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【In recent years, researchers have looked at how to stimulate T-cells to combat tumors.】
In the summer of 1890, an adventurous seventeen-year-old from New Jersey named Elizabeth Dashiell travelled across the United States by train. During the journey, she caught her hand between the seats of a Pullman car. The hand became swollen and painful, and, when it didn't heal after she returned home, Dashiell consulted William Coley, a young surgeon in New York City. Unable to determine a diagnosis, he made a small incision below the bottom joint of her pinkie finger, where it connected to the back of her hand, to relieve the pressure, but only a few drops of pus drained out. During the following weeks, Coley saw Dashiell regularly. In the operating room, he scraped hard, gristly material off the bones of her hand. But the procedure gave only fleeting relief. Finally, Coley performed a biopsy that showed that Dashiell had sarcoma, a cancer of the connective tissue, which was unrelated to her initial injury. In a desperate attempt to stop the cancer's spread, Coley followed the practice of the time and amputated Dashiell's arm just below the elbow. But the sarcoma soon reappeared, as large masses in her neck and abdomen. In January, 1891, she died at home, with Coley at her bedside.
After Dashiell's death, Coley was distraught, and searched through the records of New York Hospital for similar cases. He found one patient who stood out from the grim stories. Eleven years earlier, Fred Stein, a German immigrant who worked as a housepainter, had a rapidly growing sarcoma in his neck. After four operations and four recurrences of the cancer, a senior surgeon declared Stein's case "absolutely hopeless." Then an infection caused by streptococcal bacteria broke out in red patches across Stein's neck and face. There were no antibiotics at the time, so his immune system was left to fight off the infection unaided. Remarkably, as his white blood cells combatted the bacteria, the sarcoma shrank into a bland scar. Stein left the hospital with no infection and no discernible cancer. Coley concluded that something in Stein's own body had shrunk the cancer.
Coley spent the next decade hoping to replicate Stein's extraordinary recovery. In "A Commotion in the Blood," published in 1997, Stephen S. Hall describes how Coley inoculated cancer patients, first with extracts of streptococcal abscesses, termed "laudable pus," and later with purer cultures of the microbes. He claimed several successes, but the medical establishment did not embrace his approach, because his results could not be reliably reproduced. His primary critic, the pathologist James Ewing, believed that the new technique of radiation was the only scientifically sound way to treat cancer.
Coley's work was financially supported by John D. Rockefeller, Jr., a classmate of Dashiell's brother who had considered Elizabeth his "adopted sister." But Rockefeller also donated to Ewing's research. While Coley told stories of miraculous recoveries, Ewing presented numbers that consistently demonstrated the power of radiation. Ultimately, Rockefeller chose Ewing as his scientific adviser. Rockefeller's support led to the creation of what is now the Memorial Sloan-Kettering Cancer Center, one of the foremost institutions studying and treating malignancies. The idea that the body's immune system could play a crucial role in eradicating cancer was largely discarded. One doctor at the time called Coley's hypothesis "whispers of nature."
In the last hundred years, progress in the treatment of cancer has come mostly from radiation and chemotherapy. Previously fatal blood-cell cancers, such as childhood leukemia and Hodgkin's disease, are now curable. But solid tumors, which grow in the lungs, the colon, and the breast, have stubbornly resisted treatment once they spread beyond their initial site.
In 1971, the Nixon Administration declared a "war on cancer," promising Americans that within ten years the disease would be beaten. At the time, many researchers believed that cancer was caused by a virus that speeded up a cell's metabolism, resulting in uncontrollable growth. After all, they had discovered some hundred viruses that caused cancer in amphibians, birds, and mammals. In the early seventies, interferon, a drug that had been developed from a protein released by white blood cells during a viral infection, was widely thought to be a possible cure for cancer; in 1980, it appeared on the cover ofTime. The tumors of mice shrank dramatically when treated with the drug. But in patients interferon failed to cure solid tumors, and melanoma responded only occasionally.
Over the next decade, other proteins produced by the body as part of its immune response were made into drugs, most notably one called interleukin-2. In 1988, Armand Hammer, the ninety-year-old oil-company magnate who chaired Ronald Reagan's cancer panel, sought to raise a billion dollars, with the aim of curing cancer by his hundredth birthday. He touted interleukin-2 as an immune booster that could achieve the goal. But most solid tumors were impervious to it, too.
In the past fifteen years, as tumors have been found to contain genetic mutations that cause them to grow unrestrained, the focus of research has shifted to cancer's genome. Targeted therapies, which are designed to disarm these mutations, are now at the forefront of care. The first successful targeted therapy was Gleevec, which caused rapid remissions in chronic myelogenous leukemia, with few and mild side effects. Herceptin, a targeted therapy that attacks HER-2, a protein that is found in some twenty to thirty per cent of breast-cancer cases, has also been effective.
Advances such as these caused Coley's approach to fade into obscurity. Harold Varmus, a Nobel laureate and the director of the National Cancer Institute, told me that until very recently, "except for monoclonal antibodies, every therapy that exploited the immune system was pretty abysmal. There weren't any good ideas about why immune therapy failed." But now patients who did not respond to available therapies have shown dramatic and unexpected responses to a new series of treatments that unleash the immune system. Coley's theories are suddenly the basis for the most promising directions in cancer research. In March, 2011, the National Cancer Institute announced that it would fund a network of twenty-seven universities and cancer centers across North America to conduct trials of immune therapies. Mac Cheever, the director of the program, who is at the Fred Hutchinson Cancer Research Center, in Seattle, described it as a way to speed the practical work of developing treatments. "All of the components needed for effective immunotherapy have been invented," he said.
Jim Allison, the director of the tumor-immunology program at Memorial Sloan-Kettering, began his career as a researcher at the University of Texas Cancer Center, in 1978. At the time, he was taken with the idea that the T-cell could be directed against cancers. T-cells are a potent type of white blood cell that destroy cells infected with microbes that they recognize as foreign. The immune system uses a variety of white blood cells to fight disease. Some, like neutrophils and macrophages, engulf and chew up microbes. In contrast, T-cells attack the microbe from the outside, with a fusillade of enzymes. Cancers disarm the immune system, producing proteins that cause T-cells to either quickly become exhausted and die or blithely overlook the tumor. Allison's research focussed on why T-cells failed either to recognize cancer as being aberrant or to attack it, as they do with microbes.
Allison's mentors discouraged him from pursuing research on T-cells. "Tumor immunology had such a bad reputation," he told me when we met in December at his laboratory at Sloan-Kettering, which overlooks the East River. Allison, who is sixty-three years old, is a thickset man with a stubbly beard and a gravel voice. "Many people thought that the immune system didn't play any role in cancer." Treatments like interferon and interleukin-2 had led scientists on a roller coaster of hype followed by disappointment. Immune therapy was also tainted by popular claims that following a certain diet or reordering your mind could be natural immune-boosting ways to cause tumors to disappear, with none of the miserable side effects of chemotherapy and radiation.
But Allison started looking at how the immune system fights disease, using mice as study models, and capitalized on a critical discovery: T-cells require two signals to attack a target effectively. The first signal, he said, was "like the ignition switch," and the second "like the gas pedal." When working against a microbe, both signals were operative. But, in the presence of cancer, "T-cells don't get those signals to attack," he explained. Allison started to wonder what it would take to reliably activate the immune system against cancer.
In 1987, researchers in France discovered a protein called cytotoxic T-lymphocyte antigen-4, or CTLA-4, which protruded from the T-cell's surface. "There was a real race among a number of labs to figure out its function," Allison recalled. A scientist at Bristol-Myers Squibb, using results from his lab, contended that CTLA-4 increased the activity of T-cells and the immune system. But Allison and Jeffrey Bluestone, an immunologist, obtained results from independent experiments that contradicted that conclusion. Allison and Bluestone believed that CTLA-4 actually acted as a brake on the T-cells, and Allison thought that it might be keeping the immune system from attacking tumors. "Jeff and I were kind of in the wilderness for a while," Allison said. "Before this, people just thought that T-cells died on their own." He speculated that treatments designed to activate the immune system might have failed because the treatments were actually stimulating CTLA-4. As Allison put it, "We ought to free the immune system, so it can attack tumor cells."
Allison's postdoctoral researchers implanted cancer cells under the skin of mice, some of which were then treated with an antibody that blocked CTLA-4. After several weeks, the cancers disappeared. One of the researchers showed Allison the data in early December, 1995. Allison was astounded. The lab was about to go on Christmas break, but he wanted to repeat the experiment immediately. "I told the researcher that he should inject the tumors into a new group of mice, and have a control group that didn't get the antibody. And I'd measure the tumors myself," Allison recalled. "So it was really a blinded experiment, because I didn't know what was what." A week later, Allison measured the cancers. "The tumors were still growing, and I'm starting to despair. And then, in half of the mice, the tumors just seemed to stop, but in the other half of the group they kept going. And then the ones in which it stopped, the cancer started disappearing and just went away." Allison added, "It immediately confirmed our original assumption that this could be good for any kind of cancer."
For two years, as Allison continued his experiments on mice, he approached pharmaceutical and biotech companies for help in developing the treatment for patients, but he was repeatedly turned away: "People were skeptical of immunology and immune therapy. They would say, 'Oh, anybody can treat cancer in mice.' Sometimes they'd say, 'You think you can treat cancer by just removing this negative signal on a T-cell?' "
Allison also learned that Bristol-Myers Squibb had filed for a patent asserting that CTLA-4 stimulated T-cell growth. "If that was the case, you would never, ever think about injecting an antibody that blocked CTLA-4 into a cancer patient, because it would make things worse," he said. "People were scared of putting that into a patient." But Allison persisted, telling industry executives that Bristol-Myers Squibb was wrong. Finally, he persuaded a small company called Medarex to invest in the approach.
