This seminar took place in November 2015 and is therefore now closed.
WAY Investment Services and First Care Southwest would like to invite financial advisers to their joint Continuing Healthcare & IHT planning seminar in Truro on Tuesday 17 November 2015.
The Continuing Healthcare session will be presented by Jeanette Roberts of First Care Southwest Limited, and the IHT planning session will be run by Rob Owen of WAY Investment Services.
Location: Alverton Hotel, Tregolis Rd, Truro TR1 1ZQ.
Timings: 09.30 coffee and registration, 10.00 start, 12 noon - Q&As and finish.
Jeanette is a solicitor (Non-Practicing) of First Care Southwest Limited and will bring us up to date on NHS Continuing Healthcare (CHC) funding and The Care Act. She is an Advocate for the elderly and has lectured at the Law Society. She is a regular contributor to the Society of Later Life Advisers (SOLLA) discussion groups.
What is NHS Continuing Healthcare (CHC).
History of CHC and its relevance now and post the Care Act.
Coughlan – Quantity & Quality Test.
Guidance on the 4 Keys indicators for CHC funding.
Rob is Regional Sales Manager at WAY Investment Services, and will discuss the benefits of Flexible Reversionary Trusts (FRTs) and how they can help with IHT planning and family wealth preservation.
Practical examples of estate planning and family wealth preservation using FRTs.
The structure of FRTs and their use as an alternative to Discounted Gift Trusts and Loan Trusts.
Ideas to ensure clients don't delay IHT planning for fear of unknown future life events including later life care needs.
Changes to the IHT process that may be required following the July 2015 Budget.


I wore this small piece of technology on my stomach for three days this week. And, yes, I took a picture to show you.
More than seven years ago, I was diagnosed with Type 1 diabetes, meaning I'm dependent on insulin to maintain "normal" blood sugar levels. I take one kind of insulin each night and I take another kind with each meal. I check my blood sugar with a little finger stick at least six times day.
And most days it doesn't bother me.
But, lately, this chronic condition of mine has been making me crazy. My blood sugar levels have been up and down, often without obvious explanation. Not only is this frustrating to my perfectionist tendencies, but it also makes me feel lethargic and irritable when it's high and shaky and absent-minded when it's low. And the fluctuation leaves me with a headache.
So I went to my new-to-me doctor for help. And help he was. We had an informative, encouraging conversation about how quick-acting insulin peaks, how fat slows the digestion of food, my dosage of long-acting insulin and about many other variables, including physical stress from the fluctuating numbers and how my body protects itself during the lows.
It was information overload, in a good way.
Part of his help was gathering information in that little plastic contraption. With just a tiny, tiny catheter in my stomach, it automatically monitored my blood sugar a few times each hour I was wearing it. This means while I was exercise, while I was parenting my small, busy children, while I was eating and while I was sleeping. All of that information will be downloaded to my nurse's computer and the information overload will continue. In a good way.
There will be a line graph of what my blood sugar did over those three days. We'll be able to see if there are trends at certain times of the day, even though I already know my blood sugar tends to run high in the afternoons. We'll be able to make adjustments in insulin doses, possibly the amount but more likely the timing of the injections. We'll be able to talk more.
And maybe, hopefully, I'll get back to having diabetes management be just part of my life and not overshadow everything I'm trying to do as a wife, momma, friend, daughter, aunt and sister. I'd prefer to be consumed by these other parts of who I am.
The me-inspired picture. :) Well, not entirely. I can't wait to hear how this helps and what can be done in the future to help stabilize your blood sugar.


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Home » World » Ladakh UT involves Chinese territory, Wang told Jaishankar
Ladakh UT involves Chinese territory, Wang told Jaishankar
Wang said China was concerned about the current Kashmir situation and the escalating India-Pakistan conflict.
By AuthorIANS | Published: 13th Aug 2019 6:13 pm
File Photo: Chinese Foreign Minister Wang Yi
Beijing: China, whose forces regularly intrude into Ladakh, stuck to its opposition to the creation of Ladakh Union Territory, with Chinese Foreign Minister Wang Yi telling his Indian counterpart S. Jaishankar that the move "involves Chinese territory".
Wang told Jaishankar that the Indian government's announcement of the establishment of the Ladakh Union Territory, "which involves Chinese territory, has posed a challenge to China's sovereignty and violated the two countries' agreement on maintaining peace and stability in the border region".
Jaishankar has conveyed to Wang that the creation of Ladakh has "no implication for either the external boundaries of India or the Line of Actual Control (LAC) with China" and that "India was not raising any additional territorial claims".
"India's move is neither valid to China nor will change the status quo – that China exercises sovereignty and administrative jurisdiction over the territories involved", the Global Times quoted Wang as saying, quoting a Chinese Foreign Ministry statement.
Wang said China was concerned about the current Kashmir situation and the escalating India-Pakistan conflict. "India's move to end the constitutional status of Jammu Kashmir will change the status quo of the disputed area and result in regional tensions," he added.
China believes any unilateral action that may complicate the situation in Kashmir should not be taken, Wang said at the meeting.
The paper noted that though Jaishankar's visit was predetermined, "many observers called it an 'emergency visit' because it came after Pakistan Foreign Minister Shah Mahmood Qureshi made an emergency visit to China Friday evening and briefed Wang on Pakistan's views, position and countermeasures on Kashmir".
The state-run daily quoted "Chinese observers" to say that "India's move was reckless. They noted that Kashmir is a powderkeg filled with territorial disputes and ethnic and regional conflicts. They added that the situation is not India's 'internal affairs'."
"New Delhi's unilateral decision will bite India back in the future," warned Chinese experts.
"Scraping (sic) Kashmir's special status is just a carnival of nationalism. If the Indian government continues hyping this mood, it will become more and more radical and will surely backfire," it said, quoting Zhao Gancheng, Director of the Center for Asia-Pacific Studies at the Shanghai Institute for International Studies.
"A radical and nationalistic India won't be embraced by Asia," Zhao told the Global Times.
"India's rise needs a peaceful neighborhood, and provoking Pakistan is not a good way to solve it," Zhao said.

redpajama_set_name: RedPajamaCommonCrawl


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From the Street — Breathe. Burn. Bee.
To prepare ourselves for the retreat, we were asked to forego showers for five days before we headed out on Thursday afternoon. Since I needed to at least start a week in court on the clean side, I took my last shower Monday morning.
By thursday, I was itchy and uncomfortable. I hadn't trimmed my already full beard for a month, and it was looking pretty scraggly. I have a tendency toward dandruff so I was self-conscious about checking my dark suit-shoulders periodically.
A big part of the journey of the retreat was becoming aware of the many privileges that I possess, and being clean is a privilege that I had never considered before.
On the street, it's very hard to find a shower, or even a sink where you can do a sponge-bath, and to my shame, I am the first to admit that I have often judged people on the street because they were dirty. It used to gross me out, and made me want to give them a wide berth. I had a story that these unwashed folks just didn't care about that, but it turns out when you talk with people, almost everyone would love to shower every day.
But that is a privilege of the inside people.
There is a wonderful organization, Lava Mae, that has a truck with showers in it. They park in front of Glide Church where breakfast is served, and a hose runs from the fire hyrdant. You can make an appointment, and there is a place to leave your stuff safely while you clean up. But its only one truck with four or five showers, and there are hundreds and hundreds of outside people.
Of course, the other spot to clean up is a sink. After we would wake up early in the mornings from our cardboard beds on the sidewalk, we would go to the Safeway in the Castro to use the bathroom and find many others washing in the sink.
By the way, it turns out that being able to pee or poop whenever you want to is a privilege that is also denied to the outside people.
The management at that Safeway are incredibly nice about it, and we never saw anyone asked to leave. It's kind of a meeting place too, where we would check in with others who had slept on the concrete, and ask them how their night was, and where they were hoping to get breakfast. This is how information travels on the street.
So by the time we came to the last day, it had been six days since my last shower, and I was really starting to look and smell like a homeless person.
I laughed, and laughed again when Alycia did the same. Anya said I didn't smell like a person, I smelled like trash. Even though I knew this must be true, I couldn't actually smell it myself at all.
But in discovering the privilege of being clean, I was given a gift beyond measure.
After our last breakfast in the dingy basement of Glide, we went upstairs for the Sunday service. I had always wanted to come before, but never had, and I was excited!
They have a rocking band, and a massive choir of the most diverse people you can imagine: all shades of skin, drag queens, old, young, some with disabilities, and the stained glass in the chapel is over 100 years old.
It opened with a bang, and then we came to the part where everyone greets each other. Some people were hugging, but I was shy. In addition to my smell, I was sunburnt and my clothes were filthy and worn. I looked like an outside person.
The story in my head was that I didn't want to "subject" myself onto someone else. The deeper truth is that in that moment I didn't feel worthy to hug.
Like so many men, I carry a shadow belief about myself that there is something wrong with me, and that I am inherently unworthy, and not good enough.
Of course, this has led to many blessings for me, since out of our greatest wounds come our deepest strengths, and to compensate, I became an over-achiever, always going for the A, for the attention, for the acclaim.
My deepest truth is that I believe I must do things in order to be loved, and that I must be a good person, and serve others, and perform in all the many ways that I do, in order for people to like me.
In the old days, this deeply held story was hidden away, and I was unaware of it. But thanks to a great deal of personal work and introspection, spurred and catalyzed by the the ManKind Project, I am now quite familiar with this belief and it's limitations.
And yet, I have always had a hard time taking in love.
I have a huge heart and I pour it out to others, and I don't think it's an exaggeration to say that I am willing to love everybody, at least in some way.
But when it comes to taking in love, or compliments, or praise, I tend to deflect it away, in what appears to some people to be humility.
When I looked around in the pews for someone to greet, a well dressed, very clean older white woman turned to me and I held out my hand.
She looked at me from head to toe, grabbed my hand, shook her head at my distance, and said come on in here and she gave me a huge and lengthy bear hug.
My mom died eight years ago, and I felt her in that hug. It felt so good, and even as I write this I am crying again, as I have off and on since I got home.
In that hug, I felt unconditional love for me as a human being.
I was nobody and everyone all at once. My persona and my story and my accomplishments and my relationships all fell away, and I was simply a person born into this world by a miracle, and blessed to live a long and beautiful life.
For the first time in my life, I felt unconditional love and allowed it to come inside. I allowed my myself to accept it as a gift.
In that hug, I felt the personal love of God or the universe or spirit or that unnamed thing we feel when we sit in circle with our brothers and sisters, or when we hug our parents, or a child.
In that one hug, as I wept and held on tightly to that utter stranger, I experienced a profound healing.
I can now say with utter clarity and conviction and gratitude, I am worthy of unconditional love, just like every other being on this planet.


Our landscapes connect us to our history; they are the source of our character as a peopl, as well as our health, our safety, and our prosperity. Natural resources enrich us economically, yes. But they also enrich us aesthetically and recreationally and culturally and spiritually. Robert Kennedy, Jr.


