That’s where good equipment and training come in, so when WHEN happens, you’re prepared. Like a boy scout. Only more boss.
So let’s talk about being prepared. As an officer, I have made a concerted effort to carry some kind of tourniquet kit on my person for over ten years. Honestly, it hasn’t been easy to keep up with - mostly because technology has improved over the years, and we have been required to add more and more new gear to our duty belts (cameras, tasers, etc.). To make room, rarely used items, like bulky nylon tourniquet cases, got demoted from the belt to somewhere in the patrol vehicle. For a while, I rigged up a CAT (combat application tourniquet) on my duty belt with a complex system of rubber bands, but it was a pain in the ass and I didn’t have time to play MacGyver with it every time I took my equipment off.
I’ll be honest – I got lax about it and I frequently left it in the patrol car.
Then, a wake-up call: the Boston Marathon bombing.
An incident like that can (and should) get you thinking. What if? Would I have been prepared? Would I have been able to save a life? With my CAT way back there in the patrol car? Maybe… but maybe’s not good enough when someone’s bleeding out right in front of you.
After that introspection, the hunt was on. I needed a compact, easy to access, heavy-duty-yet-lightweight tourniquet case. Not there, but THERE for when I needed it.
Let's start with the material – Kydex. Lightweight, scratch proof, weatherproof – this essentially COP-PROOF material is what makes the Eleven 10 RIGID really hold up to the abuse of daily field wear.
But the best part about it is the size. The Eleven 10 RIGID is made specifically for a standard CAT, and is therefore only slightly larger than the tourniquet itself. The fit of the CAT in the RIGID is perfectly secure, and the compact size means it easily fits on a standard 2" duty belt.
And that brings me to the other really cool thing about the Eleven-10 RIGID.
You have the option to order it in several different carry systems – MOLLE, Tactical Tailor, Raven Concealment, and more. I ordered mine with the proven Blade-Tech TEKLOK system, which allows you to mount the equipment vertically or horizontally.
If you’re familiar with the Safariland ELS, you know the potential it gives you for instant versatility. Simply add a female connector to your belt, your bag, your vest, your whatever, and the male locking fork to your piece of equipment. In a matter of seconds and a quick squeeze, your gear can go from platform to platform.
center: Safariland single strap drop leg platform with QLS and ELS female plates
far right: Safariland Drop leg with 6004 holster and Eleven 10 RIGID attached
Big props to the team at Eleven 10 gear. (<-- Seriously, check them out)
Now, there’s no excuse for me to be without a tourniquet on my person.
I consider myself prepared.


On 3rd of October 2019, National Institute of R&D for Biological Sciences and Romanian Ministry of Research and Innovation organized the event ”SYNERGIES AND COLLABORATION OPPORTUNITIES IN ADVANCED RESEARCH FOR RIVER-SEA SYSTEMS”, held under the Romanian Presidency of EUSDR.
The main goal of the event was targeted considering both the European context of regional cooperation ensured by EUSDR and DANUBIUS-RI EFRI project, which is an EUSDR flagship project, and envisaged the exchange of good practice and identification of new collaboration opportunities for research of excellence in river-sea systems.
There was two main themes proposed:
1.Excellence in research – milestone action to ensure socio-economic progress which targeted subjects regarding research policies and steps to do in ensuring the synergies between regional, European and national research strategies in order to support sustainable energy, sustainable development while preserving/improving biodiversity and environmental quality
2.Danubius-RI role and contribution to regional and European development.
The audience was formed by academic representatives, invited lecturers being: Dr. Melania Gabriela Ciot – State Secretary, Romanian Ministry of External Affairs; Prof. Thomas Hein -University of Natural Resources and Life Sciences Vienna; Prof. Richard Preziosi – Manchester Metropolitan University, UK; Dr. Delia Dimitriu – Manchester Metropolitan University, UK;
Dr. Christos Arvanitidis, CEO LifeWatch ERIC , Spain; Dr. Davide Vignati- Université de Lorraine and CNRS, France; Prof. Andrew Tyler-University of Stirling, UK; Dr. Ekaterina Batchvarova-Bulgarian Academy of Sciences; Dr. Andreja Jonoski-IHE Delft Institute for Water Education, The Netherlands; Dr. Ioana Popescu- IHE Delft Institute for Water Education, The Netherlands; Prof. Lucian Georgescu-University “Dunarea de Jos” Galati; Dr. Adrian Stanica-National Institute of Marine Geology and Geoecology, GEOECOMAR (Romania); Dr. Manuela Elisabeta Sidoroff – National Institute of Research & Development for Biological Science.
Detailed event agenda here
At the end of event it was adopted a common declaration on “Biodiversity conservation, ecological and environmental quality”, see here


