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Pediatric Oncology Partnerships Are Models for Success
In this special issue of the Bulletin, we pay tribute to pediatric oncology, focusing on the wide-reaching partnerships that have led to exemplary progress in treating children with cancer. As you will see, these partnerships have markedly reduced pediatric cancer mortality and will most certainly hasten our progress against other cancers, such as osteosarcoma and brain tumors, for which prognosis remains poor.
NCI sponsors several cooperative clinical trials groups to study pediatric cancers, the largest of which is the Children's Oncology Group (COG). In 2000, NCI facilitated the formation of COG through a merger of the Children's Cancer Group, the Pediatric Oncology Group, the Intergroup Rhabdomyosarcoma Study Group, and the National Wilms Tumor Study Group. Because of this network, accrual to pediatric clinical trials is remarkably high: Among eligible children younger than 5, 90 percent or more are currently treated as part of a clinical trial, compared with less than 5 percent participation in trials by the adult population.
NCI's Pediatric Oncology Branch is a member of COG. Through the Advanced Technology Program at NCI-Frederick and the Office of Science and Technology Partnerships, the Pediatric Oncology Branch has unique access to technology and procedures for genetic analysis, biomarker studies, and targeted therapy development - advances that can be tested in pre-clinical and early-phase clinical trials before moving to the larger extramural community. Read more
International Ewing Sarcoma Study Under Way
Researchers at NCI have joined forces with investigators across the U.S. and Europe to launch an international clinical trial of a promising new agent against Ewing sarcoma, a rare cancer that affects mostly children, adolescents, and young adults.
The agent, called R1507, is an investigational monoclonal antibody produced by Hoffmann-La Roche that inhibits insulin-like growth factor 1 receptor (IGF-1R). Ewing sarcoma has been linked with mutated genes that promote the production of IGF-1R. Previous phase I studies that included adolescents and young adults demonstrated promising results in Ewing sarcoma patients with treatment-resistant (refractory), progressive disease who had failed multiple standard and "salvage" therapies. In some cases, there have been complete responses to IGF-1R blockers in such high-risk patients.
Dr. Lee Helman, NCI's scientific director for clinical science and a noted expert in pediatric sarcomas, received numerous calls about these early results and met with his colleagues as part of the Sarcoma Alliance for Research through Collaboration several times to hear presentations from companies, including Roche, about their IGF-1R blocker compounds for use in a planned phase II study in children and adults aged 12 years and older with relapsed or refractory Ewing sarcoma. They selected R1507 for the current study and will expand this treatment to several other pediatric and adult sarcomas, including rhabdomyosarcoma and osteosarcoma. Read more
Pediatric Oncology Partnerships Are Models for Success
In this special issue of the Bulletin, we pay tribute to pediatric oncology, focusing on the wide-reaching partnerships that have led to exemplary progress in treating children with cancer. As you will see, these partnerships have markedly reduced pediatric cancer mortality and will most certainly hasten our progress against other cancers, such as osteosarcoma and brain tumors, for which prognosis remains poor.
NCI sponsors several cooperative clinical trials groups to study pediatric cancers, the largest of which is the Children's Oncology Group (COG). In 2000, NCI facilitated the formation of COG through a merger of the Children's Cancer Group, the Pediatric Oncology Group, the Intergroup Rhabdomyosarcoma Study Group, and the National Wilms Tumor Study Group. Because of this network, accrual to pediatric clinical trials is remarkably high: Among eligible children younger than 5, 90 percent or more are currently treated as part of a clinical trial, compared with less than 5 percent participation in trials by the adult population.
NCI's Pediatric Oncology Branch is a member of COG. Through the Advanced Technology Program at NCI-Frederick and the Office of Science and Technology Partnerships, the Pediatric Oncology Branch has unique access to technology and procedures for genetic analysis, biomarker studies, and targeted therapy development - advances that can be tested in pre-clinical and early-phase clinical trials before moving to the larger extramural community.
NCI's Pediatric Oncology Branch led partnerships that facilitated the successful completion of several therapeutic advances that were first tested in children at the NIH Clinical Center. Among them was the first use of gene therapy, development of "volume photography" to measure growth of neurofibromatosis-1 tumors, and even the first multi-institute hospital unit designed specifically for children at the NIH Clinical Center.
NCI's Pediatric Oncology Branch often works closely with other NIH institutes to cosponsor important pediatric research projects, combining valuable resources and thereby speeding the delivery of new interventions. And collaboration between NCI's SEER Program, Office of Cancer Survivorship, and organizations such as the Lance Armstrong Foundation, help us monitor pediatric survivorship issues such as fertility, second cancers, and race and age-group disparities.
Children usually learn from adults, but sometimes the roles are reversed, and that has been true in pediatric oncology. Some fundamental aspects of cancer treatment today, such as combination chemotherapy and knowledge of tumor suppressor genes, can be traced to research first completed on pediatric cancer patients. Such advances appear in our "Milestones."
You may also notice the banner that spans the top of this special issue. It features artwork made by children who have stayed at the Children's Inn at NIH while undergoing cancer treatment, or children who attended therapy sessions led by Dr. Lori Wiener, a social worker and member of our Pediatric Oncology Branch. Both of these programs are highlighted in this special issue.
We at NCI are extremely proud of our Pediatric Oncology Branch and the rich interface of intramural and extramural research in childhood cancers. We always get a special lump in our throats and a smile when we have a successful outcome with one of our special kids.
Dr. John E. Niederhuber
Researchers at NCI have joined forces with investigators across the U.S. and Europe to launch an international clinical trial of a promising new agent against Ewing sarcoma, a rare cancer that affects mostly children, adolescents, and young adults.
The agent, called R1507, is an investigational monoclonal antibody produced by Hoffmann-La Roche that inhibits insulin-like growth factor 1 receptor (IGF-1R). Ewing sarcoma has been linked with mutated genes that promote the production of IGF-1R. Previous phase I studies that included adolescents and young adults demonstrated promising results in Ewing sarcoma patients with treatment-resistant (refractory), progressive disease who had failed multiple standard and "salvage" therapies. In some cases, there have been complete responses to IGF-1R blockers in such high-risk patients.
Dr. Lee Helman, NCI's scientific director for clinical science and a noted expert in pediatric sarcomas, received numerous calls about these early results and met with his colleagues as part of the Sarcoma Alliance for Research through Collaboration several times to hear presentations from companies, including Roche, about their IGF-1R blocker compounds for use in a planned phase II study in children and adults aged 12 years and older with relapsed or refractory Ewing sarcoma. They selected R1507 for the current study and will expand this treatment to several other pediatric and adult sarcomas, including rhabdomyosarcoma and osteosarcoma.
"Because these are rare tumors, no single institution can do a large enough study - nor can any one country," Dr. Helman commented, noting that there are only about 200 new cases of Ewing sarcoma diagnosed in the United States each year. "We very quickly engaged our European colleagues who we've collaborated with on a number of previous projects."
The trial got under way at several U.S. cancer centers in December and has already accrued about 30 patients. The study will open shortly at the NIH Clinical Center and at sites in France, Italy, Germany, and the United Kingdom next month.
Dr. Herbert Juergens, professor of pediatric hematology and oncology at the University of Muenster, which is one of the study sites in Germany, said that progress in treatment of Ewing sarcoma "has become very slow" in recent years. Research has achieved long-term survival rates of about 70 percent with standard treatments, which include intensive chemotherapy and "local" interventions of radiation and surgery. "Since then, we seem to have exhausted the intensity of chemotherapy we can administer to the patients," he continued. Instead, hope has focused on finding therapies that target specific receptors in these tumors.
