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DEFINITION of 'Negative Carry'
A situation in which the cost of holding a security exceeds the yield earned. A negative carry situation is typically undesirable because it means the investor is losing money. An investor might, however, achieve a positive after-tax yield on a negative carry trade if the investment comes with tax advantages, as might be the case with a bond whose interest payments were nontaxable.
BREAKING DOWN 'Negative Carry'
A negative carry would occur if an investor borrowed $1,000 at 12.5% and used the $1,000 to purchase a bond yielding 9.5%. The bond's coupons would not cover the interest owing, so the investor would end up paying 3% to make the investment.
BondA debt investment in which an investor loans money to an entity ...
Diversified Carry BasketA forex trading strategy in which multiple carry trades are conducted ...
FuturesA financial contract obligating the buyer to purchase an asset ...
Cost Of CarryCosts incurred as a result of an investment position. These costs ...
Positive CarryA strategy of holding two offsetting positions, one of which ...
YieldThe income return on an investment. This refers to the interest ...
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The Credit Crisis And The Carry TradeWhen boom times turned to bust, these trades proved devastating for traders and the broader markets.
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Advanced Bond ConceptsLearn the complex concepts and calculations for trading bonds including bond pricing, yield, term structure of interest rates and duration.
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How do I employ a cash-and-carry trade?The cash-and-carry trade is an arbitrage strategy of purchasing one security while simultaneously selling a similar security. ... Read Full Answer >>
Can mutual funds invest in options and futures?Mutual funds invest in not only stocks and fixed-income securities but also options and futures. There exists a separate ... Read Full Answer >>
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What does a futures contract cost?The value of a futures contract is derived from the cash value of the underlying asset. While a futures contract may have ... Read Full Answer >>


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Management and Non-Management Positions:
To assure consideration, please apply by visiting our web site at www.jobsatosu.com and searching by the requisition number of each posting below. All positions require successful completion of a background check.
Position: Cook 1 and Cook 2
Requisition Number: 412405 and 412407 Must apply by: October 11, 2015
Summary of Duties: This position assists in kitchen operation for the Blackwell Inn, Pfahl Conference Center, and Rohr Cafe, which in totality provides restaurant, room service, lounge, catering and banquet meals to the university community, students, conferences and hotel guests; prepares menu items and adheres to plate presentations and established recipes; assists with banquet and catering cooking; prepares garnishes for plates and chafer dishes; prepares and cleans work area using serve safe procedures and abides by state and local sanitization guidelines; makes menu suggestions; helps maintain food cost by reducing waste and utilizing byproducts; supervises and assists in the training of student employees; helps in minor ordering, produces ordering lists; creates and executes prep lists; ensures that all food prepared meets standards of excellence.
Required Qualifications: Ability to add, subtract, multiply and divide whole numbers and to read and write common vocabulary; 600 hours training in use of kitchen equipment (or 6 months experience); 600 hours training in food preparation and storage (or 6 months experience); or equivalent. Work days and hours will vary including evenings, weekends, and holidays.
Desired Qualifications: Associate's degree in hospitality management, culinary arts; 3 years of cooking experience preferably in a restaurant or conference center; ability to work as part of a team; ability to operate all kitchen equipment.
Target Salary: $11.96 - $14.00 Hourly
Position: Guest Services Manager
Requisition Number: 412406 Must apply by: October 11, 2015
Summary of Duties: The Guest Services Manager oversees daily front office operation for the Blackwell Inn and Pfahl Conference Center. In conjunction with the Rooms Division Manager, this department head is the champion of guest service throughout the hotel. This position trains and manages the front office staff; maintains high service standards and practices; assists with management of bell staff, valet parking, hotel transportation, telephone switchboard, concierge service and the gift shop; works closely with the reservations department, and is part of the revenue maximization team; monitors guest history to assure personalized service for repeat guests; assists in responding to customer feedback received from guest comment cards and via social media platforms; is responsible for resolving guest concerns; assists Rooms Division Manager and General Manager with guest correspondence, rooms division revenue management/maximization, and cost containment initiatives to ensure the division's profitability.
This position is also responsible for locating talent, interviewing, hiring, development and managing all front office staff; communicates and works in tandem with all departments of the hotel; communicates and works closely with housekeeping management regarding daily operations and guest service; maintains gift shop including: ordering, inventorying, maintaining, and merchandising all gift shop items.
Required Qualifications: Bachelor's degree in hospitality management or an equivalent combination of education and experience; minimum two years of previous experience in a hotel/conference center; demonstrated success in achieving service goals in hotel environment. This is a late morning to early evening shift position; however, business levels and shift coverage will dictate the schedule for this position. This position must work weekends as needed (football and special event weekends).
Desired Qualifications: Previous supervisory experience or work experience in a leadership role.
Target Salary: $35,000 - $45,000 Annually
Position: Lead Audio/Visual Coordinator
Requisition Number: 412404 Must apply by: October 11, 2015
Summary of Duties: This position leads the Audio/Visual department and provides technical support for programs and events in the Blackwell Inn and the Pfahl Conference Center; leads the day-to-day operations with audiovisual needs for conferences, programs and events; maintains, prepares, and sets up equipment for use; assists meeting planners by meeting with guests prior to events as needed; maintains good working knowledge of equipment such as digital projectors, laptops and personal computers, audio equipment, smart podiums, and other a/v equipment; has knowledge of new technologies available and evaluates feasibility of use at the Blackwell Inn and Pfahl Hall.
In addition, this position attends daily and weekly sheets meetings with sales team; works independently with minimal oversight and has the ability to make judgement calls when necessary to ensure success of event and guest satisfaction; assists in organizing and maintaining inventories of audiovisual equipment and supplies; manages, hires and trains staff; maintains and purchases all of the audiovisual equipment, which includes organizing and inventorying all equipment; assists in the setup of tables, chairs, coffee breaks, buffet tables, and break tables.
Required Qualifications: 100 hours training in operation or audiovisual equipment (or 1 month experience); or equivalent. Shifts will vary and may include evenings, weekends and holidays.
Desired Qualifications: Previous experience with setup and workings of A/V equipment including sound systems, equipment for computer presentations and light systems; ability to troubleshoot problems and coordinate preventative maintenance and repairs; demonstrated success in achieving service goals in conference center or customer service environment.
Target Salary: $15.00 - $18.00 Hourly
Student Positions:
Students of The Ohio State University may apply at The Blackwell Inn. Simply stop at our front desk and ask for an application. Available jobs are posted on OSU's Student Employment site

subset: commoncrawl


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Idaho's two U.S. representatives, Raul Labrador and Mike Simpson, are Mormons, though Simpson has been open with constituents and media about drinking and smoking cigarettes.
Neither Republican immediately responded to a request for comment.
Idaho politicians getting arrested for drunken driving is nothing new: Gov. C.L. "Butch" Otter was arrested in the early 1990s, when he was lieutenant governor; Democratic state Sen. Edgar Malepeai of Pocatello was arrested for DUI in 2009; and former state Sen. John McGee, a Caldwell Republican, was arrested on Father's Day 2011 after driving drunk and taking a car that didn't belong to him.
But none of them were Mormon.
Crapo raised the stakes by projecting an image of a diligent member of the faith and — at least outwardly — following church founder Joseph Smith's 1833 revelation in which he advised members that "strong spirits are not for the belly."
The U.S. Senate adjourned last week and wasn't expected to resume until Wednesday; it's unclear why Crapo had remained in Washington, D.C., ahead of the Christmas holiday.
According to the police report, he was alone in his car. It wasn't immediately clear where he'd been or where he was going when he was stopped.
Crapo was a Mormon bishop at 31 and has showed no public signs of a break from his church's teachings.
Church members must follow its guidance — including its rules on alcohol — to participate fully in the faith's rituals, including temple activities that are central to the religion.
Phone calls Monday to Mormon headquarters in Salt Lake City were not returned.
Crapo, first elected in 1998, is expected to take over the top Republican spot next year on the Senate Banking Committee. He also serves on the Senate's budget and finance panels and was a member of the so-called "Gang of Six" senators who worked in 2011 toward a deficit-reduction deal that was never adopted by Congress.
The 2010 bill he sponsored on cutting taxes for brewers ultimately stalled.


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Hotel Dome Las Tablas
- Free WiFi
- Airport within 5 mi/8 km: Madrid (XTI-Chamartin Train Station)
Main amenities
- Breakfast available
- Bar/lounge
- Conference center
- Airport shuttle
- 24-hour front desk
- Air conditioning
- Front desk safe
- Snack bar/deli
- Laundry service
- Conference space
- Multilingual staff
- Free newspapers in the lobby
What's around
- In Fuencarral
- Golf Park (1.7 mi / 2.8 km)
- Heron Diversia (2.5 mi / 4 km)
- CosmoCaixa Science Museum (2.6 mi / 4.2 km)
- Centro Comercial La Vega (2.7 mi / 4.4 km)
- Jardin de la Vega (2.8 mi / 4.6 km)
I would avoid this hotel, unless you really need to stay in the Las Tablas area, where…
Room was very clean, towels were of a good quality Bed was too hard Disappointed to find…
Enter dates to check prices
Hotel Info: 01 65 69 441from €49
- Double Room Single Use
- Family Room
- Junior Suite
- Standard Double Room
Recommended hotels
At a glance
Key facts
- Check-in time starts at 2 PM
- Check-out time is noon
- Express check-in/out
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
- Minimum check-in age is 18
Travelling with others
- Pets not allowed
- Free WiFi in public areas
- Free WiFi in rooms
Other information
- Smoke-free property
Nearby Four Star Madrid hotels
In the hotel
- Breakfast daily (surcharge)
- Bar/lounge
- Coffee shop/café
- Snack bar/deli
- Room service (during limited hours)
- Golfing nearby
- Business center
- Number of meeting rooms - 11
- Conference space
- Meeting rooms
- Conference space size (feet) - 26900
- Conference space size (meters) - 2500
- Conference center
- 24-hour front desk
- Dry cleaning/laundry service
- Free newspapers in lobby
- Luggage storage
- Elevator/lift
- Safe-deposit box at front desk
- Accessible path of travel
- Braille or raised signage
- Accessible bathroom
- In-room accessibility
- Roll-in shower
In the room
- Air conditioning
- Minibar
- Soundproofed rooms
- Private bathroom
- Shower only
- Free toiletries
- Hair dryer
- Digital TV channels
- Desk
- Free WiFi
- Phone
- In-room safe
Top Madrid hotels
Recently reviewed hotels in Madrid
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Hotel Dome Las Tablas's small print
Cash transactions at this property cannot exceed EUR 2500, due to national regulations. For further details, please contact the property using information in the booking confirmation.
