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Find out how to create unique brands at Streetsense
Savannah, GA
120 Montgomery St.
Hear managing principal Herb Heiserman discuss what a career at this expert strategy and design group looks like and how you can join this collective of creative thinkers.
Based in Bethesda, Maryland, Streetsense brings distinctive places and meaningful brands to life for clients such as Starbucks, Chipotle and The Ritz-Carlton.
This event, hosted by the office for career and alumni success, is free and open to SCAD Card holders.
Email email@example.com for more information.


text:
Labor Day became the venue for a show of force of workers and the urban poor, with 35,000 demonstrators gathered in Liwasang Bonifacio, and 80,000 more in the regions.
Category: Slideshow
Stop human rights violations, groups say
Some 5,000 progressives marched on Dec. 10, the 68th commemoration of International Human Rights Day, to denounce human rights violations, which they say continued and worsened under the six-month-old Duterte administration.
Thousands brave the rain to protest the restoration of Marcoses
Despite the rain, more than 20,000 gather at the Rizal (formerly Luneta) Park in Manila to condemn the rehabilitation of the family of the late dictator Ferdinand Marcos.
Outside Manila, protesters denounce hero's burial for Marcos
In various cities throughout the country, ordinary citizens join protest actions against the hasty burial of the late dictator Ferdinand Marcos at the Libingan ng mga Bayani.
Festive, militant march greets Duterte's first SONA
Some 40,000 activists from Metro Manila, Southern Tagalog, Central Luzon and as far as Mindanao marched along Commonwealth Avenue, June 25 to bring their demands to President Rodrigo Duterte.
On Duterte's inauguration, progressives demand genuine change
Progressive groups from different regions marched to Mendiola to present their demands to President Rodrigo Duterte, today, June 30. They called for the resumption of peace talks to finally put an to the problems plaguing the Filipino people.
Pinoys, foreigners stand in solidarity with Cotabato farmers
Filipinos and foreigners responded to the call for a Global Day of Action for Land, Food and Justice. They condemned the April 1 violent dispersal of farmers' barricade in Kidapawan City and called for immediate aid for drought-stricken Filipino farmers.
Groups demand justice for Kidapawan victims
One week after the violent dispersal of farmers' barricade in Kidapawan City, progressive groups and supporters held a protest in Manila. They condemned the silence of President Benigno Aquino III on the issue.
'Inang Lupa, Inang Bayan': Exposing sins of the Marcos dictatorship
"There is a lack of consciousness among parents, teachers, and the entire community to impart to today's youth the horrors of martial law. We have high hopes that this could be of help to change that."
Women hold Aquino accountable for crimes against the Filipino women
Thousands of Filipino women mark the International Women's Day holding President Benigno Aquino III accountable for his crimes against the Filipino women. Photos by Ronalyn V. Olea, Dee Ayroso and Loi Manalansan Produced by
#EDSA30 | Protesters call for genuine change
Marking the 30th year since the toppling of dictator Ferdinand Marcos, progressives say elite rule still governs the country and the Filipino people's fight for genuine change continues.

subset: commoncrawl


text:
It only takes a minute to get started. Fill out our uncomplicated sign up form and login to the website.
This step is optional but will drastically increase your chances of getting interest from other over 50s members on the site. Type a little about yourself, your pasttimes and attach any nice photographs of yourself.
Utilise our website's sophisticated search to locate over 50s members who satisfy your needs. Or just look through listings and locate people that you like.
Found someone who interests you? Send a message to them or just a wink and wait for their response. With a little luck you'll be on your way to an amazing adventure.
It doesn't take long


text:
I was a pretty good teenager, if I do say so myself. My biggest rebellion was becoming an Orthodox Jew. Then again, there was that pesky nihilistic phase I went through in high school.
I had been searching for the meaning of life since the age of eight when I asked my parents one day why we're alive only to discover they had no idea. (Incidentally, no one else I asked seemed to know either.)
Such a realization was extremely devastating. I had been born into a pretty cushy life: close family, good friends, health, affluence. The sum total of my world equaled happiness.
But it occurred to me that none of it was guaranteed to last. In a split second my picture-perfect existence could flip flop, and I could become a homeless, disease-ridden orphan.
If life had no meaning or direction, then events were random and based only on luck. Who knew what the future would bring? The idea of losing my good fortune prevented me from enjoying it even while I had it.
Though I stayed as normal as I could with such thoughts floating through my head, by the time I got to high school, I began to cope with my angst by telling anyone who complained about anything, "It doesn't matter, you're gonna die anyway."
Then, thankfully, after eight years of insomnia, panic attacks, and overall pessimism, my life took a spiritual turn for the better. To make a very long story short, I discovered that there is a Unity to all things one day while hiking through a tropical rain forest in Hawaii while on a family vacation.
I had grown up hearing about God, but the concept never seemed too compelling to me – especially in a world with so much sorrow. In this rain forest, though, I came across a tree that looked like it had been painted by someone. When I looked to the top and saw that the colors (swirls of pink, green, and purple) continued all the way up, I was hit by a moment of clarity where I detected a Unity that ran through everything.
It's hard to explain exactly what happened in that moment, but I suddenly sensed that every piece of the universe had its own time and place and was working together in a perfect harmony. And despite being raised to think of God as an old man with a white beard, the Unity that I stumbled upon was actually the correct Jewish definition of God.
A couple years later, while studying in Israel, I learned that this Unity I had discovered is actually described in one of the most well-known verses of our heritage – the shema. I had always thought that the shema "Hear O, Israel the Lord our God the Lord is One," was nothing more than a declaration of how many Gods we Jews have. The idolaters had many – we have only one.
In this class, though, I learned that the Hebrew root of the word "one," "echad" is actually connected to the word "achdus" which means unity. I also learned that Jacob (our forefather) upon being reunited with his long lost son, Joseph, recited the shema through his tears on Joseph's shoulder.
It's in Jacob's recitation of the shema that we find the key to hope and optimism within Judaism. Sometimes God relates to us as a judge and we see harsh results in our lives. Other times, God relates to us as a parent, and we're given more compassion than we actually deserve. Both of these attributes of God, which are respectively described in God's names "Elokeinu" and "Adonai," are one. Both come from the same source.
What that means is that the good and the bad are both ultimately good. We can't always understand God's ways, and there surely is pain and suffering in our world, but living my life knowing that everything that happens has a reason, a purpose, and ultimately comes from the Source of All Goodness turned a once despairing teenager into an optimistic adult.
This article was originally published on www.jwrp.org.


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Name something that gets hard when it gets cold. ~Family Feud
Adam Rifkin stashed this in Your argument is invalid.
Stashed in: Best of Imgur, Family Feud
To save this post, select a stash from drop-down menu or type in a new one:
You can watch him slowly die a little inside.
His reaction to stupid answers is awesome.
His reaction to stupid answers that are up on the board is even better.
Not as good as the answers to "Name something that gets passed around."


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ED Magedson – Founder
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A.Feildings Audio And AccessoriesBay Street Eustis, Florida United States of America
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Lesley Duncan was a pioneering singer-songwriter best known for her composition "Love Song", which was recorded by various artists including Elton John, Peggy Lee, David Bowie, Olivia Newton John and Dionne Warwick.
Born in Stockton on Tees, she came to London in the mid-1960s and became one of the first female singer song writers of the pop era. Her early recordings, on labels such as Parlophone, Mercury and RCA, and including "Tell Me" and "See That Guy", attracted positive attention within the industry but failed to generate meaningful sales. During this time and throughout the next two decades she worked with other female artists and friends such as Dusty Springfield, Madeleine Bell, Kay Garner, Vicky Brown and Kiki Dee as a successful session singer. This close-knit group evolved a new type of American-influenced backing vocals for each other's recordings and for leading artists of the day. Lesley's distinctive vocals can be heard on many hit records throughout the '70s and '80s, including Elton John's Madman Across the Water, Pink Floyd's Dark Side of the Moon, Black Flower by the original Nirvana and Ringo Starr's Goodnight Vienna.
Public recognition came in the early '70s when Elton John, whom she had known and worked with for many years, recorded her "Love Song" on his Tumbleweed Connection album with Duncan singing harmonies. Signing to CBS she released the albums Sing Children Sing and Earth Mother, working not only with Elton John but with other leading musicians such as Chris Spedding, Tristan Fry, Andy Bown, Terry Cox and her producer and first husband Jimmy Horowitz.
Duncan was a gregarious, thoughtful and intelligent woman, her lyrics demonstrating her commitment to social-action issues, conservation and spiritual beliefs, including a strong interest in Buddhism and the peace movement. Earth Mother was dedicated to Friends of the Earth and reflected her passionate belief in preserving nature and the environment. Also buried within the lyrics of several of her compositions were more hidden references to close friends and to her much-loved sons Sam and Joe.
Three subsequent albums – Everything Changes, Moonbathing and Maybe it's Lost – continued to build a cult following but lacked big commercial sales. Duncan's own interest in the music industry faded in favour of a more normal life in the countryside with her second husband, Tony Cox, in Cornwall, Oxfordshire and later Scotland. Cox – himself a highly regarded musician and producer – encouraged her on a couple of special projects such as a reworking of the Bob Dylan number "Masters of War" and a powerful version of "If I Could Change Your Mind" on the Alan Parson album Dammed if I Do. In 1979 she agreed to re-record "Sing Children Sing" with Kate Bush, Phil Lynott and Pete Townsend for the International Year of the Child. It generated considerable airplay and made it to the fringes of the charts.
Duncan's heart, however, was firmly rooted in her new life in the countryside, including her voluntary work for Oxfam, photography and dedicated walking of the entourage of dogs she and Cox accumulated. Her warm-hearted nature, great sense of humour and generous spirit endeared her to a wide array of friends around the world. Life in her final home on the Isle of Mull generated a whole new network of friends largely unaware of her past existence in the pop world – or her still considerable worldwide following on numerous websites dedicated to her music. She was aware and appreciative of this constant and continued interest in her work but was never tempted to capitalise on it.
Richard Stanley
Lesley Duncan, singer and songwriter: born Stockton-on-Tees 12 August 1943; married firstly Jimmy Horovitz (marriage dissolved; two sons), secondly Tony Cox; died 12 March 2010.
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Home >> Woman Wooden Handle DIY Facial Mud Mask Mixing Brush Makeup Tool
- Smooth, soft and full, give extraordinary coverage for the face with this facial mask brush.
- Easier to use around those hard to reach and smaller sections of your face, such as your eyes and nose area.
- Won not hurt your skin, good item for make-up and useful.
- For applying facial masks, smoothing masks or rehydrating masks.
- To apply facial mask mud onto face softly and comfortably with this brush.
- Wooden handle is smooth and long enough to use.
|Silver Tone, Wooden Color, Brown
|18.5 x 2.5cm/7.3" x 1"(L*Max.W)
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The Bullitt County Arts Council is forming a new writers group. Anyone interested, please call Jean Kinsey at 502-955-6417 or 502-889-1355.
We will meet Friday, October 25 at 2 p.m. at Small Town Gallery, 4313 Coral Ridge Road, Brooks, Ky. for a question and answer discussion and to determine a permanent meeting time.


