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Cropped Striped T-Shirt
Cropped Striped T-Shirt
NLST's Cropped Striped T-Shirt is a short fit luxe Japanese cotton. Color Navy/Cream.100% Cotton. Made in China. Shirt runs true to size. Ashley is wearing a size Small. Ashley is 5' 8", 35" Hip, 27" Waist.
Baby & Company
Since 1976, Baby & Company has lived by the mantra: life is a marathon not a sprint. The Seattle-based boutique is a proud member of the Slow Fashion movement where quality comes before quantity. The shop stocks up on its values with like-minded brands like Jesse Kamm, Ann Demeulemeester, Antoni & Alison, Lars Andersson and more. Clean lines and the simple, easy aesthetic found on their racks echo the 'less is often more' spirit of the brand.
Do you have questions about this product? We're here to help!


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Prices, promotions, styles, and availability may vary. Our local stores do not honor online pricing. Prices and availability of products and services are subject to change without notice. Errors will be corrected where discovered, and Lowe's reserves the right to revoke any stated offer and to correct any errors, inaccuracies or omissions including after an order has been submitted.
3M 4-Pack 4.1875-in W x 11.25-in L 180-Grit Commercial Drywall Sanding Screen Sandpaper
Item # 788467 Model # 9089P-4
Sanding Grit
Product Information
- Fine grit drywall sanding screen is made to fit most drywall sanding tools
- Made with a sharp silicon carbide mineral for long-lasting performance that can be rinsed and reused
- Designed for sanding drywall joints, patching compounds and plaster
- Use both sides of screen for long life
- Can be used on wood, metal, plastic and painted surfaces, either wet or dry
- Pre-cut for easy attachment to hand or pole sanders
- Rinse and re-use
- Features an open mesh cloth backing which reduces loading
|Sand Paper Type
|Drywall Sanding Screen
|Sanding Grade
|Sanding Grit
|Width (Inches)
|Length (Inches)
|Silicon carbide
|Package Quantity
|Series Name

subset: commoncrawl


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Have you of all time had problems next to your car? Sometime you in recent times can not brainstorm cause proximate to fix it for you. Your car may decide to die on you, once your friends are not circa. Life is not always simple. Sometime you only have to understand the bothersome motor vehicle difficulties by yourself. If you run into one of those situations, you will have to be your own automotive vehicle mechanic. Is that possible? Of course, it is researchable. Don't frenzy.
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Miss Alicia s Milton
Vienna, Virginia - United States
No approved endorsements
About Miss Alicia s Milton
I am a recruiter with iPlaceUSA and looking out for building relationships with people so that I can assist you with your job search or even just getting to know you. If you're ever interested to change jobs or interested in getting some more information about potential good opportunities for you, I would love to help you!
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Childminding information
Childminders provide opportunities for care, education and play in their own homes for children under 5 years and for school aged children. They are self-employed and negotiate terms and conditions directly with parents. A flexible service is usually provided all year round.
All childminders are required to register with the Care Inspectorate. Help (including financial help) is available to those interested.
Lists of names and addresses of registered childminders are available from Schools, Learning and Education, 7-13 Wolfcraig, Dumbarton Road, Stirling FK8 2LQ, tel: 01786 233179.
More information is available from the Scottish Family Information Service.


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BigOven Pro required (try it free)
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Evaporated Milk Substitute
How to Make Evaporated Milk
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text:
The name Runamuck has been applied to several different Transformers characters.
- Runamuck the white Decepticon Battlecharger from Generation One.
- Runamuck the Decepticon street racer from the Cybertron portion of the Unicron Trilogy.
Runamuck should not be confused with
- Runabout, the black Decepticon Battlecharger from Generation One, who was the visual inspiration for Cybertron Runamuck and partner in crime for his Generation One incarnation.
This is a disambiguation page: a list of articles associated with the same title. If an internal link referred you to this page, you may wish to change the link to point directly to the intended article.


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JACKSON — Chef Jesse Houston and his wife, Rachel Horn Houston, have unveiled plans to open Saltine this fall in Jackson. The 100-seat oyster bar, to be located in the former Duling School building in Fondren, will focus on Southern cuisine highlighting fresh seafood and seasonal vegetables to share. Open for lunch and dinner Tuesday through Sunday, the 3,000-square-foot casual ...Read More »
Home » Tag Archives: Parlor Market
Tag Archives: Parlor Market
Dining Out Spotlight: Parlor Market, Jackson
There is a reason for everything at the PM From the owner to the hostess stand and from the floors to the bar, nearly everything in Parlor Market tells a story. Owner Craig Noone got his start at the Palace Casino Resort on the coast after graduating from the Texas Culinary Academy. He then moved to Italy where he obtained ...Read More »


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Reviews - The Royal Breakwater2
Castletown, Portland, DT5 1BD
Customer Reviews
Our reviews are from genuine LateRooms.com customers. We verify that the customer has stayed before leaving a review.
Very Good
79% would recommend it to a friend
Customer service
Food quality
Room quality
The Royal Breakwater
Comfortable and value for money.
Family getaway, good value
My wife, 2 children and I stayed at the Royal Breakwater for one night during a quick tour of the south west.
The hotel is situated in rundown back street, but don't let this put you off. There is no parking area, but free roadside parking was always available and there is a paid car park across the road. Portland Castle is a short stroll up the street, and other attractions including Portland Bill area short drive away. Although basic, the room was comfortable and tidy with four proper beds. The hotel is a little tired, but is clean throughout and has a separate breakfast room. It has a busy pub area, but noise from that was limited. We ate an evening meal in the pub area, which was well cooked and freshly made prepared and good value for money. The morning breakfast which is included was again well cooked was adequate, I paid the £1 surcharge to upgrade to large. The hotel staff we met were very friendly. So all in all, a comfortable nights stay
Read More Less
Brilliant break
Great place to stay, breakfast good value for money, plenty of tea and coffee in the room.
Good location to use as a Base for exploring Dorset. Would definitely stay here again.
Read More Less
Parking was easy on this run down street in a shipping port.
The check in staff were busy also running the bar and serving food, so we're unable to provide the missing toilet roll in the shared toilet for hours after my initial complaint. In the room the floor hadn't been vacuumed and the room was tired and basic, but beds were clean and comfortable, bedding well worn but acceptable. Towels, just one each, were clean, with a daily sachet of shower gel per person. There was a choice of same sex shower blocks, one dated and tatty and the other more modern but so cramped with nowhere really to put things, and nowhere private to dress that wasn't wet, both were clean and hot. There were a few disruptive noises during the night but bearable, the curtains let a lot of light through so I woke at 4.30am sun rise, unable to get back to sleep so used my own eye mask for the second night. The free WiFi rarely connected. There were tea and coffee sachets and a kettle in the room. At breakfast coffee was only instant and the "fry up" was perfectly cooked and not at all greasy. I would never return even if you paid me, this hotel seemed to be a sailor's doss house, fine if you are a group of men in the area for work and just need somewhere to put your head. We felt an impending doom when we returned for our second night, that we had to pay up front for, and if our budget and circumstances had allowed would have definitely gone elsewhere.
Read More Less
Very poor accommodation
Whilst we appreciate that this is a Victorian building, unfortunately cleanliness was not of a very good standard.
En suite facilities are little more than a broom cupboard and were unable to close the "bathroom" door to use the loo, room and beds were damp, bedding none too fresh, no wardrobe so we left our clothes draped over the back of a chair which unfortunately were also damp the following morning. There is no separate restaurant and evening meal was taken in what I can only describe as a working mans bar. Breakfast is served in a separate room but unfortunately plastic tablecloths don't quite work for me.
Read More Less
Response from hotel
Dear Mr Knight
We are very sorry that you didnt enjoy your stay with us, we are confused
as to why you didnt let a member of staff know the concerns you had? We
will look into the bathroom door not closing, we haven't had any
information previously that there was a problem.
We dont understand the damp you mention, all of our rooms are aired
regularily and our girls do a very good job of cleaning the rooms, we also
use an outside firm to clean and return our bed linen several times a week,
the linen is changed as soon as a guest leaves.
We have adjusted some of the rooms to accomodate bathroom facilities,
however, as you rightly point out the building is victorian and is grade 2
listed, so adjustments here are limited.
We are a budget hotel and inclusive of our low prices is a full english
breakfast, again we are sorry you didnt enjoy your visit with us.
Kind regards
Assistant manager
short break
Although a little basic the rooms were clean and tidy , breakfast very good and the bar came in very handy after our journey out in the evening .
The owners are obviously trying to update the place and are carring out needed improvements
Read More Less
good value and convenient for the sailing club
Bit strange using a room key and sharing a bathroom but it was all fine.
Friendly staff a bit overstretched at times but all worked out fine. Breakfasts are great. For a walker close to loads of fun. Beware the dinner portion sizes are enormous which is fantastic after walking all weekend. Over a pub - need i say more. Never found a space for free street parking outside but always away by 8am so car park over the rd was fine. I would definitely stay there again.
Read More Less
Good Value for Basic Accommodation
Very simple accommodation - the decor is quite dated and the facilities (tea making, TV and shower) are very basic but fair for the price you are paying.
The room was clean, the staff are very friendly and helpful, and the building itself is charming, if a little on the shabby side. Absolutely fine for a short stay, and it was great to be on Portland island itself. Only disappointment was that I couldn't get Wi-Fi in my room when the hotel advertises free Wi-Fi in all rooms, and I ended up having to use mobile data which - given the signal was quite poor - was frustrating.
Read More Less
Excellent value and fabulous home cooked food
It's like going back in a time warp, fabulous experience.
Very clean . You try the lasagne it's excellent.
Read More Less
Slept well..but morning was not so pleasant!
The bed was very comfy and room spacious but in need of a touch up on the decor.
It was quiet at night and we slept well but were woken by other guests waking up at 7.30 as the doors were not soundproof at all. The shower was hopeless- erratic temperature and so you were very cold or far too hot.
The breakfast was a full English- alright but pretty greasy and nothing healthy offered at all which was a shame.
In terms of customer service I had emailed the hotel before I stayed and they hadn't replied which was frustrating, they were helpful enough on the day but there was no information in the room so it was all down to asking the right questions when you check in. For one night it was cheap and comfy..but waking up was very hard with loud people, poor shower and disappointing breakfast.
Read More Less
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(according to the 2014/15 DLHE survey)
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We'll support you every step of the way, from help with visas and the English language to making sure you feel safe and happy as you study with us.
For immigration and visa advice, please contact the International Admissions, Immigration and Engagement Manager.
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Find out if you're eligible for fee waivers, bursaries and scholarships or speak to a Student Support and Wellbeing Adviser.
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University Switchboard:+44 (0)1227 767700
Admissions Enquiry Team: +44 (0)1227 782900
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text: I'm here again to continue working! Often Bleach sex characters go displeased with their dull filming job and they are waiting impatiently for the day off to begin with sex act! It was a usual day of having sex with a sweet Rukia Kuchiki for a superhero and after that they become wild and crazy couple.