|Year : 2017 | Volume
| Issue : 3 | Page : 556-559
Primary neuroendocrine carcinoma of the thymus: A retrospective analysis from a regional cancer center in Western India
Sandeep Ramesh Kukkar, Harsha Panchal, Asha Anand
Department of Medical and Paediatric Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
|Date of Web Publication||24-May-2018|
Dr. Sandeep Ramesh Kukkar
Department of Medical and Paediatric Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat
Source of Support: None, Conflict of Interest: None
Primary neuroendocrine tumors of the thymus are unusual anterior mediastinal tumors with a variable prognosis. A retrospective analysis of five patients with primary neuroendocrine tumors of the thymus admitted to the Gujarat Cancer and Research Institute, Ahmedabad, between 2012 and 2016, was done to study the clinical profile and outcome of these patients. The role of various prognostic factors such as surgical resection, histological grade, and Masaoka-Koga staging was also analyzed. Majority of the patients present with signs and symptoms related to a rapidly expanding mediastinal mass, such as breathlessness, facial puffiness, edema over the neck and extremities, chest pain, and other features of superior vena cava (SVC) syndrome. Collateral venous dilatation over the neck and chest and edema over neck were the most common physical signs. All the patients enrolled in the study presented in advanced stages with a poor differentiation on histopathological examination. Thymic neuroendocrine tumors usually manifest as large, lobulated, and locally invasive anterior mediastinal masses surrounding the great vessels of the neck and thorax. None of the diagnosed patients underwent surgical resection in view of extensive vascular encasement in the neck and thorax, and all of them were started on platinum-based palliative chemotherapy. The median survival of the patients was 12 months with the longest survival of 16 months for one patient. Possibility of this potentially rare entity should be kept in mind when a patient presents with features of SVC syndrome and large mediastinal mass. Complete surgical resection of the tumor is prognostic of improved treatment outcome and long-term survival. Large tumor size could be a determinant of poor overall outcome, and tumor size should strongly be considered as a factor in the revised (NETT) Neuroendocrine tumours of thymus staging. Histological grade and Masaoka-Koga stage are the important prognostic factors, but this study emphasizes the utmost need to further validate the prognostic factors.
Keywords: Mediastinum, neuroendocrine carcinoma, thymus
|How to cite this article:|
Kukkar SR, Panchal H, Anand A. Primary neuroendocrine carcinoma of the thymus: A retrospective analysis from a regional cancer center in Western India. Indian J Cancer 2017;54:556-9
|How to cite this URL:|
Kukkar SR, Panchal H, Anand A. Primary neuroendocrine carcinoma of the thymus: A retrospective analysis from a regional cancer center in Western India. Indian J Cancer [serial online] 2017 [cited 2020 Feb 21];54:556-9. Available from: http://www.indianjcancer.com/text.asp?2017/54/3/556/233143
| » Introduction|| |
Thymomas are the most common mediastinal tumors while the neuroendocrine tumors of the thymus are extremely rare. These potentially rare tumors have a high propensity to develop distant metastasis even after long intervals. The possible origin of the tumor can be from ectopic tissues in the mediastinum or within the thymus itself.
The prognosis and treatment of primary neuroendocrine carcinomas of the thymus remain extremely variable. As per the World Health Organization (WHO) classification, neuroendocrine tumors are included in the thymic carcinoma group and are divided into two histopathological types: well-differentiated neuroendocrine carcinomas (typical and atypical carcinoid) and poorly differentiated neuroendocrine carcinomas (small-cell carcinoma and large-cell neuroendocrine carcinoma). The well-differentiated neuroendocrine carcinomas are low grade and biologically less aggressive, whereas poorly differentiated neuroendocrine carcinomas are high-grade tumors. We carried out a retrospective analysis of five patients to study the clinical profile, associated prognostic factors, and outcome of patients with primary neuroendocrine tumors of the thymus.
| » Patient Characteristics|| |
This retrospective analysis was conducted at the Gujarat Cancer and Research Institute, Ahmedabad, after obtaining approval from the Institutional Ethics Committee. The total of five patients diagnosed as primary neuroendocrine tumors of the thymus, who were treated at the Gujarat Cancer and Research Institute, Ahmedabad, between 2012 and 2016, were included in this study. The patients were staged according to the Masaoka-Koga system, and the histological type was determined according to the 2004 WHO classification.
| » Results|| |
The baseline clinical characteristics of the enrolled patients are summarized in [Table 1]. Of the total five patients enrolled in the present study, three were males and two were females, with a median age of 61.6 years. Majority of the patients presented in the advanced stages with Stage 4 patients accounting for 80% (n = 4) of the total cases. As per the WHO criteria, all the patients (n = 5) had poorly differentiated tumors on histopathological examination. The majority of the patients presented with large mediastinal masses encasing the great vessels of neck and thorax with a mean tumor size of 9.2 cm in the longest dimension. The summary of clinic-pathologic features and treatment outcome of the enrolled patients is depicted in [Table 2].
|Table 2: Summary of clinicopathologic features and treatment outcome in 5 patients with thymic neuroendocrine tumor|
Click here to view
The presenting symptoms and signs of our study patients are depicted in [Table 3] and [Table 4], respectively. Majority of the patients presented with symptoms of neck swelling, dyspnea, swelling of the upper extremities, and facial puffiness. Other common symptoms included dysphagia, stridor, bone pains, and weight loss. Collateral venous dilation over the neck and chest and edema over neck were the most common physical signs in this study.
As majority of the patients presented in the advanced stages, these patients did not undergo surgical resection and were started on palliative chemotherapy. Carboplatin with etoposide was the most common chemotherapy regimen used in the enrolled patients. The median survival of the patients in the study was 12 months with the longest survival of 16 months in one patient.
Patients were asked to follow-up every 2–3 months after the completion of palliative chemotherapy. The patients underwent detailed clinical examinations and interim thoracic and abdominal computed tomography (CT) scans to look for possible disease progression.
| » Discussion|| |
Primary neuroendocrine tumors of the thymus, previously classified as carcinoid tumors, are a distinct clinicopathological entity accounting for <5% of all anterior mediastinal neoplasms. Rosai and Higa first described primary neuroendocrine tumors of the thymus in 1972. Only very few single case reports and short series of cases have been reported in the literature so far. Earlier, the term mediastinal carcinoids was coined for these tumors, and later on, the term neuroendocrinoma was suggested for these tumors. However, the term thymic carcinoid tumor is most commonly used for these tumors. Moran and Suster proposed the designation of thymic neuroendocrine carcinoma for this family of tumors as these tumors are aggressive in behavior as compared to their foregut counterparts.
The median age at diagnosis ranges between 40 and 60 years with a slightly male predominance, which is consistent with the findings of our study. The median age in our study population was 61.6 years with males accounting for 60% of the study group.
The neuroendocrine tumors of thymus were earlier classified into four distinct types – typical carcinoid, atypical carcinoid, large-cell neuroendocrine carcinoma, and small-cell carcinoma, quite similar to the classification used for lung neuroendocrine tumors. Majority of the patients in our study were diagnosed as small-cell carcinoma.
Thymic neuroendocrine carcinomas may have a varied presentation, but usually, these tumors present in four different ways: (i) incidentally detected on routine chest radiography, (ii) they may present with symptoms of thoracic structure displacement or compression like superior vena cava (SVC) syndrome, (iii) they may present with symptoms related to an associated endocrine abnormalities due to secretion by the thymic carcinoid, or (iv) symptoms related to a distant metastasis, most commonly to the liver, lung, pleura, and bone.
Approximately over one-third of patients are asymptomatic and are incidentally discovered. Majority of the patients present with signs and symptoms related to a rapidly expanding mediastinal mass, such as breathlessness, facial puffiness, edema over the neck and extremities, chest pain, and other features of SVC syndrome. Distant metastasis is seen in at least 20% of affected patients at presentation, while the frequency of extrathoracic metastasis may be as high as 20%–30%. In this study, majority of the patients presented in advanced stages with symptoms either arising from compression of SVC or the symptoms related to distant metastasis. None of the patients in our study had symptoms related to endocrine abnormalities.
On the histopathological basis, the thymic neuroendocrine carcinomas have been classified into three different types: low-grade (well-differentiated), intermediate-grade (moderately differentiated), and high-grade (poorly differentiated) tumors. Most tumors of thymic origin fall into the category of well-differentiated neuroendocrine carcinomas. Moran and Suster  in their report of 80 cases concluded that almost 36% of the cases had low-grade tumors, 45% had intermediate grade, whereas only 19% had high-grade poorly differentiated tumor. In contrast, all the patients in our study had high-grade poorly differentiated carcinomas. Immunohistochemical studies were carried out in all cases with markers such as chromogranin, neuron-specific enolase, bombesin, and synaptophysin to characterize these lesions.
Thymic neuroendocrine tumors usually manifest as large, lobulated, and locally invasive anterior mediastinal masses with areas of hemorrhage and necrosis. It is often difficult to distinguish them from thymomas on plain chest radiograms, but they are usually larger compared to thymomas. CT scan images show a heterogeneously enhancing large lobulated thymic mass with central areas of low attenuation secondary to necrosis or hemorrhage. The most common differential diagnosis for these lesions includes other primary mediastinal tumors, mainly thymoma and lymphoma. Other rare differentials are paraganglioma, parathyroid adenoma or carcinoma, and medullary carcinoma of the thyroid arising in mediastinal location. Thymoma, particularly of the spindle cell variety, is the most important and difficult differential diagnosis as they often exhibit foci with neuroendocrine appearance.
Primary neuroendocrine tumors of the thymus are a group of highly aggressive neoplasms where majority of patients usually die as a result of locally invasive or distant metastatic disease. Management of these tumors is often difficult and challenging as the tumors present in advanced stages. Complete surgical resection of the tumor remains the gold standard treatment for the management of thymic tumors compared to nonsurgical options, showing a statistically significant better survival as per the Surveillance, Epidemiology, and End Results (SEER) database analysis. Surgery involves extended resections with en bloc excision of the tumor together with the pericardium, pleura, or great vessels (or a combination).
Preoperatively and postoperatively, radiotherapy should be considered, particularly in patients with capsular invasion, because the biological behavior of these tumors is uncertain and these tumors tend to recur even after long treatment-free intervals. Overall, the role of adjuvant radiation therapy and chemotherapy is still controversial and both the modalities have been used with variable success. Chemotherapeutic agents such as 5-fluorouracil, streptozocin, carmustine, VP-16, cisplatin, and others have been used either as single agents or in combination for the management of these tumors.
The median survival in our study was 12 months with the longest survival of 16 months seen in one patient. Fukai et al. in their case series of 15 patients reported a 5-year survival rate of 33%, whereas the 5-year survival rate of 31% was reported by de Montpréville et al. in their study. High propensity for local recurrence and metastatic disease after surgical excision accounts for the poor prognosis of these patients. The possible reason for shorter median overall survival in our study could be that majority of the patients in our study presented had extensive tumor infiltrations in and around the great vessels of thorax and pericardium; therefore, complete resection of the tumor was not possible.
Overall, the histological grade, Masaoka-Koga stage, and surgical resection status have been identified as important prognostic factors, but their use remains controversial. Masaoka-Koga stage remains an important determinant of outcome as patients with Stage III and IV show a poor prognosis compared to Stage I and II patients. Similarly, Detterbeck et al. emphasized the prognostic value of tumor stage and complete surgical resection, but the prognostic impact of histologic classification and tumor size remained unclear. In the present study, majority of the patients had surgically unresectable high-grade tumors and were associated with a poor prognosis. Cardillo et al. reported tumor size as the single most important and statistically significant prognostic factor for thymic neuroendocrine tumors. A large number of patients in our study presented with tumor size >9 cm which is greater than the median cutoff reported in the SEER study. Therefore, large tumor size could be a determinant of poor overall outcome and tumor size should strongly be considered as a factor in the revised NETT staging.
The major limitations of the present study are as follows: this analysis is retrospective in nature and the study group was obtained from a single institution. However, the results of the current study are still meaningful as the disease is extremely rare.
| » Conclusion|| |
- Possibility of this potentially rare entity should be kept in mind when a patient presents with features of SVC syndrome and mediastinal mass.
- Majority of the patients present with signs and symptoms related to a rapidly expanding mediastinal mass and the classical features of SVC syndrome.
- Majority of the patients had high-grade tumors and presented in the advanced stages.
- Complete surgical resection of the tumor is prognostic of improved treatment outcome and long-term survival.
- Large tumor size could be a determinant of poor overall outcome and tumor size should strongly be considered as a factor in the revised NETT staging.
- The histological grade and Masaoka-Koga stage are the important prognostic factors, but this study emphasizes the utmost need to further validate the prognostic factors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
de Montpréville VT, Macchiarini P, Dulmet E. Thymic neuroendocrine carcinoma (carcinoid): A clinicopathologic study of fourteen cases. J Thorac Cardiovasc Surg 1996;111:134-41.
Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC. editors. WHO Classification of Tumors: Pathology & Genetics of Tumors of the Lung, Pleura, Thymus and Heart. Lyon: IARC Press; 2004. p. 145-7.
Koga K, Matsuno Y, Noguchi M, Mukai K, Asamura H, Goya T, et al.
Areview of 79 thymomas: Modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int 1994;44:359-67.
Chaer R, Massad MG, Evans A, Snow NJ, Geha AS. Primary neuroendocrine tumors of the thymus. Ann Thorac Surg 2002;74:1733-40.
Rosai J, Higa E. Mediastinal endocrine neoplasm, of probable thymic origin, related to carcinoid tumor. Clinicopathologic study of 8 cases. Cancer 1972;29:1061-74.
Gould VE. Neuroendocrinomas and neuroendocrine carcinomas: APUD cell system neoplasms and their aberrant secretory activities. Pathol Annu 1977;12 Pt 2:33-62.
Moran CA, Suster S. Neuroendocrine carcinomas (carcinoid tumor) of the thymus. A clinicopathologic analysis of 80 cases. Am J Clin Pathol 2000;114:100-10.
Arora R, Gupta R, Sharma A, Dinda AK. Primary neuroendocrine carcinoma of thymus: A rare cause of Cushing's syndrome. Indian J Pathol Microbiol 2010;53:148-51.
] [Full text]
Economopoulos GC, Lewis JW Jr, Lee MW, Silverman NA. Carcinoid tumors of the thymus. Ann Thorac Surg 1990;50:58-61.
Teh BT. Thymic carcinoids in multiple endocrine neoplasia type 1. J Intern Med 1998;243:501-4.
Gaur P, Leary C, Yao JC. Thymic neuroendocrine tumors: A SEER database analysis of 160 patients. Ann Surg 2010;251:1117-21.
Kvols LK. Therapy of the malignant carcinoid syndrome. Endocrinol Metab Clin North Am 1989;18:557-68.
Wang DY, Chang DB, Kuo SH, Yang PC, Lee YC, Hsu HC, et al.
Carcinoid tumours of the thymus. Thorax 1994;49:357-60.
Fukai I, Masaoka A, Fujii Y, Yamakawa Y, Yokoyama T, Murase T, et al.
Thymic neuroendocrine tumor (thymic carcinoid): A clinicopathologic study in 15 patients. Ann Thorac Surg 1999;67:208-11.
Detterbeck F, Youssef S, Ruffini E, Okumura M. A review of prognostic factors in thymic malignancies. J Thorac Oncol 2011;6 7 Suppl 3:S1698-704.
Cardillo G, Rea F, Lucchi M, Paul MA, Margaritora S, Carleo F, et al.
Primary neuroendocrine tumors of the thymus: A multicenter experience of 35 patients. Ann Thorac Surg 2012;94:241-5.
[Table 1], [Table 2], [Table 3], [Table 4]