For transfers, guests must contact the property before arrival at the number on the booking confirmation.
Optional extras
Valet parking costs EUR 20 per night
Breakfast is offered for an extra charge of EUR 12 per person (approximately)
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


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Select Local Merchants
Blinds of All KindsRead MoreAt Blinds of All Kinds in Lakeway, you can find high-quality and long-lasting furniture that is sure to meet your standards. Liven up your home's interior with beautiful furniture sets from here, such as living room furniture. You'll love the look of your brand new office when you outfit its furniture with the selection at store. If you're looking to make your bedroom more comfortable, check out the furniture options here, such as bedroom furniture. Make sure everyone has a seat at your next BBQ. Shop the awesome selection of patio furniture that will go perfectly with any outdoor space. When you're ready to spruce up your bathroom's design, check out the furnishings on display. If you're in the market for some new wall decor, be sure to clear some space for items like curtains and mirrors. For the homiest of homes, add some warmth with goodies like rugs, throw pillows, and vases. Take any space and complete it with a beautiful new piece of art. Drivers will find parking not far from the store. If you need to replace your stained and torn furniture, check out the selection at Blinds of All Kinds in Lakeway.1017 Ranch Road 620 SLakeway, TX US
Quilting LoftRead MoreMake your interior design ideas a reality with some new fashionable furniture pieces from Quilting Loft in Lakeway. Be your own interior designer and revamp your living room with some new furniture from here, such as living room furniture. Making over your bathroom is super simple with the cute and affordable furniture selection. Find cute furnishings for your backyard or patio and have the whole family over to your place for an outdoor get-together. You'll be the most popular one at the office when you replace old furniture with some of the trendiest offerings at store. Pick out a new bedroom furniture set from here, such as bedroom furniture, and give your bedroom the makeover it deserves. Doll up your house with a little help. Items like rugs, throw pillows, and vases may be just the snazzy solution your home needs. The goodies here will work wonders for your wall including curtains and mirrors. Treat yourself to artwork at its finest when you purchase a painting, drawing, or sculpture from here. You won't need to plan ahead for parking when you travel to Quilting Loft. A new piece of furniture can really brighten up a room so head over to Quilting Loft in Lakeway and browse the furniture collection.301 Hurst Creek RdLakeway, TX US
Patio LoungeRead MoreNo matter your taste in style, Patio Lounge's amazing furniture store in Lakeway has exactly what you need for your home. Pick out a new bedroom furniture set from here, such as bedroom furniture, and give your bedroom the makeover it deserves. Keep your office looking fresh and modern with some new office furniture from this store. Making over your bathroom is super simple with the cute and affordable furniture selection. Deck out your deck with the perfect patio furniture, you're sure to find a summer style you love. This store has a huge furniture selection, including living room furniture. Quality decorations go a long way when it comes to making a home your own, so start with rugs, throw pillows, and vases. If you're in the market for a bold piece of art, check out the beautiful works featured here. Wall decorations such as curtains and mirrors are sure to catch your eye, so stop in and see what else is on hand. If you are making your way over to Patio Lounge, make sure you check out the convenient parking options located nearby. When you are ready to expand your furniture collection, Patio Lounge in Lakeway will have some perfect options waiting for you.1700 Ranch Road 620 NorthLakeway, TX US


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Winter in Mayrhofen
Ski Resort
Action Mount Penken & Leisure Mount Ahorn
Choose Mayrhofen-Hippach in Tirol as your ski holiday destination and look forward to 136 kilometres of slopes, 100 percent of which are equipped with artificial snow-making machinery, should Mother Nature happen to be sparing with the white gold. So it is with a clear conscience that we offer a 100% snow guarantee! With 57 state of the art lift systems, you can explore the slopes Mayrhofen's ski area daily from 8.00 to 16.30 hrs. Familiarize yourself with our diverse ski resort using our interactive piste map.
Information on current snow conditions is available via the HOTLINE: +43 (0)5285/6760 or online.
Ski schools & ski rentals
Professional ski & snowboard instructors will show you the stylish art of carving on our 489 kilometres of pistes in Zillertal. The very best winter sports instructors are on hand with advice and practical help - be it in learning skiing or snowboarding, back country and deep snow terrain - in the seven ski schools of the Mayrhofen-Hippach holiday region.
Who on earth likes to travel on holiday with bulky luggage? Save yourself the trouble of transporting cumbersome ski gear to Zillertal - we have top ski rentals on site that can provide you with the latest skis, boards & boots etc.! More information on ski schools & ski hire...
Away from the pistes
Whether sledding, ice-skating, cross country skiing or discovering untouched snowscapes on a leisurely winter walk, anything is possible in the holiday region of Mayrhofen-Hippach.
If you or your children fancy jumping on a toboggan and whizzing down snowy pistes or through dreamy winter landscapes - we have just what you are looking for! Tobogganing...
The dreamy, white winter landscapes have a very special appeal. Feel tension ease and your spirits rise as you drink in the stunning surroundings and allow the benefits of nature to nurture your inner peace. Savour your romantic winter holiday in the mountains along well-maintained and cleared winter walking trails. Winter walking...
A dream come true for cross country ski enthusiasts of all ages - the trails at Burgsschrofen in Schwendau near the Burgstallschrofen chapel. Cross country skiing...
There is much to discover away from the slopes - what? Discover the Mayrhofen-Hippach holiday region...
Wellness and spa offers allow you to indulge in the essential pleasures of rest and relaxation in the Mayrhofen-Hippach holiday region in Zillertal. For more health and balance in everyday life. More info on spa services...
Zillertaler Superskipass
05.12.2015 to 14.04.2016
The Zillertaler Superskipass (applies as of 2 days) is valid on all 489 kilometres of pistes and 177 cable cars and lift systems in the entire Zillertal Valley.
Here you will find the ski pass prices and operating times of Mayrhofen ski resort at a glance.
The free ski bus system transports you quickly and conveniently to the cable cars from anywhere in the region.
TOP EVENTS in WINTER
Altitude Comedy Festival
It's going to be non-stop giggles all over again!
Mayrhofen is hosting the Altitude Comedy Festival for a fourth time. Europe's number 1 comedy festival takes place at Europahaus Mayrhofen where laughter is on the cards at the eclectic range of acts.
"It's like Ibiza in the snow", according to Brit Award winner Dissee Rascal. "The world's best festival", says Tom Clarke from The Enemy. A top class line up from the club scene elite ensures burning beats and a sizzling vibe.
Mayrhofner Advent at the Forest Festival Area
Advent in the Mayrhofen-Hippach holiday region - where even stress takes a Christmas break.
The essential pleasure of peace, quiet and relaxation. Time to take a deep breath. That´s what Advent in Mayrhofen is all about. No gaudy decorations and annoying jingles. Well away from the noise and commercialism, guests to Mayrhofen will discover the true spirit of Christmas, experience wonderful customs and enjoy the special anticipation of Christmas Eve.
The Forest Festival Area will shine in pre-Christmas splendour on the following dates:
*28th and 29.11. 2015 *4th, 5th and 06.12.2015 *12th and 13.12.2015 *19th and 20.12.2015
Opening times: from 17.00 hrs to 21.00 hrs - on 06.12.2014 from 14.00 to 19.00 hrs;
Crazy relay race in Mayrhofen: 4 people - 1 team, the same goal
For the fourth year in succession, the winter season in Mayrhofen in Zillertal will kick off with the top class "RISE&FALL" sporting event.
A thrilling relay competition, with a touch of aggression, perfection, extremism as well as a healthy dose of emotion and lifestyle. An unprecedented sporting event in which teams compete in a race against the clock.
NO MERCY - these athletes are going to need plenty of staying power. The teams, consisting of four members, have four sporting disciplines to overcome. RISE: Ski touring and mountain bike & FALL: Paraglide and ski or board.
Who will leave the race venue as winners in 2015?


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In November 2011, American Airlines' parent company, AMR Corporation (NYSE:AAMRQ.PK) filed for bankruptcy, despite a rather valiant attempt at recovery by its Chairman and CEO Gerard Arpey, after taking over from CEO Donald Carty in 2003. American Airlines could not stay competitive, as it was burdened expensive labor contracts, volatile fuel costs and the need for a new fleet. It, along with other major carriers, had been facing a general trend of lower customer demand post 9/11, which looks to deepen further by the persistent global financial crisis. CEO Arpey retired from AMR convinced that the new chairman and CEO Tom Horton would need to restructure American Airlines with a free hand. Rerouting
TUTORIAL: The Industry Handbook
Cuts, Layoffs and Reductions
Bankruptcy filings by American's competitors have helped them become more cost effective. For example, United cut its fleet by about 8%, laid off 30% of its employees, terminated pensions, reduced wages of its existing employees by about 35% and cut overall expenses by $7 billion. United then merged with Continental to become America's number one airline.
Delta Airlines, which filed for bankruptcy in 2005, reduced its fleet size by 11%, employees by 17% and terminated its pension plans for pilots. It later merged with Northwest, which had filed for bankruptcy in 2005, reduced its capacity by 6% and laid-off 17% of its employees. Northwest also reduced wages, which hit its mechanics particularly hard, by 41%. The Delta-American combine stands second, today.
American, with its pension plans and large workforce, was unable to stay cost-effective in comparison to its competition. American Airline employees have braced for a loss of jobs; around 13 million of its current and retired employees could be affected by the bankruptcy.
By filing for bankruptcy, American was hoping to reduce costs and spend its money on newer, larger airplanes from Boeing and Airbus, which would subsequently reduce the size of its existing fleet. American is replacing its existing MD-80 aircrafts with Boeing 737s and new interiors. Between 2007 and 2011 American airlines has spent $5.5 billion in purchasing new aircrafts and upgrading facilities and on-board experience. American is also ordering Airbus narrow body planes. (For more on analyzing airline stocks, read Is That Airline Ready For Lift-Off?)