Among its first trials on humans, in 2001, Medarex included patients with malignant melanoma, because it was one of the few cancers that had occasionally responded to immune-based treatments like interferon or interleukin-2. In pilot studies, patients were treated with the antibody to CTLA-4, and, as in mice, the cancers continued to grow for some weeks, before a few of the tumors shrank. In 2004, Bristol-Myers Squibb formed a partnership with Medarex to collaborate on the drug. A subsequent trial showed scant impact after twelve weeks. Many of the tumors got bigger, and in some patients new lesions appeared. Pfizer was also testing an antibody to CTLA-4, and concluded that it was a failure; the trial was stopped early.
Months after the end of the Bristol-Myers Squibb study, however, several of the clinicians involved, including Jedd Wolchok, of Memorial Sloan-Kettering, and Stephen Hodi, of the Dana-Farber Cancer Institute, in Boston, realized that the tumors had either stopped growing or begun to shrink. Wolchok and his colleagues prevailed upon Bristol-Myers Squibb to include over-all survival rates of patients after several years. (Because the established criteria for judging the effectiveness of chemotherapy drugs are based on the first months of treatment, the trial had been considered a failure.) "It was pretty courageous," Allison said, "because it would take a long time to finish the study." In June, 2010, the results were presented at the annual meeting of the American Society of Clinical Oncology. Although the drug had extended the patients' lives a median of only four months, nearly a quarter of the patients were alive two years into the trial. Their predicted survival had been seven months. "This is a drug unlike any other drug you know," Allison said. "You are not treating the cancer—you are treating the immune system. And it was the first drug of any type to show a survival benefit in advanced-melanoma patients in a randomized trial."
Allison's results astounded cancer specialists. Nature published a review in December, 2011, and noted that the antibody to CTLA-4 "provides realistic hope for melanoma patients, particularly those with late stage disease who otherwise had little chance of survival. More broadly, it provides clear clinical validation for cancer immunotherapy in general." I asked Harold Varmus why Allison had had success where other researchers in immunotherapy had failed. "We need to understand what we do," he said. "Jim made things understandable."
"You've got to be careful about using the word 'cured,' because some patients have residual tumors," Allison said. "But it doesn't matter, because their cancers are not growing. And, in others, tumors just pop up and then go away. So it's become something of a chronic condition," rather than a death sentence. Allison moved to Sloan-Kettering to be closer to the clinical trials conducted by Wolchok and others. "I just wanted to be the advocate who is keeping it in everybody's face," he said.
In the fall of 2003, Sharon Belvin was a twenty-two-year-old student teacher with plans to marry the following June. She ran between four and five miles a day, and began to notice that her chest hurt after her morning workout. The student health service thought that she might have viral bronchitis, picked up from the children in her class. But her symptoms did not improve, and she was given other diagnoses, including asthma and pneumonia. Before long, she found it uncomfortable even to walk. On a visit to her mother, Belvin saw the family physician, who found a lump on her clavicle. A biopsy showed that she had metastatic melanoma. "It shocked me," Belvin told me. "I was never a sunbather. And I never had any lesions on my skin." A week before her wedding, she completed her evaluation. A body scan "lit up like a Christmas tree," she recalled. "I ended up having chemotherapy on Monday, Tuesday, and Wednesday, and got married on Saturday." During four months of therapy, the tumors shrank a bit. Then they began to grow again. An MRI showed that the melanoma had spread to her brain. Belvin went to Sloan-Kettering, where the brain tumor was treated with radiation. After recovering from the procedure, she received interleukin-2, to stimulate her T-cells. The therapy caused such a severe reaction that "my skin peeled off over my body," Belvin said. "I was so violently ill, I don't remember half of what happened." Worse yet, the treatment failed to stop the cancer's growth. "The doctor told me, 'If you are going to take a vacation, you'd better do it now.' " Belvin and her husband went on a Caribbean cruise.
When she got back, Belvin returned to the hospital and had twelve litres of fluid drained from her chest. Then Wolchok offered Belvin treatment with the antibody to CTLA-4, which was still an experimental therapy. "By that point, I had told my husband, 'If this doesn't work, I don't know how much more I can take,' " she recalled. Wolchok gave her an informed-consent release that listed all the possible side effects. "It was pages and pages of this could happen to you and that could happen to you. I didn't read one page. I just signed at the bottom and said, 'Give it to me.' "
The antibody was infused through one of Belvin's veins, and she had a drastic reaction: her body shook and she experienced drenching sweats, as well as an immune attack on her thyroid gland. "I thought I was dying, the rigors were so bad," she recalled. After four treatments given every three weeks, Belvin went for a set of scans. "I remember how Dr. Wolchok came in with this huge smile on his face, and he was like, 'This is great!' He was just floored." The massive tumors in her lungs had shrunk significantly.
Wolchok did not want to raise Belvin's hopes too much. But "every single scan that I had after that time, the tumors kept shrinking," she said. Eight years after her diagnosis, she still has no signs of the cancer.
Belvin's case is remarkable, but it contradicts the popular notion that boosting the immune system is a "natural" way to treat cancer, free of the harsh side effects associated with chemotherapy or radiation. The results of immunotherapy can include an attack on the skin, intestines, lungs, liver, thyroid, pituitary gland, kidneys, and pancreas. When T-cells are stimulated to an intensity that destroys cancer cells, they can also cause collateral damage to normal tissue. Wolchok told me, "You may need to cross the line to toxicity for the immune system to be effective against a cancer. It's not a free ride." Because Belvin's thyroid gland was destroyed by the therapy, she now requires replacement hormones.
Steven Rosenberg, the chief of surgery at the National Cancer Institute, who played a key role in developing interleukin-2, also conducted some of the early studies with the antibody to CTLA-4. He noted that the bowel often became severely inflamed with the treatment: "You have, like, eight litres of diarrhea a day. The colitis is atrocious, and would be lethal in almost everybody. If you don't put those patients on corticosteroids immediately, they'll die."
"In the field of oncology, the bar is set so low," Rosenberg told me. He welcomes the outcomes for patients like Belvin, but is cautious about the long-term benefits of similar treatments. "I believe that the antibody to CTLA-4 will cure some patients with melanoma, although the follow-up is short." But unless all detectable cancer disappears, he said, "the tumors are going to grow back eventually."
Rosenberg has pioneered a different strategy, called "adoptive cell transfer," in which T-cells are taken from a patient's tumor and given immune stimulants such as interleukin-2, which cause them to replicate. Then they are put back into the body. In the latest of three trials of patients with melanoma who underwent adoptive cell transfer at the National Cancer Institute, nine of twenty-five patients have been in complete remission for more than five years. Across all three trials, five patients who had received earlier, unsuccessful treatment with the antibody to CTLA-4 are in remission.
Sam Breidenbach, who runs a construction company in Wisconsin, was one of those five. In September, 1999, his wife noticed a small mole on his back. He went to the hospital at the University of Wisconsin in Madison, and was told that he had melanoma. It was caught early, and the doctors, after removing it, said that the cancer did not appear to have spread. But three years later, while playing volleyball, he lunged to spike the ball, and felt a pull at his left flank. "It was this roly-poly little nodule on my left hip, at the top of the bone"—a metastasis from the original melanoma. "A local oncologist just basically said, 'You'll be lucky to live five years,' " Breidenbach recalled. He returned to the hospital in Madison, where he was given high doses of interferon. "For the first month, I was just totally dead. I couldn't do anything." The treatment was ineffective. Within months, the melanoma had appeared in the lymph nodes of his left groin.
Breidenbach found out about Rosenberg through his daughter, who was in a violin class with a girl whose father had been treated for melanoma at the National Cancer Institute. Breidenbach contacted Rosenberg, who treated him with an experimental melanoma vaccine. Breidenbach did not respond to the treatment, and the melanoma spread to his liver and lungs. In the summer of 2003, after being treated with the antibody to CTLA-4, he developed excruciating pain in his abdomen—pancreatitis, caused by the toxicity of the immune response. "It was so brutal that they had to stop the treatment," Breidenbach said. "They were basically out of any other ammunition to throw at me." His doctor at the University of Wisconsin told him that he couldn't expect to live more than four to six months. One oncologist suggested chemotherapy, but "I knew the numbers, and my wife and I said, 'If this is really the remaining time I have on the planet, why make it miserable?' "
Over the week of Thanksgiving, Rosenberg called and told him that his research team had studied his T-cells in the laboratory. "Your cells are jumping out of the petri dish," Rosenberg said. He explained that Breidenbach's T-cells could be stimulated to recognize and attack melanoma. "Dr. Rosenberg basically told me to get on the plane on Monday and expect to be here for three weeks." Breidenbach's T-cells had been removed and manipulated in Rosenberg's lab. Upon his arrival at the N.I.H., they were returned to his body through a catheter entering the vein to his heart. "All the doctors were grinning in the operating room," he told me. "I felt like it was 'Dr. Strangelove.' " Breidenbach developed a fever of a hundred and four degrees, and his skin erupted in a rash. He went home on Christmas Eve, barely able to walk, but within a month the numerous metastases had started to shrink. Today, none of the melanoma remains. "My T-cells, they were fiery," Breidenbach concluded. But there was one permanent side effect of the treatment. Along with the cancer, the manipulated T-cells attacked the normal cells with melanin, causing vitiligo, in which skin loses its pigment, and his hair to turn white.
