text:
Drug Improves Induction Chemo for Head and Neck Cancers
For patients with advanced head and neck cancers who receive an initial treatment of chemotherapy prior to other therapies, three drugs appear to be better than two. Patients who received docetaxel (Taxotere) in addition to the standard combination of cisplatin and fluorouracil had better outcomes than those taking cisplatin and fluorouracil alone, according to findings in the October 25 New England Journal of Medicine.
The results are from two randomized clinical trials that evaluated the addition of docetaxel to standard chemotherapy for patients receiving induction (or neoadjuvant) treatment. This treatment is given before radiation-based therapy, as was the case in the two reported clinical trials, and/or surgery. Read more
HIV/AIDS Research at NCI: A Record of Sustained Excellence
The human immunodeficiency virus (HIV) and the disease it causes, Acquired Immune Deficiency Syndrome (AIDS), announced itself in the United States in 1981, in the form of a small, sudden uptick in reports of a rare cancer, Kaposi sarcoma (KS), and a rare form of pneumonia among young gay men in New York and San Francisco. That same year, in the NIH Clinical Center, NCI physicians treated the first patient with this deadly, yet-to-be-named disease.
NCI's history will forever be intertwined with that of HIV and AIDS. NCI scientists were at the forefront of the effort to identify HIV as the cause of AIDS, characterize how it hijacked cellular machinery, and, in turn, develop the first treatments for it. Read more
Drug Improves Induction Chemo for Head and Neck Cancers
For patients with advanced head and neck cancers who receive an initial treatment of chemotherapy prior to other therapies, three drugs appear to be better than two. Patients who received docetaxel (Taxotere) in addition to the standard combination of cisplatin and fluorouracil had better outcomes than those taking cisplatin and fluorouracil alone, according to findings in the October 25 New England Journal of Medicine.
The results are from two randomized clinical trials that evaluated the addition of docetaxel to standard chemotherapy for patients receiving induction (or neoadjuvant) treatment. This treatment is given before radiation-based therapy, as was the case in the two reported clinical trials, and/or surgery.
Although the trials differed in their designs, drug doses, and patient populations, each found that the addition of docetaxel improved survival and reduced mortality without adding significant toxicity compared with the treatment arm that used the standard induction chemotherapy regimen.
"The take-home message of these studies is that despite the grim prognosis associated with head and neck cancer, we are making significant progress in treating the disease," said Dr. Marshall Posner of the Dana-Farber Cancer Institute, who led one of the trials, called TAX 324.
The major surprise of the studies was that a third chemotherapy drug seemed to make treatment more tolerable for patients rather than less, noted Dr. Posner. Survival in the docetaxel group was 71 months on average versus 30 months in the other group.
The second study was conducted by the European Organization for Research and Treatment of Cancer. After 32 months, median survival in the docetaxel group was 18.8 months, compared with 14.5 months in the other group. Fewer patients treated with docetaxel suffered side effects such as nausea, vomiting, and mouth sores.
Previous studies have suggested that for patients with advanced head and neck cancers, chemotherapy is most effective when administered at the same time as radiation therapy. The two new trials were not designed to address the question of whether induction chemotherapy prior to concurrent chemotherapy and radiation offers advantages over concurrent chemotherapy and radiation alone, and if so, for which patients.
Answers may come soon because at least five randomized trials are testing induction chemotherapy followed by radiation and chemotherapy for these cancers.
—Edward R. Winstead
HIV/AIDS Research at NCI: A Record of Sustained Excellence
The human immunodeficiency virus (HIV) and the disease it causes, Acquired Immune Deficiency Syndrome (AIDS), announced itself in the United States in 1981, in the form of a small, sudden uptick in reports of a rare cancer, Kaposi sarcoma (KS), and a rare form of pneumonia among young gay men in New York and San Francisco. That same year, in the NIH Clinical Center, NCI physicians treated the first patient with this deadly, yet-to-be-named disease.
NCI's history will forever be intertwined with that of HIV and AIDS. NCI scientists were at the forefront of the effort to identify HIV as the cause of AIDS, characterize how it hijacked cellular machinery, and, in turn, develop the first treatments for it.
Last week, NCI and its Center for Cancer Research (CCR) hosted a symposium on NCI's role in HIV/AIDS research, during which four current and former NCI scientists - Drs. Robert Gallo, Samuel Broder, Robert Yarchoan, and Hiroaki "Mitch" Mitsuya - were honored for their pioneering work in response to this threat to global public health.
Dr. Gallo was chief of the NCI Laboratory of Tumor Cell Biology when it became apparent that the disease we would soon call AIDS was a grave public health issue. The research on human retroviruses by Dr. Gallo and his team - they discovered the first two such viruses, HTLV-1 and -2 - laid the groundwork for the co-discovery of HIV in 1984.
Dr. Gallo's lab also led the development of a blood test for HIV, meaning donated blood could be effectively screened for the virus. With others at NCI, Dr. Gallo was instrumental in developing the first treatments for HIV.
Dr. Broder, who later served as NCI director for 6 years; Dr. Mitsuya; and Dr. Yarchoan led the initial development and clinical trials of the first effective treatments for HIV. That includes AZT, a drug originally developed to treat cancer that they found could inhibit HIV replication.
The trio also led the development of two other anti-HIV drugs, didanosine (ddI) and zalcitabine (ddC), which, with AZT, were the first FDA-approved treatments for AIDS and which continue to be the cornerstone of the HAART regimen that has transformed HIV infection into a chronic disease.
What these four scientists helped to launch 26 years ago is now one of the most well-respected HIV/AIDS research programs in the world. Indeed, NCI researchers in CCR's HIV and AIDS Malignancy Branch, the HIV DRP Host Virus Interaction Branch, and Vaccine Branch are building on their historic achievements.
Among these are the identification of genetic mutations that appear to protect against HIV infection or slow its progression, new insights into HIV viral diversity that contributes to drug resistance, and the development of new treatments for AIDS-related cancers, including KS and lymphoma. NCI researchers also are at the forefront of efforts to develop both preventive and therapeutic HIV vaccines and new treatments derived from natural products.
These efforts at NCI continue now in partnership with others. Our efforts today are becoming even more important to our cancer agenda, as we can now refer to this virus as yet another cancer-causing infectious agent - not just regarding the AIDS virus-associated cancers, but now in terms of the striking increase in the incidence of all epithelial malignancies in chronically infected patients.
To ensure NCI's efforts are integrated and to foster collaboration with other NIH institutes and external partners in academia and industry, a new Center of Excellence in HIV/AIDS & Cancer Virology has been established.
The cancer community should be proud that NCI continues to expand upon the legacy of early HIV/AIDS research led by Drs. Gallo, Broder, Yarchoan, and Mitsuya. AIDS has killed more than 25 million people worldwide. Many more would have died without the efforts of these scientists and their colleagues. If their history has demonstrated anything, it's that progress can be made even in the face of the most severe challenges.
Dr. John E. Niederhuber
Recent in vitro, animal, and human research has suggested a possible role for vitamin D in decreasing cancer incidence, mortality, or both. A new study that used data collected prospectively during the third National Health and Nutrition Examination Survey (NHANES) showed no association between levels of vitamin D in the blood and total cancer mortality, but did find a significant association between higher levels of circulating vitamin D and reduced risk of colorectal cancer mortality.
"Most of the previous studies on cancer mortality [and vitamin D] have been ecologic studies or have been based on surrogates for vitamin D levels. This is the first to look at actual measured levels and total cancer mortality," says Dr. Michal Freedman from NCI's Division of Cancer Epidemiology and Genetics, lead author of the study, which was published online October 30 in the Journal of the National Cancer Institute.
Between 1988 and 1994, the investigators from NCI and the Centers for Disease Control and Prevention collected data from 16,818 NHANES participants aged 17 or older, including demographic and lifestyle factors that may contribute to increased cancer risk. Each participant contributed a blood sample that was measured for vitamin D levels.
"We found no association between [vitamin D] and total cancer mortality in the…NHANES III study population," state the authors. However, participants with serum vitamin D levels at or above 80 nmol/L had a significantly lower risk of colorectal cancer mortality than participants with levels lower than 50 nmol/L.
The investigators cite several strengths of their study, including use of a study population that was derived from a representative sample of the U.S. population, and inclusion of many variables known to influence cancer risk. They also acknowledge limitations such as a low number of total cancer deaths to analyze and a single point of measurement for vitamin D, which may not represent blood levels over time.
"The relationship between nutritional factors and colorectal as well as other cancers is complicated…Randomized clinical trials of the effects of vitamin D on the incidence of colonic polyps and invasive cancer are needed," state Drs. Cindy Davis of NCI's Division of Cancer Prevention and Johanna Dwyer of the NIH Office of Dietary Supplements in an accompanying editorial.
Brain Cancer Trial Finds Longer Survival with Temozolomide Regimen
Two years ago, researchers reported that the drug temozolomide could improve the survival of patients with glioblastoma brain cancer when given along with and following radiation therapy. The survival benefit was about 2.5 months, which was significant for the disease. Now, additional follow-up shows that some patients have survived for several years beyond the 6 to 12 months that is typical for this deadly disease.
The results, from a phase III clinical trial involving more than 500 European and Canadian patients, were presented last week at the annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) in Los Angeles.
The updated results show that 12.9 percent of patients who received temozolomide during and after radiation treatment lived for 4 years compared with 3.8 percent of those who received radiation alone and also lived for 4 years. Patients who survived for 4 years after diagnosis were mostly younger than 50 and in otherwise good health without any prior major medical condition. Approximately 28 percent of these patients who were treated with temozolomide and radiation lived for 4 years, versus only 7 percent of patients who received only radiation therapy.
"The survival advantage conferred by the addition of temozolomide to radiation therapy in glioblastoma multiforme remains highly significant with a longer follow-up, and we expect a modest but significant proportion of patients to be long-term survivors," the researchers concluded in an abstract. The study was performed by the EORTC Brain Tumor Group, the Radiation Oncology Group, and the NCIC Clinical Trials Group.
Patient Navigators Tailor Interventions in Minority, Low-Income Populations
Ethnic and racial minorities and low-income patients often encounter barriers to cancer treatment and care, and one proven strategy to reduce such health disparities is to provide ethnically and linguistically appropriate lay patient navigators (LPNs). A new study by researchers at the Centinela Freeman Medical Research Center in Inglewood, CA, identified the most problematic barriers experienced by a group of 493 African American and Latino cancer patients. Strategic intervention by LPNs reduced the average time to overcoming them from 42 days to a single day.
Dr. David Khan and colleagues from the Urban Latino African American Cancer Disparities Project (ULAAC) developed a program tailored to low-income populations using the continuous quality improvement (CQI) approach. Volunteer LPNs were trained and then monitored as they counseled patients in the cohort. Tracking of these interventions and focus groups with LPNs led to the evolution of solutions for the specific barriers faced by this patient group, 60 percent of whom accepted help.
A half dozen barriers recurred among these 300-some patients: transportation was cited most often, with 167 patients needing help; followed by psychosocial issues, financial issues, a fear of cancer, issues related to caregivers, and language issues.
Another goal of the project was to increase participation by these target populations in clinical trials. Using the CQI process, ULAAC found that the navigators possessed biases against clinical trials similar to those in the target population. LPNs were retrained and again intervened with patients, 29 of whom eventually joined clinical trials.
"These patient navigator programs should become an essential part of our health care delivery system," concludes Dr. Khan. The research, funded by NCI's Cancer Disparities Research Partnership Program, was presented last week at the ASTRO annual meeting.
"Boost" Radiation Offers Benefits for Women with Early-Stage Breast Cancer
Women ages 40 and younger with early-stage breast cancer had a reduced risk of cancer returning in the same breast by undergoing an extra dose of radiation after surgery to conserve the breast, followed by standard radiation treatment, researchers said last week at the ASTRO annual meeting in Los Angeles. The additional "boost" dose of radiation reduced the risk of recurrence in the same breast during a 10-year period from nearly 24 percent to 13.5 percent. The effect was seen in women of all ages, though the statistical evidence was strongest among younger women.
The study included 5,500 women who underwent breast-conserving surgeries (lumpectomies) and radiation treatment for stage I and stage II breast cancer. Findings from the study, led by Dr. Harry Bartelink of the Netherlands Cancer Institute, appeared in the August 1 Journal of Clinical Oncology.
The treatment did not appear to help the women live longer. Nonetheless, boost radiation offers some important benefits for these women, according to Dr. Deborah C. Citrin of NCI's Radiation Oncology Branch, who commented on the study. Preventing a recurrence is an important goal after breast-conserving surgery, she said. The boost radiation meant that fewer patients needed a mastectomy because of a recurrence in the same breast, and this helped them avoid the physical and psychological effects of losing a breast.
Following are newly released NCI research funding opportunities:
Specialized Programs of Research Excellence in Human Cancer for Years 2008 and 2009
Letter of Intent Receipt Dates: Dec. 22, 2007; Apr. 22, Aug. 22, and Dec. 23, 2008; Apr. 21 and Aug. 21, 2009.
