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Fish Memory Game - A fantastic game where memory is the challenge using fish symbols as a means of fun and excitement and training those highly valued cognitive skills that shape the minds of today and tomorrow. Fish used in the game are: Electric Fish, Herring Fish, Sea Horse, Butterfly Fish, Prawn, Flying Fish, Piranha, Gold Fish, Salmon, Lump Fish.
Excellent graphics that are sharp and crisp so that the player will know which symbol is which and not have to strain themselves. Fun sounds to carry you along and an artificial intelligence that is challenging but not frustrating.
WHY YOU SHOULD GET THIS APP
This app is important for many reasons. The primary reason is because it is a game where simple yet complex cognitive memory is tested. Both long and short term memory and other cognitive abilities are put to the test in a non invasive way.
The simple symbols allow for the player to see them clearly and recall their configurations and see the results right then and there. This is the kind of testing and gaming that has value according to numerous studies showing that video games that are of a design and engineering where higher cognitive functions are challenged actually enhance the brain and the neurons. This is a benefit of all endeavors that are challenging but now with video games that effect has brought about new ways to produce games and more. This app is a branch off of the earlier video games that brought about such challenges and fun that people would get addicted. Now these games can be translated into apps like this memory game. Now here's something that you just can't get away from. The fun of these games are such that they quickly become the primary form of entertainment for app users and that can be good. This app isn't some mindless game where you run around shooting people, this is a game for kids and adults who are young at heart. Kids can play this game at home or on those long road trips. They'll get a kick out of trying to solve this fishy fun and teachers can use it to see how the child's cognitive development grows.
Parents don't have to worry about any violence in this app. It's just the kind of family natured fun designed for kids that doesn't have offensive sounds, sights or anything. With today's parenting computing technology you might even want to record some of your child's game play so you can see how fast your child adapts. These recordings are of great value especially if you take pride and concern in your child's cognitive development. If you're not that serious then you can watch as the kids play this game and have all kinds of fun. While they're playing it you can bet they won't be getting into any trouble either. So all in all you have a simple game that using advanced but user friendly game play strategies that test the cognitive and memory functions of the brain. For children and adults you can't miss out on such a simple yet fun loving game.
Fish Memory Game features:
· 3D Icons
· Touch Screen
· Sounds on/off options
· Vibrate on/off option
· Level difficulty based on time
· Automatic High Scores
Like it? Share with your friends!
Other Android Freeware of Developer «Rex Apps»:
Boats Memory Game Boats Memory - Train your memory and sail fun boats in same timeBoats Memory Game is using simple boats symbols with today's high end graphics this image match up game provides endless hours of fun for the entire family
Cat Sounds Cat Sounds - Play free cat sounds on your phone The Cat sounds application contains 12 fun cat sounds for your easy use you can play with your cat or make your dog crazy with our Cat Sounds App
Small Birds Memory Game A fantastic game where memory is the challenge using Small Birds symbols as a means of fun and excitement and training those highly valued cognitive skills that shapes the minds of today and tomorrow
Cool Computers Match up Enjoy memory games with quality cool computers iconsSpecial for computer lovers enjoy your flavor of fun memory games with cool computers icons a real high tech game special for you guys ! hope you will enjoy it
Bleep Button Best bleep buttonThe best Bleep button on the market easy to use, choose from many bleep sounds, really useful when you need to censor some one, or just have a laugh on your buddyBleep Button:10+ Bleep Sounds
Sweets Memory Game Sweets Memory Game - great way to improve your brain and enjoy play timeSweets Memory Game - A great game where that tests the cognitive functions of the brain via memory challenges
Apk Installer Apk Installer - Easy App Installer
Easy Apps Installer by RexApps
APP Installer by RexApps, easy to use, easy to browse through your local folders and SD cards, easy to find your APP file and install it
Sea Life Memory Game Play sea life memory game and improve your brain skillsA fantastic game where memory is the challenge using sea life symbols as a means of fun and excitement and training those highly valued cognitive skills that shapes the minds of today and tomorrow
Halloween Dress Up Games Free Halloween Dress Up Games Free - Dear girls, if you are crazy about costumes and funny parties, colorful masks, then play the best Halloween Dress Up Games for free on your phone and makeover your lovely witch. Choose a model and start to dress up her to be main fashion star for scary evening
Preschool Toddler Learning Toddler Preschool Learning Games for Kids by Gameiva is a free amazing easy learning games full set of educational games for kids and kindergarten to teach them sorting, counting, matching patterns and much more
Math Pair for Kid Math Pair for Kid - Game for school kids. One pair contains an operation and its correspondence. ex if the first card is 2x2, so its correspondence is 4. Your task is to find all the pairs. Click on the tiles, pair by pair, to open the images. If you find a correct pair, the images will stay uncovered. If you miss, they will flip back
Pocket arena: Saga Pocket arena: Saga - collect fantastic monsters with unique skills and abilities. Command your monsters in battles with different enemies. Embark on a journey through the wonderful world of this game for Android inhabited by incredible monsters. Do different tasks and fight monsters to tame them and improve your collection
Supported Operation Systems:
Google Android 1.6 |
Google Android 2.0 |
Google Android 2.1 |
Google Android 2.2 |
Google Android 2.3 |
Google Android 3.0 |
Google Android 3.1 |
Google Android 3.2 |
Google Android 4.0 |
Google Android 4.1 |
Google Android 4.2 |
Google Android 4.3 |
Google Android 4.4 |
Google Android 5.x |
Google Android 6.x |
Google Android 7.x |
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HSR&D Home » Research » IIR 08-297 – HSR&D Study
Cardiovascular Intervention Improvement Telemedicine Study
Hayden B Bosworth, PhD
Durham VA Medical Center, Durham, NC
Funding Period: October 2010 - December 2014
The proposed study could significantly improve Cardiovascular Disease (CVD) risk management among veterans for several reasons: 1) This intervention was a novel extension of our previous efficacious interventions that addressed multiple chronic conditions contributing to CVD risk. 2) The intervention focused on both multiple CVD-related behaviors and medication management. 3) The intervention was developed to ensure implementation across a large and representative sample of veterans; and, 4) The intervention, once found efficacious and financially self-sustaining, could be widely implemented within the VA healthcare system.
The study took place in two VA primary care clinics (Community Based Outpatient Clinic (CBOC) and primary care clinic affiliated with a hospital). We attempted to reduce CVD risk among vulnerable, high risk veterans (e.g., African Americans, low literate) by addressing the modifiable risk factors of systolic blood pressure (SBP), smoking, and low-density lipoprotein cholesterol (LDL-C). The intervention was tailored to the needs of patients and delivered by a pharmacist familiar with the clinics, thereby enhancing the potential for benefit and generalizability to other settings.
The study is one of the first to compare whether patients randomized to a clinical pharmacist-administered telephone behavioral/medication management intervention tailored to their needs improve CVD outcomes relative to a control group over 12 months. We received a 9 month extension to examine the impact of the intervention among women veterans as well as across gender groups.
The proposed study will examine two research questions:
1. Can patients randomized to a clinical pharmacist-administered telephone behavioral/medication management intervention tailored to their needs improve CVD outcomes relative to a control group over 12 months?
Primary Hypothesis: (H1) Veterans who receive the behavioral/medication intervention will have greater improvement of their CVD Risk Profile over the 12 months of follow-up as compared to the control group.
Secondary Hypotheses: (H2) Veterans who receive the intervention will have improved medication adherence, physical activity, improved diet, lower body mass index as compared to the control group over 12 months of follow-up. (H3) Veterans who receive the intervention will have greater improvements in LDL over the 12 months of follow-up as compared to the control group. (H4) Veterans
with diabetes who receive the intervention will have greater improved HbA1c as compared to the control group over 12 months of follow-up.
2. If the intervention is found to be effective, is it cost effective?
A two-arm randomized with 12 month follow-up. Patients were selected from primary care clinics at the Raleigh CBOC and Durham VAMC hospital based primary care clinic. Of the 2153 contacted patients, 428 were randomized to either intervention or usual care. The pharmacist intervention calls were attempted to be delivered to all intervention patients on a monthly basis. Patients randomized to the control group received educational material about CVD reduction at baseline & 6month follow-up.
We enrolled 428 participants and randomized 213 to usual care and 215 to pharmacist intervention. The mean age was 61.2 years; 51% were minority; 15% women were enrolled; 33.4%% had limited health literacy. Baseline CVD risk was 32%. Baseline systolic and diastolic BP was 130.0/75.8 mmHg, while LDL was 124.7 and among the n=171 patients with diabetes, mean Glycated hemoglobin (Hba1C) was 7.8.
352 (82%) completed the 12 month follow-up. Relative to usual care, pharmacist intervention showed marginal, but not statistically significant, improvement in CVD risk at 6 (-1.78, 95% CI: -3.9, 0.3; p=0.10) and 12 months (-0.34, 95% CI: -2.4,1.7; p=0.75). Patients in the pharmacist intervention did not show improvement in SBP at 12 month relative to usual care (1.4, 95% CI: -1.5,4.3; p=0.34).
While the pharmacist intervention did not show statistically significant improvement overall, we have yet to conduct within group comparison on race, gender and intervention dose. Our expectation is that similar to other studies there will be group differences.
Cardiovascular disease (CVD) is the leading cause of death in the U.S.; more than 80% of veterans have > 2 risk factors for CVD. Additionally, certain groups including women veterans and racial minorities are at greatest risk for poor CVD control. An intervention that addresses multiple CVD risk factors among high-risk veterans may have potential to improve morbidity and mortality. However, matching the intervention to individuals with particular CVD risks are essential to ensure adequate use of limited resources and improve outcomes. Given the national prevalence of CVD and the dismal rates of risk factor control, intensive, but easily disseminated interventions are needed to improve treatment of this epidemic in the VA and identify how best to serve all veterans.
External Links for this Project
NIH ReporterGrant Number: I01HX000185-01A2
Dimensions for VADimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.
If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/
VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address. Search Dimensions for this project
DRA: Cardiovascular Disease
DRE: Treatment - Comparative Effectiveness
Keywords: Behavior (patient), Cardiovasc’r disease, Diabetes
MeSH Terms: none

