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Blood cancers are the fifth most common group of cancers in the UK. But for a small number of people, the condition may have an inherited genetic cause. In this episode of Behind the Genes, we explore the role of genetics in blood cancer, and what an inherited risk means for patients and their families. Our guests explain what blood cancer is, how inherited factors can increase risk, and why multidisciplinary teamwork is key to supporting families. They also look ahead to future advances, from whole genome sequencing to prevention trials. Our host Amanda Pichini, Clinical Director at Genomics England, is joined by: Dr Katie Snape, Principal Clinician at Genomics England and Consultant Cancer Geneticist Bev Speight, Principal Genetic Counsellor Dr Sarah Westbury, Consultant Haematologist “By doing whole genome sequencing we get all of the information about all of the changes that might have happened, we know whether any are inherited, but importantly, we're certain of the ones that have just occurred in the cancer cells and can help guide us with their treatment.” You can download the transcript or read it below. Amanda: Hello, and welcome to Behind the Genes. Sarah: When we think about blood cancers, it's a whole range of different conditions and when you talk to patients who are affected with blood cancers or are living with them, their experiences are often really different from one another, depending in part on what kind of blood cancer they have. We also know that blood cancers affect not just the cell numbers but also the way that those cells function, and so the range of symptoms that people can get is really variable. Amanda: I am your host, Amanda Pichini, clinical director at Genomics England and genetic counsellor. Today I'll be joined by Dr Katie Snape, principal clinician at Genomics England and a consultant cancer geneticist in London, Bev Speight, a principal genetic counsellor in Cambridge, and Dr Sarah Westbury, and haematologist from Bristol. They'll be talking about blood cancers and the inherited factors that increase blood cancer risk. If you enjoy this episode, we'd love your support, so please subscribe, rate and share on your favourite podcast app. Let's get started. Thanks to everyone for joining us today on this podcast, we're delighted to have so many experts in the room to talk to us about blood cancer. I'd love to start with each of you introducing yourself and telling us and the listeners a little bit about your role, so, Sarah, could we start with you? Sarah: Sure. It's great to be here. My name's Sarah Westbury, and I'm a consultant haematologist who works down in Bristol. And my interest in this area is I'm a diagnostic haematologist so I work in the laboratories here in the hospitals, helping to make a diagnosis of blood cancer for people who are affected with these conditions. And I also look after patients in clinic who have different forms of blood cancer, but particularly looking after families who have an inherited predisposition to developing blood cancer. And in the other half of my job, I work as a researcher at the University of Bristol. And in that part of my job, I'm interested in understanding the genetic basis of how blood counts are controlled and some of the factors that lead to loss of control of those normal blood counts and how the bone marrow functions and works. Amanda: Thank you. That's really interesting, we'll be looking forward to hearing more about your experience. Bev, we'll come to you next. Bev: Thank you. Hello everyone, I'm Bev Speight, I'm a genetic counsellor, and I work at Addenbrooke's Hospital in Cambridge. I work with families with hereditary cancers in the clinical genetic service, and for the last six years or so have been focused on hereditary blood cancers. So we've been helping our haematologists across the region to do genetic tests and interpret the results, and then in my clinic seeing some of the onward referrals that come to clinical genetics after a hereditary cause for blood cancer is found. I'm also part of the Council for the UK Cancer Genetics Group. Amanda: Thank you, Bev. And Katie, over to you. Katie: Hello, I'm Katie Snape. I'm a genetics doctor and I am a specialist in inherited cancer. So we look after anyone who might have an increased chance of developing cancer in their lifetime due to genetic factors. I am the chair of the UK Cancer Genetics Group, so that's a national organisation to try and improve the quality of care and care pathways for people with inherited cancer risk in the UK. And I have a special interest in inherited blood cancers through my work at King's College Hospital, I work in the haematology medicine service there seeing individuals who might have or have been diagnosed as having an inherited component to their blood cancers. So it's great to be here. Amanda: Excellent, thank you for those introductions. I'd like to then dive right in and understand a little bit more about blood cancers. So, Sarah, could you tell us a little bit more about what blood cancer is? Sarah: Yes, sure. The term blood cancer is used to describe a whole range of different kinds of cancer, all of which affect some part of the blood or sometimes parts of the immune system that kind of gets represented as part of the blood. So it's really describing a big group of conditions rather than one single kind of condition or entity itself. But like any form of cancer, we understand blood cancers as being conditions where because cells as part of the blood system are rapidly dividing and normally doing so under really well controlled circumstances to produce just the right balance of blood cells and just the right number of those cells. In a cancer affecting those cells, we see that that loss of control results in either too many of one type of blood cell being produced or too few, or that balance being lost. And like any form of cancer, this is because of genetic changes that happen in individual cells that then go on to grow in a way that is not controlled and well regulated. And because when we talk about blood cancer we're talking about such a wide range of different kinds of cancer affecting different cells within that blood system, there's a really wide range of different conditions. From conditions that we might think of as being like a form of acute leukaemia, so something that produces often symptoms and signs in patients very quickly and they can often feel quite unwell quite soon and then get picked up with having this condition because they present feeling unwell. All the way to chronic and slow growing cancers that can be found completely by chance and serendipity when blood tests are done for other reasons. So when we think about blood cancers, it's a whole range of different conditions. And when you talk to patients who are affected with blood cancers or are living with them, their experiences are often really different from one another, depending in part on what kind of blood cancer they have. We also know that blood cancers affect not just the cell numbers, but also the way that those cells function. And so the range of symptoms that people can get is really variable, again depending on which of the blood cells are really affected by that. And it may be that during the course of some of the conversations we have today in this podcast, we'll perhaps focus on particular kinds of blood cancer. But like any cancer, it's that disruption of the normal growth and development of cells that means that the number and function of those blood cells has been disrupted in some way. Amanda: Thank you so much for explaining that, Sarah, that's really helpful. In terms of across the range of blood cancers, is that something that people can get at any age, and how common is it? Sarah: It does depend, as we were sort of talking about that really wide range of different disorders that make up that group of blood cancers. And individually each of those blood cancers is reasonably uncommon compared to cancers that we might typically think of, like breast cancer or colon cancer. But actually, if you group blood cancers together, they make up quite a sizeable proportion, and they're actually as a group the fifth most common form of cancer that's diagnosed in people in the UK. In adults in particular we think that perhaps people diagnosed with leukaemia would make up about 3% of the new diagnosis of cancer made in any year. Amanda: So coming to you, Bev, when we talk about inherited blood cancers, what are the differences between those and blood cancers more generally? Bev: So at point of diagnosis, it may not be obvious that somebody with a new blood cancer diagnosis is one of the minority of people in that big group as Sarah has described, who has an inherited cause. So it may not be immediately obvious. However, in the last few years certainly, it's become more and more routine to do quite broad genetic testing. Often on a bone marrow sample or blood, because that is done looking for genetic changes, which are part of all cancer and we find within cancer cells, that can help with treatment planning. It can also find that there is an inherited cause to that new blood cancer diagnosis. Sometimes that might not be clear cut, sometimes that might be inferred from the genetic tests that are done on the blood or the bone marrow. And the proportion of blood cancers in that huge group which do have an inherited cause is fairly small, the actual proportion will depend a bit on the age of the patient and the specific subtype of blood cancer. Amanda: Okay, and could you talk us through how some of those inherited genetic factors can increase the chance of a person developing blood cancer, how does that work? Bev: Yes, so if we know that there is an inherited cause for blood cancer, then what we mean by that most of the time is that a change in a single gene has been found. And that there is enough research evidence and enough known about that specific change in that gene to say to the person who's been diagnosed, there is at least in part or perhaps a full explanation for why that blood cancer has developed and this could be shared in the family. So at that point it's information that not only has implications for the person in treatment, but also their relatives. Depending on what sort of gene alteration it is and which gene it's found in, there are different inheritance patterns, and that changes the sorts of information that we give about risks for relatives. So for lots of the genetic tests that detect an inherited cause in adults when they're diagnosed, that's most often what we would call an autosomal dominant inheritance pattern. Essentially that means you only need to have one gene alteration which is in that person's normal non-cancerous DNA inherited from a parent and can be passed onto a child. And for people in the family who have inherited this one genetic change, then they are likely to be at increased risk of developing blood cancer. Sometimes with particularly the children's blood cancers, if an inherited cause is found, it can be a different pattern, which we call autosomal recessive. And that's where two gene changes are found and one has been inherited from each parent. So parents might be what we call carriers and have one each just by chance, both have been passed onto a child who has developed blood cancer either in childhood or possibly later on, and that's the pattern we call autosomal recessive. There are other inheritance patterns too. The third one that we come across being X-linked, and so that has a gender component. That's where there's a change on the X chromosome, women have two X's, and men have one X and one Y. So sometimes with the X-linked conditions we're more likely to see the clinical signs of a condition in boys and men because they've only got that one X chromosome. But those are less common in the context of talking about hereditary blood cancers. Amanda: Thank you. That's really helpful to understand. So it sounds like you're saying that these forms of blood cancers that are caused by a single gene are relatively rare. And also by having one of these changes, it's not a given that that person will develop a blood cancer, but it makes them more likely, and how likely that is might depend on the inheritance pattern or the type of condition. Bev: That's right. So what we're saying is it can give either part of full explanation for the blood cancer diagnosis, and it could confer a risk to family members, but that doesn't mean they definitely will develop it. We're talking about an increased risk compared to the population risk. Amanda: Right. I can imagine for those families to some extent it might be helpful to know the underlying reason why they had that blood cancer, but again, that's just a small proportion. So, Katie, could I come to you next? What about the rest of all the blood cancers, how do they occur? Katie: Yes, thanks, Amanda. So most blood cancers will occur just by chance. We also know that there are some environmental factors that can increase the risk of blood cancers, so, for example, serious radiation exposure, something like that. What Bev has described is where there is this sort of quite