This is a renewal of PAR-06-505 and will use the P50 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3786. Inquiries: Dr. Jorge Gomez - email@example.com; Dr. Rajeev K. Agarwal - firstname.lastname@example.com; Dr. Ivan Ding - email@example.com; Dr. Andrew Hruszkewycz - firstname.lastname@example.com; Dr. Igor Kuzmin - firstname.lastname@example.com; Dr. Peter Ujhazy - email@example.com.
Anemia of Inflammation and of Chronic Diseases
Application Receipt Dates: Non-AIDS Applications (new): Feb. 5, June 5, and Oct. 5, 2008.
This funding opportunity will use the R01 award mechanism. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3787. Inquiries: Dr. William D. Merritt - firstname.lastname@example.com.
Ethical, Legal, and Social Implications Regular Research Program
Application Receipt Dates:
PA-08-013: Non-AIDS Applications (new): Feb. 16, June 16, and Oct. 16, 2008; Feb. 16, June 16, and Oct. 16, 2009; Feb. 16, June 16, and Oct. 16, 2010.
PA-08-012 and PA-08-013: AIDS and AIDS-related Applications (new, renewal, resubmission, or revision): Jan. 7, May 7, and Sept. 7, 2008; Jan. 7, May 7, and Sept. 7, 2009; Jan. 7, May 7, and Sept. 7, 2010; Jan. 7, 2011.
This is a renewal of PA-04-050 and will use the R01 (PA-08-012) and R03 (PA-08-013) award mechanisms. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3784. Inquiries: Dr. Carol Kasten - firstname.lastname@example.com.
Angiogenesis in the Nervous System in Health and Disease
Application Receipt Dates:
PA-08-016: Non-AIDS Applications (new): Feb. 16, June 16, and Oct. 16, 2008; Feb. 16, June 16, and Oct. 16, 2009; Feb. 16, June 16, and Oct. 16, 2010.
PA-08-015 and PA-08-016: AIDS and AIDS-related Applications (new, renewal, resubmission, or revision): Jan. 7, May 7, and Sept. 7, 2008; Jan. 7, May 7, and Sept. 7, 2009; Jan. 7, May 7, and Sept. 7, 2010; Jan. 7, 2011.
This funding opportunity will use the R01 (PA-08-015) and R21 (PA-08-016) award mechanisms. For more information, see http://cri.nci.nih.gov/4abst.cfm?initiativeparfa_id=3785. Inquiries: Dr. Nancy J. Emenaker - email@example.com.
New Guidelines Favor Chemo as Adjuvant Therapy for NSCLC
Developed by expert panels convened by the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario, the guidelines recommend the use of adjuvant chemotherapy in patients with stages IIA, IIB, or IIIA NSCLC in which the tumors have been completely resected. In most of these cases, disease has spread to nearby lymph nodes.
Until the current decade, explains guidelines panel co-chair Dr. Katherine M.W. Pisters of M.D. Anderson Cancer Center, randomized clinical trials of adjuvant therapy for NSCLC had reported negative or inconclusive results.
"It's really only been in the last 5 to 6 years that we've had positive data," she says. "These more modern trials have had better designs with larger numbers of patients studied and more homogeneous patient populations enrolled. And the chemotherapy regimens used in these trials are more effective against NSCLC than the regimens employed in older trials."
Oncologists are urged in the guidelines to embrace adjuvant chemotherapy for the appropriate patients with NSCLC.
"The guideline panel concludes that the therapeutic nihilism toward adjuvant chemotherapy for stage II-III NSCLC should now be abandoned," the panel wrote. "The findings and recommendations contained in this guideline provide clinicians with the evidentiary basis for a firm commitment to treat these patients."
Part of oncologists' reluctance to use adjuvant chemotherapy, explains Dr. Giuseppe Giaccone, chief of the Medical Oncology Branch in NCI's Center for Cancer Research, is based on patients' poor tolerance of chemotherapy after having undergone a thoracotomy - opening up the chest wall to access the lungs and remove the tumors.
"That is a major issue," Dr. Giaccone says. "In only about 70 percent or less of patients can full-dose chemo be delivered after that operation." But now, with several trials having demonstrated a clear survival benefit of adjuvant chemotherapy, he continues, that reticence "has to change."
In two cases, the guidelines note some positive, but inconclusive, data on adjuvant treatment options: adjuvant chemotherapy for stage IB patients and adjuvant radiotherapy for stage IIIA patients.
For patients with stage IB disease (a localized, larger tumor with a strong likelihood of spreading to nearby lymph nodes), says Dr. Pisters, "the trends are there," but the data are not strong enough at the moment to recommend routine use of adjuvant chemotherapy. At the 2006 ASCO annual meeting, longer-term data presented from a randomized clinical trial of only stage IB patients, the CALGB 9633 trial, showed no statistically significant overall survival benefit, although the data still trended in favor of adjuvant chemotherapy. An unplanned subset analysis, however, revealed a statistically significant benefit in patients with tumors 4 cm or larger.
"It's very complicated," Dr. Pisters admits. Oncologists "have got to sit down and talk to their [IB] patients about whether adjuvant therapy is right for them."
As for adjuvant radiotherapy, two studies have suggested it may be beneficial in stage IIIA patients. But without data from prospective, randomized clinical trials that directly addressed this issue, the panel believed the current evidence was insufficient to recommend adjuvant radiation in all stage IIIA patients.
Oncologists generally eschew adjuvant radiotherapy in their NSCLC patients, Dr. Giaccone notes, but stage IIIA is an exception. "The chance of local relapse is high in these patients," he says. "So having something that could prevent local relapse is an attractive option."
Also included in the guidelines are recommendations - which the panel acknowledged were not necessarily "evidence-based" - for communicating with patients about adjuvant therapy.
Among the recommendations is dedicating a single office session to a discussion about adjuvant therapy. The discussion, the panel suggested, should cover factors beyond survival, such as the side effects of adjuvant therapy and its potential effect on quality of life. The guidelines also provide a sample chart that allows patients to more clearly see the absolute survival benefit adjuvant therapy conferred in recent clinical trials.
—Carmen Phillips
Targeted Combinations for Metastatic Kidney Cancer
Name of the Trial
Principal Investigators
Why This Trial Is Important
Two drugs that target multiple tyrosine kinase proteins - sorafenib and sunitinib - and the drug temsirolimus, which inhibits a protein called mTOR, have been approved by the FDA for advanced kidney cancer. Additionally, treatment with a biological agent called bevacizumab, which inhibits the growth of new blood vessels (angiogenesis) to tumors by targeting a protein called VEGF, has shown promising results in a phase III trial. While all of these agents are effective in delaying the progression of kidney cancer, none are yet curative for advanced disease, and the relative importance of the molecular targets of these drugs in the biology of kidney tumors is not yet known.
In this trial, doctors are testing different combinations of bevacizumab, sorafenib, and temsirolimus in patients with metastatic kidney cancer. Like bevacizumab, sorafenib and temsirolimus inhibit angiogenesis, but they also inhibit other processes thought to be important in kidney cancer progression.
"In this trial, we're testing three different combinations of these agents against each other and against single-agent therapy with bevacizumab," said Dr. Flaherty. "We're trying to determine which combination looks most promising, so we can advance it to a phase III clinical trial that might establish the standard of care for this disease."
Who Can Join This Trial
Study Site and Contact Information
An archive of "Featured Clinical Trial" columns is available at http://cancer.gov/clinicaltrials/ft-all-featured-trials.
NCI Director Dr. John E. Niederhuber honored his predecessor for his dynamic leadership of the Institute from 2002-2006. "As NCI director, Andy spoke often of the transformation of medicine and cancer care in the new molecular era," Dr. Niederhuber said. "He embodied that vision in his enthusiastic support and development of a number of major initiatives that sought to build upon and expand NCI's leading role in the cancer research enterprise. Those include the launching of the cancer Biomedical Informatics Grid, re-engineering of the clinical trials enterprise through the Clinical Trials Working Group, NCI's Alliance for Nanotechnology in Cancer, the Integrative Cancer Biology Program, and The Cancer Genome Atlas, to name just a few."
"He also recognized the importance of science that rapidly and safely translates basic research into patient treatments - science that then takes information gleaned from the patient's bedside back to the laboratory," Dr. Niederhuber added. "Throughout these programs runs the thread of Andy's firm belief that we will increasingly be able to preempt the cancer process: preempt it with improvements in prevention, early detection, and targeted treatment for cure or modulation of aggressiveness to allow patients to live longer lives with higher quality."
The plaudits were seconded by NIH Director Dr. Elias Zerhouni, who noted Dr. von Eschenbach's keen interest in nanotechnology, bioinformatics, and the need for greater emphasis on translational research at NCI and other NIH institutes. The NIH director also honored Dr. von Eschenbach's "very difficult decision" to heed President Bush's request for him to leave NCI in 2006 to assume his current role as Commissioner of the U.S. Food and Drug Administration.
Dr. von Eschenbach thanked his colleagues and friends for their comments and support, particularly those among the NCI staff during his tenure. "When I arrived at NCI, I was enormously blessed by the incredibly talented and dedicated people I found here," he said. "Each and every day I served as NCI Director was an unbelievable privilege and honor."
He offered special thanks to his wife Madelyn, "who from the very first moment of our lives together was willing to pay any price so that we could together make a difference." His wife, four children, six grandchildren, and other family members were present at the unveiling of the oil paint portrait by noted artist James Tennison. The painting will hang in the NCI Office of the Director gallery beside the other 11 official portraits of all former NCI directors.
Shannon Bell has been named as the new director of the Office of Advocacy Relations (OAR), formerly the Office of Liaison Activities. Ms. Bell, whose appointment was effective October 29, previously served as deputy director of NCI's Office of Workforce Development. NCI Director Dr. John E. Niederhuber has relocated OAR in the immediate Office of the Director and appointed Special Assistant Anne Lubenow as his immediate liaison with individuals and organizations who advocate on behalf of cancer research. More information about OAR can be found at http://advocacy.cancer.gov.
Lowy, Schiffman Receive ACS Medals of Honor
Dr. Lowy, chief of the Laboratory of Cellular Oncology in NCI's CCR, received the Medal of Honor for Basic Research for his contributions to basic science and research leading to the development of the human papillomavirus (HPV) vaccine, which was carried out in close collaboration with his NCI colleague Dr. John Schiller. Dr. Schiffman, of the Hormonal and Reproductive Epidemiology Branch in DCEG, received the Medal of Honor for Clinical Research for his work in molecular epidemiology relating to HPV.
If Memory Serves...
The earliest NCI cancer epidemiology studies in the late 1930s and early 1940s focused on two activities: a survey of radiation protection in hospitals and an evaluation of breast cancer therapy based on records from nine large cancer hospitals. (Read more)
For more information about the birth of NCI, go to http://www.cancer.gov/
Two NCI researchers were elected as AAAS Fellows for outstanding contributions under the Section on Medical Sciences. NCI Director Dr. John E. Niederhuber was elected for his pioneering research on MHC immunology and cancer stems cells, and outstanding leadership of the University of Wisconsin Cancer Center and NCI.
Dr. Mark C. Udey, director of the Dermatology Branch in CCR, was elected for seminal research on the biology of Langerhans cells and the role of E-Cadherin and TGF-beta in their development and localization.
NCI Hosts Public Forums on Biospecimen Resources
Teleconference Focuses on NCI-Frederick
Within the U.S., the teleconference can be accessed toll free at 1-800-857-6584; the passcode is FREDERICK. Toll-free playback will be available through December 8 at 1-866-379-4229. To view the series schedule, go to http://advocacy.cancer.gov/activities/teleconferences.
Treating the Whole Person
Meeting the Emotional and Social Needs of Cancer Patients and Their Families
All too often the emotional, social, and practical problems that accompany a diagnosis of cancer are not discussed or addressed during treatment, and this may prevent patients and their families from getting the care they need, according to a report by the Institute of Medicine (IOM).
Cancer Care for the Whole Patient - Meeting Psychosocial Health Needs calls for a new standard of cancer care in which physicians screen patients for psychological and social issues as early as at the time of diagnosis. Regular follow-up would be required to ensure that recommended care was received and that new needs are being identified and addressed.
Many studies have suggested that unmet psychosocial needs can affect treatment and put patients at risk of illness later in life. Yet the report found that these needs are often not acknowledged or addressed in cancer care.
We're so focused on biomedical aspects of care that a patient's psychosocial needs are not being met," says Dr. Julia Rowland, who directs NCI's Office of Cancer Survivorship. The good news is that many community resources as well as Internet and telephone support services are available to help patients with needs.
The report includes recommendations for how to implement the new standard of care. Interest in psychosocial issues is high because many individuals are experiencing cancer as a chronic disease, and decisions made at the time of treatment can have long-term consequences.
"This report touches a nerve for people who have experienced cancer in terms of the extent to which psychosocial factors are not attended to during treatment," says Dr. Nancy E. Adler of the University of California, San Francisco, who chaired the IOM committee.
She notes that the IOM recently received an e-mail that read simply: "Thank goodness this is finally acknowledged because it is so important."
The report describes three models for delivering psychosocial care, which vary depending on the size of a practice. For instance, comprehensive cancer centers may have the support services on site, while providers in rural areas could use remote services, such as CancerCare and NCI's Cancer Information Service.
Though it focuses on cancer, the IOM report could be adapted for delivering quality care to patients with any chronic disease. The basic strategy requires a foundation of good communication between health care providers and patients.
"This is absolutely critical," notes Dr. Adler. "A health care provider has to ask what the patient's psychosocial needs are in order to help, and the patient has to articulate those needs."
The elements of effective communication are the subject of a new monograph published by NCI, Patient-Centered Communication in Cancer Care. The report shows how better communication can improve clinical outcomes and psychosocial health and lays out the research agenda for the future. The focus is on teams because cancer patients communicate with a variety of health care providers.
"We need to look at the entire journey of cancer patients and their families to understand how the health care system is meeting their needs," says Dr. Neeraj Arora of NCI's Division of Cancer Control and Population Sciences, which produced the report.
—Edward R. Winstead


