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Salomon Women's XA Pro 3D Ultra GORE-TEX
The Salomon Women's XA Pro 3D Ultra GTX is an outstanding trail running shoe that features a GORE-TEX with XCR Product Technology membrane, and has been constructed using Salomon's 3D Advanced Chassis. The upper consists of Sensifit construction, a quick-drying breathable mesh upper, Quicklace, a mud guard and a protective rubber toe cap. Other features include a Running Contagrip outsole and Ortholite Sockliner, while the triple density EVA midsole with pronation control offers the perfect blend of cushioning, shock absorption, stability and support.
Was: £110.00 Now: £77.00
- Colour: Asphalt/Black/Alumin
- Grey
We aim to offer competitive prices, however if you find products cheaper elsewhere we will match the price. click here for more info...


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HealthWise KnowledgeBase
Antidepressants for Cancer Pain
What To Think About
Do not suddenly stop taking antidepressants. The use of antidepressants should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse into another depression episode.
Studies have found that daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Before taking an SSRI, talk to your doctor about this risk.
Amitriptyline is the most common antidepressant that is used to treat cancer pain. It may cause side effects, such as dry mouth, drowsiness, constipation, or difficulty urinating.
You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.
People with cancer pain and depression are often treated with one of the following:
- Selective serotonin reuptake inhibitor (SSRI), such as sertraline (Zoloft), fluoxetine (Prozac), or paroxetine (Paxil)
- Serotonin and norepinephrine reuptake inhibitor (SNRI), such as venlafaxine (Effexor) or duloxetine (Cymbalta)
- Higher dosage of tricyclic antidepressant than is used for cancer pain alone
SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.Reference 1
Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects.
Complete the new medication information form (PDF) (What is a Reference PDF Opens New Window document?) to help you understand this medication.
By: | Reference Healthwise Staff | Last Revised: October 31, 2011 |
Medical Review: | Reference E. Gregory Thompson, MD - Internal Medicine
Reference Michael Seth Rabin, MD - Medical Oncology |
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Reference Terms of Use. Reference How this information was developed to help you make better health decisions.

subset: commoncrawl


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An awesome deal in Hampton Hall! Inventory is low and you wont find another lagoon view lot at this price! Great pie shaped lot at the end of a cul-de-sac with panaramic lagoon views. make sure you walk this lot to appreciate the terrific value. Don't wait! (T0807123)
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Halloween Table
More from this Artist:
Special Halloween, enjoy!
- Price: 100
- Stats: Halloween
- Type: Color Change
- Tool Used: Sims Transmogrifier
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#1 On Oct 18, 2012 Kilhian wrote:
http://kilhian-retro.blogspot.fr/2011/10/halloween-table.html - download link will only send you back here


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Moderators: James Johnston, Jason Poitras, Brian Sloman, Darcy Detlor, John Coldrick
Brian Sloman wrote:You can recall the bearing by typing 1..2 in the direction field, then double tap on it to copy that recalled distance into the calculator. Then enter 90 and press the DMS- button. You do not need to convert to decimal degrees.
For entering quadrants you can use NE for quadrant 1, SW for quadrant 3, etc.
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WRESTLING: Kingston falls to Middletown
KINGSTON, N.Y. — An undermanned Kingston High wrestling squad gave Middletown a battle Wednesday night before falling 45-35 in a Section 9, Division I-A match.
Because of injuries and flu, the (14-11) Tigers were without three starters.
"We handed them all they could handle,"said Kingston coach Matt Urcioli, whose team spotted the Middies an early lead by forfeiting the three lowest weight classes then won seven of the 11 bouts on the mat.
Leading the Tigers were Isaac Goldowitz with his overtime pin of Tyler Rodriguez at 126 pounds and Dwayne Richards's 7-4 decision of Johnny Grandson at 152 — the third time he's taken down a team captain.
Kingston also received pins from Deon Edmond (195) and Tyler Anderson (160) and Dylan Anderson (182), plus a major decision from Javeed Green (132).
99—Oscar Lainez (M) won by forfeit
106—Matt Calderone (M) won by forfeit
113—Isaiah Gutierrez-Vera (M) won by forfeit
120—Pedro Rosales (M) maj. dec. Joe Schaeffer, 9-0
126—Isaac Goldowitz (K) pinned Tyler Rodriguez, 6:24 Continued...
132—Javeed Green (K) maj. dec. Hunter Grogan, 15-4
138—Alec Battle-Saunders (M) pinned Connor Amado, 4:28
145—Christian Matos (M) won by forfeit
152—Dwayne Richards (K) dec. Johnny Grandson, 7-4
160—Tyler Anderson (K) pinned Shaun Nugent, 3:09
170—Tajea Johnson (K) maj. dec. Paul Green, 11-3
182—Dylan Anderson (K) pinned Daven Nieves, 5:09
195—Deon Edmond (K) pinned Juan Velasquez, 5:48
220—Alex Ortiz (M) pinned Jansen Costello, 2:33
285—Tim Wade (M) tech. fall over Chris Gage, 18-2 Continued...
Onteora 40,
Red Hook 39
At Red Hook, Onteora edged the Raiders in a tight Divison II-A match after spotting the Indians a 12-point lead in forfeits.
99—Taylor Benson (RH) pinned Dillon Ross, 1:03
106—Zach Chartrand (O) maj. dec. Jake Kelly, 14-6
113—Finbar Stuart (O) pinned Henrie Tynes, 1:49
120—Matt Rauch (RH) pinned Brandon Moore, 3:20
126—Avery Leighton (O) dec. Jon Torres, 6-5
132—Aaron Barkstrrom (RH) dec. Bernie Smith, 4-0
138—Luis Garcia (RH) pinned Dylan Little, :45 Continued...
145—Anthony DePaoli (RH) pinned Godfrey Lucas, :57
152—Ryan McDowell (O) won by forfeit
160—Luke Mueller (O) won by forfeit
170—Austin Wiegel (O) won by forfeit
182—Mike Rauch (O) pinned Rich Scott, 1:04
195—Andrew Friedel (O) pinned Darren Coon, :47
220—Dustin Mackenzie (O) dec. Bedn Zitz, 1-0
285—Will Brammer (RH) won by forfeit
Wallkill 48,
Valley Central 25
At Montgomery, pins by Logan Losito, Tyler Owen, Garret Betcher, Brandon Maxcaro and Evan Loginott lifted Wallkill past Valley Central.
99—Andrew Davis (W) dec. Bryan Roche, 7-0
106—Logan Losito (W) pinned Tyler Lynch, 5:48
113—Gabe Campbell (VC) pinned Ryan Gorman, 1:01
120—Nick Sebesta (W) dec. Jimmy Clarck, 9-0
126—Corey Cummings (VC) decd. Eddie Doering, 15-6
132—Osmah Hasan (VC) dec. Brandon Crespi, 5-3
138—Tyler Owen (W) pinned Erik Keenan, 4:15
145—Alec Guevara (W) dec. Owen Perry, 6-4
152—Tyler Blasko (W) dec. Clay Farris, 17-1
160—Michael Fekishazy (W) dec. John Florio, 11-4
170—Garret Betcher (W) pinned Mike Kania, 3:23
182—Matt Porter (VC) pinned Joe Lamonica, 1:18
195—Krajl Haxhaj (VC) won by forfeit
220—Brandon Maxcaro (W) pinned Matt Macagne, 2:17
285—Evan Loginott (W) pinned Marshall Barnes, 2:31
Rondout 24,
Tri-Valley 24
Tuxedo 48, Rondout 29
At Tuxedo, Rondout Valley came away from a non-league triangular with a loss and a tie.
Normally criteria would settle a tie, but the Ganders and Tri-Valley won an equal number of matches, gave up the same amount of forfeits and split the only two matches settled on the mat.
Brandon LaCroix won by fall for Rondout at 120, while Logan McKeon got a pin at 195 for the Bears.
Tuxedo 48, Rondout 29
99—Andrew Parete (RV) maj. dec. Henry De La Cruz Jr., 15-5
106—double forfeit
113—Peter Manana (Tux) won by forfeit
120—Jonathan Nace (RV) dec. Dylan Lynn, 2-1
126—Julian Gonzalez (Tux) pinned Brandon LaCroix, 2:23
132—Liam Heslin (Tux) pinned Daniel Kelly, 5:20
138—Josh Santiago (RV) tech. fall over Anthony Chimento, 16-1
145—Eric Morse (RV) tech. fall over Justin Martinez, 16-0
152—Keith Finn (Tux) won by forfeit
160—Zachary Williams (Tux) won by forfeit
170—Dylan Delisi (Tux) pinned Steven Snyder, 1:34
182—Kristopher Quinn (RV) pinned Cristian Maldonaldo, 3:33
195—Eric Ulbrich (RV) won by forfeit
220—Eddie Anderson (Tux) won by forfeit
285—Alex Rodriguez (Tux) won by forfeit
Rondout 24, Tri-Valley 24
99—double forfeit
106—double forfeit
113—double forfeit
120—Brandon LaCroix (RV) pinned Kyle Rogers, 5:44
126—Jonathan Nace (RV) won by forfeit
132—double forfeit
138—Steven Graham (TV) won by forfeit
145—Joshua Borozny (TV) won by forfeit
152—Kevin Palko (TV) won by forfeit
160—double forfeit
170—Steven Snyder (RV) won by forfeit
182—Kristopher Quinn (RV) won by forfeit
195—Logan McKeon (TV) pinned Eric Ulbrich (RV), :53
220—double forfeit
285—double forfeit
See inaccurate information in a story? Other feedback and/or ideas for us to consider? Tell us here.
Central New York Region Sports By Bleacher Report
Local Guide
Business Name
Location, ST | website.com
Social Wire
Athletes of the Week
- Male Athlete of the Week: Justin Farrenkopf, Ellenville High School, track and field (video)
- Female Athlete of the Week: Cora Burler, New Paltz High School, track and field (video)
- Male Athlete of the Week: Jim LaValle, Coleman Catholic High School, baseball (video)
- Male Athlete of the Week: Jeffrey Nunez, Ellenville High School, track and field (video)
National Sports Videos
Top Sports Stories
- BOYS BASKETBALL: Ellenville wins to keep pace with Spackenkill
- GYMNASTICS: Torey Puff propels Wallkill by Roosevelt
- BOYS BASKETBALL: Kingston looks to Newburgh after downing pesky Pine Bush
- GIRLS BASKETBALL: Marlboro holds off Millbrook in OT
- WRESTLING: Kingston falls to Middletown
- INDOOR TRACK & FIELD: Kingston solid at Relay Carnival meet
- MEN'S VOLLEYBALL: Unbeaten SUNY New Paltz sweeps by Bard


