINST YOU. Everyone in their head is going to cite ETERNALBLUE but that was used only once the patch was out, as far as we know. The opsec reason for this is that USING a bug you caught from someone TELLS them you caught them! Likewise every group has their own concept of operations and other people's tools don't always fit yours.
I mean it was fascinating you didn't see the FLAME exploit turned around - it was reusable - but everyone just assumed it only fit in the FLAME toolchain. It's almost easier to find new bugs than do the research necessary to re-use old bugs.
Books like this always try to back up their arguments with copious quotes to other equally bad books:
On the face of it, Libicki is clearly wrong. But it's possible his quote was used out of context! I'll never know because the Kindle edition of that book is $66. I only have so much budget to spend reading this kind of thing.
Ok so in summary: Don't buy or read this book or books like it. We need NEW thoughts in cyber policy and this is not how you get them.
The Gravity Well
Every particle, even dark matter, can bend spacetime.
Part of the reason policymakers are often confused about resistance to many of the items on their wishlist in the cyber domain is that they've already achieved the impossible: Copyright!
If you think about how amazing it is that nowhere on the Internet can you go get Avengers: Infinity Wars for free then it leads you to also ponder the vast array of international agreements, corporate pressure, and technological filtering that makes this possible. Nothing could be more inimical to the nature of the cyber domain than copyright. And yet: governments and industry have made it real.
To paraphrase Bruce, "Bits being copied is like water being wet" - and yet we have somehow made it so in cyberspace all waterfalls all run upwards, to make it possible to remove a single picture of Star Wars from the Internet. Why then, policy people ask, can we not just erase all information about computer exploitation and harmful code from the Internet? How much harder can it be?
Allan Friedman once said to me that he looks at his work at the Commerce Dept as correcting market failures. But the real market distortion is like a massive gravity well all around us. Copyright is what makes it so that a firewall vendor can hide the true nature of their weaknesses by making it illegal to write up a "performance comparisons" or "reverse engineer" their protocols. So many of the systemic vulnerabilities come from a system of our own making. And when we try to address them at the edges by regulating IOT device security or going on and on about vulnerability disclosure or revising the CFAA to add just one more exception it's like trying to chew away a piece of a black hole.
This post is a call for legislation more than my other posts are: We need to address the root of the problem. That means changing what an end-user-license can restrict. It is not just that everyone should be able to write about and patch the code running on their devices, but that we need to acknowledge that copyright has distorted who can even understand the depths of the risks we all face.
Links/Resources:
We're the Saudi Arabia of Copyright
The Vivid Dream
The Dark Gulf between the FBI and the Technical Community
https://oig.justice.gov/reports/2018/o1803.pdf
I think it's important that we acknowledge and address that each side in the encryption debate does not believe so much that the other side is wrong, but that they are lying liers who will stop at nothing to get their way.
In particular, the contrast between Susan Hennessey/Stewart Baker's take on the FBI documents that got released about the iPhone unlocking debacle and the Risky.biz (and technical community) take are quite telling.
Risky.Biz, when speaking to their audience, essentially assumed that the FBI, while not misleading the court in words, knew that it could have reached out to the contractor base for potential solutions to unlocking Farook's iPhone, and that not doing so was highly dishonest when presenting that there were "no other solutions" other than the nuclear option of forcing Apple to build decryption capability for the FBI.
Susan Hennessey (and others in the national security space) take the FBI at their word: No misleading statements went to the court and "not having the capability in our hands right now" is enough to move forward with the legal case. "Perhaps there is some stovepiping issue but nothing even slightly duplicitous" we hear from that side. "If you only read the whole report, then you'll see!"
Here's what you see when you read the whole report: There are fig leaves of truth covering the massively weird idea that in the highest profile case in the country the FBI didn't ask the head of the ROU to have a contractor maybe look into the problem. It's literally unbelievable. "Oh, I thought we could only work on classified issues" is what's in the report, as if these teams don't have each other's cell phone numbers.
This is a damning two paragraphs in the report and it validates what the technical community thinks of the FBI.
You see the same dynamic with the Ray Ozzie cryptographic proposal. The national security teams that believe the technical community isn't being straightforward about how possible it is to build secure key escrow when clearly public key encryption exists don't believe they are wrong, they simply believe the technical community knows perfectly well how to build PKI and just won't for political reasons.