rare condition where there is a kind of single gene that's really important for the blood cells in terms of keeping those control mechanisms that Sarah described. And that's not working properly, which has increased the risk of a blood cancer. But we also sometimes see some families where there is more blood cancer, or the same type of blood cancer in that family than we might expect by chance. We think that's probably not due to a single high risk genetic factor, but might be due to kind of multiple lower risk genetic factors that are sort of shared by close family members and can add up together to increase the risk a little bit. And we call that familial risk or polygenic risk. We don't have a test for that at the moment. We wouldn't offer usually any extra screening or testing to those families, but we would just suggest obviously family members are aware of any signs of symptoms of blood cancers and seek any advice if they're concerned. But, you know, the majority of blood cancers are not due to genetic factors, and it's sort of environmental or chance or bad luck. Amanda: Okay, so it's clear that obviously blood cancer is almost an oversimplification, within that category there's so many different types, so many ways that it could happen in a person. So, Bev, if we're dealing with that type of blood cancer that is inherited or has some heritability, can you tell us more about what that means for the family? What kind of impacts do you see that having for them? Bev: Yes, of course. So clearly this is another layer of information that's often coming at a family during a time where somebody is often recently diagnosed with blood cancer of one sort or another and is having to take in a lot of information about treatment and all of the uncertainty and anxiety that goes with that. So for this minority of patients and families where there is new information about an inherited cause, that needs conveying in a timely but sensitive way, bearing in mind what else is happening. And for some people it can come as a major shock and really an additional burden at that time. I think the reaction to that will of course depend on lots of factors. And what we also see is that this question about a new cancer diagnosis of any sort, including blood cancers, can generate the question in people's mind, particularly if they've got children, about does this change the risk for relatives? So sometimes this new information that, actually, there is an inherited cause is an answer to a question that families have already got. And that might be because of what Katie's described as familial clustering, there might already have been this known history in the family. So sometimes this information can feed into that and actually be quite a helpful answer. But it's quite normal for families to feel quite mixed about this and for different family members to have a different approach to it. When there's the offer of what we would call predictive testing, if we found a change in a single gene in somebody with blood cancer which we're saying is a hereditary cause for that, that might open the door for relatives to access predictive testing. I.e., the opportunity to discuss and possibly take up a genetic test for themselves when they haven't had cancer themselves, but there's an opportunity to try and quantify whether or not they're at increased risk. We know in families the uptake of those kinds of tests is different, and a lot of it is to do with timing and the way people respond to this in families might depend on their response to the cancer diagnosis in their relative, and of course what else is going on in their life at the time. This aspect for the family is where clinical genetic services come in, because these initial tests in the person with blood cancer are done in their haematology/oncology setting, and normally the results about an inherited cause has been found are conveyed through that service. That's when a referral to clinical genetics happens. And in our specialist service we're addressing those additional concerns for the family which arise because of this diagnosis. Amanda: Thanks, Bev, for explaining that. Sarah, coming back to you. Could you tell me then if someone has an inherited blood cancer does it also change the way that the patient is treated? Sarah: Well, it certainly can do, and again, it does depend a little bit on the specific circumstances of that particular person and the form of inherited blood cancer predisposition that they have. But certainly if we think about treatment as a whole, then for a lot of people it does affect the way that we might recommend treatments or look after them and their families. So, for example, for some patients who have a diagnosis of an inherited form of blood cancer, we know that some treatments might be more or less effective for their particular set of circumstances. And so that can sometimes influence the specific treatment recommendations that we would make, particularly thinking about, for example, the risks that the cancer might come back again after it's been treated. Or thinking about whether or not some of the typical drug regimes that might be used might be perhaps more likely to cause them side effects or problems with tolerating that treatment. So it can certainly make some changes in that respect. For some people, to be fair a minority of people with blood cancers, they may need a stem cell transplant as part of their treatment to hopefully cure them of their blood cancer. And this as I say is a treatment that's required for a minority of patients as a whole who have a diagnosis of a blood cancer. But for those people who have got an inherited predisposition and who might be recommended a stem cell transplant as part of their treatment, then knowing about a familial risk for this condition can also be really important. For making sure that if a family member is being considered as a donor for example that we're being really careful to make sure that we're not choosing a donor that might also be affected by the same underlying blood cancer predisposition. Because this can obviously cause problems for the person that's receiving the stem cells if it turns out that the person they're receiving them from actually has the same inherited condition as them. So in that respect knowing about the underlying predisposition and genetic cause for their cancer can be helpful. But in a more sort of general sense, yes, the other thing that it can have a big difference for is that some of these inherited cancer predispositions and syndromes also have other health conditions associated with them. So it might be that that genetic diagnosis predisposes somebody not only to a form of blood cancer but to other health conditions as well. And so actually knowing about that diagnosis can help their haematologist then make sure that they're linked in with the right other medical teams to make sure that those other health conditions are identified if they're present and taken care of. And then I think really coming back to what Bev has already touched on, there's the sort of bigger picture of just how people are looked after in their own right but also as part of their family unit. And making sure that they're given the right information and advice about their health, but also thinking about other family members. And particularly for younger patients who perhaps either are just starting their own families or for whom that's not yet a consideration, making sure that they've got the information to understand what might be relevant for future family members, if that makes sense. So it's not necessarily true to say that for every individual patient knowing that there's an inherited blood cancer present will necessarily directly affect the way that the treatment is offered. But you can see that as a part of a bigger picture for a lot of patients, it will make a difference to their care as a whole. Amanda: And you can really see how the impact is very sort of multigenerational and is going to affect people at all ages and stages of their life, so that's really interesting. Katie, Bev spoke a little earlier about the fact that there are genetic tests that can help tell us if blood cancer is inherited. Could you tell us more about what the tests involve, and some of your experience taking families through this? Katie: There's sort of two main different ways that we might identify somebody has an inherited cause for their blood cancer through testing. So traditionally what has happened, as Bev and Sarah sort of discussed before, is that when a person is diagnosed with a blood cancer, we either take a sample of their blood or bone marrow. To try and look at what are the changes within those cells that have driven that cell to become a cancer cell and have driven this blood cancer to develop. And a lot of the time, as we've said, it's not inherited, it's not genetic, so they're what we call acquired changes, they're changes that have just happened in the bone marrow or to the blood cells that have caused that kind of particular cell to become a cancer cell. And it's really important that we look at those because that can help both diagnose the blood cancer, it can give us information about how serious that blood cancer might be, and it can also help us guide our treatments and therapies. And so if we do those testings, they're primarily done within haematology for those sort of diagnostic or prognostic or treatment purposes. We do sometimes see then a change that looks a bit suspicious that it might be inherited for various reason. And if we see something that is in the cancer and it looks like there's a potential it could be inherited, we would go on and do a second test. So usually because we can't do a blood test because the cancer's in the blood, we would take a skin biopsy. And then we would look and see, well, is this change also present in the skin? And if it is, then that indicates that that change is in all of the cells of the body, because it's in both the blood cancer and it's in the skin, and therefore it's likely to be inherited. So that's one thing that we do. And I think that that can be quite challenging for patients. Because they go in to have a test for their blood cancer and then suddenly were being told, “Well, actually, we've also found something that might be inherited,” and it is something then that other members of the family might have. And as Sarah said, potentially that means that even if your relative was offering to be a bone marrow donor for you, they might not be able to if they also carry the same thing. And so that can be quite tricky just in terms of making sure that we're guiding the patient and their family members through that process. And then thinking about the work that Genomics England does, particularly with whole genome sequencing, and this is particularly offered for children and young adults in the paediatric setting. But I think we're also increasingly, as we progress we'll perhaps talk about this a bit, moving towards whole genome sequencing for adult blood cancers more routinely as well, that that is offered as a sort of standard of care. And what whole genome sequencing is, is it is looking at the entire genetic instruction manual in both the blood cancer cells and in the cells that we're born with, to look at the inherited or germline genome as well. And the reason that we look at both the cancer cells and the inherited or germline genome is because what we're trying to understand is firstly, are there any inherited changes that have led to the blood cancer developing? But also, what are the changes that have just occurred in the cancer cells that are going to help us to diagnose and treat that blood cancer? So by doing whole genome sequencing we get all of the information about all of the changes that might have happened, we know whether any are inherited, but importantly, we're certain of the ones that have just occurred in the cancer cells and can help guide us with their treatment. And so, again, when we're talking to patients, we have to explain to them that we're going to be looking at their entire genetic information. And what's interesting about that is it might find things that are not only relevant to blood cancer, but very rarely other findings, incidental findings as well, or we might find things that we don't know about. But I think certainly that's something that patients often feel very comfortable with having because it gives them the maximum amount of information. Amanda: Thanks, Katie. So it really sounds like there's a lot of advancements that are being made in genetic technology which potentially brings a lot of new things for you and Bev as genetic specialists, but also for you, Sarah, as a haematology specialist. What does that kind of change for you, and I assume it's really important then for you all to be working together as a multidisciplinary team? Katie: Yes, I mean, I think for clinical genetics, we were not involved in sort of haematology pathways for a really long time, and the haematologists are absolute experts in the genomic factors that drive blood cancers. And certainly in my practice, it's really only been as the technology advanced that we really started finding more and