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No. of Franchise Outlets: 21
Investment: Rs. 10lac - Rs. 20lac
TGS E-COM - India's premier online E-Commerce company has come up with a new business model...Read On!
TGS E-COM is India's premier online E-Commerce company in recruitment, real estate, Online Shopping, and other related services. The company has a bouquet of websites and associated businesses that spans across different verticals like real estate, event management, and etc. TGS E-Commerce portal has successfully completed 2 years and today our portal is one of the exclusive online e-commerce portal which has manages a list of online portals like Flatsdeal, tgsproperty, tgslayout, sendmygift, grandeurinternational, and udyogamitra.
TGSBazaar: This is our newest upcoming venture, we are launching an online retail grocery market with 1 Central Distribution Centre located in Whitefield and 21 delivery points strategically located in prime location of Bangalore in order to cater the delivery needs of our customers in and around Bangalore. We are the first ever online grocery store in Bangalore with a huge distribution chain covering almost every corner of Bangalore. It is an extremely user friendly platform with dedicated and experienced team to create an exceptional and unique online shopping experience.
The following are our business verticals that are managed and run successfully with unique features & result oriented vision:
- TGS Layouts: TGSLayouts is one of the extremely successful ventures of TGS E-com Pvt. Ltd. which effectively deals in selling and marketing plots/sites from interested parties and to potential buyers. This venture is successfully spread all across Bangalore and is currently handling approximately 50 projects in and around Bangalore.
- Flatsdeal: Flatsdeal is another promising endeavour managed by TGS E-com Pvt. Ltd., which is Bangalore's best Doorstep Property solution. We efficaciously perform the marketing of hot selling residential projects essentially focusing on houses and apartments. Faltsdeal also organizes offline and online home fairs in order to help the potential homebuyers to find their dream home in a single day.
- Sendmygift: Sendmygift is an unparalleled and novel venture from the family of TGS E-com Pvt. Ltd. which is widespread all over India, it is an online gift store where a wide selection of gifts from fresh flowers, teddy bears, jewelleries, chocolates to cakes and pastries, etc., for any occasions from corporate event or a causal party and Valentine's Day to any anniversaries is offered.
- Grandeur International: Grandeur International is an event management company, which offers host of services including conceptualization to organizing and executing a wide range of events that includes famous corporate events, theme parties etc. Some of the events that we have organized till now are Doctors Meet for Vikram Hospital that took place in JW Marriott Hotel, IT Festival at SJR Tech Park, and many others.
- Udyogamitra – A Charitable Trust: This is a new sister venture of TGS E-com Pvt. Ltd. That aims to provide job to educated rural people in Karnataka. We have also come-up with an online job portal udyogamitra that huge listings of job openings where anyone can register on the website for free and get their dream job and build a successful career. We have also organized job fair in rural parts of Karnataka and collected a huge data of candidates and many have got placed in top companies of Bangalore City.
Franchise Facts:
- Area Required: 1500 sq ft
- Investment: Rs. 10lac - Rs. 20lac
Franchise Benefits:
- Renowned brand name
- Proven business model
- Proper training & support
- High returns on investment
Interested in above franchise model? Contact now to know more!
Thanks & Regards
TGS E-COM Team
TGS E COMMERCE PVT LTD Investment Details
TGS E COMMERCE PVT LTD Property Details
TGS E COMMERCE PVT LTD Training Details
TGS E COMMERCE PVT LTD Agreement & Term Details
Radisson Blu Plaza Delhi Airport...
Neha has led and directed the search function in various hotels thus gathering connections within India and International landscape.
Darjeeling tea planters seek help from...
Technology- The Game Changer in the...
In an exclusive interview with the Deputy Director, OP Jindal Global University, Yugank Goyal, we were enlightened with the scenario of
Technology Augmentation on Education...


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What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
At JotForm, we want to make sure that you're getting the online form builder help that you need. Our friendly customer support team is available 24/7.
We believe that if one user has a question, there could be more users who may have the same question. This is why many of our support forum threads are public and available to be searched and viewed. If you'd like help immediately, feel free to search for a similar question, or submit your question or concern.
Can I import contacts to Jotform based formAsked by taxiapp123456 on October 31, 2016 at 12:10 PM
I would like to use Jotform to keep track of my customers. I already have 400 customers and would like to import these to Jotform so they are all in the same place. Can I do this without completing new forms individually.
JotForm Support
Thank you for contacting us.
It might be possible to import records from specially formatted Excel/CSV file using our Import Data App, please follow the guide for more information.
Import App: Easily import your Excel or CSV data into JotForm
If you need any further assistance, please let us know.

subset: commoncrawl


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Cast: Sydney Cole, Dakota, Scarlet Red, Bree Daniels, Dido Angel, Cayla Lyons, Carla Cox, Blake Bartelli, Nathaly Heaven, Val Dodds, Samantha Johnson, Katy Rose, Xandra Sixx, Ellena Woods
Lesbian Threesome – Dakota Skye, Sydney Cole & Xandra Sixx
This card game has big stakes: whichever girl loses has to strip off a piece of clothing! Once all three girls have lost their shirts the card game is quickly forgotten as they indulge in soft kisses that lead to something more.
Taking Turns – Carla Cox, Dido Angel & Samantha Joons
Samantha is kissing Carla while Dido comes up from behind with a blindfold. The blondes keep their raven-haired lovers lips busy as they take turns relieving her of her clothes and preparing her hot body for a good time.
Threesome Babes – Blake Eden, Scarlet Red & Val Dodds
Scarlet is cleaning when she hears Blake and Val making noise in the bedroom. Scarlet quickly joins them in bed where she is welcomed with open arms. Soon all three are liplocked and eagerly anticipating the pleasure to come.
Young Lesbian Lust – Cayla Lyons, Katy Rose & Nathaly
Nathaly brings her lovers breakfast but they're hungry for something else. Nathaly finds herself in the middle while her tow lovers kiss and caress every inch of her bare skin. Breakfast is always better in bed.
Lesbian Menage A Trois – Blake Eden, Bree Daniels & Ellena Woods
These girls wake in a pile of soft skin and delectable touches. Ellena glides her tongue over Bree's breast. Soon Bree is out of her panties so that it's her pussy that is the very first to experience some undivided attention.


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The GeorgiaGov Interactive team at GTA worked on an innovative enhancement to our website designs. As more and more website visitors are using mobile devices to access the web, it is important that our websites are designed to be easy to use from a mobile device. Our solution for the GeorgiaGov Platform websites is to convert your current site layout to a Responsive Design.
What is Responsive Design?
Read our Learning About Responsive Design Web Guide to learn more about this solution and why we chose it for our platform. And check out our GOVTalks: Mobile workshop videos and links, and The Mobile Moment blog to learn more about the necessity for mobile friendly websites.
Don't worry — your website will look exactly as it does now, with no content or theme changes made. This switch will only change the way your website's layout looks on a mobile and tablet device, creating a better user experience for your mobile traffic. And the backend will function exactly as it does now — no new training will be required.
Preview the Responsive Themes
Want to know what your site will look like?
Visit demo.georgia.gov and resize your browser screen to approximate tablet and mobile phone sizes. You will see the layout of the website move around, boxes stack on top of each other, and new "Menu" and "Search" buttons at the top right for tablet and mobile devices. This design determines the best layout depending on the screen size, and creates a better experience for mobile users.
Better yet, visit demo.georgia.gov on your personal phone and tablet to see the differences. Remember, your theme will remain exactly the same as it is now and might not match the Patriotic theme of our demo.georgia.gov website. But you can still see the differences with the layout in the mobile and tablet breakpoints.
What to Expect
Based on each agency's mobile analytics and needs, we have created a migration schedule for all of our sites. This will take place in 5 rounds, with each round being 4 weeks long. Before your website's round, 4-6 weeks before your migration deadline, you will be notified by your account manager with details regarding the process, deadlines, and any suggested changes to your content.
Changes to your content are not required.
Changing your website to the Responsive theme does not affect the content on your website. Each theme will look exactly as it does now, and no content will be touched by the switch. After an initial website audit at the beginning of the round , we will offer suggested content and image changes that would optimize your mobile user's experience on your website. You will have about 4 weeks to make these changes before your migration deadline. These will mostly be basic and straight-forward changes, and your account manager will be available to help with any questions you have during that process.
At the end of your round, we will switch your theme to the matching Responsive theme on a Friday afternoon. If you didn't have time to make the suggested content changes, don't worry! You can always make these changes after the switch.
We plan to sunset all Non-Responsive themes once we have finished our migration. We will coordinate with you as needed, and send reminders along the way before we switch your website. Because we plan to discontinue all of our Non-Responsive themes, all agencies will still be switched to the Responsive theme by the end of the migration project.
What should my content look like? Read our "Multi-Screen Resources from Google" blog for content tips on a mobile friendly website.
Why Should I Change?
Apart from adapting your website to the changes of new mobile technology, increased mobile users, and creating a better user experience for all, a great reason to embrace the new mobile movement is Google. On June 10, 2014, Google announced that they will lower search rankings for any sites that are NOT mobile friendly. Might sound crazy, but it's true.
Google doesn't like:
- Videos or content that don't render or play on all mobile devices.
- Pages and content not optimized for faster loading on mobile devices.
- Too many images/pictures.
Google does like:
- Using Responsive Design (our platform takes care of that for you!).
- Using a dynamic set of URLs with each URL serving a different HTML (or CSS) depending upon the device being used.
- Having a separate mobile website.
Check out the following links to read more about Google's new standards:
Below are resources and tools to help during your migration process. Your account manager will supply you with the necessary reports and audit 4-6 weeks before your migration deadline.
Migration Schedule
Round 1: June 2014
2013 Mobile Traffic 55-30%
Round 2: July 2014
2013 Mobile Traffic 30-20%
Round 3: August 2014
2013 Mobile Traffic 20-15%
Round 4: September 2014
2013 Mobile Traffic 15-12%
Round 5: October 2014
2013 Mobile Traffic 12-0%


