text:
This page contains an up-to-date list of Issued and Lifted precautionary boil advisories. For customers in a small affected area, EWSU places a door hanger notice on customer doors notifying them of the Precautionary Boil Advisory. For larger areas, the Utility will not place individual door hanger notices on each customer's door, but will instead notify the local media outlets, consisting of television, radio and newspaper.
While the potential for contamination of the drinking water is unlikely, the Evansville Water Utility is advising customers in the affected area to bring all cooking and drinking water to a complete boil for five (5) minutes before using. Please continue to boil all cooking and drinking water until we notify you that it is no longer necessary.
The Evansville Water Utility is implementing this precautionary boil advisory based upon information within the Water Supply Industry regarding additional precautionary steps that may safeguard the health of public water supply system customers. The conditions regarding this issue and the magnitude of the affected area warrant these additional precautionary measures. We will notify you when the precautionary boil advisory will be lifted.
Further information regarding this issue may be obtained by calling the Water Department / Allens Lane at (812) 421-2130. You can also visit our Frequently Asked Questions page.
Recently Issued Precautionary Boil Advisories
Issued: August 21, 2017
S. Elliott St.: from Cross St. south to the dead-end.
Walnut ST. from SE Riverside Dr. to SE Fourth St.
Recently Lifted Precautionary Boil Advisories
Lifted: August 19, 2017
Colonial Ave.: from Fairway Dr. to Stratford Rd.
Stratford Rd. address: 3100
© 2017
All Rights Reserved.
Website Designed & Developed by Vision Internet - The government website experts
City of Evansville / Vanderburgh County
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City of Evansville / Vanderburgh County


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Well hello! I seem to be on a 3.2 posts per year trajectory here, but I'm not going to fret about that and suspect you aren't, either. Onward.
The nutshell catch-up is: my husband got a job in another city and has been living there for two months. Once school is out and I've packed up the house we will move up there to be with him. This is supposedly happening in three weeks but I am not entirely certain I will be able to pull it off. It's like that tablecloth trick. Only there is an entire house on the table.
My littlest, my boy, my baby is in a pitched battle with me to win the title of Most Freaked Out By This Crap-Assed Transition Business, but I started taking Prozac so I think he is going to win. Seriously, after years — years — of my doctor gently and less-gently suggesting it, I finally filled the prescription because I recognized that my ability to cope gracefully with Life In General is a delicate matter to begin with, and coping with A Difficult And Stressful Albeit Temporary Situation trends even further towards the nonexistent side of the equation. I was becoming a menace to all that is good and sparkly in the world and becoming one of those angry driver people and rude to customer service people and annoyed with everybody for everything all the time people, and man I hate being one of those people.
So anyway I've been taking it for five days and thus far can discern no effects whatsoever excepting the inability to open my eyes in the morning until half past coffee and even then they don't really open all the way or, you know, see things for a goodly chunk of the day.
I fervently hope it kicks in the helpful chemical goods soon though, because my son's state of freakage is really derailing my sanity and my faith in myself as a parent. I think it would be easier to work through this with and for him if I weren't completely paralyzed by guilt. I don't even know how to describe what is going on with him. But that such a wee person, only five years on this earth, could hold such darkness and despair is… horrifying. That he thinks he is bad, and undeserving of love is… I think the worst thing I have ever heard in my life. The psychologist says this is not outside the bounds of a developmentally appropriate reaction to a stressful situation (Dad living away from home, house in semi-packed shambles, mom frazzled and trying to keep up) and that it is certainly not my fault.
I am not convinced. But even so, even if it is my fault, I just want to know what it is. This darkness, this rage, this despair. He says when his brain turns red that he is bad. That he wants to hurt people. That he hates people. That he knows he is bad, that the red brain tells him he is bad. And that no one loves him.
He. Is. FIVE.
I want to go to sleep and wake up in a different world where my beautiful boy does not talk about red brains and hurting people. I want my beautiful boy to live in a world where he knows he is loved. Right now I am living in the world of finishing up at my job, packing up the house, wrapping up the school year, and feeding/bathing/clothing two children who need emotional anchoring in a world that has gone crazy around them. I am trying to get to that other world by being calm and loving and reassuring, but kids are smart and they know when you're lying.
So, I'm taking it one minute at a time, hoping against hope that the Prozac will help make it true. True that I'm ok, and that things will be ok, and that the red brains are not in charge.

subset: commoncrawl


text:
- They are the precursor (cholesterol) to hormones
- They bring in important nutrients such as vitamins A, D, E, and K
- They provide a sensation of fullness
- They allow a more efficient transmission of electrical signals in the body
Teen Perspective: Nutrition and Healthy Eating
A Answers (3)
Fats have been much maligned in the past thirty years, but they are essential nutrients. Fat makes you feel full, and it makes things taste good. In addition, our bodies need the fat in foods to absorb vitamins like vitamin A for healthy skin and eyes; vitamins D and K for healthy bones and blood; and vitamin E for its antioxidant properties. Fats from whole foods -such as those found in dairy products, nuts, seeds, meats, and fish - contribute to healthy nerve development, hormonal balance, and sustained energy.
Find out more about this book:Our Bodies, Ourselves: A New Edition for a New Era
Find out more about this book:YOU: The Owner's Manual for Teens: A Guide to a Healthy Body and Happy Life


text:
| Part of the series on
Melkite Greek Catholic Church
|Melkite Greek Catholic Church
|Meaning of church name
|The Church in modern times
|Church traditions
|Article discussion
Meaning of church name
Melkite comes from the Syriac word melk for "King", which was originally a pejorative term for Middle-Eastern Christians who accepted the authority of the Council of Chalcedon (451) and the Byzantine Emperor.[1] It was given to them by anti-Chalcedonians (the Oriental Orthodox).[1] This term is now not generally used to refer to other Chalcedonian Christian groups (see Melkite for the history of this term) The Greek element signifies the Byzantine Rite heritage of the church, the liturgy used by all Eastern Orthodox Church.[2]
The term Catholic signifies the church's acknowledgment of the authority of the Pope. However, the word can also imply participation in the worldwide church (see Catholic). According to some theologians, the Melkite Church of Antioch is the "oldest continuous Christian community in the world".[3]
In Arabic, the official language of the church, it is called ar-Rūm al-Kathūlīk (Arabic: الروم الكاثوليك), which literally means "Roman" Catholic. However, in Arabic, "Rūm" can also refer to the Byzantine empire (the so-called "Second Rome"). Hence, it also can be translated as "Greek Catholic".
- ↑ Faulk (2007), p. 5
- ↑ Melkite Greek Catholic Church Information Center Unofficial History of the Melkite Greek Catholic Church / Grec Melkite Catholique