Matt Green points out the the issue is not "Can we build PKI?" but "Do we want to have companies forced to build PKI and assume the essentially unbounded liability of maintaining it?". Keep in mind, tech people have watched every PKI system they've built over the past 20 years fail in some way and companies have no desire to hold or control any data beyond that which gets them ad revenue.
Of course, Stewart Baker would then say "Unless the Chinese want it, in which case everyone seems to RUSH to find a solution". The technical community, in turn, says "But the USG is supposed to be our friends."
I'm not saying the technical community is right about these issues, although they clearly are: The FBI lied in all but words, and the "going dark" debate is insane when we can identify serial killers from their great grandparent's DNA.
But even if the FBI was right, we have to look strategically at what it means in every dimension of this debate when the US technical community and the FBI both don't trust each other even a tiny bit. Without solving this, how can we move forward on any part of the massive problems we face? How do you have public private partnerships without trust? How do you build cyber war norms? Infragard can only go so far...
What is an "Observable Characteristic" in Software...
Book Review: Cyber Strategy by Valeriano, Jensen, ...
The Dark Gulf between the FBI and the Technical Co...

redpajama_set_name: RedPajamaCommonCrawl


The perfumer who takes Grenouille on as an apprentice; Chénier's employer. Baldini is very concerned with upholding and maintaining order, both in the larger world and in the smaller world of creating perfumes in his workshop. He's described as kind, although often to his own detriment, but also treats Grenouille as little more than a fountain of brilliant ideas for perfumes. He uses Grenouille to save himself from the has-been perfumer he'd become and rises to European fame with Grenouille's formulas, though Grenouille isn't allowed to take credit for his work. When Baldini exhausts his uses for Grenouille, he grants Grenouille journeyman's papers and sends him on his way. Baldini dies that night when his business, which sits on a bridge crossing the Seine, collapses into the river.
The timeline below shows where the character Giuseppe Baldini appears in Perfume. The colored dots and icons indicate which themes are associated with that appearance.
Brock, Zoë. "Perfume Characters: Giuseppe Baldini." LitCharts. LitCharts LLC, 23 May 2017. Web. 20 Apr 2019.
Brock, Zoë. "Perfume Characters: Giuseppe Baldini." LitCharts LLC, May 23, 2017. Retrieved April 20, 2019. https://www.litcharts.com/lit/perfume/characters/giuseppe-baldini.


text:
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SAN RAFAEL, Calif., Sept. 21 /PRNewswire-FirstCall/ -- Autodesk, Inc. (NASDAQ: ADSK), a world leader in 2D and 3D design and engineering technologies, announced that certification for Autodesk 3ds Max Design software is now available in North America. Autodesk 3ds Max Design is a comprehensive 3D modeling, animation, and rendering solution that offers integrated workflows with the AutoCAD and Revit software families of products. Certification is currently available for AutoCAD, AutoCAD Architecture, AutoCAD Civil 3D, Autodesk Inventor and Revit Architecture software in 20 countries.
"Autodesk certifications are a reliable validation of an individual's skills and knowledge that demonstrate expertise in a specific area," said Paul Mailhot, senior director of Autodesk Learning. "More than just enhancing an individual's credibility, certification can lead to accelerated professional development and serve as a differentiator that helps people to stand out from the crowd. These differentiators are important in any job market, but never more so than during a down economy."
Certification can be achieved only after passing a rigorous Autodesk certification exam, or series of exams. For more information about how to become certified in Autodesk software, contact your local certification center or visit www.autodesk.com/be-remarkable.
Attendees of Autodesk University 2009 will be able to take Autodesk Certification exams for free during the event. To hear from past Autodesk University attendees as to why they became certified, watch the " Why Certify" video on YouTube.
Autodesk, Inc. is a world leader in 2D and 3D design software for the manufacturing, building and construction, and media and entertainment markets. Since its introduction of AutoCAD software in 1982, Autodesk has developed the broadest portfolio of state-of-the-art Digital Prototyping solutions to help customers experience their ideas before they are real. Fortune 1000 companies rely on Autodesk for the tools to visualize, simulate and analyze real-world performance early in the design process to save time and money, enhance quality and foster innovation. For additional information about Autodesk, visit www.autodesk.com.
Autodesk, AutoCAD, Autodesk Inventor, Civil 3D, Inventor, Revit, and 3ds Max Design are registered trademarks or trademarks of Autodesk, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. All other brand names, product names, or trademarks belong to their respective holders. Autodesk reserves the right to alter product offerings and specifications at any time without notice, and is not responsible for typographical or graphical errors that may appear in this document.