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Sister site to the original in Primrose Hill, Sweet Things Notting Hill sits just off the iconic Portobello Road Market. This boutique bakery not only focuses on sweet treats, but also offers wholesome breakfasts, and even has large sharing tables with USB sockets for those wanting to work and study.
All kinds of tempting sweet creations can be found on the Sweet Things Notting Hill menu. Beautifully made cupcakes are served in all colours and flavours, as well as red velvet cookies, indulgent baked slices, and classic British cakes like Victoria sponge topped with fresh strawberries. There are also savoury recipes on offer too, such as wholesome soups, and generously filled sourdough toasties.
Afternoon teas at Sweet Things London are extremely popular, and feature premium loose leaf teas, scones with jam and clotted cream, as well as other freshly baked surprises, including gluten-free varieties.
Also offering cake-making classes and fun workshops, Sweet Things Notting Hill is 6 minutes' walk from Ladbroke Grove Tube Station.
Sweet Things Notting Hill
8 Blenheim Crescent , Notting Hill, London, W11 1NN
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Customer reviews for Sweet Things Notting Hill
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((((( 12 October 2016 by Jeanne Ragonese from New York
Sweet Nothings is a small place off Portobello Road. I ordered an afternoon tea. The bread that the smoked salmon and tomato/cheese were on was really exceptional: not flimsy, but a wonderful homemade bread with real heft to it. The tea was fine, as were the delicious mini-scones and cupcakes. The young woman who was there and waited on me couldn't have been more polite and helpful. It was a nice quiet break from a bustling London weekend. I would go back!
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Need Appliance Repair Help? Ask a Technician for Answers ASAP
please allow me two minutes to look up your model ref
be right back
do you know what the temp is inside the ref and freezer cabinets now? or is the food spoiling? getting warmer?
ok. have the diagrams infront of me now.
have you had a power surge or power outage lately?
and finally, is the compressor in the back bottom of the machine running? or the nosies you are hearing coming from inside the freezer cabinet? is the machine blowing warm air or cold air in the freezer?
refrigerator is 40 degrees freezer is 12 degrees
ok. so the ref is ok for now. but the freezer is starting to warm up.
is the fan in the freezer running?
and if it is, is the air that is beeing blown around cold or warm? you will need to stick your hand int he back middle of the freezer section to feel the air.
and finally, if you remove the food in the freezer do you see any cold spots or spots of ice forming on the back wall of the cover inside the freezer?
are you still with me?
yes I believe I do feel air blowing around no power surge no power failure
yes ice on back wall
thank you for checking
is the ice thick?
it doesn't really matter much just wanted to check to see how long tis has been happening for.
do you have a multi meter to do some checking with?
if there is ice forming on the back wall inside the freezer section then you are experiencing a defrost failure. and the ice is choking off the cold air to the freezer. where it would normally spread throughout the freezer and ref. i know it sounds weird that the cold air is staying in the freezer and not the ref. but yet the freezer is what is warming up. the fact here is when this happens the freezer temp is affected first because all the cold is made in the freezer.
the ref is not going into a defrost cycle to allow the cold air being built up on the evaporator in the back of the freezer to be defrosted. and if the ref will not go into a defrost cycle the machine will just non stop run. and obviously produce way too much cold air.
ok now what?
and thus the machine will actually get warmer as all the cold air gets choked off into the freezer cabinet of the machine.
ok so now, if you have a meter we can test the defrost components like the def heater and thermostat and main computer. but if you dont have a meter, i suggest unplugging the ref and taking a hair dryer to the back of the freezer cabinet for about 2 hours. fanning it back and forth the whole time.
i know it will be a huge pain in the neck to do. but it beats turning the ref off for 3 days to allow it to manually defrost. unless you have another ref you can put your food into? this way it doesnt go bad and you dont loose money.
if you have another ref, store the food you have in this one in the new one for the next three days and turn the problematic machine off. allow it to stay off for three days.
then turn the problematic machine back onto its normal setting and allow it to run untouched and unoped for about a day. and see if it begins cooling.
Let me see if I can pull the freezer out
if it does, then great. put your food back in and monitor it. if this problem happens again in about a week or so, replace the main control board and defrost thermostat.
I cannot. I will call a repairman in the morning I do not have another refrig.
if you have a meter you will need to remove the food in the freezer cabinet and remove the back cover of the freezer on the inside. this will expose the parts we need to check. then when that is done you will see the heater and wiring to it. and the thermostat as well. with your meter set to continuity, you will need to check the heater and tstat. if they are good then replace the main control board in the back of the machine.
if the heater or def tstat are bad, replace them.
ok bye
i know this is a complicated repair. so if you feel it is better left to the repair man that is fine.
and if you would like to save money on parts, i can get you the info now so you can order them yourself?
this will save you a lot of money


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NBC Sports Network to Broadcast Investec Derby
The Investec Derby from Epsom Downs Racecourse in the UK will be shown live on NBC Sports Network for the first time this year.
The Investec Derby from Epsom Downs Racecourse in the UK will be shown live on NBC Sports Network for the first time this year.
Trainer Aidan O'Brien will have five of the 16 horses scheduled to run in the £1,545,000 ($2.2 million) Investec Derby (Eng-I) June 4 at Epsom Downs.
English and Irish classic winner Australia, the brilliant son of Galileo and U.S. and European champion Ouija Board, has been retired and will begin his stud career in 2015 at Coolmore Stud in Ireland.
Pre-race favorite Taghrooda has a wide draw and 19 rivals to beat in a full field for the Prix de l'Arc de Triomphe (Fr-I), Europe's premier middle-distance race Oct. 5 at Longchamp.
Roger Smith's Kingston Hill charged past runner-up Romsdal with a mighty late run and won the Ladbrokes St. Leger, the third jewel in England's Triple Crown, Sept. 13 at Doncaster.
Winless but competitive in three starts this year, Epsom Derby (Eng-I) runner-up Kingston Hill is the favorite for the Ladbrokes St. Leger (Eng-I) Sept. 13.
Dazzling Royal Ascot winner The Fugue is the favorite for the Coral-Eclipse Stakes, which attracted five other group I winners among a field of 11 for the July 5 race at Sandown Park.
Investec Epsom Derby (Eng-I) victor Australia and runner-up Kingston Hill look set for their highly anticipated rematch in the Dubai Duty Free Irish Derby (Ire-I) June 28 at the Curragh.
Australia, Coolmore and partners' regally bred Investec Epsom Derby (Eng-I) victor, could try to become the 17th horse to complete the Epsom and Irish Derby (Ire-I) double June 28 at the Curragh.
Australia won the Investec Epsom Derby (Eng-I) June 7 and provided trainer Aidan O'Brien with a third straight win in the classic and fifth overall at Epsom Downs.
Australia, third in the QIPCO Two Thousand Guineas (Eng-I) last month, is the favorite for the Investec Epsom Derby (Eng-I), which will have its 236th running June 7.
The QIPCO Two Thousand Guineas (Eng-I) drew a full field of 14 for the first jewel of England's Triple Crown May 3 at Newmarket, with Juddmonte Farms' unbeaten homebred Kingman the pre-race favorite.
Two Breeders' Cup World Championships winners, two trainers from the iconic Head family, and a filly owned by Her Majesty The Queen were among the honorees Nov. 12 when the 23rd annual Cartier Racing Awards were presented.
Mastercraftsman leapt to the top of the freshman sire list Oct. 26 following the victories of Craftsman in the JRA Killavullan Stakes and Kingston Hill in the Racing Post Trophy.
Paul Smith's unbeaten Kingston Hill will be a horse to watch for next season's classics after trouncing the field in the Racing Post Trophy (Eng-I) Oct. 26 at Doncaster.
The Coolmore stallion has already posted some astonishing figures but he will have few weekends like the one he enjoyed on the biggest stage in Europe.
Unbeaten Dawn Approach leads 24 colts going forward in the 2013 Investec Derby (Eng-I), the premier classic run at Epsom Downs June 1.
Camelot kept his perfect record intact with a superb five-length victory in the $2,054,000 Investec Derby (Eng-I) at Epsom June 2.
Last season's joint European champion 2-year-old Frankel heads 125 hopefuls going forward for the 2011 Investec Derby (Eng-I) following this week's scratching stage.
Workforce provided jockey Ryan Moore with a tremendous Classic double, romping to a seven-length victory in the Investec Derby (Eng-I) at Epsom June 5.
This Saturday, June 5, HRTV will present live coverage of the Group 1 Investec Derby, from Epsom Racecourse in the United Kingdom.
Eight horses have come forward at the second entry stage for this year's £1.25 million Investec Derby (Eng-I), highlight of the Investec Derby Festival at June 5.
Yearling entry stage, at a cost of $660, draws 16.7% more entries than last year.
Yearling entries for the 2011 running of the Investec Epsom Derby (Eng-I) must be made by noon Dec. 1.
Sea The Stars stamped his name in history with an impressive 1 3/4-length victory over Fame And Glory in the Investec Derby (Eng-I) at Epsom June 6. Sea The Stars became the first horse since Nashwan in 1989 to complete the 2000 Guineas-Derby double.
|Breeder / Owner
|Australia (GB)
|Kingston Hill (GB)
|Romsdal (GB)
|Real Good Deal S.
|Prairie Gold Juvenile S.
|Curlin S.
|Duke City Sprint S.
|Arapahoe Debutante S.