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ResourcesPER Pulse™ Recap
The Advances in Targeted Therapies series is an online CME activity that includes expert interviews accompanied by a series of clinical vignettes focusing on non-small cell lung cancer (NSCLC), breast cancer, and colorectal cancer.
Medical Writer: Kim Farina, PhD
Module 2: Breast Cancer
Advances in Targeted Therapies: Metastatic Breast Cancer
Ado-Trastuzumab Emtansine for Relapsed HER2+ Metastatic Breast Cancer
In the following interviews, Drs. Kimberly Blackwell and Sunil Vera review some of the clinical implications of emerging data on the safety and efficacy of ado-trastuzumab emtansine for HER2-positive (HER2+) metastatic breast cancer (MBC).
Ado-trastuzumab emtansine (T-DM1), a conjugate of the anti-HER2 monoclonal antibody trastuzumab and the microtubule inhibitor DM1, was approved by the FDA in February 2013 for treatment of patients with HER2+ MBC who have already received a taxane and trastuzumab. Approval was based on the results of the pivotal phase III EMILIA trial. In EMILIA, 991 patients with advanced breast cancer who had progressed after receiving a taxane and trastuzumab were randomized to receive T-DM1 (T) or capecitabine/lapatinib (C+L). Compared with capecitabine/lapatinib, T-DM1 improved median overall survival (OS; T, 30.9 months vs C+L, 25.1 months; P <.001) and median progression-free survival (PFS; T, 9.6 months, vs C+L, 6.4 months; P <.001). Dr. Blackwell noted that this was a groundbreaking advance in the treatment of HER2+ MBC, and the first time an antibody-drug conjugate was proven effective in solid tumors.
In terms of the safety of T-DM1, Dr. Vera remarked, "What is great about this drug is the toxicity profile; patients don't lose their hair, there is no nausea/vomiting, there is no diarrhea, no risk of infection, and no febrile neutropenia." In EMILIA, the toxicity profile of T-DM1 was superior to capecitabine/lapatinib. Dr. Vera cautioned, "It is important to keep an eye on liver function and the platelets and monitor doses accordingly." Based on the risk of thrombocytopenia and elevated liver enzymes (both occurring in fewer than 10% of patients) with T-DM1, these are key toxicities to monitor. There have been reports of severe liver injury, and in rare cases, neuropathy or pneumonitis (1%) may develop. It is recommended that treatment with T-DM1 be discontinued if pneumonitis occurs.
Primary results from the phase III TH3RESA trial presented at the 2013 European Society for Medical Oncology meeting and published ahead of print in May 2014 suggest that third-line T-DM1 is superior to chemotherapy and trastuzumab. TH3RESA enrolled 602 patients to compare T-DM1 with physician's treatment of choice (approximately 80% trastuzumab-containing regimens) for MBC or unresectable locally advanced, recurrent, HER2+ breast cancer after treatment with a taxane, trastuzumab, and lapatinib. Early data in this trial showed a strong trend for improvement in PFS and OS, with fewer grade 3/4 adverse events for patients who received T-DM1 therapy.
Dr. Blackwell referred to data from a large phase II study (N = 137) that demonstrated superiority of T-DM1 over trastuzumab plus docetaxel for HER2+ MBC or recurrent, locally advanced breast cancer. She summarized that the positive results from these three studies support the use of T-DM1 over taxane/trastuzumab-based regimens, chemotherapy/trastuzumab-based regimens, and capecitabine plus lapatinib.
Clinical Guidance
Dr. Blackwell typically uses T-DM1 in accordance with its US indication (ie, patients who have received prior therapy with a taxane and trastuzumab), which limits its use to the second- and third-line settings. T-DM1 is Dr. Verma's first choice for second-line therapy after first-line therapy with trastuzumab. He prescribes it as first-line therapy for patients who have relapsed within 6 months of adjuvant trastuzumab therapy.
Dr. Blackwell does not recommend initiating T-DM1 if any uncertainty exists about HER2 status. She cited an approximate 10% to 15% discrepancy in HER2 findings to support retesting prior to the initiation of T-DM1. She cautioned, "If there is any lack of clarity about HER2 expression in metastatic breast cancer or HER2 amplification, I would certainly recommend that people determine the HER2 status of the tumor that the patient is facing prior to initiating T-DM1."
T-DM1 for Central Nervous System Metastasis
The EMILIA trial allowed enrollment of patients with asymptomatic stable central nervous system (CNS) metastases and no history of radiation treatment or steroid use within 2 months of randomization. Data from a retrospective subgroup analysis that were presented at the 2013 San Antonio Breast Cancer Symposium (SABCS) suggest that T-DM1 activity is independent of whether patients are facing brain metastases. "This was important data because we have prior data that lapatinib might be active in CNS metastases," explained Dr. Blackwell. In this analysis, rates of CNS metastases among patients without CNS involvement at baseline were the same in the T-DM1 and capecitabine/lapatinib arms. Likewise, no differences in CNS progression were observed among patients with CNS metastases at baseline. It is unknown whether T-DM1 can prevent brain metastases.
Neoadjuvant Therapy with Dual HER2 Blockade for HER2+ Breast Cancer
Drs. Blackwell and Vera discussed the use of dual HER2 antibody therapy in the neoadjuvant setting for HER2+ breast cancer, including the approval of pertuzumab, validity of pathologic complete response (pCR) as a surrogate endpoint, and implications for referral patterns.
One of the most exciting developments in the field of targeted therapy, according to Dr. Blackwell, was the September 2013 approval of pertuzumab in combination with docetaxel and trastuzumab as neoadjuvant therapy for HER2-driven, locally advanced, inflammatory, or early-stage breast cancer (>2 cm in diameter or node-positive). First-line activity of pertuzumab for MBC had already been demonstrated in the CLEOPATRA trial. Approval for the neoadjuvant indication was based on results from the phase II NeoSphere trial (N = 417), demonstrating significantly higher pCR rates with docetaxel/pertuzumab/trastuzumab compared with docetaxel /trastuzumab (46% vs 29%; P = .0141). TRYPHAENA was a second phase II trial that evaluated the addition of an anthracycline or carboplatin to neoadjuvant docetaxel/trastuzumab/pertuzumab for patients with operable, locally advanced, or inflammatory breast cancer (N = 225). The 57% to 66% pCR rates seen with pertuzumab in TRYPHAENA further supported its approval in the neoadjuvant setting.
pCR as a Surrogate Marker of Benefit
pCR is a surrogate marker presumed to be predictive of long-term benefits. A recent meta-analysis suggested that pCR correlates with event-free survival (EFS) and OS, especially in hormone receptor–negative (HR-), HER2+ patients. According to Dr. Blackwell, the near doubling of pCR with pertuzumab is very meaningful for patients who are eligible for neoadjuvant treatment. "It makes the surgeon's job easier and, hopefully, it decreases the risk of positive margins," she remarked. Dr. Verma noted lingering uncertainties regarding the benefits of pertuzumab after surgery or which chemotherapy regimen to use for better response. He explained that the NeoSphere and TRYPHAENA studies evaluated a limited number of patients, and the lack of long-term safety data continues to leaves questions unanswered. In the absence of long-term data, it is uncertain whether response benefits will translate into improvements in PFS or OS. Nonetheless, the higher response rates suggest benefits to patients in the neoadjuvant arena.
"One of the biggest unanswered questions in my mind is should pertuzumab be considered for all HER2+ tumors larger than 2 cm, or should it be restricted to node-positive patients only or locally advanced breast cancer patients," said Dr. Verma. He recommended that clinicians include toxicities and benefits of pCR and long-term effects when discussing treatment options with their patients. He also advised that if a neoadjuvant strategy is implemented, physicians should involve a multidisciplinary team early in and throughout the process. A significant response is anticipated in many of the tumors, with a potential pCR rate >60%. Therefore, he emphasized, frequent monitoring and early involvement of radiologists, radiation oncologists, and surgical oncologists is imperative.
Clinical Guidance
The approval of pertuzumab marked the first approval by the FDA of a novel targeted agent for neoadjuvant treatment of HER2+ breast cancer. "I would hope that this will continue to be an exciting platform to get drugs available to patients who really need them in the curable setting, faster," said Dr. Blackwell. She considers the neoadjuvant approval an exciting development for all solid tumors, not just for breast cancer, and predicted that it will shift the types of patients seen by medical oncologists. As a result, Dr. Blackwell emphasized the need for discussions between medical oncologists and the surgical community to raise awareness that pertuzumab use is limited to the neoadjuvant arena. "I have communicated to my referring surgeons that I would like to see these patients before definitive surgery because that is a setting where we can offer pertuzumab layered on top of trastuzumab and chemotherapy," said Dr. Blackwell. "If we see the patients postop, the recent approval will not allow us to use pertuzumab in that setting."
Data presented at 2013 SABCS confirmed that HER2+ patients (including those with stage 1 disease) achieve high PFS and OS rates when treated with chemotherapy and trastuzumab. Available evidence also suggests that trastuzumab significantly reduced the recurrence of HER2-driven breast cancer. Accordingly, for nearly all HER2+ patients without other comorbidities, regardless of tumor size, Dr. Blackwell routinely offers a chemotherapy/trastuzumab-based regimen. "If I am offering chemotherapy and trastuzumab to most patients, whether it be in the neoadjuvant or adjuvant setting, my preference now will be to see these patients in the neoadjuvant setting so I can offer them the dual therapy of pertuzumab and trastuzumab in the setting of taxane-based neoadjuvant therapy," said Dr. Blackwell. She explained that with the closure of the large APHINITY trial of pertuzumab in the adjuvant setting, no current option for adjuvant pertuzumab therapy exists. For that reason, she advises medical oncologists to educate their colleagues on practicing early referrals of patients who are eligible for neoadjuvant treatment with pertuzumab. In summary, she said, "This has been an exciting year for pertuzumab, and an exciting year in the curable setting for women facing HER2+ breast cancer because physicians can now offer a double antibody approach that has been shown to be efficacious, with very limited toxicity."
Adjuvant Trastuzumab for Stage I HER2+ Breast Cancer
Drs. Blackwell and Vera discussed the use of adjuvant trastuzumab for early-stage HER2+ breast cancer and managing cardiac concerns and toxicities with trastuzumab use.
To date, close to eight to ten years of follow-up data are available from various adjuvant studies with trastuzumab for breast cancer, demonstrating improvements in OS and disease-free survival (DFS). Several known options are currently available, but concurrent anthracyclines followed by docetaxel/trastuzumab or nonanthracycline approaches with docetaxel/carboplatin/trastuzumab are generally accepted in practice.
Dr. Vera predicted that results from the phase II APT trial, presented at the 2013 SABCS by Dr. Sara Tolaney, are likely to impact practice. APT evaluated paclitaxel/trastuzumab for patients with HER2+, node-negative, <3-cm breast cancer (N = 406). At a median follow-up of 3.6 years, a DFS rate of 98.7% (P <.0001) was reported for patients who received paclitaxel/trastuzumab followed by trastuzumab for 1 year. Additionally, few recurrences or deaths were observed (2.5%). Of the 406 patients enrolled, 10 experienced disease recurrence or death. Some of the recurrences were contralateral breast cancer; 2 or 3 patients developed distant disease progression. Despite the limitations of its nonrandomized phase II design, the results of the APT trial were striking. In his own clinical practice, Dr. Vera considers paclitaxel/trastuzumab to be an effective regimen for patients with T1 tumors, and possibly tumors 2 cm to 3 cm.
Risk of Cardiotoxicity in Older Patients with HER2+ Breast Cancer
For the past decade, trastuzumab has been known to induce cardiac toxicity (left ventricular ejection fraction [LVEF] decline and congestive heart failure [CHF]) in all patients independent of age. Use of trastuzumab in combination with anthracyclines is generally avoided for first-line MBC therapy because the rate of clinically symptomatic CHF associated with this combination (16%) exceeds safety rates generally accepted by medical experts.
Two databases were introduced within the last year in the published literature, which suggest that age could be a risk factor for cardiac toxicity. Retrospective analysis of the SEER-Medicare and Texas Cancer Registry-Medicare databases evaluated cardiac toxicity of trastuzumab in older patients (N = 9535; median age, 71 years). Patients over the age of 66 years, and specifically over the age of 75 years, who received trastuzumab in the adjuvant setting were at significantly greater risk of CHF.
Clinical Guidance
In light of these data, Dr. Vera would consider carboplatin/docetaxel/trastuzumab (TCH) or paclitaxel/trastuzumab (AC-TH) in older populations who have T1/T2 node-negative tumors, with selection being patient- and toxicity assessment–dependent. For node-positive tumors, he considers anthracyclines followed by taxane/trastuzumab (the BCIRG 006 trial showed DFS rates of 84% for AC-TH and 81% for TCH), but he tends to use docetaxel/carboplatin/trastuzumab, or now, paclitaxel/trastuzumab, when there are cardiac concerns.