more of these inherited factors, particularly in the adult setting. Because I think in the paediatric and childhood setting, the haematologists again have been managing those conditions very well for years. And I think there's places that we really interface and we really need to work together as a multidisciplinary team, understanding the genetic information, really understanding when something that we've seen in the blood cancer or the bone marrow could be inherited. Do we need to check that? What should that pathway look like? But I think as you've said, a lot of these are actually really quite new conditions, particularly in the adult setting. And we don't yet 100% know why do some people get blood cancer and some people don't when they have the same inherited factor. What's the actual risk? Are there any other factors modifying it? What makes some people progress to develop a blood cancer and some people not? And for that we really need to work together to try and gather the data and sort of capture people that have these inherited changes. And hopefully develop a system and an infrastructure that we can follow it long-term and get a lot of information about long-term outcomes, both for individuals with cancer but also their families. And also from looking at doing population studies. Because I think we know that lots of people in the general population might carry some of these inherited changes and never develop a blood cancer as a result of this, certainly ones that seem a bit lower risk. So we really need to work together to understand all of that. But I'd be really interested in Sarah's views on that as well. Sarah: Yes, sure. So I think, as you say, Katie, haematologists have got a long history of understanding and interpreting genetic findings in the sort of acquired or somatic changes that we know are what occurs in some blood cells to drive the cancer forming in the first place. But this kind of newer integration of that with the germline testing is something that is becoming much more mainstream in haematology now, and I think something that people have had to sort of acquire new skills in this area to interpret that alongside. I think as you say, that multidisciplinary working, where we're able to benefit from both sides of our expertise and knowledge and put that together is so valuable, particularly in those circumstances where there is some uncertainty. And I think as a haematologist, one of the things that I really find a benefit both personally and professionally to help me navigate these tricky questions but that I also think patients benefit from is your expertise and ability to have those really quite tricky conversations with people who are not haematology patients, if that makes sense. So they may be the relatives of patients who have a haematological diagnosis for example. Who at the moment are entirely well and were just going about their daily business, and they're now told that they may or may not potentially have this inherited predisposition. And I think that as haematologists, we're very used to dealing with potentially quite poorly patients, potentially quite scared patients who find themselves, you know, the recipient of all this quite difficult information. But we're not necessarily so skilled and experienced at holding conversations with people who don't yet have that diagnosis. And I think that that's a really rich area of mutual aid to one another as haematologists and genetic doctors, if that makes sense. And I think your points about understanding actually the real risks and the nature history, as we would call it, of what happens to people who carry these variants that predispose them to blood cancers is something that we can probably only work out by working together. And of course, working with the patients and families that are affected by these conditions so that hopefully for both sides in the future we'll be able to give much better advice to patients and their families. Amanda: So, Bev, from your experience and as a genetic counsellor, what do you feel are the important things that patients and their families should know as they're going through this testing and diagnosis process? Bev: The things I think families where there is a hereditary cause found should know is that with this new information comes a whole new referral to a dedicated service. Who want to help patients and their family members at risk to navigate this, to adjust the information, and to make decisions that fit with them, about whether to have testing and the timing of that. As we already said, where there is a hereditary blood cancer risk, that risk in family members is rarely 100%. Depending on what the hereditary predisposition is in the family, we may be able to quantify that risk, sometimes we can't always. And the other thing to know which links to that is that there is growing interest in research in this area. That will really help us to improve care in terms of, for example, being able to quantify the risk of developing a blood cancer in relatives who are perfectly well that may have inherited these predisposition gene changes. Or, for example, the other obvious place where we want to make improvements in terms of some sort of evidence-based surveillance for those people who want to find out that they have inherited the genetic change and are at increased risk. Amanda: Thank you. And overall there's been a lot I think we've been covering today that's probably going to be very new to many people. Why do you think it's important to raise public awareness of inherited blood cancers? Bev: There have been lots of public awareness campaigns about other cancers, as listeners probably can think about, in terms of for women checking their breasts and breast cancer awareness. And perhaps there's been a bit less of that in general for blood cancers. As we've already talked about, clinical genetics were not so involved in all of the genetic testing happening in blood cancers. Because it wasn't so long ago in the history of how we think about inherited cancers in general that our suspicion of inherited causes in leukaemia was much lower than it is now. So I think that awareness in the public probably will take a bit more effort to bring up. But clearly public awareness about blood cancers in general, symptom awareness, and the fact that occasionally it can be something that is running in the family, clearly better public awareness of that means that people are empowered to ask the right questions. And the questions that might already be in some way going through their minds of their haematology doctors or perhaps of their GP, if they've got a family history but are not affected themselves. Amanda: Wonderful. So, looking now to the future, Katie, what genomic advancements are we seeing or are we likely to see that could impact on the care of people with an increased genetic risk of blood cancer? Katie: We touched a little bit, I think that whole genome sequencing is expanding. And as we can turn that test around and get it back more quickly that might become more commonplace. And I know Genomics England and the UK Haemato-oncology Network of Excellence have been doing a lot of work in that area. We are very lucky now we have a national inherited cancer predisposition register that NHS England have set up with the National Disease Registration Service. So that will enable us to capture individuals that have these sort of rarer but single gene disorders or conditions that increase the chance of developing blood cancers. And that will enable us to do that sort of longer-term follow-up and get really more information. We've touched on this already but I think there's really amazing research happening, why do some people develop blood cancers and some people don't, even though everyone carries the same underlying change that increases the risk? And then I think really importantly, we're seeing now in some conditions, clinical trials of certain medications to see if that can actually prevent people who carry these inherited changes from progressing to developing blood cancers. So I think all of those things are really exciting and will give us lots more information that we can then help patients and their families, particularly the sort of treatment and trials aspects. Amanda: And, Sarah, on treatment and trials, how do think genomics might improve the treatment, but also the diagnosis of people with inherited blood cancers in the future? Sarah: I think, you know, hopefully when we are able to accrue more information about these underlying genetic predispositions and how they actually then affect people's likelihood of developing blood cancer, we'll be able to build on what we have so far to make that just feel much more robust and evidence based. And it feels like at the moment there are many of us struggling to bring together small threads of evidence that have been accrued in the UK but in other centres around the world that are also interested in understanding this inherited blood cancer risk. In such a way that we can actually give patients and their families more clear information and advice about what that means to them. And I think that in terms of the diagnosis of blood cancer, I think this is something that Bev alluded to. If we could better understand who might benefit for example from having regular screening or monitoring blood tests performed to see whether we can detect an emerging blood cancer. Versus identifying those people who actually, the chances of them developing a blood cancer are so small that doing those tests is likely to do them more harm than good. Perhaps by just causing them to be anxious or have other sort of unintended consequences of that kind of testing. So understanding something more about that natural history, as we've already alluded to, will hopefully improve our ability to go from the diagnosis of the predisposition condition to working out how to then diagnose the blood cancer on the back of that. And with time, I think as Katie has alluded to, thinking about more specific treatments and more tailored treatments to the individual predisposition condition and the blood cancer. So whether it's that you're intervening before the blood cancer has developed to try and reduce that happening, or whether it's that you're then treating the blood cancer after it's developed. Understanding the genetic basis and what it is that causes that transition would be really helpful and I think that is something that will come but will take time. And I think on a sort of national level what I would really hope to see over time is that we're able to use that improvement in evidence base to then be able to bring together perhaps more defined patient pathways. So that if you're diagnosed with a particular condition, one of these leukaemia predisposition syndromes or another form of blood cancer predisposition, there's a recognised strategy and set of steps that should be taken for all of those patients. To make sure that they're getting equity of care and make sure that everything is being done in a way that feels safe, sensible and appropriate across the country. While still then enabling us to give really personalised treatment to that individual person and what that diagnosis means for them. But I think until we've gathered more information and more evidence we are just in the process of trying to do that to then bring about those changes. Amanda: If you enjoyed today's episode, we'd love your support. So please subscribe, share and rate us on wherever you listen to your podcasts. I've been your host, Amanda Pichini. This podcast was produced by Deanna Barac and edited by Bill Griffin at Ventoux Digital. Thank you for listening.
A Vancouver born native, Chef David Speight fell in love with our industry as most of us have, out of need and then finding purpose and meaning in the cooking and hospitality. After cooking and running some larger restaurant operations, he was presented with the opportunity to run the behemoth that is GM Place and did so successfully at the same time that the Canucks had their best years. Coincidence, I don't think so. Then he left for the biggest challenge of his career, running all the food operations at the University of British Columbia, with potentially 70000 people eat everyday. His passion for food security, potential food waste and sustainability has put his at the forefront of Chefs who are feed ing so many people and considering all factors involved with that process, not just the cooking. I hope you enjoy our chat.Send us your feedback
We catch up with the 2017 Young Farmer of the Year and the host of this afternoon’s Southern Storm Shout at the Woodhead farm at Lovell’s Flat (halfway between Milton and Balclutha). The Emerson’s Tiny Pub and Speight’s Bar will be in attendance, sharing the love, and Silver Fern Farms is in charge of the barbecue.See omnystudio.com/listener for privacy information.
A lot of "theologians" these days love to point out the "complicated" verses of scripture at the expense of clear ones; and a lot of Christians tend to grab ahold of one single verse or passage in order to back their belief. Thankfully, the Bible has built in keys to help prevent against these fallacies.