WHO ERIK HOLAND
WEAR khaki / military green button on shirt, biker jacket, silver masculine rings, Ray-ban Wayfarer sunglasses
WHAT Mercedes-Benz Fashion Week Sydney 2016
WHEN May 2016
STYLE smart casual
Photo by Bloggers Boyfriend
Click below to read the rest of the post.
It’s so great to finally catch up with Shaun today when we both happened to be in Sydney at the same time, here’s some photos I taken of him out of Central Park and the Old Clare Hotel. Check out his Instagram here.
Here are very limited a few photos i took for Matthew Lozzi ( Wink Models Sydney ) a month ago
Can’t wait to share more with you guys very soon !
I am so excited to collab with Nina in Brisbane this coming weekend! Sunny and beautiful water city brisbane surely is ! here is just a simple photo i took on our business trip to the fortitude valley!
All the outfits and instagrams coming soon this sunday !
If you are visiting Brisbane for a holiday, you may think that Southbank is beautiful, the river is nice, and the food in newstead is cool. But for people working in brisbane, the best wish will be the weather won’t go like the weather in Melbourne. but rather than that, there is much to expect when you are walking in the valley or spring hill. We luckily passed by this little local church just between 4000 and 4006.
Let me know if you know any really coooool brisbane spots so I can put in my next time’s travel agenda.
While Nina and i surely will take the ferry from Brisbane river and have some vintage hunting in paddington. ( not the Padding in Sydney ! )
Keep tuned for our coming sunday Brisbane shooting and travelling!
Good night !