Dr. Blackwell reviewed other risk factors that have been identified from adjuvant trastuzumab studies, including the use of antihypertensives, a borderline LVEF, and previous cardiac history. She recommends careful evaluation of these risk factors at baseline prior to initiation of therapy with trastuzumab. Trastuzumab should not be utilized when a lower-than-normal LVEF is detected unless a full disclosure of the risks and benefits to the patient has taken place.
Strategies to minimize cardiac toxicity should be adopted, such as routinely following the recommended cardiac monitoring for patients at high risk of cardiac toxicity included on approved trastuzumab labeling and temporarily withholding trastuzumab when a decline in the LVEF is observed. Patients can be rechallenged with trastuzumab after regaining normal LVEF on repeat assessments. Several options exist today for the assessment of LVEF, including cardiac echocardiogram, cardiac radionuclide imaging such as a multigated acquisition (MUGA) scan, and the use of cardiac MRI, that produce accurate information about LVEF. One should bear in mind, however, when conducting a LVEF study, that results can be affected by a number of factors such as tachycardia and high blood pressure (often observed in patients experiencing white coat/anxiety hypertension). In summary, Dr. Blackwell stressed the importance of weighing the benefits in addition to the risks of trastuzumab, examining patients thoroughly to identify potential risk factors, and adhering to package guidelines for careful and frequent cardiac monitoring of the patient.
Clinical Vignettes
Case 1: HER2+ Metastatic Breast Cancer
A patient presents with recurrent HER2+ MBC. She was originally treated with a trastuzumab-containing regimen in the adjuvant setting, with a disease-free interval of 2 years before relapsing. What would you recommend as first-line therapy at this point? What factors would influence your decision?
Drs. Blackwell and Verma recommended taxane/trastuzumab/pertuzumab as first-line treatment for this patient with HER2+ MBC. Patient preference, underlying disease burden, HR and HER2 status, and prior therapy are essential factors to consider when contemplating the treatment approach. Assuming that patient had HR-negative disease and had received anthracylines/taxanes and trastuzumab in an adjuvant setting, taxane/trastuzumab/pertuzumab could be considered. Dr. Verma tends to use weekly paclitaxel at a dosage of 80 mg/m2. He has found that regimen to be well tolerated and to have a lower risk of febrile neutropenia compared with docetaxel. In her practice, Dr. Blackwell also uses weekly paclitaxel with pertuzumab/trastuzumab for patients who have received adjuvant docetaxel. For patients who have received adjuvant paclitaxel, she uses the same regimen, but with docetaxel.
This combination usually requires a growth factor support, given the high incidence of febrile neutropenia with single-agent, every-2-week docetaxel. Dr. Blackwell typically does not give docetaxel on a weekly schedule, limiting options to a chemotherapy backbone of weekly paclitaxel or every-3-week dosing of docetaxel. Patient preference plays a major role in treatment selection; many women have received adjuvant taxanes and are familiar with their side effects. Being attentive to each patient's concerns about taking chemotherapy is a key element of care.
For patients with HR+ status and low disease burden (eg, bone-only metastases), Dr. Verma explained that data suggest an aromatase inhibitor (AI) and trastuzumab approach. However, the limitation of pertuzumab to the first-line setting may come into play and point toward giving pertuzumab along with a taxane and trastuzumab. "If it is allowed, then for those patients who are HR+ one could consider an AI with trastuzumab, and then upon progression select a pertuzumab-based regimen for some of those select patients," said Dr. Vera.
Dr. Blackwell agreed that for estrogen receptor–positive (ER+) disease, especially involving the bone, where a patient wants to avoid chemotherapy, she would consider an optimal endocrine agent (eg, ovarian shutdown in premenopausal woman or an AI in postmenopausal woman) if it could be sequenced and appropriately covered. In her practice, lapatinib plays an important role in this area. She explained that, in a subgroup of patients in a phase III randomized study, the data for lapatinib and letrozole suggested that those drugs can be combined. She considers lapatinib/letrozole/trastuzumab when appropriate coverage can be obtained.
Case 1 (cont'd)
The patient receives treatment with trastuzumab/pertuzumab/docetaxel and experiences a partial response. After 20 months, she progresses. At this point, what treatment would you recommend?
Dr. Blackwell remarked that these cases are not always straightforward, but started off by recommending evaluation of docetaxel-associated toxicities. If, for this patient, docetaxel was discontinued after the standard six cycles, a meaningful response had been reached, and the patient remained on the double-antibody pertuzumab/trastuzumab combination, that would suggest to Dr. Blackwell that her tumor was very HER2-driven. Based on the favorable therapeutic index and survival benefit of T-DM1, Dr. Blackwell considers this her "go to" agent in the second-line setting for patients who experienced a meaningful benefit from combination pertuzumab/trastuzumab.
Dr. Verma concurred; his clinical team would most likely discontinue docetaxel and continue with the double-antibody pertuzumab/trastuzumab. This is consistent with data from the CLEOPATRA trial, where a PFS of 18.5 months was observed. However, the EMILIA trial enrolled just a few patients who had received prior therapy with pertuzumab. The study compared T-DM1 to capecitabine and lapatinib. Even with limited prospective data on the effects of T-DM1, the general perception is that T-DM1 would still be effective in this patient population as the next treatment of choice in a second-line setting.
Case 2: HER2+ Early-Stage Breast Cancer
This patient presents with a 3-cm, HER2+, early-stage breast cancer. What strategy would you recommend? What factors would influence your recommendation?
Dr. Verma described two schools of thought that should factor into treatment options for HER2+ early-stage breast cancer. The first is the utility of neoadjuvant pertuzumab/trastuzumab with a chemotherapy backbone for eligible patients. The addition of pertuzumab potentially leads to an approximately 20% higher pCR rate than chemotherapy plus trastuzumab alone. It is unknown whether improved pCR is indicative of EFS or OS, but data shared at 2013 SABCS indicated that an increase in pCR rate correlated with long-term EFS. The second is the recent report of nearly 99% DFS among patients with tumors larger than 3 cm who received trastuzumab therapy after 12 weeks of weekly paclitaxel/trastuzumab. Dr. Verma offers his patients with HER2+ early-stage breast cancer neoadjuvant therapy so that they are eligible for clinical trials under way evaluating T-DM1 versus trastuzumab in patients with residual disease at the time of surgery and after completion of neoadjuvant therapy.
Alternatively, in the United States, patients with larger tumors or locally advanced disease may be offered docetaxel/trastuzumab/pertuzumab (NeoSphere trial). For patients presenting with smaller tumors of 2 cm or smaller, data suggest that paclitaxel/trastuzumab is sufficient for treatment. In summary, Dr. Verma suggests paclitaxel/trastuzumab for patients with T1 tumors, but neoadjuvant pertuzumab/trastuzumab with chemotherapy for patients with locally advanced or large tumors (≥T3). Decisions for the "in between" patients should be made in consultation with the patient and a multidisciplinary team.
Dr. Blackwell also steers patients with confirmed HER2-driven breast cancer toward neoadjuvant treatment, based on coverage of pertuzumab and the 2013 approval for its use in combination with trastuzumab in the neoadjuvant setting. She does not adhere to a particular tumor size cutoff for incorporation of pertuzumab; she even offers it to clinically node-negative patients. Even with limited data in smaller tumors, there is consensus among regulatory authorities and researchers that pertuzumab offers benefits when given in a neoadjuvant setting, with a fairly low toxicity. Dr. Blackwell tends to incorporate neoadjuvant pertuzumab/trastuzumab and include, at minimum, a docetaxel regimen. Alternatively docetaxel/carboplatin may be used, per the National Comprehensive Cancer Network (NCCN) guidelines. In some cases, doxorubicin is incorporated. In smaller tumors, Dr. Blackwell advises against a doxorubicin/taxane backbone, and recommends docetaxel or docetaxel plus carboplatin/pertuzumab/trastuzumab per the NCCN guidelines. The dilemma is that in the absence of clinical trials, it is difficult to administer pertuzumab to patients who have received definitive surgery. Dr. Blackwell explained, "At least in my geographic area, we are having to have active discussions with the surgical teams to say if you do see patients with these types of tumors, please refer them to us because this is our time to provide them with a double-antibody combination therapy." Dr. Verma agreed.
Dr. Verma added that another consideration for these patients would be their HR status. Data suggest that when compared with HR+/HER2+ patients, HR-/HER2+ patients are much more likely to have pCR, and the pCR is more likely to correlate with EFS. "At least in our group, there has been some discussion that those patients who are HR-/HER2+, given the higher likelihood of pCR, that even in the smaller tumors we are more likely to offer them neoadjuvant therapy than the HR+/HER2+ tumors," he explained.
Case 3: Triple-Negative Metastatic Breast Cancer
This patient is a 42-year-old woman who was originally treated for triple-negative, early-stage breast cancer (TNBC) with surgery followed by adjuvant therapy with doxorubicin/cyclophosphamide followed by paclitaxel. After a disease-free interval of 1 year, she recurs with metastatic disease. What would you recommend at this point? Would you recommend incorporation of a platinum in her first-line regimen, or reserve this for later? Would you rechallenge with a taxane? Single agent or combo regimen?
For this case, Drs. Blackwell and Verma strongly recommend clinical trial participation and genetic susceptibility testing. Dr. Blackwell believes that it is the best option for this patient with aggressive breast cancer with a chemorefractory time course. They also recommend evaluation of BRCA1 and BRCA2 mutation status for this and all patients under age 50 years who present with TNBC. There are many clinical trials for first-line, recurrent, or metastatic TNBC, including evaluation of a PARP inhibitor alone or with a chemotherapy backbone. In young patients, trials with immunotherapy plus chemotherapy may be of value, as clinicians have realized that TNBC mimics difficult-to-treat carcinomas such as ovarian cancer or non-small cell lung cancer.
If a clinical trial is not an option, platinum-based therapy may be considered. Based on the history of sustained and rapid response to platinum-based chemotherapy, these agents are recommended as first-line therapy for high-burden and symptomatic-disease patients. Dr. Verma tends to use platinum-based therapy early in the course of treatment for these patients. In a cohort being followed at his institution, excellent responses to platinum chemotherapy have been observed; he tends to use cisplatin or carboplatin, along with gemcitabine.
For patients who have experienced a short disease-free interval and are relapsing, Dr. Verma recommends capecitabine as a good option. In the setting of low-burden disease, he considers single-agent capecitabine a good choice to gauge response sensitivity. For high-burden symptomatic disease, he recommends a platinum-doublet regimen instead.
Assuming that the BRCA status testing was negative for deleterious mutations, Dr. Blackwell would consider a well-supervised course of single-agent capecitabine based on its favorable tolerability when managed correctly. She explained that the capecitabine approach would partly ensure absence of capecitabine sensitivities before initiation of therapy with platinum chemotherapy. Additionally, both doctors agreed that IV chemotherapy and the significant toxicities that go along with it are not attractive to patients who did not respond to previous adjuvant chemotherapy and that patients may be reluctant to return to the same chemotherapy regimen or approach with which they experienced recurrence.
Dr. Blackwell added that some of the doublet combinations such as gemcitabine/platinum should be considered for patients with a heavy symptomatic burden of disease, due to the longer onset of action seen with antimetabolites (eg, capecitabine). Alternatively, ixabepilone/capecitabine can be given. She bases recommendation of this regimen on it being one of the few regimens studied in this defined population of rapid relapsers who had received an adjuvant taxane within 1 year and that the approval population for ixabepilone/capecitabine was particularly similar to this patient's characteristics. She acknowledged that this regimen was superior in the first-line setting when added to bevacizumab, with either standard paclitaxel or weekly nanoparticle albumin-bound paclitaxel. "So, there is data to support that this combination is beneficial above capecitabine with added toxicity as a first-line setting, saving the platinums as a second-line," she concluded. "In particular, with ixabepilone/capecitabine, if you get a meaningful response, you have the option of dropping out one of the doublet agents."
Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
This activity is not approved for AMA PRA Category 1 Credit™.
This activity is supported by educational grants from Boehringer Ingelheim and Genentech.