Rosenberg believes that melanoma has a unique relationship with the immune system: there are so many mutations in the tumors that T-cells have an easier time recognizing them as foreign. This characteristic makes developing immune therapies easier. "An intense natural immune response just doesn't exist for other kinds of cancers," he said.
But Rosenberg thinks that he has the key to a more wide-ranging approach. "With six hundred thousand Americans dying every year with cancer, we need something for the common cancers," he said. He acknowledges that targeted drugs, such as Gleevec, can be effective, but he points out that most targeted therapies quickly wane in their efficacy. A recently developed therapy for melanoma dramatically shrank more than half of tumors, but nearly all patients relapsed within a year. A study published in March suggested that as a cancer spreads in the body—from the kidney to the liver and the lungs—the mutations occur in non-uniform ways, so that DNA in liver deposits may differ from DNA in tumors in the lung. This protean progression means that a drug targeted to one mutation may not work against cancer cells throughout the body.
In Rosenberg's view, with adoptive cell transfer, these malignancies would all appear equally foreign to the immune system. He is refining the treatment for other cancers by skimming patients' blood and then inserting a gene into their T-cells that targets a different protein, called NY-ESO. The protein, which was identified at Memorial Sloan-Kettering, is normally absent in tissues after fetal development, except in the testis, but it reappears in about a third of all common cancers. "I think adoptive cell transfer is going to be the secret to applying immune therapy to the treatment of many human cancers," Rosenberg said. "When T-cells are genetically engineered to target NY-ESO, there is no difference between melanoma and breast cancer or prostate cancer, or colon cancer, ovarian cancer, sarcoma, and so on."
Varmus agrees that this approach might make a wider array of tumors susceptible to therapy, and in early trials Rosenberg's strategy has been promising. In 2008, Anita Robertson, a sixty-three-year-old accountant from Long Beach, California, had a large sarcoma growing in her hip, a type of tumor similar to the one that killed Elizabeth Dashiell. In July, 2010, after treatment with genetically altered T-cells, Robertson was discharged from the N.I.H. hospital. A CAT scan in September showed that the sarcoma had begun to shrink; it is now more than fifty per cent smaller. Once immobile and in pain from the cancer, she now can drive, shop, and attend church.
Using a similar approach, researchers at the University of Pennsylvania have eradicated chronic lymphocytic leukemia in three patients who were no longer responding to other therapies. This month, Rosenberg reported remissions in eight of nine patients with advanced lymphoma, and in three of those patients the cancer disappeared completely.
"We've got much, much better now with adoptive cell transfer," Rosenberg told me, "but it's not widely available." The treatment has to be individually designed for each patient, which makes it enormously expensive, and so less valuable to pharmaceutical companies. "They want a drug, and they don't care if you spend five hundred million dollars developing the first vial, as long as they can produce the second vial for a dollar," Rosenberg said. Because his work is experimental, it has been supported by federal funds. Eventually, however, these therapies will be priced by calculating how much they offset the costs of conventional treatments. Although the new procedures could run to hundreds of thousands of dollars, they might still prove less costly than the money spent on chemotherapy, hospitalization, and hospice care for the many patients who currently cannot be cured.
Jedd Wolchok, however, argues that common cancers may not require adoptive cell therapy. He talks about the "three 'E's" in immune therapy: elimination, equilibrium, and escape. Therapy should aim for total elimination of the cancer, but "we need to think about immune-system equilibrium," in which the cancer, though present, does not grow or spread. After decades of frustration and failure in the clinic, most scientists are wary of predicting whether immune therapy will be able to completely cure the majority of cancer patients. Tumors have mutated to escape the effects of radiation, chemotherapy, and targeted agents; the body's immune responses may not be unique.
Though CTLA-4 is still the focus of much research, scientists have now identified at least five other inhibitors on T-cells. Initial studies show that treatments directed at these inhibitors can shrink some of the most deadly tumors, including those of the lung and the colon. Mario Sznol, an oncologist at Yale, has conducted clinical trials with an antibody directed against one of the inhibitors, a protein called PD-1. "I believe that in the future we can customize immune therapy to the individual patient," he said. Doctors will examine the specific characteristics of a tumor, and then treat patients with the appropriate antibody.
Allison's laboratory is an open space that occupies a large part of the fifteenth floor of the Zuckerman Research Building, at Sloan-Kettering. The day I visited, postdoctoral fellows and graduate students were analyzing data on their computers from recent experiments. In a corner was an intravital microscope, which can show cells and tissues in a living animal. Allison demonstrated how an anesthetized mouse is injected with the antibody to CTLA-4. Previously, the T-cells of the mouse had been labelled with a fluorescein dye and sensitized to a protein from a tumor. Using the intravital microscope, "you can actually watch the T-cells move into the lymph node," Allison said. They appeared as bright-green circles coursing through thin gray vessels. "And then the T-cells jump—they leave the lymph node and attack the tumor."
In another part of the lab, a postdoctoral fellow had arranged a series of mice that had been inoculated with melanoma. Some served as controls, and black masses an inch or more grew on their flanks. Others had received the antibody to CTLA-4, or to PD-1, or a combination. "The most dramatic regression is seen with the combination," Allison said, pointing to the flanks of mice where the tumors had shrunk to small black dots. Clinical trials in patients have begun with combining one antibody against CTLA-4 and another against PD-1, in order to remove two distinct brakes on the T-cell.
Last year, the antibody to CTLA-4, marketed under the name Yervoy, was approved by the Food and Drug Administration to treat melanoma. It was a vindication for immune therapy, and an important step in the treatment of cancer. Yet this branch of research has also uncovered how far we have to go to understand the mutations that make cancer the most protean of diseases. "The future is about thoughtful combinations, different antibodies, perhaps with targeted therapies," Wolchok told me. "There won't be a single silver bullet for everyone."


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Well, where do I start when it comes to yesterday. Few shows (photos above are of Holly Fulton), work and then I went to see Foals at Ally Pally. Busy but fun but then it all took a bit of a turn for the worse. Foals was awesome, although they didn't play Cassius which is possibly one of my fave songs. But I do guess its quite a old now so it's understandably. It was all over in a blur to be honest. A mixture of being tired and post fashion weekend!
Then when I got back to my hotel room my door was broken. After almost five hours of them trying to open the door, I admitted defeat and got a cab home. They eventually offered me another room in a different hotel but that wasn't a solution to the fact I didn't have any of my things including my phone charger, glasses or my outfit for today (Sunday)! I know it's petty but not having simple things like that really stressed me out, upset me and eventually made me break down in tears! Ruddy annoying.
Obviously as you guys know I live in London but I was offered a few nights stay in a central London hotel with a brand I'm doing work for. I wasn't going to turn something like that down. In theory it would have been easier as I had a central base. But the door was unexplainably broken and there was nothing the hotel could do. At first they kept telling me they would fix it and it would be fine and I was very patient despite being exhausted.
What have I learned? It may take 45 mins from my house to Somerset House but at least I can get in and out as I please! Never been so happy to see the back of that place!

subset: commoncrawl


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At 7,382 feet, the Pordoi Pass is this highest road in Italy's Dolomite mountain range. Today's Nice Price or Crack Pipe Triumph Dolomite is set up for the track rather than the road, but would you have to be high to pay its asking price?
As frightening as the prospect of the first full-chat apex taken in the car might be, yesterday's Chevy-powered Porsche won over a daring 55% of you with its push roddy goodness, securing a Nice Price win.
The blood line of the Triumph Dolomite is circuitous and confounding, having its origins in the FWD 1300 of the mid-sixties, and sharing even more with the live rear axle Toledo - the Dolly being a much more upscale version of that rear-driver. Today's SVRA-ready Dolomite Sprint will certainly get the blood boiling, and rolling in it, you'd be almost certain not to be trading paint with another through the corners.
The Dolomite Sprint was Triumph's answer to the BMW's boxy but sporty 2002. In England it went new for a good grand less than the German, and featured a number of firsts that the Bavarians couldn't match. The Sprint's 1998-cc four cylinder laid claim to the first mass-produced multi-valve engine, sporting 4 per pot and actuated by a single, very busy, overhead cam. The spoked alloy wheels were also the first to be made standard equipment on a British production saloon. The engine - sans the complicated head could also be found in the company's TR7 wedge of cheese, as well as bas-akwards in Saab's 99.
In this Dolly racer, the slant four employs a pair of Weber DCOEs and is claimed to be as fresh as a prince of Bel Air. An interesting, and somewhat jarring accessory to find topping the red roof inn under the hood is an oil cap cast in the shape of a Leyland badge. Creepy. Factory, these engines pumped out around 125-bhp, which was enough to push the 2,200-lb sedan to sixty in under 9 seconds. Here, with the big throaty carbs, it should make more than that and do so over a wider range of revs. The transmission is Triumph's 4-speed manual which you shift it with your left hand, as, just like in a Le Mans Ford GT40, you sit on the right. That's cool on counter clockwise courses, but should you need to be passed an electrolyte-refreshing Gatorade during a quick pit stop on any course full of rights you'll need to employ somebody with some extra long arms, perhaps a chimpanzee.