text:
Product Spotlight
Featured Research
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Kroger Winning with Shopper Data, Says Vice Chairman
NEW YORK -- Cincinnati-based Kroger Co. is doing better than surviving in a fast-changing retail landscape, in full command of the challenge to deliver on the diverse needs of its customers in many markets, said the vice chairman and c.f.o. at an investor's gathering here earlier this week.
NEW YORK -- Cincinnati-based Kroger Co. is doing better than surviving in a fast-changing retail landscape, in full command of the challenge to deliver on the diverse needs of its customers in many markets, said the vice chairman and c.f.o. at an investor's gathering here earlier this week.
Rodney McMullen, Kroger's vice chairman, said at Lehman Brothers Ninth Annual Retail Seminar that Kroger has a formula in place to continue competing successfully against supercenters, supermarkets, and the growing number of alternative formats selling food.
Its magic bullet? A formidable business model based on providing what customers want, on a format-by-format and store-by-store basis. "Our business model supports merchandising and operating strategies to connect better with our customers," said McMullen. Kroger's healthy, sustained identical sales growth is fueling the progress, he added.
The company is focused on improving customers' shopping experience in three major areas: value, service, and product selection.
Kroger's work with Dunnhumby USA is a key driver of the effort, according to McMullen. "[We have] one of the most robust customer loyalty databases in America," he said. Kroger is using that data to segment on a granular level the diverse customer base that shops its broad range of formats, including 2,214 combo stores, which combine food and drug; and 27 of its smaller Marketplace format. On the back end, the data helps Kroger target promotional dollars and pricing investments toward its most profitable customers, he said.
"As we remodel stores and expand, we're using several resources, including our proprietary loyalty card data, to understand the needs and expectations of our customers," noted McMullen. "Based on this, we're segmenting our combo stores into three primary iterations: value, mainstream, and upscale."
Value stores serve shoppers who are primarily focused on price, while upscale stores focus more on service and product mix. The mainstream stores serve the vast majority in between, he said.
However, shoppers in all segments want a clean, convenient place to shop, according to McMullen. Thus Kroger will stay focused on improving store conditions throughout the company.
To stay current, the retailer is adding a wide range of organics in its stores to address customer requests. In a bid to offer more convenience, it's adding more drive-through pharmacies, fuel operations, and coffee bars. Meanwhile, gleaning from its experience with Fred Meyer, Kroger is featuring more seasonal, general merchandise items in its combo stores.
Private label is another part of Kroger's strategic plan, according to McMullen. "We're continually adding new items, ranging from our Private Selection specialty meats and cheeses to Big K Diet Cola." Private label now accounts for 24 percent of Kroger's grocery dollar sales, he said.
Dismissing the idea that Kroger is among the supermarket operators getting squeezed by Wal-Mart and other supercenters, McMullen said that at the end of 2005, Kroger held the No. 1 or 2 position in 35 of its 44 major markets. In 32 of those markets, supercenters hold the No. 3 position or higher. Kroger's overall market share expanded more than 35 basis share points during 2005 on a volume-weighted basis, he added.
Kroger's s.v.p. and c.f.o., Mike Schlotman, said reiterated the company's guidance of 6 percent to 8 percent earnings per share growth in fiscal 2006. On the investment front, the retailer plans to invest $1.7 billion to $1.9 million in capital spending, to build 30 to 40 new stores, and conduct remodels of 150 to 175 stores.
When asked whether rising fuel costs have had a major impact on Kroger's operations, McMullen said he's been "surprised" that it hasn't. "One advantage we have is that our stores are close to our customers, so they don't have to drive far," he said. Customers like the company's supermarket fuel center setup, he added, as it eliminates an extra trip. "Plus, we're always priced right on fuel," he added. Kroger operates 579 supermarket fuel centers.
-- Jenny McTaggart


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Product Spotlight
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Quick Stats
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7-Eleven to House Additional 24-Hour Check Deposit Kiosks
Financial Service Centers Cooperative will supply 2,000 machines to the chain.
DALLAS -- Financial Services Centers Cooperative Inc. (FSCC), a credit union shared branch network, has provided 2,000 7-Eleven convenience stores across the nation with 24-hour check depositing kiosks, which allows customers to access credit union services, the company stated.
The self-serve kiosks, owned and operated by Cardtronics, are known as Vcom terminals and also provide ATM services to other financial services -- including depositing checks, withdrawing cash, making loan payments, transferring cash between accounts, obtaining credit advances, making balance inquiries and obtaining copies of recent history statements, the company stated.
"The combination of FSCC's technology and the Vcom distribution channel will revolutionize how consumers perform routine financial transactions," Sarah Canepa Bang, CEO of FSCC, said in a statement. "We believe members of Generation Y will find this channel very appealing."
The Vcom terminals are located in major markets including Dallas, Denver, Miami, Orlando, Los Angeles, Phoenix, Portland, San Diego and Seattle. A list of participating locations can be found on www.cuswirl.com. In some areas, such as Colorado and California, the number of access points for members will approximately double for members. In Florida, the number of Vcom terminals will more than triple, from 196 to nearly 600, the company stated.


text:
The UAB 226G Bicone Antenna from Fractal Antenna Systems provides extreme wideband and omni-directional performance for signal gathering and high power transmission. The UAB 226G is about one-quarter the size of a conventional antenna, and comes in a compact, rugged package. The antenna offers a good combination of size, bandwidth and gain. The inherent qualities of fractals enable the UAB 226G to be packaged in a considerably smaller size than conventional antennas. Plus, the UAB operates over a wide 25:1+ range of frequency, from UHF to microwave, while offering superior gain. The UAB 226G antenna is available for both commercial and defense applications and can be adapted for vehicle, marine, or fixed use. Sealed in a radome that is 7.7 inches in diameter and 10 inches high, the UAB weighs 4.8 pounds and is available in an optional watertight vehicle mounting kit.
Fractal Antenna Systems


text:
The Parallax View
MIT Press, 2009. 2. 13. - 448페이지
The Parallax View is Slavoj Žižek's most substantial theoretical work to appear in many years; Žižek himself describes it as his magnum opus. Parallax can be defined as the apparent displacement of an object, caused by a change in observational position. Žižek is interested in the "parallax gap" separating two points between which no synthesis or mediation is possible, linked by an "impossible short circuit" of levels that can never meet. From this consideration of parallax, Žižek begins a rehabilitation of dialectical materialism.Modes of parallax can be seen in different domains of today's theory, from the wave-particle duality in quantum physics to the parallax of the unconscious in Freudian psychoanalysis between interpretations of the formation of the unconscious and theories of drives. In The Parallax View, Žižek, with his usual astonishing erudition, focuses on three main modes of parallax: the ontological difference, the ultimate parallax that conditions our very access to reality; the scientific parallax, the irreducible gap between the phenomenal experience of reality and its scientific explanation, which reaches its apogee in today's brain sciences (according to which "nobody is home" in the skull, just stacks of brain meat -- a condition Žižek calls "the unbearable lightness of being no one"); and the political parallax, the social antagonism that allows for no common ground. Between his discussions of these three modes, Žižek offers interludes that deal with more specific topics -- including an ethical act in a novel by Henry James and anti-anti-Semitism.The Parallax View not only expands Žižek's Lacanian-Hegelian approach to new domains (notably cognitive brain sciences) but also provides the systematic exposition of the conceptual framework that underlies his entire work. Philosophical and theological analysis, detailed readings of literature, cinema, and music coexist with lively anecdotes and obscene jokes.
다른 사람들의 의견 - 서평 쓰기
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LibraryThing Review사용자 리뷰 - karl.steel - LibraryThing
I've read some Zizek--Plague of Fantasies, Welcome to the Desert, Enjoy Your Symptom--and found myself getting fed up with his self-plagiarism or, let's be gentle, tendency towards efficiency in ... 전체 리뷰 읽기
chapter 2 Building Blocks for a Materialist Theology
interlude 1 Kates Choice or The Materialism of Henry James
The Unbearable Lightness of Being No One
chapter 3 The Unbearable Heaviness of Being Divine Shit
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자주 나오는 단어 및 구문
Alain Badiou anti-Semitism appear aware Badiou biopolitical brain capitalism capitalist cognitivist commodity confronts consciousness crucial death death drive defines definition Densher desire dialectical difference dimension drive effect emerges Eric Santner ethical excess experience external fact fantasy fiction field fight figure film final finally find finitude first formal freedom Freudian function fundamental German Idealism gesture global Hegel Hegelian Heidegger Heidegger's human ideological infinite inherent Jacques-Alain Miller Jews jouissance Kant Kant's Kantian Kierkegaard kind Lacan Lacanian logic Marx Marx's Matrix means modern Muselmann Nazism notion noumenal object objet petit obscene one's ontological opposite Other's paradox parallax perceived phenomenal philosophical political position precisely primordial psychoanalysis pure radical Real reality reflection reflexive revolution revolutionary sacrifice scientific sexual shift signifier simply social specific Stalinist structure struggle suffering superego symbolic that,in thing tion today's transcendental true truth ultimate universal violence