ITI presents GoToINVENTOR at Autodesk University 2020
Tripp Burd, Manager
MarkForged, Inc
C3D Labs in 2020
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Jonah Myerberg, CTO
Dr. Royston Jones, Managing Director
Ken Welch, Senior Vice President
Dr. Jason Jones, CEO
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Geoff Foulds, Director of Business Development
Origin International
Ed Walsh, VP Global Sales
Sigmetrix
Iana Aranda, Director, Engineering Global Development Programs
NVIDIA GTC October 2020 Keynote Part 8: Breakthroughs in Autonomous Machine Development
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Product Design Engineer - Softgoods for Apple Inc at Cupertino, California
Service Software Expert-CATIA & CAA for Dassault Systemes at Shanghai, China
RAPID + TCT 2020 Postponed to 2021 at Anaheim Convention Center Anaheim CA - Apr 2, 2021
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Abstract This paper examines the problem of achieving efficient inter-organizational collaboration during emergency response. The authors interviewed 11 representatives from Norwegian emergency agencies and supporting organizations about a hypothetical scenario involving a large-scale chemical incident. The interviews resulted in the identification and categorization of more than 45 actors that would be involved in the response effort, clarification of the individual capabilities and knowledge those actors would possess, and descriptions of how they would interact and communicate with each other. The results illustrate the complexity and necessity of achieving inter-organizational collaboration by showing how capabilities and knowledge are distributed and communicated across different actors, and suggest that such communications are mainly verbal. Based on this, the paper discusses challenges and opportunities for improving inter-organizational collaboration in the future.


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Five meals delivered once a week to qualifying seniors and disabled.
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(Minghui.org) Surrounded by high walls topped with barbed wire and secured with an iron gate, the notorious Xingtai Brainwashing Centre lies roughly 330 yards east of the Xingtai Epilepsy Hospital on Donghuan Road, which leads into Jing'an Village. Over the last decade, the brainwashing centre has jailed and tortured many Falun Gong practitioners. Some were taken to the centre directly by local police, and others were transferred from forced labour camps and prisons.
The brainwashing centre was established by the local 6-10 Office, a Party-based security organisation that pervades all levels of government in China with the sole purpose of persecuting Falun Gong practitioners. The goal of the brainwashing centre is to force Falun Gong practitioners to renounce their belief and "transform", by whatever means it deems necessary. Chinese authorities then use these "transformed" people to spy on, and even torture, other practitioners..
Mr Zhang Guangcai and Ms Zhang Xingfang, a married couple, operated a dental clinic in Shahe City, Hebei Province. They were detained at the Xingtai Brainwashing Centre twice in 2004.
The first time was eight days after officers from the Shahe City Police Department searched their clinic and broke into their home with a crowbar on July 6th, 2004.
Mr Zhang was held there for three months. He was starved, subjected to sleep deprivation, and allowed only restricted use of the toilet.
Local police returned to the clinic on December 24th, 2004, and arrested the couple again. Mr and Mrs Zhang were taken directly to the brainwashing centre this time.
Mr Zhang went on a hunger strike to protest the torture. Deputy director of the brainwashing centre Qiu Youlin retaliated with painful force-feeding procedures that damaged Mr Zhang's windpipe and oesophagus.
Mr Zhang's health quickly deteriorated. He struggled to breathe, was in constant pain, coughed constantly, and experienced feelings of suffocation – even while he slept.
Mr Zhang was taken to a hospital, where doctors found that his lungs were severely damaged. The brainwashing centre then transferred Mr Zhang back to the Shahe City Police Department.
The police department then tried to transfer Mr Zhang back to the Handan City Forced Labour Camp, but the camp would not take him because of his poor health. The police department reluctantly released Mr Zhang.
When Ms Wen Cai went to the Xingtai Brainwashing Centre in March 2004 to seek the release of her mother, she was also detained.
The brainwashing centre staff tried to force Ms Wen to renounce her belief in Falun Gong by beating her and force-feeding her with drugs. Her family was made to pay 3,000 Yuan (GBP £335) for Ms Cai's "legal education fee" and release.
She was still breastfeeding at the time. Her one-year-old daughter had to switch to formula due to her detention.