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ED Magedson – Founder
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Catalina High School, Classmates.comInternet United States of America
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This report was posted on Ripoff Report on 09/24/2010 08:47 AM and is a permanent record located here: http://www.ripoffreport.com/reports/catalina-high-school-classmatescom/internet/catalina-high-school-classmatescom-chs-catalina-former-students-accused-of-home-invas-643977. The posting time indicated is Arizona local time. Arizona does not observe daylight savings so the post time may be Mountain or Pacific depending on the time of year.
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Fasting Can Save Your Life, Vegetarians
SUBMITTED: Tuesday, September 02, 2014POSTED: Tuesday, September 02, 2014
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PRESS DIGEST- Canada- Sept 14
Sept 14 (Reuters) - The following are the top stories from selected Canadian newspapers. Reuters has not verified these stories and does not vouch for their accuracy.
** Apple Inc revealed a new way to buy its flagship device last week - the option to pay for unlocked models of its newest iPhones through monthly installments. But the arrangement is exclusive to U.S. customers, extending a trend in smartphone shopping that has yet to make its way to Canada. (bit.ly/1UQFoUs)
** The Conservatives are trying to turn the page on the Syrian refugee crisis controversy by announcing additional measures - on Saturday, they said Ottawa would match C$100 million in private relief donations and are now amping up rhetoric on the economy to try to move the narrative back to what they consider their terms. (bit.ly/1VXm4Hz)


text:
2,479pages onAdd New Page
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this wiki
Page count: 18
Last checked: January 31, 2014
- Genre:
- Slice of Life
- Media:
- Manga
Tsuritama (つり球) is an upcoming Japanese anime television series. It will premiere on April 12, 2012.
In Enoshima, Yuki is a high school student who's never been good at making real friends thanks to his abnormally poor communication skills. Haru is the self-styled alien who decides to teach Yuki to fish. Natsuki is an irritable born-and-raised local. Akira is the mysterious Indian who watches them all from a distance. These four meet, fish, and find big adventures on their little island.
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text:
Scarlet - EncounterMature
Oh Jesus, I'm going crazy.
I watched the boy who called himself Wes walk away from me with the pain of losing Hunter all over again. It's him, it's him, I swear it's him, my heart screamed out, while my mind put its hands over its ears and shouted out rational things. He's dead, Hunter's dead, he's in a morgue somewhere with a tag around his foot, staring up at the inside of a body bag.
Wes. He could have been Hunter's twin from the dark side. He looked just like him, oh God, he did. But there was something. Something behind his eyes.
I stumbled over to a bench and collapsed onto it, watching the back of Wes's head until it disappeared among the throng. Making my hands into fists, I rubbed my eyes, trying to clear away the awful thoughts that kept stealing into my mind. Wes was just another kid. Who happened to look a lot like my best friend.
The warning bell rang, and I wearily stood up and dragged my feet to English. It was on the other side of the school, and I slid into my seat just as the teacher started her lecture. I got a few looks, probably mostly for my hair, but one or two were genuine looks of sympathy. Word had gotten out about Hunter, and people were shaken up.
The day dragged on as usual, and I drifted to my classes in an apathetic gaze, keeping to myself. It wasn't that I didn't have any other friends, there were a few girls that I occasionally hung out with. But Hunter was gone. And I wanted to be alone.
When the last bell rang, I found myself standing in the hall, staring down the dark corridor as crowds of teenagers filed past me, waiting for someone who I knew would never come to meet me, never walk me home again. A single tear slid down my nose and fell onto the ground.
I whipped around, sure that when I turned I would see him there, holding out his hand for me, smiling that secret smile that he saved for when I was around. But of course it wasn't him.
It was a kid I'd never seen before. He was about the same height as Hunter, maybe a little taller. He had a dark hoodie pulled over his head. His eyes glinted at me from the darkness of the hallway.
I clutched my books tighter to me. Something about this boy made me uncomfortable. "Yeah? Do I know you?"
"No." He smiled, a sharp-toothed grin that was more of a grimace. "And believe me, you don't want to. So stay away. Do you hear me?" His eyes flashed dangerously. "Mind your own business and you won't get hurt."
I backed up hastily, anxious to get away and almost tripping over my own feet. "I—I don't know what you mean. Leave me alone."
"Gladly." He stalked forward and thrust his face into mine, so I was staring directly into his green eyes. "Just don't ever—ever—talk to Wes again. Or I will be your worst nightmare."
And then, he was gone. Just like that. I turned and fled, out of the hallway, away from the deserted school and out into the rain.


text:
Hi, I'm about to buy these Air jordan gamma's
, but I need to know if they are 100% authentic, I think these are restocks as on the persons nike receipt it says it was in april 2014, The quality control on these could be bad but I don't know atm, if anyone could help and tell me if they are authentic or not that would be great thanks. The last picture is the sole of the the gamma 11's.
Edited by Sneakahead23 - 8/6/15 at 8:59am