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3 Comments
neanderthalis ·
I noticed that the light changes color from image to image on this tower. Does the light change or is it a film variation?
moodification ·
@neanderthalis: You're very sharp-eyed! You're right, the color of the light changes (in a rather fast pace every few seconds), but I think the different films added to the effect.
jeanhuang ·
Great !


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Oakland, Berkeley, And East Bay News, Events, Restaurants, Music, & Arts
Best place for live music : The Ivy Room
Best Dee Jay:
Best Non-Profit/ RYSE Center
Best shop/ Rich City Rides
Best place to learn art/ Richmond Art Center
Best author Nayomi Munaweera
Best author- nayomi munaweera
best author...nayomi munaweera
Best ice cream / gelato :
I want to add Anasa Yoga to he best yoga studio list.
Best COFFEE. Red Bay Coffee.
I am so disappointed that you didn't think that there was value in a category for Best Fabric Store. The Fabric Stores in this area (the ones who are left) work very hard to provide the best fabric, notions, patterns and creative value for the entire Bay Area and beyond. They deserve the chance to be Best of the East Bay 2017 as much as any you have listed.
Best Author/Heather Alaine for "Ready"
Where is the best place to score some old school horse biscuits e-tabs and perhaps hang out and swill several pre-peak cocktails, listening to some 80's Smith's, Elvis, or early Beastie Boys? Once the peak hits, who knows what happens but I really need a place like this. Had a perfect little place out in Daily City, just a dudes basement I think, but he had X, tons of music, stocked bar and it could be 330pm on Tuesday and there would be like 8 people in there,reading books, rolling out of their minds,couple girls dancing on the table. Nobody seemed to live there or be I charge but it was always clean and everyone paid for everything. The honor system actually worked, but the tabs came from 2 different blokes, very charming men, very pleasant. Seem they have shuttered their cozy space. Looking for something similar where I can tab peacefully or perhaps meet an interesting stranger to engage in polite conversation. I can be reached by email firstname.lastname@example.com or whatsapp 8054073215
Been a pleasure
Best Caf... The Octopus Literary Salon
Best Place For Literary Events... The Octopus Literary Salon
I commute from out of town for the events and fine food here.
HEART MOTIVATED, NOT MONEY MOTIVATED, the fresh food is always fine here and made with love; the owner generous.
Justice Morrighan, poet
Isnt hangar one a brand of st george distillery?
Best Wine Bar:
Residual Sugar in Walnut Creek
Best Craft beer brewery experience;
Craft Cali Brewery in Walnut Creek
Submitted by Karen Dam
Best food and drink/ Bicycle coffee
Best Non-Profit/ RYSE Center
Best shop/ Rich City Rides
Best place to learn art/ Richmond Art Center
Best shop/ RICHMOND RIDES
Best Non-Profit/ RYSE CENTER
Best place to learn art/ RICHMOND ART CENTER
During the summer season, whenever we are planning to visit any new place to spend our holiday. The first thing comes to mind about our kids if we have, basically, we should take preventive steps to protect our kids from harmful sun rays during summer. Therefore, we are looking for best place to visit on a hot day with our kids. I would like to follow the ingredients present in this article and hope to get positive results.
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I invite Richard Lee to come to southwest Florida (bring friends) and help the movement explode here when amendment 2 passes in Nov. I would love to help you make a difference Mr. Lee down here in this wonderful sunny state. We need help, seriously. The little guys.... We need y'all to come show is the California way.


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Perry adds anti-groping bill to special session
Gov. Rick Perry announced he had added legislation that would make it illegal for TSA agents to engage in "intrusive touching" at airports security checkpoints without probable cause to the list of items for the legislature to consider during the special session.
The measure had previously failed to pass in the Texas Senate after the Justice Department wrote a scathing memo against the bill that threatened legal action against the state and the bill became enmeshed in Senate politics.
There are questions about what affect the legislation might have since airport security is a federal matter.
Lt. Gov. David Dewhurst, who was accused of lobbying against the bill in May said he was "pleased" by Perry's decision.
"I'm very pleased that Governor Perry agreed to add this legislation to his Special Session call," Dewhurst said. "Addressing unreasonable and unlawful searches of innocent travelers by some TSA employees is an issue that affects all Texans who use air travel, and it should not wait until next Session."
Before the Senate took up the bill initially, the Justice Department sent a letter to state advising that passage of the bill would result in immediate legal action by the federal government and that it could result in airline flights to and from Texas being delayed or cancelled.


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This 380 piece wooden puzzle of Manhattan is by the incredible contemporary artist Matte Stephens. Stephens' work may seem familiar if you watch the sitcom Modern Family, as one of his prints has been seen hanging on a wall of Mitch and Cam's house. The puzzle features fun city-themed whimsy pieces. (Click on the small pictures beneath the puzzle image to see example pieces and packaging). All our puzzles are laser-cut from 1/4" wood and made in USA. Packaged in our standard wide pine wood box.
- 380 pieces
- 15.25" x 11"
- laser cut wooden jigsaw puzzle
- Made in USA


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How to avail the offer :
- Visit deal page here
- Like on Facebook
- And get started
(13,500) winners will each receive one free bottle of Sparkling Fruit2O in the form manufacturer's coupon. They will be announcing winners throughout the promotion via email.
Grand Prize:
A spa day for four at the Indian Springs Resort and Spa in Calistoga, CA to be awarded in the
form of a gift card(s) totaling $1,128.