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C2E2 invites the young and the young at heart to create, laugh, learn and share in family friendly activities all weekend long! Pack up the kids and join us in downtown Chicago for three full days of dedicated programming for the family. There's even more fun for kids on Sunday, April 27 when children 12 and under are free! Grab a free ticket for each of the kids and come play on C2E2 Kids Day.


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1. Representing various beneficiaries in respect of applications brought pursuant to Article 51 of the Trust (Jersey) Law 1984 seeking direction and approval of the distribution, division and sale of assets settled on trust.
2. Representing the beneficiaries of a trust regarding a claim against the corporate trustee for breach of trust and gross negligence in connection with financial investments made over a ten year period.
Paul Wilkes and Kit Hobbs acted for Butterfield in creating and reviewing fiduciary administration and service-level agreements in providing licensed management, administrative and secretarial services for an underlying client in the insurance sector. They also reviewed and updated the insurance manager's operations manual relating to the conduct of business by means of a protected cell company.
Collas Crill acted for a client of JTC Group in the sale of the entire issued share capital of a Jersey company which owns a high value mansion flat in Knightsbridge in London. The corporate aspects of the transaction were dealt with by David Dorgan and the property aspects were dealt with by Michael Morris.
We advised the trustees of a family trust, established by a deceased US resident settlor, in respect of several potential scenarios due to a lack of clarity in the trust instrument's original drafting, further complications caused by the settlor's testamentary legacies to the trustees and claims from potential beneficiaries in contradiction to the deceased principal beneficiary's wishes. In particular our advice focused on (1) whether the trust period had expired, (2) whether the default trusts were valid and if so had the principal beneficiary properly exercised their powers thereunder, (3) whether or not the acceptance of assets by the trustee pursuant to the reversionary interests under the settlor's last will and testament created new trusts and (4) practical and technical advice as to how the trustees should proceed.
Created new trust for UHNW Malaysan high tech entrepreneur to structure personal and business assets in numerous jurisdictions
Drafting bespoke commercial trust arrangement. The client appreciated the balance struck between technical drafting and commercial awareness. The matter highlights our expertise in assisting with commercial trust arrangements.
Advised widely on regulatory issues, in particular, the effect and interpretation of the Criminal Justice (Proceeds of Crime) (Financial Services Businesses) (Bailiwick of Guernsey) Regulation 2007 as they affect fiduciary businesses.
Represents the defendant in proceedings brought by Bagus Investments Limited. This matter has been to Court five times and involves an allegation that our client took money from a trust which did not belong to him and laundered it through three different jurisdictions, namely Liechtenstein (through two Anstaldts), Switzerland and London. The argument now turns on whether the defendant received the money knowing of a prior breach of trust, or innocent of this. The case has already resulted in a landmark decision on the law of constructive trusts.
Acting for and provided commercial advice in the sale and purchase of a substantial commercial property worth in excess of £15m ultimately owned by a world renowned Jersey high net worth resident.
Technical advice on disclosure of information to beneficiaries under Guernsey law. It was a significant piece of advice analysing one of the basic features of Guernsey law and highlights the technical skill within our team.
Acted in the establishment of a foundation structure with complex succession planning issues for one of the wealthiest families in the Middle East.
Acted for the family trust of a world-renowned film financier owned via a holding company shares in an AIM listed company which was itself involved in film financing. The listed company's biggest asset was a back catalogue of extremely well-known films, but was nonetheless under threat of administration because of a complex network of intergroup liabilities. There were also insolvency issues in a number of jurisdictions including Jersey and BVI.
Acted in the acquisition by a trust of a substantial property in Grenville Street, St Helier, for £6.3m.
Acting for and provided succession planning for a world renowned Jersey resident high net worth individual.
Acting for the trustees of a will trust structure for a renowned high net worth Jersey family owning substantial commercial property and dealing with bespoke issues with multiple beneficiaries including variation of the trust's terms and the retirement and appointment of trustees where financial regulation was an issue.
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+ Add to My Designers
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Soft, buttery leather composes the simple silhouette of this sophisticated Anya Hindmarch handbag, accented at with a leather tassel and enameled logo plate. Sturdy double handles fit easily over the shoulder, and the optional canvas shoulder strap adjusts with a polished buckle. The logo-lined interior includes a keyring and pen and lipstick pockets, while gold lettering assigns the 3 larger pockets as holders for 'SUNGLASSES,' 'PHONE,' and 'BITS & BOBS.'
Leather: Calfskin.
Weight: 50oz / 1.42kg.
Height: 15in / 38cm
Length: 14in / 35.5cm
Depth: 3in / 7.5cm
Strap drop: 7in / 13cm
Leather: Calfskin.
Weight: 50oz / 1.42kg.
Height: 15in / 38cm
Length: 14in / 35.5cm
Depth: 3in / 7.5cm
Strap drop: 7in / 13cm
Vibrant color, humor, and attention to detail have been Anya Hindmarch's signature since she opened her first handbag store in 1993. In 2001, after winning Best British Accessories Designer of the Year, Hindmarch added shoes and accessories to her repertoire. In 2007, Hindmarch decided to create a fashionable alternative to the environmentally unfriendly plastic bag. Her "I'm Not a Plastic Bag" canvas totes sold out in less than a month. Celebrity fans include Sienna Miller and Kate Winslet.
Shipping & Returns
Free Shipping Worldwide: No matter where you are sending your order, we offer free express shipping across the globe. USA Details. International Details.
Easy Returns: Because we understand that not every purchase is exactly right, we've made returns easy. And if you're in the USA, they're free. USA Details. International Details.


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i was thinking it would be cool if we could save links on pokemondb so when we click on our usernames we can see the links and be able to go to our favourte pages on pokemondb faster and easier
thanks elxy55 ps ur a great manger pokemaster
As DD said you can bookmark pages in your web browser. You can put them in folders as well to keep them organised if you like.
You could also put them in the "About me" section of your user profile. Lots of people have been putting their favourite TV shows, music etc there. Just add a bit for "favourite pages on Pokemon Database" and put the links in there :)
How to change your username How to add a user avatar Why was my post hidden? The points system Question etiquette Flags vs Downvotes Anime FAQ PokemonDb Tournaments PokemonDb Showdown server
Report users Name Origins corrections Location guide corrections
Type a Pokemon name, type, move or ability to see instant results.