text:
Major Recommendations
ACR Appropriateness Criteria®
Clinical Condition: Resectable Rectal Cancer
Variant 1: 70 year old woman staged with endorectal ultrasound (EUS), a T2NX rectal cancer at 3 cm from verge. Final pathology was T3N1 status post abdominoperineal resection (APR). KPS ≥70.
|Treatment Option
RT + chemotherapy
RT alone
Chemotherapy alone
|If RT + Chemo: RT Dose to Primary
45 Gy/1.8 Gy
50.4 Gy/1.8 Gy
54 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy.
59.4 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy.
Patient prone
|Unless physically unable. If using IMRT technique, may prefer supine.
Small bowel contrast at simulation
|Not mandated with CT simulation.
Patient immobilized
Use belly board
|Only needed if prone.
Perineal scar marker
Bladder full at simulation
|If RT + Chemo: RT Volume
L5/S1 pelvis to include perineal scar
L5/S1 pelvis to bottom of ischial tuberosity
|RT Technique
3 or 4 field with photons
|Depending on clinical situation.
3 field with electron boost to perineum
4 field with electron boost to perineum
|May be appropriate depending on the clinical situation on a case-by-case basis. Enrollment in a clinical trial preferred.
|Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 2: 70-year-old woman staged with EUS, aT2NX rectal cancer with caudal extent located 9 cm from verge. Final pathology was T3N1 status post LAR. KPS ≥70.
|Treatment Option
RT + chemotherapy
RT alone
Chemotherapy alone
|If RT + Chemo: RT Dose to Primary
45 Gy/1.8 Gy
50.4 Gy/1.8 Gy
54 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy.
59.4 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy.
Patient prone
|Unless physically unable. If using IMRT technique, may prefer supine.
Small bowel contrast at simulation
|Not mandated with CT simulation.
Patient immobilized
Use belly board
|Only needed if prone.
Anal marker
Bladder full at simulation
|If RT + Chemo: RT Volume
L5/S1 pelvis to include anal marker
|CT simulation preferred. Use CT to ensure margin on inferior extent of tumor. Technically, the field should extend 2-3 cm below the anastomosis on the CT.
L5/S1 pelvis to bottom of ischial tuberosity
|CT simulation preferred. Bony landmark is an approximation. Use CT to ensure margin on inferior extent of tumor. Technically, the field should extend 2-3 cm below the anastomosis on the CT.
|RT Technique
3 or 4 field with photons
|Depending on clinical situation.
|May be appropriate depending on the clinical situation on a case-by-case basis. Enrollment in a clinical trial preferred.
|Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 3: 60-year-old woman with circumferential lesion with caudal extent located 8 cm from verge. EUS stage T3N1. KPS ≥70.
Preoperative RT + chemo
Postoperative RT + chemo
Preoperative RT alone
Postoperative RT
|If Preoperative RT: RT Dose
45 Gy/1.8 Gy
50.4 Gy/1.8 Gy
54 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy.
59.4 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy. For fixed lesions only.
5 Gy X 5
|Only if LAR not technically possible.
|If Postoperative RT: RT Dose
45 Gy/1.8 Gy
50.4 Gy/1.8 Gy
54 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy.
59.4 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy. For fixed lesions only.
5 Gy × 5
Patient prone
|Unless physically unable. If using IMRT technique, may prefer supine
Small bowel contrast at simulation
|Not mandated with CT simulation.
Patient immobilized
Use belly board
|Only needed if prone.
Anal marker
Bladder full at simulation
|RT Technique
3 or 4 field with photons
|Depending on clinical situation.
|May be appropriate depending on the clinical situation on a case-by-case basis. Enrollment in a clinical trial preferred.
|Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 4: 45-year-old woman with EUS staged T4N0, 4 cm lesion at 3 cm from verge with extensive involvement of the anal canal. KPS ≥70.
|Treatment Options
Preoperative RT + chemo followed by surgery
|LAR if possible.
Preoperative RT followed by surgery
Surgery followed by adjuvant treatment if pT3+ and/or LN+
|If Preoperative RT: RT Dose
45 Gy/1.8 Gy
50.4 Gy/1.8 Gy
54 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy.
59.4 Gy/1.8 Gy
|If small bowel is completely excluded after 50.4 Gy. For fixed lesions only.
5 Gy × 5
|Will not provide sufficient downstaging.
Patient prone
|If using IMRT technique, may prefer supine.
Small bowel contrast at simulation
|Not mandated with CT simulation.
Patient immobilized
Use belly board
|Only needed if prone.
Anal marker
Bladder full at simulation
|If Preoperative RT: RT Volume
Pelvis to L5/S1 + boost
Pelvis to L5/S1 + inguinal LN + boost
|With extensive involvement of anal cancer.
|RT Technique
3 or 4 field with photons
|Depending on clinical situation.
3 field with electron boost to perineum
4 field with electron boost to perineum
|Using atlas for target delineation. Based on anal cancer data. May be helpful to treat inguinal lymph nodes and to reduce side effects.
|If Preoperative RT + Chemo: Time between RT & Surgery
2-4 weeks
>4-6 weeks
>6-8 weeks
>8 weeks
|Extended length of time without therapy is discouraged. Strongly encourage enrollment in clinical trial.
|Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Summary of Literature Review
In 2004, a randomized trial from Germany was published establishing a regimen of preoperative chemoradiotherapy and surgery followed by additional cycles of chemotherapy alone as the standard of care for clinical stages T3 or T4, or for node-positive rectal cancer. Other clinical studies from the United States, Europe, and Asia have also influenced the treatment strategies for operable rectal cancer, as various approaches using preoperative or postoperative radiotherapy, with or without chemotherapy, have been examined. A summary of the major randomized clinical trials spanning the past several decades is provided below.
Prognostic Factors
Overall survival (OS) is most affected by the extent of disease, with increasing depth of rectal wall penetration and lymph node involvement being harbingers of worse outcome. Tumor location appears to be important in rectal cancer, with low-lying tumors having a greater propensity for local recurrence. Histological tumor grade is prognostic, with poorly differentiated tumors having a worse prognosis. The signet ring cell and mucinous varieties also portend a less favorable outcome. The mucinous variety can be visualized via magnetic resonance imaging (MRI) defined by greater than 50% mucin in the tumor, and this variety has recently been shown to respond less favorably to neoadjuvant chemoradiation. The pathologic circumferential resection margin (CRM) has been demonstrated to be prognostic, and at least one retrospective series confirms decreased cancer-specific survival with a CRM ≤2 mm. Additionally, the ypCRM status (after neoadjuvant chemoradiotherapy) is a significant risk factor for local recurrence. High-quality surgery with pathological evaluation of total mesorectal excision (TME) specimens is associated with a decreased risk of local recurrence. A pathological review of specimens from the Medical Research Council/United Kingdom (MRC CR07) trial, which required TME, clearly demonstrates that excellent surgical technique is directly related to local recurrence. Only 52% of the specimens demonstrated a "good" resection truly in the mesorectal plane, 34% were found to be "intermediate" in the intramesorectal plane, and 13% were "poor" involving the plane of the muscularis propria. The 3-year risk of local recurrence was directly related to quality of surgery, with high-quality surgery resulting in a lower recurrence. Importantly, all surgical groups, regardless of quality of resection, benefitted from neoadjuvant radiation therapy.
Preoperatively large radiotherapy portals covering the tumor, entire mesorectum, and lymph node regions at risk are typically treated to 45 Gy with a boost delivered to the tumor and presacral lymph nodes. The boost dose typically ranges in clinical trials from 5.4 to 9 Gy. The Radiation Therapy Oncology Group® (RTOG®) conducted a phase II study (R-0012) investigating combined-modality therapy with higher doses and hyperfractionation. Higher doses were associated with a similar pathologic complete response (pCR) rate at the cost of increased grade 3-4 acute toxicity; thus, the standard remains 50.4 to 54 Gy.
Postoperative Radiotherapy with or without Chemotherapy
Several classic trials have examined the use of postoperative irradiation alone or in combination with chemotherapy; conducted by the Gastrointestinal Tumor Study Group (GITSG), the North Central Cancer Treatment Group (NCCTG), and the Norwegian Adjuvant Rectal Cancer Project Group, radiotherapy delivered with concurrent chemotherapy improved both local control and survival. Subsequently, studies R-01 and R-02 by the National Surgical Adjuvant Breast and Bowel Project (NSABP) demonstrated that the role of radiotherapy is primarily local control in the postoperative setting.
The method of administrating chemotherapy appears to be important in obtaining optimal results. Protracted venous infusion of 5-fluorouracil (5-FU) was found to be superior to bolus 5-FU, with a 45% to 50% decrease in hematologic toxicity and is considered to be a standard adjuvant therapy; more recent studies have investigated alternate means of optimizing chemotherapy. The choice of early versus late radiotherapy with respect to chemotherapy may also be important according to the preliminary results of a recent randomized study and warrants further investigation. Because neoadjuvant chemoradiotherapy is superior to postoperative delivery, in cases where chemoradiation is clearly indicated, cT3-4 or N+ neoadjuvant delivery is preferred. (See Variant 1 and Variant 2 above.)
Preoperative Radiotherapy with or without Chemotherapy
Exploring the role of preoperative radiotherapy alone (25 Gy in 5 fractions), a Swedish trial showed improvements in both local control and survival that persisted at 13 years of follow-up. Late toxicity with this hypofractionated regimen is substantial and includes an increased risk of small-bowel obstruction, abdominal pain, diarrhea, bleeding, and fistula formation.
Both the MRC CR07 trial and the Dutch Colorectal Cancer Group (CKVO 95-04) investigated the role of radiation therapy with high-quality TME surgery. The Dutch study randomized 1,805 eligible patients to either surgery alone or short course radiation therapy (5 x 5 Gy) followed by surgery, and concluded that the addition of radiation significantly decreases the rate of local recurrence at 2 years even with high-quality surgery (P<0.001). The MRC CR07 study attempted to select high risk patients to selectively treat with radiation therapy; 1,350 patients were randomized to either neoadjuvant short-course radiation therapy (5 x 5 Gy) or selective postoperative concurrent chemoradiation therapy (45 Gy in 25 fractions with 5-FU) to those patients with CRM involvement (defined as ≤1 mm). Patients with resectable rectal cancer who received preoperative radiation had a decreased rate of local recurrence at 3 years compared to patients who received adjuvant long-term radiation therapy. Together, the CKVO 95-04 and MRC CR07 studies confirm that radiation improves local control even with TME surgical technique. Because of the toxicity of long-term radiation treatment and the inability to safely combine the hypofractionated radiotherapy regimen with systemic chemotherapy, this approach is rarely used in the United States or Southern Europe, but it is more common in Northern Europe.
Importantly, two trials from Europe have examined the role of incorporating concurrent chemotherapy with preoperative irradiation using standard radiotherapy fractionation, in keeping with the postoperative combined chemoradiotherapy model. Two studies (one by the European Organisation for Research and Treatment of Cancer [EORTC] 22921, the other by Fondation Française de Cancérologie Digestive [FFCD] 9203) demonstrated a significant improvement in local control, in the absence of a survival or sphincter-preservation benefit, with the addition of chemotherapy. As expected, acute toxicity was increased with the addition of chemotherapy, as had been noted in the FFCD 9203 trial.
Preoperative versus Postoperative Chemoradiotherapy
The important question of comparing preoperative versus postoperative chemoradiotherapy, as noted above, was addressed by a randomized trial from Germany. The preoperative regimen was associated with significantly improved local control and increased sphincter-preservation rates with no differences in disease-free or OS. As surgical technique continues to improve, it becomes increasingly difficult to demonstrate a benefit in disease-free survival (DFS) or OS. Neoadjuvant delivery also resulted in decreased rates of acute and chronic treatment toxicity, when compared to the postoperative approach. Another randomized trial (NSABP R03) exploring the same question in the United States was terminated early due to poor accrual. This study did not require TME, but it did show a trend towards improved survival, with a significant improvement in recurrence-free survival and DFS. Clinical response to the preoperative therapy was associated with significantly improved disease-free and OS. The current standard of care in the United States is, therefore, to provide preoperative chemoradiotherapy, using standard radiotherapy fractionation and concurrent fluorouracil for clinical stages T3 or T4, or for node-positive rectal cancer.
Physical positioning to displace the small bowel is a simple way of maximizing the therapeutic ratio. A comparative study shows that when a patient is placed prone, the use of a belly board combined with a full bladder reduces the volume of small bowel irradiated by 70% (about 100 cc). Use of intensity-modulated radiation therapy (IMRT) with supine positioning potentially obviates the geometric benefit of placing the patient in the prone position on a belly board, which is uncomfortable and presumably more difficult for the patient to tolerate. A retrospective study comparing prone or supine setup with daily image guidance versus a no-action-level protocol confirmed that prone positioning leads to a greater systematic error. However, the study noted increased random error with the supine position. Error was decreased with either setup using increased frequency of image guidance. One study from the UK evaluated prone versus supine positioning in 19 consecutive patients and found the prone position did decrease dose to the small bowel, but primarily only in the low dose region of the dose-volume histogram. At doses above 20 Gy, there was no appreciable difference between supine and prone positioning, lending support to the notion of using the supine position in patients who may not tolerate lying prone with a full bladder.
Timing of Surgery
One of the major differences in the adjuvant trials from Europe versus those from the United States has been regarding the timing of surgery after chemoradiotherapy. The short-course regimens from Europe with surgery 1 week after completing radiotherapy have not allowed adequate time for downstaging, yet it appears that with a longer interval from neoadjuvant therapy to surgery downstaging may occur. In a retrospective review of patients treated with neoadjuvant chemoradiation followed by surgery with a time interval ≤7 weeks versus >7 weeks, the longer interval before surgery demonstrated an improved pCR and near-pCR rates as well as increased disease-free survival interval. A primary concern with an extended interval from chemoradiotherapy to surgery is that tumor clonogens are afforded time for repopulation and potential spread. A delay to surgery beyond 12 weeks has been investigated in selected patients and appears to be safe without an increase in metastatic spread.
Infusional versus Oral 5-FU
Since the advent of oral 5-FU, capecitabine, its equivalence has been called into question. A multitude of retrospective data exists with conflicting results. Several randomized phase III studies have recently been reported that add support to the use of capecitabine. NSABP R-04 is a randomized trial of radiotherapy with concurrent chemotherapy investigating four different chemotherapy regimens (5-FU or oral capecitabine with or without oxaliplatin). Preliminary results have recently been reported and show no significant difference between the arms with respect to pCR, sphincter preservation, or downstaging. However, the addition of oxaliplatin was associated with a notable increase in grade 3 and 4 gastrointestinal (GI) toxicity. Another randomized trial of 401 patients from Germany comparing infusional 5-FU versus oral capecitabine concurrent with neoadjuvant radiation therapy suggests different toxicity profiles between the two chemotherapy regimens with less leucopenia and increased hand-foot skin reactions associated with capecitabine. This noninferiority German study suggests that oral capecitabine is not inferior to infusional 5-FU, and is associated with an increased rate of ypN0 tumors demonstrating increased downstaging with the oral drug.
Current Questions
The role of neoadjuvant chemoradiotherapy in resectable rectal cancer has been established, but the possibility of increasing the therapeutic gain via newer chemotherapeutic agents exists. Two large trials, the French ACCORD and the Italian STAR trial, both evaluate the role of oxaliplatin, which increases the efficacy of fluorouracil-based chemotherapy in treating colon cancer. These trials clearly show an increase in toxicity with the addition of oxaliplatin with no apparent improvement in local response. This use of oxaliplatin is supported by the recent preliminary results from NSABP R-04, which showed no apparent benefit with the addition of oxaliplatin to neoadjuvant concurrent chemoradiotherapy. The use of IMRT with capecitabine and oxaliplatin is being examined in a phase II study (RTOG® 08-22), but the results are not yet available. The role of biologic agents in treating rectal cancer has not yet been established.
The role of additional adjuvant chemotherapy after chemoradiotherapy in either the neoadjuvant or adjuvant setting is also in question. Although it is clearly indicated with colon cancer, several large trials from Europe and a meta-analysis have failed to show any benefit. Adjuvant chemotherapy after either neoadjuvant or adjuvant chemoradiotherapy has remained the standard of care based on extrapolated data from colon cancer. A randomized trial was initiated to determine whether additional chemotherapy is necessary in rectal cancer, but unfortunately due to lack of clinical equipoise, the study failed to accrue and closed early. Analysis of the Surveillance, Epidemiology, and End Results (SEER) database comparing patients who received adjuvant chemotherapy with those who did not suggests that patients who are node positive may benefit from additional chemotherapy.
IMRT has a demonstrated benefit in the treatment of anal malignancies, with fewer treatment breaks presumed to be due to the decreased toxicity associated with more conformal dose delivery. The RTOG® launched a phase II study investigating the use of IMRT for T3-4N0-2 patients with capecitabine and oxaliplatin. The preliminary results, presented in abstract form only, revealed a trend towards decreased preoperative GI grade ≥2 toxicity when compared to RTOG® 0247. A recent single-institution retrospective review comparing IMRT to classic 3-field conventional radiotherapy demonstrated a significant decrease in GI toxicity grade ≥2 for patients receiving IMRT. It is the consensus of the expert panel authoring this document that IMRT clearly decreases toxicity in the treatment of rectal cancer. Certain situations requiring larger treatment volumes such as postoperative therapy after an abdominoperineal resection (APR) or radiation of the inguinal nodes warrants a stronger recommendation for IMRT; however, there are concerns regarding delivery of IMRT outside the confines of a clinical trial. IMRT requires a greater knowledge of anatomic spread and understanding of the surrounding normal tissues and tolerances than the conventional 3-field pelvis treatment based on bony anatomy. This difficulty in contouring was clearly demonstrated in RTOG® 0529 where there were a significant number of inadequately contoured cases; however, due to a rapid review process, corrections were made prior to patient treatment. Multiple studies document the interobserver variability in target delineation with highly conformal therapy, and the need for guidance or aids in target delineation to avoid missing critical targets. The need for education regarding IMRT volumes in the pelvis was addressed by consensus panel of experts convened by RTOG® to create an anorectal contouring atlas that helps delineate targets. The preferred delivery for IMRT is via clinical trials; however, when being performed outside of a clinical trial, the atlas and peer review through colleagues or an established review process is strongly recommended.
Patients with low-lying rectal tumors extending below the dentate line and with extensive involvement of the anal canal receive treatment resembling that used for anal cancer, including treatment of the external iliac and inguinal nodes based on patterns of lymph node drainage. Retrospective data from MD Anderson Cancer Center suggests that the inguinal spread of rectal cancer, even with involvement of the anal canal, may be a rare event and that prophylactic radiotherapy to the groin may be unnecessary. This study defines patients having disease within 4 cm of the anal verge as having involvement of the anal canal, but it does not comment on extensive involvement with extension to the anal verge or margin. Further validation is necessary before omitting inguinal radiation therapy in patients with extensive involvement of the anal canal (see Variant 4 above).
Need for Future Trial
Despite the published data from randomized trials that support the shift to preoperative chemoradiotherapy, a subset of patients will require surgical resection upfront for a variety of clinical reasons. A pooled analysis of five randomized clinical trials in the United States suggests that not all patients with resected tumors may require a trimodality (surgery, chemotherapy, radiotherapy) treatment approach. Patients with favorable or "intermediate-risk" (T3N0 or T1-2N1) tumors were found to have benefited equally from either postoperative chemoradiotherapy or chemotherapy alone. Other data from the Memorial Sloan-Kettering Cancer Center (MSKCC) suggests that understaging may be a significant problem, as 22% of the patients in the trial who were cT3N0 were found to be pN+ at the time of surgery. A risk-adapted approach, selecting patients for minimal surgery based on their response to preoperative chemoradiotherapy has been investigated. Preliminary results from a recently reported small phase II trial by the American College of Surgeons Oncology Group (ACOSOG Z6041) suggests select patients who have a small cT2N0 tumor may be candidates for preoperative chemoradiotherapy followed by local excision rather than proctectomy. The possibility of deferring or eliminating surgery for patients with a complete response to neoadjuvant chemoradiotherapy has also been suggested. A future clinical study is warranted to validate the appropriateness of such risk-adapted treatment-minimization strategies.
- AP/PA, anteroposterior/posteroanterior
- APR, abdominoperineal resection
- CT, computed tomography
- EUS, endorectal ultrasound
- IMRT, intensity modulated radio therapy
- KPS, Karnofsky performance scale
- LAR, low anterior resection
- LN, lymph node
- RT, radiotherapy
Clinical Algorithm(s)
Algorithms were not developed from criteria guidelines.
Resectable rectal cancer
Guideline Category
Risk Assessment
Clinical Specialty
Colon and Rectal Surgery
Internal Medicine
Radiation Oncology
Intended Users
Health Plans
Managed Care Organizations
Utilization Management
Guideline Objective(s)
To evaluate the appropriateness of procedures for management and treatment of resectable rectal cancer
Target Population
Patients with resectable rectal cancer
Interventions and Practices Considered
- Radiation therapy (RT)
- RT + chemotherapy
- RT alone
- Chemotherapy alone
- Preoperative and postoperative RT + chemotherapy or RT alone
- RT volume and dosing
- RT technique
- 3 or 4 field with photons
- Anteroposterior/posteroanterior (AP/PA)
- 3 field with electron boost to perineum
- 4 field with electron boost to perineum
- Intensity-modulated radiation therapy (IMRT)
- Surgery
- Low anterior resection (LAR)
- Abdominoperineal resection (APR)
Major Outcomes Considered
- Survival: disease-free, recurrence-free, overall
- Local control
- Anal sphincter-preservation rate
- Pathologic complete response (pCR)
Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
Literature Search Procedure
The Medline literature search is based on keywords provided by the topic author. The two general classes of keywords are those related to the condition (e.g., ankle pain, fever) and those that describe the diagnostic or therapeutic intervention of interest (e.g., mammography, MRI]).
The search terms and parameters are manipulated to produce the most relevant, current evidence to address the American College of Radiology Appropriateness Criteria (ACR AC) topic being reviewed or developed. Combining the clinical conditions and diagnostic modalities or therapeutic procedures narrows the search to be relevant to the topic. Exploding the term "diagnostic imaging" captures relevant results for diagnostic topics.
The following criteria/limits are used in the searches.
- Articles that have abstracts available and are concerned with humans.
- Restrict the search to the year prior to the last topic update or in some cases the author of the topic may specify which year range to use in the search. For new topics, the year range is restricted to the last 5 years unless the topic author provides other instructions.
- May restrict the search to Adults only or Pediatrics only.
- Articles consisting of only summaries or case reports are often excluded from final results.
The search strategy may be revised to improve the output as needed.
Number of Source Documents
The total number of source documents identified as the result of the literature search is not known.
Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence
Strength of Evidence Key
Category 1 - The conclusions of the study are valid and strongly supported by study design, analysis and results.
Category 2 - The conclusions of the study are likely valid, but study design does not permit certainty.
Category 3 - The conclusions of the study may be valid but the evidence supporting the conclusions is inconclusive or equivocal.
Category 4 - The conclusions of the study may not be valid because the evidence may not be reliable given the study design or analysis.
Methods Used to Analyze the Evidence
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence
The topic author drafts or revises the narrative text summarizing the evidence found in the literature. American College of Radiology (ACR) staff draft an evidence table based on the analysis of the selected literature. These tables rate the strength of the evidence for all articles included in the narrative text.
The expert panel reviews the narrative text, evidence table, and the supporting literature for each of the topic-variant combinations and assigns an appropriateness rating for each procedure listed in the table. Each individual panel member forms his/her own opinion based on his/her interpretation of the available evidence.
More information about the evidence table development process can be found in the ACR Appropriateness Criteria® Evidence Table Development document (see the "Availability of Companion Documents" field).
Methods Used to Formulate the Recommendations
Expert Consensus (Delphi)
Description of Methods Used to Formulate the Recommendations
Modified Delphi Technique
The appropriateness ratings for each of the procedures included in the Appropriateness Criteria topics are determined using a modified Delphi methodology. A series of surveys are conducted to elicit each panelist's expert interpretation of the evidence, based on the available data, regarding the appropriateness of an imaging or therapeutic procedure for a specific clinical scenario. American College of Radiology (ACR) staff distributes surveys to the panelists along with the evidence table and narrative. Each panelist interprets the available evidence and rates each procedure. The surveys are completed by panelists without consulting other panelists. The ratings are a scale between 1 and 9, which is further divided into three categories: 1, 2, or 3 is defined as "usually not appropriate"; 4, 5, or 6 is defined as "may be appropriate"; and 7, 8, or 9 is defined as "usually appropriate." Each panel member assigns one rating for each procedure per survey round. The surveys are collected and the results are tabulated, de-identified and redistributed after each round. A maximum of three rounds are conducted. The modified Delphi technique enables each panelist to express individual interpretations of the evidence and his or her expert opinion without excessive bias from fellow panelists in a simple, standardized and economical process.
Consensus among the panel members must be achieved to determine the final rating for each procedure. Consensus is defined as eighty percent (80%) agreement within a rating category. The final rating is determined by the median of all the ratings once consensus has been reached. Up to three rating rounds are conducted to achieve consensus.
If consensus is not reached, the panel is convened by conference call. The strengths and weaknesses of each imaging procedure that has not reached consensus are discussed and a final rating is proposed. If the panelists on the call agree, the rating is accepted as the panel's consensus. The document is circulated to all the panelists to make the final determination. If consensus cannot be reached on the call or when the document is circulated, "No consensus" appears in the rating column and the reasons for this decision are added to the comment sections.
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation
Criteria developed by the Expert Panels are reviewed by the American College of Radiology (ACR) Committee on Appropriateness Criteria.
Evidence Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The recommendations are based on analysis of the current literature and expert panel consensus.
Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
Selection of appropriate treatment procedures for resectable rectal cancer
Potential Harms
Radiotherapy or chemotherapy toxicity
Qualifying Statements
Qualifying Statements
An American College of Radiology (ACR) Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those exams generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the U.S. Food and Drug Administration (FDA) have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.
Implementation of the Guideline
Description of Implementation Strategy
An implementation strategy was not provided.
Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
Getting Better
Living with Illness
IOM Domain
Identifying Information and Availability
Bibliographic Source(s)
|Jones WE III, Thomas CR Jr, Suh WW, Herman JM, Abdel-Wahab M, Azad N, Blackstock AW, Das P, Goodman KA, Hong TS, Jabbour SK, Konski AA, Koong AC, Rodriguez-Bigas M, Small W Jr, Zook J, Expert Panel on Radiation Oncology - Rectal/Anal Cancer. ACR Appropriateness Criteria® resectable rectal cancer. [online publication]. Reston (VA): American College of Radiology (ACR); 2012. 9 p. [48 references]
Not applicable: The guideline was not adapted from another source.
Date Released
1998 (revised 2012)
Guideline Developer(s)
American College of Radiology - Medical Specialty Society
Source(s) of Funding
The American College of Radiology (ACR) provided the funding and the resources for these ACR Appropriateness Criteria®.
Guideline Committee
Committee on Appropriateness Criteria, Expert Panel Radiation Oncology-Rectal/Anal Cancer
Composition of Group That Authored the Guideline
Panel Members: William E. Jones, III, MD (Co-Author); Charles R. Thomas Jr, M (Co-Author); W. Warren Suh, MD (Panel Chair); Joseph M. Herman, MD, MSc (Panel Vice-chair); May Abdel-Wahab, MD, PhD; Nilofer Azad, MD; A. William Blackstock, MD; Prajnan Das, MD; Karyn A. Goodman, MD; Theodore S. Hong, MD; Salma K. Jabbour, MD; Andre A. Konski, MD; Albert C. Koong, MD; Miguel Rodriguez-Bigas, MD; William Small Jr, MD; Jennifer Zook, MD
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
This guideline updates a previous version. Suh WW, Johnstone PA, Blackstock AW, Herman J, Konski AA, Mohiuddin M, Poggi MM, Regine WF, Rich TA, Cosman BC, Saltz L, Expert Panel on Radiation Oncology-Rectal/Anal Cancer. Resectable rectal cancer. [online publication]. Reston (VA): American College of Radiology (ACR); 2007. 7 p.
Guideline Availability
Electronic copies: Available from the American College of Radiology (ACR) Web site .
Print copies: Available from the American College of Radiology, 1891 Preston White Drive, Reston, VA 20191. Telephone: (703) 648-8900
Availability of Companion Documents
The following are available:
- ACR Appropriateness Criteria®. Overview. Reston (VA): American College of Radiology; 2 p. Electronic copies: Available in Portable Document Format (PDF) from the American College of Radiology (ACR) Web site .
- ACR Appropriateness Criteria®. Literature search process. Reston (VA): American College of Radiology; 1 p. Electronic copies: Available in PDF from the ACR Web site .
- ACR Appropriateness Criteria®. Evidence table development – diagnostic studies. Reston (VA): American College of Radiology; 2013 Nov. 3 p. Electronic copies: Available in PDF from the ACR Web site .
- ACR Appropriateness Criteria®. Evidence table development – therapeutic studies. Reston (VA): American College of Radiology; 2013 Nov. 4 p. Electronic copies: Available in PDF from the ACR Web site .
- ACR Appropriateness Criteria® resectable rectal cancer. Evidence table. Reston (VA): American College of Radiology; 2012. 28 p. Electronic copies: Available from the ACR Web site .
Patient Resources
None available
NGC Status
This NGC summary was completed by ECRI Institute on December 17, 2007. This NGC summary was updated by ECRI Institute on August 21, 2012.
Copyright Statement
Instructions for downloading, use, and reproduction of the American College of Radiology (ACR) Appropriateness Criteria® may be found on the ACR Web site .
NGC Disclaimer
The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.
All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.
Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria.
NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.