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|Home | About | Journals | Submit | Contact Us | Français
To describe chemotherapy use and adverse events (AEs) for advanced-stage, non–small-cell lung cancer (NSCLC) in community practice, including descriptions according to variation by age.
We interviewed patients with newly diagnosed, stages IIIB and IV NSCLC in the population-based cohort studied by the Cancer Care Outcomes Research and Surveillance Consortium, and we abstracted the patient medical records. AEs were medical events occurring during chemotherapy. Using logistic regression, we assessed the association between age and chemotherapy; with Poisson regression, we estimated event rate ratios and adjusted the analysis for age, sex, ethnicity, radiation therapy, stage, histology, and presence and grade of 27 comorbidities.
Of 1,371 patients, 58% (95% CI, 55% to 61%) received chemotherapy and 35% (95% CI, 32% to 38%) had AEs. After adjustment, 72% (95% CI, 65% to 79%) of those younger than 55 years and 47% (95% CI, 42% to 52%) of those age 75 years and older received chemotherapy. Platinum-based therapies were less common in the older-age groups. Pretreatment medical event rates were 18.6% for patients younger than 55 years and were only 9.2% for those age 75 years and older (adjusted rate ratio, 0.49; 95% CI, 0.26 to 0.91). In contrast, older adults were more likely to have AEs during chemotherapy. The adjusted rate ratios compared with age younger than 55 years were 1.70 for 65- to 74-year-olds (95% CI, 1.19 to 2.43) and 1.34 for those age 75 years and older (95% CI, 0.90 to 2.00).
Older patients who received chemotherapy had fewer pretherapy events than younger patients and were less likely to receive platinum-based regimens. Nevertheless, older patients had more adverse events during chemotherapy, independent of comorbidity. Potential implicit trade-offs between symptom management and treatment toxicity should be made explicit and additionally studied.
Lung cancer is the leading cause of cancer-related death. Non–small-cell lung cancer (NSCLC) comprises 80% of occurrences, and one half have metastatic disease at the time of diagnosis.1 Clinical trials in advanced NSCLC show that chemotherapy can improve survival and has acceptable adverse event (AE) rates. A meta-analysis of randomized, controlled trials of palliative chemotherapy for NSCLC concluded that cisplatin-based chemotherapy regimens prolong survival compared with best supportive care alone.2 More recent trials have documented that doublet combinations of platinum (ie, cisplatin or carboplatin) with taxanes, vinorelbine, camptothecin analogs, and gemcitabine achieve similar response rates,3,4 and single agents have demonstrated benefits in elderly-specific trials.5,6
However, older adults have been under-represented in lung cancer clinical trials, and retrospective subgroup analysis of results in fit older patients provides limited evidence that these benefits may extend to older persons.7 This is of concern, because NSCLC is primarily a disease of older persons: 47% of patients are at least 70 years old at the time of diagnosis, and 14% are at least 80 years old.8 In marked contrast, only 25% of clinical trial patients were age 65 years or older,9 and the average age is 9 years younger than in the community.10 Although more recent trials have increasingly included people age 70 years and older, the same cannot be said of the group of patients who are 80 years and older.
Thus, the best treatment for older patients with advanced NSCLC is debated.11,12 Perhaps in part because of uncertainty about the balance between toxicity, symptom relief, and changes in quality of life and survival, a pronounced inverse association between age and receipt of recommended therapies has been observed.8,13 Clinical trials have limited utility for understanding care and effects in the community, where physicians may assume that older patients have poor prognoses or are at high risk for toxicity. However, the AE rate in the community and its association with patient age has not been reported. The purpose of this article is to describe the AEs experienced during chemotherapy for advanced-stage NSCLC in a population-based cohort and to describe how this varies by age. We tested whether age was associated with receipt of chemotherapy and, among those who received chemotherapy, whether age was associated with clinically important AEs.
Participants were enrolled on the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS).14 The consortium conducted a prospective, population-based cohort study on patients with newly diagnosed lung and colorectal cancer in 2003 to 2005 in multiple regions of the country and at a variety of healthcare delivery systems. Forty-nine percent of eligible patients with lung cancer participated. In CanCORS sites that had affiliated Surveillance, Epidemiology, and End Results (SEER) registries, the CanCORS cohort was similar to SEER in stage (stage IV, 38.1% v 41.1%), age (older than 75 years, 26.9% v 33.1%), and ethnic distribution (African American, 11.8% v 9.8%; Hispanic, 4.8% v 5.3%; Asian, 3.6% v 4.7%).
Data collection included a patient interview at enrollment and at 12 months after diagnosis, medical record abstraction, and surveys of treating physicians and informal caregivers.15 Because of the heavy burden of illness and the significant mortality, surrogate versions of the patient baseline interview were also developed: one for when the patient was alive but too ill to participate, and another if the patient was deceased. Participants (n = 1,371) included in this analysis were all those patients with stage IIIB or IV NSCLC who did not receive primary surgery and for whom medical records were collected.
Age, sex, and ethnicity were obtained from the baseline patient interview. Chemotherapy use data were obtained from the medical record and included the start and end date of each chemotherapy regimen along with the drugs administered. Chemotherapy regimens were categorized as platinum-based or non–platinum-based to explore whether older adults were more likely to receive less-toxic (ie, non–platinum-based) regimens. Radiation therapy (any v none), tumor histology (squamous cell, adenocarcinoma, other), stage (IIIB or IV), and comorbidities also were abstracted from the medical record. Comorbidity at the time of diagnosis was represented as a summary index value (none, mild decompensation, moderate decompensation, severe decompensation) across the 27 comorbidities included in the Adult Comorbidity Evaluation 27 (ACE-27) instrument.16 From the ACE-27, a cardiovascular disease index (none, mild, moderate, severe) was constructed as of the time of diagnosis from three indicators of heart disease (myocardial infarction, angina/coronary artery disease, and congestive heart failure). Similarly, the ACE-27 respiratory indicator was coded at diagnosis as a separate index (none, mild, moderate, severe disease).
Medical record abstractors were trained to record clinically important medical events in an abstraction window from 3 months before diagnosis through 15 months after diagnosis. An event was clinically important if it was acknowledged and reported by a clinician caring for the patient. Abstractors recorded medical events from a drop-down list of 34 distinct terms and associated definitions. All records for a patient, including those from hospitals, oncologist offices, and primary care offices, were reviewed. For example, abstractors were instructed to record fever with neutropenia regardless of whether it resulted in a hospitalization. Only the first occurrence of a particular medical event during the abstraction window was recorded. For this article, we analyzed medical events that occurred before treatment (ie, pretreatment medical events) and those that occurred during treatment. Any medical event that occurred while on chemotherapy was considered an AE. In addition to analyses of all AEs, we analyzed rates of AEs especially likely to be chemotherapy-related: neuropathy, fever with neutropenia, and sepsis. Because an event could be recorded only once, participants with an event in the pretreatment period (ie, between diagnosis and treatment initiation) were excluded from analyses of AEs.
Multivariable logistic regression was used to model the association between age group (< 55, 55 to 64, 65 to 74, and ≥ 75 years) and receipt of chemotherapy for all participants after the analysis was adjusted for demographic and clinical variables. Covariate-adjusted, predicted probabilities of receiving recommended therapy were estimated from these models.13,17 Next, the subset of patients who received chemotherapy was analyzed. Covariate-adjusted probabilities of receiving a platinum-based drug in the first round of chemotherapy and at least one of several types of adverse events were modeled by using logistic regression, whereas rates of the corresponding events (or first instance of the events) were modeled by using Poisson regression. Among those who received chemotherapy, Poisson regression was employed to estimate rate ratios of adverse events experienced during chemotherapy treatment, and analysis was adjusted for differences among age groups and other covariates. In these analyses, our main independent variable was patient age group, and our main dependent variable was the rate of total medical events during chemotherapy, defined as the number of first event occurrences. We classified every person-day of chemotherapy cohort follow-up as before chemotherapy, during chemotherapy (including a 30-day period after the last date chemotherapy was administered), or after chemotherapy. Finally, to examine the possibility of selection bias between age groups among those who received chemotherapy, Poisson regression estimated rate ratios of the mean number of different types of medical events experienced between diagnosis and treatment initiation.
All analyses controlled for interview type (full patient interview, brief patient interview, surrogate interview for live patient, surrogate interview for deceased patient) because of strong differences in receipt of chemotherapy by interview type. Multiple imputation methodology was used to compensate and adjust for missing information in each generalized, linear (regression) model.18
There were 1,646 participants with stage IIIB or IV lung cancer; 1,371 remained after those with prior lung surgery or with missing sex or age data were excluded. Of these remaining patients, medical records indicated receipt of at least one course of chemotherapy for 798 (58%; 95% CI, 55% to 61%; Table 1). Targeted molecular therapy was used by less than 3% of patients because of the time period of study. Almost half of patients received radiation therapy (Table 1); of these, 58% also received chemotherapy (Table 2).
Older adults were less likely to receive chemotherapy and to receive radiation therapy, had poorer respiratory function at diagnosis as measured by the ACE-27 respiratory indicator, and had more cardiovascular and other comorbidities at diagnosis (Table 1). Most patients (n = 864) were age 65 years or older, and 30% were age 75 years or older.
Age was strongly and inversely related to receipt of chemotherapy; after adjustment, 72% of patients younger than 55 years received chemotherapy, but only 47% of those age 75 years and older did (Table 2). Interview type, age, sex, histology, and degree of respiratory disease at diagnosis also were statistically significant predictors of the receipt of chemotherapy after analysis was adjusted. There were no significant interactions between age and any of the disease or comorbidity measures, which indicated that the inverse relationship between age and receipt of chemotherapy did not depend on these measures. Men were more likely than women to receive chemotherapy. To additionally explore this, we confirmed this association among the subset of participants for whom marital status was available (marital status was not collected in the brief version of the interview) and found that addition of marital status to the models eliminated the sex differences (data not shown). Those who were unable to complete the full baseline interview were less likely to receive chemotherapy.
We classified the first chemotherapy regimen for each patient as cisplatin based (n = 83; 10.4%), carboplatin based (n = 521; 65.3%), non–platinum based (n = 173; 21.6%), or unknown (n = 21; 2.6%). Most (n = 615; 79.2%) first chemotherapy regimens were multiagent regimens, and, of these, platinum-based regimens (n = 576) accounted for 93.7%. Most (n = 162) single-agent regimens were non-platinum agents. Among those treated with chemotherapy, older adults were less likely to receive a platinum-based first regimen; 84% (adjusted percent) of patients younger than 55 years were receiving a platinum-based treatment, and this decreased to 71% among patients age 75 and older (Table 3). Most of this difference was due to a lower rate of cisplatin use with advancing age (Table 1). After adjustment for all other variables, age, interview type, research site, and comorbidity were statistically significant predictors of the receipt of platinum-based chemotherapy (Table 3).