Domestic routes are ruled by local players and margins are low. Southwest Airlines, JetBlue Airways, AirTran and Alaska Air are all low-cost domestic carriers fitting into a space that is becoming unviable for legacy players to play in. These domestic carriers usually have one type of aircraft, outsource maintenance, use lesser used airports (thus reducing landing costs) and encourage direct booking online to reduce intermediary costs. For these reasons, domestic route players are primarily becoming hub feeders.
Large airlines are moving towards predominantly flying on international routes. Unfortunately, with the economic downturn in Europe, major carriers are staring at big losses in this supposedly premium segment. Furthermore, since legacy players use prime airports where landing costs are far higher, they are at a further disadvantage.
In addition to the large airlines, there are the low-cost air carriers that fly on international routes. These carriers offer much cheaper prices with no frills; they usually fly point-to-point and tickets are booked only through the Internet. They save money by using secondary, lower costing airports, enforce strict baggage weight restrictions and have customers move their own luggage between connecting flights. They also have no on-board entertainment and schedules are subject to change at anytime. These carriers work well for budget travelers who simply want to get to their destination and aren't as concerned with luxury and comfort during traveling.
The Bottom Line
The American airline industry is expected to earn $2 billion in 2011, according to the International Air Transport Association. While most of the legacy airlines have now evoked Chapter 11 to renegotiate labor contracts, the fact still remains that these airlines need to address basic issues like mishandling of baggage, arriving on time and being sensitive to different customer needs (disability, toddlers etc.). Customers do not expect the world when they travel, but they do expect their baggage to arrive with them and be treated courteously. Airline companies need to focus as seriously on generating revenues through positive customer experience as they do on keeping a lid on costs.
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The Top Performing Airlines Right NowLearn about the airline industry and its top-performing companies. Understand these top-emerging airlines and why they have taken more market share.
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Southwest & Cheap Oil: The Perfect Combination?Discover how falling oil prices (and well-timed futures contracts) benefit Southwest Airlines.
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Southwest's Strategy Is the Future of The US Airline IndustryLearn why Southwest's current profitable business model should become the future of the airline industry.
How to Travel to Tokyo on a BudgetPlanning a trip to Tokyo? Here are a few ways that you can make the trip more affordable.
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Top Resorts for Multigenerational Family VacationsAfter a week at one of these resorts that cater to families of all ages, you might swear off those exhausting road trips to Grandma's for good.
Investing Basics
The Top Five Public Railroad Stocks in the U.S.We offer a breakdown of the seven Class I railroads in North America based on their annual revenues.
A Long Road to Full Diplomatic Relations with CubaOver the past 50 years, the U.S. and Cuba have remained at odds, only recently to restore diplomatic ties. What does this mean?
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10 Tips for Renting a Vacation Home on AirbnbHere's a list to make sure that you have a seamless vacation using Airbnb.
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Most Senior-Friendly Cruise DestinationsWhen it comes to choosing a cruise for the post-retirement set, not all destinations are created equal. Here's a handful of the best.


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Keyword: Search and rescue efforts
Finding recorder key to solving the sinking of cargo ship
JACKSONVILLE, Fla. (AP) — Investigators trying to determine why a 790-foot cargo ship stalled and sank in the howling winds of Hurricane Joaquin will be searching for a brightly colored device bolted to the deck and pinging away in the blackness and pressure of the 15,000-foot-deep sea.
Coast Guard abandons search for 33 missing crew members
JACKSONVILLE, Fla. (AP) — The Coast Guard officially ended its search Wednesday for the missing crew members from a U.S. cargo ship that sank off the Bahamas during Hurricane Joaquin.
The Latest: Search for missing crew to end Wednesday evening
JACKSONVILLE, Fla. (AP) — The latest on a U.S.-based cargo ship that sank in the Atlantic and the search for crew members. All times local:
Dog rescued after fall into crack at Volcanoes National Park
HONOLULU (AP) — A Big Island family was reunited with their dog after a rescue team removed the Labrador retriever trapped in a crack in the earth at Hawaii Volcanoes National Park.
Morgue, cemetery and back: Guatemalans search for, bury kin
SANTA CATARINA PINULA, Guatemala (AP) — Ismael Estrada buried a son and a granddaughter swept away in a mudslide that killed at least 131 people and left as many as 300 missing.
A timeline on the search for missing cargo ship El Faro
MIAMI (AP) — Here is a timeline on the search for the cargo ship El Faro, missing off the coast of the Bahamas:
South Carolina flood: Door-to-door searches, swamped roads
COLUMBIA, S.C. (AP) — People across South Carolina got an object lesson Monday in how you can dodge a hurricane and still get hammered.
The Latest: Coast Guard: Missing US-based cargo ship sank
JACKSONVILLE, Fla. (AP) — The latest on the search for a U.S. cargo ship carrying 33 people that has been missing since it encountered high winds and heavy seas from Hurricane Joaquin. All times local:
Search off Bahamas for lost ship turns up debris, no answers
JACKSONVILLE, Fla. (AP) — The captain of the 790-foot El Faro planned to bypass Hurricane Joaquin, but some kind of mechanical failure left the U.S. container ship with 33 people aboard helplessly — and tragically — adrift in the path of the powerful storm, the vessel's owners say.
The Latest: Container found that may be from missing ship
NASSAU, Bahamas (AP) — The latest on the search for a cargo ship missing off the coast of Bahamas (all times local):


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Iowa Poll: Hillary Clinton Leads Socialist Bernie Sanders in Iowa 37% to 30%
Doesn't this speak volumes of the Democrat party. According to a new Des Moines Register/Bloomberg Politics Iowa Poll, self-proclaimed socialist Bernie Sanders has narrowed the gap on Hillary Clinton in polling for the Democratic presidential nominee, 37% to 30%. The Vermont Senator now only trails Hillary by 7. How is this possible? Just how damaged a candidate is Hillary Clinton, or has the Democrat party finally jumped the shark and truly has become nothing more than a Socialist party? And of course what does it say about the Democrat party in general when we have an open election for the next president of the United States and all the Donkeys can provide as candidates is a liar, a socialist, two unknowns that no one cares about and crazy VP who has not declared whether he is in or out.
Liberal revolutionary Bernie Sanders, riding an updraft of insurgent passion in Iowa, has closed to within 7 points of Hillary Clinton in the Democratic presidential race.
She's the first choice of 37 percent of likely Democratic caucusgoers; he's the pick for 30 percent, according to a new Des Moines Register/Bloomberg Politics Iowa Poll.
But Clinton has lost a third of her supporters since May, a trajectory that if sustained puts her at risk of losing again in Iowa, the initial crucible in the presidential nominating contest.
Posted August 29, 2015 by Scared Monkeys
2016 Elections, Bernie Sanders (I-VT), Democrats, Hillary Clinton, Iowa, Liberals, Polls, Progressives, Scandal, Socialism | one comment
Donald Trump Up big in New Hampshire and Socialist Bernie Sanders Leads Hillary Clinton
In the latest PPP poll in New Hampshire, Donald Trump has pulled away from the GOP field leaving them in his dust. The New Hampshire primary is still a long ways away and not until February 9, 2015, but The Donald is doing his best to crush the competition. Much ti the disbelief and puzzlement of the establishment and GOP machine. It is starting to be become very obvious that that Republicans voters are sick and tired of the lying politicians that have stabbed the electorate one too many times. Look at who is either leading in the polls or surging, its Donald Trump, Carly Fiorina and Ben Carson.
The Donald
PPP's new New Hampshire poll finds Donald Trump in the strongest position of any poll we've done anywhere since he entered the race. Trump laps the Republican field with 35% to 11% for John Kasich, 10% for Carly Fiorina, 7% each for Jeb Bush and Scott Walker, 6% for Ben Carson, 4% each for Chris Christie, Ted Cruz, and Marco Rubio, and 3% for Rand Paul. Candidates falling outside the top ten in the state are Rick Perry at 2%, Lindsey Graham, George Pataki, and Rick Santorum at 1%, and Jim Gilmore, Mike Huckabee, and Bobby Jindal all at less than 1%. Everyone does have at least one supporter on this poll.
To give an idea of how fundamentally the contest has shifted over the last four months none of Trump, Kasich, and Fiorina weren't even included in the horse race question when we last polled the state in April. The candidate who's made the most cataclysmic drop is Walker- he's gone from leading at 24% all the way down to 7% in this newest poll.
Bernie Sanders
As for the DEMOCRATS/SOCIALIST in polling in New Hampshire, socialist Bernie Sanders leads Hillary. What the hell has the Democrat party become? No wonder Democrat political insiders are begging Joe Biden to get in the race to save the embarrassment of actually nominating a self=professed socialist as their parties standard bearer.
There's been a big shift on the Democratic side since April as well. Bernie Sanders now leads the field in the state with 42% to 35% for Hillary Clinton, 6% for Jim Webb, 4% for Martin O'Malley, 2% for Lincoln Chafee, and 1% for Lawrence Lessig.
The main story in New Hampshire is how universally popular Sanders has become with the Democratic electorate. 78% see him favorably to only 12% with a negative opinion- that makes him easily the most popular candidate on either side with their party's voters. Meanwhile Hillary Clinton's favorability numbers have taken a little bit of a hit- she was at 78/10 with Democratic primary voters in April, but now she's at a 63/25 spread.
The ideological divide is actually not that stark on the Democratic side. Sanders is ahead with 'somewhat liberal' voters (45/32), 'very liberal' ones (46/37), and moderates (40/36) alike. And although there is certainly a gender gap Sanders is ahead with both men (44/30) and women (41/38). But the real big divide we see is along generational lines- Clinton is ahead 51/34 with seniors, but Sanders has a 45/29 advantage with everyone under the age of 65.
