her up to her face, emphasizing the whiteness of her skin.
possible for a human being to feel such pain and not die.
Maybe he could die too. How could God have let this happen?
knew anyway. He turned toward her. He touched her cold face.
answer. He wasn't aware that the doctor had said anything.
looked up at the doctor.
here nearly 24 hours. You've got to go home."
said, putting his face in his hands once again.
will need you back home."
"Then what?" said Peter, looking intently at the doctor.
upon, if we can locate him. Do you know him?"
"Has anyone let him know?" he asked.
memory. He leaned down and kissed her face. "I love you,"
Peter walked down the road. He couldn't take the car home.
tears fell. He hardly noticed them.
wished that he was at the bottom of it.
as often as a doctor.
straightened and smoothed the sheet. Too bad, he thought.
"I love you," he had said.
The doctor came up to him. "Who are you?" he asked.
"The priest did?" asked Leo.
for a long time. Nearly 24 hours."
couldn't pray. The tears fell down his face untouched.
Peter just stared at the statue.
Peter wiped his mouth on his sleeve.
accident." Peter had no energy for this.
"What did you do? Take her behind the statue??? "
"Stop," Niamh yelled. "Are you trying to kill him?"
was holding Leo's head and patting his face.
"I'm ok, Niamh," Leo said, starting to get up.
Leo turned to Peter. "I want you to tell me the truth."
"I'll try," said Peter, wiping the blood from his mouth.
Peter looked down and then back up at Leo. "Yes."
....Yes, I think she did."
"And when she married me?" asked Leo.
"I don't know, Leo, she never said."
what it was. As he walked into the room, he glanced at her.
very beautiful. The skin on her arm was smooth and white.
Again! He had straightened the covers on her once before.
He turned around and walked over to her. He felt her neck.
couldn't tell. He rushed out of the room.
heartbeat. It was faint, but it was there.
He remembered how she avoided talking to Father Clifford.
road. He heard the thick sound of a car door closing.
"Father," said Niamh. "Father, come here."
him and put her arms around him. "I'm so sorry, Peter."
ago, when I found a pulse. No, we didn't do brain waves.
some food, and then some sleep."
of the window. He could see Fitzgerald's across the street.
asked, still staring out the window.
Ambrose opened the door to Fitzgeralds. It was dark inside.
He heard the whining. They had all forgotten about Fionn.
door. As he stepped outside, he met Padraig.
"Town is kind of quiet, yeah."
"Yeah," he said, nodding his head.
"Leo, was here," said Ambrose.
patted him on the back.
"Let me know about the funeral," said Padraig.
ambulance first. "This is the one that was electrocuted."
"What's the name?" asked the doctor.
hours," he said, by way of explanation.
The doctor just shook her head.
"Take this one up to ICU, STAT," she ordered.
"Where's the family?" she asked.
number. I guess they were separated," the aide commented.
"No other family?" she asked.
and the laughter. And the fights. Niamh cried, remembering.
was her best friend. How would she live without her?
and hanging up the keys.
"Asleep, also. Finally," she added.
kitchen he reached for the keys.
just as it was left.
pub to be left this way.
was in and out so fast and didn't leave a phone number.
the 26th. If you need me, call me at the convention center.
Ask Mary what the number is.
"Get in touch with the priest and tell him what?"
read for a minute. She patted the woman's hand and left.
Clifford," he called. He heard some noise in the kitchen.
saw Peter stacking some boxes in the corner.
Peter turned around. "Yes," he said.
Peter didn't comment. "What can I do for you, Father?"
Peter could hardly believe what he was hearing.
"Father..I'm not going to discuss this right now."
going to make any decisions at this point."
"Well, when can we expect to know what your decision is?"
Father Mac asked, getting a little red in the face.
was here. Her handwriting was everywhere.
had any other relatives, besides her husband."
"Thank you, then," said the man.
needed to be near her. He went in.
to go through the rest of his life?
He heard the pub door close. He walked down the stairs.
Padraig was standing there. "Father," he said.
"I went over to see her this morning and she wasn't there.
"Let's see, what was his name?"..Carter?..Clifford?
dialed again. A voice said ..
"Fitzgeralds." "This is Peter Clifford."
"Yeah, I AM Father Clifford."
Oh, God, was that possible? "Where?" Oh, God.
didn't knock, but just opened the door and ran in.
Peter and Niamh came running out. They got into her car.
"Tell me what he said," she demanded.
"I told you. She is in Dublin."
"Assumpta McGarvey," he said, trying to catch his breath.
Niamh ran in behind him. "Is she here?" she asked him.
The lady at the desk said "Here she is. Second floor, ICU."
closely behind him barely got there before the door closed.
nurse said "Are you family?"
Peter and Niamh looked at each other.
"Come this way," she said.
pounding. Niamh was the first to see her.
for him. He couldn't speak. He slowly sat down beside her.
this was a dream. NO. It was too real.
"Are you friends of hers?" asked the Doctor.
Peter said nothing. He just held her hand.
He still couldn't believe it. She was here. She was alive.
the tears coursed down his face.
"Is that her husband?" the doctor asked.
"No," said Niamh. "He's her friend."
will ever come out of it. I just wanted you to know that,"
beside her head. His hand held hers. She understood.
would even remember her. She would come back to this later.
so happy. It was like waking up from a horrible nightmare.
hours a day, and besides, it was obvious that he loved her.
saying and feel, as well."
christening. I heard that you will be doing it here."
right here, where Assumpta can be with us also."
"Then what are you going to do?" Michael asked him.
"I mean, what are you going to do about the priesthood?"
"It's good to see you smile again," Michael said.
"It's good to be able to. God, what a close call that was."
Michael nodded. "What about the pub?"
talking might be good for Mrs. McGarvey."
Peter hated to hear her called that. But that was her name.
that it wouldn't matter what program was on.
Leo. He had no idea where to find him.
some things and handing them to Niamh.
message for him to call me if she heard from him."
family. He had plenty of family. Brothers and a sister.
Several cousins. An old aunt. He intended to be her family.
died, he would stay with her.
bar. The pub door opened.
"Not just a small one today?"
the food fair," Padraig said.
"What do you want?" she said, resignedly.
when Assumpta is coming back?"
"No, Eamonn, I don't know. She is still unconscious."
that Italian soap opera again.
Siobhan walked in. Niamh took a deep breath.
"What is everyone doing here? How is Assumpta?"
homes to go to, and Assumpta is the same."
sitting.. Another day of job hunting. Well, what do I say.
"Hi, Peter," said the nurse.
walked over to it and snapped it off. The doctor walked in.
wondering if you would want to take her home?"
"What?...Take her home?" he stammered.
"Yes, what do you think?"
"That would be great?......Wouldn't she need......?"
general care...but other than that, you can do it."
surroundings, she may do even better," he said, excitedly.
physically strong, I think it would be a good idea."
Peter was already on the phone, dialing Niamh.
"Yeah, Peter, is everything ok?"
"I'll say. The doctor says I can bring her home next week."
"Of course, I take care of her now almost totally."
"But what about the IV's?"
"We'll arrange that before we get there. Don't worry."
could hear the clapping and the hurrah's.
The phone rang. Peter picked it up. "Hello."
"Thanks for the card. I appreciated it."
take Assumpta home next week."
"No, I haven't had much luck finding a job here, anyway."
"I've only been out a few times."
"I don't know. I guess I will take care of the pub."
"Yeah, well tell everyone, will you?"
her face and kissed her cheek. How he loved her.
"The story.... of you and Assumpta? I am very intrigued."
a long story. About three years long," he said, smiling.
"Well, I'm off duty now, so maybe you could start it?"
his voice to break up.
witnessed this love and devotion that she had seen.
share that story with me.
"Anne, without you, none of this would have been possible,"
he said, with tears in his eyes.
sitting in his pram. "I'll be glad when Peter gets here,"
trying to talk and watch the show.
"Do you think she will ever get well?" Ambrose asked.
"I pray every night, and light candles everyday," she said.
"Niamh," Ambrose called excitedly. "Niamh!!!"
Niamh looked at Ambrose. "What happened?"
good priest. He had seen plenty of the other kind.
"Assumpta, you're home," she kept repeating.
come every day and make sure everything was fine.
about Leo. "Are you sure it was him?" Peter asked.
when he needed to be near her.