domain: literature


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Artwork by Carol Dabney. Turned into storybook fun.
Giving artwork examples in this blog.
The Animals Used by God Series 2013-2018 -by authors Everett O. Martindale and Carol Dabney. Illustrator Carol Dabney.
The Adventures of Andrew on the Golf Course series by Rod Ragsdale 2015-2018 – Illustrated by Carol Dabney.
Arkansas Cotton artwork displayed at the Agricultural Plantation Museum in Scott, Aransas 2017-2918.
Samples of my artwork. I have illustrated for five other children’s author’s in Arkansas and one out of state.
I am sharing artwork samples because I have had some request from a couple of authors to see my artwork.
I have had lots of fun since I started writing in 2010. Cindy Reyes, my sister in law joined me along the way in 2013 and writes the Spanish translation for many of my books. Rod Ragsdale joined me in 2014 helping me compose songs for several stories. Together all three of us read at libraries, churches and schools. We also started producing audiobooks for kids to listen to our stories and songs in their cars.
Ok so that some of my art… I’ll share some later. I look forward to being a speaker at this year’s Arkansas Writer’s Conference in North Little Rock. Thank you all for letting me share. check out my books and music cds on amazon. Thanks for your support.
Merry Christmas 2017. Love being a music teacher and entertainer especially at Christmas time.
…and I’m engaged to the singing Santa, which makes it all the more festive.
It doesn’t matter what age you are, we are all childlike at Christmas.
Rod Ragsdale sang Christmas carols for Holiday House at the Arkansas State convention center starting in November to kick off the season. Rod, Cindy and my daughter Michelle sang Christmas carols at the Arkansas State Capital December 2 for the annual Christmas Tree Lighting. Rod and I have been to over 30 senior centers and nursing homes in central Arkansas, festivals and several schools.
Plus the Jacksonville Library Children’s after school program and Children’s Library and Learning center.
We were the Whoville Christmas carolers for the GrinchFest along with channel 11’s Craig O’Neille, who is the Grinch master story-teller, held every year at the Children’s Library in Little Rock.
We also read our Christmas stories at the capital, several schools and libraries. Here is my sister Cindy Reyes who translates all my storybooks into Spanish.
These pictures are from the times I have traveled to Santa’s North Pole Adventureland in Jonesboro to sing and read for Kathy Johnson and her sisters for their magical store. I wrote a new story just for their Princess specials called “Santa’s North Pole Princess” the book is in their gift shop. https://www.facebook.com/santasnorthpolejonesboro/
Rod has a Christmas adventure for young children called Golfing with Santa book four in The Adventures of Andrew on the Golf Course series.
From our home to yours Merry Christmas and may God richly bless you in the new year 2018.
Happy New Year 2018.
Rod Ragsdale, Cindy Reyes and Carol Dabney will singing Christmas carols and reading our Christmas storybooks at the Clinton Children’s Library and Learning Center Saturday December 16 beginning at 10am. Little Rock, Arkansas. This is a free family event. “Twas the Mouse Before Christmas” was the first and is the biggest hit everywhere we go this time of year. I hope you add it to your holiday keepsakes. Thank you for supporting local artists.
Our holiday books: Big Book of The Animals Used By God, The Adventures of Andrew on the Golf Course -book four – Golfing with Santa, Twas The Mouse Before Christmas, and Santa’s North Pole Princess. All available through contacting me, or http://www.amazon.com
Santa’s North Pole Princess is all about a Princess named Noel, who rides a magical polar bear to gather all the Christmas mail from children around the world for Santa. Have you written your letter yet? This book is about of a wonderful place located in Jonesboro, Arkansas where families can walk through a Disney-like animal animated snowy forest on their way to take pictures with Santa.
I had a lot of fun with reading “Twas the Mouse Before Christmas” and now they have added Santa’s North Pole Princess. If you get to this wonderful adventure-land, look for Carol Dabney storybooks. Great Christmas keepsakes for ages 2-10.
Rod Ragsdale got into the spirit of Christmas by becoming a singing Santa for a Christmas in July party this past summer and as you know he loves golf. Not much golfing goes on in the snow, but with lots of imagination he wrote a Christmas golfing with Santa adventure story about his son Andrew. Book Four in his golfing series. For ages 7-12.
I had so much excitement with my St. Mark’s music students in writing The Christmas Animals Used by God last year. This is the newest published this year 2017. It can be interactive with walking with Joseph, Mary and the donkey, knocking on the inn keepers doors, making animal sounds. The kids really had fun with the repeating lines.
Its the Christmas story in an easy to read poetic form with lots of colorful pictures for kids to enjoy as they learn about the Nativity . Its also translated into Spanish by my sister Cindy Dabney Reyes. for ages 2-10.
We have read our stories at The Arkansas State Capital, Holiday House, Jacksonville Library and several classrooms. We will be at the Children’s library Saturday December 16 from10-11 and you can get these books then and we will sign them for you. From our house to your…
MERRY CHRISTMAS. Carol and Rod
Come join Carol, Rod and Cindy at the Arkansas State Capital in Little Rock Saturday December 2 for the annual Christmas tree lighting from 6-8pm to welcome Santa coming to town. Carol, Rod and Cindy will be reading their Christmas storybooks and singing Christmas carols.
Story-tellers share children’s storybook “Twas The Mouse Before Christmas” written and illustrated by Carol Dabney. In English and Spanish. Spanish translation by teacher Cindy Reyes. Available in audiobook with song online at http://www.amazon.com write ‘Carol Dabney Music’ in the search. or click the links below:
This is Carol’s first Christmas storybook published in 2013. It has a cookie recipe and an original song on sheet music in the book. The audiobook has character voices read by Cindy, Carol and Rod along with the song “Christmas in Your Heart”
Hear the story and see the illustrations on UTUBE on the link below: So much fun. Thank you for supporting teacher-artist Carol Dabney.
Thanks for listening. Hope you enjoy this very fun story. Please leave a message. Send to a friend with children.
From our house to yours… Merry Christmas…-Carol Dabney
Also enjoy being a part of the Santa’s North Pole Holiday magical Adventureland each year in Jonesboro.
We have enjoyed sharing our story over the past 4 years at schools, libraries, festivals, nursing homes, annual Holiday House Santa event and the annual Christmas tree lighting at the Arkansas State Capital.
The first time I read it was for a classroom at Schofield Army barracks in Hawaii. I also read at Ft. Lee when my daughter was stationed there. At home in Arkansas I travel the state and read with Cindy and Rod. Cindy and I are both teachers and love the classroom or school assembly events. Rod is a wonderful story-teller and has fun as the Singing Santa.
We will be presenting our story and music at the Clinton Children’s Library and Learning Center Saturday December 16, 2017 at the 10am family story hour. You can get a book and we will personally sign it with your child’s name in it. Please share this with your friends and thank you for supporting local artist. It helps us continue our work.
Merry Christmas 2017
This year 2017, my canvas paintings and stationary cards for Arkansas cotton was selected to be displayed in the Plantation Agricultural State Museum in Scott, Arkansas.
These are are some of the artwork that is displayed. My father’s first job as a young boy was picking cotton. This state attraction is located south of Little Rock, Arkansas at 4815 AR-161 in Scott.
Rod and I also sang there for the tractor expo, and sold some books, paintings and music.
Then it was time for story-telling and “The Happy Pumpkin” storybook, which I revised this year into a BIG BOOK and added some more art.
I have a great deal of fun reading this story and singing through harvest time, Halloween and into Thanksgiving about a Pilgrim named Jack who sails to the new world to plant a pumpkin seed with a big idea about sharing his pumpkin seeds. A tribute to the American farmer. Oh my, Jack must water through the intense heat and watch over that little sprout through wind and weather till it finally grows to be a huge happy pumpkin. Thank you American farmers for all you do. Jack, like you, had a desire to feed a nation. Then, in his sharing, he receives what he hoped for most, someone to share his life with. Oh the simple pleasures of life- FAMILY! A wonderful book about hard work, sharing and faith. Book also has some healthy pumpkin treats, and see the seeds come out and a jack-o-lantern with a candle made into this happy pumpkin. Celebrate Thanksgiving by reading this book to your family year after year.
click link below to see all my storybooks.
Thank you for supporting artists like myself. To all Happy Fall. -Carol Dabney
There were fall festivals and schools and libraries to read and sing at.
I teach music at my school in the mornings, but if you live in central Arkansas, I am available to come and read for your child’s classroom, school assembly or event in the afternoons. Let me know. Have a bless fall.
Holiday Books written and illustrated by Carol Dabney.
Michelle and Carol Dabney and Rod Ragsdale. We had a lot of fun the summer of 2017 playing music for senior centers and for children programs in central Arkansas. Here we are at the Hilary Clinton Children’s Library and Learning Center for story hour doing a Hawaiian program on July 18, 2017.
Michelle danced a lovely hula. She was born in the Hawaiian islands. She is a health coach in the Little Rock area.
Rod gave an indoor golfing demonstration and we sold his “The Adventures of Andrew on the Golf Course” book series.
We also did a Hawaiian program for the Kids Zone at Fitness 10 gym in Little Rock July 14, 2017. Telling the kids all about Hawaii.
We sang Hawaiian songs and danced the hula.
We also shared our Hawaiian program for the Whole Foods Kids Club September 1, 2017.
The kids enjoyed doing some hula with Michelle. I read the story of “Military Mommy” about my daughter in the army when she was stationed in Hawaii at Schofield Barracks. She is serving in Iraq now.
Rod and sang for a Hawaiian luau at The Manor Nursing Home in Little Rock, on my birthday in September and I was presented with a cake. We are regulars there and they have become like family to us the past two years.
Rod and I went into the recording studio and made a really awesome new audiobook for children. “Mia, the Mouse Used by God” with an original song “Where You Go” about a mouse who becomes a match -maker for Ruth and Boaz from the bible story out of the book of Ruth. We recorded at Blue Chair Recording Studio in Austin, Arkansas July 27, 2017.
We had a lot of fun singing this past summer. Hope you will check out all my books available on Amazon. Thank you for supporting local artists and authors.
Thanks for stopping in. -Carol Dabney
Its Tee Time. Rod Ragsdale and Carol Dabney will be sharing the fun adventures of story and music at the Jacksonville Public Library Wednesday July 12 beginning at 10:30am. Free event. Sharing “The Adventures of Andrew on the Golf Course” book one. Plus an inside golf demonstration which was presented last year and the kids lined to experience. It’s fun.
Singing songs with Miss Carol
click link above to view book details.
Author Rod Ragsdale and illustrator Carol Dabney. “The Adventures of Andrew on the Golf Course”
click link above and see details of book two.
Story book for children about golf. Rod has a passion that golf is for everyone in the family. Great outdoor sport.
click link above and read details of book three.
touring the libraries around Central Arkansas and telling kids all about golf, and nature out there on the golf course. Telling kids how it builds character. Fun books to inspire kids to learn this sport. Rod’s son Andrew is a golf Pro at DisneyWorld.
Come join us at the Library. Free event Wed July 12 Jacksonville Public library. Thank you to those who purchase our books and music online. Thanks for supporting local authors.
Oh yeah baby Book Four has golfing with Santa! Dont just dream about golf in the winter. Golf with Santa. Click link below for details
Rod and Carol Library events for Kids this summer. Grab your friends see you there!!!
July 12 Wednesday Jacksonville Public Library at 10:30am
July 18 Tuesday Clinton’s Children’s Library Little Rock 10am
Spring is here. We are sharing new music and a children’s book.
“Wisdom, the elephant used by God” and the song “I Will Follow”
Grand daughter Aliyah is helping at story time and singing along. Wisdom is about a brave little elephant with big faith to follow God. She and her parents travel from south Africa to north Africa. God protects them through many dangers and they find a man named Noah building an ark. This is a fun adventure animal parable to add to your home library or read in Sunday school class readings.
We recorded the song and audiobook at Blue Chair Recording Studio in Austin, Arkansas during Spring break 2017. Always fun creating new music. Thank you to our engineer Darian Stribling and musician Tim Crouch.
We sang at Scott, Arkansas. The annual dinner is to celebrate all that our Arkansas farmers do to feed America. Thank you Anne Turner. Always a great event.
We sang at a Hawaiian luau at Andover Opry.
We sang at Geyer Springs First Baptist Church Adult Fellowship March luncheon and received a standing ovation. Thank you Max
We recorded four new songs this year: “I Will Follow” and “Joshua” for the Animals Used by God series. “Leap of Faith” a lullaby that Rod and I composed together. and “Nothing Better Than You” a love song written by Rod Ragsdale, that everyone will love. We are in process and hopefully will finish by May. An exciting Spring has begun. Life is fun.
Happy Spring all.
Did you ever wonder what it would be like to play your favorite sport with Santa at the North Pole? Well Andrew got to do just that! See, Andrew loves golf. It just so happened that it was snowing pretty hard one Christmas Eve when suddenly who should appear? You guessed it. Andrew couldn’t believe his eyes, and that was only the beginning. https://www.amazon.com/Adventures-Andrew-Golf-Course-Book/dp/1537450476/ref=sr_1_1?s=books&ie=UTF8&qid=1481587830&sr=1-1&keywords=rod+ragsdale
The Adventures of Andrew on the Golf Course series is written by Rod Ragsdale and illustrated by Carol Dabney.
Rod on the golf course, just before making a snowman. Here is where the wheels began turning for his fourth book – Golfing with Santa.
The books starts with Andrew helping his dad shovel snow around the golf course country club. awe…work. Nothing like it to get a person day dreaming about what he or she would rather be doing.
I mean really what if..
Rod Ragsdale and Carol Dabney tour libraries and schools singing and sharing their stories. Children love putting the golf ball inside the library. Rod demonstrates and the kids love it!
next program open to the public. free family fun at the Clinton Children’s library on 10th street in Little Rock, Arkansas. Sing some Christmas carols and hear a few of Rod and Carol’s Christmas stories. Maybe golf a bit. You may even purchase an autographed book for your child. Monday December 19 beginning at 11am.