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Fiction and Fact in Mordecai Richler's Novels
Author: Craniford, Ada
This study analyzes Richler's use of biblical and literary sources as ironic subtexts for his tales. Identifying hitherto unnoticed sources, it also shows that Richler uses them to compare and judge both the world he imitates and the one he creates. Another important aspect of the study of Richler's nine novels shows that even the first novel (now out of print) is cast in the same mold as the more successful ones where he fashions his protagonist on a biblical or literary mode only to blast holes in both his hero and the model he represents. Thus he achieves his own peculiar moral density by pushing accepted conventions and beliefs to their logically absurd extremes, while keeping the realistic level intact.
"Ada Craniford has managed to combine professional quality with a work that is a damned good "read" which I found difficult to put down and which should appeal to a wide audience far beyond the narrow confines of Academia. . . . Her style is pungent, graphic, often comic, but at the same time elegant, and she reveals a wonderful knack for illustrating a point with a an appropriate anecdote which is guaranteed to continue to amuse the reader long after the source has been forgotten. . . . With its rich and rewarding prose, impressive research and sometimes almost clairvoyant insights [Mordechai Richler] is a beautifully written, interesting and important book about a great Canadian writer." - Douglas F. Parkhill
"... she provides a fresh and stimulating view of the writer. Intertextual reading, especially recognition of parody, underlies her most arresting comments." - Joan Hind-Smith
Other Literary Criticism Books
2022 - What is Poetry? Critical Essays on Ezra Pound, Chinua Achebe, Roy Campbell, Nnamdi Azikiwe, Langston Hughes, Christopher Okigbo, Dennis Brutus, Archilochus (softcover)
2020 - Marriage in China Today: Stories by Chinese Women Authors
2014 - Experience of Exile Described by Italian Writers: From Cicero Through Dante and Machiavelli Down to Carlo Levi
>> See all our Literary Criticism books


text:
Topics in Depth
Eukaryotic Cell Structure
Movement in Smaller Eukaryotes and Eukaryotic Cells
Eukaryotic Kingdoms
Origin of Eukaryotes
Eukaryotes and Environmental Problems
Eukaryotic Model Organisms
Big Themes
In the Real World
Eukaryotes Questions
1. What is evidence for mitochondria previously being free-living bacteria?
2. Endosymbiosis is named for a mutualistic benefit between two originally free-living organisms. What are the symbiotic benefits supporting endosymbiosis?
3. What structure separates chordate from the other Animal phyla and what is this structure's function?
4. What advantages do organelles allow eukaryotes?
5. Name a model organism you think is best to study brain cancer and explain your choice.
6. Only 2% of the human genome codes for proteins. As a eukaryote, what could the other DNA be used for and how is it all organized into a nucleus?
7. How can selective breeding be used to control rust growth?
8. Name and explain a process that would be appropriate to study in Arabidopsis.
9. Why did plants move from sea to land before animals did?
10. What effects does an algal bloom or red tide have on an ecosystem?
Mitochondria have a double membrane. The inner membrane was probably the original. The outer membrane was probably the one it scored when the bigger cell ate it up. These two membranes have a different composition, supporting two different origins. Icing on the cake proof: mitochondria have their own DNA and ribosomes that are more prokaryote-ish. Go ahead and lick that spoon of frosting.
The smaller prokaryotes that ended up inside the larger cells got to live rent-free in some decent accommodations. The host cells got a live-in chef. We hear that chloroplasts and mitochondria also have really good hygiene, so that helps.
Animals all have notochords during embryonic development. Some animals keep this notochord their entire animal lives, while in other animals, it develops into a backbone and spine that functions to structure the animals from head to tailbone. These chordates with backbones are also obviously braver.
Organelles play music for the cell. Okay, maybe not. But organelles do help eukaryotes organize and compartmentalize functions. This allows eukaryotes to do more and grow bigger. This also allows them the efficiency to become multicellular higher organisms with more DNA.
While you could probably justify a second choice, the best choice of the model organisms we discussed is definitely the mouse. When picking out a model organism to do mad science work on, you want to choose something that can get the disease to a similar extent that humans get it. Mice, as fellow vertebrate chordates that also appreciate fine cheeses, are the obvious choice.
What? Ninety-eight percent of DNA doesn't code for proteins? What else does DNA do? The tango? DNA doesn't just code for proteins. It codes for components of translation machinery, as well as other noncoding RNAs involved in regulation. There are also large areas of DNA that are used to repress and activate transcription of eukaryotic genes. How is that all wrapped up into one tiny nucleus? Well, that's achieved by organizing the DNA into linear chromosomes wrapped up around nucleosomes. Collectively, this is called chromatin. It's a classy term for DNA that knows how to spin with a rose in its teeth.
Rust is a fungi with an evil plan to take away your¬ Cheerios by destroying wheat plants all over the world. By finding wheat plants or other crop victims that aren't susceptible to rust, scientists can then selectively breed these plants with each other to produce a super species of wheat strong enough to fend off the parasitic mushrooms. Breakfast is saved.
Although answers here will definitely vary, yours should reflect something that happens in plants. You wouldn't want to use Arabidopsis to study toenail fungus any more than you'd want to use a mouse to study chloroplasts. Processes that are good to study in Arabidopsis are things like plant genetics, plant diseases, photosynthesis, or even chromatin or protein translation.
Plants are smarter. Plants are faster? Eh…they lack the whole brain/feet thing. Plants DO reproduce by seeds and spores, which are easily carried by the wind and sea. Once the plants made the world a beautiful, green place, providing lots of shade and food and oxygen, it wasn't long before animals realized heading on land might be a good idea for them, too.
Some algal blooms or red tides are just a totally normal part of nature, just like those few awkward teenage years. However, sometimes these things happen because of the unnatural—like humans dumping sewage into a water system and altering the delicate balance of nutrients. This can result in a crazy number of algae or dinoflagellates taking over a body of water, blocking the sunlight, taking up the resources, killing fish, and possibly even poisoning some organisms, depending on whether or not it emits toxins.