A group of around 12 people from the Shiliting Township Government, including several police officers, ransacked Ms Hao Bianyun's house on October 27th, 2004.
The group took 230 yuan (GBP £25) her family had saved to buy coal for heat in the winter.
One officer covered Ms Hao's mouth and punched her while two others carried her outside into a waiting police car.
Her 5-year-old daughter cried "Mama," and chased them outside. An officer grabbed the child and threw her into the police car, too.
Ms Hao was detained in the brainwashing centre for two months, during which time she was injected with unknown drugs several times. As a result she suffered chest pains, hallucinations, and sometimes fell unconscious.
After she was released, Ms Hao was mentally disordered. Her hallucinations worsened, and she gradually lost the ability to take care of herself. She died on March 25th, 2010.


The peak of the annual Geminid meteor shower is tonight, and the National Weather Service's forecast is for clear skies across the state that should make for easy viewing.
University of Missouri Astronomy Professor Angela Speck says the shower will be very visible in Missouri.
Speck says the peak will be around 2:00, Friday morning.
The shower is made up of pieces of dust left by the extinct comet 3200 Phaethon burning up in the Earth's atmosphere. Speck says nothing of the debris is large enough to reach the ground and pose a threat.
There could also be a bonus, second meteor shower.
Speck says the best way to see the shower is to use the naked eye, and get out-of-town and away from city lights. Those who can't get out can find various websites that will also offer views of the shower.


Here at Wildflower, we seriously love linen. In our perfect world, just about everything in the home would be made from or covered in linen: sheets and cases, duvet covers, towels, napkins, curtains, bed frames, couches - the fabric seamlessly glides its way into any look.
Of course, there's more to love about linen than its sumptuous simplicity. Traditionally made from the fibers of the flax plant, (or Linum Usitatissimum - where the word "linen" comes from) creating linen involves a labor-intensive process that produces the quality product that we consistently covet.
In the midst of the heatwave currently plaguing the country, there's nothing we can recommend more than linen bedding. Its naturally cooling and moisture wicking properties have been embraced and celebrated for centuries. Egyptian mummies were wrapped in linen because it was an obvious display of wealth; the archival nature of the fabric explains why it's been used on painters' canvases for ages. It resists dirt and stains, repels lint and moths. Kings of old were robed in purple linen as a symbol of their superior status.
Of course we're not alone in all of this infatuation. This gorgeous video from Benoit Millot does a wonderful job explaining the process of creating linen - and why it's such a truly "noble fabric".
We pride ourselves on our fantastic selection of linen bedding. Come into the store or browse online; we have a good feeling you'll fall in love just as hard as we have.


Thank you all so much for an amazing morning at Leeds Beckett University for the 2018 Year 4 Leeds City Final! The atmosphere was electric!
Please find attached the certificate results sheet as promised, to help you add the children's names and skipping skills to the certificates we presented.
Congratulations again to Kippax North on winning the event and being crowned 2018 Year 4 Leeds City champions!
We would like to thank you all for your commitment to our project throughout the last few months, and all the time and effort you have put in to preparing the children for the events. We know how hard you work and are so grateful for your dedication and enthusiasm.
Thank you again to ITN Mark for sponsoring the whole project and providing the participation certificates and winners trophy.
We'll be back to do it all again next year, and will be in touch next week with all the details.


Alban Pernet photographer, author of the talented photo story from the Skate and Cut exhibition has graciously consented to our interview.
My favorite Opinel knife : N°08 because it was my first Opinel knife. It was a gift from my parents at the age of 8… with a leather link to wear it around the neck. I was using it to be like Robinson Crusoe : to prune branches, build cabins, make bows… In recent years, I passed it on to one of my sons to do the same.
I have been taking photos since the age of 15, shooting sports I practise : ski, snowboard and mountain bike. I wanted to do it as pictures from magazines.
I'm also drawing since the age of 12, but my parents used to say « it's not a real job ». So I've passed my high school diploma with an option in science. Then, I pursued my studies in mechanical engineering, at the University Institute of Technology of Annecy.
I've worked one year in a factory and then I've chosen an outdoor activity : ski lifts technician in summer and ski patroller on winter. Since 2005, I started as independent photographer, while maintaining my job on winter until 2010, when the workload became too high.
Since 2010, I alternate between photography and graphic design. It allows me to use entirely the design value chain (shooting, printing, website, logo…). But since four years, I'm glad that photography got the drop.