The interior is of course stripped down to its skivvies and shy of a couple of planks on the dash, there's nothing left of the luxurious leather and wood interior the car once proudly carried. That's okay because a full cage and deep-scooped bucket are more important than wool carpet and vanity mirrors considering this car's current occupation. If you want to see what it used to look like, go find that Top Gear episode where Hammond destroyed a Dolly on the Industry test Circuit. Hopefully this one won't come across too many excessive slopes during its track excursions.
Like the interior, the trunk has also seen a diminution in its original functionality the majority of it now being taken up by a racing fuel cell. The rest of the car, less the delicate blade bumpers, still retains its Sprint-ness in spite of its track livery. There's the subtle front airdam below the four-lamp split grille, and a roof covered in black vinyl, probably the only track car outside of LeMons so capped, while still looking righteous. The Michelloti design looks of the era, however not dated much like its competition the 2002. The seller says the car comes with a bunch of extras, and most recently won its class at the Sebring 2-hour enduro. Good looks, exclusivity and the ability to fill trophy cases, this Triumph's got it all. It should be mentioned that for a whole lot of reasons, this car is not intended for street use, and any thought of returning it to that role would be pure fantasy.
Just finding regular wear parts are a problem on stock Dolly Sprints, so much having been proprietary to the special edition. From '73 through '80, over 20,000 Sprints were built and a healthy fan club has arisen in Jolly Olde to support the marque. That used to mean painful long distance phone bills, but these days the Internet makes finding replacement parts little more than a Google search away.
But what of this Triumphant racer's price? In full disclosure, the eBay ad referenced for this NPOCP ended yesterday, but it didn't end the way the seller wanted. His $16,300 asking price has come down since his last eBay excursion - noted a while back on BaT - where he asked $18,000, but perhaps it need to limbo even lower? Or, maybe it's just that the bay of E isn't the best place to try and unload a Dolly racer? Maybe someplace like Race-Cars.com would be better? Whichever, we need to determine if it's been venue or price that has kept this seller still playing with his Dolly. What do you think, is this rare racer worth sixteen thousand, three hundred even rarer dollars? Or, is that a Dolly that's not worth that many Madisons?
You decide!
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Hi, I have downloaded the maven 3.0.4 and extracted it.and I have seted the path correctly. I am following steps from this url. http://www.roseindia.net/maven2/installingandgettinghandson_maven.shtml and I am running this command D:\maventest>mvn archetype:create -DarchetypeGroupId=org.apache.maven.archetypes -DgroupId=net.roseindia.maven.quickstart -DartifactId=HelloMaven
but I am getting the NoPluginFoundForException in command prompt.please help me ASAP. Thanks Eshwin Sukhdeve


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About Jeff Masters
Cat 6 lead authors: WU cofounder Dr. Jeff Masters (right), who flew w/NOAA Hurricane Hunters 1986-1990, & WU meteorologist Bob Henson, @bhensonweather
By: Dr. Jeff Masters , 3:12 PM GMT on January 25, 2011
Yesterday, I introduced the National Climatic Data Center's Climate Extremes Index, which uses temperature and precipitation records to see if the U.S. climate is getting more extreme. Today, I'll focus on how the drought and precipitation extremes that go into the Climate Extremes Index have changed over the past century. The three precipitation-related factors to go into the Climate Extremes Index are:
1) The sum of: (a) the monthly percentage of the United States in severe drought (equivalent to the lowest tenth percentile) based on the Palmer Drought Severity Index (PDSI) and (b) the percentage of the United States with severe moisture surplus (equivalent to the highest tenth percentile) based on the PDSI.
2) Twice the value of the percentage of the United States with a much greater than normal proportion of precipitation derived from extreme (equivalent to the highest tenth percentile) 1-day precipitation events.
3) The sum of (a) percentage of the United States with a much greater than normal number of days with precipitation and (b) percentage of the United States with a much greater than normal number of days without precipitation.
Items 1 and 3 have shown no change in annual average value over the past century, but there has been a marked increase in the number of heavy 1-day precipitation events in recent decades. Thus, the record and near-record values of the Climate Extremes Index in recent years have been due to a combination of the increase in heavy 1-day precipitation events and an increase in maximum and minimum temperatures.
Figure 1. The Annual Climate Extremes Index (CEI) for heavy 1-day precipitation events shows that these events, on average, have affected 10% of the U.S. over the past century (black line). However, heavy precipitation events have increased in recent decades. The seven most extreme years since 1910 have all occurred since 1995, with 2010 ranking as the 5th most extreme year in the past 100 years. Image credit: National Climatic Data Center.
Heavy precipitation events
Global warming theory predicts that global precipitation will increase, and that heavy precipitation events--the ones most likely to cause flash flooding--will also increase. This occurs because as the climate warms, evaporation of moisture from the oceans increases, resulting in more water vapor in the air. According to the 2007 Intergovernmental Panel on Climate Change (IPCC) report, water vapor in the global atmosphere has increased by about 5% over the 20th century, and 4% since 1970. The Climate Extremes Index plot for extreme 1-day precipitation events (Figure 1) does indeed show a sharp increase in heavy precipitation events in recent decades, with seven of the top ten years for these events occurring since 1995, and 2010 coming in 5th place in the past 100 years. The increases in heavy precipitation events have primarily come in the spring and summer, when the most damaging floods typically occur. This mirrors the results of Groisman et al. (2004), who found an increase in annual average U.S. precipitation of 7% over the past century, which has led to a 14% increase in heavy (top 5%) and 20% increase in very heavy (top 1%) precipitation events. Kunkel et al. (2003) also found an increase in heavy precipitation events over the U.S. in recent decades, but noted that heavy precipitation events were nearly as frequent at the end of the 19th century and beginning of the 20th century, though the data is not as reliable back then.
Drought and extreme wetness
Global warming theory predicts that although global precipitation should increase in a warmer climate, droughts will also increase in intensity, areal coverage, and frequency (Dai et al., 2004). This occurs because when the normal variability of weather patterns brings a period of dry weather to a region, the increased temperatures due to global warming will intensify drought conditions by causing more evaporation and drying up of vegetation. Increases in drought and flooding are my top two concerns regarding climate change for both the U.S. and the world in the coming century. Two of the three costliest U.S. weather disasters since 1980 have been droughts--the droughts of 1988 and 1980, which cost $71 billion and $55 billion, respectively. The heat waves associated with these droughts claimed over 17,000 lives, according to the National Climatic Data Center publication, Billion-Dollar Weather Disasters. Furthermore, the drought of the 1930s Dust Bowl, which left over 500,000 people homeless and devastated large areas of the Midwest, is regarded to be the third costliest U.S. weather disaster on record, behind Katrina and the 1988 drought. (Ricky Rood has an excellent book on the Dust Bowl that he recommends in a 2008 blog post).
Figure 2. The Annual Climate Extremes Index (CEI) for drought. The worst U.S. droughts on record occurred in the 1930s and 1950s. There has been no trend in the amount of the U.S. covered by drought conditions (blue bars) or by abnormally moist conditions (red bars) over the past century. About 10% of the U.S. is typically covered by abnormally dry or wet conditions (black lines). Image credit: National Climatic Data Center.
The good news is that the intensity and areal coverage of U.S. droughts has not increased in recent decades (blue bars in Figure 2). The portion of the U.S. experiencing abnormal drought and exceptionally wet conditions has remained nearly constant at 10% over the past century. A recent paper by Andreadis et al., 2006, summed up 20th century drought in the U.S. like this: "Droughts have, for the most part, become shorter, less frequent, and cover a smaller portion of the country over the last century. The main exception is the Southwest and parts of the interior of the West, where, notwithstanding increased precipitation (and in some cases increased soil moisture and runoff), increased temperature has led to trends in drought characteristics that are mostly opposite to those for the rest of the country especially in the case of drought duration and severity, which have increased."
Other portions of the globe have not not been so fortunate. Globally, Dai and Trenberth (2004) showed that areas experiencing the three highest categories of drought--severe, extreme, and exceptional--more than doubled (from ~12 to 30%) since the 1970s, with a large jump in the early 1980s due to an El Niño-related precipitation decrease over land, and subsequent increases primarily due to warming temperatures. According to the Global Drought Monitor, 98 million people world-wide currently live in areas experiencing the highest level of drought (exceptional).
Andreadis, K. M. Lettenmaier, D. P., "Trends in 20th century drought over the continental United States", Geo. Res. Letters 33, 10, L10403, DOI 10.1029/2006GL025711
Dai A., K.E. Trenberth, and T. Qian, 2004: A global data set of Palmer Drought Severity Index for 18702002: Relationship with soil moisture and effects of surface warming", J. Hydrometeorol., 5, 11171130.
Gleason, K.L., J.H. Lawrimore, D.H. Levinson, T.R. Karl, and D.J. Karoly, 2008: "A Revised U.S. Climate Extremes Index", J. Climate, 21, 2124-2137.
Groisman, P.Y., R.W. Knight, T.R. Karl, D.R. Easterling, B. Sun, and J.H. Lawrimore, 2004, "Contemporary Changes of the Hydrological Cycle over the Contiguous United States: Trends Derived from In Situ Observations," J. Hydrometeor., 5, 64-85.
Kunkel, K. E., D. R. Easterling, K. Redmond, and K. Hubbard, 2003, "Temporal variations of extreme precipitation events in the United States: 1895-2000", Geophys. Res. Lett., 30(17), 1900, doi:10.1029/2003GL018052.