text:
"Partnership for Kids" Group Volunteering Day
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text: Plot: Scrat's epic pursuit of his elusive acorn catapults him outside of Earth, where he accidentally sets off a series of cosmic events that transform and threaten the planet. To save themselves from peril, Manny, Sid, Diego, and the rest of the herd leave their home and embark on a quest full of thrills and spills, highs and lows, laughter and adventure while traveling to exotic new lands and encountering a host of colorful new characters. Genre: Animation, Adventure, Comedy IMDB Rating: 5.8/10 from 8.936 users | Metascore 34/100 Directed by: Mike Thurmeier, Galen T. Chu Starring: Ray Romano, Denis Leary, John Leguizamo Release Name: Ice.Age.Collision.Course.2016.New.HDTS.XVID.AC3.HQ.Hive-CM8 Size: 1.38 GB Video: AVI | 720 x 304 | 2000 Kbps Audio: English | AC3 | 256 Kbps Runtime: 87 mins Information: Code: http://www.imdb.com/title/tt3416828/ Code: Download from NITROFLARE http://nitroflare.com/view/427FCF4646084F3/Ice.Age.Collision.Course.2016.New.HDTS.XVID.AC3.HQ.Hive-CM8.avi Code: Download from REDBUNKER http://www.redbunker.net/p738fi8zd90r/Ice.Age.Collision.Course.2016.New.HDTS.XVID.AC3.HQ.Hive-CM8.avi.html Screens: NFO:


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From Wikipedia: Łazanki arrived in the Polish-Lithuanian Commonwealth in mid-16th century when Bona Sforza, Italian wife of King Sigismund the Old, brought high Italian cuisine to the country. Unlike most Italian dishes in these parts of Europe, lazanki has survived until the 21st century and is still eaten today, although the long and cultural history of the dish has been largely forgotten. Stiff wheat, rye or buckwheat dough, rolled thin and cut into triangles or rectangles, is boiled, drained, and eaten with melted pork fat, vegetable oil, or sour cream. In Poland, they are often mixed with cabbage or sauerkraut and small bits of sausage and meat.
Home made noodles
- 300 g flour
- 2 small eggs
- about 30-50 ml water
- half of the spoon of salt
Sieve the flour. Mix flour with eggs, salt and water in the bowl. Made a dough with hands until firm. Make sure it is not too sticky and not too dry. Divide into 2-4 parts and roll each piece into a thin sheet on a floured board (see the picture of the dough in the recipe for chrust). Leave on the clean towel sprinkled with flour until the dough would dry out a bit. After the thin pieces are dried roll it and cut with the knife into the pieces the size of lasagne noodles. Pour into the boiled salted water and cook until soft.
Instead of preparing the home-made noodles you can buy lasagne noodles or homemade style wide noodles. But - the noodles made at home are the best!
Lasagne cabbage
- bacon - 100g
- onion - 70 g
- one medium or small cabbage
- cumin, salt and pepper to taste
Cut the bacon into slices and pour into the hot pan. Add onion sliced into small cubes. Wash and cut fresh green cabbage into the slices of the width a bit wider than lasagne noodles. Add cabbage into the pan with melted bacon and onion, add some water. Steam in the open pot, add cumin, pepper and salt. Finally add the cooked pasta, mix it well - now lazanki are ready to eat
Recommended reading(s):
If you are interested in Polish cuisine I recommend a book written by Marja Ochorowicz-Monatowa, entitled Polish Cookery
Also highly recommended: The New Polish Cuisine by Michael Baruch and Gregory Bertolini
At Hanka's Table (Hardcover) by Hanka Sawka