domain: artistic


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I have in the past shared work-in-progress posts, but usually, it’s when I’ve been purposefully documenting a painting at various different stages, and I usually share the work-in-progress images only when I’ve finished the painting!
On this occasion, its not that I’ve been documenting the stages, but more that I just reached a point in a painting when I had to stop, and now I find myself in a dilemma about how to progress!
Here’s the most recent painting that I’ve been working on:
I usually work quite quickly and more often than not finish a painting in the same session or same day that I start it. With this painting however, I had a few interruptions and progress was a little more fragmented than usual. Even so, I’m pleased with what I’ve done so far. The only thing now is that I need to add the trees on the left of the lane.
My dilemma is that I like what I’ve done so far, and I really don’t want to ruin it, but nor do I feel confident about doing the best possible job of the trees. The trees in question will link the bottom half of the painting with the top half and without them, the painting looks obviously incomplete. The trees will most likely take up between a quarter and a third of the entire painting so it’s not as if they’re going to go unnoticed. (If you look closely you may be able to see some feint pencil lines that indicate the main branches.) I keep thinking about the best way of trying to portray the trees and so far, remain unconvinced by all my solutions. I know, I should probably have thought of this before I started but I had precious little idea that it was going to work out as it has or that I’d become so attached to it before I’d even started on the trees!
The trees are leafless and there’s a temptation to go tight and end up having to suggest every individual twig. An alternative might be to just try to loosely suggest the tree with a few drags of a mop brush, in a similar vein to Edward Wesson. Another approach might be to block out the mass of the tree with a very pale wash and, when this is dry, apply some dry brushstrokes over the surface to suggest the texture of the smaller twigs and branches. This is something I think of as being a little more Roland Hilder-esq in approach. There are probably numerous other ways that I could try to tackle this too, but the fact that I can’t decide which one might work best is quite disconcerting.
I think that whatever approach I take, I need to try to paint boldly and confidently – neither of which I yet feel capable of doing to see this painting through! I’m currently trying to tell myself that I have nothing to lose – that without the trees, the painting isn’t remotely finished. Sadly there’s so much that I already like about the painting that I can’t seem to summon up this level of carefree abandon!
What a conundrum! Any thoughts on how I should proceed – both practically and mentally – would be most welcome! I’ll be sure to share with you, whatever happens, next week – assuming that is that I get over my current state of paralysis!

domain: hobby


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Clarence TeSelle Endowed Professorship
Support professorship in College of Law.
Clarence John TeSelle was born in 1887 in Wisconsin and was a professor at University of Florida from 1928 to 1958. He taught in areas such as legal ethics, trial procedure and techniques, evidence, military law and federal rules.
TeSelle passed away in 1961. His son, John TeSelle, earned his bachelor’s degree in mechanical engineering in 1947 from UF and is retired from the U.S. Bankruptcy Court in Oklahoma City. Gene Moore and his fellow 1953 College of Law classmates honored TeSelle with a bust in the Fredric G. Levin College of Law library.
Other Fredric G. Levin College of Law Giving Opportunities
Lealand L. Lovering Scholarship Fund
Allen L. Poucher Legal Education Series Fund
Coker, Schickel, Sorenson and Posgay, P.A. Trial Team

domain: law


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South Carolina (14-13, 5-9 SEC) vs. Georgia (15-11, 6-8)
Start time: 6:30 p.m.
TV: SEC Network
Live stream: watchespn.com
The Gamecocks shocked No. 10 Auburn in Columbia, upsetting the Tigers 84-75 after building a ridiculous 46-25 halftime lead and then hanging on down the stretch. Frank Booker continued his strong play with a team-leading 19 points, while Chris Silva notched his sixth double-double with 14 points and 11 rebounds and Wes Myers added 13 points off the bench. It was a fitting celebration for former Gamecocks Sindarius Thornwell, Justin McKie, and Duane Notice, who received their Final Four rings at the game.
What to watch for
The Bulldogs are coming off a winning week, having first posted a 72-69 overtime win against rival Florida and then knocking off No. 19 Tennessee 73-62. Senior forward Yante Maten has continued to stand out for Georgia, leading the team and the SEC in scoring at 19.5 points per game. He’s also in the league’s top 10 in rebounding, field goal percentage, and free-throw percentage.
In their last meeting on Jan. 13, the Gamecocks beat the Bulldogs 64-57 in Athens. South Carolina is currently enjoying a three-game winning streak over Georgia.