A new Nor'easter for New England
A low pressure system currently centered along the Gulf Coast near New Orleans is bringing heavy rain to much of the south. Rains in excess of 3 inches have fallen over central Mississippi, and the rain is expected to change to snow over northern Mississippi, northern Alabama, and much of Tennessee late tonight. A swath of 2 - 4" of snow is expected in these regions, with higher amounts in the mountains. The low will move off the coast of North Carolina on Wednesday morning, then northeastward out to sea, potentially bringing heavy snows of 4 - 8" to inland portions of New England and the mid-Atlantic. At this time, it appears that the storm will track far enough from the coast and there will be insufficient cold air in place for snowfall amounts of a foot or more to fall. A nasty mix of rain, sleet, and snow is likely for much of the coast, with the heaviest snows expected to miss New York City, Washington D.C., and Boston (Figure 3.) As the low drags its cold front over Florida this afternoon, a slight risk of severe thunderstorms exists, and Florida could see a few tornadoes.
Figure 3. Probability of more than 8 inches of snow falling, for the 24 hour period ending 7am EST Thursday January 27, 2011. Image credit: National Weather Service HPC.
Jeff Masters
The views of the author are his/her own and do not necessarily represent the position of The Weather Company or its parent, IBM.
Cat 6 lead authors: WU cofounder Dr. Jeff Masters (right), who flew w/NOAA Hurricane Hunters 1986-1990, & WU meteorologist Bob Henson, @bhensonweather


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A backpackers' paradise, Malaysia is known for being one of Southeast Asia's cheapest destinations. But that doesn't mean staying in hostels and dorms; luxury in Malaysia comes with a pleasantly small price tag. While researching the upcoming Rough Guide to Southeast Asia on a Budget, Kiki Deere went in search of the best luxury hotels and resorts for those after some pampering:
Tanjong Jara, Terengganu
This luxurious retreat overlooking the turquoise waters of Malaysia's pristine east coast is designed to reflect the elegance of seventeenth century Istanas, grand wooden palaces of Malay sultans. The tastefully decorated rooms featuring local timber are set around seventeen hectares of tropical grounds shaded by palm trees. The exclusive Anjung Suite measures 176 square metres and features an outdoor bath set in its own private garden. The resort's award-winning Spa Village offers therapies based on traditional Malay treatments that have been handed down from generation to generation.
Doubles from US$400. www.tanjongjararesort.com
Tiger Rock, Pangkor Island
Set on twelve acres of lush jungle on Pangkor Island off the west coast of Malaysia, Tiger Rock features eight tastefully decorated rooms dotted around verdant grounds overlooking the sea and the mainland. The buildings are fashioned after traditional Malay kampung (village) houses, and each is individually designed and furnished with the owners' very own collections of furniture artefacts, books and paintings, as well as intricate textiles and handmade ceramics. Rates include three daily meals, all lovingly prepared by the outstanding chef Bavanni using the island's freshest ingredients.
US$205 per person per night, full board. www.tigerrock.info
Teluk Nipah beach in Pangkor island © shaifulzamri/Shutterstock
Bon Ton Resort, Langkawi
This unique resort is home to eight antique kampung houses set amid a lush coconut plantation with an inviting swimming pool. A spectacular lagoon dotted with lotus flowers borders the resort and provides the perfect backdrop to the explosion of colours at sunset. The houses, dating back 60 to 120 years, were brought in from around the country and were painstakingly reassembled by local carpenters skilled in kampung construction. Each house is rich in its own history, and individually furnished with wonderful antiques and ornate fabrics from Malaysia, Indonesia and Thailand.
Doubles from RM650. www.bontonresort.com
Straits Collection, George Town, Penang
Located in the UNESCO World Heritage Centre of George Town, the Straits Collection comprises four wonderful apartments located in pastel-coloured colonial buildings that were formerly shophouses. All have been fully renovated to reflect the town's historical past, and are fully equipped with living area and modern amenities. Some apartments can sleep up to five.
Apartments from US$140. www.straitscollection.com.my
Photo courtesy of the Straits Collection
Villa @ World Café, Long Beach, Perhentian Islands
The smart villas here are nestled along a stretch of powdery white sand with crystal clear waters. The welcoming rooms, decorated with attractive wooden furnishings, have high ceilings, large windows and plenty of natural light, while secluded outdoor bathrooms offer airy showers set amid sprouting bamboo shoots.
Doubles from US$265. www.theworldcafe.com.my
Bagus Place, Pulau Tioman
This remarkable development of seven unique chalets is located on a beautiful stretch of beach fronted by turquoise waters. Each chalet is individually designed and blends in with the surrounding environment – quirky choices include the Tree House, with an open air living area built around a sturdy tree trunk, and the Boat House, offering accommodation in a mock wooden vessel with its own sundeck. There's no television, wifi or air-con to break the peace and silence here – only the sound of the waves caressing the shore.
Chalets from US$280. www.bagusplace.com
Photo courtesy of Bagus Place
The Majestic, Malacca
Located in the former mansion of a wealthy business tycoon with a unique mix of Straits and neoclassical architecture, The Majestic retains original fixtures such as colourful stained glass windows dating back to the 1920s. The elegant open-plan rooms appointed in fine silk and teak feature polished timber floors and wooden sliding doors between the bathroom and bedroom. The Spa Village is the world's only beauty parlour that bases its therapies on the healing heritage of the Peranakans, descendants of early fifteenth century Chinese immigrants who intermarried with Malays. Equally, the restaurant places emphasis on unique Peranakan cuisine, combining traditional Chinese ingredients and cooking methods with Malay herbs and spices.
Doubles from US$300. www.majesticmalacca.com
If you want to explore more of Malaysia, buy the Rough Guide to Southeast Asia. Book hostels for your trip, and don't forget to purchase travel insurance before you go.


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When you have been in a club for a decade like Manuel Estrada has, you learn a thing or two about what goes into building a head-turning lowrider. Now, don't for a second think this gorgeous '50 Fleetline is Manuel's first foray into building. On the contrary, he has a couple of rides under his belt, which have since been passed on to his kids for graduating from school. After passing the '78 Monte Carlo and '86 Regal on to his offspring, Manuel started looking for his next build. Manuel was browsing the pages of his local Nifty Nickel and came across this '50 Chevy, and with one look at it he knew that this was the car he had to have. He picked up the ride for $2,500 and stripped it down completely before starting the rebuild.
From the beginning, Manuel knew that he wanted to make his car a little different. "I built the car the way I wanted it," says Manuel with pride. In order to accomplish his goal of making the Fleetline unique, he opted for a different visor than the original and a different interior to give the Chevy some new life. Manuel insists that he didn't build this ride for trophies; he built it to drive so that he could cruise it down the streets of Las Vegas. "No better trophy than when you are cruising your ride and you get the thumbs up or someone rolls down their window to give appreciation to your ride," says a beaming Manuel. "To me, that is the true trophy." We couldn't agree more that a complete stranger appreciating the product of your time and effort is certainly the best reward—getting a trophy at a show is just a bonus.
Manuel would like to thank his wife, Carolina, his family, and of course, his fellow members of Tiempo car club for their continued support.
"Vegas Bomb Squad"
Owner: Manuel Estrada
Vehicle: 1950 Chevy Fleetline
City/State: Las Vegas, Nevada
Club: Tiempo Car Club
Engine: 235 Powerglide with 1½-inch straight pipes for exhaust.
Body/Paint: Ice Blue Mist
Interior: Jesse Cruz of Jessie's Upholstery in Compton, CA, gave the Fleetline an interior upgrade.


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It all started back in the summer of 1960 when two men came up with a crazy idea: to create a few exciting new apartments for affluent young singles at the top of Mt. Adams. During a time when people were migrating to the suburbs, Neil Bortz and Marvin Rosenberg focused on rehabilitating an old world neighborhood of row houses on steep, crooked streets.
Their first building was converted into two apartments overlooking Cincinnati and rented almost immediately. When the next apartments rented just as quickly and Bortz and Rosenberg realized they had a great opportunity for a sustainable business. In June 1961, Towne Properties was established and the company dedicated it's time to leading the rebirth of Mt. Adams.
It was a great place to start a business. Mt. Adams is blessed with great views of the Ohio Valley, the hills of Kentucky, and downtown Cincinnati and only steps away from the 400-acre Eden Park. Towne's new apartments in Cincinnati were unlike anything else available. Each apartment featured loft dens, wood burning fireplaces, private gardens and rooftop decks, wall to wall carpet, all within refurbished traditional exteriors.
Buoyed by their initial successes, Bortz and Rosenberg took their strategy into the suburbs in the mid-1960s. Towne welcomed its third partner, Lambert Agin, who brought an extensive understanding of residential construction. With Agin's help, Towne began developing a collection of award-winning garden apartment communities throughout Cincinnati, Dayton, and Lexington, Kentucky.
In the mid-1970s Towne began building and selling condominiums in the suburbs and started offering its management services to third-party owners. Towne also acquired, planned, zoned, and developed land for both its own use and for single-family developers.
By the mid-1980s Towne took on a number of projects with various strategic partners. Towne began developing retail centers, including strip malls and Cincinnati's Kenwood Towne Center, as well as downtown office rehabs in Cincinnati and Dayton, suburban office parks, and recreational properties like Four Seasons Marina and The Club at Harper's Point.
Towne assumed a leadership role in the renaissance of downtown Cincinnati in the early 1990s with new partner Arn Bortz, former Cincinnati mayor, in charge. Towne began developing renovated office space and mixed-use projects, including the Backstage Entertainment District and Fountain Place in the heart of downtown Cincinnati.