text:
Final Score: Philadelphia 33, Washington 27
Landover, MD (Sports Network) - With people questioning how his high-paced
offense would translate to the pro game, first-year Philadelphia head coach
Chip Kelly took a big step toward silencing his critics.
And Michael Vick and LeSean McCoy made sure their new bench boss left FedEx
Field a winner.
McCoy rushed for 184 yards and a score on 31 carries, while Vick accounted for
three touchdowns, as the Eagles spoiled the return of Redskins' quarterback
Robert Griffin III with a 33-27 triumph over reigning NFC East champion
Washington in the season opener for both teams.
Kelly had spent the last six seasons at Oregon before replacing current Kansas
City head coach Andy Reid, whose 14-year tenure in Philadelphia ended after a
4-12 finish last season and a second straight year not making the playoffs.
The Eagles (1-0) embraced the fast-paced, high-octane offense of Kelly,
racking up 443 total yards and 26 first downs en route to the victory.
Vick finished 15-of-25 passing for 203 yards and two touchdowns, while rushing
nine times for 56 yards and a score. DeSean Jackson hauled in seven passes for
a game-high 104 yards and a touchdown in the win.
Griffin, meanwhile, showed plenty of rust in his first game action since
sustaining a torn LCL and ACL in his right knee during Washington's wild card
loss to the Seattle Seahawks last January.
The reigning NFL Offensive Rookie of the Year completed 30-of-49 passes for
329 yards, two touchdowns and two interceptions, while Alfred Morris rushed
for 45 yards and a score on 12 carries for the Redskins (0-1).