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Monday, 09 April 2012
Welcome Everyone: Thoughts on Easter's Yearly Return to Church
Yesterday was Easter Sunday and as all those who regularly go to church know, Easter Sunday is the one day of the year when the church is packed and you have to go to church more than 15 minutes ahead of service instead of right when service begins. I arrived early and, as I sat down to wait for church to begin, two other guys sat down beside me.
Now this is where it becomes a very sensitive issue. Today in Homily, the Father talked about how even though Jesus knew Judas was going to betray him, he still welcomed him into the garden and paradise with a kiss. He welcomed a sinner.
I don't want to make assumptions or anything, and I am not sure, but it seemed like they were a couple. Even if they weren't gay, what came to my mind is still an issue that I haven't been able to put down since this morning. It might have been the way they dressed or the way they acted, but it felt as if they were indeed together.What really hit me was when the man sitting right beside me started tearing up during Mass.
He knew all the songs, all the prayers, everything. He gave me the impression that as a child, he was raised Christian and went to church regularly, but eventually, at some point in his life, he came out and told people of his sexual orientation. His tears made me feel as if, although he wanted to belong to the Church, he no longer felt welcomed or that he was rejected, or that he knew his life would be constantly judged as a homosexual in this religion which called it a sin.
But he came today, on Easter Sunday, the one day when everyone comes to celebrate Jesus's resurrection, and he teared up during Mass. I can't quite explain how I felt when he teared up, it seemed to me as if he believed in God but the religion was simply not accepting. I wanted really badly to tell him, that if he is indeed gay, that I love him just as much and that there are others in the community who do as well. And although I am only a child in my faith, I honestly do not believe that it is our place to judge others.Obviously it would've have been weird if I did told him that, but at the same time, I feel as if it might've given him some hope that he could come back to the Church, even as a homosexual in the life he lived; or at the very least, give him the knowledge that not all of us thinks his entire life is a sin and that he chose to be gay. I didn't say it, but it has kept me thinking throughout the day and I really want to ask others of their opinion on it.My experiences and views on homosexuality is definitely quite different from most people as I have encountered and are friends with more gays/lesbians than most people. I have no idea whether homosexuality is a phase or whether they chose it, or even if it is a sin. But what I know is that they, too, are humans and children of God. I realize that as a Catholic, the Church says that it is a sin for a man to love another man -- or a woman to love another woman -- but I honestly don't believe God gave us the power to judge them, it is His authority, not ours. But then again, I don't know when the line ends and where the next one begins when I put it this way.Jesus welcomed everyone, even Judas the sinner who would betray him and eventually commit suicide. Being welcoming, isn't this exactly contrary to a majority of Christian's hatred towards homosexuals? Once again, I am only a child but when I think about it, Christ also said that to enter His kingdom, we must be like children. A child is innocent and non-judgemental, they will befriend everyone if they were allowed to choose and grow up on their own, away from the influences of others. God created everyone just the same, heterosexuals and homosexuals, just like them, we, too, often sin, wouldn't He also welcome us into His kingdom?I have no idea how to go about this topic, whether I should raise it to the priest and discuss about the issue. But today, I really paid attention to it when I experienced the man in Church cry, I know that as someone who is a believer in Christ and someone who is accepting of homosexuals this is something that will probably bug me for a really long time.
Did you see anyone at church on Easter who you weren't expecting to see? How did you go about welcoming them to church? How can we encourage those yearly returners to come back the next week?
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We're all entitled to a pet peeve or two. Mine is disposable ballpoint pens.
No Small Problem
According to the EPA, Americans throw away 1.6 billion disposable pens every year. Add the rest of the world, multiply by over 50 years of writing with disposable pens, and that's a lot of metal and plastic waste ending up in landfill! I suspect it's just the tip of the iceberg, given the piles of disposable pens that many of us haven't thrown out yet. Not to mention the refillable pens that we never take the trouble to refill. Continue Reading →


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With a splash of digital pink, the Adair Family, the Von Trapps of apps, brings Thingamingo, Inc. to our 2013 event to showcase their intergenerational inventiveness. Ann and her husband Jon founded Thinkamingo Inc in late 2011, and share a bit here, about how they made app development an all-family effort.
"We homeschool our two children, Elizabeth, 13, and William, 9," explains Ann. "As the President, I handle the business tasks, social media, content development, and other odds and ends. Jon is our Vice President and Senior Developer. We wanted to keep our startup costs low, and Jon, a master developer, tackles all of the graphic design and programming. The kids have important roles, too. Elizabeth is our Junior Developer and future patent attorney. William is on the Creative Team and tests a lot of apps. We have the luxury of not having to outsource anything."
Ann and Jon bring some diverse backgrounds to the development process. Ann holds Bachelor and Master of Music degrees, has taught graduate studies in 20th-century/post-tonal music analysis as an adjunct instructor, and her primary occupation the last 25 years has been bassoonist, pianist, or music director. Jon has a background in computer science and was working on large enterprise software projects before starting Thinkamingo, as well as experience in photography and graphic design.
Now one year down the road, Thinkamingo has published 12 apps across a range of topics, from educational to entertainment. Their Story Dice app, around which they're focusing their TBMMF exhibit, was featured by MAKE Magazine's Mark Frauenfelder on National Public Radio and on BoingBoing.net.
Thinkamingo's Junior Developer, Elizabeth, will be on hand at the Faire to talk to kids, specifically, about building apps. She knows whereof she speaks, too! Elizabeth made and presented an app at a Microsoft Hackathon, she's a FIRST robotics team member, and a Girl Scout, to boot.
Thinkamingo will be showcasing two projects going at the TBMMF.
Flash Fiction with Story Dice, where participants will use the Story Dice app and create a short story on a souvenir card they can take with them, and a Group Fiction Project, where participants can contribute a sentence to an ongoing Mini-Maker Faire-y Tale to be featured on the Thinkamingo website in April.
The Adairs will also be providing at least one workshop at the Faire to help Makers "Spark your Creativity"!
We're delighted the Thinkamingo gang is joining us at Tampa Bay Mini Maker Faire 2013, and can't wait to see the stories that develop!