Andy presents a "Personal Worship" series tie-in by taking a look at the pillar of cloud & fire and it's practical elements to us on moving when God is moving and staying when he wants us to wait.
In this episode of GardenDC: The Podcast about Mid-Atlantic Gardening and Beyond, we talk with Teri Speight all about inspiring Black flower farmers and florists. The plant profile is on the Katsura Tree and we share what's going on in the garden as well as some upcoming local gardening events in the What's New segment. We close out with the Last Word on "Spud-tacular Crafts" from Christy Page of GreenPrints.If you liked this episode, you may also enjoy listening to:~ GardenDC Podcast Episode 66: Small Space Gardeninghttps://washingtongardener.blogspot.com/2021/07/gardendc-podcast-episode-66-small-space.html~ GardenDC Podcast Episode 5: Horticultural Storytellerhttps://washingtongardener.blogspot.com/2020/04/gardendc-podcast-episode-5.html~ GardenDC Podcast Episode 253: The Flower-to-Vase Movementhttps://washingtongardener.blogspot.com/2025/08/gardendc-podcast-episode-253-farm-to.htmlBTW, YOU can become a listener supporter/subscriber at: https://creators.spotify.com/pod/show/gardendc/subscribeYou can order Teri's book Black Flora at https://amzn.to/4p6gWnq (Note that is an affiliate link.)Show Notes will be posted after 11/25/25.We welcome your questions and comments! You can leave a voice mail message for us at: https://podcasters.spotify.com/pod/show/gardendc/message Note that we may use these messages on a future episode.And be sure to leave us a 5-star review on your favorite podcast platform plus share us on social media with #GardenDC, so other gardeners can find us too!Episode Credits:Host and Producer: Kathy JentzInterview Edit and Show Notes: Cavit IrelandMusic: Let the Sunshine by James MulvanyRecorded on 11-15-2025.
In this episode, we discuss maintaining a creative career, living with a debilitating autoimmune disease and adventures in Japan.Tom Speight is a British singer-songwriter. He is best known for his albums Everything's Waiting For You and Love & Light, both of which reached the Top 75 of the UK Albums Chart.If you want to contact the show to ask a question and get involved in the conversation, then please email us: unquestionablepod@gmail.comFind us here:Twitter: @unquestionpodInstagram: @unquestionablepodTik Tok: @unquestionablepodFacebook: @unquestionablepodcastYoutube: @unquestionablepod Hosted on Acast. See acast.com/privacy for more information.
Empathy. Innovation. Humanity. Three words that define the kind of leadership shaping the future of every industry, especially healthcare.In this episode of Ingenious Thinkers, host Ken Tencer speaks with Dr. Jane Speight, a leader who reminds us that progress is never just about technology or policy, it's about people. Her work is a testament to how understanding human experience can drive change that lasts, not just within systems, but in lives.This conversation invites listeners to reflect on how we define “care,” and how empathy and evidence can coexist to create a more balanced, sustainable approach to innovation. It's about slowing down to ask better questions, about what matters most and who we're designing for.
Diabetes is costing record numbers of Kiwis toes, feet and legs. More than 1200 lower-limb amputations were performed last year alone. Those with type two diabetes - about 95 percent of the diabetes population - are most affected. Diabetes Special Interest Group Head, Simon Speight, says GPs focus on managing symptoms to reduce the need for surgery. "Whether it's the sugar levels, the blood pressure, the cholesterol - just trying to get those levels sorted out right from the get-go, because if any of those proceed 20, 30, 40 years later down the track, that's when these things can happen." LISTEN ABOVESee omnystudio.com/listener for privacy information.
Una catastrofe di H. G. Wells tempo di lettura: 12 minuti La piccola bottega non faceva affari, anzi puzzava di liquidazione. Winslow non era uomo capace di fare i conti, ed intravvide la realtà poco a poco, benchè ne avesse sempre avuto il presentimento, e fu un cumulo di circostanze che fece nascere in lui la persuasione di essere alle porte del fallimento. Innanzi tutto che cosa ci stavano a fare quelle quattro pezze di tela? Ne aveva venduto cinquanta centimetri in tutto! E quell'altra stoffa da quaranta centesimi al metro, quella stessa che Bandersnach, il negoziante della Via Larga, vendeva a venti centesimi! Al disotto del prezzo di fabbrica? Certamente doveva rimetterci! Bandersnach poteva bene lasciar vivere il prossimo! E quei berretti che ci stavano a fare? Nessuno li voleva! Sfido io, c'era una sola misura di testa! Ed allora si rammentò del conto aperto coi negozianti all'ingrosso Helter, Skelter e Compagni…. A quanto ammontava quel conto?… Quando ci pensò, Winslow stava al banco con uno scatolone verde fra le mani, ed i suoi occhi bigi si allargarono smisuratamente, ed i suoi baffi arruffati parvero arruffarsi ancor di più. Egli aveva rimandato il pagamento di quel conto da un giorno all'altro!… Si allontanò dal banco per recarsi allo scrittoio che gli serviva da cassa. (Aveva per sistema di rilasciare al banco una tessera ai compratori, poi di correre alla cassa e ritirare i denari quasi non si fidasse della propria onestà). Osservò il calendario affisso al muro e facendovi scorrere sopra le magre dita: «uno, due, tre…. tre settimane ed un giorno? – disse fra sè. – Solamente tre settimane ed un giorno! Pare impossibile!» — Il thè è pronto, – disse la signora Winslow aprendo la porta a vetri della retrostanza. — Ora vengo, – rispose il negoziante, e girò la chiave nella serratura dello scrittoio. In quel mentre entrò in bottega un vecchio signore dall'aspetto scortese e brontolone, con un viso rosso rosso, tutto imbacuccato in un ampio mantello di pelliccia. — Uff! – esclamò il cliente, – un fazzoletto! — Benissimo, di che prezzo signore? — Un fazzoletto, e spicciatevi! Winslow alquanto turbato presentò ed aprì due scatole: — Ecco, signore. — Sono di latta i vostri fazzoletti, – esclamò l'altro tastando la tela. – Come si fa a soffiarsi il naso con questa roba! — Forse il signore desidera un fazzoletto di cotone? — Quanto costa? — Quaranta centesimi, il signore non desidera altro? — Andate al diavolo! – rispose il vecchio frugandosi nelle tasche e tirandone fuori uno scudo. Winslow cercò cogli occhi il libro di cassa che non era mai in un posto ben determinato, ed i suoi sguardi s'incontrarono con quelli del vecchio signore che andò difilato alla cassa, prese il resto ed il fazzoletto, uscì, non senza aver manifestato ad alta voce il suo sdegno contro le volgari abitudini di quella bottega. Winslow si rianimava ogni qualvolta entrava qualche cliente; ma il cassetto aperto gli ravvivò le sue inquietudini. Ad un tratto udì battere alcuni colpi contro i vetri della porta, alzò gli occhi, e vide sua moglie. Essa gli offriva un rifugio! Chiuse lo scrittoio, girò la chiave del cassetto, ed entrò nella retrostanza per bere il thè. Nondimeno egli era assai preoccupato: tre settimane ed un giorno! Contro ogni sua abitudine mangiò avidamente alcune fette di pane imburrato e rimase collo sguardo fisso sul vasetto di conserve. Minnie, sua moglie, cercava di intavolare il discorso, ma egli rispondeva distrattamente. L'ombra di Helter Skelter e Compagni sorgeva dalla tavola da thè, ed egli era alle prese con quell'idea nuova di fallimento, di liquidazione, che prendeva forma e corpo! Oramai era nè più nè meno un fatto concreto; alla Banca rimanevano trentanove sterline, e fra tre settimane ed un giorno Helter e Compagni gliene avrebbero chieste ottanta! Dopo che ebbe sorbito il thè, entrarono in bottega due o tre clienti per fare acquisti di poca importanza: dei bottoni, qualche nastro di cotone, un paio di calze. Allora Winslow temendo che i cattivi pensieri si nascondessero minacciosi in qualche canto della bottega, accese assai prima di notte le lampade ed incominciò a piegare alcune pezzuole di tela, lavoro puramente meccanico, richiedente uno sforzo più fisico che morale. E l'ombra di Minnie, nella retrostanza, girava intorno alla tavola. La buona donna era occupatissima nel rivoltare una vecchia veste. Dopo pranzo, Winslow uscì per fare due passi, e quando tornò a casa la moglie era già a letto. Qui l'aspettavano i suoi nemici, i cattivi pensieri, che lo perseguitarono tanto bene, che a mezzanotte il sonno sparì. Aveva già avuto per due o tre notti una tale compagnia; ma questa volta la cosa fu assai più seria. Prima di tutto gli si fecero innanzi i signori Helter, Skelter, Grab e Compagni col conto di ottanta sterline, una somma colossale per chi ha incominciato con un capitale di settanta sterline. E questi signori sedettero a lui davanti e lo assediarono di domande. Ed egli cercava scuse e pretesti. Se facesse una vendita di liquidazione? E si sforzava d'immaginare una vendita meravigliosa con un incasso altrettanto meraviglioso, malgrado il grande ribasso. Ma ecco che la ditta Bandersnach (101, 102, 103, 105, 106, 107, Via Larga) si univa agli assedianti. Ed egli vedeva la lunga facciata del negozio e gli articoli che erano venduti con un guadagno irrisorio. In che modo lottare contro una ditta simile? D'altronde egli stesso che cosa poteva vendere? Incominciò a far l'inventario delle mercanzie. Che cosa si poteva dunque mettere in vista per far