I started with this one day after the day I spent two hours watching slam poetry, two days before my Sociology exam and thirteen days before three hundred and sixty six days with you (so basically my three hundred and fifty third day with you, yay maths). The title is more of a warning, proceed with caution, it gets cheesier with every word (apologies).
I started by tackling this question: how do you describe a person you can’t really describe? I pride myself on accurate descriptions but you, sir, are the one person who really stumps me. Then I thought about what I could say to you, but then again, what do you say to a person you’ve already said everything to? By that time, I already had my mind set on writing this so there was no turning back because you once told me not to quit when I do start writing something. So then I came up with this: 27 things I could’ve said a bit more poetically. Kind of.
One. Since yesterday was slam poetry day, here goes: I’m not a love poet and I don’t like to read a lot of love poetry or listen to a lot of spoken word about love but my god, every time I heard Rudy Francisco describe his love for the person he met at Starbucks this one time, my mind nodded in agreement (quite vigorously, might I add) and put those words in one box labeling it “THINGS I CAN NOT SAY AS WELL AS REAL POETS CAN BUT THINGS I TOTALLY MEAN”. Point is, you make me love a lot of things to a certain magnitude I never thought I would but then again, I never imagined I would love you as much as I do, simply because I didn’t think I was capable of it.
Two. I have weird associations in my brain that connect the smallest day to day things with you. I could walk down the street and a small word in a weird font that is hardly legible would sneak into my brain, hop from association to association till it finally reaches you. I guess what I’m trying to say is that you’re always on my mind.
Three. I love you. Simple as that.
Four. Everything sounds better in my head. I find it difficult to form clear and concise sentences, my words lose their meaning halfway through my phrases, I repeat a lot of things but I’m afraid the words will detach themselves from what I’m trying to say. Basically, I say weird things sometimes and they really do sound better inside my head but my words find meaning when I am around you and when they are about you. My words would like to thank you for that.
Five. I read. A lot. As much as I can of everything I can get my hands on. Reading has been my favourite thing to do since I was five years old but hear this, my favourite thing to read isn’t even a book. Black ink on white paper in the simplest font defined true beauty for me until I noticed every single line and curve that defines your body.
Six. You brush your fingers against my arm and the trail that your fingertips leave makes my skin erupt into tiny goosebumps. Neurons send messages up my spine to my brain that both make me very excited and ask me to calm the fuck down. I can’t calm the fuck down with you around.
Seven. I love winter mornings when I reach school with freezing hands and I can press my nose against your cheek to make you jump. I love how warm you always are, my hands would like to thank yours for being the reason my writing was legible when I wrote in my notebook during the first class of the day, human heater.
Eight. How do I explain to you how I feel when I can not get an answer out of you. To be very honest, usually, I would stop. If it were anybody else I would stop. But with you, I gain the ability to do a lot of stuff but I also lose the ability to do a lot of stuff. I promise you one thing that I’ve always promised you. I am not trying to fix you. I’m never going to try and fix you. Your sea of chaos is beautiful and I love it the way it is. How do I explain to you how I feel when I sit in a room full of people with dazed eyes simply because I could not figure out why you didn’t want to talk to me.
Nine. I’m considering showing you this less and less with every single word I write. It gets cheesier, yes, but I need you to understand something I think you do already understand. There is a raw feeling behind this and this is basically me, standing bare in front of you with all my thoughts on a plate, right out and I’ve given you a loaded gun and asked you to go ahead and shoot.
Ten. I know you won’t shoot. You know how I know? Because the first time I begged for a cigarette, you refused. I can only imagine how hard it is to say no to an extremely annoying and drunk sixteen year old hanging off of your arm. Thank you.
Eleven. I know I am not supposed to but thank you. When I had an anxiety attack at my doctor’s a few weeks ago, it felt somewhat like someone was choking me. I couldn’t breathe properly, I could feel the oxygen go in but my lungs refused to take them, my nails were bitten to my cuticles, raw and red from the blood and you, you were my first breath of fresh air. Your laughter worked better than any medicine ever had and soon, I was breathing easy again.
Twelve. I know I will get the wind knocked out of me again, I know I will someday drown underneath a burden of salt water and piles of papers, I know someday my lungs will once again refuse to take in the oxygen and I know someday, someday my head will spin so fast and my body will collide with the ground and shatter, blood and bone and I will want to scream so loud but I won’t be able to find my voice. I also know that that will be the day I will look into my phone for your number again. But for now, I’m breathing easy, I have you by my side.
Three. I love you. I don’t think any other collection of twenty six alphabets can describe more beautifully what I really truly feel for you.
Thirteen. When you held my hand for the first time and laced your fingers through mine, I could feel a different kind of warmth spread through my body. It was the kind of warmth that you feel on cold winter mornings, sitting in front of a fire. As soon as you move away from the fire, the warmth retreats, as soon as you take your hand away from mine, the warmth retreats.
Fourteen. Let me tell you about something we refer to as ‘butterflies’. I used to think butterflies were just something Meg Cabot made up and girls never do feel that in real life. But when you kissed me, I swear to god, I could feel five million butterflies fluttering around in my stomach and they really haven’t left since. I think they like it there, I do hope they continue to like it there.
Fifteen. I wonder if there is a word for a male muse. That is what you are. You see, why should artists only have a woman who inspires them? If I were to really describe what you mean to me, I would start with the profound effect you have had on the way I see the world. With you around I see things in different shades entirely. You, my dear, are the reason I could ever give voice to my thoughts.
Sixteen. I know now what it is like to near a deadline. Four hours away from my three hundred and sixty sixth day with you an all I can think is that I need to get this done. I have never before more desperately run my fingers across the keyboard, never before understood the urgency of a ticking clock but I think, I think the only thing that will make me rediscover this urgency in a manner even more desperate will be my realisation of the last few days that I will spend with you right before you say goodbye.
Seventeen. It is going to be hard to let go of you. I have accepted that and I think you have too, but does acceptance lessen a blow? You can prepare and prepare and prepare yourself for something your whole life but the final blow would hurt just as much even then. I don’t think I will ever be ready maybe that is why Christmas, 2024 is a plan. Maybe that is why I will look forward to Christmas 2024 with every breath I take after you say goodbye. You will be my Christmas miracle.
Eighteen. How did we get here? I remember last year. No, I remember the year before that. I remember hating myself for hating you but I also remember hating myself for loving you so damn much that I, with all of my ‘boys don’t matter’ attitude, was reduced into spluttering girly mess of ‘Will he ever text me back?’. Thank you for always texting me back.
Nineteen. Thank you for making me trust again. You see, after my first failed relationship, all I could think was “I am never trusting or loving a boy too much again, not for a very long time. It is of no use.” But there you were, in all your glory, dark hair and piercing eyes and the cutest goddamned smile I had ever come across and soon enough I could feel myself loving harder and faster than I had ever before.
Three. Which reminds me, I love you.
Twenty. You just asked me where I reached at Fairy Tail and I lied to you and said I am out buying Subway. I am sorry, but please laugh when you read this after 3 hours and 41 minutes, alright? (Side note: thanks for making me fall in love with Fairy Tail, I adore it. I have become an even bigger nerd because I can now add “anime” to the list of things I love) (Side note for the side note: you top that list).
Twenty One. If there is one thing that I want to apologise for, it is for getting too cheesy, if I did (I definitely did). I just feel that there is no other medium where I can describe my thoughts as well as I can here, in this manner, no other way in which I can let you know your importance for me. I know I don’t do it too well here either but I tried (get me the badge). Please don’t run away. I’m trying not to be too creepy. I don’t think you scare easy though, you’ve seen all bad parts of me.
Twenty Two. I’ll let you in on a secret. When I was ten years old, I started taking my writing seriously (or about as seriously as a ten year old can take her writing) and a few years after that I promised myself I would never ever write about love. I told myself that people who wrote about love were absolute “wusses” and you know, basically lifeless idiots with nothing to do but make one person the centre of their universes. I promised myself that there was no room for love poetry. I think that is the only promise I have made to myself and felt happy about breaking because-
Twenty Three. I am so glad to have made you the centre of my being. You see, people who write about love aren’t idiots, well maybe they are, but they’re idiots capable of seeing the world in a new light. If I could really write about love, I would write about how when I kiss you I can taste my dreams and how when you hold me, I know what true comfort really means. I would write about the galaxies I would paint for you in different shades of blue and red and yellow (but I can’t paint) and I would write about every edge so sharply defined by your skin and bone.
Three. So, there, I’m saying it again. I love you.
Twenty Four. I don’t repeat three because I run out of things to say, or as a filler for the gaps between my words, I say three because I can say it over and over again and I feel the need to make sure you hear it enough from me in this one piece of writing than anybody can say to you in a lifetime.
Twenty Five. I am selfish. I am selfish enough to always want you all to myself, I am selfish enough to want to be at the back of your mind all the time, I am selfish enough to want be spoken as the girl who mattered, I am selfish enough to want to be the person you think of ten years down the line once again simply because you came across something maybe I had once mentioned to you, I am selfish enough to want your love, I am selfish.
Twenty Six. I have galaxies inside my head that have space only for you, a thousand shooting stars that I would wish on and wish only for you, there are a thousand words that I could say to you and I could rearrange these twenty six alphabets over and over and over again but I would still run out of ways to express what you truly mean to me.
Twenty Seven. These are the twenty seven things I wish I could have said more poetically but speaking from the mind of a sixteen year old with hardly any writing experience, I don’t think words could have flowed more smoothly from the roughness of my tongue and the coarse surface of my brain that lacks the creativity I wish I possessed and I really really did try. I do hope you like it.
Three. So, once again, I love you.