text:
Delegation of the European Union to New Zealand
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EU Delegation to New Zealand - Newsletter
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no. 191- 21 June 2018
EU Commissioner for Trade launches FTA Negotiations
Cecilia Malmström visited New Zealand this week to officially launch the EU-NZ free trade agreement negotiations.
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Today is an important milestone in EU-New Zealand relations. Together, we can conclude a win-win agreement that offers benefits to business and citizens alike... This agreement is an excellent opportunity to set ambitious common rules and shape globalisation, making trade easier while safeguarding sustainable development. We can lead by example." said the Commissioner.
To conclude the day, Commissioner Malmström addressed the public at Parliament and later held a question and answer session with students studying the European Union.
The following day, Malmström and Parker jointly held a civil society outreach event in Auckland at Europe House. She then had a business site visit to a New Zealand company with links to Europe.
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Read the full press release for the FTA launch here.
EU prioritises care for children with 'No Child Left Behind'
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On 15 June the No Child Left Behind conference was held in Brussels, co-hosted by the EU Commission and Lumos - an NGO focused on ending the institutionalisation of children worldwide.
Together, Commissioner Mimica and Lumos founder J.K. Rowling have called for international collaboration to address the high numbers of children who are suffering in orphanages and institutions around the world.
"Children all over the world are being severely harmed... because their primary right to a family has been taken away" said J.K. Rowling.
"We know that children thrive best in families and communities, not in orphanages and institutions that are not providing the love and care every child needs. The EU plays a key role in ensuring that no child is left behind." said Commissioner Mimica.
Joint Statement on World Refugee Day 2018
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On June 20 in recognition of World Refugee Day, Frans Timmermans, First Vice-President of the European Commission, Federica Mogherini, High Representative of the Union for Foreign Affairs and Security Policy and Vice-President of the Commission together with Commissioners Johannes Hahn, Neven Mimica, Dimitris Avramopoulos, Christos Stylianides and Vera Jourová released a joint statement:
"Every minute, every day, nearly 31 people are forcibly displaced. Today, more than 68.5 million people have been forced to leave their homes due to conflicts and violence, persecution, natural disasters or the very real consequences of climate change –25.4 million of them are refugees.
More than 67 years after the 1951 Geneva Convention on the Status of Refugees, its international principles remain more valid than ever. These principles are enshrined in the EU's asylum acquis, and the EU remains committed to continue standing up for those who are in need of help."
To read the full text, click here.
European Union Chairs Kimberley Process
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On 18-22 June the annual Kimberley Process dialogue was held in Antwerp. The Kimberley Process unites governments, civil society and the diamond industry to reduce the flow of conflict diamonds by regulating the international trade in rough diamonds.
As Kimberley Process Chair in 2018, the European Union focusses on improvement of regional cooperation in diamond-producing regions as the international trade of blood diamonds harms many local communities.
To read more about the Kimberly Process click here.
HR/VP Mogherini hosts Climate Security and Peace event
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On 22 June the Climate, Security and Peace: The Time for Action event was held in Brussels.
The conference assembled ministers, think tanks, international figures and civil society to assess the ongoing threats posed by climate change. Participants highlighted a set of clear challenges, from tensions over increasingly scarce resources to the forced movement of people in search of usable land and water.
The conference occured 10 years after the EU's first landmark report on climate change and security.
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EU Delegation to Australia - Newsletter
Your @EUinAus Update Q2, 2019.
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Vacancy: Administrative Assistant The Delegation of the European Union to New Zealand invites applications to join a small, friendly team in the role of Administrative Assistant. The role involves assistance with administrative and financial management for the Delegation, implementation of the administrative budget according to EU
Sakharov Fellowship for Human Rights Defenders 2022Calling all human rights defenders! The European Parliament is launching the call for applications for the 7th Sakharov Fellowship. Applications close 30 January 2022.
We're hiring! Intern(s) wanted We're looking for new grads for a paid internship of 3-6 months, starting this year. Come and work over the summer in Wellington with us. Our interns are kept busy organising events, managing social media, drafting reports as well as writing a wide range of internal & external texts. This
Born equal, yet striving for equalityIn many places around the world, human rights and democracy are under threat. While we combat the global pandemic, multiple challenges are mounting in particular for the most vulnerable communities. As we celebrate Human Rights Day, the EU re-commits to stand and speak out for the oppressed and
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text:
The Custom House: Introductory to The Scarlet Letter
Chapter 1: The Prison Door
Chapter 2: The Marketplace
Chapter 3: The Recognition
Chapter 4: The Interview
Chapter 5: Hester at Her Needle
Chapter 6: Pearl
Chapter 7: The Governor's Hall
Chapter 8: The Elf-Child and the Minister
Chapter 9: The Leech
Chapter 10: The Leech and His Patient
Chapter 11: Inside a Heart
Chapter 12: The Minister's Vigil
Chapter 13: Another View of Hester
Chapter 14: Hester and the Doctor
Chapter 15: Hester and Pearl
Chapter 16: A Forest Walk
Chapter 17: The Pastor and His Parishioner
Chapter 18: A Flood of Sunshine
Chapter 19: The Child at the Brookside
Chapter 20: The Minister in a Maze
Chapter 21: The New England Holiday
Chapter 22: The Procession
Chapter 23: The Revelation of the Scarlet Letter
Chapter 24: Conclusion
Chapter 23 The Revelation of the Scarlet Letter
page Chapter 23: The Revelation of the Scarlet Letter: Page 4
Chapter 23: The Revelation of the Scarlet Letter: Page 3
Table of Contents Characters The Custom House: Introductory to The Scarlet Letter Chapter 1: The Prison Door Chapter 2: The Marketplace Chapter 3: The Recognition Chapter 4: The Interview Chapter 5: Hester at Her Needle Chapter 6: Pearl Chapter 7: The Governor's Hall Chapter 8: The Elf-Child and the Minister Chapter 9: The Leech Chapter 10: The Leech and His Patient Chapter 11: Inside a Heart Chapter 12: The Minister's Vigil Chapter 13: Another View of Hester Chapter 14: Hester and the Doctor Chapter 15: Hester and Pearl Chapter 16: A Forest Walk Chapter 17: The Pastor and His Parishioner Chapter 18: A Flood of Sunshine Chapter 19: The Child at the Brookside Chapter 20: The Minister in a Maze Chapter 21: The New England Holiday Chapter 22: The Procession Chapter 23: The Revelation of the Scarlet Letter Chapter 23: The Revelation of the Scarlet Letter: Page 2 Chapter 23: The Revelation of the Scarlet Letter: Page 3 Chapter 23: The Revelation of the Scarlet Letter: Page 4 Chapter 24: Conclusion How to Cite
With a convulsive motion he tore away the ministerial band from before his breast. It was revealed! But it were irreverent to describe that revelation. For an instant the gaze of the horror-stricken multitude was concentred on the ghastly miracle; while the minister stood with a flush of triumph in his face, as one who, in the crisis of acutest pain, had won a victory. Then, down he sank upon the scaffold! Hester partly raised him, and supported his head against her bosom. Old Roger Chillingworth knelt down beside him, with a blank, dull countenance, out of which the life seemed to have departed. With a spasm, he tore his minister's robe away from his breast. It was revealed! But it would be pointless to describe that revelation. For an instant, the eyes of the horrified mass were focused on the dreadful miracle. The minister stood with a flush of triumph in his face, as though he had persevered in the midst of a great torment. Then he crumpled upon the platform! Hester raised him slightly, supporting his head against her bosom. Old Roger Chillingworth kneeled down next to him, his face blank and dull, as though the life had drained out of it.
"Thou hast escaped me!" he repeated more than once. "Thou hast escaped me!" "You have escaped me!" he said over and over. "You have escaped me!"
"May God forgive thee!" said the minister. "Thou, too, hast deeply sinned!" "May God forgive you!" said the minister. "You have sinned deeply too!"
He withdrew his dying eyes from the old man, and fixed them on the woman and the child. His dying eyes turned away from the old man and looked instead at the woman and child.
"My little Pearl," said he feebly,—and there was a sweet and gentle smile over his face, as of a spirit sinking into deep repose; nay, now that the burden was removed, it seemed almost as if he would be sportive with the child,—"dear little Pearl, wilt thou kiss me now? Thou wouldst not yonder, in the forest! But now thou wilt?" "My little Pearl!" he said, weakly. There was a sweet and gentle smile on his face, as though his spirit was sinking into a deep rest. Now that his burden was lifted, it seemed almost as though he would play with the child. "Dear little Pearl, will you kiss me now? You wouldn't when we were in the forest! But will you now?"
Pearl kissed his lips. A spell was broken. The great scene of grief, in which the wild infant bore a part, had developed all her sympathies; and as her tears fell upon her father's cheek, they were the pledge that she would grow up amid human joy and sorrow, nor for ever do battle with the world, but be a woman in it. Towards her mother, too, Pearl's errand as a messenger of anguish was all fulfilled. Pearl kissed his lips. A spell was broken. The wild infant's sympathies had been developed by the enormous grief she had grown up around. Her tears that now fell upon her father's cheek were a pledge to open herself to human joy and sorrow. She would not fight constantly against the world but would be a woman in it. Pearl's role as a bringer of pain to her mother also came to an end.
"Hester," said the clergyman, "farewell!" "Hester," said the clergyman, "goodbye!"
"Shall we not meet again?" whispered she, bending her face down close to his. "Shall we not spend our immortal life together? Surely, surely, we have ransomed one another, with all this woe! Thou lookest far into eternity, with those bright dying eyes! Then tell me what thou seest?" "Won't we meet again?" she whispered, bending her face down close to his. "Won't we spend eternity together? Surely, surely, we have saved each other through all this misery! You see far into eternity now, with those bright dying eyes! Tell me what you see!"
"Hush, Hester, hush!" said he, with tremulous solemnity. "The law we broke!—the sin here so awfully revealed!—let these alone be in thy thoughts! I fear! I fear! It may be, that, when we forgot our God,—when we violated our reverence each for the other's soul,—it was thenceforth vain to hope that we could meet hereafter, in an everlasting and pure reunion. God knows; and He is merciful! He hath proved his mercy, most of all, in my afflictions. By giving me this burning torture to bear upon my breast! By sending yonder dark and terrible old man, to keep the torture always at red-heat! By bringing me hither, to die this death of triumphant ignominy before the people! Had either of these agonies been wanting, I had been lost for ever! Praised be his name! His will be done! Farewell!" "Hush, Hester, hush!" he said, with trembling gravity. "Think only of the law that we broke and the sin that has been horribly revealed here! I am afraid! I am afraid! From the moment we forgot our God—when we forgot our love for each other's souls—it may have been vain to hope that we could have a pure and everlasting reunion in Heaven. God knows, and He is merciful. He has shown His mercy, above all, in my trials. He gave me this burning torture to bear on my breast! He sent that dark and terrible old man, to keep the torture always red-hot! He brought me here, to die in triumphant shame in front of all the people! Without either of these agonies, I would have been lost forever! Praised be His name! His will be done! Goodbye!"
That final word came forth with the minister's expiring breath. The multitude, silent till then, broke out in a strange, deep voice of awe and wonder, which could not as yet find utterance, save in this murmur that rolled so heavily after the departed spirit. That minister spoke that last word with his dying breath. The crowd, silent up to that point, erupted with a strange, deep sound of awe and wonder. Their reaction could only be expressed in this murmur, which rolled so heavily after the minister's departing soul.
Previous page Chapter 23: The Revelation of the Scarlet Letter: Page 3 Next section Chapter 24: Conclusion
Take the Chapters 23-24 Quick Quiz
Read the Summary of Chapters 23–24
The Scarlet Letter: Popular pages
CHARACTERS Hester Prynne: Character Analysis
MAIN IDEAS Is Hester Prynne a feminist?


Apple TV has never followed a predictable update path. Officially unveiled alongside the iPhone in January 2007, it has had just two revisions to speak of during its lifespan, and aside from a quiet silicon swap last year, there hasn't been any movement on the Apple TV front since March of 2012.
But the industry around it hasn't been nearly as stagnant. In the two and a half years since the third generation of Apple TV landed, we've seen a veritable explosion of streaming devices and services, with various sticks and boxes all promising to deliver high-definition content to our televisions. Apple TV has kept pace by adding channels and occasionally refreshing its software, but there's one main problem: All of these boxes, up to and including Google's new Nexus Player, pretty much do the same thing. Sure, some have a slightly better selection of channels and others play games or offer tighter integration with the particular ecosystem they serve, but when it comes to actual television, none of the digital media players have managed to break the stranglehold cable companies have on our consumption of broadcast content, leaving so-called cord-cutters to pick through the scraps.
But now there's a major crack in the blockade. You might remember a rumor earlier this year that Apple was in talks with Time Warner and Comcast–currently in the final regulatory steps of a blockbuster merger–about expanding the capabilities of Apple TV. At the time it seemed like a pointless endeavor, but now it appears as though those talks have begun to bear fruit. Time Warner-owned HBO announced Thursday that it will launch a standalone, broadband-only subscription for its HBO GO streaming service, giving people access to the holy grail of premium content without needing a cable subscription (or a friend willing to share their password).
We can assume that this new HBO Go service won't be exclusive to Apple TV–Tim Cook would never have allowed such a cavalier announcement, particularly not on the eve of an Apple event–but that doesn't mean it won't be integral to the future of the device. Ever since Steve Jobs cryptically told biographer Walter Isaacson that he had "cracked" the code for an "integrated television set," we've been patiently waiting for the ultimate Apple solution. And it may be nearly here.
At the time, Jobs was talking about building "the simplest user interface you could imagine," something that effortlessly synced with all of your devices. There's nothing necessarily complicated about today's Apple TV, but getting to the point where you can watch what you want still requires a series of steps: finding the app, searching for the show, checking login credentials, etc. Jobs's dream was to sit down and instantly start watching what you want, and the new HBO Go service brings it that much closer to reality.
The industry is finally coming around to his way of thinking; like the iPod and the iTunes Store, programming on Apple TV needs to be on-demand and à la carte to be truly simple and satisfying, not tied to a provider that may or may not let you watch via an app. There're still plenty of hands left to be shaken, but now that Apple has a major player in their court, getting other networks on board should be that much easier.
Once the content is there, everything else will fall into place. By taking the various middlemen out of the equation, Apple can work directly with the networks to integrate everything into a universal or Siri-style search mechanism that lets you instantly find what you need. There could be a master queue that shows you everything from Netflix, Hulu, iTunes and HBO that you want to watch. Or your Apple TV could automatically switch to the HBO Go app when Game of Thrones is about to start, via a reminder sent from your Apple Watch.
This is the moment Apple TV has been waiting for. For the past two and a half years, Tim Cook and Eddie Cue have been trying to sell content and cable providers on Jobs' simple, coherent vision. HBO Go is the first domino to fall. Now it's up to Apple to make sure the rest are properly lined up.


text:
Tampa's Dwight Gooden charged with cocaine possession
The former Mets great, arrested in New Jersey last month, also was charged with driving under the influence.
Former New York Mets pitcher Dwight "Doc" Gooden watches batting practice before inning of a spring training baseball game between the Mets and the Miami Marlins Monday, March 13, 2017, in Port St. Lucie. (AP Photo/John Bazemore)
By Ryan Kolakowski
In 2016, Dwight Gooden asserted that he was sober and the cocaine use that plagued him as a player and afterward was in the past. A new arrest indicates that his years-old claims may no longer hold water.
The Tampa native and former Mets standout pitcher was charged with cocaine possession and driving under the influence last month in New Jersey. The arrest was first reported by the New York Post. Gooden's attorney asked that the public reserve judgment.
Holmdel Township, N.J., police arrested Gooden early in the morning of June 7. Police said he was pulled over before 1 a.m. for failing to maintain the lane and driving too slowly on a highway.
Gooden, affectionately known as "Doc" and "Dr. K," pitched to a 3.51 ERA across 16 seasons for the Mets, Yankees, Indians and Devil Rays.
His most successful seasons resulted in the 1984 National League Rookie of the Year Award and the 1985 National League Cy Young Award with the Mets. He led the pitching staff of the 1986 World Series champion Mets.
Gooden, 54, encountered drug troubles in his professional career and afterward. He missed the start of the 1987 season after testing positive for cocaine use.
The 1994 season was Gooden's last in a Mets uniform. Major League Baseball suspended the right-hander for the entire 1995 season after another positive test.
Gooden returned to the majors in 1996, posting a 5.01 ERA in 29 starts for the Yankees. He threw a no-hitter for the Yankees in a May 14 matchup against the Mariners lineup that included Hall-of-Famers Ken Griffey Jr. and Edgar Martinez. He pitched for the Devil Rays in their third season of existence, from April 13 tol May 25, 2000.
Gooden signed with the Yankees in June of 2000 and went on to win the World Series with New York that season. He re-signed with the Yankees that offseason, but later retired before taking the mound in another official game.
How Travis d'Arnaud has emerged as an unlikely star for Rays
Released by the Mets, given a brief look by Dodgers, d'Arnaud had earned a place in Rays lineup, and now their history.
Marc Topkin's takeaways from Rays 5-4 Monday win over Yankees
On Snell's good but not good enough showing, more bad baserunning and how the bullpen is so unpredictable.
Ten things to know about Travis d'Arnaud and the Rays' thrilling win over Yankees
From how rare it was for the Rays to win, and for the Yankees to lose.