The international trial to test R1507 for Ewing sarcoma "is wonderful," Dr. Juergens said. To find sufficient patients with relapsing disease to produce statistically significant data, he added, "You need to work across the Atlantic Ocean."
Dr. Helman noted, "Over the next several years, we'll have to work hard to see if we can identify genomic profiles or markers that will predict those patients who are more likely to respond to IGF-1R inhibitors and figure out how we might move this to frontline therapy, because it might minimize toxicity" compared with current chemotherapy.
Fifty years ago, less than 10 percent of children diagnosed with cancer survived long term. Today, that number is almost 80 percent overall. This radical improvement comes largely from the efforts of the Children's Oncology Group (COG), the nation's largest cooperative clinical research group.
The first U.S. pediatric clinical trials group formed in 1955 and received NCI funding in 1956 to address the difficulty of performing clinical trials for children's cancers. In 2000, this group and other U.S. pediatric trial groups merged to form the COG.
"It was recognized that no individual cancer program or children's hospital had the number of patients that could support clinical investigation by themselves," says Dr. Gregory Reaman, professor of pediatrics at The George Washington University and chair of COG. "Cooperation and collaboration were absolutely necessary."
Today more than 40,000 children are treated on or receive followup as part of COG clinical trials at hundreds of hospitals around the world. In the U.S., "the majority of children for whom there are clinical trials, and who are eligible for those trials, are actually enrolled on clinical trials," says Dr. Reaman. This stands in stark contrast to adults, where only a few percent of eligible patients participate in clinical research.
One of COG's main goals is to increase the number of children treated on clinical trials, but they face many of the same barriers to enrollment encountered by researchers working with adult patients, including scarce funding, lack of access for patients in rural areas, and difficulty in some cases getting insurance companies to cover experimental care.
In addition to examining the genetics of childhood cancers, COG plans to expand their cancer control, prevention, supportive care, and survivorship research, with international partnerships. "Certain cancers that are rare in the U.S. are more common in other parts of the world, such as Latin America and India," says Dr. O'Leary. "If we can work together to learn how to better treat those cancers, everybody will benefit."
Because of the rarity of cancer in children and adolescents, for researchers investigating childhood cancer risks, it's proven difficult to get large enough study populations that can provide reliable, statistically valid conclusions about factors that may only moderately increase cancer risk.
However, through increased collaboration, researchers are retooling their approaches in hopes of getting stronger data on such factors. Their goal is to answer some difficult questions about how a disease like cancer, which is thought to take years or even decades to develop, can take hold in humans within just a few years - or sometimes months - of birth.
"If it's a huge risk, you don't necessarily need enormous numbers to be able to identify the risk factor," explains Dr. Martha S. Linet, chief of the Radiation Epidemiology Branch in NCI's Division of Cancer Epidemiology and Genetics (DCEG). Down syndrome, for example, increases childhood leukemia risk 40-fold. But most childhood leukemia case-control studies, Dr. Linet continues, have identified factors with far smaller risks.
"When these small risks are discovered, it's very difficult to tease apart if they're real, or due to some confounding factors," Dr. Linet says.
The International Childhood Cancer Cohort Consortium is designed to address this problem. Comprising 11 cohorts - none of which was established to study cancer - this international consortium involves more than 70,000 children who are enrolled by their parents before or at birth and, depending on which cohort, will be followed for varying time periods. Each cohort study, while not identically designed, includes detailed questionnaires about potential exposures and the collection of biological samples for molecular analyses.
"Over time," Dr. Linet says, "we're going to be exploring some promising hypotheses that are difficult to study in case-control studies."
Exploration of genetic risks for pediatric cancer has also been limited by small numbers. Such research has mostly been relegated to familial cancers or cancers associated with syndromes such as Li-Fraumeni.
"We've learned a lot from the cancer predisposition syndromes," says Dr. Sharon Savage, an investigator in DCEG's Clinical Genetics Branch. But, because of the rarity of childhood cancers, "We don't yet have a good understanding of how common genetic variants like SNPs (single nucleotide polymorphisms) may affect risk."
Despite the small sample sizes, some headway is being made. In an August 2007 Cancer Epidemiology, Biomarkers & Prevention study, for instance, Dr. Savage and NCI colleagues analyzed blood samples from 104 patients with osteosarcoma, which is most prevalent in adolescent boys, and found a two-fold increased risk associated with SNPs in IGF2R, a critical gene for growth regulation.
But now they need more numbers. And, with the help of the Children's Oncology Group (COG), they will try to replicate the study with a larger sample size, using 500 to 600 tumor samples from osteosarcoma patients enrolled in COG trials.
Although it's still unclear what this line of investigation will ultimately mean for the prevention or treatment of osteosarcoma, Dr. Savage says, "We're hopeful that it can inform osteosarcoma research as well as other research into cancers in which similar pathways play a role."
But whether a cancer occurs early or late in life, the path to more effective and less toxic therapies is essentially the same - it starts with knowing the genetic changes underlying the disease. The tools for discovering these changes may also be the same in childhood and adult cancers, as an innovative public-private initiative hopes to demonstrate.
The initiative, sponsored by NCI and the Foundation for the National Institutes of Health, is called TARGET (the Childhood Cancer Therapeutically Applicable Research to Generate Effective Treatments). The goal is to identify and validate therapeutic targets for childhood cancers using the latest genetic and genomic tools, which are the same ones used to develop targeted drugs for adult cancers.
"This project was inspired by the powerful technologies that are available for identifying genetic lesions in cancer cells," said Dr. Malcolm Smith of NCI's Cancer Therapy Evaluation Program and a leader of TARGET. The initiative grew out of a 2005 workshop among cancer specialists from the public and private sectors. A consensus emerged that available technologies could advance research on childhood cancer therapies if sufficient resources were dedicated to the challenge.
A pilot phase of TARGET involving acute lymphoblastic leukemia (ALL) and led by researchers from the University of New Mexico, St. Jude Children's Research Hospital, the Children's Oncology Group, and NCI has produced interesting early results. Profiling gene activity in patient samples revealed a previously unknown subtype of ALL associated with a poor prognosis. Additional studies are underway to search for genomic abnormalities such as extra copies of genes that may underlie the abnormal gene activity detected in the patient samples.
The initiative is benefiting from lessons learned and tools developed during the implementation of The Cancer Genome Atlas pilot project, which is cataloging genomic alterations in three adult cancers. Both projects will share, for instance, software designed to make the results easily accessible to researchers via the Internet.
The integration of different types of data will be an ongoing process in TARGET. But the researchers believe that by studying relatively large numbers of patients, using consistent research methods, and sequencing between 100 and 150 genes per disease, they will be able to identify critical genes in these cancers that can lead to more effective treatments.
The pilot project is also working on neuroblastoma, with plans to expand to rhabdomyosarcoma and other cancers in the future.
It is perhaps a good problem to have: Many more experimental cancer drugs enter clinical evaluation in adults each year than can realistically be tested in children, given the small number of children with cancer eligible for early-stage clinical trials.
This means that investigators have to prioritize agents, and their decisions have consequences. If 20 new drugs are available for study, but only one or two can be tested in children each year, then picking an agent that lacks an effect against childhood cancers may delay or prevent an agent that is truly effective from being investigated.
So how can investigators improve their chance of making good decisions about which new agents to bring forward for pediatric clinical testing? One way may be to test candidate agents in the laboratory using pediatric cancer cell lines and animal models. Launched in 2004, the NCI-sponsored Pediatric Preclinical Testing Program (PPTP) is doing this by testing 12 new agents a year against its panel of childhood cancer preclinical models.