You’ve got too much soul to be handled by someone who has never been passionate.
My father’s recipe for the man I should marry (part 1/2 of a series). /// r.i.d. (via h-o-r-n-g-r-y)
This is one more piece of advice I have for you: don’t get impatient. Even if things are so tangled up you can’t do anything, don’t get desperate or blow a fuse and start yanking on one particular thread before it’s ready to come undone. You have to figure it’s going to be a long process and that you’ll work on things slowly, one at a time.
Haruki Murakami, Norwegian Wood (via herkindoftea)


Well, I didn’t get nano done for 2018. It’s okay and I’m not upset about it. I did really well in school last semester and that is really what mattered to me.
I look forward to this next year and all that it will bring me. Finished off the year editing Mohican. It should be done soon.
Taking a short story class this upcoming semester. I am really excited about that.
Keep watching for updates and posts.
Looking for a better way to publish things I have written other than fictionpress.
Watching the dogs for my parent’s this weekend. Sitting here getting this word count in and Billy Joel shuffling on Alexa. It’s nice to write somewhere else other than home right now. Just wish I could do it all night…
I’m so excited for Nano this year!! I have my scrivener almost completely set up for it. Just need to get a good amount of note cards now..
“You know what the weirdest part of all of this is?”
“Trying to come home? The look on everyone’s face?”
“No, those are the hard parts. The easiest thing to do – oddly – was seeing my own grave. It’s especially different when your supposed death date is on it.”
So many words. Between English papers and Nano coming up there are a lot of words to be bled.
If you would like to read some of my writings I have a fiction press page – fictionpress.com/u/1100622
I will attempt to put it as a link on this page as well. I also have a facebook page with updates, articles, and poems. facebook.com/coffeepencils
Please, check them out!
I finally invested in some brand new notebooks. With school in session, they were on sale – yay! I have dedicated each one to a specific story of mine. They will be filled with the whole story plus idea, edits, sketches, and whatever else I feel I need. I think this is a good step towards writing again.


Welcome to the Hollis Center Public Library Catalog!
~~Summer Reading Program thru August 27 - all ages welcome!
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|videorecordingTo the manor born. — Silver anniversary special|
|VideodiscBeverly Lewis' The confession|
|Aunt Dimity and the buried treasure|
|Block city: how to build incredible worlds in Minecraft|
|The jungle book|
|Comics Squad: lunch!|
|Scooby-Doo! shiny spooky knights|
|The big bad blizzard|
|Feet, go to sleep|
|Zita the spacegirl — Book one, — Far from home /|
|Counted with the stars|
|Robert B. Parker's slow burn|
|the house on Bellevue Gardens|
|Howling on the playground|
|We are in a book!|
|Pete the cat and the bedtime blues|
|Starlight on Willow Lake|
|Pete the cat and his four groovy buttons|
|Chi's sweet home — #10|
|Chi's sweet home — #07|
|Chi's sweet home — #06|
|VideodiscMr. Peabody & Sherman|
|Kitten and friends|


16 Jan Navigating Recurring Revenue as a Driver of Business Value
Written By: Todd Kutcher, CVA and Ben Varone, CVA
(6 – 7 minute read)
In the dynamic landscape of modern business, companies have been increasing efforts to establish reliable and consistent revenue streams. Recurring revenue models have gained prominence, offering a steady income flow that can foster long-term sustainability and growth. Properly assessing a company’s recurring revenue is a crucial component of the analytical process, as contract terms, strength, and reliability can heavily influence valuations of these entities.
Recurring Revenue Models
There are several types of recurring revenue models that companies can employ to generate consistent cash flow. Subscription-based models involve customers paying a regular fee for access to a product or service over a set period. This could include subscription boxes, software-as-a-service (SaaS), streaming services, or membership platforms. Maintenance or support contracts are another form, where customers pay for ongoing maintenance, updates, or customer support related to a product or service. Licensing models involve granting customers the right to use a product or technology in exchange for recurring payments. Additionally, usage-based models charge customers based on their consumption of a particular resource, such as pay-as-you-go cloud services or utility-like pricing structures. Implementing these recurring revenue strategies allows businesses to build a more resilient financial foundation and establish long-term relationships with their customers.
Analysis of Recurring Revenues
Companies with recurring revenue streams typically experience greater financial benefits compared to competitors that do not offer such contracts. One of the primary advantages of recurring revenue is the establishment of a predictable cash flow. With a reliable income stream, businesses can better plan for operational expenses, investments, and strategic initiatives. This stability enhances financial resilience, particularly during economic downturns, and allows for an appraiser to project future revenue and income streams with greater confidence. Additionally, the reliability of these business models tends to increase valuation multiples relative to competitors that lack recurring revenue sources.
Recurring revenue models often involve ongoing relationships with customers. This fosters a sense of loyalty as customers become accustomed to the product or service, making them less likely to switch to competitors. Long-term customer relationships can lead to increased customer lifetime value, a crucial metric for sustained profitability. Continuous engagement with customers allows businesses to gather valuable feedback and adapt their products or services to evolving market demands. This flexibility can be a competitive advantage, enabling companies to stay ahead of the curve and maintain relevance in their respective industries.
Despite the benefits of recurring revenue streams, companies with recurring revenue streams may be prone to additional risks. Churn, or the rate at which customers cancel subscriptions or cease purchasing, poses a significant risk to businesses relying on recurring revenue. High churn rates can erode the benefits of steady cash flow and customer loyalty. Also, the structure of subscription or membership contracts is vital in managing expectations and reducing legal risks. Ambiguous terms or unfavorable contract conditions can lead to disputes and customer dissatisfaction. Clear communication and transparent agreements are essential to building trust and minimizing legal complications, along with long-term customer retention and contract renewals.
When analyzing a business that generates revenues from recurring sources, it is crucial to properly assess the components of recurring revenue. Recurring revenue models typically contribute to a stronger valuation by offering a clearer picture of future earnings. However, it is pertinent to assess the quality of all contracts with key customers to ensure that customer attrition is unlikely. Additionally, a strong recurring revenue model is closely tied to a loyal and diverse customer base. Businesses with a high percentage of repeat customers or subscribers are typically viewed as more valuable, as they possess a reliable foundation for future growth. When assessing customer contracts for a pending sale, it is essential that any existing contracts with customers transfer to a potential buyer. If certain contracts will not transfer due to a change of ownership, then the impact of the loss of these customers/contracts must be analyzed. The loss of significant customers could results in weaker earnings streams, yielding a weaker valuation on a going-concern basis.
Embracing recurring revenue can be a strategic move for businesses seeking stability and long-term success. However, careful consideration of the associated benefits and risks is essential. Businesses must focus on optimizing customer relationships, fine-tuning contract terms, and staying agile in the face of market changes to fully capitalize on the advantages of recurring revenue while mitigating potential pitfalls. By doing so, companies can not only enhance their financial performance but also position themselves favorably in the eyes of investors and potential acquirers, ultimately contributing to long-term business success while simultaneously increasing their valuations.


Je bekijkt de reis...
Reisverslag Wanderlust, and the story back home
25 september 2014
Wanderlust, and the story back home
After coming back from Malawi, I realized once more that our homes are such beautiful places, but that I would never only feel at home there. When going on an exchange, going backpacking, doing volunteer work or wherever you go doing your thing, you will feel like you’re creating new homes. Another country to have a second (or third, fourth, fifth) family in and a new place to call ‘home’. When you have lost your heart so many times in so many places, parts of you stay behind and remember you of all your travels and people you have met. You can go over the memories in your head, watching the pictures and daydreaming about walking the sandy roads to your second home, but you will never be able to relive them until you go there again and pick up the pieces you have (perhaps literary) have left behind.
Having a heart so diverse and fragmentized can make you feel sad, even sick. But call it homesick and you’ll know what to do. It makes you even stronger than you were before because on every journey, you’ll see a lot, you become independent and self-confident and above all, you’ll learn about traditions, sayings and whole societies through experiencing a culture from within. All you need is a healthy heart and an open mind! How hard can it be?! If only we cherish the changes that the journey brought us, we can keep making this world a better one (while saving money for the next flight of course).
By writing this one last blog, I wanted to let you know how difficult it is to fit back in, after being totally out of rhythm and suddenly seeing and realizing things I had never noticed before. For the first time, I felt like an outsider. Cultural norms, habits or just the way it all looks, seem odd, out of place or just weird. I asked myself: why do we do these things the way we do? The way we eat, what we eat, what we waste, the huge variety of products in supermarkets, precisely stacked and organized all for a reason, the way traffic flows, the way we greet, the way we meet; it is all so different.
But then, almost without noticing it, I was back in routine too: I started falling into old habits, thinking less about `how it was there´ and I started seeing things as normal again. There are always moments when I’m suddenly remembered of my time abroad: hearing that one song we listened to all the time, reading a word that remembers me of the local language, or best of all: seeing and speaking to the people I met there. Then all at once, wonderful memories comes back and it’s possible to recall the time we spent there together.
And now, I’ve finally found a way to name my ‘can’t-wait-to-go-travelling-again feelings’ as well: it’s not just ‘I like travelling’ anymore, I think I can now truly say, that the ‘virus’ of wanderlust, has reached me, too.
I hope that one day, you can tell me about the dreams you realized too. Don’t wait too long, or the chance will be lost.
Don’t think it’s never possible because then you’re not even trying.
Don’t give up your ambitions, dreams and hopes, they’re the best things we have.
May this be your inspiration. From now on, it’s up to you.
Foto's bij verslag (3)
25 september 2014 22:33 | Door: inge
tjonge wat een betoog! goed geschreven en overdacht..!
we hopen dat je nog vele reizen kan maken en mooie mensen kan onrmoeten.
10 oktober 2014 03:17 | Door: JokeeneriK
Het is fantastisch om andere culturen te ontmoeten en ervaringen mee te nemen. Maak mooie reizen en geniet van alle nieuwe indrukken! Doen wij ook!
Groetjes uit Australië!
Liefs eriK en Joke


[Link, ever the solitary explorer, has found the weapon shop and his stuff himself! Sitting outside on the ground, he straps a rather large blue-hilted sword and shiny red and silver shield on his back, looking relieved to be doing so. Afterwards, he stuffs a strange assortment of other gadgets into the pack on his back behind his shield.
Now -- time to figure out more of what's going on, here. He pulls out his journal and flips through it for a while, reading silently to himself in the grass, and eventually starts writing.]
Ah... Hello, everybody. I guess I should introduce myself properly, now? My name is Link. To the people writing to me in this journal earlier who helped me, I should thank you again.
I'm from Hyrule, and I hear that Princess Ruto of the Zora's here too, and possibly someone else I know named Sheik. They can read this too, right? Does anyone know where I can find them?
[Added, some time later]
To the person who wrote that short guide (Mark?) and the rest of you I suppose, it can't be that there's no way out here here, can it? That's impossible. There's no way I can stay here, I have to get home.