The pub was dark and quiet. This was the first night home.
the morning, to change her IV's. He knelt at her bedside.
before. He pushed his bed closer to her's.
so very grateful that she was alive.
Peter jumped up and went over to her.
"Yes, sweetheart, it's me," he said, his heart pounding.
"What a strange dream!" she said, lying back down.
The sound of her voice was like heaven to him.
was very quiet and very beautiful. I walked for a long time.
your voice talking to me...."
"You said, =91I love you'.
he said there it is.....and I looked and there was the pub.
As I turned back to thank him, he was gone..."
"Peter, where am I. What has happened?"
"Oh, God, Assumpta, what do you remember last?"
knees by her bed. She reached over and touched his face.
"So what happened to me?" she asked.
"Stay here by me," she whispered.
"I'll never leave you, Assumpta," he said.
"Oh God, I can't sit here for one more minute," she said.
"You have to," he said, smiling at her.
He stopped clearing the bar and walked over to her chair.
He leaned over and took her into his arms and lifted her up.
her on a bar stool.
"Please, please, let me do something," she cried.
"Okay," he said. "Wait here."
He returned with a basket of towels. "Fold these," he said.
would throw something at him. She took another deep breath.
The pub door opened. "Hey girl," said Niamh.
doubling my work load," he said, smiling at Assumpta.
A towel went flying past his head. "See what I mean?"
"Well, I'm here to take her off of your hands for awhile,"
Niamh said, walking over to get her jacket.
I thought we would go for a short walk.
"Yes!!" Assumpta said, staring victoriously at Peter.
"She can't walk far," he said.
"I know, I know," Niamh remarked.
her cheek and said, "Behave."
the door to the pub.
of white clouds floating in it. Niamh held on to her arm.
"I wish he wouldn't baby me so," she said.
that she cared for Peter. She couldn't even describe that.
"OK," she said, the breeze dancing through her hair.
garbage when he isn't looking," they both laughed.
A car came by and stopped.
"Well, you're looking good today, Assumpta," said Doc.
Ryan. "How are you feeling?"
"Great," she said, smiling at him.
Assumpta looked at Niamh. "See," she said.
Father Aiden's bike hit a rock and it wobbled dangerously.
"Be careful, Father," yelled Niamh, from across the bridge.
"Just out for a walk, Father," said Niamh.
to Peter, that she couldn't help herself.
"Just practicing for the marathon, Father,"she said.
joking. He laughed. "Well, don't overdo it," he said.
in the middle of the night. Peter was no longer in her room.
cup of tea sounded good.
"God, I thought I was being quiet."
"I heard a stair creak," he smiled.
"Boy, I can't do anything without getting caught," she said.
He smiled and leaned down and kissed her mouth.
"Want some tea?" she asked.
"Do you remember a dream at all?"
"No, I just sit up and I realize that I'm frightened."
"Dr. Blake said that you may have some trouble sleeping.
Maybe that's what she meant."
He looked at her. The look on his face made her laugh.
"I'm not joking. I miss you being there in my room with me.
me, but I have been waiting until you are well."
"How much more well, do I have to be? I am well," she said.
"Assumpta, will you marry me?"
you want me to. Tonight, even," she hugged him and laughed.
do you want to sleep?"she asked.
"I don't care. Which one do you want?"
"Then your's it is," he said, looking over at her.
"I just unpacked it," he said. "It's my mum."
"I've seen her before," she said.
"I don't think you could have," he said, shaking his head.
very soft... I don't remember what she said."
"It must have been someone else," he puzzled.
came in followed by Father Aiden.
Outside, the sun had set and the evening stars were out.
The sound of music and laughter...and love.


text:
On the Contraband Trail With Libya's Gun Smugglers
On the porous desert border with Egypt, guns, cash and other illicit goods flow from Libya's lawless frontier toward buyers in the Middle East.
Peter Schwartzstein
Kevin Frayer/AP
Trans-Sahara smugglers are a bold bunch. Offer them a tank to ferry over the Great Sand Sea's 50-meter-high dunes, and they'll promptly lop off its barrel, remove its tracks and set about slicing its body into car-sized portions.
In this instance, noted early last year, they had to admit defeat. The tank, which had been liberated from Qaddafi's arsenal, remained in Libya. But they've enjoyed plenty of success in passing more portable weapons, drugs and other illicit goods across the Egyptian border.
This flexible attitude to national sovereignty is, of course, no recent phenomenon. Bands of Bedouin and Berber tribesmen, who dominate the trade, have long wandered across the porous frontier with relative impunity. But the evolving nature of their cargo, along with increased sums of money involved and the state of post-revolutionary disorder across North Africa, have raised the stakes and trained the spotlight on a previously overlooked business.
In Siwa, a picture postcard Egyptian oasis 40 kilometers shy of the Libyan border, regional upheaval has been kind to the town's opportunistic smugglers.
"Things are good, the money is good, life is good," chuckled "Ali," a young member of the Ain Shafi Bedouin clan, which has assumed a prominent role in running guns to Cairo's eager buyers. (He spoke by phone, after neglecting to meet in person.)
A fear of the authorities once restricted him to transporting luxury car parts and cheap Chinese-made cigarettes—many of which market themselves as Marlboros and contain more tar and a smaller filter— but come 2011, the authorities melted away and with them went Ali's and his family's inhibitions.
Three times last year he traveled to Libya to take advantage of its ready supply of armaments; and propelled by Egyptians' mounting appetite for personal guns in an uncertain political atmosphere, his clan now sticks to serious contraband.
Ali can scarcely conceal his delight with this change of circumstances. Car ownership is the principal means of gauging success within his circle of friends, and his increased earnings mean he'll be able to afford a prized 4x4 much sooner than expected. "You're a loser if you don't have a Land Cruiser," he joked.
Unsurprisingly, officials in Cairo don't share his joy. The Islamist insurgency in the Sinai Peninsula is fueled, in part, by Libyan arms, and with Egypt's security apparatus busy re-imposing its will after the Muslim Brotherhood's yearlong rule, this continuing gun flow is a major threat to its authority.
Libya's tottering central government can't provide the cross-border cooperation it once could either. The country's struggles have rendered Tripoli powerless to patrol the vast, sparsely populated interior, and in its absence, a patchwork of militias and criminal gangs has provided a largely untroubled staging point for smuggling operations.
Egypt's vaunted military is still a fearsome adversary, and if Ali Ain Shafi's brother, who gave his name as Rustum, is to be believed, they've successfully blocked off some smuggling channels on their own. "People aren't going by sea now. There are too many ships," he said, speaking of the previously well-trodden maritime hop across the border from the eastern Libyan port of Tobruk.
Egyptian officials are, nevertheless, acutely aware that many routes remain open and are keen to stress the near-impossibility of completely stifling smuggling. "Our border is very long. No country can secure its border 100 percent," said a senior officer in the Ministry of Defense, who spoke on the condition of anonymity.
At the same time, interim government and military officials alike are at pains to emphasize the seriousness of their response. "We're using all our effort. Everyday, 24/7, we're arresting and seizing a lot of drugs," the same officer said.
Certainly, the army has arrested some smugglers—many of whom are serving three- to 10-year sentences in Marsa Matruh's notorious prison, 300 kilometers northeast of Siwa on the Mediterranean—but thus far, the results of its crackdown are unconvincing.
Siwa's smuggling has declined from its 2011 peak, but several hundred of its roughly 23,000 inhabitants are still associated with the trade in some capacity.
The military has, on occasion, hit upon winning—if brutal—tactics.
Earlier this year, army Apaches shot up several convoys that refused to stop while navigating mountainous dunes near the border. A few passengers were killed, and a number of other smugglers were sufficiently spooked as to ditch their work for less perilous professions.
Since then, however, the helicopters have remained grounded, and Siwa residents can only speculate as to why.
"Maybe they are tired. It costs the army a lot of money," suggested Abdulla Yosef, whose crafts shop lies in the shadow of Siwa's stunning 1,000-year-old mud-brick fortress, less than mile away from where several choppers bristling with weapons sit idle on an air base strip.
The military continues to throw up new obstacles, but for every complication, Siwa's smugglers cobble together a solution. When a big cache of weapons is inbound, rival outfits often gang together to disperse the load among their safe houses. When army convoys set out to patrol the desert, there's a stooge stationed outside the base waiting to call in the possible threat.
"If they're in 4x4s, where else would they be going?" Abdalla reasoned.