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With Windows 8 approaching a year in stores and Windows 8.1 release dates out, it's a good time to see how Microsoft's touch-centric OS has done. In particular, we wanted to talk about how Windows 8 has taken shape over the past year and the kind of reception it has got from customers.
The new Start Screen, the lack of a Start button and the constant back-and-forth between the desktop and the Start Screen have made Windows users a complaining bunch. Microsoft's radical ideas for the OS means public opinion on Windows 8 is polarised. Many customers prefer to downgrade to Windows 7 or XP instead of using Windows 8. The learning curve on the OS is quite steep for those who have only just started using Windows. The lack of affordable notebooks and touch systems is also one reason Windows 8 has not gathered as much pace as XP or Windows 7. What does the future hold for Windows? You may have seen some of our older Round Tables, but here's our first ever video Round Table:
We also touched upon the subject of privacy and email security. What do you think about Google's latest statement on Gmail privacy? Do send us your comments and also keep an eye out for more Round Tables in the future.
Publish date: August 17, 2013 3:01 pm| Modified date: January 7, 2014 11:54 am
Microsoft Windows 8, Windows 8, Windows 8 market share, Windows 8 sales, Windows 8 vs Windows 7, Windows 8.1


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This article is a stub, an article too short to provide more than rudimentary information about a subject. You can help Pro Wrestling Wiki by expanding it.
Maik Tuga is a Portuguese professional wrestler. He is best known for his current work for Swiss Championship Wrestling where he is a former SCW Lightweight Champion.
Maik Tuga trained in January 2010 and was trained by the SCW Hall of Famer Air 2 Style. He furthered his training under the expertise of Britani Knight and Sweet Saraya while in France and England. He states his role wrestling models include Steve Austin, Shawn Michaels, Dolph Ziggler and Triple H and Eddie Guerrero.