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From the psychiatrist who'd never take anti-depressants, to the heart doctor who steers clear of statins, we reveal the medical treatments the experts REFUSE to have themselves
- Leading doctors and researchers reveal what they would personally avoid
- Many surprising comments go against the established view
Ask your doctor is: 'What would you do?'
When faced with a worrying diagnosis, invasive procedure or risky operation, probably the smartest question you can ask your doctor is: 'What would you do?'
With years of experience, they know better than anyone which treatments and tests are worth having - and which are better avoided.
So here, leading doctors and researchers reveal what they would personally avoid, many of which go against the established view. Their comments may surprise and enlighten you...
Psychiatrist who'd never take anti-depressants
Dr Joanna Moncrieff, senior lecturer in psychiatry at University College London and author of The Myth Of The Chemical Cure.
I've been practising psychiatry for 20 years, and in my experience antidepressants don't do any good at all. I wouldn't take them under any circumstances - not even if I were suicidal.
All the research shows is that, at best, antidepressants make people feel a tiny bit better than a placebo. But this doesn't mean they actually treat depression.
After all these years of brain scanning, we don't even have evidence that depression is related to a chemical imbalance in the brain, so the whole idea that we can treat it chemically is questionable.
I believe depression is an extreme reaction to our circumstances, and the best way to recover from it is to work out the cause.
Sometimes that means talking therapies and sometimes it means changing your circumstances, such as getting a new job or addressing relationship problems.
There are, of course, some people who are depressed for no apparent reason, but there is still no evidence they suffer from a brain disease or that antidepressants can help. It's still better to try and find new things and break the cycle of thoughts and behaviour.
Antidepressants are psychoactive drugs -they alter the mind, like cannabis or alcohol, and I've always thought that were I depressed, I'd want to have all my faculties to get me out of the rut - not be clouded by a drug whose effects we don't really understand.
Weight-loss GP who wouldn't go on a diet
Dr Ian Campbell, GP and founder of Bodylibrium, a weight-loss programme.
'All the evidence is that diets rarely work long term' (posed by model)
All the evidence is that diets rarely work long term.
I've been working with people to help them lose weight for decades and my experience has shown me that the only way to achieve long-term success is through asking: 'Why?' - why do we comfort eat, why do we prefer fatty foods, why do we drink too much alcohol and why do we find physical activity unattractive?
Techniques based on changing behaviour (similar to cognitive behavioural therapy), combined with strategies such as keeping a food diary and setting realistic goals, are what really help people lose weight effectively.
Diets which encourage polarised approaches, such as low-carb, 5:2 diets or any other 'reductionist' approaches, will only ever achieve short-term success - you'll regain the weight you lost.
Heart doctor who refuses to have statins
Professor Kevin Channer, consultant cardiologist at Claremont Hospital, Sheffield.
Statins have had a huge effect in reducing the number of strokes and heart attacks and there's now a movement to give these cholesterol-lowering tablets to everyone.
But I wouldn't take one unless I had proof I was at significant risk.
Whenever you're taking a drug, you've got to think about the risks and the benefits.
Statins reduce your chance of heart attack or stroke by about 30 per cent, so, yes, there's a benefit. But in real terms it's very small.
As a 60-year-old, healthy, non-smoking man, statistically my annual risk of a stroke or heart attack is about 1 per cent - very low. Taking a statin would take it down to 0.7 per cent - still very low. And I've spent my professional life prescribing statins, so I know about the side-effects: muscle aches, general debility and stomach upsets.
Some say statins should be given when the risk is 1.5 per cent, but I personally wouldn't consider taking the drug unless my risk was 3 per cent.
Anyone who's had a stroke or heart attack has a risk of about 3 per cent and for them the pain is definitely worth the gain.
On the other hand, I would - and do - take blood pressure-lowering medication, even though my reading is currently borderline.
That's because, as a cardiologist, I know that as I get older it will only get higher, and studies show that the lower your blood pressure, the longer you live.
Some of the older treatments caused side-effects, but I'm on one of the newer ones called an angiotensin receptor blocker, and I'm not having any problems.
Former GP who says vitamin C is pointless
'Vitamin C probably doesn't cut short colds'
George Lewith, professor of health research at the University of Southampton and a former GP.
what many patients say, vitamin C probably doesn't cut short colds. It
probably won't do you any harm and it won't break the bank, but on the
whole the evidence is pretty limited.
There's also no evidence that it staves off colds. If you have a good diet, with plenty of vitamin C from fruit and veg, your immune system will protect you as far as possible. But those supplements containing 500 per cent of your recommended daily amount (RDA) are a waste of time.
Echinacea, on the other hand, does have some pretty positive evidence to show it may shorten the
length of a cold.
There's also some intriguing evidence around the plant extract perlargonium - that's what I take when I have a cold.
Prostate expert who won't have PSA test
Richard Ablin, professor of pathology at the University of Arizona College of Medicine.
I discovered the prostate specific antigen (PSA) in 1970, we soon
realised it could be hugely helpful to prostate cancer patients.
The protein is specific to the prostate gland - it's not found in any significant amount in any other organ. So if a man with prostate cancer had his prostate removed, our discovery meant we could measure his PSA afterwards to see if there was cancer remaining which hadn't been detected.
However, the PSA test began to be used to diagnose prostate cancer. This was a huge mistake.
PSA is not cancer-specific - it's simply a protein produced by the
prostate, so a high level can just mean a man has prostatitis (an
infection) or an enlarged prostate - sometimes troublesome but benign.
Also, 'normal' PSA levels vary dramatically from one man to the next: there's no threshold at which point we can reliably diagnose cancer. The test also cannot differentiate between a slow-growing 'pussycat' prostate cancer and an aggressive 'tiger' cancer. It's about as effective as a coin toss.
Nevertheless, it was taken up as a way to check for prostate cancer and, as a result, millions of men have been overtreated, often with unnecessary, highly debilitating side-effects. I would have a PSA test only after treatment for prostate cancer, or if I was at risk of the disease (for example because of family history), and was using it in combination with other tests, such as digital rectal examination, to diagnose it.
Health professor who says exercising isn't enough
Jack Winkler, public health expert and former professor of nutrition policy at London Metropolitan University.
To lose weight, you need to burn off more calories than you're taking in = reduce the amount you eat
Exercise can prevent you gaining weight if you overeat a bit. But if you're overweight, I'm afraid it won't be nearly enough.
That 300-calorie sandwich you had for lunch? You'd have to swim for more than an hour to compensate.
To lose weight, you need to burn off more calories than you're taking in, and the only way to do that is to reduce the amount you eat - that is the real essential.
Combining this with exercise is a good idea, as there are lots of other benefits to exercise.
Orthopaedic surgeon who'd avoid X-rays
Chris Walker, orthopaedic surgeon at Liverpool Bone and Joint Centre.
Too often, patients see their doctor about stiffness, aches and pains, wanting something to be done. The doctor sends them for an X-ray, which may or may not show a bit of wear and tear, and tells them they have arthritis.
As soon as they get that diagnosis, people tend to lose control and become victims. They take anti-inflammatories (which can have gastrointestinal side-effects), feel frightened to exercise and generally become miserable.
That's why, as long as I didn't have red-flag symptoms of severe arthritis - such as constant pain, or pain that comes on at night - I would avoid an X-ray.
Most of us will have a little wear and tear on the joints as we age, and actually the best thing to do is get out and about and keep moving.
Joints love movement - what does them harm is running and jumping. But anything like walking, swimming and cycling will actually reduce pain and stiffness and slow the onset of the arthritis.
By keeping active, you'll lose weight - which will help enormously - and you won't get depressed because you'll be too busy getting on with life.
'As soon as they get that diagnosis, people tend to lose control and become victims'
Hip specialist who says forget mid-life marathons
Jeremy Latham, orthopaedic surgeon with a special interest in hip surgery, at University Hospital Southampton.
This is partly because I'm bone-idle. But I regularly see patients in their 40s and 50s who have wrecked their joints because they had a mid-life crisis and decided to run a marathon or do a triathlon.
It's an interesting conundrum because on one hand there's good evidence that running can be good for joint health. But if you're going in cold, with no history of previous athleticism, there's a risk you'll accelerate any underlying wear and tear on your knees, ankles and hips.
If you hit middle age and decide you want to lose weight and get fit, I'd suggest walking, swimming or cycling, which are gentler on the joints.
I've got a rowing machine which I use two to three times a week - it's a great workout for the heart and is good for the upper and lower body, without overly stressing the joints.
Dietitian who won't eat reduced-fat food
Helen Bond, dietitian.
I steer clear of foods labelled 'reduced fat' and wouldn't give them to my children either. The label can be really misleading.
A reduced-fat mayonnaise or cheddar, for example, is still going to be pretty high in fat, it's just lower in fat that its previous incarnation.
A 'light' McVitie's chocolate digestive has 78 calories, compared with 86 in the standard version - a difference of only eight calories.
I eat low-fat or fat-free products, such as yoghurt, but with reduced-fat foods it's worth checking the label to see what the fat has been substituted with - often it's sugar to compensate for the loss of flavour.
Asthma professor who wants to cut inhaler use
Mike Thomas, professor of primary care research, specialising in respiratory medicine and asthma care, at the University of Southampton.
A lot of people become overly reliant on their rescue inhalers - using them every day can increase risks
A lot of people become overly reliant on their rescue inhalers, so feel out of control when they don't have them to hand. Using them every day can increase the risk of serious attacks, and side‑effects of high doses of steroids can include bone-thinning, easy bruising and increased risk of diabetes and high blood pressure.
So rather than allowing people to become reliant on their inhalers, I'm currently working on a government study looking at how simple breathing exercises and controlling anxiety can improve asthma control.
Patients find asthma episodes less stressful and so are less likely to reach for their inhaler. If I had asthma, I would learn how to self-manage; it brings patients a better quality of life and can help them reduce the drugs they are taking.
Obstetrician who would not give birth at home
Moneli Golara, obstetrician, Barnet Hospital.
I think your first pregnancy is a 'test', and generally, if you pass it, you know the likelihood of any problems second time round are very low.
There are certain conditions, such as pre-eclampsia (dangerously high blood pressure), that can occur mainly in a first pregnancy, and these may only show themselves during labour.
These are rare, but for this reason, I would never have my first child at home. I'd personally choose to be in a setting where there is access to medical intervention if needed.
Sport scientist who thinks long workouts are pointless
Stuart Phillips, professor of sport and exercise at Loughborough University.
As A young man I played rugby and ice-hockey and went running regularly. I used to be a bit sanctimonious and say that a workout was only worth doing if it was at least an hour long and you were drenched in sweat at the end.
Now if I spend longer than an hour exercising I think it's a waste of time - the data shows that shorter bouts of activity, such as ten minutes of intense exercise, are just as beneficial.
I study both the psychological and physical benefits of exercise and the incremental benefit you gain from going longer than an hour is pretty marginal.
Sleep specialist who won't take sleeping pills
Sleeping pills weaken your trust in your own natural ability to drop off
Dr Guy Meadows, sleep specialist and founder of The Sleep School.
pills weaken your trust in your own natural ability to drop off, and
can end up causing physical and psychological dependency.
You start to think 'I won't be able to sleep unless I take a pill.' The body then starts to expect the sedative to be in the system.
In turn, you run the risk of having rebound insomnia when you're coming off them, which explains why so many people struggle to ditch sleeping pills.
can include dizziness, headaches, memory loss and feeling groggy.
Recent research has also shown that sleeping medication is associated
with more than a fourfold risk of death. For me, these greatly outweigh
the benefits. Research suggests that sleeping tablets provide as little
as 20 or 30 minutes' extra sleep.
And the sleep these drugs do provide is not natural or refreshing. That's because they alter your 'sleep architecture' - limiting the amount of deep, or rapid eye movement, sleep, which we need to wake up feeling refreshed.
certain instances, when people are experiencing excessive sleep
deprivation as a result of a serious trauma, sleeping pills can provide
that essential release.
Surgeon who says avoid steroid jabs in your feet
Andy Goldberg, orthopaedic surgeon at the Wellington Hospital, London.
One of the most common reasons people visit their GP is for heel and foot pain, and an often-used treatment is a steroid injection to reduce inflammation.
It's the bane of my professional life. If an injection goes into or near a tendon, it can cause the tendon to rupture, which can lead to weak or flat feet. And if the steroid goes into the wrong place, it can lead to damage to the fat pad under the heel, which normally absorbs the shock when we run and jump.
If the fat pad is damaged then the patient walks on their heel bone without protection. It hurts like hell and there is virtually no treatment.
If a patient comes to see me with this, my heart sinks.
There are, of course, some times when a steroid can be useful, for example for treating inflammation of arthritic joints. But I would have it only if it were done under ultrasound guidance by a trained radiologist.
Most heel and foot pain can be helped with stretching, changing your footwear or resting. Often, steroids should be the final resort.
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Australian teen Feliks Zemdegs solved the notoriously tough puzzle in just 7.36 seconds.
The 17-year-old was taking part in the 2013 Rubik's Cube World Championship when he scored a fastest average time of 8.18 seconds for solving the classic 3x3 cube, with a fastest single solve of 7.36 seconds, as well as winning the 4x4 and the One Handed 3x3 competitions.
The event, held at the Riviera Hotel & Casino in Las Vegas, saw Cube solvers from all over the world attempt at outdoing each other in the mind-boggling contest.
And Zemdeg's 7.36 seconds is not even close to the world record.
“Other events at the Championship included solving the Rubik's Cube blindfolded and using feet”
Dutchman Mats Valk holds the world record for the fastest single solve at an incredible 5.55 SECONDS.
Other events at the Championship include solving the Rubik's Cube blindfolded and with FEET.
Quite how they discovered they could do any of that is anyone's guess...