A lack of imagination also appears to have haunted the army's approach. After the military took to raiding the townhouses of known smugglers last year, residents complicit in the trade simply shifted their stock to the farm outhouses tucked amid the oasis' sprawling olive and date palm plantations.
More damningly still, the effortlessness with which smugglers dodge checkpoints, dreamt up when the army threw four barriers across the road to Marsa Matruh, is almost comic."Ten kilometers before the checkpoint, smugglers go off into the desert and then just rejoin the road afterwards," said Abdalla, laughing.
It's not a foolproof means of negotiating the lone paved road out of Siwa—"reconnaissance" cars are sometimes dispatched ahead to guard against surprise stops—but the Ain Shafis have found it an effective means of getting their goods to coastal Matruh, where they hand their loads over to other gangs (both brothers insisted they never know where their loads end up).
The army has devoted plenty of manpower to aid its efforts—there are nine military installations in and around Siwa—but some Siwan Berbers insist it's no mystery as to why the central government's onslaught has struggled to gain traction.
"Our society is us and the Bedouin. The Egyptians only came into our lives 20 years ago. We don't know them," said Ismail Snosy Gagy, who works for the U.N. in Cairo.
Siwa's fantastically isolated location, nestled amid 300 natural springs, has spawned a surprising series of traditions—among which are a partial acceptance of homosexuality and a prohibition on women driving. But its differing ways have, on occasion, also set it against Egypt's governments, which have had a poor record of catering to the country's minorities.
The Berber language is still banned in schools and public buildings, while few Berbers are deemed fit for government jobs beyond Siwa (where low-level roles command a salary of 600-700 Egyptian pounds a month, which is not enough to live on).
One role the desert-dwelling Bedouin and Berbers would be perfectly suited to is aiding the army in its frontier patrols. "We know this area better than anyone," Rustum Ain Shafi said, in explaining his success in traversing the Sahara's inhospitable terrain.
Once again, though, the authorities appear to have shot themselves in the foot by refusing to tap Siwan strengths. "They don't trust us because we're on the border," Snosy Gagy said.
Military officials are dismissive of the necessity of desert expertise and say they're managing just fine. "We have GPS. All vehicles have GPS," the Ministry of Defense source said.
But Siwa residents' many tales of oblivious army drivers marooning their jeeps in the sand tell a different story.
Egyptian authorities do have some reason to doubt Berber and Bedouin loyalty. Many Siwans identify much more closely with nearby Libya—often training their radios to its romantic music stations, while close familial links with tribesmen across the region ensure they're likely to continue treating national boundaries as arbitrary lines on a map.
But many Egyptians have never tried to make Siwans feel welcome—Snosy Gagy was recently detained by police suspicious of a Berber's presence far from home, and with the continued refusal to build a border crossing near Siwa, local Bedouins and Berbers must trek 650 kilometers to the coastal crossing to legally access the nearest cities of any serious size.
Few would underestimate the magnitude of the army's mission. The desert is vast and the riches are such that ambitious young men deprived of attractive employment options will forever be enticed by smuggling's quick bucks.
But Egypt is complicated enough without rampant gun ownership, and the implications of unremitting smuggling are enough to give even the Ain Shafis pause.
"Chaos isn't good, but we need to live," he said, in a rare reflective moment.

redpajama_set_name: RedPajamaCommonCrawl


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text:
Business Daily Media
The top 6 things to do in Melbourne
There is something for everyone in Melbourne, whether you're on a luxury vacation or a backpacking trip worldwide. It is impossible to get bored in this city! Melbourne is also just a short distance from the county's natural beauty and wildlife. Being the cultural capital, Melbourne is full of attractions, museums, restaurants, nightlife, and lots of outdoor activities.
Throughout the state's coastline, whale-watching opportunities abound. As a visitor to the town, there are many adrenaline-pumping activities for all ages to choose from. Here is a list of things to do while on vacation in Melbourne city.
Visit the royal botanic gardens in Kew
The royal botanic gardens are a peaceful respite from the bustle of the city. It covers 94 acres and has nearly 50,000 plants, both native and non-native. Enjoy the fresh air by taking a stroll down the Tan, a popular walking path in the area. Evening activities such as heritage walks, wellness experiences, and movie screenings are regularly held in the gardens. Royal Botanic Garden is located on the YarraRiver's south bank.
Take a hot air balloon ride over the city skyline
Melbourne is one of the few major cities that offer the opportunities to fly in a hot air balloon. You can get a bird's eye view of the Royal Botanic Garden and the Yarra River from the air on a sunrise tour. Melbourne is one of the world's most fascinating cities, and ballooning is a great way to see it all from a new perspective.
Climb the Eureka Sky-deck
If you want to get a bird's-eye view of the city from above, the Eureka Tower observation deck is the best place to do so. It is the highest in the southern hemisphere and is nearly a thousand feet above the bustling of Melbourne. It also offers a breathtaking 360-degree view of the city and the Fitzroy Gardens urban oasis. It'll be an incredible experience to try it out if you're a daredevil or a thrill-seeker.
Play casino games
Melbourne boasts a plethora of casinos that compete fiercely with one another as well as with casinos from around the world. In Melbourne, there are a variety of casinos to choose from, with more than 50 live poker tables. If you visit Melbourne, you must visit at least one of these casinos to have an amazing experience, not only to play but also to enjoy the experience. There are also a list of top online casinos to try your luck in.
In Melbourne, the following locations are the finest for casinos and gambling: Flemington Racecourse, Crown Casino, and Moonee Valley Racecourse are all located in Melbourne, Australia.
Visit a chinatown BYOB restaurant
If you're on a tight budget while visiting Melbourne, consider dining at a BYOB restaurant in Chinatown. Here you are spoilt for choice. It deals for large groups because shanghai village dumpling serves 15 dumplings for 7 dollars. At juicy Bao, you can enjoy a more intimate dining experience with an extensive menu of pork belly, squid in the shell, and bao buns.
Attend an AFL match
AFL (Australian Football League) was formerly known as VFL (Victorian Football League). The rules of the Australian game founded in 1859, football has been named Australia's most popular sport ever since. Rugby-style oval balls and modified cricket pitches are used to play the fast-paced game, similar to Gaelic football for the uninitiated. In Australia's first city, the Australian football league still has its headquarters.
In addition to the list of things to do while in Melbourne, do not forget to visit the casino for a night of fun. Casinos aren't just about the games; they are also about dining, nightlife, and live entertainment that can be found there. It is a great place to enjoy a nightcap while observing the passing crowd. Melbourne's crown casino is a must-see attraction.
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This isn't art, but it's about an art student. A climbing wall was erected in the middle of LMC as Nov 13 as part of a health fair the college hosted. Erica pretty much smacked down anyone who thought they could scale it faster than her. That's because art students are, well, the best.


After my first semester of college in December 2013, I remember sharing confusion with a friend: Weren't college students supposed to be political? It had been four months, and even though we read our student newspaper every week, we hadn't encountered a single student-led march, sit-in, or protest of any kind. Initially, we blamed this on the culture of our isolated state school, but began to notice that, aside from the occasional divestment rally at a liberal arts college, there was very little going on at universities nationwide.


Endometrial cancer is the most common gynecologic malignancy in the United States with approximately 60,000 new cases and 10,470 deaths per year. The majority of women with endometrial cancer (approximately 80%) will present with early-stage disease and a favorable histologic subtype, and they will enjoy excellent outcomes. However, 10% to 15% of women will present with uterine papillary serous carcinoma (UPSC) or clear cell carcinoma (CC).
While these particular histologies represent a rather small number of cases, they are responsible for a disproportionate number of the deaths (approximately 40%) related to endometrial cancer. One study showed that CC carcinoma accounts for about 3% of all endometrial cancers, but accounts for 8% of all endometrial cancer related deaths. For UPSC, these numbers are 10% and 39%, respectively. This is in part to due to the more advanced stage of disease at the time of diagnosis, the aggressive histology, and lack of effective therapy.
The most common symptom of women diagnosed with UPSC, as is for women with endometrial cancer in general, is postmenopausal vaginal bleeding. This should prompt an endometrial biopsy. Often times, the diagnosis of UPSC is not made at the time of endometrial biopsy, as it may be admixed with another histologic subtype, such as a grade 3 endometrioid or clear cell carcinoma.