Posted August 26, 2015 by Scared Monkeys
Battle Ground States - Swing States, Bernie Sanders (I-VT), Democrats, Donald Trump, Donald Trump, Hillary Clinton, New Hamsphire, Polls, Republican | no comments
Fox News Poll: Socialist Bernie Sanders Gains on Hillary Clinton But Trails by Wide Margin
In the most recent FOX News poll, self-proclaimed socialist Bernie Sanders has gained some ground on the presumptive Democrat nominee and ethically challenged Hillary Clinton, 49% to 30%. Although still trailing by a great deal, Sanders has shaved the lead by 10 percentage points as Sanders trailed by 29 in the Jul-2 Aug 15 poll, 51% to 22%. If Hillary Clinton's struggles continue where the voters believe her to be a liar, it would be long before the socialist Sanders takes the lead in this poll as well. Sanders recently lead a Boston Herald/FPU poll by 7%. Vice President Joe Biden is in third with 10%; however, that may change greatly in the near future if he decides to enter the presidential race as Hillary's email and ethical challenges continue.
EXIT QUESTION: Will support for Hillary Clinton continue to wane and will Joe Biden enter the race?
Posted August 16, 2015 by Scared Monkeys
Bernie Sanders (I-VT), Democrats, Fox News Opinion Dynamic, Hillary Clinton, Liars, Liberals, Polls, Progressives, Socialism | no comments
Majority of Americans Support a 'Criminal Investigation' of Hillary Clinton's Emails
A funny thing has happened on the way to Hillary Clinton's coronation as the Democrat nominee for president in 2016 … a majority of Americans support the investigation into Hillary Clinton's emails. Could this situation have been handled any poorer and it appears that email-gate is going to dog Hillary right through the primaries. Heck, at this point its even money has to whether Hillary will be nominated or jailed. A recent Monmouth University Poll states that 82% of Republicans and 54% of Independents support an investigation, while 66% of Democrats support criminal activity when it comes to US national security. More than Democrats who would support Hillary no matter what crime she committed, I have to question the 18% of Republicans who did not support an investigation. Who are these people and maybe they need to have their GOP card taken away.
Read the full poll HERE.
A one-two punch? The news coverage of Hillary Rodham Clinton is very telling at the moment as the Democratic presidential forerunner faces inquiries about her private email system while she was secretary of state, amid some unstable favorability numbers. "Even though most voters feel Clinton's intentions may have been acceptable, a majority (52 percent) say that her emails should be subject to a criminal investigation for the potential release of classified material. Another 41 percent say the emails should not be subject to this type of investigation," notes a Monmouth University Poll released Wednesday. "Most Republicans (82 percent) and a majority of independents (54 percent) support an investigation, while two-thirds (66 percent) of Democrats are opposed."
In addition, 38 percent overall say Mrs. Clinton "has something to hide"; that includes 68 percent of Republicans, 41 percent of independents and 8 percent of Democrats. More numbers in the Poll du Jour at column's end.
But of course Hillary Clinton committed no crime, because everyone has their personal email server that they head State Department emails on that they weren't supposed to and then deleted professionally scrubbed and wiped clean. It happens all the time.
After years of holding herself above the law, telling lie after lie, and months of flat-out obstruction, Hillary Clinton has finally produced to the FBI her server and three thumb drives. Apparently, the server has been professionally wiped clean of any usable information, and the thumb drives contain only what she selectively culled. Myriad criminal offenses apply to this conduct. Anyone with knowledge of government workings has known from inception that Hillary's communications necessarily would contain classified and national security related information. Thanks to the Inspector General for the Intelligence Community, it is now beyond dispute that she had ultra-Top Secret information and more that should never have left the State Department.
Posted August 14, 2015 by Scared Monkeys
2016 Elections, Crime, Hillary Clinton, Polls, Primaries, You Got Email-gate | one comment
CNN Poll: Donald Trump Significant lead in Iowa … Ben Carson is in Second Place
According to the most recent CNN poll, Donald Trump is in the lead in Iowa. Despite Fox News, Megyn Kelly's and the establishments attempts to sabatoge Donald Trump in the last debate, Donald Trump is in the lead in Iowa. What to make of the latest polling numbers, Americans are sick and tired of politicians ad the establishment. By the way, Ben Carson is in second place!!!
Full poll results HERE
Donald Trump has a significant lead in the race to win over likely Iowa caucus-goers, according to the first CNN/ORC poll in the state this cycle.
Trump tops the field with 22% and is the candidate seen as best able to handle top issues including the economy, illegal immigration and terrorism. He's most cited as the one with the best chance of winning the general election, and, by a wide margin, as the candidate most likely to change the way things work in Washington.
Retired neurosurgeon Ben Carson follows Trump in overall preference with 14%, bumping Wisconsin Gov. Scott Walker, who had held the top spot in most recent public polling in Iowa, down to third place with 9%. Walker is nearly even with a slew of other candidates.
Posted August 13, 2015 by Scared Monkeys
2016 Elections, Benjamin Carson, CNN Opinion Research, Donald Trump, Polls, Presidential Contenders, Republican | no comments
Franklin Pierce Poll: Socialist Bernie Sanders Surges Ahead of Hillary Clinton in New Hampshire, 44% to 37%
Just how bad of a presidential candidate is Hillary Clinton for the Democrats? It has finally happened, the most recent Franklin Pierce poll shows that self-proclaimed socialist Bernie Sanders now leads Hillary Clinton by 7 percentage points, 44% to 37%. ARE YOU KIDDING? Hillary Clinton is considered by all as the presumptive Democrat nominee to run for president in 2016, but yet she finds herself behind in a poll to a socialist. Is it Hillary's lack of trustworthiness not much of an issue? However, since when have Democrats cared about their presidents or candidates telling the truth, aka you can keep your doctors, if you like your doctor promise of Obamacare. Or has this email/private server scandal just pushed people from holding their nose when it comes to Clinton, to abandoning her? What would happen if Hillary Clinton actually had a viable competitor in the primaries, rather than a socialist like Sanders? Then again, no one can tell the difference anymore between the Socialist and Democrat parties these days.
Democratic presidential hopeful Bernie Sanders has rocketed past longtime front-runner Hillary Clinton in New Hampshire, a stunning turn in a race once considered a lock for the former secretary of state, a new Franklin Pierce University/Boston Herald poll shows.
Sanders leads Clinton 44-37 percent among likely Democratic primary voters, the first time the heavily favored Clinton has trailed in the 2016 primary campaign, according to the poll of 442 Granite-Staters.
Vice President Joe Biden got 9 percent support in the test primary match-up. The other announced Democrats in the race, former Maryland Gov. Martin O'Malley, former Rhode Island Gov. Lincoln Chafee and former Virginia Gov. Jim Webb, barely register at 1 percent or below.
The live interview phone poll was conducted Aug. 7-10 and has a margin of error of plus or minus 4.7 percentage points.
Clinton is still viewed overwhelmingly by voters as the likely Democratic nominee, but the results suggest she faces an unexpectedly difficult fight to prevent an embarrassing opening loss in the first-in-the-nation primary.
Posted August 12, 2015 by Scared Monkeys
2016 Elections, Bernie Sanders (I-VT), Democrats, Hillary Clinton, Liberals, New Hamsphire, Polls, Presidential Contenders, Primaries, Progressives, Redistribution of wealth, Socialism, WTF | one comment
Donald Trump Still Leading in Polls Despite Fox News Reality Show Debate Hit Job, Leads in Iowa Poll
Imagine that establishment GOP and FOX News, The Donald still has commanding lead in the polls despite your best efforts … YOU FAILED!!!
Following the FOX News food fight Reality Show for ratings that was passed off as a debate and even after the feud with a prominent Fox News anchor Megyn Kelly, the establishment, agenda driven media could not bring Donald Trump down. The huffed and they puffed but they could not blow the Trump house down. According to several new post debate polls, Donald Trump is the leader. In fact, Trump is surging in many of the polls as establishment candidates like Jeb Bush have taken nose dives. Note to establishment, the people are pissed and they are not going to take it any more. Many of us look at FOX News as the establishment, which is a crying shame as this network was at one time considered the hard charging outsider to the liberal media.
Three online polls and a telephone survey put Trump at the top of the Republican field after Thursday's GOP presidential debate and his ensuing offensive against Fox News moderator Megyn Kelly.
Trump saw his popularity soar in a new Morning Consult survey, gaining 7 percentage points since a poll taken last week. This time around, he took 32 percent of the vote, while former Florida Gov. Jeb Bush netted just 11 percent.
Another poll, conducted by Reuters/Ipsos, showed similar results, with Trump leading the way at 24 percent. Bush took a nose dive, going from 17 percent to 12 percent.
Trump also topped an NBC News poll conducted by SurveyMonkey, in which 23 percent of those polled said they'd vote for him. Sen. Ted Cruz came in second, with 13 percent.
Trump is ahead in a phone poll, too. An Iowa survey conducted by Public Policy Polling has Trump in the lead with 19 percent, followed by Ben Carson and Scott Walker with 12 percent each.
Poll Finds Donald Trump Leads In Iowa, Fiorina Gains After Republican Debate.
Donald Trump doesn't appear to be suffering from his combative Cleveland debate performance, at least for now, and it may have helped him. The latest post-debate poll of Iowa Republican voters showed Trump was still enjoying a lead in the first caucus state.
Public Policy Polling, a liberal-leaning survey firm that uses automatic polling software and therefore is not likely to be used in determining future debate participants, found Trump placed first with 19 percent of the GOP support in Iowa. For those who watched the debate, he did even better: 21 percent of those who reported watching it live said they support Trump. Trump had a smaller lead among those who watched only news coverage with clips of the debate, and he was in first place with 15 percent but only holding that lead by a single percentage point. He also tied with Wisconsin Gov. Scott Walker among those who didn't watch the debate at all.
Trump continues to struggle with high unfavorable marks. The PPP poll found a sharp divide, with 46 percent giving him favorable marks overall but 40 percent negative. The only candidate with higher unfavorable numbers was New Jersey Gov. Chris Christie, with 44 percent.
Trump also did badly among women. Of those polled, 47 percent had an unfavorable position compared to 36 percent that had a favorable opinion of him. Men, however, were 55 percent favorable opinion and 34 percent unfavorable.