Older adults who received chemotherapy were less likely to have a clinically important acute medical event during the period from diagnosis to the start of chemotherapy than were younger adults, and this rate decreased from 18.6% among those younger than age 55 years to 9.2% among those age 75 years and older (Fig 1). Although the CIs around the adjusted percents (Fig 1) overlap, adjusted rates that incorporated variable person-times were more precise, and the adjusted rate ratio for this difference was statistically significant (adjusted rate ratio, 0.49; 95% CI, 0.26 to 0.91).
Table 4 displays the frequency of the individual AEs recorded during chemotherapy use. The rates of adverse events among 702 participants who were event free before treatment are listed in Table 5. There were 365 events during 100,769 person-days of chemotherapy among 249 people (35%; 95% CI, 32% to 39%), so some had more than one type of AE during treatment. The highest AE incidence was among 65- to 74-year-olds (adjusted percent, 42.4%; 95% CI, 36.1% to 48.7%) for an adjusted rate ratio of 1.70 (95% CI, 1.19 to 2.43) when compared with those patients age younger than 55 years. Other variables that were related to AE rate after adjustment included interview type, research site, cardiovascular disease at diagnosis, and receipt of radiation (data not shown). There were no age interactions with any covariate, suggesting that AE rate for a given age group did not vary by levels of covariates (eg, cardiovascular and other comorbidity).
When AEs that were particularly likely to be chemotherapy-related were analyzed, the age relationship continued to be evident, and the highest rates were observed among those age 65 years and older (Table 5). Rate ratios for the individual chemotherapy-sensitive AEs followed the same age pattern but were individually of too low a frequency to be statistically significant. Other variables positively related to rate of the composite neuropathy/fever with neutropenia/sepsis measure after adjustment included inability to complete the full baseline interview, Los Angeles County and Iowa research sites, and greater percent of chemotherapy time spent on platinum.
We have characterized the chemotherapy treatment experience in a population-based study of patients with advanced-stage NSCLC. Overall, 58% of patients on CanCORS who had advanced lung cancer received chemotherapy, and this was the same for both stage IIIB and IV disease. This is a considerably higher frequency than the 41% reported for patients with stage IV disease in the 1996 SEER Patterns of Care (POC) study13 that had a somewhat younger age. This suggests increasing use in more recent periods.
Older patients were much less likely to receive chemotherapy, and they were more likely to receive nonplatinum chemotherapy regimens when they did receive chemotherapy. Older patients who received chemotherapy had significantly lower baseline (ie, pretreatment) medical event rates, which reflected selection of the fittest elders for treatment. Despite this selection, significantly higher AE rates were seen during chemotherapy among the oldest age groups compared with the youngest age group, and these rates reached 42.4% (95% CI, 36.1% to 48.7%) in patients age 65 to 74 years (RR, 1.70; 95% CI, 1.19 to 2.43) before dropping slightly to 36% (95% CI, 28.7% to 43.3%) in patients age 75 years and older (RR, 1.34; 95% CI, 0.90 to 2.00). These findings are consistent with previous studies that showed that the elderly were much more likely to not receive therapy and that, when treated, the elderly were much more likely to receive less aggressive therapy.13,19–21 None of these age relationships could be explained by a severity-adjusted measure of comorbidity.
AE rates were the highest for the 65- to 74-year-old age group, and the chemotherapy treatment rate for this group was similar to that for 55- to 64-year-old patients. In contrast, treatment rates and pretreatment morbidity levels were much lower for the age group of 75 years or older, which possibly reflected selection of the fittest candidates for treatments. Thus, a likely explanation for the higher AE rate for the 65- to 74-year-old patients is that physicians may think these patients are better able to tolerate treatment and may pursue treatment more aggressively than with the age group of patients age 75 years and older.
Interestingly, we observed a lower proportion of women receiving chemotherapy, and this was not explained by age, as women with lung cancer were younger, on average, than men. Instead, a likely explanation is that married people receive chemotherapy more often, and women are more likely to outlive their husbands. Many studies, especially secondary analyses of administrative and registry data sets, do not have measures of social function, such as marital status. Such factors may be important for understanding apparent disparities in receipt of cancer treatments.
Ethnicity was not associated either with receiving chemotherapy or with adverse events. Analyses of SEER-Medicare data from earlier periods found that elderly black patients were less likely to receive chemotherapy. Absence of such a relationship in our data may reflect progress to narrow previous disparities or may reflect different data sources.
Performance status is an independent predictor of chemotherapy,22–24 and this was not well documented in medical records. However, we were able to control for a surrogate for performance status—interview type—in all analyses. In CanCORS, interview type was a strong predictor of receiving chemotherapy, as those who were unable to complete the full baseline interview were less likely to receive chemotherapy. In particular, only 38% of those who were deceased at the time of the baseline interview received chemotherapy compared with 83% of those who completed the full patient baseline interview.
The two health system research sites (ie, Cancer Research Network and the Veterans Health Administration) had the two highest unadjusted rates of use of platinum-based chemotherapy regimens, and the rates remained somewhat higher after adjustment. This was true for all age groups and, thus, did not reflect greater use in younger patients only (data not shown). Interestingly, these research sites did not have higher AE rates; the highest rates were in Los Angeles County and Iowa. Although it is possible that the health system sites were better able to minimize AEs while delivering platinum-based treatments, an alternative explanation is a geographic variability in abstracting procedures or physician AE documentation practices.
Our results confirm findings on the basis of administrative claims data that document a decline in the use of chemotherapy with increasing patient age after adjustment for other factors.13,20,25,26 Numerous previous authors have questioned whether elderly patients are denied potentially beneficial treatment and participation in clinical trials simply because of their age and out of concern that they are too frail to tolerate treatment.11–13,20,25,26 CanCORS provides important new information, including medical record–based ascertainment of AEs in defined populations with new-onset disease and robust control for 27 comorbid conditions and their severities. Our finding that treated elders have lower pretreatment rates of clinically important medical events suggests that practicing physicians require that elders be even more fit than younger adults before recommending chemotherapy. Our finding of a higher rate of AEs on treatment despite this selection suggests that some differential application of selection criteria by age may be justifiable. Because patients may weigh the quality-of-life impact of disease progression more heavily than that of severe toxicity,27 it is possible that patients would not agree. Regardless, the trade-off between disease-related symptoms and treatment toxicity is a prime example of the need to include patient preferences into medical decision making. To do so in a patient-centered fashion, we need to make these trade-offs explicit and we need to gather the information that will allow these decisions to be made jointly by patient and provider in as evidence-based a way as possible. We believe that our study advances the field in this direction but much more remains to be done.
In conclusion, this study has generated important information about the AEs experienced by a representative community population of elderly patients who received chemotherapy for advanced-stage NSCLC. The purpose of this chemotherapy is to improve quality of survival by reducing disease-related symptoms. Because older patients have at least as many disease symptoms as younger patients, a logical consequence of lower treatment rates is more disease symptoms and worse quality of life for the oldest patients. An unanswered question is whether the increased AEs associated with chemotherapy among the oldest patients who received chemotherapy was offset by improvement in their disease symptoms to provide a net positive effect on quality of life. Future quantifications of quality of life and survival outcomes for the CanCORS cohort will be important contributions to a fuller assessment of this possibility.
From the Departments of Epidemiology and Biostatistics, College of Public Health, University of Iowa, Iowa City, IA; Division of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles; Northern California Cancer Center, Fremont, CA; Departments of Biostatistics and Computational Biology and of Medical Oncology, Dana-Farber Cancer Institute; Department of Biostatistics, Harvard School of Public Health; and Harvard Medical School, Harvard University, Boston, MA; Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL; Division of Medical Oncology, Duke University Medical Center; and Veterans Affairs Medical Center, Durham, NC.
See accompanying editorial on page 523
Written on behalf of the Cancer Care Outcomes Research and Surveillance Consortium.
Supported by Grant No. U01 CA093344 from the National Cancer Institute (NCI) to the Statistical Coordinating Center; NCI-supported Primary Data Collection and Research Centers Grants No. U01 CA093332 (Dana-Farber Cancer Institute/Cancer Research Network), U01 CA093324 (Harvard Medical School/Northern California Cancer Center), U01 CA093348 (RAND/University of California, Los Angeles), U01 CA093329 (University of Alabama at Birmingham), U01 CA01013 (University of Iowa), and U01 A093326 (University of North Carolina); a grant from the Department of Veterans Affairs to the Durham Veterans' Affairs Medical Center; and Agency for Healthcare Research and Quality Centers for Education and Research on Therapeutics Cooperative Agreement No. 5 U18 HSO16094 (E.A.C., J.F.P., and R.B.W.).
Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
The author(s) indicated no potential conflicts of interest.
Conception and design: Elizabeth A. Chrischilles, Jane F. Pendergast, Katherine L. Kahn, Robert B. Wallace, Daniela C. Moga, David P. Harrington, Jane C. Weeks, Robert H. Fletcher
Administrative support: Robert B. Wallace, Daniela C. Moga, David P. Harrington, Robert H. Fletcher
Provision of study materials or patients: Elizabeth A. Chrischilles, Katherine L. Kahn, Robert B. Wallace, Jane C. Weeks, Dee W. West, Robert H. Fletcher
Collection and assembly of data: Elizabeth A. Chrischilles, Jane F. Pendergast, Katherine L. Kahn, Robert B. Wallace, Daniela C. Moga, David P. Harrington, Jane C. Weeks, Dee W. West, Robert H. Fletcher
Data analysis and interpretation: Elizabeth A. Chrischilles, Jane F. Pendergast, Katherine L. Kahn, Robert B. Wallace, Daniela C. Moga, David P. Harrington, Catarina I. Kiefe, Jane C. Weeks, Robert H. Fletcher
Manuscript writing: Elizabeth A. Chrischilles, Jane F. Pendergast, David P. Harrington, Catarina I. Kiefe, S. Yousuf Zafar, Robert H. Fletcher
Final approval of manuscript: Elizabeth A. Chrischilles, Jane F. Pendergast, Katherine L. Kahn, Robert B. Wallace, Daniela C. Moga, David P. Harrington, Catarina I. Kiefe, Jane C. Weeks, Dee W. West, S. Yousuf Zafar, Robert H. Fletcher
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Date: September 21, October 5, January 18, February 1 & 15, April 5 & 19, May 3 & 17
(All days must be attended in order to receive credit)
Location: Ft. Dodge Central Office, 104 South 17th Street
Time: 1:45 p.m. - 3:30 p.m.
Course #: EDEX 288:800
This class is available for License Renewal credit or Audit.
If you would like to receive License Renewal credit for this class payment by credit card is required at time of registration. Please note that the Ft. Dodge CSD is working in collaboration with ISEA in offering this class at a reduced fee amount.
If you are Auditing this class, please choose the Payment Method as "Purchase Order" and enter your PO number as: District Pay. The Ft. Dodge district will pay for you to audit this class.
Fort Dodge Community School District104 South 17th StreetFort Dodge, IA 50501
Rhonda Plimmer
Cvent Online Event Registration Software | Copyright © 2000-2017 Cvent, Inc. All rights reserved.