Greenpeace Living Guide
After working with Greenpeace for a number of years, typotherapy was asked to design a comprehensive hand book about sustainable living that is easy to read, navigate, and quick to retrieve a range of valuable information.
Once the visual identity was created, a custom font (Circulo) was designed specifically for the guide. typotherapy designed the 200-page guide to be organized like an encyclopedia with a user-friendly colour system, a dynamic editorial structure and a refined grid system. With entries for a range of categories from food to flooring, and toiletries to transportation, the layout was designed so that even the busiest person can skim through the guide and retrieve an abundance of information.
The result … the first edition was a Canadian bestseller, with over 8,000 copies sold to the public and distributed to Greenpeace members across Canada. It has been endorsed by many prominent Canadians including Stephen Lewis, Sarah Polley, Ed Broadbent and Maude Barlow, who called the guide “a must read for every Canadian”.
Scope of Services /


D. Paul Angel
I try and blow my nose to get it out, but the spider’s legs keep pushing the tissue away.
D. Paul Angel
I try and blow my nose to get it out, but the spider’s legs keep pushing the tissue away.
D. Paul Angel
It was a capriciously Spring day. Rain came and went in bursting sheets, necessitating my jacket, even though it was uncomfortably warm to wear. Inside the bank I simply held it, its fabric being too slick to stay tied around my waist. I awkwardly shifted it hand to hand, a nervous, near constant leapfrogging with my deposit slip and envelope.
The line moved glacially. I studied the intricate paisleys brightly interwoven throughout the carpet, and wondered how much the view would change when I was closer to the brass pole holding the stained, velvet rope.
I looked up at the CLACK CLACK CLACK of a metal cane hitting the open door’s aluminum frame. The cane’s white and red paint was scratched and chipped, especially towards its lower third. Its owner was a woman who appeared younger at first glance, older at second glance, and unplaceable with further scrutiny.
She easily found the end of the line and, despite her opaquely black sunglasses, appeared to smile and nod at my attentions. I smiled back awkwardly before taking advantage of the line’s movement to look away.
As I was studying the herringbone on the tweed jacket of my predecessor in line, I heard harsh, barking shouts and rough feet clumping into the bank at a trot. Three masked men stood before us, menacing us with black, angular rifles and pistols tucked behind their belts.
Everyone began going to the ground but I found myself frozen. I knew, deeply, that if I hadn’t chosen the restroom before the bank I would have wet myself right there. I was certain they would kill me for standing, but I could not summon enough will to move.
Then I realized none of them were looking at me.
Nor was I alone in standing.
The lady with the cane had left the line and headed towards them. Rifles to shoulders; they coldly fixed her in their sights.
Her head slowly shook. It shook neither in fear nor intimidation; ignorance nor resignation. Her head shook with sadness. Terrible, absolute, sadness. The kind of deep sorrow that attends the finality of a too long struggle, when tears have wept themselves to extinction.
“Please,” she said with quiet sternness, “it is not yet too late.”
The leader derisively cycled his rifle in intimidation, his grin obvious even through his mask. The unspent round bounced twice on the carpet’s short pile before ricocheting with a TING off of one of the brass line posts.
In the silence that followed you could barely hear her utter a sharp TSK before slamming her cane straight down with so much force the air itself warped, twisting upon itself; wrapping itself, and then finally unbinding itself in three, quick, blinks of an eye.
The men dropped.
One, the furthest, simply lay quiet.
The other two held hands to their heads, their faces contorting in the rigors of silent, agonizing screams.
The last two, mercifully, finally stilled their thrashing and a funereal quietus soaked into the lobby. I alone still stood, and no one else appeared to be ready to cease from their exhorted torpor.
“What did you to them?” I asked her, surprising myself by talking.
“I did nothing to them,” she replied simply, as her head swiveled to face me. She walked towards me and continued, “They did it to themselves.”
“Feel, of course.”
“What you did to the air with your cane?” I asked confused. And afraid.
“Interesting.” She cocked her in head thought before continuing, “You saw the Clarity.”
“Pure, unfiltered clarity. Their life as Balance. Every hurt, every fear, every horror they have ever visited on anyone, and everyone, in their life, they felt.
“Fully and instantly; knowing beyond doubt they were the cause.”
“So they were overcome by their guilt?” I asked, and then noticing that the furthest robber was the only one beginning to move, added, “What about him?”
“It is Balance. The agonies they caused are balanced by those they have endured. For him, hope yet remains.”
“What are you? A witch? Sorceress? Angel?”
“I am what I need to be,” she answered with what I suddenly knew was unimpeachable veracity.
I began to open my mouth as a logiarrheaic flow of questions forming, before her stern visage closed it. Instead I found myself nodding and smiling to her in farewell.
She walked out the door, her figure lost in the glare of the low, late afternoon Sun. The third gunman rose in her shadowy wake, divested himself of weapons, and blearily followed her.
Though the customers and tellers remained bound to the floor, the other two masked men began to rise. Freed of my invisible shackles I went and helped each of them up. Distrustful eyes glared at me before softening and looking at their weapons with confusion.
I helped them pile their weapons in a heap; watching with a smile as the leader retrieved the shell he had ejected earlier. With a shaking hand he placed it atop the pile.
We left the bank together, it not yet being too late.
D. Paul Angel
Barras slowly opened the control room door. He’d seen the light in the lab, but no one was supposed to be here this late. He cringed when he saw Pelcher at the controls. Yes, he was a superior, but he was also an ass and Barras had had a long enough day as it was. “What the Hell are you doing Pelcher!?” he heard himself shout, far angrier than he had realized.
“Oh it’s you,” Pelcher said with a sneer. “I’m doing whatever the Hell I want.”
“Lab’s closed, Pelcher,” Barras continued walking to the control panel. When he realized Pelcher had the force field prototype fully engaged he added, “You can’t be running this! We don’t have another test scheduled for days.”
Pelcher turned from the controls confronting Barras with a hard index finger straight to the chest. “I can do whatever the hell I want in my Goddamned lab! I’m the one who got the defense contracts. I’m the one who obtained the urban test facility, and I’m the one who authorizes your pittance of a salary!”
Barras’ fist clenched but his reply changed abruptly when he finally noticed the dog in the test area. He pushed past Pelcher to get a closer look through the special, thick glass.
The dog was actually a puppy. It looked like a pitbull and it was running in circles around the forcefield, lunging at it continuously despite being thrown away each time. Barras looked incredulously at Pelcher, who started laughing.
“That’s the kid’s puppy isn’t it? Where is she, Pelcher?”
“In the forcefield of course. She tried getting money from me again and that flea ridden mongrel snapped at me after I slapped her.”
“You slapped her!? Jesus Pelcher, she’s just a girl! Not even a teen yet! Jesus…”
“She wants to be on the streets, she needs to know who her betters are,” Pelcher said dismissively. “So I’m teaching her. She grabbed hermuttbefore I could kick it and said, ‘Nothing could come between them.’
“Nothing, eh? So I bet her $20 against her mutt that I could keep them apart for 10 minutes.” Pelcher looked at his watch, “Another minute and half and I can get rid of it for good. Maybe even both?”
Barras looked at the controls in disgust as Pelcher laughed again before launching into a NASAesque countdown. Barras’ disgust suddenly turned to fear as he saw the readout, “Jesus Pelcher, you overrode the safety protocols!”
“So, you’re already at 175% capacity!”
“That’s- That’s impossible! We hit the force field with a battleship round at point blank range and it only spiked to 91%. Hell, in theory not even a railgun could push it past 110%.”
“Shut it down, Pelcher, shut it down! Shut it down now!”
“And lose to street turd? Hell no.”
Barras tried pushing him away to shut it down himself when he saw the puppy jump ever more frantically; each hit raising the load that much more. Out of instinct he ducked just as he saw the puppy take running lunge, even as Pelcher derisively resumed his countdown in the 30’s.
Barras woke against the far wall, well away from the control panel where’d been before the blinding flash and shuddering BANG! He could see Pelcher knocked out too, his legs at an odd angle, but the kid was in the center of the lab unscathed. The puppy was in her lap, happily licking her face. The engineer in him realized that being in the epicenter of the blast had completely protected them both.
Barras awoke again, unsure how long he’d been unconscious this time. He hadn’t smelled the burning circuits, plastic, and wires before. He remembered Pelcher’s arrogant stupidity more clearly though, and was even more grateful to be alive. He turned his head back to Pelcher and saw the kid and the puppy standing over him. Pelcher, pinned by a chunk of concrete and twisted I-beam,was haphazardly trying to shoo them away. The kid easily ignored Pelcher’s weak efforts and began kicking him repeatedly. As the ringing in Barras’ ears slowly ebbed he began to make out her shouts, “WHERE’S MY TWENTY BUCKS ASSHOLE!?”
Barras soon passed out again, but not before he had the satisfaction of seeing the puppy lift his leg…
Tech Support Difficulty
D. Paul Angel
“Hi, Tech Support.”
“Yeah, I’m having a really hard time with my new word processor.”
“Oh? What’s going on?”
“Well, I’ve got a 90 page report I have to have in to my boss before I leave today.”
“And, well it was 90, but now it’s 88.”
“Well that’s not good.”
“Yeah, that’s why I’m calling.”
“Of course, of course. Anything else?”
“Well you know how it underlines words that are misspelled?”
“Well, I’ll look at the page and there’ll only be a couple of words misspelled, but then when I go back, there are a ton more words underlined.”
“What do you mean, ‘Oh no?'”
“Well, it’s- Have you checked your difficulty level?”
“My difficulty level?”
“Yes, you know, EASY, MEDIUM, HARD, etc…”
“Is this a joke?”
“I’m talking about a word processor, not a game. I need help. I do not need jokes.”
“I assure you sir, this isn’t a joke. Can you please click on FILE and then click on DIFFICULTY?”
“I told you- What the Hell?”
“You found it ok, sir?”
“Why in the Hell is there a Difficulty setting on a word processor?”
“Well, we found too many of the employees were getting bored with routine tasks so we added difficulty levels to keep them interested. Didn’t you get the notice?”
“No! I would’ve remembered an email like that.”
“Email? Uh, right. Um, well, it was on our FaceBook page, Pinterest, Twitter had a link to our Tumblr page too. None of those?”
“What? I don’t have any of those!”
“Not even MySpace?”
“Of course not and- And now it’s down to 87 pages!”
“OK, tell me what difficulty it’s on. EASY? MEDIUM?”
“It says LEGENDARY. Should I switch it to EASY?”
“No! Sir, whatever you do, do NOT change it now!”
“Seriously, whatever you do, don’t change it.”
“LEGENDARY is just like the games. So if, like, in the games, if you die on LEGENDARY you start the level again, right? Same thing. It knows when your report will be done, and you can’t switch it till then. And you’ll lose all your work if you leave early.”
“Sorry, there’s nothing I can do about it. But you should know it will slowly delete words to keep you typing. Oh, and the slower you type, the faster it deletes.”
“Oh is that all!?”
“Uh, no. If you don’t fix a typo within 3 seconds it will randomly spawn five additional typos on the same page.”
“Holy sh- So what the hell do I do now?”
“Type man, type! Type like you have never typed before!”
“Son of a…”
“And pray to God you finish before tonight’s update restarts your computer automatically.”
“WHAT? When is-”
Where the Shadows Lie
D. Paul Angel
He took Grey off leash, and watched as the border collie went bounding into the woods next to the trail. He loved it up here on the soft ridge. The trail criss-crossed the park below many times; thin lines of brown and gray cutting the large swath of green into crisp, geometric shapes. But there was only the one trail up here. With the steep climb there were far less people, too. You could never be truly solitary when urban sprawl surrounded “Nature” on all sides, but this little knoll was close. Once he got Grey it became even more secluded for him since dog walkers were expected to stroll up the hill and around the woods.