fruttare la vendita? Ed ecco presentarsi alla sua povera mente un mucchio disordinato di tele bianche, gialle, e nere, a fiori, tutte sgualcite, guanti macchiati e vecchi a furia di stare in negozio, e mille altre cose di mercerie ridotte oramai in uno stato poco presentabile. Non vi era alcuna speranza! Nulla contro i suoi implacabili creditori! Come mai poteva supporre che un cliente qualsiasi comprerebbe simili fondi di bottega! Perchè aveva egli comprato quegli articoli piuttosto che altri assai più utili? Ed il suo odio contro Helter Skelter e Compagni aumentava sempre più…. E poi che bisogno vi era di una cassa, e delle lampade che aveva pagato cinque sterline? Poi ad un tratto provò un acuto dolore rammentandosi che doveva pagare ancora il fitto della bottega! Diè un gemito e si avvoltolò nel letto. Innanzi agli occhi confusamente, nel buio, si disegnava la massa bianca delle spalle della signora Winslow. Quella vista fece cambiare direziono a' suoi pensieri. Come! egli era lì, torturato dagli affari, ed essa dormiva come un fanciullo. Si pentì di averla sposata, e la sua amarezza era infinita, come quella che prova il cuore umano specialmente nelle prime ore del giorno. Quella che dormiva a lui vicino non gli era di nessun aiuto, era un peso, una responsabilità. Che follia era stata la sua di averla sposata! Il placido sonno di Minnie lo irritava a tal segno che avrebbe voluto svegliarla per gridarle: Siamo rovinati! Essa avrebbe dovuto, allora, andare a stare da uno zio, da quello zio che non aveva fatto nè avrebbe mai fatto nulla per lui! Egli vedevasi elemosinando il pane, chiedendo in ogni negozio un impiego da garzone, oppure scrivendo innumerevoli lettere, egli che aborriva lo scrivere lettere: «Signore, leggendo l'avviso che avete fatto pubblicare nel *Mondo Cristiano*, ecc., ecc.» e vedeva una serie di inquietudini e di disillusioni e come fine: nulla, nulla, un baratro! . . . . . . . . . . . . . . . . . . . . . . . . . . . Winslow si vestì sbadigliando, poi andò ad aprire il negozio; si sentiva stanco prima ancora che la giornata incominciasse. E mentre toglieva le imposte domandava a sè stesso a che cosa potesse essere utile tutto ciò che faceva in quel momento. La luce penetrava nel negozio, e con la luce penetrava la realtà. Infatti quale bottega! Il pavimento mezzo rotto, il banco in pessimo stato…. miseria…. fallimento! E dire che da sei mesi egli aveva sognato un piccolo negozio civettuolo, ed un modesto ma sicuro guadagno nella cassa! Ed ecco che ad un tratto si svegliava da questo sogno. ….Il saliscendi della porta scucì una falda del suo abito, e quell'incidente lo fece andare su tutte le furie, rimase un po' indeciso, quindi diè colla mano un altro strappo all'abito e si recò da Minnie. — Ecco, – disse in tono di rimprovero, – potreste badare un po' di più agli abiti di vostro marito. — Io non aveva visto che era strappato. — Voi non vedete mai nulla, – rispose Winslow assai ingiustamente, – oramai è troppo tardi! — Se volete, ricucirò subito. — Facciamo colazione prima di tutto, e fate le cose al loro tempo. A colazione egli fu preoccupato e Minnie l'osservava ansiosa. Parlò solamente per dire che le uova erano pessime. Quelle uova non erano cattive, puzzavano solamente un po' (diamine, costavano uno scellino la quindicina), ma erano mangiabili. Winslow allontanò brontolando il piatto, mangiò una fetta di pane imburrato e ricominciò a pigliarsela colle uova. — Amico mio, – disse Minnie, quando egli si alzò da tavola per tornare in bottega, – voi siete ammalato. — Io sto benissimo, – rispose Winslow lanciando alla moglie uno sguardo pieno di odio. — Allora vi è qualcosa. Siete forse in collera per lo strappo? Dite ciò che avete! Voi eravate di cattivo umore anche ieri al thè ed a pranzo, eppure non era per lo strappo! — Ed ho ragione di essere in collera. — Ma che cosa c'è dunque? L'occasione era troppo bella per lasciarla sfuggire, e con una brutalità drammatica Winslow rispose: — Che cosa c'è! Ah! che cosa c'è?! Ho fatto tutto quello che ho potuto e se non posso pagare ottanta sterline a Helter, Skelter e Compagni fra tre settimane…. E tacque un momento, poi ripigliò: — Ebbene, saremo perduti…. perduti! Ecco che cosa c'è, perduti! — Oh! per carità, – esclamò lei. Winslow chiuse la porta violentemente. Egli si sentiva alleggerito almeno della metà del suo dispiacere. Ed incominciò a spolverare delle scatole che non avevano alcun bisogno di essere spolverate, poi ripiegò delle pezze di tela che erano già perfettamente ripiegate. Era il destino che lo rendeva di quell'umore da cane, perchè non era la sua poca energia la causa di tutto ciò, neanche per sogno! Non aveva forse egli fatto, Dio mio, tutti gli sforzi possibili, tutte le combinazioni immaginabili per salvarsi? E tutto ciò per giungere a questo stato! Un orribile dubbio gli traversò la mente: non vi era dunque più Provvidenza se esisteva un Bandersnach…. o forse era una dura prova che Iddio gli mandava? Questa idea lo consolò moltissimo e s'immaginò in tutta la mattinata di essere un martire del destino. A pranzo, un piatto di patate diede il tracollo a quel disgraziato. Alzò gli occhi improvvisamente, e vide Minnie che lo guardava. Essa era pallida, cogli occhi rossi. Fu commosso, gli si serrò la gola, le sue idee s'ingarbugliarono e presero un'altra direzione. Allontanò il suo piatto e fissò sua moglie, poi si alzò, si avvicinò a lei e le s'inginocchiò innanzi esclamando: — Oh Minnie!… Ella capì subito che era venuta l'ora della riconciliazione, l'abbracciò strettamente mentre egli singhiozzava. E singhiozzava come un fanciullo, dicendo ch'era stato un miserabile d'averla sposata, d'averla condotta alla rovina, che non meritava neppure un soldo di credito, che tutto era colpa sua, e che aveva avuta troppa fiducia in sè stesso! E le sue frasi finivano con un urlo. Minnie piangeva, ma silenziosamente, e gli batteva una mano sulle spalle adagio adagio ed andava ripetendogli: «Caro mio, caro mio!…» per calmarlo. Ad un tratto si udì suonare il campanello del negozio. Winslow si alzò di botto e si ricompose. ….Dopo quell'incidente, al thè, a pranzo, a colazione, a letto, parlavano sempre della loro situazione, seriamente, senza concludere nulla, collo sguardo fisso nel vuoto; ma confortati della loro reciproca confidenza. — Che fare? Non lo so! Era l'eterno ritornello di Winslow. Minnie, benchè in procinto di essere madre, faceva di tutto per essere gaia; ma aveva bisogno di tutto il suo coraggio e di tutta la sua energia. Chi lo sa! Lo zio le verrebbe in aiuto nel momento critico. A nessuno conviene l'essere troppo superbo! D'altronde, «qualcosa poteva succedere!» era la sua frase favorita. E speravano, e calcolavano sopra una vendita eccezionale. — Forse, diceva Minnie, – potrete raggranellare cinquanta sterline. Vi si conosce abbastanza per farvi un po' di credito. E discutevano in proposito. Ammessa la possibilità di una proroga accordata da Helter, Skelter e Compagni si sentivano incoraggiati a guadagnare la somma indispensabile. L'indomani, dal giorno in cui Winslow aveva confessato tutto, essi furono quasi totalmente rasserenati, ridevano delle loro inquietudini esagerate! Anche venti sterline, come punto di partenza sarebbero bastate! Ma ad un tratto, non so come, la speranza che Helter e Compagni potessero accordare la proroga, svanì; e Winslow precipitò nel baratro della disperazione. Diè un'occhiata ai mobili chiedendo a sè stesso quanto potevano valere. La credenza in ogni caso era in buono stato e vi erano vecchi piatti che Minnie aveva ricevuto in dono dalla madre sua. Poi gli balenarono in mente dei mezzi straordinari per allontanare il giorno maledetto. Aveva sentito parlare di vendite all'incanto, e queste parole, vendite all'incanto, lo rassicuravano. D'altronde perchè non chiedere aiuto ad uno strozzino? Un fatto che lo incoraggiò maggiormente accadde nel pomeriggio. Una bambina entrò in negozio con un campione di tela, e Winslow potè nel suo miserabile «stok» trovare la pezza della stessa qualità e contentare la piccola cliente. Non gli era mai successo un caso simile! Andò subito da Minnie a dirle l'accaduto. Del resto l'incidente è narrato per dimostrare al lettore che il cielo si rasserenava ogni tanto. I giorni seguenti, Winslow aprì bottega un po' più tardi. Quando non si dorme la notte e non vi è più speranza, a che pro alzarsi di buon mattino? Ma al venerdì mattina, quando entrò nella bottega successe un caso assai bizzarro. Vide in terra qualcosa di color bianco e di forma rettangolare. Si chinò per osservare e raccattò una busta listata a lutto. Era indirizzata a sua moglie. Certamente era qualche morto in famiglia, forse lo zio…. Egli conosceva troppo lo zio per poter fare assegnamento su di lui! E sarebbe stato necessario vestirsi a lutto ed andare ai funerali! Brutale crudeltà della gente che muore! E Winslow vide innanzi a sè dei pantaloni neri, dei guanti neri, dei cappelli col lutto! E doveva comprare tutto ciò! E la bottega chiusa per lutto di famiglia! — Ho paura, Minnie, – disse, – che vi sia qualche cattiva notizia! Ella era in ginocchio innanzi al camino affaccendata a soffiare nel fuoco. Si voltò e vedendo la busta esclamò, sospirando: — Ho paura che sia mio zio! – e prese la lettera guardando il marito con occhi di spavento. – Non conosco la calligrafia! — La busta porta il timbro di Hull. — Di Hull?! Minnie lacerò adagio adagio la busta, ne tirò fuori la lettera, l'aperse