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|3. pgreplay - Reads a PostgreSQL log file, extracts the SQL statements and executes them in the same order and timing against another database server.
Useful for performance tests with real-world workload.
|Activity Percentile: 61.11
Activity Ranking: 50.00
Registered: 2010-03-08 09:49
|4. psqlODBC - psqlODBC is the official PostgreSQL ODBC Driver.
Downloads are available on the PostgreSQL Mirror network at http://www.postgresql.org/ftp/odbc/, and support from the email@example.com mailing list (http://archives.postgresql.org/pgsql-odbc/).
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Registered: 2005-07-14 07:59


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Here you can select the passengers for this flight reservation.
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Ski Gloves
Finding the right pair of gloves for the winter can be a daunting enough task to make you want to hibernate and wake up in March. However, a little bit of information can make it a much easier task and put the wonder back into your winter wonder land. The first step in picking out ski gloves is determining what the climate is where you ski. You'll have to decide how much water protection you'll need, how much warmth you'll need and how much wind resistance will be necessary. You'll also need to know what kind of skier you are; you'll need to know if you need good grip, dexterity or the other options, such as a nose wipe, that more demanding skiers need.
Ski gloves versus ski mittens
The difference between gloves and mittens appears to be obvious, but there are more factors than style and dexterity to consider. The warmth offered by mittens is superior to the warmth offered by gloves of the same thickness. Gloves are often more breathable because of the increased surface area, so your hands will not become moist from your own sweat.
There are many levels of waterproofing, from none at all to so much that your hand would stay dry in a lake.
If you're looking for the best waterproofing available, make sure that the gloves you're buying are fully seam taped. Fabrics such as Cordura® Ventia™, Ventia™, treated leather and Deluge® DWR-treated polyester will all keep you plenty dry.
Other gloves, with critically taped seams and leather, nylon, polyester and Ventia™ shells can still provide excellent waterproofing and will not be as expensive.
If you need warmth without waterproofing, fleece and neoprene are fast drying fabrics that offer great dexterity. Some fleeces will even be waterproof and, of course, fleece offers great warmth.
There a few different materials used in ski gloves to keep your hand warm. Fleece is one of the most popular fabrics due to its low weight, its quick drying, and its excellent warmth. There are many kinds of fleece, including Polar fleece and Primaloft.
Wool is another material that is sometimes used in gloves and traps in heat while allowing breathability.
For some activities, such as spring skiing, you may not want too much insulation. Instead, you may just want a glove to act as a waterproof shell, in which case fleece or wool would cause you to overheat.
If you think you're going to need ski gloves with insulation and ski gloves without, keep in mind that there are gloves with removable liners that can multitask.
It is hard to find a pair of gloves that will allow your fingers the complete range of motion and dexterity that you're used to. Mittens will limit your ability to do some things and thick gloves are not too much better. That is one advantage of gloves or mittens with liners; if you need to work with your fingers, you can remove the snow gloves or snow mitts briefly to complete a task.
Thinner fleece and neoprene gloves offer great dexterity as they are. If you're going to be doing a lot of work with your hands and you can afford to have less insulation, these gloves will be perfect for you.To enhance grip, many ski gloves and mitts have specially treated palms or have a layer of fabric. Some gloves use rough leather and others use synthetic treatments; either way, you can be sure that the treatment will help you get a grip.
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Somebody at Google has a sense of humor. Google Maps Street View is giving fans of "Doctor Who" a glimpse inside the Tardis.
The Tardis is the machine in which the Doctor and his companions travel throughout space and time on the long-running BBC series. It's larger on the inside than it is on the outside. The outside of the Tardis appears as a British police call box, which is helpful in avoiding unwanted attention when its parked on the streets of London.
A search for 'police telephone box london' on Google Maps will yield a number of results. It is the call box numbered 'A' on Earl's Court Road that contains the surprise.
Click HERE for the external street view of the Police Telephone Box. Clicking the double arrow directly in front of the call box will take you inside.
If you prefer, click HERE to go directly to the internal view of the Tardis. Holding the left mouse button and moving the cursor will allow you to scan the full interior of the Tardis.
"Doctor Who" will celebrate it's 50th anniversary on the BBC in November.
Photo credit: Official Doctor Who Facebook page
Greg Belfrage is an avid Star Trek fan, serious Batman toy collector and hopeless geek. He hosts the morning show on KELO Newstalk 1320 AM / 107.9 FM.