Today, Towne's portfolio is in the capable hands of Robert Wahlke, John Recob, and Derek Wehman. With their 85 years combined experience Towne now manages and/or owns a portfolio of more than 15,000 apartments, 116,500 condominium and homeowner's association units, and 815,000 square feet of retail space, plus a tennis club and a marina.
Towne continues to look to the future and will continue to create communities that are "Great Places to Live, Work, Shop, and Play®."


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Crisis Intervention Guidelines
Both psychological crises and psychological emergencies warrant an immediate call to the GWU Counseling Center for crisis intervention. A psychological crisis situation occurs when the student feels unable to cope with the circumstances of his/her life. The more helpless the individual feels, the greater the crisis. Typically, a person may be temporarily overwhelmed and unable to carry on, but is not in immediate physical danger. Crisis intervention helps a person cope with the immediate situation and make a plan to address any ongoing problems. A psychological crisis may be triggered by a traumatic event such as an accident, a loss of a family member or loved one, or some kind of assault, or it may be related to exhaustion and severe stress. A psychological emergency exists when the crisis is so severe that the person is potentially in danger and may need to be hospitalized. A psychological emergency occurs when a person is:
- Suicidal
- Aggressive towards others
- Gravely impaired: confused, agitated, disoriented, having hallucinations or delusions
Gardner-Webb University provides crisis intervention as needed and as available. You may contact the GWU Counseling Center or a member of the Crisis Management Team (see appendix).
The procedure for crisis intervention is as follows:
- Contact the GWU Counseling Center for an assessment or assistance. If the GWU Counseling Center is closed or the student is acting aggressively or threatening to harm someone, call University Police. If you cannot call, enlist the help of another student – don't try to handle a crisis alone. Tell the University Police who you are and that there is a crisis.
- Until help arrives:
- Listen.... Avoid any physical contact and allow the student to talk.
- Assist.... Provide a quiet atmosphere; minimize environmental stimulation. Give the student some space. Ask the student what or who might be helpful.
- Recognize.... Know your limitations.
The Gardner-Webb Counseling Center staff will make an assessment and contact the student's family or significant other, if it is necessary to protect the health and safety of the student or other persons. If hospitalization appears warranted, staff will either assist the student and his/her family in getting an assessment for admission or contact Woodridge Psychological Associates in Rutherfordton, NC at 828-287-7806 or law enforcement if an evaluation for involuntary hospitalization is needed.
The Depressed Student
College students are at significant risk for depression. Student life is demanding and many students work. Younger students are at a developmental stage marked by uncertainty, change and strong emotions, and older students are likely to be juggling an exhausting load of school, work, and family obligations. The lifetime prevalence (how many people will meet diagnostic criteria during a specified period in their life) for major depressive disorder in 15-24 year olds is 20.6 percent for females and 10.5 percent for males. Major depression differs from feeling sad or struggling with life events. It significantly impairs a person's functioning while reducing their hope for change and motivation to seek help. In major depression, a person's appraisal of him or herself, the future and the world at large become markedly and irrationally negative and distorted. Due to the opportunities that faculty and staff have to observe and interact with students, they are often the first to recognize that a student is in distress, even when the student continues to function in class.
Depressed behavior includes:
- Tearfulness/general emotionality
- Markedly diminished performance
- Dependency (a student who makes excessive requests for your time)
- Infrequent class attendance
- Lack of energy/motivation, indecisiveness
- Increased anxiety/test anxiety/performance anxiety
- Irritability
- Deterioration in personal hygiene
- Significant weight loss or gain
- Alcohol or drug use
- Agitation, hostility, or angry outbursts
Students experiencing depression often respond well to a small amount of attention for a short period of time. Early intervention increases the chances of the student's return to health.
- Let the student know you're aware he/she is feeling down and you would like to help.
- Reach out more than halfway and encourage the student to discuss how he/she is feeling.
- Offer options to further investigate and manage the symptoms of the depression.
- Remind the student that feeling hopeless and helpless are symptoms of depression, not the objective reality – people do get better with treatment.
- Gently and directly ask the student if he/she has had/is having thoughts or impulses to harm or kill him/herself – both impulses for self-harm (e.g., cutting) and suicide can be present in students who don't "look that bad."
- Minimize the student's feelings, e.g., "Don't worry." "Everything will be better tomorrow."
- Bombard the student with "fix it" solutions or advice.
- Chastise the student for poor or incomplete work.
- Be afraid to ask whether the student is suicidal – you can't cause a suicide just by asking.
The Suicidal Student
Suicide is the second leading cause of death among college students. It is important to view all suicidal comments as serious and make appropriate referrals. Suicidal people are irrational about how bad things are, now and in the future. High-risk indicators include:
- Feelings of hopelessness, helplessness, and futility
- A severe loss or threat of loss (death, break up of a relationship, flunking out)
- Talk of ending things (quitting school, work)
- A detailed suicide plan with specified means (high risk of lethality)
- A history of a previous attempt
- Tearfulness, agitation, insomnia
- Giving away important possessions, taking care of business, saying "thank you for all you've done for me"
- History of alcohol or drug abuse
- Feelings of alienation and isolation
- Take the student seriously – 80 percent of suicides give warning of their intent.
- Be direct – ask if the student is suicidal, if he/she has a plan and if he/she has the means to carry out that plan. Exploring this with the student actually decreases the impulse to use it. Access to a gun is highly lethal, refer the student ASAP or call 911 if he/she has a weapon.
- Be available to listen but refer the student to the Gardner-Webb University Counseling Center at 704-406-4563 for additional help. The student does not need to agree to this. It's safer to offend than to overlook.
- Assure the student that you are his/her best friend; agree that you are a stranger, but even strangers can be concerned.
- Be overly warm and nurturing.
- Flatter or participate in their games; you don't know their rules.
- Be ambiguous, cute, or humorous
- Challenge or agree with any mistaken or illogical beliefs.
- Assume their family knows about their suicidal thoughts and feelings.
The Anxious Student
Anxiety is a normal response to a perceived danger or threat to one's well-being. For some students the cause of their anxiety will be clear but for others it is difficult to pinpoint the source of stress. Regardless of the cause, the resulting symptoms are similar and include: rapid heart palpitations; chest pain or discomfort; dizziness; sweating; trembling or shaking; and cold, clammy hands. The student may also complain of difficulty concentrating, always being "on the edge," having difficulty making decisions or being too fearful to take action. In rarer cases, a student may experience a panic attack in which the physical symptoms occur spontaneously and intensely in such a way that the student may fear he/she is dying.
The following guidelines remain appropriate in most cases.
- Let them discuss their feelings and thoughts. Often this alone relieves a great deal of pressure. Normalize where appropriate.
- Provide reassurance. Nobody ever died of a panic attack. However, reassurance alone, without further action, is not helpful.
- Remain calm. Be clear and directive. "Let's sit down and do some slow breathing."
- Provide a safe and quiet environment until the symptoms subside.
- Remind them that their anxiety will subside, sooner or later.
- Trivialize the perceived threat to which the student is reacting.
- Take responsibility for their emotional state.
- Overwhelm them with information or ideas to "fix" their condition. Anxious people can't take in very much. Make sure they write down appointments and phone numbers.
The Student Experiencing Delusions or Confusion
A person having delusions is literally out of touch with reality for biological reasons. This can be seen in college students who are having a "first break" episode of a thought disorder or, occasionally, in students who have abused stimulant drugs for an extended period. College-aged students are in the middle of the period (late teens to mid-thirties) when most people with thought disorders first demonstrate the symptoms of their illness.
Some of the features of being out of touch with reality are disorganized speech, disorganized behavior, odd or eccentric behavior, inappropriate or no expression of emotion, expression of erroneous beliefs that usually involve a misinterpretation of reality, expression of bizarre thoughts that could involve visual or auditory hallucinations, withdrawal from social interactions, an inability to connect with people and an inability to track and process thoughts that are based in reality. Less severe symptoms may come across as a kind of "oddness", with the student responding with non-sequiturs and showing extended delays before responding to questions or in conversations. While this student may elicit alarm or fear from others, they are generally not dangerous and are likely to be more frightened and overwhelmed by you than you are by them. Occasionally, a person experiencing a paranoid delusion may act violently, but this occurs in the minority of cases. If you cannot make sense of their conversation, they are in trouble.
When you encounter a student who demonstrates delusions or confusion:
- Call the GWU Counseling Center to consult first, if the situation is not an immediate crisis.
- Respond with warmth and kindness, but with firm limits.
- Remove extra stimulation from the environment (turn off the radio and step outside of a noisy classroom).
- Acknowledge your concerns and state that you can see they need help. "I don't really understand what you're trying to tell me, but I see that you're upset."
- Acknowledge their feelings or fears without supporting the misperceptions, e.g., "I understand you think someone is following you, but I don't see anyone and I believe you're safe."
- Acknowledge your difficulty in understanding them and ask for clarification or restatement. "Sorry, I'm not understanding you, what I asked was…"
- Focus on the "here and now." Tell the student the plan for getting him/her to a safe environment, and repeat the plan emphasizing the safe environment. "Ok, let's get you over to the Gardner-Webb University Counseling Center to talk with the folks there, it's a safe place. They'll help you figure out what to do to be safe."
- Speak to their healthy side, which they have. It's OK to laugh and joke when appropriate – but not about any of their beliefs or fears.
- Be aware that the student may show no emotions or intense emotions.
- Be aware that the student may be extremely fearful to the extent of paranoia.
- Be aware that the student may not understand you or understand only parts of what is being said. Be aware that, on occasion, a student in this state may pose a danger to self or others.