He breathed in the scent of the Eucalyptus trees as he heard Grey rustling through their fallen leaves. The smell was distinct, and overpowered the multitude of scents that any stand of trees invariably produced. It was a peaceful smell to him, one of the reasons why he always enjoyed bringing his dates up here for a picnic. The soothing scent and privacy were an intoxicating combination.
He looked at the shadows cast by the trees across the trail. From a distance there was a clear demarcation. Dark on one side, light on the other. But as you got closer, the line became less clear. The more you looked, the less definitive it became. The black wasn’t solid, nor even consistent. Instead it was thousands of individual shadows of varying depths of gray from each individual leaf, twig, branch, and trunk. He liked to look for the transition. The edge between one world and the other.
It was a comfort.
It was nice to forget.
Except, of course for when you realized you were forgetting. He grimaced as the flood of images came back. The date had been going so well. The cheese, the wine, the crackers; even the smoked salmon had been perfect. He had gently stroked some cracker crumbs from his date’s beard, causing the man to flinch. It was a subtle rejection, but final nonetheless.
Grey’s barking broke the string of memories flashing through his head, not just of the rejection but of the excuses that had followed. What else could a picnic have meant? He realized that he had come here not just to forget, but to remember. It was, after all, just one of many dates that hadn’t been perfect. It just stung more because it was so recent. And because it had started so perfectly.
Grey’s barking continued, distracting him as he tried watching the scene again. Giving up on reminiscing for now, he kept calling for Grey until he heard the dog trotting back to him.
He turned pale when he saw the dismembered arm in Grey’s mouth, only just recovering to shout, “I TOLD YOU TO LEAVE THAT UNGRATEFUL BASTARD WHERE I BURIED HIM!”
Last week I posted “Mr. Black’s Knowing Wink” as a one off #FridayFlash. There were several comments that wondered after Dolores fate, so I was inspired to continue her story…
Mrs. Black’s Withering Glare
D. Paul Angel
Dolores sat at the interrogation with her head down in silence. The Police had come in that morning to arrest her for Ableforth’s murder! She had just been starting to go through his office and all of his papers when they burst through her front door. She was all aflutter and protesting her innocence when she saw Mr. Black on the other side of the street. She’d wanted to yell and point him out, but he’d given her one of those smiles again; they just seemed to soothe her. He’d once again signaled her to be silent and she’d followed his advice from that point on.
“Well Dolores, still have nothing to say?” asked Clarance for the umpteenth time. He’d been one of Ableforth’s poker and golfing buddies, and was the county District Attorney. She stayed quiet and avoided his angry eyes. “The longer you say nothing, the worse it looks for you, I’m afraid…”
As his implication lingered, the door opened and a severe, matronly woman walked in. She was wearing an older gray, Victorian dress with an elaborate costume jewel brooch at her neck. Her hair was in a tight bun, and she had deep wrinkles around her mouth. “I am here to represent you Dolores,” she said with a wide smile that showed the origin of her wrinkles. “My husband saw your… trouble this morning and informed me.”
“I must warn you Dolores, an attorney at this stage only makes you look guilty,” Clarance said, ignoring the newcomer.
“You may call me Mrs. Black, and you will address any further questions to me.”
“Think carefully, Dolores,” Clarence continued, still ignoring Mrs. Black completely, “Do you even know this-”
He was interrupted by Mrs. Black loudly hitting the metal table in the center of the room. It was loud enough to reverberate, and Dolores was pretty sure she noticed a dent where Mrs. Black had struck it. “You will address your questions to me,” she said to Clarence.
Clarence rose from his chair and turned to face Mrs. Black for the first time. He had his hand half raised to point at her, and his mouth opened grotesquely large to yell at her, when he was hit by her withering glare. Both actions remained unfinished as he slumped back down, looking away from Mrs. Black.
“Good,” she continued, “Now you will listen to me. You have no case and you know it. Which is why you’re in here bullying a new widow in the back of the Police Station. Did you even bother reading her her rights?”
“I didn’t think so.”
“That is no excuse and you know it!”
“Can I finish!?” he shouted, only half rising before sitting down again at her look.
“Yes. You can tell us your theory.”
“It’s open and shut. Dolores poisoned her husband so she could keep the inheritance to herself. She had motive, means, and opportunity.”
“They had just come-”
“Well it was Dolores’.”
“Dolores’s, yes. So. Regardless, of whether Ableforth still lived, or not, she would receive her inheritance?”
“Well of course, but-”
“Would Ableforth have received it if she died prior to it clearing probate?”
“And, he would only be entitled to as much of it as she shared, correct?”
“Well, yes, but-”
“So Ableforth had motive to kill her, Right? So, murder weapon?”
“It was a rare poison. I can’t pronounce it, but it kills quickly with little trace.”
“Would a mortician have known of it?”
“Ableforth did the county’s autopsies, didn’t he?”
When Clarence didn’t answer she asked him again, forcefully, “Well didn’t he?”
“Yes, he helped us out sometimes.”
“So you knew Ableforth then? Tell me. Was he a good man?”
“We played poker every week and golfed a couple times a month…”
“And does that make him a good man?”
“Your pause is eloquence enough. I wonder if he spoke of Dolores during your times together?”
Clarence looked everywhere in the room except at Dolores or Mrs. Black. He tugged at his collar, loosening his tie. Dolores noticed the sweat stains under his arms, and was acutely aware of her own sweating; though Mrs. Black seemed wholly unaffected.
“It’s hot in here…” Clarence began before Mrs. Black cut him off, “Yes, that’s what happens when you turn off the air-conditioning. In the South. During the Summer.
“Now, what did Ableforth have to say about his wife?”
“He said she couldn’t keep house worth a shit and she’d be lost without him.”
“Hmmm… so this woman, who according to her husband can’t even take care of housework, would be in a position to know about, and obtain a rare poison you can’t even pronounce? That, to be clear, is your theory?”
“Will never hear it. The bottle of poison was found in Ableforth’s pocket, he had ordered it and personally received it. It had only his fingerprints on it. Both glasses, in fact, had Ableforth’s fingerprints on them, but Dolores’ fingerprints were only on hers. You have no case.”
This time Clarence did shoot up and thundered at Mrs. Black, “How do you know all that… unless you’re an accomplice?”
“It’s called, ‘Discovery,’ Clarence. You would know that if you’d studied it more in Law School.”
“I scored rather well in Discovery, thank you!” he shot back.
“Yes, with your Professors wife, I believe?”
Dolores was shocked not only by Mrs. Black’s haughty retort, but by how pale Clarence looked as he collapsed back in his chair. Mrs. Black nodded with satisfaction at Clarence and continued, “Well, I’d say Ableforth did himself in while trying to kill his own wife, wouldn’t you Clarence?”
Downcast and defeated, Clarence let them out while muttering disbelieving profanities under his breath. As Dolores and Mrs. Black triumphantly walked down the building’s red brick steps, Dolores found herself really wanting to learn how to smile as Mrs. Black did. Well, that and her masterful glare too.
Mr. Black’s Knowing Wink
D. Paul Angel
Dolores rushed into the kitchen to pull the roast out. The buzzer on the oven had stuck again, and she had lost track of time polishing the silver for dinner with Ableforth’s boss tonight. She’d asked Ableforth to fix it, but his reply was the same to all of her difficulties, “It’s not like you don’t have the time. I do enough work, at work.”
Dolores lifted the cast-aluminum lid to check the roast and potatoes. The potatoes were a little crisp, and the carrots were rubbery, but at least the roast didn’t feel dry to her poking. Ableforth hated dry roasts as a matter of course, and tonight was already important to him (“I don’t know how to get perfect out of you when you can’t even manage adequate, Dolores, but that’s what I need for tonight,” he’d commanded on his way out). As for the veggies, he’d barely touch his potatoes anyway, and he’d howl if she put even a sliver of carrot on his plate.
She was still setting the table when Ableforth bustled into the house shouting for her. She rubbed some of the last dust off a crystal goblet with her apron before rushing to the foyer. Ableforth hated it when he had to wait for her. Ableforth introduced her to Mr. Black, laughing and nudging the air next to him. “The Mortuary has my name on it, Dolores! You really think I have a Boss? That’s too rich. Mr. Black is what we call Death in the Industry. You’ll believe anything won’t you!?”
He continued on into the dining room, laughing to himself the whole way. It was better than his usual scowls, sarcasm, or drunken anger, but not by much. She almost jumped when she realized there was someone else in the foyer. He was every bit as slender as Ableforth wasn’t, and his formal, Victorian suit looked straight out of one of the Sherlock Holmes movies she watched on PBS when Ableforth had his Poker nights.
“Mr. Black?” she asked quietly. The little man didn’t respond out loud, but gave her a knowing wink as he placed his top hat and thin, black umbrella on the wooden coat rack by the door. Then he took her by the hand and pulled her into the kitchen. He held his finger to his lips to quiet her as he pointed towards Ableforth in the other room. Ableforth had poured a couple glasses of wine, but was pouring a clear liquid out of a small, dark bottle into one of them. The one he then placed on her end of the table. Mr. Black motioned her to continue making up their plates before letting himself into the dining room just as Ableforth came into the kitchen.
“It’s a great day, Dolores!’ Ableforth said, leaning on the counter as she grabbed the plates to take into the dining room. As they turned to leave, she saw Mr. Black switch the glasses of wine before primly taking the chair she had set for him. Ableforth continued without noticing Mr. Black, “The probate attorney called and your Father’s estate is finally settled. The check came this afternoon and it’s already deposited. I’m done here. Done with this town, done with this life, and done with- Well, I’m just done.
“So a toast, Dolores, to a new life,” he finished, holding up his glass and inviting her to toast. She looked over to Mr. Black who gave her a sympathetic smile and encouraged her to drink. She raised her glass with a forced smile and drank deeply as Ableforth drained his glass with a loud gulp. She was watching Mr. Black stand up when she heard Ableforth’s first gasp. She turned and saw his face contort in fear and pain as he clutched at his chest. She rounded the table as he collapsed to the floor, flailing.
She panicked, not knowing what to do and unable to speak. She let herself be moved aside by Mr. Black who, having collected his hat and umbrella, stood over Ableforth. She watched dumbfounded as Mr. Black swiped his umbrella through Ableforth, instantly stilling his convulsions. Mr. Black turned to her again, looking at her with both sympathy and encouragement. He doffed his hat and formally bowed to her before squeezing her hands and smartly walking out.
She sat back down and drained the rest of her wine in a single gulp, before smiling, truly smiling, in as long as she could remember.
Pay no attention to the man behind the curtain
A world of my own
Speculations in food, beer, and strange fiction.
Just a girl from the bush.
Writing Popular Fiction
Superheroes - Autism - Fantasy - Science Fiction
Where Great Books meet Great Minds
ON = TIME
original performance art with an imagination to change the world
Read by four out five drunken monkeys--written by the fifth.
Another construction site pumping out noise and dust.
Have pen, will travel.
Poems, Fiction, and Musings
A Daily Ritual of Writing
ALL CAKE AND HAND GRENADES
Aspiring novelist. Avid reader of fiction. Reviewer of books. By day, my undercover identity is that of meek, mild-mannered legal assistant, Kate Loveton, working in the confines of a stuffy corporate law office; by night, however, I'm a super hero: Kate Loveton, Aspiring Novelist and Spinner of Tales. My favorite words are 'Once upon a time... ' Won't you join me on my journey as I attempt to turn a hobby into something more?
Various Short Stories by Lucius Moreau
A treasure box of stories!