e guardò la firma. — È del signor Speight. — E che cosa dice? Minnie incominciò a leggere…. — Oh! – esclamò subito, abbandonando la lettera. E cadde come svenuta colle mani sugli occhi. Winslow raccolse rapidamente la lettera: «Una tremenda disgrazia è successa! «La gran torre del camino della fabbrica di Melchior è caduta ieri sul tetto della casa di vostro zio e tutti sono rimasti uccisi! «Vostro zio, vostra cugina Mary, Will e Ned, e la cameriera sono rimasti tutti schiacciati, voi li riconoscerete a mala pena! Vi scrivo per darvi la notizia prima che i giornali ne parlino….» Winslow dovette sostenersi ad una seggiola per non cadere anch'esso. Tutti morti! E vedeva la casa dello zio, rovinata, ed i cadaveri irriconoscibili! E intravvedeva la speranza della salvezza sua! e cercava di provar dolore, ma non vi riesciva! E seguitò a leggere: «Voi siete la sola parente prossima» scriveva il signor Speight. — È spaventoso! – mormorò Minnie, ricordandosi un poconota 1. Winslow la fissò tentennando il capo. Mille cose gli balenavano in mente, ma nessuna gli parve degna di essere espressa in tale occasione. — Dio l'ha voluto! – diss'egli finalmente. — Cio è terribile, – esclamò Minnie. – Mia zia! la mia cara zia! e quel caro zio! — Dio l'ha voluto! – ripetè con unzionenota 2 Winslow. — Sì, – disse dopo un po' Minnie, – sì, forse Dio l'ha voluto, ed ed osservava la busta che lentamente si accartocciava sulle ceneri ancor calde del focolare. Erano tutti e due assai mesti e nè l'uno nè l'altro avrebbero in quel momento potuto udire qualsiasi parola a proposito dell'eredità. Minnie tornò innanzi al focolare e incominciò lentamente ad accendere un giornale; anche dopo i momenti più tristi, le abitudini della vita riprendono il loro andamento. Winslow sospirò profondamente e si avviò senza far parola alla porta di strada. Quando l'aperse, un largo fascio di luce penetrò nella scura bottega, e Brandersnach, Helter, Skelter e Compagni erano spariti dalla mente sua come nubi al sole di levante. Per ora, egli era occupato a ritirare le imposte, ed al più presto possibile; in cucina il fuoco scoppiettava allegramente sotto una piccola cazzeruola che pareva cantasse, Minnie faceva cuocere due uova, uno per lei, eccezionalmente, l'altro per il marito, e la si udiva apparecchiare la tavola con una insolita ostentazione…. Il colpo era stato imprevisto e terribile; ma bisogna convenire che in questo triste ed inesplicabile mondo, noi siamo capaci di far fronte a simili disgrazie…. Era passato mezzogiorno e nessun de' due aveva ancor parlato di eredità. Fine. nota 1 – Traduzione molto discutibile. Così in originale: “How awful!” said Minnie, in a horror-struck whisper, and looking up at last. [Nota per l'edizione elettronica Manuzio] [Torna] nota 2 – In originale: with infinite feeling. [Nota per l'edizione elettronica Manuzio]. [Torna] Troverai tanti altri racconti da leggere nella Mediateca di Pagina Tre (clicca qui!) Scopri sul sito Internet di Liber Liber ciò che stiamo realizzando: migliaia di ebook gratuiti in edizione integrale, audiolibri, brani musicali con licenza libera, video e tanto altro: https://liberliber.it/. Se questo libro ti è piaciuto, aiutaci a realizzarne altri. Fai una donazione: https://liberliber.it/aiuta/. LIBRO PARLATO: VOCE: Fiorenza Auriemma DATA: 03/10/2025 QUESTO E-BOOK: TITOLO: Una catastrofe AUTORE: Wells, Herbert George DIRITTI D'AUTORE: no LICENZA: questo testo è distribuito con la licenza specificata al seguente indirizzo Internet: https://liberliber.it/opere/libri/licenze/ TRATTO DA: Novelle straordinarie / H. G. Wells ; [illustrazioni di Celso Ondano]. - Milano : Fratelli Treves, 1905. - 211 p., [10] c. di tav. : ill. ; 27 cm. SOGGETTO: FIC029000 FICTION / Brevi Racconti (autori singoli) FIC028040 FICTION / Fantascienza / Brevi Racconti
Caden Speight disappeared last week after texting an alarming message to his mom.https://www.wlbt.com/2025/09/29/teen-who-claimed-he-was-shot-kidnapped-by-4-hispanic-men-faked-his-disappearance-deputies-say/https://www.news-journalonline.com/story/news/2025/09/26/amber-alert-florida-marion-county-dunnellon-caden-speight/86364643007/https://www.fox35orlando.com/news/caden-speight-florida-amber-alert-missing-marion-county-teen-live-updatesRacial Injustice Mingo Demond Allen IIhttps://www.instagram.com/reel/DPEkLnmDrpZ/?igsh=MTZ4cW13Z2lreHc0bg==Crimes Against WomenHoward Rubinhttps://www.nbcnews.com/news/us-news/new-york-financier-howard-rubin-ex-assistant-charged-running-violent-s-rcna233935Join our squad! Kristi and Katie share true crime stories and give you actionable things you can do to help, all with a wicked sense of humor.Merch Store: https://truecrimesquad-shop.fourthwall.com/Follow our True Crime Trials Channel: https://www.youtube.com/@TrueCrimeSquadTrialsFollow our True Crime Shorts Channel: https://www.youtube.com/@truecrimesquadshorts-t6iWant to Support our work and get extra perks?https://buymeacoffee.com/truecrimesquadLooking for extra content?https://www.patreon.com/truecrimesquad*Social Media Links*Facebook: www.facebook.com/truecrimesquadFacebook Discussion Group: https://www.facebook.com/groups/215774426330767Website: https://www.truecrimesquad.comTikTok: https://www.tiktok.com/@truecrimesquadBlueSky- https://bsky.app/profile/truecrimesquad.bsky.social True Crime Squad on Spotifyhttps://open.spotify.com/show/5gIPqBHJLftbXdRgs1Bqm1
//The Wire//2300Z September 26, 2025////ROUTINE////BLUF: MISSING PERSON CASE IN FLORIDA HIGHLIGHTS MEDIA MANIPULATION CONCERNS DURING ACTIVE AMBER ALERTS. COUNTER ICE RIOTS INTENSIFY IN CHICAGO. CRACKDOWN ON SPEECH CONTINUES IN UNITED KINGDOM.// -----BEGIN TEARLINE------International Events-United Kingdom: The censorship and speech targeting concerns continue to deteriorate as another wave of arrests has emerged among right-wing political commentators. Steve Laws and Pete North have been arrested over the past few days, as PM Starmer continues to state that the U.K. has freedom of speech. Nonetheless, the arrests continue, not just among more visible influencers, but among laypeople as well. Analyst Comment: Hundreds of arrests have been reported all around the U.K. for social media posts, with most of these arrests only coming to light from family members who notice the arrests. This is due to gag orders being placed on the detainees, so that they can't even talk about why they were arrested, or else they will get slapped with higher charges. This is to ensure that the speech crime arrests go largely unnoticed, since public outcry would result if high profile arrests are made. Since the courts are now routinely placing gag orders on people who are being arrested on speech-crime charges, the sheer scale of how many arrests are being made is impossible to know.-HomeFront-Illinois: The situation in Chicago continues to deteriorate as more counter-ICE riots escalate. Various blockade-type actions remain the main vector for rioters to hinder ICE actions, such as at the detention facility in Broadview.Iowa: This afternoon a high-profile ICE raid was carried out, targeting Dr. Ian Andre Roberts. Roberts was the superintendent of the Des Moines Public School System, but he was also a fugitive and illegal immigrant from Guyana who had an active deportation order since May of 2024. After his case was reopened, ICE agents made contact with him today, after which he fled on foot before a K9 unit apprehended him. He was arrested in possession of a firearm, a large knife, and several thousand dollars.Florida: Yesterday evening a high-profile Amber Alert was issued for a hostile abduction of a 17-year-old in Marion County. Caden Speight has been found, but was initially reported missing after what was initially described as a very kinetic kidnapping. The victim's family received a text message that indicated he had been shot and kidnapped by 4x Hispanic males in a light colored van. Local authorities located his abandoned vehicle on Hwy 484 (which had at least one bullet hole in it, according to the initial story), and Speight's phone was also recovered at the scene broken in half.-----END TEARLINE-----Analyst Comments: Something is not quite right with this case, and despite the obvious media hooks to sensationalize this story, nobody really knew what was going on as the details of the search continued to change throughout the day.This morning, investigators stated that the initial details of the incident were determined to be false, and that the current evidence available does not support the abduction story. Investigators stated that he appears to have departed from the initial incident site on a bicycle, possibly with a red and grey tent that was purchased using his credit/debit card at a Walmart in Ocala shortly before the incident. At the time it appeared as though this may have been a runaway situation portrayed as a violent kidnapping.However, as the situation continued to develop, notices from officials changed from an Amber Alert to caution, urging citizens to not make contact with Speight if he was discovered. Shortly after this change in tone, Speight was reported to be found, with a gunshot wound to his leg. However some reports suggest the opposite, and that he was found without any wounds (as in
Andy gives what many believe to be his best message as it caps off his trilogy of messages from this summer. This heartfelt message centers on the focus we need to have prior to entering school.