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Astragalus Membranaceus for Brain Edema Induced by Hemorrhagic Stroke
- Full Text View
- Tabular View
- No Study Results Posted
- Disclaimer
- How to Read a Study Record
Astragalus membranaceus (AM) is used to treat stroke for a long period, and a number of studies have known that AM can reduce cerebral infarction area and has anti-oxidation. Hemorrhagic stroke will induce secondary peri-blood clot edema and that may increase intracranial pressure to exacerbate clinical symptom. Therefore, the purpose of the present study was to investigate the effect of AM on hemorrhagic stroke edema. The investigators selected 80 hemorrhagic stroke patients , and who the stroke is first attack, they were randomly divided into control and experimental groups, and each group was 40 patients as follows: 1) control group, accepted AM placebo 2.8 g three times per day (tid) treatment for continuously 14 days from second day of admission or operation, except standard ordinary treatment; 2) experimental group, accepted AM 2.8 g tid treatment for continuously 14 days from second day of admission or operation, except standard ordinary treatment. Computer tomography (CT) examination was done at first day, 4th day and 7th day of admission, respectively. The ratio of brain edema was calculated by CT image, and inflammatory index including the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR),Creatine Kinase BB Isoenzyme (CMBB). D-dimer from venous blood also were measured. In addition, the score including Glasgow outcome scale (GOS), Modified rankin scale (MRS), Function independence measure (FIM), Barthel index (BI) was recorded one week, four weeks and 12 weeks after admission or surgical operation, as an index for clinical symptoms. The index for the therapeutic effect of AM was according to above-mentioned the ratio of brain edema, inflammatory index and clinical symptoms.
The investigators expected the results of the present study may provide a scientific evidence for the hemorrhagic stroke edema treatment of AM, thus, the present study may contribute to use the method of integrated Chinese and Western Medicine for the treatment of stroke, and to the research of Chinese Medicine.
|Stroke Hemorrhagic Transformation Due to Acute Stroke
|Drug: Chinese Herb Astragalus membranaceus Other: Placebo
|Phase 2
|Study Type:
|Study Design:
|Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
- patients' scores(BI,FIM,GOS,mRS) on several clinical scales [ Time Frame: baseline (within 7 ± 1 days after the onset of stroke) and week 4 (28 ± 4 days), and between at baseline and week 12 (84 ± 10 days). ]The primary outcome measures were the differences in patients' scores on several clinical scales, between baseline (within 7 ± 1 days after the onset of stroke) and week 4 (28 ± 4 days), and between at baseline and week 12 (84 ± 10 days). The scales we used were the Functional Independence Measure scale (FIM), Barthel Index scale (BI), Glasgow Outcome Scale (GOS), and Modified Rankin Scale (MRS). The scores of FIM, BI, GOS, and MRS were assessed by an experienced research nurse.
- inflammatory index and Computer tomography (CT) examination [ Time Frame: at baseline (prior to the first AM dose), and again on the fourth and seventh day of admission ]
- inflammatory index, which included the levels of C-reactive protein (CRP) and erythrocyte sediment rate (ESR) for venous blood; these were measured at baseline (prior to the first AM dose), and again on the fourth and seventh day of admission; and
- Computer tomography (CT) examination, which was done at baseline and on the fourth and seventh days of admission. The ratio of brain edema was calculated by CT (volume of edema divided by blood clot volume)
|Study Start Date:
|January 2008
|Study Completion Date:
|March 2011
|Primary Completion Date:
|December 2010 (Final data collection date for primary outcome measure)
|Assigned Interventions
|Experimental: Arm A
Drug: Chinese Herb Astragalus membranaceus
Astragalus membranaceus ( AM) at a rate of 3 g three times per day
|Placebo Comparator: Arm B
Other: Placebo
at a rate of 3 g three times per day
|Ages Eligible for Study:
|30 Years to 75 Years (Adult, Senior)
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- female or male;
- aged between 30 and 75 years;
- randomized allocation to a study group within 24 hours of hemorrhagic stroke onset;
- this was the patient's first hemorrhagic stroke, and the location of hemorrhage was the putamen;
- treatment may or may not have been included surgery; and
- the subject or their legal representative gave written informed consent to participate.
Exclusion Criteria:
- recent thrombolysis treatment;
- history of previous stroke;
- full-dose or long-term anti-coagulation therapy;
- hemorrhagic stroke but the location was not putamen;
- coexisting systemic diseases such as terminal cancer, renal failure, liver cirrhosis, severe dementia, or psychosis;
- participation in another clinical trial within the last three months; and
- pregnancy or lactation.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01428401
|Principal Investigator:
|Chun Chung Chen, master
|Responsible Party:
|China Medical University Hospital
|ClinicalTrials.gov Identifier:
|NCT01428401 History of Changes
|Other Study ID Numbers:
|Study First Received:
|September 1, 2011
|Last Updated:
|September 2, 2011
Keywords provided by China Medical University Hospital:
Complementary therapies
Acute hemorrhagic stroke
Additional relevant MeSH terms:
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
ClinicalTrials.gov processed this record on July 19, 2017


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Submitted by Rcforums • October 9, 2012
We have different kinds of rc car models for your different unique needs. This in addition to having both nitro powered models as well as electric cars. Our stock includes all sizes that an rc car comes in, besides all parts. We specialize in upgrading and customization of your rc car.
- Category: Entertainment
- Tags: rc car, rc truck


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Jissen Women's University
From Wikipedia, the free encyclopedia
Jissen Women's University (実践女子大学 Jissen joshi daigaku) is a private women's college in Hino, Tokyo, Japan. The predecessor of the school was founded by poet and educator Utako Shimoda in 1899. It was chartered as a university in 1949.
External links[edit]
|Wikimedia Commons has media related to Jissen Women's University.
Coordinates: 35°40′17″N 139°23′23.7″E / 35.67139°N 139.389917°E
|This article on a Tokyo institute of higher education or related topic is a stub. You can help Wikipedia by expanding it.