domain: sports


text:
Happy Weekend! Most of the country will be pretty frigid this weekend, so I will not be bragging about the sunny + 70 degree weather we will be having here in central Florida too much. Below I share some perfect things to do inside this fall weekend.
1. I do not have a green thumb. Like I have said before, I laid a bamboo plant to rest recently. I am hoping that this list of 9 Air-Cleaning House Plants That Are Nearly Impossible to Kill rings true. And don’t worry, some of them are really beautiful and require little to no watering and sunlight. Beautify your home and clean the air with barely any effort? High five!
2. I am currently on a calligraphy high. I have been searching for the perfect digital translations to jazz up some of my Photoshop work and finally hit the jackpot on the Nectar Collective. In addition to 10 [free] Gorgeous Calligraphy Fonts they link to, they also suggest red flags to check the licenses for before downloading.
3. With that cold weather approaching, I need a refresher course on how best to layer clothing. Glam Radars offers tips and some amazing ideas on how to perfect the layered look this Fall.
4. Lauren Conrad can do no wrong in the fashion + beauty world, but her Fall Reading List proves there is more to her. Some of the options on this list have received a lot of press, but others are dark horses that I wouldn’t have known about otherwise. So cozy up with a blanket, hot coffee, and some of these reads this weekend.
5. Ever heard of a Brookie? It’s a brownie and cookie in one and the product of Urban Bakes sinfully genius mind. With holiday gatherings right around the corner, this is a great option that is sure to please all your guests.
6. Something about the colder weather makes me even more introspective than I am normally. This article from Huffington Posts explains the 10 Ways Introverts Interact Differently with the World. I seem to surround myself with extroverts, so realizing that shyness and introversion are not the same is pretty refreshing. Not to mention it justifies holing up this weekend with the hubs and pooch.
Even though its chilly outside, warm your belly with some brookies and your soul with some good reads and call it a weekend!


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Clarified butter is just pure butterfat without the milk solids and the water content. It is popularly used in Indian and Middle Eastern cooking. Butter is a solid fat and contains 80% butterfat, 17% water content, and 3% milk solids. The preparation of clarified butter separates the milk solids and the water content from the butterfat, and gives you pure, unadulterated butterfat that has a rich flavor. Another form of clarified butter is popularly known as 'ghee' in India. There is a slight difference between regular clarified butter and ghee. Ghee has a longer cooking time and a slightly nutty flavor, which is missing from clarified butter. Here we explain the procedure of preparing clarified butter, and the health benefits of consuming the same.
Steps to Prepare Clarified Butter
To make clarified butter, all you need is about two sticks of unsalted butter.
- Start the preparation procedure by melting the unsalted butter in a deep saucepan, on low heat. To prevent the butter from burning, you may use a double boiler.
- You will notice the formation of foam on the surface once the butter has started melting. This marks the separation of water from the butter. You will also notice the formation of a white residue. This marks the separation of the milk solids from the butterfat.
- After it has melted, allow the butter to simmer, and skim off the foam and milk solids using a ladle. You should be left with a clear, golden liquid after you have skimmed off the two.
- You may either discard the milk solids and foam, or store them to be used on a snack like popcorn.
- Remove the clarified butter from the heat and strain it through a mesh or a cheesecloth into a clean, dry jar and store.
- If you wish to prepare ghee, allow the butter to continue to simmer, and do not skim off the foam or white residue.
- As you continue to allow it to cook, you will notice the formation of solids that begin to settle at the bottom of the pan. The foam and white residue will eventually disappear, leaving you with a clear, golden liquid.
- Continue cooking till the solids turn a golden brown color, and the ghee turns into a translucent and rich, fragrant liquid. Remove from heat at this point. Do not allow it to overcook, as it will easily get burnt.
- Pour the ghee into a jar through a fine-mesh skimmer or a cheesecloth.
Clarified butter may be stored both, at room temperature, as well as in the refrigerator. It will last anywhere between six months to one year. Allow it to cool before using it. When allowed to cool, clarified butter becomes semi-solid. As mentioned earlier, ensure that the jar you use to store the clarified butter is absolutely dry, as even a little water can cause the growth of bacteria and spoil the clarified butter.
Advantages of Consuming Clarified Butter
Though the nutritional value of butter and clarified butter does not vary greatly, there are other advantages of preparing and using clarified butter in cooking, in limited amounts.
- The prime advantage of using clarified butter for cooking is its high smoke point. Regular butter browns and burns easily, thus making it difficult to cook for a long period. On the other hand, clarified butter can be used even for deep-frying, and gives you a buttery taste without burning.
- Ghee, the longer-cooked version of clarified butter, when used in small quantities is known to be good for digestion.
- Clarified butter is perfect for those who are lactose intolerant, simply because its preparation procedure helps in eliminating the milk solids from it.
- It is ideal to prepare clarified butter on your own, not only because it is a simple procedure, but also because the preparation procedure helps you ensure that no additives are added to it.
- Of course, if you are health-conscious, maybe it is better that you stick to healthier oils such as olive oil for cooking, because clarified butter, like butter, is rich in saturated fat. However, foods like pancakes cannot be prepared with olive oil, and a small amount of clarified butter used to prepare them can greatly enhance their flavors.
By learning how to make clarified butter, you are giving yourself a delicious alternative to regular butter, particularly if you are lactose intolerant. Just prepare a few of your favorite foods with clarified butter instead of plain ol' butter, and see the difference in the flavors. Here's a small hint: if you still want the flavor of clarified butter but not all the calories, combine it with your choice of a healthier oil, and relish the rich flavors without consuming all the saturated fat. Enjoy!

domain: food


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ISLAMABAD: Pakistan and the Russian Federation are scheduled to hold four-day crucial talks here from today (Monday) that will last till October 29 with an aim to finalize the shareholdings agreement for most strategic project of Pakistan Stream Gas Pipeline valued at $2.5-3 billion, shows the official document pertaining to the agenda of the talks on pipeline project.
Under the amended IGA, Pakistan will be having 74 percent shareholding and Russia 26 percent. Once the shareholding agreement is finalized and signed, then a pipeline of 56 inches diameter, having length of 1,040 kilometers, will be laid down from Karachi to Kasur (Punjab), which may have the capacity to carry 2.5-3 bcfd gas. Two LNG terminals, one by Energas and other by Tabeer, will be constructed by 2023-24. The PSGP will also transport the LNG to be re-gasified from the said LNG terminals. Under the new scenario, the government has also decided to use the Pakistan Stream Gas Pipeline to have an intake of 1.35 bcfd gas to be imported from Tajikistan through the TAPI pipeline and to this effect the government has included the required provision in the PSGP project.
Secretary petroleum, when contacted, confirmed that four-day talks on the Pakistan Stream Gas Pipeline project for finalizing the shareholding and facilitation agreements will be initiated from today (Monday).
However, as per the official document, the Russian delegation, headed by Vladimir Shcherbatvkh, Chief Executive Officer of Russian Nominated Entity (RNE) PAKSTREAM LLC, will arrive today (Monday) in the morning and usher in the important parleys to finalize the shareholding and facilitation agreements. In the talks, Pakistan Nominated Entity (PNE), the Inter State Gas System, headed by Managing Director Syed Zakria Ali Shah, would take part. Secretary Petroleum Dr Arshad Mehmood would lead Pakistan’s side.
However, top sources said the government, which has accumulated Rs325 billion from the gas consumers under the head of GIDC (Gas Infrastructure Development Cess), does not want to spend the whole money on the project as it has reportedly consumed it for budget deficit financing. Now the PTI government wants debt from the Russian EXIM bank and other financial institutions to finance the project. The Finance Division has said that it will provide Rs60-90 billion at the maximum in three years for the project, which means Rs20-30 billion every year. Pakistani authorities cannot afford the outflow of $1.5-2 billion from the reserves in one go, which is why it wants to borrow the loan from Russian banks to cater to the needs of foreign component spending in the project, which will be used to purchase pipeline and compressors. And to this effect, Pakistan intends to seek debt during talks with Russian financial institutions for the project at an international Libor rate of 1.5-2 percent with tenure of 20 years for repayment of the debt with mark-up, ensuring slow and staggered outflow of dollars from foreign reserves. This means the project that was earlier based on GIDC funding has been converted to debt based financing mode and the masses who had earlier paid for the pipeline in the shape of GIDC will again pay in the shape of pipeline transportation tariff the debt and mark- up.
In earlier meetings, Pakistan had also asked Russia to jack up its shareholding maximum up to 49 percent from 26 percent, showing that Islamabad does not have the required amount to finance its own shareholding of 74 percent. This develops a strong impression that the government that collected over Rs325 billion has utilized the GIDC amount in budget financing. Besides, the government has also decided to extend sovereign guarantee against the debt financing to lenders to be arranged by Russia. “And Russia had also been asked to work out its strategy with options of arranging supplier credits, debt financing and increase in its shareholding by up to 49 percent.”
In the four-day talks, both sides will follow and adhere to the principles agreed in the Inter-Governmental Agreement (IGA) as amended through Protocol dated 28th May, 2021 and the Heads of Terms of the Shareholders Agreement signed by the parties on 15th July, 2021. Under the earlier Inter-Governmental Agreement, Russia was to erect the whole project with its 100 percent financing. Then the Government of Pakistan took a new decision with maximum investment from its side into the project after the Supreme Court verdict on GIDC (Gas Infrastructure Development Cess). Now under the amended IGA, Pakistan will be having 74pc shares and Russia 26 percent in the project.
Russia has agreed to participate with 26 percent financing, showing how serious Moscow is about building its stakes in the Pakistan economy. Russia in the past built the Pakistan Steel Mills and OGDCL too.
Areas which witnessed rain include Saddar, II Chundrigar, North Karachi, Gulistan-e-Johar
This drama is a heart-touching story of a girl named Zoya which has engrossed the audience from the very first episode
PESCO’s field staff later restored power to the majority of the affected feeders, with work ongoing to address the...
Certain forces did not want ANP to reach the parliament because it was the only party that had always fought for the...