Andy brings a very sobering message on the need to flush out our minds of the daily junk that clutters it. We can see the need, but the question is will we do something about it every day?
On this episode of VIE Speaks: Conversations with Heart & Soul podcast, host Lisa Marie Burwell, VIE's CEO/editor-in-chief spoke with interior designer, Libby Baker Speight. Lisa and Libby talk all things design, knowing your worth, and having love for what you do. She is a member of the American Society of Interior Designers. Libby earned a Bachelor of Arts in Interior Design from the University of Southern Mississippi. But before then, at 16, she recalls grabbing the Yellow Pages and calling every interior decorator company in her area looking for a job. Libby brings us back to how the industry used to be — no Pinterest, Trading Spaces on TLC! Her extensive portfolio ranges from residential to commercial. Anyone who listens can hear the real passion she has for creating and providing her client with a one-of-a-kind space. #viemagazine #storieswithheartandsoul #magazines #alifestylepodcast #celebratestories #storytelling #viespeaks #podcast #podcasts #interview #newpodcastalert #podcastlaunch #interiordesign #designer #homedecor #style #lisamarieburwell #libbybakerspeight
7/23/25 - This message explores what it means to biblically defend the Christian faith based upon Jude 3. Learn why it's vital and be encouraged to grow deeper in God's word and stand boldly, yet humbly, for the gospel.
“At least 53 ‘bloodies' in half-an-hour last night. This is definitely not British sir! I suggest you study the British working man more!"So thundered a disgruntled viewer in 1969 after watching an episode of the Johnny Speight & Spike Milligan sitcom Curry & Chips. One notes with interest it was the word 'bloody' which triggered him, as opposed to any of the other bad language with which the series as a whole was replete. Starring Spike Milligan in brownface as Kevin O'Grady, Curry & Chips is chiefly set in the factory of Lillicrap Ltd, a supplier of novelty goods managed ineptly by Arthur Blenkinsop (Eric Sykes) with jumped-up mini-tyrant shop steward Norman (played by Norman Rossington), Kenneth (played by Kenny Lynch) and Young Dick (Geoffrey Hughes) among the workers. Much of the 'humour' was racist in tone, with Kevin subject to regular verbal abuse by his colleagues, although he usually gave as good as he got. There were also swipes at religion, class, politics, sexuality and pretty much any topic that confused, enraged or affected the grumbling Lillicrap staff.It has been suggested that Milligan and Speight hoped that the series would produce audience empathy for immigrants and put a mirror up for the working classes to see their own prejudices reflected back at them. Nice try, lads. Joining Tyler is John Williams, co-host of World Of Telly, who brings his considerable knowledge of the British television landscape in the late sixties to great use, explaining the background and build up to the show, the backlash and eventual cancellation. Curry & Chips was a pretty bloody (that word again!) awful programme but not completely without a few laughs - thanks chiefly to Spike - tune into our chat to find out what had the pair chuckling once or twice in between the wincing and sighing!
Meet Monica Speight Monica helps Christians step boldly into their calling, bring their God-given vision to life, and make a lasting Kingdom impact beyond the church walls. She's passionate about equipping believers to influence the world wherever God has placed them. Today, I sit down with her to talk about her journey, the concept of "Phantom Work," God's gifting on her life, how she found time freedom in her business, and so much more. There are so many reasons you'll want to watch this episode! Important Links: Monica Speight Website Save TIME & MONEY by running your biz on a single platform- check out my software, Equipt360
Today, we find our resident rural health advocate at the Speight’s Ale House in Palmerston North.See omnystudio.com/listener for privacy information.
If we want to live out the purpose of what we were designed for, and if we want to fulfill the mission given to us, then we ought to absorb the qualities of Christ that defined him. Being conformed to his image will help us to redeem time.
After you understand that you're not here by mistake and your life is not an accident, you need to come to the realization that your life also has a purpose. There is a mission that needs to be accomplished! Are you using your time wisely to do what needs done?
We kick off the series that will lead us to summer camp by taking a closer look at our Church's vision for the year. This is something we want to constantly keep in front of our students before, during, and after camp. How and why should you redeem the time?
The Beast Games interview Mia Speight (952)
Welcome to our show catchup podcast! Check out some of our fave parts from today's show below: We found some WILD stories about sex education class in high school, and one listener reveals how they were made an example of! Apparently, the only way for men to actually learn about women's habits, is to date them. We sent Steph around the office to get some juicy examples… There's this Facebook page called South Island Blast, which lists a whole bunch of rules to follow when visiting. Monique from Speight's Ale House in Invercargill confirms whether or not these are true! PLUS HEAPS MORE! AND FIND US ON INSTAGRAM, Cause we are thirsty: Sharyn, Steph & Sean - @Edgeafternoons Sharyn - @SharynCasey Steph - @stephmonksey Sean - @seanhillyman Producer Arun - @arunjamesbeard
What does it take to lead one of the world's largest conservation organisations through a time when 41% ofUK species are in decline?And how can today's conservation leaders inspire millions to fight for biodiversity? Today's guest, Beccy Speight, CEO of the RSPB, offers her insights into what it takes to manage over 1.2 million members and 200 reserves across the UK.In this episode, we discuss the RSPB's mission, the role of effective leadership, and Beccy's own career path from local government to conservation leadership.Beccy shares the biggest challenges she faces, her hopes for the RSPB over the next decade and what advice she'd give to anyone looking to enter the conservation sector.It's an inspiring, insightful, and mission-driven podcast.
Today on the show - 0.00 - Tales From The South 3.49 - Research Ryan 9.19 - Betcha Leaderboard 13.08 - Flooded 21.52 - We're With You Wednesday 31.17 - Rog's Ride On 33.12 - Dancing Injuries 41.56 - Lame School Holidays 50.03 - Speight's Great Mates
April Speight began her career as a menswear stylist and visual merchandiser for brands such as Club Monaco, Saks, and Neiman Marcus. She graduated with a BS in Global Business & Public Policy from the University of Maryland and subsequently embarked on a career transition into tech. To close out her former career in fashion, she completed her Masters in Luxury & Fashion Management at the Savannah College of Art and Design - with a focus on the luxury automobile and luxury marijuana sectors. In her spare time, she began to learn Python in hopes of becoming a data scientist. With a change of heart, she chose to focus on AI assistants, chat bots, and conversational design. Always curious and always learning, she witnessed a life changing demo at a Microsoft event that set her on a new path in Extended Reality (XR). In 2020, she joined the Cloud Advocacy organization at Microsoft as a Sr. Cloud Advocate for Spatial Computing. From 2020 - 2022, April became a thought leader in the XR space promoting safety, diversity, and inclusivity in the design of XR experiences. She served as the former Director of Community & Education for the XR Safety Initiative (XRSI), advising partners on XR curriculum. Internally at Microsoft, she worked alongside the former Mixed Reality and MRTK teams. She created various XR samples, technical learning content, and was part of the team that won Silver in the 2021 Telly Awards for Remote Production – Non-Broadcast for Microsoft One Dev Question with April Speight. Before her transition to the Cloud Advocacy leadership team, April hosted the 2022 Mixed Reality Dev Days and collaborated with the current Microsoft Mesh team. Today, she resides in Los Angeles as a Principal Cloud Advocate at Microsoft focused on Generative AI. You can find April on the following sites: Twitter Website GitHub LinkedIn Here are some links provided by April: Bite-Size Python Visual Studio Code for Python Programmers PLEASE SUBSCRIBE TO THE PODCAST Spotify Apple Podcasts YouTube Music Amazon Music RSS Feed You can check out more episodes of Coffee and Open Source on https://www.coffeeandopensource.com Coffee and Open Source is hosted by Isaac Levin --- Support this podcast: https://podcasters.spotify.com/pod/show/coffeandopensource/support
In this episode, we take a heartfelt and in-depth look at the life, career, and tragic death of beloved children's TV presenter Mark Speight. Best known for his infectious energy and artistic flair on SMart, Mark captured the imagination of young audiences across the UK with his creativity and playful personality. His ability to make art fun and accessible turned him into a household name, making him a cherished figure in children's television during the 1990s and 2000s. We begin by exploring Mark's early years, charting his journey from art school graduate to becoming one of the most recognisable faces on British TV. From his rise to fame as the vibrant host of SMart to his various other appearances across children's television, we reflect on his passion for art, his boundless enthusiasm, and his deep connection with his audience. Mark's career left a lasting impact on many aspiring young artists, and his work continues to be remembered fondly by fans to this day. However, Mark's personal life took a tragic turn in 2008 when his fiancée, Natasha Collins, passed away under devastating circumstances. We discuss how this loss profoundly affected him and delve into the subsequent media coverage, which brought an overwhelming amount of scrutiny and pressure to his already grief-stricken life. Despite being a beloved figure, the emotional toll of Natasha's death weighed heavily on Mark, leading to his untimely death a few months later. While his story ended tragically, the impact he had on the world of children's television and the hearts of his viewers endures, reminding us of the importance of creativity, connection, and compassion in a world that can often feel overwhelming. Talk2TheHand is an independent throwback podcast run by husband and wife, Jimmy and Beth. Obsessed with 90s nostalgia and 90s celebrities, we'll rewind the years and take you back to the greatest era of our lives. New episodes bursting with nostalgia of the 90s released on Tuesdays. Please subscribe to our podcast and we'll keep you gooey in 1990s love. Find us on Twitter @talk2thehandpod or email us at jimmy@talk2thehand.co.uk or beth@talk2thehand.co.uk
Ua faasa'olotoina le ta'ita'i o le fouvale lea na ave'eseina ai le malo na palotaina i Fiti i le 2000. O George Speight na aumaia iai le faasalaga i le oti e le faamasinoga sili i le moliaga o le 'treason' ae na suia e le peresitene i le solo atoa i le falepuipui.