text:
Q: What is the replacement for the old "too localized" OT reason? Other? I understand why the old "too localized" option was removed for OT posts closure reasons, but occasionally I still encounter posts that fall in this category.
For example, one recent questioner cited his professor's requirements and asked how he was supposed to write code to meet the requirements. Answering the question would have been valuable only to the students in that particular class, an obvious case of "too localized".
How are we supposed to flag such questions now? Use the "Other" category and just manually write in something like "This question will only help people in the student's class and is therefore too specific or localized for a general Q&A forum." In other words, writing out manually what used to be one of the choices?
Here is the actual question:
ArrayList in C++, what is it?

redpajama_set_name: RedPajamaStackExchange


text:
Q: I'm getting corrupted image when converting base64 image using webcam.js here's my html with javascript using webcam.js. I just followed the https://github.com/jhuckaby/webcamjs on how you will implement it using existing form.

    <meta http-equiv="Content-Type" content="text/html; charset=utf-8">
    <title>WebcamJS Test Page</title>

Your captured image will appear here...

WebcamJS Test Page

Demonstrates simple 320x240 capture & display

     <form id="myform" method="post" action="myscript.php">
        <input id="mydata" type="hidden" name="mydata" value=""/>
     <input type=button value="Take Snapshot" onClick="take_snapshot()">
     <input type="submit" value="submit">
    </form>

here's the myscript.php to save the image. I successfully save the PATH in the database but I'm getting a corrupted .jpg file (file size always in 7 bytes).
<?php
include 'connect.php';
  $encoded_data = $_POST['mydata'];  // to get the base 64 code image link
  $name = base64_decode($encoded_data); // to convert base 64 code
  $name = date('YmdHis');
$newname="images/".$name.".jpg";
$file = file_put_contents( $newname, file_get_contents('php://input') );
if (!$file) {
    print "Error occured here";
    exit();
}
else
{
    $sql="INSERT INTO image (images) VALUES('$newname')";
    $result=mysqli_query($con,$sql);
    $value=mysqli_insert_id($con);
    $_SESSION["myvalue"]=$value;

}

$url = 'http://' . $_SERVER['HTTP_HOST'] . dirname($_SERVER['REQUEST_URI']) . '/' . $newname;
print "$url\n";

?>

A: After all the trail and errors i found out you'll need to convert the base64 string to a blob and then attach to a file before sending.
    var binaryImg = atob(base64string);
    var length = binaryImg.length;
    var ab = new ArrayBuffer(length);
    var ua = new Uint8Array(ab);
    for (var i = 0; i < length; i++) {
        ua[i] = binaryImg.charCodeAt(i);
    }

    var blob = new Blob([ab], {
        type: "image/jpeg"
    });enter code here

    var imgFile = new File([blob], 'photo.jpeg', {type: 'image/jpeg'});

Now you can use the imgFile to send across to a remote server.


text:
Types of Americans Joining Islamic Extremists Vary Greatly, FBI Says
FBI Director James Comey Says Those Seeking to Join Islamic Groups Range in Age, Ethnicity
Federal Bureau of Investigation Director James Comey said at a counterterrorism conference at Fordham Law School on Monday that the types of Americans joining Islamic extremists vary greatly.
Andrew Grossman
BiographyAndrew Grossman
@A_Grossman
Andrew.Grossman@wsj.com
Updated Nov. 3, 2014 7:18 pm ET
NEW YORK—The U.S. faces a tough hurdle in identifying Americans seeking to join Islamic extremists in part because there is "no typical profile" of those seeking to join the fight, Federal Bureau of Investigation Director James Comey said on Monday.
Federal law-enforcement officials have become increasingly concerned about the threat posed by Americans and other holders of Western passports who travel to join extremist groups in Syria, especially Islamic State.


text:
Il Friuli Aquileia Rosato frizzante è un vino DOC la cui produzione è consentita nella provincia di Udine.

Caratteristiche organolettiche
colore: rosato tendente al cerasuolo tenue.
odore: vinoso, intenso, gradevole.
sapore: asciutto, armonico, pieno, vivace nel tipo specifico.

Storia

Abbinamenti consigliati

Produzione
Provincia, stagione, volume in ettolitri
 nessun dato disponibile

Vini DOC della provincia di Udine

redpajama_set_name: RedPajamaWikipedia


The anti-microbial material and the breakaway feature make this lanyard perfect for hospitals.
This MicroWeave lanyard with plastic no-twist hook is made from durable, easy-to-grip ribbed polyester. It includes a break away clasp, which snaps off of the wearer in unsafe situations. The wide plastic no-twist hook ensures that the ID remain facing forward. This lanyard is available in black, royal blue, and red.


Acquire basic skills that will enhance job readiness and job search competencies.
Assist each student to acclimate to center life.
Identify and address each student's personal issues that may be barriers to successful adjustment and participation.
Tailor the combination of services to each student's needs.


text:
UK Parliament accuses Apple of contributing to 'throwaway culture'
Despite recent measures to reduce the amount of electronic waste linked to its activity, Apple is attacked head-on by a report by the Special Committee on Environmental Audit of the British Parliament. The latter establishes in particular that Apple would contribute to the "culture of the disposable".
According to one of the branches of the British Parliament, Apple would contribute to the culture of the disposable, by offering products that are difficult to repair // Gamesdone: Apple
In a (very long) report published on November 26 by the Special Committee on Environmental Audit of the British Parliament, Apple is a priority target. Quoted by name on numerous occasions, the Cupertino giant is notably accused of helping to generate electronic waste by offering devices that are excessively difficult to repair.
The parliament report also accuses the firm of making repairs to its products too expensive, thus tacitly encouraging replacement with new devices. A spiral which would contribute, according to the Committee, to the entrenchment of " cdisposable " in the business model of the electronics industry, characterized by a " continuous consumption dependence ».
« Apple has been reported to glue and solder the parts together on its laptops, making it very difficult to repair. », Writes the Committee in particular on a summary page of its report, published on the House of Commons website. « They also charge very high fees for repairing their products. This trend, which runs counter to a long history of engineering in the UK, must stop », We read further.
Apple says to itself " surprised and disappointed »By the Parliament report
In a statement sent to the English daily The Guardian, Quoted by MacRumors, Apple says to itself " surprised and disappointedBy the contents of the report of the Special Committee of the British environmental audit. The brand retorts by recalling the efforts made to reduce its impact on the environment and the amount of e-waste that its activity generates.
« We were surprised and disappointed by the Environmental Audit Committee's report, which does not reflect any of Apple's efforts to conserve resources and protect the planet we all share. Customers have more options than ever to trade in, recycle, and get quality, safe repairs. Our latest range of Apple Watches, iPads and iPhones use recycled materials for major components ", Explains in particular the brand, which undertakes for the rest to continue to collaborate with the Parliament and the British government for" document Apple's commitments (…) to support the joint effort to leave a clean economy and a healthy planet for the next generation », lit-on
As specified MacRumors, the Committee also said "disappointed" through "limited involvementFrom Apple as part of the investigation that was conducted.
Launched in 2015, the iPhone 6S is still supported by Apple // Gamesdone: Marc-André Julien – Unsplash
Apple wants a neutral carbon footprint for its products within 10 years
Note, however, that Apple, like Microsoft, Dell or Logitech, has taken measures to reduce the impact of its activity on the environment. In addition to the more frequent use of recycled materials in its products and a shift towards cleaner energy, the brand recently chose to no longer provide chargers in the boxes of its new iPhones and Apple Watches, in order to help reduce the amount of electronic waste (and save on transport costs).
The American giant has also made a commitment to make all of its products carbon neutral by 2030. A commitment that Apple wishes to keep by optimizing its supply chain, but also by promoting the recycling of its products. More immediately, let's add that Apple products are also among the most durable in terms of software. For example, an iPhone 6s launched in 2015 is still updated and therefore perfectly usable in 2020 with iOS 14, the latest version of Apple's mobile operating system.
PrevPlayStation VR sees its price drop in a -33% pack
NextOne of the best PS5 headsets is down to its lowest ever price in this Black Friday deal
choosing a wallpaper by chat will be possible very soon
be careful to install the correct version on your new PlayStation
Google will be able to buy Fitbit for $ 2.1 billion
Gone from OnePlus, Carl Pei announces audio plans for 2021 with help from iPod daddy
Apple makes its iPhone 12 compatible with 5G


text:
Q: tlibimp.exe output differs on different OSes I'm trying to import a third-party .NET type library (COM server DLL) using tlibimp.exe (version 11.0). This basically works fine, but the results differ when I run it on different computers, one running Windows XP, the other Windows 7. What's worse, the code generated on the Win7 machine doesn't compile.
Both machines have:

*

*Borland C++ (RAD Studio) 2007

*tlibimp.exe version 11.0

*the same .NET framework versions installed (as far as I can tell,
Borland 2007 uses .NET v2)

*bcc32.exe version 5.93

The compiler fails in the OCX.h with:
   Parameter mismatch in write access specifier of property Font

The relevant line of code on the XP machine (which compiles ok) is:
  __property Graphics::TFont * Font={ read=GetTFontProp, write=_SetTFontProp, stored=false, index=-512 };

The same line on the Win7 machine (which fails) is:
  __property IFontDisp* Font={ read=get_Font, write=set_Font, stored=false };

Now I'm not really sure where this difference comes from. Any ideas?
cheers
Hendrik

A: This may or may not help but I had a similar issue trying to import two type libraries into delphi, from c sharp assemblies.
One type library (A) inherited from TOLeServer, the other (B) from TOleControl and I couldn't see why, as both assemblies which generated the type libraries were virtually identical.
The issue turned out to be that B had been registered with regasm and A hadn't. Registering A and re-generating the type library solved the issue.


text:
package oleacc

import (
	"unsafe"

	"github.com/go-ole/go-ole"
)

type IUIAutomationElement6 struct {
	IUIAutomationElement5
}

type IUIAutomationElement6Vtbl struct {
	IUIAutomationElement5Vtbl
	Get_CurrentFullDescription uintptr
	Get_CachedFullDescription  uintptr
}

func (v *IUIAutomationElement6) VTable() *IUIAutomationElement6Vtbl {
	return (*IUIAutomationElement6Vtbl)(unsafe.Pointer(v.RawVTable))
}

func (v *IUIAutomationElement6) Get_CurrentFullDescription() error {
	return ole.NewError(ole.E_NOTIMPL)
}

func (v *IUIAutomationElement6) Get_CachedFullDescription() error {
	return ole.NewError(ole.E_NOTIMPL)
}

redpajama_set_name: RedPajamaGithub


P1k - LED HEADLIGHTS - 08V71-HL4-A00 - Instructions | The Honda Side by Side Club!
Stylish, high intensity, direct-illumination LED headlights offer superior performance with low battery draw. *Hi/low beam provides good visibility for varied riding condition *Requires LED Headlight Wire Harness.
Dealer installation charges may apply.