Print or download your Alice In Wonderland now for free. And start colouring immediately! Of course it is also possible to share the coloring page you choose to share the coloring page on Whatsapp, Facebook and Twitter!
Did you get all the 15 colored in? Then there are plenty of other fun coloring pages with various themes online!
Do you know thatWe also have coloring pages for adults? These coloring pages are called Mandalas! They are shapes in a circle. Drawing is relaxing and healthy too! Try a Mandela coloring page!
Alice in Wonderland
Alice in Wonderland is a film released in 2010. It is a film adaptation of the books Alice's Adventures in Wonderland and Through the Looking Glass. Which were written by Lewis Carroll.
Alic is 19 years old at the time she is about to be (more or less) forced into an engagement. This she does not want and she goes on the run. She follows the white rabbit (White Rabbit) into Wonderland.
She had been there 13 years before, however she could not remember. Together with other residents of Wonderland, she must try to restore White Queen's power.
Back at home, Alice tells her that she doesn't want to marry, but to travel. At the end she is briefly seen a ship, which therefore means she has fulfilled her dream. A blue butterfly comes and sits on her shoulder for a moment; this is Absolem.


John Egbert is the main character of "Homestuck", and he is the heir of breath. Although he loves his dad, he feels strange toward his father... His fathers constant pranks and general hijinks have left him almost scared of his dad, yet he still appreciates the loving care of his father. He is a very cool person and kind of saves the world (not). After him and his friend discovered spurb everything began to come crashing down, but john kept his cool. His chumhandle is ectoBiologist. It used to be ghostyTrickster, but he changed it to avoid the trolls.
Rose is extremely Smart. She loves cats and knitting and also likes to be a bitch sometimes. She loves writing fanfiction about wizards and hates her mom who also likes wizards. Rose is a lesbian and likes a troll named Kanaya, Shes also great friends with John! She almost kill hims but its all love. Shes really cool! She uses the chumhandle tentacleTherapist.
Dave Strider is the brother of Dirk Strider, his brother is gay. He is obsessed with being cool, which manifests itself in his unceasing pursuit of new ironic depths. When the original name "Insufferable Prick" was about to be suggested, he slashed the entry box right in half with a Ninja Sword because he's just way too cool to put up with that kind of bullshit. His Chumhandle is turntechGodhead.
Jade Harley is one of the Main Homestucks. She has long black hair, round glasses, and a bucktoothed grin. She wears a shirt with a constantly changing blue picture on it, a belt, and a button-up long skirt.
Jade's chumhandle is gardenGnostic.
She also has a cute room-mate named "BEC" Its a penguin.
Back to Main Page


Clinical Psychologist Dr. Venus Nicolino
Growing up in a 600 square foot house with six individuals and a German Shepherd in West Philly is the best preparation for a PhD in Clinical Psychology. So far as we know, Dr. Venus Nicolino has taken this route. Her mother never finished high school, and her father worked as a mechanic on old Chevys.
Clinical psychologist Dr. Venus Nicolino heeded the work ethic that told her to rely on herself in the event that no one else was willing to assist her. That irreverent attitude is what sets her apart as she dives deeper and deeper into the world of self-help books. A genuine desire for help from people with real troubles is welcomed.
As one of the “five books that will change your life,” Dr. Venus Nicolino released a #1 best-seller, Bad Advice: How to Keep alive and Thrive in an Age Of Bullsh*t. Her new genre of self-help, Nobody’s an Expert, has shook up the modern self-help world (Amazon).
One day at a time, she’s dismantling the theories of gurus and life experts, and she’s doing it early and often. Dr. Venus Nicolino has also appeared in more than 100 television shows. People are drawn to her strong personality, which is complemented by her working-class upbringing, and she is now regarded as one of psychology’s most innovative and forward-thinking figures.
As a mental health professional, the doctor is all company and has the documentation to back it up. A Master of Clinical Psychology and a PhD in Clinical Psychology are among the top notch counselor degrees. If you’re looking for help with your ears, psychologist Dr. Venus Nicolino appears to be everywhere, from social media to television, radio, and print.