The project is an experiment, and it will not be known for several more years how well the models predict anticancer activity in patients. But early results are encouraging. The researchers have provided validation for the strategy by showing that standard chemotherapy drugs have similar effects in the preclinical models as in patients. Importantly, the program has already identified several novel agents that show substantial activity against one or more of the PPTP's childhood cancer tumor panels.
A recent PPTP report in Pediatric Blood Cancer describes a drug with anticancer activity against several solid tumors. The drug, SCH 717454, is a monoclonal antibody against the insulin-like growth factor 1 receptor (IGF-1R), which has been implicated in many pediatric solid tumors. Another PPTP publication reported that ABT-263, a small molecule inhibitor of Bcl-2 family proteins, has substantial single agent activity against acute lymphoblastic leukemia cell lines and xenografts.
"The project is providing useful ideas about new agents and combinations of therapies that can be studied in children," said principal investigator Dr. Peter Houghton of St. Jude Children's Research Hospital. The PPTP's research teams have more than 60 animal models and 27 cell lines available for testing, representing most of the more common cancers that occur in children.
The program tries to evaluate new agents near the time that they are entering clinical trials in adults. This allows pediatric preclinical data to be developed while adult phase 1 trials are ongoing so that the preclinical data can then inform decision-making about clinical evaluations of agents tested in children. The adult trials provide information about the drug blood levels that are tolerated in humans, and this information can be modeled in mice to learn whether children are likely to tolerate a dose of the agent that is active against preclinical models.
"The critical issue in terms of translation from the preclinical model to the clinic is using doses in the animal that produce blood levels that you can achieve in the patient," noted Dr. Houghton.
More than 20 pharmaceutical companies have submitted one or more agents for testing. "The willingness of these companies to collaborate with the PPTP has been very encouraging and is central to the success of the program," said Dr. Malcolm Smith of NCI's Cancer Therapy Evaluation Program, who oversees the PPTP.
Acting Chief of the Pediatric Oncology Branch (POB) in NCI's Center for Cancer Research (CCR)
How does the POB augment work in the extramural community?
In what case would a child, adolescent, or young adult come to clinicians in the POB at the NIH Clinical Center in Bethesda for treatment?
Why is pediatric oncology appropriate for patients who would under other circumstances be considered adults?
What are examples of cutting-edge research this year in the POB?
To learn more about the Pediatric Oncology Branch please visit: http://home.ccr.cancer.gov/oncology/pediatric/.
Compared with advances achieved for younger children over the past 30 years, there has been a relative lack of progress in identifying more effective treatments for adolescent and young adult (AYA) cancer patients. Cancer survival rates for AYA patients, who are those diagnosed with cancer at ages 15 through 39, have seen little or no improvement for decades. This concern led NCI and the Lance Armstrong Foundation (LAF) in 2005-2006 to convene a Progress Review Group (PRG) to evaluate the issues behind this bleak trend.
Now a trans-NCI study of AYA patients, led by the Division of Cancer Control and Population Sciences, is under way in seven SEER registries with support from the LAF. The study will investigate patterns of care and outcomes for patients aged 15-39 with acute lymphoblastic leukemia (ALL), lymphoma, sarcoma, and germ cell cancers through a patient survey and medical record examination. The study will assess treatment, physician and facility characteristics, clinical trials participation, barriers to care, as well as the impact of cancer on physical symptoms, psychosocial experiences, financial issues, and quality of life.
Dr. Malcolm Smith of NCI's Cancer Therapy Evaluation Program also points to clinical trials for AYA patients with ALL. "Recent publications have reported that adolescents and young adults treated on pediatric clinical trials have had better outcomes than similarly aged AYA patients treated using adult protocols for ALL," he noted.
One of the trials cited by Dr. Smith is being conducted by the Dana-Farber Cancer Institute (DFCI) Consortium, which presented preliminary findings at the American Society of Hematology annual meeting last year. Current chemotherapy regimens in children with ALL produce event-free survival (EFS) rates of greater than 80 percent compared with EFS rates of 30-40 percent in adults with ALL. DFCI Consortium researchers reported that for patients aged 18-50 with ALL who were treated with an intensive pediatric regimen, the estimated 2-year EFS was 72.5 percent. Although the study requires longer follow up, the preliminary results suggest that intensive treatment strategies for young adults with ALL could represent a major therapeutic advance.
Another study to improve outcomes for young adults with ALL, CALGB-10403, is under way with the NCI-sponsored adult cooperative groups. The study adopts the treatment approach for ALL that is used by the Children's Oncology Group (COG). A retrospective analysis conducted as part of the trial compared outcomes of ALL patients aged 16-20 who were treated by either the CALGB Intergroup physicians or by pediatric COG specialists.
"What we found was that there was tremendous disparity in outcomes and that those AYA patients who were treated on pediatric regimens had significantly improved disease-free survival and overall survival," said Dr. Wendy Stock, associate professor at the University of Chicago Department of Medicine. "It was almost a 30 percentage point difference. That was very disappointing and it stimulated a lot of questions about why this might be."
The Intergroup retrospective analysis, which will be published in Blood, found key differences in both the dose intensity of the drugs used and in the treatment schedules adopted by pediatric versus adult cancer specialists. "In addition to differences in the protocol design and schedule, the outcome disparity also raises questions about protocol compliance and whether adult medical oncologists and the patients that they treat adhere to protocols as rigorously as the pediatric oncologists and their patients," Dr. Stock noted. "We hope to begin to gather specific data about treatment compliance in addition to exploring the feasibility of using this approach to improve outcomes of AYAs with ALL in the adult cooperative groups."
In addition to watching a loved one undergo difficult treatments, families of children with cancer must deal with disruption of normal life, travel to treatment centers, arranging childcare, finances, and other challenges. The cumulative effects can have serious consequences for quality of life during treatment and after it ends.
"We realize now that in order to provide our pediatric patients with the services that they need, we have to see these children in the context of their families and their communities, and integrate each of these dimensions so they can return home with the support, tools, and coping strategies to survive cancer," explains Dr. Lori Wiener, head of the Psychosocial Section and coordinator of the Psychosocial Support and Research Program in NCI's Pediatric Oncology Branch.
She hopes that some of the research under way through her program, which has developed resources and practice models for treatment centers and families, can help people who are looking for ways to handle these challenges. Psychosocial support within the pediatric oncology program begins with social workers who contact patients as soon as they are recommended for a clinical trial at NIH, and who maintain contact with these families one-on-one throughout the course of their treatment.
Many of these families stay at the Children's Inn at NIH, where support programs compliment services at the Clinical Center, including play, art, and music therapy; support groups and workshops; psychiatric consultation; counseling; camp programs; school programs and vocational testing; pain and palliative care services; spiritual ministry; and bereavement programs, among others.
Psychotherapy for children in clinical trials also addresses fear and anxiety due to being far from home, new treatments, and invasive procedures. "It's horrifying to see a panic-stricken child trying to deal with an impending bone marrow transplant, or any kind of needle stick," says Dr. Jimmie Holland, a psychiatrist and Wayne Chapman Chair in Psychiatric Oncology at Memorial Sloan-Kettering Cancer Center, which has the country's largest training program in this field. "The experience upsets anyone who comes near it. But if you can help these children and their family members prepare for the rigors of treatment, using behavioral techniques that are proven, you can give patients and their families a sense of control and diminish panic in these situations."