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Azores Islands • Lisbon • Evora • Sintra • Funchai • Obidos • Santarem • Fatima
- 13 Days - THIS PRICE INCLUDES AIRFARE FROM ANYWHERE IN THE U.S.
To view trip details, KEEP SCROLLING DOWN
To sign up online, CLICK ON THE TRIP DATE BELOW
There are no trip dates scheduled at this time.
Trip Includes
- Flights from anywhere in the United States and flights between countries as per your itinerary. (all necessary flights on your trip are included)
- Daily Mass is available but not mandatory. Proximo Travel strives to have one or more Catholic Priests accompanying the group as chaplain(s).
- Airport Taxes, Security Fees & Fuel Surcharges Saving you an average of $400-$600!
- Transfers as per itinerary.
- 4 or 5 star hotels in downtown areas.
- Transportation with luxury bus.
- All breakfasts and all dinners. Wine included with all dinners.
- All tips to driver, hotel, and tour guide. If you feel that the tour guide did a great job, offering them extra tips is greatly appreciated.
- Guided Tours and Tour Fees ~ Our tour guides are very caring, licensed, and well educated. Many of our guides have their PhD's.
- Luggage handling (1 suitcase and 1 carry-on per person)
- Single Supplement (as long as the passengers is willing to room with someone and allows us to provide them with a roommate. If the passenger wants a guaranteed room to of their own, then they have to pay the $1,600 single supplement)
- Remember: Passengers will never be expected to pay extra for anything while on the trip ~ We always wait for passengers and never leave anyone behind.
Trip Does Not Include
- Lunch
- Trip Insurance. Work directly with Travel Guard to protect your investment and insure your money. There are different packages to choose from depending on what your travel needs are. Use the above link or the link right below the picture of the Pope on our home page to visit their site.
Steps for Registration
- Call us (855) 842-8001 or register online with a credit card and pay your $500 deposit per person to save your spot. The $500 deposit is part of the total price of the trip
- A $1,000 Airfare Deposit (AD) per person is due one month from the registration. The AD is paid ONLY in the form of Check (personal, money order, or bank check)
- The balance is due February, 2017. The balance is paid ONLY in the form of Check (personal, money order, or bank check).
- Mail all checks and correspondence to:
- NOTE: If you sign up for a trip within 4 months of the departure date, you pay the deposit of $500 with a credit card and the balance is required to be overnighted in the form of a personal check, money order or bank check.
Proximo Travel
PO Box 3479
Worcester, MA 01613
Trip Itinerary
October 2: Departure from USA.
October 3-5: Arrival in the Azores Islands. We will get checked into hotel and spend the next two days exploring several of the islands.
October 6: Late start, before transferring to the airport to fly to Lisbon. Upon arrival in Lisbon we will check into the hotel and have time to relax before dinner, overnight in Lisbon.
October 7: Full day in Lisbon, visit Jeronimos Monastery, which is one of the greatest monuments to the Age of Discovery with all its grandeur and Manueline style of architecture. Spend the remainder of the day at the Baixa, Lisbon's downtown area. It is still the traditional center of city life, and is where Lisbon's oldest and traditional shops still exist. In this heart of the city the streets that run parallel to Rua Augusta identify the various tradesmen and craftsmen, who have continued to do business there since the time of the Maritime Discoveries. You'll find jeweler's stores in the Rua do Ouro (Gold Street) and the Rua da Prata (Silver Street) and cloth and clothes stores in Rua dos Fanqueiros (Drapers' Street). Dinner and overnight in Lisbon.
October 8: After breakfast we will depart for a day in Evora, a 2,000-year old unique and historic city. Evora, a beautiful town at the foot of the mountain range of the same name, its unique characteristics have led UNESCO to classify it as a World heritage site, is filled with labyrinthine streets, squares flooded with light, Renaissance fountains, Moorish courtyards and Gothic doorways and turrets. The Romans created its elegant temple, battlements and baths, and the Moorish "Yeborah" influenced the urban network of the Mouraria district. The Praça do Giraldo of Evora, the main central square where open-air cafes now serve coffee to tourists, was once the location of many public executions. Dinner and overnight in Fatima.
October 9: This morning we will depart for Sintra. The tour of the city will include Palácio da Pena is one of the best examples of 19th-century Romantic revivalism in Portugal. Set at the top of the Monte da Pena, the palace was built on the site of an old monastery belonging to the Order of St. Jerome. The highlight of the beautiful interior of the palace is the chapel, with its magnificent alabaster altarpiece attributed to Nicolau Chanterenne, one of the architects of the Mosteiro dos Jerónimos that we saw the day we arrived in Lisbon. After lunch we will proceed to Funchal, a modern city that pays attention to its traditions with preserved churches, inviting museums, and regionally crafted wine. We will have a walking tour that includes the harbor and a cathedral more than 500 years old. We will enjoy a wine tasting before dinner at a local restaurant. Dinner and overnight in Fatima.
October 10: After breakfast we will have a tour of Óbidos, with its white-washed houses covered with bougainvilleas and honeysuckle. Encircled by a ring of medieval walls and crowned by a rebuilt Moorish castle, it is now a Pousada, The town is entered through the southern gate of Santa Maria, embellished with eighteenth-century azulejo tile. Strolling through the town one senses a medieval ambience in its winding streets and old whitewashed houses. Our tour will include a visit to the Igreja Matriz de Santa Maria (Parish Church of Santa Maria), the pretty Capela de São Martinho (Chapel of S. Martinho) and, outside the town walls, the Igreja do Senhor da Pedra (Church of the Senhor da Pedra). Dinner and overnight in Fatima.
October 11: Free morning for personal devotion in Fatima. Spend the afternoon in Santarem, one of the oldest cities in the world. You will walk through the narrow streets to the Church of St. Stephen, containing the oldest recorded Eucharistic miracle. This miracle has been on display since 1247 AD. Dinner and overnight in Fatima.
October 12: Full day in Fatima. Start off the day by going to Mass at the Little Chapel of the Apparitions. You will see the Basilica, the site of Francesco and Jacinta's graves, the Hamlet of Aljustrel, where the children lived, and Valinhos, the site of Our Lady's appearance after the children's return from prison. Experience Christ's love as you walk and follow the Stations of the Cross along the Via Sacra (The Sacred Way) culminating in the Chapel of Calvary, which overlooks all of Fatima. Join pilgrims from around the world in an evening candlelight procession to pray the rosary for the sick and drink water from the miraculous well. Time for private devotions before dinner and overnight in Fatima.
October 13: Enjoy the festivities in celebrating the 100th Anniversary of the apparition of Our Lady in Fatima.
October 14: Continue to enjoy the festivities in celebrating the 100th Anniversary of the apparition of Our Lady in Fatima.
October 15: Depart Lisbon for your return flight home to USA.
Please note: We do our best to ensure that all sites listed in this itinerary will be seen. However, due to scheduling conflicts, or other circumstances beyond our control, sites may be visited on a different day than listed. If this happens it will also necessitate a change in the restaurant for dinner. However, we will never sacrifice the quality of the meal, all restaurants will meet Proximo Travel's very high standards. Since we have several different trip configurations touring at the same time, it is likely that groups on different tours will be combined when their itineraries overlap in certain areas.


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text: Devised in collaboration with the Paul Cutlan Trio: (Cutlan, composer & sax and clarinet; Fabian Hevia, drums, percussion, vibes; Steve Arie, bass). A seductive evening of cool words and hot jazz. The show has played Sydney, Edinburgh, Recklinghausen (Germany) and Melbourne Festivals, with two revivals in Sydney, and varies from 75 to 120 minutes - muso improvisation makes it very elastic to suit the occasion. An evening of Jack Kerouac, Allen Ginsberg, William S Burroughs, Lawrence Ferlinghetti and Gregory Corso performed by John Turnbull, seamlessly interspersed with authentic jazz of the beat generation.


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How to Read the palmistry meaning behind the love and affection lines on the hand
You don't need to be an authentic palmist to know the meaning behind your lines. If you want to explore the meanings behind the lines in the palm of your hand, Jim Winter is the man to learn it from. Here, he teaches the ATTACHMENT lines, also called AFFECTION lines, MARRIAGE lines and even UNION lines. These are very popular lines to read. See how attach in matters of love and how deep you commit yourself.


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GCE N Level Timetable 2014 Released
This is good news for all those applicants who have appeared in the GCE N Level examination. The GCE N Level exam timetable has published on the official website. The General Certificate of Education Normal (GCE N) exam will be conducted on the various exam centers. The candidates can check and download timetable/ date sheet from the GCE N Level official website. The GCE N Level official website is www.seab.gov.sg.
GCE N(A)/N(T) Timetable 2014:
The Singapore Examinations and Assessment Board are known as SEAB by short name. The SEAB was established on 1 April 2004 as a statutory board under the Ministry of Education (MOE) of Singapore. The GCE 'N' Level examinations, otherwise known as the 'N' Levels, are conducted annually in Singapore.
The GCE N (T) Level-Normal Technical Level is taken by Normal Technical students after four years of secondary school education. In the exam a huge number of candidates are going to participate. The GCE N Level exam is very important for all students who want to eventually lead them to the ITE or Institute of Technical Education.
The General Certificate of Education Normal Level timetable has declared on the official website. The applicants can download your timetable in the PDF format from the official website. Through the time table candidates will be focused on the exam and they can read weak books and they can mentioned timetable according to yourself.
Check GCE N(A)/N(T) Timetable Here
GCE N Level Timetable:
How to check and download the GCE N Level timetable:
- The candidate first visits the GCE N Level official website.
- The GCE N Level official website is www.seab.gov.sg.
- They can click on the GCE N Level timetable 2014.
- Click on the printout button.
Best of luck to all candidates
Tags: seab.gov.sg


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Program Guides
Our newest initiative, the program guide is a comprehensive full-colour booklet where you can see all that's happening at the Gallery.
The Program Guide is where you'll find information about exhibitions, events, classes, youth opportunities, volunteering, as well as news about the Gallery and Surrey Art Gallery Association. We produce three a year for our main exhibition seasons: Fall, Winter and Spring/Summer.
|Spring/Summer 2016 Program Guide
|Winter 2016 Program Guide
|Fall 2015 Program Guide
If you'd prefer reading a hard copy, pick one up at the Surrey Art Gallery or sign up to receive the next edition delivered to your door!


text: PCMag Staff Vevo Reviews/ Software/ Music/ Vevo View As: One PageSlides 1 Share Tweet Pin Email Vevo Vevo offers premium online music videos in a sleek, well organized site that hopes to one day become the MTV of the Internet. 2 Share Tweet Pin Email Vevo: Sign-Up You can sign up through Vevo directly or connect to Vevo through networks like Facebook, so you can use features like saved playlists. 3 Share Tweet Pin Email Vevo: Browse Videos Vevo offers many ways to browse through videos by most popular, most favorited, newest, etc. 4 Share Tweet Pin Email Vevo: Artist Page Each of the 5,000 plus artists featured on Vevo have their own page showing their videos and letting you add them to your list of favorites. 5 Share Tweet Pin Email Vevo: Channels Vevo's Channels gives you an interesting way to view content. There are channels dedicated to different genres, videos with lyrics, lanuages, and some Vevo generated content. 6 Share Tweet Pin Email Vevo: Michael Jackson Legacy The Michael Jackson Legacy channel features Jackson's music and tribute videos you can browse from one neat page. 7 Share Tweet Pin Email Vevo: Errors I'd love to show you a slide showing off Vevo's video interface, but videos stopped loading hours after the launch due to the site not being able to handle the influx of traffic.