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Gigi Hadid and Zayn Malik Out in NYC January 2016
Gigi Hadid and Zayn Malik Heat Up a Chilly NYC With Their New Romance
Gigi Hadid and Zayn Malik Heat Up a Chilly NYC With Their New Romance
Gigi Hadid and Zayn Malik were spotted out in New York City on Tuesday night in coordinating black ensembles. The two, who reportedly began dating in November, were careful not to be photographed together. The outing comes just a few days after they were spotted looking at apartments together in the Big Apple.
The new couple have been causing a frenzy among their fans with their hot and heavy romance. While they haven't made too many public appearances yet, they certainly let their love shine on Instagram. On Sunday, Gigi posted a shirtless photo of her beau holding her kitten, Cleo, and shortly before Christmas, the former One Direction member shared a pretty cozy snap of the two. Keep scrolling to see the rest of their outing!
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How Exactly To Monitor in Order to Find Your Phone that is Lost Without An App
May Disposable Burner Cellphones Protect You From Government Monitoring? May Disposable Cellphones Guard You From Security? Can you Be Protected by Disposable Burner Cellphones From Security? Peters is Aaron Swartz and the author of The Idealist: a Stone reporter along with the Increase of Free-Culture on the Internet. On Thursday, the Parent ' s Greenwald claimed that, in conformity using a court-order, Verizon continues to be presenting data on all calls made over its community to the U.Sernment. Then you definitely need to imagine other mobile corporations are doing a similar thing if Verizon is transforming over its files. So, will there be in whatever way to utilize a mobilephone inside the United States with no note is taken by the government? May prepaid " burner" cellphones— common among people who have bad credit, international travelers, along with the drug retailers from The Cord help guard you against security? To a stage, yes. There' s actually no such matter being an untraceable phone.
Just how to Utilize The Samsung Omnia II Mobile Tracker
If the government really wants to observe or obtain info in your communications, it could more often than not find a way. But prepaid cellphones that are disposable could make you harder to monitor, because they wear't require a calling program to be signed up for by people, with all of the giving over of personal information that requires. The huge gain that writers have over instant phones that are conventional is that the user& rsquo individual info isn't logged at the pointofsale or from the supplier. Unlike at, declare, the shop, leave the store without exhibiting your identity and where purchasing a cellphone program entails posting to a creditcheck and signing a deal, you'll be able to pay income. Should you wear a hoodie, sunglasses, or even a phony beard (or all three!), you can stymie monitoring cameras. Of course if a highlight that is funny is used by you, the clerk will think you' re from England. All this could make it harder for that government to find out who you're.
Get Adult Control for iphone Control software free download for 4
But don t get also comfortable within your privacy. First calls created on writers, of all are usually carried over existing systems. (No, the people behind "Todd's Burners" possibly aren't constructing their very own mobile towers to send your calls.) Most prepaid mobile providers are rsquo & what; s referred to as mobile personal system employees. or MVNOs. (Classic providers like Verizon also present prepaid strategies in their own.) That fundamentally means they sell it to customers at a low-price and acquire area in volume on wireless sites that are present. That info is most likely rotating over to the NSA, in case your burner performs on Verizon& rsquo network. Second, it s not difficult for the government to ascertain your local area according to your burner s transmission with cell towers.
Spy on texting reviews
In 2006 the DEA arrested a person called Skinner. Who had been found transporting icloud iphone tracker 1,100 pounds of pot across the Southwest. The federal government was able to meet up by tracking the signs being released by his two prepaid cellphones and consequently triangulating his spot. (They had previously traced the burners back to Skinner. He likely didn't use a German accent at the benefit shop where he bought them.) Skinner appealed his sentence around the reasons that the checking of his cellphone indication constituted a breach of solitude. In 2012, nonetheless, a national appeals judge decided that the federal government was not blame to track aside, and that people utilizing prepaid cellphones experienced no & ldquo;reasonable requirement of solitude. Consequently if you're likely to work with a burner and don't are interested to obtain connected back to you, you probably shouldn't put it to use at your house, or your place of organization, or another spot with which you've an identifiable relationship.
Howto spy on Undetected spyware & discussions for android – Abingdon Technologies
When you employ a burner, you have to consider to leave your cellphone that is authentic athome. Last year a medical scholar called with killing a female in a Boston resort Philip Markoff incurred and was busted. Markoff had purportedly employed a prepaid cellphone to make contact with the target beforehand; he had purportedly utilized techniques that were related in another occurrence where he robbed a female that was different in an unique hotel. Both moments, Markoff had had his cellphone that was actual in his pocket, and, even though the device was not on, it had been nevertheless interacting with cell systems. Police were not unable to determine Markoff& rsquo personality partly by collecting information based on the impulses emitted from his authentic cellphone. Therefore maintain that in mind. To summarize, writers can give a way of measuring anonymity to you, however they re by no means untraceable. I will suggest using two tin containers and a period of sequence in case you& rsquo t be utilized.


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22-13750 - Double Ended Coaxial Stripper - RG7/11/213/8 and RG59/6/6 Quad
This lightweight, compact tool quickly and easily removes the cable jacket and inner conductors in a single step without any adjustments. The blades are designed to provide a 1/4" braid, 2-level strip, the standard preparation for compression connectors. Works wi...
28-11068 - 6' 14 Gauge Black Extension Cord
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50-20655 - 15.6" LED TV with 12V Car Adapter
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Overall, my MCM experience was great! They delivered fast and as promised. Great product, great price!


text: Hey sambrouk and Karo london ! I'm planning to go to thailand Laos and Vietnam for 3 weeks ! I know it's to tight but I want to see as much as possible haha but also enjoy some time on the beach ! I was wondering when are you planning to go? Maybe we could do a route togheter and try to be travel buddy's if you like !