What are your favorite subjects to photograph ?
What was your approach on the sculpture of the Opinel knife, and more generally on the skatepark ?
For the skatepark, I stepped in as a volunteer. I did it because of the passion I have for skateboard and my friendship with Jérémy Durand (the project proponent). I wanted to take part in something great for us, but also for children and next generations.
I didn't have time to be a full-time volunteer on the construction site and I though that a whole photo essay will highlight all the work done by volunteers. The participatory construction with it's collaborative aspect, that's the kind of project that seems important to me to promote today. I also found that the human and intergenerational part is interesting, with a project witch begins with the field of skateboard and ends up by rallying all the population.
Furthermore, this skatepark is an outstanding venue, sportingly and artistically. I've choosen to take pictures of the sculpture to make realize that the knife provides volume to the whole, to raise awareness of proportions in front of the elements, especially in this alpine landscape.
Where you surprised by this idea of the giant Opinel Knife ? What does it add according to you ?
It's a great idea because Saint-Jean-de-Maurienne is a town marked by Opinel. It's really nice that the brand agreed to take part in this initiative. It brings visibility for the goals, a greater influence. Without this brand image, it would have been difficult to gather local community and enterprises. In addition, this Opinel knife is an integral part of a volcano, it's a unique component of the skatepark ! That makes it more than a decorative object. It draws the bystanders and skater's attention as well.
Today, many people come to see this giant knife. This helps to expand the impact of the project, giving a tourist dimension to the site. Moreover, it should be noted that the construction goes on and the Skate and Create association is still seeking for volunteers and partners !
What does Opinel means for you, who live in Albiez ?
As a child, I was spending lot of weekends and holidays in Albiez with my family, where my parents had an apartment. I've developed a natural commitment for this area… I've caught a bit of the bug ! Born in Lyon, Albiez have been a lifestyle choice for me.
The recent Opinel place, in the village of Albiez, is the first thing that embodies the origins of Opinel knife here. In 2010, I've worked with the city council, on the communication around the development of this space. The aim was to breathe life in the center creating a new place offering various services (a day care, a school, a tourist office, shops…) and to highlight this essential patrimonial aspect.
The last word : if you had to define the Opinel Knife in one word ?
I've got a few ! Simple, efficient and sustainable… in tune with the times for over 100 years !!! In the modern world, in this era of planned obsolescence, the Opinel knife represents the simplicity and the strength of the tradition.
The Skate and Cut exhibition takes place in the new temporary exhibition gallery in the Opinel Museum.
Opening hours: open daily from 9 a.m. to 6 p.m. except on Sunday and public holiday.
From December, 3, 2018 until March, 30, 2019. Free entrance.
Link to facebook event : click here !


For most people the cost of their monthly mortgage payment is their biggest expense. It is the payment that allows them to keep a roof over the head of their family.
It can very often also be their biggest worry during periods where they are unable to work through a short term illness or injury, or during periods of unemployment.
This is where Mortgage Payment Protection Insurance comes in. It is designed to pay a monthly figure that can cover the cost of your mortgage payment plus other associated costs such as insurances. The payment can continue for 12 months or your return to work, if earlier. Some providers may pay benefits for up to 24 months.


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Zenith Award
Malpractice Damage Cap Law
Maryland Patients' Access to Quality Health Care Act of 2004
In an emergency session of the legislature, the Maryland Patients' Access to Quality Health Care Act of 2004 was passed over Governor Ehrlich's veto. The unofficial language of this paradoxically titled bill can found here.
This bill criminally froze the amount of compensation a jury can award for pain and suffering damages at $650,000 until December 25, 2008 (it increased $15,000 per year) and reduces the cap on damages in death cases from $1.6 million to $812,500. This cap applies only to medical malpractice cases. You can see a chart of how the cap in Maryland now works here.
The bill also requires doctors who testify in malpractice suits to be familiar with the specialty of the doctor they testify against, as well as encourages settlement of malpractice cases by mediation, and creates a people's counsel to represent citizens before the Maryland Insurance Administration.
Medical Mutual Liability Insurance Society of Maryland ("Med Mutual") insures most Maryland doctors. Ten years ago, they manufactured this crisis in a year where they paid out a little more than they usually do. It is suspected by us and others that they settled a lot of cases that might have settled later to create more payouts that year to gin up a crisis, one that resolved in less than a year before this new law took real effect.