Medical School Accreditation
In the United States, the accreditation status of programs leading to the MD degree is determined solely by the Liaison Committee on Medical Education (LCME). In cooperation with the Committee on Accreditation of Canadian Medical Schools (CACMS), the LCME also accredits MD programs in Canada. LCME accreditation is a voluntary, peer-review process of quality assurance. Jointly funded by the Association of American Medical Colleges and the American Medical Association, the LCME reviews the 135 US and 17 Canadian medical schools it accredits every eight years.
Accreditation seeks to answer three key questions:
1. Has the medical education program clearly established its mission and institutional learning objectives?
2. Are the medical education program’s curriculum and resources organized to meet its mission and objectives?
3. What is the evidence that the medical education program is currently achieving its mission and objectives and is likely to continue to meet them in the future?
IU School of Medicine first received LCME accreditation during World War II. To become and stay accredited, medical school education programs must meet the national standards described in the document, Functions and Structure of a Medical School. IU School of Medicine’s most recent reaccreditation site visit concluded April 23, 2017. The LCME has notified the school of its full-reaccreditation status through 2024-2025.
- Will Indiana University School of Medicine make tuition free?
- 5 takeaways from Dean Hess’ presentation to the IU Board of Trustees
- Direct from the Dean: Let’s start a conversation
- Meet Elizabeth Ryan, EdD, the new Northwest-Gary campus director
- We should be proud of our accomplishments and confident about the future
- Meet Sarah Wingfield, IU School of Medicine’s new chief of staff


If you're a follower of Japanese organising consultant Marie Kondo, you'll know what she says about the letters, postcards, invitations and magazine clippings that tend to multiply inside the home of the sentimental collector.
"My basic principle for sorting papers is to throw them all away," Kondo wrote in her best-selling book, The Life-Changing Magic of Tidying: A Simple, Effective Way to Banish Clutter Forever.
"They will never inspire joy, no matter how carefully you keep them."
But if Kondo is the patron saint of decluttering, Melbourne's Katrina Lolicato is a heretic.
At the Foundling Archive in Brunswick East, where she is the program coordinator, she has helped collect 8,000 items: photographs, letters, home videos, old format film footage, and other personal documents dating back to the 1800s.
They're not her own, of course — they were tossed aside by their original owners. But the archive reluctantly cares for them, as part of a public mission to get people to fully appreciate the things they own and the stories they tell.
"We're not asking anybody else to be interested in your postcards or letters — we're asking you to be interested in your postcards or letters," Ms Lolicato told The Drawing Room.
"We're asking you to create the same kind of value ... you might see when you see a nice building out in the street or when you see a Greek vase or a painting in a museum or a gallery.
"If we give these objects of our own everyday experience and of our ancestors' the same reverence, we're able to use them as communication, we're able to use them as mechanisms for placing yourself through time and space."
The Foundling Archive was set up by Katrina Lolicato and her sister Gracie — unashamed collectors of "all things sentimental and nostalgic".
Ms Lolicato said they began by buying the personal items they saw in second-hand stores or on eBay.
"I thought, 'You can't get rid of this! Surely it must have a meaning somewhere,'" she said.
"Beyond that, we've started acquiring collections through people coming in contact with us.
"They no longer see the relevance in what they've acquired through somebody's passing or moving into a house and finding a stash under the floorboards or wherever.
"I think that somewhere they see that they would rather not throw it in the garbage."
A family situated in Australian society
Ms Lolicato's favourite collection covers three generations of men, each named George Argo Turner, who each served in the military. The oldest fought on the western front in the First World War; his son fought in the Second World War, and his grandson in Vietnam.
"We see media clippings, we see letters, training schedules from Puckapunyal, and all these amazing documents that they would have just thrown in a drawer," she said.
"It really situates this family over nearly a century in Australian society — not just on a fun, celebratory level, but also politically."
Ms Lolicato believes each of us can have a similar experience with those things we have accumulated throughout our lives.
"The most precious thing that you have could be your granddad's cap, or it could be a sugar bowl, or it could be a photograph, it could be a letter," she said.
"These objects place you in society, through time, in history, and on the Australian landscape. They enable you to ground yourself in where you're at, and position yourself so that you're better equipped to have empathy for other people.
"Through our projects, we remind people of their mortality and their positioning in time — and that they are a blip on the continuation of human existence."
Love of collecting linked to migrant history
For Daniella Trimboli, a researcher in diasporic cultures and digital storytelling, the exciting thing about the Foundling Archive is the way it extends Australia's immigration story beyond the dominant narrative.
"These more everyday things enable us to see the complexities and differences that people actually experience in their day-to-day lives, that we wouldn't normally get an insight into," she said.
"It's not 'you settle and you live a happy life'. It's actually back and forth, memories and reconnections, new connections with other migrants and your community here."
Ms Lolicato said her own love of collecting was linked to her background as a member of the Italian diaspora.
"When you don't have a longstanding history of being on the Australian landscape, when your family has come from somewhere else, what happens is they bring these trinkets with them," she said.
"In the pre-digital age, when people were sending things through mail, the photographs and the letters that you got were so precious.
"I think that I always felt a sense of reverence or respect or authority for those trinkets and other pieces of paper and photography because they were always discussed with me as something that represented something greater than the bit of paper they were written on."
Digital age puts old artefacts in new context
But the digital age puts these trinkets into a new context. Though you can still buy postcards, many families keep in touch by posting their holiday photos on Facebook instead. Home videos are more likely to exist in the cloud than on a VHS tape gathering dust on the mantelpiece.
"Those time and space divides that made those objects so precious — we don't have that; we can connect immediately," Ms Lolicato said.
"We place different meanings now on those kinds of objects and those interactions as well."
Dr Trimboli said it enables new kinds of stories to be heard. And outside of the big capital city museums, a more nuanced story of Australian migration and multiculturalism can emerge.
"When you start looking at the way that other people are taking on digital forms and creating their own kinds of stories, really interesting things start to happen," she said.
"You pick up on all these other things that you didn't hear about before, and also it allows for different kinds of connections as well, because people find this space where they can relate to something that someone else has shared.
"It just allows for a different kind of mediation that's not often seen through these bigger institutions."
Listen to the full interview with Katrina Lolicato and Daniella Trimboli on The Drawing Room at 7:15pm on RN, or subscribe to the podcast on iTunes, the ABC Radio app or your favourite podcasting app to listen later.