text: CPO Update 2012 COF College Park, MD USPHS Pharmacy Workforce • Commissioned Corps Pharmacists ~ 1200 • PHS Pharmacists (including civil service) ~ 1700 Other 8% BOP 13% DHS 3% Other = AHRQ, CDC, DOD, CMS, HRSA, NIH, OS, PSC, SAMHSA IHS 47% FDA 29% 1200 Officers • 15 Agencies/OPDIVS • 4 Departments …and growing Leadership, Service, Integrity, Excellence USPHS Pharmacy Update • PharmPAC leadership – Chair: CDR Peter Diak (firstname.lastname@example.com) – Chair Elect: CDR Mike Crockett (firstname.lastname@example.com) • • • • Readiness Application process 'Recruitment' philosophy USPHS Commissioned Corps Pharmacy input on Department and Agency pharmacy-related initiatives Leadership, Service, Integrity, Excellence HHS Pharmacy-Related Initiatives • 2011 National Drug Control Strategy: Callto-Action on Prescription Drug Abuse • Illegal Pharmacy Internet Use • Medication Adherence • Partnership for Patients • Million Hearts Campaign Leadership, Service, Integrity, Excellence National Prevention Strategy • Extensive stakeholder and public input • Aligns and focuses on evidencebased prevention and health promotion • Moves from focus on sickness and disease to prevention and wellness • U.S. Public Health Service Pharmacy Prevention Strategy Leadership, Service, Integrity, Excellence Administrative Update • Division of Commissioned Corps Personnel and Readiness (DCCPR) – Consolidation includes • Office of Force Readiness and Deployment (OFRD) • Office of Commissioned Corps Operations (OCCO) • Office of Commissioned Corps Force Management (OCCFM) • Office of Reserve Affairs (ORA) – All operations of the Corps – Work directly with RADM Lushniak (DSG) and OSG/OASH on strategic decisions Leadership, Service, Integrity, Excellence Accountability Structure Leadership, Service, Integrity, Excellence DCCPR FY12/13 Budget Impact • FY11: had two expected funding streams totaled $23,108,203 • FY12: one major appropriated funding stream (CCI) was zeroed out. Second funding stream (SSF) also reduced. • FY12 available funds for DCCPR/DSI was $14,318,959 • All funds now consolidated under SSF fund • FY13: another $1.1M budget cut funds to ~ $13.4M • Funds cut 40% in FY12 • Hiring freeze at Corps HQ since May 2010 Leadership, Service, Integrity, Excellence DCCPR FTE/Staff History (Oct 1, 2012 represents actual estimated staff count for DCCPR/DSI) Leadership, Service, Integrity, Excellence DCCPR FY12 Outcomes • Streamlined functions, consolidated 4 flag offices into one, reduced personnel budget • Implemented Customer Service Aims • CAD 5 Focus Areas • Completed/implemented new billet system • Continue with DOD mental health partnership • Continue to maintain functions as best possible • OBC continues, now trained over 2500 officers Leadership, Service, Integrity, Excellence Domestic Training/Response Missions • Community Health and Service-oriented Missions (CHASM) – Operation Lone Star: Mission/San Juan, TX, 2011 – Operation Nexus: Paducah/Pikeville, KY, 2011 – Operation Foothold: Pine Ridge, SD, 2011 – Rosebud: Rosebud, SD (July 1-10, 2012) Leadership, Service, Integrity, Excellence CPO Strategic Goals • 1 Advance the profession and position it to support successful health reform • 2 Expand and enhance internal and external pharmacy partnerships • Recruit, retain and develop future pharmacists and health leaders 3 Next Steps Advance the Profession Report to the Surgeon General We are moving beyond discussion. Report's release and support from Dr. Benjamin has commenced a wave of momentum (and a 'review' of how we practice) ReportNext to the Steps Surgeon General IMPACT in 2012 • CMS regulation amendment • National Health Service Corps SLRP: 1st time • Organizations –APhA policy amendments via House of Delegates –Mission/vision statement revision: APhA, ASHP, NASPA, JCPP, AACP • State pharmacy associations: actions (e.g., PA provider status) and modeling of language for scope • CDC/APhA Foundation white paper on health policy and public education related to nomenclature/scope Next(cont'd) Stepsin 2012 IMPACT • Academia – Transformation in pharmacy education – Mission statement changes – Curriculum adjustments – Student pharmacists' positions on post-graduate training (APhA-ASP) • Multiple publications: Medscape, U.S. Medicine, Pharmacy Today, etc. • Speaking engagements (30+): 25 states, 2 countries, viral impact • Potential translation into 6 different languages NextPHS Steps Mobilize Pharmacy • We are being sought after… • Seize opportunity to partner wherever possible on pharmacy initiatives • Function as expert consultants on pharmacy practice – leverage your practice environment and take responsibility to connect the dots • Utilize consistent message regarding our expanded scopes • Help lead the profession I challenge all of you to engage and accomplish! Expand Partnerships Expanded Partnerships • Enhanced partnerships subsequent to the Report to Surgeon General – Pharmacy professional organizations (within U.S. & international). Ex: NASPA, APhA, ASHP, etc. – ALL state pharmacist associations – Academia – Pharmacist-physician • HRSA: Patient Safety & Clinical Pharmacy Services Collaborative – 4th year, > 170 community-based teams – 48 states, plus D.C., Puerto Rico, Virgin Islands Expanded Partnerships • IHS – IHS-VA Consolidated Mail Outpatient Pharmacy – IHS-DOD Pharmacy Technician Training Program – Ongoing clinical programs and NCPS • BOP: ongoing clinical program expansion (e.g., HIV Pharmacy Program) • CDC: pharmacy policy consortium, outreach project on chronic care • CMS: regulation amendment naming pharmacists as medical staff • FDA: new OTC paradigm initiative Federal Pharmacist Vision Federal Pharmacists are essential to health care access and delivery in the United States; recognized as health care providers of patient-centered primary and specialty care, and as trusted public health leaders. As experts in medication use and comprehensive pharmacy services, we promote wellness, prevent and manage disease, ensure patient safety, and optimize health outcomes in collaboration with the health care team. Federal Pharmacist Vision & Scope of Practice • Scope of Practice – Finalized on 10 February 2012 – Describes state of pharmacy practice when the Federal Pharmacist Vision has been achieved • Adopted by PHS, Army, Navy, Air Force, and VA • Adopted by APhA Board in guiding policy expansion • Updating OPM federal pharmacist position description standards to align with vision and scope of practice Next Steps Recruit and Retain Recruit and Retain • Category Outreach (Publications, Speaking) – Letters, certificates • UPOCs (49), student awards (65), OBC (433), etc. • Participated in OBC each month in FY12 • Recruitment model programs (e.g., UPOC, student award initiative with PPAC) • Commissioned Corps Pharmacy Mentoring Network (CCPMN) – 2011: 37 paired • Continue to go above and beyond Pride and Responsibility • Performance is the platform – Need to be diplomatic, responsive, accountable • Develop the right culture for our Corps – Know our capacity, adapt to the focus/need – Understand the 'bigger picture' – Remember WHO you are as a uniformed officer • Inspire – it motivates • Build sincere bridges Questions and Answers • RADM Scott Giberson • U.S. Assistant Surgeon General • Chief Professional Officer, Pharmacy • Director, Commissioned Corps Personnel and Readiness