Two polls are out in Pennsylvania on a prospective GOP Senate nomination fight between Senator Arlen Specter and his 2004 primary challenger, former Congressman Pat Toomey. They are front-page news across the state today in an AP story.
The Quinnipiac University poll (Connecticut based) shows Toomey leading Specter 41-27 among Pennsylvania Republicans, with 28 per cent undecided. The poll was head-to-head, leaving out recently announced candidate Peg Luksik, a pro-life activist. The poll also says almost half of the GOP electorate has an unfavorable opinion of Specter, while 45 percent of state voters as a whole have a favorable opinion of Specter — this down from a 56 percent rating in November. Quinnipiac interviewed 1,056 Pennsylvania voters between March 19-March 23rd. The sampling error was plus or minus 4.8 percentage points for 423 GOP voters polled.
Poll number two is the Franklin and Marshall College survey, which threw Luksik into the mix. Specter won this poll, with 33 percent to 18 percent for Toomey and 2 percent for Luksik. The F&M poll interviewed 586 voters, including 211 Republicans. The sampling error for the Republican voters in the poll, taken between March 17-March 22, was plus or minus 6.7 percent.
The story, by reporter Peter Jackson, notes that the results were announced one day after Specter announced he would be opposing the so-called “Card Check” bill that would make it easier for workers to unionize by shutting down the secret ballot process. Radio ads have been running in the state asking Pennsylvanians to contact Specter and demand that he oppose Card Check.
In 2004, Toomey lost to Specter in the GOP primary by 17,000 votes out of 1 million cast. It was Specter’s toughest primary fight since winning his first primary for the Senate in 1980. His recent vote as one of only three GOP votes in the entire Congress supporting the Obama stimulus plan has angered many state Republicans. Toomey, thought to be considering a race for the open seat for governor (Governor Ed Rendell is barred from a third term), has recently had second thoughts, indicating in press reports that he is now considering a second race for the Senate.
Specter’s card check opposition comes a handful of days before the state’s conservatives gather in Harrisburg for the annual Pennsylvania Leadership Conference, where they will hear from Toomey and radio talk show host and columnist Michael Reagan. The PLC has become a popular statewide version of the annual Conservative Political Action Conference (CPAC).


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Regular brain exercise can slow the decline of vital cognitive function as we get older
09 Jun 2017
Just like our body, our brain needs exercise to stay in shape too. With regular cognitive exercise, we are putting our brain in a better position to protect itself from vital brain function decline as we get older. We are also strengthening our brain to perform at its peak every day whether it’s at work or at home.
Our brain is the command centre to the body’s functions such as; moving, talking, thinking, memory, feeling and breathing. It is one of our most vital organs and is a major reason for us to look after its healthy function.
Deanne Ranyard, Head of the National Training Portfolio at CIT Solutions says your brain is like a muscle that needs constant exercise to maintain and prolong optimum function.
"Our lives are so full and busy it’s very easy to forget about our brain health. If we incorporate brain exercise into our daily routine or make sure we participate in continuous cognitive development as much as we can, the benefits will be significant."
Cognitive decline can be attributed to poor prevention tactics that include; decrease in continued learning, substance abuse, bad diet and sedentary lifestyle.
Our research suggests good prevention tactics include; regular practice in challenging cognitive activities, maintaining a healthy diet and regular physical exercise. This will put your brain in a better position to protect itself from losing vital brain function.
Vital brain function includes:
- Problem solving
- Cognitive processing
"Investing in good prevention tactics can prolong healthy cognitive function which can have a positive impact and improvement on integral brain function", says Ms Ranyard.
What types of challenging cognitive activities are out there?
- Academic study
- Continuous learning
- Word games
“There are so many benefits to maintaining our brain health. These benefits can be felt both in and out of the office", says Ms Ranyard.
Benefits of maintaining our brain health include:
- Gain new skills
- Maintains your competitive edge
- Enhances your reliability
- Improves your ability to make sound decisions
- Boosts your confidence
- Embrace challenges
- Solve complex problems
- Ignites your creativity
If you’re interested in investing in your brain health, CIT Solutions has plenty of challenging cognitive activities available to suit all learning and development needs.