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Mahalaxmi Guruvar vrat katha. This famous Aarti of Mahalakshmi Mata is recited on most occasions related to Goddess Lakshmi.
Jai Devi Jai Devi Jai Mahalakshmi is one of the most famous Marathi Aarti of Shri Mahalakshmi. Here you may download mp3 for free and without registration mahalaxmi aarti. Kala Mahadevan says: December 1, at 6: 20 am. Kindly send Margashirsha Mahalaxmi Guruvar Katha in English pls as I am unable to read marathi Hindi.
The Aarti praises the Goddess highlights the role which she plays to guide protect humanity. The Aarti also describes how she saved humanity from the demons Mahishasur English, Chand , Chamund , Sanskrit lyrics, you can free download pdf version , autiful top 2 songs maa laxmi - diwali special aarti songs - om jai lakshmi mata - jai devi jai devi jai mahalaxmi jai devi jai devi jai mahalaxmi shares Lakshmi Aarti in Hindi, also know the meaning print it. Maharashtrian people read this story on Thursday while Mahalaxmi Pujan during margashisha month. Download mahalaxmi aarti in marathi.
This Aarti in the Marathi Language is recited in praise of Mahalaxmi. Khandobachi Aarti – Jay Deva Jay Deva Jay.
Here you may download mp3 for free and without registration mahalaxmi aarti. At your service is fast music search, which is available with the help of convenient website navigation. In addition, you have an ability to listen to mp3 mahalaxmi aarti online or listen to online radio. Mahalaxmi Aarti MP3 Song by Chorus from the Marathi movie Maya Maza Aaichi. Download Mahalaxmi Aarti song on and listen Maya Maza Aaichi Mahalaxmi Aarti song offline.
Marathi Devotional Song Mahalaxmi Aarti - Aarti Sangrah. Mahalakshmi Aarti MP3 Song by Acharya Ashokji from the movie Mahalakshmi Pooja And Dipawali Pooja Paddhati.
Download Mahalakshmi Aarti song on and listen Mahalakshmi Pooja And Dipawali Pooja Paddhati Mahalakshmi Aarti song offline.
Mahalaxmi Mata Aarti, महा लक् ष् मी ची आरती. Prayer to Mahalaxmi in Marathi and english Text.


text:
Kungen & älskarinnan (engelska: Restoration) är en amerikansk historisk dramafilm från 1995 i regi av Michael Hoffman. Filmen är baserad på Rose Tremains roman Nåd och onåd från 1991. I huvudrollen som medicinstudenten Robert Merivel ses Robert Downey, Jr.

Rollista i urval
 Robert Downey, Jr. - Robert Merivel
 Sam Neill - Kung Karl II
 David Thewlis - John Pearce
 Polly Walker - Celia Clemence
 Meg Ryan - Katharine
 Ian McKellen - Will Gates
 Hugh Grant - Elias Finn
 Ian McDiarmid - Ambrose
 Benjamin Whitrow - Merivels far
 Mary MacLeod - barnmorska
 Mark Letheren - Daniel
 Sandy McDade - Hannah
 Rosalind Bennett - Eleanor

Externa länkar

Filmer 1995
Engelskspråkiga filmer
Amerikanska dramafilmer
Filmer baserade på brittiska romaner
England på film
London på film
1660-talet på film
1670-talet på film


EDTA Chelation therapy has been used for years as one of the primary remedies for arthrosclerosis or clogged arteries. It works by permitting EDTA material to enter the arteries or veins by intravenous route. EDTA is really a chemical compound which is utilized to chelate or melt the build-ups or plaques within the arteries. Today, you will find other offered routes for chelation. This consists of the suppository and oral chelation therapy.
Plaques are made from the calcified fats as well as other minerals from inside the blood. It could lead to partial or complete blockage inside the flow of the blood. With these, there cannot be sufficient supply of oxygen towards the heart that could result into "myocardial ischemia" or MI. MI could result into symptoms like "angina pectoris" or chest pains, chest congestions and palpitations. When the heart cannot receive sufficient oxygen it would boost its workload and will pump much more. Particular symptoms like high blood pressure could result. If this activity is prolonged, the heart would grow larger than its typical size. These cases could often result into cardiac overload simply because of the elevated activity of the heart.
← How safe is EDTA Chelation Therapy?


You know to leave the box of donut holes untouched in the office (for the most part), get your body moving to some degree every day, and chow down vegetables as much as possible. But there are plenty of everyday habits silently damning your health and thwarting your fitness goals.
Here are the top 25 offenders.


text:
Q: Getting 5 or 7 and returning the opposite? I get 5 or 7 and if i get 5 i need to return 7 if i get 7 i need to return 5.
i need to do this in 1 mathematical formula.
I have those:
12 - x

35 / x

There are more solutions ?
Example in code:
public static int Transform(int x)
{
    return (12-x);
    //return (35/x);
}

A: return x ^ 2;
Are you sure you aren't missing any constraints?


text:
Un descapotable (també anomenat convertible o cabriolet) és un tipus de carrosseria d'automòbil sense sostre o el sostre del qual es pot treure o bé plegar i desar al maleter. Aquest sostre, denominat capota, pot ser de vinil, roba, plàstic o de metall. Pot denominar-se popularment cabrio i de vegades es denomina erròniament cupè a causa del màrqueting que van dur a terme els fabricants d'automòbils quan van començar a ajuntar les denominacions coupé-cabriolet per referir-se als descapotables amb sostre metàl·lic. Pràcticament tots els descapotables tenen només dues portes laterals, pel fet que obertures més grans causarien problemes estructurals al xassís.

Història

En l'època dels cotxes antics, el descapotable fou el disseny de carrosseria gairebé exclusiu. No va ser sinó fins al 1910 que Cadillac va introduir el primer automòbil de disseny tancat. Una combinació de motors dèbils i la percepció que un cotxe tancat semblava un vagó, va fer que no hi hagués demanda de cotxes de sostre metàl·lic en aquells temps. Fins a mitjans dels anys vint, foren els descapotables els vehicles més venuts, ja que la seva construcció, més senzilla que la dels "sedan" de carrosseria tancada, permetien una més gran facilitat tècnica pel que fa a la seva construcció, i un preu més ajustat a la capacitat adquisitiva de l'època. Més endavant, els descapotables es varen anar fabricant cada cop amb menys freqüència, degut a una combinació de factors, entre ells, una exigència del govern dels Estats Units, a mitjans dels anys 70, per incrementar la seguretat en cas de bolcar, cosa que va fer dubtar els fabricants sobre continuar venent aquesta mena de cotxe, davant les noves restriccions. En aquella dècada, el model va arribar pràcticament a desaparèixer, fins al punt que el 1976, el Cadillac Eldorado va ser publicitat com a "El darrer convertible dels Estats Units". Durant aquest període de baixa producció de descapotables, el model T-top va esdevenir una popular alternativa als descapotables, especialment en els anomenats muscle car. En altres llocs del món, i en particular a Europa, la producció de descapotables ha estat més continuada, amb diversos models destacats.

No fou fins a la dècada del 1980 que els descapotables varen tornar a aparèixer al mercat estatunidenc, i es van consolidar amb el Mazda MX-5, a la dècada de 1990. En l'actualitat, la major part dels fabricants d'automòbils ofereixen models descapotables.

Roadster

Els automòbils esportius biplaça amb carrosseria descapotable s'anomenen de vegades roadster. Són cotxes generalment molt lleugers i amb tracció al darrere. El terme ve de l'anglès, i es feia servir per descriure els antics esportius descapotables, que tenien dues places i un banc plegable per dues altres persones al maleter. Alguns models antics no tenien capota, sinó que l'automòbil quedava completament obert, i sense finestretes laterals. El Jaguar XK és un cotxe amb les característiques del típic roadster anglès.
Amb la crisi del petroli dels 1970, les vendes de cotxes esportius varen disminuir, i els roadsters van desaparèixer. El 1989, la marca japonesa Mazda reinventà el roadster amb el seu MX-5.

Els fabricants italians, com ara Alfa Romeo, Fiat i Ferrari anomenen aquest tipus de carrosseria com a Spider (o Spyder). Els alemanys l'anomenen sovint Speedster; un cotxe clàssic alemany que empra aquest mot és el Porsche 356 Speedster.

Un possible origen de la nomenclatura "spider" es remuntaria temps enrere a un tipus de petit carruatge de cavalls anomenat Sulky, popular als Estats Units al , molt lleuger, d'una sola banqueta, dotat d'unes ballestes grans i molt flexibles que aportaven una confortable comoditat als viatgers. Les enormes rodas que tenia li donaven un aspecte estrany, que en certa manera recordaba una aranya (spider en anglès).

Sostre targa (Targa Top)

El Targa Top, també conegut com a Surrey Top, és un tipus de carrosseria semi-descapotable d'automòbil. Es tracta d'una carrosseria oberta que disposa d'una barra de protecció en accidents (sovint molt ampla), una finestra del darrere fixa o desmuntable i una secció del sostre entre el parabrisa i la barra de protecció que es pot desmuntar amb facilitat.

La nomenclatura "targa" es va popularitzar amb la introducció del Porsche 911 Targa de 1965, tot i que el primer cotxe d'aquest tipus va ser llançat realment cinc anys abans i va ser el Triumph TR4 el 1961, que oferia aquest sostre com a opció i era comunament conegut com a "Surrey Top". També va ser utilitzat en els Saab Catherina de 1964. El nom targa va ser adoptat per Porsche a la carrera de Targa Florio en la qual va competir.

Open Air (Open Top - Rag Top)
L'open Air, és un tipus de carrosseria semi descapotable, conformada per un sostre de lona o vidre removible. La característica definitòria d'aquest tipus de carrosseries és que només la part superior de l'automòbil pot ser desmuntada o plegada, i els vidres laterals i posteriors en alguns casos no poden desmuntar-se. Exemples de cotxes amb aquesta carrosseria són el Citroën C3 Pluriel, Volkswagen Polo i el Renault Twingo.