From a demographic perspective, women with UPSC tend to be older than women with the endometrioid histology. There also appears to be an increased risk in African American women as compared to other racial groups. Women with a history of breast cancer may also be at an increased risk for this disease and in some studies tamoxifen use has been associated with an increased risk of UPSC. However, this has not been a uniform finding in the literature. Emerging data suggests that there may be an association between BRCA1+ status and UPSC. This change in knowledge will have significant implications regarding risk reduction surgery for women who are BRCA1+.
A precursor lesion for UPSC has been identified. Endometrial intraepithelial carcinoma (EIC) has been seen in the majority of uteri with UPSC. However, in contrast with other precursor lesions, this lesion itself may be associated with metastatic disease at the time of presentation. So while it is a precursor lesion, it may not present clinicians with the opportunity to intervene with therapy prior to advanced disease.
While data and studies are limited with UPSC, they are even more limited in the setting of CC carcinoma of the uterus. It often times is "associated" with UPSC, so they are often treated in a similar fashion.
The most common symptom of women diagnosed with CC, is postmenopausal vaginal bleeding. Less commonly, it may also be diagnosed subsequent to an abnormal pap smear. Endometrial biopsy or other forms of endometrial sampling typically is accurate in making the diagnosis.
As with UPSC, there is an association with a personal prior history of breast cancer. It may also occur with increased frequency in women who have undergone pelvic radiation for another condition and subsequently develop an endometrial cancer.
The diagnosis of UPSC is typically made after a woman presents with postmenopausal vaginal bleeding. Endometrial sampling by any method (office endometrial biopsy, D&C, etc.) will typically make the diagnosis of an endometrial cancer, though UPSC may frequently be admixed with other histologies. Studies have shown that even when UPSC contributes to a small fraction of the total tumor (<10%), it may drive the presentation and prognosis for that patient. Endometrial biopsy, including office biopsy with a Pipelle, has a sensitivity of over 99%.
Ultrasound may not be as reliable for UPSC as it is for the endometrioid histologies. For type I endometrial cancers, an endometrial stripe thickness of 5 mm or less is reassuring with a sensitivity of 96% and a specificity of 61% for endometrial cancer. However, for women with type II endometrial cancers, 42% of the women who were subsequently diagnosed with an atypical histologic subtype had an endometrial stripe thickness of 5 mm or less. So caution must be exercised; in any women with postmenopausal bleeding, endometrial sampling should be obtained.
The use of preoperative CT scans has been evaluated in a study of women with endometrial cancer. In this study, preoperative imaging altered a patient's management in only 4% of cases. However, for women with high-risk histologies, including UPSC, the CT results altered the planned management in 11% of cases. Therefore, there may be some utility in obtaining preoperative imaging, particularly in those women who have signs and symptoms of metastatic disease. At our institution, we typically do proceed with preoperative imaging in women with UPSC and CC.
CA-125 is a tumor marker that is routinely obtained in women with ovarian masses that are worrisome for carcinoma. There is some data suggesting that CA-125 may be useful in endometrial cancer as well. CA-125 may also be a useful marker in following women with UPSC for recurrence after surgery and/or adjuvant therapy. One study of women with UPSC did show that a preoperative CA-125 correlated with the disease stage at the time of surgery and was predictive of death.
UPSC was first described in the 1980s. These tumors are characterized by a complex papillary architecture, broad fibrous stalks lined with a stratified epithelial lining, tumor necrosis, increased mitotic figures, and increased nuclear-to-cytoplasmic ration. Thirty percent of cases may also have psammoma bodies, which are often seen in papillary serous ovarian cancer.
CC may exhibit a wider variety of histologic characteristics. The papillary form of CC is the most common. Other types include tubulocystic or solid. Common features include intraluminal mucin and intracytoplasmic vacuoles. These tumors are typically estrogen receptor and progesterone receptor negative (as is UPSC). p53 staining is less common for CC than UPSC and can be used in differing the two histologies.
A. What therapies should you initiate immediately (i.e., emergently)?
There are no emergent management strategies for UPSC and CC carcinoma, but surgery should be the initial approach in those patients who can undergo operative interventions and whose disease appears to be resectable. Optimal resection of women with UPSC has been associated with improved outcomes. These women may be candidates for minimally-invasive surgery, with its associated improvements in complication rates.
While UPSC and CC are clearly different histologic subtypes, they have not been exhaustively studied in a prospective fashion. This is due to their relative rarity. In addition, the majority of retrospective published work has dealt with UPSC, as it is the more common of the two atypical histologies. Often time, a woman's tumor will also be mixed, containing variable percentages of grade 3 endometrioid, UPSC, and/or CC. For this section, the writer will combine the two histologies. While the author admits that there are differences between the two tumors, they will be presented together and only those areas that may clearly be divergent will be highlighted. We anxiously await data from two prospective Gynecologic Oncology Group trials (GOG-249; GOG -258), which will hopefully help guide future treatment for women with early (GOG-249) and advanced (GOG-258) UPSC and CC carcinomas.
Women with both UPSC and CC carcinoma may present with extrauterine disease, even in the absence of traditional risk factors for metastatic spread, including deep myometrial invasion, lymphovascular space invasion, and cervical involvement. For women with UPSC, 20% to 25% of women will have metastatic disease even with stage IA endometrial disease. However, this is based on the older FIGO staging. Therefore, this means that even in women who have no evidence of myometrial disease, they can have metastatic disease 20% to 25% of the time if comprehensive surgical staging is undertaken.
In the one study specifically evaluating this issue for CC cancer, they found that 52% of the women who had disease "confined" to the uterus had metastatic disease at the time of surgical staging. Therefore, most would agree that these women should be comprehensively surgically staged. This would involve total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymph node dissection. Due to the propensity to spread through the abdominal cavity like advanced ovarian cancer, many gynecologic oncologists would also sample the omentum or perform an omentectomy. One group has shown that in the absence of gross visible omental disease, performing an omentectomy rarely altered clinical management decisions and could be left out of the staging procedures.
With the advent of minimally invasive surgery in endometrial cancer, the issue of adequate staging for these tumors has been raised. In a prospective study conducted by the Gynecologic Oncology Group (GOG), which evaluated laparoscopy versus laparotomy for the staging of women with endometrial cancer, women with UPSC and CC were included. While they represent a smaller percentage of the patients in this study due to smaller incidence or enrollment bias, there did not appear to be an obvious negative impact to these patients undergoing minimally invasive surgery.
Retrospective trials evaluating minimally invasive surgery for UPSC and CC have similarly not shown any obvious adverse effects to offering these women traditional laparoscopy or robotic assisted laparoscopy. The majority of the robotic data is from retrospective or prospective single institution studies; however, it would not seem reasonable to expect that robotic assistance would have any detrimental effects over standard laparoscopy. In fact, lymph node yields, hospital stay, estimated blood loss, and complications appear to be more favorable with the robotic platform as compared to standard laparoscopy.
There is little prospective data currently available to help guide therapy for women with this disease. Data is emerging as the Gynecologic Oncology Group (GOG 249) conducted a trial evaluating the issue of adjuvant therapy in women with high-risk early-stage disease, which is clearly the category that women with UPSC and CC fall into.
For women with Stage IA UPSC (no myometrial invasion) who do not undergo postoperative therapy, the risk of recurrence without postoperative therapy can range up to 30% depending on the study, with a cumulative risk of about 14%. With radiation this risk is 28% (range 0% to 50%); with a combination of chemotherapy and radiation, the risk is 6% (range 0% to 17%). One recent study showed no difference in 5-year overall survival for women with stage IA: 80.2% for adjuvant therapy and 79.8% for no adjuvant therapy. However, this included women with myometrial invasion to <50%. In one study with 22 women with no myometrial invasion, there was only a 5% risk of recurrence in the untreated population.
The GOG did complete a prospective trial of 21 women with early-stage UPSC who underwent whole abdominal radiation. Of the 19 women who were evaluable, 8 women died of a disease recurrence with over half of the recurrent sites occurring in the radiation fields. The authors concluded that chemotherapy should be considered in this patient population.
Based on the retrospective data that exists and acknowledging that this may not constitute more than expert opinion, the following treatment algorithm is being proposed. This algorithm assumes that the patient has been comprehensively surgically staged (Table 1).
There are many questions that remain and we await the data from GOG 249 to guide the management of these patients. Some of the questions that remain include which chemotherapeutic agents should we use and how many cycles should the patient receive. The default for UPSC and CC has seemed to be paclitaxel and carboplatin.