- Argue or try to convince them of the irrationality of their thinking, as their brain may be literally incapable of accepting the information.
- Play along, e.g., "Oh yeah, I hear the voices (or see the devil)."
- Encourage further discussion of the delusional processes.
- Demand, command, or order.
- Expect that the student will understand you.
- Assume the student will be able to take care of him/herself when out of touch with reality.
- Allow friends to take care of the student without getting a professional opinion.
- Assume the family knows about the student's condition.
The Verbally Aggressive Student
Students usually become verbally abusive when in frustrating situations that they see as being beyond their control; anger and frustration become displaced from those situations onto the nearest target. Explosive outbursts or ongoing belligerent, hostile behavior become this student's way of gaining power and control in an otherwise out-of-control experience. It is important to remember that the student is generally not angry with you personally, but is angry at his/her world and you are the object of pent-up frustrations.
This behavior is often associated with the use of alcohol and other drugs, as intoxication is used to relieve tension, but ends up lowering their inhibitions about expressing their anger.
- Acknowledge their anger and frustration, e.g., "I hear how angry you are."
- Rephrase what they are saying and identify their emotion (e.g., "I can see how upset you are because you feel your rights are being violated and nobody will listen.")
- Reduce stimulation; invite the person to a quieter place if this is comfortable and safe for you.
- Allow them to ventilate, get the feelings out, and tell you what is upsetting them. However, if the person is escalating and becoming agitated, take care of your own safety first. ("You are getting worked up, please control yourself or I will have to call the University Police.")
- Be directive and firm about the behaviors you will accept (e.g., "Please step back; you're too close." "I cannot listen to you when you yell at me." "If you want my help, you'll have to speak politely and I will do the same.")
- Help the person problem solve and deal with the real issues when they become calmer.
- Keep a safe distance from the student. There should be a minimum of three feet between you and the student.
- Get into an argument or shouting match.
- Become hostile or punitive yourself (e.g., "You can't talk to me that way!")
- Press for explanations for their behavior.
- Ignore the situation.
- Touch the student.
The Violent Student
Violence, because of emotional distress, is rare and typically occurs when the student's level of frustration has been so intense or of such an enduring nature as to erode all of the student's emotional controls. The adage, "An ounce of prevention is worth a pound of cure," best applies here. Potentially violent people almost always exhibit warning signs prior to acting out - no one "just snaps." While no one clue indicates absolute dangerousness, any can be cause for concern and warrant a response. There are four broad categories of behaviors that might indicate a developing problem:
- Verbal clues: direct and indirect threats; talking about violent plans, fantasies or past behavior; expressing a wish to kill or die, harassing or abusive language.
- Physical clues: weapons possession, drawings or writing with violent themes; frequent listening to music with violent themes, agitated or threatening behavior, bullying, destruction of property, deteriorating appearance, isolating, inappropriate displays of anger/aggression, rebelling against college rules.
- Obsessive thinking: preoccupation with resentments or grudges against someone, romantic obsessions, perceived injustice, weapons, past violent events.
- Bizarre thoughts: persecutory delusions, paranoia, grandiose delusions involving power, control or destruction, deteriorating thought processes.
Alcohol and other drugs can reduce inhibitions against violence. If it appears the student is intoxicated and agitated, your primary goal then is to keep yourself and any others safe. Call for help.
- First determine if you feel safe with the student. If not, remove yourself and call 911 or Campus Police.
- For non-crisis situations, consult with the GWU Counseling Center.
- Attempt to prevent total frustration and helplessness by quickly and calmly acknowledging the intensity of the situation (e.g., "I can see you're really upset and are ready to lash out.")
- Explain simply, clearly and directly what behaviors are acceptable (e.g., "Sit down and lower your voice.")
- Use brief and specific directives and questions. ("What do you need?")
- Get necessary help (send a student for Counseling Center Staff, University Police, other staff, dean, etc.).
- Stay safe: have easy access to a door (student should not be between you and the door); keep furniture between you and the student.
- Debrief the situation with a colleague.
- Assume the student can take in a normal amount of information – keep it simple. Try for five to ten words in a statement, max.
- Ignore warning signs that the person is escalating (e.g., raised voice, flushed face, clenched fists, threats.)
- Threaten, tease or corner the student.
- Make promises you can't keep.
- Touch the student.
- Be alone with the student.
- Overlook bizarre or irrational statements.
The Demanding, Passive, or Manipulative Student
Typically even giving these students a tremendous amount of time and energy is not enough. They often seek to control your time and unconsciously believe the amount of time received is a reflection of their worth. You may find yourself increasingly drained and feeling responsible for this student beyond your normal involvement. It is important that this student be connected with many sources of support on-campus and in the community.
Demanding students can be difficult to interact with because they can be intrusive and persistent. Demanding traits can be associated with anxiety, agitated depression, and/or personality disorders. Some characteristics of demanding students are a sense of entitlement; an inability to empathize; a need to control; difficulty dealing with ambiguity; a strong drive for perfection; difficulty respecting structure, limits, and rules; persistence after hearing "no"; dependency on others to take care of them and a fear of dealing with the realities of life.
When dealing with a demanding student:
- Insist that they make their own decisions. You specify what you can do, then they decide.
- Set firm and clear limits on your time and involvement. End the conversation when it exceeds those limits, even if the student is not satisfied. It's not helpful to the student to stay engaged, despite their distress. You may feel like you're being harsh, but you're not.
- Offer referrals to other resources on and off campus.
- Set and enforce limits to prevent the disruption of a class, lab or study group via acting out or monopolizing the discussion.
- Set limits on where and when you talk with them, e.g., no home numbers (unless everybody gets it), no being cornered while you are having lunch.
- If excessive student demands become disruptive, consult the Student Conduct Code, located in the GWU Student Handbook, which cites the standards of student conduct.
- Remember that your ability to be able to teach or serve other students and the other students' needs for an environment conducive to learning also must be met.
- Avoid the student as an alternative to setting and enforcing limits.
- Argue with the student.
- Accommodate inappropriate requests or get trapped into giving advice, special conditions, changing your schedule, etc.
- Feel obligated to take care of him/her or feel guilty about not doing more.
- Allow the student to intimidate you. Ignore the problem and the impact that it has on you and the other students.
The Student Under the Influence
Alcohol is the most widely used psychoactive drug. It is common to find alcohol abusers in college populations also abusing other drugs, both prescription and illicit. Patterns of use are affected by fads and peer pressure. Currently, alcohol is the preferred drug on college campuses.
The effects of alcohol on the user are well known to most of us. Student alcohol abuse is most often identified, by faculty, when irresponsible, unpredictable behavior affects the learning situation (i.e., drunk and disorderly in class), or when a combination of the health and social impairments associated with alcohol/drug abuse sabotages student performance. Because of the denial that exists in most substance abusers, it is important to express your concern about the student not in terms of suspicions about alcohol and other drugs but in terms of specific changes in behavior or performance. If you are uncertain about how to approach a difficult situation, please call the GWU Counseling Center to consult.
- Confront the student with their behavior that is of concern.
- Address the substance abuse issue if the student is open and willing.
- Offer support and concern for the student's overall well-being.
- Maintain contact with the student after a referral is made.
- Consider informing your class at the beginning of the semester that students who appear to be intoxicated will be asked to leave. "This probably won't ever come up, but if anyone even appears to be intoxicated in class…"
- Convey judgment or criticism about the student's substance abuse.
- Make allowances for the student's irresponsible behavior.
- Ignore signs of intoxication in the classroom. The Prohibited Code of Behavior in the Student Handbook clearly outlines the student's responsibilities.
The Suspicious Student
Typically, these students complain about something other than their psychological difficulties. They are tense, anxious, mistrustful, loners, and have few friends. They tend to interpret minor oversights as significant personal rejection and often overact to insignificant occurrences. They see themselves as the focal point of everyone's behavior and everything that happens has special meaning to them. They are overly concerned with fairness and being treated equally. Feelings of worthlessness and inadequacy underlie most of their behavior. They seem capable and bright.
- Express compassion without intimate friendship. Remember that suspicious students have trouble with closeness and warmth.
- Be firm, steady, punctual, and consistent.
- Be clear about the expected standards of behavior. These include requirements for academic performance, (e.g., due dates, grading, expectations for classroom participation).
- Assure the student that you are his/her friend; agree that you are a stranger, but even strangers can be concerned.
- Be overly warm and nurturing.
- Flatter or participate in their games; you don't know their rules.
- Be cute or humorous.
- Challenge or agree with any mistaken or illogical beliefs.
- Be ambiguous.
The Sexually Harassed Student
Sexual harassment involves unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct; it is usually found in the context of a relationship of unequal power, rank or status. It does not matter that the person's intention was not to harass; it is the effect it has that counts. If the conduct interferes with a student's academic performance or creates an intimidating, hostile or offensive learning environment, it is considered sexual harassment.
- Sexual harassment usually is not an isolated one-time only case but a repeated pattern of behavior that may include:
- Comments about one's body or clothing
- Questions about one's sexual behavior
- Demeaning references to one's gender
- Sexually-oriented jokes
- Conversations filled with innuendoes and double meanings
- Displaying of sexually suggestive pictures or objects
- Repeated non-reciprocated demands for dates or sex
The Gardner-Webb University Student Handbook covers sexual harassment of students.
Common reactions by students who have been harassed is to doubt their perceptions, wondering if it was a joke, did it really happen or if, in some way, they have brought it on themselves. A student may begin to participate less in the classroom, drop or avoid classes, or even change majors.