Referències

Enllaços externs

 La web del descapotable
 Pàgina web oficial del Club Cabrio espanyol
 Web del Club 306 Cabriolet

Tipus de carrosseria d'automòbils


Dr. Wolf: "Sounded good. What did you say that was?"
Mr. Kent: "'Sally Goodin'. I thought you was gonna have that put on there!"
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Mr. Kent: "I learned to play it 77 years ago."
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Dr. Wolf: "Yeah, I bet it did."


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text:
Rak (łac. carcinoma, z łac. cancer – "rak", "krab", z gr. καρκινος /karkinos/ – "rak", "krab morski") – grupa  nowotworów złośliwych wywodzących się z tkanki nabłonkowej.

Nazwa ta odnosi się do guzów powstających z nabłonków pochodzenia ekto- lub endodermalnego oraz z nabłonka narządów moczowo-płciowych. Nie są nazywane rakami nowotwory złośliwe wywodzące się z "nabłonków" pochodzenia mezodermalnego, np. śródbłonka, międzybłonka, błony maziowej.

Historia pojęcia

Nazwa rak była używana przez Hipokratesa z Kos (460–370 p.n.e.), Aulusa Corneliusa Celsusa (53 p.n.e. – 7 n.e.) i Pawła z Eginy (ok. 625–690) i została rozpropagowana przez perskiego (według innych źródeł tadżycko-arabskiego) lekarza Ibn Sinę, znanego jako Awicenna (980–1037). Nazywano tak wszystkie rozrosty złośliwe. Hipokrates używał określenia karkinoi wobec twardych guzów, które przeciwstawiał miękkim οιδημαi /oidemai/ ("nabrzmienia" – łac. oedema). W przeciwieństwie do Hipokratesa, który w ogóle nie zalecał prób leczenia tych guzów, Celsus wskazywał, że twarde guzy wymagają usunięcia chirurgicznego. Paweł z Eginy tak opisuje etymologię tego słowa: "Rak pojawia się w każdej części ciała (...), ale szczególnie często w piersiach kobiet [...] i ulega owrzodzeniu. Żyły wokół są wypełnione i napięte niczym odnóża zwierzęcia zwanego krabem, i stąd choroba wzięła swą nazwę. Ale niektórzy powiadają, że jest ona tak nazywana dlatego, że przytwierdza się do części ciała, którą zawładnie tak uporczywie, jak to czyni krab". Hipokrates w podobny sposób opisywał wygląd skóry sutka w zaawansowanych przypadkach tego schorzenia. Płaskie, okrągławe zagłębienie (a później owrzodzenie) z promieniście odchodzącymi bruzdami przypomina kształtem i wielkością rozpowszechnione w Morzu Śródziemnym kraby z rodziny Cancridae (gr.  /karaboi/; nie należy ich mylić z rakami rzecznymi rodzaju Ascatus, których głowotułów i przednie odnóża są wydłużone i mało przypominają wyglądem makroskopowe cechy raka sutka, w odróżnieniu od okrągłego głowotułowia krabów). Rysunek tego rodzaju kraba, zamieszczony przez chirurga franc. Ambroise Paré (1516–1590) w odpowiednim rozdziale jego dzieła, stał się symbolem onkologii. Współczesne znaczenie tego słowa, tzn. złośliwej choroby nowotworowej wywodzącej się z tkanki nabłonkowej, ustalił w 1865 niemiecki chirurg Karl Thiersch (1822–1895), który wraz niemieckim patologiem Heinrichem Wilhelmem von Waldeyer-Hartzem (1836–1921) ustalili, że raki składają się z dwóch elementów: złośliwego (pochodzącego z nabłonka) i niezłośliwego podścieliska (z tkanki łącznej). Był to pogląd odmienny od prezentowanego przez ówczesny autorytet w patologii Rudolfa Virchowa (1821–1902), który uważał, że rak jest rozrostem tkanek zarodkowych.

Koncepcję raka "zaczynającego się" (ang. incipient carcinoma, łac. carcinoma incipiens) przedstawił i wprowadził w 1910 amer. patolog J.C. Rubin, na przykładzie raka macicy. Dwa lata później podobne poglądy przedstawili niemieccy autorzy J. Schottlander i F. Kermauner. Współczesną nazwę raka przedinwazyjnego (łac. carcinoma praeinvasivum) i jego definicję (rozrost atypowy bez przekraczania błony podstawnej nabłonka) wprowadził w 1928 austriacko-amerykański ginekolog Walter Schiller (1887–1960), na przykładzie raka płaskonabłonkowego szyjki macicy. Obecnie jednak w literaturze naukowej powszechniej używaną nazwą dla tego stanu (niedotyczącą jedynie szyjki macicy) jest określenie carcinoma in situ (dosłownie: "rak lokalny"). Nazwy takiej użył w odniesieniu do raków skóry amerykański patolog Albert Compton-Broders (1885–1964) w 1932; później często zastępowano ją skrótem "CIS", a w obecnie obowiązujących klasyfikacjach TNM oznaczeniem "pTis".

W tłumaczeniach angielsko-polskich (lub odwrotnych) często można się spotkać z niewłaściwym przyporządkowaniem słowu ang. "cancer" słowa "rak". Jest to błędne z fachowego punktu widzenia, gdyż ang. słowo "cancer" jest pojęciem ogólniejszym i oznacza "nowotwór złośliwy", tzn. wszystkie ich rodzaje: mięsaki, glejaki, chłoniaki i inne, w tym także raki. Poprawne tłumaczenie na jęz. angielski słowa "rak" (jako złośliwego rozrostu tkanek nabłonkowych) jest "carcinoma".

Rozwój naturalny choroby i jej następstwa
Patogeneza raków jest podobna do innych nowotworów złośliwych. Ogólną ich przyczyną jest uszkodzenie mechanizmów kontrolujących proliferację (rozrost) komórek na poziomie genetycznym i molekularnym i kumulacja błędów genetycznych w kolejnych pokoleniach komórek potomnych. W przypadku raków uszkodzenie dotyczy komórek nabłonków tworzących dany narząd, który ulega niekontrolowanemu rozrostowi, wtórnie wciągając w rozrost tkanki podścieliska, odżywiające patologiczny twór (tzw. angiogeneza nowotworowa). Zwykle rozwój raka trwa nawet przez okres 20–30 lat, a objętość zmienionych komórek nowotworowych (czyli masa guza) w czasie zmienia się w sposób wykładniczy (dobrym modelem matematycznym jest tzw. krzywa Gompertza). Etapy rozwoju raka zwykło się dzielić na następujące okresy:
 inicjacja nowotworowa – aktywacja onkogenów, pierwsze zmiany w aparacie genetycznym, początkowo odwracalne lub naprawiane przez mechanizmy molekularne
 promocja nowotworowa – utrwalenie się zmian genetycznych w pojedynczych komórkach i pojawienie się w nich antygenów nowotworowych jako wykładników zmienionego genotypu i fenotypu nowo powstałych komórek atypowych (czyli nowotworowych)
 progresja nowotworowa – rozplem zmienionych komórek nowotworowych, powielanie zmian genetycznych w komórkach potomnych, ale bez przekraczania błony podstawnej nabłonka (dysplazja i rak przedinwazyjny)
 rozplem niekontrolowany – atypowe komórki wydzielają w sposób niekontrolowany cytokiny należące do tzw. czynników wzrostowych (część z nich służy jako markery nowotworowe)
 inwazja początkowa – przełamanie błony podstawnej, początek angiogenezy nowotworowej, lokalne naciekanie tkanki łącznej podścieliska
 inwazja zaawansowana – pojawienie się oderwanych atypowych komórek w krwi i chłonce, początek reakcji immunologicznych ustroju na fenotypowo i genotypowo zmienione komórki i ich antygeny nowotworowe; często także naciekanie przez ciągłość sąsiednich narządów, na przykład wzdłuż nerwów
 okres przerzutowania i uogólnionej choroby nowotworowej – guz pierwotny staje się źródłem przerzutów nowotworowych. W przypadku raków przerzuty szerzą się najczęściej drogą naczyń chłonnych, pojawiając się najpierw w okolicznych węzłach chłonnych – dlatego przy leczeniu chirurgicznym wraz ze zmienionym chorobowo narządem się je usuwa, później także drogą krwionośną w narządach odległych.

Etapy i rozległość anatomiczną choroby nowotworowej u poszczególnych pacjentów są szczegółowo określane według systemu TNM (z ang. łac. tumor – wielkość guza pierwotnego, nodus – liczba zajętych węzłów chłonnych, metastasis – liczba narządów objętych przerzutami), czyli tzw. (ang.) staging. Określenie etapu rozwoju choroby nowotworowej jest precyzyjną wskazówką rokowniczą oraz stanowi pomoc przy wyborze optymalnej terapii przeciwnowotworowej.

Stany przedrakowe
Rak, podobnie jak inne nowotwory, może pojawić się w określonej lokalizacji spontanicznie, lub być poprzedzony wystąpieniem zmiany przedzłośliwej. Zmiana przedzłośliwa względna jest taką zmianą morfologiczną lub jednostką chorobową, na podłożu której – statystycznie częściej niż to wynikałoby z oszacowania prawdopodobieństwa przypadkowego – rozwija się nowotwór złośliwy. Do takich zmian zalicza się np. modzelowaty wrzód trawienny żołądka, wrzodziejące zapalenie jelita grubego, niektóre postacie metaplazji i szereg innych. Zmianą przedzłośliwą bezwzględną jest natomiast stan, w którym nowotwór złośliwy rozwija się prawie zawsze, pod warunkiem dostatecznie długiego czasu jej trwania. Przykładem stanu przedrakowego bezwzględnego jest mnoga polipowatość rodzinna jelita grubego lub rogowacenie białe krtani.

Stanów przedzłośliwych nie należy utożsamiać z czynnikami ryzyka powstania raka.

Klasyfikacja raków

W zależności od nabłonka, z którego wywodzi się nowotwór

Gruczolakoraki (łac. adenocarcinomata)

Gruczolakoraki powstają najczęściej w przewodzie pokarmowym, gruczołach dokrewnych, trzustce, wątrobie, trzonie macicy, jajnikach, płucach, gruczole krokowym, śliniankach, sutku, nerkach.

Gruczolakoraki można podzielić na podstawie obrazu histologicznego, uwzględniając m.in.:

a) Stopień dojrzałości (gruczolakoraki I°, II°, III°), a zwłaszcza stopień ukształtowania struktur gruczołowych (histioformatywność):

 gruczolakorak (łac. adenocarcinoma) – struktury gruczołowe bardzo dobrze widoczne,
 torbielakogruczolakorak (łac. cystadenocarcinoma albo kystadenocarcinoma) – obecne struktury gruczołowe w postaci torbieli,
 rak gruczołowopochodny (łac. carcinoma adenoides) – struktury gruczołowe zaznaczone,
 rak lity (łac. carcinoma solidum) – układ gruczołów nieczytelny.

Jest to ważne kryterium określające agresywność (dynamikę) rozwoju guza, czyli tzw. histologiczną złośliwość nowotworu.