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Oct 12, 2012
SBM Offshore's SBM Baleia Azul unit has raised $500m in the RegD private placement market, giving LatAm its first bond financing for a floating production, storage and offloading vessel (FPSO). The Baa2/BBB 2027 project bond for the Cidade de Anchieta vessel priced at par to yield 5.5%, SBM says. The transaction has an 8.5-year average life and was placed with 16 institutional investors following marketing that began last month. Finding comps for the bond is not straightforward, but DCM bankers away from the deal suggest the Brazilian drillship bonds backed by...
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- Home /
- BRS 4 Stage Value PLUS RO/DI System - 75GPD
Reverse Osmosis Float Valve
Starting at: $11.99
BRS 4 Stage RO/DI Replacement Filter Kit$22.99 As low as: $20.99
1⁄4" Mur-lok Polyethylene RO Tubing
Starting at: $0.25
Mur-lok RO Inline Ball Valve Push Connect
Starting at: $5.99
Best choice for RODI By shovelrider on 9/29/2014shovelrider would recommend this product to a friendI have the 4 stage 75gpd unit and it cannot be beat. I have a 75g tank and this unit makes water like a champ. I have it setup in my laundry room and the "waste" water drains into my washing machine so nothing is actually wasted. I also have the shutoff valve now and would recommend one of these for every unit. Changing the filters is a breeze. No water spills out and you only have to snug up the cartridge and it will come off easily. The TDS meter, along with the PSI gauge, is also a must and is very useful for letting you know when your filters need changing.
Anybody tried to replace the filters By Jane on 9/15/2014Jane would recommend this product to a friendI loved this unit and have no complaints except now is the time for me to replace the filters and I CANNOT get the individual canisters open using the wrench. I have tried and tried and now I fear I might have to buy a whole new unit!!
Excellent!! By Albert on 9/8/2014Albert would recommend this product to a friendI purchased this unit with the separate upgraded water saver attachment and requested that BRS install it. It all came installed and packed very well. It was wrapped in bubble wrap and surrounded by packing peanuts. The unit was very easy to attach to my hose outside. When I first started to use it I noticed that it was leaking from one of the elbows being cracked going into the unit which dropped the pressure and wouldn't produce ro/di water.
I took a pic and emailed it to BRS. They quickly responded and gave me the option of either having them send a replacement part for free or going to a local hardware store to get the part myself. I opted to get the part myself because it was faster. After replacing the elbow the unit works great. It was less than $3 for the part so no big deal. BRS credited my account more than i payed for the replacement part anyway.
I would definitely recommend upgrading with the water saver unit. It came with a valve were I can shut the water saver on or off and the difference is night and day. I get a very nice stream with the water saver on and drips when I close it off.
Excellent product!! Excellent service!! i will definitely be buying from them again!!
Game changer, love this kit By JR on 8/20/2014JR would recommend this product to a friendAt first I thought to myself "I can run to the store for distilled water, it's only a 20 gallon reef"....yeah right! I quickly became tired with this routine especially when the store ran out of distilled water. Purchased this setup ASAP and have been running it like a beast to store water on the side and have free reign on my water changes. It fills up my five gallon buckets in no time and combined with the shut-off float it works great. My shut-off valve was faulty and allowed the waste to continuously run, but BRS shipped me a free replacement without issues. Great team and super great product.
Great Product/Works Great By Jon on 8/17/2014Jon would recommend this product to a friendThis thing was a breeze to install. It works great and produces about 3 gallons per hour. Only thing I would warn other people about is read the description closely. I thought the TDS meter measured my tap water coming in but it does not. It measures the water after the first filter and coming out. This is not a problem, just something I overlooked. It doesn't really matter since the unit puts out such clean water!
Great Quality By Adam on 7/23/2014Adam would recommend this product to a friendJust got my RO system today, setup take just a few minutes, it's working great. Just ordered the 150gdp water saver kit to cut down on waste water hope it works.
great! By perry on 7/23/2014perry would recommend this product to a friendThis is a great unit for the money and would definitely recommend buying this unit.
GREAT PRODUCT By q on 7/16/2014q would recommend this product to a friendalmost a year and working wonderful
Great Item! By David on 7/9/2014David would recommend this product to a friendThis is a quality product, especially for someone on a budget!!
Amazing By Dennis on 6/28/2014Dennis would recommend this product to a friendThis RO/DI is amazing. The setup was simple and instructions were easy to follow. Sure beats spending $0.70 per gallon from our LFS. Thanks Bulk Reef Supply.
Life Saver By Michael on 6/17/2014Michael would recommend this product to a friendUse to use tap water from my sink and tank always had algae! Starting using this and now no more algae. Plus this will save you trips to the store if you want perfect water.
Solid By Sammy on 6/14/2014Sammy would recommend this product to a friendI bought this unit a few months ago. This was my first RO/DI unit I have owned and let me say, man I am glad I purchased this unit. I feel the unit is made of high quality materials and you cannot beat the price, especially comparing to some other brands. I took a star away only because I am getting about a 97% rejection and I tend to go through the DI quite quickly. This is somewhat of a byproduct of living in Phoenix and having a TDS of approx 820 during the summer months. However, a fellow reefer who lives close to me is getting a much better rejection rate with a similar features, different unit.
The Best RO/DI System AroundIn today's episode we are going to go over exactly ...
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How to Install an RO/DI SystemToday on BRSTV we are going to show how quick and ...
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Previously Asked Questions
by paul on September 29, 2013, @1:26 AM
I have 35# of water presure do I need a pump to go with this do/di and if so what do I need to get ?
Bulk Reef Supply Hi Paul,
Your pressure is low enough that I would recommend a booster pump as an RO/DI unit is going to work very poorly if at all at 35psi. Below I have linked the booster pump kit that you would want.
by andrew on March 3, 2014, @11:09 AM
any idea how much waste water this will produce? Also will this unit bring water to 0 tds? Thanks!
Bulk Reef Supply HI Andrew,
It depends on a lot of factors including incoming water and how you actually setup the system but assuming normal water pressure and temperature a waste water ratio of 3:1 - 5:1 waste to product water would be typical, with most getting closer to the 3:1
by James Low on February 25, 2014, @4:45 PM
What are the dimensions of this unit?
Bulk Reef Supply HI James,
The unit measures about 15" tall, 16" wide and about 7" deep if you measure out from the front face of the tds meter to the back of the unit.
by jack on May 12, 2014, @9:58 PM
Hi, are there pieces and valves included with the kit so I can bypass the DI to receive drinkable RO water? If not, can you please direct me to exactly what parts I need to do this? Thank You
Bulk Reef Supply Hi Jack,
If you actually want to use the unit for drinking water then you would want to look at the add on faucet kit. It has all the necessary fittings as well as the storage tank so it doesn't take you 20 minutes to fill a glass of water.
by Thomas on November 14, 2013, @4:25 PM
Is the tubing 1/4inch or 3/8inch? I need to know to order another utility sink hose connector.
Bulk Reef Supply Hi Thomas,
All of our RO/DI units use 1/4" tubing.
by Jonathan on February 24, 2014, @6:22 AM
What size tubing does this use so I can order more if the correct size?
Bulk Reef Supply Hi Jonathan,
All of our RO/DI units use 1/4" tubing.
by josh hendricks on January 1, 2014, @3:46 PM
I have this system which filter package do I need to replace mine?
Josh Hendricks
Bulk Reef Supply HI Josh,
You have the 4 stage RO/DI system so you would want the 4 stage RO/DI replacement filter kit.
by Ramin Namvar on October 25, 2013, @11:36 AM
Hi, I want to know how long will these filters (Specifically DI resin) last?
Bulk Reef Supply Hey Ramin,
The actual results will vary depending on your water but a good ballpark is that the sediment filter is generally good for around 3000g, the carbon block 6000g (this is total water, so waste + product). The RO membranes will last 3-5 years, or even longer if you treat them well. The DI resin however is really impossible to say. Its entirely dependent on your feed water. If you have high CO2 and High TDS, it will have a short life and vice versa. For most folks it lasts about as long as there sediment/carbon blocks but it does really vary significantly.
BRS 4 Stage Value PLUS RO/DI System Instructions
Value systems are smaller, portable and affordable. The BRS 4 Stage Value PLUS Reverse Osmosis/Deionization System includes all the essential features necessary to start making pure RO/DI water at 75 gallons per day. Plus an air-filled pressure gauge, membrane flush kit and HM Digital Dual Inline TDS meter.
4 Stages of Filtration:
- Purtrex 5 Micron depth sediment filter
- MATRIKX CTO 5 Micron carbon block
- 75 GPD Dow Filmtec Membrane
- Single Deionization(DI) stage with refillable cartridge
PLUS Features:
- Air-filled Pressure Gauge (100 psi) to help ensure the RO system is performing properly
- Membrane Flush Kit to help maintain RO membrane
- HM Digital Dual Inline TDS (total dissolved solids) Meter to help monitor system
Parts Bag Includes:
- Filter wrench to tighten and loosen canisters
- Chrome faucet connector to make a non-permanent connection to kitchen sink
- Utility sink/garden hose adapter to make a non-permanent connection to garden hose or laundry tub
Standard Features:
- Automatic shut-off valve
- Mur-lok Push Connect dual EPDM O-Ring fittings
- 10 Ft Each of Blue, Red and Black Tubing
- All BRS Reverse Osmosis units exclusively feature American made DOW, MATRIKX and Purtrex filters. We also use American made Mur-lok dual EPDM O-ring fittings whenever possible on all of our reverse osmosis units. These NSF certified fittings and filters cost us more than inexpensive imports, but set our units apart from the competition.
Quick Compare - BRS RO/DI Value Systems
|BRS 3 Stage Space Saver
|BRS 4 Stage
|BRS 4 Stage PLUS
|Gallons Per Day
|Sediment Filter
Omnipure 5 micron sediment filter
|Purtrex 5 micron depth sediment filter
|Purtrex 5 micron depth sediment filter
|Carbon Block
Omnipure 1 micron carbon block
|MATRIKX CTO 5 micron carbon block
|MATRIKX CTO 5 micron carbon block
75 GPD Dow Filmtec Membrane
|75 GPD Dow Filmtec Membrane
75 GPD Dow Filmtec Membrane
|Single DI stage with refillable cartridge
Single DI stage with refillable cartridge
|Pressure Gauge
Air filled pressure gauge
|Flush Kit
|Flush Kit
|TDS Meter
|Dual Inline TDS Meter
Deal of the Day!
Mag-Drive Supreme 12 Pump (1200 GPH)Ends in
Regular Price: $159.99
Special Price: $127.9900:00:00:00
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View Larger Map 6325 Sandburg Road, Suite 400, Golden Valley, MN 55427


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Stress Fracture
- Home
- Health Info
- Stress Fracture
(Fracture, Stress)
|Stress Fractures of the Tibia and Fibula
|Copyright © Nucleus Medical Media, Inc.
- Increasing the amount or intensity of an activity too quickly (most common)
- Switching to a different playing or running surface
- Wearing improper or old shoes
Risk Factors
- Sex: female
Certain sports, especially involving jumping or running:
- Tennis
- Track, especially distance running
- Gymnastics
- Dance
- Basketball
- Amenorrhea (women only)
- Reduced bone thickness or density
- Poor muscle strength or flexibility
- Overweight or underweight
- Poor physical condition
- Localized pain on the bone
- Pain when pressure is applied directly over the fracture and the area around it
- Pain when putting stress on the affected leg
- Swelling and warmth at injury site
Crutches or a Cane
- Begin with nonweight–bearing activities, such as swimming or bicycling.
- Next, you can do weight-bearing, nonimpact exercise, such as a stair machine.
- Gradually, you will be able to add low-impact activity, starting with walking.
- Once you can do fast-paced walking with no pain, you can start higher impact activity, such as light jogging.
- This gradual progression continues until you have reached your pre-injury activity level. You can return to full activity once you do not feel tenderness of the bone.
- Wear proper footwear.
- Run on a softer surface, such as grass, dirt, or certain outdoor tracks.
- Gradually increase the amount and intensity of an activity.
- Do not overdo any activity.
- Weight reduction can reduce stress on the bones
- Avoid smoking.
American Academy of Orthopaedic Surgeons http://www.aaos.org
American Orthopaedic Society for Sports Medicine http://www.sportsmed.org
American Podiatric Medical Association http://www.apma.org
Canadian Orthopaedic Association http://www.coa-aco.org
Canadian Orthopaedic Foundation http://www.canorth.org
Marx RG, Saint-Phard D, Callahan LR, Chu J, Hannafin JA. Stress fracture sites related to underlying bone health in athletic females. Clin J Sport Med . 2001;11:73-76.
Sanderlin BW, Raspa RF. Common stress fractures. Am Fam Physician . 2003;68(8):1527. Available at http://www.aafp.org/afp/2003/1015/p1527.html .
Stress fractures. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00112 . Updated October 2007. Accessed June 25, 2008.
Stress fractures. Mayo Foundation for Medical Education and Research website. Available at: http://www.mayoclinic.com/health/stress-fractures/DS00556 . Updated November 3, 2006. Accessed June 25, 2008.
Wells CL. Women, Sport & Performance: A Physiological Perspective . Champaign, IL: Human Kinetics; 1991.
Wheeler P, Batt ME. Do nonsteroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med . 2005;39:65-69.
Revision Information
- Reviewer: Michael Woods, MD
- Review Date: 09/2013 -
- Update Date: 09/30/2013 -