Drs. Holland and Wiener have worked together on resources that outline psychosocial issues and solutions that are so critical to successful cancer care, some of which are based on a report commissioned by the Institute of Medicine, Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs, as well as a reference book that will soon be available from the American Psychosocial Oncology Society, Quick Reference for Pediatric Oncology Clinicians: The Psychiatric and Psychological Dimensions of Pediatric Cancer Symptom Management, for which Dr. Wiener is lead editor.
Dr. Wiener's program has also developed tools, including several for the siblings of cancer patients: a workbook titled This is MY World, another titled Brothers and Sisters - We're in This Together, and a customizable board game available later this year.
After children complete their cancer treatment and leave the Clinical Center, they are connected with the support network in their local communities. But their relationship with staff at NIH can last a lifetime. Even when a child dies, their family members are considered cancer survivors, Dr. Wiener explains, and she is in touch with them each year on the anniversary of their loss. "There's a sense that we've lived through this life-altering experience together," Dr. Wiener says, "and a special connection often arises between families and the health care providers who traveled that journey with them."
The very high cure rate in pediatric oncology has not been achieved without a cost: treatments that save children's lives can also damage developing organs, causing a wide array of health problems that may not surface for many years.
Current understanding of the extent of "late effects" in childhood cancer survivors - health problems related to cancer treatment that occur months to years after treatment ends - has emerged largely from the Childhood Cancer Survivors Study (CCSS). Since 1994, this NCI-funded research project has followed a cohort of 20,000 people who were diagnosed with cancer as children between 1970 and 1986 and survived at least 5 years.
In a study published in the New England Journal of Medicine in 2006, which looked at outcomes in more than 10,000 survivors, CCSS researchers found that almost two-thirds of patients reported at least one chronic health problem, one-quarter had a severe condition, and almost one-quarter had three or more chronic health problems. Late effects reported most frequently in this study were second cancers, cardiovascular disease, kidney disease, musculoskeletal conditions, and endocrine abnormalities. The risk of developing a health problem related to cancer treatment in childhood increased over time.
Women face higher risks than men for late effects including breast cancer, cognitive dysfunction, heart disease, and hypothyroidism. Other factors influencing late effects include age at diagnosis, type of cancer, and types of treatment received. Radiation treatment, especially to the brain - and, in women, the chest - carries a high risk of long-term effects.
"Both the magnitude and the diversity of the long-term health effects have been striking," says CCSS principal investigator Dr. Les Robison of St. Jude Children's Research Hospital in Memphis. "At 30 years after their diagnosis, more than 70 percent of childhood cancer survivors have a late-effect chronic health condition."
Results from CCSS studies are now informing the development of guidelines for appropriate follow-up care for childhood cancer survivors, adds Dr. Robison. The limited data so far available suggest that most survivors do not receive the recommended follow-up care. CCSS researchers are now planning several new studies looking at how to ensure more survivors obtain follow-up care so that late effects are detected as early as possible.
CCSS data are available to researchers studying important questions in pediatric cancer survivorship through the St. Jude Web site (www.stjude.org/ccss). To date, the CCSS has generated more than 75 publications in the peer-reviewed literature.
Treatments for childhood cancer have changed a lot since the CCSS cohort was treated in the 1970s and early 1980s. To learn about the long-term effects of these newer therapies, researchers are now expanding the CCSS cohort by recruiting 20,000 survivors treated for childhood cancer between 1987 and 1999 who have survived at least 5 years.
In other efforts, researchers are developing new tools, such as the Passport for Care, to help clinicians and childhood cancer survivors be more aware of and communicate with each other about the long-term effects of cancer treatments, as well as decision aids to help survivors weigh the costs and benefits of treatment approaches.
"Childhood cancer survivors are in the vanguard in terms of our understanding of the impact of living long-term after cancer treatment," says Dr. Julia Rowland, director of NCI's Office of Cancer Survivorship. "The challenge is to ensure that they are appropriately followed across their lifetimes to minimize cancer's late adverse impacts and maximize these survivors' overall health."
FDA Advisory Committee Recommends Further Limits on
Use of ESAs
On March 13, the U.S. Food and Drug Administration's (FDA) Oncologic Drugs Advisory Committee (ODAC) recommended substantially limiting the use of erythropoiesis-stimulating agents (ESAs) to treat anemia in cancer patients. The panel made the recommendation after hearing additional evidence from a recently published meta-analysis showing that ESAs increase the risk of blood clots and death in patients taking the drugs for chemotherapy-induced anemia.
The committee recommended that the drugs be restricted to cancer patients with advanced disease; that the drugs not be used in patients with breast or head and neck cancer, the cancer types with the most evidence of severe side effects; and that patients be required to complete a written consent before using ESAs.
This was the third ODAC meeting held to discuss safety concerns about ESAs. The FDA isn't required to adopt the advisors' recommendations, but agency representatives indicated during the ODAC meeting that they are likely to adopt further restrictions on the use of ESAs. There are currently three FDA-approved ESAs on the U.S. market: Aranesp (darbepoetin alfa), Epogen (epoetin alfa), and Procrit (epoetin alfa).
Most colorectal cancers are thought to arise from polypoid adenomas - growths that protrude from the mucous membrane in the colon or rectum. A study from the Veterans Affairs (VA) Health Care System in Palo Alto, CA, published in the March 5 Journal of the American Medical Association adds to a growing body of evidence that nonpolypoid colorectal neoplasms (NP-CRNs) - abnormalities that can appear either flat or depressed relative to the surrounding membrane - can also contain precancerous or cancerous cells. Previous studies established the existence of NP-CRNs in Japan, but their prevalence and importance in other parts of the world has remained unclear.
In the VA study, gastroenterologists and pathologists who were trained in a special exchange program with Japanese cancer centers examined 1,819 patients at the Palo Alto VA hospital undergoing colonoscopy for screening, surveillance (for people at high risk of colorectal cancer), or symptoms of colorectal neoplasms. Patients underwent biopsy, removal of polyps or NP-CRNs, or surgery as needed.
The investigators found NP-CRNs in 170 patients (9.35 percent of those examined). Although these lesions were less common than colorectal polyps, they were more likely to contain precancerous or cancerous cells, accounting for only about 15 percent of identified neoplasms but 54 percent of superficial carcinomas. "Nonpolypoid morphology was strongly associated with findings of in situ or submucosal invasive carcinoma," stated the authors.
NP-CRNs missed during colonoscopy may help explain the occurrence of interval colorectal cancers - cancers that arise between scheduled screening colonoscopies in patients who appear not to have any precancerous polyps - explains Dr. David Lieberman from Oregon Health and Science University in an accompanying editorial.
The existence of NP-CRNs will have important implications for colorectal cancer screening in the United States, continued Dr. Lieberman. "The finding that NP-CRNs have high rates of serious pathology suggests that effective screening programs will need to accurately identify patients who harbor these lesions."
Delayed Letrozole Therapy After Tamoxifen Reduces Breast Cancer Recurrence
An analysis of data from a phase III clinical trial that was unblinded 5 years ago indicates that in some breast cancer patients, use of the aromatase inhibitor letrozole (Femara) after 5 years of adjuvant therapy with tamoxifen has survival benefits even if begun several years after completing tamoxifen.
Conducted by the National Cancer Institute of Canada Clinical Trials Group, the trial, known as MA.17, was unblinded in 2003 after an interim analysis demonstrated that letrozole, begun within 3 months after 5 years of tamoxifen, reduced breast cancer recurrence risk compared to placebo. Participants in the placebo arm of MA.17 were then offered the opportunity to begin 5 years of adjuvant treatment with letrozole. MA.17 participants were post-menopausal women with early-stage, ER-positive disease.