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|Beyond the Familiar: Long-Term Growth Through Customer Focus and Innovation
|May 12-13, 2011
|Persistent growth is elusive. Even the best companies lose the ability to generate long-term growth from time to time, in some cases irrecoverably. Long-term growth results from driving the top line organically or through acquisitions, combined with good cost management. This session offers a practical framework to help executives master the challenge of achieving long-term organic profit growth by building strong brands based on actionable customer insights flowing freely through the business and ultimately leading to consistently great customer solutions and experiences. Our discussions will centre on the underlying imperatives firms need to meet to drive sustained organic growth.
|Call Emile Borrer: +41 (0)21 618 0567


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Starting 8/23, Rite Aid will have Juicy Juice 4-packs on sale for $0.88, plus you will get 100 Plenti Points (value $1) when you buy five. We have a newspaper coupon to use with the deal that will make these dirt cheap.
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text: I'm Reggie and my quest to become the best photographer in the world started when I was a young teen. Now that I am older, I know that I can be one of the best in the world, even though there are so many photographers out here. Well to achieve my goal, I enrolled in the Art Institute of Philadelphia. While a student there, I started working in a commercial lab where I learned lighting techniques for product photography (1985). There I also began my career as a wedding photographer, all while shooting for a law firm, doing personal injury, property damage and reconstructive investigative photography. These things were happening while I was still a student learning from both ends of the spectrum technical and professional (OJT). After graduating more opportunities opened up for me. As I progressed, public relation photography became a part of my repertoire. I believe that in the field of photography the photographers work has to speak for itself. As you browse through my pages, you will see I have experience in many phases of the field of photography and I love what I'm doing in my professional life. The goal is to satisfy the customer and become the best photographer in the world! Visit www.rgainesphotography.biz or call 609-254-0974 to schedule an appointment. Also... President of the Larry Gaines Stop the Violence Organization (LGSTV) Founded in 1995, The Larry Gaines Stop the Violence Organization is a nonprofite grassroots organization committed to mentoring youth through peer mediation, conflict resolution, collaboration and cooperation. Visit www.larrygainesstoptheviolence.com


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Nipple piercings are one of the most popular piercings in male and female adults. The piercing consists of a generally horizontal barbell or ring at the base of the nipple. Because of the location on the body and the sensitivity of the area, the nipple piercing is at risk for infection if not cared for properly during the healing process.
Causes of Infection
Infection occurs in all piercings when proper after-care techniques are not followed. According to BME, one major cause of infection in nipple piercings is frequent touching or fondling the piercing. Playing with the nipple piercing introduces bacteria to the piercing site. Other forms of infection can occur when the piercer was not working in a sterile environment. This can happen by reusing equipment, not using proper hand-washing and gloving techniques or failing to disinfect the facility before piercing. Bodily fluids such as saliva can also cause infection in new piercing sites.
Signs and Symptoms
According to the Center for Young Women's Health in Boston, the following are signs of infection in a piercing site: redness, yellow or green discharge, foul odor, swelling, fever and rash. These symptoms vary in severity but can often be the first warning sign that a bacterial infection is occurring in the nipple-piercing area. If you are unsure, contact your piercer or doctor to determine if an infection may be forming.
If a serious infection is suspected, contact your physician to prevent permanent damage or spreading infection. The most common treatments recommended by FamilyDoctor.org are over-the-counter antibiotic creams, soaking with sea salt and warm compresses to draw the infection out of the body. Throughout treatment, proper hand-washing should be maintained.
While not necessarily infection, nipple piercings are also prone to rejection. Rejection occurs when the body heals the skin behind the piercing and forces it out of the site. This can occur due to allergic reactions to the metal or because not enough skin was pierced to hold the jewelry in.
While it is hard to resist, avoiding touching the piercing can make the difference between causing an infection or not. It's important to keep all other bodily fluids (even your own) away from the piercing site to not introduce any external bacteria. Using proper after-care techniques is crucial to healing the piercing as fast as possible without any infection occurring. Wearing loose clothing and not allowing frequent rubbing and irritation helps heal the piercing quickly. The Center for Young Women's Health also recommends making sure to wash off all sweat after exercise. It's most important to follow the piercer's after-care instructions for proper cleaning.
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- Photo Credit Male Nipple Piercing, Fimb/Flickr.com
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- birdsong
- noun Date: 1896 the song of one or more birds
New Collegiate Dictionary. 2001.
New Collegiate Dictionary. 2001.
Birdsong — may refer to:* Bird vocalisation, the sounds of birds * Birdsong (novel), a 1993 novel by Sebastian Faulks * Birdsong, Arkansas, USA * Birdsong, a green or black Teflon finish to firearms that was pioneered by Walter Birdsong * Birdsong, a… … Wikipedia
Birdsong — ist der Name mehrerer Orte in den Vereinigten Staaten: Birdsong (Alabama) Birdsong (Arkansas) Birdsong (Missouri) Birdsong Crossroads (Georgia) Birdsong Heights (Tennessee) Personen: Bob Birdsong (* 1948), US amerikanischer Bodybuilder Carl… … Deutsch Wikipedia
Birdsong — Birdsong, AR U.S. town in Arkansas Population (2000): 40 Housing Units (2000): 27 Land area (2000): 0.109456 sq. miles (0.283491 sq. km) Water area (2000): 0.000000 sq. miles (0.000000 sq. km) Total area (2000): 0.109456 sq. miles (0.283491 sq.… … StarDict's U.S. Gazetteer Places
birdsong — /berrd sawng , song /, n. the singing or calling of birds, esp. songbirds. [BIRD + SONG] * * * Certain vocalizations of birds, characteristic of males during the breeding season, for the attraction of a mate and for territorial defense. Birdsong… … Universalium
birdsong — [[t]bɜ͟ː(r)dsɒŋ, AM sɔːŋ[/t]] birdsongs also bird song N UNCOUNT: also N in pl Birdsong is the sound of a bird or birds calling in a way which sounds musical. The air is filled with birdsong … English dictionary
birdsong — noun (U) the musical noises made by birds: Birdsong and the hum of insects filled the air … Longman dictionary of contemporary English
birdsong — noun A musical sound made by a bird … Wiktionary
birdsong — bird|song [ˈbə:dsɔŋ US ˈbə:rdso:ŋ] n [U] the musical noises made by birds … Dictionary of contemporary English
birdsong — bird|song [ bɜrd,sɔŋ ] noun uncount the musical sounds that birds make … Usage of the words and phrases in modern English
birdsong — n. song of birds; birdcall, sound that birds make; song, collection of sounds made by a bird or other animal … English contemporary dictionary


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Lena Dunham Battling Endometriosis
The Condition That Is Preventing Lena Dunham From Promoting the Final Season of Girls
Most know and love Lena Dunham for her outspoken personality and radiant confidence, but the actress recently shocked fans after announcing her battle with a serious case of endometriosis. This condition occurs when uterine lining tissue strays outside the uterus and grows in places it isn't meant to. Along with causing severe pain, endometriosis may cause infertility. Lena shared a note about her ongoing struggle on Instagram and how it's affecting the final season of Girls.
Hey Beloved Pals, I just wanted to let you know that, while I am so excited for Girls to return on Feb 21, I won't be out and about doing press for the new season. As many of you know I have endometriosis, a chronic condition that affects approximately 1 in 10 women's reproductive health. I am currently going through a rough patch with the illness and my body (along with my amazing doctors) let me know, in no uncertain terms, that it's time to rest. That's a hard thing to do, but I'm trying, because all I want is to make season 6 of Girls the best one yet. I'm lucky enough to have support and backup from Jenni, Judd and the whole Girls gang. So many women with this disease literally don't have the option of time off and I won't take it for granted. Wishing you all health & happiness, in whatever form suits you. Back soon xxLena
Endometriosis reaches approximately 10 percent of women during their reproductive years, and many are beginning to speak out about their personal experience with the condition, including musician Halsey.
If any of my fans or followers have #endometriosis 💛 having a rough time today. laying in bed thinking of you. pic.twitter.com/LOQVn5BsSg
— HALSEY (@halsey) January 29, 2016


text: Gallery of Images for Dr. Amy Honale Main Article • Theories • Main Discussion Amy Honale Hanso file photo (The Lost Experience)Add a photo to this gallery Retrieved from "http://lost.wikia.com/wiki/Dr._Amy_Honale/Images?oldid=36187" Ad blocker interference detected! Wikia is a free-to-use site that makes money from advertising. We have a modified experience for viewers using ad blockers Wikia is not accessible if you've made further modifications. Remove the custom ad blocker rule(s) and the page will load as expected. Categories: Galleries Add category Cancel Save