domain: psychology


text:
Colorectal cancer is the fourth most common malignancy globally.1 Up to 22% of patients in the United States with this disease present with metastases.2 However, anal metastases are exceedingly rare. Some have estimated that metastasis to this location occurs in less than 1% of patients with this disease.3,4 In nearly all previously reported cases in the literature, anal metastasis was associated with a history of antecedent anal disease such as pre-existing perianal fistulae or fissures.3–13 Implantation into the surgical site following hemorrhoidectomy has also been noted on multiple occasions.14–20 Tumor implantation from trauma during rectal cancer operative procedures has also been described.21–23 To our knowledge, isolated anal metastasis to intact perianal surface tissue in the absence of epithelial injury has only been described once before in the literature.24 Herein, we present the case of a 69-year-old man with a colorectal cancer originally at the rectosigmoid junction, presenting with a recurrence at the anal verge 5 years later, with no history of prior anal disease or trauma.
The patient originally presented at age 64 to a community hospital for an asymptomatic screening colonoscopy. He had a personal history of two small adenomatous colon polyps removed in a past endoscopy but no personal or family history of any cancers at that time. That colonoscopy identified a polyp of 3cm diameter at 20cm from the anal verge. This was tattooed by the endoscopist and removed via an endoscopic submucosal dissection. Unfortunately, on histopathology this was diagnosed as a low-grade colon adenocarcinoma with a microscopically positive margin. His blood CEA level was 1.1μg/L, and his staging CT scan of the chest, abdomen and pelvis demonstrated no signs of metastatic disease, so he subsequently underwent low anterior resection with primary anastomosis. The specimen contained 30 normal regional lymph nodes without evidence of residual or metastatic disease. He was staged as T1N0M0 colon adenocarcinoma at that time, and followed routine surveillance with his surgeon. His post-operative course was complicated by an anastomotic stricture, which was effectively managed with serial endoscopic dilatations by his surgeon.
Two years later, he developed some new onset rectal bleeding. His CEA rose to 7.4μg/L, and he underwent flexible sigmoidoscopy which identified a friable mass at the colorectal anastomosis, 8cm from the anal verge. This was biopsied and demonstrated recurrent rectal cancer (MSI stable and MLH1/PMS2/MSH2/MSH6 intact). Staging CT scans and rectal MRI exam demonstrated a locally advanced lesion with spread into the peri-rectal fat, but no nodal metastasis, and he was referred to our tertiary care centre for neoadjuvant therapy and a surgical consultation. Over the subsequent months, he received long course neoadjuvant chemoradiation (capecitabine and 50.4 Gy in 28 fractions). At 6 weeks after completing neoadjuvant chemoradiation, his CEA had decreased to 2.3μg/L, and flexible sigmoidoscopy and CT scans demonstrated no clinical evidence of residual disease. The patient was offered oncologic resection at our hospital; however, he had developed significant deconditioning and fatigue which he attributed to his neoadjuvant therapy, and felt that he could not cope with another operation at that time. Against our recommendations, he declined surgery in favor of a “watch and wait” approach.
He was closely monitored with CEA, CT scans and flexible sigmoidoscopy. Two years later, his CEA suddenly rose to 9.0μg/L, and another local recurrence was identified on endoscopy, in the same location at the rectal anastomosis. CT scans demonstrated no signs of distant metastatic disease. This time, he agreed to a repeat low anterior resection, and was brought to the operating room. Intraoperatively, he was found to have significant visceral adiposity, a very narrow pelvis and significant fibrosis from his prior surgery and radiation. A primary anastomosis was deemed not practicable, and he underwent a low Hartmann’s procedure with an end colostomy. His postoperative histopathology demonstrated a T3 tumor with extension into the peri-rectal fat, but no nodal metastases and negative margins. Postoperatively, he developed a small dehiscence of his rectal stump, which was managed by a brief hospitalization with intravenous antibiotics. He was referred for adjuvant chemotherapy, which he again declined, citing the significant side effects he experienced from his neoadjuvant chemoradiation.
Six months later, he underwent surveillance flexible sigmoidoscopy of the rectal stump by his surgeon. At this time, there was some granulation tissue at the staple line, and a new large, firm lesion, similar in appearance to an acrochordon, at the anal verge (Figure 1). Both sites were biopsied. The rectal stump histopathology showed benign granulation tissue, whereas the anal lesion was rectal type adenocarcinoma. This time, his CEA remained low at 1.7μg/L. The patient was otherwise asymptomatic. He had no inguinal lymphadenopathy on physical exam, and CT scan of the chest, abdomen and pelvis showed no signs of distant metastatic disease. Following multidisciplinary discussion, the patient was considered for abdominal perineal resection (APR) and chemotherapy for management of what was presumed to be another recurrence of his rectal cancer. Consideration was given to the patient’s body habitus, significant pelvic fibrosis, and mechanical difficulties encountered during his prior operation. The risks of major oncologic resection were felt to be significant, therefore the patient opted for a more minimalist approach, with local resection and V-Y flap reconstruction, and no chemotherapy. Post-operative pathology demonstrated a rectal-type adenocarcinoma, consistent with his past tumors. The cancer was invading just to the submucosa, and the surgical margins were widely clear. Post-operatively, he had a small dehiscence in the suture line of his reconstruction, which healed without any sequelae or intervention (Figure 2). Six months after surgery he continues to do well, without any signs of recurrence.
Figure 1 Preoperative image of the adenocarcinoma metastasis at the anal verge.
Figure 2 Healed V-Y reconstruction flap on anus at 6 month post-operative visit.
This case report describes a unique presentation of a relatively common disease. While colorectal cancer metastasis to the anus itself is a rare finding, its presentation without any antecedent trauma or perianal disease has only been described once in the literature.24 The current case occurring in an irradiated and re-operative field following multiple local recurrences of a rectosigmoid cancer presents an added therapeutic challenge. Given the paucity of previous reports describing this issue, no guidelines exist to help direct management. Instead, this case report may help us to advance our understanding of this disease, and guide future options for treatment and prevention.
In the above case, the anal metastasis was managed with a local resection of the tumor. This treatment is consistent with that performed in some past case reports of isolated anal metastases,4,21–23 which appears to have led to long term disease remission in at least one instance.19 Other cases have been managed with APR.6,13,15,18,20 In the latter cases, patients often presented synchronously with their primary cancer in the rectum, thus necessitating excision of the mesorectum. In the present case, the patient’s mesorectal plane had already been violated during his two prior resections. Furthermore, he had significant adiposity, a narrow pelvis, and substantial scarring from his chemoradiation. These are all factors that are described to increase the difficulty of pelvic dissection.25 Extrapolating literature from local rectal cancer recurrence suggests that the most important factor for predicting cancer-specific survival in patients undergoing surgery for recurrent rectal cancer was an R0 resection.26,27 Therefore, a joint decision between the patient and his providers was made to pursue wide local resection only. Given the negative margins on this specimen, this resection was determined to be adequate.
The decision whether to offer adjuvant chemotherapy in this case was another challenging factor. The patient had not previously received chemotherapy during his prior recurrence due to personal preference. There are no prospective trials examining the efficacy of adjuvant chemotherapy following resection of a locally recurrent rectal cancer. The National Comprehensive Cancer Network (NCCN) guidelines suggest cisplatin-based chemotherapy (eg, FOLFOX, CAPEOX) as part of the management algorithm for resectable isolated pelvic recurrence.28 Although evidence in support of that recommendation is limited. Retrospective series exist examining the use of adjuvant chemotherapy as a component of multimodality therapy for locally recurrent rectal cancer, however, they do not demonstrate an association between administration of adjuvant chemotherapy and more favorable long-term oncologic outcomes.27,29–31 Regardless, applicability of those studies to the current presentation is tenuous. Most cancers included in those analyses had recurred at the anastomotic site or in the pelvis, rather than at the anus. An alternative perspective would be to treat this anal recurrence as a resectable distant metachronous metastasis, rather than a local recurrence. Again, NCCN guidelines suggest the provision of adjuvant chemotherapy for resectable stage IV rectal cancer patients who had not previously received chemotherapy.28 However, the evidence of benefit for this treatment is indeterminate, and is extrapolated primarily from colorectal liver metastases. The largest meta-analysis (n=1896 patients) of primarily observational studies demonstrated modest benefits for disease free survival (HR=0.81, 95% CI:0.72–0.91, p=0.0007) but no effect on overall survival (HR=0.88; 95% CI:0.77–1.01, p=0.07).32 Given the uncertain benefits, and concern for adverse side effects, our patient declined chemotherapy.
Repeat radiotherapy for this anal recurrence was another consideration. Particularly given the patient’s profound response to neoadjuvant therapy during his first recurrence over two years prior. However, there is again a paucity of evidence to guide re-irradiation. The NCCN rectal cancer guidelines suggest re-irradiation should be delivered if it can be tolerated and is feasible, citing some small studies espousing the relative safety of this approach.28,33–35 One large retrospective series of resectable locally recurrent rectal cancers found that those who received repeat radiation as part of their treatment had longer overall survival, and increased time to local recurrence or metastasis compared to patients who were not re-irradiated.36 However, our patient had previously received a large cumulative dose of radiation after his first recurrence, and had significant side effects such that he would not consider re-irradiation a viable option.
Another situation we considered was whether this was a new primary neoplasm of the anal canal. Unlike squamous cell carcinoma (SCC), adenocarcinomas are only rarely encountered in the anus, accounting for less than 10% of anal cancers.37,38 Anal adenocarcinomas can be categorized into two types according to their origin: those which arise from the anal glands, usually in conjunction with a fistula; or “Colorectal-type” anal adenocarcinomas which are thought to arise from rectal glandular cells in the anal transition zone mucosa.37 Histologically, these latter lesions are identical to ordinary colorectal adenocarcinoma, and represent an interesting diagnostic and therapeutic dilemma, as they can be difficult to distinguish from low rectal cancers. This diagnosis can be particularly important, as anal adenocarcinomas have a worse prognosis than rectal cancer, as they more frequently metastasize to the inguinal and femoral nodal basins.37,38 In the presented case, histopathology could not differentiate between the original tumor and the tumor recurrence at the anal margin; although, this does not necessarily rule out the possibility of a new primary cancer. Analysis of the tumor genotype, and comparison between the index and the recurrent tumor theoretically could help determine whether they were related. However, this type of testing is not available locally. Fortunately, management options for localized anal adenocarcinoma, and those for localized rectal cancer recurrence at the anus are similar.38
Going forward, the question remains as to the cause of this exceedingly rare site of rectal cancer metastasis. Most of the similar case presentations in the literature occurred following some damage to the anal epithelial layer. However, in the current case the patient had no anal disease, and had no significant trauma from instrumentation of his anus. Previously minor trauma from the hooks of a Lone Star retractor or those of a Gelpi retractor have been implicated in tumor cell implantation in the anus.22,23 However, these instruments were never used in any of this patient’s prior operations. The patient also had a significant stenosis at his original colorectal anastomosis, requiring multiple dilatations following his index operation 5 years prior. It remains a possibility that some minor perianal trauma that went unnoticed to the patient and the surgeon during one of these dilatation procedures or one of his past cancer operations led to the current presentation many years later.
Isolated metachronous metastasis to the anus is an extremely rare site of recurrence for rectal adenocarcinoma, with only a small number of cases reported in the literature. Therapeutic options can be extrapolated from those performed for other locally recurrent rectal cancers or from isolated metachronous metastases to the liver. Regardless of the approach, patient-informed care is paramount. A firm understanding of the quality of the available evidence (or lack thereof) for conventional therapeutic options such as chemotherapy, radiation, and aggressive surgery in this setting is essential in order to help select the best therapeutic option.
APR, abdominal perineal resection; CEA, carcinoembryonic antigen; CAPEOX, capecitabine plus oxaliplatin chemotherapy; FOLFOX, folinic acid plus 5-fluorouracil and oxaliplatin chemotherapy; NCCN, National Comprehensive Cancer Network; SCC, squamous cell carcinoma.
Ethics Approval and Informed Consent for Publication
Informed consent for publication of the patient’s medical details and photographs was obtained from the patient prior to publication. Institutional approval was obtained from the University of Manitoba’s Health Research Ethics Board. File number: HS25267 (H2021:410).
This work is original and is not under consideration elsewhere. This work has not been presented at any scientific meetings.
There was no specific funding for this research.
The authors report no conflicts of interest in this work.
2. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33.
3. Guiss RL. The implantation of cancer cells within a fistula in ano: case report. Surgery. 1954;36(1):136–139.
4. Gupta R, Kay M, Birch DW. Implantation metastasis from adenocarcinoma of the colon into a fistula-in-ano: a case report. Can J Surg. 2005;48(2):162–163.
5. Murata A, Takatsuka S, Shinkawa H, Kaizaki R, Hori T, Ikehara T. [A case report of metastatic anal fistula cancer treated with neoadjuvant chemotherapy]. Gan to Kagaku Ryoho. 2014;41(12):1869–1871. Japanese.
6. Gomes RM, Kumar RK, Desouza A, Saklani A. Implantation metastasis from adenocarcinoma of the sigmoid colon into a perianal fistula: a case report. Ann Gastroenterol. 2014;27(3):276–279.
7. Benjelloun EB, Aitalalim S, Chbani L, Mellouki I, Mazaz K, Aittaleb K. Rectosigmoid adenocarcinoma revealed by metastatic anal fistula. The visible part of the iceberg: a report of two cases with literature review. World J Surg Oncol. 2012;10(1):209.
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10. Kouraklis G, Glinavou A, Kouvaraki M, Raftopoulos J, Karatzas G. Anal lesion resulting from implantation of viable tumour cells in a pre-existing anal fistula. A case report. Acta Chir Belg. 2002;102(3):212–213.
11. Ishiyama S, Inoue S, Kobayashi K, et al. Implantation of rectal cancer in an anal fistula: report of a case. Surg Today. 2006;36(8):747–749.
12. Wakatsuki K, Oeda Y, Isono T, et al. Adenocarcinoma of the rectosigmoid colon seeding into pre-existing anal fistula. Hepatogastroenterology. 2008;55(84):952–955.
13. Buzatti KC, de LR, Reis I, Daldegan I, Rodrigues B, Rectal cancer metastasis to an anal fissure. Clin Gastroenterol Treatment. 4(2). Available from:: https://clinmedjournals.org/articles/jcgt/journal-of-clinical-gastroenterology-and-treatment-jcgt-4-061.php?jid=jcgt. Accessed December 24, 2021.
14. Algallai M, Moftah M, Manita MA, Eldruki SI. Colorectal cancer implantation metastasis in haemorrhiodectomy wound, case report. Open J Gastroenterol. 2019;9(9):185–191.
15. Hsu T-C, Lu I-L. Implantation of adenocarcinoma on hemorrhoidectomy wound. Int J Colorectal Dis. 2007;22(11):1407–1408.
16. Abbasakoor F, Srivastava V, Swarnkar K, Stephenson BM. Implantation anal metastases after out-patient treatment of haemorrhoids. Ann R Coll Surg Engl. 2004;86(1):38–39.
17. Gujral DM, Bhattacharyya S, Hargreaves P, Middleton GW. Metastatic rectal adenocarcinoma within haemorrhoids: a case report. J Med Case Rep. 2008;2(1):128.
18. Liasis L, Papaconstantinou HT. Colorectal cancer implant in an external hemorrhoidal skin tag. Proc (Bayl Univ Med Cent). 2016;29(2):194–195.
19. Cantos-Pallarés M, García-Armengol J, Mulas-Fernández C, et al. Metástasis cutáneas perianales de adenocarcinoma colorrectal. Revista Española de Enfermedades Digestivas. 2012;104(1):41–42.
20. Meshikhes A-WN. An unusual implantation of a rectosigmoid adenocarcinoma into a hemorrhoidectomy scar. Ann Saudi Med. 1998;18(3):242–243.
21. De Friend DJ, Kramer E, Prescott R, Corson J, Gallagher P. Cutaneous perianal recurrence of cancer after anterior resection using the EEA stapling device. Ann R Coll Surg Engl. 1992;74(2):142–143.
22. Tranchart H, Benoist S, Penna C, Julie C, Rougier P, Nordlinger B. Cutaneous perianal recurrence on the site of Lone Star Retractor after J-pouch coloanal anastomosis for rectal cancer: report of two cases. Dis Colon Rectum. 2008;51(12):1850–1852.
23. Zinzindohoue F, Penna C, Parc R. Adenocarcinoma arising on the site of a Gelpi retractor after coloanal anastomosis for rectal cancer. Br J Surg. 1997;84(3):362.
24. Sasaki S, Sugiyama M, Nakaji Y, et al. Anal metastasis of rectal cancer—adenocarcinoma of squamous cells: a case report and literature review. Surg Case Rep. 2017;21(3):55.
25. Pappou E. Chapter 31: proctectomy. In: Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore AJ, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery.
26. Mirnezami AH, Sagar PM, Kavanagh D, Witherspoon P, Lee P, Winter D. Clinical algorithms for the surgical management of locally recurrent rectal cancer. Dis Colon Rectum. 2010;53(9):1248–1257.
27. Roeder F, Goetz J-M, Habl G, et al. Intraoperative Electron Radiation Therapy (IOERT) in the management of locally recurrent rectal cancer. BMC Cancer. 2012;11(12):592.
28. NCCN. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines): rectal Cancer (Version 2.2021); 2021 [cited 2021 Oct 2]. Available from: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1461.
29. van den Brink M, Stiggelbout AM, van den Hout WB, et al. Clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision with or without preoperative radiotherapy. J Clin Oncol. 2004;22(19):3958–3964.
30. Asoglu O, Karanlik H, Muslumanoglu M, et al. Prognostic and predictive factors after surgical treatment for locally recurrent rectal cancer: a single institute experience. Eur J Surg Oncol. 2007;33(10):1199–1206.
31. Harris CA, Solomon MJ, Heriot AG, et al. The outcomes and patterns of treatment failure after surgery for locally recurrent rectal cancer. Ann Surg. 2016;264(2):323–329.
32. Wang Z-M, Chen -Y-Y, Chen -F-F, Wang S-Y, Xiong B. Peri-operative chemotherapy for patients with resectable colorectal hepatic metastasis: a meta-analysis. Eur J Surg Oncol. 2015;41(9):1197–1203.
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text:
CORBIN — Students honored during meeting
The Laurel County Board of Education recognized some of its best and brightest students at Monday’s regularly scheduled meeting.
Former Knox County attorney dies after battle with cancer
“He was one of the good ones.”
Curd named Promise Zone program coordinator
Corbin resident Sandi Curd received some good news this week — she has officially been named program coordinator for the federally-designated Kentucky Highlands Promise Zone.
Arrest made on sodomy indictments
Man dies in single-vehicle crash
One man was killed in a single-vehicle crash Sunday afternoon.
London-Corbin Airport to hold open house
More than 5,000 people are expected to converge on the London-Corbin Airport for its open house Saturday, according to airport manager Larry Corum.