This new analysis from MA.17, released online on March 10 by the Journal of Clinical Oncology (JCO), compared the 1,579 women in the placebo arm who began using letrozole after the trial was unblinded with the 804 women who chose not to. The analysis revealed that letrozole improved disease-free survival by 63 percent and distant (or metastatic) disease-free survival by 61 percent. The median time of letrozole initiation after tamoxifen completion was 2.8 years, with a range from 1 to 7 years.
Questions about the optimal approach to adjuvant therapy in this patient population linger, the study's lead author, Dr. Paul Goss from Harvard Medical School, and colleagues noted, because even after 5 years of adjuvant tamoxifen, there continues to be a significant risk of late recurrence and death from breast cancer.
Although interpretation of the findings is "made difficult because this therapeutic intervention was self-selected, not randomly allocated," they continued, the women who took letrozole had disease characteristics that put them at higher recurrence risk than those who did not, suggesting letrozole was responsible for the beneficial effects.
Letrozole use was also associated with an increased risk of bone fractures and osteoporosis (5.2 and 5.3 percent, respectively) compared with those on placebo (3.1 and 1.6 percent). In a related editorial in JCO, Drs. Nancy U. Lin and Eric P. Winer from Dana-Farber Cancer Institute noted that there is a chance that the findings could be understating those comorbid effects. There is a subset of patients treated with aromatase inhibitors "who experience life-altering arthralgias or other adverse effects, leading to difficult discussions weighing [quality of life] against recurrence risk," they wrote.
Everolimus Extends Progression-Free Survival in Advanced Kidney Cancer
A 400-patient, international phase III trial testing the drug everolimus in patients with advanced kidney cancer has been stopped after meeting its primary endpoint, the drug's manufacturer, Novartis, reported February 28.
The trial's Independent Data Monitoring Committee recommended that the trial be halted and patients in the placebo arm of the study be offered everolimus after an interim analysis showed a significant improvement in progression-free survival in patients given everolimus.
Everolimus, also known as RAD001, inhibits mTOR, a protein that regulates tumor cell division and angiogenesis.
Patients in this cancer trial had advanced, progressive disease despite treatment with other recently approved agents for advanced kidney cancer, including sorafenib (Nexavar) and sunitinib (Sutent). Trial participants may also have been treated with bevacizumab (Avastin) and interferon.
Complete interim results from the trial, dubbed RECORD-1, will be presented in May at the American Society of Clinical Oncology annual meeting in Chicago, Novartis explained.
Protein May Control Spread of Breast Cancer
A single protein may trigger the spread of breast cancer cells to other parts of the body by altering the behavior of large numbers of genes. The protein, SATB1, could potentially be used to identify women at risk of metastasis and may be a therapeutic target, Dr. Terumi Kohwi-Shigematsu of the Lawrence Berkeley National Laboratory and her colleagues report in the March 13 Nature.
They describe the protein as a "genome organizer." It coordinates the activity of genes from different chromosome regions by changing how DNA is packaged in the cell nucleus. For cells to acquire new functions, such as invading other tissues, they may need to induce global changes in gene activity.
In breast cancer cells, SATB1 activity may be necessary for and sufficient to induce metastasis. Blocking the protein in an aggressive breast cancer cell line altered the activity of more than a thousand genes and caused the cells to stop tumor growth and metastasis. Conversely, expressing the protein in a non-aggressive cell line fueled growth and metastasis.
The researchers say that SATB1 activity in breast cancer cells could identify women with early-stage disease who are at risk of metastasis. The primary prognostic indicator of metastasis has been the involvement of the lymph nodes, but additional markers are needed.
"Once this protein is expressed in breast cancer cells there is a very high propensity for metastasis," said Dr. Kohwi-Shigematsu. "And it may be possible to predict poor prognosis based on SATB1 expression independently from lymph node status."
SATB1 activity has also been found in colon and lung tumors, and the researchers are investigating how the protein is activated.
In a step toward therapies, the researchers are investigating ways to deliver SATB1 inhibitors directly into breast cancer cells. This is necessary to avoid disrupting the protein's critical role in the development of certain immune cells.
Methylation Markers Suggest Recurrence Risk in Lung Cancer
The switching on and off of a specific set of genes, or methylation, in patients with stage I non-small-cell lung cancer (NSCLC) appears to increase the risk of recurrence following surgery, researchers are reporting. In fact, when two of these genes were methylated (or switched off) in tissue samples from the tumor and mediastinal lymph nodes, the recurrence risk increased as much as 25-fold.
In a small, single institution, nested case-control study published in the March 13 New England Journal of Medicine, Dr. Malcolm Brock, an associate professor of surgery at Johns Hopkins' Sidney Kimmel Comprehensive Cancer Center, and colleagues analyzed the methylation status of seven genes in tumor and lymph node samples from patients who had undergone surgery for stage I NSCLC. Previous research has suggested that these genes may be associated with NSCLC recurrence.
As many as 40 percent of patients with stage I NSCLC treated with surgery will die of recurrent disease, and approximately 80 percent of patients will experience recurrence within 40 months.
Samples from 51 patients whose disease had recurred within 40 months (cases) were compared with samples from 116 patients whose cancers had not recurred (controls). The findings were tested against a small validation cohort of 11 cases and 9 controls.
The methylation status of four of the seven genes - p16, CDH13, RASSF1A, and APC - in tumor and/or lymph node samples were associated with varying levels of increased recurrence risk. The most lethal gene methylation combination was p16 and CDH13. In the original cohort, the 5-year recurrence-free survival rate was 14.3 percent in patients with methylation-induced silencing of both genes in the tumor and mediastinal lymph nodes (in the center of the chest, between the lungs), compared to 63.1 percent in patients without methylation of either gene.
"The DNA evidence we see for many of the recurring cases suggests it may be wise, if our work is confirmed, to reclassify such cancers as advanced disease instead of early stage," Dr. Brock said.
Elderly Medicaid Patients Less Likely to Receive Chemotherapy for Colorectal Cancer
A study using data from the Michigan Tumor Registry and the Centers for Medicare and Medicaid Services showed that elderly Medicaid-insured patients in the state are less likely to initiate or complete chemotherapy for colorectal cancer compared with Medicare-insured patients. The results were published in the March 10 Archives of Internal Medicine. Previous studies have shown that Medicaid-insured patients have worse survival rates for colorectal cancer, but it had not been known if they receive less treatment than patients with other forms of insurance.
The investigators collected data from 4,765 patients aged 65 or older who were diagnosed with colorectal cancer between January 1997 and December 2000 and insured through Medicaid, Medicare, or both. In addition to data on chemotherapy initiation and completion, the investigators compared whether patients were evaluated by an oncologist, subsequently hospitalized, and experienced comorbidities; demographic variables including age, race, sex, household income, and whether patients lived in a metropolitan, urban, or rural area were also studied.
Patients insured through Medicaid were more likely to be African American or of another minority race, female, and to live in a low-income area. For all patients, those with Medicaid insurance were less likely to initiate or complete chemotherapy and less likely to be evaluated by a medical oncologist. Older patients in general were also less likely to initiate chemotherapy, even though studies have shown that these patients benefit from adjuvant treatment.
"The main finding of this study is that Medicaid insurance is associated with a low likelihood of chemotherapy initiation and completion," concluded the authors. "As long as these substantially large groups of patients…have disparate treatment uptake and compliance, the nation as a whole will have difficulty reaching its goals for reduced cancer mortality."