The retrospective data (and some small phase II prospective studies) have used on the average six cycles. This is extrapolated from the comfort of using six cycles of paclitaxel and carboplatin for women with ovarian cancer. How should we use radiation therapy? PORTEC and GOG 99 both could lead one to believe that the primary benefit of pelvic radiation is to reduce vaginal cuff recurrences. Therefore, we have substituted vaginal cuff brachytherapy for pelvic radiation in women with early stage disease. This would clearly decrease the time of therapy and the morbidity of therapy.
Women with any advanced endometrial cancer, but particularly those with the atypical histologies, should be considered for eligibility in clinical trials. If there are no clinical trials available for these patients, as with the women with early-stage disease, many of the recommendations specific for UPSC and CC will be based on retrospective data. Fortunately, for women with advanced-stage endometrial cancer, there is a little more prospective cooperative group data that we can draw from.
GOG 94 concluded that women with Stage III/IV UPSC, who were treated with whole abdominal radiation, were at risk for multisite and extrapelvic recurrences.
GOG 122 concluded that for women with advanced stage endometrial cancer, chemotherapy (adriamycin and cisplatin) was superior to whole abdominal radiation therapy. In this trial, 83 women had UPSC and they had an increased risk of recurrence (HR1.39) and death (HR 1.56) as compared to the other endometrial histologies. In this trial, 17 women had CC and this particular histology did not have an increased risk of progression or death in this study when compared to the other histologies.
GOG 177 compared cisplatin and adriamycin (AC) to paclitaxel, adriamycin, and cisplatin (TAP). This trial showed improved outcomes with regards to both progression free and overall survival for the paclitaxel containing regimen with a 40% reduction in the risk of recurrence. Thus, the three-arm regimen became the GOG standard regimen.
GOG 184 compared the three-drug (adriamycin, cisplatin, paclitaxel) to the two-drug regimen (adriamycin, cisplatin) after radiation therapy for women with advanced endometrial cancer. In this study, there was no difference in the progression free or overall survival. Three-year disease-free survival rate was approximately 60%.
GOG 209 evaluated paclitaxel and carboplatin (TC) versus the GOG standard three-drug (TAP) regimen. The results of this trial are pending. However, the interim analysis suggests that in terms of progression free and overall survival, that the paclitaxel and carboplatin (TC) combination is not inferior to the three drug (TAP) regimen.
There was a recent study using the National Cancer Database that evaluated the role of multimodal therapy in women with node positive (stage IIIC) UPSC. This study of 1816 women with UPSC showed that medial overall survival was 33.6 months in women who received chemotherapy alone as compared to 42.6 months (p<0.0005) in those who received chemotherapy + radiation. In this study, multivariable analysis confirmed that consolidative radiation was independently predictive of improved overall survival. GOG 258 will hopefully inform us regarding the sequence of therapy.
Based on the retrospective data that exists and acknowledging that this may not constitute more than expert opinion, the following treatment algorithm is being proposed (Table 2).
I would recommend that women with advanced stage UPSC and CC that are not optimally debulked be enrolled in clinical trials. There is currently no GOG trial evaluating this patient population.
Based on the prospective and retrospective data that exists and acknowledging that this may not constitute more than expert opinion, the following treatment algorithm is being proposed.
A. What complications could arise as a consequence of condition?
There are surgical and treatment related toxicities that can arise as part of treatment for both UPSC and CC.
B. What complications could arise as a consequence of management of chemotherapy, radiation, and/or surgery?
Complications related to chemotherapy will depend on patient factors (performance status, nutrition, age, BMI, biologic differences); tumor factors, in which chemotherapeutic and/or biologic agents are administered; dose of the agents; use of other adjuvant therapies; and use of supportive care. To include a comprehensive list of chemotherapy-related complications is beyond the scope of this document, so the most usual side effects for a select group of agents are listed in Table 4.
The toxicities can be expected to be cumulative depending on the number of agents that are administered at any one time and on the dose and schedule. The author would refer to you specific toxicities based on the endometrial cancer clinical trials that are listed above. The reader must also be aware that the toxicities may be both short term and prolonged, and several women will have long-term sequelae.
Complications related to radiation will depend on patient factors (performance status, nutrition, age, BMI, biologic differences); tumor factors, if chemotherapeutic and/or biologic agents are also administered; dose of the radiation; location of the radiation; time of radiation therapy duration; use of other adjuvant therapies; and use of supportive care. To include a comprehensive list of radiation therapy–related complications is above the scope of this document, so the most usual side effects for a select group of agents will be listed.
The toxicities can be expected to be cumulative depending on the number of agents that are administered at any one time and on the dose and schedule. The author would refer you to specific toxicities based on the endometrial cancer clinical trials that involved radiotherapy, which are listed above.
Effects include: skin changes, fibrosis and changes in large and small intestine, hematuria, cystitis, loss of ovarian function, loss of vaginal elasticity and lubrication, and bone marrow effects.
As with chemotherapy, the reader must be aware that these side effects and complications will be both short term and long term.
In addition to the above mentioned complications, toxicities and side effects, there are psychosocial and psychosexual effects that both the woman, her partner, and family must adjust to.
More acute supportive therapies for chemotherapy include antiemetics, H2 blockers, steroids, and anxiolytics for those women acutely receiving therapy. Women may also receive growth factor support with granulocyte-colony stimulating factor (G-CSF). Red blood cell lineage growth factors have fallen out of favor for those women being treated with curative intent, but may still be appropriate for women with recurrent or progressive disease. Other adjuncts to chemotherapy may include nutritional and complementary medicine strategies including acupuncture.
Dose reductions and dose delays for chemotherapy may help reduce some of the acute hematologic toxicities.
Careful systematic review of toxicities is helpful in identifying those women who may be developing several grade 3-4 neurotoxicities and other toxicities such that treatment should be modified.
Use of vaginal dilators and vaginal lubricants during and postradiation therapy may be helpful in maintaining a more normal sexual relationship for the woman and her partner. Open discussions with the woman and her partner may be very helpful and should be encouraged.
Physical therapy may be a very useful adjunct for both surgical-, chemotherapy-, and radiation-related complications, including pain and lymphedema.
Treatment breaks and careful treatment field size and dose is imperative to minimizing radiation-related complications.
This was discussed in part in the above section related to adjuvant therapy, as it provided the rationale for proceeding with adjuvant therapy in this patient population. Women with stage 1 disease are at anywhere from a 12% to 40% risk of recurrence depending on the depth of invasion. With adjuvant radiation, this risk is approximately 28% to 33% and with chemotherapy and radiation, the risk is 6% to 11%. We await the results of GOG 249 to better answer the question of adjuvant therapy response rates for women with early-stage UPSC and CC carcinoma.
Survival rates for women with stage III/IV disease can range from 5%-60% depending on the stage, surgical resection, and adjuvant therapy. Women with suboptimally debulked stage IV disease will have the worst prognosis and women with stage III disease that involves the adnexa or microscopic nodal disease will have an improved prognosis. As stated in the National Cancer Database study, the median overall survival for women with stage IIIC disease was up to 42.6%.
The outcomes for women with recurrent endometrial cancer depend in large part whether they are treatment naive and the location of their recurrence. Unfortunately, the majority of women with UPSC/CC will have multicentric recurrences, and if they had previously received radiation therapy, often times the recurrences will be outside of the radiation field. The GOG has evaluated numerous drugs in the recurrent setting. Single agent therapies are associated with response rates of 7% to 30%. Multidrug regimens are associated with higher response rates, but not unexpectedly higher toxicities. Response rates for multidrug regimens such as TAP are 57%; however, the duration of response is dismal at approximately 8 months.
The majority of the GOG studies are not limited to women with UPSC or CC carcinoma, so specific recommendations and statistics are difficult to obtain.
We should encourage patients with recurrent disease to enroll in clinical trials so that we can advance our knowledge of options for these women. Please refer to the section on novel therapies for additional treatment opportunities.
As mentioned above, one study did show that an elevated preoperative CA-125 did correlate with risk of death. In this study of women with UPSC, women with a CA-125 greater than 35 had a 3.7 times greater risk of cancer-related death as compared to those women with a normal preoperative CA-125.
In another study of women with UPSC, a rising CA-125 level corresponded to or preceded clinical relapse in 73% of the women. While this information may be useful as a prognostic factor, there has been no data to suggest that initiating therapy at the time of a CA-125 elevation will affect patient outcome. Since there are few durable treatment options for these women, the information may cause more anxiety than benefit.