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|"metatech (JIRA)" <j...@apache.org>
|[jira] [Commented] (AMQ-3692) ActiveMQ OSGi bundle should be stopped when broker stops itself
|Sat, 22 Sep 2012 11:01:07 GMT
[ https://issues.apache.org/jira/browse/AMQ-3692?page=com.atlassian.jira.plugin.system.issuetabpanels:comment-tabpanel&focusedCommentId=13461113#comment-13461113 ] metatech commented on AMQ-3692: ------------------------------- Claus: it is a normal ShutdownHook : the object is created during broker creation, but the "run" method is only executed when the shutdown is triggered. The thread started within the "run" has no loop : it only runs once and then terminates. So I think there should be no additional thread termination mechanism. > ActiveMQ OSGi bundle should be stopped when broker stops itself > --------------------------------------------------------------- > > Key: AMQ-3692 > URL: https://issues.apache.org/jira/browse/AMQ-3692 > Project: ActiveMQ > Issue Type: New Feature > Components: Broker > Affects Versions: 5.4.2 > Environment: ServiceMix 4.3 > Reporter: metatech > Fix For: 5.8.0 > > Attachments: activemq-broker.xml, BrokerBundleWatcher.patch, BrokerBundleWatcher_v2.patch, BrokerService.patch > > > In case of error, the ActiveMQ broker can stop itself. > In an OSGi/Blueprint environment, the bundle is however still in Active/Created state, which misleads an external monitoring software into thinking that the broker is running fine. > This patch stops the bundle when the broker stops itself. > This patch can also auto-restart the bundle, which will restart the broker. > This is critical in an Master/Slave configuration : when the connection to the database is lost, the broker cannot maintain the DB exclusive lock, and it stops itself. The bundle should be stopped and started again, so that it enters again the "Creating" state, in which it waits to obtain the DB lock again. > The class "BrokerBundleWatcher" needs to be registered with the "shutdownHooks" property of the ActiveMQ "BrokerService". However, there is a limitation with the XBean syntax in a Blueprint XML, which does not allow to define inner beans. The workaround is to define the "activemq-broker.xml" in full native Blueprint syntax (no XBean). > The patch also provides a modified version of the BrokerService, that injects its own reference into the ShutdownHook's which implement the "BrokerServiceAware" interface. -- This message is automatically generated by JIRA. If you think it was sent incorrectly, please contact your JIRA administrators For more information on JIRA, see: http://www.atlassian.com/software/jira
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October 28-November 6, 2011, marks the 24th annual WRAP Week campaign (White Ribbon Against Pornography) and Concerned Women for America (CWA) once again joins the national effort to raise awareness against the scourge that is pornography.
Dr. Janice Shaw Crouse, Senior Fellow at CWA's Beverly LaHaye Institute, said, "Few parents are aware that the average age of a child's exposure to pornography is now nine years old. Also, few parents realize that pornography is now much more than simple cleavage or sexy photos; pornography is now mostly graphic and degrading and often crude and cruel. Psychologists tell us that images are permanently imprinted on the mind and that it can become addictive. We know that more and more men are substituting pornography for real relationships and that, increasingly, pornography is setting the pattern for what young men expect from their dates. CWA is doing everything we can to educate the public and to clean up the Internet and entertainment worlds to make them safe places for our children."
Penny Nance, Chief Executive Officer and President of Concerned Women for America, said, "The idea that pornography is victimless is an insidious lie from the industry. Addicted men and their families are devastated, and the women in the industry are victimized and exploited."
The WRAP Week campaign began with one woman, Norma Norris, in 1987. She heard a sermon which "lamented that local prosecutors and law enforcement had been deluded into thinking that people didn't care about the hardcore porn being sold in her community." Norma didn't accept that premise and took action to show her community that pornography is a big problem and should not be ignored.
Morality in Media became the national sponsor soon after the campaign began and uses WRAP Week to "educate the public about the extent of the pornography problem and what can constitutionally be done about it."
What many people do not know is that the United States Supreme Court declared in Miller v. California 413 U.S. 23 (1973) that obscenity is not protected speech. The ruling read, in part, "This much has been categorically settled by the Court, that obscene material is unprotected by the First Amendment."
To read more about Supreme Court rulings concerning obscenity, please see Concerned Women for America's brochure, "Obscenity is NOT Protected Speech," as well as the "Facts About Pornography" and "Pornography and Sex Trafficking: The Link" brochures.
Other ways to raise awareness about the pervasive and damaging effects of pornography on our culture, families, and communities are:
Wear a White Ribbon. You may make your own ribbons or order enamel pins and car magnets at www.wrapfamily.com. When people ask why you are wearing it, you can hand them a CWA Fact Card about WRAP Week and/or CWA's brochures. Make complaints to your United States Attorney and State prosecutor about Internet pornography or other forms of hardcore pornography at www.ObscenityCrimes.org. Ask your pastor or religious leader to give a sermon on the dangers of pornography to individuals, families, and communities.
Support decency. Wear a white ribbon during WRAP Week.