THIS WEBSITE IS NOT UPDATED ANYMORE, PLEASE VISIT https://mdmlab.fr/
How bacteria defend themselves against their viruses ?
Facing the abundance and diversity of their viruses, bacteria and archaea have developed multiple lines of defense that can be referred to as « prokaryotic immune systems« . My research focuses on these anti-phage immune systems.
I’m trying to understand evolutionary patterns and molecular mechanisms of these systems but also how to use them for medical applications. I work at several scales: from computational genomic analysis on thousands of prokaryotic genomes to experimental molecular genetics and diverse microbiology tools.
My PhD focused on the adaptive immune systems of bacteria, CRISPR-Cas systems. I focused on why they are encoded by some bacteria but not others. During my post-doc, I discovered and characterized novel immune systems of bacteria, namely retrons and viperins that showed incredible conservation with eukaryotic immune systems.
I’m currently working on the ecology and evolution of anti-phage systems, their conservation with eukaryotic immune systems and how we can harness them for the fight against pathogens.
You can discover my work through a seminar I gave in July 2020
Prokaryotic viperins, a novel family of defense systems that produce antiviral molecules
Viperin is an important anti-viral protein of humans that is conserved in animals. It has been shown to inhibit the replication of multiple human viruses by producing a molecule called ddhCTP, which acts as a chain terminator for viral RNA polymerase (Gizzi et al. 2018).
We showed that eukaryotic viperin originated from a clade of bacterial and archaeal proteins that protect against phage infection. Prokaryotic viperins produce a set of modified ribonucleotides that include ddhCTP, ddhGTP and ddhUTP. We further showed that prokaryotic viperins protect against T7 phage infection by inhibiting viral polymerase-dependent transcription, suggesting that it has an antiviral mechanism of action similar to that of animal viperin.
This study showed for the first time that natural antiviral compounds are produced by bacterial immune systems, opening avenues to look for more anti-viral molecules generated by bacteria. It’s also the first time such a strong conservation between a eukaryotic and prokaryotic immune system was demonstrated.
Publication: Prokaryotic viperins produce diverse antiviral molecules.
Bernheim A. Millman A., Ofir G., Meitav G., Abraham C., Shomar H., Rosenberg M., Tal N., Melamed S., Amitai G., Sorek R. Nature, in press (2020)
My Twitter thread explaining the discovery
Scientific Commentary: Cell Host and Microbes
General public summary: English or French:
Press: Times of Israel, Jerusalem Post, News1, israel21, Sciences et avenir…
Retrons, mysterious bacterial elements function in anti-phage defense
With two collaborators (Adi Millman and Avigail Stokar-Avihail), we elucidated the physiological functions of genetic elements that had been a mystery for 30 years: retrons. Retrons are bacterial genetic elements comprised of a reverse transcriptase (RT) and a non-coding RNA (ncRNA). We stumbled upon a defense system that encodes a retron. This led us to hypothesize that all retrons function as defense systems. We found out that the defensive unit is composed of three components: the RT, the ncRNA, and an effector protein. We examined multiple retron systems and show that they confer defense against a broad range of phages via abortive infection. Focusing on retron Ec48, we showed evidence that it ‘‘guards’’ RecBCD, a complex with central anti-phage functions in bacteria. Inhibition of RecBCD by phage proteins activates the retron, leading to abortive infection and cell death. Thus, the Ec48 retron forms a second line of defense that is triggered if the first lines of defense have collapsed.
This study solved a three-decades old question, and demonstrated a novel concept in bacterial immunology (the guard hypothesis) inspired by the plant immunology field and conserved in prokaryotes.
Publication: Bacterial retrons function in anti- phage defense
Millman A*, Bernheim A*, Stokar-Avihail A.*, Fedorenko T., Voichek M., Leavitt A., Sorek R.
Cell, in press, (2020)
Our Twitter thread explaining the discovery
Scientific Commentaries: Science, The CRISPR journal, Nature Reviews Microbiology
General public summary:English
Press: Jerusalem Post, Phys.org, Drug and Target Review, Science Daily…
Diversity and ecology of defense systems
This perspective provides a conceptual framework for the evolutionary forces that lead to the diverse immune systems and their original distribution in bacterial genomes.
The recent discovery of the unexpected diversity of prokaryotic immune arsenal have led to seemingly contradictory observations: on one hand, individual microorganisms often encode multiple distinct defense systems, some of which are acquired by horizontal gene transfer, suggesting they yield a fitness benefit. On the other hand, defense systems are frequently lost from prokaryotic genomes on short evolutionary time scales, suggesting that they impose a fitness cost. We introduced the ‘pan-immune system’ model in which we suggest that, although a single strain cannot carry all possible defense systems owing to their burden on fitness, it can employ horizontal gene transfer to access immune defense mechanisms encoded by closely related strains. Thus, we propose that the ‘effective’ immune system is not the one encoded by the genome of a single microorganism but rather by its pan-genome, comprising the sum of all immune systems available for a microorganism to horizontally acquire and use.
The bacterial pan-immune system: anti-phage defense as a community resource
Bernheim A, Sorek R
Nature Reviews Microbiology 18, 113–119 (2020)
The downsides of CRISPR-Cas systems
A small video that I made in collaboration with Adrien Bernheim, a graphic designer to summarize my PhD findings (in french)
For the past ten years, CRISPR-Cas systems have passionated the scientific community both because of their role as an adaptive immune system in bacteria and of their use in many biotechnological applications especially in genome editing. However, much remains to be studied on their evolution. My PhD research stemmed from the observation that only 50% of bacterial genomes harbor a CRISPR-Cas system despite their apparent fitness advantage and their high rate of horizontal transfer.
Hypothesis such as the cost of autoimmunity or the trade off between a constitutive or an inducible defense system have been put forward to explain this paradox. I proposed that the genetic background plays an important role in the process of maintaining a CRISPR-Cas system after its transfer. More precisely I hypothesized that CRISPR-Cas systems interact with DNA repair pathways. To test this idea, we detected DNA repair pathways and CRISPR-Cas systems in bacterial genomes and studied their co-occurences. We report both positive and negative associations that we interpret as potential antagonistic or synergistic interactions. We then focused on one interaction to validate our result experimentally and explored molecular mechanisms behind those interactions.
My findings gave insights on the complex interactions between CRISPR-Cas systems and DNA repair mechanisms in bacteria and provide a first example on the necessity of accommodation of CRISPR-Cas systems to a specific genetic context to be selected and maintained in bacterial genomes.
Atypical organizations and epistatic interactions of CRISPRs and cas clusters in genomes and their mobile gemetic elements.
Bernheim A, Bikard D, Touchon M, Rocha EPC
Nucleic Acids Research 48 (2), 748-760 (2019)
A matter of background: DNA repair, pathways as a possible cause for the sparse distribution of CRISPR–Cas, systems in bacteria.
Bernheim A, Bikard D, Touchon M, Rocha EPC
Philosophical Transactions of the Royal Society B 374 (1772), 2018008 (2019)
Inhibition of NHEJ repair by type II-A CRISPR-Cas systems
Bernheim A, Calvo-Villaman A, Basier C, Cui L, Rocha EPC, Touchon M, Bikard D,
Nature Communications 8 (1), 1-9 (2017)


HOPE FOR THE FUTURE: A FATHER'S JOURNEY IN HEALING AUTISM
HOPE FOR THE FUTURE A Father’s 10-year journey in successfully healing Autism By Miraz Ali, Eagle33 Media on YouTube This father was told his son would grow up to be an Autistic adult, something he could not accept! His doctors told him that there is no healing, no cure and that they do not know what causes Autism. For 10 years, he battled with failure and hurdles after hurdles. The last 3 years he made such progress that other parents started to see progress and their children started to heal as well. He describes Autism/ADHD/ASD as just terms and a fire that is affecting the brain. The mind being snatched away from the soul, not allowing the child to express him or her self. This father cut off the fuel, which he describes as parasites, heavy metals, chemicals, that are damaging in many different ways. He made robust movements, not just cutting it off but also replacing it with potent natural foods which helped regenerate the cells, repair damaged areas and also remove all that was toxic and dangerous. He describes this in detail with simplicity, backed up with medical research and scientific proof. ‘’In memory of all mothers, who bear children into this world, wanting the best for them, until a storm comes their way, a storm called Autism.’’ Written with such pain and emotion, you will feel his 10-year journey, Hope for The Future could not deserve to be on any book other than this one. I am adamant that this book will be read worldwide and will help with this epidemic crisis manifesting and spreading globally. Most importantly, it is not just written for parents with Autistic children, but for all who are concerned in the continuity of the future generations. You can also see his video and subscribe to his new YouTube channel Eagle33 Media. Miraz Ali, known as Eagle33 on social media is a humanitarian, lightworker and environmentalist. He is releasing 6 books in due course that all marry into the betterment of this planet and the people who inhabit it.


This site will no longer be used as of November 1st, 2017. Please check out my new website and blog at annalisesinclair.com. Curiosity, Courage, and Cake. Sounds like a new show on TLC, doesn’t it? Unfortunately, for those of you that still have a hole in your heart after the cancellation of Here Comes Honey Boo Boo, this isn’t a new TV show. Its not the latest cupcake cookbook; its not the tagline of the next Alice in Wonderland movie. It is a way of thinking that has helped me overcome some of the most difficult challenges I have faced in my short, but chaotic lifetime. I created this website to help others discover how a little bit of curiosity can change your entire life… a whole lot of courage is necessary if you are gonna make it out there… and there is nothing, NOTHING that can’t be made a little bit better with cake. “There is no greater agony than bearing an untold story inside you.” –Maya Angelou Every experience, interaction, moment in time helps to define who we are and where we will go. Sharing stories is how we, as a society, shape our reality. Sometimes, it is easy to boil all of what has shaped us down into three little words- curiosity, courage, and cake- and other times, it take a novel. This is my story.


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Discuss book ‘Koran: Forbid or Rewrite?’
« Thread started on: Jul 10th, 2011, 06:20am »
Forum ticket003 / july 2011
Topic: Discuss book ‘Koran: Forbid or Rewrite?’
I want to start a discussion about my new book, see below. It could be useful to read my book and put your comments or questions in this topic. My research on this topic wil go further and I will publish all updates on my site. If you have points that are very important, then you can mail me. See the press release below.
Study this short synopsis of my book:
Hinduistic, Dewanistic and scientific view upon the Koran, Islam, De-Islamicization, terrorism and future of religion. Commemorate Islamic attack on Twin Towers (9/11/2001).
I hope to see a serious and good discussion.
Hindu writer and researcher.
Delft city, Holland
PRESS RELEASE WITH VIDEO TRAILER EMBEDDED
Everything You Always Wanted to Know About Islam
Koran: Forbid or Rewrite? A Guide for Peaceful De-Islamicization provides an inside look into the Muslim religion. Raised as a Muslim, Hindu writer Dewanand answers many of the questions asked about the religion. His book is written to commemorate the Islamic attack on the Twin Towers 10 years ago, and to reconsider how best to tackle terrorism.
See this link for the Book Video trailer on youtube:
Why is the Koran the deeper abstract cause of terrorism, and what can Muslims and non-Muslims do about it? How can we help liberate Muslims from medieval ways of thinking? What is a real Muslim and how should we define an anti-Muslim? “I wanted to reform Islam and end the suffering and violence in many Islamic nations. I was raised as a Muslim by my mother and later on I converted to Hinduism,” Dewanand states. His book represents the meeting point of three civilizations: Islam, Western and Hinduism.
KORAN: FORBID OR REWRITE? A GUIDE FOR PEACEFUL DE-ISLAMICIZATION (ISBN: 978-1-60976-065-6) is available on March 29, 2011 for $35 and can be ordered through the publisher’s website:
• http://sbpra.com/dewanand or at
About the Author: Dewanand grew up in Surinam and at age 20 went to Holland to study. He now lives in Delft, Holland. He has published numerous books in Dutch and these can be found on his website, www.dewanand.com.
For more detailed information (where to buy, contents list, contact) you can also visit this Epage on the website of Dewanand:
Strategic Book Group, LLC
ABOUT: Strategic Book Group provides book publishing, book marketing, and e-book services to over 10,000 writers around the world, employing 150 people who live throughout the US and work virtually through telecommunication. Strategic Book Group is experiencing over 30% growth per year, having published approximately 3,000 authors with almost 100 new releases per month. Our books are available through Ingram, the largest book distributor in the world, as well as in bookstores, through Amazon, Barnes & Noble and all online channels. Strategic Book Group attends and exhibits at the major book expositions in London, New York, China, and Germany each year.