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Video shows Mexican politician accepting wads of money
Mexican television aired Wednesday a video showing Cancun Mayor Julian Ricalde Magaa accepting cash-filled envelopes. The images surfaced less than three weeks ahead of the July 7 mayoral election in the Caribbean resort city. Ricalde is barred from seeking a second consecutive term, but his PRD party does have a candidate in the race. On the video, which dates from 2010, then-mayor-elect ...
Mexican police nab one of FBIs 10 most wanted
Police at the Mexican sea resort of Playa del Carmen arrested one of the FBI's Ten Most Wanted Fugitives, a former college professor accused of sexually exploiting children. Walter Lee Williams, 64, was nabbed around 8.30 p.m. Tuesday in a coffee shop near a public park, Quintana Roo state Attorney General Gaspar Armando Garcia Torres said during a press conference in Cancun. "At present we ...
Vast Mayan city discovered in Mexico jungle
Archaeologists have discovered a previously unknown Mayan city in the southeastern state of Campeche, which for its vastness and characteristics is believed to have been a seat of government some 1,400 years ago. A team of experts headed by Slovenian archaeologist Ivan Sprajc has christened the site Chactun, Mexico's National Institute of Anthropology and History, or INAH, said. "It is one of ...
10-year-old prodigy to enter Harvard this fall
He's only 10-years old but thanks to an IQ similar to Albert Einstein's, Luis Roberto Ramirez will begin the next school year studying applied quantum physics at Harvard University. "My dream is to create a company and sell my inventions," the boy said on a video aired by the Michoacan Radio and Television System. Ramirez, who lives in Zamora, Michoacan, taught himself English at 5 and is now ...
Independent Publishing Houses in Mexico Promote Democratization of Books at Annual Fair
MEXICO CITY, MEXICO Gustavo Barr?n, 22, glances at the books on display at the Feria del Libro Independiente, a book fair featuring independent publishing houses in Mexico City, Mexicos capital. While perusing the selection, Barr?n, a university student studying history, holds a book about guerrilla groups in Mexico in the 1970s and the transition to democracy. The publisher is Ce-Acatl, a ...
Movie Review
The Last Sin Eater
The Last Sin Eater takes place in Appalachia in the mid-19th century, where recent immigrants have still maintained their Scottish accents and Celtic religious beliefs, including the idea of the Sin Eater, an outcast from society whose job is to take on all the sins of tho ... ...
On Facebook
US man wanted for child sex abuse held in Mexico
A former college professor in the US who was on the FBI's "10 most wanted" list over allegations of child sex abuse has been arrested in Mexico, officials said. Walter Lee Williams was detained Tuesday, CNN reported. The Federal Bureau of Investigation (FBI) had put the former university professor on the list for alleged sexual exploitation of children. Williams researched in the field of ...
Tropical Storm Barry headsforms off Mexican coast
This NOAA satellite image taken Wednesday, June 19, 2013 at 10:45 AM EDT shows tropical wave over the Lesser Antilles with light to moderate rain and thunderstorms. Fair weather across the remainder of the Caribbean with a chance of isolated afternoon ...
Tropical storm heads for Mexican coastal oil installations
By Reuters MEXICO CITY -- Tropical Storm Barry, the second of the Atlantic hurricane season, strengthened as it churned toward Mexico on Wednesday, threatening to bring heavy rains to oil and power installations near the country's Gulf Coast.The Minatitlan oil refinery of state oil monopoly Pemex and the Laguna Verde nuclear power plant, both in Veracruz state, are being monitored closely, ...
Were all mad for Mexican
This big daddy of the Tex Mex kitchen ticks all the boxes.In its most basic form - a spiced-up mix of minced meat and beans - chilli con carne is straightforward to prepare, economical and can be transformed into a variety of dinners quicker than you can say Speedy Gonzalez. Serve it with rice, wrap it in a burrito, splash it over corn chips for nachos, toast it in a jaffle. Americans, and a few ...
Mex to the max Agave Mexican Cuisine brings large menu to Orem
Recently opened Agave Mexican Cuisine is located on State Street in Orem but diners could be forgiven for momentarily thinking they were in Texas -- as everything seems way bigger there.For example, we're not sure we've ever encountered larger menus. Once the food started arriving, we noticed that not only were the portions a healthy size, but a couple dishes -- the Mole Poblano and ...
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Our nuclear programmes are completely transparent. But we are ready to show greater transparency and make clear for the whole world that the steps of the Islamic Republic of Iran are completely within international frameworks. The sanctions are unfair, the Iranian people are suffering, and our (nuclear) activities are legal. These sanctions are illegal and only benefit Israel.
Hassan Rouhani
Iran's president-elect was speaking after his historic election victory.
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New York-New York Hotel & Casino
Awe struck us on our arrival at this relatively new hotel and casino establishment at the top of the Strip. ...
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Family heading to Turkey to seek missing NY woman
NEW YORK (AP) — Relatives of a missing New York City woman who disappeared during a vacation to Turkey, her first trip outside the U.S., are heading to Istanbul to look for her, her brother said Sunday.
Sarai Sierra's family was last in touch with her on Monday, the day she was supposed to start her journey home. The 33-year-old mother of two had been in Turkey on her own since Jan. 7.
Her brother David Jimenez told The Associated Press that he and Sierra's husband, Steven, were planning to leave for Turkey on Sunday night. He said he had no return date planned.
"I don't want to come home without my sister," he said.
Sierra planned to head to the Galata Bridge, a well-known tourist destination that spans the Golden Horn waterway, to take some photographs, said her mother, Betzaida Jimenez. Her daughter then supposed to begin traveling home and was scheduled to arrive in New York City on Tuesday afternoon.
Sierra's father went to pick her up at the airport and "waited there for hours" with no sign of his daughter, Jimenez said.
Sierra had planned to go on the trip with a friend but ended up going by herself when the friend couldn't make it. She was looking forward to exploring her hobby of photography, her family said.
"I was nervous. I didn't want my daughter to go," Jimenez said, but the trip had passed smoothly with Sierra in regular contact with her family and friends through text messaging and phone calls.
"She would always call and let us know, 'This is what I did today,"' Jimenez said.
When she didn't show up in New York City, her husband called the place where she had been staying, David Jimenez said. The owner of the hostel checked her room and saw that her passport, equipment chargers and other items were still there. Continued...
"It looked like she was just stepping out," he said.
The family has been in touch with authorities in their efforts to find her. No one was available to comment after hours Sunday at Istanbul police headquarters. Crime in Turkey is generally low and Istanbul is a relatively safe city for travelers, though there are areas where women would be advised to avoid going alone at night. The Galata and the nearby Galata Bridge areas have been gentrified and are home to fish restaurants, cafes and boutiques.
Sierra's children, ages 11 and 9, do not know their mother is missing, her brother said. Betzaida Jimenez said the situation has "been a nightmare."
"I'm forcing myself to get up because I have to get up," she said.
But she said the tight-knit family was holding onto their faith.
"We're praying and trusting God that she's safe somewhere and we're going to find her," she said.
Associated Press writer Suzan Fraser in Ankara, Turkey, contributed to this report. Follow Deepti Hajela at www.twitter.com/dhajela
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Corruption in New JerseyLatest news on political corruption and arrests in NJ
West New York schools superintendent reads damning report on mayor's actions
May 16, 2013, 10:30PM
West New York Board Of Education members sat on a darkened stage tonight as Superintendent of Schools John Fauta read a blistering state report claiming Mayor Felix Roque and his allies in the school district controlled hirings, firings and demotions. "So help me God, no outside influence is going to penetrate this district," Fauta said before reading highlights of the... Full story »
Crowd is livid over delay in reading report about West New York mayor's involvement in district
May 16, 2013, 6:39PM
Loud "boos" rang out at tonight's West New York Board of Education meeting when the board quickly went into private session and left the auditorium at School 4 on Palisade Avenue. Hundreds of people are at the "public hearing" to hear a scathing report read about Mayor Felix Roque's involvement in the district and voice their sentiments about the... Full story »
Federal trial of WNY mayor Roque and son on hacking charges postponed until July
May 15, 2013, 2:58PM
The federal trial of West New York Mayor Dr. Felix Roque, 56, and his son on computer hacking charges has been postponed until July to give the mayor's new attorney time to prepare, according court documents. Full story »
No prison time for contractor who agreed to pay off Union City official
May 08, 2013, 12:02PM
A Clifton contractor who agreed to give corrupt payments to a Union City official in exchange for zoning approval for a development project was sentenced to three years probation yesterday. Full story »
Jersey City Mayor Healy tells Star-Ledger 'three Hispanic girls' lured him out of house for naked pix
May 05, 2013, 1:28PM
UPDATE: Campaign spokesman for Mayor Healy says voters don't care about naked photos from eight years ago. So you think you've heard all Jersey City Mayor Jerramiah Healy had to say about the naked pictures of himself, slumped on the stoop of his Ferry Street home, that surfaced shortly before the November 2004 special election? Well, think again. Star-Ledger... Full story »
High-stakes Jersey City mayoral race gets ugly
May 05, 2013, 11:03AM
While those outside the state's second largest city may not be paying much attention, for residents the May 14 election for mayor and council is impossible to ignore. Full story »
Terrifying kidnapping scam surfaces in Hoboken; residents warned to be vigilant
April 25, 2013, 3:11PM
The Hoboken Police Department is again warning the public to beware of a terrifying nationwide kidnapping scam aimed at exhorting money from concerned relatives, after a 41-year-old Hoboken woman was targeted on Tuesday. Full story »
Healy orders Fulop campaign to stop running ads featuring Dwek
April 22, 2013, 3:51PM
The ads, produced by the mayoral campaign of Ward E City Councilman Steve Fulop, should be pulled immediately or else Healy may pursue legal action, reads the April 19 letter from Healy attorney William W. Northgrave. Full story »
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Former Jersey City council candidate Serrano pleads guilty -- didn't report Dwek cash
April 22, 2013, 12:37PM
Former Jersey City City Council candidate Lori Serrano admitted to converting federal funds illegally for her personal use, U.S. Attorney Paul J. Fishman announced today. Full story »
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Jersey City mayoral candidates get into shouting match over corruption at debate
April 11, 2013, 10:34PM
The four men seeking the office of Jersey City mayor met at Lincoln High School tonight for a two-hour debate, with the two leading contenders engaging in a shouting match about public corruption. Full story »
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Morris County lab made millions of dollars by bribing doctors to give patients unneeded tests
April 09, 2013, 2:17PM
According to the criminal complaint, BLS has spent millions in the last 7 years to several physicians under the guise of consulting agreements. Full story »
Sentencing of former North Bergen housing official postponed
March 27, 2013, 1:12PM
John T. Kennell, 49, of North Bergen, was arrested last August and charged with extortion under color of official right and by fear of economic harm. Full story »
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Former Kearny councilman charged in $13M mortgage fraud scam
March 23, 2013, 7:33AM
A former Kearny councilman was charged yesterday in a $13 million mortgage fraud scam, the U.S. Attorney's Office announced. Full story »
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Court denies appeal of former Secaucus Mayor Dennis Elwell who was convicted in bribery sting
March 13, 2013, 2:20PM
The former mayor, a Democrat who resigned shortly after his 2009 arrest, was found guilty in July 2011 of accepting $10,000 in cash through a middleman from Solomon Dwek. Full story »
Author to read from book "Killing the Poormaster" at Hoboken Library Wednesday
February 14, 2013, 6:50PM
HOBOKEN -- Think Hudson County is corrupt now? Just think was it was like during the Great Depression. Author Holly Metz will be reading from her new book "Killing the Poormaster," about murder and corruption in Hoboken during the Great Depression at the city public library on Wednesday. The book reading about the story of the murder of Harry... Full story »
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About Us
Literature/Film Quarterly is is the longest standing academic journal devoted to the study of adaptation; it is edited and published at Salisbury University. To read more about our journal, click here.
Current Issue:
Volume 41, Number 2:
Includes articles on Jarman's The Tempest, Almereyda and Doran's Hamlets, Welles's Macbeth, "Radical Reflexivity in Cinematic Adaptation," and book reviews of Hitchcock at the Source: The Auteur as Adaptor, A Theory of Adaptation, Welsh Mythology and Folklore in Popular Culture, and Hideous Progeny: Disability, Eugenics, and Classic Horror Cinema.
To read the editorial letter opening this issue, click here.


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Party ideas, festive recipes, and how-to tips for casual holiday get-togethers.
"Excellent! I served it for a dinner party and several guests said it was the best cheesecake they ever had. One said it was better than you-know-what!"—Artache
Sponsored by:
Check out 140+ creative menus for any occasion.
Pin to Win lunch with Ina Garten in NYC.


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Website Re-VAMP!
Tell me what you think of the new Layout. i changed the top bar from the entire width background was white with top and bottom border of 1px black, text black and hover would be white text and black background.. i wasn't a fan of it. and then sub headings and headings were red text.
the nav now sits up at the top right hand corner neatly, and the headers and sub headers are purple, the links int the body are purple; when hover they are blue.
im not sure how i feel about them turning blue because it kind of ruins the effectiveness of links standing out from the headings. im thinking of changing it to just blue and removing the underline. but go through the site, let me know what you think. i can take criticisms well. if i deflect it lolWith all due respect you might want to check the spelling and punctuation, especially on the 'Services' page.
Also, for a web designer's site....it's pretty basic...you're gonna have to 'wow' your prospective audience and if you can't grab them on the first page then they aren't likely to bother looking into your portfolio....I know I wouldn't.Very basic, if you want a clean professional look you might try working on your typography. Also I would maybe suggest marketing yourself as efficient, specialized, personable, instead of cheap.Additionally, for someone who makes "HTML 5, PHP, JQuery part of my every day (sic) websites" I ain't seeing a lot of dynamic content...but perhaps that's coming.Definitely could use a little more work, but you've got a structure down and that's definitely a good start.hey @attilahajzer,
Like everyone else says, it's not very "WOW". @Paulie_D is correct, if you're claiming HTML5 and CSS3 abilities, you should showcase some of it. Don't get too caught up in being flashy, you don't need to have an overly amazing site if your portfolio is solid enough. Take http://astuteo.com/ for example, it's not fancy or over the top, but they design phenomenal websites. Your layout is good, just like @TheDoc said, you just need to spice it up a little. A texture rich background, some highlights here and there like corner ribbons on portfolio items or some movement in the menu. You've got a good solid start, now make it awesome.