A note to FOX News and the rest of the establishment political pundits that are paid hacks, oh sorry, contributors, keep it up and Donald Trump will run as an Independent and the GOP will lose badly in 2016. I am no Trump supporter; however, this is to be kept as a fair fight for We the People to determine who the GOP nominee is or face the consequences. Because face it, this guy is rich and if screwed like most anti-establishment candidates get, he will fire back.
Posted August 11, 2015 by Scared Monkeys
2016 Elections, Donald Trump, Donald Trump, Iowa, Polls, Presidential Contenders | 2 comments
WMUR Poll: Hillalry Clinton Leads By Only 6% Over Socialist Bernie Sanders in New Hampshire … #FeeltheBern (VIDEO)
Are you kidding … self proclaimed socialist Bernie Sanders is within the margin of error in the polls if New Hampshire.
Is Hillary Clinton beginning to #Feelthe Bern? According to the most recent WMUR Granite State Poll taken July 22-30, Clinton leads Sanders by only 6%, basically within the margin of error. How is this possible? The poll shows that as more voters get to know Sanders, the more popular he becomes. Currently, 69% view him favorably and 10 percent unfavorably, while 16 percent do not know enough about him to say. Is the Democrat party that much more socialist where the lines have now been blurred between the Democrat party and socialists, or is Hillary Clinton that bad a choice? There is no way that this should even be a race, and it is.
The WMUR Granite State Poll taken July 22-30 shows frontrunner Clinton with a 6 percentage point lead over the challenger from Vermont. The poll has a margin of error of plus or minus 5.9 percent, prompting the pollster to call the race a statistical tie.
The poll shows Clinton leading Sanders 42 percent to 36 percent, with 5 percent supporting Vice President Joe Biden, who has been the subject of speculation in recent days about the possibility of becoming a candidate. Former Maryland Gov. Martin O'Malley and former U.S. Sen. Jim Webb of Virginia each receive 1 percent, with 3 percent favoring some other candidate and 12 percent undecided.
Hilllary Clinton buying $2 million in ad time in Iowa, N.H. ahead of GOP super PAC attacks and as polls show her support softening.
Hillary Clinton has been forced to buy ads in Iowa and New Hampshire where she sees her polling numbers fall to nobodies. Could you imagine if there was actually a viable candidate opposing Hillary in the Democrat primaries? For Democrats to look at a socialist like Sanders, it is almost like they would take anyone other than Hillary.
Democratic front-runner Hillary Rodham Clinton will air her first television ads of the 2016 presidential contest this week, her campaign said Sunday, as the candidate seeks to convince voters that she is a tough crusader with a softer side.
The feel-good biographical ads will go on the air Tuesday in the early-voting states of Iowa and New Hampshire. The spots focus on Clinton's life and family and do not mention Republicans.
A campaign official said the early August ad buy of about $1 million in each state is timed to get ahead of an expected onslaught of negative ads funded by pro-Republican super PACs. The campaign calculates that GOPcandidates and their super PACs have spent or reserved $34 million in airtime in the four early primary states.
But the new 60-second Clinton ads also come at a time when Clinton's poll numbers have slipped in both states and when more voters say they do not find her trustworthy. Clinton's weakening poll numbers have caused Democrats to express concerns privately about her effectiveness as a candidate.
Watch Bill O'Reilly Talking Points on Hillary Clinton … More bad new for Hillary
Click HERE or on PIC to Watch VIDEO
Posted August 6, 2015 by Scared Monkeys
2016 Elections, Battle Ground States - Swing States, Bernie Sanders (I-VT), Democrats, Iowa, Liberals, New Hamsphire, Polls, Progressives, WTF, You Tube - VIDEO | no comments
Donald Trump Surges in New NBC News/WSJ Poll in GOP Primary Race
Just ahead of the first Republican primary debate this week, according to a recent NBC News/WSJ Poll, businessman Donald Trump has surged into the lead. Trump garnered 19% of the vote, while Jeb Bush was second with 14% followed by Ben Carson – 10%, Ted Cruz – 9%, Mike Huckabee – 6%, Rand Paul – 6% and Marco Rubio – 5%. Trump has bewildered the pundits and so-called political experts with his strong polling efforts. However, like him or hate him, the reason why Trump is resonating with so many Americans is because of his unfiltered, no-PC commentary. However, at some point he is going to have to present actual solutions and how he would do things, not just ripping the current political establishment.
Days before the first Republican debate, Donald Trump has surged into the national lead in the GOP primary race, with Wisconsin Gov. Scott Walker and former Florida Gov. Jeb Bush following, a new NBC News/ Wall Street Journal poll shows.
Trump is the first choice of 19 percent of GOP primary voters, while 15 percent back Walker and 14 percent back Bush. Ten percent support retired neurosurgeon Ben Carson.
All other Republican candidates earn single digit backing. Texas Sen. Ted Cruz is favored by nine percent of primary voters; former Arkansas Gov. Mike Huckabee and Kentucky Sen. Rand Paul are tied with six percent support; Florida Sen. Marco Rubio clocks in at five percent;
Posted August 2, 2015 by Scared Monkeys
Donald Trump, Donald Trump, Jeb Bush, Mike Huckabee, NBC/WSJ Poll, Polls, Presidential Contenders | no comments
Gallup Poll – Democrat 2016 Presidential Candidates: Hillary Clinton's Favorability Continues to Fall as Socialist Bernie Sanders Rises
According to a recent Gallup poll, the presumptive nominee for the Democrat party Hillary Clinton's favorability ratings continue to fall. In contract, the self-proclaims socialist Senator from Vermont and Democrat presidential candidate Bernie Sanders continues to rise in the polls. Hillary Clinton's rating has slipped to 43% from 48% in April, while her unfavorable rating has climbed to 46%, worst since December 2007. Maybe it is only taking some time for individuals to remember what a lying, dishonest, untrustworthy, non-transparent shrew this woman truly is? Between Benghazi and her insincerity when it comes to her emails on her personal server when she was Secretary of State under Obama, Hillary is losing favor with the American people. In some cases, other polls even have Hillary now losing in battleground states to her GOP rivals.
What difference does my unfavoability make?
However on the other hand, socialist Bernie Sanders has doubled his favorability rating in the Gallup poll since his initial reading in March, rising to 24% from 12%. What does that tell us of what the Democrat party has become … the rise of the socialist. Sanders also has a way to go on the upside as he is still not known to many. However, Hillary is a household name where the only people who don't know who Hillary is may not know their own name. There is a reason why Clinton makes herself scarce to the media and the minions, the more people get to know her, the more they hate her. Take for instance her condescending tone the other day and scratching of the chalkboard with your fingernails like voice yesterday when she blamed the heat on inaccuracies with her email scandal. Watch the VIDEO and listen to her voice if you dare. Really Hillary, you mean it wasn't a right-wing conspiracy?
Honesty, if Hillary Clinton has any kind of issue in the Democrat primary running against the likes of current US Sen. Bernie Sanders of Vermont, former Virginia Sen. Jim Webb, former Maryland Gov. Martin O'Malley at and former Rhode Island Gov. Lincoln Chafee, what does that say about Hillary? Also, shame on the Democrat party for not having another viable candidate to vote for. Or does this party really have no prospects? Its Hillary or bust.
Vermont Sen. Bernie Sanders' favorable rating among Americans has doubled since Gallup's initial reading in March, rising to 24% from 12% as he has become better known. Hillary Clinton's rating has slipped to 43% from 48% in April. At the same time, Clinton's unfavorable rating increased to 46%, tilting her image negative and producing her worst net favorable score since December 2007.
Sanders' increased favorability reflects the broader increase in the public's familiarity with him since March. Overall, 44% of Americans are able to rate him today, up from 24% in March. Not only has the percentage viewing him favorably increased, but also the percentage viewing him unfavorably has risen, up eight percentage points to 20%.
Clinton's Inauspicious Rivals
Clinton maintains a higher absolute favorable rating from Americans than any of her official rivals for the 2016 Democratic nomination. In contrast to the relative prominence of numerous candidates on the Republican side, she remains the only Democratic candidate known well enough by a majority of Americans for them to rate her, which helps Clinton maintain a higher overall favorable score.
Sanders is still an unknown to a majority of Americans, with just 44% able to rate him compared with Clinton's 89%. Total familiarity drops still further among the other three announced Democratic candidates: to 23% for former Virginia Sen. Jim Webb, former Maryland Gov. Martin O'Malley at 22% and former Rhode Island Gov. Lincoln Chafee at 17%. With slightly more Americans viewing each of these candidates unfavorably than favorably, their favorable scores reach no more than 11%.