There have been no prospective studies or retrospective reports evaluating the role of routine posttreatment imaging for women with UPSC or CC carcinoma. Routine surveillance imaging cannot be recommended at this time and should be ordered based on clinical symptoms and physical examination findings.
Physical examination and review of symptoms: Every 3 months to yearly, depending on cancer stage, grade, and histology, as well as the interval since the end of treatment.


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Nick Linn Lecture Series: Meltzer lays out 'The First Conspiracy'
Nick Linn Lecture Series opens with best-selling author Brad Meltzer
Nick Linn Lecture Series: Meltzer lays out 'The First Conspiracy' Nick Linn Lecture Series opens with best-selling author Brad Meltzer Check out this story on naplesnews.com: https://www.naplesnews.com/story/entertainment/books/2019/01/11/nick-linn-lecture-series-meltzer-lays-out-first-conspiracy/2505801002/
Thomas Witt, Naples Daily News Published 12:52 p.m. ET Jan. 11, 2019
Brad Meltzer (Photo: Michelle Watson, Catchlight Group)
Imagine a plot to kill the leader of our country — not the current one, but the first one.
Best-selling fiction author Brad Meltzer didn't have to dream up this real-life plot to kill George Washington in the early days of the American Revolution. Written with co-author Josh Mensch, "The First Conspiracy: The Secret Plot to Kill George Washington" was released Tuesday.
Meltzer will be the first speaker in the 2019 Nick Linn Lecture Series on Monday, Jan. 14, at the Grand Lawn Pavillion of The Ritz-Carlton Golf Resort in North Naples. Luncheon begins at noon; Meltzer takes the stage at 1 p.m.
The series, presented by the Friends of the Library of Collier County, continues with A.J. Finn on Feb. 4, Lisa Scottoline on March 4 and Lesley Stahl on March 18. For tickets and series information, call Marlene Kern or Cynde Decker at the Friends office, 239-262-8135, or visit www.collier-friends.org.
First Conspiracy (Photo: Brad Meltzer)
Meltzer explained his writing shift and the plot in an email: "After 20 years of writing thrillers, I've spent the past three years working on my first true nonfiction book about a real-life plot that I found a decade ago.
"During the early days of the American Revolution, the British secretly put in motion a plot to kill George Washington. The governor and mayor of New York successfully turned Washington's personal security against him and they were ready to strike. ... When Washington found out about it, he arrested the guilty guards, grabbed the ringleader, gathered together 20,000 troops and citizens in an open field, and hung the man for all to see. It was the largest public execution of its time in all of North America."
Meltzer said the story is not widely known because Washington, future first Chief Justice John Jay and others believed it would "be a sign of tremendous weakness at a time when America needed to show strength."
For his most recent novel, "The Escape Artist," released last March, Meltzer was granted access to "a place I never thought they'd let me sneak into," Dover Air Force Base, the mortuary for the federal government's most top-secret and high-profile cases. "Victims of the 9/11 Pentagon attack were brought there, as were the victims of the attack on the USS Cole, the bodies of the astronauts from the space shuttle Columbia explosion and the remains of well over 50,000 soldiers and CIA operatives who fought in Vietnam, Afghanistan, Iraq and every secret location in between." The book tells the story of how, in 1898, a man named John Elbert Wilkie, a friend of Harry Houdini, was put in charge of the U.S. Secret Service and also illuminates the job of the Army's so-called artist in residence.
The Escape Artist (Photo: Grand Central)
In November, the animated "Xavier Riddle and the Secret Museum," based on Meltzer's Ordinary People Change the World kids series, is set to premiere on PBS. The "Secret Museum" allows Xavier, his sister Yadina and their friend Brad ("who looks remarkably familiar") to travel back in time to meet real-life historical figures when they were kids.
Meltzer answered questions by email before his visit to Collier County.
Q. What were the challenges of writing nonfiction after a career writing fiction?
A. In fiction, I can make the story do whatever I want. But when it comes to George Washington, well ... he requires a bit more care (laughs). In truth, though, a good story is a good story. And this was one of the best I'd ever found.
Q. Did the current political climate influence your book?
A. This is the story of the secret plot to kill George Washington and how it was revealed. It's a story of leaders, liars, counterfeiters and jailhouse confessors. And it tells a remarkable and previously untold piece of American history that not only reveals George Washington's character, but also illuminates the origins of America's counterintelligence movement that led to the modern day CIA.
But more than anything else, it shows the lack of character in politics today. Remember when modesty was a great American trait? We need to get back to that. So there's no way to do this story without reflecting on our current political climate.
Q. How do you gain access to government facilities, like Dover Air Force Base for "The Escape Artist"?
A. I ask. That's the honest truth. People are kind enough to say yes.
Q. What is your typical work day? How do you keep up with social media? How do you relax?
A. I sit down at my desk at around 9 a.m. I fool around on social media for a little, then try to be writing by 9:30. And I relax by staying away from that same social media.
Q. Who are your favorite authors? What are you reading now?
A. I'm always reading a biography, because of our Ordinary People Change the World series. So I just read Billie Jean King's for "I Am Billie Jean King." Other than that, I just finished "Mister Miracle" by Tom King and Mitch Gerads.
Q. What's next?
A. Our newest kids book, "I Am Billie Jean King," comes out in February, then I'm working on the sequel to "The Escape Artist," then in November, we have the cartoon for the "I Am" series coming on PBS. Then I'm taking a nap.
Friends of the Library of Collier County is a nonprofit organization that supports Collier County public libraries and provides for the literary and educational needs of the community. More information: www.collier-friends.org
Read or Share this story: https://www.naplesnews.com/story/entertainment/books/2019/01/11/nick-linn-lecture-series-meltzer-lays-out-first-conspiracy/2505801002/
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Jan. 9, 2020, noon


How Can the Doctors of Chiropractic at Ashton Rehabilitation Clinic Help?
Provide nutritional advice, recommending a change in diet and perhaps the addition of B complex vitamins. Offer advice on posture, ergonomics (work postures), exercises and relaxation techniques.
Write us and request an evaluation today.
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I have a confession to make. I'm technically challenged. When it comes to blogging I can handle the writing end and maybe even a little widget and plugin installation, but when it comes to the nitty gritty, I haven't a clue. I generally hire people to design my blogs and to handle the issues I can't.
In November, I was thrilled to be able to announce I was revamping my popular Freelance Writing Jobs blog from a single blog into a network of six blogs. Imagine how it feels watching a small blog grow into the number one online community for freelance writers? This was a thrilling and scary time for me. At the recommendation of my trusted tech guys, I moved over to a more reliable hosting company. It was a company that came highly recommended, received good reviews and they patiently answered all my questions when I called.
A couple of weeks after the move and upgrade, I received a notice from the host. My site is too busy, processes are running and it's affecting the other websites on the server. Could we look into it? Indeed we could. My tech guys looked into it and fixed the problem. Or so we thought. In mid- December the host sent another notice. My blog network is too busy for the chosen plan, I had to move to a dedicated server. This must be done within 24 hours or my service would be yanked. Feeling I had no choice, I paid hundreds of dollars (that I couldn't spare during the holidays) to get this done. Some of that money, by the way, had been earmarked so I could give my bloggers an end of the year bonus. Sorry, guys.
Life went along swimmingly until the other day. I woke up to find my blog network gone. A note from the host informed me my site was still too busy and since this has been going on since November they had no choice but to remove my site. If I wanted to remain on their service, I had to pay hundreds more dollars to get upgraded to another server.
Now. I did everything this hosting company asked of me. I had my guys look into and fix any issues and I upgraded when asked to upgrade. Since, after the upgrade I didn't hear anything for almost two months, I assumed all was well. Don't I at least get 24 hours to make a decision?
I consulted my tech guys once again. Not only did they pinpoint the issue, the assessed there was no need for my blog network to even be on a dedicated server because it's not that big. The traffic is good, yes, but I'm not Darren Rowse or CopyBlogger. Still, my guys said they found the problem and if they installed a caching system the issue would be resolved. Brilliant. Life could return back to normal.
I sent a note back to the person who sent me the bad news and asked if he could put my site back up so I can fix the issue. "No" he wrote back. "We've been dealing with this since November." He said the systems admin team would review the situation but it didn't look good.