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Dec 29, 2010 | 12:27 PM
A Chinese buying frenzy helped boost U.S. exports of shredded scrap by nearly 275,000 tonnes in October.
Overall shipments climbed to 798,143 tonnes, up 52.5 percent from 523,465 tonnes delivered to foreign steelmakers in September, according to the latest figures from the U.S. Commerce Department. The October tonnage was the highest monthly total since August 2009, when 878,138 tonnes were sent abroad.
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text:
A Detroit family trying to keep warm make a dangerous mistake. A 25-year-old mother, her 9-year-old son, and the mother's girlfriend were poisoned with carbon monoxide at a home on Barlow in Detroit.Detroit fire found a gas-operated generator in the home, which had been running for a couple of hours.Recognizing something was wrong, the boy's mother called 911 and all three were taken to St. John Hospital.The mother has been released, but her son and girlfriend remain hospitalized. Doctors are monitoring their oxygen levels, but they are expected to be okay."They're fine. By the grace of God, they're fine," says the boy's mother."The symptoms of carbon monoxide poisoning are vomiting, headaches and flu-like symptoms," says capt. Chris Dixon, Detroit fire. "If you feel any of these symptoms get medical help immediately. Open windows to get fresh air into your system."DTE tells FOX 2 there is evidence of theft by a previous tenant of both natural and electric gas. Because of the thefts, DTE cut off both the natural and electric gas to the home.The gas service was installed Wednesday morning. But since the electric service lines to the home were cut at the top of a power pole, it will take a special crew to run new lines from the pole to the house. This process is more time consuming than installing standard electric lines to a residence.DTE says electric service could be back on as early as Thursday.
KTBC FOX 7119 East 10th StreetAustin, TX 78701Phone: (512) 476-7777Fax: (512) 495-7001


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Ahhhh! Chrissy your going to be a Gma!!
*backs out slowly*
Ahhhh! Chrissy your going to be a Gma!!
*backs out slowly*
...and I miss you ladies! I stalk, but can't dedicate myself to the NET quite yet, I would probably miss 2/3 of the conversation and feel awful!
Only 4 more weeks of classes at full time status and than I only have 1 summer class and I'll officially have my BA! So I should be able to come back and bore you ladies with my responses soon enough
Welcome back! And congratulations on your own soon to be LO. How is Nolan taking it?
I agree that there is no way to ask that question of someone, and not have it be noseypantsing. If someone volunteered the information, that's different.
Chrissy, how did Rich do with the news?
Well I can't wait to 'see' you back here again Christina
Yes! Yes, Xtina! Congrats on your pregnancy! Come back and tell us all about how your school year went once it's all over and done with.
Kate, it does seem like a really intimate, inappropriate question. I can honestly think of only 3 friends whom I'd feel comfortable asking, and they would probably tell me up front anyway.
Before we got pg with Nolan, while we were TTC, one of DHs aunts told me "What can't you have any kids?" while asking me one night why we hadn't had any kids yet. Good example of why we didn't tell hardly anyone what we were going through. Not the most sensitive bunch.
Rich has a gf, Chrissy? Is it that mutual friend of yours that you mentioned earlier? I think it will all get comfortable again if you just keep being around each other and giving it time. That's always been the way I handled awkwardness anyway.
I want to find you that G.I.L.F. shirt, btw.
Though, I am stuck taking a 'Religion and Personal Experience' class currently. The curriculum is basically reading these books and than writing papers on them. Currently readin 'Take This Bread'. Sigh. It's been difficult and apparently I am the only non-christian in the class, which just means our weekly 'discussions' involve in no one responding to me
Rich won't change...it's something weird about him. Because he has a gf, he has to be a d1ck to me. We were broke up before and it was the exact same thing. AND...this time we had a 'moment' and a couple days really, really talking. It ended up with us making out and me bawling about how we ended up here. The next day he sent an abrupt text stating, "I've thought about it all night and I think it's best if we just remain friends." He will not discuss anything with me, won't explain anything to me, and for a while wouldn't even come up to my apartment when he dropped Conner off or picked him up. Like it's my fault and I fooled him somehow. I dunno. I don't really care. The chick is 30-something, has two kids with two dads, currently lives with a guy that's a trucker and has a history of f'n lots of different men. I'm not feeling threatened in the least. No Myles, she's not my friend that I mentioned earlier. She's a piece of work and looks like a bar broad. But Rich likes her.
Last edited by missychrissy; 03-28-2013 at 12:29 PM.
Sigh. I am sorry Chrissy He went the total opposite of finding a woman like you didn't he
Christina!!!! Congrats! And I do consider that trying because you have talked about wanting that for a while. And how cool to be almost done with school!!! I feel for you in the religion class....I went to a catholic school and was the only atheist or anything close to one in my classes....which was at least one religion and than with my major, religion came up all the time.
It is a rude question but one that many of us think! I think sometimes it's just trying to figure out if it was a good surprise or a surprise. Not that a baby is a bad thing but there is something about having one on purpose and a surprise. People are just nosey and I like to think that most don't mean any harm.
Chrissy it's amazing how well you take things. I could just picture my mom if that was me at 18, eventually she would have come around but OMG it wouldn't have been pretty. But at 18 I was definitely not an adult. I wasn't really an adult until about 24 yrs old. That was when I was no longer taking their money to support myself in anyway.
The school I am attending is Catholic, I am pretty sure, it is a private university and I had to take one religion class in order to receive my BA. It's frustrating, because now it means I have to take a class over the summer which is not ideal! Oh well, I am almost there
Last edited by Smplyme89; 03-28-2013 at 01:23 PM.
When I got pregnant I was 16. My father wasn't pleased, but that was pretty much the role he played with me. What was done was done, and he was nothing but supportive (if not slightly disappointed as well). Everything came out all right and I really, really appreciate how he was about it. He was the best. I learned from the best.
You got me started. I wasn't going to rant about Rich. He's just going through something and it really has nothing to do with me. I've called him on the things that have to do with Conner but the rest of it I really don't care about. I cared when he got my emotions going and then suddenly pulled back, but I'm even over that bit too.
And Rich is being a complete ****. I'm so sorry.
Me (40) DH (47) & furbabies * m/c 7/08 4/12 11/12
I have to say that you're handling this with such grace, Chrissy. I'm not sure I'd be as supportive and understanding as you're being (with both Jesi and Rich).
When I got pg with dd1, I was 24, had been to college and had lived on my own for 8 years, and was working as an editor for the local paper. I wasn't married, and the guy wasn't someone they were in love with (I wasn't sure I was, either - ha). But my parents were so angry, disappointed, embarrassed -- it was a tough time for me. They came around eventually (mostly because I did end up marrying the father of my child, although I shouldn't have, and it didn't last). But I sometimes think about how much sadness and stress could have been avoided for me had they accepted and supported me from the beginning. I'll never forget the looks on their faces when I told them, sobbing, that I was pregnant. It was horrible. My mom couldn't talk to me or look me in the eye for weeks.
By loving Jesi and Kaleb, and accepting her news with joy, you're giving them a wonderful gift.


text: I have been gaining strength from these forums for months and months now and I thought I should introduce myself. I was diagnosed with PE at 33 weeks and put on bed rest. I also developed gestational diabetes at the same time. I manged to stay pregnant until 39 and a half weeks. I was then induced and after a long labor had a c-section. I had a beautiful boy Oliver on Jan. 18 2009. His sugars crashed due to the diabetes so he spent one night in the nicu. My recovery from the c-section was challenging. Our first night home I was awoken with massive heart palpitations. My husband took my bp (now an expert!) It was threw the roof. I was rushed to the hospital. They ran many tests and found nothing. I saw the doc a few days later and she found my bp to be be sky high as well. She put me on adalat. I stayed on the meds for the next 6 months. I have since been clear of diabetes and my bp is back to normal. My son is a beautiful 14 month old. I am really hoping we can try for another baby in a year or so. I am working on loosing weight and getting into shape. I figure the stronger the better before trying again. I still find that i am emotionally effected by the whole experience. I am just so thankful to have a place to read others stories and hear that some of you have been able to have a second child. Thanks for sharing and providing support for so many.