Posted July 25, 2015 by Scared Monkeys
2016 Elections, Bernie Sanders (I-VT), Gallup, Hillary Clinton, Polls, Presidential Contenders, You Got Email-gate | no comments


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Publications (90)478.79 Total impact
Article: Impact of selective neck dissection on chronic dysphagia after chemo-intensity-modulated radiotherapy for oropharyngeal carcinoma[Show abstract] [Hide abstract]
ABSTRACT: Conflicting results are reported regarding the impact of neck dissection on radiation-associated dysphagia. The purpose of this study was to reexamine this question specific to oropharyngeal intensity-modulated radiotherapy (IMRT). Three hundred forty-nine patients with oropharyngeal cancer treated with bilateral IMRT with systemic therapy (induction and/or concurrent) were reviewed. Chronic dysphagia was defined by aspiration, stricture, pneumonia, and/or gastrostomy dependence ≥12 months post-IMRT. Selective neck dissection was performed after IMRT in 75 patients (21%). Overall, 41 patients (12%) developed chronic dysphagia. Neck dissection did not increase the rate of chronic dysphagia (9% neck dissection; 12% no neck dissection; p = .464) or gastrostomy duration (p = .482). On multivariate analysis, age (odds ratio [OR] per 5-year = 1.25; 95% confidence interval [CI] = 1.04-1.51), baseline abnormal diet (OR = 2.78; 95% CI = 1.31-5.88), and IMRT dose (OR per 5-Gy = 5.11; 95% CI = 1.77-14.81) significantly predicted dysphagia. In the setting of selective neck dissection for residual adenopathy after IMRT, neck dissection did not impact dysphagia. © 2015 Wiley Periodicals, Inc. Head Neck, 2015. © 2015 Wiley Periodicals, Inc.Head & Neck 09/2015; DOI:10.1002/hed.24195 · 2.64 Impact Factor
Article: Long-term outcomes after surgical or nonsurgical initial therapy for patients with T4 squamous cell carcinoma of the larynx: A 3-decade survey: Long-Term Outcomes for T4 Larynx Cancer[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND The current study was conducted to evaluate long-term disease control, survival, and functional outcomes after surgical and nonsurgical initial treatment for patients with T4 larynx cancer. METHODS Demographics, disease stage, and treatment characteristics were reviewed for 221 sequential patients treated for T4 laryngeal squamous cell cancer at a single institution between 1983 and 2011. Survival and disease control outcomes were calculated. RESULTS The median follow-up time was 47 months (71 months for patients still alive at the time of analysis). The overall 5-year and 10-year overall survival rates were 52% and 29%, respectively, and the corresponding disease-free survival rates were 57% and 48%, respectively. Overall 5-year and 10-year locoregional control rates were 78% and 67%, respectively, and the corresponding rates for freedom from distant metastasis were 76% and 74%, respectively. On both univariate and multivariate analyses, lymph node-positive disease at the time of presentation was associated with overall mortality (P<.0001). Patients treated with laryngectomy followed by postlaryngectomy radiotherapy (161 patients) achieved better initial locoregional control than patients treated with a laryngeal preservation (LP) approach (60 patients) throughout the follow-up period (log-rank P<.007) yet the median overall survival times were equal for both groups (64 months; 95% confidence interval 47-87 months and 38-87 months, respectively [P =.7]). Patients treated with an LP approach had a tracheostomy rate of 45% and an any-event aspiration rate of 23%. Rates of high-grade dysphagia at the time of last follow-up were worse for patients treated with an LP approach (P<.01). CONCLUSIONS Surgery and postoperative radiotherapy can produce substantial long-term cancer control and survival rates for patients with T4 larynx cancer. Caution should be taken when selecting patients for initial nonsurgical treatment because of significant rates of functional impairment despite survival equivalence.Cancer 01/2015; 121(10). DOI:10.1002/cncr.29241 · 4.89 Impact Factor
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ABSTRACT: Objective We sought to describe the presentation of external head and neck lymphedema in patients treated for head and neck cancer and to examine their initial responses to complete decongestive therapy. Study Design Case series with chart review. Setting MD Anderson Cancer Center, Houston, Texas. Subjects and Methods The charts of patients who were evaluated for head and neck cancer at MD Anderson Cancer Center after treatment (January 2007-January 2013) were retrospectively reviewed. Response to complete decongestive therapy was evaluated per changes in lymphedema severity rating or surface tape measures. Predictors of therapy response were examined on the basis of regression models. Results The cases of 1202 patients were evaluated. Most patients (62%) had soft reversible pitting edema (MD Anderson Cancer Center stage 1b). Treatment response was evaluated for 733 patients; 439 (60%) improved after complete decongestive therapy. Treatment adherence independently predicted complete decongestive therapy response (P < .001). Conclusions These data support the effectiveness of a head and neck cancer-specific regimen of lymphedema therapy for cancer patients with external head and neck lymphedema. Our findings suggest that head and neck lymphedema is distinct from lymphedema that affects other sites, thus requiring adaptations in traditional methods of management and measurement.Otolaryngology Head and Neck Surgery 11/2014; 152(2). DOI:10.1177/0194599814558402 · 2.02 Impact Factor
Article: Identification and Management of Laryngeal Carcinoma Patients With Risk Factors for Gastrostomy Tube PlacementInternational journal of radiation oncology, biology, physics 09/2014; 90(1):S540-S541. DOI:10.1016/j.ijrobp.2014.05.1642 · 4.26 Impact Factor
Article: Evaluation of Ototoxicity in Patients Treated With Hyperthermic Intraperitoneal Chemotherapy (HIPEC) With Cisplatin and Sodium Thiosulfate[Show abstract] [Hide abstract]
ABSTRACT: Objectives: Ototoxic hearing loss associated with intravenous or intra-arterial administration of cisplatin is well documented. However, there is limited data regarding the ototoxic effect of cisplatin when perfused into the abdominal cavity using hyperthermic intraperitoneal chemotherapy (HIPEC). The purpose of this study is to assess and describe ototoxicity in patients treated with HIPEC with cisplatin and sodium thiosulfate for peritoneal surface malignancies. Design: We performed a retrospective chart review (2007-2012) of patients treated for advanced peritoneal malignancies at a tertiary care center using HIPEC with cisplatin and sodium thiosulfate infusion. Thirteen patients (12 males, 1 female) met study criteria. Audiometric thresholds were compared before and after treatment. A 20 dB loss at any single frequency, 10 dB decrease at any two adjacent frequencies, or loss of response at three consecutive test frequencies defined a significant ototoxic change (). Results: Despite minimal hearing change in six patients, none of the 13 patients in our study exhibited a significant ototoxic change in hearing sensitivity post HIPEC with cisplatin at any test interval in any test frequency. Conclusions: Our findings represent the first objective assessment of ototoxic effect after HIPEC with cisplatin and sodium thiosulfate infusion. Our results suggest that peritoneal perfusion of cisplatin with intravenous perfusion of sodium thiosulfate is not associated with ototoxic changes in hearing sensitivity. Further investigation of the administration and systemic mechanism of absorption of sodium thiosulfate as a potential protection against cisplatin ototoxicity is needed to confirm these findings.Ear and Hearing 08/2014; 35(6). DOI:10.1097/AUD.0000000000000070 · 2.84 Impact Factor
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ABSTRACT: To evaluate the indications, complications, and device life of the Provox NiD in a large cohort at a tertiary US cancer center. Longitudinal retrospective cohort study. We reviewed the records of patients who used the NiD prosthesis (2005-2011) for general indicators, device life, and complications. One hundred eighty-six patients who used the NiD were included (median follow-up: 21.4 months). The NiD was placed at initial fit in 41 (22%) patients, whereas 145 (78%) tried an NiD after using another type of prosthesis. Most patients used the NiD similarly to an indwelling device. Median NiD device life was significantly longer than that of other nonindwelling prostheses (45 vs. 29 days, P = .0061), and did not significantly differ from that of standard indwelling devices (45 vs. 50 days, P = .4263). Thirty-eight percent (71 of 189) of NiD users had a history of early leakage (<8 weeks) using a different prosthesis before trying the NiD. Among patients with a pre-existing history of early leakage, almost 90% of NiD prostheses outperformed the device life of other products. The NiD prosthesis offers satisfactory device life on a par with indwelling prostheses in our cohort of NiD users. Coupled with favorable published airflow characteristics and satisfactory tracheoesophageal voice, these data suggest that the NiD offers a durable, low-cost prosthetic alternative in contemporary practice. A unique indication for NiD may be improved device life in some patients with a history of early leakage. 4. Laryngoscope, 2013.The Laryngoscope 07/2014; 124(7). DOI:10.1002/lary.24488 · 2.14 Impact Factor
Article: Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy in long-term oropharyngeal cancer survivors: Video case reports[Show abstract] [Hide abstract]
ABSTRACT: Background: Lower cranial neuropathies are a late effect of radiotherapy (RT), typically reported in nasopharyngeal cancer survivors. Limited data examine these neuropathies after oropharyngeal cancer, particularly as it relates to late radiation-associated dysphagia (late-RAD). Methods: Two cases were examined over 4 to 6 years. Late-RAD was assessed per MBS impairment profile (MBSImP™©), Penetration-Aspiration Scale (PAS), Performance Status Scale for Head and Neck cancer (PSS-HN), and MD Anderson Dysphagia Inventory (MDADI). Neuropathies were examined via clinical examination and laryngeal videostroboscopy, and compared with trajectories of late-RAD. Results: Media-enriched case reports describe the course of late-RAD and neuropathies in 2 cases after definitive RT ± epidermal growth factor receptor-inhibitor for oropharyngeal cancer. Late-RAD was characterized by severe physiologic impairments per MBSImP™© and decreased swallowing-related quality of life (QOL) per MDADI. Trajectories of late-RAD paralleled the progression or stability of neuropathies. Conclusion: Late-RAD with lower cranial neuropathies resulted in profound and persistent functional impairment. Rarely reported, late radiation-associated lower cranial neuropathies may be a major contributor to new-onset or progressive dysphagia in long-term oropharyngeal cancer survivors.Head & Neck 07/2014; 37(4). DOI:10.1002/hed.23840 · 2.64 Impact Factor
Article: Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy after oropharyngeal radiotherapy: A preliminary dosimetric comparison[Show abstract] [Hide abstract]