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Eliza's Q & A
Who's your favorite sports team, and why?
The Lakers!!!! Kobe. What else is there to say? :-)
What's your favorite movie quote?
"Every man dies, but not every man really lives." - Braveheart
What's your favorite video game, and could you kick our butts at it?
Grand Theft Auto.
Piercings/Tattoos (How many? Where?)
What's the most embarrassing song on your iPod?
"Baby, Baby " by Justin Bieber.
What's your best party trick?
I get drunk after drinking a few sips!!!!! Seriously!!
What's the most memorable pick-up line you've ever heard?
"Could I have your autograph, you must be famous!!"
What's the worst job you've ever had?
Promoting Yacht toilets in a Boat show...
What's the most dangerous thing you've ever done?
Walking with Lions in South Africa. I was a volunteer and worked with lions, rehabilitating them. (I have the pictures to proof :-) !!)
It's 4AM after a crazy night out – what are we eating?
Ben & Jerry's Ice cream (Cookie dough )
What's the strangest thing in your fridge right now?
Algae... It's healthy!
What's the naughtiest thing you've ever done in public?
Doing it in the hallway of a hotel next to the soda machine.... We got caught...It was so hot though!!
What do you feel sexiest wearing?
Nothing or/and skimpy lingerie.
Tell us a joke.
"You know what Arnold Schwarzenegger calls a quickie? A Minute Maid."


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From a bluff high above the Mississippi River in Winona, Minnesota to the homes and hands of our grateful, hard–working, globally–minded customers comes the purity of Watkins. It´s wholesome, it´s refreshing and it´s never "doctored up" like some big city factory products. Watkins has been good and natural through and through since 1868.
Availability: Usually Ships Within 24-48 Hours
JR Watkins - Natural Home Care Hand Soap Grapefruit - 11 oz. (325 mL.)JR Watkins Natural Home Care Hand Soap Grapefruit is formulated with premium natural ingredients and essential oils, this hard-working, natural hand soap create a smooth lather of suds that rinse away, leaving your hands exceptionally clean and smooth.
Watkins natural cleaners feature the most popular cleaning products on the market in non-toxic, plant-based formulas that are both biodegradable and phosphate free.
Watkins is committed to delivering the same tried-and-true cleaning power their customers have come to appreciate. That is why they stand behind their natural cleaning products with Watkins legendary 100% satisfaction guarantee. Watkins believes caring for the environment and your home shouldn't be a chore; it should be a refreshing experience.
Watkins proudly formulates with:
Natural Freedom Code - Ingredients they avoid:
Frequently Asked Questions – J.R. Watkins Natural Home Care LineWhy did Watkins develop this new line of natural cleaners?Natural/organic consumers are the fastest growing market today. It is the right thing to do for you, their customers. The U.S. Center for Health and Statistics reports that one in three people suffer from allergies, asthma or bronchitis. That means, 33% of their population suffers from respiratory problems.Using conventional cleaning products can cause additional respiratory irritation. By offering natural home care products, they are making a difference in your life and the air quality in your home.
Are these products Green Seal Certified?They are currently looking into Green Seal certification and continue to research a variety of certifications that would compliment this line.
Do these products contain natural or synthetic fragrance?J.R. Watkins Natural Home Care cleaners are fragranced with:
Do Watkins All–Purpose Cleaners disinfect?There are many theories about disinfectants.Some experts say that they are creating "Super Germs" with their constant disinfecting (meaning that the germs build a resistance to the chemicals and come back even stronger/bigger). Others argue that the chemicals they are using to kill the germs are just as harmful as the germs themselves.86% of people who use disinfecting cleaners don't let the disinfecting formula penetrate the surface. They spray and immediately wipe and as a result they don't get the disinfecting properties of the cleaner at all. They've spent a great deal of time researching this issue and they've found that the best way to keep germs at bay is with regular soap and water. Regular cleaning and maintenance are the best ways to disinfect your home.Is the Window Cleaner anti–static?The J.R. Watkins Natural Window Cleaners are not anti-static.Will the Tub and Tile Cleaner work on scum build up?If you have significant build up, they recommend letting the product sit on the surface so it can penetrate for 10 to 15 minutes. Then agitate if necessary and rinse. This product works great on glass shower doors, tile and fixtures.The product will perform best if you keep up with regular maintenance.
Can the furniture cleaner be used on hardwood floors?Yes the J.R. Watkins Natural Furniture Polish can be used to clean all hard wood surfaces but they recommend testing the products in a small inconspicuous area prior to use.
Do the Aloe and Green Tea products contain aloe vera?The J.R. Watkins Natural Home Care Cleaners do not contain aloe vera.Aloe and Green Tea is the fragrance, it is not an ingredient.
Can the Aloe and Green Tea All-Purpose Wipes be used as personal care wipes?No, Watkins All-Purpose Wipes are for surface cleaning only.Please keep in mind that no Watkins product should ever be used in a manner inconsistent with its labeling.
The ingredients listed on the All-Purpose Cleaner and Window Cleaner labels are almost identical. What are the differences?There are several differences between their All-Purpose Cleaners and Window Cleaners.The primary point of difference is that their Window Cleaners contain an anti-streaking agent.Please remember that while Watkins does make every effort to list most of the natural ingredients, they do not specify every part of their proprietary formulas.
Does JR Watkins Naturals brand packaging contain BPA?JR Watkins makes every effort to ensure their products are safe and environmentally friendly. All of their packaging is comprised of BPA free plastics and they do not source packaging that may contain BPAAbout J.R. Watkins Nestled in the Mississippi River Bluff town of Winona, MN., Watkins has been America's pioneer in natural living since 1868. As America's original natural apothecary manufacturer, Watkins uses only the finest natural ingredients in its diverse lines of personal care, home care, remedies, and organic flavorings.
Committed to being America's most trusted natural products company, Watkins adheres strictly to the same quality standards set forth by its founder J.R. Watkins. J.R. Watkins Natural Apothecary line of personal care contains only natural, environmentally friendly ingredients from renewable resources, avoiding chemicals like parabens, sulfates, phthalates and more and, is one of very few lines to be certified by the Natural Products Association.
Natural cleaners have also been a large part of its diverse product mix as far back as 1917, when the company first introduced Natural Vegetable Oil Soap made with pure vegetable oils and no animal bi-products, fillers or colors. Almost a century ago its advertisements boasted "Just pure soap, that's all"... and "Pure enough to eat! " As globally-minded as its customers, Watkins now aims to make household chores a little easier with its newest line of J.R. Watkins Natural Home Care cleaning products. Made with refreshing lemon and lavender oils and highly effective plant derived surfactants, Watkins diverse line of cleaners are safe and effective for your home and your family.
Responsible manufacturing processes are as important as its commitment to providing natural, consumable items for everyday life. By utilizing gravity-fed filling, biodegradable packing materials, as well as recycling programs and much more, Watkins is devoted to leaving the smallest environmental footprint possible.
Since moving from Plainview, Minnesota to Winona in 1885, Watkins has consistently been one of the largest employers in Southeastern, Minnesota. It has remained a leader and responsible contributor to not only its local community in Minnesota, but also to the world at large and continues to support educational, cultural and humanitarian efforts, including the United Way, Pacers, Kidstock, and many other not-profit organizations dedicated to making the world a better place.
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We, at OpticsPlanet, try to make it easy to order Bifocal Glasses on line by providing as much information as we can. See our detailed Rx information page that explains How to Read Your Eyeglass Prescription.