What is the foundation for this? Despite clamoring about the need for double-digit rate increases in premiums, Medical Mutual declared double-digit dividend for doctors who renewed in 2003 and 2004, the key years in the "crisis".
Fast forward to 2014. Things are still rolling along for Med Mutual and the other malpractice insurers in Maryland. Med Mutual just announced in January, 2014, a special dividend of 25% for its policyholders for 2014. This is on top of a renewal dividend of 11% they already got. In the last 4 years, doctors have gotten back $269 million in rebates.
Why do it this way? So they can complain their rates are so high before they get their refunds. I have to give these doctors credit. They are smart, they are disciplined and they know how to do public relations.
The only victims are the people that the small minority of doctors harm with their carelessness.
Instead of lying low and trying to make everyone forget how they tricked Marylanders in 2004, doctors are now pushing for a statewide "no fault" Maryland Birth Injury Fund. This proposal would not be paid by you, dear taxpayer, but instead would be funded by hospitals, OB/GYNs, and malpractice carriers. This sounds great, right? Except the plan is to pay children a small fraction of what a jury of Maryland residents would give them for the lifelong injuries suffered as a result of a doctors not doing the job they are charged to do: be reasonable when bringing our children into the world.
Maryland Medical Malpractice: what to expect in a health care negligence claim in our state
Maryland Law Update (information on latest Maryland legal opinions)
What Is a Malpractice Case Now Worth?


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Mo Ibrahim Foundation| What They Do, Scholarships, Jobs
Scholarships Study Abroad
Mo Ibrahim Foundation|About, Scholarships_ Have you been hearing about the Mo Ibrahim Foundation and you wish to know more about them? Or do you aspire to secure a slot in the scholarship scheme by the foundation. Worry no more as this article describes in full, everything you need to know about Mo Ibrahim Foundation and their opportunities available for you.
About Mo Ibrahim Foundation, What Do They Offer?
The Mo Ibrahim Foundation (MIF) is a foundation in Africa , it was founded in the year 2006 with a single focus which is the critical and vital importance of governance and leadership as regards to the African region. It is the foundation's belief that governance and leadership solely lies at the heart of any tangible, solid and shared improvement in the quality and durability of life for African citizens. LEADERSHIP AND GOVERNANCE IN AFRICA: be it known that Leadership is basically about making choices, stating priorities, and assuming risky tasks. While Governance is more of a proper documentation and effective implemention of these leadership choices. This foundation in Africa, it has brought considerable progress over the last decade.
Do Mo Ibrahim Foundation provide scholarships?
The answer is yes! The Center of African Studies provides 1 PhD scholarship slot to students who are African nationals. This scholarship is awarded as part of the theme "Governance for Development" in Africa Initiative which is to be funded by the Mo Ibrahim Foundation. Applications are now invited for you to apply to the PhD studentship programs which has focus on the areas of state capacities, in the area of governance as well as in the area of bureaucracy for development. The Mo Ibrahim Foundation (MIF) which is a foundation based in Africa provides this opportunity for PhD level studies in London, as earlier stated, the program was founded in the year 2006 with a single focus which is the critical and vital importance of governance and leadership as regards to the African region. It is the foundation's belief that governance and leadership solely lies at the heart of any tangible, solid and shared improvement in the quality and durability of life for African citizens. The key word LEADERSHIP AND GOVERNANCE IN AFRICA will be the focus in this program. Be it known that Leadership is basically about making choices, stating priorities, and assuming risky tasks. While Governance is more of a proper documentation and effective implemention of these leadership choices. This foundation in Africa, it has brought considerable progress over the last decade. Interestingly, the program has a lot more project and offer in stock.This may contain projects designed to have a deeper understanding about public sector governance capabilities, about the issue of political settlements, about state business relations and the governance and leadership of state owned enterprises. It may also include the governance of development policy design as well as the implementation of policy, and so on. But applications for this program are expected to have a focus on the public sector or state sector as well as civil service, it may also focus on governance plus development.
Summary of Details About Mo Ibrahim Foundation Scholarship
Program Type: Available for Postgraduate level study Host Organization: Mo Ibrahim Foundation Country to study: Students are to study in the United Kingdom School to study: University of London Course to study: Not specified State of Origin: N/A Gender: both Men and Women Application Deadline: March 31, 2023
Requirements for Applications into Mo Ibrahim Foundation GDAI PhD Scholarship
* Persons interested are expected to first secure an unconditional provision for their PhD level study at SOAS University sited in London, the admission must be in the eligible departments. * Candidates Must have also obtained related bachelor and master's degree certs from a recognized university/institution of higher learning. * Applicants are expected to Demonstrate excellent educational qualities and leadership abilities.