ABSTRACT: Background and objectives Late radiation-associated dysphagia (late-RAD) is a rare delayed toxicity, in oropharyngeal cancer (OPC) survivors. Prevention of late-RAD is paramount because the functional impairment can be profound and refractory to standard therapies. The objective of this analysis is to identify candidate dosimetric predictors of late-RAD and associated lower cranial neuropathies after radiotherapy (RT) or chemo-RT (CRT) for OPC. Materials and methods An unmatched retrospective case-control analysis was conducted. Late-RAD cases were identified among OPC patients treated with definitive RT or CRT. Controls were selected with minimum of 6 years without symptoms of late-RAD. Dysphagia-aspiration related structures (DARS) and regions of interest containing cranial nerve paths (RCCNPs) were retrospectively contoured. Dose volume histograms were calculated. Non-parametric bivariate associations were analyzed with Bonferroni correction and multiple logistic regression models were fit. Results Thirty-eight patients were included (12 late-RAD cases, 26 controls). Median latency to late-RAD was 5.8 years (range: 4.5–11.3 years). Lower cranial neuropathies were present in 10 of 12 late-RAD cases. Mean superior pharyngeal constrictor (SPC) dose was higher in cases relative to controls (median: 70.5 vs. 61.6 Gy). Mean SPC dose significantly predicted late-RAD (p = 0.036) and related cranial neuropathies (p = 0.019). RCCNPs did not significantly predict late-RAD or cranial neuropathies. Conclusions SPC dose may predict for late-RAD and related lower cranial neuropathies. These data, and those of previous studies that have associated SPC dose with classical dysphagia endpoints, suggest impetus to constrain dose to the SPCs when possible.Oral Oncology 06/2014; DOI:10.1016/j.oraloncology.2014.05.003 · 3.61 Impact Factor
Article: Multifield Optimization Intensity Modulated Proton Therapy for Head and Neck Tumors: A Translation to Practice[Show abstract] [Hide abstract]
ABSTRACT: Background: We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and materials: Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment "spot by spot" and "layer by layer." Results: Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions: To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.International journal of radiation oncology, biology, physics 05/2014; 89(4). DOI:10.1016/j.ijrobp.2014.04.019 · 4.26 Impact Factor
Article: Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck[Show abstract] [Hide abstract]
ABSTRACT: Background: The purpose of this study was to evaluate long-term outcomes after induction chemotherapy followed by "risk-based" local therapy for locally-advanced squamous cell carcinoma of the head and neck (SCCHN). Methods: Forty-seven patients (stage IV; ≥N2b) were enrolled in a phase II trial. Baseline and 24-month functional measures included modified barium swallow (MBS) studies, oropharyngeal swallow efficiency (OPSE), and the MD Anderson Dysphagia Inventory (MDADI). Functional status was assessed at 5 years. Results: Five-year overall survival (OS) was 89% (95% confidence interval [CI], 81% to 99%). A nonsignificant 13% average reduction in swallowing efficiency (OPSE) was observed at 24 months relative to baseline (p = .191). MDADI scores approximated baseline at 24 months. Among 42 long-term survivors (median, 5.9 years), 3 patients (7.1%) had chronic dysphagia. The rate of final gastrostomy dependence was 4.8% (2 of 42). Conclusion: Sequential chemoradiotherapy achieved favorable outcomes among patients with locally advanced SCCHN, mainly of oropharyngeal origin. MBS and MDADI scores found modest swallowing deterioration at 2 years, and chronic aspiration was uncommon in long-term survivors.Head & Neck 04/2014; 36(4). DOI:10.1002/hed.23330 · 2.64 Impact Factor
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ABSTRACT: Summarize functional outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal cancer (OPC). A systematic review was conducted. The MEDLINE database was searched (MeSH terms: TORS, pharyngeal neoplasms, oropharyngeal neoplasms). Peer-reviewed human subject papers published through December 2013 were included. Exclusion criteria were as follows: (1) case report design (n < 10), (2) review article, or (3) technical, animal, or cadaver studies. Functional outcomes extracted included feeding tube dependence, swallow examination findings, speech ratings, velopharyngeal insufficiency, pneumonia, and oral intake measures. Twelve papers comprising 441 patients with OPC treated with TORS ± adjuvant therapy were included. Feeding tube rates were the most commonly reported functional outcome. Excluding prophylactic placement, 18-39 % of patients required gastrostomy placement, typically during adjuvant therapy. Chronic gastrostomy dependence ranged from 0 to 7 % (mean follow-up 11-26 months), regardless of disease stage. Composite MD Anderson Dysphagia Inventory (MDADI) scores ranged from 65.2 to 78 (89 patients, 3 series, mean follow-up 12-13 months). Videofluoroscopic swallowing studies were not systematically reported. Incidence of postoperative pneumonia was 0-7 %. Predictors of swallowing function included baseline function, T-stage, N-stage, tongue base primary tumors, and adjuvant chemoradiation. Rates of transient hypernasality were 4-9 %. A single study suggested dose-dependent effects of adjuvant therapy (none, radiation alone, chemoradiation) on diet scores at 6 and 12 months. Crude end points of functional recovery after TORS ± adjuvant therapy suggest promising swallowing outcomes, depending on the functional measure reported.Archives of Oto-Rhino-Laryngology 03/2014; 272(2). DOI:10.1007/s00405-014-2985-7 · 1.55 Impact Factor
Article: Adherence to preventive exercises and self-reported swallowing outcomes in post-radiation head and neck cancer patients[Show abstract] [Hide abstract]
ABSTRACT: To reduce the risk of long-term swallowing complications after radiation, swallowing exercises may be helpful. Both the rate of adherence to swallowing exercises and its impact on future swallowing function are unknown. In all, 109 patients with oropharyngeal cancer beginning radiation were tracked for 2 years to determine adherence to swallowing exercises. Participants completed the MD Anderson Dysphagia Inventory (MDADI) 1-2 years after treatment, to assess self-reported swallowing function. Adherence, demographics, tumor, and treatment variables were multivariably regressed onto the MDADI physical subscale score. In accord with speech pathologist documentation, 13% of the participants were fully adherent and 32% were partially adherent. Adherence was associated with the Physical MDADI Subscale score in the multivariate model (p = .01). The majority of patients with head and neck cancer are nonadherent to swallowing exercise regimens and may benefit from supportive care strategies to optimize their adherence. Head Neck, 2013.Head & Neck 12/2013; 35(12). DOI:10.1002/hed.23255 · 2.64 Impact Factor
Article: Bhayani MK, Hutcheson KA, Barringer DA, et al. Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: factors affecting placement and dependence[Show abstract] [Hide abstract]
ABSTRACT: Background: Although many patients require nutritional support during radiotherapy or chemoradiotherapy for oropharyngeal cancer, little is known regarding the risk factors that predispose to gastrostomy tube (g-tube) placement and prolonged dependence, or the therapeutic interventions that may abrogate these effects. Methods: We performed a retrospective medical chart review of patients who were treated for primary oropharyngeal cancer at a tertiary care center from 2003 to 2008. Patients who had a complete response at the primary site at 1-year posttreatment were included. G-tube placement and dependence ≥6 months were evaluated in relationship to site and stage of primary tumor, baseline characteristics, treatment type, smoking status, and swallowing intervention. Results: We evaluated 474 patients (79%) with oropharyngeal cancer; 215 patients (40%) had concurrent chemotherapy, 73 patients (15%) had induction chemotherapy, and 69 patients (15%) had induction chemotherapy followed by concurrent chemotherapy. Two hundred ninety-three patients (62%) received g-tubes, of which 238 (81%) received the g-tube during radiation. At 1-year follow-up, 41 patients (9%) remained dependent on enteral feedings. Placement of g-tubes and prolonged g-tube dependence were significantly more likely in patients with T3 to 4 tumors (p < .001), baseline self-reported dysphagia (p < .001), odynophagia (p < .001), >10% baseline weight loss (p < .001), and in those treated with concurrent chemoradiotherapy. Patients who reported adherence to exercises had significantly lower rates of g-tube placement (p < .001), and duration of dependence was significantly shorter in those who reported adherence to swallowing exercises (p < .001). Conclusion: Almost 40% of patients with oropharyngeal cancer treated with nonsurgical organ preservation modalities may avoid feeding tube placement. Factors that predispose to g-tube placement and prolonged dependence include T3 to T4 tumors, concurrent chemotherapy, current smoking status, and baseline swallowing dysfunction or weight loss. Adherence to an aggressive swallowing regimen may reduce long-term dependence on enteral nutrition and limit the rate of g-tube placement overall.Head & Neck 11/2013; 35(11). DOI:10.1002/hed.23200 · 2.64 Impact Factor
Article: Bhayani MK, Hutcheson KA, Barringer DA, et al. Gastrostomy tube placement in patients with hypopharyngeal cancer treated with radiotherapy or chemoradiotherapy: factors affecting placement and dependence[Show abstract] [Hide abstract]
ABSTRACT: Background: Placement of gastrostomy tubes (g-tubes) in patients with hypopharyngeal cancers undergoing radiation and chemotherapy is generally empirically determined. We examined our experience to identify predictive factors for g-tube placement and length of dependence. Methods: We performed a retrospective review of all patients with primary hypopharyngeal cancer treated with nonsurgical modalities at a tertiary care center between 2002 and 2008. Rates of g-tube placement and length of dependence on enteral feedings were analyzed in relationship to multiple risk factors. Results: Forty-three patients with hypopharyngeal primary tumors (77%) who had a complete response at the primary site after treatment were included. Thirteen patients (30%) never required g-tube placement. At 1-year follow-up, 11 patients (28%) maintained a g-tube. No clinical variables were significantly associated with g-tube placement. Duration of g-tube dependence was significantly longer in patients with a posterior hypopharyngeal wall primary tumors (p = .026), current smokers (p = .001), and patients with >40 pack-years (p = .010). The duration of g-tube dependence was significantly shorter in those who maintained oral intake at the end of treatment (p = .05), and those who reported adherence to dysphagia exercise regimens (p = .048). Conclusion: Approximately one third of patients with hypopharyngeal tumors treated on organ preservation regimens may be able to avoid g-tube placement, but further research is needed to identify clinical factors that predict g-tube placement in this population. A posterior hypopharyngeal wall primary and smoking history correlated with longer gastrostomy tube dependence. Adherence to aggressive targeted swallowing exercise regimens may help to prevent long-term dependence on feeding tubes.Head & Neck 11/2013; 35(11). DOI:10.1002/hed.23199 · 2.64 Impact Factor
Article: Early Experience With IMPT for the Treatment of Oropharyngeal Tumors: Acute Toxicities and Swallowing-Related OutcomesInternational Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S604. DOI:10.1016/j.ijrobp.2013.06.1597 · 4.26 Impact Factor
Conference Paper: Late Radiation-Associated Dysphagia (RAD) and Lower Cranial Neuropathy After Oropharyngeal Radiation Therapy: A Case–Control Dosimetric Comparison[Show abstract] [Hide abstract]