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NEW YORK (The Deal) -- Corvex Management and Related Fund Management said Monday, Nov. 25, they were restarting a solicitation process to replace trustees of office property investor CommonWealth REIT (CWH).
The battle between the funds, which together hold 9.6% of CommonWealth, and the management of the REIT dates back to a failed effort by the shareholder activists to block an equity issuance in early 2013 that Corvex and Related perceived as dilutive. An effort since to replace the board of the company by written consent has gone through fits and starts. An arbitration panel recently ruled that the consent solicitation was technically invalid, but outlined a path to resume the effort.
On Monday, Corvex and Related said they intend to pursue a new solicitation and planned to file a preliminary consent solicitation statement with the Securities and Exchange Commission to remove the entire board of trustees.
CommonWealth announced Monday that it set a date for its next annual meeting for June 13, 2014 and established a window to nominate directors for between Feb. 21 and March 24.
Corvex and Related also asked Commonwealth for a shareholder list in order to communicate with the REIT's shareholders about their intention to establish a dissident slate of directors to put forward at the upcoming meeting. Previously, the funds had support of 70% of the shareholder base.
The activist investors have complained that CommonWealth's board and the REIT's outside management, REIT Management & Research LLC, are are too inter-related and that high fees and decisions made to keep the fee structure intact have lead to underperformance of the company's shares.


text:
A continuation from previous days postings-
Horror Movie Risk Analysis – Part 1 and Horror Movie Risk Analysis – Part 2.
11. You have just shot the crazed psychopath 5 times (twice in the head, twice in the chest, and once in the leg). He has fallen dead on the floor. What do you do?
12. A monster is chasing you. To your left is your car, to your right is your
house, and straight ahead is your neighbor's home. Where DON'T you go?
13. Excluding sports equipment, tools (power or otherwise, including axes), and knives, what is the best household item to use as a weapon against a flesh-and blood monster?
14. Your group, being stalked by vicious creatures, has decided to split up. You HAVE to pair up with one of them. Which one do you pick as your partner: the science geek, the jock, the cheerleader, the hoodlum, or the quiet pale girl?
15. Taking into consideration all of the horror films ever made, who or what
would be the most dangerous, scariest person/creature to have to fight off or escape from?
Feel free to post your answers in the comments below!
We look forward to seeing how prepared (or imaginative) you are!


text: Hi, this girl I've been talking to for quite a while has agreed to meet up with me recently, only catch is she's started having doubts on her feelings for me. My question is, what can I do to win her heart back and help get rid of any doubts she might have? What would win you over? Thanks.


text:
No matter how prepared a parent thinks he or she is, when a teenager wants to start dating, it can be a scary issue to deal with. It's important to try to prepare your teen to deal with all the consequences of dating, including STDs, unwanted pregnancy and date rape. But the first step is to set a road map to follow when your teen wants to start dating seriously.

First, don't assume because your son or daughter has reached a certain age that they're ready to date, or that they should be allowed to. You know your teen's maturity level, and every potential dating situation should be handled on a case-by-case basis. For instance, just because your daughter was allowed to go on a date with a boy who drives a car doesn't mean she'll be allowed to go out with any boy who drives a car. And just because your son's friends all have steady girlfriends doesn't mean he's necessarily ready to start dating one-on-one himself.

A list of simple rules should be clearly spelled out with your teenager before any dating will be allowed. Violation of these rules should have consequences for future dating privileges. And that's how parents need to view dating by young teenagers: As a privilege, which has to be earned and respected.

Here are a few suggestions for basic dating rules for your teenager:

Don't let your teen out the door before you've had a chance to meet the person they'll be going out with. This doesn't mean your daughter gets to introduce her date when he comes to pick her up, then bolt out the door. If he wants the privilege of dating your child, he needs to come in and meet mom and/or dad for a few minutes first.

If your teen doesn't have their own cell phone, now is a good time to consider getting one for them. Put them on a family plan, and make it clear you reserve the right to review the contents of their phone at any time since you're paying the bills.

Your teen needs to let you know where they'll be at all times. If plans change, they need to let you know right away so you can grant approval. If you call your teen on their cell phone during their date (and try to avoid doing that too frequently), they must answer or text you a reply.

Set a curfew and the consequences of breaking it before the date begins. Make sure both your child and their date knows what time curfew is, and find out what time the date's curfew is. The curfew can vary by date and occasion, but needs to be clear every time before your child leaves the house.

If your child is in a situation where there are drugs or alcohol, or they do not feel safe, make sure there is a plan for picking them up if they need to get out of a dangerous situation. Emphasize that they can call you any time, and you would prefer to come get them from an out-of-control party than have to bail them out of jail, or worse.

The main point with establishing rules for dating is to keep the lines of communication open. Explain your child why the rules are what they are, and your feelings about the concepts of dating. If appropriate, share an anecdote behind your own dating experiences, to illustrate why you feel strongly about curfew, for instance. Even though they may not like the rules, it's good for teens to understand the reasons behind them.


text:
Your browser does not support iframes.
Kim Jones has been known to make history at Staunton River.
As a senior on Staunton River girls basketball team, Jones was part of the squad that made it to States for the first time in program history. This season also marked the most wins since 1976, a record that still stands to this day.
Then as head coach of the girls basketball team for more than 15 years, Jones racked up some historical accolades; most program wins (179), two State quarterfinal appearances and three Blue Ridge District titles.
The Bedford County Board of Supervisors unanimously voted, after a joint public hearing with the planning commission, to remove all references to American Electric Power (AEP) from the zoning ordinance's building permit process for docks at Smith Mountain Lake.
Floors and More moved to its new home on Burks Hill Road on Jan. 1 and has a grand reopening set for this Friday and Saturday.
It was a big move for two reasons.
"We were able to purchase the property," said Bob Sloper.
This is the first time in the six-and-a-half years they've operated the business in Bedford that they have actually owned the building where their business is located.
The annual Horse and Hound Wine Festival took place on a hot, humid day, but at least the dogs got to stay cool in the pond. The festival is always held on the second Saturday of July, which fell on July 8 this year. The event drew 3,000 people, with no official count on the number of dogs although there were plenty of the furry, friendly creatures accompanying their favorite humans.
James Oliver, the developer who is going to build a business class hotel in the Harmony development just west of Bedford, expects construction to begin in the late spring of 2018.
Oliver's company, Dogwood Development Company, has agreed to purchase the property in conjunction with Bedford's economic development authority.
"We still have some hoops to jump through," Oliver said.
While other basketball programs may just be getting started with their summer workouts, Staunton River's team has been hard at work since March.
Coming off a tough season that saw the Eagles only log in three wins, Head Coach Brandon Harris and his squad are dialing in on making the necessary improvements over the offseason.
Grayson Overstreet is closing in on not one, not two, but three State records.
The rising senior from Staunton River is only 1,428 rushing yards, 18 touchdowns and 68 points away from claiming three State career records as his own.
All three records are certainly in reach for 6'2", 220 lbs fullback/linebacker. Especially considering in just his junior season he rushed 2,958 yards, snagged 49 touchdowns and collected 385 points.
It's a little mystery that Bedford-area voters have almost figured out, but not quite. Why are the realtors, the health industry, the beer wholesalers and bankers, coal operators and electric utilities shoving all that cash into the Virginia legislature?
"Puzzles plus money produce the view that the money explains the puzzles," legal scholar Lawrence Lessig has written. "In a line: We don't trust our government."
I'll make a confession here at the start, which may surprise you. I truly get tired of writing about Donald Trump. But nearly every day, there's another outrage or stupid excess that can't be ignored.
Often, with this weirdo, it's his Twitter account, which no one can apparently take away from him. Last week, he disgraced himself again in his long-running feud with the co-hosts of MSNBC's "Morning Joe."
Last month the USS Fitzgerald (DDG-62,) collided with a container ship southwest of Yokosuka, Japan. Yokosuka is the Fitzgerald's home port. The collision ripped a 12 foot by 12 foot hole in her underwater hull, flooding a berthing compartment. News stories I've read say no collision warning alarm was sounded. The men had only a minute to escape. Seven of the men in that compartment died.
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The Bedford Bulletin is your source for local news, sports, events, and information in Bedford County and Bedford, VA and the surrounding area.