You can read 19 more articles this month
UNITE called on gig-economy retail fat cat Mike Ashley today to stop gambling with workers’ jobs after he passed the blame for further closures of House of Fraser branches onto landlords.
The owner of Sports Direct and Newcastle United, who recently bought the department store chain for £90 million when it was on the brink of going into administration, blamed “greedy landlords” for not giving him the prices he had demanded during negotiations this month.
Those talks have lead to some seven House of Fraser shops being saved from closure, including branches in Telford, Plymouth and London.
However, Mr Ashley warned that “time is running out” for the remainder of the company’s 59 shops, whose future remains unclear. He has pledged to save about 47 of them.
A company spokesman said: “Some landlords are being very collaborative in order to give us a chance at turning the business around, giving House of Fraser a lifeline and saving hundreds of jobs.
“However, some greedy landlords would rather see the stores close than help save the jobs of hundreds of people.
“We will continue to try and convince these landlords, but ultimately time is running out. Some closures will be announced.”
Unite assistant general secretary Steve Turner said Mr Ashley was wrong to pass the buck onto landlords.
“Thousands of workers’ jobs are hanging by a thread while Mike Ashley plays poker with House of Fraser landlords and suppliers struggle to meet mounting debts for orders delivered but not paid for,” Mr Turner pointed out.
“Workers and their families are, of course, concerned that even if they keep their job, it will be their pay, terms and conditions that Mike Ashley will come for next in a transfer of Sports Direct practices to the retail giant.”
Mr Turner urged Mr Ashley to “immediately commit to maintaining the existing pay, conditions and pensions of House of Fraser workers, pay suppliers what’s owed to them, protect workers in warehousing and transport, while fulfilling his broken promises to ban zero-hours contracts in-store for his Sports Direct staff, demonstrating that a leopard can indeed change his spots.”
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Garda.142 sq mi of Nature, Food, History, and Culture
Heading down the “Serenissima” Highway out of Verona in the direction of Milan, we hardly expect to find a trove of wonders in under twenty minutes. Yet there is the sign for Peschiera del Garda, signaling how close we are to the largest lake in Italy. A couple minutes later, we pass the lake’s main outlet, Mincio, which skirts Mantua before reaching the confluence of the Po and flowing gently into the delta.
The natural world suddenly looks lusher. Surrounded by an enormous body of water, the area enjoys mild temperatures that allow for the active cultivation of grapes and olives, as well as cedar, orange and lemon trees—trees otherwise nonexistent at such latitudes. Spanning 142 square miles, Garda is a massive triangle of water measuring 32 miles long, from its northern tip at the spur of the Alps—Adamello and Brenta—to its southern base, where we began our journey.
The 346-meter-deep lake was formed during the Quaternary Period, when retreating ice sheets deposited large rocks to create the incomparable beauty of its western coast. Exiting the highway at Sirmione, we spy the nearby tower of San Martino della Battaglia, a reminder of the heroic standoff between the Piedmont armies and the Austrians during the Second Italian War of Independence. The commanding, intense blue of the lake, speckled with sailboats, is a sight for sore eyes on a sunny autumn day. A light wind ripples the surface. The waves form foamy arabesques as they crash against the rocks on the shore. The quaintness of the place is complimented by its architecture: the houses, villas and gardens that surround the lake keep a respectful distance. We continue down the peninsula, the narrow, verdant spit of land that cuts into the lake. The road is bordered by well cared for plant life and pastel-colored houses.
From Sirmione to Desenzano
We park at Sirmione and walk the rest of the way to the entrance, which is presided over by the majestic Rocca Scaligera as well as swans that root around the banks of the moat. The crenellated castle is magnificent. Built in the 13th century under the dominion of Verona’s Cangrande della Scala, it serves as Sirmione’s marvelous anteroom. The town is laid out in the medieval style. Its narrow cobblestone streets are lined with small shops, bars and colorful window displays. Talk about charm. The various houses, hotels and shops combine to form a pleasant and harmonious whole. Near the shore, cypresses and laurel trees, myrtles and holm oaks stare into the deep waters. We stick to the road till the town recedes and the peninsula opens up, making room for hotels and spas. The top of the promontory, the highest point of the peninsula, boasts winning views of the lake.
To the left it encompasses the alluring skyline of Desenzano and the impressive rocky western coast as far as Riva del Garda, and to the right it includes the low-slung Veronese shore, which only becomes hilly around San Vigilio, at the foothills of Monte Baldo. From this very spot we catch a glimpse of the remains of the Grottoes of Catullus protruding into the lake. Here, the great poet of Latin antiquity sang of the beauty of these places and his love for Lesbia. Gaius Valerius Catullus was born in Verona in 56 B.C. He lived to the young age of thirty, still long enough to pen elegies and meditations of rare intensity. During his life, he split his time between Rome—where he had friends and lovers as well as thorny relationships with Cicero and Caesar Augustus— and at his father’s house in Sirmione, where the poet felt comfortably rooted. During antiquity, Garda witnessed a sharp rise in the number of Romans, thanks in part to the fact that Via Gallica passed just to the south of the lake. That strategically important arterial road connected Mediolanum (Milan) to Aquileia. But Romans also flocked to the place for its beauty and charm, including literary and patrician figures like the poet Virgil and the historian Livy. Now this enchanting town draws a multitude of visitors. In fact all the centers around Garda have become destinations for cultural and sports tourism, the latter drawing fans of water sports and sailing. There is a steady stream of Italian tourists, but still more come from abroad, in particular Germany, as well as other European countries, North America and, more recently, the Far East.
One of the biggest tourist magnets is Desenzano, a beautiful city today regarded as the capital of Garda, given its size (almost 29,000 inhabitants), its abundance of attractions, the quality of its year-round cultural events, and its fine hotels and other accommodations. From Sirmione it’s a ten-minute drive to one of the parking lots outside the city’s historic center, which is closed to traffic. This manicured urban center is more garden than city, sprinkled with colorful flowers, intriguing vistas and pretty nooks that open out to Lungolago, the boardwalk that spans almost 4 miles, from the hamlet of Rivoltella to the Lido di Lonato. The center of the city has a port from which boats ferry people to the most visited areas of Garda. To the right of the port is a magnificent walkway where you can admire the play of waves against the shore. It’s like walking on water. You can also opt for a seat on one of Lungolago’s benches and appreciate the glittering hills and mountains jutting out against the deep blue waters. At the heart of Desenzano’s historic center is Piazza Malvezzi, distinguished by its porticoes and a statue of Saint Angela Merici. The city’s patron saint was born here in 1474 and founded the Order of the Ursulines.
Off in the wings is the Duomo. Dedicated to Mary Magdalene and open for worship since 1611, the cathedral houses valuable frescoes by Andrea Celesti and a last supper by Giovanni Battista Tiepolo. There are several routes that climb up from the historic center to the highest residential area and forming a kind of amphitheater. The 11th century Castello sits at the summit. The strategic position of the castle suggests it may have been built on top of the ancient Roman castrum. Exquisitely restored by the municipality, it now hosts exhibits and concerts. Not far from the castle lie the stunning ruins of a Roman villa that was developed over several epochs, from the 1st century BC to the 4th AD. Today you can admire the villa’s splendid mosaics, a triclinium, a viridarium with some remaining murals and various lavatories and washrooms. An Antiquarium displays relics from a dig, and the nearby Archaeology Museum, housed in a former church, contains remnants from Bronze Age settlements around Garda. Not to be missed is an oak plow from 2000 BC—to this day the oldest object in the history of archaeology. Mention should also be made of a monument in Desenzano commemorating Francesco Agello, an Italian test pilot who broke the speed record, once in 1933 and again in 1934, right here on Lake Garda. In the 1930s, a group of pilots formed the famous Reparto Alta Velocità (High Speed Team) at Desenzano’s seaplane base. With their MC 72 Mach seaplanes, they would eventually claim three world titles for air speed and break the 700 km/hour ceiling.
We hop back on the coastal road and take in the castles and fortresses gilding the towns that dot the hills and shores around the lake. Each merits consideration. Each merits a visit. The Lonato and Soiano del Lago castles. The impressive castle of Moniga. The fortress of Manerba. The castle of San Felice sul Benaco. Our next stop is Salò, an enchanting town nestled in a cove. The town has preserved some of the pristine counters of a rich and powerful medieval village, despite suffering serious damage in the tragic earthquake of 1901. The splendid historic center is dominated by a bulky late Gothic cathedral. Inside the church are paintings by Paolo Veneziano, Zenone Veronese, and Girolamo Romanino. As the “Magnifica Patria” capital (traces of which can be seen in the precious palace connected to the Podestà) Salò was protected by a solid city wall. It is still easy to discern the old urban layout, despite the seismic activity and rebuilding. It takes after the Lungolago. Once a stronghold of the Viscounts of Milan, in 1426 it fell into the hands of the Serenissima Republic of Venice until the end of the 18th century. Salò later garnered unwelcome notoriety when in the fall of 1943 Mussolini established the headquarters of his notorious Social Republic there.
Don’t miss il Vittoriale
Our trip ends in Gardone Riviera, otherwise known as Vittoriale degli Italiani, where it’s impossible for an Abruzzese such as myself to neglect to pay my respects to Gabriele d’Annunzio, even if our understanding of the world differs significantly. Born in Pescara in 1863, d’Annunzio was one of Italy’s greatest poets, dramaturges and writers—given his sheer output and linguistic innovation—and the major figure in the Decadence movement. But he wasn’t only a man of letters. He was also a politician, journalist and soldier whose heroic and reckless acts became the stuff of legend: the flight over Vienna, the Bakar mockery, the endeavor to create a free state in Fiume. D’Annunzio proved too troublesome for the fascists. Despite singing his praises, they “confined” him to Villa Cargnacco, which “Vate” himself rechristened Vittoriale and transformed into a mausoleum—of extravagant and highly questionable taste—filled with mementoes and mythological symbols that celebrated his egolatry. There, d’Annunzio indulged in his decadent taste for “excesses,” living out his days in a gloomy yet gilded solitude, until his death on March 1, 1938. Today the Vittoriale has become a monumental facility and museum. Vate’s one addition is a panoramic open-air theater. The house is currently managed by the Fondazione del Vittoriale.


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Sterling Silver Four Piece Tea and Coffee Service - Art Deco Style - Vintage (1947). A fine and impressive vintage George VI English sterling silver four piece tea and coffee service in the Art Deco style; an addition to our teaware collection.
This fine vintage George VI sterling silver four piece tea and coffee service/set consists of a coffee jug, teapot, cream jug and sugar bowl. The pieces of this tea and coffee service have a plain circular tapering form onto a circular spreading foot. The surface of each piece is plain and unembellished. The upper portion of the coffee jug and teapot have impressive embossed concentric circular stepped decoration in the iconic Art Deco style. The teapot and coffee jug are fitted with hinged hallmarked covers, retaining the original iconic Art Deco style carved wood finials, securing to the interior with wing nuts.
The coffee jug and teapot are fitted with the original, fine and impressive angular wood handles featuring an iconic Art Deco style elevated thumbpiece and integrated raised panel to the handpiece. The cream jug and sugar bowl are fitted with scrolling sterling silver handles with bifurcating lower terminals.
The teapot is fitted with a plain swan necked spout embellished with stepped decoration to the lower portion in the Art Deco style. The pieces of this fine silver tea service are displayed on a tea tray for illustrative purposes only - view the complete collection of trays and salvers available at AC Silver. This vintage tea and coffee service is an excellent gauge of silver, excellent quality and in excellent condition.The service has been professionally polished and is in presentation condition. There is a small crack down one side of the each of the wooden finials, which does not affect the integrity of the pieces. Full hallmarks struck to the surface of each piece are clear with some wear due to their location and in keeping with age. The part hallmarks to the interior of the covers are all very clear.
Reflections in photographs may detract from the true representation of these impressive examples of vintage teaware. Length from back of handle to tip of lip. Height to top of finial. Length from back of handle to tip of spout.Height to top of handle. Andrew Campbell founder and owner of AC Silver has been dealing in antique diamond & gemstone jewellery and antique sterling silver since 1977. In addition to his high quality Newcastle-based shop, Andrew has developed what is now an established and internationally recognised online store. For more details see our About Us. FREE OF CHARGE to all customers - including national and international deliveries. The item "Antique George VI Sterling Silver Four Piece Tea and Coffee Set Art Deco Style" is in sale since Wednesday, August 21, 2019. This item is in the category "Antiques\Silver\Solid Silver\Teapots & Sets". The seller is "acsilver925" and is located in Newcastle upon Tyne.
This item can be shipped worldwide.


On Friday a group of us went out for a lovely dinner. It was to celebrate our friend Kylie’s 40th Birthday. As a surprise, we presented her with a collaborative quilt that we had made for her. I helped choose the fabric, and due to the time consuming house move – I made the label. Probably with more time I would have done some applique on the front, but instead I contented myself with some applique and embroidery on the label itself.
As our group meets regularly to watch a video together, while sipping champagne, and nibbling on strawberries, I decided to include this snack on the label.
The quilt was made using a jelly roll of Wiscasset fabric by Minick and Simpson with added yardage of the same fabric for the backing and a coordinating red fabric for the border.
If you can manage to see past the furry model, you can see a better rendering of the colours in the quilt, the blue goes well with Kylie’s feature wall and furniture. Happy Birthday Kylie, from your Friday Night Video Friends!