ABSTRACT: Purpose/Objective(s) Late radiation-associated dysphagia (late-RAD) is a significant delayed toxicity in oropharyngeal cancer (OPC) survivors. Physiologic impairment of dysphagia-aspiration related structures (DARS) leads to post-swallow residue and aspiration. Prevention of this complication is paramount because the functional impairment can be profound, progressive, and refractory to standard therapies. The objective of this analysis was to identify candidate dosimetric predictors of late-RAD and lower cranial neuropathy after radiation therapy (RT) or chemo-RT (CRT) for OPC. Materials/Methods A retrospective case-control analysis was conducted. OPC patients treated with definitive RT/CRT 1999 through 2006 were included. Late-RAD was defined by new or progressive pharyngeal dysphagia per MBS > 4 years after RT/CRT. As a secondary endpoint, predictors of late lower cranial neuropathies (CN IX, X, XII) in late-RAD cases were examined. Controls were treated on an institutional trial and followed a minimum of 4 years without symptoms of late-RAD. DARS and regions of interest containing cranial nerve paths (RCCNPs) were retrospectively contoured. Dose volume histograms were calculated. Non-parametric bivariate associations were analyzed with Bonferroni correction and multiple logistic regression models were fit. Results Thirty-eight patients were included (12 late-RAD cases, 26 controls). Median latency to late-RAD was 5.8 years (range, 4.5-11.3 years). Lower cranial neuropathies were present in 10 late-RAD cases (IX = 4, X = 6, XII = 8), 7 of whom had multiple nerve palsies on physical examination. IMRT was delivered in all controls and 25% of cases (p < 0.001); the remainder received 3D RT. Smoking history, tumor subsite, fractionation schedule, neck dissection, and concurrent chemotherapy did not significantly differ between cases and controls (p > 0.05). T-stage was significantly higher in late-RAD cases (p = 0.002); N-stage was higher in controls (p = 0.109). Mean superior pharyngeal constrictor (SPC) dose was higher in cases relative to controls (median: 70.5 vs 61.6 Gy). Adjusting for T-stage, mean SPC dose significantly predicted late-RAD (p = 0.036) and cranial neuropathies (p = 0.019). RCCNPs did not significantly predict late-RAD or cranial neuropathies. Conclusions SPC dose may predict for late-RAD and related cranial neuropathies. These preliminary data, and those of previous studies that have associated SPC dose with earlier dysphagia outcomes, suggest impetus to constrain dose to the SPCs.ASTRO 2013, Atlanta; 10/2013
Article: Eat and Exercise During Radiotherapy or Chemoradiotherapy for Pharyngeal Cancers Use It or Lose It[Show abstract] [Hide abstract]
ABSTRACT: Importance Data support proactive swallowing therapy during radiotherapy (RT) or chemoradiotherapy (CRT) for pharyngeal cancers. The benefits of adherence to a regimen of swallowing exercises and maintaining oral intake throughout treatment are reported, but independent effects are unclear.Objective To evaluate the independent effects of maintaining oral intake throughout radiotherapy and adherence to preventive swallowing exercise.Design Retrospective observational study.Setting The University of Texas MD Anderson Cancer Center, Houston.Patients The study included 497 patients treated with definitive RT or CRT for pharyngeal cancer (458 oropharynx, 39 hypopharynx) between 2002 and 2008.Main Outcomes and Measures Swallowing-related end points were final diet after RT or CRT and duration of gastrostomy dependence. Primary independent variables included oral intake status at the end of RT or CRT (no oral intake, partial oral intake, or full oral intake) and adherence to a swallowing exercise regimen. Multiple linear regression and ordered logistic regression models were analyzed.Results At the conclusion of RT or CRT, 131 patients (26%) had no oral intake and 74% maintained oral intake (167 partial [34%], 199 full [40%]). Fifty-eight percent (286 of 497) reported adherence to swallowing exercises. Maintenance of oral intake during RT or CRT and swallowing exercise adherence were independently associated with better long-term diet after RT or CRT (P = .045 and P < .001, respectively) and shorter duration of gastrostomy dependence (P < .001 and P = .007, respectively) in models adjusted for tumor and treatment burden.Conclusions and Relevance The data indicate independent, positive associations of maintenance of oral intake throughout RT or CRT and swallowing exercise adherence with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest rate of return to a regular diet and shortest duration of gastrostomy dependence.JAMA Otolaryngology - Head and Neck Surgery 09/2013; 139(11). DOI:10.1001/jamaoto.2013.4715 · 1.79 Impact Factor
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ABSTRACT: The number of oral cavity and oropharyngeal cancer survivors is rising. By 2030, oropharyngeal cancers are projected to account for almost half of all head and neck cancers. Normal speech, swallowing, and respiration can be disrupted by adverse effects of tumor and cancer therapy. This review summarizes clinically distinct functional outcomes of patients with oral cavity and oropharyngeal cancers, methods of pretreatment functional assessments, strategies to reduce or prevent functional complications, and posttreatment rehabilitation considerations.Otolaryngologic Clinics of North America 08/2013; 46(4):657-70. DOI:10.1016/j.otc.2013.04.006 · 1.49 Impact Factor
Article: Associations among speech, eating, and body image concerns for surgical patients with head and neck cancer[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: Body image can be affected by bodily experiences extending beyond physical appearance. This study evaluated associations among speech, eating, and body image concerns for surgically treated patients with oral cavity, midface, and cutaneous cancers of the head and neck. METHODS: Using a cross-sectional design, 280 participants completed the Body Image Scale, a survey evaluating disease-specific body image issues, and the Functional Assessment of Cancer Therapy Scale-General. RESULTS: Participants with speech and eating concerns reported the highest levels of body image/appearance dissatisfaction compared with those without such concerns. This group also reported greater cognitive and behavioral difficulties associated with body image concerns and significantly higher levels of interest in psychosocial interventions to address appearance-related difficulties compared with all other participants. CONCLUSIONS: Findings point to the need for more comprehensive psychosocial care for patients with head and neck malignancies reporting speech and eating difficulties, which extent beyond functional rehabilitation. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.Head & Neck 03/2013; 35(3). DOI:10.1002/hed.22980 · 2.64 Impact Factor
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ABSTRACT: Changing trends in head and neck cancer (HNC) merit an understanding of the late effects of therapy, but few studies examine dysphagia beyond 2 years of treatment. A case series was examined to describe the pathophysiology and outcomes in dysphagic HNC survivors referred for modified barium swallow (MBS) studies ≥5 years after definitive radiotherapy or chemoradiotherapy (January 2001 through May 2011). Functional measures included the penetration-aspiration scale (PAS), performance status scale-head and neck (PSS-HN), National Institutes of Health Swallowing Safety Scale (NIH-SSS), and MBS impairment profile (MBSImp). Twenty-nine patients previously treated with radiotherapy (38%) or chemoradiotherapy (62%) were included (median years posttreatment, 9; range, 5-19). The majority (86%) had oropharyngeal cancer; 52% were never-smokers. Seventy-five percent had T2 or T3 tumors; 52% were N+. The median age at diagnosis was 55 (range, 38-72). Abnormal late examination findings included: dysarthria/dysphonia (76%), cranial neuropathy (48%), trismus (38%), and radionecrosis (10%). MBS studies confirmed pharyngeal residue and aspiration in all dysphagic cases owing to physiologic impairment (median PAS, 8; median NIH-SSS, 10; median MBSImp, 18), whereas stricture was confirmed endoscopically in 7 (24%). Twenty-five (86%) developed pneumonia, half requiring hospitalization. Swallow postures/strategies helped 69% of cases, but no patient achieved durable improvement across functional measures at last follow-up. Ultimately, 19 (66%) were gastrostomy-dependent. Although functional organ preservation is commonly achieved, severe dysphagia represents a challenging late effect that may develop or progress years after radiation-based therapy for HNC. These data suggest that novel approaches are needed to minimize and better address this complication that is commonly refractory to many standard dysphagia therapies. Cancer 2012. © 2012 American Cancer Society.Cancer 12/2012; 118(23):5793-9. DOI:10.1002/cncr.27631 · 4.89 Impact Factor
Top Journals
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
- Department of Head and Neck Surgery
Louisiana State University Health Sciences Center New Orleans
Shreveport, LA, United States
- Department of Otolaryngology-Head and Neck Surgery
University of HoustonHouston, Texas, United States


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A Bright New Boise
Presented by Zeitgeist Stage Company at BCA Plaza Black Box
September 28 - October 20, 2012
Prepare yourself, in the parking lot of a mega-craft store in Idaho, someone is summoning the "rapture." Samuel D. Hunter's touchingly funny reckoning between a father and son will shatter your preconceptions about the sacred, the profane, and the internal operations of big-box retailers. A Bright New Boise is a quietly affecting drama that delves into the always thorny issues of faith, forgiveness, and second chances with humor, eloquence, and compassion.
539 Tremont Street
Boston , MA 02116
Admission Info:
Tickets: $25 Advance Sale; $30 Day of Performance;
Senior/Students: $20
Previews, 9/28-9/30: $20 Advance Sale, $25 Day of Performance
Phone: 617-933-8600
Garage Parking
There are several parking options available within walking distance of the Calderwood Pavilion at the BCA. Please note that all prices are subject to change.
Atelier 505 Garage
Monday - Saturday: $24 for 2-10 hours
Monday - Wednesday after 6pm: $16
Thursday - Friday after 6pm: $20
Sunday: $21 all day
This garage often fills up early and does not validate.
505 Tremont Street / Entrance located on Warren Avenue
Back Bay Garage
Evenings and Weekends: Special $7 rate, validation required from the Box Office
Entrance on Clarendon Street between Boylston and St. James Streets
Dartmouth Street Garage
Monday - Friday after 5pm: Special $8 parking rate available, patron must surrender ticket stub when exiting garage
At all other times, parking rate is $9 per hour
126 Dartmouth Street
Garade @ 100 Clarendon Street
Seven days a week after 5pm: $10 parking, this is a regular rate and no validation is needed.
Saturday and Sunday: $17 parking all day with validation.
Wednesdays 12:30pm - 6:30pm: $17 parking with validation, valid only for Huntington Wednesday matinee performances at the Calderwood Pavilion at the BCA
100 Clarendon Street
Validation is available before the show at the Calderwood Pavilion Box Office. (If you forget to validate your ticket pre-show, please contact a Front of House staff member for assistance.) Garage office cannot reimburse for tickets that are not validated.
Street Parking
Street parking is very limited but some patrons have had great luck finding coveted parking spots on Tremont Street.
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text: Clipart Building a Better Community through Volunteering By Chad McKenzie May 6, 2015 Here are this week's volunteer opportunities, brought to you by the Sioux Falls Helpline Center. Read More|Comment Category: Health & LIfestyle Tags: Main Street Cafe, Making a Difference Send to a friend! Share on Facebook Share on Twitter Pin it! Reddit This! Share on Tumblr!