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Dog Veterinary
Ask a Dog Vet and Get Answers to Your Dog Health Questions
Give us a minute. We will have to look it up online.
D-con pellets. We think she ate a few pellets
Thank you. I knew there was some restrictions related to time of consumption. That will give us some peace of mind until morning. I assume the vets will know about vitamin K.


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Suddenly today I am unable to edit my tickets. I can change the Summary, Title etc, but when I press the Save button nothing ever happens. I have uninstalled entirely then reinstalled and made sure I am on the current version (4.7.52439).
The only thing I can come up with is that my DB is somehow corrupted.
This topic was created during version 4.7.
The latest version is 7.5.00101.
12 Replies
Sep 22, 2010 at 1:39 UTC
I think so also, maybe the DB is corrupted, one question, the problem is only with on ticket or all?
Sep 22, 2010 at 1:44 UTC
All Tickets, including ones I have edited previously.
Sep 22, 2010 at 1:49 UTC
Well Bummer for me. I know for fact it is the DB. I imported a back up from when I last updated in June and it works fine. Now I get to manually feed in data to recover what I lost.
Sep 22, 2010 at 1:53 UTC
It actually appears my symantec SEP client may have had a hand in this. When I unzip my latest back up it is alerting on 4 tickets and removing them. I think this may be locking the DB up.
Sep 22, 2010 at 1:55 UTC
Without going into too many specifics, you could run the FF SQL Lite tool, and maybe import larger chunks at a time?? I don't know what your level of expertise is with SQL queries, so I hesitate to go into too much detail. I can't cover it sufficiently enough (although someone may have), and you can really hose things up!! :)
Sep 22, 2010 at 2:49 UTC
Well My knowledge of SQL is not good.
I could do a bulk import, but that requires me getting all of the info and merging it into 1 CSV file (a ton of work). My best option is just to take the hit on the 500 closed tickets I'm missing and just re-create the 15 or so I had open.
Sep 22, 2010 at 2:58 UTC
yeah...If you don't know SQL, it's not a good idea to play around in there...
It's unfortunate...I am planning on using the ticketing for historical/training issues, so not having the closed ones would really suck!! :(
Maybe on the side (you know...When you have time) you could learn a little SQL...it's not too hard for the basics (SELECT, UPDATE, INSERT, DELETE), and has saved my bacon more than once!
Sep 22, 2010 at 3:11 UTC
And I would like to do the same. I do have all the tickets in xls form, but I would have to open each one to get the data . ugh
The larger lesson is here..is to remember to turn on the backups DOH!, hoipefully someone else can use this thread as an example of what happens when you dont.
Apr 16, 2012 at 5:16 UTC
1st Post
I had the same problem. Uninstalling the LogMeIn plugin solved the problem.
Jul 25, 2012 at 10:21 UTC
1st Post
Same here. As soon as I disabled the Logmein rescue plugin, I was able to edit tickets again. Thanks!
Sep 20, 2012 at 6:48 UTC
I too had this problem, and found that the Logmein Rescue plugin, kill many aspects of spiceworks. Uncheck and delete the extension and all will be well.
Sep 20, 2012 at 8:07 UTC
The initial problem in this topic (which is a few years old) appears to be related to the database itself, but any plugin conflicts would be more of an UI issue.
If anyone has issues with the LogMeIn Rescue plugin, it sounds like an older version of the plugin may have been accidentally installed. If you encounter this please contact the support team and we're happy to help rebuild the plugin to work as intended.


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DIY Wedding Ring Boxes
Brides and grooms will love this! Create stunning, DIY wedding ring boxes with help from The Budget Savvy Bride, Jessica Bishop. Hands On starts now!
Hands On is a live-action demo of adorable DIYs that you can actually replicate at home. On-screen instructions guide viewers, while the DIYer also narrates and takes questions from the audience. Throughout each episode, the finished product will be featured on-screen so you always know what we're making - even if you're late to tune in!
Brides and grooms will love this! Create stunning, DIY wedding ring boxes with help from The Budget Savvy Bride, Jessica Bishop. Hands On starts now!
Beautiful macramé plant hangers bring life into a dull space. Watch along as textile artist Cindy Bokser teaches us how to create macramé plant hangers right now, on Hands On!
Handcrafted flower crowns, fresh headbands, and perfect flower arrangements! Watch along as artist Christy Doramus uses colorful flowers to create beautiful floral designs.
Emily creates an adorable mini picnic using felt and sequins. It's easy and fun — the perfect craft to do with your kids!
Create your very own coloring book at home! Courtney is teaching us how to make a creative coloring book out of stamps.
Learn how to make your own beautiful jewelry with Christina Miller!
Sarah returns to teach us how to make amazing crafts using old cards.
Sarah returns to show us a quick way to make a set of colorful and customizable coasters.
Candlemaker Jacob Schirmer shows us how to make our very own soy candles.
LittleThings' Ileana Paules-Bronet decorates ceramic mugs with her own fun and colorful designs.
Artist Hillary Megroz teaches us how to make beautiful DIY rose bouquets in time for Mother's Day.