So I called the hosting company and spoke to a man name Les who could have used a lesson or two in good customer service. I explained the situation to Les who was less than helpful.
Les: There's nothing I can do.
Me: We pinpointed the problem. I just need a few hours (or less) for my guys to install a plugin.
Me: May I talk to Justin who has been sending me emails.
Les: No. Justin isn't available.
Me: He sent an email five minutes ago.
Me: May I speak to someone else then?
Les: No one is available.
Me: Les, surely there is someone else who is available besides you. A manager, a supervisor, a systems administrator? I need to tell someone we know what the problem is and it's a quick fix. There has to be someone with the ability to make decisions available.
Me: I paid a lot of money to upgrade, I did everything you asked. Surely there is someone I can talk to.
Les: No one is available for you.
I hung up in frustration. No one would talk to me, no one would help me, and no one would respond to my emails anymore. I had a few hissy fits and went outside and played ball with the dog for a while to calm down. The I went inside to start my day job.
I called the host again during my lunch hour and got someone a little more pleasant and helpful, but couldn't do anything for me. He told me I had no choice but to upgrade and they wouldn't be putting my site back up because it was too busy, they were afraid I would crash the server. Thus: my tech guys couldn't install the plugin. "How come, " I asked him, "that it wasn't so busy it would crash the server when I went to bed last night, and now it is?" My new BFF at the hosting company couldn't answer this, nor could he tell me why I was pulled without at least 24 hours notice. He did, however, help me get my files back.
My tech guys did have the backup from the upgrade and put the old blog up at the old server and that will do for now. Now, I'm not claiming ignorance. Indeed we had issues since November, but I was under the impression these issues were fixed. Since upgrading to the new server I never heard from the hosting company again. No one told me there were still issues and no one told me my small blog network, receiving up to 4,000 visitors a day was too big for the VPS server. I have been working with this company all along and doing everything they asked, so why not work with me in return?
Surely after spending hundreds of dollars in two months, at least a supervisor or the Systems Admin guy who contacted me in the first place could talk to me on the phone? And why did Justin in Systems Administration refuse to respond to my emails after I told him we could fix the problem. Why did the hosting company refuse to respond to my emails until I wrote to them asking to have access to my files?
As a customer, I don't want to be frustrated. As someone who has no clue about the technical side of things, I was in tears. What was happening? How come these problems aren't getting resolved? How do I know all parties involved aren't yanking me around trying to get more money from me? I had no answers. I felt clueless and helpless and no one from the hosting company did anything to help me feel better. In my 44 years I've had to deal with utility companies, schools, township bureaucracies, and even the DMV, but no one has ever made me feel as small and useless as this hosting company.
I like to use situations like this as a model for my own behavior. Every day I deal with many terrific people, but also a few who are difficult. It would be so easy to blow them off or act as if they're the problem, but what if they're feeling as helpless as me? People reach out for help because they truly need it. For any kind of a business to succeed, they have to be helpful, attentive and needed. I wasn't made to feel like an important customer yesterday, and I hope I will never let anyone leave a customer service situation feeling the same way.


Everyone welcome to review and discuss the season gone and to hear news on plans for the new season, all committee posts will be up for election.
This is the time to stand up and be counted and to give your views on how the club should be run on and off the field.
For Agenda details please speak to club officials.


text:
What was Mitt Romney thinking?
Why offer Rick Perry a bet? Why $10,000? Enter the robotic mind of the Republican presidential candidate
By Nick Arvin
Published December 27, 2011 5:00PM (EST)
(Salon/Reuters)
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For this original fiction series, we asked writers to imagine what some of 2011's biggest newsmakers were thinking at pivotal moments during the year. We'll publish a new piece every day this week; to read earlier posts in the series, click here.
Look at Perry. Look at him talking. Be attentive. Remember what they told you. Relax. Be calm. Be confident. Be yourself. Don't tense up. That's when I get in trouble. Too tense. Smile.
Don't forget, smile with the eyes.
Perry: "I'm listening to you, Mitt, and I'm hearing you say all the right things..."
He thinks he's got something on me. Where's he going?
It's OK. Relax. Be yourself. Like staff said, Let Mitt be Mitt!
Of course, that's what staff always says.
Got a feeling in my teeth. Like gnawing inside my teeth.
Perry: "but I read your first book..."
The book again. My "first" book. Implying what? That I revised it. Everyone revises between editions, Perry.
Look at him smile!
Jeez, it's like something's chewing the inside of my teeth.
OK, OK, get a feeling like this in your body, it probably means something. Some type of physio-emotional response mechanism.
I know what this means. The gnawing in my teeth. I figured this one out before. I remember it. Means I'm angry.
This book thing, again, really makes me angry. Makes me feel like tiny hamsters are inside my teeth gnawing my teeth.
Perry: "Now I know it came out of the reprint of the book, but, you know, I'm just saying..."
He's done this before, and it's not true, per se, and he's going right back to it. And why? Why? The guy isn't even in the race anymore. He had his chance, up in the polls, everyone ready to love him -- and he blew it. He's toast. He knows it. But he hangs around, brings this up again. Why? Why? Look at him smile! Pure maliciousness.
Gah, my teeth.
Feels exactly like tiny hamsters gnawing inside my teeth.
Remember, tiny hamsters do not live in my teeth. I'm angry. Be yourself.
I have got to cut him off on at the knees on this.
Let Mitt be Mitt. What does Mitt do when he's angry?
His teeth hurt.
It's like I told Baier. People should be better informed. It's really that simple. But apparently that sounded snooty somehow.
Relax, Mitt! Relax!
I should strangle punch bite wet willie the guy.
Perry: "...you were for individual mandates, my friend."
I have got to stomp him for this.
No. No. I'm not relaxed. I'm angry. I have tiny hamsters in my teeth.
Perry looks like a hamster, actually.
Tiny little Rick Perrys are eating the inside of my teeth, and I have to stomp him.
Be yourself. Let Mitt be Mitt.
So, OK, that means what?
Let Mitt = Mitt.
When you think about it, it's just terrible advice. Be yourself. What's that supposed to mean? Really? Whatever you do is you, right? You = you. If you act like a monkey, then you are the guy who acts like a monkey. Whatever you do becomes you. How can you be anyone other than yourself?
And, on the other hand, if I could be Reagan right now, what would be wrong with that? They'd love that.
Now my fingertips are buzzing. What's that mean?
He's grinning -- grinning! At the audience!
Have to step in, say something here. Say, "You know what, you've raised that before, Rick, and you're simply wrong..."
Perry: "It was true then. It's true now."
Be. Yourself.
And smile! Don't forget the eyes.
Or be Reagan.
OK. What would Reagan do? Reagan would...
Blank.
Make a joke.
OK. A joke.
Hey Rick, what's got a hundred heads, 600 eyes, and 95 legs? No. Skip it. Even the kids didn't think that was funny.
Gosh, first my teeth, and now it's like small motors are whirring inside my fingertips. That's an old feeling. I used to get that feeling when Dad gave me that look, like he couldn't believe I was his son. What is that feeling?
Remorse? Maybe?
Actually, come to think of it, maybe the buzzing fingers are anger too.
OK, I'm not Reagan. No one is Reagan but Reagan. Reagan's dead. So he can't respond to queries. I can't know what Reagan would do.
Mitt ≠ Reagan. Let Mitt = Mitt.
Step back. Try it this way: Mitt = what? What are the higher-order variables in the equation of Mitt?
Mitt is business-smart. Knows numbers. Knows how to assess a risk. When to make a bet.
A bet! That's great!
Is it? Is it great? OK, a bet, maybe a bet. Reagan might bet. Consider. I offer a bet, what's his countermove?
Perry accepts bet. Facts will be checked. And he's wrong! I win.
Perry declines bet. He looks like a wimp. I look like Reagan. I win.
No win for him. Win win win win for me. That's really super optimal.
Say, "Rick, I'll tell you what."
Wow. Teeth, fingers and now my lungs are seething, too.
Extend hand.
I'm going to bet him! This is great. Not smiling so hard now, are you, Perry? You're looking at me looking at you, and I'm smiling, and you're wondering, aren't you? Going to bet, my friend. How much to bet? Need a number. X. How to establish X. Let's see.
X can't be too small. Rick, I'll bet you a penny. Sounds like a joke.