Documents Required for Application
* Provide a copy of the unconditional provision/offer that you received from the SOAS admissions office * Provide your CV (make sure to include your email address) * Submit a 2 pages max statement discussing your knowledge and interest in the governance-related issues * Submit Your research proposal (the same way as you sent it to the SOAS Admissions Office) * Provide one academic reference ( you are to send in the reference directly by your referee to ab17@soas.ac.uk )
Are you Interested and eligible? Go to the Mo Ibrahim Foundation online forms at docs.google.com to apply. In order to be deemed fit for this funding, Provide a copy of the unconditional provision/offer that you received from the SOAS admissions office. Provide your CV (make sure to include your email address). Submit a 2 pages max statement discussing your knowledge and interest in the governance-related issues. Submit Your research proposal (the same way as you sent it to the SOAS Admissions Office) also Provide one academic reference. * Once the place is secured, the candidates can apply for this scholarship program. Candidates will be assessed and graded on the basis of their academic merit by a panel which is made up of SOAS academic members. The assessment of every online application will depend on the information provided in your scholarship application. Bear in mind that By the 31st of March you are expected to have an Unconditional offer of admission for the selected PhD course in order to be eligible for funding. It is also Crucial to note that it takes up to 8 weeks to get an offer of admission for a PhD level study, therefore be advised to apply for the offer for at least or before the end of January 2023.
What We Have to Say About The Mo Ibrahim Foundation Scholarships
This is a very nice opportunity to utilize, make sure to apply in time. The assessment of every online application will depend on the information provided in your scholarship application. Bear in mind that By the 31st of March you are expected to have an Unconditional offer of admission for the selected PhD course in order to be eligible for funding. It is also Crucial to note that it takes up to 8 weeks to get an offer of admission for a PhD level study, therefore be advised to apply for the offer for at least or before the end of January 2023. Kindly follow studyabr.com for updates
Mo Ibrahim Foundation Jobs
The Mo Ibrahim Foundation is seeking to employ experienced and outstanding social media specialist to join its communications team. The successful candidate will head and implement creative social media strategies plus campaigns around the Foundation's key initiatives, and to take care of the day-to-day activities across MIF's social media platforms. The job description is initially remote with the Foundation's office sited in London, therefore applicants should have the right to reside and work in the UK. To know if the job is still available, please visit Mo Ibrahim Jobs
* https://mo.ibrahim.foundation/ * https://www.scholarshipair.com/scholarships/mo-ibrahim-foundation-2023-gdai-phd-scholarship-for-africans-london * https://mo.ibrahim.foundation/fellowships/scholarshipshttps://mo.ibrahim.foundation/news/2021/job-opportunity-social-media-lead
🔖Tags: African opportunities Mo Ibrahim Foundation|About Scholarship opportunities Scholarships
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When is Credit on Input Service to be reversed?
If the payment not made within 3 months from the date of Invoice, then Credit needs to be reversed.
However, if later payment made, then again credit can be taken.
Credit need not be reversed in case service tax paid by service receiver under reverse charge/partial reverse charge.
How is Amount paid under Rule 4?
Due date is same as that of normal service tax challan payment.
If amount not paid, it will be deemed that Cenvat credit is wrongly taken and it shall be recovered as per Rule 14.


The Essence Fest After Party looked like it was a blast. Check out some of the good times that were had. The Official After Party of Essence Fest was sponsored by Crown Royal. Some of the partygoers were actor Tristan Wilds, comedian/actress Loni Love, singer Ro James, Legendary Damon and singer Luke James.
Make sure you check out Crown Royal Northern Harvest Rye. This variant combines the distinctive flavor of Canadian rye grain with the unmistakable smoothness of Crown Royal for a truly exceptional Canadian whisky. Crown Royal Northern Harvest Rye is the first Canadian Whisky to earn World Whisky of the Year in Jim Murray's Annual Whisky Bible 2016.
Print article This entry was posted by Art Eddy III on July 11, 2018 at 1:48 pm, and is filed under Lifestyle. Follow any responses to this post through RSS 2.0. Both comments and pings are currently closed.