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I met my ex fiances best friend (we will call him D) about two years ago when he discharged the army, he had just got home from Iraq. The day I met him we became instant friends. He hung out at our house so much that he eventually moved in. Little by little the dynamic of our friendship changed. D and I started hanging out more then my ex fiance and I. D and I did everything together, on our down time of course, we had a lot of the same interests. Politics, history, and reality TV. We were able to talk about everything and we had fun with each other even if we were just sitting there.
D lived with my ex and I for about a year. During the last three months, my relationship with my ex turned REAL bad. He eventually went to jail. D also decided to reenlist into the National Guard because he wanted to "kick in doors." He looked for a unit that was deploying to Afghanistan ASAP and a few weeks after he was enlisted the border mission came up so he decided to apply for that. He got called to go to the border.
Okay, the last three weeks that D was home, my ex fiance and I broke up. He went to jail. D was planning on leaving to the border soon, but he continued living in our house with me anyways. Before he left he asked me to marry him. Then he asked me to move with him. I turned him down both times. I told him I wasn't ready to jump into another SERIOUS relationship. We did get intimate, and we kind of made plans to get in contact after his deployment in Afghanistan. He expressed to me that he knew I would eventually get back together with my ex fiance (his BFF). But he said that he would contact me for sure, and we would talk about an US.
Here is the question. I have no reasons to believe that D was "playing" me when our little fling happened. I think he was more afraid that I wasn't serious. Anyways, I recently found out that he got married to some chick. I also started talking to my ex again. I talked to my ex, he said that D's grandma told him that he got married for the medical benefits. Also, I'm a master spy. I found her Facebook and she has absolutely no pictures of him on her page. She says she is married, but she doesn't say to whom she is married. To me, she just doesn't seem like a newlywed.
I guess I'm kind of hoping he will divorce her and come home so I can see him. I'm kind of hoping that maybe we can works something out. I know he is married so I should forget about him, but I do really care about him. I can't forget about how amazing the time we spent together was.
Most Helpful Girl
Give it time and space00|00|0
What do you mean by space? Now its been one year and 8 days since he left. I don't get what you mean by space though. Lol he has about 500 miles of space.


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Course Level: Graduate
Development Finance and Banking (3) Alternative approaches to understanding the role of finance and banking in economic development and analysis of the interaction between international and domestic capital markets, as well as between the formal banking sector and the informal financial sector of developing economies. The role of development banks, multilateral institutions, and governments in financial market operations. Examines the effect of financial policy reforms and regulations on the performance of financial markets. Usually Offered: spring. Prerequisite: ECON-600 or ECON-803, and ECON-601 or ECON-802.


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Dave Stala remembers studying film when he was a Montreal Alouette, focusing on the sure-handed Ben Cahoon, wanting to imitate moves showcased by the veteran slotback.
Stala, a two-time Vanier Cup winner from Saint Mary's University, was seven years younger than Cahoon when he entered the Canadian Football League in 2003, a year when Cahoon set a record for Canadians with 112 receptions.
Now 31, in his third year with the Hamilton Tiger-Cats, Stala is the Canadian slotback in the spotlight, getting better with age, and the one doing the mentoring, too.
Tied with Als receiver Jamal Richardson, Stala leads the CFL with seven touchdowns, making him the first Canadian in 18 years to lead the league in that category. Calgary Stampeder Dave Sapunjis last did it with 15.
Stala studied Cahoon's game thoroughly during his time in Montreal and admired the connection between Cahoon and quarterback Anthony Calvillo.
"When I was a youngster in the league, Ben helped me out a lot, because we had the same body type, so he could teach me, and we would hang out and golf together, too," said Stala. "But years later, I've become the older guy, and we've got younger guys here, so here I am helping them."
A lasting lesson learned in Montreal is bearing fruit for Stala now. As Calvillo began to age, he started a new diet free of gluten and dairy. Stala noticed how the changes were helping Calvillo, so he went on the same plan with the same trainer from Montreal. Instead of the regular pasta he enjoyed, he learned to substitute pasta products made of corn or rice.
After playing an average 2009 season in Hamilton in which he caught two touchdown passes, Stala returned to Montreal in the off-season and worked out with Calvillo.
"We would do everything together – catching balls, doing drills, running, lifting, everything," Stala said. "A.C. was on the diet for two years before me, so I would talk to him and learn all about that. He's been a huge help to my career."
Stala has lost about 14 pounds on the diet and it continues to energize him. The 6-foot-2, 198-pound pass-catcher feels quicker and lighter on his feet, particularly since a broken foot hobbled him greatly toward the end of his time with the Als.
"There comes a point for a veteran player when you're going to get it or you're not, and for Dave, he really could have not committed himself, and his career honestly would have been over," said Calvillo, now 39. "You have to give him credit, there are a lot of guys who play for four to five years and they wash out. He's made a huge commitment to extend his career and become a better player."
Stala, who was born in Poland but raised in Hamilton, has 26 catches for 339 yards so far in 2011 and was the Canadian player of the week after grabbing five for 107 yards and two scores versus the Als on July 29. He enters Monday's Labour Day Classic against Montreal already having more touchdowns than he has ever had at the end of any of his seven previous CFL seasons.
"He was a very good player back then in Montreal, but now he's a very good pro," said Ticats head coach Marcel Bellefeuille, who was also briefly Stala's receivers coach in Montreal. "He studies more film more, takes care of his body more and understands his role on the team."
"And with Arland Bruce leaving, someone else had to step up and take that role. Dave has stepped up and filled it."
With a crop of young receivers in the fold for the Ticats this season – all imports – Stala has been instrumental in helping them adapt.
"Dave helps me out in so many ways with the nuances of the Canadian game," said Ticats rookie slotback Chris Williams. "He's got seven touchdowns already this year, so you know his connection with Kevin [Glenn]is working."
Stala attributes much of his recent success to the chemistry he and quarterback Kevin Glenn have achieved. Glenn adds that the two spend a lot more time together off the field now, always sitting beside together in meetings, even getting family together outside of football.
"When you start to take that to the next level and you're not just football teammates but you're actually friends, stuff on the field really becomes second nature," Glenn said. "I know what he's thinking now."


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Enterprise Zone
For more information visit the Economic Alliance of Kankakee County.
The Annual Community Auction featured all kinds of treasures that were taken home by their new owners. Auctioneers Bill Phelps and Danny Loftus made sure of that!
The annual kickoff for the Christmas holiday featured Santa and his reindeer, camel rides, carriage rides, beautifully decorated store windows, and many more activities. Always a favorite event for Main Street!
The annual halloween event featured downtown trick-or-treating, both kid's and pet costume contests, hayrides and lots more!
2nd & 4th Tuesdays May 23 - August 22, 5-8pm
Next up - After a record-breaking year in 2016, Washington Street Downtown will once again come alive with antique and unique "Cool Cars under the Stars" throughout the summer. The public is invited to come out and browse, listen to the music, eat some great food, and take a chance on the split the pot drawings held at each event. Mark your calendar now!


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Why Was The Stonehenge Built?
The Stonehenge is a popular mysterious ancient ruin on earth. For over 800 years, many researchers and scientists has formulated and presented ideas on why this enigmatic structure has been built. What is it really for? They fables and myths are actually based on some evidences but there are also reasons not to believe them. It consists of 35 paces across and 162 stones to be exact. The circular stone structure stands in a 320 feet hinge and the innermost area has sarsen horseshoe of blue stones. The term Stonehenge was derived from the Saxon's terminology of 'Stanhenge, which means 'to hang,.
Now, was it really an observatory, an ancient calendar or a worship place? These theories can somewhat be true, or it might not. Inigo Jones, an architect, thought that Stonehenge is a temple for Romans. But between eighteenth and nineteenth centuries, the theory has been changed. An opinion rose that the Druids used it to be a sun-worship temple. Although it has proven that the Druids became prominent 1,000 years after Stonehenge was finished, it is still included on the possible reasons list.
Another hypothesis that came to the researchers' mind is the Stonehenge as an observatory. The stones are also discovered to be celestial movements chart like a calendar. Others say that the stones are also used for religious purposes. Like it was a place where particular people are worshipping and calling their gods. It is also believed that the Stonehenge was built in three stages. They call it Stonehenge I, Stonehenge II and Stonehenge III. The basis of this theory is the continuous existence of different tribes that gather and reconstruct the stones as they want it. For simple people who are not very fond in science and architecture, these explanations can be acceptable since it fits the structure of the stones.