What does sig, mean in General?
This page is about the meanings of the acronym/abbreviation/shorthand sig, in the Business field in general and in the General terminology in particular.
Find a translation for sig, in other languages:
Select another language:
What does sig, mean?
- your name written in your own handwriting


The Mega-Clamp is the world’s new standard theatrical lighting C-Clamp. The Mega-Clamp is created from high tensile, aircraft grade, extruded aluminum; so it’s both stronger and lighter than cast iron clamps. The Mega-Clamp’s safety factor far exceeds industry standards, breaking at over 2-1/2 tons at an independent testing laboratory. It is half the weight and twice as strong as most cast iron clamps.
In 1993, the Mega-Clamp introduced to the industry the one piece solid aluminum clamp body, micro grooves to grip the pipe securely, and the spring loaded pan adjustment. The solid one piece clamp body is designed to grip pipe with its micro grooves, and will not “rock” when making adjustments to the light fixture. The Belleville spring washer has 600# of spring load when compressed. This spring pressure keeps the fixture from drifting after making small pan adjustments to the light fixture. Just grab the fixture by the top of the yoke and twist to pan the fixture. Usually, you will not need to use your wrench to tighten the pan bolt; the fixture will stay securely held.The Mega-Clamp fits from 1" pipe to 2" pipe sizes (1-1/4" OD to 2.375" inch OD tubes.) This means you can hang fixtures from a 2" pipe without having to buy an expensive “Heavy Duty Clamp”. The Mega-Clamp fits the larger pipe standard.
Available with Stainless Steel Hardware, 2" bolts, 2.5" bolts, 5/17-16 bolts, zinc bolts, or Atlas threads. Also available in white powder coat. Specific part numbers are listed below.
1" pipe, 1.315" OD
2" pipe, 2.375" OD
600 lb 273 kg
1/2″ × 1″ long hex head Grade 5 zinc bolt
1/2″ × 3″ long square head set screw
Belleville spring washer
5.875" tall x 3.675" wide x 1" thick


You are here
Hong Kong, China: Stocks open up as Fed holds rates
[HONG KONG] Shares in Hong Kong rose 0.10 per cent soon after opening Friday, in line with a broad regional advance after the US Federal Reserve held off raising interest rates.
The benchmark Hang Seng Index in Hong Kong rose 21.50 points to 21,876.13 in the first few minutes.
And in Shanghai the composite index gained 0.46 per cent, or 14.22 points, to 3,100.28.
The Shenzhen Composite Index, which tracks stocks on China's second exchange, added 0.60 per cent, or 9.91 points, to 1,668.33.


You have composed the music for the upcoming movie The
Hounds - so how would you describe your musical score?
it's my first experience as composer of soundtrack music, but it's also a
great personal achievement after 30
years as session man for the best Italian composers like Morricone,
Piovani (the solo-violin on the Academy Award winner in 1998 Life is Beautiful - it's me), Bacalov, Ortolani,etc.
I was very excited
to get this chance, and after viewing the movie I've started to record
the first musical ideas. The problem was that
the directors (Maurizio and Roberto Del Piccolo) live in Milano and me in
Rome, so we only talked on the phone, and to understand their intentions
about the "soul" of the movie I had to wait for them to be in
Rome. One thing was clear to me: in The
Hounds there were several levels of
interpretation, and I wanted to go deeper, to the psychology of the
characters. The "fear factor" was not my goal, there was enough
on the screen: I have always asked myself "What does the character
feel in this situation?" - and I tried to give answers to my questions
did you get involved in the project in the first place, and what can you
tell us about your collaboration with the directors Roberto and Maurizio
Del Piccolo [Roberto Del
Piccolo interview - click here]?
This story is
very nice: An italian movies producer, to whom I
gave my approval for another project, in november 2010,
phoned me and asked if I was free to compose a soundtrack for the "debut" of two young directors, even without a remuneration,
because it was a low-low-low budget movie. I thought, "Ok,
it's my general rehearsal for the major project;
let's do it!"
It had been a long time that I was looking for my
first experience with soundtrack for cinema. I finally found my chance;
finally I can say to M°Morricone "I'm working on my own
soundtrack", finally the time has arrived.
Would I be able to write music for an horror movie?
Would I be able to create the appropriate
musical tension? Would I be able to give the musical emotions that the
movie, the actors and directors needed?
At beginning Roberto said to me that the
first problem was to find the music for the cauterization scene; I
watched the scene and I identified with the character of Dave, and than
I asked to me: "Which is the music that I felt if I was in his
place?" - the answer was the sound of inner dialogue, the sound of doubt, of query, of misgiving.
So, I wrote a music for solo cello and
strings (stopped on hig notes): the cello plays almost resembling Dave's
answer, almost helping him to do what he has to do. That's all.
I sent the audio demo to Roberto and I
waited. The day after he wrote me an email that read "I feel
like I had said to Leonardo Da Vinci: Come to paint my home's walls"
- related to my emotional participation in that scene. It was the first answer,
and what kind of answer!!!! Sure, it was a very "melodramatic"
phrase (in a very Italian style ...), but for me it meant to have the
approval and the confidence of the director; what else?
The rest is on the screen, and the music has
been acclaimend by the critics.
Note: The producer who proposed me to
write the music didn't like my work, while we are here talking about it; I
haven't heard more from him, but his movie hasn't started yet ...
How do you approach scoring a film like The
Hounds - and since it's a horror film, is that a genre you can at
all identify with, both as a viewer and a composer?
be a question that has
a lot to do with philosophy...
I've found that after a "soft" start, you need to
stay on the screen until the end because you need to understand "who?
what? where? when? why?"
The approach for me is always the same, both
for stage drama and for movies:
need to have an emotion; I
have to find something that
gives me a feeling that I
know, that I tried
it "on my skin", then
I can start to scoring
have to be captured, passionate,
laugh or cry, I need to feel
that there are common
feelings, in short, something
in love... I think that a horror music should not be
"scary", but must suggest the tension
created in us when we do not understand something that is endangering
our safety, a music that puts on alert all
the body through the ears and, why not?, also the chair ...
Honestly my horror expertise is
rather poor: Not too many titles are in my "greatest
hits", but Psycho, Friday the
13th, The Shining and Altered States have certainly
sparked my fears; it's nnot splatter that
creates tension in me, but it's the wisdom in knowing how to
keep the tension that catches me. As a user I cannot distinguish between
being a viewer or a composer: When I enter a cinema it's not like when a surgeon
enters the operating room, I just sit down and I ask the
movie's director "let
me dream"... then of course the music of the shower scene of Psycho is
the ringtone on my mobile phone!
can you tell us about the actual recording of the musical score?
Basically in Italy the mood has changed,
but first it's the cinema that has changed; and
this change is due in part to
the mood and in part to
the economic problems which art must
fight in my country. Nobody (and I underline NOBODY)
wanted to put art as national achievement in the heads of the world,
all the people come to Italy and return home disappointed: Iit was better-looking
on a post-card or on the internet... All this is to say
that (for example) it's impossible to compose a score in "Morricone's
style" because there isn't a movie in a "Tornatore's
style" - no money? A minimal movie; a minimal movie? Minimal music,
where minimal means little, poor, impressionist... a string
orchestra and 7/8 winds? You can record a digital piano and a violin,
after you can choose an accordion (midi) or winds (midi) or strings
(midi); at present the italian
major productions go in Bulgaria or the Czech Republic to record
orchestras to save 2/3 of costs, when
our fees are the same as twenty years ago, thanks to commercial
competition of the European Community that has protected only the
producers and not the workers.
considering The Hounds
in particular and movies in general - what do you draw inspiration from when
composing film scores, and how important is the actual movie at hand for
the outcome as opposed to personal experiences and the like?
thinking, I think I already
answered this question in
the answer number 3; I can only add that, The
being my first opportunity, I had already referred
to my many theatrical experiences, but more than that I had a 30 year long
apprenticeship (it started recording the score for Once Upon a Time in America in 1983),
during which I had the opportunity to learn in studio what to write and
what to change in function of the image; but practice is the best training, so: call me!!
Would you like to talk about some
of the films you have scored besides The
Hounds was my
first work, but after some time RAI TRADE, the national tv broadcast
editions label, released my CD called Storie (Stories,
Tales) which contains ten years of my drama musics; in October 2011, some time after the end of the
Festival del Cinema di Venezia, I learned that some tracks of my
CD are in an Italian movie called Il Mundial Dimenticato (The Forgotten
Mundial) which was at festival; the movie
was out of competition but the critics loved it, and later it gained many
prizes around the world.
The fact is that
I'm very proud to participate in this movie (in spite of me) simply because
it's a mockcumentary that tells the
story of the Football World Cup 1942 that
was never realized due to the Second World
War, but that was (perhaps) played in
the Argentine Patagonia; the music is very
rhythmic comment for a documentary, but after about half the running time
it starts to get
all of the feelings of the characters and
their plots - then comes my music:
what got me excited is that
they chose my songs to emphasize the
feelings, in some moments of the script when
the mockumentary becomes "cinema"... what
How did you become a musician and
composer to begin with, and what can you tell us about your (formal)
training on the subject?
I never studied composition, but during my training at the Conservatory "S.Cecilia" of Rome
I studied harmony, and as player I always asked myself "Where am I playing?
place is the music that I'm playing?" So, I've been always attracted
to harmony, and playing in orchestras for several years and studying
my scores I learned the "counterpoint" from Monteverdi to Cage.
But I fell in love with soundtrack music, during the last 30 years as
session man, and before I started scoring I was arranging great
soundtracks for my Movies
String Quintet (www.myspace.com/moviesstringquintet).
When in September 1999 my big
friend Eugenio Allegri (actor and director for theatre) asked me to score
the music for a show in the historical jewel Teatro Olimpico di Vicenza
(near Venezia), built in 1583 by A.Palladio, I could not renounce, and I
wrote my first notes. The song called La Commedia (The Comedy) that was the "ouverture" of that show, last
summer became the theme song of a TV show for RAI 3.
I'm sure that apart from
filmscores, you have also written some standalone pieces. So how does
composing those compare to scoring movies, and what do you find more
inspiring/challenging, and why?
am very honored that you ask
me questions as a composer, but
I'd like to point out that
I have never graduated in composition (just in violin) - I'm only someone who
your question: I like to create soundtracks, my passion is
to translate music to another
artistic language: I need a
video, a series of
photos, a story, etc. to
vent my emotions arising
from that input.
Every time I listen to a song written by me I am surprised that it came out
of me and, at the same time, I still feel the same emotion that generated
Only one score I've created without an artistic input: it was an orchestral score
called A Ennio Morricone played in a concert on
the occasion of the eightieth birthday of
the Maestro - http://youtu.be/DtTLRS5kWx0. It was my present to him, but it was really hard to compose
music that tells a person
of such importance, who does this and is at the top.
was a big night, full of composers who
had written for him and I was just his concertino playing during the concert (not my score, I want to listen my
work); He was very happy about that surprise and the day after I was received
at his house to personally deliver the score. Some time late, after he
listened the demo of my CD Storie, he wrote me a beautiful letter
that I consider my Composition Diploma and that I put in the CD itself as a
Related to that, what
got you into composing for movies?
To score for
movies is something like "The Creation": You know that in a
moment, in the theatre, your notes will enter in the ears and you must
decide what kind of emotion the public will receive.
A long time ago,
viewing a documentary, I've reflected on a scene: how important is the music if in this scene where a leopard chases a gazelle
if I either underline
the joy of the leopard to have his lunch or the anguish
of the gazelle trying to
possibility that I have to
give my "sound feeling"
is what I call "creation" - very often it's the music
that particular moment in the
film. Something else?...
Any future projects
(both movie-related and standalone) you'd like to talk about?
I'm scoring to a stage show and I'm waiting for an answer on an Italian
just finished to make music
for a pilot episode of a
TV drama and I'm waiting for the next Del Piccolo/Moviedel masterpiece!!!
would you describe yourself as a composer and musician, and how would you
describe your music?
I would describe
me as an artist, I can't play without thinking about the "vertical" of
music: what is there with me, around me, when I'm playing; and I can't
score without thinking how the notes sound when played, how the player feels
My music? Oh, I
can't describe it, others must answer that; I just ask myself one thing
before go to sleep: "Are you at peace with your work?" and the answer
must always be positive.
Composers and musicians who inspire
who has written beautiful music, 'cause for me
there is only good or bad music, no styles
or genres or countries.
Some of your favourite filmscores (other than your
own of course)?
Feeling lucky ?
any of my partnershops yourself
for more, better results ?
The links below
will take you
All Morricone's music, but also
J.Williams, N.Rota, B.Herrmann, R.Ortolani, H.Mancini, H.Zimmer, F.Lai,
J.Goldsmith, D.Shostakovic, M.Nyman, Lloyd Webber, etc.
At same time I
cannot stop being moved when listening N.Piovani's Life is Beautiful or L.Bacalov's
Postman ... when the simplicity wins ...
you think of any filmscores you really disliked, you thought were utterly
out of place - and why?
I don't remember movies like this, but I just don't like the musical
"trends", and when somebody tries to lift soundtracks from
Your website, Facebook, whatever
Anything else you are dying to mention and I have
merely forgotten to ask?
you like to come to work in USA?" - Oh yeah, I've my luggage ready!!!
Thanks for the interview!