Wyróżnia się jeszcze specjalną postać raka, nazywanego rakiem gruczołowo-torbielowatym (łac. carcinoma adenoides cysticum), różniącą się od gruczolakotorbielaka. Typowo występuje on w gruczołach ślinowych, łzowych i drogach oddechowych.

b) Rodzaj wydzielanej substancji, m.in.:
 rak śluzotwórczy (łac. carcinoma mucosecretans) – wydzielanie mucyn,
 rak surowiczy (łac. carcinoma serosum) – wydzielanie substancji surowiczej (niskobiałkowej).

c) Obecność cech wydzielania śluzu, ich nasilenie i charakter (aby wykazać wydzielanie śluzu, powszechnie stosowanym barwieniem jest barwienie mucikarminem lub błękitem alcjanu):
 gruczolakorak śluzotwórczy (łac. adenocarcinoma mucinosum albo mucosecretans) obecne wydzielanie śluzu do światła gruczołów,
 (gruczolako)rak śluzowokomórkowy (łac. (adeno)carcinoma mucocellulare) obecne tworzenie śluzu w obrębie komórek,
 (gruczolako)rak galaretowaty (łac. (adeno)carcinoma gelatinosum) obecne tworzenie śluzu z wydalaniem go do podścieliska.

Ocena ta ma znaczenie w określaniu stopnia zróżnicowania raka oraz jego podatności na radioterapię (nowotwory wydzielające śluz są promieniooporne).

d) Kształt komórek
(gruczolako)rak wałeczkowatokomórkowy (łac. (adeno)carcinoma cylindrocellulare),
(gruczolako)rak sześciennokomórkowy (łac. (adeno)carcinoma cubocellulare).

e) Desmoplazję, czyli rozplem elementów łącznotkankowych podścieliska
 (gruczolako)rak twardy (łac. (adeno)carcinoma durum albo scirrhosum, albo desmoplasticum) ze znaczną przewagą podścieliska,
 (gruczolako)rak miękki lub rdzeniasty (łac. (adeno)carcinoma molle albo medullare) ze skąpym podścieliskiem guza.

Rozróżnienie to ma znaczenie w ocenie klinicznej i z użyciem metod diagnostyki obrazowej, mającej na celu wyznaczenie wielkości guza. Podczas interwencji chirurgicznej należy uwzględniać tę cechę guza przy określaniu granic zabiegu.

Raki płaskonabłonkowe (łac. carcinomata planoepithelialia)

Raki płaskonabłonkowe powstają w jamie ustnej, przełyku, oskrzelach, skórze, gardle, tarczy szyjki macicy, czasem w innych narządach. Często powstanie raka płaskonabłonkowego jest poprzedzone zjawiskiem metaplazji płaskonabłonkowej.

 Rak płaskonabłonkowy kolczystokomórkowy (łac. carcinoma planoepitheliale spinocellulare), których cechą charakterystyczną jest pojawienie się zrogowaciałych struktur mikroskopowych, tzw. pereł rakowych (Waldeyera).
 Rak płaskonabłonkowy rogowaciejący/nierogowaciejący (łac. carcinoma planoepitheliae keratodes/nonkeratodes).
 "Rak" podstawnokomórkowy (łac. carcinoma basocellulare), dla których cechą charakterystyczną jest palisadowaty układ komórek na obwodzie gniazd nacieku rakowego. Nowotwór ten nie spełnia kryteriów biologicznych raka, tzn. nie tworzy przerzutów odległych (jest nowotworem półzłośliwym, powodując wznowy miejscowe po usunięciu chirurgicznym), lokalizuje się najczęściej w skórze twarzy.
 Nabłoniak limfatyczny (guz Schminckego) (łac. lymphoepithelioma), dotyczy zwykle migdałków podniebiennych.

Raki urotelialne (łac. carcinomata urothelialia)

Raki urotelialne powstają w drogach moczowych (pęcherzu moczowym, moczowodzie, miedniczkach i kielichach nerkowych). Nowotwór ten rośnie w postaci brodaweczkowatych wypustek, w początkowym okresie rozwoju brodaweczki te wszczepiają się w inne obszary dróg moczowych.

Rozpoznania rodzaju raka dokonuje się na podstawie obrazu histopatologicznego (badanie mikroskopowe próbki tkankowej i określenie jej mikrostruktury oraz cech poszczególnych komórek tworzących guz), cytopatologicznego (badanie mikroskopowe próbki komórek wyizolowanych z guza), często uzupełnione wyznaczeniem immunofenotypu komórek nowotworowych (określenie białek charakterystycznych dla danego rodzaju komórek nowotworowych).

Istnieją raki o mieszanym utkaniu histologicznym, tzn. posiadające w swoim składzie kilka rodzajów odróżnicowanego nabłonka.

W zależności od stopnia dojrzałości i stopnia odróżnicowania

 Raki anaplastyczne – rak, w którym proces zmian genetycznych i związanych z nim przemian fenotypowych komórek jest tak głęboki, że nie można określić nabłonka, z którego powstał (utrata cech histioformatywnych, utrata immunofenotypu).
 Raki zarodkowe – raki powstające z komórek niedojrzałych morfologicznie, przypominających nie w pełni ukształtowane nabłonki płodowe. Szczególną postacią raków zarodkowych są te, które powstają w tzw. potworniakach (łac. teratoma), tj. guzach wywodzących się z komórek zarodkowych lub płciowych (najczęściej są to guzy gonad).

Jednym ze sposobów obiektywizacji określania stopnia zaburzenia replikacji materiału genetycznego DNA w komórkach nowotworów złośliwych jest ocena ich ploidii.

W zależności od stopnia zaawansowania
 Rak przedinwazyjny (łac. carcinoma praeivasivum lub carcinoma in situ). Nowotwór w początkowym stadium rozwoju, komórki rakowe nie przekraczają błony podstawnej nabłonka (usunięcie zmienionej tkanki w tym okresie choroby gwarantuje pełne wyleczenie). W klasyfikacji TNM oznacza się je jako pTis.
 Rak w okresie wczesnej inwazji (łac. carcinoma in stadio invasionis incipienti). W odniesieniu do niektórych lokalizacji (np. raka szyjki macicy) wyróżnia się takie stadium, w którym – przy dostatecznie szerokim miejscowym usunięciu zmiany – nie ma ryzyka wznowy lub przerzutów guza. Podobną kategorię "wczesnego raka" wyróżniono dla raka żołądka (ang. early gastric carcinoma). W klasyfikacji TNM oznacza się je jako pT1a.
 Rak w okresie naciekania (łac. carcinoma infiltrativum). Naciekanie podścieliska jest na tyle głębokie, że istnieje prawdopodobieństwo przedostania się komórek rakowych do naczyń chłonnych lub krwionośnych, a w związku z tym pojawienia się przerzutów. W klasyfikacji TNM oznacza się je jako pT1 do pT4.

Epidemiologia

Zgodnie z Krajowym Rejestrem Nowotworów w Polsce w 2002 roku na nowotwory złośliwe zachorowało ogółem 37462 kobiet i 50273 mężczyzn. Przyjmuje się, że ok. 90% tej liczby stanowią raki, pozostałe 10% to chłoniaki, białaczki, glejaki, mięsaki i inne nowotwory złośliwe pochodzenia nienabłonkowego. Wśród umiejscowień anatomicznych nowotworów złośliwych, w których zwykle rozwijają się raki, najczęstszymi są:

 u kobiet:

sutek (12,88%), oskrzela i płuca (12,06%), okrężnica (7,63%), jajnik (5,80%), żołądek (5,54%), trzustka (4,99%), szyjka macicy (4,95%), pęcherzyk żółciowy (3,17%), wątroba i przewody żółciowe wewnątrzwątrobowe (2,74%), odbytnica (2,64%), nerki (2,36%), trzon macicy (2,02%), pęcherz moczowy (1,37%);

 u mężczyzn:

oskrzela i płuca (33,20%), żołądek (7,56%), gruczoł krokowy (6,94%), okrężnica (5,90%), pęcherz moczowy (4,12%), trzustka (3,86%), krtań (3,06%), nerki (2,96%), przełyk (2,48%), odbytnica (2,47%), wątroba i przewody żółciowe wewnątrzwątrobowe (2,02%), odbyt i kanał odbytu (0,90%).

Częstość występowania i proporcje zachorowalności na raka w poszczególnych krajach różnią się znacznie między sobą. Jest to spowodowane różnicami wieku w poszczególnych populacjach, czynnikami rasowymi oraz zachowaniami kulturowymi i obyczajami dietetycznymi, z których wiele może mieć wpływ na powstawanie nowotworów. Przykładowo w Afryce Równikowej i na Dalekim Wschodzie jednym z najczęściej występujących nowotworów jest pierwotny rak wątroby, a w Japonii i Korei poważnym problemem jest rak żołądka.

Leczenie
Metody leczenia raków są podobne jak w innych chorobach nowotworowych i opierają się na leczeniu:
 chirurgicznym
 radioterapii
 chemioterapii
 leczeniu hormonalnym
 immunoterapii
 terapii celowanej (leczenie biologiczne).

W porównaniu z innymi nowotworami złośliwymi specyfiką leczenia raków jest fakt, że początkowy okres rozwoju choroby można precyzyjnie wyznaczyć (w oparciu o głębokość naciekania w odniesieniu do błony podstawnej nabłonka) oraz to, że przerzuty raka pojawiają się zwykle najpierw w okolicznych węzłach chłonnych, a później szerzą się drogą krwionośną (choć zdarzają się przerzuty odległe już w stosunkowo wczesnych fazach choroby). Implikuje to konieczność dokładnej diagnostyki układu chłonnego oraz usuwanie węzłów chłonnych wraz z guzem pierwotnym.

Leczenie chirurgiczne
Leczenie chirurgiczne jest dotąd uznawane za najbardziej skuteczne w leczeniu raków (z wyjątkiem raków anaplastycznych). Może być planowane jako:
 leczenie radykalne (wycięcie guza w granicach zdrowych tkanek)
 leczenie ablacyjne (zmniejszenie masy guza lub wycięcie przerzutu)
 leczenie paliatywne (operacje podtrzymujące naruszone przez raka funkcje życiowe organizmu chorego, u pacjentów w zaawansowanym okresie rozwoju choroby).

Podjęcie radykalnego leczenia chirurgicznego jest poprzedzone tak zwaną oceną resekcyjności guza, czyli oceną zaawansowania guza w kontekście technicznych możliwości jego całkowitego usunięcia. Z reguły są to pacjenci w stadium zaawansowania (zgodnie z klasyfikacją TNM) od Tis do T2, czasem do T3. Niekiedy zakres zabiegu chirurgicznego bywa ustalany dopiero w czasie trwania operacji z wykorzystaniem śródoperacyjnego badania histopatologicznego próbek tkankowych (tzw. biopsja śródoperacyjna). Podczas zabiegu chirurgicznego wymagane jest zachowanie tzw. "sterylności onkologicznej", tj. takie postępowanie, aby podczas jego trwania nie wprowadzić do krwiobiegu oderwanych komórek nowotworu (mogących przyspieszyć rozwój przerzutów).