- Separate your personal biases from your professional role.
- Listen carefully to the student, validate his/her experience.
- Encourage the student to approach the person, directly or in writing. "I am uncomfortable when you_____, please stop."
- Encourage the student to keep a log or find a witness.
- Help student seek informal advice through a department chair, supervisor, or advisor.
- If unresolved, refer to one of the College Sexual Harassment Intake Facilitators.
- Refer the student to the Student Health Center for support and assistance.
- Fail to act. Taking no action invalidates the student's already shaky perception and puts the college in a vulnerable position, should this behavior continue.
- Overreact. Listen, support, and guide the student to appropriate channels.
* This information copied and used by permission from Ventura College Student Health and Psychological Services (805-654-6346).


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| 8.4°C Dublin
PUBLIC sector workers stormed a building where Greek and German officials were meeting in the northern city of Thessaloniki today and pelted a German diplomat with water bottles in a protest over austerity measures.
Riot police used teargas and truncheons to break up a crowd of 250 city employees outside the building and formed a shield around German Consul Wolfgang Hoelscher-Obermaier as he entered.
Protesters chanted "It's now or never!" and held up mock gravestones and banners proclaiming "Fight until the end!".
They said they were furious at comments by German envoy Hans-Joachim Fuchtel, who told journalists on Wednesday that Greece could do more to reform its bloated local government sector, the head of the workers' union said.
"Experts say that as far as local government is concerned the work carried out by 3,000 Greek employees can be done by 1,000 Germans," Fuchtel said. On Thursday he said his remarks had been misinterpreted.
Fuchtel was appointed by German Chancellor Angela Merkel late last year to explore ways to boost grass-roots cooperation between the two countries, and has been lampooned as overbearing in Greek media.
His comments struck a nerve in Greece at a time when its lenders, the European Union and International Monetary Fund, have demanded layoffs and steep spending cuts in exchange for a second, 130-billion-euro ($165-billion) bailout.
At the Thessaloniki city hall, a woman who answered the switchboard phone said: "No one can talk to you now. They have occupied the building."
A spokesman for the German Foreign Ministry said: "No one was hurt and there was no material damage. The meeting continues as planned and that's what's important."
Municipal employees have held several nationwide protests and strikes in recent weeks against the new wave of budget cuts, triggering severe disruptions in public transport and causing garbage to pile up across the capital.
The head of the POE-OTA union of municipal workers, Themis Balasopoulos, said Fuchtel's comments showed the government planned to push ahead with controversial public sector layoffs, about 2,000 of which are scheduled by the end of the year.
Unions and some politicians oppose the layoffs, which are mainly expected to target local government workers.
"We are here to express our deep anger at his absurd comments," Balasopoulos told Reuters from the protest in Thessaloniki.
"We are not a democracy - we are under German supervision. If we had decent politicians they would have put him on a plane last night and sent him back home," he said.
Many Greeks, worn down by years of austerity, blame Merkel for forcing the painful cuts in exchange for the bailouts.
In Germany, media have long characterised the Mediterranean state's 11 million people as lazy, corrupt and ungrateful.
Tens of thousands of Greeks protested against a visit by Merkel to Athens in October and some burned Nazi flags


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This is one of the easiest dishes I have ever prepared. It was as yummy as you get it in a restaurant. I was wondering why restaurants charge such huge price on this simple and easy dish. So I recommend you all to give it a try and see. You can alter some of the fatty items here, but substituting butter might not be that tasty as name itself says butter masala. I made this dish from Vahrevah.com website and his video. So here is the link for the same. Enjoy.
Recipe:(This link also has the video)


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Aquavit Primer: the Scandinavian Spirit
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In today's Washington Post, Jason Wilson takes a fresh look at that old Scandinavian bone-warmer, aquavit.
Wilson writes that while the Danes and Swedes may keep a bottle of aquavit in the freezer for serving as an ice-cold shot, a recent trip to Norway taught him that things are done much differently there.
When he mentioned keeping his bottle of Linie in the freezer, like his Danish friends do, Wilson took a dressing down from Frithjof Nicolaysen, a representative from the Arcus distillery.
"It goes all the way to Australia and back to age, then you put it in the freezer!" Nicolaysen said, referring to Arcus' practice of maturing its signature Linie Aquavit in sherry oak barrels during a globe-trotting ocean voyage. "Good God, that's a sacrilege for those of us who make it!"
Derived from the Latin aqua vitae, or water of life, aquavit has been made throughout northern Europe for centuries. Typically made from grain or potato spirits, aquavit may be flavored with a number of different botanicals, giving the spirit a savory, herbaceous character. Caraway is one defining example, though aquavit may also include dill, fennel, clove, cardamom and other herbs and spices.
A number of regional styles may be found in Northern Europe. In the U.S., familiar brands include Linie from Norway, Aalborg from Denmark and O.P. Anderson from Sweden.
While the savory flavor of aquavit can seem odd at first taste, the spirit has gained some attention among American drinkers. North Shore Distillery, near Chicago, and House Spirits in Portland, Oregon, both make distinctive aquavits, and in Seattle's Ballard neighborhood—long a home for the city's Scandinavian community—the restaurant and bar Copper Gate (note: the website is NSFW) offers several types of aquavit including a house-made preparation.
I have to admit, I haven't explored aquavit as much as I should. I have bottles of O.P. Anderson and Krogstad in my liquor closet, which I break out for the occasional Trident or to drink alongside homemade gravlax, but I haven't really explored the range of flavors and styles.
Are you an aquavit fan? What's your favorite style, and how do you like to serve it?


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What Are Some Coping Skills That I Can Use To Deal With My Stress?
Dr. Redford Williams answers the question: 'Coping Skills To Deal With Stress?'
-- Question: What are some coping skills that I can use to deal with my stress?
Answer: So let's say you do have that stressful sort of job. What can you do about it? How can you apply coping skills to manage that stress better? The first thing you have to do is to be aware when you're stressed early in the process. To be aware of the negative thoughts you're having. "I can't believe he just said that in this sales meeting," for example. And the kinds of feelings that you're having -- anger, frustration, and so forth.
Once you're aware of the thoughts and feelings in a stressful situation, and have in mind the exact facts of the situation, not "he's putting me down," but "he just said I was stupid for saying we should try telemarketing for this new product." Then you need to evaluate your reaction, you need to ask some questions about those thoughts and feelings in the light of those objective facts, so you can decide whether you need to change this situation, or change your reaction, because that's the only two choices you do have in any stressful situation.
The way to decide is to ask four questions: Is this important to me? Are the thoughts and feelings I'm having appropriate? Would anybody get mad if somebody told them they were stupid for suggesting telemarketing? Is the situation modifiable? Can I get him to not tell me I'm stupid for suggesting telemarketing? And lastly, would it be worth it when I consider the needs of the other people and myself, to take that action?
Any 'no' to one of these questions means this is a time when you want to change your reaction. You can do it by self-talk: "Hey! It's not that important" or "Hey! It's not appropriate for me to get angry with him because he's got a good reason for saying it's stupid perhaps." Or maybe, "It's not worth it to take action because it would disrupt the whole thing, or maybe get me in trouble." Any 'no,' you're going to change your reaction. If you can't stop thinking about it, practice some form of meditation. Deep breathing, saying "slow down" every time you breathe out, something of that sort.
But four 'yes'es, four 'yes'es to these questions means you do need to do something. It's important, it's appropriate to be upset, the situation is modifiable, or at least it ought to be if you're not sure, and it would be worth it to get him to quit telling you you're stupid in these sales meetings. That doesn't mean that you're 007 with a license to kill. It means you need to take effective action, and when it's another person's behavior, that's assertion: "Hey Bill, you just said I was stupid for suggesting telemarketing, I need to let you know that that's kind of upsetting. I don't think it's very helpful. Could you tell me why you think it's a problem, rather than accusing me of being stupid? That would be helpful." Or if it were, or if it's a situation, problem solve. These are all damage control strategies.
Now how are you going to remember those four questions when you're really under a lot of stress? Important, appropriate, modifiable, worth it. "I-A-M-WORTH IT." I am worth it. Tell yourself "I am worth it," and that will bring up these four questions for you.
This is all damage control. Something's happened, you need to deal with it. Much more effective in the long run is damage prevention. This is communication skills, interpersonal relationship skills, speaking clearly. You walk into the room: "This room's too cold!" Everybody's on edge. What if you walk into the room and say: "Gosh…I feel cold." What's more likely to get your message heard?
Listening. Be a good listener. Keep your trap shut until the other person's finished, look like you're interested in what they're saying. When they finish, tell them what you've heard them say. Those are all behaviors that anybody can do. The fourth principle of good listening is a little bit harder. Be prepared to be changed by what you hear. If you can do that, you're going to be flexible and even more effective.
Empathy. Try to put yourself in the other guy's shoes to figure out where they're coming from. It may make you feel less stress when they're doing their number.
And lastly, look for opportunities to inject little positives into your relationships with people in everyday life. A compliment. "I really like the way your hair looks today." "Gee, that's a neat tie you've got on." Look for ways to be positive in your relationships. Being a good listener is a positive you can do.
People who've learned these kinds of skills and put them into practice are the same people who've shown decreases in these frustration, anger, depression levels, and blood pressure, and blood pressure reactions to stress. It's possible to learn to use these skills. And if you do, there's good reason to think you'll be happier and healthier.
Next: What Are Some Ways That I Can Think About Stressful Situations In Order To Make Them Less Stressful?
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