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3I am grateful to Godwhom I worship with a clear conscience, as my ancestors didwhen I remember you constantly in my prayers night and day. 4Recalling your tears, I long to see you so that I may be filled with joy. 5I am reminded of your sincere faith, a faith that lived first in your grandmother Lois and your mother Eunice and now, I am sure, lives in you.
6For this reason I remind you to rekindle the gift of God that is within you through the laying on of my hands; 7for God did not give us a spirit of cowardice, but rather a spirit of power and of love and of self-discipline.
The New Revised Standard Version, copyright 1989 by the Division of Christian Education of the National Council of the Churches of Christ in the United States of America. Used by permission. All rights reserved.
Enter another bible reference:
v 2.2.7
10 February 2011


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I don't want to be here...
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Senior Member
Join Date: Feb 2010
Location: Saskatchewan
Posts: 2,413
Originally Posted by
Any time anyone tried to get close to me, my husband shut it down and either scared them off or insisted I not 'pursue' the friendship on the grounds that
didn't need or want anyone else in his life, and if I loved him as much, then I shouldn't either.
Obviously, looking back on it
, it smacks of emotional and psychological abuse and serves to make me feel like more of an fool. I just feel like I'm drowning.
I'm glad you said it so that I don't have to.
You're no fool, though. Because you've seen it for yourself now that you've had the chance. Abusers are very good at manipulation and making you see what they want you to see. It's not your fault that you've been treated this way.
You need to get yourself and your children out of this situation. The control he exerts over you will extend over them. They will grow up believing this kind of relationship is normal, that this is the way husbands are supposed to treat their wives.
I know how daunting that sounds: you have no money (he controls the accounts), no job (he wouldn't let you get one), no friends (wouldn't let you have them) and you've lost contact with your family.
Are your family members still alive though? I would bet that if you call them up and tell them you have an abusive husband and you need to get out right away, they'll help you get started.
I'm going to end by reiterating that you are not a fool, you are not cheap, you are not pathetic. You are a woman who wanted something special and was taken in by a master manipulator who told you exactly what you wanted to hear.
As I am sure any cat owner will be able to tell you,
someone else putting you in a box is
entirely different
from getting into a box yourself.
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Find all posts by SchrodingersCat


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I would like to share my .blend conversion of Raul Mamoru's Reliant.
http://s1063.photobucket.com/user/tcb50 ... sort=6&o=0
Blender Conversion Of Raul's USS Reliant
If you know of meshes that are available, but not hosted on the STMC, or if you have made a mesh yourself and want to release it on the STMC, post here!
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Re: Blender Conversion Of Raul's USS Reliant
It's up and hosted!
Many thanks!
Many thanks!
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Holy Trinity offers a variety of retreats each year. The focus for each retreat varies from year to year, but there are always components related to community building and faith formation.
Family Camp Weekend
Held at Ox Lake, Amery WI, July 31-August 2, 2015. Please visit our registration page for more details!
Fall Retreat
The 2014 Fall Retreat was held at Villa Maria Center in Frontenac, MN. The theme was mono-tasking.
Spring Retreat
The 2013 Spring Retreat was held at Villa Maria Center in Frontenac, MN. The theme was creativity and offered a time for exploration, experimentation, building skills, and having fun.
Fall Retreat
In October 2011, our Fall Retreat was held at a retreat center just outside of the Twin Cities metro area. The retreat focused on the spiritual practices from Iona in Glasgow, Scotland. We also shared meals, a game night, nature walk, and time for personal prayer and meditation.
Spring Retreat
The Spring Retreat for 2012 featured a Poverty Simulation. We learned about the realities of poverty and the difficulties of managing a family budget on a limited income. It was truly an eye opening experience for many.
Confirmation Winter Retreat
The Confirmation class typically goes away for a weekend to a camp or cabin setting for a time of learning, spiritual formation and recreation. Past events have included sledding, nighttime stargazing, worship and games.
Canoeing at the Boundary Waters Canoe Area Wilderness
Outdoor enthusiasts enjoy the annual canoe trip to the Boundary Waters. This inter-generational trip offers opportunity for adventure and enjoyment of God's natural world.


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Kevin Federline was taken to a hospital in Sydney after he suffered heart pains Sunday while shooting weight-loss reality show Excess Baggage.
According to the Excess Baggage Facebook page, the show's medic was concerned about his high pulse rate. TMZ has photos of Britney Spears' ex sitting in a car, being treated with an oxygen mask. An ambulance was called and Federline, 33, who collapsed while filming a challenge for the show, was taken to Mt. Druitt hospital for tests.
The Sydney Morning Herald reported that Federline was treated for symptoms of minor cardiac arrest but it later determined he had not had a heart attack.
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Mind's World
de Yamane
Acerca del libro
A journey into the mind and dream world of what soldiers wish to see and come home to when they are away.
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Yuri Kavajecz
Not much. I live and work in Japan. My current career sends me all over Japan. I started photography three years ago and have made it my passion. My hope is to become a professional photographer. I hope to document my photography of Japan.
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Arkansas County is located in northwest Arkansas. The County Seat is Stuttgart and the largest city is Stuttgart. The Official Web Site is located at http://www.arcounties.org/counties/detail/1. The 2014 population estimate is 18,594 and the 2010 census population was 19,018. The land area is 988.77 square miles and there are 19.2 persons per square mile.
72.5% of the population is White, 24.8% is Black or African American, 2.8% is Hispanic or Latino, 0.9% is Asian, 0.3% is American Indian or Alaska Native, 0% is Native Hawaiian or Pacific Islander, and 1.4% is two or more races. 84.1% have a high school degree or higher, and 12.4% have a Bachelor degree or higher.
The median home value is $75,500, there are 7,883 households, an average of 2.36 persons per household. The per capita income is $23,045, the median household income is $39,633, and 15.8% of the persons in Arkansas County are considered below poverty level.
The total number of firms, at last estimate, was 1,791. Retail sales (in $1000) were $286,337, and sales per capita were $14,825. The percentage of black-owned firms is 0%, and the percentage of women-owned firms is 29.4%.
If you find a broken link below, please use the Report a Broken Link form to let us know.
|Arkansas County
Arkansas County, Arkansas website.
|Arkansas County | Assessor
Assessor's Office of Arkansas County website.
|Hot Check Fines Pay Site
Find and pay your Arkansas County hot check fines online.
|Inmates | VineLink
Inmate search of Arkansas County Jail records from VineLink.
|Property | Assessor
Arkansas County Assessor real estate search.
|Property | Tax Records
Arkansas County Tax Collector real and personal property tax records.
|Sex Offenders
Arkansas County or statewide offender search from the Arkansas Crime Information Center.
Please use the Report Broken Link form if any of the above resources do not connect


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McCall's 7203; ©1964; Misses' Dress. Sleeveless dress has dart fitted bodice and three-gore, bell shaped skirt. Underskirt of interfacing fabric is included in waistline seam. Scooped neck bodice is trimmed at front with applied ribbon and bow in yoke effect. Ribbon trimmed, patch pockets on skirt extend beyond side seams. Dress has center back zipper.
Links to reviews/blog postsEdit
- Your Pattern Shop
- MOMSPatterns
- SewKnotMe Size 18


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Saturday 18 May 1907
It was Saturday, under the sign of Taurus. The US president was Theodore Roosevelt (Republican).
Famous people born on this day include Clifford Curzon and Robley D.
But much more happened that day: find out below..
You can also have a look at the whole 1907 or at May 18 across the years.
Old Newspapers
Have a look at the old newspapers from 18 May 1907 and get them!
Which were the most popular movies released in the last months ?
Find out your future
Get a FREE Numerology report based on the digits of 18 May 1907!
Wish him/her..
Historical Events
Which were the important events of 18 May 1907 ?
Famous Birthdays:
- Clifford Curzon: London, England -- Pianist (MacFarren Gold Medal).
- Robley D: Evans nuclear physicist.
- Carl Mydans: American photographer (d. 2004).
- Roger-Gilbert Lecomte: French poet and writer he was a participant in the Surrealist movement in literature.
- Roger Lecomte: France Writer.
- Irene Hunt: American author and educator (d. 2001)
- Lincoln Stedman: American actor (d. 1948)
Music Charts
Which were the top hits in that special week of May 1907 ?
Top #1 songs in the USA
- The Wedding of Uncle Josh and Aunt Nancy Smith (new version) - Cal Stewart
Search For Your Ancestors
Subscribe to our Newsletter
Don't miss our monthly news, no spam guarantee Click here to Subscribe
...and if 18 May 1907 was your Birth Date then Join our Birthday Club!
Make this date unforgettable
Genealogy: find out your family heritage
Magazine Covers
What news were making the headlines those days in May 1907?
Which were the most popular books released in the last weeks ?
Remember when
What videogames would you be playing back in the days ?


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Design Guidelines when submitting your Round Sets to be featured on this web site
Submit new level set
Fill in the information below to upload your level set to be published to the Internet.
You must click on the "Browse" button below and then select the file for the level set you created. The file is in the Rounds folder within your "Ricochet Lost Worlds" folder. Typically that would be C:\Program Files\Ricochet Lost Worlds\Rounds\Xxxxx.RicochetLW
Do NOT submit a round set with more than 5 rings on the last round. All the extra rings on the last round will be deleted!
Please Note: All submissions become the property of Reflexive Entertainment Inc. and will be eligible for inclusion in all Reflexive Entertainment Inc. media. This means that we can share your levels with other gamers on the Web, in retail materials, and in any other way. Thanks!


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Remarkable Time-Lapse Video Shows How Women Are Made to Look Impossibly Beautiful [VIDEO]
Beauty is in the eye of the Photoshopper.
Beauty is in the eye of the Photoshopper.
Lost in the hoopla of the Boston Red Sox winning the World Series is the fact baseball will be losing one of its pre-eminent color commentators.
This girl is ready to move forward now.
The National League Championship returns to St. Louis Friday with the St. Louis Cardinals and Los Angeles Dodgers. I love to see when teams pull out all the stops to get the crowd pumped up...
This man would rather lose his job than lose his life.
The Kansas City Chiefs certainly have their fans abuzz with a 6-0 record. This start to their season prompted Kansas City Chiefs fans to go for the loudest crowd record that the Seattle Seahawks fans obtained earlier this season. It seems most people were paying attention to this record, including ESPN and the major networks. They were able to break the record last Sunday (Oct. 13), but if you didn't watch the pregame or weren't at the stadium, you may not have seen the world other record broken at the game.
You may not know this, but 'The Star-Spangled Banner' actually has four verses.
This McDonald's is serving up more than hamburgers.
Kristina Anderson may be competing in a beauty pageant, but she's got a far more challenging fight on her hands.
Brace yourself.