Picture above: Ancient tea banquet
A tea banquet is at the same time a solemn and elegant event, following the strict rules of the tradition. The tea has to be of very high quality, and the water has to result from much acknowledged sources. The tea utensils must be precious and of an outstanding quality.
According to the ritual, during a tea banquet, the person in charge of the ceremony has personally to mix the tea or oversee the blend in sign of respect to the guests. After this, the mixture ought to be seen by everyone and will be smelt for appreciation of its color before tasting.
After three turns, the dinner guests will judge the quality of the tea, will praise the high virtues of the host, take advantage of the landscape and the conversation or write poems.
Under the Ming Dynasty, the usual process grows to be simpler and thought in a more practical view.
Under the Tang dynasty, Lu Yu (733–804) was valued as the Sage of Tea for his contribution to Chinese tea culture. He is best known for his monumental book “The Classic of Tea” (茶经) Cha Jing, the first definitive work on cultivating, making and drinking tea. Cha Jing was the earliest treatise on tea in the world. For Lu Yu, tea symbolized the harmony and mysterious unity of the Universe.
The tea culture reflects the oriental traditional culture, combining the tea with Dao wisdom, pronounced in Chinese as “Dào”, which is an integral part of the Chinese culture.
The Dao of tea stresses the fact of being harmonious, quiet, optimistic and authentic. Peace of mind being the first step to get to tranquillity as a spiritual purpose in order to combine harmony and serenity. The idea is that as long as a person keeps quiet inside, he can always take advantage of the enjoyment of the conversation, of laughter, of the music and the opera (ancient Chinese entertainment).
Ones would say that the tea culture is a kind of intermediate culture which allows to pass on the spirit of the Chinese traditional culture to the future generations.
A famous tea drinker in China’s Tang Dynasty told tea has ten virtues: melting away depression, dissolving lethargy, encouraging liveliness, breaking up illness, bringing virtue and courtesy, expressing respect, making a distinction between different tastes, nurturing the body, practicing Dao, and improving one’s aspirations. “Tea brings Dao and elegance,” he was often heard saying


How To Get Career Success
Through A Go-Giver Mindset
Have you ever wondered how the massively successful people get to be so successful and how things would be if you had some of that same success in your career and life?
Let’s dive in and discover the Go-Giver mindset.
RECIEVE FREE CAREER BRANDING UPDATES
First of all, let’s get this straight before we jump into this. Being a Go-Giver doesn’t mean you’re everyone’s doormat and if that happens it’s because you’ve let others take advantage of you.
Great! Now that’s out of the way, let’s get to it!
A few years back someone in my network suggested the book The Go-Giver to me. I had never heard of the book and thought I’d give it a go.
It turned out to be this great inspiring little book that since have been one of my all-time favorite career books. When it comes to networking the Go-Giver mindset has been one of the most rewarding discoveries based on the kind of opportunities I’ve gotten, since I made the mindset shift.
The Go-Giver Mindset Breakdown
Implementing the Go-Giver mindset includes bringing value to people to the people around you in an authentic way. That being co-workers, your Boss, clients, customers and basically everyone you come across in your career.
Always come from a place of service to others. Becuase when you help other people make their lives easier by creating valuable solutions to their problems, then you’ll build trust and as a result, repeat business to you and your employer.
Another and especially relevant part of the Go-Giver mindset is to be open to whatever opportunities that also come your way.
These principals are at the core of authentic career branding as well. Because when you create authentic value for others, then, as a result, you will begin to attract more and better career opportunities.
I was very fortunate to get to sit down and talk with Bob Burg, the co-author of ‘The Go-Giver’, about the Go-Giver mindset and how applying a simple mindset shift, can help you get career success through serving others.


I just HAVE to open a little. About human..ok..womens small croups. Like i have said, i have this project. Getting me in shape again. Or even close ;) . And this croup of pro´s is awesome!!! Really, that is. But then... there´s this smaller croup of womens, who put one croup on their own. And that´s good, to encourage and to be able to talk etc....so far so good. But. Why ther´s always BUT! :D First came few women, they are this core of that croup. Actually, another croup had to be done because there was huge drama in first croup. Ok, nasty part was, that those few core women bullied one...and i just cant stand those kind of people, woman or man! I started to stay in shadows, just mostly reading. But, some people just can be so naturalistically! If you dont agree, or hype me, i dont play with you. Wow...and grow ups. ;) It really dosent matter to me, who things about what about me, way too well cooked. But, someone CAN hurt. And that´s not good. At all. Sometimes (always!) Is good to think, how we treat others. Really think. If you are in forum, full of your virtual friends...and use it badly...ignoring or being cruel...in "real" world you can end up to be alone...And I dont mean that in bad way, it´s just... like in schools..croups has power to do good...but, also way too much bad. Like i said, i read those things time to time...and actually..those gave me such a great idea for a book. Characters. You rally never know, where you can find that inspiration! Let´s be good to each others and treat good people in your life...even those you cant stand. That gives you more energy to do something positive for yourself.
ps. sorry about all mispellings...thunder is in the air and my head is real barometer...au :)
That works for everything. Really! Whatever you are going throught, doing, dreamin...that line..you can!
Really, we only have here and now. If it dosent work, you are wiser. If it works..well..good for you! We can wait till we are older..or can we? Who as giving us that promise, that we are here later? We are here now!
I had that conversation with myself week ago. I really realized, that we are not superhumans, living here forever. What ever neds to be done, do it now. Later, it just could be to late. Or not! But for me..i dont wanna take that risk.
Life changes, mind too. That´s life. As is falls, rises, laughter and crys. All part of life. And that life is here and now.
Need to cry? Cry! It´s natural and being human. :) Feel bad? Me too, for time to time. But still, we need to live.
I wanna live my life. Live. Really. Feel every feeling. Love. Stress. Happyness. Sadness.
I dont want to waist my life about me just complaining. Not woth it. And, i sont mean that telling how you feel is complaining!!! No, i mean me, compalining about not so important things.
Yep i have and always will, like everybody,bad times. And i will write those. That´s what life is all about. Feelings..:)
Now, i feel love, stress and hunger. And happiness that i feel ;)


There has been a profound sadness around me lately, so I took it upon myself the other day to cheer myself up. I was waiting for the bus with a bunch of people. Well, the bus was there, the doors just hadn't been opened for us yet. When the bus driver came to open the doors for us, as she passed, she told the elderly woman in front of me that she had too many bags and she wouldn't be able to board the bus.
I felt like helping her would be nice, and cheer me up, so I offered to take some of her bags on the bus for her. She thanked me profusely and told me that she had just been let out of the hospital and no one had been able to come and get her, so she had to take the bus. She gave me two bags to carry. One of them held her dirty clothes, and the other held a Peace Lily. I saw the plant as a good omen, and on the 45 minute trip to the next town, I felt happy that I had been able to help this person.
After, I met her off the bus and I handed her the bags and a small felt heart I had made. She thanked me and reminded me to get my bike. As I was removing my bike from the rack, the bus driver came out and scolded me for helping her. She told me that the elderly lady who had just left the hospital had taken advantage of me and that she could have kicked us both off of the bus for breaking the rules.
I felt pretty deflated as I lowered my bike off the rack, but when I looked up, I saw The Peace Wizard waving at me. The Peace Wizard, John C. Bromet, is a local celebrity. He walks around Bellingham and Mount Vernon with a large Peace sign, waving at people. He always makes me smile when I see him, but I had never talked with him before this, and now, I felt like I needed his power of peace to brighten my day.
I hold three college degrees, none of which are paid for. I am a healer and an artist. I own very little. It is my goal to bring hope to the world.


I started in the Estate Agency the day after I turned eighteen. It was in the lettings department. I wasn’t sure what I was more excited for leading up to my 18th, being able to buy a pint from my local pub, or starting my first real job as an estate agent!
Starting my career being an Estate Agent
I remember my first day like it was last week. Driving an hour and a half to Croydon with a massive grin on my face getting ready for what was a new beginning. Three months went by, and that grin was non-existent, I would wake up at half 5 and struggle to even lift my arms out of bed. By the time I arrived at the office, I was deflated. I didn’t have that passion for it anymore. There were constant arguments within the office about how this wasn’t my applicant or not my viewing. It seemed that every person looking for their next home was just a pound sign walking around the house.
You could cut the tension in the office with a blunt spoon. Every minute I was there, it felt like there was a gigantic dark cloud looming, snatching your personality and turning you into a robot. The same routine day in day out: call the enquiry, do the viewing, chase the offer. If there isn’t any offer- delete them. Eat, sleep, drained, repeat. It became clear that each staff member was an annoyance to the other. Each was there to steal commission, and I felt like an inconvenience whenever I asked for training (which wasn’t often!).
A glimpse of hope from Conran
I believed that every day would be different in the Estate Agency. But it just felt like Groundhog day
However, just like any good film, Groundhog Day had a happy ending!
At that point I began to feel that Agency wasn’t for me, a chance of hope pinged through on my phone. It was an estate agent vacancy position at Conran. I called my mum immediately and asked her to help me with my CV. She works in HR, so it makes sense! A few days went by, and I received a call for an interview; I was thrilled! The interview was in person in the Greenwich Branch (pre-COVID).
In the few minutes I stood waiting to be called, I knew this was the kind of environment I wanted to work in. Professional, fun, and most of all, passionate.
Not the passion for how much you could make, but instead, for helping people. I would soon understand the sheer joy of making your goal to help people and seeing them fall in love with their next home! From the first contact, at an excitable viewing, to the happy couple picking up the keys and a cold bottle of prosecco, this was a journey that I wanted to be a part of.
I sit at my desk a year on from that interview. I work with colleagues that I see as friends. They nurtured me into the negotiator I am, spending vast amounts of time training me, teaching me the core beliefs they live by. I know that everyone in my office has my back and supports me with my career progression. This company is filled with people with desire, a passion for helping all those viewers that walk into our office, a passion for calling customers time and again to connect with them because we want to tell them about the latest home we have to sell.
I’ve discovered that first impressions are everything in this business, and if it starts with a friendly smile and some nice words, you’re off on the right track.
Customer service is what keeps us ticking over at Conran, and I love that. I’m out of my bed at half six sharp(ish!) – I now work down the road! Driving eagerly to the office whereby I strut in with a huge grin on my face… and that grin is still there when I walk out.
A Tale of Two Agents
Although only a few miles away, these two estate agents feel worlds apart, and I am so glad I made the change. Here at Conran, the team maintained their level of excitement felt from conducting that very first viewing. We are speaking to genuine people here and treating them well.
I’m always looking to the future with Conran. I’m so thankful for the relationships I’ve formed, the job satisfaction I attain and the level of Professionalism I am surrounded by.
So, thank you Conran – you are a different class of agent, and no, not all agents are the same