text:
In homage to Benvenuto Cellini, sculptor and goldsmith to Renaissance popes and kings, Rolex created a watch collection that bears the master's name. Watchmaking has evolved from being the domain of a single craftsman to a collaboration of skilled specialists. Every Rolex is a symphony of know-how and artistry.
In 1928 Rolex created the Prince, which achieved great success and earned a place in horological history for its chronometric precision.
With its avant-garde rectangular shape and the outstanding performance of its movement, the Prince was and remains a watch of distinction.
Discontinued at the end of the 1940s, the Prince had elevated Rolex to the peak of elegance and precision. It was the first watch, produced in large quantities, to obtain chronometric certification. Although it was set apart by the precision of its timekeeping, its real success is due more to its rectangular shape and elegant, sophisticated dials.
The Prince features a manually-wound mechanical movement – the 7040 calibre – specially developed and manufactured by Rolex. Rectangular in shape, it uses all the space to ensure precision and performance and to give free rein to the decoration of the bridges with designs identical to those on the dial.
The aesthetic aspects of the movement are as important as its chronometric performance. In fact, they are entirely designed and manufactured in concert with the dial, case and bracelet, and are visible through the transparent caseback.


text:
Here is my layout. I'm not very happy with it, but this always happens to me when I have to meet deadlines
I enjoyed a lot the chat and scrap! Thank you!
Now, let's see if I used everything.
1) Date elements: the date is on the tag;
2) Trio of colors: white, black and turquoise;
3) Vellum: the word "are" in the Word art;
4) Greenery
5) Word art: you are someone;
6) Glitter and/or metal: glitter butterfly and metal tag and eyelets;
7) Frame: the big turquoise frame;
8) Worn/torn/folded paper: paper 3;
9) Ribbon and/or stitching: ribbon on the frame;
10) Polka dots: on the ladybird's back;
11) Gradient: the ribbon;
12) Something black and something white (almost everything!);
13) Something cute: the turquoise ladybug;
14) Sign/label/tag: metal tag;
15) Multipla photos: there are six of them (even if it's always the same!);
16) Layers: too many!
17) Something suspended: the frame suspended with a ribbon and a metallic hook;
18) Edge treatment: paper 2 and 4;
19) Something inexpected: the frame that frames a film;
20) Item of choice: a ribbon in a flower shape (now, it's too late in this part of the world, don't ask me to find something similar to link here...)


text:
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text:
State Symbols
From the State Dog to the State Beverage to the State Vegetable, browse the varied list of official North Carolina symbols and emblems. This list is updated as new state symbols are added.
North Carolina General Statutes, Chapter 145: State Symbols and Other Official Adoptions.
- Art Medium
- Berries
- Beverage
- Bird
- Boat
- Butterfly
- Carnivorous Plant
- Christmas Tree
- Colors
- Community Theater
- Dances
- Dog
- Festivals (and Blue Monday Shad Fry)
- Flag
- Folk Art
- Flower
- Fossil
- Freshwater Trout
- Frog
- Fruit
- Honor and Remember Flag
- Horse
- Insect
- Mammal
- Marsupial
- Military Academy
- Mineral
- Motto
- Pottery birthplace
- Reptile
- Rock
- Salamander
- Salt Water Fish
- Salute, Flag
- Seal
- Shell
- Song
- Sport
- Stone, Precious
- Tartan
- Toast
- Tree
- Vegetable
- Wildflower
18 October 2012 | Underhill, Michelle Czaikowski
Anonymous replied on Permalink
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mason replied on Permalink
You can get a lot of info about North Carolina on this website.
Cupquake replied on Permalink
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Cupquake replied on Permalink
this didn't help a lot at all because for my project i need certain information and this site didn't give it to me but thanks for some of the info. Watch my mine-craft videos and Sim videos.
Ryann Downing replied on Permalink
This has like literally no facts i need at all!!! and what happened to chat with a librarian! i need that!
kagan replied on Permalink
Hi Ryann,
Thanks for visiting NCpedia and taking the time to leave your comment. Please let us know what facts you would like to see! We are always trying to improve NCpedia content.
Also, make sure you click on the blue text for each of the symbols to see the facts for each of the state symbols. The page you commented on is primarily a list of symbols with links to the article for each.
And you'll be happy to know that you can chat with a librarian! If you look in the upper right section of this screen you'll see a box with "Ask NCknows." When the box indicates that librarians are online you can type in the box to start a live chat. You can also follow this link to the NCknows website, it's open 24/7! http://ncknows.org/
Kelly Agan, NCpedia Digital Media Librarian
Anonymous replied on Permalink
try this website
danielle replied on Permalink
this is sorta boring
corey replied on Permalink
this is sooooooooooooooooooooooo not helpful and its dumb
Anonymous replied on Permalink
awsome!this helps alot.
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text:
The Indianapolis Colts Friday Night Football Tour visits a different match-up each week of the season.
The Indianapolis Colts host annual high school football games at Lucas Oil Stadium.
Learn more about all of the Ivy Tech Community College Scholar Athlete of the Week program.
The Indianapolis Colts Coach of the Week program, presented by Anthem Blue Cross and Blue Shield, awards outstanding high school coaches for their efforts.
Each June, teams compete in a 7-on-7 style tournament for a chance to play in the NFL HSPD National 7-on-7 Tournament.
Each April, around 250 high school football players test their skills in a combine that mirrors the NFL Scouting Combine.


text:
Birthday Bestsellers
Age-Balancing Night CreamProvides maximum hydration to restore suppleness$75.001.7 FL. OZ.330 Reviews
Sheer Lustre Day Moisture Broad Spectrum SPF ...Hydrates, protects and provides a dewy glow$70.001.7 FL. OZ.319 Reviews
Birthday Bestsellers
*Individual results will vary. Study results on file.
†Offer valid through 12/31/2014. Cannot be combined with any other offers. Free standard shipping valid on U.S. orders only. Murad Terms and Conditions apply.


text:
Home | Stats | Team Search | Leagues | Awards | Drafts | About | Photo | RSS | Blog | Beta | Football | Sportbutiken
©1999-2014, www.eliteprospects.com
Free Agent List: J20 Div.2
Note: This list is automatically generated from the database and not to be considered an "official" free agent list. The players listed played in J20 Div.2 during the 2014/2015 season, but do not have a contract for the following season according to what is specified in our database. In case of errors, email firstname.lastname@example.com
ORDER BY SKATERS (Default)| FORWARDS | DEFENSEMEN | GOALIES
currently showing: J20 Div.2: Skaters (Forwards + Defensemen)
Click om column headings to sort!