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So if you are ever pressed at the gym for time (which only happens...ALWAYS), try this one out after you do an upper body workout. You will be sore the next day!!
1-35 Standing Squats (just put your hands behind your head and dip your butt straight down, be careful that your knees don't extend out past your toes.)
2-35 Lunge Jumps (Go into lunge position, then explode up while switching legs. Each leg alternating counts as one rep)
3-35 Standing lunges (with hands behind head)
4-35 Jump squats.
Try to do these with as little rest in-between as possible. Should be about 5min long...and your legs will be jelly! If they are not, then do it twice!!


text: Imagine sipping coffee on your deck overlooking Wildcat Lake . just as the sun hits the water! Imagine serenely catching fish just as the mist rises with the warmth! Nestled in the heart of Wildcat Ranch, Homestead Seven is 501 acres, bordering Wildcat Lake. Heavily timbered with pine and aspen trees, this Homestead is your own private wilderness. With miles of trails for horseback riding, hiking or cross country skiing, outdoor adventures are at your doorstep.


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Bring It On's cast recording has just hit online stores, and Broadway.com has an exclusive music video behind the scenes of the red-hot recording session! "Do Your Own Thing" and watch these incredible singers in action!
High-tech neon suits and a dark stage are all that iLuminate: Artist of Light needs to light up the night at Off-Broadway's Duke Theatre. Take an illuminating look behind the scenes at this inventive dance troupe's mind-blowing show.December 13, 2012
It's the first episode of James Monroe Iglehart's vlog, and he pulls out all the stops! Check out the backstage antics at The View, his Freestyle Love Supreme gig AND Aladdin, of course. That's a lot of backstage shenanigans!August 7, 2014
It's back-to-school time, and Broadway.com is rolling out a series of tips from esteemed Headmistress Agatha Trunchbull (Christopher Sieber) of Broadway's Matilda for incoming maggots. Learn how to get good grades and stay out of Chokey!
Laura Osnes and Santino Fontana star in the first-ever Broadway mounting of Rodgers & Hammerstein's Cinderella. See if the musical cast a spell over Broadway.com Word of Mouth panelists Brittany, Phyllis and Zander.March 4, 2013
In the final Lion King character study video, South African actor Andile Gumbi brings us behind the scenes as he transforms into the "energetic" Simba. Find out what similarities Prince Simba has to an African warrior.November 13, 2012
Scenes from the well-loved musical, now playing at the Minskoff Theatre.March 18, 2010
Join Berry Gordy, the cast and more for a sneak peek of Motown the Musical.February 10, 2014
This week, James Monroe Iglehart introduces us to the cast of Aladdin and invites you to tweet your questions to him at @jamesmiglehart with the hashtag #askthegenie.August 14, 2014
Get a sneak peek of the national tour of Wicked.January 1, 2013
This week Sierra Boggess takes us back into the exclusive Club Christine. In part two, Sierra chats with 10 more of the Phantom's past and present Christines.August 12, 2014
"Dancing Queen" from the smash hit Broadway musical "Mamma Mia!"January 25, 2010
David Byrne and Fatboy Slim's new musical Here Lies Love is earning acclaim for its world premiere run at the Public Theater—and star Jose Llana dropped by to tell us why audiences are going crazy for it!May 21, 2013


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Explore the vast, awe-inspiring heritage of India on your desktop. The Taj Mahal gives new meaning to the word majestic as its image is caught in the garden reflecting pools. A peacock's tail contains an entire galaxy of eyes. Visions of ancient palaces, exquisitely carved stone temples, and more are yours with this free Windows theme.
A theme is a combination of desktop background pictures, window colors, and sounds. All of the images will be downloaded when you click Download theme.
This theme can only be used in Windows 8.1, Windows 8, Windows RT 8.1, Windows RT, and in Windows 7 Home Premium, Professional, Enterprise, or Ultimate editions.


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Nike NFL Kansas City Chiefs Jamaal Charles Men's Replica Jersey
Kick off the season right with this Nike NFL replica jersey. The NFL jersey is made with a lightweight mesh body, screen print logos and letters and rib-knit v-neck collar. Features your favorite player's name and number, stitched jock tag and NFL emblem in the center of the neck. Available in stores or place order over the phone with Customer Care 1-888-777-3949.
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Climate change refugees struggle to survive in slums of Dhaka. The city faces a population explosion, with inadequate infrastructure.
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If we can't plead stupidity, what else is there? How do we live with ourselves? Is it all the stuff we buy that manages to numb our brains and consciences?
When I see a headline like this one at Bloomberg today, World Needs Record Saudi Oil Supply as OPEC Convenes, there's just one thought that pops into my head: what the world needs is for us to stop doing this thing we're doing. Even apart from peak oil concerns, it's obvious we're going to run out at some point or another, and it doesn't matter whether that's tomorrow or at some other point in the future, though we do know it's not going to take another 100 years, or even 50.
And nothing will ever take the place of oil; once those unique carbons are gone, that's it, we'll have to find a completely different way of running our societies, and if we're not smart enough to prepare for that beforehand, we'll be cats fighting in a sack and use the last scraps to kill off each other. And our legacy won't be the Greek thinkers and Picasso and Dostoyevsky and Walt Whitman and Maria Callas, since there won't be the means for our children anymore to share what makes man great between them. Our main legacy will instead be bloodshed, we will have gone the exact same path that any non-thinking or even primitive organism would have taken, who don't have opera or philosophy or poetry to their name.
BONANZA, a tropical town in north-eastern Nicaragua, has attracted gold miners since 1880. Still true to its name, it yields over a thousand kilos of the metal every...
The World Health Organization says more than 700 more Ebola cases emerged in West Africa in one week, a statistic that shows the outbreak is accelerating.
(HealthDay)—Sixteen major food and beverage companies have made good on their pledge to cut calories in their U.S. products, a new report finds.
Scientists have uncovered a key factor to explain why antibiotic-resistant bacteria can thrive in a hospital setting.
From phys
An 860-kilogram concept city car from Peugeot indicates impressive fuel economy. This latest concept 'has its sights set on meeting the French government's goal of putting an affordable 2.0l/100km (141mpg) car into production by 2020,' said Jordan Bishop in Auto Express. Peugeot will be showcasing its ...
From phys
Dioxins forms faster, at lower temperatures and under other conditions than previously thought. This may affect how we in the future construct sampling equipment, flue gas filtering systems for waste incineration and how to treat waste incineration fly ash. These are some of the conclusions Eva Weidemann ...
From phys
A UN summit on climate change will see the world 'change course' and begin to seriously tackle global warming, UN climate envoy Mary Robinson said Wednesday.
From phys
Last month was the hottest August on record for global average temperatures over land and ocean surfaces, the US National Oceanic and Atmospheric Administration said Thursday.
From phys
In findings of relevance to conservationists and the fishing industry, new research links short-term reductions in growth and reproduction of marine animals off the California coast to increasing variability in the strength of coastal upwelling currents—currents that supply nutrients to the region's ...
Diet sodas and those packets of artificial sweetener you put in your coffee may not be as benign as we thought, a new study suggests.
As a pulmonologist with the San Diego Veteran's Affairs hospital, Laura Crotty Alexander has probably answered every possible question about smoking. Whether her patients were looking for ways to quit or simply wondering whether their current health problems might be related to smoking, Crotty Alexander provided answers.
A couple of years ago, however, her patients began asking new questions: Are electronic cigarettes safer than conventional cigarettes, and should they switch? "I didn't have the answers. As a physician and a researcher, that was very frustrating," Crotty Alexander says.