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Charlie Puth When I See You Again Single Version MP3
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On My Mind Again (Single Version) MP3
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Peshtigo - Again Again Again (US Single Version) MP3
Peshtigo's biggest hit! The re-edited single version. Visit Peshtigo at www.myspace.com/peshtigomusic.


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I overheard these 2 women at a party say that they would only date white men and no way in the world an Asian or middle-easterner or Indian. They didn't know that an Asian was just around the corner behind the wall!
A few minutes later I casually made my way to that group, and thankfully, they were still talking about attraction. I joined in and said that I'm attracted to most races, but just not whites. The men were OK with that and go "everyone's got their own taste". The women lash out at me "what? why are you against white women? you are so mean"
I smiled and asked them back, "would you date me?" They go "not with that kind of personality, you need to learn to respect everyone". Then I busted them with "Oh, but I though you just said you don't date Asians... yes I heard you!"
Seriously, looking at the threads on GAG, this is the exact same BS that's spewed on here.
Personally, I was more attracted to white girls back in school. Things have changed for me now.
Most Helpful Guy
I'm White and I prefer Asian women and there have been a few White girls who have got buttsore about it, but that's their problem.10|10|0


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Ignat D. Corrie E. live score (and video online live stream*) starts on 19.10.2016. at 18:10 UTC time in USA F32, Singles - ITF Men. Here on SofaScore livescore you can find all Dragos Constantin Ignat vs Edward Corrie previous results sorted by their H2H matches. Links to Ignat D. vs. Corrie E. video highlights are collected in the Media tab for the most popular matches as soon as video appear on video hosting sites like Youtube or Dailymotion. We're not responsible for any video content, please contact video file owners or hosters for any legal complaints.
You can watch Ignat D. vs. Corrie E. live stream online if you are registered member of bet365, the leading online betting company that has streaming coverage for more than 70.000 live sports events with live betting during the year. If this match is covered by bet365 live streaming you can watch tennis match Ignat D. Corrie E. on your iPhone, iPad, Android or Windows phone. It's also easy to find video highlights and news from the most popular sports leagues in the world. Live bet365 odds are viewable in SofaScore's tennis livescore section. We don't offer a TV schedule here, if you would like to watch this match on TV you'll probably find it it on some more popular channels like iTV, BBC, Al Jazeera Sports, Sky Sports, Gol TV, Canal+, SportTV, FOX Soccer, Setanta, ESPN, etc.
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Dragos Constantin Ignat live score, schedule and results
Edward Corrie live score, schedule and results
SofaScore livescore is available as iPhone and iPad app, Android app on Google Play and Windows phone app. You can find us in all stores on different languages as "SofaScore". Install SofaScore app on and follow Ignat D. Corrie E. live on your mobile!
*IMPORTANT NOTICE – Sofascore.com in partnership with bet365 offers over 70,000 live streaming events per year. However, please note that the intellectual property rights to stream such events are usually owned at a country level and therefore, depending on your location, there may be certain events that you may be unable to view due to such restrictions. Prior to joining bet365 and funding your account in order to view Ignat D. Corrie E., or any other particular event via the bet365 live stream, you are strongly advised to check with bet365 if, depending on your place of residence, it is possible to view the live streamed event in question. Find out more about contacting bet365 here , either by telephone, post, email or chat.