52" Liner In 54" Wall Pool
I have a 24' above ground pool with 54" sides. I would like to order an overlap liner but most liners come 48 to 52". Will that work? I was told on a warm sunny day that it will work.
Hi. I would not hesitate trying to install it. Most overlap liners wind up with nearly a foot of extra liner that gets tucked back into the pool. This is plenty of extra liner.
If you stretch the liner into the pool on a warm day you should not have a problem. If you do not plan to stretch it, you might. Either way, the warmer it is the better chance you have of the liner fitting.
These pages show some examples of liners being stretched into an above ground pool.Above Ground Swimming Pool InstallationExpandable Liner InstallationAbove Ground Pool Liner Installation


One of the first things that I ask when I meet with someone new about their business, is what is their goal? Usually it’s a smattering of life/work balance/ successful business/adequate funding. However, that is not very specific.
In the past week I’ve talked to several people. I’ve asked them all how many hours they wanted to work on their business. Full time, they said. What do you consider full time? 20 hours, 40 hours and 45 hours were the answers.
Why such disparity?
Everyone uses the same generic language to describe their goals. However, the numbers behind those statements can vary widely.
Please the next time that you work with a coach/bookkeeper/CPA/number cruncher be sure to exactly quantify what you mean by:
- Double Sales
- Increase 100%
- Revenue Positive
- Fully Staffed
- Decrease the sales funnel
Each of those terms can have widely variable actual numbers. Save yourself some time and give some specifics.
Remember, if you are working with a consultant, you aren’t giving a speech at the local toastmasters talking about your business. You are actually creating a business model that you be able to brag about at the toast masters meeting. 🙂


- 1 pound cleaned shrimp
- 1 12-oz jar of orange marmalade
- 2-3 oz El Yucateco Caribbean Habanero Sauce
- 4 oz agave syrup
- Combine all ingredients.
- Adjust habanero and agave to taste and heat level.
- Marinate shrimp in mixture for 30 minutes, then remove and skewer.
- Grill for 2-3 minutes on each side while basting with the remainder of the sauce, until done.
As an added treat, grill large, thick slices of pineapple basted with the same orange habanero glaze and serve on the side. Yum! For more recipes or other information, check out our Facebook page at facebook.com/elyucateco.


VA builds its own online job board
- By Alice Lipowicz
- Nov 04, 2011
While the USAJobs federal jobs board has been struggling, the Veterans Affairs Department is preparing to debut its own online job search website displaying job opportunities at the department.
The VA is getting ready to launch the new “VA for Vets” website, with an online job search board, self-assessment tools, resume builder and military skills translator to help veterans identify jobs that match their skills.
Hiring veterans: strategies for success
VA's Blue Button medical app soon to add jobs data
The new website currently has 3.553 jobs listed, all of which appear to be positions with the VA. By comparison, USAJobs currently has about 12,000 job opportunities across many agencies.
The official VA for Vets launch is scheduled for Nov. 11, and the website is operating in pilot status until that time, according to a bulletin posted on the website. “At this time, access and services are limited due to continued site testing,” the notice states.
"As part of the VA’s commitment to hiring and retaining Veteran employees—and in support of the President’s pledge to bring more Veterans into civil service—I am pleased to introduce our new career support program: VA for Vets," VA Secretary Eric Shinseki wrote in an introduction to the new website.
The military skills translator on the site asks users to submit the service, pay level and military job title they held.
The VA recently announced that its “Blue Button” personal health record application would add job information, including tips on how military skills translate to civilian jobs.
Alice Lipowicz is a staff writer covering government 2.0, homeland security and other IT policies for Federal Computer Week.


East Petersburg, PA
Painting - Watercolor
This usually happens right before feeding time... overly anxious koi watching and waiting for their treats. The bright colors of the koi have resulted in many paintings, but this grouping complimented the swirling motion captured in the reflection on the water.
January 7th, 2009
Viewed 1,402 Times - Last Visitor from Webster, TX on 08/03/2015 at 9:41 PM


Ben and I report this morning:
Story Continued Below
Rep. Michele Bachmann’s prospective 2012 campaign appears increasingly set on a collision course with former Alaska Governor Sarah Palin.
The coming confrontation is being driven by a belief in Bachmann’s camp that the same grassroots, conservative primary voters and caucus-goers may have to choose between the two women—and that they will choose Bachmann if she presents herself as a more seasoned, reliable, and serious conservative than her high-profile rival. The apparent effort to draw distinctions broke into the open Tuesday when her new top strategist, Ed Rollins, dismissed Palin as “not serious” in a radio interview.
He suggested in an interview with POLITICO that Bachmann would profit from the contrast.
Bachmann will “be so much more substantive,” Rollins said. “People are going to say, ‘I gotta make a choice and go with the intelligent woman who’s every bit as attractive.’”
“I’m not afraid of Palin,” he said, adding the strategy would have been the same for Mike Huckabee.