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If you happen to be famous, you are a most likely the target of black-propaganda and demolition job.
Heartless Internet pranksters recently spread rumors that Hollywood A-lister actor Brad Pitt had already died. The nameless Internet pranksters said Pitt got killed while snowboarding in Zermatt, Switzerland.
The pranksters said the actor hit a tree which lead to his eventual death. A verification on the camp of the 48-year-old actor revealed that he remains alive, and that the report is completely false.
It was learned that aside from Pitt, other stars had also been previously declared dead on the Internet. Among the celebrities were Charlie Sheen, Christian Slater, and Lindsay Lohan among others.
Cyber pranksters need to learn some lesson: Internet death hoaxes are not funny.
Photo: Shutterstock


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Tonight: The Expedition explores Ibiza!
Residents of Ibiza have felt it coming for weeks. The Eivissa breeze carried the scent of anticipation, as a silent song filled the air. After weeks and weeks of waiting for the summer season to kick off, it's finally here. The magic of A State of Trance returns to the white isle! Who's ready for its official kick-off, tonight at Privilege?
(read more)


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Adobe Illustrator CS6 Current
Adobe Illustrator CS6 software is powered by the new Adobe Mercury Performance System so you can work with speed and stability on large, complex files.
A modern, updated user interface streamlines daily tasks. Advanced creative tools enable you to capture your vision better than ever.
Mac OS X 10.5.7 or higher with Intel chipset.
You can use software to create your Website on your PC before uploading it to the world wide web view it
In this episode, we'll show you how to browse the web on your HP TouchPad and how to use the unique Touch-to-Share feature. view it
We show you how to install a graphics card into your computer for high quality graphics rendering. view it
Using the web browser on the Samsung m360, including setting a homepage and finding mobile formatted sites. view it
Here we'll show you how to use Draw, the graphics program of OpenOffice.org! view it
We tell you about graphics cards and show you some ways that you can hook up dual monitors. view it
Using FTP to send your web pages and files from your computer to your site host view it


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National & InternationalTop StoriesNPR Topics: World NPR Topics: Nation Art & Culture NPR Topics: Business Metro & StateWBHM Seeks News DirectorJohn Archibald: Montgomery and Life are like High School Kyle Whitmire: No Traction for Jefferson County Bills Don Dailey: Capitol Journal Update Cindy Crawford: Magic City Marketplace Carsen Talks "AAA" And More On Capitol Journal Poverty on the Rise in Suburbia Kyle Whitmire: Delay for Alabama Accountability Act? Capitol Journal Update Tanya Ott's final day at WBHM John Archibald Kyle Whitmire: How was the Collapsed Airport Display Designed? John Archibald: Unrest at the Jefferson County Commission Kyle Whitmire: Jefferson County Top Attorney Job Reopens Healing the Hurt in Hurtsboro Black School, White School: Teaching The Civil Rights Movement The Postman's March I Was Told I Couldn't Be a Feminist Because I'm Black Hostess to the Civil Rights Movement 1963 Church Bombing Seeks Compensation John Archibald: Why Jeffco Is Paying Attorney $393K To Do Nothing Common Core, Part 3: More Writing May Be A Challenge Common Core, Part 2: Implementation a Challenge Commissioners Question Decision on County Attorney Jeff Sewell News Features Archive |
| Montgomery --The 2013 Alabama legislative session is underway. Legislators are tossing around many issues from gun violence and school security to Medicaid and budgets. Republicans are targeting President Obama's policies while Democrats will try to get their voices heard as the minority party. WBHM's Andrew Yeager speaks with Don Dailey, host of Alabama Public Television's Capitol Journal every Friday on Morning Edition and All Things Considered as we discuss the big legislative action of the week. | 2013-03-22 -- Click to listen about the governor signing a pair of government consolidation bills, a roll call snafu in the Senate, a Ten Commandments display bill and the newest shot fired over the school tax credit law. | 2013-03-15 -- Click to listen about the governor signing a controversial school tax credit bill, a bill repealing Common Core standards dies and a law enforcement consolidation bill gains final passage. | 2013-03-08 -- Click to listen about the climate of the legislature after last week's blow up over a school bill, the governor vetoes a school safety bill and the general fund budget passes out of committee. | 2013-03-01 -- Click to listen about last-minute, drastic changes to a school flexibility bill, a challenge to Common Core standards in Alabama and a bill to protect Airbus from lawsuits. | 2013-02-22 -- Click to listen about a bill placing more regulations on clinics that perform abortions, the first bill signed this session, a bill to arm some educators is put on hold and the prospects for legalizing homebrewing. | 2013-02-15 -- Click to listen about the House passing a school flexibility bill, proposals to consolidate state government and Senate Democrats' agenda for the legislative session. | 2013-02-08 -- Click to listen about Governor Robert Bentley's State of the State Address, his budget proposals, a school flexibility bill and the first bill to die in this year's legislative session. | 2013-02-01 -- Click to listen to a preview of the 2013 Alabama legislative session. |


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ALL HU Travellers Meetings now open for registration. We hope to see YOU at one of them this year!
Germany Meeting May 17-20,
HUBB UK May 30-June 2,
Montenegro Meeting June 27-30,
Ireland Meeting July 12-14,
Colorado Campfire July 12-14,
North Carolina Meeting Aug 8-11,
CanWest Meeting Aug 22-25,
Kyrgyzstan Mini-Meeting Aug 31, Ontario Canada Meeting Sept 12-15,
Queensland Australia Meeting Sep 26-29,
Victoria Australia Meeting Oct 11-13,
California Meeting Oct 24-27
Announcements in Forum : Bike Friendly, Northern Asia |
Commercial MARKETING on this site is PROHIBITED without prior agreement.
Anyone who visits Horizons Unlimited (the HUBB) with the intent to market goods or services to its registered members or unregistered guests, please be advised that MARKETING on this site is PROHIBITED without prior agreement from Horizons Unlimited (the HUBB) management. Consistent with the policies of similar sites, Horizons Unlimited does not provide or allow free advertising. It is possible to secure the right to market goods and services on this site in the form of paid sponsorship. Please see our Ad Rates page: http://www.horizonsunlimited.com/adrates for full details on advertising on HU. Another option for regular users on the HUBB is to become a Contributing Vendor for only US$ 40 per year. This will allow you to have your business in your signature and "recommend yourself and your business" in a post where appropriate. For more information, and the better HUBB Advertisers status and HU Sponsor status see here. NOTE: PERSONAL sales of bike and equipment is fine. Contact me for further details: http://www.horizonsunlimited.com/feedback NOTE: Any unpaid advertising will be deleted, and you can be banned. Without PAID advertisers, we can't continue to run this site. It's expensive to run, and it's our FULL time job. Please be fair to all and pay for your ads. Thanks for your understanding and support!
Grant Johnson Seek, and ye shall find. ------------------------ Inspiring, Informing and Connecting travellers since 1997! www.HorizonsUnlimited.com |


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Clinton's JV boys are holding onto their No. 1 ranking in the East Central 2A Conference as they head to Topsail Tuesday for another conference game, and after soundly defeating Swansboro in another road game Friday night.
The young Horses, now one game ahead of their conference opponents, pummeled the home team 58-27, and coach Bobby Lamb was able to play a lot of his team throughout the game.
"It was a good win and a real team effort for us," Lamb said Monday when he called in the game score. "I saw real team work out there on the court, and I like that."
Lamb said he started five different players in the opening minutes of the game to give them some playing time and experience on the court and, he noted, they did a good job for the JV Horses.
"I told the boys before we ever went out there they had an opportunity that not many others get, and I told them to go out and have some fun, and they did. They executed their plays well, worked hard and enjoyed it. That's fun to watch as a coach."
Clinton got the early 13-9 first quarter lead and stayed ahead the entire game. They were up 23-14 at the break and 42-18 by the end of the third quarter.
"We just had a good night," Lamb said, "and the boys were doing the things they know to do, passing the ball well, executing their plays, playing together."
Lamb also heaped praise on what he called "the Dark Horse family," made up of parents and fans who, he said, continued their support by traveling to Swansboro last Friday night.
"Our fans are tremendous and they help us win games. Their support means so much … they go the distance to support our program and it does make a difference."
In Friday's game, Jaalen Best had 9 points; Jaquan McLean, 9; Raquan Faison, 7; Logan Batchelor, 7; Michael Boykin, 5; Emmanuel Howard, 5; Kevin Scott, 5; Hyson Howard, 4, Josiah Pope, 2; and Jonathan Wright, 1.
Clinton's record moves to 18-1 overall.