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Environmental Learning Academy (ELA) is a teacher-owned business. Our goal is to improve the academic performance of students by learning from experienced teachers certified by the Texas Education Agency (TEA).
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For historical replications, we can authentically recreate the design you require to capture the original historical beauty of your restoration project in your choice from our quality materials. The only limitation to the columns we can build for you is your imagination.
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Our staff of experienced Column Specialists are available to assist you with the selection of the ideal columns for your design, application, and budget. Please give them a call at 8oo-963-3060 for a free personal consultation and quotation. From the first call you will be provided your own individual Column Specialist and project manager to assist you with product selection, estimation, installation guidance and any other needs you may have to ensure you have a successful column project. Thank you for your interest in quality columns by Melton Classics. We look forward to the opportunity to serve your you.
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Bethesda Handbook of Clinical Oncology, 2nd Edition
Vulvar Cancer
Christina M. Annunziata*
Michael J. Birrer†
*Medical Oncology Clinical Research Unit, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
†Department of Cell and Cancer Biology, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Vulvar cancer accounts for 4% of all female genital malignancies; 4,000 new cases were projected for 2003.
- It is most frequent in women between 65 and 75 years old, and is occasionally diagnosed in women younger than 40 years.
- The etiology remains unclear and potentially involves two distinct diseases associated with
- human papillomavirus (HPV) DNA, especially type 16, found in 80% of intraepithelial lesions and in 10% to 15% of invasive vulvar cancers (especially squamous cell)
- chronic inflammation: venereal or granulomatous lesions, Lichen sclerosus (coexists with up to 25% of vulvar cancers), and Paget disease (preinvasive, see below).
- Vulvar intraepithelial neoplasia (VIN), especially high grade (VIN III), increases risk for development of vulvar cancer.
- Classic risk factors such as hypertension, diabetes mellitus, and obesity most probably represent conditions associated with aging and are not truly independent risk factors for this malignancy.
Squamous cell carcinomas (SCCs) constitute more than 90% of cases, and melanomas constitute less than 10% of cases. The remainder are adenocarcinoma, basal cell carcinoma, verrucous carcinoma, sarcoma, and other rare tumors.
Vulvar SCC is commonly indolent, with slow extension and late metastases. Signs and symptoms in order of decreasing frequency are pruritus, mass, pain, bleeding, ulceration, dysuria, and discharge.
- Biopsy, cystoscopy, proctoscopy, chest x-ray (CXR), and i.v. urography, if needed, based on the extent of disease
- Suspected bladder or rectal involvement must be biopsied.
Indications for Excisional Biopsy of Vulvar Lesions
- Any gross lesion
- Red, white, dark brown, or black skin patches
- Areas firm to palpation
- Pruritic, tingling, or bleeding lesions
- Any nevi in the genital tract
- Enlarged or thickened areas of Bartholin glands, especially in postmenopausal women.
Location and Metastatic Spread Pattern of Vulvar Squamous Cell Carcinoma
- Vulvar squamous cell carcinoma is found on the labia majora in 50% of cases and on the labia minora in 15% to 20%; the remainder of these cancers are on the clitoris and perineum.
- The carcinoma tends to grow locally, with subsequent spread to inguinal, femoral, and pelvic lymph nodes (LNs). Hematogenous spread usually takes place after LN involvement.
- Vulvar cancer is a surgically staged disease (see Table 20.1).
TABLE 20.1. Premalignant Lesions
Prognostic Factors and Survival (True for Most Histologies)
- Survival depends on stage, LN involvement, depth of invasion, structures involved, and tumor location.
- Survival is most dependent on the pathologic status of the inguinal LNs and on the size of the primary lesion (lesions <2-cm in greatest dimension, inguinal LN(-), show 98% 5-year survival; lesions of any size, three or more unilateral LN(+) or two or more bilateral LN(+), show 29% 5-year survival).
- LN metastases are related to tumor size, clinical stage, and depth of invasion.
Stage 0
The following therapeutic approaches are equally effective:
- Wide local excision, laser beam therapy, or combination of the two
- Skinning vulvectomy with or without grafting.
In some cases, a 5% 5-fluorouracil (5-FU) cream can be used [response rate (RR) is 50% to 60%], but it is not the first choice of therapy.
Recurrences are seen regardless of type of procedure used for initial treatment (most common sites are perianal skin, presacral area, and clitoral hood).
Stage I
- Less than 1-mm invasion: wide local excision
- From 1-mm to 5-mm invasion: modified radical vulvectomy with ipsilateral superficial inguinal lymphadenectomyfor lesions located laterally, and bilateral node dissection for centrally placed lesions. Sentinel LN biopsy is an emerging technique in early stage vulvar cancer and may obviate the need for full nodal dissections in many women.
Special Considerations
- Poor surgical candidates can be treated with radiation therapy, achieving long-term survival.
- Surgical complications include mortality (2% to 5%), wound breakdown or infection, sepsis, thromboembolism, chronic leg lymphedema (use of separate incision for the groin LN dissection reduces wound breakdown and leg edema), urinary tract infection, stress urinary incontinence, and poor sexual function.
Stage II
Modified radical vulvectomy and bilateral inguinal lymphadenectomy can be used if at least 1 cm of negative margins can be achieved with preservation of midline structures.
Stages III and IV
The management of stage III and IV disease is shown in Fig. 20.1. Special considerations:
- Management of positive groin nodes: one LN requires no further therapy, whereas two or more LNs can be treated with groin and pelvic radiation therapy (based on data from GOG randomized trial in which improved survival was documented with this therapy as compared to pelvic LN dissection).
- Suggested doses of localized adjuvant radiation are 45 to 50 Gy.
- Neoadjuvant chemoradiation can be used in stage III and IV disease to improve the operability of the tumor. Recent GOG trials have been successful with the use of cisplatin and 5-FU concurrently with radiation.
- Patients with inoperable disease can achieve long-term survival with radical radiation therapy.
- When radiation is given as primary definitive treatment, it is suggested that the addition of 5-FU with cisplatin or mitomycin C be considered.
- Radiation fraction size of less than or equal to 180 cGy has been proven to minimize the radiation complication rate (i.e., late fibrosis, atrophy, telangiectasia, and necrosis). Total doses of 54 to 65 Gy should be used.
FIG. 20.1. Management algorithm for stages III and IV disease. (From DiSaia PJ, Creasman WT. Clinical gynecologic oncology, 5th ed. St. Louis: Mosby, 1997:222, with permission.)
Recurrent and Metastatic Disease
- Treatment and outcome depend on site and extent of recurrence.
- Local recurrencecan be treated with wide local reexcision with or without radiation (5-year survival of 56% if regional LNs are negative). In cases with small localized recurrence, radiation with or without 5-FU can be curative.
- Another option is radical vulvectomy and pelvic exenteration.
- Groin nodescan be subjected to radiation and surgery.
- Distant recurrence: no standard systemic chemotherapy is available for metastatic disease. These patients are appropriate candidates for clinical trials. Agents such as cisplatin, methotrexate, cyclophosphamide, bleomycin, and mitomycin C have shown a partial RR of only 10% to 15%, and they are of short duration a (few months). Trials evaluating the efficacy of paclitaxel in vulvar cancer are ongoing.
- Verrucous carcinoma is very rare and can be confused with condyloma acuminátum because of exophytic growth pattern.
- It is locally destructive and rarely metastasizes.
- It is associated with HPV type 6.
- The main treatment is surgery; LN dissection is of questionable value unless LNs are obviously involved. Radiation is contraindicated because it is not effective and can potentially lead to more aggressive behavior.
- Paget disease is characterized by preinvasive lesions.
- The most frequent symptoms include pruritus, tenderness, or vulvar lesions (i.e., hyperemic, well-demarcated, thickened lesions, with areas of induration and excoriation).
- Paget disease can be associated with underlying adenocarcinoma of the vulva (1% to 2%). These patients should be treated the same way as are patients with other vulvar malignancies.
- Malignant melanoma is a rare tumor (5% of all melanoma cases).
- Most melanomas are located on the labia minora and clitoris.
- Prognosis depends on the size of the lesion and on the depth of invasion.
- Staging of malignant melanoma is the same as for skin melanoma.
- The suggested therapy is radical vulvectomy with inguinal and pelvic lymphadenectomy (lately the tendency is for a more conservative approach). For most well-demarcated lesions, 2-cm margins are suggested for thin (up to 7 mm) lesions and 3- to 4-cm margins are suggested for thicker lesions.
- Adenocarcinoma of the Bartholin gland is a very rare tumor (1% of all vulvar malignancies).
- Its peak incidence is in women in their mid-60s.
- Enlargement of the Bartholin gland area in postmenopausal women requires evaluation for malignancy.
- The therapy includes radical vulvectomy with wide excision to achieve adequate margins and inguinal lymphadenectomy.
Adenoid Cystic Carcinoma
- Adenoid cystic carcinoma is a very rare tumor.
- It is characterized by frequent local recurrences and very slow progression.
- The recommended therapy is wide local excision with ipsilateral inguinal lymphadenectomy.
Basal Cell Carcinoma
- The natural history and therapeutic approach for basal cell carcinoma are similar to those for primary tumors seen in other sites (i.e., wide local excision).
We would like to thank Dr. Helen Frederickson for her critical review of this chapter.
DiSaia PJ, Creasman WT. Clinical gynecologic oncology, 5th ed. St. Louis: Mosby, 1997.
Moore RG, DePasquale SE, Steinhoff MM, et al. Sentinel node identification and the ability to detect metastatic tumor to inguinal lymph nodes in squamous cell cancer of the vulva. Gynecol Oncol 2003; 89(3):475–479.
Montana GS, Thomas GM, Moore DH, et al. Preoperative chemo-radiation for carcinoma of the vulva with N2/N3 nodes: a gynecologic oncology group study. Int J Radiat Oncol Biol Phys 2000;48(4): 1007–1013.
Nash JD, Curry S. Vulvar cancer. Surg Oncol Clin North Am 1998;7(2):335–346.
NCI-PDQ Page. at: http://www.cancernet.nci.nih.gov/clinpdq/soa/Cervical_cancer_Physician.html, 2003.