Leczenie chirurgiczne bywa uzupełniane terapią adiuwantową. Polega ona na uzupełniającej radioterapii i chemioterapii. Dotyczy ona zwłaszcza tych przypadków, w których stopień zaawansowania guza pierwotnego był na tyle duży, że istnieje poważne ryzyko obecności dotąd nieujawnionych mikroprzerzutów w węzłach chłonnych lub narządach odległych.

Radioterapia

Radioterapia nowotworów jest stosowana u chorych z wykrytym i zlokalizowanym anatomicznie guzem złośliwym. Istotą leczniczego działania promieniowania jonizującego stosowanego w tej metodzie leczenia jest fakt, że do zniszczenia tkanki rakowej potrzeba niższej dawki promieniowania niż do zniszczenia tkanki zdrowej (tkanka nowotworowa jest na ogół bardziej promieniowrażliwa niż otaczające ją tkanki zdrowe). Czasami stosuje się specjalne substancje zwane chemicznymi modyfikatorami promienioczułości, mające na celu zwiększenie indeksu terapeutycznego promieniowania, tj. na zwiększeniu promieniooporności tkanek zdrowych (używanym radioprotektorem jest amifostyna) lub zwiększeniu promieniowrażliwości tkanek rakowych (np. przez podanie metronidazolu). Źródłem promieniowania mogą być: lampa rentgenowska, akcelerator liniowy oraz pierwiastki i izotopy promieniotwórcze. Wyróżnia się trzy główne metody radioterapii onkologicznej:
 teleterapię – źródło promieniowania jest umieszczone na zewnątrz ciała chorego (z reguły leczenie jest prowadzone z kilku pól zewnętrznych), a wiązki promieniowania są tak dopasowywane, aby rozkład izodoz kumulował się w miejscu guza;
 brachyterapię – źródło promieniowania (najczęściej izotop promieniotwórczy) jest umieszczane w obrębie tkanek rakowych (terapia śródtkankowa), jamach ciała (terapia śródjamowa) lub na powierzchni ciała (terapia kontaktowa);
 terapię izotopową, polegającą na podaniu dożylnym lub doustnym izotopu promieniotwórczego, który jest wybiórczo wychwytywany w określonym narządzie. Stosuje się ją w takich nowotworach, w których podany pierwiastek kumuluje się w określonych tkankach – należą do nich przerzuty raka stercza do kości (podaje się stront 89) oraz rak pęcherzykowy tarczycy (podaje się jod 131).

Radioterapia może być stosowana jako samodzielna metoda leczenia onkologicznego lub w połączeniu z leczeniem chirurgicznym lub chemioterapeutycznym (leczenie skojarzone).
W przypadku połączenia radioterapii z leczeniem chirurgicznym guz może być napromieniany przed operacją (chodzi tu zwłaszcza o zmniejszenie masy guza i ułatwienie techniczne podczas zabiegu) lub po operacji (zniszczenie pozostałości nowotworu i zniszczenie mikroprzerzutów). Radioterapia paliatywna jest stosowana w nieoperacyjnych przypadkach raków i ma na celu zmniejszenie dolegliwości u chorych z zaawansowaną choroba nowotworową.

Chemioterapia

Leki przeciwnowotworowe używane w chemioterapii nowotworów mogą być podawane metodą perfuzji narządowej lub stosowane ogólnoustrojowo (często uzupełniane leczeniem hormonalnym). Leczenie perfuzyjne ma obecnie małe zastosowanie (zwłaszcza w przypadkach raków), ale bywa stosowane w przypadkach złośliwych guzów kończyn (eksperymentalnie także w guzach wątroby). Podobnie jak radioterapia, chemioterapia może być samodzielną metodą leczniczą, uzupełnieniem leczenia chirurgicznego lub radioterapii. Chemioterapia paliatywna ma na celu zmniejszenie dolegliwości u chorych z zaawansowaną choroba nowotworową. Leki przeciwnowotworowe są bardzo różnorodnymi pod względem chemicznym substancjami oraz o rozmaitych mechanizmach oddziaływania cytotoksycznego. Najczęściej ich lecznicze działanie polega na blokowaniu cyklu komórkowego, działaniu antyangiogennym, hamowaniu syntezy białek.

Hormonoterapia

Jako składnik leczenia ogólnoustrojowego hormonoterapia ma zastosowanie zwłaszcza w przypadkach raka piersi, raka gruczołu krokowego, nowotworów gonad i raka trzonu macicy. Są to tzw. nowotwory hormonozależne, tzn. takie, dla których rozwoju niezbędny jest odpowiedni dla nich stan hormonalny organizmu. Pierwowzorem leczenia hormonalnego nowotworów jest kastracja.

Immunoterapia
Do niedawna immunoterapia nowotworów polegała głównie na stosowaniu środków wzmacniających naturalną odpowiedź immunologiczną organizmu chorego na obecność obcej immunologicznie tkanki, jaką jest tkanka rakowa. Nową metodą leczenia nowotworów, stojącą na pograniczu immunoterapii i chemioterapii jest stosowanie leków opartych na przeciwciałach monoklonalnych. Istotą tego leczenia jest podawanie przeciwciał łączących się wybiórczo z takimi antygenami, których zwiększoną ekspresję obserwuje się w komórkach rakowych.

Chemioprewencja nowotworów
Chemioprewencja nowotworów jest leczeniem farmakologicznym obejmującym wczesne postacie raka (jeszcze na etapie raka przedinwazyjnego). Polega na podawaniu osobom zagrożonym rozwojem raka określonych substancji naturalnych i syntetycznych, co do których istnieją przesłanki, że zwalniają proces karcynogenezy. Stosuje się ją u osób z określonych grup ryzyka rozwoju poszczególnych typów nowotworów. Na razie metoda ta jest w fazie testów i gromadzenia obserwacji z już podjętych programów badawczych.

Zobacz też
 rak śródnabłonkowy
 apoptoza
 markery nowotworowe
 onkologia
 chemioterapia nowotworów, radioterapia, immunoterapia nowotworów

Bibliografia

 Jak żyć z rakiem i go pokonać. Carl Simonton, Reid Henson, Brenda Hampton, tłum. z ang. Jerzy Morka, wyd. "Ravi", Łódź, 2003, .
 Samolubna komórka. Robert A. Weinberg, tłum. z ang. Anna Tanalska-Dulęba, wyd. "CiS", Warszawa, 1999, .
 Choroba nowotworowa. Michael Whitehouse, Maurice Slevin, tłum. z ang. Bożena Walewska-Zielecka, Prószyński i Ska., Warszawa 1998, .
 Rak – nowotwory a choroby nowotworowe. Rudolf Klimek, Janusz M. Madej, Aleksander Sieroń, Wyd. Krakowskie, Kraków, .
 Onkologia kliniczna. praca zbiorowa pod red. Macieja Krzakowskiego, wyd. "Borgis", Warszawa, 2001, .

Linki zewnętrzne
 Cancer Index – spis witryn przedstawiających dane na temat epidemiologii nowotworów
 Najnowsze terapie przeciwnowotworowe
Zwrotnik Raka - największy portal na temat raka oraz leczenia nowotworów w Polsce

Choroby nowotworowe
Byłe Artykuły na Medal


We are away until 27th April, any orders placed until then will not be shipped until our return. Sincerest apologies for any inconvenience!
Check out the Newton watch by Divided by Zero - one of the favourites in the range. Its design is inspired by Sir Isaac Newton (1642-1727) one of the most well-known thinkers in history.
There seemed little Newton couldn't do. A true workaholic, this English genius made discoveries in mathematics, astronomy, chemistry, physics … and fighting crime (yes).
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As the United States Congress continues to import 1.1 million legal and 500,000 illegal immigrants into this country annually—enormous sociological pressures boil under the surface of America.
Today, women march to oust an elected president, Black Lives Matter march against the very concept of America as well as a separate African state, La Raza advocates for a Mexican nation within America, Moslem Brotherhood immigrants promote Sharia Law to create a parallel society, DACA illegal aliens march for amnesty, and another 20 million illegal aliens demand amnesty for violating America's borders.
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Former Peace Corps worker Karin McGuillan reported on her harrowing experiences in Africa that should sober every American. She said, "I wanted to donate two years of my life to make Africa a better place to live." She relates why we cannot import third world cultures.
Even time passing, immigrants continue their cultural norms. They maintain their foundational habits.
McQuillan decided not to turn her head and look away. She bravely wrote about it. Whether the people of Senegal, Ethiopia, Congo, Sudan or Mumbai, India, or any other third world country—they do not live up to our standards. Sixty percent of Indians do not use a toilet; they use the land. The excrement is the least of it. Our basic ideas of human relations, right and wrong, remain incompatible.
Senegalese consists of Moslems with up to four wives. Girls face having their clitorises cut off at puberty. (Female genital mutilation) Honor killings remain a matter of normal social operation when a woman no longer possesses value to her man. As the United Nations reports on honor killings, 54 women face honor killings daily in Moslem countries. That equates to 20,000 murders annually.
McQuillan witnessed women being worked half to death.
Today, in America, Moslem immigrants continue female genital mutilation by the thousands. America now features honor killings and arranged marriages. Americans have seen beheadings, running over with a car of daughters and be-handings by Moslem immigrants. America faces regular terrorist attacks by Moslem immigrants. The majority of Moslem immigrants live on American taxpayer welfare.
She reported the value system to be the exact opposite of Western countries. You steal everything you can to give to your own relatives. Today, in America, the poor and immigrants, both legal and illegal, shoplift $125,000,000.00 (million) daily, to the tune of $50 billion annually.
In Senegal, corruption ruled, from top to bottom. Go to the post office, and the clerk would name an outrageous price for a stamp. After paying the bribe, you still didn't know it if it would be mailed or thrown out. The same occurs in South America as I traveled there on my bicycle for a year.
If you look at what happened to Detroit, Michigan, corruption from the top down destroyed the fabric of that once thriving city. Within 20 years, 1.2 million residents fled Detroit. Today, it resembles a bombed-out war zone. I worked in Detroit from 1977 to 1991 to witness it firsthand.
McQuillan thought the Protestant work ethic to be universal. It's not. Her town filled with young men doing nothing. The more she worked there, visiting government officials did nothing. A job provides the place where you steal everything to give back to your family.
Democrats lecture us that we must import third-world immigration by the hundreds of millions with chain migration. They tell us we must end America as a white, Western, Judeo-Christian, capitalist nation – to prove we are not racist. Leftists want open borders because they resent whites, resent Western achievements, and hate America.


Sanctuary by Edith Wharton now in post production!
Lee Ann is happy to announce that her recording of Sanctuary by Edith Wharton is now in post-production. The audiobook should be available in a few weeks on Audible.com Please check this site for updates.
Posted by lahowlett on January 23, 2014 in Uncategorized and tagged American literature, Audible.com, audiobook, Edith Wharton, Literature, Sanctuary.


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