After being friends online for years, Hannah and Laura FINALLY have the opportunity to chat with author Jeff Speight about his books, Paladin Unbound, Mystic Reborn, and the upcoming God Ascended! They talk all about world building, character creation, and what it's like to publish a high fantasy trilogy. Be sure to pick up all of The Archives of Evelium or request them from your local library!You can follow Jeff at: https://www.jeffreyspeight.com/Instagram: @jeffsp8Twitter: @jeffspeightFacebook: Jeffrey SpeightMedia Mentions:The Red Badge of Courage by Stephen CraneThe Hobbit by J.R.R. TolkienThe Hobbit (1977)---Prime VideoRudolph the Red-nosed Reindeer---Prime VideoThe Threadlight trilogy by Zack ArgyleDelicious in Dungeon---NetflixThe Empire Strikes Back---Disney+The Wheel of Time---Prime VideoThe Lord of the Rings---MaxLegacy of the Brightwash by Krystle MatarStellar Instinct by Jonathan NevairThe Wind Tide trilogy by Jonathan NevairThe Dresden Files series by Jim ButcherBe sure to follow OWWR Pod!www.owwrpod.com Twitter: @OwwrPodBlueSky: @OwwrPodTikTok: @OwwrPodInstagram: @owwrpodThreads: @OwwrPodHive: @owwrpodSend us an email at: owwrpod@gmail.comCheck out OWWR Patreon: patreon.com/owwrpodOr join OWWR Discord! We'd love to chat with you!You can follow Hannah at:Instagram: @brews.and.booksThreads: @brews.and.booksTikTok: @brews.and.booksYou can follow Laura at:Instagram: @goodbooksgreatgoatsTwitter: @myyypodBlueSky: @myyypodHive: @myyypod
Johnny Speight, creator of Alf Garnett, had a long friendship with Spike Milligan, stretching back to the mid-fifties and the Associated London Scripts days. Speight wrote Till Death Us Do Part which delighted and shocked television audiences in equal measure, with Garnett given to frequent outbursts against what he perceived as society's ills: immigration & foreigners in general, socialism, young people, increasing secularism, homosexuals, lack of due deference to the Royal Family and the ruling elite, feminism and anything else that he didn't really understand and felt threatened by. In the mid-1980s Speight wrote a follow-up series to Till Death Us Do Part called In Sickness and in Health, which reintroduced audiences to Alf, now older but hardly any wiser. From the second series Alf was a widower (after the death of his co-star Dandy Nicholls) and there gradually grew a new set of characters to antagonise and exasperate him. In the third series Spike had a guest appearance as Fancy Fred, squaring up to Alf at a tea dance and later bickering over where he parked his van. It's not a huge part and Spike wasn't aiming for any Bafta awards, but it's an intriguing cameo and one which we thought was worth talking about this week on Goon Pod - as well as talking about the Alf Garnett universe in general. Joining Tyler is comedian John Dredge, currently riding high with a new series of his sketch show The John Dredge Nothing To Do With Anything Show - which can be found HERE: https://www.comedy.co.uk/podcasts/john_dredge_show/
In this episode of Leaving the Classroom, former teacher Jared Speight shares his journey transitioning from teaching to instructional design. Tune in to hear: Jared's story of transitioning from 14 years in the classroom to an instructional design role due to burnout from COVID. Strategies for building an instructional design portfolio through groups, challenges, and independent projects. Insights on transferring teaching skills like curiosity, delivering instruction, and empathy to instructional design work.
We studied a lot of the mindset and heartbeat behind the practicalities of making disciples, now let's hear from some of your leaders on their personal experiences being discipled as well as discipling others. Andy and Jayme's stories are a clear indication of how one-on-one discipleship can and will completely change your life no matter your background.
Join host Jeff Crank in this compelling episode of "American Potential" as he welcomes Jade Speight, a young college student who turned a challenging experience into a powerful advocacy for free speech. In 2020, during her first year of college, Jade faced bullying and threats for a social media post showing her support for police with a mask bearing the Thin Blue Line flag. Despite intense pressure and harassment, including disturbing notes and online attacks, Jade chose not to back down. Her decision to stand firm in her beliefs and not apologize for her views turned her into a champion for free speech on her campus. Her story is a stark reminder of the challenges students face in environments where differing opinions can lead to intense backlash. In this episode, Jade discusses the impact of this experience on her life, how it shaped her involvement in political activities, and her role as the president of the College Republicans Club. Her journey highlights the importance of standing up for one's beliefs and the need for open, respectful dialogue in educational institutions. This episode is not just Jade's story but a broader conversation about the state of free speech in America, particularly in academic settings. It's a testament to the courage and resilience of young individuals who dare to voice their opinions, fostering a more inclusive and tolerant society. Check out American Potential here: https://americanpotential.com Check out our Spanish episodes here: https://www.youtube.com/playlist?list=PL8wSZydeKZ6uOuFlT_1QQ53L7l6AmC83c Facebook: https://www.facebook.com/AmericanPotentialPodcast Instagram: https://www.instagram.com/americanpotentialpodcast/ X: https://twitter.com/AMPotentialPod
It's the first episode of season three! Much like the last two seasons, we stumble our way through, this time bringing you all the Oscar Noms like only two old dudes can. Lots of googling occurred. Plus Rich "neverheardofit" Speight's review of all the nominated films.
This week's lesson on "ruling" is a great compliment to last week's gift of "governments". If "governments" is concerning the behind the scenes administration of leadership, then "ruling" is the carrying out, or execution of the plan. Some people are built to be up-front leaders. Are you one of them?
Today we begin our last sub-series of the Spiritual Gifts known as the "Service Gifts". Helps are usually done behind the scene and with very little recognition, but they are just as important. Much of what makes a church function properly is due to this all-important gift.
Be an example and mature in your walk. How do we do this? In word, conversation, charity, spirit, faith, and purity.
Today we conclude our section on the "Revealing Gifts", or gifts that are used to reveal truth to others. While we all know that faith is essential for our salvation, God has gifted some of us to exuberate faith in our daily walks more than others. Do you sometimes take risks that defy human logic as you stand up for your God? Then this gift might be yours!
Jamie Speight set off on his pro journey with high hopes, but later became a proud journeyman as he navigated his way through 61 professional fights. He boxed champions and contenders including Josh Warrington, Joe Cordina, Issac Lowe, Gavin McDonnell and Jason Cunningham during a fascinating career and transition from prospect to journeyman before reading my book Damage caused him to stop fighting. However, outside the ring Jamie has had it hard. He and his partner went through years of IVF treatment trying to have a baby, his sister was seriously sexually assaulted and he's had a tenuous relationship with his mother. Here, Speight talks about his. mental health battles, struggling through lockdown and why he made the decision to retire when he did.
Eloris Speight is the Executive Director of Socially Disadvantaged Farmers and Ranchers Policy Research Center. They are located at Alcorn St in Mississippi. During our conversation, we talked about the challenges Black farmers face, the Black Farmer population continuing to decline, the bills that involve Black Farmers, and the future for Black Farmers.
Jamie Speight set off on his pro journey with high hopes, but later became a proud journeyman as he navigated his way through 61 professional fights. He boxed champions and contenders including Josh Warrington, Joe Cordina, Issac Lowe, Gavin McDonnell and Jason Cunningham during a fascinating career and transition from prospect to journeyman before reading my book Damage caused him to stop fighting. However, outside the ring Jamie has had it hard. He and his partner went through years of IVF treatment trying to have a baby, his sister was seriously sexually assaulted and he's had a tenuous relationship with his mother. Here, Speight talks about his. mental health battles, struggling through lockdown and why he made the decision to retire when he did.
Joining me for a waffle is the brilliant singer and songwriter Tom Speight!We waffle about all things music, mental health, and just how powerful music can be when it comes to expressing how you feel!Tom opens up about his journey with Crohn's Disease and how a life-saving operation changed his outlook on life!We have a waffle about his brand new album, Love & Light, the recording process and the inspiration behind it allI really hope you enjoy it! Hosted on Acast. See acast.com/privacy for more information.