X can't be too big. Rick, I'll bet you a hundred million dollars. I could liquidate some assets. Does Perry have a hundred mil? Probably not. Audience will think I'm joking.
That didn't narrow it down much.
But there's a trend there. Graph? Graph!
Yes! That's it. Second-order quadratic. Now calculate the maximum of the curve, considering the audience average age and income times unemployment rate times average Des Moines home price to the power of price of a bushel of corn times the square root of average bushels per acre -- let's see -- carry the 1 -- round up.
Say, "Ten thousand bucks?"
Now I've got him. Look at him. Smile fading.
Say, "Ten thousand dollar bet?"
Look at him fade!
Perry: "I'm not in the betting business."
Say, "Ooooh. OK. OK."
Yes! I win! Out of my teeth, Perry!
That was some kind of weird feeling. Emotions are hard to figure. But actually, I think that one might have been hate.
Look at the audience. Look at them looking at me.
I win, right?
My lungs are seething. Termites wandering around inside my lungs. What's that one?
Could be anxiety.
Nick Arvin
Nick Arvin's new novel, "The Reconstructionist," will be published in March. He is the author of the novel "Articles of War" and the story collection "In The Electric Eden."
MORE FROM Nick Arvin
Related Topics ------------------------------------------
2011 Fiction: Behind The Headlines Books Fiction
Trending Articles from Salon


First thing first, you need to check that you are able to connect to the remote server from IIS Manager of your local machine/current server. To do that, please follow the instructions given below.
Okay.Lets move to fix it up. What you require to repair this issue is to enable the Management Service of remote server so that it would allow Remote Connection. For doing this you could follow this link.
4. On the Properties window, select LogOn tab.
That's it. Try to deploy your project with TeamCity again. Problem Solved right??


Who's right, who's not, and when?
Here's a joke a friend had forwarded some time back. While I found it extremely hilarious at the time, and still do, I just realized a thing or two that we could learn from it, based on my dealings with some people I've had the (mis)fortune of interacting with in the past.
You go ahead and enjoy the joke; I'll get into more detail after the joke.
I'm writing this letter to tell you that I'm leaving you for good. I've been a good wife to you for 7 years n I have nothing to show for it. The last two weeks have been hell. Your boss called to tell me that you've quit your job today & that was the last straw. Last week, you came home n didn't even notice I had a new haircut, cooked your favorite meal n even wore a new silk dress. You ate in 2 mins, n went straight to sleep after watching all of your games. You don't tell me you love me anymore, you don't want anything that connects us as husband and wife. Either you're cheating on me or you don't love me anymore. Whatever the case, I'm gone. Don't try to find me. Your brother and I are moving to Paris together. Have a great life.!
Nothing has made my day more than receiving your letter. It's true you and I have been married for 7 years, although a good wife is a far cry from what you've been. I watch my games so much because they drown out your constant nagging. I did notice your new haircut last week, but the first thing that came to mind was 'you look just like a boy'. Since my mother raised me not to say anything if you can't say something nice, I did not comment. And when you cooked my favorite meal, you must have gotten me confused with my brother, because I stopped eating pork years ago. About that new silk dress, I turned away from you because the $49 price tag was still on it, and I prayed it was a coincidence that my brother had just borrowed $50 from me that morning. After all this, I still loved you and felt we could work it out. So when I hit the lotto for $10 million, I quit my job and bought us 2 tickets to Jamaica. But when I got home, you were gone. Everything happens for a reason. I hope you have the fulfilling life you always wanted. My lawyer said that the letter you wrote ensures you won't get a dime from me. So take care. Signed, your ex-husband, rich as hell and free.!
Now, just like the wife in the joke, you will sometimes have to deal with people who, despite being in the wrong, will convincingly accuse you, to the point where you will start to question your actions or intentions, feel guilty even.
As Rudyard Kipling rightly warned us, "If you can bear to hear the truth you've spoken, twisted by knaves to make a trap for fools." As distressing as that can be, it is also calming to know and rather interesting to see how, given enough time, things go full circle and bring you back to the pinnacle of the situation. Only this time, the basis of your actions and intentions will be proven right and acknowledged, thus renewing your faith in your actions and intentions.
So, essentially it's all about doing the right thing, at whatever cost, and having the patience to wait for when you can sit back and enjoy the moment when time proves you right.


A Natural Skin Cancer Remedy?
Sanguinaria canadensis, most commonly referred to as bloodroot, has a rich Native American background. Its nickname, war paint, should give you some indication of its importance to the early Indian culture. The name, bloodroot, came about because of the red sap that would "bleed" from the roots of the flower. Many tribes used it as a dye for clothing, baskets, and face paint. Other parts of the flower were used to create orange and yellow dyes as well. At one point it was even imported by the French for use as a coloring agent on wool.
The flower is local to eastern North America and is one of the earliest wildflower blooms found in spring. While there are many more interesting facts on the horticulture of this plant, (for instance, the bloodroot relies on ants to spread its seeds) it actually has a number of natural health benefits as well.
In fact, it is considered to have certain anti-cancer properties since it contains berberine, a substance found to fight cancer cells. In addition to laboratory tests verifying its anti-cancer potency, it has been used to treat tens of thousands of people over the last century and a half. Many of these (according to some estimates as many as 80%, which is probably greatly exaggerated) experienced remission of malignancy and longer life expectancies than people with similar conditions who chose different treatments.
Because of its ability to support healthy cells, Jon Barron uses bloodroot in his Blood Support formula. It is currently being studied further to determine its level of effectiveness as a skin cancer treatment. While the studies may not confirm its use for this yet, bloodroot has been used for years to treat a variety of other skin conditions including ringworm, skin tags, warts, polyps, and fungal growth. Dr. Andrew Weil has recommended a powered or paste version of bloodroot for the removal of skin tags and moles.
Its antibiotic properties have led to its being approved by the FDA as a toothpaste ingredient. The extract has been used to treat gingivitis and help with prevention and formation of cavities, plaque, and tartar.
"Bloodroot is used to cause vomiting, empty the bowels, and reduce tooth pain. It is also used to treat croup, hoarseness (laryngitis), sore throat (pharyngitis), poor circulation in the surface blood vessels, nasal polyps, achy joints and muscles (rheumatism), warts, and fever."
While the usage for this plant is wide, there is one caveat. A little can go a long way. According to the NYU Langone Medical Center, "In large doses, it causes nausea and vomiting, and even at lower dosages [but still larger than used by knowledgeable herbalists] it has been reported to cause peculiar side effects in some people, such as tunnel vision and pain in the feet."
It is widely used as a topical treatment, but since it can cause burns after long-term use when applied directly to the skin or with excessive application, it is important to start slowly to determine sensitivity when used topically.
For more on natural healing herbs, click here.
When I was young, my brother has poison ivy so badly that first they gave him lotions than the doctors gave him shots and nothing worked. It looks like elephantitis layer after layer on top of each other. My father's friend who was an artist and also studied plants came to visit. He saw my brother's condition and said do you have any swamps around here. We did at the time and he said let's go find some blood root. Sure enough we found some. He said you crush the plant to get the juices flowing and then you rub the plant on top of the poison ivy. The next day my brother's poison ivy had gone down by two-thirds and the next day there was none. They have since filled in most swamps around here, so I have no idea where we would find bloodroot now.
When I was in grade school I picked up Athlete's foot fungus from our local swimming pool. It became so bad on my feet and toes that our family Dr., after trying everything in ointments and soaking in bleach water, told my Mother if it wasn't cleared up in 2 weeks with a salve my Grandmother mixed up, my toes had to be amputated. Incredibly the salve dried up the fungus and I was saved. The salve had a ??? tar smell to it and was a paste, orange in color which stained the sheets, socks, and gloves I wore to bed at night. Stains were non removable. The recipe went to heaven with my ancestor's. I always figured the orange was Bloodroot and the tar smell was Pine Tar. If anyone has suggestions about what this salve could have been please post an answer. Or would anyone know of a similar sounding product on the market today as my Nephew has a serious case of Athlete's foot and the modern ointments are not correcting it.
I'm not sure about your Grandmother's salve but a couple people in my family had really bad athlete's foot and an old Indian/Mexican man told us to go into a wet horse corral barefoot and then let it dry on our feet before we washed it off. Sounds weird I know but, It really helped get rid of it.
If not pine tar, it was more likely coal tar (very useful topically). Coal tar was the old remedy I had to use as a kid for psoriasis.


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