Physicians all over the country are encountering the same questions from their patients. Out of nowhere, it seems, e-cigarettes—or electronic nicotine delivery systems, as they are formally known—are appearing at gas stations, convenience stores, and anywhere else cigarettes are sold. Advertisements claim e-cigarettes offer health benefits by helping smokers quit. All e-cigarette users inhale is "harmless water vapor."1 The e-cigarette, it would seem, takes all the risk out of smoking.
Reuters investigates how rising seas are not a future threat, but a troubling reality in the U.S. and around the world.
In the world of a constantly changing oil and gas environment, the Montney shale basin is the sleeping giant that holds the key to accelerating Canada's shale oil and gas boom, but the real treasure within this giant is a tight liquids-rich zone (approximately 15-20 miles wide) that has big and small players alike narrowing their focus for the potential of a giant payout.
The deadliest Ebola epidemic on record has now infected more than 5,000 people in west Africa and killed around half of them, the World Health Organization said Thursday.
Smoke-filled bars and packed cancer wards reflect decades of neglect of no-smoking policies in Asia, where both high- and low-income countries are belatedly waking up to a growing tobacco-related health epidemic.
Why is it that when people are too stressed they are often grouchy, grumpy, nasty, distracted or forgetful? Researchers from the Brain Mind Institute (BMI) at EPFL have just highlighted a fundamental synaptic mechanism that explains the relationship between chronic stress and the loss of social skills ...
A wild berry native to North America may strengthen the effectiveness of a chemotherapy drug commonly used to treat pancreatic cancer, reveals research published online in the Journal of Clinical Pathology.
From phys
Marshall Islands President Christopher Loeak was forced to heighten the seawall protecting his home last year, but says the year-old defences are now barely enough to protect his family from a 'climate emergency'.
From phys
Disasters last year displaced three times more people than violent conflicts, showing the urgent need to improve resilience for vulnerable people when fighting climate change, according to a study issued Wednesday.
From phys
(Phys.org) —Scientists have long been aware of the potential environment impacts that stem from the use and disposal of the array of products people use to keep themselves healthy, clean and smelling nice. Now a new concern is emerging – improper disposal of pet care products and pills.
From phys
New photos from the U.S. Geological Survey's Hawaiian Volcano Observatory give a glimpse into the hazardous work scientists undertake to monitor lava that's threatening to cross a major highway.
From phys
At the beginning of 2013 a greyish-brown blanket of smog lay over large areas of China for several months. The fine particle pollution was higher by 1 to 2 orders of magnitude than the levels normally measured in Western Europe and the United States. An international team of researchers under the lead ...
PHOENIX — The Tucson-based Center for Biological Diversity and other groups are petitioning the federal government to make the monarch butterfly an endangered species, citing a population drop of more than 90 percent over the past two decades.
Vitamin A deficiency is a deadly threat to kids and pregnant mothers in the Third World. In the Philippines, the best nutrient sources are rarely part of the daily diet, so researchers have tried adding vitamin A to rice, a staple food. Science correspondent Miles O'Brien investigates the debate that's grown up over the development of golden rice, a genetically modified crop. Continue reading →
With the harvest underway, Jon Alegria figures he'll pack more than 400 million apples from this year's crop by mid-November, relying on a widely used chemical to keep them looking fresh for months.
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Pictures really do speak a thousand words and MyVideoDesigner allows you to create beautiful and compelling video emails in minutes - you don't need to be a programmer or designer. Create an email and custom design it with full color images, logos and banners - multiple color options allow you truly match your brand image.
MyVideoWebShow features your content 24 hours a day, 7 days a week. Imagine your own live internet show with live and/or, pre-recorded HD formats. You can record your live webshows at the click of a button. Create and broadcast customizable, multiple branded web shows like fitness training, cooking, dance and more!
MyVideoBroadcaster is the most powerful LIVE web broadcast product ever released - yet it's so intuitive a child can use it. Run live video presentations and meetings with features that blow the competition out of the water. All video broadcasts can be custom branded with your own logo, banner and brand color. This technology is life-changing.
MyVideoBoardroom is a leading provider of 100% browser-based, 16 Person Video & Web Conferencing solution, complete with real time audio and video capabilities. MyVideoBoardroom is ideal for multi-location web based meetings, virtual classrooms, employee trainings, product demonstrations, company orientations, customer support, product launches and much more.
MyVideoChannel allows you to easily create custom content. Video is the most powerful communication medium on the planet. Get your personal or business message out to your target audience, with no competition or third party advertisers popping up. Your own private video channel on the web to showcase your content.
Your personally branded Video Conference call on steroids. With the ability to personalize your backgrounds you are able to give your Video Conference your own look and feel. Create, Join and Edit Calls with an easy to navigate graphical interface. Create simple Video Calls or use the advanced features such as Filesharing, Youtube Video Sharing, Noteboard, Whiteboard, Desktop and Computer Share, User options, Text Chat and customized appearance to enrich your Call.
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Mel and Amie Gill
Mel and Amie Gill entered the Direct Selling Industry in 1989, when the industry had not yet hit critical mass. At that time, they were a newly-married young couple going to college and deciding on their career paths. Mel's family had a very successful restaurant business in the San Francisco Bay Area. Mel was managing one of the newest operations while he and Amie had a newborn who was only 3 months old at the time.
On a very momentous day in November 1989, they were introduced to the Direct Selling Industry. They saw the vision of what this industry could offer in terms of time freedom and decided to go full force. This led to unprecedented recognition in the industry at an early age. Their local business soon took them global, experiencing huge success with stellar businessgrowth in Australia, Thailand, Japan, and Canada. Having their own lucrative international business in their early twenties was the springboard for further global success in Europe and Asia.
This ultimately became the foundation to what happened in October 2002 when they became owners of their own global Direct Selling company.
Mel and Amie just celebrated 21 years of full-time success in the Direct Sales Industry. Mel and Amie are passionate about this industry for what their accomplishments have created. Not just for themselves, but for so many people across the globe. They currently reside back in their hometown locale of the San Francisco Bay Area with their 3 children. They travel back and forth globally to oversee all operations with company business being a passion they love. Mel and Amie's passion is the driving force behind the company and the future direction of growth. The company is perfectly positioned in the Direct Selling industry; with the foundation and expertise of the ownership coupled with the impeccable track record of the company, it is poised for incredible growth now and into the future.


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Infertility is a condition in which a couple is unable to become pregnant after 1 year of attempting pregnancy by having sex without using birth control.
Common causes of infertility include poorly timed intercourse, and problems with ovulation, sperm production, the fallopian tubes, the uterus, or ejaculation. In some cases, no cause can be found (unexplained infertility).
eMedicineHealth Medical Reference from Healthwise
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By FOX 2 News StaffDETROIT (WJBK) -- Police are on the lookout for a man who robbed two Midtown businesses Wednesday afternoon.Sources say the suspect bought at coffee at the Starbucks on Woodward Ave. and came back to pass a worker a note demanding money. The employees took cover and the suspect ran off without any money.However, sources say the suspect walked into the 'Ye Olde Butcher Shoppe on Woodward around 90 minutes later and passed another note to the cashier demanding money. This time, he made away with around $300.No one was injured in either incident. Police are analyzing surveillance footage.Anyone with information can call Crime Stoppers at 1-800-SPEAK-UP or the Wayne State Police at 313-577-2222.
WFTC-TV11358 Viking DriveEden Prairie, MN 55344Phone: (952) 944-9999Fax: (952) 942-0455


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