domain: news


text:
President Obama’s minimum wage speech in Ann Arbor – it’s all about jobs, but not in the way he thinks
April 3, 2014
By SBAM President and CEO Rob Fowler
In his speech in Ann Arbor on April 2, the President said that “…Nobody who works full-time should be raising their family in poverty.” But his minimum wage policy goes backward from that goal by reducing opportunities for the poor to work.
It doesn’t matter what the minimum wage is if you don’t have a job.
SBAM continues to strongly oppose raising the minimum wage because it kills job opportunities and suppresses economic activity in Michigan’s communities. A minimum wage hike is a tax on employment that takes away job opportunities from workers who are trying to enter the workforce. It has a disproportional impact on small businesses that pay entry-level wages. Minimum wage increases, while perceived to help the working poor, will actually force small-business owners into the difficult choice of reducing hours or making lay-offs. Studies have shown that a five percent increase in the minimum wage leads to a loss of roughly 2.5 percent of all minimum-wage jobs.
Assisting the working poor is a serious issue that needs to be addressed from a tax policy and workforce development perspective, not by an ill-considered minimum wage increase that economically hurts small business owners and suppresses job growth.

domain: sociology


text:
Flight deals from St. Martin/St. Maarten to Moncton
When it comes to finding flight deals from St. Martin/St. Maarten to Moncton, there’s no better place to look than WestJet. We fly into more than 100 destinations in North America, Central America, the Caribbean and Europe — including Greater Moncton International Airport — which means we're able to take you wherever you want to go. One of our main priorities has always been to offer our guests superior experiences; with us that means safe, affordable travel. So start by checking out our flight deals today.
Low fare finder
Don't see what you're looking for? Find all of our great low fares in one place.
Your getaway to Hub City starts here
Airport Details: From SXM, Princess Juliana International Airport To YQM, Greater Moncton International Airport
Moncton is New Brunswick’s biggest city, and a great location for those looking to enjoy unspoiled nature and quaint cultural institutions. There’s something for everyone here, from the swanky 1920s-era Capitol Theatre to the HubCap Comedy Festival or the TreeGO’s aerial adventure course. Golfers and shoppers are often drawn here thanks to the area's numerous golf courses and nearby Champlain Place, which is the largest mall in all of Atlantic Canada.
If you need flight deals to one of the most dignified and history-laden destinations in New Brunswick, you know you can get there with WestJet. Enjoy swift, safe air travel from St. Martin/St. Maarten to Moncton with WestJet — and then get down to the serious business of enjoying the likes of Fort Beausejour, Magnetic Hill or Fundy National Park.