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NCI/PDQ® Health professionals: Adjustment to Cancer: Anxiety and Distress (PDQ®) |
National Cancer Institute |
Last Modified: June 14, 2012 |
TABLE OF CONTENTSStudies examining the prevalence of mental disorders in cancer 1 2 show that most cancer patients do not meet the diagnostic criteria for any specific mental disorder; however, many patients do experience a variety of difficult emotional responses. 3 To effectively match patient needs and treatment interventions, health care professionals must be able to distinguish the periodic difficulties that characterize normal adjustment from more serious mental disorders. Psychosocial distress exists on a continuum (see figure below) ranging from normal adjustment issues through the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Adjustment Disorders; 4 to a level close to, but below, the threshold (i.e., meets some diagnostic criteria but not all) of diagnosable mental disorders; to syndromes that meet the full diagnostic criteria for a mental disorder (e.g., major depressive disorder). This summary focuses primarily on the less severe end of this continuum: the normal adjustment issues, psychosocial distress, 5 the adjustment disorders, and cancer-related anxiety. (Refer to the PDQ® summaries on Depression and Post-traumatic Stress Disorder for more information.) Anxiety is often manifested at various times during cancer screening, diagnosis, treatment, or recurrence. It can sometimes affect a person's behavior regarding his or her health, contributing to a delay in or neglect of measures that might prevent cancer. 6 7 8 For example, when women with high levels of anxiety learn that they have a genetically higher level of risk of breast cancer than they had previously believed, they might perform breast self-examination less frequently. 9 For patients undergoing cancer treatment, anxiety can also heighten the expectancy of pain, 10 11 12 other symptoms of distress, and sleep disturbances and can be a major factor in anticipatory nausea and vomiting. Anxiety, regardless of its degree, can substantially interfere with the quality of life of patients with cancer and of their families and should be evaluated and treated. 13 14 15 In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to practice related to children may differ significantly from information related to adults. When specific information about the care of children is available, it is summarized under its own heading. References:
Adjustment or psychosocial adaptation to cancer has been defined 1 2 3 4 5 as an ongoing process in which the individual patient tries to manage emotional distress, solve specific cancer-related problems, and gain mastery or control over cancer-related life events. Adjustment to cancer is not a unitary, single event but rather a series of ongoing coping responses to the multiple tasks associated with living with cancer. Patients are faced with multiple challenges that vary with the clinical course of the disease. Common periods of crisis and significant challenge include the following:
Each of these events has certain coping tasks, particular existential questions, many common emotional responses, and specific problems. Normal or successful adjustment is indicated in patients who are able to minimize disruptions to life roles, regulate emotional distress, and remain actively involved in aspects of life that continue to hold meaning and importance. 5 Coping refers to the specific thoughts and behaviors a person uses in his or her efforts to adjust. 2 Coping style refers to the most common, more frequent, and longer-term style of coping that an individual tends to use across a variety of life situations. One's coping style is often closely related to one's overall disposition and personality (e.g., optimism, pessimism, introversion, extroversion). 7 Coping strategies refer to those less frequently used and more situation-specific coping efforts, such as readjusting one's daily routine or work schedule to adjust to the side effects of cancer treatment. Coping strategies are engaged in an effort to adjust. Although there are many successful coping strategies, three broad categories have been noted: 2 8 9 10
Problem-focused strategies help patients manage specific problems by directly trying to alter problem situations. Emotion-focused strategies help a person regulate his or her degree of emotional distress, and meaning-focused strategies help patients understand why this has happened and what impact cancer will have on their life. In general, persons who adjust well typically remain committed and actively engaged in the process of coping with cancer and continue to find meaning and importance in their lives. Conversely, persons who do not adjust well often become disengaged, withdraw, and feel hopeless. Thus, assessing the degree of engagement versus giving up may be a way to distinguish between successful and unsuccessful adjustment. 5 For example, in a correlational study of adolescent cancer patients and their parents, engagement coping by the adolescent (including cognitive restructuring, seeking social support, expressing emotions, and problem solving) was associated with lower levels of distress. Conversely, disengagement coping by parents (including problem avoidance, wishful thinking, social withdrawal, and self-criticism) was associated with increased distress. 11 In a prospective investigation of different types of problem-focused coping strategies,146 women with early-stage breast cancer were studied. Study results showed that a strategy of concentrating on symptoms, measured at the end of treatment, was predictive of less improvement in physical and mental quality of life at 6 months' follow-up, while a strategy of information seeking was associated with greater improvement in physical quality of life. These findings suggest that problem-focused coping consists of a variety of specific coping strategies, some of which may be beneficialand some of which may not be beneficialto quality of life. 12 One criticism of the literature on coping with cancer focuses on the assumption that coping with cancer is a single unitary event. In reality, coping with cancer involves coping styles and strategies that may differ and vary according to the nature of the stressors being encountered. For example, in a study of 52 adults receiving palliative care for cancer, 13 patients participated in a semistructured interview during which they were asked about their most significant stressors and how they coped with these stressors. Three stressor domains were identified:
Three categories of coping were also identified:
Results showed that most participants used a range of coping strategies; however, there were interactions between stressor domains and coping categories. Problem-focused strategies were used less frequently for the existential stressors, while emotion-focused strategies were used less frequently for the physical stressors. 13 One cognitive theory of coping 14 proposes that in response to significant life events, a person asks two important questions:
When an event is perceived to be of personal significance (nearly all cancer-related life events would be), and when one's personal resources are perceived to be inadequate to the demands of managing the event, distress can occur. One way to conceptualize the amount of distress experienced by patients is the balance or ratio between perception of the demands that a situation (e.g., chemotherapy) places upon them and perception of the resources they possess (e.g., effective antiemetics) to effectively manage these demands: Distress = Perceived Demands/Perceived Resources Individuals with the same diagnosis or treatment regimen may experience very different levels of distress. A high level of distress could result from an individual's perceptions that either the demands of a situation are very high or his or her resources are very low (or both). Conversely, low distress is the result of a perception that either the demands of a situation are very low or the individual's resources are high. 15 To lower distress, therefore, either the perceived demands of the situation should be lowered, or the perceived resources should be increased.
Although there are some commonalities in normal adjustment to the varying stressors of cancer, there are also many individual differences. It is difficult to predict how individuals will cope with cancer, so it is important to recognize factors that influence adjustment to cancer. One study of women with stage II or III breast cancer 16 reported that higher levels of stress measured postsurgically at the time of diagnosis predicted lower physical and psychological quality of life. The stress measures included the following:
All measures were predictive. 16 Another study evaluated women with stage 0 breast cancer to stage III breast cancer (N = 89) at three time points: during treatment, at 3 weeks following end of treatment, and at 3 months posttreatment. Most survivors showed good adjustment on general distress indices. The factors predicting sustained distress included young age, history of depression or anxiety, and more extensive treatment. Younger age was the only factor that predicted greater distress across all evaluated measures. 17 Psychosocial adjustment/adaptation has been determined to be influenced by three broad categories of factors: cancer derived, patient derived, and society derived. 4 18 Cancer-derived factors include the following:
Patient-derived factors include two types of resources: 19 20
Patient-derived factors also include consideration for stage of life 22 (i.e., developmental tasksyoung adults may respond quite differently from older adults). Society-derived factors include the general societal views of cancer (e.g., stigma), as well as the influence society has on issues such as availability of treatments, open versus closed discussion of the illness, and popular beliefs about cause. The personality traits of optimism and pessimism might play a critical role in the psychological well-being of cancer patients. A German study investigated the impact of optimism and pessimism on psychological well-being in 161 newly diagnosed cancer patients with heterogeneous cancers. 23 Patients were assessed for optimism/pessimism and positive/negative emotions before the start of their first chemotherapy session and at 9 months' follow-up. Before the start of chemotherapy, psychological well-being was associated with higher optimism and lower pessimism. Only pessimism predicted negative change in psychological well-being at the 9-month follow-up. Additionally, only pessimism predicted heightened perception of chemotherapy-related side effects. The availability of social support, as part of a social network, has been found to be related to mortality from breast cancer. In a longitudinal study of 2,835 female nurses with breast cancer, those who, before diagnosis, reported no close contacts (e.g., relatives, friends, or living children) had a twofold increased risk of mortality from breast cancer, compared with those who had more social contacts (e.g., ten or more close relatives). This increased mortality was only found when comparing these two extremes in social ties, suggesting that women with relatively few social contacts or an intermediate number of contacts may not be at increased risk. Overall, these results suggest the important role of close relatives willing to step in and provide needed care. 19
The process of adjusting to cancer can begin even before a diagnosis. Patients may respond with normal levels of fear, worry, and concern when they have unexplained symptoms or when they realize that they are undergoing testing to determine the presence of cancer. When they hear the diagnosis, their fears become realized, generating a psychological and existential plight (crisis). 24 Many people wonder, Could I die from this? Receiving a diagnosis of cancer results in a crisis that includes expected and normal emotional distress. One author 25 has described the normal responses to the crisis of cancer as consisting of three phases:
Phase I, the initial response, consists of disbelief, denial, and shock that the news is true. Some patients will attempt to prove that the diagnosis is not true (Are you sure you have the right test results?). Most patients will report a period of disbelief accompanied by an inability to clearly process information. They may feel numb or in shock, or as if, This can't be happening to me. Such a high level of distress can be problematic because many times, immediately after informing patients of their diagnosis, physicians outline the treatment options. Under these emotional circumstances, many patients may be unable to understand or remember this important information. Thus, the presence of others or other means of being able to review the information can be extremely important (e.g., tape recording the discussion about the treatment plan or providing a second appointment at a later date, specifically for reviewing the treatment plan). Although there are many individual differences, this initial response of disbelief, denial, and shock usually lasts about a week in patients who adjust well. Phase II, dysphoria, consists of a variable period of time (but usually lasting 12 weeks) during which the patient is slowly acknowledging the reality of the diagnosis. During this time patients will typically begin to experience a significant degree of distress in the form of depression, anxiety, insomnia, anorexia, poor concentration, and varying degrees of inability to function in daily roles. Intrusive thoughts of illness and death may occur very often and seem to be uncontrollable. As more information about treatment options is provided, correctly processed, and understood, feelings of hope and optimism begin to emerge more frequently through the dysphoria. Distress levels can be elevated for newly diagnosed patients awaiting surgery. Additional professional support to address problems such as fatigue, insomnia, and depressed mood can be helpful during this time. 26 Phase III, longer-term adaptation, consists of the extended time during which more long-lasting and permanent adjustment occurs. This period consists of weeks and months. During this period, patients are utilizing a variety of coping strategies and styles. 9 Coping styles are longer-term, established ways for coping with many previous life events; coping strategies are situation-specific efforts to resolve particular cancer-related situations. This combination of longer-term coping styles and short-term coping strategies usually serves persons well in their efforts at adaptation. There is no single best way to cope. The individual differences persons bring to their encounters with cancer will result in varied coping styles and strategies. 5 During the active treatment phase of the illness, a patient's adjustment is focused primarily on coping with the many and varied stressors of treatment. These may include apprehension and fears about:
Patients who adjust well are able to tolerate these short-term stressors via a cost-benefit approach in which they weigh the discomforts of short-term loss against the benefits of long-term gains (e.g., increased survival) and conclude, It is worth it. 25 Questions that often occur during active treatment include the following:
As these and related questions arise, patients utilize coping styles and strategies to adapt. Although many different coping strategies are useful during this phase, problem-focused copingstrategies designed to manage specific problem situations (e.g., fatigue, transportation to treatments, altered work schedules, and role changes)are often utilized. Before active treatments are completed, most patients look forward to the conclusion of treatment with positive anticipation and hopes of returning to normal. However, the completion of active treatment can be a time of great ambivalence for cancer patients and their families. The completion of treatments suggests a time of celebration and relief, yet it can also be a time of heightened distress, with a renewed sense of vulnerability that comes with the cessation of active medical efforts to fight the disease. 27 Those who adjust well are able to balance their positive expectations with the realities of ongoing fears and apprehensions. Many patients report enhanced anxiety and worry related to fears of recurrence and decreasing frequency of medical surveillance via less frequent physician contacts. Other adjustment issues include living with uncertainty, returning to previous life roles, and hypervigilance to health concerns. 6 During remission, patients begin a sequence of regular follow-up appointments with their oncologist. Normal anxiety and worry often intensify as the dates of follow-up appointments approach. Normal anxiety comes from concerns about recurrence and the related emotional consequences (e.g., re-entry into the patient role and renewed feelings of loss of control). 28 Many patients find waiting for test results to be a particularly distressing experience. In one of the few empirical studies of posttreatment adjustment, 94 women with stage 0, I, II, or III breast cancer who were completing radiation therapy were assessed on measures of depression, anxiety, and quality of life on the last day of treatment and at 2 weeks, 4 to 6 weeks, 3 months, and 6 months posttreatment. Results found elevated symptoms of depression, low-level anxiety, and diminished quality of life on the last day of treatment; however, by 2 weeks later, symptoms of depression decreased significantly, and quality of life improved significantly. No other significant changes were found at any of the later posttreatment time periods, suggesting improvements in depression and quality of life occur quickly in most patients. 29 In regard to predictors of posttreatment distress, a longitudinal, observational study of 151 women with early-stage breast cancer found that physical symptoms and side effects experienced during treatment were predictive of posttreatment cancer-related distress, amounting to 6% of the total 24% of variance accounted for. 30 Normal adjustment to posttreatment and remission involves utilization of a variety of coping strategies; however, this phase often involves the frequent use of emotion-focused coping strategies (those designed to help regulate the normal emotional distress), given the variety of ambivalent emotional reactions. Those who adjust well are more likely to be comfortable expressing a wide range of both positive and negative emotions. Emotion-focused coping strategies include the following:
The transition from a curative treatment plan to one of palliative care is extremely difficult for cancer patients. 25 Extreme anguish often accompanies this transition as the patient faces renewed psychological distress, physical symptoms, and the existential crisis of death, all of which combine to result in the suffering often associated with advanced cancer. 31 The normal adjustment to this crisis is characterized by initial shock, disbelief, and denial followed by a period of significant distress (e.g., depressed mood, difficulty concentrating, frequent intrusive thoughts of death). Normal adjustment may include the following:
However, as with the initial diagnosis, this distress is often followed by a gradual adjustment over a period of weeks. It is important to note that these common reactions do not necessarily indicate psychopathology. Although the intensity of these emotions might be similar to more severe psychopathology, their frequency of occurrence and duration tend to be shorter. Patients experiencing normal adjustment to recurrence and palliative care will typically rally from these strong emotions more quickly than those experiencing a true mental disorder. (Refer to the PDQ® summaries on Depression and Post-traumatic Stress Disorder for more information.) Adjustment to recurrence and palliative care often involves shifting expectations from cure to healing. From this perspective, healing involves a process of becoming whole again, 32 of transforming one's life in a variety of ways in the face of death. This process of adjustment involves maintaining hope, which is viewed as crucial in overall adaptation to crisis. 33 The patient who successfully adjusts to the crisis of recurrence often shifts expectations and maintains hope in a variety of meaningful life activities. For example, a patient who has confidence that pain and suffering can be controlled will have hope for future quality of life. Patients who believe they are loved and cared for will have hope in their future relationships. Religion and spirituality play a very important role in helping many patients maintain hope. Religion or spirituality can provide a belief structure that helps in coping with the crises of recurrence. During recurrence and palliative care, patients are likely to utilize meaning-based coping strategies and are likely to seek comfort in prayer and in their religious practices/rituals or spiritual beliefs. In addition, one study suggests that prognostic awareness in combination with inner peace is associated with better mental health and quality of death outcomes for patients with advanced cancer and for their surviving caregivers during bereavement. 34 In a study of women with recurrent breast cancer, significant impairments in physical, functional, and emotional well-being were found within 1 month after recurrence; however, a patient's self-efficacy (confidence in his or her ability to manage the demands of illness), social support, and family hardiness (family's internal strength and ability to manage hardship and change) had positive effects on quality of life. Conversely, more distress about physical symptoms, additional life concerns, a sense of hopelessness, and a negative perception of illness or caregiving were associated with a lower quality of life. 35 The adjustment from posttreatment to long-term survivorship is gradual and extends over many years. However, most patients, despite various cancer diagnoses and treatments, adjust well, 3 with some even reporting benefits to a cancer diagnosis (e.g., greater appreciation of life, reprioritizing of life values, strengthening of spiritual or religious beliefs). 36 37 38 39 Patients who have poorer adjustment tend to have greater medical problems, fewer social supports, poorer premorbid psychological adjustment, and fewer economic resources. 3 As cancer treatments have improved, cancer is becoming a chronic illness, particularly with certain cancer types (e.g., prostate, breast). Each of the various psychosocial areas of functioning with a chronic illness has its own unique adjustment issues. For example, long-term adjustment to being a survivor of cancer involves considerations of how one adjusts psychologically, socially, sexually, vocationally, and, of course, physically. In general, studies of cancer survivors and healthy comparison groups have found no significant differences in measures of psychological distress, marital and sexual adjustment, social functioning, and overall psychosocial functioning. 3 However, there are some common areas of distress experienced by many cancer patients that are subthreshold or not severe enough to meet diagnostic criteria. These may include the following: 3 40
In one of the few prospective longitudinal studies of cancer survivors, 752 patients from three U.S. states were asked about a variety of psychosocial problems. About 1 year after diagnosis, 68% were concerned with their illness returning, approximately 60% were worried about recurrence, and 58% had fears of the future. In addition, approximately two out of three survivors were concerned about a physical health problem such as fatigue and loss of strength. Approximately 48% reported concerns with sleep difficulties, and 48% reported concerns with sexual dysfunction. Younger survivors (aged 1854 years), women, nonwhites, unmarried survivors, and those with lower incomes reported more problems. In comparisons of four common cancers, the most concerns regarding problems in living were reported by those with lung cancer, followed by survivors of breast, colorectal, and prostate cancers. 41 A large (N = 660) longitudinal study of women breast cancer survivors older than 65 years investigated factors associated with changes in emotional well-being. The overall findings suggest that the 5-year survivorship experience for most women is relatively stable, with few changes in emotional well-being. However, it was noted that women who had fewer than 12 years of formal education and women who perceived themselves as never being cured were more likely to experience declines in emotional well-being, while those who had better physical functioning, good emotional support, and the perception of positive physician-patient communication were less likely to have poor emotional health. 42 References:
Distress has been defined as an unpleasant experience of an emotional, psychological, social, or spiritual nature that interferes with the ability to cope with cancer treatment. It extends along a continuum, from common normal feelings of vulnerability, sadness, and fears, to problems that are disabling, such as true depression, anxiety, panic, and feeling isolated or in a spiritual crisis. 1 Standards of care have been developed for the management of psychosocial distress. 2 The National Comprehensive Cancer Network (NCCN) 1 has the broad goal of establishing standards of care so that all patients experiencing psychosocial distress will be accurately and routinely identified, recognized, and treated. These guidelines include recommendations for the following:
Also included are referral and treatment guidelines for each participating profession:
The times most likely to require screening include the following periods during the illness when distress is most likely to occur:
(Refer to the Overview section of this summary for more information.) Although many screening instruments have been tested with cancer patients (see Table 1), the NCCN Distress Thermometer (DT) has been the most widely investigated. The psychometric properties of the DT (a 010 visual analogue scale, in the form of a thermometer labeled with No Distress at 0, Moderate Distress at the midpoint, and Extreme Distress at 10) have been investigated. 3 The measure was found to have reasonable convergent and divergent validity when compared to two more well-established, multidimensional symptom inventories. This very brief rapid-screening procedure was found to have a moderate ability to accurately detect distress as defined by scores indicative of caseness on the two-symptom inventories. When specific cutoff scores were tested to maximize sensitivity and specificity, no single cutoff that maximized accuracy of classification was discovered. Thus, it was recommended that varying cutoff scores result in different referral recommendations, such that low scores result in no referral, moderate scores result in an optional referral, and high scores result in a strong recommendation for further interventions.
A few studies have investigated the prevalence of distress as measured by the DT. 3 4 5 6 7 8 Prevalence rates range from 22% to 58%. Different cutoff scores have been used, with most studies using a cutoff score of 4 or 5. Pooled results from multiple studies suggest that approximately 40% of cancer patients report significant distress. 9 Patients with lung, pancreatic, and brain cancers seem more likely to report distress, but in general, type of cancer is only modestly associated with distress. In regard to prevalence of distress along the clinical course, one study of 236 newly diagnosed breast cancer patients (awaiting their initial consultation with a surgical oncologist) found that 41% reported distress scores higher than 5 on the DT. In this same group of women, 11% reported symptoms suggestive of major depression, and 10% reported symptoms of posttraumatic stress. 10 In a study of 321 women with newly diagnosed stage I to stage III breast cancer, the ability of the single-item DT to specifically predict depression, as measured by a self-report questionnaire of the nine Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptoms for major depressive disorder, was investigated. Sensitivity and specificity characteristics were evaluated, and the optimal cutoff score of 7 was identified, resulting in a sensitivity of 0.81 and a specificity of 0.85 for detecting depression. Therefore, individuals scoring 7 or above should undergo a more thorough psychosocial evaluation. 11 Regarding predictors of distress, in a large sample (N = 380) of patients with mixed cancer diagnoses, those reporting a score of 4 or higher on the DT were more likely to be women, to have poorer functional performance (self-reported Karnofsky Performance Scale), and to have reported (on the Problem List that accompanies the DT) problems with housing, dealing with children, dealing with partner, depression, fears, nervousness, sadness, worry, and 14 of 20 physical ailments. 4 In regard to predictors of posttreatment distress, a longitudinal, observational study of 151 women with early-stage breast cancer found that physical symptoms and side effects experienced during treatment were predictive of posttreatment cancer-related distress, amounting to 6% of the total 24% of variance accounted for. 12 In addition, demographic variables associated with this posttreatment cancer-related distress included younger age, nonwhite racial status, and less formal education. Clinical variables associated with distress included having a mastectomy rather than lumpectomy, receiving hormonal treatment, and the presence of a diagnosable mental disorder at the time of recruitment into the study. Screening and assessment have been viewed as two distinct processes. 13 14 Screening is a rapid method of identifying patients with psychosocial distress, typically done by using brief self-report questionnaires administered by nonmental-health professionals with the goal of determining who needs referral for more extensive assessment. 15 The psychosocial assessment of the cancer patient is a more in-depth clinical interview focused on factors relevant to coping and adaptation. Mental health professionals do the assessment interview with the goal of determining how well a patient is adjusting. 13 Various comprehensive cancer centers have developed models for screening for psychosocial distress. Although there are notable differences, most models involve the following sequential steps:
Most screening for psychosocial distress is focused on the individual patient; however, some family-focused screening procedures are being developed. 16 Administration of a screening instrument involves a brief 5- to 10-minute process in which each patient answers a series of simple, straightforward questions about distress, either orally or via a self-report questionnaire or computer. Answers are scored and evaluated on the basis of previously determined criteria. If scores are above the defined criteria, then a formal referral to the appropriate discipline (social work, psychology, psychiatry, palliative care, pastoral care) is made. Distress management then begins with a more comprehensive face-to-face psychosocial assessment interview 13 by a qualified health care professional (e.g., social worker, psychologist, psychiatrist, palliative care specialist, pastoral counselor). Few empirical studies have evaluated the impact of structured screening programs. In two randomized, longitudinal, intervention studies, no significant differences in quality of life were found. 17 18 In one of these studies, however, a subgroup of moderately to severely depressed patients showed a significant reduction in depression following the intervention. Thus, further empirical evaluation of the effectiveness of screening programs is needed. The following examples will help to illustrate the process. Memorial Sloan-Kettering Cancer Center has experimented with a distress thermometer modeled after those used to measure |
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Home » Member Tools » Members' Bulletin Board » Volpe and Koenig Associate Elected to Serve on Three National and Local Boards
Posted to Announcement on 5/15/2012 at 1:51 PM
Volpe and Koenig, P.C., an intellectual property boutique law firm with offices in Philadelphia, Pennsylvania and Princeton, New Jersey, announced today that Associate Aneesh A. Mehta was recently elected to the North American South Asian Bar Association (NASABA) Board as Vice President of Memberships, as well as two separate board positions at the Young Lawyers Division for both the Pennsylvania and Philadelphia Bar Associations. NASABA's mission beyond serving as a bar association includes providing a vital link between South Asian lawyers and the South Asian community across North America.
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Urban Garden
446 N Fairfax Ave
bt Rosewood & Oakwood Aves
Los Angeles,
Italian. Check. Chinese. Yep. French. You betcha. L.A. has lots of international cuisines covered. But Mediterranean has always been something of an oversight — until now. Restaurateur par excellence George Abou-Daoud takes a healthy and fresh approach to his native diet at this casual eatery. We pita the fool who doesn't drop by.
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Going in with an open mind is the first big step.
Most people have experiences beyond the five senses, but they have nobody to talk to, said Lansdale resident Connie Bell-Dixon, who leads a Lansdale/Philly Psychic Development meetup.com group whose meetings include monthly gatherings at the Lansdale Public Library.
As a child, I had visions and pre-cognitive dreams, which is a dream about a future event, said Bell-Dixon, who started researching how to control her psychic energies when she was 19. She said she knew she had to do something when she was visited by the spirit of a friend who had died in a car accident.
Bell-Dixon says when she was 11, she had a vision of a movie stars death that came true, but declined to say who the movie star was.
Through her studies, she found that everyone has some type of psychic ability. For example, have you ever been thinking about somebody, then the phone rings, and its that very person?
Its a similar type of ability as mathematics, said Bell-Dixon, who explained that people have varying levels of interest, education and mastery when it comes to math.
The purpose of the psychic development group, Bell-Dixon said, is to help people consciously open up their energies to understand life, to help others and maybe just continue on a spiritual path.
The first half of the Lansdale Public Library meetings she described as a meet and greet. The second half is dedicated to some metaphysical element, such as telepathy, reiki, crystals, angels, auras, chakras, reincarnation, meditation, psychometry (detecting positive or negative energy from objects), or using pendulums to access the subconscious mind. Januarys meeting topic was spiritualitys place or not in psychic development.
If theyre smart, youll try them all because you never know what your talents are, Bell-Dixon said.
The number one thing I talk about is every person has the ability to accept or reject what I say. Im into meeting people who are into using their energies in a positive way. Its fascinating to see people grow.
The group has more than 430 members on meetup.com and the next meeting is at 1 p.m. Feb. 9. Cost is $5 and you must RSVP via meetup.com.
A less broad, but nonetheless metaphysical, group that has met monthly at Lansdale Public Library for the last year and a half is the Philly Tarot Card Readers, which next meets at 11 a.m. Feb. 2.
The group, which has 120 members, is led by Cliessa Nagle of the Mystic Magick metaphysical healing center on Walnut Street in Lansdale and Randi Bieba, who owned the former Crystal Persuasion shop in Skippack.
You dont go to get your cards read, Nagle said, you learn to be a reader.
The 78-card Tarot deck, which dates back to the 15th century, features mystic pictures that can be traced back to the Kabbalah, and Egyptian, Celtic, Roman, Greek and European mythology. Depending how the cards are drawn there are 6,000 possible combinations, according to Nagle they are said to spark the readers intuition to help with resolving dilemmas and offering insight into ones personal future.
It depends on what the reading is for, Nagle said. Every card has a certain meaning. A Tarot card doesnt stand on its own, it stands in relationship to the other cards. They tell the reader a story. Within six months people should be able to do a basic reading.
Nagle acknowledged that the cards get a bad rap because of an association with the occult. Its not evil. There are no sinister connections at all, she said. To be a good reader, you need to have a deeply spiritual element.
The February meeting topic will be getting physically and spiritually prepared to do a reading.


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