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I'm a mother of 4, 3 births, 1 set of twins. No c-section but I do have low scar from tube removal due to a tubal pregnancy. I can't remember ever having a flat stomache. I had my first child at 15 and had the loose skin ever since, of course it got worse after each pregnancy. I've recently began a weight loss and fitness journey about 7months ago. I've lost 30lbs and I've worked my ass off. I've completely changed my eating habits and I work out like a beast (I'll insert before and after pics of the weight loss) . I'll insert photos of the infamous FUPA. However we all know that the loose skin can't be "worked off". So I'm finally doing it. Im very close to my goal weight, I've worked hard to save the money, and I'm excited to be doing something for me.
38yo Mom of 4 Ready to Say Goodbye to the FUPA!!
Pre-Op Visit
Hey guys, had my pre-op visit yesterday and everything went well. I received all of my prescriptions (pain meds, antibiotics, steroid pack, and bld thinner because I've had a clot in the past) blood was drawn, pics were taken, and I had a chance to ask my long list of questions. So balance is paid in full (it was so hard to hand over all that money) and I was given all my pre-op instructions leading up to the day of surgery which is Monday 12/15/16 at 9am!!! 30 pounds lighter and that saggy skin is still hanging around (pun intended). Can't wait to say goodbye to the FUPA forever!!!
'Twas the night before Tummy Tuck
I'm officially past the don't eat or drink time and wide awake!!!! I prepared a few meals set up camp in my daughter's room (she's only 2 and almost never sleeps in there), and I'm ready to be snatched!!! I go in at 9am so I'll update u guys when I can..
Surgery day!!!!
On my way to the surgery center and my stomach is in knots. I'm very excited and praying for a successful recovery. I'll update U guys as soon as I'm up to it.
6 hrs post op
So far so good. Pain not as bad as expected. Very, very uncomfortable and tight but i can't say that I'm in excruciating pain. No appetite but very thirsty. Drinking a ton of water and forced a little chicken soup
Just to have smthg with the meds. Walked to bathroom alone jus had hubby there just in case. I have 1 drain bulb but it has two tubs connected.
Just to have smthg with the meds. Walked to bathroom alone jus had hubby there just in case. I have 1 drain bulb but it has two tubs connected.
1 day post-op follow up.
I'm completely in awe about my results. Dr. Gabay did an amazing job. I'm doing well. I washed and dressed alone, for the most part. My husband helped toward the end. I'm very out of breath. I coughed to day..OMG!!!! Everything they said about that is right. Most pain I've had so far. It felt like a bomb exploded inside of me!!! My muscle felt contracted for a good 3-5'mins then it eased up. But when they took of my belt I was all smiles. Dr said my drains will be in for at least 2 weeks. I thought about a week but he was not budging and I trust him.. he said i can shower, but not long and hot. Quick and warm, so I'm happy about that.. thanks so much for all of the support so far ladies
Back soreness kicking in
Going to my follow up yesterday in the rain, in the cold, 1 day post-op was a bit much. Had to stop at a friend's house u can can't hold it, when u got to pee u gotta go asap!! Came home and showered and was just very tired. Today is day 2 post op and I'm just very tired and my back is sore. Coughing has been a problem today and I must say that's the worst pain I've felt so far. Now that almost brought tears to my eyes. It's been a little more difficult getting comfy in my recliner today because of the back pain. I did get up and move around a little. Made myself a little breakfast and later on lunch. However I'm very tired today so I'm not moving from this chair again until my shower before bed. Over all today was a bit more difficult than yesterday but still bareable
Day 4 post-op
Completely off all pain meds, just Tylenol as needed. Getting up and down is much easier, and I have my appetite back. Some back discomfort if I stand for too long but once I sit down I'm ok. Over all I don't have a lot of complaints, Coughing and sneezing is my biggest issue. Last night my husband was helping me dress after my shower and I realized for the first time in 7 yrs I stood in front if my husband completely naked with no shame!!! I'm so excited about how I'll look once I'm fully healed. I feel sexier already!!!!
Day 12 PO
Wanted to let you know ladies that I'm feeling great. A little muscle cramping in the upper ab area (taking Tylenol), exhausted after I go out for a cpl hrs, but overall feeling good. I noticed that my swelling had in creased after that first day and really wasn't going down. I would even wake up swollen. I figured my compression garment was not really compressing me enough to get rid of the fluid. So I purchased a Faja and that did the trick. It took two ppl to get it on but my swelling has gone down a lot. And it's great support
2 wk PO
Hey ladies and gents. 2 wks PO, had drains removed yesterday and boy do i feel better. Been wearing my faja 24/7 and it has helped my swelling tremendously. Starting to feel some muscle spasms in my upper ab area and sum burning around my incision area mainly at night. It's not unbearable but enough to keep me from sleeping well. My energy level is better and I'm getting around with no problem. Still taking it easy over all, returning to work next wk. first set it pics I've taken in undies and damn!!! I can't believe it, my panties lay flat on my stomach, they're not rolling under the "FUPA", and I feel so sexy!!!!
My very first bikini!!!
I'm going on a cruise in February and I'm planning on wearing a bikini for the first time ever...I mean ever in life. Im 18 days PO and Trying them on today was the best feeling I've had in a long time. I actually likes what I saw in the mirror and it blew my mind. I can wait to back in the gym but I'm so gonna rock this bikini and many more!!!
3wks PO, back to work
I work in a hospital and I'm on my feet all day drawing blood. Lots of walking, standing, and moving. Over all I'm doing very good. I only wear my spanx to work and after about 7hrs of work I start to feel tight and little back ache. But I'm still able to come home, cook, bathe the baby, and get myself together. Over all I have most of my energy back. Started sleeping in my bed this week as well, it get easier each night. This wk at PS visit I had stitches removed from my belly button, was cleared to start light cardio, and given a 3wk appt. my swelling is controlled, my scar is healing well, I'm flat and happy!!
4 wks PO, scar is great
He guys wanted to do a quick update. I'm 4wks PO and feeling good. I'm amazed at how my scar is healing. Very pleased and looking forward to the end result. Still swollen (obviously) but it's minimal. Back to work and back to the gym (light cardio)
6wks PO
6wks PO and doing great. I'm working out and pushing it a little more each day. Added some weights and light jogging this week. I'm still swollen by the end of the day but it's minimal. My surgeon says he's very pleased and that I'm above average for healing and progression for 6wks so that definitely put a smile on my face. I still find the most comfort sleeping on my back propped with pillows behind me and under my legs. I can lay on my side but not for long. Can't wait for the day I can sleep on my tummy again. Over all things are well and I'm very happy with my results
8wks PO
I'm now 8wk PO and still very much in love with my new body. I'm back in the gym, lifting weights, and jogging. I swell more after a hard workout but it's not extreme. Just started taking off my binder for a few hrs at a time and sleeping without it. It's a very weird feeling not having it on, but I'm sure it will get better in time. Over all I'm happy
10wks PO
So I've ditched the binder (not for good)!!!. I'm not wearing any compression to work or sleep in. I only wear it to the gym and for a few hrs in the evening after work if needed. It's been 2wks w/o the 24/7 compression and I'm feeling great. It took sometime to get use to but I'm glad I did it. I felt like my body was ready for next step in healing. I'm pushing myself more at the gym, and even doing planks. I'm very happy with my results and still excited to see my final outcome
Vacation @11 wks PO
I went on a cruise and visited an Island. I wore a 2 piece for the first time, partied, drank, and ate whatever I wanted. I did get a little swollen by the end of the night but no more than my normal. I'm extremely happy with my results and I had a fantastic trip. Can't till summer!!
3 1/2 months PO and it's only gotten better
Definitely feeling my new body. At this point in the healing process I no longer wear daily compression I workout 3-4 days a week (no ab exercises) and I have minimal swelling. I swell on the days I workout hard or if I eat the wrong foods so I'll wear my compression to sleep in from time to time if I have a bad day but over all I feel great. My muscles still feel very tight (think I'm just use to it now) and I'm still numb from my belly button down. I don't regret a single thing.
So far I have only great things to say. He was very patient during the consultation. He explained in detail what the procedure consist of and answered all of my questions. The office staff is wonderful, they always return my calls promptly and are very professional
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Chicken With Peaches and Basil
READY IN: 41mins
Recipe by Derf2440
This is wonderful when peaches are fresh and in season, but canned peaches can be used when necessary.
Top Review by dale7793
So Good!! I used a nectarine and was to lazy to skin it. I cut the recipe in half for 2 people but next time I will just reduce the amount of chicken but keep the sauce the same as the sauce is incredible! So flavourful! I also added a few snow peas to mine and served with pasta. This is a keeper!
See Discussion:28 Reviews 1 Tweak
Ingredients Nutrition
- 3 tablespoons all-purpose flour
- 1⁄2 teaspoon salt
- 1⁄2 teaspoon pepper
- 4 boneless skinless chicken breast halves
- 2 tablespoons olive oil
- 2 ripe peaches or 2 nectarines
- 1 small onion, chopped
- 1 garlic clove, smashed
- 3⁄4 cup chicken stock
- 1 tablespoon lemon juice
- 1⁄4 cup fresh basil, chopped
Directions See How It's Made
- In a shallow dish, combine flour and half of the salt and pepper, set aside 2 teaspoons for sauce.
- In remaining flour mixture, coat chicken well; shake of excess.
- In a large frypan, heat oil over medium heat; cook chicken, turning once, for 15 to 20 minutes or until no longer pink inside.
- Transfer to plate and keep warm.
- Meanwhile, peel and pit peaches; cut into wedges.
- Add onion, garlic and reserved flour mixture to skillet; cook, stirring for 3 minutes.
- Pour in stock and lemon juice; bring to boil, stirring to scrape up any brown bits from bottom of pan.
- Add peaches; reduce heat to medium and cook, stirring for 3 minutes.
- Stir in basil and remaining salt and pepper.
- Pour over chicken to serve.


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Georgian archbishop says, investigations prove that the relics of St. Maximus the Confessor are in Georgia
Tbilisi, October 27, 2015
With the blessing of His Holiness Catholicos-Patriarch Ilia II of Georgia the Fifth International Theological Conference was held in Tbilisi. This year scientists, researchers, and Church figures from Serbia, Greece, Russia, the UK and Australia took part in the conference which was dedicated to the life and activity of St. Maximus the Confessor (c. 580-c. 662; feast: August 13/26).
At the conference the results were announced of the investigations lasting several years that were dedicated to the authenticity of the saint's relics uncovered in Georgia in 2010.
Archbishop Stephan of Tsageri and Lentekhi, Metropolitan Anania of Manglisi and Tetritskaro as well as clergy and scholars were present at the meeting.
The excavation pit with the saint's relics, 2010.
The investigation results were read out and it was announced that the relics which had been found in 2010 in Tsageri indeed belonged to St. Maximus the Confessor and are a precious treasure of the Georgian Church.
"There has always been a Church tradition in Georgia that the relics of St. Maximus the Confessor rest in the St. Maximus Monastery at the base of the Muri fortress near Tsageri, under the altar of the now restored little church," related Archbishop Stephan in as early as 2012. "When I was a student I already knew that this saint was buried somewhere near Tsageri. With time I started familiarizing myself with this question, with the sources, theological research, the archaeological excavation results of 1914. Undoubtedly, I used the works by Prof. Korneli Kekelidze (a prominent Georgian scholar: 1879-1962), Alexander Brilliantov (a famous Russian Orthodox theologian: 1867-1933), Prof. Sergei Epifanovich (a patrologist and researcher of St. Maximus the Confessor's life: 1886-1918) as well as several others. The expedition of 1914 carried out archaeological excavations not inside the church, but only around it. According to the expedition's results, the church was old and there had been a monastery there, but no evidence directly connected with St. Maximus was found. Then the First World War began followed by the Revolution, so the works were halted."
It was Archbishop Stephan who supervised the works when the relics were finally discovered: "Embarking on the excavations inside the church we had doubts about the necessity of that decision, especially as only Patriarch Ilia II could affirm it. However, in any case we needed to carry out restoration works inside the church: to renew the floor and to install a new marble altar. This little church had been restored without any specific plan by the local residents on the site of the previous one, destroyed by the Bolsheviks. We were convinced that the relics of St. Maximus the Confessor rested there, as this tradition was passed down from generation to generation. During the Soviet era people venerated this site as marking the grave of St. Maximus the Confessor."
"We know that St. Maximus the Confessor and his disciples were tortured for their faith: their tongues and fingers were cut off that they might not preach any more. The fingers of the discovered bodies had been cut off and they had traces of mouth infections (which may have developed only from an open wound in their lifetime). The remains of four people were uncovered in all. One of them had been buried at a lower level; most probably these are the relics of St. Arsenius to whom the monastery had been originally dedicated. Those who were buried at an upper level, in the anthropologist's view, are St. Maximus the Confessor along with his disciples St. Anastasius the Apocrisiarios and St. Anastasius the Monk," the hierarch recounted soon after finding the relics.
Now the investigations, in which the scientists, archaeologists, anthropologists and pathologists were involved, have proved that the uncovered relics indeed belong to St. Maximus the Confessor.
By Tamara Manelashvili
29 / 10 / 2015
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Deadline for submission is March 15.
All 2017 Conference Clinic/Session proposals must be submitted online using this form.
NCMEA Section/Committee Chairs will review proposals and notify presenters of accepted proposals by mid May.
NOTE: Conference Performance Ensembles are invited by each NCMEA Section.
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