domain: geography


Excerpts from this story referencing "training":
"… de Center. What we used to do when we had a couple of spare minutes in our training session, we’d aim the airplane between the towers, or under the Golden G …"
"… ols set up video cameras inside simulators in order to record sessions for training purposes. But so far, no incriminating tapes have surfaced.“In many of t …"
"… n interviewed for this report knew of such a case.“Pilots can take their training anywhere; all it takes is money,” said Capt. Hal McNicol, who runs Fligh …"
"… lot and instrumentation licenses, which take a combined 300 hours worth of training. But they don’t necessarily check certification. “Their obligation is …"


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|Birth: ||Sep. 22, 1839|
|Death: ||Mar. 3, 1882|
OBITUARY - At his residence in Moulton, Iowa, on Friday, March 3, 1882 Capt. Nelson W. Edwards, of congestive chills.
He was born Sept. 22nd. 1839 in Macomb county, Mich. moved to Iowa near Council Bluffs in 1858 and enlisted in the 15th Iowa volunteer Inf't from that place in the fall of 1861 and served in that noble regiment to the end of the war, rising to the rank of Captain, and after his return home he was engaged in railroad building in north Mo. At Lineus, in 1870 he married Mrs. Pendleton, whose first husband was shot down on the streets of Lineus, during the war, by the Confederates. He moved to Moulton about the year 1871 and engaged in the business of carpenter and builders, and afterward was editor of the Moulton Record and did good service for the republican party, making it one of the best papers ever published in the county. His pen was a sharp lance in the local politics of the county, making the paper popular with all classes in the county. In the year 1876 he was admitted to the bar as a practicing attorney in this county and enjoyed a fair local practice. His wife and five children survive him, the oldest being ten years of age and the baby nine months old, his family has the sympathy of the whole community.
Adelia Frances Dryden Edwards (1838 - 1889)*
Irene Edwards (1857 - 1883)*
Harry Clifford Edwards (1873 - 1918)*
Clay McArthur Edwards (1881 - 1888)*
Created by: Burt
Record added: Apr 24, 2008
Find A Grave Memorial# 26336130

domain: history


text:
Timetric's "Erste Private Bank : Company Profile and SWOT Analysis" contains in depth information and data about the company and its operations. The profile contains a company overview, key facts, major products and services, SWOT analysis, business description, company history, financial analysis, recent developments, key employees as well as company locations and subsidiaries.
This report is a crucial resource for industry executives and anyone looking to access key information about "Erste Private Bank"
The report utilizes a wide range of primary and secondary sources, which are analyzed and presented in a consistent and easily accessible format. Timetric strictly follows a standardized research methodology to ensure high levels of data quality and these characteristics guarantee a unique report.
Examines and identifies key information and issues about "Erste Private Bank" for business intelligence requirements.
Studies and presents the company's strengths, weaknesses, opportunities (growth potential) and threats (competition). Strategic and operational business information is objectively reported.
The profile also contains information on business operations, company history, major products and services, key employees, and locations and subsidiaries.
Reasons To Buy
Quickly enhance your understanding of "Erste Private Bank"
Gain insight into the marketplace and a better understanding of internal and external factors which could impact the industry.
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Erste Private Bank (EPB) offers advisory services, discretionary portfolio management, investment funds, and treasury services. Advisory services comprises financial advisory, portfolio advisory, and investment advisory. Discretionary portfolio management includes setting up investment strategy and execution of strategy. Investment funds contains international equity and fixed income funds, ethical and substantial funds, equity and fixed income funds, asset allocation, fixed income management and investment solutions. Treasury services consist of bonds, structured products, derivatives, alternative investments, and interest and foreign exchange management. The bank offers its private banking services to high net worth individuals, wealthy clients, and institutional clients through branches and investment advisors in the Central and Eastern region of Europe. EPB is headquartered in Vienna, Austria.
1 Erste Private Bank - Business Analysis
1.1 Erste Private Bank - Company Overview
1.2 Erste Private Bank - Business Description
1.3 Erste Private Bank - Major Products and Services
2 Erste Private Bank - Recent Developments
3 Erste Private Bank - SWOT Analysis
3.1 Erste Private Bank - SWOT Analysis - Overview
3.2 Erste Private Bank - Strengths
3.3 Erste Private Bank - Weaknesses
3.4 Erste Private Bank - Opportunities
3.5 Erste Private Bank - Threats
4 Erste Private Bank - History
5 Erste Private Bank - Key Employees
6 Erste Private Bank - Locations and Subsidiaries
6.1 Erste Private Bank - Head Office
6.2 Erste Private Bank - Other Locations and Subsidiaries
Table 1: Erste Private Bank - Major Products and Services
Table 2: Erste Private Bank - History
Table 3: Erste Private Bank - Key Employees
Table 4: Erste Private Bank - Locations
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domain: finance


text:
communication between OSU Extension, industry, and regulatory agencies such as the Ohio Department of ...
Momentive and Ohio State Students Partner for Sustainability Study
Marquette, a division-level Global Sustainability Leader in Momentive. Said Marquette, “As Momentive began ...
Alumni Award and was lauded for his key role in developing ties between CFAES and Turkish institutions. ...
OARDC Eastern Agricultural Research Station 50-Year Celebration
Midwest Graduate Student Conference on Regional and Applied Economics (CRAE) Held at Ohio State on April 5th and 6th; Meeting was a Huge Success
important, and often complex, relationship between universities and agricultural producers in the regions ...
Farmers, Greenhouse Operators Invited to Natural Gas Workshop Jan. 14
the price differential between the fuel sources often makes natural gas an economical choice, ...
USDA Agricultural Economics Faculty Exchange Program Brings Ukrainian Researchers to Ohio State
Nataliia Gerasymenko these field trips have proved to be a highly successful component of the program: “A ...
200 (Wooster) Steve Culman Wednesday, February 22, 2017- 8:30am to 3:30pm ...
Miller lab intro
vegetables" grown on muck soils, including lettuce, radish, parsley and onion. Our program encompasses both ...
2010 American Phytopathological Society
A bacterial pathogen uses distinct type III secretion systems to alternate between host kingdoms. VALDIR R. ... of Rhizoctonia damping-off in lettuce. F. BAYSAL-GUREL, S. A. Miller. Relationship between grain ...

domain: agronomy


text:
Senior figures in Israeli Prime Minister Benjamin Netanyahu’s Likud party issued a call to stop unilateral legislation of the judicial overhaul.
According to Israel's Ynet news, the senior Likud members are urging Netanyahu to only proceed with the controversial reform through dialogue and consensus.
This development comes after the Reasonableness Standard Bill passed the Knesset vote on Monday, with all 64 coalition members voting in favor and the opposition boycotting the vote altogether.
The Israeli news website quoted an unnamed senior Likud official as saying that Justice Minister Yariv Levin should not lead unilateral legislation, as he intends to do in the Knesset’s winter session, which begins after the summer recess.
“Netanyahu understands that, too,” said the official. “All of the prime minister’s allies understand today that the reform had caused tremendous damage.”
The report added that some Likud ministers and Knesset members stressed that their party should not only focus on judicial reform while neglecting other policy issues. They claimed that it would hurt the party in the next elections.
Science and Technology Minister Ofir Akunis, a Likud party member, said in a radio interview, “On the behest of the prime minister, I say that the proceeding of the legislation will be with the aspiration to achieve a broad consensus. For that, you need the other side.”
Members of Netanyahu’s party also called on him to “disengage from Ben Gvir and all extreme elements of the coalition that are only harming the Likud,” the report added.
Tal Heinrich is a senior correspondent for both ALL ISRAEL NEWS and ALL ARAB NEWS. She is currently based in New York City. Tal also provides reports and analysis for Israeli Hebrew media Channel 14 News.


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A portion of the sale of each copy of Molly – A Love Story will go to support animal shelters in the Las Vegas area.
Illustrated by Evgeniya Kozhevnikova
“Molly: A Love Story is a heartwarming story of an abandoned dog finding love with her forever home and the joy that they bring to each other’s lives. This book also teaches young readers that the love of a lost pet will forever live on in their hearts through all their shared memories, while simultaneously supporting the worthy charity of animal shelters.” – Katie Specht, The Feathered Quill. For the full review, please visit https://featheredquill.com/molly-a-love-story/
Molly – A Love Story is a true story about a cute little Pit Bull, lost and alone in the world until one day she was rescued and given a home. Molly’s story teaches children about the unconditional love that a dog can bring into the lives of a family. As a cancer survivor, Molly overcame adversity, and her story shows that despite every hardship, true love is everlasting. Children and dog lovers of all ages will be touched by Molly’s story and that of her adopted brother Logan, a Siberian Husky who became her best friend. A portion of the sale of each copy of Molly – A Love Story will go to support animal shelters in the Las Vegas area.
Dana Brackob lives and works in Las Vegas. She was Molly’s real-life mom and wanted to share her story. Pit Bulls are often maligned, but Molly proved that they are one of the most loving types of dogs. The illustrator, Evgeniya Kozhevnikova, is a talented Russian artist living in Tomsk, Siberia. Her other illustrated books include The Life and Times of Fuzzy Wuzzy, also published by Histria Kids.
Imprint: Histria Kids
54 pp., 8.5 x 11 in
Date of Publication: April 6, 2021
Support animal shelters. dog stories.

domain: library