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Popular property highlights
Serhs Natal Grand Hotel places you within a short walk of Natal Convention Center and within a mile (2 km) of Praia Shopping. This 396-room, 5-star resort has 3 outdoor pools along with a full-service spa and 5 restaurants. On the beach, it's also near Christmas Tree and Dunas Arena.
Start your day off right with a free buffet breakfast. Enjoy dining at Potiguar, one of 5 onsite restaurants. Savor a meal from the comfort of your room with 24-hour room service, or entertain your taste buds with a beverage at the bar/lounge or coffee shop/café.
Serhs Natal Grand Hotel's 396 rooms are air-conditioned and provide balconies, minibars, and free newspapers. Plasma TVs come with cable channels, and free WiFi keeps guests connected. Bathrooms offer rainfall showers, hair dryers, and free toiletries. Other standard amenities include safes and desks.
Guests of Serhs Natal Grand Hotel have access to a full-service spa, 3 outdoor pools, and an indoor pool. You can take advantage of free parking, along with limo/town car service. The 24-hour front desk has multilingual staff ready to assist with dry cleaning/laundry, tours or tickets, and luggage storage. Other amenities at this beach resort include a children's pool, a fitness center, and a spa tub.
Property features
- Free buffet breakfast
- Free WiFi in rooms and public areas
- Free parking
- Onsite dining
Serhs Natal Grand Hotel
Hotel Amenities
Hotel Amenities
In addition to a full-service spa, Serhs Natal Grand Hotel features an indoor pool, an outdoor pool, a health club, and a spa tub. The resort offers a restaurant and a coffee shop/café. Guests can unwind with a drink at one of the hotel's bars, which include a poolside bar and a bar/lounge. A complimentary breakfast is offered in the mornings, and complimentary wireless Internet access is available.
Business amenities at this 5-star resort consist of a business center, limo/town car service, and audio-visual equipment. Event facilities include conference/meeting rooms, a meeting/conference room, small meeting rooms, and banquet facilities. This Art Deco hotel also offers a fitness facility, and services for children, such as supervised activities and childcare. For a surcharge, an area shuttle is available to guests. Onsite parking is complimentary.
Serhs Natal Grand Hotel has designated areas for smoking.
- 24-hour front desk
- Babysitting or childcare (surcharge)
- Children's club (free)
- Supervised childcare/activities (free)
- Number of floors - 7
- Babysitting or childcare
- Bar/lounge
- Barbecue grill(s)
- Business center
- Coffee shop or café
- Dry cleaning/laundry service
- Fitness facilities
- Full-service spa
- Gift shops or newsstand
- Hair salon
- Pool umbrellas
- Tours/ticket assistance
- Free WiFi
- Number of outdoor pools - 3
- One meeting room
- Designated smoking areas
- Rooftop terrace
- Luggage storage
- Area shuttle (surcharge)
- Children's club
- Garden
- Arcade/game room
- Total number of rooms - 396
- Elevator/lift
- Laundry facilities
- Limo or Town Car service available
- Spa treatment room(s)
- Multilingual staff
- Picnic area
- Poolside bar
- Porter/bellhop
- Safe-deposit box at front desk
- Number of restaurants - 5
- Free self parking
- Free beach cabanas
- Free pool cabanas
- Beach sun loungers
- Pool sun loungers
- Beach towels
- Sauna
- Shopping on site
- Spa services on site
- Spa tub
- Steam room
- Supervised childcare/activities
- Children's pool
- Indoor pool
- Free breakfast
- Year Built 2005
Family Friendly Amenities
- Family Hotel
- Outdoor pools
- Indoor pool
- Children's pool
- Supervised childcare/activities (free)
- Free Wi-Fi
- Children's club (free)
- Laundry facilities
- Babysitting or childcare (surcharge)
- Arcade/game room
- Playground on site
- Cribs/infant beds (complimentary)
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Free self parking
Room Amenities
Serhs Natal Grand Hotel offers 396 air-conditioned accommodations with minibars and safes. Rooms open to balconies. Plasma televisions come with cable channels. Bathrooms include showers with rainfall showerheads, bathrobes, complimentary toiletries, and hair dryers.
Guests can surf the web using the complimentary wireless Internet access. Business-friendly amenities include desks and complimentary newspapers. A nightly turndown service is provided and housekeeping is offered daily.
- Balcony
- In-room climate control (air conditioning)
- Air conditioning
- Minibar
- Daily housekeeping
- Turndown service
- Private bathroom
- Bathrobes
- Free toiletries
- Hair dryer
- Shower only
- Rainfall showerhead
- Cable TV service
- Desk
- In-room safe
- Blackout drapes/curtains
- Free WiFi
- Free newspaper
- Room service (24 hours)
- Plasma TV
- Free cribs/infant beds
Where to Eat
Serhs Natal Grand Hotel has a restaurant on site. Guests are offered a complimentary buffet breakfast. 24-hour room service is available.
Nearby Things to Do
An indoor pool, an outdoor pool, a children's pool, and a spa tub are on site. Other recreational amenities include a health club, a sauna, a steam room, and a fitness facility.
The recreational activities listed below are available either on site or nearby; fees may apply.
- Fitness classes on site
- Playground on site
- Volleyball on site
Spa Services
The on-site spa has massage/treatment rooms.
- Minimum age to access spa is 10
- Number of treatment rooms 3
- Couples treatment rooms
- Manicures and pedicures
- Aromatherapy treatments
- Sauna in spa
- Spa tub in spa
- Massages
- Body treatments
- Facial treatments
If you have requests for specific accessibility needs, please note them at check-out when you book your room.
- Accessible bathroom
- Roll-in shower
- In-room accessibility
Hotel Policies
Check-in time ends at midnight
Check-in time starts at 3 PM
Minimum check-in age is 18
Check-out time is noon
Payment types
Children and extra beds
- Children are welcome.
- Kids stay free! Children 2 years old and younger stay free when using existing bedding.
- Free cribs (infant beds)!
- Pets not allowed
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
No rollaway/extra beds available
This property's half board rates include breakfast and buffet dinner. The full board rates include breakfast, buffet lunch, and buffet dinner. Drinks are not included with either meal plan. For more details, please contact the office using the information on the reservation confirmation received after booking.
Hotel Name
- Hotel Serhs
- Natal Grand Hotel
- Serhs
- Serhs Grand
- Serhs Grand Hotel
- Serhs Hotel
- Serhs Natal Grand
- Serhs Natal Grand Hotel
- Serhs Grand Natal
- Serhs Natal Grand Hotel Brazil
We should mention
Parents or a legal guardian traveling with children under 18 years must present the child's birth certificate and an identity card with photo (passport, for example) at the check-in. For international travels from Brazil, if just one of the parents is traveling with the child, she/he must present – in addition to the child's certificate of birth and identity card with photo – a letter authorizing the trip signed by the other parent with a notarial certification of signature. In case the parents or the legal guardian, as applicable, cannot or are unwilling to give this authorization, a judicial authorization is required. People who intend to travel to Brazil with children must consult with the Brazilian consulate before traveling for more information. Reservations are required for massage services and spa treatments. Reservations can be made by contacting the resort prior to arrival, using the contact information on the booking confirmation. Children 2 years old and younger stay free when occupying the parent or guardian's room, using existing bedding.


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Sterling, Ballmer discuss possible Clippers deal: source
By Eric Kelsey
LOS ANGELES (Reuters) - Embattled Los Angeles Clippers owner Donald Sterling on Monday met with former Microsoft Corp Chief Executive Officer Steve Ballmer to discuss a possible settlement over Sterling's opposition to the $2 billion sale of the basketball team, a source close to the case said.
Ballmer met with Sterling for 90 minutes at the 80-year-old real estate billionaire' s request, but the talks did not resolve Sterling's opposition to the deal brokered by his estranged wife, the source said.
Sterling and his wife, Shelly Sterling, are locked in a court battle over whether Sterling has legal standing to block the NBA-record sale to Ballmer.
Ballmer's attorney Adam Streisand and Shelly Sterling's attorney Pierce O'Donnell also attended the meeting, the source said.
Messages left with representatives for Sterling seeking comment were not immediately returned.
The Sterlings' probate trial has entered its final phase and Donald Sterling's lawyers, who were scheduled to present their case on Monday, called off the day's hearing after less than an hour.
Sterling's case was dealt a significant blow last week when Los Angeles Superior Court Judge Michael Levanas refused to throw out testimony by physicians who said he has early Alzheimer's disease and cannot handle his business affairs.
The trial picks up on Tuesday with testimony from current Clippers interim CEO Richard Parsons, the former head of Time Warner Inc. Continued...


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Cwinnes avait besoin d'un nouveau design de logo et a lancé un concours sur 99designs.
Un gagnant a été sélectionné de 69 designs proposés par 28 designers freelance.
CWI Pool Service our current website is http://www.cwipools.com
We are a pool service cleaning company located in Los Angeles, CA. We are looking for a logo to be used on website, trucks, cards, flyers, t-shirts etc.
People who own pools.
I am leaving it up to you guys. I will provide a lot of feedback but really am not sure exactly what I'm looking for. Obviously we deal with water but its not a necessity.