Some people spend their entire lives in the service of others. These people are teachers, nurses, councilors and an untold number of what are often called jobs but are in fact callings.
I have spent my life in the company of others and often we are able to be of service to people, friends, family or even those whose paths we cross just briefly.
The question is what kind of effect did you have on those lives and often we don’t know the answer and never will.
Two things have happened in my life to make me sure that the effects of others touching our lives is never forgotten.
- Garth Giles. He was my math teacher and although I never quite got the hang of math, I did learn to learn. I learned from him that I was capable of more than I may had been given credit for. Thank you. I have not forgotten.
- My Uncle Mark. He taught me that I was responsible. At the time I did not get it at all because he told me I was responsible for the sun coming up. I have since figured out he did not mean I was God. I may not cause the sun to rise but I am 100% responsible for my reaction to its rising, if any.
I was inspired to write this by one such person who has literally given their life to the service of others and really has no idea whether she has made a difference in the world or not.
The short answer is yes. A very big YES because although I have known her only a short while and burdened her with only trivial matters it is known to me that thousands of people with far more deserving and grave issues have been graced by her care. Only the simplest or most callus of people forget a kindness that was shown to them in their time of need.
When these people I will refer to as the The Called give to others they do it on a scale of one to many but when they themselves are in need of support it seems they have given so much of themselves that to be effective in our support of them it takes may to one. I hope there are enough people out there with memories to take up that challenge and give back what you have received.
Even I in my amateurish way know I have touched the lives of a few people when my experience and dare I say it, wisdom, was required. So " You Go Girl".


Some people don’t have problems to idolize the others. That’s why I’m doing an introduction design.
I don’t have problems to idolize people’s work instead. Maybe it’s because an object can pretend, be similar, and tend to perfection, whether an human being, as much as it could express kalokagathia, it will always be made of mud, it will always be corrupted.
It’s with this disenchanted preface that I want announce this series of articles about design, art, maybe cinema and culture… who knows, it’s better being unpredictable in life, or not?
I’ll try, of giving you as a certainty originality and love for what I’m doing. I’ll take you with me in enchanted worlds of mechanisms, polymers, mortise, worlds of glass and carton, to make you admire what can be human creative flair.
That creativity who stands near divine sense, the act of creation who gets you nearer to the creator.
The most fun part of this mumbling is that, in fact, everybody creates something, in one moment or another, with our ideas, words, actions, reactions, compositions, accidents, all things that belong to us, that are linked to us, but invisible in their creation. So, as a plant, we do. Man of technology but attached to hearth, to their origin, because necessary part our being.
An object is, instead, a simple organic material, who has being created, but that can’t be destroyed from humans touch. Don’t you think it’s amazing? How something unoffensive, beautiful, who can have a soul, but can’t have an existence. A poetry, a melody, a study, something instinctive, or all this thing together. All that we need.
But it’s difficult to perceive the sublime from an object, isn’t it? When we see a cascade, the sea, a mountain. Than that’s sublime. But also a painting can be sublime. What’s the difference between a lamp and a portrait?Emotion.That’s the difference. Objects made to work and not to enhance our life experience, from those we won’t perceive the sublime. That’s why I’ll try to choose objects that transmit something, whether they’re beautiful, util, functional, or an experience by themselves. But overall I’ll choose object and architectures that i love, so don’t be offended if I’ll look ridiculous sometimes.
Have a good journey through life.


Guidelines Live 2019 was a great success—what were the best bits from the most popular clinical streams?
The sessions in the cardiovascular stream covered hypertension, tailoring antithrombotic protection in cardiovascular patients, and the ABC cardiovascular plan. The NHS Long term plan has set ambitious targets for reduction in cardiovascular disease (CVD) over the next 10 years. The CVD prevention strategy is focused on the detection and treatment of high-risk conditions including atrial fibrillation (AF), raised blood pressure, and cholesterol—termed ‘the ABC of CVD’. The key messages from the three sessions were aligned to this core theme.
The session on hypertension focused on the recently updated NICE hypertension guideline, which recommends that people aged under 80 years with an initial clinic blood pressure (BP) between 140/90 mmHg and 180/120 mmHg and subsequent ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) of 135/85 mmHg or higher should be considered for treatment. Those aged 80 and over should be considered for treatment if their BP is over 150/90 mmHg.
Tailoring of antithrombotic protection in people with existing cardiovascular disease was discussed, with emphasis on the importance of considering the addition of low-dose rivaroxaban therapy to standard secondary prevention therapy in people with coronary artery disease or symptomatic peripheral arterial disease who are at high risk of ischaemic events.
The talk on ABC cardiovascular plan focused mainly on the ‘A’ and ‘C’ elements: AF and cholesterol. There is a need to reduce the burden of AF-related stroke by seeking to find those with AF who are undiagnosed, offering anticoagulation to those at high risk of stroke, using the correct dose of anticoagulant therapy, and monitoring ongoing treatment. In people taking lipid-lowering therapy for both primary and secondary prevention of CVD the aim should be to lower non-HDL cholesterol by more than 40%.
The three presentations on acne, psoriasis, and pharmacist-led eczema clinics in primary care had in common their use of different guidelines, which each shared remarkably similar aims and cross-speciality working. Another similarity was the emphasis on anti-inflammatory therapy and, where possible, avoiding the use (and certainly overuse) of antibiotics.
The session on acne focused on how topical retinoids are fundamental to the treatment of all types and severity of acne and should be tailored to treat inflammatory papules and pustules only for as long as the inflammation persists.
In psoriasis, a full clinical assessment is required because of the connection between the skin manifestations and the systemic inflammation in blood vessels, joints, and metabolic system, not least to identify significant and treatable arthritis, which may need early referral to prevent permanent damage.
The session on eczema highlighted the role of the practice pharmacist in the management of eczema and how pharmacists can support patients to manage their condition as well as bringing cost savings to the practice.
The diabetes stream included sessions covering different aspects of the management of diabetes including supporting patients with dietary choices, adapting management in frailty, and the guideline recommendations about pharmacological management.
The talk on dietary management focused on how to help patients understand the impact of their dietary choices with the use of infographics that show how common foods affect blood sugar compared with a teaspoon of table sugar. Careful dietary management can lead to drug-free diabetes remission, which in turn can help to reduce diabetes drug spend for the practice.
Frailty is a serious but manageable complication of diabetes and this session covered how to assess frailty, understand the impact of frailty on those with diabetes, and manage diabetes in line with the individual’s frailty status, including the practical implications on targets, treatment choice, and de-intensification.
The final session in the diabetes stream provided an overview of guidance on the pharmacological management of type 2 diabetes, highlighting key similarities and differences between the different guidelines. The session also included practical advice on how practice pharmacists can support management of patients with diabetes to improve clinical outcomes and reduce GP workload.
Antibiotic stewardship and resistance was the theme of the first two talks in the infection stream, starting with the startling fact that over 20% of Escherichia coli urinary tract infections are resistant to co-amoxiclav and that the number of resistant bloodstream infections has increased by 32% over a 4-year period. Another useful tip was that certain antibiotics, including nitrofurantoin, don’t reach high levels in the kidneys and therefore should not be used for pyelonephritis, even if the infecting organism is sensitive to them.
The theme of antibiotic resistance continued in a presentation from a representative from Antibiotic Research UK who presented case studies of patients with multiply resistant infections. There was plenty of practical advice and the offer of help for patients who could be signposted to Antibiotic Research UK for individual help, or given one of their downloadable leaflets.
The next talk was on sexually transmitted infections (STIs) and HIV. We were reminded that all London GPs are in an area of high or very high HIV prevalence and that tests should be considered for every patient, particularly if there is an indicator condition or a suggestion of seroconversion. New guidelines for chlamydia were covered, as well as the less well-known infection Mycoplasma genitalium, and the difficulties of helping patients to access sexual health services that are increasingly unavailable.
The last talk was from a GP who has had Lyme disease and subsequently sat on the NICE guideline development group. While steering clear of the controversial topic of chronic Lyme disease, the presentation included a very useful and easy-to-follow guide about when to suspect Lyme disease, how to investigate it, and when to continue investigating despite an initial negative test. Treatment was also discussed as well as use of the NICE guideline algorithm to guide management.
The women’s health stream covered three very topical areas— contraception, menopause, and heavy menstrual bleeding (HMB).
The talk on contraception focused on the recent FSRH guidelines on combined hormonal contraception, and overweight, obesity, and contraception. This included the reminder that some contraceptive methods become less effective at a certain body weight rather than body mass index (BMI), so a tall patient may run into problems at a BMI lower than might be expected.
The session on the menopause inevitably discussed the problem of supply of hormone replacement therapy (HRT) and how our prescribing decisions may be guided more by what is available than anything else. The talk made it clear that the menopause is a clinical decision, with blood tests not being useful in those aged over 45 years, and that vaginal oestrogen is very low risk and can be used on a long-term basis.
A joint talk between a pharmacist and GP covered the topic of HMB. The NICE guidance makes it clear that not all women will need investigations, but those with risk factors or concerning symptoms in the history should go straight for a hysteroscopy rather than a scan first. A lively debate followed about the role of pharmacists in primary care for the initial assessment of women with HMB.