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Freemuse calls for the release of five Tibetan musicians imprisoned for their art
On World Human Rights Day (HRD), 10 December 2016, we remind China and the world that the Chinese government has held five Tibetan musicians in its prisons for nothing more than singing and writing songs.
As of 10 December 2016:
- Lo Lo spent 1,386 days in prison
- Shawo Tashi spent 1,414 days in prison
- Kelsang Yarphel spent 744 days in prison
- Gonpo Tenzin spent 605 days in prison
- Trinley Tsekar spent 1,087 days in prison
On World Human Rights Day, these five artists have collectively spent 5,236 days in prison; that is nearly 14 years and 4 months of collective prison time for practicing their human right to artistic freedom.
Art is not a crime.
Freemuse calls on the Chinese government to:
- Immediate release the imprisoned musicians, as well as other artists
- Abolish the arbitrary charge of "seditiously splitting the state"
- Respect the rule of law and international human rights
- Provide transparency in cases of imprisoned artists
Freemuse began its "#ArtIsNotACrime not in Tibet, not anywhere" campaign on 5 December 2016, highlighting the case of each of the musicians imprisoned for their art each day until World Human Rights Day 2016.
But our work does not stop now.
We will continue to campaign for the release of Lo Lo, Shawo Tashi, Kelsang Yarphel, Gonpo Tenzin, Trinley Tsekar, and any other artist China imprisons for violating their human right to freely create art.
We will continue to monitor and document China's violations on artistic freedom because the country holds the unenviable position of consistently being one of the top human rights violators on artistic freedom, according to our reports.
Please help us by sharing these musicians' stories today, and every day until they are released.
#ArtIsNotACrime – not in Tibet, not anywhere.
Find out about each imprisoned musician and how you can help by clicking on their profile photo below:


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Kim Kardashian Family Magazine Launch
January 21, 2012 by staff
Kim Kardashian Family Magazine Launch, Was a magazine featuring Kim Kardashian ever really in the cards? That is a question that ultimately many people are asking at the moment.
At first, we were hearing that the E! reality star was looking (along with the rest of her family) to control some of the content put out there by the media by launching a magazine with the parent company of the National Enquirer. However, other sources denied this, saying that the family was just trying to create a "fanzine" like what many other stars have done over the years.
Now, a new story from the New York Post claims that the deal didn't go through thanks to Kris Jenner wanting too much control.
So who do we believe? At this point, it really doesn't even matter — all you need to know is that a Kardashian magazine does not seem to be in the cards.
Please feel free to send if you have any questions regarding this post , you can contact on
Disclaimer: The views expressed on this site are that of the authors and not necessarily that of U.S.S.POST.


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Need an extra hand?Book extra event staff for your needs, they can help supervise items you have hired from us or third parties equipment, crowd control and so much more
Please Note: *All our inflatables attractions require 2 supervisors to be present at all times to ensure maximum safety.
This staff can be provided by us, you or a mixture of both. Please note that our staff are in place to supervise the equipment only. Our staff are not babysitters and are in no way responsible for the organisation, safety and wellbeing of the participants or their property.
In some cases an operator is required by law or we feel passing the responsibility of supervision onto the individual hiring the equipment is not acceptable and as such we will staff the equipment for you. This will be indicated in the main headings by the words - Includes STAFF.
REMEMBER: Although most of the entertainment on our website does not require our staff members, they still do require adult supervision at all times, most inflatable items require 2 members supervisors at all times. This does not have to be one of our staff members but please ensure a supervisor is available at all time for maximum safety & maximum fun.
Price: From £120
© 2017 Prestige Bouncy Castle Hire Leicester, Coventry, Rugby & Northampton | Funfair Ride Hire | Mobile Catering Hire | Mini Golf HireBouncy Castles, Funfair and Entertainment hire in Leicester, Rugby, Coventry, Nuneaton, Hinckley, Lutterworth & surrounding areas


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Our goal is to provide a compassionate professional environment to make your experience comfortable. Our staff is friendly, knowledgable and very helpful in addressing your health and fin......more
Our goal is to provide a compassionate professional environment to make your experience comfortable. Our staff is friendly, knowledgable and very helpful in addressing your health and financial concerns.
More about Apollo Spectra Hospitals and Apollo cradle hospitals
Apollo Spectra Hospitals and Apollo cradle hospitals is known for housing experienced Pediatricians. Dr. Anjani Kumar, a well-reputed Pediatrician, practices in Delhi. Visit this medical health centre for Pediatricians recommended by 73 patients.
New rohtak road. Karol Bagh
Karol Bagh Delhi, Delhi - 110005
Dr. Anjani Kumar
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Patient Review Highlights
34 years old male from Bareilly asked
Sir, c/o itching in whole body time to time daily Please refer my wife's (33 wks of pregnancy) LFT and urea/creatinine test. LFT-Total bilirubin-1.2 mg/dl, direct bilirubin-0.4 mg/dl, sgot-45 mg/dl, sgpt-53 mg/dl and BLOOD- urea-34 mg/dl creatinine-0.8 mg/dl medication: Tab Udiliv 300 mg tds syp alcasole 2 tsf tds vit c tab avil . But no relief so what to do next? Doctor has advised to take Cap Nitrofurantoin 100 mg 1 BD for 5 days, after seeing urine culture report which showed E.Coli infection, is it safe in pregnancy of 33 week?
20 years old male from Kolkata asked
Hello! I am 20 years old and my height is about 5'3" and weight is about 65 kgs. My problem is that I wakeup in the night 2 to 3 times to go for toilet. Although it doesn't happen in summer due to sweat. But in winter and monsoon it becomes really a problem. My question is that, is it normal? Or I have any issue with my kidney.
it is perfectly normal to urinate twice in winters. but waking up at night do get troublesome. so try to avoid fluids before bedtime and empty ur bladder before going to sleep.
27 years old male from Bhubaneswar asked
Dear Sir/Madam, How to control frequent urination which am getting since some days. I ve hd conducted culture everything but everything negative no signs of diabetes. But I was mas******g frequently now am trying to leave forever not to attempt. So please suggest me what medicine should I take.
Masterbating does not increses the frequency of urination and to add to its perfectly normal to masterbate. It does not cause urinary infection or weakness. If there is no infection of urine on urine examination. Just relax.
20 years old male asked
I am a 19 year old male. For about 4-5 days now, I've been having pain around my anus. The pain began after a rather intense bowel movement. Since the pain began, sitting, shifting position in bed, and many other simple movements bring moderate pain. Pain is made worse with a bowel movement and with an erection. Pain has been made better with exercise, a hot bath, or by passing gas. I would like to know possible conditions, the severity of each, and treatment.
You might be having fissure in ano. That is condition when there is anal mucosal tear when you pass hard stools and due to spasm of anal sphincter. Take some laxative at bedtime so you pass soft stool and continue with sitz bath. If pain persists go and see your surgeon.
22 years old female from Mumbai asked
Hii I just wanted to know if a girls who's had multiple sexual relationship. . Unprotected and after been diagnosed with urine infections which led to sum minor kidney issue. Can the female be rest assure to have a normal relationship with her husband in future. As she was diagnosed and had no std or hiv result. But she scared to get married cx of all the past relationship. And mainly cx of urine infection . ?
Its perfectly normal to get married. Uti is common in females who r sexually active. If no std/ hiv detected on test it is completly safe to get married and hve blissful life.
18 years old male asked
Can numerous fibroids and an enlarged uterus cause bladder prolapse? Why does my gynecologist think my bladder bulging into my vaginal canal is a fibroid even after I was sent to a urologist for stress incontinence issues?
Yes enlarged fibroids can cause bladder prolapse. It is more due to lax ligaments. Best way to know is get an ultrasound done and hve 2 nd opinion from other gynaecologist.
22 years old female from Hyderabad asked
Well it is going to make things worse for u. Its better to take sme laxatives or stool softeners and apply lox jelly per anus before defecating. And show to a surgeon.
24 years old female from Palakkad asked
My son of 6 months refused to drink milk just before his naps when he want to sleep he usually cries a lot, so swaddled too much, now he can't sleep without swaddling, I want to decrease it because sometimes I am badly tried and can't swaddle in cradle, please tell me a way to stop this swaddling.
Child learns what you teach. Children do not have memory till 1 and half yrs. So if you will stop. Child will also get used to it over a short period of time.
30 years old female from Pune asked
Mother feed is the best feed. It prevents constipation. If constipation persists, visit your pediatrician.
32 years old male from Rajouri asked
Mere bachhe ne lohe ka tukhdha nigal liya hai abhi ander hai x Ray me dikhai de raha hai kya karu bachhe 5 saal hai kafi tension hai.
Do not worry. Give him/ her bananna's and high fiber diet. Get a x ray done to see the position of foreign body. Usually child will pass it in 2-3 days along with stool.
year old male from Chennai asked
Last month my wife delivered baby boy. Gestation period is approximately 36-37 weeks. After child birth during first pediatric visit doctor noticed missing testicles in scrotum. Then now after 20 days left side testicles reached scrotum. Right side I can feel it near adjacent side to penis beginning place. Should I wait for one more month? Should I meet surgeon immediately? What is the future consequences.
Hi I am pediatric surgeon. Normally if testis are palpable, then they usually descend by 3 months in full term baby. If not visit and consult pediatric surgeon.
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