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June 1, 2015, U.S. News
Senator Jon Kyl is quoted in this article on Lindsey Graham announcing that he will run for President:
"Adds former Arizona Sen. Jon Kyl, a friend of Graham's who is also advising and helping raise money for three other GOP candidates: "It's not to say some of the others don't have international affairs and national security credentials, but his are the best."
"His role in the campaign is very, very important, argues Kyl. "Even if he does not prevail, he's done an incredibly important favor for the country."


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Story Behind this Recipe
These are stir-fried udon noodles that you can make in no time for a quick lunch on a day off, or when you don't have much time to make dinner.
It's a really convenient dish that you can make in no time on a busy day, plus it has lots of vegetables.
It's also easy on your wallet so it's a great dish to have especially right before payday.


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The Seven ChairsMature
Okay, so before you read the story i just wanted to put in a little word about it's origins. Once again this is a piece of fiction that I've created for an English Language A-level assignment. We were told the story of a certain Harris Burdick, (you may have heard it yourself?) we were then shown a collection of pictures associated with him and asked to write a short story to correspond with it. In the short story we had to tell of what had happened before the events shown in-picture as well as the event itself and any preceding events. The picture I chose was dubbed "The Seven Chairs" and can be seen here
Being a bit of an atheist attending a Catholic Sixth-form college I couldn't resist this opportunity to stir things up a little bit, knowing that the Head of the college will read it.
A further note to anyone who maybe Catholic and reading this story... Please don't be offended. I don't mean to come across as ignorant to other people's beliefs. I have nothing but respect for people who stand firm to their faith. This is purely a work of fiction written in an attempt to turn a few scholastic, authoritative heads.
Continue on to the next chapter to read on.
Hope you enjoy it... and keep in mind that it's still a work-in-progress.
Peace out!


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Chapter 6Mature
Chapter 6
My alarm really scared me when it went off! So much that I made me bump my head on my shelf above my bed.
"Morning" Adam said to me walking in my door
"Morning" I groaned "Where are you off too?"
"I didn't know you had a job"
"I have had for quite a while now!"
"What do you do?"
"I'm a mechanic!"
"Wow, cool" I said surprised "See you later then!
"See you" Adam called back from the hall
When I got to school Frankie was leaning over a bench looking at pieces of paper
"What's all this?" I asked
"All the pictures of the dresses I like and can afford!"
"Oh great, Let me look" I said pushing her out of the way. I looked at all of them and all of them were Gorgeous.
"Which one's your favourite?" I asked. She pointed to this red silk one in the middle of all the papers.
"Oh Frankie that would look so gorgeous on you
"Well that's the one I reserved in stock!"
The bell went and I and Frankie went up to form were Toni was listening to her IPod as usual.
"Hiya" I said as I took out one earphone
"Oh, hey" She replied as she put her IPod away
"Have you got your Prom dress yet?" Frankie asked
"Yeah, I got it at the weekend!" She explained "And I look so hot in it!!!"
Toni is one of those girls that thinks that she looks fabulous in anything she wears, She won't go anywhere without her mobile, fake ID and her make-up. She has a model type face, and a body someone would kill for even though she hates her thighs (which I don't understand because she has gorgeous legs).
"Have you two got yours?" Toni asked looking at both of them
"I have" I proudly said
"I'm going to get mine today!" Frankie also said proudly
"Are you still going with Luke?" I asked
"Of course I am!" She said "I am going out with him aren't I?"
"Yes, of course" I replied
"Speak of the devil" Frankie said as she spotted Charlie, Eddie and Luke walking through the door.
"Morning Gorgeous" Luke swished at Toni putting his arms around her
"Morning" She replied Kissing him
"And morning to you" Eddie said as he pulled Frankie towards him
"And a very good morning it is" She replied kissing him
"Morning" I said to Charlie
"Hey" He said putting his arm round my waist
Charlie and I are the type of couple that don't go full on like Toni, Luke, Eddie and Frankie! We just like being around each other and acting couplish! Plus, I always get nervous, especially around other people.
"You guys looking forward to the prom then?" I asked
"Wearing a stupid penguin suit tux, no way but spending the night with you girls with way cool chaperones it's going to be brilliant!" Eddie replied while looking into Frankie's deep green eyes
"Then we're all heading out to the court for the rest of the night right?" I asked
The Court was a food court but it had a massive field behind it with swings n stuff but it also had a house on the outskirts of the grounds that us lot went to when we snuck out.
"Of course" Eddie replied pulling Frankie onto his lap
Luke wolf whistled at them
"Get a room" Charlie called out
"Maybe we should!" Eddie said to Frankie as the bell went
"Too bad!" Frankie smirked jumping off Eddie's lap and grabbing her bag
"Meet up at the pitch after last bell right?" Toni asked
"On the Stands!" Luke replied
"See ya then!" Charlie said to me
I walked over to Charlie, hugged him…went to kiss him then quickly turned to walk away, looked back and said
"See ya"
Everyone whistled at this and as soon as me, Frankie and Toni where out of the guys sight they pushed me against the wall
"Oh my god! What did I just do?" I squealed at Frankie
"You gave your guy the Tease!" Toni said turning me towards her
"What's the tease?" I asked
"The tease is going for it then suddenly stopping!" Frankie Butted in
"But I wasn't going for it!" I pleaded
"It looked like it!" Toni said as she started walking across the hall balcony
"It sure did Ror!" Frankie added following her
I ran after them and we went to French
After the last bell for the end of the day we went to the stands that overlooked the football pitch, luckily there was a pep-rally going on in the gym so all the sports guys were too pre-occupied to play that day.
We ate our lunch (Eddie was feeding jelly to Frankie and they started making out, Toni and Luke went off because Toni was actually a cheer leader but they wanted a quick make out session before she went to the pep rally to apparently give her 'more spirit'. So that just left me n Charlie and we went for a walk around the pitch.
We walked for ages, throwing stones at the flock of seagulls following us for food and talking about what we were going to do in the summer holidays
We were just walking (with me as usual staring at Charlie as he talked) and I felt a sudden rush come over me
"I like you" I suddenly Blurted out
Oh my god! What did I just do? Did I really just say that?
"I like you too" he replied calmly
"No, I mean I like, like you! You know what I mean!"
"No, really, I don't!" He smirked "Explain Ror!"
I lightly pushed him and he turned me to face him
"I know what you mean Ror! I really like you too"
"Yes!" he slightly shouted
"Ok, ok. I believe you!" I giggled "So, how long have you liked me for?" I asked going red
"I have liked you ever since we met!"
"We've only known each other for a year!"
"Why didn't you say anything before?"
"I don't know! I was just shy I guess!" He said going red too
I giggled at his shyness
"And what about you little missy! Why didn't you say anything?" He said elbowing me
"I was just as shy as you I guess!" I giggled going red again
"See! You can't giggle at me now can you?!" He smirked as he gave me a light push
We stopped walking and turned towards each other, Charlie smirked at me so I looked down at the ground which was grass with a white line right between us
"Look at me!" Charlie said to me picking up my chin to look into his eyes
"Yes?" I choked
"I really do like you, Ror!" He said in a very deep voice
When he talks to me seriously but lovingly in that deep sexy voice my knees weaken
"I really like you too!" I said in a slightly girly yet sexy voice turning my head away again
"So…what would you think of being my girlfriend?" he said shyly
"Is that an offer?!" I wittingly said
"I guess" he said turning away
"Then, I guess, I would like that!" I sexily whispered turning his face to mineThen we just started making out in the middle of the football pitch


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|Stainless steel
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Take Control of Your Peavey Vypyr!
The Peavey Sanpera 1 foot controller lets you take charge of your Peavey Vypyr amp onstage, in the studio, or at home! Giving you an expression pedal for controlling volume, wah, and pitch shifter functions, you also get four momentary feature selector buttons complete with LEDs for ultimate control. Boasting tap tempo capabilities, looper activation and control, as well as a convenient bank select function, the Sanpera I is housed in roadworthy cast-metal, with high-quality, reliable metal switches. For truly tapping into the performance possibilities of your Peavey Vypyr, the Sanpera 1 foot controller is a must-have!Peavey Sanpera I Foot Controller for Vypyr Amps at a Glance:
- Take command of your Vypyr amp
- Rugged design
The Sanpera I lets you remotely control your Peavey Vypyr amp, giving you incredible expression capabilities. As you conveniently tap in the tempo, or activate the looper, you can use the onboard expression pedal to thrill your bandmates with perfectly-timed volume swells, wah effects, and creative pitch-shifting!Rugged design
With its cast-metal housing, your Peavey Sanpera I is definitely roadworthy and built to last. Peavey used high-quality metal switches to ensure that this foot controller just keeps on working and working.Sanpera 1 Foot Controller for Vypyr Amps Features:
- Whammy / Volume / Wah / Pitch Shifter Gas Pedal
- Four momentary selector buttons with LEDs
- Tap on current channel for Tap Tempo
- Looper activation and control
- Bank select function
- Roadworthy cast-metal housing
- High quality metal switches
- Self-powered via MIDI
- Includes MIDI cable


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Joseph M Rodriguez Photographer
Carly PenelopeModel Female Portland, Oregon, US
My MM URL: http://www.modelmayhem.com/carlypenelope
Mayhem # 2881036
About MeMy name is Carly and I enjoy art of all kinds. I am interested in collaborating with photographers and artists to make beautiful things together, and to expand my portfolio. I am comfortable in a lot of settings, so if you are interested in setting up a shoot, contact me!
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