text:
Table of Contents
Collection Overview
Collection Inventory+/-
Biographical Note/Historical Note
Content Description
Collection Use
Administrative Information
Collection Overview +/-
Collection Inventory +/-
Box 1: (1927-1988)
FD1 Acacia Club Attendance Roll book- 1941-1960
FD 2 December 2, 1927 Card of Appreciation – Frank J. Stevens and Family.
FD 3 April 9, 1944 – Golden Wedding Anniversary Announcement of Dr. and Mrs. Edward Israel Rich, Ogden Utah.
FD 4 October 26, 1962 – Membership notification for Dorothy D. H. Stevenson from Edna R. Wallace, Salt Lake City, Utah.
FD 5 December 11, 1964 – David J. and Mary Wilson to The Acacia Club.
FD 6 October 29, 1966 – Myrene Brewer to Dorothy D. H. Stevenson.
FD 7 July 28, 1967 – Edna R. Wallace to Dorothy D. H. Stevenson - contains useful summary of the history of the Acacia Club.
FD 8 November 2, 1967 – Thank you card to the Acacia Club members from Lucile Dixon.
FD 9 November 28, 1967 – Thank you card to Lucile Dixon from Bertha Reader. FD 10 December 27, 1967 – Correspondence to the Acacia Club from Margaret McFarlane.
FD 11 January 27, 1968 – Correspondence to Lucile Dixon from Cleone R. Eccles, Ogden, Utah.
FD 12 April 26, 1969 – Correspondence to Dorothy D. H. Stevenson from Norma S. Evans.
FD 13 September 6, 1969 – Invitation for the Acacia Club members to attend reception honoring Dr. Joseph R. and Jeanette McKay Morrell.
FD 14 October 25, 1969 – Correspondence to Dorothy D. H. Stevenson from Beatrice B. Corn. BOX 1
FD 15 February 12, 1970 – Note to the Acacia Club from Jeanette McKay Morrell.
FD 16 December 1971 – Christmas card and correspondence to members of the Acacia Club from Norma S. E. Patterson, Sedona, AZ.
FD 17 January 22, 1979 - Correspondence from Lucile Dixon to Dorothy D.H. Stevenson, Salt Lake City, Utah.
FD 18 January 22, 1982 – Correspondence from Lucile Dixon to Dorothy D.H. Stevenson, Salt Lake City, Utah.
FD 19 [n. d.] – Correspondence to the Acacia Club members from Mildred Meikle.
FD 20 [n. d.] – Correspondence to Lucile Dixon from Jeannette McKay Morrell.
FD 21 Curriculum Guides and Annual Programs – 1927- 1972.
FD 22 The Acacia Club Receipts and disbursements October 24, 1924 – May 24, 1960.
FD 23 Membership Records- 1962-1975- Red binder Presidents of Acacia Club:
Cleone Eccles-1962-1963
Bertha Reeder-1964-1965
Lucile Dixon-1966-1968
Dorothy D. H. Stevenson-1968-1970
Kathleen Klomp-1970-1972
Lucile Webb-1973-1974
Myrene Brewer-1974-1975
FD 24 Membership Records - 1964-1975
FD 25 Membership Records- List of Presidents of the Acacia Club (1916-1967) and members. Calligraphy by Ralph Stevenson
FD 26 Acacia Club Minute Book Volume One – October 25, 1911 – November 27, 1925. Contains the following:
Bee Hive Chautauqua Circle, October, 1911 to August, 1914
Bee Hive Sewing Circle, September to November, 1915
Bee Hive Literary & Sewing Circle, December, 1915 to September, 1916
The Acacia Club, September 15, 1916 to November 27, 1925
FD 27 Acacia Club Minute Book Volume Two – October 30, 1925 – January 6, 1933. Contains the recorded meetings of The Acacia Club.
Box 2: ORGANIZATION RECORDS (1911-1966)
FD 1 Acacia Club Minute Book Volume Three – March 10, 1933 – June 27, 1952. Contains the recorded meetings of The Acacia Club.
FD 2 Acacia Club Minute Book Volume Four – September 26, 1952 – May 26, 1966. Contains the recorded meetings of The Acacia Club.
FD 3 1930 – "Acacia Club Celebrates its Anniversary." Ogden Standard Examiner.
FD 4 May 27, 1932 – Acacia Club Activities Announced - Local Newspapers – (2 items).
FD 5 1966 – "Golden Wedding – Judge and Mrs. David J. Wilson (Mary J)." – Local Newspaper.
FD 6 February 26, 1984 – "Utah's Mother of the Year for 1984." Deseret News, Salt Lake City, Utah – Honoring Phyllis Dixon Shaw.
FD 7 February 21, 1927 – Obituary of Henrietta Woodmansee Watson – Ogden Standard Examiner.
FD 8 November 21, 1927 – Obituary of Agnes (Aggie) Herrick Stevens – Local Newspaper.
FD 9 November 23, 1931 – Obituary of Sara A. Scowcroft McCune – Local Newspaper.
FD 10 1933 – Obituary of Florence Scowcroft Scoville – Local Newspaper.
FD 11 1960 – Obituary of Fawn Brimhall McKay – Local Newspaper.
FD 12 January 26, 1966 – Obituary of Dr. Reed W. Bailey – The Salt Lake Tribune.
FD 13 1967 – Obituary of Rosella Ferrin Larkin – The Salt Lake Tribune.
FD 14 February 20, 1969 – Obituary of Dr. Edward I. Rich – The Salt Lake Tribune.
FD 15 April 11, 1971 – Obituary of Jeanette McKay Morrell – The Salt Lake Tribune.
FD 16 April 23, 1976 – Obituary of David J. Wilson – The Deseret News.
FD 17 November 14, 1987 – Obituary of Blanche Budge Johnson – Local Newspaper.
FD 18 March 10, 1988 – Obituary of Myrene Rich Brewer – Local Newspaper.
FD 19 1968 – Obituary of Earline P. Silver – Local Newspaper; September 18, 1973 –
Obituary of Norma S. E. Patterson – The Salt Lake Tribune; April 1976 –
Maude S. M. Silver – Local Newspaper; July 16, 1982 –
Obituary of Adaleine B. Bailey – Local Newspaper. (All glued on one sheet)
PROGRAMS FD 20 Programs - The Acacia Club 1946-1963 (12 items)
TEXTBOOKS FD 21 Textbooks – Ogg Fredric Austin. Social Progress in Contemporary Europe. Chautauqua Home Reading Series, 1912.
FD 22 Textbooks - Sidgwick, Mrs. Alfred- Home Life in Germany. Chautauqua Reading Series, 1912.
Biographical Note/Historical Note +/-
In the fall of 1907, several women of Ogden led by Agnes Stevens organized themselves to "acquire culture and to polish our priceless companionship". These charter members included: Lettie Burton, Martha Cooley, Catherine Carnahan, Joan Emmett, Ray McKay, Pearl McFarlane, Jeanette Morrell and Katherine Wright. From 1907 to 1916 the membership adopted a succession of names-- "Bay View Reading Club", "Bee Hive Chautauqua Circle", "Bee Hive Sewing Circle", and "Bee Hive Literary and Sewing Circle". After much discussion "The Acacia Club" was chosen as the name which reflected the "friendship" on which the group was formed. The women met every week in a different member's home to discuss current events, literary works and the fine arts, while they sewed or quilted. Their prime motivation was to avoid idle gossip by studying an organized reading course. They had enjoyed periodic lectures series of the New York Chautauqua Society, which would tour Utah and other western states with cultural programs and books. In addition to their cultural pursuits, the members of Acacia performed acts of compassionate and community service. The minutes of their early meetings reveal their efforts for "Bundles for Britain", Red Cross bandages, Armenian Relief Fund, The Crittenton Home for Children and Utah State School for the Deaf and Blind. One interesting entry, dated October 12, 1917, indicated that club members voted to discontinue serving refreshments as a token of their willingness to conserve foodstuffs and "to comply with Mr. Hoover's request during wartime." The group also decided to double their dues and devote their social hour to "Red Cross knitting". In time the Acacia Club adopted a formal, written constitution and by-laws, but they resisted efforts to combine with larger statewide women's organizations. The success of the Acacia Club became apparent with the continuous years of uninterrupted, regularly-held meetings from 1907 to 1974. This was the way that the membership demonstrated their dedication to the club's mission. One devoted member, Mrs. Henry Aldous Dixon (Lucile), wrote in her 90th year about her continuing interest in the Acacia friends. Another letter from Margaret McFarlane indicated the influence of Acacia on the next generation. "Mother taught us about the Acacia Club and the power of loyal friendships right along with the Word of Wisdom, the Ten Commandments and the Articles of Faith!" For more than 60 years, the Acacia Club met the needs of scores of Utah women. The record of how these intellectual, cultural and social requirements were met provides us with a valuable standard for the future.
Content Description +/-
This collection was donated to the Stewart Library Special Collections Department, Weber State College by the Acacia Club through the efforts and funding of Dorothy D. H. Stevenson. The papers have been arranged chronologically by category. The minute books, membership rosters, financial records and personal correspondence covering the years 1911 to 1974 are found in two document cases. The current-event topics and discussions of service and charitable works provide valuable insight into the concerns of the day, and also into perception of world affairs. Of particular interest are the letters, thank you cards and notes written by the individual members to the group. Within this correspondence the spirit of lasting friendship is expressed poignantly after decades of association. The collection includes newspaper clippings and obituary notices, which highlight the rich diversity of backgrounds and accomplishments of the Acacia Club members.
Collection Use +/-
Restrictions on Access:
Open for public research.
Administrative Information +/-
This collection is arranged in chronological order.
Acquisition Information:
Processing Note:
Process date unknown
Acacia Club
Material in English .
Library Services and Technology Act (LSTA) grant, 2007-2008
2 boxes
Language of the Finding Aid:
Finding aid encoded in English .
Author of the Finding Aid:
Sarah Langsdon
EAD Creation Date:
Finding aid based on DACS
Subjects +/-
Corporate Names:
Acacia Club
Subject Terms:
Ogden, Utah
Geographical Names:
Western States


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Diet for Diabetes Mccomb MS
Tylertown, MS
McComb, MS
Circuit Training, Elliptical Trainers, Free Weights, Personal Training, Pilates, Stair Climber, Stationary Bikes, Towel Service, Treadmill, Weight Machines
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24-hr Operations, Cardio Equipment, Circuit Training, Elliptical Trainers, Free Weights, Parking, Personal Training, Spinning, Stair Climber, Stationary Bikes, Treadmill, Weight Machines
Summit, MS
McComb, MS
A Better Type of Iron
By Julia Rosien
According to an article in the June issue of the journal Diabetes Care, too much heme iron—the kind found in meat—may cause long-term cell damage and contribute to the development of diabetes. Harvard researchers studied 85,000 women 34 to 59 years old for 20 years and discovered that those who consumed more meat had a higher incidence of type-2 diabetes. Women who ate the most meat had a 28 percent higher risk compared to those who ate the least, even with factors like body weight, exercise, and overall diet considered. What's interesting is that iron from plant sources doesn't seem to affect the body in the same way. Red meat has long been associated with an increased risk of certain cancers, especially colon, which makes incorporating meatless options into your diet a healthy shift.
If signing off meat wholesale isn't for you, consider part-time vegetarianism and become an expert at ferreting out healthy proteins. "Being a vegetarian has nothing to do with eating vegetables—we should all be eating vegetables—but it has everything to do with where you get your protein," says Nikki Goldbeck, author of American Wholefoods Cuisine (Ceres Press, 2006). Meatless options like soy burgers, bean soup, and veggie lasagna can be alternated with eggs, fish, or poultry. According to the American Institute for Cancer Research, fish and poultry contain less heme iron than red meat. Limiting the amount of meat in your diet in favor of vegetarian fare and carefully choosing the source of your protein can reduce your risk for diabetes, heart disease, and cancer.
Author: Julia Rosien
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